Cardiology Letters 2015, 24(6):430-434

Markers of endothelial dysfunction as predictors of gestational hypertension and preeclampsia

Kolesárová E¹, Janičko M²

¹ Neštátna interná a nefrologická ambulancia, Medikol s.r.o., Košice

² I. interná klinika LF UPJŠ, Košice, Slovenská republika

Objective: To determine markers of endothelial dysfunction (ED) during pregnancy, identifying risk patients in terms of the development of gestational hypertension and possible development of cardiovascular (CV) disease in later life, and the evaluation of later cardiovascular risk in women with abortions in anamnesis.

Materials and methods: A prospective cohort study was performed on 61 pregnant patients during the first trimester of pregnancy, with anamnesis of risk for developing gestational hypertension. While 11 patients had pre-existing arterial hypertension (AH), 10 pregnant women had developed gestational AH and 40 women did not have hypertensive disorders. Their average age was 33.49 ± 3.99 years. Patients were examined in three stages: before the 20th week of pregnancy, after the 20th week of pregnancy and after puerperium. As a marker of ED in our work we monitored the asymmetric dimethylarginine (ADMA), C-reactive protein determined by the ultrasensitive method (CRPus), uric acid, microalbuminury (MAU), and procoagulant factors of D-dimer and fibrinogen.

Results: We found a significant difference in levels of CRPus before 20th week of pregnancy. Patients who later developed gestational AH had about 3 times higher average values of CRPus before 20th week, compared with patients without AH (13.77 ± 3.17 mg/ml vs. 5.29 ± 4.31 mg/ml, p = 0.002), and even higher values than patients with pre-existing AH (13.77 ± 3.17 mcg/ml vs. 7.98 ± 3.85 mg/ml, p = 0.002). An important predictor of gestational AH in our study has clearly proven to be CRPus, whose significantly higher level before 20th week of pregnancy identifies patients at risk for developing gestational AH. We did not find statistically significant difference in levels of ADMA among the three groups of patients. Levels of ADMA were significantly higher after puerperium in women with an anamnesis of previous spontaneous abortions, which supports the hypothesis that these patients also have an increased cardiovascular risk in later life. Discussion and conclusion: For common practice we recommend routine determination of CRPus in the first half of pregnancy to identify women at risk of developing gestational hypertension or preeclampsia.

Keywords: gestational hypertension; CRPus; endothelial dysfunction; cardiovascular risk

Published: June 1, 2015  Show citation