Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2009) 19 P295

University of Glasgow, Glasgow, UK.


Although improvements in obstetric and neonatal care in recent years have led to reduction in morbidity and mortality from pre-eclampsia, our ability to predict the condition has not improved significantly. Endothelial dysfunction underlies many of the manifestations of pre-eclampsia. In this study we will assess methods of detecting endothelial dysfunction and arterial stiffness in high-risk pregnant women in early and late pregnancy. Sixty women with 2 or more risk factors for pre-eclampsia were seen at gestational weeks 16 and 28. Arterial stiffness was assessed using applanation tonometry with the SphygmoCor device; central aortic pressures and peripheral and central augmentation index (AIx) were then calculated. Endothelial function was assessed with the EndoPAT 2000 device. Pneumatic probes were fitted to the index fingers; after baseline recordings a blood pressure cuff was inflated in the dominant arm, then released after 5 min to induce flow-mediated reactive hyperaemia. The ratio of readings before and after the period of occlusion was then used to calculate a score for endothelial function, or reactive hyperaemia index (RHI). RHI was significantly reduced at week 28 compared to week 16 (1.61±0.40 vs 2.02±0.67, P<0.001), indicating endothelial dysfunction. At week 16, there was an inverse relationship between maternal age and RHI (r=−0.274, P=0.043). AIx calculated by EndoPAT 2000 correlated with peripheral (r=0.335, P=0.013) and central AIx (r=0.330, P=0.014) derived from SphygmoCor. Central AIx was significantly higher in women with a history of pre-eclampsia in a previous pregnancy (15.8±6.9 vs 4.5±13.3%, P<0.001), which remained significant (P=0.05) when adjusted for maternal age. In this interim data analysis we have demonstrated that women with a history of pre-eclampsia have increased central augmentation index suggesting vascular stiffness in a subsequent pregnancy, that endothelial function deteriorates throughout pregnancy, and that older women have worse endothelial function. Ongoing studies will determine the utility of these studies in predicting pre-eclampsia.

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