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Underlying disorders associated with severe early-onset preeclampsia
G A Dekker1, J I de Vries, P M Doelitzsch
1Department of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands.
Insights
Women with severe early-onset preeclampsia often have clotting and metabolic issues. Screening for protein S deficiency, hyperhomocysteinemia, and anticardiolipin antibodies is recommended for future pregnancy management.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Metabolic Disorders
Background:
- Severe early-onset preeclampsia is linked to an increased risk of vascular thrombosis.
- Understanding underlying hemostatic and metabolic abnormalities is crucial for patient management.
Purpose of the Study:
- To investigate hemostatic and metabolic abnormalities in patients with a history of severe early-onset preeclampsia.
- To determine associations with a tendency for vascular thrombosis.
Main Methods:
- A cohort of 101 patients with severe early-onset preeclampsia were evaluated post partum.
- Tests included hyperhomocysteinemia (methionine loading test), protein S deficiency, activated protein C resistance, and anticardiolipin antibodies.
Main Results:
- Protein S deficiency was found in 24.7% of tested patients.
- Hyperhomocysteinemia was present in 17.7%, activated protein C resistance in 16.0%, and anticardiolipin antibodies in 29.4%.
Conclusions:
- Patients with severe early-onset preeclampsia show a high prevalence of clotting and metabolic abnormalities.
- Screening for protein S deficiency, hyperhomocysteinemia, activated protein C resistance, and anticardiolipin antibodies is advised for future pregnancy counseling and management.
Objective:
Our purpose was to determine whether patients with severe early-onset preeclampsia have hemostatic or metabolic abnormalities that are associated with a tendency to vascular thrombosis.
Study Design:
A total of 101 patients with a history of severe early-onset preeclampsia were tested at least 10 weeks post partum for the presence of hyperhomocysteinemia (methionine loading test), protein C, protein S, and antithrombin III deficiency, activated protein C resistance, lupus anticoagulant, and immunoglobulin G and/or M anticardiolipin antibodies.
Results:
Of the 101 patients, 39 (38.6%) had chronic hypertension. Of the 85 patients tested for coagulation disturbances, 21 (24.7%) had protein S deficiency. Of the 50 patients tested for activated protein C resistance, 8 (16.0%) were positive. Of the 79 patients tested for hyperhomocysteinemia, 14 (17.7%) had a positive methionine loading test. Finally, 95 patients were tested for anticardiolipin antibodies; 27 (29.4%) had detectable immunoglobulin G and/or M anticardiolipin antibodies.
Conclusion:
Patients with a history of severe early-onset preeclampsia should be screened for protein S deficiency, activated protein C resistance, hyperhomocysteinemia, and anticardiolipin antibodies, since these results may have an impact on counseling for and pharmacologic management in future pregnancies.