***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background Systemic endothelial dysfunction has been identified as one of the main events in preeclampsia ( PE ) . A nonhealthy vascular endothelium can be pointed out as the pathophysiological explanation of the clinical manifestations and complications of PE . Once normal pregnancy is characterized by a constant increase in endothelial function , a follow-up of this physiological event could be used as an early marker or a prediction tool to predict PE . Objectives To perform a longitudinal assessment of endothelial function , using an ultrasound study of brachial artery flow Flow-mediated dilation ( FMD ) , in normotensive and preeclamptic pregnancies , to evaluate the difference of FMD values along the second trimester of pregnancy to predict PE . Patients and methods In a prospect i ve cohort study , 91 pregnant women with a high risk of developing PE were subjected to FMD of the brachial artery . The difference in the FMD values , between 16 + 0 and 19 + 6 and 24 + 0 and 27 + 6 weeks of gestation were compared , taking PE development into consideration . Receiver operator characteristics ( ROC ) curves were created to determine the sensibility and specificity of FMD difference to predict PE . Results A total of 19 patients developed PE  and the other 72 women remained  normotensive  until 1 week after delivery . When considering a cut off of + 2.50 % , FMD difference , between the two evaluations , sensitivity for PE prediction was 87.5 % for early onset PE and 95.5 % for late PE . Conclusion The difference of FMD values between the second trimester of pregnancy can be used for PE prediction for both , early and late forms of PE Background Preterm preeclampsia is an important cause of maternal and perinatal death and complications . It is uncertain whether the intake of low‐dose aspirin during pregnancy reduces the risk of preterm preeclampsia . Methods In this multicenter , double‐blind , placebo‐controlled trial , we r and omly assigned 1776 women with singleton pregnancies who were at high risk for preterm preeclampsia to receive aspirin , at a dose of 150 mg per day , or placebo from 11 to 14 weeks of gestation until 36 weeks of gestation . The primary outcome was delivery with preeclampsia before 37 weeks of gestation . The analysis was performed according to the intention‐to‐treat principle . Results A total of 152 women withdrew consent during the trial , and 4 were lost to follow up , which left 798 participants in the aspirin group and 822 in the placebo group . Preterm preeclampsia occurred in 13 participants ( 1.6 % ) in the aspirin group , as compared with 35 ( 4.3 % ) in the placebo group ( odds ratio in the aspirin group , 0.38 ; 95 % confidence interval , 0.20 to 0.74 ; P=0.004 ) . Results were material ly unchanged in a sensitivity analysis that took into account participants who had withdrawn or were lost to follow‐up . Adherence was good , with a reported intake of 85 % or more of the required number of tablets in 79.9 % of the participants . There were no significant between‐group differences in the incidence of neonatal adverse outcomes or other adverse events . Conclusions Treatment with low‐dose aspirin in women at high risk for preterm preeclampsia result ed in a lower incidence of this diagnosis than placebo . ( Funded by the European Union Seventh Framework Program and the Fetal Medicine Foundation ; EudraCT number , 2013‐003778‐29 ; Current Controlled Trials number , IS RCT N13633058 . This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Background — Preeclampsia is a life-threatening pregnancy syndrome of uncertain origin . To eluci date the pathogenesis , we evaluated the temporal relationships between changes in vascular function and circulating biomarkers of angiogenic activity before and after the onset of preeclampsia and gestational hypertension . Methods and Results — Maternal mean arterial pressure , uterine artery pulsatility index , brachial artery flow-mediated dilatation , and serum concentrations of placental growth factor ( PlGF ) , soluble fms-like tyrosine kinase 1 ( sFlt-1 ) , and soluble endoglin  were prospect ively measured in 159 women from 10 weeks gestation until 12 weeks postpartum . At 10 to 17 weeks , women who developed preterm preeclampsia had lower serum PlGF ( P=0.003 ) , higher soluble endoglin ( P=0.006 ) , and higher sFlt-1:PlGF ratio ( P=0.005 ) compared with women who later developed term preeclampsia , gestational hypertension , or normotensive pregnancy . At 10 to 17 weeks , mean arterial pressure inversely correlated with serum PlGF ( r=−0.19 , P=0.02 ) ; at 18 to 25 weeks , with soluble endoglin ( r=0.18 , P=0.02 ) ; and at 26 to 33 weeks , with sFlt-1 ( r=0.28 , P<0.001 ) . At 23 to 25 weeks , uterine artery pulsatility index correlated with serum soluble endoglin ( r=0.19 , P=0.02 ) and sFlt-1 levels ( r=0.17 , P=0.03 ) . Flow-mediated dilatation was higher during a pregnancy with gestational hypertension compared with preeclampsia ( P=0.001 ) . Twelve weeks postpartum , serum PlGF was higher in women who had a hypertensive pregnancy compared with a normotensive pregnancy ( P<0.001 ) . Conclusions — These observations support a role for placenta-derived angiogenic biomarkers in the control of maternal vascular resistance of preeclampsia . Gestational hypertension develops differently , with a hyperdynamic circulation and angiogenic biomarker profile similar to normotensive pregnancy . Larger studies of unselected women are needed to ascertain whether measures of these angiogenic biomarkers assist with the prediction and prognosis of preeclampsia and whether postpartum measures of serum PlGF have a role in predicting future cardiovascular disease Background —  Coronary artery calcium ( CAC )  has been demonstrated to be associated with the risk of coronary heart disease . The Multi-Ethnic Study of Atherosclerosis ( MESA ) provides a unique opportunity to examine the distribution of CAC  on the basis of age , gender , and race/ethnicity in a cohort free of clinical cardiovascular disease and treated diabetes . Methods and Results — MESA is a prospect i ve cohort study design ed to investigate sub clinical cardiovascular disease in a multiethnic cohort free of clinical cardiovascular disease . The percentiles of the CAC distribution were estimated with nonparametric techniques . Treated diabetics were excluded from analysis . There were 6110 included in the analysis , with 53 % female and an average age of 62 years . Men had greater calcium levels than women , and calcium amount and prevalence were steadily higher with increasing age . There were significant differences in calcium by race , and these associations differed across age and gender . For women , whites had the highest percentiles and Hispanics generally had the lowest ; in the oldest age group , however , Chinese women had the lowest values . Overall , Chinese and black women were intermediate , with their order dependent on age . For men , whites consistently had the highest percentiles , and Hispanics had the second highest . Blacks were lowest at the younger ages , and Chinese were lowest at the older ages . At the MESA public website ( http://www.mesa-nhlbi.org ) , an interactive form allows one to enter an age , gender , race/ethnicity , and CAC score to obtain a corresponding estimated percentile . Conclusions — The information provided here can be used to examine whether a patient has a high CAC score relative to others with the same age , gender , and race/ethnicity who do not have clinical cardiovascular disease or treated diabetes Preeclampsia is a leading cause of maternal morbidity and mortality . The degree of maternal cardiovascular dysfunction that precedes the onset of preeclampsia is largely unknown . This prospect i ve cohort study aim ed to characterize differences in vivo in retinal microvascular caliber and blood pressure throughout pregnancy in relation to preeclampsia development . Women were recruited from Royal Prince Alfred Hospital , Sydney , Australia , of which 92 women were included in the study .  Retinal images and blood pressures were collected at 13 , 19 , 29 , and 38 weeks of gestation . Retinal vessels were analyzed as the central retinal arteriolar equivalent corrected for mean arterial blood pressure and the central retinal venular equivalent corrected for mean arterial blood pressure , using generalized linear models adjusted for age and body mass index . The preeclampsia group were significantly older ( P=0.002 ) and had a significantly higher mean body mass index ( P=0.005 ) . The central retinal arteriolar equivalent corrected for mean arterial blood pressure was significantly reduced at 13 ( P=0.03 ) , 19 ( P=0.007 ) , and 38 ( P=0.03 ) weeks of gestation in the preeclampsia group . The central retinal venular equivalent corrected for mean arterial blood pressure was also significantly lower at 13 ( P=0.04 ) and 19 ( P=0.001 ) weeks of gestation in the women who progressed to preeclampsia . This study directly documents increased peripheral resistance in vivo , observed as the combination of constricted retinal arterioles or venules and elevated blood pressure , in women who later developed preeclampsia . This difference preceded the clinical signs of preeclampsia OBJECTIVES The purpose of this study was to determine the prognostic accuracy of electron beam computed tomographic ( CT ) scanning of the coronary arteries and the relationship of coronary calcification to st and ard coronary disease risk factors and C-reactive protein ( CRP ) in the prediction of atherosclerotic cardiovascular disease ( ASCVD ) events in apparently healthy middle-age persons . BACKGROUND As a screening test for coronary artery disease ( CAD ) , electron beam CT scanning remains controversial . METHODS In a prospect i ve , population -based study , 4,903 asymptomatic persons age 50 to 70 years underwent  electron beam CT scanning of the coronary arteries . RESULTS At 4.3 years , follow-up was available in 4,613 participants ( 94 % ) , and 119 had sustained at least one ASCVD event . Subjects with ASCVD events had higher baseline coronary calcium scores ( median [ interquartile range ] , Agatston method ) than those without events : 384 ( 127 , 800 ) versus 10 ( 0 , 86 ) ( p < 0.0001 ) . For coronary calcium score threshold > or = 100 versus < 100 , relative risk ( 95 % confidence interval ) was 9.6 ( 6.7 to 13.9 ) for all ASCVD events , 11.1 ( 7.3 to 16.7 ) for all CAD events , and 9.2 ( 4.9 to 17.3 ) for non-fatal myocardial infa rct ion and death . The coronary calcium score predicted CAD events independently of st and ard risk factors and CRP ( p = 0.004 ) , was superior to the Framingham risk index in the prediction of events ( area under the receiver-operating characteristic curve of 0.79 + /- 0.03 vs. 0.69 + /- 0.03 , p = 0.0006 ) , and enhanced stratification of those falling into the Framingham categories of low , intermediate , and high risk ( p < 0.0001 ) . CONCLUSIONS The electron beam CT coronary calcium score predicts CAD events independent of st and ard risk factors , more accurately than st and ard risk factors and CRP , and refines Framingham risk stratification OBJECTIVES To assess the evolution of the soluble fms-like tyrosine kinase-1 ( sFlt-1 ) to placental growth factor ( PlGF ) ratio in women with suspected or confirmed pre-eclampsia ( PE ) , and to investigate the changes in sFlt-1 and PlGF levels in pre-eclamptic women after delivery . METHODS This was an exploratory study in which secondary analysis was performed on a prospect i ve cohort study that enrolled women with a singleton pregnancy and suspected or confirmed PE from 18 weeks ' gestation , carried out between December 2013 and April 2016 at the Department of Obstetrics of the Erasmus Medical Center in Rotterdam .  sFlt 
    Output:
    
Accelerated coronary calcification and plaque deposition was identified , with greater rates of increased calcium scores and sub clinical coronary artery disease shown by CTCA in women with a history of pre-eclampsia at 30 years postpartum .
The evidence was less conclusive for the persistence of long-term endothelial dysfunction .