title: Low-molecular-weight heparin lowers the recurrence rate of preeclampsia and restores the physiological vascular changes in angiotensin-converting enzyme DD women.
abstract: Data from literature report that angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism affects the recurrence of preeclampsia and that low-molecular-weight heparin (LMWH) prevents adverse outcomes in thrombophilic women. We investigated the effect of LMWH on the pregnancy outcome, on maternal blood pressure values, and on uteroplacental flow in ACE DD nonthrombophilic women with history of preeclampsia. Eighty nonthrombophilic ACE DD women were randomized in 2 groups: 41 treated with dalteparin 5000 IU/day and 39 untreated (control group). Women underwent 24-hour automated blood pressure monitoring in the preconceptional period and every 2 weeks from weeks 8 to 36 and transabdominal color flow/pulsed Doppler examination at weeks 16, 20, and 24. LMWH reduced the risk of clinical negative outcomes (74.1% reduction of preeclampsia and 77.5% reduction of fetal growth restriction) and the severity (88.3% reduction of early onset of preeclampsia and 86.4% reduction of early onset of fetal growth restriction). In treated women, the relative risk for preeclampsia was 0.26 (P=0.02), and the relative risk for fetal growth restriction was 0.14 (P<0.001). Systolic (P=0.002) and diastolic (P=0.002) blood pressures, as well as awake (P=0.04) and asleep (P=0.01) period values, and the resistance indexes of both uterine arteries (P=0.002) were lower in the treated group. LMWH reduces the recurrence of preeclampsia, of negative outcomes, and the resistance of uteroplacental flow, and also prevents maternal blood pressure increase in ACE DD homozygote women with a previous history of preeclampsia.
authors.affiliation: Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Viale GB. Morgagni 85, 50134 Florence, Italy. mellog@unifi.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Mello
authors.forename: Elena
authors.initials: E
authors.lastname: Parretti
authors.forename: Cinzia
authors.initials: C
authors.lastname: Fatini
authors.forename: Chiara
authors.initials: C
authors.lastname: Riviello
authors.forename: Francesca
authors.initials: F
authors.lastname: Gensini
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Scarselli
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001724:Birth Weight; D002940:Circadian Rhythm; D017985:Dalteparin / Q000627:therapeutic use*; D003971:Diastole / Q000187:drug effects; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D020022:Genetic Predisposition to Disease; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006720:Homozygote; D006801:Humans; D007231:Infant, Newborn; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D021041:Placental Circulation / Q000187:drug effects; D011225:Pre-Eclampsia / Q000201:enzymology / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012008:Recurrence; D012306:Risk; D017384:Sequence Deletion; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D007703:Peptidyl-Dipeptidase A; D017985:Dalteparin