Evidence for distinct preterm and term phenotypes of preeclampsia

Abstract

Objective To determine if there are differences in maternal and fetal characteristics in pregnancies complicated by preterm versus term preeclampsia. Methods Using our electronic database we identified 143 women who met the ACOG criteria for preeclampsia between January 1995 and August 2003. We collected data on age, weight, height, smoking status, maternal serum biochemical markers and newborn data. We compared the group delivering preterm (<37 weeks) with those delivering at term (≥37 weeks). Analyses were based on ANOVA, Wilcoxon Rank Sum tests and chi-square tests. Statistical significance was determined based on alpha = .05. Data are expressed as mean ± s.d. unless otherwise indicated. Results Eighty women delivered preterm and 63 delivered at term. Women who delivered preterm with preeclampsia were younger (age 24.4 ± 4.9 years vs 27.7 ± 6.0 yrs, P<0.001), lighter (BMI 25.8 ± 5.6 vs 28.9 ± 7.3 kg/m2, P=0.01) and were more likely to smoke cigarettes (28% vs 9%, P=0.008) than those delivering at term with preeclampsia. Maternal serum liver enzyme concentrations were significantly greater in the preterm group (peak AST 38 vs 30 U/L, P=0.006), (peak ALT 31 vs 23 U/L, P=0.001). Newborn birth weight percentile (gestational age specific) was significantly lower for preterm preeclampsia (25th ±29 vs 47th ±32 percentile, P<0.001). We found no significant differences in maternal platelet count nadir, peak uric acid concentration, or newborn gender between groups. Conclusions Differences exist in maternal and fetal characteristics between women who develop preterm preeclampsia and those who develop preeclampsia at term. These data support the hypothesis that multiple preeclamptic phenotypes exist.

Association Between Pre-Pregnancy Depression/Anxiety Symptoms and Hypertensive Disorders of Pregnancy

“…25,26,37 In addition, PE that co-occurs with preterm delivery is also thought to differ etiologically from PE that co-occurs with term delivery, with the former being more likely to involve poor placentation, high maternal vascular resistance, low cardiac output, and alterations in liver enzymes. 25,[37][38][39] We found that links between depression/anxiety symptoms in the prepregnancy period and PE emerged following stratification by preterm delivery. However, it is important to note that sparse data led to ''zero cells'' for certain variable combinations, for example, lifetime history of depression symptoms and PE among women delivering at term (Table 5).…”

“…Additionally, the contribution of gestational age at delivery has not been fully explored within studies focusing solely on PE. Given that the etiology and severity of PE may differ when it coincides with preterm versus term delivery, 25,26 stratification of PE by gestational age may offer additional clues to associations with maternal psychological health. With respect to maternal depression or anxiety symptoms, measurement has relied upon maternal self-reports during the early weeks of pregnancy (prior to 20 weeks) as the frame of reference.…”

Glycogen Phosphorylase Isoenzyme BB Plasma Concentration Is Elevated in Pregnancy and Preterm Preeclampsia

“…26,35–39 Preeclampsia developing before 37 weeks of gestation (preterm preeclampsia) is a more severe and complicated maternal phenotype of preeclampsia than that developing at term (term preeclampsia) in general. 39 The risk of the recurrence in later pregnancies, 35 the long-term risk of mortality from the following cardiovascular causes, 36 the proportion of SGA neonates, 37,38 and the concentrations of maternal serum liver enzymes 39 are higher in preterm preeclampsia patients than in term preeclampsia patients. Huppertz recently proposed that these features largely comprise the phenotype of early-onset but not late-onset preeclampsia.…”

A role for the liver in parturition and preterm birth

“…58 In a study of women with preeclampsia, those who delivered preterm had significantly greater liver enzyme concentrations than those who delivered at term. 59 Menon et al 60 studied metabolic changes associated with early spontaneous preterm birth (<34 weeks) using high-throughput metabolomics of amniotic fluid (AF) retrieved by transvaginal amniocentesis at the time of labor prior to delivery in an African American population that included a control group of women who delivered at term. They found evidence of altered liver function in many cytochrome P450-related pathways including bile acids, steroids, xanthines, heme, and phase II detoxification of xenobiotics.…”