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Villalaín González C, Herraiz García I, Fernández-Friera L, Ruiz-Hurtado G, Morales E, Solís J, Galindo A. Cardiovascular and renal health: Preeclampsia as a risk marker. Nefrologia 2023; 43:269-280. [PMID: 37635012 DOI: 10.1016/j.nefroe.2022.04.009] [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: 02/07/2022] [Accepted: 04/24/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Cardiovascular (CVD) and chronic kidney disease (CKD) in women have unique risk factors related to hormonal status and obstetric history that must be taken into account. Pregnancy complications, such as preeclampsia (PE), can reveal a subclinical predisposition for the development of future disease that may help identify women who could benefit from early CVD and CKD prevention strategies. MATERIALS AND METHODS Review of PE and its association with future development of CVD and CKD. RESULTS Multiple studies have established an association between PE and the development of ischemic heart disease, chronic hypertension, peripheral vascular disease, stroke and CKD. It has not been sufficiently clarified if this relation is a causal one or if it is mediated by common risk factors. Nevertheless, the presence of endothelial dysfunction and thrombotic microangiopathy during pregnancies complicated with PE makes us believe that PE may leave a long-term imprint. Early identification of women who have had a pregnancy complicated by PE becomes a window of opportunity to improve women's health through adequate follow-up and targeted preventive actions. Oxidative stress biomarkers and vascular ultrasound may play a key role in the early detection of this arterial damage. CONCLUSIONS The implementation of preventive multidisciplinary targeted strategies can help slow down CVD and CKD's natural history in women at risk through lifestyle modifications and adequate blood pressure control. Therefore, we propose a series of recommendations to guide the prediction and prevention of CVD and CKD throughout life of women with a history of PE.
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Affiliation(s)
- Cecilia Villalaín González
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Herraiz García
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
| | - Leticia Fernández-Friera
- Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enrique Morales
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Servicio de Nefrología, Departamento de Medicina, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
| | - Jorge Solís
- Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Galindo
- Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Departamento de Salud Pública y Materno-Infantil, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Instituto de Salud Carlos III, Madrid, Spain
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Salud cardiovascular y renal en la mujer: la preeclampsia como marcador de riesgo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dall'Asta A, D'Antonio F, Saccone G, Buca D, Mastantuoni E, Liberati M, Flacco ME, Frusca T, Ghi T. Cardiovascular events following pregnancy complicated by pre-eclampsia with emphasis on comparison between early- and late-onset forms: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:698-709. [PMID: 32484256 DOI: 10.1002/uog.22107] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To elucidate whether pre-eclampsia (PE) and the gestational age at onset of the disease (early- vs late-onset PE) have an impact on the risk of long-term maternal cardiovascular complications. METHODS MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for 'pre-eclampsia', 'cardiovascular disease' and 'outcome'. Inclusion criteria were cohort or case-control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early- vs late-onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type-2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random-effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed. RESULTS Seventy-three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9-2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8-2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6-2.0)), hypertension (OR, 3.93 (95% CI, 3.1-5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4-8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3-1.4)), Type-2 diabetes (OR, 2.14 (95% CI, 1.5-3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3-5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6-7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1-10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early-onset PE, compared to those with previous late-onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0-3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5-21.4)), hypertension (OR, 1.48 (95% CI, 1.3-1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3-1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1-2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1-2.5). CONCLUSIONS Both early- and late-onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early-onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late-onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - F D'Antonio
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - D Buca
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - E Mastantuoni
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - M Liberati
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Scott K, Morgan HL, Delles C, Fisher S, Graham D, McBride MW. Distinct uterine artery gene expression profiles during early gestation in the stroke-prone spontaneously hypertensive rat. Physiol Genomics 2021; 53:160-171. [PMID: 33719581 DOI: 10.1152/physiolgenomics.00159.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
During pregnancy, the uterine spiral arteries undergo major vascular remodeling to ensure sufficient uteroplacental perfusion to support the fetus. In pregnancies complicated by hypertensive disorders, this remodeling is deficient leading to impaired uteroplacental blood flow and poor maternal and fetal outcomes. The underlying genetic mechanisms for failed vascular remodeling are not fully understood. This study aimed to examine the early-pregnancy-associated gene changes in the uterine arteries of spontaneously hypertensive stroke-prone rats (SHRSP) compared with their normotensive counterparts, Wistar-Kyoto rats (WKY). Uterine arteries from gestational day 6.5 WKY and SHRSP were processed for RNA-sequencing, along with virgin, age-matched controls for each strain. Gene expression changes were identified and biological pathways were implicated and interpretated using ingenuity pathway analysis (IPA). This study found that WKY uterine arteries from early pregnancy exhibit a gene expression pattern that is suggestive of a pregnancy-dependent reduction in Ca2+ handling and renin-angiotensin-aldosterone system (RAAS) components and an increase in ATP production. In contrast, the expression pattern of pregnant SHRSP uterine arteries was dominated by an elevated immune response and increased production of reactive oxygen species (ROS) and downstream effectors of the RAAS. These results suggest that in a rat model, hypertension during pregnancy impacts uterine artery gene expression patterns as early as the first week of pregnancy. The pathway changes involved may underlie or contribute to the adverse vascular remodeling and resultant placental ischemia and systemic vascular dysfunction observed in SHRSP in late gestation.
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Affiliation(s)
- Kayley Scott
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Hannah L Morgan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Christian Delles
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Simon Fisher
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Delyth Graham
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Martin W McBride
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
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Wu R, Wang T, Gu R, Xing D, Ye C, Chen Y, Liu X, Chen L. Hypertensive Disorders of Pregnancy and Risk of Cardiovascular Disease-Related Morbidity and Mortality: A Systematic Review and Meta-Analysis. Cardiology 2020; 145:633-647. [PMID: 32841945 DOI: 10.1159/000508036] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several studies have demonstrated that there is a higher risk of cardiovascular disease (CVD) in women with a history of hypertensive disorders of pregnancy (HDP). However, effect sizes varied greatly between these studies, and a complete overview of the existing data in the literature is lacking. We aimed to evaluate the association between HDP and the risk of CVD-related morbidity and mortality. METHODS Systematic literature searches were conducted in several electronic databases from inception to July 2019. Exposure of interest was any type of HDP. Outcomes of interest included any CVD, CVD-related mortality, and hypertension. RESULTS Sixty-six cohort and 7 case-control studies involving >13 million women were included. The overall combined relative risks (RRs) for women with a history of HDP compared with the reference group were 1.80 (95% confidence interval [CI] 1.67-1.94) for any CVD, 1.66 (1.49-1.84) for coronary artery heart disease, 2.87 (2.14-3.85) for heart failure, 1.60 (1.29-2.00) for peripheral vascular disease, 1.72 (1.50-1.97) for stroke, 1.78 (1.58-2.00) for CVD-related mortality, and 3.16 (2.74-3.64) for hypertension. Significant heterogeneity was partially explained by all or part of the variables including type of exposure, follow-up time, geographic region, and sample source. CONCLUSIONS Women with a history of HDP are at an increased risk of future CVD-related morbidity and mortality. Our study highlights the importance of life-long monitoring of cardiovascular risk factors in women with a history of HDP.
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Affiliation(s)
- Rong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Runhui Gu
- School of Public Health, Nanjing Medical University, Jiangsu, China
| | - Dexiu Xing
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Changxiang Ye
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Yan Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Xiaoling Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China,
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Groenhof TKJ, van Rijn BB, Franx A, Roeters van Lennep JE, Bots ML, Lely AT. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when. Eur J Prev Cardiol 2017; 24:1735-1745. [PMID: 28895439 PMCID: PMC5669282 DOI: 10.1177/2047487317730472] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts (N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.
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Affiliation(s)
- T Katrien J Groenhof
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | - Bas B van Rijn
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands.,2 Academic Unit of Human Development and Health, Institute for Life Sciences, University of Southampton, UK
| | - Arie Franx
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
| | | | - Michiel L Bots
- 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - A Titia Lely
- 1 Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, The Netherlands
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Karppanen T, Kaartokallio T, Klemetti MM, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Staff AC, Laivuori H. An RGS2 3'UTR polymorphism is associated with preeclampsia in overweight women. BMC Genet 2016; 17:121. [PMID: 27558088 PMCID: PMC4997762 DOI: 10.1186/s12863-016-0428-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preeclampsia is a common and heterogeneous vascular syndrome of pregnancy. Its genetic risk profile is yet unknown and may vary between individuals and populations. The rs4606 3' UTR polymorphism of the Regulator of G-protein signaling 2 gene (RGS2) in the mother has been implicated in preeclampsia as well as in the development of chronic hypertension after preeclampsia. The RGS2 protein acts as an inhibitor of physiological vasoconstrictive pathways, and a low RGS2 level is associated with hypertension and obesity, two conditions that predispose to preeclampsia. We genotyped the rs4606 polymorphism in 1339 preeclamptic patients and in 697 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort to study the association of the variant with preeclampsia. RESULTS No association between rs4606 and preeclampsia was detected in the analysis including all women. However, the polymorphism was associated with preeclampsia in a subgroup of overweight women (body mass index ≥ 25 kg/m(2), and < 30 kg/m(2)) (dominant model; odds ratio, 1.64; 95 % confidence interval, 1.10-2.42). CONCLUSIONS Our results suggest that RGS2 might be involved in the pathogenesis of preeclampsia particularly in overweight women and contribute to their increased risk for hypertension and other types of cardiovascular disease later in life.
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Affiliation(s)
- Tiina Karppanen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Tea Kaartokallio
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miira M Klemetti
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Seppo Heinonen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Kajantie
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Kere
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.,Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Katja Kivinen
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Anneli Pouta
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Government services, National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Cathrine Staff
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
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Hod T, Cerdeira AS, Karumanchi SA. Molecular Mechanisms of Preeclampsia. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a023473. [PMID: 26292986 DOI: 10.1101/cshperspect.a023473] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Preeclampsia is a pregnancy-specific disease characterized by new onset hypertension and proteinuria after 20 wk of gestation. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Exciting discoveries in the last decade have contributed to a better understanding of the molecular basis of this disease. Epidemiological, experimental, and therapeutic studies from several laboratories have provided compelling evidence that an antiangiogenic state owing to alterations in circulating angiogenic factors leads to preeclampsia. In this review, we highlight the role of key circulating antiangiogenic factors as pathogenic biomarkers and in the development of novel therapies for preeclampsia.
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Affiliation(s)
- Tammy Hod
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214
| | - Ana Sofia Cerdeira
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Gulbenkian Program for Advanced Medical Education, 1067-001 Lisbon, Portugal
| | - S Ananth Karumanchi
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Howard Hughes Medical Institute, Chevy Chase, Maryland 20815
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Barrett HL, Dekker Nitert M, McIntyre HD, Callaway LK. Maternal lipids in pre-eclampsia: innocent bystander or culprit? Hypertens Pregnancy 2014; 33:508-23. [PMID: 25121342 DOI: 10.3109/10641955.2014.946614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pre-eclampsia continues to be a challenge--to understand the underlying pathogenesis and to prevent or treat in the clinical setting. One area of potential therapies opening up is treatment of maternal lipids and clinical trials are underway using statins in early pre-eclampsia. At present, most potential therapies to treat lipids cannot be recommended for general use in pregnancy and if we were to target maternal lipids to reduce rates of pre-eclampsia, very large numbers of women may need to be treated. Prior to reaching that point, we first need to understand whether maternal lipids are pathogenic in the processes underlying pre-eclampsia. The aim of this review is to examine the role of lipids in the pathogenesis and outcomes of pre-eclampsia, how abnormal lipid genes may be implicated and consider whether treatment of hyperlipidemia has a more general place in the prevention or treatment of pre-eclampsia.
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Affiliation(s)
- Helen L Barrett
- School of Medicine, The University of Queensland, St Lucia , Queensland , Australia
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10
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Lin P, Rhew E, Ness RB, Peaceman A, Dyer A, McPherson D, Kondos GT, Edmundowicz D, Sutton-Tyrrell K, Thompson T, Ramsey-Goldman R. Adverse pregnancy outcomes and subsequent risk of cardiovascular disease in women with systemic lupus erythematosus. Lupus Sci Med 2014; 1:e000024. [PMID: 25379191 PMCID: PMC4213826 DOI: 10.1136/lupus-2014-000024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/22/2014] [Accepted: 04/28/2014] [Indexed: 12/25/2022]
Abstract
Background/objective Patients with systemic lupus erythematosus (SLE) are at increased risk for adverse pregnancy outcomes and cardiovascular disease (CVD). The objective of this exploratory study was to investigate the association between a history of adverse pregnancy outcomes and subsequent risk of subclinical CVD assessed by imaging studies and verified clinical CVD events in 129 women with SLE. Methods The occurrence of adverse pregnancy outcomes, specifically pre-eclampsia, preterm birth and low birth weight was ascertained by questionnaire. Subclinical CVD was assessed by coronary artery calcium (CAC) as measured by electron beam CT and carotid plaque measured by B mode ultrasound. Clinical CVD events were verified by medical record review. Logistic regression was used to estimate the association of pregnancy complications with occurrence of subclinical CVD and clinical CVD with a priori adjustment for age, which is associated with CVD and SLE disease duration as a measure of SLE disease burden. Results Fifty-six women reported at least one pregnancy complication while 73 had none. Twenty-six women had at least one pregnancy complicated by pre-eclampsia and were more likely to have a CAC score greater than or equal to 10 (adjusted OR=3.7; 95% CI 1.2 to 11.9), but the presence of plaque was not associated with this pregnancy complication, OR=1.1, (95% CI 0.4 to 2.8). Low birth weight and preterm birth were not associated with CAC or plaque. Conclusions Patients with SLE with a history of pre-eclampsia had a higher rate of subclinical CVD as measured by CAC score. Future studies are needed to confirm the relationship between adverse pregnancy outcomes and subsequent subclinical CVD and clinical CVD events.
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Affiliation(s)
- Pin Lin
- Division of Rheumatology, Department of Medicine , Northwestern University, Feinberg School of Medicine , Chicago, Illinois , USA
| | - Elisa Rhew
- Division of Rheumatology, Department of Medicine , Northwestern University, Feinberg School of Medicine , Chicago, Illinois , USA
| | - Roberta B Ness
- Department of Epidemiology , The University of Texas, School of Public Health , Houston, Texas , USA
| | - Alan Peaceman
- Department of Obstetrics and Gynecology , Northwestern University, Feinberg School of Medicine , Chicago, Illinois , USA
| | - Alan Dyer
- Department of Preventive Medicine, Feinberg School of Medicine , Chicago, Illinois , USA
| | - David McPherson
- Division of Cardiology, Department of Medicine , University of Texas Health Science Center , Houston, Texas , USA
| | - George T Kondos
- Division of Cardiology, Department of Medicine , University of Illinois , Chicago, Illinois , USA
| | | | - Kim Sutton-Tyrrell
- Department of Epidemiology , University of Pittsburgh, Graduate School of Public Health , Pittsburgh, Pennsylvania , USA
| | - Trina Thompson
- Department of Epidemiology , University of Pittsburgh, Graduate School of Public Health , Pittsburgh, Pennsylvania , USA
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine , Northwestern University, Feinberg School of Medicine , Chicago, Illinois , USA
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11
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Kaartokallio T, Klemetti MM, Timonen A, Uotila J, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Lakkisto P, Laivuori H. Microsatellite polymorphism in the heme oxygenase-1 promoter is associated with nonsevere and late-onset preeclampsia. Hypertension 2014; 64:172-7. [PMID: 24799610 DOI: 10.1161/hypertensionaha.114.03337] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preeclampsia is a serious and phenotypically heterogeneous vascular pregnancy disorder. Heme oxygenase-1 (HO-1) is a stress response enzyme that may protect the maternal endothelium and facilitate adequate metabolic adaptation to pregnancy by its antioxidant and anti-inflammatory functions. HO-1 stress response is modulated by HO-1 gene (HMOX1) polymorphisms. Individuals with the long allele of a guanine-thymine (GTn) microsatellite repeat located in the promoter region of HMOX1 have a higher risk of cardiometabolic diseases compared with those with the short allele. We investigated whether the long GTn allele of HMOX1 is associated with subtypes of preeclampsia. The GTn repeat was genotyped in 759 patients and in 779 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort using DNA fragment analysis. In subtype analyses, the long-long (LL) genotype was associated with nonsevere (additive model: odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.31; recessive model: OR, 1.39; 95% CI, 1.02-1.89) and late-onset (additive model: OR, 1.44; 95% CI, 1.02-2.05; recessive model: OR, 1.28; 95% CI, 1.02-1.59) preeclampsia and with preeclampsia without a small-for-gestational-age infant (recessive model: OR, 1.27; 95% CI, 1.02-1.58). The long allele was associated with nonsevere (OR, 1.35; 95% CI, 1.07-1.70) and late-onset (OR, 1.21; 95% CI, 1.03-1.42) preeclampsia and with preeclampsia without a small-for-gestational-age infant (OR, 1.19; 95% CI, 1.02-1.40). Moreover, both the LL genotype and the long allele were associated with preeclampsia in women who had smoked during pregnancy. In conclusion, the GTn long allele seems to predispose to late-onset, less severe form of preeclampsia. This finding supports the role of HO-1 in the pathogenesis of preeclampsia and suggests that the HO-1 pathway may provide a potential target for the treatment of preeclampsia.
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Affiliation(s)
- Tea Kaartokallio
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.).
| | - Miira M Klemetti
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Anni Timonen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Jukka Uotila
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Seppo Heinonen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Eero Kajantie
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Juha Kere
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Katja Kivinen
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Anneli Pouta
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Päivi Lakkisto
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
| | - Hannele Laivuori
- From the Haartman Institute, Medical Genetics (T.K., M.M.K., A.T., J.K., H.L.), Research Programs Unit, Molecular Neurology (A.T.), Department of Clinical Chemistry (P.L.), and Institute for Molecular Medicine Finland (H.L.), University of Helsinki, Helsinki, Finland; Departments of Obstetrics and Gynecology (M.M.K., H.L.) and Clinical Chemistry (P.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland (M.M.K.); Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland (J.U.); Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland (S.H.); Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (E.K.); Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland (A.P.); Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland (E.K.); Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E.K., A.P.); Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden (J.K.); Folkhälsan Institute of Genetics, Helsinki, Finland (J.K.); Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (K.K.); and Minerva Institute for Medical Research, Helsinki, Finland (P.L.)
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Abstract
Heart disease is the leading cause of death in women in all countries. A history of pre-eclampsia, one of the most deadly hypertensive complications of pregnancy, increases cardiovascular risk by two to four times, which is comparable with the risk induced by smoking. Substantial epidemiological data reveal that pregnancy-related hypertensive complications are associated with a predisposition to chronic hypertension, premature heart attacks, strokes, and renal complications. In this review, we summarize clinical studies that demonstrate this relationship and also discuss the pathogenesis of these long-term complications of pre-eclampsia. Future studies should focus on strategies to prevent the progression of cardiovascular disease in women exposed to pre-eclampsia, thereby improving long-term cardiovascular health in women.
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Affiliation(s)
- Christina W Chen
- Division of Nephrology/Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN 370D, Boston, MA 02215, USA
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13
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Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Piña IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:1545-88. [PMID: 24503673 PMCID: PMC10152977 DOI: 10.1161/01.str.0000442009.06663.48] [Citation(s) in RCA: 613] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. CONCLUSIONS To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.
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Al-Jameil N, Aziz Khan F, Fareed Khan M, Tabassum H. A brief overview of preeclampsia. J Clin Med Res 2013; 6:1-7. [PMID: 24400024 PMCID: PMC3881982 DOI: 10.4021/jocmr1682w] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 01/13/2023] Open
Abstract
Preeclampsia (PE) is a leading cause of maternal mortality and morbidity worldwide. It occurs in women with first or multiple pregnancies and is characterized by new onset hypertension and proteinuria. Improper placentation is mainly responsible for the disease. If PE remains untreated, it moves towards more serious condition known as eclampsia. Hypertension, diabetes mellitus, proteinuria, obesity, family history, nulliparity, multiple pregnancies and thrombotic vascular disease contribute as the risk factors for PE. PE triggered metabolic stress causes vascular injury, thus contributing to the development of cardiovascular disease (CVD) and/or chronic kidney disease (CKD) in future. This risk appears to be increased especially in women with a history of recurrent PE and eclampsia. Clinically increased serum levels of sFlt-1 and decreased placental growth factor (PIGF) and vascular endothelial growth factor (VEGF) represent the severe condition of PE. The clinical findings of sever PE are assorted by the presence of systemic endothelial dysfunction, microangiopathy, the liver (hemolysis, elevated liver function tests and low platelet count, namely HELLP syndrome) and the kidney (proteinuria). The early detection of PE is one of the most important goals in obstetrics.
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Affiliation(s)
- Noura Al-Jameil
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Farah Aziz Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Fareed Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hajera Tabassum
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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15
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Charlton F, Tooher J, Rye KA, Hennessy A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ 2013; 23:203-12. [PMID: 24268601 DOI: 10.1016/j.hlc.2013.10.087] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/20/2013] [Indexed: 01/15/2023]
Abstract
It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated that the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease (CVD) in later life. The contributions of hypertension and dyslipidaemia before and during the pregnancy are also important and contribute to future risk. Serum lipids are complex and change dramatically in pregnancy. In general there is an increase in most plasma lipid components, notably triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular disease is influenced by preeclampsia and in part potentially by the lipid changes which escalate late in disease. Whether we can influence the risk of preeclampsia by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular disease after preeclampsia is yet to be determined. Ultimately, strategies to control lipid concentrations will only be viable when we understand the safety to the mother at the time of the pregnancy, and to the foetus both immediately and in the very long term. Strategies to control blood pressure are well established in the non-pregnant population, and previous preeclampsia and gestational hypertension should be considered in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy per se is of any longer term benefit is also yet to be determined.
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Affiliation(s)
- Francesca Charlton
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Jane Tooher
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Kerry-Anne Rye
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia
| | - Annemarie Hennessy
- Lipid Research Group and Vascular Immunology Research Group, Heart Research Institute, and the School of Medicine, University of Western Sydney, Australia.
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Abstract
Cardiovascular death rates continue to rise for women under age 55, underlying the importance of focusing on female-specific conditions that may increase cardiovascular risk, including pregnancy-related disorders. Hypertension complicates about 5-10 % of pregnancies. Preeclampsia, a pregnancy-specific condition, is characterized by hypertension and proteinuria after 20 weeks of gestation and remains one of the major causes of maternal deaths in the United States. In addition, preeclampsia may have an impact on women's health beyond their pregnancies, and has been associated with increased risks for future hypertension and cardiovascular disease, such as coronary heart disease and stroke. In this review, we discuss the evidence supporting the association between preeclampsia and future hypertension; possible mechanisms that underlie this association; current approach to women with a history of preeclampsia; and future research that is needed in this field in order to deliver optimal and timely medical care to the affected women.
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Hermes W, Franx A, van Pampus MG, Bloemenkamp KW, Bots ML, van der Post JA, Porath M, Ponjee GA, Tamsma JT, Mol BWJ, de Groot CJ. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study. Am J Obstet Gynecol 2013; 208:474.e1-8. [PMID: 23399350 DOI: 10.1016/j.ajog.2013.02.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/25/2012] [Accepted: 02/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. STUDY DESIGN In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular risk factors were compared between women with a history of HTP (HTP cohort, n = 306) and women with a history of normotensive pregnancies at term (NTP cohort, n = 99). HTP women had participated in a randomized, longitudinal trial assessing the effectiveness of induction of labor in women with hypertensive pregnancy disorders at term. All women were assessed 2.5 years after pregnancy for blood pressure, anthropometrics, glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, high-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and microalbumin and metabolic syndrome. RESULTS After a mean follow-up period of 2.5 years, hypertension (HTP, 34%; NTP, 1%; P < .001) and metabolic syndrome (HTP, 25%; NTP, 5%; P < .001) were more prevalent in HTP women compared with NTP women. HTP women had significantly higher systolic and diastolic blood pressure, higher body mass index, and higher waist circumference. Glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, triglycerides, and high-sensitivity C-reactive protein levels were significantly higher and high-density lipoprotein cholesterol was significantly lower in HTP women. CONCLUSION In women with a history of HTP, hypertension and metabolic syndrome are more common, and they have higher levels of biochemical cardiovascular risk factors 2.5 years after pregnancy.
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Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 2013; 28:1-19. [PMID: 23397514 DOI: 10.1007/s10654-013-9762-6] [Citation(s) in RCA: 468] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 01/07/2013] [Indexed: 12/11/2022]
Abstract
There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular disease (CVD), cerebrovascular events and hypertension associated with prior diagnosis of pre-eclampsia. Medline and Embase were searched with no language restrictions, as were core journals and reference lists from reviews up until January 2012. Case-control and cohort studies which reported cardiovascular and cerebrovascular diseases or hypertension diagnosed more than 6 weeks postpartum, in women who had a history of pre-eclampsia relative to women who had unaffected pregnancies, were included. Fifty articles were included in the systematic review and 43 in the meta-analysis. Women with a history of pre-eclampsia or eclampsia were at significantly increased odds of fatal or diagnosed CVD [odds ratio (OR) = 2.28, 95% confidence interval (CI): 1.87, 2.78], cerebrovascular disease (OR = 1.76, 95% CI 1.43, 2.21) and hypertension [relative risk (RR) = 3.13, 95% CI 2.51, 3.89]. Among pre-eclamptic women, pre-term delivery was not associated with an increased risk of a future cardiovascular event (RR = 1.32, 95% CI 0.79, 2.22). Women diagnosed with pre-eclampsia are at increased risk of future cardiovascular or cerebrovascular events, with an estimated doubling of odds compared to unaffected women. This has implications for the follow-up of all women who experience pre-eclampsia, not just those who deliver pre-term. This association may reflect shared common risk factors for both pre-eclampsia and cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Morven Caroline Brown
- Institute of Health & Society, Newcastle University, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, England NE1 4LP, UK
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Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders. Obstet Gynecol Surv 2012; 67:793-809. [DOI: 10.1097/ogx.0b013e31827682fc] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Pre-eclampsia is a syndrome of pregnancy, defined by the gestational-onset of hypertension and proteinuria, which resolves postpartum. This definition does not consider the variable multiorgan involvement of a syndrome that can include seizures, fulminating hepatic necrosis and a consumptive coagulopathy. These disparate clinical features are a consequence of an accelerated but transient metabolic syndrome with widespread maternal endothelial dysfunction and inflammation. A trigger to this maternal state is the relatively ischaemic placenta. As pregnancy progresses, the concentration of vaso-toxic factors released by the relatively ischaemic placenta gradually builds up in the maternal circulation. Those predisposed to endothelial dysfunction, e.g. women with risk factors for cardiovascular disease, are more sensitive to these placental derived factors and will develop pre-eclampsia before natural onset of labour. A woman's vulnerability to pre-eclampsia is therefore composed of a unique balance between her pre-existing maternal endothelial and metabolic health and the concentration of placental derived factors toxic to maternal endothelium. Delivery of the placenta remains the only cure. Years later, women who had pre-eclampsia are at increased risk of chronic hypertension, ischaemic heart disease, cerebrovascular disease, kidney disease, diabetes mellitus, thromboembolism, hypothyroidism and even impaired memory. This article describes how a brief, usually single episode of this acute pregnancy syndrome might both identify those vulnerable to chronic disease in later life and in some cases initiate chronic disease.
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Affiliation(s)
- David Williams
- Consultant Obstetric Physician, Department of Maternal Medicine, Institute for Women's Health, University College London Hospital, London, UK
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An obesity-related FTO variant and the risk of preeclampsia in a Finnish study population. J Pregnancy 2011; 2011:251470. [PMID: 22132335 PMCID: PMC3216321 DOI: 10.1155/2011/251470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 01/09/2023] Open
Abstract
Previous studies have demonstrated a common variant of the obesity and fat mass-related FTO gene, rs9939609, to be associated with obesity, type 2 diabetes, and elevated blood pressure. We investigated whether the FTO SNP rs9939609 is associated with the risk of preeclampsia (PE) in a Finnish study population. 485 women with prior PE and 449 women who had given birth after a normotensive pregnancy were genotyped (TaqMan) for the SNP rs9939609. The prevalences of genotypes AA, AT, and TT were 15%, 53%, and 32%, respectively, among the PE cases, and 16%, 47%, and 37%, respectively, among the controls (P = 0.199). We found no evidence of an association between the FTO SNP rs9939609 and PE. However, our cases were dominated by severe, early-onset PE. Thus, we are unable to exclude an association with the milder, later-onset form of the disease in which the role of maternal metabolic predisposition could be more significant.
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Kaaja R. Lipid abnormalities in pre-eclampsia: implications for vascular health. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/clp.10.82] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Levine RJ, Vatten LJ, Horowitz GL, Qian C, Romundstad PR, Yu KF, Hollenberg AN, Hellevik AI, Asvold BO, Karumanchi SA. Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-control and population based study. BMJ 2009; 339:b4336. [PMID: 19920004 PMCID: PMC2778749 DOI: 10.1136/bmj.b4336] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine if pre-eclampsia is associated with reduced thyroid function during and after pregnancy. DESIGN Nested case-control study during pregnancy and population based follow-up study after pregnancy. SETTING Calcium for Pre-eclampsia Prevention trial of healthy pregnant nulliparous women in the United States during 1992-5, and a Norwegian population based study (Nord-Trondelag Health Study or HUNT-2) during 1995-7 with linkage to the medical birth registry of Norway. PARTICIPANTS All 141 women (cases) in the Calcium for Pre-eclampsia Prevention trial with serum measurements before 21 weeks' gestation (baseline) and after onset of pre-eclampsia (before delivery), 141 normotensive controls with serum measurements at similar gestational ages, and 7121 women in the Nord-Trondelag Health Study whose first birth had occurred in 1967 or later and in whom serum levels of thyroid stimulating hormone had been subsequently measured. MAIN OUTCOME MEASURES Thyroid function tests and human chorionic gonadotrophin and soluble fms-like tyrosine kinase 1 concentrations in the Calcium for Pre-eclampsia Prevention cohort and odds ratios for levels of thyroid stimulating hormone above the reference range, according to pre-eclampsia status in singleton pregnancies before the Nord-Trondelag Health Study. RESULTS In predelivery specimens of the Calcium for Pre-eclampsia Prevention cohort after the onset of pre-eclampsia, thyroid stimulating hormone levels increased 2.42 times above baseline compared with a 1.48 times increase in controls. The ratio of the predelivery to baseline ratio of cases to that of the controls was 1.64 (95% confidence interval 1.29 to 2.08). Free triiodothyronine decreased more in the women with pre-eclampsia than in the controls (case ratio to control ratio 0.96, 95% confidence interval 0.92 to 0.99). The predelivery specimens but not baseline samples from women with pre-eclampsia were significantly more likely than those from controls to have concentrations of thyroid stimulating hormone above the reference range (adjusted odds ratio 2.2, 95% confidence interval 1.1 to 4.4). Both in women who developed pre-eclampsia and in normotensive controls the increase in thyroid stimulating hormone concentration between baseline and predelivery specimens was strongly associated with increasing quarters of predelivery soluble fms-like tyrosine kinase 1 (P for trend 0.002 and <0.001, respectively). In the Nord-Trondelag Health Study, women with a history of pre-eclampsia in their first pregnancy were more likely than other women (adjusted odds ratio 1.7, 95% confidence interval 1.1 to 2.5) to have concentrations of thyroid stimulating hormone above the reference range (>3.5 mIU/l). In particular, they were more likely to have high concentrations of thyroid stimulating hormone without thyroid peroxidase antibodies (adjusted odds ratio 2.6, 95% confidence interval 1.3 to 5.0), suggesting hypothyroid function in the absence of an autoimmune process. This association was especially strong (5.8, 1.3 to 25.5) if pre-eclampsia had occurred in both the first and the second pregnancies. CONCLUSION Increased serum concentration of soluble fms-like tyrosine kinase 1 during pre-eclampsia is associated with subclinical hypothyroidism during pregnancy. Pre-eclampsia may also predispose to reduced thyroid function in later years.
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Affiliation(s)
- Richard J Levine
- Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, Bethesda, MD 20892, USA.
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Gingery A, Bahe EL, Gilbert JS. Placental ischemia and breast cancer risk after preeclampsia: tying the knot. Expert Rev Anticancer Ther 2009; 9:671-81. [PMID: 19445583 DOI: 10.1586/era.09.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although hypertensive disorders of pregnancy, such as preeclampsia, continue to be a significant source of maternal and fetal morbidity and mortality, there is emerging evidence that effects of the preeclamptic syndrome persist into later life. In contrast to recent studies that have reported that formerly preeclamptic women are at increased risk for cardiovascular disease, it appears that preeclampsia may be associated with a decreased risk of breast cancer. Recent investigations have provided exciting new insights into potential mechanisms underlying the pathogenesis of preeclampsia and some of these findings may bear relevance to the anticancer effects reported in the epidemiological literature. Placental ischemia is regarded to be a primary factor in preeclampsia and the ischemic placenta produces a variety of factors that generate profound effects on endothelial cell function and the cardiovascular system during pregnancy. Moreover, several of these factors are reportedly elevated many years after preeclamptic pregnancies. This group of molecules includes factors such as soluble fms-like tyrosine kinase-1 (sFlt-1), soluble endoglin/CD105 (sEng) and various cytokines. Many of these factors have been strongly associated with cancer incidence and, hence, could contribute to the modification of cancer risk observed in these women. Therefore, identifying potential connections between placental dysfunction and future cancer risk is an important endeavor towards realizing novel therapeutic regimens for cancer patients.
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Affiliation(s)
- Anne Gingery
- University of Minnesota Medical School-Duluth, Department of Physiology and Pharmacology, 1035 University Drive, Duluth, MN 55812, USA.
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Fitzpatrick E, Johnson MP, Dyer TD, Forrest S, Elliott K, Blangero J, Brennecke SP, Moses EK. Genetic association of the activin A receptor gene (ACVR2A) and pre-eclampsia. Mol Hum Reprod 2009; 15:195-204. [PMID: 19126782 DOI: 10.1093/molehr/gap001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pre-eclampsia is a common serious disorder of human pregnancy, which is associated with significant maternal and perinatal morbidity and mortality. The suspected aetiology of pre-eclampsia is complex, with susceptibility being attributable to multiple environmental factors and a large genetic component. Recently, we reported significant linkage to chromosome 2q22 in 34 Australian/New Zealand (Aust/NZ) pre-eclampsia/eclampsia families, and activin A receptor type IIA (ACVR2A) was identified as a strong positional candidate gene at this locus. In an attempt to identify the putative risk variants, we have now comprehensively re-sequenced the entire coding region of the ACVR2A gene and the conserved non-coding sequences in a subset of 16 individuals from these families. We identified 45 single nucleotide polymorphisms (SNPs), with 9 being novel. These SNPs were genotyped in our total family sample of 480 individuals from 74 Aust/NZ pre-eclampsia families (including the original 34 genome-scanned families). Our best associations between ACVR2A polymorphisms and pre-eclampsia were for rs10497025 (P = 0.025), rs13430086 (P = 0.010) and three novel SNPs: LF004, LF013 and LF020 (all with P = 0.018). After correction for multiple hypothesis testing, none of these associations reached significance (P > 0.05). Based on these data, it remains unclear what role, if any, ACVR2A polymorphisms play in pre-eclampsia risk, at least in these Australian families. However, it would be premature to rule out this gene as significant associations between ACVR2A SNPs and pre-eclampsia have recently been reported in a large Norwegian (HUNT) population sample.
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Affiliation(s)
- E Fitzpatrick
- Department of Perinatal Medicine and University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Australia
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Catov JM, Newman AB, Sutton-Tyrrell K, Harris TB, Tylavsky F, Visser M, Ayonayon HN, Ness RB. Parity and cardiovascular disease risk among older women: how do pregnancy complications mediate the association? Ann Epidemiol 2008; 18:873-9. [PMID: 19041585 PMCID: PMC2614660 DOI: 10.1016/j.annepidem.2008.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/05/2008] [Accepted: 09/30/2008] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether parity is associated with increased risk of cardiovascular disease (CVD) after accounting for perinatal complications. METHODS CVD prevalence, number of births, and a history of preeclampsia, term low birth weight, preterm or stillbirth were evaluated among 540 women (mean age, 80 years; 47% black) enrolled in the Pittsburgh, PA site of the Health, Aging and Body Composition Study. Biomarkers were measured and CVD status was determined by self-report and hospital records. RESULTS Nulliparous women (n = 89) had lower CVD prevalence compared with parous women (18.0% vs. 30.2%). Parous women without perinatal complications of interest (n = 321) had higher statin use compared with nulliparas, a trend accompanied by lower high-density lipoprotein (HDL) and higher triglycerides among women with perinatal complications (n = 130). After adjustment, parous women with no complicated births had a 1.95-fold (95% confidence interval [CI], 1.03-3.7) higher CVD prevalence compared to nulliparas. Among women with one or more pregnancy complications, CVD prevalence was 2.67 times (CI, 1.34-5.33) higher. Women with five or more births had the highest CVD prevalence (odds ratio [OR], 2.60; CI, 1.17-5.76) that was attenuated to 2.27 (1.00-5.15) after adjustment for complications of interest. CONCLUSIONS History of pregnancy complications and higher statin use accounted for some but not all of the excess CVD prevalence among older parous women.
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Affiliation(s)
- Janet M Catov
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh PA 15213, USA.
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Gilbert JS, Nijland MJ, Knoblich P. Placental ischemia and cardiovascular dysfunction in preeclampsia and beyond: making the connections. Expert Rev Cardiovasc Ther 2008; 6:1367-77. [PMID: 19018690 PMCID: PMC2650232 DOI: 10.1586/14779072.6.10.1367] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypertensive disorders of pregnancy continue to be a significant source of maternal and fetal morbidity and mortality, and recent evidence suggests that the incidence of preeclampsia (PE) is increasing. Recent epidemiological studies indicate that the effects of PE may persist long after pregnancy, in both the mother and the offspring, as increased incidence of cardiovascular disease. The last decade has produced new insights into the pathogenesis of PE. The initiating event in PE appears to be impaired placental perfusion and subsequent placental ischemia, which results in the elaboration of numerous factors. Factors such as soluble fms-like tyrosine kinase-1, soluble endoglin and the angiotensin II type-1 receptor autoantibodies contribute to maternal endothelial and cardiovascular dysfunction, marked by increased reactive oxygen species and decreased bioavailable VEGF, nitric oxide and prostacyclin. However, the importance of the various endothelial and humoral factors that mediate these changes during PE remain to be elucidated.
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Affiliation(s)
- Jeffrey S Gilbert
- Department of Physiology and Pharmacology, University of Minnesota Medical School-Duluth and Duluth Medical Research Institute, Duluth, MN 55812, USA.
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Lampinen KH, Rönnback M, Groop PH, Kaaja RJ. A relationship between insulin sensitivity and vasodilation in women with a history of preeclamptic pregnancy. Hypertension 2008; 52:394-401. [PMID: 18574072 DOI: 10.1161/hypertensionaha.108.113423] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women with a history of preeclampsia are characterized by vascular dysfunction and an increased risk of cardiovascular disease. In the present study we investigated whether insulin sensitivity is decreased in women with previous preeclampsia and whether it is associated with endothelium-dependent and/or -independent vasodilation and/or features of metabolic syndrome. Twenty-eight nonobese women with previous severe preeclampsia and 20 women with a previous normotensive pregnancy were studied 5 to 6 years after the index pregnancy. Vasodilation was measured by venous occlusion plethysmography after intra-arterial infusions of sodium nitroprusside and acetylcholine and insulin sensitivity by the intravenous glucose tolerance test using the minimal model technique. The women were tested for lipid profile, inflammatory status and endothelial activation. Insulin sensitivity did not differ between the groups (P=0.24). Insulin sensitivity correlated positively to endothelium-dependent vasodilation only in the patient group in both low (beta=0.59; P=0.04) and high (beta=0.53; P=0.04) concentrations of acetylcholine and in a high concentration of sodium nitroprusside (beta=0.0007; P=0.006). In multivariate analysis, the waist/hip ratio (P=0.04) and serum triglycerides (P=0.04) had the most effect on insulin sensitivity in the patient group. Gestational weeks at the onset of preeclamptic hypertension (P=0.02) and proteinuria (P=0.02) associated positively with insulin sensitivity together with first-trimester body mass index (P=0.008) and maximum diastolic blood pressure during preeclampsia (P=0.005). The present study indicates a relation between insulin sensitivity with vascular dilatory function in women with previous preeclampsia. Furthermore, early onset preeclampsia correlates with impaired insulin sensitivity later in life.
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Affiliation(s)
- Katja H Lampinen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Department of Obstetrics and Gynecology, Haartmaninkatu 2, 00290 Helsinki, Finland
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Hubel CA, Powers RW, Snaedal S, Gammill HS, Ness RB, Roberts JM, Arngrímsson R. C-reactive protein is elevated 30 years after eclamptic pregnancy. Hypertension 2008; 51:1499-505. [PMID: 18413489 DOI: 10.1161/hypertensionaha.108.109934] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Women with a history of preeclampsia or eclampsia (seizure during preeclamptic pregnancy) are at increased risk for cardiovascular disease after pregnancy for reasons that remain unclear. Prospective studies during pregnancy suggest that inflammation, dyslipidemia, and insulin resistance are associated with increased risk of preeclampsia. Elevated serum C-reactive protein (CRP >3 mg/L) is an indicator of inflammation and cardiovascular risk. We hypothesized that Icelandic postmenopausal women with a history of eclampsia would manifest higher concentrations of serum CRP than Icelandic postmenopausal controls with a history of uncomplicated pregnancies. We also asked whether elevated CRP is associated with the dyslipidemia and insulin resistance previously identified in this cohort. CRP, measured by high-sensitivity enzyme-linked immunoassay, was higher in women with prior eclampsia (n=25) than controls (n=28) (median mg/L [interquartile range]: 9.0 [0.9 to 13.2] versus 2.0 [0.3 to 5.1]; P<0.03). This difference remained significant after adjustment for body mass index, smoking, hormone replacement, and current age. Women with prior eclampsia clustered into either high CRP (range 8.97 to 40.6 mg/L, n=13) or lower CRP (median 1.0, range 0.05 to 3.77, n=12) subsets. The prior eclampsia/high CRP subset displayed significantly elevated systolic blood pressures, lower high-density lipoprotein (HDL) cholesterol, higher apolipoprotein B, and higher fasting insulin and homeostasis model of insulin resistance (HOMA) values compared to controls, whereas the prior eclampsia/low CRP subset differed from controls only by marginally increased apolipoprotein B. The triad of inflammation, low HDL, and insulin resistance may elevate risk for both preeclampsia/eclampsia and cardiovascular disease in later life.
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Affiliation(s)
- Carl A Hubel
- Magee-Womens Research Institute and Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pa., USA
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Short- and long-term prognosis of blood pressure and kidney disease in women with a past history of preeclampsia. Clin Exp Nephrol 2008; 12:102-109. [DOI: 10.1007/s10157-007-0018-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
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Ilekis JV, Reddy UM, Roberts JM. Preeclampsia--a pressing problem: an executive summary of a National Institute of Child Health and Human Development workshop. Reprod Sci 2007; 14:508-23. [PMID: 17959880 DOI: 10.1177/1933719107306232] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On September 21 and 22, 2006, the National Institute of Child Health and Human Development of the National Institutes of Health sponsored a 2-day workshop titled "Preeclampsia--A Pressing Problem." The purpose of the workshop was to bring together leaders in the field to present and discuss their diverse research areas, which ranged from basic science to clinical trials and management, and to identify scientific gaps. This article is a summary of the proceedings of that workshop. Although much progress is being made in understanding the underpinnings of preeclampsia, a number of research gaps are identified that, if filled, would hasten progress in the field. It is the overall consensus that preeclampsia is a multifactorial disease whose pathogenesis is not solely vascular, genetic, immunologic, or environmental but a complex combination of factors. In addition, a number of specific scientific gaps are identified including insufficient multidisciplinary and collaborative research, clinical trials and studies of patient management, and a lack of in-depth mechanistic research. The research community needs to focus on these gaps to better understand the disease, with the ultimate goal of preventing the disorder.
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Affiliation(s)
- John V Ilekis
- Pregnancy and Perinatology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-7510, USA.
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Hypertension in pregnancy: an emerging risk factor for cardiovascular disease. ACTA ACUST UNITED AC 2007; 3:613-22. [DOI: 10.1038/ncpneph0623] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 06/29/2007] [Indexed: 11/08/2022]
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Manten GTR, Sikkema MJ, Voorbij HAM, Visser GHA, Bruinse HW, Franx A. Risk factors for cardiovascular disease in women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction. Hypertens Pregnancy 2007; 26:39-50. [PMID: 17454217 DOI: 10.1080/10641950601146574] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Women with a history of preeclampsia or intrauterine growth restriction (IUGR) have an increased risk for cardiovascular disease in later life. We determined the presence of traditional and novel risk factors for cardiovascular disease in these women. METHODS We studied 256 women with a history of preeclampsia and 59 women with a history of intrauterine growth restriction. Fifty-three women with a history of uncomplicated pregnancy served as controls. We determined values for blood pressure, body mass index, concentrations of cholesterol, high-density lipoprotein cholesterol, triglycerides and lipoprotein (a), and insulin resistance. RESULTS Women with a history of preeclampsia exhibited more risk factors for future cardiovascular disease such as dyslipidemia, hypertension, obesity, and increased insulin resistance compared with women with a history of uncomplicated pregnancy. Women with a history of IUGR have higher concentrations of cholesterol and show a tendency to higher BMI, higher triglyceride concentrations, and increased insulin resistance as compared with women with a history of normal pregnancy. CONCLUSIONS Preeclampsia or IUGR may represent an early marker for increased risk for early cardiovascular disease.
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Affiliation(s)
- Gwendolyn T R Manten
- Department of Perinatology and Gynecology, University Medical Center, Utrecht, The Netherlands.
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Ness RB, Sibai BM. Shared and disparate components of the pathophysiologies of fetal growth restriction and preeclampsia. Am J Obstet Gynecol 2006; 195:40-9. [PMID: 16813742 DOI: 10.1016/j.ajog.2005.07.049] [Citation(s) in RCA: 310] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 05/25/2005] [Accepted: 07/13/2005] [Indexed: 12/22/2022]
Abstract
Intrauterine growth restriction (IUGR) and preeclampsia differ in their association with maternal disease but share a similar placental pathology. Moreover, mothers who have had pregnancies complicated by preeclampsia or IUGR are at elevated later-life cardiovascular risk. Why, then, do some women develop IUGR and others develop preeclampsia? In this clinical opinion, based on a review of the literature, we hypothesize that both women experiencing preeclampsia and IUGR enter pregnancy with some degree of endothelial dysfunction, a lesion that predisposes to shallow placentation. In our opinion, preeclampsia develops when abnormal placentation, through the mediator of elevated circulating cytokines, interacts with maternal metabolic syndrome, comprised of adiposity, insulin resistance/hyperglycemia, hyperlipidemia, and coagulopathy. IUGR develops in the absence of antenatal metabolic syndrome. Among these women, the baby is affected by shallow placentation but the mother does not develop clinically apparent disease. This conceptualization provides a testable framework for future etiologic studies of preeclampsia and IUGR.
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Affiliation(s)
- Roberta B Ness
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15261, USA.
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Lampinen KH, Rönnback M, Kaaja RJ, Groop PH. Impaired vascular dilatation in women with a history of pre-eclampsia. J Hypertens 2006; 24:751-6. [PMID: 16531805 DOI: 10.1097/01.hjh.0000217859.27864.19] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The mechanisms underlying increased cardiovascular risk among women with a history of pre-eclampsia remain unclear. Impaired endothelial function has been observed in both pre-eclampsia and atherosclerosis, and provides a plausible link between the two conditions. We studied endothelial function and arterial compliance in non-pregnant, previously pre-eclamptic women. DESIGN A study of 30 women with a history of pre-eclampsia and 21 women with a previous normotensive, uncomplicated pregnancy was carried out. METHODS Changes in brachial artery blood flow, induced by intra-arterial infusions of an endothelium-independent (sodium nitroprusside) and an endothelium-dependent (acetylcholine) vasodilator, were measured by venous occlusion plethysmography. Arterial stiffness was assessed by pulse-wave analysis. RESULTS Vasodilatation was impaired in women with previous pre-eclampsia; at low and high concentrations of endothelium-independent (P = 0.004 and P = 0.057, respectively) and endothelium-dependent (P = 0.045 and P = 0.02) vasodilators, respectively. There was no difference in arterial stiffness between the groups (P = 0.45). In multiple regression analyses both endothelium-independent and endothelium-dependent vasodilatations were independently associated with a history of pre-eclampsia and parity. There was no correlation with blood pressure, body mass index (BMI), smoking or age. CONCLUSIONS The finding of impaired vascular dilatation several years after a pre-eclamptic pregnancy could contribute to the higher risk of cardiovascular disease in these women.
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Affiliation(s)
- Katja H Lampinen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
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39
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Llurba E, Casals E, Domínguez C, Delgado J, Mercadé I, Crispi F, Martín-Gallán P, Cabero L, Gratacós E. Atherogenic lipoprotein subfraction profile in preeclamptic women with and without high triglycerides: different pathophysiologic subsets in preeclampsia. Metabolism 2005; 54:1504-9. [PMID: 16253640 DOI: 10.1016/j.metabol.2005.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 05/15/2005] [Indexed: 11/22/2022]
Abstract
Abnormal lipid metabolism has been proposed as a pathogenic factor of preeclampsia, although whether it is a constant feature in all preeclamptic patients is unclear. We assessed whether plasma triglyceride (TG) levels can distinguish a subgroup of preeclamptic women with alterations in lipoprotein profile from those with normal lipid metabolism and can be used to identify 2 distinct pathogenic groups in preeclampsia. This prospective study included 34 women with preeclampsia and 23 healthy pregnant women. Preeclamptic women were further subclassified into normal-TG (<250 mg/dL) and high-TG (>or=250 mg/dL) groups on the basis of the 90th percentile in our population. Low-density lipoproteins (LDLs) were ultracentrifuged and were separated into 4 subfractions, and lipid distribution in the subfractions was analyzed in all study groups. Vascular cell adhesion molecule-1 was also measured as a marker of endothelial dysfunction. Sixteen women with preeclampsia had high TGs (47% vs 13% in control subjects, P<.001). This subgroup showed a significant shift in lipid distribution, mainly, TGs, toward the small, dense LDL subfractions. However, preeclamptic patients in the normal-TG subgroup showed LDL subfraction lipid distribution similar to that of healthy pregnancies. Vascular cell adhesion molecule-1 levels were significantly elevated in preeclamptic patients in comparison with those in control subjects regardless of TG levels. The presence of a proatherogenic lipoprotein profile, previously described in preeclampsia, is characterized by increased small dense LDL and is exclusive to a subset of preeclamptic patients with high TG levels. These findings support the concept of heterogeneous pathogenic lines in preeclampsia and the use of subclassifications in pathophysiologic research on this condition.
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Affiliation(s)
- Elisa Llurba
- Fetal Medicine Unit, Department of Obstetrics, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
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40
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Ness RB, Hubel CA. Risk for Coronary Artery Disease and Morbid Preeclampsia: A Commentary. Ann Epidemiol 2005; 15:726-33. [PMID: 15990335 DOI: 10.1016/j.annepidem.2005.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 02/02/2005] [Indexed: 12/01/2022]
Abstract
PURPOSE A predisposition to coronary artery disease (CAD) may put women at risk for preeclampsia. Morbid preeclampsia (early, severe, recurrent, and with neonatal morbidity) represents the subset of preeclampsia of greatest public health concern. METHODS We review here the published links between preeclampsia and CAD. RESULTS Many risk factors are common to both CAD and preeclampsia. These include obesity; elevated blood pressure; dyslipidemia; insulin resistance; and hyperglycemia, together termed "Syndrome X"; as well as endothelial dysfunction; hyperuricemia; hyperhomocysteinemia; and abnormalities of inflammation, thrombosis, and angiogenesis. After pregnancy, women with preeclampsia are more likely to experience later life CAD. CONCLUSIONS Both the association between CAD risk factors and preeclampsia and the association between preeclampsia and later CAD appears to be more pronounced among the subset of women with morbid preeclampsia. Thus, women at elevated risk for CAD may be at particularly high risk for morbid preeclampsia and women with morbid preeclampsia may be those at highest risk for later life CAD.
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Affiliation(s)
- Roberta B Ness
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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41
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Carr DB, Epplein M, Johnson CO, Easterling TR, Critchlow CW. A sister's risk: family history as a predictor of preeclampsia. Am J Obstet Gynecol 2005; 193:965-72. [PMID: 16157095 DOI: 10.1016/j.ajog.2005.06.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 06/03/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if women with preeclampsia are more likely to have a sister who also had preeclampsia. STUDY DESIGN This was a population-based case-control study using data from Washington (WA) state birth certificates linked to hospital discharge records. Cases were women with gestational hypertension (n = 1611) or preeclampsia (n = 1071); controls (n = 8041) had normotensive pregnancies. All women delivered their first child between 1987 to 2002 and had a sister with a previous delivery in WA. RESULTS Women with preeclampsia were 2.3 times (95%CI 1.8-2.9) more likely to have a sister who had preeclampsia; those with gestational hypertension were 1.6 times (95%CI 1.3-2.0) more likely to have a sister with gestational hypertension. Similar results were obtained following stratification by age, race, smoking status, or body mass index. CONCLUSION The greater likelihood of preeclampsia among sisters of women with a previous preeclamptic pregnancy is consistent with a pathophysiologic role for genetic and/or behavioral factors that cluster in families.
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Affiliation(s)
- Darcy B Carr
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, Seattle, USA
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42
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Abstract
Preeclampsia is a syndrome that affects 5% of all pregnancies, producing substantial maternal and perinatal morbidity and mortality. The aim of this review is to summarize our current understanding of the pathogenesis of preeclampsia with special emphasis on the recent discovery that circulating anti-angiogenic proteins of placental origin may play an important role in the pathogenesis of proteinuria and hypertension of preeclampsia.
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Affiliation(s)
- S Ananth Karumanchi
- Renal Division and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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43
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Forest JC, Girouard J, Massé J, Moutquin JM, Kharfi A, Ness RB, Roberts JM, Giguère Y. Early Occurrence of Metabolic Syndrome After Hypertension in Pregnancy. Obstet Gynecol 2005; 105:1373-80. [PMID: 15932832 DOI: 10.1097/01.aog.0000163252.02227.f8] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the present study was to evaluate the cardiovascular risk profile and the prevalence of metabolic syndrome among women with a history of pregnancy-induced hypertension (PIH). METHODS From a cohort of 3,799 nulliparous women prospectively recruited between 1989 and 1997, we performed an observational study on 168 case-control pairs 7.8 years after delivery. Participants were scheduled for a visit with a research nurse to evaluate their cardiovascular risk profile using a questionnaire, anthropometric measurements and blood specimen analysis. RESULTS One hundred sixty-eight women with prior PIH (105 with gestational hypertension and 63 with preeclampsia) and 168 controls matched for age and year of index delivery were evaluated. The women with PIH (34.6 +/- 4.4 years) were more obese and had higher systolic (115 mm Hg versus 108 mm Hg) and diastolic (75 mm Hg versus 70 mm Hg) blood pressures (P < .001) than the 168 controls (35.1 +/- 4.5 years). They had lower high-density lipoprotein cholesterol level (1.30 mmol/L versus 1.42 mmol/L; P < .001), increased fasting blood glucose concentration (5.2 mmol/L versus 5.0 mmol/L; P = .002), and higher insulin levels (119 versus 91 pmol/L; P < .001). The prevalence of the metabolic syndrome was higher in the PIH group (unadjusted odds ratio = 4.9; 95% confidence interval 2.1-10.9) compared with controls, even after adjustment for confounders (adjusted odds ratio = 3.6; 95% confidence interval 1.4 -9.0). CONCLUSION In white women in their mid-30s, the prevalence of the metabolic syndrome is 3- to 5-fold increased in those with a history of PIH in their first pregnancy. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors in these women.
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Affiliation(s)
- Jean-Claude Forest
- Center for the Development, Evaluation and Rational Implementation of New Medical Diagnostic, Hôpital St-François d'Assise du Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada
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44
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Arnadottir GA, Geirsson RT, Arngrimsson R, Jonsdottir LS, Olafsson O. Cardiovascular death in women who had hypertension in pregnancy: a case-control study. BJOG 2005; 112:286-92. [PMID: 15713141 DOI: 10.1111/j.1471-0528.2004.00396.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether an association exists between hypertension in pregnancy and later development of cardiovascular disease. DESIGN Case-control study of women who delivered with and without hypertensive complications during the same period. SETTING University Hospital in Reykjavik, Iceland. POPULATION Three hundred and twenty-five women with hypertension in pregnancy (blood pressure > or =140/90 mmHg after 20 weeks of gestation) in the years 1931-1947, graded by severity. For each case, two normotensive control women, delivering before or after the case and matched for parity and age were selected, giving a total of 629 women. METHODS Causes of death were evaluated for the presence of ischaemic heart disease, cerebrovascular events and cancer, up until the end of 1996. MAIN OUTCOME MEASURES Survival curves, median survival times, risk of death by age group and severity of disease. RESULTS Death with evidence of ischaemic heart disease was more common in cases (24.3%) than in control women (14.6%) (RR 1.66; 95% CI 1.27-2.17). Cerebrovascular event deaths occurred in 9.5% of cases and in 6.5% of controls (RR 1.46; 95% CI 0.94-2.28). Cancer death rates were not different (RR 1.22; 95% CI 0.91-1.63). Survival times were shorter on average by three to nine years as a consequence of cardiovascular disease. This varied by age group in the index pregnancy for women with a history of hypertension in pregnancy. The effect was smaller if the case pregnancy occurred at a young age. There was a linear trend with increasing severity of hypertensive disease in pregnancy in death rates from ischaemic heart disease (chi(2) (1)= 5.8, P= 0.02). CONCLUSIONS Long term follow up suggests an increased risk of death from ischaemic heart disease and cerebrovascular events among women who suffered hypertension in pregnancy.
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Affiliation(s)
- Gerdur A Arnadottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, 101 Reykjavik, Iceland
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45
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Pouta A, Hartikainen AL, Sovio U, Gissler M, Laitinen J, McCarthy MI, Ruokonen A, Elliott P, Järvelin MR. Manifestations of Metabolic Syndrome After Hypertensive Pregnancy. Hypertension 2004; 43:825-31. [PMID: 14981067 DOI: 10.1161/01.hyp.0000120122.39231.88] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Small follow-up studies of hospital-based series indicate women with preeclampsia have an increased risk of insulin resistance postpartum. However, long-term data are lacking among women with gestational hypertension without proteinuria. Using a general population-based sample of 5889 women from Northern Finland followed longitudinally since birth in 1966, we examined these associations and the influence of the subject’s own birth weight and gestational age on this relationship. At age 31, blood pressure was measured and blood samples collected from 2678 women, of which 1463 women had had at least 1 singleton pregnancy. Of these, 45 had been hospitalized because of gestational hypertension and 49 because of preeclampsia. Women who had had either gestational hypertension or preeclampsia during their first pregnancy (average age 25 years) had increased blood pressure at 31 years compared with women with previous normotensive pregnancy, even after adjustment for body mass index (
P
<0.001 in gestational hypertension,
P
=0.023 in preeclampsia group). When compared with the whole female population, women with previous gestational hypertension at same age still had higher blood pressure, while this difference was weaker for women with previous preeclampsia. Women with gestational hypertension and preeclampsia also had higher waist circumference, waist/hip ratio, and body mass index, as well as increased serum insulin levels and lower glucose/insulin ratio than women with previous normotensive pregnancy. The associations remained after adjustment for participant’s own birth weight or gestational age. Women born before gestational week 37 had a 2-fold risk for gestational hypertension in their first pregnancy (RR: 2.53; 95% CI: 1.0, 6.2).
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Affiliation(s)
- Anneli Pouta
- Academy of Finland, Department of Public Health Science and General Practice, University of Oulu, Aapistie 1, PO Box 5000, FIN-90014 University of Oulu, Finland.
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46
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Roberts JM, Pearson GD, Cutler JA, Lindheimer MD. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertens Pregnancy 2003; 22:109-27. [PMID: 12908996 DOI: 10.1081/prg-120016792] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A Working Group on Research in Hypertension in Pregnancy was recently convened by the National Heart Lung and Blood Institute to determine the state of knowledge in this area and suggest appropriate directions for research. Hypertensive disorders in pregnancy, especially preeclampsia, are a leading cause of maternal mortality worldwide and even in developed countries increase perinatal mortality five-fold. Much has been learned about preeclampsia but gaps in the knowledge necessary to direct therapeutic strategies remain. Oxidative stress is a biologically plausible contributor to the disorder that may be amenable to intervention. Hypertension that antedates pregnancy (chronic hypertension) bears many similarities to hypertension in nonpregnant women but the special setting of pregnancy demands information to guide evidence based therapy. The recommendations of the Working Group are to attempt a clinical trial of antioxidant therapy to prevent preeclampsia that is be complemented by mechanistic research to increase understanding of the genetics and pathogenesis of the disorder. For chronic hypertension clinical trials are recommended to direct choice of drugs, evaluate degree of control and assess implications to the mother and fetus. Recommendations to increase participation in this research are also presented.
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Affiliation(s)
- James M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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47
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Dechend R, Viedt C, Müller DN, Ugele B, Brandes RP, Wallukat G, Park JK, Janke J, Barta P, Theuer J, Fiebeler A, Homuth V, Dietz R, Haller H, Kreuzer J, Luft FC. AT1 receptor agonistic antibodies from preeclamptic patients stimulate NADPH oxidase. Circulation 2003; 107:1632-9. [PMID: 12668498 DOI: 10.1161/01.cir.0000058200.90059.b1] [Citation(s) in RCA: 230] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We recently identified agonistic autoantibodies directed against the angiotensin AT1 receptor (AT1-AA) in the plasma of preeclamptic women. To elucidate their role further, we studied the effects of AT1-AA on reactive oxygen species (ROS), NADPH oxidase expression, and nuclear factor-kappaB (NF-kappaB) activation. METHODS AND RESULTS We investigated human vascular smooth muscle cells (VSMC) and trophoblasts, as well as placentas. AT1-AA were isolated from sera of preeclamptic women. Angiotensin II (Ang II) and AT1-AA increased ROS production and the NADPH oxidase components, p22, p47, and p67 phox in Western blotting. We next tested if AT1-AA lead to NF-kappaB activation in VSMC and trophoblasts. AT1-AA activated NF-kappaB. Inhibitor-kappaBalpha (I-kappaBalpha) expression was reduced in response to AT1-AA. AT1 receptor blockade with losartan, diphenylene iodonium, tiron, and antisense against p22 phox all reduced ROS production and NF-kappaB activation. VSMC from p47phox-/- mice showed markedly reduced ROS generation and NF-kappaB activation in response to Ang II and AT1-AA. The p22, p47, and p67 phox expression in placentas from preeclamptic patients was increased, compared with normal placentas. Furthermore, NF-kappaB was activated and I-kappaBalpha reduced in placentas from preeclamptic women. CONCLUSIONS NADPH oxidase is potentially an important source of ROS that may upregulate NF-kappaB in preeclampsia. We suggest that AT1-AA through activation of NADPH oxidase could contribute to ROS production and inflammatory responses in preeclampsia.
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MESH Headings
- Adult
- Angiotensin II/pharmacology
- Animals
- Autoantibodies/pharmacology
- Cells, Cultured
- Enzyme Activation
- Female
- Humans
- Mice
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/metabolism
- NADPH Oxidases/metabolism
- NF-kappa B/metabolism
- Placenta/drug effects
- Placenta/enzymology
- Placenta/metabolism
- Pre-Eclampsia/enzymology
- Pre-Eclampsia/immunology
- Pre-Eclampsia/metabolism
- Pregnancy
- Reactive Oxygen Species/metabolism
- Receptor, Angiotensin, Type 1
- Receptors, Angiotensin/agonists
- Receptors, Angiotensin/immunology
- Trophoblasts/drug effects
- Trophoblasts/enzymology
- Trophoblasts/metabolism
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Affiliation(s)
- Ralf Dechend
- HELIOS Klinikum-Berlin, Franz Volhard Clinic and the Max Delbrück Center for Molecular Medicine, Humboldt University of Berlin, Germany
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48
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Gratacos E, Casals E, Gomez O, Llurba E, Mercader I, Cararach V, Cabero L. Increased susceptibility to low density lipoprotein oxidation in women with a history of pre-eclampsia. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.02349.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Roberts JM, Pearson G, Cutler J, Lindheimer M. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 2003; 41:437-45. [PMID: 12623940 DOI: 10.1161/01.hyp.0000054981.03589.e9] [Citation(s) in RCA: 490] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A Working Group on Research in Hypertension in Pregnancy was recently convened by the National Heart, Lung, and Blood Institute to determine the state of knowledge in this area and suggest appropriate directions for research. Hypertensive disorders in pregnancy, especially preeclampsia, are a leading cause of maternal death worldwide and even in developed countries increase perinatal mortality rates 5-fold. Much has been learned about preeclampsia, but gaps in the knowledge necessary to direct therapeutic strategies remain. Oxidative stress is a biologically plausible contributor to the disorder that may be amenable to intervention. Hypertension that antedates pregnancy (chronic hypertension) bears many similarities to hypertension in nonpregnant women, but the special setting of pregnancy demands information to guide evidence-based therapy. The recommendations of the Working Group are to attempt a clinical trial of antioxidant therapy to prevent preeclampsia that is be complemented by mechanistic research to increase understanding of the genetics and pathogenesis of the disorder. For chronic hypertension, clinical trials are recommended to direct choice of drugs, evaluate degree of control, and assess implications to the mother and fetus. Recommendations to increase participation in this research are also presented.
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Affiliation(s)
- James M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Graduate School of Public Health, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, Pa, USA.
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50
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Lachmeijer AMA, Dekker GA, Pals G, Aarnoudse JG, ten Kate LP, Arngrímsson R. Searching for preeclampsia genes: the current position. Eur J Obstet Gynecol Reprod Biol 2002; 105:94-113. [PMID: 12381470 DOI: 10.1016/s0301-2115(02)00208-7] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although there is substantial evidence that preeclampsia has a genetic background, the complexity of the processes involved and the fact that preeclampsia is a maternal-fetal phenomenon does not make the search for the molecular basis of preeclampsia genes easy. It is possible that the single phenotype 'preeclampsia' in fact should be divided into different sub-groups on genetic or biochemical level. In the present review, the preeclampsia phenotype and its pathophysiologic features are discussed. Family studies and postulated inheritance models are summarized. A systematic overview is given on the numerous candidate gene studies and gene-expression studies performed so far and on the currently available genome-wide scan data. Despite extensive research the molecular genetic basis of preeclampsia remains unclear. Future studies will hopefully enhance our insights in the molecular pathogenesis of preeclampsia.
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Affiliation(s)
- Augusta M A Lachmeijer
- Department of Clinical Genetics and Human Genetics, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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