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Guzmán-Delgado NE, Velázquez-Sotelo CE, Fernández-Gómez MJ, González-Barrera LG, Muñiz-García A, Sánchez-Sotelo VM, Carranza-Rosales P, Hernández-Juárez A, Morán-Martínez J, Martínez-Gaytan V. Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease. Rev Clin Esp 2024; 224:337-345. [PMID: 38697610 DOI: 10.1016/j.rceng.2024.04.016] [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: 02/12/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND OBJECTIVES cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, p = 0.021). CONCLUSIONS severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
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Affiliation(s)
- N E Guzmán-Delgado
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - C E Velázquez-Sotelo
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico.
| | - M J Fernández-Gómez
- División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - L G González-Barrera
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - A Muñiz-García
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - V M Sánchez-Sotelo
- Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
| | - P Carranza-Rosales
- Centro de investigación Biomédica del Noreste. Instituto Mexicano del Seguro Social. Monterrey, Nuevo León, Mexico
| | - A Hernández-Juárez
- Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, "Dr. Alfonso J. Treviño Treviño" del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico; Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
| | - J Morán-Martínez
- Departamento de Biología Celular y Ultraestructura, Facultad de Medicina, Universidad Autónoma de Coahuila unidad Torreón, Torreón, Coahuila, Mexico
| | - V Martínez-Gaytan
- División de Investigación en Salud, Unidad Médica de Alta Especialidad de Gineco Obstetricia No.23, Dr. Ignacio Morones Prieto, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
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Morales-Suárez-Varela M, Peraita-Costa I, Guerrero Cervera B, Llopis-Morales A, Botella Juan L, Marcos Puig B. Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes. Semergen 2024; 50:102171. [PMID: 38159344 DOI: 10.1016/j.semerg.2023.102171] [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: 09/21/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.
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Affiliation(s)
- M Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - I Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - B Guerrero Cervera
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain; Department of Cardiology, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
| | - A Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot (València), Spain
| | - L Botella Juan
- Area of Preventive Medicine and Public Health, Department of Biomedical Sciences, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; The Research Group in Gene-Environment and Health Interactions (GIIGAS), Institute of Biomedicine (IBIOMED), Universidad de León, 24071 León, Spain
| | - B Marcos Puig
- Department of Obstetrics, La Fe University Hospital, Avinguda de Fernando Abril Martorell, 106, 46026 València, Spain
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Lin J, Xie Q, Xu C, Wan Q. Live Births in Women over 40 Years of Age Correlate with Obesity Rates. Endocr Metab Immune Disord Drug Targets 2024; 24:255-264. [PMID: 37282645 DOI: 10.2174/1871530323666230606120744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/01/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023]
Abstract
AIMS This cross-sectional study aimed to analyze the relationship between live birth and the prevalence of obesity in Chinese women over 40 years of age. METHODS From April to November 2011, the Endocrinology Branch of the Chinese Medical Association conducted the REACTION project, a national, multicenter, cross-sectional study of Chinese adults aged 40 years and older. Demographic and medical data were collected through validated questionnaires and equipment. Anthropometric indicators, blood pressure, and biochemical data were measured by professional medical personnel. Data were analyzed using descriptive statistics and logistic analysis. Multivariate regression models were used to analyze obesity-related risk factors. RESULTS The prevalence of obesity among women increased gradually from 3.8% to 6.0% with an increasing number of live births. Women with two live births had the highest prevalence of overweight at 34.3%. Overall, the obesity and overweight rates were slightly higher in premenopausal women than in postmenopausal women. Univariate regression analysis showed that the risk of obesity in women increased with an increasing number of live births. In addition, multivariate regression analysis showed that the risk of obesity increased with an increasing number of live births in women with systolic blood pressure (SBP) < 121 mmHg or current smoking (P < 0.05). CONCLUSION The risk of obesity increases with the number of live births in Chinese women over 40 years of age with SBP < 121 mmHg or current smoking. Our findings may facilitate the development of interventions to prevent obesity in this population.
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Affiliation(s)
- Jie Lin
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
| | - Qian Xie
- The people's Hospital of Leshan, Leshan, China
| | - Chaoran Xu
- The people's Hospital of Leshan, Leshan, China
| | - Qin Wan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, Luzhou, China
- Sichuan Clinical Research Center for Nephropathy, Luzhou, China
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, China
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Pregnancy causes a transient decrease in systemic ventricular function in women with pre-existing cardiac disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Martínez-Quintana E, Romero-Requejo A, Rodríguez-González F. Cardiopatías congénitas y embarazo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Holgado CM, Coves S. [Anaesthetic management of caesarean section in pregnancy with diabetes and hypertrophic myocardiopathy with restrictive diastolic dysfunction]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:106-109. [PMID: 22565223 DOI: 10.1016/j.redar.2012.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/08/2012] [Indexed: 05/31/2023]
Abstract
Haemodynamic changes that occur during pregnancy are maximal between 28 and 34 weeks. In the pregnant woman with several associated diseases, such as hypertensive myocardiopathy and pre-gestational diabetes, these changes can lead to a difficult control of pulmonary hypertension and acute pulmonary oedema. We report the case of a pregnant woman with long term type 1 diabetes mellitus who suffered pre-eclampsia in a previous pregnancy, and since then developed hypertensive cardiomyopathy. She was admitted at 30 week gestation for metabolic and blood pressure control, and developed congestive cardiac failure after the administration of betamethasone for foetal lung maturity. A transthoracic echocardiogram showed a non-dilated hypertrophic left ventricle with good systolic function, restrictive diastolic dysfunction and moderate pulmonary arterial hypertension. When her general condition improved, we performed a caesarean section under regional anaesthesia to prevent the complications of pulmonary and systemic hypertension. We present the anaesthetic management and resolution of complications after oxytocin administration.
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MESH Headings
- Adult
- Anesthesia, Epidural/methods
- Anesthesia, Obstetrical/methods
- Betamethasone/adverse effects
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/drug therapy
- Cardiovascular Agents/therapeutic use
- Cesarean Section, Repeat
- Diabetes Mellitus, Type 1/complications
- Diastole
- Female
- Heart Failure/etiology
- Humans
- Hypertension, Pulmonary/etiology
- Hypotension/chemically induced
- Hypotension/drug therapy
- Infant, Newborn
- Intraoperative Complications/chemically induced
- Intraoperative Complications/drug therapy
- Norepinephrine/therapeutic use
- Oxytocin/adverse effects
- Phenylephrine/therapeutic use
- Pre-Eclampsia/physiopathology
- Preanesthetic Medication
- Pregnancy
- Pregnancy Complications, Cardiovascular/drug therapy
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy in Diabetics
- Supine Position
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Affiliation(s)
- C M Holgado
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Tarragona Juan XXIII, Tarragona, España.
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Manaf RA, Ismail IZ, Latiff LA. Contraceptive use among women with chronic medical conditions and factors associated with its non-use in Malaysia. Glob J Health Sci 2012; 4:91-9. [PMID: 22980381 PMCID: PMC4776942 DOI: 10.5539/gjhs.v4n5p91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/22/2012] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use. METHODS This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants. RESULTS A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77). CONCLUSION About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.
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Affiliation(s)
- Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia.
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Alonso Gómez AM, Comín J, Borrás X, del Castillo S, Elvira González A, Mazón P, Monserrat L, Pijuan A, Salvador Sanz A, Anguita M, Cequier A, Fernández-Ortiz A, Pan M, Worner F, Alonso Gómez AM, Comín J, Alonso C, Bardají A, Cobo M, García-Pavía P, González Costello J, Oliver JM, Pedreira M, Serrano JM, Subirana M, Tornos P. Comments on the ESC guidelines on the management of cardiovascular diseases during pregnancy. A critical vision of Spanish cardiology. Rev Esp Cardiol 2012; 65:113-8. [PMID: 22265198 DOI: 10.1016/j.recesp.2011.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 02/06/2023]
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Santiago-Díaz P, Arrebola-Moreno AL, Ramírez-Hernández JA, Melgares-Moreno R. Platelet antiaggregants in pregnancy. Rev Esp Cardiol 2010; 62:1197-8. [PMID: 19793530 DOI: 10.1016/s1885-5857(09)73339-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Manso B, Gran F, Pijuán A, Giralt G, Ferrer Q, Betrián P, Albert D, Rosés F, Rivas N, Parra M, Girona J, Farrán I, Casaldáliga J. Embarazo y cardiopatías congénitas. Rev Esp Cardiol 2008. [DOI: 10.1157/13116650] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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