968: Anti-angiogenic imbalance during pregnancy: is the Fas/FasL system a contributor?

Abstract

In this case control study, human maternal plasma < 20 weeks from control (n¼40) and preeclamptic (n¼21) pregnancies and nonpregnant women (n¼113) and clinical data were obtained from the Iowa Women's Health Tissue Repository (IRB# 200910784, 201010769). CP was measured using a commercially available ELISA. Posm was measured using the freezing point depression method. RESULTS: Compared to non-pregnant women (288AE2 mOsm/kg) and consistent with previous studies, pregnant women exhibited a suppressed Posm (p<0.001). Posm was even more suppressed in PreE pregnancies than in control pregnancies in both first (276AE6 vs 288AE2 mOsm/kg, p<0.02) and second (275AE7 vs 288AE2, p¼0.13) trimesters. After controlling for age, chronic hypertension, diabetes, and BMI, first trimester Posm is significantly associated with PreE (aOR¼0.902, p<0.013). As previously published, first (1031AE87 vs 618AE72 pg/mL, p<0.003) and second (1070AE89 vs 501AE75, p<0.001) trimester plasma CP was elevated in PreE pregnancies. ROC curve analyses indicated that first trimester maternal plasma CP is predictive of PreE (AUC¼0.88, p<0.001), but the CP/Posm ratio did not add to the predictive strength of CP alone (AUC¼0.88, p<0.001). CONCLUSION: Consistent with an elevated secretion and action of AVP during PreE, Posm suppression is exaggerated in PreE pregnancies. While combining CP and Posm values did not improve the predictive power of CP alone, the data support the concept that excess AVP during PreE drives water retention, while the renal response to AVP is maintained. These data support an over-sensitization of the AVP-Posm relationship in very early gestation in pregnancies which develop PreE. The future identification of factors which amplify AVP secretion in very early gestation may lead to earlier and more accurate diagnostic tests and novel preventative therapeutic targets for PreE.