An internationally known authority, Dr. Roberts will argue that preeclampsia is a maternal disease. Christopher Redman, M.D., of the University of Oxford, England, will take a contrary position, arguing that preeclampsia is a fetal disease.
"It's a way to present the state-of-the-art in preeclampsia research," said Dr. Roberts, professor and vice chairman of research in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "But the impact goes beyond pregnancy because the risks for preeclampsia are the same as those for cardiovascular disease later in life."
Some 5 percent of first pregnancies are complicated by preeclampsia, a condition characterized by soaring blood pressure and protein in the urine, that is a leading cause of maternal, fetal and neonatal disability and death, particularly in undeveloped countries and among underserved populations.
The preeclampsia debate is scheduled for 2 p.m. ET Thursday, March 23.
Among other findings being presented are:
Heart disease biomarker remains elevated even 30 years after eclamptic pregnancy
C-reactive protein (CRP), an inflammatory marker associated with a higher risk of cardiovascular disease, remains elevated even 30 years after a pregnancy distinguished by eclampsia, according to a study from MWRI. A life-threatening complication of pregnancy, eclampsia occasionally succeeds preeclampsia and can involve coma, convulsions and organ failure. Although intravenous infusion of magnesium sulfate can decrease the likelihood that a woman with preeclampsia will develop eclamptic seizures, the only effective treatment for the syndrome is immediate delivery, which can be dangerous for the baby if it is too early in the pregnancy.
"We found that levels of CRP were doubled in postmenopausal women who had a prior episode of eclampsia compared to those who had a history of normal pregnancies," said Carl Hubel, Ph.D., lead author, assistant professor of obstetrics, gynecology and reproductive sciences and environmental and occupational health at the University of Pittsburgh School of Medicine and an MWRI assistant investigator. "The finding is even more striking because this difference remained after adjusting for other, potentially confounding risk factors such as age, weight, smoking and use of hormone-replacement therapy."
The finding indicates that pregnancy outcome could be viewed as "a natural early stress test" for future risk of cardiovascular disease – the leading cause of death for women. "We propose that prior preeclampsia – particularly severe preeclampsia – be considered as a red flag to identify women of reproductive age who stand to benefit from cardiovascular risk factor modification," said Dr. Hubel. "If we can identify these differences during a woman's reproductive years and intervene with lifestyle changes early and aggressively, we may be able to impact her future risk. Early screening here is vital."
For the current study, Dr. Hubel and his colleagues compared data available from a previous study on 25 Icelandic women with prior eclampsia and 28 Icelandic women with normal pregnancies. Additional authors include Robert Powers, Ph.D.; Hilary Gammill, M.D.; James Roberts, M.D.; and Roberta Ness, M.D., M.P.H., all of the University of Pittsburgh; and Sunna Snaedal, M.D., Karolinska University Hospital, Stockholm, Sweden; and Reynir Arngrimsson, Ph.D., University of Iceland, Reykjavik.
Dr. Hubel will be presenting at 12:45 p.m. ET Saturday, March 25.
Imaging technology allows first-time visualization of infection related to preterm birth
Using positron emission tomography (PET) scanning, University of Pittsburgh researchers were able to visualize changes associated with intrauterine infection for the first time in a non-invasive way, according to lead author Hyagriv Simhan, M.D., assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and a specialist in infectious diseases in pregnancy.
"Much of preterm birth can be associated with infection and inflammation," said Dr. Simhan, who is an assistant investigator at MWRI. "Using this powerful technology gives us an opportunity to evaluate therapeutic strategies with respect to the inflammatory response and may lead to future clinical application for the detection of fetal inflammation."
In the current study, Dr. Simhan and his colleagues used microPET imaging to evaluate biomarkers employed to trace the action of amniotic fluid infection in an animal model. Tracer molecules attached to immune system cells, called macrophages, that are part of the body's inflammatory response, allowed the researchers to see evidence of inflammation in infected animals, all of which delivered preterm. By contrast, control animals experienced normal pregnancies.
"Using PET, we also discovered decreased activity in fetal brain glucose metabolism in the infected animals," said Dr. Simhan. "Although we don't yet know what this means, the ability to visualize these changes is significant. To be able to do this non-invasively is a real advance in the possible treatment of preterm birth related to infection."
Additional authors include Neal Mason, Ph.D.; Saviero Capuano, D.V.M.; Gerald Schatten, Ph.D.; Brian Lopresti, B.S.; and Steve Caritis, M.D.; all of the University of Pittsburgh.
Dr. Simhan will be presenting at 12:45 p.m. ET Saturday, March 25.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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