Jg Aarnoudse

Posttraumatic stress disorder following preeclampsia and HELLP syndrome

Posttraumatic stress disorder (PTSD) in connection with pregnancy was first described in the 1990s - initially in relation to childbirth but later more specifically to the mode of delivery. Instrumental vaginal delivery carries the highest risk of PTSD followed by emergency caesarean section and normal spontaneous delivery. Loss of pregnancy, spontaneous abortion or intrauterine death for example can also lead to PTSD. Little systematic research has been performed regarding the psychological consequences of severe preeclampsia or HELLP syndrome, although it would seem obvious that these conditions may have a great effect. The combination of suffering a serious illness combined with an unexpected caesarean section or delivery, often of a premature child, is a heavy burden to bear both physically and psychologically. We describe here three patients who developed PTSD after pregnancies complicated by severe preeclampsia or HELLP syndrome. PTSD can develop after preeclampsia or HELLP syndrome.

Abnormal endothelium-dependent microvascular reactivity in recently preeclamptic women

OBJECTIVE: To assess endothelial function at the level of skin microvasculature, using iontophoretic administration of acetylcholine (endothelium-dependent vasodilator) and sodium nitroprusside (endothelium-independent vasodilator), in women who recently had a preeclamptic pregnancy. METHODS: Microvascular skin reactivity was assessed by laser Doppler perfusion monitoring and iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP) in 25 women with a history of early onset preeclampsia and 23 women with previous uncomplicated pregnancies, all of whom were between 3 and 11 months postpartum. RESULTS: Mean (± standard error of the mean) ACh-mediated vasodilatation, expressed as a percentage increase in flux, was higher in women who recently had a preeclampsia than in controls (535 ± 46% versus 314 ± 29%, P < .001). In contrast, SNP-mediated vasodilatation was not significantly different (560 ± 71% versus 483 ± 69%, P = .4) in both groups. Linear regression analysis revealed that the difference in ACh-mediated vasodilatation was explained by preeclampsia (P = .004), whereas vascular risk factors such as maternal age, diastolic blood pressure, and family history of premature cardiovascular diseases had no significant effect. CONCLUSION: The increased ACh-mediated vasodilatation in the microcirculation of recently preeclamptic women indicates abnormal endothelial function. Furthermore, it may represent a compensatory response to an impaired vasodilatory response of the macrocirculation, thereby supporting the hypothesis of an underlying (micro)angiopathy. LEVEL OF EVIDENCE: II-2

Posttraumatic Stress Disorder Following Preeclampsia and PPROM : A Prospective Study With 15 Months Follow-Up

Objective: A prospective longitudinal evaluation of the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in women with preeclampsia (PE) or preterm premature rupture of membranes (PPROM) compared to uncomplicated pregnancies. Methods: Participating women completed PTSD and depression questionnaires during pregnancy, 6 weeks, and 15 months postpartum. Data regarding psychiatric history and indices of obstetric care were collected from patient charts. Results: We included 57 PE, 53 PPROM, and 65 healthy pregnant women, of whom 137 also participated in the 15-month follow-up (PE 70%, PPROM 48%, and controls 95%; P < .001). At 6 weeks postpartum, the prevalence of PTSD, but not depression, following childbirth was significantly higher in patients than in controls (14% vs 3%; P = .023). A history of depression, depressive symptoms during pregnancy, and infant death were significantly associated with symptoms of postpartum PTSD. The maternal condition seems to be of less decisive value, as there was no difference between the prevalence of PTSD after PE and PPROM (11% vs 17%; P = .324). At 15 months postpartum, 11% of women with PE had PTSD, some of which did not have PTSD 6 weeks postpartum. The low response rate in the PPROM group at 15 months postpartum does not allow for definite conclusions. Conclusion: Pregnancies complicated by PE or PPROM are associated with PTSD in a substantial number of women. Especially women with proven vulnerability for psychological problems are at risk of developing PTSD postpartum, as are women whose children died in the perinatal period.

The HELLP-syndrome; maternal-fetal outcome and follow up of infants

Abstract Objective: To investigate maternal-fetal outcome of infants born after pregnancies complicated by (H)ELLP syndrome. Study design: A retrospective cohort study was performed on patients with the HELLP or ELLP syndrome. Maternal and perinatal complications were recorded. The follow-up period of the infants was at least 18 months. A multivariate regression analysis was done to define the variables mostly contributing to adverse outcome. Results: No maternal deaths occurred. Eighteen infants of the HELLP group and six infants of the ELLP group died; total perinatal mortality was 17.6%. After 18 months four infants had major handicaps, making a total adverse outcome of 22.8%. Statistical analysis shows early gestational age, prolongation of pregnancy and administration of antihypertensive medication as the factors influencing outcome of the infants most. Conclusions: Prolongation of pregnancy contributed to better perinatal outcome, while administration of antihypertensive medication and early gestational age were related to a more unfavorable outcome.

The effect of Porphyromonas gingivalis lipopolysaccharide on pregnancy in the rat.

OBJECTIVEnPeriodontitis, mostly associated with Porphyromonas gingivalis, has frequently been related to adverse pregnancy outcomes. We therefore investigated whether lipopolysaccharides of P.xa0gingivalis (Pg-LPS) induced pregnancy complications in the rat.nnnMETHODSnExperiment 1: pregnant rats (day 14) received increasing Pg-LPS doses (0.0-50.0xa0μgxa0kg(-1) bw; nxa0=xa02/3 p per dose). Maternal intra-aortic blood pressure, urinary albumin excretion, placental and foetal weight and foetal resorptions were documented. Experiment 2: 10.0xa0μgxa0kg(-1) bw (which induced the highest blood pressure together with decreased foetal weight in experiment 1) or saline was infused in pregnant and non-pregnant rats (nxa0=xa07/9 p per group). Parameters of experiment 1 and numbers of peripheral leucocytes as well as signs of inflammation in the kidney and placenta were evaluated.nnnRESULTSnPg-LPS infusion in pregnant rats increased maternal systolic blood pressure, reduced placental weight (dose dependently) and decreased foetal weight and induced foetal resorptions. It, however, did not induce proteinuria or a generalised inflammatory response. No effects of Pg-LPS were seen in non-pregnant rats.nnnCONCLUSIONnPg-LPS increased maternal blood pressure, induced placental and foetal growth restriction, and increased foetal resorptions, without inducing proteinuria and inflammation. Pg-LPS may therefore play a role in pregnancy complications induced by periodontitis.

Fathers with PTSD and depression in pregnancies complicated by preterm preeclampsia or PPROM

PurposeTo assess prevalence and risk factors for posttraumatic stress disorder (PTSD) and depression in fathers after early preeclampsia (PE) or preterm premature rupture of membranes (PPROM).MethodsPartners of patients hospitalized for PE or PPROM and partners of healthy controls completed PTSD (PSS-SR) and depression (BDI-II) questionnaires during pregnancy (t1) and 6 weeks postpartum (t2). 85 of the 187 eligible men participated (51 partners of patients, 34 partners of control) at t1, and 66 men participated both time points.ResultsNo significant differences were found between partners of patients and partners of controls in symptoms of PTSD and depression (t1: pxa0=xa00.28 for PTSD and pxa0=xa00.34 for depression; t2: pxa0=xa00.08 for PTSD and pxa0=xa00.31 for depression). For partners of patients, correlation between PTSD and depression sum-scores was 0.48 (pxa0<xa00.001) at t1 and 0.86 (pxa0<xa00.001) at t2. Within-couple correlation was low and not significant during pregnancy, but strong at postpartum (PSS-SR: rxa0=xa00.62, pxa0<xa00.001; BDI-II: rxa0=xa00.59, pxa0<xa00.001). Higher paternal age was associated with more symptoms of PTSD and depression postpartum in partners of patients. Symptoms of PTSD and depression during pregnancy predicted the occurrence of PTSD symptoms following childbirth in partners of patients.ConclusionsSymptoms of PTSD and depression occurred at a similar rate in partners of women with PE or PPROM and partners of healthy pregnant controls. Symptoms of PTSD and depression during pregnancy predicted the occurrence of PTSD symptoms following childbirth. Increased paternal age predicted more symptoms of PTSD and depression postpartum. At 6xa0weeks postpartum, a strong association was found between men and women in symptoms of PTSD and depression.

PERINEAL PAIN AND DYSPAREUNIA AFTER UNCOMPLICATED PRIMIPAROUS DELIVERY

In a prospective cohort study of 210 women who underwent uncomplicated primiparous childbirth the relative effects of episiotomy, first or second degree perineal tears and delivery without tears or episiotomy on perineal pain and dyspareunia have been investigated. After childbirth, women who underwent an episiotomy indicated a significantly higher level of perineal pain than women whose perineum was intact or torn. On physical examination significant differences in the occurrence of hematomas between the various groups of women could be detected, probably accounting for the differences in pain level observed. While perineal pain in the first postpartum week is most likely following episiotomy, dyspareunia at 6 months is most frequently found in women having perineal tears. In comparison to the situation before pregnancy, for the total experimental patient population dyspareunia decreased. This decline in dyspareunia is most obvious for women whose perineum remained intact, less obvious for women with an ...

OS072. Regional distribution of cerebral white matter lesions years following (pre)eclampsia.

tensive pregnancies. Methods: It is a cross-sectional study in which 23 chronic hypertensive women in use of an alpha-adrenergic agonist drug (methyldopa), between 20 and 40 weeks gestation, had their common and internal carotid arteries, and vertebral artery, evaluated by Doppler sonography. They were compared to 223 normotensive patients. All patients were in use of methyldopa as prescribed by their attending physician. The following Doppler variables were assessed: peak systolic velocity, end diastolic velocity, resistance index, pulsatility index, and systolic/diastolic ratio. B-mode ultrasound was used to measure the vessel diameter. Differences between the two groups were tested by Independent t-test and Mann–Whittney test when appropriate. MedCalc statistical software was used to perform the statistical analysis. Results: Velocity measurements and resistance indices were lower in hypertensive patients in the internal carotid artery and the vertebral artery. The diameters of the carotid arteries were larger in the hypertensive group but did not change in the vertebral arteries (Table 1). Conclusion: Vasodilation was observed in the common and internal carotid arteries, which is an expected effect of methyldopa. It may be responsible for the lower values observed for the velocity measurements and resistance indices. The vessel diameter did not change in the vertebral arteries.

P43. Fathers with PTSD and depression in pregnancies complicated by preeclampsia or PPROM

Objective: We examined if hypertension and preeclampsia in pregnancy predict serious mental disorders in the offspring, and if sex, childhood socioeconomic background, length of gestation and parity modify these associations. Methods: We included 5.970 women and men born at term after a normotensive, hypertensive or preeclamptic pregnancy defined by using mother’s blood pressure and urinary protein measurements at maternity clinics and birth hospitals, and who participated in the Helsinki Birth Cohort 1934-44 Study. Mental disorders requiring hospitalization or contributing to death were identified from the Finnish Hospital Discharge and Causes of Death Registers between years 1969 and 2004. Results: In comparison to the offspring born after normotensive pregnancies, offspring born after pregnancies complicated by hypertension were at 1.19-fold (CI: 1.01 to 1.41, P-value = 0.04) higher risk of any mental disorder and 1.44(CI: 1.11 to 1.88, P-value <0.01) and 1.39-fold (CI: 0.99 to 1.93, P-value = 0.05) higher risk of mood and anxiety disorder, respectively. Preeclampsia was associated, in contrast, with lower risk of any mental disorder in the male offspring (P-value = 0.02; P-value = 0.04 for interaction ‘sex preeclampsia/normotension). Conclusions: Hypertension in pregnancy was associated with a higher risk of serious mental disorders in the offspring in adulthood. Preeclampsia seems to, in turn, associate with lower risk of severe mental disorders in the male offspring. Our findings are compatible with the Developmental Origins of Health and Disease -hypothesis and, if replicated, may shed light into the mechanisms linking prenatal adversity with higher mental health risk later in life. First Author < 35 years: Yes