Objective- To assess maternal endothelial function in singleton pregnancies complicated by intrauterine growth restriction (IUGR) due to placental dysfunction. Design- Prospective cohort study. Setting- 37 pregnant women who underwent endothelial function assessment using EndoPATTM device. Population or Sample- Study population included two groups: 1. Pregnancies with estimated fetal weight below 10th percentile and abnormal umbilical artery flow (n=15); 2. Pregnancies with normal fetal growth without placental complications matched by gestational age (n=22). Exclusion criteria included diseases with potential vascular dysfunction or smoking. Methods- EndoPAT device evaluates changes in peripheral vascular flow and tone in reaction to temporal ischemia. Normal post-ischemic endothelial reaction is an increase in vascular flow. A ratio of the readings before and after ischemia is used to calculate the score for endothelial function, called reactive hyperemic index (RHI). Low RHI value indicates endothelial dysfunction. Main outcome measures- RHI values. Results- Mean gestational age at endoPAT examination was comparable between the IUGR and control group (32.5 ± 2.2 vs, 31.6 ± 3.2, respectively; p=0.21). Mean RHI was significantly lower in the IUGR group compared to the control group (1.32 ± 0.16 vs 1.51 ± 0.31, p= 0.02, respectively). As expected, mean gestational age at delivery and neonatal birth weight were lower in the IUGR group compared to the control group (35.4 ± 2.3 vs 37.3 ± 2.6 p=0.04; 1640 ± 414 grams vs 2785 ± 587 grams, p<0.001 respectively). Conclusions- Pregnant women with isolated IUGR due to placental dysfunction had impaired endothelial function.

Objective: To evaluate whether early-onset severe preeclampsia prior to 34 weeks’ gestation is clinically different when associated with antiphospholipid antibodies. Design: A retrospective case-control study. Setting: Single university-affiliated tertiary referral center Population: 55 women with singleton pregnancies who delivered prior to 34 weeks’ gestation due to preeclampsia with severe features. Methods: Out of the 101 women with preeclampsia with severe features, the antiphospholipid antibodies status of 55 was available for analysis. The study group comprised 20 women with positive antiphospholipid antibodies (positive-aPL group), while the control group comprised 35 women without antiphospholipid antibodies (negative-aPL group). Main outcome measures: Obstetric and neonatal outcomes, laboratory results and pregnancy complications. Results: Positive-aPL women were hospitalized earlier (29, IQR 26.3–32, vs. 32, IQR 28-33 weeks gestation, p=0.05), gave birth at a significantly earlier gestational age (30, IQR 28.3-32.8 vs. 33, IQR 30-34, p=0.02) with a lower mean birth weight (1266.7±579.6 vs. 1567.3±539.7 grams, p=0.058) compared with negative-aPL women. Furthermore, platelet nadir was significantly lower for positive-aPL compared with negative-aPL women (97.2±49.7103/µL vs 141.3±61.13/µL, p<0.001) and maximal serum creatinine was higher (1.02±0.32 mg/dL vs. 0.92±0.13 mg/dL, p=0.03). Rates of neonatal complications were low and comparable between groups, although there was a trend for higher perinatal mortality among study group infants. Conclusions: The presence of antiphospholipid antibodies in women with early-onset preeclampsia with severe features is associated with earlier, more severe multi-organ involvement. Expedited screening for antiphospholipid antibodies in cases of early-onset severe preeclampsia may be considered.