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Woolcock H, Parra N, Zhang Y, Reddy UM, Bello NA, Miller E, Booker WA. Pregnancy Outcomes in Women Who Developed Elevated Blood Pressure and Stage I Hypertension after 20 Weeks Gestation. Am J Perinatol 2024. [PMID: 38569509 DOI: 10.1055/a-2298-5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The American College of Obstetrics threshold for hypertension (≥140/90 mm Hg) differs from those of the American College of Cardiology (ACC) and the American Heart Association (AHA). It is unknown if ACC/AHA hypertension levels are associated with adverse pregnancy outcomes (APOs) after 20 weeks gestation. The purpose of this study is to analyze APOs in women with blood pressure (BP) in the elevated or stage 1 range after 20 weeks gestation. STUDY DESIGN This was a secondary analysis of the nuMoM2b prospective cohort study of 10,038 nulliparous, singleton pregnancies between 2010 and 2014. BP was measured at three visits during the pregnancy using a standard protocol. Women without medical comorbidities, with normal BP by ACC/AHA guidelines (systolic BP [SBP] < 120 and diastolic BP [DBP] < 80 mm Hg) up to 22 weeks, were included. Exposure was BP between 22 and 29 weeks gestation: normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP: 120-129 and DBP < 80 mm Hg), and stage 1 (SBP: 130-139 or DBP: 80-89 mm Hg). The primary outcome was hypertensive disorder of pregnancy (HDP) at delivery. Secondary outcomes included fetal growth restriction (FGR), placental abruption, preterm delivery, and cesarean delivery. Multivariable-adjusted odds ratio (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. RESULTS Of 4,460 patients that met inclusion criteria, 3,832 (85.9%) had BP in the normal range, 408 (9.1%) in elevated, and 220 (4.9%) in stage 1 range between 22 and 29 weeks. The likelihood of HDP was significantly higher in women with elevated BP (aOR 1.71, 95%CI: 1.18,2.48), and stage 1 BP (aOR: 2.79, 95%CI: 1.84,4.23) compared to normal BP (p < 0.001). Stage 1 BP had twice odds of FGR (aOR: 2.33, 95%CI: 1.22,4.47) and elevated BP had three times odds of placental abruption (aOR: 3.03; 95%CI: 1.24,7.39). CONCLUSION Elevated or stage 1 BP >20 weeks of pregnancy are associated with HDP, FGR, and placental abruption. KEY POINTS · Elevated and stage 1 BP increases risk for HDP.. · Elevated BP increases risk for placental abruption.. · Stage 1 BP increases risk for FGR..
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Affiliation(s)
- Helen Woolcock
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
| | - Natalia Parra
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
| | - Yijia Zhang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Eliza Miller
- Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York
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Helms AS, Thompson AD, Glazier AA, Hafeez N, Kabani S, Rodriguez J, Yob JM, Woolcock H, Mazzarotto F, Lakdawala NK, Wittekind SG, Pereira AC, Jacoby DL, Colan SD, Ashley EA, Saberi S, Ware JS, Ingles J, Semsarian C, Michels M, Olivotto I, Ho CY, Day SM. Spatial and Functional Distribution of MYBPC3 Pathogenic Variants and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy. Circ Genom Precis Med 2020; 13:396-405. [PMID: 32841044 PMCID: PMC7676622 DOI: 10.1161/circgen.120.002929] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Pathogenic variants in MYBPC3, encoding cardiac MyBP-C (myosin binding protein C), are the most common cause of familial hypertrophic cardiomyopathy. A large number of unique MYBPC3 variants and relatively small genotyped hypertrophic cardiomyopathy cohorts have precluded detailed genotype-phenotype correlations.
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Affiliation(s)
- Adam S Helms
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Andrea D Thompson
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Amelia A Glazier
- Molecular & Integrative Physiology (A.A.G.), University of Michigan, Ann Arbor
| | - Neha Hafeez
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Samat Kabani
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Juliani Rodriguez
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Jaime M Yob
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Helen Woolcock
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | - Francesco Mazzarotto
- Department of Experimental & Clinical Medicine, University of Florence, Italy (F.M., I.O.).,National Heart & Lung Institute & Royal Brompton Cardiovascular Research Center, Imperial College London, United Kingdom (F.M., J.S.W.)
| | - Neal K Lakdawala
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., C.Y.H.)
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH (S.G.W.)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of Sao Paolo Medical School, Brazil (A.C.P.)
| | - Daniel L Jacoby
- Cardiovascular Medicine, Yale University, New Haven, CT (D.L.J.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Euan A Ashley
- Center for Inherited Heart Disease, Stanford University, CA (E.A.A.)
| | - Sara Saberi
- Cardiovascular Medicine (A.S.H., A.D.T., N.H., S.K., J.R., J.M.Y., H.W., S.S.), University of Michigan, Ann Arbor
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (J.I., C.S.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Australia (J.I., C.S.)
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.M.)
| | - Iacopo Olivotto
- Department of Experimental & Clinical Medicine, University of Florence, Italy (F.M., I.O.).,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O.)
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., C.Y.H.)
| | - Sharlene M Day
- Cardiovascular Medicine, University of Pennsylvania, Philadelphia (S.M.D.)
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Davio A, Woolcock H, Nanba AT, Rege J, O’Day P, Ren J, Zhao L, Ebina H, Auchus R, Rainey WE, Turcu AF. Sex Differences in 11-Oxygenated Androgen Patterns Across Adulthood. J Clin Endocrinol Metab 2020; 105:5851527. [PMID: 32498089 PMCID: PMC7340191 DOI: 10.1210/clinem/dgaa343] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The gonads are the major source of sex steroids during reproductive ages. The gonadal function declines abruptly in women and gradually in men. The adrenals produce 11-oxygenated androgens (11-oxyandrogens), which start rising during adrenarche. Following menopause, 11-oxyandrogens levels remain similar to reproductive ages. OBJECTIVE To compare the circulating 11-oxyandrogen concentrations in men and women across adult ages. METHODS We used mass spectrometry to measure testosterone (T), androstenedione (A4), 11β-hydroxytestosterone (11OHT), 11-ketotestosterone (11KT), 11β-hydroxyandrostenedione (11OHA4), 11-ketoandrostenedione (11KA4), cortisol, and cortisone in morning sera obtained from adults in outpatient setting. We performed double immunofluorescence of 3β-hydroxysteroid dehydrogenase type 2 and cytochrome b5 in adrenal tissue from 19 men, age 23-78 years. RESULTS We included 590 patients (319 men), aged 18 to 97 years, and 84% white. 11KT and 11KA4 were stable across ages in women, but they declined in men (0.21 and 0.06 ng/dL/year, respectively; P < 0.05). 11OHA4 and 11OHT increased modestly with age in women (0.6 and 0.09 ng/dL/year, respectively; P < 0.01), and both remained stable across ages in men. As body mass index (BMI) increased, 11KA4 decreased in women, and 11KT increased in men, both suggesting higher 17β-hydroxysteroid dehydrogenase activity in obese individuals. A4 and T declined with age and A4 with BMI in both sexes; T declined with BMI in men. Adrenal androgenic enzyme expressions in aging men were similar to those observed in women. CONCLUSIONS In contrast with traditional androgens, the production of 11OHA4 and 11OHT is sustained with aging in both sexes. The bioactive androgen 11KT declines in aging men but not in women.
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Affiliation(s)
- Angela Davio
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
| | - Helen Woolcock
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, US
| | - Aya T Nanba
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
| | - Juilee Rege
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, US
| | - Patrick O’Day
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
| | - Jianwei Ren
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
| | - Lili Zhao
- School of Public Health, University of Michigan, Ann Arbor, MI, US
| | - Hiroki Ebina
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, US
| | - Richard Auchus
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
- Department of Pathology, Tohoku University, Sendai, Miyagi, Japan
| | - William E Rainey
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, US
| | - Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, US
- Correspondence and Reprint Requests: Adina F. Turcu, MD, MS, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 1150 W Medical Center Drive, MSRB II, 5570B, Ann Arbor, MI, 48109. E-mail:
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