Pre-pregnant prediction of recurrent preeclampsia in normotensive thrombophilic formerly preeclamptic women receiving prophylactic antithrombotic medication

Autor: Peter W. de Leeuw, Hugo W. F. van Eyndhoven, Robert Aardenburg, T.H.A. Ekhart, Marc E. A. Spaanderman, Louis L.H. Peeters
Rok vydání: 2005
Předmět:
Adult
Gestational hypertension
medicine.medical_specialty
Health aging / healthy living [IGMD 5]
Blood Pressure
Thrombophilia
Preeclampsia
03 medical and health sciences
Folic Acid
0302 clinical medicine
Fibrinolytic Agents
Pre-Eclampsia
Heart Rate
Pregnancy
Recurrence
medicine
Birth Weight
Humans
Cardiac Output
Plasma Volume
030219 obstetrics & reproductive medicine
Cardiovascular diseases [NCEBP 14]
Placental abruption
Endocrinology and reproduction [UMCN 5.2]
Obstetrics
business.industry
Effective Hospital Care [EBP 2]
Infant
Newborn
Pyridoxine
Obstetrics and Gynecology
Heparin
Low-Molecular-Weight
medicine.disease
Human Reproduction [NCEBP 12]
Logistic Models
Blood pressure
Multivariate Analysis
Gestation
Female
Vascular Resistance
business
030217 neurology & neurosurgery
Fibrinolytic agent
Zdroj: Journal of the Society for Gynecologic Investigation, 12, 112-7
Journal of the Society for Gynecologic Investigation, 12, 2, pp. 112-7
ISSN: 1071-5576
Popis: Contains fulltext : 49207.pdf (Publisher’s version ) (Open Access) BACKGROUND: Both hemodynamic abnormalities and thrombophilia predispose to pregnancy-associated vascular complications such as fetal growth restriction, stillbirth, preeclampsia, and placental abruption. Antithrombotic treatment may reduce the risk for these events. In this study we tested the hypothesis that in normotensive thrombophilic formerly preeclamptic women certain alterations in hemodynamic function as measured under nonpregnant conditions predict the development of hypertensive disorders and/or fetal growth restriction in the subsequent pregnancy. METHODS: In 350 nondiabetic formerly preeclamptic women, we measured in the follicular phase of the menstrual cycle at least 5 months postpartum central hemodynamic, metabolic, and hemostatic variables. In the subsequent ongoing pregnancy we determined fetal outcome variables and the incidence of maternal vascular complications. In addition to a normotensive thrombophilic profile, inclusion for final analysis required a subsequent singleton pregnancy, established within 1 year following the pre-pregnant evaluation and ongoing beyond 16 weeks' gestation. As a consequence, 47 normotensive thrombophilic formerly preeclamptic women could be included for final analysis. All formerly preeclamptic participants received aspirin throughout pregnancy. Additionally, those with thrombophilia or hyperhomocysteinemia were treated with low molecular weight heparin and with pyridoxine and folic acid supplementation, respectively. RESULTS: Among 350 formerly preeclamptic women, 266 (76%) were normotensive and 84 (24%) hypertensive. About half (140/266) of normotensive formerly preeclamptic participants were thrombophilic. One hundred eighteen formerly preeclamptic participants succeeded in establishing an ongoing pregnancy within 1 year. From this subset of formerly preeclamptic women, 47 were normotensive thrombophilic; 23 remained normotensive (THROMB), whereas 24 developed at least gestational hypertension (COMPLITHROMB). Participants in the latter subgroup were more obese than those remaining normotensive. In addition, this former subset of women had a higher vascular resistance index, and a lower plasma volume and cardiac index. With respect to fetal outcome, COMPLITHROMB gave birth to an infant with a lower birth weight relative to THROMB. Preeclampsia with or without the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome recurred in 26% of the participants in the whole thrombophilic group, in which a low pre-pregnant plasma volume and a raised vascular resistance predisposed for recurrent hypertensive disorders. CONCLUSION: Pre-pregnant hemodynamic, metabolic, and clotting variables in formerly preeclamptic women can predict hypertension in the subsequent pregnancy.
Databáze: OpenAIRE
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