Background <ul><li>Preeclampsia is a pregnancy specific syndrome characterized by new onset hypertension and proteinuria in the second half of pregnacy </li></ul><ul><li>Preeclampsia causes substantial morbidity and mortality in mothers and infants. </li></ul>
Background <ul><li>Women with a history of pre-eclampsia have an increased risk of lipid disorders, hypertension, cardiovascular disease and renal disease. </li></ul><ul><li>The cause of preeclampsia is unknown </li></ul>
Antiangiogenesis Antiangiogenesis (AN-tee-AN-jee-oh-JEN-eh-sis) Prevention of the growth of new blood vessels.
The Importance of Antiangiogenesis The formation of new blood vessels is essential for a normal pregnancy Studies in both humans and animals suggest that excess circulating antiangiogenic factors may be responsible for pre-eclampsia
Examples of Antiangiogenic Factors Soluble fms-like Tyrosine Kinase 1 (sFlt-1) Soluble endoglin *Laboratory rats exposed to sFlt-1 and Soluble endoglin develop severe preeclampsia.
Hypothyroidism Hypothyroidism is a decreased activity of the thyroid gland Hypothyroidism can affect all body functions. Slow metabolism due to hypothyroidism can cause mental and physical sluggishness. The most severe form of hypothyroidism is myxedema, which is a medical emergency.
TREATMENT OF HYPOTHYROIDISM Small differences in dosage have significant clinical impact, both on safety and efficacy
THE STUDY <ul><li>Small differences in dosage have significant clinical impact, both on safety and efficacy </li></ul>
Richard J. Levine, M.D., et al. Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-control and population based study BMJ 2009;339:b4336 Richard J Levine, Lars J Vatten,Gary L Horowitz, Cong Qian, Pal R Romundstad, Kai F Yu, Anthony N Hollenberg, Alf I Hellevik, Bjorn O Asvold, S Ananth Karumanchi,
Results Women who develop preeclampsia are more likely to have slightly reduced thyroid function during the final weeks of their pregnancies. Women who develop preeclampsia are also more likely to have low thyroid function more than 20 years after giving birth.
Conclusions The level of hypothyroidism was strongly associated with levels of soluble fms-like tyrosine kinase 1 in patients with preeclampsia The researchers write that this suggests that the effect of preeclampsia on thyroid function may be mediated by this protein.
Clinical Significance The findings of this study have important implications for the subsequent care of women with pre-eclampsia. Women who have had preeclampsia should be followed closely for the development of cardiovascular and renal disease. Women who have had preeclampsia should be monitored for reduced thyroid function and clinically important hypothyroidism.
Implications for Patients Early treatment of hypothyroidism may substantially reduce the associated morbidity and improve quality of life in women who have had preeclampsia Treatment of hypothyroidism might prevent early cardiovascular disease in women with a history of pre-eclampsia.
Questions for Further Research Does hypothyroidism contribute to cardiovascular disease in women with a history of pre-eclampsia? Does subclinical hypothyroidism in women with pre-eclampsia have adverse effects on the long term health of the children? Does the risk of hypothyroidism in women with pre-eclampsia increase with time elapsed after pregnancy?