Effect of early use of low-dose aspirin therapy on late-onset preeclampsia.

OBJECTIVE: Low-dose aspirin (LDA) therapy has been found to be effective in preventing the development of early-onset preeclampsia. However, its effect on late-onset preeclampsia has not been described. Our study was aimed at determining if LDA therapy prescribed from early in pregnancy modified the severity of late-onset preeclampsia. MATERIALS AND METHODS: A retrospective analysis of all women who were screened for early-onset preeclampsia at 11-13+6 weeks' gestation between April 2012 and October 2014 at our institution, and who subsequently developed late-onset preeclampsia. The treatment group consisted of women who were prescribed LDA therapy from early in pregnancy as a result of the screening. The control group consisted of women who did not receive LDA therapy. RESULTS: The aspirin group was associated with earlier delivery at 38.0 (37.5-38.5) weeks' gestation versus 39.0 (38.7-39.4) weeks' gestation for the nonaspirin group (p < .01). The aspirin group was also associated with lower absolute birth weight 2851 (2646-3055) versus 3215 (3068-3362) grams in the nonaspirin group (p < .01). However, when normalised for gestational age at delivery, the proportion of foetuses that were small for gestation age (< 10th centile) were not significantly different between the two groups [28% in aspirin group versus 23% in nonaspirin group; p = .62]. No other significant difference was noted. CONCLUSIONS: There was no difference in the clinical severity of late-onset preeclampsia between women screened as high risk for early-onset preeclampsia and subsequently prescribed LDA during their pregnancy, compared to women found to be at low risk and not prescribed LDA.

Home blood pressure measurement in women with pregnancy-related hypertensive disorders.

OBJECTIVES: To determine if home blood pressure measurement (HBPM) provides comparable results to clinic blood pressure (BP) measurement. STUDY DESIGN: A prospective, single-centre study of 37 pregnant and early post-partum women with a hypertensive pregnancy or at high-risk of developing a hypertensive pregnancy were asked to perform HBPM for a minimum period of one week. This was subsequently compared to clinic BP measurement both before and after the period of home measurement. MAIN OUTCOME MEASURES: The accuracy of HBPM compared to clinic measurement, and the acceptability by patients for HBPM. RESULTS: The HBPM was comparable to clinic measurements [for the systolic blood pressure (SBP), the mean home reading was 123.4mmHg (122.0-124.9mmHg) versus 123.9mmHg (121.3-126.5mmHg) for the clinic reading (p=0.69); for the diastolic blood pressure (DBP) the mean home reading was 81.6mmHg (80.4-82.8mmHg) versus 84.4mmHg (82.6-86.2mmHg) for the clinic (p<0.01)]. There were no reported issues associated with the use of HBPM, but it did lead to 5 women contacting health care professionals for management of their BP between clinic visits. CONCLUSIONS: HBPM provides comparable results to the clinic BP measurement. It is also an acceptable technique for pregnant and early post-partum women. However, it should be used as an adjunct to clinic measurement, and cannot at this present stage replace clinic visits or clinic BP measurement.

Measuring blood pressure in pregnancy and postpartum: assessing the reliability of automated measuring devices.

OBJECTIVE: To determine the reliability of automated blood pressure (BP) measuring devices in hypertensive pregnancies. METHODS: Three sequential measurements were taken using mercury sphygmomanometry and an automated device in pregnant hypertensive women (n = 89). RESULTS: Systolic BP (SBP) was higher with the automated device (mean difference 2.5 mmHg, 95% CI: 1.9-3.2 mmHg), whereas diastolic BP (DBP) was higher with the mercury sphygmomanometer (mean difference 2.0 mmHg, 95% CI: 1.5-2.6 mmHg). Within-patient variability for the automated device was: SBP 4.8 mmHg (95% CI: 4.6-5.2 mmHg), DBP 3.4 mmHg (95% CI: 3.1-3.7 mmHg); and for mercury sphygmomanometry: SBP 3.7 mmHg (95% CI: 3.5-4.0 mmHg), DBP 3.0 mmHg (95% CI: 2.8-3.3 mmHg). CONCLUSION: Outpatient automated BP measurement agrees well with mercury sphygmomanometry in hypertensive pregnancies.

A randomised comparison of hydralazine and mini-bolus diazoxide for hypertensive emergencies in pregnancy: the PIVOT trial.

AIMS: Diazoxide is one of few available agents for treatment of hypertensive emergencies in pregnancy. From previous studies, there is a question concerning safety after moderate-dose administration caused episodes of hypotension. Rapid control of severe hypertension is necessary to reduce maternal morbidity, for example, stroke and placental abruption. This study was designed to compare the efficacy of mini-bolus diazoxide with intravenous (i.v.) hydralazine. DESIGN: A randomised controlled trial. SETTING: Tertiary referral maternity hospital, Royal Prince Alfred Women and Babies, Sydney Australia. POPULATION: Antenatal and postnatal women with severe hypertension. METHODS: One hundred and twenty-four hypertensive women were randomised to either i.v. hydralazine (5 mg doses) or mini-bolus diazoxide (15 mg doses). PRIMARY OUTCOME MEASURE: Achievement of target blood pressure reduction; secondary measures included requirement for Caesarean section because of fetal deterioration as determined by non-reassuring cardiotocograph (CTG). RESULTS: Reduction in systolic and diastolic blood pressure was 34 min for hydralazine and 19 min for diazoxide (P < 0.001). There were no episodes of hypotension after diazoxide and one after hydralazine (after epidural). Episodes of persistent severe hypertension were more common with hydralazine (38%) than with diazoxide (16%), P < 0.01. The Caesarean section rate for no-reassuring CTG was no different between the two groups. Neonatal outcomes were similar. CONCLUSION: Diazoxide and hydralazine are safe and effective antihypertensives, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. The mini-bolus doses of 15 mg of diazoxide did not precipitate maternal hypotension as previously described and reduces episodes of persistent severe hypertension.

Structural and functional changes in left ventricle during normotensive and preeclamptic pregnancy.

Increased cardiac output in pregnancy is associated with cardiac remodeling and possible reduction in contractility, which may worsen in preeclampsia. Left ventricular (LV) geometry and function were compared between nonpregnant controls (n = 12) and normotensive (n = 44) and preeclamptic (n = 15) pregnant women using echocardiography. Load-independent comparisons of LV systolic function compared end-systolic stress (ESS) and rate-corrected velocity of circumferential fiber shortening (V(CFC)). Mean arterial pressures were 101 +/- 14 mmHg in preeclampsia, 76 +/- 6 mmHg in normotensive pregnancy, and 78 +/- 6 mmHg in controls (P < 0.005 vs. preeclampsia). LV mass increased during normotensive pregnancy (66 +/- 13 to 76 +/- 16 g/m(2); P < 0.05; controls, 65 +/- 10 g/m(2); P < 0.05) and was greater in preeclampsia (90 +/- 18 g/m(2); P < 0.05). In normotensive pregnancy, ESS decreased (59 +/- 9 to 52 +/- 11 g/cm(2); P < 0.05; controls, 66 +/- 14 g/cm(2); P < 0.005). ESS was greater in preeclampsia (60 +/- 14 g/cm(2); P < 0.05). In controls, there was an inverse relationship between ESS and V(CFC) (r = -0.78). The ESS-V(CFC) relationships in normotensive and preeclamptic pregnancy were unchanged from controls. We conclude that LV hypertrophy in normotensive and preeclamptic pregnancy matches changes in cardiac work, and LV contractility is preserved.

The effects of aminoguanidine on renal changes in a baboon model of Type 1 diabetes.

BACKGROUND: The efficacy of aminoguanidine (AG) on primary prevention of diabetic nephropathy was investigated in a nonhuman primate model of Type 1 diabetes over a period of 4 years. METHODS: Adolescent male baboons (Papio hamadryas) were assigned to four groups: control, diabetic, and control and diabetic treated with AG. Diabetes was induced with streptozocin (60 mg/kg) and treated with insulin to maintain a mean HbA1c level of about 9%. AG was given subcutaneously (10 mg/kg) each day. All animals had annual renal biopsies and 24-h urine collections for measurements of glomerular basement membrane (GBM) thickness, fractional mesangium volume (FMV), albumin excretion rate (AER), and creatinine clearance. Glomerular filtration rate (GFR) and renal plasma flow (RPF) were also determined. RESULT: The diabetic animals had increased GBM after 2 years of diabetes, but there was no increase in FMV over the study period. AG prevented the thickening of GBM at the 3- and 4-year time points. AG and diabetes synergistically increased the GFR. All diabetic animals developed increased albuminuria during the study although lower than the conventionally accepted microalbuminuria range. AG was not able to prevent this and, in fact, led to the nondiabetic animals also developing albuminuria. CONCLUSION: This is the first study to investigate the early use of AG in ameliorating renal damage in a primate model of Type 1 diabetes. The structural and functional changes in the kidney of these animals resemble those seen in the early stages of the human disease. AG was able to significantly reduce the thickening of GBM due to diabetes. This may suggest a potential role for this in primary prevention of diabetic nephropathy in the future.