1. Mothers with preterm deliveries have significantly different levels of metabolites among them compared to term mothers.
2. There are different levels of metabolites among mothers with spontaneous preterm deliveries and with medically-indicated spontaneous preterm deliveries with or without preeclampsia.
Evidence Rating Level: 2 (Good)
Mothers who have preterm deliveries (PTD) may experience an increased risk for cardiovascular disease up to three times of their baseline. Previous studies show that this increased risk may be due to metabolic disorders that occur during pregnancy, such as eclampsia, which accounts for 24-26% of the association, or postpartum, which accounts for 13-15% of the association. However, much of the increased risk still remains unaccounted for. Metabolomic profiling, in which a large number of circulating metabolites involved in various pathways are analyzed, has been successful in identifying early biomarkers for cardiovascular disease. Using this method of high-throughput assessment, this study analyzed 380 metabolites in 1330 women, collected up to 72 hours after giving birth, by either term delivery (n=980), medically indicated PTD (mPTD) with preeclampsia (n=79), mPTD without preeclampsia (n=52), and spontaneous PTD (SPTD, n=219). The study was performed using patients in the Boston Birth Cohort in a socially disadvantaged area with a predominantly minority population. Metabolomic profiles were most different between term controls and women having PTD with preeclampsia, in which they found a significant increase of 26 metabolites (diacylglycerols, triacylglycerols, phosphocholines and lysophosphocholines) and decrease in 11 metabolites in the latter (including nucleotides, steroids, and cholesteryl esters). Women having mPTD and preeclampsia had significantly more diacylglycerols and triacylglycerols in circulation, and fewer cholesteryl esters than women with mPTD only. mPTD only women only had significantly different phosphatidylethanolamines from at term women. Meanwhile, sPTD women also had a different metabolic profile than at-term mothers and those with mPTD with preeclampsia, though these groups did share similar metabolite changes when compared to at-term mothers. The different groups in this study showed differing levels of unique metabolites with some overlap, with some identified metabolites already known for being predictors of future cardiovascular disease. These findings will have to be replicated in other studies before identified metabolites can be used for follow-up longer-term studies to see if they are truly associated with increased risk of cardiovascular disease.
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