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Xu J, Zhang Y, Huang Y, Nie H, Yan J, Ruan L, Zhang C. The association between pulse wave velocity and pregnancy-associated diseases: A systematic review and meta-analysis. Heliyon 2024; 10:e29281. [PMID: 38707450 PMCID: PMC11066146 DOI: 10.1016/j.heliyon.2024.e29281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Maintaining healthy vascular structure and function is important for a healthy pregnancy. Obesity is a well-known predictor for poor postoperative outcomes of vascular surgery. However, the association between pulse wave velocity (PWV), a well-recognized parameter for arterial stiffness assessment, and pregnancy-associated diseases is still unclear. Therefore, we conducted this systematic review, and a meta-analysis was performed to assess the relevant associations. Methods We systematically searched the Web of Science and PubMed databases to obtain articles on PWV and pregnancy-associated diseases published before April 2023. The mean with standard deviation was used to assess the differences in PWV in pregnant women with or without relevant diseases. Subgroup analysis was conducted according to specific types of PWV. The Newcastle‒Ottawa Scale was used to evaluate the quality of the enrolled studies. Results A total of 6488 individuals from 21 studies were included. All enrolled studies were high-quality. Overall, the PWV was elevated in pregnant women who suffered from preeclampsia (mean difference (MD) = 0.67, 95 % confidence interval (CI): 0.51,0.83, P < 0.00001), hypertension (MD = 1.04, 95 % CI: 1.00,1.08, P < 0.00001), gestational diabetes mellitus (MD = 0.34, 95%CI: 0.19,0.48, P < 0.00001), and diabetes (MD = 0.49, 95%CI: 0.27,0.70, P < 0.00001). Subgroup analysis based on specific types of PWV showed similar results. Conclusion In our study, PWV is elevated in pregnancy-associated diseases, including preeclampsia, hypertension, and diabetes. The PWV assessment should be regarded as a clinical routine for pregnant women to prevent and manage cardiovascular diseases during pregnancy.
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Affiliation(s)
| | | | - Yue Huang
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao Nie
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jinhua Yan
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Ruan
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cuntai Zhang
- Department of Geriatrics, Institute of Gerontology, Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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de Lima Castro M, Dos Passos RR, Justina VD, do Amaral WN, Giachini FR. Physiological and pathological evidence of O-GlcNAcylation regulation during pregnancy related process. Placenta 2023; 141:43-50. [PMID: 37210277 DOI: 10.1016/j.placenta.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023]
Abstract
O-GlcNAcylation is a dynamic and reversible post-translational modification (PTM) controlled by the enzymes O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Changes in its expression lead to a breakdown in cellular homeostasis, which is linked to several pathological processes. Placentation and embryonic development are periods of high cell activity, and imbalances in cell signaling pathways can result in infertility, miscarriage, or pregnancy complications. O-GlcNAcylation is involved in cellular processes such as genome maintenance, epigenetic regulation, protein synthesis/degradation, metabolic pathways, signaling pathways, apoptosis, and stress response. Trophoblastic differentiation/invasion and placental vasculogenesis, as well as zygote viability and embryonic neuronal development, are all dependent on O-GlcNAcylation. This PTM is required for pluripotency, which is a required condition for embryonic development. Further, this pathway is a nutritional sensor and cell stress marker, which is primarily measured by the OGT enzyme and its product, protein O-GlcNAcylation. Yet, this post-translational modification is enrolled in metabolic and cardiovascular adaptations during pregnancy. Finally, evidence of how O-GlcNAc impacts pregnancy during pathological conditions such as hyperglycemia, gestational diabetes, hypertension, and stress disorders are reviewed. Considering this scenario, progress in understanding the role of O- GlcNAcylation in pregnancy is required.
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Affiliation(s)
- Marta de Lima Castro
- Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
| | - Rinaldo Rodrigues Dos Passos
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil; Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Vanessa Dela Justina
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil; Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Waldemar Naves do Amaral
- Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goiânia, Brazil
| | - Fernanda Regina Giachini
- Institute of Biological Sciences, Federal University of Goias, Goiânia, Brazil; Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil.
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Dela Justina V, Dos Passos Júnior RR, Lima VV, Giachini FR. Evidence of Nitric Oxide Impairment During Hypertensive Pregnancies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:99-125. [PMID: 37466771 DOI: 10.1007/978-3-031-32554-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, and they can be classified into (1) gestational hypertension, (2) preeclampsia, (3) chronic hypertension and (4) chronic hypertension with preeclampsia. Nitric oxide (NO) plays an essential role in the haemodynamic adaptations observed during pregnancy. It has been shown that the nitric oxide pathway's dysfunction during pregnancy is associated with placental- and vascular-related diseases such as hypertensive disorders of pregnancy. This review aims to present a brief definition of hypertensive disorders of pregnancy and physiological maternal cardiovascular adaptations during pregnancy. We also detail how NO signalling is altered in the (a) systemic vasculature, (b) uterine artery/spiral arteries, (c) implantation and (d) placenta of hypertensive disorders during pregnancy. We conclude by summarizing the anti-hypertensive therapy of hypertensive disorders of pregnancy as a specific management strategy.
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Affiliation(s)
- Vanessa Dela Justina
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Rinaldo Rodrigues Dos Passos Júnior
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
- Institute of Health Sciences and Health, Universidad Federal De Mato Grosso, Barra do Garcas, Brazil
| | - Victor Vitorino Lima
- Institute of Health Sciences and Health, Universidad Federal De Mato Grosso, Barra do Garcas, Brazil
| | - Fernanda Regina Giachini
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
- Institute of Health Sciences and Health, Universidad Federal De Mato Grosso, Barra do Garcas, Brazil
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Williamson SP, Moffitt RL, Broadbent J, Neumann DL, Hamblin PS. Coping, wellbeing, and psychopathology during high-risk pregnancy: A systematic review. Midwifery 2023; 116:103556. [PMID: 36427386 DOI: 10.1016/j.midw.2022.103556] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Complications during pregnancy can negatively impact the physical and psychological wellbeing of mothers. This systematic review aimed to synthesise evidence which has examined the impact of high-risk conditions developed during pregnancy on women's coping, wellbeing, and symptoms of psychopathology. DATA SOURCES Medline (Ovid), PsycINFO (ProQuest), Scopus, Web of science, AMED (Ebsco), CINAHL (Ebsco) and ProQuest databases were searched in May 2021 with no restrictions on publication date. STUDY SELECTION English-language literature was reviewed to identify 31 articles. DATA EXTRACTION Fifteen articles examined Gestational Diabetes Mellitus (GDM: 48%), nine examined multiple high-risk pregnancy conditions (29%), four examined Hypertensive disorders of pregnancy, Preeclampsia (PE: 13%), two did not specify the condition examined (7%), and one examined Pregnancy-Related Acute Kidney Injury (PR-AKI: 3%). The most common study design was quantitative, non-randomised, and survey-based. DATA SYNTHESIS Twenty-seven articles (87%) reported a high-risk pregnancy resulted in decreased wellbeing and ability to cope, and increased symptoms of psychopathology. The remaining four articles (13%) reported no difference in wellbeing or psychopathology outcomes for women experiencing high-risk compared to healthy pregnancies. Moreover, hypertensive disorders and GDM were associated with ineffective submissive or avoidant coping, reduced wellbeing, and quality-of-life, and exacerbated symptoms of anxiety and depression. CONCLUSION High-risk pregnancy negatively impacts coping, wellbeing, and psychopathology, and preventive and supportive interventions to mitigate this should focus on empowering women to feel optimistic and in control of their pregnancy. A holistic and culturally sensitive approach is recommended, where pregnant women (and their partners or support people) are involved in healthcare decisions, thus promoting wellbeing, coping, satisfaction, and improved treatment outcome.
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Affiliation(s)
| | - Robyn L Moffitt
- School of Psychology, Deakin University, Melbourne, Australia
| | | | - David L Neumann
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia; Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia
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Association between Obstetric Complications and Intravitreal Anti-Vascular Endothelial Growth Factor Agents or Intravitreal Corticosteroids. J Pers Med 2022; 12:jpm12091374. [PMID: 36143159 PMCID: PMC9501719 DOI: 10.3390/jpm12091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
This nationwide population-based cohort study aimed to describe the use of intravitreal injections (IVTs) of anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids in pregnant women in France and to report on the incidence of obstetric and neonatal complications. All pregnant women in France who received any anti-VEGF or corticosteroid IVT during pregnancy or in the month preceding pregnancy from 1 January 2009 to 31 December 2018 were identified in the national medico-administrative databases. Between 2009 and 2018, there were 5,672,921 IVTs performed in France. Among these IVTs, 228 anti-VEGF or corticosteroid IVTs were administered to 139 women during their pregnancy or in the month preceding their pregnancy. Spontaneous abortion or the medical termination of pregnancy occurred in 10 women (16.1%) who received anti-VEGF agents and in one (3.1%) of the women who received corticosteroids (p = 0.09). This is the first national cohort study of pregnant women treated with anti-VEGF or corticosteroid IVTs. We found a high incidence of obstetric complications in pregnant women treated with anti-VEGF or corticosteroid IVTs but could not demonstrate a statistically significant association between the intravitreal agents and these complications. These agents should continue to be used with great caution in pregnant women.
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Shi XF, Zhang Z, Wu HY, Wang Y, Chang AM, Gao JJ, Liu K, Song WY, Wang L, Wang HP. Lysine (K)-specific demethylase 5C regulates the incidence of severe preeclampsia by adjusting the expression of bone morphogenetic protein-7. Bioengineered 2022; 13:8538-8547. [PMID: 35331081 PMCID: PMC9161961 DOI: 10.1080/21655979.2022.2051840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the roles of the lysine (K)-specific demethylase 5C (KDM5C)-bone morphogenetic protein-7 (BMP-7) signaling pathway in the pathogenesis of severe preeclampsia (sPE). A total of 180 pregnant patients were enrolled in the study and classified into three groups: an early-onset sPE group (EOsPE) (n = 60), a late-onset sPE group (LOsPE) (n = 60), and a control group (normal pregnancy; n = 60). The messenger RNA (mRNA) and protein expression levels of bone morphogenetic protein receptor II (BMPRII), BMP-7, and KDM5C were detected in placenta samples from the two sPE groups, and their sites were evaluated using immunohistochemistry (IHC). The sPE groups showed an increased KDM5C mRNA expression, and the EOsPE group showed a decreased BMP-7 and BMPRII mRNA expression compared with the LOsPE group. However, contradictory results were discovered in terms of protein expression. Immunostaining of KDM5C, BMP-7, and BMPRII was observed in villous trophoblast and extravillous trophoblast cells. Compared with the control group, the staining intensity of KDM5C in the placental tissue trophoblast cell nucleus and vascular endothelial cells of the sPE groups was weaker, while that of BMP-7 and BMPRII was stronger, and the staining intensity was more subjective in the LOsPE group. Consistent findings were obtained by IHC and Western blot analysis. KDM5C nuclear-cytoplasmic translocation may regulate sPE through BMP-7 and its receptors. The KDM5C-BMP-7 signaling pathway may also lead to less invasion and increased apoptosis of the trophoblast cells, which is involved in the pathogenesis of sPE.
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Affiliation(s)
- Xu-Feng Shi
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhan Zhang
- Department of Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Ying Wu
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Wang
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Ai-Min Chang
- Department of Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Jun Gao
- Department of Laboratory, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kan Liu
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Yu Song
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Huan-Ping Wang
- Department of Obstetrics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
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Tsigas EZ. The Preeclampsia Foundation: the voice and views of the patient and her family. Am J Obstet Gynecol 2022; 226:S1254-S1264.e1. [PMID: 34479720 DOI: 10.1016/j.ajog.2020.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
Preeclampsia is a disease exclusive to pregnancy and the immediate postpartum period, occurring in 4.6% of pregnancies worldwide. Preeclampsia and other gestational hypertensive disorders can affect any pregnant woman. The consequences of developing this disease can lead to severe maternal and neonatal morbidities and mortalities, including fetal growth restriction, placental abruption, preterm birth, stillbirth, and maternal death. When pregnant women recover, they are at higher risk of long-term complications such as hypertension, stroke, heart failure, renal disease, and Alzheimer disease. The consequences extend to the offspring because they are at higher risk of cardiovascular diseases, and female offspring are at greater risk of developing preeclampsia when they become pregnant. For society, preeclampsia presents an economic burden related to the additional healthcare costs associated with low birthweight, prematurity, and adverse outcomes to the mother and baby. This article shares the unique perspective of affected women and their families, the effect preeclampsia has on us, and what we hope the healthcare system can deliver for our sisters and daughters in the future. Patients and their families established the Preeclampsia Foundation 21 years ago. Devoted to education and patient advocacy to raise awareness, improve healthcare practices, and catalyze research, we share some of the Foundation's realized strategies and achievements. We tell you our stories and struggles, and we issue a call to action for all stakeholders to help fulfill our vision for a world where hypertensive disorders of pregnancy no longer threaten the lives of mothers and their babies.
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dos Passos Junior RR, de Freitas RA, Dela Justina V, San Martín S, Lima VV, Giachini FR. Protein O-GlcNAcylation as a nutrient sensor signaling placental dysfunction in hypertensive pregnancy. Front Endocrinol (Lausanne) 2022; 13:1032499. [PMID: 36531508 PMCID: PMC9754152 DOI: 10.3389/fendo.2022.1032499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION During pregnancy, arterial hypertension may impair placental function, which is critical for a healthy baby's growth. Important proteins during placentation are known to be targets for O-linked β-N-acetylglucosamine modification (O-GlcNAcylation), and abnormal protein O-GlcNAcylation has been linked to pathological conditions such as hypertension. However, it is unclear how protein O-GlcNAcylation affects placental function and fetal growth throughout pregnancy during hypertension. METHODS To investigate this question, female Wistar and spontaneously hypertensive rats (SHR) were mated with male Wistar rats, and after pregnancy confirmation by vaginal smear, rats were divided into groups of 14, 17, and 20 days of pregnancy (DOPs). On the 14th, 17th, and 20th DOP, rats were euthanized, fetal parameters were measured, and placentas were collected for western blot, immunohistochemical, and morphological analyses. RESULTS SHR presented a higher blood pressure than the Wistar rats (p=0.001). Across all DOPs, SHR showed reduced fetal weight and an increase in small-for-gestational-age fetuses. While near-term placentas were heavier in SHR (p=0.006), placental efficiency decreased at 17 (p=0.01) and 20 DOPs (p<0.0001) in this group. Morphological analysis revealed reduced junctional zone area and labyrinth vasculature changes on SHR placentas in all DOPs. O-GlcNAc protein expression was lower in placentas from SHR compared with Wistar at 14, 17, and 20 DOPs. Decreased expression of O-GlcNAc transferase (p=0.01) and O-GlcNAcase (p=0.002) enzymes was found at 14 DOPs in SHR. Immunohistochemistry showed reduced placental O-GlcNAc content in both the junctional zone and labyrinth of the placentas from SHR. Periodic acid-Schiff analysis showed decreased glycogen cell content in the placentas from SHR at 14, 17, and 20 DOPs. Moreover, glucose transporter 1 expression was decreased in placentas from SHR in all DOPs. CONCLUSIONS These findings suggest that decreased protein O-GlcNAcylation caused by insufficient placental nutritional apport contributes to placental dysfunction during hypertensive pregnancy, impairing fetal growth.
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Affiliation(s)
| | | | - Vanessa Dela Justina
- Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Sebastián San Martín
- Biomedical Research Center, School of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Victor Vitorino Lima
- Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Fernanda Regina Giachini
- Graduate Program in Biological Sciences, Federal University of Goiás, Goiânia, Brazil
- Institute of Biological and Health Sciences, Federal University of Mato Grosso, Barra do Garças, Brazil
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9
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Association between ELABELA Serum Concentrations in First Trimester and Pregnancy-Induced Hypertension. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2051701. [PMID: 33062670 PMCID: PMC7539101 DOI: 10.1155/2020/2051701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
ELABELA (ELA) is considered to be implicated in the pathophysiology of preeclampsia (PE), since ELA-deficient mice exhibited PE-like symptoms and infusion of exogenous ELA normalized the gestational hypertension (GH) and proteinuria. However, no evidence show that circulating ELA is deficient in early placental development among women who destined to develop GH/PE. This nested case-control study was conducted to investigate the association between serum ELA concentration in early pregnancy and the risk of later GH/PE. Participants were recruited and sampled in 10-14+6 weeks of gestation. Definite GH/PE cases were matched 1 : 3 to controls with respect to age and gestational age. Serum concentration of ELA was measured using enzyme immunoassay. Women with later GH (N = 28) had a slightly lower median concentration of ELA (46.72 ng/mL versus 53.54 ng/mL), while those with later PE (N = 16) had a slightly higher median concentration of ELA (74.8 ng/mL versus 66.30 ng/mL) compared to the controls. Yet, both the increments did not reach statistically significant difference (GH: P = 0.380, PE: P = 0.799). ELA serum concentrations were unchanged in first trimester in women with GH/PE. Further studies are still needed to identify the dynamic changes in serum ELA concentrations during the whole pregnancy, especially in those with pregnancy-induced hypertensive disorders.
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Levine L, Habertheuer A, Ram C, Korutla L, Schwartz N, Hu RW, Reddy S, Freas A, Zielinski PD, Harmon J, Molugu SK, Parry S, Vallabhajosyula P. Syncytiotrophoblast extracellular microvesicle profiles in maternal circulation for noninvasive diagnosis of preeclampsia. Sci Rep 2020; 10:6398. [PMID: 32286341 PMCID: PMC7156695 DOI: 10.1038/s41598-020-62193-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/04/2020] [Indexed: 12/23/2022] Open
Abstract
Preeclampsia is the most common placental pathology in pregnant females, with increased morbidity and mortality incurred on the mother and the fetus. There is a need for improved biomarkers for diagnosis and monitoring of this condition. Placental syncytiotrophoblasts at the maternal-fetal interface release nanoparticles, including extracellular microvesicles, into the maternal blood during pregnancy. Syncytiotrophoblast extracellular microvesicles (STEVs) are being studied for their diagnostic potential and for their potential physiologic role in preeclampsia. We hypothesized that STEV profiles in maternal circulation would be altered under conditions of preeclampsia compared to normal pregnancy. Extracellular vesicles (EVs) released by BeWo cells in vitro showed high expression of syncytin-1, but no plac1 expression, demonstrating that trophoblast cell EVs express syncytin-1 on their surface. Placental alkaline phosphatase also showed high expression on BeWo EVs, but due to concern for cross reactivity to highly prevalent isoforms of intestinal and bone alkaline phosphatase, we utilized syncytin-1 as a marker for STEVs. In vivo, syncytin-1 protein expression was confirmed in maternal plasma EVs from Control and Preeclampsia subjects by Western blot, and overall, lower expression was noted in samples from patients with preeclampsia (n = 8). By nanoparticle analysis, EV profiles from Control and Preeclampsia groups showed similar total plasma EV quantities (p = 0.313) and size distribution (p = 0.415), but STEV quantitative signal, marked by syncytin-1 specific EVs, was significantly decreased in the Preeclampsia group (p = 2.8 × 10−11). Receiver operating characteristic curve demonstrated that STEV signal threshold cut-off of <0.316 was 95.2% sensitive and 95.6% specific for diagnosis of preeclampsia in this cohort (area under curve = 0.975 ± 0.020). In conclusion, we report that the syncytin-1 expressing EV profiles in maternal plasma might serve as a placental tissue specific biomarker for preeclampsia.
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Affiliation(s)
- Lisa Levine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, USA
| | - Andreas Habertheuer
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Chirag Ram
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Laxminarayana Korutla
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Nadav Schwartz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, USA
| | - Robert W Hu
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Sanjana Reddy
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Andrew Freas
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Patrick D Zielinski
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Joey Harmon
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA
| | - Sudheer Kumar Molugu
- Department of Biochemistry and Biophysics, University of Pennsylvania, Pennsylvania, USA
| | - Samuel Parry
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Pennsylvania, USA
| | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Pennsylvania, USA. .,Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, USA.
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Puia-Dumitrescu M, Greenberg RG, Younge N, Bidegain M, Cotten CM, McCaffrey M, Murtha A, Gutierrez S, DeJoseph J, Cochran KM, Ollendorff A. Disparities in the use of antenatal corticosteroids among women with hypertension in North Carolina. J Perinatol 2020; 40:456-462. [PMID: 31767978 PMCID: PMC7455922 DOI: 10.1038/s41372-019-0555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate antenatal corticosteroids (ANS) use in pregnant women with hypertension. STUDY DESIGN Retrospective analysis of ANS use in the Perinatal Quality Collaborative of North Carolina between 2015 and 2017. RESULTS Twenty-five centers participated, with 9% (1580/17,692) of mothers delivering at <34 weeks; of these, 81% (1286/1580) received a full course of ANS, which was not different between phases (p = 0.32), or between Level III/IV neonatal intensive care units (NICUs; 82%), and I/II NICUs (76%) (p = 0.05). In Level III/IV NICUs, White mothers were more likely to receive ANS (87%) than African Americans (77%) or other race/ethnicity (80%) (including Hispanics) (p = 0.001). ANS use did not differ among mothers with different payers (p = 0.94). CONCLUSION The rates of full ANS courses did not significantly increase from 2015-2017 and disparities persisted. Targeted efforts to improve ANS exposures among hypertensive African American and Hispanic mothers, as well as in community hospital settings are needed.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, WA, USA,Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA,Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - C. Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Martin McCaffrey
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Amy Murtha
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Susan Gutierrez
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Jodi DeJoseph
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Keith M. Cochran
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Arthur Ollendorff
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Mountain Area Health Education Center (MAHEC) OB/GYN Specialists, Asheville, NC, USA
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Rodrigues Simões AP, Cristina Maronezi M, Andres Ramirez Uscategui R, Garcia Kako Rodrigues M, Sitta Gomes Mariano R, Tavares de Almeida V, José Correia Santos V, Del Aguila da Silva P, Ricardo Russiano Vicente W, Antonio Rossi Feliciano M. Placental ARFI elastography and biometry evaluation in bitches. Anim Reprod Sci 2020; 214:106289. [PMID: 32087915 DOI: 10.1016/j.anireprosci.2020.106289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/22/2019] [Accepted: 01/19/2020] [Indexed: 02/05/2023]
Abstract
Placental rigidity and biometry of twelve pregnant bitches were evaluated using B-mode and Acoustic Radiation Force Impulse (ARFI) ultrasonography, performed once daily, from day 15 of gestation until parturition. Specific software (Virtual Touch Tissue Quantification® VTTQ and Virtual Touch Tissue Imaging Quantification® VTTIQ) were used. Values for results for variables were correlated and regression models related to gestational day were used to make evaluations. Maternal-fetal placental thickness increased to day 63 (P < 0.0001; R² = 0.91); maternal placental thickness increased until day 40 (P = 0.0340; R² = 0.54); and fetal placental thickness increased to day 50 (P < 0.0001; R² = 0.83) of gestation. Shear wave velocity (SWV) of the dorsal (P < 0.0010) was greater than lateral, which in turn was greater (P = 0.020) than the ventral area. The SWV of the dorsal area as determined using VTTQ, decreased from day 21-35 and increased to day 56 of gestation (P = 0.0291; R² = 0.4021); lateral SWV decreased from day 24-45 and increased until the time of parturition (P < 0.001; R² = 0.6055). The SWV of the dorsal area, as determined using VTTIQ, decreased from day 21-43 and then increased to day 60 of gestation (P = 0.0016; R² = 0.5075); and ventral area SWV increased from day 21-23 and decreased until the time of parturition (P < 0.001; R² = 0.8055). Placental alterations reflect structural and biochemical gestational adaptations and can become useful techniques for obstetrics.
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Affiliation(s)
- Ana Paula Rodrigues Simões
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil.
| | - Marjury Cristina Maronezi
- Department of Veterinary Surgery, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | | | - Mariana Garcia Kako Rodrigues
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Renata Sitta Gomes Mariano
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Vivian Tavares de Almeida
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Victor José Correia Santos
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Priscila Del Aguila da Silva
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Wilter Ricardo Russiano Vicente
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil
| | - Marcus Antonio Rossi Feliciano
- Department of Animal Reproduction, Faculty of Agricultural and Veterinary Sciences, Univ. Estadual Paulista "Júlio de Mesquita Filho", Jaboticabal, São Paulo, Brazil; Department of Large Animals Clinic and Surgery. Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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Kaplinski M, Taylor D, Mitchell LE, Hammond DA, Goldmuntz E, Agopian AJ. The association of elevated maternal genetic risk scores for hypertension, type 2 diabetes and obesity and having a child with a congenital heart defect. PLoS One 2019; 14:e0216477. [PMID: 31141530 PMCID: PMC6541344 DOI: 10.1371/journal.pone.0216477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background Maternal hypertension, type 2 diabetes (T2D) and obesity are associated with an increased risk of having offspring with conotruncal heart defects (CTDs). Prior studies have identified sets of single nucleotide polymorphisms (SNPs) that are associated with risk for each of these three adult phenotypes. We hypothesized that these same SNPs are associated with maternal risk of CTDs in offspring. Methods and results We evaluated the parents of children with a CTD ascertained from the Children’s Hospital of Philadelphia (n = 466) and by the Pediatric Cardiac Genomic Consortium (n = 255). We used a family-based design to assess the association between CTDs and the maternal genotype for individual hypertension, T2D, and obesity-related SNPs and found no association between CTDs and the maternal genotype for any individual SNP. In addition, we calculated genetic risk scores (GRS) for hypertension, T2D, and obesity using previously published GRS formulas. When comparing the GRS of mothers to fathers, there were no statistically significant differences in the mean for the combined GRS or the GRS for each individual condition. However, when we categorized the mothers and fathers of cases with CTDs as having high (>95th percentile) or low (≤95th percentile) scores, compared to fathers, mothers had almost two times the odds of having a high GRS for hypertension (OR 1.7, 95% CI 1.0, 2.8) and T2D (OR 1.8, 95% CI 1.1, 3.1). Conclusions Our results support a link between maternal genetic risk for hypertension/T2D and CTDs in their offspring. These associations might be independent of maternal phenotype at conception.
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MESH Headings
- Adult
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/physiopathology
- Female
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/physiopathology
- Humans
- Hypertension/genetics
- Hypertension/pathology
- Hypertension/physiopathology
- Male
- Obesity, Maternal/genetics
- Obesity, Maternal/pathology
- Obesity, Maternal/physiopathology
- Polymorphism, Single Nucleotide
- Pregnancy
- Pregnancy Complications, Cardiovascular/genetics
- Pregnancy Complications, Cardiovascular/pathology
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy in Diabetics/genetics
- Pregnancy in Diabetics/pathology
- Pregnancy in Diabetics/physiopathology
- Risk Factors
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Affiliation(s)
- Michelle Kaplinski
- Department of Pediatrics, Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Deanne Taylor
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Laura E. Mitchell
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, United States of America
| | - Dorothy A. Hammond
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth Goldmuntz
- Department of Pediatrics, Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - A. J. Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, United States of America
- * E-mail:
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Heart Rate Variability and Cardiovascular Reflex Tests for Assessment of Autonomic Functions in Preeclampsia. Int J Hypertens 2018; 2018:8163824. [PMID: 30319820 PMCID: PMC6167570 DOI: 10.1155/2018/8163824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 11/23/2022] Open
Abstract
Alterations in the autonomic cardiovascular control have been implicated to play an important etiologic role in preeclampsia. The present study was designed to evaluate autonomic functions in preeclamptic pregnant women and compare the values with normotensive pregnant and healthy nonpregnant controls. Assessment of autonomic functions was done by cardiovascular reflex tests and by analysis of heart rate variability (HRV). Cardiovascular reflex tests included deep breathing test (DBT) and lying to standing test (LST). HRV was analyzed in both time and frequency domain for quantifying the tone of autonomic nervous system to the heart. The time domain measures included standard deviation of normal R-R intervals (SDNN) and square root of mean squared differences of successive R-R intervals (RMSSD). In the frequency domain we measured total power (TP), high frequency (HF) power, low frequency (LF) power, and LF/HF ratio. Cardiovascular reflex tests showed a significant parasympathetic deficit in preeclamptic women. Among parameters of HRV, preeclamptic group had lower values of SDNN, RMSSD, TP, HF, and LF (ms2) and higher value of LF in normalised units along with high LF/HF ratio compared to normotensive pregnant and nonpregnant controls. Furthermore, normotensive pregnant women had lower values of SDNN, TP, and LF component in both absolute power and normalised units compared to nonpregnant females. The results confirm that normal pregnancy is associated with autonomic disturbances which get exaggerated in the state of preeclampsia.
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Biochemical Assessment of Renal and Liver Function among Preeclamptics in Lagos Metropolis. Int J Reprod Med 2018; 2018:1594182. [PMID: 30155474 PMCID: PMC6091329 DOI: 10.1155/2018/1594182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Preeclampsia is a pregnancy specific syndrome. Studies have shown that preeclampsia has multiorgan dysfunction effects. This study evaluated biomarkers of renal and liver function among preeclamptic Nigerian women. Study Design This was a cross-sectional study conducted among 49 preeclamptic women and 50 normotensive healthy pregnant women. Method The baseline data comprising age, gestational age, and blood pressure were obtained. Venous blood and spot urine samples were collected from each participant. Plasma obtained from blood samples taken into lithium heparinized vacutainer bottles was assayed for electrolytes, urea, creatinine, total protein, albumin, and uric acid, while sera samples from blood samples taken into serum separation tube- (SST-) gel vacutainer were assayed for aspartate transaminase and alanine transaminase using ion selective electrode technique and Cobas autoanalyzer. Spot urine samples were assayed for protein and creatinine using Pyrogallol's reagent and Jaffe's methods, respectively. Microalbuminuria (protein/creatinine ratio) was generated from spot urine protein and creatinine data. Result The plasma sodium, total protein, and albumin in preeclamptic group were significantly decreased (p<0.05) when compared with control. There was statistically significant increase (p<0.05) in microalbuminuria, plasma potassium, urea, creatinine, uric acid levels, serum AST, and ALT activities in preeclamptic group. A positive association (p<0.05) between alanine aminotransferase and biomarkers of renal function was observed. Conclusion Preeclampsia has deleterious effects on renal and liver function as shown by alteration of these parameters.
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Zhang G, Srivastava A, Bacelis J, Juodakis J, Jacobsson B, Muglia LJ. Genetic studies of gestational duration and preterm birth. Best Pract Res Clin Obstet Gynaecol 2018; 52:33-47. [PMID: 30007778 PMCID: PMC6290110 DOI: 10.1016/j.bpobgyn.2018.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 01/12/2023]
Abstract
The fine control of birth timing is important to human survival and evolution. A key challenge in studying the mechanisms underlying the regulation of human birth timing is that human parturition is a unique to human event — animal models provide only limited information. The duration of gestation or the risk of preterm birth is a complex human trait under genetic control from both maternal and fetal genomes. Genomic discoveries through genome-wide association (GWA) studies would implicate relevant genes and pathways. Similar to other complex human traits, gestational duration is likely to be influenced by numerous genetic variants of small effect size. The detection of these small-effect genetic variants requires very large sample sizes. In addition, several practical and analytical challenges, in particular the involvement of both maternal and fetal genomes, further complicate the genetic studies of gestational duration and other pregnancy phenotypes. Despite these challenges, large-scale GWA studies have already identified several genomic loci associated with gestational duration or the risk of preterm birth. These genomic discoveries have revealed novel insights about the biology of human birth timing. Expanding genomic discoveries in larger datasets by more refined analytical approaches, together with the functional analysis of the identified genomic loci, will collectively elucidate the biological processes underlying the control of human birth timing.
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Affiliation(s)
- Ge Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, USA; The Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA; March of Dimes Prematurity Research Center Ohio Collaborative, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA.
| | - Amit Srivastava
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, USA; The Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA; March of Dimes Prematurity Research Center Ohio Collaborative, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Jonas Bacelis
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital Östra (East), Gothenburg, Sweden
| | - Julius Juodakis
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Area of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Louis J Muglia
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, USA; The Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA; March of Dimes Prematurity Research Center Ohio Collaborative, USA; Department of Pediatrics, University of Cincinnati College of Medicine, USA
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Self-monitoring of blood pressure during pregnancy: an observational study in the obstetrical waiting room. Blood Press Monit 2018; 22:268-273. [PMID: 28617718 DOI: 10.1097/mbp.0000000000000277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of self-monitoring of blood pressure with a semiautomatic device in pregnant women. PARTICIPANTS AND METHODS Women attending routine obstetrical ultrasound scanning were invited to participate. The hospital staff initially demonstrated and instructed each participant in correct measurement and then took three measurements on both arms. The participant then repeated the measurements and filled an evaluation questionnaire. We used a validated semiautomatic device for all measurements. Mean values were calculated for systolic, diastolic and mean arterial blood pressure (MAP) and were compared using the paired sample t-test. Mean values and differences of systolic and diastolic pressure were plotted in Bland-Altman plots to test the agreement of the measurements. Finally, a mean evaluation score was calculated. RESULTS One hundred pregnant women were included in the study. Mean values of systolic, diastolic and MAP were 110.6, 69.7 and 83.3 mmHg, respectively, as assessed by the hospital staff. The corresponding self-measurements were 111.4, 70.2 and 83.9 mmHg, respectively. Mean differences between hospital and self-measurements were 0.79 mmHg for systolic [P=0.052, 95% confidence interval (CI)=-0.008 to 1.58], 0.49 mmHg for diastolic (P=0.056, 95% CI=-0.01 to 0.99) and 0.59 mmHg for MAP (P=0.019, 95% CI=0.099-1.08). The mean evaluation score was 9.2 of 10. CONCLUSION Differences between hospital staff and self-measurements in systolic, diastolic and MAP are within acceptable international standards. The semiautomatic device Microlife-VSA is well suited for self-measurement; however, safety studies on the use of home measurements in hypertensive pregnancies are still warranted.
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Goldman BG, Hehir MP, Yambasu S, O'Donnell EM. The presentation and management of platelet disorders in pregnancy. Eur J Haematol 2018; 100:560-566. [DOI: 10.1111/ejh.13049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Bernardus G. Goldman
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
| | - Mark P. Hehir
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
| | | | - Edward M. O'Donnell
- Department of Obstetrics and Gynaecology; University Hospital Waterford; Waterford Ireland
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Chen S, Li N, Mei Z, Ye R, Li Z, Liu J, Serdula MK. Micronutrient supplementation during pregnancy and the risk of pregnancy-induced hypertension: A randomized clinical trial. Clin Nutr 2018; 38:146-151. [PMID: 29428785 DOI: 10.1016/j.clnu.2018.01.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/29/2017] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Increasing evidence suggests that iron-containing multiple micronutrient may reduce the risk of pregnancy-induced hypertension including gestational hypertension or preeclampsia. We aimed to examine whether 30 mg iron plus folic acid or multiple micronutrients during pregnancy reduces the risk of pregnancy-induced hypertension. METHODS We conducted a secondary data analysis by the dataset from a double-blind randomized controlled trial in China from 2006 to 2009 that was conducted to investigate the effects of multiple micronutrient supplements on adverse pregnancy outcomes when provided to pregnant women with no/mild anemia. We used logistic regression to estimate the adjusted odds ratio and 95% confidence interval and test for effect modification. RESULTS The incidence of pregnancy-induced hypertension was 7.1% (423/5923), 6.3% (374/5933) and 6.3% (372/5914) among the pregnant women who took folic acid only, iron-folic acid and multiple micronutrient supplements, respectively. The adjusted odds ratios associated with iron-folic acid supplements and multiple micronutrient supplements for pregnancy-induced hypertension were both nearly 0.88 (95% confidence interval, 0.76-1.02), compared with folic acid supplements only. Among pregnant women aged 20-24 years, iron-folic acid (adjusted odds ratios: 0.81, 95% confidence interval: 0.67-0.96) or multiple micronutrient supplementation (adjusted odds ratios: 0.83, 95% confidence interval: 0.70-0.99) can significantly reduce the risk of pregnancy-induced hypertension compared to folic acid supplementation. CONCLUSIONS Overall, there were no significant differences in pregnancy-induced hypertension across supplement groups. However, among pregnant women aged 20-24 years, iron-containing multiple micronutrient supplementation was associated with a reduced risk of pregnancy-induced hypertension compared with folic acid supplements only. TRIAL REGISTRATION ClinicalTrials.gov NCT00133744.
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Affiliation(s)
- Sen Chen
- The Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Nan Li
- The Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zuguo Mei
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Rongwei Ye
- The Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Zhiwen Li
- The Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jianmeng Liu
- The Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Mary K Serdula
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
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Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal. J Cardiovasc Dev Dis 2018; 5:jcdd5010003. [PMID: 29367581 PMCID: PMC5872351 DOI: 10.3390/jcdd5010003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 12/13/2022] Open
Abstract
Pre-eclampsia and eclampsia are two hypertensive disorders of pregnancy, considered major causes of maternal and perinatal death worldwide. Pre-eclampsia is a multisystemic disease characterized by the development of hypertension after 20 weeks of gestation, with the presence of proteinuria or, in its absence, of signs or symptoms indicative of target organ injury. Eclampsia represents the consequence of brain injuries caused by pre-eclampsia. The correct diagnosis and classification of the disease are essential, since the therapies for the mild and severe forms of pre-eclampsia are different. Thus, this review aims to describe the most advisable antepartum pharmacotherapy for pre-eclampsia and eclampsia applied in Portugal and based on several national and international available guidelines. Slow-release nifedipine is the most recommended drug for mild pre-eclampsia, and labetalol is the drug of choice for the severe form of the disease. Magnesium sulfate is used to prevent seizures caused by eclampsia. Corticosteroids are used for fetal lung maturation. Overall, the pharmacological prevention of these diseases is limited to low-dose aspirin, so it is important to establish the safest and most effective available treatment.
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Fitton CA, Steiner MF, Aucott L, Pell JP, Mackay DF, Fleming M, McLay JS. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens 2017; 35:2123-2137. [PMID: 28661961 PMCID: PMC5625961 DOI: 10.1097/hjh.0000000000001456] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although medication is generally avoided wherever possible during pregnancy, pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of maternal and fetal morbidity and mortality. The long-term effects to the child of in-utero exposure to antihypertensive agents remains largely unknown. OBJECTIVE The aim of this study was to systematically review published studies on adverse outcomes to the child associated with in-utero exposure to antihypertensive medications. METHODS OVID, Scopus, EBSCO Collections, the Cochrane Library, and Web of Science databases were searched for relevant publications published between January 1950 and October 2016 and a total of 688 potentially eligible studies were identified. RESULTS Following review, 47 primary studies were eligible for inclusion. The Critical Appraisal Skills Programme checklist was used to assess study quality. Five studies were of excellent quality; the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth, and congenital defects following in-utero exposure to all antihypertensive agents were identified. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. CONCLUSION The current systematic review demonstrates a paucity of relevant published high-quality studies. A small number of studies suggest possible increased risk of adverse child health outcomes; however, most published studies have methodological weaknesses and/or lacked statistical power thus preventing any firm conclusions being drawn.
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Affiliation(s)
- Catherine A. Fitton
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Markus F.C. Steiner
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Lorna Aucott
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James S. McLay
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
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Nieto-Calvache AJ, Loaiza-Osorio S, Casallas-Carrillo J, Escobar-Vidarte MF. Abducens Nerve Palsy In Gestational Hypertension: A Case Report and Review of the Literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:890-893. [DOI: 10.1016/j.jogc.2017.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/27/2022]
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Kumar M, Sharma K, Singh S, Singh R, Singh A, Bhattacharjee J. Use of first-trimester placenta growth factor concentration to predict hypertensive disorders of pregnancy in a low-risk Asian population. Int J Gynaecol Obstet 2017; 139:301-306. [DOI: 10.1002/ijgo.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/23/2017] [Accepted: 08/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology; Lady Hardinge Medical College; New Delhi India
| | - Karuna Sharma
- Department of Biochemistry; Lady Hardinge Medical College; New Delhi India
| | - Shalini Singh
- Division of Reproductive Biology; Maternal and Child Health; Indian Council of Medical Research; New Delhi India
| | - Ritu Singh
- Department of Biochemistry; Lady Hardinge Medical College; New Delhi India
| | - Abha Singh
- Department of Obstetrics and Gynecology; Lady Hardinge Medical College; New Delhi India
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Ali N, Auerbach HE. New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach. J Community Hosp Intern Med Perspect 2017; 7:157-167. [PMID: 28808508 PMCID: PMC5538216 DOI: 10.1080/20009666.2017.1335156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022] Open
Abstract
Thrombocytopenia is a hematological finding commonly encountered in daily clinical practice from asymptomatic clinic patients to critically ill intensive care unit patients. A broad spectrum of etiologies and variation in clinical presentation often present a diagnostic challenge. Furthermore, concomitant presence of thrombosis and thrombocytopenia, as in cases of thrombotic thrombocytopenia, complicates the management. In hospitalized patients, new-onset thrombocytopenia is an important reason for hematology consultation. Therefore, it is of utmost importance that the etiology is diagnosed accurately. In addition, a basic understanding of the pathophysiology and the differential diagnosis avoids delay in the diagnosis and leads to rapid initiation of treatment. This review will address causes of thrombocytopenia that arises in hospitalized patients with an emphasis on the pathophysiological basis of each disorder.
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Affiliation(s)
- Naveed Ali
- Department of Internal Medicine, Abington Memorial Hospital / Abington-Jefferson Health, Abington, PA, USA
| | - Herbert E. Auerbach
- Department of Pathology, Abington Memorial Hospital / Abington-Jefferson Health, Abington, PA, USA
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Best LG, Lunday L, Webster E, Falcon GR, Beal JR. Pre-eclampsia and risk of subsequent hypertension: in an American Indian population. Hypertens Pregnancy 2017; 36:131-137. [PMID: 28001098 PMCID: PMC6097877 DOI: 10.1080/10641955.2016.1250905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/18/2016] [Accepted: 10/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Pre-eclampsia (PE) shares a number of proposed pathophysiologic mechanisms related to those implicated in cardiovascular disease (CVD), such as endothelial dysfunction, inflammation, insulin resistance, and impaired renal regulation. PE has also been associated with subsequent hypertension, CVD, and related mortality in later life. METHODS At follow-up, the four most recent blood pressures, body mass index (BMI), and use of hypertensive medications were recorded from clinic visits of 130 PE cases and 289 normal pregnancies. Student's t test, Chi-square testing, multivariate linear, and logistic regression were used in analysis. RESULTS Follow-up measurements occurred a mean of 13.11 years post PE pregnancy. Multivariate linear regression showed a significant and independent association between current systolic blood pressure and previous history of PE (β = 4.47, p = 0.04), while adjusting for age, BMI, and blood pressure from 1 year prior to and up to the 20th week of gestation. A similarly adjusted multivariate logistic regression model found an odds ratio of 3.43, 95% CI 1.83-6.43, p = 0.001 for subsequent hypertension. Logistic regression analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with subsequent hypertension. DISCUSSION AND CONCLUSIONS PE appears to confer risk of subsequent hypertension on this cohort of American Indian women within as little as 8 years. This risk is independent of additional risk factors such as increased age, BMI, and blood pressure prior to 20 weeks of gestation. There is evidence of increased risk among those with more severe PE.
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Affiliation(s)
- Lyle G Best
- a Turtle Mountain Community College , Natural Science Department , Belcourt , North Dakota , USA
| | - Laramie Lunday
- b University of North Dakota, School of Medicine , Family and Community Medicine Department , Grand Forks , North Dakota , USA
| | - Elisha Webster
- b University of North Dakota, School of Medicine , Family and Community Medicine Department , Grand Forks , North Dakota , USA
| | - Gilbert R Falcon
- b University of North Dakota, School of Medicine , Family and Community Medicine Department , Grand Forks , North Dakota , USA
| | - James R Beal
- b University of North Dakota, School of Medicine , Family and Community Medicine Department , Grand Forks , North Dakota , USA
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Gernsheimer TB. Congenital and acquired bleeding disorders in pregnancy. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:232-235. [PMID: 27913485 PMCID: PMC6142506 DOI: 10.1182/asheducation-2016.1.232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Obstetrical hematology represents challenges not only for the patient, but also for her progeny. In particular, bleeding disorders, both congenital and acquired, not only present problems both for delivery and in the immediate postpartum period, but also may have significant implications for the fetus and neonate. Women with congenital bleeding disorders or who are carriers of X-linked or autosomal disorders should be counseled prior to conception so that pregnancy can be safely undertaken with careful preparation. A treatment plan should be set up by a specialized care team that includes the hematologist, obstetrician, and anesthesiologist; the patient should be followed closely during pregnancy, through delivery, and in the immediate postpartum period. Acquired disorders of hemostasis that occur with pregnancy may present particular diagnostic difficulties and require rapid diagnosis and management.
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Affiliation(s)
- Terry B Gernsheimer
- Division of Hematology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
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Acharya A. Management of Acute Kidney Injury in Pregnancy for the Obstetrician. Obstet Gynecol Clin North Am 2016; 43:747-765. [DOI: 10.1016/j.ogc.2016.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Cetin O, Karaman E, Arslan H, Kolusarı A, Yıldızhan R, Ozgokce M, Batur A, Akbudak I. Evaluation of maternal liver elasticity by acoustic radiation force impulse elastosonography in hypertensive disorders of pregnancy: a preliminary descriptive study. J Matern Fetal Neonatal Med 2016; 30:2281-2286. [DOI: 10.1080/14767058.2016.1246526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Orkun Cetin
- Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey and
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey and
| | - Harun Arslan
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Ali Kolusarı
- Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey and
| | - Recep Yıldızhan
- Department of Obstetrics and Gynecology, Yuzuncu Yil University, Van, Turkey and
| | - Mesut Ozgokce
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Ibrahim Akbudak
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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Patel S, Korst LM, Ouzounian JG, Lee RH. Awaiting blood pressure stabilization in ambulatory pregnant women: is 5 minutes sufficient? J Matern Fetal Neonatal Med 2016; 30:1933-1937. [PMID: 27594139 DOI: 10.1080/14767058.2016.1232710] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Current recommendations for timing of blood pressure measurement in ambulatory pregnant women vary and are based on studies in the nonpregnant population. The objective of this study was to determine if there is a difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between minute-5 and minute-10. METHODS A prospective study was conducted at our prenatal care clinics. Participants had their blood pressure measured upon sitting and every 5 minutes for 15 minutes. Initial SBP and DBP were compared to measurements at each time point. Additionally, the SBP and DBP at minute-5 were compared to minute-10. All statistical tests were two-sided. RESULTS Data from 400 patients were analyzed. Of these, 34.0% were in the first, 30.7% were in the second trimester, and 35.2% were in the third trimester. In each trimester, there was a significant difference in the SBP and DBP at minute-5 compared to minute-0. At minute-10 compared to minute-5, there was no further drop for all trimesters, except for a small drop in DBP in the second trimester (-1.3 ± 6.0, p = 0.012). CONCLUSION In an ambulatory setting, 5 minutes after sitting appears to be an appropriate time point to measure blood pressure in pregnancy.
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Affiliation(s)
- Shivani Patel
- a Department of Obstetrics and Gynecology , University of Texas Southwestern Medical School , Dallas , TX , USA
| | - Lisa M Korst
- b Childbirth Research Associates, LLP , North Hollywood , CA , USA , and
| | - Joseph G Ouzounian
- c Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | - Richard H Lee
- c Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
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Karaman E, Arslan H, Çetin O, Şahin HG, Bora A, Yavuz A, Elasan S, Akbudak İ. Comparison of placental elasticity in normal and pre-eclamptic pregnant women by acoustic radiation force impulse elastosonography. J Obstet Gynaecol Res 2016; 42:1464-1470. [PMID: 27460858 DOI: 10.1111/jog.13078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/07/2016] [Indexed: 12/01/2022]
Abstract
AIM The aim of this research was to study and compare placental elasticity with acoustic radiation force impulse (ARFI) elastography in pre-eclamptic and normal pregnancies. METHODS A total of 107 singleton pregnancies in the third trimester (38 healthy control subjects, 34 patients with gestational hypertension, and 35 pre-eclampsia patients) were included in the study. ARFI elastography was used to determine the placental elasticity in the three predetermined regions of the placenta (the fetal edge, maternal edge, and central part of the placenta). The obstetrical data regarding grayscale and Doppler ultrasonography and perinatal outcomes were reviewed. A mean placental shear wave velocity cut-off value that predicts the presence of pre-eclampsia was determined. RESULTS The shear wave elasticity values in the pre-eclampsia group in all three regions were significantly higher than in the gestational hypertension and healthy control groups (P = 0.001). The most significant difference was found in the peripheral edge of the placenta from the fetal surface in the pre-eclampsia group (P = 0.001). CONCLUSION The stiffness of the placenta determined by the ARFI technique is significantly higher in pre-eclampsia patients. ARFI elastography of the placenta might be used as a non-invasive and easy method in the diagnosis and evaluation of pre-eclampsia as a supplement to the already existing methods.
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Affiliation(s)
- Erbil Karaman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey.
| | - Harun Arslan
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Orkun Çetin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Hanιm Güler Şahin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Aydin Bora
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Alparslan Yavuz
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Sadi Elasan
- Department of Biostatistics, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - İbrahim Akbudak
- Department of Radiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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Quinn AK, Ae-Ngibise KA, Jack DW, Boamah EA, Enuameh Y, Mujtaba MN, Chillrud SN, Wylie BJ, Owusu-Agyei S, Kinney PL, Asante KP. Association of Carbon Monoxide exposure with blood pressure among pregnant women in rural Ghana: Evidence from GRAPHS. Int J Hyg Environ Health 2015; 219:176-83. [PMID: 26614250 DOI: 10.1016/j.ijheh.2015.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/15/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a community-level randomized-controlled trial of cookstove interventions for pregnant women and their newborns in rural Ghana. Given that household air pollution from biomass burning may be implicated in adverse cardiovascular outcomes, we sought to determine whether exposure to carbon monoxide (CO) from woodsmoke was associated with blood pressure (BP) among 817 adult women. METHODS Multivariate linear regression models were used to evaluate the association between CO exposure, determined with 72 hour personal monitoring at study enrollment, and BP, also measured at study enrollment. At the time of these assessments, women were in the first or second trimester of pregnancy. RESULTS A significant positive association was found between CO exposure and diastolic blood pressure (DBP): on average, each 1 ppm increase in exposure to CO was associated with 0.43 mmHg higher DBP [0.01, 0.86]. A non-significant positive trend was also observed for systolic blood pressure (SBP). CONCLUSION This study is one of very few to have examined the relationship between household air pollution and blood pressure among pregnant women, who are at particular risk for hypertensive complications. The results of this cross-sectional study suggest that household air pollution from wood-burning fires is associated with higher blood pressure, particularly DBP, in pregnant women at early to mid-gestation. The clinical implications of the observed association toward the eventual development of chronic hypertension and/or hypertensive complications of pregnancy remain uncertain, as few of the women were overtly hypertensive at this point in their pregnancies.
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Affiliation(s)
- Ashlinn K Quinn
- Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | - Darby W Jack
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ellen Abrafi Boamah
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Yeetey Enuameh
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Mohammed Nuhu Mujtaba
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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Liu X, Luo Q, Zheng Y, Liu X, Hu Y, Wang F, Zou L. The role of Delta-like 4 ligand/Notch-ephrin-B2 cascade in the pathogenesis of preeclampsia by regulating functions of endothelial progenitor cell. Placenta 2015. [DOI: 10.1016/j.placenta.2015.07.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Angeli F, Angeli E, Verdecchia P. Novel Electrocardiographic Patterns for the Prediction of Hypertensive Disorders of Pregnancy--From Pathophysiology to Practical Implications. Int J Mol Sci 2015; 16:18454-73. [PMID: 26262614 PMCID: PMC4581255 DOI: 10.3390/ijms160818454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 01/09/2023] Open
Abstract
Hypertensive disorders of pregnancy are a major cause of poor outcome, including placental abruption, organ failure, cerebrovascular accident and disseminated intravascular coagulation. These disorders are associated with increased fetal risk of intrauterine growth restriction, intrauterine death and prematurity. Electrocardiography (ECG) recently emerged as a useful tool to evaluate cardiovascular complications during pregnancy. Specifically, left atrial abnormalities detected by standard ECG are associated with a fourfold increased risk of developing hypertensive disorders during pregnancy. The mechanisms linking left atrial abnormality on ECG with hypertensive disorders are still elusive. Several mechanisms, possibly reflected by abnormal left atrial activation on ECG, has been suggested. These include increased reactivity to angiotensin II and up-regulation of angiotensin type 1 receptors, with activation of autoantibodies targeting these receptors.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital "S.M. della Misericordia", Perugia 06100, Italy.
| | - Enrica Angeli
- Department of Obstetrics and Gynecology, Hospital "San Giovanni Battista", Foligno 06034, Italy.
| | - Paolo Verdecchia
- Department of Internal medicine, Hospital of Assisi, Assisi 06081, Italy.
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Zhang P, Qi YX, Yao QP, Chen XH, Wang GL, Shen BR, Han Y, Gao LZ, Jiang ZL. Neuropeptide Y Stimulates Proliferation and Migration of Vascular Smooth Muscle Cells from Pregnancy Hypertensive Rats via Y1 and Y5 Receptors. PLoS One 2015; 10:e0131124. [PMID: 26131716 PMCID: PMC4488588 DOI: 10.1371/journal.pone.0131124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/27/2015] [Indexed: 12/20/2022] Open
Abstract
The increased proliferation and migration of vascular smooth muscle cells (VSMCs) play important roles in pathophysiological remodeling of arteries during hypertension in pregnancy. However, the mechanisms involved in this process remain unclear. We hypothesized that Neuropeptide Y (NPY), which is a potent mitogenic peptide, participates in modulating proliferation and migration of VSMCs during hypertension in pregnancy. Using pregnant hypertensive rats, induced by intraperitoneal injection of L-nitro-arginine methylester (L-NAME), the plasma concentration of NPY was detected. Open angle, which reflects the non-uniform remodeling with high sensitivity, was used to detect the pathophysiological vascular remodeling in vivo. The results revealed that NPY concentration and artery open angle were both significantly increased in rats with hypertension in pregnant. The underlying mechanism of elevated NPY on vascular remodeling were further analyzed by using cultured VSMCs in vitro. In cultured VSMCs, NPY most effectively stimulated the migration and proliferation of VSMCs at 10-6 mol/L, similar to the plasma concentration in L-NAME hypertension in pregnant rats. NPY up-regulated the expressions of both Y1 and Y5 receptors, increased the phosphorylations of STAT3 on Tyr705 and Ser727 residues, and induced the expression of c-Fos. The NPY-induced VSMCs proliferation was reduced by Y5 receptor antagonist, and fully blocked by combinations with other antagonist, such as Y2+Y5, Y1+Y5, and Y1+Y2+Y5. In contrast, the NPY-induced VSMC migration was blocked by either Y receptor antagonist or any combination of Y receptor antagonists. These results suggest that the elevated plasma concentration of NPY during hypertension in pregnancy may induce VSMC proliferation mainly via Y5 receptor, which subsequently modulate STAT3 and c-Fos signaling pathways to result in the vascular remodeling. These results also suggest that NPY mainly acts on VSMCs in vitro via Y1, Y5 receptors and in vascular tissues in vivo via Y5 receptor.
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MESH Headings
- Animals
- Cell Movement
- Cell Proliferation
- Cells, Cultured
- Female
- Hypertension, Pregnancy-Induced/metabolism
- Hypertension, Pregnancy-Induced/pathology
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/physiology
- Neuropeptide Y/pharmacology
- Pregnancy
- Purinergic P2Y Receptor Antagonists/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, Neuropeptide Y/antagonists & inhibitors
- Receptors, Neuropeptide Y/genetics
- Receptors, Neuropeptide Y/metabolism
- Receptors, Purinergic P2Y1/genetics
- Receptors, Purinergic P2Y1/metabolism
- Vascular Remodeling
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Affiliation(s)
- Ping Zhang
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Xin Qi
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Qing-Ping Yao
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Hu Chen
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Liang Wang
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Bao-Rong Shen
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Han
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Zhi Gao
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
| | - Zong-Lai Jiang
- Institute of Mechanobiology and Biomedical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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Wang L, Yang T, Ding Y, Zhong Y, Yu L, Peng M. Chemerin plays a protective role by regulating human umbilical vein endothelial cell-induced nitric oxide signaling in preeclampsia. Endocrine 2015; 48:299-308. [PMID: 24840719 DOI: 10.1007/s12020-014-0286-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/03/2014] [Indexed: 12/30/2022]
Abstract
The aim of this study was to determine chemerin levels in preeclampsia and to assess the effects of this anti-inflammatory factor on endothelial nitric oxide synthase (eNOS), nuclear factor (NF)-κB, and vascular cell adhesion molecule (VCAM) expression in human umbilical vein endothelial cells (HUVECs). Serum chemerin and eNOS levels were measured by enzyme-linked immunosorbent assays, while chemerin mRNA and protein levels were measured by fluorescent quantitative polymerase chain reaction and Western blotting, respectively. Nitric oxide (NO) concentrations were determined with a colorimetric method. Akt and eNOS phosphorylation were assessed by Western blotting. We also tested the effects of the phosphoinositide 3-kinase inhibitor LY294002 and the eNOS inhibitor L-NAME. NF-κB p65 and VCAM-1 phosphorylation were assessed by Western blotting to investigate the role of chemerin in tumor necrosis factor (TNF)-α-induced HUVEC injury. Serum chemerin levels were increased in preeclampsia, while eNOS was decreased. Chemerin mRNA and protein were both increased in placentae from patients with preeclampsia. Furthermore, chemerin serum level positively correlated with blood pressure, body mass index, and serum insulin and was negatively correlated with serum eNOS. Chemerin dose-dependently increased NO concentrations in supernatants. Chemerin can increase eNOS and Akt levels in HUVECs, and these results could be partly blocked by LY294002 and L-NAME. Chemerin significantly decreased TNF-α-induced NF-κB and VCAM-1 in HUVECs, and these changes were partly inhibited by LY294002 and L-NAME. Chemerin may play a protective role by regulating NO signaling. Future studies should assess the role of chemerin in preeclampsia and other vascular diseases.
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Affiliation(s)
- Liqiong Wang
- Department of Gynaecology and Obstetrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
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Bahr BL, Price MD, Merrill D, Mejia C, Call L, Bearss D, Arroyo J. Different expression of placental pyruvate kinase in normal, preeclamptic and intrauterine growth restriction pregnancies. Placenta 2014; 35:883-90. [PMID: 25260566 DOI: 10.1016/j.placenta.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Preeclampsia (PE) and intrauterine growth restriction (IUGR) are two diseases that affect pregnant women and their unborn children. These diseases cause low birth weight, pre-term delivery, and neurological and cardiovascular disorders in babies. Combined they account for 20% of preterm deliveries. Pyruvate kinase M2 (PKM2) is a metabolism enzyme found in developing embryonic and cancer tissues. Our objective is to determine the expression of PKM2 in human PE and IUGR compared to normal pregnancies. Understanding expression of PKM2 in PE and IUGR could help us to better understand the mechanisms and find treatments for PE and IUGR. METHODS Human placental tissues were obtained for PKM2 determination and analyzed by immunohistochemistry, Western blot, and a pyruvate assay. Placental samples were homogenized and cytoplasmic and nuclear proteins were extracted for Western blot analysis. RESULTS Preeclampsia samples had elevated levels of p-PKM2, p-ERK, and ERK in the cytoplasm. Beta-catenin and lactose dehydrogenase (LDH) were also elevated in preeclampsia placenta samples. DISCUSSION AND CONCLUSION We conclude that PKM2 is expressed in normal, PE and IUGR pregnancies. Also, that this expression is increased in the PE placenta at delivery. These results suggest placental metabolism through PKM2 could play a role in human preeclampsia.
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Affiliation(s)
- B L Bahr
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - M D Price
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - D Merrill
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - C Mejia
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - L Call
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - D Bearss
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA
| | - J Arroyo
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, UT, USA.
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Pregnancy outcomes of expectant management of stable mild to moderate chronic hypertension as compared with planned delivery. Int J Gynaecol Obstet 2014; 127:15-20. [PMID: 24957533 DOI: 10.1016/j.ijgo.2014.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/22/2014] [Accepted: 05/28/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension. METHODS In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41 weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ(2) test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined. RESULTS There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery (P=0.001) and birth weight (P=0.01), but lower cesarean (OR 3.4; 95% CI, 1.2-10.3; P=0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4-21.0; P=0.01) rates. More women with SPE were diagnosed before than after 37 weeks in group B (P=0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not. CONCLUSION Mild to moderate chronic hypertension could be managed expectantly up to 41 weeks if SPE did not develop.
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Affiliation(s)
- Ellen W Seely
- Endocrinology, Diabetes, and Hypertension Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.W.S.); and Maternal Fetal Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.E.)
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Scantlebury DC, Schwartz GL, Acquah LA, White WM, Moser M, Garovic VD. The treatment of hypertension during pregnancy: when should blood pressure medications be started? Curr Cardiol Rep 2014; 15:412. [PMID: 24057769 DOI: 10.1007/s11886-013-0412-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hypertensive pregnancy disorders (HPD) are important causes of maternal and fetal morbidity and mortality worldwide. In addition, a history of HPD has been associated with an increased risk for maternal cardiovascular disease later in life, possibly because of irreversible vascular and metabolic changes that persist beyond the affected pregnancies. Therefore, treatment of HPD may not only improve immediate pregnancy outcomes, but also maternal long-term cardiovascular health. Unlike the recommendations for hypertension treatment in the general population, treatment recommendations for HPD have not changed substantially for more than 2 decades. This is particularly true for mild to moderate hypertension in pregnancy, defined as a blood pressure of 140-159/90-109 mm Hg. This review focuses on the goals of therapy, treatment strategies, and new developments in the field of HPD that should be taken into account when considering blood pressure targets and pharmacologic options for treatment of hypertension in pregnant women.
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Risk of Adverse Pregnancy Outcomes in Women With Mild Chronic Hypertension Before 20 Weeks of Gestation. Obstet Gynecol 2014; 123:966-972. [DOI: 10.1097/aog.0000000000000205] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Inflammatory markers in the second trimester prior to clinical onset of preeclampsia, intrauterine growth restriction, and spontaneous preterm birth. Inflammation 2014; 36:907-13. [PMID: 23471783 DOI: 10.1007/s10753-013-9619-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Low-grade inflammation has been associated with pregnancy complications including preeclampsia (PE), intrauterine growth restriction (IUGR), and spontaneous preterm birth (SPB). In an unmatched, nested case-control study, we assessed the possible predictive association of maternal C-reactive protein (CRP), interferon-γ-inducible protein 10 (IP-10), and soluble urokinase plasminogen activator receptor (suPAR) in second trimester plasma samples in relation to later development of PE (n = 29), IUGR (n = 53), and SPB (n = 9). Inflammatory marker levels in these groups were compared to normotensive healthy pregnant controls (n = 127). We found no statistically significant difference in CRP, IP-10, or suPAR in second trimester plasma samples from pregnant women with later PE, IUGR, and SPB when compared to normotensive healthy controls. Second trimester plasma samples of CRP, IP-10, and suPAR cannot be used as a prognostic marker for PE, IUGR, and SPB.
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 613] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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Wu CC, Chen SH, Ho CH, Liang FW, Chu CC, Wang HY, Lu YH. End-stage renal disease after hypertensive disorders in pregnancy. Am J Obstet Gynecol 2014; 210:147.e1-8. [PMID: 24060448 DOI: 10.1016/j.ajog.2013.09.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/16/2013] [Accepted: 09/18/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the long-term postpartum risk of end-stage renal disease in women with hypertensive disorders in pregnancy. Although most women with hypertensive disorders in pregnancy recover after delivery, some may experience acute renal failure. STUDY DESIGN We searched Taiwan's National Health Insurance Research Database to identify women with hypertensive disorders in pregnancies and deliveries between 1998 and 2002. All cases were followed for a maximum of 11 years (median, 9 years; interquartile range, 7.79-10.02 years) to estimate the incidence of end-stage renal disease; Cox regression analysis that was adjusted for potential confounding was used to determine the relative risk. RESULTS Of the 13,633 women with hypertensive disorders in pregnancy, 46 experienced end-stage renal disease. Women with hypertensive disorders in pregnancy had a risk of end-stage renal disease that was 10.64 times greater than did women without them (95% confidence interval [CI], 7.53-15.05). The risk was highest in women with a history of preeclampsia superimposed on chronic hypertension (hazard ratio, 44.72; 95% CI, 22.59-88.51). Women with gestational hypertension had a higher risk of end-stage renal disease than did women without hypertensive disorders in pregnancy (hazard ratio, 5.82; 95% CI, 2.15-15.77). CONCLUSION Women with hypertensive disorders in pregnancy have a higher risk of postpartum end-stage renal disease, regardless of which type of hypertensive disorder they have. Women with a history of hypertensive disorders in pregnancy are encouraged to have regular postpartum checkups, especially of renal function.
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Maternal serum CA-125 level is elevated in severe preeclampsia. Pregnancy Hypertens 2014; 4:29-33. [PMID: 26104251 DOI: 10.1016/j.preghy.2013.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/09/2013] [Accepted: 08/26/2013] [Indexed: 11/21/2022]
Abstract
AIM The aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity. METHODS We evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n=34) and those with mild pre-eclampsia (n=24). Females with healthy pregnancies (n=31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index. RESULTS The CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p<0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r=0.489, p=0.000), systolic blood pressure (r=0.503, p=0.018), and diastolic blood pressure (r=0.532, p=0.000). In contrast, CA-125 was negatively correlated with birth weight (r=0.266, p=0.012) and gestational age at birth (r=0.250, p=0.018). CONCLUSIONS CA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.
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Microcirculation Approach in HELLP Syndrome Complicated by Posterior Reversible Encephalopathy Syndrome and Massive Hepatic Infarction. Case Rep Emerg Med 2014; 2014:389680. [PMID: 25485160 PMCID: PMC4251630 DOI: 10.1155/2014/389680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/02/2014] [Indexed: 11/17/2022] Open
Abstract
HELLP syndrome is a complication of severe forms of preeclampsia and occurs mainly in the third trimester of pregnancy. In extreme cases, it may evolve unfavorably and substantially increase maternal mortality. We present the case of an 18-year-old pregnant woman who was admitted to our emergency service in her 31st week, presenting with headache, visual disturbances, and epigastralgia, with progression to a severe condition of HELLP syndrome followed by posterior reversible encephalopathy syndrome (PRES) and hepatic infarction. We highlight the approach taken towards this patient and the case management, in which, in addition to the imaging examinations routinely available, we also used the sidestream dark field (SDF) technique to evaluate the systemic microcirculation.
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[How to manage a patient with chronic arterial hypertension during pregnancy and the postpartum period]. Rev Med Interne 2013; 36:191-7. [PMID: 24075628 DOI: 10.1016/j.revmed.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
Abstract
The management of chronic arterial hypertension during pregnancy and postpartum requires first to estimate the risk of the pregnancy, linked with the severity of hypertension, with cardiac and renal involvement, with its cause as well as with the background (obesity, diabetes, possible history of placental vascular pathology). On a very practical approach, antihypertensive drug has to be started or increased if systolic pressure reaches or exceeds 160 mmHg or if diastolic pressure reaches or exceeds 105 mmHg. Below this level, there are no evidence-based medicine data, but it seems reasonable to treat if pressure increases over 150/100 mmHg (140/90 mmHg in case of ambulatory monitoring). Excessive pressure figures control must be avoided as much as insufficient ones: in practice, it is necessary to decrease the treatment dose if figures are below 130/80 mmHg. Three antihypertensive drugs are consensually recommended today: alphametyldopa, calcium-channel blockers and labetalol. Monotherapy is most often sufficient; if needed, two of these drugs can easily be associated, and even three if necessary. Converting enzyme inhibitors and angiotensin receptor II antagonists should not be prescribed to pregnant women. Betablockers and diuretics are not recommended. Whatever is the antihypertensive drug used, it is necessary to detect the signs of bad placenta blood circulation with uterine Doppler ultrasound and regular controls of fetal growth, and to check for appearance of proteinuria, defining then over-imposed pre-eclampsia needing immediate admission to the maternity. After delivery, lacatation suppresion with bromocriptin should not be prescribed.
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Gordin D, Kaaja R, Forsblom C, Hiilesmaa V, Teramo K, Groop PH. Pre-eclampsia and pregnancy-induced hypertension are associated with severe diabetic retinopathy in type 1 diabetes later in life. Acta Diabetol 2013; 50:781-7. [PMID: 22955518 DOI: 10.1007/s00592-012-0415-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/28/2012] [Indexed: 12/21/2022]
Abstract
To investigate whether pre-eclampsia (PE) or pregnancy-induced hypertension (PIH) predicts the development of severe diabetic retinopathy (SDR) in type 1 diabetes. Altogether, 203 women with type 1 diabetes who were followed during pregnancy were re-examined within the Finnish Diabetic Nephropathy Study. After excluding patients with pre-pregnancy hypertension and those who had had laser treatment or whose retinopathy was graded as proliferative at the index pregnancy, 158 were prospectively studied. As a surrogate marker for SDR, retinal laser photocoagulation was used. The time from pregnancy to SDR (N = 21) or follow-up was 16 years (interquartile range, 11-19). HbA1c was repeatedly measured both during pregnancy and follow-up. Women with prior PE (26 % vs. 6 %, P = 0.003) or PIH (24 % vs. 6 %, P = 0.008) had more often incident SDR during follow-up compared to those with normotensive pregnancy. The hazard ratios (HR) remained associated with the progression to SDR after adjustment for duration of diabetes and diabetic nephropathy in a Cox regression analysis [PE: 3.5 (95 % CI 1.1-10.9); P = 0.03 and for PIH: 3.2 (1.1-9.8); P = 0.04]. The association between PIH and incident SDR did not change after inclusion of mean HbA1c, measured during pregnancy (all 3 trimesters) and serial HbA1c measurements during follow-up, 3.5 (1.1-11.8; P = 0.03). However, in a similar model, the HR for PE was no more significant 2.0 (0.6-6.8; P = NS). The results suggest that women with type 1 diabetes and a hypertensive pregnancy have an increased risk of severe diabetic retinopathy later in life.
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Affiliation(s)
- Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland,
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Josephson MA, McKay DB. Women and transplantation: fertility, sexuality, pregnancy, contraception. Adv Chronic Kidney Dis 2013; 20:433-40. [PMID: 23978550 DOI: 10.1053/j.ackd.2013.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 01/23/2023]
Abstract
Since 1958, thousands of women with kidney transplants have become pregnant. Although most pregnancies in kidney transplant recipients are successful, they are high-risk endeavors. This seems more a function of the associated issues and comorbidities that often affect individuals with kidney transplants (eg, hypertension) or immunosuppression side effects rather than the kidney transplant per se. Regardless of the underlying pathophysiology, these pregnancies are associated with a high rate of preeclampsia diagnoses, preterm deliveries, Cesarean sections, and small-for-gestational-age babies. Given these risks, it is critical to counsel and inform transplant recipients and prospective transplant recipients of childbearing age and their partners regarding many aspects of pregnancy, including the need for contraception to prevent pregnancy after transplant, immunosuppression concerns, and the potential effect of pregnancy on the outcome of the mother, baby, and kidney transplant.
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Chaiworapongsa T, Romero R, Korzeniewski SJ, Cortez JM, Pappas A, Tarca AL, Chaemsaithong P, Dong Z, Yeo L, Hassan SS. Plasma concentrations of angiogenic/anti-angiogenic factors have prognostic value in women presenting with suspected preeclampsia to the obstetrical triage area: a prospective study. J Matern Fetal Neonatal Med 2013; 27:132-44. [PMID: 23687930 DOI: 10.3109/14767058.2013.806905] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To prospectively determine the prognostic value of maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng) and soluble vascular endothelial growth factor receptors-1 and -2 (sVEGFR-1 and -2) in identifying patients with suspected preeclampsia (PE), who require preterm delivery (PTD) or develop adverse outcomes. STUDY DESIGN This prospective cohort study included 85 consecutive patients who presented to the obstetrical triage area at 20-36 weeks with a diagnosis of "rule out PE." Patients were classified as: 1) those who remained stable until term (n = 37); and 2) those who developed severe PE and required PTD (n = 48). Plasma concentrations of PlGF, sEng and sVEGFR-1 and -2 were determined by ELISA. RESULTS Patients with PlGF/sVEGFR-1 ≤0.05 multiples of the median (MoM) or PlGF/sEng ≤0.07 MoM were more likely to deliver preterm due to PE [adjusted odd ratio (aOR) 7.4 and 8.8], and to develop maternal (aOR 3.7 and 2.4) or neonatal complications (aOR 10.0 and 10.1). Among patients who presented <34 weeks of gestation, PlGF/sVEGFR-1 ≤ 0.035 MoM or PlGF/sEng ≤0.05 MoM had a sensitivity of 89% (16/18), specificity of 96% (24/25) and likelihood ratio for a positive test of 22 to identify patients who delivered within 2 weeks. The addition of the PlGF/sVEGFR-1 ratio to standard clinical tests improved the sensitivity at a fixed false-positive rate of 3% (p = 0.004) for the identification of patients who were delivered due to PE within 2 weeks. Among patients who had a plasma concentration of PlGF/sVEGFR-1 ratio ≤0.035 MoM, 0.036-0.34 MoM and ≥0.35 MoM, the rates of PTD <34 weeks were 94%, 27% and 7%, respectively. CONCLUSIONS The determination of angiogenic/anti-angiogenic factors has prognostic value in patients presenting to the obstetrical triage area with suspected PE for the identification of those requiring preterm delivery and at risk for adverse maternal/neonatal outcomes.
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