Comparison of outcomes between normal and preeclamptic pregnancies: a prospective study
Authors: Kalagiri Ram R , Afroze Syeda H , Reyes Michelle , Drever Nathan N , Allen Steven R , Beeram Madhava R , Govande Vinayak , Zawieja David C , Kuehl Thomas J , Uddin Mohammad N 
Published: November 2023

Objective

Preeclampsia (PreE) is a complex syndrome with multiple pathophysiologic triggers and mechanisms affecting 3–8% of pregnancies. PreE is a major cause of maternal and fetal morbidity & mortality that is characterized by de novo development of hypertension and proteinuria after 20 weeks of gestation. PreE has a significant link to alterations of placental stress and apoptotic factors that pass to the offspring. We assessed the comparison of pregnancy outcomes between patients with and without preE.

Methods

We recruited 20 normal pregnant (NP) and 20 PreE consenting patients after deliveries in an IRB approved prospective study from Scott & White Hospital, Temple, Texas. We evaluated the following parameters for mothers; age, body mass index (BMI), blood pressures, proteinuria, gestational age at delivery. Placental thickness and volumes and stress signaling proteins; p38 mitogen‐activated kinase (p38 MAPK), cyclooxygenase‐2 (COX‐2) and Bcl‐2‐associated‐X protein (Bax), anti‐apoptotic Bcl‐2 were measured by western blotting. We also evaluated babies for intrauterine growth restriction (IUGR), gestational age at birth, anthropometric measurements including ponderal index (PI), length of hospitalization and complications like hypoglycemia, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and gastroesophageal reflux disease (GERD). Comparisons were performed using Student's t test.

Results

The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in preE (SBP 166 ± 11; DBP 92 ± 12) compared to normal pregnancies (SBP 122 ± 10; DBP 72 ± 9; p = 0.001 for each case). PreE mothers had higher urinary protein excretion (457mg/24h ± 140) compared to NP (160 mg/24h ± 44; p = 0.002). We did not find any difference in maternal ages & BMI, placental thickness and placental volumes between the two groups. The average gestational age at delivery was lower in preE (36.2 weeks ± 2.7) compared to NP (38.8 weeks ± 1; p = 0.017). Average hospital stay for preE babies were longer (20 days ± 25) compared to NP (2 days ± 1; p = 0.0019). No complications were reported for NP babies; however, preE babies had multiple complications like hypoglycemia, RDS, BPD, ROP, IVH, Infections and GERD. The birth weights of the preE babies were much lower (2672gms ± 727) than the NP babies (3345gms ± 451; p = 0.027) indicating the IUGR. The preE babies were small for gestational age with lower PI (2.46 ± 0.3) when compare to the NP babies (2.95 ± 0.2; p = 0.0004). The placental stress signaling proteins p38 MAPK, COX‐2 and Bax/Bcl‐2 were up‐regulated in preE compared to normal pregnancy (p<0.05, in each case).

Conclusions

PreE alters the intrauterine environment and activates the detrimental signaling that is transported to fetus resulting in premature deliveries, IUGR babies and their related complications with extended hospitalization. The detrimental signaling molecules that have been overexpressed in preE patients raises the possibility that those signals could be therapeutically blocked one day.