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CME Credit Offered
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Poster Session 1

(186) Low renin angiotensin aldosterone system (RAAS) activation and delivery outcomes in preeclampsia with severe features

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Elizabeth L. Mirsky, MD (she/her/hers)

    Maternal Fetal Medicine Fellow
    University of Kentucky
    Lexington, Kentucky, United States

    • Coauthor(s)

  • RS

    Robin Shoemaker, PhD

    University of Kentucky
    Lexington, Kentucky, United States

  • Neil B. Patel, MD

    Maternal Fetal Medicine Physician
    Ascension Sacred Heart - Pensacola
    Pensacola, FL, United States

  • DD

    Dolph Davis

    University of Kentucky
    Lexington, Kentucky, United States

  • HH

    Hong Huang, PhD

    University of Kentucky
    Lexington, Kentucky, United States

  • JB

    John A. Bauer, PhD

    University of Kentucky
    Lexington, Kentucky, United States

  • JO

    John O'Brien, MD

    Professor of Maternal Fetal Medicine, Medical Director of Maternal Maternal Fetal Medicine
    University of Kentucky
    Lexington, Kentucky, United States

Objective: To determine if a correlation exists between defects in RAAS activation and adverse delivery outcomes in patients diagnosed with preeclampsia with severe features. 

Study Design: Prospective cohort study of patients admitted with preeclampsia with severe features from 2022 to 2024. Demographics, medical history and laboratory parameters were collected on admission.  Serum samples were also analyzed from enrollment for angiotensin I, angiotensin II, and aldosterone by LC-MS/MS using RAAS-Triple A and compared based on serum aldosterone concentration. Maternal and fetal outcomes were compared between those with a low aldosterone concentration (Shoemaker et al, 2023) vs. the remainder of the cohort. A composite of delivery outcome complications including fetal growth restriction, abnormal umbilical artery Doppler, oligohydramnios, pulmonary edema, eclampsia, and postpartum hemorrhage was compared between subgroups, in addition to individual elements of the composite.

Results: 50 patients were enrolled. RAAS profiling revealed two distinct subpopulations: 35 patients had low serum aldosterone [median 120.0 pmol/L; IQR (35.0 – 132.2 pmol/L)]. In contrast, 15 patients had normal pregnancy concentration [median 589.8 pmol/L; IQR (402.2 - 769.6 pmol/L)]. Demographic variables were similar between the two populations, apart from enrollment serum creatinine (Table 1). Delivery outcomes were mostly similar (Table 2). The rate of pulmonary edema varied between groups, but the composite complication rate did not reach statistical significance (RR 1.71, 95% CI 0.79-3.70). Neonatal length of stay was longer in the low aldosterone population [median 16.5, IQR (7-69) vs. 5, IQR (3-25)], and maternal length of stay similarly approached significance. 

Conclusion: Serum aldosterone concentration in patients with severe features may be associated with select maternal complications of preeclampsia at or near delivery. Additional studies are needed due to the rarity of these complications.