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Camargos LFD, Lemos PL, Martins EF, Felisbino-Mendes MS. Avaliação da qualidade dos registros de cartões de pré-natal de mulheres urbanas. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar registros dos cartões de pré-natal de puérperas atendidas em maternidades públicas e privadas. Método Estudo transversal que analisou fotos de 394 cartões de pré-natal de mulheres que participaram da pesquisa Nascer em Belo Horizonte. Os registros foram avaliados quanto ao preenchimento, legibilidade e completude das informações sociodemográficas, clínicas, obstétricas e exames laboratoriais. Resultados Evidenciou-se que 88,5% dos cartões não apresentaram registro do nome da unidade básica de referência, 76,9%, da maternidade de referência e 82,4%, da instituição de realização do pré-natal. A avaliação do edema, o uso de sulfato ferroso e ácido fólico não foram registrados em 55%, 91,1% e 92,6% dos cartões, respectivamente. A ausência de registros no gráfico de peso foi identificada em 86,8% dos cartões, e no de altura uterina, 79,7%. Conclusão e implicações para a prática Existem grandes lacunas no registro do processo de cuidado pré-natal nos cartões e cadernetas, o que pode comprometer a qualidade da assistência e o acompanhamento das gestantes. Os achados apontam para a necessidade da educação permanente em serviço direcionada aos profissionais de saúde, como os enfermeiros, quanto à importância da realização e registro das ações preconizadas no cuidado pré-natal.
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Abdallah A, Khairy M, Tawfik M, Mohamed S, Abdel-Rasheed M, Salem S, Khalifa E. Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia. Int J Gynaecol Obstet 2020; 154:466-473. [PMID: 33368264 DOI: 10.1002/ijgo.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the efficacy of first-trimester three-dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre-eclampsia. METHODS The prospective cohort study included over 2019 women with a singleton pregnancy in their first trimester at 11-13+ weeks of pregnancy. All women were examined by 3D abdominal ultrasound, including Doppler techniques for the placental volume and placental vascular indices. Uterine artery Doppler indices were also assessed. All participants were cared for until delivery for assessment of pregnancy outcomes. RESULTS In all, 163 women developed pre-eclampsia while 1856 women remained normotensive. The women with pre-eclampsia had significantly lower placental volume (77.09 ml vs. 99.8 ml, p < 0.001), and placental vascular indices (vascularization index, flow index, and vascularization flow index were 7.41 vs. 9.89, 39.03 vs. 46.63, and 2.77 vs. 4.4, respectively, p < 0.001). In contrast, women with pre-eclampsia had significantly high mean uterine pulsatility index and resistance index (2.02 vs. 1.11, 0.83 vs. 0.64, respectively, p < 0.001) compared with the normotensive women. The placental vascular indices were highly sensitive, whereas the placental volume and the mean uterine pulsatility index and resistance index had higher specificity for the prediction of pre-eclampsia. CONCLUSION First-trimester assessment through 3D placental volume and power Doppler of placental vascular indices, especially in combination with uterine artery Doppler assessment, revealed an increase in the accuracy of early detection of women at risk for developing pre-eclampsia.
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Affiliation(s)
- Ameer Abdallah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohammed Khairy
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohamed Tawfik
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Safaa Mohamed
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mazen Abdel-Rasheed
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Sondos Salem
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Eissa Khalifa
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
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I/D Polymorphism Gene ACE and Risk of Preeclampsia in Women with Gestational Diabetes Mellitus. DISEASE MARKERS 2020; 2020:8875230. [PMID: 33456632 PMCID: PMC7785338 DOI: 10.1155/2020/8875230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022]
Abstract
Preeclampsia (PE) and gestational diabetes mellitus (GDM) are the most common complications of pregnancy, which result in adverse outcomes for the mother and the fetus. GDM is regarded as a separate independent risk factor for PE development, as evidenced by a higher preeclampsia rate in gestational diabetes mellitus than in the general population. The role the endothelial cell dysfunction plays is considered to be the most reasonable one in the origin of these diseases. The activity of plasma and tissue angiotensin converting enzyme (ACE) is believed to be genetically controlled. The available data suggests that increased ACE activity due to deletion (D)/insertion (I) in the 16th intron of ACE gene, which is called ACE gene I/D polymorphism, is associated with preeclampsia and varies depending on the studied population and the geography. We did not find any literature data that estimates the influence of ACE gene I/D polymorphism on PE rate in pregnant women with GDM. Therefore, the present study aimed to investigate a relationship between ACE gene I/D polymorphism and preeclampsia development in the case of GDM in the Russian population. The study used the genomic DNA derived by phenol-chloroform extraction method from venous blood samples in 137 pregnant women, including samples of 74 women with GDM accompanied with PE and the blood samples of 63 women with GDM w/o preeclampsia. Genotyping of insertion/deletion in the I/D region (16 intron of АСЕ gene) was conducted by real-time PCR using the TaqMan competing probe technology. The particular features in the frequency array of alleles and genotypes of the ACE gen I/D polymorphism under review, as associated with preeclampsia development risk in pregnant women with GDM, were identified. The acquired data testify to the need to further study of ACE gene I/D region polymorphism association in a large patient sample taking into account the PE and GDM risk factors estimated in the clinical practice.
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Veisian M, Javaheri A, Amjadi N, Tabatabaei RS, Zanbagh L, Hadadan A, Abbasi H, Salimi E, Dastgheib SA, Neamatzadeh H. Association of IL-6 -176G > C Polymorphism with Susceptibility to Preeclampsia: A Systematic Review and Meta-Analysis. Fetal Pediatr Pathol 2020; 39:491-502. [PMID: 31738646 DOI: 10.1080/15513815.2019.1675110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Many studies have described the influence of -176G > C polymorphism of the IL-6 gene on susceptibility to preeclampsia. However, the results have remained inconclusive and controversial. Therefore, we performed a meta-analysis to more precisely determine the association between the IL-6 -176G > C polymorphism and preeclampsia risk. Methods: Electronic databases including PubMed, Embase, Web of Science, and CNKI were searched up to August 15, 2019. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were used to calculate the association. Results: A total of 12 studies with 1,821 preeclampsia cases and 3,339 controls were selected. Overall, no significant association was found between IL-6 -176G > C polymorphism and preeclampsia risk. In the stratified analyses by ethnicity, there was a significant association in Asians, but not in Caucasians and mixed populations. Conclusions: The results of meta-analysis indicated that IL-6 -176G > C polymorphism was not significantly associated with risk of preeclampsia in overall population.
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Affiliation(s)
- Mehrnaz Veisian
- Department of Gynecology and Obstetrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atiyeh Javaheri
- Department of Gynecology and Obstetrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nooshin Amjadi
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Razieh Sadat Tabatabaei
- Department of Gynecology and Obstetrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Leila Zanbagh
- Department of Gynecology and Obstetrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Gynecology and Obstetrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amaneh Hadadan
- Department of Gynecology and Obstetrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hajar Abbasi
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfaneh Salimi
- Department of Gynecology and Obstetrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Dastgheib
- Department of Medical Genetics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Comprehensive Analysis of Differently Expressed and Methylated Genes in Preeclampsia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:2139270. [PMID: 33204297 PMCID: PMC7652635 DOI: 10.1155/2020/2139270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
Preeclampsia (PE) is one of the mainly caused maternal and infant incidences and mortalities worldwide. However, the mechanisms underlying PE remained largely unclear. The present study identified 1716 high expressions of gene and 2705 low expressions of gene using GSE60438 database, and identified 7087 hypermethylated and 15120 hypomethylated genes in preeclampsia using GSE100197. Finally, 536 upregulated genes with hypomethylation and 322 downregulated genes with hypermethylation were for the first time revealed in PE. Gene Ontology (GO) analysis revealed that these genes were associated with peptidyl-tyrosine phosphorylation, skeletal system development, leukocyte migration, transcription regulation, T cell receptor and IFN-γ-involved pathways, innate immune response, signal transduction, cell adhesion, angiogenesis, and hemopoiesis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis demonstrated that aberrantly methylated differentially expressed genes were involved in regulating adherens junction, pluripotency of stem cell regulation, immune processing, T cell receptor and NF-κB pathways, HTLV-I and HSV infections, leishmaniasis, and NK-induced cytotoxicity. Protein-protein interaction (PPI) network analysis identified several hub networks and key genes, including MAPK8, CCNF, CDC23, ABL1, NF1, UBE2E3, CD44, and PIK3R1. We hope these findings will draw more attention to these hub genes in future PE studies.
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Li X, Yang R, Xu Y, Zhang Y. Circ_0001438 participates in the pathogenesis of preeclampsia via the circ_0001438/miR-942/NLRP3 regulatory network. Placenta 2020; 104:40-50. [PMID: 33253995 DOI: 10.1016/j.placenta.2020.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Preeclampsia (PE) is a common pregnancy disorder with multisystem complications. The growing data suggest that circular RNAs (circRNAs) involve in the development of PE. This study proposed to investigate the function and potential mechanisms of circ_0001438 in PE. METHODS The expression of circ_0001438, miR-942 and NOD-like receptor pyrin domain-containing protein 3 (NLRP3) was measured by quantitative real-time polymerase chain reaction (qRT-PCR). The expression at the protein level of NLRP3, interleukin 1 beta (IL-1β), interleukin 10 (IL-10), B-cell lymphoma 2 (Bcl-2), Cleaved-caspase-3 (Cleaved-casp-3), N-cadherin and E-cadherin was detected by Western blot. Cell proliferation was assessed by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation assay. Cell apoptosis was determined by flow cytometry assay. Cell migration and invasion were monitored by transwell assay. The target genes were obtained and verified by the online bioinformatics tool and dual-luciferase reporter assay. RESULTS The expression of circ_0001438 and NLRP3 was enhanced in PE placenta tissues. Circ_0001438 knockdown promoted cell proliferation, migration and invasion but inhibited apoptosis and inflammatory responses in HTR-8/Svneo cells, and these effects were reversed by the inhibition of miR-942, a target of circ_0001438. Moreover, NLRP3 was bounded by miR-942. The enrichment of miR-942 accelerated cell proliferation, migration and invasion but depleted apoptosis and inflammatory responses, while these impacts were partly abolished by NLRP3 overexpression. DISCUSSION Circ_0001438 sponged miR-942 to regulate the expression of NLRP3, and circ_0001438 aggravated the dysfunctions of human villous trophoblasts by mediating the miR-942/NLRP3 axis at least in part.
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Affiliation(s)
- Xiaoping Li
- Department of Obstetrics, Jinan Maternal and Child Health Hospital, Shandong, China
| | - Rui Yang
- Department of Outpatient, Jinan Maternal and Child Health Hospital, Shandong, China
| | - Ying Xu
- Department of Prenatal Diagnosis, Jinan Maternal and Child Health Hospital, Shandong, China
| | - Yongshui Zhang
- Department of Medicine, Jinan Maternal and Child Health Hospital, Shandong, China.
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Johnson AC, Li Z, Orfila JE, Herson PS, Cipolla MJ. Hippocampal network dysfunction as a mechanism of early-onset dementia after preeclampsia and eclampsia. Prog Neurobiol 2020; 199:101938. [PMID: 33130230 DOI: 10.1016/j.pneurobio.2020.101938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy that can involve dangerous neurological symptoms such as spontaneous seizures (eclampsia). Despite being diseases specific to the pregnant state, preeclampsia and eclampsia have long-lasting neurological consequences later in life, including changes in brain structure and cognitive decline at relatively young ages. However, the effects of preeclampsia on brain regions central to memory and cognition, such as the hippocampus, are unclear. Here, we present a case reporting the progressive and permanent cognitive decline in a woman that had eclamptic seizures in the absence of evidence of brain injury on MRI. We then use rat models of normal pregnancy and preeclampsia to investigate mechanisms by which eclampsia-like seizures may disrupt hippocampal function. We show that experimental preeclampsia causes delayed memory decline in rats and disruption of hippocampal neuroplasticity. Further, seizures in pregnancy and preeclampsia caused acute memory dysfunction and impaired neuroplasticity but did not cause acute neuronal cell death. Importantly, hippocampal dysfunction persisted 5 weeks postpartum, suggesting seizure-induced injury is long lasting and may be permanent. Our data provide the first evidence of a model of preeclampsia that may mimic the cognitive decline of formerly preeclamptic women, and that preeclampsia and eclampsia affect hippocampal network plasticity and impair memory.
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Affiliation(s)
- Abbie C Johnson
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
| | - Zhaojin Li
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
| | - James E Orfila
- Dept. of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Paco S Herson
- Dept. of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA; Dept. of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Marilyn J Cipolla
- Dept. of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA; Dept. of Pharmacology, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA; Dept. of Ob/Gyn & Repro Sciences, University of Vermont Larner College of Medicine, Burlington, VT, 05405, USA.
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Garti I, Gray M, Tan JY, Bromley A. Midwives' knowledge of pre-eclampsia management: A scoping review. Women Birth 2020; 34:87-104. [PMID: 32928690 DOI: 10.1016/j.wombi.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries. AIM To identify what midwives' around the world know about pre-eclampsia management. METHODS A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes. FINDINGS Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia. CONCLUSION Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.
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Affiliation(s)
- Isabella Garti
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Angela Bromley
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders. J Pregnancy 2020; 2020:7864816. [PMID: 32802511 PMCID: PMC7416270 DOI: 10.1155/2020/7864816] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.
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60
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Ngene NC, Moodley J. Pre-eclampsia with severe features: management of antihypertensive therapy in the postpartum period. Pan Afr Med J 2020; 36:216. [PMID: 32963682 PMCID: PMC7490136 DOI: 10.11604/pamj.2020.36.216.19895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/21/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction there is variance in both the types and combinations of antihypertensive drugs used for managing pre-eclampsia in the postpartum period. Knowledge of the most common and suitable single or combination antihypertensive drug therapies in the postpartum period will minimize harmful effects, promote adherence to medications, overcome any fears that lactating mothers may have about these drugs and will assist in healthcare planning. Objective: to determine the types of antihypertensive drug therapies used in managing pre-eclampsia with severe features (sPE) in the postpartum period in a regional hospital in South Africa. Methods fifty consecutively presenting pregnant women with sPE were followed up prospectively from the pre-delivery period (within 48 hours before delivery) until day 3 postpartum. The antihypertensive drug therapies administered to the participants were observed. Their blood pressures were measured daily at 04: 00, 08: 00, 14: 00 and 22: 00 hours. Results nifedipine was the commonest rapid-acting agent used for severe hypertension. Prepartum, 9 different combinations of antihypertensive drugs were prescribed; alpha-methyldopa was the commonest single long-acting agent used. Postpartum, the number of different drug combinations administered were 15, 18, 22 and 16 on days 0, 1, 2 and 3 respectively. Alpha-methyldopa was the commonest single agent used on postpartum days 0 - 2 while hydrochlorothiazide was the most frequently used single agent on postpartum day 3. Postpartum, the commonest combination therapy was alpha-methyldopa and amlodipine on day 0; alpha-methyldopa and amlodipine as a regimen as well as alpha-methyldopa, amlodipine and hydrochlorothiazide as another regimen on day 1; alpha-methyldopa and amlodipine on day 2; and many amlodipine-based regimens on day 3. Conclusion a variety of antihypertensive drug combinations were used in the postpartum period indicating the need for standardised guidelines; however, detailed studies are required to evaluate their efficacies completely.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa.,Department of Obstetrics and Gynaecology, Klerksdorp Hospital, North West Province, Klerksdorp, South Africa.,Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
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Skarżyńska E, Wilczyńska P, Kiersztyn B, Żytyńska-Daniluk J, Jakimiuk A, Lisowska-Myjak B. Comparison of protease and aminopeptidase activities in meconium: A pilot study. Biomed Rep 2020; 13:7. [PMID: 32607236 DOI: 10.3892/br.2020.1314] [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: 09/21/2019] [Accepted: 04/21/2020] [Indexed: 11/06/2022] Open
Abstract
The successive accumulation of proteases and aminopeptidases in meconium are important physiological components of the intrauterine environment in which a fetus develops. The aim of the present study was to assess the changes in the activities of these enzymes in meconium of healthy infants, and to investigate whether there were any statistically significant associations between activity of the enzymes of interest and the mode of delivery. The activities of proteases and aminopeptidases were determined in meconium portions (n=110) using the substrates BODIPY FL casein and L-leucine-7-amido-4-methylcoumarin hydrochloride, respectively. Serial meconium samples (2-5 per neonate) were collected from healthy infants born vaginally (n=14), and by a cesarean section (n=16). Protease activity (104 RFU/h) was lower in the first meconium sample compared with the final sample from the same infant (3.99±2.03 vs. 5.76±2.24, respectively, mean ± standard deviation; P=0.004). Conversely, there was no significant difference in aminopeptidase activity (103 nM/l/h) between consecutive meconium samples (P=0.702). The ratios of the first-meconium sample enzyme activity to the last-meconium sample enzyme activity were lower for proteases compared with aminopeptidases (0.76±0.48 vs. 1.35±1.04, respectively mean ± standard deviation; P=0.014), and sustained in the infants born by a cesarean section (P=0.008). Spearman's correlation coefficient analysis between the first and last meconium samples showed the correlation increased in the infants born vaginally compared with the rest of the infants (proteases, R=0.618 vs. R=0.314; aminopeptidases, R=0.688 vs. R=0.566). Aminopeptidase activity did not exhibit any notable dynamic changes during meconium accumulation in the fetal intestine. In infants born vaginally compared with those born by a cesarean section, the activity of both proteases and aminopeptidases in the first meconium sample showed an improved correlation with the activity of the final meconium sample. This may suggest that in the intrauterine environment, during accumulation of meconium in the digestive tract of the fetus, the activity and/or levels of these enzymes and the substrates they catalyze were more stable in newborns born vaginally compared with infants born by caesarean section.
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Affiliation(s)
- Ewa Skarżyńska
- Department of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw 02-097, Poland
| | - Paulina Wilczyńska
- Department of Biochemistry, Warsaw University of Life Sciences - SGGW, Warsaw 02-776, Poland
| | - Bartosz Kiersztyn
- Microbial Ecology and Environmental Biotechnology Department, Institute of Botany, Faculty of Biology, University of Warsaw; Biological and Chemical Research Centre, Warsaw 02-089, Poland
| | - Joanna Żytyńska-Daniluk
- Clinical Department of Obstetrics, Female Diseases and Gynaecological Oncology, Central Clinical Hospital of The Ministry of The Interior, Warsaw 02-507, Poland
| | - Artur Jakimiuk
- Reproductive Health Department, Institute of Mother and Child, Warsaw 01-211, Poland
| | - Barbara Lisowska-Myjak
- Department of Biochemistry and Clinical Chemistry, Medical University of Warsaw, Warsaw 02-097, Poland
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Ndwiga C, Odwe G, Pooja S, Ogutu O, Osoti A, E. Warren C. Clinical presentation and outcomes of pre-eclampsia and eclampsia at a national hospital, Kenya: A retrospective cohort study. PLoS One 2020; 15:e0233323. [PMID: 32502144 PMCID: PMC7274433 DOI: 10.1371/journal.pone.0233323] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy including pre-eclampsia are associated with maternal and newborn mortality and morbidity. Early detection is vital for effective treatment and management of pre-eclampsia. This study examines and compares the clinical presentation and outcomes between early- and late-onset pre-eclampsia over a two year period. METHODS A retrospective cohort study design which examines socio-demographic characteristics, treatment, outcomes, and fetal and maternal complications among women with early onset of pre-eclampsia (EO-PE) and late onset of pre-eclampsia (LO-PE). De-identified records of women who attended antenatal, intrapartum and postnatal care services and experienced pre-eclampsia at Kenyatta National teaching and referral hospital were reviewed. We used chi square, t-test, and calculated odds ratio to determine any significant differences between the EO-PE and LO-PE cohorts. RESULTS Out of 620 pre-eclamptic and eclamptic patients' records analyzed; 44 percent (n = 273) exhibited EO-PE, while 56 percent had late onset. Women with EO-PE compared to LO-PE had greater odds of adverse maternal and perinatal outcomes including hemolysis elevated liver enzymes and low platelets (HELLP) syndrome (OR: 4.3; CI 2.0-10.2; p<0.001), renal dysfunction (OR; 1.7; CI 0.7-4.1; p = 0.192), stillbirth (OR = 4.9; CI 3.1-8.1; p<0.001), and neonatal death (OR: 8.5; CI 3.8-21.3; p<0.001). EO-PE was also associated with higher odds of prolonged maternal hospitalization, beyond seven days (OR = 5.8; CI 3.9-8.4; p<0.001), and antepartum hemorrhage (OR = 5.8; CI 1.1-56.4; p<0.001). Neonates born after early onset of pre-eclampsia had increased odds of respiratory distress (OR = 17.0; CI 9.0-32.3, p<0.001) and birth asphyxia (OR: 1.9; CI 0.7-4.8; p = 0.142). CONCLUSIONS The profiles and outcomes of women with EO-PE (compared to late onset) suggest that seriousness of morbidity increases with earlier onset. To reduce adverse neonatal and maternal outcomes, it is critical to identify, manage, referral and closely follow-up pregnant women with pre-eclampsia throughout the pregnancy continuum. ETHICAL APPROVAL This study protocol was approved by Population Council's research ethics Institutional Review Board, Protocol 813, and KNH-UoN Ethics and Research Committee, Protocol 293/06/2017.
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Affiliation(s)
| | | | - Sripad Pooja
- Population Council, Washington, DC, United States of America
| | - Omondi Ogutu
- OBGyn Department, University of Nairobi, Nairobi, Kenya
| | - Alfred Osoti
- OBGyn Department, University of Nairobi, Nairobi, Kenya
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil
- Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil
- Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
- Hospital Barão de Lucena, Recife, PE – Brazil
- Hospital EMCOR, Recife, PE – Brazil
- Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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Abstract
OBJECTIVE Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6 weeks) versus full term (≥ 39 0 weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. METHODS This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering ≥ 37 weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. RESULTS Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. CONCLUSIONS FOR PRACTICE Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.
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Mhiri R, Mvogo A, Kamga A, Yassinguezo S, Fagla H, Dotou D, Kallel H. Epidemiology and maternal prognosis of hypertension disorders of pregnancy in French Guiana. Pregnancy Hypertens 2020; 20:96-101. [PMID: 32224440 DOI: 10.1016/j.preghy.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/18/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are responsible for high maternal mortality and morbidity worldwide. OBJECTIVE Our primary objective was to report the epidemiological and clinical features of HDP in Cayenne General Hospital. Our secondary objectives were to search for factors associated to preeclampsia (PE) and to severe PE in patients with HDP. METHODS Our study was observational and non-interventional. It was conducted over 4-month period (January to April 2019) in the Obstetrics and Gynaecology Unit of the Cayenne General Hospital. We included all pregnant women after 20 weeks of gestation (WG), who gave birth and who presented HDP and/or PE. RESULTS During the study period 1243 patients gave birth in our unit. Among them, 156 were diagnosed with HDP (12.6%). The median age was 33 years (IQR 28 - 38 years). The most frequent medical histories were diabetes (27.5%) and chronic hypertension (23.5%). The socioeconomic status was low in 31% of patients. Ninety-four patients (61.4%) developed PE with a severe form in 80.9% of cases. HELLP syndrome was diagnosed in 6.5% and nephropathy in 3.3% of cases. Delivery was by cesarean in 49.7% of cases. The median gestational age at delivery was 37 WG (IQR: 35-39). Multivariate analysis showed no independent factors associated with the occurrence of PE or severe PE in patients with HDP. CONCLUSION Our study shows a high prevalence of PE in patients with HDP. Hospitalization and repeated clinical evaluation are needed to screen for women exposed to develop PE or severe PE.
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Affiliation(s)
- Raoudha Mhiri
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana.
| | - Alexandra Mvogo
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Alain Kamga
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Samson Yassinguezo
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Herliche Fagla
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Dominique Dotou
- Obstetrics and Gynecology Unit, Cayenne General Hospital, Cayenne, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana
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Nur H, Ridwan A, Atik T, Lalu S M, Megawahyuni A, Wahyuni, Wahdaniyah, Sutria E. Makassar ethnic community perception about pre-eclampsia: A study phenomenology. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mekie M, Mekonnen W, Assegid M. Cohabitation duration, obstetric, behavioral and nutritional factors predict preeclampsia among nulliparous women in West Amhara Zones of Ethiopia: Age matched case control study. PLoS One 2020; 15:e0228127. [PMID: 31986179 PMCID: PMC6984729 DOI: 10.1371/journal.pone.0228127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preeclampsia is a major cause of maternal and perinatal mortality in developing countries. Identifying its risk factors is essential for early diagnosis and management. However, there has been a paucity of information on predictors of preeclampsia among nulliparous women in a resource limited setting. This study bridges the gap in this regard by examining the association of cohabitation duration, obstetric, behavioral and nutrition factors with preeclampsia among nulliparous women in West Amhara Zones of Ethiopia. METHODS Age matched case-control study design was employed among 110 preeclamptic and 220 non-preeclamptic women who came for delivery services at Felege Hiwot, Addis Alem, and Debre Tabor hospitals. Double population proportion formula with an assumption of 95% confidence interval, 80% power and a 2:1 control to case ratio was used to calculate sample size. Epi data 3.1 and SPSS 20 were used for data entry and analysis, respectively. Magnitudes of cohabitation duration, obstetric, behavioral and nutritional factors among nulliparous women with preeclampsia and their controls were calculated and the differences were tested with a Chi-square test. Conditional bivariable and multivariable logistic regression analysis were fitted to identify predictors of preeclampsia. Odds ratio along with their 95% confidence interval were used to identify the strength, direction and significance of association. Ethical clearance was secured from the research ethics committee of the School of Public Health in Addis Ababa University. RESULTS A total of 107 cases and 214 controls completed the interview giving a response rate of 97.27% for both cases and controls. Short cohabitation duration (AOR = 2.13, 95% CI (1.10, 4.1)), unplanned pregnancy (AOR = 2.35, 95% CI (1.01, 5.52)), and high body weight (AOR = 2.00, 95% CI (1.10, 3.63)) were found to be significant risk factors for preeclampsia. Whereas, antenatal advice about nutrition (AOR = 0.52, 95% CI (0.29, 0.96)), vegetable intake (AOR = 0.42, 95% CI (0.22, 0.82)) and fruit intake during pregnancy (AOR = 0.45, 95% CI (0.24, 0.87)) were protective factors for preeclampsia. CONCLUSION Special attention should be given to nulliparous women with short cohabitation duration, unplanned pregnancy, and high body weight to minimize the effect of preeclampsia. Nutritional counseling shall be stressed during antenatal care follow ups.
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Affiliation(s)
- Maru Mekie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubegzier Mekonnen
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meselech Assegid
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Illamola SM, Amaeze OU, Krepkova LV, Birnbaum AK, Karanam A, Job KM, Bortnikova VV, Sherwin CM, Enioutina EY. Use of Herbal Medicine by Pregnant Women: What Physicians Need to Know. Front Pharmacol 2020; 10:1483. [PMID: 31998122 PMCID: PMC6962104 DOI: 10.3389/fphar.2019.01483] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
About 80% of the consumers worldwide use herbal medicine (HMs) or other natural products. The percentage may vary significantly (7%-55%) among pregnant women, depending upon social status, ethnicity, and cultural traditions. This manuscript discusses the most common HMs used by pregnant women, and the potential interactions of HMs with conventional drugs in some medical conditions that occur during pregnancy (e.g., hypertension, asthma, epilepsy). It also includes an examination of the characteristics of pregnant HM consumers, the primary conditions for which HMs are taken, and a discussion related to the potential toxicity of HMs taken during pregnancy. Many cultures have used HMs in pregnancy to improve wellbeing of the mother and/or baby, or to help decrease nausea and vomiting, treat infection, ease gastrointestinal problems, prepare for labor, induce labor, or ease labor pains. One of the reasons why pregnant women use HMs is an assumption that HMs are safer than conventional medicine. However, for pregnant women with pre-existing conditions like epilepsy and asthma, supplementation of conventional treatment with HMs may further complicate their care. The use of HMs is frequently not reported to healthcare professionals. Providers are often not questioning HM use, despite little being known about the HM safety and HM-drug interactions during pregnancy. This lack of knowledge on potential toxicity and the ability to interact with conventional treatments may impact both mother and fetus. There is a need for education of women and their healthcare professionals to move away from the idea of HMs not being harmful. Healthcare professionals need to question women on whether they use any HMs or natural products during pregnancy, especially when conventional treatment is less efficient and/or adverse events have occurred as herbal-drug interactions could be the reason for these observations. Additionally, more preclinical and clinical studies are needed to evaluate HM efficacy and toxicity.
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Affiliation(s)
- Sílvia M. Illamola
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Ogochukwu U. Amaeze
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Lagos, Nigeria
| | - Lubov V. Krepkova
- Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia
| | - Angela K. Birnbaum
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Ashwin Karanam
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen M. Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Valentina V. Bortnikova
- Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia
| | - Catherine M.T. Sherwin
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Elena Y. Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
- Department of Pathology, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Pharmaceutics & Pharmaceutical Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Abstract
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
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Affiliation(s)
- Rutai Hui
- Chinese Academy of Medical Sciences FUWAI Hospital Hypertension Division, 167 Beilishilu West City District, 100037, Beijing People's Republic of China, China.
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Murali S, Miller K, McDermott M. Preeclampsia, eclampsia, and posterior reversible encephalopathy syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:63-77. [PMID: 32768095 DOI: 10.1016/b978-0-444-64240-0.00004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Preeclampsia is a disorder of pregnancy associated with gestational hypertension and end-organ dysfunction. Patients with eclampsia, by definition, have seizures as part of the clinical syndrome. However, patients with preeclampsia can also have other neurologic symptoms and deficits. Both disorders can be associated with radiographic abnormalities similar to that of posterior reversible encephalopathy syndrome, suggesting a common pathophysiology or unified clinical spectrum of disorders. This chapter reviews the pathophysiology, clinical presentation, diagnostic findings, and prognosis of patients with neurologic complications associated with preeclampsia and eclampsia.
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Affiliation(s)
- Sadhana Murali
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States
| | - Kristin Miller
- Department of Neurology, University of Illinois at Chicago, Stroke Program, Chicago, IL, United States
| | - Mollie McDermott
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States.
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Harati-Sadegh M, Kohan L, Teimoori B, Mehrabani M, Salimi S. The effects of placental long noncoding RNA H19 polymorphisms and promoter methylation on H19 expression in association with preeclampsia susceptibility. IUBMB Life 2019; 72:413-425. [PMID: 31769935 DOI: 10.1002/iub.2199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
The effect of DNA methylation on gene expression triggered it as a susceptibility factor in various diseases including preeclampsia (PE). The pathogenesis of PE is closely associated with the methylation status and genetic variants of relevant genes. Therefore, the aim of the study was to investigate the possible impacts of the placental DNA methylation and rs3741219, rs217727, and rs2107425 polymorphisms of the H19 gene on the PE susceptibility as well as the its mRNA expression. Moreover, eight haplotypes of three loci in the H19 gene were analyzed. In this case-control study, the placentas of 107 preeclamptic and 113 non-preeclamptic women were collected after delivery. The methylation status was assessed by methylation-specific polymerase chain reaction (PCR). The H19 polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism or amplification refractory mutation system-polymerase chain reaction methods. The quantitative real time PCR was used for mRNA expression assay. The placental H19 rs3741219 and rs2107425 polymorphisms were not associated with PE. However, H19 rs217727CT and TT genotypes might be associated with a 9.2- and 17.7-fold increased risk of PE, respectively. The Trs3741219 Crs217727 Crs2107425 and Trs3741219 Crs217727 Trs2107425 haplotypes were significantly lower, whereas the Trs3741219 Trs217727 Crs2107425 and Crs3741219 Trs217727 Crs2107425 haplotypes were significantly higher in PE women. Promoter but not upstream region hypermethylation of H19 gene could be led to decreased risk of PE (MM vs. UM + UU). No significant difference was observed in the placental mRNA expression between two groups. The H19 expression was significantly higher in women with unmethylated (UU), compared to methylated promoter (MM). The H19 expression was 17- and 15-fold higher in H19-rs2107425 CC and CT genotypes in PE women. In conclusion, the H19 rs2107425 polymorphism was associated with a higher risk of PE and increased H19 mRNA expression. The promoter hypermethylation of H19 gene was associated with a lower risk of PE and decreased H19 mRNA expression.
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Affiliation(s)
- Mahdiyeh Harati-Sadegh
- Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Leila Kohan
- Department of Biology, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
| | - Batool Teimoori
- Department of Obstetrics and Gynecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehrnaz Mehrabani
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeedeh Salimi
- Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.,Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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From pregnancy to renal disease: Understanding preeclampsia. Nursing 2019; 50:24-30. [PMID: 31764581 DOI: 10.1097/01.nurse.0000615068.61059.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy defined as new-onset hypertension that develops during pregnancy and resolves after delivery. Using a case history as an illustration, this article discusses hypertensive disorders of pregnancy with a focus on preeclampsia and its renal implications.
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de Sousa MG, Lopes RGC, da Rocha MLTLF, Lippi UG, Costa EDS, dos Santos CMP. Epidemiology of artherial hypertension in pregnants. EINSTEIN-SAO PAULO 2019; 18:eAO4682. [PMID: 31664330 PMCID: PMC6896657 DOI: 10.31744/einstein_journal/2020ao4682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 05/07/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the epidemiological data of hypertension in pregnant women, as well as to identify its possible associated events. METHODS Data collection was performed at the high-risk prenatal outpatient clinic and in the maternity ward at a public hospital in the São Paulo city, during the morning and afternoon periods, from October 2015 to July 2016. A questionnaire with 22 questions prepared by the researchers was used. The margin of error was 5% and the confidence level was 95%. For the calculation, the two-proportion equality, Pearson correlation and ANOVA tests were used. RESULTS Among the interviewees, 43% had chronic hypertension, 33.3% presented with up to 20 weeks of gestation, 23.7% presented after the 20th week of gestation, 62.3% were between 18 and 35 years of age, 78.1% had a family history of hypertension, and among those aged 36 to 45 years, 11.4% were in the first gestation, and 26.3% in the second gestation. Considering the associated conditions, diabetes prevailed with 50%; obesity with 22.2%, and the most selected foods for consumption among pregnant women, 47.5% had high energy content (processed/ultraprocessed). CONCLUSION After an epidemiological analysis of the prevalence of hypertension, pregnant women with chronic hypertension, preexisting hypertension diagnosed during pregnancy, and hypertensive disease of pregnancy were identified. Regarding the possible factors associated with arterial hypertension, higher age, family history of hypertension, preexistence of hypertension, late pregnancies, diabetes, obesity and frequent consumption of processed/ultraprocessed foods were found.
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Affiliation(s)
- Marilda Gonçalves de Sousa
- Instituto de Assistência Médica ao Servidor Público EstadualSão PauloSPBrazilInstituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil.
| | - Reginaldo Guedes Coelho Lopes
- Instituto de Assistência Médica ao Servidor Público EstadualSão PauloSPBrazilInstituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil.
| | | | - Umberto Gazi Lippi
- Instituto de Assistência Médica ao Servidor Público EstadualSão PauloSPBrazilInstituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil.
| | - Edgar de Sousa Costa
- Universidade Federal de São PauloSão PauloSPBrazilUniversidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Célia Maria Pinheiro dos Santos
- Instituto de Assistência Médica ao Servidor Público EstadualSão PauloSPBrazilInstituto de Assistência Médica ao Servidor Público Estadual, São Paulo, SP, Brazil.
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Yousif D, Bellos I, Penzlin AI, Hijazi MM, Illigens BMW, Pinter A, Siepmann T. Autonomic Dysfunction in Preeclampsia: A Systematic Review. Front Neurol 2019; 10:816. [PMID: 31447757 PMCID: PMC6691156 DOI: 10.3389/fneur.2019.00816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Preeclampsia (PE) is a major obstetric complication that leads to severe maternal and fetal morbidity. Early detection of preeclampsia can reduce the severity of complications and improve clinical outcomes. It is believed that the autonomic nervous system (ANS) is involved in the pathogenesis of PE. We aimed to review the current literature on the prevalence and nature of ANS dysfunction in women with PE and the possible prognostic value of ANS testing in the early detection of PE. Methods: Literature search was performed using Medline (1966–2018), EMBase (1947–2018), Google Scholar (1970–2018), BIOSIS (1926–2018), Web of science (1900–2018); CINAHL (1937–2018); Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Methodology Register (1999–2018). Additionally, the reference lists of articles included were screened. Results: A total of 26 studies were included in the present review presenting data of 1,854 pregnant women. Among these women, 453 were diagnosed with PE, 93.6% (424/453) of which displayed autonomic dysfunction. ANS function was assessed by cardiovascular reflex tests (n = 9), heart rate variability (n = 11), cardiac baroreflex gain (n = 5), muscle sympathetic nerve activity (MSNA) (n = 3), and biomarkers of sympathetic activity (n = 4). Overall, 21 studies (80.8%) reported at least one of the following abnormalities in ANS function in women diagnosed with PE compared to healthy pregnant control women: reduced parasympathetic activity (n = 16/21, 76%), increased sympathetic activity (n = 12/20, 60%), or reduced baroreflex gain (n = 4/5, 80%). Some of these studies indicated that pressor and orthostatic stress test may be useful in early pregnancy to help estimate the risk of developing PE. However, autonomic function tests seem not to be able to differentiate between mild and severe PE. Conclusions: Current evidence suggests that autonomic dysfunction is highly prevalent in pre-eclamptic women. Among autonomic functions, cardiovascular reflexes appear to be predominantly affected, seen as reduced cardiac parasympathetic activity and elevated cardiac sympathetic activity. The diagnostic value of autonomic testing in the prediction and monitoring of autonomic failure in pre-eclamptic women remains to be determined.
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Affiliation(s)
- Dalia Yousif
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ana Isabel Penzlin
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mido Max Hijazi
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexandra Pinter
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Timo Siepmann
- Division of Healthcare Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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76
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Wertaschnigg D, Reddy M, Mol BWJ, da Silva Costa F, Rolnik DL. Evidence-Based Prevention of Preeclampsia: Commonly Asked Questions in Clinical Practice. J Pregnancy 2019; 2019:2675101. [PMID: 31467716 PMCID: PMC6699262 DOI: 10.1155/2019/2675101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/11/2019] [Indexed: 11/17/2022] Open
Abstract
In this review, we discuss the recent literature regarding the prevention of preeclampsia and aim to answer common questions that arise in the routine antenatal care of pregnant women. Prescription of low-dose aspirin for high-risk patients has been shown to reduce the risk of preeclampsia (PE). A daily dose between 100 and 150 mg taken in the evening should be initiated prior to 16 weeks of gestation and can be continued until delivery. Calcium supplementation seems to be advantageous but currently it is only considered for patients with poor dietary intake and high risk for PE. Recent data about heparin are still conflicting, and therefore, heparin can currently not be recommended in the prevention of PE.
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Affiliation(s)
- Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton Victoria, Australia
| | - Ben W. J. Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton Victoria, Australia
| | - Fabricio da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton Victoria, Australia
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77
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Motedayen M, Rafiei M, Rezaei Tavirani M, Sayehmiri K, Dousti M. The relationship between body mass index and preeclampsia: A systematic review and meta-analysis. Int J Reprod Biomed 2019; 17:463-472. [PMID: 31508571 PMCID: PMC6718883 DOI: 10.18502/ijrm.v17i7.4857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 11/28/2018] [Accepted: 12/26/2018] [Indexed: 01/22/2023] Open
Abstract
Background One of the causes of maternal and fetal mortality and morbidity is pregnancy-induced hypertension, the most common form of which is preeclampsia that causes many complications for mother and fetus. Objective The aim of this systematic review and meta-analysis was to determine the relationship between body mass index (BMI) and preeclampsia in Iran. Materials and Methods Using valid keywords in the SID database, PubMed, Scopus, data obtained from all the articles, which were reviewed in Iran between 2000 and 2016, were combined using the meta-analysis method (random-effects model) and analyzed using STATA version 11.1. Results A total number of 5,946 samples were enrolled in 16 studies with the mean BMI values of 25.13, 27.42, and 26.33 kg /m2 in the healthy, mild, and severe preeclamptic groups, respectively. Conclusion The results of this study revealed that there is a significant relationship between BMI and the risk of preeclampsia, so it can be said that BMI may be one of the ways to diagnose preeclampsia.
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Affiliation(s)
- Morteza Motedayen
- Department of Cardiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Rafiei
- Department of Biostatistics and Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Kourosh Sayehmiri
- Psychosocial Injuries Research Center, Department of Biostatistics, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Majid Dousti
- Psychosocial Injuries Research Center, Department of Biostatistics, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
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78
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Adekomi AD, Moodley J, Naicker T. Neuropathological complications associated with hypertensive disorders of pregnancy. Hypertens Pregnancy 2019; 38:171-175. [PMID: 31213115 DOI: 10.1080/10641955.2019.1626417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Hypertensive disorders in pregnancy particularly severe preeclampsia and eclampsia result in significant maternal and neonatal morbidity and mortality. Many of these misfunctions can aggravate some of the neuropathological complications of hypertensive disorders during pregnancy. Method: In this review article, we described some of the neuropathological complications associated with hypertensive disorders of pregnancy. Results and conclusion: It is explained how the possible mechanism of neuropathological events triggers some of the complications associated with hypertensive disorders of pregnancy. Conclusion: A strong plea is made for the early detection of high blood pressure, its immediate control with rapid acting anti-hypertensive agents if necessary and timeous delivery of fetus as the exact pathogenesis of preeclampsia remains unknown.
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Affiliation(s)
- Adedayo Damilare Adekomi
- a Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa.,b Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences , Osun State University , Osogbo , Nigeria
| | - Jagidesa Moodley
- c Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, School of Laboratory Medicine and Medical Sciences, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
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79
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Abstract
Hypertensive disorders of pregnancy are common and contribute inordinately to maternal and fetal morbidity and mortality. Although not completely understood, recent clinical trials have provided important insights into pathogenesis of preeclampsia. Preeclampsia is considered a systemic disease with generalized endothelial dysfunction and risk of future cardiovascular disease. This review revisits the definitions and classifications of hypertensive disorders of pregnancy; discusses updates on pathophysiology, prevention, and early prediction of preeclampsia; reviews current management guidelines; and discusses potential risks and benefits associated with treatment. Improvement in management and outcomes of women with hypertensive disorders of pregnancy seems in sight in the near future.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology, Kidney CARE Program, University of Cincinnati, 231 Albert Sabin Way, MSB 6211, Cincinnati, OH 45267, USA.
| | - Anu Gupta
- Buffalo Medical Group, 2121 Main Street #305, Buffalo, NY 14214, USA
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80
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Topel ML, Duncan EM, Krishna I, Badell ML, Vaccarino V, Quyyumi AA. Estimated Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Reproductive-Aged Women. Hypertension 2019; 72:e39-e42. [PMID: 30354726 DOI: 10.1161/hypertensionaha.118.11660] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew L Topel
- From the Division of Cardiology, Department of Medicine (M.L.T., A.A.Q.), Emory University School of Medicine, Atlanta, GA
| | | | - Iris Krishna
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics (I.K., M.L.B.), Emory University School of Medicine, Atlanta, GA
| | - Martina L Badell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics (I.K., M.L.B.), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (V.V.)
| | - Arshed A Quyyumi
- From the Division of Cardiology, Department of Medicine (M.L.T., A.A.Q.), Emory University School of Medicine, Atlanta, GA
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81
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Govender N, Moodley J, Naicker T. Copeptin in Preeclampsia Development. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404815666190110094636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:
Preeclampsia complicates 2-8% of all pregnancies worldwide and is one of
the leading causes of maternal and neonatal morbidity and mortality. It occurs after the 20th week of
gestation and is characterized by high blood pressure, proteinuria or end-organ disease. The heterogeneous
and multi-systemic nature of this disease has led to the elusive pathophysiology which
delays timely diagnoses and the clinical treatment of those affected.
Objective:
Despite the extensive investigations surrounding the inclusion of various potential markers
for PE prediction, early diagnosis remains unresolved. Quantification of copeptin, a stable component
of the arginine vasopressin (AVP) precursor is shown to be relatively reliable in confirming
the circulating levels of AVP.
Conclusion:
Elevated copeptin levels confirmed in pregnant women have also provided clinical
support for its role in PE development. However, its clinical use in predicting disease severity in
early-onset pre-eclampsia has been debatable. This review thus recapitulates the current literature
surrounding copeptin and its potential as a risk indicator for PE development.</P>
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Affiliation(s)
- Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Discipline of Optics and Imaging, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
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82
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Spradley FT. Sympathetic nervous system control of vascular function and blood pressure during pregnancy and preeclampsia. J Hypertens 2019; 37:476-487. [PMID: 30160658 PMCID: PMC6355368 DOI: 10.1097/hjh.0000000000001901] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Proper vascular tone and blood pressure regulation during pregnancy are important for immediate and long-term cardiovascular health of the mother and her offspring. Preeclampsia is clinically defined as new-onset maternal hypertension accompanied by cardiovascular, renal, and/or neural abnormalities presenting in the second half of pregnancy. There is strong evidence to support that preeclampsia is mediated by attenuations in uteroplacental vascular remodeling and increases in vasoconstriction with subsequent placental ischemia/reperfusion-induced release of hypertensive substances into the maternal circulation. These include antiangiogenic and pro-inflammatory factors. There is also evidence implicating increased sympathetic nervous system activity (SNA) in this maternal disorder, but this mostly includes data correlating severity of disease with catecholamine levels and elevated muscle SNA. These measurements have not confirmed a causative role for SNA in the pathogenesis of preeclampsia. Therefore, studies are needed to provide a comprehensive understanding of SNA and its control of vascular function and blood pressure regulation during normal pregnancy in order to set the stage for exploring the mechanisms mediating the exaggerated SNA and signaling during preeclampsia. This review examines the role of SNA in control of uteroplacental vascular tone and blood pressure regulation during normal pregnancy. Furthermore, it is proposed that over-activation of the SNA contributes to altered uteroplacental vascular tone and perfusion leading to placental ischemic events and modulates the systemic vasoconstriction and hypertensive responses to soluble placenta ischemic factors. Recognizing the integrative role and importance of SNA in the pathophysiology of preeclampsia will advance our understanding of this maternal disorder.
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Affiliation(s)
- Frank T Spradley
- Department of Surgery, The University of Mississippi Medical Center, Jackson, Mississippi, USA
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83
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Huppertz B. The Critical Role of Abnormal Trophoblast Development in the Etiology of Preeclampsia. Curr Pharm Biotechnol 2019; 19:771-780. [PMID: 29701150 PMCID: PMC6463401 DOI: 10.2174/1389201019666180427110547] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/06/2018] [Accepted: 04/08/2018] [Indexed: 11/22/2022]
Abstract
Background: The pregnancy pathology preeclampsia is still among the leading causes of ma-ternal and perinatal morbidity and mortality. At the same time, its etiology is far from being identified and remains obscure in a number of facets. A number of hypotheses have been developed to explain the altered interplay between placenta and mother leading to the clinical symptoms of preeclampsia. However, none of them offers the opportunity to explain the variability of cases with late-onset versus early-onset, mild versus severe and with or with-out additional fetal growth restriction. Conclusion: This paper identifies the weaknesses of the most important current hypothesis and at the same time offers a set of new elucidations including maternal susceptibility, and villous/extravillous trophoblast differentiation to explain the development of preeclampsia. Such elucidations allow following new scientific routes and pathways to untangle the etiology of preeclampsia.
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Affiliation(s)
- Berthold Huppertz
- Department of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
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84
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Abstract
Acute complications of preeclampsia contribute substantially to maternal and fetal morbidity and mortality. The considerable variation in onset, clinical presentation, and severity of this hypertensive disease that is unique to pregnancy creates challenges in identifying risk factors for clinical deterioration. Delivery of the fetus remains the only definitive treatment for preeclampsia. Surveillance of signs and symptoms and laboratory parameters consistent with progression in severity requires an appreciation of the dynamic and progressive nature of the disease. This article provides a comprehensive overview of the pathophysiology of preeclampsia, setting the foundation for discussion of management priorities for acute complications that pose the greatest risks to maternal health.
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Affiliation(s)
- Patricia M Witcher
- Patricia M. Witcher is Clinical Outcomes Manager, Women's Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA 30342
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85
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Ekun OA, Ogidi NO, Lawal RA, Ogunmuyiwa OA, Umewune MC, Adefolaju FO, Oshundun MF, Oremosu AI. Interrelationship Between Markers of Oxidative Stress, Inflammation and Hematological Parameters Among Preeclamptic Nigerian Women. Med Sci Monit Basic Res 2018; 24:225-231. [PMID: 30555153 PMCID: PMC6319160 DOI: 10.12659/msmbr.910660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/21/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preeclampsia is a multifaceted pregnancy-related disorder affecting women and fetuses. A link between preeclampsia, oxidative stress, and inflammation has been suggested. This study evaluated the interrelationship between biomarkers of oxidative stress, inflammation, and hematological parameters among preeclamptic Nigerian women. MATERIAL AND METHODS A cross-sectional study was conducted among 49 preeclamptic and 50 normotensive healthy pregnant women. Blood samples were obtained after 20-week gestation in all participants. Levels of superoxide dismutase (SOD), catalase, glutathione (GSH), malonaldehyde (MDA), total protein, high-sensitivity C-reactive protein (hs-CRP), and cardiac-specific troponin I (cTnI) were determined by spectrophotometric and ELISA techniques. FBC, prothrombin time, and activated partial thromboplastin time were determined using an auto-analyzer, Quick's one-stage, and Proctor's and Rappaport's modification methods, respectively. RESULTS The mean SOD (0.051±0.050 vs. 0.073±0.047, p 0.029), catalase (2.62±1.93 vs. 8.48±4.40, p<0.001), GSH (49.05±17.57 vs. 187.10±56.07 p<0.001), platelet (127.63±89.75 vs. 267.16±212.82, p<0.001 were lower in preeclampsia. MDA (7.16±5.00 vs. 2.91±2.66, p<0.001), cTnI (0.46±0.31 vs. 0.13±0.14 p<0.001), PT (19.36±4.06 vs. 13.45±1.97 p<0.001), APTT (45.53±2.92 vs. 37.49±4.99; p<0.001) were higher in preeclampsia. Negative associations between SOD and MDA (r -0.527 p<0.001), CAT and MDA (r -0.469, p 0.001) and positive associations between catalase and hs-CRP (r 0.844, p 0.029), RBC and HB (r 0.442, p 0.001), platelet, and SOD (r 0.353, p 0.013) were observed among preeclamptic volunteers. CONCLUSIONS Preeclampsia is associated with oxidative stress, derangement of hematological and coagulation homeostasis, as well as deleterious effects on the cardiovascular system.
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Affiliation(s)
- Oloruntoba Ayodele Ekun
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Nkeiruka Ogochukwu Ogidi
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rukayat Adetutu Lawal
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Mirian Chiamaka Umewune
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Florence Oreitan Adefolaju
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mary Foluke Oshundun
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayoola Islamiyat Oremosu
- Department of Medical Laboratory Science, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria
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86
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Huppertz B. Biology of preeclampsia: Combined actions of angiogenic factors, their receptors and placental proteins. Biochim Biophys Acta Mol Basis Dis 2018; 1866:165349. [PMID: 30553017 DOI: 10.1016/j.bbadis.2018.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 12/13/2022]
Abstract
Although massive efforts have been undertaken to elucidate the etiology of the pregnancy syndrome preeclampsia, its developmental origin remains a mystery. Most efforts of the last decade have focused on biomarkers to predict and/or diagnose preeclampsia, including the anti-angiogenic factor sFlt-1 (soluble fms-like tyrosin kinase-1), the angiogenic factor PGF (placental growth factor) and PP13 (placental protein 13). The origins of these marker proteins are still under debate, and so far their actions have only been describe separate from each other. This study will focus on the origins and actions of all three markers during pregnancy and outside pregnancy and will describe a scenario where all three markers act synergistically to rescue the mother from the deleterious effects of the debris that is released from the placenta during preeclampsia. This more holistic approach may open new avenues to think about maternal-fetal interactions and putative therapies.
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Affiliation(s)
- Berthold Huppertz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.
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87
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Pharmacological Effect of Quercetin in Hypertension and Its Potential Application in Pregnancy-Induced Hypertension: Review of In Vitro, In Vivo, and Clinical Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:7421489. [PMID: 30622610 PMCID: PMC6304490 DOI: 10.1155/2018/7421489] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 01/27/2023]
Abstract
Since improving maternal and child health is a public health priority worldwide, the main aim of treatment of hypertension in pregnant women is to prevent complications during pregnancy, labor, and postpartum. In consequence, much attention is paid to the use of antihypertensive drugs that can be used safely during pregnancy. Several side effects of methyldopa, which is currently the most commonly used antihypertensive drug in pregnant women, mean that the search for an effective and safe alternative still continues. Flavonoid compounds present in medicinal plants, vegetables, and fruits may be a promising source of new drugs. In this aspect, quercetin, a well-known flavonoid due to its antihypertensive action, may be considered a prototype for safe antihypertensive drugs. This review focuses on the selective activity of quercetin. Based on recent studies, a few problems were discussed, including (1) pathology of pregnancy-induced hypertension; (2) search for new pharmacological treatments of pregnancy-induced hypertension; (3) issues with the use of herbal extracts during pregnancy; (4) flavonoids as natural active chemical compounds; (5) quercetin: its action during pregnancy, in vitro and in vivo pharmacological activities, clinical trials, and meta-analysis; (6) quercetin intake during pregnancy; (7) other natural compounds tested during pregnancy; (8) potential problems with the use of quercetin; (9) safety profile of quercetin. Various studies have shown a beneficial effect of quercetin on vascular endothelial function and its antioxidative and anti-inflammatory activity on cellular and tissue level. It is known that in animal models quercetin affects positively the development of embryo, fetus, and placenta. Because this flavonoid did not have teratogenic and abortive effect, it is generally recognized as safe. For this reason it should be appreciated and studied in the aspect of its potential use in the prevention and treatment of pregnancy-induced hypertension among women in this risk group.
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88
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Scott H, Phillips T, Stuart G, Rogers M, Steinkraus B, Grant S, Case C. Preeclamptic placentae release factors that damage neurons: implications for foetal programming of disease. Neuronal Signal 2018; 2:NS20180139. [PMID: 32714596 PMCID: PMC7363326 DOI: 10.1042/ns20180139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/03/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022] Open
Abstract
Prenatal development is a critical period for programming of neurological disease. Preeclampsia, a pregnancy complication involving oxidative stress in the placenta, has been associated with long-term health implications for the child, including an increased risk of developing schizophrenia and autism spectrum disorders in later life. To investigate if molecules released by the placenta may be important mediators in foetal programming of the brain, we analysed if placental tissue delivered from patients with preeclampsia secreted molecules that could affect cortical cells in culture. Application of culture medium conditioned by preeclamptic placentae to mixed cortical cultures caused changes in neurons and astrocytes that were related to key changes observed in brains of patients with schizophrenia and autism, including effects on dendrite lengths, astrocyte number as well as on levels of glutamate and γ-aminobutyric acid receptors. Treatment of the placental explants with an antioxidant prevented neuronal abnormalities. Furthermore, we identified that bidirectional communication between neurons and astrocytes, potentially via glutamate, is required to produce the effects of preeclamptic placenta medium on cortical cells. Analysis of possible signalling molecules in the placenta-conditioned medium showed that the secretion profile of extracellular microRNAs, small post-transcriptional regulators, was altered in preeclampsia and partially rescued by antioxidant treatment of the placental explants. Predicted targets of these differentially abundant microRNAs were linked to neurodevelopment and the placenta. The present study provides further evidence that the diseased placenta may release factors that damage cortical cells and suggests the possibility of targeted antioxidant treatment of the placenta to prevent neurodevelopmental disorders.
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Affiliation(s)
- Hannah Scott
- School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, U.K
- UK Dementia Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, U.K
| | - Tom J. Phillips
- School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, U.K
- UK Dementia Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, U.K
| | - Greer C. Stuart
- Department of Obstetrics, Southmead Hospital, Bristol BS10 5NB, U.K
| | - Mark F. Rogers
- Intelligent Systems Laboratory, University of Bristol, Merchant Venturers Building, Woodland Road, Bristol BS8 1UB, U.K
| | - Bruno R. Steinkraus
- Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, U.K
| | - Simon Grant
- Department of Obstetrics, Southmead Hospital, Bristol BS10 5NB, U.K
| | - C. Patrick Case
- School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, U.K
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Gomes SZ, Araujo F, Bandeira CL, Oliveira LG, Hoshida MS, Zugaib M, Francisco RPV, Bevilacqua E. The Impact of Immunosuppressive Drugs on Human Placental Explants. Reprod Sci 2018; 26:1225-1234. [DOI: 10.1177/1933719118812739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of immunosuppressive drugs guarantees the vitality of the graft and allows gestation in spite of intercurrences such as prematurity and intrauterine growth restriction. However, little is known about the direct effects of immunosuppressive drugs on placental cells. We investigated the effects of immunosuppressive drugs in the chorionic villous explants from human term placentas of healthy gestations. Human placental explants from term gestations (37-39 week gestational age, n = 12) were exposed to cyclosporine A (CSA, 0, 62.5, 125, 1250 ng/mL) or azathioprine (AZA, 0, 5, 10, 100 ng/mL) separately or, in combination for up to 48 hours. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays showed a significant decrease in the explant metabolic activity between AZA and the control group (24 hours, 100 ng/mL, 48 hours, all concentrations, P < .005). Cyclosporin A (CsA) reduced cell activity when associated with AZA (48 hours, P < .005). Fibrinoid deposits increased in AZA-treated explants alone (5 ng/mL, 48 hours; 10 ng/mL, 24-48 hours; P < .005) or when associated with CsA (10 AZA/125 CsA, P < .05), whereas in CsA treatment alone, there was an augment in syncytial knots (24-48 hours, P < .005). The sFLT1 gene (24 hours, P < .05) and protein ( P < .005) expression increased in AZA and CsA-treatments separately or in combination ( P < .05). Placental growth factor increased in AZA (24 hours, 10 ng/mL) and CsA (125 ng/mL; P < .05). In conclusion, our data indicate that AZA primarily acts on the villous metabolism, perturbing placental homeostasis. Since these drugs may alter the balance of angiogenic factors in its selection for clinical application, their impact on the behavior of placental villous should be considered.
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Affiliation(s)
- Sara Z. Gomes
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Franciele Araujo
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Carla L. Bandeira
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Leandro G. Oliveira
- Gynecology and Obstetrics Department, Botucatu Medical School, Sao Paulo State University, São Paulo, Brazil
| | - Mara S. Hoshida
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Zugaib
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Rossana P. V. Francisco
- Obstetrics and Gynecology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Estela Bevilacqua
- Department of Cellular and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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90
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Huppertz B. An updated view on the origin and use of angiogenic biomarkers for preeclampsia. Expert Rev Mol Diagn 2018; 18:1053-1061. [PMID: 30413130 DOI: 10.1080/14737159.2018.1546579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The last decade has seen massive efforts towards the identification and the potential use of predictive biomarkers for the pregnancy pathology preeclampsia. The angiogenic factors sFlt-1 and placental growth factor (PGF) have been in focus and have been massively supported. Areas covered: This review describes preeclampsia and intra-uterine growth restriction (IUGR), focusing on sFlt-1 and PGF, their sources during and outside pregnancy and the application of these markers in diseases outside pregnancy. Finally, the specificity of the angiogenic markers for preeclampsia is discussed. Expert commentary: The admixture of the two independent syndromes preeclampsia and IUGR has not helped in identifying the etiologies of either. Rather, it has made the search for new markers and pathways much more complicated as has the constriction on the angiogenic markers. The current markers sFlt-1 and PGF have a clear value once an adverse outcome is diagnosed but are not specific for preeclampsia. Also, they are mostly derived from the maternal vascular system rather than the placenta and are already in use as markers outside pregnancy. A new holistic approach using disease maps and interoperable workflows based on topic-related big data will help in broadening our understanding of the etiology of preeclampsia and hence, develop new markers and therapies.
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Affiliation(s)
- Berthold Huppertz
- a Division of Cell Biology, Histology and Embryology , Gottfried Schatz Research Center, Medical University of Graz , Graz , Austria
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91
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McIntyre WF, Mendoza PA, Belley‐Côté EP, Whitlock RP, Um KJ, Maystrenko N, Devereaux P, Conen D, Wong JA, Connolly SJ, Healey JS. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow-up cohort study. Clin Cardiol 2018; 41:1273-1280. [PMID: 30125047 PMCID: PMC6489868 DOI: 10.1002/clc.23053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation occurring transiently with stress (AFOTS) describes the first detection of AF in a patient who is hospitalized for a non-cardiac medical illness or following non-cardiac surgery. Uncertainty exists whether episodes of AFOTS are due to reversible precipitants and will not recur after recovery, or if they are paroxysmal atrial fibrillation (AF) that is detected during inpatient cardiac monitoring. Previous studies have used retrospective, non-systematic and ultimately low-sensitivity protocols to investigate the recurrence of AF in patients with AFOTS. The prospective, multi-center, investigator-initiated AFOTS Follow-Up Cohort Study will enroll 138 case patients with AFOTS in the setting of non-cardiac surgery or medical illness, matched 1:1 with control patients for age, sex, stressor, and hospital unit. Participants will wear a 14-day ECG heart monitor at 1 and 6 months after hospital discharge. Over 12 months of follow-up, we will collect data regarding participant's medications, and clinical events. The primary endpoint is detection of 30 or more seconds of AF after hospital discharge. To date, 50% of the target sample has been enrolled. The study is expected to complete enrolment in mid-2019 and conclude 1 year later. The AFOTS follow-up study will employ a systematic protocol to detect AF and will provide a precise and valid estimate of AF recurrence following AFOTS. This study will establish whether patients with AFOTS have an increased propensity to AF after hospitalization as compared to matched controls and may inform the management of this population.
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Affiliation(s)
- William F. McIntyre
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Pablo A. Mendoza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Emilie P. Belley‐Côté
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Richard P. Whitlock
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Division of Cardiac Surgery, Department of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Kevin J. Um
- Population Health Research InstituteHamiltonOntarioCanada
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - P.J. Devereaux
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - David Conen
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jorge A. Wong
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Stuart J. Connolly
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jeff S. Healey
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
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92
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Subki AH, Algethami MR, Baabdullah WM, Alnefaie MN, Alzanbagi MA, Alsolami RM, Abduljabbar HS. Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia. Oman Med J 2018; 33:409-415. [PMID: 30210720 DOI: 10.5001/omj.2018.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. Methods We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. Results We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. Conclusions The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.
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Affiliation(s)
- Ahmed Hussein Subki
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Ridha Algethami
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wejdan Mohammad Baabdullah
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majed Nasser Alnefaie
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Abdullah Alzanbagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rawan Marzooq Alsolami
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hassan S Abduljabbar
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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93
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Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study. J Immunol Res 2018; 2018:2413637. [PMID: 30255104 PMCID: PMC6140277 DOI: 10.1155/2018/2413637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called "planned pregnancy." Methods. A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded. Results The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8-17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5-21.8) were associated with composite fetal APOs. Conclusion Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.
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94
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Spradley FT, Ge Y, Haynes BP, Granger JP, Anderson CD. Adrenergic receptor blockade attenuates placental ischemia-induced hypertension. Physiol Rep 2018; 6:e13814. [PMID: 30229567 PMCID: PMC6121121 DOI: 10.14814/phy2.13814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 12/15/2022] Open
Abstract
Preeclampsia (PE), a disorder of new-onset maternal hypertension and vascular dysfunction during pregnancy, is thought to be linked to placental ischemia-induced release of prohypertensive factors and reductions of vasoprotective factors in the maternal circulation. Although markers of sympathetic nervous activity are elevated in experimental models of placental ischemia-induced hypertension and women with PE compared with their normal pregnant counterparts, the importance of adrenergic receptor signaling in the development of hypertension in PE is unknown. Therefore, we tested the hypothesis that adrenergic receptor blockade attenuates the development of placental ischemia-induced hypertension in rats. Wistar Hannover rats underwent reduced uterine perfusion pressure (RUPP) or Sham surgeries on gestational day 14. By day 19, mean arterial blood pressure (MAP) was increased in RUPP over Sham rats. Groups of RUPP and Sham pregnant rats received terazosin and propranolol (3 mg/kg per day of each via subcutaneous osmotic minipump) to block α1- and β-adrenergic receptors, respectively, beginning on gestational day 14. Adrenergic blockade significantly attenuated the development of hypertension in the RUPP rats with a slight blood pressure-lowering response in the Sham, normal pregnant rats by day 19. In conclusion, these data implicate that placental ischemia-induced hypertension involves adrenergic receptor signaling to promote increases in blood pressure during PE.
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Affiliation(s)
- Frank T. Spradley
- Department of SurgeryThe University of Mississippi Medical CenterJacksonMississippi
- Department of Physiology & BiophysicsThe University of Mississippi Medical CenterJacksonMississippi
- Cardiovascular‐Renal Research CenterThe University of Mississippi Medical CenterJacksonMississippi
- Women's Health Research CenterThe University of Mississippi Medical CenterJacksonMississippi
| | - Ying Ge
- Department of SurgeryThe University of Mississippi Medical CenterJacksonMississippi
| | - B. Peyton Haynes
- Department of SurgeryThe University of Mississippi Medical CenterJacksonMississippi
| | - Joey P. Granger
- Department of Physiology & BiophysicsThe University of Mississippi Medical CenterJacksonMississippi
- Cardiovascular‐Renal Research CenterThe University of Mississippi Medical CenterJacksonMississippi
- Women's Health Research CenterThe University of Mississippi Medical CenterJacksonMississippi
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95
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Bortolotto MR, Francisco RPV, Zugaib M. Resistant Hypertension in Pregnancy: How to Manage? Curr Hypertens Rep 2018; 20:63. [PMID: 29892919 DOI: 10.1007/s11906-018-0865-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. RECENT FINDINGS The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.
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Affiliation(s)
- Maria Rita Bortolotto
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Zugaib
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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96
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Eastabrook G, Aksoy T, Bedell S, Penava D, de Vrijer B. Preeclampsia biomarkers: An assessment of maternal cardiometabolic health. Pregnancy Hypertens 2018; 13:204-213. [PMID: 30177053 DOI: 10.1016/j.preghy.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/09/2018] [Accepted: 06/09/2018] [Indexed: 12/15/2022]
Abstract
Preeclampsia is a serious pregnancy condition defined as new-onset hypertension and proteinuria, commonly characterized as either early, 'placental', or late onset, 'maternal', using a cut-off of 34 weeks gestation. However, it may be more useful to differentiate between the vascular remodelling and placental invasion vs. inflammation and metabolic pathophysiology that underlie these forms of preeclampsia. Due to rising rates of obesity, the late-onset, maternal form is increasingly occurring earlier in pregnancy. Predictive tests for preeclampsia typically include biophysical markers such as maternal body mass index and mean arterial pressure, indicating the importance of cardiovascular and metabolic health in its pathophysiology. In contrast, the placental, inflammatory, endothelial and/or metabolic biomarkers used in these tests are generally thought to indicate an abnormal response to placentation and predict the disease. However, many of these non-placental biomarkers are known to predict impaired metabolic health in non-pregnant subjects with obesity (metabolically unhealthy obesity) and coronary artery disease or stroke in people at risk for cardiovascular events. Similarities between the performance of these markers in the prediction of cardiovascular and metabolic health outside of pregnancy suggests that they may be more indicative of maternal health than predictive for preeclampsia. This paper reviews the biophysical and biochemical markers in preeclampsia prediction and compares their performance to tests assessing metabolic health and risk of cardiovascular disease, particularly in the obese population.
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Affiliation(s)
- Genevieve Eastabrook
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Tuba Aksoy
- Department of Obstetrics and Gynecology, Mackenzie Richmond Hill Hospital, Richmond Hill, Ontario, Canada.
| | - Samantha Bedell
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Debbie Penava
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
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97
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Folk DM. Hypertensive Disorders of Pregnancy: Overview and Current Recommendations. J Midwifery Womens Health 2018; 63:289-300. [PMID: 29764001 DOI: 10.1111/jmwh.12725] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are an important cause of maternal and fetal morbidity and mortality. Although advances in effective treatments have been made, current research has yet to identify a biochemical or diagnostic imaging marker to reliably predict preeclampsia. Despite current guidelines that address diagnosis and management of hypertensive disorders in pregnancy, health care providers may overlook or be unaware of signs that require immediate evaluation and treatment. This article reviews the definitions of hypertensive disorders of pregnancy, diagnosis, pathophysiology of preeclampsia, indications for treatment, neurologic sequelae, and counseling about the implications of hypertension in pregnancy for subsequent health.
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98
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Soobryan N, Murugesan S, Pandiyan A, Moodley J, Mackraj I. Angiogenic Dysregulation in Pregnancy-Related Hypertension-A Role for Metformin. Reprod Sci 2018; 25:1531-1539. [PMID: 29739273 DOI: 10.1177/1933719118773484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the face of escalating maternal and fetal health threats, hypertensive pregnancy disorders (HPDs) is one of the leading cause of maternal and fetal morbidity and mortality. The range of HPDs include white-coat hypertension, chronic hypertension, gestational hypertension, mild-to-moderate and severe preeclampsia and eclampsia. Current evidence implicates an imbalance of circulating anti- and angiogenic factors in HPDs emanating from the placental vasculature, impacting on angiogenesis. Delivery of the fetus is thus far the only curative measure, albeit with increased risk. Resultant endothelial dysfunction caused by the excessive production of placental soluble fms-like tyrosine kinase-1 has been the basis of many studies to find a safer treatment strategy. Metformin, used historically in the treatment of diabetes mellitus has also found its therapeutic reach in many other disease states. These include, but are not limited to, improving blood flow in certain cancer types, treatment of polycystic ovarian disease, improving vasodilation, and reducing inflammation. Metformin is used to treat hyperglycemic endothelial dysfunction through the enhancement of the nitric oxide system, endothelin-derived hyperpolarizing factor and sirtuin 1. Similarly, endothelial dysfunction in preeclampsia and other HPDs leads to a hypoxic state and elevated blood pressures. Dubbed as the new "aspirin" of current times, the retardation of the antiangiogenic status by metformin provides an exciting and promising alternate strategy in treating these pregnancy disorders.
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Affiliation(s)
- Nerolen Soobryan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saravanakumar Murugesan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arunagiri Pandiyan
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- 2 Department of Obstetrics and Gynaecology and Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Irene Mackraj
- 1 Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Meta-Prediction of MTHFR Gene Polymorphisms and Air Pollution on the Risk of Hypertensive Disorders in Pregnancy Worldwide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020326. [PMID: 29438331 PMCID: PMC5858395 DOI: 10.3390/ijerph15020326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/24/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are devastating health hazards for both women and children. Both methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and air pollution can affect health status and result in increased risk of HDP for women. The major objective of this study was to investigate the effect of MTHFR polymorphisms, air pollution, and their interaction on the risk of HDP by using meta-predictive analytics. We searched various databases comprehensively to access all available studies conducted for various ethnic populations from countries worldwide, from 1997 to 2017. Seventy-one studies with 8064 cases and 13,232 controls for MTHFR C677T and 11 studies with 1425 cases and 1859 controls for MTHFR A1298C were included. MTHFR C677T homozygous TT (risk ratio (RR) = 1.28, p < 0.0001) and CT plus TT (RR = 1.07, p = 0.0002) were the risk genotypes, while wild-type CC played a protective role (RR = 0.94, p = 0.0017) for HDP. The meta-predictive analysis found that the percentage of MTHFR C677T TT plus CT (p = 0.044) and CT (p = 0.043) genotypes in the HDP case group were significantly increased with elevated levels of air pollution worldwide. Additionally, in countries with higher air pollution levels, the pregnant women with wild-type CC MTHFR 677 had a protection effect against HDP (p = 0.014), whereas, the homozygous TT of MTHFR C677T polymorphism was a risk genotype for developing HDP. Air pollution level is an environmental factor interacting with increased MTHFR C677T polymorphisms, impacting the susceptibility of HDP for women.
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100
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Flanagan B, Lord B, Barnes M. Is unplanned out-of-hospital birth managed by paramedics 'infrequent', 'normal' and 'uncomplicated'? BMC Pregnancy Childbirth 2017; 17:436. [PMID: 29273024 PMCID: PMC5741876 DOI: 10.1186/s12884-017-1617-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/07/2017] [Indexed: 01/06/2023] Open
Abstract
Background Unplanned out-of-hospital birth is often perceived as precipitate in nature, ‘infrequent’, ‘normal’ and ‘uncomplicated’. However, international studies report unplanned out-of-hospital birth is associated with increased rates of maternal and neonatal morbidity and mortality. This research describes intrapartum, immediate postpartum and neonatal care provided by paramedics in Queensland, Australia. The objectives were to (1) determine the number of cases where the paramedic documented birth or imminent birth during the study period (2) to describe the incidence of births prior to or during paramedic care (3) to detail any risk factors and/or complications recorded by paramedics during these cases, (4) identify paramedic pain management practices for intrapartum care, and (5) to examine the maternal and neonatal outcomes as documented by paramedics. Method A retrospective analysis of Queensland Ambulance Service (QAS) de-identified patient care records, generated from clinical case data between the 1st of Jan 2010 and 31st of Dec 2011, was undertaken. Descriptive analysis and x2 tests were used to test associations between categorical variables, and the Wilcoxon rank-sum for associates between continuous variables which were not normally distributed. Content analysis was utilised to code free text fields. Results Six thousand one hundred thirty-five records were identified as intrapartum cases. This represented approximately 0.5% of the annual QAS caseload; 5722 were classified as maternal records and 413 were neonatal records. Paramedics recorded antenatal and/or intrapartum complications in 27.3% (n = 1563) of cases. Abnormal maternal vital signs were recorded in 30.1% (n = 1725) of cases. Of the 5722 women attended by paramedics during their labour, a birth occured in 10.8% (n = 618) of cases. Parity was documented in 41.4% (n = 256) of mothers who birthed. Neonatal records were available for 66.8% (n = 413) of actual births, 60.0% (n = 248) recorded a full set of neonatal vital signs and an Apgar score. When an Apgar score was recorded, 21.8% (n = 91) scored ≤7 out of 10. Conclusions The research described intrapartum, immediate postpartum and neonatal care provided by paramedics and identified factors that may complicate paramedic clinical management of labouring and birthing women. Further research is required to determine if there are opportunities to improve the paramedic management of such cases.
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Affiliation(s)
- Belinda Flanagan
- University of the Sunshine Coast, ML40, Locked bag 4, Maroochydore DC, Qld, 4558, Australia.
| | - Bill Lord
- University of the Sunshine Coast, ML40, Locked bag 4, Maroochydore DC, Qld, 4558, Australia
| | - Margaret Barnes
- University of the Sunshine Coast, ML40, Locked bag 4, Maroochydore DC, Qld, 4558, Australia
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