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Ngene NC, Moodley J. Preventing maternal morbidity and mortality from preeclampsia and eclampsia particularly in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102473. [PMID: 38513504 DOI: 10.1016/j.bpobgyn.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, Johannesburg, Gauteng, South Africa; Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa.
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Yang L, Zhou Y, Jiang M, Wen W, Guo Y, Pakhale S, Wen SW. Why Female Smokers Have Poorer Long-Term Health Outcomes than Male Smokers: The Role of Cigarette Smoking During Pregnancy. Public Health Rev 2024; 45:1605579. [PMID: 38487619 PMCID: PMC10938403 DOI: 10.3389/phrs.2024.1605579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/11/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives: Women's health status is better than men but the opposite is true for female smokers who usually have poorer long-health outcomes than male smokers. The objectives of this study were to thoroughly reviewed and analyzed relevant literature and to propose a hypothesis that may explain this paradox phenomenon. Methods: We conducted a search of literature from three English databases (EMBASE, MEDLINE, and Google Scholar) from inception to 13 November 2023. A combination of key words and/or subject headings in English was applied, including relevant terms for cigarette smoking, sex/gender, pregnancy, and health indicators. We then performed analysis of the searched literature. Results: Based on this review/analysis of literature, we proposed a hypothesis that may explain this paradox phenomenon: female smokers have worse long-term health outcomes than male smokers because some of them smoke during pregnancy, and the adverse effects of cigarette smoking during pregnancy is much stronger than cigarette smoking during non-pregnancy periods. Conclusion: Approval of our pregnancy-amplification theory could provide additional evidence on the adverse effect on women's long-term health outcomes for cigarette smoking during pregnancy.
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Affiliation(s)
- Li Yang
- Respiratory Medicine Department of Xiangtan Central Hospital of Hunan Province, Xiangtan, Hunan, China
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Yunchun Zhou
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Pulmonary and Critical Care Medicine of Yuxi People’s Hospital of Yunnan Province, Yuxi, Yunnan, China
| | - Mingyan Jiang
- Respiratory Medicine Department of Xiangtan Central Hospital of Hunan Province, Xiangtan, Hunan, China
| | - Wendy Wen
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Yanfang Guo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- BORN (Better Outcome Registry Network) Ontario, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Smita Pakhale
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Division of Respiratory, The Ottawa Hospital, Ottawa, ON, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
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3
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Cohen Y, Gutvirtz G, Avnon T, Sheiner E. Chronic Hypertension in Pregnancy and Placenta-Mediated Complications Regardless of Preeclampsia. J Clin Med 2024; 13:1111. [PMID: 38398426 PMCID: PMC10889586 DOI: 10.3390/jcm13041111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia with adverse maternal and fetal outcomes, specifically as a result of placental dysfunction. We aimed to investigate whether chronic hypertension is associated with placenta-mediated complications regardless of the development of preeclampsia in pregnancy. METHODS This was a population-based, retrospective cohort study from 'Soroka' university medical center (SUMC) in Israel, of women who gave birth between 1991 and 2021, comparing placenta-mediated complications (including fetal growth restriction (FGR), placental abruption, preterm delivery, and perinatal mortality) in women with and without chronic hypertension. Generalized estimating equation (GEE) models were used for each outcome to control for possible confounding factors. RESULTS A total of 356,356 deliveries met the study's inclusion criteria. Of them, 3949 (1.1%) deliveries were of mothers with chronic hypertension. Women with chronic hypertension had significantly higher rates of all placenta-mediated complications investigated in this study. The GEE models adjusting for preeclampsia and other confounding factors affirmed that chronic hypertension is independently associated with all the studied placental complications except placental abruption. CONCLUSIONS Chronic hypertension in pregnancy is associated with placenta-mediated complications, regardless of preeclampsia. Therefore, early diagnosis of chronic hypertension is warranted in order to provide adequate pregnancy follow-up and close monitoring for placental complications, especially in an era of advanced maternal age.
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Affiliation(s)
- Yair Cohen
- Department of Internal Medicine, Soroka University Medical Center, Beer-Sheva 84101, Israel;
| | - Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (G.G.); (T.A.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Taeer Avnon
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (G.G.); (T.A.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (G.G.); (T.A.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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4
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Ishmail H, Khaliq OP, Ngene NC. The role of genetics in maternal susceptibility to preeclampsia in women of African ancestry. J Reprod Immunol 2023; 160:104139. [PMID: 37683532 DOI: 10.1016/j.jri.2023.104139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
Racial disparities exist in the prevalence of preeclampsia (PE), with women of African ancestry suffering the highest rates of morbidity and mortality. Genetic changes may play a role in the preponderance of PE among women of African ancestry. This review discusses 30 genes with variants that have been studied in PE in women of African ancestry. These studies found that a single gene is not responsible for PE susceptibility as 13 genes have been implicated. These genes subserve endothelial, immune, hemodynamic, homeostatic, thrombophilic, oxidative stress, and lipid metabolic pathways. Notably, maternal-fetal gene interactions also contribute to the susceptibility of the disease. For instance, the maternal KIR AA genotype and paternally inherited fetal HLA-C2 genotype confer risk for developing PE. Additionally, genetic changes such as epigenetic modulation of expression of the MTHFR gene through DNA methylation is also associated with the occurrence of PE. In contrast, some genes such as the KIR B centromeric region protect against development of PE in some women. The soluble fms-like tyrosine kinase 1 (sFlt-1) contributes to the development of PE and is a potential novel therapeutic option for targeted gene silencing of anti-angiogenic sFLT-1 gene. Additionally, NOS3 gene is an important target for pharmacogenomics because it is responsible for the production of endothelial nitric oxide. In conclusion, maternal genetic and epigenetic variants confer susceptibility to PE, indicating the need for further studies to develop a screening tool incorporating maternal genetic variants to identify women at high risk for PE and offer them a preventive therapy.
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Affiliation(s)
- Habiba Ishmail
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa.
| | - Olive Pearl Khaliq
- Department of Paediatrics, University of Free State, Bloemfontein, South Africa
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa; Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Kuate Defo A, Daskalopoulou SS. Alterations in Vessel Hemodynamics Across Uncomplicated Pregnancy. Am J Hypertens 2023; 36:183-191. [PMID: 36638267 DOI: 10.1093/ajh/hpac132] [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: 05/27/2022] [Revised: 12/03/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Pregnancy is marked by the onset of rapid hemodynamic alterations in order to accommodate the needs of the developing fetus. Arterial stiffness is an independent predictor of cardiovascular events and mortality, and its measurement in clinical practice has been recommended. It follows a U-shaped curve in uncomplicated pregnancy, decreasing to a nadir in mid-pregnancy and rising at term. Systemic vasodilation occurs due to elevated nitric oxide, prostacyclin, endothelium-derived hyperpolarizing factor, estrogen, progesterone, and relaxin. Vascular resistance decreases to a nadir in mid-pregnancy, while endothelial function is enhanced starting in the first trimester. Plasma volume increases by about 50%, and total red blood cell mass increases by up to 40%. Cardiac output increases by up to 45%, at first due primarily to elevated stroke volume, then mainly due to increased heart rate. Along with echocardiography, cardiac magnetic resonance imaging is safe for use in pregnancy. It may assess cardiac function more accurately than echocardiography, and may be indicated in specific clinical cases. Moreover, blood pressure decreases to a nadir in mid-pregnancy and rises to near preconception values postpartum. An appreciation of the vascular changes occurring in healthy pregnancy can aid in the prediction and diagnosis of pregnancy complications, such as preeclampsia and other hypertensive disorders of pregnancy, and inform treatment. In particular, noninvasive arterial stiffness/hemodynamics assessment provides unique clinical information beyond blood pressure and traditional maternal characteristics, and can signal a need for further testing, or be used in combination with other tests to predict or diagnose complications of pregnancy.
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Affiliation(s)
- Alvin Kuate Defo
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Vascular Health Unit, Research Institute of the McGill University Health Centre, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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6
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Aja-Okorie U, Ngene NC. Atypical preeclampsia-eclampsia syndrome at 18 weeks of gestation: A case report. Case Rep Womens Health 2022; 36:e00470. [DOI: 10.1016/j.crwh.2022.e00470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
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Myers MC, Brandt DS, Prunty A, Gilbertson-White S, Sanborn A, Santillan MK, Santillan DA. Effect of positioning on blood pressure measurement in pregnancy. Pregnancy Hypertens 2022; 27:110-114. [PMID: 34998224 PMCID: PMC8959067 DOI: 10.1016/j.preghy.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
Abstract
Blood pressure is the key vital sign to detecting hypertensive disorders in pregnancy. The importance of taking blood pressure properly was recently underscored by the publication of updated ACC/AHA guidelines for measuring blood pressure in patients. However, the recommended position of seating with arms and back supported is not always feasible to achieve clinically, especially for inpatient women who are pregnant. Therefore, it is clinically important to understand the effects of alternative patient positioning on blood pressure measurements. We conducted a review of studies which considered patient position on the effect of blood pressure in pregnancy. This review demonstrates that clinically significant differences may occur based on patient positioning. Despite the small number of primary studies that include pregnant women, notable reductions in blood pressure measurements have been observed in the left lateral recumbent position, a common position during labor or during monitoring, in comparison to measurements taken in the supported seated position. Ultimately, these differences could affect the clinical management of patients and care should be taken to document and consider the position in which the reading was taken.
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Affiliation(s)
| | | | | | | | - Amy Sanborn
- Department of Nursing, Children’s & Women’s Services, University of Iowa Hospitals & Clinics
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Moazzeni SS, Asgari S, Azizi F, Hadaegh F. Live birth/parity number and the risk of incident hypertension among parous women during over 13 years of follow-up. J Clin Hypertens (Greenwich) 2021; 23:2000-2008. [PMID: 34657376 PMCID: PMC8630610 DOI: 10.1111/jch.14369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
The effect of live birth/parity number on incident hypertension was investigated among Iranian parous women aged 30–70 years. The study population included 2188 normotensive women who were enrolled in 1999–2001. They were followed for incident hypertension (based on JNC 7 report) by 3‐year intervals up to April 2018. Multivariable Cox proportional hazard models, adjusted for a wide set of potential hypertension risk factors, reproductive factors, and pregnancy complications, were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the number of parity/live birth(s) for incident hypertension. Additionally, as a sensitivity analysis, age‐scale Cox regression was also done. During a median follow‐up of 13.5 years, 935 incident hypertension have occurred. Compared to those with two live births, the participants who had 3 and ≥4 live births were at higher risk of hypertension development by the HRs of 1.25 [95% CI: 1.02–1.55] and 1.39 [1.12–1.72], respectively, in the full‐adjusted model. Moreover, each additional live birth increased the risk of hypertension by a HR of 1.06 [95%CI: 1.02–1.11]. Results of parity number were also similar. Considering age as time scale also did not change the results generally. The authors found a significant interaction between live birth/parity number and age groups; the adverse effect of higher live birth/parity numbers on hypertension development was mainly found among those aged < 50 years. To sum up, compared to the live birth/parity number of two, Iranian women with ≥3 live birth/parity had a higher risk of incident hypertension; the issue was more prominent among younger mothers.
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Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Supine hypotensive syndrome of pregnancy: A review of current knowledge. Eur J Anaesthesiol 2021; 39:236-243. [PMID: 34231500 DOI: 10.1097/eja.0000000000001554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 15° left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.
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10
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Pregnancy-Related Extracellular Vesicles Revisited. Int J Mol Sci 2021; 22:ijms22083904. [PMID: 33918880 PMCID: PMC8068855 DOI: 10.3390/ijms22083904] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EVs) are small vesicles ranging from 20–200 nm to 10 μm in diameter that are discharged and taken in by many different types of cells. Depending on the nature and quantity of their content—which generally includes proteins, lipids as well as microRNAs (miRNAs), messenger-RNA (mRNA), and DNA—these particles can bring about functional modifications in the receiving cells. During pregnancy, placenta and/or fetal-derived EVs have recently been isolated, eliciting interest in discovering their clinical significance. To date, various studies have associated variations in the circulating levels of maternal and fetal EVs and their contents, with complications including gestational diabetes and preeclampsia, ultimately leading to adverse pregnancy outcomes. Furthermore, EVs have also been identified as messengers and important players in viral infections during pregnancy, as well as in various congenital malformations. Their presence can be detected in the maternal blood from the first trimester and their level increases towards term, thus acting as liquid biopsies that give invaluable insight into the status of the feto-placental unit. However, their exact roles in the metabolic and vascular adaptations associated with physiological and pathological pregnancy is still under investigation. Analyzing peer-reviewed journal articles available in online databases, the purpose of this review is to synthesize current knowledge regarding the utility of quantification of pregnancy related EVs in general and placental EVs in particular as non-invasive evidence of placental dysfunction and adverse pregnancy outcomes, and to develop the current understanding of these particles and their applicability in clinical practice.
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Insulin-regulated aminopeptidase deficiency impairs cardiovascular adaptations and placental development during pregnancy. Clin Sci (Lond) 2021; 134:3213-3228. [PMID: 33252660 PMCID: PMC7733041 DOI: 10.1042/cs20201233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Insulin-regulated aminopeptidase (IRAP), an enzyme that cleaves vasoactive peptides including oxytocin and vasopressin, is suggested to play a role in pregnancy and the onset of preeclampsia. Our aim was to examine the contribution of IRAP to arterial pressure regulation and placental development during pregnancy in mice. Mean arterial pressure and heart rate were measured via radiotelemetry in 12-week-old female wild-type and IRAP knockout mice. Females were time-mated with males of the same genotype. Placentae were collected at embryonic day 18.5 for histological analysis. Basal heart rate was ∼40 bpm lower in IRAP knockout females compared with wild-type females. The increase in heart rate across gestation was greater in IRAP knockout females than wild-type females. Neither basal nor gestational mean arterial pressure was different between wildtype and IRAP knockout females. Urine output and water intake of IRAP knockout mice were ∼45% less than wild-type mice at late gestation. IRAP deficiency had no effect on fetal weight. Morphological assessment of placentae revealed that IRAP deficiency was associated with reduced labyrinth surface area and accumulation of glycogen in the junctional zone. Our data demonstrate that IRAP deficiency alters maternal fluid handling and impairs placental labyrinth expansion at late gestation, indicating that IRAP contributes to the normal adaptions to pregnancy.
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12
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Ngene NC, Daef G. Transient gestational hypertension and pre-eclampsia: Two case reports and literature review on the need for stringent monitoring. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 33764141 PMCID: PMC8377990 DOI: 10.4102/safp.v63i1.5236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 01/28/2023] Open
Abstract
Transient gestation hypertension is a contributor to adverse pregnancy outcomes particularly when it progresses to pre-eclampsia (PE). This requires frequent monitoring. We illustrate the need for stringent monitoring of gestational hypertension, transient gestational hypertension (TGH) and PE without severe features and conducted a brief rapid review of the literature. Two cases are presented: Firstly, a 25-year-old primigravida at 30 gestational weeks who had an isolated TGH with high blood pressure (BP) of 141/87 mmHg, which was not investigated. Four weeks later, she presented with a BP of 202/128 mmHg, imminent eclampsia and intrauterine foetal death and had an uncomplicated induction of labour and delivered a 1400 g macerated male stillborn. Secondly, a 30-year-old primigravida at 30 gestational weeks who developed PE but her monitoring was compromised initially by inadequate healthcare capacity including unavailability of hospital bed-space for inpatient care and later by poor clinic attendance as a result of poor finances. At 32 gestational weeks, she presented with decreased foetal movement and was diagnosed as haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome and intrauterine foetal death. She was stabilised, had induction of labour and delivered a 1400 g male macerated stillborn. Thereafter, the need for her to go home to complete the cultural burial rites of her baby and the pressure from her workplace resulted in an inadequate postpartum follow-up care. In conclusion, transient gestational hypertension is associated with adverse maternal and foetal outcomes, including foetal demise. Unavailability of hospital bed-space and poor personal finances interfere with stringent monitoring of hypertensive disorders and can be associated with adverse pregnancy outcomes. Stringent laboratory monitoring in these cases is defined by the authors as testing at least blood levels of serum Creatinine, Haemoglobin concentration, Alanine transaminase and Platelet count (abbreviated as ‘CHAP’) weekly.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; and, Department of Obstetrics and Gynaecology, Leratong Hospital, Krugersdorp.
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13
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Sundström-Poromaa I, Comasco E, Sumner R, Luders E. Progesterone - Friend or foe? Front Neuroendocrinol 2020; 59:100856. [PMID: 32730861 DOI: 10.1016/j.yfrne.2020.100856] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/05/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
Estradiol is the "prototypic" sex hormone of women. Yet, women have another sex hormone, which is often disregarded: Progesterone. The goal of this article is to provide a comprehensive review on progesterone, and its metabolite allopregnanolone, emphasizing three key areas: biological properties, main functions, and effects on mood in women. Recent years of intensive research on progesterone and allopregnanolone have paved the way for new treatment of postpartum depression. However, treatment for premenstrual syndrome and premenstrual dysphoric disorder as well as contraception that women can use without risking mental health problems are still needed. As far as progesterone is concerned, we might be dealing with a two-edged sword: while its metabolite allopregnanolone has been proven useful for treatment of PPD, it may trigger negative symptoms in women with PMS and PMDD. Overall, our current knowledge on the beneficial and harmful effects of progesterone is limited and further research is imperative.
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Affiliation(s)
| | - Erika Comasco
- Department of Neuroscience, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Eileen Luders
- School of Psychology, University of Auckland, New Zealand; Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, USA
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Ngene NC, Moodley J. Pre-eclampsia with severe features: management of antihypertensive therapy in the postpartum period. Pan Afr Med J 2020; 36:216. [PMID: 32963682 PMCID: PMC7490136 DOI: 10.11604/pamj.2020.36.216.19895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/21/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction there is variance in both the types and combinations of antihypertensive drugs used for managing pre-eclampsia in the postpartum period. Knowledge of the most common and suitable single or combination antihypertensive drug therapies in the postpartum period will minimize harmful effects, promote adherence to medications, overcome any fears that lactating mothers may have about these drugs and will assist in healthcare planning. Objective: to determine the types of antihypertensive drug therapies used in managing pre-eclampsia with severe features (sPE) in the postpartum period in a regional hospital in South Africa. Methods fifty consecutively presenting pregnant women with sPE were followed up prospectively from the pre-delivery period (within 48 hours before delivery) until day 3 postpartum. The antihypertensive drug therapies administered to the participants were observed. Their blood pressures were measured daily at 04: 00, 08: 00, 14: 00 and 22: 00 hours. Results nifedipine was the commonest rapid-acting agent used for severe hypertension. Prepartum, 9 different combinations of antihypertensive drugs were prescribed; alpha-methyldopa was the commonest single long-acting agent used. Postpartum, the number of different drug combinations administered were 15, 18, 22 and 16 on days 0, 1, 2 and 3 respectively. Alpha-methyldopa was the commonest single agent used on postpartum days 0 - 2 while hydrochlorothiazide was the most frequently used single agent on postpartum day 3. Postpartum, the commonest combination therapy was alpha-methyldopa and amlodipine on day 0; alpha-methyldopa and amlodipine as a regimen as well as alpha-methyldopa, amlodipine and hydrochlorothiazide as another regimen on day 1; alpha-methyldopa and amlodipine on day 2; and many amlodipine-based regimens on day 3. Conclusion a variety of antihypertensive drug combinations were used in the postpartum period indicating the need for standardised guidelines; however, detailed studies are required to evaluate their efficacies completely.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa.,Department of Obstetrics and Gynaecology, Klerksdorp Hospital, North West Province, Klerksdorp, South Africa.,Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
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Turi V, Dragan S, Iurciuc M, Moleriu L, Bungau S, Tit DM, Toader DO, Diaconu CC, Behl T, Petre I. Arterial Function in Healthy Pregnant Women vs. Non-Pregnant Women-A 10-Year Study. Diagnostics (Basel) 2020; 10:diagnostics10060374. [PMID: 32516990 PMCID: PMC7344931 DOI: 10.3390/diagnostics10060374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Maternal age for the first pregnancy is increasing and so, the prevalence of cardiovascular risk factors in pregnancy is also increasing. Heart disease is the main reason for maternal death during pregnancy in developed countries. Arterial stiffness is an independent risk factor for atherosclerosis and a predictor of cardiovascular morbidity and mortality. The most widespread parameters for detecting subclinical atherosclerosis are augmentation index (AIx) and pulse wave velocity (PWV). The objective of this prospective study was to assess the differences between arterial function in pregnant vs. non-pregnant women of the same age, and its changes throughout the gestation period. MATERIALS AND METHODS Between 2010-2019, 887 patients were enrolled into 2 groups: pregnant (N1 = 471) and non-pregnant (N2 = 416). Data about their anthropometric characteristics, arterial function (for group 1 in all three trimesters and 6 weeks post-partum), smoking status and physical activity were collected. RESULTS There were statistically significant differences (p < α, α = 0.05) between the two groups regarding the body mass index, brachial AIx, systolic, diastolic and central blood pressure, and pulse pressure values. In the first group, there was a decrease of both brachial AIx and PWV in the second and third trimester, followed by a post-partum increase; better outcomes were noticed in physically active women. CONCLUSIONS Arterial function modifies during pregnancy and these alterations differ according to the trimester of gestation. Further research is needed to establish the cut-off values for this category. Pregnant women can have better outcomes through physical activity.
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Affiliation(s)
- Vladiana Turi
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Simona Dragan
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Mircea Iurciuc
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Lavinia Moleriu
- Department III Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
- Correspondence: ; Tel.: +40-726-776-588
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
| | - Daniela-Oana Toader
- Department 13, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health, Bucharest, Polizu Clinical Hospital, 011062 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department 5, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Izabella Petre
- Department XII of Obstetrics and Gynaecology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
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Hypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy. Curr Opin Anaesthesiol 2020; 33:291-298. [DOI: 10.1097/aco.0000000000000848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maducolil MK, Al-Obaidly S, Olukade T, Salama H, AlQubaisi M, Al Rifai H. Maternal characteristics and pregnancy outcomes of women with chronic hypertension: a population-based study. J Perinat Med 2020; 48:139-143. [PMID: 31860472 DOI: 10.1515/jpm-2019-0293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/21/2019] [Indexed: 11/15/2022]
Abstract
Background We aimed to study the maternal characteristics and obstetric and neonatal outcomes in pregnant mothers with chronic hypertension (CHTN) compared to non-CHTN. Methods The study was a population-based cohort study, and a PEARL-Peristat Study (PPS) for the year of 2017. There were 20,210 total births including 19,762 singleton and 448 multiple births. We excluded multiple gestations from the analysis as they differ in fetal growth, duration of gestation and have a higher rate of obstetric and neonatal complications. We compared the maternal characteristics of mothers with pre-existing HTN with non-hypertensive mothers and studied the obstetric and neonatal outcomes including cesarean section, stillbirths, prematurity, macrosomia and postpartum hemorrhage (PPH). Results We identified 223 births of mothers with essential HTN. The overall prevalence of CHTN in our population was 1.1% (223/20,210). In regard to maternal characteristics, women with CHTN were at or above 35 years of age at the time of delivery 58.9% compared to non-CHTN women 18.7%, P-value <0.001. Pre-existing diabetes was found more in women with CHTN 15.1% compared to non-CHTN women 1.9%, P-value <0.001; while obesity was found in 64% of women with CHTN compared to 32.5% in non-CHTN women, P-value <0.001. Preterm birth was noted in 26% compared to 8% in CHTN compared to non-CHTN women, respectively, P-value <0.001. The rate of stillbirth was similar between the two groups, 0.9% compared to 0.6% in CHTN compared to non-CHTN women, respectively, P-value 0.369. Conclusion Hypertensive mothers have multiple other comorbidities. When compared to the general population, they are older, parous, diabetic and obese with an increased risk of preterm birth and cesarean deliveries. Lifestyle modification, extensive pre-conceptional counseling and multidisciplinary antenatal care are required for such a high-risk group.
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Affiliation(s)
- Mariam K Maducolil
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Sawsan Al-Obaidly
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Tawa Olukade
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Husam Salama
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mai AlQubaisi
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hilal Al Rifai
- Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Ngene NC, Moodley J, Naicker T. The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy. PLoS One 2019; 14:e0215807. [PMID: 31022243 PMCID: PMC6485032 DOI: 10.1371/journal.pone.0215807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background The imbalance between circulating concentrations of anti- and pro-angiogenic
factors is usually intense in preeclampsia with severe features (sPE). It is
possible that pre-delivery circulating levels of angiogenic factors in sPE
may be associated with postpartum antihypertensive drug requirements. Objective To determine the predictive association between maternal pre-delivery serum
concentrations of angiogenic factors and the use of ≥3 slow- and/or a
rapid-acting antihypertensive drug therapy in sPE on postpartum days zero to
three following caesarean delivery. Study design Women with sPE (n = 50) and normotensive pregnancies (n = 90) were recruited
prior to childbirth. Serum samples were obtained from each participant <
48 hours before delivery to assess the concentrations of placental growth
factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) using the
Roche Elecsys platform. Each participant was followed up on postpartum days
zero, one, two and three to monitor BP and confirm antihypertensive
treatment. The optimal cut-off thresholds of sFlt-1/PIGF ratio from receiver
operating characteristic curve predictive of the antihypertensive therapy
were subjected to diagnostic accuracy assessment. Results The majority 58% (29/50) of sPE had multiple severe features of preeclampsia
in the antenatal period with the commonest presentation being severe
hypertension in 88% (44/50) of this group, followed by features of impending
eclampsia which occurred in 42% (21/50). The median gestational age at
delivery was 38 (Interquartile range, IQR 1) vs 36 (IQR 6)
weeks, p < 0.001 in normotensive and sPE groups
respectively. Notably, the median sFlt-1/PIGF ratio in normotensive and sPE
groups were 7.3 (IQR 17.9) and 179.1 (IQR 271.2) respectively,
p < 0.001. Of the 50 sPE participants, 34% (17/50)
had early-onset preeclampsia. The median (IQR) of sFlt-1/PIGF in the early-
and late-onset preeclampsia groups were 313.52 (502.25), and 166.59(195.37)
respectively, p = 0.006. From postpartum days zero to
three, 48% (24/50) of sPE received ≥ 3 slow- and/or a rapid-acting
antihypertensive drug. However, the daily administration of ≥ 3 slow- and/or
a rapid-acting antihypertensive drug in sPE were pre-delivery 26% (13/50),
postpartum day zero 18% (9/50), postpartum day one 34% (17/50), postpartum
day two 24% (12/50) and postpartum day three 20% (10/50). In sPE, the
pre-delivery sFlt-1/PIGF ratio was predictive of administration of ≥3 slow-
and/or a rapid-acting antihypertensive drug on postpartum days zero, one and
two with the optimal cut-off ratio being ≥315.0, ≥181.5 and ≥ 267.8
respectively (sensitivity 72.7–75.0%, specificity 64.7–78.6%, positive
predictive value 40.0–50.0% and negative predictive value 84.6% - 94.3%).
The predictive performance of sFlt-1/PIG ratio on postpartum day 3 among the
sPE was not statistically significant (area under receiver operating
characteristic curve, 0.6; 95% CI, 0.3–0.8). Conclusion A pre-delivery sFlt-1/PIGF ratio (< 181.5) is a promising predictor for
excluding the need for ≥3 slow- and/or a rapid-acting antihypertensive drug
therapy in the immediate postpartum period in sPE.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal,
South Africa
- * E-mail:
| | - Jagidesa Moodley
- Women’s Health and HIV Research Group, Department of Obstetrics and
Gynaecology, University of KwaZulu-Natal, South Africa
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Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
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20
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Ngene NC, Moodley J. Postpartum blood pressure patterns in severe preeclampsia and normotensive pregnant women following abdominal deliveries: a cohort study. J Matern Fetal Neonatal Med 2019; 33:3152-3162. [PMID: 30700189 DOI: 10.1080/14767058.2019.1569621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To determine blood pressure (BP) patterns in the immediate postpartum period in preeclampsia with severe features (sPE) and normotensive pregnant women who had cesarean deliveries (CD).Study design: The BP levels of two groups comprising 50 sPE and 90 normotensive pregnant women who had CD were measured before delivery and on days 0-3 postpartum at four time points (05:00, 08:00, 14:00, and 22:00). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) were measured in the maternal serum ≤48 h before delivery.Results: Antihypertensive therapy was administered to 98, 96, 82, 78, and 56% of sPE antepartum and on postpartum days 0-3, respectively. De novo postpartum hypertension (BP ≥ 140/90 mmHg) occurred in 24.4% (22/90) of the normotensive group but only one required antihypertensive therapy. The occurrence of de novo postpartum hypertension was associated with maternal weight before delivery ≥ 84.5 kg (relative risks (RR) 2.6, CI 95% 1.2-5.8, p = .017), and body mass index before delivery ≥ 33.3 kg/m2 (RR 2.9, CI 95% 1.3-6.4, p = .008). In sPE, the BP decreased between predelivery period and postpartum day 0. From days 1 to 3 postpartum, there was a continuous increase in the daily mean BPs in both groups, with average daily increments (systolic/diastolic) being 5.6/4.6 mmHg and 0.6/1.3 mmHg in the sPE and normotensive women, respectively. Patient's group and time had a significant effect on BP, p < .001. Overall, daily mean BPs were higher in the sPE than the normotensive group (p < .001). Perceived stress (p = .022), low birth weight (p = .002), 5 min Apgar score ≤ 6 (p < .001) were significantly higher in the sPE group. sFlt-1/PIGF ratio was high in the hypertensive groups: sPE versus normotensive group, p < .001; de novo postpartum hypertension versus normotensives group that remained normotensive, p = .102.Conclusion: Postpartum BP and antihypertensive requirements are important considerations in managing sPE and normotensive pregnancies. sPE is associated with increased maternal stress and poor perinatal outcomes.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
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Tran K, Potts J, Purkiss S, Robertson J, Khan N, Padwal R, Chan WS. Validation of an Automated Office Blood Pressure Machine in Pregnant Women According to the AAMI 2013/ISO Protocol. Hypertension 2018; 72:e91-e94. [PMID: 30571239 DOI: 10.1161/hypertensionaha.118.12085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Tran
- From the Division of General Internal Medicine, Department of Medicine (K.T., J.P., S.P., N.K., W.-S.C.), University of British Columbia, Vancouver, Canada
| | - Jayson Potts
- From the Division of General Internal Medicine, Department of Medicine (K.T., J.P., S.P., N.K., W.-S.C.), University of British Columbia, Vancouver, Canada
| | - Susan Purkiss
- From the Division of General Internal Medicine, Department of Medicine (K.T., J.P., S.P., N.K., W.-S.C.), University of British Columbia, Vancouver, Canada
| | - Julie Robertson
- Department of Obstetrics and Gynecology (J.R.), University of British Columbia, Vancouver, Canada
| | - Nadia Khan
- From the Division of General Internal Medicine, Department of Medicine (K.T., J.P., S.P., N.K., W.-S.C.), University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada (N.K.)
| | - Raj Padwal
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (R.P.)
| | - Wee-Shian Chan
- From the Division of General Internal Medicine, Department of Medicine (K.T., J.P., S.P., N.K., W.-S.C.), University of British Columbia, Vancouver, Canada
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Abstract
RATIONALE IgA nephropathy is one of the most common causes of renal hypertension. The clinical management of IgA renal patients during pregnancy is challenging, as complex pathophysiological changes may occur that affect both the patient's prognosis and the outcome of the pregnancy. PATIENT CONCERNS A 36-year-old woman with a family history of hypertension and at least one year of untreated mild high blood pressure was admitted to our hospital in the 28th week of pregnancy. She suffered from hypertensive disorder complicating pregnancy (HDCP) with renal insufficiency and stillbirth. Treatment with duplex antihypertensive drugs did not improve her blood pressure and she presented with abnormal renal function. DIAGNOSES A renal biopsy led to the diagnosis of a grade IV IgA nephropathy (Lee's grading system) with renal hypertension. INTERVENTIONS The prescribed treatment regimen consisted of low dose cyclophosphamide 0.2 g per day for two days, followed by daily oral administration of 30 mg prednisone, 30 mg Nifedipine extended-release tablets and 80 mg Telmisartan to regulate the blood pressure. OUTCOMES The medication with a combination of antihypertensive and immunosuppressive drugs led to a clinical improvement with a nearly normal renal function and a stable blood pressure during the one-year follow-up. LESSONS This case underlines that 1) the pregnancy outcomes of patients with IgA nephropathy are variable and depend on the renal function, blood pressure, status of urine proteins and the renal histological grade, and 2) especially female patients of childbearing age with hypertension need to be carefully examined to determine the cause of hypertension to avoid damage to target organs and complications during pregnancy.
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MESH Headings
- Adult
- Antihypertensive Agents/therapeutic use
- Benzimidazoles/therapeutic use
- Benzoates/therapeutic use
- Biopsy
- Blood Pressure/drug effects
- Cyclophosphamide/therapeutic use
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Glomerulonephritis, IGA/diagnosis
- Glomerulonephritis, IGA/genetics
- Glomerulonephritis, IGA/pathology
- Glomerulonephritis, IGA/therapy
- Humans
- Hypertension, Pregnancy-Induced/diagnosis
- Hypertension, Pregnancy-Induced/genetics
- Hypertension, Pregnancy-Induced/pathology
- Hypertension, Pregnancy-Induced/therapy
- Infant, Newborn
- Kidney/pathology
- Nifedipine/therapeutic use
- Prednisone/therapeutic use
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/genetics
- Pregnancy Complications/pathology
- Pregnancy Complications/therapy
- Pregnancy Outcome
- Stillbirth
- Telmisartan
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Affiliation(s)
| | - Xuelan Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, Shaanxi, China
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Ngene NC, Moodley J. Baseline check of blood pressure readings of an automated device in severe pre-eclampsia and healthy normotensive pregnancy. Pregnancy Hypertens 2018; 12:47-52. [PMID: 29674198 PMCID: PMC5984682 DOI: 10.1016/j.preghy.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The baseline blood pressure (BP) readings of an automated device that have not been validated in pregnancy require comparison with those from a reference standard before the device is utilized in pregnancy. We aimed to perform a baseline check of BP readings of an automated device, Mindray iMEC12 patient monitor, in severe pre-eclampsia and healthy pregnancy. STUDY DESIGN The BP of 50 severe pre-eclamptic and 90 normotensive pregnancies were measured using Mindray iMEC12 patient monitor (test device) and Welch Allyn 767 aneroid sphygmomanometer (reference device). A pass in either the International Organization for Standardization (ISO) or British Hypertension Society (BHS) rating was considered acceptable. The cumulative percentage of absolute BP difference between the test and reference devices within 5, 10 and 15 mmHg were calculated to rate the test device according to the BHS grades (A, B, C or D). The ISO recommends that an accurate device should achieve a mean BP difference ± SD of ≤5 ± 8 mmHg. RESULTS The mean BP difference between the test and reference devices were 1.27 ± 7.51 mmHg and 0.05 ± 6.09 mmHg for systolic and diastolic BPs respectively. The test device achieved the BHS grades B and A rating in systolic and diastolic BPs respectively. In each of the 2 groups (pre-eclamptic and normotensive pregnancies), the test device also satisfied the set pass criteria. CONCLUSIONS In settings that do not have a validated BP device, Mindray iMEC12 patient monitor may be used for BP measurement in normotensive and severe pre-eclamptic pregnancies.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, South Africa
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24
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Ngene NC, Moodley J. Role of angiogenic factors in the pathogenesis and management of pre-eclampsia. Int J Gynaecol Obstet 2018; 141:5-13. [PMID: 29222938 DOI: 10.1002/ijgo.12424] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 12/29/2022]
Abstract
The cause of pre-eclampsia is unknown. Different postulates have been developed to explain its pathogenesis. The two-stage theory and angiogenic imbalance are two notable postulates of the disease. Together, they propose that there is a lack of cytotrophoblastic invasion of the uterine spiral arteries in pre-eclampsia. The lumen of these arteries remains narrow instead of converting to the wide channels seen in normal pregnancy, and result in poor placental perfusion. Coupled with maternal susceptibility, this process leads to the release of mediators, including an excess of anti-angiogenic factors that result in the clinical manifestations of the disease. Circulating levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 increase, whereas pro-angiogenic factors such as placental growth factor decrease. Assessment of the circulating concentrations of these angiogenic factors, such as the soluble fms-like tyrosine kinase-1/placental growth factor ratio, has diverse clinical relevance in pre-eclampsia. The present review describes the role of angiogenic factors in the pathogenesis and management of pre-eclampsia.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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