Objective To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women. Design A nested case–control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls. Setting A multicentre study in 16 academic medical centres in the USA. Population Low-risk nulliparous women. Methods Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9–12, 15–18 and 23–26 weeks of gestation. Rate of change of analyte between first and either early or late second trimester was calculated with and without adjustment for baseline clinical characteristics. Main outcome measures Change in PlGF, sFlt-1 and sEng. Results Rates of change of PlGF, sEng and sFlt-1 between first and either early or late second trimesters were significantly different in women who developed pre-eclampsia, severe pre-eclampsia or early-onset pre-eclampsia compared with women who remained normotensive. Inclusion of clinical characteristics (race, body mass index and blood pressure at entry) increased sensitivity for detecting severe and particularly early-onset pre-eclampsia but not pre-eclampsia overall. Receiver operating characteristics curves for change from first to early second trimester in sEng, PlGF and sFlt-1 with clinical characteristics had areas under the curve of 0.88, 0.84 and 0.86, respectively, and for early-onset pre-eclampsia with sensitivities of 88% (95% CI 64–99%), 77% (95% CI 50–93%) and 77% (95%CI 50–93%) for 80% specificity, respectively. Similar results were seen in the change from first to late second trimester. Conclusion Change in angiogenic biomarkers between first and early second trimester combined with clinical characteristics has strong utility for predicting early-onset pre-eclampsia.

OBJECTIVE Smoking and Preeclampsia (PE) are associated with increases in preterm birth, placental abruption and low birth weight. We evaluated the relationship between prenatal vitamin C/E supplementation and perinatal outcomes by maternal self-reported smoking status focusing on outcomes known to be impacted by maternal smoking. DESIGN/POPULATION A secondary analysis of a multi-center trial of vitamin C/E supplementation starting at 9–16 weeks in low-risk nulliparous women with singleton gestations. METHODS We examined the effect of C/E by smoking status at randomization using the Breslow-Day test for interaction. MAIN OUTCOME MEASURES The trial’s primary outcomes were PE and a composite outcome of pregnancy-associated hypertension (PAH) with serious adverse outcomes. Perinatal outcomes included preterm birth and abruption. RESULTS There were no differences in baseline characteristics within subgroups (smokers vs. non-smokers) by vitamin supplementation status. The effect of prenatal vitamin C/E on the risk of PE (p=0.66) or PAH composite outcome (p=0.86) did not differ by smoking status. Vitamin C/E was protective for placental abruption in smokers [RR of 0.09 (95% CI 0.00, 0.87)], but not in non-smokers [RR 0.92 (0.52, 1.62)] (p= 0.01), and for preterm birth in smokers [RR 0.76 (0.58, 0.99)] but not in non-smokers [RR 1.03 (0.90, 1.17)] (p= 0.046). CONCLUSION In this cohort of women, smoking was not associated with a reduction in PE or the composite outcome of PAH.. Vitamin C/E supplementation appears to be associated with a reduction in placental abruption and preterm birth among smokers. Tweetable abstract Vitamin C/E associated with a reduction in placental abruption and preterm birth among smokers.

in blood pressure or urine output. During the period of 12 to 24 hours after start of treatment, the mean urine output for the 12-hour group was 128.3 mL/h and 159.8 mL/h for the 24-hour group (P = 0.008). Episodes of very high blood pressure did not differ between the groups. In the 12-hour group, 3 women had the therapy extended, but in the 24 hours, no patient required extension of her treatment. No patient stopped therapy because of adverse effects of the drug and none had to restart treatment after suspension of the drug. No occurrences of eclampsia, acute pulmonary edema, thromboembolic complications, kidney failure, liver failure, disseminated intravascular coagulation, cerebrovascular accident, or maternal death were reported. Overall, 98.2% and 62% of the women in the 24-and 12-hour group, respectively, used an indwelling urinary catheter for >12 hours (relative risk, 0.63; 95% confidence interval, 0.51-0.78). Time from delivery to ambulation was 18.8 and 25.8 hours in the 12-and 24-hour groups, respectively (P < 0.001). Time between delivery and contact with the newborn was 29.6 hours in the 12-hour group and 35.0 hours in the 24-hour group (P = 0.03).Magnesium sulfate therapy for shorter duration (12 h) in patients with stable severe preeclampsia was associated with less exposure to the drug, similar outcomes, and quicker contact with the newborn as compared with therapy for 24 hours. Early discontinuation of postpartum anticonvulsant therapy is not recommended for women with other more severe hypertensive syndromes or with clinical conditions not included in this study, such as eclampsia, HELLP syndrome, preexisting diabetes mellitus, epilepsy, renal disease, and anuric or oliguric urinary output of <25 mL/h. Larger trials are necessary to confirm the results from this single study.Topics: Preeclampsia/Eclampsia, Maternal Morbidity and Mortality, Neonatal Morbidity and Mortality H ypertensive disorders occur in 12% to 22% of parturients and can lead to significant maternal and neonatal morbidity and mortality. Pregnancy-associated hypertension (PAH) can be mild or severe depending on the severity of the hypertension, presence of clinical signs and symptoms, proteinuria, and other laboratory abnormalities. Although laboratory tests are used routinely to evaluate PAH, the cost is considerable and the results can lead to hospital admission and labor induction. This study was undertaken to estimate the frequency of laboratory abnormalities in women with PAH and to determine the relationship with adverse perinatal outcomes.The study was a secondary analysis of a large, randomized, double-blind trial of low-risk nulliparous women receiving daily vitamin C and E supplementation or placebo to prevent PAH. This present analysis included women who developed new-onset hypertension, including gestational hypertension and preeclampsia. Mild hypertension in these parturients was defined as blood pressure (BP) of 140 to 159/90 to 109 mm Hg. Severe hypertension was defined as persistent BPZ160/110 mm Hg, acute antihy...