Some thoughts about PE

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jacinta
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Re : Some thoughts about PE

Postby jacinta » Mon Mar 16, 2009 06:40 pm

Caryn, that is so wonderful, many thanks for your insights delivered in a language that a grade 10 science dropout can understand!
The part about the remodelling from a first pregnancy remaining has been the hope that I cling to for future pregnancies, so thanks for that as well.
Will keep you posted.
Incidentally, my husband used to take his own blood pressure every time he took mine. I just can't remember the results as I was busy whacking him and reminding him who the patient was!

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caryn
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Re : Some thoughts about PE

Postby caryn » Mon Mar 16, 2009 02:31 pm

Patty, see http://www.preeclampsia.org/forum/viewtopic.php?t=20887 and http://www.preeclampsia.org/forum/viewtopic.php?t=24698 and http://www.ncbi.nlm.nih.gov/pubmed/1616 ... stractPlus.

This is a really hot area of research -- epigenetic evo-devo stuff -- and they're all working on it like mad, but it's really, really hard. I can hardly read some of it.

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patty
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Re : Some thoughts about PE

Postby patty » Mon Mar 16, 2009 02:23 pm

quote:Originally posted by Caryn


so that offspring of hypertensive pregnancies are more likely to be hypertensive themselves, and more likely to have children who have hypertensive pregnancies.


That is very interesting. Do you have any links to research on that part? My 13 year old son has already been diagnosed with hypertension bad enough for meds I knew there was a genetic component for him having high bp so young but I would hate to think my having pre-e while I was pregnant with him contributed.

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caryn
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Re : Some thoughts about PE

Postby caryn » Mon Mar 16, 2009 10:34 am

Oh, and the "normal pregnancies afterwards" thing is likely because any placental remodelling that the first placenta does manage to do sticks around between pregnancies, and so the subsequent placentas are starting with the house halfway rebuilt to suit them, if you know what I mean. It's like they move into a two-bedroom and need to add a wing to accomodate the children, and the first placenta doesn't get the job finished. :-)

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caryn
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Re : Some thoughts about PE

Postby caryn » Mon Mar 16, 2009 10:32 am

Hi Jacinta,

The male offspring of hypertensive pregnancies are more likely to father hypertensive pregnancies, and there's also a link with offspring with IUGR and and hypertensive pregnancies in those offspring, if I'm remembering right, though that might have just shown up in the females. And pregnancy can also unmask a genetic tendency towards chronic hypertension, so it's not uncommon for pressures just not to drop ever again postpartum.

There's lifelong epigenetic programming of metabolic factors that results from nutritional status in utero, only the mother's not really in *charge* of nutritional status in utero (no matter how well she eats), because that's all driven by how well the placenta is supplied, and that's all driven by how well it implants in the first place. It can't readily send the signals to increase plasma volume, or to relax maternal blood vessels, and it adopts other strategies for improving bloodflow like mucking about with the adrenal gland, because the whole chemical milieu is just *off*. (Lately it seems like very time they evaluate a soluble factor in preeclamptics vs. normal pregnancies, it's off.) And that epigenetic programming can stick around, so that offspring of hypertensive pregnancies are more likely to be hypertensive themselves, and more likely to have children who have hypertensive pregnancies.

That initial placentation involves coordination between two different known sets of genes, the maternal KIR and the paternal HLA, plus probably a whole bunch of other players. They work together to direct growth and development of the placenta, but we have the necessary conditions in place for an arms race, so they're also the most variable parts of the human genome. The male will adopt a strategy to deepen placentation, only that grows the baby too big to fit out, so then the mother will adopt a strategy to counteract that, like earlier delivery so the baby will be smaller, and then the male will try something else... (Of course, none of this is occuring on a conscious level -- it's all genetic. But it's likely why we have our babies so early, and so immature.)

Sorry; I can ramble on about this for days because it's so fascinating. :-)

(And I owe you email!)

jacinta
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Re : Some thoughts about PE

Postby jacinta » Mon Mar 16, 2009 03:30 am

Caryn, that is interesting about the father's genes directing placental growth. I have wracked my brains trying to work out how I ended up with severe preeclampsia.
I've recently discovered that my mother in law had hypertension when she was pregnant with my husband. She claims her blood pressure has been medicated ever since, as it has never returned to normal following their delivery.
My husband is 34 and was the smaller of two identical twins - 5 pounds to his brothers 8 pound birthweight. They were delivered at 36 weeks due to rising blood pressure.
I thought that it would have been nice to know this a few months ago, although my dear sister in law didn't have any problems with her son.
The plot thickens ......

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caryn
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Re : Some thoughts about PE

Postby caryn » Sun Mar 15, 2009 11:26 pm

Holly, they call it "maternal-fetal conflict". The placental growth and development is directed by the father's genes, and they have different interests than the mother's genes. In particular, the mother's genes care whether or not the baby can fit out, but the father's genes don't, really -- instead, they care about survival after delivery, because if this woman dies, he can impregnate someone else -- so when the genes work together to develop the placenta, they have different agendas.

There's a lot of research data suggesting that in some pregnancies, it's just straight genetic incompatability, because the part of the blastocyst that forms the placenta, the trophoblast, is producing proteins meant to direct the growth and development of the placenta, only the mother's body just can't see them, because they're the wrong shape to fit into her receptors.

And yes, autoimmune conditions are *definitely* implicated in the development of this, at least for some people, and that's a lot like an allergy.

There's a whole lot about this in the articles in my .sig, and two articles linked from my profile. It's a really fascinating area of research.

momma1408
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Some thoughts about PE

Postby momma1408 » Sun Mar 15, 2009 02:22 pm

I have recently been thinking a lot about why the heck this crazy complication happens. I have heard thoughts about it could be caused by many different things. A few things that really I thought were interesting were the fact that some studies may suggest that it could be the mom is allergic to the father's sperm. I also heard that some women's bodies may not recognize the placenta and try to fight it off or their bodies are "allergic" to the placenta. I was wondering I have so many allergies myself if it could kinda be an allergy. I guess I'm just trying to see if any of you also have a history of allergies or anything like that to wear it could possibly explain this. I have heard of so many of you have complications the first time and then having all normal pregnancies after. I also have heard of some of you still have PE and or HELLP is sbusequent pregnancies. I am very interested in this topic and have been since I first suspected having PE myself. Well just a thought, any input would be great and if any of you also have a history of allergies do you think this could really be what the deal is?? Thanks and have a good week everyone!!


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