Erken ve Geç Başlangıçlı Preeklampside Risk Faktörleri ve Neonatal Sonuçların Karşılaştırılması

Yıl 2020, Cilt: 20 Sayı: 3, 100 - 106, 29.12.2020

Özgül Bulut , Meryem Hocaoğlu , Nurgül Bulut , Selin Demirer Abdulkadir Turgut , Fahri Ovalı

Öz

Amaç: Erken başlangıçlı ve geç başlangıçlı preeklampside maternal risk faktörleri ve erken dönem neonatal sonuçların karşılaştırılması. Gereç ve Yöntem: Hastanemizde preeklampsi tanısı almış hastalar retrospektif olarak değerlendirildi. Hastalar erken başlangıçlı preeklampsi (≤34 hafta) ve geç başlangıçlı preeklampsi (>34 hafta) olmak üzere 2 gruba ayrıldı. İki grup arasında demografik data, maternal risk faktörleri ve neonatal sonuçları karşılaştırmak için istatistiksel analiz yapıldı. Bulgular: Preeklampsi tanısı alan 92 hastanın, 45 (%49)’i erken başlangıçlı preeklampsi ve 47 (%51)’si geç başlangıçlı preeklampsi idi. Erken başlangıçlı preeklampsi grubunda, sezaryen doğum ve intrauterin büyüme kısıtlılığı (İUBK) oranları anlamlı şekilde daha yüksek bulundu (p=0.01, p=0.025). Lojistik regresyon analizinde, gebelikte yüksek vücut kitle indeksinin geç başlangıçlı preeklampsi için bağımsız bir risk faktörü olduğu saptandı (p=0.012). Erken başlangıçlı preeklampsi grubunda, neonatal morbidite ve yenidoğan yoğun bakım ünitesine (YDYBÜ) yatış oranları anlamlı şekilde daha yüksek bulundu (p<0.05, p=0.005, sırasıyla). Bunun yanında, lojistik regresyon analizinde erken başlangıçlı preeklampsinin, İUBK (OR 2.96; 95% CL: 1.12–7.81), SGA (OR 2.5; 95% CL: 1.05–5.95), respiratuar distres sendromu (OR 15.34; 95% CL: 3.06–76.99), patent duktus arteriosus (OR 11.43; 95% CL: 1.36–96.16) ve YDYBÜ’ne yatış (OR 2.48; 95% CL: 1.06–5.77) riskini anlamlı şekilde artırdığı saptandı. Sonuç: Çalışmamızda, erken başlangıçlı preeklampsi, olumsuz neonatal sonuçlar için önemli bir risk faktörü olarak bulunurken, gebelikte yüksek vücut kitle indeksi geç başlangıçlı preeklampsi ile ilişkili bulundu.

Anahtar Kelimeler

Erken başlangıç, geç başlangıç, preeklampsi, risk faktörleri, neonatal sonuçlar

Comparison of Risk Factors and Neonatal Outcomes in Early-Onset and Late-Onset Preeclampsia

Öz

Objective: To compare the maternal risk factors and early neonatal outcomes in early-onset and late-onset preeclampsia. Material and Methods: In our hospital, patients diagnosed with preeclampsia were evaluated retrospectively. The patients were divided into two groups as early onset preeclampsia (≤34 weeks) and late onset preeclampsia (>34 weeks). Statistical analyses were used to compare demographic data, maternal risk factors and neonatal outcomes between the two groups. Results: Out of 92 patients, 45 (49%) were in the early onset preeclampsia and 47 (51%) were in the late onset preeclampsia groups. Cesarean delivery and intrauterine growth retardation (IUGR) rates were significantly higher in the early onset preeclampsia group (p=0.01, p=0.025). High body mass index was an independent risk factor for late onset preeclampsia in the logistic regression analysis (p=0.012). Neonatal morbidities and hospitalization rates in the neonatal intensive care unit (NICU) were significantly higher in the early onset preeclampsia group (p<0.05, p=0.005, respectively). In addition, in the logistic regression analysis, it was found that early onset preeclampsia significantly increased the risks of IUGR (OR 2.96; 95% CL: 1.12–7.81), being small for gestational age (OR 2.5; 95% CL: 1.05–5.95), respiratory distress syndrome (OR 15.35; 95% CL: 3.06–76.99), patent ductus arteriosus (OR 11.43; 95% CL: 1.36–96.16) and hospitalization in the NICU (OR 2.48; 95% CL: 1.06–5.77). Conclusion: Early-onset preeclampsia was found to be an important risk factor for adverse neonatal outcomes while high body mass index during pregnancy was associated with late-onset preeclampsia.

Anahtar Kelimeler

Early-onset, late-onset, preeclampsia, risk factors, outcomes

Kaynakça

• 1. Monteith C, Egan K, O’Connor H, Maguire P, Kevane B, Szklanna PB, et al. Early-onset preeclampsia is associated with an elevated mean platelet volume (MPV) and a greater rise in MPV from time of booking compared with pregnant controls: results of the CAPE study. J Perinat Med 2018;46(9):1010-15. https://doi.org/ 10.1515/ jpm-2017-0188.
• 2. American College of Obstetricians and Gynecologists. Practice Bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019;133(1):1-25. https://doi.org/10.1097/AOG.0000000000003018.
• 3. Machado JSR, Machado MSR, Bertagnolli TV, Martins LAB, Freitas SF, Ovidio PP, et al. Role of plasma PlGF, PDGF-AA, ANG-1, ANG- 2, and the ANG-1/ANG-2 ratio as predictors of preeclampsia in a cohort of pregnant women. Pregnancy Hypertens 2019;16:105- 111. https://doi:10.1016/j.preghy.2019.03.011.
• 4. Staff AC. The two-stage placental model of preeclampsia: An update. J Reprod Immunol 2019;134-135:1-10. https:// doi:10.1016/j.jri.2019.07.00.
• 5. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ 2019;366:l2381. https://doi.org/10.1136/bmj.l2381.
• 6. Kucukbas GN, Sanhal CY, Uygur D. Plasma endocan levels in early and late-onset preeclampsia. Fetal Pediatr Pathol 2019;1-8. https://doi.org/10.1080/15513815.2019.1693674.
• 7. Ni Y, Cheng W. Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia. Hypertens Pregnancy 2016; 35(3): 315-22. https:// doi.org/10.3109/10641955.2016.1143486.
• 8. Publications Committee, Society for Maternal-Fetal Medicine, Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks’ gestation. Am J Obstet Gynecol 2011;205(3):191-198. https://doi.org/10.1016/j.ajog.2011.07.017.
• 9. Pettit F, Mangos G, Davis G, Henry A, Brown MA. Pre-eclampsia causes adverse maternal outcomes across the gestational spectrum. Pregnancy Hypertens 2015;5(2):198-204. https://doi. org/10.1016/j.preghy.2015.02.002
• 10. Wójtowicz A, Zembala-Szczerba M, Babczyk D, Kołodziejczyk- Pietruszka M, Lewaczyńska O, Huras H.et al. Early- and late-onset preeclampsia: a comprehensive cohort study of laboratory and clinical findings according to the New ISHHP Criteria. Int J Hypertens 2019;2019:4108271. https://doi.org/10.1155/2019/4108271.
• 11. Weitzner O, Yagur Y, Weissbach T, Man El G, Biron-Shental T. Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. J Matern Fetal Neonatal Med 2020;33(5):780-84. https://doi.org/10.1080/14767058.2018.150 0551.
• 12. Gruslin A, Lemyre B. Pre-eclampsia: fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011;25(4):491- 507. https://doi.org/10.1016/j.bpobgyn.2011.02.004.
• 13. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. 2013;209(6):544.e1-544.e12. https://doi:10.1016/j. ajog.2013.08.019
• 14. Madazli R, Yuksel MA, Imamoglu M, et al. Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia. Arch Gynecol Obstet 2014;290(1):53-57. https://doi.org/10.1007/ s00404-014-3176-x.
• 15. Soliman Y, Alshaikh B, Alawad E, Akierman A, Elsharkawy A, Yusuf K. Respiratory outcomes of late preterm infants of mothers with early and late-onset preeclampsia. J Perinatol 2020;40(1):39-45. https://doi.org/10.1038/s41372-019-0497-4.
• 16. Orgeig S, Crittenden TA, Marchant C, McMillen IC, Morrison JL. Intrauterine growth restriction delays surfactant protein maturation in the sheep fetus. Am J Physiol Lung Cell Mol Physiol 2010;298(4):575-83. https://doi.org/10.1152/ajplung.00226.2009.
• 17. Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Preeclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014;10(8):466-80. https://doi.org/10.1038/ nrneph.2014.102.
• 18. Wang A, Holston AM, Yu KF, Zhang J, Toporsian M, Karumanchi SA, et al. Circulating anti-angiogenic factors during hypertensive pregnancy and increased risk of respiratory distress syndrome in preterm neonates. J Matern Fetal Neonatal Med 2012;25(8):1447- 52. https://doi.org/10.3109/14767058.2011.640368.
• 19. Simchen MJ, Beiner ME, Strauss-Liviathan N, Dulitzky M, Kuint J, Mashiach S, et al. Neonatal outcome in growth-restricted versus appropriately grown preterm infants. Am J Perinatol 2000;17(4):187-92. https://doi.org/10.1055/s-2000-9423.
• 20. Bányász I, Bokodi G, Vásárhelyi B, Treszl A, Derzbach L, Szabó A, et al. Genetic polymorphisms for vascular endothelial growth factor in perinatal complications. Eur Cytokine Netw 2006;17:266-70. https://doi.org/10.1684/ecn.2006.0041.
• 21. Withagen MI, Visser W, Wallenburg HC. Neonatal outcome of temporizing treatment in early-onset preeclampsia. Eur J Obstet Gynecol Reprod Biol 2001;94(2):211-5. https://doi.org/10.1016/ s0301-2115(00)00332-8.
• 22. Shah DM, Shenai JP, Vaughn WK. Neonatal outcome of premature infants of mothers with preeclampsia. J Perinatol 1995;15(4):264-7.
• 23. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010;125(5):1020-30. https://doi.org/10.1542/ peds.2009-3506
• 24. Teramo KA, Widness JA. Increased fetal plasma and amniotic fluid erythropoietin concentrations: markers of intrauterine hypoxia. Neonatology 2009;95(2):105-16. https://doi.org/10.1159/000153094.
• 25. Park YH, Lee GM, Yoon JM, Cheon EJ, Ko KO, Lee YH, et al. Effect of early postnatal neutropenia in very low birth weight infants born to mothers with pregnancy-induced hypertension. Korean J Pediatr 2012;55(12):462-9. https://doi.org/10.3345/kjp.2012.55.12.462.
• 26. Akbar AMI, Herdiyantini M, Aryananda RA, CIninta N, Wardhana MP, Gumilar KE, et al. Serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1) level, and neonatal outcome in early-onset, late-onset preeclampsia, and normal pregnancy. Hypertens Pregnancy 2018;37(4):175-81. https://doi.org/10.10 80/10641955.2018.1494187.
• 27. Kucukgoz GU, Ozgunen FT, Buyukkurt S, Guzel AB, Urunsak IF, Demir SC, et al. Comparison of clinical and laboratory findings in early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2013;26(12):1228-33. https://doi.org/10.3109/14767058.2013.7 76533.
• 28. Poorolajal J, Jenabi E. The association between body mass index and preeclampsia: a meta-analysis. J Matern Fetal Neonatal Med 2016;29(22):3670-6. https://doi.org/10.3109/14767058.2016.11 40738.
• 29. Roberts JM, Redman CWG, Global Pregnancy Collaboration. Global Pregnancy Collaboration symposium: prepregnancy and very early pregnancy antecedents of adverse pregnancy outcomes: overview and recommendations. Placenta 2017;60:103-109. https://doi. org/10.1016/j.placenta.2017.07.012.
• 30. O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003;14(3):368-74. https://doi.org/10.1097/00001648- 200305000-00020
• 31. Ornaghi S, Tyurmorezova A, Algeri P, Giardini V, Ceruti P, Vertemati E, et al. Influencing factors for late-onset preeclampsia. J Matern Fetal Neonatal Med 2013;26(13):1299-302. https://doi.org/10.31 09/14767058.2013.783807.