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Zhu X, Jiang P, Ying X, Tang X, Deng Y, Gao X, Yang X. Pregnancy induced hypertension and umbilical cord blood DNA methylation in newborns: an epigenome-wide DNA methylation study. BMC Pregnancy Childbirth 2024; 24:433. [PMID: 38886689 PMCID: PMC11181590 DOI: 10.1186/s12884-024-06623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVIES Pregnancy induced hypertension (PIH) syndrome is a disease that unique to pregnant women and is associated with elevated risk of offspring cardiovascular diseases (CVDs) and neurodevelopmental disorders in their kids. Previous research on cord blood utilizing the Human Methylation BeadChip or EPIC array revealed that PIH is associated with specific DNA methylation site. Here, we investigate the whole genome DNA methylation landscape of cord blood from newborns of PIH mother. METHODS Whole-genome bisulfite sequencing (WGBS) was used to examine the changes in whole genome DNA methylation in the umbilical cord blood of three healthy (NC) and four PIH individuals. Using methylKit, we discovered Hypo- and hyper- differentially methylated probes (DMPs) or methylated regions (DMRs) in the PIH patients' cord blood DNA. Pathway enrichments were assessed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment assays. DMPs or DMRs relevant to the immunological, neurological, and circulatory systems were also employed for enrichment assay, Metascape analysis and PPI network analysis. RESULTS 520 hyper- and 224 hypo-DMPs, and 374 hyper- and 186 hypo-DMRs between NC and PIH group, respectively. Both DMPs and DMRs have enhanced pathways for cardiovascular, neurological system, and immune system development. Further investigation of DMPs or DMRs related to immunological, neurological, and circulatory system development revealed that TBK1 served as a hub gene for all three developmental pathways. CONCLUSION PIH-associated DMPs or DMRs in umbilical cord blood DNA may play a role in immunological, neurological, and circulatory system development. Abnormal DNA methylation in the immune system may also contribute to the development of CVDs and neurodevelopment disorders.
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Affiliation(s)
- Xiaojun Zhu
- Department of Obstetrics, Women's Hospital, Medicine School of Zhejiang University, Hangzhou, 310006, China
| | - Peiyue Jiang
- Department of Obstetrics, Women's Hospital, Medicine School of Zhejiang University, Hangzhou, 310006, China
| | - Xia Ying
- Department of Obstetrics, Women's Hospital, Medicine School of Zhejiang University, Hangzhou, 310006, China
| | - Xueling Tang
- Department of Obstetrics, Women's Hospital, Medicine School of Zhejiang University, Hangzhou, 310006, China
| | - Youcai Deng
- Department of Hematology, College of Pharmacy and Laboratory Medicine Science, Army Medical University, Chongqing, 400038, China
| | - Xinghong Gao
- School of Basic Medicine, Zunyi Medical University, Zunyi , Guizhou, 563006, China.
| | - Xiaofu Yang
- Department of Obstetrics, Women's Hospital, Medicine School of Zhejiang University, Hangzhou, 310006, China.
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MacCallum-Bridges CL, Gartner DR, Hettinger K, Zamani-Hank Y, Margerison CE. Did the Affordable Care Act Promote Racial Equity in Pregnancy-Related Health? A Scoping Review. Popul Health Manag 2024; 27:206-215. [PMID: 38574270 DOI: 10.1089/pop.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
In the United States, there are profound and persistent racial and ethnic disparities in pregnancy-related health, emphasizing the need to promote racial health equity through public policy. There is evidence that the Affordable Care Act (ACA) increased health insurance coverage, access to health care, and health care utilization, and may have affected some pregnancy-related health outcomes (eg, preterm delivery). It is unclear, however, whether these impacts on pregnancy-related outcomes were equitably distributed across race and ethnicity. Thus, the objective of this study was to fill that gap by summarizing the peer-reviewed evidence regarding the impact of the ACA on racial and ethnic disparities in pregnancy-related health outcomes. The authors conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), using broad search terms to identify relevant peer-reviewed literature in PubMed, Web of Science, and EconLit. The authors identified and reviewed n = 21 studies and found that the current literature suggests that the ACA and its components were differentially associated with contraception-related and fertility-related outcomes by race/ethnicity. Literature regarding pregnancy health, birth outcomes, and postpartum health, however, was sparse and mixed, making it difficult to draw conclusions regarding the impact on racial/ethnic disparities in these outcomes. To inform future health policy that reduces racial disparities, additional work is needed to clarify the impacts of contemporary health policy, like the ACA, on racial disparities in pregnancy health, birth outcomes, and postpartum health.
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Affiliation(s)
| | - Danielle R Gartner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Katlyn Hettinger
- Department of Economics, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Claire E Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
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3
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Kuklina EV, Merritt RK, Wright JS, Vaughan AS, Coronado F. Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research. J Womens Health (Larchmt) 2024; 33:553-562. [PMID: 38529887 PMCID: PMC11260429 DOI: 10.1089/jwh.2023.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.
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Affiliation(s)
- Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fátima Coronado
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Elkattawy O, Patel S, Montoya J, Sarfaraz K, Alabed S, Gobji O, Elkattawy S, Romero J, Shamoon F. The Impact of Congestive Heart Failure on Outcomes in Patients Hospitalized With Preeclampsia. Cureus 2024; 16:e56387. [PMID: 38633946 PMCID: PMC11022979 DOI: 10.7759/cureus.56387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine the prevalence of congestive heart failure (CHF) among patients admitted with preeclampsia as well as to analyze the independent association of CHF with in-hospital outcomes among women with preeclampsia. METHODS Data were obtained from the National (Nationwide) Inpatient Sample (NIS) from January 2016 to December 2019. We assessed the independent association of CHF with outcomes in patients admitted with preeclampsia. Predictors of mortality in patients admitted with preeclampsia were also analyzed. RESULTS Women with preeclampsia in the United States between 2016 and 2019 were included in our analysis. A total of 256,010 cases were isolated, comprising 1150 patients with preeclampsia and CHF (0.45%). Multivariate analysis demonstrated that CHF in patients with preeclampsia was independently associated with several outcomes, among them cardiac arrest (adjusted OR (aOR) 4.635, p=0.004), ventricular tachycardia (aOR 17.487, p<0.001), pulmonary embolism (aOR 6.987, p<0.001), and eclampsia (aOR 2.503, p=0.011). Conversely, we found CHF to be protective against postpartum hemorrhage (aOR 0.665, p=0.003). Among the predictors of mortality in preeclampsia are age (aOR 1.062, p=0.022), Asian or Pacific Islander race (aOR 4.695, p=0.001), and CHF (aOR 25.457, p<0.001). Conclusions: In a large cohort of patients admitted with preeclampsia, we found the prevalence of CHF to be 0.45%. CHF was associated with several adverse outcomes as well as increased length of stay.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Saahil Patel
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Javier Montoya
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Kanzah Sarfaraz
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sedra Alabed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Omar Gobji
- Internal Medicine, New York Medical College, Valhalla, USA
| | - Sherif Elkattawy
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Jesus Romero
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
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5
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Reding KW, Jordan JH. Multimodal Imaging Evidence for Optimized Blood Pressure Control Following Hypertensive Pregnancy: Mechanistic Insights Into Beneficial Cardiac Remodeling From the POP-HT Trial. Circulation 2024; 149:542-544. [PMID: 38346108 DOI: 10.1161/circulationaha.124.068282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Kerryn W Reding
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle (K.W.R.)
- Division of Public Health Sciences, Fred Hutch Cancer Center, Seattle, WA (K.W.R.)
| | - Jennifer H Jordan
- Department of Biomedical Engineering, College of Engineering (J.H.J.), Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond
- Department of Internal Medicine, Division of Cardiology (J.H.J.), Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond
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Hercus JC, Metcalfe KX, Christians JK. Sex differences in growth and mortality in pregnancy-associated hypertension. PLoS One 2024; 19:e0296853. [PMID: 38206980 PMCID: PMC10783718 DOI: 10.1371/journal.pone.0296853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND It is hypothesized that male fetuses prioritize growth, resulting in increased mortality, whereas females reduce growth in the presence of adversity. Preeclampsia reflects a chronic condition, in which fetuses have the opportunity to adjust growth. If females reduce their growth in response to preeclampsia, but males attempt to maintain growth at the cost of survival, we predict that differences in birthweight between preeclamptic and non-preeclamptic pregnancies will be greater among females, whereas differences in mortality will be greater among males. METHODS We analysed data from the Centers for Disease Control and Prevention. We compared pregnancies with pregnancy-associated hypertension (PAH) and controls. RESULTS The difference in birthweight between pregnancies affected by PAH and controls varied by fetal sex and gestational age. Among pregnancies of White individuals, at 34-35 weeks, the difference between PAH and controls was higher among females, as predicted. However, this pattern was reversed earlier in pregnancy and around term. Such variation was not significant in Black pregnancies. In both Black and White pregnancies, early in gestation, males had lower odds of death in PAH pregnancies, but higher odds of death in control pregnancies, counter to our prediction. Later, males had higher odds of death in PAH and controls, although the increased odds of death in males was not higher in PAH pregnancies than in controls. Overall, the difference in birthweight between surviving and non-surviving infants was greater in males than in females, opposite to our prediction. CONCLUSIONS The impact of PAH on birthweight and survival varies widely throughout gestation. Differences in birthweight and survival between male and female PAH and controls are generally not consistent with the hypothesis that males prioritize fetal growth more than females, and that this is a cause of increased mortality in males.
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Affiliation(s)
- Jess C. Hercus
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Katherine X. Metcalfe
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julian K. Christians
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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Kaur S, Ewing HT, Warrington JP. Blood-Brain Barrier Dysfunction in Hypertensive Disorders of Pregnancy. Curr Hypertens Rep 2023; 25:463-470. [PMID: 37996623 DOI: 10.1007/s11906-023-01288-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW The incidence of hypertensive disorders of pregnancy (HDP), especially preeclampsia has increased significantly over the last two decades. Patients with these disorders often report cerebral and visual symptoms, which are listed as potential diagnosis criteria for preeclampsia, if accompanied by new-onset hypertension. Recent studies indicate that cerebral complications in HDP patients are associated with a compromised blood-brain barrier (BBB). The purpose of this review is to highlight the recent literature focused on the BBB in HDP, identify gaps in knowledge, and discuss future directions in this research area. RECENT FINDINGS Majority of the studies addressing BBB changes in HDP are focused on preeclampsia. Recent studies show that hypertension induces increased association of perivascular macrophages/microglia to the cerebral vessels, increased circulating extracellular vesicles, and decreased autoregulation of cerebral blood flow. There is a critical need for more animal studies targeted to protecting the BBB and preventing cerebrovascular complications in the context of HDP. More clinical studies are needed that investigate both the short- and long-term interplay between each HDP subtype and BBB and cognitive function.
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Affiliation(s)
- Simranjit Kaur
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Hadley T Ewing
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Junie P Warrington
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
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Thomas G, Syngelaki A, Hamed K, Perez-Montaño A, Panigassi A, Tuytten R, Nicolaides KH. Preterm preeclampsia screening using biomarkers: combining phenotypic classifiers into robust prediction models. Am J Obstet Gynecol MFM 2023; 5:101110. [PMID: 37752025 DOI: 10.1016/j.ajogmf.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Preeclampsia screening is a critical component of antenatal care worldwide. Currently, the most developed screening test for preeclampsia at 11 to 13 weeks' gestation integrates maternal demographic characteristics and medical history with 3 biomarkers-serum placental growth factor, mean arterial pressure, and uterine artery pulsatility index-to identify approximately 75% of women who develop preterm preeclampsia with delivery before 37 weeks of gestation. It is generally accepted that further improvements to preeclampsia screening require the use of additional biomarkers. We recently reported that the levels of specific metabolites and metabolite ratios are associated with preterm preeclampsia. Notably, for several of these markers, preterm preeclampsia prediction varied according to maternal body mass index class. These findings motivated us to study whether patient classification allowed for combining metabolites with the current biomarkers more effectively to improve prediction of preterm preeclampsia. OBJECTIVE This study aimed to investigate whether metabolite biomarkers can improve biomarker-based preterm preeclampsia prediction in 3 screening resource scenarios according to the availability of: (1) placental growth factor, (2) placental growth factor+mean arterial pressure, and (3) placental growth factor+mean arterial pressure+uterine artery pulsatility index. STUDY DESIGN This was an observational case-control study, drawn from a large prospective screening study at 11 to 13 weeks' gestation on the prediction of pregnancy complications, conducted at King's College Hospital, London, United Kingdom. Maternal blood samples were also collected for subsequent research studies. We used liquid chromatography-mass spectrometry to quantify levels of 50 metabolites previously associated with pregnancy complications in plasma samples from singleton pregnancies. Biomarker data, normalized using multiples of medians, on 1635 control and 106 preterm preeclampsia pregnancies were available for model development. Modeling was performed using a methodology that generated a prediction model for preterm preeclampsia in 4 consecutive steps: (1) z-normalization of predictors, (2) combinatorial modeling of so-called (weak) classifiers in the unstratified patient set and in discrete patient strata based on body mass index and/or race, (3) selection of classifiers, and (4) aggregation of the selected classifiers (ie, bagging) into the final prediction model. The prediction performance of models was evaluated using the area under the receiver operating characteristic curve, and detection rate at 10% false-positive rate. RESULTS First, the predictor development methodology itself was evaluated. The patient set was split into a training set (2/3) and a test set (1/3) for predictor model development and internal validation. A prediction model was developed for each of the 3 different predictor panels, that is, placental growth factor+metabolites, placental growth factor+mean arterial pressure+metabolites, and placental growth factor+mean arterial pressure+uterine artery pulsatility index+metabolites. For all 3 models, the area under the receiver operating characteristic curve in the test set did not differ significantly from that of the training set. Next, a prediction model was developed using the complete data set for the 3 predictor panels. Among the 50 metabolites available for modeling, 26 were selected across the 3 prediction models; 21 contributed to at least 2 out of the 3 prediction models developed. Each time, area under the receiver operating characteristic curve and detection rate were significantly higher with the new prediction model than with the reference model. Markedly, the estimated detection rate with the placental growth factor+mean arterial pressure+metabolites prediction model in all patients was 0.58 (95% confidence interval, 0.49-0.70), a 15% increase (P<.001) over the detection rate of 0.43 (95% confidence interval, 0.33-0.55) estimated for the reference placental growth factor+mean arterial pressure. The same prediction model significantly improved detection in Black (14%) and White (19%) patients, and in the normal-weight group (18.5≤body mass index<25) and the obese group (body mass index≥30), with respectively 19% and 20% more cases detected, but not in the overweight group, when compared with the reference model. Similar improvement patterns in detection rates were found in the other 2 scenarios, but with smaller improvement amplitudes. CONCLUSION Metabolite biomarkers can be combined with the established biomarkers of placental growth factor, mean arterial pressure, and uterine artery pulsatility index to improve the biomarker component of early-pregnancy preterm preeclampsia prediction tests. Classification of the pregnant women according to the maternal characteristics of body mass index and/or race proved instrumental in achieving improved prediction. This suggests that maternal phenotyping can have a role in improving the prediction of obstetrical syndromes such as preeclampsia.
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Affiliation(s)
- Grégoire Thomas
- SQU4RE, Lokeren, Belgium (Dr Thomas); Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten)
| | - Argyro Syngelaki
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Karam Hamed
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Anais Perez-Montaño
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
| | - Ana Panigassi
- Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten)
| | - Robin Tuytten
- Metabolomic Diagnostics, Cork, Ireland (Drs Thomas, Panigassi, and Tuytten).
| | - Kypros H Nicolaides
- The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom (Drs Syngelaki, Hamed, Perez-Montaño, and Nicolaides)
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Abstract
Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Natalie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Kathryn J. Lindley
- Department of Medicine, Vanderbilt University Medical Center
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
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Akre S, Sharma K, Chakole S, Wanjari MB. Eclampsia and Its Treatment Modalities: A Review Article. Cureus 2022; 14:e29080. [PMID: 36249647 PMCID: PMC9555679 DOI: 10.7759/cureus.29080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Hypertension in pregnancy is one of the major contributors to mortality and morbidity. Pregnant women and fetuses are both at high risk of the severe complications of preeclampsia known as eclampsia. Eclampsia is a disorder that requires immediate detection and treatment. Eclampsia and preeclampsia during pregnancy are known to cause morbidity and even death in both the mother and fetus if not properly diagnosed. Chronic hypertension, prenatal hypertension, preeclampsia on top of chronic hypertension, and eclampsia are the four types of hypertension. Preeclampsia is the precursor to eclampsia. Associated with end-organ failure and proteinuria after 20 weeks of pregnancy, preeclampsia is characterized by the development of hypertension with systolic blood pressure (BP) of at least 140 mmHg and/or diastolic BP of at least 90 mmHg. It can lead to the failure of the liver, thrombocytopenia, pulmonary edema, central nervous system (CNS) abnormalities, and renal dysfunction. The emergence of new generalized tonic-clonic seizures in a pregnant woman with preeclampsia is known as eclampsia. Eclamptic seizures can happen prior to delivery, 20 weeks following conception, during delivery, and after delivery. Although rare, gestational trophoblastic illness has been associated with seizures that start before 20 weeks. In this article, we examine the pathogenesis, causes, signs, symptoms, and treatment modalities in patients with eclampsia.
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