OBSTETRIC COMPLICATIONS IN DIFFERENT FORMS OF HYPERTENSION IN PREGNANT WOMEN

Objective. To assess the relationship of genetic and acquired risk factors and hemostatic status to complicated pregnancy in different forms of hypertension. Design. A prospective cohort study. Methods. Clinical, coagulation, molecular genetic, immunological, and statistical studies. Subject. These included 106 women with chronic hypertension, 21 with chronic hypertension concurrent with preeclampsia, 63 with gestational hypertension, 10 with preeclampsia, and 100 nonhypertensive women who had no family history of obstetric/gynecological and/or thrombotic diseases. Results. Overweight, obesity, and smoking were most common in the pregnant women with all forms of hypertension and the women with chronic hypertension and preeclampsia had also more frequently a family history of hypertension and venous and arterial thrombosis than the nonhypertensive pregnant women. Pregnancy was more often complicated by chronic placental insufficiency and fetal growth restriction in the women with all forms of hypertension. The outcomes of pregnancy were characterized by higher preterm birth rates and lower neonatal weight for height indicators in the chronic hypertension + preeclampsia group than in the nonhypertension one. Evaluation of hemostatic status in the women with hypertension concurrent with preeclampsia showed excessive activation of the platelet and coagulation components of hemostasis throughout their pregnancy as compared to the nonhypertensive women. The women with chronic hypertension were found to have a higher frequency of the D allele and DD genotype in the angiotensin-converting enzyme gene, the C allele in the angiotensinogen II type-1 receptor gene, the T allele and CT genotype in the MTHFR gene, as well as the T allele and TC genotype in the NO synthase gene than the nonhypertensive women. The pregnant women with preeclampsia were observed to have a higher frequency of the M allele and MM genotype in the angiotensinogen T174M gene. The factors independently associated with hypertension during pregnancy were an increased Quetelet index (>25 kg/m 2), TM genotype in the angiotensin-II gene, and the AC genotype in the angiotensin II type-1 receptor gene. Conclusion. Identification of genetic and clinical predictors makes it possible to improve the prediction of different forms of hypertension during pregnancy and to timely form risk groups to prevent hypertension-associated gestational complications.

hypertension, pregnancy, hemostatic indicators, genetic polymorphisms