title: Circulating anti-angiogenic factors during hypertensive pregnancy and increased risk of respiratory distress syndrome in preterm neonates.
abstract: OBJECTIVE
  To test the hypothesis that high circulating concentrations of maternal anti-angiogenic factors are associated with increased risk of respiratory distress syndrome (RDS).
  
  
  METHODS
  This is a nested case-control study of nulliparous women who delivered less than 37 weeks of gestation within the Calcium for Preeclampsia Prevention (CPEP) trial. The study included 116 women with preeclampsia or gestational hypertension and 323 normotensive controls. Soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) in maternal serum were measured at 21-32 weeks of gestation.
  
  
  RESULTS
  Preterm infants born to hypertensive mothers were more likely to develop RDS (22.5% vs. 20.9%, p = 0.03). After adjustment for gestational age at delivery, the odds ratio for the relationship between hypertension in pregnancy and RDS was 2.18 (95% CI 1.08-4.39). In hypertensive pregnancies women whose infants developed RDS had significantly higher circulating mean sFlt1 levels during midpregnancy (21-32 weeks of gestation) even after adjustment for gestational age at delivery (21,516 pg/mL vs. 7,000 pg/mL, p = 0.01).
  
  
  CONCLUSIONS
  Preterm preeclampsia and gestational hypertension, characterized by high circulating levels of sFlt1, are associated with a twofold increased risk of RDS in infants delivered before 37 weeks. Among women with these hypertensive pregnancies circulating sFlt1 concentrations during midpregnancy were substantially higher in women whose infants developed RDS.
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston University, Boston, Massachusetts, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Wang
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Holston
authors.forename: Kai F
authors.initials: KF
authors.lastname: Yu
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Mourad
authors.initials: M
authors.lastname: Toporsian
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000032:analysis / Q000097:blood*; D016022:Case-Control Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood* / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors
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