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Theilen LH, Varner MW, Esplin MS, Horne BD. Cardiovascular morbidity and mortality following hypertensive disorders of pregnancy. Pregnancy Hypertens 2024; 36:101122. [PMID: 38579620 PMCID: PMC11162897 DOI: 10.1016/j.preghy.2024.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To determine whether hypertensive disorders of pregnancy (HDP) are associated with maternal coronary artery disease (CAD) and other cardiovascular (CV) diseases within 10-20 years following delivery. STUDY DESIGN Retrospective cohort including all women who delivered ≥ 1 pregnancy ≥ 20 weeks' gestation within a single health system from 1998 to 2008. We excluded those with CV risk factors preceding first delivery or with no follow-up after delivery. The exposure of interest was any HDP, determined by ICD coding. MAIN OUTCOME MEASURES The primary outcome was a composite of ICD codes for CAD, peripheral vascular disease, and CV events (myocardial infarction, stroke, and death). Multivariable Cox proportional hazards estimated the association between exposure and outcomes. A nested cohort of women who underwent cardiac catheterization had a primary outcome of angiographic CAD, and multivariable logistic regression estimated the association between HDP and CAD. RESULTS Of 33,959 women included, 2,385 women had HDP. HDP was associated with the composite outcome (adjusted HR 1.50, 95 % CI 1.11, 2.03). There was a significant difference in event-free survival between groups (p = 0.003) with a median follow-up of 17.3 years. 592 women (1.7 %) underwent cardiac catheterization: 20 of 90 women with HDP had CAD (22.2 %) on angiography vs 49 of 502 without HDP (9.8 %, p < 0.001). HDP was associated with angiographic CAD (adjusted OR 2.08, 95 % CI 1.05, 4.11). CONCLUSIONS Women with HDP had twice the incidence of CAD on angiography compared to parous women without HDP. Obstetric history may inform the decision to perform cardiac catheterization in relatively young women.
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Affiliation(s)
- Lauren H Theilen
- University of Utah Health, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States; Intermountain Healthcare, Women & Newborn Clinical Program, Salt Lake City, UT, United States.
| | - Michael W Varner
- University of Utah Health, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States; Intermountain Healthcare, Women & Newborn Clinical Program, Salt Lake City, UT, United States
| | - M Sean Esplin
- University of Utah Health, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States; Intermountain Healthcare, Women & Newborn Clinical Program, Salt Lake City, UT, United States
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, United States; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
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Stanhewicz AE, Dillon GA, Serviente C, Alexander LM. Acute systemic inhibition of inflammation augments endothelium-dependent dilation in women with a history of preeclamptic pregnancy. Pregnancy Hypertens 2022; 27:81-86. [PMID: 34973597 PMCID: PMC8858855 DOI: 10.1016/j.preghy.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022]
Abstract
Women who have had preeclampsia demonstrate microvascular endothelial-dysfunction, mediated in part by reduced nitric oxide (NO)-dependent dilation. Preeclamptic pregnancies are associated with elevated inflammation, and inhibition of inflammation attenuates endothelial damage in animal models of preeclampsia. However, it is unclear if inhibition of vascular inflammation improves endothelial function in women after a preeclamptic pregnancy. Using the cutaneous microcirculation as a model, we hypothesized that acute systemic inhibition of vascular inflammation (oral salsalate; 1500 mg/twice daily, 4 days) would improve endothelium- and NO-dependent vasodilation in women with a history of preeclampsia (PE) but not in women with a history of uncomplicated pregnancy (HC). Twelve HC (30 ± 1yrs, 10 ± 2 months postpartum) and 10 PE (30 ± 2yrs, 8 ± 2 months postpartum) participated in a double-blind placebo-controlled study. Following each treatment, 2 intradermal microdialysis fibers were placed in the skin of the ventral forearm for graded infusion of acetylcholine (Ach, 10-7-102mM) or Ach + 15 mM L-NAME (NO synthase antagonist). Red blood cell flux was measured over each site by laser-Doppler flowmetry (LDF). Cutaneous vascular conductance was calculated (CVC = LDF/mean arterial pressure) and normalized to maximum (%CVCmax; 28 mM SNP + local heat 43 °C). ACh-induced (77 ± 3 vs. 92 ± 3%CVCmax; p = 0.01) and NO-dependent (20 ± 6 vs. 33 ± 4%; p = 0.02) vasodilation were attenuated in PE compared to HC. Salsalate augmented ACh-induced (95 ± 2%CVCmax; p = 0.002) and NO-dependent (39 ± 3%; p = 0.009) dilation in PE compared to placebo but had no effect in HC (all p > 0.05). Salsalate treatment augmented endothelium-dependent vasodilation via NO-mediated pathways in women who have had preeclampsia, suggesting that inflammatory signaling mediates persistent endothelial dysfunction following preeclampsia.
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Affiliation(s)
- Anna E. Stanhewicz
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA,Department of Kinesiology, Pennsylvania State University, University Park, PA
| | - Gabrielle A. Dillon
- Department of Kinesiology, Pennsylvania State University, University Park, PA,Center for Healthy Aging, Pennsylvania State University, University Park, PA
| | - Corinna Serviente
- Center for Healthy Aging, Pennsylvania State University, University Park, PA,Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA,Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA
| | - Lacy M. Alexander
- Department of Kinesiology, Pennsylvania State University, University Park, PA,Center for Healthy Aging, Pennsylvania State University, University Park, PA
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Johnston A, Tseung V, Dancey SR, Visintini SM, Coutinho T, Edwards JD. Use of Race, Ethnicity, and National Origin in Studies Assessing Cardiovascular Risk in Women With a History of Hypertensive Disorders of Pregnancy. CJC Open 2021; 3:S102-S117. [PMID: 34993440 PMCID: PMC8712581 DOI: 10.1016/j.cjco.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022] Open
Abstract
Women with a history of hyperBtensive disorders of pregnancy (HDP) are at particularly high risk for cardiovascular disease (CVD) and CVD-related death, and certain racial and ethnic subpopulations are disproportionately affected by these conditions. We examined the use of race, ethnicity, and national origin in observational studies assessing CVD morbidity and mortality in women with a history of HDP. A total of 124 studies, published between 1976 and 2021, were reviewed. We found that white women were heavily overrepresented, encompassing 53% of all participants with HDP. There was limited and heterogeneous reporting of race and ethnicity information across studies and only 27 studies reported including race and/or ethnicity variables in at least 1 statistical analysis. Only 2 studies mentioned the use of these variables as a strength; several others (k = 18) reported a lack of diversity among participants as a study limitation. Just over half of included articles (k = 68) reported at least 1 sociodemographic variable other than race and ethnicity (eg, marital status and income); however, none investigated how they might have worked synergistically or antagonistically with race and/or ethnicity to influence participants' risk of CVD. These findings highlight significant areas for improvement in cardiovascular obstetrics research, including the need for more robust and standardized methods for collecting, reporting, and using sociodemographic information. Future studies of CVD risk in women with a history of HDP should explicitly examine racial and ethnic differences and use an intersectional approach.
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Affiliation(s)
- Amy Johnston
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Victrine Tseung
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sonia R. Dancey
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah M. Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Canadian Women’s Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jodi D. Edwards
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- IC/ES, Ottawa, Ontario, Canada
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Maternal microvascular dysfunction during preeclamptic pregnancy. Clin Sci (Lond) 2021; 135:1083-1101. [PMID: 33960392 DOI: 10.1042/cs20200894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy effecting ∼5-8% of pregnancies in the United States, and ∼8 million pregnancies worldwide. Preeclampsia is clinically diagnosed after the 20th week of gestation and is characterized by new onset hypertension accompanied by proteinuria and/or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. This broad definition emphasizes the heterogeneity of the clinical presentation of preeclampsia, but also underscores the role of the microvascular beds, specifically the renal, cerebral, and hepatic circulations, in the pathophysiology of the disease. While the diagnostic criteria for preeclampsia relies on the development of de novo hypertension and accompanying clinical symptoms after 20-week gestation, it is likely that subclinical dysfunction of the maternal microvascular beds occurs in parallel and may even precede the development of overt cardiovascular symptoms in these women. However, little is known about the physiology of the non-reproductive maternal microvascular beds during preeclampsia, and the mechanism(s) mediating microvascular dysfunction during preeclamptic pregnancy are largely unexplored in humans despite their integral role in the pathophysiology of the disease. Therefore, the purpose of this review is to provide a summary of the existing literature on maternal microvascular dysfunction during preeclamptic pregnancy by reviewing the functional evidence in humans, highlighting potential mechanisms, and providing recommendations for future work in this area.
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Dall'Asta A, D'Antonio F, Saccone G, Buca D, Mastantuoni E, Liberati M, Flacco ME, Frusca T, Ghi T. Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:698-709. [PMID: 32484256 DOI: 10.1002/uog.22107] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To elucidate whether pre-eclampsia (PE) and the gestational age at onset of the disease (early- vs late-onset PE) have an impact on the risk of long-term maternal cardiovascular complications. METHODS MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for 'pre-eclampsia', 'cardiovascular disease' and 'outcome'. Inclusion criteria were cohort or case-control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early- vs late-onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type-2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random-effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed. RESULTS Seventy-three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9-2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8-2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6-2.0)), hypertension (OR, 3.93 (95% CI, 3.1-5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4-8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3-1.4)), Type-2 diabetes (OR, 2.14 (95% CI, 1.5-3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3-5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6-7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1-10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early-onset PE, compared to those with previous late-onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0-3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5-21.4)), hypertension (OR, 1.48 (95% CI, 1.3-1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3-1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1-2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1-2.5). CONCLUSIONS Both early- and late-onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late-onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - F D'Antonio
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - D Buca
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - E Mastantuoni
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - M Liberati
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Wu R, Wang T, Gu R, Xing D, Ye C, Chen Y, Liu X, Chen L. Hypertensive Disorders of Pregnancy and Risk of Cardiovascular Disease-Related Morbidity and Mortality: A Systematic Review and Meta-Analysis. Cardiology 2020; 145:633-647. [PMID: 32841945 DOI: 10.1159/000508036] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several studies have demonstrated that there is a higher risk of cardiovascular disease (CVD) in women with a history of hypertensive disorders of pregnancy (HDP). However, effect sizes varied greatly between these studies, and a complete overview of the existing data in the literature is lacking. We aimed to evaluate the association between HDP and the risk of CVD-related morbidity and mortality. METHODS Systematic literature searches were conducted in several electronic databases from inception to July 2019. Exposure of interest was any type of HDP. Outcomes of interest included any CVD, CVD-related mortality, and hypertension. RESULTS Sixty-six cohort and 7 case-control studies involving >13 million women were included. The overall combined relative risks (RRs) for women with a history of HDP compared with the reference group were 1.80 (95% confidence interval [CI] 1.67-1.94) for any CVD, 1.66 (1.49-1.84) for coronary artery heart disease, 2.87 (2.14-3.85) for heart failure, 1.60 (1.29-2.00) for peripheral vascular disease, 1.72 (1.50-1.97) for stroke, 1.78 (1.58-2.00) for CVD-related mortality, and 3.16 (2.74-3.64) for hypertension. Significant heterogeneity was partially explained by all or part of the variables including type of exposure, follow-up time, geographic region, and sample source. CONCLUSIONS Women with a history of HDP are at an increased risk of future CVD-related morbidity and mortality. Our study highlights the importance of life-long monitoring of cardiovascular risk factors in women with a history of HDP.
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Affiliation(s)
- Rong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Runhui Gu
- School of Public Health, Nanjing Medical University, Jiangsu, China
| | - Dexiu Xing
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Changxiang Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Yan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Xiaoling Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China,
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Keepanasseril A, Thilaganathan B, Velmurugan B, Kar SS, Maurya DK, Pillai AA. Influence of maternal and perinatal characteristics on risk of postpartum chronic hypertension after pre-eclampsia. Int J Gynaecol Obstet 2020; 151:128-133. [PMID: 32588441 DOI: 10.1002/ijgo.13281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/23/2020] [Accepted: 06/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the prevalence of new-onset postpartum chronic hypertension (PPCH) after pre-eclampsia and to determine the factors are associated with it. METHODS This study was conducted in a tertiary center in south India, between June 2018 and February 2019, consisting of pre-eclamptic women who were recruited as part of an ongoing cohort and had completed at least 3 months of postpartum follow-up. Demographic, medical, and laboratory details were collected. Primary outcome was a diagnosis of new-onset PPCH at 3 months. RESULTS PPCH at 3 months was noted in 32 (18.1%) women. During postnatal follow-up, 2 (1.1%) women experienced hemiplegia from stroke and 19 (10.7%) had elevated serum creatinine levels (>1.1 mg/dL). On multivariate analysis, advancing maternal age (adjusted odds ratio [aOR] 1.10, 95% confidence interval [CI] 1.01-1.21), multiparity (aOR 2.79, 95% CI 1.07-7.24), and eclampsia (aOR 3.07, 95% CI 1.03-9.13) increased the risk of PPCH at 3 months postpartum. CONCLUSION One in five women present with a diagnosis of new-onset PPCH within 3 months postpartum in a cohort of predominantly preterm and/or severe pre-eclampsia. A significant but weak association of PPCH with peripartum clinical characteristics was noted. The role of biochemical, hemodynamic, and echocardiographic biomarkers should be evaluated for prediction of PPCH after pre-eclampsia in future studies.
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Affiliation(s)
- Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Baskaran Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Bharathi Velmurugan
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sitanshu S Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Dilip K Maurya
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Ajith A Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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Huo X, Huang R, Gan Y, Luo K, Aimuzi R, Nian M, Ao J, Feng L, Tian Y, Wang W, Ye W, Zhang J. Perfluoroalkyl substances in early pregnancy and risk of hypertensive disorders of pregnancy: A prospective cohort study. ENVIRONMENT INTERNATIONAL 2020; 138:105656. [PMID: 32222612 DOI: 10.1016/j.envint.2020.105656] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) were reported to be associated with hypertensive disorders of pregnancy (HDP) but the results were inconsistent and prospective data are scarce. We aimed to examine these associations in a large prospective birth cohort study in Shanghai, China. METHODS A total of 10 PFASs were measured by high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS) in the plasma samples from 3220 women who were enrolled during early pregnancy and gave birth to a singleton live birth between 2013 and 2016. The outcomes included gestational hypertension (GH), preeclampsia (PE) and overall HDP. Associations of these outcomes with each PFASs were estimated by multivariable logistic regression and expressed as odd ratios (ORs) and 95% confidence intervals (95% CIs). Potential non-linear association between PFASs and HDP was examined with restricted cubic spline model. To handle the potential confounding by correlated PFASs, we applied elastic net regression (ENR) to identify independent PFASs components of outcomes. RESULTS Among all singleton live births, the incidence rates of GH and PE were 2.0% and 2.2%, respectively. Overall, PFASs did not show a significant and consistent pattern of the associations with GH, PE or overall HDP, both before and after controlling for potential confounders. ENR model confirmed the results that there was no independently predictive role of PFASs on GH, PE or overall HDP. CONCLUSIONS In this large prospective cohort study, maternal plasma concentration of PFASs in early pregnancy were not associated with GH, PE or overall HDP in singleton livebirths.
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Affiliation(s)
- Xiaona Huo
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Rong Huang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Yuexin Gan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Kai Luo
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai 200052, China.
| | - Ruxianguli Aimuzi
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai 200052, China.
| | - Min Nian
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai 200052, China.
| | - Junjie Ao
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Liping Feng
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Ying Tian
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai 200052, China.
| | - Weiye Wang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Weiping Ye
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. 1665 Kong Jiang Road, Shanghai 200092, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai 200052, China.
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Circulating Neutrophils Do Not Predict Subclinical Coronary Artery Disease in Women with Former Preeclampsia. Cells 2020; 9:cells9020468. [PMID: 32085575 PMCID: PMC7072843 DOI: 10.3390/cells9020468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
: Introduction: Preeclampsia (PE) represents a hypertensive pregnancy disorder that is associated with increased cardiovascular disease (CVD) risk. This increased risk has been attributed to accelerated atherosclerosis, with inflammation being a major contributor. Neutrophils play an important role in the onset and progression of atherosclerosis and have been associated with vascular damage in the placenta as well as the chronic inflammatory state in women with PE. We therefore investigated whether circulating neutrophil numbers or reactivity were associated with the presence and severity of subclinical atherosclerosis in women with a history of PE. METHODS Women aged 45-60 years with a 10 to 20 years earlier history of early onset preeclampsia (delivery <34 weeks of gestation) (n = 90), but without symptomatic CVD burden were screened for the presence of subclinical coronary artery disease (CAD) using both contrast-enhanced and non-contrast coronary CT angiography. Subclinical CAD was defined as a coronary artery calcium (CAC) score ≥100 Agatston Units and/or ≥50% coronary luminal stenosis. We assessed whether the numbers and activity of circulating neutrophils were associated with the presence of subclinical CAD and as secondary outcome measurements, with the presence of any calcium (CAC score > 0 AU) or stenosis, categorized as absent (0%), minimal to mild (>0 and <50%), and moderate to severe (≥50%) narrowing of the coronary artery. Blood was drawn just before CT and neutrophil numbers were assessed by flow cytometry. In addition, the presence of the chemokine receptors CXCR2 and CXCR4, which are known to be instrumental in neutrophil recruitment, and neutrophil activity upon stimulation with the bacterial peptide N-Formylmethionyl-leucyl-phenylalanine (fMLF) was assessed by flow cytometry. RESULTS Of the participating women, with an average age of 49 years, 13% (12 out of 90) presented with subclinical signs of CAD (CAC score ≥100 AU and/or ≥50% luminal stenosis), and 37% (33 out of 90) had a positive CAC score (>0). Total white blood cell count and neutrophil counts were not associated with the presence of subclinical CAD or with a positive CAC score. When assessing the presence of the chemokine receptors CXCR4 and CXCR2, we observed a slight decrease of neutrophil CXCR2 expression in women with CAC (median MFI 22.0 [interquartile range (IQR) 20.2-23.8]) compared to women without CAC (23.8 [IQR 21.6-25.6], p = 0.02). We observed no differences regarding neutrophil CXCR4 expression. In addition, expression of the early activity marker CD35 was slightly lower on neutrophils of women with subclinical CAD (median MFI 1.6 [IQR 1.5-1.9] compared to 1.9 [IQR 1.7-2.1] in women without CAD, p = 0.02). However, for all findings, statistical significance disappeared after adjustment for multiple testing. CONCLUSION Our findings indicate that neutrophil counts and (re)activity are not directly associated with silent CAD disease burden and as such are not suitable as biomarkers to predict the presence of subclinical CAD in a high-risk population of women with a history of preeclampsia.
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10
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Grandi SM, Filion KB, Yoon S, Ayele HT, Doyle CM, Hutcheon JA, Smith GN, Gore GC, Ray JG, Nerenberg K, Platt RW. Cardiovascular Disease-Related Morbidity and Mortality in Women With a History of Pregnancy Complications. Circulation 2019; 139:1069-1079. [PMID: 30779636 DOI: 10.1161/circulationaha.118.036748] [Citation(s) in RCA: 305] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women with a history of certain pregnancy complications are at higher risk for cardiovascular (CVD) disease. However, most clinical guidelines only recommend postpartum follow-up of those with a history of preeclampsia, gestational diabetes mellitus, or preterm birth. This systematic review was undertaken to determine if there is an association between a broader array of pregnancy complications and the future risk of CVD. METHODS We systematically searched PubMed, MEDLINE and EMBASE (via Ovid), CINAHL, and the Cochrane Library from inception to September 22, 2017, for observational studies of the association between the hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage and subsequent CVD. Likelihood ratio meta-analyses were performed to generate pooled odds ratios (OR) and 95% intrinsic confidence intervals (ICI). RESULTS Our systematic review included 84 studies (28 993 438 patients). Sample sizes varied from 250 to 2 000 000, with a median follow-up of 7.5 years postpartum. The risk of CVD was highest in women with gestational hypertension (OR 1.7; 95% ICI, 1.3-2.2), preeclampsia (OR 2.7; 95% ICI, 2.5-3.0), placental abruption (OR 1.8; 95% ICI, 1.4-2.3), preterm birth (OR 1.6; 95% ICI, 1.4-1.9), gestational diabetes mellitus (OR 1.7; 95% ICI, 1.1-2.5), and stillbirth (OR 1.5; 95% ICI, 1.1-2.1). A consistent trend was seen for low birth weight and small-for-gestational-age birth weight but not for miscarriage. CONCLUSIONS Women with a broader array of pregnancy complications, including placental abruption and stillbirth, are at increased risk of future CVD. The findings support the need for assessment and risk factor management beyond the postpartum period.
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Affiliation(s)
- Sonia M Grandi
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Kristian B Filion
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Department of Medicine, McGill University, Montreal, QC, Canada (K.F.)
| | - Sarah Yoon
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Henok T Ayele
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Carla M Doyle
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.)
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Canada (J.H.)
| | - Graeme N Smith
- Department of Obstetrics and Gynaecology, School of Medicine, Queen's University, Kingston, ON, Canada (G.S.)
| | - Genevieve C Gore
- Schulich Library of Science and Engineering, McGill University, Montreal, QC, Canada (G.G.)
| | - Joel G Ray
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada (J.R.)
| | - Kara Nerenberg
- University of Calgary, Department of Medicine, Cumming School of Medicine, AB, Canada (K.N.)
| | - Robert W Platt
- Department of Epidemiology, Biostatisticcs and Occupational Health, McGill University, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (S.G., K.F., S.Y., H.A., C.D., R.P.).,McGill University Health Center Research Institute and Department of Pediatrics, McGill University, Montreal, QC, Canada (R.P.)
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11
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Stanhewicz AE, Alexander LM. Local angiotensin-(1-7) administration improves microvascular endothelial function in women who have had preeclampsia. Am J Physiol Regul Integr Comp Physiol 2019; 318:R148-R155. [PMID: 31577152 DOI: 10.1152/ajpregu.00221.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite remission of clinical symptoms postpartum, women who have had preeclampsia demonstrate microvascular endothelial dysfunction, mediated in part by increased sensitivity to angiotensin II (ANG II). Angiotensin-(1-7) [Ang-(1-7)] is an endogenous inhibitor of the actions of ANG II and plausible druggable target in women who had preeclampsia. We therefore examined the therapeutic potential of Ang-(1-7) in the microvasculature of women with a history of preeclampsia (PrEC; n = 13) and parity-matched healthy control women (HC; n = 13) hypothesizing that administration of Ang-(1-7) would increase endothelium-dependent dilation and nitric oxide (NO)-dependent dilation and decrease ANG II-mediated constriction in PrEC. Using the cutaneous microcirculation, we assessed endothelium-dependent vasodilator function in response to graded infusion of acetylcholine (ACh; 10-7 to 102 mmol/L) in control sites and sites treated with 15 mmol/L NG-nitro-l-arginine methyl ester (l-NAME; NO-synthase inhibitor), 100 µmol/L Ang-(1-7), or 15 mmol/L l-NAME + 100 µmol/L Ang-(1-7). Vasoconstrictor function was measured in response to ANG II (10-20-10-4 mol/L) in control sites and sites treated with 100 µmol/L Ang-(1-7). PrEC had reduced endothelium-dependent dilation (P < 0.001) and NO-dependent dilation (P = 0.04 vs. HC). Ang-(1-7) coinfusion augmented endothelium-dependent dilation (P < 0.01) and NO-dependent dilation (P = 0.03) in PrEC but had no effect in HC. PrEC demonstrated augmented vasoconstrictor responses to ANG II (P < 0.01 vs. HC), which was attenuated by coinfusion of Ang-(1-7) (P < 0.001). Ang-(1-7) increased endothelium-dependent vasodilation via NO synthase-mediated pathways and attenuated ANG II-mediated constriction in women who have had preeclampsia, suggesting that Ang-(1-7) may be a viable therapeutic target for improved microvascular function in women who have had a preeclamptic pregnancy.
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Affiliation(s)
- Anna E Stanhewicz
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Lacy M Alexander
- Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
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12
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Gastrich MD, Zinonos S, Bachmann G, Cosgrove NM, Cabrera J, Cheng JQ, Kostis JB. Preeclamptic Women Are at Significantly Higher Risk of Future Cardiovascular Outcomes Over a 15-Year Period. J Womens Health (Larchmt) 2019; 29:74-83. [PMID: 31414929 DOI: 10.1089/jwh.2019.7671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Preeclampsia (PE) may lead to maternal and infant mortality and severe medical complications. Understanding future short- and long-term cardiovascular (CV) outcomes of PE is important to women's health. Materials and Methods: A retrospective matched case-control study assessed the risks of CV outcomes over a 15-year period (1999-2013) in pregnant case women, with gravidity and parity of one, diagnosed with PE, compared to pregnant primiparous control women who were not diagnosed with PE. The New Jersey Electronic Birth Certificate (EBC) database and the Myocardial Infarction Data Acquisition System (MIDAS), a database of all hospital admissions in New Jersey with longitudinal follow-up, were used to conduct the analysis. Participants were 18 years and older with demographics consistent with New Jersey, a state with a range of racial and ethnic diversity. Main outcome measures postpregnancy and over this 15-year period were myocardial infarction (MI), stroke, CV death, and all-cause death. Results: Women with PE (N = 6,360) were more likely to suffer MI, stroke, CV death, and all-cause death than controls (N = 325,347). After matching cases to controls for demographics and comorbidities, hazard ratios of PE cases for the outcomes of MI (p adjusted for comorbidities and demographics = 0.0196), CV death (adjusted p = 0.007), and all-cause death (adjusted p = 0.0026) were significantly higher than 1 compared to matched controls. Women with PE had 3.94 (95% CI: 1.25-12.4) times higher hazard for MI, 4.66 (95% CI: 1.52-14.26) times higher hazard of CV death, and 2.32 (95% CI: 1.34-4.02) times higher hazard for all-cause death than matched controls. Conclusions: This 15-year study indicates that women who have PE with their first pregnancy have a significantly higher risk of adverse CV outcomes compared to controls and suggest a heightened and continued CV monitoring after birth for this population of women.
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Affiliation(s)
- Mary Downes Gastrich
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey.,Department of Ob/Gyn and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Stavros Zinonos
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - Gloria Bachmann
- Department of Ob/Gyn and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nora M Cosgrove
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - Javier Cabrera
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey.,Department of Statistics and Biostatics, Rutgers University, New Brunswick, New Jersey
| | - Jerry Q Cheng
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
| | - John B Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute of New Jersey, New Brunswick, New Jersey
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13
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Wichmann JL, Takx RAP, Nunez JH, Vliegenthart R, Otani K, Litwin SE, Morris PB, De Cecco CN, Rosenberg RD, Bayer RR, Baumann S, Renker M, Vogl TJ, Wenger NK, Schoepf UJ. Relationship Between Pregnancy Complications and Subsequent Coronary Artery Disease Assessed by Coronary Computed Tomographic Angiography in Black Women. Circ Cardiovasc Imaging 2019; 12:e008754. [PMID: 31303028 DOI: 10.1161/circimaging.118.008754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications. METHODS We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD. RESULTS All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03-5.22; P<0.001) and obstructive CAD (odds ratio, 3.00; 95% CI, 1.55-5.80; P<0.001) on CCTA. CONCLUSIONS Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.
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Affiliation(s)
- Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Di Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany (J.L.W., T.J.V.)
| | - Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Radiology, University Medical Center Utrecht, the Netherlands (R.A.P.T.)
| | - Johanna H Nunez
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston
| | - Rozemarijn Vliegenthart
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands (R.V.)
| | - Katharina Otani
- Imaging & Therapy Systems Division, Healthcare Sector, Siemens Japan K.K., Tokyo, Japan (K.O.)
| | - Sheldon E Litwin
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Pamela B Morris
- Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston
| | - Russell D Rosenberg
- Department of Medicine, Medical University of South Carolina, Charleston (R.D.R.)
| | - Richard R Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
| | - Stefan Baumann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany and with DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (S.B.)
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany (M.R.)
| | - Thomas J Vogl
- Department of Di Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany (J.L.W., T.J.V.)
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (N.K.W.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.L.W., R.A.P.T., J.H.N., R.V., S.E.L., C.N.D.C., R.R.B., S.B., M.R., U.J.S.), Medical University of South Carolina, Charleston.,Division of Cardiology, Department of Medicine (S.E.L., P.B.M., R.R.B., U.J.S.), Medical University of South Carolina, Charleston
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14
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Sia WW, Pertman SM, Yan RM, Tsuyuki RT. Are Preeclampsia and Adverse Obstetrical Outcomes Predictors of Cardiovascular Disease? A Case-Control Study of Women With Heart Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1760-1767. [PMID: 31279766 DOI: 10.1016/j.jogc.2019.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to determine whether preeclampsia; gestational diabetes; and adverse obstetrical outcomes such as placental abruption, intrauterine growth restriction, and preterm delivery are independent risk factors for cardiovascular disease later in life. METHODS This was a retrospective, age-matched, case-control study that surveyed 244 cases (women with confirmed coronary artery disease) and 246 controls (women who did not have coronary artery disease) on their obstetrical history and outcomes, as well as traditional cardiovascular risk factors. Analyses were performed using SAS software version 9.1.3. (Canadian Task Force Classification II-2). RESULTS Women with coronary artery disease had significantly higher rates of maternal complications such as gestational hypertension (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.03-10.9), as well as conventional vascular risk factors such as dyslipidemia (OR 5.38; 95% CI 2.70-10.7), hypertension (OR 2.40; 95% CI 1.23-4.70), diabetes (OR 2.32; 95% CI 1.07-5.01), and smoking (current smoker: OR; 4.82 95% CI 1.66-14.00; former smoker: OR 2.86; 95% CI 1.43-5.71). There were more cases with preeclampsia (9.8%, vs. 5.4% in controls); however, the difference was not statistically significant. CONCLUSION Among the adverse maternal conditions, there was more gestational hypertension in women with coronary artery disease. In this study, hypertensive disorders of pregnancy were the most important maternal risk factors for cardiovascular disease later in life and should be flagged early for close monitoring and/or intervention.
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Affiliation(s)
- Winnie W Sia
- Department of Medicine, University of Alberta, Edmonton, AB.
| | - Shea M Pertman
- Department of Medicine, University of Alberta, Edmonton, AB
| | - Raymond M Yan
- Faculty of Medicine, University of Calgary, Calgary, AB
| | - Ross T Tsuyuki
- Department of Medicine, University of Alberta, Edmonton, AB
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15
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Ortved D, Hawkins TLA, Johnson JA, Hyett J, Metcalfe A. Cost-effectiveness of first-trimester screening with early preventative use of aspirin in women at high risk of early-onset pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:239-244. [PMID: 29700870 DOI: 10.1002/uog.19076] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/30/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. A first-trimester screening algorithm predicting the risk of early-onset PE has been developed and validated. Early prediction coupled with initiation of aspirin at 11-13 weeks in women identified as high risk is effective at reducing the prevalence of early-onset PE. The aim of this study was to evaluate the cost-effectiveness of this first-trimester screening program coupled with early use of low-dose aspirin in women at high risk of developing early-onset PE, in comparison to current practice in Canada. METHODS A decision analysis was performed based on a theoretical population of 387 516 live births in Canada in 1 year. The clinical and financial impact of early preventative screening using the Fetal Medicine Foundation algorithm for prediction of early-onset PE coupled with early (< 16 weeks) use of low-dose aspirin in those at high risk was simulated and compared with current practice using decision-tree analysis. The probabilities at each decision point and associated costs of utilized resources were calculated based on published literature and public databases. RESULTS Of the theoretical 387 516 births per year, the estimated prevalence of early PE based on first-trimester screening and aspirin use was 705 vs 1801 cases based on the current practice. This was associated with an estimated total cost of C$9.52 million with the first-trimester screening program compared with C$23.91 million with current practice for the diagnosis and management of women with early-onset PE. This equals an annual cost saving to the Canadian healthcare system of approximately C$14.39 million. CONCLUSIONS The implementation of a first-trimester screening program for PE and early intervention with aspirin in women identified as high risk for early PE has the potential to prevent a significant number of early-onset PE cases with a substantial associated cost saving to the healthcare system in Canada. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Ortved
- Department of Medicine, Royal Inland Hospital, Kamloops, BC, Canada
| | - T L-A Hawkins
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - J-A Johnson
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - J Hyett
- Central Clinical School, Faculty of Medicine, University of Sydney; and Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A Metcalfe
- Department of Medicine and Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
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16
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Stanhewicz AE. Residual vascular dysfunction in women with a history of preeclampsia. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1062-R1071. [PMID: 30133302 DOI: 10.1152/ajpregu.00204.2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension, proteinuria, and edema occurring after 20 wk of gestation, with a prevalence of ~7-10% of pregnancies in the United States and ~8 million pregnancies worldwide. Despite the postpartum remission of preeclamptic symptoms, women who have had preeclampsia are two to four times more likely to develop cardiovascular disease (CVD) and are significantly more likely to die of CVD compared with women with a history of normal pregnancy. Although the relation between history of preeclampsia and elevated CVD risk is well documented, the mechanism(s) underlying this association remains unclear. One hypothesis explaining this association is that the initial vascular damage and dysfunction sustained during the preeclamptic pregnancy persist chronically. Indeed, even in the absence of, or in advance of, overt CVD women who have had preeclampsia have compromised vascular endothelial function. Emerging mechanistic studies in these women have provided some insight into the underlying mechanisms of this persistent vascular dysfunction and have begun to identify potential therapeutic targets for the prevention or mitigation of CVD progression in this vulnerable population. This review summarizes the existing literature examining vascular function and dysfunction in women with a history of preeclampsia and highlights future directions for mechanistic investigations and development of novel intervention strategies aimed at halting or slowing the progression of CVD in these women.
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Affiliation(s)
- Anna E Stanhewicz
- Department of Kinesiology, Pennsylvania State University , University Park, Pennsylvania
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17
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Gray KJ, Kovacheva VP, Mirzakhani H, Bjonnes AC, Almoguera B, DeWan AT, Triche EW, Saftlas AF, Hoh J, Bodian DL, Klein E, Huddleston KC, Ingles SA, Lockwood CJ, Hakonarson H, McElrath TF, Murray JC, Wilson ML, Norwitz ER, Karumanchi SA, Bateman BT, Keating BJ, Saxena R. Gene-Centric Analysis of Preeclampsia Identifies Maternal Association at PLEKHG1. Hypertension 2018; 72:408-416. [PMID: 29967039 PMCID: PMC6043396 DOI: 10.1161/hypertensionaha.117.10688] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/30/2017] [Accepted: 04/14/2018] [Indexed: 12/13/2022]
Abstract
The genetic susceptibility to preeclampsia, a pregnancy-specific complication with significant maternal and fetal morbidity, has been poorly characterized. To identify maternal genes associated with preeclampsia risk, we assembled 498 cases and 1864 controls of European ancestry from preeclampsia case-control collections in 5 different US sites (with additional matched population controls), genotyped samples on a cardiovascular gene-centric array composed of variants from ≈2000 genes selected based on prior genetic studies of cardiovascular and metabolic diseases and performed case-control genetic association analysis on 27 429 variants passing quality control. In silico replication testing of 9 lead signals with P<10-4 was performed in independent European samples from the SOPHIA (Study of Pregnancy Hypertension in Iowa) and Inova cohorts (212 cases, 456 controls). Multiethnic assessment of lead signals was then performed in samples of black (26 cases, 136 controls), Hispanic (132 cases, 468 controls), and East Asian (9 cases, 80 controls) ancestry. Multiethnic meta-analysis (877 cases, 3004 controls) revealed a study-wide statistically significant association of the rs9478812 variant in the pleiotropic PLEKHG1 gene (odds ratio, 1.40 [1.23-1.60]; Pmeta=5.90×10-7). The rs9478812 effect was even stronger in the subset of European cases with known early-onset preeclampsia (236 cases diagnosed <37 weeks, 1864 controls; odds ratio, 1.59 [1.27-1.98]; P=4.01×10-5). PLEKHG1 variants have previously been implicated in genome-wide association studies of blood pressure, body weight, and neurological disorders. Although larger studies are required to further define maternal preeclampsia heritability, this study identifies a novel maternal risk locus for further investigation.
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Affiliation(s)
- Kathryn J Gray
- From the Division of Maternal-Fetal Medicine (K.J.G., T.F.M.)
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
| | | | - Hooman Mirzakhani
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
| | - Andrew C Bjonnes
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
| | - Berta Almoguera
- Center for Applied Genomics, Children's Hospital of Philadelphia, PA (B.A., H.H.)
| | | | - Elizabeth W Triche
- Yale School of Public Health, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT (E.W.T.)
| | - Audrey F Saftlas
- Department of Epidemiology, College of Public Health, University of Iowa (A.F.S.)
| | | | - Dale L Bodian
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Elisabeth Klein
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Kathi C Huddleston
- Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (D.L.B., E.K., K.C.H.)
| | - Sue Ann Ingles
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles (S.A.I., M.L.W.)
| | - Charles J Lockwood
- University of South Florida, Morsani College of Medicine, Tampa (C.J.L.)
| | - Hakon Hakonarson
- Divisions of Human Genetics and Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (H.H.)
| | | | - Jeffrey C Murray
- Department of Pediatrics, Carver College of Medicine, University of Iowa (J.C.M.)
| | - Melissa L Wilson
- Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles (S.A.I., M.L.W.)
| | - Errol R Norwitz
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA (E.R.N.)
| | - S Ananth Karumanchi
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Boston, MA (S.A.K.)
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.A.K.)
| | - Brian T Bateman
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
| | - Brendan J Keating
- Department of Surgery and Pediatrics, University of Pennsylvania, Philadelphia (B.J.K.)
| | - Richa Saxena
- Brigham and Women's Hospital, Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (H.M., B.T.B., R.S.)
- Center for Genomic Medicine (K.J.G., A.C.B., R.S.)
- Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.J.G., A.C.B., R.S.)
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18
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Stanhewicz AE, Jandu S, Santhanam L, Alexander LM. Alterations in endothelin type B receptor contribute to microvascular dysfunction in women who have had preeclampsia. Clin Sci (Lond) 2017; 131:2777-2789. [PMID: 29042489 PMCID: PMC5922254 DOI: 10.1042/cs20171292] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/26/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022]
Abstract
Microvascular dysfunction originating during a preeclamptic pregnancy persists postpartum and probably contributes to increased CVD risk in these women. One putative mechanism contributing to this dysfunction is increased vasoconstrictor sensitivity to endothelin-1 (ET-1), mediated by alterations in ET-1 receptor type-B (ETBR). We evaluated ET-1 sensitivity, ETAR, and ETBR contributions to ET-1-mediated constriction, and the mechanistic role of ETBR in endothelium-dependent dilation in vivo in the microvasculature of postpartum women who had preeclampsia (PrEC, n=12) and control women who had a healthy pregnancy (HC, n=12). We hypothesized that (1) PrEC would have a greater vasoconstrictor response to ET-1, and (2) reduced ETBR-mediated dilation. We further hypothesized that ETBR-blockade would attenuate endothelium-dependent vasodilation in HC, but not PrEC. Microvascular reactivity was assessed by measurement of cutaneous vascular conductance responses to graded infusion of ET-1 (10-20-10-8 mol/l), ET-1 + 500 nmol/l BQ-123 (ETAR-blockade), and ET-1 + 300 nmol/l BQ-788 (ETBR-blockade), and during graded infusion of acetylcholine (ACh, 10-7-102 mmol/l) and a standardized local heating protocol with and without ETBR-inhibition. PrEC had an increased vasoconstriction response to ET-1 (P=0.02). PrEC demonstrated reduced dilation responses to selective ETBR stimulation with ET-1 (P=0.01). ETBR-inhibition augmented ET-1-mediated constriction in HC (P=0.01) but attenuated ET-1-mediated constriction in PrEC (P=0.003). ETBR-inhibition attenuated endothelium-dependent vasodilation responses to 100mmol/l ACh (P=0.04) and local heat (P=0.003) in HC but increased vasodilation (ACh: P=0.01; local heat: P=0.03) in PrEC. Women who have had preeclampsia demonstrate augmented vasoconstrictor sensitivity to ET-1, mediated by altered ETBR signaling. Furthermore, altered ETBR function contributes to diminished endothelium-dependent dilation in previously preeclamptic women.
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Affiliation(s)
- Anna E Stanhewicz
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, U.S.A.
| | - Sandeep Jandu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, U.S.A
| | - Lakshmi Santhanam
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, U.S.A
| | - Lacy M Alexander
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, U.S.A
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19
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Visser V, Hermes W, Twisk J, Franx A, van Pampus M, Koopmans C, Mol B, de Groot C. Prognostic model for chronic hypertension in women with a history of hypertensive pregnancy disorders at term. Pregnancy Hypertens 2017; 10:118-123. [DOI: 10.1016/j.preghy.2017.07.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/23/2017] [Accepted: 07/23/2017] [Indexed: 01/06/2023]
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20
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Zoet GA, Meun C, Benschop L, Boersma E, Budde RPJ, Fauser BCJM, de Groot CJM, van der Lugt A, Maas AHEM, Moons KGM, Roeters van Lennep JE, Roos-Hesselink JW, Steegers EAP, van Rijn BB, Laven JSE, Franx A, Velthuis BK. Cardiovascular RiskprofilE - IMaging and gender-specific disOrders (CREw-IMAGO): rationale and design of a multicenter cohort study. BMC WOMENS HEALTH 2017; 17:60. [PMID: 28784118 PMCID: PMC5547459 DOI: 10.1186/s12905-017-0415-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 08/01/2017] [Indexed: 01/30/2023]
Abstract
Background Reproductive disorders, such as polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI) and hypertensive pregnancy disorders (HPD) like pre-eclampsia (PE), are associated with an increased risk of cardiovascular disease (CVD). Detection of early signs of cardiovascular disease (CVD), as well as identification of risk factors among women of reproductive age which improve cardiovascular risk prediction, is a challenge and current models might underestimate long-term health risks. The aim of this study is to assess cardiovascular disease in patients with a history of a reproductive disorder by low-dose computed tomography (CT). Methods Women of 45 - 55 years, who experienced a reproductive disorder (PCOS, POI, HPD), are invited to participate in this multicenter, prospective, cohort study. Women will be recruited after regular cardiovascular screening, including assessment of classical cardiovascular risk factors. CT of the coronary arteries (both coronary artery calcium scoring (CACS), and contrast-enhanced coronary CT angiography (CCTA)) and carotid siphon calcium scoring (CSC) is planned in 300 women with HPD and 300 women with PCOS or POI. In addition, arterial stiffness (non-invasive pulse wave velocity (PWV)) measurement and cell-based biomarkers (inflammatory circulating cells) will be obtained. Discussion Initial inclusion is focused on women of 45 - 55 years. However, the age range (40 - 45 years and/or ≥ 55 years) and group composition may be adjusted based on the findings of the interim analysis. Participants can potentially benefit from information obtained in this study concerning their current cardiovascular health and expected future risk of cardiovascular events. The results of this study will provide insights in the development of CVD in women with a history of reproductive disorders. Ultimately, this study may lead to improved cardiovascular prediction models and will provide an opportunity for timely adjustment of preventive strategies. Limitations of this study include the possibility of overdiagnosis and the average radiation dose of 3.5 mSv during coronary and carotid siphon CT, although the increased lifetime malignancy risk is negligible. Trial registration Netherlands Trial Register, NTR5531. Date registered: October 21st, 2015.
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Affiliation(s)
- Gerbrand A Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands.
| | - Cindy Meun
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Laura Benschop
- Department of Obstetrics & Gynaecology, University Medical Center Rotterdam, Erasmus MC, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Bart C J M Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Karl G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, University Medical Center Rotterdam, Erasmus MC, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Bas B van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands.,Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK
| | - Joop S E Laven
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Center, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands
| | - Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, 3508, AB, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
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21
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Long-Term Effects of Pregnancy Complications on Maternal Health: A Review. J Clin Med 2017; 6:jcm6080076. [PMID: 28749442 PMCID: PMC5575578 DOI: 10.3390/jcm6080076] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Most pregnancy-related medical complications appear to resolve at delivery or shortly thereafter. Common examples are preterm labor, placental abruption, preeclampsia, and gestational diabetes. Women who developed such complications are known to be at increased risk of developing similar complications in future pregnancies. It has recently become evident that these women are at an increased risk of long term medical complications. Methods: A search through scientific publications in English regarding the association of obstetric complications and long-term maternal illness. Results: There is a clear association between various obstetric complications and long-term effects on maternal health. Conclusions: Women with a history of adverse pregnancy outcomes are at increased risk of cardiovascular and metabolic diseases later in life. Data increasingly links maternal vascular, metabolic, and inflammatory complications of pregnancy with an increased risk of vascular disease in later life.
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22
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Stanhewicz AE, Jandu S, Santhanam L, Alexander LM. Increased Angiotensin II Sensitivity Contributes to Microvascular Dysfunction in Women Who Have Had Preeclampsia. Hypertension 2017; 70:382-389. [PMID: 28652473 DOI: 10.1161/hypertensionaha.117.09386] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/03/2017] [Accepted: 05/01/2017] [Indexed: 01/13/2023]
Abstract
Women who have had preeclampsia have increased cardiovascular disease risk; however, the mechanism(s) responsible for this association remain unclear. Microvascular damage sustained during a preeclamptic pregnancy may persist postpartum. The putative mechanisms mediating this dysfunction include a reduction in NO-dependent dilation and an increased sensitivity to angiotensin II. In this study, we evaluated endothelium-dependent dilation, angiotensin II sensitivity, and the therapeutic effect of angiotensin II receptor blockade (losartan) on endothelium-dependent dilation in vivo in the microvasculature of women with a history of preeclampsia (n=12) and control women who had a healthy pregnancy (n=12). We hypothesized that preeclampsia would have (1) reduced endothelium-dependent dilation, (2) reduced NO-mediated dilation, and (3) increased sensitivity to angiotensin II. We further hypothesized that localized losartan would increase endothelium-dependent vasodilation in preeclampsia. We assessed microvascular endothelium-dependent vasodilator function by measurement of cutaneous vascular conductance responses to graded infusion of acetylcholine (acetylcholine; 10-7-102 mmol/L) and a standardized local heating protocol in control sites and sites treated with 15 mmol/L L-NAME (NG-nitro-l-arginine methyl ester; NO-synthase inhibitor) or 43 µmol/L losartan. Further, we assessed microvascular vasoconstrictor sensitivity to angiotensin II (10-20-10-4 mol/L). Preeclampsia had significantly reduced endothelium-dependent dilation (-0.3±0.5 versus -1.0±0.4 logEC50; P<0.001) and NO-dependent dilation (16±3% versus 39±6%; P=0.006). Preeclampsia also had augmented vasoconstrictor sensitivity to angiotensin II (-10.2±1.3 versus -8.3±0.5; P=0.006). Angiotensin II type I receptor inhibition augmented endothelium-dependent vasodilation and NO-dependent dilation in preeclampsia but had no effect in healthy pregnancy. These data suggest that women who have had preeclampsia have persistent microvascular dysfunction postpartum, mediated, in part, by increased sensitivity to angiotensin II.
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Affiliation(s)
- Anna E Stanhewicz
- From the Department of Kinesiology, Pennsylvania State University, University Park, (A.E.S., L.M.A.); and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.J., L.S.).
| | - Sandeep Jandu
- From the Department of Kinesiology, Pennsylvania State University, University Park, (A.E.S., L.M.A.); and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.J., L.S.)
| | - Lakshmi Santhanam
- From the Department of Kinesiology, Pennsylvania State University, University Park, (A.E.S., L.M.A.); and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.J., L.S.)
| | - Lacy M Alexander
- From the Department of Kinesiology, Pennsylvania State University, University Park, (A.E.S., L.M.A.); and Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.J., L.S.)
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23
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Katsi V, Georgountzos G, Kallistratos MS, Zerdes I, Makris T, Manolis AJ, Nihoyannopoulos P, Tousoulis D. The Role of Statins in Prevention of Preeclampsia: A Promise for the Future? Front Pharmacol 2017; 8:247. [PMID: 28529486 PMCID: PMC5418337 DOI: 10.3389/fphar.2017.00247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Preeclampsia has been linked to high morbidity and mortality during pregnancy. However, no efficient pharmacological options for the prevention of this condition are currently available. Preeclampsia is thought to share several pathophysiologic mechanisms with cardiovascular disease, which has led to investigations for the potential role of statins (HMG CoA reductase inhibitors) in its prevention and early management. Pravastatin seems to have a safer pharmacokinetic profile compared to other statins, however, the existing preclinical evidence for its effectiveness in preeclampsia treatment has been mostly restricted to animal models. This review aims to summarize the current data and delineate the potential future role of statins in the prevention and management of preeclampsia.
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Affiliation(s)
- Vasiliki Katsi
- Department of Cardiology, Hippokration HospitalAthens, Greece
| | | | | | - Ioannis Zerdes
- Faculty of Medicine, School of Health Sciences, University of IoanninaIoannina, Greece
| | - Thomas Makris
- Department of Cardiology, Elena Venizelou HospitalAthens, Greece
| | | | - Petros Nihoyannopoulos
- First University Department of Cardiology, Hippokration Hospital, University of AthensAthens, Greece
| | - Dimitris Tousoulis
- First University Department of Cardiology, Hippokration Hospital, University of AthensAthens, Greece
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24
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Kajantie E, Kaaja R, Ylikorkala O, Andersson S, Laivuori H. Adiponectin Concentrations in Maternal Serum: Elevated in Preeclampsis But Unrelated to Insulin Sensitivity. ACTA ACUST UNITED AC 2016; 12:433-9. [PMID: 15979355 DOI: 10.1016/j.jsgi.2005.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adiponectin is an adipocyte-derived protein with profound insulin-sensitizing, anti-inflammatory, and antiatherogenic effects. Surprisingly, recent evidence suggests that adiponectin concentrations are increased during preeclampsia, which is characterized by insulin resistance. We studied whether serum adiponectin is related to insulin sensitivity in preeclamptic and normotensive pregnant women. METHODS We measured serum adiponectin concentrations and insulin sensitivity (intravenous glucose tolerance test/minimal model) in 22 women with preeclampsia and 15 normotensive controls with similar pre-pregnancy body mass index (BMI) (range 18-29 kg/m(2)) between 29 and 39 weeks of gestation. Fourteen cases and 10 controls were also studied 6-22 weeks after delivery. No subject had gestational diabetes. RESULTS During pregnancy, the mean adiponectin concentration in preeclamptic women was 10.3 (SD 4.2) mug/mL as compared to 7.9 (SD 2.9) microg/mL in normotensive controls (95% confidence interval [CI] for difference 0.1-5.3 microg/mL; P = .04). Adiponectin concentrations were unrelated to insulin sensitivity both in preeclamptic and normotensive subjects; insulin sensitivity was decreased in preeclampsia (P = .01). After delivery, mean adiponectin concentration was lower than during pregnancy: 7.4 (SD 3.0) microg/mL in preeclamptic subjects (P = .001) and 7.1 (SD 1.6) microg/mL in normotensive controls (P = .06) and similar in cases and controls (95% CI for difference -1.7-2.3 microg/mL, P = .7). CONCLUSIONS Despite their reduced insulin sensitivity, preeclamptic women have higher adiponectin concentrations than normotensive pregnant women. These concentrations are unrelated to insulin sensitivity. After pregnancy, the difference in adiponectin concentrations is no longer present between the two groups. These findings are consistent with a role of adiponectin in the pathophysiology of preeclampsia.
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Affiliation(s)
- Eero Kajantie
- Hospital of Children and Adolescents and Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland.
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25
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Karppanen T, Kaartokallio T, Klemetti MM, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Staff AC, Laivuori H. An RGS2 3'UTR polymorphism is associated with preeclampsia in overweight women. BMC Genet 2016; 17:121. [PMID: 27558088 PMCID: PMC4997762 DOI: 10.1186/s12863-016-0428-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preeclampsia is a common and heterogeneous vascular syndrome of pregnancy. Its genetic risk profile is yet unknown and may vary between individuals and populations. The rs4606 3' UTR polymorphism of the Regulator of G-protein signaling 2 gene (RGS2) in the mother has been implicated in preeclampsia as well as in the development of chronic hypertension after preeclampsia. The RGS2 protein acts as an inhibitor of physiological vasoconstrictive pathways, and a low RGS2 level is associated with hypertension and obesity, two conditions that predispose to preeclampsia. We genotyped the rs4606 polymorphism in 1339 preeclamptic patients and in 697 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort to study the association of the variant with preeclampsia. RESULTS No association between rs4606 and preeclampsia was detected in the analysis including all women. However, the polymorphism was associated with preeclampsia in a subgroup of overweight women (body mass index ≥ 25 kg/m(2), and < 30 kg/m(2)) (dominant model; odds ratio, 1.64; 95 % confidence interval, 1.10-2.42). CONCLUSIONS Our results suggest that RGS2 might be involved in the pathogenesis of preeclampsia particularly in overweight women and contribute to their increased risk for hypertension and other types of cardiovascular disease later in life.
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Affiliation(s)
- Tiina Karppanen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Tea Kaartokallio
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miira M Klemetti
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Seppo Heinonen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Kere
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.,Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Katja Kivinen
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Anneli Pouta
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Government services, National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
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26
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Kaartokallio T, Lokki AI, Peterson H, Kivinen K, Hiltunen L, Salmela E, Lappalainen T, Maanselkä P, Heino S, Knuutila S, Sayed A, Poston L, Brennecke SP, Johnson MP, Morgan L, Moses EK, Kere J, Laivuori H. Preeclampsia does not share common risk alleles in 9p21 with coronary artery disease and type 2 diabetes. Ann Med 2016; 48:330-6. [PMID: 27111527 DOI: 10.1080/07853890.2016.1174877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Preeclampsia is a common and partially genetic pregnancy complication characterized by hypertension and proteinuria. Association with cardiovascular disease and type 2 diabetes has been reported in 9p21 by several genome-wide association studies. It has been hypothesized that cardiometabolic diseases may share common etiology with preeclampsia. MATERIALS AND METHODS We tested association with the 9p21 region to preeclampsia in the Finnish population by genotyping 23 tagging single nucleotide polymorphisms (SNPs) in 15 extended preeclampsia families and in a nationwide cohort consisting of 281 cases and 349 matched controls. Replication was conducted in additional datasets. RESULTS Four SNPs (rs7044859, rs496892, rs564398 and rs7865618) showed nominal association (p ≤ 0.024 uncorrected) with preeclampsia in the case-control cohort. To increase power, we genotyped two SNPs in additional 388 cases and 341 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort. Partial replication was also attempted in a UK cohort (237 cases and 199 controls) and in 74 preeclamptic families from Australia/New Zealand. We were unable to replicate the initial association in the extended Finnish dataset or in the two international cohorts. CONCLUSIONS Our study did not find evidence for the involvement of the 9p21 region in the risk of preeclampsia. Key Message Chromosome 9p21 is not associated with preeclampsia.
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Affiliation(s)
- Tea Kaartokallio
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - A Inkeri Lokki
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,b Bacteriology and Immunology Department , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,c Immunobiology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hanna Peterson
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden
| | - Katja Kivinen
- e Division of Cardiovascular Medicine, University of Cambridge , Cambridge , UK
| | | | - Elina Salmela
- g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Tuuli Lappalainen
- i New York Genome Center , New York City , NY , USA ;,j Department of Systems Biology , Columbia University , New York City , NY , USA
| | - Paula Maanselkä
- k Institute of Biotechnology , University of Helsinki , Helsinki , Finland
| | - Sanna Heino
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sakari Knuutila
- l Department of Pathology , University of Helsinki , Helsinki , Finland
| | - Ayat Sayed
- m Department of Medical Biochemistry, Faculty of Medicine , Assiut University , Assiut , Egypt ;,n School of Molecular Medical Sciences , University of Nottingham , Nottingham , UK
| | - Lucilla Poston
- o Division of Women's Health , King's College London , London , UK
| | - Shaun P Brennecke
- p Department of Maternal-Fetal Medicine , Pregnancy Research Centre and University of Melbourne's Department of Obstetrics and Gynaecology, Royal Women's Hospital , Parkville , Victoria , Australia
| | - Matthew P Johnson
- q South Texas Diabetes and Obesity Institute, School of Medicine , University of Texas Rio Grande Valley , Brownsville , TX , USA
| | - Linda Morgan
- r School of Life Sciences , University of Nottingham , Nottingham , UK
| | - Eric K Moses
- s Faculty of Medicine Dentistry and Health Sciences , The University of Western Australia , Perth , Australia ;,t School of Biomedical Sciences , Faculty of Health Science, Curtin University , Perth , Australia ;,u Centre for Genetic Origins of Health and Disease, Medical Research Foundation , Royal Perth Hospital , Perth , Australia
| | - Juha Kere
- d Department of Biosciences and Nutrition , Karolinska Institutet , Stockholm , Sweden ;,g Molecular Neurology Research Program, Research Programs Unit , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,h Folkhälsan Institute of Genetics , Helsinki , Finland
| | - Hannele Laivuori
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,v Institute for Molecular Medicine Finland , University of Helsinki , Helsinki , Finland
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Mastrolia SA, Novack L, Thachil J, Rabinovich A, Pikovsky O, Klaitman V, Loverro G, Erez O. LMWH in the prevention of preeclampsia and fetal growth restriction in women without thrombophilia. A systematic review and meta-analysis. Thromb Haemost 2016; 116:868-878. [PMID: 27440387 DOI: 10.1160/th16-02-0169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Abstract
Placental mediated pregnancy complications such as preeclampsia and fetal growth restriction (FGR) are common, serious, and associated with increased morbidity and mortality. We conducted a systematic review and meta-analysis to determine the effect of treatment with low-molecular-weight heparins (LMWHs) for secondary prevention of these complications in non thrombophilic women. We searched the electronic databases PubMed, Scopus, and Cochrane Library for randomised controlled trials addressing this question. Five studies including 403 patients met the inclusion criteria, 68 developed preeclampsia and 118 FGR. The studies were very heterogeneous in terms of inclusion criteria, LMWH preparation, and dosage. Meta-analyses were performed using random-effect models. The overall use of LMWHs was associated with a risk reduction for preeclampsia (Relative risk (RR) 0.366; 95 % confidence interval (CI), 0.219-0.614) and FGR (RR 0.409; 95 % CI, 0.195-0.932) vs. no treatment. From the data available for analysis it appears that the use of Dalteparin is associated with a risk reduction for preeclampsia (p=0.002) and FGR (p<0.001); while Enoxaparin is associated with risk reduction for preeclampsia (p=0.013) but not for FGR (p=0.3). In spite of the small number of studies addressing the research question, and the high variability among them, our meta-analysis found a modest beneficial effect of LMWH for secondary prevention of preeclampsia and FGR. Further studies are needed to address these questions before a definite conclusion can be reached.
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Affiliation(s)
| | | | | | | | | | | | | | - Offer Erez
- Prof. Offer Erez, MD, Acting Director Maternity Department D and Obstetrical Day care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, P. O.Box 151, 84101, Beer Sheva, Israel, Tel.: +972 8 6400061, E-mail
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Abstract
OBJECTIVE Several studies have reported the detrimental effects on maternal health due to pregnancy during adolescence, but no studies have reported the influence of adolescent pregnancy on blood pressure in women's later life. METHOD We investigated whether there was an association between adolescent pregnancy and the risk of hypertension in Korean postmenopausal women. This study used the data of 2538 postmenopausal women from the Korean National Health and Nutrition Examination Survey in 2010-2011. Multivariate logistic regression analyses were used to evaluate the independent association between adolescent pregnancy and hypertension by adjusting for potential confounding factors. RESULTS Postmenopausal women with a history of adolescent pregnancy had a higher prevalence of hypertension than those without a history of adolescent pregnancy. After fully adjusting for potential confounding factors such as age, lifestyle, sociodemographic factors, known hypertension risk factors, and reproductive factors, a history of adolescent pregnancy was significantly associated with hypertension (odds ratio, 1.702; 95% confidence interval, 1.125-2.574). CONCLUSION This study showed that a history of adolescent pregnancy is significantly and independently associated with a higher risk of hypertension in postmenopausal women.
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Stefanović M, Vukomanović P, Popović J, Kutlešić R, Milošević-Stevanović J, Pop Trajković-Dinić S. INSULIN RESISTANCE SYNDROM IN PREECLAMPSIA – THE INFLUENCE ON THE OFFSPRING. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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McDonald EG, Dayan N, Pelletier R, Eisenberg MJ, Pilote L. Premature cardiovascular disease following a history of hypertensive disorder of pregnancy. Int J Cardiol 2016; 219:9-13. [PMID: 27257849 DOI: 10.1016/j.ijcard.2016.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population. METHODS GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome. RESULTS The median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22-8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60-3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23-1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease. CONCLUSION In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
| | - Natalie Dayan
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Roxanne Pelletier
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec
| | - Mark J Eisenberg
- Division of Cardiology, Department of Medicine, McGill University, Canada
| | - Louise Pilote
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Pregnancy-induced hypertension is associated with an increase in the prevalence of cardiovascular disease risk factors in Japanese women. Menopause 2016; 22:656-9. [PMID: 25387344 DOI: 10.1097/gme.0000000000000361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study assessed whether pregnancy-induced hypertension (PIH) affects the prevalence of cardiovascular disease (CVD) risk factors in later life among Japanese women. METHODS Study participants were 1,185 women (mean [SD] age, 46.5 [5.6] y; range, 38-73 y) aged 40 years or older who underwent a health checkup at a periodic health examination facility between January 2012 and December 2013 and had experienced giving birth. Questionnaires were sent to potential participants, and they were encouraged to provide their Maternal and Child Health Handbook (handbook). We recruited 101 women with a history of PIH (PIH group) and 1,084 women with uncomplicated pregnancy at delivery (control group). Groupings were based on information from the handbook. We assessed the association between PIH and CVD in later life among Japanese women by focusing on hypertension, diabetes mellitus, and dyslipidemia as risk factors for CVD. Odds ratios (ORs) for the use of antihypertensive, diabetes mellitus, and dyslipidemic medications in the PIH group were determined. RESULTS Women with PIH had increased risk of antihypertensive medication use compared with women without PIH (2.9% vs 13.9%; OR, 4.28; 95% CI, 2.14-8.57). Triglycerides were significantly higher and high-density lipoprotein cholesterol was significantly lower in the PIH group than in the control group. The OR for dyslipidemic medication use in the PIH group relative to the control group was 3.20 (95% CI, 1.42-7.22). CONCLUSIONS Our findings suggest that a history of PIH may be associated with an increased risk of hypertension (a risk factor for CVD) in later life among Japanese women.
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van Kesteren F, Visser S, Hermes W, Franx A, van Pampus MG, Poppel MNM, Tamsma JT, Mol BW, de Groot CJ. Prevention of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation. Hypertens Pregnancy 2015; 34:261-9. [PMID: 25815424 DOI: 10.3109/10641955.2015.1009544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyse preventive interventions of women with cardiovascular risk factors postpartum. METHODS 3.5 years postpartum, women with history of hypertension in pregnancy were invited for a questionnaire, 1 year after a cardiovascular risk assessment. RESULTS Two hundred and fifty-seven women completed the questionnaire. At risk factor analyses, 35% had hypertension, 37% abnormal lipid- or glucose levels, 63% BMI ≥ 25 and 19% smoked. One year later, 36% of women with hypertension used anti-hypertensives, 0% of women with abnormal laboratory findings used anti-cholesterol and 1% anti-diabetes medication, 31% of the obese women achieved BMI reduction (≥ 5%), 42% of the women who smoked, quit. CONCLUSION A minority improved their risk profile.
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Affiliation(s)
- Floortje van Kesteren
- Department of Obstetrics and Gynaecology, VU Medical Center , Amsterdam , The Netherlands
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Procopciuc LM, Caracostea G, Zaharie G, Stamatian F. Newborn APOE genotype influences maternal lipid profile and the severity of high-risk pregnancy - preeclampsia: Interaction with maternal genotypes as a modulating risk factor in preeclampsia. Hypertens Pregnancy 2015; 34:271-83. [PMID: 25806651 DOI: 10.3109/10641955.2015.1009541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To establish the role of the interaction between maternal and newborn apolipoprotein E (APOE) genotypes on the risk, lipid profile and prognosis of preeclampsia (PE). MATERIALS AND METHODS Forty-seven preeclamptic women and 94 normotensive pregnant women and their newborns were genotyped for APOE using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS Maternal APOE-ε4 allele was associated with an about eight times higher risk of PE (adjusted OR = 8.4, 95% CI: 2.51-28.17, p = 0.001). The multivariate logistic regression model showed that the newborn APOE-ε4 allele was associated with an about six times higher risk of PE (adjusted OR = 5.6, 95% CI: 2.09-15.21, p = 0.001) for the given gestational age levels. Pregnant women with severe PE whose newborns carried the APOE-ε4 allele delivered at earlier gestational ages neonates with a lower birth weight compared to pregnant women with newborns negative for this allele. Higher TG and LDL-C levels and lower HDL-C levels were found in pregnant women with severe PE whose newborns were carriers of the APOE-ε4 allele compared to preeclamptic women whose newborns were carriers of the ε3/ε3 genotype. If we checked the combined effect of the mother/newborn genotypes on the risk of PE, we found that the risk to develop PE was 15.4-fold (p < 0.001) increased if mothers or newborns were carriers of the APOE-ε4 allele. The risk increased to 20.02 (p < 0.001) if both the mother and newborn were carriers of the APOE-ε4 allele. CONCLUSIONS Our study confirms the maternal/newborn APOE genotype interaction influences the risk for PE, as well as prognosis and lipid profile.
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Yeh JS, Cheng HM, Hsu PF, Sung SH, Liu WL, Fang HL, Chuang SY. Synergistic effect of gestational hypertension and postpartum incident hypertension on cardiovascular health: a nationwide population study. J Am Heart Assoc 2014; 3:e001008. [PMID: 25389282 PMCID: PMC4338688 DOI: 10.1161/jaha.114.001008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gestational hypertension (GH) is a common complication of pregnancy and is associated with increased risk of incident hypertension in later life (IH) and cardiovascular events. However, the interactive effect of GH and IH on postpartum cardiovascular health remains unclear. METHODS AND RESULTS A nationwide population-based study was conducted using 1 million individuals from the Taiwan National Health Insurance database. Records from 1998 to 2009 were used to identify 1260 pregnant women with GH and without previous cardiovascular disease. The control group comprised 5040 pregnant women without GH, matched for age and date of delivery. During the follow-up period (median duration, 5.8 years), 182 cardiovascular events developed. Women with GH had significantly higher risk of cardiovascular events (hazard ratio [95% CI], 2.44 [1.80 to 3.31]) and IH (8.29 [6.30 to 10.91]) than controls. Compared with women without GH and IH, there was a significantly higher risk of cardiovascular events for women without GH but with IH (relative risk [95% CI], 2.89 [1.27-6.58]), women with GH but without IH (1.66 [1.16-2.39]), and women with GH and IH (8.11 [5.36-12.30]). The synergy index was 2.91 (95% CI 1.11 to 7.59), suggesting a positive interaction between GH and IH. CONCLUSIONS GH increased the risk of subsequent IH. Women with both GH and IH were at a substantially higher cardiovascular risk than were women with either GH or IH. The synergistic adverse effect of GH and IH on postpartum cardiovascular health indicates that more attention should be paid to this special population.
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Affiliation(s)
- Jong Shiuan Yeh
- Cardiology Division, Internal Medicine Department, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan (J.S.Y.) Department of Medicine, Taipei Medical University, Taipei, Taiwan (J.S.Y.)
| | - Hao-Min Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C., S.H.S.) Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan (P.F.H.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C., S.H.S.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Wen-Ling Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
| | - Hsin-Ling Fang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
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Lao TT. The mother--the long-term implications on metabolic and cardiovascular complications. Best Pract Res Clin Obstet Gynaecol 2014; 29:244-55. [PMID: 25261964 DOI: 10.1016/j.bpobgyn.2014.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 01/21/2023]
Abstract
There is cumulating evidence linking the occurrence of pregnancy complications, including miscarriage, stillbirth, hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, and fetal growth restriction, with increased future risk of type 2 diabetes mellitus, and hospitalization and death due to cardiovascular and cerebrovascular diseases. Such association is largely related to genetic predisposition and shared pathophysiological mechanisms and changes, which may precede the index pregnancy. Awareness of this association would allow identification of the at-risk women for implementation of preventive measures to reduce the recurrence risk of these complications and mitigate the future development of metabolic and cardiovascular diseases worldwide.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Ma Q, Xiong F, Zhang L. Gestational hypoxia and epigenetic programming of brain development disorders. Drug Discov Today 2014; 19:1883-96. [PMID: 25256780 DOI: 10.1016/j.drudis.2014.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/23/2014] [Accepted: 09/16/2014] [Indexed: 01/04/2023]
Abstract
Adverse environmental conditions faced by an individual early during its life, such as gestational hypoxia, can have a profound influence on the risk of diseases, such as neurological disorders, in later life. Clinical and preclinical studies suggest that epigenetic programming of gene expression patterns in response to maternal stress have a crucial role in the fetal origins of neurological diseases. Herein, we summarize recent studies regarding the role of epigenetic mechanisms in the developmental programming of neurological diseases in offspring, primarily focusing on DNA methylation/demethylation and miRNAs. Such information could increase our understanding of the fetal origins of adult diseases and help develop effective prevention and intervention against neurological diseases.
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Affiliation(s)
- Qingyi Ma
- Center for Perinatal Biology, Division of Pharmacology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Fuxia Xiong
- Center for Perinatal Biology, Division of Pharmacology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA
| | - Lubo Zhang
- Center for Perinatal Biology, Division of Pharmacology, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
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Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
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Kaartokallio T, Klemetti MM, Timonen A, Uotila J, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Lakkisto P, Laivuori H. Microsatellite polymorphism in the heme oxygenase-1 promoter is associated with nonsevere and late-onset preeclampsia. Hypertension 2014; 64:172-7. [PMID: 24799610 DOI: 10.1161/hypertensionaha.114.03337] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preeclampsia is a serious and phenotypically heterogeneous vascular pregnancy disorder. Heme oxygenase-1 (HO-1) is a stress response enzyme that may protect the maternal endothelium and facilitate adequate metabolic adaptation to pregnancy by its antioxidant and anti-inflammatory functions. HO-1 stress response is modulated by HO-1 gene (HMOX1) polymorphisms. Individuals with the long allele of a guanine-thymine (GTn) microsatellite repeat located in the promoter region of HMOX1 have a higher risk of cardiometabolic diseases compared with those with the short allele. We investigated whether the long GTn allele of HMOX1 is associated with subtypes of preeclampsia. The GTn repeat was genotyped in 759 patients and in 779 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort using DNA fragment analysis. In subtype analyses, the long-long (LL) genotype was associated with nonsevere (additive model: odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.31; recessive model: OR, 1.39; 95% CI, 1.02-1.89) and late-onset (additive model: OR, 1.44; 95% CI, 1.02-2.05; recessive model: OR, 1.28; 95% CI, 1.02-1.59) preeclampsia and with preeclampsia without a small-for-gestational-age infant (recessive model: OR, 1.27; 95% CI, 1.02-1.58). The long allele was associated with nonsevere (OR, 1.35; 95% CI, 1.07-1.70) and late-onset (OR, 1.21; 95% CI, 1.03-1.42) preeclampsia and with preeclampsia without a small-for-gestational-age infant (OR, 1.19; 95% CI, 1.02-1.40). Moreover, both the LL genotype and the long allele were associated with preeclampsia in women who had smoked during pregnancy. In conclusion, the GTn long allele seems to predispose to late-onset, less severe form of preeclampsia. This finding supports the role of HO-1 in the pathogenesis of preeclampsia and suggests that the HO-1 pathway may provide a potential target for the treatment of preeclampsia.
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Affiliation(s)
- Tea Kaartokallio
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.).
| | - Miira M Klemetti
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Anni Timonen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Jukka Uotila
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Seppo Heinonen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Eero Kajantie
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Juha Kere
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Katja Kivinen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Anneli Pouta
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Päivi Lakkisto
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Hannele Laivuori
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
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Gordin D, Kaaja R, Forsblom C, Hiilesmaa V, Teramo K, Groop PH. Pre-eclampsia and pregnancy-induced hypertension are associated with severe diabetic retinopathy in type 1 diabetes later in life. Acta Diabetol 2013; 50:781-7. [PMID: 22955518 DOI: 10.1007/s00592-012-0415-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 06/28/2012] [Indexed: 12/21/2022]
Abstract
To investigate whether pre-eclampsia (PE) or pregnancy-induced hypertension (PIH) predicts the development of severe diabetic retinopathy (SDR) in type 1 diabetes. Altogether, 203 women with type 1 diabetes who were followed during pregnancy were re-examined within the Finnish Diabetic Nephropathy Study. After excluding patients with pre-pregnancy hypertension and those who had had laser treatment or whose retinopathy was graded as proliferative at the index pregnancy, 158 were prospectively studied. As a surrogate marker for SDR, retinal laser photocoagulation was used. The time from pregnancy to SDR (N = 21) or follow-up was 16 years (interquartile range, 11-19). HbA1c was repeatedly measured both during pregnancy and follow-up. Women with prior PE (26 % vs. 6 %, P = 0.003) or PIH (24 % vs. 6 %, P = 0.008) had more often incident SDR during follow-up compared to those with normotensive pregnancy. The hazard ratios (HR) remained associated with the progression to SDR after adjustment for duration of diabetes and diabetic nephropathy in a Cox regression analysis [PE: 3.5 (95 % CI 1.1-10.9); P = 0.03 and for PIH: 3.2 (1.1-9.8); P = 0.04]. The association between PIH and incident SDR did not change after inclusion of mean HbA1c, measured during pregnancy (all 3 trimesters) and serial HbA1c measurements during follow-up, 3.5 (1.1-11.8; P = 0.03). However, in a similar model, the HR for PE was no more significant 2.0 (0.6-6.8; P = NS). The results suggest that women with type 1 diabetes and a hypertensive pregnancy have an increased risk of severe diabetic retinopathy later in life.
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Affiliation(s)
- Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland,
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Increased plasma norepinephrine levels in previously pre-eclamptic women. J Hum Hypertens 2013; 28:269-73. [DOI: 10.1038/jhh.2013.84] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/25/2013] [Accepted: 08/04/2013] [Indexed: 11/08/2022]
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Visser VS, Hermes W, Franx A, Koopmans CM, van Pampus MG, Mol BW, de Groot CJM. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension. Pregnancy Hypertens 2013; 3:242-7. [PMID: 26103803 DOI: 10.1016/j.preghy.2013.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Hypertension in pregnancy is associated with cardiovascular disease (CVD) later in life. Blood pressure monitoring in women who experienced hypertension in pregnancy after puerperium has been suggested to be important for early detection and prevention of CVD. The aim of this study is to evaluate if hypertension six weeks postpartum is associated with chronic hypertension in women with a history of term hypertensive pregnancy disorders. STUDY DESIGN Women with a history of term gestational hypertension or preeclampsia were included in a follow up study of the HYPITAT trial. Blood pressures were measured six weeks and 2.5years postpartum according to the study protocol. MAIN OUTCOME MEASURES Hypertension was defined as a diastolic blood pressure ⩾90mmHg and/or a systolic blood pressure ⩾140mmHg or use of antihypertensive medication. Differences in categorical variables between groups were analyzed by Chi-Square tests. Blood pressure was analyzed using unpaired t-tests and Wilcox ranked tests. RESULTS Among 187 women who had term hypertensive pregnancy disorders, 75 (40%) had hypertension at six weeks postpartum. Of these 46 (61%) had hypertension 2.5years postpartum. In contrast, of 112 women without hypertension at six weeks postpartum, 36 (32%) had hypertension 2.5years (OR 3.3, 95% CI 1.8-6.2). CONCLUSION Among 61% of women who had hypertensive pregnancy disorders at term, high blood pressure at six weeks postpartum indicated chronic hypertension. This warrants the importance of identification of hypertension 6weeks postpartum for women's future health.
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Affiliation(s)
- V S Visser
- Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands; Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - W Hermes
- Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands; Obstetrics and Gynaecology, Medical Centre Haaglanden, The Netherlands
| | - A Franx
- Obstetrics and Gyanecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C M Koopmans
- Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M G van Pampus
- Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - B W Mol
- Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - C J M de Groot
- Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
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Hermes W, Tamsma JT, Grootendorst DC, Franx A, van der Post J, van Pampus MG, Bloemenkamp KW, Porath M, Mol BW, de Groot CJM. Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study. BMC Pregnancy Childbirth 2013; 13:126. [PMID: 23734952 PMCID: PMC3680191 DOI: 10.1186/1471-2393-13-126] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term. METHODS In a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student's T test and Mann-Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories. RESULTS After a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (p<.001, IRR 5.8, 95% CI 1.9 to 19)) and 30-year cardiovascular event risks (HTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results. CONCLUSIONS Women with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as compared to women with a history of uncomplicated pregnancies. Further large prospective studies have to evaluate whether hypertensive pregnancy disorders have to be included as an independent variable in cardiovascular risk prediction models for women.
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Hermes W, Franx A, van Pampus MG, Bloemenkamp KW, Bots ML, van der Post JA, Porath M, Ponjee GA, Tamsma JT, Mol BWJ, de Groot CJ. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study. Am J Obstet Gynecol 2013; 208:474.e1-8. [PMID: 23399350 DOI: 10.1016/j.ajog.2013.02.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/25/2012] [Accepted: 02/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. STUDY DESIGN In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular risk factors were compared between women with a history of HTP (HTP cohort, n = 306) and women with a history of normotensive pregnancies at term (NTP cohort, n = 99). HTP women had participated in a randomized, longitudinal trial assessing the effectiveness of induction of labor in women with hypertensive pregnancy disorders at term. All women were assessed 2.5 years after pregnancy for blood pressure, anthropometrics, glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, high-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and microalbumin and metabolic syndrome. RESULTS After a mean follow-up period of 2.5 years, hypertension (HTP, 34%; NTP, 1%; P < .001) and metabolic syndrome (HTP, 25%; NTP, 5%; P < .001) were more prevalent in HTP women compared with NTP women. HTP women had significantly higher systolic and diastolic blood pressure, higher body mass index, and higher waist circumference. Glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, triglycerides, and high-sensitivity C-reactive protein levels were significantly higher and high-density lipoprotein cholesterol was significantly lower in HTP women. CONCLUSION In women with a history of HTP, hypertension and metabolic syndrome are more common, and they have higher levels of biochemical cardiovascular risk factors 2.5 years after pregnancy.
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Hashemi S, Ramezani Tehrani F, Mehrabi Y, Azizi F. Hypertensive pregnancy disorders as a risk factor for future cardiovascular and metabolic disorders (Tehran Lipid and Glucose Study). J Obstet Gynaecol Res 2013; 39:891-7. [PMID: 23438323 DOI: 10.1111/j.1447-0756.2012.02069.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 09/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although hypertensive pregnancy disorders (HPD) are common worldwide, there is no consensus regarding their long-term cardiovascular and metabolic consequences. We aimed to ascertain the association between HPD and the development of cardiovascular and metabolic disturbances later in life. MATERIAL AND METHODS A cohort of 226 women with a history of HPD was selected as the case group, and a group of 226 age- and body-mass-index-matched women, with no history of HPD, was selected as controls. Both groups were selected from among participants of the Tehran Lipid and Glucose Study and were compared for concentrations of metabolic parameters and incidence of hypertension, type 2 diabetes mellitus (T2DM) and dyslipidemia over a follow up of 10 years. RESULTS Women with a history of HPD, compared with age- and body-mass-index-matched women without such a history, had an increased risk of cardiovascular and metabolic disorders, including a twofold increased risk for hypertension (95% confidence interval [CI]: 1.4-3.2), a threefold increased risk for T2DM (95% CI: 1.8-5.2) and a 1.3-fold increased risk for dyslipidemia (95% CI: 1.2-1.5). CONCLUSIONS Women with a history of hypertension in pregnancy are at increased risk for subsequent diagnosis of hypertension, dyslipidemia and T2DM later in life. These women may benefit from close monitoring and timely implementation of primary prevention measures of cardiovascular and metabolic risk factors and lifestyle modifications.
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Affiliation(s)
- Somayeh Hashemi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran
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Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 2013; 28:1-19. [PMID: 23397514 DOI: 10.1007/s10654-013-9762-6] [Citation(s) in RCA: 468] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/07/2013] [Indexed: 12/11/2022]
Abstract
There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular disease (CVD), cerebrovascular events and hypertension associated with prior diagnosis of pre-eclampsia. Medline and Embase were searched with no language restrictions, as were core journals and reference lists from reviews up until January 2012. Case-control and cohort studies which reported cardiovascular and cerebrovascular diseases or hypertension diagnosed more than 6 weeks postpartum, in women who had a history of pre-eclampsia relative to women who had unaffected pregnancies, were included. Fifty articles were included in the systematic review and 43 in the meta-analysis. Women with a history of pre-eclampsia or eclampsia were at significantly increased odds of fatal or diagnosed CVD [odds ratio (OR) = 2.28, 95% confidence interval (CI): 1.87, 2.78], cerebrovascular disease (OR = 1.76, 95% CI 1.43, 2.21) and hypertension [relative risk (RR) = 3.13, 95% CI 2.51, 3.89]. Among pre-eclamptic women, pre-term delivery was not associated with an increased risk of a future cardiovascular event (RR = 1.32, 95% CI 0.79, 2.22). Women diagnosed with pre-eclampsia are at increased risk of future cardiovascular or cerebrovascular events, with an estimated doubling of odds compared to unaffected women. This has implications for the follow-up of all women who experience pre-eclampsia, not just those who deliver pre-term. This association may reflect shared common risk factors for both pre-eclampsia and cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Morven Caroline Brown
- Institute of Health & Society, Newcastle University, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, England NE1 4LP, UK
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Gastrich MD, Gandhi SK, Pantazopoulos J, Zang EA, Cosgrove NM, Cabrera J, Sedjro JE, Bachmann G, Kostis JB. Cardiovascular outcomes after preeclampsia or eclampsia complicated by myocardial infarction or stroke. Obstet Gynecol 2013; 120:823-31. [PMID: 22996100 DOI: 10.1097/aog.0b013e31826ae78a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the relationship between preeclampsia or eclampsia and stroke, myocardial infarction (MI), subsequent cardiovascular outcomes, and long-term survival. METHODS Using the Myocardial Infarction Data Acquisition System in New Jersey (1994-2009), we analyzed cardiovascular outcomes in women with and without preeclampsia or eclampsia and a first MI or stroke but with a hospitalization for a first MI or stroke (analysis 1: MI case group, n=57; MI control group, n=155; stroke case group, n=132; stroke control group, n=379). We also compared these outcomes in women with preeclampsia or eclampsia and a first MI or stroke during pregnancy with women with preeclampsia or eclampsia without MI or stroke during pregnancy (analysis 2: MI case group, n=23; MI control group, n=67; stroke case group, n=90; stroke control group, n=263). A subsequent occurrence of MI, stroke, and cardiovascular death, as well as a combined cardiovascular outcome, was ascertained. RESULTS In analysis 1, women with preeclampsia or eclampsia were at significantly lower risk for combined cardiovascular outcome with all deaths (frequency of outcome 16.7%) and with cardiovascular deaths (10.6%) compared with women without preeclampsia or eclampsia after a first stroke (33.8% and 23.5%, respectively). In analysis 2, women with preeclampsia or eclampsia and a first stroke during admission were at significantly higher risk of all death (11.1%) and the combined cardiovascular outcome with all deaths (11.1%) compared with women with preeclampsia or eclampsia without a stroke (1.9% and 2.7%, respectively) during that admission. CONCLUSION Our study indicates that preeclampsia or eclampsia not complicated by MI or stroke during pregnancy may not confer a very high risk for subsequent MI and stroke in up to 16 years of follow-up. Our data suggest that other known risk factors put women at greater risk for stroke than preeclampsia or eclampsia complicated by a stroke. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mary Downes Gastrich
- Department of Obstetrics/Gynecology and Reproductive Sciences and the Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA.
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Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders. Obstet Gynecol Surv 2012; 67:793-809. [DOI: 10.1097/ogx.0b013e31827682fc] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Valdiviezo C, Garovic VD, Ouyang P. Preeclampsia and hypertensive disease in pregnancy: their contributions to cardiovascular risk. Clin Cardiol 2012; 35:160-5. [PMID: 22389120 DOI: 10.1002/clc.21965] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with CV risk later in life and may identify women in whom earlier primary prevention may reduce their risk. This article reviews the physiologic changes in blood pressure during pregnancy, current definitions of hypertensive diseases of pregnancy and preeclampsia, and postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk. Also summarized are studies providing evidence on the association between hypertensive diseases of pregnancy and future CV risk.
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Affiliation(s)
- Carolina Valdiviezo
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Obeidat M, Obeidat M, Ballermann BJ. Glomerular endothelium: A porous sieve and formidable barrier. Exp Cell Res 2012; 318:964-72. [DOI: 10.1016/j.yexcr.2012.02.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 02/24/2012] [Indexed: 12/20/2022]
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