BackgroundPreeclampsia (PE) is a pregnancy-specific vascular endothelial disorder characterized by multi-organ system involvement. This includes the maternal kidneys, with changes such as continuous vasospasm of renal arteries and reduced renal blood flow. However, it is unclear whether similar renal vascular changes are seen in the fetus. This study sought to compare renal artery impedance in fetuses of women with and without PE.MethodsThis was a prospective Doppler assessment study of the fetal renal artery impedance in 48 singleton fetuses. The group with PE consisted of 24 appropriately grown fetuses in pregnancy complicated by both mild and severe PE and a control group of 24 uncomplicated pregnancies. Doppler studies included renal artery systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and identification of end-diastolic blood flow.ResultsFetuses of mothers with PE were more likely to have a lower renal artery Doppler S/D ratio (7.85 [6.4–10.2] vs. 10.8 [7.75–22.5], P = 0.03) and lower RI (0.875 [0.842–0.898] vs. 0.905 [0.872–0.957], P = 0.03). However, there was no statistically significant difference in PI. There was also no difference in the incidence of absent end-diastolic flow.ConclusionThis study suggests that PE results in changes in blood flow to the renal arteries of the fetus. This may be associated with long-term adverse health effects later in adulthood.

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INTRODUCTION: Preeclampsia affects 3-5% of pregnancies with significant morbidity and mortality. Aspirin may reduce the risk of developing preeclampsia by up to 24%. Several organizations have created guidelines for initiation of aspirin therapy, each using different criteria. This study was designed to assess the impact of differing guidelines for aspirin use on maternal and fetal outcomes. METHODS: A retrospective cohort study of women who delivered between January 2009 and September 2010 with a diagnosis of preeclampsia with severe features was performed. Guidelines from six different OBGYN societies were applied to these patients to identify the percentage who met criteria for aspirin administration. Published risk reduction rates for preeclampsia, intrauterine growth restriction (IUGR), and preterm birth were applied to estimate adjusted maternal and fetal outcomes. RESULTS: Of 153 deliveries with 173 neonates, 31 cases of IUGR (20%) and 107 cases of preterm births (70%) were identified. The Canadian society (SOGC) guideline identified 97% of our patients for aspirin therapy, while the remaining guidelines identified between 4-46% (P<.001) The SOGC was the only guideline to meet the published 24% reduction in cases of preeclampsia and 14% reduction of preterm birth with 35.3% and 14.3% reduction respectively. None of the guidelines reduced IUGR by the published 20% rate. CONCLUSION: The Canadian society’s guideline is comprehensive and captures more women who should start aspirin therapy. While these guidelines are beneficial for initiation of aspirin therapy, few of the published guidelines will effectively reduce rates of preeclampsia. Development of a more effective preventive treatment remains essential.

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