Vasoactive mediators in pregnancy-induced hypertensive disorders: A longitudinal study

• Published in: American journal of obstetrics and gynecology 1998-12, Vol.179 (6), p.1559-1564
• Main Authors: Paarlberg, K.Marieke, de Jong, Catharina L.D., van Geijn, Herman P., van Kamp, Gerard J., Heinen, Antonius G.J.J., Dekker, Gustaaf A.
• Format: Article
• Language: English
• Subjects: 6-Keto-prostaglandin F 1α , endothelin, endothelium, preeclampsia, thromboxane A 2 /prostacyclin balance, thromboxane B 2; 6-Ketoprostaglandin F1 alpha - urine; Adult; Biological and medical sciences; Diseases of mother, fetus and pregnancy; Eicosanoids - urine; Endothelins - blood; Female; Gynecology. Andrology. Obstetrics; Humans; Hypertension - blood; Hypertension - metabolism; Hypertension - urine; Longitudinal Studies; Medical sciences; Pre-Eclampsia - blood; Pre-Eclampsia - metabolism; Pre-Eclampsia - urine; Pregnancy - blood; Pregnancy - urine; Pregnancy Complications, Cardiovascular - blood; Pregnancy Complications, Cardiovascular - metabolism; Pregnancy Complications, Cardiovascular - urine; Pregnancy. Fetus. Placenta; Reference Values; Thromboxane A2 - urine; Thromboxane B2 - urine
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70024-9

Objective: The objective of this study was to evaluate the extent to which endothelin and the eicosanoids prostacyclin and thromboxane A 2 are involved in the pathophysiology of gestational hypertension and preeclampsia. Study Design: In a longitudinal design, venous blood samples and 24-hour urine specimens were collected from 396 women in each trimester of pregnancy. After delivery of all patients, venous plasma endothelin was assessed in 20 subjects with identified preeclampsia, 48 subjects with gestational hypertension, and 59 normotensive subjects. Urinary excretions of the thromboxane A 2 and of the prostacyclin metabolites thromboxane B 2 and 6-keto-prostaglandin F 1 α were assessed in 16 subjects with preeclampsia, 35 subjects with gestational hypertension, and 31 normotensive subjects. Results: Endothelin levels showed a second-trimester drop in all groups. In all 3 gestational trimesters a high correlation was found between the excretion of thromboxane B 2 and that of 6-keto-prostaglandin F 1 α ( P < .001). The overall thromboxane B 2 and 6-keto-prostaglandin F 1 α urinary excretions increased throughout pregnancy and the overall thromboxane B 2 /6-keto-prostaglandin F 1 α ratio decreased. No significant differences in endothelin, thromboxane B 2 , and 6-keto-prostaglandin F 1 α excretion levels or in thromboxane B 2 /6-keto-prostaglandin F 1 α ratios were found between women with preeclampsia, gestational hypertension, and normotension. Only in a small group of patients with severe preeclampsia (n = 2) and severe gestational hypertension (n = 2) were increased second-trimester endothelin values and increased thromboxane B 2 /6-keto-prostaglandin F 1 α ratios found. Conclusion: In this longitudinal study we found no evidence for prostacyclin deficiency or increased endothelin levels in preeclampsia. Only women with severe preeclampsia and severe gestational hypertension expressed increased endothelin levels and thromboxane dominance over prostacyclin. (Am J Obstet Gynecol 1998;179:1559-64.)