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Abstract
There is widespread acceptance of the increased prevalence of cardiovascular diseases occurring within 1 to 2 decades in women following a preeclamptic pregnancy. More recent evidence suggests that the deranged biochemical and echocardiographic findings in women do not resolve in the majority of preeclamptic women following giving birth. Many women continue to be hypertensive in the immediate postnatal period with some exhibiting occult signs of cardiac dysfunction. There is now promising evidence that with close monitoring and effective control of blood pressure control in the immediate postnatal period, women may have persistently lower blood pressures many years after stopping their medication. This review highlights the evidence that delivering effective medical care in the fourth trimester of pregnancy can improve the long-term cardiovascular health after a preeclamptic birth.
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Affiliation(s)
- Veronica Giorgione
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
| | - Gwyneth Jansen
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands (G.J.)
| | - Jamie Kitt
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Chahinda Ghossein-Doha
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (G.J., C.G.-D.)
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht' the Netherlands (C.G.-D.)
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford' United Kingdom (J.K., P.L.)
| | - Basky Thilaganathan
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, United Kingdom (V.G., B.T.)
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (V.G., B.T.)
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Pustjens TFS, Vranken NPA, Jansen G, Winkler PJC, Stein M, Hoebers L, Kietselaer B, Spaanderman MEA, Rasoul S, Ghossein-Doha C, van 't Hof AWJ. Prevalence of a History of Metabolic or Hypertensive Pregnancy Disorder in Patients With Myocardial Infarction and Non-obstructive Coronary Arteries: An Observational Cohort Study. Front Cardiovasc Med 2022; 9:932799. [PMID: 35911523 PMCID: PMC9334660 DOI: 10.3389/fcvm.2022.932799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Myocardial infarction with non-obstructive coronary arteries (MINOCA) predominantly affects younger females. Women with a history of gestational hypertension (GH), preeclampsia (PE), and gestational diabetes mellitus (GDM) are subjected to an elevated lifetime risk of cardiovascular disease. However, data on the potential association between these obstetric complications and MINOCA is lacking. Therefore, the current study aimed to provide insight in the prevalence of metabolic and hypertensive pregnancy disorders (MHPD) in MINOCA patients and their clinical characteristics. Methods In this observational cohort study conducted at the Zuyderland Medical Center and Maastricht University Medical Center in the Netherlands, patients were enrolled if they were identified as having MINOCA. Data on individual patient characteristics, laboratory results, electrocardiography as well as (non-)invasive imaging procedures were derived from the electronic health record system. Patients were asked to complete a questionnaire about prior MHPD including GDM, GH, and PE. Patients were grouped into those with MHPD and those with prior uncomplicated normotensive pregnancy (or pregnancies; NP). Results After excluding patients without 1-year follow-up (n = 53), 86 female MINOCA patients remained eligible for analysis. Of the total female population, 25 (29.1%) patients had MHPD, including GH (n = 19; 22.1%), PE (n = 4; 4.7%), and GDM (n = 7; 8.1%). The MHPD patients showed higher rates of chronic hypertension (84.0 vs. 55.7%; p = 0.013), hypercholesterolemia (64.0 vs. 34.4%; p = 0.012), a family history of CVD (84.0 vs. 45.9%; p = 0.001), gout or rheumatic arthritis (16.0 vs. 1.6%; p = 0.024), and were more often non-smokers (45.8 vs. 78.3%; p = 0.004), compared to the NP patients. Moreover, MHPD patients were more likely to use cardiovascular medications at baseline. A trend toward no specific cause found for the MINOCA event was observed in MHPD patients compared to the NP group (64.0 vs. 42.6%, p = 0.072). Conclusion A history of metabolic and hypertensive pregnancy disorders occurred in one-third of female MINOCA patients. In these patients, conventional cardiovascular risk factors were more prevalent compared to NP patients. In most MHPD patients, the specific cause for MINOCA remained unclear.
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Affiliation(s)
- Tobias F. S. Pustjens
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- *Correspondence: Tobias F. S. Pustjens
| | | | - Gwyneth Jansen
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | | | - Mera Stein
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Loes Hoebers
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Marc E. A. Spaanderman
- GROW School for Oncology and Reproduction, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Saman Rasoul
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Chahinda Ghossein-Doha
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arnoud W. J. van 't Hof
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
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de Haas S, Mulder E, Schartmann N, Mohseni Z, Abo Hasson F, Alsadah F, van Kuijk S, van Drongelen J, Ghossein-Doha C, Spaanderman M. Blood pressure adjustments throughout healthy and hypertensive pregnancy: A systematic review and meta-analysis. Pregnancy Hypertens 2021; 27:51-58. [PMID: 34929556 DOI: 10.1016/j.preghy.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/03/2021] [Indexed: 01/20/2023]
Abstract
Gestational hypertensive complications are preceded by deviant hemodynamic adjustments affecting blood pressure. Our objective was to determine the timing and magnitude of changes in blood pressure during singleton normotensive and hypertensive pregnancies. PubMed (NCBI) and Embase (Ovid) databases were searched for relevant studies up to November 2019. Studies reporting original blood pressure measurements during pregnancy together with a non-pregnant reference measurement were included. Studies including women with a history of cardiovascular or metabolic disease, or women using antihypertensive drugs were excluded. Pooled mean differences between pregnant and non-pregnant women, and absolute blood pressure values were calculated for predefined gestational intervals in normotensive and hypertensive pregnancy, using a random-effects model. Meta-regression analysis was used to analyze group differences in adjustments. In early normotensive pregnancy, both systolic and diastolic blood pressure decreased, reaching their maximum reduction of -4 mmHg (95%CI -6 to -1 mmHg) and -4 mmHg (95%CI, -5 to -3 mmHg), respectively in the second trimester. Thereafter, blood pressure gradually increased towards non-pregnant values. All absolute blood pressure measurements throughout normotensive pregnancy were below 130/80 mmHg. In hypertensive pregnancies, only diastolic blood pressure decreased early in pregnancy. In conclusion, this meta-analysis showed a clinically moderate, but significant mid-pregnancy drop in blood pressure during normotensive pregnancy. Reference curves with absolute values underscore the current liberal cut-off limit for gestational hypertension. A lack of a mid-pregnancy systolic blood pressure drop might reflect increased vascular resistance in women destined to develop hypertensive pregnancy complications.
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Affiliation(s)
- Sander de Haas
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Eva Mulder
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Niklas Schartmann
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Zenab Mohseni
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Fatimah Abo Hasson
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Fatimah Alsadah
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, PO box 5800, 6202 AZ Maastricht, Maastricht University Medical Center, The Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marc Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Affiliation(s)
| | - Faustino R Pérez-López
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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Liu J, Tao L, Cao Y, Teng H, Wang J, Wang M, Li F, Wang Y, Yang L, Zhao X, Qin L, Yin J, Zhang Y. Stage 1 hypertension defined by the 2017 American College of Cardiology/American Heart Association guideline and risk of adverse birth outcomes in Eastern China. J Hypertens 2020; 38:1090-102. [PMID: 32371799 DOI: 10.1097/HJH.0000000000002380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline recommended a lower threshold (130/80 mmHg) for hypertension in nonpregnant adults. However, the influence of this guideline in Chinese pregnant women is not well characterized. METHODS Data of 32 742 and 14 479 mothers who had blood pressure (BP) less than 130/80 mmHg and no proteinuria before 20 gestational weeks and delivered live singletons between 1 January 2014 and 30 November 2019 were extracted from Taizhou and Taicang register-based cohorts, respectively. The average measured BP in the third trimester was obtained and categorized according to the 2017 ACC/AHA guideline. The association between BP and risk of adverse birth outcomes was assessed by multivariate logistic regression analysis. RESULTS In the third trimester, 331 (1.01%) and 378 (2.61%) women had mean BP at least 140/90 mmHg, but 2435 (7.44%) and 1054 (7.28%) had stage 1 hypertension (130-139/80-89 mmHg) in Taizhou and Taicang, respectively. Significant associations between stage 1 hypertension and small for gestational age [odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.14-1.52] and low birth weight (OR = 1.81, 95% CI = 1.46-2.25) were observed in the Taizhou population. Consistent results were also shown in the Taicang population [OR (95% CI), of 1.46 (1.18-1.79) and 1.50 (1.07-2.11), respectively]. CONCLUSION Stage 1 hypertension in the third trimester defined by the 2017 ACC/AHA guideline was associated with an increased risk for adverse birth outcomes in Eastern Chinese pregnant women, suggesting that this guideline may improve the detection of high BP and surveillance of adverse neonatal outcomes in China.
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Meyer R, Schwartz A, Horesh N, Alcalay M, Ram E, Levin G. A dynamic prediction score for obstetric anal sphincter injury among nulliparous women delivering vaginally. Int J Gynaecol Obstet 2021; 157:271-276. [PMID: 33930180 DOI: 10.1002/ijgo.13730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop a risk score for obstetric anal sphincter injury (OASI) occurrence among nulliparous women delivering vaginally, based on data available at admission for delivery and as labor progresses. METHODS A retrospective study of all nulliparous women who delivered vaginally between March 2011 and January 2021. Characteristics were compared between OASI and no-OASI groups. Multivariable analyses were performed to identify independent risk factors for OASI occurrence. RESULTS OASI occurred in 453 (1.7%) of 26 081 women who met the inclusion criteria. The following variables were independently associated with OASI: maternal height (adjusted odds ratio [aOR] 0.97, 95% confidence interval (CI) 0.95-0.99), hypertensive disorders (aOR 1.74, 95% CI 1.03-2.95), sonographic fetal weight estimation (aOR 1.00, 95% CI 1.00-1.00), second-stage duration (aOR 1.00, 95% CI 1.00-1.00), occiput posterior position (aOR 2.87, 95% CI 1.79-4.62), and episiotomy performance (aOR 0.63, 95% CI 0.47-0.84). In a risk score based on variables available at admission for delivery, the presence of two factors was associated with 4.3% OASI risk. Upon incorporating intrapartum variables, the presence of two risk factors was associated with 2.9% OASI rate. CONCLUSION A dynamic risk score for OASI occurrence based on data available at admission for delivery and as delivery progresses can assist in counseling regarding OASI risk. A dynamic risk score for obstetric anal sphincter injury occurrence based on data available at admission for delivery and intrapartum was developed.
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Affiliation(s)
- Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Schwartz
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Department of Surgery and Transplantation, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Menachem Alcalay
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Urogynecology Unit, The Department of Obstetrics and Gynecology, Baruch Padeh-Poria Medical Center, Tiberias, Israel.,The Faculty of Medicine at Galille, Bar-Ilan University, Ramat Gan, Israel
| | - Edward Ram
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Department of Surgery and Transplantation, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Lappen JR, Pettker CM, Louis JM, Louis JM. Society for Maternal-Fetal Medicine Consult Series #54: Assessing the risk of maternal morbidity and mortality. Am J Obstet Gynecol 2021; 224:B2-B15. [PMID: 33309560 DOI: 10.1016/j.ajog.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The rates of maternal morbidity and mortality in the United States demand a comprehensive approach to assessing pregnancy-related risks. Numerous medical and nonmedical factors contribute to maternal morbidity and mortality. Reducing the number of women who experience pregnancy morbidity requires identifying which women are at greatest risk and initiating appropriate interventions early in the reproductive life course. The purpose of this Consult is to educate all healthcare practitioners about factors contributing to a high-risk pregnancy, strategies to assess maternal health risks due to pregnancy, and the importance of risk assessment across the reproductive spectrum in reducing maternal morbidity and mortality.
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Affiliation(s)
| | | | | | - Judette M Louis
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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Abstract
Pregnancy identifies women who may be at a greater risk of cardiovascular disease (CVD), based on the development of adverse pregnancy outcomes (APOs), and may identify women who may benefit from atherosclerotic CVD (ASCVD) risk reduction efforts. APOs are common and although they are separate diagnoses, all these disorders seem to share an underlying pathogenesis. What is not clear is whether the APO itself initiates a pathway that results in CVD or whether the APO uncovers a woman's predisposition to CVD. Regardless, APOs have immediate risks to maternal and foetal health, in addition to longer-term CVD consequences. CVD risk assessment and stratification in women remains complex and, historically, has underestimated risk, especially in young women. Further research is needed into the role of ASCVD risk assessment and the effect of aggressive ASCVD risk modification on CVD outcomes in women with a history of APOs.
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Affiliation(s)
- Pensée Wu
- School of Medicine, Keele UniversityStaffordshire, UK
| | - Ki Park
- University of FloridaGainesville, FL, US
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Mulder EG, Ghossein-Doha C, Crutsen J, Van Kuijk S, Thilaganathan B, Spaanderman M. Effect of pregnancy prolongation in early-onset pre-eclampsia on postpartum maternal cardiovascular, renal and metabolic function in primiparous women: an observational study. BJOG 2020; 128:121-129. [PMID: 32725713 PMCID: PMC7754285 DOI: 10.1111/1471-0528.16435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate the association between deferred delivery in early‐onset pre‐eclampsia and offspring outcome and maternal cardiovascular, renal and metabolic function in the postpartum period. Design Observational study. Setting Tertiary referral hospital. Population Nulliparous women diagnosed with pre‐eclampsia before 34 weeks’ gestation who participated in a routine postpartum cardiovascular risk assessment programme. Women with hypertension, diabetes mellitus or renal disease prior to pregnancy were excluded. Methods Regression analyses were performed to assess the association between pregnancy prolongation and outcome measures. Main outcome measures Offspring outcome and prevalence of deviant maternal cardiovascular, renal and metabolic function. Results The study population included 564 women with a median pregnancy prolongation of 10 days (interquartile range [IQR] 4–18) who were assessed at on average 8 months (IQR 6–12) postpartum. Pregnancy prolongation after diagnosis resulted in a decrease in infant mortality (adjusted odd ratio [aOR] 0.907, 95% CI 0.852–0.965 per day prolongation). This improvement in offspring outcome was associated with an elevated risk of moderately increased albuminuria (aOR 1.025, 95% CI 1.006–1.045 per day prolongation), but not with aberrant cardiac geometry, cardiac systolic or diastolic dysfunction, persistent hypertension or metabolic syndrome. Conclusion Pregnancy prolongation in early‐onset pre‐eclampsia is associated with improved offspring outcome and survival. These effects do not appear to be deleterious to short‐term maternal cardiovascular and metabolic function but are associated with a modest increase in risk of residual albuminuria. Tweetable abstract Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function. Pregnancy prolongation in pre‐eclampsia has only a limited effect on postpartum maternal cardiovascular function.
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Affiliation(s)
- E G Mulder
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jrw Crutsen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Smj Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B Thilaganathan
- St George's University of London, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mea Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Rotem R, Rottenstreich M, Prado E, Baumfeld Y, Yohay D, Pariente G, Weintraub AY. Trends of change in the individual contribution of risk factors for small for gestational age over more than 2 decades. Arch Gynecol Obstet 2020; 302:1159-1166. [PMID: 32748052 DOI: 10.1007/s00404-020-05725-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Over the past years, the prevalence of various risk factors for small for gestational age (SGA) neonates has changed. Little is known if there was also a change in the specific contribution of these risk factors to the prevalence of SGA. We aim to identify trends in the specific contribution of various risk factors for SGA by observing their odds ratios (ORs) throughout different time periods. METHODS A nested case-control study was conducted. The ORs for selected known risk factors for SGA occurring in three consecutive 8-year intervals between 1988 and 2014 (T1 - 1988-1996; T2 - 1997-2005; T3 - 2006-2014) were compared. Data were retrieved from the medical centre's computerized perinatal database. Multivariable logistic regression models were constructed and ORs were compared to identify the specific contribution of independent risk factors for SGA along the study period. RESULTS During the study period, 285,992 pregnancies met the study's inclusion criteria, of which 15,013 (5.25%) were SGA. Between 1988 and 2014, the incidence of SGA increased from 2.6% in 1988 to 2.9% in 2014. Using logistic regression models, nulliparity, maternal age, gestational age, hypertensive disorders of pregnancy, oligohydramnios and pre-gestational diabetes mellitus were found to be independently associated with SGA. While the adjusted ORs (aOR) of hypertensive disorders of pregnancy and pre-gestational diabetes mellitus had increased, aORs for nulliparity, maternal age and gestational age had remained stable over time. Oligohydramnios had demonstrated a mixed trend of change over the time. CONCLUSION In our study, the specific contribution of factors associated with SGA had changed over time. Having a better understating of the changes in the specific contribution of different risk factors for SGA may enable obstetricians to provide consultations.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Jerusalem, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Jerusalem, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.
| | - Ella Prado
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Horn J, Haug EB, Markovitz AR, Fraser A, Vatten LJ, Romundstad PR, Rich-Edwards JW, Åsvold BO. Life Course Trajectories of Maternal Cardiovascular Risk Factors according to Offspring Birthweight: The HUNT Study. Sci Rep 2020; 10:10436. [PMID: 32591565 DOI: 10.1038/s41598-020-66365-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022] Open
Abstract
Women with small or large for gestational age offspring are at increased risk of cardiovascular disease later in life. How their cardiovascular risk factors develop across the life course is incompletely known. We linked data from the population-based HUNT Study (1984–2008) and the Medical Birth Registry of Norway (1967–2012) for 22,487 women. Mixed effect models were used to compare cardiovascular risk factor trajectories for women according to first offspring birthweight for gestational age. Women with small for gestational age (SGA) offspring had 1–2 mmHg higher systolic and diastolic blood pressure across the life course, but lower measures of adiposity, compared to women with offspring who were appropriate for gestational age (AGA). In contrast, women with large for gestational age (LGA) offspring had higher measures of adiposity, ~0.1 mmol/l higher non-HDL cholesterol and triglycerides and 0.2 mmol/l higher non-fasting glucose, compared with mothers of AGA offspring. These differences were broadly stable from prior to first pregnancy until 60 years of age. Our findings point to different cardiovascular risk profiles in mothers of SGA versus LGA offspring, where giving birth to SGA offspring might primarily reflect adverse maternal vascular health whereas LGA offspring might reflect the mother’s metabolic health.
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Abstract
Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.
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Affiliation(s)
- Anandita Agarwala
- Division of Cardiology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8086, St. Louis, MO
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christie M. Ballantyne
- Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston TX
| | - Salim S. Virani
- The Aga Khan University, Karachi, Pakistan
- Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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Parikh NI, Laria B, Nah G, Singhal M, Vittinghoff E, Vieten C, Stotland N, Coleman-Phox K, Adler N, Albert MA, Epel E. Cardiovascular Disease-Related Pregnancy Complications Are Associated with Increased Maternal Levels and Trajectories of Cardiovascular Disease Biomarkers During and After Pregnancy. J Womens Health (Larchmt) 2020; 29:1283-1291. [PMID: 31934809 DOI: 10.1089/jwh.2018.7560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Having a pregnancy complicated by hypertensive disorders of pregnancy (HDP) and/or having a small or preterm baby put a woman at risk for later cardiovascular disease (CVD). It is uncertain if higher maternal CVD risk factors (reflected by increased peripartum CVD biomarker levels) account for this risk, or if experiencing a complicated pregnancy itself increases a woman's CVD risk (reflected by an increase in biomarker trajectories from early pregnancy to postpartum). Methods: We conducted a secondary analysis of an 8-week mindful eating and stress reduction intervention in 110 pregnant women. We used mixed linear regression analysis to compare CVD biomarker levels and trajectories, between women with and without a CVD-related pregnancy complication (including HDP [gestational hypertension or preeclampsia] or having a small for gestational age [<10th percentile] or preterm [<37 weeks] baby), at three times: (1) 12-20 weeks of gestation, (2) 3 months postpartum, and (3) 9 months postpartum. CVD biomarkers studied included serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI), blood pressure (BP), interleukin-6 (IL-6), tumor necrosis factor, and lipids. We adjusted for age, maternal smoking, prepregnancy BMI, BP, age × time, and BMI × time. Results: Women had a mean age of 28 years (standard deviation [SD] 6), mean prior pregnancies of 0.8 (SD 1.0), and 22 women had one or more CVD-related pregnancy complications. HOMA-IR, diastolic BP, triglyceride, high-density lipoprotein cholesterol, and IL-6 average levels, but not trajectories, differed among women with complicated versus normal pregnancy (all p values were ≤0.04). Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values were 0.008 and 0.01, respectively). Conclusion: We conclude that the experience of a complicated pregnancy in addition to elevated CVD risk factor levels may both increase a woman's risk of future CVD. ClinicalTrials.gov Identifier: NCT01307683.
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Affiliation(s)
- Nisha I Parikh
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbara Laria
- School of Public Health, University of California at Berkeley, Berkeley, California, USA
| | - Gregory Nah
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Meghali Singhal
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Integrative Biology, University of California at Berkeley, Berkeley, California, USA
| | - Eric Vittinghoff
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Cassandra Vieten
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Naomi Stotland
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Kimberly Coleman-Phox
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Nancy Adler
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Michelle A Albert
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Nurture Center, University of California San Francisco, San Francisco, California, USA
| | - Elissa Epel
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
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Osoti AO, Page ST, Richardson BA, Guthrie BL, Kinuthia J, Polyak SJ, Farquhar C. Postpartum metabolic syndrome after gestational hypertension and preeclampsia, a prospective cohort study. Pregnancy Hypertens 2019; 18:35-41. [PMID: 31493627 PMCID: PMC6884686 DOI: 10.1016/j.preghy.2019.08.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/29/2019] [Accepted: 08/17/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We evaluated the 6-month postpartum risk of metabolic syndrome (MetS), a marker of future cardiovascular disease (CVD) risk, comparing women whose most recent pregnancies were complicated with gestational hypertension (GH) or preeclampsia (PE) versus those who had normotensive pregnancies. STUDY DESIGN This was a prospective cohort study in which women with GH or PE and normotensive women were actively enrolled during the first 12 weeks after delivery in Nairobi, Kenya. Participants were interviewed, blood pressures and anthropometric measurements including waist circumference obtained at enrollment and 6 months postpartum. Fasting lipid profile and plasma glucose were measured at 6 months postpartum. A generalized linear regression model with Poisson distribution was used to estimate crude relative risk (RR) of 6-month postpartum MetS and adjusted RR (ARR) after adjusting for apriori potential confounders. RESULTS Among 194 postpartum women, 63 (32%) had experienced GH or PE. Prevalence of MetS at 6 months postpartum was higher among women whose pregnancies were complicated with GH or PE (34.9%) compared to those who were normotensive (11.5%). GH and PE were associated with a 3-fold or greater risk of MetS (ARR) 3.01; 95% Confidence interval [CI] 1.58, 5.71; p < 0.001) overall and three of the five components, namely hypertension (ARR 3.35 [2.04, 5.51], p < 0.001), hypertriglyceridemia (ARR 3.25 [1.16-9.10], p = 0.01), and fasting hyperglycemia (ARR 6.20 [1.07-35.76], p = 0.03), compared to having normal blood pressures during pregnancy. CONCLUSION At 6 months postpartum, GH and PE were associated with three-fold or higher risk of MetS and especially hypertension, fasting hypertriglyceridemia, and fasting hyperglycemia.
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Affiliation(s)
- Alfred O Osoti
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
| | - Stephanie T Page
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, Diabetes Institute, University of Washington, Seattle, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Vaccine and Infectious Disease Division, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, USA; Department of Research and Programs and Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, USA
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Medicine (Allergy and Infectious Diseases), University of Washington, Seattle, USA
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15
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Yang W, Wang L, Tian T, Liu L, Jin L, Liu J, Ren A. Maternal hypertensive disorders in pregnancy and risk of hypoxic-ischemia encephalopathy. J Matern Fetal Neonatal Med 2019; 34:1754-1762. [PMID: 31331218 DOI: 10.1080/14767058.2019.1647529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is one of the most serious birth complications for neonates. Few studies reported the relationship between maternal blood pressure disorders and risk of neonatal HIE. OBJECTIVE This study was conducted to examine whether maternal hypertensive disorders in pregnancy increase the risk of HIE. METHODS The analyses were performed using data from a large population-based cohort study aiming to prevent neural tube defects by supplementation with folic acid. The subjects comprised 183,981 women with singleton live births delivered at gestational ages of 32-42 weeks, who registered in two southern provinces in China. Blood pressure was measured by trained health care workers at each prenatal visit. Diagnosis information on HIE was recorded at the time of delivery. RESULTS Totally 19,298 women (10.49%) were diagnosed with maternal hypertensive disorders in pregnancy and 255 infants (1.4 per 1000) with HIE, respectively. Compared with the normotensive group, a great increment in the risk of HIE was observed in women with hypertensive disorders (adjusted RR = 2.40, 95% confidence interval [CI]: 1.79-3.22) after adjusting for maternal confounding factors. A greater association was presented among preterm (32-36 weeks) infants with an adjusted RR of 5.45 (95% CI: 2.79, 10.65) compared to a RR of 2.09 (95% CI: 1.49, 2.92) among full-term (37-42 weeks) infants (p for heterogeneity < .05). Further stratification analyses showed that no matter with or without small for gestational age (SGA), maternal hypertensive disorders were associated with the increased risk for HIE. Sensitivity analyses excluding infants with low or high birth weight did not appreciably change the findings. CONCLUSIONS Our present study demonstrated a positive association of maternal hypertensive disorders in pregnancy with the risk of neonatal HIE.
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Affiliation(s)
- Wenlei Yang
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Linlin Wang
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Tian Tian
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lijun Liu
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lei Jin
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jianmeng Liu
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health, NHC Key Laboratory of Reproductive Health, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
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16
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Abstract
Background Assessing and optimizing cardiovascular health (CVH) early in life, such as in pregnancy, could lead to a longer lifetime spent in better CVH and reduce the risk of cardiovascular disease. This might especially benefit women with a hypertensive disorder of pregnancy (HDP) who are more likely to develop atherosclerosis and cardiovascular disease. We hypothesized that CVH in pregnancy is related to later life CVH and carotid intima-media thickness (CIMT), and that these associations differ between women with a normotensive pregnancy and women with an HDP. Methods and Results This study was conducted within the prospective population-based Generation R Study. CVH in pregnancy was based on 5 metrics (blood pressure, total-cholesterol, glucose, smoking, and body mass index). Postpartum CVH additionally included physical activity and diet scores, according to the American Heart Association classification. Postpartum CVH and CIMT were measured 10 years after pregnancy. Results were analyzed for women with a normotensive pregnancy and those with an HDP. Women with a normotensive pregnancy (n=1786) and women with an HDP (n=138) were evaluated from early pregnancy until 10 years postpartum. Better CVH in early pregnancy was associated with a smaller CIMT and better postpartum CVH in all women, especially in those with an HDP (CIMT: -9.82 μm [95% CI: -17.98, -1.67]). Conclusions Already in pregnancy, better CVH is associated with a smaller CIMT and better CVH 10 years postpartum, especially in women with an HDP. As pregnancy is an incentive for women to improve lifestyle, assessing CVH in pregnancy might help improve postpartum CVH and reduce cardiovascular disease risk.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands.,Department of Epidemiology Erasmus Medical Center Rotterdam the Netherlands
| | | | - Sara J C Schelling
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam the Netherlands
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17
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Hooijschuur MCE, Ghossein-Doha C, Kroon AA, De Leeuw PW, Zandbergen AAM, Van Kuijk SMJ, Spaanderman MEA. Metabolic syndrome and pre-eclampsia. Ultrasound Obstet Gynecol 2019; 54:64-71. [PMID: 30246464 DOI: 10.1002/uog.20126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/25/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the association between different pre-eclampsia (PE) phenotypes and the development of metabolic syndrome postpartum, in order to identify the subgroup of formerly pre-eclamptic women with a worse cardiovascular risk profile requiring tailored postpartum follow-up. METHODS This was a cohort study of 1102 formerly pre-eclamptic women in whom cardiovascular and cardiometabolic evaluation was performed at least 3 months postpartum. Women were divided into four subgroups based on PE resulting in delivery before 34 weeks (early-onset (EO)) or at or after 34 weeks (late onset (LO)) of gestation and whether they delivered a small-for-gestational-age (SGA) neonate. Metabolic syndrome was diagnosed as the presence of hyperinsulinemia along with two or more of: body mass index ≥ 30 kg/m2 ; dyslipidemia; hypertension; and microalbuminuria or proteinuria. Data were compared between groups using ANOVA after Bonferroni correction. Odds ratios (OR) were calculated using logistic regression to determine the association between metabolic syndrome and the four subgroups. We constructed receiver-operating characteristics curves and computed the area under the curve (AUC) to quantify the ability of different obstetric variables to distinguish between women who developed metabolic syndrome and those who did not. RESULTS The prevalence of metabolic syndrome was higher in women with EO-PE and SGA (25.8%) than in those with EO-PE without SGA (14.7%) (OR 2.01 (95% CI, 1.34-3.03)) and approximately five-fold higher than in women with LO-PE with SGA (5.6%) (OR 5.85 (95% CI, 2.60-13.10)). In women with LO-PE, the prevalence of metabolic syndrome did not differ significantly between women with and those without SGA. Multivariate analysis revealed that a history of SGA, a history of EO-PE and systolic blood pressure at the time of screening are the best predictors of developing metabolic syndrome postpartum. The AUC of the model combining these three variables was 74.6% (95% CI, 70.7-78.5%). The probability of the presence of metabolic syndrome was calculated as: P = 1/(1 + e-LP ), where LP is linear predictor = -8.693 + (0.312 × SGA (yes = 1)) + (0.507 × EO-PE (yes = 1)) + (0.053 × systolic blood pressure). CONCLUSIONS The incidence of metabolic syndrome postpartum was associated more strongly with EO-PE in combination with SGA as compared with LO-PE or EO-PE without SGA. Both time of onset of PE and fetal growth affect the risk of metabolic syndrome after a pre-eclamptic pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M C E Hooijschuur
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
| | - C Ghossein-Doha
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
| | - A A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - P W De Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A A M Zandbergen
- Department of Internal Medicine, Erasmus Medical Centre (EMC), Rotterdam, The Netherlands
| | - S M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC) and GROW, Maastricht, The Netherlands
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18
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Jabalie G, Ahmadi M, Koushaeian L, Eghbal‐Fard S, Mehdizadeh A, Kamrani A, Abdollahi‐Fard S, Farzadi L, Hojjat‐ Farsangi M, Nouri M, Yousefi M. Metabolic syndrome mediates proinflammatory responses of inflammatory cells in preeclampsia. Am J Reprod Immunol 2019; 81:e13086. [DOI: 10.1111/aji.13086] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Gisoo Jabalie
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Majid Ahmadi
- Student’s Research CommitteeTabriz University of Medical Sciences Tabriz Iran
- Reproductive Biology Department Tabriz University of Medical Sciences Tabriz Iran
| | - Ladan Koushaeian
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Shadi Eghbal‐Fard
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Amir Mehdizadeh
- Endocrine Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Amin Kamrani
- Stem Cell Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Sedigheh Abdollahi‐Fard
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences Tabriz Iran
| | - Laya Farzadi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences Tabriz Iran
| | - Mohammad Hojjat‐ Farsangi
- Department of Oncology‐Pathology, Immune and Gene Therapy Lab, Cancer Center Karolinska (CCK)Karolinska University Hospital Solna and Karolinska Institute Stockholm Sweden
| | - Mohammad Nouri
- Reproductive Biology Department Tabriz University of Medical Sciences Tabriz Iran
| | - Mehdi Yousefi
- Drug Applied Research CenterTabriz University of Medical Sciences Tabriz Iran
- Aging Research Institute Tabriz University of Medical Sciences Tabriz Iran
- Department of Immunology Tabriz University of Medical Sciences Tabriz Iran
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19
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Mohsenzadeh-Ledari F, Taghizadeh Z, Motaghi Z, Keramat A, Moosazadeh M, Najafi A. Appropriate Interventions for Pregnant Women with Indicators of Metabolic Syndrome on Pregnancy Outcomes: A Systematic Review. Int J Prev Med 2019; 10:2. [PMID: 30774836 PMCID: PMC6360852 DOI: 10.4103/ijpvm.ijpvm_46_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 10/07/2018] [Indexed: 11/04/2022] Open
Abstract
Metabolic syndrome (MetS), a series of symptoms, including abdominal obesity, impaired glucose tolerance and insulin metabolism, hypertension, and dyslipidemia, is considered as the risk of developing cardiovascular disease and diabetes that can predispose a pregnant women to serious health problem, women in the developed as well as the developing countries. This study was aimed to investigate the effects of appropriate interventions on pregnant women with indicators of MetS to further improve the outcome of pregnancy. This systematic review was performed to extract articles of randomized controlled trials (RCT) on pregnant women with indicators of (MetS) and focusing on physical activity, dietary or lifestyle interventions on maternal health or perinatal outcomes, with searching in the Web of Science, PubMed, CDSR, Scopus, and Google Scholar were investigated. Two researchers independently evaluated the quality of the studies, being presented in all the articles and ranked the studies as high/low quality; the level of evidence was based on the number of high-quality studies and the coordination of the obtained results. Then, 17 articles, which met the inclusion criteria, were selected; among these, 7 articles studied the physical activity, 3 articles reviewed diets, 6 probed the lifestyle interventions, and 1 article was on counseling. In general, evidence suggested how the physical activity and proper diet impacts on proper weight gain during pregnancy, prevents maternal complications, and improves the outcome of pregnancy. According to the results of this systematic review, proper interventions during pregnancy can have a positive effect on maternal weight gain and the general health condition of pregnant women with indicators of MetS.
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Affiliation(s)
- Farideh Mohsenzadeh-Ledari
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Motaghi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Reproductive Studies and Women's Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Najafi
- Shahroud University of Medical Sciences, Shahroud, Iran
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20
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Abstract
Comorbidities are a hallmark of stroke that both increase the incidence of stroke and worsen outcome. Hypertension is prevalent in the stroke population and the most important modifiable risk factor for stroke. Hypertensive disorders promote stroke through increased shear stress, endothelial dysfunction, and large artery stiffness that transmits pulsatile flow to the cerebral microcirculation. Hypertension also promotes cerebral small vessel disease through several mechanisms, including hypoperfusion, diminished autoregulatory capacity and localized increase in blood-brain barrier permeability. Preeclampsia, a hypertensive disorder of pregnancy, also increases the risk of stroke 4-5-fold compared to normal pregnancy that predisposes women to early-onset cognitive impairment. In this review, we highlight how comorbidities and concomitant disorders are not only risk factors for ischemic stroke, but alter the response to acute ischemia. We focus on hypertension as a comorbidity and its effects on the cerebral circulation that alters the pathophysiology of ischemic stroke and should be considered in guiding future therapeutic strategies.
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Affiliation(s)
- Marilyn J Cipolla
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - David S Liebeskind
- 2 Neurovascular Imaging Research Core and Stroke Center, Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Siu-Lung Chan
- 1 Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
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21
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Köninger A, Enekwe A, Mach P, Andrikos D, Schmidt B, Frank M, Birdir C, Kimmig R, Gellhaus A, Dieplinger H. Afamin: an early predictor of preeclampsia. Arch Gynecol Obstet 2018; 298:1009-16. [PMID: 30220025 DOI: 10.1007/s00404-018-4897-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/06/2018] [Indexed: 12/23/2022]
Abstract
Purpose Oxidative stress is involved in the pathogenesis of hypertensive disorders such as preeclampsia (PE) and associated with the human vitamin E-binding protein afamin. The aim of this study was, therefore, to analyse afamin in the first trimester of patients developing PE later in pregnancy and in control subjects without pregnancy complications. Methods In this retrospective study, 137 serum samples from the first trimester of pregnancy were analysed in a case–control study design. 39 patients developed PE (10 patients with early-onset and 29 patients with late onset disease) and 98 women had an uncomplicated pregnancy. Mann–Whitney U test, t test, logistic regression and ROC analyses were performed for statistical evaluation. Results Pregnant women developing PE presented with higher afamin concentrations in the first trimester [median 101.81 mg/L; interquartile range (IQR) 88.94–113.26] compared to subjects with uncomplicated pregnancy (median 86.40; IQR 75.26–96.92; p < 0.001). After adjusting for confounders, the odds ratio per afamin standard deviation was 1.60 (95% CI: 1.04–2.58; p = 0.04). An afamin threshold concentration of 87.8 mg/L exhibited the best sensitivity (79.5%) and specificity (57.1%) in predicting PE. Subgroup analysis of early- and late-onset disease resulted in substantially higher afamin concentrations in women with developing late-onset PE compared to controls (p < 0.001) with an odds ratio per afamin standard deviation of 1.62 (95% CI: 0.98–2.70; p = 0.06). Conclusions Serum afamin concentrations are elevated in the first trimester among patients developing PE compared to controls. Substantial differences were observed mainly among patients with late-onset PE.
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22
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Zhu B, Huang K, Bao W, Yan S, Hao J, Zhu P, Gao H, Niu Y, Tong S, Tao F. Dose-response relationship between maternal blood pressure in pregnancy and risk of adverse birth outcomes: Ma'anshan birth cohort study. Pregnancy Hypertens 2018; 15:16-22. [PMID: 30825914 DOI: 10.1016/j.preghy.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/20/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study depicts the dose-response relationship between blood pressure (BP) during pregnancy and adverse birth outcomes in different trimesters. STUDY DESIGN We used restricted cubic spline to quantify the dose-response relationship between maternal BP in different trimesters and risk of adverse birth outcomes (small for gestational age, SGA; and pre-term birth, PTB). The data were from the Ma'anshan birth cohort study in China (N = 3273). MAIN OUTCOME MEASURES Risk of SGA and PTB. RESULTS There were dose-response associations of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with risk of SGA in the third trimester and with PTB in both second and third trimesters. In the third trimester, compared with SBP of 120 mmHg, the odds ratios (ORs) and 95% confidence intervals (CI) of SGA were 1.12 (1.01-1.19), 1.32 (1.10-1.60), 1.65 (1.20-2.27) and 2.05 (1.30-3.24) for SBP of 125, 130, 135 and 140 mmHg, respectively. The corresponding ORs and 95% CIs of PTB were 1.15 (1.00-1.32), 1.59 (1.28-1.98), 2.35 (1.66-3.33) and 3.47 (2.10-5.73), respectively. Compared with DBP of 70 mmHg, the ORs and 95% CIs of SGA were 1.44 (1.16-1.78) and 3.04 (2.06-4.50) for DBP of 80 and 90 mmHg, respectively. The corresponding ORs and 95% CIs of PTB were 1.32 (0.93-1.90) and 3.58 (2.21-5.78), respectively. CONCLUSIONS A consistent set of dose-response relationships between maternal BP and adverse birth outcomes were observed. Most importantly, we found that moderately elevated maternal BP, even within a normal range, increased the risk of adverse birth outcomes.
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Affiliation(s)
- Beibei Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Care Center, Ma'anshan, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Peng Zhu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Hui Gao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
| | - Ying Niu
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China
| | - Shilu Tong
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China; Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China; School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, Anhui Medical University, Hefei, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China.
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23
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Foo FL, Mahendru AA, Masini G, Fraser A, Cacciatore S, MacIntyre DA, McEniery CM, Wilkinson IB, Bennett PR, Lees CC. Association Between Prepregnancy Cardiovascular Function and Subsequent Preeclampsia or Fetal Growth Restriction. Hypertension 2018; 72:442-450. [PMID: 29967040 DOI: 10.1161/hypertensionaha.118.11092] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022]
Abstract
Preeclampsia and fetal growth restriction during pregnancy are associated with increased risk of maternal cardiovascular disease later in life. It is unclear whether this association is causal or driven by similar antecedent risk factors. Clarification requires recruitment before conception which is methodologically difficult with high attrition rates and loss of outcome numbers to nonconception/miscarriage. Few prospective studies have, therefore, been adequately powered to address these questions. We recruited 530 healthy women (mean age: 35.0 years) intending to conceive and assessed cardiac output, cardiac index, stroke volume, total peripheral resistance, mean arterial pressure, and heart rate before pregnancy. Participants were followed to completion of subsequent pregnancy with repeat longitudinal assessments. Of 356 spontaneously conceived pregnancies, 15 (4.2%) were affected by preeclampsia and fetal growth restriction. Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mm Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm-5; P<0.001) were higher. Longitudinal trajectories for cardiac output and total peripheral resistance were similar between affected and healthy pregnancies, but the former group showed a more exaggerated fall in mean arterial pressure in the first trimester, followed by a steeper rise and a steeper fall to postpartum values. Significant relationships were observed between cardiac output, total peripheral resistance, and mean arterial pressure and gestational epoch. We conclude that in healthy women, an altered prepregnancy hemodynamic phenotype is associated with the subsequent development of preeclampsia/fetal growth restriction.
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Affiliation(s)
- Fung L Foo
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Amita A Mahendru
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Giulia Masini
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School (A.F.).,MRC Integrative Epidemiology Unit (A.F.)
| | - Stefano Cacciatore
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.).,University of Bristol, United Kingdom; and International Centre for Genetic Engineering and Biotechnology, Cancer Genomics Group, Cape Town, South Africa (S.C.)
| | - David A MacIntyre
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Carmel M McEniery
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Ian B Wilkinson
- Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (A.M.M., C.M.M., I.B.W.)
| | - Phillip R Bennett
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
| | - Christoph C Lees
- From the Institute for Reproductive and Developmental Biology, Imperial College, London, United Kingdom (F.L.F., G.M., S.C., D.A.M., P.R.B., C.C.L.)
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24
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Harville EW, Juonala M, Viikari JSA, Kähönen M, Raitakari OT. Pregnancy complications and later vascular ultrasound measures: A cohort study. Pregnancy Hypertens 2017; 10:171-176. [PMID: 29153673 DOI: 10.1016/j.preghy.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Pregnancy complications predict or even predispose to later cardiovascular disease in the mother. We examined whether pregnancy complications are associated with post-pregnancy measures of endothelial dysfunction and arterial stiffness. STUDY DESIGN Prospective cohort; Data for 847 women female participants in the Cardiovascular Risk in Young Finns study were linked with the national birth registry. Preterm birth (<37weeks), low birthweight (<2500g), small-for-gestational-age (weight <10th percentile for gestational age), and hypertensive disorders of pregnancy were examined as predictors of later vascular measures. MAIN OUTCOME MEASURES Flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), Young's elastic modulus (YEM), and carotid artery distensibility. RESULTS In some analyses, gestational hypertension and pre-eclampsia were associated with increased YEM. Low birthweight was also associated with an increase in IMT, and this increased risk was present prior to the pregnancy. CONCLUSIONS The increased cardiovascular risk in the mother observed after low birthweight and hypertensive disorders may be due to vascular changes, and some of this increased risk may be present before pregnancy.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health, USA.
| | - Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland; Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Psychology, Tampere University Hospital and University of Tampere, Finland
| | - Olli T Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical Physiology, Turku University Hospital, Finland
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25
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Stampalija T, Monasta L, Di Martino DD, Quadrifoglio M, Lo Bello L, D’Ottavio G, Zullino S, Mastroianni C, Casati D, Signorelli V, Rosti E, Cecotti V, Ceccarello M, Ferrazzi E. The association of first trimester uterine arteries Doppler velocimetry with different clinical phenotypes of hypertensive disorders of pregnancy: a longitudinal study. J Matern Fetal Neonatal Med 2017; 32:1191-1199. [DOI: 10.1080/14767058.2017.1402878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tamara Stampalija
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Daniela D. Di Martino
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Mariachiara Quadrifoglio
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Leila Lo Bello
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Giuseppina D’Ottavio
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Sara Zullino
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Cristina Mastroianni
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Daniela Casati
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Valentina Signorelli
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Eleonora Rosti
- Department of Women, Mother and Neonate, Buzzi Children’s Hospital University of Milan, Milan, Italy
| | - Vera Cecotti
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Matteo Ceccarello
- Unit of Ultrasound and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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26
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Lin X, Yang P, Reece EA, Yang P. Pregestational type 2 diabetes mellitus induces cardiac hypertrophy in the murine embryo through cardiac remodeling and fibrosis. Am J Obstet Gynecol 2017; 217:216.e1-216.e13. [PMID: 28412087 PMCID: PMC5787338 DOI: 10.1016/j.ajog.2017.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/27/2017] [Accepted: 04/04/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiac hypertrophy is highly prevalent in patients with type 2 diabetes mellitus. Experimental evidence has implied that pregnant women with type 2 diabetes mellitus and their children are at an increased risk of cardiovascular diseases. Our previous mouse model study revealed that maternal type 2 diabetes mellitus induces structural heart defects in their offspring. OBJECTIVE This study aims to determine whether maternal type 2 diabetes mellitus induces embryonic heart hypertrophy in a murine model of diabetic embryopathy. STUDY DESIGN The type 2 diabetes mellitus embryopathy model was established by feeding 4-week-old female C57BL/6J mice with a high-fat diet for 15 weeks. Cardiac hypertrophy in embryos at embryonic day 17.5 was characterized by measuring heart size and thickness of the right and left ventricle walls and the interventricular septum, as well as the expression of β-myosin heavy chain, atrial natriuretic peptide, insulin-like growth factor-1, desmin, and adrenomedullin. Cardiac remodeling was determined by collagen synthesis and fibronectin synthesis. Fibrosis was evaluated by Masson staining and determining the expression of connective tissue growth factor, osteopontin, and galectin-3 genes. Cell apoptosis also was measured in the developing heart. RESULTS The thicknesses of the left ventricle walls and the interventricular septum of embryonic hearts exposed to maternal diabetes were significantly thicker than those in the nondiabetic group. Maternal diabetes significantly increased β-myosin heavy chain, atrial natriuretic peptide, insulin-like growth factor-1, and desmin expression, but decreased expression of adrenomedullin. Moreover, collagen synthesis was significantly elevated, whereas fibronectin synthesis was suppressed, in embryonic hearts from diabetic dams, suggesting that cardiac remodeling is a contributing factor to cardiac hypertrophy. The cardiac fibrosis marker, galectin-3, was induced by maternal diabetes. Furthermore, maternal type 2 diabetes mellitus activated the proapoptotic c-Jun-N-terminal kinase 1/2 stress signaling and triggered cell apoptosis by increasing the number of terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick end labeling-positive cells (10.4 ± 2.2% of the type 2 diabetes mellitus group vs 3.8 ± 0.7% of the nondiabetic group, P < .05). CONCLUSION Maternal type 2 diabetes mellitus induces cardiac hypertrophy in embryonic hearts. Adverse cardiac remodeling, including elevated collagen synthesis, suppressed fibronectin synthesis, profibrosis, and apoptosis, is implicated as the etiology of cardiac hypertrophy.
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Affiliation(s)
- Xue Lin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Penghua Yang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - E Albert Reece
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Peixin Yang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD; Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD.
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27
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Dypvik J, Larsen S, Haavaldsen C, Jukic AM, Vatten LJ, Eskild A. Placental weight in the first pregnancy and risk for preeclampsia in the second pregnancy: A population-based study of 186 859 women. Eur J Obstet Gynecol Reprod Biol 2017; 214:184-189. [PMID: 28551527 PMCID: PMC5538889 DOI: 10.1016/j.ejogrb.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To study whether placental weight in the first pregnancy is associated with preeclampsia in the second pregnancy. STUDY DESIGN In this population-based study, we included all women with two consecutive singleton pregnancies reported to the Medical Birth Registry of Norway during 1999-2012 (n=186 859). Placental weight in the first pregnancy was calculated as z-scores, and the distribution was divided into five groups of equal size (quintiles). We estimated crude and adjusted odds ratios with 95% confidence intervals for preeclampsia in the second pregnancy according to quintiles of placental weight z-scores in the first pregnancy. The 3rd quintile was used as the reference group. RESULTS Among women without preeclampsia in the first pregnancy, 1.4% (2507/177 149) developed preeclampsia in the second pregnancy. In these women, the risk for preeclampsia in the second pregnancy was associated with placental weight in the first pregnancy in both lowest (crude odds ratio (cOR) 1.30, 95% confidence interval (CI); 1.14-1.47) and highest quintile (cOR 1.20, 95% CI; 1.06-1.36). The risk associated with the highest quintile of placental weight was confined to term preeclampsia. Among women with preeclampsia in the first pregnancy, 15.7% (1522/9710) developed recurrent preeclampsia, and the risk for recurrent preeclampsia was associated with placental weight in lowest quintile in the first pregnancy (cOR 1.30, 95% CI; 1.10-1.55). Adjustment for interval between pregnancies, maternal diabetes, age, and smoking in the first pregnancy did not alter these estimates notably. CONCLUSION Placental weight in the first pregnancy might help to identify women who could be at risk for developing preeclampsia in a second pregnancy.
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Affiliation(s)
- Johanne Dypvik
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Sandra Larsen
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Camilla Haavaldsen
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Anne M Jukic
- School of Public Health, Yale University, New Haven, CT, USA
| | - Lars J Vatten
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway; School of Public Health, Harvard University, Boston, MA, USA
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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28
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Abstract
AbstractInfertility and fertility treatments utilized are associated with abnormal placentation leading to adverse pregnancy outcomes related to placentation, including preterm birth, low birth weight, placenta accrete, and placenta previa. This may be due to the underlying genetics predisposing to infertility or the epigenetic changes associated with the fertility treatments utilized, as specific disease states leading to infertility are at increased risk of adverse outcomes, including placental abruption, fetal loss, gestational diabetes mellitus, and outcomes related to placentation, as well as the treatments utilized including in vitro fertilization (IVF) and non-IVF fertility treatment. Placentation defects, leading to adverse maternal and fetal outcomes, which are more pronounced in the infertile population, occur due to changes in trophoblast invasion, vascular defects, changes in the environmental milieu, chronic inflammation, and oxidative stress. These similar processes are recognized as major contributors to lifelong risk of cardiovascular and metabolic disease for both the mother and her offspring. Thus, abnormal placentation, found to be more prevalent in the infertile population, may be the key to better understand how infertility affects overall and long-term health.
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Affiliation(s)
- Lauren W Sundheimer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Reproductive Endocrinology and Infertility, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Reproductive Endocrinology and Infertility, UCLA David Geffen School of Medicine, Los Angeles, California
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29
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Chauhan M, Betancourt A, Balakrishnan M, Yallampalli U, Dong Y, Fox K, Belfort M, Yallampalli C. Impaired Vasodilatory Responses of Omental Arteries to CGRP Family Peptides in Pregnancies Complicated by Fetal Growth Restriction. J Clin Endocrinol Metab 2016; 101:2984-93. [PMID: 27258937 PMCID: PMC6287517 DOI: 10.1210/jc.2016-1798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
RATIONALE Calcitonin gene-related peptide (CGRP), adrenomedullin (ADM), and adrenomedullin2 (ADM2)/intermedin are potent vasorelaxant peptides considered to play a role in the adaptive mechanisms in rat pregnancy through increased vasodilation in mesenteric and uterine artery. OBJECTIVE This study was designed to demonstrate the response of omental arteries (OA) to vasoactive peptides CGRP, ADM, and ADM2 in pregnancy complications such as fetal growth restriction (FGR), and assess the changes in the expression of their receptor components in segments of OA from FGR pregnancy compared to the control. FINDINGS The findings for this study are: 1) relaxation responses of OA were higher for bradykinin (78.55 ± 3.91 vs 52.67 ± 2.19; P < .05) in pregnancy with FGR compared to the normal, 2) relaxation response of OA segments to CGRP was similar with no change in the expression of G-protein couple receptor-calcitonin receptor-like receptor complex in normal healthy pregnancy and pregnancy complicated by FGR, 3) maximal relaxation response of OA were significantly (P < .05) lower for both ADM (18.2 ± 6.7 vs 38 ± 2.5) and ADM2 (26.9 ± 6.7 vs 48 ± 2.6) along with decreases in their respective ligand-receptor complex in FGR compared to the normal pregnancies, 4) expression of calcitonin receptor-like receptor mRNA was higher but its immunoreactivity was lower in OA from FGR pregnancy compared to the normal, and 5) mRNA and protein levels of RAMP1, RAMP2, and RAMP3 were lower in OA isolated from FGR pregnancies compared to the normal. CONCLUSION The current study demonstrates that FGR is associated with an increase in the sensitivity of OA to bradykinin and decreased sensitivity for ADM and ADM2 ligand-receptor system with no change in the response for CGRP compared to the normal healthy pregnancy, and suggests a potential role for ADM and ADM2 in the pathophysiology of maternal vasculature in FGR pregnancy.
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Affiliation(s)
- Madhu Chauhan
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Ancizar Betancourt
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Meena Balakrishnan
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Uma Yallampalli
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Yuanlin Dong
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Karin Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Chandra Yallampalli
- Department of Obstetrics and Gynecology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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30
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Ghossein-Doha C. Re: Elastic properties of ascending aorta in women with previous pregnancy complicated by early- or late-onset pre-eclampsia. R. Orabona, E. Sciatti, E. Vizzardi, I. Bonadei, A. Valcamonico, M. Metra and T. Frusca. Ultrasound Obstet Gynecol 2016; 47: 316-323. Ultrasound Obstet Gynecol 2016; 47:279. [PMID: 26940674 DOI: 10.1002/uog.15868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Ghossein-Doha
- Department of Obstetrics & Gynaecology, P. Debeyelaan 25, 6229 HX Maastricht, PO Box 5800, Maastricht, The Netherlands
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