Impact of early- and late-onset preeclampsia on features of placental and newborn vascular health.

INTRODUCTION: Offspring exposed to preeclampsia (PE) show an increased risk of cardiovascular disease in adulthood. We hypothesize that this is mediated by a disturbed vascular development of the placenta, umbilical cord and fetus. Therefore, we investigated associations between early-onset PE (EOPE), late-onset PE (LOPE) and features of placental and newborn vascular health. METHODS: We performed a nested case-control study in The Rotterdam Periconceptional Cohort, including 30 PE pregnancies (15 EOPE, 15 LOPE) and 218 control pregnancies (164 uncomplicated controls, 54 complicated controls including 28 fetal growth restriction, 26 preterm birth) and assessed macroscopic and histomorphometric outcomes of the placenta and umbilical cord. RESULTS: A significant association was observed between PE and a smaller umbilical vein area and wall thickness, independent of gestational age and birth weight. In EOPE we observed significant associations with a lower weight, length and width of the placenta, length of the umbilical cord, and thickness and wall area of the umbilical vein and artery. These associations attenuated after gestational age and birth weight adjustment. In LOPE a significant association with a larger placental width and smaller umbilical vein wall thickness was shown, independent of gestational age and birth weight. DISCUSSION: Our study suggests that PE is associated with a smaller umbilical cord vein area and wall thickness, independent of gestational age and birth weight, which may serve as a proxy of disturbed cardiovascular development in the newborn. Follow-up studies are needed to ultimately predict and lower the risk of cardiovascular disease in offspring exposed to PE.

Late complications of bariatric surgery in pregnancy.

Severe complications of bariatric surgery in pregnancy can appear many years later, even if there is a history of an uneventful pregnancy after bariatric surgery and a stable body mass index for years. We present the case of a pregnant patient who presented to our gynaecology department with an internal herniation after Roux and Y gastric bypass surgery.

PP012. Abnormal vascular umbilical cord morphology in vascular-related pregnancy complications.

BACKGROUND: Preeclampsia (PE), foetal growth restriction (FGR) and preterm birth (PTB) are associated with an increased risk on the development of cardiovascular disease in offspring. Abnormal programming of the embryonic and extra-embryonic vasculature may be involved. The umbilical cord could be a good model for studying foetal vascular development. OBJECTIVES: We examined the morphology of the umbilical cord vasculature in complicated (PE, FGR, PTB) and uncomplicated pregnancies. METHODS: In a case-control study, we included 105 patients consisting of PE (n=31), FGR (n=26), PTB (n=24) and controls (n=24). Macroscopic measurements were performed and tissue samples were formalin-fixed within 1 hour after birth, for microscopic analysis of digitised paraffin sections. RESULTS: The macroscopic evaluation showed shorter umbilical cords in PE than in controls. Microscopic measurements revealed a smaller total cord area in all complicated pregnancies compared to controls. The artery wall area was smaller in PE and IUGR, and a smaller vein wall area was present in PE only, compared to controls. The percentage of elastic fibres in the vein was lower in PE and IUGR than in controls (Table 1). CONCLUSION: Our study demonstrates umbilical cord vascular abnormalities in PE, FGR and PTB, suggesting early vascular damage. Future studies should focus on similar structural changes in foetal vasculature and associations with cardiovascular disease in later life.