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Hauge MG, Linde JJ, Kofoed KF, Ersbøll AS, Johansen M, Sigvardsen PE, Fuchs A, Mikkelsen AP, Gustafsson F, Damm P. Early-onset vs late-onset preeclampsia and risk of coronary atherosclerosis later in life: a clinical follow-up study. Am J Obstet Gynecol MFM 2024; 6:101371. [PMID: 38588914 DOI: 10.1016/j.ajogmf.2024.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Younger women with previous preeclampsia have an increased risk of coronary atherosclerosis. It is unknown if this risk is associated with the time of onset of preeclampsia. OBJECTIVE This study aimed to investigate if women with early-onset preeclampsia have a higher risk of coronary atherosclerosis compared with women with late-onset preeclampsia, independent of other perinatal risk factors. STUDY DESIGN A total of 911 women with previous preeclampsia aged 35 to 55 years participated in a clinical follow-up study, including clinical examination, comprehensive questionnaires, and cardiac computed tomography scan 13 years (range, 0-28) after index pregnancy. Early- and late-onset preeclampsia were defined as gestational age at delivery of <34+0 and ≥34+0 gestational weeks, respectively. The primary outcome of the study was the presence of coronary atherosclerosis on the cardiac computed tomography. A logistic regression analysis was performed to investigate the association between time of onset of preeclampsia, perinatal risk factors, and the primary outcome. RESULTS Women with early-onset preeclampsia (N=139) were older (46.2±5.7 vs 44.4±5.5 years; P<.001), more likely to have hypertension (51.1% vs 35.1%; P≤.001), and had a higher body mass index (27.9±6.3 vs 26.9±5.5 kg/m2; P=.051) compared with women with late-onset preeclampsia (N=772) at follow-up. The prevalence of the primary outcome (coronary atherosclerosis) on the cardiac computed tomography among women with early- and late-onset preeclampsia was 28.8% vs 22.2%, respectively (P=.088; adjusted odds ratio, 1.74; 95% confidence interval, 1.01-3.01; P=.045 after adjustment for maternal age at index pregnancy, prepregnancy body mass index, parity, diabetes in pregnancy, smoking in pregnancy, offspring birthweight and sex, and follow-up length). CONCLUSION Women with early-onset preeclampsia had a slightly higher risk of coronary atherosclerosis compared with women with late-onset preeclampsia. However, according to the current evidence, it does not seem indicated to limit screening, diagnostic, and preventive measures for cardiovascular disease only to women with early-onset preeclampsia.
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Affiliation(s)
- Maria G Hauge
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm).
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm); Department of Radiology, The Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Dr Kofoed)
| | - Anne S Ersbøll
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm)
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm)
| | - Per E Sigvardsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson)
| | - Anders P Mikkelsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Gynaecology and Obstetrics, Herlev-Gentofte University Hospital, Herlev, Denmark (Dr Mikkelsen)
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Linde, Kofoed, Sigvardsen, Fuchs, and Gustafsson); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm)
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Drs Hauge, Ersbøll, Johansen, Mikkelsen, and Damm); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Drs Hauge, Kofoed, Gustafsson, and Damm)
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Zulhijayanti NA, Ernawati E, Akbar MIA. A retrospective cohort study of hypertension, cardiovascular disease, and metabolic syndrome risk in women with history of preterm and term preeclampsia five years after delivery. Pregnancy Hypertens 2023; 32:57-63. [PMID: 37104925 DOI: 10.1016/j.preghy.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES To evaluate maternal hypertension, risk of cardiovascular disease (CVD), and metabolic syndrome five years after delivery in preterm preeclampsia (P-PE), term preeclampsia (T-PE), and normal pregnancy. STUDY DESIGN This was a retrospective cohort study of women who delivered at Dr. Soetomo Academic Hospital (Indonesia) in 2013 with a diagnosis of PE and were compared with women with normal pregnancies. MAIN OUTCOMES MEASURES Blood pressure, National Cholesterol Education Program Adult Treatment Panel III criteria for metabolic syndrome (NCE-ATP III), and Framingham Risk Score (FRS). RESULTS In this study, 92 women participated. They were divided into the P-PE (27), T-PE (35), and control groups (30). Women with a history of PE, P-PE, or T-PE had higher blood pressure five years after delivery than those in the control group (p < 0.05). Systolic blood pressure (SBP) >140 mmHg was seen in 66.7% of P-PE and 25.7% of T-PE, while 55.6% of P-PE and 34.3% of T-PE had diastolic blood pressure (DBP) >90 mmHg (p < 0.05). Women with P-PE had the highest risk of developing hypertension (Relative risk (RR): 20; 95% Confidence interval [CI]: 2.85-139.92). Women with history of P-PE (RR: 1.85; 95% CI: 0.77-4.41), T-PE (RR: 1.28; 95% CI: 0.51-3.19), and total PE (RR: 1.53; 95% CI: 0.68-3.43) had an increased risk of positive NECP-ATP III five years after delivery. Women with history of P-PE (RR: 5.17; 95% CI: 0.26-103.22; p = 0.282) and T-PE (RR: 6.03; 95% CI: 0.32-112.22; p = 0.228) are at a greater risk of having an FRS >10% compared to the control group (p = 0.04). CONCLUSIONS History of PE, P-PE, and T-PE increased the risk of hypertension and CVD five years after delivery. The results also showed a tendency toward an increased risk of metabolic syndrome in women with a previous history of PE and P-PE.
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Affiliation(s)
- Noor Assyifa Zulhijayanti
- Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia; Department of Obstetrics and Gynecology, Universitas Airlangga Academic Hospital, Surabaya, East Java, Indonesia
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Salazar MR, Espeche WG, Leiva Sisnieguez CE, Minetto J, Balbín E, Soria A, Yoma O, Prudente M, Torres S, Grassi F, Santillan C, Carbajal HA. Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies. Hypertens Res 2021; 44:1633-1640. [PMID: 34480133 DOI: 10.1038/s41440-021-00740-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/21/2023]
Abstract
To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.
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Affiliation(s)
- Martin R Salazar
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina. .,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina.
| | - Walter G Espeche
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Carlos E Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Julián Minetto
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | | | - Adelaida Soria
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Osvaldo Yoma
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Marcelo Prudente
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Soledad Torres
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Florencia Grassi
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Claudia Santillan
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
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Dubon Garcia A, Devlieger R, Redekop K, Vandeweyer K, Verlohren S, Poon LC. Cost-utility of a first-trimester screening strategy versus the standard of care for nulliparous women to prevent pre-term pre-eclampsia in Belgium. Pregnancy Hypertens 2021; 25:219-224. [PMID: 34271426 DOI: 10.1016/j.preghy.2021.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the cost-effectiveness of the Fetal Medicine Foundation (FMF) combined first-trimester pre-eclampsia (PE) screening algorithm, coupled with low-dose aspirin treatment in high-risk patients, compared to the standard of care (SOC; screening based on maternal risk factors) for nulliparous pregnancies in Belgium. STUDY DESIGN A decision analytic model was used to estimate the costs and outcomes for patients screened using the SOC and for those using the FMF screening algorithm, from the Belgian payers' perspective. Where possible, the probabilities and associated costs at each decision point were calculated based on published literature and public databases. MAIN OUTCOME MEASURES Cost-effectiveness was assessed using an incremental cost-effectiveness ratio. One-way sensitivity analyses were performed to assess the impact of independent variations in each model parameter. A probabilistic sensitivity analysis was used to estimate the impact of the overall uncertainty of the model on the estimated cost-effectiveness. RESULTS Considering an estimated 51,309 pregnancies in nulliparous women in Belgium per year, the FMF screening algorithm resulted in fewer cases of pre-term PE compared with the SOC (479 versus 816 cases) and a cost saving of €28.67 per patient. The outcome in quality-adjusted life-years was similar for both screening approaches (FMF screening algorithm 1.8521 versus SOC 1.8518). The FMF screening algorithm was cost-saving and more effective in 99.4% of simulations. CONCLUSIONS The FMF screening algorithm coupled with early intervention using low-dose aspirin has the potential to prevent an additional 337 cases of pre-term PE per year compared with the current SOC in this population, along with a cost saving.
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Affiliation(s)
- Ana Dubon Garcia
- Roche Diagnostics Belgium NV/SA, Berkenlaan 8, 1831 Diegem, Belgium.
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands.
| | | | - Stefan Verlohren
- Department of Obstetrics (S.V.), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Sha Tin, Hong Kong.
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Christensen M, Petersen JL, Sivanandam P, Kronborg CS, Knudsen UB, Martensen PM. Reduction of serum-induced endothelial STAT3(Y705) activation is associated with preeclampsia. Pregnancy Hypertens 2021; 25:103-109. [PMID: 34098522 DOI: 10.1016/j.preghy.2021.05.012] [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] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Preeclampsia is associated with maternal morbidity and mortality during pregnancy, and also an increased cardiovascular disease (CVD) risk later in life. During preeclampsia, alterations in secreted placental factors leading to systemic maternal endothelial dysfunction are evident. However, little is known about the associated endothelial intracellular signaling. STAT3 is a latent cytoplasmic transcription factor involved in endothelial cell differentiation, survival, and angiogenesis. We aimed to test if preeclampsia and preeclampsia-related placental factors could alter serum-induced STAT3(Y705) activation in endothelial cells. Furthermore, if altered serum-induced endothelial STAT3 (Y705) activation is related to post-preeclamptic CVD risk. STUDY DESIGN HUVECs were used as a model of maternal endothelium. Experiments entailed addition of 20% human pregnancy serum as well as addition of recombinant PlGF, sFLT1 and VEGF-A165a to the cells. MAIN OUTCOME MEASURES Levels of pSTAT3(Y705) related to STAT3 levels were evaluated by immunoblotting analysis. RESULTS Our results show that preeclamptic serum induces significantly lower STAT3(Y705) phosphorylation compared with uncomplicated pregnancy serum (P = 0.0089) in endothelial cells. Furthermore, STAT3(Y705) phosphorylation was not changed upon addition of PlGF, sFLT1, or VEGF-A165a together with pregnancy sera compared with sera alone. Finally, sera from women with previous preeclampsia and current hypertension and carotid atherosclerotic plaques show significantly lower STAT3(Y705) phosphorylation capabilities compared with healthy women with previous uncomplicated pregnancies 8-18 years after deliveries (P = 0.029). CONCLUSIONS Reduction in serum-induced endothelial STAT3(Y705) activation may play an important role in the preeclampsia-associated endothelial dysfunction. Additionally, reduced endothelial STAT3(Y705) phosphorylation may contribute to increased post-preeclamptic CVD risk 8-18 years after delivery.
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Affiliation(s)
- M Christensen
- Clinical Research Unit, Randers Regional Hospital, 8930 Randers NOE, Denmark; Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - J L Petersen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - P Sivanandam
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - C S Kronborg
- Department of Oncology, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - P M Martensen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark.
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Amor AJ, Vinagre I, Valverde M, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Nuclear magnetic resonance lipoproteins are associated with carotid atherosclerosis in type 1 diabetes and pre-eclampsia. Diabetes Metab Res Rev 2021; 37:e3362. [PMID: 32515046 DOI: 10.1002/dmrr.3362] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
AIMS Persistence of lipoprotein abnormalities in type 1 diabetes (T1D) and/or pre-eclampsia could be associated with cardiovascular disease (CVD). We assessed differences in the advanced lipoprotein profiles according to the presence of both conditions and their differential association with atherosclerosis. MATERIAL AND METHODS We recruited 112 women without CVD and last pregnancy ≥5 years previously, divided into four groups (n = 28 per group): (a) T1D and previous pre-eclampsia; (b) T1D without pre-eclampsia; (c) pre-eclampsia without T1D; and (d) controls (without T1D/pre-eclampsia). Groups were matched by several risk factors, and diabetes duration and retinopathy in T1D. Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥1.5 mm) were assessed by ultrasonography. The lipoprotein profile was evaluated by nuclear magnetic resonance (NMR) spectroscopy. RESULTS The participants were 44.9 ± 7.8 years old. Carotid plaque presence was 20.5%, with a higher prevalence in T1D and/or pre-eclampsia vs controls (P < .05). High-density lipoprotein (HDL)-related variables differed among groups, mainly driven by an increase in T1D (P < .05), whereas triglyceride-related variables were increased in pre-eclampsia [medium very low-density lipoprotein (VLDL) particles and triglyceride enrichment in HDL and low-density lipoprotein (LDL)]. Overall, in multivariate-adjusted models, LDL-related variables were the most strongly associated with atherosclerosis (P < .05). In age- and statin-adjusted models, previous pre-eclampsia showed an independent association with triglyceride-related variables (plaque: medium-VLDL-particles, OR 1.550 [1.013-2.374]; HDL-cholesterol/HDL-triglycerides ratio, OR 0.411 [0.175-0.967]). Regarding T1D, HDL-parameters were also differentially associated (maximum-IMT: HDL-cholesterol/HDL-particles ratio, β = -.258, P = .036). CONCLUSIONS NMR lipoproteins were differentially and independently associated with atherosclerosis in T1D/pre-eclampsia. Further studies are needed to ascertain the role of NMR parameters as CVD biomarkers in this high-risk population.
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Affiliation(s)
- Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
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Clemmensen TS, Christensen M, Løgstrup BB, Kronborg CJS, Knudsen UB. Reduced coronary flow velocity reserve in women with previous pre-eclampsia: link to increased cardiovascular disease risk. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:786-792. [PMID: 31343097 DOI: 10.1002/uog.20407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/26/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate differences in coronary microvascular function approximately 12 years after delivery between women who had had early- (EO-PE) or late- (LO-PE) onset pre-eclampsia and those who had had a normotensive pregnancy, and to assess the relationship between microvascular function and myocardial deformation at follow-up in these women. METHODS This was a case-control study of 88 women who had delivered at the Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark, between 1998 and 2008. Coronary flow velocity reserve (CFVR) was assessed by Doppler echocardiography approximately 12 years after delivery. Women were grouped according to whether the pregnancy had been complicated by EO-PE (n = 29) or LO-PE (n = 20), or had been normotensive (controls) (n = 39). Study groups were matched for maternal age and time since delivery. CFVR at follow-up was compared between the study groups. Regression analysis was used to assess the association between gestational age at onset of PE and CFVR. The association between left ventricular global longitudinal strain (LV-GLS) and CFVR at follow-up was also evaluated. RESULTS Resting coronary flow velocity assessed 12 years after delivery was comparable between the study groups (P = 0.55), whereas peak hyperemic flow velocity was significantly lower in the EO-PE group than in the LO-PE group (P < 0.01) and controls (P < 0.0001). As such, mean CFVR at follow-up was significantly lower in the EO-PE group than in the LO-PE group (P < 0.01) and controls (P < 0.0001). CFVR was < 2.5 in 48% of women in the EO-PE group, 25% of those in the LO-PE group and 8% of controls (P < 0.01). There was a significant positive association between gestational age at diagnosis of PE and CFVR at 12-year follow-up (β1 = 1.8 (95% CI, 0.8-2.9); P < 0.01). This relationship remained significant after adjustment for cardiovascular risk factors, namely mean arterial blood pressure, glycated hemoglobin level, body mass index, low-density lipoprotein cholesterol level and smoking status (P < 0.05). There was a significant association between LV-GLS and CFVR in women who had had PE (β1 = -1.5 (95% CI, -2.2 to -0.9); R2 = 0.33, P < 0.0001). CONCLUSIONS Low gestational age at onset of PE, both as a continuous variable and when categorized as early onset, was associated with decreased CFVR 12 years after delivery. Nearly 50% of women who had had EO-PE had CFVR < 2.5 at follow-up. Reduced CFVR in women who had had PE was associated with subclinical myocardial dysfunction in terms of reduced LV-GLS. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T S Clemmensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - M Christensen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
| | - B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - C J S Kronborg
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Horsens Regional Hospital, Horsens, Denmark
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Analyzing Preeclampsia as the Tip of the Iceberg Represented by Women with Long-Term Cardiovascular Disease, Atherosclerosis, and Inflammation. Curr Atheroscler Rep 2020; 22:13. [DOI: 10.1007/s11883-020-0830-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amor AJ, Vinagre I, Valverde M, Pané A, Urquizu X, Meler E, López E, Quirós C, Giménez M, Codina L, Conget I, Barahona MJ, Perea V. Preeclampsia Is Associated With Increased Preclinical Carotid Atherosclerosis in Women With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:5570566. [PMID: 31529047 DOI: 10.1210/clinem/dgz031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Although preeclampsia (PE) is a well-established cardiovascular risk factor (CVRF) in the general population, its role in type 1 diabetes (T1D) has been scarcely studied. We assessed the association between PE and preclinical atherosclerosis in T1D. METHODS We recruited 112 women without cardiovascular disease and last pregnancy ≥5 years before: (1) T1D and previous PE (T1D+/PE+; n = 28); (2) T1D without preeclampsia (T1D+/PE-; n = 28); (3) previous PE without T1D (T1D-/PE+; n = 28); and (4) controls (without T1D or PE; T1D-/PE-; n = 28). Groups were matched by age, several CVRFs, and diabetes duration and retinopathy (in T1D participants). Carotid intima-media thickness (IMT) and the presence of plaque (IMT ≥ 1.5 mm) were assessed by standardized ultrasonography protocol. RESULTS Mean age of the participants was 44.9 ± 7.8 years (14.3% hypertension and 21.4% active smokers). Groups including T1D (T1D+/PE+ and T1D+/PE-) more frequently presented hypertension and statin treatment (23.2% vs 5.4% and 37.5% vs 8.9%; respectively; P < 0.01), without differences in other CVRFs. Carotid plaques were observed in 20.5%. In multivariate models adjusted for age, CVRF, and statins, both T1D and PE showed a similar impact on the presence of plaque, with odds ratios (95% confidence interval), 5.45 (1.36-21.9) and 4.24 (1.04-17.3), respectively. Both entities showed an additive effect when combined, both in common carotid-IMT (T1D+/PE- or T1D-/PE+, β = 0.198; T1D+/PE+, β = 0.297) and in the presence of plaque (8.53 [1.07-68.2] and 28.1 [2.67-296.4], respectively). CONCLUSIONS Previous PE was independently associated with preclinical atherosclerosis in T1D. Further studies are needed to ascertain its usefulness for stratifying risk in T1D women.
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Affiliation(s)
- Antonio J Amor
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Irene Vinagre
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Maite Valverde
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Adriana Pané
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
| | - Xavier Urquizu
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Eva Meler
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona 08036, Spain
| | - Eva López
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Marga Giménez
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Laura Codina
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Ignacio Conget
- Endocrinology an d Nutrition Department, Hospital Clínic de Barcelona, Barcelona 08036, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid 28029, Spain
| | - Maria J Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa 08221, Spain
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Lui NA, Jeyaram G, Henry A. Postpartum Interventions to Reduce Long-Term Cardiovascular Disease Risk in Women After Hypertensive Disorders of Pregnancy: A Systematic Review. Front Cardiovasc Med 2019; 6:160. [PMID: 31803757 PMCID: PMC6873287 DOI: 10.3389/fcvm.2019.00160] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction: Hypertensive disorders (HDP) affect ~7% of pregnancies. Epidemiological evidence strongly suggests HDP independently increases that individual's risk of later cardiovascular disease (CVD). Focus on reduction or mitigation of this risk has been limited. This review seeks to identify trialed interventions to reduce cardiovascular risk after HDP. Methods: Online medical databases were searched to identify full-text published results of randomized controlled trials (RCT) in women <10 years postpartum after HDP that trialed interventions to reduce cardiovascular risk. Outcomes sought included cardiovascular disease events, chronic hypertension, and other measures of cardiovascular risk such as obesity, smoking status, diet, and physical activity. Publications from January 2008 to July 2019 were included. Results: Two RCTs were identified. One, a trial of calcium vs. placebo in 201 women with calcium commenced from the first follow-up visit outside of pregnancy and continued until 20 weeks' gestation if another pregnancy occurred. A non-significant trend toward decreased blood pressure was noted. The second RCT of 151 women tested an online education programme (vs. general information to control group) to increase awareness of risk factors and personalized phone-based lifestyle coaching in women who had a preeclampsia affected pregnancy in the 5 years preceding enrolment. Significant findings included increase in knowledge of CVD risk factors, reported healthy eating and decreased physical inactivity, however adoption of a promoted heart healthy diet and physical activity levels did not differ significantly between groups. Several observational studies after HDP, and one meta-analysis of studies of lifestyle interventions not performed specifically after HDP but used to extrapolate likely benefits of lifestyle interventions, were identified which supported the use of lifestyle interventions. Several ongoing RCTs were also noted. Discussion: There is a paucity of intervention trials in the early years after HDP to guide evidence-based cardiovascular risk reduction in affected women. Limited evidence suggests lifestyle intervention may be effective, however degree of any risk reduction remains uncertain. Conclusion: Sufficiently powered randomized controlled trials of appropriate interventions (e.g., lifestyle behavior change, pharmacological) are required to assess the best method of reducing the risk of cardiovascular disease in this at-risk population of women.
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Affiliation(s)
- Nicla A Lui
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Gajana Jeyaram
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Amanda Henry
- Department of Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
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11
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Tarca AL, Romero R, Benshalom-Tirosh N, Than NG, Gudicha DW, Done B, Pacora P, Chaiworapongsa T, Panaitescu B, Tirosh D, Gomez-Lopez N, Draghici S, Hassan SS, Erez O. The prediction of early preeclampsia: Results from a longitudinal proteomics study. PLoS One 2019; 14:e0217273. [PMID: 31163045 PMCID: PMC6548389 DOI: 10.1371/journal.pone.0217273] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify maternal plasma protein markers for early preeclampsia (delivery <34 weeks of gestation) and to determine whether the prediction performance is affected by disease severity and presence of placental lesions consistent with maternal vascular malperfusion (MVM) among cases. STUDY DESIGN This longitudinal case-control study included 90 patients with a normal pregnancy and 33 patients with early preeclampsia. Two to six maternal plasma samples were collected throughout gestation from each woman. The abundance of 1,125 proteins was measured using high-affinity aptamer-based proteomic assays, and data were modeled using linear mixed-effects models. After data transformation into multiples of the mean values for gestational age, parsimonious linear discriminant analysis risk models were fit for each gestational-age interval (8-16, 16.1-22, 22.1-28, 28.1-32 weeks). Proteomic profiles of early preeclampsia cases were also compared to those of a combined set of controls and late preeclampsia cases (n = 76) reported previously. Prediction performance was estimated via bootstrap. RESULTS We found that 1) multi-protein models at 16.1-22 weeks of gestation predicted early preeclampsia with a sensitivity of 71% at a false-positive rate (FPR) of 10%. High abundance of matrix metalloproteinase-7 and glycoprotein IIbIIIa complex were the most reliable predictors at this gestational age; 2) at 22.1-28 weeks of gestation, lower abundance of placental growth factor (PlGF) and vascular endothelial growth factor A, isoform 121 (VEGF-121), as well as elevated sialic acid binding immunoglobulin-like lectin 6 (siglec-6) and activin-A, were the best predictors of the subsequent development of early preeclampsia (81% sensitivity, FPR = 10%); 3) at 28.1-32 weeks of gestation, the sensitivity of multi-protein models was 85% (FPR = 10%) with the best predictors being activated leukocyte cell adhesion molecule, siglec-6, and VEGF-121; 4) the increase in siglec-6, activin-A, and VEGF-121 at 22.1-28 weeks of gestation differentiated women who subsequently developed early preeclampsia from those who had a normal pregnancy or developed late preeclampsia (sensitivity 77%, FPR = 10%); 5) the sensitivity of risk models was higher for early preeclampsia with placental MVM lesions than for the entire early preeclampsia group (90% versus 71% at 16.1-22 weeks; 87% versus 81% at 22.1-28 weeks; and 90% versus 85% at 28.1-32 weeks, all FPR = 10%); and 6) the sensitivity of prediction models was higher for severe early preeclampsia than for the entire early preeclampsia group (84% versus 71% at 16.1-22 weeks). CONCLUSION We have presented herein a catalogue of proteome changes in maternal plasma proteome that precede the diagnosis of preeclampsia and can distinguish among early and late phenotypes. The sensitivity of maternal plasma protein models for early preeclampsia is higher in women with underlying vascular placental disease and in those with a severe phenotype.
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Affiliation(s)
- Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
- * E-mail: (RR); (ALT)
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (RR); (ALT)
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nandor Gabor Than
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- Maternity Clinic, Kutvolgyi Clinical Block, Semmelweis University, Budapest, Hungary
| | - Dereje W. Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, Michigan, United States of America
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Sorin Draghici
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Maternity Department "D," Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Bhat PV, Vinod V, Priyanka AN, Kamath A. Maternal serum lipid levels, oxidative stress and antioxidant activity in pre-eclampsia patients from Southwest India. Pregnancy Hypertens 2018; 15:130-133. [PMID: 30825910 DOI: 10.1016/j.preghy.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/11/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A study was carried out to evaluate the effects of metabolic syndrome components and oxidative stress factors among preeclamptic women from South West India. STUDY DESIGN A case-control study was carried out by enrolling fifty pre-eclampsia cases and hundred low-risk pregnant women within the age group of 18-40 years, at 28-34 weeks of pregnancy. The fasting glucose level, fasting insulin level, insulin resistance, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), malondialdehyde, the ferric reducing ability of plasma (FRAP assay), cardiac output and aortic wall distensibility were measured. MAIN OUTCOME MEASURES There was a significant rise in the fasting blood glucose, fasting insulin, insulin resistance levels, total cholesterol, triglycerides, LDL, and antioxidant levels in pre-eclamptic women (p < 0.001). The cardiac output and aortic wall distensibility were observed to be low in the cases. CONCLUSION We conclude that abnormal lipid metabolism and high lipid peroxide concentrations observed in pre-eclampsia may result in oxidative stress and vascular dysfunction.
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Affiliation(s)
- Parvati V Bhat
- Department of Obstetrics and Gynecology, Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Vinutha Vinod
- Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Alluri Naga Priyanka
- Department of Obstetrics and Gynecology, Dr T M A Pai Hospital, MMMC, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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Clemmensen TS, Christensen M, Kronborg CJS, Knudsen UB, Løgstrup BB. Long-term follow-up of women with early onset pre-eclampsia shows subclinical impairment of the left ventricular function by two-dimensional speckle tracking echocardiography. Pregnancy Hypertens 2018; 14:9-14. [DOI: 10.1016/j.preghy.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/21/2018] [Accepted: 07/05/2018] [Indexed: 01/15/2023]
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14
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Angiogenic profile in the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort. Pregnancy Hypertens 2018; 14:252-259. [DOI: 10.1016/j.preghy.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/26/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
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15
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Bro Schmidt G, Christensen M, Breth Knudsen U. Preeclampsia and later cardiovascular disease - What do national guidelines recommend? Pregnancy Hypertens 2017; 10:14-17. [PMID: 29153667 DOI: 10.1016/j.preghy.2017.07.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/17/2017] [Accepted: 07/22/2017] [Indexed: 11/17/2022]
Abstract
Preeclamptic women have an increased risk of hypertension and cardiovascular disease (CVD) later in life. The aim was to compare the latest clinical recommendations on post-preeclamptic prevention of hypertension and CVD published by eight National Associations of Gynecologists and Obstetricians. Definitions of preeclampsia differ internationally. Recommendations on when, how and who to screen to reduce post-preeclamptic CVD risk also show substantial variation. The diverging preeclampsia definitions make CVD prevention strategies difficult to compare. The variations in clinical recommendations are in line with the lacking evidence of cost-efficient follow-up strategies and stress the need for further research to optimize prevention strategies.
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Affiliation(s)
- Gitte Bro Schmidt
- Department of Surgery - Woman and Child, Regional Hospital of Northern Denmark, Hjoerring, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Christensen
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark
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