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Elawad T, Scott G, Bone JN, Elwell H, Lopez CE, Filippi V, Green M, Khalil A, Kinshella MLW, Mistry HD, Pickerill K, Shanmugam R, Singer J, Townsend R, Tsigas EZ, Vidler M, Volvert ML, von Dadelszen P, Magee LA. Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG 2024; 131:46-62. [PMID: 36209504 DOI: 10.1111/1471-0528.17320] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-eclampsia prevention. DESIGN Our search strategy provided hierarchical evidence of relationships between risk factors and pre-eclampsia using Medline (Ovid), searched from January 2010 to January 2021. SETTING Published studies and CPGs. POPULATION Pregnant women. METHODS We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. MAIN OUTCOME MEASURE Pre-eclampsia. RESULTS Of 78 pre-eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130-139/80-89 mmHg in early pregnancy. CONCLUSIONS Pre-eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.
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Affiliation(s)
- Terteel Elawad
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Georgia Scott
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- North West London Foundation School, London, UK
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Helen Elwell
- British Medical Association (BMA) Library, BMA, London, UK
| | - Cristina Escalona Lopez
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Asma Khalil
- St George's Hospital NHS Foundation Trust, London, UK
| | - Mai-Lei W Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Reshma Shanmugam
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- West Midlands Central Foundation School, Birmingham, UK
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Vancouver, Canada
| | | | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Marie-Laure Volvert
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
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Bazzano AN, Keenan A, Woltz S, Subramanian A, Akpogheneta O, Coronado Daza J, Bazzano LAL. Quality and Content Concordance of International Clinical Guidelines on Hypertensive Disorders of Pregnancy Using the AGREE II Instrument: An Updated Systematic Review. J Cardiovasc Dev Dis 2023; 10:295. [PMID: 37504551 PMCID: PMC10380410 DOI: 10.3390/jcdd10070295] [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: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Utilization of high-quality clinical practice guidelines has the potential to positively impact health outcomes. This study aimed to assess the quality and content concordance of national and international recommendations on hypertensive disorders of pregnancy (HDPs). Searches were conducted of the MEDLINE database and reference lists generated from national and international agencies. Covidence software was used for the management of the systematic review process, the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to assess guidelines for quality, and three reviewers independently screened records. The research team identified and screened a total of 399 records of which 10 were deemed high quality. Guidelines were assessed and compared regarding the treatment, prevention, and categorization of disorders. The quality of guidelines varied across different domains, with significant variation in domain scores even within individual guidelines. Not all recommendations showed a high level of methodologic rigor, and the highest-rated guidelines were from the American Heart Association, the World Health Organization, and South Africa national guidelines. Classification of hypertension differed among the guidelines, particularly in defining chronic hypertension, severe hypertension, and preeclampsia. Prevention modalities varied across guidelines, with recommendations for aspirin, calcium supplementation, and against the use of certain approaches. Treatment modalities highlighted the importance of delivery as the definitive way to terminate hypertensive disorders of pregnancy, with other management strategies provided for symptom control. The variability in guidelines and consensus statements across different contexts may reflect regional differences in healthcare practices, available resources, and research evidence. There is potential to harmonize guidelines for HDP globally while considering the unique needs of individual countries. Where guidelines may be synthesized and condensed into an accessible format, doing so could improve their use in clinical decision-making.
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Affiliation(s)
- Alessandra N Bazzano
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Alexandra Keenan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA
| | - Sara Woltz
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Advaith Subramanian
- The Murphy Institute, School of Liberal Arts, Tulane University, New Orleans, LA 70118, USA
| | - Onome Akpogheneta
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
- Infectious Diseases Program, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Lydia A L Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA
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Song Y, Wang W, Liu X, Chen J, Chen D, Wang X, Li W, Ouyang D. Physiologically Based Pharmacokinetic Modeling for Multiple Oral Administration Labetalol in Pregnant Women. Pharm Res 2023; 40:1765-1775. [PMID: 37142805 DOI: 10.1007/s11095-023-03523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Labetalol has an irreplaceable role in treating Hypertensive disorders of pregnancy (HDP), a common disease during pregnancy with a prevalence of 5.2-8.2%. However, there were big differences in dosage regimens between various guidelines. PURPOSE A physiologically-based pharmacokinetics (PBPK) model was established and validated to evaluate the existing oral dosage regimens, and to compare the difference in plasma concentration between pregnant and non-pregnant women. METHODS First, non-pregnant woman models with specific plasma clearance or enzymatic metabolism (UGT1A1, UGT2B7, CYP2C19) were established and validated. For CYP2C19, slow, intermediate, and rapid metabolic phenotypes were considered. Then, a pregnant model with proper structure and parameters adjustment was established and validated against the multiple oral administration data. RESULTS The predicted labetalol exposure captured the experimental data well. The following simulations with criteria lowering 15 mmHg blood pressure (corresponding to around 108 ng/ml plasma labetalol) found that the maximum daily dosage in the Chinese guideline may be insufficient for some severe HDP patients. Moreover, similar predicted steady-state trough plasma concentration was found between the maximum daily dosage in the American College of Obstetricians and Gynecologists (ACOG) guideline, 800 mg Q8h and a regimen of 200 mg Q6h. Simulations comparing non-pregnant and pregnant women found that the difference in labetalol exposure highly depended on the CYP2C19 metabolic phenotype. CONCLUSIONS In summary, this work initially established a PBPK model for multiple oral administration of labetalol for pregnant women. This PBPK model may lead to personalized labetalol medication in the future.
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Affiliation(s)
- Yudi Song
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS), University of Macau, Macau, China
| | - Wei Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS), University of Macau, Macau, China
| | - Xinyang Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS), University of Macau, Macau, China
| | - Jingsi Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
| | - Xiaoyi Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
- Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
| | - Wei Li
- Department of Pharmacy, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Defang Ouyang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS), University of Macau, Macau, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences (FHS), University of Macau, Macau, China.
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The Targeting of Nuclear Factor Kappa B by Drugs Adopted for the Prevention and Treatment of Preeclampsia. Int J Mol Sci 2022; 23:ijms23052881. [PMID: 35270023 PMCID: PMC8911173 DOI: 10.3390/ijms23052881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
Preeclampsia (PE) is characterised by high levels and activity of the transcription factor Nuclear Factor kappa B (NFĸB) in the maternal blood and placental cells. This factor is responsible for the regulation of over 400 genes known to influence processes related to inflammation, apoptosis and angiogenesis, and cellular responses to oxidative stress and hypoxia. Although high NFĸB activity induces hypoxia and inflammation, which are beneficial for the process of implantation, NFĸB level should be reduced in the later stages of physiological pregnancy to favour maternal immunosuppression and maintain gestation. It is believed that the downregulation of NFĸB activity by pharmacotherapy might be a promising way to treat preeclampsia. Interestingly, many of the drugs adopted for the prevention and treatment of preeclampsia have been found to regulate NFĸB activity. Despite this, further innovation is urgently needed to ensure treatment safety and efficacy. The present article summarizes the current state of knowledge about the drugs recommended by cardiology, obstetrics, and gynaecology societies for the prevention and treatment of preeclampsia with regard to their impact on the cellular regulation of NFĸB pathways.
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Scott G, Gillon TE, Pels A, von Dadelszen P, Magee LA. Guidelines-similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension. Am J Obstet Gynecol 2022; 226:S1222-S1236. [PMID: 32828743 DOI: 10.1016/j.ajog.2020.08.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/15/2020] [Accepted: 08/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study aimed to review pregnancy hypertension clinical practice guidelines to inform international clinical practice and research priorities. STUDY ELIGIBILITY CRITERIA Relevant national and international clinical practice guidelines, 2009-19, published in English, French, Dutch or German. STUDY APPRAISAL AND SYNTHESIS METHODS Following published methods and prospective registration (CRD42019123787), a literature search was updated. CPGs were identified by 2 authors independently who scored quality and usefulness for practice (Appraisal of Guidelines for Research and Evaluation II instrument), abstracted data, and resolved any disagreement by consensus. RESULTS Of note, 15 of 17 identified clinical practice guidelines (4 international) were deemed "clinically useful" and had recommendations abstracted. The highest Appraisal of Guidelines for Research and Evaluation II scores were from government organizations, and scores have improved over time. The following were consistently recommended: (1) automated blood pressure measurement with devices validated for pregnancy and preeclampsia, reflecting increasing recognition of the prevalence of white-coat hypertension and the potential usefulness of home blood pressure monitoring; (2) use of dipstick proteinuria testing for screening followed by quantitative testing by urinary protein-to-creatinine ratio or 24-hour urine collection; (3) key definitions and most aspects of classification, including a broad definition of preeclampsia (which includes proteinuria and maternal end-organ dysfunction, including headache and visual symptoms and laboratory abnormalities of platelets, creatinine, or liver enzymes) and a recognition that it can worsen after delivery; (4) preeclampsia prevention with aspirin; (5) treatment of severe hypertension, most commonly with intravenous labetalol, oral nifedipine, or intravenous hydralazine; (6) treatment for nonsevere hypertension when undertaken, with oral labetalol (in particular), methyldopa, or nifedipine, with recommendations against the use of renin-angiotensin-aldosterone inhibitors; (7) magnesium sulfate for eclampsia treatment and prevention among women with "severe" preeclampsia; (8) antenatal corticosteroids for preterm birth but not hemolysis, elevated liver enzymes, and low platelet count syndrome; (9) delivery at term for preeclampsia; (10) a focus on usual labor and delivery care but avoidance of ergometrine; and (11) an appreciation that long-term health complications are increased in incidence, mandating lifestyle change and risk factor modification. Lack of uniformity was seen in the following areas: (1) the components of a broad preeclampsia definition (specifically respiratory and gastrointestinal symptoms, fetal manifestations, and biomarkers), what constitutes severe preeclampsia, and whether the definition has utility because at present what constitutes severe preeclampsia by some guidelines that mandate proteinuria now defines any preeclampsia for most other clinical practice guidelines; (2) how preeclampsia risk should be identified early in pregnancy, and aspirin administered for preeclampsia prevention, because multivariable models (with biomarkers and ultrasonography added to clinical risk markers) used in this way to guide aspirin therapy can substantially reduce the incidence of preterm preeclampsia; (3) the value of calcium added to aspirin for preeclampsia prevention, particularly for women with low intake and at increased risk of preeclampsia; (4) emerging recommendations to normalize blood pressure with antihypertensive agents even in the absence of comorbidities; (5) fetal neuroprotection as an indication for magnesium sulfate in the absence of "severe" preeclampsia; and (6) timing of birth for chronic and gestational hypertension and preterm preeclampsia. CONCLUSION Consistent recommendations should be implemented and audited. Inconsistencies should be the focus of research.
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Hofstede A, Lomme M, Gosselink S, van Drongelen J. The Cloud DX connected HealthKit Pulsewave in home blood pressure monitoring during pregnancy: a clinical evaluation and user experience study. Pregnancy Hypertens 2022; 28:1-8. [DOI: 10.1016/j.preghy.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Olié V. [Hypertensive disorders of pregnancy and early cardiovascular diseases]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:879-880. [PMID: 34653672 DOI: 10.1016/j.gofs.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- V Olié
- Santé publique France, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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Wang Z, Bao X, Song L, Tian Y, Sun P. Role of miR-106-mediated mitogen-activated protein kinase signaling pathway in oxidative stress injury and inflammatory infiltration in the liver of the mouse with gestational hypertension. J Cell Biochem 2021; 122:958-968. [PMID: 31773798 DOI: 10.1002/jcb.29552] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023]
Abstract
We aim to investigate the role of miR-106-mediated mitogen-activated protein kinase (MAPK) signaling pathway in oxidative stress (OS) injury and inflammatory infiltration in the liver of the mouse with gestational hypertension (GH). Ninety specific pathogen-free mice (Kunming species) during middle to late gestation were selected for the study. Fifteen mice were used as control, while the rest were used for establishing the GH model. The mice were assigned to six groups: normal group (normal gestation), model group (GH model), negative control group (GH model, intravenously injected with negative control vector), miR-106a-mimic group (GH model, intravenously injected with vector overexpressing miR-106a, which mimics the overexpression of endogenous mature miR-106a), SB203580 group (GH model, intravenously injected with MAPK pathway inhibitor SB203580), and miR-106a-mimic+SB203580 group (GH model, intravenously injected with SB203580 and vector overexpressing miR-106a). Fourteen days after electrical stimulation, all the groups except for the normal group had elevated blood pressure vs those on day 0 and 7. Compared with the normal group, the other groups had lower levels of miR-106a expression, nitric oxide, nitric oxide synthase, catalase, superoxide dismutase, S cell ratio, and interleukin-4 (IL-4) and IL-10 in the serum and liver as opposed to increased levels of blood pressure, p38MAPK mRNA expression, p-p38MAPK positive expression rate, protein expressions of p-p38MAPK, p-ERK, and p-JNK, H2 O2 and malondialdehyde in liver, G0/G1 cell ratio, apoptosis rate, and IL-6, interferon-γ (IFN-γ), and IFN-α in the serum and liver (all P < .05). The miR-106 overexpression or inhibiting MAPK signaling pathway can attenuate OS injury and inflammatory response in the liver of the mouse with GH, and the effect can be even better if both miR-106a overexpression and inhibiting MAPK pathway are applied. In conclusion, miR-106a overexpression can inhibit OS injury and inflammatory infiltration in the liver of the mouse with GH by mediating MAPK signaling pathway.
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Affiliation(s)
- Zhihui Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Xiufang Bao
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Limeng Song
- Department of Obstetrics and Gynecology, Inner Mongolia People's Hospital, Hohhot, China
| | - Yuying Tian
- Department of Pathology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
| | - Ping Sun
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao, China
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Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BJH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 6:384-393. [PMID: 31841131 DOI: 10.1093/ehjcvp/pvz082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
Hypertensive disorders are the most common medical complications in the peripartum period associated with a substantial increase in morbidity and mortality. Hypertension in the peripartum period may be due to the continuation of pre-existing or gestational hypertension, de novo development of pre-eclampsia or it may be also induced by some drugs used for analgesia or suppression of postpartum haemorrhage. Women with severe hypertension and hypertensive emergencies are at high risk of life-threatening complications, therefore, despite the lack of evidence-based data, based on expert opinion, antihypertensive treatment is recommended. Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available. Induction of labour is associated with improved maternal outcome and should be advised for women with gestational hypertension or mild pre-eclampsia at 37 weeks' gestation. This position paper provides the first interdisciplinary approach to the management of hypertension in the peripartum period based on the best available evidence and expert consensus.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Vídeňská 800, 140 59 Prague 4, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Mark R Johnson
- Institute of Reproductive and Developmental Biology, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jana Brguljan
- Division of Internal Medicine, Department of Hypertension, Medical Faculty, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, London, UK
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou General & Maternal Hospital, Athens, Greece
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S.Luca Hospital, Milan, Italy
| | - Isabella Sudano
- Department of Cardiology, University Heart Center Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bert-Jan H van den Born
- Departments of Internal and Vascular Medicine, Department of Public Health, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Vera Regitz-Zagrosek
- Berlin Institute for Gender in Medicine and CCR, Charité University Medicine Berlin, and DZHK, Partner Site Berlin, Germany
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Hypertension Research Center, Federico II University, Naples, Italy
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Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks. PLoS One 2021; 16:e0246392. [PMID: 33534858 PMCID: PMC7857578 DOI: 10.1371/journal.pone.0246392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To compare maternal complications and describe neonatal outcomes in women with severe preeclampsia at ≤ 26+0 weeks in two countries with different management policies: expectant management (Brazil) versus termination of pregnancy (France). Methods We conducted a retrospective comparative study by reviewing the medical records of women with severe preeclampsia at ≤ 26+0 weeks, from January 2010 to June 2018, in two centers: Hospital das Clínicas da Faculdade de Medicina, in Sao Paulo, Brazil (where medical abortion is forbidden in this indication) and Hôpital Antoine-Béclère, Clamart, France (where medical termination is accepted). We collected information on maternal characteristics, laboratory tests, maternal complications and fetal and newborn characteristics. We used Student’s t-test and the Mann-Whitney U nonparametric test to compare quantitative variables, and Chi-square test or Fisher's exact test to evaluate the associations between the qualitative variables. Results There was no between-group difference in maternal complications during hospitalization (p = 0.846). In Brazil, the rate of cesarean section was 66.7%, and 20% of patients had vertical incision. The rate of spontaneous fetal death was 35.6% and among the live-born infants 26.6% were discharged from hospital. In France, one patient had a cesarean section with vertical incision. Conclusion When comparing termination of pregnancy to expectant management in severe preeclampsia before 26 weeks, maternal complications were equivalent but maternal reproductive future might have been compromised in 20% of cases due to a higher risk of uterine rupture in subsequent pregnancies for patients having classic cesarean (vertical incision). 26.6% of children survived the neonatal period when pregnancy was pursued, however we lack information on their long-term follow-up.
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Delorme P, Kayem G, Lorthe E, Sentilhes L, Zeitlin J, Subtil D, Rozé JC, Vayssière C, Durox M, Ancel PY, Pierrat V, Goffinet F. Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: EPIPAGE-2 prospective population-based cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:557-565. [PMID: 32212388 DOI: 10.1002/uog.22025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders. METHODS The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods. RESULTS The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9). CONCLUSION Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Delorme
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - G Kayem
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - E Lorthe
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - D Subtil
- Université de Lille, CHU Lille, Hop Jeanne de Flandre, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - J C Rozé
- CHU, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
| | - C Vayssière
- UMR 1027 INSERM, Team SPHERE, Université Toulouse III Paul Sabatier, Toulouse, France
- CHU de Toulouse, Service de Gynécologie Obstétrique, Toulouse, France
| | - M Durox
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - P Y Ancel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- URC-CIC P1419, HUPC, Assistance Publique Hôpitaux de Paris, Paris, France
| | - V Pierrat
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - F Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Department of Obstetrics and Gynaecology, AP-HP Cochin Port Royal, FHU PREMA Paris, France
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12
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Salvator M, Veyrie N, Rozenberg P, Berveiller P. [Which management of pregnancy after bariatric surgery?]. ACTA ACUST UNITED AC 2020; 48:746-753. [PMID: 32387764 DOI: 10.1016/j.gofs.2020.04.015] [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: 03/15/2020] [Indexed: 11/16/2022]
Abstract
Obesity represents a major public health issue and a potential threat for people health. Moreover, the incidence of obesity has been increasing and therefore, the incidence of women with an history of bariatric surgery with a pregnancy desire has been also increased. Although the weight loss after bariatric surgery has positive effects on pregnancy outcomes, these surgical procedures may be associated with adverse outcomes as well, for example micronutrient deficiencies, dumping syndrome, surgical complications such as internal hernias, and obstetrical complications such as small for gestational age as instance. Nevertheless, physician knowledge about pregnancy management after bariatric surgery is currently insufficient and a multidisciplinary approach is therefore mandatory. The aim of this article is to provide to readers general and recent data regarding the management of pregnancy after bariatric surgery.
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Affiliation(s)
- M Salvator
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - N Veyrie
- International Obesity Center of Paris - IOCP, Paris, France
| | - P Rozenberg
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - P Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France; UVSQ, INRAE, BREED, université Paris-Saclay, 78350 Jouy-en-Josas, France; BREED, école nationale vétérinaire d'Alfort, 94700 Maisons-Alfort, France.
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13
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Association of maternal home blood pressure trajectory during pregnancy with infant birth weight: the BOSHI study. Hypertens Res 2020; 43:550-559. [DOI: 10.1038/s41440-020-0416-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023]
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14
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Ekawati FM, Emilia O, Brennecke S, Gunn J, Licqurish S, Lau P. Opportunities for improving hypertensive disorders of pregnancy (HDP) management in primary care settings: A review of international published guidelines in the context of pregnancy care in Indonesia. Pregnancy Hypertens 2020; 19:195-204. [PMID: 32078932 DOI: 10.1016/j.preghy.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
Almost all of global maternal mortality caused by HDP occurs in low to middle-income countries (LMIC). However, limited guidance is available to local primary care practitioners who are usually the main health care providers. This review examined existing international practice guidelines to identify potential practices to improve HDP management in Indonesian primary care settings. We performed structured literature search strategies and snowballing searches in six databases (MEDLINE, Web of Science, EMBASE, CINAHL, Cochrane reviews and Google Scholar) for guidelines that were published between 2007 and 2018 using relevant keywords and phrases of 'guidelines', 'hypertensive disorders of pregnancy' or 'preeclampsia' and 'primary care'. The AGREE II instrument was used to assess quality and reporting of the eligible guidelines. Thematic analysis was performed on all of the guidelines and the results were discussed among the project investigators. Sixteen international practice guidelines or similar management recommendations were reviewed. Almost all of them were partially applicable, with some managements potentially able to be adopted to Indonesian primary care settings. Three main themes for improving HDP management were identified, namely clinical management, care planning, and professional communication. These potential improvements in managing women with HDP in Indonesia may also be relevant in other LMIC. Further contextualisation is required to facilitate their adoption in practice settings.
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Affiliation(s)
- Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of General Practice, University of Melbourne, Victoria, Australia.
| | - Ova Emilia
- Department of Obstetrics and Gynaecology, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia
| | - Shaun Brennecke
- Department of Obstetrics and Gynaecology, University of Melbourne/Royal Women's Hospital, Parkville, Victoria, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Victoria, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Victoria, Australia
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15
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Amar J, Angoulvant T, Boivin JM, Amar L, Lantelme P, Blacher J, Plu-Bureau G, Vehier CM. Spécificités du traitement médicamenteux antihypertenseur chez la femme. Presse Med 2019; 48:1261-1264. [PMID: 31735525 DOI: 10.1016/j.lpm.2019.07.028] [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] [Received: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.
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Affiliation(s)
- Jacques Amar
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France.
| | - Theodora Angoulvant
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Jean Marc Boivin
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Laurence Amar
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Pierre Lantelme
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Jacques Blacher
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Geneviève Plu-Bureau
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
| | - Claire Mounier Vehier
- CHU de Toulouse, fédération de cardiologie, service d'HTA, avenue Jean-Pouhles, Toulouse, France
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16
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Mounier-Vehier C, Madika AL. [Post-menopausal hypertension: Detecting, treating, accompany, prevent]. Presse Med 2019; 48:1288-1294. [PMID: 31727484 DOI: 10.1016/j.lpm.2019.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
Menopause is associated with a significant increase in arterial and metabolic risk. Systolic hypertension is common in post-menopausal women. Measurement of blood pressure should be repeated systematically at each visit. Ambulatory blood pressure measurements should be encouraged, especially to detect nocturnal hypertension and to prevent more efficiently women at risk. Self-testing of hypertension by home blood pressure should be encouraged at menopause. Antihypertensive treatment should be initiated after ambulatory blood pressure monitoring in association with reinforced lifestyle. Furthermore, global level of cardiovascular risk should take into account before starting antihypertensive treatment. There are no women specificities in the choice of the initial treatment except thiazide diuretics which should be preferred in osteoporotic women. In hypertensive women and with disabling climacteric symptoms under 60 and within 10 years after the onset of menopause, post-menopausal hormone therapy can be offered in absence of arterial or venous contraindications. A preliminary discussion between gynecologist, cardiologist and general practionner is necessary before deciding to treat a post-menopausal women for her climacteric symptoms. A clear information on the benefit-risk balance of post-menopausal hormone therapy should be given to the women. The information should be recorded in the medical file. Cooperation between cardiologists, gynecologists and general practionners should be promoted in France, to optimize the care pathways in these women at risk and to improve medical practices.
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Affiliation(s)
- Claire Mounier-Vehier
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
| | - Anne-Laure Madika
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France
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17
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Mounier-Vehier C, Nasserdine P, Madika AL. [Stratification of cardiovascular risk in women: Optimize the medical care]. Presse Med 2019; 48:1249-1256. [PMID: 31727491 DOI: 10.1016/j.lpm.2019.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022] Open
Abstract
Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.
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Affiliation(s)
- Claire Mounier-Vehier
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
| | - Phenicia Nasserdine
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France
| | - Anne-Laure Madika
- CHU Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France
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18
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Boivin JM, Mounier-Vehier C. [Organize the care pathways for hypertensive women during menopause]. Presse Med 2019; 48:1301-1305. [PMID: 31727486 DOI: 10.1016/j.lpm.2019.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022] Open
Abstract
Menopause requires the implementation of organized screening and dedicated care pathways in collaboration with the attending physician, the gynaecologist-obstetrician and the cardiovascular physician. It will be necessary to take into account the hormonal specificities of the cardiovascular risk, in order to know-how to properly prescribe hormonal treatments.
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Affiliation(s)
- Jean-Marc Boivin
- CHRU de Nancy, CIC-P Inserm, 54500 Vandoeuvre-les-Nancy, France; Université de Lorraine, faculté de médecine, département de médecine générale, 54000 Nancy, France.
| | - Claire Mounier-Vehier
- CHU de Lille, institut cœur poumon, médecine vasculaire et HTA, 59000 Lille, France; Université Lille, santé publique : épidémiologie et qualité des soins, EA 2694, 59000 Lille, France
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19
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Hu J, Zhang J, Zhu B. Protective effect of metformin on a rat model of lipopolysaccharide-induced preeclampsia. Fundam Clin Pharmacol 2019; 33:649-658. [PMID: 31334867 DOI: 10.1111/fcp.12501] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/05/2019] [Accepted: 07/18/2019] [Indexed: 12/23/2022]
Abstract
Recent in vitro and clinical studies have found that metformin (MET) may play a preventive or therapeutic role in preeclampsia (PE) and may be a candidate drug for the prevention and/or treatment of PE. In this study, we used lipopolysaccharide (LPS) to induce a PE-like rat model and investigated the intervention effect of MET from the perspectives of clinical manifestations, placental morphology, serum marker for placental injury, systemic inflammatory response and oxidative/nitrative stress, and placental nuclear factor-κB (NF-κB) signaling. The results showed that MET improved LPS-induced hypertension, proteinuria, fetal growth restriction (FGR) and stillbirth, alleviated placental injury and decreased maternal serum marker alpha-fetoprotein (MS-AFP) level; MET suppressed LPS-induced TNF-α and IL-6 productions, reduced oxidative/nitrative stress as evidenced by increased superoxide dismutase (SOD) activity, decreased inducible nitric oxide synthase (iNOS) activity, and decreased levels of malondialdehyde (MDA) and nitric oxide (NO); MET inhibited LPS-induced NF-κB activation in placentas. Based on these findings, it can be concluded that MET is beneficial to the PE-like rat model by protecting placentas from injury, suppressing systemic inflammatory response and oxidative/nitrative stress, and inhibiting placental NF-κB signaling pathway. MET is a promising drug for prevention and/or treatment of PE.
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Affiliation(s)
- Jilin Hu
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, China.,Medical School, Kunming University of Science and Technology, Kunming, 650500, China
| | - Jinman Zhang
- Medical School, Kunming University of Science and Technology, Kunming, 650500, China.,National Health Commission's Key Laboratory for Healthy Births in Western China, Department of Obstetrics and Gynecology, First People's Hospital of Yunnan Province, Kunming, 650032, China
| | - Baosheng Zhu
- Medical School, Kunming University of Science and Technology, Kunming, 650500, China.,National Health Commission's Key Laboratory for Healthy Births in Western China, Department of Obstetrics and Gynecology, First People's Hospital of Yunnan Province, Kunming, 650032, China
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20
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Gamble DT, Brikinns B, Myint PK, Bhattacharya S. Hypertensive Disorders of Pregnancy and Subsequent Cardiovascular Disease: Current National and International Guidelines and the Need for Future Research. Front Cardiovasc Med 2019; 6:55. [PMID: 31157237 PMCID: PMC6533460 DOI: 10.3389/fcvm.2019.00055] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background: It is well-established that hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease (CVD) in later life. National and International guidelines recognize this but due to a lack of research in this area few details are provided on how best to risk stratify or when and how to monitor these women. Objectives: This article aims to summarize current guidelines in this area in order to raise awareness of need for further research in this important clinical area. Search Strategy: A review of the published literature was carried out in August 2018 using the databases EMBASE and Medline and the websites of professional societies were searched manually using the search terms "pre-eclampsia," "hypertensive disorders of pregnancy," "management," "guidelines," "long term follow up" and "cardiovascular risk." Guidelines published in English were included and articles that provided guidance on follow up post-partum of women with HDP. Main Results: The search identified 360 records. Of these, 16 guidelines mentioned the follow up of women with HDP; their reported years ranges from 2010 to 2018. Only 8 (50%) provided some level of recommendation for follow up beyond the immediate post-partum period. These recognized the future risk of CVD to women from HDP and provide detailed recommendations for the management of these conditions during pregnancy and in the immediate post-partum period. Guidelines recommended that women and primary care clinicians are made aware of this risk and some suggest yearly BP monitoring, and at least 5 yearly monitoring of renal functions, urinalysis and lipid profile testing alongside lifestyle modifications and control of CVD risk factors. Guidelines used a combination of meta-analysis, individual cohort studies and expert opinions to inform their recommendations. Conclusions: There is a need for future studies of women with a history of HDP to define their trajectory for the development of CVD and candidate biomarkers in order to develop screening, risk stratification, and preventive measures to reduce the significant CV burden associated with HDP in women.
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Affiliation(s)
- David T Gamble
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Bolanle Brikinns
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Sohinee Bhattacharya
- Obstetric Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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21
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Developing management pathways for hypertensive disorders of pregnancy (HDP) in Indonesian primary care: a study protocol. Reprod Health 2019; 16:12. [PMID: 30709408 PMCID: PMC6359831 DOI: 10.1186/s12978-019-0674-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
Background National and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better. Objectives This paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings. Methods This study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways’ acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods. Discussion The implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants’ consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients’ medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.
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22
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de Moreuil C, Fauchais AL, Merviel P, Tremouilhac C, Le Moigne E, Pasquier E, Pan-Petesch B, Lacut K. [Pre-eclampsia prevention in 2018 in general population and in lupic women: At the dawn of a personalized medicine?]. Rev Med Interne 2018; 39:935-941. [PMID: 29933972 DOI: 10.1016/j.revmed.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia prevention represents a major public health issue, as this vasculo-placental disorder generates a great burden of foeto-maternal morbi-mortality. Aspirin has proved its efficacy in primary and secondary pre-eclampsia prevention, especially when it is given at 150mg per day bedtime before 15 weeks of gestation to high-risk women. In the English trial ASPRE, high-risk women were identified by an algorithm taking into account angiogenic biomarkers ascertained at the end of first trimester of pregnancy. This article focuses on physiopathological mechanisms and risk factors of pre-eclampsia and on the interest of early angiogenic biomarkers dosing during pregnancy, for the assessment of pre-eclampsia risk. Unlike Great Britain or Israel, cost-effectiveness of this algorithm in general population has not been assessed in France. Finally, systemic lupus erythematous is at high risk of vasculo-placental disorders. Although few studies of angiogenic biomarkers dosing during lupus pregnancies identified a correlation between high sFlt1 levels at the end of first trimester and subsequent onset of severe vasculo-placental disorders, with a very good negative predictive value of sFtl1. Angiogenic biomarkers ascertainment for screening of vasculo-placental disorders in pregnant women with systemic lupus erythematous could allow targeting at best women needing an aspirin treatment and a closer monitoring.
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Affiliation(s)
- C de Moreuil
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France.
| | - A-L Fauchais
- Département de médecine interne, CHU de Limoges, 29200 Limoges, France
| | - P Merviel
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - C Tremouilhac
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - E Pasquier
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - B Pan-Petesch
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Fédération de cancérologie et d'hématologie, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - K Lacut
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
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Cournot M, Lairez O, Medzech B. [Preeclampsia: A challenge also for cardiologists]. Ann Cardiol Angeiol (Paris) 2018; 67:280-287. [PMID: 29786511 DOI: 10.1016/j.ancard.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/06/2018] [Indexed: 01/25/2023]
Abstract
Due to its short-term consequences on perinatal outcome, preeclampsia has been long regarded as an obstetrical disease, strictly confined to a management by OB/GYNs. It has been now widely accepted that preeclampsia is most a systemic inflammatory and systemic vascular disease during pregnancy and then a lifelong risk factor for subsequent cardiovascular event in women's life. The aim of this review is to propose an overview in the current state-of-art in definition, early identification and management of preeclampsia. We will also discuss the growing evidence that support that cardiologists must be fully involved in screening and prevention of preeclampsia during pregnancy and beyond in the subsequent medical follow-up of women who have experienced a preeclampsia.
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Affiliation(s)
- M Cournot
- Services de cardiologie et de gynécologie-obstétrique, centre hospitalier Gabriel Martin, Saint-Paul, France; Inserm, UMR 1188 Diabète athérothrombose thérapies Réunion Océan Indien (DéTROI), université de La Réunion, Saint-Denis de La Réunion, France.
| | - O Lairez
- Department of cardiology, Rangueil university hospital, Toulouse, France
| | - B Medzech
- Services de cardiologie et de gynécologie-obstétrique, centre hospitalier Gabriel Martin, Saint-Paul, France
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