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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Longitudinal Maternal Risk Assessment for Severe Early-Onset Preeclampsia

Abstract Number: GM 1
Abstract Type: Original Research

Anne Doherty MD1 ; John Kingdom MD2; Sascha Drewlo PhD3; Afif El Khuffash MD4; Kristi Downey MSc5; Jose C.A. Carvalho MD, PhD6

Introduction: Early identification of women at risk of severe early-onset preeclampsia(sPE) is a key aim in high-risk obstetrics(1). Conventional markers of the disease such as serum uric acid have been of uncertain value(2). Recent studies have shown that systemic vascular resistance(SVR) and blood levels of placental angiogenic/antiangiogenic factors(PlGF/sFlt) may assist in identifying these patients as early as 24 weeks gestation(3,4).

Methods: We followed 20 normotensive women at high risk of developing sPE from 20 weeks gestation until delivery/32 weeks. Risk was determined by the presence of 2 or more of: complex medical and/or obstetric history; abnormal integrated placenta screening at 14-22 weeks; abnormal uterine artery Doppler or abnormal placental shape/size at 16-20 weeks. Noninvasive hemodynamic monitoring using bioreactance technology(NICOM) was performed at 20-22, 24, 26, 28, 30, and 32-34 weeks. Blood samples for uric acid, PlGF and sFlt levels were taken concurrently; PlGF and sFlt levels were determined by ELISA. Receiver Operating Characteristics(ROC) analysis assessed the ability of SVR and biomarkers to predict sPE. Correlations were performed using Spearman’s Correlation Coefficient.

Results: Six out of twenty(30%) women delivered <33 weeks with ACOG-defined sPE. The median gestational age at which hypertension developed was 28 weeks. These women had significantly higher SVR, uric acid and sFlt and lower PlGF at 24 weeks than those who remained normotensive. The area under the curve, 95% CI, p value, cut-off values, sensitivity and specificity of the ROC analysis to predict sPE at 24 weeks are presented in table 1. SVR and sFlt positively correlated in the sPE group prior to antihypertensive treatment(r=0.65, p=0.01). Uric acid correlated with both sFlt(r=0.65, p=0.003) and sFlt/PlGF ratio(r=0.54, p=0.02).

Discussion: Serum uric acid, sFlt, sFlt/PlGF ratio and SVR may all be used to identify normotensive pregnant women who will subsequently develop sPE. The correlation of uric acid with the angiogenic/antiangiogenic factors lends value to its use in identifying those in the preclinical phase of sPE. The correlation of SVR with sFlt prior to the onset of clinical sPE suggests a causal role for this protein, possibly by diminishing the vasodilator action of PlGF.

References: 1)Am J Obstet Gynecol 2007;196:363.e1-7; 2)Acta Obstet Gynecol Scand 2006;85:519-525; 3)Hypertension 2008;51:1020-1026; 4) Circulation 2012;125:911-919.

SOAP 2013