POS0933 NAILFOLD VIDEOCAPILLAROSCOPY AS A POSSIBLE BIOMARKER TO DETECT ABERRANT PLACENTAL MICROCIRCULATION IN PREGNANT WOMEN: A PILOT STUDY

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 778
• Main Authors: Schenone, C, Pacini, G, Hysa, E, Sammorì, S, Pizzorni, C, Paolino, S, Sulli, A, Schiavetti, I, Ferraiolo, A, Vellone, V G, Smith, V, Cutolo, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Angiogenesis; Biomarkers; Blood vessels; Capillaries; Comorbidity; Connective tissue diseases; Connective tissues; Doppler effect; Fetuses; Microvasculature; Placenta; Pregnancy; Pregnancy complications; Statistical analysis; Womens health
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.6160

BackgroundDuring pregnancy, exchanges between mother and fetus are provided by the placenta. Defects in the early stages of placentation prevent the creation of a high-flow, low-resistance circle resulting in an impaired maternal-fetal exchange. The development of aberrant microcirculation leads to placental abnormalities, detectable by placental histologic examination [1].ObjectivesTo assess whether nailfold videocapillaroscopy (NVC), in combination with umbilical artery doppler ultrasound (UA-dU), can detect microvascular status during pregnancy [2]; and to evaluate if NVC follow-up during pregnancy might operate as a red flag biomarker of placental microcirculation abnormalities.MethodsWe conducted a longitudinal observational exploratory study on 54 healthy pregnant women (age range 26-46 y) within the 16th gestational week, excluding those with cardiovascular comorbidities. We performed clinical, UA-dU and NVC evaluation with an optical probe (200x magnification) at each trimester of pregnancy and post-partum [3]. We performed an after-birth placenta histology (abPH) in a subgroup of 20 women (among the 54 women) who developed complications during pregnancy (e.g., gestational hypertension) evaluated through optical microscopic technique, according to Amsterdam criteria [4].ResultsWe noticed over time, in the whole cohort, a statistically significant increase in neo-angiogenesis (p<0.05), considering the absolute count of microvessel ramifications (abnormal shapes) (Figure 1a). Conversely, we did not observe any statistically significant variation in capillary density (n/linear mm), microhaemorrhages or dilated capillaries over time. Besides, a statistically significant difference in the absolute number of capillaries in the first trimester between subjects with and without areas of placental dysmaturity (aberrant placental microcirculation) was detected at abPH (7.0/mm ± 0.82 vs 8.2/mm ± 0.62; p=0.030), (Figure 1b). A receiver operating characteristic curve was drawn for calculating the Area Under the Curve (AUC: 0.87; 95%CI: 0.66–1.00), identifying the optimal discriminatory cut-off value for prediction of placental dysmaturity areas (≤7.50/mm capillaries, sensitivity: 88.9%; specificity: 75.0%). Of note, a similar difference was confirmed at the third trimester, although not reaching statistical significance (p=0.06). Not any significant association was found between UA-dU and any of the assessed NVC parameters.ConclusionThis study confirms, in a large cohort of pregnant women, the NVC detection of increased neoangiogenesis over time, even during post-partum. In addition, this is the first report suggesting the possible role of NVC (capillary density) for the early detection of aberrant placental microcirculation noticeable at abPH. A study in pregnant patients affected by autoimmune connective tissue diseases has already started, using those findings as reference parameters.References[1]Rana S. et al. Circ Res, vol. 124, n. 7, pp. 1094–1112, Mar 2019.[2]Pacini G. et al. Microvasc Res, vol. 141, May 2022.[3]Smith V. et al. Autoimmun Rev vol. 19, n. 3. Elsevier B.V., Mar. 01, 2020.[4]Khong T.Y. et al. Arch Pathol Lab Med, Jul. 2016, vol. 140, n. 7, pp. 698–713Figure 1.a. Neo-angiogenesis (arrows) at the 3rd trimester (magnification 200x). b. Difference in the absolute number of capillaries in the 1st trimester between women with and without areas of placental dysmaturity at abPH.[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.