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Chen G, Chen Y, Shi Y, Mao Z, Lou J, Ma J. A dynamic prediction model for preeclampsia using the sFlt-1/PLGF ratio combined with multiple factors. BMC Pregnancy Childbirth 2024; 24:443. [PMID: 38926668 PMCID: PMC11202363 DOI: 10.1186/s12884-024-06627-4] [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: 12/17/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Preeclampsia (PE) is a pregnancy-related multi-organ disease and a significant cause of incidence rate and mortality of pregnant women and newborns worldwide. Delivery remains the only available treatment for PE. This study aims to establish a dynamic prediction model for PE. METHODS A total of 737 patients who visited our hospital from January 2021 to June 2022 were identified according to the inclusion and exclusion criteria, forming the primary dataset. Additionally, 176 singleton pregnant women who visited our hospital from July 2022 to November 2022 comprised the verification set. We investigated different gestational weeks of sFlt-1/PLGF (soluble FMS-like tyrosine kinase-1, placental growth factor) ratio combined with maternal characteristics and routine prenatal laboratory results in order to predict PE in each trimester. Multivariate logistic regression was used to establish the prediction model for PE at different gestational weeks. The discrimination, calibration, and clinical validity were utilized to evaluate predictive models as well as models in external validation queues. RESULTS At 20-24 weeks, the obtained prediction model for PE yielded an area under the curve of 0.568 (95% confidence interval, 0.479-0.657). At 25-29 weeks, the obtained prediction model for PE yielded an area under the curve of 0.773 (95% confidence interval, 0.703-0.842)and 0.731 (95% confidence interval, 0.653-0.809) at 30-34 weeks. After adding maternal factors, uterine artery pulsation index(Ut-IP), and other laboratory indicators to the sFlt-1/PLGF ratio, the predicted performance of PE improved. It found that the AUC improved to 0.826(95% confidence interval, 0.748 ∼ 0.904) at 20-24 weeks, 0.879 (95% confidence interval, 0.823 ∼ 0.935) at 25-29 weeks, and 0.862(95% confidence interval, 0.799 ∼ 0.925) at 30-34 weeks.The calibration plot of the prediction model indicates good predictive accuracy between the predicted probability of PE and the observed probability. Furthermore, decision-curve analysis showed an excellent clinical application value of the models. CONCLUSION Using the sFlt-1/PLGF ratio combined with multiple factors at 25-29 weeks can effectively predict PE, but the significance of re-examination in late pregnancy is not significant.
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Affiliation(s)
- Guili Chen
- The People's Hospital of Yuyao, Zhejiang, 315400, China
| | - Yuanyuan Chen
- Ningbo University Medical Department, Zhejiang, 315000, China
| | - Yao Shi
- The People's Hospital of Yuyao, Zhejiang, 315400, China
| | - Zhoufen Mao
- The People's Hospital of Yuyao, Zhejiang, 315400, China
| | - Jiaqi Lou
- Health Science Center, Ningbo University, Zhejiang, 315000, China
| | - Jianting Ma
- The People's Hospital of Yuyao, Zhejiang, 315400, China.
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Badenoosh B, Yazdani S, Hossieni Gohar S, Mehdizadeh Tourzani Z, Kabir K, Bakhtiyari M. Comparison of echocardiographic findings in women with late preeclampsia and healthy pregnant women: a case-control study. J Matern Fetal Neonatal Med 2021; 35:7491-7496. [PMID: 34304669 DOI: 10.1080/14767058.2021.1949707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Preeclampsia is one of the most common types of pregnancy disorders, and it is essential to know its cardiovascular complications. Therefore, we aimed to compare echocardiographic findings in women with late preeclampsia and healthy pregnant women. METHOD In this case-control study, 80 women with late preeclampsia and 80 healthy pregnant women were randomly selected and echocardiographic findings were determined and compared in the two groups. RESULTS Evaluating the relationship between late preeclampsia and echocardiographic variables in pregnant women showed a significant relationship between diastolic disorder (15% in the case group vs. 5% in the control group) (p = .035), systolic artery pressure (p = .002), and TR gradient (p = .003) with late preeclampsia; However, this relationship was not observed with other echocardiographic variables (p > .05). CONCLUSION Since the role of transthoracic echocardiography in the management of women with preeclampsia has been emphasized by international groups, the results of this study suggest that increased TR Gradient and diastolic dysfunction are the most important echocardiography findings in patients with late preeclampsia.
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Affiliation(s)
- Bita Badenoosh
- Department of Obstetrics and Gynecology, Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahrooz Yazdani
- Cardiovascular Research Center, Shahid Rajaei Educational and Medical Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Solaleh Hossieni Gohar
- Clinical Research Development Unit (CRDU) of Emam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Kourosh Kabir
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahmood Bakhtiyari
- Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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The Impact of Preeclampsia on Women's Health: Cardiovascular Long-term Implications. Obstet Gynecol Surv 2021; 75:703-709. [PMID: 33252700 DOI: 10.1097/ogx.0000000000000846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Women with a history of preeclampsia have a 2- to 5-fold increased risk of cardiovascular diseases, which represent almost half of mortality in the female population worldwide. Objective To summarize the current evidence concerning women's future cardiovascular risk after pregnancies complicated by preeclampsia. Evidence Acquisition A PubMed and Web of Science search was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Relevant studies on cardiovascular risk after preeclampsia were included. Results Evidence suggests that the cardiovascular implications of preeclampsia do not cease with delivery, with a significant proportion of women demonstrating persistent asymptomatic myocardial impairment, aortic stiffening, and microcirculatory dysfunction. More severe and early-onset preeclampsia, as well as preeclampsia with concurrent neonatal morbidity, increases the risk of cardiovascular disease later in life. Conclusions and Relevance As former preeclamptics have been shown to be at increased cardiovascular risk, this identifies a subgroup of women who may benefit from early preventive measures.
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An association study between MiR-146a and INSR gene polymorphisms and hypertensive disorders of pregnancy in Northeastern Han Chinese population. Placenta 2020; 104:94-101. [PMID: 33310299 DOI: 10.1016/j.placenta.2020.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy(HDP) is a complex and challenging group of pregnancy complications that is one of the leading causes of maternal and fetal death worldwide. Recent studies have shown that the single nucleotide polymorphism(SNP) may play a role in the pathogenesis of HDP. This study aimed to investigate the association of MiR-146a rs2910164 and insulin receptor(INSR) rs2059806 SNPs with HDP and their associated complications in the Han population of Northeast China. METHODS A total of 240 HDP patients and 380 healthy controls were selected for genotype determination. For the most special and high incidence of HDP, we also studied the SNPs in association with pre-eclampsia(PE) patients. In addition, HDP complicated with gestational diabetes mellitus(GDM) patients was further analyzed to identify the association between SNPs and HDP-related complications. Multivariate logical regression analysis combined with 10, 000 permutation test corrections was used to analyze the association of MiR-146a and INSR SNPs with HDP. RESULTS After adjusting for relevant factors, MiR-146a rs2910164 or INSR rs2059806 SNPs were not significantly different between HDP or PE patients and healthy controls(P>0.05). Meanwhile, MiR146a rs2910164 and INSR rs2059806 SNPs were not significantly different between HDP complicated with GDM and control group. DISCUSSION Our data indicates that MiR-146a rs2910164 and INSR rs2059806 SNPs may not be significantly related with HDP in the Han population of Northeast China living in Heilongjiang Province.
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Gastrich MD, Zinonos S, Bachmann G, Cosgrove NM, Cabrera J, Cheng JQ, Kostis JB. Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period. J Womens Health (Larchmt) 2019; 29:74-83. [PMID: 31414929 DOI: 10.1089/jwh.2019.7671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Preeclampsia (PE) may lead to maternal and infant mortality and severe medical complications. Understanding future short- and long-term cardiovascular (CV) outcomes of PE is important to women's health. Materials and Methods: A retrospective matched case-control study assessed the risks of CV outcomes over a 15-year period (1999-2013) in pregnant case women, with gravidity and parity of one, diagnosed with PE, compared to pregnant primiparous control women who were not diagnosed with PE. The New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS), a database of all hospital admissions in New Jersey with longitudinal follow-up, were used to conduct the analysis. Participants were 18 years and older with demographics consistent with New Jersey, a state with a range of racial and ethnic diversity. Main outcome measures postpregnancy and over this 15-year period were myocardial infarction (MI), stroke, CV death, and all-cause death. Results: Women with PE (N = 6,360) were more likely to suffer MI, stroke, CV death, and all-cause death than controls (N = 325,347). After matching cases to controls for demographics and comorbidities, hazard ratios of PE cases for the outcomes of MI (p adjusted for comorbidities and demographics = 0.0196), CV death (adjusted p = 0.007), and all-cause death (adjusted p = 0.0026) were significantly higher than 1 compared to matched controls. Women with PE had 3.94 (95% CI: 1.25-12.4) times higher hazard for MI, 4.66 (95% CI: 1.52-14.26) times higher hazard of CV death, and 2.32 (95% CI: 1.34-4.02) times higher hazard for all-cause death than matched controls. Conclusions: This 15-year study indicates that women who have PE with their first pregnancy have a significantly higher risk of adverse CV outcomes compared to controls and suggest a heightened and continued CV monitoring after birth for this population of women.
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Affiliation(s)
- Mary Downes Gastrich
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey.,Department of Ob/Gyn and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Stavros Zinonos
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - Gloria Bachmann
- Department of Ob/Gyn and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nora M Cosgrove
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - Javier Cabrera
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey.,Department of Statistics and Biostatics, Rutgers University, New Brunswick, New Jersey
| | - Jerry Q Cheng
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - John B Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
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Abstract
PURPOSE OF REVIEW To assess the strength of evidence for associations between environmental toxicants and hypertensive disorders of pregnancy, suggest potential biological mechanisms based on animal and in vitro studies, and highlight avenues for future research. RECENT FINDINGS Evidence is strongest for links between persistent chemicals, including lead, cadmium, organochlorine pesticides, and polycyclic biphenyls, and preeclampsia, although associations are sometimes not detectable at low-exposure levels. Results have been inconclusive for bisphenols, phthalates, and organophosphates. Biological pathways may include oxidative stress, epigenetic changes, endocrine disruption, and abnormal placental vascularization. Additional prospective epidemiologic studies beginning in the preconception period and extending postpartum are needed to assess the life course trajectory of environmental exposures and women's reproductive and cardiovascular health. Future studies should also consider interactions between chemicals and consider nonlinear associations. These results confirm recommendations by the International Federation of Gynecology and Obstetrics, the American Society for Reproductive Medicine, the American Academy of Pediatrics, and the Endocrine Society that providers counsel their pregnant patients to limit exposure to environmental toxicants.
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Zhu ML, Zhao JP, Cui N, Gonçalves-Rizzi VH, Possomato-Vieira JS, Nascimento RA, Dias-Junior CA. Cardiac myeloperoxidase activity is elevated in hypertensive pregnant rats. Curr Med Sci 2017; 37:904-909. [PMID: 29270751 DOI: 10.1007/s11596-017-1825-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/24/2017] [Indexed: 01/21/2023]
Abstract
Myeloperoxidase (MPO) is released from activated neutrophils. The inflammation in preeclampsia was found to be associated with endothelial dysfunction. We hypothesized that cardiac and circulating MPO levels are elevated in hypertensive pregnancy. Systolic and diastolic blood pressure and heart rate were measured on pregnancy days 14, 16, 18 and 20 in normal pregnant and hypertensive pregnant rats. Left and right ventricle weights, the number of viable fetuses, litter size, fetal and placenta weights were recorded on gestational day 21. Circulating and cardiac MPO activities, soluble fms-like tyrosine kinase-1 (sFlt-1) and vascular endothelial growth factor (VEGF) and nitric oxide (NO) were detected. The results showed increases in cardiac (left, but not right ventricle) and circulating MPO activities, and concomitantly lower number of viable fetuses, litter size, and fetal and placenta weights, and decreases in NO in hypertensive pregnant rats. Also, the increases in circulating sFlt-1 and VEGF were found in hypertensive pregnant group. In conclusion, maternal and fetal detrimental changes along with increases in circulating sFlt-1 and VEGF in hypertensive pregnancy may be associated with increases in cardiac and circulating MPO activities, confirming the causative role of inflammatory response in preeclampsia.
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Affiliation(s)
- Ming-Lin Zhu
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China
| | - Jin-Ping Zhao
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.
| | - Ning Cui
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Victor H Gonçalves-Rizzi
- Department of Pharmacology, Biosciences Institute of Botucatu, Sao Paulo State University (UNESP), Botucatu, 18618681, Brazil
| | - Jose S Possomato-Vieira
- Department of Pharmacology, Biosciences Institute of Botucatu, Sao Paulo State University (UNESP), Botucatu, 18618681, Brazil
| | - Regina A Nascimento
- Department of Pharmacology, Biosciences Institute of Botucatu, Sao Paulo State University (UNESP), Botucatu, 18618681, Brazil
| | - Carlos A Dias-Junior
- Department of Pharmacology, Biosciences Institute of Botucatu, Sao Paulo State University (UNESP), Botucatu, 18618681, Brazil.
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Maternal cardiac function in gestational hypertension, mild and severe preeclampsia and normal pregnancy: A comparative study. Pregnancy Hypertens 2017; 10:238-241. [DOI: 10.1016/j.preghy.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/07/2017] [Accepted: 10/07/2017] [Indexed: 11/20/2022]
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10
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Wen SW, Tan H, Retnakaran R, Shen M, Zhou S, Xie RH, Smith GN, Davidge ST, Trasler J, Walker MC. Pre-gravid predictors of new onset hypertension in pregnancy − Results from a pre-conception cohort study in China. Eur J Obstet Gynecol Reprod Biol 2017; 214:140-144. [DOI: 10.1016/j.ejogrb.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
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Andraweera PH, Gatford KL, Dekker GA, Leemaqz S, Jayasekara RW, Dissanayake VHW, McCowan L, Roberts CT. The INSR rs2059806 single nucleotide polymorphism, a genetic risk factor for vascular and metabolic disease, associates with pre-eclampsia. Reprod Biomed Online 2017; 34:392-398. [PMID: 28117222 DOI: 10.1016/j.rbmo.2017.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/01/2017] [Accepted: 01/04/2017] [Indexed: 12/16/2022]
Abstract
Pre-eclampsia is a risk factor for later life vascular and metabolic diseases. This study postulates that this reflects a common genetic cause, and investigates whether the INSR rs2059806 single nucleotide polymorphism (SNP) (a risk factor for essential hypertension, type 2 diabetes and metabolic syndrome) is also associated with pre-eclampsia. The association of INSR rs2059806 with pre-eclampsia was tested in two cohorts - a Caucasian case control group (123 pre-eclamptic mother-father-baby trios and 1185 mother-father-baby trios from uncomplicated pregnancies) and an independent cohort of Sinhalese women (175 women with pre-eclampsia and 171 women with uncomplicated pregnancies). In the Caucasian cohort, the prevalence of the INSR rs2059806 AA genotype was greater among pre-eclamptic women compared with the uncomplicated pregnancies (12.7% versus 4.7%, OR[95%CI] = 3.1[1.6-5.8], P = 0.0003). In the Sinhalese cohort, maternal INSR rs2059806 AA genotype was greater among pre-eclamptic women who delivered small for gestational age infants compared with the uncomplicated pregnancies (10.8% versus 4.2%, OR[95%CI] = 2.8[1.0-7.4], P = 0.03). Thus, it was found that the INSR rs2059806 SNP is also associated with pre-eclampsia phenotypes in two independent cohorts suggesting that genetic susceptibility may be implicated in the link between pre-eclampsia and subsequent vascular and metabolic diseases.
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Affiliation(s)
- Prabha H Andraweera
- Discipline of Obstetrics and Gynaecology, School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Kathryn L Gatford
- Discipline of Obstetrics and Gynaecology, School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Gustaaf A Dekker
- Discipline of Obstetrics and Gynaecology, School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, Australia; Women's and Children's Division, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Shalem Leemaqz
- Discipline of Obstetrics and Gynaecology, School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Rohan W Jayasekara
- Human Genetics Unit, Faculty of Medicine, The University of Colombo, Colombo, Sri Lanka
| | | | - Lesley McCowan
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Claire T Roberts
- Discipline of Obstetrics and Gynaecology, School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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Kaartokallio T, Lokki AI, Peterson H, Kivinen K, Hiltunen L, Salmela E, Lappalainen T, Maanselkä P, Heino S, Knuutila S, Sayed A, Poston L, Brennecke SP, Johnson MP, Morgan L, Moses EK, Kere J, Laivuori H. Preeclampsia does not share common risk alleles in 9p21 with coronary artery disease and type 2 diabetes. Ann Med 2016; 48:330-6. [PMID: 27111527 DOI: 10.1080/07853890.2016.1174877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Preeclampsia is a common and partially genetic pregnancy complication characterized by hypertension and proteinuria. Association with cardiovascular disease and type 2 diabetes has been reported in 9p21 by several genome-wide association studies. It has been hypothesized that cardiometabolic diseases may share common etiology with preeclampsia. MATERIALS AND METHODS We tested association with the 9p21 region to preeclampsia in the Finnish population by genotyping 23 tagging single nucleotide polymorphisms (SNPs) in 15 extended preeclampsia families and in a nationwide cohort consisting of 281 cases and 349 matched controls. Replication was conducted in additional datasets. RESULTS Four SNPs (rs7044859, rs496892, rs564398 and rs7865618) showed nominal association (p ≤ 0.024 uncorrected) with preeclampsia in the case-control cohort. To increase power, we genotyped two SNPs in additional 388 cases and 341 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort. Partial replication was also attempted in a UK cohort (237 cases and 199 controls) and in 74 preeclamptic families from Australia/New Zealand. We were unable to replicate the initial association in the extended Finnish dataset or in the two international cohorts. CONCLUSIONS Our study did not find evidence for the involvement of the 9p21 region in the risk of preeclampsia. Key Message Chromosome 9p21 is not associated with preeclampsia.
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Affiliation(s)
- Tea Kaartokallio
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - A Inkeri Lokki
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,b Bacteriology and Immunology Department , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,c Immunobiology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hanna Peterson
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden
| | - Katja Kivinen
- e Division of Cardiovascular Medicine, University of Cambridge , Cambridge , UK
| | | | - Elina Salmela
- g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Tuuli Lappalainen
- i New York Genome Center , New York City , NY , USA ;,j Department of Systems Biology , Columbia University , New York City , NY , USA
| | - Paula Maanselkä
- k Institute of Biotechnology , University of Helsinki , Helsinki , Finland
| | - Sanna Heino
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sakari Knuutila
- l Department of Pathology , University of Helsinki , Helsinki , Finland
| | - Ayat Sayed
- m Department of Medical Biochemistry, Faculty of Medicine , Assiut University , Assiut , Egypt ;,n School of Molecular Medical Sciences , University of Nottingham , Nottingham , UK
| | - Lucilla Poston
- o Division of Women's Health , King's College London , London , UK
| | - Shaun P Brennecke
- p Department of Maternal-Fetal Medicine , Pregnancy Research Centre and University of Melbourne's Department of Obstetrics and Gynaecology, Royal Women's Hospital , Parkville , Victoria , Australia
| | - Matthew P Johnson
- q South Texas Diabetes and Obesity Institute, School of Medicine , University of Texas Rio Grande Valley , Brownsville , TX , USA
| | - Linda Morgan
- r School of Life Sciences , University of Nottingham , Nottingham , UK
| | - Eric K Moses
- s Faculty of Medicine Dentistry and Health Sciences , The University of Western Australia , Perth , Australia ;,t School of Biomedical Sciences , Faculty of Health Science, Curtin University , Perth , Australia ;,u Centre for Genetic Origins of Health and Disease, Medical Research Foundation , Royal Perth Hospital , Perth , Australia
| | - Juha Kere
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden ;,g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Hannele Laivuori
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,v Institute for Molecular Medicine Finland , University of Helsinki , Helsinki , Finland
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Staff AC, Redman CWG, Williams D, Leeson P, Moe K, Thilaganathan B, Magnus P, Steegers EAP, Tsigas EZ, Ness RB, Myatt L, Poston L, Roberts JM. Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks. Hypertension 2015; 67:251-60. [PMID: 26667417 DOI: 10.1161/hypertensionaha.115.06357] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Anne Cathrine Staff
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Christopher W G Redman
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - David Williams
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Paul Leeson
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Basky Thilaganathan
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Per Magnus
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eric A P Steegers
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Eleni Z Tsigas
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Roberta B Ness
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Leslie Myatt
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - Lucilla Poston
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
| | - James M Roberts
- From the Faculty of Medicine, University of Oslo, Oslo, Norway and Departments of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway (A.C.S., K.M.); Nuffield Department of Obstetrics and Gynaecology (C.W.G.R), Radcliffe Department of Medicine (P.L.), University of Oxford, Oxford, United Kingdom; Department of Maternal Medicine, Institute for Women's Health, University College London, London, United Kingdom (D.W.); Department of Obstetrics and Gynaecology, St. George's Hospital, London, United Kingdom (B.T.); Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway (P.M.); Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands (E.A.P.S.); Preeclampsia Foundation, Melbourne, FL (E.Z.T.); Division of Epidemiology and Disease Control, University of Texas School of Public Health, Houston (R.B.N.); University of Texas Health Science Center San Antonio (L.M.); Department of Women's Health, King's College London, London, United Kingdom (L.P.); and Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee-Womens Institute, University of Pittsburgh, PA (J.M.R.)
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Wenger NK. Recognizing pregnancy-associated cardiovascular risk factors. Am J Cardiol 2014; 113:406-9. [PMID: 24188889 DOI: 10.1016/j.amjcard.2013.08.054] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
Abstract
Preeclampsia, gestational diabetes, or pregnancy-induced hypertension identify a woman at risk for cardiovascular disease. This information should be incorporated into the routine cardiovascular risk assessment for women, as a basis for appropriate risk factor screening, counseling, and preventive interventions. There is need for development and validation of a clinometric tool to assess cardiovascular risk and guide management.
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Abstract
Pregnancy is a metabolic and vascular 'stress test' for women and those who 'fail' are at increased risk of long-term cardiovascular complications. Specifically, women who develop preeclampsia (and/or other manifestations of placental dysfunction) are at increased risk of coronary heart disease, stroke and cardiovascular disease in general. The risk is highest among women who develop both maternal (e.g., hypertension and proteinuria) and fetal (e.g., intrauterine growth restriction) manifestations of abnormal placentation, especially with preterm delivery. Most women who develop a maternal placental syndrome return to a normal clinical state in the weeks following pregnancy and their absolute risk of cardiovascular disease in the short term is very low. However, perhaps having a placentally complicated pregnancy affords women the opportunity to personalize risk and take action. Action is needed. The fact that we, as a population, are getting heavier and more sedentary is an urgent public health issue. The American Heart Association recommends that all women (even those at low cardiovascular risk) pursue dietary and lifestyle changes, in addition to smoking cessation. Engaging women of child-bearing age who may be motivated by a complicated pregnancy would be very valuable, from a public health perspective, given the prevalence and importance of cardiovascular disease in women, and the central role of the woman as caregiver to children, spouses and other family members.
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Affiliation(s)
- J Newstead
- University of Saskatchewan, Department of Medicine, Saskatoon, SK, Canada.
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Staff AC, Benton SJ, von Dadelszen P, Roberts JM, Taylor RN, Powers RW, Charnock-Jones DS, Redman CWG. Redefining preeclampsia using placenta-derived biomarkers. Hypertension 2013; 61:932-42. [PMID: 23460278 DOI: 10.1161/hypertensionaha.111.00250] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gastrich MD, Gandhi SK, Pantazopoulos J, Zang EA, Cosgrove NM, Cabrera J, Sedjro JE, Bachmann G, Kostis JB. Cardiovascular outcomes after preeclampsia or eclampsia complicated by myocardial infarction or stroke. Obstet Gynecol 2013; 120:823-31. [PMID: 22996100 DOI: 10.1097/aog.0b013e31826ae78a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the relationship between preeclampsia or eclampsia and stroke, myocardial infarction (MI), subsequent cardiovascular outcomes, and long-term survival. METHODS Using the Myocardial Infarction Data Acquisition System in New Jersey (1994-2009), we analyzed cardiovascular outcomes in women with and without preeclampsia or eclampsia and a first MI or stroke but with a hospitalization for a first MI or stroke (analysis 1: MI case group, n=57; MI control group, n=155; stroke case group, n=132; stroke control group, n=379). We also compared these outcomes in women with preeclampsia or eclampsia and a first MI or stroke during pregnancy with women with preeclampsia or eclampsia without MI or stroke during pregnancy (analysis 2: MI case group, n=23; MI control group, n=67; stroke case group, n=90; stroke control group, n=263). A subsequent occurrence of MI, stroke, and cardiovascular death, as well as a combined cardiovascular outcome, was ascertained. RESULTS In analysis 1, women with preeclampsia or eclampsia were at significantly lower risk for combined cardiovascular outcome with all deaths (frequency of outcome 16.7%) and with cardiovascular deaths (10.6%) compared with women without preeclampsia or eclampsia after a first stroke (33.8% and 23.5%, respectively). In analysis 2, women with preeclampsia or eclampsia and a first stroke during admission were at significantly higher risk of all death (11.1%) and the combined cardiovascular outcome with all deaths (11.1%) compared with women with preeclampsia or eclampsia without a stroke (1.9% and 2.7%, respectively) during that admission. CONCLUSION Our study indicates that preeclampsia or eclampsia not complicated by MI or stroke during pregnancy may not confer a very high risk for subsequent MI and stroke in up to 16 years of follow-up. Our data suggest that other known risk factors put women at greater risk for stroke than preeclampsia or eclampsia complicated by a stroke. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mary Downes Gastrich
- Department of Obstetrics/Gynecology and Reproductive Sciences and the Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA.
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Monga R, Buck S, Sharma P, Thomas R, Chouthai NS. Effect of preeclampsia and intrauterine growth restriction on endothelial progenitor cells in human umbilical cord blood. J Matern Fetal Neonatal Med 2012; 25:2385-9. [PMID: 22640270 DOI: 10.3109/14767058.2012.697228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Endothelial progenitor cells (EPCs) might play important roles in vascular homeostasis. This study evaluated the influence of prematurity, preeclampsia (PE) and intrauterine growth restriction (IUGR) on the EPC population in human umbilical cord blood (CB). METHODS CB was obtained from 19 preterm and 27 term deliveries. Mononuclear cells were isolated by gradient centrifugation and subjected to flow cytometry to obtain percentages of CD45(d) CD34+, CD45(d) CD133+, CD 45(d) CD34+ CD133+, and CD45(d) CD34+ CD133+ VEGFR-2+ cells. Clinical data were obtained using chart review. RESULTS Percentages of EPCs were comparable between preterm and term cord blood. CD45(d) CD34+ CD133+ cells were significantly decreased in CB samples obtained from women with PE (n = 14) [0.01, (0.00-2.6), [median, (range)], as compared to those without PE (n = 32) [1.74 (0.00-3.1)] (p = 0.005). CD45(d) CD133+ CD34- cells were significantly increased in presence of PE [0.43, (0.06-1.38)], (p = 0.002). CD45(d) CD34+ CD133+ cells were significantly decreased in presence of IUGR, with no change in CD45(d) CD133+ CD34- cells. Differences in EPC types associated with PE and IUGR were present only in term CB. CONCLUSIONS Exposure to PE and IUGR is associated with significant changes in EPC population. Future studies are needed to explore the clinical impact of observed changes.
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Affiliation(s)
- Ranjan Monga
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan, Hutzel Women's Hospital, Wayne State University, Detroit, MI 48201, USA
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Wen SW, Xie RH, Tan H, Walker MC, Smith GN, Retnakaran R. Preeclampsia and gestational diabetes mellitus: pre-conception origins? Med Hypotheses 2012; 79:120-5. [PMID: 22541860 DOI: 10.1016/j.mehy.2012.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/03/2012] [Indexed: 02/08/2023]
Abstract
Preeclampsia (PE) and gestational diabetes mellitus (GDM) are two of the most common medical complications of pregnancy, with risks for both mother and child. Like many other antepartum complications, PE and GDM occur only in pregnancy. However, it is not clear if pregnancy itself is the cause of these complications or it these conditions are caused by factors that existed prior to gestation. In this paper, we hypothesize that although the clinical findings of PE and GDM are first noted during pregnancy, the origins of both conditions may actually precede pregnancy. We further hypothesize that pathophysiologic changes underlying PE and GDM are present prior to pregnancy, but remain undetected in the non-gravid state either because pregnancy is the trigger that makes these pathologies become clinically detectable or because there has been limited prospective longitudinal data comparing the pre-gravid and antepartum status of women that go on to develop these conditions. Rigorous prospective cohort studies in which women undergo serial systematic evaluation in the pre-conception period, throughout pregnancy and into the postpartum are ideally needed to test this hypothesis of pre-conception origins of PE and GDM. In this context, we are creating a pre-conception cohort, involving about 5000 couples who plan to have a baby within six months in Liuyang county in the Chinese province of Hunan. Results from this pre-conception cohort program should be able to provide definitive answer to the question of whether the underpinnings of PE and GDM originate prior to pregnancy. Ultimately, the significance of addressing this hypothesis is underscored by its potential implications for targeted interventions that could be designed to (i) prevent the deleterious effects of PE/GDM and (ii) thereby interrupt the vicious cycle of disease that links affected women and their offspring.
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Affiliation(s)
- S W Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
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Borna S, Neamatipoor E, Radman N. Risk of coronary artery disease in women with history of pregnancies complicated by preeclampsia and LBW. J Matern Fetal Neonatal Med 2011; 25:1114-6. [PMID: 21923611 DOI: 10.3109/14767058.2011.624218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction and low infant birth weight looks at a higher risk for subsequent ischemic heart disease. OBJECTIVE To determine the relationship between pregnancy complications and maternal coronary artery disease (CAD) in the future. MATERIALS AND METHOD We performed a case-control study on 690 patients (345 patients in each group) referred to Tehran Heart Center. Women with CAD were in the case group and women without CAD were in the control group. The history of pregnancy complications (including preeclampsia, low birth weight [LBW] delivery, preterm labor and gestational hypertension) was evaluated in the two groups. RESULTS 12.5% of the patients in the case group had a history of preeclampsia, compared with the control group (1.7%). (p < 0. 0001). Seven percent of the patients in the case group and 0.9% of the patients in the control group had history of LBW delivery. The difference was significant (p < 0.0001). A history of preterm labor was recorded in 11% of cases and 3.2% of controls. Performing multivariate analysis showed that there is a strong association between preeclampsia and CAD (OR: 16.92; 95% CI; p < 0.0001), LBW delivery and CAD (OR: 6.52; 95% CI; p: 0.0038), and also between high parity and CAD. (OR: 1.135; 95% CI; p: 0.0479). CONCLUSION Our results suggest preeclampsia, LBW delivery and high parity of the mother as independent risk factors for CAD in the future.
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Affiliation(s)
- Sedigheh Borna
- Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Myklestad K, Vatten LJ, Salvesen KÅ, Davey Smith G, Romundstad PR. Hypertensive Disorders in Pregnancy and Paternal Cardiovascular Risk: A Population-Based Study. Ann Epidemiol 2011; 21:407-12. [DOI: 10.1016/j.annepidem.2010.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/29/2010] [Accepted: 12/27/2010] [Indexed: 11/17/2022]
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Freibert SM, Mannino DM, Bush H, Crofford LJ. The association of adverse pregnancy events and cardiovascular disease in women 50 years of age and older. J Womens Health (Larchmt) 2011; 20:287-93. [PMID: 21265636 DOI: 10.1089/jwh.2010.2097] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study investigates the association between a prior history of pregnancy complications and cardiovascular disease (CVD) among Kentucky women aged ≥50 years. METHODS Data were analyzed from participants (n = 3909) in the Kentucky Women's Health Registry (2006-2008). Primary outcomes were self-reported prevalence of CVD, including angina, heart attack, heart failure, and arrhythmia. Pregnancy complications used as predictors were preterm labor, preeclampsia, gestational diabetes mellitus (GDM), and third trimester bleeding. Logistic regression analyses were conducted to determine associations between prevalence of CVD and pregnancy complications, controlling for age, education, and smoking status. RESULTS Overall, 199 (5.1%) women reported angina, 79 (2.0%) reported heart attack, 44 (1.1%) reported heart failure, and 642 (16.4%) reported arrhythmia. One pregnancy complication was reported by 614 (15.7%) women, and two or more complications were reported by 130 (3.3%) women. In regression models adjusting for age, education, and smoking, compared to women who were never pregnant, women with no pregnancy complications had a similar risk of reporting heart attack (odds ratio [OR] 1.2, 95% confidence interval [CI] 0.5-2.7), but women with one pregnancy complication (OR 2.5, 95% CI 1.03-6.0) and two or more complications (OR 4.2, 95% CI 1.4-10.6) had an increased risk. Similar results were seen for angina and arrhythmia, but not heart failure. CONCLUSIONS Women who experience pregnancy complications are more likely to report prevalent CVD (including angina, heart attack, and arrhythmia), suggesting a link between adverse pregnancy events and CVD. Pregnancy complications may serve as signals for future CVD, presenting an opportunity for early intervention and prevention.
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Affiliation(s)
- Sara M Freibert
- University of Kentucky, College of Public Health, Lexington, Kentucky, USA.
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Pregnancy: a screening test for later life cardiovascular disease. Womens Health Issues 2010; 20:304-7. [PMID: 20800765 DOI: 10.1016/j.whi.2010.05.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/19/2010] [Accepted: 05/20/2010] [Indexed: 01/06/2023]
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Affiliation(s)
- Anne Cathrine Staff
- From the Department of Obstetrics and Gynaecology (A.C.S.), Oslo University Hospital, Ullevål, Norway; Faculty of Medicine (A.C.S.), University of Oslo, Oslo, Norway; HELIOS Klinikum Berlin (R.D.), Franz-Volhard Clinic, Berlin, Germany; Experimental and Clinical Research Center (R.D.), Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; Department of Obstetrics and Gynaecology (R.P.), University Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium
| | - Ralf Dechend
- From the Department of Obstetrics and Gynaecology (A.C.S.), Oslo University Hospital, Ullevål, Norway; Faculty of Medicine (A.C.S.), University of Oslo, Oslo, Norway; HELIOS Klinikum Berlin (R.D.), Franz-Volhard Clinic, Berlin, Germany; Experimental and Clinical Research Center (R.D.), Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; Department of Obstetrics and Gynaecology (R.P.), University Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium
| | - Robert Pijnenborg
- From the Department of Obstetrics and Gynaecology (A.C.S.), Oslo University Hospital, Ullevål, Norway; Faculty of Medicine (A.C.S.), University of Oslo, Oslo, Norway; HELIOS Klinikum Berlin (R.D.), Franz-Volhard Clinic, Berlin, Germany; Experimental and Clinical Research Center (R.D.), Max-Delbrück-Center for Molecular Medicine, Berlin, Germany; Department of Obstetrics and Gynaecology (R.P.), University Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium
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Srinivas SK, Sammel MD, Bastek J, Ofori E, Andrela CM, Wolfe ML, Reilly M, Elovitz MA. Evaluating the association between all components of the metabolic syndrome and pre-eclampsia. J Matern Fetal Neonatal Med 2009; 22:501-9. [PMID: 19479639 DOI: 10.1080/14767050902794642] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Hypothesising that metabolic syndrome may be associated with or useful in the prediction of pre-eclampsia, we investigated the association between all components of metabolic syndrome and C-reactive protein (CRP) in women with and without pre-eclampsia. METHODS A case-control study was performed. Cases had gestational hypertension or pre-eclampsia and controls were term deliveries. Clinical data and maternal serum was collected. The presence of metabolic syndrome (3/5 variables present) and a metabolic score (continuous 0-5) were investigated. Significant associations were evaluated using t-tests, and Pearson chi-square tests of association. Multivariable logistic regression was used to control for confounders. RESULTS One-hundred and one cases and 267 controls were evaluated. We observed a higher odds of pre-eclampsia when metabolic syndrome was present (AOR = 2.71 [1.1-6.67], p = 0.03). For every one-unit increase in metabolic score, there was a 39% increased odds of pre-eclampsia (AOR = 1.39 [1.06-1.82], p = 0.017). The odds of pre-eclampsia were nearly four times higher when hs- CRP was >8 (AOR = 3.61 [2.14-6.12], p < 0.001). CONCLUSIONS Metabolic syndrome and hs-CRP are associated with pre-eclampsia. Investigation is crucial to determine if these abnormal lipid and inflammatory pathways observed in women with pre-eclampsia are present pre-pregnancy or develop as a result of the disease process of pre-eclampsia. Further investigation is also warranted to determine whether these abnormalities persist post-pregnancy and if so, their contribution to long-term cardiovascular disease.
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Affiliation(s)
- Sindhu K Srinivas
- Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA.
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Steinert JR, Wyatt AW, Jacob R, Mann GE. Redox modulation of Ca2+ signaling in human endothelial and smooth muscle cells in pre-eclampsia. Antioxid Redox Signal 2009; 11:1149-63. [PMID: 19125611 DOI: 10.1089/ars.2008.2303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pre-eclampsia (PE) is a leading cause of maternal hypertension in pregnancy and is associated with fetal growth restriction, premature birth, and fetal and maternal mortality. Activation and dysfunction of the maternal and fetal endothelium in PE appears to be a consequence of increased oxidative stress, resulting from elevated levels of circulating lipid peroxides. Accumulating evidence implicates reactive oxygen species (ROS) in the pathogenesis of vascular dysfunction in PE, perhaps involving a disturbance in intracellular Ca(2+) signaling. Several ion-transport pathways are highly sensitive to oxidative stress, and the resulting modulation of ion transport by ROS will affect intracellular Ca(2+) homeostasis. We review the evidence that changes in ion transport induced by ROS may be linked with abnormalities in Ca(2+)-mediated signal transduction, leading to endothelial and smooth muscle dysfunction in maternal and fetal circulations in PE. As dysregulation of Ca(2+) signaling in fetal umbilical endothelial cells is maintained in culture and embryonic, fetal, and postnatal development is affected by the cellular redox state, we hypothesize that impaired redox signaling in PE may influence "programming" of the fetal cardiovascular system and endothelial function in adulthood.
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Affiliation(s)
- Joern R Steinert
- Cardiovascular Division, School of Medicine, King's College London, London, England
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28
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Abstract
Preeclampsia, a pregnancy-specific syndrome characterized by hypertension, proteinuria and edema, resolves on delivery of the placenta. Normal pregnancy is itself characterized by systemic inflammation, oxidative stress and alterations in levels of angiogenic factors and vascular reactivity. This is exacerbated in preeclampsia with an associated breakdown of compensatory mechanisms, eventually leading to placental and vascular dysfunction. The underlying pathology of preeclampsia is thought to be a relatively hypoxic or ischemic placenta. Both the placenta and maternal vasculatures are major sources of reactive oxygen and nitrogen species which can interact to produce peroxynitrite a powerful prooxidant that covalently modifies proteins by nitration of tyrosine residues, to possibly alter vascular function in preeclampsia. The linkage between placental hypoxia and maternal vascular dysfunction has been proposed to be via placental syncytiotrophoblast basement membranes shed by the placenta or via angiogenic factors which include soluble flt1 and endoglin secreted by the placenta that bind vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) in the maternal circulation. There is also abundant evidence of altered reactivity of the maternal and placental vasculature and of the altered production of autocoids in preeclampsia. The occurrence of preeclampsia is increased in women with preexisting vascular disease and confers a long-term risk for development of cardiovascular disease. The vascular stress test of pregnancy thus identifies those women with a previously unrecognized at risk vascular system and promotes the development of preeclampsia. Preexisting maternal vascular dysfunction intensified by placental factors is possibly responsible for the individual pathologies of preeclampsia.
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Affiliation(s)
- L Myatt
- Department of Obstetrics & Gynecology, University of Cincinnati, College of Medicine, Cincinnati, OH 45267-0526, USA
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29
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Long-term blood pressure changes measured from before to after pregnancy relative to nonparous women. Obstet Gynecol 2009; 112:1294-1302. [PMID: 19037039 DOI: 10.1097/aog.0b013e31818da09b] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To prospectively examine whether blood pressure changes persist after pregnancy among women of reproductive age. METHODS This was a prospective, population-based, observational cohort of 2,304 (1,167 black, 1,137 white) women (aged 18-30 years) who were free of hypertension at baseline (1985-1986) and reexamined up to six times at 2, 5, 7, 10, or 20 years later (2005-2006). We obtained standardized blood pressure measurements before and after pregnancies and categorized women into time-dependent groups by the cumulative number of births since baseline within each time interval (zero births [referent]; one interim birth and two or more interim births; nonhypertensive pregnancies). The study assessed differences in systolic and diastolic blood pressures among interim birth groups using multivariable, repeated measures linear regression models stratified by baseline parity (nulliparous and parous), adjusted for time, age, race, baseline covariates (blood pressure, body mass index, education, and oral contraceptive use), and follow-up covariates (smoking, antihypertensive medications, oral contraceptive use, and weight gain). RESULTS Among nulliparas at baseline, mean (95% confidence interval) fully adjusted systolic and diastolic blood pressures (mm Hg), respectively, were lower by -2.06 (-2.72 to -1.41) and -1.50 (-2.08 to -0.92) after one interim birth, and lower by -1.89 (-2.63 to -1.15) and -1.29 (-1.96 to -0.63) after two or more interim births compared with no births (all P<.001). Among women already parous at baseline, adjusted mean blood pressure changes did not differ by number of subsequent births. CONCLUSION A first birth is accompanied by persistent lowering of blood pressure from preconception to years after delivery. Although the biologic mechanism is unclear, pregnancy may create enduring alterations in vascular endothelial function. LEVEL OF EVIDENCE II.
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30
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Gandley RE, Rohland J, Zhou Y, Shibata E, Harger GF, Rajakumar A, Kagan VE, Markovic N, Hubel CA. Increased myeloperoxidase in the placenta and circulation of women with preeclampsia. Hypertension 2008; 52:387-93. [PMID: 18591459 DOI: 10.1161/hypertensionaha.107.107532] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Myeloperoxidase (MPO) is a hemoprotein normally released from activated monocytes and neutrophils. Traditionally viewed as a microbicidal enzyme, MPO also induces low-density lipoprotein oxidation, activates metalloproteinases, and oxidatively consumes endothelium-derived NO. The elevated plasma MPO level is a risk factor for myocardial events in patients with coronary artery disease. Patients with preeclampsia display evidence of the inflammation and endothelial dysfunction associated with oxidative stress in the circulation, vasculature, and placenta. We hypothesized that MPO levels in the circulation and placental extracts from women with preeclampsia would be greater than levels in women with normal pregnancies. Placental extracts were prepared from placental villous biopsies from preeclamptic (n=27) and control (n=43) placentas. EDTA plasma samples were obtained from gestationally age-matched preeclamptic and control normal pregnancies. MPO concentrations were measured by ELISA. Immunohistochemistry was used to determine MPO localization in the placenta. MPO levels in placental extracts from women with preeclampsia were significantly higher than the levels in normal control subjects (546+/-62 versus 347+/-32 ng/mL; P=0.025). MPO was found in the floating villi and basal plate of placentas with a greater staining in the basal plates from preeclampsia placentas compared with normal pregnancies. Plasma MPO levels were 3-fold higher in patients with preeclampsia compared with normal control subjects (36.6+/-7.6 versus 11.0+/-3.1 ng/mL; P=0.003). In conclusion, MPO levels are significantly increased in the circulation and placenta of women with preeclampsia. We speculate that MPO may contribute to the oxidative damage reported in the endothelium and placenta of women with preeclampsia.
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Affiliation(s)
- Robin E Gandley
- Magee Womens Research Institute, 204 Craft Ave, Pittsburgh, PA 15213, USA.
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31
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Hubel CA, Powers RW, Snaedal S, Gammill HS, Ness RB, Roberts JM, Arngrímsson R. C-reactive protein is elevated 30 years after eclamptic pregnancy. Hypertension 2008; 51:1499-505. [PMID: 18413489 DOI: 10.1161/hypertensionaha.108.109934] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Women with a history of preeclampsia or eclampsia (seizure during preeclamptic pregnancy) are at increased risk for cardiovascular disease after pregnancy for reasons that remain unclear. Prospective studies during pregnancy suggest that inflammation, dyslipidemia, and insulin resistance are associated with increased risk of preeclampsia. Elevated serum C-reactive protein (CRP >3 mg/L) is an indicator of inflammation and cardiovascular risk. We hypothesized that Icelandic postmenopausal women with a history of eclampsia would manifest higher concentrations of serum CRP than Icelandic postmenopausal controls with a history of uncomplicated pregnancies. We also asked whether elevated CRP is associated with the dyslipidemia and insulin resistance previously identified in this cohort. CRP, measured by high-sensitivity enzyme-linked immunoassay, was higher in women with prior eclampsia (n=25) than controls (n=28) (median mg/L [interquartile range]: 9.0 [0.9 to 13.2] versus 2.0 [0.3 to 5.1]; P<0.03). This difference remained significant after adjustment for body mass index, smoking, hormone replacement, and current age. Women with prior eclampsia clustered into either high CRP (range 8.97 to 40.6 mg/L, n=13) or lower CRP (median 1.0, range 0.05 to 3.77, n=12) subsets. The prior eclampsia/high CRP subset displayed significantly elevated systolic blood pressures, lower high-density lipoprotein (HDL) cholesterol, higher apolipoprotein B, and higher fasting insulin and homeostasis model of insulin resistance (HOMA) values compared to controls, whereas the prior eclampsia/low CRP subset differed from controls only by marginally increased apolipoprotein B. The triad of inflammation, low HDL, and insulin resistance may elevate risk for both preeclampsia/eclampsia and cardiovascular disease in later life.
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Affiliation(s)
- Carl A Hubel
- Magee-Womens Research Institute and Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pa., USA
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Ilekis JV, Reddy UM, Roberts JM. Preeclampsia--a pressing problem: an executive summary of a National Institute of Child Health and Human Development workshop. Reprod Sci 2007; 14:508-23. [PMID: 17959880 DOI: 10.1177/1933719107306232] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On September 21 and 22, 2006, the National Institute of Child Health and Human Development of the National Institutes of Health sponsored a 2-day workshop titled "Preeclampsia--A Pressing Problem." The purpose of the workshop was to bring together leaders in the field to present and discuss their diverse research areas, which ranged from basic science to clinical trials and management, and to identify scientific gaps. This article is a summary of the proceedings of that workshop. Although much progress is being made in understanding the underpinnings of preeclampsia, a number of research gaps are identified that, if filled, would hasten progress in the field. It is the overall consensus that preeclampsia is a multifactorial disease whose pathogenesis is not solely vascular, genetic, immunologic, or environmental but a complex combination of factors. In addition, a number of specific scientific gaps are identified including insufficient multidisciplinary and collaborative research, clinical trials and studies of patient management, and a lack of in-depth mechanistic research. The research community needs to focus on these gaps to better understand the disease, with the ultimate goal of preventing the disorder.
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Affiliation(s)
- John V Ilekis
- Pregnancy and Perinatology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-7510, USA.
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Hubel CA, Wallukat G, Wolf M, Herse F, Rajakumar A, Roberts JM, Markovic N, Thadhani R, Luft FC, Dechend R. Agonistic Angiotensin II Type 1 Receptor Autoantibodies in Postpartum Women With a History of Preeclampsia. Hypertension 2007; 49:612-7. [PMID: 17210828 DOI: 10.1161/01.hyp.0000256565.20983.d4] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Activating angiotensin II type 1 autoantibodies (AT1-AAs) develop in women with preeclampsia and may contribute to the disorder. Insulin resistance and serum concentrations of the antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt-1) are also increased in women with preeclampsia compared with normal pregnancy. sFlt-1 and insulin resistance decrease substantially after delivery; however, significant group differences persist postpartum. Women who have had preeclampsia are at increased cardiovascular risk later in life. We measured AT1-AAs in groups of women with previous preeclampsia (n=29) and previous normal pregnancies (n=35) 18+/-9 months after the first completed pregnancy. These women had had sFlt-1, insulin resistance homeostasis model assessment score, and related cardiovascular risk factors measured. Activating antibodies were detected by the chronotropic response of cultured neonatal rat cardiomyocytes coupled with receptor-specific antagonists (losartan and prazosin). AT1-AAs were detected in 17.2% of women with previous preeclampsia versus 2.9% of women with previous uncomplicated pregnancies (P<0.05). In contrast, there was no difference in the prevalence of autoantibodies against the alpha1-adrenoceptor (10% of previous preeclamptic versus 14% of previous normal pregnant). Women with activating autoantibodies had significantly increased sFlt-1, reduced free vascular endothelial growth factor, and higher insulin resistance homeostasis model assessment values compared with autoantibody-negative women. These data suggest that, as with sFlt-1 and insulin resistance, the AT1-AA does not regress completely after delivery and, secondarily, that correlations exist among these variables. The impact of AT1-AA after preeclampsia, especially in the context of cardiovascular risk, remains to be determined.
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Affiliation(s)
- Carl A Hubel
- Magee-Womens Research Institute and Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pa, USA
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