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1.
Rev Med Suisse ; 15(662): 1603-1606, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508911

RESUMO

Hypertensive disorders of the pregnancy represent a major cause of maternal and fetal morbidity and mortality worldwide. Immediate and future complications are already well known, but recently gestational hypertension emerged as an equally serious risk factor for future maternal health. This article so offers a review of knowledge and recent changes about the diagnosis, treatment and long-term follow-up of hypertensive troubles of the pregnancy which are useful to know for the general practitioner. It also describes the ambulatory follow-up that has been implemented in the University hospitals of Geneva.


Assuntos
Hipertensão Induzida pela Gravidez , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Gravidez , Cuidado Pré-Natal , Fatores de Risco
2.
Dis Markers ; 2019: 5870239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31481983

RESUMO

Background: Placental soluble fms-like tyrosine kinase-1 (sFlt-1), an antagonist of vascular endothelial growth factor, is considered an etiological factor of endothelial damage in pregnancy pathologies. An increase in the sFlt-1 level is associated with alterations of endothelial integrity. In contrast, vitamin D exerts a protective effect and low concentrations of 25(OH)D may have an adverse effect on common complications of pregnancy, such as gestational hypertension (GH), preeclampsia (PE), and gestational diabetes mellitus (GDM). The aim of this study was to analyze the levels of sFlt-1 in Polish women with physiological pregnancies and pregnancies complicated by GH, PE, and GDM. Moreover, we analyzed relationships between the maternal serum sFlt-1 level and the sFlt-1 to 25(OH)D ratio and the risk of GH and PE. Material and Methods: The study included 171 women with complicated pregnancies; among them are 45 with GH, 23 with PE, and 103 with GDM. The control group was comprised of 36 women with physiological pregnancies. Concentrations of sFl-1 and 25(OH)D were measured before delivery, with commercially available immunoassays. Results: Women with GH differed significantly from the controls in terms of their serum sFlt-1 levels (5797 pg/ml vs. 3531 pg/ml, p = 0.0014). Moreover, a significant difference in sFlt-1 concentrations was found between women with PE and those with physiological pregnancies (6074 pg/ml vs. 3531 pg/ml, p < 0.0001). GDM did not exert a statistically significant effect on serum sFlt-1 levels. Both logistic regression and ROC analysis demonstrated that elevated concentration of sFlt-1 was associated with greater risk of GH (AUC = 0.70, p = 0.0001) and PE (AUC = 0.82, p < 0.0001). Also, the sFlt-1 to 25(OH)D ratio, with the cutoff values of 652 (AUC = 0.74, p < 0.0001) and 653 (AUC = 0.88, p < 0.0001), respectively, was identified as a significant predictor of GH and PE. Conclusions: Determination of the sFlt-1/25(OH)D ratio might provide additional important information and, thus, be helpful in the identification of patients with PE and GH, facilitating their qualification for intensive treatment and improving the neonatal outcomes.


Assuntos
25-Hidroxivitamina D 2/sangue , Diabetes Gestacional/diagnóstico , Hipertensão Induzida pela Gravidez/diagnóstico , Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Biomarcadores/sangue , Diabetes Gestacional/sangue , Feminino , Humanos , Hipertensão Induzida pela Gravidez/sangue , Pré-Eclâmpsia/sangue , Gravidez
3.
Hypertension ; 74(5): 1089-1095, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31495278

RESUMO

We estimated changes in the prevalence of chronic hypertension among pregnant women and evaluated the extent to which changes in obesity and smoking were associated with these trends. We designed a population-based cross-sectional analysis of over 151 million women with delivery-related hospitalizations in the United States, 1970 to 2010. Maternal age, year of delivery (period), and maternal year of birth (birth cohort), as well as race, were examined as risk factors for chronic hypertension. Prevalence rates and rate ratios with 95% CIs of chronic hypertension in relation to age, period, and birth cohort were derived through age-period-cohort models. We also examined how changes in obesity and smoking rates influenced age-period-cohort effects. The overall prevalence of chronic hypertension was 0.63%, with black women (1.24%) having more than a 2-fold higher rate than white women (0.53%; rate ratio, 2.31; 95% CI, 2.30-2.32). In the age-period-cohort analysis, the rate of chronic hypertension increased sharply with advancing age and period from 0.11% in 1970 to 1.52% in 2010 (rate ratio, 13.41; 95% CI, 13.22-13.61). The rate of hypertension increased, on average, by 6% (95% CI, 5-6) per year, with the increase being slightly higher among white (7%; 95% CI, 6%-7%) than black (4%; 95% CI, 3%-4%) women. Adjustments for changes in rates of obesity and smoking were not associated with age and period effects. We observed a substantial increase in chronic hypertension rates by age and period and an over 2-fold race disparity in chronic hypertension rates.


Assuntos
Afro-Americanos/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Idade Materna , Obesidade/complicações , Fumar/efeitos adversos , Adolescente , Adulto , Fatores Etários , Doença Crônica , Estudos Transversais , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Pessoa de Meia-Idade , Gravidez , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estados Unidos , Adulto Jovem
4.
Pregnancy Hypertens ; 17: 253-260, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487649

RESUMO

OBJECTIVES: To describe patient outcomes, management of hypertensive disorders of pregnancy, and evaluate provider knowledge of practice guidelines at a tertiary care center in urban China. STUDY DESIGN: Retrospective chart review of patients admitted between September 2017 and March 2018 with a diagnosis of any hypertensive disorder at Zhongnan Hospital of Wuhan University Medical Center in China. Healthcare providers including physicians, midwives, nurses and medical students were surveyed. Patient outcomes were compared to those at the University of Chicago, USA. MAIN OUTCOME MEASURES: Prevalence of hypertensive disorders of pregnancy, comparative rates of medication administration, mode of delivery, and other pregnancy characteristics were abstracted. Responses regarding definitions, treatment and outcomes of hypertension were analyzed using survey data. RESULTS: Among 2834 patients, the prevalence of hypertensive disorders at the Zhongnan Hospital was 7.1%, with a 6.4% prevalence of preeclampsia. Compared to hypertensive women from the University of Chicago, hypertensive patients at Zhongnan Hospital were more likely to be older and weigh less but had higher rates of antihypertensive drug administration and delivery via cesarean section. Infants born at Zhongnan Hospital were less likely to be admitted to the neonatal intensive care unit. Survey respondents demonstrated poor knowledge of preeclampsia diagnoses and first line treatments for severe hypertension in pregnancy. CONCLUSIONS: Although several clinical characteristics of preeclampsia were similar between hospitals, the rates of cesarean section were higher in China. Provider knowledge was most lacking in areas about diagnostic criteria and medication use for preeclampsia. Future studies are needed to explore these differences.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Padrões de Prática Médica , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Adulto , China , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/prevenção & controle , Registros Médicos , Gravidez , Prevalência , Estudos Retrospectivos , Estados Unidos , População Urbana
5.
BMC Pregnancy Childbirth ; 19(1): 297, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416427

RESUMO

BACKGROUND: Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening. METHODS: We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP. RESULTS: Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11-3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86-10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07-11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24-8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14-5.02; P = 0.021). CONCLUSION: Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics' characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Diagnóstico Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , República Democrática do Congo , Feminino , Idade Gestacional , Humanos , Gravidez , Fatores de Risco
6.
Expert Rev Med Devices ; 16(8): 653-661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282755

RESUMO

Introduction: Telemonitoring of hypertension in pregnancy is becoming increasingly common. Several small studies have described the potential benefits of patient-led remote monitoring, including fewer hospital visits, better blood pressure control, and cost savings. Areas covered: This review summarises the principles of prenatal remote monitoring of hypertension as well as the types of devices and applications currently in use. We summarise current evidence regarding the potential benefits and pitfalls with respect to outcomes for mothers, neonates and wider population health. Core topics for ongoing and future research are discussed, with special emphasis on feasibility and validation of technologies, methodological standardization, patient safety, privacy and acceptability, and health economics and governance. Expert opinion: Telemonitoring of hypertension in pregnancy is likely to become commonplace in the next five to ten years and research now must be directed to ensure it is used in the safest way before its general introduction into daily clinical practice can be recommended. Raising women's awareness of their health condition could improve both pregnancy and long-term health outcomes.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Monitorização Fisiológica/métodos , Telemedicina/métodos , Monitorização Ambulatorial da Pressão Arterial , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Humanos , Hipertensão Induzida pela Gravidez/economia , Monitorização Fisiológica/efeitos adversos , Monitorização Fisiológica/economia , Gravidez , Telemedicina/economia
7.
Am J Obstet Gynecol ; 221(3): 277.e1-277.e8, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31255629

RESUMO

BACKGROUND: Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130-139 mm Hg or diastolic, 80-89 mm Hg), elevated (systolic, 120-129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. OBJECTIVE: We sought to evaluate the risk of gestational hypertension or preeclampsia based on early pregnancy blood pressure category and trajectory. STUDY DESIGN: We utilized data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, a prospective observational study of nulliparous women with singleton pregnancies conducted at 8 clinical sites between 2010 and 2014. Women included in this analysis had no known history of prepregnancy hypertension (blood pressure, ≥140/90 mm Hg) or diabetes. We compared the frequency of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, among women based on ACC/AHA blood pressure category at a first-trimester study visit and blood pressure trajectory between study visits in the first and second trimesters. Blood pressure trajectories were categorized based on blood pressure difference between visits 1 and 2 as stable (<5 mm Hg difference), upward (≥5 mm Hg), or downward (≤-5 mm Hg). Associations of blood pressure category and trajectory with preeclampsia and gestational hypertension were assessed via univariate analysis and multinomial logistic regression analysis with covariates identified a priori. RESULTS: A total of 8899 women were included in the analysis. Study visit 1 occurred at a mean gestational age of 11.6 ± 1.5 weeks and study visit 2 at a mean gestational age of 19.0 ± 1.6 weeks. First-trimester blood pressure category was significantly associated with both preeclampsia and gestational hypertension, with increasing blood pressure category associated with a higher risk of all hypertensive disorders of pregnancy. Elevated blood pressure was associated with an adjusted relative risk of 1.54 (95% confidence interval, 1.18-2.02) and stage 1 hypertension was associated with adjusted relative risk of 2.16 (95% confidence interval, 1.31-3.57) of any hypertensive disorder of pregnancy. Stage 1 hypertension was associated with the highest risk of preeclampsia with severe features, with an adjusted relative risk of 2.48 (95% confidence interval, 1.38-8.74). Both systolic and diastolic blood pressure trajectories were also significantly associated with the risk of hypertensive disorders of pregnancy independent of blood pressure category (P < .001). Women with a blood pressure categorized as normal and with an upward systolic trajectory had a 41% increased risk of any hypertensive disorder of pregnancy (adjusted relative risk, 1.41; 95% confidence interval, 1.20-1.65) compared to women with a downward systolic trajectory. CONCLUSION: In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.


Assuntos
Determinação da Pressão Arterial/métodos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/etiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Modelos Logísticos , Paridade , Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco
8.
BMC Health Serv Res ; 19(1): 411, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234838

RESUMO

BACKGROUND: Nigeria has one of the highest rates of maternal mortality in the world (576/100,000 births), with a significant proportion of death attributed to hypertensive disorders in pregnancy (HDPs). High quality antenatal care (ANC) plays a crucial role in early detection and management of HDPs. We conducted an assessment of quality of antenatal care, and its capacity to detect and manage HDPs, in two tiers of Nigerian facilities, with the aim of describing the state of service delivery and identifying the most urgent gaps. METHODS: Quality of antenatal care was assessed and compared between primary healthcare centers (PHCs) (n = 56) and hospitals (secondary + tertiary facilities, n = 39) in seven states of Nigeria. A cross-sectional design captured quality of care using facility inventory checklists, semi-structured interviews with healthcare providers and clients, and observations of ANC consultations. A quality of care framework and scoring system was established based on aspects of structure, process, and outcome. Average scores were compared using independent sample t-tests and measures of effect were assessed by multivariate linear regression. RESULTS: All domains of quality except provider interpersonal skills scored below 55%. The lowest overall scores were observed in provider knowledge (49.9%) and provider technical skill (47.7%). PHCs performed significantly worse than hospitals in all elements of quality except for provider interpersonal skills. Provider knowledge was significantly associated with their level of designation (i.e., obstetrician vs. other providers). CONCLUSIONS: In order to provide high quality care, ANC in Nigeria must experience massive improvements to inventory, infrastructure and provider knowledge and training. In particular, ANC programs in PHCs must be revitalized to minimize the disparity in quality of care provided between PHCs and hospitals. The relatively low quality of care observed may be contributing to Nigeria's high rate of maternal mortality and burden of disease attributed to HDPs.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/prevenção & controle , Cuidado Pré-Natal , Qualidade da Assistência à Saúde , Adulto , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Nigéria , Gravidez , Atenção Primária à Saúde
9.
Hypertension ; 74(2): 375-383, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230546

RESUMO

Hypertensive disorders of pregnancy (HDP) are associated with low birth weight, shorter gestational age, and increased risk of maternal and offspring cardiovascular diseases later in life. The mechanisms involved are poorly understood, but epigenetic regulation of gene expression may play a part. We performed meta-analyses in the Pregnancy and Childhood Epigenetics Consortium to test the association between either maternal HDP (10 cohorts; n=5242 [cases=476]) or preeclampsia (3 cohorts; n=2219 [cases=135]) and epigenome-wide DNA methylation in cord blood using the Illumina HumanMethylation450 BeadChip. In models adjusted for confounders, and with Bonferroni correction, HDP and preeclampsia were associated with DNA methylation at 43 and 26 CpG sites, respectively. HDP was associated with higher methylation at 27 (63%) of the 43 sites, and across all 43 sites, the mean absolute difference in methylation was between 0.6% and 2.6%. Epigenome-wide associations of HDP with offspring DNA methylation were modestly consistent with the equivalent epigenome-wide associations of preeclampsia with offspring DNA methylation (R2=0.26). In longitudinal analyses conducted in 1 study (n=108 HDP cases; 550 controls), there were similar changes in DNA methylation in offspring of those with and without HDP up to adolescence. Pathway analysis suggested that genes located at/near HDP-associated sites may be involved in developmental, embryogenesis, or neurological pathways. HDP is associated with offspring DNA methylation with potential relevance to development.


Assuntos
Metilação de DNA/genética , Proteínas de Ligação a DNA/genética , Estudo de Associação Genômica Ampla , Hipertensão Induzida pela Gravidez/genética , Recém-Nascido Prematuro , Resultado da Gravidez , Adulto , Estudos de Coortes , Epigênese Genética , Feminino , Sangue Fetal , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Recém-Nascido , Gravidez
10.
Hypertension ; 74(2): 384-390, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230552

RESUMO

Although ambient air pollution may increase hypertension risk through endothelial damage and oxidative stress, evidence is inconsistent regarding its effect on hypertension in pregnancy. Prior research has evaluated a limited scope of pollution species and often not differentiated preeclampsia, which may have a placental origin, from gestational hypertension. Among 49 607 women with at least 2 singleton deliveries in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Consecutive Pregnancies Study (2002-2010), we estimated criteria pollutant and volatile organic compound levels during pregnancy using Community Multiscale Air Quality models and abstracted gestational hypertension and preeclampsia diagnoses from medical records. Generalized estimating equations accounted for repeat pregnancies and adjusted for ambient temperature and maternal age, race/ethnicity, body mass index, smoking, alcohol, parity, insurance, marital status, and asthma. Air pollution levels were low to moderate (eg, median 41.6 ppb [interquartile range, 38.9-43.7 ppb] for ozone and 35.1 ppb [28.9-40.3 ppb] for nitrogen oxides). Higher levels of most criteria pollutants during preconception and the first trimester were associated with lower preeclampsia risk, while higher second-trimester levels were associated with greater gestational hypertension risk. For example, an interquartile increase in first-trimester carbon monoxide was associated with a relative risk of 0.88 (95% CI, 0.81-0.95) for preeclampsia and second-trimester carbon monoxide a relative risk of 1.14 (95% CI, 1.07-1.22) for gestational hypertension. Volatile organic compounds, conversely, were not associated with gestational hypertension but consistently associated with higher preeclampsia risk. These findings further suggest air pollution may affect the development of hypertension in pregnancy, although differing causes of preeclampsia and gestational hypertension may alter these relationships.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Hipertensão Induzida pela Gravidez/diagnóstico , Exposição Materna/efeitos adversos , Pré-Eclâmpsia/etiologia , Resultado da Gravidez , Adulto , Poluição do Ar/efeitos adversos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Medição de Risco , Estados Unidos
13.
Int J Mol Sci ; 20(12)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31216670

RESUMO

The aim of the study was to verify if quantification of placental specific C19MC microRNAs in plasma exosomes would be able to differentiate during the early stages of gestation between patients subsequently developing pregnancy-related complications and women with the normal course of gestation and if this differentiation would lead to the improvement of the diagnostical potential. The retrospective study on singleton Caucasian pregnancies was performed within 6/2011-2/2019. The case control study, nested in a cohort, involved women that later developed GH (n = 57), PE (n = 43), FGR (n = 63), and 102 controls. Maternal plasma exosome profiling was performed with the selection of C19MC microRNAs with diagnostical potential only (miR-516b-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, and miR-525-5p) using real-time RT-PCR. The down-regulation of miR-517-5p, miR-520a-5p, and miR-525-5p was observed in patients with later occurrence of GH and PE. Maternal plasma exosomal profiling of selected C19MC microRNAs also revealed a novel down-regulated biomarker during the first trimester of gestation (miR-520a-5p) for women destinated to develop FGR. First trimester circulating plasma exosomes possess the identical C19MC microRNA expression profile as placental tissues derived from patients with GH, PE and FGR after labor. The predictive accuracy of first trimester C19MC microRNA screening (miR-517-5p, miR-520a-5p, and miR-525-5p) for the diagnosis of GH and PE was significantly higher in the case of expression profiling of maternal plasma exosomes compared to expression profiling of the whole maternal plasma samples.


Assuntos
MicroRNA Circulante , Exossomos , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/diagnóstico , Hipertensão Induzida pela Gravidez/sangue , Hipertensão Induzida pela Gravidez/diagnóstico , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Biomarcadores , Exossomos/metabolismo , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Prognóstico , Curva ROC
15.
Pregnancy Hypertens ; 16: 148-153, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056151

RESUMO

OBJECTIVE: To examine the association of low fetal fraction of cell-free DNA (cfDNA) with placental compromise and adverse perinatal outcomes. MATERIALS AND METHODS: This was a retrospective cohort utilizing a sample of convenience including 639 women undergoing cfDNA screening at our institution from January 2013 to January 2017. Low fetal fraction was defined as less than the 25th percentile. Indicators of placental compromise were examined individually and as a composite outcome, including hypertensive disease of pregnancy, intrauterine growth restriction, abruption, and oligohydramnios. Neonatal outcomes, including preterm delivery, low Apgar scores, and small for gestational age, also were examined. We calculated risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Low fetal fraction was associated with placental compromise (RR 1.6 [CI 1.1-2.2]), hypertensive disease of pregnancy (RR 1.6 [CI 1.003-2.6]), and preeclampsia with severe features (RR 3.3 [CI 1.2-8.9]). Low fetal faction was not associated with preterm delivery, low Apgar scores, or small for gestational age. CONCLUSIONS: Low fetal fraction of cfDNA among asymptomatic women may serve as a predictor of subsequent placental dysfunction and hypertensive disease.


Assuntos
Ácidos Nucleicos Livres/sangue , Hipertensão Induzida pela Gravidez/epidemiologia , Placenta/fisiopatologia , Adulto , Biomarcadores/sangue , Estudos de Coortes , Feminino , Feto/patologia , Humanos , Hipertensão Induzida pela Gravidez/sangue , Hipertensão Induzida pela Gravidez/diagnóstico , Recém-Nascido , Massachusetts/epidemiologia , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos
16.
J Biomed Sci ; 26(1): 38, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109316

RESUMO

BACKGROUND: To investigate the possibility of using maternal biophysical parameters only in screening for the different types of gestational hypertensive diseases. METHODS: A total of 969 pregnant women were randomly screened in first and second trimester, of which 8 developed Early-onset Preeclampsia, 29 Late-onset Preeclampsia, 35 Gestational Hypertension and 897 women had a normal outcome. An observational maternal hemodynamics assessment was done via standardized electrocardiogram-Doppler ultrasonography, Impedance Cardiography and bio-impedance, acquiring functional information on heart, arteries, veins and body fluid. Preliminary prediction models were developed to test the screening potential for early preeclampsia, late preeclampsia and gestational hypertension using a Partial Least Square Discriminant Analysis. RESULTS: A combined model using maternal characteristics with cardiovascular parameters in first and second trimester offers high screening performance with Area Under the Curve of 99,9% for Early-onset Preeclampsia, 95,3% for Late-onset Preeclampsia and 94% for Gestational Hypertension. CONCLUSIONS: Using biophysical parameters as fundament for a new prediction model, without the need of biochemical parameters, seems feasible. However, validation in a large prospective study will reveal its true potential.


Assuntos
Testes Diagnósticos de Rotina/métodos , Hipertensão Induzida pela Gravidez/diagnóstico , Adulto , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Gravidez
17.
J Perinat Neonatal Nurs ; 33(2): 136-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31021939

RESUMO

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.


Assuntos
Diabetes Gestacional/diagnóstico , Disparidades em Assistência à Saúde/economia , Hipertensão Induzida pela Gravidez/diagnóstico , Programas de Rastreamento/normas , Morte Materna/prevenção & controle , Cuidado Pós-Natal/métodos , Diabetes Gestacional/mortalidade , Diabetes Gestacional/terapia , Feminino , Seguimentos , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Programas de Rastreamento/tendências , Período Pós-Parto , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco
19.
Implement Sci ; 14(1): 38, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999963

RESUMO

BACKGROUND: Interventions aimed at reducing maternal mortality are increasingly complex. Understanding how complex interventions are delivered, to whom, and how they work is key in ensuring their rapid scale-up. We delivered a vital signs triage intervention into routine maternity care in eight low- and middle-income countries with the aim of reducing a composite outcome of morbidity and mortality. This was a pragmatic, hybrid effectiveness-implementation stepped-wedge randomised controlled trial. In this study, we present the results of the mixed-methods process evaluation. The aim was to describe implementation and local context and integrate results to determine whether differences in the effect of the intervention across sites could be explained. METHODS: The duration and content of implementation, uptake of the intervention and its impact on clinical management were recorded. These were integrated with interviews (n = 36) and focus groups (n = 19) at 3 months and 6-9 months after implementation. In order to determine the effect of implementation on effectiveness, measures were ranked and averaged across implementation domains to create a composite implementation strength score and then correlated with the primary outcome. RESULTS: Overall, 61.1% (n = 2747) of health care providers were trained in the intervention (range 16.5% to 89.2%) over a mean of 10.8 days. Uptake and acceptability of the intervention was good. All clusters demonstrated improved availability of vital signs equipment. There was an increase in the proportion of women having their blood pressure measured in pregnancy following the intervention (79.2% vs. 97.6%; OR 1.30 (1.29-1.31)) and no significant change in referral rates (3.7% vs. 4.4% OR 0.89; (0.39-2.05)). Availability of resources and acceptable, effective referral systems influenced health care provider interaction with the intervention. There was no correlation between process measures within or between domains, or between the composite score and the primary outcome. CONCLUSIONS: This process evaluation has successfully described the quantity and quality of implementation. Variation in implementation and context did not explain differences in the effectiveness of the intervention on maternal mortality and morbidity. We suggest future trials should prioritise in-depth evaluation of local context and clinical pathways. TRIAL REGISTRATION: Trial registration: ISRCTN41244132 . Registered on 2 Feb 2016.


Assuntos
Determinação da Pressão Arterial/instrumentação , Países em Desenvolvimento , Hipertensão Induzida pela Gravidez/diagnóstico , Mortalidade Materna , Triagem , Sinais Vitais , Adulto , Desenho de Equipamento , Feminino , Grupos Focais , Humanos , Ciência da Implementação , Entrevistas como Assunto , Gravidez , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
20.
Clin Liver Dis ; 23(2): 345-361, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30947881

RESUMO

Liver diseases during pregnancy pose a unique clinical challenge because they can affect the lives of both the mother and unborn child. Although severe liver disease is rare, pregnancy-related liver disease affects approximately 3% of pregnancies and can be fatal. Timely recognition and diagnosis are essential in order to institute appropriate management strategies. This article provides an overview of liver diseases during pregnancy and is divided into 2 sections: (1) liver diseases specific to pregnancy, and (2) preexisting or coincident liver diseases during pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Hepatopatias/diagnóstico , Hepatopatias/terapia , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/diagnóstico , Colestase Intra-Hepática/tratamento farmacológico , Fígado Gorduroso/diagnóstico , Feminino , Hepatite B/diagnóstico , Hepatite B/terapia , Hepatite B/transmissão , Hepatite C/diagnóstico , Hepatite C/terapia , Hepatite C/transmissão , Hepatite Autoimune/tratamento farmacológico , Humanos , Hiperêmese Gravídica/sangue , Hipertensão Induzida pela Gravidez/terapia , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Hepatopatias/sangue , Testes de Função Hepática , Transplante de Fígado , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico
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