OBJECTIVE: In the pathogenesis of pre-eclampsia, endothelial cell activation or dysfunction is the central theme and marked dyslipidemia may contribute to endothelial cell dysfunction. The objective of this study was to evaluate the association between pre-eclampsia and the Asp9Asn mutation and the -93G promotor mutation. STUDY DESIGN: DNA was extracted from whole blood or cheek swabs of 224 pre-eclamptic patients, 265 controls, and 106 babies from pre-eclamptic patients. Controls consisted of women who had undergone at least two term pregnancies unaffected by pre-eclampsia. All samples were genotyped for all the polymorphisms using Polymerase Chain Reaction (PCR) of known allelic variants. Sequences were confirmed on an Applied Biosystems 373 DNA Sequencer. Results were analyzed with a x2 contingency table. RESULTS: The prevalences of the LPL Asp9Asn mutation and the LPL -93G promotor mutation were not significantly different between the patients with pre-eclamptic patients, severe pre-eclamptic patients, and HELLP syndrome patients and controls and also not significantly different between the babies born from pre-eclamptic mothers and controls. CONCLUSION: In this caucasian population, the LPL Asp9Asn mutation and the LPL -93G promotor mutation are not associated with an increased risk for pre-eclampsia and HELLP syndrome.
Cheek ; DNA ; Dyslipidemias ; Endothelial Cells ; Female ; HELLP Syndrome ; Humans ; Hypertension, Pregnancy-Induced* ; Lipoprotein Lipase* ; Lipoproteins* ; Mothers ; Polymerase Chain Reaction ; Pre-Eclampsia ; Pregnancy ; Prevalence

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.
Anemia, Hemolytic ; Autopsy* ; Classification ; Conjunctiva ; Emergencies ; Female ; Fetus ; Gestational Age ; HELLP Syndrome ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Hypovolemia ; Korea ; Liver ; Parity ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pregnant Women* ; Rupture* ; Rupture, Spontaneous ; Skin

OBJECTIVE: The purpose of this study was to assess the impact of vascular endothelial growth factor (VEGF) in pregnancies with mild and severe preeclampsia. METHODS: From January 1999 to June 2001, we studied the severity for pregnant women with pregnancy induced hypertension between 28 and 40 weeks gestation. In the mild (n=46) and severe preeclamptic women (n=28), the laboratory evaluation included liver function test, platelet counts, and serum creatinine. The systolic/diastolic (S/D) ratio of the fetal umbilical artery flow for placental resistance was measured by ultrasonographic doppler velocimetry. To detect the damage of vascular endothelial cells in all preeclamptic women, serum concentrations of VEGF were measured. RESULTS: Severe preeclampsia had more elevated liver enzymes, thrombocytopenia, high creatinine than mild preeclampsia. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) was encountered in 8/28 (28.6%) of severe preeclampsia. Fifteen out of twenty-eight cases (53.6%) in severe preeclampsia had elevated S/D ratio from 3.0 to 4.5 including 6 cases with absent end diastolic velocity, whereas 4/46 (8.7%) was elevated SD ratio (>3.0) in mild preeclampsia. Serum concentrations of VEGF were elevated in both mild (7.5+/-4.9 ng/mL, p<0.05) and severe preeclampsia (19.3+/-8.8 ng/mL, p<0.05) compared to normal pregnancy (0.5~2.1 ng/mL). CONCLUSION: The higher serum concentration of VEGF and elevated S/D ratio of umbilical artery were responsible for the changes of the resistance of placental blood flow in severe preeclampsia. Furthermore, elevated S/D ratio of umbilical artery velocity was essential as a surveillance method of fetal health status with IUGR (Intrauterine growth restriction) by vascular declination of placenta.
Creatinine ; Endothelial Cells ; Female ; Fetal Growth Retardation ; HELLP Syndrome ; Humans ; Hypertension, Pregnancy-Induced ; Liver ; Liver Function Tests ; Placenta ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women ; Rheology ; Thrombocytopenia ; Umbilical Arteries ; Vascular Endothelial Growth Factor A*

OBJECTIVE: New-onset postpartum preeclampsia is a poorly defined condition that accounts for a significant percentage of eclampsia cases. It is unclear whether new-onset postpartum preeclampsia is a different disorder from or belongs to the same spectrum of classic antepartum preeclampsia. The objective of this study was to compare the clinical presentation and pregnancy outcomes of antepartum preeclampsia and new-onset postpartum preeclampsia. METHODS: A retrospective study including 92 patients with antepartum preeclampsia and 92 patients with new-onset postpartum preeclampsia was performed. Clinical presentation and pregnancy outcomes were compared. Chi-square test was used to analyze categorical variables, and independent t-test and Mann-Whitney U-test for numerical variables. P-values of <0.05 were used to indicate statistical signifi cance. RESULTS: Patients with antepartum preeclampsia and new-onset postpartum preeclampsia differ significantly in profile, symptoms at presentation, laboratory markers and pregnancy outcomes. CONCLUSION: New-onset postpartum preeclampsia has a distinct patient profile and clinical presentation than antepartum preeclampsia, suggesting they may represent different disorders. Characterization of a patient profile with increased risk of developing this condition will help clinicians to identify patients at risk and provide early and targeted interventions to decrease the morbidity associated with this condition.
Biomarkers ; Eclampsia ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Postnatal Care ; Postpartum Period* ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Retrospective Studies

OBJECTIVE: To investigate the incidence of hypertension disorders complicating pregnancy (HDCP) and vitamin E (VE) nutritional status among pregnant women in Beijing, and to determine the relationship between serum VE concentration in the first trimester of pregnancy and the risk of developing HDCP. METHODS: A retrospective cohort study was performed including 22 283 cases of pregnant women who underwent singleton deliveries in Tongzhou Maternal & Child Health Hospital of Beijing from January 2016 through December 2018 and received tests of serum VE concentrations in the first trimester of pregnancy. Nonconditional Logistic regression model was used to analyze the association between serum VE concentration levels and the risk of developing HDCP. RESULTS: The total incidence of HDCP was 5.4%, with the incidence of gestational hypertension around 2.1% and the incidence of preeclampsia-eclampsia around 3.3%. The median concentration of serum VE in early pregnancy was 10.1 (8.8-11.6) mg/L, and 99.7% of the participants had normal serum VE concentrations. The incidence of gestational hypertension and that of preeclampsia-eclampsia had been annually increasing in three years; a linear-by-linear association had also been observed between the serum VE concentrations and the years of delivery. According to the results of the univariable and the multivariable Logistic regression analyses, higher risks of developing HDCP had been observed among women with higher serum VE concentrations. Compared to those with serum VE concentrations in interquartile range (P₂₅-P₇₅) of all the participants, the women whose serum VE concentrations above P₇₅ were at higher risks to be attacked by HDCP (OR = 1.34, P < 0.001), gestational hypertension (OR = 1.39, P = 0.002), or preeclampsia-eclampsia (OR = 1.34, P = 0.001), as suggested by the results of the multivariable Logistic regression model analyses. In addition, the women with serum VE concentrations of 11.2 mg/L or above had a significantly higher risk of developing HDCP than those whose serum VE concentrations of P₄₀-P₆₀ of all the participants, and this risk grew higher as serum VE concentrations in the first trimester of pregnancy increased. CONCLUSION Women in Beijing are at good nutritional status. From January 2016 to December 2018, the incidence of HDCP increased with serum VE concentration level, and serum VE concentration of 11.2 mg/L is an indicator of an increased risk of developing HDCP, suggesting that pregnant women should take nutritional supplements containing VE carefully.
Female ; Humans ; Hypertension, Pregnancy-Induced ; Pre-Eclampsia ; Pregnancy ; Pregnancy Trimester, First ; Retrospective Studies ; Vitamin E

OBJECTIVE: High thromboxane level evidence supports pivotal involvement of TxA2 in pathophysiology of pregnancy induced hypertension and provides a strong rationale for pursuing TxA2-blocking strategies in drug development. METHODS: The stable metabolites of TXA2 (Thromboxane B2) in maternal blood of 12 patients with mild preeclampsia, 4 patients with severe preeclampsia and 14 normal parturients were measured by competitive enzyme immunoassay. RESULTS: TxB2 concentrations were not increased in mild preeclampsia (101 +/- 12 pg/mL, n=12) as compared with normal pregnancy (150 +/- 15 pg/mL, n=14), but they were significantly increased in severe preeclampsia (454 +/- 102 pg/mL, p<0.0001, n=4). CONCLUSION: Maternal plasma thromboxane is increased only in severe preeclampsia. Thus, increased thromboxane A2 biosynthesis correlates with disease severity and may have a pathogenetic role in pregnancy-induced hypertension. These findings provide a rationale for the use of aspirin in the treatment as well as in the prevention of this disorder.
Aspirin ; Female ; Humans ; Hypertension, Pregnancy-Induced* ; Immunoenzyme Techniques ; Plasma ; Pre-Eclampsia ; Pregnancy ; Thromboxane A2

Pregnancy ; Female ; Humans ; Cardiovascular Diseases/epidemiology* ; Hypertension, Pregnancy-Induced ; Risk Factors ; Cardiovascular System ; Pre-Eclampsia

Objective: To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. Methods: A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. Results: (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all P<0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all P<0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Conclusions: Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.
Humans ; Pregnancy ; Female ; Hypertension, Pregnancy-Induced/diagnosis* ; Retrospective Studies ; Pre-Eclampsia/epidemiology* ; Risk Factors ; Incidence

Retinal detachment is a rare and unusual complication of preeclampsia. In 6,194 consecutive deliveries from January 1987 to July 1990 at the Soonchunhuang University Hospital, pregnancy induced hypertension was diagnosed in 223 patients(3.6%), and in 11 cases serous retinal detachment occured. We studied retrospectively the incidence, clinical characteristics and pathophysiology of the retinal detachment in the pregnany induced hypertension. The results were as follows: 1. Retinal detachment was serous type and mostly bilateral(90.9%). 2. Retinal detchment occured principally in primigravid(63.64%). 3. Serotts retinal detachment occured in 11 cases in 6,194 consecutive diliveries(0.18%) with 9 cases in 211 preeclampsia(4.27%) and 2 cases in 12 eclampsia(17.67%). 4. Reattachment of the retina occured at an interval of 7 to 29 days with an average interval of 14 days after delivery. 5. The fluorescein angiographic findings provide clinical evidence that retinal detachment in pregnancy induced hypertension is secondary to choroidal damage.
Choroid ; Female ; Fluorescein ; Hypertension ; Hypertension, Pregnancy-Induced ; Incidence ; Pre-Eclampsia ; Pregnancy* ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies

Retinal detachment is a rare and unusual complication of preeclampsia. In 6,194 consecutive deliveries from January 1987 to July 1990 at the Soonchunhuang University Hospital, pregnancy induced hypertension was diagnosed in 223 patients(3.6%), and in 11 cases serous retinal detachment occured. We studied retrospectively the incidence, clinical characteristics and pathophysiology of the retinal detachment in the pregnany induced hypertension. The results were as follows: 1. Retinal detachment was serous type and mostly bilateral(90.9%). 2. Retinal detchment occured principally in primigravid(63.64%). 3. Serotts retinal detachment occured in 11 cases in 6,194 consecutive diliveries(0.18%) with 9 cases in 211 preeclampsia(4.27%) and 2 cases in 12 eclampsia(17.67%). 4. Reattachment of the retina occured at an interval of 7 to 29 days with an average interval of 14 days after delivery. 5. The fluorescein angiographic findings provide clinical evidence that retinal detachment in pregnancy induced hypertension is secondary to choroidal damage.
Choroid ; Female ; Fluorescein ; Hypertension ; Hypertension, Pregnancy-Induced ; Incidence ; Pre-Eclampsia ; Pregnancy* ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies