Women with a history of preeclampsia have a decreased innate immune response
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101 WOMEN WITH A HISTORY OF PREECLAMPSIA HAVE A DECREASED INNATE IMMUNE RESPONSE LAN TRAN 1 , DARCY CARR 1 , JOSEPHINE AMORY 1 , THOMAS EASTERLING 1 , 1 University of Washington, Obstetrics and Gynecology, Seattle, Washington OBJECTIVE: Women with a history of preeclampsia (PE) have an increased risk of subsequent cardiovascular disease. Therefore, we sought to determine if women who have a remote history of PE have an exaggerated proinflammatory response. STUDY DESIGN: Women with prior PE (N = 4) and age-matched controls (N = 8) who delivered at R39 weeks were studied R8 months postpartum. LPS stimulation of whole blood (1 mg/mL LPS for 6 hours) was performed. Proinflammatory cytokines, TNF-a and IL-6, were measured by ELISA in duplicate. RESULTS: TNF-a and IL-6 levels were lower in women with prior PE. CONCLUSION: As LPS stimulation works primarily through CD14+ mono- cytes, these results suggest that women with a history of PE have less of an innate immune response and that the increased cardiovascular morbidity in these women is likely mediated through other cellular mechanisms. 102 DOES MATERNAL RACE OR ETHNICITY AFFECT THE EXPRESSION OF SEVERE PREECLAMPSIA? AMY GOODWIN 1 , BRIAN MERCER 1 , 1 MetroHealth Medical Center at CWRU School of Medicine, Maternal Fetal Medicine, Cleveland, Ohio OBJECTIVE: There is considerable variation in the expression of severe preeclampsia (PET). Our purpose was to determine if this is associated with maternal race or ethnicity. STUDY DESIGN: Individual chart review was performed for 473 women diagnosed with severe PET at a tertiary care center from 1993 to 2003. Demographic, clinical and lab findings from diagnosis (Dx) to 6 weeks postpartum (PP) were documented. Data were compared between Caucasian (C), African American (AA) and Hispanic (H) women using c 2 , Fisher’s exact and t tests; P ! .05 defined significance. Data presented for the total cohort if no significant difference. RESULTS: We evaluated 473 pregnancies; 201 (C), 216 (AA) and 56 (H). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (BP: 118/68). C women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49%) and had more multiple gestations (9 vs 1.5%), P % .002 for each. At Dx, headache, RUQ pain, chest pain, shortness of breath, and scotomata were similar. AA women had less epigastric pain (7.4 vs 10%) and nausea (2.3 vs 5%), P ! .05 for each. Platelets !100 K and AST >60 mg/dL were more common in C women at Dx (9 vs 12%, 11 vs 21%) and at delivery (14 vs 24%, 19 vs 34%), P ! .05 for each. No difference in severe proteinuria was seen. AA women had more severe HTN at both Dx (44.9 vs 30%) and peak BP (85 vs 67%) and required more anti-HTN meds intrapartum (12 vs 6%), PP (38 vs 12%) and at discharge (D/C: 35 vs 21%), P % .03 for each. H women presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40%), P % .04 for each. BP on D/C was not different between groups (123/76) though AA women had a longer time to D/C (3.8 vs 3.2 days) despite a similar cesarean rate (59 vs 51%) to C women, P % .02 for each. C women had more HELLP syndrome (29 vs 19% P = .01). Eclampsia, IUFD, IUGR, abruption, PP PET and recurrent PET were similar between groups. CONCLUSION: AA women with severe PET demonstrate more severe HTN and required more anti-HTN meds, while C women have more frequent HELLP syndrome. 103 IS SEVERE PREECLAMPSIA EXPRESSION DIFFERENT WHEN IT OCCURS PRETERM OR AT TERM? AMY GOODWIN 1 , BRIAN MERCER 2 , 1 MetroHealth Medical Center, Cleveland, Ohio, 2 MetroHealth Medical Center at CWRU School of Medicine, Maternal Fetal Medicine, Cleveland, Ohio OBJECTIVE: Severe preeclampsia (SPET) is associated with significant maternal and fetal risk, more so when it occurs preterm. SPET has a diverse clinical spectrum; our goal was to evaluate if expression is different in those who present when conservative management might be considered, vs at/near term. STUDY DESIGN: Individual chart review was performed for 485 women diagnosed with SPET from 1993 to 2003 at one center. Demographic, clinical and lab findings from diagnosis (Dx) to 6 weeks postpartum (PP) were gathered. Those at significant risk for complications of preterm birth (!34 weeks: Early) were compared to those having onset >34 weeks (Late). Fisher’s exact and t-tests were used; P ! .05 defined significance. RESULTS: 485 pregnancies were evaluated: 196 (Early); 289 (Late). Baseline characteristics were similar regarding age, race, screening BP, nulliparity and multiple gestation. The Early group had more chronic hypertension (HTN: 9.2 vs 2.4%) previous PET (34 vs 19%), and anti-HTN med use(11.7 vs 2.8%), P % .002 for each. At Dx, the Early group had more symptoms including headache (44 vs 28%), RUQ pain (9.7 vs 4.2%) and epigastric pain (14.8 vs 7.3%) P ! .01 for each. Visual symptoms were not different between the groups. Mean BP at presentation was higher in the Early group (159/95 vs 154/92, P ! .01 for each), although rate of severe HTN was equal. During their course the Early group had more severe HTN (46 vs 34%), received more IV meds antepartum (16.3 vs 3.5%), and meds at discharge (D/C: 38 vs 19%) P ! .006 for each. Need for intra- and postpartum IV meds was similar between groups. The Early group had more HELLP (29 vs 21%), and IUGR(13.8 vs 7.6%) and also had a longer time from Dx to Del (81 vs 24 hrs), ! .03 for each, Neither eclampsia, recurrent PET, time from Del to D/C, or severe HTN at D/C or 6 weeks PP were different between groups. CONCLUSION: Women with SPET presenting remote from term have more severe disease than those at/near term. Conservative management is desirable and sometimes feasible, attention should be paid to these additional risks in this group. 104 PREDICTION OF SUPERIMPOSED PREECLAMPSIA USING UTERINE ARTERY DOPPLER VELOCIMETRY IN WOMEN WITH CHRONIC HYPERTENSION NADIA RONCAGLIA 1 , ISABELLA CRIPPA 1 , CINZIA PATREGNANI 1 , ANNA LOCATELLI 1 , PATRIZIA VERGANI 1 , CAMILLA ANDREOTTI 1 , ALESSANDRO GHIDINI 2 , 1 University of Milano-Bicocca, Obstetrics and Gynecology, Monza, Italy, Italy, 2 Georgetown University, Obstetrics and Gynecology, Washington, District of Columbia OBJECTIVE: To assess the role of uterine artery Doppler velocimetry to predict superimposed preeclampsia (PE) in women with chronic hypertension. STUDY DESIGN: We reviewed the results of Doppler studies of the uterine arteries in a cohort of 108 women with chronic hypertension between 1/2000 and 12/2003. The Doppler studies were performed at %24 weeks in 94% of cases (mean 19.5 G 2.1 weeks) and in 92% of cases they were repeated later in pregnancy (mean 34.1 G 2.8 weeks). Uterine artery Doppler findings were considered abnormal if the average Resistance Index was >0.58 or there was bilateral notching. The diagnostic indices of the two exams for the prediction of PE were compared using Fisher’s exact test and c 2 with P ! .05 considered significant. RESULTS: The incidence of PE was 11% (12/108). Abnormal uterine Doppler findings were observed sometime in pregnancy in 67% of PE cases (8/12). None of the PE cases with abnormal uterine Doppler results had normal findings at the early exam. The prevalence of abnormal uterine Doppler results was 57% at early exam and 20% at late exam; 26% of abnormal findings at the early exam persisted in pregnancy and identified the subset with the highest risk of PE (36%). There was a significant increase in rates of PE with advancing gestation at detection of abnormal uterine Dopplers: normal at early exam: 5%; abnormal at early exam: 12%; abnormal at late exam: 36% (c 2 for trend: P = .008). The rate of PE among 40 women with abnormal early but normal late uterine Doppler findings was identical to that of women with normal findings at the early exam (5% vs 5%). CONCLUSION: The later in pregnancy abnormal uterine Doppler findings are observed, the greater the risk of PE. Abnormal findings at %24 weeks identify a subset of women who may benefit from close surveillance. Normalization of uterine artery Doppler findings after 25 weeks reduces the risk of PE to 5%. SMFM Abstracts S39
Transcript of Women with a history of preeclampsia have a decreased innate immune response
103 IS SEVERE PREECLAMPSIA EXPRESSION DIFFERENT WHEN IT OCCURS PRETERM ORAT TERM? AMY GOODWIN1, BRIAN MERCER2, 1MetroHealth Medical Center,Cleveland, Ohio, 2MetroHealth Medical Center at CWRU School ofMedicine, Maternal Fetal Medicine, Cleveland, Ohio
OBJECTIVE: Severe preeclampsia (SPET) is associated with significantmaternal and fetal risk, more so when it occurs preterm. SPET has a diverseclinical spectrum; our goal was to evaluate if expression is different in those whopresent when conservative management might be considered, vs at/near term.
STUDY DESIGN: Individual chart review was performed for 485 womendiagnosed with SPET from 1993 to 2003 at one center. Demographic, clinicaland lab findings from diagnosis (Dx) to 6 weeks postpartum (PP) were gathered.Those at significant risk for complications of preterm birth (!34 weeks: Early)were compared to those having onset >34 weeks (Late). Fisher’s exact andt-tests were used; P ! .05 defined significance.
RESULTS: 485 pregnancies were evaluated: 196 (Early); 289 (Late). Baselinecharacteristics were similar regarding age, race, screening BP, nulliparity andmultiple gestation. The Early group had more chronic hypertension (HTN: 9.2vs 2.4%) previous PET (34 vs 19%), and anti-HTN med use(11.7 vs 2.8%), P %.002 for each. At Dx, the Early group had more symptoms including headache(44 vs 28%), RUQ pain (9.7 vs 4.2%) and epigastric pain (14.8 vs 7.3%) P ! .01for each. Visual symptoms were not different between the groups. Mean BP atpresentation was higher in the Early group (159/95 vs 154/92, P ! .01 for each),although rate of severe HTN was equal. During their course the Early group hadmore severe HTN (46 vs 34%), received more IV meds antepartum (16.3 vs3.5%), and meds at discharge (D/C: 38 vs 19%) P ! .006 for each. Need forintra- and postpartum IV meds was similar between groups. The Early grouphad more HELLP (29 vs 21%), and IUGR(13.8 vs 7.6%) and also had a longertime from Dx to Del (81 vs 24 hrs), ! .03 for each, Neither eclampsia, recurrentPET, time from Del to D/C, or severe HTN at D/C or 6 weeks PP were differentbetween groups.
CONCLUSION: Women with SPET presenting remote from term have moresevere disease than those at/near term. Conservative management is desirableand sometimes feasible, attention should be paid to these additional risks in thisgroup.
SMFM Abstracts S39
101 WOMEN WITH A HISTORY OF PREECLAMPSIA HAVE A DECREASED INNATE IMMUNERESPONSE LAN TRAN1, DARCY CARR1, JOSEPHINE AMORY1, THOMAS EASTERLING1,1University of Washington, Obstetrics and Gynecology, Seattle, Washington
OBJECTIVE: Women with a history of preeclampsia (PE) have an increasedrisk of subsequent cardiovascular disease. Therefore, we sought to determine ifwomen who have a remote history of PE have an exaggerated proinflammatoryresponse.
STUDY DESIGN: Women with prior PE (N = 4) and age-matched controls(N = 8) who delivered at R39 weeks were studied R8 months postpartum. LPSstimulation of whole blood (1 mg/mL LPS for 6 hours) was performed.Proinflammatory cytokines, TNF-a and IL-6, were measured by ELISA induplicate.
RESULTS: TNF-a and IL-6 levels were lower in women with prior PE.
CONCLUSION: As LPS stimulation works primarily through CD14+ mono-cytes, these results suggest that women with a history of PE have less of an innateimmune response and that the increased cardiovascular morbidity in thesewomen is likely mediated through other cellular mechanisms.
102 DOES MATERNAL RACE OR ETHNICITY AFFECT THE EXPRESSION OF SEVEREPREECLAMPSIA? AMY GOODWIN1, BRIAN MERCER1, 1MetroHealth Medical Centerat CWRU School of Medicine, Maternal Fetal Medicine, Cleveland, Ohio
OBJECTIVE: There is considerable variation in the expression of severepreeclampsia (PET). Our purpose was to determine if this is associated withmaternal race or ethnicity.
STUDY DESIGN: Individual chart review was performed for 473 womendiagnosed with severe PET at a tertiary care center from 1993 to 2003.Demographic, clinical and lab findings from diagnosis (Dx) to 6 weekspostpartum (PP) were documented. Data were compared between Caucasian(C), African American (AA) and Hispanic (H) women using c2, Fisher’s exactand t tests; P! .05 defined significance. Data presented for the total cohort if nosignificant difference.
RESULTS: We evaluated 473 pregnancies; 201 (C), 216 (AA) and 56 (H).Groups had similar baseline characteristics: chronic hypertension (HTN),diabetes, and initial antenatal blood pressure (BP: 118/68). C women were older(27 vs 24 yrs), more likely nulliparous (63 vs 49%) and had more multiplegestations (9 vs 1.5%), P % .002 for each. At Dx, headache, RUQ pain, chestpain, shortness of breath, and scotomata were similar. AA women had lessepigastric pain (7.4 vs 10%) and nausea (2.3 vs 5%), P ! .05 for each. Platelets!100 K and AST>60 mg/dL were more common in C women at Dx (9 vs 12%,11 vs 21%) and at delivery (14 vs 24%, 19 vs 34%), P ! .05 for each. Nodifference in severe proteinuria was seen. AA women had more severe HTN atboth Dx (44.9 vs 30%) and peak BP (85 vs 67%) and required more anti-HTNmeds intrapartum (12 vs 6%), PP (38 vs 12%) and at discharge (D/C: 35 vs21%), P% .03 for each. H women presented later (36 vs 34.6 weeks) and had lesssevere HTN (27 vs 40%), P% .04 for each. BP on D/C was not different betweengroups (123/76) though AA women had a longer time to D/C (3.8 vs 3.2 days)despite a similar cesarean rate (59 vs 51%) to C women, P % .02 for each. Cwomen had more HELLP syndrome (29 vs 19% P = .01). Eclampsia, IUFD,IUGR, abruption, PP PET and recurrent PET were similar between groups.
CONCLUSION: AA women with severe PET demonstrate more severe HTNand required more anti-HTN meds, while C women have more frequent HELLPsyndrome.
104 PREDICTION OF SUPERIMPOSED PREECLAMPSIA USING UTERINE ARTERY DOPPLERVELOCIMETRY IN WOMEN WITH CHRONIC HYPERTENSION NADIA RONCAGLIA1,ISABELLA CRIPPA1, CINZIA PATREGNANI1, ANNA LOCATELLI1, PATRIZIA VERGANI1,CAMILLA ANDREOTTI1, ALESSANDRO GHIDINI2, 1University of Milano-Bicocca,Obstetrics and Gynecology, Monza, Italy, Italy, 2Georgetown University,Obstetrics and Gynecology, Washington, District of Columbia
OBJECTIVE: To assess the role of uterine artery Doppler velocimetry topredict superimposed preeclampsia (PE) in women with chronic hypertension.
STUDY DESIGN: We reviewed the results of Doppler studies of the uterinearteries in a cohort of 108 women with chronic hypertension between 1/2000 and12/2003. The Doppler studies were performed at %24 weeks in 94% of cases(mean 19.5 G 2.1 weeks) and in 92% of cases they were repeated later inpregnancy (mean 34.1 G 2.8 weeks). Uterine artery Doppler findings wereconsidered abnormal if the average Resistance Index was >0.58 or there wasbilateral notching. The diagnostic indices of the two exams for the prediction ofPE were compared using Fisher’s exact test and c2 with P ! .05 consideredsignificant.
RESULTS: The incidence of PE was 11% (12/108). Abnormal uterine Dopplerfindings were observed sometime in pregnancy in 67% of PE cases (8/12). Noneof the PE cases with abnormal uterine Doppler results had normal findings at theearly exam. The prevalence of abnormal uterine Doppler results was 57% atearly exam and 20% at late exam; 26% of abnormal findings at the early exampersisted in pregnancy and identified the subset with the highest risk of PE(36%). There was a significant increase in rates of PE with advancing gestationat detection of abnormal uterine Dopplers: normal at early exam: 5%; abnormalat early exam: 12%; abnormal at late exam: 36% (c2 for trend: P= .008). Therate of PE among 40 women with abnormal early but normal late uterineDoppler findings was identical to that of women with normal findings at theearly exam (5% vs 5%).
CONCLUSION: The later in pregnancy abnormal uterine Doppler findings areobserved, the greater the risk of PE. Abnormal findings at %24 weeks identifya subset of women who may benefit from close surveillance. Normalization ofuterine artery Doppler findings after 25 weeks reduces the risk of PE to 5%.
