Chorionic Villus Sampling at 11 to 13 Weeks of Gestation and Hypertensive Disorders in Pregnancy EDITORIAL COMMENT

TY - JOUR

T1 - Chorionic Villus Sampling at 11 to 13 Weeks of Gestation and Hypertensive Disorders in Pregnancy EDITORIAL COMMENT

AU - Khalil, Asma

AU - Akolekar, Ranjit

AU - Pandya, Pranav

AU - Syngelaki, Argyro

AU - Nicolaides, Kypros

PY - 2010/12

Y1 - 2010/12

N2 - It is unclear whether chorionic villus sampling (CVS) in early pregnancy increases the risk of preeclampsia. A randomized comparative study reported that rates of preeclampsia and/or gestational hypertension were significantly increased in the CVS group following early amniocentesis at 11 to 14 weeks. Results of several case-control studies on the relationship between early CVS sampling and the subsequent development of preeclampsia were contradictory. Differences in study design appear to have contributed to these conflicting results. No adjustment had been made in these studies for the possible contribution to the development of preeclampsia of either known maternal characteristics or maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A). This study was designed to assess the potential association of CVS in early pregnancy (first-trimester screening) with subsequent development of hypertensive disorders during pregnancy, and to determine whether any association found remained significant after adjustment for maternal characteristics and maternal serum concentration of PAPP-A. Entry criteria included singleton pregnancies with live fetus at 11 0/7 to 13 6/7 weeks surviving beyond 23 weeks of gestation, with available data on free beta-human chorionic gonadotrophin and PAPP-A. Exclusion criteria included pregnancies with miscarriage or termination before 24 weeks, and women who had an amniocentesis or unknown pregnancy outcome. Multiple logistic regression analysis was used to estimate the likelihood of an association between CVS and hypertensive disorders of pregnancy and to adjust for possible confounding maternal and fetal characteristics. Among the 31,138 individuals included in the final analysis, preeclampsia subsequently developed in 697 (2.2%), gestational hypertension developed in 857 (2.8%), and 29,584 (95.0%) were unaffected by either preeclampsia or gestational hypertension. A CVS was performed at 11 to 13 weeks in 7.3% (2278/31,138) of the included pregnancies. Multivariate analysis showed no significant difference between the CVS and the non-CVS group in the prevalence of early preeclampsia (P = 0.677), late preeclampsia (P = 0.535), or gestational hypertension (P = 0.848). In the adjusted data, significant contributions were found from maternal factors and serum biochemistry, but these did not affect the subsequent development of preeclampsia. These findings show no association between first-trimester CVS and subsequent development of hypertensive disorders of pregnancy, and, therefore, provide no support for the hypothesis that CVS in early pregnancy increases the risk of preeclampsia.

AB - It is unclear whether chorionic villus sampling (CVS) in early pregnancy increases the risk of preeclampsia. A randomized comparative study reported that rates of preeclampsia and/or gestational hypertension were significantly increased in the CVS group following early amniocentesis at 11 to 14 weeks. Results of several case-control studies on the relationship between early CVS sampling and the subsequent development of preeclampsia were contradictory. Differences in study design appear to have contributed to these conflicting results. No adjustment had been made in these studies for the possible contribution to the development of preeclampsia of either known maternal characteristics or maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A). This study was designed to assess the potential association of CVS in early pregnancy (first-trimester screening) with subsequent development of hypertensive disorders during pregnancy, and to determine whether any association found remained significant after adjustment for maternal characteristics and maternal serum concentration of PAPP-A. Entry criteria included singleton pregnancies with live fetus at 11 0/7 to 13 6/7 weeks surviving beyond 23 weeks of gestation, with available data on free beta-human chorionic gonadotrophin and PAPP-A. Exclusion criteria included pregnancies with miscarriage or termination before 24 weeks, and women who had an amniocentesis or unknown pregnancy outcome. Multiple logistic regression analysis was used to estimate the likelihood of an association between CVS and hypertensive disorders of pregnancy and to adjust for possible confounding maternal and fetal characteristics. Among the 31,138 individuals included in the final analysis, preeclampsia subsequently developed in 697 (2.2%), gestational hypertension developed in 857 (2.8%), and 29,584 (95.0%) were unaffected by either preeclampsia or gestational hypertension. A CVS was performed at 11 to 13 weeks in 7.3% (2278/31,138) of the included pregnancies. Multivariate analysis showed no significant difference between the CVS and the non-CVS group in the prevalence of early preeclampsia (P = 0.677), late preeclampsia (P = 0.535), or gestational hypertension (P = 0.848). In the adjusted data, significant contributions were found from maternal factors and serum biochemistry, but these did not affect the subsequent development of preeclampsia. These findings show no association between first-trimester CVS and subsequent development of hypertensive disorders of pregnancy, and, therefore, provide no support for the hypothesis that CVS in early pregnancy increases the risk of preeclampsia.

U2 - 10.1097/OGX.0b013e3182134005

DO - 10.1097/OGX.0b013e3182134005

M3 - Editorial

VL - 65

SP - 751

EP - 752

JO - Obstetrical and Gynecological Survey

JF - Obstetrical and Gynecological Survey

IS - 12

ER -