Prognostic Value of Cardiovascular Disease Risk Factors Measured in the First-Trimester on the Severity of Preeclampsia

Abstract

Recent studies have suggested that preeclampsia and cardiovascular disease may share common mechanisms. The purpose of this prospective nested case-controlled study was to characterize a variety of cardiovascular disease risk factors measured during the first trimester of pregnancy in predicting subsequent outcomes and the severity of preeclampsia.We ascertained the severity of preeclampsia at the onset of the disease, and the presence of intrauterine growth restriction (IUGR). We compared first trimester maternal serum cardiovascular disease risk factors in preeclampsia subjects versus normal pregnancies, early-onset versus late-onset preeclampsia, and preeclampsia with IUGR versus without IUGR. To identify the prognostic value of independent predictors on the severity of preeclampsia, we calculated the area under the receiver operating characteristics curve (AUC) using logistic regression analysis.There were 134 cases of preeclampsia and 150 uncomplicated pregnancies, and preeclampsia cases were classified as early-onset (53 cases) or late-onset (81 cases), or as with IUGR (44 cases) or without IUGR (90 cases). Among the cardiovascular disease risk factors, maternal serum high-sensitive C-reactive protein (hsCRP) and homocysteine were predictors of both early-onset preeclampsia and preeclampsia with IUGR. For the detection of early onset preeclampsia or preeclampsia with IUGR, the AUC for the combination model (0.943 and 0.952, respectively) was significantly higher than with serum hsCRP or serum homocysteine only.Patients with preeclampsia can be subdivided into different severities according to time of onset and fetal weight. Cardiovascular risk factors distinguish a subgroup of these patients.

FIGURE 1

Receiver operating characteristics curves of high-sensitive C-reactive protein (hsCRP), homocysteine, and the combination of the 2 in the prediction of early-onset preeclampsia.

FIGURE 2

Receiver operating characteristics curves of hsCRP, homocysteine, and the combination of the 2 in the prediction of preeclampsia with IUGR. hsCRP = high-sensitive C-reactive protein, IUGR = intrauterine growth restriction.

FIGURE 3

Two-stage different-disease model of the pathogenesis of preeclampsia. The model emphasizes that abnormal placental perfusion (stage I) interacts with different maternal constitutional factors (oxidative, inflammatory, and dysmetabolic processes) to result in diseases with different severities in stage II.