Placental production and maternal serum and urine levels of inhibin A and activin A are modified by antihypertensive therapy in hypertensive disorders of pregnancy.
OBJECTIVE
Levels of inhibin A and activin A are raised in pre-eclampsia (PE) but it is not known if antihypertensive therapy can affect their levels. Our aim was to investigate the effect of the antihypertensive drug alpha-methyldopa on serum, urine and placental concentrations of inhibin A and activin A in women presenting with hypertensive disorders of pregnancy.


METHODS
This was a cross-sectional study.


METHODS
We recruited 65 women presenting with PE, 39 with gestational hypertension (GH) and 104 normotensive controls matched for maternal age, gestational age and parity.


METHODS
Using specific validated ELISAs, serum and urine levels of inhibin A and activin A, and uterine artery Doppler indices, were measured before and 24-48 h after initiating alpha-methyldopa therapy in women with PE, with GH and controls. Protein extracts were obtained from samples of placental tissue from another group of women with PE, GH and controls for the same analysis.


RESULTS
In PE, but not GH, alpha-methyldopa therapy was associated with significantly (P < 0.05) lower levels of both serum and urine inhibin A and activin A. Similarly, in PE but not GH, alpha-methyldopa therapy was associated with lower placental levels of both markers (P < 0.05). There was no significant difference in pulsatility index following treatment in either PE or GH.


CONCLUSIONS
Our data indicate that antihypertensive therapy with alpha-methyldopa may have an effect on the synthesis and/or release of placental proteins in pregnancies complicated by PE and that this effect may be independent of its known antihypertensive action.
Khalil
Asma
A
Academic Department of Obstetrics and Gynaecology, EGA Institute for Women's Health, University College, London, UK. asmakhalil79@googlemail.com
Jauniaux
Eric
E
Harrington
Kevin
K
Muttukrishna
Shanthi
S
D028341:Activins / Q000032:analysis* / Q000097:blood / Q000652:urine; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D007265:Inhibins / Q000032:analysis* / Q000097:blood / Q000652:urine; D008750:Methyldopa / Q000627:therapeutic use*; D010920:Placenta / Q000187:drug effects / Q000378:metabolism*; D011247:Pregnancy
D000959:Antihypertensive Agents; C422405:activin A; C422362:inhibin A; D028341:Activins; D008750:Methyldopa; D007265:Inhibins