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Tiruneh SA, Vu TTT, Moran LJ, Callander EJ, Allotey J, Thangaratinam S, Rolnik DL, Teede HJ, Wang R, Enticott J. Externally validated prediction models for pre-eclampsia: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:592-604. [PMID: 37724649 DOI: 10.1002/uog.27490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the performance of existing externally validated prediction models for pre-eclampsia (PE) (specifically, any-onset, early-onset, late-onset and preterm PE). METHODS A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta-analysis of discrimination and calibration performance was conducted when appropriate. RESULTS Twenty-three studies reported 52 externally validated prediction models for PE (one preterm, 20 any-onset, 17 early-onset and 14 late-onset PE models). No model had the same set of predictors. Fifteen any-onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing-risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy-associated plasma protein-A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver-operating-characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76-0.96), and was well calibrated. The other models generally had poor-to-good discrimination performance (median AUC, 0.66 (range, 0.53-0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any-onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66-0.76) and 0.73 (95% PI, 0.55-0.86). CONCLUSIONS Existing externally validated prediction models for any-, early- and late-onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple-test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high-resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S A Tiruneh
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - T T T Vu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - L J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - E J Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Allotey
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - S Thangaratinam
- World Health Organization (WHO) Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - H J Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - J Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Slater K, Taylor R, McLaughlin K, Pennell C, Collins C, Hutchesson M. Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys. Nutrients 2023; 15:3817. [PMID: 37686849 PMCID: PMC10490358 DOI: 10.3390/nu15173817] [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: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women's barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose 'increasing women's awareness of increased CVD risk' and 67% of GPs and 55% of women chose 'improving communication between hospitals and primary care' as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors.
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Affiliation(s)
- Kaylee Slater
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Rachael Taylor
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Karen McLaughlin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Craig Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Melinda Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.S.); (R.T.); (C.C.)
- Food and Nutrition Research Program, Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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Smith C, Fatima H, McClain E, Bryant K, Verbiest S, Hassmiller Lich K. Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action. Health Serv Res 2023; 58:521-533. [PMID: 36632673 PMCID: PMC10012242 DOI: 10.1111/1475-6773.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE (STUDY QUESTION) To use systems thinking with diverse system actors to (a) characterize current problems at the intersection of chronic conditions (CCs) and reproductive health (RH) care and their determinants, (b) determine necessary system actors for change, and (c) document cross-system actions that can improve identified problems in the United States. DATA SOURCES/STUDY SETTING Data were collected from six groups of system actors via online focus groups. STUDY DESIGN This is a qualitative multilevel study using the iceberg systems thinking framework. DATA COLLECTION/EXTRACTION METHODS Data were collected by note-taking and recording six focus groups; analysis incorporated perspective triangulation using the systems thinking iceberg and system mapping to visualize interconnected system challenges, actors, and action ideas. PRINCIPAL FINDINGS Participants described eight necessary system actors: health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payors, policy makers, and research funders. Forty pain points were identified, spread across each of the four levels of the systems thinking iceberg: undesirable outcomes (6), concerning trends (9), system structure flaws (15), and problematic mental models (10). In response to these pain points, a set of 46 action ideas was generated by participants and mapped into nine action themes: (1) adjust QI metrics, incentives, and reimbursement, (2) bolster RH medical education and training, (3) break down medical silos, (4) enrich patient education, (5) expand the health care team, (6) improve holistic health care, (7) modify research and programmatic funding to prioritize RH and CC, (8) spur innovation for patient visits, and (9) support professional champions and leaders. CONCLUSIONS By embracing system complexity, creating visual maps, and pushing participants to identify actionable strategies for improvement, this study generates a set of specific actions that can be used to address pain points across the multiple system levels that make improving reproductive care for people with CCs so challenging.
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Affiliation(s)
- Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hiba Fatima
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin McClain
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine Bryant
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Verbiest
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Malone SL, Haj Yahya R, Kane SC. Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers. Int J Womens Health 2022; 14:1371-1384. [PMID: 36161188 PMCID: PMC9507456 DOI: 10.2147/ijwh.s283239] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Preeclampsia is a common and important complication of pregnancy, one with potentially significant morbidity and even mortality to both mother and baby. Identifying those at high risk of developing the condition is helpful as there is evidence that the incidence of preeclampsia can be reduced with low dose aspirin taken in pregnancy. Accurately predicting the risk of preeclampsia allows for more targeted aspirin prophylaxis and a greater opportunity for early detection of maternal and/or fetal complications associated with impaired placentation through a schedule of enhanced antenatal surveillance. Traditional preeclampsia prediction models use maternal characteristics and risk factors and have been shown to be of low predictive value. Multiparametric screening tests combine patient characteristics with serum biomarkers and ultrasound Doppler indices and have been shown to be more effective at detecting those at high risk of preeclampsia – more specifically, early-onset preeclampsia (onset of preeclampsia <34 weeks’ gestation). Multiparametric screening has now been validated in different populations. The true cost effectiveness of a multiparametric screening model for preeclampsia screening is not yet fully known and will vary depending on the clinical setting. Despite the growing body of evidence for its improved detection rates, first trimester preeclampsia screening using multiparametric models is not widely implemented and is not part of the recommendations for antenatal screening from most international bodies. The International Federation of Gynecology and Obstetrics has advised universal preeclampsia screening using maternal risk factors and biomarkers and has strongly encouraged its promotion worldwide. Various barriers to implementation must be considered such as the immediate cost of equipment and training, the need for audit and quality control, and the expected benefit to the population. Low to middle income settings may require a pragmatic approach to the implementation of multiparametric screening given limited resources.
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Affiliation(s)
- Sarah L Malone
- Department of Maternal Fetal Medicine, the Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rani Haj Yahya
- Department of Maternal Fetal Medicine, the Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stefan C Kane
- Department of Maternal Fetal Medicine, the Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, Victoria, Australia
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5
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Pre-eclampsia: a Scoping Review of Risk Factors and Suggestions for Future Research Direction. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2022; 8:394-406. [PMID: 35571151 PMCID: PMC9090120 DOI: 10.1007/s40883-021-00243-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/13/2021] [Accepted: 12/02/2021] [Indexed: 10/25/2022]
Abstract
Abstract Most of maternal deaths are preventable, and one-quarter of maternal deaths are due to pre-eclampsia and eclampsia. Prenatal screening is essential for detecting and managing pre-eclampsia. However, pre-eclampsia screening is solely based on maternal risk factors and has low (< 5% in the USA) detection rates. This review looks at pre-eclampsia from engineering, public health, and medical points of view. First, pre-eclampsia is defined clinically, and the biological basis of established risk factors is described. The multiple theories behind pre-eclampsia etiology should serve as the scientific basis behind established risk factors for pre-eclampsia; however, African American race does not have sufficient evidence as a risk factor. We then briefly describe predictive statistical models that have been created to improve screening detection rates, which use a combination of biophysical and biochemical biomarkers, as well as aspects of patient medical history as inputs. Lastly, technologies that aid in advancing pre-eclampsia screening worldwide are explored. The review concludes with suggestions for more robust pre-eclampsia research, which includes diversifying study sites, improving biomarker analytical tools, and for researchers to consider studying patients before they become pregnant to improve pre-eclampsia detection rates. Additionally, researchers must acknowledge the systemic racism involved in using race as a risk factor and include qualitative measures in study designs to capture the effects of racism on patients. Lay Summary Pre-eclampsia is a pregnancy-specific hypertensive disorder that can affect almost every organ system and complicates 2-8% of pregnancies globally. Here, we focus on the biological basis of the risk factors that have been identified for the condition. African American race currently does not have sufficient evidence as a risk factor and has been poorly studied. Current clinical methods poorly predict a patient's likelihood of developing pre-eclampsia; thus, researchers have made statistical models that are briefly described in this review. Then, low-cost technologies that aid in advancing pre-eclampsia screening are discussed. The review ends with suggestions for research direction to improve pre-eclampsia screening in all settings.Overall, we suggest that the future of pre-eclampsia screening should aim to identify those at risk before they become pregnant. We also suggest that the clinical standard of assessing patient risk solely on patient characteristics needs to be reevaluated, that study locations of pre-eclampsia research need to be expanded beyond a few high-income countries, and that low-cost technologies should be developed to increase access to prenatal screening.
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Appraisal of Short- and Long-Term Outcomes of Partial Versus Complete HELLP Syndromes: A Retrospective Cohort Study. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00316-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Role of Oxidative Stress in Hypertensive Disorders of Pregnancy (Preeclampsia, Gestational Hypertension) and Metabolic Disorder of Pregnancy (Gestational Diabetes Mellitus). OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5581570. [PMID: 34194606 PMCID: PMC8184326 DOI: 10.1155/2021/5581570] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/25/2021] [Indexed: 11/17/2022]
Abstract
Purpose of the Review.To highlight the role of oxidative stress in hypertensive disorders of pregnancy (HDP) and metabolic disorders of pregnancy (gestational diabetes mellitus). Recent Findings. In both preeclampsia (PE) and gestational hypertension (GH), oxidative stress leads to inadequate placental perfusion thus resulting in a hypoxic placenta, which generally leads to the activation of maternal systemic inflammatory response. In PE, this causes inflammation in the kidneys and leads to proteinuria. A proteinuria marker known as urinary 8-oxoGuo excretion is expressed in preeclampsia. In GDM, oxidative stress plays a role in the pathogenesis of the disease, as a result of over secretion of insulin during pregnancy. This uncontrolled secretion of insulin results in the production of lipid peroxidation factors that also mask the secretion of antioxidants. Therefore, ROS becomes abundant at cellular level and prevents the cells from transporting glucose to body tissues. Summary. There is a need for more research investigating the role of oxidative stress, especially in obstetrics-related conditions. More studies are required in order to understand the difference between the pathogenesis and pathophysiology of PE versus GH since investigations on the differences in genetic aspects of each condition are lacking. Furthermore, research to improve diagnostic procedures for GDM in pregnancy is needed.
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Chorioretinal Alterations Induced by Preeclampsia. J Ophthalmol 2021; 2021:8847001. [PMID: 33777446 PMCID: PMC7969093 DOI: 10.1155/2021/8847001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 01/22/2023] Open
Abstract
Hypertension during pregnancy, which is essentially a microvascular disease that destroys the end-organ microcirculation, should not be underestimated, as it could lead to organ failure in the kidneys, lungs, and brain. Preassessment of the microcirculatory state through systematic observation of the fundus has been proven to be noninvasive and feasible. Although hypertension in preeclampsia patients will resolve after childbirth, the sticking point is determining the best termination moment. Early diagnosis and treatment can prevent long-term ocular complications and cardiovascular risks for pregnant women in the future. In order to adjust the treatment strategy through more sensitive and precise fundus changes, we comprehensively summarized the common structural changes in the fundus in preeclampsia patients, including changes in the blood vessels, choroid, and retina, as well as the application of quantitative observation for chorioretinal alterations in recent years.
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Bastola K, Koponen P, Härkänen T, Luoto R, Gissler M, Kinnunen TI. Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland. ACTA ACUST UNITED AC 2020; 16:1745506520910911. [PMID: 32294026 PMCID: PMC7160768 DOI: 10.1177/1745506520910911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: We compared the prevalence of gestational diabetes and hypertensive disorders
in the most recent pregnancy among women of Russian, Somali, and Kurdish
origin and women in the general population in Finland. Methods: The study groups were selected from population-based samples of 18- to
64-year-old women. The women were of Russian (n = 318), Somali (n = 583),
and Kurdish (n = 373) origin or from the general population (n = 243), and
had given birth in Finland between 2004 and 2014. The data were obtained
from the National Medical Birth Register and the Hospital Discharge
Register. Data on gestational diabetes and hypertensive disorders were
extracted based on relevant International Classification of
Diseases, Tenth Revision codes. The main statistical methods
were logistic regression analyses adjusted for age, parity, body mass index,
socioeconomic status, and smoking. Results: The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali,
9.3% in Russian, and 11.8% in the general population. The prevalence of
hypertensive disorders was 5.4% in the general population, 3.8% in Somali,
3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish
women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95%
confidence interval = 1.20–3.32) compared with the general population, but
the odds for hypertensive disorders did not differ between groups. Conclusion: Women of Kurdish origin were more likely to develop gestational diabetes.
Studies with larger samples are required to confirm these findings to
develop prevention strategies for later development of type 2 diabetes.
Future research including other migrant groups is recommended to identify
differences in pregnancy complications among the women in migrant and
general population.
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Affiliation(s)
- Kalpana Bastola
- Faculty of Social Sciences/ Health Sciences, Tampere University, Tampere, Finland
| | - Päivikki Koponen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Luoto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tarja I Kinnunen
- Faculty of Social Sciences/ Health Sciences, Tampere University, Tampere, Finland
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Liu F, Yang L, Zheng Y, Zhang W, Zhi J. Effects and molecular mechanisms of AT1-AA in retinopathy of preeclampsia. Acta Biochim Biophys Sin (Shanghai) 2019; 51:51-58. [PMID: 30566576 DOI: 10.1093/abbs/gmy144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
Preeclampsia not only seriously endangers maternal and fetal health during pregnancy but may incur many sequelae in postpartum women such as reduced visual acuity. Agonistic autoantibodies to the angiotensin II type I receptor (AT1-AA) is closely associated with preeclampsia. The aim of the present study is to determine whether AT1-AA is associated with retinal impairment during the course of preeclampsia. A preeclampsia model was established by injecting AT1-AA into pregnant rats via the tail vein. Changes in the retinal histological structure were observed. Cell apoptosis and cytokines including reactive oxygen species (ROS), as well as apoptosis-related proteins such as Bcl-2, Bax, and caspase-3 were detected. In addition, flash electroretinograms obtained at different postpartum days were analyzed. Compared with the control group, the retinal structure became edematous and the cell density was reduced significantly in preeclampsia group. The cell apoptosis rate was increased significantly. In addition, the content of ROS, the levels of Bax and caspase-3 in the retina were increased, while the content of Bcl-2 was reduced significantly. Continuous observation of the electroretinograms showed loss of retinal ganglion cells postpartum. The present study demonstrated that AT1-AA induced retinal cell apoptosis by promoting ROS release and activating caspase, suggesting that the increased postpartum susceptibility of preeclamptic women to retinopathy is related to AT1-AA-induced cell apoptosis.
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Affiliation(s)
- Fang Liu
- Department of Ophthalmology, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
| | - Lei Yang
- School of Health and Social Care, Shanghai Urban Construction Vocational College, Shanghai, China
| | - Yanqian Zheng
- Department of Anatomy and Physiology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Zhang
- Department of Anatomy and Physiology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianming Zhi
- Department of Anatomy and Physiology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Rivera-Romero O, Olmo A, Muñoz R, Stiefel P, Miranda ML, Beltrán LM. Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review. JMIR Mhealth Uhealth 2018; 6:e130. [PMID: 29848473 PMCID: PMC6000483 DOI: 10.2196/mhealth.9671] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC.
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Affiliation(s)
| | - Alberto Olmo
- Department of Electronic Technology, Universidad de Sevilla, Sevilla, Spain
| | - Rocío Muñoz
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Luisa Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis M Beltrán
- Instituto de Biomedicina de Sevilla (IBiS), Laboratorio de Hipertensión Arterial e Hipercolesterolemia, Servicio Andaluz de Salud / Consejo Superior de Investigaciones Científicas / Universidad de Sevilla, Seville, Spain.,Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Fluhr H. Präeklampsierisiko bei Schwangerschaften nach artifizieller Reproduktion. GYNAKOLOGISCHE ENDOKRINOLOGIE 2016. [DOI: 10.1007/s10304-016-0089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang YA, Chughtai AA, Farquhar CM, Pollock W, Lui K, Sullivan EA. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment. Fertil Steril 2016; 105:920-926.e2. [PMID: 26780118 DOI: 10.1016/j.fertnstert.2015.12.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the association between assisted reproductive technology (ART) treatment and the rate of combined gestational hypertension (GH), preeclampsia (PE). DESIGN Retrospective population study. SETTING Not applicable. PATIENT(S) A total of 596,520 mothers (3.6% ART mothers) who gave birth between 2007 and 2011. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Comparison of the rate of GH/PE for ART and non-ART mothers, with odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI) used to assess the association between ART and GH/PE. RESULT(S) The overall rate of GH/PE was 4.3%, with 6.4% for ART mothers and 4.3% for non-ART mothers. The rate of GH/PE was higher for mothers of twins than singletons (12.4% vs. 5.7% for ART mothers; 8.6% vs. 4.2% for non-ART mothers). The ART mothers had a 17% increased odds of GH/PE compared with the non-ART mothers (AOR 1.17; 95% CI, 1.10-1.24). After stratification by plurality, the difference in GH/PE rates between ART and non-ART mothers was not statistically significant, with AOR 1.05 (95% CI, 0.98-1.12) for mothers of singletons and AOR 1.10 (95% CI, 0.94-1.30) for mothers of twins. CONCLUSION(S) The changes in AOR after stratification indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of GH/PE among ART mothers. The lower rate of GH/PE among mothers of singletons compared with mothers of twins suggests that a policy to minimize multiple pregnancies after ART may reduce the excess risk of GH/PE due to ART treatment.
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Affiliation(s)
- Yueping A Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Abrar A Chughtai
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Wendy Pollock
- Mercy Hospital for Women, La Trobe University, Melbourne, Victoria, Australia
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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