Objective To determine the behaviour of the coagulation variables antithrombin I11 (ATIII), protein C , thrombin/antithrombin 111 (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre-eclamptic pregnancies. Design Longitudinal and cross-sectional observational study.Setting Antenatal clinic and maternity hospital.Subjects Thirty-six primigravid normotensive Caucasian patients, four of whom subsequently developed pre-eclampsia, and 12 patients with established pre-eclampsia.Main outcome measures Plasma levels of PAI-1, PAI-2 and t-PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.Results PAI-1 and PAL2 antigen levels rose progressively throughout normal pregnancy. Among the established pre-eclamptic group compared with matched normal pregnancies, the PAI-2 antigen level was significantly lower (48.5 f 22.8 versus 183.5 k 37.4; P c 0*001), the PAI-I antigen level was significantly higher (122k34.4 versus 79.2f 19.7; P c 0.001), ATIII activity was significantly lower (87.8k27.1 versus 110.9+ 19.3; P c O*OOl) and TATIII complex levels were significantly higher (16.9k6.4 versus 102+ 5.9; P c 0.001). Among the four initially normotensive patients who subsequently developed pre-eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.Conclusion Significantly elevated levels of PAI-1 and fibronectin occurring early in pregnancies that subsequently develop pre-eclampsia suggest that these variables may have predictive values. PAI-2 would seem to be a marker of placental function in pre-eclampsia while increased t-PA and TATIII complex levels reflect the severity of the condition.Despite recent advances in antenatal care, pre-eclampsia remains a major cause of maternal and perinatal mortality and morbidity (WHO 1987). Many centres have investigated markers for coagulation and fibrinolytic activation and for endothelial injury in order to characterise

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Objective To assess the role of 24-hour ambulatory blood pressure measurement in the mid-second Design Prospective intervention. Setting The Rotunda Hospital, Dublin. Participants One thousand one hundred and two healthy primigravid women, Intervention 24-hour ambulatory blood pressure measurement at 18 to 24 weeks of gestation. Main outcome measures The development of pre-eclampsia or gestational hypertension. Results A total of 1048 women had sufficient readings to be included in the final analysis. Of these, 23 (2.2%) developed pre-eclampsia, 64 (6.1%) developed gestational hypertension and 96 1 (91.7%) remained normotensive. Significantly higher ambulatory blood pressures were recorded in both the pre-eclamptic and gestational hypertensive group compared with the normotensive group. In addition, the gestational hypertensive group had significantly higher clinically measured blood pressure compared with the normotensive group. There were no differences between the preeclamptic and the gestational hypertensive group for any of the blood pressure parameters analysed. The best overall predictor for pre-eclampsia was 24-hour mean diastolic pressure which using a cutoff level of 71 mmHg gave a test with a sensitivity of only 22% and a positive predictive value of 15%.Conclusion Because the absolute differences are small and the overlap between the hypertensive and normotensive groups large, ambulatory blood pressure measurement, in a healthy primigravid population, between 18 and 24 weeks of gestation is not a useful predictor of hypertension.trimester as a predictive test for the development of hypertension in pregnancy.

Objectives To estimate the rate of folate catabolism in pregnant and nonpregnant women and to derive Design Prospective, observational study.Setting Rotunda Hospital, Dublin.Women Wenty-four healthy gravid women were studied once during each trimester and postpartum.Wenty-five nonpregnant controls were assessed before and after folk acid supplementation.Interventions Women provided 24-hour urine collections while adhering to a strict dietary regimen containing no exogenous folate catabolites.Main outcome measum Urinary levels of p-acetamidobenzoylglutamate and p-aminobenzoylglutamate were measured by high pressure liquid chromatography.Results The 24-hour excretion of folate catabolites, expressed as mean [95% CI] folate equivalents in pg) progressively increased during pregnancy. A peak was reached in the third trimester (349.1 pg [308.1 to 390.11) where the rate was more than twice the rate in the nonpregnant control group Conclusions The rate of folate catabolism progressively increases during pregnancy reaching a peak in the third trimester at the time of maximal fetal growth. The increased demand for folate during pregnancy appears to be due to the accelerated breakdown of the vitamin because of its participation in cellular biosynthesis. These results provide a quantitative basis for the current debate on the appropriate recommended dietary allowance for folate in both pregnant and nonpregnant women.the recommended dietary allowance for folate.