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Miller HE, Tierney S, Stefanick ML, Mayo JA, Sedan O, Rosas LG, Melbye M, Boyd HA, Stevenson DK, Shaw GM, Winn VD, Hlatky MA. Vascular health years after a hypertensive disorder of pregnancy: The EPOCH study. Am Heart J 2024; 272:96-105. [PMID: 38484963 PMCID: PMC11070303 DOI: 10.1016/j.ahj.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Preeclampsia is associated with a two-fold increase in a woman's lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD), but the reasons for this association are uncertain. The objective of this study was to examine the associations between vascular health and a hypertensive disorder of pregnancy among women ≥ 2 years postpartum. METHODS Pre-menopausal women with a history of either a hypertensive disorder of pregnancy (cases: preeclampsia or gestational hypertension) or a normotensive pregnancy (controls) were enrolled. Participants were assessed for standard ASCVD risk factors and underwent vascular testing, including measurements of blood pressure, endothelial function, and carotid artery ultrasound. The primary outcomes were blood pressure, ASCVD risk, reactive hyperemia index measured by EndoPAT and carotid intima-medial thickness. The secondary outcomes were augmentation index normalized to 75 beats per minute and pulse wave amplitude measured by EndoPAT, and carotid elastic modulus and carotid beta-stiffness measured by carotid ultrasound. RESULTS Participants had a mean age of 40.7 years and were 5.7 years since their last pregnancy. In bivariate analyses, cases (N = 68) were more likely than controls (N = 71) to have hypertension (18% vs 4%, P = .034), higher calculated ASCVD risk (0.6 vs 0.4, P = .02), higher blood pressures (systolic: 118.5 vs 111.6 mm Hg, P = .0004; diastolic: 75.2 vs 69.8 mm Hg, P = .0004), and higher augmentation index values (7.7 vs 2.3, P = .03). They did not, however, differ significantly in carotid intima-media thickness (0.5 vs 0.5, P = .29) or reactive hyperemia index (2.1 vs 2.1, P = .93), nor in pulse wave amplitude (416 vs 326, P = .11), carotid elastic modulus (445 vs 426, P = .36), or carotid beta stiffness (2.8 vs 2.8, P = .86). CONCLUSION Women with a prior hypertensive disorder of pregnancy had higher ASCVD risk and blood pressures several years postpartum, but did not have more endothelial dysfunction or subclinical atherosclerosis.
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Affiliation(s)
- Hayley E Miller
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Seda Tierney
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Jonathan A Mayo
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Oshra Sedan
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mads Melbye
- Danish Cancer Institute, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather A Boyd
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Mark A Hlatky
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Stanford University School of Medicine, Stanford, CA.
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Zhou L, Liu X, He G, Sun C. Causal effects of hypertensive disorders of pregnancy on future gynecologic tumors: A two-sample Mendelian randomization study. Cancer Med 2024; 13:e7300. [PMID: 38800978 PMCID: PMC11129165 DOI: 10.1002/cam4.7300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/02/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Numerous observational studies have investigated the potential link between hypertensive disorders of pregnancy (HDPs) and the subsequent risks of gynecologic tumors, yet the findings have been inconsistent. In this study, we utilized Mendelian randomization (MR) approach to assess the influence of HDPs on the future risks of ovarian, cervical, endometrial, and breast cancer and uterine fibroids, controlling for confounding factors. METHODS The genome-wide association studies (GWAS) summary data relevant to HDPs was obtained from the FinnGen databases (10,736 cases and 136,325 controls). Gynecologic tumor outcomes were extracted from the IEU Open GWAS project and UK Biobank (47,690 cases and 1, 092,073 controls). The inverse variance weighted (IVW) approach was selected as the principal method for MR analysis, supplemented by MR-Egger, weighted median, weighted model, simple model methods, MR pleiotropy residual sum and outlier (MR-PRESSO) test, and leave-one-out method. Multivariate MR (MVMR) analysis was conducted after adjusting systolic blood pressure (SBP), body mass index (BMI) and type 2 diabetes mellitus (T2DM). RESULTS Our univariate MR analysis (UVMR) results revealed no significant relationship between HDPs and the risks of ovarian cancer (odds ratio [OR] = 0.924, p = 0.360), cervical cancer (OR = 1.230, p = 0.738), endometrial cancer (OR = 1.006, p = 0.949), uterine fibroids (OR = 1.155, p = 0.158), and breast cancer (OR = 0.792, p = 0.241) by IVW test. Similar results were observed in gestational hypertension and preeclampsia/eclampsia. Additionally, our study detected neither heterogeneity nor pleiotropy. MVMR analysis also provided no evidence of a causal association between HDPs and common gynecologic tumors after adjusting SBP, BMI, and T2DM. CONCLUSION We discovered no causal relationship between HDPs and ovarian, cervical, endometrial, breast cancer, and uterine fibroids in European populations. However, present analysis did not explore the effect of HDPs on the subtypes of gynecologic tumors across varied ethnic populations, which may require additional research.
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Affiliation(s)
- Le Zhou
- Department of Gynecology and ObstetricsWest China Second University Hospital, Sichuan UniversityChengduChina
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationWest China Second University Hospital, Sichuan UniversityChengduChina
| | - Xinghui Liu
- Department of Gynecology and ObstetricsWest China Second University Hospital, Sichuan UniversityChengduChina
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationWest China Second University Hospital, Sichuan UniversityChengduChina
| | - Guolin He
- Department of Gynecology and ObstetricsWest China Second University Hospital, Sichuan UniversityChengduChina
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationWest China Second University Hospital, Sichuan UniversityChengduChina
| | - Chuntang Sun
- Department of Gynecology and ObstetricsWest China Second University Hospital, Sichuan UniversityChengduChina
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationWest China Second University Hospital, Sichuan UniversityChengduChina
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Inversetti A, Pivato CA, Cristodoro M, Latini AC, Condorelli G, Di Simone N, Stefanini G. Update on long-term cardiovascular risk after pre-eclampsia: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:4-13. [PMID: 37974053 DOI: 10.1093/ehjqcco/qcad065] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND/INTRODUCTION There is a need for further studies on the cardiovascular risk of women experiencing pre-eclampsia (PE). PURPOSE To update the literature regarding the association between a history of PE and subsequent cardiovascular diseases, including cardiovascular death, coronary heart diseases, heart failure, and stroke, focusing on the trend in the effect size (ES) estimates over time. METHODS AND RESULTS Following PRISMA guidelines, from inception to May 2023, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort, or case-control studies in English were included if fulfiling the following criteria:(i) The association between PE and subsequent cardiovascular disease was adjusted for clinically relevant variables, (ii) the presence of a control group, and (iii) at least 1 year of follow-up. Pooled adjusted ESs and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model. Twenty-two studies met the inclusion criteria. PE was associated with a higher risk of cardiovascular death (ES 2.08, 95% CI 1.70-2.54, I2 56%, P < 0.00001), coronary artery diseases (ES 2.04, 95% CI 1.76-2.38, I2 87%, P < 0.00001), heart failure (ES 2.47, 95% CI 1.89-3.22, I2 83%, P < 0.00001), and stroke (ES 1.75, 95% CI 1.52-2.02, I2 72%, P < 0.00001) after adjusting for potential confounders. This risk is evident in the first 1-to-3 years of follow-up and remains significant until 39 years of follow-up. CONCLUSIONS Compared to women who experienced a normal pregnancy, those suffering from PE have about double the risk of lifetime cardiovascular disease.
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Affiliation(s)
- Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Martina Cristodoro
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Alessia Chiara Latini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
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Yao M, Chen L, Peng P, Zhong Z. Women with preeclampsia may have reduced risk of breast cancer: a meta-analysis of cohort studies with 7.8 million participants. Hypertens Pregnancy 2023; 42:2265482. [PMID: 37847190 DOI: 10.1080/10641955.2023.2265482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
This review pooled data from the literature to examine the association between preeclampsia (PE) and subsequent risk of breast cancer in women. Cohort studies published in the databases of PubMed, Embase, Scopus, and Web of Science up to 18 July 2023 were searched. Adjusted data were pooled to obtain the risk ratio (RR). Eleven studies with 15 cohorts and a cumulative sample size of 7,838,693 women were included. Meta-analysis of all studies demonstrated a reduced risk of breast cancer in women with PE as compared to those without PE (RR: 0.89 95% CI: 0.83, 0.95 p < 0.001 I2 = 50%). Follow-up ranged from 8 to 29.2 years. Results did not change during sensitivity analysis. Outcomes varied on subgroup analysis based on location, study type, data extraction method, incidence of breast cancer, and follow-up. To conclude, women with PE may have a reduced risk of breast cancer later in life. However, the risk reduction is minimal and may not have much clinical significance. The evidence is also limited by high inter-study heterogeneity and lack of adjustment of all possible confounders.
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Affiliation(s)
- Min Yao
- Department of Breast Surgery, Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Lijie Chen
- Department of Breast Surgery, Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Puchao Peng
- Department of Breast Surgery, Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Zhiwei Zhong
- Department of Breast Surgery, Huzhou Maternity & Child Health Care Hospital, Huzhou, China
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Ashworth D, Battersby C, Bick D, Green M, Hardy P, Leighton L, Magee LA, Maher A, McManus RJ, Moakes C, Morris RK, Nelson-Piercy C, Sparkes J, Rivero-Arias O, Webb A, Wilson H, Myers J, Chappell LC. A treatment strategy with nifedipine versus labetalol for women with pregnancy hypertension: study protocol for a randomised controlled trial (Giant PANDA). Trials 2023; 24:584. [PMID: 37700365 PMCID: PMC10496358 DOI: 10.1186/s13063-023-07582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Approximately one in ten women have high blood pressure during pregnancy. Hypertension is associated with adverse maternal and perinatal outcomes, and as treatment improves maternal outcomes, antihypertensive treatment is recommended. Previous trials have been unable to provide a definitive answer on which antihypertensive treatment is associated with optimal maternal and neonatal outcomes and the need for robust evidence evaluating maternal and infant benefits and risks remains an important, unanswered question for research and clinical communities. METHODS The Giant PANDA study is a pragmatic, open-label, multicentre, randomised controlled trial of a treatment initiation strategy with nifedipine (calcium channel blocker), versus labetalol (mixed alpha/beta blocker) in 2300 women with pregnancy hypertension. The primary objective is to evaluate if treatment with nifedipine compared to labetalol in women with pregnancy hypertension reduces severe maternal hypertension without increasing fetal or neonatal death or neonatal unit admission. Subgroup analyses will be undertaken by hypertension type (chronic, gestational, pre-eclampsia), diabetes (yes, no), singleton (yes, no), self-reported ethnicity (Black, all other), and gestational age at randomisation categories (11 + 0 to 19 + 6, 20 + 0 to 27 + 6, 28 + 0 to 34 + 6 weeks). A cost-effectiveness analysis using an NHS perspective will be undertaken using a cost-consequence analysis up to postnatal hospital discharge and an extrapolation exercise with a lifetime horizon conditional on the results of the cost-consequence analysis. DISCUSSION This trial aims to address the uncertainty of which antihypertensive treatment is associated with optimal maternal and neonatal outcomes. The trial results are intended to provide definitive evidence to inform guidelines and linked, shared decision-making tools, thus influencing clinical practice. TRIAL REGISTRATION EudraCT number: 2020-003410-12, ISRCTN: 12,792,616 registered on 18 November 2020.
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Affiliation(s)
- Danielle Ashworth
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Pollyanna Hardy
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Leighton
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura A Magee
- Institute of Women and Children's Health, King's College London, London, UK
| | - Alisha Maher
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Catherine Moakes
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - R Katie Morris
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jenie Sparkes
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Webb
- Clinical Pharmacology, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London British Heart Foundation Centre of Research Excellence, London, UK
| | - Hannah Wilson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jenny Myers
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
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Brohan MP, Daly FP, Kelly L, McCarthy FP, Khashan AS, Kublickiene K, Barrett PM. Hypertensive disorders of pregnancy and long-term risk of maternal stroke-a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:248-268. [PMID: 36990309 DOI: 10.1016/j.ajog.2023.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke. DATA SOURCES PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022. STUDY ELIGIBILITY CRITERIA Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke. METHODS Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment. RESULTS The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19). CONCLUSION In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.
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Affiliation(s)
- Matthew P Brohan
- School of Public Health, University College Cork, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland.
| | - Fionn P Daly
- School of Medicine, University College Cork, Cork, Ireland
| | - Louise Kelly
- Department of General Medicine, Beaumont Hospital, Dublin, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
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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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Jordao H, Herink K, Ka E, McVicker L, Kearns C, McMenamin ÚC. Pre-eclampsia during pregnancy and risk of endometrial cancer: a systematic review and meta-analysis. BMC Womens Health 2023; 23:259. [PMID: 37173714 PMCID: PMC10182685 DOI: 10.1186/s12905-023-02408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Pre-eclampsia may be associated with the development of endometrial cancer; however, previous findings have been conflicting. OBJECTIVES To investigate if pre-eclampsia is associated with an increased risk of endometrial cancer. METHOD Two independent reviewers screened titles and abstracts of studies identified in MEDLINE, Embase, and Web of Science databases from inception until March 2022. Studies were included if they investigated pre-eclampsia and subsequent risk of endometrial cancer (or precursor lesions). Random-effects meta-analysis was used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between pre-eclampsia during pregnancy and endometrial cancer risk. MAIN RESULTS There were seven articles identified which investigated endometrial cancer, of which one also investigated endometrial cancer precursors. Overall, the studies include 11,724 endometrial cancer cases. No association was observed between pre-eclampsia and risk of endometrial cancer with moderate heterogeneity observed (pooled HR 1.07, 95% CI 0.79-1.46, I2 = 34.1%). In sensitivity analysis investigating risk of endometrial neoplasia (atypical hyperplasia, carcinoma in situ, or cancer), there was some evidence that pre-eclampsia was associated with an increased risk (HR 1.34, 95% CI 1.15-1.57, I2 = 29.6%). CONCLUSIONS Pre-eclampsia was not associated with an increased risk of endometrial cancer. Additional large studies with information on pre-eclampsia sub-type aiming to investigate endometrial cancer precursor conditions are merited.
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Affiliation(s)
- H Jordao
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - K Herink
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - Eastwood Ka
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
- Department of St. Michael's Hospital, Bristol, UK
| | - L McVicker
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - C Kearns
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - Ú C McMenamin
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
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Powell M, Fuller S, Gunderson E, Benz C. A common IGF1R gene variant predicts later life breast cancer risk in women with preeclampsia. Breast Cancer Res Treat 2023; 197:149-159. [PMID: 36331687 PMCID: PMC9823040 DOI: 10.1007/s10549-022-06789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Preeclampsia has been inconsistently associated with altered later life risk of cancer. This study utilizes the Nurses' Health Study 2 (NHS2) to determine if the future risk of breast and non-breast cancers in women who experience preeclampsia is modified by carrying a protective variant of rs2016347, a functional insulin-like growth factor receptor-1 (IGF1R) single nucleotide polymorphism. METHODS This retrospective cohort study completed within the NHS2 evaluated participants enrolled in 1989 and followed them through 2015, with a study population of 86,751 after exclusions. Cox proportional hazards models both with and without the impact of rs2016347 genotype were used to assess the risk of invasive breast cancer, hormone receptor-positive (HR+) breast cancer, and non-breast cancers. RESULTS Women with preeclampsia had no change in risk of all breast, HR+ breast, or non-breast cancers when not considering genotype. However, women carrying at least one T allele of rs2016347 had a lower risk of HR+ breast cancer, HR 0.67, 95% CI: 0.47-0.97, P = 0.04, with interaction term P = 0.06. For non-breast cancers as a group, women carrying a T allele had an HR 0.76, 95% CI: 0.53-1.08, P = 0.12, with interaction term P = 0.26. CONCLUSIONS This retrospective cohort study found that women with preeclampsia who carry a T allele of IGF1R rs2016347 had a reduced future risk of developing HR+ breast cancer, and a reduced but not statistically significant decreased risk of non-breast cancers suggesting a possible role for the IGF-1 axis in the development of cancer in these women.
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Affiliation(s)
- Mark Powell
- grid.272799.00000 0000 8687 5377Buck Institute for Research On Aging, 8001 Redwood Blvd, Novato, CA 94945 USA
| | - Sophia Fuller
- grid.47840.3f0000 0001 2181 7878Graduate Group in Biostatistics, School of Public Health, University of California, Berkeley, CA USA
| | - Erica Gunderson
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente Northern California, Oakland, CA USA
| | - Christopher Benz
- grid.272799.00000 0000 8687 5377Buck Institute for Research On Aging, 8001 Redwood Blvd, Novato, CA 94945 USA
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10
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Welters SM, de Boer M, Teunissen PW, Hermes W, Ravelli ACJ, Mol BW, de Groot CJM. Cardiovascular mortality in women in their forties after hypertensive disorders of pregnancy in the Netherlands: a national cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e34-e42. [PMID: 36610446 DOI: 10.1016/s2666-7568(22)00292-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are associated with cardiovascular disease later in life. Given that hypertensive disorders of pregnancy often occur at a relatively young age, there might be an opportunity to use preventive measures to reduce the risk of early cardiovascular disease and mortality. The aim of this study was to assess the risk of cardiovascular mortality in women after a hypertensive disorder of pregnancy. METHODS In this population-based cohort study, the Netherlands Perinatal Registry (PRN) and the national death registry at the Dutch Central Bureau for Statistics were linked. We analysed women in the Netherlands with a first birth during 1995-2015 to determine the association between cardiovascular mortality and hypertensive disorders of pregnancy (based on recorded diastolic blood pressure or proteinuria, or both). We analysed the association between the highest diastolic blood pressure measured in pregnancy and cardiovascular mortality and constructed survival curves to assess cardiovascular mortality after hypertensive disorders of pregnancy, specifically pre-eclampsia and gestational hypertension. To differentiate between the severity of hypertensive disorders of pregnancy, cardiovascular mortality was assessed in women with a combination of hypertensive disorders of pregnancy with preterm birth (gestational age <37 weeks) and growth restriction (birthweight in the 10th percentile or less). All hazard ratios (HRs)were adjusted for maternal age. FINDINGS Between Jan 1, 1995, and Dec 31, 2015, the PRN contained 2 462 931 deliveries and 1 625 246 women. In 1 243 890 women data on their first pregnancy were available and were included in this analysis after linkage, with a median follow-up time of 11·2 years (IQR 6·1-16·3). 259 177 (20·8%) women had hypertensive disorders of pregnancy, and of these 45 482 (3·7%) women had pre-eclampsia and 213 695 (17·2%) women had gestational hypertension; 984 713 (79·2%) women did not develop hypertension in their first pregnancy. Compared with women without hypertensive disorders of pregnancy, the risk of death from any cause was higher in women who had hypertensive disorders (HR 1·30 [95% CI 1·23-1·37], p<0·001), pre-eclampsia (1·65 [1·48-1·83]; p<0·0001), and gestational hypertension (1·23 [1·16-1·30]; p<0·0001). Those women with pre-eclampsia had a higher risk of cardiovascular mortality compared with those without any hypertensive disorders of pregnancy (adjusted HR 3·39 [95% CI 2·67-4·29]), as did those with gestational hypertension (2·22 [1·91-2·57]). For women with a history of hypertensive disorders of pregnancy combined with preterm birth (gestational age <37 weeks) and birthweight in the 10th percentile or less, the adjusted HR for cardiovascular mortality was 6·43 (95% CI 4·36-9·47), compared with women without a hypertensive disorder of pregnancy. The highest diastolic blood pressure measured during pregnancy was the strongest risk factor for cardiovascular mortality (for 80-89 mm Hg: adjusted HR 1·47 [95% CI 1·00-2·17]; for 130 mm Hg and higher: 14·70 [7·31-29·52]). INTERPRETATION Women with a history of hypertensive disorders of pregnancy have a risk of cardiovascular mortality that is 2-3 times higher than that of women with normal blood pressure during pregnancy. The highest measured diastolic blood pressure during pregnancy is an important predictor for cardiovascular mortality later in life; therefore, women who have hypertensive disorders of pregnancy should be given personalised cardiovascular follow-up plans to reduce their risk of cardiovascular mortality. FUNDING None.
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Affiliation(s)
- Sophie M Welters
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands.
| | - Marjon de Boer
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Wietske Hermes
- Department of Obstetrics and Gynecology, Haaglanden Medical Center, The Hague, Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, and Department of Medical Informatics, Academic Medical Center, Amsterdam, Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, VU Medical Center, Amsterdam, Netherlands
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11
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Venetkoski M, Joensuu J, Gissler M, Ylikorkala O, Mikkola TS, Savolainen-Peltonen H. Pre-eclampsia and cardiovascular risk: a long-term nationwide cohort study on over 120 000 Finnish women. BMJ Open 2022; 12:e064736. [PMID: 36549728 PMCID: PMC9791391 DOI: 10.1136/bmjopen-2022-064736] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate the impact of pre-eclampsia on the future cardiovascular risk in Finnish women DESIGN: A registry-based nationwide controlled cohort study. SETTING Women hospitalised for pre-eclampsia in 1969-1993 and control women with a history of normotensive pregnancies followed from the pre-eclampsia diagnosis until 2019 for cardiovascular outcomes. PARTICIPANTS 31 688 women with and 91 726 control women without a history of pre-eclampsia. PRIMARY OUTCOME MEASURES Incidences of and deaths from ischaemic heart disease (IHD), myocardial infarction (MI) and stroke. RESULTS In total, 25 813 (81.5%) women had pre-eclampsia without severe features, 4867 (15.4%) had pre-eclampsia with severe features and 1006 (3.2%) women developed eclampsia. Women with a history of pre-eclampsia showed elevated risks for IHD (HR 1.52, 95% CI 1.44 to 1.59), MI (HR 1.66, 95% CI 1.52 to 1.81) and stroke (HR 1.40, 95% CI 1.32 to 1.48). The risks for death from IHD (HR 1.50, 95% CI 1.28 to 1.75), MI (1.63, 95% CI 1.30 to 2.05) and stroke (1.44, 95% CI 1.03 to 2.01) were also elevated. Pre-eclampsia with severe features or eclampsia was accompanied with 15% higher IHD risk, 19% higher MI risk and 26% higher stroke risk than pre-eclampsia without severe features. The highest risk elevations of 30% for IHD, 32% for MI and 30% for stroke were observed in women with recurrent pre-eclampsia (n=4180). CONCLUSION Pre-eclampsia-related significant elevations in CVD risks of Finnish women with inherently high risk for these diseases were of the same magnitude as reported previously from other countries. Thus, women with a history of pre-eclampsia should be screened and treated early for modifiable cardiovascular risk factors.
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Affiliation(s)
- Minttu Venetkoski
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Joensuu
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Information, THL National Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Olavi Ylikorkala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomi Sakari Mikkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Savolainen-Peltonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Goldberg M, Díaz-Santana MV, O’Brien KM, Zhao S, Weinberg CR, Sandler DP. Gestational Hypertensive Disorders and Maternal Breast Cancer Risk in a Nationwide Cohort of 40,720 Parous Women. Epidemiology 2022; 33:868-879. [PMID: 35648421 PMCID: PMC9560953 DOI: 10.1097/ede.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Preeclampsia and gestational hypertension are hypothesized to be associated with reduced maternal breast cancer risk, but the epidemiologic evidence is inconclusive. Our objective was to examine associations between gestational hypertensive disorders and breast cancer in a nationwide cohort of women with a family history of breast cancer. METHODS Women ages 35-74 years who had a sister previously diagnosed with breast cancer, but had never had breast cancer themselves, were enrolled in the Sister Study from 2003 to 2009 (N = 50,884). At enrollment, participants reported diagnoses of eclampsia, preeclampsia, or gestational hypertension in each pregnancy. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between history of a gestational hypertensive disorder and incident invasive breast cancer or ductal carcinoma in situ among 40,720 parous women. We used age as the time scale and adjusted for birth cohort, race-ethnicity, and reproductive, socioeconomic, and behavioral factors. We examined effect measure modification by risk factors for gestational hypertensive disease and breast cancer and assessed possible etiologic heterogeneity across tumor characteristics. RESULTS The prevalence of gestational hypertensive disease was 12%. During follow-up (mean = 10.9 years), 3,198 eligible women self-reported a breast cancer diagnosis. History of a gestational hypertensive disorder was not associated with breast cancer risk (HR = 1.0; 95% CI = 0.90, 1.1). We did not observe clear evidence of effect measure modification or etiologic heterogeneity. CONCLUSIONS History of a gestational hypertensive disorder was not associated with breast cancer risk in a cohort of women with a first-degree family history of breast cancer.
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Affiliation(s)
- Mandy Goldberg
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Mary V. Díaz-Santana
- Biostatistics & Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Katie M. O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Shanshan Zhao
- Biostatistics & Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Clarice R. Weinberg
- Biostatistics & Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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13
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Validation of the French translation of a self-administered questionnaire looking for a history of pre-eclampsia. Pregnancy Hypertens 2022; 28:146-148. [PMID: 35405412 DOI: 10.1016/j.preghy.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
We evaluated the diagnostic performances of the French translation of a self-administered questionnaire designed by Diehl et al. looking for a history of pre-eclampsia. After a phone call, 206 women who gave birth at Brest University Hospital responded to the questionnaire online. Then, their responses were compared to their medical files. The sensitivity of the questionnaire was 95.2% and its specificity was 98.0%. This French questionnaire has then demonstrated its validity. It can now be used to explore the role of a pre-eclampsia history on various pathologies and, by this mean, to improve knowledge about women's health.
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14
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Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
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15
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Park Y, Cho GJ, Roh SY, Na JO, Oh MJ. Increased Cardiac Arrhythmia After Pregnancy-Induced Hypertension: A South Korean Nationwide Database Study. J Am Heart Assoc 2022; 11:e023013. [PMID: 35014853 PMCID: PMC9238534 DOI: 10.1161/jaha.121.023013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Although pregnancy‐induced hypertension (PIH) is associated with an elevated cardiovascular risk, long‐term studies or prepregnancy baseline data are scarce. Therefore, using a large nationwide cohort with prepregnancy periodic health screening data, we investigated whether clinically significant arrhythmia incidence increases after PIH. Methods and Results Data were extracted from the Korea National Health Insurance database and combined with the National Health Screening Examination database; women who gave birth between 2007 and 2015 and underwent the national health screening test within a year before pregnancy were followed up until 2016. We excluded women who had a diagnosis of arrhythmia within 1 year before pregnancy. The primary outcome was significant arrhythmia during the year after delivery. Secondary analysis included only specific diagnostic codes of arrhythmia with clinical significance. Additionally, the risk of arrhythmia was stratified by the use of magnesium sulfate. Of 2 035 684 women (PIH; n=37 297 versus normotensive pregnancy; n=1 998 387), the PIH group had a higher prepregnancy risk profile and showed a higher incidence of arrhythmia than women with normotensive pregnancies within 1 year. Women with PIH had a significantly higher risk of atrial flutter/fibrillation and atrioventricular block, but not lethal arrhythmias. Other predictors of arrhythmia development included advanced maternal age and cesarean section. Stratified analysis showed a higher risk of arrhythmia with magnesium sulfate use. Conclusions PIH was significantly associated with the development of arrhythmia within 1 year after delivery. Nevertheless, the incidence of lethal arrhythmias was not increased by PIH. Arrhythmia, especially atrial fibrillation, may largely contribute to increasing the future cardiovascular risk in women with a PIH history.
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Affiliation(s)
- Yoonjee Park
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology Korea University College of Medicine Seoul South Korea
| | - Seung-Young Roh
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul South Korea
| | - Jin Oh Na
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul South Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology Korea University College of Medicine Seoul South Korea
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16
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Oliver-Williams C, Johnson JD, Vladutiu CJ. Maternal Cardiovascular Disease After Pre-Eclampsia and Gestational Hypertension: A Narrative Review. Am J Lifestyle Med 2021; 17:8-17. [PMID: 36636385 PMCID: PMC9830232 DOI: 10.1177/15598276211037964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Previous literature has highlighted that women who have a pregnancy affected by gestational hypertension or preeclampsia are at higher risk of cardiovascular disease (CVD) in later life. However, CVD is a composite of multiple outcomes, including coronary heart disease, heart failure, and stroke, and the risk of both CVD and hypertensive disorders of pregnancy varies by the population studied. We conducted a narrative review of the risk of cardiovascular outcomes for women with prior gestational hypertension and pre-eclampsia. Previous literature is summarized by country and ethnicity, with a higher risk of CVD and coronary heart disease observed after gestational hypertension and a higher risk of CVD, coronary heart disease and heart failure observed after pre-eclampsia in most of the populations studied. Only one study was identified in a low- or middle-income country, and the majority of studies were conducted in white or mixed ethnicity populations. We discuss potential interventions to mitigate cardiovascular risk for these women in different settings and highlight the need for a greater understanding of the epidemiology of CVD risk after gestational hypertension and pre-eclampsia outside of high-income, white populations.
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Affiliation(s)
- Clare Oliver-Williams
- Clare Oliver-Williams, Strangeways Research
Laboratory, Department of Public Health and Primary Care, University of
Cambridge, Cambridge CB1 8RN, United Kingdom; e-mail:
| | - Jasmine D. Johnson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Catherine J. Vladutiu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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17
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Johnston A, Tseung V, Dancey SR, Visintini SM, Coutinho T, Edwards JD. Use of Race, Ethnicity, and National Origin in Studies Assessing Cardiovascular Risk in Women With a History of Hypertensive Disorders of Pregnancy. CJC Open 2021; 3:S102-S117. [PMID: 34993440 PMCID: PMC8712581 DOI: 10.1016/j.cjco.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Women with a history of hyperBtensive disorders of pregnancy (HDP) are at particularly high risk for cardiovascular disease (CVD) and CVD-related death, and certain racial and ethnic subpopulations are disproportionately affected by these conditions. We examined the use of race, ethnicity, and national origin in observational studies assessing CVD morbidity and mortality in women with a history of HDP. A total of 124 studies, published between 1976 and 2021, were reviewed. We found that white women were heavily overrepresented, encompassing 53% of all participants with HDP. There was limited and heterogeneous reporting of race and ethnicity information across studies and only 27 studies reported including race and/or ethnicity variables in at least 1 statistical analysis. Only 2 studies mentioned the use of these variables as a strength; several others (k = 18) reported a lack of diversity among participants as a study limitation. Just over half of included articles (k = 68) reported at least 1 sociodemographic variable other than race and ethnicity (eg, marital status and income); however, none investigated how they might have worked synergistically or antagonistically with race and/or ethnicity to influence participants' risk of CVD. These findings highlight significant areas for improvement in cardiovascular obstetrics research, including the need for more robust and standardized methods for collecting, reporting, and using sociodemographic information. Future studies of CVD risk in women with a history of HDP should explicitly examine racial and ethnic differences and use an intersectional approach.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Victrine Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sonia R. Dancey
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah M. Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- IC/ES, Ottawa, Ontario, Canada
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18
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Malek AM, Wilson DA, Turan TN, Mateus J, Lackland DT, Hunt KJ. Incident Heart Failure Within the First and Fifth Year after Delivery Among Women With Hypertensive Disorders of Pregnancy and Prepregnancy Hypertension in a Diverse Population. J Am Heart Assoc 2021; 10:e021616. [PMID: 34431312 PMCID: PMC8649300 DOI: 10.1161/jaha.121.021616] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
Background Hypertensive disorders of pregnancy (HDP) and pre-pregnancy hypertension are associated with increased morbidity and mortality for the mother. Our aim was to investigate the relationships between HDP and pre-pregnancy hypertension with maternal heart failure (HF) within 1 and 5 years of delivery and to examine racial/ethnic differences. Methods and Results We conducted a retrospective cohort study in South Carolina (2004-2016) involving 425 649 women aged 12 to 49 years (58.9% non-Hispanic White [NHW], 31.5% non-Hispanic Black [NHB], 9.6% Hispanic) with a live, singleton birth. Incident HF was defined by hospital/emergency department visit and death certificate data. Pre-pregnancy hypertension and HDP (preeclampsia, eclampsia, or gestational hypertension) were based on hospitalization/emergency department visit and birth certificate data (i.e., gestational hypertension for HDP). The 425 649 women had pre-pregnancy hypertension without superimposed HDP (pre-pregnancy hypertension alone; 0.4%), HDP alone (15.7%), pre-pregnancy hypertension with superimposed HDP (both conditions; 2.2%), or neither condition in any pregnancy (81.7%). Incident HF event rates per 1000 person-years were higher in NHB than NHW women with HDP (HDP: 2.28 versus 0.96; both conditions: 4.30 versus 1.22, respectively). After adjustment, compared with women with neither condition, incident HF risk within 5 years of delivery was increased for women with pre-pregnancy hypertension (HR,2.55, 95% CI: 1.31-4.95), HDP (HR,4.20, 95% CI: 3.66-4.81), and both conditions (HR,5.25, 95% CI: 4.24-6.50). Conclusions Women with HDP and pre-pregnancy hypertension were at higher HF risk (highest for superimposed preeclampsia) within 5 years of delivery. NHB women with HDP had higher HF risk than NHW women, regardless of pre-pregnancy hypertension.
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Affiliation(s)
- Angela M. Malek
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Dulaney A. Wilson
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Tanya N. Turan
- Department of NeurologyMedical University of South CarolinaCharlestonSC
| | - Julio Mateus
- Department of Obstetrics & Gynecology, Maternal‐Fetal Medicine DivisionAtrium HealthCharlotteNC
| | | | - Kelly J. Hunt
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
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19
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Preeclampsia and cancer risk in women in later life: a systematic review and meta-analysis of cohort studies. ACTA ACUST UNITED AC 2021; 28:1070-1078. [PMID: 34374685 DOI: 10.1097/gme.0000000000001806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE Results of this work may provide some guidance for subsequent ovarian cancer screening in women with preeclampsia and provide new directions for future studies. OBJECTIVE This study investigated the difference in cancer risk between women with preeclampsia and women with a normal pregnancy. EVIDENCE REVIEW Electronic databases, namely PubMed, Embase, and the Cochrane Library, were searched for relevant studies from database inception to February 4, 2021. The results are expressed as risk ratios (RRs). FINDINGS The study included 13 cohort studies comprising 5,254,150 participants. The difference in the total cancer risk between the control and preeclampsia groups was statistically nonsignificant. However, breast cancer (BC) risk was lower in the preeclampsia group (RR = 0.88, 95% confidence interval (CI) = 0.83-0.93; I2 = 57.2%). A subgroup analysis stratified by reproductive factors demonstrated that BC risk in the preeclampsia population decreased in parous women (RR = 0.79, 95% CI = 0.72-0.87; I2 = 0%), women with full-term pregnancies (RR = 0.79, 95% CI = 0.75-0.84; I2 = 0%), and women with increasing parity. Furthermore, BC risk reduced in women with preeclampsia regardless of their menopausal status and the sex of their offspring. CONCLUSIONS AND RELEVANCE Overall, women with preeclampsia have a decreased BC risk and increased ovarian cancer risk compared with the normal population. A subgroup analysis stratified by reproductive factors demonstrated that BC risk decreased in the preeclampsia population in parous women, women with full-term pregnancies, and women with increasing parity regardless of their menopausal status and the sex of their offspring.
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Dall'Asta A, D'Antonio F, Saccone G, Buca D, Mastantuoni E, Liberati M, Flacco ME, Frusca T, Ghi T. Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:698-709. [PMID: 32484256 DOI: 10.1002/uog.22107] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To elucidate whether pre-eclampsia (PE) and the gestational age at onset of the disease (early- vs late-onset PE) have an impact on the risk of long-term maternal cardiovascular complications. METHODS MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for 'pre-eclampsia', 'cardiovascular disease' and 'outcome'. Inclusion criteria were cohort or case-control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early- vs late-onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type-2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random-effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed. RESULTS Seventy-three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9-2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8-2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6-2.0)), hypertension (OR, 3.93 (95% CI, 3.1-5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4-8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3-1.4)), Type-2 diabetes (OR, 2.14 (95% CI, 1.5-3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3-5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6-7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1-10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early-onset PE, compared to those with previous late-onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0-3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5-21.4)), hypertension (OR, 1.48 (95% CI, 1.3-1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3-1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1-2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1-2.5). CONCLUSIONS Both early- and late-onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late-onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - F D'Antonio
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - D Buca
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - E Mastantuoni
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - M Liberati
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Malek AM, Wilson DA, Turan TN, Mateus J, Lackland DT, Hunt KJ. Maternal Coronary Heart Disease, Stroke, and Mortality Within 1, 3, and 5 Years of Delivery Among Women With Hypertensive Disorders of Pregnancy and Pre-Pregnancy Hypertension. J Am Heart Assoc 2021; 10:e018155. [PMID: 33619981 PMCID: PMC8174275 DOI: 10.1161/jaha.120.018155] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
Background Pre-pregnancy hypertension and hypertensive disorders of pregnancy (HDP; preeclampsia, eclampsia, gestational hypertension) are major health risks for maternal morbidity and mortality. However, it is unknown if racial/ethnic differences exist. We aimed to determine the impact of HDP and pre-pregnancy hypertension on maternal coronary heart disease, stroke, and mortality risk ≤1, 3, and 5 years post-delivery and by race/ethnicity ≤5 years. Methods and Results This retrospective cohort study included women aged 12 to 49 years with a live, singleton birth between 2004 to 2016 (n=254 491 non-Hispanic White; n=137 784 non-Hispanic Black; n=41 155 Hispanic). Birth and death certificates and International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM) diagnosis codes in hospitalization/emergency department visit data defined HDP, pre-pregnancy hypertension, incident coronary heart disease and stroke, and all-cause mortality. During at least 1 pregnancy of the 433 430 women, 2.3% had pre-pregnancy hypertension with superimposed HDP, 15.7% had no pre-pregnancy hypertension with HDP, and 0.4% had pre-pregnancy hypertension without superimposed HDP, whereas 81.6% had neither condition. Maternal deaths from coronary heart disease, stroke, and all causes totaled 2136. Within 5 years of delivery, pre-pregnancy hypertension, and HDP were associated with all-cause mortality (hazard ratio [HR], 2.21; 95% CI, 1.61-3.03), incident coronary heart disease (HR, 3.79; 95% CI, 3.09-4.65), and incident stroke (HR, 3.10; 95% CI, 2.09-4.60). HDP alone was related to all outcomes. Race/ethnic differences were observed for non-Hispanic Black and non-Hispanic White women, respectively, in the associations of pre-pregnancy hypertension and HDP with all-cause mortality within 5 years of delivery (HR, 2.34 [95% CI, 1.58-3.47]; HR, 2.11 [95% CI, 1.23-3.65]; P interaction=0.001). Conclusions Maternal cardiovascular outcomes including mortality were increased ≤5 years post-delivery in HDP, pre-pregnancy hypertension, or pre-pregnancy hypertension with superimposed HDP. The race/ethnic interaction for all-cause mortality ≤5 years of delivery warrants further research.
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Affiliation(s)
- Angela M. Malek
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Dulaney A. Wilson
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
| | - Tanya N. Turan
- Department of NeurologyMedical University of South CarolinaCharlestonSC
| | - Julio Mateus
- Atrium HealthDepartment of Obstetrics & GynecologyMaternal‐Fetal Medicine DivisionCharlotteNC
| | | | - Kelly J. Hunt
- Department of Public Health SciencesMedical University of South CarolinaCharlestonSC
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Powell MJ, Dufault SM, Gunderson EP, Benz CC. Cancer and Cardiovascular Risk in Women With Hypertensive Disorders of Pregnancy Carrying a Common IGF1R Variant. Mayo Clin Proc 2020; 95:2684-2696. [PMID: 33168159 DOI: 10.1016/j.mayocp.2020.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/31/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the impact of insulin-like growth factor 1 receptor variant rs2016347 on the risk for breast and nonbreast cancers and cardiovascular disease in women with a history of hypertensive disorders of pregnancy (HDP). PATIENTS AND METHODS This retrospective cohort study included all parous women in the UK Biobank with prior rs2016347 genotyping (N=204,155), with enrollment taking place from March 2006 to July 2010. History of HDP was self-reported, and outcomes included breast and all nonbreast cancers, hospital diagnoses of hypertension and cardiovascular disease, and direct blood pressure measurements. RESULTS Women with previous HDP had a higher risk for future hypertension and cardiovascular diagnoses, increased blood pressures, and lower risk for breast cancer compared with women without HDP, consistent with prior studies. Hazard ratios for all nonbreast cancers were unchanged. However, when taking genotype into account, HDP-positive women carrying at least 1 thymine (T) allele of rs2016347 had a lower risk for nonbreast cancer (hazard ratio, 0.59; 95% CI, 0.37 to 0.92; P=.02) and lower systolic blood pressure (-2.08±0.98 mm Hg; P=.03) compared with women with the guanine/guanine (GG) genotype with positive evidence of interaction (HDP:T allele) for both outcomes; P=.04 and P=.03, respectively. CONCLUSION Women who experience HDP and carry a T allele of rs2016347 have 41% lower risk for developing nonbreast cancer and a lower systolic blood pressure of 2.08 mm Hg when compared with those with the GG genotype, suggesting a possible role of the insulin-like growth factor 1 axis for both cardiovascular and cancer risk in women with HDP.
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Affiliation(s)
| | - Suzanne M Dufault
- Graduate Group in Biostatistics, University of California, Berkeley, School of Public Health, Berkeley
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland
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Hypertensive Disorders of Pregnancy (HDP) and the Risk of Common Cancers in Women: Evidence from the European Prospective Investigation into Cancer (EPIC)-Norfolk Prospective Population-Based Study. Cancers (Basel) 2020; 12:cancers12113100. [PMID: 33114193 PMCID: PMC7690818 DOI: 10.3390/cancers12113100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary One in ten pregnancies is complicated with high blood pressure. Whilst the association between high blood pressure during pregnancy and cardiovascular disease in later life is well-established, its association with cancer is less so. We aimed to determine the association between hypertensive disorders of pregnancy (HDP) and common cancers in a UK population-based longitudinal study. No statistically significant association was found between HDP and the odds of future cancer, and independent site-specific cancers of breast, colorectal, lung, ovarian and endometrial cancers in a UK-based general practice-derived population. Current research underlining HDP and cancer risk is limited to specific populations only. Future work in different populations is required, focusing on complex genetic and hormonal factors involved in these conditions. Abstract Purpose: The purpose was to determine the association between HDP and cancer in a UK cohort. Methods: Between 1993 and 1997, participants from the EPIC-Norfolk cohort attended baseline health-checks and completed questionnaires, where a history of HDP was collected. Incident cancer cases were identified through NHS record linkage until March 2016. Univariable and multivariable logistic regression analyses were employed to determine the association between HDP and odds of cancer, with adjustment for potential confounders including co-morbidities, sociodemographic, lifestyle and reproductive factors. Results: 13,562 women were included after excluding prevalent cancer cases and women with no pregnancies. 2919 (21.5%) reported HDP and 2615 incident cancers occurred during mean follow up of 19 years. Median age (IQR) at baseline for incident cancer was 60.8 (±14.8) years. Among incident cancer cases, 578 (22.1%) had HDP. In multivariable analyses, HDP had odds ratio (OR) 1.06; 95% CI 0.95–1.18 for incident cancer. The ORs (95% CIs) for common site-specific cancers including breast, colorectal, lung, ovarian and endometrial cancers were 1.06 (0.88–1.28), 1.15 (0.92–1.45), 0.96 (0.68–1.35), 1.30 (0.93–1.83) and 1.16 (0.80–1.67). Conclusion: We found no association between HDP and cancer risk. Further studies are required to confirm and account for any underlying genetic factors involved in pregnancy-related exposures and cancer risk.
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Wu R, Wang T, Gu R, Xing D, Ye C, Chen Y, Liu X, Chen L. Hypertensive Disorders of Pregnancy and Risk of Cardiovascular Disease-Related Morbidity and Mortality: A Systematic Review and Meta-Analysis. Cardiology 2020; 145:633-647. [PMID: 32841945 DOI: 10.1159/000508036] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several studies have demonstrated that there is a higher risk of cardiovascular disease (CVD) in women with a history of hypertensive disorders of pregnancy (HDP). However, effect sizes varied greatly between these studies, and a complete overview of the existing data in the literature is lacking. We aimed to evaluate the association between HDP and the risk of CVD-related morbidity and mortality. METHODS Systematic literature searches were conducted in several electronic databases from inception to July 2019. Exposure of interest was any type of HDP. Outcomes of interest included any CVD, CVD-related mortality, and hypertension. RESULTS Sixty-six cohort and 7 case-control studies involving >13 million women were included. The overall combined relative risks (RRs) for women with a history of HDP compared with the reference group were 1.80 (95% confidence interval [CI] 1.67-1.94) for any CVD, 1.66 (1.49-1.84) for coronary artery heart disease, 2.87 (2.14-3.85) for heart failure, 1.60 (1.29-2.00) for peripheral vascular disease, 1.72 (1.50-1.97) for stroke, 1.78 (1.58-2.00) for CVD-related mortality, and 3.16 (2.74-3.64) for hypertension. Significant heterogeneity was partially explained by all or part of the variables including type of exposure, follow-up time, geographic region, and sample source. CONCLUSIONS Women with a history of HDP are at an increased risk of future CVD-related morbidity and mortality. Our study highlights the importance of life-long monitoring of cardiovascular risk factors in women with a history of HDP.
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Affiliation(s)
- Rong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Runhui Gu
- School of Public Health, Nanjing Medical University, Jiangsu, China
| | - Dexiu Xing
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Changxiang Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Yan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Xiaoling Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China,
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Ferreira RC, Fragoso MBT, Dos Santos Tenório MC, Silva JVF, Bueno NB, Goulart MOF, de Oliveira ACM. Pre-eclampsia is associated with later kidney chronic disease and end-stage renal disease: Systematic review and meta-analysis of observational studies. Pregnancy Hypertens 2020; 22:71-85. [PMID: 32755806 DOI: 10.1016/j.preghy.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/22/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess whether there is a risk of kidney disease during the postpartum period of women who had preeclampsia (PE). STUDY DESIGN Observational trials were searched in the PubMed, Science Direct, Clinical trials, Cochrane, LILACS and Web of Science databases. The data extracted from the studies were systematized, and the risk of bias was evaluated for each of them. Meta-analyses were performed with studies that evaluated chronic kidney disease (CKD) and end-stage renal disease (ESRD), pooling the natural logarithms of the adjusted risk measures and the confidence intervals of each study in a random effects model. RESULTS Of the 4149 studies evaluated, 35 articles were included in the review, of which 3 of the CKD and 6 of the ESRD presented the necessary outcomes to compose the meta-analysis. A formal registration protocol was included in the PROSPERO database (number: CRD42019111821). There was a statistically significant difference between the development of CKD (hazard ratio (HR): 1.82, confidence interval to 95% (95% CI): 1.27-2.62, P < 0.01) and ESRD (HR: 3.01, confidence interval to 95% (95% CI): 1.92-4.70, P < 0.01) in postpartum women affected by PE. CONCLUSIONS PE was considered a risk factor for the onset of CKD and ESRD in the postpartum period. Thus, more research is needed to clarify the underlying mechanisms of this association, and to assist in determining the most appropriate and effective clinical conduct to prevent and/or treat such complications.
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Lo CCW, Lo ACQ, Leow SH, Fisher G, Corker B, Batho O, Morris B, Chowaniec M, Vladutiu CJ, Fraser A, Oliver‐Williams C. Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e013991. [PMID: 32578465 PMCID: PMC7670531 DOI: 10.1161/jaha.119.013991] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random-effects meta-analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17-1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23-1.73), but not stroke (RR, 1.26; 95% CI, 0.96-1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73-1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42-2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33-2.51), and heart failure (RR, 1.77; 95% CI, 1.47-2.13), but not stroke (RR, 1.50; 95% CI, 0.75-2.99). Conclusions Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42018119031.
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Affiliation(s)
- Charmaine Chu Wen Lo
- Faculty of Health and MedicineUniversity of NewcastleNew South WalesAustralia
- Liverpool HospitalLiverpoolNew South WalesAustralia
| | | | - Shu Hui Leow
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Grace Fisher
- Hills Road Sixth Form CollegeCambridgeUnited Kingdom
| | - Beth Corker
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Olivia Batho
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | - Bethan Morris
- Homerton CollegeUniversity of CambridgeUnited Kingdom
| | | | - Catherine J. Vladutiu
- Department of Obstetrics & GynecologySchool of MedicineUniversity of North CarolinaChapel HillNC
| | - Abigail Fraser
- Population Health SciencesBristol Medical SchoolUniversity of BristolUnited Kingdom
| | - Clare Oliver‐Williams
- Homerton CollegeUniversity of CambridgeUnited Kingdom
- Cardiovascular Epidemiology UnitDepartment of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
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Watanabe M, Sairenchi T, Nishida K, Uchiyama K, Haruyama Y, Satonaka H, Ishimitsu T, Yasu T, Fukasawa I, Kobashi G. Gestational Hypertension as Risk Factor of Hypertension in Middle-Aged and Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114052. [PMID: 32517151 PMCID: PMC7312590 DOI: 10.3390/ijerph17114052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/07/2023]
Abstract
The association of gestational hypertension (GH) with future hypertension in Japanese women is unclear. Hence, this study aimed to examine the association between GH and the risk of future hypertension in middle-aged-to-older Japanese women. A case-control study was performed, including 62 hypertensive women (case) and 75 nonhypertensive women (control). GH during the first pregnancy was diagnosed on the basis of the Maternal and Child Health Handbook record. Hypertensive women were recruited from outpatients in the hospital and residents who completed an annual health check-up in a community. Hypertension was defined as blood pressure with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or taking antihypertensive medications. The average age (SD) of the cases and controls at the time of recruitment was 63.1 (8.4) and 57.7 (9.4), respectively. The multivariable-adjusted odds ratio of GH for hypertension in middle-aged-to-older women was 4.2 (95% confidence interval, 1.0–17.5) after adjustment for potential confounding factors such as age and body-mass index (BMI) upon recruitment, prepregnancy BMI, and age at first delivery. In conclusion, GH can be an independent risk factor for future hypertension among Japanese women.
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Affiliation(s)
- Mariko Watanabe
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan;
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (T.S.); (K.N.); (Y.H.); (G.K.)
- Correspondence: ; Tel.: +81-282-87-2166
| | - Toshimi Sairenchi
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (T.S.); (K.N.); (Y.H.); (G.K.)
| | - Keiko Nishida
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (T.S.); (K.N.); (Y.H.); (G.K.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Koji Uchiyama
- Laboratory of International Environmental Health, Center for International Cooperation, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan;
| | - Yasuo Haruyama
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (T.S.); (K.N.); (Y.H.); (G.K.)
| | - Hiroshi Satonaka
- Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (H.S.); (T.I.)
| | - Toshihiko Ishimitsu
- Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (H.S.); (T.I.)
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi 321-2593, Japan;
| | - Ichio Fukasawa
- Department of Obstetrics and Gynecology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan;
| | - Gen Kobashi
- Department of Public Health, School of Medicine, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan; (T.S.); (K.N.); (Y.H.); (G.K.)
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Arnott C, Nelson M, Alfaro Ramirez M, Hyett J, Gale M, Henry A, Celermajer DS, Taylor L, Woodward M. Maternal cardiovascular risk after hypertensive disorder of pregnancy. Heart 2020; 106:1927-1933. [PMID: 32404402 DOI: 10.1136/heartjnl-2020-316541] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hypertensive disorders of pregnancy (HDPs) affect 5%-10% of pregnancies and have been associated with excess maternal cardiovascular disease (CVD) risk. The primary aim of this study was to reliably estimate absolute and relative risks of CVD after HDP. METHODS A retrospective cohort of women who had singleton pregnancies in New South Wales, Australia, between 2002 and 2016 and identified using linked population health administrative databases. The primary exposure was new-onset HDP (pre-eclampsia/eclampsia and gestational hypertension), and the endpoint was hospitalisation or death due to ischaemic or hypertensive heart disease, or stroke. Kaplan-Meier analysis estimated risks among mothers following their first birth, and multivariable time-dependent Cox regression estimated the association between HDP and CVD. RESULTS Among 528 106 women, 10.3% experienced HDP in their first pregnancy. The 10-year estimated risk of CVD was 2.1 per 1000 if no HDP and 5.5 per 1000 following HDP. Adjusting for demographics, gestational diabetes, small for gestational age and preterm birth, we found that there was an interaction between smoking and HDP, and a larger effect of early-onset (<34 weeks) HDP, compared with late-onset HDP. The HR for women with early-onset HDP who did not smoke was 4.90 (95% CI 3.00 to 7.80) and the HR for those who did smoke was 23.5 (95% CI 13.5 to 40.5), each compared with women without HDP who did not smoke. CONCLUSION In this nationally representative Australian cohort, HDP, especially early onset, conferred a clear increase in the risk of CVD, with amplification by smoking. Targeted preventive health, during and after pregnancy, could prevent a substantial burden of CVD among childbearing women.
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Affiliation(s)
- Clare Arnott
- Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Cardiometabolic, George Institute for Global Health, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael Nelson
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Maria Alfaro Ramirez
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Jon Hyett
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Sydney Institute for Women, Children and their Families, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
| | - Marianne Gale
- Office of the Chief Health Officer, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Amanda Henry
- Maternal Health, George Institute for Global Health, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - David S Celermajer
- Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lee Taylor
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Mark Woodward
- Epidemiology, Johns Hopkins University, Baltimore, MD, United States .,The George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, UK.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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29
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Barrett PM, McCarthy FP, Kublickiene K, Cormican S, Judge C, Evans M, Kublickas M, Perry IJ, Stenvinkel P, Khashan AS. Adverse Pregnancy Outcomes and Long-term Maternal Kidney Disease: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e1920964. [PMID: 32049292 DOI: 10.1001/jamanetworkopen.2019.20964] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Adverse pregnancy outcomes, such as hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery, are associated with increased risk of maternal cardiovascular disease. Little is known about whether adverse pregnancy outcomes are associated with increased risk of maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD). OBJECTIVE To review and synthesize the published literature on adverse pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery) and subsequent maternal CKD and ESKD. DATA SOURCES PubMed, Embase, and Web of Science were searched from inception to July 31, 2019, for cohort and case-control studies of adverse pregnancy outcomes and maternal CKD and ESKD. STUDY SELECTION Selected studies included the following: a population of pregnant women, exposure to an adverse pregnancy outcome of interest, and at least 1 primary outcome (CKD or ESKD) or secondary outcome (hospitalization or death due to kidney disease). Adverse pregnancy outcomes included exposure to hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, or chronic hypertension), preterm delivery (<37 weeks), and gestational diabetes. Three reviewers were involved in study selection. Of 5656 studies retrieved, 23 were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed throughout. Three reviewers extracted data and appraised study quality. Random-effects meta-analyses were used to calculate overall pooled estimates using the generic inverse variance method. MAIN OUTCOMES AND MEASURES Primary outcomes included CKD and ESKD diagnosis, defined using established clinical criteria (estimated glomerular filtration rate or albuminuria values) or hospital records. The protocol for this systematic review was registered on PROSPERO (CRD42018110891). RESULTS Of 23 studies included (5 769 891 participants), 5 studies reported effect estimates for more than 1 adverse pregnancy outcome. Preeclampsia was associated with significantly increased risk of CKD (pooled adjusted risk ratio [aRR], 2.11; 95% CI, 1.72-2.59), ESKD (aRR, 4.90; 95% CI, 3.56-6.74), and kidney-related hospitalization (aRR, 2.65; 95% CI, 1.03-6.77). Gestational hypertension was associated with increased risk of CKD (aRR, 1.49; 95% CI, 1.11-2.01) and ESKD (aRR, 3.64; 95% CI, 2.34-5.66). Preterm preeclampsia was associated with increased risk of ESKD (aRR, 5.66; 95% CI, 3.06-10.48); this association with ESKD persisted for women who had preterm deliveries without preeclampsia (aRR, 2.09; 95% CI, 1.64-2.66). Gestational diabetes was associated with increased risk of CKD among black women (aRR, 1.78; 95% CI, 1.18-2.70), but not white women (aRR, 0.81; 95% CI, 0.58-1.13). CONCLUSIONS AND RELEVANCE In this meta-analysis, exposure to adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery, was associated with higher risk of long-term kidney disease. The risk of ESKD was highest among women who experienced preeclampsia. A systematic approach may be warranted to identify women at increased risk of kidney disease, particularly after hypertensive disorders of pregnancy, and to optimize their long-term follow-up.
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Affiliation(s)
- Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
- Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Cormican
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - Conor Judge
- Department of Nephrology, University Hospital Galway, Galway, Ireland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marius Kublickas
- Department of Obstetrics & Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Intervention, Science and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal & Child Health, University College Cork, Cork, Ireland
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30
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Melchiorre K, Thilaganathan B, Giorgione V, Ridder A, Memmo A, Khalil A. Hypertensive Disorders of Pregnancy and Future Cardiovascular Health. Front Cardiovasc Med 2020; 7:59. [PMID: 32351977 PMCID: PMC7174679 DOI: 10.3389/fcvm.2020.00059] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/24/2020] [Indexed: 12/24/2022] Open
Abstract
Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations. These women are known to have higher cardiovascular morbidity and mortality later in life in comparison with parous controls who had normotensive pregnancies. Several studies have demonstrated that women with preeclampsia present in a state of segmental impaired myocardial function, biventricular chamber dysfunction, adverse biventricular remodeling, and hypertrophy, a compromised hemodynamic state and indirect echocardiographic signs of localized myocardial ischemia and fibrosis. These cardiac functional and geometric changes are known to have strong predictive value for cardiovascular disease in non-pregnant subjects. A "dose effect" response seems to regulate this relationship with severe HDP, early-onset HDP, coexistence of fetal growth disorders, and recurrence of HDP resulting in poorer cardiovascular measures. The mechanism underlying the relationship between HDP in younger women and cardiovascular disease later in life is unclear but could be explained by sharing of pre-pregnancy cardiovascular risk factors or due to a direct impact of HDP on the maternal cardiovascular system conferring a state of increased susceptibility to future metabolic or hemodynamic insults. If so, the prevention of HDP itself would become all the more urgent. Shortly after delivery, women who experienced HDP express an increased risk of classic cardiovascular risk factors such as essential hypertension, renal disease, abnormal lipid profile, and diabetes with higher frequency than controls. Within one or two decades after delivery, this group of women are more likely to experience premature cardiovascular events, such as symptomatic heart failure, myocardial ischemia, and cerebral vascular disease. Although there is general agreement that women who suffered from HDP should undertake early screening for cardiovascular risk factors in order to allow for appropriate prevention, the exact timing and modality of screening has not been standardized yet. Our findings suggest that prevention should start as early as possible after delivery by making the women aware of their increased cardiovascular risk and encouraging weight control, stop smoking, healthy diet, and daily exercise which are well-established and cost-effective prevention strategies.
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Affiliation(s)
- Karen Melchiorre
- Department of Obstetrics and Gynecology, Spirito Santo Hospital of Pescara, Pescara, Italy
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Veronica Giorgione
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Anna Ridder
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Alessia Memmo
- Department of Obstetrics and Gynecology, Spirito Santo Hospital of Pescara, Pescara, Italy
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
- *Correspondence: Asma Khalil
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31
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Association between cardiovascular diseases and pregnancy-induced hypertensive disorders in a population of Cameroonian women at Yaoundé: A case-control study. PLoS One 2019; 14:e0225591. [PMID: 31841512 PMCID: PMC6913940 DOI: 10.1371/journal.pone.0225591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022] Open
Abstract
Background Positive associations have been found between Hypertensive Disorders of Pregnancy gestational hypertension, preeclampsia and cardiovascular diseases within non-African populations, no data exist from sub-Saharan Africa. We aimed to assess this association in Cameroonian mothers. Methods We used a case-control study. Cases were women diagnosed with any arteriosclerotic cardiovascular disease between 2012 and 2017 at two major hospitals of Yaoundé. Controls were mothers of children who sought pediatric care at the Gyneco-obstetric hospital of Yaoundé, with no diagnosis of cardiovascular disease. We abstracted data from patient files to assess cardiovascular disease and used phone-based questionnaires to assess a prior history of Hypertensive Disorders of Pregnancy. We used logistic regression and propensity scores for data analysis. Results Out of 1228 individuals selected, 173 cases and 339 controls participated in the study. We found no increased risk of cardiovascular diseases for women with a history of Hypertensive Disorders of Pregnancy (OR = 0.83, 95% CI, 0.51 to 1.34). Women with gestational hypertension had 2.33 (95% CI, 0.99 to 5.50) times the risk of women with no history of Hypertensive Disorders of Pregnancy, an inverse association was observed between preeclampsia and cardiovascular diseases (OR = 0.28, 95% CI, 0.10 to 0.72). Conclusions Cameroonian women with a history of gestational hypertension may have a higher risk of cardiovascular diseases. However, population-based studies with more accurate data on the exposure are needed.
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32
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Grandi SM, Filion KB, Yoon S, Ayele HT, Doyle CM, Hutcheon JA, Smith GN, Gore GC, Ray JG, Nerenberg K, Platt RW. Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation 2019; 139:1069-1079. [PMID: 30779636 DOI: 10.1161/circulationaha.118.036748] [Citation(s) in RCA: 331] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women with a history of certain pregnancy complications are at higher risk for cardiovascular (CVD) disease. However, most clinical guidelines only recommend postpartum follow-up of those with a history of preeclampsia, gestational diabetes mellitus, or preterm birth. This systematic review was undertaken to determine if there is an association between a broader array of pregnancy complications and the future risk of CVD. METHODS We systematically searched PubMed, MEDLINE and EMBASE (via Ovid), CINAHL, and the Cochrane Library from inception to September 22, 2017, for observational studies of the association between the hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage and subsequent CVD. Likelihood ratio meta-analyses were performed to generate pooled odds ratios (OR) and 95% intrinsic confidence intervals (ICI). RESULTS Our systematic review included 84 studies (28 993 438 patients). Sample sizes varied from 250 to 2 000 000, with a median follow-up of 7.5 years postpartum. The risk of CVD was highest in women with gestational hypertension (OR 1.7; 95% ICI, 1.3-2.2), preeclampsia (OR 2.7; 95% ICI, 2.5-3.0), placental abruption (OR 1.8; 95% ICI, 1.4-2.3), preterm birth (OR 1.6; 95% ICI, 1.4-1.9), gestational diabetes mellitus (OR 1.7; 95% ICI, 1.1-2.5), and stillbirth (OR 1.5; 95% ICI, 1.1-2.1). A consistent trend was seen for low birth weight and small-for-gestational-age birth weight but not for miscarriage. CONCLUSIONS Women with a broader array of pregnancy complications, including placental abruption and stillbirth, are at increased risk of future CVD. The findings support the need for assessment and risk factor management beyond the postpartum period.
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Affiliation(s)
- Sonia M Grandi
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Kristian B Filion
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Department of Medicine, McGill University, Montreal, QC, Canada (K.F.)
| | - Sarah Yoon
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Henok T Ayele
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Carla M Doyle
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Canada (J.H.)
| | - Graeme N Smith
- Department of Obstetrics and Gynaecology, School of Medicine, Queen's University, Kingston, ON, Canada (G.S.)
| | - Genevieve C Gore
- Schulich Library of Science and Engineering, McGill University, Montreal, QC, Canada (G.G.)
| | - Joel G Ray
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (J.R.)
| | - Kara Nerenberg
- University of Calgary, Department of Medicine, Cumming School of Medicine, AB, Canada (K.N.)
| | - Robert W Platt
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,McGill University Health Center Research Institute and Department of Pediatrics, McGill University, Montreal, QC, Canada (R.P.)
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Wu P, Mamas MA, Gulati M. Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. J Womens Health (Larchmt) 2019; 28:1037-1050. [DOI: 10.1089/jwh.2018.7480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pensee Wu
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
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Covella B, Vinturache AE, Cabiddu G, Attini R, Gesualdo L, Versino E, Piccoli GB. A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia. Kidney Int 2019; 96:711-727. [PMID: 31352975 DOI: 10.1016/j.kint.2019.03.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/23/2019] [Accepted: 03/28/2019] [Indexed: 11/30/2022]
Abstract
Preeclampsia is a pregnancy-related syndrome of variable severity, classically characterized by acute kidney involvement, with hypertension and/or proteinuria and reduced kidney function. Once considered a self-limited disease healed by delivery, it is now acknowledged that preeclampsia can affect cardiovascular and kidney health in the long term. The entity of risk has not been established and consequently follow-up policies have not been defined. Here we undertook a systematic review to gain better insights into the need for post-preeclampsia follow-up. Articles published between January 2000 and March 2018 were selected, dealing with at least 20 preeclampsia patients, with follow-up of 4 years or more (MEDLINE, Embase, and Cochrane Library). No quality selection or language restriction was performed. Of the 10,510 titles and abstracts originally considered, 21 papers were selected, providing information on 110,803 cases with and 2,680,929 controls without preeclampsia, with partial overlap between studies on the same databases. Heterogeneity was high, and a random meta-analytic model selected. The increase in risk of end stage renal disease after preeclampsia was significant (meta-analytic risk ratios (95% confidence interval) 6.35 (2.73-14.79)); the risk of albuminuria and chronic kidney disease increased but statistical significance was not reached (4.31 (0.95-19.58) and 2.03 (0.58-7.32), respectively). Translating meta-analytic risk into the number of patients who need follow-up to detect one adverse event, 310 patients with preeclampsia are needed to identify one woman with end stage renal disease or four to identify one woman with albuminuria. Heterogeneity in definitions, insufficient follow-up and incomplete recruitment may account for discrepancies. Thus, preeclampsia significantly increases the risk of end stage renal disease. However, there is lack of sufficient data to show a relationship between preeclampsia, albuminuria and chronic kidney disease, underlining the need for further prospective studies.
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Affiliation(s)
- Bianca Covella
- Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Polyclinic University Hospital, Bari, Italy
| | - Angela Elena Vinturache
- Department of Obstetrics and Gynaecology Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Rossella Attini
- Department of Surgery, Obstetrics, University of Torino, Torino, Italy
| | - Loreto Gesualdo
- Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Polyclinic University Hospital, Bari, Italy
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Covella B, Alrukhaimi M, Liu ZH, Ashuntantang G, Orozco Guillen A, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases. J Clin Med 2018; 7:jcm7100318. [PMID: 30275392 PMCID: PMC6210235 DOI: 10.3390/jcm7100318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/14/2022] Open
Abstract
Pregnancy-related acute kidney injury (pAKI), preeclampsia (PE), and the hypertensive disorders of pregnancy are closely related conditions, which are, in turn, frequently linked to pre-existing and often non-diagnosed chronic kidney disease (CKD). The current literature and research mainly underline the effects of pregnancy complications on the offspring; this review strongly emphasizes the maternal health as well. These conditions not only negatively affect pregnancy outcomes, but have a relevant effect on the future health of affected mothers and their children. Therefore, dedicated diagnostic and follow-up programs are needed, for optimizing materno-foetal health and reducing the impact of pregnancy-related problems in the mothers and in the new generations. This narrative review, performed on the occasion of the 2018 World Kidney Day dedicated to women’s health, focuses on three aspects of the problem. Firstly, the risk of AKI in the hypertensive disorders of pregnancy (the risk is the highest in developing countries; however PE is the main cause of pregnancy related AKI worldwide). Secondly, the effect of AKI and the hypertensive disorders of pregnancy on the development of CKD in the mother and offspring: long-term risks are increased; the entity and the trajectories are still unknown. Thirdly, the role of CKD in the pathogenesis of AKI and the hypertensive disorders of pregnancy: CKD is a major risk factor and the most important element in the differential diagnosis; pregnancy is a precious occasion for early diagnosis of CKD. Higher awareness on the importance of AKI in pregnancy is needed to improve short and long term outcomes in mothers and children.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | | | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Gulliermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Sun M, Fan Y, Hou Y, Fan Y. Preeclampsia and maternal risk of breast cancer: a meta-analysis of cohort studies. J Matern Fetal Neonatal Med 2017; 31:2484-2491. [PMID: 28715959 DOI: 10.1080/14767058.2017.1342806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pregnancy-related hypertensive disorders, including preeclampsia (PE) and pregnancy-induced hypertension (PIH), may influence the maternal risk of breast cancer. However, results of the cohort studies were inconsistent. METHODS An updated meta-analysis of cohort studies was performed to evaluate the association between PE, PIH and maternal breast cancer incidence. Relevant studies were identified via searching of PubMed and Embase databases. A random effect model was applied to synthesize the results. Stratified analyses were performed to evaluate the potential influence of parity, gender of offspring, and study design on the association between PE and maternal breast cancer incidence. RESULTS Ten cohort studies with 2,417,899 pregnant women were included. Maternal risk of breast cancer was not significantly affected by PE (risk ration [RR] = 0.93, 95% confidence interval [CI]: 0.82-1.06, p = .27), or PIH (RR = 0.95, 95% CI: 0.81-1.12, p = .54). Interestingly, PE was associated with significantly lowered maternal incidence of breast cancer in women who give birth to male offspring (RR = 0.79, p < .01), and in those of prospective cohort studies (RR = 0.87, p < .01). However, no significant association between PE and maternal breast cancer was detected in primiparous women, those who gave birth to female offspring, or those of retrospective cohorts. CONCLUSIONS Current evidence did not support a conclusive association between PE, PIH and the maternal risk of breast cancer. Gender of the offspring may influence the association between PE and maternal breast cancer incidence.
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Affiliation(s)
- Meizhen Sun
- a Department of Obstetrics , Yuhuangding Hospital , Yantai , China
| | - Yongling Fan
- a Department of Obstetrics , Yuhuangding Hospital , Yantai , China
| | - Yuanyuan Hou
- b Department of Health, Care Center , Yuhuangding Hospital , Yantai , China
| | - Yanyan Fan
- c Department of Nursing School , Binzhou Medical College , Yantai , China
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Wang Z, Wang Z, Wang L, Qiu M, Wang Y, Hou X, Guo Z, Wang B. Hypertensive disorders during pregnancy and risk of type 2 diabetes in later life: a systematic review and meta-analysis. Endocrine 2017; 55:809-821. [PMID: 27518283 DOI: 10.1007/s12020-016-1075-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/31/2016] [Indexed: 12/24/2022]
Abstract
Many studies assessed the association between hypertensive disorders during pregnancy and risk of type 2 diabetes mellitus in later life, but contradictory findings were reported. A systemic review and meta-analysis was carried out to elucidate type 2 diabetes mellitus risk in women with hypertensive disorders during pregnancy. Pubmed, Embase, and Web of Science were searched for cohort or case-control studies on the association between hypertensive disorders during pregnancy and subsequent type 2 diabetes mellitus. Random-effect model was used to pool risk estimates. Bayesian meta-analysis was carried out to further estimate the type 2 diabetes mellitus risk associated with hypertensive disorders during pregnancy. Seventeen cohort or prospective matched case-control studies were finally included. Those 17 studies involved 2,984,634 women and 46,732 type 2 diabetes mellitus cases. Overall, hypertensive disorders during pregnancy were significantly correlated with type 2 diabetes mellitus risk (relative risk = 1.56, 95 % confidence interval 1.21-2.01, P = 0.001). Preeclampsia was significantly and independently correlated with type 2 diabetes mellitus risk (relative risk = 2.25, 95 % confidence interval 1.73-2.90, P < 0.001). In addition, gestational hypertension was also significantly and independently correlated with subsequent type 2 diabetes mellitus risk (relative risk = 2.06, 95 % confidence interval 1.57-2.69, P < 0.001). The pooled estimates were not significantly altered in the subgroup analyses of studies on preeclampsia or gestational hypertension. Bayesian meta-analysis showed the relative risks of type 2 diabetes mellitus risk for individuals with hypertensive disorders during pregnancy, preeclampsia, and gestational hypertension were 1.59 (95 % credibility interval: 1.11-2.32), 2.27 (95 % credibility interval: 1.67-2.97), and 2.06 (95 % credibility interval: 1.41-2.84), respectively. Publication bias was not evident in the meta-analysis. Preeclampsia and gestational hypertension are independently associated with substantially elevated risk of type 2 diabetes mellitus in later life.
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Affiliation(s)
- Zengfang Wang
- Department of Obstetrics, Maternal and Children Health's Hospital of Weifang, Weifang, 261011, China.
| | - Zengyan Wang
- Surgical Center, Zhucheng People's Hospital, Zhucheng, 262201, China
| | - Luang Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Mingyue Qiu
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yangang Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xu Hou
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Zhong Guo
- Department of Medical Education, Health School of Ganzhou in Jiangxi Province, Ganzhou, 341000, China
| | - Bin Wang
- Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, 266003, China
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Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, Zaman A, Fryer AA, Kadam U, Chew-Graham CA, Mamas MA. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003497. [PMID: 28228456 DOI: 10.1161/circoutcomes.116.003497] [Citation(s) in RCA: 627] [Impact Index Per Article: 89.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific disorder resulting in hypertension and multiorgan dysfunction. There is growing evidence that these effects persist after pregnancy. We aimed to systematically evaluate and quantify the evidence on the relationship between preeclampsia and the future risk of cardiovascular diseases. METHODS AND RESULTS We studied the future risk of heart failure, coronary heart disease, composite cardiovascular disease, death because of coronary heart or cardiovascular disease, stroke, and stroke death after preeclampsia. A systematic search of MEDLINE and EMBASE was performed to identify relevant studies. We used random-effects meta-analysis to determine the risk. Twenty-two studies were identified with >6.4 million women including >258 000 women with preeclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that preeclampsia was independently associated with an increased risk of future heart failure (risk ratio [RR], 4.19; 95% confidence interval [CI], 2.09-8.38), coronary heart disease (RR, 2.50; 95% CI, 1.43-4.37), cardiovascular disease death (RR, 2.21; 95% CI, 1.83-2.66), and stroke (RR, 1.81; 95% CI, 1.29-2.55). Sensitivity analyses showed that preeclampsia continued to be associated with an increased risk of future coronary heart disease, heart failure, and stroke after adjusting for age (RR, 3.89; 95% CI, 1.83-8.26), body mass index (RR, 3.16; 95% CI, 1.41-7.07), and diabetes mellitus (RR, 4.19; 95% CI, 2.09-8.38). CONCLUSIONS Preeclampsia is associated with a 4-fold increase in future incident heart failure and a 2-fold increased risk in coronary heart disease, stroke, and death because of coronary heart or cardiovascular disease. Our study highlights the importance of lifelong monitoring of cardiovascular risk factors in women with a history of preeclampsia.
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Affiliation(s)
- Pensée Wu
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Randula Haththotuwa
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.).
| | - Chun Shing Kwok
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Aswin Babu
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Rafail A Kotronias
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Claire Rushton
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Azfar Zaman
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Anthony A Fryer
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Umesh Kadam
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Carolyn A Chew-Graham
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
| | - Mamas A Mamas
- From the Institute for Science and Technology in Medicine (P.W.), Keele Cardiovascular Research Group (P.W., C.S.K., A.B., R.A.K., C.R., U.K., M.A.M.), Institute for Primary Care and Health Sciences (R.H., C.A.C.-G.), Institute for Applied Clinical Sciences (A.A.F., C.S.K., C.R., U.K., M.A.M.), and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands (C.A.C.-G.), Keele University, Stoke-on-Trent, United Kingdom; Academic Obstetrics and Gynaecology (P.W.) and The Heart Centre (C.S.K., M.A.M.), Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; and Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, United Kingdom (A.Z.)
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Canoy D, Cairns BJ, Balkwill A, Wright FL, Khalil A, Beral V, Green J, Reeves G. Hypertension in pregnancy and risk of coronary heart disease and stroke: A prospective study in a large UK cohort. Int J Cardiol 2016; 222:1012-1018. [PMID: 27529390 PMCID: PMC5047033 DOI: 10.1016/j.ijcard.2016.07.170] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many studies investigating long-term vascular disease risk associated with hypertensive pregnancies examined risks in relatively young women among whom vascular disease is uncommon. We examined the prospective relation between a history of hypertension during pregnancy and coronary heart disease (CHD) and stroke in middle-aged UK women. METHODS In 1996-2001, 1.1 million parous women (mean age=56years) without vascular disease at baseline reported their history of hypertension during pregnancy and other factors. They were followed for incident CHD and stroke (hospitalisation or death). Adjusted relative risks (RRs) were calculated using Cox regression. RESULTS Twenty-six percent (290,008/1.1 million) reported having had a hypertensive pregnancy; 27% (79,163/290,008) of women with hypertensive pregnancy, but only 10% (82,145/815,560) of those without hypertensive pregnancy, reported being treated for hypertension at baseline. Mean follow-up was 11.6years (mean ages at diagnosis/N of events: CHD=65years/N=68,161, ischaemic stroke=67years/N=8365, haemorrhagic stroke=64years/N=5702). Overall, the RRs (95% confidence interval [CI]) of incident disease in women with hypertensive pregnancy versus those without such history were: CHD=1.29 (1.27-1.31), ischaemic stroke=1.29 (1.23-1.35), and haemorrhagic stroke=1.14 (1.07-1.21). However, among women with hypertensive pregnancy who were not taking hypertension treatment at baseline, their RRs (95% CI) were only modestly increased: CHD=1.17 (1.14-1.19), ischaemic stroke=1.18 (1.11-1.25), and haemorrhagic stroke=1.09 (1.02-1.18). CONCLUSION Hypertension during pregnancy was associated with increased CHD and stroke incidence in middle age, largely because such women also had hypertension in their 50s and 60s, which has a substantially greater effect on vascular disease risk than hypertension during pregnancy without hypertension later in life.
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Affiliation(s)
- Dexter Canoy
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Angela Balkwill
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - F Lucy Wright
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's Medical School, University of London, London, UK.
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Bldg., Roosevelt Drive, Oxford OX3 7LF, UK.
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Reuter DG, Law Y, Levy WC, Seslar SP, Zierler RE, Ferguson M, Chattra J, McQuinn T, Liu LL, Terry M, Coffey PS, Dimer JA, Hanevold C, Flynn JT, Stapleton FB. Can preeclampsia be considered a renal compartment syndrome? A hypothesis and analysis of the literature. ACTA ACUST UNITED AC 2016; 10:891-899. [PMID: 27751879 DOI: 10.1016/j.jash.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
The morbidity and mortality associated with preeclampsia is staggering. The physiology of the Page kidney, a condition in which increased intrarenal pressure causes hypertension, appears to provide a unifying framework to explain the complex pathophysiology. Page kidney hypertension is renin-mediated acutely and ischemia-mediated chronically. Renal venous outflow obstruction also causes a Page kidney phenomenon, providing a hypothesis for the increased vulnerability of a subset of women who have what we are hypothesizing is a "renal compartment syndrome" due to inadequate ipsilateral collateral renal venous circulation consistent with well-known variation in normal venous anatomy. Dynamic changes in renal venous anatomy and physiology in pregnancy appear to correlate with disease onset, severity, and recurrence. Since maternal recumbent position is well known to affect renal perfusion and since chronic outflow obstruction makes women vulnerable to the ischemic/inflammatory sequelae, heightened awareness of renal compartment syndrome physiology is critical. The anatomic and physiologic insights provide immediate strategies to predict and prevent preeclampsia with straightforward, low-cost interventions that make renewed global advocacy for pregnant women a realistic goal.
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Affiliation(s)
- David G Reuter
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA; General Pediatrics, Allegro Pediatrics, Bellevue, WA.
| | - Yuk Law
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - Wayne C Levy
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Stephen P Seslar
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - R Eugene Zierler
- Division of Vascular Surgery, University of Washington School of Medicine, Seattle, WA
| | - Mark Ferguson
- Department of Radiology, Seattle Children's Hospital, Seattle, WA
| | - James Chattra
- General Pediatrics, Allegro Pediatrics, Bellevue, WA
| | - Tim McQuinn
- Department of Pediatrics, Division of Cardiology, Seattle Children's Hospital, Seattle, WA
| | - Lenna L Liu
- Division of General Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Mark Terry
- Science Department, The Northwest School, Seattle, WA
| | | | - Jane A Dimer
- Division of Obstetrics, University of Washington School of Medicine, Seattle, WA
| | - Coral Hanevold
- Department of Nephrology, Seattle Children's Hospital, Seattle, WA
| | - Joseph T Flynn
- Department of Nephrology, Seattle Children's Hospital, Seattle, WA
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Tooher J, Thornton C, Makris A, Ogle R, Korda A, Horvath J, Hennessy A. Hypertension in pregnancy and long-term cardiovascular mortality: a retrospective cohort study. Am J Obstet Gynecol 2016; 214:722.e1-6. [PMID: 26739795 DOI: 10.1016/j.ajog.2015.12.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is growing evidence that hypertensive disorders of pregnancy are associated with increased long-term cardiovascular mortality in the mother. Hypertension in pregnancy, until recently, however, has been ignored largely as a risk factor for future cardiovascular disease and mortality because the link between the 2 is not fully understood. OBJECTIVE To determine the association between women with hypertension in pregnancy and long-term cardiovascular disease mortality. STUDY DESIGN All women who delivered at a metropolitan hospital between the periods of January 1, 1980, and December 31, 1989, were identified by use of the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification. RESULTS The total number of deliveries in the given time period was 31,656, with 4387 (14%) of the women identified as having had hypertension in their pregnancy. Using information from the New South Wales Births, Deaths and Marriages Registry and the Australian Bureau of Statistics Death Registry, we identified a total of 651 deaths from this cohort (n = 31,656). There were 521 deaths among the women who remained normotensive in their pregnancy and 129 deaths for women who had hypertension during their pregnancy. Overall, the women with hypertensive disorders of pregnancy were at greater risk of death than the women who remained normotensive in their pregnancy (odds ratio 1.56; 95% confidence interval 1.28-1.89; P < .001). CONCLUSION Women with a history of hypertension in their pregnancy are at an increased risk of future cardiovascular mortality, and this work identifies a group of women who may benefit from early screening and intervention strategies to help decrease their risk of future cardiovascular disease.
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Affiliation(s)
- Jane Tooher
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia.
| | - Charlene Thornton
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
| | - Angela Makris
- Liverpool Hospital, Renal Department, Liverpool, NSW, Australia
| | - Robert Ogle
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Korda
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
| | - John Horvath
- The University of Sydney, Honorary Professor Sydney Medical School, Camperdown, NSW, Australia
| | - Annemarie Hennessy
- University of Western Sydney, School of Medicine, Campbelltown, NSW, Australia
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Long-term renal and cardiovascular risk after preeclampsia: towards screening and prevention. Clin Sci (Lond) 2016; 130:239-46. [PMID: 26769659 DOI: 10.1042/cs20150567] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) is a hypertensive pregnancy disorder complicating up to 1-5% of pregnancies, and a major cause of maternal and fetal morbidity and mortality. In recent years, observational studies have consistently shown that PE carries an increased risk for the mother to develop cardiovascular and renal disease later in life. Women with a history of PE experience a 2-fold increased risk of long-term cardiovascular disease (CVD) and an approximate 5-12-fold increased risk of end-stage renal disease (ESRD). Recognition of PE as a risk factor for renal disease and CVD allows identification of a young population of women at high risk of developing of cardiovascular and renal disease. For this reason, current guidelines recommend cardiovascular screening and treatment for formerly preeclamptic women. However, these recommendations are based on low levels of evidence due to a lack of studies on screening and prevention in formerly preeclamptic women. This review lists the incidence of premature CVD and ESRD observed after PE and outlines observed abnormalities that might contribute to the increased CVD risk with a focus on kidney-related disturbances. We discuss gaps in current knowledge to guide optimal screening and prevention strategies. We emphasize the need for research on mechanisms of late disease manifestations, and on effective screening and therapeutic strategies aimed at reducing the late disease burden in formerly preeclamptic women.
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Zoet GA, Koster MPH, Velthuis BK, de Groot CJM, Maas AHEM, Fauser BCJM, Franx A, van Rijn BB. Determinants of future cardiovascular health in women with a history of preeclampsia. Maturitas 2015; 82:153-61. [PMID: 26255680 DOI: 10.1016/j.maturitas.2015.07.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
Women who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life. However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging. Furthermore, we explore how female-specific risk factors may have additional value in cardiovascular screening, in particular in relatively young women, although their implementation in clinical practice is challenged by inconsistent results and lack of long-term outcome data. Non-invasive imaging techniques, e.g., coronary artery intima-media thickness (CIMT), can be helpful to detect subclinical atherosclerotic disease, and coronary artery calcium scoring (CACS) has shown to be effective in early detection of cardiovascular damage. However, while more short-term and long-term follow-up studies are becoming available, few studies have investigated women with a history of preeclampsia in the fourth and fifth decade of life, when early signs of premature CVD are most likely to become apparent. Further studies are needed to inform new and improved clinical practice guidelines, and provide long-term strategies to effectively prevent CVD, specifically targeted at women with a history of preeclampsia. Additionally, evaluation of feasibility, cost-effectiveness, and implementation of CVD screening and prevention initiatives targeted at former preeclampsia patients are needed.
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Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Maria P H Koster
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - Bas 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
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Charlton F, Tooher J, Rye KA, Hennessy A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ 2013; 23:203-12. [PMID: 24268601 DOI: 10.1016/j.hlc.2013.10.087] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/20/2013] [Indexed: 01/15/2023]
Abstract
It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated that the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease (CVD) in later life. The contributions of hypertension and dyslipidaemia before and during the pregnancy are also important and contribute to future risk. Serum lipids are complex and change dramatically in pregnancy. In general there is an increase in most plasma lipid components, notably triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular disease is influenced by preeclampsia and in part potentially by the lipid changes which escalate late in disease. Whether we can influence the risk of preeclampsia by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular disease after preeclampsia is yet to be determined. Ultimately, strategies to control lipid concentrations will only be viable when we understand the safety to the mother at the time of the pregnancy, and to the foetus both immediately and in the very long term. Strategies to control blood pressure are well established in the non-pregnant population, and previous preeclampsia and gestational hypertension should be considered in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy per se is of any longer term benefit is also yet to be determined.
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Affiliation(s)
- Francesca Charlton
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Jane Tooher
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Kerry-Anne Rye
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Annemarie Hennessy
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
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Tranquilli AL, Landi B, Giannubilo SR, Sibai BM. Preeclampsia: No longer solely a pregnancy disease. Pregnancy Hypertens 2012; 2:350-7. [DOI: 10.1016/j.preghy.2012.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/19/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022]
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