La preeclampsia es precedida por alteración de la función cardiovascular / Preeclampsia is Preceded by Cardiovascular Function Abnormalities

RESUMEN Introducción: La preeclampsia (PE) se acompaña de cambios en la función cardiovascular (FCV). Sin embargo, es desconocido si los cambios preceden y persisten a la manifestación clínica de PE. Objetivos: Evaluar las diferencias en la FCV, en la semana 22 de gestación (22sg) y un año posterior al parto (1app) en las pacientes que evolucionaron a la PE vs. a la normotensión (N). También, la asociación entre la FCV en 22sg y la evolución a PE. Material y métodos: Estudio prospectivo, que incluyó 260 primíparas normotensas. Se midió en la semana 22sg y a 1app: laboratorio de rutina, proteinuria de 24horas, presión arterial (PA). Por cardiografía por impedancia: índice cardíaco (IC) y de resistencia vascular sistémica (IRVS), velocidad de onda de pulso (VOP). Se formaron 3 grupos según la evolución a: PE, G1, HTA gestacional (HG) G2, y N, G3. Los resultados se presentan como media ± DS, ANOVA y test post hoc, p < 0,05. Resultados: 12 pacientes evolucionaron a PE, 18 a HG y 220 a N. El G1 presentó en los dos tiempos de medición, valores inferiores de IC y superiores de PA, IRP y VOP comparados al G3. El G2 presentó valores intermedios entre el G1 y el G3. La VOP y el IRP en la 22sg de gestación resultaron predictores de PE. Conclusiones: Las pacientes que evolucionaron a PE presentaron en fase temprana del embarazo diferente FCV respecto a las normotensas. El diagnóstico temprano de estos cambios contribuiría a predecir la PE y prevenir sus complicaciones.

ABSTRACT Background: Preeclampsia (PE) is associated with changes in cardiovascular function (CVF), but whether these changes precede and persist in the clinical phase of the disease is still unknown. Objectives: The aim of this study was to evaluate the differences in CVF during 22 weeks of gestation and one year after delivery in patients who developed PE vs. those with normotension (N). The association between CVF on 22 weeks of gestation and the development of PE was also analyzed. Methods: We conducted a prospective study including 260 normotensive primiparous women. Routine laboratory tests, 24-hour urine protein and blood pressure (BP) were measured on 22 weeks and one year after delivery. Cardiac index (CI) systemic vascular resistance index (SVRI) and pulse wave velocity (PWV) were measured by impedance cardiography. The population was divided into three groups according to the outcome during pregnancy: PE: G1, gestational hypertension (GH): G2 and normotension: G3. The results are presented as mean ± SD, ANOVA and post hoc test, p < 0.05. Results: Twelve patients evolved to PE, 18 to GH and 220 remained with N. In G1, CI was lower and BP, SVRI and PWV were higher than in G3 on 22 weeks and one year after delivery. In G2, values were always intermediate between G1 and G3. PWV and SVRI measured on 22 weeks resulted predictors of PE. Conclusions: Patients who developed PE had different CVF in the early stage of pregnancy than those with normotension. The early diagnosis of those changes could predict PE and thus contribute to prevent its complications.

Prevalence of Pertussis Antibodies in Maternal Blood, Cord Serum, and Infants From Mothers With and Those Without Tdap Booster Vaccination During Pregnancy in Argentina.

BACKGROUND: Morbidity and mortality rates for pertussis in infants are high because disease often occurs before the onset of routine immunization or in those who do not complete a primary immunization series. Pertussis immunization is recommended during pregnancy to achieve antibody levels sufficient to protect young infants. To our knowledge, no previous reports of maternal pertussis immunization results in Latin America exist in the literature. METHODS: This study compared pertussis antibody levels in newborns from mothers who received or did not receive a tetanus-diphtheria-acellular pertussis vaccination (TdapV) during pregnancy. Each mother's level of immunoglobulin G antibodies against pertussis toxin (IgG-PT) was measured with a validated, specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Paired mother and cord serum samples were compared in 105 mothers with and 99 mothers without a TdapV. At birth, the mothers with and those without a TdapV had serum IgG-PT geometric mean concentrations (GMCs) of 35.1 and 9.8 ELISA units (EU)/mL, respectively (P < .0001); cord blood GMCs were 51.3 and 11.6 EU/mL, respectively (P < .0003); and cord blood IgG-PT levels were <5 EU/mL in 2.9% and 16.1% of the cord blood samples, respectively (P < .001). The mothers received their TdapV at a mean (± standard deviation [SD]) of 24.7 ± 4.8 weeks' gestation. Vaccination timing did not affect the IgG-PT GMC at birth. Placental antibody transference efficiencies (measured as the ratio of the cord blood GMC to the maternal GMC) were 1.46 and 1.18 for mothers with and those without a TdapV, respectively. The IgG-PT GMCs were 17.7 EU/mL in 36 infants in their first month of life and 11.6 EU/mL in 32 infants in their second month of life. CONCLUSIONS: Women who received a TdapV during pregnancy had significantly a higher serum/cord IgG-PT concentration at birth than mothers who did not receive a TdapV. Timing of the immunization was not correlated with antibody concentrations. Infants born to immunized mothers had significantly higher antibody levels during their first 2 months of life.

Hipertensión matinal y comportamiento non-dipper en embarazadas con hipertensión de guardapolvo blanco / Morning Hypertension and Non-dipper Behavior in Pregnant Women with White Coat Syndrome

Introducción: La hipertensión de guardapolvo blanco (HGB) es común en el embarazo, aunque su evolución clínica durante la gestación se conoce poco. La hipertensión matinal y el comportamiento non-dipper, medidos por monitoreo ambulatorio de la presión arterial (MAPA), se asocian con mayor riesgo de eventos cardiovasculares; no obstante ello, son escasos los estudios en la gestación. Objetivos: El objetivo primario del estudio fue evaluar la hipertensión matinal y el comportamiento non-dipper en embarazadas con HGB versus un grupo control de normotensas. Se planteó como objetivo secundario evaluar si la HGB, la hipertensión matinal y el comportamiento non-dipper en el segundo trimestre del embarazo se relacionan con mayor hipertensión sostenida en el tercer trimestre. Material y métodos: Estudio prospectivo en el que se incluyeron 95 primigestas en la semana 20 de gestación, 50 con HGB y 45 normotensas como grupo control. Se registraron laboratorio de rutina, presión de consultorio y MAPA en la inclusión y a las 32 semanas de gestación. La hipertensión matinal y el comportamiento non-dipper se evaluaron por MAPA. Resultados: La edad, la glucemia y la presión diurna y nocturna por MAPA fueron similares en el examen basal en ambos grupos. Por el contrario, las pacientes con HGB presentaron valores significativamente superiores de hipertensión matinal y comportamiento non-dipper, lo cual se asoció en forma independiente con hipertensión sostenida en el tercer trimestre del embarazo. Conclusiones: Las gestantes con HGB en la semana 20 de embarazo presentaron mayor hipertensión matinal y comportamiento non-dipper y evolucionaron con más frecuencia a hipertensión sostenida que el grupo control de normotensas.

Background: White coat syndrome (WCS) is common during pregnancy, although little is known about its clinical outcome during gestation. Morning hypertension and the non-dipper behavior, measured by ambulatory blood pressure monitoring (ABPM), are associated with greater risk of cardiovascular events. However, there are few studies during pregnancy. Objectives: The primary aim of the study was to evaluate morning hypertension and the non-dipper behavior in pregnant women with WCS versus a control normotensive group. A secondary objective was to evaluate whether WCS, morning hypertension and the non-dipper behavior in the second trimester of pregnancy were associated with greater hypertension in the third trimester. Methods: This prospective study included 95 primiparae in the 20th week of gestation, 50 with WCS and 45 as normotensive control group. Routine lab tests, office blood pressure and ABPM at inclusion and in the 32th week of gestation were recorded. Morning hypertension and the non-dipper behavior were evaluated by ABPM. Results: Age, and baseline blood glucose level and daytime and nighttime blood pressure by ABPM were similar in both groups. Conversely, patients presenting WCS had significantly higher values of morning hypertension and non-dipper behavior, which were independently associated with sustained hypertension in the third trimester of pregnancy. Conclusions: Pregnant women with WCS in the 20th week of gestation presented greater morning hypertension and non-dipper behavior and progressed more frequently to sustained hypertension than the control normotensive group.

Estudio de seroprevalencia de coqueluche en adultos jóvenes, mujeres en puerperio inmediato y sangre del cordón umbilical / Pertussis seroprevalence in adults, post-partum women and umbilical cord blood

La coqueluche es una enfermedad inmunopreve-nible que afecta a todas las edades. Los adultos jóvenes que han perdido su inmunidad contra pertussis son una importante fuente de infección para los lactantes. Ante el aumento sostenido de casos de coqueluche, se plantean nuevas estrategias de prevención.Objetivo. Evaluar la seroprevalencia de coqueluche en donantes de sangre adultos, puérperas y cordones.Métodos. Determinación de títulos de anticuerpos totales anti-Bordetella spp (Bordetella) mediante el ensayo por inmunoabsorción ligado a enzimas. Se evaluaron sueros de 103 donantes, 101 puérperas y 100 cordones. Los títulos < 80 fueron considerados de bajo impacto contra la enfermedad. El pasaje transplacentario de anticuerpos fue evaluado como la relación en los títulos de anticuerpos en cordones/madres. Resultados. Media de edad de los donantes: 28 ± 6 años. Mediana títulos anti-Bordetella: 320; rango intercuartil: 160-320 (RIC); 10% presentaron títulos < 80. Media de edad de las puérperas: 26 ± 6 años. Mediana títulos anti-Bordetella: 160 (RIC: 80320), títulos significativamente menores que las mujeres donantes (p= 0,00002). El 30% de las puérperas presentaron títulos < 80. Mediana anti-Bordetella cordones: 160 (RIC: 80160). Los cordones presentaron títulos < 80 más frecuentemente que sus madres (44% vs. 30%, p= 0,04). El pasaje transplacentario fue 0,83. El título en los cordones fue igual a sus madres en el 54%, menor en el 37% y mayor solo en el 8%.Conclusiones. Los títulos de anticuerpos anti-Bordetella en las puérperas fueron significativamente menores que en las donantes. Las madres y los cordones presentaron títulos < 80 en el 30% y el 44%, respectivamente. Estos datos podrían explicar las altas tasas de ataque en lactantes pequeños que no han completado su esquema de vacunación.

Estudio de seroprevalencia de coqueluche en adultos jóvenes, mujeres en puerperio inmediato y sangre del cordón umbilical / Pertussis seroprevalence in adults, post-partum women and umbilical cord blood

La coqueluche es una enfermedad inmunopreve-nible que afecta a todas las edades. Los adultos jóvenes que han perdido su inmunidad contra pertussis son una importante fuente de infección para los lactantes. Ante el aumento sostenido de casos de coqueluche, se plantean nuevas estrategias de prevención.Objetivo. Evaluar la seroprevalencia de coqueluche en donantes de sangre adultos, puérperas y cordones.Métodos. Determinación de títulos de anticuerpos totales anti-Bordetella spp (Bordetella) mediante el ensayo por inmunoabsorción ligado a enzimas. Se evaluaron sueros de 103 donantes, 101 puérperas y 100 cordones. Los títulos < 80 fueron considerados de bajo impacto contra la enfermedad. El pasaje transplacentario de anticuerpos fue evaluado como la relación en los títulos de anticuerpos en cordones/madres. Resultados. Media de edad de los donantes: 28 ± 6 años. Mediana títulos anti-Bordetella: 320; rango intercuartil: 160-320 (RIC); 10% presentaron títulos < 80. Media de edad de las puérperas: 26 ± 6 años. Mediana títulos anti-Bordetella: 160 (RIC: 80320), títulos significativamente menores que las mujeres donantes (p= 0,00002). El 30% de las puérperas presentaron títulos < 80. Mediana anti-Bordetella cordones: 160 (RIC: 80160). Los cordones presentaron títulos < 80 más frecuentemente que sus madres (44% vs. 30%, p= 0,04). El pasaje transplacentario fue 0,83. El título en los cordones fue igual a sus madres en el 54%, menor en el 37% y mayor solo en el 8%.Conclusiones. Los títulos de anticuerpos anti-Bordetella en las puérperas fueron significativamente menores que en las donantes. Las madres y los cordones presentaron títulos < 80 en el 30% y el 44%, respectivamente. Estos datos podrían explicar las altas tasas de ataque en lactantes pequeños que no han completado su esquema de vacunación.(AU)

Pertussis seroprevalence in adults, post-partum women and umbilical cord blood.

Pertussis is a vaccine-preventable disease that affects people of all ages. Young adults who have lost their immunity to pertussis are the major source of infection in infants. Given the steady increase of pertussis cases, new prevention strategies are required. Objective. To assess pertussis seroprevalence in adult blood donors, post-partum women, and umbilical cords. Metod. Measurement of total titers of anti-Bordetella spp. (Bordetella) antibodies using an enzyme-linked immunosorbent assay. Serum samples from 103 donors, 101 post-partum women and 100 umbilical cords were analyzed. Titers <80 were considered of low impact against the disease. The assessment included transplacental transfer of antibodies and the umbilical cord/maternal ratio of antibody titers. Results. Donors mean age was: 28 ± 6 years old. Mediananti-Bordetella titers: 320; interquartile range (IQR):160-320; 10% had titers <80. Post-partum women mean age was: 26 ± 6 years old. Median anti-Bordetella titers:160 (IQR:80-320), with titers significantly lower than in female donors (p= 0.00002). Titers <80 were found in 30% of post-partum women. Median anti-Bordetella titers in umbilical cords: 160 (IQR: 80-160). Titers <80 were more frequently found in umbilical cords than in mothers (44% versus 30%, p= 0.04). Transplacental transfer was 0.83. Umbilical cord titers were equal to maternal titers in 54% of cases, lower in 37%, and higher only in 8%. Conclusion. Titers of anti-Bordetella antibodies in post-partum women were significantly lower than in female blood donors. Titers <80 were found in 30% of post-partum women and 44% of umbilical cords. These data may account for the high rates of pertussis in young infants who have not yet completed their vaccination schedule.

Pertussis seroprevalence in adults, post-partum women and umbilical cord blood. / Pertussis seroprevalence in adults, post-partum women and umbilical cord blood.

Pertussis is a vaccine-preventable disease that affects people of all ages. Young adults who have lost their immunity to pertussis are the major source of infection in infants. Given the steady increase of pertussis cases, new prevention strategies are required. Objective. To assess pertussis seroprevalence in adult blood donors, post-partum women, and umbilical cords. Metod. Measurement of total titers of anti-Bordetella spp. (Bordetella) antibodies using an enzyme-linked immunosorbent assay. Serum samples from 103 donors, 101 post-partum women and 100 umbilical cords were analyzed. Titers <80 were considered of low impact against the disease. The assessment included transplacental transfer of antibodies and the umbilical cord/maternal ratio of antibody titers. Results. Donors mean age was: 28 ± 6 years old. Mediananti-Bordetella titers: 320; interquartile range (IQR):160-320; 10

had titers <80. Post-partum women mean age was: 26 ± 6 years old. Median anti-Bordetella titers:160 (IQR:80-320), with titers significantly lower than in female donors (p= 0.00002). Titers <80 were found in 30

of post-partum women. Median anti-Bordetella titers in umbilical cords: 160 (IQR: 80-160). Titers <80 were more frequently found in umbilical cords than in mothers (44

versus 30

, p= 0.04). Transplacental transfer was 0.83. Umbilical cord titers were equal to maternal titers in 54

of cases, lower in 37

, and higher only in 8

. Conclusion. Titers of anti-Bordetella antibodies in post-partum women were significantly lower than in female blood donors. Titers <80 were found in 30

of post-partum women and 44

of umbilical cords. These data may account for the high rates of pertussis in young infants who have not yet completed their vaccination schedule.