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1.
Exp Mol Pathol ; 111: 104323, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31669131

RESUMO

Gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) can jeopardize mother and/or fetus. Vascular ATP-sensitive potassium (KATP) channels most likely participate in the processes of diabetes and hypertension. The aim of this research was to examine whether GDM and PIH cause changes in the expression and function of KATP channels in vascular smooth muscle of human umbilical vein (HUV). Western blot and immunohistochemistry detected significantly decreased expression of Kir6.1 subunit of KATP channels in GDM and PIH, while the expression of SUR2B was unchanged. In GDM, a K+ channel opener, pinacidil caused reduced relaxation of the endothelium-denuded HUVs compared to normal pregnancy. However, its effects in HUVs from PIH subjects were similar to normal pregnancy. In all groups KATP channel blocker glibenclamide antagonized the relaxation of HUV induced by pinacidil without change in the maximal relaxations indicating additional KATP channel-independent mechanisms of pinacidil action. Iberiotoxin, a selective antagonist of large-conductance calcium-activated potassium channels, inhibited the relaxant effect of pinacidil in PIH, but not in normal pregnancy and GDM. Experiments performed in K+-rich solution confirmed the existence of K+-independent effects of pinacidil, which also appear to be impaired in GDM and PIH. Thus, the expression of KATP channels is decreased in GDM and PIH. In GDM, vasorelaxant response of HUV to pinacidil is reduced, while in PIH it remains unchanged. It is very likely that KATP channels modulation and more detailed insight in KATP channel-independent actions of pinacidil may be precious in the therapy of pathological pregnancies.


Assuntos
Trifosfato de Adenosina/metabolismo , Diabetes Gestacional/fisiopatologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Canais KATP/metabolismo , Músculo Liso Vascular/metabolismo , Veias Umbilicais/metabolismo , Adulto , Feminino , Humanos , Músculo Liso Vascular/patologia , Gravidez , Veias Umbilicais/patologia
2.
S Afr Med J ; 109(9): 665-667, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635591

RESUMO

BACKGROUND: Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD). OBJECTIVES: To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA. METHODS: This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented. RESULTS: Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p<0.001), higher serum creatinine 1 045 v. 751 µmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p<0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p<0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p<0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%). CONCLUSIONS: This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum.


Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Falência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal/métodos , Adulto , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
3.
Pregnancy Hypertens ; 17: 104-108, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487624

RESUMO

OBJECTIVES: To determine the association of cardiac remodeling in early pregnancy and adverse perinatal outcomes among women with BMI ≥ 40 kg/m2. STUDY DESIGN: We performed a retrospective cohort study including women with BMI ≥ 40 kg/m2 without known cardiac disease. Women who underwent screening transthoracic echocardiography prior to gestational age 24 weeks were included. Women were analyzed by group with normal or abnormal geometry, including concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Multivariable logistic regression was used to assess the association of abnormal geometry with perinatal outcomes. We had 80% power with alpha 0.05 to detect a 3.0-fold increase in the primary outcome among women with abnormal geometry. MAIN OUTCOME MEASURES: Our primary outcome was a composite of adverse perinatal outcomes including any 1 of the following: preterm birth (<37 weeks), low birth weight (<2500 g), or hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. RESULTS: Of 140 women, 53 (37.9%) had abnormal geometry. The average BMI was similar between those with normal and abnormal geometry (44.7 vs. 44.2 kg/m2, p = 0.53). The primary outcome occurred in 20.7% with normal geometry and 30.2% with abnormal geometry (p = 0.20). After adjustment for parity, chronic hypertension, and tobacco use, abnormal cardiac geometry was not associated with the composite primary outcome (adjusted OR 2.01 [95% CI 0.84-4.78]) but was associated with hypertensive disorders of pregnancy (adjusted OR 2.82 [95% CI 1.03-7.78]). CONCLUSIONS: Cardiac remodeling early in pregnancy is associated with hypertensive disorders of pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Obesidade Mórbida , Cuidado Pré-Natal , Remodelação Ventricular , Adulto , Índice de Massa Corporal , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico por imagem , Hipertensão Induzida pela Gravidez/prevenção & controle , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
4.
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
5.
Cardiol Clin ; 37(3): 345-354, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279428

RESUMO

Hypertensive disorders of pregnancy are common and contribute inordinately to maternal and fetal morbidity and mortality. Although not completely understood, recent clinical trials have provided important insights into pathogenesis of preeclampsia. Preeclampsia is considered a systemic disease with generalized endothelial dysfunction and risk of future cardiovascular disease. This review revisits the definitions and classifications of hypertensive disorders of pregnancy; discusses updates on pathophysiology, prevention, and early prediction of preeclampsia; reviews current management guidelines; and discusses potential risks and benefits associated with treatment. Improvement in management and outcomes of women with hypertensive disorders of pregnancy seems in sight in the near future.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Induzida pela Gravidez , Feminino , Saúde Global , Humanos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Incidência , Gravidez , Fatores de Risco
6.
Hypertension ; 74(1): 173-183, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104564

RESUMO

Preeclampsia is a hypertensive disorder of pregnancy associated with vascular dysfunction and cardiovascular risk to offspring. We hypothesize that endothelial PPARγ (peroxisome proliferator-activated receptor-γ) provides cardiovascular protection in offspring from pregnancies complicated by hypertension. C57BL/6J dams were bred with E-V290M sires, which express a dominant-negative allele of PPARγ selectively in the endothelium. Arginine vasopressin was infused throughout gestation. Vasopressin elevated maternal blood pressure at gestational day 14 to 15 and urinary protein at day 17 consistent. Systolic blood pressure and vasodilation responses to acetylcholine were similar in vasopressin-exposed offspring compared to offspring from control pregnancies. We treated offspring with a subpressor dose of angiotensin II to test if hypertension during pregnancy predisposes offspring to hypertension. Male and female angiotensin II-treated E-V290M offspring from vasopressin-exposed but not control pregnancy exhibited significant impairment in acetylcholine-induced relaxation in carotid artery. Endothelial dysfunction in angiotensin II-treated E-V290M vasopressin-exposed offspring was attenuated by tempol, an effect which was more prominent in male offspring. Nrf2 (nuclear factor-E2-related factor) protein levels were significantly elevated in aorta from male E-V290M offspring, but not female offspring compared to controls. Blockade of ROCK (Rho-kinase) signaling and incubation with a ROCK2-specific inhibitor improved endothelial function in both male and female E-V290M offspring from vasopressin-exposed pregnancy. Our data suggest that interference with endothelial PPARγ in offspring from vasopressin-exposed pregnancies increases the risk for endothelial dysfunction on exposure to a cardiovascular stressor in adulthood. This implies that endothelial PPARγ provides protection to cardiovascular stressors in offspring of a pregnancy complicated by hypertension and perhaps in preeclampsia.


Assuntos
Angiotensina II/farmacologia , Endotélio Vascular/metabolismo , Hipertensão Induzida pela Gravidez/genética , NF-kappa B/metabolismo , PPAR gama/genética , Prenhez , Acetilcolina/farmacologia , Animais , Animais Recém-Nascidos , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Camundongos Endogâmicos C57BL , Estresse Oxidativo/fisiologia , Gravidez , Substâncias Protetoras/farmacologia , Transdução de Sinais/genética
7.
BMC Pregnancy Childbirth ; 19(1): 186, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138157

RESUMO

BACKGROUND: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). METHODS: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to mid-gestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg) in early gestation was estimated. RESULTS: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6-2.0]) and SGA birth (aOR: 1.3 [1.2-1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8-2.8] and 2.3 [1.8-3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. CONCLUSION: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders.


Assuntos
Pressão Sanguínea , Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido Pequeno para a Idade Gestacional , Pré-Eclâmpsia/etiologia , Nascimento Prematuro/etiologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
9.
Pregnancy Hypertens ; 16: 154-160, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056152

RESUMO

OBJECTIVES: Chronic hypertension in pregnancy is an important cause of maternal and neonatal morbidity and mortality. The aim of this study was to determine the effect of severity of chronic hypertension in pregnancy on maternal and perinatal outcome in an Indonesian population. STUDY DESIGN: This study was performed in Dr Soetomo General Hospital, a tertiary center in East - Java, Indonesia over the period of 2013-2017. Chronic hypertension (CH) was divided using JNC VII criteria, as stage 1 (Blood pressure ≥140/90 mmHg) and Stage 2 (BP > 160/110 mmHg) hypertension. MAIN OUTCOME MEASURES: The primary outcomes were maternal and perinatal outcome. Data was statistically analyzed using Chi-square, Fischer exact test, and Mann-Whitney test (program: SPSS ®23). RESULTS: Over these 5 years, 352 patients were diagnosed with CH. The stage 2 of CH was associated with worse maternal outcome: maternal death (5.6% vs 0.8%; p = 0.016), laboratory values of urinary protein +3 (67% vs 21,5%, p = 0.001) and +4 (12.3% vs 0.4%, p = 0.001), LDH > 600 IU/L (11.3% vs 5.3%, p = 0.04), ALT > 70 IU/L (11.3% vs 4.1%, p = 0.01), AST > 70 IU/L (12.3% vs 5.3%, p = 0.02), BUN > 25 mg/dL (27.4% vs 8.1%, p = 0.001), SK > 1.1 mg/dL (29.2% vs 6.5%, p = 0.001) and Albumin <3 g/dL (65.1% vs 10.2%, p = 0.001), need for ICU admission (76.4% vs 36.6%, p = 0.001), mechanical ventilation (48.1% vs 21.1%, p = 0.001), and occurrence of complications (72.6% vs 57.7%, p = 0.006). Stage 2 CH in pregnancy was associated with an increased risk of maternal death (OR: 7.22; 95% CI: 1.43-36.36; p = 0,016). Stage 2 CH was also associated with worse perinatal outcome, in terms of lower birth weight (1635 ±â€¯863.27 vs 2063.74 ±â€¯935.43, p = 0.001), lower Apgar score (p = 0.001), and number of intra uterine complications such as: IUGR, stillbirth, and placental abruption (27.4% vs 11.8%, p = 0.001). CONCLUSIONS: Stage 2 CH in pregnancy is associated with worse maternal and perinatal outcomes compared with stage 1. Intervention to prevent disease progression to stage 2 before pregnancy may improve maternal and perinatal outcomes during pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Indonésia/epidemiologia , Recém-Nascido , Mortalidade Materna , Gravidez , Resultado da Gravidez , Índice de Gravidade de Doença , Natimorto , Adulto Jovem
10.
Pregnancy Hypertens ; 16: 89-96, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31056165

RESUMO

OBJECTIVES: Evaluating maternal haemodynamics across pregnancy in uncomplicated pregnancies and those complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN: Prospective cohort study from 2015 to 2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamics assessed by Uscom BP+ at 9-16 and 32-36 weeks' gestation in pregnancies complicated by HDP [preeclampsia with severe (sPE n = 12) and without severe clinical features (nsPE n = 49), gestational hypertension (GH n = 25), transient gestational hypertension (TGH n = 33)] were compared to uncomplicated pregnancies (n = 286) using mixed-effects linear modelling. MAIN OUTCOME MEASURES: Maternal haemodynamic adaptation in uncomplicated pregnancies and those complicated by HDP. RESULTS: Between the two measurements, haemodynamic adaptation in women with sPE and nsPE was significantly different compared to those with uncomplicated pregnancies. An additional increase was observed for peripheral systolic blood pressure [SBP; 14.3 mmHg, 8.6-20.1 (sPE)], peripheral diastolic blood pressure [DBP; 7.7 mmHg, 3.3-12.1 (sPE); 2.6 mmHg, 3.3-12.1 (nsPE)] peripheral mean arterial pressure [MAP; 10.6 mmHg, 5.8-15.5 (sPE); 3.4 mmHg, 0.8-6.0 (nsPE)], peripheral pulse pressure [PP; 6.6 mmHg, 2.1-11.1 (sPE)], central SBP [15.8 mmHg, 10.4-21.2 (sPE); 2.9 mmHg, 0.1-5.8 (nsPE)], central DBP [8.3 mmHg, 3.9-12.6 (sPE); 2.5 mmHg, 0.2-4.8 (nsPE), central MAP [10.8 mmHg, 6.4-15.2 (sPE); 2.6 mmHg, 0.3-5.0 (nsPE)] and central PP [7.6 mmHg, 3.9-11.3 (sPE)]. Augmentation index (AIx) decreased less (15.5%, 6.3-24.6 (sPE); 9.0%, 4.2-13.6 (nsPE)] compared to uncomplicated pregnancies. Haemodynamic adaptation across pregnancy in women with GH and TGH was not different from those with uncomplicated pregnancies. CONCLUSION: Women who develop preeclampsia show an altered, while those who develop GH or TGH demonstrate a comparable haemodynamic adaptation compared to uncomplicated pregnancies. TGH is not a benign condition.


Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Hemodinâmica , Humanos , Gravidez , Trimestres da Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Adulto Jovem
12.
Intern Med ; 58(15): 2257-2261, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996172

RESUMO

We present a report of a 29-year-old woman with non-dipper type refractory hypertension due to the vascular compression of the medulla oblongata. The patient was diagnosed with hypertension at 17 years of age and underwent emergency Caesarean section at 26 weeks of gestation during 2 pregnancies due to severe high blood pressure. We suspected medullary compression by the curved posterior inferior cerebellar artery as the cause of her intractable hypertension, and she underwent Jannetta's decompression surgery. After the surgery, her blood pressure swiftly decreased to almost within the normal range, and her blood pressure pattern normalized to dipper type.


Assuntos
Descompressão Cirúrgica/métodos , Hipertensão Induzida pela Gravidez/cirurgia , Bulbo/irrigação sanguínea , Artéria Vertebral/cirurgia , Adulto , Pressão Sanguínea , Cesárea , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Gravidez
13.
J Clin Ultrasound ; 47(5): 285-291, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30883813

RESUMO

PURPOSE: To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension affects cardiac function in fetuses. METHODS: We enrolled 104 singleton pregnant women with gestational ages ranging 30 to 33 weeks, visiting for prenatal care. Among them, 34 had gestational hypertension (GH), 32 had preeclampsia (PE), and 38 were healthy and formed the control group. Conventional echocardiographic and velocity vector imaging (VVI) variables were prospectively collected. Blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from cord blood drawn at birth. RESULTS: The fetuses of mothers with preeclampsia had significantly lower left (LV) and right ventricle (RV) diastolic strain rate (SRd) and RV strain (S) and systolic strain rate (SRs) than controls. LV and RV S, SRd, and SRS were not different in fetuses of mothers with GH and controls. The NT-proBNP levels were higher in fetuses of patients with PE than in GH and controls. CONCLUSIONS: In the third trimester of pregnancy, fetal biventricular function and NT-proBNP levels are not significantly influenced by GH. Fetuses of mothers with PE present signs of LV and RV diastolic dysfunction, right ventricular systolic dysfunction, and elevated NT-pro-BNP levels. VVI echocardiography appears more sensitive than conventional echocardiography to evaluate fetal cardiac function.


Assuntos
Ecocardiografia/métodos , Coração Fetal/diagnóstico por imagem , Hipertensão Induzida pela Gravidez/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Ultrassonografia Pré-Natal/métodos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Feminino , Sangue Fetal/metabolismo , Coração Fetal/fisiopatologia , Idade Gestacional , Ventrículos do Coração/diagnóstico por imagem , Humanos , Recém-Nascido , Masculino , Variações Dependentes do Observador , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Método Simples-Cego , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/fisiopatologia
14.
Pregnancy Hypertens ; 15: 134-140, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30713829

RESUMO

Objectives: To investigate whether age at menarche is related to maternal blood pressure in pregnancy and, if so, whether obesity and insulin resistance can modify the associations. Study Design: Analysis of data collected from 438 pregnant women from the longitudinal and prospective Cambridge Baby Growth Study. Main Outcome: Testing associations between questionnaire-derived age at menarche and blood pressure measurements in pregnancy collected from hospital notes, and investigating whether any associations were altered by maternal pre-pregnancy body mass index (BMI) and insulin resistance. Measures: Mean arterial blood pressure at four time points across pregnancy, age at menarche, (Homeostasis Model Assessment) insulin resistance around week 28 of pregnancy. Results: For each increased year in age at menarche there was a drop in mean arterial blood pressure (mmHg) of 0.6 at 11.9 weeks, 0.9 at 31.4 and 37.0 weeks, and 0.4 at 38.8 weeks (a maximal difference of over 7 mmHg across extremes of AAM). Each association was attenuated by both maternal pre-pregnancy BMI and insulin resistance. Conclusions: Age at menarche is negatively associated with future blood pressure in pregnancy, so those with the earliest age at menarche have the highest blood pressures. Either these associations may be mediated by links between age at menarche and obesity/insulin resistance, or there may be a confounder (e.g. systemic inflammation) that links age at menarche to each of them.


Assuntos
Pressão Arterial , Hipertensão Induzida pela Gravidez/epidemiologia , Hipotensão/epidemiologia , Resistência à Insulina/fisiologia , Menarca , Obesidade/fisiopatologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Criança , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipotensão/fisiopatologia , Gravidez
15.
Ultrasound Obstet Gynecol ; 54(1): 35-50, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737852

RESUMO

Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Débito Cardíaco/fisiologia , Ecocardiografia/métodos , Hemodinâmica/fisiologia , Resistência Vascular/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Cateterismo de Swan-Ganz/métodos , Feminino , Coração/diagnóstico por imagem , Coração/fisiologia , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Gravidez , Gestantes , Análise de Onda de Pulso/métodos , Ultrassonografia Doppler/métodos
16.
PLoS One ; 14(2): e0211857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785920

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a serious cardiac disorder occurring late in pregnancy or early in the postpartum period. We examined associations between hypertensive disorders of pregnancy (HDP: preeclampsia and gestational hypertension) and PPCM, accounting for other pregnancy-related risk factors for PPCM. METHODS: Using nationwide Danish register data, we constructed a cohort of all women with ≥1 live birth or stillbirth in Denmark between 1978 and 2012. Using log-linear binomial regression and generalized estimating equations, we estimated risk ratios (RRs) for PPCM associated with HDP of varying severity. RESULTS: In a cohort of 1,088,063 women with 2,078,822 eligible pregnancies, 126 women developed PPCM (39 in connection with an HDP-complicated pregnancy). The risks of PPCM were significantly higher in women with HDP-complicated pregnancies than in women with normotensive pregnancies (severe preeclampsia, RR 21.2, 95% confidence interval [CI] 12.0-37.4; moderate preeclampsia, RR 10.2, 95% CI 6.18-16.9; gestational hypertension, RR 5.16, 95% CI 2.11-12.6). The RRs for moderate preeclampsia and gestational hypertension were not significantly different from one another (p = 0.18); the RR for severe preeclampsia was significantly different from the RR for moderate preeclampsia and gestational hypertension combined (p = 0.02). CONCLUSIONS: Although 70% of PPCM occurred in women with normotensive pregnancies, HDPs were associated with substantial increases in PPCM risk that depended on HDP severity. The heart's capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult, contributing to PPCM. HDPs, severe preeclampsia in particular, probably represent an additional cardiac stressor during pregnancy.


Assuntos
Cardiomiopatias/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Dinamarca , Feminino , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Período Periparto/fisiologia , Período Pós-Parto/fisiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Resultado da Gravidez , Fatores de Risco
17.
Cardiovasc J Afr ; 30(2): 120-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720845

RESUMO

Measurement of blood pressure is essential for clinical management of patients. To obtain an accurate blood pressure reading, the use of a validated device and an appropriate technique are required. This is of particular importance in pregnancy where the physiological changes affect vessel wall compliance. Moreover, currently it is difficult to predict in early pregnancy (prior to 20 weeks of gestation) which women would develop hypertension or pre-eclampsia. For this reason, blood pressure devices require validation in pregnancy and in hypertensive disorders of pregnancy to ensure that accurate readings are obtained and utilised for clinical decisions, otherwise the safety of the mother or the foetus/neonate or both may be compromised. The authors provide a narrative review on devices and techniques for blood pressure measurement in pregnancy and hypertensive disorders of pregnancy as well as the associated challenges.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea , Hipertensão Induzida pela Gravidez/diagnóstico , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipertensão Induzida pela Gravidez/terapia , Valor Preditivo dos Testes , Gravidez , Prognóstico , Reprodutibilidade dos Testes
18.
Pak J Pharm Sci ; 32(1): 213-215, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30772811

RESUMO

To evaluate the anti-hypertensive drugs used in pregnancy induced hypertension and to determine the safety of the anti-hypertensive drugs administered in gestational hypertensive patients. Pregnancy induced hypertension are very common in women and if unnoticed may lead to severe complications. The appropriate therapy is very much essential for the welfare of both the mother and the child. Hence this study was undertaken to identify the commonly used and safe drugs in pregnancy induced hypertension. This retrospective study was carried out in the Medical Records Department of a specialized gynecological hospital. Patient details - Name, Age, Sex, Occupation, Body Mass Index (BMI), Social History (SH), Past Medical History (PMH), Diagnosis, mother weight and BP, baby weight, specific anti-hypertensives given, outcome, complication in both mother and baby if any, duration of anti-hypertensive drug use, duration of hospital stay were all recorded in a proforma. Adverse Drug Reactions for anti-hypertensive drugs given were also noted. Nifedipine was the most common drug prescribed both in monotherapy and dual therapy. Adverse drug reaction was seen only in 2% of patients. Pregnancy induced hypertension is one of the riskiest conditions to occur during pregnancy. Dietary modification and lifestyle modification might help in controlling pre-eclampsia.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Adulto , Anti-Hipertensivos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/fisiopatologia , Segurança do Paciente , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
19.
Int J Cardiol ; 282: 81-87, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30773269

RESUMO

BACKGROUND AND AIM: Hypertensive pregnancy disorders are associated with subsequent cardiovascular disease (CVD), but the extent to which this association is explained by shared risk factors is unknown. We aimed to evaluate whether hypertensive pregnancy disorder in first pregnancy is associated with increased subsequent risk of maternal CVD after adjustment for established CVD risk factors measured after pregnancy. METHODS AND RESULTS: A total of 20,075 women with a first delivery registered in the Medical Birth Registry of Norway (1980-2003) participated in Cohort of Norway (CONOR) health surveys a mean (standard deviation) of 10.7 (5.5) years after delivery. They were then followed (median 11.4 years) for an incident fatal or non-fatal CVD event through linkage to the Cardiovascular Disease in Norway (CVDNOR) database and the Norwegian Cause of Death Registry. Hypertensive pregnancy disorders were associated with an increased risk of CVD [Hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.9-2.8], which remained significant after adjustment for established CVD risk factors including body mass index, smoking, hypertension, diabetes, serum glucose and lipid levels (HR 1.5; 95% CI 1.2-1.8). The population attributable fraction of CVD due to hypertensive pregnancy disorder was 4.3% (95% CI 1.9-6.6) after multivariable adjustment. CONCLUSION: The association between hypertensive pregnancy disorders and CVD risk was mediated in part by related CVD risk factors measured 10 years following delivery. These results underline the importance of post-pregnancy follow-up of women with hypertensive pregnancy disorders focusing on modifiable, lifestyle related risk factors to prevent future CVD.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Adolescente , Adulto , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido , Pessoa de Meia-Idade , Noruega/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
20.
Ethiop J Health Sci ; 29(1): 831-840, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30700950

RESUMO

Background: Disorders of pregnancy induced hypertensive are a major health problem in the obstetric population as they are one of the leading causes of maternal and perinatal morbidity and mortality. The World Health Organization estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy. The objective of this study is to assess pregnancy induced hypertension and its associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Gebretsadikshawo Hospital and Tepi General Hospital. Methods: A health facility based cross-sectional study was carried out from October 01 to November 30/2016. The total sample size (422) was proportionally allocated to the three hospitals. Systematic sampling technique was used to select study participants. Variables with p-value of less than 0.25 in binary logistic regression were entered into the multivariable logistic regression to control cofounding. Odds ratio with 95% confidence interval was used. P-value less than 0.05 was considered as statistically significant. Results: The prevalence of pregnancy induced hypertension was 33(7.9%); of which 5(15.2%) were gestational hypertension, 12 (36.4%) were mild preeclampsia, 15(45.5%) were severe preeclampsia and 1 (3%) eclampsia. Positive family history of pregnancy induced hypertension [AOR5.25 (1.39-19.86)], kidney diseases (AOR 3.32(1.04-10.58)), having asthma [AOR 37.95(1.41-1021)] and gestational age (AOR 0.096(0.04-.23)) were predictors of pregnancy induced hypertension. Conclusion: The prevalence of pregnancy induced hypertension among women attending delivery service was 7.9%. Having family history of pregnancy induced hypertension, chronic kidney diseases and gestational age were predictors of pregnancy induced hypertension.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Gerais , Hospitais de Ensino , Hospitais Universitários , Humanos , Gravidez , Fatores de Risco , Adulto Jovem
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