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CPAP May Benefit Women At Risk for Preeclampsia


 

SALT LAKE CITY — Use of continuous positive airway pressure may help prevent preeclampsia in pregnant women at risk for the condition, a study suggests.

In 9 of 12 women with risk factors for preeclampsia who used continuous positive airway pressure (CPAP) and medical therapy beginning before 9 weeks' gestation, blood pressure remained stable and pregnancy was normal, Dr. Christian Guilleminault reported in a poster at the annual meeting of the Associated Professional Sleep Societies.

Sleep-disordered breathing has been suggested by several studies as a possible contributor to preeclampsia. In one study, snoring was linked with preeclampsia, with the disorder occurring in 10% of snorers compared with 4% of nonsnorers. In another study, snoring was shown to be a significant predictor of hypertension and fetal growth retardation, even after controlling for maternal weight, age, and smoking status.

Based on such findings, some researchers have recommended polysomnography and/or CPAP use in pregnant women with risk factors—including snoring—for preeclampsia. In the current study, all 12 participants had risk factors for preeclampsia: All were snorers; seven had hypertension; two had prior preeclampsia; and three were obese, with a body mass index (kg/m

The women, who had a mean age of 29 years, underwent polysomnography at a mean of 7.5 weeks' gestation, and all had flow limitations at the nasal cannula without apnea or hypopnea. Nasal CPAP was used in all participants at an initial pressure of 5–6 cm H2O, and in eight women the pressure was increased to 6–9 cm H2O at between 5 and 6 months' gestation.

Of the seven women with hypertension at baseline, diastolic blood pressure below 90 mm Hg was maintained without a change in medication. All seven delivered healthy, full-term infants, as did one of the women with a history of preeclampsia, reported Dr. Guilleminault, of the department of psychiatry at Stanford (Calif.) University. One of the obese women miscarried at near 14 weeks' gestation and the other delivered at 34 weeks, but did not develop preeclampsia.

The third obese patient and the second woman with prior preeclampsia developed clinical features of preeclampsia, and both underwent cesarean section at 7.5 months' gestation.

Systematic treatment with nasal CPAP initiated prior to 9 weeks' gestation was associated with stable blood pressure and normal pregnancy in most women with risk factors for preeclampsia, Dr. Guilleminault concluded.

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