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Ludidi A, Siboto A, Nkosi A, Xulu ND, Khathi A, Sibiya NH, Ngubane PS. High-fat, high-carbohydrate diet-induced prediabetes preconception in Sprague-Dawley rats as a risk factor for the development of preeclampsia: assessing changes in placental metabolic insults. Front Nutr 2023; 10:1241785. [PMID: 37937252 PMCID: PMC10626547 DOI: 10.3389/fnut.2023.1241785] [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: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Hyperglycemia preconception deranges the establishment of a functional placenta; however, the risk of developing preeclampsia (PE) in prediabetic patients remains obscure. The aim was to assess abnormal placental changes as a risk factor for the development of PE in high-fat, high-carbohydrate (HFHC) diet-induced prediabetic (PD) rats. Methods HFHC diet-induced female prediabetic Sprague-Dawley rats were mated, and blood glucose concentrations, mean arterial pressure (MAP), and body weights were monitored on gestational days (GNDs) 0, 9, and 18. On GND 18, animals were euthanized. Blood and placentas were collected for biochemical analysis. Results Prediabetic rats showed significantly increased blood glucose concentration, proinflammatory cytokines, MAP, placental weight, and fetoplacental ratio compared with non-prediabetic (NPD) rats. Prediabetic rats showed significantly decreased placental vascular endothelial growth factor receptor 1 (VEGFR1) and placental growth factor (PLGF) and plasma nitric oxide (NO) compared with NPD. Discussion Prediabetes may have promoted endothelial dysfunction in the placenta and hypoxia, thus reducing PLGF and VEGFR1, which may have promoted proinflammation, endothelial dysfunction associated with NO decline, and hypertension, which is also observed in preeclamptic patients. Prediabetes may have promoted lipogenesis in placentas and fetuses that may have induced macrosomia and IUGR, also observed in preeclamptic patients. The findings from this study highlight the need for screening and monitoring of prediabetes during pregnancy to reduce the risk of developing preeclampsia.
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Affiliation(s)
- Asiphaphola Ludidi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anelisiwe Siboto
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ayanda Nkosi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nombuso Duduzile Xulu
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Khathi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Phikelelani Siphosethu Ngubane
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Lv Y, Zhou Y, Hu R, Liang Y, Lian Y, Wang J, Wei Y, Zhang Y, Qiao Y, He T. Association between hypoproteinaemia with massive proteinuria and small for gestational age in pre-eclampsia: a single-centre, retrospective cohort study using propensity score matching. BMJ Open 2023; 13:e071835. [PMID: 37463811 PMCID: PMC10357757 DOI: 10.1136/bmjopen-2023-071835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To investigate the association between hypoproteinaemia with massive proteinuria and the incidence of small for gestational age in pre-eclampsia. DESIGN Retrospective cohort study using propensity score matching. SETTING Northwest Women's and Children's Hospital in Shaanxi Province, China, using data from January 2016 to December 2021. PARTICIPANTS Patients diagnosed with pre-eclampsia were grouped into the massive proteinuria group if the maximum proteinuria was >3.5 g/day and the minimum serum albumin was <30 g/L; otherwise, they were placed in the control group. OUTCOME MEASURES The primary outcome was the incidence of small for gestational age infants. Secondary outcomes included fetal death, admission to the neonatal intensive care unit, a 5 min APGAR score <7, severe small for gestational age, fetal growth restriction, birth weight, premature birth, and maternal outcomes such as eclampsia, encephalopathy, placental abruption, haemolysis, elevated liver enzymes and low platelet syndrome, heart failure and retinal detachment. RESULTS In total, 468 patients (234 from each group) were included, and the groups were well matched. The incidences of small for gestational age (33.76% vs 20.51%, OR 1.646, 95% CI 1.208 to 2.243, p=0.001), severe small for gestational age (14.70% vs 7.69%, OR 1.833, 95% CI 1.063 to 3.162, p=0.026), fetal growth restriction (23.93% vs 16.24%, OR 1.474, 95% CI 1.018 to 2.133, p=0.038), and the numbers of infants admitted to the neonatal intensive care unit (67.52% vs 58.55%, OR 1.153, 95% CI 1.003 to 1.326, p=0.044) were significantly higher in patients with hypoproteinaemia and massive proteinuria than in the control group. In addition, the median birth weight was significantly lower in the massive proteinuria group. There were no significant differences in maternal outcomes except for renal parameters, which were worse in the massive proteinuria group. CONCLUSION Hypoproteinaemia with massive proteinuria was associated with fetal growth and a higher incidence of small for gestational age infants in pre-eclampsia.
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Affiliation(s)
- Yanxiang Lv
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Ying Zhou
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Rui Hu
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yan Liang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yanan Lian
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Jun Wang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yang Wei
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yanmei Zhang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yuan Qiao
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Tongqiang He
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
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Cheetham TC, Shortreed SM, Avalos LA, Reynolds K, Holt VL, Easterling TR, Portugal C, Zhou H, Neugebauer RS, Bider Z, Idu A, Dublin S. Identifying hypertensive disorders of pregnancy, a comparison of two epidemiologic definitions. Front Cardiovasc Med 2022; 9:1006104. [PMID: 36505381 PMCID: PMC9727220 DOI: 10.3389/fcvm.2022.1006104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Studies of hypertension in pregnancy that use electronic health care data generally identify hypertension using hospital diagnosis codes alone. We sought to compare results from this approach to an approach that included diagnosis codes, antihypertensive medications and blood pressure (BP) values. Materials and methods We conducted a retrospective cohort study of 1,45,739 pregnancies from 2009 to 2014 within an integrated healthcare system. Hypertensive pregnancies were identified using the "BP-Inclusive Definition" if at least one of three criteria were met: (1) two elevated outpatient BPs, (2) antihypertensive medication fill plus an outpatient hypertension diagnosis, or (3) hospital discharge diagnosis for preeclampsia or eclampsia. The "Traditional Definition" considered only delivery hospitalization discharge diagnoses. Outcome event analyses compared rates of preterm delivery and small for gestational age (SGA) between the two definitions. Results The BP-Inclusive Definition identified 14,225 (9.8%) hypertensive pregnancies while the Traditional Definition identified 13,637 (9.4%); 10,809 women met both definitions. Preterm delivery occurred in 20.9% of BP-Inclusive Definition pregnancies, 21.8% of Traditional Definition pregnancies and 6.6% of non-hypertensive pregnancies; for SGA the numbers were 15.6, 16.3, and 8.6%, respectively (p < 0.001 for all events compared to non-hypertensive pregnancies). Analyses in women meeting only one hypertension definition (21-24% of positive cases) found much lower rates of both preterm delivery and SGA. Conclusion Prevalence of hypertension in pregnancy was similar between the two study definitions. However, a substantial number of women met only one of the study definitions. Women who met only one of the hypertension definitions had much lower rates of adverse neonatal events than women meeting both definitions.
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Affiliation(s)
- T. Craig Cheetham
- School of Pharmacy, Chapman University, Irvine, CA, United States,*Correspondence: T. Craig Cheetham,
| | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lyndsay A. Avalos
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Kristi Reynolds
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States
| | - Victoria L. Holt
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Thomas R. Easterling
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Cecilia Portugal
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States
| | - Hui Zhou
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States
| | - Romain S. Neugebauer
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Zoe Bider
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States
| | - Abisola Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Amount of proteinuria as associated with severity classification of pregnant women with preeclampsia. Pregnancy Hypertens 2022; 29:30-35. [DOI: 10.1016/j.preghy.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022]
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Toward personalized management of chronic hypertension in pregnancy. Am J Obstet Gynecol 2022; 226:S1196-S1210. [PMID: 32687817 PMCID: PMC7367795 DOI: 10.1016/j.ajog.2020.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/27/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Abstract
Chronic hypertension complicates 1% to 2% of pregnancies, and it is increasingly common. Women with chronic hypertension are an easily recognized group who are in touch with a wide variety of healthcare providers before, during, and after pregnancy, mandating that chronic hypertension in pregnancy be within the scope of many practitioners. We reviewed recent data on management to inform current care and future research. This study is a narrative review of published literature. Compared with normotensive women, women with chronic hypertension are at an increased risk of maternal and perinatal complications. Women with chronic hypertension who wish to be involved in their care can do by measuring blood pressure at home. Accurate devices for home blood pressure monitoring are now readily available. The diagnostic criteria for superimposed preeclampsia remain problematic because most guidelines continue to include deteriorating blood pressure control in the definition. It has not been established how angiogenic markers may aid in confirmation of the diagnosis of superimposed preeclampsia when suspected, over and above information provided by routinely available clinical data and laboratory results. Although chronic hypertension is a strong risk factor for preeclampsia, and aspirin decreases preeclampsia risk, the effectiveness specifically among women with chronic hypertension has been questioned. It is unclear whether calcium has an independent effect in preeclampsia prevention in such women. Treating hypertension with antihypertensive therapy halves the risk of progression to severe hypertension, thrombocytopenia, and elevated liver enzymes, but a reduction in preeclampsia or serious maternal complications has not been observed; however, the lack of evidence for the latter is possibly owing to few events. In addition, treating chronic hypertension neither reduces nor increases fetal or newborn death or morbidity, regardless of the gestational age at which the antihypertensive treatment is started. Antihypertensive agents are not teratogenic, but there may be an increase in malformations associated with chronic hypertension itself. At present, blood pressure treatment targets used in clinics are the same as those used at home, although blood pressure values tend to be inconsistently lower at home among women with hypertension. Although starting all women on the same antihypertensive medication is usually effective in reducing blood pressure, it remains unclear whether there is an optimal agent for such an approach or how best to use combinations of antihypertensive medications. An alternative approach is to individualize care, using maternal characteristics and blood pressure features beyond blood pressure level (eg, variability) that are of prognostic value. Outcomes may be improved by timed birth between 38 0/7 and 39 6/7 weeks' gestation based on observational literature; of note, confirmatory trial evidence is pending. Postnatal care is facilitated by the acceptability of most antihypertensives (including angiotensin-converting enzymes inhibitors) for use in breastfeeding. The evidence base to guide the care of pregnant women with chronic hypertension is growing and aligning with international guidelines. Addressing outstanding research questions would inform personalized care of chronic hypertension in pregnancy.
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Kametas NA, Nzelu D, Nicolaides KH. Chronic hypertension and superimposed preeclampsia: screening and diagnosis. Am J Obstet Gynecol 2022; 226:S1182-S1195. [PMID: 35177217 DOI: 10.1016/j.ajog.2020.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 01/23/2023]
Abstract
Superimposed preeclampsia complicates about 20% of pregnancies in women with chronic hypertension and is associated with increased maternal and perinatal morbidity compared with preeclampsia alone. Distinguishing superimposed preeclampsia from chronic hypertension can be challenging because, in chronic hypertension, the traditional criteria for the diagnosis of preeclampsia, hypertension, and significant proteinuria can often predate the pregnancy. Furthermore, the prevalence of superimposed preeclampsia is unlikely to be uniformly distributed across this high-risk group but is related to the severity of preexisting endothelial dysfunction. This has led to interest in identifying biomarkers that could help in screening and diagnosis of superimposed preeclampsia and in the stratification of risk in women with chronic hypertension. Elevated levels of uric acid and suppression of other renal biomarkers, such as the renin-angiotensin aldosterone system, have been demonstrated in women with superimposed preeclampsia but perform only modestly in its prediction. In addition, central to the pathogenesis of preeclampsia is a tendency toward an antiangiogenic state thought to be triggered by an impaired placenta and, ultimately, contributing to the endothelial dysfunction pathognomonic of the disease. In the general obstetrical population, angiogenic factors, such as soluble fms-like tyrosine kinase-1 and placental growth factor, have shown promise in the prediction of preeclampsia. However, soluble fms-like tyrosine kinase-1 and placental growth factor are impaired in women with chronic hypertension irrespective of whether they develop superimposed preeclampsia. Therefore, the differences in levels are less discriminatory in the prediction of superimposed preeclampsia compared with the general obstetrical population. Alternative biomarkers to the angiogenic and renal factors include those of endothelial dysfunction. A characteristic of both preeclampsia and chronic hypertension is an exaggerated systemic inflammatory response causing or augmenting endothelial dysfunction. Thus, proinflammatory mediators, such as tumor necrosis factor-α, interleukin-6, cell adhesion molecules, and endothelin, have been investigated for their role in the screening and diagnosis of superimposed preeclampsia in women with chronic hypertension. To date, the existing limited evidence suggests that the differences between those who develop superimposed preeclampsia and those who do not are, as with angiogenic factors, also modest and not clinically useful for the stratification of women with chronic hypertension. Finally, pro-B-type natriuretic peptide is regarded as a sensitive marker of early cardiac dysfunction that, in women with chronic hypertension, may predate the pregnancy. Thus, it has been proposed that pro-B-type natriuretic peptide could give insight as to the ability of women with chronic hypertension to adapt to the hemodynamic requirements of pregnancy and, subsequently, their risk of developing superimposed preeclampsia. Although higher levels of pro-B-type natriuretic peptide have been demonstrated in women with superimposed preeclampsia compared with those without, current evidence suggests that pro-B-type natriuretic peptide is not a predictor for the disease. The objectives of this review are to, first, discuss the current criteria for the diagnosis of superimposed preeclampsia and, second, to summarize the evidence for these potential biomarkers that may assist in the diagnosis of superimposed preeclampsia.
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Affiliation(s)
- Nikos A Kametas
- Antenatal Hypertension Clinic, Division of Women's Health, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom.
| | - Diane Nzelu
- Antenatal Hypertension Clinic, Division of Women's Health, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Kypros H Nicolaides
- Antenatal Hypertension Clinic, Division of Women's Health, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
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Shinar S, Melamed N, Abdulaziz KE, Ray JG, Riddell C, Barrett J, Murray-Davis B, Mawjee K, McDonald SD, Geary M, Berger H. Changes in rate of preterm birth and adverse pregnancy outcomes attributed to preeclampsia after introduction of a refined definition of preeclampsia: A population-based study. Acta Obstet Gynecol Scand 2021; 100:1627-1635. [PMID: 34043808 DOI: 10.1111/aogs.14199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Since 2013, various guidelines for hypertension in pregnancy have been refined, no longer requiring proteinuria as a requisite criterion for preeclampsia. We aimed to evaluate the impact of the new definition on preterm birth (PTB) and adverse pregnancy outcomes. MATERIAL AND METHODS Women delivering in Ontario between April 2012 and November 2016 were included. Delivery <24+0/7 weeks, major fetal anomalies or preexisting renal disease were excluded. The primary outcome was livebirth <37, <34 or <32 weeks. Rates, adjusted rate ratios (aRR) and ratio of the rate ratio (RRR) were used to compare outcomes in the 2 years after the new Society of Obstetricians and Gynaecologists of Canada (SOGC) guideline (December 2014-November 2016; period 2) vs the 2 years before (April 2012-March 2014; period 1), among women with and without preeclampsia. RESULTS In all, 268 543 and 267 964 births in periods 1 & 2, respectively, were included. Respective preeclampsia rates increased significantly from 3.9% to 4.4% (p < 0.001), with no change in maternal morbidity rates. In preeclamptic women, respective rates of PTB <37 weeks were 21.0% and 20.7% (aRR 1.01, 95% confidence interval [CI] 1.00-1.02), with significant aRR for PTB <34 (0.86, 95% CI 0.77-0.96) and <32 weeks (0.79, 95% CI 0.67-0.94). A similar aRR was observed in women without preeclampsia. In preeclamptic women, composite severe neonatal morbidity decreased after guideline change (aRR 0.95, 95% CI 0.91-0.99), a finding not observed in women without preeclampsia (RRR 0.95, 95% CI 0.91-0.99). CONCLUSIONS The new definition of preeclampsia was associated with increased disease rates, a modest reduction in adverse neonatal outcomes and no change in maternal outcomes.
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Affiliation(s)
- Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Joel G Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Jon Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Beth Murray-Davis
- Department of Obstetrics and Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Karizma Mawjee
- Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Radiology & Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael Geary
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Howard Berger
- Department of Obstetrics and Gynaecology, Saint Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Magee LA, Singer J, Lee T, Rey E, Asztalos E, Hutton E, Helewa M, Logan AG, Ganzevoort W, Welch R, Thornton JG, Woo Kinshella ML, Green M, Tsigas E, von Dadelszen P. The impact of pre-eclampsia definitions on the identification of adverse outcome risk in hypertensive pregnancy - analyses from the CHIPS trial (Control of Hypertension in Pregnancy Study). BJOG 2021; 128:1373-1382. [PMID: 33230924 DOI: 10.1111/1471-0528.16602] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between pre-eclampsia definition and pregnancy outcome. DESIGN Secondary analysis of Control of Hypertension in Pregnancy Study (CHIPS) trial data. SETTING International multicentre randomised controlled trial (RCT). POPULATION In all, 987 women with non-severe non-proteinuric pregnancy hypertension. METHODS We evaluated the association between pre-eclampsia definitions and adverse pregnancy outcomes, stratified by hypertension type and blood pressure control. MAIN OUTCOME MEASURES Main CHIPS trial outcomes: primary (perinatal loss or high-level neonatal care for >48 hours), secondary (serious maternal complications), birthweight <10th centile, severe maternal hypertension, delivery at <34 or <37 weeks, and maternal hospitalisation before birth. RESULTS Of 979/987 women with informative data, 280 (28.6%) progressed to pre-eclampsia defined restrictively by new proteinuria, and 471 (48.1%) to pre-eclampsia defined broadly as proteinuria or one/more maternal symptoms, signs or abnormal laboratory tests. The broad (versus restrictive) definition had significantly higher sensitivities (range 62-79% versus 36-50%), lower specificities (range 53-65% versus 72-82%), and similar or higher diagnostic odds ratios and 'true-positive' to 'false-positive' ratios. Stratified analyses showed similar results. Addition of available fetoplacental manifestations (stillbirth or birthweight <10th centile) to the broad pre-eclampsia definition improved sensitivity (74-87%). CONCLUSIONS A broad (versus restrictive) pre-eclampsia definition better identifies women who develop adverse pregnancy outcomes. These findings should be replicated in a prospective study within routine healthcare to ensure that the anticipated increase in surveillance and intervention in a larger number of women with pre-eclampsia is associated with improved outcomes, reasonable costs and congruence with women's values. TWEETABLE ABSTRACT A broad (versus restrictive) pre-eclampsia definition better identifies the risk of adverse pregnancy outcomes.
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Affiliation(s)
- L A Magee
- Department of Women and Children's Health, King's College London, London, UK
| | - J Singer
- School of Population and Public Health, Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - T Lee
- Centre for Health Evaluation and Outcome Science, Providence Health Care Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - E Rey
- Department of Medicine, Université de Montreal, Montreal, QC, Canada.,Department of Obstetrics and Gynaecology, Université de Montreal, Montreal, QC, Canada
| | - E Asztalos
- Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Hutton
- Midwifery, McMaster University, Hamilton, ON, Canada
| | - M Helewa
- Obstetrics and Gynaecology, University of Manitoba, Winnipeg, MB, Canada
| | - A G Logan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - W Ganzevoort
- Department of Obstetrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - R Welch
- University of Plymouth, Plymouth, UK
| | - J G Thornton
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - M Green
- Action on Pre-eclampsia Charity (APEC), Evesham, UK
| | - E Tsigas
- Preeclampsia Foundation, Melbourne, FL, USA
| | - P von Dadelszen
- Department of Women and Children's Health, King's College London, London, UK
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Casagrande L, Rezende GP, Guida JP, Costa RS, Parpinelli MA, Surita FG, Costa ML. Maternal and perinatal outcomes related to superimposed pre-eclampsia in a Brazilian cohort of women with chronic hypertension. Int J Gynaecol Obstet 2020; 149:148-153. [PMID: 32037536 DOI: 10.1002/ijgo.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/18/2019] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe maternal and perinatal outcomes for women with chronic hypertension, comparing those with superimposed pre-eclampsia (SPE) with those without pre-eclampsia (NPE). METHODS In a retrospective cohort study in a tertiary hospital in Brazil, the records of women with chronic hypertension were reviewed between January 1, 2012, and May 31, 2017, in order to compare maternal and perinatal outcomes among those with and without SPE. Poisson regression was performed to investigate factors independently associated with severe pre-eclampsia. RESULTS Of 385 women with chronic hypertension included in the study, 167 were in the SPE group and 218 in the NPE group. The majority were white, overweight (body mass index ≥30 kg/m2 ), with mean age around 31 years. Adverse neonatal outcomes were significantly more prevalent among women with SPE, including small for gestational age (SPE 17.46% vs NPE 9.63%, P=0.01), low birth weight (SPE 2577 g ± 938 vs NPE 3128 g ± 723, P=0.003), neonatal intensive care unit admission (SPE 44.91% vs NPE 18.34%, P=0.08), and incidence of cesarean delivery (SPE 79.64% vs NPE 62.38%, P=0.003). Fetal growth restriction (PR [prevalence ratio] 2.62, 95% confidence interval [CI] 1.39-4.94) and previous pre-eclampsia (PR 1.96, 95% CI 1.17-3.28) were associated with severe pre-eclampsia. CONCLUSION SPE is associated with prematurity and higher rates of admission to neonatal intensive care unit. Fetal growth restriction and previous pre-eclampsia are factors associated with severe complications of pre-eclampsia.
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Affiliation(s)
- Laura Casagrande
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Gabriela P Rezende
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - José P Guida
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Raquel S Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Mary A Parpinelli
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Govender N, Moodley J, Naicker T. Copeptin in Preeclampsia Development. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404815666190110094636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:
Preeclampsia complicates 2-8% of all pregnancies worldwide and is one of
the leading causes of maternal and neonatal morbidity and mortality. It occurs after the 20th week of
gestation and is characterized by high blood pressure, proteinuria or end-organ disease. The heterogeneous
and multi-systemic nature of this disease has led to the elusive pathophysiology which
delays timely diagnoses and the clinical treatment of those affected.
Objective:
Despite the extensive investigations surrounding the inclusion of various potential markers
for PE prediction, early diagnosis remains unresolved. Quantification of copeptin, a stable component
of the arginine vasopressin (AVP) precursor is shown to be relatively reliable in confirming
the circulating levels of AVP.
Conclusion:
Elevated copeptin levels confirmed in pregnant women have also provided clinical
support for its role in PE development. However, its clinical use in predicting disease severity in
early-onset pre-eclampsia has been debatable. This review thus recapitulates the current literature
surrounding copeptin and its potential as a risk indicator for PE development.</P>
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Affiliation(s)
- Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Discipline of Optics and Imaging, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
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Stryuk RI, Brytkova YV, Berns SA, Barkova EL, Ivanova EY, Gomova TA. Arterial hypertension as a risk factor for complications during pregnancy and adverse perinatal outcomes - an analysis of the registry of pregnant women 'BEREG'. ACTA ACUST UNITED AC 2018. [DOI: 10.17116/cardiobulletin201813116-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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