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BMFMS: Maternal Medicine

	PMM.01 DIFFERENCES IN PLACENTAL GLUTATHIONE PEROXIDASE ACTIVITIES AND MRNA EXPRESSION BETWEEN NORMAL AND PRE-ECLAMPTIC PREGNANCIES

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

Background: Pre-eclampsia is associated with impaired placentation, oxidative stress and systemic endothelial damage. Glutathione peroxidases (GPx1, 3 and 4) are selenoproteins and play critical roles in regulating antioxidant status; they reduce damaging hydrogen peroxide products, preventing the propagation of reactive oxygen species thereby protecting the endothelial lining of placental spiral arteries. We know of no systematic study of placental GPx in pre-eclampsia.

Objectives: To measure mRNA expression and activity of placental GPx in Caucasian women with pre-eclampsia (PE) and matched normotensive controls (NC).

Design: Hospital-based cross-sectional study, approved by LREC; informed, written consent was obtained from all subjects. PE: resting blood pressure of 140/90 mm Hg in a previously normotensive woman, with significant new, sustained proteinuria after 20 weeks’ gestation. Placentae were taken from 27 NC and 23 PE women. The mRNA expression levels of the three GPx (real-time PCR) and total GPx activities (spectrophotometric assay) were measured.

Results: Placental mRNA expression levels of all three GPx were not significantly different in PE compared with NC (p>0.05). However, total GPx enzyme activities (mean ± SD) were significantly reduced (p<0.05) in placentae from PE (0.1 ± 0.1 nmol/l) compared with NC (0.4 ± 0.3 nmol/l); no differences were found between placental sampling sites.

Conclusions: Oxidative stress associated with pre-eclampsia may be a consequence of reduced antioxidant defence specifically involving GPx. Our results indicate that a post-translational alteration leads to reduced GPx activities and that this may be important in the pathophysiology of pre-eclampsia.

	PMM.02 VITAMIN D DEFICIENCY AND SUPPLEMENTATION IN PREGNANT WOMEN OF FOUR ETHNIC GROUPS

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
C. Yu², L. Newton², S. Robinson¹, T. G. Teoh², M. Sethi¹. ¹Imperial College, London, UK, ²St Mary’s Hospital, London, UK

Objective: To determine the vitamin D status in pregnancy and to evaluate the effects of daily versus single-dose vitamin D supplementation in four ethnic groups.

Design: A randomised study in a London antenatal clinic.

Participants: 180 pregnant women: 45 Indian Asians, 45 middle eastern, 45 black and 45 Caucasian.

Intervention: Randomisation into three groups: a single oral dose of 200 000 IU vitamin D, a daily supplement of 800 IU vitamin D from 27 weeks and a no treatment group.

Results: At 27 weeks’ gestation, there was a significantly lower vitamin D level in Asian (25 ± 9.8 nmol/l), middle eastern (21 ± 9.3 nmol/l) and black women (23 ± 13.1 nmol/l) compared with Caucasian women (42 ± 16.6 nmol/l); p<0.001. Secondary hyperparathyroidism (n = 46) was significantly higher in Asian (26.7%), middle eastern (48.9%) and black women (24.4%) compared with Caucasian women (2.2%); p<0.05. Calcium levels were normal in all women at 27 weeks and at delivery. Predictors of vitamin D levels were ethnicity, age, parity and sunlight exposure. There was a significant increase in the maternal vitamin D in the supplemented group (daily dose 42 ± 24 nmol/l, stat dose 34 ± 15 nmol/l versus 27 ± 19 nmol/l in the no treatment group; p<0.0001), with no significant difference in the method of supplementation. Cord vitamin D was significantly increased after supplementation (daily dose 27 ± 16 nmol/l, stat dose 25 ± 10 nmol/l versus 17 ± 11 nmol/l in the no treatment group; p = 0.001).

Conclusions: Pregnant women may benefit from vitamin D supplementation in pregnancy, which can be achieved with a single dose at 27 weeks’ gestation.

	PMM.03 THE INFLUENCE OF PREGNANCY ON COGNITIVE ABILITY

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
D. Farrar², J. Neill¹, K. M. Marshall¹, D. J. Tuffnell². ¹University of Bradford, Bradford, UK, ²Bradford Institute for Health Research, Bradford, UK

Background: Studies suggest sex steroids influence learning and memory strategies. Data from human trials involving various hormone replacement regimens and assessment of memory in pregnancy appear equivocal. Pregnancy allows elevation of endogenous ovarian steroid levels, depending on concentration oestrogen can be neurologically protective or toxic. This investigation aims to increase the understanding of steroid effects on memory and attention during pregnancy.

Methods: Participants (n = 40) were tested preconceptually, each trimester and postnatally. A control group was tested using the same methodology. The Cambridge Neuropsychological Test Automated Battery, an objective computer-based psychometric assessment, was utilised to examine specific cognitive domains. Demographic, mood and general health data were collected at each session along with plasma for later analysis of hormone levels.

Results: Data indicate first and second trimester deficit in certain cognitive tasks. Group numbers at present are insufficient to provide meaningful third trimester examination. Analysis indicates groups are comparable in age, intelligence and general wellbeing (see table).

	PMM.04 WITHDRAWN

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 

	PMM.05 UTERINE MALFORMATIONS MAY BE ASSOCIATED WITH ABNORMALITIES IN THE HEPATOCYTE NUCLEAR FACTOR 1β GENE

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
J. Blackman, E. Edghill, S. Ellard, M. J. O. Taylor, C. Bingham. Royal Devon and Exeter NHS Trust, Exeter, UK

Introduction: Congenital genital tract malformations in women have a prevalence of 0.5–4.3%. During embryological development in the female the two Müllerian ducts fuse to form the vaginal tract and uterus. Incomplete fusion leads to numerous anomalies of the genital system. Renal tract malformations are sometimes associated with uterine malformations. Hepatocyte nuclear factor 1β (HNF1β) is a widely distributed transcription factor that plays a critical role in the development of the kidney, Müllerian duct, pancreas and liver. Heterozygous mutations and whole or partial gene deletions of the HNF1β gene are associated with renal disease, typically renal cysts, uterine malformations, diabetes, abnormal liver function tests and hyperuricaemia.

Aim: We aimed to identify women with Müllerian tract malformations and screen them for abnormalities in the HNF1β gene.

Methods: A total of 23 women were recruited from the early pregnancy assessment unit, or at the time of Caesarean section or gynaecological surgery. The HNF1β gene was screened for mutations using direct sequencing and a multiplex ligation-dependent probe amplification assay to detect whole and partial gene deletions.

Results: One patient with a bicornuate uterus had a heterozygous whole HNF1β gene deletion (Met1_Trp557del). On subsequent investigation this patient was found to have cystic kidneys and abnormal liver function tests. Tests of renal function, blood glucose and urate were normal.

Conclusions: Uterine malformations may be associated with abnormalities in the HNF1β gene. The HNF1β phenotype is associated with multisystem disease but patients may present initially to obstetricians.

	PMM.06 WITHDRAWN

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 

	PMM.07 WITHDRAWN

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 

	PMM.08 A PROSPECTIVE STUDY OF MATERNAL ENDOTHELIAL FUNCTION, ANGIOGENIC FACTORS AND PLACENTAL PERFUSION IN WOMEN WHO DEVELOP FUTURE PRE-ECLAMPSIA

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
M. Noori¹, A. Donald², M. Savvidou³, A. Hingorani⁴, D. Williams⁵. ¹Imperial College, London, UK, ²Institute of Child Health, University College London, London, UK, ³Harris Birthright Research Centre, Kings College Hospital, London, UK, ⁴Centre for Clinical Pharmacology, British Heart Foundation Laboratories, University College London, London, UK, ⁵Institute of Women’s Health and Elizabeth Garrett Anderson Hospital, University College London, London, UK

Introduction: It has been postulated from cross-sectional studies that inhibitors of angiogenesis induce maternal endothelial dysfunction that leads to pre-eclampsia. We tested this hypothesis in a prospective study.

Methods: 163 women were followed from early pregnancy (12 weeks) until 3 months postpartum. Twenty-four of these women developed pre-eclampsia. Endothelial function (flow-mediated dilatation), mean arterial pressure (MAP) and levels of placental growth factor (PlGF), soluble vascular endothelial growth factor receptor-1 (sFlt-1), soluble endoglin (sEng) and the sFlt-1 : PlGF ratio were measured prospectively through pregnancy. At 24 weeks’ gestation, uteroplacental blood flow (pulsatility index; PI) was assessed using Doppler ultrasound.

Results: From the first trimester, women who developed pre-eclampsia, particularly before 34 weeks, had a higher MAP (p<0.0005), endoglin (p = 0.002), sFlt-1 : PlGF ratio (p<0.0005) and suppressed levels of PlGF (p = 0.001) compared with those who did not develop pre-eclampsia. Women who developed pre-eclampsia also had the highest uteroplacental PI at 24 weeks’ gestation compared with women who did not develop pre-eclampsia (p = 0.0008). Brachial artery FMD was not significantly different among the two groups as pregnancy advanced. At 24 weeks’ gestation, levels of pro and anti-angiogenic factors correlated with MAP and PI.

Conclusions: We have prospectively demonstrated alterations in serum PlGF, sFlt-1 and endoglin from early pregnancy in women who went on to develop pre-eclampsia. Levels of soluble factors correlated with MAP and PI at 24 weeks suggesting possible causality. Measurement of pro and anti-angiogenic factors in conjunction with MAP and PI hold promise as a tool for evaluating the risk of developing pre-eclampsia.

	PMM.09 EFFECT OF ANTIHYPERTENSIVE TREATMENT ON ANGIOGENIC FACTORS IN WOMEN WITH HYPERTENSIVE DISORDERS IN PREGNANCY

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
A. Khalil¹, S. Muttukrishna², K. Harrington¹, E. Jauniaux². ¹Queen Mary, University of London, London, UK, ²University College London, London, UK

Angiogenic factors play an important role in the pathophysiology of pre-eclampsia. It has recently been shown that antihypertensive drugs can alter cytokine release in normal and hypertensive pregnancy. These cytokines are known to stimulate secretion of both soluble fms-like tyrosine kinase 1 (sFlt-1) and vascular endothelial growth factor. It is not known if antihypertensive therapy can affect the secretion of angiogenic factors in pre-eclampsia.

We recruited 63 women with pre-eclampsia, 66 with non-proteinuric hypertension and 129 matched normotensive controls. Placental growth factor (PlGF), sFlt-1 and soluble endoglin (sEng) levels, before and 24–48 h after initiating antihypertensives, were measured using an ELISA. Having validated these assays for placenta, the same markers were measured in 84 placentas delivered at Caesarean section (29 pre-eclampsia, 24 hypertension and 31 controls).

The three study groups were compared using ANOVA multiple comparisons. Data were normally distributed after logarithmic transformation. Marker levels before and after antihypertensive therapy were compared using a paired t-test.

In both pre-eclampsia and hypertension, serum sFlt-1 was increased, and PlGF reduced at all gestations (p<0.0001). sEng levels were also increased in pre-eclampsia. After 28 weeks, antihypertensive treatment was associated with a significant fall in serum sFlt-1 and sEng in pre-eclampsia only. The concentrations of both sFlt-1 and sEng were significantly higher in the placentas of women with pre-eclampsia, but not hypertension, compared with controls (p = 0.0002). Only sFlt-1 was significantly reduced in the placenta in treated women.

Antihypertensive drugs may have an effect on the pathophysiology of pre-eclampsia other than their known antihypertensive action.

	PMM.10 PRE-ECLAMPSIA IN THE SECOND PREGNANCY: DOES PREVIOUS OUTCOME MATTER?

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
S. Bhattacharya¹, D. M. Campbell¹, N. Smith². ¹University of Aberdeen, Aberdeen, UK, ²Grampian University Hospitals Trust, Aberdeen, UK

Background: Although previous term live birth has been unequivocally shown to be protective, opinion is divided as to the effect of a previous abortive outcome on the risk of pre-eclampsia.

Objective: To assess the effect of initial pregnancy outcome and gestational age on the risk of pre-eclampsia in the second pregnancy.

Methods: We conducted a case–control study using data from the Aberdeen Maternity and Neonatal Databank between 1986 and 2006. Cases were women who had pre-eclampsia and controls were normotensive in their second pregnancy. Crude and adjusted odds ratios (OR) were produced for each of the risk factors using logistic regression.

Results: Inter-pregnancy intervals of 6 years or more were associated with increased incidence of pre-eclampsia (19.4% versus 14.7%). A change of partner had a protective effect whereas an increase in BMI increased the risk of pre-eclampsia. A history of pre-eclampsia was associated with a five times higher risk (adjusted OR 5.12, 95% CI 4.42 to 6.48) of pre-eclampsia in the second pregnancy. Compared with a term delivery, a previous second trimester abortion was associated with a four times higher risk of pre-eclampsia in the next pregnancy. Previous very preterm and preterm births were associated with adjusted OR of 2.32 (95% CI 1.62 to 3.32) and 1.62 (95% CI 1.46 to 1.72), respectively. The risk of pre-eclampsia was no higher in women with a previous history of stillbirth or late miscarriage than those with a previous live birth.

Conclusions: Only deliveries beyond 37 weeks, irrespective of outcome, were protective against pre-eclampsia in the second pregnancy.

	PMM.11 THE USE OF SPOT URINE PROTEIN : CREATININE RATIO IN THE DIAGNOSIS OF PRE-ECLAMPSIA

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF... PMM.12 MATERNAL VITAMIN D... PMM.13 PHYSICAL ACTIVITY... PMM.14 OBESITY IN PREGNANCY:... PMM.15 ARE WE OVERTREATING... PMM.16 PLASMA SFLT-1 AND... PMM.17 PREGNANCY OUTCOMES IN... PMM.18 PROGESTERONE FOR... PMM.19 ASSESSMENT OF CERVICAL... PMM.20 IS ANTENATAL STRESS,... PMM.21 THE INCREASING INCIDENCE... PMM.22 PREGNANT SUBSTANCE... PMM.23 ALTERNATIVE VILLOUS... PMM.24 ORAL HEALTH-RELATED... PMM.25 PERINATAL CONSEQUENCES OF... PMM.26 ANTENATAL SUPPORT AND... PMM.27 DON'T THROW THE... PMM.28 PRECOG DAY ASSESSMENT... PMM.29 THERAPEUTIC MANAGEMENT OF... PMM.30 WEST MIDLANDS... PMM.31 THE RISK OF... PMM.32 HOW ACCURATE IS... PMM.33 OUTCOMES AND ADVERSE... PMM.34 A LONGITUDINAL ANALYSIS... PMM.35 DON'T OVER EGG... PMM.36 OBSTETRIC OUTCOME IN... PMM.37 PEOPLE'S UNDERSTANDING OF... PMM.38 TYPE 1 AND... PMM.39 PREGNANCY IN WOMEN... PMM.40 EXTERNAL CEPHALIC... PMM.41 IMPROVING MANAGEMENT OF... PMM.42 IMPACT OF PERSISTENT... PMM.43 SEROEPIDEMIOLOGICAL STUDY... PMM.44 TREND OF OBESITY... PMM.45 "THYROTOXICOSIS IN... PMM.46 PRELIMINARY EXPERIENCE... PMM.47 PRE-PREGNANCY COUNSELLING... PMM.48 STUDY OF PREGNANT... PMM.49 PRECONCEPTION CARE IN... PMM.50 MANAGEMENT OF PREGNANCY... PMM.51 TEENAGE PREGNANCY OUTCOME... PMM.52 MULTIDISCIPLINARY TEAM... PMM.53 AUDIT OF PARENTERAL... REFERENCES

 
L. Newton, C. Biswas. St Mary’s NHS Trust, London, UK

Aim: The aim of this retrospective observational study was to compare the accuracy of the spot urine protein : creatinine ratio with the gold standard of a 24-h urine collection in the diagnosis of pre-eclampsia in 66 paired samples.

Results: Using uPCR cut-off value of 30 as "positive", 22.2% (2/9) women with <0.3 g/24 h of protein had a false positive result. In women with mild proteinuria (between 0.3 g and 1 g/24 h; n = 12) there were no false positives or false negatives; in these women, the value of (uPCR x 10) approximated the amount of protein in the urine over 24 h. In women with >1 g/24 h of proteinuria, four of nine uPCR samples underestimated the amount of protein in the urine; however, there were no negative uPCR. Similarly in women with >3 g/24 h of proteinuria two of three samples underestimated the amount of proteinuria, but again there were no negative uPCR. In summary, the sensitivity of urine protein : creatinine ratios was found to be 100% (24/24) with a positive predictive value of 92% (24/26). The specificity was 77% (7/9) and the negative predictive value was 100% (7/7).

Conclusions: Spot urine protein : creatinine ratio can be used as a quick, convenient and effective method of screening to assist with the diagnosis of pre-eclampsia. However, we found that it underestimated the amount of protein in women with >1 g urine protein/24 h, thus a 24-h urine collection may still be indicated in women with pre-eclampsia.

	PMM.12 MATERNAL VITAMIN D STATUS IN DIABETIC PREGNANCY

TOP PMM.01 DIFFERENCES IN PLACENTAL... PMM.02 VITAMIN D DEFICIENCY... PMM.03 THE INFLUENCE OF... PMM.04 WITHDRAWN PMM.05 UTERINE MALFORMATIONS MAY... PMM.06 WITHDRAWN PMM.07 WITHDRAWN PMM.08 A PROSPECTIVE STUDY... PMM.09 EFFECT OF... PMM.10 PRE-ECLAMPSIA IN THE... PMM.11 THE USE OF...