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Nazeer N, Rohanachandra YM, Prathapan S. Predictors of Attention Deficit Hyperactivity Disorder in Sri Lankan Children: A School Based Community Study. J Atten Disord 2023:10870547231167571. [PMID: 37052253 DOI: 10.1177/10870547231167571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To evaluate potential risk-factors of ADHD among primary school-children (PSC) in state schools in Colombo district of Sri Lanka. METHOD A case-control study was conducted with 73 cases and 264 controls selected randomly among 6 to 10-year-old PSC from Sinhala medium state schools in Colombo district. Primary care givers completed the SNAP-IV P/T-S scale to screen for ADHD and an interviewer-administered questionnaire on risk-factors. Children's diagnostic status was confirmed by a Consultant Child and Adolescent Psychiatrist based on DSM-5 criteria. RESULTS A binomial regression model identified male sex (aOR = 3.45; 95% CI [1.65, 7.18]), lower educational level of the mother (aOR = 2.99; 95% CI [1.31, 6.48]), birth weight <2,500 g (aOR = 2.83; 95% CI [1.17, 6.81]),a neonatal complications (aOR = 3.82; 95% CI [191, 7.65]) and child having witnessed verbal/emotional aggression between parents (aOR = 2.08; 95% CI [1.01, 4.27])as significant predictors of ADHD. CONCLUSION Primary prevention should focus on strengthening neonatal, maternal and child health services within the country.
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Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement. Hypertens Res 2022; 45:1298-1309. [PMID: 35726086 PMCID: PMC9207424 DOI: 10.1038/s41440-022-00965-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders of pregnancy increase the risk of adverse maternal and fetal outcomes. In 2018, the Japanese classification of hypertensive disorders of pregnancy was standardized with those of other countries, and a hypertensive disorder of pregnancy was considered to be present if hypertension existed during pregnancy and up to 12 weeks after delivery. Strategies for the prevention of hypertensive disorders of pregnancy have become much clearer, but further research is needed on appropriate subjects and methods of administration, and these have not been clarified in Japan. Although guidelines for the use of antihypertensive drugs are also being studied and standardized with those of other countries, the use of calcium antagonists before 20 weeks of gestation is still contraindicated in Japan because of the safety concerns that were raised regarding possible fetal anomalies associated with their use at the time of their market launch. Chronic hypertension is now included in the definition of hypertensive disorders of pregnancy, and blood pressure measurement is a fundamental component of the diagnosis of hypertensive disorders of pregnancy. Out-of-office blood pressure measurements, including ambulatory and home blood pressure measurements, are important for pregnant and nonpregnant women. Although conditions such as white-coat hypertension and masked hypertension have been reported, determining their occurrence in pregnancy is complicated by the gestational week. This narrative review focused on recent reports on hypertensive disorders of pregnancy, including those related to blood pressure measurement and classification. ![]()
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Fitton CA, Fleming M, Aucott L, Pell JP, Mackay DF, McLay JS. Congenital defects and early childhood outcomes following in-utero exposure to antihypertensive medication. J Hypertens 2021; 39:581-588. [PMID: 33044380 DOI: 10.1097/hjh.0000000000002670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in-utero exposure to antihypertensive treatment is conflicting with many studies suffering from significant methodological issues. METHOD We conducted a retrospective cohort study using linked routinely collected healthcare records for 268 711 children born 2010-2014 in Scotland to assess outcomes following in-utero exposure to antihypertensive medication. RESULTS We identified a cohort of 265 488 eligible mother-child pairs born over the study period; of which, 2433 were exposed in utero to antihypertensive medication, 4391 exposed to treated late-onset hypertension and 6066 exposed to untreated hypertension during pregnancy. In-utero antihypertensive exposure was associated with an increased risk of circulatory defects (aOR 2.29; 99% CI 1.14-4.59) compared with normal controls and the untreated hypertensive group. We report no increased odds of any developmental outcomes at 2.5 years of age following exposure to antihypertensive medication during pregnancy, untreated hypertension or late-onset hypertension. CONCLUSION Although circulatory defects may be associated with antihypertensive medication exposure during pregnancy, the mechanisms underlying this process are unclear.
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Affiliation(s)
- Catherine A Fitton
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Michael Fleming
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Lorna Aucott
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Jill P Pell
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Daniel F Mackay
- The Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - James S McLay
- Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
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Florio KL, DeZorzi C, Williams E, Swearingen K, Magalski A. Cardiovascular Medications in Pregnancy: A Primer. Cardiol Clin 2020; 39:33-54. [PMID: 33222813 DOI: 10.1016/j.ccl.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiovascular disease and cardiovascular disease-related disorders remain among the most common causes of maternal morbidity and mortality in the United States. Due to increased rates of obesity, delayed childbearing, and improvements in medical technology, greater numbers of women are entering pregnancy with preexisting medical comorbidities. Use of cardiovascular medications in pregnancy continues to increase, and medical management of cardiovascular conditions in pregnancy will become increasingly common. Obstetricians and cardiologists must familiarize themselves with the pharmacokinetics of the most commonly used cardiovascular medications in pregnancy and how these medications respond to the physiologic changes related to pregnancy, embryogenesis, and lactation.
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Affiliation(s)
- Karen L Florio
- Heart Disease in Pregnancy Program, Saint Luke's Hospital of Kansas City, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA.
| | - Christopher DeZorzi
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Emily Williams
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA
| | - Kathleen Swearingen
- Heart Disease in Pregnancy Program, Saint Luke's Hospital of Kansas City, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA
| | - Anthony Magalski
- University of Missouri-Kansas City School of Medicine, 4401 Wornall Road PEET Center, Kansas City, MO 64111, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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Marcelle ET, Oliva MT, Hinshaw SP. Gestational Smoking and Hypertension as Predictors of Working Memory Functioning in Childhood Attention-Deficit/Hyperactivity Disorder. Front Psychol 2020; 11:1950. [PMID: 33041878 PMCID: PMC7518085 DOI: 10.3389/fpsyg.2020.01950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/14/2020] [Indexed: 01/03/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting between 5 and 8% of all children and adolescents, characterized by impairing levels of inattention, hyperactivity, and impulsivity. Existing cognitive models of ADHD have placed working memory (WM) deficits at the core of ADHD and suggest that primary WM deficits may also underlie the additional deficits associated with the condition. Although not all children with ADHD show WM deficits, those with such deficits have been found to have worse functional outcomes when compared to their diagnosed peers with typical WM functioning. Even so, contributors to the variability of impaired WM functioning seen within this population remain unknown. In the present study, we examined the association between two known prenatal and perinatal risk factors for impaired cognitive functioning - gestational smoking and hypertension - in three independent samples of children and adolescents with ADHD (samples varied with respect to sample size and WM measurement procedures). Contrary to hypotheses and existing literature, presence of high blood pressure during pregnancy was unexpectedly found to be a positive predictor of offspring WM capacity in one of three samples (a sample of all girls with ADHD). Implications and considerations for future research are discussed.
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Affiliation(s)
- Enitan T. Marcelle
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Mercedes T. Oliva
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
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Fitton CA, Fleming M, Steiner MFC, Aucott L, Pell JP, Mackay DF, Mclay JS. In Utero Antihypertensive Medication Exposure and Neonatal Outcomes: A Data Linkage Cohort Study. Hypertension 2019; 75:628-633. [PMID: 31884860 PMCID: PMC8032216 DOI: 10.1161/hypertensionaha.119.13802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertensive disorders during pregnancy are an important risk to mother and fetus, frequently necessitating antihypertensive treatment. Data describing the safety of in utero exposure to antihypertensive treatment is conflicting, with many studies suffering from significant methodological issues, such as inappropriate study design, small sample sizes, and no untreated control group. We conducted a retrospective cohort study using linked routinely collected healthcare records for 268 711 children born 2010-2014 in Scotland to assess outcomes following in utero exposure to antihypertensive medication. We identified a cohort of 265 488 eligible children born over the study period; of which, 2350 were exposed to in utero antihypertensive medication, 4391 exposed to treated late-onset hypertension, and 7971 exposed to untreated hypertension during pregnancy. Untreated hypertension was associated with increased risk of preterm birth (adjusted risk ratio [aRR], 1.15 [99% CI, 1.01-1.30]), low birth weight (aRR, 2.01 [99% CI, 1.72-2.36]) and being small for gestational age (aRR, 1.50 [99% CI, 1.35-1.66]), while in utero antihypertensive exposure was also associated with preterm birth (aRR, 3.12 [99% CI, 2.68-3.64]), low birth weight (aRR, 2.23 [99% CI, 1.79-2.78]), and being small for gestational age (aRR, 2.13 [99% CI, 1.81-2.52]). Late-onset hypertension was also associated with preterm birth (aRR, 2.21 [99% CI, 1.86-2.62]), low birth weight (aRR, 2.06 [99% CI, 1.74-2.43]), and being small for gestational age (aRR, 1.90 [99% CI, 1.68-2.16]). Our results suggest that hypertension is a key risk factor for low birth weight and preterm birth. Although preterm birth may be associated with antihypertensive medication exposure during pregnancy, these associations may reflect increasing hypertension severity necessitating treatment.
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Affiliation(s)
- Catherine A Fitton
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Michael Fleming
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - Markus F C Steiner
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Lorna Aucott
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
| | - Jill P Pell
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - Daniel F Mackay
- The Institute of Health and Wellbeing, University of Glasgow, Scotland (M.F., J.P.P., D.F.M.)
| | - James S Mclay
- From the Department of Child Health, Division of Applied Health Sciences, University of Aberdeen, Royal Aberdeen Children's Hospital, Scotland (C.A.F., M.F.C.S., L.A., J.S.M.)
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Tamargo J, Caballero R, Delpón E. Pharmacotherapy for hypertension in pregnant patients: special considerations. Expert Opin Pharmacother 2019; 20:963-982. [PMID: 30943045 DOI: 10.1080/14656566.2019.1594773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.
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Affiliation(s)
- Juan Tamargo
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Ricardo Caballero
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Eva Delpón
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
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Fitton CA, Steiner MF, Aucott L, Pell JP, Mackay DF, Fleming M, McLay JS. In-utero exposure to antihypertensive medication and neonatal and child health outcomes: a systematic review. J Hypertens 2017; 35:2123-2137. [PMID: 28661961 PMCID: PMC5625961 DOI: 10.1097/hjh.0000000000001456] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although medication is generally avoided wherever possible during pregnancy, pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of maternal and fetal morbidity and mortality. The long-term effects to the child of in-utero exposure to antihypertensive agents remains largely unknown. OBJECTIVE The aim of this study was to systematically review published studies on adverse outcomes to the child associated with in-utero exposure to antihypertensive medications. METHODS OVID, Scopus, EBSCO Collections, the Cochrane Library, and Web of Science databases were searched for relevant publications published between January 1950 and October 2016 and a total of 688 potentially eligible studies were identified. RESULTS Following review, 47 primary studies were eligible for inclusion. The Critical Appraisal Skills Programme checklist was used to assess study quality. Five studies were of excellent quality; the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth, and congenital defects following in-utero exposure to all antihypertensive agents were identified. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. CONCLUSION The current systematic review demonstrates a paucity of relevant published high-quality studies. A small number of studies suggest possible increased risk of adverse child health outcomes; however, most published studies have methodological weaknesses and/or lacked statistical power thus preventing any firm conclusions being drawn.
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Affiliation(s)
- Catherine A. Fitton
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Markus F.C. Steiner
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Lorna Aucott
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James S. McLay
- The Department of Child Health, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen
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Pohlabeln H, Rach S, De Henauw S, Eiben G, Gwozdz W, Hadjigeorgiou C, Molnár D, Moreno LA, Russo P, Veidebaum T, Pigeot I. Further evidence for the role of pregnancy-induced hypertension and other early life influences in the development of ADHD: results from the IDEFICS study. Eur Child Adolesc Psychiatry 2017; 26:957-967. [PMID: 28258320 DOI: 10.1007/s00787-017-0966-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/21/2017] [Indexed: 12/25/2022]
Abstract
The aim of this study is to investigate whether in addition to established early risk factors other, less studied pre-, peri-, and postnatal influences, like gestational hypertension or neonatal respiratory disorders and infections, may increase a child's risk of developing attention-deficit/hyperactivity disorders (ADHD). In the IDEFICS study more than 18,000 children, aged 2-11.9 years, underwent extensive medical examinations supplemented by parental questionnaires on pregnancy and early childhood. The present analyses are restricted to children whose parents also completed a supplementary medical questionnaire (n = 15,577), including the question whether or not the child was ever diagnosed with ADHD. Multilevel multivariable logistic regression was used to assess the association between early life influences and the risk of ADHD. Our study confirms the well-known association between maternal smoking during pregnancy and a child's risk of ADHD. In addition, our study showed that children born to mothers younger than 20 years old were 3-4 times more likely to develop ADHD as compared to children born to mothers aged 25 years and older. Moreover, we found that children whose mothers suffered from pregnancy-induced hypertension had an approximately twofold risk of ADHD (OR 1.95; 95% CI 1.09-3.48). This also holds true for infections during the first 4 weeks after birth (OR 2.06; 95% CI 1.05-4.04). In addition, although not statistically significant, we observed a noticeable elevated risk estimate for neonatal respiratory disorders (OR 1.76; 95% CI 0.91-3.41). Hence, we recommend that these less often studied pre-, peri, and postnatal influences should get more attention when considering early indicators or predictors for ADHD in children. However, special study designs such as genetically sensitive designs may be needed to derive causal conclusions.
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Affiliation(s)
- Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359, Bremen, Germany.
| | - Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Gabriele Eiben
- Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Wencke Gwozdz
- Department of Intercultural Communication and Management, Centre for Corporate Social Responsibility, Copenhagen Business School, Copenhagen, Denmark
| | | | - Dénes Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pecs, Hungary
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Saragossa, Spain
| | - Paola Russo
- Unit of Epidemiology & Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359, Bremen, Germany
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Hollegaard B, Lykke JA, Boomsma JJ. Time from pre-eclampsia diagnosis to delivery affects future health prospects of children. EVOLUTION MEDICINE AND PUBLIC HEALTH 2017; 2017:53-66. [PMID: 28421136 PMCID: PMC5387983 DOI: 10.1093/emph/eox004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
Background and objectives Pre-eclampsia often has detrimental health effects for pregnant women and their fetuses, but whether exposure in the womb has long-term health-consequences for children as they grow up remains poorly understood. We assessed overall morbidity of children following exposure to either mild or severe pre-eclampsia up to 30 years after birth and related disease risks to duration of exposure, i.e. the time from diagnosis to delivery. Methodology We did a registry-based retrospective cohort study in Denmark covering the years 1979–2009, using the separate diagnoses of mild and severe pre-eclampsia and the duration of exposure as predictor variables for specific and overall risks of later disease. We analysed 3 537 525 diagnoses for 14 disease groups, accumulated by 758 524 singleton children, after subdividing deliveries in six gestational age categories, partialing out effects of eight potentially confounding factors. Results Exposure to mild pre-eclampsia appeared to have consistent negative effects on health later in life, although only a few specific disease cases remained significant after corrections for multiple testing. Morbidity risks associated with mild pre-eclampsia were of similar magnitude as those associated with severe pre-eclampsia. Apart from this overall trend in number of diagnoses incurred across disease groups, hazard ratios for several disorders also increased with the duration of exposure, including disorders related to the metabolic syndrome. Conclusions and implications Maternal pre-eclampsia has lasting effects on offspring health and differences between exposure to severe and mild pre-eclampsia appear to be less than previously assumed. Our results suggest that it would be prudent to include the long-term health prospects of children in the complex clinical management of mild pre-eclampsia.
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Affiliation(s)
- Birgitte Hollegaard
- Centre for Social Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jacob A Lykke
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Jacobus J Boomsma
- Centre for Social Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark
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Bokslag A, van Weissenbruch M, Mol BW, de Groot CJM. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev 2016; 102:47-50. [PMID: 27659865 DOI: 10.1016/j.earlhumdev.2016.09.007] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Preeclampsia is a common pregnancy specific disease, that presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver and lungs. At present, the only definitive treatment of preeclampsia is end the pregnancy and deliver the neonate and placenta. For women with mild preeclampsia in the preterm phase of pregnancy, expectant management is generally indicated to improve fetal maturity, often requiring maternal medical treatment. Last decades, more evidence is available that the underlying mechanism of preeclampsia, endothelial disease, is not limited to pregnancy but increases cardiovascular risk in later life. In this review, we present the most recent insight in preeclampsia with focus on impact on the fetus, short and long-term outcome of offspring's, and long-term outcome of women with a history of preeclampsia.
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Affiliation(s)
- Anouk Bokslag
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Mirjam van Weissenbruch
- Department of Pediatrics, Division of Neonatology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Ben Willem Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, Australia; The South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
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Magee LA, Namouz-Haddad S, Cao V, Koren G, von Dadelszen P. Labetalol for hypertension in pregnancy. Expert Opin Drug Saf 2015; 14:453-61. [PMID: 25692529 DOI: 10.1517/14740338.2015.998197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Labetalol is one of the most commonly used antihypertensive medications for the treatment of hypertension during pregnancy, an increasingly common and leading cause of maternal mortality and morbidity worldwide. AREAS COVERED The literature reviewed included the 2014 Canadian national pregnancy hypertension guideline and its references. The additional published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library using appropriate controlled vocabulary (e.g., pregnancy, hypertension, pre-eclampsia, pregnancy toxemias) and key words (e.g., diagnosis, evaluation, classification, prediction, prevention, prognosis, treatment, and postpartum follow-up).Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies published in French or English, Jan-Mar/14. The unpublished literature was identified by searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. We evaluated the impact of interventions on substantive clinical outcomes for mothers and babies. EXPERT OPINION Labetalol is a reasonable choice for treatment of severe or non-severe hypertension in pregnancy. However, we should continue our search for other therapeutic options.
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Affiliation(s)
- Laura A Magee
- University of British Columbia, BC Women's Hospital and Health Centre , 4500 Oak Street, Room 1U59, Vancouver, BC V6H 3N1 , Canada +1 604 875 3054; +1 604 875 2424; Ext: 6012 ; +1 604 875 3212 ;
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Abstract
OBJECTIVE Recent research has linked hypertensive diseases of pregnancy with adverse neurodevelopmental outcomes in childhood and adulthood. This study aimed to establish whether such effects are observed in infancy. METHODS This was a prospective pregnancy cohort study of 2,785 pregnancies with complete data on hypertensive diseases of pregnancy. Mothers completed a validated Australian adaptation of the Toddler Temperament Scale when the children were 1 year of age (n = 2,384). Algorithms were used to classify children as difficult, slow to warm up, intermediate high, intermediate low, or easy, on the basis of their temperament scores. We then grouped difficult and intermediate-high infants together and compared them with easy, intermediate-low, and slow-to-warm-up infants. We used a multivariable logistic regression model and adjusted for known biomedical, sociodemographic, and psychological factors from the pre- and postnatal period that may influence child behavioral development. RESULTS After adjusting for confounders, mothers who were diagnosed with gestational hypertension (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.06-1.75) or preeclampsia (OR, 2.23; 95% CI, 1.18-4.23) were more likely to report that their infants were in the difficult or intermediate-high classifications in the first year of life compared with infants born to mothers without gestational hypertension or preeclampsia. CONCLUSION These data suggest that the link between maternal hypertensive diseases of pregnancy and child behavioral development begins in the first year of life.
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van Gelder MMHJ, Bretveld RW, Roukema J, Steenhoek M, Drongelen J, Spaanderman MEA, van Rumpt D, Zielhuis GA, Verhaak CM, Roeleveld N. Rationale and design of the PRegnancy and Infant DEvelopment (PRIDE) Study. Paediatr Perinat Epidemiol 2013; 27:34-43. [PMID: 23215710 PMCID: PMC3549557 DOI: 10.1111/ppe.12023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To optimise the health of pregnant women and their children by evidence-based primary and secondary prevention, more scientific knowledge is needed. To overcome the methodological limitations of many studies on pregnancy and child health, which often use a retrospective design, we established the PRIDE (PRegnancy and Infant DEvelopment) Study. METHODS AND RESULTS The PRIDE Study is a large prospective cohort study that aims at including 150 000-200 000 women in early pregnancy to study a broad range of research questions pertaining to pregnancy complications, maternal and child health, and adverse developmental effects in offspring. Women are invited to participate by their prenatal care provider before or at their first prenatal care visit and are asked to fill out web-based questionnaires in gestational weeks 8-10, 17, and 34, as well as biannually throughout childhood. In addition, a food frequency questionnaire and a paternal questionnaire are administered and medical records are consulted. Multiple validation studies will be conducted and paper-and-pencil questionnaires are available for women who cannot or do not want to participate through the Internet. For subgroups of participants, blood and saliva samples for genetic and biochemical analyses are being collected. The pilot phase, which started in July 2011, showed a response rate of 47%. Recruitment will eventually cover all of the Netherlands. CONCLUSIONS We expect that this study, which will be the largest birth cohort in the world so far, will provide new insights in the aetiology of disorders and diseases that originate in pregnancy. The PRIDE Study is open for collaboration.
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Affiliation(s)
- Marleen M H J van Gelder
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Reini W Bretveld
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands,Department of Cancer Registry and Research, Comprehensive Cancer Center the NetherlandsUtrecht, The Netherlands
| | - Jolt Roukema
- Department of Paediatric Pulmonology, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands
| | | | - Joris Drongelen
- Department of Obstetrics & Gynaecology, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, University Hospital MaastrichtMaastricht, The Netherlands
| | - Dick van Rumpt
- SHO Centers for Medical DiagnosticsVelp, The Netherlands
| | - Gerhard A Zielhuis
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands
| | - Chris M Verhaak
- Department of and Medical Psychology, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands
| | - Nel Roeleveld
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical CentreNijmegen, The Netherlands
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15
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Maternal Recall of Prescription Medication Use During Pregnancy Using a Paper-Based Questionnaire. Drug Saf 2012; 36:43-54. [DOI: 10.1007/s40264-012-0004-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Kernaghan D, Duncan AC, McKay GA. Hypertension in pregnancy: a review of therapeutic options. Obstet Med 2012; 5:44-9. [PMID: 27579135 PMCID: PMC4989617 DOI: 10.1258/om.2011.110061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 11/18/2022] Open
Abstract
Hypertensive disorders in pregnancy are common and can occur as a result of pre-existing hypertension or as new onset hypertension usually in the second half of pregnancy. In either situation there is potential for considerable perinatal and maternal morbidity and mortality. This review article aims to compare therapeutic options outlined in a selection of national guidelines and to look in more detail at the most commonly prescribed drugs - labetalol, methyldopa and nifedipine - with respect to their pharmacology and the evidence for their use in pregnancy. We will also consider the rationale for identifying and treating hypertension in pregnancy and the effect this can have on short- and long-term maternal and neonatal outcomes.
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Affiliation(s)
- D Kernaghan
- Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow G31 2ER
| | - A C Duncan
- Princess Royal Maternity Hospital, 16 Alexandra Parade, Glasgow G31 2ER
| | - G A McKay
- Glasgow Royal Infirmary, Castle Street, Glasgow, UK
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17
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Bulloch MN, Carroll DG. When one drug affects 2 patients: a review of medication for the management of nonlabor-related pain, sedation, infection, and hypertension in the hospitalized pregnant patient. J Pharm Pract 2012; 25:352-67. [PMID: 22544624 DOI: 10.1177/0897190012442070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the most difficult challenges health care providers encounter is drug selection for pregnant patients. Drug selection can be complex as efficacy and maternal side effects must be weighed against potential risk to the embryo or fetus. Verification of an individual drug's fetal safety is limited as most evidence is deduced from epidemiologic, prospective cohort, or case-control studies. Medication selection for the pregnant inpatient is a particularly complex task as the illnesses and conditions that require hospitalization mandate different medications, and the risk versus benefit ratio can vary significantly compared to the outpatient setting. Some degree of acute pain is not uncommon among inpatients. Acetaminophen is generally considered the drug of choice in pregnancy for mild to moderate acute pain, while most opioids are thought to be safe for short-term use to manage moderate to severe pain. Providing sedation is particularly challenging as the few options available for the general population are further limited by either known increased risk of congenital malformations or very limited human pregnancy data. Propofol is the only agent recommended for continuous sedation, which has a Food and Drug Administration classification as a pregnancy category B medication. Treatment of infections in hospitalized patients requires balancing the microbiology profile against the fetal risk. Older antimicrobials proven generally safe include beta-lactams, and those with proven fetal risks include tetracyclines. However, little to no information regarding gestational use is available on the newer antimicrobials that are frequently employed to treat resistant infections more commonly found in the inpatient setting. Management of maternal blood pressure is based on the severity of blood pressure elevations and not the hypertensive classification. Agents generally considered safe to use in hypertensive pregnant patients include methyldopa, labetolol, and hydralazine, while angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, hydrochlorothiazide, and atenolol should be avoided.
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18
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Froehlich TE, Anixt JS, Loe IM, Chirdkiatgumchai V, Kuan L, Gilman RC. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2011; 13:333-44. [PMID: 21779823 PMCID: PMC3277258 DOI: 10.1007/s11920-011-0221-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder affecting 5% to 10% of children. Although considered to be a highly familial disorder, ADHD heritability estimates of 60% to 80% highlight the considerable role that environmental factors may still play in disorder susceptibility. Proposed ADHD environmental risk factors include prenatal substance exposures, heavy metal and chemical exposures, nutritional factors, and lifestyle/psychosocial factors. This paper reviews the literature published in 2010 investigating the association between environmental risk factors and ADHD or related symptomatology. Sources of risk factor exposure and the proposed mechanism by which each exposure is linked to ADHD-related neurobehavioral changes are also reported. Methodologic limitations of the current literature are discussed, and guidelines for future study are proposed. An improved understanding of the role that environmental factors play in ADHD etiology is critical to future ADHD prevention efforts.
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Affiliation(s)
- Tanya E. Froehlich
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Julia S. Anixt
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Irene M. Loe
- Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA
| | | | - Lisa Kuan
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Richard C. Gilman
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
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20
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Magee LA, Abalos E, von Dadelszen P, Sibai B, Easterling T, Walkinshaw S. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol 2011; 72:394-401. [PMID: 21545480 PMCID: PMC3175509 DOI: 10.1111/j.1365-2125.2011.04002.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 04/07/2011] [Indexed: 11/29/2022] Open
Abstract
The hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in both well and under-resourced settings. Maternal, fetal, and neonatal complications of the HDP are concentrated among, but not limited to, women with pre-eclampsia. Pre-eclampsia is a systemic disorder of endothelial cell dysfunction and as such, blood pressure (BP) treatment is but one aspect of its management. The most appropriate BP threshold and goal of antihypertensive treatment are controversial. Variation between international guidelines has more to do with differences in opinion rather than differences in published data. For women with severe hypertension [defined as a sustained systolic BP (sBP) of ≥160 mmHg and/or a diastolic BP (dBP) of ≥110 mmHg], there is consensus that antihypertensive therapy should be given to lower the maternal risk of central nervous system complications. The bulk of the evidence relates to parenteral hydralazine and labetalol, or to oral calcium channel blockers such as nifedipine capsules. There is, however, no consensus regarding management of non-severe hypertension (defined as a sBP of 140-159 mmHg or a dBP of 90-109 mmHg), because the relevant randomized trials have been underpowered to define the maternal and perinatal benefits and risks. Although antihypertensive therapy may decrease the occurrence of BP values of 160-170/100-110 mmHg, therapy may also impair fetal growth. The potential benefits and risks do not seem to be associated with any particular drug or drug class. Oral labetalol and methyldopa are used most commonly, but many different β-adrenoceptor blockers and calcium channel blockers have been studied in clinical trials.
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Affiliation(s)
- Laura A Magee
- BC Women's Hospital and Heath Centre and University of British Columbia, 4500 Oak Street, Room D213, Vancouver, BC V6H 3N1, Canada.
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21
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Magee LA, Lowe S, Douglas MJ, Kathirgamanathan A. Therapeutics and anaesthesia. Best Pract Res Clin Obstet Gynaecol 2011; 25:477-90. [PMID: 21478058 DOI: 10.1016/j.bpobgyn.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
Many aspects of hypertension care outside pregnancy may be applied in pregnancy, but little information is available on which to base decision-making. It would seem reasonable to continue previous dietary salt restriction and physical activity in women with pre-existing (and controlled) hypertension, encourage a heart-healthy diet in all women with a hypertension disorder of pregnancy, and take patient preference into account when deciding on place of care. Although bed rest has become a key part of obstetric practice and for care of women with a hypertension disorder of pregnancy, in particular, the evidence is lacking to support this practice. This may also increase thromboembolic risk. Antihypertensive treatment is strongly advised for women with severe hypertension. The most common agents are parenteral labetalol, hydralazine, or oral nifedipine capsules. Clinicians should familiarise themselves with multiple agents. Until the role of antihypertensive treatment for non-severe hypertension in pregnancy is clarified by ongoing research, clinicians should explicitly state an individual patient's blood pressure goal, which could reasonably be anywhere between 130/80 and 155/105 mmHg. Labetalol and methyldopa are used most commonly. Breastfeeding should be encouraged. Many risk factors for hypertension (e.g. obesity), as well as hospitalisation and pre-eclampsia, all increase the thromboembolic risk for pregnant women, and care providers should consider thromboprophylaxis in the appropriate setting. Finally, anaesthetists play a critical role in the management of women with a hypertension disorder of pregnancy, and should be involved earlier rather than later in the course of their care.
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Affiliation(s)
- Laura A Magee
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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