title: Difference of endothelial function during pregnancies as a method to predict preeclampsia.
abstract: BACKGROUND
  Systemic endothelial dysfunction has been identified as one of the main events in preeclampsia (PE). A nonhealthy vascular endothelium can be pointed out as the pathophysiological explanation of the clinical manifestations and complications of PE. Once normal pregnancy is characterized by a constant increase in endothelial function, a follow-up of this physiological event could be used as an early marker or a prediction tool to predict PE.
  
  
  OBJECTIVE
  To perform a longitudinal assessment of endothelial function, using an ultrasound study of brachial artery flow Flow-mediated dilation (FMD), in normotensive and preeclamptic pregnancies, to evaluate the difference of FMD values along the second trimester of pregnancy to predict PE.
  
  
  METHODS
  In a prospective cohort study, 91 pregnant women with a high risk of developing PE were subjected to FMD of the brachial artery. The difference in the FMD values, between 16(+0) and 19(+6) and 24(+0) and 27(+6) weeks of gestation were compared, taking PE development into consideration. Receiver operator characteristics (ROC) curves were created to determine the sensibility and specificity of FMD difference to predict PE.
  
  
  RESULTS
  A total of 19 patients developed PE and the other 72 women remained normotensive until 1 week after delivery. When considering a cut off of +2.50 %, FMD difference, between the two evaluations, sensitivity for PE prediction was 87.5 % for early onset PE and 95.5 % for late PE.
  
  
  CONCLUSIONS
  The difference of FMD values between the second trimester of pregnancy can be used for PE prediction for both, early and late forms of PE.
authors.affiliation: Department of Obstetrics and Gynecology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Av. Professor Alfredo Balena 110-4° andar, Belo Horizonte, MG, Brazil, augustohfbrandao@hotmail.com.
authors.forename: Augusto Henriques Fulgêncio
authors.initials: AH
authors.lastname: Brandão
authors.forename: Lara Rodrigues
authors.initials: LR
authors.lastname: Félix
authors.forename: Evilane do Carmo
authors.initials: Edo C
authors.lastname: Patrício
authors.forename: Henrique Vítor
authors.initials: HV
authors.lastname: Leite
authors.forename: Antônio Carlos Vieira
authors.initials: AC
authors.lastname: Cabral
mesh_terms: D000328:Adult; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging*; D036861:Delivery, Obstetric; D042241:Early Diagnosis; D005260:Female; D020567:Fetal Weight; D005865:Gestational Age; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology*; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*