Key result
Increased second-trimester PAF-AH activity linked to ~44% incidence of transient hypertension in later pregnancy.
Why the study?
Does elevated plasma PAF-AH activity in the 2nd trimester predict the development of transient hypertension in pregnant women?
Cohort (n=51)
Does elevated plasma PAF-AH activity in the 2nd trimester predict the development of transient hypertension in pregnant women?
An increase in plasma PAF-AH activity during the 2nd trimester of pregnancy is associated with a significantly higher risk of developing transient hypertension later in pregnancy.
Answers are grounded in this paper and cite their sources.
May identify pregnancies at risk for transient hypertension; hypothesis-generating and requires prospective validation before clinical use.
It is reported that plasma platelet-activating-factor-acetylhydrolase (PAF-AH) is elevated in patients with essential hypertension. In this study, plasma PAF-AH activity was measured during pregnancy and after delivery to examine the relationship between plasma PAF-AH activity and the development of transient hypertension (TH) during pregnancy. Moreover, in order to examine the involvement of endothelial injury in TH, the plasma level of nitric oxide metabolite (NOx; NO2+NO3) was measured. The plasma PAF-AH activity in 51 pregnant women was consecutively measured in the 1st, 2nd and 3rd trimesters of gestation, and after delivery. Forty-one cases were normal pregnancies and 10 cases were complicated by TH later during pregnancy. The PAF-AH activity in the normal pregnancy group decreased in the 2nd trimester of gestation compared with the 1st trimester, but was elevated in the TH group. The incidence of elevation of PAF-AH in the TH group was significantly (7/10; 70.0%; P<0.01, Chi-squared test) higher than in the normal pregnancy group (9/41; 22.0%). The plasma NOx levels in the 2nd trimester were higher than those in the 1st trimester in both the normotensive and TH group (P<0.05 for both comparisons). The 51 patients were classified into two groups according to the change in the PAF-AH in the 2nd trimester: group A consisted of 35 patients whose PAF-AH activity did not increase, and group B consisted of 16 patients whose PAF-AH activity increased. The incidence of development of TH during later pregnancy in group B was significantly (7/16; 43.8%; P<0.01, Chi-squared test) higher than in group A (3/35; 8.6%). Hypertension developed after 36 weeks' gestation in all patients in the TH group. The results of the present study suggest that changes in PAF metabolism may relate to regulation of blood pressure in pregnant women whose pregnancy is complicated with TH, whereas NO metabolism does not differ between women with TH and those having a normal pregnancy.
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Okumura et al. (1999) conducted a cohort in Transient hypertension during pregnancy (n=51). Increased plasma PAF-AH activity in the 2nd trimester vs. No increase in plasma PAF-AH activity in the 2nd trimester was evaluated on Development of transient hypertension during later pregnancy (p=<0.01). Increased plasma PAF-AH activity in the second trimester was associated with a significantly higher incidence of transient hypertension during later pregnancy (43.8% vs 8.6%; P<0.01).
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