natriuretic-peptide--brain and Pre-Eclampsia

Superimposed preeclampsia complicates about 20% of pregnancies in women with chronic hypertension and is associated with increased maternal and perinatal morbidity compared with preeclampsia alone. Distinguishing superimposed preeclampsia from chronic hypertension can be challenging because, in chronic hypertension, the traditional criteria for the diagnosis of preeclampsia, hypertension, and significant proteinuria can often predate the pregnancy. Furthermore, the prevalence of superimposed preeclampsia is unlikely to be uniformly distributed across this high-risk group but is related to the severity of preexisting endothelial dysfunction. This has led to interest in identifying biomarkers that could help in screening and diagnosis of superimposed preeclampsia and in the stratification of risk in women with chronic hypertension. Elevated levels of uric acid and suppression of other renal biomarkers, such as the renin-angiotensin aldosterone system, have been demonstrated in women with superimposed preeclampsia but perform only modestly in its prediction. In addition, central to the pathogenesis of preeclampsia is a tendency toward an antiangiogenic state thought to be triggered by an impaired placenta and, ultimately, contributing to the endothelial dysfunction pathognomonic of the disease. In the general obstetrical population, angiogenic factors, such as soluble fms-like tyrosine kinase-1 and placental growth factor, have shown promise in the prediction of preeclampsia. However, soluble fms-like tyrosine kinase-1 and placental growth factor are impaired in women with chronic hypertension irrespective of whether they develop superimposed preeclampsia. Therefore, the differences in levels are less discriminatory in the prediction of superimposed preeclampsia compared with the general obstetrical population. Alternative biomarkers to the angiogenic and renal factors include those of endothelial dysfunction. A characteristic of both preeclampsia and chronic hypertension is an exaggerated systemic inflammatory response causing or augmenting endothelial dysfunction. Thus, proinflammatory mediators, such as tumor necrosis factor-α, interleukin-6, cell adhesion molecules, and endothelin, have been investigated for their role in the screening and diagnosis of superimposed preeclampsia in women with chronic hypertension. To date, the existing limited evidence suggests that the differences between those who develop superimposed preeclampsia and those who do not a

Topics: Aldosterone; Angiogenic Proteins; Biomarkers; Chronic Disease; Cytokines; Female; Humans; Hypertension; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Proteinuria; Renin; Ultrasonography, Doppler; Uric Acid; Uterine Artery

Targeted prevention of heart failure (HF) remains a critical need given the high prevalence of HF morbidity and mortality. Similar to risk-based prevention of atherosclerotic cardiovascular disease, optimal HF prevention strategies should include quantification of risk in the individual patient. In this review, we discuss incorporation of a quantitative risk-based approach into the existing HF staging landscape and the clinical opportunity that exists to translate available data on risk estimation to help guide personalized decision making. We first summarize the recent development of key HF risk prediction tools that can be applied broadly at a population level to estimate risk of incident HF. Next, we provide an in-depth description of the clinical utility of biomarkers to personalize risk estimation in select patients at the highest risk of developing HF. We also discuss integration of genomics-enhanced approaches (eg,

Topics: Antineoplastic Agents; Autoimmune Diseases; Biomarkers; Cardiac Imaging Techniques; Cardiotoxicity; Carrier Proteins; Comorbidity; Connectin; Female; Genomics; Heart Failure; HIV Infections; Humans; Liver Diseases; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Prealbumin; Precision Medicine; Pregnancy; Premature Birth; Radiotherapy; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Troponin T

Preeclampsia and its complications may be associated with elevated B-type natriuretic peptide levels during and after pregnancy.. We conducted a systematic review to determine whether preeclampsia and/or related cardiovascular complications, eclampsia and preterm delivery are associated with elevated natriuretic peptide levels. Three bibliographic databases were searched, using the terms "natriuretic peptide", "pregnancy", "preeclampsia", "eclampsia" and "BNP". Twelve studies fulfilled our inclusion criteria for full paper analysis. The data were too heterogeneous to allow for meaningful quantitative analyses.. In healthy patients, B-type natriuretic peptide levels did not change during pregnancy. Compared with normal pregnancies, preeclamptic patients were shown to have significantly higher natriuretic peptide levels in the third trimester, which remained elevated for 3-6 months postpartum. Several papers suggested that cardiovascular dysfunction in preeclampsia is associated with NP elevation. Abnormalities were elevated systemic vascular resistance and cardiac filling pressures, decreased cardiac output, left ventricular diastolic dysfunction, and elevated left ventricular mass index. One investigation found that natriuretic peptide levels were higher in preeclamptic women who subsequently had preterm delivery, compared with those who delivered after 34 weeks. There were no data on natriuretic peptide levels in eclampsia.. Preeclampsia is associated with elevated natriuretic peptide levels. Cardiovascular complications and preterm delivery in this setting may also be associated with elevated natriuretic peptide levels. Large prospective studies of natriuretic peptide measurement in preeclampsia are needed to determine whether elevated levels predict the development of severe preeclampsia and/or associated complications.

Topics: Adult; Animals; Biomarkers; Eclampsia; Female; Gestational Age; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Cardiovascular; Reference Values

In the last three decades many members of the natriuretic peptide family was isolated. The function and physiological role of these peptides are pleiotropic. All natriuretic peptides are synthesized from polypeptide precursors. Together with the sympathetic nervous system and other hormones they play key roles, like an endogenous system in the regulation of the body fluid homeostasis and blood pressure. Changes in this balance lead to dysfunction in the endothel and left ventricle, which can cause severe complications. In many cardiovascular diseases natriuretic peptides serve not only as marker for diagnosis and prognosis but they have therapeutic importance. In the last years the potential use of the elevated BNP levels for diagnosis of pre-eclampsia was examined. In our review we discuss the current understanding of molecular biology, biochemistry and clinical relevance of natriuretic peptides.

Topics: Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Diseases; Female; Humans; Liver Cirrhosis; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Natriuretic Peptides; Pre-Eclampsia; Pregnancy; Renal Insufficiency; Shock, Septic; Tissue Distribution

Corin is a serine protease known to convert B-type natriuretic peptide (BNP) prohormone into BNP and its amino-terminal fragment (NT-proBNP). In mice lacking corin, high blood pressure and proteinuria were found at late gestational stages, with associated delayed trophoblast invasion and impaired spiral artery remodeling in the uterus. We hypothesize that both NT-proBNP and soluble corin elevation predict the presence of preeclampsia in pregnant patients with hypertension.. We prospectively enrolled 149 pregnant women with a history of chronic hypertension or gestational hypertension presenting at a tertiary-care hospital. We compared plasma NT-proBNP and soluble corin concentrations based on their preeclamptic status.. In our study cohort, 62 patients with preeclampsia had lower gestational age than 87 patients without preeclampsia (33.3 ± 3 versus 36.6 ± 3 weeks; P < .001), otherwise the baseline characteristics were similar. We observed higher NT-proBNP concentrations in patients with preeclampsia compared to those without preeclampsia (304.3 [96.34, 570.4] vs. 60.8 [35.61, 136.8] ng/L, P < .001), with no differences between chronic and gestational hypertension. However, the concentration of corin was not statistically different between the two groups (1756 [1214, 2133] vs. 1571 [1171, 1961] ng/L, P = .1087). ROC curve analysis demonstrated stronger predictive value of NT-proBNP compared to soluble corin in predicting the presence of preeclampsia in our study population (AUC 0.7406 vs. 0.5789, P < .0001).. While corin may contribute to mechanistic underpinnings of the development of preeclampsia in animal models, soluble corin likely has no diagnostic role in human pregnancies for preeclampsia beyond natriuretic peptide levels.

Topics: Adult; Biomarkers; Female; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Prospective Studies; Serine Endopeptidases; Solubility

To determine whether preeclampsia causes fetal cardiac cell damage by assessing umbilical artery NT-proBNP, cardiac troponin I and homocysteine.. A cross-sectional study with 73 fetuses between 26 and 40 weeks of gestation was performed. Thirty-three healthy mothers' fetuses were control group (Group I). While 12 mildly pre-eclamptic mothers' fetuses constituted Group II, 28 fetuses of severe pre-eclamptic mothers were Group III.. Umbilical cord mean NT-proBNP levels of Group I, II and III are 520.8 ± 404.5 pg/ml; 664.2 ± 215.9 pg/ml; and 1932.8 ± 2979.5 pg/ml, respectively (p = 0.0001). The number of neonates with NT-proBNP > 500 pg/mL that indicates severe cardiac damage is higher in Group III (p = 0.001). The mean homocysteine levels are also statistically significantly higher in Group III. Cardiac troponin I levels are not different between the groups (p = 0.46).. Increased NT-proBNP and homocysteine might not only indicate some degree of in-utero cardiac cell damage but also feto-placental endothelial injury in the fetuses of severe pre-eclamptic mothers. Our finding that shows no evidence of correlation between cardiac troponin I levels with cell damage and endothelial injury requires further research.

Topics: Adult; Biomarkers; Cross-Sectional Studies; Female; Fetal Blood; Fetal Heart; Homocysteine; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Prospective Studies; Severity of Illness Index; Troponin I

To determine if a rapid serum assay for B-type natriuretic peptide (BNP) provides information regarding ventricular function in obstetric patients with acute dyspnea.. A review of 17 charts for 15 patients was undertaken. Seven patients had preeclampsia, 3 had preterm labor treated with aggressive tocolysis, and 5 had underlying cardiac and/or pulmonary disease. Each presented with signs and symptoms consistent with acute dyspnea. Serum BNP levels were obtained and other standard diagnostic procedures performed. Each patient was treated based on the findings of the standard diagnostic procedures.. For the 7 patients with preeclampsia, elevated serum BNP levels correlated with acute ventricular overload that responded to volume management and diuresis. Two patients had marked elevation of serum BNP levels and were found to have significant left ventricular dysfunction that was not apparent by standard clinical evaluation. For preterm labor patients on tocolysis and patients with underlying cardiac or pulmonary disease, serum BNP levels were elevated for 5 of 6 patients with evidence of acute volume overload.. Serum BNP levels provided useful information for the clinical evaluation and management of obstetric patients with acute dyspnea. In 2 patients, more serious cardiac dysfunction was detected with BNP than with clinical evaluation alone.

Topics: Acute Disease; Adolescent; Adult; Dyspnea; Female; Fluid Therapy; Heart Diseases; Humans; Lung Diseases; Natriuretic Agents; Natriuretic Peptide, Brain; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Sensitivity and Specificity; Tocolytic Agents; Ventricular Function

The aim of this work is to identify the correlation between serum brain natriuretic peptide (BNP) and left ventricle (LV) systolic and diastolic function in hypertensive pregnancy disorders (HPD) through echocardiographic parameters.. Eighty-seven pregnant patients were included, 23 with normotensive pregnancy (NP), 28 with gestational hypertension (GH) and 36 with preeclampsia (PE). Conventional 2D echocardiography was used to evaluate systolic and diastolic function such as E/a, E/e', LV mass index, LV ejection fraction, as well as left atria (LA) diameters, LA indexed volume, LV strain and LA strain (LAS). Brain natriuretic levels (BNP) blood levels were also determined.. The serum levels of BNP were higher in patients with PE [median (interquartile range, IQR)] 189 (142-215) pg/ml and GH 105 (46-162) pg/ml compared to NP 23 (9-33) pg/ml, (p = 0.001). BNP levels had a negative correlation with LAS (Rho = -0.79, p < 0.001). Preeclampsia patients had lower LAS [median (IQR)] 22% (20%-24%) compared to the GH group 23% (20%-24%) and NP 35% (34% -35%), p = 0.001. Classification and Regression Trees multivariate analysis found patterns that define trends to form mutually excluding homogeneous groups such as: a) First parameter that separates 2 groups is septal e > 8.2 or < 8.2b), BNP serum levels above 89 pg/ml, and c) LAS increases the discriminatory performance to detect and define the diastolic dysfunction or not.. At least one third of women with HPD had moderate diastolic dysfunction. The degree of diastolic dysfunction was negatively correlated with serum BNP levels and severity of HPD. LAS increase discriminatory performance to identify diastolic dysfunction in HPD.

Topics: Biomarkers; Case-Control Studies; Cross-Sectional Studies; Echocardiography, Doppler; Female; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Prospective Studies; Ventricular Dysfunction, Left

BACKGROUND Pre-eclampsia is one of the primary causes of maternal and newborn mortality. The pathogenesis of pre-eclampsia is still unclear. We aimed to investigate the link between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and pre-eclampsia. MATERIAL AND METHODS A total of 102 pregnant women with hypertensive disorders of pregnancy who were hospitalized and delivered in Wenzhou People's Hospital from January 2019 to December 2019 were selected, including 43 patients with gestational hypertension, 32 patients with mild pre-eclampsia, and 27 patients with severe pre-eclampsia. Enzyme-linked fluorescence analysis was used to detect the serum NT-proBNP levels of the patients before delivery. We used the t test and ANOVA to compare differences between groups. Receiver operating curve (ROC) and the Youden index were used to evaluate the detection efficiency. RESULTS The average level of serum NT-proBNP in patients with mild pre-eclampsia was 197.12±105.80 pg/mL, which was significantly higher than that of patients with gestational hypertension (48.98±32.45 pg/mL) (P<0.05). Serum NT-proBNP in patients with severe pre-eclampsia (851.04±879.85 pg/mL) was higher than that in patients with moderate pre-eclampsia (P<0.05). The area under the ROC curve for diagnosing pre-eclampsia using NT-proBNP was 0.973, with NT-proBNP of 129.5 pg/mL as the cut-off value. The Youden index was 0.824, with a sensitivity for predicting pre-eclampsia of 84.7% and a specificity of 97.7%. CONCLUSIONS The level of serum NT-proBNP was as an effective indicator for predicting pre-eclampsia and judging the risk of pre-eclampsia.

Topics: Adult; Biomarkers; Blood Pressure; China; Female; Follow-Up Studies; Humans; Hypertension, Pregnancy-Induced; Incidence; Infant, Newborn; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Protein Precursors; Retrospective Studies; ROC Curve; Severity of Illness Index

To evaluate left ventricular function and measure N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in women with hypertensive disorders of pregnancy (HDP) in comparison to normotensive women and correlate these with maternal and neonatal outcomes. This was a prospective observational case-control study from 2018 to 2020 in an Indian tertiary care hospital and included antenatal women beyond 20 weeks of pregnancy with 160 women with HDP as cases and 160 normotensive women as controls. Echocardiography was performed to assess left ventricular structure and function. Quantitative analysis of NT-proBNP levels was performed based on fluorescence immunochromatography. Women with HDP were observed to have a significant difference in the value of left ventricular structure and function (P < 0.001). Mild systolic dysfunction was found in 13 (8.1%) women in the HDP group 8 (20%) women with severe pre-eclampsia and 5 (33.3%) women with eclampsia). Significantly lower values of left ventricular ejection fraction and higher values of NT-proBNP were recorded in women with HDP who developed maternal complications and had adverse neonatal outcomes (P < 0.001). Echocardiography and NT-proBNP levels have been shown to have a significant role in women with severe forms of HDP to detect early signs of cardiac dysfunction.

Topics: Biomarkers; Case-Control Studies; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Male; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left

The primary objective of this study was to determine the longitudinal profile of serum sST2 (soluble suppression of tumorigenicity 2), IL-33 (interleukin-33) and NT-proBNP (N-terminal pro-brain natriuretic peptide) concentrations in twin pregnancies with pre-eclampsia (PE) and those normotensive twins. The secondary objective was to test whether the change of serum sST2,IL-33 and NT-proBNP is related to PE in twin pregnancies. This is a longitudinal nested case-control study and all 156 dichorionic (DC) pregnancies were from a prospective cohort of twin pregnancies who received antenatal care and gave two live births at Peking University Third Hospital between October 2017 and September 2020. Four to five milliliters of peripheral blood of each pregnant woman were collected during the following three intervals: (1) 6-11

Topics: Biomarkers; Case-Control Studies; Female; Humans; Hypertension; Interleukin-33; Longitudinal Studies; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Pregnancy, Twin; Prospective Studies

Topics: Atrial Natriuretic Factor; Biomarkers; Female; Heart Atria; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Ventricular Dysfunction, Left

Elevated B-type natriuretic peptide (BNP) is closely related to preeclampsia. Whether it is a predictor of adverse outcomes in preeclampsia is unclear. This study aimed to investigate the relationship between BNP and adverse outcomes of preeclampsia, and to establish the prediction models and nomograms based on BNP.. A retrospective analysis was conducted involving 284 women with preeclampsia admitted to a tertiary hospital from January 2017 to July 2019. Logistic regression and receiver operating characteristic (ROC) curve were used to analyze the relationship between BNP and adverse outcomes. Multivariate logistic regression was used to establish the models for predicting adverse outcomes. Then the nomogram and ROC curve of the models were generated.. In preeclampsia, BNP is a risk factor for adverse outcomes, and as the level of BNP increases, the incidence of adverse outcomes increases. Preeclampsia with BNP >118 pg/mL was associated with a significantly increased risk of adverse outcomes. The results showed that BNP has a predictive value for adverse maternal outcomes, and the area under the ROC curve (AUC) was 0.739 [P<0.001, 95% confidence interval (CI): 0.684-0.789]. Then, the prediction models for adverse maternal and perinatal outcomes based on BNP combined with other multi-factors were established. The discriminative ability of the 2 models was found to be good, the AUC was 0.844 (95% CI: 0.796-0.884) and 0.792 (95% CI: 0.740-0.838), respectively. Therefore, BNP was shown to significantly improve the discriminative ability of the prediction models.. The BNP is an important risk factor for evaluating the adverse outcomes of preeclampsia. Combined with multi-factors, BNP can be used to predict the adverse outcomes.

Topics: Biomarkers; Female; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Retrospective Studies; Risk Factors; ROC Curve

Studies of cardiovascular function in pregnancy have shown inconsistent and, in some cases, contradictory results, particularly regarding cardiac output. While some studies report preeclampsia associated with high cardiac output, other studies suggest that preeclampsia should be further subdivided into women with high or low cardiac output. This study was conducted to examine the NT-proBNP levels in preeclampsia, intrauterine growth restriction, and hypertensive pregnancies without preeclampsia. We also examined N-terminal pro-B natriuretic peptide (NT-proBNP) levels three to four months after delivery, in preeclamptic women as well as the prediction of delivery within 10 days. In a reduced number of preeclamptic women and controls we performed echocardiograms to study their diastolic function.. We investigated the NT-proBNP levels in 213 subjects with preeclampsia only, 73 with intrauterine growth restriction, 44 with preeclampsia and intrauterine growth restriction, 211 who were hypertensive and 662 unaffected pregnancies (controls). We also performed echocardiograms on 36 preeclampsia and 19 controls before delivery and three to five months after delivery.. NT-proBNP levels are higher in early onset preeclampsia than in late onset preeclampsia. Intrauterine growth restriction pregnancies showed a NT-proBNP levels similar to hypertensive and unaffected pregnancies. Compared with healthy pregnancies, women with preterm preeclampsia (<37 gestational weeks) had altered left atrial segments.. We observed that NT-proBNP levels are higher in early onset preeclampsia than in late onset. Moreover, diastolic dysfunction is higher in early onset than in late-onset term preeclampsia. An NT-proBNP value >136 pg/mL has a high positive predictive value for an imminent delivery within 10 days.

Topics: Biomarkers; Female; Fetal Growth Retardation; Humans; Hypertension; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy

To evaluate the performance of maternal risk factors (BMI and mean arterial pressure [MAP]) and first-trimester maternal serum markers in the early prediction of preeclampsia (PE) in nulliparous women.. This was a case-cohort study based on a cohort of 14,207 nulliparous women. A total of 213 cases with term PE (from 37 weeks + 0 days) and 55 cases with preterm PE (before 37 weeks + 0 days) were identified and validated. Randomly, 449 controls were selected. Serum samples previously collected for the double test (pregnancy-associated plasma protein A [PAPP-A] and free β human chorionic gonadotrophin [hCGβ]) as part of the first-trimester screening program were retrieved and analyzed for placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and neutrophil gelatinase-associated lipocalin (NGAL). Concentrations were transformed to multiples of the median (MoM). Multivariate regression analysis was used for prediction models. Receiver-operating characteristics (ROC) curves were used for evaluation of the screening performance.. In preterm PE, the PlGF (0.79 MoM), sFlt-1 (0.86 MoM), NGAL (1.15 MoM), and PAPP-A (0.89 MoM) medians were significantly altered. In term PE, PlGF (0.90 MoM) and NT-proBNP (0.86 MoM) medians were significantly reduced. The combination of MAP and PlGF yielded a 39% detection rate of preterm PE for a 10% false-positive rate. The combination of MAP, BMI, and PlGF yielded a 33% detection rate of term PE with a 10% false-positive rate.. First-trimester MAP, maternal serum PlGF, and NGAL are markers of preterm PE. Maternal serum sFlt-1 is a significant marker of preterm PE, but only early in the first trimester. First-trimester maternal serum NT-proBNP is not a predictor of PE. Screening performance for PE with these markers individually or in combination is modest.

Topics: Adult; Arterial Pressure; Biomarkers; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Lipocalin-2; Natriuretic Peptide, Brain; Peptide Fragments; Placenta Growth Factor; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A; Risk Factors; Vascular Endothelial Growth Factor Receptor-1

Background The management of potential pre-eclamptic patients using the soluble FMS-like tyrosine kinase 1 (sFlt-1)/ placental growth factor (PlGF) ratio is characterised by frequent false-positive results. Methods A retrospective cohort study was conducted to identify and validate cut-off values, obtained using a machine learning model, for the sFlt-1/PlGF ratio and NT-proBNP that would be predictive of the absence or presence of early-onset pre-eclampsia (PE) in singleton pregnancies presenting at 24 to 33 + 6 weeks of gestation. Results For the development cohort, we defined two sFlt-1/PlGF ratio cut-off values of 23 and 45 to rule out and rule in early-onset PE at any time between 24 and 33 + 6 weeks of gestation. Using an sFlt-1/PlGF ratio cut-off value of 23, the negative predictive value (NPV) for the development of early-onset PE was 100% (95% confidence interval [CI]: 99.5-100). The positive predictive value (PPV) of an sFlt-1/PlGF ratio >45 for a diagnosis of early-onset PE was 49.5% (95% CI: 45.8-55.6). When an NT-proBNP value >174 was combined with an sFlt-1/PlGF ratio >45, the PPV was 86% (95% CI: 79.2-92.6). In the validation cohort, the negative and positive values were very similar to those found for the development cohort. Conclusions An sFlt-1/PlGF ratio <23 rules out early-onset PE between 24 and 33 + 6 weeks of gestation at any time, with an NPV of 100%. An sFlt-1/PlGF ratio >45 with an NT-proBNP value >174 significantly enhances the probability of developing early-onset PE.

Topics: Adult; Biomarkers; Female; Humans; Membrane Proteins; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Retrospective Studies; Vascular Endothelial Growth Factor Receptor-1

Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus.. To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies.. This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus-fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted.. Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23-0.29], fetal growth restriction 0.31 [0.26-0.34], preeclampsia with a normally grown fetus 0.31 [0.29-0.33), and preeclampsia with fetal growth restriction 0.28 [0.26-0.33]; P<.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25-1.72], fetal growth restriction 1.29 [1.22-1.72], preeclampsia with a normally grown fetus 1.30 [1.33-1.51], and preeclampsia with fetal growth restriction 1.35 [1.27-1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48-0.61], fetal growth restriction 0.67 [0.58-0.8], preeclampsia with a normally grown fetus 0.68 [0.61-0.76], and preeclampsia with fetal growth restriction 0.66 [0.58-0.77]; P<.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32-1.41], fetal growth restriction 1.48 [0.97-2.08], preeclampsia with a normally grown fetus 1.15 [0.75-2.17], and preeclampsia with fetal growth restriction 0.45 [0.54-1.94]; P<.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4-30.9] pg/mL, fetal growth restriction 20.8 [13.1-33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4-45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7-105.4] pg/mL; P<.001) and troponin I as compared with uncomplicated pregnancies.. Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions.

Topics: Adult; Cardiomegaly; Echocardiography; Female; Fetal Blood; Fetal Growth Retardation; Fetal Heart; Gestational Age; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Spain; Troponin I; Ventricular Dysfunction; Ventricular Remodeling

Frances Conti-Ramsden MBBS Academic Clinical Fellow. To determine whether glycogen phosphorylase isoenzyme B (GPBB) and/or brain natriuretic peptide (BNP) concentrations are elevated in pre-eclampsia and superimposed pre-eclampsia (SPE), demonstrating cardiac ischaemia and strain.. A nested case-control study was performed using samples and clinical data available from a prospective pregnancy cohort. Four groups were selected: healthy pregnant controls (n = 21), pre-eclampsia (n = 19), pre-existing chronic hypertension (CHT) and/or chronic kidney disease (CKD) without (n = 20) or with superimposed pre-eclampsia (SPE) (n = 19). Plasma samples were taken at time of disease or the third trimester in controls.. Plasma concentrations of GPBB and BNP.. There was no significant difference in GPBB plasma concentrations between controls and pre-eclampsia (geometric mean (GM) [95% CI]: 4.74 [2.54-8.84]ng/mL vs 5.01 [2.58-9.74]ng/mL, p = 0.90)), or between CHT and/or CKD and SPE (GM [95% CI]: 9.49 [4.93-18.25]ng/mL vs 10.24 [5.27-19.92]ng/mL, p = 0.87). BNP plasma concentrations were significantly raised in women with pre-eclampsia compared to controls (GM [95% CI]: 31.83 [20.18-50.22]pg/mL vs 11.33 [7.34-17.51]pg/mL, p = 0.001). Women with CKD, but not CHT, who developed SPE had elevated BNP concentrations. There were no significant differences in BNP concentration between women with comorbidity (CHT and/or CKD) and controls.. GPBB has a limited role as a biomarker in hypertensive disorders of pregnancy. BNP concentrations were elevated in pre-eclampsia compared to controls. This suggests cardiac strain at the time of pre-eclampsia. Further studies are needed to examine whether BNP can identify women at increased risk of cardiovascular disease.

Topics: Adult; Biomarkers; Case-Control Studies; Female; Glycogen Phosphorylase; Humans; Myocardial Ischemia; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Young Adult

Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late-onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level and between POCUS-derived parameters and a suspicious or pathological cardiotocograph.. Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart, and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung ultrasound and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD >5.8 mm was interpreted as compatible with raised intracranial pressure (>20 mm Hg). Serum BNP and albumin levels were also measured.. PIS, diastolic dysfunction, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%), 31 (33%), 9 (10%), and 20 (25%) women, respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (P = .4) or ONSD (P = .63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (P = .21) or raised LVEDP (P = .44). PIS was associated with diastolic dysfunction (P = .02) and raised LVEDP (P = .009; negative predictive value, 85%). BNP level was associated with systolic (P < .001) and diastolic dysfunction (P = .003) and LVEDP (P = .007). No association was found between POCUS abnormalities and a suspicious/pathological cardiotocograph (P = .07).. PIS, diastolic dysfunction, and increased ONSD were common in preeclampsia with severe features. Cardiac ultrasound abnormalities may be more useful than albumin levels in predicting PIS. The absence of PIS may exclude raised LVEDP. The further clinical relevance of PIS and raised ONSD remains to be established. BNP level was associated with cardiac ultrasound abnormalities. Although this study was not designed to directly influence clinical management, the findings suggest that POCUS may serve as a useful adjunct to clinical examination for the obstetric anesthesiologist managing these complex patients.

Topics: Adult; Algorithms; Cardiotocography; Echocardiography; Female; Heart; Heart Defects, Congenital; Heart Ventricles; Humans; Incidence; Intracranial Pressure; Lung; Lung Diseases; Natriuretic Peptide, Brain; Observer Variation; Optic Nerve; Point-of-Care Systems; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Prevalence; Prospective Studies; Serum Albumin; Ultrasonography, Prenatal; Ventricular Dysfunction, Left

Pre-eclampsia (PE) is associated with maternal cardiac remodeling and diastolic dysfunction. The aim of this study was to assess and compare maternal left ventricular structure and diastolic function and levels of brain natriuretic peptide (BNP) in women with early-onset (< 34 weeks' gestation) vs those with late-onset (≥ 34 weeks' gestation) PE.. This was a prospective, cross-sectional, observational study of 30 women with early-onset PE, 32 with late-onset PE and 23 normotensive controls. Maternal cardiac structure and diastolic function were assessed by echocardiography and plasma levels of BNP were measured by enzyme immunoassay.. Early- and late-onset PE were associated with increased left ventricular mass index and relative wall thickness compared with normotensive controls. In women with early-onset PE, the prevalence of concentric hypertrophy (40%) and diastolic dysfunction (23%) was also significantly higher (both P < 0.05) compared with women with late-onset PE (16% for both). Maternal serum BNP levels were significantly higher (P < 0.05) in women with early-onset PE and correlated with relative wall thickness and left ventricular mass index.. Early-onset PE is associated with more severe cardiac impairment than is late-onset PE, as evidenced by an increased prevalence of concentric hypertrophy, diastolic dysfunction and higher levels of BNP. These findings suggest that early-onset PE causes greater myocardial damage, increasing the risk of both peripartum and postpartum cardiovascular morbidity. Although these cardiovascular effects are easily identified by echocardiographic parameters and measuring BNP, further studies are needed to assess their clinical utility. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Topics: Adult; Biomarkers; Cross-Sectional Studies; Disease Progression; Echocardiography; Female; Humans; Hypertrophy, Left Ventricular; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Prospective Studies; Risk Factors; Ventricular Dysfunction, Left; Young Adult

Short-term prediction of pre-eclampsia (PE) using the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio is characterized by frequent false-positive results. As such, no treatment can be recommended to test-positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N-terminal pro-B natriuretic peptide (NT-proBNP), uric acid and the sFlt-1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt-1/PlGF ratio > 38.. This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt-1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best-fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired-ROC curve (AUC) analysis.. The best-fit model included the sFlt-1/PlGF ratio, NT-proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt-1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787-0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722-0.844)).. The addition of NT-proBNP assessment improves the short-term prediction of delivery as a result of PE compared with sFlt-1/PlGF ratio alone, when the sFlt-1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short-term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Topics: Adult; Biomarkers; Cohort Studies; Delivery, Obstetric; Female; Gestational Age; Humans; Longitudinal Studies; Natriuretic Peptide, Brain; Peptide Fragments; Placenta Growth Factor; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Prenatal Diagnosis; Vascular Endothelial Growth Factor Receptor-1

Preeclampsia (PE) is considered a specific vascular disease in which endothelial dysfunction may be the crucial factor of its pathogenesis. It has been suggested that strontium (Sr) may play a role in the pathophysiology of PE. Our group established in a previous study the serum levels of Sr in healthy pregnancies, and the main aim of the present study was to evaluate Sr concentrations and oxidative status in preeclamptic women.. The study population included women with early-onset PE (E-PE, n = 39), late-onset PE (L-PE, n = 67) and serial samples from a subset of preeclamptic women (PE-ss, n = 20). The control group included women with gestational hypertension (GH, n = 56) and healthy pregnancies (samples collected in the 1st (n = 50), 2nd (n = 51) and 3rd trimesters (n = 53)). Strontium, calcium (Ca), uric acid (UA), placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), lipid peroxidation and total antioxidant activity (TAA) were measured in these samples.. Mean Sr levels were significantly higher in PE than in control groups (p ≤ 0.0001). Calcium values were found to be significantly lower in E-PE compared to control groups (p = 0.03). Higher levels of NT-proBNP were found in PE vs. control groups (p < 0.001). sFlt-1/PlGF ratio was higher in E-PE compared to L-PE and GH (p < 0.001). Uric acid levels in PE were significantly higher than in control groups (p < 0.0001). There was a strong positive correlation between UA and Sr in the E-PE serial samples (r = 0.80, p < 0.0001). Lipid peroxidation and lipid peroxidation/TAA ratios were found to be higher in PE, with lower values of TAA.. The higher levels of Sr and the alterations of redox status found in preeclamptic women, along with the strong correlation between UA and Sr suggest that this element may be involved in the pathogenesis of PE.

Topics: Adult; Biomarkers; Calcium; Case-Control Studies; Female; Gestational Age; Humans; Hypertension, Pregnancy-Induced; Membrane Proteins; Natriuretic Peptide, Brain; Oxidative Stress; Peptide Fragments; Pre-Eclampsia; Pregnancy; Strontium; Uric Acid; Vascular Endothelial Growth Factor Receptor-1

Preeclampsia is one of the most frequent and difficult illnesses in pregnancy, which jeopardizes both mother and fetus. There are several diagnostic criteria for preeclampsia. However, the preeclampsia-associated myocardial damage has not been described. In this study, we employed reduced uterine perfusion pressure (RUPP) to generate a rat model of preeclampsia for the evaluation of myocardial damage in late-gestation rats. The expressions of cardiac injury markers were analyzed by immunohistochemistry and ELISA. The arterial pressure and myocardial tissue velocities were also measured. The role of interleukin (IL)-6 in RUPP-associated myocardial damage was further explored. The results showed that RUPP rats had significant myocardial damage, as demonstrated by the high expressions of myoglobin, creatine kinase isoenzyme, cardiac troponin I, and brain natriuretic peptide. In addition, RUPP increased the mean arterial pressure and the early transmitral flow velocity to mitral annulus early diastolic velocity ratio (E/Ea). Furthermore, IL-6 deteriorated these abnormalities, whereas inhibition of IL-6 significantly relieved them. In conclusion, our study demonstrated that RUPP rats displayed myocardial damage in an IL-6-dependent manner.

Topics: Animals; Antibodies, Monoclonal, Humanized; Arterial Pressure; Cardiomyopathies; Creatine Kinase, MB Form; Disease Models, Animal; Echocardiography, Doppler, Color; Female; Heart; Interleukin-6; Myocardium; Myoglobin; Natriuretic Peptide, Brain; Perfusion; Pre-Eclampsia; Pregnancy; Random Allocation; Rats, Sprague-Dawley; Troponin I

Pre-eclampsia with severe features (PEC) is a pregnancy-specific syndrome characterized by severe hypertension and end-organ dysfunction, and is associated with short-term adverse cardiovascular events, including heart failure, pulmonary edema, and stroke.. The authors aimed to characterize the short-term echocardiographic, clinical, and laboratory changes in women with PEC, focusing on right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle tracking parameters.. In this prospective observational study, the authors recruited 63 women with PEC and 36 pregnant control patients.. The PEC cohort had higher RVSP (31.0 ± 7.9 mm Hg vs. 22.5 ± 6.1 mm Hg; p < 0.001) and decreased global RV longitudinal systolic strain (RVLSS) (-19.6 ± 3.2% vs. -23.8 ± 2.9% [p < 0.0001]) when compared with the control cohort. For left-sided cardiac parameters, there were differences (p < 0.001) in mitral septal e' velocity (9.6 ± 2.4 cm/s vs. 11.6 ± 1.9 cm/s), septal E/e' ratio (10.8 ± 2.8 vs. 7.4 ± 1.6), left atrial area size (20.1 ± 3.8 cm. Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.

Topics: Adult; Blood Pressure; Echocardiography; Female; Heart; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Prospective Studies; Young Adult

Preeclampsia is a hypertensive disorder of pregnancy known to increase the risk of cardiovascular disease in mothers and offspring. Offspring exposed to a suboptimal intrauterine environment may experience altered fetal programming and subsequent long-term cardiovascular changes. This study investigated changes in the vascular response in offspring from experimental preeclampsia (EPE) induced by uterine artery ligation, in the absence of fetal growth restriction, compared to normal baboon pregnancies (controls), following a high salt diet challenge. After 1 week of standard diet (containing <1% salt), animals were fed a high salt diet (6%) for 2 weeks. Systolic and diastolic blood pressure (SBP, DBP), aldosterone, renin and creatinine clearance were evaluated in EPE (n = 6, 50% male) and control (n = 6, 50% male) offspring. A repeated measures analysis was performed, and P < 0.05 was considered significant. At baseline, there were no differences between the groups in any parameter (EPE, mean age and weight 3.2 ± 1.2 years, 6.8 ± 1.0 kg, respectively; Control, 2.9 ± 0.8 years, 7.1 ± 1.5 kg). After salt loading the EPE group had significantly higher SBP (92 ± 5 mm Hg) compared to the control group (83 ± 4 mm Hg, P = 0.03). Aldosterone concentration was higher in the EPE group despite the same salt excretion and no difference in renal function. Salt sensitivity may differ in offspring from hypertensive pregnancies due to fetal programming. This could have long-term consequences for cardiovascular health of EPE offspring and further research is required to determine the exact pathological mechanisms.

Topics: Animals; Blood Vessels; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Fetus; Hemodynamics; Natriuretic Peptide, Brain; Papio hamadryas; Pre-Eclampsia; Pregnancy; Sodium Chloride, Dietary

Postpartum stratification of cardiovascular risk for women with pregnancies complicated by pre-eclampsia is challenging. Our aim was to identify potential clinical and biomarker predictors of future cardiovascular risk at six weeks postpartum in women with hypertensive pregnancies.. Prospective longitudinal cohort.. Ten year-Framingham cardiovascular risk scores were calculated for 477 women (94 with gestational hypertension, 288 with pre-eclampsia, 30 with superimposed pre-eclampsia, 51 with chronic hypertension, 14 women with uncomplicated pregnancies). B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL) and placental growth factor (PlGF) were quantified at six weeks postpartum.. Framingham cardiovascular risk scores were not higher in women with pregnancies complicated by pre-eclampsia than healthy controls, nor were scores higher in women with pre-existing chronic hypertension complicated with superimposed pre-eclampsia compared with those without superimposed pre-eclampsia. Women with gestational hypertension had higher risk scores than women with pre-eclampsia and healthy controls. Established risk factors of cardiovascular disease including diastolic blood pressure and previously diagnosed chronic hypertension were associated with higher scores, and African ethnicity, parity and estimated glomerular filtration rate also were independently associated with higher Framingham risk scores at six weeks postpartum. PlGF, BNP and NGAL concentrations were not associated with Framingham cardiovascular risk scores after adjustment for independent variables.. A history of pre-eclampsia or superimposed pre-eclampsia in most recent pregnancy was not associated with elevated Framingham risk score at six weeks postpartum. Established clinical predictors may enable risk stratification at six weeks postpartum, which are not enhanced by the biomarkers included in this study.

Topics: Adult; Biomarkers; Black People; Blood Pressure; Cardiovascular Diseases; England; Female; Glomerular Filtration Rate; Humans; Hypertension, Pregnancy-Induced; Kidney; Lipocalin-2; Longitudinal Studies; Natriuretic Peptide, Brain; Parity; Placenta Growth Factor; Postpartum Period; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Young Adult

To define and compare the reference interval of B-type natriuretic peptide (BNP) in healthy newborns (HN) from healthy mothers and with severe pre-eclampsia.. Prospective, multicentre, cross-sectional study.. Four obstetric wards of second-level academic hospitals.. 167 HN, from 146 healthy and 21 severe pre-eclamptic women. We included newborns from healthy mothers with full-term pregnancies (38 to 42 gestational weeks), who received adequate prenatal care and who had Apgar scores ≥7 at 0 and 5 min. Newborns with chromosomopathies identified during prenatal consultations, those with respiratory distress and those with cardiac or pulmonary disease detected in the first paediatric evaluation were excluded from this study. In the group of pre-eclamptic women, we considered the same inclusion criteria, but the patients also had to meet the diagnostic criteria for pre-eclampsia with severity features, according to the American College of Obstetricians and Gynaecologists guidelines. The same exclusion criteria used for the healthy group were applied to the pre-eclampsia-associated newborn.. A single blood sample from the umbilical cord artery after delivery (vaginal or caesarean section).. Reference level of BNP in HN.. In the HN group, the median BNP was 12.15 pg/mL (IQR 7.7-16.8 pg/mL) and in the pre-eclamptic group 20.8 pg/mL (IQR 5.8-46.5 pg/mL). The reference interval for BNP in HN was 5pg/mL (95% CI 5 to 5) to 34 pg/mL (95% CI 28.4 to 38.8). We identified higher expression of BNP in newborns from pre-eclamptic women overall (p=0.037, r=0.16) and in newborns exposed to stress conditions, such as complications during labour and delivery (p=0.004, r=0.33).. In HN, BNP concentrations at birth were lower than reported in other similar populations. In neonates with stress conditions, the higher expression of this biomarker establishes another possible link between stress and the cardiovascular response.. NCT02574806; Pre-results.

Topics: Adult; Biomarkers; Cross-Sectional Studies; Female; Fetal Blood; Humans; Infant, Newborn; Male; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Prospective Studies; Reference Values; Umbilical Arteries

Topics: Brain; Cognition; Female; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy

Angiogenic and antiangiogenic factors have proven to be an accurate predictive means of preeclampsia. Echocardiographic studies have shown that women with preeclampsia exhibit significant cardiovascular strain, especially early-onset preeclampsia. The aim of this study is to determine preeclampsia risk with soluble fms-like tyrosin kinase 1/placental growth factor ratio, serum NT-proBNP (N-terminal pro B-type natriuretic peptide), and biophysical markers of cardiovascular function in a prospective case-control study. We examined a cohort of 110 pregnant women with uneventful pregnancy outcome (controls) and 129 with hypertensive pregnancy disorders, including 77 with preeclampsia and 52 with pregnancy-induced hypertension. Cardiac indices were obtained with a USCOM-1A monitor, and soluble fms-like tyrosin kinase 1, placental growth factor, and NT-proBNP were measured in serum samples on automated platforms. Logistic regression, as well as Cox proportional hazard analysis, was performed. There were significant contributions from all variables tested, except for heart rate, stroke volume index, and cardiac index to the prediction model. When testing accuracy of respective markers in combination (full model) versus individual markers (soluble fms-like tyrosin kinase 1/placental growth factor ratio and total peripheral resistance) was compared. The soluble fms-like tyrosin kinase 1/placental growth factor ratio and total peripheral resistance performed as good as the full model, except for hypertensive pregnancy disorders and pregnancy-induced hypertension, where the full model performed better. The additional assessment of biophysical and biochemical markers of cardiovascular strain in pregnancy increases the detection of the composite group of hypertensive pregnancy disorders, while not significantly improving detection of preeclampsia alone. This offers a more precise insight into the pathogenesis of the disease, as well as offering a window for intervention, possibly decreasing cardiovascular mortality in these women.

Topics: Adult; Analysis of Variance; Biomarkers; Blood Pressure Determination; Cardiovascular Diseases; Case-Control Studies; Female; Gestational Age; Humans; Hypertension, Pregnancy-Induced; Logistic Models; Natriuretic Peptide, Brain; Placenta Growth Factor; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Proportional Hazards Models; Prospective Studies; ROC Curve; Ultrasonography, Prenatal; United States; Vascular Endothelial Growth Factor Receptor-1

Plasma levels of NT-proBNP are elevated in women with preeclampsia at the time of diagnosis. The objective of this case-control study was to evaluate N-terminal proBNP (NT-proBNP) in maternal plasma as an early second-trimester biomarker for prediction of early-onset preeclampsia. In early second-trimester samples, women who later developed preeclampsia at gestational age 34 wk + 0 or earlier (n = 16) had similar plasma levels of NT-proBNP (median 51.8, range 26.1-131.9 pg/ml) as women with uncomplicated pregnancy outcomes (n = 43) (53.0, 14.9-184.2 pg/ml). The early second-trimester level of NT-proBNP cannot therefore be used as a predictive biomarker of early-onset preeclampsia.

Topics: Adult; Biomarkers; Case-Control Studies; Chi-Square Distribution; Female; Humans; Infant, Newborn; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Ultrasonography, Prenatal

A proper maternal cardiovascular adaptation to the pregnancy plays a key role for promoting an adequate uteroplacental perfusion, for ensuring normal fetal development and for preventing gestational hypertensive complications such as preeclampsia. This study aims to evaluate hemodynamic measurements obtained by noninvasive methods among preclamptic women with and without fetal growth restriction (FGR) and the relationship with plasma levels of natriuretic peptides.. The study compared 98 pregnant women (n=48 with preeclampsia; n=50 normotensive pregnant women) and 50 nonpregnant normotensive control subjects undergoing anultrasonic cardiac output monitor (USCOM) and plasma assessment of atrial N-terminal pro B-type natriuretic peptide (NT-proBNP). The statistical analysis was carried out by analysis of variance and correlation analysis.. Preeclampsia state is associated with increased vascular resistance (mean 1587±236 vs 978±153 dyn s cm. The elevated NT-proBNP in preeclampsia may reflect ventricular stress and subclinical cardiac dysfunction worsening if FGR is present. This may have implications for the acute management of the preeclampsia and FGR women and for appropriately timed therapeutic interventions later in life.

Topics: Adult; Case-Control Studies; Female; Fetal Growth Retardation; Gestational Age; Heart Ventricles; Hemodynamics; Humans; Italy; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy

To investigate whether serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could be used as a marker to determine the severity of preeclampsia.. This prospective cohort study included pregnant women with preeclampsia and severe preeclampsia and normotensive pregnant controls admitted between January 2013 and July 2014. Preeclampsia was graded according to the recently revised criteria of the American College of Obstetricians and Gynecologists (ACOG). Serum NT-proBNP levels were compared among the groups.. Of the 49 women with preeclampsia, 25 had severe preeclampsia. The controls were 27 normotensive pregnant women admitted during the same period. Serum NT-proBNP levels were significantly higher in the preeclampsia groups than in the control group (p < 0.001). In addition, NT-proBNP levels were significantly higher in the severe preeclampsia group compared with both the preeclampsia group (p < 0.001) and the control group (p < 0.001).. The ACOG has recently revised the grading of hypertensive diseases of pregnancy and the criteria for severe preeclampsia. In line with these revised guidelines, serum NT-proBNP levels appear to be a useful marker to evaluate the severity of preeclampsia.

Topics: Adolescent; Adult; Biomarkers; Female; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Prospective Studies; Severity of Illness Index; Young Adult

Preeclampsia (PE) is associated with acute left ventricular dysfunction. Whether these changes eventually resolve remains unclear. This study assessed left and right ventricular structure and function, and ventricular-arterial interaction in 15 women 11 years after a pregnancy with PE and 16 matched control subjects with a normal pregnancy. We found normal left and right ventricular dimensions, systolic function, and global left ventricular strain, with no differences between the groups. In addition, indices of diastolic function, left and right atrial size, and amino-terminal pro-brain natriuretic peptide were normal and did not differ between the groups. Women with a previous PE had impaired night/day ratios for systolic and diastolic ambulatory blood pressure. However, indices of aortic stiffness or ventricular-arterial coupling did not differ between the groups. In conclusion, we could not demonstrate remaining alterations in systolic or diastolic left or right ventricular function, or in ventricular-arterial interaction in women 11 years after PE.

Topics: Adult; Atrial Function; Blood Pressure Monitoring, Ambulatory; Case-Control Studies; Diastole; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Atria; Heart Ventricles; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Systole; Vascular Stiffness; Ventricular Dysfunction, Left; Ventricular Function

Women with chronic kidney disease (CKD) and chronic hypertension (CHT) frequently develop superimposed pre-eclampsia, but distinction from pre-existing disease is challenging. Plasma placental growth factor (PlGF), B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), and serum relaxin concentrations were quantified in a longitudinal prospective cohort of 121 women with CKD: 44 with chronic hypertension, and 79 healthy controls. Biomarker concentrations were compared with 32 women with pre-eclampsia without pre-existing disease. Test performance was evaluated for diagnosis of superimposed pre-eclampsia requiring delivery within 14 days of sampling. PlGF was evaluated as a promising marker in a validation cohort of women with suspected pre-eclampsia (29 with CKD; 94 with chronic hypertension; 29 with superimposed pre-eclampsia requiring delivery within 14 days) and compared with women without pre-existing disease (290 with no pre-eclampsia and 176 with pre-eclampsia requiring delivery within 14 days). From 20 and up to 42 weeks of gestation, lower maternal PlGF concentrations had high diagnostic accuracy for superimposed pre-eclampsia requiring delivery within 14 days (receiver operator characteristic 0.85) and confirmed in the validation cohort. The other plasma and serum biomarkers were not discriminatory. Thus, plasma PlGF concentrations could potentially help guide clinical decision making regarding admission and delivery for superimposed pre-eclampsia.

Topics: Acute Kidney Injury; Adult; Biomarkers; Case-Control Studies; Female; Gestational Age; Humans; Hypertension; Lipocalin-2; Longitudinal Studies; Natriuretic Peptide, Brain; Placenta Growth Factor; Pre-Eclampsia; Pregnancy; Relaxin; Renal Insufficiency, Chronic

To evaluate fetal cardiopulmonary stress in pregnancies complicated by preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PT), and fetal distress (FD) using umbilical arterial blood N-terminal pro-B-type natriuretic peptide (NT-proBNP).. The study included 146 blood samples that were drawn from umbilical arteries at the time of delivery (20 cases of PE, 11 cases of FGR, 31 cases of PT, 23 cases of FD, and 61 cases of gestational age-matched controls) and analyzed. The main outcome measures included neonatal birthweight, cord pH, and umbilical arterial NT-proBNP.. The umbilical arterial NT-proBNP levels were significantly higher in the PE, FGR, PT, and FD groups than in the control group. The umbilical arterial NT-proBNP levels were negatively correlated with gestational age, birthweight, and umbilical arterial pH.. Umbilical arterial NT-proBNP levels are elevated in stressful fetal conditions and have the potential to be considered as a marker for fetal cardiopulmonary stress.

Topics: Adult; Biomarkers; Birth Weight; Female; Fetal Blood; Fetal Distress; Fetal Growth Retardation; Gestational Age; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Premature Birth; Prospective Studies; Umbilical Arteries

This study compares the performance of the soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) ratio and the cardiac biomarker N-terminal pro-B type natriuretic peptide (NT-proBNP) in the prediction of adverse outcomes in women with suspicion of PE.. A retrospective cohort study was conducted on women admitted at triage with signs and/or symptoms of PE (n=340). Serum levels of sFlt-1, PlGF and NT-proBNP were determined by an electrochemiluminescence immunoassay (Roche Diagnostics). The main outcomes were early- or late-onset PE and development of adverse outcome, defined as delivery within the first week since clinical presentation or fetal/early neonatal death.. NT-proBNP concentrations (ng/L) were significantly increased in PE versus non-PE women, both at <34 (169 versus 34) and ≥34weeks of gestation (101 versus 49) (p<0.001). A cut-point of 70 showed sensitivities/specificities of 78/74% for early-, and 70/62% for late-onset PE; slightly lower than those offered by the sFlt-1/PlGF ratio or uric acid. The respective cut-points of 178 and 219 for sFlt-1/PlGF ratio and NT-proBNP, demonstrated similar performance in the prediction of adverse outcome, with sensitivity/specificity of 95/84% and 94/76%, respectively.. NT-proBNP and sFlt-1/PlGF ratio can be used to predict the development of an adverse outcome.

Topics: Adult; Biomarkers; Female; Gestational Age; Humans; Natriuretic Peptide, Brain; Neovascularization, Physiologic; Peptide Fragments; Placenta Growth Factor; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; Vascular Endothelial Growth Factor Receptor-1

To determine the maternal serum N-Terminal proBNP levels in predicting development of preeclampsia.. Sixty-eight patients were included in the study. The study group consisted of patients with the finding of diastolic notch with abnormal pulsatility index (PI) between 21-24 weeks gestation and the control group consisted of patients without diastolic notch and normal PI. The study included high-risk patients who did not have a history of hypertensive disorder before pregnancy, heart failure, recurrent pregnancy loss, autoimmune disorder or diabetes. The groups were compared in terms of NT-ProBNP levels, development of preeclampsia, obstetric and neonatal problems.. There was no significant difference between groups in terms of age, gravidity, parity, uric acid levels, and NT-proBNP levels. There was significant difference between the groups in terms of week of birth, rate of cesarean section and fetal weight. Furthermore, there were significant differences between the two groups when compared in terms of obstetric and neonatal problems (p < 0.05). Obstetric and neonatal problems were more common in the notch with abnormal (PI) group. The NT-pro BNP levels were found to be comparable among groups. Preeclampsia was the most common obstetric problem (11.7%). We were unable to document significant difference in patients who developed preeclampsia.. Bilateral notch together with abnormal PI measurements in the uterine artery Doppler screening during the second trimester was associated with poor perinatal outcomes. Such an association was not significant in the NT-proBNP measurements. Larger trials focused on late-onset preeclampsia are needed to draw definitive conclusions.

Topics: Adult; Cesarean Section; Cohort Studies; Female; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Prospective Studies; Ultrasonography, Doppler; Ultrasonography, Prenatal; Uterine Artery; Young Adult

We compared B-type natriuretic peptide (BNP) levels, clinical and laboratory findings in early-onset preeclampsia (EOP), late-onset preeclampsia (LOP) and healthy pregnant groups.. We studied 40 healthy pregnant and 40 preeclamptic patients. Preeclamptics were divided in two groups, the EOP group (n=20) and LOP group (n=20), according to gestational age at the onset of disease. The distinction criterion for early- vs. late-onset was set as week 34 of gestation. The concentration of the BNP levels was measured by a sandwich fluorescence immunoassay. For statistical analysis of the clinical and laboratory findings non-parametric methods were applied.. BNP levels were higher in EOP [61.35 (36.95-93.25) pg/mL] and LOP patients [32.4 (19.15-39.2) pg/mL] than in healthy pregnant women [10.05 (6.08-16.03) pg/mL] (both p<0.001). Furthermore, EOPs had significantly higher BNP levels as compared to LOP patients (p<0.001). A BNP cut-off <24.5 pg/mL had a negative-predictive value of 85.1% excluding preeclampsia. There was a significant inverse correlation between plasma BNP levels of EOP patients and sodium (p<0.05) and total protein concentrations (p<0.05). In the EOP group, a significant positive correlation was observed between plasma levels of BNP and hematocrit (p<0.05), serum potassium (p<0.05), urea (p<0.05) and 24-h proteinuria (p<0.05).. BNP levels were significantly higher in EOP than in LOP patients. The cut-off value <24.5 pg/mL seems to be a powerful discriminative indicator excluding preeclampsia. The amount of proteinuria and total protein levels correlate with the elevation of the BNP levels. In EOP the extent of proteinuria is higher than in the LOP.

Topics: Adult; Area Under Curve; Blood Pressure; Female; Gestational Age; Humans; Immunoassay; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; ROC Curve

Levels of plasma N-terminal pro B-type natriuretic peptide (NT-proBNP) are elevated in preeclampsia. In this study, the possibility that the placenta produces and releases proBNP/NT-proBNP was explored. Plasma levels of NT-proBNP in early- and late-onset preeclampsia were also measured.. Placental proBNP mRNA in early-onset preeclampsia (n = 7), late-onset preeclampsia (n = 8), and controls of similar gestational age (n = 10) was assessed by quantitative real-time polymerase chain reaction. ProBNP/NT-proBNP protein was studied in placental samples with immunohistochemistry (n = 8) and tissue culture (n = 2). Plasma levels of NT-proBNP were measured in early-onset preeclampsia (n = 18), late-onset preeclampsia (n = 20), and relevant controls (n = 36).. Transcripts of proBNP mRNA were found in 20 out of 25 samples, there were no differences in expression between the groups. ProBNP/NT-proBNP protein was observed in maternal spiral arteries and in syncytiotrophoblasts in all placental samples. After placental tissue culture, there were measurable amounts of NT-proBNP in the culture media. Women with both early- (365 [14-9815] pg/ml) and late-onset preeclampsia (176 [33-2547] pg/ml) had higher levels of NT-proBNP than their controls (P < 0.001). There was a tendency toward higher levels of NT-proBNP in women with early-onset preeclampsia than in women with late-onset preeclampsia (P = 0.057).. The results indicate possible placental production and release of proBNP/NT-proBNP into the maternal circulation.

Topics: Adult; Case-Control Studies; Enzyme-Linked Immunosorbent Assay; Female; Genetic Markers; Gestational Age; Humans; Immunohistochemistry; Natriuretic Peptide, Brain; Peptide Fragments; Placenta; Pre-Eclampsia; Pregnancy; Protein Precursors; Real-Time Polymerase Chain Reaction; RNA, Messenger; Tissue Culture Techniques; Up-Regulation; Young Adult

Topics: Adult; Biomarkers; Blood Pressure; Chronic Disease; Female; Humans; Hypertension, Pregnancy-Induced; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Protein Precursors

Women with a history of preeclampsia are at increased risk of future cardiovascular disease. Preeclampsia is associated with elevated blood pressure, inflammation and endothelial dysfunction, and these findings remain 1 year after delivery. Whether these abnormalities persist long after delivery, and whether they may contribute to future cardiovascular disease, is not well studied. We studied 15 women with a history of preeclampsia and 16 matched controls with an uncomplicated pregnancy 11 years following the index pregnancy; all had also been previously examined at 1 year. We assessed arterial stiffness (pulse wave analysis), 24 h ambulatory blood pressure and endothelial function (forearm flow-mediated dilatation and pulse wave analysis following β receptor agonist provocation), and determined markers of glucose and lipid metabolism, inflammation and vascular function. The preeclampsia group had higher blood pressures and reduced night/day blood pressure ratios, increased body mass index and reduced glucose tolerance, and increased levels of tissue necrosis factor receptor 1 and intracellular adhesion molecule-1, suggesting inflammatory and vascular activation. However, the endothelial impairment observed in the preeclampsia group at 1 year was normalized at 11 years, whereas the control group remained unchanged during follow-up. Our findings of higher blood pressures, impaired glucose tolerance and normalization of endothelial function 11 years after preeclampsia suggest cardiovascular risk factors present already before pregnancy to be more important than permanent endothelial damage for the increased risk of future cardiovascular complications in women with a history of preeclampsia.

Topics: Adrenergic beta-2 Receptor Agonists; Adult; Age Factors; Biomarkers; Blood Pressure; Body Mass Index; Cardiovascular Diseases; Endothelium, Vascular; Female; Follow-Up Studies; Glucose Tolerance Test; Heart Rate; Humans; Hyperemia; Lipid Metabolism; Longitudinal Studies; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Pulse Wave Analysis; Risk Assessment; Risk Factors; Vasodilation

To determine early haemodynamic changes in preeclampsia (PE) using tissue Doppler echocardiography and brain natriuretic peptide (BNP), and to relate these changes to obstetric outcomes.. Consenting primigravidae patients in the third trimester of pregnancy were included in the study, which was carried out in a large regional hospital in Durban, South Africa; 115 primigravidae (52 pre-eclamptics and 63 normotensive pregnant patients) attending the maternity unit including the antenatal clinics at the study site were studied. The patients, matched for maternal and gestational age, were examined during pregnancy and within the puerperium. Transthoracic echocardiography (TTE), tissue Doppler imaging (TDI), umbilical artery Doppler and laboratory investigations were performed.. BNP levels were significantly increased in the antepartum period [23.8 (2-184.1) vs 6.0 (0.5-45.2) pmol/l; p < 0.0001] and during labour [15.0 (1.8-206.4) vs 8.7 (1.9-24.8) pmol/l; p < 0.01] in the pre-eclamptic group compared to the normotensive controls. In the postpartum period, mean BNP levels were 4.2 (1.7-51.4) and 5.95 (2.2-38.7) pmol/l in the preeclamptic and normotensive groups, respectively (p > 0.05). Tissue Doppler Em/Ea ratios were elevated in the pre-eclamptic compared to the normotensive group (11.02 ± 5.6 vs 9.16 ± 2.6; p < 0.05). Mean left atrial size was larger (38 mm) in the pre-eclamptic group than in the normotensive group (35 mm) but this difference was not significant (p > 0.05). The umbilical artery resistance index was significantly higher in the pre-eclamptic group compared to the normotensive group (0.68 ± 0.06 vs 0.63 ± 0.05; p < 0.001). There was an increased rate of Caesarean sections performed in the pre-eclamptic group (n = 24) compared to the normotensive group (n = 18; p < 0.001). There were two stillbirths in the pre-eclamptic group and none in the normotensive group. As expected, birth weight (2.6 ± 0.8 kg vs 3.14 ± 0.42 kg; p < 0.0001) was lower in the pre-eclamptic group compared to the normotensive group.. In pregnancies complicated by pre-eclampsia, BNP levels were increased in comparison to normotensive pregnancies and this was accompanied by early changes in left ventricular diastolic function as determined by the tissue Doppler Em/Ea ratios. These changes reverted to baseline values, as indicated by return of BNP levels in the pre-eclamptic group to levels seen in the normotensive group. These changes were associated with an increased Caesarean section rate and lower birth weights in pre-eclamptic mothers.

Topics: Adolescent; Adult; Biomarkers; Birth Weight; Case-Control Studies; Echocardiography, Doppler; Female; Gravidity; Hemodynamics; Humans; Infant, Newborn; Labor, Obstetric; Live Birth; Natriuretic Peptide, Brain; Postpartum Period; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Third; Prognosis; South Africa; Stroke Volume; Ultrasonography, Doppler, Pulsed; Ultrasonography, Prenatal; Umbilical Arteries; Up-Regulation; Vasoconstriction; Ventricular Function, Left; Young Adult

In very preterm infants, clinical decision-making, such as closing a patent ductus arteriosus (PDA), may be aided by measuring circulating natriuretic and endothelial pro-peptides.. To investigate the association between perinatal characteristics, PDA echocardiography and plasma concentrations of stable pro-peptides of B-type natriuretic peptide (NT-proBNP), atrial natriuretic peptide (MR-proANP) and endothelin-1 (CT-proET-1).. A prospective, cross-sectional, single-center study was performed in 66 infants who were less than 32 weeks of gestational age. Pro-peptide concentrations were determined at birth and at day 2-3 of life.. Plasma concentrations of all 3 pro-peptides increased on average 2- to 5-fold from birth to day 2-3 of life. NT-proBNP and MR-proANP were closely related at birth and at day 2-3 (Rs 0.902 and 0.897, respectively, p < 0.001), whereas CT-proET-1 was related to NT-proBNP and MR-proANP at birth (Rs 0.478 and 0.460, respectively, p < 0.001) but not at day 2-3. Birth weight was negatively related to all 3 pro-peptides at birth (p < 0.01); however, preeclampsia and compromised placental perfusion were associated with elevated NT-proBNP and MR-proANP concentrations at birth. At day 2-3, MR-proANP and NT-proBNP correlated significantly with the ductal diameter (Rs 0.416 and 0.415, respectively, both p = 0.011), whereas CT-proET-1 correlated with the left atrium/aorta ratio (Rs 0.506, p = 0.027). CT-proET-1 was elevated in infants with treated compared to untreated PDA [median (5-95% range) 388 (272-723) vs. 303 (152-422) pmol/l, p = 0.011], but not NT-proBNP or MR-proANP.. CT-proET-1 is a promising predictor in determining the need for PDA intervention.

Topics: Atrial Natriuretic Factor; Ductus Arteriosus, Patent; Echocardiography; Endothelin-1; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Natriuretic Peptide, Brain; Peptide Fragments; Placenta; Pre-Eclampsia; Pregnancy; Protein Precursors

Adiponectin was reported recently to have roles in the pathophysiology of preeclampsia. Moreover, elevation of adiponectin and brain natriuretic peptide (BNP) has been observed in preeclampsia. We examined the possible links between adiponectin and BNP in the pathophysiology of preeclampsia. We performed a cross-sectional study in 56 preeclampsia patients and 56 controls matched for gestational age and body mass index. The BNP, leptin, and adiponectin levels were measured by ELISA, and their mRNA expressions were evaluated in omental adipose tissue by real-time PCR. The effects of BNP on adiponectin and leptin mRNA expression and secretion were investigated in primary cultures of adipocytes from obese and normal-weight women. The BNP, adiponectin, and leptin levels were significantly higher in preeclampsia patients compared with controls. The adiponectin level was increased significantly in normal-weight preeclampsia patients compared with overweight preeclampsia patients. Adiponectin mRNA expression was increased significantly in adipose tissues of preeclampsia patients compared with controls and was also increased significantly in normal-weight preeclampsia patients compared with overweight preeclampsia patients, whereas leptin was not. BNP and adiponectin showed significant positive correlations in both normal-weight and overweight preeclampsia patients. BNP had a significantly weaker effect on adiponectin in overweight compared with normal-weight preeclampsia patients. Moreover, BNP had a weaker effect on adiponectin production in adipocytes from overweight women compared with adipocytes from normal-weight women using primary culture of human adipocytes. These data suggested that BNP may play a role in hyperadiponectinemia of preeclampsia patients. The weaker effect of BNP on adiponectin production may participate in the pathophysiology of overweight preeclampsia patients.

Topics: Adipocytes; Adipokines; Adiponectin; Adipose Tissue; Adult; Body Mass Index; Cells, Cultured; Cross-Sectional Studies; Female; Humans; Insulin Resistance; Natriuretic Peptide, Brain; Obesity; Pre-Eclampsia; Pregnancy; Real-Time Polymerase Chain Reaction

Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated NT-proBNP levels to determine the clinical correlation with the severity of hypertensive disorders complicating pregnancy.. NT-proBNP levels of 95 pregnant women (severe preeclampsia [n = 26], mild preeclampsia [n = 15], gestational hypertension [n = 9], and healthy controls [n = 45]) were determined using an electrochemiluminescence immunoassay.. Comparisons of the mean values of NT-proBNP levels in the different groups were significantly different, as follows: 1766.43 ± 4197.39 pg/mL (median, 339.8 pg/mL) in severe preeclampsia, 214.97 ± 226.35 pg/mL (median, 152.3 pg/mL) in mild preeclampsia, 39.75 ± 24.85 pg/mL (median, 34.09 pg/mL) in gestational hypertension, and 78.78 ± 81.56 pg/mL (median, 48.54 pg/mL) in the healthy controls. The NT-proBNP levels of the patients with mild and severe preeclampsia were significantly higher than in the patients with gestational hypertension and the healthy control patients. There was no significant difference in NT-proBNP levels between patients with mild and severe preeclampsia (p = 0.17).. In patients with mild and severe preeclampsia, NT-proBNP levels were elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

Topics: Adult; Biomarkers; Female; Humans; Hypertension, Pregnancy-Induced; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Severity of Illness Index

There is a variable tandem repeat polymorphism in the 5'-flanking region of the natriuretic peptide precursor B gene (NPPB). A previous study showed association of the (TTTC) small tandem repeat (STR) variants of this gene and essential hypertension. Our aim was to identify this polymorphism in samples of pre-eclamptic patients and healthy controls. We also compared the natriuretic peptide B (BNP) concentrations.. Blood samples were collected from healthy pregnant normotensive women (n=235) and women with pre-eclampsia (n=220). DNA was isolated and fluorescent PCR and DNA fragment analysis was performed for the detection of (TTTC) repeats. The plasma BNP concentration was measured by fluorescence immunoassay method.. We detected 12 different (TTTC) repeats on the NPPB gene in the studied population. The overall distribution of alleles and genotypes was significantly different between the control and pre-eclamptic groups. The number of 10-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnant controls (p=0.032). After adjustment for confounding factors pre-pregnancy BMI, maternal age, primiparity and smoking, the calculated odds ratio (OR) was 0.19 (95% CI: 0.04-0.87). Similarly, the 12-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnants (p=0.037; adjusted OR: 0.53 (95% CI: 0.29-0.96)). In contrast the 11-repeat genotype carrier frequency was significantly higher in the pre-eclamptic than in the healthy pregnant group (p<0.001; adjusted OR 2.91 (95% CI: 1.75-4.84)). The concentration of the BNP was 9.75pg/ml in the healthy controls and 32.40pg/ml in the pre-eclamptic group (p<0.0001). The 11/11 genotype carriers had significantly higher BNP levels in both groups.. The NPPB gene (TTTC) microsatellite polymorphism in the 5'-flanking region showed significant difference in the distribution of alleles and genotypes between healthy pregnant controls and pre-eclamptic patients in an ethnically homogeneous population. The concentration of the BNP was higher in pre-eclamptic women, and it showed association with the (TTTC) genotypes. We introduced an F-PCR and DNA fragment analysis method for the fast and reliable detection of this STR.

Topics: Adult; Biomarkers; Female; Humans; Microsatellite Repeats; Natriuretic Peptide, Brain; Polymorphism, Genetic; Pre-Eclampsia; Pregnancy; Protein Precursors; Sensitivity and Specificity

We compared nitrite, B-type natriuretic peptide (BNP), and cGMP levels in preeclamptic with those found in healthy pregnant.. We studied 21 healthy pregnant and 27 preeclamptic. Plasma cGMP and BNP levels were determined by ELISA. Nitrite levels were determined by chemiluminescence.. Higher cGMP and BNP, and lower nitrite levels were found in preeclamptic versus healthy pregnant.. Altered cGMP levels reflect increased BNP levels and not impaired nitric oxide activity in preeclampsia.

Topics: Adult; Blood Pressure; Case-Control Studies; Cyclic GMP; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Natriuretic Peptide, Brain; Nitric Oxide; Nitrites; Pre-Eclampsia; Pregnancy; Reference Values; Young Adult

The vasoactive markers of cardiac overload Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP) are elevated in preeclampsia. This study documents higher ANP concentrations as early as at 9 weeks in type 1 diabetic women subsequently developing preeclampsia suggesting that preeclampsia is associated with cardiovascular changes in early pregnancy.

Topics: Adult; Atrial Natriuretic Factor; Diabetes Mellitus, Type 1; Female; Gestational Age; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Young Adult

We tested the hypothesis that the cardiac biomarker N-terminal pro-brain natriuretic peptide would be elevated in hypertensive disorders of pregnancy, with an increase in levels of this biomarker across increasing gradations of disease severity. We performed a case-controlled study of women admitted to labor and delivery at the Hospital of the University of Pennsylvania between 24 and 42 weeks of gestation. Cases had hypertension that developed after 20 weeks of gestation, and controls were normotensive women presenting for delivery. N-terminal pro-brain natriuretic peptide levels were compared between cases ( N = 83) and controls ( N = 290). Cases were subclassified into gestational hypertension ( N = 20) and mild ( N = 15) and severe preeclampsia ( N = 48), and N-terminal pro-brain natriuretic peptide levels were compared between these subgroups. N-terminal pro-brain natriuretic peptide levels were higher in cases than in controls (81 pg/mL versus 37 pg/mL, P < 0.001), with a graded increase in levels from gestational hypertension (64 pg/mL) to preeclampsia (89 pg/mL) to severe preeclampsia (157 pg/mL; P < 0.001). Each log increase in N-terminal pro-brain natriuretic peptide doubled the risk of preeclampsia (odds ratio = 2.10 P < 0.001). N-terminal pro-brain natriuretic peptide levels were increased in hypertensive disorders of pregnancy and discriminate between subcategories of disease.

Topics: Adult; Analysis of Variance; Biomarkers; Case-Control Studies; Female; Gestational Age; Humans; Hypertension, Pregnancy-Induced; Logistic Models; Multivariate Analysis; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prospective Studies; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index

To evaluate if amino-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels reflect intracardiac filling pressures in pre-eclamptic patients.. In a cross-sectional study we investigated 22 untreated critically ill pre-eclamptic women between 22 and 34 weeks gestation. All patients underwent intra-arterial blood pressure and central hemodynamic measurements and NT-proBNP was determined in stored plasma. Baseline characteristics, plasma NT-proBNP concentrations and relevant laboratory variables were investigated for correlations with hemodynamic values using Spearman's rank correlation test.. No significant correlations were demonstrated between NT-proBNP concentrations and variables associated with the severity of the pre-eclampsia. We found significant positive correlations between NT-proBNP and diastolic pulmonary pressure (r = 0.59; p = 0.005) and pulmonary capillary wedge pressure (PCWP) (r = 0.51; p = 0.015). Multiple linear regression analysis showed that the association between NT-proBNP and PCWP was not affected by creatinine level.. NT-proBNP is a biomarker of left ventricular cardiac filling pressures in untreated pre-eclamptic patients.

Topics: Adult; Biomarkers; Diastole; Female; Hemodynamics; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Pulmonary Wedge Pressure; Young Adult

To assess left ventricular (LV) structure and function in preeclampsia, a serious vascular-related pregnancy disorder, by Doppler tissue imaging (DTI) in combination with the levels of cardiovascular biomarkers.. Thirty-five pregnant women with preeclampsia and 30 with normal pregnancy, matched for age and gestational age were examined during pregnancy and 3-6 months after delivery. Transthoracic echocardiography and DTI were performed and blood levels of amino-terminal pro-brain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cystatin C and troponin I were analyzed.. There were significant differences in LV and left atrial dimensions and function between the groups. A higher septal and lateral E/E' ratio (E = early transmitral diastolic flow velocity and E' = early diastolic myocardial velocity) (P < 0.0001, 0.0008) and higher levels of NT-pro-BNP, cystatin C, and lower cystatin C estimated GFR in ml/min per 1.73 m(2) (P < 0.0001) were seen in the preeclampsia both during pregnancy and at follow-up. In addition the levels of E/E' ratio lateral and NT-pro-BNP were higher in pregnant women with early-onset preeclampsia necessitating delivery before 34 weeks of gestation than those who developed preeclampsia and delivered at or after 34 weeks (P = 0.0004, 0.005).. In pregnancies complicated by preeclampsia, especially early-onset preeclampsia, the diastolic LV function is impaired and levels of biomarkers, NT-pro-BNP and cystatin C, are increased in comparison to normal pregnancy.

Topics: Adult; Biomarkers; C-Reactive Protein; Case-Control Studies; Cystatin C; Echocardiography; Female; Glomerular Filtration Rate; Heart Ventricles; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Pregnancy; Troponin I

Increasing evidence shows that intrauterine growth restriction (IUGR) is associated with fetal cardiac dysfunction. Most studies group IUGR with and without pre-eclampsia (PE) altogether. Our objective was to evaluate whether the association with PE has any impact on cardiac function in IUGR fetuses. Thirty-one normotensive IUGR cases and 31 IUGR cases with pre-eclampsia (PE + IUGR) below 34 weeks of gestation were included. IUGR was defined as a birth weight below the 10(th) centile together with an umbilical artery pulsatility index above 2 SD. Fetal cardiac function was assessed by measuring ductus venosus pulsatility index, modified myocardial performance index, aortic isthmus blood flow, E/A ratios and cardiac output. The presence of fetal cardiac dysfunction was also assessed by measuring cord blood B-type natriuretic peptide (BNP) levels collected at birth. Echocardiographic data were compared with those in 80 term appropriate-for-gestational age (AGA) fetuses from normotensive mothers. Cord blood BNP levels were compared with those in 40 AGA cases that delivered preterm.. All IUGR cases (with or without PE) showed echocardiographic and biochemical signs of cardiac dysfunction compared with AGA cases. However, no differences were observed between IUGR and PE + IUGR cases either in echocardiographic or in biochemical parameters. IUGR cases with or without PE had similar perinatal results.. IUGR fetuses showed echocardiographic and biochemical signs of cardiac dysfunction. Pre-eclampsia per se does not influence cardiac function in IUGR fetuses.

Topics: Biomarkers; Cardiac Output, Low; Female; Fetal Development; Fetal Growth Retardation; Fetal Heart; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Infant, Small for Gestational Age; Male; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pulsatile Flow; Risk Assessment; Ultrasonography, Prenatal

The purpose of this study was to evaluate the relationship between natriuretic peptides (NT-proANP and NT-proBNP) and hemodynamic parameters in preeclampsia.. This was a cross-sectional study of 19 preeclamptic, 15 chronic hypertensive, and 26 normotensive women in the third trimester of pregnancy. Stroke index (SI), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), and left cardiac work index (LCWI) were derived by whole-body impedance cardiography. Systolic blood pressure (SAP), diastolic blood pressure (DAP), and mean arterial pressure (MAP) were measured. The plasma levels of NT-proANP and NT-proBNP were determined with radioimmunoassays.. NT-proANP and NT-proBNP concentrations were significantly higher in preeclamptic women compared to chronic hypertensive and normotensive pregnancies. Preeclamptic women had lower CI and HR and higher SAP, MAP, and SVRI than the control groups. In preeclampsia NT-proANP correlated significantly with SAP and SVRI; meanwhile, NT-proBNP correlated significantly with SVRI and CI. These correlations persisted in the subgroup of nonmedicated preeclamptic women, except in the case of NT-proBNP and CI.. High NT-proANP and NT-proBNP concentrations in preeclampsia reflect the strain on the heart caused by high afterload, rather than the function of the heart expressed as SI or CI.

Topics: Adult; Atrial Natriuretic Factor; Biomarkers; Chronic Disease; Cross-Sectional Studies; Female; Humans; Hypertension; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Placental Circulation; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Probability; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index

Topics: Dyspnea; Electrocardiography; Female; Heart Diseases; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Reference Values

The purpose of this study was to evaluate the levels of amino-terminal probrain natriuretic peptide (Nt pro-BNP) in preeclampsia in comparison with normotensive pregnancy.. Women with preeclampsia (proteinuria > or = 300 mg/24 h and at least two readings of systolic blood pressure > or = 140 mm Hg and diastolic blood pressure > or = 90 mm Hg) (n = 32 mild preeclampsia and n = 8 severe preeclampsia) were compared with normotensive women (n = 40). Serum Nt pro-BNP was measured using an electrochemiluminescence immunoassay (ECLIA) method (Nt pro-BNP, Roche) with a Roche modular analytics E170 immunoassay analyzer. Statistical analysis was carried out by the Student t-test, and a P value of <0.05 was accepted as statistically significant.. The median serum Nt pro-BNP was 430+/-28.91 pg/mL in preeclampsia. The levels of serum Nt pro-BNP were 74+/-16.82 pg/mL in normotensive pregnant women (P < 0.001) and significantly higher in women with preeclampsia (P < 0.001).. The higher levels of serum Nt pro-BNP in preeclamptic women may be an indicator of high left-ventricular filling pressure, and indicate left-ventricular diastolic dysfunction.

Topics: Adult; Biomarkers; Case-Control Studies; Female; Humans; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Pre-Eclampsia; Pregnancy; Protein Precursors; Reference Values; Ventricular Function, Left

B-type natriuretic peptide (BNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated BNP levels to determine trends during pregnancy, and to assess BNP as a diagnostic tool in preeclampsia.. We studied 163 BNP levels in 118 pregnant women, ranging from first trimester to term. An additional 34 patients with preeclampsia were studied and compared to 25 normal control patients at term. Plasma BNP values were determined using a standard assay.. The median BNP levels during the 1st, 2nd, 3rd trimester, and at term were equivalent (18.4, 17.9, 15.5, and 17.8 pg/mL, respectively, P = .796). The median BNP levels in normal patients, mild preeclamptics, and severe preeclamptics were 17.8, 21.1, and 101 pg/mL, respectively, with the severe group being significantly higher than the mild group (P = .003) and any phase of normal pregnancy (P < .001 in each case). A BNP cut-off of <40.6 pg/mL had a negative predictive value of 92% in excluding preeclampsia.. In normal pregnancies, median BNP values are <20 pg/mL, and stable throughout gestation. In severe preeclampsia BNP levels are elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

Topics: Adult; Area Under Curve; Female; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; ROC Curve; Ventricular Dysfunction, Left

This study was done to evaluate left ventricular structure and function among pregnant patients with preeclampsia and compare them with those of normotensive pregnant and nonpregnant subjects. It also tested the hypothesis that abnormalities in left ventricular structure and function are associated with elevated plasma levels of natriuretic peptides.. The study compared 75 pregnant women (n = 40 with preeclampsia; n = 35 normotensive pregnant women) and 10 nonpregnant normotensive control subjects undergoing an echocardiographic and biohumoral (renin activity and aldosterone, atrial natriuretic peptide, and brain natriuretic peptide concentrations) evaluation. The statistical analysis was carried out by analysis of variance, and significance was set at P <.05.. Comparison of pregnant patients with preeclampsia versus both normotensive pregnant women and nonpregnant women showed significant increases in left ventricular mass and left ventricular endsystolic and end-diastolic volumes and significant reductions in left ventricular ejection fraction and percentage of fractional shortening. These changes coincided with increases in plasma levels of atrial natriuretic peptide and brain natriuretic peptide that were linearly related to the left ventricular structural and functional changes observed in patients with preeclampsia.. Pregnant patients with preeclampsia showed adaptation to the increase in systemic blood pressure, with significant modification of left ventricular structure and function related to the plasma levels of both atrial natriuretic peptide and brain natriuretic peptide. A simple evaluation of plasma natriuretic peptide concentrations could help to discriminate patients with preeclampsia who have a condition of mild left ventricular overload.

Topics: Adult; Aldosterone; Atrial Natriuretic Factor; Blood Pressure; Echocardiography; Female; Gestational Age; Heart Ventricles; Hemodynamics; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Renin; Ventricular Function, Left

Our purpose was to evaluate plasma levels of brain natriuretic peptide (pBNP) and cyclic guanosine monophosphate (pcGMP) in preeclamptic patients and controls.. Blood samples were obtained from 35 patients with preeclampsia and from the same women during the subsequent puerperal period. The control group consisted of normotensive pregnant women, matched with the patients for age, gestational age, and parity. The concentrations of pBNP and pcGMP were determined by the RIA method. Statistical analysis was performed using the Mann-Whitney's U test.. The pBNP level in the preeclampsia group was significantly increased, to 7-fold that of the control group. The pcGMP level was 50% higher in the preeclampsia group than in the control group, but this was not significant. Both the pBNP level and the pcGMP level in the puerperal period did not significantly differ between the patients and the controls.. The pBNP concentrations increased in the preeclamptic women, and then these compensations were normalized in the puerperal period.

Topics: Adult; Case-Control Studies; Cyclic GMP; Female; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Reference Values

Brain natriuretic peptide (BNP) was increased in many hypertensive subjects. In this study, we have evaluated maternal, umbilical plasma and amniotic fluid BNP and atrial natriuretic peptide (ANP) in 19 normotensive pregnant women and in 35 preeclamptic patients. The maternal plasma and umbilical cord plasma ANP (p < 0.05) and BNP (p < 0.005) levels were significantly higher than those in normal pregnancy. There was no significant correlation among ANP level, BNP level, clinical symptoms and laboratory examinations. It is suggested that ANP and BNP may be rather a sequel to preeclamptic pathophysiological changes, and may not play an important role as the etiological factor of preeclampsia.

Topics: Amniotic Fluid; Atrial Natriuretic Factor; Female; Fetal Blood; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Postpartum Period; Pre-Eclampsia; Pregnancy

To investigate the involvement of brain natriuretic peptide in the circulation of pregnant women with pregnancy-induced hypertension.. We determined the plasma levels of brain and atrial natriuretic peptides in a cross-sectional study of 36 normal pregnant women and 17 women with pregnancy-induced hypertension.. During normal pregnancy, the plasma brain natriuretic peptide level was similar to that in nonpregnant women, but the plasma atrial natriuretic peptide level in the second trimester was significantly higher than that in nonpregnant women (P < .05). In women with severe pregnancy-induced hypertension, the plasma brain natriuretic peptide level was eight times higher than that in normal pregnant women in the third trimester; the plasma atrial natriuretic peptide level in the same patients was three times higher than that in normal pregnancy. The plasma brain natriuretic peptide level showed a positive correlation with the mean blood pressure (r = 0.62, P < .001).. The present findings suggest that brain natriuretic peptide is increased in the plasma of women with pregnancy-induced hypertension and that brain natriuretic peptide, in concert with atrial natriuretic peptide, participates in maintaining homeostasis of the maternal circulation.

Topics: Adult; Atrial Natriuretic Factor; Blood Pressure; Blood Urea Nitrogen; Cross-Sectional Studies; Female; Humans; Hypertension; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular

Topics: Adult; Blood Pressure; Female; Humans; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third