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Jones RD, Peng C, Jones CD, Long B, Helton V, Eswaran H. Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:156-163. [PMID: 38989044 PMCID: PMC11232352 DOI: 10.1016/j.cvdhj.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Introduction Unmanaged hypertension in pregnancy is the second most common cause of direct maternal death and disproportionately affects women in rural areas. While telehealth technologies have worked to reduce barriers to healthcare, lack of internet access has created new challenges. Cellular-enabled remote patient monitoring devices provide an alternative option for those without access to internet. Objective This study aimed to assess maternal and neonatal clinical outcomes and patient acceptability of an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. Methods In a mixed-methods study, 20 women with hypertension during pregnancy were given a cellular-enabled BodyTrace blood pressure cuff. Participants' blood pressures were continuously monitored by a nurse call center. Participants completed a baseline survey, post-survey, and semi-structured interview after 8 weeks of device use. Results Participants reported a significant decrease in perceived stress after device use (P = .0004), high satisfaction with device usability (mean = 78.38, SD = 13.68), and high intention to continue device use (mean = 9.05, SD = 1.96). Relatively low hospitalization and emergency department rates was observed (mean = 0.35, SD = 0.59; mean = 0.75, SD = 0.91). Participant-perceived benefits of device use included convenience, perceived better care owing to increased monitoring, and patient empowerment. Perceived disadvantages included higher blood pressure readings compared to clinical readings and excessive calls from call center. Conclusion Remote patient monitoring for women whose pregnancies are complicated by hypertension can reduce barriers and improve health outcomes for women living in rural and low-health-resource areas.
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Affiliation(s)
- Rebecca D Jones
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cheng Peng
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Crystal D Jones
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Brianna Long
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Helton
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hari Eswaran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Esposito M, Gatto M, Cipolla MJ, Bernstein IM, Mandalà M. Dilation of Pregnant Rat Uterine Arteries with Phenols from Extra Virgin Olive Oil Is Endothelium-Dependent and Involves Calcium and Potassium Channels. Cells 2024; 13:619. [PMID: 38607058 PMCID: PMC11011993 DOI: 10.3390/cells13070619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
During pregnancy, uterine vasculature undergoes significant circumferential growth to increase uterine blood flow, vital for the growing feto-placental unit. However, this process is often compromised in conditions like maternal high blood pressure, particularly in preeclampsia (PE), leading to fetal growth impairment. Currently, there is no cure for PE, partly due to the adverse effects of anti-hypertensive drugs on maternal and fetal health. This study aimed to investigate the vasodilator effect of extra virgin olive oil (EVOO) phenols on the reproductive vasculature, potentially benefiting both mother and fetus. Isolated uterine arteries (UAs) from pregnant rats were tested with EVOO phenols in a pressurized myograph. To elucidate the underlying mechanisms, additional experiments were conducted with specific inhibitors: L-NAME/L-NNA (10-4 M) for nitric oxide synthases, ODQ (10-5 M) for guanylate cyclase, Verapamil (10-5 M) for the L-type calcium channel, Ryanodine (10-5 M) + 2-APB (3 × 10-5 M) for ryanodine and the inositol triphosphate receptors, respectively, and Paxilline (10-5 M) for the large-conductance calcium-activated potassium channel. The results indicated that EVOO-phenols activate Ca2+ signaling pathways, generating nitric oxide, inducing vasodilation via cGMP and BKCa2+ signals in smooth muscle cells. This study suggests the potential use of EVOO phenols to prevent utero-placental blood flow restriction, offering a promising avenue for managing PE.
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Affiliation(s)
- Milena Esposito
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
| | - Mariacarmela Gatto
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
| | - Marilyn J. Cipolla
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
| | - Ira M. Bernstein
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
| | - Maurizio Mandalà
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
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John B, Dorairajan G, Chinnakali P, Mondal N. Factors Associated with Perinatal Mortality in Adult Pregnant Women with Hypertensive Disorders: A Case-Control Study. J Obstet Gynaecol India 2023; 73:11-18. [PMID: 37916003 PMCID: PMC10616052 DOI: 10.1007/s13224-023-01782-8] [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: 11/09/2022] [Accepted: 05/28/2023] [Indexed: 11/03/2023] Open
Abstract
Background Hypertension complicates 5-10% of pregnancies and is a common cause of perinatal death. The perinatal mortality is estimated to be 3 to 5 times higher in hypertensive women compared to those without hypertension. Methods A hypertensive mother either with a stillbirth or if baby died within 7 days of life was included as a case. Once a case was recognized, the next two consecutive hypertensive mothers who delivered a live baby, who survived up to 7 days of life, were taken as controls. Fetuses with congenital malformations incompatible with life and multiple pregnancies were excluded from the study. One hundred and twelve women in cases and 224 women in controls were studied. Results Among 112 cases of perinatal death, 70% had died in utero before labor. Among the 33 fetuses alive, 50% were born still after labor and 50% died within 7 days of birth. We found that early onset hypertension (< 34 weeks) (p-< 0.001 (Chi2-23.819)), gestational age at termination of 28-32 weeks (OR 2.76), value of serum creatinine > 1.1 mg/dl (OR 10.1), abruption (OR 6.2) and birth weight < 1.5 kg was significantly associated with perinatal mortality (p-0.007, OR 5.7). Abnormal Doppler findings was a predictor of perinatal deaths. Conclusion Severely growth retarded fetuses in association with early onset severe preeclampsia are likely to die in utero and need vigilant monitoring antenatally. Abnormal umbilical artery Dopplers predict perinatal mortality. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg in our hospital resulted in favorable outcome.
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Affiliation(s)
- Blessy John
- Professor and HOD, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Puducherry, 605 006 India
- Present Address: Specialist Obstetrics and Gynecology, KIMSHEALTH Hospital, Umm Al Hassam, Manama, 75829 Kingdom of Bahrain
| | - Gowri Dorairajan
- Professor and HOD, Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Puducherry, 605 006 India
| | - Palanivel Chinnakali
- Additional Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Puducherry, 605 006 India
| | - Nivedita Mondal
- Additional Professor and HOD, Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Dhanvantri Nagar, Puducherry, 605 006 India
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Chen B, Zhang M, He Y, Si Y, Shi Y, Jiang K, Shen J, Hong J, Ni S. The association between caffeine exposure during pregnancy and risk of gestational hypertension/preeclampsia: A meta-analysis and systematical review. J Obstet Gynaecol Res 2022; 48:3045-3055. [PMID: 36156331 PMCID: PMC10087308 DOI: 10.1111/jog.15445] [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: 07/13/2022] [Revised: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The potential effect of caffeine exposure during pregnancy on gestational hypertension (GH)/preeclampsia has attracted attention but remains unclear. METHODS A systematic literature search of PubMed, Embase, and Cochrane Library databases was performed until March 2022. Observational studies assessing the association between caffeine exposure during pregnancy and the risk of GH/preeclampsia were included. The study protocol was registered in PROSPERO: CRD42022322387. RESULTS Ten studies involving 114 984 pregnant women (2548 diagnosed with GH and 2473 diagnosed with preeclampsia) were included. Comparing caffeine exposure with noncaffeine exposure, no significant association was found between caffeine exposure during pregnancy and the risk of GH (odds ratio [OR] = 0.99, 95% confidence interval [CI]: 0.90-1.08, p = 0.800) and preeclampsia (OR = 1.13, 95% CI: 0.97-1.31, p = 0.114). Subgroup analyses comparing low to moderate doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.00, p = 0.987) or preeclampsia (OR = 1.03, p = 0.648). Besides, subgroup analyses comparing high doses with no/lowest doses showed that caffeine exposure during pregnancy was not significant associated with GH (OR = 1.06, p = 0.623) or preeclampsia (OR = 1.18, p = 0.192). CONCLUSION This study found that caffeine exposure during pregnancy was not significantly associated with the risk of GH/preeclampsia.
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Affiliation(s)
- Bangsheng Chen
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
| | - Mengting Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuexiu Si
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yetan Shi
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ke Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jingyi Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiaze Hong
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Saisai Ni
- Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Neonatal outcomes of twins <29 weeks gestation of mothers with hypertensive disorders of pregnancy. Pediatr Res 2022; 92:748-753. [PMID: 35383262 DOI: 10.1038/s41390-022-02044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/17/2021] [Accepted: 03/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with dysfunctional placentation and are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancies have a larger placental mass and are a risk factor for HDP. The effect of HDP on neonatal outcomes in twin pregnancies is unknown. METHODS Retrospective cohort study using the Canadian Neonatal Network database from 2010-2018 of twin infants <29 weeks gestation born to mothers with HDP and normotensive pregnancies. Using multivariable models, we determined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis, and nosocomial infection in twin infants of mothers with HDP compared to twin infants of normotensive mothers. RESULTS Of the 2414 eligible twin infants <29 weeks gestational age, 164 (6.8%) were born to mothers with HDP and had higher odds of severe ROP (AOR 2.48, 95% CI 1.34-4.59). Preterm twin infants born to mothers with HDP also had higher odds of mortality (AOR 2.02, 95% CI 1.23-3.32). There was no difference in other outcomes. CONCLUSION Preterm twin infants <29 weeks gestation of HDP mothers have higher odds of severe ROP and mortality. IMPACT Hypertensive disorders of pregnancy, associated with placental dysfunction, are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancy, associated with a larger placental mass, is a risk factor for hypertensive disorders of pregnancy. The effect of hypertensive disorders of pregnancy on outcomes of preterm twins is unknown. Preterm twins of mothers with hypertensive disorders of pregnancy are at higher risk of severe retinopathy of prematurity and mortality. Our data can be used to counsel parents and identify infants at higher risk of severe retinopathy of prematurity and mortality.
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Francis J, Waller K, Wilson A, Dickton D. Hypertensive Disorders of Pregnancy in a Military Hospital Birth Cohort. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:740-748. [PMID: 36147831 PMCID: PMC9436257 DOI: 10.1089/whr.2022.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are risk factors for maternal and fetal complications with long-term sequelae for mother and children. HDP are not clearly understood; however, there appears to be a relationship with maternal weight gain. The effects of maternal weight gain and pregnancy outcomes, including HDP, are understudied. Few studies have assessed maternal weight gain in service-connected women and its effects on HDP. This study aimed to evaluate the relationship between blood pressure and birth outcomes in women who delivered their infants at a military hospital. METHODS This birth cohort study included all patients admitted to a military hospital for delivery over a 12-month period. Data were analyzed for hypertensive disorders, maternal weight gain, delivery type, infant maturity, and infant weight at delivery. RESULTS Of the 1,018 participants, 186 were diagnosed with HDP with no statistical difference observed for maternal age. The hypertensive group had higher mean weight gain. More patients in the hypertension group delivered at term with lower mean birth weight. The rate of small-for-gestational age infants was higher in the HDP group (p < 0.001). DISCUSSION The rate of HDP in this cohort of military members and dependents was 18.3%, which was similar to the 19% rate reported for a southern US hospital, but higher than in other regions of the United States. This evidence indicates that HDP are increasing, and maternal/infant morbidity was affected by hypertension in this study.
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Affiliation(s)
- Jimi Francis
- Department of Kinesiology, College for Health, Community, and Policy, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Karla Waller
- Obstetrics, Austin Regional Clinic, Austin, Texas, USA
| | - Amber Wilson
- Indian Health Services, Obstetrics, Women's Health Department, Claremore, Texas, USA
| | - Darby Dickton
- Foundation for Maternal, Infant, and Lactation Knowledge, San Antonio, Texas, USA
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Kong L, Chen X, Liang Y, Forsell Y, Gissler M, Lavebratt C. Association of Preeclampsia and Perinatal Complications With Offspring Neurodevelopmental and Psychiatric Disorders. JAMA Netw Open 2022; 5:e2145719. [PMID: 35089349 PMCID: PMC8800079 DOI: 10.1001/jamanetworkopen.2021.45719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Maternal preeclampsia has been reported to increase the risk of autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability in offspring. However, the association between maternal preeclampsia combined with perinatal complications and neurodevelopmental and psychiatric disorders in offspring is less well documented. OBJECTIVE To examine the association of maternal preeclampsia, separately and together with perinatal complications, with neurodevelopmental and psychiatric disorders in offspring. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from nationwide registries in Finland to assess all singleton live births (N = 1 012 723) between January 1, 1996, and December 31, 2014. Offspring were followed up until December 31, 2018 (when the oldest reached age 22 years). Exclusion criteria were maternal inpatient psychiatric diagnoses and pregestational diabetes. The study and data analysis were conducted from May 1, 2020, to June 1, 2021. EXPOSURES Preeclampsia and perinatal complications (delivery earlier than 34 weeks' gestation and/or small for gestational age). MAIN OUTCOMES AND MEASURES The primary outcomes were neurodevelopmental and psychiatric diagnoses and dispensation of psychotropic drugs among offspring until December 31, 2018. Cox proportional hazards regression analyses were performed to assess the associations. RESULTS Of 1 012 723 singleton live births (51.1% boys; mean [SD] maternal age at birth, 30.0 [5.4] years; specific data on race and ethnicity were not available in the data set), 21 010 children (2.1%) were exposed to preeclampsia alone, 33 625 children (3.3%) were exposed to perinatal complications alone, and 4891 children (0.5%) were exposed to both preeclampsia and perinatal complications. A total of 93 281 children (9.2%) were diagnosed with a neurodevelopmental or psychiatric disorder. Offspring exposed to both preeclampsia and perinatal complications had an increased risk of any neurodevelopmental or psychiatric disorder after adjusting for potential confounding (adjusted hazard ratio [aHR], 2.11; 95% CI, 1.96-2.26) compared with those not exposed to either preeclampsia or perinatal complications; this risk was higher than exposure to either preeclampsia alone (aHR, 1.18; 95% CI, 1.12-1.23) or perinatal complications alone (aHR, 1.77; 95% CI, 1.72-1.82). Sibling pair analyses did not detect any increase in the risk of neurodevelopmental or psychiatric disorders after exposure to preeclampsia alone, but offspring exposed to both preeclampsia and perinatal complications had increased risks of intellectual disabilities (aHR, 3.24; 95% CI, 1.05-10.06), specific developmental disorders (aHR, 3.56; 95% CI, 2.35-5.41), ADHD and conduct disorders (aHR, 2.42; 95% CI, 1.09-5.39), and other behavioral and emotional disorders (aHR, 2.45; 95% CI, 1.17-5.13). The risk estimates for specific developmental disorders (aHR, 2.82; 95% CI, 2.60-3.05) and ADHD and conduct disorders (aHR, 1.88; 95% CI, 1.65-2.14) were higher among offspring exposed to both preeclampsia and perinatal complications compared with those exposed to perinatal complications alone (aHR, 2.26 [95% CI, 2.18-2.33] and 1.60 [95% CI, 1.52-1.68], respectively). CONCLUSIONS AND RELEVANCE In this study, exposure to both maternal preeclampsia and perinatal complications was associated with intellectual disabilities, specific developmental disorders, ADHD and conduct disorders, and other behavioral and emotional disorders in offspring. For specific developmental disorders and ADHD and conduct disorders, the risk estimates were higher among offspring exposed to both preeclampsia and perinatal complications compared with those exposed to perinatal complications only.
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Affiliation(s)
- Linghua Kong
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Xinxia Chen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Mou AD, Barman Z, Hasan M, Miah R, Hafsa JM, Das Trisha A, Ali N. Prevalence of preeclampsia and the associated risk factors among pregnant women in Bangladesh. Sci Rep 2021; 11:21339. [PMID: 34716385 PMCID: PMC8556297 DOI: 10.1038/s41598-021-00839-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022] Open
Abstract
Preeclampsia is a multi-organ system disorder of pregnancy and is responsible for a significant rate of maternal morbidity and mortality worldwide. In Bangladesh, a large number of obstetric deaths occur every year but the exact reasons are not well investigated. The data regarding preeclampsia and its associated risk factors are scarce or limited in pregnant women in Bangladesh. Therefore, we aimed to conduct a cross-sectional study to estimate the prevalence of preeclampsia and identify the possible risk factors in a pregnant women cohort in Bangladesh. In this cross-sectional study, a total of 111 participants were enrolled and asked to include their anthropometric, socio-demographic, and other related lifestyle information in a standard questionnaire form. Blood samples were also collected from each participant to analyze serum levels of lipid profile, liver enzymes, uric acid, and creatinine by using standard methods. Logistic regression analysis was performed to identify the factors associated with preeclampsia. The overall prevalence of preeclampsia was 14.4%. About 10% of the pregnancies were found to have preeclampsia after 20 weeks of gestation without a previous history of hypertension. On the other hand, the prevalence of preeclampsia that superimposed on chronic hypertension was found to be 5.4%. Serum levels of TC, LDL-C, ALT and uric acid were significantly higher and HDL-C was significantly lower in preeclamptic pregnancies than the non-preeclamptic pregnancies. Respondents who required to take antihypertensive medications (AOR 5.45, 95% CI [1.09, 27.31]) and who never took antenatal care (AOR 6.83, 95% CI [1.00, 46.48]) were more likely to be preeclamptic. In conclusion, the present study showed a comparatively high prevalence of preeclampsia among pregnant women in Bangladesh. Some programmatic interventions such as medication for hypertension, antenatal visits to doctors, delivery and postnatal care services should be considered to reduce and prevent the hypertensive pregnancy disorders in Bangladesh.
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Affiliation(s)
- Ananya Dutta Mou
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Zitu Barman
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Mahmudul Hasan
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Rakib Miah
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Jaasia Momtahena Hafsa
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Aporajita Das Trisha
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
| | - Nurshad Ali
- grid.412506.40000 0001 0689 2212Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114 Bangladesh
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Liu Y, Wang Z, Zhao L. A Potential Three-Gene-Based Diagnostic Signature for Hypertension in Pregnancy. Int J Gen Med 2021; 14:6847-6856. [PMID: 34703289 PMCID: PMC8526516 DOI: 10.2147/ijgm.s331573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hypertensive disorders of pregnancy affect approximately 5–10% of all pregnancies, and this study aims to identify potential diagnostic signatures. Methods We downloaded the mRNA profiles of GSE75010 (placenta samples) and GSE48424 (blood samples) datasets with or without hypertension in pregnancy from the Gene Expression Omnibus database. Differential expression analysis was performed on the placenta samples using limma package of R language. GO terms and KEGG pathways enrichment analyses were performed on the placenta samples by the clusterProfiler package of R language. Infiltrating immune cell proportion of the placenta samples was evaluated using CIBERSORT software. The key genes involved in hypertension in pregnancy were screened from protein–protein interaction (PPI) network constructed based on the differentially expressed genes (DEGs). The logistic regression model was constructed by the glm package of R language, and receiver operating characteristic (ROC) curve was plotted to determine the accuracy of the model. Results For the placenta samples, a total of 104 DEGs were identified, and 39 GO terms and 7 KEGG pathways were significantly enriched based on these 104 genes. Furthermore, the analysis of infiltrating immune cells indicated that the difference in the amount of immune cells might be the potential cause of hypertension in pregnancy. The logistic regression model was constructed based on three optimal genes (LEP, PRL and IGFBP1) screened from PPI network and could efficiently separate patients with hypertension in pregnancy from healthy subjects. Conclusion A predictive model based on three potential genes LEP, PRL and IGFBP1 was obtained, suggesting that these genes might be potential diagnostic signatures for hypertension in pregnancy.
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Affiliation(s)
- Yan Liu
- Department of Obstetrics, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Zhenglu Wang
- Biobank, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Lin Zhao
- Department of Obstetrics, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, People's Republic of China
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Binder NK, MacDonald TM, Beard SA, de Alwis N, Tong S, Kaitu’u-Lino TJ, Hannan NJ. Pre-Clinical Investigation of Cardioprotective Beta-Blockers as a Therapeutic Strategy for Preeclampsia. J Clin Med 2021; 10:3384. [PMID: 34362171 PMCID: PMC8348612 DOI: 10.3390/jcm10153384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Despite significant maternal and fetal morbidity, a treatment for preeclampsia currently remains an unmet need in clinical care. As too does the lifelong cardiovascular risks imparted on preeclampsia sufferers. Endothelial dysfunction and end-organ injury are synonymous with both preeclampsia and cardiovascular disease, including heart failure. We propose that beta-blockers, known to improve endothelial dysfunction in the treatment of cardiovascular disease, and specifically known to reduce mortality in the treatment of heart failure, may be beneficial in the treatment of preeclampsia. Here, we assessed whether the beta-blockers carvedilol, bisoprolol, and metoprolol could quench the release of anti-angiogenic factors, promote production of pro-angiogenic factors, reduce markers of inflammation, and reduce endothelial dysfunction using our in vitro pre-clinical preeclampsia models encompassing primary placental tissue and endothelial cells. Here, we show beta-blockers effected a modest reduction in secretion of anti-angiogenic soluble fms-like tyrosine kinase-1 and soluble endoglin and increased expression of pro-angiogenic placental growth factor, vascular endothelial growth factor and adrenomedullin in endothelial cells. Beta-blocker treatment mitigated inflammatory changes occurring after endothelial dysfunction and promoted cytoprotective antioxidant heme oxygenase-1. The positive effects of the beta-blockers were predominantly seen in endothelial cells, with a less consistent response seen in placental cells/tissue. In conclusion, beta-blockers show potential as a novel therapeutic approach in the treatment of preeclampsia and warrant further investigation.
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Affiliation(s)
- Natalie K. Binder
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Teresa M. MacDonald
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Sally A. Beard
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Natasha de Alwis
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Stephen Tong
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Tu’uhevaha J. Kaitu’u-Lino
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
- Diagnostics Discovery and Reverse Translation, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Natalie J. Hannan
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia; (N.K.B.); (T.M.M.); (S.A.B.); (N.d.A.); (S.T.); (T.J.K.-L.)
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg 3084, Australia
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Overexpression of microRNA-100-5p attenuates the endothelial cell dysfunction by targeting HIPK2 under hypoxia and reoxygenation treatment. J Mol Histol 2021; 52:1115-1125. [PMID: 34213736 DOI: 10.1007/s10735-021-10002-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/22/2021] [Indexed: 01/21/2023]
Abstract
MicroRNAs (miRNAs) are important regulators of many cellular processes, and the dysregulation of miRNAs is associated with various diseases. MiR-100-5p is revealed to be downregulated in gestational hypertension, while its underlying regulatory mechanism remains unclear. The pathological condition of gestational hypertension was mimicked by the hypoxia and reoxygenation (H/R) treatment to human placental microvascular endothelial cells (HPMECs). RT-qPCR and western blotting were conducted to detect the mRNA and protein expression of RNAs. HPMEC viability was assessed by CCK-8 assay. HPMEC angiogenesis was examined using tube formation assay. The concentrations of ANG-1 and ANG-2 in HPMECs were detected by ELISA. The binding relationship between miR-100-5p and homeodomain interacting protein kinase 2 (HIPK2) was investigated using luciferase reporter assay. MiR-100-5p was downregulated in HPMECs after H/R treatment. MiR-100-5p overexpression reversed the H/R-induced decrease in viability, angiogenesis of HPMECs. HIPK2 was targeted by miR-100-5p in HPMECs, and miR-100-5p negatively modulated HIPK2 expression at the mRNA and protein levels. MiR-100-5p activated the PI3K/AKT pathway by downregulating HIPK2. Rescue assays demonstrated that miR-100-5p promoted the viability and angiogenesis of H/R treated HPMECs by targeting HIPK2 to activate the PI3K/AKT pathway. MiR-100-5p overexpression inhibits the dysfunction of HPMECs under hypoxia and reoxygenation by downregulating HIPK2 to activate the PI3K/AKT pathway.
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12
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Dos Passos Junior RR, de Freitas RA, Reppetti J, Medina Y, Dela Justina V, Bach CW, Bomfim GF, Lima VV, Damiano AE, Giachini FR. High Levels of Tumor Necrosis Factor-Alpha Reduce Placental Aquaporin 3 Expression and Impair in vitro Trophoblastic Cell Migration. Front Physiol 2021; 12:696495. [PMID: 34267676 PMCID: PMC8276056 DOI: 10.3389/fphys.2021.696495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
Placentas from preeclamptic women display augmented tumor necrosis factor-alpha (TNF-α) levels with reduced expression of aquaporin 3 (AQP3). However, whether TNF-α modulates AQP3 expression remains to be elucidated. We hypothesize that elevated levels of TNF-α reduce AQP3 expression and negatively impact trophoblastic cell migration. Spontaneously hypertensive rats (SHRs) and Wistar rats (14-16 weeks) were divided into hypertensive and normotensive groups, respectively. Systolic blood pressure (SBP) was measured, and animals mated. In a third group, pregnant SHRs were treated with a TNF-α antagonist, etanercept (0.8 mg/kg, subcutaneously) on days 0, 6, 12, and 18 of pregnancy. Placentas were collected on the 20th day of pregnancy. Human placental explants, from normotensive pregnancies, were incubated with TNF-α (5, 10, and 20 ng/ml) and/or etanercept (1 μg/ml). Swan 71 cells were incubated with TNF-α (10 ng/ml) and/or etanercept (1 μg/ml) and subjected to the wound healing assay. AQP3 expression was assessed by Western blot and TNF-α levels by ELISA. SBP (mmHg) was elevated in the hypertensive group, and etanercept treatment reduced this parameter. Placental TNF-α levels (pg/ml) were higher in the hypertensive group. AQP3 expression was reduced in the hypertensive group, and etanercept treatment reversed this parameter. Explants submitted to TNF-α exposition displayed reduced expression of AQP3, and etanercept incubation reversed it. Trophoblastic cells incubated with TNF-α showed decreased cell migration and reduced AQP3 expression, and etanercept incubation ameliorated it. Altogether, these data demonstrate that high TNF-α levels negatively modulate AQP3 in placental tissue, impairing cell migration, and its relationship in a pregnancy affected by hypertension.
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Affiliation(s)
| | | | - Julieta Reppetti
- Faculty of Medicine, Institute of Physiology and Biophysics Bernardo Houssay (IFIBIO)-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - Yollyseth Medina
- Faculty of Medicine, Institute of Physiology and Biophysics Bernardo Houssay (IFIBIO)-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Camila Werle Bach
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | | | - Victor Vitorino Lima
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Alicia E Damiano
- Faculty of Medicine, Institute of Physiology and Biophysics Bernardo Houssay (IFIBIO)-CONICET, University of Buenos Aires, Buenos Aires, Argentina.,Department of Biological Sciences, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Fernanda R Giachini
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil.,Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
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13
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Helou A, Stewart K, George J. Adherence to anti-hypertensive medication in pregnancy. Pregnancy Hypertens 2021; 25:230-234. [PMID: 34273672 DOI: 10.1016/j.preghy.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess adherence to anti-hypertensive medication by pregnant women and to identify the factors associated with adherence or lack thereof. STUDY DESIGN Observational study in 100 pregnant women with either chronic hypertension or gestational hypertension who were being treated with at least one anti-hypertensive medication and attending antenatal clinics at one of two maternity hospitals. In-depth interviews were conducted with a subset of 27 women from the same group. Quotes from interview transcripts were used to illustrate the quantitative results. MAIN OUTCOME MEASURES BP control, self-reported adherence, complexity of medication regimen. RESULTS Participants (mean age 33 [±4.9] years; mean gestation 29 (±7) weeks) had a median blood pressure (BP) of 130/80 mmHg (IQR: 16/15). Sixty-five women had chronic hypertension, of whom 13 were diagnosed during pregnancy, before 20 weeks gestation. Thirty-five women had gestational hypertension. Ninety-two per cent of participants had sub-optimal adherence. There were no significant differences in adherence scores between participants with chronic hypertension and their counterparts. The main contributors to sub-optimal adherence were intentionally putting up with medical problems before taking any action, confusion about the medication, and making changes to the recommended medication regimen to suit lifestyle. CONCLUSIONS Nine out of ten pregnant women using anti-hypertensives self-reported some degree of suboptimal adherence, intentionally and/or unintentionally. Health professionals, including pharmacists, general practitioners and obstetricians, have a role in promoting optimal medication adherence.
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Affiliation(s)
- Amyna Helou
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
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14
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Influence of Swimming Program on the Blood Pressure of Pregnant Hypertensive Rats and Their Fetuses. REPRODUCTIVE SCIENCES (THOUSAND OAKS, CALIF.) 2021; 28:3440-3447. [PMID: 33987823 DOI: 10.1007/s43032-021-00617-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
The hypertension incidence and its complication on pregnant women are growing and can lead to adverse consequences on their fetuses. However, it is known that regular exercise practice can be healthful to hypertensive pregnant women but harmful to fetal growth. So, the objective of this study was to evaluate the effects of exercise beginning before pregnancy or during pregnancy on the maternal blood pressure and reproductive outcome and on the fetal development of spontaneously hypertensive rats (SHR). Pregnant SHR were randomly distributed into three experimental groups: (1) SHR-Control, non-exercised; (2) SHR-Ex0, rats submitted to physical exercise (swimming program) from day zero to 20 of pregnancy; (3) and SHR-ExPr, rats submitted to swimming program before and during pregnancy. At end of pregnancy (day 21), the rats were anesthetized, and reproductive parameters and fetal development were assessed. Blood pressure was reduced at the end of pregnancy in all the groups. Regardless of swimming exposure time, there was reduced maternal weight gain. The exercise decreased fetal weight at term pregnancy, with a higher percentage of small for gestational age (SGA) fetuses and lower number ossification sites, indicating intrauterine growth restriction (IUGR). In conclusion, our findings provide insight to support that swimming exercise in pregnant SHR impairs fetal development, causing IUGR and visceral malformations. Therefore, the indication of physical exercise must be defined very carefully, as it can compromise fetal development.
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15
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Mata K, Nobre AVV, Felix Silva PH, Oliezer RS, Fernandes C, Amaral J, Ramos J, Constante Gabriel Del-Arco M, Messora MR, Tanus-Santos JE, Gerlach RF, Salvador SL. A new mixed model of periodontitis-induced preeclampsia: A pilot study. J Periodontal Res 2021; 56:726-734. [PMID: 33686671 DOI: 10.1111/jre.12869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/BACKGROUND Recent studies have shown that periodontal disease is strongly related to gestational complications such as preeclampsia (PE). PE is responsible for 42% of maternal deaths worldwide and kills approximately 76 000 women a year. In addition, children born under PE conditions are at increased risk of hospitalization due to metabolic disorders, epilepsy, and other complications. Numerous reviews and clinical studies on PE have been published, but the mechanisms underlying the relationship between periodontal disease and PE and the way periodontopathogens alter vascular response in pregnant women remain unclear. METHODS This study aims to verify whether periodontal disease induces PE by using the association of two periodontitis (PD) models: ligature and oral Porphyromonas gingivalis (P. gingivalis) W83 inoculation in Wistar rats. At gestational day 5, the ligature was placed on each mandibular first molar, which was followed by daily oral P. gingivalis inoculation for 15 days. At gestational day 19, urine was collected, and invasive arterial pressure was measured. The animals were euthanized, and plasma and tissues were collected. RESULTS After 15 days of the association of ligature and P. gingivalis inoculation, the animals presented the characteristic symptoms of PE: altered blood pressure, proteinuria, and change in litter size (number of pups) and pup weight when compared to the control group (p < .005). The PE animals also presented greater bone porosity, trabecular separation, and reduced bone volume in the hemimandibles, as well as altered inflammatory response. The level of cytokine IL-6 was higher in the PE group than in the control group (p < .005). CONCLUSION The association of two PD models effectively induced PE. To our knowledge, this is the first study on the oral use of P. gingivalis for PE induction. Our results support the importance of PD as a possible cause for PE development, opening an important new avenue to study cause and consequence relationships in inflammation and PE due to exposure to periodontal infection.
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Affiliation(s)
- Karina Mata
- Department of Basic and Oral Biology, Dental School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil.,University of Rio Verde, UniRV, Formosa, GO, Brazil
| | - Atila Vinícius Vitor Nobre
- Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto Dental School, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
| | - Pedro Henrique Felix Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto Dental School, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
| | - Rene Seabra Oliezer
- Department of Basic and Oral Biology, Dental School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Cleverson Fernandes
- University of Rio Verde, UniRV, Formosa, GO, Brazil.,Department of Pathology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Jefferson Amaral
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Junia Ramos
- Department of Basic and Oral Biology, Dental School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Marina Constante Gabriel Del-Arco
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
| | - Michel Reis Messora
- Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto Dental School, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
| | - José Eduardo Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Raquel Fernanda Gerlach
- Department of Basic and Oral Biology, Dental School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Sergio Luiz Salvador
- Department of Clinical Analyses, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
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Li F, Qin J, Zhang S, Chen L. Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis. Pregnancy Hypertens 2021; 24:13-21. [PMID: 33626437 DOI: 10.1016/j.preghy.2021.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.
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Affiliation(s)
- Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Jiabi Qin
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Senmao Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Changsha, Hunan Province 410078, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province 410078, China.
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17
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Mollard E, Wittmaack A. Experiences of Women Who Gave Birth in US Hospitals During the COVID-19 Pandemic. J Patient Exp 2021; 8:2374373520981492. [PMID: 34179360 PMCID: PMC8205382 DOI: 10.1177/2374373520981492] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to describe the experiences of women who gave birth in a US hospital during the COVID-19 pandemic. Women who gave birth between March and July 2020 completed a survey on the experience of giving birth during a pandemic. Of this, 885 women were consented and participated in the study; 22.5% of women reported hypertension, 33.8% reported anxiety, 18.6% reported depression, and 1.13% reported testing positive for COVID-19. Of this, 61% of women reported inadequate support for childbirth, and 20.5% reported that they did not feel safe giving birth in the hospital. Women who tested positive for COVID-19 were more likely to be of Asian race, have a cesarean delivery, not have a birth partner present, and discontinue breastfeeding before 6 weeks. Pandemic-related changes to maternity care practices may have impacted birthing women's perceptions of safety and support in the hospital environment and affected symptoms of stress. Health care policy and maternity care practices should promote feelings of safety and control and overall experience for women giving birth in the hospital during a pandemic.
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18
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Cheng B, Meng Y, Zhou Y, Li J, Zeng J, Tan X, Zhang K, Luo Y, Zhang Y. Cerebral Regional Homogeneity Alternation of Pregnant Women With Antenatal Depression During the Pandemic. Front Psychiatry 2021; 12:627871. [PMID: 33959047 PMCID: PMC8093433 DOI: 10.3389/fpsyt.2021.627871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/22/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: The COVID-19 epidemic has been a threat to the health of people all over the world. Various precautions during COVID-19 in China have kept a large number of people in isolation, and this has inconvenienced and placed enormous stress on pregnant women. Pregnant women are more likely to suffer from antenatal depression (ANDP) with social isolation or low social support. This research aims to investigate the neurobiological mechanisms underlying ANDP, which impedes early detection and intervention in this disorder. Methods: A total of 43 singleton pregnant women who experienced isolation were recruited, including 21 treatment-naïve ANDP patients and 22 healthy pregnant women (HPW). To explore the intrinsic cerebral activity alternations in ANDP using resting-state functional MRI (rsfMRI), we assessed the local regional homogeneity (ReHo) differences in two groups using the voxel-based whole-brain analysis. The correlation between the regional functional abnormalities and clinical variables in ANDP patients was also examined. Results: Compared with HPW, ANDP patients showed decreased ReHo in the left dorsolateral prefrontal cortex, right insular and the cluster coving the right ventral temporal cortex (VTC), amygdala (AMG), and hippocampus (HIP). The Edinburgh Postnatal Depression Scale (EPDS) scores of ANDP patients negatively correlated with the ReHo in the right VTC, AMG, and HIP. Conclusion: Elucidating the neurobiological features of ANDP patients during COVID-19 is crucial for evolving adequate methods for early diagnosis, precaution, and intervention in a future epidemic.
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Affiliation(s)
- Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yajing Meng
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Yushan Zhou
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jinrong Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jianguang Zeng
- School of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Xi Tan
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyou Zhang
- Department of Clinical Laboratory, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ya Luo
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Gynecology and Obstetrics, Wuxi Maternal and Child Health Hospital, The Affiliated Hospital of Nanjing Medical University, Wuxi, China
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Liu Y, Chen W, Yang Y, Chen Y, Tang S. Exposure to electronic screen before nocturnal sleep increases the risk of hypertensive disorders of pregnancy: A case-control study. J Obstet Gynaecol Res 2020; 47:698-704. [PMID: 33274550 DOI: 10.1111/jog.14588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
AIM Previous studies indicated that excessive screen time was associated with hypertension in children and adolescents. In our hospital, pregnant women tended to spend a lot of time on electronic devices like smartphones. We aimed to explore the relationship between the screen time and hypertensive disorders of pregnancy (HDP). METHODS A case-control study was conducted from November 2019 to May 2020. A total of 160 women with HDP and 197 healthy controls who gave birth to children in the same hospital were recruited and information was recorded by questionnaires. Multivariate analysis was conducted to assess the effect of screen time on HDP. RESULTS The results showed that, exposure to electronic screen before nocturnal sleep in cases was significantly longer than that in controls (P = 0.011, odds ratio = 1.50). Smartphones (and/or tablet computers) used only for entertainment also significantly increased the susceptibility to HDP (P < 0.001, odds ratio = 2.84). Other related factors were following: work experience during pregnancy (P = 0.034, odds ratio = 0.53), history of diabetes mellitus (P = 0.013, odds ratio = 2.55), history of family hypertension (P < 0.001, odds ratio = 3.81), body mass index of pre-pregnancy (>25 kg/m2 ) (P < 0.001, odds ratio = 6.16). CONCLUSION In conclusion, long exposure to electronic screen before nocturnal sleep and the smartphones usage for only entertainment may be associated with the susceptibility to HDP.
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Affiliation(s)
- Yun Liu
- Department of Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Wenjun Chen
- Department of Endocrinology, Liyang People's Hospital, Liyang, China
| | - Yixin Yang
- Department of Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Yu Chen
- Department of Obstetrics, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, China
| | - Shaidi Tang
- Department of Prevention and Health, Liyang People's Hospital, Liyang, China
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20
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The association between first trimester placental biomarkers and placental lesions of maternal vascular malperfusion. Placenta 2020; 103:206-213. [PMID: 33161363 DOI: 10.1016/j.placenta.2020.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Abnormal levels of first trimester placental biomarkers are associated with the development of placental syndrome (PS). However, prediction performance is moderate, possibly explained by the clinical heterogeneity of PS. Aim of this study is to investigate the association between first trimester biomarkers and the presence of maternal vascular malperfusion (MVM), as a marker for placental insufficiency. METHODS This retrospective study included 195 women with available first trimester blood sample and placenta histological sections for examination at the Maastricht University Medical Centre. Women were divided into 4 groups, based on the presence of having MVM lesions and/or PS. Levels of PAPP-A, PlGF and sFlt-1 were measured and MVM lesions were classified according to the Amsterdam Placental Workshop Group Consensus Statement. RESULTS MVM occurrence was observed in 32% of the uncomplicated pregnancies. Women with MVM (regardless of the PS) had lower levels of PAPP-A (p = 0.038) and sFLt-1 (p = 0.006), and a non-significant trend for lower PlGF and sFlt-1/PlGF ratio compared to women without MVM. Low PAPP-A levels individually and in combination with the presence of PS was significantly associated with MVM lesions (aOR = 3.0 and 6.1, respectively), as did the combination of low PlGF levels and PS (aOR = 4.6). In women with PS, having MVM increased the incidence of fetal growth restriction, small for gestational age neonates, lower birthweight and adverse neonatal outcome. DISCUSSION Our findings suggest that MVM lesions were found to be associated with increased obstetric risks due to early placental dysfunction that can potentially be predicted by the use of first trimester biomarkers.
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Florio KL, DeZorzi C, Williams E, Swearingen K, Magalski A. Cardiovascular Medications in Pregnancy: A Primer. Cardiol Clin 2020; 39:33-54. [PMID: 33222813 DOI: 10.1016/j.ccl.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiovascular disease and cardiovascular disease-related disorders remain among the most common causes of maternal morbidity and mortality in the United States. Due to increased rates of obesity, delayed childbearing, and improvements in medical technology, greater numbers of women are entering pregnancy with preexisting medical comorbidities. Use of cardiovascular medications in pregnancy continues to increase, and medical management of cardiovascular conditions in pregnancy will become increasingly common. Obstetricians and cardiologists must familiarize themselves with the pharmacokinetics of the most commonly used cardiovascular medications in pregnancy and how these medications respond to the physiologic changes related to pregnancy, embryogenesis, and lactation.
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Affiliation(s)
- Karen L Florio
- Heart Disease in Pregnancy Program, Saint Luke's Hospital of Kansas City, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA.
| | - Christopher DeZorzi
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Emily Williams
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA
| | - Kathleen Swearingen
- Heart Disease in Pregnancy Program, Saint Luke's Hospital of Kansas City, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA
| | - Anthony Magalski
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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Magnesium Lithospermate B Downregulates the Levels of Blood Pressure, Inflammation, and Oxidative Stress in Pregnant Rats with Hypertension. Int J Hypertens 2020; 2020:6250425. [PMID: 33014451 PMCID: PMC7519462 DOI: 10.1155/2020/6250425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/19/2020] [Accepted: 09/07/2020] [Indexed: 01/16/2023] Open
Abstract
Background Magnesium lithospermate B (MLB) was shown to suppress oxidative stress and reduce hypertension, but the role of MLB in pregnancy-induced hypertension (PIH) remains unknown. The objective of this study was to demonstrate the effects of MLB on rats with PIH. Methods A total of 40 pregnant SD rats were selected, and 30 rats were orally given NG-nitro-L-arginine methyl ester (L-NAME, 60 mg/kg/day) to establish PIH rat models. Rats were equally divided into four groups: control, PIH, 5 mg/kg MLB, and 10 mg/kg MLB. MLB was consecutively administered into PIH rats for one week. The effects of MLB on mean arterial blood pressure (MAP), urine protein level, inflammation, and oxidative stress together with angiogenesis were analyzed. Results MLB prevented the elevation in MAP and urine protein levels induced by L-NAME. The activities of inflammatory cytokines were highly increased in serum and placental tissues of PIH rats, while cotreatment with MLB partially reversed the activities of these cytokines. MLB also recovered the expression of reactive oxygen species (ROS) in plasma of PIH rats together with levels of oxidative stress and antioxidant capacity in the placenta of PIH rats. The decreased expressions of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and NO observed in PIH rats were increased by MLB. In addition, 10 mg/kg MLB exhibited higher protective effects as compared to lower doses of 5 mg/kg. Conclusion This study demonstrated that pretreatment with MLB decreased MAP, inflammation, and oxidative stress in rats with gestational hypertension.
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Pheochromocytoma and Paraganglioma: From Clinical Findings to Diagnosis. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:271-280. [PMID: 33312023 PMCID: PMC7729715 DOI: 10.14744/semb.2020.14826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
The majority of pheochromocytoma (PCC) and paraganglioma (PGL) are endocrine active tumors, and they cause clinical symptoms by secreting excess one or more catecholamines (epinephrine, norepinephrine, and dopamine) and their inactive metabolites (metanephrine, normetanephrine, 3-metoxythromine). Although signs and symptoms regarding excess catecholamine often develop in PCC and PGL (PPGL), non-functional PPGLs may present with local compression symptoms. Persistent, sometimes worsening hypertension is the most common finding and occurs in 80-90% of the patients. Classically defined symptom triad; headache, sweating and palpitations are seen in only 25% of the patients with PCC. The difference of clinical symptoms may be related to the tumor secretion, epinephrine or norepinephrine. All patients with signs and symptoms suggestive of catecholamine excess should be screened by biochemical tests regardless of whether they have hypertension or not. Not all patients with newly diagnosed hypertension need to be screened, but only patients with additional tips for catecholamine excess should be screened. Approximately 20% of the PPGLs are diagnosed in childhood, and the male/female ratio is 2/1. 60-90% of pediatric patients present with hypertension. PPGL in pregnancy is rare, and the estimated incidence ranges between 1/15000-1/54000. Although early diagnosis is the most important factor in preventing mortality, diagnosis is not as easy as it is a rare condition. Hypertension is a common complication in pregnancy, occurring in 5-10%. Computed tomography should not be used as the imaging method during pregnancy; the first choice is magnetic resonance imaging with gadolinium or without contrast. Plasma free metanephrine or 24-hour urinary fractionated metanephrine level is recommended as a screening test for the diagnosis of PPGL in the Endocrine Society Clinical Practice Guideline. In suspicious situations, tests should be repeated. Since 40% of these patients have germline mutations, genetic tests are recommended for all patients with PPGL regardless of family history and age. Preoperative knowledge of germline mutations affects the surgical approach and the extent of adrenalectomy. After the biochemical diagnosis is made in PPGL, the tumor is localized with imaging methods to make the operation plan. In this review, we aimed to evaluate the clinical findings, diagnostic tests, and imaging studies for tumor localization in PPGL.
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de Gaalon S, Donnet A. Headaches during pregnancy. Rev Neurol (Paris) 2020; 177:195-202. [PMID: 32838992 DOI: 10.1016/j.neurol.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 12/31/2022]
Abstract
Headache during pregnancy is frequent and challenging. A secondary headache is diagnosed in one third of women, and most causes are vascular and infectious disorders. Anamnestic and clinical features must be investigated, and brain imaging is often required. Primary headaches are commonly modified during pregnancy. Migraine is mainly improved in this context, especially migraine without aura. Particular cautions about treatment must be applied, and non-pharmacological measures must be preferred. Tension-type headache and cluster headache seem to be less hormone-dependent.
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Affiliation(s)
- S de Gaalon
- Service de neurologie, hôpital Laënnec, CHU de Nantes, Nantes, France.
| | - A Donnet
- Centre d'évaluation et de traitement de la douleur, FHU INOVPAIN, hôpital de La Timone, Marseille, France
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Perez M, Robbins ME, Revhaug C, Saugstad OD. Oxygen radical disease in the newborn, revisited: Oxidative stress and disease in the newborn period. Free Radic Biol Med 2019; 142:61-72. [PMID: 30954546 PMCID: PMC6791125 DOI: 10.1016/j.freeradbiomed.2019.03.035] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/06/2019] [Accepted: 03/29/2019] [Indexed: 12/28/2022]
Abstract
Thirty years ago, there was an emerging appreciation for the significance of oxidative stress in newborn disease. This prompted a renewed interest in the impact of oxygen therapy for the newborn in the delivery room and beyond, especially in premature infants. Today, the complexity of oxidative stress both in normal regulation and pathology is better understood, especially as it relates to neonatal mitochondrial oxidative stress responses to hyperoxia. Mitochondria are recipients of oxidative damage and have a propensity for oxidative self-injury that has been implicated in the pathogenesis of neonatal lung diseases. Similarly, both intrauterine growth restriction (IUGR) and macrosomia are associated with mitochondrial dysfunction and oxidative stress. Additionally, reoxygenation with 100% O2 in a hypoxic-ischemic newborn lamb model increased the production of pro-inflammatory cytokines in the brain. Moreover, the interplay between inflammation and oxidative stress in the newborn is better understood because of animal studies. Transcriptomic analyses have found a number of genes to be differentially expressed in murine models of bronchopulmonary dysplasia (BPD). Epigenetic changes have also been detected both in animal models of BPD and premature infants exposed to oxygen. Antioxidant therapy to prevent newborn disease has not been very successful; however, new therapeutic principles, like melatonin, are under investigation.
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Affiliation(s)
- Marta Perez
- Division of Neonatology, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Mary E Robbins
- Division of Neonatology, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Cecilie Revhaug
- Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway
| | - Ola D Saugstad
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States; Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway.
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Bao LX, Shi WT, Han YX. Metformin versus insulin for gestational diabetes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:2741-2753. [PMID: 31558075 DOI: 10.1080/14767058.2019.1670804] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Metformin is increasingly used in clinical practice for the treatment of gestational diabetes mellitus. However, its safety and long-term effects on fetuses exposed to metformin in uterus remain controversial. METHODS We systematically searched PubMed, Embase, and the Cochrane database (last search was updated on 1 May 2019) for randomized controlled trials comparing metformin with insulin. Two reviewers extracted the data and calculated pooled estimates by use of a random-effects model. RESULTS Twenty-four studies were included. Among these, seventeen RCTs (N = 2828 participants) were included for quantitative analyses and seven studies were included only for qualitative synthesis. Metformin lowered the risk of pregnancy-induced hypertension (p = .03; risk ratio (RR) = 0.64; confidence interval (95%CI) [0.44, 0.95]), large for gestational age babies (p = .04; RR = 0.82; 95% CI [0.68, 0.99]), macrosomia (p = .01; RR = 0.63; 95%CI [0.45, 0.90]), neonatal hypoglycemia (p = .001; RR = 0.72; 95%CI [0.59, 0.88]), and neonatal intensive care unit admission (p = .01; RR = 0.74; 95%CI [0.58, 0.94]). Metformin did not increase premature delivery (p = .11; RR = 1.28; 95%CI [0.95, 1.73]), preeclampsia (p = .45; RR = 0.89; 95%CI [0.65, 1.21]), caesarean delivery (p = .20; RR = 0.94; 95%CI [0.85, 1.04]), small for gestational age babies (p = .95; RR = 0.99; 95%CI [0.69, 1.42]). The long-term results seemed to have no adverse effect, but the information was still limited. CONCLUSIONS According to our review, metformin may have potential benefits for pregnant women and newborns with no obvious adverse effects. However, even more studies are needed to provide evidence for the future use of metformin.
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Affiliation(s)
- Le-Xin Bao
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
| | - Wan-Ting Shi
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
| | - Yu-Xin Han
- Affiliated Hospital of Qingdao, University, Qingdao University, Qingdao, People's Republic of China
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Chen D, Lao M, Cai X, Li H, Zhan Y, Wang X, Zhan Z. Hypertensive disorders of pregnancy associated with adverse pregnant outcomes in patients with systemic lupus erythematosus: a multicenter retrospective study. Clin Rheumatol 2019; 38:3501-3509. [PMID: 31377919 DOI: 10.1007/s10067-019-04696-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored. METHODS A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography. RESULTS HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupus patients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5-9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7-18.6, P < 0.001) were independent risk factors for HDP in lupus patients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively. CONCLUSIONS HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupus patients with HDP.Key Points• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.• HDP led to lupus activation during the second and third trimesters.• Disease activation and aCL positivity were predictors for HDP.• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.
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Affiliation(s)
- Dongying Chen
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Minxi Lao
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China.,Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Cai
- Department of Rheumatology, Guangzhou First People's Hospital, Guangzhou, China
| | - Hao Li
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yanfeng Zhan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Wang
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No 16, Jichang Road, Guangzhou, 510405, China.
| | - Zhongping Zhan
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, No 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
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Akahoshi N, Handa H, Takemoto R, Kamata S, Yoshida M, Onaka T, Ishii I. Preeclampsia-Like Features and Partial Lactation Failure in Mice Lacking Cystathionine γ-Lyase-An Animal Model of Cystathioninuria. Int J Mol Sci 2019; 20:ijms20143507. [PMID: 31319489 PMCID: PMC6679037 DOI: 10.3390/ijms20143507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 01/01/2023] Open
Abstract
Elevated plasma homocysteine levels are considered as a risk factor for cardiovascular diseases as well as preeclampsia—a pregnancy disorder characterized by hypertension and proteinuria. We previously generated mice lacking cystathionine γ-lyase (Cth) as cystathioninuria models and found them to be with cystathioninemia/homocysteinemia. We investigated whether Cth-deficient (Cth−/−) pregnant mice display any features of preeclampsia. Cth−/− females developed normally but showed mild hypertension (~10 mmHg systolic blood pressure elevation) in late pregnancy and mild proteinuria throughout development/pregnancy. Cth−/− dams had normal numbers of pups and exhibited normal maternal behavior except slightly lower breastfeeding activity. However, half of them could not raise their pups owing to defective lactation; they could produce/store the first milk in their mammary glands but not often provide milk to their pups after the first ejection. The serum oxytocin levels and oxytocin receptor expression in the mammary glands were comparable between wild-type and Cth−/− dams, but the contraction responses of mammary gland myoepithelial cells to oxytocin were significantly lower in Cth−/− dams. The contraction responses to oxytocin were lower in uteruses isolated from Cth−/− mice. Our results suggest that elevated homocysteine or other unknown factors in preeclampsia-like Cth−/− dams interfere with oxytocin that regulates milk ejection reflex.
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Affiliation(s)
- Noriyuki Akahoshi
- Department of Health Chemistry, Showa Pharmaceutical University, Tokyo 194-8543, Japan
| | - Hiroki Handa
- Department of Health Chemistry, Showa Pharmaceutical University, Tokyo 194-8543, Japan
| | - Rintaro Takemoto
- Department of Health Chemistry, Showa Pharmaceutical University, Tokyo 194-8543, Japan
| | - Shotaro Kamata
- Department of Health Chemistry, Showa Pharmaceutical University, Tokyo 194-8543, Japan
| | - Masahide Yoshida
- Department of Physiology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Tatsushi Onaka
- Department of Physiology, Jichi Medical University, Tochigi 329-0498, Japan
| | - Isao Ishii
- Department of Health Chemistry, Showa Pharmaceutical University, Tokyo 194-8543, Japan.
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Su M, Hu Z, Dong C, Xu X. Vascular endothelial growth factor gene polymorphisms and hypertensive disorder of pregnancy: A meta-analysis. Pregnancy Hypertens 2019; 17:191-196. [PMID: 31487639 DOI: 10.1016/j.preghy.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/20/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Whether vascular endothelial growth factor (VEGF) polymorphisms affect individual susceptibility to hypertensive disorder of pregnancy remain controversial. Therefore, we performed this meta-analysis to better evaluate associations between VEGF polymorphisms and hypertensive disorder of pregnancy in a larger pooled population. METHODS Pubmed, Web of Science, Embase and CNKI were searched for eligible studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS Totally 24 studies were eligible for analyses. In overall analyses, a significant association with hypertensive disorder of pregnancy was observed for rs3025039 polymorphism in dominant (p = 0.01, OR = 0.66, 95%CI 0.48-0.91), recessive (p = 0.002, OR = 1.79, 95%CI 1.25-2.58), overdominant (p = 0.04, OR = 1.35, 95%CI 1.01-1.80) and allele (p = 0.01, OR = 0.72, 95%CI 0.56-0.93) comparisons. But we did not observe any significant associations with hypertensive disorder of pregnancy for other VEGF polymorphisms in overall analyses. Further subgroup analyses by ethnicity showed that rs2010963 polymorphism was significantly associated with hypertensive disorder of pregnancy in Caucasians (dominant and recessive models) and Africans (allele model), whereas rs3025039 polymorphism was significantly associated with hypertensive disorder of pregnancy in Asians (recessive model). CONCLUSIONS In summary, our findings indicated that rs2010963 and rs3025039 polymorphisms were both significantly associated with the susceptibility to hypertensive disorder of pregnancy in certain populations.
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Affiliation(s)
- Meng Su
- Department of Obstetrics, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Zongyan Hu
- Department of Obstetrics, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Changmin Dong
- Department of Obstetrics, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Xuejuan Xu
- Department of Obstetrics, Tengzhou Central People's Hospital, Tengzhou 277500, China.
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Ronkainen J, Lowry E, Heiskala A, Uusitalo I, Koivunen P, Kajantie E, Vääräsmäki M, Järvelin MR, Sebert S. Maternal hemoglobin associates with preterm delivery and small for gestational age in two Finnish birth cohorts. Eur J Obstet Gynecol Reprod Biol 2019; 238:44-48. [PMID: 31082743 DOI: 10.1016/j.ejogrb.2019.04.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/27/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test whether maternal hemoglobin during pregnancy associates with offspring perinatal outcomes in a developed country. Changes in maternal hemoglobin concentration during pregnancy are partly physiological phenomena reflecting alterations of maternal blood volume. Especially hemoglobin measures outside the physiological range may influence maternal health and fetal growth with long-lasting consequences. STUDY DESIGN We studied an unselected sample drawn from two regional birth cohorts born 20 years apart: The Northern Finland Birth Cohorts 1966 and 1986. These are two mother-and-child population-based birth cohorts together comprising 21,710 mothers and their children. After exclusions, the sample size of the current study was 20,554. Concentrations of maternal hemoglobin at first and last antenatal visits were categorized as low (lowest 10%), medium (reference) or high (highest 10%). Multinomial logistic regression analyses for categories of maternal hemoglobin and perinatal outcomes such as preterm delivery and full-term small and large for gestational age were conducted with adjustments for maternal cofactors. RESULTS Low maternal hemoglobin at early pregnancy associated with decreased risk of full-term small for gestational age (adjusted OR 0.73, 95% CI [0.58, 0.93], p = 0.010). At late pregnancy, low maternal hemoglobin associated with increased risk of preterm delivery (adjusted OR 1.60, 95% CI [1.26, 2.02], p < 0.0005) whereas high maternal hemoglobin associated with increased risk of full-term small for gestational age (adjusted OR 1.29, 95% CI [1.07, 1.56], p = 0.009). Maternal hemoglobin did not show constant association with risk of large for gestational age. CONCLUSION The results from this study support evidence that both low and high maternal hemoglobin associate with adverse perinatal outcomes. Low maternal hemoglobin associated with preterm delivery and high with full-term small for gestational age. Association was mainly present when maternal hemoglobin was measured during the third trimester. These results indicate that it is important to monitor both extremes of maternal hemoglobin throughout the pregnancy.
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Affiliation(s)
- Justiina Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland.
| | - Estelle Lowry
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Anni Heiskala
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Iida Uusitalo
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Peppi Koivunen
- Biocenter Oulu, University of Oulu, Oulu, Finland; Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland; Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marja Vääräsmäki
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland; Department for Genomics of Common Diseases, School of Medicine, Imperial College London, London, United Kingdom
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Li Y, Ruan Y. Association of hypertensive disorders of pregnancy risk and factor V Leiden mutation: A meta-analysis. J Obstet Gynaecol Res 2019; 45:1303-1310. [PMID: 31037802 DOI: 10.1111/jog.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/06/2019] [Indexed: 12/14/2022]
Abstract
AIM To date, the conclusions of studies on a possible association between factor V Leiden (FVL, FV G1691A, rs6025) and hypertensive disorders of pregnancy (HDP) are conflicting. Here, we aimed to estimate the relationship between the risk of HDP and FVL. METHODS Eligible studies focused on FVL and HDP were searched from the PubMed and the Web of Science databases up to March 31, 2018. We used random effects model for the meta-analysis, and I2 statistic to assess the degree of heterogeneity between all included studies. To evaluate the association between FVL and the risk of HDP, we calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing cases and controls of all samples and each subgroup based on different regions. RESULTS Fifty citations on FVL and HDP were identified through the literature search, and a meta-analysis on the GA + AA genotype between 6041 cases and 8364 controls was conducted. The holistic analysis found that pregnant women with GA or AA genotype of FVL have a 1.97-fold (95% CI: 1.64-2.35, P < 0.00001) increased risk of HDP compared with GG carriers. While the OR are 2.23 (95% CI: 1.76-2.84, P < 0.00001) and 1.90 (95% CI: 1.12-3.23, P = 0.02) in Europe and the Middle East subgroups, respectively. CONCLUSION Factor V Leiden mutation is associated with an increased risk of HDP, and is particularly associated with preeclampsia and eclampsia in European women. However, further high-quality studies are warranted to confirm the possible effectiveness of FVL in HDP patients.
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Affiliation(s)
- Yuan Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Tamargo J, Caballero R, Delpón E. Pharmacotherapy for hypertension in pregnant patients: special considerations. Expert Opin Pharmacother 2019; 20:963-982. [PMID: 30943045 DOI: 10.1080/14656566.2019.1594773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.
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Affiliation(s)
- Juan Tamargo
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Ricardo Caballero
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Eva Delpón
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
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Wang H, Liu J, Zhang R, Liu Y, Ren X, Gao K, Zhao C, Liu S. The relationship between DNA repair genes (XPA, XPF, XPG) polymorphism and the risk of preeclampsia in Chinese Han Women. Pregnancy Hypertens 2018; 14:145-149. [DOI: 10.1016/j.preghy.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/30/2018] [Indexed: 01/12/2023]
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Fetal and Maternal Outcomes of Planned Pregnancy in Patients with Systemic Lupus Erythematosus: A Retrospective Multicenter Study. J Immunol Res 2018; 2018:2413637. [PMID: 30255104 PMCID: PMC6140277 DOI: 10.1155/2018/2413637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the fetal and maternal outcomes as well as predictors of APOs in women with SLE who conceived when the disease was stable, the so-called "planned pregnancy." Methods. A retrospective multicenter study of 243 patients with SLE who underwent a planned pregnancy was performed. APOs in fetus and mothers were recorded. Results The average age at conception was 28.9 ± 3.9 years. Duration of SLE prior to pregnancy was 4.4 ± 4.3 years. Fetal APOs occurred in 86 (86/243, 35.4%) patients. Preterm births, intrauterine growth retardation (IUGR), fetal distress, and fetal loss accounted for 22.2%, 14.8%, 11.1%, and 4.9%, respectively. Forty-two preterm infants (42/54, 77.8%) were delivered after the 34th week of gestation. All the preterm infants were viable. Fifty-two patients (52/243, 21.4%) had disease flares, among which 45 cases (45/52, 86.5%) were mild, 6 (6/52, 11.5%) were moderate, and 1 (1/52, 1.9%) was severe. Disease flares were mainly presented as active lupus nephritis (41/52, 78.8%), thrombocytopenia (10/52, 19.2%), and skin/mucosa lesions (9/52, 17.3%). Pregnancy-induced hypertension (PIH) occurred in 29 patients, among which 3 were gestational hypertension and 26 were preeclampsia. Multiple analysis showed that disease flares (OR, 8.1; CI, 3.8-17.2) and anticardiolipin antibody positivity (OR, 7.4; CI, 2.5-21.8) were associated with composite fetal APOs. Conclusion Planned pregnancy improved fetal and maternal outcomes, presenting as a lower rate of fetal loss, more favorable outcomes for preterm infants, and less severe disease flares during pregnancy.
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Kurosaki H, Nakahata K, Donishi T, Shiro M, Ino K, Terada M, Kawamata T, Kaneoke Y. Effects of perinatal blood pressure on maternal brain functional connectivity. PLoS One 2018; 13:e0203067. [PMID: 30153298 PMCID: PMC6112678 DOI: 10.1371/journal.pone.0203067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/14/2018] [Indexed: 01/21/2023] Open
Abstract
Perinatal hypertensive disorder including pre-eclampsia is a systemic syndrome that occurs in 3–5% of pregnant women. It can result in various degrees of brain damage. A recent study suggested that even gestational hypertension without proteinuria can cause cardiovascular or cognitive impairments later in life. We hypothesized that perinatal hypertension affects the brain functional connectivity (FC) regardless of the clinical manifestation of brain functional impairment. In the present study, we analyzed regional global connectivity (rGC) strength (mean cross-correlation coefficient between a brain region and all other regions) using resting-state functional magnetic resonance imaging to clarify brain FC changes associated with perinatal blood pressure using data from 16 women with a normal pregnancy and 21 pregnant women with pre-eclampsia. The rGC values in the bilateral orbitofrontal gyri were negatively correlated with diastolic blood pressure (dBP), which could not be explained by other pre-eclampsia symptoms. The strength of FC seeding at the left orbitofrontal gyrus was negatively correlated with dBP in the anterior cingulate gyri and right middle frontal gyrus. These results suggest that dBP elevation during pregnancy can affect the brain FC. Since FC is known to be associated with various brain functions and diseases, our findings are important for elucidating the neural correlate of cognitive impairments related to hypertension in pregnancy.
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Affiliation(s)
- Hiromichi Kurosaki
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
- * E-mail: (HK); (KN)
| | - Katsutoshi Nakahata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
- * E-mail: (HK); (KN)
| | - Tomohiro Donishi
- Department of System Neurophysiology, Graduate School of Wakayama Medical University, Wakayama, Japan
| | - Michihisa Shiro
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | | | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Kaneoke
- Department of System Neurophysiology, Graduate School of Wakayama Medical University, Wakayama, Japan
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Kong D, Wang H, Liu Y, Li H, Wang H, Zhu P. Correlation between the expression of inflammatory cytokines IL-6, TNF-α and hs-CRP and unfavorable fetal outcomes in patients with pregnancy-induced hypertension. Exp Ther Med 2018; 16:1982-1986. [PMID: 30186428 PMCID: PMC6122102 DOI: 10.3892/etm.2018.6393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/21/2018] [Indexed: 11/12/2022] Open
Abstract
The expression of inflammatory factors, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP), in patients with pregnancy-induced hypertension (PIH) was investigated, to analyze correlation of expression levels of these factors in patients with unfavorable fetal outcome. A total of 100 patients diagnosed with PIH treated in Jining First People's Hospital (Jining, China) from January 2012 to October 2017 were selected as the experimental group, while 100 normal pregnant women during the same period were selected as the control group. Results showed that the levels of IL-6, TNF-α and hs-CRP in patients with PIH were significantly higher than those in normal pregnant women (p<0.01). There were significant differences in levels of IL-6, TNF-α and hs-CRP among patients with hypertension in different degrees. The expression levels of IL-6, TNF-α and hs-CRP in PIH patients with favorable pregnancy outcome were lower than those in patients with unfavorable pregnancy outcome (p<0.05). Moreover, the expression levels of IL-6, TNF-α and hs-CRP had a linearly positive correlation with systolic blood pressure in PIH patients. Age, height and weight had no significant correlation with unfavorable pregnancy outcome of PIH patients (p>0.05). Finally, inflammatory factors (TNF-α, IL-6 and hs-CRP) and blood pressure were obviously and positively correlated with unfavorable pregnancy outcome of PIH patients (p<0.05). In conclusion, the expression of inflammatory factors (TNF-α, IL-6 and hs-CRP) in PIH patients are positively correlated with the systolic blood pressure and unfavorable fetal outcome of patients, which can be used as indexes of prognosis evaluation of PIH patients.
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Affiliation(s)
- Dehua Kong
- Department of Obstetrics, Jining First People's Hospital, Jining, Shandong 272000, P.R. China
| | - Hui Wang
- Reproductive Center, Yantaishan Hospital, Yantai, Shandong 264000, P.R. China
| | - Yan Liu
- Department of Surgery People's Hospital of Zhangqiu, Jinan, Shandong 250000, P.R. China
| | - Hongjun Li
- EEG Room, Jinan Zhangqiu District Hospital of TCM, Jinan, Shandong 250000, P.R. China
| | - Hongyan Wang
- Department of Obstetrics, People's Hospital of Zhangqiu, Jinan, Shandong 250000, P.R. China
| | - Peng Zhu
- Department of Obstetrics, Jining First People's Hospital, Jining, Shandong 272000, P.R. China
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Nguefack CT, Ako MA, Dzudie AT, Nana TN, Tolefack PN, Mboudou E. Comparison of materno-fetal predictors and short-term outcomes between early and late onset pre-eclampsia in the low-income setting of Douala, Cameroon. Int J Gynaecol Obstet 2018; 142:228-234. [PMID: 29761476 DOI: 10.1002/ijgo.12531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe and compare materno-fetal predictors and short-term outcomes of early onset pre-eclampsia (EOPE) and late onset pre-eclampsia (LOPE) in Douala, Cameroon. METHODS The present prospective hospital-based cross-sectional study included women with pre-eclampsia attending obstetric units at four hospitals in Douala between December 1, 2016, and April 30, 2017. To determine maternal predictors, sociodemographic and medical data were recorded using a pretested questionnaire. Pregnancy outcomes, and maternal and fetal adverse events were recorded. Univariate and multivariate logistic regression analyses were used to examine associations. RESULTS Of 170 participants, 58 (34.1%) had EOPE and 112 (65.9%) had LOPE. EOPE was associated with higher incidences of chronic hypertension (P=0.027) and history of pre-eclampsia (P=0.003) compared with LOPE. Higher incidences of nulliparity and a different partner from prior pregnancy (P=0.024) were associated with LOPE. Women with EOPE had higher odds of acute kidney injury (odds ratio [OR] 6.67, 95% confidence interval [CI] 1.73-25.73) and HELLP (hemolysis, elevated liver enzyme, low platelets) syndrome (OR 10.47, 95% CI 1.19-91.9), and lower odds of deliveries without perinatal adverse events (OR 0.19, 95% CI 0.09-0.38), compared with patients with LOPE. CONCLUSION In the low-income setting of Douala, there was a higher rate of LOPE than EOPE. Factors associated with EOPE and LOPE varied, and outcomes were worse for women with EOPE.
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Affiliation(s)
- Charlotte T Nguefack
- Faculty of Medicine and Pharmaceutical Science, University of Douala, Douala, Cameroon.,Department of Gynecology and Obstetrics, Douala General Hospital, Douala, Cameroon
| | - Mangwi A Ako
- Faculty of Medicine and Pharmaceutical Science, University of Douala, Douala, Cameroon.,Department of Gynecology and Obstetrics, Douala General Hospital, Douala, Cameroon
| | - Anastase T Dzudie
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Health Sciences, University of Buéa, Buéa, Cameroon
| | - Théophile N Nana
- Department of Gynecology and Obstetrics, Douala General Hospital, Douala, Cameroon.,Faculty of Health Sciences, University of Buéa, Buéa, Cameroon
| | - Paul N Tolefack
- Department of Gynecology and Obstetrics, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Emile Mboudou
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon.,Department of Gynecology and Obstetrics, Gynecology-Obstetric and Pediatric Hospital, Douala, Cameroon
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Is metformin a viable alternative to insulin in the treatment of gestational diabetes mellitus (GDM)? Comparison of maternal and neonatal outcomes. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2018. [DOI: 10.1016/j.epag.2018.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Ejike DE, Ambrose B, Moses DA, Karimah MR, Iliya E, Sheu OS, Nganda P. Determination, knowledge and prevalence of pregnancy-induced hypertension/eclampsia among women of childbearing age at Same District Hospital in Tanzania. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/ijmms2017.1343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ausman J, Abbade J, Ermini L, Farrell A, Tagliaferro A, Post M, Caniggia I. Ceramide-induced BOK promotes mitochondrial fission in preeclampsia. Cell Death Dis 2018; 9:298. [PMID: 29463805 PMCID: PMC5833856 DOI: 10.1038/s41419-018-0360-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 12/12/2022]
Abstract
Mitochondria are in a constant balance of fusing and dividing in response to cellular cues. Fusion creates healthy mitochondria, whereas fission results in removal of non-functional organelles. Changes in mitochondrial dynamics typify several human diseases. However, the contribution of mitochondrial dynamics to preeclampsia, a hypertensive disorder of pregnancy characterized by placental cell autophagy and death, remains unknown. Herein, we show that the mitochondrial dynamic balance in preeclamptic placentae is tilted toward fission (increased DRP1 expression/activation and decreased OPA1 expression). Increased phosphorylation of DRP1 (p-DRP1) in mitochondrial isolates from preeclamptic placentae and transmission electron microscopy corroborated augmented mitochondrial fragmentation in cytotrophoblast cells of PE placentae. Increased fission was accompanied by build-up of ceramides (CERs) in mitochondria from preeclamptic placentae relative to controls. Treatment of human choriocarcinoma JEG3 cells and primary isolated cytrophoblast cells with CER 16:0 enhanced mitochondrial fission. Loss- and gain-of-function experiments showed that Bcl-2 member BOK, whose expression is increased by CER, positively regulated p-DRP1/DRP1 and MFN2 expression, and localized mitochondrial fission events to the ER/MAM compartments. We also identified that the BH3 and transmembrane domains of BOK were vital for BOK regulation of fission. Moreover, we found that full-length PTEN-induced putative kinase 1 (PINK1) and Parkin, were elevated in mitochondria from PE placentae, implicating mitophagy as the process that degrades excess mitochondria fragments produced from CER/BOK-induced fission in preeclampsia. In summary, our study uncovered a novel CER/BOK-induced regulation of mitochondrial fission and its functional consequence for heightened trophoblast cell autophagy in preeclampsia.
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Affiliation(s)
- Jonathan Ausman
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Joelcio Abbade
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada.,Department of Obstetrics and Gynecology, Botucatu Medical School, UNESP - Sao Paulo State University, São Paulo, Brazil
| | - Leonardo Ermini
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada
| | - Abby Farrell
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Andrea Tagliaferro
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada
| | - Martin Post
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Peter Gilgan Center for Research and Learning, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Isabella Caniggia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, M5T 1X5, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Department of Physiology, University of Toronto, Toronto, ON, Canada. .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
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Sava RI, March KL, Pepine CJ. Hypertension in pregnancy: Taking cues from pathophysiology for clinical practice. Clin Cardiol 2018; 41:220-227. [PMID: 29485737 PMCID: PMC6490052 DOI: 10.1002/clc.22892] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/05/2018] [Indexed: 12/19/2022] Open
Abstract
Pregnancy-related hypertension (PHTN) syndromes are a frequent and potentially deadly complication of pregnancy, while also negatively impacting the lifelong health of the mother and child. PHTN appears in women likely to develop hypertension later in life, with the stress of pregnancy unmasking a subclinical hypertensive phenotype. However, distinguishing between PHTN and chronic hypertension is essential for optimal management. Preeclampsia (PE) is linked to potentially severe outcomes and lacks effective treatments due to poorly understood mechanisms. Inadequate remodeling of spiral uterine arteries (SUAs), the cornerstone of PE pathophysiology, leads to hypoperfusion of the developing placenta. In normal pregnancies, extravillous trophoblast (EVT) cells assume an invasive phenotype and invade SUAs, transforming them into large conduits. Decidual natural killer cells play an essential role, mediating materno-fetal immune tolerance, inducing early SUA remodeling and regulating EVT invasiveness. Notch signaling is important in EVT phenotypic switch and is dysregulated in PE. The hypoxic placenta releases antiangiogenic and proinflammatory factors that converge upon maternal endothelium, inducing endothelial dysfunction, hypertension, and organ damage. Hypoxia-inducible factor 1-α is upstream of such molecules, whereas endothelin-1 is a major effector. We also describe important genetic links and evidence of incomplete materno-fetal immune tolerance, with PE patients presenting with autoantibodies, lower Treg , and higher Th 17 cells. Thus, PE manifestations arise as a consequence of mal-placentation or/and because of a predisposition of the maternal vascular bed to excessively react to pathogenic molecules. From this pathophysiological basis, we provide current and propose future therapeutic directions for PE.
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Affiliation(s)
- Ruxandra I. Sava
- Center for Regenerative MedicineUniversity of FloridaGainesvilleFlorida
- “Elias” Emergency University Hospital“Carol Davila” University of Medicine and PharmacyBucharestRomania
- Division of Cardiovascular MedicineUniversity of Florida College of MedicineGainesvilleFlorida
| | - Keith L. March
- Center for Regenerative MedicineUniversity of FloridaGainesvilleFlorida
- Division of Cardiovascular MedicineUniversity of Florida College of MedicineGainesvilleFlorida
| | - Carl J. Pepine
- Center for Regenerative MedicineUniversity of FloridaGainesvilleFlorida
- Division of Cardiovascular MedicineUniversity of Florida College of MedicineGainesvilleFlorida
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Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
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Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
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Singh SK, Bhatia K. Ultrasonographic Optic Nerve Sheath Diameter as a Surrogate Measure of Raised Intracranial Pressure in Severe Pregnancy-induced Hypertension Patients. Anesth Essays Res 2018; 12:42-46. [PMID: 29628552 PMCID: PMC5872891 DOI: 10.4103/aer.aer_218_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: It is a well-known fact that severe pregnancy-induced hypertension (PIH) can be disastrous at times as it can cause a lot of complications to both pregnant women and her baby. Hence, it is always desirable to know the extent of severity by a real-time and easily accessible modality like ultrasound. Aims: The aim of the study was to evaluate the incidence of raised intracranial pressure (ICP) in severe preeclampsia and eclampsia patients using ocular ultrasonography with optic nerve sheath diameter (ONSD) measurement. Settings and Design: This study design was a prospective and clinically controlled blinded observational study. Materials and Methods: After taking necessary permissions from the Institution Ethical Committee, 75 patients were enrolled for the study. However, finally, 25 patients in severe preeclampsia and 24 in eclampsia group were compared with 25 normal term antenatal women. Demographic profiles, hemodynamic parameters, laboratory markers for severity of PIH, and ultrasonographic OSND were measured. Statistical Analysis Used: They were statistically analyzed and compared using one-way ANOVA and Tukey's test. Value of P < 0.05 was considered statistically significant. Results: All the three groups were comparable in terms of age, body weight, gestation age, gestity, and the number of primigravida in each group. There was a significant difference (P < 0.05) in mean levels of hepatic aminotransferase levels and platelet counts between groups. Aspartate transaminase and alanine transaminase levels were much higher in Group II and III as compared to Group I, while platelet levels were lower in study groups indicating increase in severity of PIH. There was also a significant difference for systolic blood pressure and diastolic blood pressure (P < 0.001) as both were significantly higher in study groups. Among severe PIH groups (Group II and III), the difference was comparable. Conclusions: OSND is a surrogate marker for raised ICP in severe PIH patients. It is a rapid, bedside, noninvasive, and readily accessible tool and could be a part of a holistic approach for managing such patients.
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Affiliation(s)
- Shiv Kumar Singh
- Department of Anaesthesiology, SHKM Government Medical College, Nalhar, Mewat, Haryana, India
| | - Kiran Bhatia
- Department of Anaesthesiology, SHKM Government Medical College, Nalhar, Mewat, Haryana, India
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Grandi SM, Vallée-Pouliot K, Reynier P, Eberg M, Platt RW, Arel R, Basso O, Filion KB. Hypertensive Disorders in Pregnancy and the Risk of Subsequent Cardiovascular Disease. Paediatr Perinat Epidemiol 2017; 31:412-421. [PMID: 28816365 DOI: 10.1111/ppe.12388] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypertensive disorders in pregnancy (HDP) have been shown to predict later risk of cardiovascular disease (CVD). However, previous studies have not accounted for subsequent pregnancies and their complications, which are potential confounders and intermediates of this association. METHODS A cohort of 146 748 women with a first pregnancy was constructed using the Clinical Practice Research Datalink. HDP was defined using diagnostic codes, elevated blood pressure readings, or new use of an anti-hypertensive drug between 18 weeks' gestation and 6 weeks post-partum. The study outcomes were incident CVD and hypertension. Marginal structural Cox models (MSM) were used to account for time-varying confounders and intermediates. Time-fixed exposure defined at the first pregnancy was used in secondary analyses. RESULTS A total of 997 women were diagnosed with incident CVD, and 6812 women were diagnosed with hypertension or received a new anti-hypertensive medication during the follow-up period. Compared with women without HDP, those with HDP had a substantially higher rate of CVD (hazard ratio (HR) 2.2, 95% confidence interval (CI) 1.7, 2.7). In women with HDP, the rate of hypertension was five times that of women without a HDP (HR 5.6, 95% CI 5.1, 6.3). With overlapping 95% CIs, the time-fixed analysis and the MSM produced consistent results for both outcomes. CONCLUSIONS Women with HDP are at increased risk of developing subsequent CVD and hypertension. Similar estimates obtained with the MSM and the time-fixed analysis suggests that subsequent pregnancies do not confound a first episode of HDP and later CVD.
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Affiliation(s)
- Sonia M Grandi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Karine Vallée-Pouliot
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Pauline Reynier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Maria Eberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill University Health Center Research Institute, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Roxane Arel
- Department of Family Medicine, St. Mary's Hospital Centre, McGill University, Montreal, QC, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill University Health Center Research Institute, Montreal, QC, Canada.,Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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45
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Kharkova OA, Grjibovski AM, Krettek A, Nieboer E, Odland JØ. First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study. PLoS One 2017; 12:e0179354. [PMID: 28797036 PMCID: PMC5552310 DOI: 10.1371/journal.pone.0179354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/05/2022] Open
Abstract
Background Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk. Methods A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006–2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression. Results The prevalence of preeclampsia/eclampsia was 8.3% (95%CI: 8.0–8.6). Preeclampsia/eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/eclampsia (adjusted OR1-5 cig/day = 0.69 with 95%CI: 0.56–0.87; OR6-10 cig/day = 0.65 with 95%CI: 0.51–0.82; and OR≥11 cig/day = 0.49 with 95%CI: 0.30–0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95%CI: 0.91–1.32). Conclusions Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.
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Affiliation(s)
- Olga A. Kharkova
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- International School of Public Health, Northern State Medical University, Arkhangelsk, Russia
- * E-mail:
| | - Andrej M. Grjibovski
- International School of Public Health, Northern State Medical University, Arkhangelsk, Russia
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - Alexandra Krettek
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Evert Nieboer
- Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada
| | - Jon Ø. Odland
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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46
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van der Weerd K, van Noord C, Loeve M, Knapen MFCM, Visser W, de Herder WW, Franssen G, van der Marel CD, Feelders RA. ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature. Eur J Endocrinol 2017; 177:R49-R58. [PMID: 28381449 DOI: 10.1530/eje-16-0920] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022]
Abstract
Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.
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Affiliation(s)
- K van der Weerd
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C van Noord
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Loeve
- Department of Anesthesiology, Unit of Obstetric Anesthesiology
| | - M F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - W Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W W de Herder
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Franssen
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - R A Feelders
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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47
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Gray SG, McGuire TM, Cohen N, Little PJ. The emerging role of metformin in gestational diabetes mellitus. Diabetes Obes Metab 2017; 19:765-772. [PMID: 28127850 DOI: 10.1111/dom.12893] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/11/2017] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
Metformin use during pregnancy is controversial and there is disparity in the acceptance of metformin treatment in women with gestational diabetes mellitus (GDM) in Australia. Despite short term maternal and neonatal safety measures, the placental transfer of metformin during GDM treatment and the absence of long-term safety data in offspring has regulators and prescribers cautious about its use. To determine the current role in GDM management, this literature review describes the physiological changes that occur in GDM and other forms of diabetes in pregnancy (DIP) and international changes in guidelines for GDM diagnosis. Management options are considered, with a focus on the evolving evidence for metformin, its mechanism of action, the maternal, foetal and neonatal outcomes associated with its use and benefit vs risk when compared with the current gold standard, insulin. Investigation reveals a favourable balance of evidence to support the safety and long-term benefits, to mother and child, of using metformin as an alternate to insulin for treatment of GDM. Recent findings of the gastrointestinal-directed action of metformin are at least as important as the hepatic effect and the availability of a novel delayed-release metformin dose form to exploit this new information provides a product and therapeutic strategy ideally suited to the use of metformin in GDM.
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Affiliation(s)
- Susan G Gray
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Mater Pharmacy Services, Mater Health Services, Brisbane, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Neale Cohen
- Diabetes Clinics, BakerIDI Heart and Diabetes Institute, Prahran, Australia
| | - Peter J Little
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Pharmacy, Xinhua College of Sun Yat-sen University, Guangzhou, China
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48
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Lindström L, Skjaerven R, Bergman E, Lundgren M, Klungsøyr K, Cnattingius S, Wikström AK. Chronic Hypertension in Women after Perinatal Exposure to Preeclampsia, Being Born Small for Gestational Age or Preterm. Paediatr Perinat Epidemiol 2017; 31:89-98. [PMID: 28218407 DOI: 10.1111/ppe.12346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is an established association between adverse events during perinatal life and chronic hypertension in adult life. However, disadvantageous conditions often co-exist in the same pregnancy. We investigated single and joint perinatal exposure to preeclampsia, being born small for gestational age (SGA) or preterm and subsequent risk of chronic hypertension. METHODS The study population consisted of 731 008 primiparous women from Norway and Sweden registered in the Medical Birth Registers, both as infants and as first time mothers between 1967-2009 (Norway) and 1973-2010 (Sweden). Risk of chronic hypertension in early pregnancy was calculated in women with perinatal exposures to preeclampsia, born SGA or preterm by log-binominal regression analysis, and adjusted for maternal age and level of education in the first generation. RESULTS The rate of chronic hypertension was 0.4%. Risk of chronic hypertension was associated with single perinatal exposure to preeclampsia, being born SGA or preterm with adjusted relative risk (95% confidence interval, CI) of 2.2 (95% CI 1.8, 2.7), 1.1 (95% CI 1.0, 1.3), and 1.3 (95% CI 1.0, 1.5) respectively. The risks increased after joint exposures, with an almost fourfold risk increase after perinatal exposure to preeclampsia and preterm birth. Additional adjustment for BMI and smoking in the second generation in a subset of the cohort only had a minor impact on the results. CONCLUSIONS Perinatal exposure to preeclampsia, being born SGA or preterm is independently associated with increased risk of chronic hypertension. The highest risk was seen after exposure to preeclampsia, especially if combined with SGA or preterm birth.
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Affiliation(s)
- Linda Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rolv Skjaerven
- Department of Global Public Health and Primary Care, Medical Birth Registry of Norway, Norwegian Institute of Public Health, University of Bergen, Bergen, Norway
| | - Eva Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Lundgren
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, Medical Birth Registry of Norway, Norwegian Institute of Public Health, University of Bergen, Bergen, Norway
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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49
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Zhang Y, Zhou H, Perkins A, Wang Y, Sun J. Maternal Dietary Nutrient Intake and Its Association with Preterm Birth: A Case-control Study in Beijing, China. Nutrients 2017; 9:nu9030221. [PMID: 28257050 PMCID: PMC5372884 DOI: 10.3390/nu9030221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/27/2017] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate dietary nutrient intake among Chinese pregnant women by comparison with Chinese Dietary Reference Intakes (DRIs) and to explore the association between dietary nutrients and preterm birth. A case-control design was conducted in Beijing with 130 preterm delivery mothers in case group and 381 term delivery mothers in control group. Information on mothers’ diet was collected using a food frequency questionnaire, and nutrients and energy intakes were subsequently calculated based on DRIs. Multivariate analysis of variance was used to compare the differences between term and preterm groups in relation to dietary nutrients. Dietary nutrient intakes were imbalanced in both groups compared with Chinese DRIs. Preterm delivery mothers had a lower level of fat and vitamin E intake than term delivery mothers (p < 0.05). Multivariate analysis showed lower vitamin E intake in preterm delivery mothers with a prepregnancy BMI < 18.5 kg/m2 (p < 0.05) and higher carbohydrate intake in preterm delivery mothers with prepregnancy BMI ≥ 24 kg/m2 (p < 0.05). An imbalanced diet in both groups and low level of dietary intakes of fat and vitamin E in preterm group suggest health education measures should be taken to improve the dietary quality of pregnant women, especially for those with an abnormal prepregnancy BMI.
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Affiliation(s)
- Yan Zhang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100871, China.
| | - Hong Zhou
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100871, China.
| | - Anthony Perkins
- Menzies Health Institute Queensland, Griffith University, Queensland 4222, Australia.
| | - Yan Wang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University, Beijing 100871, China.
| | - Jing Sun
- Menzies Health Institute Queensland, Griffith University, Queensland 4222, Australia.
- School of Medicine, Griffith University, Queensland 4222, Australia.
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50
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Choi R, Choi S, Lim Y, Cho YY, Kim HJ, Kim SW, Chung JH, Oh SY, Lee SY. A Prospective Study on Serum Methylmalonic Acid and Homocysteine in Pregnant Women. Nutrients 2016; 8:nu8120797. [PMID: 27941633 PMCID: PMC5188452 DOI: 10.3390/nu8120797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/15/2016] [Accepted: 12/02/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate serum methylmalonic acid (MMA) and homocysteine levels and to assess their effects on pregnancy and neonatal outcomes. Serum MMA and homocysteine levels in 278 pregnant Korean women, determined by liquid chromatography–tandem mass spectrometry in each trimester, were compared with those of previous studies in other ethnic groups. We investigated the association between MMA and homocysteine status with pregnancy and neonatal events: gestational diabetes, preeclampsia, gestational age at delivery, preterm birth, small for gestational age, neonatal birth weight, and congenital abnormalities. The median (range) MMA level was 0.142 (0.063–0.446) µmol/L and homocysteine level was 10.6 (4.4–38.0) µmol/L in pregnant women. MMA levels were significantly higher in the third trimester than during other trimesters (p < 0.05), while homocysteine levels were not. No significant association was observed between MMA or homocysteine levels and any of the maternal or neonatal outcomes examined. Future studies are needed to assess the associations among maternal serum concentrations of MMA and homocysteine, and maternal and neonatal outcomes.
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Affiliation(s)
- Rihwa Choi
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Sunkyu Choi
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Yaeji Lim
- Biostatistics Team, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
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