Abstract
Background
Systemic endothelial dysfunction has been identified as one of the main events in preeclampsia (PE). A nonhealthy vascular endothelium can be pointed out as the pathophysiological explanation of the clinical manifestations and complications of PE. Once normal pregnancy is characterized by a constant increase in endothelial function, a follow-up of this physiological event could be used as an early marker or a prediction tool to predict PE.
Objectives
To perform a longitudinal assessment of endothelial function, using an ultrasound study of brachial artery flow Flow-mediated dilation (FMD), in normotensive and preeclamptic pregnancies, to evaluate the difference of FMD values along the second trimester of pregnancy to predict PE.
Patients and methods
In a prospective cohort study, 91 pregnant women with a high risk of developing PE were subjected to FMD of the brachial artery. The difference in the FMD values, between 16+0 and 19+6 and 24+0 and 27+6 weeks of gestation were compared, taking PE development into consideration. Receiver operator characteristics (ROC) curves were created to determine the sensibility and specificity of FMD difference to predict PE.
Results
A total of 19 patients developed PE and the other 72 women remained normotensive until 1 week after delivery. When considering a cut off of +2.50 %, FMD difference, between the two evaluations, sensitivity for PE prediction was 87.5 % for early onset PE and 95.5 % for late PE.
Conclusion
The difference of FMD values between the second trimester of pregnancy can be used for PE prediction for both, early and late forms of PE.
Similar content being viewed by others
References
Pennington KA, Schlitt JM, Jackson DL, Schulz LC, Schust DJ (2012) Preeclampsia: multiple approaches for a multifactorial disease. Dis Model Mech 5(1):9–18 Epub 2012/01/10
Campbell OM, Graham WJ (2006) Lancet maternal survival series steering g. Strategies for reducing maternal mortality: getting on with what works. Lancet 368(9543):1284–1299 Epub 2006/10/10
Barton JR, Sibai BM (2008) Prediction and prevention of recurrent preeclampsia. Obstet Gynecol 112(2 Pt 1):359–372 Epub 2008/08/02
Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline C, Strategic Training Initiative in Research in the Reproductive Health Sciences S (2008) Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can JOGC Journal d’obstetrique et gynecologie du Canada JOGC 30(3 Suppl):S1–S48 Epub 2008/12/17
Foidart JM, Munaut C, Chantraine F, Akolekar R, Nicolaides KH (2010) Maternal plasma soluble endoglin at 11-13 weeks’ gestation in pre-eclampsia. Ultrasound Obstet Gynecol 35(6):680–687 Epub 2010/03/06
Nicolaides KH (2011) A model for a new pyramid of prenatal care based on the 11 to 13 weeks’ assessment. Prenat Diagn 31(1):3–6 Epub 2011/01/07
Onwudiwe N, Yu CK, Poon LC, Spiliopoulos I, Nicolaides KH (2008) Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure. Ultrasound Obstet Gynecol 32(7):877–883 Epub 2008/11/11
Germain AM, Romanik MC, Guerra I, Solari S, Reyes MS, Johnson RJ et al (2007) Endothelial dysfunction: a link among preeclampsia, recurrent pregnancy loss, and future cardiovascular events? Hypertension 49(1):90–95 Epub 2006/11/23
Myatt L, Webster RP (2009) Vascular biology of preeclampsia. J Thromb Haemost JTH 7(3):375–384 Epub 2008/12/18
Roberts JM, Lain KY (2002) Recent Insights into the pathogenesis of pre-eclampsia. Placenta 23(5):359–372 Epub 2002/06/14
Harris RA, Nishiyama SK, Wray DW, Richardson RS (2010) Ultrasound assessment of flow-mediated dilation. Hypertension 55(5):1075–1085 Epub 2010/03/31
Sierra-Laguado J, Garcia RG, Lopez-Jaramillo P (2006) Flow-mediated dilatation of the brachial artery in pregnancy. Int J Gynaecol Obstet 93(1):60–61 Epub 2006/03/11
Green DJ, Jones H, Thijssen D, Cable NT, Atkinson G (2011) Flow-mediated dilation and cardiovascular event prediction: does nitric oxide matter? Hypertension 57(3):363–369 Epub 2011/01/26
Gomez O, Figueras F, Fernandez S, Bennasar M, Martinez JM, Puerto B et al (2008) Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 32(2):128–132 Epub 2008/05/07
Davison JM, Homuth V, Jeyabalan A, Conrad KP, Karumanchi SA, Quaggin S et al (2004) New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol JASN 15(9):2440–2448 Epub 2004/09/02
Erez O, Romero R, Espinoza J, Fu W, Todem D, Kusanovic JP et al (2008) The change in concentrations of angiogenic and anti-angiogenic factors in maternal plasma between the first and second trimesters in risk assessment for the subsequent development of preeclampsia and small-for-gestational age. J Matern Fet Neonatal Med 21(5):279–287 Epub 2008/05/01
Report of the National High Blood Pressure Education (2000) Program working group on high blood pressure in pregnancy. Am J Obstet Gynecol 183(1):S1–S22 Epub 2000/08/02
Savvidou MD, Kametas NA, Donald AE, Nicolaides KH (2000) Non-invasive assessment of endothelial function in normal pregnancy. Ultrasound Obstet Gynecol 15:502–507
Huppertz B (2008) Placental Origins of Preeclampsia. Hypertension 51(4):970–975
Llurba E, Carreras E, Gratacos E, Juan M, Astor J, Vives A et al (2009) Maternal history and uterine artery Doppler in the assessment of risk for development of early- and late-onset preeclampsia and intrauterine growth restriction. Obstet Gynecol Int 2009:275613 Epub 2009/11/26
Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH (2008) Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 32(2):138–146 Epub 2008/07/18
Noori M, Donald AE, Angelakopoulou A, Hingorani AD, Williams DJ (2010) Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation 122(5):478–487. doi:10.1161/CIRCULATIONAHA.109.895458 Epub 2010 Jul 19
Takase B, Goto T, Hamabe A, Uehata A, Kuroda K, Satomura K et al (2003) Flow-mediated dilation in brachial artery in the second half of pregnancy and prediction of pre-eclampsia. J Hum Hypertens 17(10):697–704 Epub 2003/09/25
Savvidou MD, Hingorani AD, Tsikas D, Frölich JC, Vallance P, Nicolaides KH (2003) Endothelial dysfunction and raised plasma concentrations of asymmetric dimethylarginine in pregnant women who subsequently develop pre-eclampsia. Lancet 361(9368):1511–1517
Acknowledgments
This study was funded by Fundação de Amparo à Pesquisa de Minas Gerais.
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Author information
Authors and Affiliations
Corresponding author
Additional information
Study Association This article is part of the thesis of doctoral submitted by Augusto Henrique Fulgêncio Brandão, from Faculdade de Medicina da Universidade Federal de Minas Gerais.
Rights and permissions
About this article
Cite this article
Brandão, A.H.F., Félix, L.R., do Carmo Patrício, E. et al. Difference of endothelial function during pregnancies as a method to predict preeclampsia. Arch Gynecol Obstet 290, 471–477 (2014). https://doi.org/10.1007/s00404-014-3243-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3243-3