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Q&A

Hypertension

Poster Session 4

(1059) Maternal Angiogenic Imbalance & Placental Sexual Dimorphism

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Elizabeth Lemoine, MD (she/her/hers)

    Dr. Elizabeth Lemoine
    University of North Carolina
    Durham, NC, United States

    • Coauthor(s)

  • VC

    Vinicius Calsavara, PhD

    Research Scientist I - Statistician
    Cedars-Sinai Health System
    Los Angeles, CA, United States

  • RT

    Ravi Thadhani, MD, MPH

    Professor of Medicine with Tenure, Emory School of Medicine; Executive Director, Woodruff Health Sciences Center; Vice Chair of the Board, Emory Healthcare; Executive Vice President for Health Affairs
    Emory University
    Atlanta, GA, United States

  • SK

    Sarah Kilpatrick, MD,PhD

    Cedars-Sinai Medical Center
    Los Angeles, CA, United States

  • S. Ananth Karumanchi, MD

    Professor of Medicine; Medallion Chair, Vascular Biology
    Cedars-Sinai Medical Center
    Los Angeles, CA, United States

  • Kim Boggess, MD

    Professor
    University of North Carolina
    Chapel Hill, NC, United States

Objective: Sex-based responses to the in-utero environment & resultant infant outcomes are reported.  While preeclampsia occurs more frequently in patients carrying a male fetus, carrying a female fetus is associated with higher odds of preterm preeclampsia.  We hypothesize that fetal sex differences in maternal serum sFLT-1/PlGF contribute to differences in sex differences in preterm preeclampsia. We sought to compare maternal serum sFLT-1/PlGF ratio within 2 weeks of delivery in hypertensive patients between those with a male vs. female fetus.

Study Design: This is a secondary analysis of data from a prospective cohort study in 18 US centers of hospitalized patients with hypertensive disorders of pregnancy & a singleton fetus between 24 & 35-weeks’ gestation. We compared maternal characteristics with student t-test or chi-square tests. We calculated the median (95% CI) of maternal sFlt-1/PlGF ratios & compared between those with a female vs. male fetus using Mann Whitney U tests. All analyses were performed in R.

Results: Of 551 patients without missing data, 260 (47%) had a male & 287 (52%) a female. Demographic and clinical characteristics were comparable by fetal sex. Compared to male group, maternal sFLT-1/PlGF ratio was significantly higher in the female group [224.7 vs. 181.8, P = 0.024]. Severe maternal adverse outcomes (HELLP syndrome, abruption, DIC, eclampsia, pulmonary edema) & severe fetal/neonatal adverse outcomes (fetal/neonatal death, birthweight < 3% percentile & delivery < 32 weeks) were not different between groups. Pregnancies with female fetuses were more likely than male to be delivered for worsening hypertension or non-reassuring fetal status (97.56 vs. 87.69%, P < 0.001).

Conclusion: Our data support that placental sexual dimorphism in angiogenic imbalance occurs in preterm preeclampsia. Further studies are needed to determine if sexual dimorphism impacts response to prevention or treatment strategies.