Peruka Neumaier-Wagner

RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany

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Publications (16)32.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the recurrence risk for hypertensive diseases in pregnancy after HELLP (Hemolysis Elevated Liver enzymes and Low Platelets) syndrome in a first pregnancy. The study was designed as a cohort study investigating 148 Caucasian primiparae with a diagnosis of HELLP syndrome in a first pregnancy and at least one subsequent pregnancy conducted beyond the 24th gestational week. Diagnoses were verified by reviewing medical records and classified according to ISSHP (International Society for the Study of Hypertension in Pregnancy) criteria. The recurrence risk of HELLP syndrome or other hypertensive disorders in the subsequent pregnancy was calculated with regard to disease severity in the index pregnancy. Among 148 pregnancies subsequent to HELLP syndrome, 56.1% of the women were normotensive. The recurrence rate was 12.8% for HELLP syndrome, 16.2% for pre-eclampsia, and 14.2% for gestational hypertension only. Women with HELLP syndrome ≤32 gestational weeks tended to show a greater risk of complicated subsequent pregnancies compared to women presenting with HELLP after 32 gestational weeks. Women with a diagnosis of HELLP syndrome are at a strongly increased risk of recurrent HELLP syndrome, pre-eclampsia or gestational hypertension, however, currently no clinical or laboratory parameters allow the prediction of recurrence risk in any individual case.
    Journal of Perinatal Medicine 08/2011; 39(6):673-8. · 1.95 Impact Factor
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    ABSTRACT: To investigate the motivation for motherhood in women with hypertensive diseases in pregnancy. A questionnaire was sent to 2600 women with hypertensive diseases in pregnancy and 1233 controls. Diagnoses from medical records were differentiated according to the International Society for the Study of Hypertension in Pregnancy criteria. After matching, data from 739 patients and 623 controls were evaluated with Student's-t, Chi square tests and multiple logistic regression models. Women with hypertensive diseases in pregnancy longed more often for children (85.3%/70.3%, p < 0.0001), considered children more often as the sense of their life (33.6%/29.7%, p < 0.005) and used pregnancy more often to stop a disliked professional activity (9.7%/2.3%, p < 0.0001). Controls reported more often to give birth to avoid termination of pregnancy (5.3%/10.4%, p = 0.0005). Women with hypertensive diseases in pregnancy concentrate more extensively on motherhood in their life. If this attitude is already present before pregnancy it may augment the risk for disease and might be used for prophylaxis.
    Journal of Psychosomatic Obstetrics & Gynecology 06/2009; 30(2):133-40. · 1.59 Impact Factor
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    ABSTRACT: To determine maternal serum placental protein 13 (PP13) in normal pregnancy and preeclampsia. A prospective, longitudinal study with 41 normal pregnant women, 18 cases with preterm delivery or cervix insufficiency and 4 with developing late-onset preeclampsia. Six hundred and sixty-six maternal blood samples were obtained every 2-4 weeks starting at 5-8 weeks gestation (10-12 samples/patient) and tested for serum PP13 by ELISA. In normal pregnant women delivering at term, median maternal serum PP13 levels were growing from 166 to 202 pg/ml and 382 pg/ml in the first, second and third trimester, respectively. Preeclamptic women had significantly reduced PP13 levels in the first trimester (multiples of median of 0.14 at 7-8 weeks; p = 0.005 compared to normal). PP13 in the third trimester was significantly higher compared to normal at 35-36 weeks with PP13 multiples of median of 1.79. This preliminary study indicates that low levels of PP13 in early pregnancy identify at-risk pregnancies, whereas high levels precede the syndrome in late pregnancy and suggest syncytiotrophoblast necrosis.
    Fetal Diagnosis and Therapy 09/2008; 24(3):230-6. · 1.90 Impact Factor
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    ABSTRACT: Hypertensive diseases in pregnancy (HDP) are a great challenge for healthcare providers. The study aimed to investigate the experience of women developing HDP with different stressors associated with healthcare after a diagnosis of HDP. A self- administered questionnaire referring to stress associated with general aspects, hospital stay, and mode of delivery was given to a convenience sample of 738 women with one pregnancy complicated by HDP. The three main aspects causing stress after diagnosis of HDP were the duration of hospital stay for women having to stay at least 7 days in the hospital, the infant's prematurity, and uncertainty about the child's health. Most stress factors did not vary among women showing different types of HDP, but with infants' gestational age at delivery. The diagnosis of HDP leads to important stress during pregnancy. In addition to stressors caused by other obstetrical complications, women developing HDP have to deal with a sudden and dramatic change in fetal health risk as well as their own sometimes life-threatening situation. Because stress may have an unfavorable effect on the clinical course of the disease, these aspects should be considered when treating women with HDP.
    Psychosomatics 01/2008; 49(5):413-9. · 1.73 Impact Factor
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    ABSTRACT: Cardiovascular diseases are strongly influenced by stress and do share several risk factors with hypertensive diseases in pregnancy (HDP). The aim of the study is to investigate the correlation between emotional stress during pregnancy and the risk for HDP. A self-administered questionnaire comprising obstetrical and psychosocial questions was completed by 725 patients and 880 controls matched for age, parity, nationality, and educational level. Emotional stress during pregnancy was associated with a 1.6-fold increased risk for HDP. Psychosocial interventions to reduce emotional stress during pregnancy may help to decrease the risk to develop HDP.
    Hypertension in Pregnancy 02/2007; 26(2):211-26. · 0.93 Impact Factor
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    ABSTRACT: An association between maternal HELLP syndrome and fetal long chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency has been proposed. LCHAD catalyzes the third step in the beta-oxidation of fatty acids in mitochondria. Whereas about 75% of LCHAD-deficient patients carry a G-to-C mutation at nucleotide position 1528 (Glu474Gln, E474Q) on both chromosomes, compound heterozygosity for E474Q on one chromosome and a second different LCHAD mutation on the other can be observed in up to 25% of LCHAD-deficiency cases; only very few patients carry two mutations different from E474Q. Genetic analysis of the mother alone is insufficient in case of compound heterozygosity. Since information on the fetal carrier status of the E474Q mutation in maternal HELLP syndrome is rare, we investigated the frequency of the E474Q mutation in families where the mother had HELLP syndrome. The occurrence of the E474Q mutation was analyzed by PCR and RFLP in 103 mothers with HELLP syndrome, in 82 children of affected pregnancies and in 21 fathers in families where fetal DNA was not available. In addition, 103 control women with only uncomplicated pregnancies were investigated. The mutation E474Q was not detected in the study population. Neither maternal nor fetal heterozygosity for the E474Q mutation is a relevant factor of HELLP syndrome.
    Journal of Perinatal Medicine 02/2007; 35(1):76-8. · 1.95 Impact Factor
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    ABSTRACT: Differentiation processes in the trophoblast comprise polarization, cell fusion and migration. All these processes involve dramatic reorganizations of cytoskeletal proteins such as intermediate filaments or actin. Due to very restricted knowledge on cytoskeletal changes in trophoblast, we analyzed the protein expression of an actin stress fiber-associated protein, the carboxy-terminal LIM domain protein (CLP36). CLP36 belongs to the enigma family of proteins, binds to alpha-actinin and is involved in the cytoskeletal reorganization and signal transduction of a variety of cells. CLP36 protein was found to be exclusively expressed in the cytotrophoblast layer. Colocalization of CLP36 with Mib-1 revealed that CLP36 protein expression is restricted to proliferative and early post-proliferative trophoblast cells. Blockage of syncytial fusion by culture of villous explants in the presence of caspase 8 inhibitors further supported this notion since CLP36 was only found in the basal and proliferative layer of the multilayered cytotrophoblast. We present evidence for the exclusive protein expression of CLP36 in proliferative and early post-proliferative trophoblast cells. Pathological pregnancy syndromes such as preeclampsia are driven by alterations of trophoblast differentiation and turnover, where it needs to be elucidated whether CLP36 is involved in these alterations.
    Histochemie 11/2006; 126(4):465-71. · 2.61 Impact Factor
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    ABSTRACT: Hypertensive diseases in pregnancy are still a major cause of foetal and maternal mortality. Known risk factors allow identification of only a small number of patients at risk of developing such a complication. However, better knowledge of the risk profile would improve an early adequate monitoring of these pregnancies. We therefore investigated the correlation between under- or overweight during childhood and the development of hypertensive diseases during pregnancy. The study was designed as a cross-sectional case control study. A self-administered questionnaire was distributed to 2600 women, who had contacted the German pre-eclampsia self-help group for information on hypertensive diseases in pregnancy and 1233 control women recruited in different hospitals. Diagnosis according to criteria of the international society for hypertensive diseases in pregnancy was based on medical records. 766 women with a hypertensive disease during their pregnancy and 951 control women with normal pregnancies were evaluated after verifying for exclusion criteria and complete data sets. Student t-test, chi square test and multivariate logistic regression models were used for statistical analysis. A history of under- (OR 2.1, 95% CI 1.23-3.61) or overweight (OR 1.46, 95% CI 1.01-2.12) during childhood is associated with an increased risk for hypertensive diseases in pregnancy, which is at least partly independent of pre-pregnancy BMI. In combination with other risk factors, a history of under- or overweight during childhood will help to identify patients at risk for hypertensive diseases in pregnancy.
    Early Human Development 11/2006; 82(10):663-8. · 2.02 Impact Factor
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    ABSTRACT: HDP (hypertensive diseases in pregnancy) are one of the leading causes of maternal and fetal mortality and morbidity. BMI (body mass index) is an established risk factor for pre-eclampsia, but its role in HELLP syndrome is unknown. We therefore investigated BMI as a risk factor in the development of HELLP syndrome. At the beginning of pregnancy, BMI was measured in 1067 women with a history of HDP and 1063 controls. Diagnoses of HDP were classified according to ISSHP (International Society for the Study of Hypertension in Pregnancy) and BMI according to WHO (World Health Organization) criteria. After verification of exclusion criteria and matching for confounders, 687 women with hypertensive diseases in pregnancy and 601 controls remained for statistical evaluation by chi(2) test and multiple logistic regressions. As a continuous variable, the increase in BMI was associated with an increase in the development of gestational hypertension {OR (odds ratio), 1.1 [95% CI (confidence interval) 1.062-1.197]} and pre-eclampsia [OR, 1.1 (95% CI, 1.055-1.144)]}, but not for HELLP syndrome. According to WHO definitions, overweight women (BMI > or =25 and <30 kg/m(2)) had a 2-fold (95% CI, 1.365-2.983) risk and obese women (BMI > or =30 kg/m(2)) had a 3.2-fold (95% CI, 1.7-5.909) risk of developing pre-eclampsia when compared with women of normal weight (BMI > or =15.5 and <25 kg/m(2)). Being overweight or having obesity had no effect on the risk of HELLP syndrome. As an increased BMI is correlated with the risk of developing pre-eclampsia but not HELLP syndrome, both diseases have a different risk profile. This finding supports that underlying physiological mechanisms in pre-eclampsia vary from those in HELLP syndrome.
    Clinical Science 08/2006; 111(1):81-6. · 4.86 Impact Factor
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    ABSTRACT: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal death and fetal prematurity. The purpose of this study was to examine HDP patients' reported satisfaction with the medical information provided by their health care providers. A convenient sample of N=620 patients with a diagnosis of HDP within 24 months prior to the study period completed a self-administered questionnaire dealing with the medical information received and their reported satisfaction. Chi-square, Fisher's Exact, and Student's t tests were used to determine the differences in sociodemographic data and potential confounders between HDP patients who were satisfied and dissatisfied with medical information. Of the women, 68.6% were not satisfied with the medical information. Women were particularly dissatisfied when they suffered from preeclampsia (PE), were informed of their actual situation, including eventual consequences only after delivery, and in case of fetal disorders resulting from HDP. Based on the background information reported on the importance of medical information to the patient, women developing HDP should be informed of their disease and potential sequelae as early and as differentiated as possible. Doctors need to be convinced of the role of the provider in counseling women with HDP. Information has to be repeated and health care providers are supposed to check whether the women understood the information received.
    Journal of Psychosomatic Research 02/2006; 60(1):39-44. · 3.27 Impact Factor
  • Brigitte Leeners, Peruka Neumaier-Wagner, Sabine Kuse, Werner Rath
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    ABSTRACT: The aim of our study was to investigate the role of smoking in the development of HELLP syndrome, pre-eclampsia and gestational hypertension. A self-administered questionnaire was sent to 2,600 women who had contacted the German Pre-eclampsia Self-help Group previously for information on hypertensive disorders in pregnancy and to 1,233 controls. Diagnoses were verified by reviewing medical records and classified according to ISSHP criteria. Student's t-test, Wilcoxon test, Chi-square test, and multiple logistic regressions were used for statistical analysis. After matching age, parity, nationality, and education a total of 905 women with a hypertensive disease in pregnancy and 945 controls were evaluated for the present study. In comparison to the patients, controls smoked significantly more often during their pregnancies (8.5%/18%, p<0.0001). Smoking during pregnancy was associated with a decreased risk of developing hypertensive disorders in pregnancy by 56%. The most prominent effect of smoking was on the risk of developing HELLP syndrome (OR 0.19, 95% CI 0.08-0.43) followed by HELLP syndrome + pre-eclampsia (OR 0.33, 95% CI 0.17-0.63), pre-eclampsia only (OR 0.46, 95% CI 0.26-0.8), and gestational hypertension (OR 0.66, 95% CI 0.41-1.08). Smoking is associated with an 80% reduction of the risk developing HELLP syndrome. However, pregnant women should be advised to quit smoking. Understanding the different effects of smoking in the etiology of each subtype of hypertensive diseases in pregnancy will improve the knowledge of underlying pathophysiological mechanisms and may help in designing more effective prevention and treatment strategies.
    Acta Obstetricia Et Gynecologica Scandinavica 01/2006; 85(10):1217-24. · 1.85 Impact Factor
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    ABSTRACT: The human endometrium prepares for implantation of the blastocyst by reorganization of its whole cellular network. Endometrial stroma cells change their phenotype starting around the 23rd day of the menstrual cycle. These predecidual stroma cells first appear next to spiral arteries, and after implantation these cells further differentiate into decidual stroma cells. The phenotypical changes in these cells during decidualization are characterized by distinct changes in the actin filaments and filament-related proteins such as alpha-actinin. The carboxy-terminal LIM domain protein with a molecular weight of 36 kDa (CLP36) is a cytoskeletal component that has been shown to associate with contractile actin filaments and to bind to alpha-actinin supporting a role for CLP36 in cytoskeletal reorganization and signal transduction by binding to signaling proteins. The expression patterns of CLP36, alpha-actinin and actin were studied in endometrial stroma cells from different stages of the menstrual cycle and in decidual stroma cells from the 6th week of gestation until the end of pregnancy. During the menstrual cycle, CLP36 is only expressed in the luminal and glandular epithelium but not in endometrial stroma cells. During decidualization and throughout pregnancy, a parallel upregulation of CLP36 and smooth muscle actin, an early marker of decidualization in the baboon, was observed in endometrial decidual cells. Since both proteins maintain a high expression level throughout pregnancy, a role of both proteins is suggested in the stabilization of the cytoskeleton of these cells that come into close contact with invading trophoblast cells.
    Cells Tissues Organs 02/2005; 179(3):109-14. · 1.96 Impact Factor
  • Brigitte Leeners, Werner Rath, Sabine Kuse, Peruka Neumaier-Wagner
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    ABSTRACT: Breast feeding is particularly important and difficult in children born prematurely, especially after hypertensive diseases in pregnancies (HDP). Therefore, we aimed to investigate breast feeding in women who developed HDP. Data on breast-feeding was collected within a nationwide research project on psychosocial factors in HDP. A self-administered questionnaire was given to 2600 women with a suspected history of HDP and 1233 controls. After matching and confirming diagnosis according to ISSHP criteria, 877 women with HDP and 623 controls were included into the study. Control women initiated (48.9/39.2%; P<0.001) and continued (42.2/37.2%; P<0.005) breast-feeding significantly more often than women with HDP. This holds particularly for women who developed HELLP syndrome (48.9/34.7%; P<0.0001, 42.2/33.5%; P<0.0001). A delivery before the 32(nd) gestational week (19.5/81.8%; P<0.0001) and a birth weight of less than 1500 g (18.8/75%; P<0.0001) were associated with the decision not to breast-feed. Women affected by HDP breast fed significantly less often than control women. This effect is at least partly caused by the increased rate of prematurity. Encouraging and supporting these women in breast-feeding is important to improve neonatal physical and mental development.
    Journal of Perinatal Medicine 02/2005; 33(6):553-60. · 1.95 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2005; 193(6).
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    Gundula Hebisch, Peruka M Neumaier-Wagner, Renate Huch, Ursula von Mandach
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    ABSTRACT: To measure maternal serum interleukins (IL) in pregnancy, delivery and early puerperium, and to identify their potential determinants. Prospective longitudinal measures of serum IL-1 beta, IL-6 and IL-8 in 38 healthy pregnant women at antenatal visits, through labor and delivery, with clinical correlates (infection, vaginal hemorrhage and anemia) recorded by questionnaire. Pregnancy IL levels remained consistently low. IL-1 beta increased shortly before delivery, then returned to pregnant levels, except where blood loss exceeded 500 ml. IL-6 and IL-8 rose at labor onset and exceeded pregnancy levels through postpartum day three. Postpartum IL-6 was higher after non-elective cesarean section than after spontaneous delivery (P < 0.0001), and where blood loss exceeded 500 ml. IL-6 and IL-8 were higher with systemic infection during delivery (P < 0.0001) and on postpartum day one (P < 0.05); IL-8 was higher in anemia (delivery: P < 0.005; postpartum day 1: P < 0.05). Differences due to delivery mode and systemic infection remained significant after correction for other conditions. Labor-dependent inflammation increases all IL levels at delivery. Further studies with larger sample sizes are required to establish reference values differentiating physiology from pathology as an aid to peripartum management.
    Journal of Perinatal Medicine 02/2004; 32(6):475-80. · 1.95 Impact Factor
  • G Hebisch, A A Grauaug, P M Neumaier-Wagner, T Stallmach, A Huch, R Huch
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    ABSTRACT: To determine interleukin-6 and interleukin-8 levels in amniotic fluid, retroplacental blood and maternal serum and relate these values with cervical dilatation in term labor. Prospective study. n=78 healthy women undergoing term cesarean section, divided into four groups: controls, n=42, (elective cesarean section; no contractions, membrane rupture or cervical dilatation); latent labor, n=12, (latent phase labor; cervix <2 cm dilated); established labor, n=12, (active labor, cervix 2-5 cm); advanced labor, n=12, (active labor, cervix >5 cm). Interleukin-6 and interleukin-8 were determined by ELISA (pg/ml), placenta and placental bed biopsy examined histopathologically, and amniotic fluid also microbiologically. Results were expressed as median and ranges or mean and standard deviations, as appropriate. For statistical analysis, Mann-Whitney U-tests or Kruskal-Wallis tests were used as applicable (Statview 4.5). Power and linear regression analyses were performed. p<0.05 was considered significant, p<0.001 highly significant. Compared with controls, IL-6 and IL-8 increased significantly with cervical dilatation in all compartments tested for almost all labor groups (p<0.05 to p<0.0001). Significant changes were also seen between latent and advanced labor groups in some compartments (p<0.05), but not between established and advanced labor groups. Intrauterine infection was excluded in any of the patients clinically and on histopathological or microbiological analysis of placentae and amniotic fluid. In term labor without intraamniotic infection, interleukin-6 and interleukin-8 at the fetomaternal interface and in maternal serum rise significantly with cervical dilatation. These cytokines could be used as markers of active labor if vaginal examination is not applicable.
    Acta Obstetricia Et Gynecologica Scandinavica 09/2001; 80(9):840-8. · 1.85 Impact Factor

Publication Stats

177 Citations
32.37 Total Impact Points

Institutions

  • 2011
    • RWTH Aachen University
      • Department of Gynaecology and Obstetrics
      Aachen, North Rhine-Westphalia, Germany
  • 2005–2009
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2006
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany