Pre-eclampsia (PE), characterized by ofe novo hypertension and proteinuria during pregnancy, is a major cause of maternal and fetal death, and the leading cause of premature delivery worldwide. Currently there is no effective treatment, and delivery of the baby is the only "cure". The incidence of PE is dramatically increased in pregnancies complicated by any form of diabetes (-20% vs -5% in general population), especially pre-gestational diabetes. However, new evidence suggests that the risk for PE among American Indian and Hispanic women, despite their increased risk for Type 2 diabetes (T2DM), may be lower than among white women. The present study will measure established and novel risk factors for PE, late in pregnancy, in women from three racial/ethnic categories (American Indian, Hispanic, Caucasian) with and without pre-gestational diabetes.
Our aim i s to define PE risk factors that are influenced by the presence of T2DM, and to determine whether these differ among the three groups. We will recruit a cross-sectional cohort of 300 pregnant women at 34-38 weeks'gestation. Of these, 100 will come from each racial/ethnic category, and of each group of 100, 50 will have pre-gestational T2DM and 50 will have no history of dysglycemia. Groups will be matched for established PE risk factors: age, parity, BMI, and among T2DM women, for glycemia and known duration of diabetes. Our hypothesis is that T2DM is associated with specific risk profiles for PE, and that these may differ among the racial/ethnic groups.
Our Specific Aims are: (1) To assess ethnic differences in dietary and behavioral factors that may modulate risk for PE;(2) To measure levels of anti-angiogenic factors (endoglin, sFlt-1) and to perform exploratory metabolomic and micro-RNA analyses using fasting maternal serum and plasma collected near the time of delivery;(3) To establish repositories for future genetic studies, specifically fasting maternal blood obtained prior to delivery, and placental tissue and cord blood at delivery. This is the first occasion upon which Oklahoma Chickasaw and Choctaw Nations have agreed to enable genetic studies. The outcome of this study will have a major influence on future research directions, and on the rational development of treatments to prevent or arrest PE in pregnant diabetic women, particularly from minority populations.
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