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Thomopoulos C, Hitij JB, De Backer T, Gkaliagkousi E, Kreutz R, Lopez-Sublet M, Marketou M, Mihailidou AS, Olszanecka A, Pechère-Bertschi A, Pérez MP, Persu A, Piani F, Socrates T, Stolarz-Skrzypek K, Cífková R. Management of hypertensive disorders in pregnancy: a Position Statement of the European Society of Hypertension Working Group 'Hypertension in Women'. J Hypertens 2024; 42:1109-1132. [PMID: 38690949 DOI: 10.1097/hjh.0000000000003739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.
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Affiliation(s)
- Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens 'Laiko', Athens, Greece
| | - Jana Brguljan Hitij
- Department of Hypertension, University Medical Centre Ljubljana, Medical University Ljubljana, Slovenia
| | - Tine De Backer
- Cardiovascular Center & Clinical Pharmacology, University Hospital Gent, Belgium
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Reinhold Kreutz
- Charite-Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Marilucy Lopez-Sublet
- AP-HP, Hopital Avicenne, Centre d'Excellence Europeen en Hypertension Arterielle, Service de Medecine Interne, INSERM UMR 942 MASCOT, Paris 13-Universite Paris Nord, Bobigny, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists)
| | - Maria Marketou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Mariana Paula Pérez
- Department of Hypertension. Hospital de Agudos J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thenral Socrates
- Medical Outpatient and Hypertension Clinic, ESH Hypertension Centre of Excellence University Hospital Basel, Basel, Switzerland
| | - Katarzyna Stolarz-Skrzypek
- 1st Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Renata Cífková
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer University Hospital
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
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Soykan Sert Z, Bertizlioğlu M. Predictive value of the HALP score for pre-eclampsia with severe features. Postgrad Med 2024; 136:468-473. [PMID: 38781027 DOI: 10.1080/00325481.2024.2359892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Predictive tests are needed to ensure the development and subsequent follow-up of pre-eclampsia, which is responsible for significant rates of morbidity and mortality during pregnancy. This study aimed to evaluate the predictive value of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for the severity of preeclampsia. METHODS We retrospectively analyzed the data of women diagnosed with pre-eclampsia at our clinic from January 2019 to January 2023. The control group consisted of normotensive, healthy pregnant women. Women diagnosed with preeclampsia were further evaluated in two groups: those with severe features and those without severe features. The clinical and demographic data of the cases were evaluated. The HALP score was calculated using the first trimester blood parameters of the cases and compared between groups. RESULTS The study included 229 patients with preeclampsia and 142 normotensive healthy controls. Of the patients with preeclampsia, 104 (28.1%) had severe features of the disease. The HALP score was significantly higher in the preeclampsia group with severe features than in the control group (6.18 ± 2.66 vs. 3.75 ± 1.86; p = 0.006). In multivariate logistic regression analysis, the HALP score (odds ratio: 2.02, 95% confidence interval: 1.10-3.32, p = 0.017) was found to be an independent indicator for preeclampsia with severe features. A HALP score of > 4.61 predicted the development of preeclampsia with severe features with a sensitivity of 74.5% and a specificity of 81.3%. CONCLUSION We found a significant correlation between the HALP score and preeclampsia with severe features. The HALP score may be useful in predicting the severity of preeclampsia.
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Affiliation(s)
- Zekiye Soykan Sert
- Department of Gynecology and Obstetrics, Aksaray University Medical School, Aksaray, Turkey
| | - Mete Bertizlioğlu
- Department of Obstetrics and Gynecology, Konya City Hospital, Konya, Turkey
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Razzak R, Shivkumar PV. Early Prediction of Hypertensive Diseases of Pregnancy by Using Combined Screening Methods in a Rural Population. Cureus 2023; 15:e50624. [PMID: 38226112 PMCID: PMC10789305 DOI: 10.7759/cureus.50624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION The most frequent medical issue during pregnancy is hypertension, which can complicate up to 10% to 15% of pregnancies worldwide. An estimated 14% of all maternal fatalities worldwide are thought to be caused by hypertensive disease of pregnancy, one of the main causes of maternal and fetal morbidity and mortality. Despite the fact that maternal mortality is substantially lower in high-income countries than in low- and middle-income countries, hypertension is still one of the leading causes of maternal death globally. Maternal mortality associated with hypertension fluctuated between 0.08 and 0.42 per 100,000 births between 2009 and 2015. In India, the estimated overall pooled prevalence of HDP was determined to be one out of 11 women, or 11% (95% CI, 5%-17%). Despite various government programs, there is still a high prevalence of hypertension, which calls for stakeholders and healthcare professionals to focus on providing both therapeutic and preventive care. The best solution is to concentrate more on the early detection of pregnancy-related hypertension and to guarantee its universal application so that proper care can be carried out to prevent maternal and fetal morbidity. AIM To estimate the predictive value of the combination of maternal characteristics, i.e., mean arterial pressure (MAP), biophysical evaluation (uterine artery Doppler), and biochemical markers (pregnancy-associated plasma protein A (PAPP-A)), in the first trimester of pregnancy for hypertensive diseases of pregnancy. METHODOLOGY It was a prospective observational study of longitudinal variety that took over 18 months in a tertiary care rural hospital. The number of women admitted to the hospital for labor care during 2019 was 5261. A total of 513 were diagnosed with hypertensive illnesses during pregnancy. At a prevalence rate of 10%, we calculated a sample size of 350 to achieve a sensitivity of 85% with an absolute error of 12.5% at a 95% CI. Maternal histories, such as age, education, socio-economic status, gravidity, and BMI, were taken along with three parameters, i.e., MAP, which was significant above 90 mmHg, uterine artery Doppler, which was taken significant above 1.69, and serum PAPP-A, which was significant at less than 0.69 ml/IU. OBSERVATION AND RESULTS We have found that the following are associated with the prediction of hypertension: among the maternal characteristics are advanced age >35 years, presence of body edema, and urine proteins along with MAP, uterine artery pulsatility index (UtA-PI), and PAPP-A are significant. The predictive accuracy of the combination of MAP, UtA-PI, and PAPP-A is also significant. We also found that there is a significant increase in cesarean sections and NICU admissions in hypertensive patients. CONCLUSION A combination of screening parameters, including MAP, UtA-PI, and PAPP-A, to predict early hypertensive disease of pregnancy is developed and tested.
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Affiliation(s)
- Ruhida Razzak
- Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Poonam V Shivkumar
- Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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Prasad P. Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience. Indian J Crit Care Med 2023; 27:488-492. [PMID: 37502297 PMCID: PMC10369320 DOI: 10.5005/jp-journals-10071-24492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023] Open
Abstract
Background Though epileptic seizures are common in posterior reversible encephalopathy syndrome (PRES), status epilepticus (SE) as the presenting feature is rare. Objective To study the clinical spectrum and outcome of patients with SE as presenting feature of PRES. Methods This is a retrospective study. PRES was diagnosed based on the clinical features and imaging findings on brain MRI (n = 40) which became normal after 6 months follow-up imaging. Patients with SE as the initial manifestation of PRES were identified. Baseline information regarding the clinical presentation, etiology, past history of illness, treatment history, imaging findings, EEG and long-term clinical outcome. Result Seizure was the most common presentation seen in 31 patients (77.5%). The etiologies in PRES were preeclampsia, or eclampsia [n = 33 (82.5%)], hypertensive encephalopathy [n = 3 (7.5%)], systemic lupus erythematosus (SLE), AIP, and chronic renal failure (CRF) in one patient each [n = 01 (2.5%)]. Brain MRI showed the involvement of parieto-occipital lobes (n = 33 [82.5%]) mostly. Status epilepticus (generalized convulsive) was the presenting feature in eight cases (20%). Among them, five cases (0.5%) had a history of chronic epilepsy. In the remaining three patients, SLE and acute intermittent porphyria, CRF precipitated the SE. Conclusion The study highlights the clinico-etiological spectrum of PRES and the identification of SE within its context leading to the early diagnosis and management if treated early. The role of antenatal care is important for the identification and treatment of etiologies, blood pressure, proper antiepileptic drug compliance and appropriate counseling. How to cite this article Prasad P. Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience. Indian J Crit Care Med 2023;27(7):488-492.
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Yin X, Duan Y, Zhang L, Feng Z, Yin C, Zhu S, Chen J, Peng X. Eclampsia with hypothyroidism complicated with posterior reversible encephalopathy syndrome-a case report. BMC Neurol 2023; 23:63. [PMID: 36765280 PMCID: PMC9911940 DOI: 10.1186/s12883-023-03068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with complex physiopathological mechanisms that have not been fully understood. Early identification is of great prognostic significance, of which the symptoms and radiological abnormalities can be completely reversed. If the diagnosis and treatment are delayed, ischemia and massive infarction may be developed in some patients. Posterior reversible encephalopathy syndrome (PRES) has been reported mainly in association with postpartum eclampsia, which have been rarely reported, while the association with hypothyroidism has not been reported at home or abroad. CASE PRESENTATION Here we report on a pregnant 29-year-old with multipara and a chief complication of hypothyroidism. She presented in the emergency department with frequent attacks of severe headache symptoms resulting from reversible cerebral vasoconstriction syndrome (RCVS), accompanied with prenatal eclampsia. PRES was determined by radiological examination. CONCLUSION To the best of our knowledge, this is the first case of PRES complicated by hypothyroidism and prepartum eclampsia.Clinicians should be alert for the co-occurence of eclampsia, PRES, and RCVS when patients have convulsions after a typical throbbing headache. Moreover, regular monitoring of thyroid function during pregnancy should also occupy certain special attention.
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Affiliation(s)
- Xuejing Yin
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Yu Duan
- grid.263452.40000 0004 1798 4018Department of Emergency Medicine, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province 046000 China
| | - Lifang Zhang
- grid.263452.40000 0004 1798 4018Department of Neurology, Changzhi People’s Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province 046000 China
| | - Zhichao Feng
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Caixia Yin
- grid.263452.40000 0004 1798 4018Department of Neurology, Shanxi Medical University, Taiyuan, Shanxi Province 030000 China
| | - Sujie Zhu
- grid.254020.10000 0004 1798 4253Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
| | - Jinhua Chen
- Department of Emergency Medicine, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province, 046000, China. .,Department of Neurology, Changzhi People's Hospital, The Affiliated Hospital of Shanxi Medical University, Changzhi, Shanxi Province, 046000, China. .,Department of Emergency Medicine and Neurology, The Affiliated Hospital of Shanxi Medical University, No. 502 Changxing Middle Road, Changzhi, Shanxi Province, 046000, China.
| | - Xinsen Peng
- grid.254020.10000 0004 1798 4253Department of Cardiovascular Medicine, Changzhi Medical College, Changzhi, Shanxi Province 046000 China
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KUDRET U, ÖZÇİL MD. Ağır preeklampsiyi öngörmede hemogram inflamatuar belirteçlerin önemi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1034264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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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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Schmidt LJ, Rieger O, Neznansky M, Hackelöer M, Dröge LA, Henrich W, Higgins D, Verlohren S. A machine-learning-based algorithm improves prediction of preeclampsia-associated adverse outcomes. Am J Obstet Gynecol 2022; 227:77.e1-77.e30. [PMID: 35114187 DOI: 10.1016/j.ajog.2022.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preeclampsia presents a highly prevalent burden on pregnant women with an estimated incidence of 2% to 5%. Preeclampsia increases the maternal risk of death 20-fold and is one of the main causes of perinatal morbidity and mortality. Novel biomarkers, such as soluble fms-like tyrosine kinase-1 and placental growth factor in addition to a wide span of conventional clinical data (medical history, physical symptoms, laboratory parameters, etc.), present an excellent basis for the application of early-detection machine-learning models. OBJECTIVE This study aimed to develop, train, and test an automated machine-learning model for the prediction of adverse outcomes in patients with suspected preeclampsia. STUDY DESIGN Our real-world dataset of 1647 (2472 samples) women was retrospectively recruited from women who presented to the Department of Obstetrics at the Charité - Universitätsmedizin Berlin, Berlin, Germany, between July 2010 and March 2019. After standardization and data cleaning, we calculated additional features regarding the biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor and sonography data (umbilical artery pulsatility index, middle cerebral artery pulsatility index, mean uterine artery pulsatility index), resulting in a total of 114 features. The target metric was the occurrence of adverse outcomes throughout the remaining pregnancy and 2 weeks after delivery. We trained 2 different models, a gradient-boosted tree and a random forest classifier. Hyperparameter training was performed using a grid search approach. All results were evaluated via a 10 × 10-fold cross-validation regimen. RESULTS We obtained metrics for the 2 naive machine-learning models. A gradient-boosted tree model was performed with a positive predictive value of 88%±6%, a negative predictive value of 89%±3%, a sensitivity of 66%±5%, a specificity of 97%±2%, an overall accuracy of 89%±3%, an area under the receiver operating characteristic curve of 0.82±0.03, an F1 score of 0.76±0.04, and a threat score of 0.61±0.05. The random forest classifier returned an equal positive predictive value (88%±6%) and specificity (97%±1%) while performing slightly inferior on the other available metrics. Applying differential cutoffs instead of a naive cutoff for positive prediction at ≥0.5 for the classifier's results yielded additional increases in performance. CONCLUSION Machine-learning techniques were a valid approach to improve the prediction of adverse outcomes in pregnant women at high risk of preeclampsia vs current clinical standard techniques. Furthermore, we presented an automated system that did not rely on manual tuning or adjustments.
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Affiliation(s)
- Leon J Schmidt
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Rieger
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mark Neznansky
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Max Hackelöer
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa A Dröge
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Higgins
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charité BIH Innovation, BIH Digital Health Accelerator Program, Berlin, Germany.
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany.
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Poggiali E, Morelli N, Terracciano C, Minervino G, Contardi E, Zaino D, Vercelli A, Magnacavallo A. Not all is COVID19: a case of eclampsia and posterior reversible encephalopathy syndrome in the emergency room. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021117. [PMID: 34747378 PMCID: PMC10523041 DOI: 10.23750/abm.v92is1.11017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
In the so called COVID19 era, headache, fever and gastrointestinal symptoms are highly suggestive for SARS-CoV-2 infection, but in all the cases presenting to the emergency room, clinicians should always keep in mind alternative diagnoses, particularly if the patient is pregnant. Life-threatening diseases, such as eclampsia and posterior reversible encephalopathy syndrome (PRES), should be promptly recognized and treated. Eclampsia is defined as a seizure occurring in association with pre-eclampsia, and it represents one of the major and serious obstetric disorders associated with significant maternal and perinatal morbidity and mortality. PRES is a distinctive clinical and imaging syndrome characterized by acute headaches, visual impairment, seizures, and altered sensorium, that can be associated with severe eclampsia. Emergency clinicians should always consider eclampsia in the differential diagnosis of headache in pregnant women. The prompt and accurate diagnosis of eclampsia/PRES is crucial to prevent adverse maternal and perinatal outcomes. Here we describe the case of a young pregnant woman admitted to our emergency department for fever, dyspnea, headache, nausea and vomiting, who developed generalized tonic clonic seizures and a subsequent status epilepticus due to eclampsia and PRES.
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Affiliation(s)
- Erika Poggiali
- Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Nicola Morelli
- Ospedale Guglielmo da Saliceto, Neurology Department, Piacenza, Italy.
| | | | - Guglielmo Minervino
- Ospedale Guglielmo da Saliceto, Gynecologic and Obstretic Unit, Piacenza, Italy.
| | - Emanuela Contardi
- Ospedale Guglielmo da Saliceto, Gynecologic and Obstretic Unit, Piacenza, Italy.
| | - Domenica Zaino
- Ospedale Guglielmo da Saliceto, Neurology Department, Piacenza, Italy.
| | - Andrea Vercelli
- Ospedale Guglielmo da Saliceto, Emergency Department, Piacenza, Italy.
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Anticoagulation of women with congenital heart disease during pregnancy. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Best LG, Azure C, Martell K, Tsosie KS, Voels B. Unactivated leukocyte expression of C-reactive protein is minimal and not dependent on rs1205 genotype. Sci Rep 2021; 11:5691. [PMID: 33707594 PMCID: PMC7952394 DOI: 10.1038/s41598-021-85272-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
C-reactive protein (CRP), a prominent component of the innate immune system, is implicated in the pathophysiology of many conditions. CRP production primarily occurs in the liver; but contributions from other tissues is unclear. The Genotype-Tissue Expression Portal shows essentially no expression in whole blood and reports in the literature are conflicting. Multiple genomic variants influence serum levels of CRP. We measured CRP mRNA expression in leukocytes and sought to determine if rs1205 genotype influences leukocyte expression. Leukocytes were obtained from 20 women differing by genotype. Quantitative, real-time PCR (RT-qPCR) detected CRP and reference gene (GAPDH) mRNA. Leukocyte expression was calculated by the 2ΔCT method, and against a standard curve. Digital drop PCR was also used to calculate expression ratios. Student's t test and linear regression methods examined possible differences between genotypes. During 32 runs (10 replicates each), the RT-qPCR mean (SD) CRP/GAPDH ratio was 3.39 × 10–4 (SD 1.73 × 10–4) and 3.15 × 10–4 (SD 1.64 × 10–4) for TT and CC genotypes respectively, p = 0.76; and digital drop PCR results were similar. Serum CRP was not significantly different between genotypes, nor correlated with leukocyte expression. CRP is minimally expressed in unactivated leukocytes and this expression is not likely influenced by rs1205 genotype.
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Affiliation(s)
- L G Best
- University of North Dakota, Grand Forks, ND, USA. .,Natural Sciences, Turtle Mountain Community College, Belcourt, ND, USA. .,, 1935 118th Ave NW, Watford City, ND, 58854, USA.
| | - C Azure
- Natural Sciences, Turtle Mountain Community College, Belcourt, ND, USA
| | - K Martell
- Natural Sciences, Turtle Mountain Community College, Belcourt, ND, USA
| | - K S Tsosie
- Natural Sciences, Turtle Mountain Community College, Belcourt, ND, USA
| | - B Voels
- Science, Cankdeska Cikana Community College, Fort Totten, ND, USA
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Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy affect about 5-10% of pregnancies impacting maternal, fetal, and neonatal outcomes. We review the recent studies in this field and discuss the pathophysiology, diagnosis, and management of hypertension during pregnancy, as well as the short- and long-term consequences on the cardiovascular health of women. RECENT FINDINGS Although the American College of Cardiology/American Heart Association revised their guidelines for hypertension in the general population in 2017, hypertension during pregnancy continues to be defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, measured on two separate occasions. The addition of stage 1 hypertension will increase the prevalence of hypertension during pregnancy, identifying more women at risk of preeclampsia; however, more research is needed before changing the BP goal because a lower target BP has a risk of poor placental perfusion. Women with chronic hypertension have a higher incidence of superimposed preeclampsia, cesarean section, preterm delivery before 37 weeks' gestation, birth weight less than 2500 g, neonatal unit admission, and perinatal death. They also have a higher risk of developing cardiovascular disease later in life. The guidelines recommend low-dose aspirin for women with moderate and high risk of preeclampsia. While treating pregnant women with hypertension, the effectiveness of the antihypertensive agent must be balanced with risks to the fetus. Hypertensive disorders of pregnancy should be appropriately and promptly recognized and treated during pregnancy. They should further be co-managed by the obstetrician and cardiologist to decrease the long-term negative impact on the cardiovascular health of women.
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Affiliation(s)
- Akanksha Agrawal
- Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Suite 319, Atlanta, GA, 30322, USA.
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, 101 Woodruff Circle, Suite 319, Atlanta, GA, 30322, USA
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Selanno JF, Riu DS, Tessy T, Chalid MT, Pelupessy NU, Hartono E. Maternal serum levels of asymmetric dimethylarginine in normal and preeclamptic pregnancies. Gynecol Endocrinol 2020; 36:702-704. [PMID: 32129698 DOI: 10.1080/09513590.2019.1707793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The study aims to investigate maternal serum levels of asymmetric dimethylarginine (ADMA) in preeclampsia. Serum samples were collected from 57 women with preeclamptic pregnancies and 30 women with normal pregnancies during the third trimester. ADMA levels were measured with the ELISA method. ADMA levels in preeclamptic pregnancies were significantly higher when compared with normal pregnancies (2.35 ± 3.20 nmol/l versus 0.35 ± 0.10 nmol/l; p < .05). ADMA levels show a significant positive correlation with systolic and diastolic pressure, urea, and creatinine but a negative correlation with proteinuria. ADMA levels have a significant strong correlation with PE. ADMA levels are significantly higher in preeclamptic pregnancy compared with normal pregnancy.
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Affiliation(s)
- Johan Frangky Selanno
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Deviana Soraya Riu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Telly Tessy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Maisuri Tajuddin Chalid
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Nugraha Utama Pelupessy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Eddy Hartono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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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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Karaki H, Khazaal J, Chahine R, Kharoubi M, Cuckle H. Cost-Effectiveness of First Trimester Screening for Preterm Pre-eclampsia in Lebanon. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00236-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kim YR, Jung I, Heo SJ, Chang SW, Cho HY. A preeclampsia risk prediction model based on maternal characteristics and serum markers in twin pregnancy. J Matern Fetal Neonatal Med 2019; 34:3623-3628. [PMID: 31739715 DOI: 10.1080/14767058.2019.1686757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim: To develop preeclampsia (PE) risk prediction model based on maternal characteristics and serum markers at the first and second trimester in the twin pregnancy.Methods: Between January 2005 and September 2017, we retrospectively reviewed medical records of 532 twin pregnant women who underwent maternal serum integrated test and gave birth at a Bundang CHA Medical Center. Maternal serum pregnancy-associated plasma protein A (PAPP-A) was determined at 10+0 to 13+6 weeks and the serum alpha-fetoprotein (MSAFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3) and inhibin A were assayed at 14+0 to 22+0 weeks. We assessed the relationships of maternal characteristics and serum markers by using multiple logistic regression analysis.Results: The study included 35 patients who diagnosed PE and a control group consisting of the other 497 patients in twin pregnancy. There were no significant differences in the maternal age and body mass index (BMI) between two groups. However, the gestational age and placenta weight at delivery were significantly different between groups (p < .001, p = .005, respectively. Among the maternal serum markers, inhibin A value was significantly higher in women with PE compared to those without preeclampsia (p < .001). In addition, we predicted the PE using maternal age, BMI, uE3, and inhibin A which were achieving an area under the curve of 0.73 overall in twin pregnancy.Conclusion: A risk prediction model of PE which combined maternal age, BMI, uE3, and inhibin A was better early predictors than any individual marker twin pregnancy.
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Affiliation(s)
- Young Ran Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Woon Chang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Hee Young Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Pan L, Fu Z, Yin P, Chen D. Pre-existing medical disorders as risk factors for preeclampsia: an exploratory case-control study. Hypertens Pregnancy 2019; 38:245-251. [PMID: 31530202 DOI: 10.1080/10641955.2019.1667381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: We sought to explore pre-existing medical disorders as risk factors for preeclampsia as thoroughly as possible. Methods: A case-control design. A group of 1,652 patients were identified as the preeclampsia group, and another randomly selected 4,500 patients were identified as the non-preeclampsia group. Results: Mature ovarian teratoma (adjusted odds ratio [OR] 7.69, 95% CI 1.58-37.53), uterine fibroids (adjusted OR 2.24, 95% CI 1.28-3.92) and pregestational hypothyroidism (adjusted OR 5.17, 95% CI 2.43-11.00), were significantly correlated with preeclampsia. Conclusions: Mature ovarian teratoma, uterine fibroids and pregestational hypothyroidism may also contribute to the incidence of preeclampsia.
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Affiliation(s)
- Linglan Pan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, , China
| | - Ping Yin
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, , China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
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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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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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van Londen M, Schaeffers AWMA, de Borst MH, Joles JA, Navis G, Lely AT. Overweight young female kidney donors have low renal functional reserve postdonation. Am J Physiol Renal Physiol 2018; 315:F454-F459. [PMID: 29357424 DOI: 10.1152/ajprenal.00492.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Maintenance of adequate renal function after living kidney donation is important for donor outcome. Overweight donors, in particular, may have an increased risk for end-stage kidney disease (ESKD), and young female donors have an increased preeclampsia risk. Both of these risks may be associated with low postdonation renal functional reserve (RFR). Because we previously found that higher body mass index (BMI) was associated with lower postdonation RFR, we now studied the relationship between BMI and RFR in young female donors. RFR, the rise in glomerular filtration rate (GFR) (125I-iothalamate clearance) during dopamine, was measured in female donors (<45 yr) before and after kidney donation. Donors who are overweight (BMI >25) and nonoverweight donors were compared by Student's t-test; the association was subsequently explored with regression analysis. We included 105 female donors [age 41 (36-44) median(IQR)] with a BMI of 25 (22-27) kg/m2. Predonation GFR was 118 (17) ml/min [mean(SD)] rising to 128 (19) ml/min during dopamine; mean RFR was 10 (10) ml/min. Postdonation GFR was 76 (13) ml/min, rising to 80 (12); RFR was 4 (6) ml/min ( P < 0.001 vs. predonation). In overweight donors, RFR was fully lost after donation (1 ml/min vs. 10 ml/min predonation, P < 0.001), and BMI was inversely associated with RFR after donation, independent of confounders (standardized β 0.37, P = 0.02). Reduced RFR might associate with the risk of preeclampsia and ESKD in kidney donors. Prospective studies should explore whether RFR is related to preeclampsia and whether BMI reduction before conception is of benefit to overweight female kidney donors during and after pregnancy.
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Affiliation(s)
- Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Anouk W M A Schaeffers
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - A Titia Lely
- Department of Obstetrics and Gynecology, Division of Women and Baby, University Medical Center Utrecht , Utrecht , The Netherlands
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Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1121] [Impact Index Per Article: 186.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Reduced placental protein 13 (PP13) in placental derived syncytiotrophoblast extracellular vesicles in preeclampsia – A novel tool to study the impaired cargo transmission of the placenta to the maternal organs. Placenta 2018; 66:17-25. [DOI: 10.1016/j.placenta.2018.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022]
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Barekat M, Ahmadi S. Hypertensive Disorders in Pregnant Women Receiving Fertility Treatments. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2018; 12:92-98. [PMID: 29707923 PMCID: PMC5936619 DOI: 10.22074/ijfs.2018.5232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/16/2017] [Indexed: 11/17/2022]
Abstract
Hypertensive disorders (HDs) as the most prevalent medical problem during pregnancy, predispose the patient to a
lot of comorbidities and may even cause maternal or fetal death. The rate of infertility has been increasing in recent
decades. So, we collected and summarized data about the co-existence of these two entities and found that HDs are
somewhat more common in women receiving fertility treatments regardless of pathophysiologic correlation of infer-
tility and hypertension or older age and chance of multiple pregnancies.
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Affiliation(s)
- Maryam Barekat
- Department of Cardiovascular, Bushehr University of Medical Sciences, Bushehr, Iran.,Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Shahnaz Ahmadi
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran.
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Sachan R, Patel ML, Sachan P, Shyam R, Verma P, Dheeman S. Diagnostic accuracy of spot albumin creatinine ratio and its association with fetomaternal outcome in preeclampsia and eclampsia. Niger Med J 2017; 58:58-62. [PMID: 29269982 PMCID: PMC5726174 DOI: 10.4103/0300-1652.219345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Hypertensive disorders in pregnancy are one of the leading causes of maternal and perinatal mortality. Proteinuria is one of the common and important features of preeclampsia. To evaluate the diagnostic accuracy of albumin-creatinine ratio (ACR) in woman with preeclampsia and eclampsia and examine the association between ACR and fetomaternal outcome. Materials and Methods: Prospective study carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, after informed consent and ethical clearance total ninety pregnant women from gestational age 20 to 40 weeks were enrolled, including, thirty preeclampsia, thirty antepartum eclampsia, considered as cases and thirty normotensive pregnant women as controls. Preeclampsia was defined as per National High Blood Pressure Education Program 2000 working group. All patients were asked for a spot midstream urine sample, followed by 24 h urine collection. Urinary protein was estimated by the sulfosalicylic acid method and creatinine by the Jaffe's method. The urinary ACR was determined by automated analyzer. Results: Mean value of urinary ACR of controls was significantly lower (0.103 ± 0.037) as compared to both groups. On comparing between groups the difference was significant (<0.001), a strong correlation between urinary ACR levels and 24 h urinary proteins was observed. Conclusion: In our study, an association of raised ACR values with severity of disease as well as with adverse fetomaternal outcome was observed.
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Affiliation(s)
- Rekha Sachan
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pushpalata Sachan
- Department of Physiology, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Radhey Shyam
- Department of Geriatric and Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pratima Verma
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Soniya Dheeman
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Nathan HL, Seed PT, Hezelgrave NL, De Greeff A, Lawley E, Anthony J, Hall DR, Steyn W, Chappell LC, Shennan AH. Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study. Pregnancy Hypertens 2017; 12:183-188. [PMID: 29175171 PMCID: PMC6008490 DOI: 10.1016/j.preghy.2017.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/26/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
Abstract
The CRADLE Vital Signs Alert is designed to risk stratify women with pre-eclampsia. A yellow or red light corresponds to increased risk of pre-eclampsia complications. Those who trigger a yellow or red light need escalation of care.
Objectives To evaluate the association between blood pressure (BP) measurements and adverse outcomes in women with pre-eclampsia. Study design A prospective cohort study of women with pre-eclampsia admitted to three South African tertiary facilities. BP was measured using the CRADLE Vital Signs Alert (VSA), incorporated with a traffic light early warning system; green: systolic BP <140 mmHg and diastolic BP <90 mmHg, yellow: systolic BP 140–159 and/or diastolic BP 90–109 mmHg (but neither is above the upper threshold), red: systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg. Main outcome measures Maternal: death, eclampsia, stroke, kidney injury; process measures: magnesium sulfate use, Critical Care Unit (CCU) admission; perinatal: stillbirth, neonatal death, preterm delivery. Results Of 1547 women with pre-eclampsia (including 42 twin pregnancies), 33.0% of women triggered a red light on admission and 78.6% at their highest BP. Severe hypertension and adverse outcomes were common across yellow and red categories. Comparing admission red to yellow lights, there was a significant increase in kidney injury (OR 1.74, CI 1.31–2.33, trend test p = .003), magnesium sulfate use (OR 3.40, CI 2.24–5.18, p < .001) and CCU admission (OR 1.50, CI 1.18–1.91, p < .001), but not for maternal death, eclampsia, extended perinatal death or preterm delivery. Conclusion The CRADLE VSA, with integrated traffic light early warning system, can identify women who are hypertensive, at increased risk of severe pre-eclampsia complications and in need of escalation of care. Women who triggered a red light were at increased risk of kidney injury, magnesium sulfate use and CCU admission.
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Affiliation(s)
- Hannah L Nathan
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - Paul T Seed
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - Natasha L Hezelgrave
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - Annemarie De Greeff
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - Elodie Lawley
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - John Anthony
- Maternity Centre, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town 7935, South Africa.
| | - David R Hall
- Department of Obstetrics and Gynaecology, Tygerberg Hospital, Stellenbosch University, Francie Van Zijl Drive, Cape Town 7500, South Africa.
| | - Wilhelm Steyn
- Department of Obstetrics and Gynaecology, Tygerberg Hospital, Stellenbosch University, Francie Van Zijl Drive, Cape Town 7500, South Africa.
| | - Lucy C Chappell
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
| | - Andrew H Shennan
- Women's Health Academic Centre, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, King's College London, London SE1 7EH, UK.
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Meiri H, Osol G, Cetin I, Gizurarson S, Huppertz B. Personalized Therapy Against Preeclampsia by Replenishing Placental Protein 13 (PP13) Targeted to Patients With Impaired PP13 Molecule or Function. Comput Struct Biotechnol J 2017; 15:433-446. [PMID: 29034064 PMCID: PMC5633742 DOI: 10.1016/j.csbj.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/27/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertensive disorders affect about one third of all people aged 20 and above, and are treated with anti-hypertensive drugs. Preeclampsia (PE) is one form of such disorders that only develops during pregnancy. It affects ten million pregnant women globally and additionally causes fetal loss and major newborn disabilities. The syndrome's origin is multifactorial, and anti-hypertensive drugs are ineffective in treating it. Biomarkers are helpful for predict its development. Generic drugs, such as low dose aspirin, were proven effective in preventing preterm PE. However, it does not cure the majority of cases and many studies are underway for fighting PE with extended use of additional generic drugs, or through new drug development programs. This review focuses on placental protein 13 (PP13). This protein is only expressed in the placenta. Impaired PP13 DNA structure and/or its reduced mRNA expression leads to lower blood PP13 level that predict a higher risk of developing PE. Two polymorphic PP13 variants have been identified: (1) The promoter PP13 variant with an "A/A" genotype in the -98 position (versus "A/C" or "C/C"). Having the "A/A" genotype is coupled to lower PP13 expression, mainly during placental syncytiotrophoblast differentiation and, if associated with obesity and history of previous preeclampsia, it accurately predicts higher risk for developing the disorder. (2) A thymidine deletion at position 221 causes a frame shift in the open reading frame, and the formation of an early stop codon resulting in the formation of DelT221, a truncated variant of PP13. In pregnant rodents, both short- and long- term replenishment of PP13 causes reversible hypotension and vasodilation of uterine vessels. Long-term exposure is also accompanied by the development of larger placentas and newborns. Also, only w/t PP13 is capable of inducing leukocyte apoptosis, providing maternal immune tolerance to pregnancy. Based on published data, we propose a targeted PP13 therapy to fight PE, and consider the design and conduct of animal studies to explore this hypothesis. Accordingly, a new targeted therapy can be implemented in humans combining prediction and prevention.
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Affiliation(s)
- Hamutal Meiri
- Hy Laboratories, Rehovot, and TeleMarpe, Tel Aviv, Israel
| | - George Osol
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Irene Cetin
- Department of Obstetrics and Gynecology, University of Milano, Italy
- Department of Mother and Child, Hospital Luigi Sacco, and Center for Fetal Research “Giorgio Pardi”, Milano, Italy
| | - Sveinbjörn Gizurarson
- Faculty of Pharmaceutical Sciences, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - Berthold Huppertz
- Institute of Cell Biology, Histology and Embryology & Biobank Graz, Medical University of Graz, Graz, Austria
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Madar-Shapiro L, Karady I, Trahtenherts A, Syngelaki A, Akolekar R, Poon L, Cohen R, Sharabi-Nov A, Huppertz B, Sammar M, Juhasz K, Than NG, Papp Z, Romero R, Nicolaides KH, Meiri H. Predicting the Risk to Develop Preeclampsia in the First Trimester Combining Promoter Variant -98A/C of LGALS13 (Placental Protein 13), Black Ethnicity, Previous Preeclampsia, Obesity, and Maternal Age. Fetal Diagn Ther 2017; 43:250-265. [PMID: 28728156 PMCID: PMC5882584 DOI: 10.1159/000477933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/30/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND LGALS13 (placental protein 13 [PP13]) promoter DNA polymorphisms was evaluated in predicting preeclampsia (PE), given PP13's effects on hypotension, angiogenesis, and immune tolerance. METHODS First-trimester plasma samples (49 term and 18 intermediate) of PE cases matched with 196 controls were collected from King's College Hospital, London, repository. Cell-free DNA was extracted and the LGALS13 exons were sequenced after PCR amplification. Expression of LGALS13 promoter reporter constructs was determined in BeWo trophoblast-like cells with luciferase assays. Adjusted odds ratio (OR) was calculated for the A/A genotype combined with maternal risk factors. RESULTS The A/A, A/C, and C/C genotypes in the -98 promoter position were in Hardy-Weinberg equilibrium in the control but not in the PE group (p < 0.036). The dominant A/A genotype had higher frequency in the PE group (p < 0.001). The A/C and C/C genotypes protected from PE (p < 0.032). The ORs to develop term and all PE, calculated for the A/A genotype, previous PE, body mass index (BMI) >35, black ethnicity, and maternal age >40 were 15.6 and 11.0, respectively (p < 0.001). In luciferase assays, the "-98A" promoter variant had lower expression than the "-98C" variant in non-differentiated (-13%, p = 0.04) and differentiated (-26%, p < 0.001) BeWo cells. Forskolin-induced differentiation led to a larger expression increase in the "-98C" variant than in the "-98A" variant (4.55-fold vs. 3.85-fold, p < 0.001). CONCLUSION Lower LGALS13 (PP13) expression with the "A" nucleotide in the -98 promoter region position (compared to "C") and high OR calculated for the A/A genotype in the -98A/C promoter region position, history of previous PE, BMI >35, advanced maternal age >40, and black ethnicity could serve to aid in PE prediction in the first trimester.
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The Role of Interleukin-17, Interleukin-23, and Transforming Growth Factor- β in Pregnancy Complicated by Placental Insufficiency. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6904325. [PMID: 28698875 PMCID: PMC5494064 DOI: 10.1155/2017/6904325] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022]
Abstract
AIM The aim of the study was to evaluate the role of Interleukin-17 (IL-17), Interleukin-23 (IL-23), and transforming growth factor-β (TGF-β) in pregnancy complicated by placental insufficiency and in normal pregnancy. MATERIAL AND METHODS The study comprised 34 patients with pregnancy complicated by fetal growth restriction (FGR) associated with preeclampsia (PE), as well as 35 healthy pregnant women. The concentrations of IL-17, IL-23, and TGF-β in sera from maternal peripheral blood were determined by an immunoenzymatic assay. RESULTS There were higher concentrations of IL-17 in the study group when compared to the controls. In the group of patients with placental insufficiency, the levels of IL-17 positively correlated with systolic blood pressure (R = 0.42, p < 0.01). The study obtained comparable concentrations of IL-23 in both studied groups. The concentrations of TGF-β were significantly lower in pregnancy complicated by the insufficiency of placenta when compared to the controls. CONCLUSIONS It seems possible that the increased concentrations of IL-17 and the deficiency of TGF-β in pregnancy complicated by FGR and PE can be responsible for the activation of inflammatory response observed in PE cases.
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Fisher SC, Van Zutphen AR, Werler MM, Lin AE, Romitti PA, Druschel CM, Browne ML. Maternal Antihypertensive Medication Use and Congenital Heart Defects: Updated Results From the National Birth Defects Prevention Study. Hypertension 2017; 69:798-805. [PMID: 28373593 PMCID: PMC9976617 DOI: 10.1161/hypertensionaha.116.08773] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/18/2016] [Accepted: 02/22/2017] [Indexed: 11/16/2022]
Abstract
Previous NBDPS (National Birth Defects Prevention Study) findings from 1997 to 2003 suggested that maternal antihypertensive use was associated with congenital heart defects (CHDs). We re-examined associations between specific antihypertensive medication classes and specific CHDs with additional NBDPS data from 2004 to 2011. After excluding mothers missing hypertension information or who reported pregestational diabetes mellitus, a multiple birth, or antihypertensive use but no hypertension, we compared self-reported maternal exposure data on 10 625 CHD cases and 11 137 nonmalformed controls. We calculated adjusted odds ratios [95% confidence intervals] to estimate the risk of specific CHDs associated with antihypertensive use during the month before conception through the third month of pregnancy, controlling for maternal age, race/ethnicity, body mass index, first trimester cigarette smoking, and NBDPS site. Overall, 164 (1.5%) case mothers and 102 (0.9%) control mothers reported early pregnancy antihypertensive use for their hypertension. We observed increased risk of 4 CHD phenotypes, regardless of antihypertensive medication class reported: coarctation of the aorta (2.50 [1.52-4.11]), pulmonary valve stenosis (2.19 [1.44-3.34]), perimembranous ventricular septal defect (1.90 [1.09-3.31]), and secundum atrial septal defect (1.94 [1.36-2.79]). The associations for these phenotypes were statistically significant for mothers who reported β-blocker use or renin-angiotensin system blocker use; estimates for other antihypertensive medication classes were generally based on fewer exposed cases and were less stable but remained elevated. Our results support and expand on earlier NBDPS findings that antihypertensive medication use may be associated with increased risk of specific CHDs, although we cannot completely rule out confounding by underlying disease characteristics.
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Affiliation(s)
- Sarah C. Fisher
- Congenital Malformations Registry, New York State Department of Health, Albany, NY
| | - Alissa R. Van Zutphen
- Congenital Malformations Registry, New York State Department of Health, Albany, NY,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Martha M. Werler
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Angela E. Lin
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts,Massachusetts Center for Birth Defects Prevention, Massachusetts Department of Public Health
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Charlotte M. Druschel
- Congenital Malformations Registry, New York State Department of Health, Albany, NY,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Marilyn L. Browne
- Congenital Malformations Registry, New York State Department of Health, Albany, NY,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
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Seki H. Animal models of preeclampsia: an examination of usefulness and limitations based on the metabolic domino theory. HYPERTENSION RESEARCH IN PREGNANCY 2017. [DOI: 10.14390/jsshp.hrp2017-015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroyuki Seki
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University
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Maymon R, Trahtenherts A, Svirsky R, Melcer Y, Madar-Shapiro L, Klog E, Meiri H, Cuckle H. Developing a new algorithm for first and second trimester preeclampsia screening in twin pregnancies. Hypertens Pregnancy 2016; 36:108-115. [DOI: 10.1080/10641955.2016.1242605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ron Maymon
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | | | - Ran Svirsky
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Yaakov Melcer
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | | | - Esther Klog
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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32
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Svirsky R, Maymon R, Melcer Y, Klog E, Cuckle H. First and second trimester maternal serum inhibin A levels in twins with pre-eclampsia. Prenat Diagn 2016; 36:1071-1074. [DOI: 10.1002/pd.4937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Ran Svirsky
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Ron Maymon
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Yaakov Melcer
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
| | - Esther Klog
- Institute of Ultrasound, Department of Obstetrics and Gynecology; Assaf Harofeh Medical Centre, affiliated with the Sackler School of Medicine; Tel Aviv Israel
- Tel Aviv University; Tel Aviv Israel
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Chang Y, Chen X, Cui HY, Li X, Xu YL. New Predictive Model at 11 +0 to 13 +6 Gestational Weeks for Early-Onset Preeclampsia With Fetal Growth Restriction. Reprod Sci 2016; 24:783-789. [PMID: 27678097 DOI: 10.1177/1933719116669053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to determine a predictive model for early-onset preeclampsia with fetal growth restriction (FGR) to be used at 11+0 to 13+6 gestational weeks, by combining the maternal serum level of pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF), placental protein 13 (PP13), soluble endoglin (sEng), mean arterial pressure (MAP), and uterine artery Doppler. This was a retrospective cohort study of 4453 pregnant women. Uterine artery Doppler examination was conducted in the first trimester. Maternal serum PAPP-A, PLGF, PP13, and sEng were measured. Mean arterial pressure was obtained. Women were classified as with/without early-onset preeclampsia, and women with preeclampsia were classified as with/without FGR. Receiver operating characteristic analysis was performed to determine the value of the model. There were 30 and 32 pregnant women with early-onset preeclampsia with and without FGR. The diagnosis rate of early-onset preeclampsia with FGR was 67.4% using the predictive model when the false positive rate was set at 5% and 73.2% when the false positive rate was 10%. The predictive model (MAP, uterine artery Doppler measurements, and serum biomarkers) had some predictive value for the early diagnosis (11+0 to 13+6 gestational weeks) of early-onset preeclampsia with FGR.
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Affiliation(s)
- Ying Chang
- 1 Obstetrics Department, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Xu Chen
- 1 Obstetrics Department, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Hong-Yan Cui
- 1 Obstetrics Department, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Xing Li
- 1 Obstetrics Department, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Ya-Ling Xu
- 1 Obstetrics Department, Tianjin Center Hospital of Obstetrics and Gynecology, Tianjin, China
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34
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Zhou L, Cheng L, He Y, Gu Y, Wang Y, Wang C. Association of gene polymorphisms of FV, FII, MTHFR, SERPINE1, CTLA4, IL10, and TNFalpha with pre-eclampsia in Chinese women. Inflamm Res 2016; 65:717-24. [DOI: 10.1007/s00011-016-0953-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 11/27/2022] Open
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35
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Svirsky R, Levinsohn-Tavor O, Feldman N, Klog E, Cuckle H, Maymon R. First- and second-trimester maternal serum markers of pre-eclampsia in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:560-564. [PMID: 25865365 DOI: 10.1002/uog.14873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the distribution of first- and second-trimester maternal serum markers in twin pregnancy with and without pre-eclampsia. METHODS One-hundred and forty-four twin and 109 unaffected singleton pregnancies were recruited from the same institution. First- and second-trimester maternal blood samples were stored and measured retrospectively for serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP). All had measurement of first-trimester serum markers, and 167 (66%) had second-trimester tests. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight, as appropriate. RESULTS Pre-eclampsia was diagnosed in 12 (9.0%) twin pregnancies of 133 continuing beyond 22 weeks. In unaffected twin pregnancies, all serum markers were statistically significantly increased (P < 0.0001), consistent with a doubling of concentration. Among twin pregnancies, those with pre-eclampsia had a significantly reduced median PlGF compared with surviving unaffected twin pregnancies (0.96 MoM vs 1.46 MoM; P < 0.0002, two-tailed), whilst median PAPP-A, which is known to be reduced in affected singleton pregnancies, was increased (3.91 MoM vs 2.43 MoM; P < 0.0005, two-tailed). The levels of free β-hCG (P < 0.02) and AFP (P < 0.05) were also significantly raised, but to a lesser extent than was the level of PAPP-A. Using a logistic regression algorithm based on first- and second-trimester PlGF and PAPP-A, together with previously published uterine artery Doppler and mean arterial pressure measurements in the same series, the predicted pre-eclampsia detection rate was 65% for a 10% false-positive rate. CONCLUSIONS In twin pregnancy, the predicted detection rate of pre-eclampsia using first- and second-trimester maternal serum and biophysical markers is good. In contrast to singleton pregnancy, PAPP-A levels are raised in the first trimester of twin pregnancies destined to develop pre-eclampsia and therefore a different prediction algorithm is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Levinsohn-Tavor
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Feldman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Klog
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Cuckle
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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36
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Marrs JC, Thompson AM. Antihypertensive Therapy in Females: A Clinical Review Across the Lifespan. Pharmacotherapy 2016; 36:638-51. [PMID: 27072935 DOI: 10.1002/phar.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hypertension affects one-third of all females in the United States, with the prevalence increasing over a female's lifespan. The approach to treating females with hypertension varies depending on a female's age, race, comorbidities, and whether she is of child-bearing age or pregnant. It is important to factor in the safety and effectiveness of antihypertensive medications across these populations of females. Blood pressure target goals are the same in females as in males regardless of comorbidities or stage of life, with the exception of those females who are pregnant. Recommendations for antihypertensive medication do not differ between females and males based on disease state or stage of life, with the exception of females who are pregnant, breastfeeding, or of child-bearing age. Multiple guidelines recommend avoiding renin-angiotensin system blockers during pregnancy and suggest balancing the risk versus benefit in females of child-bearing age. Further, multiple guidelines provide race-based therapy recommendations for the use of calcium channel blockers and thiazide diuretics in black versus nonblack patients, irrespective of sex. Future research is needed to evaluate whether there are sex differences relative to blood pressure and cardiovascular event-lowering relative to specific antihypertensive medications with a focus on pharmacogenomic differences.
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Affiliation(s)
- Joel C Marrs
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | - Angela M Thompson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
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Anthony J, Damasceno A, Ojjii D. Hypertensive disorders of pregnancy: what the physician needs to know. Cardiovasc J Afr 2016; 27:104-10. [PMID: 27213858 PMCID: PMC4928160 DOI: 10.5830/cvja-2016-051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/14/2016] [Indexed: 12/04/2022] Open
Abstract
Hypertension developing during pregnancy may be caused by a variety of different pathophysiological mechanisms. The occurrence of proteinuric hypertension during the second half of pregnancy identifies a group of women whose hypertensive disorder is most likely to be caused by the pregnancy itself and for whom the risk of complications, including maternal mortality, is highest. Physicians identifying patients with hypertension in pregnancy need to discriminate between pre-eclampsia and other forms of hypertensive disease. Pre-eclamptic disease requires obstetric intervention before it will resolve and it must be managed in a multidisciplinary environment. The principles of diagnosis and management of these different entities are outlined in this review.
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Affiliation(s)
- John Anthony
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dike Ojjii
- Department of Cardiology, University of Abuja, Abuja, Nigeria
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Abstract
Preeclampsia (PE) is one of the leading causes of maternal and fetal morbidity and mortality, with incidence rates ranging between 2 and 5 % in the Western World. The exact causes of the disease remain largely unknown, because of the complex pathophysiologic mechanisms involved in the process. Genetic, environmental, and epigenetic parameters have been implicated by various authors as culprits for the pathogenesis of PE. Recent reports in the literature highlight the paternal role. Still, the exact extent and mechanism remain elusive. In this systematic review, we attempt to present data regarding the paternal role in a concise and comprehensive manner.
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Abstract
Heart disease is a common cause of morbidity and mortality during pregnancy. Symptoms and signs of heart failure in a pregnant woman are an indication for urgent assessment to establish a diagnosis and appropriate management. This is best accomplished through a multidisciplinary approach in which both cardiologists and obstetricians need to participate in order to provide expert counselling and care in pursuit of safe motherhood. Congenital heart disease, although common, once corrected is an unusual source of complications, which are more likely to develop as a consequence of ventricular failure, pulmonary hypertension and aortic arch disease. Rheumatic valvular heart disease is a challenge because of the need for anticoagulation during pregnancy and the risk of sepsis associated with childbirth. This review outlines a contemporary approach to heart failure presenting during pregnancy.
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Affiliation(s)
- John Anthony
- Division of Obstetrics and Gynaecology Groote Schuur Hospital, University of Cape Town,Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town,Cape Town, South Africa.,Soweto Cardiovascular Research Group University of theWitwatersrand, South Africa
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40
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Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology 2015; 26:17-26. [PMID: 25437315 DOI: 10.1097/ede.0000000000000213] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth. METHODS We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002-2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery. Controlled direct effects of preeclampsia on perinatal mortality, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, anemia, apnea, asphyxia, peri- or intraventricular hemorrhage, and cardiomyopathy were estimated for the hypothesized intervention of term delivery for all infants. RESULTS When delivery was set at ≥37 weeks, preeclampsia increased the odds of perinatal mortality (odds ratio = 2.2 [95% confidence interval = 1.1-4.5], SGA = (1.9 [1.8-2.1]), NICU admission (1.9 [1.7-2.1]), respiratory distress syndrome (2.8 [2.0-3.7], transient tachypnea of the newborn (1.6 [1.3-1.9]), apnea (2.2 [1.6-3.1]), asphyxia (2.7 [1.5-4.9]), and peri- or intraventricular hemorrhage (3.2 [1.4-7.7]). No direct effect of preeclampsia at term was observed for anemia or cardiomyopathy. Our results appear robust in the presence of moderate confounding, and restriction to severe preeclampsia yielded similar findings. CONCLUSION Preeclampsia was directly associated with adverse neonatal outcomes beyond morbidity mediated by preterm birth. Although severe neonatal outcomes were less common at later gestational ages, marginal structural models suggested elevated neonatal risk due to preeclampsia even if it was possible to deliver all infants at term.
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Bian Z, Shixia C, Duan T. First-Trimester Maternal Serum Levels of sFLT1, PGF and ADMA Predict Preeclampsia. PLoS One 2015; 10:e0124684. [PMID: 25906026 PMCID: PMC4408038 DOI: 10.1371/journal.pone.0124684] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 03/17/2015] [Indexed: 11/19/2022] Open
Abstract
Background Placental growth factor (PGF), soluble fms-like tyrosine kinase 1 (sFLT1) and asymmetric dimethylarginine (ADMA) are involved in the pathogenesis of preeclampsia. Abnormal maternal sFLT1, PGF and ADMA levels are detectable weeks before the onset of preeclampsia. Objective To investigate sFLT1, PGF and ADMA in the first trimester of pregnancy as predictors of preeclampsia. Methods In this prospective nested case-control study, 740 pregnant women enrolled at 12–16 weeks of gestation and followed up until 6 weeks after delivery at the Shanghai First Maternity and Infant Health Hospital of Tongji University between January 2010 and December 2012. Forty-four women developed preeclampsia. Urinary proteins were measured using 24-hour collection or dipsticks. sFLT1, PGF and ADMA were measured by ELISA in the first trimester. Pulsatility index (PI) was measured by Doppler ultrasound in the second trimester. Results First-trimester serum sFLT1 and ADMA levels of women who developed preeclampsia were significantly higher compared with women with normal pregnancies (sFLT1: 0.321±0.023 vs. 0.308±0.019 ng/ml, P = 0.001; ADMA: 0.86±0.16 vs. 0.68±0.20 μM, P<0.001). First-trimester serum PGF levels of women who developed preeclampsia were significantly lower than in women with normal pregnancies (115.72±32.55 vs. 217.30±74.48 pg/ml, P<0.001). Multiple logistic regression and receiver-operating characteristic curves identified first-trimester PGF and ADMA to be sensitive and selective predictors of preeclampsia (area under the curve [AUC]: 0.902), as well as second-trimester uterine artery pulse index (AUC: 0.836). Conclusion In the first trimester, maternal serum sFLT1, PGF and ADMA levels, as well as second-trimester uterine artery PI, could predict preeclampsia.
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Affiliation(s)
- Zheng Bian
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Health Hospital of Tongji University, Shanghai, China
| | - Chenzi Shixia
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Health Hospital of Tongji University, Shanghai, China
| | - Tao Duan
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Health Hospital of Tongji University, Shanghai, China
- * E-mail:
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Foo L, Tay J, Lees CC, McEniery CM, Wilkinson IB. Hypertension in Pregnancy: Natural History and Treatment Options. Curr Hypertens Rep 2015; 17:36. [DOI: 10.1007/s11906-015-0545-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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43
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Bahadoran P, Pouya F, Zolaktaf V, Taebi M. The effect of stretching exercise and walking on changes of blood pressure in nulliparous women. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:205-10. [PMID: 25878697 PMCID: PMC4387644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertension in pregnancy is one of the prevalent disorder resulting in maternal death. The aim of this study was to investigate the effect of stretching exercise and walking on changes of blood pressure in nulliparous women during pregnancy. MATERIALS AND METHODS This was a quasi-experimental trial that consisted three groups of women who took part in pre- and post-tests. We used a simple randomized sample, including 118 pregnant females (walking: 29 subjects, stretching exercise: 30 subjects control: 59 subjects). The data were collected using the demographic checklist and blood pressure was measured every week. SPSS 16 was used to analyze the data by one-way analysis of variance (ANOVA) and repeated measure ANOVA. RESULTS No significant difference was found in the demographic characteristics of the three groups of women. Mean systolic and diastolic blood pressure in the three groups (stretching exercises, walking, and routine care) at three intervals (pre-test, first post-test, and second post-test) were significantly different (P < 0.05). In this case, Tukey's test showed significant improvement of systolic and diastolic blood pressure in stretching exercise group. Walking and control groups showed no change or significant reduction (P < 0.05). No significant difference was found between the walking and control groups (P > 0.05). CONCLUSIONS The results of the study showed that stretching exercise versus walking reduces systolic and diastolic blood pressure in the second trimester of pregnancy and controls it in the third trimester of pregnancy. In contrast, walking has no effect on blood pressure during pregnancy.
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Affiliation(s)
- Parvin Bahadoran
- Departmet of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Pouya
- Departmet of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Zolaktaf
- Department of Sport Injury and Rehabilitation, School of Exercise Science, University of Isfahan, Isfahan, Iran
| | - Mahboubeh Taebi
- Departmet of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Ms. Mahboubeh Taebi, Departmet of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran E-mail:
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Gillon TER, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One 2014; 9:e113715. [PMID: 25436639 PMCID: PMC4249974 DOI: 10.1371/journal.pone.0113715] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. METHODOLOGY & PRINCIPAL FINDINGS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. CONCLUSIONS Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.
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Affiliation(s)
| | - Anouk Pels
- Academic Medical Center, Amsterdam, The Netherlands
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen MacDonell
- College of Physicians and Surgeons of British Columbia, Vancouver, British Columbia, Canada
| | - Laura A. Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
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Zawiejska A, Wender-Ozegowska E, Iciek R, Brazert J. Concentrations of endothelial nitric oxide synthase, angiotensin-converting enzyme, vascular endothelial growth factor and placental growth factor in maternal blood and maternal metabolic status in pregnancy complicated by hypertensive disorders. J Hum Hypertens 2014; 28:670-6. [PMID: 25186136 DOI: 10.1038/jhh.2014.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 03/20/2014] [Accepted: 04/29/2014] [Indexed: 01/21/2023]
Abstract
Hypertensive disorders of pregnancy (HDPs) are associated with altered maternal metabolism, impaired perinatal outcome and increased risk for remote maternal complications. The aim of our study was to analyse associations between circulating levels of angiogenic factors and markers of oxidative stress and metabolic status in women with HDP. Forty-six women in singleton pregnancies complicated by HDP and 30 healthy controls were enrolled in a prospective observational study. Serum concentrations of endothelial nitric oxide synthase (eNOS), angiotensin-converting enzyme, vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) were measured in the third trimester and correlated with maternal anthropometrics and metabolic status. We found significantly lower eNOS levels in patients with severe hypertension vs controls, a strong association between eNOS and PlGF in the study group, a significant association between maternal prepregnancy body mass index (BMI) and VEGF levels and an inverse correlation between VEGF and PlGF. Maternal prepregnancy BMI was the only independent predictor for VEGF concentrations. We noted reduced levels of PlGF and eNOS and increased VEGF levels in women with severe hypertension/preeclampsia. First, different forms of HDP are associated with different alteration patterns in concentrations of angiogenic factors and markers of oxidative stress. Second, maternal prepregnancy BMI, but not body weight, is a significant predictor for VEGF levels in late pregnancy.
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Affiliation(s)
- A Zawiejska
- Department of Obstetrics and Women's Diseases, University of Medical Sciences, Poznan, Poland
| | - E Wender-Ozegowska
- Department of Obstetrics and Women's Diseases, University of Medical Sciences, Poznan, Poland
| | - R Iciek
- Department of Obstetrics and Women's Diseases, University of Medical Sciences, Poznan, Poland
| | - J Brazert
- Department of Obstetrics and Women's Diseases, University of Medical Sciences, Poznan, Poland
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46
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Early pregnancy waist-to-hip ratio and risk of preeclampsia: a prospective cohort study. Hypertens Res 2014; 38:80-3. [DOI: 10.1038/hr.2014.133] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/25/2014] [Accepted: 07/03/2014] [Indexed: 12/21/2022]
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Meiri H, Sammar M, Herzog A, Grimpel YI, Fihaman G, Cohen A, Kivity V, Sharabi-Nov A, Gonen R. Prediction of preeclampsia by placental protein 13 and background risk factors and its prevention by aspirin. J Perinat Med 2014; 42:591-601. [PMID: 24607918 DOI: 10.1515/jpm-2013-0298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/07/2014] [Indexed: 11/15/2022]
Abstract
AIM Evaluation of placental protein 13 (PP13) and risk factors (RFs) as markers for predicting preeclampsia (PE) and use of aspirin for PE prevention. MATERIALS AND METHODS First-trimester pregnancy screening was based on having PP13 level ≤0.4 multiple of the median (MoM) and/or at least one major risk factor (RF) for PE. Management was by routine care or combined with daily treatment with 75 mg aspirin between 14 and 35 weeks of gestation. RESULTS Of 820 deliveries, 63 women developed PE (7.7%). Median PP13 levels was 0.2MoM in the PE group compared with 0.83MoM among unaffected and 1.0MoM in unaffected not treated with aspirin (P<0.0001). Low PP13 was a better predictor for PE versus major RFs, particularly for young nuliparous. Combining low PP13 with RFs increased prediction accuracy. Mean arterial pressure (not included in the initial prediction), could add to prediction accuracy when combined with low PP13 and RFs. PE prevention by aspirin was most effective when the risk was determined by low PP13 alone, less effective for combining low PP13 with RFs, and ineffective when determined by RFs alone. CONCLUSION When PE risk is determined by low first trimester PP13 or by combined low PP13 and RFs, prevention with aspirin is warranted.
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Montagnoli C, Larciprete G. Preeclampsia: Definitions, screening tools and diagnostic criteria in the supersonic era. World J Obstet Gynecol 2014; 3:98-108. [DOI: 10.5317/wjog.v3.i3.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/15/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Preeclampsia is still a major risk factor for maternal-fetal health. Therefore, early identification of pregnant women at risk for preeclampsia is a big priority in obstetrics in order to decrease the mortality and morbidity associated with this disease. On the basis of well known and new pathophysiological mechanisms of preeclampsia, different biochemical and ultrasonographic parameters have been investigated in the literature, without finding an ideal marker for early screening. In this brief review, we present the best studied ultrasonographic markers and the most recent genetic factors and promising emerging biomarkers of preeclampsia, to date. We hope that in the future the combination of these tests will allow us to predict which women are at risk of preeclampsia.
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49
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Sammar M, Nisamblatt S, Gonen R, Huppertz B, Gizurarson S, Osol G, Meiri H. The role of the carbohydrate recognition domain of placental protein 13 (PP13) in pregnancy evaluated with recombinant PP13 and the DelT221 PP13 variant. PLoS One 2014; 9:e102832. [PMID: 25079598 PMCID: PMC4117483 DOI: 10.1371/journal.pone.0102832] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Placental protein 13 (PP13), a placenta specific protein, is reduced in the first trimester of pregnancy in women who subsequently develop preeclampsia. A naturally occurring PP13 deletion of thymidine at position 221 (DelT221 or truncated variant) is associated with increased frequency of severe preeclampsia. In this study we compared the full length (wildtype) PP13 and the truncated variant. METHODS Full length PP13 or its DelT221 variant were cloned, expressed and purified from E-Coli. Both variants were administrated into pregnant rats at day 8 of pregnancy for slow release (>5 days) through osmotic pumps and rat blood pressure was measured. Animals were sacrificed at day 15 or day 21 and their utero-placental vasculature was examined. RESULTS The DelT221 variant (11 kDA) lacked exon 4 and a part of exon 3, and is short of 2 amino acids involved in the carbohydrate (CRD) binding of the wildtype (18 kDA). Unlike the wildtype PP13, purification of DelT221 variant required special refolding. PP13 specific poly- clonal antibodies recognized both PP13 and DelT221 but PP13 specific monoclonal antibodies recognized only the wildtype, indicating the loss of major epitopes. Wildtype PP13 mRNA and its respective proteins were both lower in PE patients compared to normal pregnancies. The DelT221 mutant was not found in a large Caucasian cohort. Pregnant rats exposed to wildtype or DelT221 PP13 variants had significantly lower blood pressure compared to control. The wildtype but not the DelT221 mutant caused extensive vein expansion. CONCLUSION This study revealed the importance of PP13 in regulating blood pressure and expanding the utero-placental vasculature in pregnant rats. PP13 mutant lacking amino acids of the PP13 CRD domain fails to cause vein expansion but did reduce blood pressure. The study provides a basis for replenishing patients at risk for preeclampsia by the full length but not the truncated PP13.
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Affiliation(s)
- Marei Sammar
- Prof. Ephraim Katzir Department of Biotechnology Engineering, ORT Braude College, Karmiel, Israel
| | - Shahar Nisamblatt
- Prof. Ephraim Katzir Department of Biotechnology Engineering, ORT Braude College, Karmiel, Israel
| | - Ron Gonen
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, and Technion-Israel Institute of Technology, Haifa, Israel
| | - Berthold Huppertz
- Institute of Cell Biology, Histology and Embryology/Biobank Graz, Medical University of Graz, Graz, Austria
| | - Sveinbjorn Gizurarson
- Faculty of Pharmaceutical Sciences, School of Health Science, University of Iceland, Reykjavik, Iceland
| | - George Osol
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Hamutal Meiri
- Telemarpe Ltd, Tel Aviv, and Hy-Laboratories, Rehovot, Israel
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Svirsky R, Yagel S, Ben-Ami I, Cuckle H, Klug E, Maymon R. First trimester markers of preeclampsia in twins: maternal mean arterial pressure and uterine artery Doppler pulsatility index. Prenat Diagn 2014; 34:956-60. [DOI: 10.1002/pd.4402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/06/2022]
Affiliation(s)
- R. Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - S. Yagel
- Division of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Centers; Jerusalem Israel
| | - I. Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - H. Cuckle
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Columbia University Medical Center; New York NY USA
- Reproductive Epidemiology; University of Leeds; Leeds UK
| | - E. Klug
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - R. Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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