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Placental dysfunction in early-onset and late-onset preeclampsia
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
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Article in journal (Refereed) Submitted
URN: urn:nbn:se:uu:diva-96346OAI: oai:DiVA.org:uu-96346DiVA: diva2:170890
Available from: 2007-11-01 Created: 2007-11-01Bibliographically approved
In thesis
1. Biochemical and Epidemiological Studies of Early-Onset and Late-Onset Pre-Eclampsia
Open this publication in new window or tab >>Biochemical and Epidemiological Studies of Early-Onset and Late-Onset Pre-Eclampsia
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Biochemical and epidemiological aspects of pre-eclampsia were investigated, with the main focus on possible pathophysiological differences between early-onset and late-onset disease.

In pre-eclamptic women poor correlation was found between albumin-creatinine ratio (ACR) in a random urine sample and total amount of albumin in a 24-hour urine collection. (Paper I)

In a cohort of women giving birth in Sweden in 1973-82 we estimated the adjusted incidence rate ratio (IRR) for ischaemic heart disease (IHD) during the years 1987–2001. The adjusted IRR for development of IHD was 1.6-2.8 in woman exposed to gestational hypertensive disease during her pregnancy compared with unexposed women. The higher risk represents more severe or recurrent hypertensive disease. (Paper II)

Before delivery, in early-onset pre-eclampsia (24-32 weeks) there were pronounced alterations in plasma concentrations of soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), and also a higher placental 8-iso-PGF concentration and an elevated serum ratio of plasminogen-activator inhibitor (PAI)-1 to PAI-2 compared with early controls. In late-onset pre-eclampsia (35-42 weeks) there were only moderate alterations in sFlt1 and PlGF concentrations, and the placental 8-iso-PGF concentration and PAI-1/ PAI-2 ratio were similar to those in late controls. (Papers III, V) There was a rapid postpartum decrease in sFlt1 concentration in all groups. One week postpartum the sFlt1 concentration was persistently higher, however, in women with early-onset pre-eclampsia compared with early controls. (Paper IV)

In conclusion: random ACR cannot replace 24-hour urine collections for quantification of albuminuria in pre-eclamptic women; gestational hypertensive disease, especially severe or recurrent, increases the risk for later IHD; early-onset, but not late-onset pre-eclampsia is associated with pronounced alterations of angiogenesis-related markers and only early-onset pre-eclampsia is associated with placental oxidative stress and an increased PAI-1/ PAI-2 ratio, all suggesting a stronger link between early-onset than late-onset pre-eclampsia and a dysfunctional placenta.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 80 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 282
Obstetrics and gynaecology, pre-eclampsia, proteinuria, albumin-creatinine ratio, ischaemic heart disease, angiogenesis, sFlt1, oxidative stress, isoprostane, PAI-1, PAI-2, Obstetrik och kvinnosjukdomar
urn:nbn:se:uu:diva-8279 (URN)978-91-554-7001-2 (ISBN)
Public defence
2007-11-23, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:15
Available from: 2007-11-01 Created: 2007-11-01Bibliographically approved

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