P2632Gestational hypertension: endothelial dysfunction as a marker of pre-eclampsia

Abstract

Background: Pregnancy-induced hypertension (PIH), especially preeclampsia, is the most common cause of the maternal and fetal morbidity and mortality in developing countries. It complicates 8-10% of all pregnancies, generally after 20 weeks of gestation. Purpose(s): The objective of the study was to compare the temporal changes in vascular function during pregnancy in healthy women and in those with pregnancyinduced hypertension (PIH). Vascular function was assessed at four time points (11-13+6 weeks+days, 20- 22+6 weeks+days, 30-32+6 weeks+days and first trimester after delivery) by brachial flow-mediated dilatation (b-FMD), uterine resistance index (u-IR) and carotid-intima media tickness (c-IMT) in women with singleton pregnancies. Method(s): 43 normal pregnant females and 43 hypertensive pregnant females were included in this study. Detailed history, clinical examination, FMD, c-IMT Doppler ultrasound, u-IR and relevant biochemical parameters (high sensitivity C-reactive protein: hs-PCR) were assessed at each visit. The study groups were found to be age matched (p=0,78). FMD level in the pregnancy-induced hypertensive group (average = 6,34+/-1,23%) was significantly lower in the third trimester than the normal pregnant (average: 12,65+/-2,74%) and the difference between these 2 groups was significant (p<0,01). Normal pregnancy is associated with increased or normal endothelial function during the pregnancy. Significantly lower levels of FMD during the third trimester were assessed in PIH subjects compared to normal pregnant, and after the delivery the FMD values in PIH were better than the third trimester (average: 8,56+/-1,71%) but lower than the baseline (10,5+/-2,36%; p=0,036). The lower values of FMD are probably caused by a state of inflammation because FMD correlated with hs-CRP that directly increases in the third trimester of pregnancy in hypertensive women. IMT does not statistically change in two study group. U-RI is reduced in the third pregnancy quarter and correlates with FMD (r: 0.798). Conclusion(s): Values of FMD in the first quarter post partum improve compared to the third trimester of pregnancy, but are still lower compared to baseline in the group of hypertensive pregnant as opposed to the control group of healthy pregnant in which FMD values remain consistently high. This predisposes that gestational hypertension increases cardiovascular risk although seriated monitoring to more long time are needed.