Endocrine Abstracts

Although improvements in obstetric and neonatal care in recent years have led to reduction in morbidity and mortality from pre-eclampsia, our ability to predict the condition has not improved significantly. Endothelial dysfunction underlies many of the manifestations of pre-eclampsia. In this study we will assess methods of detecting endothelial dysfunction and arterial stiffness in high-risk pregnant women in early and late pregnancy. Sixty women with 2 or more risk factors for pre-eclampsia were seen at gestational weeks 16 and 28. Arterial stiffness was assessed using applanation tonometry with the SphygmoCor device; central aortic pressures and peripheral and central augmentation index (AIx) were then calculated. Endothelial function was assessed with the EndoPAT 2000 device. Pneumatic probes were fitted to the index fingers; after baseline recordings a blood pressure cuff was inflated in the dominant arm, then released after 5 min to induce flow-mediated reactive hyperaemia. The ratio of readings before and after the period of occlusion was then used to calculate a score for endothelial function, or reactive hyperaemia index (RHI). RHI was significantly reduced at week 28 compared to week 16 (1.61±0.40 vs 2.02±0.67, P<0.001), indicating endothelial dysfunction. At week 16, there was an inverse relationship between maternal age and RHI (r=−0.274, P=0.043). AIx calculated by EndoPAT 2000 correlated with peripheral (r=0.335, P=0.013) and central AIx (r=0.330, P=0.014) derived from SphygmoCor. Central AIx was significantly higher in women with a history of pre-eclampsia in a previous pregnancy (15.8±6.9 vs 4.5±13.3%, P<0.001), which remained significant (P=0.05) when adjusted for maternal age. In this interim data analysis we have demonstrated that women with a history of pre-eclampsia have increased central augmentation index suggesting vascular stiffness in a subsequent pregnancy, that endothelial function deteriorates throughout pregnancy, and that older women have worse endothelial function. Ongoing studies will determine the utility of these studies in predicting pre-eclampsia.