A Peripartum Assessment of Nailfold Capillary Density in Women With Preeclampsia

Abstract

Preeclampsia (PE) is characterized as new-onset hypertension in pregnancy (>140mmHg systolic or >90mmHg diastolic), along with proteinuria and is a leading cause of maternal mortality and morbidity worldwide. Despite the etiology of PE remaining elusive, it is thought that placental trophoblast cells do not adequately invade into the inner myometrium layer of the uterus during placentation, resulting in the incomplete remodelling of the uterine spiral arteries. As a result, the placenta becomes hypoperfused and releases pathogenic factors in response. Pathogenic factors, such as reactive oxygen species (ROS) and soluble fms-like tyrosine kinase one (sFlt-1), cause systemic endothelial dysfunction, ultimately leading to hypertension and accompanying symptoms of PE. While symptoms typically resolve after delivery, those with a history of PE are at an increased risk of developing cardiovascular disease (CVD) later in life. Despite this, many individuals with a history of PE in pregnancy are not offered cardiovascular risk surveillance or intervention to prevent CVD postpartum. Since CVD and increased risk of CVD have both been associated with declined nailfold capillary density, nailfold video capillaroscopy (NVC) could be used as a postpartum assessment tool to identify those at increased risk of CVD. The objective of the current study was to determine if the nailfold capillary density (capillaries/mm2) of women with PE is reduced when compared to controls both antepartum and postpartum. Previous literature supports our hypothesis that nailfold capillary density will be reduced in preeclamptic participants when compared to controls and that this decline in density will persist postpartum. The nailfold capillaries of 32 control and 15 preeclamptic participants were assessed using NVC within 2 weeks antepartum and 48-hours postpartum. No difference in the average nailfold capillary densities was found between groups before or after delivery. Prior evidence of structural and functional changes to the microvasculature after a pregnancy complicated by PE suggests that further investigation to clarify these results is necessary. Further awareness of the lasting impacts of PE on the microvasculature may provide support for the surveillance of PE patients postpartum and to mitigate their increased risk of CVD later in life with pharmaceutical and lifestyle interventions.