Date of Award

May 2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Teresa Johnson

Committee Members

Sandeep Gopalakrishnan, Amanda Simanek, Ann Aschenbrenner, Sandra Founds

Keywords

ABO Blood Type, Cardiovascular Disease, Preeclampsia, Preeclampsia Subtype

Abstract

Preeclampsia affects 3-8% of all pregnancies and is a global issue that significantly effects the short and long-term health of women and neonates. The pathophysiology of preeclampsia remains unclear and there seems to be two distinct subtypes, early and late onset. Each subtype may have a unique pathophysiology and set of risk factors. Preeclampsia is linked to long-term risk of cardiovascular disease in previously affected women. Subsequently, risk factors shared between preeclampsia and cardiovascular disease should be explored. The main aim of this study was to determine the strength of association between maternal ABO blood type and preeclampsia subtype. This hospital-based case control study was completed at one community hospital in the Mid Atlantic, United States. The study included 126 female subjects with early onset preeclampsia (≤ 33 6/7 weeks gestation), 126 female subjects with late onset preeclampsia (≥ 34 weeks gestation) and 259 control subjects with no history of preeclampsia. Strict diagnostic criteria were used and preeclamptic subjects were classified by subtype based on gestational age at diagnosis. Data on ABO blood type, as well other physical and socio-demographic variables were extracted from the electronic health record. No significant association was noted between preeclampsia subtype and non-O blood type (p=.456) and ABO blood phenotype trended towards significance (p=.062). After exclusion of subjects with comorbidities (CHTN, GDM and DM) from the sample (n=403), there was a significant association noted between ABO blood type and preeclampsia subtype (p=.001). A significant association was also noted between preeclamptic subjects with growth restriction and ABO blood type (p= <.001). Preeclamptic subjects with the B blood type had OR=3.44, 95% CI 1.58, 7.50 of having a growth-restricted fetus than did those with other blood types. Finally, when adjusting for race only, subjects with AB blood type had the following odds (OR=3.03, 95% CI 1.04, 8.80; OR=3.35, 95% CI 1.02, 11.03.) of developing pre-eclampsia and late onset preeclampsia respectively. When other clinical risk factors of preeclampsia are included in the model, AB blood type significantly predicts membership in the early onset preeclampsia subtype (OR=5.41, 95% CI, 1.19, 24.55) and was trend-level in the late onset group (p=.053). Preeclamptic women with B blood type had three times the odds of having a growth-restricted fetus, subsequently; they may require close ultrasound surveillance. AB blood type was significantly associated with three times increased odds of late onset preeclampsia. When included in a model with other common risk factors of preeclampsia, ABO blood type only accounted for a small amount of variability in the model. ABO blood type may not be a valuable addition to a preeclampsia-screening algorithm that already includes common clinical risk factors of preeclampsia. However, when controlling for other common clinical risk factors of preeclampsia, women with AB blood type had over 5 times the odds of developing early onset preeclampsia. Further research is necessary to examine if blood type regulates biomarkers that mediate the development of each preeclampsia subtype or in some way is associated with severe features of the disease.

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