1
|
Esposito M, Gatto M, Cipolla MJ, Bernstein IM, Mandalà M. Dilation of Pregnant Rat Uterine Arteries with Phenols from Extra Virgin Olive Oil Is Endothelium-Dependent and Involves Calcium and Potassium Channels. Cells 2024; 13:619. [PMID: 38607058 PMCID: PMC11011993 DOI: 10.3390/cells13070619] [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: 03/08/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
During pregnancy, uterine vasculature undergoes significant circumferential growth to increase uterine blood flow, vital for the growing feto-placental unit. However, this process is often compromised in conditions like maternal high blood pressure, particularly in preeclampsia (PE), leading to fetal growth impairment. Currently, there is no cure for PE, partly due to the adverse effects of anti-hypertensive drugs on maternal and fetal health. This study aimed to investigate the vasodilator effect of extra virgin olive oil (EVOO) phenols on the reproductive vasculature, potentially benefiting both mother and fetus. Isolated uterine arteries (UAs) from pregnant rats were tested with EVOO phenols in a pressurized myograph. To elucidate the underlying mechanisms, additional experiments were conducted with specific inhibitors: L-NAME/L-NNA (10-4 M) for nitric oxide synthases, ODQ (10-5 M) for guanylate cyclase, Verapamil (10-5 M) for the L-type calcium channel, Ryanodine (10-5 M) + 2-APB (3 × 10-5 M) for ryanodine and the inositol triphosphate receptors, respectively, and Paxilline (10-5 M) for the large-conductance calcium-activated potassium channel. The results indicated that EVOO-phenols activate Ca2+ signaling pathways, generating nitric oxide, inducing vasodilation via cGMP and BKCa2+ signals in smooth muscle cells. This study suggests the potential use of EVOO phenols to prevent utero-placental blood flow restriction, offering a promising avenue for managing PE.
Collapse
Affiliation(s)
- Milena Esposito
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
| | - Mariacarmela Gatto
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
| | - Marilyn J. Cipolla
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
| | - Ira M. Bernstein
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
| | - Maurizio Mandalà
- Department of Biology, Ecology & Earth Science, University of Calabria, 87036 Arcavacata di Rende, CS, Italy; (M.E.); (M.G.)
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Larner College of Medicine, Burlington, VT 05405, USA;
| |
Collapse
|
2
|
McBride CA, Russom Z, Bernstein IM, Dumas JA. Subclinical Metabolic and Cardiovascular Factors and Brain White Matter Microstructural Integrity in Young Women. Reprod Sci 2024:10.1007/s43032-024-01516-9. [PMID: 38565839 DOI: 10.1007/s43032-024-01516-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Women who have experienced pregnancy complications, specifically preeclampsia and gestational diabetes, have well documented increased risks of cardiovascular, metabolic, and neurological disease later in life. This study examined how specific cardiovascular and metabolic risk factors for preeclampsia assessed in a non-pregnant state were associated with brain white matter microstructural integrity. This study examined sixty-two healthy women (mean age 31 ± 5 years) who received metabolic and cardiovascular assessments as well as multiple modality MRI imaging. Participants were either nulliparous (n = 31) or had a history of preterm preeclampsia (n = 31). Imaging included acquisition Diffusion Tensor Imaging (DTI) to assess white matter integrity within the brain. We hypothesized that healthy, young, non-pregnant women with cardiovascular and metabolic profiles suggesting elevated risk would have decreased white matter integrity, represented by lower Fractional Anisotropy (FA) and increased Mean Diffusivity (MD) estimates in the posterior cortical areas of the brain. We observed increased white matter degradation (lower FA and increased MD) in posterior and occipital tracts, commissural fibers, and subcortical structures in women with increased adiposity, worse measures of cardiovascular and metabolic function, including greater insulin resistance (HOMA-IR), hyperlipidemia, elevated blood pressure, and increased arterial stiffness. The relationships detected between subclinical cardiovascular and metabolic phenotypes and increased white matter disruption at a young age, outside of pregnancy, are indicative that adverse changes are detectable long before cognitive clinical presentation. This may suggest that many of the long-term cardiovascular and metabolic risks of aging are influenced by physiologic aging trajectories rather than damage caused by pregnancy complications.
Collapse
Affiliation(s)
- Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Zane Russom
- Department of Psychiatry, University of Vermont Larner College of Medicine, 1 South Prospect St, Burlington, VT, 05401, USA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Julie A Dumas
- Department of Psychiatry, University of Vermont Larner College of Medicine, 1 South Prospect St, Burlington, VT, 05401, USA.
| |
Collapse
|
3
|
Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, Forgues-Lackie MA, Facco FL, Gernand AD, Graves CR, Jeyabalan A, Hauspurg A, Manuck TA, Myers JE, Powell TM, Sutton EF, Tinker E, Tsigas E, Myatt L. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol 2023; 229:193-213. [PMID: 37120055 DOI: 10.1016/j.ajog.2023.04.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that affects 250,000 pregnant individuals in the United States and approximately 10 million worldwide per annum. Preeclampsia is associated with substantial immediate morbidity and mortality but also long-term morbidity for both mother and offspring. It is now clearly established that a low dose of aspirin given daily, beginning early in pregnancy modestly reduces the occurrence of preeclampsia. Low-dose aspirin seems safe, but because there is a paucity of information about long-term effects on the infant, it is not recommended for all pregnant individuals. Thus, several expert groups have identified clinical factors that indicate sufficient risk to recommend low-dose aspirin preventive therapy. These risk factors may be complemented by biochemical and/or biophysical tests that either indicate increased probability of preeclampsia in individuals with clinical risk factors, or more importantly, identify increased likelihood in those without other evident risk. In addition, the opportunity exists to provide this population with additional care that may prevent or mitigate the short- and long-term effects of preeclampsia. Patient and provider education, increased surveillance, behavioral modification, and other approaches to improve outcomes in these individuals can improve the chance of a healthy outcome. We assembled a group with diverse, relevant expertise (clinicians, investigators, advocates, and public and private stakeholders) to develop a care plan in which providers and pregnant individuals at risk can work together to reduce the risk of preeclampsia and associated morbidities. The plan is for care of individuals at moderate to high risk for developing preeclampsia, sufficient to receive low-dose aspirin therapy, as identified by clinical and/or laboratory findings. The recommendations are presented using the GRADE methodology with the quality of evidence upon which each is based. In addition, printable appendices with concise summaries of the care plan's recommendations for patients and healthcare providers are provided. We believe that this shared approach to care will facilitate prevention of preeclampsia and its attendant short- and long-term morbidity in patients identified as at risk for development of this disorder.
Collapse
Affiliation(s)
- James M Roberts
- Magee-Womens Research Institute and Clinical and Translational Science Institute, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
| | - Tekoa L King
- School of Nursing, University of California, San Francisco, Oakland, CA
| | - John R Barton
- Maternal-Fetal Medicine, Baptist Health, Lexington, KY
| | - Stacy Beck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT
| | | | | | - Francesca L Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alison D Gernand
- Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Cornelia R Graves
- Division of Maternal-Fetal Medicine, University of Tennessee College of Medicine, Nashville, TN
| | - Arundhati Jeyabalan
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Tracy A Manuck
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jenny E Myers
- Division of Developmental Biology and Medicine, University of Manchester, Manchester, United Kingdom
| | - Trashaun M Powell
- National Racial Disparity Taskforce, Preeclampsia Foundation and New Jersey Family Planning League, Somerset, NJ
| | | | | | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| |
Collapse
|
4
|
McBride CA, Russom Z, Achenbach E, Bernstein IM, Dumas JA. Cardiovascular profiles associated with white matter hyperintensities in healthy young women. Front Physiol 2023; 13:979899. [PMID: 36714317 PMCID: PMC9880329 DOI: 10.3389/fphys.2022.979899] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Women who experience hypertension in pregnancy have increased risk of both chronic hypertension and dementia. High blood pressure is associated with increased evidence of white matter hyperintensities (WMH) in brain imaging. WMH are disruptions of the white matter of the brain that occur with demyelination and axonal degeneration, are associated with vascular disease, occur more frequently in people with hypertension, and are associated with cognitive impairment. We evaluated the relationship between WMH and subclinical cardiovascular function in healthy young nulliparous women and women with a history of early-onset preeclampsia. Sixty-two reproductive-aged women were assessed during the follicular phase of the menstrual cycle after a 3-day sodium/potassium-controlled diet. Half of participants had a history of early-onset preeclampsia, and half were nulliparous. Blood was drawn to assess inflammatory markers. Cardiovascular assessments included tonometric blood pressure monitoring, volume loading to assess vascular compliance, echocardiography to assess cardiac ejection time, brachial pulse wave velocity of the brachial artery, assessing cardiovascular stiffness, and brachial artery flow mediated vasodilation to assess endothelial mediated dilatory response. T2 fluid-attenuated inversion recovery (FLAIR) MRI imaging was obtained. Two raters, blinded to cardiovascular assessments and pregnancy history, reviewed MRI scans for evidence of WMH using the Fazekas rating scale. WMHs were detected in 17 women; 45 had normal white matter structure. Participants with Fazekas score>0 had exaggerated response to volume loading compared to women with a Fazekas score of 0 and longer cardiac ejection times. Fazekas scores >0 had lower brachial flow-mediated vasodilation and increased white blood count compared to those with no evidence of WMH. Women with WMH had reduced cardiovascular compliance, and a trend towards decreased endothelial responsiveness compared to those without WMH. These data demonstrated that the relationship between cardiovascular and brain health was detectable in young, healthy, reproductive-aged women, and may play a role in later development of clinical disease. These findings may help identify women who are at risk for cognitive decline and pathological aging.
Collapse
Affiliation(s)
- Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States,*Correspondence: Carole A. McBride,
| | - Zane Russom
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ella Achenbach
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Julie A. Dumas
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| |
Collapse
|
5
|
Testo A, McBride C, Bernstein IM, Dumas J. Corrigendum: Preeclampsia and its relationship to pathological brain aging. Front Physiol 2022; 13:1096042. [PMID: 36579025 PMCID: PMC9791248 DOI: 10.3389/fphys.2022.1096042] [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: 11/11/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fphys.2022.979547.].
Collapse
Affiliation(s)
- Abigail Testo
- Neuroscience Graduate Program, University of Vermont, Burlington, VT, United States
| | - Carole McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Julie Dumas
- Department of Psychiatry Larner College of Medicine, University of Vermont, Burlington, VT, United States,*Correspondence: Julie Dumas,
| |
Collapse
|
6
|
Higgins ST, Nighbor TD, Kurti AN, Heil SH, Slade EP, Shepard DS, Solomon LJ, Lynch ME, Johnson HK, Markesich C, Rippberger PL, Skelly JM, DeSarno M, Bunn J, Hammond JB, Roemhildt ML, Williams RK, O'Reilly DM, Bernstein IM. Randomized Controlled Trial Examining the Efficacy of Adding Financial Incentives to Best practices for Smoking Cessation Among pregnant and Newly postpartum Women. Prev Med 2022; 165:107012. [PMID: 35248683 PMCID: PMC9440164 DOI: 10.1016/j.ypmed.2022.107012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
Abstract
We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women. Participants included 169 women assigned to best practices (BP) or BP plus financial incentives (BP + FI) for smoking cessation available through 12-weeks postpartum. A third condition included 80 never-smokers (NS) sociodemographically-matched to women who smoked. Trial setting was Burlington, Vermont, USA, January, 2014 through January, 2020. Outcomes included 7-day point-prevalence abstinence antepartum and postpartum, and birth and other infant outcomes during 1st year of life. Reliability and external validity of results were assessed using pooled results from the current and four prior controlled trials coupled with data on maternal-smoking status and birth outcomes for all 2019 singleton live births in Vermont. Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32-29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37-13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05-5.75) although not 24- (AOR = 1.31; CI,0.54-3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55-3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk. Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210832.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Allison N Kurti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Johns Hopkins University School of Nursing, United States of America
| | - Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Laura J Solomon
- Department of Family Medicine, Psychology Emerita, University of Vermont, United States of America
| | - Mary Ellen Lynch
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Harley K Johnson
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Catherine Markesich
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Peter L Rippberger
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Joan M Skelly
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Janice Bunn
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | | | | | | | - Deirdre M O'Reilly
- Department of Pediatrics, University of Vermont, United States of America
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, United States of America
| |
Collapse
|
7
|
Testo AA, McBride C, Bernstein IM, Dumas JA. Preeclampsia and its relationship to pathological brain aging. Front Physiol 2022; 13:979547. [PMID: 36324311 PMCID: PMC9618619 DOI: 10.3389/fphys.2022.979547] [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: 06/27/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022] Open
Abstract
The development of preeclampsia during pregnancy may have long-term effects on brain aging in women. Associations between preeclampsia and vascular dementia have been established, however the connection between preeclampsia and Alzheimer's disease has not been as thoroughly explored. Both preeclampsia and Alzheimer's disease have been associated with misfolded amyloid beta proteins and inflammation; due to these similarities, in this minireview, we examined the potential links between a history of preeclampsia and the development of dementia. We also discussed how hypertensive disorders of pregnancy may relate to both normal brain aging and dementia to highlight the need for additional research regarding the long-term cognitive effects of preeclampsia on the brain.
Collapse
Affiliation(s)
- Abigail A. Testo
- Neuroscience Graduate Program, University of Vermont, Burlington, VT, United States
| | - Carole McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States
| | - Julie A. Dumas
- Department of Psychiatry Larner College of Medicine, University of Vermont, Burlington, VT, United States,*Correspondence: Julie A. Dumas,
| |
Collapse
|
8
|
McBride CA, Bernstein IM, Sybenga AB, McLean KC, Orfeo T, Bravo MC. Placental Maternal Vascular Malperfusion is Associated with Prepregnancy and Early Pregnancy Maternal Cardiovascular and Thrombotic Profiles. Reprod Med (Basel) 2022; 3:50-61. [PMID: 36923963 PMCID: PMC10012330 DOI: 10.3390/reprodmed3010006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Characteristics of maternal vascular malperfusion (MVM) are frequently observed in placentas from pregnancies impacted by preeclampsia, intrauterine growth restriction, preterm labor, and intrauterine fetal demise. We sought to evaluate the associations of features of MVM with subclinical measures of cardiovascular health and coagulation potential in healthy young women. Sixty-three healthy young women were recruited and assessed prior to pregnancy on cycle day 9 ± 4, at gestational age 90 ± 6 of early pregnancy, and gestational age 216 ± 5 of late pregnancy. Women were assessed for plasma volume, blood pressure, response to volume loading, cardiac output, and uterine hemodynamics. Platelet-poor plasma was collected to assess thrombin generation on a subset of 33 women at all time points. Following delivery, placentas were collected and analyzed for evidence of MVM. Thrombin generation (TG) was evaluated in the presence of tissue factor (TF) with and without recombinant soluble thrombomodulin (TM). For each, we compared TG lagtime, peak level, and endogenous thrombin potential (ETP). Comparisons were made between dichotomized presence and absence of each individual feature of MVM and cardiovascular and coagulation features. Mean ± standard deviation are presented. Women were 31 ± 4 years of age, body mass index of 24 ± 5 kg/m2, 86% white race, and 80% nulliparous. MVM occurred in 70% of placentas, with infarcts and agglutination (44%), decidual arteriopathy (40%), accelerated villous maturation (32%), placental hypoplasia (29%), and distal villous hypoplasia (17%) documented. Decidual arteriopathy and distal villous hypoplasia were associated with prepregnancy maternal physiology, including decreased plasma volume and subclinical cardiovascular variations. All assessed MVM characteristics had identifiable early pregnancy physiologic characteristics consistent with altered cardiovascular function and decreased uterine response to pregnancy when compared with women who did and did not develop MVM. Accelerated villous maturation was the only MVM feature to differ by thrombin generation parameters in early pregnancy. Thrombin generation potential and blood pressure were elevated in late pregnancy in women who developed decidual arteriopathy. Prepregnancy health status and adaptation to pregnancy play important roles in pregnancy outcomes. Both cardiovascular health and thrombin generation potential may influence early placentation. Longitudinal assessment of subclinical maternal factors may allow for better understanding of the etiologies of MVM lesions, as well as allow for identification of a timeline of the origins of placental pathologies.
Collapse
Affiliation(s)
- Carole A McBride
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
- Correspondence:
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Amelia B Sybenga
- Department of Pathology, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Kelley C McLean
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Thomas Orfeo
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Maria Cristina Bravo
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| |
Collapse
|
9
|
Psoinos RBC, Morris EA, McBride CA, Bernstein IM. Association of pre-pregnancy subclinical insulin resistance with cardiac dysfunction in healthy nulliparous women. Pregnancy Hypertens 2021; 26:11-16. [PMID: 34392165 DOI: 10.1016/j.preghy.2021.07.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/11/2021] [Accepted: 07/19/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate the association between pre-pregnancy subclinical insulin resistance and cardiovascular dysfunction in healthy nulliparous women, and with hypertension in subsequent pregnancy. STUDY DESIGN Secondary analysis of a single center prospective observational study conducted November 2011-June 2014. Healthy nulliparous women underwent detailed cardiovascular and metabolic assessment. Insulin resistance was determined by homeostasis model assessment (HOMA-IR). Associations of HOMA-IR with metabolic and cardiovascular measurements were assessed with Spearman correlations. Charts were reviewed in women who conceived singleton pregnancies. MAIN OUTCOME MEASURES Metabolic measurements included serum glucose, insulin, creatinine, CRP, and lipids. HOMA-IR was calculated using fasting serum insulin and glucose. Indices of cardiovascular stiffness were determined from pulse wave velocity and response to volume challenge. Pregnancy outcomes included delivery mode and gestational age, birthweight, and hypertension. RESULTS HOMA-IR was positively associated with BMI (r = 0.462, p < 0.001), body fat percentile (r = 0.463, p < 0.001), CRP (r = 0.364, p = 0.003), and negatively associated with serum HDL (r = -0.38, p = 0.002) and creatinine (r = -0.242, p = 0.049). HOMA-IR was positively associated with blood pressure (r = 0.347, p = 0.004), resting heart rate (r = 0.433, p = <0.001), response to volume challenge (r = 0.325, p < 0.01). Increased HOMA-IR was associated with a faster cardiac ejection time in response to volume challenge (r = -0.415, p < 0.001), which is a marker of decreased cardiac compliance to volume increase, or cardiac stiffness. CONCLUSION HOMA-IR is associated with pre-pregnancy cardiac stiffness. Cholesterol was not associated with cardiovascular dysfunction. A non-significant trend was observed between HOMA-IR and hypertension in subsequent pregnancy.
Collapse
Affiliation(s)
- Rachel B C Psoinos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington VT 05401, United States.
| | - Erin A Morris
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington VT 05401, United States
| | - Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington VT 05401, United States
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington VT 05401, United States
| |
Collapse
|
10
|
Williams FB, McBride CA, Badger GJ, Bernstein IM. Measures of adiposity correlate with renal filtration in young nulliparous women: An observational cohort study. Obes Sci Pract 2020; 6:70-75. [PMID: 32128244 PMCID: PMC7042107 DOI: 10.1002/osp4.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/09/2019] [Accepted: 09/28/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Renal hyperfiltration, which has been documented in severe obesity and obesity-associated hypertension, can occur with hypertensive disorders of pregnancy. Identification of prepregnancy risk factors for unrecognized renal hyperfiltration could inform screening and intervention strategies to protect against pregnancy complications. In young, healthy, nulliparous women, associations between associations between measures of adiposity, insulin resistance, and renal vascular resistance were thus evaluated. METHODS This is a secondary analysis of a prospective observational trial characterizing associations of prepregnancy and late-pregnancy maternal physiology. Seventy-nine nulligravid women aged 18-42 years without major medical conditions were assessed for percent android body fat using dual-energy X-ray absorption. Renal cortical vessel blood flow resistance index (CVRI) was determined using Doppler ultrasonography. Creatinine clearance was calculated from 24-hour urine collection. RESULTS Renal CVRI inversely correlates with body mass index (r = -0.23, p = 0.047), percent android fat (r = -0.30, p = 0.008), and supine pulse (r = -0.44, p < 0.001). Creatinine clearance is positively associated with BMI and HOMA-IR.In regression modeling, supine pulse (r2 = 0.22, p < 0.001) and cardiac index (r2 = 0.05, p = 0.045) predict renal CVRI, whereas HOMA-IR (r2 = 0.11, p = 0.008) and cardiac output (r2 = 0.06, p = 0.039) predict creatinine clearance. Measures of adiposity are not independently predictive of either measure. CONCLUSIONS In healthy young women, measures of adiposity and insulin resistance correlate positively with renal filtration. Preclinical manifestations of renal hyperfiltration may have implications for pregnancy outcomes.
Collapse
Affiliation(s)
- Frank B. Williams
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Gary J. Badger
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Services, Larner College of MedicineUniversity of VermontBurlingtonVermont
| |
Collapse
|
11
|
Cooper KM, Barrett T, McBride CA, Badger GJ, Steiner J, LeWinter MM, Bernstein IM. Subclinical cardiac stiffness is associated with arterial stiffness in healthy young nulligravid women: Potential links to preeclampsia. Pregnancy Hypertens 2019; 18:49-54. [PMID: 31525709 DOI: 10.1016/j.preghy.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/05/2019] [Accepted: 09/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Preeclampsia is an independent risk factor for subsequent cardiovascular disease and diastolic dysfunction and has been linked to arterial stiffness. We hypothesized that arterial stiffness would be associated with echocardiographic markers of diastolic dysfunction in healthy nulligravid women. STUDY DESIGN 31 healthy nulligravid women underwent assessment of peripheral arterial stiffness via aorto-femoral pulse wave velocity, popliteal distensibility and β stiffness measures as well as hemodynamic response to volume challenge. 22 underwent cardiac assessment via conventional and stress echocardiography with a focus on diastolic function utilizing tissue/pulse wave Doppler imaging and 3D speckle tracking. Bivariate associations between variables were evaluated using correlation coefficients (Pearson r) and Student's t-tests. RESULTS No participants had echocardiographic values meeting criteria for overt diastolic dysfunction. Baseline global circumferential strain was significantly correlated with distensibility and β stiffness (n = 18, r = -0.61, p = 0.007, n = 18, r = 0.56, p = 0.01). Peak deceleration time was correlated with βstiffness (n = 9; r = 0.80, p = 0.01). Pulse wave velocity was not significantly correlated with cardiac measures (p > 0.05). Family history of a first or second degree relative with myocardial infarction or hypertension was associated with decreased popliteal artery distensibility (p = 0.02 and p = 0.03, respectively). CONCLUSIONS In healthy nulligravid women there is evidence that markers of decreased left ventricular relaxation are associated with increased peripheral vascular stiffness as is a family history of myocardial infarction or hypertension. These findings raise the possibility that the diastolic dysfunction and arterial stiffness observed in the setting of preeclampsia are driven by underlying properties present prior to pregnancy and contribute to lifetime cardiovascular risk.
Collapse
Affiliation(s)
- Kylie M Cooper
- Maternal Fetal Medicine, St. Luke's Health System, Boise, ID, United States.
| | - Trace Barrett
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont, Burlington, VT, United States.
| | - Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States.
| | - Gary J Badger
- Medical Biostatistics, University of Vermont Robert Larner M.D. College of Medicine, Burlington, VT, United States.
| | - Johannes Steiner
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont, Burlington, VT, United States.
| | - Martin M LeWinter
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont, Burlington, VT, United States.
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, United States.
| |
Collapse
|
12
|
Phillips JK, Skelly JM, Roberts LM, Bernstein IM, Higgins ST. Combined financial incentives and behavioral weight management to enhance adherence with gestational weight gain guidelines: a randomized controlled trial. Am J Obstet Gynecol MFM 2019; 1:42-49. [PMID: 33319756 DOI: 10.1016/j.ajogmf.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/14/2019] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Excessive gestational weight gain, particularly among overweight and obese women, is associated with adverse perinatal outcomes. Current interventions to limit gestational weight gain have achieved only modest success. OBJECTIVE We sought to improve adherence to gestational weight gain guidelines with a dual intervention of financial incentives and antenatal behavioral weight management. STUDY DESIGN This was a prospective randomized controlled trial at a single academic medical center in which women were assigned randomly to the intervention group or standard care. The primary outcome was adherence to gestational weight gain guidelines. Secondary outcomes included total gestational weight gain, mode of delivery, birthweight, neonatal intensive care unit admission, and development of gestational diabetes mellitus and hypertensive disorders of pregnancy. RESULTS A total of 136 women were assigned randomly, with data available for analysis of 124 women. Gestational weight gain within the Institutes of Medicine guidelines was similar (30% vs 29%) in the intervention and standard care groups, respectively. There were no statistically significant differences in total gestational weight gain or perinatal outcomes. There was a nonstatistically significant decrease in macrosomia in the intervention compared with standard care condition. CONCLUSION A combined financial incentive and behavioral weight management intervention did not improve adherence to gestational weight gain guidelines. Modifications to the intervention may achieve improved results.
Collapse
Affiliation(s)
- Julie K Phillips
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT.
| | - Joan M Skelly
- Department of Medical Biostatistics, University of Vermont Larner College of Medicine, Burlington, VT
| | - Lorinda M Roberts
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT; Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT; Department of Psychological Science, University of Vermont Larner College of Medicine, Burlington, VT
| |
Collapse
|
13
|
Ehret DEY, Edwards EM, Greenberg LT, Bernstein IM, Buzas JS, Soll RF, Horbar JD. Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks' Gestation. JAMA Netw Open 2018; 1:e183235. [PMID: 30646235 PMCID: PMC6324435 DOI: 10.1001/jamanetworkopen.2018.3235] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Although evidence of antenatal steroids (ANS) efficacy at 22 to 25 weeks' gestation is limited, increasingly these infants are treated with postnatal life support. OBJECTIVES To estimate the proportion of infants receiving postnatal life support at 22 to 25 weeks' gestation who had exposure to ANS, and to examine if the provision of ANS was associated with a higher rate of survival to hospital discharge and survival without major morbidities. DESIGN, SETTING, AND PARTICIPANTS This multicenter observational cohort study consisted of 33 472 eligible infants liveborn at 431 US Vermont Oxford Network member hospitals between January 1, 2012, and December 31, 2016. We excluded infants with recognized syndromes or major congenital anomalies. Of the eligible infants, 29 932 received postnatal life support and were included in the analyses. Data analysis was conducted from July 2017 to July 2018. EXPOSURE Antenatal steroids administered to the mother at any time prior to delivery. MAIN OUTCOMES AND MEASURES Survival to hospital discharge, major morbidities among survivors, and the composite of survival to discharge without major morbidities. RESULTS Among 29 932 infants who received postnatal life support, 51.9% were male, with a mean (SD) gestational age of 24.12 (0.86) weeks and mean (SD) birth weight of 668 (140) g; 26 090 (87.2%) had ANS exposure and 3842 (12.8%) had no ANS exposure. Survival to hospital discharge was higher for infants with ANS exposure (18 717 of 25 892 [72.3%]) compared with infants without ANS exposure (1981 of 3820 [51.9%]); the adjusted risk ratio for 22 weeks was 2.11 (95% CI, 1.68-2.65), for 23 weeks was 1.54 (95% CI, 1.40-1.70), for 24 weeks was 1.18 (95% CI, 1.12-1.25), and for 25 weeks was 1.11 (95% CI, 1.07-1.14). Survival to hospital discharge without major morbidities was higher for infants with ANS exposure (3777 of 25 833 [14.6%]) compared with infants without ANS exposure (347 of 3806 [9.1%]); the adjusted risk ratio for 22 through 25 weeks was 1.67 (95% CI, 1.49-1.87). CONCLUSIONS AND RELEVANCE Concordant receipt of ANS and postnatal life support was associated with significantly higher survival and survival without major morbidities at 22 through 25 weeks' gestation compared with life support alone. Although statistically higher with ANS, survival without major morbidities remains low at 22 and 23 weeks. There is an opportunity to reevaluate national obstetric guidelines, allowing for shared decision making at the edge of viability with concordant obstetrical and neonatal treatment plans.
Collapse
Affiliation(s)
- Danielle E. Y. Ehret
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington
| | | | - Ira M. Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Services, Robert Larner College of Medicine, University of Vermont, Burlington
| | - Jeffrey S. Buzas
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington
| | - Roger F. Soll
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
| | - Jeffrey D. Horbar
- Vermont Oxford Network, Burlington, Vermont
- Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington
| |
Collapse
|
14
|
Cooper KM, Bernstein IM, Skelly JM, Heil SH, Higgins ST. The Independent Contribution of Uterine Blood Flow to Birth Weight and Body Composition in Smoking Mothers. Am J Perinatol 2018; 35:521-526. [PMID: 29183095 DOI: 10.1055/s-0037-1608810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aims to evaluate the relationship of maternal smoking to uterine artery hemodynamics and examine independent contributions to birth weight and fetal body composition. STUDY DESIGN Women were enrolled in a prospective randomized controlled study targeting smoking abstinence. Uterine artery Doppler ultrasound was performed and volumetric blood flow was calculated. Third trimester ultrasound estimates of fetal body composition were performed and birth weight was recorded. RESULTS Uterine artery volumetric flow and resistance index (RI) were significantly correlated with birth weight adjusted for gestational age (R = 0.35, p = 0.002; R = - 0.27, p = 0.02). Volumetric flow was significantly associated with fetal fat mass (R = 0.30, p = 0.018). Smoking status did not have significant effects on lean body mass (t [61] = 0.60, p = 0.55), fat mass (t [61] = 1.67, p = 0.10), or volumetric flow (t = 0.86, df = 87, p = 0.39). Stepwise regression identified volumetric flow (β = 0.81, 95% confidence interval [CI]: 0.35-1.27, p < 0.001), maternal prepregnancy body mass index (β = 16.04, 95% CI: 2.57-29.50, p = 0.02), and fetal sex (β = 346.28, 95% CI: -532.64 to 159.91, p < 0.001, where male = 0 and female = 1) as independent contributors to birth weight adjusted for gestational age. CONCLUSION No direct relationship of smoking to uterine artery hemodynamics was demonstrated. Volumetric flow was an independent contributor to birth weight and was associated with fetal fat deposition, while smoking was not independently associated with either outcome.
Collapse
Affiliation(s)
- Kylie M Cooper
- Department of Maternal Fetal Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont
| | - Joan M Skelly
- Department of Biostatistician, Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Sarah H Heil
- Department of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
| | - Stephen T Higgins
- Department of Psychiatry, University of Vermont, Burlington, Vermont
| |
Collapse
|
15
|
Sites CK, Wilson D, Barsky M, Bernson D, Bernstein IM, Boulet S, Zhang Y. Embryo cryopreservation and preeclampsia risk. Fertil Steril 2017; 108:784-790. [PMID: 28974308 PMCID: PMC10999961 DOI: 10.1016/j.fertnstert.2017.08.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 05/08/2017] [Revised: 08/09/2017] [Accepted: 08/25/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether assisted reproductive technology (ART) cycles involving cryopreserved-warmed embryos are associated with the development of preeclampsia. DESIGN Retrospective cohort study. SETTING IVF clinics and hospitals. PATIENT(S) A total of 15,937 births from ART: 9,417 singleton and 6,520 twin. INTERVENTION(S) We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data, considering resident singleton and twin births from autologous or donor eggs from 2005-2010. MAIN OUTCOME MEASURE(S) We compared the frequency of preeclampsia diagnosis for cryopreserved-warmed versus fresh ET and used multivariable logistic regression to adjust for confounders. RESULT(S) Among pregnancies conceived with autologous eggs resulting in singletons, preeclampsia was greater after cryopreserved-warmed versus fresh ET (7.51% vs. 4.29%, adjusted odds ratio = 2.17 [95% CI 1.67-2.82]). Preeclampsia without and with severe features, preeclampsia with preterm delivery, and chronic hypertension with superimposed preeclampsia were more frequent after cryopreserved-warmed versus fresh ET (3.99% vs. 2.55%; 2.95% vs. 1.41%; 2.76 vs. 1.48%; and 0.95% vs. 0.43%, respectively). Among pregnancies from autologous eggs resulting in twins, the frequency of preeclampsia with severe features (9.26% vs. 5.70%) and preeclampsia with preterm delivery (14.81% vs. 11.74%) was higher after cryopreserved versus fresh transfers. Among donor egg pregnancies, rates of preeclampsia did not differ significantly between cryopreserved-warmed and fresh ET (10.78% vs. 12.13% for singletons and 28.0% vs. 25.15% for twins). CONCLUSION(S) Among ART pregnancies conceived using autologous eggs resulting in live births, those involving transfer of cryopreserved-warmed embryos, as compared with fresh ETs, had increased risk for preeclampsia with severe features and preeclampsia with preterm delivery.
Collapse
Affiliation(s)
- Cynthia K Sites
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts.
| | - Donna Wilson
- Department of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts
| | - Maya Barsky
- Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Ira M Bernstein
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Sheree Boulet
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yujia Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
16
|
Abstract
OBJECTIVE Preeclampsia generally occurs in first pregnancies and tends not to recur when the interpregnancy interval (IPI) is short. We hypothesized that, in women experiencing preeclampsia in their first pregnancy, the difference in mean arterial pressure (MAP) across pregnancy between their index and subsequent pregnancy would be inversely associated with the length of time between pregnancies and that the interval between pregnancies will be directly associated with the likelihood of preeclampsia recurrence. METHODS This was a retrospective chart review evaluating 171 women diagnosed with preeclampsia during their first pregnancy who had a subsequent pregnancy at our institution. Blood pressures were collected from each pregnancy, marking the recurrence of hypertensive disorders, including preeclampsia. Antepartum MAP was compared between pregnancies, examining differences as a function of IPI. RESULTS There was a significant association of IPI with the reduction in MAP between pregnancies across trimesters ( P = .04), but this reduction became smaller over time. The MAP during the third trimester decreased significantly between pregnancies across all patient groups (IPI <24 months: -5.7 mm Hg, P < .0001; IPI 24-48 months: -4.5 mm Hg, P < .0001; IPI >48 months -3.4 mm Hg, P = .03). The recurrence rate of preeclampsia did not vary significantly with IPI ( P = .21). CONCLUSION The IPI influences the MAP of the second pregnancy in women with prior preeclampsia. Shorter IPI is associated with a greater reduction in MAP when compared to the longer IPI. Although there was a trend toward higher preeclampsia recurrence with longer IPI, this trend did not reach statistical significance.
Collapse
Affiliation(s)
- Lindsay Howe
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Erica Hammer
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Gary Badger
- 2 Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Ira M Bernstein
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| |
Collapse
|
17
|
McBride CA, Bernstein IM, Badger GJ, Soll RF. Maternal Hypertension and Mortality in Small for Gestational Age 22- to 29-Week Infants. Reprod Sci 2017; 25:276-280. [DOI: 10.1177/1933719117711260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Roger F. Soll
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| |
Collapse
|
18
|
Phillips JK, Skelly JM, King SE, Bernstein IM, Higgins ST. Associations of maternal obesity and smoking status with perinatal outcomes. J Matern Fetal Neonatal Med 2017; 31:1620-1626. [PMID: 28438062 DOI: 10.1080/14767058.2017.1322950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maternal obesity and smoking are associated with adverse perinatal outcomes. These prevalent conditions contribute to health disparities. In this study, we examine whether maternal BMI moderates the impact of smoking cessation on short-term perinatal outcomes. This is a secondary analysis of assessments conducted from several prospective clinical trials examining the efficacy of incentives to promote smoking cessation during pregnancy. Participants were randomly assigned to receive financial incentives contingent upon smoking abstinence or a control condition. Pregnancy outcomes were abstracted from the medical record. ANCOVA and multiple logistic regression were used for statistical analysis. Among 388 women, there was a significant interaction between maternal pre-pregnancy BMI and smoking status on gestational age at delivery (p = .03) and admission to the NICU (p = .04). Among underweight/normal weight gravidas, smoking resulted in earlier deliveries and a greater likelihood of NICU admission than in those who abstained. Among overweight/obese gravidas, there was no effect of smoking on gestational age at delivery and infants of smokers were less likely to be admitted to the NICU. Maternal obesity and smoking have significant individual effects on perinatal outcome. Maternal overweight/obesity appears to moderate the effect of smoking on gestational age at delivery and on NICU admissions.
Collapse
Affiliation(s)
- Julie K Phillips
- a Vermont Center on Behavior and Health , University of Vermont , Burlington , VT , USA.,b Department of Obstetrics, Gynecology, and Reproductive Sciences , University of Vermont , Burlington , VT , USA
| | - Joan M Skelly
- c Department of Medical Biostatistics , University of Vermont , Burlington , VT , USA
| | - Sarah E King
- b Department of Obstetrics, Gynecology, and Reproductive Sciences , University of Vermont , Burlington , VT , USA
| | - Ira M Bernstein
- a Vermont Center on Behavior and Health , University of Vermont , Burlington , VT , USA.,b Department of Obstetrics, Gynecology, and Reproductive Sciences , University of Vermont , Burlington , VT , USA
| | - Stephen T Higgins
- a Vermont Center on Behavior and Health , University of Vermont , Burlington , VT , USA.,d Department of Psychiatry , University of Vermont , Burlington , VT , USA.,e Department of Psychological Science , University of Vermont , Burlington , VT , USA
| |
Collapse
|
19
|
Morris EA, Bernstein IM. Re: Endothelial dysfunction and vascular stiffness in women with previous pregnancy complicated by early or late pre-eclampsia. R. Orabona, E. Sciatti, E. Vizzardi, I. Bonadei and A. Valcamonico. Ultrasound Obstet Gynecol 2017; 49: 116-123. Ultrasound Obstet Gynecol 2017; 49:22-23. [PMID: 28058790 DOI: 10.1002/uog.17374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- E A Morris
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, and Women's Health Care Services, University of Vermont Medical Center, Burlington, VT, USA
| | - I M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, and Women's Health Care Services, University of Vermont Medical Center, Burlington, VT, USA
| |
Collapse
|
20
|
Chase VL, McBride CA, Badger G, Morris EA, Bernstein IM. 934: Association of pre-pregnancy and longitudinal change in angiotensin-II with preterm preeclampsia. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.843] [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: 10/20/2022]
|
21
|
Damron DP, Bernstein IM, Shapiro RE, Schonberg A. Uterine Blood Flow Response to Alpha-Adrenergic Blockade in Nulligravid Women of Reproductive Age. ACTA ACUST UNITED AC 2016; 11:388-92. [PMID: 15350252 DOI: 10.1016/j.jsgi.2004.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Elevated uterine artery resistance has been associated with the development of preeclampsia. We sought to determine if the human uterine arterial circulation was more sensitive to alpha-adrenergic blockade than a control vascular bed. METHODS We studied 38 healthy nulliparous women during the follicular phase of the menstrual cycle. Arteriolized venous blood was measured for plasma epinephrine and norepinephrine. Doppler ultrasound of the uterine and upper extremity radial artery was performed before and after intravenous administration of phentolamine. Heart rate and volumetric flow were calculated. Data are presented as means +/- SD. RESULTS Mean heart rate before and after administration of phentolamine was 63 +/- 11 and 68 +/- 12 beats per minute (7.5% increase, P <.001). Mean radial artery blood flow before and after administration of phentolamine was 4.6 +/- 4.7 mL/min and 5.8 +/- 5.9 mL/min (19.9% increase, P =.071). Mean uterine blood flow before and administration of phentolamine was 15.4 +/- 10.1 mL/min and 27.3 +/- 17.5 mL/min (43.7% increase, P <.001). The uterine response (43.7% increase) and radial response (19.9% increase) were significantly different (P <.001). The increase in uterine blood flow after phentolamine administration was linked with resting norepinephrine (r = 0.394, P =.063). CONCLUSION We found evidence that uterine alpha-adrenergic tone is more sensitive to blockade by phentolamine than upper extremity radial circulation. This provides evidence for a differential responsiveness and sensitivity to alpha-adrenergic blockade in different vascular beds. We theorize that the increased adrenergic tone associated with preeclampsia may contribute disproportionately to decreased uterine blood flow.
Collapse
Affiliation(s)
- Dana P Damron
- Department of Obstetrics-Gyencology, University of Vermont College of Medicine, Burlington, Vermont, USA.
| | | | | | | |
Collapse
|
22
|
Phillips JK, McBride CA, Hale SA, Solomon RJ, Badger GJ, Bernstein IM. Examination of Prepregnancy and Pregnancy Urinary Protein Levels in Healthy Nulliparous Women. Reprod Sci 2016; 24:407-412. [PMID: 27460407 DOI: 10.1177/1933719116657198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/17/2022]
Abstract
During pregnancy, abnormal proteinuria is defined as urine protein excretion greater than 300 mg/24 h. Although widely accepted, this definition is not based on clinical outcomes. Our study aimed to longitudinally examine proteinuria in healthy women prior to, and in late pregnancy and to compare inpatient and outpatient 24-hour urine collections. Nulliparous women planning to conceive were recruited and completed a 24-hour urinary collection. Those who subsequently conceived completed a second 24-hour urinary collection in late pregnancy. In the first 5 years of the study, urinary collections were completed during an inpatient admission; all collections during the latter part of the study were performed as outpatients. Urine protein was measured using the VITROS UPRO Slide kit. Wilcoxon signed rank tests were used for paired comparisons of prepregnancy and late pregnancy proteinuria and Wilcoxon rank sum tests were used to compare inpatient and outpatient collections. Among 134 women completing a prepregnancy collection, median urinary protein excretion was 188 mg/24 h (IQR 103-280). Sixty-five women subsequently conceived and completed a late pregnancy collection. In healthy women, urinary protein increased to 254 mg/24 h during pregnancy (IQR 166-396). Forty-five percent of women exceeded the defined normal threshold of proteinuria in 24 hours in the absence of disease. Inpatient collections resulted in higher levels of urinary protein than outpatient at both time points. Our data suggest that significant proteinuria is present in healthy nonpregnant women. Even in the absence of disease, proteinuria increases during pregnancy. Outpatient collections may underestimate proteinuria, especially in late pregnancy.
Collapse
Affiliation(s)
- Julie K Phillips
- 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Carole A McBride
- 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sarah A Hale
- 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Richard J Solomon
- 2 Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Gary J Badger
- 3 Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Ira M Bernstein
- 1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| |
Collapse
|
23
|
Bernstein IM, Hale SA, Badger GJ, McBride CA. Differences in cardiovascular function comparing prior preeclamptics with nulliparous controls. Pregnancy Hypertens 2016; 6:320-326. [PMID: 27939476 DOI: 10.1016/j.preghy.2016.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 03/22/2016] [Revised: 06/30/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the current study was to evaluate cardiovascular function; including blood pressure, cardiac output, pulse wave velocity and vascular compliance in nonpregnant nulliparous women compared to women with a history of preterm preeclampsia. STUDY DESIGN This was a case control study. Blood pressure was measured using the Finapres Pro. Baseline cardiac output was determined by echocardiography. Pulse wave velocity was estimated using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow. During volume challenge, 500mL of lactated Ringers solution was infused through an indwelling antecubital catheter over 10min. Cardiac output and blood pressure during and 15min after the infusion were estimated using the Finapres Pro. MAIN OUTCOME MEASURES Indices of arterial stiffness and vascular compliance. RESULTS Previous preeclamptics exhibited a significant increase in pulse pressure and cardiac output in response to volume challenge when compared with nulliparous controls. Prior preeclamptics had a strong positive correlation between blood pressure indices (r=0.50-0.68, p⩽0.01) and pulse pressure (r=0.58, P=0.008) with pulse wave velocity that was not evident in control women. CONCLUSIONS In women with prior preterm preeclampsia a relationship between blood pressure, intravascular volume and arterial stiffness, is evident in the nonpregnant state and in the absence of hypertension or overt cardiovascular disease. This supports an overarching hypothesis that nonpregnant physiology is an important contributor to pregnancy adaptations.
Collapse
Affiliation(s)
- Ira M Bernstein
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States.
| | - Sarah A Hale
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05405, United States
| | - Carole A McBride
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT 05405, United States
| |
Collapse
|
24
|
Tourville TW, Shultz SJ, Vacek PM, Knudsen EJ, Bernstein IM, Tourville KJ, Hardy DM, Johnson RJ, Slauterbeck JR, Beynnon BD. Evaluation of an Algorithm to Predict Menstrual-Cycle Phase at the Time of Injury. J Athl Train 2016; 51:47-56. [PMID: 26807868 DOI: 10.4085/1062-6050-51.3.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Women are 2 to 8 times more likely to sustain an anterior cruciate ligament (ACL) injury than men, and previous studies indicated an increased risk for injury during the preovulatory phase of the menstrual cycle (MC). However, investigations of risk rely on retrospective classification of MC phase, and no tools for this have been validated. OBJECTIVE To evaluate the accuracy of an algorithm for retrospectively classifying MC phase at the time of a mock injury based on MC history and salivary progesterone (P4) concentration. DESIGN Descriptive laboratory study. SETTING Research laboratory. PARTICIPANTS Thirty-one healthy female collegiate athletes (age range, 18-24 years) provided serum or saliva (or both) samples at 8 visits over 1 complete MC. MAIN OUTCOME MEASURE(S) Self-reported MC information was obtained on a randomized date (1-45 days) after mock injury, which is the typical timeframe in which researchers have access to ACL-injured study participants. The MC phase was classified using the algorithm as applied in a stand-alone computational fashion and also by 4 clinical experts using the algorithm and additional subjective hormonal history information to help inform their decision. To assess algorithm accuracy, phase classifications were compared with the actual MC phase at the time of mock injury (ascertained using urinary luteinizing hormone tests and serial serum P4 samples). Clinical expert and computed classifications were compared using κ statistics. RESULTS Fourteen participants (45%) experienced anovulatory cycles. The algorithm correctly classified MC phase for 23 participants (74%): 22 (76%) of 29 who were preovulatory/anovulatory and 1 (50%) of 2 who were postovulatory. Agreement between expert and algorithm classifications ranged from 80.6% (κ = 0.50) to 93% (κ = 0.83). Classifications based on same-day saliva sample and optimal P4 threshold were the same as those based on MC history alone (87.1% correct). Algorithm accuracy varied during the MC but at no time were both sensitivity and specificity levels acceptable. CONCLUSIONS These findings raise concerns about the accuracy of previous retrospective MC-phase classification systems, particularly in a population with a high occurrence of anovulatory cycles.
Collapse
Affiliation(s)
- Timothy W Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont, Burlington
| | | | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - Kelly J Tourville
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington
| | - Daniel M Hardy
- Department of Cell Biology and Biochemistry, Texas Tech University, Lubbock
| | - Robert J Johnson
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - James R Slauterbeck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington
| | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington
| |
Collapse
|
25
|
Supple JS, McBride C, Badger GJ, Morris EA, Bernstein IM. 682: Sympathetic responsiveness and subsequent hypertension in pregnancy. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.729] [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: 11/25/2022]
|
26
|
McBride CA, Bernstein IM, Badger GJ, Horbar JD, Soll RF. The effect of maternal hypertension on mortality in infants 22, 29weeks gestation. Pregnancy Hypertens 2015; 5:362-6. [PMID: 26597755 DOI: 10.1016/j.preghy.2015.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effect of maternal hypertension on mortality risk prior to discharge, in infants 22+0 to 29+6weeks gestational age. STUDY DESIGN We evaluated 88,275 North American infants whose births were recorded in Vermont Oxford Network centers between 2008 and 2011 Infants born between 22+0 and 29+6weeks gestational age were evaluated in 2-week gestational age cohorts and followed until death or discharge. Logistic regression was used to adjust for birth weight, antenatal steroid exposure, infant sex, maternal race, inborn/outborn, prenatal care and birth year. RESULTS 21,896 infants were born to hypertensive mothers; 13% died prior to Neonatal Intensive Care Unit discharge compared to 20% of the 66,379 infants born to mothers without hypertension. After adjustment, infants had significantly lower mortality compared to preterm infants not born to hypertensive mothers, at all gestational ages examined (22/23: odds ratio (OR)=0.65 (95% Confidence Interval (CI): 0.55, 0.77; 24/25); OR=0.77 (95% CI: 0.71, 0.84); 26/27: OR=0.66 (95% CI: 0.59, 0.74); 28/29: OR=0.58 (95% CI: 0.51, 0.67). Additionally, births associated with maternal hypertension increase dramatically by gestational age, resulting in a larger proportion of births associated with maternal hypertension at later gestational ages. CONCLUSIONS Preterm birth due to any cause carries significant risk of mortality, especially at the earliest of viable gestational ages. Maternal hypertension independently influences mortality, with lower odds of mortality seen in infants born to hypertensive mothers, after adjustment, and should be taken into consideration as an element in counseling parents.
Collapse
Affiliation(s)
- Carole A McBride
- University of Vermont, Department of Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT 05405, United States.
| | - Ira M Bernstein
- University of Vermont, Department of Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
| | - Gary J Badger
- University of Vermont, Department of Medical Biostatistics, Burlington, VT 05405, United States
| | - Jeffrey D Horbar
- University of Vermont, Department of Pediatrics, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
| | - Roger F Soll
- University of Vermont, Department of Pediatrics, Burlington, VT 05405, United States; Vermont Oxford Network, Burlington, VT 05401, United States
| |
Collapse
|
27
|
Morris EA, Hale SA, Badger GJ, Magness RR, Bernstein IM. Pregnancy induces persistent changes in vascular compliance in primiparous women. Am J Obstet Gynecol 2015; 212:633.e1-6. [PMID: 25576820 DOI: 10.1016/j.ajog.2015.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/01/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pregnancy induces rapid, progressive, and substantial changes to the cardiovascular system. The low recurrence risk of preeclampsia, despite familial predisposition, suggests an adaptation associated with pregnancy that attenuates the risk for subsequent preeclampsia. We aimed to evaluate the persistent effect of pregnancy on maternal cardiovascular physiology. STUDY DESIGN Forty-five healthy nulliparous women underwent baseline cardiovascular assessment before conception and repeated an average of 30 months later. After baseline evaluation, 17 women conceived singleton pregnancies and all delivered at term. The remaining 28 women comprised the nonpregnant control group. We measured mean arterial blood pressure, cardiac output, plasma volume, pulse wave velocity, uterine blood flow, and flow-mediated vasodilation at each visit. RESULTS There was a significant decrease in mean arterial pressure from the prepregnancy visit to postpartum in women with an interval pregnancy (prepregnancy, 85.3±1.8; postpartum, 80.5±1.8 mm Hg), with no change in nonpregnant control subjects (visit 1, 80.3±1.4; visit 2, 82.8±1.4 mm Hg) (P=.002). Pulse wave velocity was significantly decreased in women with an interval pregnancy (prepregnancy, 2.73±0.05; postpartum, 2.49±0.05 m/s), as compared with those without an interval pregnancy (visit 1, 2.56±0.04; visit 2, 2.50±0.04 m/s) (P=.005). We did not observe a residual effect of pregnancy on cardiac output, plasma volume, uterine blood flow, or flow-mediated vasodilation. CONCLUSION Our observations of decreased mean arterial pressure and reduced arterial stiffness following pregnancy suggest a significant favorable effect of pregnancy on maternal cardiovascular remodeling. These findings may represent a mechanism by which preeclampsia risk is reduced in subsequent pregnancies.
Collapse
|
28
|
Higgins ST, Washio Y, Lopez AA, Heil SH, Solomon LJ, Lynch ME, Hanson JD, Higgins TM, Skelly JM, Redner R, Bernstein IM. Examining two different schedules of financial incentives for smoking cessation among pregnant women. Prev Med 2014; 68:51-7. [PMID: 24704135 PMCID: PMC4183736 DOI: 10.1016/j.ypmed.2014.03.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 11/08/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs. The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt. METHOD 118 pregnant smokers in greater Burlington, Vermont (studied December, 2006-June, 2012) were randomly assigned to the revised contingent voucher (RCV) or usual contingent voucher (CV) schedule of abstinence-contingent vouchers, or to a non-contingent voucher (NCV) control condition wherein vouchers were provided independent of smoking status. Smoking status was biochemically verified; serial sonographic estimates of fetal growth were obtained at gestational weeks 30-34. RESULTS RCV and CV conditions increased point-prevalence abstinence above NCV levels at early (RCV: 40%, CV: 46%, NCV: 13%, p=.007) and late-pregnancy (RCV: 45%; CV: 36%; NCV, 18%; p=.04) assessments, but abstinence levels did not differ between the RCV and CV conditions. The RCV intervention did not increase fetal growth above control levels while the CV condition did so (p<.05). CONCLUSION This trial further supports the efficacy of CV for increasing antepartum abstinence and fetal growth, but other strategies (e.g., increasing overall incentive values) will be necessary to improve outcomes further.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Yukiko Washio
- Department of Psychiatry, University of Vermont, USA
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | | | - Mary Ellen Lynch
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | | | | | - Joan M Skelly
- Department of Medical Biostatistics, University of Vermont, USA
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA
| |
Collapse
|
29
|
Heil SH, Herrmann ES, Badger GJ, Solomon LJ, Bernstein IM, Higgins ST. Examining the timing of changes in cigarette smoking upon learning of pregnancy. Prev Med 2014; 68:58-61. [PMID: 25016042 PMCID: PMC4252916 DOI: 10.1016/j.ypmed.2014.06.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 02/01/2014] [Revised: 06/28/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE AND METHOD Timeline Follow-back interviews were conducted with 107 pregnant women enrolling in smoking cessation and relapse prevention clinical trials in the Burlington, VT area between 2006 and 2009 to examine the time course of changes in smoking between learning of pregnancy and the first prenatal care visit. We know of no systematic studies of this topic. RESULTS Women reported learning of pregnancy at 5.1±2.2 weeks gestation and attending a first prenatal care visit at 10.1±3.6 weeks gestation. In the intervening five weeks, 22% of women became abstainers, 62% reduced their smoking, and 16% maintained or increased their smoking. Women who made changes typically reported doing so within the first 2 days after learning of pregnancy, with few changes occurring beyond the first week after learning of pregnancy. CONCLUSION In this first effort to systematically characterize the time course of changes in smoking upon learning of pregnancy, the majority of pregnant smokers who quit or made reductions reported doing so soon after receiving the news. Further research is needed to assess the reliability of these results and to examine whether devising strategies to provide early interventions for women who continue smoking after learning of pregnancy is warranted.
Collapse
Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, USA
| | | | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| |
Collapse
|
30
|
Buhimschi IA, Nayeri UA, Zhao G, Shook LL, Pensalfini A, Funai EF, Bernstein IM, Glabe CG, Buhimschi CS. Protein misfolding, congophilia, oligomerization, and defective amyloid processing in preeclampsia. Sci Transl Med 2014; 6:245ra92. [DOI: 10.1126/scitranslmed.3008808] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Preeclampsia is a pregnancy-specific disorder of unknown etiology and a leading contributor to maternal and perinatal morbidity and mortality worldwide. Because there is no cure other than delivery, preeclampsia is the leading cause of iatrogenic preterm birth. We show that preeclampsia shares pathophysiologic features with recognized protein misfolding disorders. These features include urine congophilia (affinity for the amyloidophilic dye Congo red), affinity for conformational state–dependent antibodies, and dysregulation of prototype proteolytic enzymes involved in amyloid precursor protein (APP) processing. Assessment of global protein misfolding load in pregnancy based on urine congophilia (Congo red dot test) carries diagnostic and prognostic potential for preeclampsia. We used conformational state–dependent antibodies to demonstrate the presence of generic supramolecular assemblies (prefibrillar oligomers and annular protofibrils), which vary in quantitative and qualitative representation with preeclampsia severity. In the first attempt to characterize the preeclampsia misfoldome, we report that the urine congophilic material includes proteoforms of ceruloplasmin, immunoglobulin free light chains, SERPINA1, albumin, interferon-inducible protein 6-16, and Alzheimer’s β-amyloid. The human placenta abundantly expresses APP along with prototype APP-processing enzymes, of which the α-secretase ADAM10, the β-secretases BACE1 and BACE2, and the γ-secretase presenilin-1 were all up-regulated in preeclampsia. The presence of β-amyloid aggregates in placentas of women with preeclampsia and fetal growth restriction further supports the notion that this condition should join the growing list of protein conformational disorders. If these aggregates play a pathophysiologic role, our findings may lead to treatment for preeclampsia.
Collapse
|
31
|
Vurbic D, Higgins ST, McDonough SR, Skelly JM, Bernstein IM. Maternal body mass index moderates the influence of smoking cessation on breast feeding. Nicotine Tob Res 2013; 16:527-35. [PMID: 24203932 DOI: 10.1093/ntr/ntt173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoking cessation is associated with greater breast feeding in newly postpartum women, while being overweight or obese is associated with lower rates of breast feeding. The purpose of this study is to examine whether the increases in breast feeding associated with smoking cessation are moderated by maternal body mass index (BMI). To our knowledge, the interaction of maternal smoking status and overweight/obesity on breast feeding has not been previously reported. METHODS Participants (N = 370) were current or recent smokers at the start of prenatal care who participated in controlled trials on smoking cessation or relapse prevention during/after pregnancy. Study participants were followed from the start of prenatal care through 24 weeks postpartum. Smoking status was biochemically verified, and maternal reports of breast feeding were collected at 2-, 4-, 8-, 12-, and 24-week postpartum assessments. RESULTS Women who reported postpartum smoking abstinence or had a normal/underweight prepregnancy BMI (<25) were more likely to be breast feeding at the time that smoking status was ascertained (odds ratio [OR] = 3.02, confidence interval [CI] = 2.09-4.36, and OR = 2.07, CI = 1.37-3.12, respectively). However, smoking status and BMI interacted such that (a) normal/underweight women showed a stronger association between smoking abstinence and breast feeding (OR = 4.58, CI = 2.73-7.66) than overweight/obese women (OR = 1.89, CI = 1.11-3.23), and (b) abstainers showed an association between normal/underweight BMI and breast feeding (OR = 3.53, CI = 1.96-6.37), but smokers did not (OR = 1.46, CI = 0.88-2.44). CONCLUSIONS Overweight/obesity attenuates the positive relationship between smoking abstinence and greater breast feeding among newly postpartum women.
Collapse
Affiliation(s)
- Drina Vurbic
- Department of Psychiatry, University of Vermont, Burlington, VT
| | | | | | | | | |
Collapse
|
32
|
McBride CA, Hale SA, Subramanian M, Badger GJ, Bernstein IM. The relationship of a family history for hypertension, myocardial infarction, or stroke with cardiovascular physiology in young women. Reprod Sci 2013; 21:509-16. [PMID: 24023034 DOI: 10.1177/1933719113503402] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease (CVD) and preeclampsia share several pathophysiologic risk factors. We examined family history (FH) and physiologic status in 60 healthy, nulliparous women to determine the relationship between FH and known risk factors for CVD. Data are presented as mean ± standard error (SE). Decreased uterine blood flow was observed in women with FH of hypertension (+FH: 21.5 ± 1.7, no FH: 33.3 ± 9.0 mL/min; P = .04). Women reporting an FH of stroke showed increased alpha- and beta-adrenergic response, as measured by Valsalva maneuver (α: FH: 24.7 ± 1.9, -FH: 18.9 ± 1.1 mm Hg, P = .02; β: FH: 22.0 ± 2.1, -FH: 16.9 ± 1.4 mm Hg; P = .04), and increased cardiac output (4.83 ± 0.22 vs 4.31 ± 0.12 L/min; P = .01). We identified no significant physiologic associations linked to an FH of myocardial infarction. Our observations show significant differences in physiologic characteristics in women with specific CVD family histories. These data, coupled with known heritable contributions to CVD and preeclampsia, suggest a distinct physiologic phenotype that may link preeclampsia risk with FH of CVD, independent of pregnancy.
Collapse
Affiliation(s)
- Carole A McBride
- 1University of Vermont, Departments of Obstetrics, Gynecology and Reproductive Sciences, Burlington, VT, USA
| | | | | | | | | |
Collapse
|
33
|
Hale SA, Badger GJ, McBride C, Magness R, Bernstein IM. Prepregnancy Vascular Dysfunction in Women who Subsequently Develop Hypertension During Pregnancy. Pregnancy Hypertens 2013; 3:140-145. [PMID: 23772359 DOI: 10.1016/j.preghy.2013.01.006] [Citation(s) in RCA: 20] [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] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate vascular dysfunction using both physiologic measures and biochemical markers, longitudinally, prior to and during pregnancy, in nulliparous women who had uncomplicated pregnancies compared to those who developed complicated hypertension during pregnancy. METHODS Twenty healthy nulliparous women were studied during the follicular phase and in early (EP) and late (LP) pregnancy. All had singleton conceptions and delivered at term, seventeen with uncomplicated pregnancies (NP) and three who developed complicated hypertension (HP) after the LP evaluation. We compared prepregnancy, EP and LP pulse wave velocity (PWV) and soluble vascular cell adhesion molecule (sVCAM-1) between the NP and HP groups. PWV was measured using ultrasound and simultaneous echocardiogram tracing then calculated as the estimated distance divided by interval between EKG r-wave peak and peak brachial artery flow. SVCAM-1 was measured using a commercially available kit. Data are means ± SE, significance accepted as p < 0.05. RESULTS The NP group had significantly lower prepregnant PWV (NP: 2.66 ± 0.06 m/s, HP: 3.00 ± 0.04, p=.02), but PWV was not different at the EP or LP time points. SVCAM-1 was significantly lower prior to pregnancy and during EP and LP in the NP group (Prepregnancy: NP: 712 ± 32 ng/mL, HP: 1058 ± 107, p < .001; EP: NP: 695 ± 31 ng/mL, HP: 924 ± 52, p = .004; LP: NP: 663 ± 25 ng/mL, HP: 946 ± 36, p < .001). CONCLUSIONS PWV and sVCAM-1 may be important prepregnancy discriminators useful in assessing risk for preeclampsia prior to pregnancy.
Collapse
Affiliation(s)
- Sarah A Hale
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT, United States, 05405
| | | | | | | | | |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Foley JH, Orfeo T, Undas A, McLean KC, Bernstein IM, Rivard GE, Mann KG, Everse SJ, Brummel-Ziedins KE. From principle to practice: bridging the gap in patient profiling. PLoS One 2013; 8:e54728. [PMID: 23372761 PMCID: PMC3556038 DOI: 10.1371/journal.pone.0054728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/14/2012] [Indexed: 12/20/2022] Open
Abstract
The standard clinical coagulation assays, activated partial thromboplastin time (aPTT) and prothrombin time (PT) cannot predict thrombotic or bleeding risk. Since thrombin generation is central to haemorrhage control and when unregulated, is the likely cause of thrombosis, thrombin generation assays (TGA) have gained acceptance as "global assays" of haemostasis. These assays generate an enormous amount of data including four key thrombin parameters (lag time, maximum rate, peak and total thrombin) that may change to varying degrees over time in longitudinal studies. Currently, each thrombin parameter is averaged and presented individually in a table, bar graph or box plot; no method exists to visualize comprehensive thrombin generation data over time. To address this need, we have created a method that visualizes all four thrombin parameters simultaneously and can be animated to evaluate how thrombin generation changes over time. This method uses all thrombin parameters to intrinsically rank individuals based on their haemostatic status. The thrombin generation parameters can be derived empirically using TGA or simulated using computational models (CM). To establish the utility and diverse applicability of our method we demonstrate how warfarin therapy (CM), factor VIII prophylaxis for haemophilia A (CM), and pregnancy (TGA) affects thrombin generation over time. The method is especially suited to evaluate an individual's thrombotic and bleeding risk during "normal" processes (e.g pregnancy or aging) or during therapeutic challenges to the haemostatic system. Ultimately, our method is designed to visualize individualized patient profiles which are becoming evermore important as personalized medicine strategies become routine clinical practice.
Collapse
Affiliation(s)
- Jonathan H. Foley
- Department of Biochemistry, University of Vermont, Burlington, Vermont, United States of America
| | - Thomas Orfeo
- Department of Biochemistry, University of Vermont, Burlington, Vermont, United States of America
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University School of Medicine, Krakow, Poland
| | - Kelley C. McLean
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, Vermont, United States of America
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, Vermont, United States of America
| | - Georges-Etienne Rivard
- Department of Hematology-Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Kenneth G. Mann
- Department of Biochemistry, University of Vermont, Burlington, Vermont, United States of America
| | - Stephen J. Everse
- Department of Biochemistry, University of Vermont, Burlington, Vermont, United States of America
| | | |
Collapse
|
36
|
Gaalema DE, Higgins ST, Pepin CS, Heil SH, Bernstein IM. Illicit drug use among pregnant women enrolled in treatment for cigarette smoking cessation. Nicotine Tob Res 2012; 15:987-91. [PMID: 23072871 DOI: 10.1093/ntr/nts220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the United States. In population studies and nationwide surveys, pregnant smokers report more illicit drug use than pregnant nonsmokers. The purpose of this study was to examine the prevalence of illicit drug use among pregnant women enrolled in clinical trials for smoking cessation. METHODS Urine specimens from 115 pregnant women were tested for illicit drug use during a study intake visit (~10th week of pregnancy) and during the final antepartum (FAP) smoking-status assessment (~28th week of pregnancy). Participants smoked about 18 cigarettes/day prepregnancy, were generally young (<25 years), Caucasian, with a high school education and without private insurance. RESULTS About 34% of specimens from the intake visit and 25% of those from the FAP assessment tested positive for an illicit drug. The most common drug detected was marijuana (90% of positive specimens), followed by opioids (18%), cocaine (5%), benzodiazepines (3%), and methadone (3%). None tested positive for amphetamines. The majority of women (53%) who tested positive for an illicit substance at intake also tested positive at the FAP assessment. CONCLUSIONS Approximately a quarter to a third of pregnant women enrolled in these smoking-cessation trials were determined to be using illicit drugs, with marijuana use being the most prevalent. Those providing smoking-cessation services to pregnant women may want to be prepared to assist with obtaining services for other drug use as well.
Collapse
Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
| | | | | | | | | |
Collapse
|
37
|
Hale SA, McBride C, Bernstein IM. Abstract 49: Blood Pressure is Correlated with Arterial Stiffness in Previous Preterm Preeclamptics. Hypertension 2012. [DOI: 10.1161/hyp.60.suppl_1.a49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) and arterial stiffness are known to be correlated and have independent value in assessing risk for future cardiovascular disease. The objective of the current study was to evaluate the relationship between arterial stiffness, as measured by pulse wave velocity (PWV), and BP, in nulliparous women (CTL) as compared to women with a history of preterm preeclampsia (PE). Twenty-eight nulliparous women and 19 PEs were evaluated during the follicular phase of the menstrual cycle. There were no differences in age: CTL: 30.9 ± 0.9 vs. PE: 31.3 ± 1.1 yrs, p = 0.78. BMI was significantly lower in CTL: 24.4 ± 1.1 vs. PE: 28.5 ± 1.6 kg/m
2
, p = 0.02. Time interval from delivery to evaluation in PE was 2.46 ± 0.29 yrs. PWV was measured using simultaneous electrocardiographic tracings and ultrasound determined arterial flow waveforms and calculated as the estimated distance divided by the time interval between EKG r-wave peak and ultrasound derived peak popliteal artery flow. Beat to beat BPs were measured in the seated position using the Finapres Pro and averaged over one minute. The data are expressed as mean ± SE. P < 0.05 accepted for significance. MAP was significantly lower in CTLs than in PEs: 87.7 ± 1.4 vs PE: 94.4 ± 2.4, p = 0.02. There was no difference in PWV between CTL and PE: CTL: 2.51 ± 0.05, PE: 2.52 ± 0.06, p = 0.88. Pulse pressure was significantly correlated with PWV in PEs, but not in CTLs, CTL: r = 0.26, p = 0.18, PE: r = 0.54, p = 0.02. Systolic BP was significantly correlated in both CTL and PE with PWV: CTL: r = 0.43, p = 0.02, PE: r = 0.53, p = 0.02. There was a trend for a significant positive correlation between diastolic BP and PWV in the PE group, but not in the CTL: r = 0.11, p = 0.57, PE: r = 0.44, p = 0.06. The same trend existed in the PE for MAP and PWV: CTL: r = 0.27, p = 0.17, PE: 0.44, p = 0.06. For women who have had previous PE, a significant relationship exists between BP and arterial stiffness, while women who have not had a pregnancy do not exhibit this relationship. Pregnancy likely unmasks subclinical cardiovascular derangement resulting in PE, and persisting years beyond delivery. Our observations suggest that for women who have had prior PE evaluating the relationship between arterial stiffness and BP may be more informative for cardiovascular risk than assessing PWV alone.
Collapse
|
38
|
McLean KC, Bernstein IM, Brummel-Ziedins KE. Tissue factor-dependent thrombin generation across pregnancy. Am J Obstet Gynecol 2012; 207:135.e1-6. [PMID: 22840726 DOI: 10.1016/j.ajog.2012.05.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Normal pregnancy results in a prothrombotic state. Studies that have investigated the capacity of pregnant women to generate thrombin are limited. Our aim was to evaluate thrombin generation longitudinally from the preconception period, through pregnancy, and after pregnancy. STUDY DESIGN We evaluated young, healthy nulligravid women (n = 20) at 4 time points and compared the data with 10 control women at 2 time points. Coagulation was initiated with tissue factor in contact pathway inhibited plasma, and thrombin generation was determined in the presence of a fluorogenic substrate. RESULTS The maximum level and rate of thrombin generation increased during pregnancy; the highest level and rate occurred in late pregnancy compared with prepregnancy (P < .001). Subsequently, thrombin generation decreased in the postpregnancy samples that included maximum level, rate, and area under the curve (P < .001). CONCLUSION Our data provide evidence for an increase in tissue factor-dependent thrombin generation with pregnancy progression, followed by a return to prepregnancy thrombin levels.
Collapse
Affiliation(s)
- Kelley C McLean
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Fletcher Allen Health Care/University of Vermont, Burlington, USA
| | | | | |
Collapse
|
39
|
Hale SA, Sobel B, Benvenuto A, Schonberg A, Badger GJ, Bernstein IM. Coagulation and Fibrinolytic System Protein Profiles in Women with Normal Pregnancies and Pregnancies Complicated by Hypertension. Pregnancy Hypertens 2012; 2:152-157. [PMID: 22712057 DOI: 10.1016/j.preghy.2012.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE: The current study longitudinally evaluated concentrations of fibrinogen (Fib), D-Dimer, plasminogen activator type-1 (PAI-1) and tissue type plasminogen activator (T-Pa) before pregnancy and in the first and third trimesters of pregnancy with a focus on the pregnancy transition. STUDY DESIGN: Twenty healthy, nonsmoking, nulliparous women, aged 29.8 ± 3.0 years, BMI 23.3 ± 3.2 kg/m(2) were studied during menstrual cycle day 8 ± 4 and again in early (11 - 15 wks) and late (31 - 34 wks) pregnancy. Seventeen women had singleton conceptions and delivered at term with uncomplicated pregnancies (CTL) and three women developed complicated hypertension (CH) during pregnancy after the third trimester (late pregnancy) evaluation. Data are means ± SEM, Significance was based on p < 0.05. RESULTS: Fib was the only protein evaluated that increased in early pregnancy relative to the prepregnancy assessment. D-dimer, PAI-1 and T-Pa increased in the third trimester compared with prepregnant and early pregnant values (p < .001). T-PA was significantly higher during late pregnancy in CH subjects compared with CTL (8.1 ± 0.7 ng/ml vs. 5.0 ± 0.2 ng/ml, p = .02). There were no other differences between groups. CONCLUSIONS: Increases in fibrinogen are evident in early pregnancy whereas fibrinolysis, perhaps in response to the procoagulant environment of pregnancy, is increased during late pregnancy. Before development of clinically overt hypertension, T-Pa is increased without concomitant changes in other proteins assessed. This is consistent with altered endothelial function with preeclampsia that may contribute to, or reflect, the vasculopathy accompanying this disorder.
Collapse
Affiliation(s)
- Sarah A Hale
- Obstetrics, Gynecology and Reproductive Sciences, 89 Beaumont Ave, University of Vermont, Burlington, VT, United States, 05405
| | | | | | | | | | | |
Collapse
|
40
|
Gaalema DE, Higgins ST, Bradstreet MP, Heil SH, Bernstein IM. Using NicAlert strips to verify smoking status among pregnant cigarette smokers. Drug Alcohol Depend 2011; 119:130-3. [PMID: 21652155 PMCID: PMC3205243 DOI: 10.1016/j.drugalcdep.2011.05.014] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Decreasing smoking during pregnancy is an important public health priority. An important step towards decreasing smoking during pregnancy is wider dissemination of evidence-based smoking cessation interventions. One such intervention is contingency management wherein mothers earn vouchers exchangeable for retail items contingent on biochemically verified smoking abstinence. Wider dissemination may be possible by using smoking verification methods that require minimal training and equipment. One possibility is to use a cotinine-sensitive dipstick (NicAlert) rather than a bench-top cotinine analyzer, which is expensive and requires relatively extensive technician expertise, or breath carbon monoxide analysis, which is relatively nonspecific. The present study was conducted to begin examining the utility of cotinine-sensitive dipsticks for this purpose. METHODS Fifty urine samples from pregnant women enrolled in a smoking cessation program were analyzed to compare three different methods for verifying smoking status: NicAlert strips, a bench-top enzyme multiplied immunoassay technique (EMIT) analyzer, and gas chromatography (GC), the current gold standard for determining cotinine levels in urine. RESULTS Agreement between GC and NicAlert results were high (96%) and comparable to agreement between GC and EMIT results (94%). Semi-quantitative measurements using NicAlert were low with only 30% of samples in agreement between GC and specific ranges given on the strips. CONCLUSIONS NicAlert strips appear to be a valid measure of determining smoking status among pregnant smokers although not of absolute cotinine concentration. With minimal training and equipment required, NicAlert strips provide a potentially practical method for using urine cotinine to verify smoking status in community treatment settings.
Collapse
Affiliation(s)
- Diann E. Gaalema
- University of Vermont, Department of Psychiatry, 1 South Prospect Street UHC, Burlington, VT 05401
| | - Stephen T. Higgins
- University of Vermont, Department of Psychiatry, 1 South Prospect Street UHC, Burlington, VT 05401, University of Vermont, Department of Psychology, 1 South Prospect Street UHC, Burlington, VT 05401
| | - Matthew P. Bradstreet
- University of Vermont, Department of Psychiatry, 1 South Prospect Street UHC, Burlington, VT 05401
| | - Sarah H. Heil
- University of Vermont, Department of Psychiatry, 1 South Prospect Street UHC, Burlington, VT 05401, University of Vermont, Department of Psychology, 1 South Prospect Street UHC, Burlington, VT 05401
| | - Ira M. Bernstein
- University of Vermont, Department of Obstetrics, Gynecology and Reproductive Sciences, Smith 410, MCHV Campus 111 Colchester Avenue, Burlington, VT 05401
| |
Collapse
|
41
|
Washio Y, Higgins ST, Heil SH, Badger GJ, Skelly J, Bernstein IM, Solomon LJ, Higgins TM, Lynch ME, Hanson JD. Examining maternal weight gain during contingency-management treatment for smoking cessation among pregnant women. Drug Alcohol Depend 2011; 114:73-6. [PMID: 20870365 PMCID: PMC3027838 DOI: 10.1016/j.drugalcdep.2010.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 08/23/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
Abstract
Excessive maternal weight gain during pregnancy can result in serious adverse maternal and neonatal health consequences making it an important outcome to monitor in developing smoking-cessation interventions for pregnant women. Maternal weight gain was investigated in the present study with 154 pregnant participants in controlled trials investigating the efficacy of contingency management (CM) for smoking cessation. Women were assigned to either an abstinence-contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a control condition where they received comparable vouchers independent of smoking status. Mean percent of negative smoking-status tests throughout antepartum was greater in the incentive than control condition (45.2±4.6 vs. 15.5±2.4, p<.001) as was late-pregnancy point-prevalence abstinence (36% vs. 8%, p<.001) but maternal weight gain did not differ significantly between treatment conditions (15.0±0.8kg vs. 15.0±0.9 kg, p=.97). In a comparison of women classified by smoking status rather than treatment condition, a greater percent of negative smoking-status tests predicted significantly more weight gain (0.34 kg per 10% increase in negative tests), an effect that appeared to be attributable to women with greater abstinence having larger infants. This study shows no evidence of excessive maternal weight gain among pregnant women receiving a CM intervention for smoking cessation.
Collapse
Affiliation(s)
- Yukiko Washio
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Higgins ST, Bernstein IM, Washio Y, Heil SH, Badger GJ, Skelly JM, Higgins TM, Solomon LJ. Effects of smoking cessation with voucher-based contingency management on birth outcomes. Addiction 2010; 105:2023-30. [PMID: 20840188 PMCID: PMC2970671 DOI: 10.1111/j.1360-0443.2010.03073.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [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: 11/29/2022]
Abstract
AIMS This study examined whether smoking cessation using voucher-based contingency management (CM) improves birth outcomes. DESIGN Data were combined from three controlled trials. SETTING Each of the trials was conducted in the same research clinic devoted to smoking and pregnancy. PARTICIPANTS Participants (n=166) were pregnant women who participated in trials examining the efficacy of voucher-based CM for smoking cessation. Women were assigned to either a contingent condition, wherein they earned vouchers exchangeable for retail items by abstaining from smoking, or to a non-contingent condition where they received vouchers independent of smoking status. MEASUREMENT Birth outcomes were determined by review of hospital delivery records. FINDINGS Antepartum abstinence was greater in the contingent than non-contingent condition, with late-pregnancy abstinence being 34.1% versus 7.4% (P<0.001). Mean birth weight of infants born to mothers treated in the contingent condition was greater than infants born to mothers treated in the non-contingent condition (3295.6 ± 63.8 g versus 3093.6 ± 67.0 g, P = 0.03) and the percentage of low birth weight (<2500 g) deliveries was less (5.9% versus 18.5%, P = 0.02). No significant treatment effects were observed across three other outcomes investigated, although each was in the direction of improved outcomes in the contingent versus the non-contingent condition: mean gestational age (39.1 ± 0.2 weeks versus 38.5 ± 0.3 weeks, P = 0.06), percentage of preterm deliveries (5.9 versus 13.6, P = 0.09), and percentage of admissions to the neonatal intensive care unit (4.7% versus 13.8%, P = 0.06). CONCLUSIONS These results provide evidence that smoking-cessation treatment with voucher-based CM may improve important birth outcomes.
Collapse
Affiliation(s)
- Stephen T. Higgins
- Department of Psychiatry, University of Vermont, Department of Psychology, University of Vermont
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont
| | | | - Sarah H. Heil
- Department of Psychiatry, University of Vermont, Department of Psychology, University of Vermont
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont
| | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE To determine differences in maternal and fetal characteristics in pregnancies complicated by preterm versus term preeclampsia. METHODS Using our electronic database we identified 143 women who met the American College of Obstetricians and Gynecologists criteria for preeclampsia between January 1995 and August 2003. We collected data on age, smoking status, maternal serum markers, and newborns. We compared the group delivering preterm (<37 weeks) with those delivering at term (> or =37 weeks). Analyses were based on ANOVA, Wilcoxon Rank Sum test, and chi-square test. Statistical significance was determined based on alpha = 0.05. Data are expressed as mean +/- SD unless otherwise indicated. RESULTS Eighty women delivered preterm and 63 delivered at term. Women who delivered preterm with preeclampsia were younger, lighter, and were more likely to smoke cigarettes than those delivering at term with preeclampsia. Maternal liver enzyme concentrations were significantly greater in the preterm group. Newborn birthweight percentile (gestational age specific) was significantly lower for preterm preeclampsia. We found no significant differences in maternal platelet count, uric acid concentration, or newborn gender between groups. CONCLUSIONS Differences exist in maternal and fetal characteristics between women who develop preterm preeclampsia and those who develop preeclampsia at term. These data support the hypothesis that multiple preeclamptic phenotypes exist.
Collapse
Affiliation(s)
- Julie K Phillips
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, Vermont, USA.
| | | | | | | |
Collapse
|
44
|
Amburgey OA, Chapman AC, May V, Bernstein IM, Cipolla MJ. Plasma from preeclamptic women increases blood-brain barrier permeability: role of vascular endothelial growth factor signaling. Hypertension 2010; 56:1003-8. [PMID: 20855653 DOI: 10.1161/hypertensionaha.110.158931] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Circulating factors in preeclamptic women are thought to cause endothelial dysfunction and thereby contribute to the progression of this hypertensive condition. Despite the involvement of neurological complications in preeclampsia, there is a paucity of data regarding the effect of circulating factors on cerebrovascular function. Using a rat model of pregnancy, we investigated blood-brain barrier permeability, myogenic activity, and the influence of endothelial vasodilator mechanisms in cerebral vessels exposed intraluminally to plasma from normal pregnant or preeclamptic women. In addition, the role of vascular endothelial growth factor signaling in mediating changes in permeability in response to plasma was investigated. A 3-hour exposure to 20% normal pregnant or preeclamptic plasma increased blood-brain barrier permeability by ≈6.5- and 18.0-fold, respectively, compared with no plasma exposure (P<0.01). Inhibition of vascular endothelial growth factor receptor kinase activity prevented the increase in permeability in response to preeclamptic plasma but had no effect on changes in permeability of vessels exposed to normal pregnant plasma. Circulating factors in preeclamptic plasma did not affect myogenic activity or the influence of endothelium on vascular tone. These findings demonstrate that acute exposure to preeclamptic plasma has little effect on reactivity of cerebral arteries but significantly increases blood-brain barrier permeability. Prevention of increased permeability by inhibition of vascular endothelial growth factor signaling suggests that activation of this pathway may be responsible for increased blood-brain barrier permeability after exposure to preeclamptic plasma.
Collapse
Affiliation(s)
- Odül A Amburgey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA
| | | | | | | | | |
Collapse
|
45
|
Hale S, Choate M, Schonberg A, Shapiro R, Badger G, Bernstein IM. Pulse pressure and arterial compliance prior to pregnancy and the development of complicated hypertension during pregnancy. Reprod Sci 2010; 17:871-7. [PMID: 20639475 DOI: 10.1177/1933719110376545] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the relationship between prepregnant pulse pressure (PP), mean arterial pressure (MAP), cardiac output (CO)/PP, a measure of arterial compliance, and development of complicated hypertension (CH) during pregnancy with the goal of identifying a potential predictor of CH. Twenty nulliparous participants were studied before pregnancy; 17 had normal pregnancies (control; CTL) and 3 CH. Blood pressure monitoring was performed using tonometry. Cardiac output was determined by Doppler echocardiograph. Data are expressed as mean +/- SD. Prepregnant PP was significantly higher in CH participants (CH: 58.3 +/- 6.3, CTL: 46.2 +/- 1.7 mm Hg; P = .02). Cardiac output /pulse pressure was significantly lower in CH participants (CH: 6.9 +/- 1.8, CTL: 10.6 +/- 2.8; P = .04). Mean arterial pressure was not significantly different. Increased PP before pregnancy may suggest increased risk for CH. With accurate prediction of CH before pregnancy, initiation of preventative measures could begin earlier, either prior to or in early pregnancy, potentially increasing preventative efficacy and decreasing CH.
Collapse
Affiliation(s)
- Sarah Hale
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT 05405, USA
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
This study investigated the effect of sildenafil on uterine volumetric blood flow (UVF) and vascular impedance in nonpregnant, nulliparous women. Fifteen women were randomized in a double-blind fashion to receive either placebo or sildenafil (25 or 100 mg) during the luteal phase of the menstrual cycle. Color Doppler ultrasound of both uterine arteries was performed at baseline and at 1 and 3 hours postdosing to calculate resistance index (RI) and UVF. Those who received sildenafil significantly increased UVF and decreased RI over the 3-hour monitoring period. When UVF responses to sildenafil were examined as a function of baseline UVF, a significant increase in UVF was observed in only those participants with higher baseline UVF. Overall, women in the luteal phase demonstrated a significant increase in UVF in response to sildenafil. However, this increase appears to be directly associated with basal UVF.
Collapse
Affiliation(s)
- Sarah A Hale
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, Vermont 05405, USA
| | | | | | | | | | | |
Collapse
|
47
|
Higgins TM, Higgins ST, Heil SH, Badger GJ, Skelly JM, Bernstein IM, Solomon LJ, Washio Y, Preston AM. Effects of cigarette smoking cessation on breastfeeding duration. Nicotine Tob Res 2010; 12:483-8. [PMID: 20339141 PMCID: PMC2861887 DOI: 10.1093/ntr/ntq031] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 02/10/2010] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The purpose of this study was to use data from controlled trials to examine whether smoking cessation increases breastfeeding duration. Correlational studies have confirmed associations between smoking status and breastfeeding duration, but whether smoking cessation increases breastfeeding duration has not been established. METHODS Participants (N = 158) were smokers at the start of prenatal care who participated in controlled trials on smoking cessation. Women were assigned to either an incentive-based intervention wherein they earned vouchers exchangeable for retail items by abstaining from smoking or a control condition where they received comparable vouchers independent of smoking status. Treatments were provided antepartum through 12-week postpartum. Maternal reports of breastfeeding collected at 2-, 4-, 8-, 12-, and 24-week postpartum were compared between treatment conditions. Whether women were exclusively breastfeeding was not investigated. RESULTS The incentive-based treatment significantly increased breastfeeding duration compared with rates observed among women receiving the control treatment, with significant differences between treatment conditions observed at 8-week (41% vs. 26%; odds ratio [OR] = 2.7, 95% CI = 1.3-5.6, p = .01) and 12-week (35% vs. 17%; OR = 3.4, 95% CI = 1.5-7.6, p = .002) postpartum. No significant treatment effects on breastfeeding were observed at other assessments. Changes in smoking status mediated the effects of treatment condition on breastfeeding duration. CONCLUSIONS These results provide evidence from controlled studies that smoking cessation increases breastfeeding duration, which, to our knowledge, has not been previously reported.
Collapse
Affiliation(s)
- Tara M. Higgins
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Stephen T. Higgins
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychology, University of Vermont, Burlington, VT
| | - Sarah H. Heil
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychology, University of Vermont, Burlington, VT
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Ira M. Bernstein
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT
| | - Laura J. Solomon
- Department of Family Practice, University of Vermont, Burlington, VT
| | - Yukiko Washio
- Department of Psychiatry, University of Vermont, Burlington, VT
| | | |
Collapse
|
48
|
Amburgey OA, Ing E, Badger GJ, Bernstein IM. Maternal hemoglobin concentration and its association with birth weight in newborns of mothers with preeclampsia. J Matern Fetal Neonatal Med 2009; 22:740-4. [PMID: 19557662 DOI: 10.3109/14767050902926947] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Maternal hemoglobin concentration is inversely related to newborn size presumably through plasma volume constriction. We sought to determine whether birth weight would show an inverse relationship to hemoglobin concentration in a group of infants whose mothers had preeclampsia, where plasma volume constriction is common. METHODS Electronic and paper chart review identified 142 nulliparous women with preeclampsia (excluding hemolysis, elevated liver enzymes, low platelets syndrome). Birth weight percentile was determined based on cross-sectional hybrid growth curves. Maximal third trimester maternal hemoglobin concentrations were obtained and standardised to z-scores based on gestational age matched normative data. Birth weight percentile was examined as a function of hemoglobin z-score using appropriate statistics. RESULTS Average gestational age at delivery was 35.9 +/- 1.9 weeks. Mean birth weight percentile for infants of preeclamptic mothers was 34 +/- 32. Mean hemoglobin z-score for mothers with preeclampsia was 0.3 +/- 1.5, significantly higher than a control population (p = 0.04). Maternal hemoglobin z-score was inversely associated with birth weight percentile (r = -0.18, p = 0.03). CONCLUSION Maternal hemoglobin concentrations are significantly elevated prior to delivery in women with preeclampsia. There is a statistically significant inverse correlation of maternal hemoglobin concentration to birth weight percentile.
Collapse
Affiliation(s)
- Odül A Amburgey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, Vermont, USA
| | | | | | | |
Collapse
|
49
|
Higgins ST, Heil SH, Badger GJ, Skelly JM, Solomon LJ, Bernstein IM. Educational disadvantage and cigarette smoking during pregnancy. Drug Alcohol Depend 2009; 104 Suppl 1:S100-5. [PMID: 19442460 PMCID: PMC2763386 DOI: 10.1016/j.drugalcdep.2009.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 03/11/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022]
Abstract
This study examined the influence of education on smoking status in a cohort (n=316) of pregnant women who were smokers at the time they learned of the current pregnancy. Subjects were participants in clinical trials examining the efficacy of monetary-based incentives for smoking-cessation and relapse prevention. In multivariate analyses, educational achievement was a robust predictor of smoking status upon entering prenatal care, of achieving abstinence antepartum among those still smoking at entry into prenatal care, and of smoking status at 6-month postpartum in the entire cohort and the subsample who received smoking-cessation treatment. In addition to educational attainment, other predictors of smoking status included smoking-related characteristics (e.g., number of cigarettes/day smoked pre-pregnancy), treatment, maternal age, and stress ratings. We suggest that strategies to increase educational attainment be included with more conventional tobacco-control policies in efforts to reduce smoking among girls and young women.
Collapse
Affiliation(s)
- Stephen T Higgins
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Bernstein IM, Damron D, Schonberg AL, Sallam RM, Shapiro R. The relationship of plasma volume, sympathetic tone, and proinflammatory cytokines in young healthy nonpregnant women. Reprod Sci 2009; 16:980-5. [PMID: 19531800 PMCID: PMC2874877 DOI: 10.1177/1933719109338876] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Preeclampsia has been associated with elevated proinflammatory markers, increased sympathetic activity, and decreased plasma volume (PV). We hypothesized that these associations would be identified in women prior to a first pregnancy. METHODS We studied 76 healthy nulligravid participants measuring the proinflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha). Plasma volume was measured in supine position and corrected for body mass index (BMI). We examined supine plasma levels of epinephrine and norepinephrine and blood pressure response to Valsalva maneuver to quantify sympathetic activation. We then examined the association of PV and sympathetic activity with proinflammatory cytokines with P < .05 accepted for significance. RESULTS CRP was significantly increased in participants with lowest PV/BMI quartile when compared to middle 2 quartiles and highest quartile (analysis of variance [ANOVA], P = .037). We found no significant association of PV/BMI with either IL-6 or TNF-alpha. Both plasma epinephrine concentration (r = .29, P = .02) and the late phase II (phase II_L) blood pressure response to Valsalva maneuver (r = .44, P < .0001) were associated with serum IL-6 concentrations. CONCLUSIONS Low PV is associated with increased CRP levels and increased sympathetic tone is linked to elevated IL-6 concentration in young nonpregnant women. These findings represent elements of a nonpregnancy phenotype that parallels the findings observed in preeclampsia and in women at risk for ischemic cardiovascular disease. This suggests that the relationships observed during preeclampsia, which have been associated with placental pathology, may predate pregnancy and be independent of placental activity.
Collapse
Affiliation(s)
- Ira M Bernstein
- Department of Obstetrics and Gynecology, University of Vermont College of Medicine, Burlington, Vermont 05405, USA.
| | | | | | | | | |
Collapse
|