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Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol 2022; 226:S835-S843. [PMID: 35177221 DOI: 10.1016/j.ajog.2021.11.1371] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 01/01/2023]
Abstract
As the understanding of the pathophysiology of preeclampsia has improved, its diagnostic criteria have evolved. The classical triad of hypertension, edema, and proteinuria has become hypertension and organ dysfunction-renal, hepatic, neurologic, hematological, or uteroplacental. However, the most recent definitions have largely been based off consensus and expert opinion, not primary research. In this review, we explore how the criteria have evolved, particularly through the second half of the 20th and the beginning of the 21st century and offer a critical appraisal of the evidence that has led the criteria to where they stand today. Some key themes are the following: the debate between having a simple and convenient blood pressure cutoff vs a blood pressure cutoff that accounts for influencing factors such as age and weight; whether a uniform blood pressure threshold, a rise in blood pressure, or a combination is most discriminatory; whether existing evidence supports blood pressure and proteinuria thresholds in diagnosing preeclampsia; and whether using flow-charts and decision trees might be more appropriate than a single set of criteria. We also discuss the future of a preeclampsia diagnosis. We challenge the move toward a broad (vs restrictive) diagnosis, arguing instead for criteria that directly relate to the prognosis of preeclampsia and the response to treatments.
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Roell KR, Harmon QE, Klungsøyr K, Bauer AE, Magnus P, Engel SM. Clustering Longitudinal Blood Pressure Trajectories to Examine Heterogeneity in Outcomes Among Preeclampsia Cases and Controls. Hypertension 2021; 77:2034-2044. [PMID: 33813841 DOI: 10.1161/hypertensionaha.120.16239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kyle R Roell
- Department of Epidemiology (K.R.R., S.M.E.), University of North Carolina at Chapel Hill
| | - Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC (Q.E.H.)
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway (K.K.).,Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway (K.K.)
| | - Anna E Bauer
- Perinatal Psychiatry Program, Department of Psychiatry (A.E.B.), University of North Carolina at Chapel Hill
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway (P.M.)
| | - Stephanie M Engel
- Department of Epidemiology (K.R.R., S.M.E.), University of North Carolina at Chapel Hill
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Verschueren KJC, Paidin RR, Broekhuis A, Ramkhelawan OSS, Kodan LR, Kanhai HHH, Browne JL, Bloemenkamp KWM, Rijken MJ. Why magnesium sulfate 'coverage' only is not enough to reduce eclampsia: Lessons learned in a middle-income country. Pregnancy Hypertens 2020; 22:136-143. [PMID: 32979728 DOI: 10.1016/j.preghy.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Determine the eclampsia prevalence and factors associated with eclampsia and recurrent seizures in Suriname and evaluate quality-of-care indicator 'magnesium sulfate (MgSO4) coverage'. STUDY DESIGN A two-year prospective nationwide cohort study was conducted in Suriname and included women with eclampsia at home or in a healthcare facility. MAIN OUTCOME MEASURES We calculated the prevalence by the number of live births obtained from vital registration. Risk factor denominator data concerned hospital births. Descriptive statistics and multivariate regression analysis were performed. RESULTS Seventy-two women with eclampsia (37/10.000 live births) were identified, including two maternal deaths (case-fatality 2.8%). Nulliparity, African-descent and adolescence were associated with eclampsia. Adolescents with eclampsia had significantly lower BPs (150/100 mmHg) than adult women (168/105 mmHg). The first seizure occurred antepartum in 54% (n = 39/72), intrapartum in 19% (n = 14/72) and postpartum in 26% (n = 19/72). Recurrent seizures were observed in 60% (n = 43/72). MgSO4 was administered to 99% (n = 69/70) of women; however 26% received no loading dosage and, in 22% of cases MgSO4 duration was <24 h, i.e. guideline adherence existed in only 43%. MgSO4 was ceased during CS in all women (n = 40). Stable BP was achieved before CS in 46%. The median seizure-to-delivery interval was 27 h, and ranged from four to 36 h. CONCLUSION Solely 'MgSO4 coverage' is not a reliable quality-of-care indicator, as it conceals inadequate MgSO4 dosage and timing, discontinuation during CS, stabilization before delivery, and seizure-to-delivery interval. These other quality-of-care indicators need attention from the international community in order to reduce the prevalence of eclampsia.
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Affiliation(s)
- Kim J C Verschueren
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands.
| | - Rubinah R Paidin
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Annabel Broekhuis
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | | | - Lachmi R Kodan
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Humphrey H H Kanhai
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands.
| | - Marcus J Rijken
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
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Blood Pressure Changes in Adolescents with Preeclampsia: A Multicentre, Case-Control Study in Latin American Hospitals. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:50-57. [PMID: 33041217 DOI: 10.1016/j.jogc.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the minimum blood pressure increases that would confirm or exclude, with the greatest predictive values, hypertensive disorders of pregnancy (HDP) in pregnant adolescents after 24 weeks gestation. METHODS We conducted a case-control study of pregnant women aged ≤19 years with and without HDP. Using systolic and diastolic blood pressure increases, a predictive analysis was performed, and the area under the curve was calculated. RESULTS The cases and controls had systolic blood pressure increases of 45.3 ± 17.5 mm Hg and 6.4 ± 7.9 mm Hg, respectively (P = 0.001) and diastolic blood pressure increases of 30.8 ± 11.7 mm Hg and 3.5 ± 5.7 mm Hg, respectively (P = 0.001). Systolic and diastolic increases of ≥20 mm Hg showed the greatest sensitivity and specificity. A combined analysis showed that an increase of ≥20 mm Hg had a greater positive likelihood ratio of 35.4 (95% CI 22.4-55.9) and negative likelihood ratio of 0.10 (95% CI 0.07-0.13), with an area under the curve of 0.98 (95% CI 0.96-0.99). CONCLUSIONS Systolic and diastolic blood pressure increases of ≥20 mm Hg must be considered in the diagnostic criteria for preeclampsia and gestational hypertension among pregnant adolescents past 24 weeks gestation.
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Farrar D, Santorelli G, Lawlor DA, Tuffnell D, Sheldon TA, West J, Macdonald-Wallis C. Blood pressure change across pregnancy in white British and Pakistani women: analysis of data from the Born in Bradford cohort. Sci Rep 2019; 9:13199. [PMID: 31520065 PMCID: PMC6744423 DOI: 10.1038/s41598-019-49722-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022] Open
Abstract
The incidence of gestational hypertension (GH) and pre-eclampsia (PE) is increasing. Use of blood pressure (BP) change patterns may improve early detection of BP abnormalities. We used Linear spline random-effects models to estimate BP patterns across pregnancy for white British and Pakistani women. Pakistani women compared to white British women had lower BP during the first two trimesters of pregnancy, irrespective of the development of GH or PE or presence of a risk factor. Pakistani compared to white British women with GH and PE showed steeper BP increases towards the end of pregnancy. Pakistani women were half as likely to develop GH, but as likely to develop PE than white British women. To conclude; BP trajectories differ by ethnicity. Because GH developed evenly from 20 weeks gestation, and PE occurred more commonly after 36 weeks in both ethnic groups, the lower BP up to the third trimester in Pakistani women resulted in a lower GH rate, whereas PE rates, influenced by the steep third trimester BP increase were similar. Criteria for diagnosing GH and PE may benefit from considering ethnic differences in BP change across pregnancy.
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Affiliation(s)
- Diane Farrar
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol National Institute for Health Research Biomedical Resource Centre, Bristol, UK
| | | | | | - Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Doğan S, Sel G, Arıkan İİ, Harma Mİ, Harma M, Barut A, Özmen Ü, Can M. Accuracy of the 24-h urine protein excretion value in patients with preeclampsia: correlation with instant and 24-h urine protein/creatinine and albumin/creatinine ratios. J OBSTET GYNAECOL 2019; 39:1075-1080. [DOI: 10.1080/01443615.2019.1586854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suat Doğan
- Obstetrics and Gynecology, Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - Görker Sel
- Obstetrics and Gynecology, Bülent Ecevit University Hospital, Zonguldak, Turkey
| | | | | | - Müge Harma
- Obstetrics and Gynecology, Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - Aykut Barut
- Obstetrics and Gynecology, Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - Ülkü Özmen
- Obstetrics and Gynecology, Bülent Ecevit University Hospital, Zonguldak, Turkey
| | - Murat Can
- Biochemistry, Bülent Ecevit University Hospital, Zonguldak, Turkey
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Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1071] [Impact Index Per Article: 178.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Blood pressure in adolescent patients with pre-eclampsia and eclampsia. Int J Gynaecol Obstet 2017; 138:335-339. [DOI: 10.1002/ijgo.12237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/24/2017] [Accepted: 06/07/2017] [Indexed: 11/07/2022]
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Wikström AK, Gunnarsdottir J, Nelander M, Simic M, Stephansson O, Cnattingius S. Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth. Hypertension 2016; 67:640-6. [DOI: 10.1161/hypertensionaha.115.06752] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (≥37 weeks) singleton births (n=157 446). Using normotensive (diastolic blood pressure [DBP] <80 mm Hg) women as reference, we calculated adjusted odds ratios with 95% confidence intervals between prehypertension (DBP 80–89 mm Hg) at 36 gestational weeks (late pregnancy) and risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51–1.90) and 1.70 (1.16–2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5–2.8) per each mm Hg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth.
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Affiliation(s)
- Anna-Karin Wikström
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
| | - Johanna Gunnarsdottir
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
| | - Maria Nelander
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
| | - Marija Simic
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
| | - Olof Stephansson
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
| | - Sven Cnattingius
- From the Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden (A.-K.W., J.G., M.N., M.S.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden (A.-K.W., M.S., O.S., S.C.); and School of Public Health, University of California, Berkeley (O.S.)
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Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, Paech M, Said JM. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55:e1-29. [PMID: 26412014 DOI: 10.1111/ajo.12399] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Morton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Michael Paech
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Joanne M Said
- Sunshine Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Ekiz A, Kaya B, Polat I, Avci ME, Ozkose B, Kicik Caliskan R, Yildirim G. The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study. J Matern Fetal Neonatal Med 2015; 29:1765-9. [PMID: 26135772 DOI: 10.3109/14767058.2015.1061497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate preeclampsia progression of isolated proteinuria and associations with pregnancy outcome. METHOD We performed a retrospective analysis in patients who were hospitalized for evaluation of new onset proteinuria without hypertension after 20 weeks of gestation between January 2012 and January 2014. One hundred fifty-seven patients who met the inclusion criteria were enrolled the study. RESULTS After detection of new onset proteinuria, 53 of 157 (33.7%) patients developed preeclampsia and the incidence of gestational proteinuria was found to be 0.33%. Twenty-four hours urine proteinuria testing results were significantly higher in preeclampsia (PE) group compared with the gestational proteinuria (GP) group (p < 0.01). Patients who developed preeclampsia delivered significantly earlier than the GP group (p < 0.01). The weights of the infants born to mothers in the PE group were significantly lower than the other group (p < 0.01). CONCLUSION The incidence of gestational proteinuria was lower than the previous studies. Preeclampsia developed in 33% of patients with new onset proteinuria in pregnancy. In patients who developed PE had significantly higher proteinuria, lower delivery time and birth weight in their infants. Therefore, patients with new onset proteinuria should be followed-up for preeclampsia development and associated morbidities.
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Affiliation(s)
- Ali Ekiz
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Basak Kaya
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Ibrahim Polat
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Muhittin Eftal Avci
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
| | - Burak Ozkose
- b Department of Obstetrics and Gynaecology , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Raziye Kicik Caliskan
- b Department of Obstetrics and Gynaecology , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey
| | - Gokhan Yildirim
- a Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit , Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey and
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Diastolic blood pressure increase is a risk indicator for pre-eclampsia. Arch Gynecol Obstet 2014; 291:819-23. [DOI: 10.1007/s00404-014-3476-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
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Regitz-Zagrosek V, Gohlke-Bärwolf C, Iung B, Pieper PG. Management of cardiovascular diseases during pregnancy. Curr Probl Cardiol 2014; 39:85-151. [PMID: 24794710 DOI: 10.1016/j.cpcardiol.2014.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of cardiovascular diseases (CVDs) in women of childbearing age is rising. The successes in medical and surgical treatment of congenital heart disease have led to an increasing number of women at childbearing age presenting with problems of treated congenital heart disease. Furthermore, in developing countries and in immigrants from these countries, rheumatic valvular heart disease still plays a significant role in young women. Increasing age of pregnant women and increasing prevalence of atherosclerotic risk factors have led to an increase in women with coronary artery disease at pregnancy. Successful management of pregnancy in women with CVDs requires early diagnosis, a thorough risk stratification, and appropriate management by a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and primary care physicians. The following review is based on the recent European guidelines on the management of CVDs during pregnancy, which aim at providing concise and simple recommendations for these challenging problems.
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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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Ono Y, Takagi K, Seki H, Takai Y, Samejima K, Matsunaga S, Matsumura H. Neonatal outcome in infants of chronically hypertensive mothers. J Obstet Gynaecol Res 2013; 39:1142-6. [PMID: 23718727 DOI: 10.1111/jog.12041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/30/2012] [Indexed: 01/13/2023]
Abstract
AIM We investigated the neonatal outcome in chronically hypertensive patients with controlled hypertension, uncontrollable hypertension, or superimposed pre-eclampsia. MATERIAL AND METHODS The study included 120 patients who had chronic hypertension and were divided into three groups for which the perinatal and neonatal outcomes were retrospectively compared: pre-eclampsia superimposed on chronic hypertension (SP: n = 28), chronic hypertension with severe hypertension uncontrolled in spite of intravenous or multiple oral antihypertensive medications in the latter half of pregnancy (uCH: n = 44), and chronic hypertension with controlled to mild hypertension with or without medication (cCH: n = 48). RESULTS Preterm birth rate incidence was significantly higher in the SP and uCH groups than in the cCH group (P < 0.05 for both). The incidence rates of low birthweight, very low birthweight, and extremely low birthweight for the groups were as follows: SP > uCH > cCH. Admission to the neonatal intensive care unit was significantly higher in the uCH and SP groups than in the cCH group (P < 0.05 for both). CONCLUSION Like superimposed pre-eclampsia, uncontrolled chronic severe hypertension during late pregnancy results in a poorer neonatal outcome than controlled chronic mild hypertension. We conclude that absolute blood pressure can be used as a predictor of clinical outcome in pregnant chronic hypertension patients.
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Affiliation(s)
- Yoshihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi, Saitama, Japan
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Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JSR, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AHEM, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147-97. [PMID: 21873418 DOI: 10.1093/eurheartj/ehr218] [Citation(s) in RCA: 935] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Cifkova R. Can blood pressure in the first trimester predict the development of gestational hypertensive disorders? Eur Heart J 2011; 32:3067-9. [DOI: 10.1093/eurheartj/ehr295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A. 2007 ESH‐ESC Guidelines for the management of arterial hypertension. Blood Press 2009; 16:135-232. [PMID: 17846925 DOI: 10.1080/08037050701461084] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Mansia
- Clinica Medica, Ospedale San Gerardo, Universita Milano-Bicocca, Via Pergolesi, 33 - 20052 MONZA (Milano), Italy.
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Ohkuchi A, Iwasaki R, Ojima T, Matsubara S, Sato I, Suzuki M, Minakami H. Increase in Systolic Blood Pressure of ≥ 30 mm Hg and/or Diastolic Blood Pressure of ≥ 15 mm Hg During Pregnancy: Is It Pathologic? Hypertens Pregnancy 2009; 22:275-85. [PMID: 14572364 DOI: 10.1081/prg-120024031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether a rise in systolic blood pressure (SBP) > or = 30 mm Hg and/or diastolic blood pressure (DBP) > or = 15 mm Hg in the absence of hypertension during pregnancy is associated with adverse pregnancy outcomes. METHOD We conducted a retrospective, longitudinal study of 1,498 pregnant women without hypertension or proteinuria in the first trimester. The blood pressure levels measured during the first (7.8 +/- 2.3 weeks), second (20.7 +/- 1.2 weeks), and third trimesters (38.6 +/- 1.5 weeks) were analyzed. The perinatal outcome was compared between women who exhibited a rise in SBP > or = 30 mm Hg and/or DBP > or = 15 mm Hg during pregnancy (large Delta BP group) and women who did not (small Delta BP group) using one way analysis of variance, chi-square test, or Fisher's exact test. The contribution of gestational hypertension and a large Delta BP to the development of adverse pregnancy outcomes was evaluated using multivariate logistic regression analysis. RESULTS Of 1441 women who remained normotensive (SBP < 140 mm Hg and DBP < 90 mm Hg) during pregnancy, 238 (16.5%) and 1,203 (83.5%) belonged to the large Delta BP and small Delta BP groups, respectively. There were no significant differences between the two groups in the occurrence rate of gestational proteinuria, preterm deliveries, low-birth-weight infants, or small-for-gestational age infants. A large Delta BP was not a risk factor in itself for the occurrence of gestational proteinuria or small-for-gestational age infants after controlling for the effect of gestational hypertension. CONCLUSION A rise in SBP > or = 30 mm Hg and/or DBP > or = 15 mm Hg is not a risk factor of adverse outcome among women who remain normotensive during pregnancy.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical School, Yakushiji, Tochigi-ken, Japan.
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20
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Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol 2009; 200:481.e1-7. [PMID: 19019323 DOI: 10.1016/j.ajog.2008.07.048] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/02/2008] [Accepted: 07/28/2008] [Indexed: 11/18/2022]
Abstract
Preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets syndrome are major obstetric disorders that are associated with substantial maternal and perinatal morbidities. As a result, it is important that clinicians make timely and accurate diagnoses to prevent adverse maternal and perinatal outcomes associated with these syndromes. In general, most women will have a classic presentation of preeclampsia (hypertension and proteinuria) at > 20 weeks of gestation and/or < 48 hours after delivery. However, recent studies have suggested that some women will experience preeclampsia without > or = 1 of these classic findings and/or outside of these time periods. Atypical cases are those that develop at < 20 weeks of gestation and > 48 hours after delivery and that have some of the signs and symptoms of preeclampsia without the usual hypertension or proteinuria. The purpose of this review was to increase awareness of the nonclassic and atypical features of preeclampsia-eclampsia. In addition, a stepwise approach toward diagnosis and treatment of patients with these atypical features is described.
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Affiliation(s)
- Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
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21
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Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HAJS, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosion E, Fagard R, Lindholm LH, Manolis A, Nilsson PM, Redon J, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Bertomeu V, Clement D, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL. [ESH/ESC 2007 Guidelines for the management of arterial hypertension]. Rev Esp Cardiol 2007; 60:968.e1-94. [PMID: 17915153 DOI: 10.1157/13109650] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Gordin D, Hiilesmaa V, Fagerudd J, Rönnback M, Forsblom C, Kaaja R, Teramo K, Groop PH. Pre-eclampsia but not pregnancy-induced hypertension is a risk factor for diabetic nephropathy in type 1 diabetic women. Diabetologia 2007; 50:516-22. [PMID: 17216281 DOI: 10.1007/s00125-006-0544-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 10/30/2006] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Our aim was to study whether pre-eclampsia and pregnancy-induced hypertension are predictors of diabetic nephropathy in type 1 diabetic women. MATERIALS AND METHODS A total of 203 type 1 diabetic women, who were pregnant between 1988 and 1996 and followed at the Department of Obstetrics and Gynaecology in Helsinki, were re-assessed after an average of 11 years within the nationwide, multi-centre Finnish Diabetic Nephropathy Study. Diabetic nephropathy was defined as microalbuminuria, macroalbuminuria or end-stage renal disease. RESULTS Patients with prior pre-eclampsia had diabetic nephropathy more often than patients with a normotensive pregnancy (diabetic nephropathy vs normal albumin excretion rate: 41.9% vs 8.9%; p<0.001), whereas patients with a history of pregnancy-induced hypertension did not (10.3% vs 8.9%; p=0.81). CHD was more prevalent in patients with a history of pre-eclampsia than in patients with a normotensive pregnancy (12.2% vs. 2.2%; p=0.03). Pre-eclampsia (odds ratio [OR] 7.7, 95% CI 1.6-36.1; p=0.01) and HbA(1c) (OR 2.0, 95% CI 1.1-3.8; p<0.05) were associated with incident diabetic nephropathy even when adjusted for follow-up time, BMI, smoking, diabetes duration and age. CONCLUSIONS/INTERPRETATION These data suggest that a history of pre-eclamptic pregnancy but not pregnancy-induced hypertension is associated with an elevated risk of diabetic nephropathy.
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Affiliation(s)
- D Gordin
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, and Department of Medicine, Helsinki University Central Hospital, Finland
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Lee ES, Oh MJ, Jung JW, Lim JE, Seol HJ, Lee KJ, Kim HJ. The levels of circulating vascular endothelial growth factor and soluble Flt-1 in pregnancies complicated by preeclampsia. J Korean Med Sci 2007; 22:94-8. [PMID: 17297258 PMCID: PMC2693576 DOI: 10.3346/jkms.2007.22.1.94] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 06/07/2006] [Indexed: 01/23/2023] Open
Abstract
To evaluate the role of vascular endothelial growth factor (VEGF) in the pathogenesis of preeclampsia, we measured total VEGF, free VEGF and soluble Flt-1 (sFlt-1) concentrations and determined their relationships. Maternal serum samples were collected from 20 patients with preeclampsia and 20 normotensive women with uncomplicated pregnancies matched with the patients with preeclampsia for gestational age and parity. The serum concentrations of total VEGF (2.39+/-0.75 vs. 0.28+/-0.14) and sFlt-1 (934.5+/-235.5 vs. 298.0+/-161.2) were significantly increased in the patients with preeclampsia compared to the women with uncomplicated pregnancies. However the serum concentration of free VEGF (21.5+/-6.3 vs. 134.0+/-16.3) was lower in patients with preeclampsia. There was a positive correlation between the serum concentrations of total VEGF and sFlt-1 with systolic and diastolic blood pressure, respectively. There was a negative correlation between the serum concentration of free VEGF and systolic and diastolic blood pressure. There was a strong negative correlation between free VEGF and sFlt-1 concentrations. In conclusion, we found VEGF and sFlt-1 were related to the pathogenesis of preeclampsia. Although reduced concentrations of free VEGF might interfere with endothelial cell function and survival, further studies are required to clarify its specific role in the pathogenesis of preeclampsia.
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Affiliation(s)
- Eun Sung Lee
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Jae Won Jung
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Ji-Eun Lim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Kyung-Ju Lee
- Department of Obstetrics and Gynecology, College of Medicine, Pochon CHA University, Pochon, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
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Cnossen JS, van der Post JAM, Mol BWJ, Khan KS, Meads CA, ter Riet G. Prediction of pre-eclampsia: a protocol for systematic reviews of test accuracy. BMC Pregnancy Childbirth 2006; 6:29. [PMID: 17052339 PMCID: PMC1630696 DOI: 10.1186/1471-2393-6-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 10/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia, a syndrome of hypertension and proteinuria, is a major cause of maternal and perinatal morbidity and mortality. Accurate prediction of pre-eclampsia is important, since high risk women could benefit from intensive monitoring and preventive treatment. However, decision making is currently hampered due to lack of precise and up to date comprehensive evidence summaries on estimates of risk of developing pre-eclampsia. METHODS/DESIGN A series of systematic reviews and meta-analyses will be undertaken to determine, among women in early pregnancy, the accuracy of various tests (history, examinations and investigations) for predicting pre-eclampsia. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Reviewers working independently will select studies, extract data, and assess study validity according to established criteria. Language restrictions will not be applied. Bivariate meta-analysis of sensitivity and specificity will be considered for tests whose studies allow generation of 2 x 2 tables. DISCUSSION The results of the test accuracy reviews will be integrated with results of effectiveness reviews of preventive interventions to assess the impact of test-intervention combinations for prevention of pre-eclampsia.
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Affiliation(s)
- Jeltsje S Cnossen
- Academic Medical Center-University of Amsterdam, Department of General Practice, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
- Academic Medical Center-University of Amsterdam, Department of Obstetrics and Gynaecology, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Joris AM van der Post
- Academic Medical Center-University of Amsterdam, Department of Obstetrics and Gynaecology, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Ben WJ Mol
- Academic Medical Center-University of Amsterdam, Department of Obstetrics and Gynaecology, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Khalid S Khan
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital/University of Birmingham, Birmingham, B15 2TG, UK
| | - Catherine A Meads
- Department of Public Health and Epidemiology, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gerben ter Riet
- Academic Medical Center-University of Amsterdam, Department of General Practice, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
- Horten Center, University of Zurich, Bolleystrasse 40, CH-8091, Zurich, Switzerland
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Abstract
Gestational hypertension-preeclampsia is the most common medical disorder of pregnancy. It is also a major cause of maternal and perinatal morbidities. The majority of adverse pregnancy outcomes occur in patients who develop severe hypertension or severe preeclampsia, and in those who develop the clinical manifestations before 34 weeks' gestation. There is some concern regarding neonatal morbidity in the late preterm (near term) infant (34 0/7 through 36 6/7 weeks' gestation) as a result of gestational hypertension and preeclampsia. A review of the available data suggests that most deliveries of the late preterm infant in such women are justified because of the concerns about maternal and fetal safety with continued gestation. In addition, the rate of preterm delivery at 34 to 36 weeks' gestation in women with gestational hypertension or preeclampsia is low. Indeed, most admissions to Neonatal Intensive Care Unit in such pregnancies occur in those at > or =37 weeks' gestation. There is urgent need for research to assess the reasons behind preterm delivery at 34 to 36 weeks' gestation in women with hypertension and preeclampsia. In addition, there is need for research to assess the reasons for admission to the NICU in term infants born of mothers with varying severities of hypertension and preeclampsia. In this paper, the phrase "late-preterm" has been used instead of "near term," as the former was considered more appropriate to reflect this subgroup of preterm infants in a workshop on this topic held in July 2005, organized by the National Institute of Child Health and Human Development.
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Affiliation(s)
- Baha M Sibai
- Department of Obstetrics and Gynecology, University of Cincinnati, OH, USA.
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26
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Noris M, Perico N, Remuzzi G. Mechanisms of Disease: pre-eclampsia. ACTA ACUST UNITED AC 2005; 1:98-114; quiz 120. [PMID: 16932375 DOI: 10.1038/ncpneph0035] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 08/25/2005] [Indexed: 01/11/2023]
Abstract
Pre-eclampsia, a syndrome of pregnant women, is one of the leading causes of maternal and fetal morbidity and mortality. Despite active research, the etiology of this disorder remains an enigma. Recent work has, however, provided promising explanations for the causation of the disorder and some of its phenotypes. Evidence indicates that the symptoms of hypertension and proteinuria, upon which the diagnosis of pre-eclampsia is based, have several underlying causes. Nevertheless, the treatment of pre-eclampsia has not changed significantly in over 50 years. This review describes the most recent insights into the pathophysiology of pre-eclampsia from both basic and clinical research, and attempts to provide a unifying hypothesis to reconcile the abnormalities at the feto-placental level and the clinical features of the maternal syndrome. The novel findings outlined in this review provide a rationale for potential future prophylactic and therapeutic interventions for pre-eclampsia.
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Affiliation(s)
- Marina Noris
- Laboratory of Immunology and Genetics of Transplantation and Rare Diseases, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
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Abstract
Eclampsia continues to be a significant cause of maternal and fetal death throughout the world. Neurologists have a specific role to play in the diagnosis and management of patients who have eclampsia, especially those who have recurrent seizures, raised intracranial pressure, and coma. Postpartum patients may be admitted to a neurology service when they present to the emergency department with seizures. The cornerstone of treatment has been blood pressure control and magnesium sulfate with its antivasospastic effect. Should this fail, antiepileptic drugs of proved efficacy, such as diazepam and phenytoin, can be used. Recent studies reveal genetic and mitochondrial defects in eclampsia, but further investigation is warranted to determine the complex underlying pathophysiologic interplay and the optimum prophylactic and therapeutic management.
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Affiliation(s)
- Peter W Kaplan
- Department of Neurology, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, B. Building, 1 North, Room 125, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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Lyell DJ, Lambert-Messerlian GM, Giudice LC. Prenatal screening, epidemiology, diagnosis, and management of preeclampsia. Clin Lab Med 2003; 23:413-42. [PMID: 12848452 DOI: 10.1016/s0272-2712(03)00027-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The cause of preeclampsia remains unknown. The disease manifests itself across a broad clinical spectrum from mild to severe, conferring vastly different morbidities and suggesting possibly different disease processes. Oxidative stress, endothelial dysfunction, maternal-fetal immune incompatibility, and abnormal placental implantation are among the suggested causes. The need for a marker or set of markers that allow for definitive diagnosis and assessment of future risk of preeclampsia is tremendous. Ultrasound techniques and several markers have been identified that are increased among patients with preeclampsia, but no test is highly sensitive. In the future, a combination of markers likely will be used to assess risk and, establish the diagnosis, and test treatment strategies. Such an approach would allow for more refined treatment studies of patients who are at highest risk for preeclampsia.
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Affiliation(s)
- Deirdre J Lyell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Strevens H, Kristensen K, Langhoff-Roos J, Wide-Swensson D. Blood pressure patterns through consecutive pregnancies are influenced by body mass index. Am J Obstet Gynecol 2002; 187:1343-8. [PMID: 12439529 DOI: 10.1067/mob.2002.126851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the impact of parity and baseline body mass index on blood pressure levels in pregnancy. STUDY DESIGN We studied a longitudinal historic cohort of 166 healthy pregnant women who gave birth in 2000 to a third child at the University Hospital of Lund; blood pressure measurements were obtained at each antenatal visit during the three consecutive pregnancies. RESULTS The mean systolic and diastolic blood pressure levels were consistently higher during the first pregnancy at comparable weeks of gestation, significantly so during the third trimester. The body mass index correlated with diastolic blood pressure levels only in the first pregnancy, and the impact of parity on third trimester blood pressure levels was greatest in the women with a high body mass index. Age, smoking, change of paternity, or a short time interval between pregnancies did not influence blood pressure levels. CONCLUSION The interrelationship among blood pressure levels, parity, and body mass index in normal pregnancy resembles the situation in hypertensive pregnancies, which implies common adaptive mechanisms.
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Affiliation(s)
- Helena Strevens
- Department of Obstetrics and Gynaecology, University Hospital, University of Lund, Sweden.
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Chaiworapongsa T, Gervasi MT, Refuerzo J, Espinoza J, Yoshimatsu J, Berman S, Romero R. Maternal lymphocyte subpopulations (CD45RA+ and CD45RO+) in preeclampsia. Am J Obstet Gynecol 2002; 187:889-93. [PMID: 12388971 DOI: 10.1067/mob.2002.127309] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The maternal syndrome of preeclampsia has been attributed to a systemic intravascular inflammatory response and endothelial cell dysfunction. The stimulus responsible for intravascular inflammation in preeclampsia has not been determined. The expression of CD45 isoforms on the surface of human T cells has been used to classify CD4(+) T lymphocytes into naïve cells (CD45RA+) and memory T cells (CD45RO+). An increased percentage of CD45RO+ cells has been interpreted as consistent with previous exposure to microbial products or other antigens. The purpose of this study was to determine whether preeclampsia is associated with a change in the proportion of CD45RA+ and CD45RO+. STUDY DESIGN A prospective study was conducted in patients with preeclampsia (n = 24) and normal pregnancy (n = 75). The percentage of CD45RA+ and CD45RO+ on CD4(+) T lymphocytes in peripheral blood was determined using flow cytometry and monoclonal antibodies. Results were reported as a percentage of CD4(+) lymphocytes. Parametric statistics were used for analysis. A probability value of <.05 was considered statistically significant. RESULTS Patients with preeclampsia had a significantly higher percentage of CD45RO+ than normal pregnant women (P <.01). A significantly lower percentage of CD45RA+ was found in patients with preeclampsia than in normal pregnant women (P <.01). CONCLUSION Preeclampsia is associated with an increase in the percentage of CD45RO+ and a decrease in the CD45RA+ lymphocyte subpopulation. Therefore, patients with preeclampsia have evidence of previous antigenic exposure, the nature of which remains to be established.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, National Institute of Child Health and Human Development, and the Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, 4707 St. Antoine Boulevard, Detroit, MI 48201, USA
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Human Chorionic Gonadotropin and Testosterone in Normal and Preeclamptic Pregnancies in Relation to Fetal Sex. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200209000-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gervasi MT, Chaiworapongsa T, Pacora P, Naccasha N, Yoon BH, Maymon E, Romero R. Phenotypic and metabolic characteristics of monocytes and granulocytes in preeclampsia. Am J Obstet Gynecol 2001; 185:792-7. [PMID: 11641653 DOI: 10.1067/mob.2001.117311] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The maternal syndrome of preeclampsia has recently been attributed to a systemic intravascular inflammatory response and endothelial cell activation and dysfunction. This novel hypothesis has considerable clinical and biological implications. This study was designed to determine whether women with preeclampsia have evidence of intravascular inflammation by examination of the phenotypic and metabolic activity of granulocytes and monocytes. STUDY DESIGN A cross-sectional study was performed that included patients with preeclampsia (n = 31) and normal pregnancies (n = 58) matched for gestational age at blood draw. Intravascular inflammation was studied with use of flow cytometry. Peripheral venous blood was assayed to determine granulocyte and monocyte phenotype with the use of monoclonal antibodies for selective cluster differentiation (CD) antigens. The panel of antibodies included CD11b, CD14, CD16, CD18, CD49d, CD62L, CD64, CD66b, and HLA-DR. The quantity of basal intracellular reactive oxygen species and oxidative burst was assessed. Results were reported as mean channel brightness or intensity of detected fluorescence. Analysis was conducted with nonparametric statistics. A P value <.01 was considered to be significant. RESULTS Preeclampsia was associated with a significant increase in mean channel brightness for CD11b on granulocytes and monocytes but lower mean channel brightness for CD62L on granulocytes than those from women with normal pregnancy (P <.01 for each). Basal intracellular reactive oxygen species were increased in monocytes but not in granulocytes. The oxidative burst was higher in both cell types. CONCLUSION Preeclampsia is associated with phenotypic and metabolic changes in granulocytes and monocytes.
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Affiliation(s)
- M T Gervasi
- Perinatology Research Branch, National Institute of Child Health and Human Development, Wayne State University/Hutzel Hospital, Detroit, MI, USA
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Schneider MC, Landau R, Mörtl MG. New insights in hypertensive disorders of pregnancy. Curr Opin Anaesthesiol 2001; 14:291-7. [PMID: 17019105 DOI: 10.1097/00001503-200106000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research reported during the past year has enhanced our understanding of conditions that lead to the complex changes that are observed in hypertensive disorders of pregnancy. An association between placental pathology and a multisystem disorder that is characterized by endothelial dysfunction which involves genetic and immunological investigations has been identified. On the basis of these findings, promising screening tools for early detection of pre-eclampsia were identified. No marked changes in anaesthetic approach to hypertensive disorders of pregnancy occurred during the period of review, apart from a reappraisal of spinal anaesthesia as a safe technique in caesarean section, even in patients with severe pre-eclampsia. A multidisciplinary approach to management and therapy is needed and the right balance must be sought between the needs of the mother and baby, both of which are jeopardized by the hypertensive disorders of pregnancy.
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Affiliation(s)
- M C Schneider
- Department of Anesthesiology, University of Basel/Women's Hospital, Basel, Switzerland.
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