Prediction and prevention of pre-eclampsia

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Pre-eclampsia occurs in 2 to 8% of all pregnancies. Every year 70,000 women die due to pre-eclampsia and its complications. Most of these deaths occur in developing countries. In developed countries, the risk of maternal or fetal death is low, but the complications of pre-eclampsia may be severe. Early-onset disease may end in a very preterm birth, since delivery is the only treatment available. We studied prediction and prevention of pre-eclampsia in the PREDO cohort, which involved 947 pregnant women with risk factors of pre-eclampsia and 117 controls. Our study included also a meta-analysis showing that low-dose aspirin, 100 mg per day, prevents pre-eclampsia (risk ratio [RR] 0.6, 95% CI 0.37-0.83) and particularly severe (RR 0.3, 95% CI 0.11-0.69) pre-eclampsia, when the treatment is started before the 16th week of pregnancy in high-risk women. We estimated the risk using medical history and by measuring uterine artery flow with Doppler ultrasound. In our cohort, those women who had had pre-eclampsia or a small-for-gestational-age newborn in an earlier pregnancy, or who had chronic hypertension or type I diabetes mellitus had a high risk for developing early onset pre-eclampsia. The risk of pre-eclampsia increased exponentially with increasing number of risk factors. In the future, it may be possible to predict pre-eclampsia in early pregnancy with risk-estimating algorithms. In the midpregnancy, it is possible to predict pre-eclampsia by measuring serum placental growth factor (PlGF) and soluble vascular endothelial growth factor-1 (sFlt-1) concentrations. In our cohort, all women who developed early-onset pre-eclampsia could be identified, with no false positives, 4 to 6 weeks prior to the diagnosis with sFlt-1:PlGF ratio measurement. This may help to plan individual follow-up in at-risk women, and also help in the clinical decision-making among women with signs and symptoms of pre-eclampsia. Women with chronic hypertension are followed during pregnancy because of an increased risk of pre-eclampsia. We found that an increased albumin:creatine ratio predicts pre-eclampsia in early pregnancy in these women and may help in individual risk estimation. We showed that free fatty acid concentrations are significantly elevated in women with established pre-eclampsia compared to controls. This may underlie several characteristics of pre-eclampsia, for example endothelial cell dysfunction.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3605-3
Electronic ISBNs978-951-51-3606-0
Publication statusPublished - 2017
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3123 Gynaecology and paediatrics

Cite this

Villa, P. M. (2017). Prediction and prevention of pre-eclampsia. Helsinki: [P. M. Villa] .
Villa, Pia Maria. / Prediction and prevention of pre-eclampsia. Helsinki : [P. M. Villa] , 2017. 107 p.
@phdthesis{18fb1009327848f797d3300717abaf5c,
title = "Prediction and prevention of pre-eclampsia",
abstract = "Pre-eclampsia occurs in 2 to 8{\%} of all pregnancies. Every year 70,000 women die due to pre-eclampsia and its complications. Most of these deaths occur in developing countries. In developed countries, the risk of maternal or fetal death is low, but the complications of pre-eclampsia may be severe. Early-onset disease may end in a very preterm birth, since delivery is the only treatment available. We studied prediction and prevention of pre-eclampsia in the PREDO cohort, which involved 947 pregnant women with risk factors of pre-eclampsia and 117 controls. Our study included also a meta-analysis showing that low-dose aspirin, 100 mg per day, prevents pre-eclampsia (risk ratio [RR] 0.6, 95{\%} CI 0.37-0.83) and particularly severe (RR 0.3, 95{\%} CI 0.11-0.69) pre-eclampsia, when the treatment is started before the 16th week of pregnancy in high-risk women. We estimated the risk using medical history and by measuring uterine artery flow with Doppler ultrasound. In our cohort, those women who had had pre-eclampsia or a small-for-gestational-age newborn in an earlier pregnancy, or who had chronic hypertension or type I diabetes mellitus had a high risk for developing early onset pre-eclampsia. The risk of pre-eclampsia increased exponentially with increasing number of risk factors. In the future, it may be possible to predict pre-eclampsia in early pregnancy with risk-estimating algorithms. In the midpregnancy, it is possible to predict pre-eclampsia by measuring serum placental growth factor (PlGF) and soluble vascular endothelial growth factor-1 (sFlt-1) concentrations. In our cohort, all women who developed early-onset pre-eclampsia could be identified, with no false positives, 4 to 6 weeks prior to the diagnosis with sFlt-1:PlGF ratio measurement. This may help to plan individual follow-up in at-risk women, and also help in the clinical decision-making among women with signs and symptoms of pre-eclampsia. Women with chronic hypertension are followed during pregnancy because of an increased risk of pre-eclampsia. We found that an increased albumin:creatine ratio predicts pre-eclampsia in early pregnancy in these women and may help in individual risk estimation. We showed that free fatty acid concentrations are significantly elevated in women with established pre-eclampsia compared to controls. This may underlie several characteristics of pre-eclampsia, for example endothelial cell dysfunction.",
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author = "Villa, {Pia Maria}",
note = "M1 - 107 s. + liitteet Volume: Proceeding volume:",
year = "2017",
language = "English",
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publisher = "[P. M. Villa]",
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Prediction and prevention of pre-eclampsia. / Villa, Pia Maria.

Helsinki : [P. M. Villa] , 2017. 107 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Prediction and prevention of pre-eclampsia

AU - Villa, Pia Maria

N1 - M1 - 107 s. + liitteet Volume: Proceeding volume:

PY - 2017

Y1 - 2017

N2 - Pre-eclampsia occurs in 2 to 8% of all pregnancies. Every year 70,000 women die due to pre-eclampsia and its complications. Most of these deaths occur in developing countries. In developed countries, the risk of maternal or fetal death is low, but the complications of pre-eclampsia may be severe. Early-onset disease may end in a very preterm birth, since delivery is the only treatment available. We studied prediction and prevention of pre-eclampsia in the PREDO cohort, which involved 947 pregnant women with risk factors of pre-eclampsia and 117 controls. Our study included also a meta-analysis showing that low-dose aspirin, 100 mg per day, prevents pre-eclampsia (risk ratio [RR] 0.6, 95% CI 0.37-0.83) and particularly severe (RR 0.3, 95% CI 0.11-0.69) pre-eclampsia, when the treatment is started before the 16th week of pregnancy in high-risk women. We estimated the risk using medical history and by measuring uterine artery flow with Doppler ultrasound. In our cohort, those women who had had pre-eclampsia or a small-for-gestational-age newborn in an earlier pregnancy, or who had chronic hypertension or type I diabetes mellitus had a high risk for developing early onset pre-eclampsia. The risk of pre-eclampsia increased exponentially with increasing number of risk factors. In the future, it may be possible to predict pre-eclampsia in early pregnancy with risk-estimating algorithms. In the midpregnancy, it is possible to predict pre-eclampsia by measuring serum placental growth factor (PlGF) and soluble vascular endothelial growth factor-1 (sFlt-1) concentrations. In our cohort, all women who developed early-onset pre-eclampsia could be identified, with no false positives, 4 to 6 weeks prior to the diagnosis with sFlt-1:PlGF ratio measurement. This may help to plan individual follow-up in at-risk women, and also help in the clinical decision-making among women with signs and symptoms of pre-eclampsia. Women with chronic hypertension are followed during pregnancy because of an increased risk of pre-eclampsia. We found that an increased albumin:creatine ratio predicts pre-eclampsia in early pregnancy in these women and may help in individual risk estimation. We showed that free fatty acid concentrations are significantly elevated in women with established pre-eclampsia compared to controls. This may underlie several characteristics of pre-eclampsia, for example endothelial cell dysfunction.

AB - Pre-eclampsia occurs in 2 to 8% of all pregnancies. Every year 70,000 women die due to pre-eclampsia and its complications. Most of these deaths occur in developing countries. In developed countries, the risk of maternal or fetal death is low, but the complications of pre-eclampsia may be severe. Early-onset disease may end in a very preterm birth, since delivery is the only treatment available. We studied prediction and prevention of pre-eclampsia in the PREDO cohort, which involved 947 pregnant women with risk factors of pre-eclampsia and 117 controls. Our study included also a meta-analysis showing that low-dose aspirin, 100 mg per day, prevents pre-eclampsia (risk ratio [RR] 0.6, 95% CI 0.37-0.83) and particularly severe (RR 0.3, 95% CI 0.11-0.69) pre-eclampsia, when the treatment is started before the 16th week of pregnancy in high-risk women. We estimated the risk using medical history and by measuring uterine artery flow with Doppler ultrasound. In our cohort, those women who had had pre-eclampsia or a small-for-gestational-age newborn in an earlier pregnancy, or who had chronic hypertension or type I diabetes mellitus had a high risk for developing early onset pre-eclampsia. The risk of pre-eclampsia increased exponentially with increasing number of risk factors. In the future, it may be possible to predict pre-eclampsia in early pregnancy with risk-estimating algorithms. In the midpregnancy, it is possible to predict pre-eclampsia by measuring serum placental growth factor (PlGF) and soluble vascular endothelial growth factor-1 (sFlt-1) concentrations. In our cohort, all women who developed early-onset pre-eclampsia could be identified, with no false positives, 4 to 6 weeks prior to the diagnosis with sFlt-1:PlGF ratio measurement. This may help to plan individual follow-up in at-risk women, and also help in the clinical decision-making among women with signs and symptoms of pre-eclampsia. Women with chronic hypertension are followed during pregnancy because of an increased risk of pre-eclampsia. We found that an increased albumin:creatine ratio predicts pre-eclampsia in early pregnancy in these women and may help in individual risk estimation. We showed that free fatty acid concentrations are significantly elevated in women with established pre-eclampsia compared to controls. This may underlie several characteristics of pre-eclampsia, for example endothelial cell dysfunction.

KW - Aspirin

KW - +therapeutic use

KW - Biomarkers

KW - Fatty Acids

KW - +blood

KW - Predictive Value of Tests

KW - Pre-Eclampsia

KW - +diagnosis

KW - +prevention & control

KW - Pregnancy, High-Risk

KW - Pregnancy Proteins

KW - Risk factors

KW - 3123 Gynaecology and paediatrics

M3 - Doctoral Thesis

SN - 978-951-51-3605-3

PB - [P. M. Villa]

CY - Helsinki

ER -

Villa PM. Prediction and prevention of pre-eclampsia. Helsinki: [P. M. Villa] , 2017. 107 p.