RISK GROUPS FOR PREGNANCY HYPERTENSIVE DISORDERS DEVELOPMENT

Aim.  Development of clinical, anamnestic, immunological and instrumental prognostic markers of high and low risk of gestational hypertensive disorders.

Material and methods. A range of risk factors was assessed in 220 pregnant women with hypertensive states (main group) and 50 healthy pregant women (control group). In the pregnant, clinical and anamnestic risk factors of preeclampsia were assessed (age, parity, anamnesis of hypertensive disorders, extragenital diseases, etc.), autoantibodies to 12 antigenes (by ELI-P test), placental growth factor (PGF) and resistance index (RI) in uterus arteries, by Doppler.

Results. During the study, it was found that clinical and anamnestic factors of high risk of pre-eclampsia are: first pregnancy, chronic hypertension, extragenital pathology in woman, anamnesis of pre- and eclampsia, combination of three and more factors. Preclinical immunological predictors of high risk of pre-eclampsia in the 1st trimester are high titre of autoantibodies to S-100, B-2QP, ANCA (range -65 to +94 units), combined raise of three kinds of antibodies, immunity suppression, PGF level in the blood 50-100 pg/mL — for pre-eclampsia, up to 50 pg/mL — for fetal development delay. Doppler markers of high risk of pre-eclampsia: increase of
RI up to 0,60 and dicrotic notch in both uterine arteries; RI increase 0,61-0,70 with one dicrotic notch only in one uterine artery; increase of RI more than 0,70 and no dicrotic notch.

Conclusion. The most useful and predictive for pre-eclampsia are clinical and anamnestic, as immunological predictors that are revealed within 15 weeks of pregnancy. Instrumental prognostic markers that are explored after 20 weeks are useful for prognosis prediction on possible pre-eclampsia development and for control of treatment efficacy.

1. Hypertensive Disorders in Pregnancy (HDP) Guideline Summary, NY State Department of Health, 2013.

2. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Obstet Gynecol. 2013; 25 (2): 124-32. DOI: 10.1097/GCO.0b013e32835e0ef5

3. Ghulmiyah L, Sibai B. Maternal mortality from preeclapsia/eclampsia. Semin Perinatol. 2012; 36 (1): 56-9. DOI: 10.1053/j.semperi.2011.09.011.

4. Say L, Chou D, Gemmill A, et al. Global Causes of Maternal Death: A WHO Systematic Analysis. The Lancet Global Health 2014; 2 (6): 323-33. DOI: : 10.1016/S2214109X(14)70227-X.

5. Sidorova IS, Phillippe OS, Nikitina NA, et al. Causes of maternal deaths from preeclampsia and eclampsia in 2013. Obstet Gynecol 2015; 4: 11-18. (In Russ.) Сидорова И. С., Филиппов О. С., Никитина Н. А. и др. Причины материнской смертности от преэклампсии и эклампсии в 2013 году. Акуш и гинек 2015, 4: 11-18.

6. Buurma AJ, Turner RJ, Driessen JH, et al. Genetic variants in preeclampsia: a metaanalysis. Human Reproduction Update 2013; 3 (19): 289-303.

7. Vettorazzi J, Torres FV, De Avila TT, et al. Serum S100 B in pregnancy complicated by preeclampsia: case-control study. Pregnancy Hypertens 2012; 2: 101-5.

8. Wu P, van den Berg C, Alfirevic Z, et al. Early pregnancy biomarkers in preeclampsia: a systematic review and meta-analysis. Int J Mol Sci 2015; 16: 23035-56. DOI: 10.3390/ ijms160923035.

9. Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn 2014; 34 (7): 618-27. DOI: 10.1002/pd.4397.

10. Johanes C. Mose. The role of maternal and fetal Doppler in preeclampsia. Pregnancy Hypertens 2014; 4 (3): 242.

11. Redman CWG. Diagnostic and predictive accuracy of placental growth factor in suspected preeclampsia. Pregnancy Hypertens 2014; 4 (3): 241.

12. Anderson UD, Gram M, Ranstam J, et al. Fetal hemoglobin, α1-microglobulin and hemopexin are potential predictive first trimester biomarkers for preeclampsia. Pregnancy Hypertens 2016; 6 (2): 103-9.

13. Muminova KT, Wavina OB, Polushkina ES. The search for new preeclampsia markers. Obstet Gynecol 2016; 7: 41-5. (In Russ.) Муминова К. Т., Вавина О.В, Полушкина Е. С. и др. Поиск новых маркеров преэклампсии. Акуш и гинек 2016, 7: 41-5.

14. Poletaev AB, Morozov SG. ELIP-test methods to assess the reproductive health of women of fertile age. M. Medicine 2001; 16 р. (In Russ.) Полетаев А. Б., Морозов С. Г. Методы ЭЛИП-тестов в оценке состояния репродуктивного здоровья женщин фертильного возраста. М. Медицина 2001; 16 с.