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Ramlakhan KP, Roos-Hesselink JW, Basso T, Greenslade J, Flint RB, Krieger EV, Shotan A, Budts W, De Backer J, Hall R, Johnson MR, Parsonage WA. Perinatal outcomes after in-utero exposure to beta-blockers in women with heart disease: Data from the ESC EORP registry of pregnancy and cardiac disease (ROPAC). Int J Cardiol 2024; 410:132234. [PMID: 38844094 DOI: 10.1016/j.ijcard.2024.132234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/20/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Beta-blockers are commonly used drugs during pregnancy, especially in women with heart disease, and are regarded as relatively safe although evidence is sparse. Differences between beta-blockers are not well-studied. METHODS In the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders). RESULTS Beta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p < 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was -177 g (-5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3-2.1) and for nCHD 2.3 (1.6-3.5). With metoprolol as reference, labetalol (0.2, 0.1-0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1-4.9) the most. CONCLUSIONS In women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Thomas Basso
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jaimi Greenslade
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Australian Centre for Health Services Innovation, School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert B Flint
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Avraham Shotan
- Heart Institute, Laniado Medical Center, Netanya, Adelson School of Medicine, Ariel University, Israel
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Julie De Backer
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Roger Hall
- Department of Cardiology, University of East Anglia, Norwich, United Kingdom
| | - Mark R Johnson
- Department of Obstetric Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - William A Parsonage
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Australian Centre for Health Services Innovation, School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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2
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S282-S294. [PMID: 38078583 PMCID: PMC10725801 DOI: 10.2337/dc24-s015] [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] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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3
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Sharma DD, Chandresh NR, Javed A, Girgis P, Zeeshan M, Fatima SS, Arab TT, Gopidasan S, Daddala VC, Vaghasiya KV, Soofia A, Mylavarapu M. The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions. Cureus 2024; 16:e51512. [PMID: 38304688 PMCID: PMC10832549 DOI: 10.7759/cureus.51512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Preeclampsia (PE) is a disease in pregnancy that is characterized by new-onset hypertension end-organ dysfunction, often occurring after 20 weeks of gestation. Risk factors include a prior history of PE, diabetes, kidney disease, obesity, and high maternal age at pregnancy. Current treatment and management guidelines focus on the management of high blood pressure and any potential complications. The only known curative treatment is termination of pregnancy (either induction of delivery or cesarean section). However, the current guidelines and recommendations lack adequate prediction markers and are unable to prevent maternal and fetal mortality. There also exists a need for multidisciplinary collaborative action in view of the quality of life and psycho-educational counseling.
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Affiliation(s)
- Dhruvikumari D Sharma
- Biochemistry, Spartan Health Sciences University, Vieux Fort, LCA
- Medicine, Avalon University School of Medicine, Willemstad, CUW
| | | | - Ayesha Javed
- Gynecology, Hearts International Hospital, Rawalpindi, Rawalpindi, PAK
| | - Peter Girgis
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Madiha Zeeshan
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Syeda Simrah Fatima
- Internal Medicine, Rajarajeswari Medical College and Hospital, Bangalore, IND
| | - Taneen T Arab
- Family Medicine, Saint James School of Medicine, Chicago, USA
| | - Sreeja Gopidasan
- Internal Medicine, American International School of Medicine, George Town, GUY
| | | | - Kalgi V Vaghasiya
- College of Medicine, Community Health Center (CHC) Vartej, Vartej, IND
| | - Ameena Soofia
- Internal Medicine, Shadan Institute of Medical Sciences, Hyderabad, IND
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4
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Albadrani M, Tobaiqi M, Al-Dubai S. An evaluation of the efficacy and the safety of home blood pressure monitoring in the control of hypertensive disorders of pregnancy in both pre and postpartum periods: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:550. [PMID: 37528352 PMCID: PMC10392017 DOI: 10.1186/s12884-023-05663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/29/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) can significantly impact maternal, neonatal, and fetal health. For controlling these disorders, frequent blood pressure measurements are required. Home blood pressure monitoring (HBPM) is a suggested alternative to conventional office monitoring that requires frequent visits. This systematic review was conducted to evaluate the efficacy and safety of HBPM in the control of HDP. METHODS We systematically conducted databases search for relevant studies in June 2022. The relevant studies were identified, and qualitative synthesis was performed. An inverse variance quantitative synthesis was conducted using RevMan software. Continuous outcome data were pooled as means differences, whereas dichotomous ones were summarized as risk ratios. The 95% confidence interval was the measure of variance. RESULTS Fifteen studies were included in our review (n = 5335). Our analysis revealed a superiority of HBPM in reducing the risk of induction of labor, and postpartum readmission (P = 0.02, and 0.01 respectively). Moreover, the comparison of birth weights showed a significant variation in favor of HBPM (P = 0.02). In the analysis of other outcomes, HBPM was equally effective as office monitoring. Furthermore, HBPM did not result in an elevated risk of maternal, neonatal, and fetal adverse outcomes. CONCLUSION Home monitoring of blood pressure showed superiority over office monitoring in some outcomes and equal efficacy in other outcomes.
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Affiliation(s)
- Muayad Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia.
| | - Muhammad Tobaiqi
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Sami Al-Dubai
- Joint Program of Saudi Board of Preventive Medicine Madinah, Madinah Health Cluster, Al-Madinah, Saudi Arabia
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5
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Taj S, Mujtaba M, Miller B, Dandu S, Austin CP, Ali Akbar U, Sanekommu H, Hossain MA. Role of Plasmapheresis in Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) Syndrome. Cureus 2023; 15:e35520. [PMID: 37007368 PMCID: PMC10054188 DOI: 10.7759/cureus.35520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a rare abnormality comprising a series of symptoms that make up a syndrome. It usually happens during pregnancy or right after delivery. We describe a case of a 31-year-old female G4P2A2 (Gravida 4 Para 2 Abortions 2) who presented to the hospital for normal vaginal delivery but immediately postpartum developed HELLP syndrome. Acute fatty liver of pregnancy was a differential that the patient also met the criteria for. Her condition improved after starting her on plasmapheresis without considering hepatic transplantation. We emphasize distinguishing the overlap of symptoms between HELLP syndrome vs. acute fatty liver of pregnancy and the outcomes of plasmapheresis in managing HELLP syndrome without needing hepatic transplantation.
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6
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S254-S266. [PMID: 36507645 PMCID: PMC9810465 DOI: 10.2337/dc23-s015] [Citation(s) in RCA: 100] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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7
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van de Vusse D, Mian P, Schoenmakers S, Flint RB, Visser W, Allegaert K, Versmissen J. Pharmacokinetics of the most commonly used antihypertensive drugs throughout pregnancy methyldopa, labetalol, and nifedipine: a systematic review. Eur J Clin Pharmacol 2022; 78:1763-1776. [PMID: 36104450 PMCID: PMC9474278 DOI: 10.1007/s00228-022-03382-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/03/2022] [Indexed: 01/09/2023]
Abstract
Abstract
Purpose
Antihypertensive drugs are among the most prescribed drugs during pregnancy. Methyldopa, labetalol, and nifedipine have been perceived safe to use during pregnancy and are therefore recommended in international guidelines for treatment of hypertension. In this review, we provide a complete overview of what is known on the pharmacokinetics (PK) of the antihypertensive drugs methyldopa, labetalol, and nifedipine throughout pregnancy.
Methods
A systematic search was performed to retrieve studies on the PK of methyldopa, labetalol, and nifedipine used throughout pregnancy. The search was restricted to English and original studies. The systematic search was conducted on July 27, 2021, in Embase, Medline Ovid, Web of Science, Cochrane Library, and Google Scholar. Keywords were methyldopa, labetalol, nifedipine, pharmacokinetics, pregnancy, and placenta.
Results
A total of 1459 unique references were identified of which title and abstract were screened. Based on this screening, 67 full-text papers were assessed, to retain 30 PK studies of which 2 described methyldopa, 12 labetalol, and 16 nifedipine. No fetal accumulation is found for any of the antihypertensive drugs studied.
Conclusion
We conclude that despite decades of prescribing methyldopa, labetalol, and nifedipine throughout pregnancy, descriptions of their PK during pregnancy are hampered by a large heterogeneity in the low number of available studies. Aiming for evidence-based and personalized dosing of antihypertensive medication in the future, further studies on the relationship of both PK and pharmacodynamics (including the optimal blood pressure targeting) during pregnancy and pregnancy-related pathology are urgently needed to prevent undertreatment, overtreatment, and side effects.
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Affiliation(s)
- Dylan van de Vusse
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Paola Mian
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sam Schoenmakers
- Obstetrics and Gynecology, Division Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Pediatrics, Division of Neonatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willy Visser
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Obstetrics and Gynecology, Division Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Karel Allegaert
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jorie Versmissen
- Department of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Clinical Pharmacy, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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8
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Hypertensive Disorders of Pregnancy: Common Clinical Conundrums. Obstet Gynecol Surv 2022; 77:234-244. [PMID: 35395093 DOI: 10.1097/ogx.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Hypertensive complications of pregnancy comprise 16% of maternal deaths in developed countries and 7.4% of deaths in the United States. Rates of preeclampsia increased 25% from 1987 to 2004, and rates of severe preeclampsia have increased 6.7-fold between 1980 and 2003. Objective The aim of this study was to review current and available evidence for common clinical questions regarding the management of hypertensive disorders of pregnancy. Evidence Acquisition Original research articles, review articles, and guidelines on hypertension in pregnancy were reviewed. Results Severe gestational hypertension should be managed as preeclampsia with severe features. Serum uric acid levels can be useful in predicting development of superimposed preeclampsia for women with chronic hypertension. When presenting with preeclampsia with severe features before 34 weeks, expectant management should be considered only when both maternal and fetal conditions are stable. In the setting of hypertensive disorders of pregnancy, oral antihypertensive medications should be initiated when systolic blood pressure is greater than 160 mm Hg or when diastolic blood pressure is greater than 110 mm Hg, with the most ideal agents being labetalol or nifedipine. Furthermore, although risk of preeclampsia recurrence in future pregnancy is low, women with a history of preeclampsia should be managed with 81 mg aspirin daily for preeclampsia prevention. Conclusions and Relevance Despite the frequency with which hypertensive disorders of pregnancy are encountered clinically, situations arise frequently with limited evidence to guide providers in their management. An urgent need exists to better understand this disease to optimize outcomes for impacted patients.
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9
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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10
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Kyozuka H, Murata T, Fukuda T, Endo Y, Yamaguchi A, Yasuda S, Kanno A, Sato A, Ogata Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Immunoglobulin E levels and pregnancy-induced hypertension: Japan Environment and Children's Study. Sci Rep 2021; 11:8664. [PMID: 33883660 PMCID: PMC8060415 DOI: 10.1038/s41598-021-88227-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/09/2021] [Indexed: 02/08/2023] Open
Abstract
High serum immunoglobulin E (IgE) levels are associated with cardiovascular events. We aimed to evaluate the association between total IgE levels during the first trimester of pregnancy and pregnancy-induced hypertension (PIH) development in a large Japanese cohort. We analysed data pertaining to singleton primipara pregnancies recorded in the Japan Environment and Children's Study involving births from 2011 to 2014. Serum IgE levels were determined using the immunonephelometric technique. High serum IgE was defined as level ≥ 170 IU/ml. Hypertensive disorders in pregnancy (HDP) were categorized into early onset (Eo) PIH (developed < 34 weeks) or late onset (Lo) PIH (developed ≧ 34 weeks). A multiple logistic regression model was used to estimate the risk of high serum IgE levels on PIH, Eo-PIH, and Lo-PIH. Overall, 32,518 participants were enrolled. The prevalence of total, Eo-, and Lo-PIH was 3.2%, 0.6%, and 2.3%, respectively. Patients with high serum IgE levels had an increased risk of Lo-HDP (adjusted odds ratio [aOR]:1.19, 95% confidence interval 1.01-1.40). No correlation was found with either PIH (total) or Eo-PIH. High serum IgE levels during the first trimester were associated with the risk of Lo-PIH. Our results could influence and shape further research regarding the pathogenesis of Lo hypertension.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuta Endo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Aya Kanno
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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11
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Bogacz A, Mikołajczak PŁ, Wolek M, Górska A, Szulc M, Ożarowski M, Kujawski R, Czerny B, Wolski H, Karpiński TM, Seremak-Mrozikiewicz A. Combined Effects of Methyldopa and Flavonoids on the Expression of Selected Factors Related to Inflammatory Processes and Vascular Diseases in Human Placenta Cells-An In Vitro Study. Molecules 2021; 26:molecules26051259. [PMID: 33652665 PMCID: PMC7956652 DOI: 10.3390/molecules26051259] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
The aim of the study was to investigate combined effects of flavonoids (apigenin, baicalein, chrysin, quercetin, and scutellarin) and methyldopa on the expression of selected proinflammatory and vascular factors in vitro for prediction of their action in pregnancy-induced hypertension. The research was conducted on a trophoblast-derived human choriocarcinoma cell line and a primary human umbilical vein endothelial cell line. Cytotoxicity of compounds in selected concentrations (20, 40, and 100 µmol) was measured using the MTT test and the concentration of 40 µmol was selected for further analysis. Subsequently, their effects with methyldopa on the expression of selected markers responsible for inflammation (TNF-α; IL-1β; IL-6) and vascular effects (hypoxia-inducible factor 1α—HIF-1α; placental growth factor—PIGF; transforming growth factor β—TGF-β; vascular endothelial growth factor—VEGF) at the mRNA and protein levels were assessed. It was found that every combined administration of a flavonoid and methyldopa in these cells induced a down-regulating effect on all tested factors, except PIGF, especially at the mRNA expression level. As hypertension generally raises TNF-α, IL-1β, IL-6, HIF-1α, TGF-β, and VEGF mRNA expression and/or protein levels, the results obtained in the studied model may provide a positive prognostic factor for such activity in vivo.
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Affiliation(s)
- Anna Bogacz
- Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (A.B.); (P.Ł.M.); (A.S.-M.)
| | - Przemysław Ł. Mikołajczak
- Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (A.B.); (P.Ł.M.); (A.S.-M.)
- Department of Pharmacology, Poznan University of Medical Sciences, Rokietnicka 5a, 60-806 Poznań, Poland; (M.S.); (R.K.)
| | - Marlena Wolek
- Department of Stem Cells and Regenerative Medicine, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (M.W.); (A.G.); (B.C.)
| | - Aleksandra Górska
- Department of Stem Cells and Regenerative Medicine, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (M.W.); (A.G.); (B.C.)
| | - Michał Szulc
- Department of Pharmacology, Poznan University of Medical Sciences, Rokietnicka 5a, 60-806 Poznań, Poland; (M.S.); (R.K.)
| | - Marcin Ożarowski
- Department of Biotechnology, Institute of Natural Fibres and Medicinal Plants, WojskaPolskiego 71b, 60-630 Poznań, Poland
- Correspondence:
| | - Radosław Kujawski
- Department of Pharmacology, Poznan University of Medical Sciences, Rokietnicka 5a, 60-806 Poznań, Poland; (M.S.); (R.K.)
| | - Bogusław Czerny
- Department of Stem Cells and Regenerative Medicine, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (M.W.); (A.G.); (B.C.)
- Department of General Pharmacology and Pharmacoeconomics, Pomeranian Medical University in Szczecin, Żołnierska 48, 70-204 Szczecin, Poland
| | - Hubert Wolski
- Division of Gynecology and Obstetrics, Podhale Multidisciplinary Hospital, 34-400 NowyTarg, Poland;
- Division of Perinatology and Women’s Diseases, Poznan University of Medical Sciences, Polna 33, 60-535 Poznań, Poland
| | - Tomasz M. Karpiński
- Chair and Department of Medical Microbiology, Poznań University of Medical Sciences, Wieniawskiego 3, 61-712 Poznań, Poland;
| | - Agnieszka Seremak-Mrozikiewicz
- Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, Kolejowa 2, 62-064 Plewiska, Poland; (A.B.); (P.Ł.M.); (A.S.-M.)
- Division of Perinatology and Women’s Diseases, Poznan University of Medical Sciences, Polna 33, 60-535 Poznań, Poland
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Kyozuka H, Murata T, Fukuda T, Yamaguchi A, Kanno A, Yasuda S, Sato A, Ogata Y, Kuse M, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Association between pre-pregnancy calcium intake and hypertensive disorders during the first pregnancy: the Japan environment and children's study. BMC Pregnancy Childbirth 2020; 20:424. [PMID: 32723367 PMCID: PMC7385887 DOI: 10.1186/s12884-020-03108-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Determining the appropriate preconception care to reduce the occurrence of hypertensive disorder of pregnancy (HDP) remains a challenge in modern obstetrics. This study aimed to examine the association between pre-pregnancy calcium (Ca) intake and HDP in normotensive primiparas. METHODS We used data from the Japan Environment Children's study (JECS), which is the largest birth cohort study. A total of 33,894 normotensive Japanese primiparas were recruited for JECS between January 2011 and March 2014. Participants were categorized into five groups according to pre-pregnancy Ca intake quintiles (Q1 and Q5 were the lowest and highest Ca intake groups, respectively) to compare their basic background and obstetrics outcome. Multiple logistic regressions were performed to identify the effect of pre-pregnancy Ca intake on HDP, early onset HDP, and late-onset HDP, using Ca intake thresholds of 500, 550, 650, 700, 1000, 1500, and 1500 mg. RESULTS We found significant differences in maternal background among the Ca intake groups; in particular, there were more participants with low socioeconomic status, indicated by low education level and low household income, and smokers in the lowest Ca intake group. Multiple logistic regression did not show any significant difference with regard to HDP, early onset HDP, and late-onset HDP in each Ca intake threshold. CONCLUSIONS Despite considerable recommendations concerning Ca intake for women of reproductive age, the present study indicates that pre-pregnancy Ca intake was not associated with an increased risk of new-onset hypertension among primiparas during pregnancy. Further studies examining the effect of other pre-pregnancy dietary factors on obstetric outcomes should be considered in the formulation of earlier preventive strategies for primiparas.
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Affiliation(s)
- Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan.
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan.
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Aya Kanno
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Masahito Kuse
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, 960-1295, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, 960-1295, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, 960-1295, Fukushima, Japan
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15
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Affiliation(s)
- Susan Hou
- Loyola University Medical Center, Maywood, Illinois, U.S.A
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16
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Azeez O, Kulkarni A, Kuklina EV, Kim SY, Cox S. Hypertension and Diabetes in Non-Pregnant Women of Reproductive Age in the United States. Prev Chronic Dis 2019; 16:E146. [PMID: 31651378 PMCID: PMC6824149 DOI: 10.5888/pcd16.190105] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Diagnosis and control of chronic conditions have implications for women’s health and are major contributing factors to maternal and infant morbidity and mortality. This study estimated the prevalence of hypertension and diabetes in non-pregnant women of reproductive age in the United States, the proportion who were unaware of their condition or whose condition was not controlled, and differences in the prevalence of these conditions by selected characteristics. Methods We used data from the 2011–2016 National Health and Nutrition Examination Survey to estimate overall prevalence of hypertension and diabetes among women of reproductive age (aged 20–44 y), the proportion who were unaware of having hypertension or diabetes, and the proportion whose diabetes or hypertension was not controlled. We used logistic regression models to calculate adjusted prevalence ratios to assess differences by selected characteristics. Results The estimated prevalence of hypertension was 9.3% overall. Among those with hypertension, 16.9% were unaware of their hypertension status and 40.7% had uncontrolled hypertension. Among women with diabetes, almost 30% had undiagnosed diabetes, and among those with diagnosed diabetes, the condition was not controlled in 51.5%. Conclusion This analysis improves our understanding of the prevalence of hypertension and diabetes among women of reproductive age and may facilitate opportunities to improve awareness and control of these conditions, reduce disparities in women’s health, and improve birth outcomes.
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Affiliation(s)
- Olumayowa Azeez
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, 200 Independence Ave, SW, Room 732F, Washington, DC 20201.
| | - Aniket Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena V Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shin Y Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Karemore MN, Avari JG. Formulation, Optimization, and In vivo Evaluation of Gastroretentive Drug Delivery System of Nifedipine for the Treatment of Preeclampsia. AAPS PharmSciTech 2019; 20:200. [PMID: 31127399 DOI: 10.1208/s12249-019-1391-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022] Open
Abstract
The study aimed to develop gastroretentive drug delivery system of nifedipine, its optimization, and in vivo evaluation. Bilayered tablet of nifedipine was prepared using central composite design with 3 factors, 5 responses, and 15 experimental trials. Response surface methodology along with numerical and graphical optimization was used to select the best formulation. Scanning electron microscopy study of optimized tablet at different time interval was carried out which showed formation of porous structure on the tablet surface. In vivo studies for optimized formulation were carried out on 10 healthy human volunteers and obtained pharmacokinetic parameters were compared with the marketed formulation, "Nicardia XL." Optimized formulation containing 3.083 mg HPMC K15M, 29.859 mg HPMC E15LV, and 3.541 mg Carbopol 974P releases the drug in a desired manner and remain buoyant for more than 12 h in human stomach. Both the formulations were found to have similar in vitro release profile (f1 4.5089 and f2 55.8274) and also were found to be bioequivalent. Finally, the stability study of the optimized formulation proved the integrity of the optimized formulation. Hence, the data suggest gastroretention as a promising approach to enhance bioavailability of nifedipine.
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Karemore MN, Avari JG. In-situ gel of nifedipine for preeclampsia: Optimization, in-vitro and in-vivo evaluation. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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20
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Pharmacological Effect of Quercetin in Hypertension and Its Potential Application in Pregnancy-Induced Hypertension: Review of In Vitro, In Vivo, and Clinical Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:7421489. [PMID: 30622610 PMCID: PMC6304490 DOI: 10.1155/2018/7421489] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 01/27/2023]
Abstract
Since improving maternal and child health is a public health priority worldwide, the main aim of treatment of hypertension in pregnant women is to prevent complications during pregnancy, labor, and postpartum. In consequence, much attention is paid to the use of antihypertensive drugs that can be used safely during pregnancy. Several side effects of methyldopa, which is currently the most commonly used antihypertensive drug in pregnant women, mean that the search for an effective and safe alternative still continues. Flavonoid compounds present in medicinal plants, vegetables, and fruits may be a promising source of new drugs. In this aspect, quercetin, a well-known flavonoid due to its antihypertensive action, may be considered a prototype for safe antihypertensive drugs. This review focuses on the selective activity of quercetin. Based on recent studies, a few problems were discussed, including (1) pathology of pregnancy-induced hypertension; (2) search for new pharmacological treatments of pregnancy-induced hypertension; (3) issues with the use of herbal extracts during pregnancy; (4) flavonoids as natural active chemical compounds; (5) quercetin: its action during pregnancy, in vitro and in vivo pharmacological activities, clinical trials, and meta-analysis; (6) quercetin intake during pregnancy; (7) other natural compounds tested during pregnancy; (8) potential problems with the use of quercetin; (9) safety profile of quercetin. Various studies have shown a beneficial effect of quercetin on vascular endothelial function and its antioxidative and anti-inflammatory activity on cellular and tissue level. It is known that in animal models quercetin affects positively the development of embryo, fetus, and placenta. Because this flavonoid did not have teratogenic and abortive effect, it is generally recognized as safe. For this reason it should be appreciated and studied in the aspect of its potential use in the prevention and treatment of pregnancy-induced hypertension among women in this risk group.
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Lu Y, Chen R, Cai J, Huang Z, Yuan H. The management of hypertension in women planning for pregnancy. Br Med Bull 2018; 128:75-84. [PMID: 30371746 PMCID: PMC6289217 DOI: 10.1093/bmb/ldy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION OR BACKGROUND Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension. SOURCES OF DATA PubMed. AREAS OF AGREEMENT Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant. AREAS OF CONTROVERSY There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin. GROWING POINTS A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy. TIMELY AREAS FOR DEVELOPING RESEARCH Large, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.
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Affiliation(s)
- Yao Lu
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Ruifang Chen
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Jingjing Cai
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Hong Yuan
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
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Kamper CH, Rasmussen NH, Ahrendt P, Toftegaard TS, Bertelsen OW, Wagner S. Reliable Blood Pressure Self-measurement in the Obstetric Waiting Room. Methods Inf Med 2018; 53:225-34. [DOI: 10.3414/me13-01-0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Abstract
SummaryBackground: Patients often fail to adhere to clinical recommendations when using current blood pressure self-measurement (BPSM) methods and equipment. As existing BPSM equipment is not able to detect non-adherent behavior, this could result in mis-diagnosis and treatment error. To overcome this problem, we suggest introducing an alternative method for achieving reliable BPSM by measuring additional context meta-data for validating patient adherence. To facilitate this, we have developed ValidAid, a context-aware system for determining patient adherence levels during BPSM.Objectives: The aim of this study was to validate this new reliable BPSM method based on ValidAid in the clinical setting. Specifically, we wanted to evaluate ValidAid’s ability to accurately detect and model patient adherence levels during BPSM in the clinic.Methods: The validation was done by asking 41 pregnant diabetic patients scheduled for self-measuring their blood pressure (BP) in the waiting room at an obstetrics department’s outpatient clinic to perform an additional BPSM using ValidAid. We then compared the automatically measured and classified values from ValidAid with our manual observations.Results: We found that a) the pregnant diabetics did not adhere to given instructions when performing BPSM in the waiting room, and that b) the ValidAid system was able to accurately classify patient adherence to the modeled recommendations.Conclusions: A new method for ensuring reliable BPSM based on the ValidAid system was validated. Results indicate that context-aware technology is useful for accurately modeling important aspects of non-adherent patient behavior. This may be used to identify patients in need of additional training, or to design better aids to actively assist the patients during measurements. ValidAid is also applicable to other self-measurement environments including the home setting and outpatient clinics in remote or underserved areas as it is built using telemedicine technology and thus well-suited for remote monitoring and diagnosis.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Bae EH, Kim JW, Choi HS, Ma SK, Kim SW. Impact of random urine proteinuria on maternal and fetal outcomes of pregnancy: a retrospective case-control study. Korean J Intern Med 2017; 32:1062-1068. [PMID: 27733023 PMCID: PMC5668390 DOI: 10.3904/kjim.2016.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Proteinuria is associated with hypertension and preeclampsia in pregnancy. However, the impact of random urine proteinuria on fetal and maternal outcomes has not been established. We investigated the influence of random urine proteinuria on the clinical outcomes of pregnancy. METHODS From January 2008 to December 2010, 2,822 patients were retrospectively studied. A total of 536 pregnant women with proteinuria in random urine and matched controls without proteinuria via propensity score matching were analyzed. Proteinuria was checked by the dipstick method. RESULTS The patients' mean age was 33.0 ± 4.7 years, and the mean gestational age was 235.6 ± 50.6 days on admission. The prevalence of hypertension and chronic kidney disease was 2.4% (n = 67) and 1.0% (n = 29), respectively. Women with random urine proteinuria showed higher blood urea nitrogen levels and a higher incidence of hematuria. These women also had a higher incidence of preeclampsia, preterm labor, premature rupture of membranes, and intrauterine growth restriction. Proteinuria was strongly correlated with preeclampsia in both propensity score matching (p < 0.001, r = 0.783) and unmatched whole samples (p < 0.001, r = 0.851). CONCLUSIONS These findings suggest that random urine proteinuria is associated with preeclampsia, preterm labor, premature rupture of membrane, and intrauterine growth restriction.
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Affiliation(s)
- Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Woon Kim
- Department of Obsterics, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Correspondence to Soo Wan Kim, M.D. Department of Internal Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6271 Fax: +82-62-225-8578 E-mail:
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Oelkrug R, Herrmann B, Geissler C, Harder L, Koch C, Lehnert H, Oster H, Kirchner H, Mittag J. Dwarfism and insulin resistance in male offspring caused by α1-adrenergic antagonism during pregnancy. Mol Metab 2017; 6:1126-1136. [PMID: 29031714 PMCID: PMC5641602 DOI: 10.1016/j.molmet.2017.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Maternal and environmental factors control the epigenetic fetal programming of the embryo, thereby defining the susceptibility for metabolic or endocrine disorders in the offspring. Pharmacological interventions required as a consequence of gestational problems, e.g. hypertension, can potentially interfere with correct fetal programming. As epigenetic alterations are usually only revealed later in life and not detected in studies focusing on early perinatal outcomes, little is known about the long-term epigenetic effects of gestational drug treatments. We sought to test the consequences of maternal α1-adrenergic antagonism during pregnancy, which can occur e.g. during hypertension treatment, for the endocrine and metabolic phenotype of the offspring. METHODS We treated C57BL/6NCrl female mice with the α1-adrenergic antagonist prazosin during pregnancy and analyzed the male and female offspring for endocrine and metabolic abnormalities. RESULTS Our data revealed that maternal α1-adrenergic blockade caused dwarfism, elevated body temperature, and insulin resistance in male offspring, accompanied by reduced IGF-1 serum concentrations as the result of reduced hepatic growth hormone receptor (Ghr) expression. We subsequently identified increased CpG DNA methylation at the transcriptional start site of the alternative Ghr promotor caused by the maternal treatment, which showed a strong inverse correlation to hepatic Ghr expression. CONCLUSIONS Our results demonstrate that maternal α1-adrenergic blockade can constitute an epigenetic cause for dwarfism and insulin resistance. The findings are of immediate clinical relevance as combined α/β-adrenergic blockers are first-line treatment of maternal hypertension.
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Affiliation(s)
- Rebecca Oelkrug
- Department of Molecular Endocrinology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Beate Herrmann
- Department of Molecular Endocrinology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Cathleen Geissler
- Department of Epigenetics & Metabolism/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Lisbeth Harder
- Department of Molecular Endocrinology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Christiane Koch
- Department of Chronophysiology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Hendrik Lehnert
- Department of Experimental Neuroendocrinology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Henrik Oster
- Department of Chronophysiology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Henriette Kirchner
- Department of Epigenetics & Metabolism/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jens Mittag
- Department of Molecular Endocrinology/CBBM, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
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Lari NF, DeBaun MR, Oppong SA. The emerging challenge of optimal blood pressure management and hypertensive syndromes in pregnant women with sickle cell disease: a review. Expert Rev Hematol 2017; 10:987-994. [DOI: 10.1080/17474086.2017.1379895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nabilah F. Lari
- Department of Family Medicine, Meharry Medical College, Nashville, TN, USA
| | - Michael R. DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel A. Oppong
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Kwiatkowski S, Dołęgowska B, Kwiatkowska E, Rzepka R, Marczuk N, Loj B, Mikolajek-Bedner W, Torbe A. Do the physiological aging of the placenta and the changes in angiogenesis marker sFlt-1 and PlGF concentrations predispose patients to late-onset preeclampsia? J Matern Fetal Neonatal Med 2017; 32:11-20. [DOI: 10.1080/14767058.2017.1369517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian University of Medicine, Szczecin, Poland
| | - Barbara Dołęgowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Univesity of Medicine, Szczecin, Poland
| | - Rafał Rzepka
- Department of Obstetrics and Gynecology, Pomeranian University of Medicine, Szczecin, Poland
| | - Natalia Marczuk
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Beata Loj
- Department of Obstetrics and Gynecology, Ernst-Moritz-Arndt Universitat Greifswald, Mecklenburg-Vorpommern, Germany
| | | | - Andrzej Torbe
- Department of Obstetrics and Gynecology, Pomeranian University of Medicine, Szczecin, Poland
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Schoen CN, Moreno SC, Saccone G, Graham NM, Hand LC, Maruotti GM, Martinelli P, Berghella V, Roman A. Outpatient versus inpatient management for superimposed preeclampsia without severe features: a retrospective, multicenter study. J Matern Fetal Neonatal Med 2017; 31:1993-1999. [DOI: 10.1080/14767058.2017.1333101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Corina N. Schoen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sindy C. Moreno
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Nora M. Graham
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Lauren C. Hand
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Giuseppe M. Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Hoeltzenbein M, Beck E, Fietz AK, Wernicke J, Zinke S, Kayser A, Padberg S, Weber-Schoendorfer C, Meister R, Schaefer C. Pregnancy Outcome After First Trimester Use of Methyldopa: A Prospective Cohort Study. Hypertension 2017; 70:201-208. [PMID: 28533329 DOI: 10.1161/hypertensionaha.117.09110] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/01/2017] [Accepted: 04/20/2017] [Indexed: 01/23/2023]
Abstract
Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4-4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. CLINICAL TRIAL REGISTRATION URL: https://drks-neu.uniklinik-freiburg.de/drks_web/. Unique identifier: DRKS00010502.
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Affiliation(s)
- Maria Hoeltzenbein
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.).
| | - Evelin Beck
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Anne-Katrin Fietz
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Juliane Wernicke
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Sandra Zinke
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Angela Kayser
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Stephanie Padberg
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Corinna Weber-Schoendorfer
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Reinhard Meister
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
| | - Christof Schaefer
- From the Pharmakovigilanzzentrum Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin Berlin, Germany (M.H., E.B., A.-K.F., J.W., S.Z., A.K., S.P., C.W.-S., C.S.); and Department of Mathematics, Beuth Hochschule für Technik Berlin, University of Applied Sciences, Germany (A.-K.F., R.M.)
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Affiliation(s)
- Errol R. Norwitz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, University of Nebraska Medical Center, University of Nebraska Medical School, Omaha, Nebraska
| | - John T. Repke
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, University of Nebraska Medical Center, University of Nebraska Medical School, Omaha, Nebraska
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Kehler S, Ashford K, Cho M, Dekker RL. Experience of Preeclampsia and Bed Rest: Mental Health Implications. Issues Ment Health Nurs 2016; 37:674-681. [PMID: 27322754 DOI: 10.1080/01612840.2016.1189635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Preeclampsia is a major cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. Mental health issues are often exhibited in this vulnerable population partly due to the rigid management of this condition including prolonged bed rest. The purpose of this qualitative study is to describe women's experience with preeclampsia and being placed on bed rest. Six themes emerged including: negative feelings and thoughts, lack of guidelines about their diagnosis, family stressors, lack of social support, not being heard, loss of normal pregnancy, and physical symptoms. The identified categories provide insight into improving care for these women.
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Affiliation(s)
- Stephanie Kehler
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Kristin Ashford
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Mary Cho
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Rebecca L Dekker
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
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Denolle T. [Methods of blood pressure measurement during pregnancy]. Presse Med 2016; 45:622-6. [PMID: 27208917 DOI: 10.1016/j.lpm.2016.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
Hypertension during pregnancy is associated with high perinatal morbidity and mortality. The prevalence of white coat hypertension is high during pregnancy and is associated with a good prognosis and must be excluded. The definition of hypertension during pregnancy is office BP≥140/90mmHg and ≥135/85mmHg with home BP and diurnal ambulatory BP. How to use HBPM during pregnancy? To get an adapted and validated BP humeral device during pregnancy; to use it in good conditions with the "3 rules". When to use HBPM during pregnancy? To confirm the diagnosis of hypertension; to monitor BP during pregnancy and to alert the obstetrician when severe hypertension occurs; to manage BP treatment and avoid excessive treatment. HBP and ABP monitoring may be used to exclude white coat effect but HBPM must be preferred when prolonged use.
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Affiliation(s)
- Thierry Denolle
- Hôpital Arthur-Gardiner, centre d'excellence en HTA, 35800 Dinard, France.
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Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, Paech M, Said JM. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55:e1-29. [PMID: 26412014 DOI: 10.1111/ajo.12399] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Morton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Michael Paech
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Joanne M Said
- Sunshine Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Stepan H, Kuse-Föhl S, Klockenbusch W, Rath W, Schauf B, Walther T, Schlembach D. Diagnosis and Treatment of Hypertensive Pregnancy Disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkd 2015; 75:900-914. [PMID: 28435172 PMCID: PMC5396549 DOI: 10.1055/s-0035-1557924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Hypertensive pregnancy disorders contribute significantly to perinatal as well as maternal morbidity and mortality worldwide. Also in Germany these diseases are a major course for hospitalization during pregnancy, iatrogenic preterm birth and long-term cardiovascular morbidity. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. Recommendations: This guideline summarizes the state-of-art for classification, risk stratification, diagnostic, treatment of hypertensive pregnancy disorders.
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Affiliation(s)
- H. Stepan
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - S. Kuse-Föhl
- Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig,
Leipzig
| | - W. Klockenbusch
- Universitätsklinikum Münster, Klinik und Poliklinik für Frauenheilkunde und
Geburtshilfe, Abt. für Geburtshilfe, Münster
| | - W. Rath
- Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH
Aachen, Aachen
| | - B. Schauf
- Frauenklinik Sozialstiftung Bamberg, Bamberg
| | - T. Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork,
Ireland
| | - D. Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
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Ephraim RKD, Osakunor DNM, Denkyira SW, Eshun H, Amoah S, Anto EO. Serum calcium and magnesium levels in women presenting with pre-eclampsia and pregnancy-induced hypertension: a case-control study in the Cape Coast metropolis, Ghana. BMC Pregnancy Childbirth 2014; 14:390. [PMID: 25410280 PMCID: PMC4243325 DOI: 10.1186/s12884-014-0390-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 11/06/2014] [Indexed: 01/25/2023] Open
Abstract
Background Hypertensive disorders of pregnancy are important causes of morbidity and mortality. The levels of calcium (Ca2+) and magnesium (Mg2+) in pregnancy may implicate their possible role in pregnancy-induced hypertension. This study assessed serum Ca2+ and Mg2+ levels in women with PIH (pregnancy-induced hypertension) and PE (pre-eclampsia), compared to that in normal pregnancy. Methods This case–control study was conducted on 380 pregnant women (≥20 weeks gestation) receiving antenatal care at three hospitals in the Cape Coast metropolis, Ghana. This comprised 120 women with PIH, 100 women with PE and 160 healthy, age-matched pregnant women (controls). Demographic, anthropometric, clinical and obstetric data were gathered using an interview-based questionnaire. Venous blood samples were drawn for the estimation of calcium and magnesium. Results Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly raised in women with PIH (p < 0.0001) and PE (p < 0.0001). Women with hypertensive disorders (PE and PIH) had significantly lower serum calcium and magnesium levels than those in the control group (p < 0.0001 each). Of those with PIH, SBP correlated positively with BMI (r = 0.575, p < 0.01) and Ca2+ correlated positively with Mg2+ (r = 0.494, p < 0.01). This was similar amongst the PE group for SBP and BMI as well as for Ca2+and Mg2+ but was not significant. Multivariate analysis showed that women aged ≥40 years were at a significant risk of developing PIH (OR = 2.14, p = 0.000). Conclusion In this study population, serum calcium and magnesium levels are lower in PIH and PE than in normal pregnancy. Mineral supplementation during the antenatal period may influence significantly, the occurrence of hypertensive disorders in pregnancy.
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Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations. J Hypertens 2014; 32:454-63. [PMID: 24384846 DOI: 10.1097/hjh.0000000000000069] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice.
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Abstract
Hypertension during pregnancy is associated with high perinatal morbidity and mortality The prevalence of white coat hypertension is high during pregnancy and is associated with a good prognosis. This must be excluded before beginning antihypertensive treatment. When to use HBPM during pregnancy? To confirm the diagnosis of hypertension; to monitor BP during pregnancy and to alert the obstetrician when severe hypertension occurs; to manage BP treatment and avoid excessive treatment. How to use HBPM during pregnancy? To get an adapted and validated BP device during pregnancy; to compare the results with reference HBP values during the 3 trimesters of pregnancy. Telemetry to monitor BP at home during pregnancy is a feasible, safe and well-tolerated alternative to repeated clinic visits or BP monitoring during hospitalisations.
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Affiliation(s)
- Thierry Denolle
- Hôpital Arthur-Gardiner, Centre d'excellence en HTA, 1, rue Henri-Dunant, 35800 Dinard, France.
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Lee SH, Shin JY, Park MJ, Park BJ. Agreement of label information of cardiovascular drugs in pregnancy among Korea, the USA, the UK, and Japan. Regul Toxicol Pharmacol 2014; 68:363-9. [PMID: 24513085 DOI: 10.1016/j.yrtph.2014.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/02/2014] [Accepted: 01/30/2014] [Indexed: 11/19/2022]
Abstract
Drug label is a common source of information; however, the content varies widely. This study aims to evaluate label information on cardiovascular drugs regarding pregnancy for their similarities in Korea, USA, UK, and Japan. Study drugs were selected as following (1) cardiovascular drugs according to the WHO ATC code (C01-C09) and (2) drugs currently marketed in all four countries were included. Evidence level was classified into five categories ('Definite', 'Probable', 'Possible', 'Unlikely', and 'Unclassified') and recommendation level was classified into four categories ('Contraindicated', 'Cautious', 'Compatible', and 'Unclassified'). Frequency and proportion were presented. Percent agreement and kappa coefficient with 95% confidence interval (CI) were calculated using SAS ver. 9.3. Total of 50 cardiovascular drugs were included. 'Unclassified' was represented the most in Korea, followed by Japan and UK (58%, 54%, and 46%, p<0.05). For recommendation level, the majority of drugs in all four countries were classified as 'contraindicated' or 'cautious'. Japanese labels had the largest proportion of 'contraindicated' level (62%), and Korea and UK followed (58%, 44%, p<0.05). Only in the USA, 10.0% of the drugs were 'compatible' whereas, there were none in Korea, UK, and Japan (p<0.01). Korea and Japan showed a substantial agreement in evidence and recommendation level (kappa=0.69, 0.67). Labels of cardiovascular drugs in pregnancy differed widely. Reliable safety information in pregnancy should be provided through regular updates.
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Affiliation(s)
- Shin Haeng Lee
- Korea Institute of Drug Safety and Risk Management, 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea
| | - Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management, 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea
| | - Mi-Ju Park
- Korea Institute of Drug Safety and Risk Management, 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea
| | - Byung-Joo Park
- Korea Institute of Drug Safety and Risk Management, 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea; Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Chongno-gu, Seoul 110-799, Republic of Korea.
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Newstead-Angel J, Gibson PS. Cardiac drug use in pregnancy: safety, effectiveness and obstetric implications. Expert Rev Cardiovasc Ther 2014; 7:1569-80. [DOI: 10.1586/erc.09.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Edvardsson B. Hypertensive encephalopathy and cerebral infarction. SPRINGERPLUS 2014; 3:741. [PMID: 25932363 PMCID: PMC4409617 DOI: 10.1186/2193-1801-3-741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Abstract
Introduction Hypertensive encephalopathy is one cause of posterior reversible encephalopathy syndrome. Hypertensive encephalopathy and cerebral infarction have only been reported in a few individual case reports. Case description A 51-year-old woman presented with hypertensive encephalopathy. T2-weighted images from magnetic resonance imaging showed hyperintense lesions in both occipital and parietal lobes. Diffusion-weighted imaging showed that this represented cytotoxic oedema and perfusion magnetic resonance imaging revealed reduced blood volume and flow. The magnetic resonance imaging was repeated 5 months later and subtotal regression of theT2-hyperintensity had occurred. However, small bilateral infarcts were seen on T1-weighted images. Perfusion magnetic resonance imaging presented reduced blood volume and flow on the right side. Discussion and evaluation The patient in this report had posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy. Magnetic resonance imaging of the brain showed bilateral cytotoxic oedema that partially resolved and resulted in small infarcts. The imaging findings are compatible with posterior reversible encephalopathy syndrome with subtotal resolution and infarct evolution. Conclusion The case report suggests that the presence of hypertensive encephalopathy and posterior reversible encephalopathy syndrome should alert clinicians and lead to prompt treatment in order to prevent cerebral damage.
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Affiliation(s)
- Bengt Edvardsson
- Department of Clinical Sciences, Lund, Neurology, Skane University Hospital, Lund University, S-221 85 Lund, Sweden
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The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol 2013; 209:438.e1-438.e12. [PMID: 23850528 DOI: 10.1016/j.ajog.2013.07.003] [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: 03/20/2013] [Revised: 05/25/2013] [Accepted: 07/01/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk. STUDY DESIGN This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria. RESULTS Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia. CONCLUSION This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.
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