257113 Endothelial dysfunction increases preterm delivery risk

Tuesday, October 30, 2012 : 3:05 PM - 3:20 PM

Xinhua Chen, MD, MS , Obstetrics and Gynecology, University Medicine Dentistry New Jersey-SOM, Stratford, NJ
Theresa Scholl, PhD, MPH , Obstetrics and Gynecology, University Medicine Dentistry New Jersey-SOM, Stratford, NJ
Preterm delivery complicates 12-13% of all births in the United States. It is a leading cause of neonatal morbidity and mortality; a positive history may also presage later maternal cardiovascular disease (CVD). We conducted a case (N=240) control (N=450) study nested within a prospective cohort of low income and minority gravidae (Camden Study) to examine if soluble adhesion molecules which are biomarkers of endothelial dysfunction were associated with preterm delivery. These include soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1) and sE-selectin measured at entry (14.20.3 wk) and 3rd trimester (wk 28). After control for potential confounding variables (age, parity, ethnicity, BMI, smoking) we found that high levels (highest tertile) of sICAM-1 at entry (AOR=1.41, 95% CI 1.01-1.98) and 3rd trimester (AOR=1.80, 95% CI 1.25-2.61). sVCAM-1 at entry (AOR= 1.82, 95% CI 1.29-2.57) and 3rd trimester (AOR= 1.94, 95% CI 1.35-2.79) and 3rd trimester sE-selectin (AOR=1.44, 95% CI 1.01-2.15) all were associated with increased risk. When we examined preterm delivery without preeclampsia, risks associated with high sICAM-1 and sVCAM-1 persisted. High sE-selectin was specific to preterm delivery with preeclampsia (AOR= 1.94, 95% CI 1.04-3.64 at entry, AOR= 3.13, 95% CI 1.63-6.02 at 3rd trimester). A history of preeclampsia increases later maternal CVD risk. Consequently, increased endothelial dysfunction during the metabolic stress of pregnancy may well foreshadow later CVD for women whose pregnancies were complicated by preterm delivery.

Learning Areas:
Basic medical science applied in public health
Biostatistics, economics
Chronic disease management and prevention
Epidemiology

Learning Objectives:
(1) to describe risks associated with preterm delivery (2)to discuss maternal factors related to cardiovascular risk (3)to demonstrate that some CVD risk factors increase risk of preterm delivery

Keywords: Birth Outcomes, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the PI or CO PI on a number of federal grants focusing on maternal health, maternal risk factors and pregnancy outcome
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.