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Eghan P, Folson AA, Donkor A, Kokuro C, Amo Wiafe Y. Relationship between hypertensive disorders of pregnancy (HDP) and cardiac remodeling during pregnancy: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 298:108-115. [PMID: 38749071 DOI: 10.1016/j.ejogrb.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal morbidity and mortality. The primary objective of this study was to ascertain whether maternal cardiac remodeling is more prevalent in HDP than normotensive pregnancy and if significant change in aortic root size is involved. The secondary objective was to determine the types of cardiac remodeling often associated with HDP. METHODS A systematic search was conducted across four electronic databases, including Medline, PubMed, Cochrane and EMBASE. The reference lists of selected articles were also searched to ensure no relevant studies were missed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed in this systematic review. RESULTS Out of 5,278 articles identified by the search terms, 9 were eligible for inclusion in the meta-analysis. The investigation unveiled a greater prevalence of maternal cardiac remodeling in HDP than normotensive pregnancies. The commonest type of maternal cardiac remodeling in both HDP and normotensive pregnancies was eccentric left ventricular hypertrophy, followed by concentric left ventricular remodeling which was more specific to HDP. Notably, left atrial diameter was significantly increased in HDP than normotensive pregnancies, suggesting higher prevalence of diastolic dysfunction. Additionally, the aortic root dimension was significantly increased in HDP than normotensive pregnancies. CONCLUSION This study underscores the importance of monitoring cardiac health in pregnancy, particularly in those with hypertensive disorders, in order to mitigate potential complications and improve maternal outcomes. Finally, the risk of aortic dissection that may occur as a long-term effect of aortic root enlargement in women with history of HDP ought to be investigated in future studies.
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Affiliation(s)
- Philip Eghan
- Department of Radiology, University of Ghana Medical Centre, Accra, Ghana; Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aba A Folson
- Department of Internal Medicine and Therapeutics, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Andrew Donkor
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi Ghana
| | - Yaw Amo Wiafe
- Department of Medical Imaging, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Krishnamurthy G, Nguyen PT, Tran BN, Phan HT, Brennecke SP, Moses EK, Melton PE. Genomic variation associated with cardiovascular disease progression following preeclampsia: a systematic review. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1221222. [PMID: 38455895 PMCID: PMC10911037 DOI: 10.3389/fepid.2023.1221222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 03/09/2024]
Abstract
Background Women with a history of preeclampsia (PE) have been shown to have up to five times the risk of developing later-life cardiovascular disease (CVD). While PE and CVD are known to share clinical and molecular characteristics, there are limited studies investigating their shared genomics (genetics, epigenetics or transcriptomics) variation over time. Therefore, we sought to systematically review the literature to identify longitudinal studies focused on the genomic progression to CVD following PE. Methods A literature search of primary sources through PubMed, Scopus, Web of Science and Embase via OVID was performed. Studies published from January 1, 1980, to July 28, 2023, that investigated genomics in PE and CVD were eligible for inclusion. Included studies were screened based on Cochrane systematic review guidelines in conjunction with the PRISMA 2020 checklist. Eligible articles were further assessed for quality using the Newcastle-Ottawa scale. Results A total of 9,231 articles were screened, with 14 studies subjected to quality assessment. Following further evaluation, six studies were included for the final review. All six of these studies were heterogeneous in regard to CVD/risk factor as outcome, gene mapping approach, and in different targeted genes. The associated genes were RGS2, LPA, and AQP3, alongside microRNAs miR-122-5p, miR-126-3p, miR-146a-5p, and miR-206. Additionally, 12 differentially methylated regions potentially linked to later-life CVD following PE were identified. The only common variable across all six studies was the use of a case-control study design. Conclusions Our results provide critical insight into the heterogeneous nature of genomic studies investigating CVD following PE and highlight the urgent need for longitudinal studies to further investigate the genetic variation underlying the progression to CVD following PE.
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Affiliation(s)
- Gayathry Krishnamurthy
- Menzies Institute for Medical Research, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
| | - Phuong Tram Nguyen
- Menzies Institute for Medical Research, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
| | - Bao Ngoc Tran
- Wicking Dementia Research and Education Center, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
| | - Hoang T. Phan
- Menzies Institute for Medical Research, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
| | - Shaun P. Brennecke
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women’s Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric K. Moses
- Menzies Institute for Medical Research, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
| | - Phillip E. Melton
- Menzies Institute for Medical Research, College of Health and Medicine, The University of Tasmania, Hobart, TAS, Australia
- School of Global and Population Health, The University of Western Australia, Crawley, WA, Australia
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Latt SM, Alderdice F, Elkington M, Awng Shar M, Kurinczuk JJ, Rowe R. Primary postpartum haemorrhage and longer-term physical, psychological, and psychosocial health outcomes for women and their partners in high income countries: A mixed-methods systematic review. PLoS One 2023; 18:e0274041. [PMID: 37315027 PMCID: PMC10266652 DOI: 10.1371/journal.pone.0274041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Most research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings. METHODS The review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH. RESULTS Data were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH. CONCLUSION This review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth. PROSPERO REGISTRATION PROSPERO registration number: CRD42020161144.
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Affiliation(s)
- Su Mon Latt
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Madeline Elkington
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mahkawnghta Awng Shar
- Health and Nutrition Specialist, United Nations International Children Fund, Myanmar
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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4
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Haßdenteufel K, Müller M, Gutsfeld R, Goetz M, Bauer A, Wallwiener M, Brucker SY, Joos S, Colombo MG, Hawighorst-Knapstein S, Chaudhuri A, Kirtschig G, Saalmann F, Wallwiener S. Long-term effects of preeclampsia on maternal cardiovascular health and postpartum utilization of primary care: an observational claims data study. Arch Gynecol Obstet 2023; 307:275-284. [PMID: 35482068 PMCID: PMC9836976 DOI: 10.1007/s00404-022-06561-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Preeclampsia occurs in up to 15% of pregnancies and constitutes a major risk factor for cardiovascular disease. This observational cohort study aimed to examine the association between preeclamptic pregnancies and cardiovascular outcomes as well as primary and specialized care utilization after delivery. METHODS Using statutory claims data we identified women with singleton live births between 2010 and 2017. Main outcomes included the occurrence of either hypertension or cardiovascular disease after one or more preeclamptic pregnancies, number of contacts to a general practitioner or cardiologist after delivery and prescribed antihypertensive medication. Data were analyzed using Cox proportional hazard regression models adjusted for maternal age, diabetes, dyslipidemia, and obesity. RESULTS The study cohort consisted of 181,574 women with 240,698 births. Women who experienced preeclampsia once had an increased risk for cardiovascular (hazard ratio, HR = 1.29) or hypertensive (HR = 4.13) events. In women affected by recurrent preeclampsia, risks were even higher to develop cardiovascular disease (HR = 1.53) or hypertension (HR = 6.01). In the following years after delivery, general practitioners were seen frequently, whereas cardiologists were consulted rarely (0.3 and 2.4%). CONCLUSION Women affected by preeclampsia experience an increased risk of developing chronic hypertension and cardiovascular disease, especially those with recurrent preeclampsia. Future medical guidelines should take this potential risk into account.
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Affiliation(s)
- Kathrin Haßdenteufel
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Raphael Gutsfeld
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Maren Goetz
- Department of General Pediatrics, University Children’s Hospital, Heidelberg, Germany
| | - Armin Bauer
- Department of Women’s Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Sara Y. Brucker
- Department of Women’s Health, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Tuebingen, Germany
| | - Miriam Giovanna Colombo
- Institute for General Practice and Interprofessional Healthcare, Eberhardt-Karls-University, Tuebingen, Germany
| | | | - Ariane Chaudhuri
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Gudula Kirtschig
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Frauke Saalmann
- Department of Health Promotion, AOK Baden-Wuerttemberg, Stuttgart, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
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Burger RJ, Delagrange H, van Valkengoed IGM, de Groot CJM, van den Born BJH, Gordijn SJ, Ganzevoort W. Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review. Front Cardiovasc Med 2022; 9:933822. [PMID: 35837605 PMCID: PMC9273843 DOI: 10.3389/fcvm.2022.933822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Pregnancy is often considered to be a "cardiometabolic stress-test" and pregnancy complications including hypertensive disorders of pregnancy can be the first indicator of increased risk of future cardiovascular disease. Over the last two decades, more evidence on the association between hypertensive disorders of pregnancy and cardiovascular disease has become available. However, despite the importance of addressing existing racial and ethnic differences in the incidence of cardiovascular disease, most research on the role of hypertensive disorders of pregnancy is conducted in white majority populations. The fragmented knowledge prohibits evidence-based targeted prevention and intervention strategies in multi-ethnic populations and maintains the gap in health outcomes. In this review, we present an overview of the evidence on racial and ethnic differences in the occurrence of hypertensive disorders of pregnancy, as well as evidence on the association of hypertensive disorders of pregnancy with cardiovascular risk factors and cardiovascular disease across different non-White populations, aiming to advance equity in medicine.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
| | - Hannelore Delagrange
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
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Noninvasive Cardiac Imaging in Formerly Preeclamptic Women for Early Detection of Subclinical Myocardial Abnormalities: A 2022 Update. Biomolecules 2022; 12:biom12030415. [PMID: 35327607 PMCID: PMC8946283 DOI: 10.3390/biom12030415] [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: 02/01/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Preeclampsia is a maternal hypertensive disease, complicating 2–8% of all pregnancies. It has been linked to a 2–7-fold increased risk for the development of cardiovascular disease, including heart failure, later in life. A total of 40% of formerly preeclamptic women develop preclinical heart failure, which may further deteriorate into clinical heart failure. Noninvasive cardiac imaging could assist in the early detection of myocardial abnormalities, especially in the preclinical stage, when these changes are likely to be reversible. Moreover, imaging studies can improve our insights into the relationship between preeclampsia and heart failure and can be used for monitoring. Cardiac ultrasound is used to assess quantitative changes, including the left ventricular cavity volume and wall thickness, myocardial mass, systolic and diastolic function, and strain. Cardiac magnetic resonance imaging may be of additional diagnostic value to assess diffuse and focal fibrosis and perfusion. After preeclampsia, sustained elevated myocardial mass along with reduced myocardial circumferential and longitudinal strain and decreased diastolic function is reported. These findings are consistent with the early phases of heart failure, referred to as preclinical (asymptomatic) or B-stage heart failure. In this review, we will provide an up-to-date overview of the potential of cardiac magnetic resonance imaging and echocardiography in identifying formerly preeclamptic women who are at high risk for developing heart failure. The potential contribution to early cardiac screening of women with a history of preeclampsia and the pros and cons of these imaging modalities are outlined. Finally, recommendations for future research are presented.
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7
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Ebogo-Belobo JT, Bilongo CM, Voufo RA, Atembeh-Noura E, Djabidatou O, Kenfack MT, Ateba TP, Enoka P. Maternal serum lipids in some women with pre-eclampsia in Yaoundé. Pan Afr Med J 2021; 39:14. [PMID: 34394805 PMCID: PMC8348250 DOI: 10.11604/pamj.2021.39.14.22734] [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: 04/09/2020] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
Preeclampsia is one of the most common complications of pregnancy and occurs in approximately 3-8% of all pregnancies worldwide. Although the aetiology of preeclampsia still largely remains unclear, it is thought to be related to endothelial dysfunction and can lead to serum lipid abnormalities. Therefore, this case-control study was conceived and designed with the aim to compare maternal lipid profile parameters and cardiovascular risk factors, between preeclamptic and healthy pregnancies. Blood samples were collected after overnight fasting from 48 preeclamptics and 96 healthy pregnant controls matched for age and gestational weeks and serum lipid profile concentrations were estimated and used them to calculate cardiac risk ratio I and II. There was a significant rise in serum lipid levels in pregnancies complicated by preeclampsia. These lipids turn out to be risk factor for cardiovascular diseases. Positive correlation of maternal serum lipids to high blood pressure suggests a causal relationship.
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Affiliation(s)
| | | | - Roger Ahouga Voufo
- Institute of Medical Research and Medicinal Plant Study, Yaoundé, Cameroon
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8
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Guittet M, Lamirault G, Connault J, Durant C, Hamidou M, Wargny M, Le Bras M, Winer N, Artifoni M. [Evaluation of a woman's care program after pre-eclampsia]. Rev Med Interne 2021; 42:154-161. [PMID: 33485699 DOI: 10.1016/j.revmed.2020.12.004] [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: 01/04/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. METHODS The study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. RESULTS The study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p=0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p=0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p=0.035). CONCLUSION The study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women.
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Affiliation(s)
- M Guittet
- CHU Nantes, Médecine interne Nantes, France.
| | - G Lamirault
- Université de Nantes, CHU Nantes, CNRS, Inserm, l'institut du thorax, 44000 Nantes, France.
| | - J Connault
- CHU Nantes, Médecine interne Nantes, France.
| | - C Durant
- CHU Nantes, Médecine interne Nantes, France.
| | - M Hamidou
- CHU Nantes, Médecine interne Nantes, France.
| | - M Wargny
- CHU Nantes, Santé publique Nantes, France.
| | - M Le Bras
- CHU Nantes, Endocrinologie Nantes, France
| | - N Winer
- CHU Nantes, Gynéco-obstetricologie Nantes, France.
| | - M Artifoni
- CHU Nantes, Médecine interne Nantes, France.
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9
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O’Kelly AC, Lau ES. Sex Differences in HFpEF. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Faubion SS, King A, Kattah AG, Kuhle CL, Sood R, Kling JM, Mara KC, Kapoor E. Hypertensive disorders of pregnancy and menopausal symptoms: a cross-sectional study from the data registry on experiences of aging, menopause, and sexuality. Menopause 2020; 28:25-31. [PMID: 32810078 PMCID: PMC7769885 DOI: 10.1097/gme.0000000000001638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy and menopausal symptoms, specifically vasomotor symptoms, have both been associated with cardiovascular disease risk in women. However, data are sparse on the association between these two female-specific cardiovascular risk factors. This study was conducted to investigate the association between a history of a hypertensive disorder of pregnancy and menopausal symptoms. METHODS This was a cross-sectional study of women aged 40 to 65 years seen for specialty consultation in women's health clinics at Mayo Clinic Rochester, MN and Scottsdale, AZ, between May, 2015 and September, 2019. A self-reported history of hypertensive disorders of pregnancy served as the independent variable, and menopause symptoms as assessed by the Menopause Rating Scale were the primary outcome measure. RESULTS Of 2,684 women included in the analysis, 180 had a self-reported history of a hypertensive disorder of pregnancy. The total menopausal symptom scores as well as somatic and psychological domain scores were higher in women with a history of a hypertensive disorder of pregnancy compared to women without a history of a hypertensive disorder of pregnancy or to women without a pregnancy. On multivariable analysis, women with a hypertensive disorder of pregnancy using hormone therapy had significantly higher total menopause symptom scores than women with no such history. CONCLUSIONS In this large cross-sectional study, a history of hypertensive disorders of pregnancy was associated with more bothersome menopausal symptoms. Additional study is needed to determine the strength of this association, underlying mechanisms of the association, and clinical implications for cardiovascular risk prediction in women.
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Affiliation(s)
- Stephanie S. Faubion
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Amanda King
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Andrea G. Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Carol L. Kuhle
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Richa Sood
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Juliana M. Kling
- Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
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11
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Association between low fetal fraction of cell free DNA at the early second-trimester and adverse pregnancy outcomes. Pregnancy Hypertens 2020; 22:101-108. [PMID: 32777709 DOI: 10.1016/j.preghy.2020.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The purpose of this study was to examine whether low fetal fraction (FF) of cell free DNA is associated with risks of adverse pregnancy outcomes. METHODS This was a historical cohort study of 2191 women with singleton pregnancies who had non-invasive prenatal test (NIPT) at 13 to 26 weeks of gestation. Data were collected from prenatal screening system and hospital records. Main outcome was the subsequent diagnosis of gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), preeclampsia (PE), pregnancy induced hypertension (PIH) and preterm birth (PTB). Logistic regression analysis was performed to evaluate the association between LFF and adverse pregnancy outcomes. RESULTS The prevalence of GDM, ICP, PE, PIH and PTB was 23.87% (523), 4.02% (88), 2.92% (64), 2.83% (62) and 6.85% (150), respectively. Low FF, defined as less than the 10th percentile, was associated with an increased risk of PE (adjusted OR = 2.06, 95% CI: 1.07-3.98) and early PTB (<34 weeks' gestation: adjusted OR = 3.09, 95% CI: 1.21-7.92). In addition, low FF, defined as less than the 5th percentile, was associated with an increased risk of low birth weight babies (<2500 g: adjusted OR = 2.50, 95% CI: 1.01-6.17). However, there was no significant association between low FF and GDM, as well as ICP and PIH. CONCLUSION Our study provides evidence that low FF is associated with PE and early PTB. Further exploration of the clinical significance of low FF is warranted.
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Cirkovic A, Garovic V, Milin Lazovic J, Milicevic O, Savic M, Rajovic N, Aleksic N, Weissgerber T, Stefanovic A, Stanisavljevic D, Milic N. Systematic review supports the role of DNA methylation in the pathophysiology of preeclampsia: a call for analytical and methodological standardization. Biol Sex Differ 2020; 11:36. [PMID: 32631423 PMCID: PMC7336649 DOI: 10.1186/s13293-020-00313-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Studies have recently examined the role of epigenetic mechanisms in preeclampsia pathophysiology. One commonly examined epigenetic process is DNA methylation. This heritable epigenetic marker is involved in many important cellular functions. The aim of this study was to establish the association between DNA methylation and preeclampsia and to critically appraise the roles of major study characteristics that can significantly impact the association between DNA methylation and preeclampsia. MAIN BODY A systematic review was performed by searching PubMed, Web of Science, and EMBASE for original research articles published over time, until May 31, 2019 in English. Eligible studies compared DNA methylation levels in pregnant women with vs. without preeclampsia. Ninety articles were included. Epigenome-wide studies identified hundreds of differentially methylated places/regions in preeclamptic patients. Hypomethylation was the predominant finding in studies analyzing placental tissue (14/19), while hypermethylation was detected in three studies that analyzed maternal white blood cells (3/3). In candidate gene studies, methylation alterations for a number of genes were found to be associated with preeclampsia. A greater number of differentially methylated genes was found when analyzing more severe preeclampsia (70/82), compared to studies analyzing less severe preeclampsia vs. controls (13/27). A high degree of heterogeneity existed among the studies in terms of methodological study characteristics including design (study design, definition of preeclampsia, control group, sample size, confounders), implementation (biological sample, DNA methylation method, purification of DNA extraction, and validation of methylation), analysis (analytical method, batch effect, genotyping, and gene expression), and data presentation (methylation quantification measure, measure of variability, reporting). Based on the results of this review, we provide recommendations for study design and analytical approach for further studies. CONCLUSIONS The findings from this review support the role of DNA methylation in the pathophysiology of preeclampsia. Establishing field-wide methodological and analytical standards may increase value and reduce waste, allowing researchers to gain additional insights into the role of DNA methylation in the pathophysiology of preeclampsia.
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Affiliation(s)
- A Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - J Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - O Milicevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Savic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Aleksic
- Center for Molecular Biology, University of Vienna, Vienna, Austria
| | - T Weissgerber
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Charité - Universitätsmedizin Berlin, Berlin Institute of Health, QUEST Center, Berlin, Germany
| | - A Stefanovic
- Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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13
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Lekva T, Sugulle M, Moe K, Redman C, Dechend R, Staff AC. Multiplex Analysis of Circulating Maternal Cardiovascular Biomarkers Comparing Preeclampsia Subtypes. Hypertension 2020; 75:1513-1522. [PMID: 32336238 DOI: 10.1161/hypertensionaha.119.14580] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preeclampsia, a hypertensive pregnancy disorder, links to increased long-term maternal cardiovascular disease (CVD). The risk is further increased with early-onset preeclampsia (EPE) and delivery of a growth-restricted child. We hypothesized that circulating biomarkers associated with CVD risk differed between preeclampsia subtypes and controls. We compared EPE; n=37, delivery <week 34, late-onset preeclampsia (LPE); n=29, delivery ≥week 34, and normotensive controls (n=49) using Olink Proseek multiplex CVD I assay (targeting 92 biomarkers). We stratified analysis to uteroplacental spiral artery acute atherosis presence in preeclampsia patients, sharing morphological similarities with atherosclerosis. We found 47 CVD-related biomarkers differing between the groups, 42 markers between normotensive controls and EPE, 28 markers between normotensive controls and LPE, and 9 markers between EPE and LPE. Among these 9 markers, ST2 (ST2 protein), MMP (matrix metalloproteinase) 1, MMP3, and fractalkine (CX3CL1) were uniquely dysregulated in EPE. Principal component (PC) analysis of the differing markers identified 4 clusters (named PC1-PC4) that largely separated the preeclampsia and control groups as well as pregnancies with low and high circulating PlGF (placental growth factor). The combination of the single markers PlGF, ST2, MMP1, MMP3, and CX3CL1 had a high discriminatory property to differentiate between EPE and LPE. Preeclampsia with acute atherosis or with fetal growth restriction could be differentiated by Olink biomarkers as compared with preeclampsia without these features. We identified specific CVD-related biomarkers in pregnancy depending on preeclampsia subtypes and uteroplacental acute atherosis. Assessment of these pregnancy measured biomarkers' relation to long-term cardiovascular dysfunction and hard end points is warranted.
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Affiliation(s)
- Tove Lekva
- From the Department of Obstetrics and Gynecology, Oslo University Hospital, Ullevål, Norway (T.L., M.S., K.M., A.C.S.).,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Norway (T.L.)
| | - Meryam Sugulle
- From the Department of Obstetrics and Gynecology, Oslo University Hospital, Ullevål, Norway (T.L., M.S., K.M., A.C.S.).,Faculty of Medicine, University of Oslo, Norway (M.S., K.M., A.C.S.)
| | - Kjartan Moe
- From the Department of Obstetrics and Gynecology, Oslo University Hospital, Ullevål, Norway (T.L., M.S., K.M., A.C.S.).,Faculty of Medicine, University of Oslo, Norway (M.S., K.M., A.C.S.).,Department of Gynecology and Obstetrics, Bærum Hospital, Vestre Viken HF, Norway (K.M.)
| | | | - Ralf Dechend
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max-Delbruck Center for Molecular Medicine, Germany (R.D.).,Department of Cardiology and Nephrology, HELIOS-Klinikum, Berlin, Germany (R.D.)
| | - Anne Cathrine Staff
- From the Department of Obstetrics and Gynecology, Oslo University Hospital, Ullevål, Norway (T.L., M.S., K.M., A.C.S.).,Faculty of Medicine, University of Oslo, Norway (M.S., K.M., A.C.S.)
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14
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Usselman CW, Adler TE, Coovadia Y, Leone C, Paidas MJ, Stachenfeld NS. A recent history of preeclampsia is associated with elevated central pulse wave velocity and muscle sympathetic outflow. Am J Physiol Heart Circ Physiol 2020; 318:H581-H589. [DOI: 10.1152/ajpheart.00578.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We demonstrate that resting muscle sympathetic nerve activity is elevated in women with a recent history of preeclampsia relative to women who have recently had uncomplicated pregnancies and without a history of preeclampsia. Structural changes in the central arteries are associated with arterial stiffness following preeclampsia, independent of changes in the sympathetic nervous system. The structural changes are observed in these relatively young previously preeclamptic women, indicating elevated cardiovascular risk. Our data suggest that with aging (and the gradual loss of vascular protection for women, as established by others), this risk will become exaggerated compared with women who have had normal pregnancies.
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Affiliation(s)
- Charlotte W. Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- McGill Research Centre for Physical Activity and Health, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Tessa E. Adler
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut
| | - Yasmine Coovadia
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Cheryl Leone
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Nina S. Stachenfeld
- The John B. Pierce Laboratory, Yale School of Medicine, New Haven, Connecticut
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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15
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Fjeldstad HE, Johnsen GM, Staff AC. Fetal microchimerism and implications for maternal health. Obstet Med 2019; 13:112-119. [PMID: 33093862 DOI: 10.1177/1753495x19884484] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/28/2019] [Indexed: 12/22/2022] Open
Abstract
This review paper outlines the definition, pathophysiology, and potential maternal health consequences of cellular fetal microchimerism, the maternal acquisition of intact cells of fetal origin during pregnancy. Increased rates and amounts of cellular fetal microchimerism are associated with several placental syndromes, including preeclampsia and fetal growth restriction. The discovery of cellular fetal microchimerism and methods of detection are briefly outlined, and we present the mechanisms hypothesized to govern pregnancy-related and long-term maternal health effects of cellular fetal microchimerism. Specifically, we discuss the potential implications of cellular fetal microchimerism in wound healing, autoimmunity, cancer, and possibly cardiovascular disease. Cellular fetal microchimerism represents a novel area of research on maternal and transgenerational health and disease, providing exciting opportunities for developing new disease biomarkers and precision medicine with targeted prophylaxis against long-term maternal disease.
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Affiliation(s)
- Heidi Es Fjeldstad
- Division of Obstetrics and Gyneacology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guro M Johnsen
- Division of Obstetrics and Gyneacology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gyneacology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Roth H, LeMarquand G, Henry A, Homer C. Assessing Knowledge Gaps of Women and Healthcare Providers Concerning Cardiovascular Risk After Hypertensive Disorders of Pregnancy-A Scoping Review. Front Cardiovasc Med 2019; 6:178. [PMID: 31850374 PMCID: PMC6895842 DOI: 10.3389/fcvm.2019.00178] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background: A history of a Hypertensive Disorder of Pregnancy (HDP) at least doubles a woman's risk of cardiovascular disease (CVD). The risk increases within 10 years after HDP and continues for life, making long-term health after HDP of major public health importance. Understanding knowledge gaps in health care professionals and women regarding cardiovascular health after HDP is an important component in addressing these risks. Objectives: The primary aim was to examine what women and healthcare providers (HCP) know about cardiovascular risks after HDP. The secondary aims were to identify enablers and barriers to knowledge and action on knowledge. Methods: A scoping review was conducted. This was a narrative synthesis, using PRISMA-ScR guidelines, of English-language full text articles that included assessment of knowledge of women, and/or HCP, on long term cardiovascular risk after HDP. The databases Embase, Medline, Scopus, ProQuest, Cochrane, and PsycInfo were searched from 01 January 2005 to 31 May 2019. Results: Twelve studies were included, six addressing women's knowledge, five addressing HCP knowledge, and one addressing both. The studies included 402 women and 1,215 HCP from seven countries. Regarding women's knowledge, six of seven studies found women had limited or no knowledge about the link between HDP and CVD. Where women were aware of the link, the majority had sourced their own information, rather than obtaining it through their HCP. In five of six studies, HCP also mostly had limited knowledge about HDP-CVD links. Primary enablers for HCP acquisition of knowledge and counseling were the availability and knowledge of guidelines. Where comparisons between HCP groups were made, obstetricians had greater knowledge than family physicians, internal medical specialists, or midwives. Conclusion: There was a low level of knowledge amongst HCP and women about increased CVD risk after HDP. Where women had higher levels of knowledge, the information was often obtained informally rather than from HCP. There were variations in knowledge of HCP, with obstetricians generally more aware than other professions. Further country and context-specific research on current status of women's and HCP's knowledge is therefore necessary when creating educational strategies to address knowledge gaps after HDP.
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Affiliation(s)
- Heike Roth
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Grace LeMarquand
- School of Women's and Children's Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia
| | - Amanda Henry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Medicine, University of NSW, Sydney, NSW, Australia.,Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, NSW, Australia
| | - Caroline Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Burnet Institute, Maternal and Child Health, Melbourne, VIC, Australia
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17
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Lui NA, Jeyaram G, Henry A. Postpartum Interventions to Reduce Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: A Systematic Review. Front Cardiovasc Med 2019; 6:160. [PMID: 31803757 PMCID: PMC6873287 DOI: 10.3389/fcvm.2019.00160] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction: Hypertensive disorders (HDP) affect ~7% of pregnancies. Epidemiological evidence strongly suggests HDP independently increases that individual's risk of later cardiovascular disease (CVD). Focus on reduction or mitigation of this risk has been limited. This review seeks to identify trialed interventions to reduce cardiovascular risk after HDP. Methods: Online medical databases were searched to identify full-text published results of randomized controlled trials (RCT) in women <10 years postpartum after HDP that trialed interventions to reduce cardiovascular risk. Outcomes sought included cardiovascular disease events, chronic hypertension, and other measures of cardiovascular risk such as obesity, smoking status, diet, and physical activity. Publications from January 2008 to July 2019 were included. Results: Two RCTs were identified. One, a trial of calcium vs. placebo in 201 women with calcium commenced from the first follow-up visit outside of pregnancy and continued until 20 weeks' gestation if another pregnancy occurred. A non-significant trend toward decreased blood pressure was noted. The second RCT of 151 women tested an online education programme (vs. general information to control group) to increase awareness of risk factors and personalized phone-based lifestyle coaching in women who had a preeclampsia affected pregnancy in the 5 years preceding enrolment. Significant findings included increase in knowledge of CVD risk factors, reported healthy eating and decreased physical inactivity, however adoption of a promoted heart healthy diet and physical activity levels did not differ significantly between groups. Several observational studies after HDP, and one meta-analysis of studies of lifestyle interventions not performed specifically after HDP but used to extrapolate likely benefits of lifestyle interventions, were identified which supported the use of lifestyle interventions. Several ongoing RCTs were also noted. Discussion: There is a paucity of intervention trials in the early years after HDP to guide evidence-based cardiovascular risk reduction in affected women. Limited evidence suggests lifestyle intervention may be effective, however degree of any risk reduction remains uncertain. Conclusion: Sufficiently powered randomized controlled trials of appropriate interventions (e.g., lifestyle behavior change, pharmacological) are required to assess the best method of reducing the risk of cardiovascular disease in this at-risk population of women.
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Affiliation(s)
- Nicla A. Lui
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Gajana Jeyaram
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Amanda Henry
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
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18
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Haug EB, Horn J, Markovitz AR, Fraser A, Vatten LJ, Macdonald-Wallis C, Tilling K, Romundstad PR, Rich-Edwards JW, Åsvold BO. Life Course Trajectories of Cardiovascular Risk Factors in Women With and Without Hypertensive Disorders in First Pregnancy: The HUNT Study in Norway. J Am Heart Assoc 2019; 7:e009250. [PMID: 30371249 PMCID: PMC6201453 DOI: 10.1161/jaha.118.009250] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Women with hypertensive pregnancy disorders have adverse levels of cardiovascular risk factors. It is unclear how this adverse risk factor profile evolves during adult life. We compared life course trajectories of cardiovascular risk factors in women with preeclampsia or gestational hypertension in their first pregnancy to normotensive women. Methods and Results We linked information on cardiovascular risk factors from the population‐based HUNT (Nord‐Trøndelag Health Study) surveys with pregnancy information from the Medical Birth Registry of Norway. Trajectories of cardiovascular risk factors were constructed for 22 308 women with a normotensive first pregnancy; 1092 with preeclampsia, and 478 with gestational hypertension in first pregnancy. Already before first pregnancy, women with preeclampsia in their first pregnancy had higher measures of adiposity, blood pressure, heart rate, and serum lipids and glucose compared with women with a normotensive first pregnancy. After first pregnancy, there was a parallel development in cardiovascular risk factor levels, but women with a normotensive first pregnancy had a time lag of >10 years compared with the preeclampsia group. There were no clear differences in risk factor trajectories between women with gestational hypertension and women with preeclampsia. Conclusions Women with hypertensive pregnancy disorders in their first pregnancy had an adverse cardiovascular risk factor profile before pregnancy compared with normotensive women, and the differences persisted beyond 50 years of age. Hypertensive disorders in pregnancy signal long‐term increases in modifiable cardiovascular risk factors, and may be used to identify women who would benefit from early prevention strategies.
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Affiliation(s)
- Eirin B Haug
- 1 Department of Public Health and Nursing NTNU Norwegian University of Science and Technology Trondheim Norway
| | - Julie Horn
- 1 Department of Public Health and Nursing NTNU Norwegian University of Science and Technology Trondheim Norway.,2 Department of Obstetrics and Gynecology Levanger Hospital Nord-Trøndelag Hospital Trust Levanger Norway
| | - Amanda R Markovitz
- 3 Harvard T.H. Chan School of Public Health Harvard University Boston MA.,4 Division of Women's Health Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Abigail Fraser
- 5 MRC Integrative Epidemiology Unit and Population Health Sciences Bristol Medical School University of Bristol United Kingdom
| | - Lars J Vatten
- 1 Department of Public Health and Nursing NTNU Norwegian University of Science and Technology Trondheim Norway
| | - Corrie Macdonald-Wallis
- 5 MRC Integrative Epidemiology Unit and Population Health Sciences Bristol Medical School University of Bristol United Kingdom
| | - Kate Tilling
- 5 MRC Integrative Epidemiology Unit and Population Health Sciences Bristol Medical School University of Bristol United Kingdom
| | - Pål R Romundstad
- 1 Department of Public Health and Nursing NTNU Norwegian University of Science and Technology Trondheim Norway
| | - Janet W Rich-Edwards
- 3 Harvard T.H. Chan School of Public Health Harvard University Boston MA.,4 Division of Women's Health Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Bjørn O Åsvold
- 1 Department of Public Health and Nursing NTNU Norwegian University of Science and Technology Trondheim Norway.,6 Department of Endocrinology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
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19
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Moe K, Sugulle M, Dechend R, Staff AC. Risk prediction of maternal cardiovascular disease one year after hypertensive pregnancy complications or gestational diabetes mellitus. Eur J Prev Cardiol 2019; 27:1273-1283. [PMID: 31600083 DOI: 10.1177/2047487319879791] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous preeclampsia, gestational hypertension and gestational diabetes mellitus show a firm epidemiological association to maternal cardiovascular disease risk. Cardiovascular disease risk assessment is recommended in women after these pregnancy complications, but not offered in most countries. We therefore wanted to evaluate the applicability of currently recommended cardiovascular disease risk scores for women one-year postpartum of such pregnancy complications. DESIGN AND METHODS We tested applicability of three scoring systems, the Atherosclerotic Cardiovascular Disease (ASCVD) score, the Joint British Societies for the Prevention of Cardiovascular Disease (JBS3) score and Framingham 30 year Risk Score-Cardiovascular Disease (FRS-CVD) in 235 women one-year postpartum (controls: 94, gestational hypertension: 35, preeclampsia: 81, gestational diabetes mellitus: 25). Statistical analysis was performed with Mann-Whitney U test for continuous and Fisher's mid-corrected p and Pearson's r for dichotomous variables. A value of p < 0.050 was considered significant. RESULTS Most women (87.7%) were below 40 years of age, rendering 10-year risk estimations recommended by American and European societies inapplicable. FRS-CVD could be assessed in all women. Significantly fewer could be assessed by the ASCVD (81.5%) and JBS3 (91.6%). All scoring systems showed small, but significant increases in risk scores for one or more of the pregnancy complication groups, but none at the risk magnitude for cardiovascular disease shown in epidemiological studies. CONCLUSION We demonstrate that ASCVD, JBS3 and FRS-CVD are inadequate in assessing cardiovascular disease risk one-year postpartum. We suggest that pregnancy complications need to be considered separately when evaluating maternal cardiovascular disease risk and need for postpartum follow-up.
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Affiliation(s)
- Kjartan Moe
- Faculty of Medicine, University of Oslo, Norway.,Department of Obstetrics and Gynaecology, Baerum Hospital, Vestre Viken Hospital Trust, Norway
| | - Meryam Sugulle
- Faculty of Medicine, University of Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway
| | - Ralf Dechend
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Centre for Molecular Medicine, Germany.,HELIOS-Klinikum, Germany
| | - Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway
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20
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Sheiner E, Kapur A, Retnakaran R, Hadar E, Poon LC, McIntyre HD, Divakar H, Staff AC, Narula J, Kihara AB, Hod M. FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long-term Maternal Implications of Pregnancy Complications-Follow-up Considerations. Int J Gynaecol Obstet 2019; 147 Suppl 1:1-31. [PMID: 32323876 DOI: 10.1002/ijgo.12926] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Eyal Sheiner
- Department of Obstetrics and Gynecology B, Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Ravi Retnakaran
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - H David McIntyre
- University of Queensland Mater Clinical School, Brisbane, Qld, Australia
| | - Hema Divakar
- Divakar's Speciality Hospital, Bengaluru, Karnataka, India
| | - Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Cardiology, Mount Sinai St Luke's Hospital, New York, NY, USA
| | - Anne B Kihara
- African Federation of Obstetricians and Gynaecologists, Khartoum, Sudan
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Ling HZ, Guy GP, Bisquera A, Poon LC, Nicolaides KH, Kametas NA. The effect of parity on longitudinal maternal hemodynamics. Am J Obstet Gynecol 2019; 221:249.e1-249.e14. [PMID: 30951684 DOI: 10.1016/j.ajog.2019.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parous women have a lower risk for pregnancy complications, such as preeclampsia or delivery of small-for-gestational-age neonates. However, parous women are a heterogeneous group of patients because they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by preeclampsia and/or small for gestational age. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output and peripheral vascular resistance, did not distinguish between parous women with and without a history of preeclampsia or small for gestational age and reported contradictory results. OBJECTIVE The objective of the study was to compare maternal hemodynamics in nulliparous women and in parous women with and without previous preeclampsia and/or small for gestational age. STUDY DESIGN This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks' gestation in 3 groups of women. Group 1 was composed of parous women without a history of preeclampsia and/or small for gestational age (n = 632), group 2 was composed of nulliparous women (n = 829), and group 3 was composed of parous women with a history of preeclampsia and/or small for gestational age (n = 113). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of preeclampsia or small for gestational age in the current pregnancy. RESULTS In groups 1 and 2, cardiac output increased with gestational age to a peak at 32 weeks and peripheral vascular resistance showed a reversed pattern with its nadir at 32 weeks; in group 1, compared with group 2, there was better cardiac adaptation, reflected in higher cardiac output and lower peripheral vascular resistance. In group 3 there was a hyperdynamic profile of higher cardiac output and lower peripheral vascular resistance at the first trimester followed by an earlier sharp decline of cardiac output and increase of peripheral vascular resistance from midgestation. The incidence of preeclampsia and small for gestational age was highest in group 3 and lowest in group 1. CONCLUSION There are parity-specific differences in maternal cardiac adaptation in pregnancy.
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22
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Burgess A, Feliu K. Women's Knowledge of Cardiovascular Risk After Preeclampsia. Nurs Womens Health 2019; 23:424-432. [PMID: 31445987 DOI: 10.1016/j.nwh.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/19/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine women's self-reported knowledge of the association between preeclampsia and cardiovascular disease and to determine if they received appropriate education on the recommendations of the American Heart Association for follow-up and for cardiovascular risk reduction strategies after preeclampsia. DESIGN Cross-sectional descriptive study using an online survey. SETTING/LOCAL PROBLEM A survey link was placed on the Facebook pages for two preeclampsia support groups. PARTICIPANTS A total of 241 women who were members of these Facebook groups completed the online survey. INTERVENTION/MEASUREMENTS An online survey was created using Campus Labs software. Most questions were closed response. Participants were asked to answer survey questions about their first pregnancy with preeclampsia and the education/referrals they received specific to the association between preeclampsia and cardiovascular risk. RESULTS Of all those who responded, 36.9% (n = 89) reported being unaware of the association between preeclampsia and cardiovascular disease. Of those who gave birth since the American Heart Association issued recommendations for follow-up after preeclampsia, 43.9% (n = 61) reported that they received no counseling regarding incorporating healthful lifestyle changes or follow-up after their diagnosis of preeclampsia. CONCLUSION Women with a history of preeclampsia may not be receiving adequate education on its association with cardiovascular disease. Nurses can work to fill this gap through collaboration with cardiovascular and primary care providers to orchestrate seamless cardioprotective follow-up for this population of women.
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24
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Horjus DL, Bokslag A, Hooijberg F, Hutten BA, Middeldorp S, de Groot CJM. Creatine kinase and blood pressure in women with a history of early-onset preeclampsia. Pregnancy Hypertens 2019; 15:118-122. [PMID: 30825907 DOI: 10.1016/j.preghy.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/17/2018] [Accepted: 12/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES High plasma creatine kinase (CK) activity is associated with hypertension in the general and pregnant population. We hypothesize that women with a history of early-onset preeclampsia are prone to hypertension due to a high CK activity level. STUDY DESIGN Nine to 16 years after pregnancy, serum CK activity and blood pressure were measured in 117 women with a history of early-onset preeclampsia and 50 women with a history of an uncomplicated pregnancy. MAIN OUTCOME MEASURES CK activity levels of the two groups were compared using the Mann-Whitney U test. The association between CK activity and blood pressure was evaluated by means of multivariable regression analysis. RESULTS There was no significant difference in median (interquartile range) CK activity between women with a history of early-onset preeclampsia and an uncomplicated pregnancy (59.00 [47.00-85.00] vs. 58.00 [46.50-75.25], respectively, p = 0.774). The association between CK and systolic blood pressure was significant in women with a pregnancy history of early-onset preeclampsia (regression coefficient [95% confidence interval]: 0.123 mmHg [0.020-0.226], p = 0.019), and a trend was found for diastolic blood pressure (p = 0.069). CK and blood pressure were not significantly associated in women with a history of an uncomplicated pregnancy. CONCLUSIONS Median CK did not significantly differ between the two groups. Serum CK activity was significantly associated with systolic blood pressure in women with a history of early-onset preeclampsia. These data suggest that CK is not a predominant factor in the increased risk of hypertension in women with a history of early-onset preeclampsia.
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Affiliation(s)
- Deborah L Horjus
- Amsterdam UMC, University of Amsterdam, Vascular Medicine, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Anouk Bokslag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, de Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
| | - Femke Hooijberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, de Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
| | - Barbara A Hutten
- Amsterdam UMC, University of Amsterdam, Clinical Epidemiology, Biostatistics and Bioinformatics, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Saskia Middeldorp
- Amsterdam UMC, University of Amsterdam, Vascular Medicine, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - Christianne J M de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Obstetrics and Gynecology, Amsterdam Cardiovascular Sciences, de Boelelaan 1117, 1081 HV Amsterdam, Netherlands.
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Groenhof TKJ, Zoet GA, Franx A, Gansevoort RT, Bots ML, Groen H, Lely AT. Trajectory of Cardiovascular Risk Factors After Hypertensive Disorders of Pregnancy. Hypertension 2019; 73:171-178. [DOI: 10.1161/hypertensionaha.118.11726] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- T. Katrien J. Groenhof
- From the Julius Centre for Health Sciences and Primary Care (T.K.J.G., M.L.B.), University Medical Centre Utrecht, the Netherlands
| | - Gerbrand A. Zoet
- Wilhelmina Children’s Hospital Birth Centre (G.A.Z., A.F., A.T.L.), University Medical Centre Utrecht, the Netherlands
| | - Arie Franx
- Wilhelmina Children’s Hospital Birth Centre (G.A.Z., A.F., A.T.L.), University Medical Centre Utrecht, the Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine (R.T.G., ), University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Michiel L. Bots
- From the Julius Centre for Health Sciences and Primary Care (T.K.J.G., M.L.B.), University Medical Centre Utrecht, the Netherlands
| | - Henk Groen
- Department of Epidemiology (H.G.), University Medical Centre Groningen, University of Groningen, the Netherlands
| | - A. Titia Lely
- Wilhelmina Children’s Hospital Birth Centre (G.A.Z., A.F., A.T.L.), University Medical Centre Utrecht, the Netherlands
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Oliverio AL, Zee J, Mariani LH, Reynolds ML, O'Shaughnessy M, Hendren EM, Alachkar N, Herreshoff E, Rizk DV, Nester CM, Steinke J, Twombley KE, Hladunewich MA. Renal Complications in Pregnancy Preceding Glomerulonephropathy Diagnosis. Kidney Int Rep 2018; 4:159-162. [PMID: 30596179 PMCID: PMC6308828 DOI: 10.1016/j.ekir.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/20/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Andrea L Oliverio
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Laura H Mariani
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Monica L Reynolds
- Division of Nephrology, Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle O'Shaughnessy
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Elizabeth M Hendren
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nada Alachkar
- Division of Nephrology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily Herreshoff
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana V Rizk
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carla M Nester
- Division of Nephrology, Departments of Internal Medicine and Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Julia Steinke
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Katherine E Twombley
- Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Dam V, Onland-Moret NC, Verschuren WMM, Boer JMA, Benschop L, Franx A, Moons KGM, Boersma E, van der Schouw YT. Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy. Heart 2018; 105:330-336. [PMID: 30209122 DOI: 10.1136/heartjnl-2018-313439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Compare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance. METHODS We included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated (updating intercept and slope) and refitted (recalculating coefficients) the models. RESULTS Original FRS and PCEs overpredicted 10-year CVD risks, with expected:observed (E:O) ratios ranging from 1.51 (for FRS in women with hHDP) to 2.29 (for PCEs in women without hHDP), while E:O ratios were close to 1 for SCORE. Overprediction attenuated slightly after recalibration for FRS and PCEs in both hHDP groups. Discrimination was reasonable for all models, with C-statistics ranging from 0.70-0.81 (women with hHDP) and 0.72-0.74 (women without hHDP). C-statistics improved slightly after refitting 0.71-0.83 (with hHDP) and 0.73-0.80 (without hHDP). The E:O ratio of the original PCE model was statistically significantly better in women with hHDP compared with women without hHDP. CONCLUSIONS SCORE performed best in terms of both calibration and discrimination, while FRS and PCEs overpredicted risk in women with and without hHDP, but improved after recalibrating and refitting the models. No separate model for women with hHDP seems necessary, despite their higher baseline risk.
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Affiliation(s)
- Veerle Dam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Jolanda M A Boer
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Laura Benschop
- Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arie Franx
- Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center, Rotterdam
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Gerbrand Zoet GA, Anna Sverrisdóttir AK, Anouk Eikendal ALM, Arie Franx A, Tim Leiner T, Bas van Rijn BB. MRI-derived aortic characteristics after pregnancy: The AMBITYON study. Pregnancy Hypertens 2018; 13:46-50. [PMID: 30177070 DOI: 10.1016/j.preghy.2018.04.018] [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: 12/29/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Pregnancy and pregnancy complications have been associated with increased arterial stiffness even at young age. In this study we assessed the impact of parity on CMR-derived aortic characteristics as early markers of atherosclerosis and arterial stiffness in healthy women between 25 and 35 years. STUDY DESIGN We studied 68 women who participated in the AMBITYON study, a prospective population-based cohort study for assessment of atherosclerotic burden by MRI and traditional CVD risk factors in healthy, young adults. Of these women, 40 (58.8%) were nulliparous, 13 (19.1%) were primiparous and 15 (22.1%) were multiparous. MAIN OUTCOME MEASURES Descending thoracic aortic wall thickness (AWT) and pulse wave velocity (PWV) were measured using 3.0T CMR. RESULTS AWT measurements were similar between nulliparous women and primi- or multiparous women (1.6 mm ± 0.2 mm vs. 1.6 mm ± 0.2 mm; p = 0.79). Correction for age and systolic blood pressure did not change these results. Applying percentile based cut-off values showed a non-significant increase in AWT in parous women. PWV measurements did not differ between nulliparous women and parous women (4.5 m/s ± 0.7 m/s vs. 4.5 m/s ± 0.8 m/s; p = 0.78). Correction for age and systolic blood pressure did not influence these results. Using percentile based cut-off values, showed an increasing likelihood of higher PWV-values in parous women, although not statistically significant. CONCLUSIONS Direct measurement of aortic AWT and PWV by CMR showed no difference between nulliparous and parous women, probably indicating limited effect of pregnancy on arterial stiffness and early markers of atherosclerosis. TRIAL REGISTRATION Netherlands Trial Register (NTR) number: 4742.
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Affiliation(s)
- G A Gerbrand Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - A K Anna Sverrisdóttir
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - A L M Anouk Eikendal
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - T Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B B Bas van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands; Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, United Kingdom
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29
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Moe K, Alnaes-Katjavivi P, Størvold GL, Sugulle M, Johnsen GM, Redman CW, Dechend R, Staff AC. Classical Cardiovascular Risk Markers in Pregnancy and Associations to Uteroplacental Acute Atherosis. Hypertension 2018; 72:695-702. [DOI: 10.1161/hypertensionaha.118.10964] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kjartan Moe
- From the Faculty of Medicine, University of Oslo, Norway (K.M., P.A.-K., G.L.S., G.M.J., A.C.S.)
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
| | - Patji Alnaes-Katjavivi
- From the Faculty of Medicine, University of Oslo, Norway (K.M., P.A.-K., G.L.S., G.M.J., A.C.S.)
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
| | - Gro L. Størvold
- From the Faculty of Medicine, University of Oslo, Norway (K.M., P.A.-K., G.L.S., G.M.J., A.C.S.)
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
- Institute for Experimental Medical Research (G.L.S., G.M.J.), Oslo University Hospital, Norway
| | - Meryam Sugulle
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
| | - Guro M. Johnsen
- From the Faculty of Medicine, University of Oslo, Norway (K.M., P.A.-K., G.L.S., G.M.J., A.C.S.)
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
- Institute for Experimental Medical Research (G.L.S., G.M.J.), Oslo University Hospital, Norway
| | - Christopher W.G. Redman
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (C.W.G.R.)
| | - Ralf Dechend
- HELIOS Clinic, Berlin-Buch, Germany (R.D.)
- Experimental and Clinical Research Center, Charité Medical Faculty and Max-Delbrueck Center for Molecular Medicine, Berlin, Germany (R.D.)
| | - Anne C. Staff
- From the Faculty of Medicine, University of Oslo, Norway (K.M., P.A.-K., G.L.S., G.M.J., A.C.S.)
- Division of Obstetrics and Gynaecology (K.M., P.A.-K., G.L.S., M.S., G.M.J., A.C.S.)
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30
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Brouwers L, van der Meiden-van Roest AJ, Savelkoul C, Vogelvang TE, Lely AT, Franx A, van Rijn BB. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG 2018; 125:1642-1654. [PMID: 29978553 PMCID: PMC6283049 DOI: 10.1111/1471-0528.15394] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 02/03/2023]
Abstract
Background Women with a history of hypertensive disorders, including pre‐eclampsia, during pregnancy have a two‐ to‐five‐fold increased risk of cardiovascular disease (CVD). In 15% of women, pre‐eclampsia recurs in the following pregnancy. Objectives To evaluate all evidence on the future risk of developing hypertension and CVD after multiple pregnancies complicated by pre‐eclampsia compared with pre‐eclampsia in a single pregnancy followed by normal subsequent pregnancy. Search strategy Embase and Medline were searched until June 2017. Selection criteria All relevant studies on the risk of developing hypertension, atherosclerosis, ischaemic heart disease, cerebrovascular accident (CVA), thromboembolism, heart failure or overall hospitalisation and mortality due to CVD after having had recurrent pre‐eclampsia. Data collection and analysis Twenty‐two studies were included in the review. When possible, we calculated pooled risk ratios (RR) with 95% CI through random‐effect analysis. Main results Recurrent pre‐eclampsia was consistently associated with an increased pooled risk ratio of hypertension (RR 2.3; 95% CI 1.9–2.9), ischaemic heart disease (RR 2.4; 95% CI 2.2–2.7), heart failure (RR 2.9; 95% CI 2.3–3.7), CVA (RR 1.7; 95% CI 1.2–2.6) and hospitalisation due to CVD (RR 1.6; 95% CI 1.3–1.9) when compared with women with subsequent uncomplicated pregnancies. Other studies on thromboembolism, atherosclerosis and cardiovascular mortality found a positive effect, but data could not be pooled. Conclusions This systematic review and meta‐analysis support consistent higher risk for future development of hypertension and CVD in women with recurring pre‐eclampsia as opposed to women with a single episode of pre‐eclampsia. Tweetable abstract The risk of future cardiovascular disease increases when women have recurrence of pre‐eclampsia compared with a single episode. The risk of future cardiovascular disease increases when women have recurrence of pre‐eclampsia compared to a single episode. This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights15394
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Affiliation(s)
- L Brouwers
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A J van der Meiden-van Roest
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - C Savelkoul
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, the Netherlands
| | - A T Lely
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Franx
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - B B van Rijn
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Kamravamanesh M, Kohan S, Rezavand N, Farajzadegan Z. A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research. Reprod Health 2018; 15:81. [PMID: 29776432 PMCID: PMC5960172 DOI: 10.1186/s12978-018-0521-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
Background Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women’s life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. Methods This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. Discussion It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is effective, it could be included in the postpartum health care guidelines. Trial registration IRCT20170927036445N2 Registered 10 March 2018.
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Affiliation(s)
- Mastaneh Kamravamanesh
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Rezavand
- Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Ziba Farajzadegan
- Community medicine Department, Faculty of medicine, Isfahan University of Medical Sciences, Hezar Jereb St, Isfahan, Iran.
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32
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Tanz LJ, Stuart JJ, Missmer SA, Rimm EB, Sumner JA, Vadnais MA, Rich-Edwards JW. Cardiovascular biomarkers in the years following pregnancies complicated by hypertensive disorders or delivered preterm. Pregnancy Hypertens 2018; 13:14-21. [PMID: 30177042 DOI: 10.1016/j.preghy.2018.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/17/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Women with a history of hypertensive disorders of pregnancy and preterm delivery have an increased risk of cardiovascular disease (CVD). Chronic inflammation, endothelial dysfunction, and dyslipidemia may link pregnancy outcomes with CVD. OBJECTIVE We evaluated whether women with a history of HDP or normotensive preterm delivery had adverse CVD biomarker profiles after pregnancy. STUDY DESIGN We identified parous women from the Nurses' Health Study II with C-reactive protein (CRP; n = 2614), interleukin-6 (IL-6; n = 2490), glycated hemoglobin (n = 885), intracellular adhesion molecule-1 (n = 1231), high density lipoprotein cholesterol (n = 931), low density lipoprotein cholesterol (n = 931), triglycerides (n = 1428), or total cholesterol (n = 2940) assessed in stored blood samples. Multivariable-adjusted robust linear regression models evaluated percent differences and 95% confidence intervals (CIs) in each biomarker associated with a history of HDP or preterm delivery. RESULTS Ten percent of women had a history of HDP, while 11% with normotensive pregnancies had at least one preterm delivery. Median time from first pregnancy to blood draw was 17 years (interquartile range: 12, 22). Plasma levels of CRP and IL-6 were 34.4% (95% CI: 17.2, 54.1), and 11.6% higher (95% CI: 2.1, 21.9) respectively, among women with a history of HDP compared to those with only normotensive pregnancies. Altered CVD biomarker levels were otherwise not present in women with a history of HDP or preterm delivery. CONCLUSION CRP and IL-6, but not other CVD biomarkers, were elevated in women with a history of HDP in the years following pregnancy, suggesting inflammation may be a pathway linking HDP with future CVD risk.
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Affiliation(s)
- Lauren J Tanz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jennifer J Stuart
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Stacey A Missmer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
| | - Mary A Vadnais
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Vanguard Medical Associates, Boston, MA, USA.
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Ejike DE, Ambrose B, Moses DA, Karimah MR, Iliya E, Sheu OS, Nganda P. Determination, knowledge and prevalence of pregnancy-induced hypertension/eclampsia among women of childbearing age at Same District Hospital in Tanzania. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/ijmms2017.1343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Paauw ND, Lely AT. Cardiovascular Sequels During and After Preeclampsia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:455-470. [PMID: 30051401 DOI: 10.1007/978-3-319-77932-4_28] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a pregnancy-specific disorder complicating 2%-8% of pregnancies worldwide and characterized by de novo development of hypertension and proteinuria. Current understanding of the pathophysiology of preeclampsia is limited. A main feature is disrupted spiral artery remodeling in the placenta, which restricts the blood flow to the placenta, which in turn leads to decreased uteroplacental perfusion. Impaired blood flow through the placenta might result in fetal growth restriction and secretion of several factors by the placenta-mainly pro-inflammatory cytokines and anti-angiogenic factors-which spread into the maternal circulation, leading to endothelial dysfunction, which subsequently results in disrupted maternal hemodynamics. To date, no treatment options are available apart from termination of pregnancy. Despite normalization of the maternal vascular disturbances after birth, it has become apparent that formerly preeclamptic women experience an increased risk to develop cardiovascular and kidney disease later in life. One well-accepted concept is that the development of preeclampsia is an indicator of maternal susceptibility to develop future cardiovascular conditions, although the increased risk might also be the result of organ damage caused during preeclampsia. Given the associations between preeclampsia and long-term complications, preeclampsia is acknowledged as woman-specific risk factor for cardiovascular disease. Current research focuses on finding effective screening and prevention strategies for the reduction of cardiovascular disease in women with a history of preeclampsia.
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Affiliation(s)
- Nina D Paauw
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Titia Lely
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Raman MR, Tosakulwong N, Zuk SM, Senjem ML, White WM, Fields JA, Mielke MM, Lesnick TG, Bailey KR, Jack CR, Miller VM, Garovic VD, Kantarci K. Influence of preeclampsia and late-life hypertension on MRI measures of cortical atrophy. J Hypertens 2017; 35:2479-2485. [PMID: 28800041 PMCID: PMC5668159 DOI: 10.1097/hjh.0000000000001492] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Women with a history of preeclampsia are at an increased risk of hypertension and structural brain changes. However, the combined effect of both preeclampsia and late-life hypertension on brain structural changes is not known and was investigated in this study. METHODS Participants were identified from the population-based Rochester Epidemiology Project cohort. Four groups of women were recruited and investigated in this study: first, women with a history of normotensive pregnancy who have late-life hypertension (n = 8, median age = 62), second, women with a history of normotensive pregnancy who do not have late-life hypertension (n = 32, median age = 59), third, women with a history of preeclampsia who have late-life hypertension (n = 24, median age = 60), and fourth, women with a history of preeclampsia who do not have late-life hypertension (n = 16, median age = 57). Cerebrovascular disease lesions on MRI, and total gray matter volumes were assessed. RESULTS Total gray matter volumes were smaller in women with a history of preeclampsia and late-life hypertension compared with the other groups. Voxel-based morphometry demonstrated that the volume changes were localized to the posterior brain regions, particularly the occipital lobe gray matter in women with a history of preeclampsia and late-life hypertension. CONCLUSION Having late-life hypertension superimposed on a history of preeclampsia affects the brain structure differently than having either a history of preeclampsia alone or a history of normotensive pregnancy either with or without late-life hypertension.
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Affiliation(s)
| | | | | | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | - Wendy M. White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Michelle M. Mielke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Kent R. Bailey
- Department of Health Sciences Research, Divisions of Biomedical Statistics and Informatics and Epidemiology, Mayo Clinic, Rochester, MN
| | | | - Virginia M. Miller
- Department of Surgery, Mayo Clinic, Rochester, MN
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Vesna D. Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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Zoet GA, van Rijn BB, Rehfeldt M, Franx A, Maas AHEM. Similar pro-NT and pro-RLX2 levels after preeclampsia and after uncomplicated pregnancy. Maturitas 2017; 106:87-91. [PMID: 29150171 DOI: 10.1016/j.maturitas.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/28/2017] [Accepted: 09/20/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Women are at increased risk of developing cardiovascular disease (CVD) after preeclampsia. Proneurotensin 1-117 (pro-NT) and prorelaxin 2 connecting peptide (pro-RLX2) have recently emerged as potential biomarkers for CVD risk in women. We assessed pro-NT and pro-RLX2 levels in women with and without a history of preeclampsia. STUDY DESIGN 339 women with a history of early-onset preeclampsia and 327 women with an uncomplicated pregnancy underwent cardiovascular screening 10 years after delivery (the Preeclampsia Risk EValuation in FEMales (PREVFEM) cohort). MAIN OUTCOME MEASURES Pro-NT, a stable fragment of the neurotensin precursor, was assessed in the whole cohort. Pro-RLX2, the stable connecting peptide of the relaxin 2 prohormone, was assessed in a subset of this cohort, consisting of 27 women with a history of preeclampsia and 23 healthy controls. Associations between biomarker levels and traditional CVD risk factors in the preeclampsia and control group were assessed by Pearson's correlation coefficient. RESULTS We found no differences in pro-NT and pro-RLX2 levels between the preeclampsia and control group. Pro-NT levels were associated with higher HbA1c levels (r=0.113, p-value 0.045) and with BMI (r=0.124, p-value 0.027), but only in the control group. Pro-RLX2 was related to current smoking and triglyceride levels in women with a history of preeclampsia and related to LDL-cholesterol in women with an uncomplicated pregnancy. CONCLUSIONS Pro-NT and pro-RLX2 levels were comparable in women 10 years after preeclampsia and women with an uncomplicated pregnancy. The role of pro-NT and pro-RLX2 in CVD development after preeclampsia should be further investigated.
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Affiliation(s)
- G A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - B B van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands; Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, United Kingdom
| | | | - A Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - A H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Sari I, Pinarbasi H, Pinarbasi E, Yildiz C. Association between the soluble epoxide hydrolase gene and preeclampsia. Hypertens Pregnancy 2017; 36:315-325. [DOI: 10.1080/10641955.2017.1388390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ismail Sari
- Department of Medical Biochemistry, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Hatice Pinarbasi
- Department of Biochemistry, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ergun Pinarbasi
- Department of Medical Biology, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Caglar Yildiz
- Department of Gynecology and Obstetrics, School of Medicine, Cumhuriyet University, Sivas, Turkey
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Jayachandran M, Garovic VD, Mielke MM, Bailey KR, Lahr BD, Miller VM. Characterization of intravascular cellular activation in relationship to subclinical atherosclerosis in postmenopausal women. PLoS One 2017; 12:e0183159. [PMID: 28910282 PMCID: PMC5598935 DOI: 10.1371/journal.pone.0183159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/31/2017] [Indexed: 02/02/2023] Open
Abstract
Objective Mechanisms and interactions among intravascular cells contributing to development of subclinical atherosclerosis are poorly understood. In women, both menopausal status and pregnancy history influence progression of atherosclerosis. This study examined activation and interactions among blood elements with subclinical atherosclerosis in menopausal women with known pregnancy histories. Methods Carotid intima-media thickness (CIMT), as a marker of subclinical atherosclerosis, was measured using B-mode ultrasound in age- and parity-matched women [40 with and 40 without a history of preeclampsia] 35 years after the index pregnancy. Interactions among intravascular cells (38 parameters) were measured by flow cytometry in venous blood. Data analysis was by principal component which retained 7 independent dimensions accounting for 63% of the variability among 38 parameters. Results CIMT was significantly greater in women with a history of preeclampsia (P = 0.004). Platelet aggregation and platelet interactions with granulocytes and monocytes positively associated with CIMT in postmenopausal women independent of their pregnancy history (ρ = 0.258, P< 0.05). However, the association of the number of platelets, platelet activation and monocyte-platelet interactions with CIMT differed significantly depending upon pregnancy history (test for interaction, P<0.001). Conclusion Interactions among actived intravascular cells and their association with subclinical atherosclerosis differ in women depending upon their pregnancy histories.
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Affiliation(s)
- Muthuvel Jayachandran
- Departments of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Vesna D. Garovic
- General Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michelle M. Mielke
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kent R. Bailey
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Health Science Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brian D. Lahr
- Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
- Health Science Research, Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Virginia M. Miller
- Departments of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol 2017; 24:1735-1745. [PMID: 28895439 PMCID: PMC5669282 DOI: 10.1177/2047487317730472] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts (N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.
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Affiliation(s)
- T Katrien J Groenhof
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | - Bas B van Rijn
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands.,2 Academic Unit of Human Development and Health, Institute for Life Sciences, University of Southampton, UK
| | - Arie Franx
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | | | - Michiel L Bots
- 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - A Titia Lely
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
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Garovic VD, Milic NM, Weissgerber TL, Mielke MM, Bailey KR, Lahr B, Jayachandran M, White WM, Hodis HN, Miller VM. Carotid Artery Intima-Media Thickness and Subclinical Atherosclerosis in Women With Remote Histories of Preeclampsia: Results From a Rochester Epidemiology Project-Based Study and Meta-analysis. Mayo Clin Proc 2017; 92:1328-1340. [PMID: 28847600 PMCID: PMC5663464 DOI: 10.1016/j.mayocp.2017.05.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To measure carotid artery intima-media thickness (CIMT), a marker of subclinical atherosclerosis, in postmenopausal women with and without histories of preeclampsia and to synthesize these results with those from prior studies of CIMT performed 10 or more years after preeclamptic pregnancies. PATIENTS AND METHODS Forty women (median age, 59 years) with histories of preeclampsia and 40 with histories of normotensive pregnancy (confirmed by medical record review) were selected from women who resided and gave birth in Olmsted County, Minnesota, between January 1, 1976, and December 31, 1982. The participants were identified and recruited in 2014-2015, and CIMT was measured by B-mode ultrasonography. Meta-analysis included CIMT studies that were performed 10 or more years after preeclamptic pregnancies and which were identified through PubMed, EMBASE, and Web of Science. Heterogeneity was assessed using the I2 statistic. Standardized mean difference was used as a measure of effect size. RESULTS Carotid artery intima-media thickness, expressed as a median (interquartile range), was greater in the preeclamptic than in the normotensive group (0.80 mm [0.75-0.85 mm] vs 0.73 mm [0.70-0.78]; P=.004); the odds of having CIMT higher than threshold (0.77 mm) was statistically significant after adjusting for confounding factors (odds ratio, 3.17; 95% CI, 1.10-9.14). A meta-analysis of 10 studies conducted 10 or more years post partum included 813 women with and 2874 without histories of preeclampsia. Carotid artery intima-media thickness was greater among women with histories of preeclampsia, with a standardized mean difference of 0.18 and 95% CI of 0.05 to 0.30 mm (P=.004). CONCLUSION Among women with histories of preeclampsia, CIMT may identify those with subclinical atherosclerosis, thus offering an opportunity for early intervention.
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Affiliation(s)
- Vesna D Garovic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
| | - Natasa M Milic
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Tracey L Weissgerber
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Wendy M White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Howard N Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Bro Schmidt G, Christensen M, Breth Knudsen U. Preeclampsia and later cardiovascular disease - What do national guidelines recommend? Pregnancy Hypertens 2017; 10:14-17. [PMID: 29153667 DOI: 10.1016/j.preghy.2017.07.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/17/2017] [Accepted: 07/22/2017] [Indexed: 11/17/2022]
Abstract
Preeclamptic women have an increased risk of hypertension and cardiovascular disease (CVD) later in life. The aim was to compare the latest clinical recommendations on post-preeclamptic prevention of hypertension and CVD published by eight National Associations of Gynecologists and Obstetricians. Definitions of preeclampsia differ internationally. Recommendations on when, how and who to screen to reduce post-preeclamptic CVD risk also show substantial variation. The diverging preeclampsia definitions make CVD prevention strategies difficult to compare. The variations in clinical recommendations are in line with the lacking evidence of cost-efficient follow-up strategies and stress the need for further research to optimize prevention strategies.
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Affiliation(s)
- Gitte Bro Schmidt
- Department of Surgery - Woman and Child, Regional Hospital of Northern Denmark, Hjoerring, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Christensen
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark
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Ghodke B, Pusukuru R, Mehta V. Association of Lipid Profile in Pregnancy with Preeclampsia, Gestational Diabetes Mellitus, and Preterm Delivery. Cureus 2017; 9:e1420. [PMID: 28875093 PMCID: PMC5580975 DOI: 10.7759/cureus.1420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction During the last two trimesters of pregnancy, glucose is spared (for the foetus), while the concentration of fatty acids in plasma increases, which can create complications like preeclampsia, gestational diabetes mellitus (GDM), and preterm delivery. Aim To study the association of serum lipid levels during the second and third trimesters with the development of pregnancy-associated diseases, such as preeclampsia, GDM, and preterm delivery. Methods and Materials The present study was carried out at MGM Hospital, Navi Mumbai, India. Two hundred antenatal cases from October 2012 to October 2014 were enrolled after giving an informed consent. A lipid profile was recorded for each subject and was later accessed. The lipid profile of the subjects having either GDM, preterm, or preeclampsia was further used to find an association with the individual disorders. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY). All reported p-values are two-tailed, and confidence intervals were calculated at the 95% level. Results In preeclamptic patients, the mean systolic blood pressure was 151.40 mm/Hg and the mean diastolic blood pressure was 74.03 mm/Hg in the third trimester. In preeclamptic patients, the mean serum triglyceride levels in the second trimester were 204.00 mg/dl, while the mean was 243.20 mg/dl in the third trimester. In GDM patients, the mean serum triglyceride was 214.33 mg/dl in the second trimester, while it was 230.50 mg/dl in the third trimester. In patients with preterm, the mean triglycerides levels were 212.83 mg/dl and 240.16 mg/dl in the second and third trimesters, respectively. In preeclamptic patients, the mean serum cholesterol levels in the second trimester were 210 mg/dl, while in the third trimester, the mean was 243.60 mg/dl. In GDM patients, the mean serum cholesterol was 223.50 mg/dl and 242.83 mg/dl in the second and third trimester, respectively. The mean cholesterol levels in patients with preterm in second and third trimesters were 213.33 mg/dl and 243.66 mg/dl, respectively. Out of the total 200 patients, 168 had no complications, while 20 (10%) had preeclampsia, six (3%) had gestational diabetes mellitus, and the other six {3%} had preterm deliveries. Conclusion An association between maternal early pregnancy triglyceridaemia and the subsequent risk of preeclampsia, gestational diabetes, and preterm deliveries was observed. The occurrence of preeclampsia, gestational diabetes, and preterm deliveries cannot be predicted based on the values of serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C). Hence, estimation of lipid profile is strongly recommended during pregnancy to prevent the deleterious effect of hyperlipidaemia associated with pregnancy.
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Affiliation(s)
- Babita Ghodke
- Department of Medicine, MGM Medical College, Navi Mumbai, India
| | | | - Varshil Mehta
- Department of Internal Medicine, MGM Medical College, Navi Mumbai, India
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Effect of early-onset preeclampsia on cardiovascular risk in the fifth decade of life. Am J Obstet Gynecol 2017; 216:523.e1-523.e7. [PMID: 28209494 DOI: 10.1016/j.ajog.2017.02.015] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/13/2017] [Accepted: 02/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with hypertensive disorders in pregnancy, in particular early-onset preeclampsia, are at increased risk of developing cardiovascular disease later in life. These women have a more than 2-fold increased risk of dying from cardiovascular diseases. Most studies have focused on identification of risk factors shortly after pregnancy. Less is known on the prevalence of risk factors or actual signs of cardiovascular disease 5-20 years later. The presence of hypertension or metabolic syndrome can be seen as an opportunity for preventive interventions to reduce the development of severe cardiovascular diseases like myocardial infarction and stroke. OBJECTIVE To assess cardiovascular risk factors and established cardiovascular disease in women after early-onset preeclampsia, in the fifth decade of life. As a consequence, we can assess whether there is still a window of opportunity for preventive measures and to establish in what proportion of women cardiovascular disease already has developed. STUDY DESIGN In a prospective observational study, cardiovascular risk assessment was performed in women with early-onset preeclampsia (<34 weeks' gestation) and normotensive controls (≥37 weeks' gestation) 9-16 years after their index pregnancy. Medical records of 2 tertiary hospitals in Amsterdam, The Netherlands, were screened consecutively, and all eligible women were invited. Cardiovascular risk assessment consisted of a questionnaire, blood pressure measurement, anthropometrics, and blood and urine for fasting lipids, lipoproteins, glucose levels, glycated hemoglobin, renal function, N-terminal brain natriuretic peptide, and albuminuria. History of cardiovascular diseases (ie, myocardial infarction and stroke) was determined. Prevalence of women presenting in an optimal window of opportunity for preventive measures was defined by the presence of cardiovascular risk factors (ie, hypertension and metabolic syndrome) but in the absence of established cardiovascular diseases (ie, myocardial infarction and stroke). RESULTS Women with a history of early-onset preeclampsia (n = 131) had significantly greater systolic and diastolic blood pressure, greater body mass index, more often had an abnormal lipid profile (lower high-density lipoprotein levels, higher triglycerides), greater glycated hemoglobin, and greater levels of albuminuria compared to controls (n = 56). None of the women with a history of early-onset preeclampsia was diagnosed with cardiovascular disease; 38.2% were diagnosed with hypertension; and 18.2% were diagnosed with metabolic syndrome. A total of 42% met the criteria for the window of opportunity for preventive measures. In women with a history of an uncomplicated pregnancy, no women were diagnosed with cardiovascular disease; 14.3% were diagnosed with hypertension; 1.8% with metabolic syndrome. In this cohort, 14.3% met the criteria for the window of opportunity for preventive measures. CONCLUSION A large proportion of women who experienced early-onset preeclampsia had major cardiovascular risk factors in the fifth decade of life, compared with healthy controls. These women are currently outside the scope of most preventive programs due to their relatively young age, but have important modifiable risk factors for cardiovascular diseases.
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Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM. Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail 2017; 4:88-98. [PMID: 28451444 PMCID: PMC5396047 DOI: 10.1002/ehf2.12129] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022] Open
Abstract
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre‐eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre‐eclampsia.This systematic review and meta‐analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre‐eclampsia from women with non‐hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta‐analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre‐eclampsia from controls as well: C‐reactive protein, HDL, insulin, fatty acid‐binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid‐region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre‐eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
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Affiliation(s)
- Lisa J Alma
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Anouk Bokslag
- Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands
| | - Angela H E M Maas
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Arie Franx
- Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Walter J Paulus
- Department of PhysiologyVU University Medical CenterAmsterdamThe Netherlands
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Gallucci G, Gallicchio R, Storto G. Gynecologic history: What is the aftermath of a complicated pregnancy? Int J Cardiol 2016; 222:990-991. [PMID: 27526379 DOI: 10.1016/j.ijcard.2016.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/03/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppina Gallucci
- Cardio-oncology Unit, - Clinical Governance Department, - IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, PZ, Italy.
| | - Rosj Gallicchio
- Nuclear Medicine Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, PZ, Italy.
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, PZ, Italy.
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Auger N, Fraser WD, Schnitzer M, Leduc L, Healy-Profitós J, Paradis G. Recurrent pre-eclampsia and subsequent cardiovascular risk. Heart 2016; 103:235-243. [DOI: 10.1136/heartjnl-2016-309671] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 12/14/2022] Open
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Bryant A, Blake-Lamb T, Hatoum I, Kotelchuck M. Women’s Use of Health Care in the First 2 Years Postpartum: Occurrence and Correlates. Matern Child Health J 2016; 20:81-91. [DOI: 10.1007/s10995-016-2168-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jin WY, Lin SL, Hou RL, Chen XY, Han T, Jin Y, Tang L, Zhu ZW, Zhao ZY. Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth 2016; 16:60. [PMID: 27000102 PMCID: PMC4802610 DOI: 10.1186/s12884-016-0852-9] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 03/17/2016] [Indexed: 02/07/2023] Open
Abstract
Background Dyslipidemia in pregnancy are associated with gestational diabetes mellitus (GDM), preeclampsia, preterm birth and other adverse outcomes, which has been extensively studied in western countries. However, similar studies have rarely been conducted in Asian countries. Our study was aimed at investigating the associations between maternal dyslipidemia and adverse pregnancy outcomes among Chinese population. Methods Data were derived from 934 pairs of non-diabetic mothers and neonates between 2010 and 2011. Serum blood samples were assayed for fasting total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) concentrations during the first, second and third trimesters. The present study explored the associations between maternal lipid profile and pregnancy complications and perinatal outcomes. The pregnancy complications included GDM, preeclampsia and intrahepatic cholestasis of pregnancy (ICP); the perinatal outcomes included preterm birth, small/large for gestational age (SGA/LGA) infants and macrosomia. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were calculated and adjusted via stepwise logistic regression analysis. Optimal cut-off points were determined by ROC curve analysis. Results After adjustments for confounders, every unit elevation in third-trimester TG concentration was associated with increased risk for GDM (OR = 1.37, 95 % CI: 1.18-1.58), preeclampsia (OR = 1.50, 95 % CI: 1.16-1.93), ICP (OR = 1.28, 95 % CI: 1.09-1.51), LGA (OR = 1.13, 95 % CI: 1.02-1.26), macrosomia (OR = 1.19, 95 % CI: 1.02-1.39) and decreased risk for SGA (OR = 0.63, 95 % CI: 0.40-0.99); every unit increase in HDL-C concentration was associated with decreased risk for GDM and macrosomia, especially during the second trimester (GDM: OR = 0.10, 95 % CI: 0.03-0.31; macrosomia: OR = 0.25, 95 % CI: 0.09-0.73). The optimal cut-off points for third-trimester TG predicting GDM, preeclampsia, ICP, LGA and SGA were separately ≥3.871, 3.528, 3.177, 3.534 and ≤2.530 mmol/L. The optimal cut-off points for third-trimester HDL-C identifying GDM, macrosomia and SGA were respectively ≤1.712, 1.817 and ≥2.238 mmol/L. Conclusions Among Chinese population, maternal high TG in late pregnancy was independently associated with increased risk of GDM, preeclampsia, ICP, LGA, macrosomia and decreased risk of SGA. Relative low maternal HDL-C during pregnancy was significantly associated with increased risk of GDM and macrosomia; whereas relative high HDL-C was a protective factor for both of them.
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Affiliation(s)
- Wen-Yuan Jin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Sheng-Liang Lin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ruo-Lin Hou
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xiao-Yang Chen
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Ting Han
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yan Jin
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Li Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, WA6845, Australia
| | - Zhi-Wei Zhu
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zheng-Yan Zhao
- Department of Children's Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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