PB0545 - The Effect of a History of Preeclampsia on Hemostatic Balance in the Non-pregnant State

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

CH

Christine E. Horn

Medical Student
The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States

Co-Author(s)

MB

Maria Bravo, PhD

Faculty Scientist
Department of Biochemistry, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States
TO

Thomas Orfeo, PhD

Faculty Scientist
Department of Biochemistry, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States
LR

Lorinda Roberts, MA

Clinical Research Coordinator
Department of Obstetrics, Gynecology & Reproductive Sciences, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States
KM

Kelley McLean, MD

Associate Professor, Maternal Fetal Medicine
Department of Obstetrics, Gynecology & Reproductive Sciences, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States
IB

Ira Bernstein, MD

Professor and John van Sicklen Maeck Chair
Department of Obstetrics, Gynecology & Reproductive Sciences, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT 05405, USA
Burlington, Vermont, United States

Background: Women with preeclampsia exhibit altered procoagulant profiles during pregnancy and the immediate postpartum period. However, the extent to which altered hemostatic balance persists past the immediate postpartum is not well-understood.

Aims: To evaluate whether a history of preterm preeclampsia (PPE) is associated with abnormal hemostatic features during the non-pregnant state, relative to women without a history of PPE.

Methods: We conducted a retrospective sub-analysis of three prospective IRB-approved studies in which nulliparous and parous women with prior uncomplicated pregnancies, or pregnancies complicated by PPE, were evaluated outside of pregnancy. Functional levels of coagulation factors (II, V, VII, VIII, IX, X, XI, XII, antithrombin, and protein C (PC)) and thrombin generation (TG) in the presence of thrombomodulin were assessed. T-tests were used to compare parameters between women with prior PPE (PP, n=21) with a combined cohort (NP, n=78) of healthy nulliparous women (n=59) and women with a prior normotensive pregnancy (n=19).

Results: Women with a history of PPE had significantly increased levels of factors II, V, VII, IX, X, XI, and PC compared to those without this history (Table). In dynamic assays examining TG, reduced rates of formation (PP: 41.25± 27.22 vs NP: 53.45± 24.33, p=.049) and diminished peak levels (PP: 100.10± 61.41 vs. NP: 127.69± 53.86, p=.046) were observed in PP relative to NP group. There were no observed differences between healthy nulliparous and healthy primiparous women in the NP group.

Conclusion(s): Increased procoagulant factor levels are associated with increased TG, suggesting here that women with prior PPE would have a procoagulant shift in the non-pregnant state. However, the observed concurrent increase in anticoagulant PC linked with a decrease in dynamic TG suggests a compensatory mechanism to maintain hemostatic balance. In the non-pregnant state, women with prior PPE exhibit different hemostatic profiles relative to healthy nulliparous women and women with prior normotensive pregnancies.