Hypertension during pregnancy increases the risk of adverse maternal and fetal outcomes, but the mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define the features of the renin–angiotensin–aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of 74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, 27 patients) versus those remaining normotensive (NT, 47 patients). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of Angiotensin I + Angiotensin II) and aldosterone concentrations significantly increased from the first to the third trimester, accompanied by a modest increase in the concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies, PRA-S and angiotensin peptides were largely unchanged over gestation, and third-trimester aldosterone concentrations were significantly lower compared with those in NT pregnancies. The results indicated that the predominant features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and the attenuated secretion of aldosterone.

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specificity of 70% (95%CI 50.6-85.2%) and 86.2% (95%CI 68.3-96.1%) for PAS. PPV and NPV were 84% (95%CI 67.2-93%) and 73.5% (95%CI 61.2-83%), superior to ultrasound and MRI, from previously published data. In addition, VEGF identified 65% (9/14) of patients transfused >4 units of blood, 74% (22/30) with a length of stay >4 days and 65% (9/14) admitted to the ICU. CONCLUSION: In this large cohort, urine VEGF was associated with PAS as well as maternal morbidity. VEGF warrants further evaluation as a biomarker for diagnosis of PAS and prediction of PAS associated morbidity.

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