Abstract P322: Vasopressin Release is Enhanced Before the Development of Preeclampsia in Humans Despite Exaggerated Suppression of Plasma Osmolality

Plasma osmolality (Osm) suppression is of critical importance to maintain appropriate blood volume to perfuse the uterus during pregnancy. Osm is reduced starting at the fifth week of gestation via increased arginine vasopressin (AVP) secretion. This increased secretion is maintained via a decrease in the AVP/osmotic release threshold. We previously demonstrated that pregnant women who develop preeclampsia (PreE) exhibit exaggerated AVP secretion as early as the 6th week of gestation via measurement of copeptin, the stable C-terminal fragment of AVP. It is unclear whether AVP secretion is elevated before the onset of PreE due to osmotic or non-osmotic stimuli. We tested the hypothesis that elevated AVP secretion before PreE may be associated with elevated Osm (a strong stimulant of AVP secretion). Plasma and clinical data from pregnant women were obtained from the University of Iowa Maternal-Fetal Tissue Bank (IRB#200910784). Osm was measured using the freezing-point suppression technique. Osm was assessed in non-pregnant women (n=109), pregnant women who later developed PreE (n=12 for 7-12 weeks, n=9 for 16-24 weeks), and maternal and gestational age matched controls (n=25 for 6-13 weeks, n=15 for 14-27 weeks). As expected, Osm was decreased in control pregnancies (non-pregnant 291±1 vs pregnant 286±1 mOsm/kg, p<0.05). Contrary to our hypothesis, the Osm decrease was exaggerated in women who would later develop PreE (1st trimester: PreE 279±4 vs control 287±3, and 2 nd trimester: PreE 277±4 vs control 285±3 mOsm/kg; effect of PreE p<0.05, gestational age p=NS, interaction p=NS) even after controlling for age, BMI, diabetes, chronic hypertension, history of preeclampsia, and gravida (model p<0.05). Despite suppressed Osm, plasma copeptin was elevated in the PreE group at all timepoints (p<0.05). These data support the conclusion that long before the development of clinical symptoms of PreE, the rate of secretion of AVP is inappropriately increased despite maintenance of normal osmotic-regulating actions of AVP. This effect must be the result of increased non-osmotic stimuli for AVP, and a suppression of the AVP/osmotic release threshold beyond that observed in control pregnancies.

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Socioeconomic, demographic and obstetric profile of pregnant women with Hypertensive Syndrome in a public maternity

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2020.20190180 ◽

2020 ◽

Vol 41 ◽

Author(s):

Lia Maristela da Silva Jacob ◽

Artur Paiva Santos ◽

Maria Helena Baena de Moraes Lopes ◽

Antonieta Keiko Kakuda Shimo

Keyword(s):

High School ◽

Blood Pressure ◽

Body Mass Index ◽

Pregnant Women ◽

Body Mass ◽

Gestational Age ◽

Skin Color ◽

High School Education ◽

Chronic Hypertension ◽

Elevated Blood

ABSTRACT Objective: To describe the socioeconomic, demographic and obstetric profile of pregnant women with Gestational Hypertensive Syndrome. Methods: A descriptive and correlational study, conducted in Maternity School Assis Chateaubriand, with 120 pregnant women, through a questionnaire analyzed by descriptive and analytical statistics. Results: most women had chronic hypertension (60.83%). Regarding the socioeconomic and demographic profile, most pregnant women had a mean age of 30.9 ± 6.9 years, were Catholic, brown skin color, employed, in stable unions, complete high school education, and income of up to R$ 954.00. Regarding the obstetric profile, their Body Mass Index was up to 66, slightly elevated blood pressure, an average of five prenatal consultations, two pregnancies, one delivery and no abortions. Women with chronic hypertension were older (p = 0.0024), had lower gestational age (p = 0.0219) and a higher number of abortions (p = 0.0140). Conclusions: Pregnant women are overweight/obese, with a mean age of 30.9 years and are socially vulnerable. Pregnant women with chronic hypertension are older and have a higher number of abortions.

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Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy

Hypertension ◽

10.1161/hypertensionaha.119.14627 ◽

2020 ◽

Vol 76 (1) ◽

pp. 157-166 ◽

Cited By ~ 1

Author(s):

Sonia Johnson ◽

Becky Liu ◽

Erkan Kalafat ◽

Basky Thilaganathan ◽

Asma Khalil

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Risk Ratio ◽

Gestational Age ◽

Small For Gestational Age ◽

Gestational Hypertension ◽

White Coat Hypertension ◽

Chronic Hypertension ◽

Increased Risk ◽

Risk Of Preeclampsia

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov , and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00–14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21–5.05], P =0.013) and preterm birth (RR, 2.86 [95% CI, 1.44–5.68], P =0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23–0.78], P =0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26–0.82], P =0.008), preterm birth (RR, 0.47 [95% CI, 0.31–0.71], P <0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44–1.67 weeks]; P <0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.

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Association between gestational glycemic profile and delivery with a large for gestational age baby in pregnant women with type 1 diabetes

Endocrine Abstracts ◽

10.1530/endoabs.70.aep266 ◽

2020 ◽

Author(s):

Ekaterine Inashvili ◽

Natalia Asatiani ◽

Ramaz Kurashvili ◽

Elena Shelestova ◽

Mzia Dundua ◽

...

Keyword(s):

Type 1 Diabetes ◽

Pregnant Women ◽

Gestational Age ◽

Large For Gestational Age ◽

Glycemic Profile

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199-LB: Low Prevalence of Small-for-Gestational-Age in Women with Type 1 Diabetes and Chronic Hypertension

Diabetes ◽

10.2337/db19-199-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 199-LB

Author(s):

SARIT HELMAN ◽

TAMARRA JAMES-TODD ◽

FLORENCE M. BROWN

Keyword(s):

Type 1 Diabetes ◽

Gestational Age ◽

Small For Gestational Age ◽

Chronic Hypertension ◽

Low Prevalence

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Is there a Need for Own Median Calculation in the Second Trimester Biochemical Markers Screening?

Revista de Chimie ◽

10.37358/rc.17.5.5613 ◽

2017 ◽

Vol 68 (5) ◽

pp. 1070-1072

Author(s):

Dan Navolan ◽

Mirela Nicolov ◽

Simona Vladareanu ◽

Ioana Ciohat ◽

Marius Craina ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Biochemical Markers ◽

Biochemical Marker ◽

Second Trimester ◽

Established Method ◽

Crown Rump Length ◽

The Difference ◽

Fetal Aneuploidies ◽

Singleton Pregnancies

Screening of fetal aneuploidies in early pregnancy is a well-established method in the materno-fetal medicine. The aim of our study was to analyze if the medians recommended by the manufacturers are adequate to perform an accurate screening or if there is a need for own laboratory medians calculation in second trimester biochemical marker screening.Sera were collected between 14 wp and 22 wp from 3374 singleton pregnancies. We analyzed three second trimester biochemical markers (AFP, hCG and free Estriol) concentration in all pregnant women and in a subgroup of pregnant women in which gestational age was determined based on crown-rump length. Our results showed that for all biochemical markers the difference between the manufacturer and the own calculated median was lower than 10% excepting the hCG value in the group of pregnant women in which the gestational age was determined on basis of crown-rump-length. Our results show it is recommended to replace the values of the median for hCG measurement with the own laboratory calculated medians. This does not seem to be necessary in the case of AFP and free Estriol measurement.

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Does genetically-defined ancestry predict booking blood pressure in pregnant women with chronic hypertension?

Pregnancy Hypertension ◽

10.1016/j.preghy.2019.08.108 ◽

2019 ◽

Vol 17 ◽

pp. S11

Author(s):

Frances Conti-Ramsden ◽

Raquel Iniesta ◽

Phil Chowienczyk ◽

Lucy C. Chappell

Keyword(s):

Blood Pressure ◽

Pregnant Women ◽

Chronic Hypertension

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The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽

10.1093/rheumatology/keab372 ◽

2021 ◽

Author(s):

Rugina I Neuman ◽

Hieronymus T W Smeele ◽

A H Jan Danser ◽

Radboud J E M Dolhain ◽

Willy Visser

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Disease Activity ◽

Pregnant Women ◽

Gestational Age ◽

Third Trimester ◽

Low Disease Activity ◽

The Third ◽

Observational Prospective Cohort Study ◽

Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio > 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

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Establishment of Early Pregnancy Related Thyroid Hormone Models and Reference Intervals for Pregnant Women in China Based on Real World Data

Hormone and Metabolic Research ◽

10.1055/a-1402-0290 ◽

2021 ◽

Vol 53 (04) ◽

pp. 272-279

Author(s):

Chaochao Ma ◽

Xiaoqi Li ◽

Lixin Liu ◽

Xinqi Cheng ◽

Fang Xue ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Hormones ◽

Pregnant Women ◽

Early Pregnancy ◽

Gestational Age ◽

Dynamic Change ◽

Reference Intervals ◽

Thyroid Stimulating Hormone ◽

Free Thyroxine ◽

Stimulating Hormone

AbstractThyroid hormone reference intervals are crucial for diagnosing and monitoring thyroid dysfunction during early pregnancy, and the dynamic change trend of thyroid hormones during pregnancy can assist clinicians to assess the thyroid function of pregnant women. This study aims to establish early pregnancy related thyroid hormones models and reference intervals for pregnant women. We established two derived databases: derived database* and derived database#. Reference individuals in database* were used to establish gestational age-specific reference intervals for thyroid hormones and early pregnancy related thyroid hormones models for pregnant women. Individuals in database# were apparently healthy non-pregnant women. The thyroid hormones levels of individuals in database# were compared with that of individuals in database* using nonparametric methods and the comparative confidence interval method. The differences in thyroid stimulating hormone and free thyroxine between early pregnant and non-pregnant women were statistically significant (p<0.0001). The reference intervals of thyroid stimulating hormone, free thyroxine and free triiodothyronine for early pregnant women were 0.052–3.393 μIU/ml, 1.01–1.54 ng/dl, and 2.51–3.66 pg/ml, respectively. Results concerning thyroid stimulating hormone and free thyroxine reference intervals of early pregnancy are comparable with those from other studies using the same detection platform. Early pregnancy related thyroid hormones models showed various change patterns with gestational age for thyroid hormones. Early pregnancy related thyroid hormones models and reference intervals for pregnant women were established, so as to provide accurate and reliable reference basis for the diagnosing and monitoring of maternal thyroid disfunction in early pregnancy.

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Birth elicits a conserved neuroendocrine response with implications for perinatal osmoregulation and neuronal cell death

Scientific Reports ◽

10.1038/s41598-021-81511-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yarely C. Hoffiz ◽

Alexandra Castillo-Ruiz ◽

Megan A. L. Hall ◽

Taylor A. Hite ◽

Jennifer M. Gray ◽

...

Keyword(s):

Cell Death ◽

Neuronal Cell Death ◽

Surrogate Marker ◽

Plasma Osmolality ◽

Neuronal Cell ◽

Clinical Findings ◽

Neural Activation ◽

Vasopressin Release ◽

Neuroendocrine Response ◽

The Difference

AbstractLong-standing clinical findings report a dramatic surge of vasopressin in umbilical cord blood of the human neonate, but the neural underpinnings and function(s) of this phenomenon remain obscure. We studied neural activation in perinatal mice and rats, and found that birth triggers activation of the suprachiasmatic, supraoptic, and paraventricular nuclei of the hypothalamus. This was seen whether mice were born vaginally or via Cesarean section (C-section), and when birth timing was experimentally manipulated. Neuronal phenotyping showed that the activated neurons were predominantly vasopressinergic, and vasopressin mRNA increased fivefold in the hypothalamus during the 2–3 days before birth. Copeptin, a surrogate marker of vasopressin, was elevated 30-to 50-fold in plasma of perinatal mice, with higher levels after a vaginal than a C-section birth. We also found an acute decrease in plasma osmolality after a vaginal, but not C-section birth, suggesting that the difference in vasopressin release between birth modes is functionally meaningful. When vasopressin was administered centrally to newborns, we found an ~ 50% reduction in neuronal cell death in specific brain areas. Collectively, our results identify a conserved neuroendocrine response to birth that is sensitive to birth mode, and influences peripheral physiology and neurodevelopment.

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