Obstetrics

NEW ORLEANS — Measurement of B-type natriuretic peptide levels in pregnancy shows promise for the management of preeclamptic patients, Vikas Bhalla, M.D., said during the annual scientific sessions of the American Heart Association.

The plasma B-type natriuretic peptide (BNP) test is a rapid, relatively inexpensive point-of-care test approved for diagnosis of heart failure in patients presenting with shortness of breath to the emergency department and other acute care settings. In this setting, BNP level correlates with wedge pressure, severity of heart failure, and prognosis.

Potential obstetric applications under study include use of the BNP test to identify women with preeclampsia before they become hypertensive and proteinuric, as well as to guide physicians in the particularly thorny problem of when to deliver affected patients, according to Dr. Bhalla of the University of California, San Diego.

BNP is synthesized in cardiac ventricular tissue, primarily in response to volume expansion and pressure overload. Preeclampsia, which complicates 5% of pregnancies and causes considerable maternal and neonatal morbidity, is characterized by markedly increased peripheral vascular resistance, which leads to increasing blood pressure, in turn causing pressure overload in the already volume-overloaded hemodynamic state of pregnancy.

Dr. Bhalla reported on 119 women who underwent serial BNP testing in each trimester of normal pregnancy, 9 mildly preeclamptic patients, 25 women with severe preeclampsia, and 25 normal controls at term.

Plasma BNP stayed in the range of 16–18 pg/mL throughout normal pregnancy, remaining in all cases below 20 pg/mL. Levels in mild preeclampsia were significantly higher, with a median value of 21.1 pg/mL. BNP levels were even higher in severe eclampsia, at a median 88.1 pg/mL.

Statistical analysis showed the best cutoff point for the diagnosis of preeclampsia was a BNP of 40 pg/mL. It yielded a sensitivity of 73%, a specificity of 85%, a positive predictive value of 57%, an accuracy rate of 82%, and—most importantly—a negative predictive value of 92%.

The area under the curve described by the test results was 0.86. That's superior to the performance of tests widely used in obstetrics and gynecology, including the Pap smear and mammography. An area under the curve in excess of 0.9 is considered an excellent test, while 0.8–0.9 is considered very good and 0.7–0.8 is reasonably good, Dr. Bhalla said.

He and his coinvestigators are also accumulating data from a different patient series that suggest a rise in plasma BNP may precede development of the hypertension and proteinuria of preeclampsia.

Dr. Bhalla's coinvestigator Alan S. Maisel, M.D., commented that BNP may be of assistance in “one of the hardest things for ob.gyn. people to determine—which women with preeclampsia have got to get delivered early and which don't.”

“We know that BNP probably reflects the endothelial dysfunction that goes along with preeclampsia. And when the BNP starts skyrocketing—in some of the patients we're following the levels get above 200 and 300—that, I believe, is going to lead physicians to start delivering patients earlier,” said Dr. Maisel, professor of medicine at UCSD, and director of the coronary care unit and heart failure program at San Diego Veterans Affairs Medical Center.

“Also, when people present in their third trimester with shortness of breath and volume overload, a normal BNP level will tell you that the heart is functioning well, taking care of that volume and not experiencing too much stress. If there's any question about that issue, a simple BNP test will certainly help,” added Dr. Maisel.

Obstetricians also are investigating the potential application of BNP as a general screen for underlying heart dysfunction.

“I'm talking to ob. people who are doing studies now and are thinking about using this test, especially in areas where people don't get the maternal health care they normally might get in some of our better hospitals,” the cardiologist said.

NEW ORLEANS — Measurement of B-type natriuretic peptide levels in pregnancy shows promise for the management of preeclamptic patients, Vikas Bhalla, M.D., said during the annual scientific sessions of the American Heart Association.

The plasma B-type natriuretic peptide (BNP) test is a rapid, relatively inexpensive point-of-care test approved for diagnosis of heart failure in patients presenting with shortness of breath to the emergency department and other acute care settings. In this setting, BNP level correlates with wedge pressure, severity of heart failure, and prognosis.

Potential obstetric applications under study include use of the BNP test to identify women with preeclampsia before they become hypertensive and proteinuric, as well as to guide physicians in the particularly thorny problem of when to deliver affected patients, according to Dr. Bhalla of the University of California, San Diego.

BNP is synthesized in cardiac ventricular tissue, primarily in response to volume expansion and pressure overload. Preeclampsia, which complicates 5% of pregnancies and causes considerable maternal and neonatal morbidity, is characterized by markedly increased peripheral vascular resistance, which leads to increasing blood pressure, in turn causing pressure overload in the already volume-overloaded hemodynamic state of pregnancy.

Dr. Bhalla reported on 119 women who underwent serial BNP testing in each trimester of normal pregnancy, 9 mildly preeclamptic patients, 25 women with severe preeclampsia, and 25 normal controls at term.

Plasma BNP stayed in the range of 16–18 pg/mL throughout normal pregnancy, remaining in all cases below 20 pg/mL. Levels in mild preeclampsia were significantly higher, with a median value of 21.1 pg/mL. BNP levels were even higher in severe eclampsia, at a median 88.1 pg/mL.

Statistical analysis showed the best cutoff point for the diagnosis of preeclampsia was a BNP of 40 pg/mL. It yielded a sensitivity of 73%, a specificity of 85%, a positive predictive value of 57%, an accuracy rate of 82%, and—most importantly—a negative predictive value of 92%.

The area under the curve described by the test results was 0.86. That's superior to the performance of tests widely used in obstetrics and gynecology, including the Pap smear and mammography. An area under the curve in excess of 0.9 is considered an excellent test, while 0.8–0.9 is considered very good and 0.7–0.8 is reasonably good, Dr. Bhalla said.

He and his coinvestigators are also accumulating data from a different patient series that suggest a rise in plasma BNP may precede development of the hypertension and proteinuria of preeclampsia.

Dr. Bhalla's coinvestigator Alan S. Maisel, M.D., commented that BNP may be of assistance in “one of the hardest things for ob.gyn. people to determine—which women with preeclampsia have got to get delivered early and which don't.”

“We know that BNP probably reflects the endothelial dysfunction that goes along with preeclampsia. And when the BNP starts skyrocketing—in some of the patients we're following the levels get above 200 and 300—that, I believe, is going to lead physicians to start delivering patients earlier,” said Dr. Maisel, professor of medicine at UCSD, and director of the coronary care unit and heart failure program at San Diego Veterans Affairs Medical Center.

“Also, when people present in their third trimester with shortness of breath and volume overload, a normal BNP level will tell you that the heart is functioning well, taking care of that volume and not experiencing too much stress. If there's any question about that issue, a simple BNP test will certainly help,” added Dr. Maisel.

Obstetricians also are investigating the potential application of BNP as a general screen for underlying heart dysfunction.

“I'm talking to ob. people who are doing studies now and are thinking about using this test, especially in areas where people don't get the maternal health care they normally might get in some of our better hospitals,” the cardiologist said.

NEW ORLEANS — Measurement of B-type natriuretic peptide levels in pregnancy shows promise for the management of preeclamptic patients, Vikas Bhalla, M.D., said during the annual scientific sessions of the American Heart Association.

The plasma B-type natriuretic peptide (BNP) test is a rapid, relatively inexpensive point-of-care test approved for diagnosis of heart failure in patients presenting with shortness of breath to the emergency department and other acute care settings. In this setting, BNP level correlates with wedge pressure, severity of heart failure, and prognosis.

Potential obstetric applications under study include use of the BNP test to identify women with preeclampsia before they become hypertensive and proteinuric, as well as to guide physicians in the particularly thorny problem of when to deliver affected patients, according to Dr. Bhalla of the University of California, San Diego.

BNP is synthesized in cardiac ventricular tissue, primarily in response to volume expansion and pressure overload. Preeclampsia, which complicates 5% of pregnancies and causes considerable maternal and neonatal morbidity, is characterized by markedly increased peripheral vascular resistance, which leads to increasing blood pressure, in turn causing pressure overload in the already volume-overloaded hemodynamic state of pregnancy.

Dr. Bhalla reported on 119 women who underwent serial BNP testing in each trimester of normal pregnancy, 9 mildly preeclamptic patients, 25 women with severe preeclampsia, and 25 normal controls at term.

Plasma BNP stayed in the range of 16–18 pg/mL throughout normal pregnancy, remaining in all cases below 20 pg/mL. Levels in mild preeclampsia were significantly higher, with a median value of 21.1 pg/mL. BNP levels were even higher in severe eclampsia, at a median 88.1 pg/mL.

Statistical analysis showed the best cutoff point for the diagnosis of preeclampsia was a BNP of 40 pg/mL. It yielded a sensitivity of 73%, a specificity of 85%, a positive predictive value of 57%, an accuracy rate of 82%, and—most importantly—a negative predictive value of 92%.

The area under the curve described by the test results was 0.86. That's superior to the performance of tests widely used in obstetrics and gynecology, including the Pap smear and mammography. An area under the curve in excess of 0.9 is considered an excellent test, while 0.8–0.9 is considered very good and 0.7–0.8 is reasonably good, Dr. Bhalla said.

He and his coinvestigators are also accumulating data from a different patient series that suggest a rise in plasma BNP may precede development of the hypertension and proteinuria of preeclampsia.

Dr. Bhalla's coinvestigator Alan S. Maisel, M.D., commented that BNP may be of assistance in “one of the hardest things for ob.gyn. people to determine—which women with preeclampsia have got to get delivered early and which don't.”

“We know that BNP probably reflects the endothelial dysfunction that goes along with preeclampsia. And when the BNP starts skyrocketing—in some of the patients we're following the levels get above 200 and 300—that, I believe, is going to lead physicians to start delivering patients earlier,” said Dr. Maisel, professor of medicine at UCSD, and director of the coronary care unit and heart failure program at San Diego Veterans Affairs Medical Center.

“Also, when people present in their third trimester with shortness of breath and volume overload, a normal BNP level will tell you that the heart is functioning well, taking care of that volume and not experiencing too much stress. If there's any question about that issue, a simple BNP test will certainly help,” added Dr. Maisel.

Obstetricians also are investigating the potential application of BNP as a general screen for underlying heart dysfunction.

“I'm talking to ob. people who are doing studies now and are thinking about using this test, especially in areas where people don't get the maternal health care they normally might get in some of our better hospitals,” the cardiologist said.

VIENNA — Preeclamptic women on magnesium sulfate treatment do not appear to be at increased risk for cognitive deficits, Judith Hibbard, M.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

In fact, women who are being treated with magnesium sulfate (MgSO₄) for preeclampsia appear to have better attention and working memory capacity than do normotensive laboring women, said Dr. Hibbard, who is professor of ob.gyn. at the University of Illinois at Chicago.

Dr. Hibbard presented the paper for Sarosh Rana, M.D., of the University of Chicago.

These preliminary findings come from a study that was prompted by a news report of a nanny from Mexico who delivered and abandoned her baby on a Florida beach. She was arrested, but all charges were dropped when the physician at a local hospital stated that the mother had preeclampsia, and that associated mental changes could have prompted her temporary irrational behavior.

An initial literature search yielded a small amount of data suggesting that mild cognitive deficits may occur during normal pregnancy, as well as a few anecdotal reports of psychosis, but no previous formal studies looking specifically at cognition in preeclampsia.

Thus, the current study was initiated in which a battery of neurocognitive tests were administered twice to three groups of women: 15 with preeclampsia who were treated with MgSO₄, 15 women in preterm labor who received tocolytic MgSO₄, and 15 normal laboring women.

Tests assessing intelligence (IQ), auditory comprehension, attention, memory, pain, and distress were first performed prior to delivery (at least 2 hours after initiation of MgSO₄ in the preeclamptic and preterm groups and shortly after admission in the controls), and again after delivery (at least 12 hours after discontinuation of MgSO₄ in the two treatment groups).

Prior to delivery, there were no apparent differences in age, parity, IQ, education, auditory comprehension, or fatigue level among the three groups. Distress was greater among the preeclamptics, whereas pain was higher in the normal controls, Dr. Hibbard noted.

Immediate verbal memory was similar before and after delivery within the three groups. Delayed verbal memory, on the other hand, improved in all three groups following delivery, and significantly so in both the preeclamptics and preterm patients.

Digit span scores, which assess attention, did not differ significantly before and after delivery in any group, but were significantly better at both time points in the preeclamptic patients on MgSO₄ than they were in the other two groups. Out of a possible 30, the preeclamptics scored 18.8 post delivery, compared with 16.86 among the normal laboring women and 14.8 among the preterm patients, she said.

Similarly, whereas all three groups improved modestly post delivery on letter-number sequencing, which assesses attention and working memory, the preeclamptics also did better at both end points than did the other two groups.

Magnesium has been shown to have neuroprotective actions in cerebral ischemia and is a cerebral vasodilator for the ischemic—but not for the normally perfused—brain. This difference might explain the adverse cognitive effects of MgSO₄ on women in preterm labor and the absence of those effects in the preeclamptics in this study, Dr. Hibbard noted.

These preliminary results are part of a larger study that is looking at cognition among women with preeclampsia prior to the administration of magnesium, as well as among nonpregnant women, she said.

VIENNA — Preeclamptic women on magnesium sulfate treatment do not appear to be at increased risk for cognitive deficits, Judith Hibbard, M.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

In fact, women who are being treated with magnesium sulfate (MgSO₄) for preeclampsia appear to have better attention and working memory capacity than do normotensive laboring women, said Dr. Hibbard, who is professor of ob.gyn. at the University of Illinois at Chicago.

Dr. Hibbard presented the paper for Sarosh Rana, M.D., of the University of Chicago.

These preliminary findings come from a study that was prompted by a news report of a nanny from Mexico who delivered and abandoned her baby on a Florida beach. She was arrested, but all charges were dropped when the physician at a local hospital stated that the mother had preeclampsia, and that associated mental changes could have prompted her temporary irrational behavior.

An initial literature search yielded a small amount of data suggesting that mild cognitive deficits may occur during normal pregnancy, as well as a few anecdotal reports of psychosis, but no previous formal studies looking specifically at cognition in preeclampsia.

Thus, the current study was initiated in which a battery of neurocognitive tests were administered twice to three groups of women: 15 with preeclampsia who were treated with MgSO₄, 15 women in preterm labor who received tocolytic MgSO₄, and 15 normal laboring women.

Tests assessing intelligence (IQ), auditory comprehension, attention, memory, pain, and distress were first performed prior to delivery (at least 2 hours after initiation of MgSO₄ in the preeclamptic and preterm groups and shortly after admission in the controls), and again after delivery (at least 12 hours after discontinuation of MgSO₄ in the two treatment groups).

Prior to delivery, there were no apparent differences in age, parity, IQ, education, auditory comprehension, or fatigue level among the three groups. Distress was greater among the preeclamptics, whereas pain was higher in the normal controls, Dr. Hibbard noted.

Immediate verbal memory was similar before and after delivery within the three groups. Delayed verbal memory, on the other hand, improved in all three groups following delivery, and significantly so in both the preeclamptics and preterm patients.

Digit span scores, which assess attention, did not differ significantly before and after delivery in any group, but were significantly better at both time points in the preeclamptic patients on MgSO₄ than they were in the other two groups. Out of a possible 30, the preeclamptics scored 18.8 post delivery, compared with 16.86 among the normal laboring women and 14.8 among the preterm patients, she said.

Similarly, whereas all three groups improved modestly post delivery on letter-number sequencing, which assesses attention and working memory, the preeclamptics also did better at both end points than did the other two groups.

Magnesium has been shown to have neuroprotective actions in cerebral ischemia and is a cerebral vasodilator for the ischemic—but not for the normally perfused—brain. This difference might explain the adverse cognitive effects of MgSO₄ on women in preterm labor and the absence of those effects in the preeclamptics in this study, Dr. Hibbard noted.

These preliminary results are part of a larger study that is looking at cognition among women with preeclampsia prior to the administration of magnesium, as well as among nonpregnant women, she said.

VIENNA — Preeclamptic women on magnesium sulfate treatment do not appear to be at increased risk for cognitive deficits, Judith Hibbard, M.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

In fact, women who are being treated with magnesium sulfate (MgSO₄) for preeclampsia appear to have better attention and working memory capacity than do normotensive laboring women, said Dr. Hibbard, who is professor of ob.gyn. at the University of Illinois at Chicago.

Dr. Hibbard presented the paper for Sarosh Rana, M.D., of the University of Chicago.

These preliminary findings come from a study that was prompted by a news report of a nanny from Mexico who delivered and abandoned her baby on a Florida beach. She was arrested, but all charges were dropped when the physician at a local hospital stated that the mother had preeclampsia, and that associated mental changes could have prompted her temporary irrational behavior.

An initial literature search yielded a small amount of data suggesting that mild cognitive deficits may occur during normal pregnancy, as well as a few anecdotal reports of psychosis, but no previous formal studies looking specifically at cognition in preeclampsia.

Thus, the current study was initiated in which a battery of neurocognitive tests were administered twice to three groups of women: 15 with preeclampsia who were treated with MgSO₄, 15 women in preterm labor who received tocolytic MgSO₄, and 15 normal laboring women.

Tests assessing intelligence (IQ), auditory comprehension, attention, memory, pain, and distress were first performed prior to delivery (at least 2 hours after initiation of MgSO₄ in the preeclamptic and preterm groups and shortly after admission in the controls), and again after delivery (at least 12 hours after discontinuation of MgSO₄ in the two treatment groups).

Prior to delivery, there were no apparent differences in age, parity, IQ, education, auditory comprehension, or fatigue level among the three groups. Distress was greater among the preeclamptics, whereas pain was higher in the normal controls, Dr. Hibbard noted.

Immediate verbal memory was similar before and after delivery within the three groups. Delayed verbal memory, on the other hand, improved in all three groups following delivery, and significantly so in both the preeclamptics and preterm patients.

Digit span scores, which assess attention, did not differ significantly before and after delivery in any group, but were significantly better at both time points in the preeclamptic patients on MgSO₄ than they were in the other two groups. Out of a possible 30, the preeclamptics scored 18.8 post delivery, compared with 16.86 among the normal laboring women and 14.8 among the preterm patients, she said.

Similarly, whereas all three groups improved modestly post delivery on letter-number sequencing, which assesses attention and working memory, the preeclamptics also did better at both end points than did the other two groups.

Magnesium has been shown to have neuroprotective actions in cerebral ischemia and is a cerebral vasodilator for the ischemic—but not for the normally perfused—brain. This difference might explain the adverse cognitive effects of MgSO₄ on women in preterm labor and the absence of those effects in the preeclamptics in this study, Dr. Hibbard noted.

These preliminary results are part of a larger study that is looking at cognition among women with preeclampsia prior to the administration of magnesium, as well as among nonpregnant women, she said.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20-30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls, retrospectively, completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

Median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g vs. 253 g), as was fiber consumption (18 g vs. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest.

Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported at the meeting.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20-30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls, retrospectively, completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

Median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g vs. 253 g), as was fiber consumption (18 g vs. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest.

Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported at the meeting.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20-30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls, retrospectively, completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

Median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g vs. 253 g), as was fiber consumption (18 g vs. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest.

Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported at the meeting.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption.

Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV and included hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin, according to Dr. Frusca.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

“A normal uterine artery velocimetry at 24 weeks is a very reassuring sign in a woman with previous preeclampsia,” Dr. Frusca said.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption.

Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV and included hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin, according to Dr. Frusca.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

“A normal uterine artery velocimetry at 24 weeks is a very reassuring sign in a woman with previous preeclampsia,” Dr. Frusca said.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption.

Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV and included hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin, according to Dr. Frusca.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

“A normal uterine artery velocimetry at 24 weeks is a very reassuring sign in a woman with previous preeclampsia,” Dr. Frusca said.

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Dr. Anna-Karin Wikström said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included.

Women with chronic hypertension and/or diabetes were excluded from the study.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19-28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy. The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

“We don't think that [this] information must be given to all women with gestational hypertensive disease, since it could create a lot of anxiety in a large group of women who will never go on to develop ischemic heart disease,” Dr. Wikström said.

Nevertheless, she added that giving such information “could be considered in women with a history of severe or recurrent preeclampsia, or gestation with coexisting, avoidable independent risk factors such as smoking and obesity.”

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Dr. Anna-Karin Wikström said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included.

Women with chronic hypertension and/or diabetes were excluded from the study.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19-28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy. The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

“We don't think that [this] information must be given to all women with gestational hypertensive disease, since it could create a lot of anxiety in a large group of women who will never go on to develop ischemic heart disease,” Dr. Wikström said.

Nevertheless, she added that giving such information “could be considered in women with a history of severe or recurrent preeclampsia, or gestation with coexisting, avoidable independent risk factors such as smoking and obesity.”

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Dr. Anna-Karin Wikström said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included.

Women with chronic hypertension and/or diabetes were excluded from the study.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19-28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy. The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

“We don't think that [this] information must be given to all women with gestational hypertensive disease, since it could create a lot of anxiety in a large group of women who will never go on to develop ischemic heart disease,” Dr. Wikström said.

Nevertheless, she added that giving such information “could be considered in women with a history of severe or recurrent preeclampsia, or gestation with coexisting, avoidable independent risk factors such as smoking and obesity.”

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton explained during a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20-25 kg/m

All of the women had singleton pregnancies, according to Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%).

However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported at the meeting.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%).

Perinatal deaths did not differ between the obese and nonobese groups, according to the study.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester Dr. Barton recommended.

Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton explained during a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20-25 kg/m

All of the women had singleton pregnancies, according to Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%).

However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported at the meeting.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%).

Perinatal deaths did not differ between the obese and nonobese groups, according to the study.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester Dr. Barton recommended.

Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton explained during a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20-25 kg/m

All of the women had singleton pregnancies, according to Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%).

However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported at the meeting.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%).

Perinatal deaths did not differ between the obese and nonobese groups, according to the study.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester Dr. Barton recommended.

Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — Labetalol may be a viable alternative to magnesium sulfate for the prevention of eclampsia, Jennifer Warren, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous data from Dr. Warren's colleagues at the University of Utah, Salt Lake City, suggest that labetalol reduces cerebral perfusion pressure while maintaining cerebral blood flow.

It is potentially an ideal agent for preventing eclampsia, which is believed to be the result of cerebral overperfusion (Hypertens. Pregnancy 2002;21:185-97).

Labetalol also offers several advantages over MgSO₄, including its lack of life-threatening side effects (MgSO₄ is a respiratory and cardiac depressant). Labetalol has a rapid onset of action with sustained antihypertensive effects and can be administered orally with minimal need for monitoring; MgSO₄ is given parenterally. In addition, labetalol is less expensive than MgSO₄, according to Dr. Warren.

She presented preliminary data for the first 202 participants in the Labetalol Versus Magnesium Sulfate for the Prevention of Eclampsia Trial (LAMPET), an international, multicenter, nonblinded, randomized controlled trial in which women with preeclampsia receive either labetalol (200 mg orally every 6 hours, with additional intravenous doses every 20 minutes based on blood pressure measurements) or magnesium (6-g IV bolus followed by 2-g IV continuous infusion, with intravenous hydralazine if blood pressure remains uncontrolled after 20 minutes).

Institutions were permitted to substitute their own regimens for these. All medications were administered until 24 hours post partum.

The 115 women randomized to labetalol were similar to the 87 who received MgSO₄ with regard to demographics such as maternal age, gestational age, race, height, and weight.

Admission data, including blood pressure, lab values, history, and symptoms, also did not differ.

Seizures occurred in 1.7% of the labetalol group (two women) and 2.3% of the MgSO₄ group (two women), which was not a significant difference. All the seizures occurred at one institution where blood pressure control protocol violations were subsequently documented, Dr. Warren noted.

The labetalol subjects were significantly less likely to require additional blood pressure control medication (1.7% vs. 9.2%), and to experience flushing (0% vs. 12.6%). Rates of other side effects, including headache, diplopia, hypotension, nausea, vomiting, and respiratory depression, did not differ. Rates of abruption, postpartum hemorrhage, cardiac complications, and cesarean deliveries were also similar.

Intrapartum blood pressures did not differ between the two groups, but postpartum mean systolic and diastolic pressures were both significantly lower in the labetalol group, compared with the MgSO₄ group (133/77 mm Hg vs. 140/80 mm Hg). Overall mean intrapartum and postpartum heart rates were also lower in the labetalol subjects, Dr. Warren reported.

Neonatal Apgar scores at 1 and 5 minutes did not differ between the groups, and there were no differences in rates of newborn intubation, respiratory depression, hypotension, hypotonia, or dysrhythmia.

The LAMPET trial, which is being conducted at three centers in two countries, will ultimately include 4,000 women. Final results are expected in about 2 years, Dr. Warren told this newspaper.

VIENNA — Labetalol may be a viable alternative to magnesium sulfate for the prevention of eclampsia, Jennifer Warren, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous data from Dr. Warren's colleagues at the University of Utah, Salt Lake City, suggest that labetalol reduces cerebral perfusion pressure while maintaining cerebral blood flow.

It is potentially an ideal agent for preventing eclampsia, which is believed to be the result of cerebral overperfusion (Hypertens. Pregnancy 2002;21:185-97).

Labetalol also offers several advantages over MgSO₄, including its lack of life-threatening side effects (MgSO₄ is a respiratory and cardiac depressant). Labetalol has a rapid onset of action with sustained antihypertensive effects and can be administered orally with minimal need for monitoring; MgSO₄ is given parenterally. In addition, labetalol is less expensive than MgSO₄, according to Dr. Warren.

She presented preliminary data for the first 202 participants in the Labetalol Versus Magnesium Sulfate for the Prevention of Eclampsia Trial (LAMPET), an international, multicenter, nonblinded, randomized controlled trial in which women with preeclampsia receive either labetalol (200 mg orally every 6 hours, with additional intravenous doses every 20 minutes based on blood pressure measurements) or magnesium (6-g IV bolus followed by 2-g IV continuous infusion, with intravenous hydralazine if blood pressure remains uncontrolled after 20 minutes).

Institutions were permitted to substitute their own regimens for these. All medications were administered until 24 hours post partum.

The 115 women randomized to labetalol were similar to the 87 who received MgSO₄ with regard to demographics such as maternal age, gestational age, race, height, and weight.

Admission data, including blood pressure, lab values, history, and symptoms, also did not differ.

Seizures occurred in 1.7% of the labetalol group (two women) and 2.3% of the MgSO₄ group (two women), which was not a significant difference. All the seizures occurred at one institution where blood pressure control protocol violations were subsequently documented, Dr. Warren noted.

The labetalol subjects were significantly less likely to require additional blood pressure control medication (1.7% vs. 9.2%), and to experience flushing (0% vs. 12.6%). Rates of other side effects, including headache, diplopia, hypotension, nausea, vomiting, and respiratory depression, did not differ. Rates of abruption, postpartum hemorrhage, cardiac complications, and cesarean deliveries were also similar.

Intrapartum blood pressures did not differ between the two groups, but postpartum mean systolic and diastolic pressures were both significantly lower in the labetalol group, compared with the MgSO₄ group (133/77 mm Hg vs. 140/80 mm Hg). Overall mean intrapartum and postpartum heart rates were also lower in the labetalol subjects, Dr. Warren reported.

Neonatal Apgar scores at 1 and 5 minutes did not differ between the groups, and there were no differences in rates of newborn intubation, respiratory depression, hypotension, hypotonia, or dysrhythmia.

The LAMPET trial, which is being conducted at three centers in two countries, will ultimately include 4,000 women. Final results are expected in about 2 years, Dr. Warren told this newspaper.

VIENNA — Labetalol may be a viable alternative to magnesium sulfate for the prevention of eclampsia, Jennifer Warren, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous data from Dr. Warren's colleagues at the University of Utah, Salt Lake City, suggest that labetalol reduces cerebral perfusion pressure while maintaining cerebral blood flow.

It is potentially an ideal agent for preventing eclampsia, which is believed to be the result of cerebral overperfusion (Hypertens. Pregnancy 2002;21:185-97).

Labetalol also offers several advantages over MgSO₄, including its lack of life-threatening side effects (MgSO₄ is a respiratory and cardiac depressant). Labetalol has a rapid onset of action with sustained antihypertensive effects and can be administered orally with minimal need for monitoring; MgSO₄ is given parenterally. In addition, labetalol is less expensive than MgSO₄, according to Dr. Warren.

She presented preliminary data for the first 202 participants in the Labetalol Versus Magnesium Sulfate for the Prevention of Eclampsia Trial (LAMPET), an international, multicenter, nonblinded, randomized controlled trial in which women with preeclampsia receive either labetalol (200 mg orally every 6 hours, with additional intravenous doses every 20 minutes based on blood pressure measurements) or magnesium (6-g IV bolus followed by 2-g IV continuous infusion, with intravenous hydralazine if blood pressure remains uncontrolled after 20 minutes).

Institutions were permitted to substitute their own regimens for these. All medications were administered until 24 hours post partum.

The 115 women randomized to labetalol were similar to the 87 who received MgSO₄ with regard to demographics such as maternal age, gestational age, race, height, and weight.

Admission data, including blood pressure, lab values, history, and symptoms, also did not differ.

Seizures occurred in 1.7% of the labetalol group (two women) and 2.3% of the MgSO₄ group (two women), which was not a significant difference. All the seizures occurred at one institution where blood pressure control protocol violations were subsequently documented, Dr. Warren noted.

The labetalol subjects were significantly less likely to require additional blood pressure control medication (1.7% vs. 9.2%), and to experience flushing (0% vs. 12.6%). Rates of other side effects, including headache, diplopia, hypotension, nausea, vomiting, and respiratory depression, did not differ. Rates of abruption, postpartum hemorrhage, cardiac complications, and cesarean deliveries were also similar.

Intrapartum blood pressures did not differ between the two groups, but postpartum mean systolic and diastolic pressures were both significantly lower in the labetalol group, compared with the MgSO₄ group (133/77 mm Hg vs. 140/80 mm Hg). Overall mean intrapartum and postpartum heart rates were also lower in the labetalol subjects, Dr. Warren reported.

Neonatal Apgar scores at 1 and 5 minutes did not differ between the groups, and there were no differences in rates of newborn intubation, respiratory depression, hypotension, hypotonia, or dysrhythmia.

The LAMPET trial, which is being conducted at three centers in two countries, will ultimately include 4,000 women. Final results are expected in about 2 years, Dr. Warren told this newspaper.

VIENNA — Obesity and excess prenatal weight gain increase the risk of preeclampsia among women from a diverse urban population, Terry J. Rosenberg, Ph.D., reported.

The findings suggest that the focus should shift from the treatment of preeclampsia to its prevention, said Dr. Rosenberg, who is the deputy director of research and evaluation, Medical Health and Research Association of New York City Inc. The association is an independent, nonprofit organization that works with the New York City Department of Health and Mental Hygiene in studying medically underserved populations.

Since many low-income women do not have regular health care providers, “There's a window of opportunity during pregnancy for ob.gyns. to provide the kind of advice that these women aren't likely to get from another physician. … Providing encouragement for a healthy diet and exercise during the perinatal period will carry over to better health throughout the lifetime of these women,” she said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 330,216 singleton births during 1999-2001 from New York City's birth certificate database, 6% (20,702) of the mothers had a prepregnancy weight of more than 199 pounds. This weight was used as the definition of obesity, since height data were not included in the database.

Excess prenatal weight gain, which was defined as more than 40 pounds, was recorded for 18% (60,695) of the women in the study.

Preeclampsia, which was diagnosed by the physician, was recorded for 2% of the study population (7,011).

One-third of the mothers (33%) were Hispanic, 29% were white, 26% were black, and 12% were Asian.

One-third were foreign-born.

Obesity rates were highest among the black women (12.7%), followed by the Hispanic women (5.2%), and the whites (4.8%), with Asians far lower (0.8%), she said.

Excess weight gain was recorded for 21% of the Hispanic women, 20% of the black women, 17% of the whites, and 11% of the Asians.

Preeclampsia was diagnosed in 2.9% of the black women and 2.6% of the Hispanic women, at least double the rates among white (1.3%) and Asian (1.2%) women, Dr. Rosenberg reported during her presentation at the meeting.

After adjustment for significant predictors of preeclampsia—which included age older than 35, black or Hispanic ethnicity, low socioeconomic status, and chronic diabetes and/or hypertension—the risk for preeclampsia was 1.8 times greater for women who weighed 200-299 pounds, compared with those women weighing 100-149 pounds, the investigators found.

The risk was elevated 2.6-fold among women weighing at least 300 pounds.

Moreover, preeclampsia was 1.5 times as common among the women who gained more than 40 pounds during pregnancy, compared with those who gained less weight.

Those elevated risks did not differ significantly after 4,036 women with chronic diabetes and/or hypertension were removed from the analysis, Dr. Rosenberg noted.

VIENNA — Obesity and excess prenatal weight gain increase the risk of preeclampsia among women from a diverse urban population, Terry J. Rosenberg, Ph.D., reported.

The findings suggest that the focus should shift from the treatment of preeclampsia to its prevention, said Dr. Rosenberg, who is the deputy director of research and evaluation, Medical Health and Research Association of New York City Inc. The association is an independent, nonprofit organization that works with the New York City Department of Health and Mental Hygiene in studying medically underserved populations.

Since many low-income women do not have regular health care providers, “There's a window of opportunity during pregnancy for ob.gyns. to provide the kind of advice that these women aren't likely to get from another physician. … Providing encouragement for a healthy diet and exercise during the perinatal period will carry over to better health throughout the lifetime of these women,” she said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 330,216 singleton births during 1999-2001 from New York City's birth certificate database, 6% (20,702) of the mothers had a prepregnancy weight of more than 199 pounds. This weight was used as the definition of obesity, since height data were not included in the database.

Excess prenatal weight gain, which was defined as more than 40 pounds, was recorded for 18% (60,695) of the women in the study.

Preeclampsia, which was diagnosed by the physician, was recorded for 2% of the study population (7,011).

One-third of the mothers (33%) were Hispanic, 29% were white, 26% were black, and 12% were Asian.

One-third were foreign-born.

Obesity rates were highest among the black women (12.7%), followed by the Hispanic women (5.2%), and the whites (4.8%), with Asians far lower (0.8%), she said.

Excess weight gain was recorded for 21% of the Hispanic women, 20% of the black women, 17% of the whites, and 11% of the Asians.

Preeclampsia was diagnosed in 2.9% of the black women and 2.6% of the Hispanic women, at least double the rates among white (1.3%) and Asian (1.2%) women, Dr. Rosenberg reported during her presentation at the meeting.

After adjustment for significant predictors of preeclampsia—which included age older than 35, black or Hispanic ethnicity, low socioeconomic status, and chronic diabetes and/or hypertension—the risk for preeclampsia was 1.8 times greater for women who weighed 200-299 pounds, compared with those women weighing 100-149 pounds, the investigators found.

The risk was elevated 2.6-fold among women weighing at least 300 pounds.

Moreover, preeclampsia was 1.5 times as common among the women who gained more than 40 pounds during pregnancy, compared with those who gained less weight.

Those elevated risks did not differ significantly after 4,036 women with chronic diabetes and/or hypertension were removed from the analysis, Dr. Rosenberg noted.

VIENNA — Obesity and excess prenatal weight gain increase the risk of preeclampsia among women from a diverse urban population, Terry J. Rosenberg, Ph.D., reported.

The findings suggest that the focus should shift from the treatment of preeclampsia to its prevention, said Dr. Rosenberg, who is the deputy director of research and evaluation, Medical Health and Research Association of New York City Inc. The association is an independent, nonprofit organization that works with the New York City Department of Health and Mental Hygiene in studying medically underserved populations.

Since many low-income women do not have regular health care providers, “There's a window of opportunity during pregnancy for ob.gyns. to provide the kind of advice that these women aren't likely to get from another physician. … Providing encouragement for a healthy diet and exercise during the perinatal period will carry over to better health throughout the lifetime of these women,” she said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 330,216 singleton births during 1999-2001 from New York City's birth certificate database, 6% (20,702) of the mothers had a prepregnancy weight of more than 199 pounds. This weight was used as the definition of obesity, since height data were not included in the database.

Excess prenatal weight gain, which was defined as more than 40 pounds, was recorded for 18% (60,695) of the women in the study.

Preeclampsia, which was diagnosed by the physician, was recorded for 2% of the study population (7,011).

One-third of the mothers (33%) were Hispanic, 29% were white, 26% were black, and 12% were Asian.

One-third were foreign-born.

Obesity rates were highest among the black women (12.7%), followed by the Hispanic women (5.2%), and the whites (4.8%), with Asians far lower (0.8%), she said.

Excess weight gain was recorded for 21% of the Hispanic women, 20% of the black women, 17% of the whites, and 11% of the Asians.

Preeclampsia was diagnosed in 2.9% of the black women and 2.6% of the Hispanic women, at least double the rates among white (1.3%) and Asian (1.2%) women, Dr. Rosenberg reported during her presentation at the meeting.

After adjustment for significant predictors of preeclampsia—which included age older than 35, black or Hispanic ethnicity, low socioeconomic status, and chronic diabetes and/or hypertension—the risk for preeclampsia was 1.8 times greater for women who weighed 200-299 pounds, compared with those women weighing 100-149 pounds, the investigators found.

The risk was elevated 2.6-fold among women weighing at least 300 pounds.

Moreover, preeclampsia was 1.5 times as common among the women who gained more than 40 pounds during pregnancy, compared with those who gained less weight.

Those elevated risks did not differ significantly after 4,036 women with chronic diabetes and/or hypertension were removed from the analysis, Dr. Rosenberg noted.

WASHINGTON — A paradoxical benefit of cigarette smoking during pregnancy finally may have been explained.

Smoking has long been linked to a decreased rate of preeclampsia. But rather than protecting against the disorder, smoking may mask the true incidence of preeclampsia by indirectly inducing preterm delivery, so that smokers' infants are simply born before preeclampsia can be manifested, Ahmad O. Hammoud, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

A 1999 study published in the New England Journal of Medicine found that the risk of developing preeclampsia was 32% lower in women who smoked than in nonsmokers. And most studies—a total of 99—cited in a review of the literature since 1959 also showed that smoking was associated with decreased risk. But this link “has always been questioned,” because it is counterintuitive that smoking could benefit pregnancy and because many of these studies had relatively small sample sizes, said Dr. Hammoud, a fourth-year resident in the department of ob.gyn. at Wayne State University, Detroit.

He and his associates examined the issue using a large German database of 170,254 singleton deliveries that took place at 29 hospitals across Germany during the late 1990s. Mean maternal age was 29 years. Overall, 23% of the women were smokers, and the overall rate of preeclampsia was 3.5%.

The incidence of preeclampsia was 2.5% among nonsmokers, compared with only 1.9% among smokers. Moreover, the incidence of preeclampsia showed a clear inverse correlation with the number of cigarettes smoked per day. Nonsmokers had the highest rate of preeclampsia, followed by women who smoked 1-5 cigarettes per day, then by women who smoked 6-10 cigarettes per day, and finally, by women who smoked more than 10 cigarettes per day.

“The new finding in our study was that the incidence of preeclampsia was not uniformly low in all smokers. It increased with advancing gestational age and was especially high in smokers who made it to 40 weeks or more,” Dr. Hammoud said.

“We postulate that placental damage from smoking leads to severe complications, such as placental abruption and restricted fetal growth, which in turn lead to preterm delivery before preeclampsia is manifested. So what smokers actually have is just an apparent decrease in preeclampsia,” he said.

This hypothesis is supported by the finding that smokers had a higher rate of placental abruption than nonsmokers and that fetal weight was adversely affected by smoking in a dose-response fashion, he noted.

WASHINGTON — A paradoxical benefit of cigarette smoking during pregnancy finally may have been explained.

Smoking has long been linked to a decreased rate of preeclampsia. But rather than protecting against the disorder, smoking may mask the true incidence of preeclampsia by indirectly inducing preterm delivery, so that smokers' infants are simply born before preeclampsia can be manifested, Ahmad O. Hammoud, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

A 1999 study published in the New England Journal of Medicine found that the risk of developing preeclampsia was 32% lower in women who smoked than in nonsmokers. And most studies—a total of 99—cited in a review of the literature since 1959 also showed that smoking was associated with decreased risk. But this link “has always been questioned,” because it is counterintuitive that smoking could benefit pregnancy and because many of these studies had relatively small sample sizes, said Dr. Hammoud, a fourth-year resident in the department of ob.gyn. at Wayne State University, Detroit.

He and his associates examined the issue using a large German database of 170,254 singleton deliveries that took place at 29 hospitals across Germany during the late 1990s. Mean maternal age was 29 years. Overall, 23% of the women were smokers, and the overall rate of preeclampsia was 3.5%.

The incidence of preeclampsia was 2.5% among nonsmokers, compared with only 1.9% among smokers. Moreover, the incidence of preeclampsia showed a clear inverse correlation with the number of cigarettes smoked per day. Nonsmokers had the highest rate of preeclampsia, followed by women who smoked 1-5 cigarettes per day, then by women who smoked 6-10 cigarettes per day, and finally, by women who smoked more than 10 cigarettes per day.

“The new finding in our study was that the incidence of preeclampsia was not uniformly low in all smokers. It increased with advancing gestational age and was especially high in smokers who made it to 40 weeks or more,” Dr. Hammoud said.

“We postulate that placental damage from smoking leads to severe complications, such as placental abruption and restricted fetal growth, which in turn lead to preterm delivery before preeclampsia is manifested. So what smokers actually have is just an apparent decrease in preeclampsia,” he said.

This hypothesis is supported by the finding that smokers had a higher rate of placental abruption than nonsmokers and that fetal weight was adversely affected by smoking in a dose-response fashion, he noted.

WASHINGTON — A paradoxical benefit of cigarette smoking during pregnancy finally may have been explained.

Smoking has long been linked to a decreased rate of preeclampsia. But rather than protecting against the disorder, smoking may mask the true incidence of preeclampsia by indirectly inducing preterm delivery, so that smokers' infants are simply born before preeclampsia can be manifested, Ahmad O. Hammoud, M.D., said at the annual meeting of the Central Association of Obstetricians and Gynecologists.

A 1999 study published in the New England Journal of Medicine found that the risk of developing preeclampsia was 32% lower in women who smoked than in nonsmokers. And most studies—a total of 99—cited in a review of the literature since 1959 also showed that smoking was associated with decreased risk. But this link “has always been questioned,” because it is counterintuitive that smoking could benefit pregnancy and because many of these studies had relatively small sample sizes, said Dr. Hammoud, a fourth-year resident in the department of ob.gyn. at Wayne State University, Detroit.

He and his associates examined the issue using a large German database of 170,254 singleton deliveries that took place at 29 hospitals across Germany during the late 1990s. Mean maternal age was 29 years. Overall, 23% of the women were smokers, and the overall rate of preeclampsia was 3.5%.

The incidence of preeclampsia was 2.5% among nonsmokers, compared with only 1.9% among smokers. Moreover, the incidence of preeclampsia showed a clear inverse correlation with the number of cigarettes smoked per day. Nonsmokers had the highest rate of preeclampsia, followed by women who smoked 1-5 cigarettes per day, then by women who smoked 6-10 cigarettes per day, and finally, by women who smoked more than 10 cigarettes per day.

“The new finding in our study was that the incidence of preeclampsia was not uniformly low in all smokers. It increased with advancing gestational age and was especially high in smokers who made it to 40 weeks or more,” Dr. Hammoud said.

“We postulate that placental damage from smoking leads to severe complications, such as placental abruption and restricted fetal growth, which in turn lead to preterm delivery before preeclampsia is manifested. So what smokers actually have is just an apparent decrease in preeclampsia,” he said.

This hypothesis is supported by the finding that smokers had a higher rate of placental abruption than nonsmokers and that fetal weight was adversely affected by smoking in a dose-response fashion, he noted.

WASHINGTON — Methicillin-resistant Staphylococcus aureus has been transmitted via breast milk, Dawn Terashita Gastelum, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The two reported cases, which resulted in MRSA outbreaks in neonatal intensive care units at two Los Angeles hospitals, suggest that hospital NICUs should consider screening mothers and family members for skin lesions at the time of delivery and obtaining breast milk cultures before infant feedings, said Dr. Terashita Gastelum of the Los Angeles County Department of Health Services.

The first case was in a premature (1,180 g at birth) quadruplet born to an Algerian mother who developed mastitis the day after delivery and was treated with dicloxacillin. Her breast milk was collected 3 days later and fed to the quadruplets. Twelve days after that, the baby girl died of MRSA sepsis.

The bacterium subsequently was found in nasopharyngeal cultures of the mother and her three surviving infants, another infant in the NICU, and the mother's frozen postpartum breast milk samples. Molecular fingerprinting was identical for the four infants and the breast milk, but the mother's nasopharyngeal isolate was different.

“Since the mother was actually colonized by a different strain, it is unlikely that the infants obtained the MRSA during birth or through skin-to-skin contact with the mother. The breast milk is the only known source,” Dr. Terashita Gastelum told this newspaper.

And, though it is possible to be colonized with two different strains of MRSA, it's rare. On the other hand, “it is easy to imagine that the macerated skin of the nipple on a postpartum woman is more susceptible to infection from any organism,” she said at the conference, sponsored by the American Society for Microbiology.

The second case was an 1,199-g male infant born to an African American mother, who was fed her breast milk the day of birth and developed MRSA sepsis 8 days later. This mother had no sign of mastitis, but MRSA was cultured from her breast milk collected on the day of delivery. Four other infants from the NICU were also positive: two colonized and two infected. Isolates from the breast milk and the five cases were identical.

WASHINGTON — Methicillin-resistant Staphylococcus aureus has been transmitted via breast milk, Dawn Terashita Gastelum, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The two reported cases, which resulted in MRSA outbreaks in neonatal intensive care units at two Los Angeles hospitals, suggest that hospital NICUs should consider screening mothers and family members for skin lesions at the time of delivery and obtaining breast milk cultures before infant feedings, said Dr. Terashita Gastelum of the Los Angeles County Department of Health Services.

The first case was in a premature (1,180 g at birth) quadruplet born to an Algerian mother who developed mastitis the day after delivery and was treated with dicloxacillin. Her breast milk was collected 3 days later and fed to the quadruplets. Twelve days after that, the baby girl died of MRSA sepsis.

The bacterium subsequently was found in nasopharyngeal cultures of the mother and her three surviving infants, another infant in the NICU, and the mother's frozen postpartum breast milk samples. Molecular fingerprinting was identical for the four infants and the breast milk, but the mother's nasopharyngeal isolate was different.

“Since the mother was actually colonized by a different strain, it is unlikely that the infants obtained the MRSA during birth or through skin-to-skin contact with the mother. The breast milk is the only known source,” Dr. Terashita Gastelum told this newspaper.

And, though it is possible to be colonized with two different strains of MRSA, it's rare. On the other hand, “it is easy to imagine that the macerated skin of the nipple on a postpartum woman is more susceptible to infection from any organism,” she said at the conference, sponsored by the American Society for Microbiology.

The second case was an 1,199-g male infant born to an African American mother, who was fed her breast milk the day of birth and developed MRSA sepsis 8 days later. This mother had no sign of mastitis, but MRSA was cultured from her breast milk collected on the day of delivery. Four other infants from the NICU were also positive: two colonized and two infected. Isolates from the breast milk and the five cases were identical.

WASHINGTON — Methicillin-resistant Staphylococcus aureus has been transmitted via breast milk, Dawn Terashita Gastelum, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The two reported cases, which resulted in MRSA outbreaks in neonatal intensive care units at two Los Angeles hospitals, suggest that hospital NICUs should consider screening mothers and family members for skin lesions at the time of delivery and obtaining breast milk cultures before infant feedings, said Dr. Terashita Gastelum of the Los Angeles County Department of Health Services.

The first case was in a premature (1,180 g at birth) quadruplet born to an Algerian mother who developed mastitis the day after delivery and was treated with dicloxacillin. Her breast milk was collected 3 days later and fed to the quadruplets. Twelve days after that, the baby girl died of MRSA sepsis.

The bacterium subsequently was found in nasopharyngeal cultures of the mother and her three surviving infants, another infant in the NICU, and the mother's frozen postpartum breast milk samples. Molecular fingerprinting was identical for the four infants and the breast milk, but the mother's nasopharyngeal isolate was different.

“Since the mother was actually colonized by a different strain, it is unlikely that the infants obtained the MRSA during birth or through skin-to-skin contact with the mother. The breast milk is the only known source,” Dr. Terashita Gastelum told this newspaper.

And, though it is possible to be colonized with two different strains of MRSA, it's rare. On the other hand, “it is easy to imagine that the macerated skin of the nipple on a postpartum woman is more susceptible to infection from any organism,” she said at the conference, sponsored by the American Society for Microbiology.

The second case was an 1,199-g male infant born to an African American mother, who was fed her breast milk the day of birth and developed MRSA sepsis 8 days later. This mother had no sign of mastitis, but MRSA was cultured from her breast milk collected on the day of delivery. Four other infants from the NICU were also positive: two colonized and two infected. Isolates from the breast milk and the five cases were identical.