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Hauspurg A, Bryan S, Jeyabalan A, Davis EM, Hart R, Shirriel J, Muldoon M, Catov J. Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy. Hypertension 2024; 81:302-310. [PMID: 38073563 PMCID: PMC10872368 DOI: 10.1161/hypertensionaha.123.22231] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are associated with cardiovascular disease; however, patterns of blood pressure (BP) recovery are understudied. We compared pregnancy and postpartum BP trajectories among individuals with hypertensive disorders of pregnancy who developed persistent hypertension at 1-year postpartum compared with individuals with normalization of BP. METHODS We used data from a randomized clinical trial of individuals with overweight, obesity, and hypertensive disorders of pregnancy conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits; postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of antihypertensive medications) at 1 year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines. RESULTS We included 129 individuals; 75 (58%) individuals progressed to hypertension by 1-year postpartum. Individuals with hypertension were older, delivered at earlier gestational ages, and had higher body mass index at 1-year postpartum compared with those with normalization. Individuals with hypertension had similar BP trajectories during pregnancy to those with BP normalization but a significantly different BP trajectory (P<0.01 for systolic and diastolic BPs) in the first year postpartum. These differences persisted in multivariable models after adjustment for early pregnancy body mass index, age, and severity of hypertensive disorder of pregnancy (P<0.01 for systolic and diastolic BPs). CONCLUSIONS BP trajectories in the first year postpartum, but not during pregnancy, may provide important information for risk stratification after a hypertensive disorder of pregnancy. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT03749746.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Samantha Bryan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Esa M. Davis
- University of Maryland School of Medicine, Baltimore, PA
| | - Renee Hart
- University of Maryland School of Medicine, Baltimore, PA
| | - Jada Shirriel
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Janet Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Ibarra AJ, Butters MA, Lim G, Jeyabalan A, Li R, Balasubramani GK, Catov JM. Longitudinal cognitive evaluation before and after delivery among people with preeclampsia. Am J Obstet Gynecol MFM 2023; 5:100966. [PMID: 37084869 PMCID: PMC10876122 DOI: 10.1016/j.ajogmf.2023.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Cognitive impairments related to preeclampsia after pregnancy have been reported; however, it is not known if weaknesses in cognition occur before and shortly after delivery. OBJECTIVE This study aimed to assess the feasibility of longitudinal cognitive testing before and after delivery, and to investigate whether those with preeclampsia have cognitive weaknesses during the third trimester of pregnancy and at 1 and 3 months postpartum. We hypothesized that people with preeclampsia would have lower cognition scores across all time points compared with normotensive people. STUDY DESIGN This longitudinal, prospective, observational study in a single institution enrolled people (N=30) at ≥28 weeks of gestation with preeclampsia (N=16) or normotension (N=14). People with chronic hypertension, neurologic or developmental disabilities, moderate or severe depression or anxiety, or current substance use were excluded. Subjective (Everyday Cognition Scale) and objective assessment of executive function (Stroop Color-Word Interference Test, Trail-Making Test), attention and working memory (Digit Span subtest), and information processing speed (Digit Symbol Substitution Test) was conducted, and Z-scores were calculated. Baseline characteristics (eg, prepregnancy body mass index) were collected from the medical record. Generalized linear models were used to estimate associations. RESULTS We enrolled 37% (30/81) of eligible people and retained 80% (24/30) and 53% (16/30) at 1 and 3 months postpartum, respectively. People with preeclampsia reported more memory problems (ß=0.87; 95% confidence interval, 0.44-1.31), and scored worse on attention and working memory (ß=-0.94; 95% confidence interval, -1.42 to -0.45) and executive function (Stroop test ß=-0.86; 95% confidence interval, -1.53 to -0.19) domains compared with normotensive people after adjusting for time, age, education, and prepregnancy body mass index. CONCLUSION Longitudinal assessment of cognition in pregnant preeclamptic and normotensive people is feasible. People with preeclampsia reported worse subjective memory and had lower scores in attention, working memory, and executive function.
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Affiliation(s)
- Andrea J Ibarra
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim).
| | | | - Grace Lim
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim)
| | - Arun Jeyabalan
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA
| | - Runjia Li
- Departments of Epidemiology (Ms Li and Dr Catov)
| | | | - Janet M Catov
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA; Departments of Epidemiology (Ms Li and Dr Catov); Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
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White GE, Courcoulas AP, Broskey NT, Rogan SC, Jeyabalan A, King WC. Maternal and Neonatal Outcomes of Pregnancy within 7 years after Roux-Y Gastric Bypass or Sleeve Gastrectomy Surgery. Obes Surg 2023; 33:1764-1772. [PMID: 37014543 PMCID: PMC10450590 DOI: 10.1007/s11695-023-06575-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Few studies examine whether maternal and neonatal outcomes differ by time from metabolic and bariatric surgery (MBS) to conception. We describe maternal and neonatal outcomes among women with pregnancy after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) overall and by whether conception occurred during the period when pregnancy is not recommended (< 18 months postoperative) versus later. MATERIALS AND METHODS A prospective cohort study enrolled 135 US adult women (median age, 30 years, body mass index [BMI], 47.2 kg/m2) who underwent RYGB or SG (2006-2009) and subsequently reported ≥ 1 pregnancy within 7 years. Participants self-reported pregnancy-related information annually. Differences in prevalence of maternal and neonatal outcomes by postoperative conception timeframe (< 18 versus ≥ 18 months) were assessed. RESULTS Thirty-one women reported ≥ 2 postoperative pregnancies. At time of postoperative conception (median 26 [IQR:22-52] months postoperative) median BMI was 31 (IQR:27-36) kg/m2. Excessive gestational weight gain (55%), cesarean section (42%) and preterm labor or rupture of membranes (40%) were the most common maternal outcomes. Forty percent of neonates had a composite outcome of still birth (1%), preterm birth (26%), small for gestational age (11%), or neonatal intensive care unit admission (8%). Prevalence of outcomes did not statistically significantly differ by timeframe. CONCLUSION In US women who conceived ≤ 7 years following RYGB or SG, 40% of neonates had the composite neonatal outcome. The prevalence of maternal and neonatal outcomes post-MBS were not statistically significant by conception timeframe.
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Affiliation(s)
- Gretchen E White
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA.
| | - Anita P Courcoulas
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Nicholas T Broskey
- Department of Kinesiology, East Carolina University, E 5Th St, Greenville, NC, 27858, USA
| | - Sarah C Rogan
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Arun Jeyabalan
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Wendy C King
- School of Public Health, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
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Hauspurg A, Seely EW, Rich-Edwards J, Hayduchok C, Bryan S, Roche AT, Jeyabalan A, Davis EM, Hart R, Shirriel J, Catov J. Postpartum home blood pressure monitoring and lifestyle intervention in overweight and obese individuals the first year after gestational hypertension or pre-eclampsia: A pilot feasibility trial. BJOG 2023; 130:715-726. [PMID: 36655365 PMCID: PMC10880812 DOI: 10.1111/1471-0528.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/25/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To test the feasibility of a randomised trial of home blood pressure monitoring paired with a remote lifestyle intervention (Heart Health 4 New Moms) versus home blood pressure monitoring alone versus control in individuals with a hypertensive disorder of pregnancy in the first year postpartum. DESIGN Single-blinded three-arm randomised clinical trial. SETTING Two tertiary care hospitals and a community organisation. POPULATION Postpartum overweight and obese individuals with a hypertensive disorder of pregnancy and without pre-pregnancy hypertension or diabetes. METHODS We assessed the feasibility of recruitment and retention of 150 participants to study completion at 1-year postpartum with randomisation 1:1:1 into each arm. Secondary aims were to test effects of the interventions on weight, blood pressure and self-efficacy. RESULTS Over 23 months, we enrolled 148 of 400 eligible, screened individuals (37%); 28% black or other race and mean pre-pregnancy body mass index (BMI) of 33.4 ± 6.7 kg/m2 . In total, 129 (87%) participants completed the 1-year postpartum study visit. Overall, 22% of participants developed stage 2 hypertension (≥140/90 mmHg or on anti-hypertensive medications) by 1 year postpartum. There were no differences in weight or self-efficacy across the study arms. CONCLUSION In this pilot, randomised trial, we demonstrate feasibility of HBPM paired with a lifestyle intervention in the first year postpartum. We detected high rates of ongoing hypertension, emphasising the need for the development of effective interventions in this population.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ellen W. Seely
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Rich-Edwards
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Hayduchok
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Samantha Bryan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrea T. Roche
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esa M. Davis
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Renee Hart
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Janet Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Nicholas A, Countouris M, Jeyabalan A, Lim G. A Case Series of Parturients With Mechanical Mitral Valves: Anticoagulation Management During Labor and Delivery. JACC Case Rep 2023; 9:101741. [PMID: 36909263 PMCID: PMC9998718 DOI: 10.1016/j.jaccas.2023.101741] [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] [Received: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 03/05/2023]
Abstract
More women with mechanical mitral valves (MMVs) are pursuing pregnancy. Guidelines exist for pregnancy anticoagulation, but they do not address individualized anticoagulation during delivery-a period of risk for bleeding, thrombosis, and anesthetic complications. This case series of parturients with MMVs highlights the challenges in, and the evidence and strategies for, treating these patients. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Alexandra Nicholas
- Division of Obstetric and Women's Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.,Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Malamo Countouris
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arun Jeyabalan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Grace Lim
- Division of Obstetric and Women's Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Magee Women's Hospital, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Liu S, Fu H, Ray M, Heinsberg LW, Conley YP, Anderson CM, Hubel CA, Roberts JM, Jeyabalan A, Weeks DE, Schmella MJ. A longitudinal epigenome-wide association study of preeclamptic and normotensive pregnancy. Epigenetics Commun 2023; 3:1. [PMID: 37063698 PMCID: PMC10101051 DOI: 10.1186/s43682-022-00014-w] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 01/28/2023]
Abstract
Background While preeclampsia (PE) is a leading cause of pregnancy-related morbidity/mortality, its underlying mechanisms are not fully understood. DNA methylation (DNAm) is a dynamic regulator of gene expression that may offer insight into PE pathophysiology and/or serve as a biomarker (e.g., risk, subtype, a therapeutic response). This study's purpose was to evaluate for differences in blood-based DNAm across all trimesters between individuals eventually diagnosed with PE (cases) and individuals who remained normotensive throughout pregnancy, did not develop proteinuria, and birthed a normally grown infant (controls). Results In the discovery phase, longitudinal, genome-wide DNAm data were generated across three trimesters of pregnancy in 56 participants (n=28 cases, n=28 controls) individually matched on self-identified race, pre-pregnancy body mass index, smoking, and gestational age at sample collection. An epigenome-wide association study (EWAS) was conducted, using surrogate variable analysis to account for unwanted sources of variation. No CpGs met the genome-wide significance p value threshold of 9×10-8, but 16 CpGs (trimester 1: 5; trimester 2: 1; trimester 3: 10) met the suggestive significance threshold of 1×10-5. DNAm data were also evaluated for differentially methylated regions (DMRs) by PE status. Three DMRs in each trimester were significant after Bonferonni-adjustment. Since only third-trimester samples were available from an independent replication sample (n=64 cases, n=50 controls), the top suggestive hits from trimester 3 (cg16155413 and cg21882990 associated with TRAF3IP2-AS1/TRAF3IP2 genes, which also made up the top DMR) were carried forward for replication. During replication, DNAm data were also generated for validation purposes from discovery phase third trimester samples. While significant associations between DNAm and PE status were observed at both sites in the validation sample, no associations between DNAm and PE status were observed in the independent replication sample. Conclusions The discovery phase findings for cg16155413/cg21882990 (TRAF3IP2-AS1/TRAF3IP2) were validated with a new platform but were not replicated in an independent sample. Given the differences in participant characteristics between the discovery and replication samples, we cannot rule out important signals for these CpGs. Additional research is warranted for cg16155413/cg21882990, as well as top hits in trimesters 1-2 and significant DMRs that were not examined in the replication phase.
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Affiliation(s)
- Shuwei Liu
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Haoyi Fu
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mitali Ray
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Lacey W. Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P. Conley
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
| | - Cindy M. Anderson
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Carl A. Hubel
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James M. Roberts
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel E. Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mandy J. Schmella
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA
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Hauspurg A, Hart R, Wang T, Bryan S, Jeyabalan A, Catov JM. Blood pressure trajectories through pregnancy and first year postpartum following a hypertensive disorder of pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sutherland L, Hart R, Bryan S, Jeyabalan A, Catov JM, Hauspurg A. Postpartum perception of cardiovascular risk and risk modification in patients with hypertensive disorders of pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Countouris M, Jaramillo Restrepo V, Bidani S, Catov J, Berlacher K, Jeyabalan A, Hauspurg A. Feasibility of Utilizing Telehealth in a Multidisciplinary Postpartum Hypertension Clinic. Womens Health Rep (New Rochelle) 2022; 3:877-886. [PMID: 36479373 PMCID: PMC9712043 DOI: 10.1089/whr.2022.0066] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/07/2022]
Abstract
Introduction Remote delivery of care improves outcomes following hypertensive disorders of pregnancy, but little is known about the implementation of a multidisciplinary clinic in the virtual space. In this study, we developed a multidisciplinary postpartum hypertension clinic with a telehealth component run jointly with Maternal-Fetal Medicine and Cardiology. Materials and Methods Women were referred from Cardiology and Obstetrics providers or through our postpartum remote blood pressure (BP) program and were offered the option of an in-person or telemedicine visit. For virtual visits, BP was recorded by home measurement. We compared clinical and demographic characteristics by visit type (virtual vs. in-person). Results Of 175 patients scheduled (2019-2021), 140 attended visits (80% show rate) a mean of 11 weeks postpartum, with 92 (65.7%) seen virtually and 48 (34.2%) seen in-person. Clinical and demographic factors, including self-reported race and insurance type, did not differ between women seen virtually versus in-person. Overall, 97 (69.3%) of women were still on antihypertensive agents at the time of their visit with 33 (34.0%) on more than one antihypertensive agent, which did not differ by visit type. Women who were seen virtually lived a farther distance from the clinic (median 11.6 [interquartile range; IQR 7.7, 30.8] vs. median 7.9 [IQR 5.8, 21.1] miles; p = 0.02). Conclusions Implementation of a multidisciplinary postpartum hypertension clinic in the virtual space is feasible, targets women at high risk for persistently elevated postpartum BP, and maintains equal attendance compared with in-person visits. Virtual visits deliver care equitably across different racial and socioeconomic groups and may improve access to care in rural areas.
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Affiliation(s)
- Malamo Countouris
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Address correspondence to: Malamo Countouris, MD, MS, Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | | | - Shruti Bidani
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janet Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathryn Berlacher
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hacker FM, Jeyabalan A, Quinn B, Hauspurg A. Implementation of a universal postpartum blood pressure monitoring program: feasibility and outcomes. Am J Obstet Gynecol MFM 2022; 4:100613. [PMID: 35283352 PMCID: PMC9900496 DOI: 10.1016/j.ajogmf.2022.100613] [Citation(s) in RCA: 6] [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: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND New-onset postpartum preeclampsia has a higher risk of maternal morbidity and mortality than preeclampsia with antepartum onset, underscoring the need for earlier identification of elevated blood pressure among patients with this condition. Given the decrease in healthcare engagement, which is typical of the postpartum period, new-onset postpartum hypertension often goes unrecognized. Currently, there are no recommendations for universal postpartum blood pressure surveillance in women without hypertensive disorders of pregnancy. With the shift to telemedicine because of the COVID-19 pandemic, our institution's approach was to distribute blood pressure cuffs to women receiving any portion of their prenatal care virtually, thus also providing access to an opportunity for blood pressure measurement during the postpartum period for all women. OBJECTIVE To explore the feasibility of a patient-driven universal postpartum home blood pressure monitoring program in women without a previous diagnosis of a hypertensive disorder. STUDY DESIGN This was a prospective observational study of all postpartum women who were discharged from our institution from July 2020 through June 2021 and who were not previously identified to have hypertension. A clinical algorithm was developed and followed. All the women received discharge educational materials and were called at a 1-week interval by a nurse to review blood pressure and preeclampsia symptoms. The maternal demographics and delivery outcomes were recorded. RESULTS Of the 10,092 deliveries during the study period, 5959 (59%) were successfully contacted. 352 were excluded, as they did not deliver at the primary hospital; 1052 (18%) had a previous hypertensive disorder of pregnancy diagnosis; 1522 (26%) did not have a blood pressure cuff; and 1841 (31%) planned to take their blood pressure at a later time. Precautions and blood pressure parameters were given to this last group. Of the remaining 1192, 222 (19%) had an initial elevated blood pressure. Of these, 98 had a second elevated blood pressure on recheck; 17 were referred to the emergency room for evaluation, with 8 being diagnosed with severe preeclampsia; and the remainder were recommended to follow with their obstetrical provider and enrolled in our institution's remote blood pressure management program. Of the 1192 women, 8% potentially had a new diagnosis of a hypertensive disorder of pregnancy, with 0.7% having severe hypertension. Women with elevated blood pressures were more likely to be of non-Hispanic Black race and have a higher early pregnancy body mass index than those without elevated blood pressures. CONCLUSION Our study indicates that a patient-driven postpartum blood pressure monitoring program is feasible and may be incorporated using existing resources. In addition, our findings suggest that the incidence of new-onset postpartum hypertensive disorders of pregnancy may be higher than previously assessed in retrospective cohorts. Thus, there may be a role for closer surveillance of all women with patient-driven home blood pressure monitoring, particularly those with risk factors or in the setting of limited resources.
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Affiliation(s)
- Francis M Hacker
- Department of Obstetrics, Gynecology and Reproductive Science, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology and Reproductive Science, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Beth Quinn
- Department of Obstetrics, Gynecology and Reproductive Science, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Science, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA.
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket St., Pittsburgh, PA 15213; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA
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12
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Hauspurg A, Restrepo VJ, Bidani S, Berlacher K, Jeyabalan A, Countouris M. Feasibility of utilizing telehealth in a multi-disciplinary postpartum hypertension clinic. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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13
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Ray M, Heinsberg LW, Conley YP, Roberts JM, Jeyabalan A, Hubel CA, Weeks DE, Schmella MJ. An exploratory study of white blood cell proportions across preeclamptic and normotensive pregnancy by self-identified race in individuals with overweight or obesity. Hypertens Pregnancy 2021; 40:312-321. [PMID: 34697971 DOI: 10.1080/10641955.2021.1987453] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: Examine white blood cell (WBC) proportions across preeclamptic (n = 28 cases) and normotensive (n = 28 controls) pregnancy in individuals with overweight/obesity.Methods: WBC proportions were inferred from genome-wide DNA methylation data and compared by case/control status and self-identified race.Results: In Trimester 1, ean B cell proportions were suggestively lower in cases in the overall sample and significantly lower in White participants but not in Black participants. More significant WBC proportion changes were observed across normotensive than preeclamptic pregnancy.Conclusions: These findings in a small sample demonstrate need for additional studies investigating the relationship between self-identified race and WBCs in pregnancy.
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Affiliation(s)
- Mitali Ray
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lacey W Heinsberg
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James M Roberts
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Global Pregnancy Collaboration, Pittsburgh, Pennsylvania, USA
| | - Arun Jeyabalan
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Global Pregnancy Collaboration, Pittsburgh, Pennsylvania, USA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel E Weeks
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mandy J Schmella
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Jones MA, Catov JM, Jeyabalan A, Whitaker KM, Gibbs BB. Sedentary behaviour and physical activity across pregnancy and birth outcomes. Paediatr Perinat Epidemiol 2021; 35:341-349. [PMID: 33124060 PMCID: PMC8186559 DOI: 10.1111/ppe.12731] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/06/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shorter gestation or smaller birth size are indicators of a suboptimal fetal environment and negatively impact short- and long-term offspring health. Understanding how modifiable maternal behaviours, such as moderate-to-vigorous intensity physical activity (MVPA) or sedentary behaviour (SED), improve fetal outcomes could inform strategies to improve health across the lifespan. OBJECTIVES The objective of this study was to examine the association of MVPA and SED across pregnancy trimesters on gestational age at delivery and newborn anthropometrics. METHODS The MoM Health Study measured SED (thigh-mounted activPAL3 micro) and MVPA (waist-worn Actigraph GTX3) in each trimester of pregnancy. Birth outcomes (gestational age at delivery, birthweight, birth length, and head circumference) were abstracted from medical records and used to calculate ponderal index (grams*100/cm3 ) and size-for-gestational age percentiles. Associations of group-based trajectories and trimester-specific SED and MVPA with birth outcomes were analysed using regression models. RESULTS Low, medium, and high trajectory groups were generated SED and MVPA in 103 and 99 pregnant women, respectively. High vs low SED trajectory was associated with earlier gestational age at delivery (β -1.03 weeks, 95% CI -2.01, -0.06), larger head circumference (β 0.83 cm, 95% CI 0.24, 1.63), longer birth length (β 1.37 cm, 95% CI 0.09, 2.64), and lower ponderal index (β -0.24 g*100/cm3 , 95% CI -0.42, -0.06), after adjustment for demographics, pre-pregnancy BMI, and (for newborn anthropometric outcomes) gestational age. The association of high SED with lower ponderal index was the most robust across progressively adjusted models (β -0.25 g*100/cm3 , 95% CI -0.44, -0.07). SED trajectory was not associated with birthweight or size-for-gestational age. High vs low MVPA trajectory was only associated with smaller head circumference (β -0.86 cm, 95% CI -1.70, -0.02). CONCLUSIONS Higher SED during pregnancy may result in shorter gestation and inhibited fetal growth. Further research evaluating the effect of reducing SED during pregnancy on birth outcomes is warranted.
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Affiliation(s)
- Melissa A. Jones
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet M. Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Womens Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Department of Ob/Gyn and Reproductive Sciences, Magee-Womens Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara M. Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Heinsberg LW, Ray M, Conley YP, Roberts JM, Jeyabalan A, Hubel CA, Weeks DE, Schmella MJ. An Exploratory Study of Epigenetic Age in Preeclamptic and Normotensive Pregnancy Reveals Differences by Self-Reported Race but Not Pregnancy Outcome. Reprod Sci 2021; 28:3519-3528. [PMID: 33877642 DOI: 10.1007/s43032-021-00575-6] [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] [Received: 01/17/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality. Chronological age and race are associated with preeclampsia, but the role of these factors is not entirely understood. We hypothesized that DNA methylation age, a measure of biological age, would be higher in individuals with preeclampsia than in individuals with normotensive pregnancy and that DNA methylation age would differ by race across pregnancy. This was a longitudinal, exploratory study of 56 pregnant individuals (n = 28 preeclampsia cases and n = 28 normotensive controls). Genome-wide DNA methylation data were generated from trimester-specific peripheral blood samples. DNA methylation age was estimated using the "Improved Precision" clock, and ∆age, the difference between DNA methylation age and chronological age, was computed. DNA methylation age was compared with chronological age using Pearson correlations. The relationships between ∆age and preeclampsia status, self-reported race, and covariates were tested using multiple linear regression and performed both with and without consideration of cell-type heterogeneity. We observed strong correlation between chronological age and DNA methylation age across pregnancy, with significantly stronger correlation observed in White participants than in Black participants. We observed no association between ∆age and preeclampsia status. However, ∆age was higher in participants with higher pre-pregnancy body mass index in trimester 1 and lower in Black participants than in White participants in trimesters 2 and 3. Observations were largely consistent when controlling for cell-type heterogeneity. Our findings in a small sample support the need for additional studies to investigate the relationship between race and biological age, which could provide further insight into racial disparities across pregnancy. However, this study does not support an association between ∆age and preeclampsia status.
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Affiliation(s)
- Lacey W Heinsberg
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA. .,Division of Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. .,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Mitali Ray
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.,Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - James M Roberts
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Global Pregnancy Collaboration, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Global Pregnancy Collaboration, Pittsburgh, PA, USA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, & Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Daniel E Weeks
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mandy J Schmella
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Rietze AH, Conley YP, Ren D, Anderson CM, Roberts JM, Jeyabalan A, Hubel CA, Schmella MJ. DNA Methylation of Endoglin Pathway Genes in Pregnant Women With and Without Preeclampsia. Epigenet Insights 2020; 13:2516865720959682. [PMID: 33103056 PMCID: PMC7550939 DOI: 10.1177/2516865720959682] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
Objective We compared blood-based DNA methylation levels of endoglin (ENG) and transforming growth factor beta receptor 2 (TGFβR2) gene promoter regions between women with clinically-overt preeclampsia and women with uncomplicated, normotensive pregnancies. Methods We used EpiTect Methyl II PCR Assays to evaluate DNA methylation of CpG islands located in promoter regions of ENG (CpG Island 114642) and TGFβR2 (CpG Island 110111). Preeclampsia was diagnosed based on blood pressure, protein, and uric acid criteria. N = 21 nulliparous preeclampsia case participants were 1:1 frequency matched to N = 21 nulliparous normotensive control participants on gestational age at sample collection (±2 weeks), smoking status, and labor status at sample collection. Methylation values were compared between case and control participant groups [(ENG subset: n = 20 (9 cases, 11 controls); TGFβR2 subset: n = 28 (15 cases, 13 controls)]. Results The majority of the preeclampsia cases delivered at ⩾34 weeks' gestation (83%). Average methylation levels for ENG ([M ± (SD)]; Case Participant Group = 6.54% ± 4.57 versus Control Participant group = 4.81% ± 5.08; P = .102) and TGFβR2 (Case Participant Group = 1.50% ± 1.37 vs Control Participant Group = 1.70% ± 1.40; P = .695) promoter CpG islands did not differ significantly between the participant groups. Removal of 2 extreme outliers in the ENG analytic subset revealed a trend between levels of ENG methylation and pregnancy outcome (Case Participant Group = 5.17% ± 2.16 vs Control Participant Group = 3.36% ± 1.73; P = .062). Conclusion Additional epigenetic studies that include larger sample sizes, investigate preeclampsia subtypes, and capture methylation status of CpG island shores and shelves are needed to further inform us of the potential role that ENG and TGFβR2 DNA methylation plays in preeclampsia pathophysiology.
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Affiliation(s)
- Allison H Rietze
- Department of Health Promotion and Development (School of Nursing), University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- Department of Health Promotion and Development (School of Nursing), University of Pittsburgh, Pittsburgh, PA, USA.,Department of Human Genetics (Graduate School of Public Health), University of Pittsburgh, Pittsburgh, PA, USA
| | - Dianxu Ren
- Department of Health and Community Systems (School of Nursing), University of Pittsburgh, Pittsburgh, PA, USA
| | - Cindy M Anderson
- Martha S Pitzer Center for Women, Children, and Youth (College of Nursing), The Ohio State University, Columbus, OH, USA
| | - James M Roberts
- Department of Obstetrics, Gynecology, & Reproductive Sciences (School of Medicine), University of Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Department of Epidemiology (Graduate School of Public Health), University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology, & Reproductive Sciences (School of Medicine), University of Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, & Reproductive Sciences (School of Medicine), University of Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Mandy J Schmella
- Department of Health Promotion and Development (School of Nursing), University of Pittsburgh, Pittsburgh, PA, USA
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17
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Post Uiterweer ED, Koster MPH, Jeyabalan A, Kuc S, Siljee JE, Stewart DR, Conrad KP, Franx A. Circulating pregnancy hormone relaxin as a first trimester biomarker for preeclampsia. Pregnancy Hypertens 2020; 22:47-53. [PMID: 32738589 DOI: 10.1016/j.preghy.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/19/2020] [Revised: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Preeclampsia, a multi-system hypertensive disorder, is associated with perturbations in the maternal cardiovascular system during early pregnancy. The corpus luteal hormone relaxin, a potent vasodilator, may contribute to physiological circulatory changes especially in early gestation when circulating levels are highest. This study investigated whether first trimester circulating relaxin may be a suitable biomarker for the early prediction of preeclampsia. METHODS Relaxin was initially measured in first-trimester samples of women who developed late-onset preeclamptic (LO-PE; delivery ≥ 34 weeks; n = 33) and uncomplicated pregnancies (n = 25) in Pittsburgh, USA. Subsequently, to expand the group numbers, relaxin was measured in women who developed LO-PE (n = 95), early-onset preeclamptic (EO-PE; delivery < 34 weeks; n = 57), and uncomplicated pregnancies (n = 469) in Utrecht, the Netherlands. RESULTS In the Pittsburgh subjects, low relaxin levels (lowest centile: <p10) showed an adjusted odds ratio (OR) of 5.29 (95%CI 1.10-25.5) for LO-PE. In the Utrecht population, low relaxin levels (<p10) demonstrated adjusted ORs of 1.45 (95%CI 0.54-3.90) and 2.03 (95%CI 1.06-3.88) for EO-PE and LO-PE respectively, the latter increasing to an adjusted OR of 3.18 (95%CI 1.41-7.20) when newborn weight was < 10%. Serum relaxin concentrations slightly improved the detection rate of a previously derived prediction model for LO-PE from 42.5% to 45.1% at a fixed 10% false-positive rate. CONCLUSION Relaxin shows little improvement in the performance of first trimester prediction models, which does not support its clinical implementation as a biomarker. Although this study was only correlational, the results point to a possible pathophysiologic role for low relaxin levels in pregnancies that later develop LO-PE.
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Affiliation(s)
- Emiel D Post Uiterweer
- Department of Obstetrics, University Medical Center of Utrecht, Utrecht, The Netherlands; Laboratory of Neuroimmunology and Developmental Origins of Disease (NIDOD), University Medical Center of Utrecht, Utrecht, The Netherlands; Departments of Physiology and Functional Genomics and of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, USA.
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center of Rotterdam, The Netherlands
| | - Arun Jeyabalan
- Magee-Womens Research Institute and Foundation and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA
| | - Sylwia Kuc
- Department of Obstetrics, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Jacqueline E Siljee
- Center for Infectious Disease Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Kirk P Conrad
- Departments of Physiology and Functional Genomics and of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, USA; Magee-Womens Research Institute and Foundation and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.
| | - Arie Franx
- Department of Obstetrics, University Medical Center of Utrecht, Utrecht, The Netherlands; Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center of Rotterdam, The Netherlands
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18
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Maric-Bilkan C, Abrahams VM, Arteaga SS, Bourjeily G, Conrad KP, Catov JM, Costantine MM, Cox B, Garovic V, George EM, Gernand AD, Jeyabalan A, Karumanchi SA, Laposky AD, Miodovnik M, Mitchell M, Pemberton VL, Reddy UM, Santillan MK, Tsigas E, Thornburg KLR, Ward K, Myatt L, Roberts JM. Research Recommendations From the National Institutes of Health Workshop on Predicting, Preventing, and Treating Preeclampsia. Hypertension 2019; 73:757-766. [PMID: 30686084 DOI: 10.1161/hypertensionaha.118.11644] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Christine Maric-Bilkan
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Vikki M Abrahams
- Department of Ob/Gyn and Reproductive Sciences, Yale University School of Medicine, New Haven, CT (V.M.A.)
| | - S Sonia Arteaga
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI (G.B.)
| | - Kirk P Conrad
- Department of Physiology and Functional Genomics and Ob/Gyn, University of Florida College of Medicine, Gainesville (K.P.C.)
| | - Janet M Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - Maged M Costantine
- Department of Ob/Gyn, University of Texas Medical Branch, Galveston (M.M.C.)
| | - Brian Cox
- Department of Physiology and Ob/Gyn, University of Toronto, ON, Canada (B.C.)
| | - Vesna Garovic
- Department of Internal Medicine and Division of Nephrology and Hypertension, Department of Ob/Gyn, Mayo Clinic, Rochester, MN (V.G.)
| | - Eric M George
- Department of Physiology and Biophysics and Cell and Molecular Biology, University of Mississippi Medical Center, Jackson (E.M.G.)
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University (A.D.G.)
| | - Arun Jeyabalan
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (S.A.K.)
| | - Aaron D Laposky
- Division of Lung Diseases, National Center on Sleep Disorders Research (A.D.L.), National Institutes of Health, Bethesda, MD
| | - Menachem Miodovnik
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Megan Mitchell
- Division of Extramural Research Activities (M. Mitchell), National Institutes of Health, Bethesda, MD
| | - Victoria L Pemberton
- From the Division of Cardiovascular Sciences (C.M.-B., S.S.A., V.L.P.), National Institutes of Health, Bethesda, MD
| | - Uma M Reddy
- National Heart, Lung, and Blood Institute and Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (M. Miodovnik, U.M.R.), National Institutes of Health, Bethesda, MD
| | - Mark K Santillan
- Department of Ob/Gyn, University of Iowa Carver College of Medicine (M.K.S.)
| | | | - Kent L R Thornburg
- Bob & Charlee Moore Institute for Nutrition & Wellness, Oregon Health and Science University, Portland (K.L.R.T.)
| | | | - Leslie Myatt
- Bob & Charlee Moore Institute for Nutrition & Wellness and Department of Ob/Gyn, Oregon Health and Science University, Portland (L.M.)
| | - James M Roberts
- Department of Ob/Gyn and Reproductive Sciences, Magee-Women's Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, PA (J.M.C., A.J., J.M.R.)
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19
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Koczo A, Marino A, Jeyabalan A, Elkayam U, Cooper LT, Fett J, Briller J, Hsich E, Blauwet L, McTiernan C, Morel PA, Hanley-Yanez K, McNamara DM. Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy. JACC Basic Transl Sci 2019; 4:291-300. [PMID: 31312753 PMCID: PMC6609998 DOI: 10.1016/j.jacbts.2019.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 12/13/2022]
Abstract
The etiology of peripartum cardiomyopathy remains unknown. One hypothesis is that an increase in the 16-kDa form of prolactin is pathogenic and suggests that breastfeeding may worsen peripartum cardiomyopathy by increasing prolactin, while bromocriptine, which blocks prolactin release, may be therapeutic. An autoimmune etiology has also been proposed. The authors investigated the impact of breastfeeding on cellular immunity and myocardial recovery for women with peripartum cardiomyopathy in the IPAC (Investigations in Pregnancy Associated Cardiomyopathy) study. Women who breastfed had elevated prolactin, and prolactin levels correlated with elevations in CD8+ T cells. However, despite elevated prolactin and cytotoxic T cell subsets, myocardial recovery was not impaired in breastfeeding women.
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Affiliation(s)
- Agnes Koczo
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy Marino
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arun Jeyabalan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Uri Elkayam
- University of Southern California, Los Angeles, California
| | | | - James Fett
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | - Penelope A Morel
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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20
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Davidson J, McErlane J, Aljboor K, Barratt SL, Jeyabalan A, Medford ARL, Borman AM, Adamali H. Musical instruments, fungal spores and hypersensitivity pneumonitis. QJM 2019; 112:287-289. [PMID: 30649525 DOI: 10.1093/qjmed/hcz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/03/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- J Davidson
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - J McErlane
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - K Aljboor
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - S L Barratt
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A Jeyabalan
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A M Borman
- UK National Mycology Reference Laboratory (MRL), Public Health England South-West, Southmead Hospital, Bristol, UK
| | - H Adamali
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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21
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Schmella MJ, Assibey-Mensah V, Parks WT, Roberts JM, Jeyabalan A, Hubel CA, Catov JM. Plasma concentrations of soluble endoglin in the maternal circulation are associated with maternal vascular malperfusion lesions in the placenta of women with preeclampsia. Placenta 2019; 78:29-35. [PMID: 30955708 DOI: 10.1016/j.placenta.2019.02.014] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 01/09/2023]
Abstract
We evaluated the association between plasma soluble endoglin (sENG) and maternal vascular malperfusion (MVM) lesions of the placenta in women with preeclampsia. We measured sENG (sCD105) by ELISA in N = 70 women diagnosed with preeclampsia (median [IQR] GA at sampling = 36.4 [6.0] weeks) and available placental pathology. Placental pathology reports were reviewed for evidence of MVM based on the presence of ≥1 of the following: villous infarct, decidual vasculopathy, accelerated villous maturation, intervillous fibrin deposition, and/or low placental weight (<10th percentile for GA). We categorized plasma sENG concentrations into tertiles and used a modified Poisson regression approach to estimate the prevalence of MVM associated with sENG. We separately estimated the association between sENG and accelerated villous maturation, villous infarct, and low placental weight, the three most frequent lesions in the sample. We adjusted all models for age, parity, pre-pregnancy obesity, smoking, and infant sex. The prevalence of MVM in our sample of women with preeclampsia was 74%. Women in the highest sENG tertile had a higher prevalence of MVM (aPR[adjusted prevalence ratio] 1.70, 95% CI 1.15-2.52), low placental weight (aPR 3.26, 95% CI 1.25-8.50), and villous infarcts (aPR 2.93, 95% CI 1.27-6.73) compared with women in the lowest sENG tertile, after adjusting for covariates. Medium (aPR 2.57, 95% CI 1.17-5.66) and high (aPR 3.14, 95% CI 1.47-6.70) tertile concentrations of sENG were associated with higher accelerated villous maturation. Our results suggest that sENG may mark a more severe placental phenotype of preeclampsia, although findings should be replicated in larger cohorts.
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Affiliation(s)
- Mandy J Schmella
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Vanessa Assibey-Mensah
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - W Tony Parks
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - James M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet M Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Hauspurg A, Brands J, Gandley RE, Redman E, Simhan H, Jeyabalan A, Hubel CA. 424: Increased peripheral vascular resistance and arterial stiffness one year after preeclampsia. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Countouris ME, Demirci JR, Jeyabalan A, Catov JM, Schwarz EB. Relationship of Postpartum Levels of Cystatin and High-Sensitivity C-Reactive Protein and Duration of Lactation in Mothers with Previous Gestational Hypertension or Preeclampsia. Breastfeed Med 2019; 14:408-415. [PMID: 30874448 PMCID: PMC6648190 DOI: 10.1089/bfm.2018.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Women with hypertensive disorders of pregnancy are at increased risk of cardiovascular disease in later life. We sought to determine the association between lactation and markers of maternal cardiovascular health among postpartum women with and without hypertensive disorders of pregnancy via measures of inflammation (high-sensitivity C-reactive protein [hsCRP]) and renal function (cystatin C). Materials and Methods: This prospective cohort study enrolled primarily overweight and obese women during early pregnancy. At a postpartum study visit occurring 6-24 months after delivery, we collected data on lactation duration and measured hsCRP and cystatin C. We assessed associations between lactation duration and levels of hsCRP and cystatin C among normotensive women and women with preeclampsia or gestational hypertension using analysis of variance and chi-squared tests. Linear regression models adjusted for age, race, education, prepregnancy body mass index, current smoking, and time since delivery. Results: Of 425 women, 37 (9%) had preeclampsia and 48 (11%) had gestational hypertension during enrollment pregnancy. The postpartum visit occurred at a mean of 8.6 ± 4.4 months after delivery. Women with a history of preeclampsia had significantly higher levels of cystatin C (mean 0.86 versus 0.78 mg/L; p = 0.03) compared with normotensive women, but nonsignificant elevation in hsCRP (mean 8.39 versus 6.04 mg/L; p = 0.08). Women with gestational hypertension had no differences in mean hsCRP or cystatin C compared with normotensive women. Among the 237 women with any lactation, 78 (18%) lactated for at least 6 months. Lactation duration both in the overall sample and among women with gestational hypertension or preeclampsia was not associated with levels of hsCRP or cystatin C. Conclusions: Preeclampsia history was associated with elevated postpartum levels of cystatin C; however, duration of lactation was not associated with postpartum hsCRP or cystatin C, regardless of history of gestational hypertension or preeclampsia. Further research is needed on mechanisms through which lactation may affect maternal risk of cardiovascular disease.
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Affiliation(s)
- Malamo E Countouris
- 1 Department of Cardiology, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Jill R Demirci
- 2 Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Arun Jeyabalan
- 3 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Clinical and Translational Sciences Institute, Pittsburgh, Pennsylvania
| | - Janet M Catov
- 4 Department of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor B Schwarz
- 5 Department of General Internal Medicine, University of California Davis, Sacramento, California
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Hauspurg A, Countouris ME, Jeyabalan A, Hubel CA, Roberts JM, Schwarz EB, Catov JM. Risk of hypertension and abnormal biomarkers in the first year postpartum associated with hypertensive disorders of pregnancy among overweight and obese women. Pregnancy Hypertens 2018; 15:1-6. [PMID: 30825904 DOI: 10.1016/j.preghy.2018.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 09/06/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Hypertension and obesity are common cardiometabolic risk factors in reproductive age women. The association of hypertensive disorders of pregnancy with later-life cardiovascular disease is well-established, however, it is unknown how obesity and hypertensive disorders of pregnancy converge to accelerate development of hypertension in the postpartum period. The aim of this study was to characterize rates of sustained hypertension at one year postpartum using the new American Heart Association/American College of Cardiology Guidelines among overweight and obese women with a normotensive pregnancy or hypertensive disorder of pregnancy. STUDY DESIGN 315 early pregnant women were enrolled prospectively and followed up to 12 months after delivery (mean 7.0 ± 1.8 months). At a postpartum research visit, we measured blood pressure and collected blood samples to measure cystatin C and high sensitivity C-reactive protein. RESULTS A total of 254 women had a normotensive pregnancy, 39 had gestational hypertension (12.4%) and 22 had preeclampsia (7.0%). 91 women had hypertension at the postpartum study visit (28.9%). After adjustment for maternal age, BMI, lactation and time postpartum, preeclampsia was associated with an aOR 2.35 (95%CI 1.63-3.41) of development of sustained hypertension and an aOR 3.23 (95%CI 1.56-6.68) of hypertension with abnormal biomarkers compared to women with normotensive pregnancies. CONCLUSIONS We demonstrate a high prevalence of hypertension and abnormal biomarkers associated with hypertensive disorders of pregnancy among overweight and obese women. Our findings support the need for structured follow up and risk reduction in overweight and obese women with hypertensive disorders of pregnancy as early as the first year postpartum.
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Affiliation(s)
- Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States.
| | - Malamo E Countouris
- University of Pittsburgh Medical Center Heart and Vascular Institute, United States
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, United States
| | - Carl A Hubel
- Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States
| | - James M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States; Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, United States; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, United States
| | | | - Janet M Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, United States
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Marino A, Koczo A, Jeyabalan A, Elkayam U, Cooper L, Fett J, McNamara D. MULTI-FETAL GESTATION, BREASTFEEDING, DELIVERY METHOD AND MYOCARDIAL RECOVERY IN PERIPARTUM CARDIOMYOPATHY: RESULTS FROM THE MULTICENTER IPAC STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rabaglino MB, Post Uiterweer ED, Jeyabalan A, Hogge WA, Conrad KP. Bioinformatics approach reveals evidence for impaired endometrial maturation before and during early pregnancy in women who developed preeclampsia. Hypertension 2014; 65:421-9. [PMID: 25421975 DOI: 10.1161/hypertensionaha.114.04481] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impaired uterine invasion by extravillous trophoblast in early gestation is implicated in the genesis of preeclampsia, a potentially lethal malady of human pregnancy. However, reasons for extravillous trophoblast dysfunction remain unclear because of virtual inaccessibility of early placental and uterine tissues from women who develop preeclampsia, and the absence of animal models in which the disease spontaneously occurs. Consequently, the possibility that deficient or defective maturation of the endometrium (decidualization) may compromise extravillous trophoblast invasion in preeclampsia remains unexplored. Using a bioinformatics approach, we tested this hypothesis identifying 396 differentially expressed genes (DEG) in chorionic villous samples from women at ≈11.5 gestational weeks who developed severe preeclampsia symptoms 6 months later compared with chorionic villous samples from normal pregnancies. A large number, 154 or 40%, overlapped with DEG associated with various stages of normal endometrial maturation before and after implantation as identified by other microarray data sets (P=4.7×10(-14)). One-hundred and sixteen of the 154 DEG or 75% overlapped with DEG associated with normal decidualization in the absence of extravillous trophoblast, ie, late-secretory endometrium (LSE) and endometrium from tubal ectopic pregnancy (EP; P=4.2×10(-9)). Finally, 112 of these 154 DEG or 73% changed in the opposite direction in microarray data sets related to normal endometrial maturation (P=0.01), including 16 DEG upregulated in decidual (relative to peripheral blood) natural killer cells that were downregulated in chorionic villous samples from women who developed preeclampsia (P<0.0001). Taken together, these results suggest that insufficient or defective maturation of endometrium and decidual natural killer cells during the secretory phase and early pregnancy preceded the development of preeclampsia.
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Affiliation(s)
- Maria B Rabaglino
- From the Department of Animal Reproduction, Universidad Nacional de Rio Cuarto, Rio Cuarto, Cordoba, Argentina (M.B.R.); Department of Obstetrics and Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands (E.D.P.U.); Department of Ob/Gyn, Magee Womens Hospital, Pittsburgh, PA (A.J., W.A.H.); and D.H. Barron Reproductive and Perinatal Biology Research Program, Departments of Physiology and Functional Genomics and of Ob/Gyn, University of Florida, Gainesville (E.D.P.U., K.P.C.).
| | - Emiel D Post Uiterweer
- From the Department of Animal Reproduction, Universidad Nacional de Rio Cuarto, Rio Cuarto, Cordoba, Argentina (M.B.R.); Department of Obstetrics and Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands (E.D.P.U.); Department of Ob/Gyn, Magee Womens Hospital, Pittsburgh, PA (A.J., W.A.H.); and D.H. Barron Reproductive and Perinatal Biology Research Program, Departments of Physiology and Functional Genomics and of Ob/Gyn, University of Florida, Gainesville (E.D.P.U., K.P.C.)
| | - Arun Jeyabalan
- From the Department of Animal Reproduction, Universidad Nacional de Rio Cuarto, Rio Cuarto, Cordoba, Argentina (M.B.R.); Department of Obstetrics and Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands (E.D.P.U.); Department of Ob/Gyn, Magee Womens Hospital, Pittsburgh, PA (A.J., W.A.H.); and D.H. Barron Reproductive and Perinatal Biology Research Program, Departments of Physiology and Functional Genomics and of Ob/Gyn, University of Florida, Gainesville (E.D.P.U., K.P.C.)
| | - William A Hogge
- From the Department of Animal Reproduction, Universidad Nacional de Rio Cuarto, Rio Cuarto, Cordoba, Argentina (M.B.R.); Department of Obstetrics and Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands (E.D.P.U.); Department of Ob/Gyn, Magee Womens Hospital, Pittsburgh, PA (A.J., W.A.H.); and D.H. Barron Reproductive and Perinatal Biology Research Program, Departments of Physiology and Functional Genomics and of Ob/Gyn, University of Florida, Gainesville (E.D.P.U., K.P.C.)
| | - Kirk P Conrad
- From the Department of Animal Reproduction, Universidad Nacional de Rio Cuarto, Rio Cuarto, Cordoba, Argentina (M.B.R.); Department of Obstetrics and Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands (E.D.P.U.); Department of Ob/Gyn, Magee Womens Hospital, Pittsburgh, PA (A.J., W.A.H.); and D.H. Barron Reproductive and Perinatal Biology Research Program, Departments of Physiology and Functional Genomics and of Ob/Gyn, University of Florida, Gainesville (E.D.P.U., K.P.C.).
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Jeyabalan A, Bhatt N, Medford ARL. Isolated colorectal mediastinal metastasis. QJM 2014; 107:473-4. [PMID: 22661543 DOI: 10.1093/qjmed/hcs089] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- A Jeyabalan
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - N Bhatt
- Department of Pathology, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, England, UK
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
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Founds SA, Ren D, Roberts JM, Jeyabalan A, Powers RW. Follistatin-like 3 across gestation in preeclampsia and uncomplicated pregnancies among lean and obese women. Reprod Sci 2014; 22:402-9. [PMID: 24700053 DOI: 10.1177/1933719114529372] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 11/16/2022]
Abstract
The purpose of this study was to examine circulating maternal follistatin-like 3 (FSTL-3) by gestational age and obesity in pregnancy and preeclampsia. FSTL-3 was quantified in maternal plasma collected in each trimester from prepregnancy body mass index-determined groups: 15 lean and 24 obese controls and 20 obese women who developed preeclampsia. Repeated measures mixed models and logistic regression were conducted (P ≤ .05). FSTL-3 was not related to maternal adiposity. FSTL-3 changed across pregnancy in lean controls and obese preeclampsia but not in obese controls. FSTL-3 was higher in preeclampsia in the second trimester compared to lean controls and in the third trimester compared to both control groups. Elevated FSTL-3 at mid-gestation was associated with an increased odds of preeclampsia (odds ratio 3.15; 95% confidence interval 1.19-8.36; P = .02). Elevated FSTL-3 concentrations were attributable to preeclampsia and were associated with increased likelihood of later developing preeclampsia, suggesting further study as a biomarker prior to clinically evident disease.
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Affiliation(s)
- Sandra A Founds
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA Magee-Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA Center for Research and Evaluation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James M Roberts
- Magee-Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, PA, USA Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA Clinical and Translational Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Magee-Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, PA, USA Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert W Powers
- Magee-Womens Research Institute and Foundation, University of Pittsburgh, Pittsburgh, PA, USA Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Jeyabalan A, Bhatt N, Edey AJ, West DG, Medford ARL. A node or not a node; that is the question? QJM 2014; 107:309-10. [PMID: 22661544 DOI: 10.1093/qjmed/hcs090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Xu L, Lee M, Jeyabalan A, Roberts JM. The relationship of hypovitaminosis D and IL-6 in preeclampsia. Am J Obstet Gynecol 2014; 210:149.e1-7. [PMID: 24080305 DOI: 10.1016/j.ajog.2013.09.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 06/18/2013] [Revised: 08/30/2013] [Accepted: 09/25/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Vitamin D deficiency has been linked to the pathogenesis of preeclampsia. Given the demonstrated antiinflammatory function of vitamin D in multiple organ systems including trophoblast cells and placenta, we hypothesized that vitamin D deficiency contributes to the development of preeclampsia through increased inflammation, as indicated by elevated interleukin (IL)-6 concentrations. STUDY DESIGN Plasma samples from a large preeclampsia cohort study were examined in 100 preeclamptic and 100 normotensive pregnant women. Comparisons of vitamin D and IL-6 concentrations used Student t test and χ(2) test or their nonparametric counterparts. A logistic regression model assessed the association among vitamin D, IL-6 concentrations, and preeclampsia risk. RESULTS The mean concentration of 25-hydroxyvitamin D was 49.4 ± 22.6 nmol/L in normotensives and 42.3 ± 17.3 nmol/L in preeclamptic women (P = .01). The median (interquartile range: Q1, Q3) concentrations of IL-6 were 2.0 (1.3, 3.4) pg/mL and 4.4 (2.2, 10.0) pg/mL in the control and preeclampsia groups, respectively (P < .01). We observed a significant association between IL-6 elevation and preeclampsia (odds ratio, 4.4; 95% confidence interval, 1.8-10.8; P < .01) and between vitamin D deficiency and preeclampsia (odds ratio, 4.2; 95% confidence interval, 1.4-12.8; P = .04). However, there was no association between vitamin D deficiency and IL-6 elevation. CONCLUSION Third-trimester IL-6 elevation and vitamin D deficiency were independently associated with the risk of preeclampsia. We found no evidence to support the hypothesis that vitamin D deficiency alters the pathogenesis of preeclampsia by activation of inflammation as assessed by IL-6 concentration.
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Affiliation(s)
- Lai Xu
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Minjae Lee
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, University of Texas Health Science Center, Houston, TX
| | - Arun Jeyabalan
- Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James M Roberts
- Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; Clinical and Translational Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Abstract
Preeclampsia is a pregnancy-specific disorder that affects 2-8% of all pregnancies and remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Diagnosis is based on new onset of hypertension and proteinuria. Multiple organ systems can be affected, with severe disease resulting. The wide range of risk factors reflects the heterogeneity of preeclampsia. Obesity, which is increasing at an alarming rate, is also a risk factor for preeclampsia as well as for later-life cardiovascular disease. Exploring common features may provide insight into the pathophysiologic mechanisms underlying preeclampsia among obese and overweight women.
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Affiliation(s)
- Arun Jeyabalan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- A Jeyabalan
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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Bell MJ, Roberts JM, Founds SA, Jeyabalan A, Terhorst L, Conley YP. Variation in endoglin pathway genes is associated with preeclampsia: a case-control candidate gene association study. BMC Pregnancy Childbirth 2013; 13:82. [PMID: 23548068 PMCID: PMC3651360 DOI: 10.1186/1471-2393-13-82] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 12/19/2012] [Accepted: 03/15/2013] [Indexed: 02/04/2023] Open
Abstract
Background Preeclampsia is a hypertensive, multi-system pregnancy disorder whose pathophysiology remains unclear. Elevations in circulating soluble endoglin (sENG) and placental/blood ENG mRNA expression antedate the clinical onset of preeclampsia. This study investigated if endoglin (ENG) pathway genetic variation was also associated with the development of preeclampsia. Methods We used a case–control candidate gene association design. Data from 355 white (181 preeclampsia cases/174 controls) and 60 black (30 preeclampsia cases/30 controls) women matched on ancestry, age, and parity were analyzed. Tagging single nucleotide polymorphisms (tSNPs) and potentially functional SNPs in ENG, TGFβ1, TGFβR1, ALK1, and TGFβR2 were genotyped with iPLEX® and TaqMan®. Chi-square or Fisher’s exact tests were used to conduct allele/genotype/haplotype tests in white/black subgroups separately. Odds ratios were computed with binary logistic regression for tSNPs with significant genotype tests. Results Of the 49 SNPs evaluated, variation in two ENG tSNPs (rs11792480, rs10121110) and one TGFβR2 tSNP (rs6550005) was associated with preeclampsia in white women (P <0.05, each). In black women, variation in two TGFβ1 tSNPs (rs4803455, rs4803457), one TGFβR1 tSNP (rs10739778), and three TGFβR2 tSNPs (rs6550005, rs1346907, rs877572) was associated with preeclampsia (P <0.05, each). Further evaluation of ENG tSNP rs10121110 revealed that white women inheriting the AA genotype were 2.29 times more likely to develop preeclampsia compared to the GG genotype (P = 0.008, [99% CI: 1.02 to 5.13]). For black women, similar evaluation of TGFβ1 tSNP rs4803457 revealed women inheriting the CT genotype were 7.44 times more likely to develop preeclampsia than those with the CC genotype (P = 0.005, [99% CI: 1.19 to 46.41]). Conclusions ENG pathway genetic variation is associated with preeclampsia. Different ENG pathway genes may be involved in preeclampsia development among white and black women. Additional studies are needed to validate these findings and to determine if genetic variation in ENG pathway genes impacts ENG and sENG levels in preeclampsia.
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Affiliation(s)
- Mandy J Bell
- University of Pittsburgh School of Nursing, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA 15261, USA.
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Schreurs MPH, Hubel CA, Bernstein IM, Jeyabalan A, Cipolla MJ. Increased oxidized low-density lipoprotein causes blood-brain barrier disruption in early-onset preeclampsia through LOX-1. FASEB J 2013; 27:1254-63. [PMID: 23230281 PMCID: PMC3574277 DOI: 10.1096/fj.12-222216] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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: 10/09/2012] [Accepted: 11/19/2012] [Indexed: 11/11/2022]
Abstract
Early-onset preeclampsia (EPE) is a severe form of preeclampsia that involves life-threatening neurological complications. However, the underlying mechanism by which EPE affects the maternal brain is not known. We hypothesized that plasma from women with EPE increases blood-brain barrier (BBB) permeability vs. plasma from women with late-onset preeclampsia (LPE) or normal pregnancy (NP) and investigated its underlying mechanism by perfusing cerebral veins from nonpregnant rats (n=6-7/group) with human plasma from women with EPE, LPE, or NP and measuring permeability. We show that plasma from women with EPE significantly increased BBB permeability vs. plasma from women with LPE or NP (P<0.001). BBB disruption in response to EPE plasma was due to a 260% increase of circulating oxidized LDL (oxLDL) binding to its receptor, LOX-1, and subsequent generation of peroxynitrite (P<0.001). A rat model with pathologically high lipid levels in pregnancy showed symptoms of preeclampsia, including elevated blood pressure, growth-restricted fetuses, and LOX-1-dependent BBB disruption, similar to EPE (P<0.05). Thus, we have identified LOX-1 activation by oxLDL and subsequent peroxynitrite generation as a novel mechanism by which disruption of the BBB occurs in EPE. As increased BBB permeability is a primary means by which seizure and other neurological symptoms ensue, our findings highlight oxLDL, LOX-1, and peroxynitrite as important therapeutic targets in EPE.
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Affiliation(s)
| | - Carl A. Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences and
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, and
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology, and Reproductive Sciences and
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn J. Cipolla
- Department of Neurology
- Department of Obstetrics, Gynecology, and Reproductive Sciences, and
- Department of Pharmacology, University of Vermont College of Medicine, Burlington, Vermont, USA; and
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Jeyabalan A, Lockman H. P71 Patient Satisfaction During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Performed Under Mild Conscious Sedation. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jeyabalan A, Medford ARL. S22 The Effect Of Needle Gauge On Characterisation Of Histology Samples At Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Abstract S22 Table 1. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Powers RW, Roberts JM, Plymire DA, Pucci D, Datwyler SA, Laird DM, Sogin DC, Jeyabalan A, Hubel CA, Gandley RE. Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia? Hypertension 2012; 60:239-46. [PMID: 22647886 DOI: 10.1161/hypertensionaha.112.191213] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia is a heterogeneous syndrome affecting 3% to 5% of all pregnancies. An imbalance of the antiangiogenic and proangiogenic factors, soluble receptor fms-like tyrosine kinase 1 and placental growth factor (PGF), is thought to contribute to the pathophysiology of preeclampsia. Maternal plasma PGF and soluble receptor fms-like tyrosine kinase 1 were quantified by specific immunoassays in cross-sectional samples from 130 preeclamptic subjects and 342 normotensive controls at delivery and longitudinally in samples from 50 women who developed preeclampsia and 250 normotensive controls. Among women who developed preeclampsia, 46% (n=23) evidenced a pattern of consistently low maternal PGF across pregnancy below the lower 95% CI of controls from 15 weeks' gestation to term. In contrast, the remaining 54% (n=27) of women who developed preeclampsia had maternal PGF concentrations similar to or above (n=7) those of normotensive controls. Subjects with low PGF across pregnancy who developed preeclampsia evidenced significantly higher blood pressure in early pregnancy (P<0.05) and, after diagnosis, earlier gestational age at delivery (P<0.05) and more preterm birth (P<0.05) compared with preeclamptic patients with high PGF. A significant subset of women who develop preeclampsia show evidence of consistently low PGF across pregnancy. Low PGF with preeclampsia was associated with preterm delivery compared with preeclamptic patients with high PGF. Identifying women with consistently low plasma PGF during pregnancy may provide a greater understanding of preeclampsia pathophysiology and may provide more focused research and clinical activities.
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Affiliation(s)
- Robert W Powers
- Department of Obstetrics, Gynecology, and Reproductive SciencesMagee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
Preeclampsia is a common and potentially lethal pregnancy disorder with lifelong increased risk of cardiovascular disease in survivors. Our prior global gene expression microarray analysis led to a novel set of 36 candidates in first trimester placentas of women who subsequently developed preeclampsia. In this report, we present preliminary studies demonstrating biomarkers of genotype and methylation variations in a subset of these candidate genes in maternal leukocyte and fetoplacental DNA of 28 case and 27 control dyads. We tested 84 single nucleotide polymorphisms (SNPs) using MassArray iPLEX and 50 CpG sites using EpiTYPER assays. Promising prediction modeling was identified with 25 SNPs selected using Fisher's exact tests (p ≤ 0.05) and 20 CpG sites selected on fold change. Genotype Distribution Analysis identified SNP variations that differed between nine paired cases versus paired controls. The findings validate the examined candidate genes and support feasibility of methods for further biomarker development. The integrative approach that was implemented begins to translate the 36 candidates toward clinical utility as a screening modality for preeclampsia.
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Affiliation(s)
- Sandra A Founds
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Rajakumar A, Cerdeira AS, Rana S, Zsengeller Z, Edmunds L, Jeyabalan A, Hubel CA, Stillman IE, Parikh SM, Karumanchi SA. Transcriptionally active syncytial aggregates in the maternal circulation may contribute to circulating soluble fms-like tyrosine kinase 1 in preeclampsia. Hypertension 2012; 59:256-64. [PMID: 22215706 DOI: 10.1161/hypertensionaha.111.182170] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cardinal manifestations of the pregnancy-specific disorder preeclampsia, new-onset hypertension, and proteinuria that resolve with placental delivery have been linked to an extracellular protein made by the placenta, soluble fms-like tyrosine kinase 1 (sFlt1), that injures the maternal vasculature. However, the mechanisms by which sFlt1, which is heavily matrix bound, gain access to the systemic circulation remain unclear. Here we report that the preeclamptic placenta's outermost layer, the syncytiotrophoblast, forms abundant "knots" that are enriched with sFlt1 protein. These syncytial knots easily detach from the syncytiotrophoblast, resulting in free, multinucleated aggregates (50-150 μm diameter) that are loaded with sFlt1 protein and mRNA, are metabolically active, and are capable of de novo gene transcription and translation. At least 25% of the measurable sFlt1 in the third-trimester maternal plasma is bound to circulating placental microparticles. We conclude that detachment of syncytial knots from the placenta results in free, transcriptionally active syncytial aggregates that represent an autonomous source of sFlt1 delivery into the maternal circulation. The process of syncytial knot formation, shedding of syncytial aggregates, and appearance of placental microparticles in the maternal circulation appears to be greatly accelerated in preeclampsia and may contribute to the maternal vascular injury that characterizes this disorder.
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Affiliation(s)
- Augustine Rajakumar
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Samuel A, Lin C, Parviainen K, Jeyabalan A. Expectant management of preeclampsia superimposed on chronic hypertension. J Matern Fetal Neonatal Med 2010; 24:907-11. [DOI: 10.3109/14767058.2010.535874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jeyabalan A, Pillai A, Smith S, Darby M, Ibrahim N, Maskell NA. P193 The value of a regional mesothelioma multidisciplinary team meeting--an audit. Thorax 2010. [DOI: 10.1136/thx.2010.151043.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rajakumar A, Chu T, Handley DE, Bunce KD, Burke B, Hubel CA, Jeyabalan A, Peters DG. Maternal gene expression profiling during pregnancy and preeclampsia in human peripheral blood mononuclear cells. Placenta 2010; 32:70-8. [PMID: 21075447 DOI: 10.1016/j.placenta.2010.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 01/04/2023]
Abstract
UNLABELLED Preeclampsia is a major obstetrical complication affecting maternal and fetal health. While it is clear that there is a substantial placental contribution to preeclampsia pathogenesis, the maternal contribution is less well characterized. We therefore performed a genome-wide transcriptome analysis to explore disease-associated changes in maternal gene expression patterns in peripheral blood mononuclear cells (PBMCs). METHODS Preeclampsia was defined as gestational hypertension, proteinuria and hyperurecimia. Total RNA was isolated from PBMCs obtained from women with uncomplicated pregnancies (n = 5) and women with preeclamptic pregnancies (n = 5). Gene expression analysis was carried out using Agilent oligonucleotide microarrays. Biological pathway analysis was undertaken using Ingenuity Pathway Analysis software. Quantitative real-time PCR (QRTPCR) was performed to validate the gene expression changes of selected genes in normotensive and preeclamptic patients (n = 12 each). RESULTS We identified a total of 368 genes that were differentially expressed in women with preeclampsia compared to normal controls with false discovery rate (FDR) controlled at 10%. In follow up experiments we further analyzed the expression levels of a number of genes that were identified as altered by the microarray data including survivin (BIRC5), caveolin (CAV1), GATA binding protein-1 (GATA1), signal tranducer and activator of transcription 1 (STAT1), E2F transcription factor-1 (E2F1), fibronectin-1 (FN1), interleukin-4 (IL-4), matrix metalloprotease-9 (MMP-9) and WAP four disulfide domain protein (WFDC-1) by QRTPCR. Additionally we performed immuno blot analysis and zymography to verify some of these candidate genes at the protein level. Computational analysis of gene function identified an anti-proliferative and altered immune function cellular phenotype in severe preeclamptic samples. CONCLUSIONS We have characterized the genome-wide mRNA expression changes associated with preeclampsia-specific genes in circulating maternal blood cells at the time of delivery. In addition to providing information relating to the biological basis of the preeclampsia phenotype, our data provide a number of potential biomarkers for use in the further characterization of this disease.
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Affiliation(s)
- A Rajakumar
- Divisions of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Abstract
BACKGROUND The goal of this study was to further validate eight candidate genes identified in a microarray analysis of first trimester placentas in preeclampsia. MATERIAL AND METHOD Surplus chorionic villus sampling (CVS) specimens of 4 women subsequently diagnosed with preeclampsia (PE) and 8 control women (C) without preeclampsia analyzed previously by microarray and 24 independent additional control samples (AS) were submitted for confirmatory studies by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS Downregulation was significant in FSTL3 in PE as compared to C and AS (p = .04). PAEP was downregulated, but the difference was only significant between C and AS (p = .002) rather than between PE and either of the control groups. Expression levels for CFH, EPAS1, IGFBP1, MMP12, and SEMA3C were not statistically different among groups, but trends were consistent with microarray results; there was no anti-correlation. S100A8 was not measurable in all samples, probably because different probes and primers were needed. CONCLUSIONS This study corroborates reduced FSTL3 expression in the first trimester of preeclampsia. Nonsignificant trends in the other genes may require follow-up in studies powered for medium or medium/large effect sizes. qRT-PCR verification of the prior microarray of CVS may support the placental origins of preeclampsia hypothesis. Replication is needed for the candidate genes as potential biomarkers of susceptibility, early detection, and/or individualized care of maternal-infant preeclampsia.
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Affiliation(s)
- Sandra A Founds
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
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Jeyabalan A, Powers RW, Clifton RG, Van Dorsten P, Hauth JC, Klebanoff MA, Lindheimer MD, Sibai B, Landon M, Miodovnik M. Effect of smoking on circulating angiogenic factors in high risk pregnancies. PLoS One 2010; 5:e13270. [PMID: 20967275 PMCID: PMC2953508 DOI: 10.1371/journal.pone.0013270] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 06/14/2010] [Accepted: 09/04/2010] [Indexed: 11/18/2022] Open
Abstract
Objective Changes in maternal concentrations of the anti-angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng), and the pro-angiogenic placental growth factor (PlGF) precede the development of preeclampsia in healthy women. The risk of preeclampsia is reduced in women who smoke during pregnancy. The objective of this study was to investigate whether smoking affects concentrations of angiogenic factors (sFlt1, PlGF, and sEng) in women at high risk for developing preeclampsia. Study Design We performed a secondary analysis of serum samples from 993 high-risk women (chronic hypertension, diabetes, multifetal gestation, and previous preeclampsia) in a preeclampsia prevention trial. sFlt1, sEng and PlGF were measured in serum samples obtained at study entry, which was prior to initiation of aspirin (median 19.0 weeks' [interquartile range of 16.0–22.6 weeks']). Smoking status was determined by self-report. Results sFlt1 was not significantly different in smokers from any high-risk groups compared to their nonsmoking counterparts. PlGF was higher among smokers compared to nonsmokers among diabetic women (142.7 [77.4–337.3] vs 95.9 [48.5–180.7] pg/ml, p = 0.005) and women with a history of preeclampsia (252.2 [137.1–486.0] vs 152.2 [73.6–253.7] pg/ml, p = 0.001). sEng was lower in smokers with multifetal gestations (5.8 [4.6–6.5] vs 6.8 [5.5–8.7] ng/ml, p = 0.002) and trended lower among smokers with diabetes (4.9 [3.8–5.6] vs 5.3 [4.3–6.3] ng/ml, p = 0.05). Smoking was not associated with a lower incidence of preeclampsia in any of these groups. Conclusions In certain high-risk groups, smoking is associated with changes in the concentrations of these factors towards a pro-angiogenic direction during early pregnancy; however, there was no apparent association between smoking and the development of preeclampsia in our cohort.
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Affiliation(s)
- Arun Jeyabalan
- Department of Obstetrics, Gynecology and Women's Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
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Powers R, Roberts J, Plymire D, Pucci D, Datwyler S, Laird D, Sogin D, Jeyabalan A, Gandley R. M15.4 Low maternal PlGF across pregnancy identifies a subset of women with preterm preeclampsia; type 1 vs. type 2 preeclampsia? Pregnancy Hypertens 2010. [DOI: 10.1016/s2210-7789(10)60065-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Powers R, Roberts J, Jeyabalan A, Gandley R, Hubel C. W6.4 Plasma ADMA is elevated throughout pregnancy in women who develop preeclampsia and is accentuated by pre-pregnancy obesity. Pregnancy Hypertens 2010. [DOI: 10.1016/s2210-7789(10)60129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Powers R, Roberts J, Plymire D, Pucci D, Datwyler S, Laird D, Sogin D, Jeyabalan A, Gandley R. W6.2 High prepregnancy body mass index is associated with low PlGF in preeclampsia and uncomplicated pregnancies. Pregnancy Hypertens 2010. [DOI: 10.1016/s2210-7789(10)60127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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