Endothelial Progenitor Cells in Umbilical Cord Blood in Preeclampsia and IUGR

Preeclampsia remains a significant cause of neonatal and maternal morbidity and mortality.
This disorder is found in 5-7% of pregnancies and its incidence is increased in gravid
patients with multiple gestations, chronic hypertension, renal disease, autoimmune disease,
and at extremes of maternal age. It is responsible for 15% of preterm births which is
accompanied by a resultant increase in neonatal morbidity and mortality. In developing
countries, it is responsible for approximately 50,000 maternal deaths each year. No
widespread intervention to prevent this disease has been found effective and the only
effective treatment remains delivery of the fetus.

To date, the cause of preeclampsia is not known although many agree that preeclampsia is a
two-stage disease as described by Roberts et al. with the placenta of central importance. The
first stage involves poor placental perfusion usually a result of impaired vascular
remodeling in early pregnancy or from maternal disease. This leads to the second stage, which
is the maternal syndrome of preeclampsia and involves both endothelial and leukocyte
activation.

Preeclampsia is associated with an increased maternal cardiovascular risk later in life.
Women with a history of preeclampsia demonstrate altered expression of angiogenesis-related
proteins and increased insulin resistance as measured by the homeostasis model of insulin
resistance. Additionally, preeclampsia is associated with an increase in future
cardiovascular risk in the fetus.

Endothelial dysfunction and abnormal regulation of vascular tone that is present in
preeclampsia suggests abnormal development of vascular cells such as endothelial progenitor
cells. The increased cardiovascular risk of neonates born in the setting of IUGR and
preeclampsia also suggests the possibility of abnormal development of endothelial progenitor
cells in the fetal compartment in these disease states. The purpose of this pilot project is
to determine the effects of preeclampsia/IUGR on endothelial progenitor cells derived from
fresh umbilical cord blood.

Inclusion Criteria:

- Pregnant women 18-45

- Gestational age between 30-40 weeks plus:

- Uncomplicated pregnancy or

- Fetal estimated weight <10% for gestational age or abdominal circumference <5% or

- Preeclampsia by ACOG criteria:

1. HTN > 140/90 on two occasions

2. Proteinuria > 300mg on 24 hour urine specimen or 1+ on urine dip

Exclusion Criteria:

- Non-reassuring fetal status

- Congenital abnormalities

- Multiple gestations

- Clinical Chorioamnionitis

- Recent infectious disease (within 2 weeks)