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Slater, Kaylee, Niamh Chapman e Dean Picone. "O29 LACK OF VALIDATED BLOOD PRESSURE DEVICES FOR USE IN PREGNANCY AVAILABLE FROM AUSTRALIAN PHARMACIES". Journal of Hypertension 42, Suppl 3 (setembro de 2024): e14. http://dx.doi.org/10.1097/01.hjh.0001062580.31122.e4.
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Background and objective. Self-monitoring of blood pressure (BP) at home can aid in the management of hypertension, including during pregnancy. Only 20% of home BP devices have been validated for the general population. However, specific accuracy validation in pregnant women is required for use among this population. The availability of home BP devices that have been validated for use in pregnant women is unknown, which was the aim of this study. Secondary aims were to assess device cost and claims regarding use in pregnancy. Methods. A search of pharmacies with physical and online stores in Australia that sell upper-arm cuff home BP devices was conducted. Validation status in pregnant women was determined by checking model numbers on the STRIDE-BP website. Cost of device and claims about the devices’ use in pregnancy were extracted from instruction manuals and information on the pharmacy webpage. Results. Eighteen pharmacies and 40 unique home BP devices were identified. Four (10%) devices were validated for use in pregnancy, and these were more expensive than other devices (Table). Fifteen devices listed a caution warning to seek healthcare provider advice before use if pregnant, including all four that had been validated for pregnancy. Concerningly, information about four devices stated they were recommended for pregnancy, although evidence of validation was not found on STRIDE-BP. Information about one device stated it had not been tested on pregnant women and was not suitable for use, although this information was only available in the device manual and not point-of-sale. Nineteen devices had no mention of pregnancy at all. Conclusion. Very few home BP devices available from Australian pharmacies are specifically validated for use in pregnancy, are priced higher than non-validated devices and do not effectively target their intended users. To guarantee that only validated home BP devices are used in pregnancy increased awareness is urgently needed and could be assisted by clear labelling on devices provided at the point-of-sale instore or online. Table. Home BP devices sold in 18 Australian pharmacies. BP: blood pressure. Cost displayed in Australian dollars (AUD). The percentages add to more than 100% because some devices validated in the general population were also validated for pregnancy and pre-eclampsia.
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VASILIEV, S. A., S. A. VIKTOR, T. P. VASHCHILINA, E. V. KOVALKOVA, J. K. AVER e J. L. SEGEN. "HEMODYNAMIC PARAMETERS IN WOMEN WITH HYPERTENSIVE DISORDERS DURING PREGNANCY". MODERN PERINATAL MEDICAL TECHNOLOGIES IN SOLVING THE PROBLEM OF DEMOGRAPHIC SECURITY, n.º 17 (dezembro de 2024): 22–29. https://doi.org/10.63030/2307-4795/2024.17.a.03.
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Аn analysis of blood pressure (hereinafter referred to as BP) and derived hemodynamic parameters was performed in women with hypertension that existed previously (n=40) or was caused by pregnancy (n=40) and 30 women without hypertensive disorders during pregnancy. It was established that at the stage of pre-pregnancy preparation and during pregnancy, the recommended values of office and home BP should be in the range of optimal BP values according to the modern classification of BP threshold values for optimal, elevated pressure and hypertension (ESH, 2024). Blood pressure corresponding to elevated pressure (120/70 mm Hg and higher) should be considered as a risk factor for the development of hypertensive disorders during pregnancy.
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Zhang, Yu, Juxiao Li, Jiaqiang Liao, Chen Hu, Zhongqiang Cao, Wei Xia, Shunqing Xu e Yuanyuan Li. "Impacts of Ambient Fine Particulate Matter on Blood Pressure Pattern and Hypertensive Disorders of Pregnancy". Hypertension 77, n.º 4 (abril de 2021): 1133–40. http://dx.doi.org/10.1161/hypertensionaha.120.15608.
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Ambient fine particulate matter (PM 2.5 ) exposure during pregnancy was associated with hypertensive disorders of pregnancy (HDP) in previous studies, however, the results were inconsistent. In addition, its effects on blood pressure (BP) pattern, which was different between normal pregnancy and pregnancy with HDP, remain unclear. In this study, we estimate daily PM 2.5 exposure levels of 7658 pregnant women from a prospective cohort study in Wuhan, China, using land use regression model. BP was repeatedly measured in each trimester. Linear mixed-effect model was used to examine associations of PM 2.5 exposure with BP patterns during pregnancy. The association between PM 2.5 exposure and HDP was estimated by modified Poisson regression. In the lowest quartile of PM 2.5 exposure, BP fell gradually during early pregnancy and increase subsequently after a nadir at mid-pregnancy. In higher quartiles of PM 2.5 exposure, a slower drop of BP was observed during early pregnancy, and the mid-pregnancy drop was less obvious compared with the lowest quartile. PM 2.5 exposure during the second trimester was positively associated with the risk of HDP (relative risk =1.42 [95% CI, 1.19–1.70]), especially among women with excessive gestational weight gain (relative risk =1.48 [95% CI, 1.16–1.90; P for interaction =0.03). Our study suggests that PM 2.5 exposure might play an important role in BP pattern during pregnancy and might increase the risk of HDP, especially among women with excessive gestational weight gain.
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Jacobs, Brandiese E., Yong Liu, Maria V. Pulina, Vera A. Golovina e John M. Hamlyn. "Normal pregnancy: mechanisms underlying the paradox of a ouabain-resistant state with elevated endogenous ouabain, suppressed arterial sodium calcium exchange, and low blood pressure". American Journal of Physiology-Heart and Circulatory Physiology 302, n.º 6 (15 de março de 2012): H1317—H1329. http://dx.doi.org/10.1152/ajpheart.00532.2011.
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Endogenous cardiotonic steroids (CTS) raise blood pressure (BP) via vascular sodium calcium exchange (NCX1.3) and transient receptor-operated channels (TRPCs). Circulating CTS are superelevated in pregnancy-induced hypertension and preeclampsia. However, their significance in normal pregnancy, where BP is low, is paradoxical. Here we test the hypothesis that vascular resistance to endogenous ouabain (EO) develops in normal pregnancy and is mediated by reduced expression of NCX1.3 and TRPCs. We determined plasma and adrenal levels of EO and the impact of exogenous ouabain in pregnancy on arterial expression of Na+ pumps, NCX1.3, TRPC3, and TRPC6 and BP. Pregnant (embryonic day 4) and nonpregnant rats received infusions of ouabain or vehicle. At 14–16 days, tissues and plasma were collected for blotting and EO assay by radioimmunoassay (RIA), liquid chromatography (LC)-RIA, and LC-multidimensional mass spectrometry (MS3). BP (−8 mmHg; P < 0.05) and NCX1.3 expression fell (aorta −60% and mesenteric artery −30%; P < 0.001) in pregnancy while TRPC expression was unchanged. Circulating EO increased (1.14 ± 0.13 nM) vs. nonpregnant (0.6 ± 0.08 nM; P < 0.05) and was confirmed by LC-MS3 and LC-RIA. LC-MS3 revealed two previously unknown isomers of EO; one increased ∼90-fold in pregnancy. Adrenal EO but not isomers were increased in pregnancy. In nonpregnant rats, similar infusions of ouabain raised BP (+24 ± 3 mmHg; P < 0.001). In ouabain-infused rats, impaired fetal and placental growth occurred with no BP increase. In summary, normal pregnancy is an ouabain-resistant state associated with low BP, elevated circulating levels of EO, two novel steroidal EO isomers, and increased adrenal mass and EO content. Ouabain raises BP only in nonpregnant animals. Vascular resistance to the chronic pressor activity of endogenous and exogenous ouabain is mediated by suppressed NCX1.3 and reduced sensitivity of events downstream of Ca2+ entry. The mechanisms of EO resistance and the impaired fetal and placental growth due to elevated ouabain may be important in pregnancy-induced hypertension (PIH) and preeclampsia (PE).
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Menti, Ariadni, Dimitrios Mariglis, Konstantinos Kyriakoulis, Anastasios Kollias, Paolo Palatini, Gianfranco Parati, Jiguang Wang, Aletta Schutte e George Stergiou. "O32 AVAILABILITY OF PROPERLY VALIDATED BLOOD PRESSURE MEASURING DEVICES FOR PREGNANT WOMEN: STRIDE BP SYSTEMATIC REVIEW". Journal of Hypertension 42, Suppl 3 (setembro de 2024): e15. http://dx.doi.org/10.1097/01.hjh.0001062592.89400.1e.
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Background and Objective: Validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for BP measurement. However, a validated BP device in the general population may be inaccurate in pregnant women. Thus, separate validation studies are required in pregnant women with normal BP, hypertension, and preeclampsia. This study assessed the published evidence on BP devices in pregnancy. Methods: STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify validation studies of automated cuff BP monitors. Validation studies in pregnancy conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and BHS 1993/1990, were identified. Results: Of 569 validation studies included in the STRIDE BP database, 63 (35 devices) were identified including pregnant women. Among them, STRIDE BP rejected 45 studies, of which 25 were reported as “device pass” in the published validation paper. Among the studies rejected by STRIDE BP but published as “pass”, the main reasons for rejection were violations in the BP measurement protocol (44%), inadequate reference device or cuffs for reference and test device (36%), no data in women with hypertension and/or preeclampsia (36%), single observer for reference BP measurement (28%), and inappropriate data analysis (20%). Eventually 18 studies in pregnant women (28.6%) fulfilled the protocol requirements, and 16 devices (8 of them available on the market) can be recommended for clinical use in pregnancy. When additional ‘equivalent’ devices were considered (devices lacking validation studies but with differences from validated devices not affecting the BP measurement accuracy), 37 devices were found to be accurate in pregnancy, with 27 of them available on the market (Table). Conclusions: This analysis showed a shortage of properly validated BP devices for pregnant women available in the market, with published validation often having major methodological issues. There is an urgent need to develop and properly validate more BP devices in pregnancy. TABLE. Validated devices for office, home, and ambulatory BP measurement in pregnant women.
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Dunietz, Galit Levi, Wei Hao, Kerby Shedden, Claudia Holzman, Ronald Chervin, Lynda Lisabeth, Marjorie Treadwell e Louise O’Brien. "470 Maternal Habitual Snoring and Blood Pressure Trajectories in Pregnancy". Sleep 44, Supplement_2 (1 de maio de 2021): A185. http://dx.doi.org/10.1093/sleep/zsab072.469.
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Abstract Introduction Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic versus pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. Methods In a cohort study of 1,305 pregnant women from a large Midwestern medical center, participants were asked about habitual snoring (≥3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic and BP data throughout pregnancy, systolic (SBP) and diastolic (DBP) were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. Results Thirty percent of women reported snoring before pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Overall, women with pregnancy-onset snoring had higher mean SBP and DBP compared to those with chronic habitual snoring or controls (non-habitual snoring). In gestational week-specific comparisons with controls, SBP became significantly higher around 20 weeks’ gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. Pairwise mean differences in DBP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks’ gestation. Conclusion In a large cohort of pregnant women, those with pregnancy-onset or chronic habitual snoring had significantly elevated systolic BP in comparison to non-habitual snoring controls, in the second and third trimester, respectively. The findings of divergent BP trajectories suggest the two groups of women with habitual snoring in pregnancy should be considered separately when evaluating gestational ‘windows’ for increased BP monitoring and provide insight into pathophysiologic changes. Support (if any) Dr. Dunietz was supported by an F32 National Research Service Award from the National Institute of Child Health and Development (NIH/NICHD F32 HD091938); Dr. O’Brien was supported by the following during the course of this study: the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grants UL1RR024986 and UL1TR000433, MICHR seed pilot grant F021024, the National Heart, Lung, and Blood Institute (R21 HL089918 and K23 HL095739) and in part by R21 HL087819.
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Zhu, Jing, Jun Zhang, Mor Jack Ng, Bernard Chern, George SH Yeo e Kok Hian Tan. "Angiogenic factors during pregnancy in Asian women with elevated blood pressure in early pregnancy and the risk of preeclampsia: a longitudinal cohort study". BMJ Open 9, n.º 11 (novembro de 2019): e032237. http://dx.doi.org/10.1136/bmjopen-2019-032237.
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ObjectiveIt remains unclear what roles placenta-originated angiogenic factors play in the pathogenesis of preeclampsia among hypertensive women. We compared maternal soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) levels throughout pregnancy in women with normal blood pressure (BP), elevated BP and hypertension in early pregnancy and their risks of developing preeclampsia.DesignA prospective cohort study.SettingKK Women’s and Children’s Hospital, Singapore.Participants923 women with singleton pregnancy <14 weeks of gestation were included in the prospective Neonatal and Obstetrics Risks Assessment cohort between September 2010 and October 2014. Systolic, diastolic, mean arterial blood pressure (MAP) were measured at 11–14 weeks.Primary and secondary outcomesMaternal serum sFlt-1, PlGF and sFlt-1/PlGF ratio were tested at 11–14, 18–22, 28–32 and 34 weeks onwards of gestation. Preeclampsia was main pregnancy outcome.ResultsWomen were divided based on their BP in early pregnancy: normal (n=750), elevated BP (n=98) and hypertension (n=75). Maternal sFlt-1 levels and sFlt-1/PlGF ratios were higher in hypertensive women throughout pregnancy, but maternal PlGF levels were not significantly lower. Rise in maternal systolic, diastolic BP and MAP at 11–14 weeks were significantly associated with higher sFlt-1/PlGF ratios during pregnancy. A 10 mm Hg increase in MAP was associated with a 5.6-fold increase in risk of preterm preeclampsia and a 3.3-fold increase in risk of term preeclampsia, respectively.ConclusionWomen with elevated BP in early pregnancy already had a higher sFlt-1/PlGF ratio in early gestation and throughout pregnancy, and an increased risk of preeclampsia. In contrast, PlGF levels in these women remained normal.
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Dougall, Greig, Marloes Franssen, Katherine Louise Tucker, Ly-Mee Yu, Lisa Hinton, Oliver Rivero-Arias, Lucy Abel et al. "Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials". BMJ Open 10, n.º 1 (janeiro de 2020): e034593. http://dx.doi.org/10.1136/bmjopen-2019-034593.
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IntroductionSelf-monitoring of blood pressure (BP) in pregnancy could improve the detection and management of pregnancy hypertension, while also empowering and engaging women in their own care. Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies (BUMP 1) and whether self-monitoring reduces systolic BP during hypertensive pregnancy (BUMP 2).Methods and analysesBoth are multicentre, non-masked, parallel group, randomised controlled trials. Participants will be randomised to self-monitoring with telemonitoring or usual care. BUMP 1 will recruit a minimum of 2262 pregnant women at higher risk of pregnancy hypertension and BUMP 2 will recruit a minimum of 512 pregnant women with either gestational or chronic hypertension. The BUMP 1 primary outcome is the time to the first recording of raised BP by a healthcare professional. The BUMP 2 primary outcome is mean systolic BP between baseline and delivery recorded by healthcare professionals. Other outcomes will include maternal and perinatal outcomes, quality of life and adverse events. An economic evaluation of BP self-monitoring in addition to usual care compared with usual care alone will be assessed across both study populations within trial and with modelling to estimate long-term cost-effectiveness. A linked process evaluation will combine quantitative and qualitative data to examine how BP self-monitoring in pregnancy is implemented and accepted in both daily life and routine clinical practice.Ethics and disseminationThe trials have been approved by a Research Ethics Committee (17/WM/0241) and relevant research authorities. They will be published in peer-reviewed journals and presented at national and international conferences. If shown to be effective, BP self-monitoring would be applicable to a large population of pregnant women.Trial registration numberNCT03334149
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Alabeidi, Fahad, Faisal Mohammed Alosaimi, Sarah Abdullah Alsaeed, Ibrahim Furih Alshammari, Mohammed Hamdan Al Shamry, Abdulelah Mohammed Mubashir Alamri, Mohammad Raja Aljehani et al. "Home monitoring of blood pressure in children, pregnancy, and chronic kidney diseases via personal blood pressure meters- An updated review for pharmacists". International journal of health sciences 4, S1 (8 de janeiro de 2020): 320–31. http://dx.doi.org/10.53730/ijhs.v4ns1.15263.
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Background: Blood pressure (BP) monitoring is critical in managing hypertension across various populations, including children, pregnant women, and patients with chronic kidney disease (CKD). Traditional clinic-based BP measurements often lead to misdiagnoses due to white-coat and masked hypertension. Aim: This review highlights the significance of home BP monitoring in children, pregnancy, and CKD, evaluating its accuracy, practicality, and integration into clinical practice. Methods: A literature review was conducted, analyzing studies on home BP monitoring across pediatric, pregnancy, and CKD populations. Data on oscillometric devices and validation studies were included. Results: Home BP monitoring is increasingly used in pediatric hypertension, with an 80–85% agreement with ambulatory monitoring. In pregnancy, home monitoring aids in detecting preeclampsia and helps maintain optimal BP levels. For CKD, home BP readings are superior to clinical measurements, accurately predicting disease progression and cardiovascular risk. Conclusion: Home BP monitoring proves valuable in managing hypertension across vulnerable populations, offering convenience, reliability, and better diagnostic precision. Further research is needed to refine device accuracy and integrate home monitoring into routine care for children, pregnant women, and CKD patients.
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Shim, Soon-Sup, Jong Kwan Jun, Joong Shin Park, Yoon-Mi Hur, Young Min Choi, Bo Hyun Yoon e Hee Chul Syn. "Angiotensinogen G(–6)A Polymorphism Is Associated With the Elevation of Blood Pressure in the Hypertensive Disorders of Pregnancy". Twin Research and Human Genetics 9, n.º 1 (1 de fevereiro de 2006): 76–80. http://dx.doi.org/10.1375/twin.9.1.76.
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AbstractThe objective of the present study was to determine whether angiotensinogen G(–6)A polymorphism is associated with the elevation of blood pressure (BP) in the hypertensive disorders of pregnancy in Korean population. The subjects included 201 cases with the hypertensive disorders of pregnancy and 160 healthy controls. The medical records of subjects were reviewed. Cases were classified into the four subtypes (transient hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension) by the diagnostic criteria suggested by the National High Blood Pressure Education Program Working Group. Cases were also divided into the high and low BP group by the elevation of BP (diastolic BP greater than or equal to 110 mmHg). Maternal angiotensinogen G(–6)A polymorphism was determined by restriction fragment length polymorphism. Frequencies of AA genotype were significantly higher in the high than in the low BP group in the preeclampsia, superimposed preeclampsia, and the combined group (N = 201), suggesting that the angiotensinogen G(–6)A allele was significantly associated with the elevation of BP in the hypertensive disorders of pregnancy among South Korean women. The present findings imply that the elevation of BP can serve as an endophenotype for a spectrum of hypertensive conditions in pregnancy.
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Korenek, Antonin, e Martin Prochazka. "IODINE IN EARLY PREGNANCY - IS THERE ENOUGH?" Biomedical Papers 152, n.º 1 (1 de junho de 2008): 97–99. http://dx.doi.org/10.5507/bp.2008.015.
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Magee, Laura A., Jeffrey Bone, Salwa Banoo Owasil, Joel Singer, Terry Lee, Mrutunjaya B. Bellad, Shivaprasad S. Goudar et al. "Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries". Hypertension 77, n.º 5 (maio de 2021): 1714–22. http://dx.doi.org/10.1161/hypertensionaha.120.16851.
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In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03–1.07] and OR, 1.08 [1.06–1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98–2.21] for SD and 1.52 [1.45–1.60] for ARV; diastolic: OR, 2.70 [2.54–2.87] for SD and 1.86 [1.76–1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06–1.14] for SD and 1.06 [1.02–1.10] for ARV; diastolic: OR, 1.07 [1.03–1.11] for SD and 1.06 [1.02–1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.
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Prochazka, Martin, Marek Lubusky, Ludek Slavik, Petr Hrachovec, Petr Zielina, Milan Kudela e Pelle G. Lindqvist. "SELECTED PREGNANCY VARIABLES IN WOMEN WITH PLACENTAL ABRUPTION". Biomedical Papers 150, n.º 2 (1 de dezembro de 2006): 271–73. http://dx.doi.org/10.5507/bp.2006.040.
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Szczepaniak-chichel, Ludwina, Dawid Lipski, Pawel Uruski e Andrzej Tykarski. "DIFFERENCES BETWEEN PROFILE OF OFFICE, HOME AND 24H AMBULATORY BLOOD PRESSURE MONITORING IN PREECLAMPSIA AND UNCOMPLICATED HYPERTENSION IN PREGNANCY". Journal of Hypertension 42, Suppl 1 (maio de 2024): e321. http://dx.doi.org/10.1097/01.hjh.0001022852.28310.4a.
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Objective: Definition of arterial hypertension and management decision making in guidelines is still based on office blood pressure measurement (OBPM), both in general and pregnant population, although in clinical practice 24h ambulatory monitoring (ABPM) seems to be more accurate, which if not available often replaced with home BP (HBPM). Information on differences between values of BP depending on method in course of pregnancy are scarce. Aim of the study was to assess profile and compare results of three methods of BP measurement used simultaneously – HBPM, OBPM and 24 ABPM in pregnancy in real clinical setting with regard to hypertensive status, development of preeclampsia (PE) and time of pregnancy. Design and method: In a prospective longitudinal study 241 pregnant women admitted between 2017 and 2023 to outpatient clinic had their BP examined - monthly throughout pregnancy and 6-8 weeks, 6 months and 1 year postpartum. On each occasion data on HBPM (from 7 days prior) were collected, compared with OBPM in standardized conditions (OMRON®-705I) as well as with result of 24h ABPM (AND®TM-2430). Pharmacotherapy in hypertensive patients was managed in accordance with ESH/ESC guidelines. Results: We have recruited 40 normotensive controls and 201 women with hypertension (145 chronic; 56 pregnancy induced). Preeclampsia developed in 49 of hypertensives (HT+PE) (18,6% of chronic HT, 39,3% of PIH) – on average in 32,8 w.g. (20-39). SBP/DBP as median are presented in table 1. BP of controls differed significantly from both complicated (HT+PE) and uncomplicated hypertensive patients (HT) in all three methods at all stages of pregnancy and postpartum (p< 0.05). Significant differences between HT+PE and HT are marked in table 2 in gray. Conclusions: Regardless of method of BP assessment and good BP control with antihypertensives achieved values in HT pregnancies differed significantly from normotensive pregnancies. Preeclamptic patients were characterized with significantly higher BP values in HBPM, OBPM and – most strongly expressed - in night-ABPM than uncomplicated hypertensives already 2 months before average time of PE recognition. The night-time BP values from ABPM seems to have the strongest predictive and diagnostic value for early recognition of preeclampsia.
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Gaisin, I. R., R. M. Valeeva e N. I. Maksimov. "Cardiorenal continuum in hypertensive pregnancy". "Arterial’naya Gipertenziya" ("Arterial Hypertension") 15, n.º 5 (28 de outubro de 2009): 590–97. http://dx.doi.org/10.18705/1607-419x-2009-15-5-590-597.
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Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analyzed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were separately investigated in patients with different gestational hypertension (HT) depending on the diagnostic method: 13 with isolated clinic HT (1CHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement methods (clinic, ambulatory, and home BP). The number of RF (age, family history of CVD and pre-eclampsia, pre-pregnancy history of smoking, lack of physical exercise, and oral contraception, BP levels, abdominal obesity, dyslipidaemia, anxiety and depression, oxidative stress, altered fasting plasma glucose, metabolic syndrome), signs of subclinical organ damage (cell membrane destabilization, left ventricular hypertrophy, intima-media thickening, slight increase in serum creatinine, hyperuricaemia, endothelial dysfunction, albuminuria, low glomerular filtration rate), and total cardiovascular risk progressively increased from the condition of being normotensive at the time of office, home, and 24-hour measurements to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum «healthy pregnant women - ICHT - IAHT - gestational HT». Assessment of cardiorenal state in all pregnant women allowed to compose the cline «healthy pregnants- gestational HT- stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia» with the growing risk of CVD and CKD and potential danger of cardiovascular events and chronic renal failure.
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Kitt, Jamie A., Rachael L. Fox, Alexandra E. Cairns, Jill Mollison, Holger H. Burchert, Yvonne Kenworthy, Annabelle McCourt et al. "Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial". Hypertension 78, n.º 2 (agosto de 2021): 469–79. http://dx.doi.org/10.1161/hypertensionaha.120.17101.
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Women with hypertensive pregnancies are 4× more likely to develop chronic hypertension. Previously, we showed a short period of blood pressure (BP) self-management following hypertensive pregnancy resulted in persistently lower BP after 6 months. We now report the impact on long-term BP control. Women who participated in the postpartum randomized controlled trial, SNAP-HT (Self-Management of Postnatal Hypertension; NCT02333240), were invited for 24-hour ambulatory and clinic BP measures. Height and weight were measured by calibrated scales and standardized tape measures, activity by 7-day wrist-worn accelerometer, and dietary factors assessed by questionnaire. Sixty-one of 70 eligible women were followed up 3.6±0.4 years after their original pregnancy. Twenty-four–hour diastolic BP was 7.0 mm Hg lower in those originally randomized to postpartum BP self-management instead of usual care. This difference remained significant after adjustment for either BP at the time of delivery (−7.4 mm Hg [95% CI, −10.7 to −4.2]; P <0.001) or pregnancy booking BP (−6.9 mm Hg [95% CI, −10.3 to −3.6]; P <0.001). Adjustment for current salt intake, age, body mass index, waist-to-hip ratio, arm circumference, parity, alcohol intake, and physical activity had no effect on this difference. Reductions in diastolic BP at 6 months, following self-management of BP postpartum, are maintained 3.6 years later as measured by lower 24-hour diastolic BP. Interventions to optimize BP control during the puerperium in women with hypertensive pregnancies improve BP in the longer term, in a cohort at increased risk of developing chronic hypertension and major adverse cardiovascular events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02333240.
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Kivioja, Anna, Elli Toivonen, Jaakko Tyrmi, Sanni Ruotsalainen, Samuli Ripatti, Heini Huhtala, Tiina Jääskeläinen et al. "Increased Risk of Preeclampsia in Women With a Genetic Predisposition to Elevated Blood Pressure". Hypertension 79, n.º 9 (setembro de 2022): 2008–15. http://dx.doi.org/10.1161/hypertensionaha.122.18996.
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Background: Preeclampsia causes significant maternal and perinatal morbidity. Genetic factors seem to affect the onset of the disease. We aimed to investigate whether the polygenic risk score for blood pressure (BP; BP-PRS) is associated with preeclampsia, its subtypes, and BP values during pregnancy. Methods: The analyses were performed in the FINNPEC study (Finnish Genetics of Pre-Eclampsia Consortium) cohort of 1514 preeclamptic and 983 control women. In a case-control setting, the data were divided into percentiles to compare women with high BP-PRS (HBP-PRS; >95th percentile) or low BP-PRS (≤5th percentile) to others. Furthermore, to evaluate the effect of BP-PRS on BP, we studied 3 cohorts: women with preeclampsia, hypertensive controls, and normotensive controls. Results: BP values were higher in women with HBP-PRS throughout the pregnancy. Preeclampsia was more common in women with HBP-PRS compared with others (71.8% and 60.1%, respectively; P =0.009), and women with low BP-PRS presented with preeclampsia less frequently than others (44.8% and 61.5%, respectively; P <0.001). HBP-PRS was associated with an increased risk for preeclampsia (odds ratio, 1.7 [95% CI, 1.1–2.5]). Furthermore, women with HBP-PRS presented with recurrent preeclampsia and preeclampsia with severe features more often. Conclusions: Our results suggest that HBP-PRS is associated with an increased risk of preeclampsia, recurrent preeclampsia, and preeclampsia with severe features. Furthermore, women with HBP-PRS present higher BP values during pregnancy. The results strengthen the evidence pointing toward the role of genetic variants associated with BP regulation in the etiology of preeclampsia, especially its more severe forms.
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Buxton, Miatta A., Safa Heydarzadeh, Carina J. Gronlund, Marisol Castillo-Castrejon, Myrna Souraye Godines-Enriquez, Marie S. O’Neill e Felipe Vadillo-Ortega. "Associations between Air Pollution Exposure and Blood Pressure during Pregnancy among PRINCESA Cohort Participants". Toxics 11, n.º 5 (3 de maio de 2023): 424. http://dx.doi.org/10.3390/toxics11050424.
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High blood pressure (BP) is a risk factor for hypertensive disease during pregnancy. Exposure to multiple toxic air pollutants can affect BP in pregnancy but has been rarely studied. We evaluated trimester-specific associations between air pollution exposure and systolic (SBP) and diastolic BP (DBP). Ozone (O3), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter less than 10 and 2.5 μm in aerodynamic diameter (PM10, PM2.5) in the Pregnancy Research on Inflammation, Nutrition, & City Environment: Systematic Analyses (PRINCESA) study. Multipollutant generalized linear regression models with each pollutant and O3 were fit. Due to nonlinear pollution/BP associations, results are presented for “below the median” or “above the median”, where the beta estimate is the change in BP at a pollutant’s median versus BP at the pollutant’s minimum or maximum, respectively. Associations varied across trimesters and pollutants, and deleterious associations (higher blood pressure with higher pollution) were found only at pollutant values below the median: for SBP with NO2 in the second and third trimesters, and PM2.5 during the third trimester, and for DBP, PM2.5, and NO2 in the second and third trimesters. Findings suggest that minimizing prenatal exposure to air pollution may reduce the risks of changes in BP.
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Freeman, Alyssa, Corrine Hanson, Matthew Van Ormer, Maranda Thompson, Melissa Thoene, Mackenzie Enmeier, Paula Evans, Anya Morozov, Jeremy Furtado e Ann Anderson-Berry. "Associations Between Maternal Tocopherol Levels and Pregnancy-Induced Blood Pressure Changes". Current Developments in Nutrition 4, Supplement_2 (29 de maio de 2020): 987. http://dx.doi.org/10.1093/cdn/nzaa054_059.
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Abstract Objectives Vitamin E plays different roles in health based on its three isoforms: alpha (α)-tocopherol is anti-inflammatory, gamma (γ)-tocopherol is pro-inflammatory, delta (δ)-tocopherol remains unknown. As inflammation may promote hypertension, the objective of this study is to examine relationships between maternal serum tocopherol levels at time of delivery and pregnancy-related blood pressure (BP) changes. Hypothesis is that increased level of α-tocopherol has favorable effects and γ-tocopherol has adverse effects on maternal BP. Methods An IRB-approved cross-sectional study enrolled mother-infant dyads (n = 342) at time of delivery (Omaha, NE, USA) for collection of electronic health data and maternal blood. High-performance liquid chromatography analyzed serum tocopherol levels. Maternal BP values were collected from 1st and 3rd trimester clinic/hospital visits with changes calculated in systolic BP and mean arterial pressure (MAP = diastolic BP + 1/3(systolic BP – diastolic BP). Mothers were classified as hypertensive if: systolic BP ≥140, diastolic BP ≥ 90, or diagnosis of preeclampsia. Two-sample t-test and Pearson correlation coefficients compared relationships between serum tocopherol levels and BP data. P-value < 0.05 was significant. Results Mean maternal age was 28.5 years, majority (61.4%) Caucasian, 10.4% (n = 29) with hypertension. Mean serum levels: α-tocopherol 15,229 + 5849 mcg/L, γ-tocopherol 1642 + 868 mcg/L, δ-tocopherol 226 + 164 mcg/L, with α: γ ratio 11.5 + 8.7. Mean serum α-tocopherol level was higher in normotensive vs. hypertensive mothers (15,751 vs. 13,819 mcg/L; P = 0.06). Ratio of α: γ demonstrated an inverse correlation with change in maternal systolic BP (r = −0.128; P = 0.03). No other relationships were significant. Conclusions Increasing maternal α-tocopherol and α: γ ratio has favorable association with maintaining normal BP during pregnancy. More research is needed to specifically identify serum thresholds and tocopherol isoform ratios for favorably reducing risk of pregnancy-related hypertension. Funding Sources Department of Pediatrics and the Child Health Research Institute at the University of Nebraska Medical Center and Children's Hospital & Medical Center (Omaha, NE).
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Eguchi, K., T. Ohmaru, A. Ohkuchi, C. Hirashima, K. Takahashi, H. Suzuki, K. Kario, S. Matsubara e Mitsuaki Suzuki. "Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy". Journal of Human Hypertension 30, n.º 1 (19 de março de 2015): 62–67. http://dx.doi.org/10.1038/jhh.2015.20.
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Gonsalves, Kavita Peter, Mallikarjun V. J., Annamma Thomas e Ganapathi Bantwal. "Intractable hypoglycemia in pregnancy". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, n.º 4 (30 de março de 2017): 1672. http://dx.doi.org/10.18203/2320-1770.ijrcog20171452.
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Insulinomas are rare tumours developed from pancreatic beta cells; 27 cases of insulinoma associated with pregnancy have been reported till date, mostly diagnosed before the 16th week. Triad of insulinoma; hypoglycemic symptoms, plasma glucose < 3.0 mmol/L, symptomatic relief with glucose administration. 28-year-old primi presented to us at 29 weeks with high BP and neuroglycopenic symptoms. Repeated episodes of loss of consciousness with hypoglycemia since 14 weeks. On evaluation diagnosed to have insulinoma and managed conservatively with dietary modifications, and medical treatment. She failed to respond and pregnancy was terminated due to high BP, hypoglycemia and Doppler changes. Delivered a stillborn girl at 31 weeks. Underwent laparotomy post-delivery for enucleation of the lesion. Quick normalization of sugar levels and overall recovery remarkable. Patient is on regular follow up. Insulinoma is a rare cause of severe repeated episodes of hypoglycemia early in pregnancy.
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Kumordzie, Sika M., Seth Adu-Afarwuah, Rebecca R. Young, Brietta M. Oaks, Solace M. Tamakloe, Maku E. Ocansey, Harriet Okronipa, Elizabeth L. Prado e Kathryn G. Dewey. "Maternal–Infant Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Does Not Affect Child Blood Pressure at 4–6 Y in Ghana: Follow-up of a Randomized Trial". Journal of Nutrition 149, n.º 3 (11 de fevereiro de 2019): 522–31. http://dx.doi.org/10.1093/jn/nxy285.
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ABSTRACT Background In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, prenatal small-quantity lipid-based nutrient supplements (LNSs) had a positive effect on birth weight. Birth weight may be inversely related to blood pressure (BP) later in life. Objectives We examined the effect of the intervention on BP at 4–6 y of age, and maternal and child factors related to BP. Methods The iLiNS-DYAD-Ghana study was a partially double-blind, randomized controlled trial which assigned women (n = 1320) ≤20 weeks of gestation to daily supplementation with: 1) iron and folic acid during pregnancy and 200 mg Ca for 6 mo postpartum , 2) multiple micronutrients during pregnancy and postpartum, or 3) LNSs during pregnancy and postpartum plus LNSs for infants from 6 to 18 mo of age. At 4–6 y of age (n = 858, 70% of live births), we compared BP, a secondary outcome, between non-LNS and LNS groups and examined whether BP was related to several factors including maternal BP, child weight-for-age z score (WAZ), and physical activity. Results Non-LNS and LNS groups did not differ in systolic (99.2 ± 0.4 compared with 98.5 ± 0.6 mm Hg; P = 0.317) or diastolic (60.1 ± 0.3 compared with 60.0 ± 0.4 mm Hg; P = 0.805) BP, or prevalence of high BP (systolic or diastolic BP ≥90th percentile of the US National Heart, Lung, and Blood Institute reference: 31% compared with 28%; P = 0.251). BP at 4–6 y of age was positively related to birth weight; this relation was largely mediated through concurrent WAZ in a path model. Concurrent WAZ and maternal BP were the factors most strongly related to child BP. Conclusions Despite greater birth weight in the LNS group, there was no intervention group difference in BP at 4–6 y. In this preschool population at high risk of adult hypertension based on BP at 4–6 y, high maternal BP and child WAZ were key factors related to BP. This trial was registered at clinicaltrials.gov as NCT00970866.
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Dragunova, N. V., Zh E. Belaia, G. S. Kolesnikova e L. Ia Rozhinskaia. "The course of pregnancy and labour in a patient with the remission of Cushing's disease treated with ibandronic acid (Bonviva) for severe steroid-induced osteoporosis. A case report and literature review". Problems of Endocrinology 59, n.º 5 (15 de outubro de 2013): 32–35. http://dx.doi.org/10.14341/probl201359532-35.
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Therapy with bisphosphonates (BP) is recognized to be "the golden standard" for the treatment of osteoporosis of different etiology. However, the data on the use of BP by the women during pregnancy and lactation are scarce. This paper reports a case of gestation, labour, and lactation in a patient treated with ibandronic acid (Bonviva) for severe steroid-induced osteoporosis attributable to Cushing's disease. To our knowledge, the application of ibandronic acid during pregnancy has never been described in the literature before. The present study has demonstrated that therapy with ibandronic acid does not necessarily require the interruption of pregnancy or cessation of birth feeding. Nevertheless, the treatment of the women of reproductive age with BP can be prescribed only upon strict indications.
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Stutzman, Sherri S., C. Ann Brown, Sylvia M. J. Hains, Marshall Godwin, Graeme N. Smith, Joel L. Parlow e Barbara S. Kisilevsky. "The Effects of Exercise Conditioning in Normal and Overweight Pregnant Women on Blood Pressure and Heart Rate Variability". Biological Research For Nursing 12, n.º 2 (26 de agosto de 2010): 137–48. http://dx.doi.org/10.1177/1099800410375979.
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Pre-pregnancy obesity is a risk factor for preeclampsia, gestational diabetes, and hypertension. Regular exercise during pregnancy has been shown to decrease the risk of these obstetrical complications. The purpose of this prospective study was to measure the effects of an exercise program in normal-weight and overweight/obese pregnant women on blood pressure (BP) and cardiac autonomic function, determined by heart rate variability (HRV) and baroreflex sensitivity (BRS). Twenty-two sedentary pregnant women, recruited at 20 weeks gestational age (GA), were grouped as normal weight or overweight/obese. They were systematically assigned to an exercise (walking) group or control (nonwalking) group after the first participants were randomly assigned. Women in the walking groups participated in a 16-week, low-intensity walking program. BP, HRV, and BRS were measured at rest and during exercise at the beginning (20 weeks GA) and end (36 weeks GA) of the walking program. Results indicated that women in the control groups (especially overweight women) showed changes in BP, HRV, and BRS over pregnancy that were not seen in the walking group. Overweight women in the control group increased resting systolic BP by 10 mmHg and diastolic BP by 7 mmHg. HRV declined in the control group but not in the walking group. A reduction in BRS and R-R interval at rest was found in all groups except the walking normal-weight group. The results suggest that an exercise program could attenuate the increase in BP and the loss of parasympathetic tone associated with pregnancy, especially in overweight women.
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Wu, Dan-dan, Ling Gao, Ou Huang, Kamran Ullah, Meng-xi Guo, Ye Liu, Jian Zhang et al. "Increased Adverse Pregnancy Outcomes Associated With Stage 1 Hypertension in a Low-Risk Cohort". Hypertension 75, n.º 3 (março de 2020): 772–80. http://dx.doi.org/10.1161/hypertensionaha.119.14252.
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The recommendations for the diagnosis of stage 1 hypertension were recently revised by the American Heart Association primarily based on its impact on cardiovascular disease risks. Whether the newly diagnosed stage 1 hypertension impacts pregnancy complications remain poorly defined. We designed a retrospective cohort study to investigate the associations of stage 1 hypertension detected in early gestation (<20 weeks) with risks of adverse pregnancy outcomes stratified by prepregnancy body mass index. A total of 47 874 women with singleton live births and blood pressure (BP) <140/90 mm Hg were included, with 5781 identified as stage 1a (systolic BP, 130–134 mm Hg; diastolic BP, 80–84 mm Hg; or both) and 3267 as stage 1b hypertension (systolic BP, 135–139 mm Hg; diastolic BP, 85–90 mm Hg; or both). Slightly higher, yet significant, rates and risks of gestational diabetes mellitus, preterm delivery, and low birth weight (<2500 g) were observed in both groups compared with normotensive controls. Importantly, women with stage 1a and stage 1b hypertension had significantly increased incidences of hypertensive disorders in pregnancy compared with normotensive women (adjusted odds ratio, 2.34 [95% CI, 2.16–2.53]; 3.05 [2.78–3.34], respectively). After stratifying by body mass index, stage 1a and 1b hypertension were associated with increased hypertensive disorders in pregnancy risks in both normal weight (body mass index, 18.5–24.9; adjusted odds ratio, 2.44 [2.23–2.67]; 3.26 [2.93–3.63]) and the overweight/obese (body mass index, ≥25; adjusted odds ratio, 1.90 [1.56–2.31]; 2.36 [1.92–2.90]). Current findings suggested significantly increased adverse pregnancy outcomes associated with stage 1 hypertension based on the revised American Heart Association guidelines, especially in women with prepregnancy normal weight.
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Parker, Samantha E., Ayodele Ajayi e Christina D. Yarrington. "De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital". Hypertension 80, n.º 2 (fevereiro de 2023): 279–87. http://dx.doi.org/10.1161/hypertensionaha.122.19275.
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Background: Postpartum hypertension can be persistent, following a pregnancy complicated by hypertension, or new onset (de novo), following a normotensive pregnancy. The aim of this study is to estimate the incidence and identify risk factors for de novo postpartum hypertension (dn-PPHTN) among a diverse safety-net hospital population. Methods: We conducted a retrospective cohort study of 3925 deliveries from 2016 to 2018. All blood pressure (BP) measures during pregnancy through 12 months postpartum were extracted from medical records. Patients with chronic hypertension or hypertensive disorders of pregnancy were excluded. dn-PPHTN was defined as 2 separate BP readings with systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg at least 48 hours after delivery. Severe dn-PPHTN was defined as systolic BP ≥160 and diastolic BP ≥110. We examined risk factors individually and in combination and timing of diagnosis. Results: Among the 2465 patients without a history of hypertension, 12.1% (n=298) developed dn-PPHTN; 17.1% of whom had severe dn-PPHTN (n=51). Compared to those without dn-PPHTN; cases were more likely to be ≥35 years, delivered via cesarean, or be current or former smokers. Patients with all of these characteristics had a 29% risk of developing dn-PPHTN, which was elevated among non-Hispanic Black patients (36%). Approximately 22% of cases were diagnosed after 6 weeks postpartum. Conclusions: More than 1 in 10 patients with normotensive pregnancies experience dn-PPHTN in the year after delivery. Opportunities to monitor and manage patients at the highest risk of dn-PPHTN throughout the entire year postpartum could mitigate cardiovascular related maternal morbidity.
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Zhang, Mengyue, Jianchao Qiao, Pinpeng Xie, Zhuoyan Li, Chengyang Hu e Fei Li. "The Association between Maternal Urinary Phthalate Concentrations and Blood Pressure in Pregnancy: A Systematic Review and Meta-Analysis". Metabolites 13, n.º 7 (30 de junho de 2023): 812. http://dx.doi.org/10.3390/metabo13070812.
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Phthalates are commonly found in a wide range of environments and have been linked to several negative health outcomes. While earlier research indicated a potential connection between phthalate exposure and blood pressure (BP) during pregnancy, the results of these studies remain inconclusive. The objective of this meta-analysis was to elucidate the relationship between phthalate exposure and BP in pregnancy. A comprehensive literature search was carried out with PubMed, EMBASE, and Web of Science, and pertinent studies published up until 5 March 2023 were reviewed. Random-effects models were utilized to consolidate the findings of continuous outcomes, such as diastolic and systolic BP, as well as the binary outcomes of hypertensive disorders of pregnancy (HDP). The present study included a total of 10 studies. First-trimester MBP exposure exhibited a positive association with mean systolic and diastolic BP during both the second and third trimesters (β = 1.05, 95% CI: 0.27, 1.83, I2 = 93%; β = 0.40, 95% CI: 0.05, 0.74, I2 = 71%, respectively). Second-trimester monobenzyl phthalate (MBzP) exposure was positively associated with systolic and diastolic BP in the third trimester (β = 0.57, 95% CI: 0.01, 1.13, I2 = 0; β = 0.70, 95% CI: 0.27, 1.13, I2 = 0, respectively). Conversely, first-trimester mono-2-ethylhexyl phthalate (MEHP) exposure demonstrated a negative association with mean systolic and diastolic BP during the second and third trimesters (β = −0.32, 95% CI: −0.60, −0.05, I2 = 0; β = −0.32, 95% CI: −0.60, −0.05, I2 = 0, respectively). Additionally, monoethyl phthalate (MEP) exposure was found to be associated with an increased risk of HDP (OR = 1.12, 95% CI: 1.02, 1.23, I2 = 26%). Our study found that several phthalate metabolites were associated with increased systolic and diastolic BP, as well as the risk of HDP across pregnancies. Nevertheless, given the limited number of studies analyzed, additional research is essential to corroborate these findings and elucidate the molecular mechanisms linking phthalates to BP changes during pregnancy.
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Eudy, Amanda M., Anna Maria Siega-Riz, Stephanie M. Engel, Nora Franceschini, Annie Green Howard, Megan E. B. Clowse e Michelle Petri. "Preconceptional Cardiovascular Health and Pregnancy Outcomes in Women with Systemic Lupus Erythematosus". Journal of Rheumatology 46, n.º 1 (15 de julho de 2018): 70–77. http://dx.doi.org/10.3899/jrheum.171066.
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Objective.To estimate the effects of preconceptional cardiovascular (CV) health, measured by American Heart Association (AHA) guidelines, on pregnancy outcomes in women with systemic lupus erythematosus (SLE).Methods.The study included patients in the Hopkins Lupus Pregnancy Cohort. Body mass index (BMI), total cholesterol, and blood pressure (BP) in the most recent clinic visit prior to conception or first trimester were used to determine CV health (ideal, intermediate, or poor health) based on AHA definitions. Outcomes included preterm birth, gestational age at birth, and small for gestational age (SGA). Multivariable linear and logistic regression models with generalized estimating equations estimated the association of each CV health factor and outcome.Results.The analysis included 309 live births. There were 95 preterm births (31%), and of the 293 pregnancies with birth weights, 18% were SGA. Ideal BMI, total cholesterol, and BP were reported in 56%, 85%, and 51% of pregnancies, respectively. Intermediate BMI was associated with decreased odds of SGA (OR 0.26, 95% CI 0.11–0.63), adjusted for race and prednisone use. Intermediate/poor total cholesterol was associated with increased odds of preterm birth (OR 2.21, 95% CI 1.06–4.62). Intermediate/poor BP was associated with decreased gestational age at birth (β −0.96, 95% CI −1.62 to −0.29).Conclusion.Poor/intermediate preconception CV health affects pregnancy outcomes of preterm birth and SGA infants among women with SLE. Efforts to maintain BMI, total cholesterol, and BP within the recommended ideal range prior to pregnancy is important to improve pregnancy outcomes in women with SLE.
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Waites, G. T., R. F. L. James e S. C. Bell. "Human 'pregnancy-associated endometrial α1-globulin', an insulin-like growth factor-binding protein: immunohistological localization in the decidua and placenta during pregnancy employing monoclonal antibodies". Journal of Endocrinology 120, n.º 2 (fevereiro de 1989): 351—NP. http://dx.doi.org/10.1677/joe.0.1200351.
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ABSTRACT We have previously shown that pregnancy-associated endometrial α1-globulin, a small molecular weight insulin-like growth factor-binding protein (IGF-BP), is quantitatively the major secretory protein product of the decidualized endometrium during human pregnancy. In the present study, employing monoclonal antibodies raised against this protein in an immunohistological technique, the cellular localization of the protein has been examined in the decidua and placenta during pregnancy. During the first trimester the protein was principally associated with the decidual cell in the decidualized decidua compacta region of the endometrium with both cytoplasmic and extracellular matrix-associated staining patterns being detected. No extensive staining was observed in the placenta. At term the protein was localized in similar cells in the placental bed and endometrium associated with the amniochorion but not in the placenta. These studies suggest that the decidual cell represents the major source of IGF-BP during pregnancy and have relevance to the origin of amniotic fluid IGF-BP and the paracrine role of the decidual cell in the control of trophoblast growth. Journal of Endocrinology (1989) 120, 351–357
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Chen, Shaomin, Yang Wang, Yongqing Wang, Yuan Wei, Yanguang Li, Zhaoping Li e Rong Li. "Pregnancy Outcomes in Females with Stage 1 Hypertension and Elevated Blood Pressure Undergoing In Vitro Fertilization and Embryo Transfer". Journal of Clinical Medicine 12, n.º 1 (23 de dezembro de 2022): 121. http://dx.doi.org/10.3390/jcm12010121.
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Objective: To determine whether stage 1 hypertension and elevated blood pressure (BP), as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, prior to pregnancy contributes to adverse pregnancy outcomes in females who conceived by in vitro fertilization and embryo transfer (IVF–ET). Methods: This retrospective cohort study involved 2239 females who conceived by IVF–ET and delivered live neonates. BPs recorded before IVF–ET were collected. Elevated BP was defined as at least two systolic BPs of 120 to 129 mmHg. Stage 1 hypertension was defined as at least two systolic BPs of 130 to 139 mmHg or diastolic BPs of 80 to 89 mmHg. Results: Among the females included in this study, 18.5% (415/2239) had elevated BP and 10.0% (223/2239) had stage 1 hypertension. Multiple logistic regression analysis showed that females with stage 1 hypertension had higher risks of hypertensive disorders in pregnancy (HDP) [adjusted odds ratio (aOR) 1.65; 95% confidence interval (CI) 1.16–2.35] and preeclampsia (aOR 1.52; 95% CI 1.02–2.26) than normotensive females. However, the risks of HDP (aOR 0.88; 95% CI 0.64–1.21) and preeclampsia (aOR 0.83; 95% CI, 0.57–1.20) in females with elevated BP were not significantly different from those in normotensive females. The females were then categorized into five groups by systolic and diastolic BP; females with systolic BP of 130 to 139 mmHg or diastolic BP of 85 to 89 mmHg had significantly increased risks of HDP and preeclampsia. Conclusion: Stage 1 hypertension before IVF–ET was an independent risk factor for HDP and preeclampsia.
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Agarwal, Manika, Makakmayum Rukshana, Ritisha Basu, Wansalan K. Shullai e Santa A. Singh. "Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation". Journal of Family Medicine and Primary Care 12, n.º 12 (dezembro de 2023): 3119–22. http://dx.doi.org/10.4103/jfmpc.jfmpc_2427_22.
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Hypertensive disorders of pregnancy affect 5% to 10% of all pregnancies globally. The aim of treatment is to bring down blood pressure (BP) quickly and smoothly, which is safe for the mother and baby. The aim of our study was to study the efficacy and safety of intravenous labetalol and oral nifedipine in severe pregnancy-induced hypertension. Materials and Methods: It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. Results: In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. Conclusion: From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.
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Goncalves, Lucas Melo, Samir Burato, Madison Walker, Greg Clements, Shane Morgan, Lucas Neira e Pedro Fontes. "100 Impact of luteal blood perfusion and estrus expression on pregnancy rates of beef cows exposed to embryo transfer". Journal of Animal Science 102, Supplement_3 (1 de setembro de 2024): 267–68. http://dx.doi.org/10.1093/jas/skae234.308.
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Abstract This study aimed to evaluate the impact of luteal blood perfusion and estrus expression on pregnancy rates of beef cows exposed to fixed-timed embryo transfer (FTET). Postpartum beef cows (n = 763) from 22 locations were exposed to a 7-d Select Synch + controlled internal drug releasing (CIDR) and breeding indicator patches were affixed upon CIDR removal. Estrus expression was assessed twice daily for 72 h and a 100-µg injection of gonadotropin-releasing hormone was administered to cows that failed to express estrus 72 h after CIDR removal. Brightness mode ultrasonography of the corpus luteum (CL) was conducted to select recipients for FTET 9 d after CIDR removal. Suitable recipients were assigned to receive a single fresh or frozen embryo derived from either in vitro (IVF) or in vivo (IVD) method. After embryo recipient selection, CL morphometries and blood perfusion (BP) were then assessed at the time of embryo transfer via transrectal ultrasonography. Embryo recipients were categorized according to CL area [small (< 3 cm²), medium (3 to 4 cm²), or large (> 4 cm²)] and based on the percentage of luteal area with blood perfusion signals [low (< 25%), medium (25 to 45%), or high (> 45%)]. Pregnancy diagnoses were performed between d 60 and 90 of gestation. Cows that failed to express estrus prior FTET had decreased (P ≤ 0.02) luteal area, luteal diameter, and pregnancy rates compared with cows that expressed estrus. Luteal area category had no effect (P = 0.61) on pregnancy rates. Embryo recipients that expressed estrus had similar (P = 0.12) luteal blood perfusion compared with recipients that failed to express estrus. Embryo recipients with high (P = 0.02) and medium (P = 0.05) BP had greater pregnancy rates compared with embryo recipients with low BP. There was no interaction between estrus expression and luteal BP (P = 0.84). In summary, estrus expression and luteal BP positively impacted pregnancy rates to embryo transfer and may be used to facilitate embryo recipient selection.
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O’Brien, Louise, Rivkah Levine e Galit Levi Dunietz. "418 The Berlin Questionnaire in Pregnancy Predominantly Identifies Obesity". Sleep 44, Supplement_2 (1 de maio de 2021): A165—A166. http://dx.doi.org/10.1093/sleep/zsab072.417.
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Abstract Introduction Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, it performs poorly in this population, likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity-related. Therefore, this study examined associations between each of the three BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP). Methods Pregnant third-trimester women aged at least 18 years with a single fetus were recruited from a tertiary medical center. All women completed the BQ, which includes three domains: snoring; sleepiness; and obesity/high blood pressure (BMI/BP). The latter domain was further examined as two separate sub-domains: obesity or chronic hypertension. A positive response in 2-of-3 domains identifies high OSA risk. Medical records were accessed for diagnoses of GDM and HDP. Results Of 1,588 women, 44% had a positive BQ. Women with positive domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk of GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the BMI/BP domain had increased odds of GDM (OR 2.0, 95%CI 1.3–3.3) and HDP (OR 2.9, 95%CI 1.6–5.5). Any positive score in domain combinations that included BMI/BP had increased odds of GDM and HDP compared with negative scores in all domains. A positive score in BMI/BP-alone, BMI/BP-and-sleepiness, BMI/BP-and-snoring, and an intersection of all three domains, had increased HDP odds compared with controls: OR 2.9 (95%CI 1.6–5.5), OR 2.2 (95%CI 1.1–4.4), OR 2.9 (95%CI 1.5–5.7), and OR 4.6 (95%CI 2.6–8.6), respectively. Women absent of positive BMI/BP domain but with a positive score in the other two domains (or their combination) had similar odds of GDM and HDP as controls. Conclusion The poor performance of the BQ in screening for OSA risk in pregnant women may be attributed to its predominant reliance on identification of obesity. Support (if any) NIH NHLBIHL089918
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Gaisin, I. R., e A. S. Iskhakova. "Diagnosis and treatment of hypertensive disorders of pregnancy: a narrative review". "Arterial’naya Gipertenziya" ("Arterial Hypertension") 27, n.º 2 (29 de junho de 2021): 146–69. http://dx.doi.org/10.18705/1607-419x-2021-27-2-146-169.
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The paper overviews classification, diagnosis and treatment of hypertensive disorders of pregnancy and early postpartum period (chronic hypertension (HTN), gestational HTN, pre-eclampsia) provided by different societies of cardiology and obstetrics and gynecology. The definition of pre-eclampsia offered by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018 and supported by the International Federation of Gynecology and Obstetrics (FIGO) in 2019, its screening and prevention are considered. All treatment options of moderate and severe HTN in pregnancy are reviewed. A new US Food and Drug Administration (FDA) classification system of drug therapy for pregnancy and lactation Pregnancy and Lactation Labelling Rule (PLLR, 2015) is presented. Treatment goals of HTN and blood pressure (BP) thresholds in pregnancy as well as risk factors, causes, clinical presentation, diagnostic workup and management of hypertensive emergencies in pregnancy are provided. We discuss the evidence of BP ≥ 130/80 mmHg as a factor of high maternal and neonatal risks proposed by the American College of Cardiology/American Heart Association (2017) as the HTN criteria in pregnancy.
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Spangmose, Anne Lærke, Niels Skipper, Sine Knorr, Tina Wullum Gundersen, Rikke Beck Jensen, Peter Damm, Erik Lykke Mortensen, Anja Pinborg, Jannet Svensson e Tine Clausen. "School performance in Danish children exposed to maternal type 1 diabetes in utero: A nationwide retrospective cohort study". PLOS Medicine 19, n.º 4 (26 de abril de 2022): e1003977. http://dx.doi.org/10.1371/journal.pmed.1003977.
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Background Conflicting results have been reported concerning possible adverse effects on the cognitive function of offspring of mothers with type 1 diabetes (O-mT1D). Previous studies have included offspring of parents from the background population (O-BP), but not offspring of fathers with type 1 diabetes (O-fT1D) as the unexposed reference group. Methods and findings This is a population-based retrospective cohort study from 2010 to 2016. Nationally standardized school test scores (range, 1 to 100) were obtained for public school grades 2, 3, 4, 6, and 8 in O-mT1D and compared with those in O-fT1D and O-BP. Of the 622,073 included children, 2,144 were O-mT1D, and 3,474 were O-fT1D. Multiple linear regression models were used to compare outcomes, including the covariates offspring with type 1 diabetes, parity, number of siblings, offspring sex, smoking during pregnancy, parental age, and socioeconomic factors. Mean test scores were 54.2 (standard deviation, SD 24.8) in O-mT1D, 54.4 (SD 24.8) in O-fT1D, and 56.4 (SD 24.7) in O-BP. In adjusted analyses, the mean differences in test scores were −1.59 (95% CI −2.48 to −0.71, p < 0.001) between O-mT1D and O-BP and −0.78 (95% CI −1.48 to −0.08, p = 0.03) between O-fT1D and O-BP. No significant difference in the adjusted mean test scores was found between O-mT1D and O-fT1D (p = 0.16). The study’s limitation was no access to measures of glycemic control during pregnancy. Conclusions O-mT1D achieved lower test scores than O-BP but similar test scores compared with O-fT1D. Glycemic control during pregnancy is essential to prevent various adverse pregnancy outcomes in women with type 1 diabetes. However, the present study reduces previous concerns regarding adverse effects of in utero hyperglycemia on offspring cognitive function.
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Spangmose, Anne Lærke, Niels Skipper, Sine Knorr, Tina Wullum Gundersen, Rikke Beck Jensen, Peter Damm, Erik Lykke Mortensen, Anja Pinborg, Jannet Svensson e Tine Clausen. "School performance in Danish children exposed to maternal type 1 diabetes in utero: A nationwide retrospective cohort study". PLOS Medicine 19, n.º 4 (26 de abril de 2022): e1003977. http://dx.doi.org/10.1371/journal.pmed.1003977.
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Background Conflicting results have been reported concerning possible adverse effects on the cognitive function of offspring of mothers with type 1 diabetes (O-mT1D). Previous studies have included offspring of parents from the background population (O-BP), but not offspring of fathers with type 1 diabetes (O-fT1D) as the unexposed reference group. Methods and findings This is a population-based retrospective cohort study from 2010 to 2016. Nationally standardized school test scores (range, 1 to 100) were obtained for public school grades 2, 3, 4, 6, and 8 in O-mT1D and compared with those in O-fT1D and O-BP. Of the 622,073 included children, 2,144 were O-mT1D, and 3,474 were O-fT1D. Multiple linear regression models were used to compare outcomes, including the covariates offspring with type 1 diabetes, parity, number of siblings, offspring sex, smoking during pregnancy, parental age, and socioeconomic factors. Mean test scores were 54.2 (standard deviation, SD 24.8) in O-mT1D, 54.4 (SD 24.8) in O-fT1D, and 56.4 (SD 24.7) in O-BP. In adjusted analyses, the mean differences in test scores were −1.59 (95% CI −2.48 to −0.71, p < 0.001) between O-mT1D and O-BP and −0.78 (95% CI −1.48 to −0.08, p = 0.03) between O-fT1D and O-BP. No significant difference in the adjusted mean test scores was found between O-mT1D and O-fT1D (p = 0.16). The study’s limitation was no access to measures of glycemic control during pregnancy. Conclusions O-mT1D achieved lower test scores than O-BP but similar test scores compared with O-fT1D. Glycemic control during pregnancy is essential to prevent various adverse pregnancy outcomes in women with type 1 diabetes. However, the present study reduces previous concerns regarding adverse effects of in utero hyperglycemia on offspring cognitive function.
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Gosse, Philippe, Loïc Sentilhes, Romain Boulestreau, Julien Doublet, Julie Gaudissard, Michel Azizi e Antoine Cremer. "Endovascular ultrasound renal denervation to lower blood pressure in young hypertensive women planning pregnancy: study protocol for a multicentre randomised, blinded and sham controlled proof of concept study". BMJ Open 13, n.º 9 (setembro de 2023): e071164. http://dx.doi.org/10.1136/bmjopen-2022-071164.
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IntroductionA major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP) in patients with hypertension by reducing the activity of the renal sympathetic nervous system. Drugs that affect this system are safe in pregnant women. So there is reasonable evidence that RDN performed before pregnancy should not have deleterious effects for the fetus. Because the efficacy of RDN may be greater in younger patients and in women, we may expect a larger proportion of BP normalisation in young hypertensive women, but this remains to be proven. Our primary objective is to quantify the proportion of BP normalisation with RDN in this population.Methods and analysisWHY-RDN is a multicentre randomised sham-controlled trial conducted in six French hypertension centres that will include 80 women with essential hypertension treated or untreated, who are planning a pregnancy in the next 2 years and will be randomly assigned to RDN or classic renal arteriography and sham RDN in a ratio of 1:1. The primary outcome is the normalisation of 24-hour BP (<130/80 mm Hg) at 2-month post procedure off treatment. Sample size is calculated with the following assumptions: 5% one-sided significance level (α), 80% power (1-β), expected responder rates of 24% and 3% in the treatment and control group, respectively. Secondary outcomes include the absence of adverse outcomes for a future pregnancy, the variations of BP in ambulatory and home BP measurements and the evaluation of treatment prescribed.Ethics and disseminationWHY-RDN has been approved by the French Ethics Committee (Tours, Region Centre, Ouest 1- number 2021T1-28 HPS). This project is being carried out in accordance with national and international guidelines. The findings of this study will be disseminated by publication.Trial registration numberClinicalTrials.gov,NCT05563337.
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Blizard, D. A., e T. G. Folk. "Resource sharing in rat gestation: role of maternal cardiovascular hemodynamics". American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 258, n.º 6 (1 de junho de 1990): R1299—R1307. http://dx.doi.org/10.1152/ajpregu.1990.258.6.r1299.
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There is a substantial decrease in blood pressure (BP) in late pregnancy in the laboratory rat. It is so pronounced that manipulations that produce sustained elevations in BP in nonpregnant animals have little or no effect during pregnancy. It is commonly believed that this decrease in BP is a consequence of a large decrease in total peripheral resistance resulting from the passive combination of the placental vasculature with a preexisting maternal vasodilation. An alternative view is presented here. We suggest that, in small mammals like the laboratory rat, pregnancy severely challenges the ability of the maternal cardiovascular system to meet its metabolic demands, so that during the last stages of maturation of the low-resistance placental circulation delivery of vital metabolic or nutritional substances to the maternal vasculature becomes marginal. When the so-called maternal hemodynamic preservation threshold is reached, a pronounced and wide-spread vasodilation occurs to maintain adequate perfusion of maternal organs. The late-gestational decrease in BP thus reflects a dynamic interaction between the maternal and placental circulations rather than reflecting their passive combination. The hypothesis provides a framework for the integrated discussion of a number of important phenomena: the fact that hypertensive rats exhibit a larger decrease in BP in late gestation than normotensive rats; the existence of a positive association between litter size and the magnitude of the late-gestational decrease in BP; and, finally, the well-established ability of the food-restricted pregnant rat to compartmentalize its nutritional resources.
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Sipak, Olimpia, Aleksandra Rył, Anna Grzywacz, Maria Laszczyńska, Sławomir Szymański, Beata Karakiewicz, Iwona Rotter e Cezary Cybulski. "Molecular Analysis of HLA-G in Women with High-Risk Pregnancy and Their Partners with Regard to Possible Complications". International Journal of Environmental Research and Public Health 16, n.º 6 (19 de março de 2019): 982. http://dx.doi.org/10.3390/ijerph16060982.
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The understanding of the molecular and biochemical characteristics of the human leukocyte antigen-G (HLA-G) is important because of the diverse influence of this antigen’s polymorphisms on the course of a pregnancy. The aim of our study was to assess how the variation of the HLA-G allele and the HLA-G 14-bp ins/del polymorphism influence predisposition to a complicated pregnancy. The clinical material consisted of parental pairs with complicated pregnancies (210 women; 190 men). The control group included parental pairs without complications during pregnancy (89 women; 86 men). The study involved isolation of genome DNA from peripheral blood leukocytes, sequencing, and analysis of the 14-bp ins/del polymorphism in the 3′-untranslated region (3′-UTR) of the HLA-G gene based on polymerase chain reaction (PCR). The most common HLA-G allele in the group of women with complicated pregnancies was the HLA-G 10101 allele. There were no statistically significant differences in the frequencies of the 14-bp ins/del polymorphism in the 3′UTR of the HLA-G gene between the groups. Our results suggest that the risk of complications in pregnancy is influenced by the HLA-G 10101, HLA-G 10108, and HLA-G 10106 alleles and is not influenced by the 14-bp ins/del polymorphism in the 3′UTR of the HLA-G gene.
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Bugri, Amos Adapalala, Solomon Kwabena Gumanga, Peter Yamoah, Ebenezer Kwabena Frimpong e Manimbulu Nlooto. "Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana". International Journal of Environmental Research and Public Health 20, n.º 12 (16 de junho de 2023): 6153. http://dx.doi.org/10.3390/ijerph20126153.
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Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.
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Glushkov, A. N., K. S. Krasilnikova, E. G. Polenok, M. V. Kostyanko, R. V. Olennikova e S. L. Nersesyan. "COMBINED EFFECT OF ANTIBODIES TO BENZO[A]PYRENE, ESTRADIOL AND PROGESTERONE UPON SEX HORMONE CONCENTRATIONS IN BLOOD SERUM OF PREGNANT WOMEN WITH CONGENITAL MALFORMATIONS OF FETUS". Medical Immunology (Russia) 20, n.º 5 (6 de novembro de 2018): 647–56. http://dx.doi.org/10.15789/1563-0625-2018-5-647-656.
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Specific antibodies against environmental chemical gene toxicants and endogenous steroid hormones are shown to modulate concentrations of these compounds in blood serum and their biological effects in experimental models. However, probable hazards of such antibodies in human teratogenesis are still unknown. In particular, potential correlations between specific serum antibodies, sex hormone levels in pregnant women, and congenital malformations in newborns are not clear. The aim of this study was to identify possible associations between occurrence of antibodies to benzo[a]pyrene, estradiol and progesterone (Bp, Es and Pg, respectively), and congenital malformations, and effects of these antibodies upon Es and Pg concentrations in blood serum of pregnant women. We have included into the study 182 women with normal pregnancy and 101 females with congenital malformations of fetus. A non-competitive solid phase immunoassay was performed using Bp, Es and Pg conjugated to bovine serum albumin as antigens. Es and Pg serum concentrations were measured using immunoassay test-systems of “Immunotech” (Moscow). Results: strong positive correlations were revealed between the levels of studied antibodies in the both groups. High IgA-Bp/IgA-Es (> 3) and IgA-Bp/IgA-Pg ratios (> 3) were associated with congenital malformations (OR = 2.2, p = 0.013 and OR = 6.8, p < 0.0001). Positive correlations were revealed between Pg/Es and IgA-Bp/IgA-Es (rS = 0.62, p < 0.0001), and IgA-Bp/IgA-Pg ratios (rS = 0.77, p < 0.0001) in cases with inborn malformations. Similar correlations were found for the women who had normal pregnancy (rS = 0.4, p = 0.0001, and rS = 0.23, p = 0.026, respectively). The Pg/Es proportion correlated with IgG-Bp/IgG-Es (rS = 0.46, p = 0.002), and with IgG-Bp/IgG-Pg ratio (rS = 0.5, p = 0.0009) in cases of malformations, but not in women with normal pregnancy. Conclusion: we have revealed novel associations between congenital malformations of fetus and ratios of IgA-Bp/IgA-Es, as well as IgA-Bp/IgA-Pg, like as positive correlations between hormonal Pg/Es proportions, and ratios of specific antibodies in pregnant women.
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Chulkov, V. S., N. K. Vereina, S. P. Sinitsyn e V. F. Dolgushina. "EVALUATION OF AN INTERRELATION OF TARGET BLOOD PRESSURE ACHIEVEMENT AND COMPLICATIONS AND OUTCOMES OF PREGNANCY IN ARTERIAL HYPERTENSION". Cardiovascular Therapy and Prevention 13, n.º 6 (28 de dezembro de 2014): 23–27. http://dx.doi.org/10.15829/1728-8800-2014-6-23-27.
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Aim. To evaluate the influence of target BP achievement on clinical course and outcomes of pregnancy in pregnant women with arterial hypertension (AH).Material and methods. A cohort study with prospective cohort. Totally 300 pregnant women included; of those in to the 1st group 103 included with AH, who had not reached target BP; into the 2nd – 97 women with AH, who had reached target BP; control consisted of 100 women without AH. Women underwent clinical examination and observation, analysis of medical data, standard laboratory and instrumental investigation, genetic investigation by polymerase chain reaction.Results. Women who had not reached target BP pregnancy complicated more often with fetus development retardation and pre-eclampsy, and in pregancy outcomes there were preterm delivery and antenatal fetus death, newborns from this group had lower weight and height; also they had more often mutation of D-allele of ACE gene (I/D) and mutant C-allele of receptor 1 type angiotensine II gene (ATR11166 A/C) comparing to the group with achieved BP and with controls. By the result of logistic regression study the factor independently associated with total worse outcome, were premature deliveries in anamnesis - increase the risk almost 6 times (OR=5,93, 95% CI 1,83-19,2; p=0,003), pre-eclampsy during current preganancy – increases risk 3,7 times (OR=3,68, 95% CI 1,48-9,16; p=0,005), and target BP acievement (less than 140/90 mmHg) decreases the risk of total negative outcome 8 times (OR=0,12, 95% CI 0,05-0,28; p<0,001).Conclusion. Target BP achievement in pregnant women with AH might be an independent factor influencing the prevalence of obstetric complications and negative outcomes of pregnancy. A definite impact on target BP levels achievement make genetic polymorphisms of renin-angiotensin system genes.
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&NA;. "A marine diet is associated with lower BP during pregnancy". Inpharma Weekly &NA;, n.º 806 (setembro de 1991): 11–12. http://dx.doi.org/10.2165/00128413-199108060-00027.
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Maheshwari, Hiralal G., e Michael R. Norman. "Human Growth Hormone-Binding Protein (hGH-BP) Profile in Pregnancy". Clinical Science 79, s23 (1 de outubro de 1990): 22P. http://dx.doi.org/10.1042/cs079022p.
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Zhu, Hui, Xue You, Yu Jing, Yiyuan Chen, Yangqian Jiang, Yuan Lin, Tao Jiang et al. "Maternal Hypertensive Disorder in Pregnancy and Childhood Strabismus in Offspring". JAMA Network Open 7, n.º 7 (22 de julho de 2024): e2423946. http://dx.doi.org/10.1001/jamanetworkopen.2024.23946.
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ImportanceMaternal hypertensive disorder in pregnancy (HDP) might affect ocular health in offspring; however, its association with strabismus remains unclear.ObjectiveTo examine the association of maternal HDP with overall and type-specific strabismus in offspring.Design, Setting, and ParticipantsIn the Jiangsu Birth Cohort study, a population-based study in China, pregnant women were recruited from April 24, 2014, to November 30, 2018. A total of 6195 offspring had maternal HDP diagnosis information, of whom 3078 were excluded due to having no information on ocular alignment or due to having ocular diseases other than strabismus or refractive error. Offspring underwent ocular examinations at 3 years of age, completed May 21, 2022. Data were analyzed from May 28, 2022, through December 15, 2023.ExposureMaternal HDP, categorized into hypertension and preeclampsia or with blood pressure (BP) well controlled (systolic BP, &lt;130; diastolic BP, &lt;80 mm Hg) and poorly controlled (systolic BP, ≥130; diastolic BP, ≥80 mm Hg).Main Outcomes and MeasuresThe primary outcome was the incidence of strabismus in offspring. Poisson generalized linear mixed models were used to estimate the association between maternal HDP and strabismus.ResultsAmong the included 3117 children (mean [SD] age, 36.30 [0.74] months; 1629 boys [52.3%]), 143 (4.6%) were exposed to maternal HDP and 368 (11.8%) had strabismus. Offspring exposed to maternal HDP had an 82% increased risk of overall strabismus (relative risk [RR], 1.82 [95% CI, 1.21-2.74]), an 82% increased risk of exophoria (RR, 1.82 [95% CI, 1.11-3.00]), and a 136% increased risk of intermittent exotropia (RR, 2.36 [95% CI, 1.13-4.93]) compared with unexposed offspring. When considering the type of maternal HDP, the risk for all strabismus was high for offspring exposed to preeclampsia (RR, 2.38 [95% CI, 1.39-4.09]) compared with unexposed offspring. When considering the BP control level of maternal HDP, the risk for all strabismus was high for offspring born to mothers with HDP and poorly controlled BP (RR, 2.07 [95% CI, 1.32-3.24]) compared with unexposed offspring.Conclusions and RelevanceThese findings suggest that maternal HDP is associated with an increased risk of offspring strabismus. Early screening of strabismus might be recommended for offspring with maternal HDP. Further exploration of the underlying mechanism of the association between HDP and strabismus is warranted.
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Hauspurg, Alisse, Samantha Bryan, Arun Jeyabalan, Esa M. Davis, Renee Hart, Jada Shirriel, Matthew Muldoon e Janet Catov. "Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy". Hypertension, 11 de dezembro de 2023. http://dx.doi.org/10.1161/hypertensionaha.123.22231.
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Background: Hypertensive disorders of pregnancy are associated with cardiovascular disease; however, patterns of blood pressure (BP) recovery are understudied. We compared pregnancy and postpartum BP trajectories among individuals with hypertensive disorders of pregnancy who developed persistent hypertension at 1-year postpartum compared with individuals with normalization of BP. Methods: We used data from a randomized clinical trial of individuals with overweight, obesity, and hypertensive disorders of pregnancy conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits; postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of antihypertensive medications) at 1 year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines. Results: We included 129 individuals; 75 (58%) individuals progressed to hypertension by 1-year postpartum. Individuals with hypertension were older, delivered at earlier gestational ages, and had higher body mass index at 1-year postpartum compared with those with normalization. Individuals with hypertension had similar BP trajectories during pregnancy to those with BP normalization but a significantly different BP trajectory ( P <0.01 for systolic and diastolic BPs) in the first year postpartum. These differences persisted in multivariable models after adjustment for early pregnancy body mass index, age, and severity of hypertensive disorder of pregnancy ( P <0.01 for systolic and diastolic BPs). Conclusions: BP trajectories in the first year postpartum, but not during pregnancy, may provide important information for risk stratification after a hypertensive disorder of pregnancy. REGISTRATION: URL: https://clinicaltrials.gov ; Unique identifier: NCT03749746.
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Torres, Camila Honorato A., Lidiane F. Schultz, Paul J. Veugelers, Silmara S. B. S. Mastroeni e Marco F. Mastroeni. "The effect of pre-pregnancy weight and gestational weight gain on blood pressure in children at 6 years of age". Journal of Public Health, 23 de abril de 2020. http://dx.doi.org/10.1093/pubmed/fdaa044.
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Abstract Background We evaluated the effect of maternal gestational weight gain (GWG) and pre-pregnancy weight on blood pressure (BP) of children 6 years after delivery. Methods Cross-sectional study that compared the anthropometric measurements of 181 mothers and their children’s BP 6 years after delivery. The BP was measured by the auscultatory method. We used log-binomial regression to investigate the association of pre-pregnancy body mass index (BMI) and GWG categories with BP in mid-childhood. Results The prevalence of elevated BP in children was 26.5%. Maternal pre-pregnancy overweight and concurrent excessive GWG were positively associated with elevated BP at 6 years of age. Mothers with pre-pregnancy overweight and excessive GWG were more likely to have children with elevated BP at 6 years of age (OR = 2.05; P = 0.018) compared to mothers who were of normal weight pre-pregnancy and experienced appropriate GWG. We also found that mothers with pre-pregnancy BMI ≥25 kg/m2 and concurrent excessive GWG were more likely to have children with elevated diastolic blood pressure (OR = 2.72; P = 0.005). Conclusions Pre-pregnancy overweight/obesity had impact on BP in mid-childhood. Interventions aimed at reducing cardiovascular diseases in children should promote weight loss in women of reproductive age rather than in pregnant women.
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Niu, Zhongzheng J., Tingyu Yang, Fangqi Guo, Brendan Grubbs, Sandrah P. Eckel, Claudia M. Toledo-Corral, Jill Johnston et al. "Abstract 57: Distinct Gestational Blood Pressure Trajectories Predict Pregnancy, Birth, and Postpartum Health in a Low-Income Hispanic Population". Circulation 147, Suppl_1 (28 de fevereiro de 2023). http://dx.doi.org/10.1161/circ.147.suppl_1.57.
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Objective: Blood pressure (BP) typically drops to a nadir around 20 to 24 gestation weeks in a normal pregnancy. Distinct BP trajectories over pregnancy could reveal underlying cardiovascular function and predict future cardiovascular risk, but little is known about BP trajectories in Hispanic women. We aim to identify BP trajectories during pregnancy among low-income, Hispanic women. Methods: In the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, we abstracted clinic BP measures of 732 participants who had an average of 12 BP measures over pregnancy, ranging from 4 to 41 weeks. We used latent class mixture modeling to identify BP trajectories. We examined associations of population characteristics, pregnancy and birth outcomes, and 1-year postpartum BP with the identified trajectories. Results: We identified three distinct BP trajectories ( Figure ). Compared to the majority (class 1, n=569), the consistently high class 2 (14.8%, 108) was characterized by a higher pre-pregnancy BMI (ppBMI, 32.3±7.6 vs. 27.6 ±6.1 Kg/m 2 ) and a higher proportion of having college or above education (21.3% vs. 14.9%), while the high-low-high U-shape class 3 (7.5%, 55) had a higher ppBMI (32.0±7.9 Kg/m 2 ) but lower proportion of having college or above education (9.1%). Risk of preeclampsia was the highest in class 3 (43.6%), followed by class 2 (10.2%) and class 1 (6.0%), while the risk of gestational diabetes was the highest in class 2 (14.8%), followed by class 1 (7.9%) and class 3 (7.3%). Birthweight and gestational duration were both significantly lower in class 3 than classes 1 and 2. One-year postpartum systolic BP was significantly higher in class 2 (120.2±16.0 mmHg) and class 3 (122.4±16.0 mmHg) than class 1 (111.7±26.2 mmHg) after adjusting for maternal age, pre-pregnancy BMI, parity, and education. Conclusion: Elevated blood pressure may develop into district trajectories in pregnancy that further predict pregnancy and birth outcomes, as well as postpartum blood pressure.
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Sanapo, Laura, Christina Raker, Basma Merhi, Melissa Guillen, Ashanti Avalos, Annaly Aldana, Margaret Bublitz, Alice Bai e Ghada Bourjeily. "Pregnancy-onset obstructive sleep apnea and ambulatory blood pressure". SLEEP, 25 de novembro de 2024. http://dx.doi.org/10.1093/sleep/zsae277.
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Abstract Study Objective Elevated nocturnal blood pressure (BP) increases the risk for hypertensive disorders of pregnancy (HDP). Though obstructive sleep apnea (OSA) increases the risk for HDP, data on OSA and 24-hour ambulatory blood pressure monitoring (ABPM) in pregnancy are scarce. We aim to examine the BP profile of women with pregnancy-onset OSA. Methods Pregnant women with overweight / obesity and snoring were recruited at <13 weeks gestation and underwent level III home sleep apnea testing and 24-hour ABPM at enrollment and at 31-34 weeks’ gestation. Women with OSA at enrollment were excluded . Mean differences in nocturnal BP and 24-hour BP measurements, between women with pregnancy-onset OSA and women without OSA, were computed by multivariable linear regression. Results 40 / 101 participants had pregnancy-onset OSA (respiratory event index (REI) >5 events per hour) in the third trimester. Despite no significant differences in baseline BP, nocturnal systolic and diastolic BP were significantly higher in women with pregnancy-onset OSA compared to women without OSA, after adjusting for multiple covariates (mean difference 5.49 (1.45-9.52) and 3.89 (0.19-7.60), respectively). Differences in systolic BP persisted into the daytime in the OSA group. Lack of nocturnal dipping was highly prevalent in both groups, but the difference was not significant in the adjusted model. Conclusion Pregnancy-onset OSA in the 3rd trimester is associated with elevated nocturnal BP and daytime systolic BP. The lack of nocturnal dipping irrespective of REI cut-off in pregnant women at risk for SDB further demonstrates limitations of REI in defining pathology in pregnancy.
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Cameron, Natalie A., Xiaoning Huang, Lucia C. Petito, Rebecca B. McNeil, Jasmina Varagic, Janet M. Catov, C. Noel Bairey Merz MD, FACC, FAHA, FESC et al. "Abstract 17032: Association of Blood Pressure Patterns During Pregnancy With Incident Hypertension and Cardiovascular Disease Risk at 2-7 Years After Delivery: The nuMoM2b Heart Health Study". Circulation 148, Suppl_1 (7 de novembro de 2023). http://dx.doi.org/10.1161/circ.148.suppl_1.17032.
Texto completo da fonteResumo:
Introduction: Hypertensive disorders of pregnancy (HDP) are risk factors for cardiovascular disease (CVD). However, associations between subclinical blood pressure (BP) elevations in pregnancy and CVD risk are unknown. Aims: To identify BP patterns during pregnancy among individuals without HDP and determine their association with long-term CVD risk and hypertension (HTN) 2-7 years after delivery. Methods: We included nulliparous individuals from the prospective, multicenter nuMoM2b Study Heart Health Study (nuMoM2b-HHS) who had > 1 BP from each trimester, and excluded those with chronic HTN or HDP. We modeled patterns using group-based trajectory analysis of the mid-BP (average of systolic and diastolic BP) during pregnancy. We selected the final number of groups based on the Bayesian Information Criteria. At 2-7 years after delivery, 30-year predicted CVD risk was estimated using the Framingham risk score; incident HTN was defined as BP > 130/80. Generalized linear models estimated associations between mid-BP trajectory group and CVD risk, adjusting for sociodemographics, adverse pregnancy outcomes, and first-trimester mid-BP. Results: Of 3309 participants, mean age was 27.1 (SD 5.5) years. Five mid-BP groups were identified ( FIGURE ). Incident HTN at mean follow-up of 3.7 years after delivery was 4.2% in low-stable, 11.1% moderate-stable, 21.4% moderate-decreasing, 21.8% moderate increasing, and 44.2% in elevated-stable groups. Compared with the moderate-stable group, adjusted 30-year predicted CVD risk was significantly higher by 0.8% (0.4, 1.1), 1.6% (0.9, 2.3) and 2.6% (2.1, 3.1) in the moderate-decreasing, moderate-increasing and elevated-stable groups, respectively. Conclusions: Among people not meeting HDP criteria, but with elevated mid-BP during pregnancy, nearly half had HTN within 5 years after delivery, and long-term CVD risk was higher. Mid-BP elevations during pregnancy may inform long-term CVD risk even in the absence of HDP.