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Additional file 1: Supplementary Fig. 1. Maternal Heart Rate (HR): Overview of maternal HR (bpm) over all time points: Music Group, Guided Imagery Group, Resting Group. Supplementary Fig. 2. Skin conductance level (SCL): Baseline corrected SCL (microsiemens) over all timepoints for the three groups separately.

Women with preeclampsia (PE) have elevated plasma levels of NT-proBNP. We hypothesized that the placenta may be a source to these elevated levels.Our objectives were to study the plasma levels of NT-proBNP and the protein and mRNA expression of placental BNP in women with early and late onset PE and controls.Plasma levels of NT-proBNP were measured in women with early (n=18) and late (n=20) onset PE, in two groups of healthy pregnant women in gestational week 24-32 (n=22) and 36-42 (n=14), and in non-pregnant women (n=20). Placental BNP protein and mRNA was studied with immunohistochemistry and qPCR. Placental release of NT-proBNP was studied with tissue culturing.Women with early (365 (14-9815) pg/ml) and late (176 (33-2547) pg/ml) onset PE had higher levels of NT-proBNP in plasma than their respective controls (p0.001). A tendency towards higher plasma levels in early compared to late onset PE was observed (p=0.057). 20 out of 25 placental tissue samples had proBNP mRNA, no differences between the study groups were found. BNP protein was found in maternal spiral arteries and syncytiotrophoblasts. NT-proBNP peptide (6-7pg/ml) was present in medium used for placenta cultures.Our results suggest that there may be a placental source of NT-proBNP. If this source is responsible for the elevated plasma levels of NT-proBNP in preeclamptic women and what role, if any, BNP/NT-proBNP play in PE pathophysiology remains to be elucidated.

Placental perfusion is of key interest for the understanding of the pathophysiology of different types of preeclampsia (PE). With magnetic resonance imaging (MRI) perfusion can be estimated non-invasively by calculation of the tissue perfusion fraction from a diffusion weighted sequence (DWI).Our primary aim was to investigate if women with early or late PE have different placental perfusion compared with normal pregnancies. A secondary aim was to investigate if placental perfusion changes with increased gestational length in normal pregnancy.5 women with early PE (34weeks), 8 women with late PE (⩾34weeks), and 19 women with normal pregnancies were included. All women underwent an MRI examination including a DWI sequence at 1.5T. The perfusion fraction was calculated.Women with early PE had a lower placental perfusion fraction (p=0.002) and women with late PE had a higher placental perfusion fraction (p=0.012) than gestational age matched women with normal pregnancies. The placental perfusion fraction decreased with increased gestational length in normal pregnancies (p=0.001).Our finding of reduced placental perfusion in early, but not late PE is in agreement with the hypothesis that early and late PE have partly different pathophysiology, where early PE is a mainly placental disease. The placental perfusion, as estimated by the perfusion fraction, decreased with increased gestational length in normal pregnancies.

Preeclampsia (PE) is associated with increased risk for cardiovascular disease later in life. Studies using gold standard of non-invasive estimation of atherosclerosis, the common carotid artery intima-media-thickness (CCA-IMT), have not indicated increased atherosclerosis in women with previous PE. That reason may be that with increasing age and degree of atherosclerosis the intima increases, while the media decreases.To assess whether the individual thickness of the CCA intima and media layers and calculation of intima/media (I/M) ratio indicate an increased cardiovascular risk in women with previous severe PE.Arterial intima- and media tthicknesses were obtained by non-invasive high-frequency ultrasound (22MHz) in 42 women with previous severe PE and 44 women with previous normal pregnancies.Women with previous severe PE had a thicker mean CCA intima and a higher I/M ratio, compared to women with previous normal pregnancies (both p0.0001). In ROC curve analysis, intima thickness and I/M ratio discriminated strongly with regard to previous severe PE.The method using individual estimation of the CCA intima and media layers and calculating the I/M ratio, clearly showed an increased degree of atherosclerosis in women with previous severe PE. This method might become a clinically useful tool to stratify cardiovascular risk, enabling early intervention and hopefully reduce their long-term cardiovascular risk.