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Hu G, Lin J, Feng H, Horswell R, Chu S, Shen Y. Trends of hypertensive disorders of pregnancy among the Medicaid population before and during COVID-19. RESEARCH SQUARE 2023:rs.3.rs-3616259. [PMID: 38077001 PMCID: PMC10705593 DOI: 10.21203/rs.3.rs-3616259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are a group of high blood pressure disorders during pregnancy that are a leading cause of maternal and infant morbidity and mortality. The trend of HDP among the Medicaid population during the coronavirus disease of 2019 (COVID-19) is severely lacking. To determine the trends in the annual prevalence of HDP among Louisiana Medicaid pregnant women before and during the COVID-19 pandemic (2016-2021), a total of 113,776 pregnant women aged 15-50 years was included in this study. For multiparous individuals, only the first pregnancy was used in the analyses. Women with a diagnosis of each type-specific HDP were identified by using the ICD-10 codes. The prevalence of HDP increased from 10.5% in 2016 to 17.7% in 2021. The highest race/ethnicity-specific incidence of HDP was seen in African American women (13.1%), then white women (9.4%), followed by other women (7.9%). HDP remains as a very prevalent and significant global health issue, especially in African American women. Obesity and physical inactivity are major risk factors of HDP, which became amplified during the COVID-19 pandemic and led to a higher prevalence of HDP. Severe HDP substantially increases the risk of mortality in offspring and long-term issues in both the mother and infant. This is very pertinent to the Medicaid population due to the disparities and barriers that diminish the quality of healthcare they receive.
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Affiliation(s)
- Gang Hu
- Pennington Biomedical Research Center
| | | | | | | | - San Chu
- Pennington Biomedical Research Center
| | - Yun Shen
- Pennington Biomedical Research Center
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Garcia-Puente LM, Fraile-Martinez O, García-Montero C, Bujan J, De León-Luis JA, Bravo C, Rodríguez-Benitez P, Pintado P, Ruiz-Labarta FJ, Álvarez-Mon M, García-Honduvilla N, Cancelo MJ, Saez MA, Ortega MA. Placentas from Women with Late-Onset Preeclampsia Exhibit Increased Expression of the NLRP3 Inflammasome Machinery. Biomolecules 2023; 13:1644. [PMID: 38002326 PMCID: PMC10669618 DOI: 10.3390/biom13111644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Pre-eclampsia is a harmful and potentially lethal medical condition during pregnancy clinically diagnosed by hypertension and commonly accompanied by proteinuria and multiorgan affections. According to the time of diagnosis, it is differentiated between early-onset (EO-PE) and late-onset preeclampsia (LO-PE). Despite being less dangerous and presenting distinct pathophysiological signatures, LO-PE has a greater prevalence than EO-PE, both having significant consequences on the placenta. Previous works have evidenced that exacerbated inflammation in this organ might play a potential pathogenic role in the development of pre-eclampsia, and there is some preliminary evidence that the hyperactivation of inflammasomes can be related to the altered immunoinflammatory responses observed in the placentas of these patients. However, the precise role of inflammasomes in the placentas of women with LO-PE remains to be fully understood. In this work, we have studied the gene and protein expression of the main components related to the canonical and non-canonical pathways of the inflammasome NLRP3 (NLRP3, ASC, caspase 1, caspase 5, caspase 8, interleukin 1β, and interleukin 18) in the placental tissue of women with LO-PE. Our results show a marked increase in all these components in the placentas of women who have undergone LO-PE, suggesting that NLRP3 inflammasome plays a potentially pathophysiological role in the development of this entity. Future works should aim to evaluate possible translational approaches to this dysregulation in these patients.
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Affiliation(s)
- Luis M Garcia-Puente
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan A De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Patrocinio Rodríguez-Benitez
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Department of Nephrology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
| | - Pilar Pintado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Francisco Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Prince of Asturias, Networking Research Center on for Liver and Digestive Diseases (CIBEREHD), 28806 Alcalá de Henares, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - María J Cancelo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
- Department of Obstetrics and Gynecology, University Hospital of Guadalajara, 19002 Guadalajara, Spain
| | - Miguel A Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Pathological Anatomy Service, University Hospital Gómez-Ulla, 28806 Alcalá de Henares, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
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Barda S, Yoeli Y, Stav N, Naeh A, Maor-Sagie E, Hallak M, Gabbay-Benziv R. Factors Associated with Progression to Preeclampsia with Severe Features in Pregnancies Complicated by Mild Hypertensive Disorders. J Clin Med 2023; 12:7022. [PMID: 38002636 PMCID: PMC10672209 DOI: 10.3390/jcm12227022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. All women admitted due to hypertensive disorders were included. Data collected was compared between parturients who progressed and did not progress to preeclampsia with severe features. Among 359 women presenting without severe features, 18 (5%) developed severe features, delivered smaller babies at lower gestational age, and with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, any previous gestational hypertensive disorder, gestational diabetes, number of hospitalizations, earlier gestational age at initial presentation, and superimposed preeclampsia as the preliminary diagnosis were all associated with preeclampsia progression to severe features. Previous delivery within 2-5 years was a protective variable from preeclampsia progression. Following regression analysis and adjustment to confounders, only gestational age at initial presentation and superimposed preeclampsia remained significant variables associated with progression to severe features (aOR 0.74 (0.55-0.96) and 34.44 (1.07-1111.85), aOR (95% CI), respectively, p < 0.05 for both) with combined ROC-AUC prediction performance of 0.89, 95% CI 0.83-0.95, p < 0.001. In conclusion, according to our study results, early gestational age at presentation and superimposed preeclampsia as the preliminary diagnosis are the only independent factors that are associated with progression to severe features in women already diagnosed with mild hypertensive disorders during pregnancy.
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Affiliation(s)
- Sivan Barda
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel (A.N.); (E.M.-S.); (M.H.)
| | | | | | | | | | | | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel (A.N.); (E.M.-S.); (M.H.)
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Countouris ME, Koczo A. Reproductive Healthcare Access and the Cardiologist's Role Addressing Hypertensive Disorders of Pregnancy and Cardiovascular Risk. JACC. ADVANCES 2023; 2:100665. [PMID: 38938734 PMCID: PMC11198641 DOI: 10.1016/j.jacadv.2023.100665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Malamo E. Countouris
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Agnes Koczo
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Willmott T, Ormesher L, McBain AJ, Humphreys GJ, Myers JE, Singh G, Lundberg JO, Weitzberg E, Nihlen C, Cottrell EC. Altered Oral Nitrate Reduction and Bacterial Profiles in Hypertensive Women Predict Blood Pressure Lowering Following Acute Dietary Nitrate Supplementation. Hypertension 2023; 80:2397-2406. [PMID: 37702047 DOI: 10.1161/hypertensionaha.123.21263] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The efficacy of dietary nitrate supplementation to lower blood pressure (BP) in pregnant women is highly variable. We aimed to investigate whether differences in oral microbiota profiles and oral nitrate-reducing capacity may explain interindividual differences in BP lowering following nitrate supplementation. METHODS Participants recruited for this study were both pregnant and nonpregnant women, with or without hypertension (n=55). Following an overnight fast, plasma, saliva, and tongue scraping samples were collected for measurement of nitrate/nitrite concentrations, oral NaR (nitrate reductase) activity, and microbiota profiling using 16S rRNA gene sequencing. Baseline BP was measured, followed by the administration of a single dose of dietary nitrate (400 mg nitrate in 70 mL beetroot juice). Post-nitrate intervention, plasma and salivary nitrate/nitrite concentrations and BP were determined 2.5 hours later. RESULTS Women with hypertension had significantly lower salivary nitrite concentrations (P=0.006) and reduced abundance of the nitrate-reducing taxa Veillonella(P=0.007) compared with normotensive women. Oral NaR activity was not significantly different in pregnant versus nonpregnant women (P=0.991) but tended to be lower in hypertensive compared with normotensive women (P=0.099). Oral NaR activity was associated with both baseline diastolic BP (P=0.050) and change in diastolic BP following acute nitrate intake (P=0.01, adjusted for baseline BP). CONCLUSIONS The abundance and activity of oral nitrate-reducing bacteria impact both baseline BP as well as the ability of dietary nitrate supplementation to lower BP. Strategies to increase oral nitrate-reducing capacity could lower BP and enhance the efficacy of dietary nitrate supplementation, in pregnancy as well as in nonpregnant adults. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03930693.
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Affiliation(s)
- Thomas Willmott
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences (T.W., L.O., J.E.M., E.C.C.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
- Division of Pharmacy and Optometry, School of Health Sciences (T.W., A.J.M., G.J.H.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Laura Ormesher
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences (T.W., L.O., J.E.M., E.C.C.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences (T.W., A.J.M., G.J.H.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Gavin J Humphreys
- Division of Pharmacy and Optometry, School of Health Sciences (T.W., A.J.M., G.J.H.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Jenny E Myers
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences (T.W., L.O., J.E.M., E.C.C.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Gurdeep Singh
- Lydia Becker Institute of Immunology and Inflammation, Manchester Academic Health Science Centre (G.S.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Jon O Lundberg
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden (J.O.L., E.W., C.N.)
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden (J.O.L., E.W., C.N.)
| | - Carina Nihlen
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden (J.O.L., E.W., C.N.)
| | - Elizabeth C Cottrell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences (T.W., L.O., J.E.M., E.C.C.), Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
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56
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Shoemaker R, Poglitsch M, Davis D, Huang H, Schadler A, Patel N, Vignes K, Srinivasan A, Cockerham C, Bauer JA, O’Brien JM. Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines 2023; 11:2954. [PMID: 38001956 PMCID: PMC10669350 DOI: 10.3390/biomedicines11112954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.
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Affiliation(s)
- Robin Shoemaker
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA
| | | | - Dolph Davis
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA
| | - Hong Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - Aric Schadler
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - Neil Patel
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Katherine Vignes
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Aarthi Srinivasan
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Cynthia Cockerham
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - John A. Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - John M. O’Brien
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
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De Marco S, Marziali E, Nachira L, Arcaro P, Villani L, Galasso V, Bruno S, Laurenti P. A multidisciplinary primary prevention intervention to increase adherence to the Mediterranean diet: a pilot study. BMC Public Health 2023; 23:2051. [PMID: 37980473 PMCID: PMC10657599 DOI: 10.1186/s12889-023-16893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk. METHODS In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants' anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite. RESULTS The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants. CONCLUSIONS These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people's lifestyles.
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Affiliation(s)
- Silvia De Marco
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Marziali
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Lorenza Nachira
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Arcaro
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Villani
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefania Bruno
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Laurenti
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Wang X, Zhang S, Yu W, Li G, Li J, Ji J, Mi Y, Luo X. Pre-pregnancy body mass index and glycated-hemoglobin with the risk of metabolic diseases in gestational diabetes: a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1238873. [PMID: 37842297 PMCID: PMC10569468 DOI: 10.3389/fendo.2023.1238873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background Metabolic diseases during pregnancy result in negative consequences for mothers. Pre-pregnancy body mass index (BMI) and late-pregnancy glycated-hemoglobin (HbA1c) are most important factors independently affecting the risk of gestational diabetes mellitus (GDM). However how both affect the combined risk of other metabolic diseases in women with GDM is unclear. The study aims to investigate the influence of pre-pregnancy BMI and pregnancy glycemic levels on other gestational metabolic diseases in women with GDM. Methods Pregnancies with GDM from January 2015 to December 2018 in the Xi'an longitudinal mother-child cohort study (XAMC) were retrospectively enrolled. Those without other metabolic diseases by the time of oral glucose tolerance test (OGTT) detection were finally recruited and divided into four groups by pre-pregnancy BMI (Underweight <18.5kg/m2; Normal weight 18.5-23.9 kg/m2; Overweight 24.0-27.9 kg/m2; Obesity ≥28.0 kg/m2, respectively) or two groups by HbA1c in late pregnancy (normal HbA1c<5.7%; high HbA1c≥5.7%). Multivariate logistic regression analysis was used to identify risk factors. Interaction between pre-pregnancy BMI (reference group 18.5-23.9 kg/m2) and HbA1c (reference group <5.7%) was determined using strata-specific analysis. Results A total of 8928 subjects with GDM were included, 16.2% of which had a composite of metabolic diseases. The pre-pregnancy overweight and obesity, compared with normal BMI, were linked to the elevated risk of the composite of metabolic diseases, particularly pre-eclampsia (both P <0.001) and gestational hypertension (both P <0.001). Meanwhile, patients with high HbA1c had an obvious higher risk of pre-eclampsia (P< 0.001) and gestational hypertension (P= 0.005) compared to those with normal HbA1c. In addition, there were significant interactions between pre-pregnancy BMI and HbA1c (P< 0.001). The OR of pre-pregnancy BMI≥ 28 kg/m2 and HbA1c≥ 5.7% was 4.46 (95% CI: 2.85, 6.99; P< 0.001). The risk of other metabolic diseases, except for pre-eclampsia (P= 0.003), was comparable between the two groups of patients with different HbA1c levels at normal pre-pregnancy BMI group. However, that was remarkably elevated in obese patients (P= 0.004), particularly the risk of gestational hypertension (P= 0.004). Conclusion Pre-pregnancy overweight/obesity and late-pregnancy high HbA1c increased the risk of other gestational metabolic diseases of women with GDM. Monitoring and controlling late-pregnancy HbA1c was effective in reducing metabolic diseases, particularly in those who were overweight/obese before conception.
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Affiliation(s)
- Xinyue Wang
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Simin Zhang
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Wenlu Yu
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Guohua Li
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Jinglin Li
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Jing Ji
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
- Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University, Xi’an, China
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Suvakov S, Kattah AG, Gojkovic T, Enninga EAL, Pruett J, Jayachandran M, Sousa C, Santos J, Abou Hassan C, Gonzales-Suarez M, Garovic VD. Impact of Aging and Cellular Senescence in the Pathophysiology of Preeclampsia. Compr Physiol 2023; 13:5077-5114. [PMID: 37770190 DOI: 10.1002/cphy.c230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The incidence of hypertensive disorders of pregnancy is increasing, which may be due to several factors, including an increased age at pregnancy and more comorbid health conditions during reproductive years. Preeclampsia, the most severe hypertensive disorder of pregnancy, has been associated with an increased risk of future disease, including cardiovascular and kidney diseases. Cellular senescence, the process of cell cycle arrest in response to many physiologic and maladaptive stimuli, may play an important role in the pathogenesis of preeclampsia and provide a mechanistic link to future disease. In this article, we will discuss the pathophysiology of preeclampsia, the many mechanisms of cellular senescence, evidence for the involvement of senescence in the development of preeclampsia, as well as evidence that cellular senescence may link preeclampsia to the risk of future disease. Lastly, we will explore how a better understanding of the role of cellular senescence in preeclampsia may lead to therapeutic trials. © 2023 American Physiological Society. Compr Physiol 13:5077-5114, 2023.
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Affiliation(s)
- Sonja Suvakov
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Tamara Gojkovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth A L Enninga
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jacob Pruett
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ciria Sousa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Janelle Santos
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Coline Abou Hassan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Division of Research, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Dangudubiyyam SV, Bosse B, Yadav P, Song R, Hofmann A, Mishra JS, Kumar S. Restoring Angiotensin Type 2 Receptor Function Reverses PFOS-Induced Vascular Hyper-Reactivity and Hypertension in Pregnancy. Int J Mol Sci 2023; 24:14180. [PMID: 37762482 PMCID: PMC10531530 DOI: 10.3390/ijms241814180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Perfluorooctane sulfonic acid (PFOS) exposure during pregnancy induces hypertension with decreased vasodilatory angiotensin type-2 receptor (AT2R) expression and impaired vascular reactivity and fetal weights. We hypothesized that AT2R activation restores the AT1R/AT2R balance and reverses gestational hypertension by improving vascular mechanisms. Pregnant Sprague-Dawley rats were exposed to PFOS through drinking water (50 μg/mL) from gestation day (GD) 4-20. Controls received drinking water with no detectable PFOS. Control and PFOS-exposed rats were treated with AT2R agonist Compound 21 (C21; 0.3 mg/kg/day, SC) from GD 15-20. In PFOS dams, blood pressure was higher, blood flow in the uterine artery was reduced, and C21 reversed these to control levels. C21 mitigated the heightened contraction response to Ang II and enhanced endothelium-dependent vasorelaxation in uterine arteries of PFOS dams. The observed vascular effects of C21 were correlated with reduced AT1R levels and increased AT2R and eNOS protein levels. C21 also increased plasma bradykinin production in PFOS dams and attenuated the fetoplacental growth restriction. These data suggest that C21 improves the PFOS-induced maternal vascular dysfunction and blood flow to the fetoplacental unit, providing preclinical evidence to support that AT2R activation may be an important target for preventing or treating PFOS-induced adverse maternal and fetal outcomes.
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Affiliation(s)
- Sri Vidya Dangudubiyyam
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
- Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, WI 53715, USA
| | - Bradley Bosse
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Pankaj Yadav
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
| | - Ruolin Song
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
| | - Alissa Hofmann
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
- Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, WI 53715, USA
| | - Jay S. Mishra
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
| | - Sathish Kumar
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; (S.V.D.); (P.Y.); (R.S.); (A.H.); (J.S.M.)
- Endocrinology-Reproductive Physiology Program, University of Wisconsin, Madison, WI 53715, USA
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
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Simon E, Bechraoui-Quantin S, Tapia S, Cottenet J, Mariet AS, Cottin Y, Giroud M, Eicher JC, Thilaganathan B, Quantin C. Time to onset of cardiovascular and cerebrovascular outcomes after hypertensive disorders of pregnancy: a nationwide, population-based retrospective cohort study. Am J Obstet Gynecol 2023; 229:296.e1-296.e22. [PMID: 36935070 DOI: 10.1016/j.ajog.2023.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The increased maternal cardiocerebrovascular risk after a pregnancy complicated by hypertensive disorders of pregnancy, is well documented in the literature. Recent evidence has suggested a shorter timeframe for the development of these postnatal outcomes, which could have major clinical implications. OBJECTIVE This study aimed to determine the risk of and time to onset of maternal cardiovascular and cerebrovascular outcomes after a pregnancy complicated by hypertensive disorders of pregnancy. STUDY DESIGN This study included 2,227,711 women, without preexisting chronic hypertension, who delivered during the period 2008 to 2010: 37,043 (1.66%) were diagnosed with preeclampsia, 34,220 (1.54%) were diagnosed with gestational hypertension, and 2,156,448 had normotensive pregnancies. Hospitalizations for chronic hypertension, heart failure, coronary heart disease, cerebrovascular disease, and peripheral arterial disease were studied. A classical Cox regression was performed to estimate the average effect of hypertensive disorders of pregnancy over 10 years compared with normotensive pregnancy; moreover, an extended Cox regression was performed with a step function model to estimate the effect of the exposure variable in different time intervals: <1, 1 to 3, 3 to 5, and 5 to 10 years of follow-up. RESULTS The risk of chronic hypertension after a pregnancy complicated by preeclampsia was 18 times higher in the first year (adjusted hazard ratio, 18.531; 95% confidence interval, 16.520-20.787) to only 5 times higher at 5 to 10 years after birth (adjusted hazard ratio, 4.921; 95% confidence interval, 4.640-5.218). The corresponding risks of women with gestational hypertension were 12 times higher (adjusted hazard ratio, 11.727; 95% confidence interval, 10.257-13.409]) and 6 times higher (adjusted hazard ratio, 5.854; 95% confidence interval, 5.550-6.176), respectively. For other cardiovascular and cerebrovascular outcomes, there was also a significant effect with preeclampsia (heart failure: adjusted hazard ratio, 6.662 [95% confidence interval, 4.547-9.762]; coronary heart disease: adjusted hazard ratio, 3.083 [95% confidence interval, 1.626-5.844]; cerebrovascular disease: adjusted hazard ratio, 3.567 [95% confidence interval, 2.600-4.893]; peripheral arterial disease: adjusted hazard ratio, 4.802 [95% confidence interval, 2.072-11.132]) compared with gestational hypertension in the first year of follow-up. A dose-response effect was evident for the severity of preeclampsia with the averaged 10-year adjusted hazard ratios for developing chronic hypertension after early, preterm, and late preeclampsia being 10, 7, and 6 times higher, respectively. CONCLUSION The risks of cardiovascular and cerebrovascular outcomes were the highest in the first year after a birth complicated by hypertensive disorders of pregnancy. We found a significant relationship with both the severity of hypertensive disorders of pregnancy and the gestational age of onset suggesting a possible dose-response relationship for the development of cardiovascular and cerebrovascular outcomes. These findings call for an urgent focus on research into effective postnatal screening and cardiocerebrovascular risk prevention for women with hypertensive disorders of pregnancy.
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Affiliation(s)
- Emmanuel Simon
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France
| | - Sonia Bechraoui-Quantin
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France; Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Solène Tapia
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Jonathan Cottenet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon, Dijon, France; Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France; Registre des Infarctus du Myocarde de Côte d'Or, University Hospital of Dijon, Dijon, France
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, Dijon, France; Dijon Stroke Registry, Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France
| | | | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catherine Quantin
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France; Center of Research in Epidemiology and Population Health, Université Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, National Institute of Health and Medical Research, Villejuif, France.
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Dines VA, Kattah AG, Weaver A, Vaughan LE, Chamberlain AM, Bielinski SJ, Mielke M, Garovic V. Risk of Adult Hypertension in Offspring From Pregnancies Complicated by Hypertension: Population-Based Estimates. Hypertension 2023; 80:1940-1948. [PMID: 37489531 PMCID: PMC10529480 DOI: 10.1161/hypertensionaha.123.20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) have been associated with an increased risk of chronic hypertension for both mothers and offspring. We sought to quantify the incidence of chronic hypertension in offspring from HDP-affected pregnancies in a large, population-based cohort study. Furthermore, we evaluate the association of HDP exposure in utero and maternal chronic hypertension in offspring. METHODS We performed a population-based cohort study of 8755 individuals born during 1976 to 1982 to 7544 women who all resided in the same community at the time of delivery. HDP were identified using a previously validated algorithm. Diagnosis of chronic hypertension in mothers and their offspring was determined using diagnostic codes. Cox proportional hazards regression was used to assess the association between HDP and chronic hypertension. RESULTS HDP exposure (hazard ratio, 1.50 [95% CI, 1.18-1.90]) and maternal chronic hypertension (hazard ratio, 1.73 [95% CI, 1.48-2.02]) were both associated with a significant increased risk for chronic hypertension in offspring. Both risk factors remained significantly associated with increased risk of hypertension in offspring when included together in a multivariate model. Having both exposures was associated with a 2.4-fold increase in the risk of hypertension in offspring, suggesting a synergistic additive interaction. CONCLUSIONS HDP exposure in gestation and maternal hypertension are both independently associated with an increased risk of chronic hypertension in offspring. Our results suggest that HDP exposure in utero, in addition to maternal chronic hypertension, may lead to a greater risk for the development of hypertension in offspring.
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Affiliation(s)
- Virginia A Dines
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amy Weaver
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Lisa E. Vaughan
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Alanna M. Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Michelle Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Vesna Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
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Mandelbrot L. Is there a link between antiretroviral therapy and hypertensive disorders of pregnancy? AIDS 2023; 37:1759-1761. [PMID: 37534726 DOI: 10.1097/qad.0000000000003638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris and Université Paris Cité, IAME, Inserm, F-75018, Paris, France
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Yang C, Baker PN, Granger JP, Davidge ST, Tong C. Long-Term Impacts of Preeclampsia on the Cardiovascular System of Mother and Offspring. Hypertension 2023; 80:1821-1833. [PMID: 37377011 DOI: 10.1161/hypertensionaha.123.21061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Preeclampsia is a pregnancy-specific complication that is associated with an increased postpartum risk of cardiovascular disease (CVD) in both women and their offspring, although the underlying mechanisms have yet to be fully elucidated. Nevertheless, differential methylation of cytosine-phosphate-guanosine islands and alterations in the expression of microRNA, associated with an elevated risk of CVD, have been observed in women and their children following preeclampsia. Among this specific population, genetic and epigenetic factors play crucial roles in the development of CVD in later life. A series of biomolecules involved in inflammation, oxidative stress, and angiogenesis may link pregnancy vascular bed disorders in preeclampsia to the pathogenesis of future CVD and thus could be valuable for the prediction and intervention of long-term CVD in women with a history of preeclampsia and their offspring. Here, we present insights into the cardiovascular structure and functional changes of women with a history of preeclampsia and their offspring. With a focus on various underlying mechanisms, the conclusions from this review are expected to provide more potential diagnostics and treatment strategies for clinical practice.
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Affiliation(s)
- Chuyu Yang
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, China (C.Y., C.T.)
- Ministry of Education-International Collaborative Laboratory of Reproduction and Development, Chongqing, China (C.Y., P.N.B., C.T.)
| | - Philip N Baker
- Ministry of Education-International Collaborative Laboratory of Reproduction and Development, Chongqing, China (C.Y., P.N.B., C.T.)
- College of Life Sciences, University of Leicester, United Kingdom (P.N.B.)
| | - Joey P Granger
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.P.G.)
| | - Sandra T Davidge
- Department of Obstetrics and Gynecology and Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada (S.T.D.)
| | - Chao Tong
- State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, China (C.Y., C.T.)
- Ministry of Education-International Collaborative Laboratory of Reproduction and Development, Chongqing, China (C.Y., P.N.B., C.T.)
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Jiang W, Yu G, Wang C, Yin S, Huang Y, Chen Q, Sun K, Zhang J. Exposure to multiple air pollutant mixtures and the subtypes of hypertensive disorders in pregnancy: A multicenter study. Int J Hyg Environ Health 2023; 253:114238. [PMID: 37531934 DOI: 10.1016/j.ijheh.2023.114238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Hypertensive disorders in pregnancy (HDP) have heterogeneous etiologies. Previous studies have linked individual air pollutants to overall HDP with inconsistent results. Moreover, it has not been explored how exposure to a mixture of multiple air pollutants may affect the risks of the subtypes of the disorders. OBJECTIVES To investigate the associations of exposure to air pollutant mixture in the 1st and 2nd trimesters of pregnancy with the risks of HDP and its subtypes. METHODS Pregnancy data were obtained from the China Labor and Delivery Survey, a nationwide cross-sectional survey in 2015 and 2016. Levels of air pollutants [including fine particulate matter (PM2.5), carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide (SO2)] in the 1st and 2nd trimesters were estimated based on the model developed by the Institution of Atmospheric Physics, Chinese Academy of Science. Generalized linear mixed models were built to assess the single-exposure effects of air pollutants in early gestation on HDP. The restricted cubic spline function was further applied to assess the potential non-linearity. The weighted quantile sum (WQS) regression was used to investigate the effects of co-exposure to multiple air pollutants. RESULTS A total of 67,512 pregnancies were included, and 2,834 were HDP cases. The single-effect analysis showed that CO, PM2.5, and SO2 exposure in the 2nd trimester was positively associated with the risks of gestational hypertension (GH), with adjusted odds ratios (aORs) and 95% confidence intervals (CI) of 1.16 (1.04, 1.28), 1.19 (1.04, 1.37), and 1.13 (1.04, 1.22), respectively. The first-trimester O3 exposure was also associated with an increased preeclampsia/eclampsia (PE) risk (aOR = 1.17; 95%CI: 1.02, 1.33). WQS regression confirmed positive associations of air pollutant mixture with HDP subtypes, with PM2.5 as the main contributing pollutant to GH, and CO and O3 as the main pollutants to PE. CONCLUSIONS Exposure to multiple air pollutant mixtures in early pregnancy was associated with increased risks of hypertensive disorders in pregnancy.
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Affiliation(s)
- Wen Jiang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Guoqi Yu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; Global Centre for Asian Women's Health, Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cuiping Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Shengju Yin
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yun Huang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Qian Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Hirsch C, Roberts L, Salisbury J, Denney-Wilson E, Henry A, Gow M. The Association between Nutrition, Physical Activity, and Cardiometabolic Health at 6 Months following a Hypertensive Pregnancy: A BP 2 Sub-Study. Nutrients 2023; 15:3294. [PMID: 37571231 PMCID: PMC10421276 DOI: 10.3390/nu15153294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies, with resultant lifelong increased risks of cardiovascular disease (CVD). We aimed to describe lifestyle behaviours at 6 months post-HDP in four HDP subgroups, and their association with markers of cardiometabolic health. Subgroups were chronic hypertension (CH), gestational hypertension (GH), preeclampsia, and preeclampsia superimposed on chronic hypertension (CH + PE). The BP2 study is a multi-site, three-arm, randomised controlled trial. At 6 months postpartum, the NSW Population Health Survey and BP2 surveys collected lifestyle behaviours and demographic data. Body mass index (BMI), waist circumference, and blood pressure (BP) were also assessed. Descriptive statistics, ANOVA and Spearman's correlation coefficients were used. Of 484 women (16% CH, 23% GH, 55% preeclampsia, and 6% CH + PE), 62% were overweight or obese. Only 6% met the recommended five vegetable and two fruit serves per day, and 43% did not meet the recommended 150 min of moderate-vigorous physical activity in five sessions per week. Adherence to both diet and physical activity recommendations was correlated with more favourable cardiometabolic outcomes, including lower BMI, waist circumference, and systolic and diastolic BP. Lifestyle interventions that improve diet and physical activity post-HDP are needed to reduce BP, BMI, and long-term CVD in this high-risk population.
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Affiliation(s)
- Camilla Hirsch
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.); (A.H.)
| | - Lynne Roberts
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- St. George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing, University of Sydney, Camperdown, Sydney, NSW 2006, Australia;
| | - Amanda Henry
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.); (A.H.)
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- St. George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Megan Gow
- Women’s and Children’s Health, St. George Hospital, Sydney, NSW 2217, Australia;
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Children’s Hospital Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia
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Ibarra AJ, Butters MA, Lim G, Jeyabalan A, Li R, Balasubramani GK, Catov JM. Longitudinal cognitive evaluation before and after delivery among people with preeclampsia. Am J Obstet Gynecol MFM 2023; 5:100966. [PMID: 37084869 PMCID: PMC10876122 DOI: 10.1016/j.ajogmf.2023.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Cognitive impairments related to preeclampsia after pregnancy have been reported; however, it is not known if weaknesses in cognition occur before and shortly after delivery. OBJECTIVE This study aimed to assess the feasibility of longitudinal cognitive testing before and after delivery, and to investigate whether those with preeclampsia have cognitive weaknesses during the third trimester of pregnancy and at 1 and 3 months postpartum. We hypothesized that people with preeclampsia would have lower cognition scores across all time points compared with normotensive people. STUDY DESIGN This longitudinal, prospective, observational study in a single institution enrolled people (N=30) at ≥28 weeks of gestation with preeclampsia (N=16) or normotension (N=14). People with chronic hypertension, neurologic or developmental disabilities, moderate or severe depression or anxiety, or current substance use were excluded. Subjective (Everyday Cognition Scale) and objective assessment of executive function (Stroop Color-Word Interference Test, Trail-Making Test), attention and working memory (Digit Span subtest), and information processing speed (Digit Symbol Substitution Test) was conducted, and Z-scores were calculated. Baseline characteristics (eg, prepregnancy body mass index) were collected from the medical record. Generalized linear models were used to estimate associations. RESULTS We enrolled 37% (30/81) of eligible people and retained 80% (24/30) and 53% (16/30) at 1 and 3 months postpartum, respectively. People with preeclampsia reported more memory problems (ß=0.87; 95% confidence interval, 0.44-1.31), and scored worse on attention and working memory (ß=-0.94; 95% confidence interval, -1.42 to -0.45) and executive function (Stroop test ß=-0.86; 95% confidence interval, -1.53 to -0.19) domains compared with normotensive people after adjusting for time, age, education, and prepregnancy body mass index. CONCLUSION Longitudinal assessment of cognition in pregnant preeclamptic and normotensive people is feasible. People with preeclampsia reported worse subjective memory and had lower scores in attention, working memory, and executive function.
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Affiliation(s)
- Andrea J Ibarra
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim).
| | | | - Grace Lim
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim)
| | - Arun Jeyabalan
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA
| | - Runjia Li
- Departments of Epidemiology (Ms Li and Dr Catov)
| | | | - Janet M Catov
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA; Departments of Epidemiology (Ms Li and Dr Catov); Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
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Ackerman-Banks CM, Lipkind HS, Palmsten K, Ahrens KA. Association between hypertensive disorders of pregnancy and cardiovascular diseases within 24 months after delivery. Am J Obstet Gynecol 2023; 229:65.e1-65.e15. [PMID: 37031763 PMCID: PMC10330109 DOI: 10.1016/j.ajog.2023.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Despite the well-known association between hypertensive disorders of pregnancy and cardiovascular diseases, there are limited data on which specific cardiovascular diagnoses have the greatest risk profiles during the first 24 months after delivery. Most existing data on hypertensive disorders of pregnancy and short-term cardiovascular disease risks are limited to the immediate postpartum period; however, it is crucial to determine cardiovascular disease risk up to 24 months after delivery to inform cardiovascular disease screening protocols during the extended postpartum period. OBJECTIVE This study aimed to delineate the risk of cardiovascular diagnoses in the first 24 months after delivery among patients with hypertensive disorders of pregnancy compared with patients without hypertensive disorders of pregnancy. STUDY DESIGN This longitudinal population-based study included pregnant individuals with deliveries during 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Data. This study excluded patients with preexisting cardiovascular disease, with multifetal pregnancies, or without continuous insurance during pregnancy. Hypertensive disorders of pregnancy and cardiovascular diseases (categorized by specific conditions: heart failure, ischemic heart disease, arrhythmia or cardiac arrest, cardiomyopathy, cerebrovascular disease or stroke, and new chronic hypertension) were identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, diagnosis codes. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounding factors. RESULTS Of the 119,422 pregnancies examined, the cumulative risk of cardiovascular disease within 24 months after delivery for those with hypertensive disorders of pregnancy vs those without hypertensive disorders of pregnancy was 0.6% vs 0.2% for heart failure, 0.3% vs 0.1% for ischemic heart disease, 0.2% vs 0.2% for arrhythmia or cardiac arrest, 0.6% vs 0.2% for cardiomyopathy, 0.8% vs 0.4% for cerebrovascular disease or stroke, 1.6% vs 0.7% for severe cardiac disease (composite outcome of heart failure, cerebrovascular disease or stroke, or cardiomyopathy), and 9.7% vs 1.5% for new chronic hypertension. After adjustment for potential confounders, those with hypertensive disorders of pregnancy had an increased risk of heart failure, cerebrovascular disease, cardiomyopathy, and severe cardiac disease within the first 24 months after delivery (adjusted hazard ratio, 2.81 [95% confidence interval, 1.90-4.15], 1.43 [95% confidence interval, 1.07-1.91], 2.90 [95% confidence interval, 1.96-4.27], and 1.90 [95% confidence interval, 1.54-2.30], respectively) compared with those without hypertensive disorders of pregnancy. In addition, those with hypertensive disorders of pregnancy had an increased risk for new chronic hypertension diagnosed after 42 days after delivery (adjusted hazard ratio, 7.29; 95% confidence interval, 6.57-8.09). There was no association between hypertensive disorders of pregnancy and ischemic heart disease (adjusted hazard ratio, 0.92; 95% confidence interval, 0.55-1.54) or cardiac arrest or arrhythmia (adjusted hazard ratio, 0.90; 95% confidence interval, 0.52-1.57). In addition, among women with hypertensive disorders of pregnancy, the highest proportion of first cardiovascular disease diagnoses occurred during the first month after delivery for cardiomyopathy (44%), heart failure (39%), cerebrovascular disease or stroke (39%), and severe cardiac disease (41%). CONCLUSION Patients with hypertensive disorders of pregnancy had an increased risk of developing new chronic hypertension, heart failure, cerebrovascular disease, and cardiomyopathy within 24 months after delivery. There was no association between hypertensive disorders of pregnancy and ischemic heart disease or cardiac arrest or arrhythmia. Patients with hypertensive disorders of pregnancy need targeted early postpartum interventions and increased monitoring in the first 24 months after delivery. This may preserve long-term health and improve maternal and neonatal outcomes in a subsequent pregnancy.
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Affiliation(s)
| | - Heather S Lipkind
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, NY
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, Health Partners Institute, Minneapolis, MN
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME
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Rao A, Brewster UC. Pregnancy in Chronic Kidney Disease: Acute Kidney Injury in Pregnant Women and Management of Chronic Kidney Disease in the Pregnant Patient. Med Clin North Am 2023; 107:717-726. [PMID: 37258009 DOI: 10.1016/j.mcna.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Women pursue pregnancy with comorbidities such as hypertension and kidney disease, necessitating primary care physicians to remain up to date with current clinical practice. Hypertensive disorders of pregnancy pose risks to the pregnancy and to the woman in the short and long term. These risks and their management are detailed in this review. Normally, pregnancy is associated with hemodynamic and kidney-specific changes. Here the authors discuss these changes and review the impact and management of pregnancy-related acute kidney injury, chronic kidney disease, and dialysis in pregnant patients. Kidney transplant recipients may experience return of fertility and require counseling to improve outcomes.
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Affiliation(s)
- Arundati Rao
- Yale University School of Medicine, 330 Cedar Street, BB114, New Haven, CT 06510, USA
| | - Ursula C Brewster
- Yale University School of Medicine, 330 Cedar Street, BB114, New Haven, CT 06510, USA.
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Giorgione V, Cauldwell M, Thilaganathan B. Pre-eclampsia and Cardiovascular Disease: From Pregnancy to Postpartum. Eur Cardiol 2023; 18:e42. [PMID: 37456771 PMCID: PMC10345941 DOI: 10.15420/ecr.2022.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/02/2022] [Indexed: 07/18/2023] Open
Abstract
Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies. In addition to multiorgan manifestations related to endothelial dysfunction, HDP confers an increased risk of cardiovascular disease during delivery hospitalisation, such as heart failure, pulmonary oedema, acute MI and cerebrovascular events. However, the cardiovascular legacy of HDP extends beyond birth since these women are significantly more likely to develop cardiovascular risk factors in the immediate postnatal period and major cardiovascular disease in the long term. The main mediator of cardiovascular disease in women with a history of HDP is chronic hypertension, followed by obesity, hypercholesterolaemia and diabetes. Therefore, optimising blood pressure levels from the immediate postpartum period until the first months postnatally could have beneficial effects on the development of hypertension and improve long-term cardiovascular health. Peripartum screening based on maternal demographic, and clinical and echocardiographic data could help clinicians identify women with HDP at highest risk of developing postpartum hypertension who would benefit from targeted primary cardiovascular prevention.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Matthew Cauldwell
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of LondonLondon, UK
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation TrustLondon, UK
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Echouffo-Tcheugui JB, Guan J, Fu L, Retnakaran R, Shah BR. Incidence of Heart Failure Related to Co-Occurrence of Gestational Hypertensive Disorders and Gestational Diabetes. JACC. ADVANCES 2023; 2:100377. [PMID: 37476567 PMCID: PMC10358333 DOI: 10.1016/j.jacadv.2023.100377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/06/2023] [Accepted: 03/21/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The extent to which their co-occurrence of gestational hypertensive disorders (GHTD) and gestational diabetes mellitus (GDM) influences heart failure (HF) risk is unclear. OBJECTIVES The purpose of this study was to characterize the risk of HF related to concomitant GHTD and GDM. METHODS We conducted a population-based cohort study using the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. We included women with a livebirth singleton delivery between July 1, 2007, and March 31, 2018, and excluded those with prepregnancy diabetes, hypertension, HF, or coronary artery disease. GDM, GHTD, peripartum cardiomyopathy (at index pregnancy) were identified using diagnosis coding. Incident HF was assessed from index pregnancy until March 31, 2020. We estimated associations of GDM and/or GHTD with peripartum cardiomyopathy and incident HF. RESULTS Among 885,873 women (mean age: 30 years, 54,015 with isolated GDM, 43,750 with isolated GHTD, 4,960 with GDM and GHTD), there were 489 HF events over 8 years. Compared to no-GDM and no-GHTD, isolated GDM (adjusted hazard ratio [aHR]: 1.44; 95% CI: 1.02-2.04) and isolated GHTD (aHR: 1.65; 95% CI: 1.17-2.31) were associated with a higher risk of incident HF. The co-occurrence of GDM and GHTD was associated with a higher HF risk (aHR: 2.64; 95% CI: 1.24-5.61). GDM and GHTD increased the risk of peripartum cardiomyopathy (adjusted risk ratio [aRR]: 7.30; 95% CI: 6.92-7.58), similarly to isolated GHTD (aRR: 7.40; 95% CI: 7.23-7.58). CONCLUSIONS The co-occurrence of GDM and GHTD was associated with a significantly high risk of incident HF.
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Affiliation(s)
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R. Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Honigberg MC, Truong B, Khan RR, Xiao B, Bhatta L, Vy HMT, Guerrero RF, Schuermans A, Selvaraj MS, Patel AP, Koyama S, Cho SMJ, Vellarikkal SK, Trinder M, Urbut SM, Gray KJ, Brumpton BM, Patil S, Zöllner S, Antopia MC, Saxena R, Nadkarni GN, Do R, Yan Q, Pe'er I, Verma SS, Gupta RM, Haas DM, Martin HC, van Heel DA, Laisk T, Natarajan P. Polygenic prediction of preeclampsia and gestational hypertension. Nat Med 2023; 29:1540-1549. [PMID: 37248299 PMCID: PMC10330886 DOI: 10.1038/s41591-023-02374-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
Preeclampsia and gestational hypertension are common pregnancy complications associated with adverse maternal and child outcomes. Current tools for prediction, prevention and treatment are limited. Here we tested the association of maternal DNA sequence variants with preeclampsia in 20,064 cases and 703,117 control individuals and with gestational hypertension in 11,027 cases and 412,788 control individuals across discovery and follow-up cohorts using multi-ancestry meta-analysis. Altogether, we identified 18 independent loci associated with preeclampsia/eclampsia and/or gestational hypertension, 12 of which are new (for example, MTHFR-CLCN6, WNT3A, NPR3, PGR and RGL3), including two loci (PLCE1 and FURIN) identified in the multitrait analysis. Identified loci highlight the role of natriuretic peptide signaling, angiogenesis, renal glomerular function, trophoblast development and immune dysregulation. We derived genome-wide polygenic risk scores that predicted preeclampsia/eclampsia and gestational hypertension in external cohorts, independent of clinical risk factors, and reclassified eligibility for low-dose aspirin to prevent preeclampsia. Collectively, these findings provide mechanistic insights into the hypertensive disorders of pregnancy and have the potential to advance pregnancy risk stratification.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
| | - Buu Truong
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Raiyan R Khan
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Brenda Xiao
- University of Pennsylvania, Philadelphia, PA, USA
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Ha My T Vy
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael F Guerrero
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Art Schuermans
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Margaret Sunitha Selvaraj
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Aniruddh P Patel
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Satoshi Koyama
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - So Mi Jemma Cho
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, Republic of Korea
| | - Shamsudheen Karuthedath Vellarikkal
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Trinder
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Urbut
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Kathryn J Gray
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ben M Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Snehal Patil
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sebastian Zöllner
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Mariah C Antopia
- Department of Integrative Biology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Richa Saxena
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Itsik Pe'er
- Department of Computer Science, Columbia University, New York, NY, USA
| | | | - Rajat M Gupta
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David M Haas
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hilary C Martin
- Department of Human Genetics, Wellcome Sanger Institute, Cambridge, UK
| | - David A van Heel
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Triin Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Ng AP, Verma A, Sanaiha Y, Williamson CG, Afshar Y, Benharash P. Maternal and Fetal Outcomes in Pregnant Patients With Mechanical and Bioprosthetic Heart Valves. J Am Heart Assoc 2023; 12:e028653. [PMID: 37183876 DOI: 10.1161/jaha.122.028653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Guidelines for choice of prosthetic heart valve in people of reproductive age are not well established. Although biologic heart valves (BHVs) have risk of deterioration, mechanical heart valves (MHVs) require lifelong anticoagulation. This study aimed to characterize the association of prosthetic valve type with maternal and fetal outcomes in pregnant patients. Methods and Results Using the 2008 to 2019 National Inpatient Sample, we identified all adult patients hospitalized for delivery with prior heart valve implantation. Multivariable regressions were used to analyze the primary outcome, major adverse cardiovascular events, and secondary outcomes, including maternal and fetal complications, length of stay, and costs. Among 39 871 862 birth hospitalizations, 4152 had MHVs and 874 had BHVs. Age, comorbidities, and cesarean birth rates were similar between patients with MHVs and BHVs. The presence of a prosthetic valve was associated with over 22-fold increase in likelihood of major adverse cardiovascular events (MHV: adjusted odds ratio, 22.1 [95% CI, 17.3-28.2]; BHV: adjusted odds ratio, 22.5 [95% CI, 13.9-36.5]) as well as increased duration of stay and hospitalization costs. However, patients with MHVs and BHVs had no significant difference in the odds of any maternal outcome, including major adverse cardiovascular events, hypertensive disease of pregnancy, and ante/postpartum hemorrhage. Similarly, fetal complications were more likely in patients with valve prostheses, including a 4-fold increase in odds of stillbirth, but remained comparable between MHVs and BHVs. Conclusions Patients hospitalized for delivery with prior valve replacement carry substantial risk of adverse maternal and fetal events, regardless of valve type. Our findings reveal comparable outcomes between MHVs and BHVs.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology David Geffen School of Medicine at UCLA Los Angeles CA USA
- Molecular Biology Insitute University of California Los Angeles CA USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery David Geffen School of Medicine at UCLA Los Angeles CA USA
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Sui C, Wen H, Han J, Chen T, Gao Y, Wang Y, Yang L, Guo L. Decreased gray matter volume in the right middle temporal gyrus associated with cognitive dysfunction in preeclampsia superimposed on chronic hypertension. Front Neurosci 2023; 17:1138952. [PMID: 37250424 PMCID: PMC10217781 DOI: 10.3389/fnins.2023.1138952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The effects of preeclampsia superimposed on chronic hypertension (CHTN-PE) on the structure and function of the human brain are mostly unknown. The purpose of this study was to examine altered gray matter volume (GMV) and its correlation with cognitive function in pregnant healthy women, healthy non-pregnant individuals, and CHTN-PE patients. Methods Twenty-five CHTN-PE patients, thirty-five pregnant healthy controls (PHC) and thirty-five non-pregnant healthy controls (NPHC) were included in this study and underwent cognitive assessment testing. A voxel-based morphometry (VBM) approach was applied to investigate variations in brain GMV among the three groups. Pearson's correlations between mean GMV and the Stroop color-word test (SCWT) scores were calculated. Results Compared with the NPHC group, the PHC and CHTN-PE groups showed significantly decreased GMV in a cluster of the right middle temporal gyrus (MTG), and the GMV decrease was more significant in the CHTN-PE group. There were significant differences in the Montreal Cognitive Assessment (MoCA) and Stroop word scores among the three groups. Notably, the mean GMV values in the right MTG cluster were not only significantly negatively correlated with Stroop word and Stroop color scores but also significantly distinguished CHTN-PE patients from the NPHC and PHC groups in receiver operating characteristic curve analysis. Discussion Pregnancy may cause a decrease in local GMV in the right MTG, and the GMV decrease is more significant in CHTN-PE patients. The right MTG affects multiple cognitive functions, and combined with the SCWT scores, it may explain the decline in speech motor function and cognitive flexibility in CHTN-PE patients.
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Affiliation(s)
- Chaofan Sui
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Jingchao Han
- Department of Medical Imaging, Jinan Stomatological Hospital, Jinan, Shandong, China
| | - Tao Chen
- Department of Clinical Laboratory, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yian Gao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yuanyuan Wang
- Department of Radiology, Binzhou Medical University, Yantai, Shandong, China
| | - Linfeng Yang
- Department of Radiology, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Mielke MM, Frank RD, Christenson LR, Fields JA, Rocca WA, Garovic VD. Association of Hypertensive Disorders of Pregnancy With Cognition in Later Life. Neurology 2023; 100:e2017-e2026. [PMID: 36859405 PMCID: PMC10186223 DOI: 10.1212/wnl.0000000000207134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/17/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies of hypertensive disorders of pregnancy (HDP), including gestational or chronic hypertension (GH/CH) and preeclampsia/eclampsia (PE/E), suggest associations with early-life and mid-life cognition but have been limited by self-report or use of diagnostic codes, exclusion of nulliparous women, and lack of measurement of cognition in later life. We examined the effects of any HDP, GH/CH, PE/E, and nulliparity on cognition in later life. METHODS Participants included 2,239 women (median age 73) enrolled in the Mayo Clinic Study of Aging with medical record-abstracted pregnancy information. A cognitive battery of 9 tests was conducted every 15 months. Global cognitive and domain-specific z scores (memory, executive/attention, visuospatial, and language) were outcomes. Linear mixed-effect models evaluated associations between pregnancy history (all normotensive, any HPD, HPD subtype [GH/CH, PE/E], or nulliparous) and cognitive decline, adjusting for age and education. Additional models adjusted for APOE, smoking, hypertension, dyslipidemia, body mass index (BMI), diabetes, stroke, and heart disease. Interactions between pregnancy history and age or education on cognitive performance were examined. RESULTS Of the 2,239 women, 1,854 (82.8%) had at least 1 pregnancy (1,607 all normotensive, 100 GH/CH, and 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E vs women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p < 0.05) in age- and education-adjusted models. There was an interaction (p = 0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, p < 0.001) vs 12 + years (b = -0.11, p = 0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z scores compared with women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, p < 0.001), language (beta = -0.03, p = 0.001), and attention (beta = -0.04, p < 0.001) z scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results. DISCUSSION Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life.
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Affiliation(s)
- Michelle M Mielke
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Ryan D Frank
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Luke R Christenson
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Julie A Fields
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- From the Department of Epidemiology and Prevention (M.M.M.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Quantitative Health Sciences (R.D.F., L.R.C., W.A.R.), Mayo Clinic, Rochester, MN; Division of Neurocognitive Disorders, Department of Psychiatry and Psychology (J.A.F.), Mayo Clinic, Rochester, MN; Department of Neurology and Women's Health Research Center (W.A.R.), Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension and Department of Obstetrics and Gynecology (V.D.G.), Mayo Clinic, Rochester, MN
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76
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Prodan CI. Bridging the Gap Between Hypertensive Disorders of Pregnancy and Cognitive Decline in Older Women. Neurology 2023; 100:893-894. [PMID: 36859409 DOI: 10.1212/wnl.0000000000207237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Affiliation(s)
- Calin I Prodan
- From the Department of Neurology (C.I.P.), University of Oklahoma Health Sciences Center,Oklahoma City, OK and Veterans Affairs Medical Center, Oklahoma City, OK.
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77
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Buxton MA, Heydarzadeh S, Gronlund CJ, Castillo-Castrejon M, Godines-Enriquez MS, O’Neill MS, Vadillo-Ortega F. Associations between Air Pollution Exposure and Blood Pressure during Pregnancy among PRINCESA Cohort Participants. TOXICS 2023; 11:424. [PMID: 37235239 PMCID: PMC10222039 DOI: 10.3390/toxics11050424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
High blood pressure (BP) is a risk factor for hypertensive disease during pregnancy. Exposure to multiple toxic air pollutants can affect BP in pregnancy but has been rarely studied. We evaluated trimester-specific associations between air pollution exposure and systolic (SBP) and diastolic BP (DBP). Ozone (O3), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter less than 10 and 2.5 μm in aerodynamic diameter (PM10, PM2.5) in the Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses (PRINCESA) study. Multipollutant generalized linear regression models with each pollutant and O3 were fit. Due to nonlinear pollution/BP associations, results are presented for "below the median" or "above the median", where the beta estimate is the change in BP at a pollutant's median versus BP at the pollutant's minimum or maximum, respectively. Associations varied across trimesters and pollutants, and deleterious associations (higher blood pressure with higher pollution) were found only at pollutant values below the median: for SBP with NO2 in the second and third trimesters, and PM2.5 during the third trimester, and for DBP, PM2.5, and NO2 in the second and third trimesters. Findings suggest that minimizing prenatal exposure to air pollution may reduce the risks of changes in BP.
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Affiliation(s)
- Miatta A. Buxton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.H.); (C.J.G.); (M.S.O.)
| | - Safa Heydarzadeh
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.H.); (C.J.G.); (M.S.O.)
| | - Carina J. Gronlund
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.H.); (C.J.G.); (M.S.O.)
- Institute for Social Research, Survey Research Center, University of Michigan, Ann Arbor, MI 48104, USA
| | - Marisol Castillo-Castrejon
- Department of Pathology, Stephenson Cancer Center, Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | - Marie S. O’Neill
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (S.H.); (C.J.G.); (M.S.O.)
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Felipe Vadillo-Ortega
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
- Unidad de Vinculación Científica de la Facultad de Medicina, Universidad Nacional Autónoma de México en el Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
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Niu Y, Suo L, Zhao D, Wang Y, Miao R, Zou J, Han X, Chen ZJ, Li Y, Wei D. Is artificial endometrial preparation more associated with early-onset or late-onset preeclampsia after frozen embryo transfer? J Assist Reprod Genet 2023; 40:1045-1054. [PMID: 37000343 PMCID: PMC10239427 DOI: 10.1007/s10815-023-02785-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To explore whether the risks of early- or late-onset preeclampsia vary among frozen embryo transfer (FET) with different regimens for endometrial preparation and fresh embryo transfer (FreET). METHODS We retrospectively included a total of 24129 women who achieved singleton delivery during their first cycles of in vitro fertilization (IVF) between January 2012 and March 2020. The risks of early- and late-onset preeclampsia after FET with endometrial preparation by natural ovulation cycles (FET-NC) or by artificial cycles (FET-AC) were compared to that after FreET. RESULTS After adjustment via multivariable logistic regression, the total risk of preeclampsia was higher in the FET-AC group compared to the FreET group [2.2% vs. 0.9%; adjusted odds ratio (aOR): 2.00; 95% confidence interval (CI): 1.45-2.76] and FET-NC group (2.2% vs. 0.9%; aOR: 2.17; 95% CI: 1.59-2.96).When stratified by the gestational age at delivery based on < 34 weeks or ≥ 34 weeks, the risk of late-onset preeclampsia remained higher in the FET-AC group than that in the and FreET group (1.8% vs. 0.6%; aOR: 2.56; 95% CI: 1.83-3.58) and the FET-NC group (1.8% vs. 0.6%; aOR: 2.63; 95% CI: 1.86-3.73). We did not find a statistically significant difference in the risk of early-onset preeclampsia among the three groups. CONCLUSIONS An artificial regimen for endometrial preparation was more associated with an increased risk of late-onset preeclampsia after FET. Given that FET-AC is widely used in clinical practice, the potential maternal risk factors for late-onset preeclampsia when using the FET-AC regimen should be further explored, considering the maternal origin of late-onset preeclampsia.
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Affiliation(s)
- Yue Niu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Lu Suo
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Dingying Zhao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Yuhuan Wang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Ruolan Miao
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Jialin Zou
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Xinwei Han
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China
| | - Yan Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China.
| | - Daimin Wei
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Medical Integration and Practice Center, Shandong University, No. 44 Wenhua Xi Rd, Jinan, 250012, Shandong, China.
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Villalaín González C, Herraiz García I, Fernández-Friera L, Ruiz-Hurtado G, Morales E, Solís J, Galindo A. Cardiovascular and renal health: Preeclampsia as a risk marker. Nefrologia 2023; 43:269-280. [PMID: 37635012 DOI: 10.1016/j.nefroe.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/24/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Cardiovascular (CVD) and chronic kidney disease (CKD) in women have unique risk factors related to hormonal status and obstetric history that must be taken into account. Pregnancy complications, such as preeclampsia (PE), can reveal a subclinical predisposition for the development of future disease that may help identify women who could benefit from early CVD and CKD prevention strategies. MATERIALS AND METHODS Review of PE and its association with future development of CVD and CKD. RESULTS Multiple studies have established an association between PE and the development of ischemic heart disease, chronic hypertension, peripheral vascular disease, stroke and CKD. It has not been sufficiently clarified if this relation is a causal one or if it is mediated by common risk factors. Nevertheless, the presence of endothelial dysfunction and thrombotic microangiopathy during pregnancies complicated with PE makes us believe that PE may leave a long-term imprint. Early identification of women who have had a pregnancy complicated by PE becomes a window of opportunity to improve women's health through adequate follow-up and targeted preventive actions. Oxidative stress biomarkers and vascular ultrasound may play a key role in the early detection of this arterial damage. CONCLUSIONS The implementation of preventive multidisciplinary targeted strategies can help slow down CVD and CKD's natural history in women at risk through lifestyle modifications and adequate blood pressure control. Therefore, we propose a series of recommendations to guide the prediction and prevention of CVD and CKD throughout life of women with a history of PE.
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Affiliation(s)
- Cecilia Villalaín González
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Herraiz García
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Leticia Fernández-Friera
- Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enrique Morales
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Servicio de Nefrología, Departamento de Medicina, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
| | - Jorge Solís
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Galindo
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
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80
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Enninga EAL, Garovic VD. Novel mechanism of increased preeclampsia risk after kidney donation. Kidney Int 2023; 103:653-655. [PMID: 36948763 PMCID: PMC10758218 DOI: 10.1016/j.kint.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/24/2023]
Affiliation(s)
| | - Vesna D Garovic
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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Schliep KC, Shaaban CE, Meeks H, Fraser A, Smith KR, Majersik JJ, Foster NL, Wactawski‐Wende J, Østbye T, Tschanz J, Padbury JF, Sharma S, Zhang Y, Facelli JC, Abdelrahman CS, Theilen L, Varner MW. Hypertensive disorders of pregnancy and subsequent risk of Alzheimer's disease and other dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12443. [PMID: 37223334 PMCID: PMC10201212 DOI: 10.1002/dad2.12443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023]
Abstract
Introduction Women with hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease. Whether HDP is also associated with later-life dementia has not been fully explored. Methods Using the Utah Population Database, we performed an 80-year retrospective cohort study of 59,668 parous women. Results Women with, versus without, HDP, had a 1.37 higher risk of all-cause dementia (95% confidence interval [CI]: 1.26, 1.50) after adjustment for maternal age at index birth, birth year, and parity. HDP was associated with a 1.64 higher risk of vascular dementia (95% CI: 1.19, 2.26) and 1.49 higher risk of other dementia (95% CI: 1.34, 1.65) but not Alzheimer's disease dementia (adjusted hazard ratio = 1.04; 95% CI: 0.87, 1.24). Gestational hypertension and preeclampsia/eclampsia showed similar increased dementia risk. Nine mid-life cardiometabolic and mental health conditions explained 61% of HDP's effect on subsequent dementia risk. Discussion Improved HDP and mid-life care could reduce the risk of dementia.
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Affiliation(s)
- Karen C. Schliep
- Department of Family and Preventative MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Huong Meeks
- Department of Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Alison Fraser
- Department of Population SciencesHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Ken R. Smith
- Department of Family and Consumer StudiesUniversity of UtahSalt Lake CityUtahUSA
| | | | | | - Jean Wactawski‐Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsUniversity at BuffaloThe State University of New YorkBuffaloNew YorkUSA
| | - Truls Østbye
- Community and Family Medicine and Community HealthNursing and Global HealthDuke UniversityDurhamNorth CarolinaUSA
| | - JoAnn Tschanz
- Department of PsychologyUtah State UniversityLoganUtahUSA
| | - James F. Padbury
- Department of PediatricsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Surrendra Sharma
- Department of PediatricsWomen & Infants HospitalAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Yue Zhang
- Department of Internal MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julio C. Facelli
- Department of Biomedical InformaticsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - C. Samir Abdelrahman
- Department of Biomedical InformaticsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Lauren Theilen
- Department of Obstetrics and GynecologyUniversity of UtahSalt Lake CityUtahUSA
| | - Michael W. Varner
- Department of Obstetrics and GynecologyUniversity of UtahSalt Lake CityUtahUSA
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Sun Y, Guo Y, Xu H, Zhao J, Wu D, Hu J, Wang D, Wu L, Peng H, Li H. The relationship between arginine vasopressin gene polymorphisms and plasma copeptin and hypertensive disorders of pregnancy: a nested case-control study. J Hypertens 2023; 41:608-617. [PMID: 36723473 DOI: 10.1097/hjh.0000000000003376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aims to explore the relationship between polymorphism of the arginine vasopressin (AVP) gene and plasma copeptin concentration with the occurrence of hypertension in pregnancy. METHODS We conducted a matched nested case-control study in Chinese women. The genotypes of rs3729965, rs3761249, rs1410713, rs2740204, and rs2282018 loci of AVP gene and plasma copeptin at 16-20 gestational weeks were detected in 288 patients with gestational hypertension (GH), 82 with preeclampsia (PE), and 14 with chronic hypertension with superimposed preeclampsia (CH-PE) and their healthy matched controls. RESULTS For every natural logarithm unit increment in copeptin, the risks of GH and PE/CH-PE increased by 5.556 (adjusted odds ratio [aOR]: 6.556, 95% confidence interval [CI]: 2.734-15.717) and 3.312 times (aOR: 4.312, 95% CI: 1.168-15.914). Under the dominant model, the genotype CC + CT of rs2282018 and GG + GT of rs3761249 had higher risks of GH than genotype TT, with aORs of 1.757 (95% CI: 1.077-2.867) and 1.814 (95% CI: 1.111-2.963). Allele A of rs3729965 loci had a lower risk of PE/CH-PE than allele G (aOR: 0.441, 95% CI: 0.199-0.978). However, the frequencies of rs1410713 and rs2740204 genotypes were not significantly different between cases and controls. The model of copeptin combined with the AVP gene and traditional factors (TFs) had a higher ability than the TFs model in predicting GH and PE/CH-PE. CONCLUSION Our study confirms that higher plasma copeptin and AVP gene variants are associated with the occurrence of GH and PE/CH-PE. The detection of copeptin and AVP gene in the early second trimester improves the predictive ability of TFs for GH and PE/CH-PE.
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Affiliation(s)
- Yexiu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
| | - Ying Guo
- Department of Community Healthcare, Maternal and Child Health Bureau of Kunshan, Kunshan
| | - He Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
| | - Ji Zhao
- Department of Community Healthcare, Maternal and Child Health Bureau of Kunshan, Kunshan
| | - Di Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
| | - Jianwei Hu
- Department of Community Healthcare, Maternal and Child Health Bureau of Kunshan, Kunshan
| | - Dandan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
| | - Lei Wu
- Department of Maternal and Child Health, Suzhou Industrial Park Center for Disease Control and Prevention
| | - Hao Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou, PR China
| | - Hongmei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou, PR China
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83
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Li C, Xu JJ, Zhou FY, Ge YZ, Qin KZ, Huang HF, Wu YT. Effects of Particulate Matter on the Risk of Gestational Hypertensive Disorders and Their Progression. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:4930-4939. [PMID: 36913485 PMCID: PMC10061918 DOI: 10.1021/acs.est.2c06573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Associations between particulate matter (PM) and gestational hypertensive disorders (GHDs) are well documented, but there is no evidence on the associations between PM and GHD progression, especially among those with assisted reproductive technology (ART) conceptions. To explore the effects of PM on the risk of GHDs and their progression among pregnant women with natural or ART conception, we enrolled 185,140 pregnant women during 2014-2020 in Shanghai and estimated the associations during different periods using multivariate logistic regression. During the 3 months of preconception, 10 μg/m3 increases in PM concentrations were associated with increased risks of gestational hypertension (GH) (PM2.5: aOR = 1.076, 95% CI: 1.034-1.120; PM10: aOR = 1.042, 95% CI: 1.006-1.079) and preeclampsia (PM2.5: aOR = 1.064, 95% CI: 1.008-1.122; PM10: aOR = 1.048, 95% CI: 1.006-1.092 ) among women with natural conception. Furthermore, for women with ART conceptions who suffered current GHD, 10 μg/m3 increases in PM concentrations in the third trimester elevated the risk of progression (PM2.5: aOR = 1.156, 95% CI: 1.022-1.306 ; PM10: aOR = 1.134, 95% CI: 1.013-1.270). In summary, women with natural conception should avoid preconceptional PM exposure to protect themselves from GH and preeclampsia. For women with ART conceptions suffering from GHD, it is necessary to avoid PM exposure in late pregnancy to prevent the disease from progressing.
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Affiliation(s)
- Cheng Li
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
| | - Jing-Jing Xu
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
| | - Fang-Yue Zhou
- International
Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ying-Zhou Ge
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
| | - Kai-Zhou Qin
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
| | - He-Feng Huang
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
- Research
Units of Embryo Original Diseases, Chinese
Academy of Medical Sciences, Shanghai 200011, China
- International
Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yan-Ting Wu
- Obstetrics
and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China
- Research
Units of Embryo Original Diseases, Chinese
Academy of Medical Sciences, Shanghai 200011, China
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Fang M, Wang J, Wang Z, Chen Y, Xu W, Tao C, Ma L, You C, Hu X, Xia F. Impact of hypertensive disorders of pregnancy on short- and long-term outcomes of pregnancy-associated hemorrhagic stroke. Front Neurol 2023; 14:1097183. [PMID: 37006493 PMCID: PMC10060960 DOI: 10.3389/fneur.2023.1097183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
Background and purposeThough hypertension disorders of pregnancy (HDP) are recognized as independent pregnancy-associated stroke risk factors, few studies have considered their impact on stroke prognosis. Therefore, we intended to evaluate the impact of HDP on short- and long-term outcomes of pregnancy-associated hemorrhagic stroke (HS).MethodsWe conducted a retrospective analysis of patients admitted to our hospital from May 2009 to December 2021 with a diagnosis of pregnancy-associated HS. After dividing patients into two groups by the presence of a diagnosis of HDP or not, the short- (at the time of discharge) and long-term (after discharge follow-up) outcomes were compared by mRS (modified Rankin Scale) scores, and poor functional outcome defined as mRS > 2. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported.ResultsTwenty-two HDP and 72 non-HDP pregnancy-associated HS patients were enrolled and follow-up after 4.7 ± 3.6 years. There was no significant difference between the two groups regarding short-term outcomes, but patients with HDP were more likely to reach poor functional outcomes at long-term follow-up (aOR = 4.47, 95% CI = 1.28–15.67, p = 0.019).ConclusionsIn this retrospective study, women with hypertension disorders of pregnancy did not show worse short-term outcomes of pregnancy-associated hemorrhagic stroke compared to those without but had poorer long-term functional outcomes. This underlines the importance of prevention, recognition, and treatment of hypertension disorders in these women.
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Affiliation(s)
- Mei Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jiayan Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Zexu Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yuqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Wei Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Xin Hu
| | - Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Fan Xia
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Magnus MC, Wallace MK, Demirci JR, Catov JM, Schmella MJ, Fraser A. Breastfeeding and Later-Life Cardiometabolic Health in Women With and Without Hypertensive Disorders of Pregnancy. J Am Heart Assoc 2023; 12:e026696. [PMID: 36847057 PMCID: PMC10111449 DOI: 10.1161/jaha.122.026696] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Breastfeeding is associated with improved cardiometabolic profiles decades after pregnancy. Whether this association exists for women who experience hypertensive disorders of pregnancy (HDP) is unknown. The authors examined whether breastfeeding duration or exclusivity are associated with long-term cardiometabolic health, and whether this relationship differs by HDP status. Methods and Results Participants (N=3598) were from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. HDP status was assessed by medical record review. Breastfeeding behaviors were assessed by contemporaneous questionnaires. Breastfeeding duration was categorized as never, <1, 1 to <3, 3 to <6, 6 to <9, and 9+ months. Breastfeeding exclusivity was categorized as never, <1, 1 to <3, and 3 to 6 months. Measures of cardiometabolic health (body mass index, waist circumference, C-reactive protein, insulin, proinsulin, glucose, lipids, blood pressure, mean arterial pressure, carotid intima-media thickness, and arterial distensibility) were measured 18 years after pregnancy. Analyses were conducted using linear regression adjusting for relevant covariates. Breastfeeding was associated with improved cardiometabolic health (lower body mass index, waist circumference, C-reactive protein, triglycerides, insulin, and proinsulin) in all women, but not for every breastfeeding duration. Interaction tests revealed additional benefits in women with a history of HDP, with the strongest benefit observed in the 6- to 9-month breastfeeding category (diastolic blood pressure, -4.87 mm Hg [95% CI, -7.86 to -1.88], mean arterial pressure -4.61 [95% CI, -7.45 to -1.77], and low-density lipoprotein cholesterol, -0.40 mmol/L [95% CI, -0.62 to -0.17 mmol/L]). Differences in C-reactive protein and low-density lipoprotein "survived" Bonferroni correction (P<0.001). Similar results were observed in the exclusive breastfeeding analyses. Conclusions Breastfeeding may be a mechanism to reduce the cardiovascular disease sequela associated with HDP; however, there is a need to establish whether associations reflect a causal effect.
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Affiliation(s)
- Maria C Magnus
- Center for Fertility and Health Norwegian Institute of Public Health Oslo Norway.,MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
| | - McKenzie K Wallace
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing The Ohio State University Columbus OH
| | - Jill R Demirci
- School of Nursing University of Pittsburgh Pittsburgh PA
| | - Janet M Catov
- Department of Epidemiology University of Pittsburgh Pittsburgh PA.,Department of Obstetrics, Gynecology & Reproductive Science University of Pittsburgh Pittsburgh PA
| | | | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
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86
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Ren J, Jin H, Zhu Y. The Role of Placental Non-Coding RNAs in Adverse Pregnancy Outcomes. Int J Mol Sci 2023; 24:ijms24055030. [PMID: 36902459 PMCID: PMC10003511 DOI: 10.3390/ijms24055030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Non-coding RNAs (ncRNAs) are transcribed from the genome and do not encode proteins. In recent years, ncRNAs have attracted increasing attention as critical participants in gene regulation and disease pathogenesis. Different categories of ncRNAs, which mainly include microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are involved in the progression of pregnancy, while abnormal expression of placental ncRNAs impacts the onset and development of adverse pregnancy outcomes (APOs). Therefore, we reviewed the current status of research on placental ncRNAs and APOs to further understand the regulatory mechanisms of placental ncRNAs, which provides a new perspective for treating and preventing related diseases.
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Affiliation(s)
- Jiawen Ren
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Heyue Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
| | - Yumin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- MOE Key Laboratory of Population Health Across Life Cycle, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei 230032, China
- Correspondence:
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of death in women. Women with history of adverse pregnancy outcomes (APOs) have approximately two-fold risk of future CVD, but until recently the association with future heart failure (HF) was unclear. Here, we summarize evidence for associations of APOs with HF, potential underlying mechanisms, and future directions for clinical translation. RECENT FINDINGS Women with history of hypertensive disorders of pregnancy (HDPs) have roughly two-fold risk of future HF compared with other parous women even after accounting for interval development of coronary artery disease. The HDPs portend heightened risk of HF with both reduced and preserved ejection fraction. Gestational diabetes mellitus (GDM) and other APOs such as preterm delivery, small-for-gestational-age delivery, and placental abruption may also confer additional risk for HF development. Possible underlying mechanisms linking APOs to HF include shared upstream risk factors and genetics, accelerated development of cardiometabolic risk factors postpartum, persistent endothelial and microvascular dysfunction, and impaired natriuretic peptide signaling. SUMMARY History of APOs, including HDPs and GDM, confer increased risk for development of HF years after delivery. Further research is needed to define strategies to optimize prepregnancy and postpartum cardiovascular health toward HF prevention.
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Zhang X, Meng Y, Jiang M, Yang L, Zhang K, Lian C, Li Z. Machine learning-based evaluation of application value of pulse wave parameter model in the diagnosis of hypertensive disorder in pregnancy. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:8308-8319. [PMID: 37161199 DOI: 10.3934/mbe.2023363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Hypertensive disorder in pregnancy (HDP) remains a major health burden, and it is associated with systemic cardiovascular adaptation. The pulse wave is an important basis for evaluating the status of the human cardiovascular system. This research aims to evaluate the application value of pulse waves in the diagnosis of hypertensive disorder in pregnancy.This research a retrospective study of pregnant women who attended prenatal care and labored at Beijing Haidian District Maternal and Child Health Hospital. We extracted maternal hemodynamic factors and measured the pulse wave of the pregnant women. We developed an HDP predictive model by using support vector machine algorithms at five-gestational-week stages.At five-gestational-week stages, the area under the receiver operating characteristic curve (AUC) of the predictive model with pulse wave parameters was higher than that of the predictive model with hemodynamic factors. The AUC values of the predictive model with pulse wave parameters were 0.77 (95% CI 0.64 to 0.9), 0.83 (95% CI 0.77 to 0.9), 0.85 (95% CI 0.81 to 0.9), 0.93 (95% CI 0.9 to 0.96) and 0.88 (95% CI 0.8 to 0.95) at five-gestational-week stages, respectively. Compared to the predictive models with hemodynamic factors, the predictive model with pulse wave parameters had better prediction effects on HDP.Pulse waves had good predictive effects for HDP and provided appropriate guidance and a basis for non-invasive detection of HDP.
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Affiliation(s)
- Xinyu Zhang
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China
| | - Yu Meng
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China
| | - Mei Jiang
- College of Intelligence and Information Engineering, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Lin Yang
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China
| | - Kuixing Zhang
- College of Intelligence and Information Engineering, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Cuiting Lian
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China
| | - Ziwei Li
- Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing 100124, China
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Al Bahhawi T, Aqeeli A, Harrison SL, Lane DA, Skjøth F, Buchan I, Sharp A, Auger N, Lip GYH. Pregnancy-Related Complications and Incidence of Atrial Fibrillation: A Systematic Review. J Clin Med 2023; 12:jcm12041316. [PMID: 36835851 PMCID: PMC9959873 DOI: 10.3390/jcm12041316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Pregnancy-related complications are associated with a higher risk of various incident cardiovascular diseases, but their specific potential relationship with incident atrial fibrillation (AF) is less clear. This systematic review summarises the available evidence from observational studies which have examined associations between pregnancy-related complications and the risk of AF. MEDLINE and EMBASE (Ovid) were searched for studies between 1990 to 10 February 2022. Pregnancy-related complications examined included hypertensive disorders of pregnancy (HDP), gestational diabetes, placental abruption, preterm birth, small-for-gestational-age and stillbirth. Study selection, data extraction and quality assessment were completed independently by two reviewers. Narrative synthesis was used to evaluate the results of the included studies. Nine observational studies were included, with eight eligible for narrative synthesis. Sample sizes ranged from 1839 to 2,359,386. Median follow-up ranged from 2 to 36 years. Six studies reported that pregnancy-related complications were associated with a significantly increased risk of incident AF. Hazard ratios (HRs) (95% confidence intervals) for the four studies that evaluated HDP ranged from 1.1 (0.8-1.6) to 1.9 (1.4-2.7). For the four studies that evaluated pre-eclampsia, HRs ranged from 1.2 (0.9-1.6) to 1.9 (1.7-2.2). Current evidence from observational studies suggests pregnancy-related complications are associated with a significantly higher risk of incident AF. However, only a small number of studies examining each pregnancy-related complication were identified, and considerable statistical heterogeneity was observed. Further large-scale prospective studies are required to confirm the association between pregnancy-related complications and incident AF.
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Affiliation(s)
- Tariq Al Bahhawi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Faculty of Medicine, Jazan University, Jazan 82817, Saudi Arabia
| | - Abdulwahab Aqeeli
- Faculty of Medicine, Jazan University, Jazan 82817, Saudi Arabia
- Joint Program of Preventive Medicine, Saudi Commission for Health Specialties, Jeddah 21589, Saudi Arabia
| | - Stephanie L. Harrison
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
| | - Flemming Skjøth
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9100 Aalborg, Denmark
| | - Iain Buchan
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Andrew Sharp
- Harris-Wellbeing Preterm Birth Research Centre, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, School of Public Health, University of Montreal, Montreal, QC H2X 0A9, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Faculty of Health, Aalborg University, DK-9100 Aalborg, Denmark
- Correspondence: ; Tel.: +44-(0)151-794-9020
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Badrov MB, Yoo JK, Hissen SL, Nelson DB, Shoemaker JK, Fu Q. Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension. Hypertension 2023; 80:291-301. [PMID: 36065805 PMCID: PMC9851937 DOI: 10.1161/hypertensionaha.122.19754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32-36 weeks), both at supine rest and during postural stress. METHODS Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology. RESULTS At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all P≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all P<0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all P<0.0001). In pregnancy, AP frequency is related directly to systolic (R2=46%) and diastolic (R2=20%) blood pressure (both P≤0.01). Unlike CTRL (both P<0.01), women who developed GH were unable to increase within-burst AP firing (P=0.71) or recruit latent subpopulations of larger-sized APs (P=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all P<0.05). CONCLUSIONS Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.
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Affiliation(s)
- Mark B. Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Medicine, Toronto General Health Research Institute, University Health Network, Toronto, ON, Canada
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah L. Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B. Nelson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J. Kevin Shoemaker
- School of Kinesiology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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91
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Yuan Z, Li Q, Su T, Yang J, Chen J, Peng Y, Zhou S, Bao H, Luo S, Wang H, Liu J, Han N, Guo Y, Ji Y, Wang HJ. Effects of fine ambient particulate matters on de novo hypertensive disorders of pregnancy and blood pressure before 20 weeks. ENVIRONMENTAL RESEARCH 2023; 218:115023. [PMID: 36502896 DOI: 10.1016/j.envres.2022.115023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/13/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The effects of fine particulate matter (PM) on de novo hypertensive disorders of pregnancy (HDP) were inconsistent during the first and second trimesters. This study aimed to assess the trimester-specific effects of PM2.5 and PM1 prior to diagnosis of de novo HDP. The exposure of fine PM was predicted by satellite remote sensing data according to maternal residential addresses. De novo HDP was defined as gestational hypertension and preeclampsia during the current pregnancy. A logistic regression model was performed to assess the association of PM2.5 and PM1 with HDP during the first and early second trimesters (0-13 weeks and 14-20 weeks). The generalized estimating equation model was conducted to assess the effect of PM2.5 and PM1 on blood pressure. The present study included 22,821 pregnant women (mean age, 29.1 years) from 2013 to 2017. PM2.5 and PM1 were significantly associated with an increased risk of de novo HDP during the first trimester (OR = 1.070, 95% CI: 1.013-1.130; OR = 1.264, 95% CI: 1.058-1.511 for per 10 μg/m3) and early second trimester (OR = 1.045, 95% CI: 1.003-1.088; OR = 1.170, 95% CI: 1.002-1.366 for per 10 μg/m3). Significant trends of increased de novo HDP risk was also observed with the increment of PM (all P for trend <0.05). The stratified analyses demonstrated that the associations between exposure to fine PM and the risk of HDP were more pronounced among the pregnant women with maternal age above 35 and low maternal education level (all OR >1.047). Each 10 μg/m3 increase of PM1 and PM2.5 before diagnosis of de novo HDP elevated 0.204 (95% CI: 0.098-0.310) and 0.058 (95%CI: 0.033-0.083) mmHg of systolic blood pressure. Exposure to PM2.5 and PM1 during the first and early second trimester were positively associated with the risk of de novo HDP. The fine PM before diagnosis of de novo HDP elevated the systolic blood pressure.
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Affiliation(s)
- Zhichao Yuan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Qin Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Tao Su
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, 101101, China
| | - Jie Yang
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, 101101, China
| | - Junjun Chen
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China; Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, United States
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Heling Bao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Na Han
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, 101101, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China.
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China; National Health Commission Key Laboratory of Reproductive Health, Beijing, 100191, China.
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Giorgione V, Jansen G, Kitt J, Ghossein-Doha C, Leeson P, Thilaganathan B. Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia. Hypertension 2023; 80:231-241. [PMID: 35904012 DOI: 10.1161/hypertensionaha.122.18730] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is widespread acceptance of the increased prevalence of cardiovascular diseases occurring within 1 to 2 decades in women following a preeclamptic pregnancy. More recent evidence suggests that the deranged biochemical and echocardiographic findings in women do not resolve in the majority of preeclamptic women following giving birth. Many women continue to be hypertensive in the immediate postnatal period with some exhibiting occult signs of cardiac dysfunction. There is now promising evidence that with close monitoring and effective control of blood pressure control in the immediate postnatal period, women may have persistently lower blood pressures many years after stopping their medication. This review highlights the evidence that delivering effective medical care in the fourth trimester of pregnancy can improve the long-term cardiovascular health after a preeclamptic birth.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
| | - Gwyneth Jansen
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands (G.J.)
| | - Jamie Kitt
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Chahinda Ghossein-Doha
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht' the Netherlands (C.G.-D.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
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Ogushi S, Nakanishi T, Kimura T. Cadmium inhibits differentiation of human trophoblast stem cells into extravillous trophoblasts and disrupts epigenetic changes within the promoter region of the HLA-G gene. Toxicol Sci 2023; 191:25-33. [PMID: 36370079 DOI: 10.1093/toxsci/kfac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cadmium (Cd) is a toxic heavy metal widely distributed in the environment. Maternal whole-blood Cd levels during pregnancy are positively associated with the risk of early preterm birth. We hypothesized that Cd inhibits trophoblast differentiation, resulting in the development of hypertensive disorders of pregnancy and a high risk of early preterm birth. Using the CT27 human trophoblast stem cell line, we found that exposing these cells to 0.1-0.4 µM Cd inhibited their differentiation into extravillous cytotrophoblasts (EVTs). Supporting this finding, we found that expression of the metal-binding protein metallothionein, which suppresses the toxicity of Cd, is low in EVTs. We also found that Cd exposure changes the methylation status of the promoter region of the HLA-G gene, which is specifically expressed in EVTs. Together, these results suggest that Cd inhibits placental formation by suppressing trophoblast differentiation into EVTs. This suppression may underlie the increased risk of gestational hypertension in women with high whole-blood Cd levels.
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Affiliation(s)
- Shoko Ogushi
- Department of Life Science, Faculty of Science and Engineering, Setsunan University, Neyagawa, Osaka 572-8508, Japan
| | - Tsuyoshi Nakanishi
- Laboratory of Hygienic Chemistry and Molecular Toxicology, Gifu Pharmaceutical University, Gifu, Gifu 501-1196, Japan
| | - Tomoki Kimura
- Department of Life Science, Faculty of Science and Engineering, Setsunan University, Neyagawa, Osaka 572-8508, Japan
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94
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Dines V, Suvakov S, Kattah A, Vermunt J, Narang K, Jayachandran M, Abou Hassan C, Norby AM, Garovic VD. Preeclampsia and the Kidney: Pathophysiology and Clinical Implications. Compr Physiol 2023; 13:4231-4267. [PMID: 36715282 DOI: 10.1002/cphy.c210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Preeclampsia and other hypertensive disorders of pregnancy are major contributors to maternal morbidity and mortality worldwide. This group of disorders includes chronic hypertension, gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and eclampsia. The body undergoes important physiological changes during pregnancy to allow for normal placental and fetal development. Several mechanisms have been proposed that may lead to preeclampsia, including abnormal placentation and placental hypoxia, impaired angiogenesis, excessive pro-inflammatory response, immune system imbalance, abnormalities of cellular senescence, alterations in regulation and activity of angiotensin II, and oxidative stress, ultimately resulting in upregulation of multiple mediators of endothelial cell dysfunction leading to maternal disease. The clinical implications of preeclampsia are significant as there are important short-term and long-term health consequences for those affected. Preeclampsia leads to increased risk of preterm delivery and increased morbidity and mortality of both the developing fetus and mother. Preeclampsia also commonly leads to acute kidney injury, and women who experience preeclampsia or another hypertensive disorder of pregnancy are at increased lifetime risk of chronic kidney disease and cardiovascular disease. An understanding of normal pregnancy physiology and the pathophysiology of preeclampsia is essential to develop novel treatment approaches and manage patients with preeclampsia and hypertensive disorders of pregnancy. © 2023 American Physiological Society. Compr Physiol 13:4231-4267, 2023.
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Affiliation(s)
- Virginia Dines
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Sonja Suvakov
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane Vermunt
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Kavita Narang
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Coline Abou Hassan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander M Norby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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95
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Yuan Z, Wang HJ, Li Q, Su T, Yang J, Chen J, Peng Y, Zhou S, Bao H, Luo S, Wang H, Liu J, Han N, Guo Y, Ji Y. Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study. JMIR Public Health Surveill 2023; 9:e41442. [PMID: 36689262 PMCID: PMC9903185 DOI: 10.2196/41442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). OBJECTIVE We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. METHODS Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure-reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. RESULTS A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 μg/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. CONCLUSIONS Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs.
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Affiliation(s)
- Zhichao Yuan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Qin Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Tao Su
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Jie Yang
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Junjun Chen
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Heling Bao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Na Han
- Tongzhou Maternal and Child Health Care Hospital of Beijing, Beijing, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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96
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Pan Y, Zou S, Xu Y, Di R, Gu H, Wang Z, Wei X, Yang C, Zhang G. Is there any association between early trimester Triglyceride-glucose index and incidence of hypertensive disorder of pregnancy and adverse pregnancy outcomes? Front Endocrinol (Lausanne) 2023; 14:1093991. [PMID: 36950677 PMCID: PMC10025371 DOI: 10.3389/fendo.2023.1093991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) is a normal feature of pregnancy and plays a crucial role in the pathophysiology of hypertensive disorder of pregnancy (HDP). The triglyceride-glucose index (TyG index) has been shown as a simple and reliable alternative IR marker. This work aimed to investigate the association between the TyG index and the incidence of HDP and adverse pregnancy outcomes. METHODS From January 2016 to December 2018, 289 women with HDP and 861 women without HDP were recruited at Shanghai Fifth People's Hospital, Fudan University to determine the relationship between the TyG index and the incidence of HDP and adverse pregnancy outcomes. RESULTS In the case-control study, the incidence of HDP was found to be significantly associated with the TyG index. Moreover, logistic regression indicated that the TyG index is an independent risk factor for HDP development and incidence of low birth weight (LBW) and fetal distress. In the cohort study, the results showed that the TyG index increased, there was a stepwise increase in HDP incidence, SBP, and DBP levels one week before delivery as well as in LBW and fetal distress incidence. The early trimester TyG index was positively associated with pre-pregnancy BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) one week before delivery. Spline regression showed that there was a significant linear association between HDP incidence and early trimester TyG index when it was >8.5. CONCLUSIONS This work suggested that the early trimester TyG index was closely associated with the development of HDP and adverse pregnancy outcomes.
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97
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Lin PID, Cardenas A, Rifas-Shiman SL, Zota AR, Hivert MF, Aris IM, Sanders AP. Non-essential and essential trace element mixtures and kidney function in early pregnancy - A cross-sectional analysis in project viva. ENVIRONMENTAL RESEARCH 2023; 216:114846. [PMID: 36402181 PMCID: PMC9732973 DOI: 10.1016/j.envres.2022.114846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Some trace elements are established nephrotoxicants, yet their associations with kidney function remain understudied in the context of pregnancy, a time of substantial change in kidney physiology and function. We aimed to estimate the individual and joint associations of trace element mixtures with maternal kidney function during the 1st trimester of pregnancy (mean 9.7 gestational weeks). 1040 women from Project Viva contributed blood samples which were assessed for erythrocyte non-essential [arsenic (As), cadmium (Cd), cesium (Cs), mercury (Hg), lead (Pb)] and essential [barium (Ba), magnesium (Mg), manganese (Mn), selenium (Se), and Zinc (Zn)] trace elements, and plasma creatinine for kidney function. We estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration (eGFRCKD-EPI) equation without race-adjustment factors. We examined associations of eGFRCKD-EPI with individual trace elements using multivariable linear regression and their mixtures using quantile-based g-computation, adjusting for sociodemographics, pregnancy characteristics, and diet. Participants in our study were predominantly White (75%), college graduates (72%), and had household income >$70,000/year (63%). After adjusting for covariates, higher Pb (β -3.51 ml/min/1.73 m2; 95% CI -5.83, -1.18) concentrations were associated with lower eGFRCKD-EPI, while higher Mg (β 10.53 ml/min/1.73 m2; 95% CI 5.35, 15.71), Se (β 5.56 ml/min/1.73 m2; 95% CI 0.82, 10.31), and Zn (β 5.88 ml/min/1.73 m2; 95% CI 0.51, 11.26) concentrations were associated with higher eGFRCKD-EPI. In mixture analyses, higher non-essential trace elements mixture concentration was associated with reduced eGFRCKD-EPI (Ψ -1.03 ml/min/1.73 m2; 95% CI: 1.92, -0.14). Conversely, higher essential trace elements mixture concentration was associated with higher eGFR (Ψ 1.42; 95% CI: 0.48, 2.37). Exposure to trace elements in early pregnancy may influence women's kidney function although reverse causation cannot be eliminated in this cross-sectional analysis. These findings have important implications for long-term cardiovascular and postpartum kidney health that warrant additional studies.
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Affiliation(s)
- Pi-I D Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Andres Cardenas
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Ami R Zota
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Alison P Sanders
- Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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98
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Yang Y, Xie Y, Li M, Mu Y, Chen P, Liu Z, Wang Y, Li Q, Li X, Dai L, Liang J, Zhu J. Characteristics and fetal outcomes of pregnant women with hypertensive disorders in China: a 9-year national hospital-based cohort study. BMC Pregnancy Childbirth 2022; 22:924. [PMID: 36482386 PMCID: PMC9733350 DOI: 10.1186/s12884-022-05260-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are a growing concern and a challenge for maternity care providers as the prevalence of hypertension continues to increase. However, optimal management of HDP is unclear. Therefore, we aimed to explore the differences in adverse fetal outcomes among women with different subtypes of HDP and different blood pressure (BP) levels, to provide evidence-based management of HDP. METHODS We obtained data from China's National Maternal Near-Miss Surveillance System from 2012 to 2020. Associations between BP management and adverse fetal outcomes, stratified by the four subtypes of HDP, were assessed using logistic regression analysis with a robust variance estimator. RESULTS For the period, a total of 393,353 pregnant women with HDP were included in the study; 8.51% had chronic hypertension, 2.27% had superimposed preeclampsia, 50.17% had preeclampsia or eclampsia, and 39.04% had gestational hypertension. The BP levels at delivery admission were mostly (61.14%) of non-severe stage 2 (systolic BP 140-159 mm Hg and/or diastolic BP 90-109 mm Hg) hypertension by American Heart Association classification. A high rate of adverse fetal outcomes was observed among women with HDP, especially among those aged < 20 or > 35 y or those diagnosed with superimposed preeclampsia. Compared with those with normal BP levels at delivery admission, we found an upward curve with increased risk among pregnant women with more severe BP levels, including the risk of preterm birth and small for gestational age (SGA) fetus. The odds ratios (ORs) of stillbirth, neonatal death, and low Apgar scores associated with severe stage 2 hypertension increased significantly. In addition, the association between BP at admission and fetal outcomes differed among women with varying HDP subtypes. Pregnant women with preeclampsia or eclampsia had an increased risk for preterm birth (adjusted OR [aOR], 1.33 [95% confidence interval {CI}, 1.07 ~ 1.65]) and SGA (aOR, 1.37 [95% CI, 1.10 ~ 1.71]) even when the admission BP was at stage 1 level. CONCLUSION Greater attention should be paid to cases involving preeclampsia superimposed on chronic hypertension and pregnant women aged < 20 or > 35 y to mitigate the burden of adverse fetal outcomes caused by HDP.
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Affiliation(s)
- Yi Yang
- grid.13291.380000 0001 0807 1581Department of obstetrics and gynecology intensive care unit Nursing, West China Second University Hospital, West China School of Nursing, Sichuan University, Ren Min South Road Section 3 No.17, Sichuan Chengdu, China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Ren Min South Road Section 3 No.17, Sichuan Chengdu, China
| | - Yanxia Xie
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Mingrong Li
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Yi Mu
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Peiran Chen
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Zheng Liu
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Yanping Wang
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China ,grid.461863.e0000 0004 1757 9397Department of Pediatric, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China, Sichuan Chengdu, China
| | - Qi Li
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Xiaohong Li
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Li Dai
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China ,grid.13291.380000 0001 0807 1581Medical Big Data Center, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China, Sichuan Chengdu, China
| | - Juan Liang
- grid.419897.a0000 0004 0369 313XKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Ren Min South Road Section 3 No.17, Sichuan Chengdu, China ,grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China
| | - Jun Zhu
- grid.461863.e0000 0004 1757 9397National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu Sichuan, China ,grid.461863.e0000 0004 1757 9397Department of Obstetrics, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China, Sichuan Chengdu, China
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99
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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100
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Yang L, Chen H, Li F, Liao J, Lin X. The Sonographic Features of Malformation in Fetal Echogenic Bowel and Its Relationship With Chromosome Abnormalities. Ultrasound Q 2022; 38:284-290. [PMID: 35420062 DOI: 10.1097/ruq.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The aims of this study were to analyze the sonographic features and clinical prognosis of fetal echogenic bowel (FEB) and to evaluate the value of FEB in the prediction of fetal chromosomal abnormalities. Eight hundred eighty-two fetuses with FEB were selected. The ultrasonographic features and the chromosomal examination were retrospectively analyzed. Among the 882 FEB, 272 (30.8%) cases had malformation. The most common malformation was cardiovascular malformation (21.6%), followed by urinary malformation (9.0%), craniocerebral malformation (6.8%), and gastrointestinal malformations (5.6%). According to other combined ultrasound abnormalities, the FEBs were divided into 4 groups: isolated FEB group (490 cases), ultrasound soft indicators group (130 cases), single malformation group (117 cases), and multiple malformation group (145 cases). A total of 45 cases (5.1%) were detected with chromosomal abnormalities. Compared with isolated FEB group, the rate of chromosomal abnormality in other 3 groups was significantly higher. Among 490 cases of isolated FEB, 114 cases of isolated FEB group with adverse pregnancy outcomes were selected as the experimental group, and 376 cases of FEB group with good prognosis were selected as the control group. There were significant differences of the location, shape, intensity, and progression between the 2 groups. Multivariate logistic regression analysis showed that central location and progression of FEB were independent risk predictors of poor prognosis. The combined malformation rate is high for FEB fetuses. The fetal systems should be carefully examined when FEB is found in prenatal ultrasound.
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Affiliation(s)
| | | | | | | | - Xiangbo Lin
- Obstetrics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou City, China
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