201
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Rosato E, Perrone G, Capri O, Galoppi P, Candelieri M, Marcoccia E, Schiavi MC, Zannini I, Brunelli R. Hypertension and early menopause after the use of assisted reproductive technologies in women aged 43 years or older: Long-term follow-up study. J Obstet Gynaecol Res 2016; 42:1782-1788. [PMID: 27718320 DOI: 10.1111/jog.13141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/16/2016] [Indexed: 01/23/2023]
Abstract
AIM The aim of this study was to investigate the long-term consequences to women's health and the onset of menopause in healthy women of advanced reproductive age who conceived by assisted reproductive technologies (ART). METHODS Healthy women who conceived by ART (72) and controls (80) were selected among 320 women ≥ 43 years, who delivered between January 2010 and December 2011 in the Department of Gynecological and Obstetrical Sciences and Urological Sciences of "Sapienza" University of Rome. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and presence of hypertension and diabetes were analyzed at three days, six months, and three years after delivery. The onset of menopause was analyzed after three years. RESULTS In the ART group, SBP, DBP and hypertension were higher at three days, six months, and three years after delivery. Menopausal age was significantly lower. CONCLUSION The impact of ART in healthy women of advanced reproductive age in the years after delivery is not limited to the possible development of cardiovascular risk factors, such as hypertension, but can also influence the age of onset of menopause.
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Affiliation(s)
- Elena Rosato
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppina Perrone
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Oriana Capri
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Paola Galoppi
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Miriam Candelieri
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Eleonora Marcoccia
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Michele Carlo Schiavi
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Zannini
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
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202
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Catov JM, Margerison-Zilko C. Pregnancy as a window to future health: short-term costs and consequences. Am J Obstet Gynecol 2016; 215:406-7. [PMID: 27686037 DOI: 10.1016/j.ajog.2016.06.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Janet M Catov
- Departments of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Magee-Womens Research Institute, Pittsburgh, PA.
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203
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Tan J, Liu X, Mao X, Yu J, Chen M, Li Y, Sun X. HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis. J Viral Hepat 2016; 23:812-9. [PMID: 27167604 DOI: 10.1111/jvh.12545] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/24/2016] [Indexed: 02/05/2023]
Abstract
Hepatitis B virus infection characterized by HBsAg positivity during pregnancy is a well-recognized issue in developing countries, but the association between HBsAg positivity and adverse maternal outcomes remains uncertain. To examine the association between HBsAg positivity during pregnancy and adverse maternal outcomes, a retrospective cohort study was conducted in Sichuan province, China. Deliveries were recorded from six hospitals between 1 January 2009 and 31 December 2010. Pre-eclampsia, gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), intrahepatic cholestasis, Caesarean section and placenta previa were prespecified adverse maternal outcomes. We used two multivariate logistic regression models to assess the association between HBsAg positivity and adverse maternal outcomes. In total, 948 (4.2%) pregnant women were HBsAg positive from 22 374 deliveries. Pregnant women with positive HBsAg had higher risk of GDM (aOR1.41, 95%CI 1.15-1.74), PPH (1.44, 1.13-1.83), intrahepatic cholestasis (1.74, 1.40-2.16) and Caesarean section (1.24, 1.06-1.45). No statistical associations were found between HBsAg positivity and pre-eclampsia (1.36, 0.94-1.97), and placenta previa (1.21, 0.87-1.67). HBsAg positivity during pregnancy was associated with higher risk of multiple adverse maternal outcomes. Although the causality has yet to be established, efforts may be warranted in routine care, particularly in those with high risk for adverse maternal outcomes, given the volume population infected with HBsAg. Future studies are needed to establish causality and examine the impact of HBeAg on the adverse outcomes.
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Affiliation(s)
- J Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,School of Public Health, Sichuan University, Chengdu, China.,Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - X Liu
- West China Women's and Children's Hospital, Sichuan University, Chengdu, China
| | - X Mao
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - J Yu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - M Chen
- West China Women's and Children's Hospital, Sichuan University, Chengdu, China
| | - Y Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - X Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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204
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Cain MA, Salemi JL, Tanner JP, Kirby RS, Salihu HM, Louis JM. Pregnancy as a window to future health: maternal placental syndromes and short-term cardiovascular outcomes. Am J Obstet Gynecol 2016; 215:484.e1-484.e14. [PMID: 27263996 DOI: 10.1016/j.ajog.2016.05.047] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/27/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among women. Identifying risk factors for future cardiovascular disease may lead to earlier lifestyle modifications and disease prevention. Additionally, interpregnancy development of cardiovascular disease can lead to increased perinatal morbidity in subsequent pregnancies. Identification and implementation of interventions in the short term (within 5 years of first pregnancy) may decrease morbidity in subsequent pregnancies. OBJECTIVE We identified the short-term risk (within 5 years of first pregnancy) of cardiovascular disease among women who experienced a maternal placental syndrome, as well as preterm birth and/or delivered a small-for-gestational-age infant. STUDY DESIGN We conducted a retrospective cohort study using a population-based, clinically enhanced database of women in the state of Florida. Nulliparous women and girls aged 15-49 years experiencing their first delivery during the study time period with no prepregnancy history of diabetes mellitus, hypertension, or heart or renal disease were included in the study. The risk of subsequent cardiovascular disease was compared among women who did and did not experience a placental syndrome during their first pregnancy. Risk was then reassessed among women with placental syndrome and preterm birth or delivering a small-for-gestational-age infant vs those without these adverse pregnancy outcomes. RESULTS The final study population was 302,686 women and girls. Median follow-up time for each patient was 4.9 years. The unadjusted rate of subsequent cardiovascular disease among women and girls with any placental syndrome (11.8 per 1000 women) was 39% higher than the rate among women and girls without a placental syndrome (8.5 per 1000 women). Even after adjusting for sociodemographic factors, preexisting conditions, and clinical and behavioral conditions associated with the current pregnancy, women and girls with any placental syndrome experienced a 19% increased risk of cardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.07-1.32). Women and girls with >1 placental syndrome had the highest cardiovascular disease risk (hazard ratio, 1.43; 95% confidence interval, 1.20-1.70), followed by those with eclampsia/preeclampsia alone (hazard ratio, 1.42; 95% confidence interval, 1.14-1.76). When placental syndrome was combined with preterm birth and/or small for gestational age, the adjusted risk of cardiovascular disease increased 45% (95% confidence interval, 1.24-1.71). Women and girls with placental syndrome who then developed cardiovascular disease experienced a 5-fold increase in health care-related costs during follow-up, compared to those who did not develop cardiovascular disease. CONCLUSION Women and girls experiencing placental syndromes and preterm birth or small-for-gestational-age infant are at increased risk of subsequent cardiovascular disease in short-term follow-up. Strategies to identify and improve cardiovascular disease risk in the postpartum period may improve future heart disease outcomes.
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Affiliation(s)
- Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL.
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Jean Paul Tanner
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
| | - Russell S Kirby
- Birth Defects Surveillance Program, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL
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205
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Kattah AG, Scantlebury DC, Agarwal S, Mielke MM, Rocca WA, Weaver AL, Vaughan LE, Miller VM, Weissgerber TL, White W, Garovic VD. Preeclampsia and ESRD: The Role of Shared Risk Factors. Am J Kidney Dis 2016; 69:498-505. [PMID: 27707553 DOI: 10.1053/j.ajkd.2016.07.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Several registry-based studies, using diagnostic codes, have suggested that preeclampsia is a risk factor for end-stage renal disease (ESRD). However, because the 2 diseases share risk factors, the true nature of their association remains uncertain. Our goals were to conduct a population-based study to determine the magnitude of the association between preeclampsia and ESRD and evaluate the role of shared risk factors. STUDY DESIGN Population-based nested case-control study. SETTING & PARTICIPANTS The US Renal Data System was used to identify women with ESRD from a cohort of 34,581 women who gave birth in 1976 to 2010 in Olmsted County, MN. 44 cases of ESRD were identified and each one was matched to 2 controls based on year of birth (±1 year), age at first pregnancy (±2 years), and parity (±1 or ≥4). PREDICTOR Preeclamptic pregnancy, confirmed by medical record review. OUTCOME ESRD. MEASUREMENTS Prepregnancy serum creatinine and urine protein measurements were recorded. Comorbid conditions existing prior to pregnancy were abstracted from medical records and included kidney disease, obesity, diabetes, and hypertension. RESULTS There was evidence of kidney disease prior to the first pregnancy in 9 of 44 (21%) cases and 1 of 88 (<1%) controls. Per chart review, 8 of 44 (18%) cases versus 4 of 88 (5%) controls had preeclamptic pregnancies (unadjusted OR, 4.0; 95% CI, 1.21-13.28). Results were similar after independent adjustment for race, education, diabetes, and hypertension prior to pregnancy. However, the association was attenuated and no longer significant after adjustment for obesity (OR, 3.25; 95% CI, 0.93-11.37). LIMITATIONS The limited number of ESRD cases and missing data for prepregnancy kidney function. CONCLUSIONS Our findings confirm that there is a sizable association between preeclampsia and ESRD; however, obesity is a previously unexplored confounder. Pre-existing kidney disease was common, but not consistently coded or diagnosed.
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Affiliation(s)
- Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Dawn C Scantlebury
- Department of Cardiovascular Services, The Queen Elizabeth Hospital, Barbados
| | - Sanket Agarwal
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Walter A Rocca
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Wendy White
- Division of Maternal Fetal Medicine, Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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206
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Gardiner HM. A Womb With a View. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005437. [PMID: 27601369 DOI: 10.1161/circimaging.116.005437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helena M Gardiner
- From The Fetal Center at Children's Memorial Hermann Hospital, McGovern Medical School at UTHealth, The University of Texas Health Science Center at Houston.
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207
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Cheong JN, Wlodek ME, Moritz KM, Cuffe JSM. Programming of maternal and offspring disease: impact of growth restriction, fetal sex and transmission across generations. J Physiol 2016; 594:4727-40. [PMID: 26970222 PMCID: PMC5009791 DOI: 10.1113/jp271745] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/16/2016] [Indexed: 12/16/2022] Open
Abstract
Babies born small are at an increased risk of developing myriad adult diseases. While growth restriction increases disease risk in all individuals, often a second hit is required to unmask 'programmed' impairments in physiology. Programmed disease outcomes are demonstrated more commonly in male offspring compared with females, with these sex-specific outcomes partly attributed to different placenta-regulated growth strategies of the male and female fetus. Pregnancy is known to be a major risk factor for unmasking a number of conditions and can be considered a 'second hit' for women who were born small. As such, female offspring often develop impairments of physiology for the first time during pregnancy that present as pregnancy complications. Numerous maternal stressors can further increase the risk of developing a maternal complication during pregnancy. Importantly, these maternal complications can have long-term consequences for both the mother after pregnancy and the developing fetus. Conditions such as preeclampsia, gestational diabetes and hypertension as well as thyroid, liver and kidney diseases are all conditions that can complicate pregnancy and have long-term consequences for maternal and offspring health. Babies born to mothers who develop these conditions are often at a greater risk of developing disease in adulthood. This has implications as a mechanism for transmission of disease across generations. In this review, we discuss the evidence surrounding long-term intergenerational implications of being born small and/or experiencing stress during pregnancy on programming outcomes.
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Affiliation(s)
- Jean N Cheong
- Department of Physiology, Faculty of Medicine, Dentistry and Health Sciences, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Mary E Wlodek
- Department of Physiology, Faculty of Medicine, Dentistry and Health Sciences, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Karen M Moritz
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - James S M Cuffe
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, 4072, Australia
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208
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Krentz AJ. Type 2 diabetes and atherosclerotic cardiovascular disease: do they share common antecedents? ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514020020050501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It has been suggested that the association between type 2 diabetes and atherosclerotic cardiovascular disease might result from a shared antecedent — the `common soil' hypothesis. The antecedent could provide a fundamental link between type 2 diabetes and atherosclerosis via the metabolic (or insulin resistance) syndrome. The relative contributions of genes, fetal nutrition and environmental factors to this syndrome remain unclear. Although most patients with type 2 diabetes have insulin resistance, it is uncertain whether the insulin resistance-hyperinsulinaemia complex directly promotes atherogenesis, and whether type 2 diabetes and atheroma are connected via a common mediator such as central obesity, vascular endothelial dysfunction, or disordered lipid metabolism. Insulin sensitivity and cardiovascular risk may be influenced by adipocytokines (e.g. leptin and adiponectin), by excess fatty acids liberated from visceral fat, and inflammatory processes. Disturbances of the neuro-endocrine system, possibly mediated via visceral obesity, are also under investigation. Other putative links between type 2 diabetes and atheroma include polymorphisms in the genes for tumour necrosis factor-α,insulin-like growth factor-1 promoter, and lamin A/C. Trials with certain cardioprotective agents including inhibitors of the renin-angiotensin-aldosterone system and statins can improve cardiovascular outcomes and protect against the development of type 2 diabetes, lending support to the common soil hypothesis.
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Affiliation(s)
- Andrew J Krentz
- Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK,
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209
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Kaartokallio T, Lokki AI, Peterson H, Kivinen K, Hiltunen L, Salmela E, Lappalainen T, Maanselkä P, Heino S, Knuutila S, Sayed A, Poston L, Brennecke SP, Johnson MP, Morgan L, Moses EK, Kere J, Laivuori H. Preeclampsia does not share common risk alleles in 9p21 with coronary artery disease and type 2 diabetes. Ann Med 2016; 48:330-6. [PMID: 27111527 DOI: 10.1080/07853890.2016.1174877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Preeclampsia is a common and partially genetic pregnancy complication characterized by hypertension and proteinuria. Association with cardiovascular disease and type 2 diabetes has been reported in 9p21 by several genome-wide association studies. It has been hypothesized that cardiometabolic diseases may share common etiology with preeclampsia. MATERIALS AND METHODS We tested association with the 9p21 region to preeclampsia in the Finnish population by genotyping 23 tagging single nucleotide polymorphisms (SNPs) in 15 extended preeclampsia families and in a nationwide cohort consisting of 281 cases and 349 matched controls. Replication was conducted in additional datasets. RESULTS Four SNPs (rs7044859, rs496892, rs564398 and rs7865618) showed nominal association (p ≤ 0.024 uncorrected) with preeclampsia in the case-control cohort. To increase power, we genotyped two SNPs in additional 388 cases and 341 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort. Partial replication was also attempted in a UK cohort (237 cases and 199 controls) and in 74 preeclamptic families from Australia/New Zealand. We were unable to replicate the initial association in the extended Finnish dataset or in the two international cohorts. CONCLUSIONS Our study did not find evidence for the involvement of the 9p21 region in the risk of preeclampsia. Key Message Chromosome 9p21 is not associated with preeclampsia.
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Affiliation(s)
- Tea Kaartokallio
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - A Inkeri Lokki
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,b Bacteriology and Immunology Department , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,c Immunobiology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hanna Peterson
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden
| | - Katja Kivinen
- e Division of Cardiovascular Medicine, University of Cambridge , Cambridge , UK
| | | | - Elina Salmela
- g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Tuuli Lappalainen
- i New York Genome Center , New York City , NY , USA ;,j Department of Systems Biology , Columbia University , New York City , NY , USA
| | - Paula Maanselkä
- k Institute of Biotechnology , University of Helsinki , Helsinki , Finland
| | - Sanna Heino
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sakari Knuutila
- l Department of Pathology , University of Helsinki , Helsinki , Finland
| | - Ayat Sayed
- m Department of Medical Biochemistry, Faculty of Medicine , Assiut University , Assiut , Egypt ;,n School of Molecular Medical Sciences , University of Nottingham , Nottingham , UK
| | - Lucilla Poston
- o Division of Women's Health , King's College London , London , UK
| | - Shaun P Brennecke
- p Department of Maternal-Fetal Medicine , Pregnancy Research Centre and University of Melbourne's Department of Obstetrics and Gynaecology, Royal Women's Hospital , Parkville , Victoria , Australia
| | - Matthew P Johnson
- q South Texas Diabetes and Obesity Institute, School of Medicine , University of Texas Rio Grande Valley , Brownsville , TX , USA
| | - Linda Morgan
- r School of Life Sciences , University of Nottingham , Nottingham , UK
| | - Eric K Moses
- s Faculty of Medicine Dentistry and Health Sciences , The University of Western Australia , Perth , Australia ;,t School of Biomedical Sciences , Faculty of Health Science, Curtin University , Perth , Australia ;,u Centre for Genetic Origins of Health and Disease, Medical Research Foundation , Royal Perth Hospital , Perth , Australia
| | - Juha Kere
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden ;,g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Hannele Laivuori
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,v Institute for Molecular Medicine Finland , University of Helsinki , Helsinki , Finland
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210
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Townsend R, O'Brien P, Khalil A. Current best practice in the management of hypertensive disorders in pregnancy. Integr Blood Press Control 2016; 9:79-94. [PMID: 27555797 PMCID: PMC4968992 DOI: 10.2147/ibpc.s77344] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%–26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition. In addition it is known that preeclampsia is a risk factor for cardiovascular disease in both the mother and the child and presents an opportunity for early preventative measures. New tools for early detection, prevention, and management of preeclampsia have the potential to revolutionize practice in the coming years. This review presents the current best practice in diagnosis and management of preeclampsia and the hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, St George's University of London, London, UK
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211
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Long-Term Mortality After Hypertensive Disease of Pregnancy. Obstet Gynecol 2016; 128:231-233. [PMID: 27399993 DOI: 10.1097/aog.0000000000001537] [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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212
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Alvarez-Alvarez B, Martell-Claros N, Abad-Cardiel M, García-Donaire JA. [Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:85-92. [PMID: 27394656 DOI: 10.1016/j.hipert.2016.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women.
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Affiliation(s)
| | - N Martell-Claros
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España.
| | - M Abad-Cardiel
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España
| | - J A García-Donaire
- Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, España
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213
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare, but life-threatening condition that occurs during the peripartum period in previously healthy women. Although its etiology remains unknown, potential risk factors include hypertensive disorders during pregnancy, such as preeclampsia, advanced maternal age, multiparity, multiple gestation, and African descent. Several cohort studies of PPCM revealed that the prevalence of these risk factors was quite similar. Clinically, approximately 40% of PPCM patients are complicated with hypertensive disorders during pregnancy. Because PPCM is a diagnosis of exclusion, heterogeneity is a common element in its pathogenesis. Recent genetic research has given us new aspects of the disease. PPCM and dilated cardiomyopathy (DCM) share genetic predisposition: 15% of PPCM patients were found to have genetic mutations that have been associated with DCM, and they showed a lower recovery rate. Other basic research using PPCM model mice suggests that predisposition genes related to both hypertensive and cardiac disorders via angiogenic imbalance may explain common elements of hypertensive disorders and PPCM. Furthermore, hypertensive disorders during pregnancy are now found to be a risk factor of not only PPCM, but also cardiomyopathy in the future. Understanding genetic variations allows us to stratify PPCM patients and to guide therapy. (Circ J 2016; 80: 1684-1688).
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Affiliation(s)
- Chizuko A Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
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214
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Charach R, Wolak T, Shoham-Vardi I, Sergienko R, Sheiner E. Can slight glucose intolerance during pregnancy predict future maternal atherosclerotic morbidity? Diabet Med 2016; 33:920-5. [PMID: 26606683 DOI: 10.1111/dme.13036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
Abstract
AIM o examine the association between glucose level during pregnancy and the subsequent development of long-term maternal atherosclerotic morbidity. METHODS A retrospective case-control study was conducted. The study included all women who had at least one glucose measurement during their pregnancies. Cases were all women who delivered between the years 2000-2012 and subsequently developed atherosclerotic morbidity (n = 815). Controls were randomly matched by age and year of delivery (n = 6065). The atherosclerotic morbidity group was further divided by severity: major events (cardiovascular, cerebrovascular disease, chronic renal failure), minor events (hypertension, diabetes mellitus and hyperlipidaemia without target organ damage or complications) and cardiac evaluation tests (such as coronary angiography without records of atherosclerosis, cardiac scan and stress test). The mean follow-up duration for the study group was 74 months. Cox proportional hazards model was used to control for confounders. RESULTS A significant linear association was found between glucose levels during pregnancy and long-term maternal atherosclerotic morbidity. Among the cases with severe atherosclerotic morbidity, the proportion of women with a high glucose level (> 5.5 mmol/l) was the highest, whereas in controls it was the lowest (P < 0.001). In a Cox proportional hazard model, adjusted for atherosclerotic confounders such as gestational diabetes, pre-eclampsia and obesity, a glucose level of > 5.5 mmol/l was noted as an independent risk factor for hospitalizations later in non-pregnant life (hazard ratio = 1.3, 95% confidence interval 1.1-1.5, P < 0.003). CONCLUSION A high glucose level during pregnancy, even if within the range of slight glucose intolerance, may serve as a marker for future maternal atherosclerotic morbidity. Further long-term studies are needed to confirm our findings.
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Affiliation(s)
- R Charach
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Wolak
- Hypertension Unit, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Shoham-Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - R Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - E Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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215
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Tooher J, Thornton C, Makris A, Ogle R, Korda A, Horvath J, Hennessy A. Hypertension in pregnancy and long-term cardiovascular mortality: a retrospective cohort study. Am J Obstet Gynecol 2016; 214:722.e1-6. [PMID: 26739795 DOI: 10.1016/j.ajog.2015.12.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is growing evidence that hypertensive disorders of pregnancy are associated with increased long-term cardiovascular mortality in the mother. Hypertension in pregnancy, until recently, however, has been ignored largely as a risk factor for future cardiovascular disease and mortality because the link between the 2 is not fully understood. OBJECTIVE To determine the association between women with hypertension in pregnancy and long-term cardiovascular disease mortality. STUDY DESIGN All women who delivered at a metropolitan hospital between the periods of January 1, 1980, and December 31, 1989, were identified by use of the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification. RESULTS The total number of deliveries in the given time period was 31,656, with 4387 (14%) of the women identified as having had hypertension in their pregnancy. Using information from the New South Wales Births, Deaths and Marriages Registry and the Australian Bureau of Statistics Death Registry, we identified a total of 651 deaths from this cohort (n = 31,656). There were 521 deaths among the women who remained normotensive in their pregnancy and 129 deaths for women who had hypertension during their pregnancy. Overall, the women with hypertensive disorders of pregnancy were at greater risk of death than the women who remained normotensive in their pregnancy (odds ratio 1.56; 95% confidence interval 1.28-1.89; P < .001). CONCLUSION Women with a history of hypertension in their pregnancy are at an increased risk of future cardiovascular mortality, and this work identifies a group of women who may benefit from early screening and intervention strategies to help decrease their risk of future cardiovascular disease.
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Affiliation(s)
- Jane Tooher
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia.
| | - Charlene Thornton
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
| | - Angela Makris
- Liverpool Hospital, Renal Department, Liverpool, NSW, Australia
| | - Robert Ogle
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Korda
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
| | - John Horvath
- The University of Sydney, Honorary Professor Sydney Medical School, Camperdown, NSW, Australia
| | - Annemarie Hennessy
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
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216
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Sanghavi M, Gulati M. Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention. Obstet Gynecol Clin North Am 2016; 43:265-85. [PMID: 27212092 DOI: 10.1016/j.ogc.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease remains the leading cause of death in the United States. Primary prevention of cardiovascular disease requires involvement of an extended health care team. Obstetricians and gynecologists are uniquely positioned within the health care system because they are often the primary or only contact women have with the system. This review article discusses initial assessment, treatment recommendations, and practical tips regarding primary and secondary prevention of cardiovascular disease in women with a focus on coronary heart disease; discussion includes peripheral and cerebrovascular disease.
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Affiliation(s)
- Monika Sanghavi
- Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona-Phoenix, 1300 North 12th Street, Suite 407, Phoenix, AZ 85006, USA.
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217
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McDonald EG, Dayan N, Pelletier R, Eisenberg MJ, Pilote L. Premature cardiovascular disease following a history of hypertensive disorder of pregnancy. Int J Cardiol 2016; 219:9-13. [PMID: 27257849 DOI: 10.1016/j.ijcard.2016.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population. METHODS GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome. RESULTS The median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22-8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60-3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23-1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease. CONCLUSION In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
| | - Natalie Dayan
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Roxanne Pelletier
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec
| | - Mark J Eisenberg
- Division of Cardiology, Department of Medicine, McGill University, Canada
| | - Louise Pilote
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
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218
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Romagnuolo I, Sticchi E, Attanasio M, Grifoni E, Cioni G, Cellai AP, Abbate R, Fatini C. Searching for a common mechanism for placenta-mediated pregnancy complications and cardiovascular disease: role of lipoprotein(a). Fertil Steril 2016; 105:1287-1293.e3. [DOI: 10.1016/j.fertnstert.2016.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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219
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Iino K, Higuchi T, Ogawa M, Yamauchi Y, Misaki N, Tanaka K, Takahashi I, Mizunuma H. Blood pressure during pregnancy is a useful predictive maker for hypertension and dyslipidemia later in life, a population-based, cross-sectional study. Maturitas 2016; 87:84-8. [DOI: 10.1016/j.maturitas.2016.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/15/2016] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
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220
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Egeland GM, Klungsøyr K, Øyen N, Tell GS, Næss Ø, Skjærven R. Preconception Cardiovascular Risk Factor Differences Between Gestational Hypertension and Preeclampsia: Cohort Norway Study. Hypertension 2016; 67:1173-80. [PMID: 27113053 PMCID: PMC4861703 DOI: 10.1161/hypertensionaha.116.07099] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Preconception predictors of gestational hypertension and preeclampsia may identify opportunities for early detection and improve our understanding of the pathogenesis and life course epidemiology of these conditions. Female participants in community-based Cohort Norway health surveys, 1994 to 2003, were prospectively followed through 2012 via record linkages to Medical Birth Registry of Norway. Analyses included 13 217 singleton pregnancies (average of 1.59 births to 8321 women) without preexisting hypertension. Outcomes were gestational hypertension without proteinuria (n=237) and preeclampsia (n=429). Mean age (SD) at baseline was 27.9 years (4.5), and median follow-up was 4.8 years (interquartile range 2.6–7.8). Gestational hypertension and preeclampsia shared several baseline risk factors: family history of diabetes mellitus, pregravid diabetes mellitus, a high total cholesterol/high-density lipoprotein cholesterol ratio (>5), overweight and obesity, and elevated blood pressure status. For preeclampsia, a family history of myocardial infarction before 60 years of age and elevated triglyceride levels (≥1.7 mmol/L) also predicted risk while physical activity was protective. Preterm preeclampsia was predicted by past-year binge drinking (≥5 drinks on one occasion) with an adjusted odds ratio of 3.7 (95% confidence interval 1.3–10.8) and by past-year physical activity of ≥3 hours per week with an adjusted odds ratio of 0.5 (95% confidence interval 0.3–0.8). The results suggest similarities and important differences between gestational hypertension, preeclampsia, and preterm preeclampsia. Modifiable risk factors could be targeted for improving pregnancy outcomes and the short- and long-term sequelae for mothers and offspring.
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Affiliation(s)
- Grace M Egeland
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.).
| | - Kari Klungsøyr
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.)
| | - Nina Øyen
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.)
| | - Grethe S Tell
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.)
| | - Øyvind Næss
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.)
| | - Rolv Skjærven
- From the Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway (G.M.E., K.K., N.Ø., G.S.T., R.S.); Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway (G.M.E., K.K., G.S.T., Ø.N., R.S.); and Institute of Health and Society, Blindern, University of Oslo, Oslo, Norway (Ø.N.)
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221
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Wijnands K, van Uitert E, Roeters van Lennep J, Koning A, Mulders A, Laven J, Steegers E, Steegers-Theunissen R. The periconception maternal cardiovascular risk profile influences human embryonic growth trajectories in IVF/ICSI pregnancies. Hum Reprod 2016; 31:1173-81. [DOI: 10.1093/humrep/dew060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/18/2016] [Indexed: 11/14/2022] Open
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222
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Soh MC, Dib F, Nelson-Piercy C, Westgren M, McCowan L, Pasupathy D. Maternal-placental syndrome and future risk of accelerated cardiovascular events in Parous Swedish women with systemic lupus erythematosus - a population-based retrospective cohort study with time-to-event analysis. Rheumatology (Oxford) 2016; 55:1235-42. [PMID: 27016663 DOI: 10.1093/rheumatology/kew043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Women with SLE are at increased risk of cardiovascular events (CVEs), but a relationship with traditional cardiovascular and SLE-specific risk factors has not been established. In unselected populations, adverse pregnancy outcomes linked to maternal-placental syndrome (MPS) are associated with an increased risk of CVEs. However, the effect of MPS on CVEs is unknown in women with SLE. The aim of this study was to determine if MPS increased the risk and accelerated the development of CVEs in women with SLE. METHODS Utilizing Swedish population registries, parous women with SLE were identified. Exposures were the following: MPS defined as hypertensive disorders of pregnancy; small-for-gestational-age; placental abruption and stillbirth; and preterm delivery <34 weeks. Outcomes were CVE encompassing cardiovascular morbidity and mortality. Risk of an event was modelled using Cox proportional hazards adjusted for year of delivery, age at CVE, severity of SLE and cardiovascular risk factors. Time-to-CVE was estimated using Kaplan-Meier methods. RESULTS Over the 38-year study period, there were 3977 women with 7410 pregnancies, of whom 413 (10.2%) suffered a CVE. Hazard of CVE was higher in those with MPS, particularly when MPS (adjusted HR = 1.64; 95% CI: 1.31, 2.05) was combined with preterm delivery < 34 weeks' gestation (adjusted HR 1.99; 95% CI 1.39, 2.84). There was accelerated development of CVEs in women with MPS of 10.5% (vs 7.3% in uncomplicated pregnancies) over the 38-year interval (P < 0.05). CONCLUSION Pregnancy complicated by MPS and preterm delivery exerts an independent effect to increase the risk and accelerate the development of CVEs in parous women with SLE.
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Affiliation(s)
- May Ching Soh
- Division of Women's Health, Women's Health Academic Centre, King's College London, King's Health Partners, London, UK Department of Obstetrics & Gynaecology, South Auckland Clinical School, University of Auckland & National Women's Health, Auckland, New Zealand
| | - Fadia Dib
- Division of Women's Health, Women's Health Academic Centre, King's College London, King's Health Partners, London, UK
| | - Catherine Nelson-Piercy
- Division of Women's Health, Women's Health Academic Centre, King's College London, King's Health Partners, London, UK
| | - Magnus Westgren
- Department of Clinical Science, Intervention and Technology Karolinska Institutet, Sweden
| | - Lesley McCowan
- Department of Obstetrics & Gynaecology, South Auckland Clinical School, University of Auckland & National Women's Health, Auckland, New Zealand
| | - Dharmintra Pasupathy
- Division of Women's Health, Women's Health Academic Centre, King's College London, King's Health Partners, London, UK
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223
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Appiah D, Schreiner PJ, Gunderson EP, Konety SH, Jacobs DR, Nwabuo CC, Ebong IA, Whitham HK, Goff DC, Lima JA, Ku IA, Gidding SS. Association of Gestational Diabetes Mellitus With Left Ventricular Structure and Function: The CARDIA Study. Diabetes Care 2016; 39:400-7. [PMID: 26740637 PMCID: PMC4764033 DOI: 10.2337/dc15-1759] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/04/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mechanisms linking GDM to CVD beyond intervening incident diabetes are not well understood. We examined the relation of GDM with echocardiographic parameters of left ventricular (LV) structure and function, which are important predictors of future CVD risk. RESEARCH DESIGN AND METHODS We studied 609 women (43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who delivered one or more births during follow-up and had echocardiograms in 1990-1991 (mean age 28.8 years) and 2010-2011. RESULTS During the 20-year follow-up, 965 births were reported, with GDM developing in 64 women (10.5%). In linear regression models adjusted for sociodemographic factors, BMI, physical activity, parity, smoking, use of oral contraceptives, alcohol intake, family history of coronary heart disease, systolic blood pressure, and lipid levels, women with GDM had impaired longitudinal peak strain (-15.0 vs. -15.7%, P = 0.025), circumferential peak strain (-14.8 vs. -15.6%, P = 0.028), lateral e' wave velocity (11.0 vs. 11.8 cm/s, P = 0.012), and septal e' wave velocity (8.6 vs. 9.3 cm/s, P = 0.015) in 2010-2011 and a greater 20-year increase in LV mass indexed to body surface area (14.3 vs. 6.0 g/m(2), P = 0.006) compared with women with non-GDM pregnancies. Further adjustment for incident type 2 diabetes after pregnancy did not attenuate these associations. CONCLUSIONS Pregnancy complicated by GDM is independently associated with increased LV mass and impaired LV relaxation and systolic function. Implementation of postpartum cardiovascular health interventions in women with a history of GDM may offer an additional opportunity to reduce future CVD risk.
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Affiliation(s)
| | | | | | | | | | | | - Imo A Ebong
- University of Arizona College of Medicine, Tucson, AZ
| | | | | | | | - Ivy A Ku
- Kaiser Permanente San Francisco, San Francisco, CA
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van Kesteren F, Visser S, Hermes W, Teunissen PW, Franx A, van Pampus MG, Mol BW, de Groot CJ. Counselling and management of cardiovascular risk factors after preeclampsia. Hypertens Pregnancy 2016; 35:55-61. [DOI: 10.3109/10641955.2015.1100311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Floortje van Kesteren
- Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, The Netherlands
- Heart Centre, Academic Medical Centre, Amsterdam, The Netherlands
| | - Sanne Visser
- Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Zaans Medical Centre Zaandam, The Netherlands
| | - Wietske Hermes
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Pim W. Teunissen
- Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maria G. van Pampus
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ben W. Mol
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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225
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Pregnancy-induced hypertension is associated with an increase in the prevalence of cardiovascular disease risk factors in Japanese women. Menopause 2016; 22:656-9. [PMID: 25387344 DOI: 10.1097/gme.0000000000000361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study assessed whether pregnancy-induced hypertension (PIH) affects the prevalence of cardiovascular disease (CVD) risk factors in later life among Japanese women. METHODS Study participants were 1,185 women (mean [SD] age, 46.5 [5.6] y; range, 38-73 y) aged 40 years or older who underwent a health checkup at a periodic health examination facility between January 2012 and December 2013 and had experienced giving birth. Questionnaires were sent to potential participants, and they were encouraged to provide their Maternal and Child Health Handbook (handbook). We recruited 101 women with a history of PIH (PIH group) and 1,084 women with uncomplicated pregnancy at delivery (control group). Groupings were based on information from the handbook. We assessed the association between PIH and CVD in later life among Japanese women by focusing on hypertension, diabetes mellitus, and dyslipidemia as risk factors for CVD. Odds ratios (ORs) for the use of antihypertensive, diabetes mellitus, and dyslipidemic medications in the PIH group were determined. RESULTS Women with PIH had increased risk of antihypertensive medication use compared with women without PIH (2.9% vs 13.9%; OR, 4.28; 95% CI, 2.14-8.57). Triglycerides were significantly higher and high-density lipoprotein cholesterol was significantly lower in the PIH group than in the control group. The OR for dyslipidemic medication use in the PIH group relative to the control group was 3.20 (95% CI, 1.42-7.22). CONCLUSIONS Our findings suggest that a history of PIH may be associated with an increased risk of hypertension (a risk factor for CVD) in later life among Japanese women.
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226
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Cheng PJ, Huang SY, Su SY, Hsiao CH, Peng HH, Duan T. Prognostic Value of Cardiovascular Disease Risk Factors Measured in the First-Trimester on the Severity of Preeclampsia. Medicine (Baltimore) 2016; 95:e2653. [PMID: 26844488 PMCID: PMC4748905 DOI: 10.1097/md.0000000000002653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent studies have suggested that preeclampsia and cardiovascular disease may share common mechanisms. The purpose of this prospective nested case-controlled study was to characterize a variety of cardiovascular disease risk factors measured during the first trimester of pregnancy in predicting subsequent outcomes and the severity of preeclampsia.We ascertained the severity of preeclampsia at the onset of the disease, and the presence of intrauterine growth restriction (IUGR). We compared first trimester maternal serum cardiovascular disease risk factors in preeclampsia subjects versus normal pregnancies, early-onset versus late-onset preeclampsia, and preeclampsia with IUGR versus without IUGR. To identify the prognostic value of independent predictors on the severity of preeclampsia, we calculated the area under the receiver operating characteristics curve (AUC) using logistic regression analysis.There were 134 cases of preeclampsia and 150 uncomplicated pregnancies, and preeclampsia cases were classified as early-onset (53 cases) or late-onset (81 cases), or as with IUGR (44 cases) or without IUGR (90 cases). Among the cardiovascular disease risk factors, maternal serum high-sensitive C-reactive protein (hsCRP) and homocysteine were predictors of both early-onset preeclampsia and preeclampsia with IUGR. For the detection of early onset preeclampsia or preeclampsia with IUGR, the AUC for the combination model (0.943 and 0.952, respectively) was significantly higher than with serum hsCRP or serum homocysteine only.Patients with preeclampsia can be subdivided into different severities according to time of onset and fetal weight. Cardiovascular risk factors distinguish a subgroup of these patients.
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Affiliation(s)
- Po-Jen Cheng
- From the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital-Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan (PJC, SYH, SYS, HHP); Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei, Taiwan, R.O.C. (CHH); and Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, P.R. China (TD)
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227
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Goueslard K, Cottenet J, Mariet AS, Giroud M, Cottin Y, Petit JM, Quantin C. Early cardiovascular events in women with a history of gestational diabetes mellitus. Cardiovasc Diabetol 2016; 15:15. [PMID: 26817691 PMCID: PMC4728938 DOI: 10.1186/s12933-016-0338-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/14/2016] [Indexed: 12/25/2022] Open
Abstract
Background The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum. Methods This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid endarterectomy and fibrinolysis. Hypertensive disease was assessed separately. Determinants studied included age, obesity, subsequent diabetes mellitus and hypertensive diseases during pregnancy. Adjusted odds ratios for outcomes were calculated using multiple logistic regressions. Results The hospital database recorded 1,518,990 deliveries in 2007 and 2008. Among these, 62,958 women had a history of GDM. After adjusting for age, DM, obesity and hypertensive disorders in pregnancy, GDM was significantly associated with a higher risk of CVD (adjusted Odds Ratio aOR = 1.25 [1.09–1.43]). Considering each variable in a separate model, GDM was associated with angina pectoris (aOR = 1.68 [1.29–2.20]), myocardial infarction (aOR = 1.92 [1.36–2.71]) and hypertension (aOR = 2.72 [2.58–2.88]) but not with stroke. Conclusions A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported.
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Affiliation(s)
- Karine Goueslard
- CHRU Dijon, Service de Biostatistique et d'Informatique Médicale (DIM), Université de Bourgogne, 21000, Dijon, France.
| | - Jonathan Cottenet
- CHRU Dijon, Service de Biostatistique et d'Informatique Médicale (DIM), Université de Bourgogne, 21000, Dijon, France.
| | - Anne-Sophie Mariet
- CHRU Dijon, Service de Biostatistique et d'Informatique Médicale (DIM), Université de Bourgogne, 21000, Dijon, France.
| | - Maurice Giroud
- Registre dijonnais des AVC, INSERM, INVS, EA4184, Univ. Bourgogne Franche-Comté, 21000, Dijon, France.
| | - Yves Cottin
- Service de Cardiologie, CHRU Dijon, 21000, Dijon, France.
| | - Jean-Michel Petit
- Centre de Recherche INSERM Unité 866, Univ. Bourgogne Franche-Comté, 21000, Dijon, France. .,Services de diabétologie et endocrinologie, CHRU Dijon, 21000, Dijon, France. .,Centre Hospitalier Universitaire, BP 77908, 21079, Dijon Cedex, France.
| | - Catherine Quantin
- CHRU Dijon, Service de Biostatistique et d'Informatique Médicale (DIM), Université de Bourgogne, 21000, Dijon, France. .,Clinical Investigation Center, clinical epidemiology/clinical trials unit, INSERM CIC 1432, Dijon University Hospital, 21000, Dijon, France. .,INSERM, UMR1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Univ. Bourgogne Franche-Comté, 21000, Dijon, France.
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228
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Ahmed A, Ramma W. Unravelling the theories of pre-eclampsia: are the protective pathways the new paradigm? Br J Pharmacol 2016; 172:1574-86. [PMID: 25303561 PMCID: PMC4354257 DOI: 10.1111/bph.12977] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/30/2014] [Accepted: 10/05/2014] [Indexed: 01/03/2023] Open
Abstract
Pre-eclampsia is a vascular disorder of pregnancy where anti-angiogenic factors, systemic inflammation and oxidative stress predominate, but none can claim to cause pre-eclampsia. This review provides an alternative to the ‘two-stage model’ of pre-eclampsia in which abnormal spiral arteries modification leads to placental hypoxia, oxidative stress and aberrant maternal systemic inflammation. Very high maternal soluble fms-like tyrosine kinase-1 (sFlt-1 also known as sVEGFR) and very low placenta growth factor (PlGF) are unique to pre-eclampsia; however, abnormal spiral arteries and excessive inflammation are also prevalent in other placental disorders. Metaphorically speaking, pregnancy can be viewed as a car with an accelerator and brakes, where inflammation, oxidative stress and an imbalance in the angiogenic milieu act as the ‘accelerator’. The ‘braking system’ includes the protective pathways of haem oxygenase 1 (also referred as Hmox1 or HO-1) and cystathionine-γ-lyase (also known as CSE or Cth), which generate carbon monoxide (CO) and hydrogen sulphide (H2S) respectively. The failure in these pathways (brakes) results in the pregnancy going out of control and the system crashing. Put simply, pre-eclampsia is an accelerator–brake defect disorder. CO and H2S hold great promise because of their unique ability to suppress the anti-angiogenic factors sFlt-1 and soluble endoglin as well as to promote PlGF and endothelial NOS activity. The key to finding a cure lies in the identification of cheap, safe and effective drugs that induce the braking system to keep the pregnancy vehicle on track past the finishing line.
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Affiliation(s)
- Asif Ahmed
- Vascular Therapeutics Unit, Aston Medical School, Aston University, Birmingham, UK
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Intrauterine Growth Retardation (IUGR) as a Novel Condition of Insulin-Like Growth Factor-1 (IGF-1) Deficiency. Rev Physiol Biochem Pharmacol 2016; 170:1-35. [DOI: 10.1007/112_2015_5001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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230
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Ahmed A, Rezai H, Broadway-Stringer S. Evidence-Based Revised View of the Pathophysiology of Preeclampsia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:355-374. [PMID: 27873232 DOI: 10.1007/5584_2016_168] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Preeclampsia is a life-threatening vascular disorder of pregnancy due to a failing stressed placenta. Millions of women risk death to give birth each year and globally each year, almost 300,000 lose their life in this process and over 500,000 babies die as a consequence of preeclampsia. Despite decades of research, we lack pharmacological agents to treat it. Maternal endothelial oxidative stress is a central phenomenon responsible for the preeclampsia phenotype of high maternal blood pressure and proteinuria. In 1997, it was proposed that preeclampsia arises due to the loss of VEGF activity, possibly due to elevation in anti-angiogenic factor, soluble Flt-1 (sFlt-1). Researchers showed that high sFlt-1 and soluble endoglin (sEng) elicit the severe preeclampsia phenotype in pregnant rodents. We demonstrated that heme oxygenase-1 (HO-1)/carbon monoxide (CO) pathway prevents placental stress and suppresses sFlt-1 and sEng release. Likewise, hydrogen sulphide (H2S)/cystathionine-γ-lyase (Cth) systems limit sFlt-1 and sEng and protect against the preeclampsia phenotype in mice. Importantly, H2S restores placental vasculature, and in doing so improves lagging fetal growth. These molecules act as the inhibitor systems in pregnancy and when they fail, preeclampsia is triggered. In this review, we discuss what are the hypotheses and models for the pathophysiology of preeclampsia on the basis of Bradford Hill causation criteria for disease causation and how further in vivo experimentation is needed to establish 'proof of principle'. Hypotheses that fail to meet the Bradford Hill causation criteria include abnormal spiral artery remodelling and inflammation and should be considered associated or consequential to the disorder. In contrast, the protection against cellular stress hypothesis that states that the protective pathways mitigate cellular stress by limiting elevation of anti-angiogenic factors or oxidative stress and the subsequent clinical signs of preeclampsia appear to fulfil most of Bradford Hill causation criteria. Identifying the candidates on the roadmap to this pathway is essential in developing diagnostics and therapeutics to target the pathogenesis of preeclampsia.
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Affiliation(s)
- Asif Ahmed
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
| | - Homira Rezai
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
| | - Sophie Broadway-Stringer
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, B4 7ET, UK
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231
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Rom AL, Wu CS, Olsen J, Jawaheer D, Hetland ML, Ottesen B, Mørch LS. Parental rheumatoid arthritis and long-term child morbidity: a nationwide cohort study. Ann Rheum Dis 2015; 75:1831-7. [PMID: 26698849 DOI: 10.1136/annrheumdis-2015-208072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/13/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate the influence of parental rheumatoid arthritis (RA) on child morbidity. DESIGN Nationwide cohort study. SETTING Individual linkage to nationwide Danish registries. PARTICIPANTS All singletons born in Denmark during 1977-2008 (n=1 917 723) were followed for an average of 16 years. MAIN OUTCOME MEASURES Adjusted HRs for child morbidity; that is, 11 main diagnostic groups and specific autoimmune diseases within the International Classification of Diseases 8th and 10th versions. RESULTS Compared with unexposed children, children exposed to maternal RA ('clinical' and 'preclinical') (n=13 566) had up to 26% higher morbidity in 8 of 11 main diagnostic groups. Similar tendencies were found in children exposed to paternal RA ('clinical' and 'preclinical') (n=6330), with statistically significantly higher morbidity in 6 of 11 diagnostic groups. HRs were highest for autoimmune diseases with up to three times increased risk of juvenile idiopathic arthritis (HR, 95% CI 3.30, 2.71 to 4.03 and 2.97, 2.20 to 4.01) and increased risk of up to 40% of diabetes mellitus type 1 (HR, 95% CI 1.37, 1.12 to 1.66 and 1.44, 1.09 to 1.90) and up to 30% increased HR of asthma (HR, 95% CI 1.28, 1.20 to 1.36 and 1.15, 1.04 to 1.26). Conclusions were roughly similar for children exposed to maternal clinical RA and for children only followed up to 16 years of age. CONCLUSION Children of parents with RA had consistent excess morbidity. If the associations reflect biological mechanisms, genetic factors seem to play an important role. These findings call for attention given to children of parents with RA.
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Affiliation(s)
- Ane Lilleøre Rom
- Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Chun Sen Wu
- Section for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Damini Jawaheer
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Glostrup Hospital, Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bent Ottesen
- Department of Obstetrics and Gynecology, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lina Steinrud Mørch
- Gynaecological Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Virus, Lifestyle and Genes Unit, Danish Cancer Society Research Centre, Copenhagen, Denmark
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232
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Human placenta-derived stromal cells decrease inflammation, placental injury and blood pressure in hypertensive pregnant mice. Clin Sci (Lond) 2015; 130:513-23. [PMID: 26685104 DOI: 10.1042/cs20150555] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia, the development of hypertension and proteinuria or end-organ damage during pregnancy, is a leading cause of both maternal and fetal morbidity and mortality, and there are no effective clinical treatments for pre-eclampsia aside from delivery. The development of pre-eclampsia is characterized by maladaptation of the maternal immune system, excessive inflammation and endothelial dysfunction. We have reported that detection of extracellular RNA by the Toll-like receptors (TLRs) 3 and 7 is a key initiating signal that contributes to the development of pre-eclampsia. PLacental eXpanded (PLX-PAD) cells are human placenta-derived, mesenchymal-like, adherent stromal cells that have anti-inflammatory, proangiogenic, cytoprotective and regenerative properties, secondary to paracrine secretion of various molecules in response to environmental stimulation. We hypothesized that PLX-PAD cells would reduce the associated inflammation and tissue damage and lower blood pressure in mice with pre-eclampsia induced by TLR3 or TLR7 activation. Injection of PLX-PAD cells on gestational day 14 significantly decreased systolic blood pressure by day 17 in TLR3-induced and TLR7-induced hypertensive mice (TLR3 144-111 mmHg; TLR7 145-106 mmHg; both P<0.05), and also normalized their elevated urinary protein:creatinine ratios (TLR3 5.68-3.72; TLR7 5.57-3.84; both P<0.05). On gestational day 17, aortic endothelium-dependent relaxation responses improved significantly in TLR3-induced and TLR7-induced hypertensive mice that received PLX-PAD cells on gestational day 14 (TLR3 35-65%; TLR7 37-63%; both P<0.05). In addition, markers of systemic inflammation and placental injury, increased markedly in both groups of TLR-induced hypertensive mice, were reduced by PLX-PAD cells. Importantly, PLX-PAD cell therapy had no effects on these measures in pregnant control mice or on the fetuses. These data demonstrate that PLX-PAD cell therapy can safely reverse pre-eclampsia-like features during pregnancy and have a potential therapeutic role in pre-eclampsia treatment.
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Staff AC, Redman CWG, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EAP, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM. Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension 2015; 67:251-60. [PMID: 26667417 DOI: 10.1161/hypertensionaha.115.06357] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Cathrine Staff
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Christopher W G Redman
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - David Williams
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Paul Leeson
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Basky Thilaganathan
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Per Magnus
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eric A P Steegers
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eleni Z Tsigas
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Roberta B Ness
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Leslie Myatt
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Lucilla Poston
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - James M Roberts
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
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Parets SE, Knight AK, Smith AK. Insights into genetic susceptibility in the etiology of spontaneous preterm birth. APPLICATION OF CLINICAL GENETICS 2015; 8:283-90. [PMID: 26715857 PMCID: PMC4685889 DOI: 10.2147/tacg.s58612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Preterm birth (PTB; <37 weeks of gestation) is a complex disorder, whose etiology is influenced by a variety of factors. A greater understanding of the biological mechanisms that contribute to PTB will facilitate identification of those at increased risk and may inform new treatments. To accomplish this, it is vital to elucidate the heritability patterns of this condition as well as the environment and lifestyle factors that increase risk for PTB. Identifying individual genes that contribute to the etiology of PTB presents particular challenges, and there has been little agreement among candidate gene and genome-wide studies performed to date. In this review we will evaluate recent genetic studies of spontaneous PTB, discuss common themes among their findings, and suggest approaches for future studies of PTB.
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Affiliation(s)
- Sasha E Parets
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Anna K Knight
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA ; Genetics and Molecular Biology Program, Emory University, Atlanta, GA, USA
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235
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Stergiotou I, Bijnens B, Cruz-Lemini M, Figueras F, Gratacos E, Crispi F. Maternal subclinical vascular changes in fetal growth restriction with and without pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:706-712. [PMID: 25678131 DOI: 10.1002/uog.14815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 02/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess maternal vascular structure and function in pregnancies complicated by fetal growth restriction (FGR), in women with and without pre-eclampsia (PE) at the time of FGR diagnosis. METHODS We evaluated 124 women with a pregnancy complicated by FGR, of whom 60 had PE and 64 did not, and compared these findings to those of 110 normal women (controls). The group of FGR pregnancies without PE was further subdivided according to gestational age at FGR diagnosis into early onset (< 32 weeks) or late onset (≥ 32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS) and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. RESULTS Compared to controls, cases of FGR with PE showed increased maternal carotid IMT (0.425 (interquartile range (IQR), 0.381-0.486) vs 0.409 (IQR, 0.386-0.439) mm; P = 0.021), BP (mean, 109 (IQR, 101-117) vs 82 (IQR, 77-89) mmHg; P < 0.001) and CWS (19.7 (IQR, 17.0-22.7) vs 12.2 (IQR, 11.1-13.7) kPa; P < 0.001), and reduced CD (25.3 (IQR, 15.7-35.6) vs 31.9 (IQR, 25.4-41.1) kPa(-1) × 10(-3) ; P = 0.037) and IVC collapsibility indices (0.07 (IQR, 0.06-1.11) vs 0.10 (IQR, 0.06-0.13); P = 0.136). Similarly, compared to controls, in cases of FGR without PE maternal carotid IMT (0.436 (IQR, 0.392-0.476) mm; P = 0.001) and BP (88 (IQR, 81-95) mmHg; P < 0.001) were increased but CD and IVC collapsibility were similar. When analysis was subclassified according to gestational age at diagnosis, IMT and CWS were significantly increased only in early-onset FGR while BP was increased in both groups. CONCLUSION Normotensive women with pregnancy complicated by FGR share some subclinical vascular features with those of women with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features.
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Affiliation(s)
- I Stergiotou
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Cruz-Lemini
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacos
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Crispi
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Barcelona, Spain
- IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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236
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Cho GJ, Park JH, Shin SA, Oh MJ, Seo HS. Metabolic syndrome in the non-pregnant state is associated with the development of preeclampsia. Int J Cardiol 2015; 203:982-6. [PMID: 26625326 DOI: 10.1016/j.ijcard.2015.11.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/16/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between metabolic syndrome in the non-pregnant state and the development of preeclampsia. METHODS We enrolled 212,463 Korean women who had their first delivery between January, 2011 and December, 2012 and had undergone a national health screening examination through the National Health Insurance during the 1-2 years before their first delivery. Women who had hypertension in the non-pregnant state were excluded. The presence of metabolic syndrome was defined using the modified criteria published in National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS The prevalence of metabolic syndrome in non-pregnant state was 1.2%. Preeclampsia developed in 3.1% and its prevalence among women with and without metabolic syndrome was 7.3% and 3.0%, respectively. The pre-pregnancy prevalence of metabolic syndrome was higher in women who developed preeclampsia compared to that in those who had a normal pregnancy (1.1% vs. 2.8%; p<0.001). On multivariate regression analysis, women with metabolic syndrome had an increased risk of developing preeclampsia (odds ratio: 1.48; 95% CI: 1.26 to 1.74) compared to that in those without metabolic syndrome, after adjusting for age, family history of hypertension, smoking status, and pre-pregnancy body mass index. The risk of preeclampsia increased with a rise in the number of components of metabolic syndrome. CONCLUSION Metabolic syndrome in the non-pregnant state was associated with the development of preeclampsia. Further studies are needed to evaluate whether early intervention for metabolic syndrome before pregnancy can decrease the risk of developing preeclampsia.
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Affiliation(s)
- Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Seoul, Republic of Korea
| | - Soon-Ae Shin
- Big Data Steering Department, National Health Insurance Service, Seoul, Republic of Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hong Seog Seo
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; KU-KIST Graduate School of Converging Science and Technology, Korea University, 145,Anam-ro, Seongbuk-gu, Seoul 136-701, Republic of Korea.
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237
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Hypertension in pregnancy is associated with elevated C-reactive protein levels later in life. J Hypertens 2015; 31:2213-9; discussion 2219. [PMID: 24029867 DOI: 10.1097/hjh.0b013e3283642f6c] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES We assessed whether hypertension in pregnancy is associated with elevated C-reactive protein (CRP) levels in later life, possibly reflecting an increased risk of cardiovascular disease (CVD). BACKGROUND Elevated CRP levels have been associated with hypertension in pregnancy and with CVD. METHODS We studied 2463 women from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Participants were categorized as nulliparous women (n = 219), women with a history of normotensive pregnancies (n = 1839), or women with a history of a hypertensive pregnancy (n = 405). Using multiple linear regression models, we compared mean CRP levels among the groups after adjusting for age, race, education, smoking, hypertension, personal history of coronary heart disease (CHD) or stroke, diabetes, dyslipidemia, statins, hormone replacement therapy, and family history of CHD or stroke. As CRP levels may be influenced by BMI, the model was fit both with and without adjusting for BMI. RESULTS There was no significant difference in CRP levels between nulliparous women and those with a history of normotensive pregnancies, either with (P = 0.82) or without (P = 0.46) adjusting for BMI. In contrast, women with hypertensive pregnancies, compared with those with normotensive pregnancies, had higher CRP levels, both with (P = 0.009) and without (P < 0.001) adjusting for BMI. CONCLUSION A history of hypertension in pregnancy is associated with elevated CRP levels later in life, independent of traditional CVD risk factors and BMI. An elevated CRP may reflect an inflammatory state in women with a history of hypertensive pregnancy disorders who are at increased risk for CVD.
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238
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Rich-Edwards JW, Ananth CV. The Importance of Null Findings: Preterm Delivery and Cardiovascular Disease. Paediatr Perinat Epidemiol 2015; 29:520-2. [PMID: 26443984 DOI: 10.1111/ppe.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Janet W Rich-Edwards
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.,Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
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239
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Adekanle DA, Adeyemi AS, Olowookere SA, Akinleye CA. Health workers' knowledge on future vascular disease risk in women with pre-eclampsia in south western Nigeria. BMC Res Notes 2015; 8:576. [PMID: 26475345 PMCID: PMC4608265 DOI: 10.1186/s13104-015-1553-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia progressing to eclampsia is one of the major causes of maternal death in Nigeria. Since there is long term association of pre-eclampsia with cardiovascular disease, cerebrovascular disease, renal disease, short life expectancy and mortality, it is essential to obtain obstetric history for better counseling and long term monitoring. The study assessed the knowledge of health workers about the association of pre-eclampsia with future cardiovascular disease and offering any risk-reduction counseling to women with pre-eclampsia. METHODS During a training workshop, a validated questionnaire on the association between pre-eclampsia and cardiovascular risk was distributed among health care workers working at the infant welfare and family planning clinics in Osun State. Data were analysed using descriptive and inferential statistics. RESULTS One hundred and forty-six out of 150 health workers approached participated in the study (response rate 97.3%). Mean age of respondents was 35.6 ± 9.1 years. Median age of practice was 7 years, ranging from 1-40 years. They were medical doctors (60.3%), community health workers (26.7%) and nurses/midwives (13.0%). Most participants had good knowledge on future cardiovascular risk of pre-eclampsia. The medical doctors had better knowledge compared to nurses/midwives and community health workers (78.4 vs. 57.9 vs. 53.8%; p < 0.05). Below half (45.9%) offered risk-reduction counseling. CONCLUSION Knowledge of the cardiovascular risk factors was lower among the nurses/midwives and community health workers. Risk reduction counseling was quite low across all the health workers. There is need for continuous medical education and possible review of the training curriculum of the lower cadres of health workers.
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Affiliation(s)
- D A Adekanle
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria.
| | - A S Adeyemi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria.
| | - S A Olowookere
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - C A Akinleye
- Department of Community Medicine, LAUTECH Teaching Hospital, Osogbo, Nigeria.
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240
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Gongora MC, Wenger NK. Cardiovascular Complications of Pregnancy. Int J Mol Sci 2015; 16:23905-28. [PMID: 26473833 PMCID: PMC4632731 DOI: 10.3390/ijms161023905] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023] Open
Abstract
Pregnancy causes significant metabolic and hemodynamic changes in a woman's physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.
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Affiliation(s)
- Maria Carolina Gongora
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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241
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Grandparental morbidity and mortality patterns are associated with infant birth weight in the Lifeways cross-generation cohort study 2001-2010. J Dev Orig Health Dis 2015; 3:458-68. [PMID: 25084299 DOI: 10.1017/s2040174412000451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The association of infants' birth weight with maternal cardiovascular morbidity (CVD) and mortality substantiates the foetal origins hypothesis. Few studies to date have investigated grandparent-infant risk association. We prospectively examined this relationship in the Lifeways three-generation familial cohort, contrasting lineage and gender differences to understand mechanisms of intergenerational risk transmission. In 2001, a cohort of 1082 families was established at antenatal stage. A total of 539 families (n = 539 infants) had both a participating grandparent (n = 1054) and information on infants' gestational age. At baseline, grandparents provided their diagnosed CVD status and 79% also underwent a cardiovascular risk factors assessment. In 2005, general practitioners provided an update for 61% grandparents. In 2010, a search of civil register confirmed 77 grandparental deaths in 539 families. Grandchildren's birth weight and grandparental cardiovascular risk factors associations were examined with linear regressions. Grandparental CVD associations were analysed using ANCOVA. Cox proportional hazard ratios (HR) were calculated for all-cause mortality associations. Models were adjusted for infants', mothers' and grandparents' demographic, anthropometric and socio-behavioural characteristics, as appropriate. The paternal grandfathers' (PGF) systolic blood pressure (mmHg) [β (95% CI) = 6.6 (0.8 - 12.5); P = 0.03] and paternal grandmothers' serum triglycerides (mmol/l) [β (95% CI) = 78.8 (7.0 - 150.7); P = 0.03] were linearly predictive of infants' birth weight, which was not observed for maternal grandparents. Mean birth weight for infants of maternal grandmothers with diabetes {-272.7 [(-499.7) - (-45.6)] g; P = 0.02} or stroke {-292.1 [(-544.5) - (-39.6)] g; P = 0.02} was lower than those without diabetes or stroke, a pattern not observed for paternal grandparents. Whereas PGFs' mortality was significantly associated with infants' high birth weight (≥4000 g) [HR (95% CI) = 4.9 (1.2 - 19.9); P = 0.03], maternal grandparents' mortality showed a converse pattern with infants' low birth weight (<2500 g) [HR (95% CI) = 1.7 (0.4 - 8.2); P = 0.7], although not statistically significant. These findings suggest that intergenerational transmission of risk differs in maternal and paternal lines.
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Abstract
PURPOSE OF REVIEW Preeclampsia is a gestational kidney disease characterized by glomerular endothelial injury, leading to maternal hypertension and proteinuria. If not addressed promptly, there is significant maternal and fetal morbidity and mortality. When severe, this disorder can cause hepatic and neurologic dysfunction. Understandably, this placental disease enters the focus of the obstetrician first; however, with progression, the nephrologist can also be enlisted. Typical complications include acute kidney injury, refractory hypertension, and acute pulmonary edema. This review summarizes recent literature on the pathogenesis of this condition and will highlight new diagnostic and therapeutic options for preeclampsia. RECENT FINDINGS Over the past decade, the role of soluble vascular factors in preeclampsia has shed light on the mechanism underlying this disease. During the last 2 years, several new therapeutics have been developed that target implicated circulating angiogenic factors, including soluble fms-like tyrosine kinase 1, an endogenous vascular endothelial growth factor inhibitor. Serum levels of angiogenic factors have been correlated with a constellation of hemodynamic and pathophysiologic changes. Thus, circulating levels of these factors may serve both diagnostic and prognostic purposes. SUMMARY Overall, our understanding of preeclampsia has developed significantly and the future holds promise for mechanism-based novel diagnostics and therapeutics.
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243
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Rich-Edwards JW, Klungsoyr K, Wilcox AJ, Skjaerven R. Duration of pregnancy, even at term, predicts long-term risk of coronary heart disease and stroke mortality in women: a population-based study. Am J Obstet Gynecol 2015; 213:518.e1-8. [PMID: 26070706 DOI: 10.1016/j.ajog.2015.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/20/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Preterm delivery may predict an increased risk of cardiovascular disease in mothers, providing opportunities for prevention. No study had examined whether gestation length within the term period predicts future CVD, and there are few data segregating spontaneous from medically indicated deliveries. STUDY DESIGN We used proportional hazards models to predict CVD death by gestation length, adjusted for age, education, and delivery year among 688,662 women with births from 1967 through 1998 in the Medical Birth Registry of Norway. Mothers were traced in the National Cause of Death Registry through 2009; there were 2324 CVD deaths. RESULTS Compared with women who delivered spontaneously at 39-41 weeks' gestation, women who spontaneously delivered earlier had higher risks of CVD death. Hazard ratios were 1.9 at 22-31 weeks, 2.2 at 32-34 weeks, 1.6 at 35-36 weeks, and 1.4 at 37-38 weeks. Risks were higher among women with medically indicated deliveries (hazard ratio, 4.8 at 22-31 weeks, 2.7 at 32-34 weeks, 4.3 at 35-36 weeks, and 1.6 at 37-38 weeks compared with spontaneous deliveries at 39-41 weeks). Neither spontaneous nor indicated delivery after 41 weeks was associated with CVD mortality. Risks were highest with recurrent preterm pregnancies, and for women who delivered only one child, especially if that delivery was preterm. CONCLUSION Women who deliver spontaneously before 37 weeks had a 2-fold increased risk of CVD mortality compared with women who had delivered after 38 weeks. Even women with spontaneous deliveries at early term (37-38 weeks) had a 41% elevated risk of CVD death compared with women delivering at 39-41 weeks.
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244
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Ornaghi S, Mueller M, Barnea ER, Paidas MJ. Thrombosis during pregnancy: Risks, prevention, and treatment for mother and fetus-harvesting the power of omic technology, biomarkers and in vitro or in vivo models to facilitate the treatment of thrombosis. ACTA ACUST UNITED AC 2015; 105:209-25. [DOI: 10.1002/bdrc.21103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology; University of Milan-Bicocca; Monza Italy
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
| | - Martin Mueller
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
- Department of Obstetrics and Gynecology; University Hospital Bern; Bern Switzerland
| | - Eytan R. Barnea
- Society for the Investigation of Early Pregnancy; Cherry Hill New Jersey
- BioIncept LLC; Cherry Hill New Jersey
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
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245
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Abstract
A life course approach in epidemiology investigates the biological, behavioral and social pathways that link physical and social exposures and experiences during gestation, childhood, adolescence and adult life, and across generations, to later-life health and disease risk. We illustrate how a life course approach has been applied to cardiovascular disease, highlighting the evidence in support of the early origins of disease risk. We summarize how trajectories of cardiometabolic risk factors change over the life course and suggest that understanding underlying 'normal' or 'healthy' trajectories and the characteristics that drive deviations from such trajectories offer the potential for early prevention and for identifying means of preventing future disease.
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Affiliation(s)
- Rebecca Hardy
- MRC Unit for Lifelong Health & Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK
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246
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Cirillo PM, Cohn BA. Pregnancy complications and cardiovascular disease death: 50-year follow-up of the Child Health and Development Studies pregnancy cohort. Circulation 2015; 132:1234-42. [PMID: 26391409 DOI: 10.1161/circulationaha.113.003901] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/20/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Few studies have investigated the combination of pregnancy complications that predict risk for cardiovascular disease (CVD) death and how risk changes with age. This report presents a comprehensive investigation of the relation of the occurrence of multiple pregnancy complications to CVD death over 5 decades in a large pregnancy cohort. METHODS AND RESULTS We examined pregnancy events (1959-1967) and CVD death through 2011 in 14 062 women from the Child Health and Development Studies. CVD death was determined by linkage to California Vital Statistics and National Death Index. Women were a median age of 26 years at enrollment and 66 years in 2011. Preexisting hypertension (hazard ratio, 3.5; 95% confidence interval, 2.4-5.1); glycosuria (hazard ratio, 4.2; confidence interval, 1.3-13.1); late-onset preeclampsia (after week 34, hazard ratio, 2.0; confidence interval, 1.2-3.5); and hemoglobin decline over the second and third trimesters (hazard ratio, 1.7; confidence interval, 1.2-2.7) predicted CVD death. Delivery of a small-for-gestation or preterm infant and early-onset preeclampsia (by week 34) significantly predicted premature CVD death (P<0.05 for age dependence). Preterm birth combined with hemorrhage, gestational hypertension, or preexisting hypertension identified women with a 4- to 7-fold increased risk of CVD death. Preeclampsia in combination with preexisting hypertension conferred a significant nearly 6-fold risk in comparison with a 4-fold risk for preexisting hypertension alone. CONCLUSIONS We observed combinations of pregnancy complications that predict high risk of death and 2 new risk markers, glycosuria and hemoglobin decline. Obstetricians serve as primary care physicians for many young women and can readily use these complications to identify high-risk women to implement early prevention.
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Affiliation(s)
- Piera M Cirillo
- From Child Health and Development Studies, Public Health Institute, Berkeley, CA.
| | - Barbara A Cohn
- From Child Health and Development Studies, Public Health Institute, Berkeley, CA
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247
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Singh MD, Thomas P, Owens J, Hague W, Fenech M. Potential role of folate in pre-eclampsia. Nutr Rev 2015; 73:694-722. [PMID: 26359215 DOI: 10.1093/nutrit/nuv028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Dietary deficiencies of folate and other B vitamin cofactors involved in one-carbon metabolism, together with genetic polymorphisms in key folate-methionine metabolic pathway enzymes, are associated with increases in circulating plasma homocysteine, reduction in DNA methylation patterns, and genome instability events. All of these biomarkers have also been associated with pre-eclampsia. The aim of this review was to explore the literature and identify potential knowledge gaps in relation to the role of folate at the genomic level in either the etiology or the prevention of pre-eclampsia. A systematic search strategy was designed to identify citations in electronic databases for the following terms: folic acid supplementation AND pre-eclampsia, folic acid supplementation AND genome stability, folate AND genome stability AND pre-eclampsia, folic acid supplementation AND DNA methylation, and folate AND DNA methylation AND pre-eclampsia. Forty-three articles were selected according to predefined selection criteria. The studies included in the present review were not homogeneous, which made pooled analysis of the data very difficult. The present review highlights associations between folate deficiency and certain biomarkers observed in various tissues of women at risk of pre-eclampsia. Further investigation is required to understand the role of folate in either the etiology or the prevention of pre-eclampsia.
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Affiliation(s)
- Mansi Dass Singh
- M.D. Singh, J. Owens, and W. Hague are with the School of Pediatrics and Reproductive Health, Discipline of Obstetrics and Gynecology, Faculty of Health Sciences, Robinson Institute, Australian Research Centre for Health of Women and Babies, The University of Adelaide, Adelaide, South Australia, Australia. M.D. Singh, P. Thomas and M. Fenech are with the Genome Health and Personalized Nutrition Laboratory Commonwealth Scientific and Industrial Research Organization (CSIRO), Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Philip Thomas
- M.D. Singh, J. Owens, and W. Hague are with the School of Pediatrics and Reproductive Health, Discipline of Obstetrics and Gynecology, Faculty of Health Sciences, Robinson Institute, Australian Research Centre for Health of Women and Babies, The University of Adelaide, Adelaide, South Australia, Australia. M.D. Singh, P. Thomas and M. Fenech are with the Genome Health and Personalized Nutrition Laboratory Commonwealth Scientific and Industrial Research Organization (CSIRO), Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Julie Owens
- M.D. Singh, J. Owens, and W. Hague are with the School of Pediatrics and Reproductive Health, Discipline of Obstetrics and Gynecology, Faculty of Health Sciences, Robinson Institute, Australian Research Centre for Health of Women and Babies, The University of Adelaide, Adelaide, South Australia, Australia. M.D. Singh, P. Thomas and M. Fenech are with the Genome Health and Personalized Nutrition Laboratory Commonwealth Scientific and Industrial Research Organization (CSIRO), Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - William Hague
- M.D. Singh, J. Owens, and W. Hague are with the School of Pediatrics and Reproductive Health, Discipline of Obstetrics and Gynecology, Faculty of Health Sciences, Robinson Institute, Australian Research Centre for Health of Women and Babies, The University of Adelaide, Adelaide, South Australia, Australia. M.D. Singh, P. Thomas and M. Fenech are with the Genome Health and Personalized Nutrition Laboratory Commonwealth Scientific and Industrial Research Organization (CSIRO), Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Michael Fenech
- M.D. Singh, J. Owens, and W. Hague are with the School of Pediatrics and Reproductive Health, Discipline of Obstetrics and Gynecology, Faculty of Health Sciences, Robinson Institute, Australian Research Centre for Health of Women and Babies, The University of Adelaide, Adelaide, South Australia, Australia. M.D. Singh, P. Thomas and M. Fenech are with the Genome Health and Personalized Nutrition Laboratory Commonwealth Scientific and Industrial Research Organization (CSIRO), Food and Nutrition Flagship, Adelaide, South Australia, Australia.
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Palomba S, de Wilde MA, Falbo A, Koster MP, La Sala GB, Fauser BC. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 2015; 21:575-592. [DOI: 10.1093/humupd/dmv029] [Citation(s) in RCA: 361] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Maternal metabolic syndrome, preeclampsia, and small for gestational age infancy. Am J Obstet Gynecol 2015; 213:370.e1-7. [PMID: 26008179 DOI: 10.1016/j.ajog.2015.05.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/20/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to explore to what extent the presence of cardiometabolic and cardiovascular risk constitutions differ between pregnancies complicated by small-for-gestational-age (SGA) infancy, preeclampsia (PE), or a combination of both. STUDY DESIGN We conducted a cohort study in women after pregnancies complicated by placental syndrome with fetal manifestations (SGA infancy [n = 113]), maternal manifestations (PE [n = 729]), or both (n = 461). Independent sample t test was used to compare cardiometabolic and cardiovascular risk factors between groups. Logistic regression was used to calculate odds ratios and adjusted odds ratios of the prevalence of the metabolic syndrome and its constituents between groups. Adjustments were made for maternal age, parity, smoking, interval between delivery and measurements, and intrauterine fetal demise. RESULTS The metabolic syndrome was present in 7.5% of women who delivered SGA infants, 15.6% of former PE women, and 19.8% of women after pregnancy complicated by both SGA and PE. Hypertension was observed in 25% of former PE women and 15% of women with solely SGA. Women who delivered a SGA infant had lower global vascular compliance compared to former PE women without SGA. CONCLUSION Cardiometabolic risk factors consistent with metabolic syndrome relate to the maternal rather than to the fetal presentation of placental syndrome. Nonetheless, highest incidence of metabolic syndrome was observed in women with both PE and SGA. PE relates to chronic hypertension, whereas increased arterial stiffness seems to be associated with women who deliver a SGA infant.
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Hao H, He M, Li J, Zhou Y, Dang J, Li F, Yang M, Deng D. Upregulation of the Tim-3/Gal-9 pathway and correlation with the development of preeclampsia. Eur J Obstet Gynecol Reprod Biol 2015; 194:85-91. [PMID: 26342682 DOI: 10.1016/j.ejogrb.2015.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/27/2015] [Accepted: 08/13/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE It is well documented that an imbalance in immune tolerance at the maternal-fetal interface is likely to play an essential role in the etiology of preeclampsia. However, the mechanisms underlying immune tolerance during preeclampsia are still poorly understood. Tim-3, a Th1-specific cell surface molecule, is a relatively newly described molecule with important immunological functions. It can regulate Th1 responses with its ligand galectin-9 (Gal-9), and has become an attractive candidate for exploring the pathogenesis of preeclampsia. STUDY DESIGN Twenty normal pregnancies and 20 preeclamptic pregnancies were enrolled in the present study. We examined the expression and function of Tim-3/Gal-9 in decidual tissue at the RNA and protein levels. In order to analyze their correlation with the development of preeclampsia, we measured the expression of Tim-3 on peripheral blood leukocytes using flow cytometry. IFN-γ, IL-10, and IL-17 in the peripheral blood plasma were measured by ELISA. RESULTS Tim-3/Gal-9 was upregulated in decidual tissue of preeclamptic vs. normotensive pregnancies. There was a significantly increased Th1 and Th17 response in PE as demonstrated by the upregulated levels of IFN-γ/IL-17, whereas IL-10 secreted by Th2 cells was sharply reduced. CONCLUSIONS The present study showed that an abnormal Tim-3/Gal-9 pathway was able to facilitate the development of preeclampsia. Our data uncovered a novel mechanism by which the Tim-3/Gal-9 pathway regulates immune responses, and we now identify this pathway as a potential therapeutic target in preeclampsia.
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Affiliation(s)
- Haiyan Hao
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; People's Hospital of Dancheng County, Zhoukou, Henan, PR China
| | - Mengzhou He
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Faculty of Reproductive Medical Center of the Third Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yuan Zhou
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Dang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fanfan Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Meitao Yang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Dongrui Deng
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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