Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia

BackgroundPreeclampsia (PE) is associated with subsequent higher risk of cardiovascular and kidney disease. Serum copeptin, as a proxy for vasopressin, and urinary uromodulin, were associated with PE physiopathology and kidney functional mass respectively. We describe concentrations of these proteins in the post-partum period and characterize their association with persistent hypertension (HTN) or albuminuria.MethodsPatients with PE and healthy controls with uncomplicated pregnancy were prospectively included at two teaching hospitals in Switzerland. Clinical parameters along with serum copeptin and urinary uromodulin were measured at 6 weeks post-partum. PE patients were further characterized based on presence of HTN (defined as either systolic BP (SBP) ≥140 mmHg or diastolic (BP) ≥90 mmHg) or albuminuria [defined as urinary albumin to creatinine ratio (ACR) ≥3 mg/mmol].ResultsWe included 226 patients with 35 controls, 120 (62.8%) PE with persistent HTN/albuminuria and 71 (37.1%) PE without persistent HTN/albuminuria. Median serum copeptin concentration was 4.27 (2.9–6.2) pmol/L without differences between study groups (p > 0.05). Higher copeptin levels were associated with higher SBP in controls (p = 0.039), but not in PE (p > 0.05). Median urinary uromodulin concentration was 17.5 (7.8–28.7) mg/g with lower levels in PE patients as compared to healthy controls (p < 0.001), but comparable levels between PE patients with or without HTN/albuminuria (p > 0.05). Higher uromodulin levels were associated with lower albuminuria in PE as well as control patients (p = 0.040).ConclusionSerum copeptin levels at 6 weeks post-partum are similar between PE patients and healthy controls and cannot distinguish between PE with or without residual kidney damage. This would argue against a significant pathophysiological role of the vasopressin pathway in mediating organ damage in the post-partum period. On the opposite, post-partum urinary uromodulin levels are markedly lower in PE patients as compared to healthy controls, potentially reflecting an increased susceptibility to vascular and kidney damage that could associate with adverse long-term cardiovascular and kidney outcomes

Impact materno-foetal et obstétrical d'un surpoids et d'une obésité anté-conceptionnels

La prévalence de l obésité et du surpoids augmente chez les femmes en âge de procréer. L objectif était d étudier l impact materno-fœtal et obstétrical d un surpoids ou d une obésité anté-conceptionnels. Il s agit d une étude rétrospective réalisée au CHU de Dijon comparant 292 patientes en surpoids et 192 patientes obèses, enceintes de singletons, à 3064 parturientes de poids normal ayant accouché sur la même période. Les caractéristiques maternelles, les pathologies gravidiques, les modalités d accouchements et le devenir néonatal ont été étudiés. Les patientes en surpoids ont plus de recours à l assistance médicale à la procréation. Les patientes en surpoids et obèses ont plus d antécédent d utérus cicatriciel. Les femmes obèses sont plus âgées, multipares et présentent plus de comorbidités pré-existantes. Etre en surpoids ou obèse entraîne un risque augmenté de diabète gestationnel et d hypertension artérielle gravidique. L obésité multiplie par 2 le risque de pré-éclampsie et entraîne plus d hospitalisations pendant la grossesse. Elles présentent plus de déclenchements et plus de césariennes en urgence. Etre obèse morbide augmente le risque de prématurité. Les patientes en surpoids accouchent moins par voie basse notamment après un antécédent d utérus cicatriciel. Elles présentent 2 fois plus d hémorragies de la délivrance. L obésité multiplie par 3 le risque de macrosomie. Les morts fœtales in utéro et les issues néonatales péjoratives ne sont pas plus fréquentes. L obésité et le surpoids sont des facteurs de risque de pathologies gravidiques. Etre obèse est un facteur de risque obstétrical indépendant. L obésité et le surpoids n ont pas d impact sur l issue néonatale en dehors de la macrosomie.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Gynécologie-obstétrique. Prise en charge et dépistage du diabète gestationnel : ce qui a changé en 2023

Dû à l’augmentation du surpoids, de l’obésité et de l’âge maternel chez les femmes enceintes, le diabète gestationnel (DG) est de plus en plus fréquent. De ce fait, afin d’offrir une prise en charge hygiénodiététique précoce, il est recommandé d’effectuer un dépistage ciblé au premier trimestre de la grossesse pour identifier les facteurs de risque. En leur absence, le dépistage du DG doit être réalisé chez toutes les femmes enceintes entre 24 et 28 SA. Au cours de la grossesse, le traitement pharmacologique le plus sécuritaire reste l’insuline et le terme d’accouchement doit tenir compte des facteurs de risque surajoutés, des besoins en insuline, de la cinétique de croissance foetale et de l’équilibre du DG. À plus long terme, le DG doit être considéré comme une alerte métabolique et cardiovasculaire

Consultation prénatale : anticiper pour les futures mères et enfants

Prenatal care allows early detection of risks and complications in the pregnant women in an attempt to minimize problems at birth and delivery. In Geneva, prenatal care is organized as a collaboration between private and liberal in-hospital network with a ranking in the pregnancy risk levels to adapt follow-up. The perinatal care structure should be built in a way to identify risks prompting professionals to adapt from the normal physiological care to a therapeutic escalation one appropriated to the detected risk level. Effective inter-professional collaboration around the mother-child dyad (and even the family) depends on a privileged multidisciplinary interaction platform in which, wide inter-professional communication, particularly between midwife-obstetrician-neonatalogist, is essential

Risques maternels et infantiles associés à l'obésité préconceptionnelle et efficacité des interventions

One in five pregnant women has obesity in Europe. It is an independent risk factor for maternal and foetal complications during pregnancy and delivery, increasing linearly with pre-conceptional body mass index. Excessive gestational weight gain further aggravates these risks. The clinician should measure body weight at each visit from the 1st trimester of pregnancy, search and monitor complications and be aware of preventive measures. A balanced diet with low glycemic load and light to moderate physical activity 30‑60 minutes 3‑5 times per week should be recommended during pregnancy and postpartum to control gestational weight gain and reduce the risks of short and long-term maternal and infant complications

Table1_Association of serum copeptin and urinary uromodulin with kidney function, blood pressure and albuminuria at 6 weeks post-partum in pre-eclampsia.docx

BackgroundPreeclampsia (PE) is associated with subsequent higher risk of cardiovascular and kidney disease. Serum copeptin, as a proxy for vasopressin, and urinary uromodulin, were associated with PE physiopathology and kidney functional mass respectively. We describe concentrations of these proteins in the post-partum period and characterize their association with persistent hypertension (HTN) or albuminuria.MethodsPatients with PE and healthy controls with uncomplicated pregnancy were prospectively included at two teaching hospitals in Switzerland. Clinical parameters along with serum copeptin and urinary uromodulin were measured at 6 weeks post-partum. PE patients were further characterized based on presence of HTN (defined as either systolic BP (SBP) ≥140 mmHg or diastolic (BP) ≥90 mmHg) or albuminuria [defined as urinary albumin to creatinine ratio (ACR) ≥3 mg/mmol].ResultsWe included 226 patients with 35 controls, 120 (62.8%) PE with persistent HTN/albuminuria and 71 (37.1%) PE without persistent HTN/albuminuria. Median serum copeptin concentration was 4.27 (2.9–6.2) pmol/L without differences between study groups (p > 0.05). Higher copeptin levels were associated with higher SBP in controls (p = 0.039), but not in PE (p > 0.05). Median urinary uromodulin concentration was 17.5 (7.8–28.7) mg/g with lower levels in PE patients as compared to healthy controls (p  0.05). Higher uromodulin levels were associated with lower albuminuria in PE as well as control patients (p = 0.040).ConclusionSerum copeptin levels at 6 weeks post-partum are similar between PE patients and healthy controls and cannot distinguish between PE with or without residual kidney damage. This would argue against a significant pathophysiological role of the vasopressin pathway in mediating organ damage in the post-partum period. On the opposite, post-partum urinary uromodulin levels are markedly lower in PE patients as compared to healthy controls, potentially reflecting an increased susceptibility to vascular and kidney damage that could associate with adverse long-term cardiovascular and kidney outcomes.</p