CCR5Δ32 in Brazil: Impacts of a European Genetic Variant on a Highly Admixed Population.

The genetic background of Brazilians encompasses Amerindian, African, and European components as a result of the colonization of an already Amerindian inhabited region by Europeans, associated to a massive influx of Africans. Other migratory flows introduced into the Brazilian population genetic components from Asia and the Middle East. Currently, Brazil has a highly admixed population and, therefore, the study of genetic factors in the context of health or disease in Brazil is a challenging and remarkably interesting subject. This phenomenon is exemplified by the genetic variant CCR5Δ32, a 32 base-pair deletion in the CCR5 gene. CCR5Δ32 originated in Europe, but the time of origin as well as the selective pressures that allowed the maintenance of this variant and the establishment of its current frequencies in the different human populations is still a field of debates. Due to its origin, the CCR5Δ32 allele frequency is high in European-derived populations (~10%) and low in Asian and African native human populations. In Brazil, the CCR5Δ32 allele frequency is intermediate (4-6%) and varies on the Brazilian States, depending on the migratory history of each region. CCR5 is a protein that regulates the activity of several immune cells, also acting as the main HIV-1 co-receptor. The CCR5 expression is influenced by CCR5Δ32 genotypes. No CCR5 expression is observed in CCR5Δ32 homozygous individuals. Thus, the CCR5Δ32 has particular effects on different diseases. At the population level, the effect that CCR5Δ32 has on European populations may be different than that observed in highly admixed populations. Besides less evident due to its low frequency in admixed groups, the effect of the CCR5Δ32 variant may be affected by other genetic traits. Understanding the effects of CCR5Δ32 on Brazilians is essential to predict the potential use of pharmacological CCR5 modulators in Brazil. Therefore, this study reviews the impacts of the CCR5Δ32 on the Brazilian population, considering infectious diseases, inflammatory conditions, and cancer. Finally, this article provides a general discussion concerning the impacts of a European-derived variant, the CCR5Δ32, on a highly admixed population.

Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe.

BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

Association among ACE, ESR1 polymorphisms and preeclampsia in Brazilian pregnant women.

BACKGROUND: Genetic, immune and environmental factors are involved in preeclampsia (PE) etiopathogenesis. Considering that hypertension and poor placental perfusion are important features in PE, polymorphisms in the angiotensin-converting enzyme (ACE) and estrogen nuclear receptor 1 (ESR1) genes could be involved in the predisposition and/or development of the disease. The aim of this study was to evaluate if polymorphisms in ACE and ESR1 genes were associated with PE occurrence. MATERIAL AND METHODS: This case-control study included 209 Brazilian pregnant women (107 with severe PE and 102 normotensive controls). The polymorphisms were investigated by polymerase chain reaction (PCR) followed by polyacrylamide gel electrophoresis. RESULTS: No significant difference between PE versus normotensive pregnant women, as well as early versus late PE, was observed when compared the allelic and genotypic frequencies of insertion/deletion polymorphism in intron 16 of the ACE gene and the single nucleotide polymorphisms (SNPs - rs2234693 and rs9340799) of the ESR1 gene. CONCLUSION: This pioneer study involving Brazilian women showed no association among the studied polymorphisms and PE, which suggests that ins/del ACE and SNPs ESR1 do not contribute to this disease occurrence in Brazil.

Postpartum evaluation of cardiovascular disease risk for women with pregnancies complicated by hypertension.

OBJECTIVES: Postpartum stratification of cardiovascular risk for women with pregnancies complicated by pre-eclampsia is challenging. Our aim was to identify potential clinical and biomarker predictors of future cardiovascular risk at six weeks postpartum in women with hypertensive pregnancies. STUDY DESIGN: Prospective longitudinal cohort. MAIN OUTCOME MEASURES: Ten year-Framingham cardiovascular risk scores were calculated for 477 women (94 with gestational hypertension, 288 with pre-eclampsia, 30 with superimposed pre-eclampsia, 51 with chronic hypertension, 14 women with uncomplicated pregnancies). B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL) and placental growth factor (PlGF) were quantified at six weeks postpartum. RESULTS: Framingham cardiovascular risk scores were not higher in women with pregnancies complicated by pre-eclampsia than healthy controls, nor were scores higher in women with pre-existing chronic hypertension complicated with superimposed pre-eclampsia compared with those without superimposed pre-eclampsia. Women with gestational hypertension had higher risk scores than women with pre-eclampsia and healthy controls. Established risk factors of cardiovascular disease including diastolic blood pressure and previously diagnosed chronic hypertension were associated with higher scores, and African ethnicity, parity and estimated glomerular filtration rate also were independently associated with higher Framingham risk scores at six weeks postpartum. PlGF, BNP and NGAL concentrations were not associated with Framingham cardiovascular risk scores after adjustment for independent variables. CONCLUSIONS: A history of pre-eclampsia or superimposed pre-eclampsia in most recent pregnancy was not associated with elevated Framingham risk score at six weeks postpartum. Established clinical predictors may enable risk stratification at six weeks postpartum, which are not enhanced by the biomarkers included in this study.

Can thrombophilia worsen maternal and perinatal outcomes in cases of severe preeclampsia?

OBJECTIVE: To evaluate whether thrombophilia worsens maternal and foetal outcomes among patients with severe preeclampsia (PE). METHOD: From October 2009 to October 2014, an observational retrospective cohort study was performed on pregnant women with severe PE diagnosed before 34 weeks of gestation and their newborns hospitalized at the Clinics Hospital, FMUSP. Patients who had no heart disease, nephropathies, pre-gestational diabetes, gestational trophoblastic disease, foetal malformation, or twin pregnancy and who underwent thrombophilia screening during the postnatal period were included. New pregnancies of the same patient; cases of foetal morphological, genetic, or chromosomal abnormalities after birth; and women who used heparin or acetylsalicylic acid during pregnancy were excluded. Factor V Leiden, G20210A prothrombin mutation, antithrombin, protein C, protein S, homocysteine, lupus anticoagulant, and anticardiolipin IgG and IgM antibodies were analysed. The groups with and without thrombophilia were compared regarding their maternal clinical and laboratory parameters and perinatal outcomes. RESULTS: Of the 127 patients selected, 30 (23.6%) had thrombophilia (hereditary or acquired). We found more white patients in thrombophilia group (p = .036). Analysis of maternal parameters showed a tendency of thrombophilic women to have more thrombocytopenia (p = .056) and showed worsening of composite laboratory abnormalities (aspartate aminotransferase ≥ 70 mg/dL, alanine aminotransferase ≥ 70 mg/dL, platelets < 100,000/mm3, serum creatinine ≥ 1.1 mg/dL; p = .017). There were no differences in foetal perinatal outcomes. CONCLUSION: The presence of thrombophilia leads to worsening of maternal laboratory parameters among patients with severe forms of PE but without worsening perinatal outcomes.

Polymorphisms in interleukin-6 and interleukin-10 may be associated with risk of preeclampsia.

Preeclampsia is a common condition unique to pregnant women. Previous studies have suggested that several cytokines may contribute to defective placental invasion and endothelial damage in this condition. We investigated the influence of four single nucleotide polymorphisms (SNPs) in the promoters of IL-6 (-572G/C, -597G/A, and -174G/C) and IL-10 (-592A/C) on susceptibility to preeclampsia in a Chinese population. This study included 142 newly diagnosed preeclampsia patients and 260 controls recruited from Qingdao Women and Children's Hospital between January 2013 and May 2015. Genotyping of IL-6 and IL-10 SNPs was performed using the polymerase chain reaction-restriction fragment length polymorphism method. Logistic regression analysis was then performed to determine the association between these variants and preeclampsia risk. Our findings indicated that compared to the AA genotype, the CC and AC+CC genotypes of IL-10 -592A/C correlate with elevated risk of developing preeclampsia, with adjusted odds ratios (and 95% confidence intervals) of 2.45 (1.26-4.72) and 1.71 (1.09-2.68), respectively. However, the IL-6 -572G/C, -597G/A, and -174G/C polymorphisms were not found to play a critical role in susceptibility to this disorder. In conclusion, the IL-10 -592A/C genetic variant was observed to be associated with preeclampsia risk in pregnant women.

Investigations into the association between polymorphisms in the interleukin-10 gene and risk of early-onset preeclampsia.

In this case-control study, we assessed the influence of IL-10 -1082A/G and -819T/C on the development of preeclampsia. The IL-10 -1082A/G and -819T/C polymorphisms were assessed by polymerase chain reaction-restriction fragment length polymorphism. The genotype distributions of the IL-10 -1082A/G and -819T/C polymorphisms in the control subjects were in conformance with Hardy-Weinberg equilibrium (HWE; P = 0.46 and 0.17). Unconditional logistic regression analyses revealed that individuals carrying the CC genotype of IL-10 -819T/C were associated with an increased risk of preeclampsia compared to the TT genotype. The odds ratio (95% confidence interval) for the CC genotype of IL-10 -819T/C was 1.71 (1.07-3.27) compared to the TT genotype. In conclusion, the results of our study indicated that the IL-10 -819T/C polymorphism was associated with an increased risk of preeclampsia in a Chinese population.

Evaluation of association of maternal IL-10 polymorphisms with risk of preeclampsia by A meta-analysis.

Emerging evidence shows that interleukin (IL)-10 gene polymorphisms can regulate its expression level and thus influence person's susceptibility to preeclampsia. However, various published results were inconsistent. To explore the association between maternal IL-10 gene polymorphisms and preeclampsia, we performed a meta-analysis based upon 11 individual studies here. Our meta-analysis results indicated that IL-10 -819 C/T (C versus T, OR = 1.28, 95% CI = 1.08-1.50, P = 0.003) and -592 C/A (C versus A, OR = 1.28, 95% CI = 1.03-1.59, P = 0.03) polymorphisms were associated with preeclampsia. Although there was no overall association between -1082 A/G polymorphism and preeclampsia (G versus A, OR = 0.93, 95% CI = 0.77-1.13, P = 0.49), such association existed among Asian (G versus A, OR = 1.29, 95% CI = 1.04-1.60, P = 0.02) and South American (G versus A, OR = 0.72, 95% CI = 0.54-0.94, P = 0.02) populations in the subgroup analysis stratified by continents.

Analysis of polymorphisms and haplotypes in genes associated with vascular tone, hypertension and oxidative stress in Mexican-Mestizo women with severe preeclampsia.

OBJECTIVE: Several studies have reported the association of genes related to vascular tone, hypertension, oxidative stress and preeclampsia. We investigated the possible association among three polymorphisms in eNOS (as well their haplotypes): one of MTHFR, one of GSTP1 and one of AGT, with severe preeclampsia in Mexican-Mestizo women. METHODS: Two hundred thirty women with severe preeclampsia and 350 control subjects were genotyped; for rs2070744 and rs1799983 of eNOS, rs1801133 of MTHFR, rs1695 of GSTP1 and rs699 of AGT we used real-time PCR allelic discrimination and for VNTR of eNOS, PCR. Allele frequency differences were assessed by χ(2). Logistic regression was used to test for associations and for haplotype frequencies using Haploview 4.2. RESULTS: Genotypic and allelic distribution of the polymorphisms was similar between cases and controls; likewise, haplotype frequencies of the three polymorphisms of eNOS did not differ significantly. CONCLUSIONS: To our knowledge, this is the first time that these polymorphisms have been analyzed together and exclusively in women with severe preeclampsia. However, we did not find an association between polymorphisms of eNOS, MTHFR, GSTP1 and AGT with severe preeclampsia in our population. Additionally, we observed differences in the distribution of the alleles and genotypes of these polymorphisms in our population in comparison to those described in other ethnic groups.

Analysis of polymorphisms in interleukin-10, interleukin-6, and interleukin-1 receptor antagonist in Mexican-Mestizo women with pre-eclampsia.

Due to the fact that studies seeking associations of polymorphisms in regulatory regions of cytokine genes with pre-eclampsia (PE) have not always been consistent in different population analyses, the aim of this study was to investigate the possible association between rs1800896 of interleukin-10 (IL-10), rs1800795 of interleukin-6 (IL-6), and the variable number of tandem repeats (VNTR) in intron 2 of interleukin-1 receptor antagonist (IL-1Ra), as well as gene-gene interactions between these three polymorphisms with the presence of PE in Mexican-Mestizo women and one Amerindian population from México (Maya). A case-control study was performed where 411 pre-eclamptic cases and 613 controls were genotyped. For the rs1800896 of IL-10 and rs1800795 of IL-6, we used real-time polymerase chain reaction (PCR) allelic discrimination and for the VNTR of IL-1Ra, PCR. Allele frequency differences were assessed by Chi-squared test; logistic regression was used to test for associations; a gene-gene interaction was conducted. Genotypic and allelic distribution of the polymorphisms was similar in our population. The estimated of the gene-gene interaction between the polymorphisms did not differ significantly. However, we observed important differences in the distribution of the alleles and genotypes of the three polymorphisms analyzed between Mestiza-Mexicanas and Maya-Mestizo women. In conclusion, we did not find an association between polymorphisms in IL-10, IL-6, and IL-1Ra and PE in Mexican-Mestizo and Maya-Mestizo women. To our knowledge, this is the first time that these three polymorphisms were analyzed together with gene-gene interaction in women with PE.

Interethnic differences in ADMA concentrations and negative association with nitric oxide formation in preeclampsia.

BACKGROUND: Recent studies have suggested that impaired nitric oxide (NO) formation in preeclampsia may result from increased concentrations of an endogenous NO synthase inhibitor, the asymmetric dimethylarginine (ADMA). However, no previous study has examined whether a negative association exists between ADMA and nitrite concentrations in preeclampsia. Moreover, no previous study has compared ADMA and nitrite levels in black and white preeclamptic pregnant women. METHODS: We measured plasma nitrite concentrations using an ozone-based chemiluminescence assay, and plasma ADMA levels using enzyme immunoassays in 94 pregnant (47 healthy pregnant: 16 blacks and 31 whites; and 47 preeclamptic: 14 blacks and 33 whites). RESULTS: We found higher ADMA (2.199 + or -0.016 micromol/l vs. 2.112 + or - 0.012 micromol/l; P<0.0001) and lower plasma nitrite levels (102 + or - 7.1 nmol/l vs. 214.8 + or - 26.1 nmol/l; P<0.0001) in preeclamptic compared with healthy pregnant women. Black pregnant had higher ADMA levels than white pregnant women (P<0.05), both in preeclamptic (2.239 + or - 0.020 micromol/l vs. 2.144 + or - 0.019 micromol/l) and in healthy pregnant (2.172 + or - 0.025 micromol/l vs. 2.077 + or - 0.018 micromol/l). Conversely, we found no significant effects of ethnicity on the plasma nitrite levels, both in healthy pregnant and in preeclamptic women (P>0.05). We found a significant negative correlation (P<0.05) between these markers (r=-0.28; P<0.05). CONCLUSIONS: Our findings show higher ADMA and lower nitrite levels in preeclamptic compared with healthy pregnant, and the concentrations of these biomarkers are inversely associated. While ethnicity affected ADMA concentrations, no such effect was found with respect to nitrite levels. These results may have important implications for studies on NO biology and therapeutic approaches of preeclampsia.

Methylenetetrahydrofolate reductase C677T and glutathione S-transferase P1 A313G are associated with a reduced risk of preeclampsia in Maya-Mestizo women.

Preeclampsia, a common complication of pregnancy, is characterized by elevated blood pressure and proteinuria developing after 20 weeks' gestational age. Susceptibility to this syndrome is believed to have a genetic component. The aim of this study was to investigate whether or not the 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T and glutathione S-transferase P1 (GSTP1) A313G polymorphisms are associated with preeclampsia in Maya-Mestizo women. A case-control study was performed, in which 125 preeclamptic patients and 274 healthy controls were genotyped for the MTHFR C677T and GSTP1 A313G polymorphisms by real-time PCR allelic discrimination. Allele and genotype frequencies were compared using the chi2 tests. The MTHFR 677T allele and the 677TT genotype were significantly more frequent in the controls, suggesting an association with a decreased risk of preeclampsia (p = 0.017 and p = 0.007, respectively). Similarly, GSTP1 313GG/GC genotypes and the G allele were more frequent in controls, showing a significant association with reduced risk of preeclampsia (p = 0.008 and p = 0.013, respectively). Our results suggest, for the first time, that the MTHFR 677T and GSTP1 313G polymorphisms confer a significantly decreased risk of developing preeclampsia in the Mexican Maya-Mestizo population.

Intimate partner violence (IPV) and preeclampsia among Peruvian women.

OBJECTIVE: Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. STUDY DESIGN: We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. RESULTS: The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). CONCLUSIONS: IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.

Analysis of C-850T and G-308A polymorphisms of the tumor necrosis factor-alpha gene in Maya-Mestizo women with preeclampsia.

OBJECTIVE: To determine whether polymorphisms in the TNF-alpha promoter gene are associated with preeclampsia. METHODS: 105 women with preeclampsia and 200 controls were genotyped for the G-308A and C-850T polymorphisms by RFLP. Differences in allele, genotype, and haplotype frequencies between groups were assessed. RESULTS: The genotypic and allelic distribution of both polymorphisms was similar between groups. Moreover, the estimated overall pair of loci haplotype frequencies did not differ significantly. CONCLUSION: We did not find any association between these polymorphisms and the risk for preeclampsia. However, we found that both the genotypic and allelic distribution in our population differed from those reported in other populations.

Booking blood pressures and plasma nitrite in Jamaican women with pre-eclampsia.

Our objective was to assess the levels of nitric oxide (NO) in pre-eclampsia and to investigate its effect on blood pressure (BP) in the Jamaican population. A total of 103 participants (50 pre-eclampsia, 53 controls) were recruited from the University Hospital of the West Indies (UHWI). Blood samples were collected in the fasting state and trimester BP measurements were obtained from their records. A commercially available kit supplied by Oxford Biomedical Research Inc. (MI, USA) was used to measure plasma levels of NO. All measures of booking BP were significantly higher in women who later developed pre-eclampsia compared with those whose pregnancies remained normotensive (p 0.05. We concluded that in the Jamaican population, booking BP measurements may be predictors of pre-eclampsia and NO production increases in pre-eclampsia but is not related to the height of the BP.

Maternal hypertension as a risk factor for low birth weight infants: comparison of Haitian and African-American women.

BACKGROUND: The rate of low birth weight (LBW) of Black women is more than twice that of White women. This study explores if the rate of LBW differs between Haitian and African-American women with chronic hypertension. METHODS: A retrospective cohort study of all Black women self-identified as African-American (n = 12,258) or Haitian (n = 4320) delivering a singleton infant in Massachusetts between 1996 and 2000. RESULTS: Haitian women were more likely than African-American women to have chronic hypertension (2.7% vs. 2.1%, p = 0.006), but had similar rates of preeclampsia (3.1% vs. 3.3%, p = 0.27). The LBW rate was 10% among African-American women and 8.2% among Haitian women. After adjustment for sociodemographic, medical, and prenatal care characteristics, the greatest risks for delivering a LBW infant for Haitian women were chronic hypertension (OR = 6.8; 95% CI, 4.3, 10.6) and preeclampsia (OR = 3.2; 95% CI, 2.0, 5.1). For African-American women, the greatest risks for LBW infants were a history of delivering a LBW infant (OR = 3.9; 95% CI, 2.8, 5.4) and chronic hypertension (OR = 2.9; 95% CI, 2.1, 4.0). In a combined logistic regression model including interaction terms, chronic hypertension and preeclampsia continued to be associated with the greatest risk of LBW among all women. CONCLUSIONS: Differences in maternal risk factors and rates of LBW (8.2% vs. 10%) exist between Haitian and African-American women delivering infants in Massachusetts. While chronic hypertension and preeclampsia are strong risk factors for LBW for both Haitian and African-American women, unknown factors make these disorders much more potent for Haitian women.

Obstetric and neonatal outcome following chronic hypertension in pregnancy among different ethnic groups.

We retrospectively studied pre-eclampsia rate and obstetric outcome in a cohort of 436 pregnancies amongst 318 women of different ethnic backgrounds attending an antenatal hypertension clinic from 1980-1997, identifying 152 women (213 pregnancies) with chronic essential hypertension. The ethnic breakdown was: White, 64 (30.0%) pregnancies in 48 (31.5%) women; Black/Afro-Caribbean, 79 (37.1%) pregnancies in 56 (36.8%) women; and Indo-Asians, 70 (32.3%) pregnancies in 48 (31.6%) women. The prevalences of pre-eclampsia in White, Black and Indo-Asian women were 17.2%, 12.7% and 18.6%, respectively (p = 0.58). Pregnancies of Indo-Asian women were of shorter gestation, and babies in this group also had lower birth weight and ponderal index compared to those of White and Black women (all p < 0.05). The proportions of overall perinatal mortality were 1.6% for Whites (1/64), 3.8% for Blacks (3/79) and 10.0% for Indo-Asians (7/70), suggesting increased risk in the Indo-Asian group. Indo-Asian women with chronic essential hypertension need careful antenatal care and observation during pregnancy.

Preeclampsia and neonatal outcomes in chronic hypertension: comparison between white and black women.

We compared the incidence of preeclampsia and neonatal outcomes in 208 white (born in Canada) and 74 black (born in Haiti) women with mild chronic hypertension. Controls included 17,677 white and 2,400 black normotensive women delivered in the same center between 1987 and 1991. Superimposed preeclampsia (32.4% vs 14.9%; p < 0.01), perinatal mortality (9.5% vs 2.9%; p < 0.05) and prematurity (32.4% vs 19.7%; p < 0.05) were more frequent in black than in white women with chronic hypertension. Within both races, chronic hypertensive women with superimposed preeclampsia demonstrated higher rates of perinatal mortality and morbidity than controls. White chronic hypertensive women without preeclampsia and controls had similar rates of perinatal mortality as compared to black study participants and controls (2.3% vs 1.4%), small-for-gestational-age newborns (10.7% vs 7.8%) and prematurity (12.4% vs 15.3%). Compared to black controls, black chronic hypertensive women without preeclampsia had higher rates of perinatal mortality (1.2% vs 8.0%; p < 0.001) and prematurity (9.0% vs 18.0%; p < 0.05). These data provide evidence of ethnic differences in perinatal outcomes in chronic hypertensive women that are not explained only by superimposed preeclampsia.

Incidencia y características de la enfermedad hipertensiva en el embarazo: estudio retrospectivo a nivel del mar y en la altura / Incidence and characteristics of the hypertensive disease in the pregnancy: retrospective study at sea level and high altitude

Los objetivos del estudio son conocer la incidencia de enfermedad hipertensive del embarazo (EHE) y sus características a nivel del mar y en la altura. Para tal efecto se han utilizado registros del Ministerio de Salud así como la información de hospitales públicos de Lima (150 m), Huancayo (3280 m), Cerro de Pasco (4320 m), Puno (3800 m), La Oroya (3800 m) y del Cusco (3370 m) durante el período 1982-89. La tasa de incidencia de enfermedad hipertensiva del embarazo/10 mil nacidos vivos en Lima es de 1110, seguido, en orden decreciente, por los casos en Cusco, Puno, La Oroya, Cerro de Pasco y Huancayo. Las formas leves de la enfermedad ocurren menos en Puno y Cerro de Pasco, seguido por Puno y Huancayo. La tasa de mortalidad materna/100 mil nv es alta en puno. La edad de presentación de la enfermedad hipertensiva del embarazo fue mayor en Cusco con 29.7 + 5 años y menor en Cerro de Pasco. La paridad fue menor en Huancayo, Cusco y Cerro de Pasco. La edad gestacional es mayor en Lima seguida de Cusco, Huancayo y Cerro de Pasco. El peso corporal y el edema fue mayor en Cerro de Pasco. El peso del recién nacido fue menor en Cerro de Pasco, pero el peso del recién nacido en eclampsia fue menor en Cusco que en Lima y Huancayo. Se concluye que la incidencia de EHE es mayor en la Costa que en la Sierra, pero que la mortalidad materna por esta causa es mayor en la Sierra y que no existen diferencias remarcables entre las características de esta enfermedad en ambas regiones.