Plasma Level of Umbilical Cord Hemeoxygenase-1 (HO-1) and Neonatal Outcome in Early Onset and Late Onset Severe Preeclampsia

Abstract

Background: Many studies had discovered that early onset severe preeclampsia (EO-PE) has worst maternal and neonatal outcome compared to late-onset type (LO-PE), related to its placental involvement. Severe preeclampsia was defined as newly onset severe hypertension developed after 20 weeks gestation in previously normal blood pressure women, with coexistence of proteinuria, or maternal organ or uteroplacental dysfunction. Hemeoxygenase-1 (HO-1) is an enzyme with multiple effect which is protective to pregnancy.Materials and Methods: The total study subjects were 40 pregnant women consisted of 10 EO-PE, 10 normal early onset pregnancy (EO-NP), 10 LO-PE, and 10 normal late onset pregnancy (LO-NP). As much as 5 cc of plasma from umbilical cord was taken as soon as the baby was born, and the HO-1 level was examined by enzyme-linked immunosorbent assay (ELISA). The primary outcome were umbilical cord HO-1 level and neonatal composite morbidity (low Apgar score, low birthweight, length of stay >5 day, respiratory distress syndrome, jaundice and neonatal death).Results: The plasma level of HO-1 in EO-PE subjects were lower than EO-NP (0.96±0.37 ng/mL vs. 2.43±0.58 ng/mL, p<0.001). There were no significant differences in the level of HO-1 in LO-PE and LO-NP (2.18±1.07 ng/mL vs. 3.02±0.64 ng/mL, p=0.277). Plasma level of umbilical cord HO-1 of EO-PE patients was lower compared to LO-PE (0.96±0.37 ng/mL vs. 2.18±1.07 ng/mL, p=0.034). Neonatal outcome of EO-PE was worse than EO-NP (p=0.033), and LO-PE (p=0.003), while in LO-PE did not different with LO-NP (p=0.211).Conclusion: EO-PE is associated with lower plasma umbilical cord level of HO-1 and worse neonatal outcome compared to LO-PE. This indicating abnormal placental blood vessel development, placental ischemia in EO-PE, lead to reduced uteroplacental perfusion and significantly worse neonatal outcome compared to LO-PE.Keywords: severe preeclampsia, early onset preeclampsia, late onset preeclampsia, hemeoxygenase-1

Maternal and Perinatal Outcomes of Early-onset and Late-onset Preeclampsia at a Tertiary Center Hospital

“…This similar pathophysiology may lead to shared placental and clinical manifestation between EO-PE and HELLP syndrome. 22 Another explanation is that HELLP syndrome is characterized by 11 The other explanation is related to the timing and duration of the disease. Since EO-PE occurred early in the second trimester compared to LO-PE, this will provide a longer chronic in utero hypoxic environment, while most LO-PEs occurred at the end of the third trimester, leading to a shorter-time uteroplacental perfusion impairment.…”

Bax mRNA Expression as A Potential Biomarker of Placental Apoptosis in Early-onset Preeclampsia

“…(7,8) Early-onset preeclampsia is associated with worse maternal and perinatal outcomes. (9) This subtype has the characteristics of more prolonged trophoblast cell oxidative stress, related to the consequences of placental hypoxia since early pregnancy due to shallow placentation and impaired spiral artery remodeling. (10) Early-onset preeclampsia is also associated with a lower compensation of antioxidants and mitochondrial adaptation compared to late-onset preeclampsia.…”

The Role of Malondialdehyde (MDA) and Ferric Reducing Antioxidant Power (FRAP) in Patients with Hypertension

“…Furthermore, eclampsia, a hypertensive emergency with multiple complications, such as seizures or convulsions, vision loss, disseminated intravascular coagulation (a blood clotting disorder), pulmonary edema, kidney failure, and brain swelling, may occasionally develop from preeclampsia. [23][24][25][26][27] In this review, we summarize the recent advances in oxidative stress and how it contributes to hypertension in humans.…”