ABSTRACT
Hypertensive disorders of pregnancy (HDP) are among the major causes of high maternal and fetal/neonatal morbidity and mortality rates. Patients with HDP have significantly elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at diagnosis; however, the NT-proBNP levels during early pregnancy are largely unknown. This study aimed to validate the association between HDP and NT-proBNP levels. This retrospective study evaluated 103 pregnant women who developed HDP diagnosed after 35 weeks of gestation and 667 who did not. The HDP group had significantly lower early-pregnancy NT-proBNP levels than the without HDP group. However, the two groups did not significantly differ in terms of the late-pregnancy NT-proBNP levels. After adjusting for confounding factors such as age, body mass index, parity, and blood pressure levels, high early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Early-pregnancy NT-proBNP levels ≥ 60.5 pg/mL had a negative predictive value of 97.0% for ruling out HDP, with a sensitivity of 87.4% and specificity of 62.5%. In conclusion, elevated early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Moreover, a cutoff point of ≥ 60.5 pg/mL for early-pregnancy NT-proBNP levels had a high negative predictive value and sensitivity for ruling out HDP. These findings can provide new clinical implications.
Subject(s)
Hypertension, Pregnancy-Induced , Natriuretic Peptide, Brain , Peptide Fragments , Humans , Female , Pregnancy , Natriuretic Peptide, Brain/blood , Adult , Peptide Fragments/blood , Hypertension, Pregnancy-Induced/blood , Hypertension, Pregnancy-Induced/diagnosis , Retrospective Studies , Biomarkers/blood , Gestational AgeABSTRACT
PURPOSE: Transvaginal sonographic findings of an absent cervical gland area (CGA) and a short cervical length (CL) are frequently observed in patients with threatened preterm delivery. The present study aimed to clarify whether sonographic findings are due to active production of hyaluronic acid (HA)in the cervix. METHODS: Possible relationships between sonographic findings of the presence or absence of the CGA and/or a short CL and cervical mucus HA concentration were investigated in 68 women with threatened preterm delivery at 22 31 weeks' gestation and 136 women without threatened preterm delivery as controls. RESULTS: HA levels were higher in women with threatened preterm delivery (68.0 ng/mL) than in controls (39.0 ng/mL; P = 0.001). Similarly, HA levels were higher in women with preterm labor showing an absent CGA and a short CL than in women with threatened preterm delivery without such findings (P < 0.01). Stepwise multivariate logistic regression identified an absent CGA and threatened preterm delivery as independent predictors of high HA levels (P = 0.04). HA concentration was not predictive for preterm delivery. CONCLUSION: A sonographic finding of an absent CGA reflects high HA levels in the cervix with threatened preterm delivery.
Subject(s)
Cervix Mucus/metabolism , Cervix Uteri/diagnostic imaging , Cervix Uteri/metabolism , Hyaluronic Acid/metabolism , Obstetric Labor, Premature/diagnostic imaging , Obstetric Labor, Premature/metabolism , Adult , Case-Control Studies , Cervical Ripening/metabolism , Female , Humans , Hyaluronic Acid/biosynthesis , Infant, Newborn , Logistic Models , Obstetric Labor, Premature/etiology , Predictive Value of Tests , Pregnancy , Pregnancy, High-Risk/metabolism , Ultrasonography, PrenatalABSTRACT
BACKGROUND/AIMS: Absent cervical gland area (CGA) has been considered a predictor of preterm delivery (PTD) for women at low risk. Predictive efficacy was analyzed in women at high risk for PTD and compared with cervical length (CL) <20 mm and fetal fibronectin (fFN) in cervicovaginal secretions. METHODS: Case notes were reviewed for 108 subjects with gestation of 22-33 weeks who had been admitted to hospital with threatened PTD. The uterine cervix was observed by vaginal sonography and fFN was sampled on admission. Relationships between findings and outcome of PTD at <34 weeks' gestation were analyzed. RESULTS: Delivery at <34 weeks' gestation occurred in 14.8% of patients. Absent CGA (68.8%), short CL (75.0%), short CL without CGA (62.5%) and positive fFN (62.5%) were more frequent in these patients than in patients undelivered at <34 weeks' gestation (p < 0.05). Logistic regression analysis identified positive fFN and short CL with absent CGA as independent predictors for PTD (p < 0.0001). The mean interval from admission to delivery was 2.9 weeks in cases with fFN and both sonographic findings, compared to 9.3 weeks in cases with fFN but both sonographic finding (p = 0.0005). CONCLUSION: Short CL with absent CGA represents an independent predictor for PTD, as does fFN.
