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Magai DN, Chandna J, Volvert ML, Craik R, Jah H, Kongira F, Bojang K, Koech A, Mwashigadi G, Mutua AM, Blencowe H, D'Alessandro U, Roca A, Temmerman M, von Dadelszen P, Abubakar A, Gladstone M. The PRECISE-DYAD Neurodevelopmental substudy protocol: neurodevelopmental risk in children of mothers with pregnancy complications. Wellcome Open Res 2024; 8:508. [PMID: 39129914 PMCID: PMC11316179 DOI: 10.12688/wellcomeopenres.19689.2] [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: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Background Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear-particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories. Methods This is an observational cohort study of female and male children (≈3,950) born to women (≈4,200) with and without pregnancy complications (pregnancy-induced hypertension, foetal growth restriction, and premature birth) previously recruited into PREgnancy Care Integrating Translational Science, Everywhere study with detailed biological data collected in intrapartum and post-partum periods. Children will be assessed at six weeks to 6 months, 11-13 months, 23-25 months and 35-37 months in rural and semi-urban Gambia (Farafenni, Illiasa, and Ngayen Sanjal) and Kenya (Mariakani and Rabai). We will assess children's neurodevelopment using Prechtls General Movement Assessment, the Malawi Development Assessment Tool (primary outcome), Observation of Maternal-Child Interaction, the Neurodevelopmental Disorder Screening Tool, and the Epilepsy Screening tool. Children screening positive will be assessed with Cardiff cards (vision), Modified Checklist for Autism in Toddlers Revised, and Pediatric Quality of Life Inventory Family Impact. We will use multivariate logistic regression analysis to investigate the impact of pregnancy complications on neurodevelopment and conduct structural equation modelling using latent class growth to study trajectories and relationships between biological, environmental, and psychosocial factors on child development. Conclusions We aim to provide information regarding the neurodevelopment of infants and children born to women with and without pregnancy complications at multiple time points during the first three years of life in two low-resource African communities. A detailed evaluation of developmental trajectories and their predictors will provide information on the most strategic points of intervention to prevent and reduce the incidence of neurodevelopmental impairments.
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Affiliation(s)
- Dorcas N. Magai
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, England, L12 2AP, UK
| | - Jaya Chandna
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, Keppel Street, WC1E 7HT, UK
| | - Marie-Laure Volvert
- Department of Women's and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England, UK
| | - Rachel Craik
- Department of Women's and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England, UK
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, England, UK
| | - Hawanatu Jah
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Fatoumata Kongira
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kalilu Bojang
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Angela Koech
- Centre of Excellence Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Grace Mwashigadi
- Centre of Excellence Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Agnes M. Mutua
- Centre of Excellence Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Hannah Blencowe
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, Keppel Street, WC1E 7HT, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Peter von Dadelszen
- Department of Women's and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England, UK
| | - Amina Abubakar
- Institute for Human Development, The Aga Khan University, Nairobi, Kenya
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, England, L12 2AP, UK
| | - The PRECISE DYAD Network
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, England, L12 2AP, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, Keppel Street, WC1E 7HT, UK
- Department of Women's and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, England, UK
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, England, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Centre of Excellence Women and Child Health, The Aga Khan University, Nairobi, Kenya
- Institute for Human Development, The Aga Khan University, Nairobi, Kenya
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2
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Ibarra-Ibarra BR, Luna-Muñoz L, Mutchinick OM, Arteaga-Vázquez J. Moderate altitude as a risk factor for isolated congenital malformations. Results from a case-control multicenter-multiregional study. Birth Defects Res 2024; 116:e2335. [PMID: 39056527 DOI: 10.1002/bdr2.2335] [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: 07/04/2023] [Revised: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Living in high-altitude regions has been associated with a higher prevalence of some birth defects. Moderate altitudes (1500-2500 m) have been associated with some congenital heart diseases and low birth weight. However, no studies have been conducted for other isolated congenital malformations. OBJECTIVES To estimate the prevalence at birth of isolated congenital malformations in low and moderate altitudes and to determine if moderate altitudes are a risk factor, such as high altitudes, for isolated congenital malformations adjusted for other factors. METHODS The study consisted of a case-control multicenter-multiregional study of 13 isolated congenital malformations. Cases included live births with isolated congenital malformations and controls at low (10-1433 m) and moderate altitudes (1511-2426 m) from a Mexican registry from January 1978 to December 2019. Prevalence per 10,000 (95% CI) per altitude group was estimated. We performed unadjusted and adjusted logistic regression models (adjusted for maternal age, parity, malformed relatives, socioeconomic level, and maternal diabetes) for each isolated congenital malformation. RESULTS Hydrocephaly and microtia had a higher at-birth prevalence, and spina bifida, preauricular tag, and gastroschisis showed a lower at-birth prevalence in moderate altitudes. Moderate altitudes were a risk factor for hydrocephaly (aOR 1.39), microtia (aOR 1.60), cleft-lip-palate (aOR 1.27), and polydactyly (aOR 1.32) and a protective effect for spina bifida (aOR 0.87) compared with low altitudes. CONCLUSIONS Our findings provide evidence that moderate altitudes as higher altitudes are an associated risk or protective factor to some isolated congenital malformations, suggesting a possible gradient effect.
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Affiliation(s)
- Blanca Rebeca Ibarra-Ibarra
- Laboratory of Translational Medicine, UNAM-INC Unit, Instituto Nacional de Cardiología, Ignacio Chávez, Mexico City, Mexico
| | - Leonora Luna-Muñoz
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Osvaldo M Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Jazmín Arteaga-Vázquez
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Roman-Lazarte V, Angela Roman L, Moncada-Mapelli E, Uribe-Cavero LJ, Luz Marcelo-Armas M. Clinical manifestations and complications of preeclampsia and eclampsia in populations residing at high altitudes and very high altitudes: A scoping review. Pregnancy Hypertens 2024; 36:101119. [PMID: 38461671 DOI: 10.1016/j.preghy.2024.101119] [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: 12/09/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Preeclampsia and eclampsia are conditions that affect gestation, characterized by high blood pressure and direct organ damage, while geographical altitude directly affects cardiovascular physiology. The aim of this review is to identify the clinical manifestations and complications of preeclampsia in pregnant women at high and very high altitudes. METHODS A scoping review was conducted to assess the objective. A systematic search was performed on Pubmed, Web of Science, Embase, Scopus, Scielo, and Lilacs. Studies including pregnant women with preeclampsia or eclampsia at high altitudes and very high altitudes were included, excluding non-citable documents. Results were summarized in tables based on bibliographic data, methodological aspects, and key findings. RESULTS Eight documents meeting the inclusion and exclusion criteria were obtained. Seven studies focused on populations in Latin America, with the highest geographical altitude being 4380 m above sea level in the city of Cerro de Pasco, Peru. One report suggests a higher admission rate to the Intensive Care Unit and a higher frequency of HELLP syndrome. Functional cardiovascular changes were also observed. CONCLUSIONS There are few studies directly evaluating pregnant populations at high altitudes and very high altitudes experiencing preeclampsia and eclampsia. Complications may be more frequent at high altitudes and very high altitudes with clinically unobservable cardiovascular changes.
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Affiliation(s)
| | - Luz Angela Roman
- Sociedad Científica de Estudiantes de Medicina Daniel Alcides Carrion, Universidad Nacional Daniel Alcides Carrion, Cerro de Pasco, Peru
| | | | - Leonardo J Uribe-Cavero
- Sociedad Científica de Estudiantes de Medicina de Ica, Facultad de Medicina Humana, Universidad Nacional San Luis Gonzaga de Ica, Ica, Perú
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Brown ER, Giussani DA. Cause of fetal growth restriction during high-altitude pregnancy. iScience 2024; 27:109702. [PMID: 38694168 PMCID: PMC11061758 DOI: 10.1016/j.isci.2024.109702] [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: 01/25/2024] [Revised: 02/23/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024] Open
Abstract
High-altitude pregnancy increases the incidence of fetal growth restriction and reduces birth weight. This poses a significant clinical challenge as both are linked to adverse health outcomes, including raised infant mortality and the development of the metabolic syndrome in later life. While this reduction in birth weight is mostly understood to be driven by the hypobaric hypoxia of high altitude, the causative mechanism is unclear. Moreover, it is now recognized that highland ancestry confers protection against this reduction in birth weight. Here, we analyze the evidence that pregnancy at high altitude reduces birth weight and that highland ancestry confers protection, discussing mechanisms contributing to both effects.
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Affiliation(s)
- Emily R. Brown
- Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, UK
| | - Dino A. Giussani
- Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
- Cambridge Strategic Research Initiative in Reproduction
- Cambridge Cardiovascular Centre for Research Excellence
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5
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Schlein SM, Reno EM, Coffey CH, Casper LM, Klein DA, Claypool MS, Wiitala EL, Keyes LE. Environmental Exposures and Risks During Pregnancy. Wilderness Environ Med 2024:10806032241248626. [PMID: 38706212 DOI: 10.1177/10806032241248626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The Women in Wilderness Medicine Research Committee of the Wilderness Medical Society conducted a narrative review to address considerations for pregnant individuals in wilderness environments. There is limited evidence behind many opinion-based recommendations on the safety of various environmental exposures in pregnancy. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolation from physiological data, as well as evaluating expert consensus statements. The benefits of exposure to natural environments include better pregnancy outcomes and improved maternal mental and physical health. Risks are similar to nonpregnant individuals with the added risks associated with maternal-fetal physiology in wilderness environments and difficulties of evacuation. This narrative review discusses pregnancy-specific concerns in extreme environments, including high altitude, hypothermia, hyperthermia, lightning strikes, envenomations, and common outdoor exposures.
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Affiliation(s)
- Sarah M Schlein
- Larner College of Medicine, University of Vermont, Burlington, VT
| | - Elaine M Reno
- Department of Emergency Medicine, University of Colorado, Aurora, CO
| | | | | | - David A Klein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA
| | | | - Ellen L Wiitala
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO
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6
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Salinas CE, Patey OV, Murillo C, Gonzales M, Espinoza V, Mendoza S, Ruiz R, Vargas R, Perez Y, Montaño J, Toledo-Jaldin L, Badner A, Jimenez J, Peñaranda J, Romero C, Aguilar M, Riveros L, Arana I, Giussani DA. Preeclampsia and risk of maternal pulmonary hypertension at high altitude in Bolivia. J Dev Orig Health Dis 2023; 14:523-531. [PMID: 37497575 DOI: 10.1017/s2040174423000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Women with a history of preeclampsia (PE) have a greater risk of pulmonary arterial hypertension (PAH). In turn, pregnancy at high altitude is a risk factor for PE. However, whether women who develop PE during highland pregnancy are at risk of PAH before and after birth has not been investigated. We tested the hypothesis that during highland pregnancy, women who develop PE are at greater risk of PAH compared to women undergoing healthy highland pregnancies. The study was on 140 women in La Paz, Bolivia (3640m). Women undergoing healthy highland pregnancy were controls (C, n = 70; 29 ± 3.3 years old, mean±SD). Women diagnosed with PE were the experimental group (PE, n = 70, 31 ± 2 years old). Conventional (B- and M-mode, PW Doppler) and modern (pulsed wave tissue Doppler imaging) ultrasound were applied for cardiovascular íííassessment. Spirometry determined maternal lung function. Assessments occurred at 35 ± 4 weeks of pregnancy and 6 ± 0.3 weeks after birth. Relative to highland controls, highland PE women had enlarged right ventricular (RV) and right atrial chamber sizes, greater pulmonary artery dimensions and increased estimated RV contractility, pulmonary artery pressure and pulmonary vascular resistance. Highland PE women had lower values for peripheral oxygen saturation, forced expiratory flow and the bronchial permeability index. Differences remained 6 weeks after birth. Therefore, women who develop PE at high altitude are at greater risk of PAH before and long after birth. Hence, women with a history of PE at high altitude have an increased cardiovascular risk that transcends the systemic circulation to include the pulmonary vascular bed.
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Affiliation(s)
- C E Salinas
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - O V Patey
- Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, UK
| | - C Murillo
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - M Gonzales
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - V Espinoza
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - S Mendoza
- Centro de Salud Tembladerani, La Paz, Bolivia
| | - R Ruiz
- Hospital Materno Infantil, La Paz, Bolivia
| | - R Vargas
- Hospital de la Mujer, La Paz, Bolivia
| | - Y Perez
- Hospital de la Mujer, La Paz, Bolivia
| | - J Montaño
- Hospital de la Mujer, La Paz, Bolivia
| | | | - A Badner
- Hospital Materno Infantil, La Paz, Bolivia
| | - J Jimenez
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | | | - C Romero
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - M Aguilar
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - L Riveros
- Instituto Boliviano de Biología de Altura (IBBA), UMSA, La Paz, Bolivia
| | - I Arana
- Grupo Premio Nobel, La Paz, Bolivia
| | - D A Giussani
- Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, UK
- BHF Centre for Research Excellence, University of Cambridge, Cambridge, UK
- Strategic Research Initiative in Reproduction, University of Cambridge, Cambridge, UK
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Keyes LE, Sanders L. Pregnancy and Exercise in Mountain Travelers. Curr Sports Med Rep 2023; 22:78-81. [PMID: 36866950 DOI: 10.1249/jsr.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Pregnant women are traveling to high altitude and evidence-based recommendations are needed. Yet, there are limited data regarding the safety of short-term prenatal high-altitude exposure. There are benefits to prenatal exercise and may be benefits to altitude exposure. Studies evaluating maternofetal responses to exercise at altitude found the only complication was transient fetal bradycardia, a finding of questionable significance. There are no published cases of acute mountain sickness in pregnant women, and data suggesting an increase in preterm labor are of poor quality. Current recommendations across professional societies are overly cautious and inconsistent. Non-evidence-based restrictions to altitude exposure can have negative consequences for a pregnant women's physical, social, mental, and economic health. Available data suggest that risks of prenatal travel to altitude are low. Altitude exposure is likely safe for women with uncomplicated pregnancies. We do not recommend absolute restrictions to high altitude exposure, but rather caution and close self-monitoring.
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Affiliation(s)
- Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Anschutz, Aurora, CO
| | - Linda Sanders
- Department of Emergency Medicine, St Elizabeth's Hospital, Fort Morgan, CO
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Hu XQ, Zhang L. Oxidative Regulation of Vascular Ca v1.2 Channels Triggers Vascular Dysfunction in Hypertension-Related Disorders. Antioxidants (Basel) 2022; 11:antiox11122432. [PMID: 36552639 PMCID: PMC9774363 DOI: 10.3390/antiox11122432] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Blood pressure is determined by cardiac output and peripheral vascular resistance. The L-type voltage-gated Ca2+ (Cav1.2) channel in small arteries and arterioles plays an essential role in regulating Ca2+ influx, vascular resistance, and blood pressure. Hypertension and preeclampsia are characterized by high blood pressure. In addition, diabetes has a high prevalence of hypertension. The etiology of these disorders remains elusive, involving the complex interplay of environmental and genetic factors. Common to these disorders are oxidative stress and vascular dysfunction. Reactive oxygen species (ROS) derived from NADPH oxidases (NOXs) and mitochondria are primary sources of vascular oxidative stress, whereas dysfunction of the Cav1.2 channel confers increased vascular resistance in hypertension. This review will discuss the importance of ROS derived from NOXs and mitochondria in regulating vascular Cav1.2 and potential roles of ROS-mediated Cav1.2 dysfunction in aberrant vascular function in hypertension, diabetes, and preeclampsia.
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Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement. Hypertens Res 2022; 45:1298-1309. [PMID: 35726086 PMCID: PMC9207424 DOI: 10.1038/s41440-022-00965-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders of pregnancy increase the risk of adverse maternal and fetal outcomes. In 2018, the Japanese classification of hypertensive disorders of pregnancy was standardized with those of other countries, and a hypertensive disorder of pregnancy was considered to be present if hypertension existed during pregnancy and up to 12 weeks after delivery. Strategies for the prevention of hypertensive disorders of pregnancy have become much clearer, but further research is needed on appropriate subjects and methods of administration, and these have not been clarified in Japan. Although guidelines for the use of antihypertensive drugs are also being studied and standardized with those of other countries, the use of calcium antagonists before 20 weeks of gestation is still contraindicated in Japan because of the safety concerns that were raised regarding possible fetal anomalies associated with their use at the time of their market launch. Chronic hypertension is now included in the definition of hypertensive disorders of pregnancy, and blood pressure measurement is a fundamental component of the diagnosis of hypertensive disorders of pregnancy. Out-of-office blood pressure measurements, including ambulatory and home blood pressure measurements, are important for pregnant and nonpregnant women. Although conditions such as white-coat hypertension and masked hypertension have been reported, determining their occurrence in pregnancy is complicated by the gestational week. This narrative review focused on recent reports on hypertensive disorders of pregnancy, including those related to blood pressure measurement and classification. ![]()
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A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status. Life (Basel) 2022; 12:life12050727. [PMID: 35629394 PMCID: PMC9143551 DOI: 10.3390/life12050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
The objectives of the study were to determine differences in the parameters of red blood cells (RBC), white blood cells (WBC), and platelets at low altitude (LA) and at high altitude (HA) and with the gestation being advanced, and to determine correlations between parameters of RBC and platelets. We also studied the association of RBC and platelets with markers of iron status. In addition, markers of iron status and inflammation were measured and compared at each trimester of gestation in pregnant women at LA and HA. A cross-sectional comparative study was conducted at Lima (150 m above sea level) and Cusco at 3400 m above sea level from May to December 2019. Hematological parameters in pregnant women (233 at LA and 211 at HA) were analyzed using an automated hematology analyzer. Serum ferritin levels, soluble transferrin receptor (sTfR), hepcidin, erythropoietin, testosterone, estradiol, and interleukin-6 (IL6) levels were measured by ELISA. One-way ANOVA supplemented with post hoc test, chi-square test, and Pearson correlation test statistical analyses were performed. p < 0.05 was considered significant. Pregnant woman at HA compared to LA had significantly lower WBC (p < 0.01), associated with higher parameters of the RBC, except for the mean corpuscular volume (MCV) that was no different (p > 0.05). Platelets and mean platelet volume (MPV) were higher (p < 0.01), and platelet distribution width (PDW) was lower at HA than at LA (p < 0.01). A higher value of serum ferritin (p < 0.01), testosterone (p < 0.05), and hepcidin (p < 0.01) was observed at HA, while the concentration of sTfR was lower at HA than at LA (p < 0.01). At LA, neutrophils increased in the third trimester (p < 0.05). RBC parameters decreased with the progress of the gestation, except RDW-CV, which increased. The platelet count decreased and the MPV and PDW were significantly higher in the third trimester. Serum ferritin, hepcidin, and serum testosterone decreased, while sTfR and serum estradiol increased during gestation. At HA, the WBC and red blood cell distribution width- coefficient of variation (RDW-CV), PCT, and serum IL-6 did not change with gestational trimesters. RBC, hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet count were lower as gestation advanced. MCV, MPV, and PDW increased in the third trimester. Serum ferritin, testosterone, and hepcidin were lower in the third trimester. Serum estradiol, erythropoietin, and sTfR increased as gestation progressed. Direct or inverse correlations were observed between RBC and platelet parameters and LA and HA. A better number of significant correlations were observed at HA. Hb, Hct, and RDW-CV showed a significant correlation with serum ferritin at LA and HA. Of these parameters, RDW-CV and PDW showed an inversely significant association with ferritin (p < 0.05). In conclusion, a different pattern was observed in hematological markers as well as in iron status markers between pregnant women at LA and HA. In pregnant women a significant correlation between several RBC parameters with platelet marker parameters was also observed. Data suggest that pregnant women at HA have adequate iron status during pregnancy as reflected by higher serum ferritin levels, lower sTfR levels, and higher hepcidin values than pregnant women at LA.
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Grant ID, Giussani DA, Aiken CE. Fetal growth and spontaneous preterm birth in high-altitude pregnancy: A systematic review, meta-analysis, and meta-regression. Int J Gynaecol Obstet 2022; 157:221-229. [PMID: 34101174 DOI: 10.1002/ijgo.13779] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To understand the relationship between birth weight and altitude to improve health outcomes in high-altitude populations, to systematically assess the impact of altitude on the likelihood of low birth weight (LBW), small for gestational age (SGA), and spontaneous preterm birth (sPTB), and to estimate the magnitude of reduced birth weight associated with altitude. METHODS PubMed, OvidEMBASE, Cochrane Library, Medline, Web of Science, and clinicaltrials.gov were searched (from inception to November 11, 2020). Observational, cohort, or case-control studies were included if they reported a high altitude (>2500 m) and appropriate control population. RESULTS Of 2524 studies identified, 59 were included (n = 1 604 770 pregnancies). Data were abstracted according to PRISMA guidelines, and were pooled using random-effects models. There are greater odds of LBW (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.33-1.62, P < 0.001), SGA (OR 1.88, 95% CI 1.08-3.28, P = 0.026), and sPTB (OR 1.23, 95% CI 1.04-1.47, P = 0.016) in high- versus low-altitude pregnancies. Birth weight decreases by 54.7 g (±13.0 g, P < 0.0001) per 1000 m increase in altitude. Average gestational age at delivery was not significantly different. CONCLUSION Globally, the likelihood of adverse perinatal outcomes, including LBW, SGA, and sPTB, increases in high-altitude pregnancies. There is an inverse relationship between birth weight and altitude. These findings have important implications for the increasing global population living at altitudes above 2500 m.
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Affiliation(s)
- Imogen D Grant
- University Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Dino A Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Catherine E Aiken
- University Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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Gonzalez-Candia A, Herrera EA. High Altitude Pregnancies and Vascular Dysfunction: Observations From Latin American Studies. Front Physiol 2021; 12:786038. [PMID: 34950057 PMCID: PMC8688922 DOI: 10.3389/fphys.2021.786038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022] Open
Abstract
An estimated human population of 170 million inhabit at high-altitude (HA, above 2,500 m). The potential pathological effects of HA hypobaric hypoxia during gestation have been the focus of several researchers around the world. The studies based on the Himalayan and Central/South American mountains are particularly interesting as these areas account for nearly 70% of the HA world population. At present, studies in human and animal models revealed important alterations in fetal development and growth at HA. Moreover, vascular responses to chronic hypobaria in the pregnant mother and her fetus may induce marked cardiovascular impairments during pregnancy or in the neonatal period. In addition, recent studies have shown potential long-lasting postnatal effects that may increase cardiovascular risk in individuals gestated under chronic hypobaria. Hence, the maternal and fetal adaptive responses to hypoxia, influenced by HA ancestry, are vital for a better developmental and cardiovascular outcome of the offspring. This mini-review exposes and discusses the main determinants of vascular dysfunction due to developmental hypoxia at HA, such as the Andean Mountains, at the maternal and fetal/neonatal levels. Although significant advances have been made from Latin American studies, this area still needs further investigations to reveal the mechanisms involved in vascular dysfunction, to estimate complications of pregnancy and postnatal life adequately, and most importantly, to determine potential treatments to prevent or treat the pathological effects of being developed under chronic hypobaric hypoxia.
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Affiliation(s)
- Alejandro Gonzalez-Candia
- Laboratorio de Función y Reactividad Vascular, Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Emilio A Herrera
- Laboratorio de Función y Reactividad Vascular, Programa de Fisiopatología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,International Center for Andean Studies (INCAS), Universidad de Chile, Santiago, Chile
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