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Gana N, Chatzakis C, Sarno M, Charakida M, Nicolaides KH. Evidence that systemic vascular resistance is increased before the development of gestational diabetes mellitus. Am J Obstet Gynecol 2024:S0002-9378(24)00879-2. [PMID: 39216812 DOI: 10.1016/j.ajog.2024.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/21/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The ophthalmic artery, which is the first branch of the internal carotid artery, has a Doppler velocity waveform with 2 systolic peaks. The ratio of the peak systolic velocity of the second wave divided by that of the first wave is used to reflect increased peripheral resistance. Previous studies in the first, second, and third trimesters of pregnancy have reported that in pregnant women who subsequently develop preeclampsia, the peak systolic velocity ratio is increased. Both preeclampsia and gestational diabetes mellitus are associated with endothelial dysfunction and an increased risk for cardiovascular diseases during the first decade after pregnancy. OBJECTIVE This study aimed to compare the ophthalmic artery peak systolic velocity ratio at 11 to 13 weeks' gestation of women who subsequently develop gestational diabetes mellitus with that of unaffected pregnant women and those who develop preeclampsia. STUDY DESIGN This was a prospective observational study of women who attended the King's College Hospital, London, United Kingdom, for a routine hospital visit at 11+0 to 13+6 weeks' gestation. This visit included recording of the maternal demographic characteristics and medical history, an ultrasound examination for fetal anatomy and growth, assessment of the flow velocity waveforms from the maternal ophthalmic arteries, calculation of the peak systolic velocity ratio, and measurement of the mean arterial pressure. Linear regression was performed to predict the ophthalmic artery peak systolic velocity ratio based on maternal characteristics and the mean arterial pressure. The peak systolic velocity ratio in the group with gestational diabetes mellitus was compared with that of preeclamptic and unaffected pregnancies. RESULTS A total of 3999 women were included in this study, including 375 (9.8%) who developed gestational diabetes mellitus and 101 (2.5%) who developed preeclampsia. In the gestational diabetes mellitus group, 161 (43.3%) were treated by diet alone, 130 (34.1%) were treated with metformin, and 84 (22.6%) received insulin with or without metformin. Prediction of peak systolic velocity ratio was provided by development of preeclampsia, maternal age, body mass index, mean arterial pressure, first-degree family history of diabetes mellitus, family history of preeclampsia, Asian ethnicity, and smoking. There was no significant contribution from gestational diabetes mellitus. Among women who developed gestational diabetes mellitus that required insulin treatment, the ophthalmic artery peak systolic velocity ratio (0.67±0.09) was higher (P<.001) than that in unaffected pregnancies (0.63±0.10), but it was not significantly different from that in the preeclampsia group (0.69±0.10; P=.90). CONCLUSION Among women who developed severe gestational diabetes mellitus that required insulin treatment, there was evidence of increased peripheral resistance, which was apparent from the first trimester of pregnancy.
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Affiliation(s)
- Nicoleta Gana
- Harris Birthright Research Centre for Fetal Medicine, King's College, London, United Kingdom
| | - Christos Chatzakis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Manoel Sarno
- Harris Birthright Research Centre for Fetal Medicine, King's College, London, United Kingdom; Department of Obstetrics and Gynecology, Federal University of Bahia, Bahia, Brazil
| | - Marietta Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College, London, United Kingdom.
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Panelli DM, Wang X, Mayo J, Wong RJ, Hong X, Becker M, Aghaeepour N, Druzin ML, Zuckerman BS, Stevenson DK, Shaw DrPH GM, Bianco K. Association of pregnancy complications and postpartum maternal leukocyte telomeres in two diverse cohorts: a nested case-control study. BMC Pregnancy Childbirth 2024; 24:490. [PMID: 39033276 PMCID: PMC11264806 DOI: 10.1186/s12884-024-06688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Biologic strain such as oxidative stress has been associated with short leukocyte telomere length (LTL), as well as with preeclampsia and spontaneous preterm birth, yet little is known about their relationships with each other. We investigated associations of postpartum maternal LTL with preeclampsia and spontaneous preterm birth. METHODS This pilot nested case control study included independent cohorts of pregnant people with singleton gestations from two academic institutions: Cohort 1 (hereafter referred to as Suburban) were enrolled prior to 20 weeks' gestation between 2012 and 2018; and Cohort 2 (hereafter referred to as Urban) were enrolled at delivery between 2000 and 2012. Spontaneous preterm birth or preeclampsia were the selected pregnancy complications and served as cases. Cases were compared with controls from each study cohort of uncomplicated term births. Blood was collected between postpartum day 1 and up to 6 months postpartum and samples were frozen, then simultaneously thawed for analysis. Postpartum LTL was the primary outcome, measured using quantitative polymerase chain reaction (PCR) and compared using linear multivariable regression models adjusting for maternal age. Secondary analyses were done stratified by mode of delivery and self-reported level of stress during pregnancy. RESULTS 156 people were included; 66 from the Suburban Cohort and 90 from the Urban Cohort. The Suburban Cohort was predominantly White, Hispanic, higher income and the Urban Cohort was predominantly Black, Haitian, and lower income. We found a trend towards shorter LTLs among people with preeclampsia in the Urban Cohort (6517 versus 6913 bp, p = 0.07), but not in the Suburban Cohort. There were no significant differences in LTLs among people with spontaneous preterm birth compared to term controls in the Suburban Cohort (6044 versus 6144 bp, p = 0.64) or in the Urban Cohort (6717 versus 6913, p = 0.37). No differences were noted by mode of delivery. When stratifying by stress levels in the Urban Cohort, preeclampsia was associated with shorter postpartum LTLs in people with moderate stress levels (p = 0.02). CONCLUSION Our exploratory results compare postpartum maternal LTLs between cases with preeclampsia or spontaneous preterm birth and controls in two distinct cohorts. These pilot data contribute to emerging literature on LTLs in pregnancy.
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Affiliation(s)
- Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Center for Academic Medicine, Obstetrics and Gynecology, MC 5317, 453 Quarry Road, Stanford, CA, 94304, USA.
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Departments of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan Mayo
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Center for Academic Medicine, Obstetrics and Gynecology, MC 5317, 453 Quarry Road, Stanford, CA, 94304, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Departments of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin Becker
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Computer Science and Electrical Engineering, University of Rostock, Rostock, Germany
| | - Nima Aghaeepour
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Maurice L Druzin
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Center for Academic Medicine, Obstetrics and Gynecology, MC 5317, 453 Quarry Road, Stanford, CA, 94304, USA
| | | | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary M Shaw DrPH
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine Bianco
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Center for Academic Medicine, Obstetrics and Gynecology, MC 5317, 453 Quarry Road, Stanford, CA, 94304, USA
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Saxon CE, Bast J, Chou JC. Short and long-term complications of hypertensive disorders of pregnancy: lifelong cardiovascular risks we cannot ignore. Curr Opin Cardiol 2024; 39:259-265. [PMID: 38386339 DOI: 10.1097/hco.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Hypertensive disorders of pregnancy (HDP) pose a significant threat to maternal cardiovascular health, with emerging research shedding light on the enduring risks beyond the gestational period. This review highlights updates regarding cardiovascular risks associated with HDP and their implications for long-term health. RECENT FINDINGS Patients with a history of HDP are at an elevated risk of developing chronic hypertension, ischemic heart disease, stroke, valvular heart disease, and heart failure.Not surprisingly, patients with HDP experience higher rates of maternal and fetal adverse events in the antepartum and immediate postpartum periods, with high readmission rates for cardiovascular complications. The high risk of chronic hypertension after a HDP then leads to the development of subclinical disease over 5-10 years with overt cardiovascular disease becoming most prevalent in the decades following pregnancy. Early hypertension management in the antepartum and postpartum periods has lifelong health benefits and highlights the need for seamless postpartum transitions with close blood pressure monitoring and cardiovascular risk mitigation. SUMMARY HDP significantly increases the risk of short and long-term adverse cardiovascular events. Integrated healthcare models that assess and address postpartum cardiovascular risk are necessary to improve the cardiovascular health and longevity of those effected by HDP.
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Affiliation(s)
| | - Julia Bast
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Burgess A, Deannuntis T, Wheeling J. Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy. MCN Am J Matern Child Nurs 2024; 49:194-203. [PMID: 38512155 DOI: 10.1097/nmc.0000000000001019] [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: 03/22/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. LOCAL PROBLEM At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. INTERVENTIONS A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. RESULTS A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). CONCLUSION Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.
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Reed T, Patil C, Kershaw KN, Crooks N, Jeremiah R, Park C. Prevalence of Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus by Race and Ethnicity in Illinois, 2018 to 2020. MCN Am J Matern Child Nurs 2024:00005721-990000000-00057. [PMID: 38865102 DOI: 10.1097/nmc.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE Use administrative discharge data from 2018 to 2020 to determine if there are differences in the prevalence of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) by race and ethnicity in Illinois. STUDY DESIGN AND METHODS This retrospective cross-sectional study used administrative discharge records from all patients who had live births in Illinois over a 3-year period; 2018, 2019, 2020. Multivariate analyses were performed to control for covariates and determine if associations vary by race and ethnicity for HDP and GDM. RESULTS A total of 287,250 discharge records were included. Multivariate analyses showed that after adjusting for covariates, non-Hispanic Black women had 1.60 increased odds of HDP compared to non-Hispanic White women (OR, 1.60; 95% CI, 1.55-1.65). Hispanic women (OR, 1.45; 95% CI, 1.40-1.50), Asian/Pacific Islander women (OR, 2.07; 95% CI, 1.97-2.17), and American Indian/Alaska Native women (OR, 1.43; 95% CI, 1.17-1.74) had an increased odds of GDM compared to non-Hispanic White women. CLINICAL IMPLICATIONS Women of color were at increased odds for HDP and GDM in Illinois. To eliminate poor maternal outcomes in women of color at risk for HDP and GDM, more culturally congruent health equity practices, policies, and comprehensive care interventions must be adopted.
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Staff AC, Costa ML, Dechend R, Jacobsen DP, Sugulle M. Hypertensive disorders of pregnancy and long-term maternal cardiovascular risk: Bridging epidemiological knowledge into personalized postpartum care and follow-up. Pregnancy Hypertens 2024; 36:101127. [PMID: 38643570 DOI: 10.1016/j.preghy.2024.101127] [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: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
Cardiovascular disease (CVD) is globally the leading cause of death and disability. Sex-specific causes of female CVD are under-investigated. Pregnancy remains an underinvestigated sex-specific stress test for future CVD and a hitherto missed opportunity to initiate prevention of CVD at a young age. Population-based studies show a strong association between female CVD and hypertensive disorders of pregnancy. This association is also present after other pregnancy complications that are associated with placental dysfunction, including fetal growth restriction, preterm delivery and gestational diabetes mellitus. Few women are, however, offered systematic cardio-preventive follow-up after such pregnancy complications. These women typically seek help from the health system at first clinical symptom of CVD, which may be decades later. By this time, morbidity is established and years of preventive opportunities have been missed out. Early identification of modifiable risk factors starting postpartum followed by systematic preventive measures could improve maternal cardiovascular health trajectories, promoting healthier societies. In this non-systematic review we briefly summarize the epidemiological associations and pathophysiological hypotheses for the associations. We summarize current clinical follow-up strategies, including some proposed by international and national guidelines as well as user support groups. We address modifiable factors that may be underexploited in the postpartum period, including breastfeeding and blood pressure management. We suggest a way forward and discuss the remaining knowledge gaps and barriers for securing the best evidence-based follow-up, relative to available resources after a hypertensive pregnancy complication in order to prevent or delay onset of premature CVD.
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Affiliation(s)
- Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, PB 1171, Blindern, 0381 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, PB 4956 Nydalen, 0424 Oslo, Norway.
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas/SP, Brazil
| | - Ralf Dechend
- HELIOS Clinic, Berlin, Germany; Experimental and Clinical Research Center, Charité Medical Faculty and Max-Delbrueck Center for Molecular Medicine, and HELIOS Clinic Berlin, Germany
| | - Daniel P Jacobsen
- Faculty of Medicine, University of Oslo, PB 1171, Blindern, 0381 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, PB 4956 Nydalen, 0424 Oslo, Norway
| | - Meryam Sugulle
- Faculty of Medicine, University of Oslo, PB 1171, Blindern, 0381 Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, PB 4956 Nydalen, 0424 Oslo, Norway
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Ushida T, Tano S, Imai K, Matsuo S, Kajiyama H, Kotani T. Postpartum and interpregnancy care of women with a history of hypertensive disorders of pregnancy. Hypertens Res 2024; 47:1457-1469. [PMID: 38467793 DOI: 10.1038/s41440-024-01641-7] [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: 10/24/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) are common complications associated with maternal and neonatal morbidity and mortality worldwide. Insights gained from long-term cohort studies have revealed that women with a history of HDP are predisposed to recurrent HDP in subsequent pregnancies and face heightened risks for cardiovascular and metabolic diseases later in life. Pregnancy is a unique condition that overloads maternal cardiac and metabolic functions, and is recognized as a "maternal stress test" for future cardiovascular and metabolic diseases. Pregnancy and postpartum period provide a valuable opportunity for identifying women with underlying and unrecognized cardiovascular and metabolic risk factors. Establishing an effective postpartum healthcare program for women who have experienced HDP is crucial in reducing the future risk of health complications. Postpartum care consists of supportive care for both mothers and children, including not only the assessment of physical and psychological well-being but also long-term postpartum preventive health management. Interpregnancy care is a continuum from postpartum care and includes supportive care to prepare for future pregnancies. Various initiatives across nations have been initiated to establish follow-up programs for women with a history of HDP; however, sufficient evidence of the impact of such programs is not available. Substantial challenges persist in establishing an efficient postpartum follow-up program, including educational strategies, selection of effective lifestyle interventions, and collaboration among various healthcare providers. This review outlines the postpartum and interpregnancy care of women who have experienced HDP as well as the current status and challenges of related healthcare initiatives in Japan.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Seiko Matsuo
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Choi ES, Jung YM, Kim D, Cho SE, Park ES, Park CW, Park JS, Jun JK, Lee SM. Long-term cardiovascular outcome in women with preeclampsia in Korea: a large population-based cohort study and meta-analysis. Sci Rep 2024; 14:7480. [PMID: 38553468 PMCID: PMC10980767 DOI: 10.1038/s41598-024-57858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Recent studies reported the long-term cardiovascular risk of preeclampsia. However, only a few studies have investigated the association between preeclampsia and long-term cardiovascular disease in Asian populations, although there could be racial/ethnic differences in the risk of cardiovascular diseases. Therefore, we aimed to evaluate the long-term effects of preeclampsia on cardiovascular disease in an Asian population. This study included 68,658 parous women in the Health Examinees Study (HEXA) cohort of South Korea and compared the risk of long-term cardiovascular disease, including ischemic heart disease and stroke, according to the history of preeclampsia. We also performed a meta-analysis combining current study data with data from existing literature in the Asian population. Among the study population, 3413 (5.23%) women had a history of preeclampsia, and 767 (1.12%) and 404 (0.59%) women developed ischemic heart disease and stroke for 22 years. Women with a history of preeclampsia were at a higher risk for both ischemic heart disease (adjusted hazard ratio 1.66 [1.19-2.04]) and stroke (adjusted hazard ratio 1.48 [1.02-2.16]) than those without. In the meta-analysis, the pooled hazard ratio of ischemic heart disease and stroke were also increased in women with a history of preeclampsia (ischemic heart disease 1.65 [1.51-1.82]; stroke 1.78 [1.52-2.10]).
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, College of Medicine, Guro Hospital, Korea University, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Dayoung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Su Eun Cho
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Eun Sun Park
- Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Bello NA, Cheng S. Where Do We Go From Here: Reflections on a Century in Women's Cardiovascular Health Research, 1924-2024. Circ Res 2024; 134:247-251. [PMID: 38300985 PMCID: PMC10836819 DOI: 10.1161/circresaha.123.323182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Saraf A. Echocardiographic Changes in Hypertensive Disorders of Pregnancy: Just Another Finding or a Clinical Outcomes Biomarker? JACC. ADVANCES 2024; 3:100728. [PMID: 38299036 PMCID: PMC10829941 DOI: 10.1016/j.jacadv.2023.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Anita Saraf
- Department of Medicine and Pediatrics, Adult Congenital Heart Disease Program, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- John G. Rangos Sr. Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania, USA
- Aging Institute of Pittsburgh, Bridgeside Point 1, Pittsburgh, Pennsylvania, USA
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McDougall HE, Yuan G, Olivier N, Tacey M, Langsford D. Multivariable risk model for postpartum re-presentation with hypertension: development phase. BMJ Open Qual 2023; 12:e002212. [PMID: 38154822 PMCID: PMC10759057 DOI: 10.1136/bmjoq-2022-002212] [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: 01/05/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Postpartum hypertension is one of the leading causes of re-presentation to hospital postpartum and is associated with adverse long-term cardiovascular risk. Postpartum blood pressure monitoring and management interventions have been shown to reduce hospital re-presentation, complications and long-term blood pressure control. Identifying patients at risk can be difficult as 40%-50% present with de novo postpartum hypertension. We aim to develop a risk model for postpartum re-presentation with hypertension using data readily available at the point of discharge. DESIGN A case-control study comparing all patients who re-presented to hospital with hypertension within 28 days post partum to a random sample of all deliveries who did not re-present with hypertension. Multivariable analysis identified risk factors and bootstrapping selected variables for inclusion in the model. The area under the receiver operator characteristic curve or C-statistic was used to test the model's discriminative ability. SETTING A retrospective review of all deliveries at a tertiary metropolitan hospital in Melbourne, Australia from 1 January 2016 to 30 December 2020. RESULTS There were 17 746 deliveries, 72 hypertension re-presentations of which 51.4% presented with de novo postpartum hypertension. 15 variables were considered for the multivariable model. We estimated a maximum of seven factors could be included to avoid overfitting. Bootstrapping selected six factors including pre-eclampsia, gestational hypertension, peak systolic blood pressure in the delivery admission, aspirin prescription and elective caesarean delivery with a C-statistic of 0.90 in a training cohort. CONCLUSION The development phase of this risk model builds on the three previously published models and uses factors readily available at the point of delivery admission discharge. Once tested in a validation cohort, this model could be used to identify at risk women for interventions to help prevent hypertension re-presentation and the short-term and long-term complications of postpartum hypertension.
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Affiliation(s)
| | - Grace Yuan
- Northern Health, Melbourne, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | | | - Mark Tacey
- Northern Health, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David Langsford
- The University of Melbourne, Parkville, Victoria, Australia
- Grampians Health, Ballarat, Victoria, Australia
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Kuwabara M, Fukuuchi T, Aoki Y, Mizuta E, Ouchi M, Kurajoh M, Maruhashi T, Tanaka A, Morikawa N, Nishimiya K, Akashi N, Tanaka Y, Otani N, Morita M, Miyata H, Takada T, Tsutani H, Ogino K, Ichida K, Hisatome I, Abe K. Exploring the Multifaceted Nexus of Uric Acid and Health: A Review of Recent Studies on Diverse Diseases. Biomolecules 2023; 13:1519. [PMID: 37892201 PMCID: PMC10604821 DOI: 10.3390/biom13101519] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
The prevalence of patients with hyperuricemia or gout is increasing worldwide. Hyperuricemia and gout are primarily attributed to genetic factors, along with lifestyle factors like consuming a purine-rich diet, alcohol and/or fructose intake, and physical activity. While numerous studies have reported various comorbidities linked to hyperuricemia or gout, the range of these associations is extensive. This review article focuses on the relationship between uric acid and thirteen specific domains: transporters, genetic factors, diet, lifestyle, gout, diabetes mellitus, metabolic syndrome, atherosclerosis, hypertension, kidney diseases, cardiovascular diseases, neurological diseases, and malignancies. The present article provides a comprehensive review of recent developments in these areas, compiled by experts from the Young Committee of the Japanese Society of Gout and Uric and Nucleic Acids. The consolidated summary serves to enhance the global comprehension of uric acid-related matters.
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Affiliation(s)
- Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, 2-2-2-Toranomon, Minato, Tokyo 105-8470, Japan
| | - Tomoko Fukuuchi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Itabashi, Tokyo 173-8605, Japan;
| | - Yuhei Aoki
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Takamatsu 761-0793, Kagawa, Japan;
| | - Einosuke Mizuta
- Department of Cardiology, Sanin Rosai Hospital, Yonago 683-8605, Tottori, Japan;
| | - Motoshi Ouchi
- Department of Health Promotion in Nursing and Midwifery, Innovative Nursing for Life Course, Graduate School of Nursing, Chiba University, Chiba 260-8672, Chiba, Japan;
- Department of Pharmacology and Toxicology, School of Medicine, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka 5454-8585, Osaka, Japan;
| | - Tatsuya Maruhashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Hiroshima, Japan;
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga 849-8501, Saga, Japan;
| | - Nagisa Morikawa
- Division of Cardio-Vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan;
- Department of Community Medicine, Kurume University School of Medicine, Kurume 830-0011, Fukuoka, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Hospital, Sendai 980-8574, Miyagi, Japan;
| | - Naoyuki Akashi
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Saitama, Japan;
| | - Yoshihiro Tanaka
- Division of Epidemiology, Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka 420-0881, Shizuoka, Japan;
| | - Naoyuki Otani
- Cardiovascular Center, Dokkyo Medical University Nikko Medical Center, Nikko 321-1298, Tochigi, Japan;
| | - Mihoko Morita
- Department of Hematology and Oncology, University of Fukui Hospital, Eiheiji 910-1193, Fukui, Japan;
| | - Hiroshi Miyata
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo, Tokyo 113-8655, Japan; (H.M.); (T.T.)
| | - Tappei Takada
- Department of Pharmacy, The University of Tokyo Hospital, Bunkyo, Tokyo 113-8655, Japan; (H.M.); (T.T.)
| | - Hiroshi Tsutani
- National Hospital Organization Awara Hospital, Awara 910-4272, Fukui, Japan;
| | - Kazuhide Ogino
- Department of Cardiology, Japanese Red Cross Tottori Hospital, Tottori 680-8517, Tottori, Japan;
| | - Kimiyoshi Ichida
- Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan;
| | - Ichiro Hisatome
- National Hospital Organization Yonago Medical Center, Yonago 683-0006, Tottori, Japan;
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Fukuoka, Japan;
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Docheva N, Woelkers D, Yao W, Jin Y, Espinoza J, Kunz L, Amegashie C, Gencay M, Harris J, Rana S. Racial differences in healthcare utilization among patients with suspected or diagnosed preeclampsia: A retrospective cohort study. Pregnancy Hypertens 2023; 33:8-16. [PMID: 37245376 DOI: 10.1016/j.preghy.2023.05.001] [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: 10/17/2022] [Revised: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To analyze healthcare resource utilization and severe maternal morbidity (SMM) in Black and White patients with preeclampsia diagnosis versus signs/symptoms. STUDY DESIGN This was a retrospective cohort study analyzing data from the IBM® Explorys Database between 7/31/2012-12/31/2020. Demographic, clinical, and laboratory data were extracted. Healthcare utilization and SMM were analyzed during the antepartum period (20 weeks of gestation until delivery) among Black and White patients with signs/symptoms of preeclampsia, with a diagnosis of preeclampsia, or neither (control). MAIN OUTCOME MEASURES Healthcare utilization and SMM in those with a preeclampsia diagnosis or signs/symptoms of preeclampsia only were compared with a control group (White patients with no preeclampsia diagnosis or signs/symptoms). RESULTS Data from 38,190 Black and 248,568 White patients were analyzed. Patients with preeclampsia diagnosis or signs/symptoms were more likely to visit the emergency room compared to those without diagnosis or signs/symptoms. Black patients with signs/symptoms of preeclampsia had the highest elevated risk (odds ratio [OR] = 3.4), followed by Black patients with a preeclampsia diagnosis (OR = 3.2), White patients with signs/symptoms (OR = 2.2), and White patients with a preeclampsia diagnosis (OR = 1.8). More Black patients experienced SMM (SMM rate 6.1% [Black with preeclampsia diagnosis] and 2.6% [Black with signs/symptoms]) than White patients (5.0% [White with preeclampsia diagnosis] and 2.0% [White with signs/symptoms]). SMM rates were higher for Black preeclampsia patients with severe features than for White preeclampsia patients with severe features (8.9% vs 7.3%). CONCLUSIONS Compared with White patients, Black patients had higher rates of antepartum emergency care and antepartum SMM.
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Affiliation(s)
- N Docheva
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, Chicago, IL, USA
| | - D Woelkers
- Department of Reproductive Medicine, University of California, San Diego, CA, USA
| | - W Yao
- Roche Diagnostics, Indianapolis, IN, USA
| | - Y Jin
- Roche Diagnostics, Indianapolis, IN, USA
| | - J Espinoza
- The Fetal Center at Children's Memorial Hermann Hospital and McGovern Medical School at the University of Texas, Houston, TX, USA
| | - L Kunz
- Roche Diagnostics, Indianapolis, IN, USA
| | - C Amegashie
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, Chicago, IL, USA
| | - M Gencay
- Roche Diagnostics, Indianapolis, IN, USA
| | - J Harris
- Roche Diagnostics, Indianapolis, IN, USA
| | - S Rana
- Department of Obstetrics and Gynecology/Division of Maternal Fetal Medicine, University of Chicago, Chicago, IL, USA.
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Casey H, Dennehy N, Fraser A, Lees C, McEniery C, Scott K, Wilkinson I, Delles C. Placental syndromes and maternal cardiovascular health. Clin Sci (Lond) 2023; 137:1211-1224. [PMID: 37606085 PMCID: PMC10447226 DOI: 10.1042/cs20211130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
The placental syndromes gestational hypertension, preeclampsia and intrauterine growth restriction are associated with an increased cardiovascular risk to the mother later in life. In this review, we argue that a woman's pre-conception cardiovascular health drives both the development of placental syndromes and long-term cardiovascular risk but acknowledge that placental syndromes can also contribute to future cardiovascular risk independent of pre-conception health. We describe how preclinical studies in models of preeclampsia inform our understanding of the links with later cardiovascular disease, and how current pre-pregnancy studies may explain relative contributions of both pre-conception factors and the occurrence of placental syndromes to long-term cardiovascular disease.
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Affiliation(s)
- Helen Casey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Natalie Dennehy
- Chelsea and Westminster NHS Foundation Trust, London, England, U.K
| | - Abigail Fraser
- Department of Population Health Sciences, Bristol Medical School, and the MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, U.K
| | - Christoph Lees
- Chelsea and Westminster NHS Foundation Trust, London, England, U.K
| | - Carmel M. McEniery
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, England, U.K
| | - Kayley Scott
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
| | - Ian B. Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, England, U.K
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, U.K
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Hussien NA, Shuaib N, Baraia ZA, Laradhi AO, Wang W, Zhang Z. Perceived Cardiovascular Disease Risk Following Preeclampsia: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2356. [PMID: 37628554 PMCID: PMC10454291 DOI: 10.3390/healthcare11162356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Preeclampsia has been linked to an increased risk of cardiovascular disease (CVD), and the preeclamptic women were unaware of this link. Therefore, this study aims to assess women's knowledge and perception of future CVD after preeclampsia. This study used a cross-sectional descriptive design. Two hundred and forty-six women with a preeclampsia history were recruited from the Al Salam MCH Center and Suez Canal University Hospital. Data were collected during March 2022 using a socio-demographic questionnaire, an Adapted Coronary Heart disease knowledge tool for preeclamptic women, and The Perception of Risk of Heart Disease Scale (PRHDS). Most women (96%) were unaware of the relationship between CVD and preeclampsia. The women had a low CVD knowledge level (10.26 ± 6.08) as well as a low perception of cardiovascular disease risk (37.15 ± 7.22). There was a significant positive correlation between CVD knowledge and CVD risk perception (r = 0.434, p = 0.000). This study found that preeclampsia survivors underestimated their CVD risk. Based on these findings, preeclamptic women should receive health education sessions on CVD risk and prevention from their nurses and obstetricians. The hospital pre-discharge plan must contain these sessions in written and electronic formats to help women remember and follow CVD risk reduction measures.
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Affiliation(s)
- Nahed Ahmed Hussien
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
- Faculty of Nursing, Suez Canal University, Ismailia 41522, Egypt;
| | - Nazia Shuaib
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | | | - Adel Omar Laradhi
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | - Wenna Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (N.A.H.); (N.S.); (A.O.L.); (W.W.)
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Brown CE, Casey H, Dominiczak AF, Kerr S, Campbell A, Delles C. Impact of preeclampsia on cardiovascular events: An analysis of the Generation Scotland: Scottish family health study. J Hum Hypertens 2023; 37:735-741. [PMID: 36973315 PMCID: PMC10403345 DOI: 10.1038/s41371-023-00812-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/14/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023]
Abstract
Preeclampsia is a recognised cause of an increased risk of major adverse cardiovascular events when compared to the background risk in women who did not have hypertensive disorders during pregnancy. The Generation Scotland: Scottish Family Health Study (GS:SFHS) is a population cohort of more than 20,000 members of the Scottish population. Using the Scottish Morbidity Records, we linked the women in the GS:SFHS cohort to validated maternity and inpatient admission data. This allowed us to robustly identify cardiovascular outcomes in the form of inpatient admission for cardiovascular events, We also aimed to explore the risk of pregnancy on future cardiovascular events, using data from nulliparous and parous women.In total, 9732 women were selected. 3693 women were nulliparous, and after study exclusion, 5253 women with 9583 pregnancies remained. Pregnancies from 1980 until the end of the study period of 1st of July 2013 were included. Cardiovascular events occurred in 9.0% of nulliparous women, 4.2% of women with pregnancies and in 7.6% of women with a history of preeclampsia. A total of 218 parous women experienced cardiovascular events, 25 in the preeclampsia group and 193 in the normotensive group.Survival analysis was undertaken, with index pregnancy taken as first pregnancy in normotensive controls and first preeclampsia pregnancy in cases. Endpoint of interest was admission to hospital with first cardiovascular event. After further exclusions a total of 169 cardiovascular events occurred in the normotensive pregnancy group and 20 in the preeclampsia group. Women with a history of preeclampsia were more likely to have cardiovascular events later in life than women with normotensive deliveries., This was statistically significantly different on Kaplan Meier survival analysis, (log rank Mantel-Cox p-value < 0.001). The women in our study were middle-aged, within 33 years of pregnancy, with a mean age of 53 years in the preeclampsia cardiovascular events group.Our study supports the urgent need for uniform guidelines and implementation to improve the health in women with this medical history. Increased awareness among the public of the cardiovascular risk associated with PE is vital to aid uptake of cardiovascular prevention programmes.
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Affiliation(s)
- Catriona E Brown
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Helen Casey
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK.
| | - Anna F Dominiczak
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Shona Kerr
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK.
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Siu SC, Lee DS, Fang J, Austin PC, Silversides CK. New Hypertension After Pregnancy in Patients With Heart Disease. J Am Heart Assoc 2023; 12:e029260. [PMID: 37158089 PMCID: PMC10227309 DOI: 10.1161/jaha.122.029260] [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: 12/23/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
Background After pregnancy, patients with preexisting heart disease are at high risk for cardiovascular complications. The primary objective was to compare the incidence of new hypertension after pregnancy in patients with and without heart disease. Methods and Results This was a retrospective matched-cohort study comparing the incidence of new hypertension after pregnancy in 832 patients who are pregnant with congenital or acquired heart disease to a comparison group of 1664 patients who are pregnant without heart disease; matching was by demographics and baseline risk for hypertension at the time of the index pregnancy. We also examined whether new hypertension was associated with subsequent death or cardiovascular events. The 20-year cumulative incidence of hypertension was 24% in patients with heart disease, compared with 14% in patients without heart disease (hazard ratio [HR], 1.81 [95% CI, 1.44-2.27]). The median follow-up time at hypertension diagnosis in the heart disease group was 8.1 years (interquartile range, 4.2-11.9 years). The elevated rate of new hypertension was observed not only in patients with ischemic heart disease, but also in those with left-sided valve disease, cardiomyopathy, and congenital heart disease. Pregnancy risk prediction methods can further stratify risk of new hypertension. New hypertension was associated with an increased rate of subsequent death or cardiovascular events (HR, 1.54 [95% CI, 1.05-2.25]). Conclusions Patients with heart disease are at higher risk for developing hypertension in the decades after pregnancy when compared with those without heart disease. New hypertension in this young cohort is associated with adverse cardiovascular events highlighting the importance of systematic and lifelong surveillance.
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Affiliation(s)
- Samuel C. Siu
- Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease ProgramTorontoCanada
- Maternal Cardiology Program, Division of CardiologyDepartment of MedicineSchulich School of Medicine and DentistryLondonOntarioCanada
- ICESTorontoOntarioCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoOntarioCanada
| | - Douglas S. Lee
- ICESTorontoOntarioCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | | | - Peter C. Austin
- ICESTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | - Candice K. Silversides
- Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease ProgramTorontoCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoOntarioCanada
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Druyan B, Platner M, Jamieson DJ, Boulet SL. Severe Maternal Morbidity and Postpartum Readmission Through 1 Year. Obstet Gynecol 2023; 141:949-955. [PMID: 37103535 DOI: 10.1097/aog.0000000000005150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To conduct a cohort study to estimate risk for readmission through 1 year postpartum and the most common readmission diagnoses for individuals with and without severe maternal morbidity (SMM) at delivery. METHODS Using national health care claims data from IBM MarketScan Commercial Research Databases (now known as Merative), we identified all delivery hospitalizations for continuously enrolled individuals 15-49 years of age that occurred between January 1, 2016, and December 31, 2018. Severe maternal morbidity at delivery was identified using diagnosis and procedure codes. Individuals were followed for 365 days after delivery discharge, and cumulative readmission rates were calculated for up to 42 days, up to 90 days, up to 180 days, and up to 365 days. We used multivariable generalized linear models to estimate adjusted relative risks (aRR), adjusted risk differences, and 95% CIs for the association between readmission and SMM at each of the timepoints. RESULTS The study population included 459,872 deliveries; 5,146 (1.1%) individuals had SMM during the delivery hospitalization, and 11,603 (2.5%) were readmitted within 365 days. The cumulative incidence of readmission was higher in individuals with SMM than those without at all timepoints (within 42 days: 3.5% vs 1.2%, aRR 1.44, 95% CI 1.23-1.68; within 90 days: 4.1% vs 1.4%, aRR 1.46, 95% CI 1.26-1.69); within 180 days: 5.0% vs 1.8%, aRR 1.48, 95% CI 1.30-1.69; within 365 days: 6.4% vs 2.5%, aRR 1.44, 95% CI 1.28-1.61). Sepsis and hypertensive disorders were the most common reason for readmission within 42 and 365 days for individuals with SMM (35.2% and 25.8%, respectively). CONCLUSION Severe maternal morbidity at delivery was associated with increased risk for readmission throughout the year after delivery, a finding that underscores the need for heightened awareness of risk for complications beyond the traditional 6-week postpartum period.
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Affiliation(s)
- Brian Druyan
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; and the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Zulhijayanti NA, Ernawati E, Akbar MIA. A retrospective cohort study of hypertension, cardiovascular disease, and metabolic syndrome risk in women with history of preterm and term preeclampsia five years after delivery. Pregnancy Hypertens 2023; 32:57-63. [PMID: 37104925 DOI: 10.1016/j.preghy.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES To evaluate maternal hypertension, risk of cardiovascular disease (CVD), and metabolic syndrome five years after delivery in preterm preeclampsia (P-PE), term preeclampsia (T-PE), and normal pregnancy. STUDY DESIGN This was a retrospective cohort study of women who delivered at Dr. Soetomo Academic Hospital (Indonesia) in 2013 with a diagnosis of PE and were compared with women with normal pregnancies. MAIN OUTCOMES MEASURES Blood pressure, National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome (NCE-ATP III), and Framingham Risk Score (FRS). RESULTS In this study, 92 women participated. They were divided into the P-PE (27), T-PE (35), and control groups (30). Women with a history of PE, P-PE, or T-PE had higher blood pressure five years after delivery than those in the control group (p < 0.05). Systolic blood pressure (SBP) >140 mmHg was seen in 66.7% of P-PE and 25.7% of T-PE, while 55.6% of P-PE and 34.3% of T-PE had diastolic blood pressure (DBP) >90 mmHg (p < 0.05). Women with P-PE had the highest risk of developing hypertension (Relative risk (RR): 20; 95% Confidence interval [CI]: 2.85-139.92). Women with history of P-PE (RR: 1.85; 95% CI: 0.77-4.41), T-PE (RR: 1.28; 95% CI: 0.51-3.19), and total PE (RR: 1.53; 95% CI: 0.68-3.43) had an increased risk of positive NECP-ATP III five years after delivery. Women with history of P-PE (RR: 5.17; 95% CI: 0.26-103.22; p = 0.282) and T-PE (RR: 6.03; 95% CI: 0.32-112.22; p = 0.228) are at a greater risk of having an FRS >10% compared to the control group (p = 0.04). CONCLUSIONS History of PE, P-PE, and T-PE increased the risk of hypertension and CVD five years after delivery. The results also showed a tendency toward an increased risk of metabolic syndrome in women with a previous history of PE and P-PE.
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Affiliation(s)
- Noor Assyifa Zulhijayanti
- Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Obstetrics and Gynecology, Universitas Airlangga Academic Hospital, Surabaya, East Java, Indonesia
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Galbally M, Watson SJ, Spigset O. Depression and antidepressant treatment in the development of hypertensive disorders of pregnancy: Results from a prospective cohort study. Aust N Z J Psychiatry 2023; 57:520-527. [PMID: 35786007 DOI: 10.1177/00048674221106915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are associated with longer term cardiovascular risk. Understanding if depression or antidepressant use in pregnancy is associated with HDP is important in identifying those potentially vulnerable to poorer health in later life. This study examines if depression and antidepressants are associated with HDP. METHODS In all, 815 pregnant women were recruited within an Australian pregnancy cohort study at less than 20 weeks of pregnancy, all undertook the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and were assigned to four groups for this paper: those with unmedicated depression meeting criteria for current depression (n = 97), those taking selective serotonin reuptake inhibitors in early pregnancy (n = 101), those taking serotonin and noradrenaline reuptake inhibitors in early pregnancy (n = 31), and those without depression or taking antidepressant medication (control; n = 586). Women were then assessed again following birth. Hypertensive disorders of pregnancy were diagnosed according to the Society of Obstetric Medicine in Australia and New Zealand Guidelines. RESULTS Use of serotonin and noradrenaline reuptake inhibitors (SNRIs) (adjusted risk ratio = 9.10, 95% confidence interval = [3.82, 21.67]) and unmedicated depression (adjusted risk ratio = 3.11, 95% confidence interval = [1.32, 7.35]) were independently associated with significantly higher risk for developing hypertensive disorders of pregnancy compared to controls. Selective serotonin reuptake inhibitors (SSRIs) use did not confer any increased risk. Higher doses of SNRIs, but not selective serotonin reuptake inhibitors, were associated with significantly higher risk for developing HDP (adjusted risk ratio = 4.83, 95% confidence interval = [1.50, 15.58]). CONCLUSIONS Our findings suggest that those with depression in pregnancy and/or on an serotonin and noradrenaline reuptake inhibitor should have closer surveillance for the development of hypertensive disorders of pregnancy. These findings support treatment of depression in pregnancy, however, also the consideration of class of antidepressant.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Stuart J Watson
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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22
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Mureddu GF. How much does hypertension in pregnancy affect the risk of future cardiovascular events? Eur Heart J Suppl 2023; 25:B111-B113. [PMID: 37091660 PMCID: PMC10120948 DOI: 10.1093/eurheartjsupp/suad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Hypertensive disorders in pregnancy (HDP) include essential (or secondary) hypertension occurring before 20 weeks of gestation or in women already on antihypertensive therapy prior to pregnancy, gestational hypertension, developing after 20 weeks of gestation without significant proteinuria, and pre-eclampsia or AH onset after 20 weeks of pregnancy in the presence of proteinuria. The development of HDP is associated with a higher incidence of long-term cardiovascular (CV) adverse events, such as myocardial infarction, heart failure, stroke, and CV death. Women who develop high blood pressure in their first pregnancy have an increased risk of complication in a subsequent pregnancy. In the years following delivery, pregnant women with hypertensive disorders develop subclinical atherosclerosis and alterations of cardiac structure and function that may lead to CV disease and heart failure. Thus, it is recommended to monitor these changes over time and subject in pregnant women with these characteristics to CV surveillance through structured and multidisciplinary interventions for CV prevention.
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Affiliation(s)
- Gian Francesco Mureddu
- Cardiac Rehabilitation Unit, Cardio-Thoraco-Vascular Department, San Giovanni Addolorata Hospital, Rome
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23
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Nurkkala J, Kauko A, FinnGen, Laivuori H, Saarela T, Tyrmi JS, Vaura F, Cheng S, Bello NA, Aittokallio J, Niiranen T. Associations of polygenic risk scores for preeclampsia and blood pressure with hypertensive disorders of pregnancy. J Hypertens 2023; 41:380-387. [PMID: 36947680 PMCID: PMC9894151 DOI: 10.1097/hjh.0000000000003336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Preexisting hypertension increases risk for preeclampsia. We examined whether a generic blood pressure polygenic risk score (BP-PRS), compared with a preeclampsia-specific polygenic risk score (PE-PRS), could better predict hypertensive disorders of pregnancy. METHODS Our study sample included 141 298 genotyped FinnGen study participants with at least one childbirth and followed from 1969 to 2021. We calculated PRSs for SBP and preeclampsia using summary statistics for greater than 1.1 million single nucleotide polymorphisms. RESULTS We observed 8488 cases of gestational hypertension (GHT) and 6643 cases of preeclampsia. BP-PRS was associated with GHT [multivariable-adjusted hazard ratio for 1SD increase in PRS (hazard ratio 1.38; 95% CI 1.35-1.41)] and preeclampsia (1.26, 1.23-1.29), respectively. The PE-PRS was also associated with GHT (1.16; 1.14-1.19) and preeclampsia (1.21, 1.18-1.24), but with statistically more modest magnitudes of effect (P = 0.01). The model c-statistic for preeclampsia improved when PE-PRS was added to clinical risk factors (P = 4.6 × 10-15). Additional increment in the c-statistic was observed when BP-PRS was added to a model already including both clinical risk factors and PE-PRS (P = 1.1 × 10-14). CONCLUSION BP-PRS is strongly associated with hypertensive disorders of pregnancy. Our current observations suggest that the BP-PRS could capture the genetic architecture of preeclampsia better than the current PE-PRSs. These findings also emphasize the common pathways in the development of all BP disorders. The clinical utility of a BP-PRS for preeclampsia prediction warrants further investigation.
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Affiliation(s)
- Jouko Nurkkala
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital
- Department of Anesthesiology and Intensive Care
| | - Anni Kauko
- Department of Internal Medicine, University of Turku, Turku
| | | | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Tanja Saarela
- Department of Clinical Genetics, Kuopio University Hospital, Kuopio
| | - Jaakko S. Tyrmi
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Felix Vaura
- Department of Internal Medicine, University of Turku, Turku
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Cardiology Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalie A. Bello
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jenni Aittokallio
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital
- Department of Anesthesiology and Intensive Care
| | - Teemu Niiranen
- Department of Internal Medicine, University of Turku, Turku
- Division of Medicine, Turku University Hospital
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland
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He D, Peng X, Xie H, Peng R, Li Q, Guo Y, Wang W, He H, Chen Y. Genetic Variations in Angiotensinogen Gene and Risk of Preeclampsia: A Pilot Study. J Clin Med 2023; 12:jcm12041509. [PMID: 36836041 PMCID: PMC9966751 DOI: 10.3390/jcm12041509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Preeclampsia (PE) is a typical hypertensive disorders of pregnancy (HDP) which can cause substantial morbidity and mortality in both pregnant women and fetuses. The renin-angiotensin system (RAS) genes are the main HDP-causing genes, and Angiotensinogen (AGT) as the initial substrate can directly reflect the activity of the entire RAS. However, the association between AGT SNPs and PE risk has rarely been confirmed. This study was carried out to determine whether AGT SNPs could affect the risk of PE in 228 cases and 358 controls. The genotyping result revealed that the AGT rs7079 TT carrier was related to increased PE risk. Further stratified analysis illustrated that the rs7079 TT genotype significantly increased the PE risk in subgroups of Age < 35, BMI < 25, Albumin (ALB) ≥ 30 and Aspartate aminotransferase (AST) < 30. These findings demonstrated that the rs7079 might be a promising candidate SNP strongly associated with PE susceptibility.
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Affiliation(s)
- Dong He
- Guangdong Provincial Key Laboratory of Pathogenesis of Heart and Spleen and Prescription Drugs Research, Department of Pharmacology, School of Chinese Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Xianglan Peng
- Department of Obstetrics and Gynecology, Department of Gynecologic Oncology Research Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Hongkai Xie
- Guangdong Provincial Key Laboratory of Pathogenesis of Heart and Spleen and Prescription Drugs Research, Department of Pharmacology, School of Chinese Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Rui Peng
- Department of Obstetrics and Gynecology, Department of Gynecologic Oncology Research Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Qixuan Li
- Department of Obstetrics and Gynecology, Department of Gynecologic Oncology Research Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Yitong Guo
- Guangdong Provincial Key Laboratory of Pathogenesis of Heart and Spleen and Prescription Drugs Research, Department of Pharmacology, School of Chinese Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Wei Wang
- Guangdong Provincial Key Laboratory of Pathogenesis of Heart and Spleen and Prescription Drugs Research, Department of Pharmacology, School of Chinese Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Hong He
- Department of Obstetrics and Gynecology, Department of Gynecologic Oncology Research Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
- Correspondence: (H.H.); (Y.C.)
| | - Yang Chen
- Guangdong Provincial Key Laboratory of Pathogenesis of Heart and Spleen and Prescription Drugs Research, Department of Pharmacology, School of Chinese Pharmaceutical Science, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- Correspondence: (H.H.); (Y.C.)
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25
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Chen Q, Wang Y, Tang HR, Wang Y, Gu AH, Zhai XJ, Zheng MM. Cumulative effects of temperature on blood pressure during pregnancy: A cohort study of differing effects in three trimesters. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 859:160143. [PMID: 36375544 DOI: 10.1016/j.scitotenv.2022.160143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Little is known about the non-linear cumulative effects of temperature on blood pressure (BP) during pregnancy. We investigated the differing effects of daily ambient temperature on BP for up to 30 days in three trimesters. METHODS The first, second, and third trimester analyses included 2547, 2299, and 2011 pregnant women, respectively, from a prospective cohort in Nanjing from January 2017 to January 2020. BP was measured at each follow-up visit. The individual daily temperature exposures were calculated for 30 days prior to the follow-up date. The Distributed Lag Non-linear Model was used to investigate the relationship between temperature and BP in each trimester. RESULTS Temperatures under 15 °C elevate systolic, diastolic BP, and mean arterial pressure (SBP, DBP, and MAP) in the first trimester, while temperatures above 15 °C reduce SBP in the second and third trimesters. By using Distributed Lag Linear Models, we estimated that with a 1 °C decrease in daily temperature, the SBP and DBP increased by 0.32 (95 % CI: 0.12, 0.52) and 0.23 (95 % CI: 0.07, 0.39) mmHg, respectively, in the first trimester with a 20-day cumulative lag, while with a 1 °C increase in daily temperature, the SBP decreased by 0.23 (0.35, 0.10) mmHg in the third trimester with a 30-day cumulative lag. The significant effects of temperature mainly manifested between 2 and 4 weeks of exposure. CONCLUSIONS Temperature has different effects on BP over three trimesters. Protective measures to reduce cold-related BP rise will help reduce the risk of hypertensive disorders of pregnancy.
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Affiliation(s)
- Qi Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Ya Wang
- Center for Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Hui-Rong Tang
- Center for Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Yuan Wang
- Center for Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China
| | - Ai-Hua Gu
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Xiang-Jun Zhai
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
| | - Ming-Ming Zheng
- Center for Obstetrics and Gynecology, The Affiliated Drum and Tower Hospital of Medical School of Nanjing University, Nanjing, China.
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26
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Ling HZ, Guy G, Nicolaides KH, Kametas NA. Longitudinal maternal cardiac function in hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM 2023; 5:100824. [PMID: 36464241 DOI: 10.1016/j.ajogmf.2022.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Compared with gestational hypertension, preeclampsia has traditionally been considered the worse end of the spectrum of hypertensive disorders of pregnancy. It is associated with worse pregnancy outcomes and future cardiovascular morbidities. Both hypertensive disorders may be associated with cardiac maladaptation in pregnancy. However, previous studies were limited by small numbers and a paucity of longitudinal data and unaccounted for the contribution of maternal characteristics that can affect hemodynamics. OBJECTIVE This study aimed to assess, in an unselected population, the maternal cardiac adaptation in normotensive and hypertensive pregnancies after controlling for important maternal characteristics that affect maternal cardiac function and the interaction among these covariates. STUDY DESIGN This was a prospective, multicenter longitudinal study of maternal hemodynamics, assessed by a noninvasive bioreactance technology, measured at 11 0/7 to 13 6/7, 19 0/7 to 24 0/7, 30 0/7 to 34 0/7, and 35 0/7 to 37 0/7 weeks of gestation in 3 groups of women. Group 1 was composed of women with preeclampsia (n=45), group 2 was composed of women with gestational hypertension (n=61), and group 3 was composed of normotensive women (n=1643). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal age, height, weight, weight gain, race, previous obstetrical history, and birthweight. RESULTS After adjusting for confounders that significantly affect maternal hemodynamics, both group 1 and group 2, compared with group 3, had pathologic cardiac adaptation. Group 1, compared with group 3, demonstrated hyperdynamic circulation with significantly higher cardiac output driven by greater stroke volume in the first trimester of pregnancy. As the pregnancies progressed to after 20 0/7 weeks of gestation, this hyperdynamic state transitioned to hypodynamic state with low cardiac output and high peripheral vascular resistance. Group 2, compared with group 3, had no significant differences in cardiac output, stroke volume, and heart rate before 20 0/7 weeks of gestation but thereafter demonstrated a continuous decline in cardiac output and stroke volume, similar to group 1. Both groups 1 and 2, compared with group 3, had persistently elevated mean arterial pressure and uterine artery pulsatility index throughout pregnancy. CONCLUSION After adjusting for confounders that affect maternal hemodynamics in an unselected pregnant population, women with preeclampsia and gestational hypertension, compared with normotensive women, demonstrated similar cardiac maladaptation. This pathologic profile was evident after 20 0/7 weeks of gestation and at least 10 weeks before the clinical manifestation of the disease.
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Affiliation(s)
- Hua Zen Ling
- Fetal Medicine Research Institute, King's College London, Denmark Hill, London
| | - Gavin Guy
- Fetal Medicine Research Institute, King's College London, Denmark Hill, London
| | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College London, Denmark Hill, London
| | - Nikos A Kametas
- Fetal Medicine Research Institute, King's College London, Denmark Hill, London.
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27
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Fitzgerald AC, Kaimal AJ, Little SE. Cost-effectiveness of induction of labor at 39 weeks vs expectant management by cervical examination. Am J Obstet Gynecol 2023:S0002-9378(23)00014-5. [PMID: 36642340 DOI: 10.1016/j.ajog.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous analyses have demonstrated the cost effectiveness of elective induction of labor at 39 weeks of gestation for healthy nulliparous people. However, elective induction of labor is resource intensive, and optimal resource allocation requires a thorough understanding of which subgroups of patients will benefit most. OBJECTIVE This study aimed to determine whether induction of labor at 39 weeks of gestation is more cost-effective in patients with favorable or unfavorable cervical examinations. STUDY DESIGN We constructed 2 decision analysis models using TreeAge software: one modeling induction of labor at 39 weeks of gestation vs expectant management for a group of nulliparous patients with unfavorable cervical examinations and the other modeling induction of labor at 39 weeks of gestation vs expectant management for a group with favorable cervical examinations. Estimates of cost, probability, and health state utility were derived from the literature. Based on previous literature, we assumed that people with favorable cervical examinations would have a lower baseline rate of cesarean delivery and higher rates of spontaneous labor. RESULTS In our base case analysis, induction of labor at 39 weeks of gestation was cost-effective for patients with unfavorable cervical examinations, but not for patients with favorable cervical examinations. The incremental cost per quality-adjusted life year was 50-fold lower for people with unfavorable cervical examinations ($2150 vs $115,100). Induction of labor resulted in 3885 fewer cesarean deliveries and 58 fewer stillbirths per 100,000 patients for those with unfavorable examinations, whereas induction of labor resulted in 2293 fewer cesarean deliveries and 48 fewer stillbirths with labor induction for those with favorable cervical examinations. The results were sensitive to multiple inputs, including the likelihood of cesarean delivery, the cost of induction, the cost of vaginal or cesarean delivery, and the probability of spontaneous labor. In Monte Carlo analysis, the base case findings held true for 64.1% of modeled scenarios for patients with unfavorable cervixes and 55.4% of modeled scenarios for patients with favorable cervixes. CONCLUSION With a willingness-to-pay threshold of $100,000 per quality-adjusted life year, induction of labor at 39 weeks of gestation may be cost-effective for patients with unfavorable cervical examinations, but not for patients with favorable cervical examinations. This result was driven by the likelihood of labor in patients with favorable cervical examinations, and the resultant avoidance of prolonged pregnancy and its complications, including hypertensive disorders of pregnancy and stillbirths. Health systems may wish to prioritize patients with unfavorable cervical examinations for elective induction of labor at 39 weeks of gestation, which may be opposite to common practice.
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Affiliation(s)
- Alison C Fitzgerald
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
| | - Anjali J Kaimal
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Sarah E Little
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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28
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Stanhope KK, Levinson AN, Stallworth CT, Leruth S, Clevenger E, Master M, Dunlop AL, Boulet SL, Jamieson DJ, Blake S. A Qualitative Study of Perceptions, Strengths, and Opportunities in Cardiometabolic Risk Management During Pregnancy and Postpartum in a Georgia Safety-Net Hospital, 2021. Prev Chronic Dis 2022; 19:E68. [PMID: 36302381 PMCID: PMC9616128 DOI: 10.5888/pcd19.220059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Despite the strong link between cardiometabolic pregnancy complications and future heart disease, there are documented gaps in engaging those who experience such conditions in recommended postpartum follow-up and preventive care. The goal of our study was to understand how people in a Medicaid-insured population perceive and manage risks during and after pregnancy related to an ongoing cardiometabolic disorder. METHODS We conducted in-depth qualitative interviews with postpartum participants who had a cardiometabolic conditions during pregnancy (chronic or gestational diabetes, chronic or gestational hypertension, or preeclampsia). We recruited postpartum participants from a single safety-net hospital system in Atlanta, Georgia, and conducted virtual interviews during January through May 2021. We conducted a content analysis guided by the Health Belief Model and present themes related to risk management. RESULTS From the 28 interviews we conducted, we found that during pregnancy, advice and intervention by the clinical care team facilitated management behaviors for high-risk conditions. However, participants described limited understanding of how pregnancy complications might affect future outcomes, and few described engaging in postpartum management behaviors. CONCLUSION Improving continuity and content of care during postpartum may improve uptake of preventive behaviors among postpartum patients at risk of heart disease.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Dr SE, Atlanta, GA 30303.
| | | | | | - Sophie Leruth
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Emma Clevenger
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Margaret Master
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anne L Dunlop
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Sarah Blake
- Emory University Rollins School of Public Health, Atlanta, Georgia
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29
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Anzoategui S, Gibbone E, Wright A, Nicolaides KH, Charakida M. Midgestation cardiovascular phenotype in women who develop gestational diabetes and hypertensive disorders of pregnancy: comparative study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:207-214. [PMID: 35502146 DOI: 10.1002/uog.24929] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Women with gestational diabetes mellitus (GDM) and/or hypertensive disorders of pregnancy (HDP) are at increased long-term cardiovascular risk. Mild cardiac functional alterations have been detected in women with GDM or HDP in midgestation, prior to clinical onset of the disease, but these functional alterations have not been found to be useful as screening tools. In contrast, increased impedance to peripheral blood flow, measured by echocardiography or ophthalmic artery Doppler, has been shown to provide incremental value to maternal characteristics for the prediction of pre-eclampsia. However, it is unknown whether similar changes can be detected in women at risk of GDM. In this study, we performed detailed cardiovascular phenotyping in a large, unselected population of women in midgestation to identify similarities and differences in cardiovascular adaptation in women who are at risk of GDM and/or HDP. METHODS This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries, echocardiography for assessment of maternal cardiovascular function and measurement of uterine artery pulsatility index and serum placental growth factor (PlGF) for assessment of placental perfusion and function. The measured indices were converted to either multiples of the median (MoM) values or deviation from the median (delta) after adjusting for maternal characteristics and elements of medical history. Biomarker delta or MoM values in the GDM and HDP groups were compared with those in the unaffected group using 95% CI and t-tests. RESULTS The study population of 5214 pregnancies contained 4429 (84.9%) that were unaffected by GDM or HDP, 509 (9.8%) complicated by GDM without HDP, 41 (0.8%) with GDM and HDP, and 235 (4.5%) with HDP without GDM. In HDP cases, with or without GDM, there was evidence of impaired placentation, with a decrease in PlGF, and increased impedance to flow in the peripheral circulation, suggested by an increase in ophthalmic artery peak systolic velocity (PSV) ratio, peripheral vascular resistance assessed on echocardiography and mean arterial pressure. In the GDM group without HDP, there was no evidence of altered placental perfusion or function and ophthalmic artery PSV ratio was not significantly different from that in the unaffected group; peripheral vascular resistance and mean arterial pressure were increased but to a lesser degree than in the HDP group. In the HDP group, there was an increase in global longitudinal systolic strain and slight increase in isovolumic relaxation time, while in the GDM group, there was an increase in mitral valve E/e', myocardial performance index and global longitudinal systolic strain. CONCLUSIONS In midgestation, women who subsequently develop HDP or GDM have a mild subclinical reduction in left ventricular function. In HDP cases, with or without GDM, there is evidence of impaired placentation and all biomarkers of impedance to peripheral blood flow are consistently increased. In contrast, in the GDM group without HDP, biomarkers of placental function are normal and those of impedance to peripheral blood flow are either marginally increased or not significantly different from those in normal pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Anzoategui
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Gibbone
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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30
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Santoyo JM, Noguera JA, Avilés F, Delgado JL, de Paco-Matallana C, Pérez V, Hernández I. Factors Involved in Endothelial Dysfunction Related to Angiogenic Disbalance and Oxidative Stress, in Women at High Risk of Term Pre-Eclampsia. Antioxidants (Basel) 2022; 11:antiox11071409. [PMID: 35883900 PMCID: PMC9311926 DOI: 10.3390/antiox11071409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Oxidative and inflammatory stress, angiogenic imbalance, and endothelial dysfunction are pathophysiological mechanisms occurring in pre-eclampsia (PE) that may persist over time and predispose women to a higher risk of cardiovascular disease (CVD) in the future. However, there is little evidence on the vascular function of women at risk of PE who have not developed the disease. The main objective of this research is to study factors and biomarkers involved in endothelial dysfunction related to oxidative stress, angiogenic disbalance, and inflammation in women at high risk of term PE who do not develop the disease. An observational, analytical, retrospective, and descriptive study was carried out in a selected sample of 68 high-risk and 57 non-risk of term PE participants in the STATIN study (FFIS/2016/02/ST EUDRACT No: 2016-005206-19). A significant increase in mean arterial pressure (MAP) levels and oxidative stress biomarkers (uric acid, homocysteine, and total serum antioxidant capacity) was found. Biomarkers of inflammation (interleukin-6 and growth differentiation factor 15) and endothelial function (asymmetric dimethylarginine) were significantly elevated in the group at risk of pre-eclampsia. A significative dependence relationship was also established between MAP and interleukin-6 and uric acid. These results suggest that women at high risk of term PE may represent pregnancies with pre-existing maternal risk factors for CVD, manifested by the own cardiovascular overload of pregnancy. A better understanding of maternal cardiovascular function in pregnancy would allow the improved prediction of CVD late in life in women.
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Affiliation(s)
- Jean Michell Santoyo
- Physiology Department, Institute of Biomedical Research (IMIB-Arrixaca), Universidad de Murcia, 30120 Murcia, Spain;
| | - José Antonio Noguera
- Institute of Biomedical Research (IMIB-Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.A.N.); (F.A.); (J.L.D.); (C.d.P.-M.)
| | - Francisco Avilés
- Institute of Biomedical Research (IMIB-Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.A.N.); (F.A.); (J.L.D.); (C.d.P.-M.)
| | - Juan Luis Delgado
- Institute of Biomedical Research (IMIB-Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.A.N.); (F.A.); (J.L.D.); (C.d.P.-M.)
| | - Catalina de Paco-Matallana
- Institute of Biomedical Research (IMIB-Arrixaca), Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.A.N.); (F.A.); (J.L.D.); (C.d.P.-M.)
| | - Virginia Pérez
- Departamento de Ciencias Sociosanitarias, Institute of Biomedical Research (IMIB-Arrixaca), Universidad de Murcia, 30120 Murcia, Spain;
| | - Isabel Hernández
- Physiology Department, Institute of Biomedical Research (IMIB-Arrixaca), Universidad de Murcia, 30120 Murcia, Spain;
- Correspondence:
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Mendola P, Ha S. Beyond the infant in your arms: effects of climate change last for generations. Fertil Steril 2022; 118:224-229. [DOI: 10.1016/j.fertnstert.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 01/22/2023]
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Longhitano E, Siligato R, Torreggiani M, Attini R, Masturzo B, Casula V, Matarazzo I, Cabiddu G, Santoro D, Versino E, Piccoli GB. The Hypertensive Disorders of Pregnancy: A Focus on Definitions for Clinical Nephrologists. J Clin Med 2022; 11:jcm11123420. [PMID: 35743489 PMCID: PMC9225655 DOI: 10.3390/jcm11123420] [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: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
About 5-10% of pregnancies are complicated by one of the hypertensive disorders of pregnancy. The women who experience these disorders have a greater risk of having or developing kidney diseases than women with normotensive pregnancies. While international guidelines do not provide clear indications for a nephrology work-up after pregnancy, this is increasingly being advised by nephrology societies. The definitions of the hypertensive disorders of pregnancy have changed greatly in recent years. The objective of this short review is to gather and comment upon the main definitions of the hypertensive disorders of pregnancy as a support for nephrologists, who are increasingly involved in the short- and long-term management of women with these disorders.
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Affiliation(s)
- Elisa Longhitano
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; (E.L.); (R.S.); (M.T.); (I.M.)
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino”, University of Messina, 98125 Messina, Italy;
| | - Rossella Siligato
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; (E.L.); (R.S.); (M.T.); (I.M.)
- Unit of Nephrology, Azienda Ospedaliera Universitaria Sant’Anna, 44124 Ferrara, Italy
| | - Massimo Torreggiani
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; (E.L.); (R.S.); (M.T.); (I.M.)
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant’Anna, University of Torino, 10126 Torino, Italy; (R.A.); (V.C.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynaecology, Ospedale Degli Infermi, 13875 Biella, Italy;
| | - Viola Casula
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant’Anna, University of Torino, 10126 Torino, Italy; (R.A.); (V.C.)
| | - Ida Matarazzo
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; (E.L.); (R.S.); (M.T.); (I.M.)
- Unit of Nephrology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | | | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino”, University of Messina, 98125 Messina, Italy;
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Torino, 10064 Torino, Italy;
- University Centre of Biostatistics, Epidemiology and Public Health, University of Torino, 10064 Torino, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; (E.L.); (R.S.); (M.T.); (I.M.)
- Correspondence:
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Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T. Menopause: a cardiometabolic transition. Lancet Diabetes Endocrinol 2022; 10:442-456. [PMID: 35525259 DOI: 10.1016/s2213-8587(22)00076-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Menopause is often a turning point for women's health worldwide. Increasing knowledge from experimental data and clinical studies indicates that cardiometabolic changes can manifest at the menopausal transition, superimposing the effect of ageing onto the risk of cardiovascular disease. The menopausal transition is associated with an increase in fat mass (predominantly in the truncal region), an increase in insulin resistance, dyslipidaemia, and endothelial dysfunction. Exposure to endogenous oestrogen during the reproductive years provides women with protection against cardiovascular disease, which is lost around 10 years after the onset of menopause. In particular, women with vasomotor symptoms during menopause seem to have an unfavourable cardiometabolic profile. Early management of the traditional risk factors of cardiovascular disease (ie, hypertension, obesity, diabetes, dyslipidaemia, and smoking) is essential; however, it is important to recognise in the reproductive history the female-specific conditions (ie, gestational hypertension or diabetes, premature ovarian insufficiency, some gynaecological diseases such as functional hypothalamic amenorrhoea, and probably others) that could enhance the risk of cardiovascular disease during and after the menopausal transition. In this Review, the first of a Series of two papers, we provide an overview of the literature for understanding cardiometabolic changes and the management of women at midlife (40-65 years) who are at higher risk, focusing on the identification of factors that can predict the occurrence of cardiovascular disease. We also summarise evidence about preventive non-hormonal strategies in the context of cardiometabolic health.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral and Laboratorio de Biomedicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Irene Lambrinoudaki
- Menopause Unit, 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Wall HK, Wright JS, Jackson SL, Daussat L, Ramkissoon N, Schieb LJ, Stolp H, Tong X, Loustalot F. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Addressing Barriers Beyond the Published Literature. Am J Hypertens 2022; 35:244-255. [PMID: 35259238 PMCID: PMC10061272 DOI: 10.1093/ajh/hpab170] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023] Open
Abstract
Hypertension is highly prevalent in the United States, and many persons with hypertension do not have controlled blood pressure. Self-measured blood pressure monitoring (SMBP), when combined with clinical support, is an evidence-based strategy for lowering blood pressure and improving control in persons with hypertension. For years, there has been support for widespread implementation of SMBP by national organizations and the federal government, and SMBP was highlighted as a primary intervention in the 2020 Surgeon General's Call to Action to Control Hypertension, yet optimal SMBP use remains low. There are well-known patient and clinician barriers to optimal SMBP documented in the literature. We explore additional high-level barriers that have been encountered, as broad policy and systems-level changes have been attempted, and offer potential solutions. Collective efforts could modernize data transfer and processing, improve broadband access, expand device coverage and increase affordability, integrate SMBP into routine care and reimbursement practices, and strengthen patient engagement, trust, and access.
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Affiliation(s)
- Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lura Daussat
- Practice Support Unit, Public Health Informatics Institute, Decatur, Georgia, USA
| | - Nar Ramkissoon
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Linda J Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Haley Stolp
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Everitt IK, Trinh KV, Underberg DL, Beach L, Khan SS. Moving the Paradigm Forward for Prediction and Risk-Based Primary Prevention of Heart Failure in Special Populations. Curr Atheroscler Rep 2022; 24:343-356. [PMID: 35235166 DOI: 10.1007/s11883-022-01009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Heart failure (HF) treatment paradigms increasingly recognize the importance of primary prevention. This review explores factors that enhance HF risk, summarizes evidence supporting the pharmacologic primary prevention of HF, and notes barriers to the implementation of primary prevention of HF with a focus on female and sexual and gender minority patients. RECENT FINDINGS HF has pathophysiologic sex-specific distinctions, suggesting that sex-specific preventive strategies may be beneficial. Pharmacologic agents that have shown benefit in reducing the risk of HF address the pathobiology underpinning these sex-specific risk factors. The implementation of pharmacologic therapies for primary prevention of HF needs to consider a risk-based model. Current pharmacotherapies hold mechanistic promise for the primary prevention of HF in females and gender and sexual minorities, although research is needed to understand the specific populations most likely to benefit. There are significant systemic barriers to the equitable provision of HF primary prevention.
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Affiliation(s)
- Ian K Everitt
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine V Trinh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel L Underberg
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren Beach
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Stanhewicz AE, Dillon GA, Serviente C, Alexander LM. Acute systemic inhibition of inflammation augments endothelium-dependent dilation in women with a history of preeclamptic pregnancy. Pregnancy Hypertens 2022; 27:81-86. [PMID: 34973597 PMCID: PMC8858855 DOI: 10.1016/j.preghy.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022]
Abstract
Women who have had preeclampsia demonstrate microvascular endothelial-dysfunction, mediated in part by reduced nitric oxide (NO)-dependent dilation. Preeclamptic pregnancies are associated with elevated inflammation, and inhibition of inflammation attenuates endothelial damage in animal models of preeclampsia. However, it is unclear if inhibition of vascular inflammation improves endothelial function in women after a preeclamptic pregnancy. Using the cutaneous microcirculation as a model, we hypothesized that acute systemic inhibition of vascular inflammation (oral salsalate; 1500 mg/twice daily, 4 days) would improve endothelium- and NO-dependent vasodilation in women with a history of preeclampsia (PE) but not in women with a history of uncomplicated pregnancy (HC). Twelve HC (30 ± 1yrs, 10 ± 2 months postpartum) and 10 PE (30 ± 2yrs, 8 ± 2 months postpartum) participated in a double-blind placebo-controlled study. Following each treatment, 2 intradermal microdialysis fibers were placed in the skin of the ventral forearm for graded infusion of acetylcholine (Ach, 10-7-102mM) or Ach + 15 mM L-NAME (NO synthase antagonist). Red blood cell flux was measured over each site by laser-Doppler flowmetry (LDF). Cutaneous vascular conductance was calculated (CVC = LDF/mean arterial pressure) and normalized to maximum (%CVCmax; 28 mM SNP + local heat 43 °C). ACh-induced (77 ± 3 vs. 92 ± 3%CVCmax; p = 0.01) and NO-dependent (20 ± 6 vs. 33 ± 4%; p = 0.02) vasodilation were attenuated in PE compared to HC. Salsalate augmented ACh-induced (95 ± 2%CVCmax; p = 0.002) and NO-dependent (39 ± 3%; p = 0.009) dilation in PE compared to placebo but had no effect in HC (all p > 0.05). Salsalate treatment augmented endothelium-dependent vasodilation via NO-mediated pathways in women who have had preeclampsia, suggesting that inflammatory signaling mediates persistent endothelial dysfunction following preeclampsia.
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Affiliation(s)
- Anna E. Stanhewicz
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA,Department of Kinesiology, Pennsylvania State University, University Park, PA
| | - Gabrielle A. Dillon
- Department of Kinesiology, Pennsylvania State University, University Park, PA,Center for Healthy Aging, Pennsylvania State University, University Park, PA
| | - Corinna Serviente
- Center for Healthy Aging, Pennsylvania State University, University Park, PA,Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA,Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA
| | - Lacy M. Alexander
- Department of Kinesiology, Pennsylvania State University, University Park, PA,Center for Healthy Aging, Pennsylvania State University, University Park, PA
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Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, Kenny LC, McCarthy F, Myers J, Poon LC, Rana S, Saito S, Staff AC, Tsigas E, von Dadelszen P. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2022; 27:148-169. [DOI: 10.1016/j.preghy.2021.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
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Defective Uteroplacental Vascular Remodeling in Preeclampsia: Key Molecular Factors Leading to Long Term Cardiovascular Disease. Int J Mol Sci 2021; 22:ijms222011202. [PMID: 34681861 PMCID: PMC8539609 DOI: 10.3390/ijms222011202] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 12/12/2022] Open
Abstract
Preeclampsia is a complex hypertensive disorder in pregnancy which can be lethal and is responsible for more than 70,000 maternal deaths worldwide every year. Besides the higher risk of unfavorable obstetric outcomes in women with preeclampsia, another crucial aspect that needs to be considered is the association between preeclampsia and the postpartum cardiovascular health of the mother. Currently, preeclampsia is classified as one of the major risk factors of cardiovascular disease (CVD) in women, which doubles the risk of venous thromboembolic events, stroke, and ischemic heart disease. In order to comprehend the pathophysiology behind the linkage between preeclampsia and the development of postpartum CVD, a thorough understanding of the abnormal uteroplacental vascular remodeling in preeclampsia is essential. Therefore, this review aims to summarize the current knowledge of the defective process of spiral artery remodeling in preeclampsia and how the resulting placental damage leads to excessive angiogenic imbalance and systemic inflammation in long term CVD. Key molecular factors in the pathway-including novel findings of microRNAs-will be discussed with suggestions of future management strategies of preventing CVD in women with a history of preeclampsia.
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Epigenetic processes during preeclampsia and effects on fetal development and chronic health. Clin Sci (Lond) 2021; 135:2307-2327. [PMID: 34643675 DOI: 10.1042/cs20190070] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/29/2021] [Indexed: 01/12/2023]
Abstract
Preeclampsia (PE), the leading cause of maternal and fetal morbidity and mortality, is associated with poor fetal growth, intrauterine growth restriction (IUGR) and low birth weight (LBW). Offspring of women who had PE are at increased risk for cardiovascular (CV) disease later in life. However, the exact etiology of PE is unknown. Moreover, there are no effective interventions to treat PE or alleviate IUGR and the developmental origins of chronic disease in the offspring. The placenta is critical to fetal growth and development. Epigenetic regulatory processes such as histone modifications, microRNAs and DNA methylation play an important role in placental development including contributions to the regulation of trophoblast invasion and remodeling of the spiral arteries. Epigenetic processes that lead to changes in placental gene expression in PE mediate downstream effects that contribute to the development of placenta dysfunction, a critical mediator in the onset of PE, impaired fetal growth and IUGR. Therefore, this review will focus on epigenetic processes that contribute to the pathogenesis of PE and IUGR. Understanding the epigenetic mechanisms that contribute to normal placental development and the initiating events in PE may lead to novel therapeutic targets in PE that improve fetal growth and mitigate increased CV risk in the offspring.
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