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1.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 741-746, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752456

RESUMO

Objective: To explore the characteristics of maternal glucose and lipid metabolism in twin pregnancies complicated by gestational diabetes mellitus (GDM). Methods: The clinical features of twin and singleton pregnancies complicated by GDM, which delivered in Peking University First Hospital from January 1st, 2012 to December 31st, 2017 were retrospectively analyzed. A total of 286 twin pregnancies with GDM (GDM-T group) were collected, and 572 singleton pregnancies complicated by GDM (GDM-S group) which were matched by delivery time in a ratio of 1∶2 among all singleton pregnancies with GDM. The characteristics of maternal glucolipid metabolism in the second trimesters of pregnancy was compared between two groups. Results: (1) Compared with GDM-S group, the maternal delivery age were lower [(32±4), (33±4) years] and prepregnancy body mass index (BMI) were higher [(24±4), (23±4) kg/m(2)] in GDM-T group, the differences were statistically significant (all P<0.05). The incidence of chronic hypertension was found no significant difference (P=0.581). (2) The 3 points of glucose values in 75 g oral glucose tolerance test (OGTT) and OGTT-area under curve (AUC) had no significant difference between GDM-T and GDM-S group.When compared with GDM-S group, the maternal glycosylated hemoglobin levels [(5.41±0.35)%, (5.32±0.28)%], the insulin resistance index (4.07±0.77, 2.63±1.50) and the proportion of insulin use (7.7%, 4.4%) were all significantly higher in GDM-T group (all P<0.05). The values of triglyceride [(3.4±1.4), (2.6±1.2) mmol/L], total cholesterol [(6.3±1.1), (6.0±1.0) mmol/L], low density lipoprotein cholesterol [(3.3±0.9), (3.1±0.8) mmol/L] were significantly higher and values of high density lipoprotein cholesterol [(1.7±0.4), (2.0±0.5) mmol/L] were significantly lower in GDM-T group than GDM-S group (all P<0.05). (3) There was no significant difference in the incidence of gestational hypertension between the two groups (P>0.05). When compared with GDM-S group, the incidences of preeclampsia and small for gestational age were both significantly higher (13.3% vs 2.4%; 28.7% vs 1.7%) and the incidence of large for gestational age was significantly lower in GDM-T group (4.5% vs 15.2%; all P<0.05). Conclusions: The insulin resistance is aggravated in twin pregnancies and the characteristics of lipid metabolism are different between singleton and twin pregnant women complicated by GDM, and there are more complications in twin GDM pregnancies.


Assuntos
Diabetes Gestacional/etiologia , Hipertensão Induzida pela Gravidez/etiologia , Gravidez de Gêmeos , Glicemia/análise , Feminino , Teste de Tolerância a Glucose , Humanos , Gravidez , Estudos Retrospectivos
2.
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
3.
Gac Med Mex ; 155(Suppl 1): S27-S31, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31182871

RESUMO

Background: Preeclampsia occurs in 8% of pregnancies and generates 25% of perinatal deaths. Although its etiology is multifactorial, some metabolic alterations are associated with the endothelial dysfunction present in the disease, and its study could identify early markers of damage. Objective: To determine the relationship between plasma concentration of triglycerides in pregnant patients with hypertensive disease induced by pregnancy. Methods: Prospective study that included 147 healthy pregnant women and 120 women with hypertensive disease induced by pregnancy. Total cholesterol, low-density lipoprotein, high-density lipoprotein, Hemoglobin A1c, triglycerides, BH, QS, serum electrolytes, serum nitrites and liver function tests were determined. Results: A significant difference was found in the concentration of triglycerides between normotensive and patients with preeclampsia (261.22 ± 80.27 vs. 361.46 ± 135.17 mg/dl, p < 0.0008). In addition, a lower serum concentration of nitrites was observed in patients with preeclampsia, which helps explain vasoconstriction. Conclusions: We found an association between hypertriglyceridemia and the presence of diabetes mellitus II with the development of hypertensive disease induced by pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/etiologia , Hipertrigliceridemia/complicações , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/sangue , Pré-Eclâmpsia/etiologia , Gravidez , Estudos Prospectivos
4.
J Assist Reprod Genet ; 36(7): 1449-1456, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31134412

RESUMO

PURPOSE: To explore associations between infertility treatment and hypertensive disorders of pregnancy. METHODS: We collated multi-year as well as multi-state data from a national representative survey examining the association between self-reported infertility treatment (i.e., medication, intrauterine insemination, or assisted reproductive technology) and hypertensive disorders of pregnancy (i.e., high blood pressure, pregnancy-induced hypertension (PIH), preeclampsia, and toxemia). Data were analyzed using logistic regression. A total of 21,884 women in the United States (U.S.), from the Centers for Disease Control and Prevention's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) survey (2009-2015), participated in the study. RESULTS: In our analysis, 12.91% women reported a history of infertility treatment and 15.19% reported a history of hypertensive disorder of pregnancy. Compared with women who had never had infertility treatment, women who reported infertility treatment had 1.18 (adjusted OR, 95% confidence interval (CI) 1.05, 1.33) higher odds of reporting hypertensive disorder of pregnancy. Neither types of infertility treatment nor proximity of treatment to pregnancy were independently associated with hypertensive disorder of pregnancy. CONCLUSIONS: Our results suggest that among U.S. women, the treatment of infertility may be associated with hypertension disorder of pregnancy regardless of type of treatment.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Infertilidade/terapia , Adulto , Feminino , Fertilização In Vitro/tendências , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/patologia , Infertilidade/complicações , Infertilidade/epidemiologia , Gravidez , Técnicas de Reprodução Assistida , Medição de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
Obstet Gynecol ; 133(6): 1182-1194, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135733

RESUMO

Chronic kidney disease represents a heterogeneous group of disorders characterized by alterations in the structure and function of the kidney. Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes, and these risks increase with the severity of the underlying renal dysfunction, degree of proteinuria, as well as the frequent coexistence of hypertension. Further, renal anatomic changes result in dilatation of the collecting system, and physiologic adaptations include alterations in the balance of vasodilatory and vasoconstrictive hormones, resulting in decreased systemic and renal vascular resistance, increased glomerular filtration rate, and modifications in tubular function. These alterations have important clinical implications and can make the diagnosis of renal compromise challenging. The effect of pregnancy on kidney disease may manifest as a loss of renal function, particularly in the context of concomitant hypertension and proteinuria, and chronic kidney disease, even when mild, contributes to the high risk of adverse pregnancy outcomes, including increased risks of preeclampsia, preterm delivery, and small-for-gestational age neonates. Strategies for optimization of pregnancy outcomes include meticulous management of hypertension and proteinuria where possible and the initiation of preeclampsia prevention strategies, including aspirin. Avoidance of nephrotoxic and teratogenic medications is necessary, and renal dosing of commonly used medications must also be considered. Mode of delivery in women with chronic kidney disease should be based on usual obstetric indications, although more frequent prenatal assessments by an expert multidisciplinary team are desirable for the care of this particularly vulnerable patient population. Obstetricians represent a critical component of this team responsible for managing each stage of pregnancy to optimize both maternal and neonatal outcomes, but collaboration with nephrology colleagues in combined clinics wherein both specialists can make joint management decisions is typically very helpful.


Assuntos
Rim/fisiopatologia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Aspirina/uso terapêutico , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido , Rim/anatomia & histologia , Transplante de Rim , Pré-Eclâmpsia/prevenção & controle , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Proteinúria/etiologia , Insuficiência Renal Crônica/complicações , Fatores de Risco
6.
Medicine (Baltimore) ; 98(20): e15733, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096533

RESUMO

BACKGROUND: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. METHODS: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. RESULTS: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 - 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00-1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46-4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47-5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52-2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78-2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11-19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98-7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04-1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52-2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29-4.89; P = .00001) were also significantly higher in women with APS. CONCLUSION: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.


Assuntos
Síndrome Antifosfolipídica/complicações , Complicações na Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Síndrome Antifosfolipídica/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Lactente , Mortalidade Infantil , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações na Gravidez/classificação , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia
7.
Nutrients ; 11(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31071931

RESUMO

Selenium (Se) is an antioxidant nutrient whose deficiency can influence adverse outcomes of pregnancy. The aim of this study is to determine whether serum Se level in early healthy pregnancy may be a risk marker for pregnancy induced hypertension. We obtained data from our prospective study in which we recruited healthy women in weeks 10-14 of a single pregnancy. In this analysis, we examined 121 women who subsequently developed pregnancy-induced hypertension and matched 363 women who remained normotensive. We measured Se levels (using the ICP-MS technique) in the serum in weeks 10-14 of the pregnancy. The odds ratios of pregnancy-induced hypertension (95% confidence intervals) were calculated using multivariate logistic regression. We found that the mean Se level was lower in the case group compared to the control (57.51 vs. 62.89 µg/L; p = 2.6 × 10-10). Excessive body mass index (BMI) and smoking influenced the estimated odds ratios. In the subgroup of women who had never smoked with normal pre-pregnancy BMI, the adjusted odds ratio (AOR) of pregnancy-induced hypertension was 15.34 (95% CI: 2.73-86.31, p = 0.002) for Se levels in the lowest quartile (≤57.68 µg/L), as compared to the highest quartile (>66.60 µg/L), after adjusting for all the accepted confounders. In the whole cohort, the prognostic value of Se by logistic regression showed that the area under curve (AUC) = 0.814. In our study, one can consider the role of Se as a risk marker of pregnancy-induced hypertension.


Assuntos
Hipertensão Induzida pela Gravidez/etiologia , Selênio/sangue , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Fatores de Risco , Adulto Jovem
8.
Pregnancy Hypertens ; 16: 79-84, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056163

RESUMO

INTRODUCTION: Hypertensive disorders of Pregnancy are the major complications that cause about 60%-80% of all maternal deaths. Preeclampsia is a major hypertensive disorder of pregnancy that had caused maternal mortalities and morbidities all round the world. OBJECTIVE: To assess the prevalence of pregnancy induced hypertension disorder and associated factors among pregnant women attending antenatal care service at Gondar town public health institutions. METHODS: Institutional based cross-sectional study were conducted from April-June 2017 in Gondar town public health institutions, Northwest Ethiopia. The data were entered and analyzed by using SPSS version 20.0. RESULT: The prevalence of hypertensive disorder of pregnancy were 16.8%. Maternal age, family history of hypertension, and alcohol intake during pregnancy were significantly associated with hypertensive disorder of pregnancy. CONCLUSION: The finding of this study showed that there were a considerable proportion of women had hypertensive disorder of pregnancy. Therefore, it is important to give health education to develop health seeking behavior of pregnant women.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Cuidado Pré-Natal , Adulto , Fatores Etários , Instituições de Assistência Ambulatorial , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Gravidez , Prevalência , Fatores de Risco , Adulto Jovem
9.
Am J Clin Nutr ; 109(Suppl_7): 705S-728S, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30982868

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. OBJECTIVE: Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. METHODS: A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. RESULTS: Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. CONCLUSIONS: Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.


Assuntos
Diabetes Gestacional/prevenção & controle , Dieta , Comportamento Alimentar , Hipertensão Induzida pela Gravidez/prevenção & controle , Fenômenos Fisiológicos da Nutrição Materna , Diabetes Gestacional/etiologia , Eclampsia/etiologia , Eclampsia/prevenção & controle , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Gravidez
10.
Rev Bras Ginecol Obstet ; 41(4): 220-229, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30939606

RESUMO

OBJECTIVE: Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). METHODS: It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016. Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. RESULTS: A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6 months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ∼ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. CONCLUSION: This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Sobrepeso , Gravidez em Diabéticas/epidemiologia , Fumar , Adulto , Brasil/epidemiologia , Estudos de Coortes , Dieta , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Entrevistas como Assunto , Modelos Lineares , Estudos Longitudinais , Modelos Teóricos , Gravidez , Gravidez em Diabéticas/etiologia , Inquéritos e Questionários , Ganho de Peso , Adulto Jovem
11.
J Pregnancy ; 2019: 3849596, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30941218

RESUMO

In 1990, Institute of Medicine (IOM) recommended gestational weight gain (GWG) ranges for women in the United States primarily to improve infant birth weight. Changes in key aspects of reproductive health of women of child bearing age, a rising prevalence of obesity, and noncommunicable diseases prompted the revision of IOM guidelines in 2009. However, there is no such recommendation available for Asian women. This systematic review assesses the utility of IOM-2009 guidelines among Indian and other Asian pregnant women in terms of maternal and fetal outcomes. 624 citations were identified using PubMed and Google Scholar, out of which 13 were included. Prospective/retrospective studies of healthy Asian women with a singleton pregnancy which specifically examined fetal-maternal outcomes relative to IOM-2009 guidelines were included. Results. Majority of pregnant Indian women achieved less GWG than the recommendations whereas a mixed trend was noticed among the other Asian pregnant women. The most common fetal-maternal complications among the excessive GWG women were found to be macrosomia, large for gestational age and caesarean section followed by gestational diabetes and hypertension, whereas low birth weight, small for gestational age and preterm birth, was found to be associated with low GWG women. The findings highlight the need for appropriate GWG limits across the different body mass index levels specifically for Indians and other Asian population. However, there are not enough publications regarding the utility of IOM-2009 guidelines among the Indian and other Asian women. Thus, higher-quality researches are warranted in future to further validate the findings of the present review.


Assuntos
Ganho de Peso na Gestação , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Cesárea , Bases de Dados Bibliográficas , Diabetes Gestacional/etiologia , Diabetes Gestacional/prevenção & controle , Feminino , Macrossomia Fetal/etiologia , Macrossomia Fetal/prevenção & controle , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido de Baixo Peso , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 19(1): 126, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975086

RESUMO

BACKGROUND: Maternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m2 was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes. METHODS: Data containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain. RESULTS: Obese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes. CONCLUSIONS: Obese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate.


Assuntos
Ganho de Peso na Gestação , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez/epidemiologia , Adulto , Teorema de Bayes , Índice de Massa Corporal , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/etiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Saúde do Lactente , Recém-Nascido , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Fatores de Risco , Estados Unidos/epidemiologia
13.
BJOG ; 126(8): 1033-1041, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30801948

RESUMO

OBJECTIVE: To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor. DESIGN: Population-based cohort-nested case-control study. SETTING: Six French regions in 2012/13. POPULATION: Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM. METHODS: Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis. MAIN OUTCOME MEASURES: Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses). RESULTS: The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO. CONCLUSION: The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy. TWEETABLE ABSTRACT: The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means.


Assuntos
Fertilização In Vitro/efeitos adversos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Modelos Logísticos , Análise Multivariada , Razão de Chances , Oócitos/transplante , Hemorragia Pós-Parto/etiologia , Gravidez , Gravidez Múltipla , Fatores de Risco
14.
Horm Mol Biol Clin Investig ; 39(3)2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712023

RESUMO

Background Hypertension disorder in pregnancy (HDP) is the second most common contributor to maternal morbidity and mortality worldwide. Blood pressure variability (BPV), with the assistance of ambulatory blood pressure monitoring (ABPM), measures blood pressure readings in pregnant women and has the potential to predict the occurrence of pregnancy-induced hypertension (PIH) or preeclampsia (PE) before any symptoms develop. Methodology Studies involving ABPM among pregnant women were identified using electronic databases such as PubMed, Scopus, Google Scholar, ScienceDirect, Medscape, Ovid and ProQuest. These electronic databases were assessed from 1990 to 2018. Keywords used to search for literatures included a combination of BPV matched with pregnancy, pregnant women and HDP, gestational hypertension and/or PE. Results Out of 21,526 articles identified, a total of 10 studies met the criteria. Seven articles used the spectral analysis method while another two articles used a combination of spectral analysis, time domain and a non-linear method for BPV analysis. The final article described BPV as vagal baroreflex. Four articles agreed that high frequency (HF) BPV was mainly dominant from the second trimester until 4 days postpartum in HDP patients. This reflects the dominant features of parasympathetic activities among these patients. Two articles that used time domain also agreed that standard deviation (SD) BPV increased in PE patients. Conclusions In pregnancy, BPV has a strong impact on the knowledge understanding of the disease in clinical fields, allows a superior ability to predict PIH and PE in mid-pregnancy and offers potential value for addressing hypertension in pregnancy.


Assuntos
Variação Biológica da População , Pressão Sanguínea , Adulto , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações na Gravidez , Fluxo de Trabalho
15.
Eur J Obstet Gynecol Reprod Biol ; 234: 190-194, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30710766

RESUMO

OBJECTIVE: The Institute of Medicine (IOM) recommended a gestational weight gain for full-term twin pregnancies of 17-25 kg for normal Body mass Index patients', and characterize its guidelines on during twin pregnancies as "provisional". Indeed, they are exclusively based on observational epidemiological data. The objective of this study was to investigate whether the IOM's gestational weight gain guidelines are optimal for maternal and neonatal. OUTCOMES STUDY DESIGN: We included all consecutive twin pregnancies delivering two live births retrospectively. Monoamniotic pregnancies, major congenital abnormalities, twin-to-twin transfusion syndrome, patients with missing gestational weight gain data in the last month before delivery, and patients with a body mass index (BMI) ≤18.5 were excluded. To control for gestational length, we divided the total weight gain by the gestational age in weeks at the last weight measurement to obtain the weight gain per week. Patients were classified as having low gestational weight gain, adequate gestational weight gain, or excessive gestational weight gain, with the results adjusted for BMI and tobacco use. RESULTS: There were 878 patients in our level-III university hospital maternity ward who met the inclusion criteria in 1997-2013. Excessive gestational weight gain women had greater rates of preeclampsia than adequate gestational weight gain women did. Low gestational weight gain women showed a lower rate of gestational hypertension than AGWG women did. Delivery before 37 weeks of gestation (26.9% vs. 17.3%, p = 0.009), birth weight <2500 g, respiratory distress syndrome, and transfer to the neonatal intensive care unit were more frequent in the LGWG group compared with the AGWG group. Apgar score <7 at 5 min were more frequent in the EGWG group. CONCLUSION: Adequate gestational weight gain was associated with better outcomes. Our results suggest that the IOM guidelines for twin pregnancy are appropriate and therefore should be routinely used.


Assuntos
Ganho de Peso na Gestação , Hipertensão Induzida pela Gravidez/etiologia , Guias de Prática Clínica como Assunto , Pré-Eclâmpsia/etiologia , Gravidez de Gêmeos/fisiologia , Adulto , Índice de Massa Corporal , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Nascimento Vivo , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Gêmeos , Estados Unidos
16.
J Pregnancy ; 2019: 9847057, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30693108

RESUMO

Purpose: To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. Methods: This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women without PCOS who had a delivered pregnancy within Kaiser Permanente Northern California. Preexisting hypertension was defined by hypertension diagnosis, treatment, or elevated blood pressure prior to 20 weeks of gestation. The development of PIH, including gestational hypertension, preeclampsia/eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count), was ascertained by chart review. Among women without preexisting hypertension who had a singleton pregnancy, the association of PCOS and PIH was examined using multivariable logistic regression. Results: Among 1902 women (910 PCOS) with singleton pregnancy, 101 (11.1%) PCOS and 36 (3.6%) non-PCOS women had preexisting hypertension and were excluded. Of the remaining 1765 women, those with PCOS (compared to non-PCOS) were slightly older (mean age 31.2 versus 30.7), more likely to be obese (39.6% versus 15.1%), nulliparous (63.8% versus 43.4%), and conceive with fertility treatment (54.1% versus 1.9%); they also had a higher incidence of PIH (10.8% versus 6.6%), including gestational hypertension (5.8% versus 3.6%) and preeclampsia or HELLP (4.9% versus 3.0%; all p<0.05). PCOS was associated with increased odds of PIH (odds ratio, OR 1.7, 95% confidence interval, CI 1.2-2.4), remaining significant after adjusting for age, race/ethnicity, nulliparity, and fertility treatment; however, findings were attenuated and no longer significant after adjusting for weight status (OR 1.1, CI 0.7-1.7). Maternal PCOS was also associated with preeclampsia/HELLP in unadjusted but not adjusted (OR 1.0, CI 0.5-1.9) analyses. Nulliparity and higher prepregnancy BMI were associated with PIH in both groups. Conclusion: Compared to women without PCOS, women with PCOS are at higher risk for PIH but this association was not independent of weight status.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/etiologia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/epidemiologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , California/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Modelos Logísticos , Paridade , Estudos Retrospectivos , Risco , Adulto Jovem
17.
PLoS One ; 14(1): e0208873, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625154

RESUMO

Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is important to understand the relative contributions of different risk factors. We assessed the incidence of these among cases of transvaginal delivery. Between June 2013 and July 2016, a prospective cohort study was conducted at a tertiary perinatal medical facility in Japan. Women were administered a questionnaire to ascertain risk factors for PPH, defined as a blood loss of 1,000 ml or more assessed using a calibrated under-buttocks drape and collection vessel at childbirth. We analyzed 1,068 transvaginal deliveries of singleton pregnancies. The incidence of PPH was 8.7%, and of severe PPH (1,500 ml blood loss or more) was 2.1%. Risk factors for postpartum hemorrhage among the deliveries were: fetal macrosomia (over 4000 g); pregnancy-induced hypertension; pregnancy generated by assisted reproductive technology; severe vaginal or perineal lacerations; and weight gain over 15 kg during pregnancy. Such high weight gain significantly increased the incidence of PPH compared with women showing less than 10 kg weight gain during pregnancy. Monitoring these identified risk factors could enable extra vigilance during labor, and preparedness for managing PPH in all women giving birth.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/etiologia , Incidência , Japão/epidemiologia , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
18.
BJOG ; 126(5): 663-673, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30675768

RESUMO

OBJECTIVE: To examine the association between mid-pregnancy dietary patterns and pregnancy-associated hypertension (PAH). DESIGN: A prospective longitudinal cohort study. SETTING: Denmark. POPULATION: About 55 139 Danish women with single enrolments and recorded food frequency questionnaire dates with complete information on dietary intake. METHODS: Women were eligible if they could speak Danish and were planning to carry to term. Diet was assessed using a validated semi-quantitative 360-item food frequency questionnaire and dietary patterns were derived using factor analysis. MAIN OUTCOME MEASURES: Gestational hypertension (GH) and pre-eclampsia (PE). RESULTS: Disease prevalence was 14% for GH (5491/39 362); 2% for PE (1168/54 778), and 0.4% for severe PE (234/55 086). Seven dietary patterns were characterised in the population, of which two were associated with PAH. The Seafood diet characterised by high consumption of fish and vegetables was inversely associated with the odds of developing GH [odds ratio (OR) 0.86; 95% CI 0.77-0.95)] and PE (OR 0.79; 95% CI 0.65-0.97). The Western diet characterised by high consumption of potatoes (including French fries), mixed meat, margarine and white bread increased the odds of developing GH (OR 1.18; 95% CI 1.05-1.33) and PE (OR 1.40; 95% CI 1.11-1.76). No association was seen with severe PE. CONCLUSIONS: We found protective associations of Seafood diet and harmful associations of Western diet with PAH. Dietary interventions encouraging the reduction of Western diet may contribute to a decrease of PAH. TWEETABLE ABSTRACT: Western diet increases (Seafood diet decreases) the likelihood of developing pre-eclampsia among Danish pregnant women.


Assuntos
Dieta Ocidental/efeitos adversos , Dieta/efeitos adversos , Hipertensão Induzida pela Gravidez/etiologia , Alimentos Marinhos/efeitos adversos , Adulto , Dinamarca/epidemiologia , Dieta/métodos , Inquéritos sobre Dietas , Análise Fatorial , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Estudos Longitudinais , Fenômenos Fisiológicos da Nutrição Materna , Razão de Chances , Gravidez , Cuidado Pré-Natal/métodos , Prevalência , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
19.
J Matern Fetal Neonatal Med ; 32(8): 1368-1377, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29172798

RESUMO

PURPOSE: Pregnancy causes physiological changes in maternal organ systems, and blood pressure (BP) is one of the variables affected. This review is focusing on the physiology of BP relevant to the management of hypertension in pregnancy. MATERIALS AND METHODS: A detailed literature search was performed using electronic databases (including WorldCat, PubMed, MEDLINE, Google Scholar) to retrieve and review reports related to physiology of BP in pregnancy. RESULTS: During pregnancy, there is vasodilation caused by mediators such as increased levels of progesterone and nitric oxide. The vasodilation leads to a reduction in vascular resistance, BP, and renal blood flow. In compensation, the following postulated events occur: activation of renin-angiotensin-aldosterone axis, resetting of osmotic threshold for thirst, and an increase in the production of vasopressin. Sodium and water conservation ensue to increase the total body water, end-diastolic volume, cardiac output, and BP. The increase in cardiac output incompletely compensates for the decreased vascular resistance, and BP therefore decreases in midpregnancy and returns to prepregnancy level toward term. CONCLUSIONS: An understanding of the physiological changes in BP is essential for appropriate management of pregnancy-related hypertension.


Assuntos
Pressão Sanguínea/fisiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/terapia , Gravidez
20.
J Matern Fetal Neonatal Med ; 32(16): 2662-2666, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29478342

RESUMO

OBJECTIVE: Early-onset fetal growth restriction is associated with poor pregnancy outcomes, but frequently is due to fetal structural or chromosomal abnormalities. The objective of this study was to determine outcomes in patients with early-onset fetal growth restriction without diagnosed fetal or genetic anomalies and to identify additional risk factors for poor outcomes in these patients. METHODS: This was retrospective cohort study of singleton pregnancies in women with early-onset growth restriction defined as a sonographic estimated fetal weight <10% diagnosed between 16-28 weeks' gestation. We excluded all women with a fetal structural or chromosomal abnormality diagnosed prenatally. Data on pregnancy characteristics and outcomes were collected and analyzed for estimated fetal weight <10% and ≤5%. A nested case-control study within the cohort of patients with ongoing pregnancies was then performed to identify risk factors associated with poor pregnancy outcome using chi-squared test. RESULTS: One hundred forty-two patients were identified who met inclusion and exclusion criteria and 20 patients were found to have fetal structural or chromosomal abnormalities. In the remaining 122 patients, the incidence of intrauterine fetal demise was 5.7% and there were high rates of preterm birth <37 weeks (20%), birth weight <10% (59.3%), and gestational hypertension (14.1%). Later gestational age at diagnosis and the presence of echogenic bowel and abnormal initial umbilical artery Dopplers were associated with poor pregnancy outcome (22.56 versus 20.86 weeks, p = .046), (17.4 versus 2.2%, OR 9.68, 95%CI 1.65-56.73), and (35.3 versus 0%, OR 4.46, 95%CI 2.65-7.50) respectively. CONCLUSIONS: Patients with early-onset fetal growth restriction with no fetal structural or genetic abnormality have a high risk of poor pregnancy outcomes. Gestational age at diagnosis and certain ultrasound findings are associated with poor pregnancy outcome.


Assuntos
Morte Fetal/etiologia , Retardo do Crescimento Fetal/diagnóstico , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido de Baixo Peso , Nascimento Prematuro/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Retardo do Crescimento Fetal/mortalidade , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Ultrassonografia Pré-Natal
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