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Lewkowitz AK, Hauspurg A. Perinatal Remote Blood Pressure Monitoring. Obstet Gynecol 2024; 144:339-345. [PMID: 39053003 PMCID: PMC11326962 DOI: 10.1097/aog.0000000000005690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/14/2024] [Indexed: 07/27/2024]
Abstract
Perinatal mortality and severe maternal morbidity among individuals with hypertensive disorders of pregnancy (HDP) are often driven by persistent, uncontrolled hypertension. Whereas traditional perinatal blood pressure (BP) ascertainment occurs through in-person clinic appointments, self-measured blood pressure (SMBP) programs allow individuals to measure their BP remotely and receive remote management by a medical team. Though data remain limited on clinically important outcomes such as maternal morbidity, these programs have shown promise in improving BP ascertainment rates in the immediate postpartum period and enhancing racial and ethnic equity in BP ascertainment after hospital discharge. In this narrative review, we provide an overview of perinatal SMBP programs that have been described in the literature and the data that support their efficacy. Furthermore, we offer suggestions for practitioners, institutions, and health systems that may be considering implementing SMBP programs, including important health equity concerns to be considered. Last, we discuss opportunities for ongoing and future research regarding SMBP programs' effects on maternal morbidity, long-term health outcomes, inequities that are known to exist in HDP and HDP-related outcomes, and the cost effectiveness of these programs.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, and the Center for Digital Health, Brown School of Public Health, Providence, Rhode Island; and the Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
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2
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Yang Y, Chen M, Lan R, Gong H. LINC01410 accelerates the invasion of trophoblast cells by modulating METTL3/Fas. Mol Biol Rep 2024; 51:895. [PMID: 39115693 PMCID: PMC11310249 DOI: 10.1007/s11033-024-09834-6] [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: 06/21/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024]
Abstract
BACKGROUND Insufficient trophoblast invasion, culminating in suboptimal uterine spiral artery remodeling, is pinpointed as a pivotal contributor to preeclampsia (PE) development. LINC01410 has been documented to be increased in various neoplasms, and is significantly associated with the invasive capabilities of tumor cells. Nonetheless, its function and the mechanisms in the pathogenesis of PE require further investigation. METHODS AND RESULTS LINC01410 and methyltransferase-like 3 (METTL3) were ectopically expressed in HTR-8/Svneo cells via lentiviral transduction. Subsequently, the cells' invasive capabilities and apoptosis rates were evaluated employing Transwell assays and flow cytometry, respectively. The interplay between LINC01410 and METTL3, alongside the m6A methylation of FAS, was probed through RNA immunoprecipitation (RIP). Additionally, the association between FAS and METTL3 was elucidated via Coimmunoprecipitation (Co-IP) assays. The protein level of NF-κB, BAX, and BCL-2 in LINC01410-overexpressing cells was detected by Western blot. Our findings revealed that LINC01410 elevation increased the invasive ability of HTR-8/Svneo cells, directly impacting METTL3 then leading to its reduced expression. Conversely, heightened METTL3 expression mitigated invasiveness while enhancing apoptosis in these cells. Moreover, METTL3's interaction with FAS led to increased FAS expression, subject to m6A methylation. A surge in LINC01410 markedly decreased both mRNA and protein levels of FAS. Furthermore, LINC01410 overexpression significantly reduced NF-κB and BAX protein levels while augmenting BCL-2. CONCLUSIONS Upregulation of LINC01410 expression promotes trophoblast cell invasion by inhibiting FAS levels through modified m6A alteration and suppressing the NF-κB pathway. These findings underscore the pivotal role of LINC01410 in regulating trophoblast cell invasion and propose it as a promising therapeutic strategy for preventing or alleviating PE. This offers valuable insights for the clinical treatment of PE, for which definitive targeted therapy methods are currently lacking.
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Affiliation(s)
- Yang Yang
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 19 Xiu hua Road, Xiuying District, Haikou, Hainan, 570311, China
| | - Meihua Chen
- Hainan Medical University, 3 Xue yuan Road, Long hua District, Haikou, Hainan, 571199, China
| | - Ruihong Lan
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 19 Xiu hua Road, Xiuying District, Haikou, Hainan, 570311, China
| | - Humin Gong
- Department of Obstetrics, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, 19 Xiu hua Road, Xiuying District, Haikou, Hainan, 570311, China.
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Perelman AD, Braithwaite RS, Caughey AB, Marty LN, Hirschberg CI, Pass AR, Penfield CA. Progression of hypertensive disorders of pregnancy during induction of labor in term nulliparous patients. Am J Obstet Gynecol 2024:S0002-9378(24)00746-4. [PMID: 38992814 DOI: 10.1016/j.ajog.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Allison D Perelman
- Department of Obstetrics & Gynecology, New York University (NYU) Langone Health, 5 East 98 St., Room 256, New York, NY 10029; Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Hospital, New York, NY.
| | - R Scott Braithwaite
- Department of Medicine and Population Health, NYU Langone Health, New York, NY
| | - Aaron B Caughey
- Division of Perinatology, Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR
| | - Lindsay N Marty
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, NY
| | - Carly I Hirschberg
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, North Shore University Hospital & Long Island Jewish Medical Center, New Hyde Park, NY
| | - Alexandra R Pass
- Department of Obstetrics & Gynecology, NYU Langone Health, New York, NY
| | - Christina A Penfield
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Health, New York, NY
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Saxon CE, Bast J, Chou JC. Short and long-term complications of hypertensive disorders of pregnancy: lifelong cardiovascular risks we cannot ignore. Curr Opin Cardiol 2024; 39:259-265. [PMID: 38386339 DOI: 10.1097/hco.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy (HDP) pose a significant threat to maternal cardiovascular health, with emerging research shedding light on the enduring risks beyond the gestational period. This review highlights updates regarding cardiovascular risks associated with HDP and their implications for long-term health. RECENT FINDINGS Patients with a history of HDP are at an elevated risk of developing chronic hypertension, ischemic heart disease, stroke, valvular heart disease, and heart failure.Not surprisingly, patients with HDP experience higher rates of maternal and fetal adverse events in the antepartum and immediate postpartum periods, with high readmission rates for cardiovascular complications. The high risk of chronic hypertension after a HDP then leads to the development of subclinical disease over 5-10 years with overt cardiovascular disease becoming most prevalent in the decades following pregnancy. Early hypertension management in the antepartum and postpartum periods has lifelong health benefits and highlights the need for seamless postpartum transitions with close blood pressure monitoring and cardiovascular risk mitigation. SUMMARY HDP significantly increases the risk of short and long-term adverse cardiovascular events. Integrated healthcare models that assess and address postpartum cardiovascular risk are necessary to improve the cardiovascular health and longevity of those effected by HDP.
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Affiliation(s)
| | - Julia Bast
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Balduit A, Agostinis C, Mangogna A, Zito G, Stampalija T, Ricci G, Bulla R. Systematic review of the complement components as potential biomarkers of pre-eclampsia: pitfalls and opportunities. Front Immunol 2024; 15:1419540. [PMID: 38983853 PMCID: PMC11232388 DOI: 10.3389/fimmu.2024.1419540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
The complement system (C) is a crucial component of the innate immune system. An increasing body of research has progressively shed light on the pivotal role of C in immunological tolerance at the feto-maternal interface. Excessive C activation or impaired C regulation may determine the onset of pregnancy-related pathological conditions, including pre-eclampsia (PE). Thus, several studies have investigated the presence of C components or split products in blood matrixes (i.e., plasma, serum), urine, and amniotic fluid in PE. In the current study, we systematically reviewed the currently available scientific literature reporting measurements of C components as circulating biomarkers in PE, based on a literature search using Pubmed, Scopus, and Embase databases. A total of 41 out of 456 studies were selected after full-text analysis. Fourteen studies (34.1%) were identified as measuring the blood concentrations of the classical pathway, 5 (12.1%) for the lectin pathway, 28 (68.3%) for the alternative pathway, 17 (41.5%) for the terminal pathway components, and 16 (39%) for C regulators. Retrieved results consistently reported C4, C3, and factor H reduction, and increased circulating levels of C4d, Bb, factor D, C3a, C5a, and C5b-9 in PE compared to normal pregnancies, depicting an overall scenario of excessive C activation and aberrant C regulation. With evidence of C activation and dysregulation, C-targeted therapy is an intriguing perspective in PE management. Moreover, we also discussed emerging pitfalls in C analysis, mainly due to a lack of experimental uniformity and biased cohort selection among different studies and laboratories, aiming to raise a more comprehensive awareness for future standardization. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024503070.
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Affiliation(s)
- Andrea Balduit
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Chiara Agostinis
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gabriella Zito
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Khosla K, Jin Y, Espinoza J, Kent M, Gencay M, Kunz LH, Mueller A, Xiao Y, Frank Peacock W, Neath SX, Stuart JJ, Woelkers D, Harris JM, Rana S. Signs or symptoms of suspected preeclampsia - A retrospective national database study of prevalence, costs, and outcomes. Pregnancy Hypertens 2024; 36:101124. [PMID: 38608393 DOI: 10.1016/j.preghy.2024.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Most patients with signs or symptoms (s/s) of suspected preeclampsia are not diagnosed with preeclampsia. We sought to determine and compare the prevalence of s/s, pregnancy outcomes, and costs between patients with and without diagnosed preeclampsia. METHODS This retrospective cohort study analyzed a large insurance research database. Pregnancies with s/s of preeclampsia versus a confirmed preeclampsia diagnosis were identified using International Classification of Diseases codes. S/s include hypertension, proteinuria, headache, visual symptoms, edema, abdominal pain, and nausea/vomiting. Pregnancies were classed as 1) s/s of preeclampsia without a confirmed preeclampsia diagnosis (suspicion only), 2) s/s with a confirmed diagnosis (preeclampsia with suspicion), 3) diagnosed preeclampsia without s/s recorded (preeclampsia only), and 4) no s/s, nor preeclampsia diagnosis (control). RESULTS Of 1,324,424 pregnancies, 29.2 % had ≥1 documented s/s of suspected preeclampsia, and 14.2 % received a preeclampsia diagnosis. Hypertension and headache were the most common s/s, leading 20.2 % and 9.2 % pregnancies developed to preeclampsia diagnosis, respectively. Preeclampsia, with or without suspicion, had the highest rates of hypertension-related severe maternal morbidity (HR [95 % CI]: 3.0 [2.7, 3.2] and 3.6 [3.3, 4.0], respectively) versus controls. A similar trend was seen in neonatal outcomes such as preterm delivery and low birth weight. Cases in which preeclampsia was suspected but not confirmed had the highest average total maternal care costs ($6096 [95 % CI: 602, 6170] over control). CONCLUSION There is a high prevalence but poor selectivity of traditional s/s of preeclampsia, highlighting a clinical need for improved screening method and cost-effectiveness disease management.
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Affiliation(s)
- Kavia Khosla
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yue Jin
- Roche Diagnostics, Indianapolis, IN, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Division of Fetal Intervention, McGovern Medical School at the University of Texas Health Science Center Houston, and UT Physicians, The Fetal Center, Affiliated with Children's Memorial Hermann Hospital, TX, USA
| | - Matthew Kent
- Department of Epidemiology and Biostatistics, Genesis Research, Hoboken, NJ, USA
| | | | - Liza H Kunz
- Roche Diagnostics Systems, San Jose, CA, USA
| | - Ariel Mueller
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan Xiao
- Roche Diagnostics Systems, San Jose, CA, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sean-Xavier Neath
- Department of Emergency Medicine, Gynecology and Reproductive Science, University of California, La Jolla, CA, USA
| | - Jennifer J Stuart
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Douglas Woelkers
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, La Jolla, CA, USA
| | | | - Sarosh Rana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Chicago, Chicago, IL, USA.
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De Oliveira L, Korkes H, Rizzo MD, Siaulys MM, Cordioli E. Magnesium sulfate in preeclampsia: Broad indications, not only in neurological symptoms. Pregnancy Hypertens 2024; 36:101126. [PMID: 38669914 DOI: 10.1016/j.preghy.2024.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
The role of magnesium sulfate for treatment of eclampsia is well established. The medication proved to be superior to other anticonvulsants to reduce the incidence of recurrent convulsions among women with eclampsia. Additionally, magnesium sulfate has been indicated for women with preeclampsia with different severe features. However, despite these recommendations, many clinicians are still not confident with the use of magnesium sulfate, even in settings with high incidence of preeclampsia and unacceptable rates of maternal mortality. This review brings basic science and clinical information to endorse recommendations to encourage clinicians to use magnesium sulfate for patients with all severe features of preeclampsia, not only for women with neurological symptoms. Additionally, other benefits of magnesium sulfate in anesthesia and fetal neuroprotection are also presented. Finally, a comprehensive algorithm presents recommendations to manage patients with preeclampsia with severe features between 34 and 36+6 weeks.
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Affiliation(s)
- Leandro De Oliveira
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil; Department of Gynecology & Obstetrics, Sao Paulo State University (UNESP), Medical School, Botucatu, SP, Brazil.
| | - Henri Korkes
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil; Department of Obstetrics and Gynecology, Faculty of Medicine, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | - Marina de Rizzo
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
| | - Monica Maria Siaulys
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
| | - Eduardo Cordioli
- Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inovação, São Paulo, Brazil
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Moustafa ASZ, Yimer W, Perry A, Solis L, Belk S, Morris R, Spencer SK, Rana S, Wallace K. Report from a text-based blood pressure monitoring prospective cohort trial among postpartum women with hypertensive disorders of pregnancy. BMC Pregnancy Childbirth 2024; 24:340. [PMID: 38702619 PMCID: PMC11067202 DOI: 10.1186/s12884-024-06511-1] [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: 11/29/2023] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a main cause of maternal morbidity and mortality in the United States and worldwide, and it is estimated that approximately 60% of maternal deaths in the United States occur during the postpartum period. The utilization of telehealth modalities such as home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow up visits. Our study sought to determine if standardized education improved patient hypertension knowledge and if this when combined with home blood pressure telemonitoring increased participants' postpartum self-blood pressure monitoring and postpartum visit attendance. METHODS This is an Institutional Review Board approved prospective cohort study conducted at the University of Mississippi Medical Center. Women with a hypertensive disorder of pregnancy who met the inclusion criteria and provided written informed consent to participate were enrolled. Participants received a baseline pre-education questionnaire designed to assess their knowledge of their hypertensive diagnosis, hypertension management, and postpartum preeclampsia (PreE). Participants then received standard education, a blood pressure monitor, and were scheduled a follow-up visit during the first 10 days following discharge. Remote home blood pressure monitoring was performed via text messages and voice calls for 6-weeks postpartum. At the conclusion of the study, participants repeated their original questionnaire. RESULTS 250 women provided informed consent to participate in the study and were included in this analysis. Relative to the baseline survey, there was a significant increase (p = 0.0001) in the percentage of correct responses. There was not an association between study engagement and percentage of correct responses on end of study questionnaire (p = 0.33) or postpartum visit attendance (p = 0.69). Maternal age was found to drive study engagement, even when adjusted for community-level distress (p = 0.03) and maternal race (p = 0.0002). CONCLUSION Implementing a standardized postpartum education session was associated with improvement in patient's knowledge. Further studies are needed with more longitudinal follow up to assess if this program would also result in improved long-term outcomes and decreased hospital readmission rates. TRIAL REGISTRATION NCT04570124.
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Affiliation(s)
- Ahmed S Z Moustafa
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wondwosen Yimer
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ana Perry
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lucia Solis
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sheila Belk
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rachael Morris
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Shauna-Kay Spencer
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sarosh Rana
- Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Pharmacology &Toxicology, University of Mississippi Medical Center, Jackson, MS, USA.
- Myrlie Evers Williams Institute for the Elimination of Health Disparities, University of Mississippi Medical Center, Jackson, MS, USA.
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Picon M, Stanhope KK, Jamieson DJ, Boulet SL. Identification of Distinct Risk Factors for Antepartum and Postpartum Preeclampsia in a High-Risk Safety-Net Hospital. Am J Perinatol 2024; 41:e267-e274. [PMID: 35709733 DOI: 10.1055/a-1878-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Postpartum preeclampsia (PE), defined as de novo PE that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia (PPPE). STUDY DESIGN In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between demographic, medical, and obstetric factors and development of PE, categorized as a three-level outcome: no PE, antepartum/intrapartum preeclampsia (APE) (diagnosed prior to or < 48 hours of delivery), and late PPPE (diagnosed ≥ 48-hour postpartum). RESULTS Among 3,681 deliveries, women were primarily of ages 20 to 35 years (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). PE was diagnosed prior to delivery or within 48-hour postpartum in 12% (n = 477) of the study population, and 1.5% (57) developed PE greater than 48-hour postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pregestational or gestational diabetes, and chronic hypertension were associated with increased odds of APE only, while maternal obesity (OR: 1.9; 95% CI: 1.0-3.5) and gestational hypertension (OR: 2.7; 95% CI: 1.5-4.8) were uniquely associated with PPPE. Multifetal gestations and cesarean delivery predicted both PPPE and APE; however, the association was stronger for PPPE. CONCLUSION Patients with obesity, gestational hypertension, multifetal gestations, or cesarean delivery may benefit from additional follow-up in the early postpartum period to detect PPPE. KEY POINTS · Late postpartum preeclampsia may go undetected, particularly in low-income patients.. · In a delivery cohort in Georgia, 1.5% of patients developed late postpartum preeclampsia.. · Maternal obesity and gestational hypertension were strongly associated only with late postpartum preeclampsia..
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Affiliation(s)
- Michelle Picon
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Kalmegh S, Patvekar M. Postpartum Eclampsia Unresponsive to Magnesium Sulfate Therapy: An Uncommon Case Report. Cureus 2024; 16:e60047. [PMID: 38854206 PMCID: PMC11162698 DOI: 10.7759/cureus.60047] [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: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Despite advances in obstetric care, postpartum eclampsia continues to be a major cause of morbidity and mortality among mothers. Although the most common treatment for eclampsia during the postpartum phase is magnesium sulfate (MgSO4), a small percentage of individuals show resistance to this approach. Clinical challenges arise from MgSO4 resistance, which calls for different approaches to care to avoid unfavorable consequences for mothers. In this case study, we provide a thorough clinical description of a 19-year-old primigravida who gave birth at 37 weeks and developed postpartum eclampsia and did not improve with MgSO4 treatment. This case thus highlights the significance of accurate clinical diagnosis of patients and prompt use of alternative therapy modalities. We also discuss possible approaches to treating this uncommon but serious illness.
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Affiliation(s)
- Sai Kalmegh
- Obstetrics and Gynecology, Dr. D Y Patil Medical College, Hospital and Research Center, Pune, IND
| | - Meenal Patvekar
- Obstetrics and Gynecology, Dr. D Y Patil Medical College, Hospital and Research Center, Pune, IND
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11
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Kuklina EV, Merritt RK, Wright JS, Vaughan AS, Coronado F. Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research. J Womens Health (Larchmt) 2024; 33:553-562. [PMID: 38529887 PMCID: PMC11260429 DOI: 10.1089/jwh.2023.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.
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Affiliation(s)
- Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fátima Coronado
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Butler L, Gunturkun F, Chinthala L, Karabayir I, Tootooni MS, Bakir-Batu B, Celik T, Akbilgic O, Davis RL. AI-based preeclampsia detection and prediction with electrocardiogram data. Front Cardiovasc Med 2024; 11:1360238. [PMID: 38500752 PMCID: PMC10945012 DOI: 10.3389/fcvm.2024.1360238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction More than 76,000 women die yearly from preeclampsia and hypertensive disorders of pregnancy. Early diagnosis and management of preeclampsia can improve outcomes for both mother and baby. In this study, we developed artificial intelligence models to detect and predict preeclampsia from electrocardiograms (ECGs) in point-of-care settings. Methods Ten-second 12-lead ECG data was obtained from two large health care settings: University of Tennessee Health Science Center (UTHSC) and Atrium Health Wake Forest Baptist (AHWFB). UTHSC data was split into 80% training and 20% holdout data. The model used a modified ResNet convolutional neural network, taking one-dimensional raw ECG signals comprising 12 channels as an input, to predict risk of preeclampsia. Sub-analyses were performed to assess the predictive accuracy for preeclampsia prediction within 30, 60, or 90 days before diagnosis. Results The UTHSC cohort included 904 ECGs from 759 females (78.8% African American) with a mean ± sd age of 27.3 ± 5.0 years. The AHWFB cohort included 817 ECGs from 141 females (45.4 African American) with a mean ± sd age of 27.4 ± 5.9 years. The cross-validated ECG-AI model yielded an AUC (95% CI) of 0.85 (0.77-0.93) on UTHSC holdout data, and an AUC (95% CI) of 0.81 (0.77-0.84) on AHWFB data. The sub-analysis of different time windows before preeclampsia prediction resulted in AUCs (95% CI) of 0.92 (0.84-1.00), 0.89 (0.81-0.98) and 0.90 (0.81-0.98) when tested on ECGs 30 days, 60 days and 90 days, respectively, before diagnosis. When assessed on early onset preeclampsia (preeclampsia diagnosed at <34 weeks of pregnancy), the model's AUC (95% CI) was 0.98 (0.89-1.00). Discussion We conclude that preeclampsia can be identified with high accuracy via application of AI models to ECG data.
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Affiliation(s)
- Liam Butler
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Fatma Gunturkun
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Lokesh Chinthala
- Center for Biomedical Informatics, UTHSC, Memphis, TN, United States
| | - Ibrahim Karabayir
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Mohammad S. Tootooni
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, United States
| | - Berna Bakir-Batu
- Center for Biomedical Informatics, UTHSC, Memphis, TN, United States
| | - Turgay Celik
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Oguz Akbilgic
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robert L. Davis
- Center for Biomedical Informatics, UTHSC, Memphis, TN, United States
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Radparvar AA, Vani K, Fiori K, Gupta S, Chavez P, Fisher M, Sharma G, Wolfe D, Bortnick AE. Hypertensive Disorders of Pregnancy: Innovative Management Strategies. JACC. ADVANCES 2024; 3:100864. [PMID: 38938826 PMCID: PMC11198296 DOI: 10.1016/j.jacadv.2024.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) complicate 13% to 15% of pregnancies in the United States. Historically marginalized communities are at increased risk, with preeclampsia and eclampsia being the leading cause of death in this population. Pregnant individuals with HDP require more frequent and intensive monitoring throughout the antepartum period outside of routine standard of care prenatal visits. Additionally, acute rises in blood pressure often occur 3 to 6 days postpartum and are challenging to identify and treat, as most postpartum individuals are usually scheduled for their first visit 6 weeks after delivery. Thus, a multifaceted approach is necessary to improve recognition and treatment of HDP throughout the peripartum course. There are limited studies investigating interventions for the management of HDP, especially within the United States, where maternal mortality is rising, and in higher-risk groups. We review the state of current management of HDP and innovative strategies such as blood pressure self-monitoring, telemedicine, and community health worker intervention.
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Affiliation(s)
| | - Kavita Vani
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin Fiori
- Division of Academic General Pediatrics and Department of Family and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sonali Gupta
- Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Chavez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Fisher
- Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Diana Wolfe
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anna E. Bortnick
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Saffian E, Palatnik A. Association Between Recurrent Preeclampsia and Attendance at the Blood Pressure Monitoring Appointment After Birth. J Obstet Gynecol Neonatal Nurs 2024; 53:132-139. [PMID: 38006903 PMCID: PMC10939826 DOI: 10.1016/j.jogn.2023.11.002] [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: 07/28/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE To examine the association between recurrent preeclampsia and attendance at the standard of care blood pressure monitoring appointment after birth. DESIGN Retrospective cohort. SETTING Single Magnet-accredited hospital affiliated with an academic medical center. PARTICIPANTS Multiparous women who gave birth between 2010 and 2020 and were diagnosed with preeclampsia (N = 313). METHODS We divided participants into two groups: those with prior preeclampsia (n = 119) and those without prior preeclampsia (n = 194). Using logistic regression, we calculated unadjusted and adjusted odds ratios to estimate the association between attendance at the postpartum blood pressure (PPBP) monitoring appointment and prior preeclampsia. We also explored the relationship between attendance at the PPBP monitoring appointment and use of magnesium sulfate during labor and birth and the relationship between attendance at the PPBP monitoring appointment and use of maintenance antihypertensive medications. RESULTS In adjusted analysis, participants with prior preeclampsia were 66.4% less likely to attend the PPBP monitoring appointment compared with those without prior preeclampsia, adjusted OR = 0.34, 95% CI [0.18, 0.62]. Administration of magnesium sulfate during delivery admission and use of maintenance antihypertensive medications were not associated with a change in attendance at the PPBP appointment. CONCLUSION Further research on patient-perceived risk of recurrent preeclampsia and improvement of systems to facilitate postpartum follow-up is needed.
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Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, Miller EC, Sharma G, Mehta LS. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e330-e346. [PMID: 38346104 PMCID: PMC11185178 DOI: 10.1161/cir.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
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Norman SJ, Fontus G, Forestier C, Hiba T, Colon Pagan S, Osondu M, Shylovich V. The Protective Effect of Abortion on Preeclampsia: An Analysis of Current Research. Cureus 2024; 16:e54131. [PMID: 38496185 PMCID: PMC10942113 DOI: 10.7759/cureus.54131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
A review of the current literature on preeclampsia (PE) confirms that this pregnancy complication remains a common cause of maternal mortality. Within the last several decades, obstetric and gynecological researchers worldwide have indicated an association between prior abortions and the development of PE. Different studies have debated whether abortion is a protective or risk factor for PE. However, the most current literature demonstrates a stronger likelihood that a positive history of abortions will offer a protective effect against PE. This association has been supported by advancements in the reproductive immunology literature, which states complex fetal and paternal pathological mechanisms help to build maternal immunological tolerance, thus protecting expectant mothers from pregnancy complications. This literature review will compare studies supporting prior abortions offering a protective effect against PE with those stating prior abortions are a risk factor for the development of PE. Additionally, this critical review will discuss the advancements and current understanding of reproductive immunology and how it pertains to this association between positive abortion history and PE.
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Affiliation(s)
- Sarah J Norman
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Gena Fontus
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | - Tasneem Hiba
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | - Michael Osondu
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Volha Shylovich
- Obstetrics and Gynecology, BronxCare Health System, New York, USA
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Gupta A, Nayak D, Sharma J, Keepanasseril A. Comparing the efficacy of oral labetalol with oral amlodipine in achieving blood pressure control in women with postpartum hypertension: randomized controlled trial (HIPPO study-Hypertension In Pregnancy & Postpartum Oral-antihypertensive therapy). J Hum Hypertens 2023; 37:1056-1062. [PMID: 37231139 DOI: 10.1038/s41371-023-00841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
De novo - or as a continuum of antenatal hypertension -postpartum hypertension complicates ~2% of pregnancies. Many maternal complications, such as eclampsia and cerebrovascular accidents, occur in the postpartum period. Despite widespread use of antihypertensives during pregnancy and childbirth, there is a paucity of data on preferred medications in the postpartum period. This randomized controlled study enrolled 130 women who were started on antihypertensives. They were randomized to receive oral Labetalol(LAB, maximum 900 mg per day in three doses) or oral Amlodipine(AML, maximum 10 mg per day given in two doses). In the immediate postpartum, all women were closely monitored for neurological symptoms, blood pressure, heart rate, respiratory rate, urine output, and deep tendon reflex. The primary outcome was the time to achieve sustained blood pressure control for 12 h from the initiation of medication; secondary outcomes included side effects of both medications. Mean time to achieve sustained blood pressure control was lower in women who received AML than in those who received LAB-(mean difference 7.2 h; 38 95% CI 1.4, 12.9, p = 0.011). There were fewer severe hypertensive episodes among those with AML than in those who received LAB. However, the proportion of women who continued to require antihypertensives at discharge was higher in the AML group than in the LAB group (55.4% versus 32.3%, p = 0.008). None of the participants developed drug-related side effects. Among women with postpartum persistence or new-onset hypertension, oral AML achieved sustained blood pressure control in a shorter duration, with fewer hypertensive emergencies than oral LAB. (CTRI/2020/02/023236).Trial Registration details: The study protocol was registered with Clinical Trial Registry of India with CTRI Number CTRI/2020/02/023236 dated 11.02.2020. Protocol can be accessed at https://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=40435&EncHid=&modid=&compid=%27,%2740435det%27 .
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Affiliation(s)
- Avantika Gupta
- Departments of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Nagpur, India
| | - Deepthi Nayak
- Departments of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
- Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Jyotsna Sharma
- Departments of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Anish Keepanasseril
- Departments of Obstetrics & Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India.
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Cagino K, Prabhu M, Sibai B. Is magnesium sulfate therapy warranted in all cases of late postpartum severe hypertension? A suggested approach to a clinical conundrum. Am J Obstet Gynecol 2023; 229:641-646. [PMID: 37467840 DOI: 10.1016/j.ajog.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
Magnesium sulfate reduces the risk for eclamptic seizures antepartum, intrapartum, and in the immediate postpartum period, however, there are no studies that have evaluated the benefits and risks of magnesium sulfate among women with late postpartum severe hypertension only. Juxtaposed on this clinical uncertainty is the increased incidence of severe hypertension owing to a rise in pregnancies complicated by advanced maternal age, obesity, chronic hypertension, diabetes, and recent protocols for intensive monitoring of blood pressure in the postpartum period. These factors have led to a significant increase in postpartum presentations for the evaluation and management of severe hypertension, in some cases leading to postpartum readmissions for administration of antihypertensive therapy and magnesium sulfate without data demonstrating clear clinical benefit. Postpartum readmissions can have several negative consequences, including interfering with early bonding with a newborn, breastfeeding, and use of scarce healthcare resources. In addition, magnesium sulfate is associated with risks for serious cardiorespiratory depression and bothersome side effects and can delay determining the optimal antihypertensive regimen, which is typically the most pressing clinical need during postpartum presentations of late-postpartum severe hypertension. Eclampsia that occurs more than 48 hours after delivery is rare (constitutes 16% of all cases of eclampsia) and is most commonly preceded by headaches or other cerebral symptoms. In this commentary, we propose an approach to evaluating and managing patients with late postpartum severe hypertension aimed at identifying those women at highest risk for end-organ injury. We recommend that the short- and long-term focus for all patients with severe hypertension should be the optimal management of blood pressures with a goal of close outpatient monitoring when logistically feasible and clinically appropriate. We suggest reserving magnesium sulfate therapy for the subset of patients with neurologic symptoms who may be at highest risk for an eclamptic seizure.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX.
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Baha Sibai
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX
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Ushida T, Nakamura N, Katsuki S, Mizutani H, Iitani Y, Imai K, Yoshida S, Yamashita M, Kajiyama H, Kotani T. New-onset postpartum hypertension in women without a history of hypertensive disorders of pregnancy: a multicenter study in Japan. Hypertens Res 2023; 46:2583-2592. [PMID: 37463981 DOI: 10.1038/s41440-023-01372-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/10/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023]
Abstract
The aim of this study was to investigate the prevalence and risk factors of new-onset postpartum hypertension (PPHTN), defined as new-onset hypertension during the postpartum period, among women without a history of hypertension during pregnancy and labor. A multicenter retrospective study was conducted using clinical data of women who delivered at term between 2011 and 2018 at 12 maternity hospitals. A total of 18,295 normotensive women were eligible, after excluding those with hypertensive disorders of pregnancy or hypertension during labor. New-onset PPHTN was defined as multiple blood pressure readings of ≥ 140/90 mmHg between 1 d and 4 weeks postpartum among normotensive women throughout pregnancy. Multivariate regression analyses were performed to evaluate the risk factors for new-onset PPHTN. Among the 18,295 normotensive women, 227 (1.2%) presented with new-onset PPHTN. The prevalence was higher in women who delivered via cesarean section than in those who delivered vaginally (7.0% and 1.0%, respectively). The independent risk factors were maternal age ≥ 35 years (adjusted odds ratio 1.67, 95% confidence interval [1.10-2.53]), nulliparity (1.83 [1.24-2.71]), high normal blood pressure (systolic blood pressure [SBP] 120-129 and diastolic blood pressure [DBP] < 80) at the last prenatal check-up (1.96 [1.23-3.13]), elevated blood pressure (SBP 130-139 and/or DBP 80-89) (6.42 [4.15-9.95]), urinary protein 1+ (1.99 [1.27-3.11]), scheduled cesarean section (4.05 [1.69-9.69]), and emergency cesarean section (10.02 [5.10-19.70]). New-onset PPHTN was observed in 1.2% of the normotensive women, with women who delivered via cesarean section having the highest risk. Close postpartum blood pressure monitoring may be required for women with multiple risk factors to identify new-onset PPHTN in a timely manner and reduce adverse maternal consequences.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Anjo Kosei Hospital, Aichi, Japan
| | - Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidesuke Mizutani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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Rho JD, Kim YH, Shin JH, Kim TK. Case report: A case of posterior reversible encephalopathy in postpartum preeclampsia. Medicine (Baltimore) 2023; 102:e36023. [PMID: 38013383 PMCID: PMC10681536 DOI: 10.1097/md.0000000000036023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
RATIONALE Posterior reversible encephalopathy syndrome is a neurological condition characterized by headache, convulsions, altered consciousness, and visual disturbance with specific radiological features, which is characterized by contrast enhancement in the occipital lobe on T2-weighted image. We report a case of sudden visual impairment of both eyes 6 days after childbirth diagnosed as postpartum preeclampsia and posterior reversible encephalopathy syndrome (PRES) through radiological examination. PATIENT CONCERNS A 31-year-old female patient with headache and visual disturbance visited the clinic. DIAGNOSIS Visual acuity was light perception in the right eye and hand motion in the left eye; pupillary light reflections of both eyes were normal. In the field of view test, the waveform was not observed in the defect pattern visual field power test, and the amplitude was greatly reduced in the visual field test. 1+ proteinuria was observed on urine test and magnetic resonance imaging showed contrast enhancement under both parietal and occipital cortex. INTERVENTIONS Hospitalization was done for blood pressure control and examination of related disease under suspicion of PRES caused by postpartum preeclampsia. OUTCOMES Four weeks after diagnosis, vision and visual field defects recovered to normal, and the previously observed lesion on magnetic resonance imaging completely improved 3 months after the initial visit, and it was diagnosed as PRES. LESSONS PRES in postpartum preeclampsia can cause rapid vision and symptoms, visual field loss, and accurate follow-up diagnosis with relevant imaging and clinical patterns can improve vision.
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Affiliation(s)
- Joong-Dong Rho
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Yeon-Hee Kim
- Department of Obstetrics & Gynecology, Uijeonbu St. Mary Hospital, The Catholic University of Korea College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jae-Ho Shin
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Tae Ki Kim
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Li D, Zhang M, Xu S, Bian Z, Huang X, Hu G, Li J. A study of adverse maternal-foetal outcomes in nephrotic syndrome combined with preeclampsia. BMC Pregnancy Childbirth 2023; 23:773. [PMID: 37936071 PMCID: PMC10629058 DOI: 10.1186/s12884-023-06073-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Although the majority of pregnancies with preeclampsia are characterised by elevated blood pressure, preeclampsia is often associated with nephrotic syndrome with similar symptoms such as high proteinuria and bilateral lower limb oedema. In this study, we compared the maternal-foetal outcomes of pregnant women with preeclampsia in a population with nephrotic syndrome and explored the factors that contribute to the corresponding outcomes and disease development. METHODS A total of 90 pregnant women were included in this study, of whom 30 had nephrotic syndrome and were diagnosed with preeclampsia during pregnancy, and 60 had nephrotic syndrome alone. Descriptive statistical analyses of baseline data were performed to analyse the effect of combined preeclampsia on maternal and foetal pregnancy outcomes using unadjusted and adjusted logistic regression models. RESULTS In this study, the baseline data of the two study populations demonstrated no differences except for the history of caesarean section and 24-h proteinuria results, which were significantly different (P < 0.05). The risk of preterm birth in the nephrotic syndrome with preeclampsia group was 8.25 (95% CI:3.041-22.084 P < 0.05); for a low birth weight, the risk was 6.00 (95% CI:2.302-15.638 P < 0.05); for foetal distress,the risk was 5.667 (95% CI:2.070-15.514 P < 0.05); and the risk of foetal birth restriction was 7.429 (95% CI: 2.642-20.885 P < 0.05). A risk-based analysis of adverse maternal outcomes yielded a risk of miscarriage of 2.200 (95% CI: 0.584-8.291; P > 0.05). After adjusting the model for each outcome, significant risks of preterm labour, foetal birth restriction, and low birth weight were revealed (P < 0.05). CONCLUSION Combined preeclampsia has a significantly higher risk of adverse pregnancy outcomes for the foetus.Therefore, the prevention and control of eclampsia in pregnant women should be improved to ensure maternal and neonatal health.
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Affiliation(s)
- Dong Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Minyi Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shuxiu Xu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou, Guangdong, China
| | - Ziwei Bian
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiaoli Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Guifang Hu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Jing Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou, Guangdong, China.
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Upadhyay NS, Vafadari N, Zhang RK, Salami J, Castaneda M. The Importance of Interdisciplinary Care in the Management of Postpartum Hypertensive Crisis. Cureus 2023; 15:e47423. [PMID: 38021534 PMCID: PMC10658817 DOI: 10.7759/cureus.47423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Postpartum hypertension can significantly increase maternal morbidity and mortality, and hence it requires prompt interdisciplinary evaluation and interventions. We present a case of a gravid patient with significant comorbidities who required multiple treatments and care from several specialists following a complicated vaginal delivery. The outcome of this case depended on a focused differential diagnosis and interdisciplinary consultation with the several teams involved. This case report illustrates the importance of effective communication and an interdisciplinary approach in the management of postpartum hypertensive emergencies. Such an approach is crucial in reducing maternal complications following postpartum hypertension, as well as reducing the length of hospital stay to improve maternal and fetal outcomes.
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Affiliation(s)
- Niyati S Upadhyay
- Obstetrics and Gynecology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Nika Vafadari
- Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Rebecca K Zhang
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Joseph Salami
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Martin Castaneda
- Obstetrics and Gynecology, Bethesda Hospital East, Boynton Beach, USA
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Henderson JT, Webber EM, Thomas RG, Vesco KK. Screening for Hypertensive Disorders of Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 330:1083-1091. [PMID: 37721606 DOI: 10.1001/jama.2023.4934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Importance Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality in the US. Objective To conduct a targeted systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy to inform the US Preventive Services Task Force. Data Sources MEDLINE and the Cochrane Central Register of Controlled Trials for relevant studies published between January 1, 2014, and January 4, 2022; surveillance through February 21, 2023. Study Selection English-language comparative effectiveness studies comparing screening strategies in pregnant or postpartum individuals. Data Extraction and Synthesis Two reviewers independently appraised articles and extracted relevant data from fair-or good-quality studies; no quantitative synthesis was conducted. Main outcomes and measures Morbidity or mortality, measures of health-related quality of life. Results The review included 6 fair-quality studies (5 trials and 1 nonrandomized study; N = 10 165) comparing changes in prenatal screening practices with usual care, which was routine screening at in-person office visits. No studies addressed screening for new-onset hypertensive disorders of pregnancy in the postpartum period. One trial (n = 2521) evaluated home blood pressure measurement as a supplement to usual care; 3 trials (total n = 5203) evaluated reduced prenatal visit schedules. One study (n = 2441) evaluated proteinuria screening conducted only for specific clinical indications, compared with a historical control group that received routine proteinuria screening. One additional trial (n = 80) only addressed the comparative harms of home blood pressure measurement. The studies did not report statistically significant differences in maternal and infant complications with alternate strategies compared with usual care; however, estimates were imprecise for serious, rare health outcomes. Home blood pressure measurement added to prenatal care visits was not associated with earlier diagnosis of a hypertensive disorder of pregnancy (104.3 vs 106.2 days), and incidence was not different between groups in 3 trials of reduced prenatal visit schedules. No harms of the different screening strategies were identified. Conclusions and Relevance This review did not identify evidence that any alternative screening strategies for hypertensive disorders of pregnancy were more effective than routine blood pressure measurement at in-person prenatal visits. Morbidity and mortality from hypertensive disorders of pregnancy can be prevented, yet American Indian/Alaska Native persons and Black persons experience inequitable rates of adverse outcomes. Further research is needed to identify screening approaches that may lead to improved disease detection and health outcomes.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
- CareOregon, Portland
| | - Kimberly K Vesco
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Miller EC, Katsidoniotaki MI, Haghighi N, Dos Santos KRM, Booker WA, Petersen N, Wapner R, Bello NA, Kougioumtzoglou IA, Marshall RS. Dynamic cerebral autoregulation in postpartum individuals with and without preeclampsia. Pregnancy Hypertens 2023; 33:39-45. [PMID: 37524001 PMCID: PMC10528950 DOI: 10.1016/j.preghy.2023.07.176] [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: 01/31/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Changes in dynamic cerebral autoregulation (DCA) may contribute to postpartum maternal cerebrovascular complications after preeclampsia. We hypothesized that DCA is impaired in the first week postpartum after diagnosis of preeclampsia with severe features (PSF), compared with normotensive postpartum individuals and healthy non-pregnant female volunteers. METHODS We measured DCA within seven days after delivery in individuals with and without PSF, using transcranial Doppler and continuous arterial blood pressure monitoring with finger plethysmography. Historical data from 28 healthy female non-pregnant volunteers, collected using the same methods, were used for comparison. We used generalized harmonic wavelets to estimate autoregulation parameters (phase shift and gain) in very low frequency and low frequency bands, with lower phase shift and higher gain indicating impaired DCA function. We compared DCA parameters between the three groups using the Kruskal Wallis test. RESULTS A total of 69 postpartum participants contributed data, of whom 49 had preeclampsia with severe features. Median phase shifts in both postpartum groups were higher compared with historical controls across all frequency ranges (p = 0.001), indicating faster autoregulatory response. Gain was higher in both postpartum groups than in historical controls across all frequency ranges (p = 0.04), indicating impaired dampening effect. CONCLUSION We found that postpartum individuals, regardless of preeclampsia diagnosis, had higher phase shifts and higher gain than healthy non-pregnant/postpartum female volunteers. Our results suggest hyperdynamic DCA with impaired dampening effect in the first week postpartum, regardless of preeclampsia diagnosis.
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Affiliation(s)
- Eliza C Miller
- Department of Neurology, Columbia University, New York, NY, United States.
| | - Maria I Katsidoniotaki
- Department of Civil Engineering and Engineering Mechanics, Columbia University, New York, NY, United States
| | - Noora Haghighi
- Department of Neurology, Columbia University, New York, NY, United States
| | - Ketson R M Dos Santos
- Earthquake Engineering and Structural Dynamics Laboratory, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States
| | - Nils Petersen
- Department of Neurology, Division of Stroke and Neurocritical Care, Yale University School of Medicine, New Haven, CT, United States
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States
| | - Natalie A Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ioannis A Kougioumtzoglou
- Department of Civil Engineering and Engineering Mechanics, Columbia University, New York, NY, United States
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25
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Garovic VD, Piccoli GB. A kidney-centric view of pre-eclampsia through the kidney-placental bidirectional lens. Kidney Int 2023; 104:213-217. [PMID: 37479381 DOI: 10.1016/j.kint.2023.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
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26
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Balhotra K, Minkoff H, McLaren RA. More evidence on postpartum blood pressure thresholds for starting antihypertensive medication is needed. Am J Obstet Gynecol 2023; 229:184-185. [PMID: 36893958 DOI: 10.1016/j.ajog.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Kimen Balhotra
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY; School of Public Health, SUNY Downstate Health Sciences, Brooklyn, NY
| | - Rodney A McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, 833 Chestnut, F1, Philadelphia, PA 19107.
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27
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Stavart L, Verly C, Venetz JP, Baud D, Legardeur H, Vial Y, Golshayan D. Pregnancy after kidney transplantation: an observational study on maternal, graft and offspring outcomes in view of current literature. FRONTIERS IN NEPHROLOGY 2023; 3:1216762. [PMID: 37675349 PMCID: PMC10479688 DOI: 10.3389/fneph.2023.1216762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/30/2023] [Indexed: 09/08/2023]
Abstract
Introduction Pregnancy after kidney transplantation (KTx) is considered to have a high risk of non-negligible complications for the mother, the allograft, and the offspring. With an increased incidence of these pregnancies over the past decades, transplant nephrologists and specialized obstetricians face increasing challenges, with scarce literature regarding long-term outcomes. Methods We retrospectively collected data from all women with at least one live birth pregnancy after KTx who were followed at our tertiary hospital between 2000 and 2021 to study maternal, graft and fetal outcomes. Results Ten patients underwent 14 live birth pregnancies after KTx. Preponderant maternal complications were stage 1 acute kidney injury (43%), urinary tract infections (UTI, 43%), progression of proteinuria without diagnostic criteria for preeclampsia (29%), and preeclampsia (14%). Median baseline serum creatinine at conception was 126.5 µmol/L [median estimated glomerular filtration rate (eGFR) 49 mL/min/1.73m2], and eGFR tended to be lower than baseline at follow-ups. Overall, there was no increase in preexisting or occurrence of de novo donor-specific antibodies. No graft loss was documented within the 2-year follow-up. There were nine premature births (64%), with a median gestational age of 35.7 weeks. The median birth weight, height, and head circumference were 2,560 g, 45.5 cm, and 32.1 cm, respectively. These measurements tended to improve over time, reaching a higher percentile than at birth, especially in terms of height, but on average remained under the 50th percentile curve. Discussion Overall, pregnancies after KTx came with a range of risks for the mother, with a high prevalence of cesarean sections, emergency deliveries, UTI, and preeclampsia, and for the child, with a high proportion of prematurity, lower measurements at birth, and a tendency to stay under the 50th percentile in growth charts. The short- and long-term impact on the allograft seemed reassuring; however, there was a trend toward lower eGFR after pregnancy. With these data, we emphasize the need for a careful examination of individual risks via specialized pre-conception consultations and regular monitoring by a transplant nephrologist and a specialist in maternal-fetal medicine during pregnancy. More data about the long-term development of children are required to fully apprehend the impact of KTx on offspring.
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Affiliation(s)
- Louis Stavart
- Transplantation Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Camille Verly
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jean-Pierre Venetz
- Transplantation Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Baud
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Gynecology and Obstetrics, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Helene Legardeur
- Service of Gynecology and Obstetrics, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yvan Vial
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Gynecology and Obstetrics, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dela Golshayan
- Transplantation Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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28
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Abu-Awwad SA, Craina M, Gluhovschi A, Boscu L, Bernad E, Iurciuc M, Abu-Awwad A, Iurciuc S, Tudoran C, Bernad R, Maghiari AL. Comparative Analysis of Neonatal Effects in Pregnant Women with Cardiovascular Risk versus Low-Risk Pregnant Women. J Clin Med 2023; 12:4082. [PMID: 37373775 DOI: 10.3390/jcm12124082] [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: 05/26/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are a leading cause of mortality and morbidity worldwide. Pregnancy imposes unique physiological changes on a woman's cardiovascular system. MATERIALS AND METHODS A cohort of 68 participants, comprising 30 pregnant women with cardiovascular risk and 38 without cardiovascular risk, was recruited for this study. These participants were prospectively followed during their pregnancies from 2020 to 2022 at the Obstetrics and Gynecology Department of the "Pius Brînzeu" Emergency County Clinical Hospital in Timişoara, Romania. All women included in this study underwent cesarean section deliveries at the same medical facility. Data regarding the gestational weeks at delivery, birth weight, and Apgar scores assessed by neonatologists were collected for each participant. Statistical analyses were performed to compare the neonatal effects between the two groups. RESULTS The results of this study revealed significant differences between the groups in terms of Apgar scores (p = 0.0055), gestational weeks (p = 0.0471), and baby birth weight (p = 0.0392). CONCLUSION The findings underscore the importance of considering maternal cardiovascular health as a potential determinant of neonatal outcomes. Further research is needed to elucidate the underlying mechanisms and develop strategies for optimizing neonatal outcomes in high-risk pregnancies.
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Affiliation(s)
- Simona-Alina Abu-Awwad
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Marius Craina
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Gluhovschi
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Lioara Boscu
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Elena Bernad
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mircea Iurciuc
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Departament VI-Discipline of Outpatient Internal Medicine, Cardiovascular Prevention and Recovery, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Ahmed Abu-Awwad
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department XV-Discipline of Orthopedics-Traumatology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center University Professor Doctor Teodor Șora, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Stela Iurciuc
- Senate Office, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Departament VI-Discipline of Outpatient Internal Medicine, Cardiovascular Prevention and Recovery, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Cristina Tudoran
- Discipline of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- "Pius Brinzeu" Emergency County Clinical Hospital, Blvd Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Robert Bernad
- Department of Automatic Control and Applied Informatics, Politehnica University of Timisoara, 300223 Timisoara, Romania
| | - Anca Laura Maghiari
- "Clinic of Obstetrics and Gynecology", "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Department I-Discipline of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
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Steele DW, Adam GP, Saldanha IJ, Kanaan G, Zahradnik ML, Danilack-Fekete VA, Stuebe AM, Peahl AF, Chen KK, Balk EM. Postpartum Home Blood Pressure Monitoring: A Systematic Review. Obstet Gynecol 2023; Publish Ahead of Print:00006250-990000000-00798. [PMID: 37311173 DOI: 10.1097/aog.0000000000005270] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP-monitoring regimens. DATA SOURCES Search of Medline, Cochrane, EMBASE, CINAHL, and ClinicalTrials.gov from inception to December 1, 2022, searching for home BP monitoring in postpartum individuals. METHODS OF STUDY SELECTION We included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, we extracted demographics and outcomes to SRDR+. TABULATION, INTEGRATION, AND RESULTS Thirteen studies (three RCTs, two nonrandomized comparative studies, and eight single-arm studies) met eligibility criteria. All comparative studies enrolled participants with a diagnosis of hypertensive disorders of pregnancy. One RCT compared home BP monitoring with bidirectional text messaging with scheduled clinic-based BP visits, finding an increased likelihood that at least one BP measurement was ascertained during the first 10 days postpartum for participants in the home BP-monitoring arm (relative risk 2.11, 95% CI 1.68-2.65). One nonrandomized comparative study reported a similar effect (adjusted relative risk [aRR] 1.59, 95% CI 1.36-1.77). Home BP monitoring was not associated with the rate of BP treatment initiation (aRR 1.03, 95% CI 0.74-1.44) but was associated with reduced unplanned hypertension-related hospital admissions (aRR 0.12, 95% CI 0.01-0.96). Most patients (83.3-87.0%) were satisfied with management related to home BP monitoring. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. CONCLUSION Home BP monitoring likely improves ascertainment of BP, which is necessary for early recognition of hypertension in postpartum individuals, and may compensate for racial disparities in office-based follow-up. There is insufficient evidence to conclude that home BP monitoring reduces severe maternal morbidity or mortality or reduces racial disparities in clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022313075.
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Affiliation(s)
- Dale W Steele
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and the Department of Epidemiology, Brown University School of Public Health, and the Department of Emergency Medicine, the Department of Pediatrics, and Department of Medicine, and the Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island; the Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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30
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Abstract
Race is a social and power construct whose meaning has shifted over time. Racist beliefs in medicine fostered the continuation of these notions. In this commentary, we review race-based medicine versus race-conscious medicine. Race-conscious medicine emphasizes racism as a key determinant of illness and health. Racism in obstetrics and gynecology has deep roots in its history. The use of race in clinical decision-making tools, such as those that predict successful vaginal birth after cesarean delivery, should be eliminated. Research that explores the complexities of health disparities and their effects on clinical outcomes are pivotal to race-conscious approaches in medicine.
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31
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Banayan JM. Postpartum Preeclampsia-A Diagnosis Not to Be Missed. J Cardiothorac Vasc Anesth 2023; 37:1039-1041. [PMID: 36964082 DOI: 10.1053/j.jvca.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Jennifer M Banayan
- Department of Anesthesiology, Northwestern University,Feinberg School of Medicine, Chicago, IL.
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32
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Giorgione V, Jansen G, Kitt J, Ghossein-Doha C, Leeson P, Thilaganathan B. Peripartum and Long-Term Maternal Cardiovascular Health After Preeclampsia. Hypertension 2023; 80:231-241. [PMID: 35904012 DOI: 10.1161/hypertensionaha.122.18730] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is widespread acceptance of the increased prevalence of cardiovascular diseases occurring within 1 to 2 decades in women following a preeclamptic pregnancy. More recent evidence suggests that the deranged biochemical and echocardiographic findings in women do not resolve in the majority of preeclamptic women following giving birth. Many women continue to be hypertensive in the immediate postnatal period with some exhibiting occult signs of cardiac dysfunction. There is now promising evidence that with close monitoring and effective control of blood pressure control in the immediate postnatal period, women may have persistently lower blood pressures many years after stopping their medication. This review highlights the evidence that delivering effective medical care in the fourth trimester of pregnancy can improve the long-term cardiovascular health after a preeclamptic birth.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
| | - Gwyneth Jansen
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands (G.J.)
| | - Jamie Kitt
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Chahinda Ghossein-Doha
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht' the Netherlands (C.G.-D.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
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Herrock O, Deer E, LaMarca B. Setting a stage: Inflammation during preeclampsia and postpartum. Front Physiol 2023; 14:1130116. [PMID: 36909242 PMCID: PMC9995795 DOI: 10.3389/fphys.2023.1130116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Preeclampsia (PE) is a leading cause of maternal and fetal mortality worldwide. The immune system plays a critical role in normal pregnancy progression; however, inappropriate inflammatory responses have been consistently linked with PE pathophysiology. This inflammatory phenotype consists of activation of the innate immune system, adaptive immune system, and increased inflammatory mediators in circulation. Moreover, recent studies have shown that the inflammatory profile seen in PE persists into the postpartum period. This manuscript aims to highlight recent advances in research relating to inflammation in PE as well as the inflammation that persists postpartum in women after a PE pregnancy. With the advent of the COVID-19 pandemic, there has been an increase in obstetric disorders associated with COVID-19 infection during pregnancy. This manuscript also aims to shed light on the relationship between COVID-19 infection during pregnancy and the increased incidence of PE in these women.
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Affiliation(s)
- Owen Herrock
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Evangeline Deer
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Babbette LaMarca
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, United States
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34
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Gomez-Lopez N, Romero R, Escobar MF, Carvajal JA, Echavarria MP, Albornoz LL, Nasner D, Miller D, Gallo DM, Galaz J, Arenas-Hernandez M, Bhatti G, Done B, Zambrano MA, Ramos I, Fernandez PA, Posada L, Chaiworapongsa T, Jung E, Garcia-Flores V, Suksai M, Gotsch F, Bosco M, Than NG, Tarca AL. Pregnancy-specific responses to COVID-19 are revealed by high-throughput proteomics of human plasma. RESEARCH SQUARE 2022:rs.3.rs-1906806. [PMID: 36032966 PMCID: PMC9413722 DOI: 10.21203/rs.3.rs-1906806/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnant women are at greater risk of adverse outcomes, including mortality, as well as obstetrical complications resulting from COVID-19. However, pregnancy-specific changes that underlie such worsened outcomes remain unclear. Herein, we profiled the plasma proteome of pregnant and non-pregnant COVID-19 patients and controls and showed alterations that display a dose-response relationship with disease severity; yet, such proteomic perturbations are dampened during pregnancy. In both pregnant and non-pregnant state, the proteome response induced by COVID-19 showed enrichment of mediators implicated in cytokine storm, endothelial dysfunction, and angiogenesis. Shared and pregnancy-specific proteomic changes were identified: pregnant women display a tailored response that may protect the conceptus from heightened inflammation, while non-pregnant individuals display a stronger response to repel infection. Furthermore, the plasma proteome can accurately identify COVID-19 patients, even when asymptomatic or with mild symptoms. This study represents the most comprehensive characterization of the plasma proteome of pregnant and non-pregnant COVID-19 patients.
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Affiliation(s)
- Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - María Fernanda Escobar
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Javier Andres Carvajal
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Paula Echavarria
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Ludwig L. Albornoz
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Derek Miller
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dahiana M. Gallo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jose Galaz
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Arenas-Hernandez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Maria Andrea Zambrano
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paula Andrea Fernandez
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Leandro Posada
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Valeria Garcia-Flores
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Manaphat Suksai
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mariachiara Bosco
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nandor Gabor Than
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, USA
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Sarma AA, Aggarwal NR, Briller JE, Davis M, Economy KE, Hameed AB, Januzzi JL, Lindley KJ, Mattina DJ, McBay B, Quesada O, Scott NS. The Utilization and Interpretation of Cardiac Biomarkers During Pregnancy: JACC: Advances Expert Panel. JACC. ADVANCES 2022; 1:100064. [PMID: 38938393 PMCID: PMC11198183 DOI: 10.1016/j.jacadv.2022.100064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 06/29/2024]
Abstract
Cardiac biomarkers are widely used in the nonpregnant population when acute cardiovascular (CV) pathology is suspected; however, the behavior of these biomarkers in the context of pregnancy is less well understood. Pregnant individuals often have symptoms that mimic those of cardiac dysfunction, and complications of pregnancy may include CV disease. This paper will summarize our current knowledge on the use of cardiac biomarkers in pregnancy and provide suggestions on how to use these tools in clinical practice based on the available evidence. Natriuretic peptides and troponin should not be measured routinely in uncomplicated pregnancy, where values should remain low as in the nonpregnant population. In the context of pre-existing or suspected CV disease, these biomarkers retain their negative predictive value. Elevations of both natriuretic peptides and troponin may occur without clear clinical significance in the immediate postpartum period. Elevations of these markers should always prompt further investigation into possible CV pathology.
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Affiliation(s)
- Amy A. Sarma
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melinda Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine E. Economy
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - James L. Januzzi
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon McBay
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Odayme Quesada
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - American College of Cardiology Cardiovascular Disease in Women Committee and Cardio-obstetrics Work Group
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular diseases, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- University of California, Irvine, Orange, California, USA
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
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36
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Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, Langlois EV, Monaghan J, Ollivier R, Parker R, Roos N, Scott H, Shin HD, Curran J. Timing of maternal mortality and severe morbidity during the postpartum period. JBI Evid Synth 2022; 20:2119-2194. [PMID: 35916004 PMCID: PMC9594153 DOI: 10.11124/jbies-20-00578] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. Introduction: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. Inclusion criteria: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2–7, and days 8–42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). Methods: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. Results: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2–7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). Conclusion: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. Systematic review registration number: PROSPERO CRD42020187341
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Brianna Hughes
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Mercedes Bonet
- UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Dorey
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jon Dorling
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, NS, Canada
| | - Etienne V. Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Joelle Monaghan
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Robin Parker
- W.K. Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Nathalie Roos
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heather Scott
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hwayeon Danielle Shin
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Curran
- Aligning Health Needs and Evidence for Transformative Change (AH_NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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37
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Hauspurg A, Jeyabalan A. The risk factor is racism, not race. Am J Obstet Gynecol 2022; 227:358-359. [PMID: 35278377 DOI: 10.1016/j.ajog.2022.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA.
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA
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38
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Clare CA. Race as a social construct should not be cited as a risk factor for postpartum preeclampsia. Am J Obstet Gynecol 2022; 227:357-358. [PMID: 35278376 DOI: 10.1016/j.ajog.2022.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
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