748: Risk of early severe preeclampsia in singleton and twin pregnancies
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Table 1. Demographic characteristics Characteristics Normal (N10) PE (N10) p- value Maternal Age(yr) 33.44.5 30.110.6 0.436 .......................................................................................................................................................................................... Maternal BMI 26.53.2 29.03.2 0.045 .......................................................................................................................................................................................... GA at delivery 38.61.1 34.62.6 <0.001 .......................................................................................................................................................................................... Parity 0.654 ................................................................................................................................................................................. Primigravida 6(60%) 5(50%) .......................................................................................................................................................................................... Delivery 0.146 ................................................................................................................................................................................. Cesarean 6(60%) 9(90%) .......................................................................................................................................................................................... Birth weight(gm) 3515.5489.4 2235986.9 0.002 .......................................................................................................................................................................................... Sex 0.408 .......................................................................................................................................................................................... Male 5(50%) 3(30%) .......................................................................................................................................................................................... Placental weight(gm) 736.6141.5 480.0164..4 0.001 .......................................................................................................................................................................................... PE: preeclampsia BMI: Body mass index GA: gestational age 748 Risk of early severe preeclampsia in singleton and twin pregnancies Dana Henry 1 , Nicole A Smith 2 , Thomas F McElrath 3 1 Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2 Brigham and Women’s Hospital, Boston, MA, 3 Brigham and Women’s Hospital/Harvard Medical School, Boston, MA OBJECTIVE: Preeclampsia is more common in twin, as compared to sin- gleton pregnancies, however, it is unknown whether the severity and tim- ing of disease varies by fetal number. We aimed to evaluate whether rates of early and late preterm birth for the indication of severe preeclampsia differ between singleton and twin gestations. STUDY DESIGN: This is a retrospective cohort study at a single institution including all deliveries from 2000-2009. Rates of delivery for severe pre- eclampsia (sPE) among infants born prior to 32 and 37 weeks gestation (GA) were compared, and diagnostic criteria for preeclampsia were com- pared between groups. Chi-squared tests were used for analysis. RESULTS: There were 6259 preterm deliveries, including 1399 twins, among 86,554 births. Among babies born 32 weeks GA, delivery for sPE was equally common in singleton and twin pregnancies (140 and 27 deliveries, or 8% and 8%). Between 32 and 37 weeks GA, the rate of delivery for sPE was greater for singletons than twins (201 and 51 deliveries, or 6% vs. 5%, p0.04). However, when examining delivery for sPE as a percentage of total births, early severe preeclampsia was significantly more common in twin compared to singleton pregnan- cies (2.3% vs. 0.4%, p 0.001). In all gestational age categories, crite- ria for delivery including HELLP syndrome, abruption, and fetal in- dications were similar between groups. CONCLUSIONS: Among babies born 32 wks gestation in this large co- hort, delivery for the indication of severe preeclampsia is equally com- mon in singleton and twin pregnancies, however, a priori risk of early severe preeclampsia is significantly greater in twin gestations. These find- ings are of value in both antenatal surveillance and patient counseling. 749 Identification of predictive biomarkers for pre-eclampsia by plasma proteomic profiling Eamonn Breslin 1 , Susan Slade 2 , Kypros Nicolaides 3 , James Scrivens 1 , Steve Thornton 1 1 University of Warwick, Coventry, 2 University of Warwick, Coventry, 3 King’s College Hospital, London OBJECTIVE: To identify peptides in maternal serum which predict the onset of severe early onset preeclampsia (requiring delivery before 33 weeks) before the onset of signs or symptoms. STUDY DESIGN: Samples were taken from women at 11-13 weeks who did (n20) or did not (n20) subsequently develop preeclampsia (PE) which required delivery before 34 weeks gestation Samples (in triplicate) from individual women were immunodepleted to remove the highly abundant proteins, using an IgY-14 trapping coluMN. Proteins were sep- arated by Reversed Phase chromatography or 2D RP/RP-LC-MS E ,. The raw data files produced were processed using ProteinLynx. Peptides must have been observed in at least two of the three technical replicate analyses to be included in the list of proteins identified from the analyses. RESULTS: A unique protein or peptide was classified as such if it was present in only one sample at a sufficient quantity. In our initial study we found on 24 peptides unique in PE samples. From these, there were 2 peptides of significant concentration. There were18 peptides unique to the normal plasma. In addition to this we have found marked in- crease in pro-inflammatory proteins when comparing PE samples to non PE ones. CONCLUSIONS: The Proteome in plasma of women who will develop PE are different to those that do not, even in the first trimester. Char- acterisation of these compounds should enable the development of a screening test in the first trimester for prediction of PE. 750 Adverse maternal and perinatal outcomes in women with chronic hypertension: a retrospective study of 362 patients Edouard Lecarpentier 1 , Gilles Kayem 1 , Vassilis Tsatsaris 2 , Francois Goffinet 2 , Baha Sibai 3 , Bassam Haddad 1 1 University Paris 12, Creteil, 2 University Paris 5, Paris, 3 University of Cincinnati, Cincinnati, OH OBJECTIVE: To determine risk factors of adverse maternal and perina- tal outcomes in women with chronic hypertension. STUDY DESIGN: A retrospective study of 362 patients that analyzed risk factors of severe maternal and perinatal composite morbidity defined as superimposed preeclampsia, abruption, fetal growth restriction (FGR, 5 th percentile), and perinatal mortality (PNM). Continuous variables were compared with a two-tailed student t test and categor- ical variables with X 2 square test or Fisher’s exact test. Variables with a p .05 were included in a logistic regression model. RESULTS: Composite morbidity was observed in 157 (43.4%) patients (107 superimposed preeclampsia, 6 abruption, 60 FGR, and 21 PNM). In univariate analysis, ethnicity, nephropathy, chronic renal insuffi- ciency, systolic blood pressure at first prenatal visit, diastolic blood pressure at first prenatal visit, and a history of preeclampsia, or ab- ruption, or FGR, or fetal death, or neonatal death were associated with increased risk of the composite morbidity. Logistic regression analysis (table) shows factors that are independently associated with the com- posite morbidity. CONCLUSIONS: Our study shows that in chronic hypertensive women, diastolic blood pressure at first prenatal visit, chronic renal disease, previous preeclampsia are independently associated with increased risk of severe maternal and perinatal morbidity. Table. logistic regression analysis (adjusted odds ratios and 95% Confidence interval) Variable Adjusted OR 95% CI Diastolic blood pressure 1.03 1.00-1.06 .......................................................................................................................................................................................... Nephropathy 4.43 1.42-13.76 .......................................................................................................................................................................................... Chronic renal insufficiency 6.67 1.20-37.03 .......................................................................................................................................................................................... Previous preeclampsia 2.43 1.29-4.56 .......................................................................................................................................................................................... 751 The effect of magnesium sulfate and angiotensin II on the level of prostaglandin E2 secretion in preeclamptic placentas Bella Bronfenmacher 1 , Adi Y. Weintraub 2 , Eyal Sheiner 2 , Alaa Amash 1 , Mahmoud Huleihel 1 , Gershon Holcberg 2 1 Ben-Gurion University of the Negev, Beer Sheva, 2 Soroka University Medical Center, Beer Sheva OBJECTIVE: To study the potential effect of magnesium sulfate (MgSO4) and angiotensin II (AngII) on the levels of prostaglandin E2 (PGE2) in preeclamptic placentas. Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org S294 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2011
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Transcript of 748: Risk of early severe preeclampsia in singleton and twin pregnancies
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Poster Session V Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical Complications, Ultrasound-Imaging www.AJOG.org
Table 1. Demographic characteristics
CharacteristicsNormal(N�10) PE (N�10)
p-value
Maternal Age(yr) 33.4�4.5 30.1�10.6 0.436..........................................................................................................................................................................................
Maternal BMI 26.5�3.2 29.0�3.2 0.045..........................................................................................................................................................................................
GA at delivery 38.6�1.1 34.6�2.6 <0.001..........................................................................................................................................................................................
Parity 0.654.................................................................................................................................................................................
Primigravida 6(60%) 5(50%)..........................................................................................................................................................................................
Delivery 0.146.................................................................................................................................................................................
Cesarean 6(60%) 9(90%)..........................................................................................................................................................................................
Birth weight(gm) 3515.5�489.4 2235�986.9 0.002..........................................................................................................................................................................................
Sex 0.408..........................................................................................................................................................................................
Male 5(50%) 3(30%)..........................................................................................................................................................................................
Placental weight(gm) 736.6�141.5 480.0�164..4 0.001..........................................................................................................................................................................................
PE: preeclampsia BMI: Body mass index GA: gestational age
748 Risk of early severe preeclampsian singleton and twin pregnancies
Dana Henry1, Nicole A Smith2, Thomas F McElrath3
1Massachusetts General Hospital/Harvard Medical School, Boston,A, 2Brigham and Women’s Hospital, Boston, MA, 3Brigham
nd Women’s Hospital/Harvard Medical School, Boston, MAOBJECTIVE: Preeclampsia is more common in twin, as compared to sin-leton pregnancies, however, it is unknown whether the severity and tim-ng of disease varies by fetal number. We aimed to evaluate whether ratesf early and late preterm birth for the indication of severe preeclampsiaiffer between singleton and twin gestations.
STUDY DESIGN: This is a retrospective cohort study at a single institutionincluding all deliveries from 2000-2009. Rates of delivery for severe pre-eclampsia (sPE) among infants born prior to 32 and 37 weeks gestation(GA) were compared, and diagnostic criteria for preeclampsia were com-pared between groups. Chi-squared tests were used for analysis.RESULTS: There were 6259 preterm deliveries, including 1399 twins,mong 86,554 births. Among babies born � 32 weeks GA, delivery forPE was equally common in singleton and twin pregnancies (140 and7 deliveries, or 8% and 8%). Between 32 and 37 weeks GA, the rate ofelivery for sPE was greater for singletons than twins (201 and 51eliveries, or 6% vs. 5%, p�0.04). However, when examining delivery
or sPE as a percentage of total births, early severe preeclampsia wasignificantly more common in twin compared to singleton pregnan-ies (2.3% vs. 0.4%, p� 0.001). In all gestational age categories, crite-ia for delivery including HELLP syndrome, abruption, and fetal in-ications were similar between groups.
CONCLUSIONS: Among babies born � 32 wks gestation in this large co-ort, delivery for the indication of severe preeclampsia is equally com-on in singleton and twin pregnancies, however, a priori risk of early
evere preeclampsia is significantly greater in twin gestations. These find-ngs are of value in both antenatal surveillance and patient counseling.
749 Identification of predictive biomarkers forre-eclampsia by plasma proteomic profiling
Eamonn Breslin1, Susan Slade2, Kypros Nicolaides3,ames Scrivens1, Steve Thornton1
1University of Warwick, Coventry, 2University of Warwick,Coventry, 3King’s College Hospital, LondonOBJECTIVE: To identify peptides in maternal serum which predict the
nset of severe early onset preeclampsia (requiring delivery before 33eeks) before the onset of signs or symptoms.
STUDY DESIGN: Samples were taken from women at 11-13 weeks who did(n�20) or did not (n�20) subsequently develop preeclampsia (PE)
hich required delivery before 34 weeks gestation Samples (in triplicate)
rom individual women were immunodepleted to remove the highly (S294 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2
bundant proteins, using an IgY-14 trapping coluMN. Proteins were sep-rated by Reversed Phase chromatography or 2D RP/RP-LC-MSE,. The
raw data files produced were processed using ProteinLynx. Peptides musthave been observed in at least two of the three technical replicate analysesto be included in the list of proteins identified from the analyses.RESULTS: A unique protein or peptide was classified as such if it was
resent in only one sample at a sufficient quantity. In our initial studye found on 24 peptides unique in PE samples. From these, there werepeptides of significant concentration. There were18 peptides unique
o the normal plasma. In addition to this we have found marked in-rease in pro-inflammatory proteins when comparing PE samples toon PE ones.
CONCLUSIONS: The Proteome in plasma of women who will developE are different to those that do not, even in the first trimester. Char-cterisation of these compounds should enable the development of acreening test in the first trimester for prediction of PE.
750 Adverse maternal and perinatal outcomesn women with chronic hypertension:
retrospective study of 362 patientsEdouard Lecarpentier1, Gilles Kayem1, Vassilis Tsatsaris2,
rancois Goffinet2, Baha Sibai3, Bassam Haddad1
1University Paris 12, Creteil, 2University Paris 5,Paris, 3University of Cincinnati, Cincinnati, OHOBJECTIVE: To determine risk factors of adverse maternal and perina-al outcomes in women with chronic hypertension.
STUDY DESIGN: A retrospective study of 362 patients that analyzed riskfactors of severe maternal and perinatal composite morbidity definedas superimposed preeclampsia, abruption, fetal growth restriction(FGR, � 5th percentile), and perinatal mortality (PNM). Continuousvariables were compared with a two-tailed student t test and categor-ical variables with X2 square test or Fisher’s exact test. Variables with a
� .05 were included in a logistic regression model.RESULTS: Composite morbidity was observed in 157 (43.4%) patients107 superimposed preeclampsia, 6 abruption, 60 FGR, and 21 PNM).n univariate analysis, ethnicity, nephropathy, chronic renal insuffi-iency, systolic blood pressure at first prenatal visit, diastolic bloodressure at first prenatal visit, and a history of preeclampsia, or ab-uption, or FGR, or fetal death, or neonatal death were associated withncreased risk of the composite morbidity. Logistic regression analysistable) shows factors that are independently associated with the com-osite morbidity.
CONCLUSIONS: Our study shows that in chronic hypertensive women,iastolic blood pressure at first prenatal visit, chronic renal disease,revious preeclampsia are independently associated with increasedisk of severe maternal and perinatal morbidity.
Table. logistic regression analysis (adjustedodds ratios and 95% Confidence interval)
Variable Adjusted OR 95% CI
Diastolic blood pressure 1.03 1.00-1.06..........................................................................................................................................................................................
Nephropathy 4.43 1.42-13.76..........................................................................................................................................................................................
Chronic renal insufficiency 6.67 1.20-37.03..........................................................................................................................................................................................
Previous preeclampsia 2.43 1.29-4.56..........................................................................................................................................................................................
751 The effect of magnesium sulfate andngiotensin II on the level of prostaglandin2 secretion in preeclamptic placentas
Bella Bronfenmacher1, Adi Y. Weintraub2, Eyal Sheiner2,laa Amash1, Mahmoud Huleihel1, Gershon Holcberg2
1Ben-Gurion University of the Negev, Beer Sheva,2Soroka University Medical Center, Beer ShevaOBJECTIVE: To study the potential effect of magnesium sulfateMgSO4) and angiotensin II (AngII) on the levels of prostaglandin E2
PGE2) in preeclamptic placentas.011
