PP160. Endothelial dysfunction with obesity, pregnancy and preeclampsia.

INTRODUCTION

Preeclampsia, a pregnancy specific syndrome diagnosed clinically by new onset hypertension and proteinuria after twenty weeks of gestation, is a leading cause of maternal and fetal morbidity and mortality worldwide. The pathogenesis of preeclampsia is unknown but it is associated with a number of risk factors including past history of preeclampsia, diabetes, multiple pregnancies and obesity. The relationship between obesity and preeclampsia is not yet clear but endothelial dysfunction is implicated in both disorders. However, to date no studies have evaluated endothelial dysfunction in the presence of both obesity and preeclampsia. sE-selectin, a specific marker of endothelial dysfunction, has been shown to be increased in obese individuals and preeclamptic patients. We examined the relationship between concentrations of sE-selectin with respect to preeclampsia status (preeclampsia/no preeclampsia), BMI (obese/lean) and delivery status (preterm/term).

OBJECTIVES

We hypothesized that endothelial dysfunction, as indicated by increased concentrations of sE-selectin, would be increased in obese patients. This increase would help to explain obesity as a risk factor in preeclampsia.

METHODS

This was a retrospective case-control study of 91 Caucasian women enrolled in an ongoing investigation of preeclampsia at Magee-Womens Hospital. The women were grouped as preeclampsia lean preterms (n=14), control lean preterms (n=14), preeclampsia lean terms (n=10), control lean terms (n=7), preeclampsia obese preterms (n=9), control obese preterms (n=8), preeclampsia obese terms (n=14) and control obese terms (n=15). Preterm status was defined as delivery less than 37 weeks. Obese patients were defined as having a BMI >30 and lean patients were defined as having a BMI⩾18.5 but ⩽24. Controls were matched on race, gestational age of sample ±2 weeks and age of mother ±3 years. Serum samples were collected longitudinally across pregnancy from as early as 4weeks gestation through to 48h postpartum, and stored at -70° C until assayed. sE-selectin concentrations were measured using an enzyme-linked immunosorbent assay, purchased from R&D Systems immunoassay.

RESULTS

We conducted univariate comparison for subjects with and without preeclampsia, BMI and preterm birth, using a t-test and Wilcoxon/Krushal-Wallis test and linear regression to evaluate the association of sE-selectin and other factors. sE-selectin was higher in women with preeclampsia (p〈0.05). Furthermore, lean preterm preeclamptics had higher sE-selectin concentrations than obese preterm preeclamptics (p=0.04), otherwise there was no effect of BMI. All the analyses were performed using SAS 9.2 (SAS Institute, Cary, NC) at a significance level of 0.05.

CONCLUSION

sE-selectin is increased in preeclampsia but is not increased with obesity. Underlying endothelial dysfunction as defined by increased sE-selectin does not provide an explanation for obesity as a risk factor for preeclampsia.