301
|
Furuya K, Kumasawa K, Nakamura H, Nishimori K, Kimura T. Novel biomarker profiles in experimental aged maternal mice with hypertensive disorders of pregnancy. Hypertens Res 2018; 42:29-39. [PMID: 30214030 DOI: 10.1038/s41440-018-0092-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 01/29/2023]
Abstract
Recently, advanced maternal age (AMA) has increased in Western countries because of late marriage and advances in assisted reproductive technology. One major complication of AMA is hypertensive disorders of pregnancy (HDP). While clinical investigations into human AMA have been reported, there has been limited information obtained from basic research. In this investigation, we established the AMA mouse model using aged pregnant ICR mice. We demonstrated that the phenotypes of aged pregnant ICR mice reflect the same characteristics as human AMA. The significant findings of our investigation are as follows: (1) The AMA mouse model manifested the same complication phenotypes of human AMA, including maternal obesity, declining fertility, small for gestational age, and a higher rate of intrauterine fetal death; (2) The AMA mouse model exhibited an increasing systolic blood pressure at late gestation (108.2 ± 7.7 vs. 92.7 ± 5.7 mmHg, P < 0.01) that normalized after delivery similar to human HDP patients; and (3) While HDP and placental dysfunction are complicated, AMA mice and human HDP AMA patients manifested a low serum soluble fms-like tyrosine kinase-1 (sFlt-1) level in late gestation (AMA group vs. control group, mice, 16800.0 ± 10709.5 vs. 26611.9 ± 8702.0 pg/mL, respectively, P < 0.01; human, 8507.6 ± 3298.7 vs. 14816.9 ± 5413.5 pg/mL, respectively, P < 0.05). In conclusion, the aged pregnant mouse model resembled human AMA. The AMA mouse model was complicated with HDP despite the low serum sFlt-1 level. Our findings provide evidence that the serum sFlt-1 level does not necessarily reflect the conventional pathogenesis of HDP in aged human and murine pregnancies and may contribute to the future management of HDP in AMA.
Collapse
Affiliation(s)
- Kiichiro Furuya
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hitomi Nakamura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuhiko Nishimori
- Department of Molecular and Cell Biology, Graduate School of Agricultural Science, Tohoku University, Tohoku, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
302
|
Subki AH, Algethami MR, Baabdullah WM, Alnefaie MN, Alzanbagi MA, Alsolami RM, Abduljabbar HS. Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia. Oman Med J 2018; 33:409-415. [PMID: 30210720 DOI: 10.5001/omj.2018.75] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. Methods We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. Results We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. Conclusions The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.
Collapse
Affiliation(s)
- Ahmed Hussein Subki
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Ridha Algethami
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wejdan Mohammad Baabdullah
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majed Nasser Alnefaie
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Abdullah Alzanbagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rawan Marzooq Alsolami
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hassan S Abduljabbar
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
303
|
Choe SA, Jun YB, Kim SY. Exposure to air pollution during preconceptional and prenatal periods and risk of hypertensive disorders of pregnancy: a retrospective cohort study in Seoul, Korea. BMC Pregnancy Childbirth 2018; 18:340. [PMID: 30134853 PMCID: PMC6106837 DOI: 10.1186/s12884-018-1982-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2018] [Indexed: 01/06/2023] Open
Abstract
Background Previous studies suggested associations between prenatal exposure to air pollution and hypertensive disorders of pregnancy. We explored the associations between ambient concentrations of five major air pollutants during preconceptional and prenatal periods and three hypertensive disorders of pregnancy in Seoul, Korea, using a population-representative cohort. Methods We obtained heath and demographic data of pregnant women residing in Seoul for 2002–2013 from the Korean National Health Insurance Service–National Sample Cohort. For mother’s individual exposures to air pollution, we computed concentrations of particulate matter ≤10 μm in diameter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3) during 1, 3, 6, and 12 months to birth using regulatory monitoring data in Seoul. The associations between air pollution and hypertensive disorders were explored by using logistic regression models after adjusting for individual confounders. Results Among 18,835 pregnant women in Seoul, 0.6, 0.5, and 0.4% of women developed gestational hypertension, preeclampsia, and preeclampsia requiring magnesium sulfate (Mg-preeclampsia), respectively. Although most odds ratios (ORs) were not statistically significant, we found increasing risk gradients with disease severity depending on the pollutant. There was the association between PM10 during 6 months to birth and gestational hypertension (OR for an interquartile range increase = 1.68 [95% confidence interval = 1.09–2.58]). NO2 and ozone during 12 and 1 month, respectively, before birth were associated with Mg-preeclampsia (1.43 [1.01–2.03], 1.53 [1.03–2.27]). Conclusions We observed positive associations of exposure to some air pollutants before and during pregnancy with hypertensive disorders of pregnancy among the Korean general population. Future studies with refined exposure metrics should confirm our findings. Electronic supplementary material The online version of this article (10.1186/s12884-018-1982-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Seung-Ah Choe
- Department of Obstetrics and Gynecology, School of Medicine, CHA University, Gyeonggi-do, Seongnam, 13488, South Korea.,Department of Epidemiology, Brown University School of Public Health, Providence, 02903, RI, USA
| | - Yoon-Bae Jun
- Department of Statistics, Seoul National University, Seoul, 08826, South Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Gyeonggi-do, Goyang, 10408, South Korea.
| |
Collapse
|
304
|
Yusuf K, Alshaikh B, da Silva O, Lodha AK, Wilson RD, Alvaro RE, Lee SK, Shah PS. Neonatal outcomes of extremely preterm infants exposed to maternal hypertension and cigarette smoking. J Perinatol 2018; 38:1051-1059. [PMID: 29740191 DOI: 10.1038/s41372-018-0111-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the outcomes of extremely preterm infants of hypertensive mothers who smoke. STUDY DESIGN This retrospective cohort study included infants born between 2003 and 2012 at <29 weeks' gestation and admitted to neonatal intensive care units participating in the Canadian Neonatal Network. Infants were divided into four mutually exclusive groups. Infants of hypertensive mothers who smoked; infants of hypertensive, non-smoking mothers; infants of normotensive mothers who smoked; and infants of normotensive, non-smoking mothers. Using infants of normotensive, non-smoking mothers as the reference group, neonatal outcomes were compared between the groups. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using univariate and multivariate regression analysis. RESULTS Of the 12,307 eligible infants, 172 had hypertensive mothers who smoked, 1689 had hypertensive non-smoking mothers, 1535 had normotensive mothers who smoked, and 8911 had normotensive non-smoking mothers. Compared to infants of normotensive non-smoking mothers, infants of hypertensive mothers, regardless of smoking status, had higher odds of developing bronchopulmonary dysplasia (AORs of smokers 1.62; 95% CI 1.12-2.35 and of non-smokers 1.43; 95% CI 1.24-1.64). There was no difference in the odds of mortality and retinopathy of prematurity stage ≥3 between the groups. Infants of hypertensive, non-smoking mothers had decreased odds of intraventricular hemorrhage >grade 2 and higher odds of necrotizing enterocolitis. There was decreased odds of hypertension if the mother was a smoker (AOR 0.71; 95% CI 0.59-0.85). CONCLUSION Maternal hypertension is associated with increased rates of bronchopulmonary dysplasia, irrespective of smoking status.
Collapse
Affiliation(s)
- Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Belal Alshaikh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Orlando da Silva
- Department of Pediatrics, University of Western Ontario, London, ON, Canada
| | - Abhay K Lodha
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert D Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ruben E Alvaro
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
305
|
Wang C, Lin L, Su R, Zhu W, Wei Y, Yan J, Feng H, Li B, Li S, Yang H. Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study. BMC Pregnancy Childbirth 2018; 18:263. [PMID: 29940874 PMCID: PMC6020184 DOI: 10.1186/s12884-018-1800-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hemoglobin (Hb) measurement is a standard test among pregnant women during the first perinatal visit that is used to evaluate physical status and anemia. However, studies focusing on Hb levels and pregnancy outcomes are scarce. This study aimed to determine whether Hb levels in early pregnancy were associated with the risk of gestational diabetes mellitus (GDM), pre-eclampsia (PE) and preterm birth. METHODS A hospital-based retrospective study was conducted among 21,577 singleton, non-smoking pregnancies between June 2013 and January 2015. The demographic data and medical information of each participant were collected individually through questionnaires and patient medical records. Odds ratios were generated using a multivariate logistic regression analysis to evaluate the relative risk of GDM, PE and preterm birth continuously and across different hemoglobin ranges in the overall population and in women from different pre-pregnancy body mass index (BMI) categories, respectively. The level of statistical significance was set at 0.05. RESULTS (1) For women who were underweight, normal-weight, overweight and obese, early pregnancy Hb levels were 127.8 ± 10.1 g/L, 129.6 ± 9.7 g/L, 132.2 ± 9.5 g/L and 133.4 ± 9.4 g/L, respectively. (2) Women with GDM and PE had significantly increased Hb levels during early pregnancy compared with controls, whereas women with preterm birth processed significantly decreased Hb levels. (3) After adjusting for confounders, the risks for GDM and PE increased with high maternal Hb (OR: 1.27 for Hb 130-149; OR: 2.06 for Hb ≥ 150 g/L), and the risk for preterm birth decreased with high maternal Hb (OR: 1.30 for Hb 130-149; OR: 2.38 for Hb ≥ 150 g/L) and increased with low maternal Hb (OR: 1.41 for Hb < 110 g/L). Among women whose BMI was < 24 kg/m2, high GDM (OR: 1.27 for Hb 130-149; OR: 1.84 for Hb ≥ 150 g/L) and low preterm rates (OR: 0.77 for Hb 130-149; OR: 0.23 for Hb ≥ 150 g/L) were observed with high Hb, whereas in women whose BMI was ≥24 kg/m2, only high GDM rates were observed with Hb > 150 g/L (OR: 2.33). CONCLUSION These findings suggest that Hb levels during early pregnancy play a role in predicting the risk of GDM, PE and preterm birth.
Collapse
Affiliation(s)
- Chen Wang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Li Lin
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Rina Su
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Weiwei Zhu
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
- National Institute of Hospital Administration, Beijing, China
| | - Yumei Wei
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Jie Yan
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Hui Feng
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Boya Li
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Shuang Li
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| | - Huixia Yang
- Department of Obstetrics and Gynecology of Peking University First Hospital, Xianmen Street No. 1, Xicheng District, Beijing, 100034 China
| |
Collapse
|
306
|
Dincgez Cakmak B, Dundar B, Ketenci Gencer F, Turker U, Kanat S. P-wave and QT dispersion in hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med 2018; 32:4051-4059. [PMID: 29792098 DOI: 10.1080/14767058.2018.1481041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n = 43), chronic hypertension (n = 51), and gestational hypertension (n = 46). P-wave and QT dispersion values were compared between groups.Results: Hypertensive pregnants had higher P-wave (41.74 ± 5.51 vs. 37.73 ± 5.62, p < .001) and QTc dispersion (45.44 ± 7.62 vs. 39.77 ± 8.34, p < .001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r = 0.409, p < .001 and r = 0.306, p < .001) and diastolic blood pressure (r = 0.390, p < .001 and r = 0.287, p < .001) which are main clinical determinants of hypertensive disorders.Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.
Collapse
Affiliation(s)
- Burcu Dincgez Cakmak
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Betul Dundar
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Fatma Ketenci Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, Istanbul, Turkey
| | - Ulku Turker
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Selçuk Kanat
- Department of Cardiology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| |
Collapse
|
307
|
Chen SN, Cheng CC, Tsui KH, Tang PL, Chern CU, Huang WC, Lin LT. Hypertensive disorders of pregnancy and future heart failure risk: A nationwide population-based retrospective cohort study. Pregnancy Hypertens 2018; 13:110-115. [PMID: 30177036 DOI: 10.1016/j.preghy.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/01/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether hypertensive disorders of pregnancy (HDP) increased the risk of subsequent heart failure (HF) and identify possible risk factors. STUDY DESIGN A nationwide population-based retrospective cohort study. MAIN OUTCOME MEASURES Incidence of heart failure. RESULTS Among the 23.3 million individuals registered in the National Health Insurance Research Database in Taiwan, 29,186 patients with HDP and 116,744 matched controls were identified. The overall incidence of HF was greater in the HDP group than it was in the control group (9.83 vs. 1.67 per 10,000 person-years), with a significant incidence rate ratio (IRR = 5.88, 95% confidence interval [CI] 5.84-5.92, p < 0.0001). When stratified by age, parity, gestational age, gestational number, and follow-up years, the IRR for subsequent HF remained significantly higher in the HDP group in all stratifications. Additionally, the Kaplan-Meier analysis indicated that the cumulative incidence rate of HF was higher in the HDP group than it was in the control group. The Cox proportional-hazard model analysis showed that in addition to HDP, single parity, preterm and hypertension were independent risk factors for developing HF. Moreover, HF was more likely to develop within 5 years post-partum. Among patients with a history of HDP, the Cox proportional-hazard model showed that severe forms of HDP and increased HDP occurrences were independently associated with the subsequent development of HF. CONCLUSIONS Patients who have experienced HDP presented an increased risk for developing HF later in life. Moreover, among individuals with a history of HDP, those with severe forms of HDP or recurrent HDP displayed an increased subsequent risk of HF.
Collapse
Affiliation(s)
- San-Nung Chen
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chyi-Uei Chern
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| |
Collapse
|
308
|
van der Pligt P, Willcox J, Szymlek-Gay EA, Murray E, Worsley A, Daly RM. Associations of Maternal Vitamin D Deficiency with Pregnancy and Neonatal Complications in Developing Countries: A Systematic Review. Nutrients 2018; 10:E640. [PMID: 29783717 PMCID: PMC5986519 DOI: 10.3390/nu10050640] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/16/2018] [Accepted: 05/12/2018] [Indexed: 01/01/2023] Open
Abstract
Pregnant women in Asia, the Middle East, Africa and Latin America are at risk of vitamin D deficiency (VDD) and prevalence throughout these regions are among the highest, globally. Maternal VDD has been associated with increased risk of a number of adverse maternal and neonatal health outcomes, yet research from developing countries is limited. We assessed the associations of maternal VDD during pregnancy with adverse health outcomes by synthesizing the literature from observational studies conducted in developing countries. Six electronic databases were searched for English-language studies published between 2000 and 2017. Thirteen studies from seven countries were included in the review. Prevalence of VDD ranged from 51.3% to 100%. Six studies assessed both maternal and neonatal outcomes, four studies assessed only maternal outcomes and three studies assessed only neonatal outcomes. Ten studies showed at least one significant association between VDD and adverse maternal and/or neonatal health outcomes including pre-eclampsia (n = 3), gestational diabetes mellitus (n = 1), postpartum depression (n = 1), emergency cesarean section delivery (n = 1), low birth weight babies (n = 4), small for gestational age (n = 2), stunting (n = 1). However most of these studies (n = 6) also showed no association with multiple health outcomes. Vitamin D assessment methods, criteria applied to define VDD, season and trimester in which studies were conducted varied considerably across studies. In conclusion, this study highlights the need to improve maternal vitamin D status in developing countries in an effort to support best maternal and child health outcomes across these regions. Future research should focus on more unified approaches to vitamin D assessment and preventative approaches that may be embedded into already existing antenatal care settings.
Collapse
Affiliation(s)
- Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Jane Willcox
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora 3083, Australia.
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Emily Murray
- School of Exercise and Nutrition Sciences, Deakin University, Burwood 3125, Australia.
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| |
Collapse
|
309
|
Meta-Prediction of MTHFR Gene Polymorphisms and Air Pollution on the Risk of Hypertensive Disorders in Pregnancy Worldwide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020326. [PMID: 29438331 PMCID: PMC5858395 DOI: 10.3390/ijerph15020326] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/24/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are devastating health hazards for both women and children. Both methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and air pollution can affect health status and result in increased risk of HDP for women. The major objective of this study was to investigate the effect of MTHFR polymorphisms, air pollution, and their interaction on the risk of HDP by using meta-predictive analytics. We searched various databases comprehensively to access all available studies conducted for various ethnic populations from countries worldwide, from 1997 to 2017. Seventy-one studies with 8064 cases and 13,232 controls for MTHFR C677T and 11 studies with 1425 cases and 1859 controls for MTHFR A1298C were included. MTHFR C677T homozygous TT (risk ratio (RR) = 1.28, p < 0.0001) and CT plus TT (RR = 1.07, p = 0.0002) were the risk genotypes, while wild-type CC played a protective role (RR = 0.94, p = 0.0017) for HDP. The meta-predictive analysis found that the percentage of MTHFR C677T TT plus CT (p = 0.044) and CT (p = 0.043) genotypes in the HDP case group were significantly increased with elevated levels of air pollution worldwide. Additionally, in countries with higher air pollution levels, the pregnant women with wild-type CC MTHFR 677 had a protection effect against HDP (p = 0.014), whereas, the homozygous TT of MTHFR C677T polymorphism was a risk genotype for developing HDP. Air pollution level is an environmental factor interacting with increased MTHFR C677T polymorphisms, impacting the susceptibility of HDP for women.
Collapse
|
310
|
Varela PLR, Oliveira RRD, Melo EC, Mathias TADF. Pregnancy complications in Brazilian puerperal women treated in the public and private health systems. Rev Lat Am Enfermagem 2018; 25:e2949. [PMID: 29319740 PMCID: PMC5768206 DOI: 10.1590/1518-8345.2156.2949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/07/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile
of puerperal patients with complications, according to the form of financing of
the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was
financed by the Unified Health System, health plans and private sources (other
sources than the Unified Health System). The sample was calculated based on the
births registered in the Information System on Live Births, stratified by hospital
and form of financing of the childbirth service. Data were analyzed using the
chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4
complications per woman. In the case of deliveries covered by the Unified Health
System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%)
were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection
(23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered
by the Unified Health System. Puerperal women that had their delivery covered by
the Unified Health System reported a greater number of intercurrences related to
infectious diseases, while women who used health plans and private sources
reported intercurrences related to chronic diseases. A higher frequency of
puerperal adolescents, non-white women, and women without partner among those
assisted in the Unified Health System (p < 0.001). Conclusion: the high prevalence of complications indicates the need for monitoring and
preventing diseases during pregnancy, especially in the case of pregnant women
with unfavorable sociodemographic characteristics.
Collapse
Affiliation(s)
| | - Rosana Rosseto de Oliveira
- Post-doctoral fellow, Departamento de Enfermagem, Universidade Estadual de Maringá, Maringá, PR, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Emiliana Cristina Melo
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Estadual do Norte do Paraná, Bandeirantes, PR, Brazil
| | | |
Collapse
|
311
|
Affiliation(s)
- Claire Infante-Rivard
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| |
Collapse
|
312
|
Babah OA, Olaleye O, Afolabi BB. Postpartum Sequelae of the Hypertensive Diseases of Pregnancy: A Pilot Study. Niger Med J 2018; 59:1-6. [PMID: 31198271 PMCID: PMC6561077 DOI: 10.4103/nmj.nmj_101_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Hypertensive disorders are one of the most common medical conditions that may complicate pregnancy. Postpartum blood pressure (BP) pattern is, however, less clear in affected women and decision to discharge them is usually decided arbitrarily. Materials and Methods A cohort study conducted at Lagos University Teaching Hospital, Lagos, Nigeria, aimed at determining the proportion of pregnant women with pregnancy-induced hypertension (PIH) and preeclampsia (PE) whose BP remains elevated 6 weeks postdelivery and factors associated with the persistent rise. Fifteen women each with PIH and PE were studied in different phases of pregnancy and followed up until 6 weeks postdelivery. Fifteen normotensive pregnant women served as controls. BP patterns were monitored and fasting lipid levels, serum creatinine, fasting glucose profile (FGP), and FGP/insulin ratio were assayed. Data were analyzed with IBM SPSS version 20. Results Proportion of women with PIH or PE who had persistent hypertension at 6 weeks postpartum was 3/29 (10.3%), risk ratio of 1.1. No statistically significant association was found between mean arterial BP at 6 weeks postpartum and age, parity, gestational age at delivery, body mass index, and family history of hypertension. Serum creatinine level showed moderate correlation with persistent hypertension at 6 weeks postpartum (r = 0.441,P = 0.006), with sensitivity of 100% and specificity of 81.8% at cutoff value of 1.2 mg/dL in detecting pregnant women with hypertensive disorders who will likely remain hypertensive at 6 weeks postpartum. Conclusion There is a need for long-term follow-up of women with PIH/PE beyond puerperium.
Collapse
Affiliation(s)
- Ochuwa Adiketu Babah
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olalekan Olaleye
- Department of Obstetrics and Gynaecology, Paelon Memorial Hospital, Victoria Island, Lagos, Nigeria
| | - Bosede B Afolabi
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| |
Collapse
|
313
|
Mito A, Arata N, Qiu D, Sakamoto N, Murashima A, Ichihara A, Matsuoka R, Sekizawa A, Ohya Y, Kitagawa M. Hypertensive disorders of pregnancy: a strong risk factor for subsequent hypertension 5 years after delivery. Hypertens Res 2017; 41:141-146. [PMID: 29093561 DOI: 10.1038/hr.2017.100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 01/02/2023]
Abstract
Hypertensive disorders of pregnancy are known to be a risk factor for future cardiovascular diseases. In contrast, there is a paucity of data on the not so distant future prognosis of hypertensive disorders of pregnancy. In the present study, we evaluated the incidence of the diseases causing cardiovascular problems (hypertension, diabetes mellitus, dyslipidemia and metabolic syndrome) 5 years after delivery in Japanese women with hypertensive disorders of pregnancy. We performed a double-cohort study and compared medical conditions between women with and without a history of hypertensive disorders of pregnancy. A total of 1513 women who participated in the cohort study were invited to undergo a medical checkup 5 years after the index delivery, of whom 829 responded. After excluding pregnant and lactating women at the time of examination, 25 women with hypertensive disorders of pregnancy and 746 control subjects were analyzed. The incidence of hypertension was significantly higher among women with hypertensive disorders of pregnancy than women who were normotensive during pregnancy (24.0 vs. 2.5%, P<0.001). They were also at an increased risk of subsequent hypertension 5 years after the index delivery, after adjusting for confounding factors such as age, body mass index, family history of hypertension and salt intake (odds ratio 7.1, 95% CI, 2.0-25.6, P<0.003). These is no significant difference in the incidence of diabetes mellitus, dyslipidemia and metabolic syndrome. In conclusion, hypertensive disorders of pregnancy are strong risk factors for subsequent hypertension only 5 years after delivery.
Collapse
Affiliation(s)
- Asako Mito
- Division of Maternal Medicine, Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Dongmei Qiu
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Faculty of Nursing, Toho University, Tokyo, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Yukihiro Ohya
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Michihiro Kitagawa
- Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
314
|
Abstract
Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke - including diabetes mellitus and atrial fibrillation - are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials - despite governmental actions highlighting the need to include both men and women in clinical trials - resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.
Collapse
|
315
|
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center and New York Medical College Valhalla, NY, USA
| |
Collapse
|
316
|
Rocha-Penha L, Caldeira-Dias M, Tanus-Santos JE, de Carvalho Cavalli R, Sandrim VC. Myeloperoxidase in Hypertensive Disorders of Pregnancy and Its Relation With Nitric Oxide. Hypertension 2017; 69:1173-1180. [PMID: 28461600 DOI: 10.1161/hypertensionaha.116.08854] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/21/2016] [Accepted: 04/04/2017] [Indexed: 01/15/2023]
Abstract
Elevated levels of myeloperoxidase have been demonstrated in women with preeclampsia where it may contribute to endothelial dysfunction mediated, in part, by nitric oxide impairment. In this study, we investigated myeloperoxidase in hypertensive disorders of pregnancy and its contribution to the impairment of the vasodilator nitric oxide. We found higher levels of myeloperoxidase in supernatant from human umbilical vein endothelial cells cultures incubated with plasma from preeclampsia group compared with healthy pregnant women. Further, we measured plasma concentration and activity of myeloperoxidase in 219 healthy pregnant women, 130 gestational hypertension (on antihypertensive therapy or not), and 143 preeclampsia patients (on antihypertensive therapy or not). We found that patients with preeclampsia and gestational hypertension without antihypertensive treatment showed higher levels and activity of this enzyme, respectively. Moreover, the inhibition of myeloperoxidase activity in vitro improved nitric oxide bioavailability. Our results indicate a higher cardiovascular risk in pregnant women with hypertensive disorders, and that active myeloperoxidase may play a role in endothelial dysfunction in these conditions by impairment of nitric oxide availability. Besides, the use of antihypertensive drugs seems to decrease enzyme levels suggesting a new protective feature for these drugs.
Collapse
Affiliation(s)
- Lilliam Rocha-Penha
- From the Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, Brazil (L.R.-P., M.C.-D., V.C.S.); and Department of Pharmacology (J.E.T.-S.) and Department of Gynecology and Obstetrics (R.d.C.C.), Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Mayara Caldeira-Dias
- From the Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, Brazil (L.R.-P., M.C.-D., V.C.S.); and Department of Pharmacology (J.E.T.-S.) and Department of Gynecology and Obstetrics (R.d.C.C.), Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - José Eduardo Tanus-Santos
- From the Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, Brazil (L.R.-P., M.C.-D., V.C.S.); and Department of Pharmacology (J.E.T.-S.) and Department of Gynecology and Obstetrics (R.d.C.C.), Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ricardo de Carvalho Cavalli
- From the Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, Brazil (L.R.-P., M.C.-D., V.C.S.); and Department of Pharmacology (J.E.T.-S.) and Department of Gynecology and Obstetrics (R.d.C.C.), Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Valéria Cristina Sandrim
- From the Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, Brazil (L.R.-P., M.C.-D., V.C.S.); and Department of Pharmacology (J.E.T.-S.) and Department of Gynecology and Obstetrics (R.d.C.C.), Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil.
| |
Collapse
|
317
|
Luizon MR, Palei ACT, Cavalli RC, Sandrim VC. Pharmacogenetics in the treatment of pre-eclampsia: current findings, challenges and perspectives. Pharmacogenomics 2017; 18:571-583. [DOI: 10.2217/pgs-2016-0198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Pre-eclampsia (PE) is defined as pregnancy-induced hypertension and proteinuria, and is a major cause of maternal and perinatal morbidity and mortality. A large subgroup of pregnant women with PE is nonresponsive to antihypertensive drugs, including methyldopa, nifedipine and hydralazine. Pharmacogenomics may help to guide the individualized therapy for this nonresponsive subgroup. However, just a few pharmacogenetic studies examined the effects of genetic polymorphisms on response to antihypertensive drugs in PE, and the criteria of responsiveness used to define responsive or nonresponsive subgroups to antihypertensive therapy should be replicated by others. We review these gene–drugs interactions, novel approaches to pharmacogenomics research and potential novel drugs for PE therapy. Finally, we discuss the challenges and perspectives of pharmacogenetics in the treatment of PE.
Collapse
Affiliation(s)
- Marcelo R Luizon
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo 18680-000, Brazil
- Department of General Biology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Ana CT Palei
- Department of Surgery, Division of Pediatric & Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Ricardo C Cavalli
- Department of Gynecology & Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo 14049-900, Brazil
| | - Valeria C Sandrim
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, Sao Paulo 18680-000, Brazil
| |
Collapse
|
318
|
Seki H. Animal models of preeclampsia: an examination of usefulness and limitations based on the metabolic domino theory. HYPERTENSION RESEARCH IN PREGNANCY 2017. [DOI: 10.14390/jsshp.hrp2017-015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroyuki Seki
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University
| |
Collapse
|