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Baschat AA, Darwin K, Vaught AJ. Hypertensive Disorders of Pregnancy and the Cardiovascular System: Causes, Consequences, Therapy, and Prevention. Am J Perinatol 2024; 41:1298-1310. [PMID: 36894160 DOI: 10.1055/a-2051-2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Hypertensive disorders of pregnancy continue to be significant contributors to adverse perinatal outcome and maternal mortality, as well as inducing life-long cardiovascular health impacts that are proportional to the severity and frequency of pregnancy complications. The placenta is the interface between the mother and fetus and its failure to undergo vascular maturation in tandem with maternal cardiovascular adaptation by the end of the first trimester predisposes to hypertensive disorders and fetal growth restriction. While primary failure of trophoblastic invasion with incomplete maternal spiral artery remodeling has been considered central to the pathogenesis of preeclampsia, cardiovascular risk factors associated with abnormal first trimester maternal blood pressure and cardiovascular adaptation produce identical placental pathology leading to hypertensive pregnancy disorders. Outside pregnancy blood pressure treatment thresholds are identified with the goal to prevent immediate risks from severe hypertension >160/100 mm Hg and long-term health impacts that arise from elevated blood pressures as low as 120/80 mm Hg. Until recently, the trend for less aggressive blood pressure management during pregnancy was driven by fear of inducing placental malperfusion without a clear clinical benefit. However, placental perfusion is not dependent on maternal perfusion pressure during the first trimester and risk-appropriate blood pressure normalization may provide the opportunity to protect from the placental maldevelopment that predisposes to hypertensive disorders of pregnancy. Recent randomized trials set the stage for more aggressive risk-appropriate blood pressure management that may offer a greater potential for prevention for hypertensive disorders of pregnancy. KEY POINTS: · Optimal management of maternal blood pressure to prevent preeclampsia and its risks is undefined.. · Early gestational rheological damage to the intervillous space predisposes to preeclampsia and FGR.. · First trimester blood pressure management may need to aim for normotension to prevent preeclampsia..
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Affiliation(s)
| | - Kristin Darwin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arthur J Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Garovic VD, Dechend R, Easterling T, Karumanchi SA, McMurtry Baird S, Magee LA, Rana S, Vermunt JV, August P. Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e21-e41. [PMID: 34905954 PMCID: PMC9031058 DOI: 10.1161/hyp.0000000000000208] [Citation(s) in RCA: 148] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.
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Felton M, Hundley VA, Grigsby S, McConnell AK. Effects of slow and deep breathing on reducing obstetric intervention in women with pregnancy-induced hypertension: a feasibility study protocol. Hypertens Pregnancy 2021; 40:81-87. [PMID: 33463384 DOI: 10.1080/10641955.2020.1869250] [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: 09/23/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
Objective: To evaluate whether a slow and deep breathing (SDB) intervention is acceptable to pregnant women. Methods: The trial aims to recruit 67 pregnant women who have developed pregnancy-induced hypertension (clinicaltrials.gov: NCT04059822). SDB will be undertaken daily for 10 min using a video aid and women will self-monitor blood pressure (BP) daily. At 36-weeks gestation women will complete an online questionnaire. Adherence, recruitment rates, and acceptance of the intervention will be evaluated. Conclusion: The findings from this trial will evaluate if women accept SDB as a treatment method. Initial analysis will evaluate if BP and/or obstetric interventions reduce following SDB intervention.
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Affiliation(s)
- M Felton
- Department of Midwifery & Health Sciences, Bournemouth University , Bournemouth, UK
| | - V A Hundley
- Department of Midwifery & Health Sciences, Bournemouth University , Bournemouth, UK
| | - S Grigsby
- Department of Midwifery & Health Sciences, Bournemouth University , Bournemouth, UK
- St Mary's Maternity Unit, University Hospitals Dorset NHS Foundation Trust , Poole, UK
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Siregar DAS, Rianda D, Irwinda R, Dwi Utami A, Hanifa H, Shankar AH, Agustina R. Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta. PLoS One 2020; 15:e0242150. [PMID: 33237938 PMCID: PMC7688158 DOI: 10.1371/journal.pone.0242150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project. METHODS Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose by capillary glucometer. General linear models were used to identify associations. RESULTS The median AHEI-P score was 47.4 (IQR 19.1-76.6). The middle tertile of the AHEI-P score (39.59-56.58) was associated with a 0.4 SD (standardized effect size, 95% CI -0.7 to -0.06; p = 0.02) lower diastolic blood pressure compared with the lowest tertile (<39.59), after adjustment for level of education, smoking status, MUAC, gestational age, history of hypertension, and family history of hypertension. However, no associations were found between the AHEI-P score and systolic blood pressure and blood glucose. CONCLUSION Higher diet quality was associated with lower diastolic blood pressure among pregnant women in an urban LMIC community, but not with systolic blood pressure and blood glucose. A behavioral change intervention trial would be warranted to confirm the influence of diet quality on blood pressure and glucose levels and among pregnant women, and even before pregnancy.
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Affiliation(s)
- Deviana A. S. Siregar
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Davrina Rianda
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rima Irwinda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Annisa Dwi Utami
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hanifa Hanifa
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anuraj H. Shankar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Prevalence of diabetes mellitus and hypertension during pregnancy in eastern China after the implementation of universal two-child policy. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Istrate-Ofiţeru AM, Berceanu C, Berceanu S, Busuioc CJ, Roşu GC, Diţescu D, Grosu F, Voicu NL. The influence of gestational diabetes mellitus (GDM) and gestational hypertension (GH) on placental morphological changes. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:371-384. [PMID: 33544789 PMCID: PMC7864320 DOI: 10.47162/rjme.61.2.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are some of the most common medical conditions associated with pregnancy. These can be correlated with placental morphopathological changes and implicitly can influence good fetal development. The age and weight of the mother can be correlated directly proportionally with those of the fetus but also with histoarchitecture and placental vascularization. The placental appearance associated with GDM and GH reveals macroscopic features, such as calcifications, fibrin deposits and placental infarcts, but the most relevant pathological features are the microscopic ones, highlighted by the classical staining techniques: Hematoxylin-Eosin (HE), Periodic Acid-Schiff (PAS)-Hematoxylin and Masson's trichrome (MT), but also by immunohistochemical technique with the help of the anti-cluster of differentiation 34 (CD34) antibody that labeled the capital endothelium in the structure of the placental terminal villi and thus we were able to quantify the vascular density according to the associated medical pathology. The microscopic changes identified were represented by intravillous and extravillous fibrin depositions, massive placental infarctions caused by vascular suppression due to various causes, such as thrombosis, but also placental calcifications. All these macroscopic and microscopic morphopathological changes, together with the clinical data of the mother and the newborn, we have demonstrated that they are interconnected and that they can vary depending on the pathology, GH or GDM.
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Affiliation(s)
- Anca Maria Istrate-Ofiţeru
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Histology, Victor Papilian Faculty of Medicine, Lucian Blaga University of Sibiu, Romania;
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Oyekale AS. Effect of Obesity and Other Risk Factors on Hypertension among Women of Reproductive Age in Ghana: An Instrumental Variable Probit Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4699. [PMID: 31779087 PMCID: PMC6926784 DOI: 10.3390/ijerph16234699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022]
Abstract
Background: The growing incidence of mortality as a result cardiovascular diseases (CVDs) is a major public health concern in several developing countries. In Ghana, unhealthy food consumption pattern and sedentary lifestyle are promoting overweight and obesity, with significant consequences on the incidence of CVDs. Specifically, hypertension morbidity is now a public health concern among Ghanaian health policy makers. This paper analysed the effect of body mass index (BMI)/arm circumference and other associated factors on hypertension risk among women of reproductive ages in Ghana. Methods: The data were collected as Demographic and Health Survey (DHS) in 2014. This paper analysed the subset of the data that were collected from eligible women 15-49 years of age. The total sample was 9396, while 9367 gave consents to have their blood pressure measured. Data were analysed with instrumental probit regression model with consideration of potential endogeneity of BMI and arm circumference. Results: The results showed that 25% of the women were either overweight or obese, while 13.28% were hypertensive. Women from the Greater Accra (18.15%), Ashanti (15.53%) and Volta (15.02%) regions had the highest incidences of hypertension. BMI and arm circumferences were truly endogenous and positively associated with the probability of being hypertensive. Other factors that influenced hypertension were age of women, region of residence, urban/rural residence, being pregnant, access to medical insurance, currently working, consumption of broth cubes, processed can meats, salted meat and fruits. Conclusion: It was concluded that hypertension risk was positively associated with being overweight, obesity, age and consumption of salted meat.It was inter aliaemphasized that engagement in healthy eating with less consumption of salted meats, and more consumption of fruits would assist in controlling hypertension among Ghanaian women.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Wada K, Evans MK, de Vrijer B, Nisker J. Clinical Research With Pregnant Women: Perspectives of Pregnant Women, Health Care Providers, and Researchers. QUALITATIVE HEALTH RESEARCH 2018; 28:2033-2047. [PMID: 29865990 DOI: 10.1177/1049732318773724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Limited clinical research with pregnant women has resulted in insufficient data to promote evidence-informed prenatal care. Charmaz's constructivist grounded theory methodology was used to explore how research with pregnant women would be determined ethically acceptable from the perspectives of pregnant women, health care providers, and researchers in reproductive sciences. Semistructured interviews were conducted with a purposive sample of 12 pregnant women, 10 health care providers, and nine reproductive science researchers. All three groups suggested the importance of informed consent and that permissible risk would be very limited and complex, being dependent on the personal benefits and risks of each particular study. Pregnant women, clinicians, and researchers shared concerns about the well-being of the woman and her fetus, and expressed a dilemma between promoting research for evidence-informed prenatal care while securing the safety in the course of research participation.
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Affiliation(s)
- Kyoko Wada
- 1 St. Joseph's Health Centre Toronto, Toronto, Ontario, Canada
| | | | | | - Jeff Nisker
- 2 Western University, London, Ontario, Canada
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Cao C, Cai W, Niu X, Fu J, Ni J, Lei Q, Niu J, Zhou X, Li Y. Prehypertension during pregnancy and risk of small for gestational age: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 33:1447-1454. [PMID: 30173597 DOI: 10.1080/14767058.2018.1519015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Emerging evidence shows that high blood pressure (BP) level even below 140/90 mmHg during pregnancy is associated with increased risk for maternal and infant complications. The meta-analysis evaluated the associations between prehypertension (BP 120-139/80-89 mmHg) during pregnancy and the risk of small for gestational age (SGA), as well as the impact of prehypertension on birth weight (BW).Methods: Databases (PubMed, Embase, and Cochrane Library) were searched for cohort studies with data on prehypertension in pregnancy and adverse obstetrical outcomes, including SGA and/or BW. The relative risks (RRs) of SGA and weighted mean differences (WMD) in BW were calculated and reported with 95% confidence intervals (95% CIs). We calculated pooled RRs using fixed- and random-effects models.Results: A total of 143,835 participants from five cohort studies were included. Prehypertension in pregnancy increased the risk of SGA (RR 1.59, 95%CI 1.44 to 1.76, p < .00001) and lowered BW (WMD -13.71, 95% CI -83.28 to 55.87, p = .70) compared with optimal BP (<120/80 mmHg). In subgroup analyses, for prehypertension in late pregnancy, the risk of SGA was significantly higher than for optimal BP (RR 1.60, 95% CI 1.44 to 1.78).Conclusion: BP within the range of 120-139/80-89 mmHg during pregnancy, as previously defined as prehypertension, particularly in late pregnancy, was associated with a 59% increase in the risk of having an SGA birth.
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Affiliation(s)
- Chunxia Cao
- Institute of Disaster Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Wei Cai
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Xiulong Niu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Jiaxi Fu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Jianmei Ni
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Qiong Lei
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianmin Niu
- Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
| | - Yuming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Centre, Tianjin, China
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Bortolotto MR, Francisco RPV, Zugaib M. Resistant Hypertension in Pregnancy: How to Manage? Curr Hypertens Rep 2018; 20:63. [PMID: 29892919 DOI: 10.1007/s11906-018-0865-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. RECENT FINDINGS The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.
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Affiliation(s)
- Maria Rita Bortolotto
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Zugaib
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Zhao Y, Yang N, Li H, Cai W, Zhang X, Ma Y, Niu X, Yang G, Zhou X, Li Y. Systemic Evaluation of Vascular Dysfunction by High-Resolution Sonography in an N ω -Nitro-l-Arginine Methyl Ester Hydrochloride-Induced Mouse Model of Preeclampsia-Like Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:657-666. [PMID: 28914979 DOI: 10.1002/jum.14380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate vascular function, including arterial resistance and endothelial function, by high-resolution sonography in an Nω -nitro-l-arginine methyl ester hydrochloride (l-NAME)-induced mouse model of preeclampsia-like symptoms. METHODS Pregnant mice were subcutaneously injected with a saline solution (control; n = 10) or l-NAME (n = 10) between the 7th and 18th days of gestation. The resistive index and pulsatility index (RI and PI, indicators of arterial resistance) of the uteroplacental, umbilical, femoral, and common carotid arteries and the flow-mediated dilatation (index of endothelial function) of the femoral artery were measured by high-frequency sonography in both groups. RESULTS We noted significant increases in the RI and PI of the uteroplacental and umbilical arteries and a decrease in the flow-mediated dilatation of the femoral artery in the l-NAME group compared with the control group. We also found that the RI and PI of the uteroplacental and umbilical arteries were negatively correlated with fetal weight and crown-rump length. The results of the multivariate analysis using a logistic regression model indicated that the flow-mediated dilatation at 120 seconds was an independent diagnostic criterion for the l-NAME-induced preeclampsia-like model. A receiver operating characteristic analysis showed that flow-mediated dilatation at 120 seconds had the greatest area under the curve of 0.934, with an optimal cutoff point of 11.1%, yielding sensitivity of 100% and specificity of 84.6%. CONCLUSIONS The PI and RI of the fetomaternal vasculature can identify fetuses in "high-risk" pregnancies, and flow-mediated dilatation is a reliable indicator for predicting preeclampsia. Assessment of vascular function by high-resolution sonography provides a useful platform for preeclampsia-related basic research with high reproducibility.
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Affiliation(s)
- Ying Zhao
- Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Ning Yang
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Hanying Li
- Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Wei Cai
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Xin Zhang
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Yongqiang Ma
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Xiulong Niu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Guohong Yang
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
| | - Yuming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of the People's Armed Police Force, Tianjin, China
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1552] [Impact Index Per Article: 221.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 3006] [Impact Index Per Article: 429.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sheppard R, Hsich E, Damp J, Elkayam U, Kealey A, Ramani G, Zucker M, Alexis JD, Horne BD, Hanley-Yanez K, Pisarcik J, Halder I, Fett JD, McNamara DM. GNB3 C825T Polymorphism and Myocardial Recovery in Peripartum Cardiomyopathy: Results of the Multicenter Investigations of Pregnancy-Associated Cardiomyopathy Study. Circ Heart Fail 2016; 9:e002683. [PMID: 26915373 DOI: 10.1161/circheartfailure.115.002683] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Black women are at greater risk for peripartum cardiomyopathy (PPCM). The guanine nucleotide-binding proteins β-3 subunit (GNB3) has a polymorphism C825T. The GNB3 TT genotype more prevalent in blacks is associated with poorer outcomes. We evaluated GNB3 genotype and myocardial recovery in PPCM. METHODS AND RESULTS A total of 97 women with PPCM were enrolled and genotyped for the GNB3 T/C polymorphism. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6 and 12 months postpartum. LVEF over time in subjects with the GNB3 TT genotype was compared with those with the C allele overall and in black and white subsets. The cohort was 30% black, age 30+6, LVEF 0.34+0.10 at entry 31+25 days postpartum. The % GNB3 genotype for TT/CT/CC=23/41/36 and differed markedly by race (blacks=52/38/10 versus whites=10/44/46, P<0.001). In subjects with the TT genotype, LVEF at entry was lower (TT=0.31+0.09; CT+CC=0.35+0.09, P=0.054) and this difference increased at 6 (TT=0.45+0.15; CT+CC=0.53+0.08, P=0.002) and 12 months (TT=0.45+0.15; CT+CC=0.56+0.07, P<0.001.). The difference in LVEF at 12 months by genotype was most pronounced in blacks (12 months LVEF for GNB3 TT=0.39+0.16; versus CT+CC=0.53+0.09, P=0.02) but evident in whites (TT=0.50++0.11; CT+CC=0.56+0.06, P=0.04). CONCLUSIONS The GNB3 TT genotype was associated with lower LVEF at 6 and 12 months in women with PPCM, and this was particularly evident in blacks. Racial differences in the prevalence and impact of GNB3 TT may contribute to poorer outcomes in black women with PPCM.
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Affiliation(s)
- Richard Sheppard
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.).
| | - Eileen Hsich
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Julie Damp
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Uri Elkayam
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Angela Kealey
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Gautam Ramani
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Mark Zucker
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Jeffrey D Alexis
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Benjamin D Horne
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Karen Hanley-Yanez
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Jessica Pisarcik
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Indrani Halder
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - James D Fett
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Dennis M McNamara
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
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Block-Abraham DM, Adamovich D, Turan OM, Doyle LE, Blitzer MG, Baschat AA. Maternal blood pressures during pregnancy and the risk of delivering a small-for-gestational-age neonate. Hypertens Pregnancy 2016; 35:350-60. [DOI: 10.3109/10641955.2016.1150487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Dana M. Block-Abraham
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dasha Adamovich
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M. Turan
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lauren E. Doyle
- Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miriam G. Blitzer
- Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ahmet A. Baschat
- Gynecology & Obstetrics, Center for Fetal Therapy, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW Hypertension in pregnancy contributes substantially to perinatal mortality and morbidity of both the mother and her child. High blood pressure is mainly responsible for this adverse outcome, in particular when associated with preeclampsia. Although preeclampsia is nowadays a well-known clinical-obstetrical entity, and screening for this complication has been part of routine care during pregnancy for nearly 100 years, its cause is still enigmatic. RECENT FINDINGS Profound changes of the demographic development of our society, the worldwide rising prevalence of obesity and metabolic disorders, and progress in reproductive medicine will inevitably modify the prevalence of many medical problems in pregnancy. Complications such as gestational diabetes mellitus, chronic hypertension, and preeclampsia will rise and an interdisciplinary approach is necessary to handle these women during pregnancy and also after delivery. Indeed, it is now well established that these women and their offspring born large or small-for-gestational age are at increased risk for severe cardiovascular and metabolic complications later in life. SUMMARY Knowledge of the pregnancy course is not only important for an obstetrician but also increasingly inevitable for the general practitioner. Recognition, classification, and adequate management of hypertensive pregnancy disorders and associated complications may considerably reduce perinatal death and morbidity.
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Scantlebury DC, Schwartz GL, Acquah LA, White WM, Moser M, Garovic VD. The treatment of hypertension during pregnancy: when should blood pressure medications be started? Curr Cardiol Rep 2014; 15:412. [PMID: 24057769 DOI: 10.1007/s11886-013-0412-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hypertensive pregnancy disorders (HPD) are important causes of maternal and fetal morbidity and mortality worldwide. In addition, a history of HPD has been associated with an increased risk for maternal cardiovascular disease later in life, possibly because of irreversible vascular and metabolic changes that persist beyond the affected pregnancies. Therefore, treatment of HPD may not only improve immediate pregnancy outcomes, but also maternal long-term cardiovascular health. Unlike the recommendations for hypertension treatment in the general population, treatment recommendations for HPD have not changed substantially for more than 2 decades. This is particularly true for mild to moderate hypertension in pregnancy, defined as a blood pressure of 140-159/90-109 mm Hg. This review focuses on the goals of therapy, treatment strategies, and new developments in the field of HPD that should be taken into account when considering blood pressure targets and pharmacologic options for treatment of hypertension in pregnant women.
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Sheppard R, Rajagopalan N, Safirstein J, Briller J. An update on treatments and outcomes in peripartum cardiomyopathy. Future Cardiol 2014; 10:435-47. [DOI: 10.2217/fca.14.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
ABSTRACT: Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria include heart failure that presents with reduced left ventricular function, signs and symptoms of heart failure either late in pregnancy or early in the postpartum period. The incidence varies widely depending geography and ethnicity. The pathophysiology of PPCM is still an area of active investigation, but includes immune and inflammatory mechanisms, which are the subject of several investigations. Therapies for chronic heart failure from PPCM are similar to those patients with nonischemic cardiomyopathy from different etiologies, however novel therapies may include bromocriptine, pentoxifylline or other potential therapies influencing the immune system. The need for implantable defibrillators, left ventricular assist devices and cardiac transplant in women with PPCM is rare, and prognosis is better than other forms of nonischemic cardiomyopathy. Despite this, further information about the epidemiology, prognosis and potential therapies are required to better manage and diagnose PPCM in women with signs and symptoms of heart failure.
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Affiliation(s)
- Richard Sheppard
- Jewish General Hospital, McGill University, Montreal H3T1E2, Canada
| | - Navin Rajagopalan
- University of Kentucky, Division of Cardiovascular Medicine, KY, USA
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22
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Antihypertensive drugs methyldopa, labetalol, hydralazine, and clonidine improve trophoblast interaction with endothelial cellular networks in vitro. J Hypertens 2014; 32:1075-83; discussion 1083. [DOI: 10.1097/hjh.0000000000000134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Tranquilli A, Dekker G, Magee L, Roberts J, Sibai B, Steyn W, Zeeman G, Brown M. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens 2014; 4:97-104. [DOI: 10.1016/j.preghy.2014.02.001] [Citation(s) in RCA: 802] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/15/2022]
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24
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Schaap TP, Knight M, Zwart JJ, Kurinczuk JJ, Brocklehurst P, van Roosmalen J, Bloemenkamp KWM. Eclampsia, a comparison within the International Network of Obstetric Survey Systems. BJOG 2014; 121:1521-8. [DOI: 10.1111/1471-0528.12712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- TP Schaap
- Department of Obstetrics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - M Knight
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - JJ Zwart
- Department of Obstetrics and Gynaecology; Deventer Ziekenhuis; Deventer the Netherlands
| | - JJ Kurinczuk
- National Perinatal Epidemiology Unit; University of Oxford; Oxford UK
| | - P Brocklehurst
- Institute for Women's Health; University College London; London UK
| | - J van Roosmalen
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
- Department of Medical Humanities; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics; Leiden University Medical Centre; Leiden the Netherlands
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25
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Clemow DB, Dewulf L, Koren G, Mikita JS, Nolan MR, Michaels DL, Cantrell SA, Kogelnik AM. Clinical Data for Informed Medication Use in Pregnancy: Strengths, Limitations, Gaps, and a Need to Continue Moving Forward. Ther Innov Regul Sci 2014; 48:134-144. [PMID: 30227507 DOI: 10.1177/2168479014523006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this paper is to explore the strengths, weaknesses, gaps, and needs in research on medication use in pregnancy, where opportunities have been bypassed to develop standards and collaborations for collecting data to better understand how medications can impact clinical outcomes in pregnant women and developing fetuses. The availability of existing data and the methods of its capture are reviewed, including registries, claims and health record databases, and meta-analyses. The paper focuses on why these efforts have not fundamentally provided benefit-risk information and clinical treatment algorithms for medication use in pregnant women. Methodological issues, such as lack of standardization and central data collection, are discussed. Common barriers are examined, including a lack of awareness and education, cultural hurdles, collaboration deficiency, and an insufficient development of new data collection methods.
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Affiliation(s)
| | | | - Gideon Koren
- 3 The Hospital for Sick Children, Toronto, ON, Canada.,4 The University of Toronto, Toronto, ON, Canada.,5 The University of Western Ontario, Toronto, ON, Canada
| | | | - Martha R Nolan
- 7 Society for Women's Health Research, Washington, DC, USA
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26
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Abstract
Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6-8 % of pregnancies. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy-related maternal deaths in the USA, accounting for 579 (12.3 %) of the 4,693 maternal deaths that occurred between 1998 and 2005. In low-income and middle-income countries, preeclampsia and its convulsive form, eclampsia, are associated with 10-15 % of direct maternal deaths. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. In this review, we have compared and contrasted the recommendations from different treatment guidelines and outlined some newer perspectives on management. We aim to provide a clinically oriented guide to the drug treatment of hypertension in pregnancy.
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Affiliation(s)
- Catherine M Brown
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
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27
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 617] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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28
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Kattah AG, Garovic VD. The management of hypertension in pregnancy. Adv Chronic Kidney Dis 2013; 20:229-39. [PMID: 23928387 PMCID: PMC3925675 DOI: 10.1053/j.ackd.2013.01.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 01/30/2023]
Abstract
Hypertensive pregnancy disorders complicate 6% to 8% of pregnancies and cause significant maternal and fetal morbidity and mortality. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother without compromising fetal well-being. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and women with preexisting chronic hypertension in pregnancy. This review will address the management of hypertension in pregnancy, review the various pharmacologic therapies, and discuss the future directions in this field.
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Affiliation(s)
- Andrea G Kattah
- Department of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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29
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Jim B, Hou S. Pregnancy and kidney disease-the miracle continues against all odds. Adv Chronic Kidney Dis 2013; 20:206-8. [PMID: 23928383 DOI: 10.1053/j.ackd.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 11/11/2022]
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30
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Caicedo A, Thewissen L, Naulaers G, Lemmers P, van Bel F, Van Huffel S. Effect of maternal use of labetalol on the cerebral autoregulation in premature infants. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 789:105-111. [PMID: 23852483 DOI: 10.1007/978-1-4614-7411-1_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) are normally treated to avoid maternal complications. In this study we aimed to investigate if there was an effect of maternal HDP treatment on the cerebral autoregulation of the neonates by analysing measurements of mean arterial blood pressure (MABP) and rScO2 by means of correlation, coherence, and transfer function analysis. We found that these infants presented higher values of transfer function gain, which indicates impaired cerebral autoregulation, with a decreasing trend towards normality. We hypothesised that this trend was due to a vasodilation effect of the maternal use of labetalol due to accumulation, which disappeared by the third day after birth. Therefore, we investigated the values of pulse pressure in order to find evidence for a vasodilatory effect. We found that lower values of pulse pressure were present in these infants when compared with a control population, which, together with increased transfer function gain values, suggests an effect of the drug on the cerebral autoregulation.
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Affiliation(s)
- Alexander Caicedo
- Department of Electrical Engineering, ESAT/SCD, KU Leuven, Leuven, Belgium. .,iMinds Future Health Department, Leuven, Belgium.
| | - Liesbeth Thewissen
- Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Petra Lemmers
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, University Medical Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sabine Van Huffel
- Department of Electrical Engineering, ESAT/SCD, KU Leuven, Leuven, Belgium.,iMinds Future Health Department, Leuven, Belgium
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32
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Abstract
Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy of unclear etiology affecting women without preexisting heart disease during the last month of pregnancy or during the first 5 months postpartum. Its incidence shows marked geographic and ethnic variation, being most common in Africa and among women of African descent. Most women present in the first month postpartum with typical heart failure symptoms such as dyspnea, lower extremity edema, and fatigue. These symptoms are often initially erroneously diagnosed as part of the normal puerperal process. Diagnosis can be aided by the finding of a significantly elevated serum brain natriuretic peptide. The etiology of PPCM is unclear; however, recent research suggests abnormal prolactin metabolism is seminal in its development, and prolactin antagonism with bromocriptine shows promise as a novel treatment for PPCM.
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Affiliation(s)
- Michael Capriola
- Thomasville Medical Center, Department of Emergency Medicine, Thomasville Medical Center, Thomasville, NC, USA
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33
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New therapeutic approaches to treating hypertension in pregnancy. Drug Discov Today 2012; 17:1307-15. [DOI: 10.1016/j.drudis.2012.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/11/2012] [Accepted: 07/06/2012] [Indexed: 02/04/2023]
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