dynamic aspects of preeclampsia

89

90

91 MICROARRAY ANALYSIS OF GENE EXPRESSION IN LEUKOCYTES FROM WOMEN WITHPREECLAMPSIA YUPING WANG1, DAVID F. LEWIS1, YANG GU1, LYNN GROOME1,LISA PHILIBERT1, 1Louisiana State University Health Sciences Center atShreveport, Obstetrics and Gynecology, Shreveport, Louisiana

OBJECTIVE: Altered leukocyte function contributes to the maternal vasculardysfunction in women with preeclampsia (PE). The purpose of this study was togain insight of gene profiles in leukocytes in PE.

STUDY DESIGN: Venous blood was obtained from women with PE (n = 4)between 31-34 weeks of gestation before delivery. Leukocytes were isolated.Total RNA was extracted and biotin-labeled cRNA was synthesized. cRNAsamples were hybridized to the Affymetrix U133A human microarray chip.Results were analyzed using Data mining tool to identify gene transcripts andMicroarray Suite for statistical analysis by t-test and P ! .05 was set asstatistically significant. Ontology analysis was performed using Spotfire com-puter software.

RESULTS: Transcripts were identified as ‘‘present’’ or ‘‘absent’’ in all 4samples (two were African Americans (AA) and two were Caucasians (C).Among the 22283 known genes, a total of 7089 (32%) transcripts were present inall 4 samples. 7926 (35.5%) transcripts were present only in the AA group and7430 (33.3%) transcripts were present only in the C group. Expression profiles ofthe known genes revealed 17 transcripts identified with more than 2-fold increasein the AA group compared to that in the C group, P ! .05. In contrast, 13transcripts were identified with more than 2-fold increase in the C groupcompared to that in the AA group, P ! .05. Based on ontology analysis,significant patterns of gene clusters that are involved in physiological processand cellular process were identified either increased in the AA group or increasedin the C group. Specific functional related gene changes include: responses tostress (9 genes), external stimulus (10 genes), cellular defense (4 genes),inflammatory (2 genes), innate immune response (2 genes), and genes relatedto antigen and MHC protein binding (3 genes).

CONCLUSION: Significant gene profile changes that relate to stress, defenseand immune responses were identified in leukocytes in PE. These findingsrepresent the first step towards the identification of altered leukocyte geneexpression during PE.

S36 SMFM Abstracts

DYNAMIC ASPECTS OF PREECLAMPSIA WESSEL GANZEVOORT1, ANNELIES REP2,HANNEKE DE VRIES2, GOUKE BONSEL3, HANS WOLF4, 1Academisch MedischCentrum, Amsterdam, Netherlands, 2VU University Medical Center,Amsterdam, Netherlands, 3Academic Medical Center, Amsterdam,Netherlands, Amsterdam, Netherlands, 4Academisch Medisch CentrumAmsterdam, Obstetrics, Amsterdam, Netherlands

OBJECTIVE: Exploration of the dynamic aspects of preeclampsia.STUDY DESIGN: 216 patients with (H)ELLP-syndrome (n = 54), severe

preeclampsia (n = 80),or pregnancy-induced-hypertension related fetal growthrestriction (n = 82) and gestational age between 24 and 34 completed weekswere randomized for temporizing management with plasma volume expansion(n = 111; 250 ml HydroxyEthylStarch 6% twice daily in 4 hours) or without(n = 105). Primary endpoints of the study were a neurological optimality scoreof the neonate at term age (Prechtl) and perinatal mortality. Composite maternalcomplications (CMC) were defined as major maternal morbidity (abruptioplacentae, pulmonary edema, liver hematoma, sepsis, pulmonary embolism),newly acquired, persistent or recurrent HELLP and eclampsia after inclusion.Onset of morbidity after admission was categorized in three-day periods.

RESULTS: Median prolongation until delivery was 7.4 (0.2-35) days in thetreatment group and 10.5 (0.2-44) days (P = .054) in the control group, and theincidence of CMC 32% and 35% (P = .6). Primary outcome criteria weresimilar. The incidence of CMC in the total group was 8 % (range 4-11) / 3 daysduring the first 14 days after admission and thereafter 3% (range 0-6) / 3 days.Postpartum incidence of CMC was 8%.

CONCLUSION: The incidence of CMC was constant during the first two weeksafer admission and diminished thereafter. Treatment allocation had no influence.

LONG-TERM INFANT OUTCOME OF A RANDOMIZED TRIAL OF PLASMA VOLUMEEXPANSION IN WOMEN WITH PREECLAMPSIA REMOTE FROM TERMWESSEL GANZEVOORT1, ANNELIES REP2, ALEID G. VAN WASSENAER3, AGAATHG. KASPERS3, HANNEKE DE VRIES2, GOUKE BONSEL4, HANS WOLF5, 1AcademischMedisch Centrum, Amsterdam, Netherlands, 2VU University Medical Center,Amsterdam, Netherlands, 3Academisch Medisch Centrum Amsterdam,Neonatology, Amsterdam, Netherlands, 4Academic Medical Center, Amsterdam,Netherlands, Amsterdam, Netherlands, 5Academisch Medisch CentrumAmsterdam, Obstetrics, Amsterdam, Netherlands

OBJECTIVE: We report major long-term infant outcome parameters from thefirst large randomised trial on plasma volume expansion (PVE) in temporisingmanagement of severe and early hypertensive disorders of pregnancy. Thehypothesis of the study was that plasma volume expansion might facilitateantihypertensive treatment and improve placental perfusion, thereby reducingthe risk for poor cognitive outcome of the infant.

STUDY DESIGN: Between April 1, 2000, and May 31, 2003, 216 patients witha gestational age between 24 and 34 weeks were randomized for temporizingmanagement with PVE (treatment group; n = 111) or without PVE (controlgroup; n = 105). Endpoints were neonatal neurological development at term age(Prechtl), mental development index (MDI) and psychomotor developmentindex (PDI) at one year corrected age (Bayley), perinatal death, neonatalmorbidity and maternal morbidity.

RESULTS: At baseline groups were comparable, median gestational age 30weeks. In the treatment group, patients received higher amounts of intravenousfluids than in the control group (median 813 mL/day versus 14 mL/day;P ! .001) with concomitant decreased hemoglobin count (median �0,6 versus�0.2 mmol/L; P ! .001). Neither neurological score at term age, nor MDI orPDI score at one year corrected age were different. There was no difference inmajor maternal morbidity (total 11%).

CONCLUSION: Development index (Bayley) at one year corrected age isequivalent following temporising management with or without PVE. The studyhypothesis could not be confirmed. (At submission follow-up not yet completed.)

Treatment group(n = 111)

Control group(n = 105) Follow-up

Perinatal mortality 23 (21%) 15 (14%) 100%Term age score (Prechtl) 59 (47-60) 59 (49-60) 98%One year MDI (Bayley) 88 (66-123) 86 (59-102) 76%One year PDI (Bayley) 77 (50-118) 77 (53-114) 76%

92 RECURRENCT PREECLAMPSIA IN THE SECOND PREGNANCY – EFFECTS OFGESTATIONAL AGE AT FIRST BIRTH, PATERNITY, AND INTERVAL BETWEENBIRTHS DORINA KALLOGJERI1, RACHATA TUNGSIRIPAT1, DOROTHEA MOSTELLO2,TERRY LEET1, 1Saint Louis University, School of Public Health, St. Louis,Missouri, 2Saint Louis University, Maternal-Fetal Medicine, St. Louis, Missouri

OBJECTIVE: The purpose of this study was to evaluate the effect ofpreeclampsia in the first pregnancy on the likelihood of preeclampsia in thesecond pregnancy and to determine the effects of gestational age at the firstdelivery, inter-birth interval, change in paternity, and body mass index (BMI) onthis relationship.

STUDY DESIGN: We performed a population-based, cohort study using datafrom the Missouri maternally-linked cohort. The study population includedwomen who had two singleton deliveries between 1989 and 1997. 6,152 womenwith preeclampsia and 96,608 women without preeclampsia in the firstpregnancy were identified. Data were analyzed by stratified analysis and logisticregression.

RESULTS: In the second pregnancy, 907 (14.7%) of women with priorpreeclampsia developed preeclampsia in contrast to 1704 (1.4%) without priorpreeclampsia. As inter-birth interval increased, rate of recurrent preeclampsiaincreased from 14.3% for women with both deliveries within one year to 17.4%for women with both deliveries within 6-7 years. Change in paternity did notaffect the risk of recurrent preeclampsia. Rate of recurrent preeclampsia washigher for women whose first delivery was preterm (38.6% for 20-28 weeks,29.1% for 29-32 weeks, 21.9% for 33-36 weeks vs. 12.9% for R37 weeksgestation). Obese and overweight women had higher rates of recurrent pre-eclampsia, compared to women with normal BMI (19.3% and 14.2% vs. 11.2%).In women with preeclampsia in the first pregnancy, adjusted odds ratio forrecurrent preeclampsia was 6.6 (95% CI: 5.9-7.3).

CONCLUSION: Among women with prior preeclampsia, risk of recurrentpreeclampsia is high, but less than predicted by non-population-based studies.Change in paternity does not modify the recurrence risk. Longer inter-birthinterval, obesity and prior preterm delivery increase the likelihood of recurrentpreeclampsia.