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Sample records for pregnancy related hypertensive

  1. Hypertension in pregnancy

    Directory of Open Access Journals (Sweden)

    Andrea Ungar

    2007-03-01

    Full Text Available Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories: chronic hypertension, pre-eclampsia/eclampsia, pre-eclampsia superimposed on chronic hypertension, and gestational hypertension. A relative paucity of investigative data, as well as the frequent difficulty in making an etiological diagnosis, may lead to problems in its management. This case report analyses current concepts regarding the hypertensive disorders of gestation, focusing on chronic hypertension. Chronic hypertension is defined as blood pressure exceeding 140/90 mmHg before pregnancy or before 20 weeks gestation. Hypertensive disorders in pregnancy may cause maternal and fetal morbidity and remain a leading source of maternal mortality. A prompt diagnosis is needed also because hypertension may be an indicator of pre-eclampsia, a condition which can evolve into serious complications. Maintaining blood pressure below 140/90 mmHg is recommended, although treatment should be determined on an individual basis. Many anti-hypertensive agents appear to be safe for use during pregnancy: methildopa has been the most studied of the anti-hypertensive drugs and has the best safety record. Labetalol, idralazine and nifedipine also have been found to be safe; ACE-inhibitors are absolutely contraindicated, because they are associated with intrauterine growth retardation.

  2. Hypertension and pregnancy.

    Science.gov (United States)

    Deak, Teresa M; Moskovitz, Joshua B

    2012-11-01

    Hypertension in pregnancy is increasing in prevalence and incidence and its treatment becoming more commonplace. Associated complications of pregnancy, including end-organ damage, preeclampsia, eclampsia, and postpartum eclampsia, are leading sources of maternal and fetal morbidity and mortality, requiring an emergency physician to become proficient with their identification and treatment. This article reviews hypertension in pregnancy as it relates to outcomes, with special emphasis on preeclampsia, eclampsia, and postpartum eclampsia.

  3. Hypertension in pregnancy.

    Science.gov (United States)

    Lindheimer, Marshall D; Taler, Sandra J; Cunningham, F Gary

    2010-01-01

    Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, and status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous MgSO(4) is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists.

  4. Hypertensive Disorders of Pregnancy

    OpenAIRE

    Mammaro, Alessia; Carrara, Sabina; Cavaliere, Alessandro; Ermito, Santina; Dinatale, Angela; Pappalardo, Elisa Maria; Militello, Mariapia; Pedata, Rosa

    2009-01-01

    Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension, and 4) gestational hypertension (transient hypertension of pregnancy or chronic hyper...

  5. Treating Hypertension in Pregnancy.

    Science.gov (United States)

    Schlembach, Dietmar; Homuth, Volker; Dechend, Ralf

    2015-08-01

    Hypertension is present in about 10 % of all pregnancies. The frequency of chronic hypertension and that of gestational hypertension is increasing. The management of pregnant women with hypertension remains a significant, but controversial, public health problem. Although treatment of hypertension in pregnancy has shown to reduce maternal target organ damage, considerable debate remains concerning treatment. We review current evidence regarding treatment goals, the ideal treatment starting time, and which drugs are available for the treatment of hypertension in pregnancy.

  6. [Hypertension during pregnancy

    DEFF Research Database (Denmark)

    Mathiesen, E.R.; Johansen, M.; Kamper, A.L.;

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...... and disadvantages of different classes of antihypertensive drugs during pregnancy and lactation are described Udgivelsesdato: 2009/6/15...

  7. Pregnancy and pulmonary hypertension

    NARCIS (Netherlands)

    Pieper, Petronella G.; Lameijer, Heleen; Hoendermis, Elke S.

    Pulmonary hypertension during pregnancy is associated with considerable risks of maternal mortality and morbidity. Our systematic review of the literature on the use of targeted treatments for pulmonary arterial hypertension during pregnancy indicates a considerable decrease of mortality since a

  8. Hypertensive Emergencies in Pregnancy.

    Science.gov (United States)

    Olson-Chen, Courtney; Seligman, Neil S

    2016-01-01

    The prevalence of hypertensive disorders in pregnancy is increasing. The etiology and pathophysiology of hypertensive disorders in pregnancy remain poorly understood. Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension, but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.

  9. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review.

    Science.gov (United States)

    Thomopoulos, C; Tsioufis, C; Michalopoulou, H; Makris, T; Papademetriou, V; Stefanadis, C

    2013-03-01

    Hypertensive complications in pregnancy are the leading cause of maternal morbidity, at least in the developed countries. In recent years, infertility issues are managed with ever growing therapeutic options namely assisted reproductive technologies (ART), which improve the ratio of successful induction of pregnancy. It is still debated whether various ART modalities are associated with adverse pregnancy outcomes, including hypertensive complications, particularly with higher incidence of preeclampsia. The main source of controversy stems from the diversity of effect modifiers modulating the association between ART-oriented pregnancy and hypertensive disorders. Indeed, women undergoing an ART procedure are affected by diverse causes of infertility, are frequently characterized by different genetic patterns with respect to their artificially conceived embryo and experienced multiple gestations. In order to investigate whether ART modalities are associated with increased incidence of hypertensive complications in pregnancy, we reviewed all published studies carried out before the end of 2010 and identified in the PubMed database. Among the 47 studies finally selected and by acknowledging the potential of shortcomings related to the different study design and populations, the overall evidence suggests that ART-oriented pregnancies-especially the in-vitro fertilization techniques-are accompanied by increased risk for gestational hypertension and preeclampsia as compared with non-ART pregnancies, even after adjustment for confounders. Multiple gestations, advanced age and underlying polycystic ovary syndrome resulted in constant confounders of the questioned association. Reducing multiple gestations by implementing single embryo techniques might be the therapeutic limiting step to lower the rate of hypertensive complications in assisted pregnancies.

  10. Pregnancy and pulmonary hypertension

    NARCIS (Netherlands)

    Pieper, Petronella G.; Lameijer, Heleen; Hoendermis, Elke S.

    2014-01-01

    Pulmonary hypertension during pregnancy is associated with considerable risks of maternal mortality and morbidity. Our systematic review of the literature on the use of targeted treatments for pulmonary arterial hypertension during pregnancy indicates a considerable decrease of mortality since a pre

  11. [Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011].

    Science.gov (United States)

    Szczepaniak-Chicheł, Ludwina; Tykarski, Andrzej

    2012-10-01

    Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists - obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary

  12. Hypertension in pregnancy.

    Science.gov (United States)

    Vest, Amanda R; Cho, Leslie S

    2014-03-01

    Hypertensive disorders of pregnancy represent the second commonest cause of direct maternal death and complicate an estimated 5-10 % of pregnancies. Classification systems aim to separate hypertension similar to that seen outside pregnancy (chronic and gestational hypertension) from the potentially fatal pregnancy-specific conditions. Preeclampsia, HELLP syndrome, and eclampsia represent increasing severities of this disease spectrum. The American College of Obstetricians and Gynecologists' 2013 guidelines no longer require proteinuria as a diagnostic criterion, because of its variable appearance in the disease spectrum. The cause involves inadequate cytotrophoblastic invasion of the myometrium, resulting in placental hypoperfusion and diffuse maternal endothelial dysfunction. Changes in angiogenic and antiangiogentic peptide profiles precede the onset of clinical preeclampsia. Women with preeclampsia should be closely monitored and receive magnesium sulfate intravenously if severe features, HELLP syndrome, or eclampsia occur. Definitive therapy is delivery of the fetus. Hypertension in pregnancy increases future maternal risk of hypertension and cardiovascular disorders.

  13. Secondary Hypertension in Pregnancy.

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    Malha, Line; August, Phyllis

    2015-07-01

    Hypertension is a common medical complication of pregnancy. Although 75-80 % of women with preexisting essential hypertension will have uncomplicated pregnancies, the presence of secondary forms of hypertension adds considerably to both maternal and fetal morbidity and mortality. Renovascular hypertension, pheochromocytoma, and Cushing's syndrome in particular are associated with accelerating hypertension, superimposed preeclampsia, preterm delivery, and fetal loss. Primary aldosteronism is a more heterogeneous disorder; there are well-documented cases where blood pressure and hypokalemia are improved during pregnancy due to elevated levels of progesterone. However, superimposed preeclampsia, worsening hypertension, and early delivery are also reported. When possible, secondary forms of hypertension should be diagnosed and treated prior to conception in order to avoid these complications.

  14. Hypertension in pregnancy.

    Science.gov (United States)

    Solomon, Caren G; Seely, Ellen W

    2011-12-01

    Hypertension is a common complication of pregnancy. Preeclampsia, in particular, is associated with substantial risk to both the mother and the fetus. Several risk factors have been recognized to predict risk for preeclampsia. However, at present no biomarkers have sufficient discriminatory ability to be useful in clinical practice, and no effective preventive strategies have yet been identified. Commonly used medications for the treatment of hypertension in pregnancy include methyldopa and labetalol. Blood pressure thresholds for initiating antihypertensive therapy are higher than outside of pregnancy. Women with prior preeclampsia are at increased risk of hypertension, cardiovascular disease, and renal disease.

  15. Management of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    Nurike S Mudjari

    2015-03-01

    Full Text Available Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC, cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in lifethreatening situation for maternal and fetal health. Key words: blood pressure, hypertension, eclampsia, preeclampsia, pregnant women, gestational.

  16. Management of hypertension in pregnancy.

    Science.gov (United States)

    Mudjari, Nurike S; Samsu, Nur

    2015-01-01

    Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnancy should be managed appropriately to reduce maternal and fetal morbidity and mortality rate, i.e. by preventing women from getting the risks of increased blood pressure, preventing disease progression and preventing the development of seizure and considering termination of pregnancy in life-threatening situation for maternal and fetal health.

  17. Hypertensive Disorders of Pregnancy.

    Science.gov (United States)

    Leeman, Lawrence; Dresang, Lee T; Fontaine, Patricia

    2016-01-15

    Elevated blood pressure in pregnancy may represent chronic hypertension (occurring before 20 weeks' gestation or persisting longer than 12 weeks after delivery), gestational hypertension (occurring after 20 weeks' gestation), preeclampsia, or preeclampsia superimposed on chronic hypertension. Preeclampsia is defined as hypertension and either proteinuria or thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. Proteinuria is not essential for the diagnosis and does not correlate with outcomes. Severe features of preeclampsia include a systolic blood pressure of at least 160 mm Hg or a diastolic blood pressure of at least 110 mm Hg, platelet count less than 100 × 103 per µL, liver transaminase levels two times the upper limit of normal, a doubling of the serum creatinine level or level greater than 1.1 mg per dL, severe persistent right upper-quadrant pain, pulmonary edema, or new-onset cerebral or visual disturbances. Preeclampsia without severe features can be managed with twice-weekly blood pressure monitoring, antenatal testing for fetal well-being and disease progression, and delivery by 37 weeks' gestation. Preeclampsia with any severe feature requires immediate stabilization and inpatient treatment with magnesium sulfate, antihypertensive drugs, corticosteroids for fetal lung maturity if less than 34 weeks' gestation, and delivery plans. Preeclampsia can worsen or initially present after delivery. Women with hypertensive disorders should be monitored as inpatients or closely at home for 72 hours postpartum.

  18. Work-related maternal risk factors and the risk of pregnancy induced hypertension and preeclampsia during pregnancy. The Generation R Study.

    Directory of Open Access Journals (Sweden)

    Jaap Jan Nugteren

    Full Text Available OBJECTIVE: To study the associations between physically demanding work and occupational exposure to chemicals and hypertensive disorders during pregnancy within a large birth cohort study, the Generation R Study. METHODS: Associations between occupational characteristics and hypertensive disorders during pregnancy were studied in 4465 pregnant woman participating in a population-based prospective cohort study from early pregnancy onwards in the Netherlands (2002-2006. Mothers who filled out a questionnaire during mid-pregnancy (response 77% of enrolment, were included if they conducted paid employment, had a spontaneously conceived singleton live born pregnancy, and did not suffer from pre-existing hypertension (n = 4465. Questions on physical demanding work were obtained from the Dutch Musculoskeletal Questionnaire and concerned questions on manually handling loads of 25 kg or more, long periods of standing or walking, night shifts, and working hours. To assess occupational exposure to chemicals, job titles and task descriptions were linked to a job-exposure-matrix (JEM, an expert judgment on exposure to chemicals at the workplace. Information on hypertensive disorders during pregnancy was obtained from medical records. RESULTS: We observed no consistent associations between any of the work related risk factors, such as long periods of standing or walking, heavy lifting, night shifts, and working hours, nor exposure to chemicals with hypertensive disorders during pregnancy. CONCLUSION: This prospective birth cohort study suggests that there is no association of hypertensive disorders during pregnancy with physically demanding work or exposure to chemicals. However, the low prevalence of PIH and PE, combined with the low prevalence of occupational risk factors limit the power for inference and larger studies are needed to corroborate or refute these findings.

  19. [Hypertension In pregnancy: practical considerations].

    Science.gov (United States)

    Jaafar, Jaafar; Pechère-Bertschi, Antoinette; Ditisheim, Agnès

    2014-09-10

    Hypertension is the most frequent medical disorder of pregnancy. Whether in the form of a chronic hypertension or a pregnancy induced-hypertension, or preeclampsia, it is associated with major maternal and neonatal morbidity and mortality. Improvement of prenatal care allowed a reduction in the number of poor outcomes. However, our partial understanding of the origin of gestational hypertension and preeclampsia limits the establishment of robust prediction models and efficient preventive interventions. This review discusses actual considerations on the clinical approach to hypertension in pregnancy.

  20. Hypertensive disorders in twin pregnancy

    NARCIS (Netherlands)

    J.G. Santema (Job); E. Koppelaar (Elin); H.C.S. Wallenburg (Henk)

    1995-01-01

    textabstractObjective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation. Study design: Case-control study in the setting of a University Hospital. Each pregnancy of a consecutive series of 187 twin pregnancies attending th

  1. Pulmonary arterial hypertension in pregnancy.

    Science.gov (United States)

    Običan, Sarah G; Cleary, Kirsten L

    2014-08-01

    Pulmonary hypertension is a medical condition characterized by elevated pulmonary arterial pressure and secondary right heart failure. Pulmonary arterial hypertension is a subset of pulmonary hypertension, which is characterized by an underlying disorder of the pulmonary arterial vasculature. Pulmonary hypertension can also occur secondarily to structural cardiac disease, autoimmune disorders, and toxic exposures. Although pregnancies affected by pulmonary hypertension and pulmonary arterial hypertension are rare, the pathophysiology exacerbated by pregnancy confers both high maternal and fetal mortality and morbidity. In light of new treatment modalities and the use of a multidisciplinary approach to care, maternal outcomes may be improving.

  2. Recurrence of hypertensive disorders of pregnancy

    DEFF Research Database (Denmark)

    van Oostwaard, Miriam F; Langenveld, Josje; Schuit, Ewoud

    2015-01-01

    OBJECTIVE: We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN: We performed an electronic literature search for cohort studies that reported...... that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome...... delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION: Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low...

  3. Hypertensive disorders in twin pregnancy

    OpenAIRE

    Santema, Job; Koppelaar, Elin; Wallenburg, Henk

    1995-01-01

    textabstractObjective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation. Study design: Case-control study in the setting of a University Hospital. Each pregnancy of a consecutive series of 187 twin pregnancies attending the antenatal clinic and booked before a gestational age of 24 weeks was matched for maternal age, parity, and gestational age at delivery with a singleton pregnancy delivered in the same year. Prima...

  4. Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy

    Directory of Open Access Journals (Sweden)

    Campbell Oona

    2011-04-01

    Full Text Available Abstract Background In this paper we review the evidence of the effect of health interventions on mortality reduction from hypertensive diseases in pregnancy (HDP. We chose HDP because they represent a major cause of death in low income countries and evidence of effect on maternal mortality from randomised studies is available for some interventions. Methods We used four approaches to review the evidence of the effect of interventions to prevent or treat HDP on mortality reduction from HDP. We first reviewed the Cochrane Library to identify systematic reviews and individual trials of the efficacy of single interventions for the prevention or treatment of HDP. We then searched the literature for articles quantifying the impact of maternal health interventions on the reduction of maternal mortality at the population level and describe the approaches used by various authors for interventions related to HDP. Third, we examined levels of HDP-specific mortality over time or between regions in an attempt to quantify the actual or potential reduction in mortality from HDP in these regions or over time. Lastly, we compared case fatality rates in women with HDP-related severe acute maternal morbidity with those reported historically in high income countries before any effective treatment was available. Results The Cochrane review identified 5 effective interventions: routine calcium supplementation in pregnancy, antiplatelet agents during pregnancy in women at risk of pre-eclampsia, Magnesium sulphate (MgS04 for the treatment of eclampsia, MgS04 for the treatment of pre-eclampsia, and hypertensive drugs for the treatment of mild to moderate hypertension in pregnancy. We found 10 studies quantifying the effect of maternal health interventions on reducing maternal mortality from HDP, but the heterogeneity in the methods make it difficult to draw uniform conclusions for effectiveness of interventions at various levels of the health system. Most authors

  5. Hypertension in pregnancy: An unresectable mediastinal pheochromocytoma.

    Science.gov (United States)

    Gazala, Sayf; Switzer, Noah; Bédard, Eric L R

    2016-02-01

    Hypertension is a relatively common occurrence during pregnancy, which usually has a benign course with an excellent prognosis. However, physicians caring for pregnant women should have a high index of suspicion for underlying medical conditions that could lead to a more perilous outcome. Herein, we present the case of a pregnant woman who was found to have uncontrollable hypertension late in her pregnancy, secondary to a mediastinal pheochromocytoma, which was deemed unresectable at the time of exploration after her delivery.

  6. Management of hypertensive disorders in pregnancy.

    Science.gov (United States)

    Moussa, Hind N; Arian, Sara E; Sibai, Baha M

    2014-07-01

    Hypertensive disorders are the most common medical complication of pregnancy, with an incidence of 5-10%, and a common cause of maternal mortality in the USA. Incidence of pre-eclampsia has increased by 25% in the past two decades. In addition to being among the lethal triad, there are likely up to 100 other women who experience 'near miss' significant maternal morbidity that stops short of death for every pre-eclampsia-related mortality. The purpose of this review is to present the new task force statement and novel definitions, as well as management approaches to each of the hypertensive disorders in pregnancy. The increased understanding of the pathophysiology of hypertension in pregnancy, as well as advances in medical therapy to minimize risks of fetal toxicity and teratogenicity, will improve our ability to prevent and treat hypertension in pregnancy. Fetal programming and fetal origins of adult disease theories extrapolate the benefit of such therapy to future generations.

  7. [Hypertension during pregnancy: Epidemiology, definition].

    Science.gov (United States)

    Fauvel, Jean-Pierre

    2016-01-01

    Hypertension in pregnancy has several forms that differ by their mechanisms and their consequences for mothers and fetus. Chronic hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg before pregnancy or before the 20th week of amenorrhea. Gestational hypertension is defined by SBP≥140mm Hg or DBP≥90mm Hg during or after the 20th week of amenorrhea. Preeclampsia is the occurrence of hypertension and proteinuria after 20weeks of amenorrhea. Severe preeclampsia is accompanied by clinical signs and symptoms indicating visceral pain. The HELLP syndrome is a severe preeclampsia accompanied by intravascular hemolysis and hepatic cytolysis. Eclampsia is characterized by seizures of the tonic-clonic type. A chronic hypertension is observed in 1-5% of pregnancies. Gestational hypertension without proteinuria appears in 5-6% of pregnancies. A preeclampsia develops in 1-2% of pregnancies, but much more frequently (up 34%) in the presence of risk factors. High blood pressure during pregnancy remains, by its complications, the leading cause of maternal morbidity and mortality.

  8. Work-related maternal risk factors and the risk of pregnancy induced hypertension and Preeclampsia during pregnancy. The generation R study

    NARCIS (Netherlands)

    J.J. Nugteren (Jaap); C.A. Snijder (Claudia); A. Hofman (Albert); V.W.V. Jaddoe (Vincent); E.A.P. Steegers (Eric); A. Burdorf (Alex)

    2012-01-01

    textabstractObjective: To study the associations between physically demanding work and occupational exposure to chemicals and hypertensive disorders during pregnancy within a large birth cohort study, the Generation R Study. Methods: Associations between occupational characteristics and hypertensive

  9. Work-related maternal risk factors and the risk of pregnancy induced hypertension and Preeclampsia during pregnancy. The generation R study

    NARCIS (Netherlands)

    J.J. Nugteren (Jaap); C.A. Snijder (Claudia); A. Hofman (Albert); V.W.V. Jaddoe (Vincent); E.A.P. Steegers (Eric); A. Burdorf (Alex)

    2012-01-01

    textabstractObjective: To study the associations between physically demanding work and occupational exposure to chemicals and hypertensive disorders during pregnancy within a large birth cohort study, the Generation R Study. Methods: Associations between occupational characteristics and hypertensive

  10. Drug treatment of hypertension in pregnancy.

    Science.gov (United States)

    Brown, Catherine M; Garovic, Vesna D

    2014-03-01

    Hypertensive disorders represent major causes of pregnancy-related maternal mortality worldwide. Similar to the non-pregnant population, hypertension is the most common medical disorder encountered during pregnancy and is estimated to occur in about 6-8 % of pregnancies. A recent report highlighted hypertensive disorders as one of the major causes of pregnancy-related maternal deaths in the USA, accounting for 579 (12.3 %) of the 4,693 maternal deaths that occurred between 1998 and 2005. In low-income and middle-income countries, preeclampsia and its convulsive form, eclampsia, are associated with 10-15 % of direct maternal deaths. The optimal timing and choice of therapy for hypertensive pregnancy disorders involves carefully weighing the risk-versus-benefit ratio for each individual patient, with an overall goal of improving maternal and fetal outcomes. In this review, we have compared and contrasted the recommendations from different treatment guidelines and outlined some newer perspectives on management. We aim to provide a clinically oriented guide to the drug treatment of hypertension in pregnancy.

  11. Relationship between lupus anticoagulant (LAC) and pregnancy-induced hypertension.

    Science.gov (United States)

    Matsumoto, T; Sagawa, N; Ihara, Y; Kobayashi, F; Itoh, H; Mori, T

    1995-01-01

    Lupus anticoagulant (LAC), a serum antiphospholipid autoantibody, is believed to be one of the causes of infertility or fetal loss. The purpose of the present study was to evaluate the role of LAC in the pathogenesis of hypertension during pregnancy. In this study, 20 pregnant women with hypertension were classified into two groups: 14 patients who did not have hypertension before the pregnancy but developed it during the pregnancy (pregnancy-induced hypertension; Group A) and 6 patients who had hypertensive or renal disease before the pregnancy, and developed further hypertension during the pregnancy (pregnancy-aggravated hypertension; Group B). A LAC coagulation assay was performed, and the presence of LAC in each group was compared. All 14 patients in group A were LAC-negative. In contrast, 3 of the 6 patients in group B were LAC-positive, and had clinical autoimmune diseases. The incidence of pregnancy-induced hypertension was also examined in 15 pregnancies from 9 LAC-positive women who had a history of repeated fetal loss but no systemic autoimmune disease (Group C). None of these 15 pregnancies had hypertensive complications, even when they reached term. In the placentas of LAC-positive women, no characteristic changes other than fibrinoid degeneration and microscopic infarction were observed upon histological examination. These results suggest that LAC does not relate with the onset of hypertension during pregnancy.

  12. Hypertensive disorders in pregnancy

    OpenAIRE

    Berry, Casey; Atta, Mohamed G.

    2016-01-01

    Renal injury or failure may occur in the context of pregnancy requiring special considerations with regard to fetal and maternal health. The condition of pregnancy itself may be a major factor in such injuries. In addition, for many young women previously known to be healthy, pregnancy may be the first presentation for routine urine and blood testing which may yield previously subclinical renal disease. As such, pregnancy may add complexity to considerations in the management of renal disease...

  13. Hypertensive disorders in pregnancy.

    Science.gov (United States)

    Berry, Casey; Atta, Mohamed G

    2016-09-06

    Renal injury or failure may occur in the context of pregnancy requiring special considerations with regard to fetal and maternal health. The condition of pregnancy itself may be a major factor in such injuries. In addition, for many young women previously known to be healthy, pregnancy may be the first presentation for routine urine and blood testing which may yield previously subclinical renal disease. As such, pregnancy may add complexity to considerations in the management of renal disease presenting coincidentally requiring knowledge of the physiologic changes and potential renal disorders that may be encountered during pregnancy.

  14. ASH position paper: hypertension in pregnancy.

    Science.gov (United States)

    Lindheimer, Marshall D; Taler, Sandra J; Cunningham, F Gary

    2009-04-01

    The American Society of Hypertension is publishing a series of Position Papers in their official journals throughout the 2008-2009 years. The following Position Paper originally appeared: JASH. 2008;2(6):484-494. Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension, Inc (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous magnesium sulfate is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists.

  15. A Comprehensive Review of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    Reem Mustafa

    2012-01-01

    Full Text Available Hypertension is the most common medical disorder encountered during pregnancy. Hypertensive disorders are one of the major causes of pregnancy-related maternal deaths in the United States. We will present a comprehensive update of the literature pertinent to hypertension in pregnancy. The paper begins by defining and classifying hypertensive disorders in pregnancy. The normal vascular and renal physiological changes which occur during pregnancy are detailed. We will summarize the intriguing aspects of pathophysiology of preeclampsia, emphasizing on recent advances in this field. The existing diagnostic tools and the tests which have been proposed for screening preeclampsia are comprehensively described. We also highlight the short- and long-term implications of preeclampsia. Finally, we review the current management guidelines, goals of treatment and describe the potential risks and benefits associated with various antihypertensive drug classes. Preeclampsia still remains an enigma, and the present management focuses on monitoring and treatment of its manifestations. We are hopeful that this in depth critique will stimulate the blossoming research in the field and assist practitioners to identify women at risk and more effectively treat affected individuals.

  16. The management of hypertension in pregnancy.

    Science.gov (United States)

    Kattah, Andrea G; Garovic, Vesna D

    2013-05-01

    Hypertensive pregnancy disorders complicate 6% to 8% of pregnancies and cause significant maternal and fetal morbidity and mortality. The goal of treatment is to prevent significant cerebrovascular and cardiovascular events in the mother without compromising fetal well-being. Current guidelines differentiate between the treatment of women with acute hypertensive syndromes of pregnancy and women with preexisting chronic hypertension in pregnancy. This review will address the management of hypertension in pregnancy, review the various pharmacologic therapies, and discuss the future directions in this field.

  17. Management of Hypertension in Pregnancy

    OpenAIRE

    Nurike S Mudjari; Nur Samsu

    2015-01-01

    Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for experiencing numerous complications including disseminated intravascular coagulation (DIC), cerebral hemorrhage, liver dysfunction and acute renal failure; while to the fetus, it may cause intrauterine growth retardation, prematurity and perinatal mortality. Hypertension in pregnan...

  18. Association between insulin resistance, glucose intolerance, and hypertension in pregnancy.

    Science.gov (United States)

    Negrato, Carlos Antonio; Jovanovic, Lois; Tambascia, Marcos Antonio; Geloneze, Bruno; Dias, Adriano; Calderon, Iracema de Mattos Paranhos; Rudge, Marilza Vieira Cunha

    2009-02-01

    There is an association between insulin resistance, glucose intolerance, and essential hypertension, but the relation between insulin resistance, glucose intolerance, and hypertension diagnosed during pregnancy is not well understood. Transient hypertension of pregnancy, the new-onset nonproteinuric hypertension of late pregnancy, is associated with a high risk of later essential hypertension and glucose intolerance; thus, these conditions may have a similar pathophysiology. To assess the association between insulin resistance, glucose intolerance, essential hypertension, and subsequent development of proteinuric and nonproteinuric hypertension in pregnancy in women without underlying essential hypertension, we performed a prospective study comparing glucose (fasting, 1 and 2 hours postglucose load), insulin, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), and triglycerides levels on routine screening for gestational diabetes mellitus. Women who developed hypertension in pregnancy (n = 37) had higher glycemic levels (fasting, 1 and 2 hours postglucose load) on a 100-gram oral glucose loading test, although only the fasting values showed a statistical significance (p or=140 mg/dL) (p hypertension in pregnancy, particularly preeclampsia, and support the hypothesis that insulin resistance may play a role in the pathogenesis of this disorder.

  19. Ambulatory management of chronic hypertension in pregnancy.

    Science.gov (United States)

    Ames, Mary; Rueda, Jose; Caughey, Aaron B

    2012-09-01

    Chronic hypertension in pregnancy is one of the most common medical diseases affecting pregnancy. It is associated with serious maternal and fetal complications, including superimposed pre-eclampsia, fetal growth restriction, premature delivery, placental abruption, and stillbirth. Baseline evaluation as early as possible is important to differentiate women with essential hypertension from those with severe hypertension, coexisting end-organ damage, and secondary causes of hypertension, as their risks of poor outcomes are increased. An optimal plan for maternal treatment and fetal surveillance can then be formulated. Coordination of care after delivery is important for long-term maternal health and future pregnancies.

  20. Hypertensive pregnancy disorders and future renal disease.

    Science.gov (United States)

    Wagner, Steven; Craici, Iasmina

    2014-10-01

    Hypertensive pregnancy disorders affect approximately 6 to 8 % of otherwise normal pregnancies. A growing body of evidence links these disorders with the future development of hypertension, coronary disease, cerebrovascular disease, and peripheral arterial disease. Larger studies associating hypertensive pregnancy to future development of renal disease have been lacking until recently, with publication of several compelling studies in the last 5 years. In this review, we will focus on the recent evidence associating hypertensive pregnancy disorders with the future development of chronic kidney disease (CKD) and end-stage renal disease (ESRD), as well as the development of microalbuminuria. We will also attempt to answer whether these renal risks are due to direct effects of hypertension during pregnancy, or whether they are due to shared environmental and genetic risk factors.

  1. Pulmonary arterial hypertension and pregnancy

    Directory of Open Access Journals (Sweden)

    Demet Terek

    2013-01-01

    Full Text Available This is the case report of a pregnant woman who refused pregnancy termination when diagnosed with pulmonary arterial hypertension (PAH functional class 2-3 at the 24th week of gestation and of her newborn. A pregnant woman with PAH functional class 2-3 was treated with inhaled prostacyclin analog (iloprost, oral sildenafil, oxygen, and low molecular weight heparin. She delivered at 32nd week by Cesarean section. The infant required oxygen up to 36th week postconceptional age and had a short steroid treatment. The mother needed close cardiovascular monitorization, intensive oxygen and pulmonary vasodilator therapy for 2 months and was discharged with oxygen and oral iloprost treatment. A multidisciplinary approach together with pulmonary vasodilator therapy may be succesful in such a high-risk pregnant woman.

  2. An unusual cause of hypertension in pregnancy.

    Science.gov (United States)

    Vriend, Joris W J; van Montfrans, Gert A; van der Post, Joris A M; Lam, Jan; Mulder, Barbara J M

    2004-01-01

    Aortic coarctation is an unusual cause of hypertension in pregnancy. We report the case of a 34-year-old woman with severe hypertension after surgical repair of aortic coarctation in childhood. An MRI showed a residual stenosis of the aortic arch and a small aneurysm. Pregnant postcoarctectomy patients are at an increased risk for developing hypertension during pregnancy due to residual aortic gradients and abnormal vascular reactivity of the precoarctation vessels. Women after repair of aortic coarctation should be closely monitored for blood pressure during pregnancy.

  3. Pharmacological management of hypertension in pregnancy.

    Science.gov (United States)

    Easterling, Thomas R

    2014-12-01

    Hypertension in pregnancy remains a significant public health problem. Pharmacological management of blood pressure in pregnancy is impacted by changes in maternal drug disposition and by the pharmacodynamic effects of specific agents. This article will review the impact of pregnancy on pathways of drug elimination and the associated clinical implications, the pharmacodynamic effects of specific drugs and classes of drugs in pregnancy, and the data to date on the impact of antihypertensive therapy on mothers and their fetuses.

  4. [Pregnancy experiences of women with pregnancy-induced hypertension].

    Science.gov (United States)

    Rauchfuß, Martina; Enderwitz, Judith; Klapp, Burghard; Maier, Barbara; Bölter, Annette; Frommer, Jörg

    2012-01-01

    The study assesses the experience of pregnancy of women who have pregnancy induced hypertension (PIH) compared to women with an uncomplicated course of pregnancy. 21 women were retrospectively investigated between 5 and 13 months after giving birth via a semistandardised interview focussing on the personal experience of pregnancy. The interviews were analysed by means of qualitative content analysis. The categories "development and course," "coping with anxiety," "image of one's mother" and "relationship with partner" were determined and described. Finally, we developed data-driven, ideal-type models of pregnancies with pregnancy-induced hypertension versus normal pregnancies by detecting the similarities and contrasts between the groups. Interviewees with pregnancy-induced hypertension showed an ambivalence with regard to their pregnancy, which was more often than not unplanned and/or unwanted. Conflicts with significant others, especially with their partners, were also reported more often. Emotions tended to be understated. The results can be employed in the operationalisation of future projects in a hitherto unclear research field. They should also be considered in the care of patients with pregnancy-induced hypertension.

  5. A CASE REPORT: HYPERTENSION IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Sagung Desy Kristiyani

    2014-10-01

    Full Text Available Hypertension in pregnancy is 15 percent of the comorbid of pregnancy and one of the threehighest causes of maternal mortality and morbidity in childbirth. This can be either ChronicHypertension, Gestational Hypertension,and developed further into Preeclampsia orEclampsia. In Indonesia, the mortality and morbidity of hypertension in pregnancy is alsostill quite high. This is caused not only by the etiology that is stillunclear, but also bychildbirth care that is still handled by non-medical officers and referral system which hasnot been perfect. This case report discusses about Severe Preeclampsia with ImpendingEclampsiaon a 28 years old pregnant woman, supporting urinalysis examination showedprotein and ketones in the urine, blood chemistry examination also obtained an increase ofthe liver enzyme and lactate dehydrogenase . In these patients is done handling atermination of pregnancy by Sectio Caesarea method.

  6. nigerian mothers with hypertensive disorders in pregnancy

    African Journals Online (AJOL)

    Results: The incidence of some neonatal morbidities such as birth asphyxia, ... Conclusion: Pregnancies complicated by hypertension are associated with an increase in neonatal morbidity. ... an out-patient unless they developed complication.

  7. Tests Related to Pregnancy

    Science.gov (United States)

    ... to learn. Search form Search Tests related to pregnancy You are here Home Testing & Services Testing for ... to Genetic Counseling . What Are Tests Related to Pregnancy? Pregnancy related testing is done before or during ...

  8. Vertical teaching principles: pregnancy induced hypertension

    Directory of Open Access Journals (Sweden)

    Nidhi Sharma

    2016-06-01

    Conclusions: Vertical integration of medical disciplines helps medical students to understand a clinical problem in the light of basic sciences. The modules beginning with the pathophysiology of pregnancy induced hypertension and concluded with anesthetic considerations. An elaborate module helps to translate an understanding of pharmaco therapeutics of hypertension in pregnancy. A well-trained medical student can help to reduce maternal mortality due to preeclampsia. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1739-1743

  9. [Hypertension and pregnancy. Diagnosis, physiopathology and treatment].

    Science.gov (United States)

    Fournier, A; Fievet, P; el Esper, I; el Esper, N; Vaillant, P; Gondry, J

    1995-11-25

    This review on hypertension in pregnancy focuses mainly on the pathophysiology and prevention of pregnancy induced hypertension which, when associated with proteinuria, is usually called preeclampsia. Rather than a genuine hypertensive disease, preeclampsia is mainly a systemic endothelial disease causing activation of platelets and diffuse ischemic disorders whose most obvious clinical manifestations involve the kidney (hence the proteinuria, edema and hyperuricemia), the liver (hence the hemolytic elevated liver enzymes and low platelets, or HELLP syndrome), and the brain (hence eclamptic convulsions). Hypertension is explained by increased vascular reactivity rather than by an imbalance between vasoconstrictive and vasodilating circulating hormones. This increased reactivity is due to endothelial dysfunction with imbalance between prostacyclin and thromboxane A2 and possibly dysfunction of NO and endothelin synthesis. The aggressive substances for endothelium are thought to be of placentar origin and the cause of their release is explained by placentar ischemia related to a defect of trophoblastic invasion of the spiral arteries. The etiology of this latter defect is unknown but involves immunologic mechanisms with genetic predisposition. The only effective treatment for PIH is extraction of the baby with the whole placenta. The decision for extraction is often a very delicate obstetric problem. Antihypertensive drugs are mainly indicated in severe hypertension (> 160-100 mm Hg), with the aim of preventing cerebral hemorrhage in the mother, but have not been shown to improve fetal morbidity or mortality. Eclamptic seizures can be prevented and treated more effectively with magnesium sulfate than with diazepam or phenytoin. Prevention of preeclampsia remains the main challenge. Whereas antihypertensive drugs are ineffective, calcium supplementation and low dose aspirin have proven effective but mainly in selected populations with a relatively high incidence of

  10. [Hypertension in pregnancy and future maternal health].

    Science.gov (United States)

    Mounier-Vehier, Claire; Madika, Anne-Laure; Boudghène-Stambouli, Fanny; Ledieu, Guillaume; Delsart, Pascal; Tsatsaris, Vassilis

    2016-01-01

    Preeclampsia is a specific risk factor chronic of hypertension, of coronary events (Ray et al., 2005), of stroke (Brown et al., 2006), of chronic renal failure (Kattah and Garovic, 2005; McDonald et al., 2003; Williams, 2003) and a specific risk factor of cardio-cerebrovascular mortality (Magnussen et al., 2009). According to Magnusson et al. (2009), the relative long-term risk of developing hypertension is multiplied by 4; the risk of diabetes and metabolic syndrome multiplied by 3; the risk of coronary heart disease and stroke multiplied by 2. Cardiovascular risk is particularly important when pregnancy was complicated by maternal and fetal events or occurring precociously (Williams, 2003; Newstead et al., 2007). Early PE is associated with a relative risk of death by 7 of CV disease. Several pathophysiological factors are common between CV disease and preeclampsia: endothelial dysfunction, hypertension, obesity, insulin resistance, dyslipidemia and CV heredity. Metabolic syndrome could be the link between preeclampsia and CV disease. Hypertension in pregnancy and preeclampsia could unmask metabolic syndrome "latent" existing (Silva et al., 2008). Recently, scientific societies have published guidelines dedicated to cardiovascular risk in women and for the prevention of stroke in women. They recognize hypertension in pregnancy and preeclampsia as specific emerging risk (Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014). Paradoxically, information and prevention of these women at risk is insufficient to ignorance and lack of awareness among health professionals (Brown et al., 2013). The education of women has become a major issue of prevention, developing specific consultation after delivery, encouraging them to optimize their lifestyle with a coordinated follow-up (Newstead et al., 2007; Mosca et al., 2011; European Society of Gynecology et al., 2011; Bushnell et al., 2014, Harskamp and Zeeman, 2007). In the end, the

  11. Prediction and prognosis of hypertension in pregnancy

    NARCIS (Netherlands)

    Nijdam, M.E.

    2011-01-01

    Hypertensive disorders represent the most significant complication of pregnancy and affect about 10% of all pregnancies. Early referral for specialist care for those who are at risk might translate into improved management of these women, while the possibility to identify women at very low risk for

  12. Study of the relationship of serum insulin-like growth factor-related indicators and interleukins with pregnancy-induced hypertension

    Institute of Scientific and Technical Information of China (English)

    Minawar.Aziz

    2016-01-01

    Objective:To study the relationship of serum insulin-like growth factor-related indicators and interleukins with pregnancy-induced hypertension.Methods:34 patients with gestational hypertension, 27 patients with mild preeclampsia, 18 patients with severe preeclampsia and 50 healthy women were selected as the research subjects, serum was collected to determine serum IGF-I, IGF-II, IGFBP-1, IL-6, IL-8 and IL-18 content, and the placenta was collect to determine IGF-I, IGF-II, IGFBP-1, IL-6, IL-8 and IL-18 content.Results: IGF-I and IGF-II levels in placenta tissue and serum of gestational hypertension group, mild preeclampsia group and severe preeclampsia group were significantly lower than those of control group, and IGFBP-1, IL-6, IL-8 and IL-18 levels were significantly higher than those of control group; serum IGF-I and IGF-II levels were negatively correlated with IL-6, IL-8 and IL-18 levels, and serum IGFBP-1 level was positively correlated with IL-6, IL-8 and IL-18 levels.Conclusion:decreased serum IGF-I, IGF-II levels and increased serum IGFBP-1, IL-6, IL-8 and IL-18 levels are associated with pregnancy-induced hypertension, and decreased IGF-I and IGF-II levels and increased IGFBP-1 level are closely related to increased levels of interleukins.

  13. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy

    DEFF Research Database (Denmark)

    Behrens, Ida; Basit, Saima; Melbye, Mads

    2017-01-01

    Objectives To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time.Design Nationwide register based cohort study.Setting Denmark.Populations 482 972 primiparous women with a first l...

  14. Hypertensive crisis during pregnancy and postpartum period.

    Science.gov (United States)

    Too, Gloria T; Hill, James B

    2013-08-01

    Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period.

  15. Hypertensive Disorders of Pregnancy - A Life-Long Risk?!

    Science.gov (United States)

    Schausberger, C E; Jacobs, V R; Bogner, G; Wolfrum-Ristau, P; Fischer, T

    2013-01-01

    Background: Arterial hypertension is one of the most important causes of cardiovascular diseases, and the latter are responsible for almost half of the deaths in the industrialised nations. Hypertensive disorders of pregnancy constitute one of the most frequent causes of feto-maternal morbidity and mortality; on the other hand the occurrence of a hypertensive disorder of pregnancy represents a risk for the later development of hypertension and the cardiovascular risks resulting therefrom. The aim of this article is to demonstrate the association of hypertensive disorders of pregnancy with consecutive cardiovascular diseases. Materials and Methods: Specific selective literature research. Results: After the occurrence of a hypertensive disorder of pregnancy the relative risks for hypertension are 3.7 (2.70-5.05), for ischaemic heart disease 2.2 (1.86-2.52), for cerebral insult 1.8 (1.45-2.27) and for mortality resulting from cardiovascular causes 1.5 (1.05-2.14) and are thus significant. According to a recent study 56 % of internal specialists and 23 % of gynecologists do not know about the association of preeclampsia with ischemic heart disease, 48 % and 38 % respectively are not aware of the link with stroke and 79 % and 77 % respectively are not aware of the association with a reduced life expectancy after preeclampsia. The presence of hypertension is not known by many of the patients, merely 28-38 % receive an appropriate therapy. Conclusion: Adequate follow-up after hypertensive disorders of pregnancy and the early recognition of and therapy for hypertension represent the cornerstones in the prevention of late cardiovascular sequelae. General practitioners, specialist for internal medicine and gynaecologists have a special responsibility with regard to the reduction of later complications.

  16. Pregnancy hypertension and umbilical cord blood lead levels

    Energy Technology Data Exchange (ETDEWEB)

    Rabinowitz, M.; Bellinger, D.; Leviton, A. (Children' s Hospital, Boston, MA (USA)); Needleman, H. (Children' s Hospital, Pittsburgh, PA (USA)); Schoenbaum, S. (Harvard Community Health Plan, Brookline Village, MA (USA))

    Pregnancy hypertension, blood pressure during labor, and the umbilical cord blood lead concentration were assessed in 3,851 women for whom additional demographic, medical, and personal information was available. Lead levels correlated with both systolic and diastolic blood pressure during labor. The incidence of clinically defined pregnancy hypertension, nearly 11% overall, increased with lead level. A series of multivariate models of pregnancy hypertension and of systolic blood pressure as a function of maternal age, parity, hematocrit, ponderal index, race, season, and diabetes were improved by including lead as a predictor variable. These other risk factors are not affected by the lead term. The relative risk for pregnancy hypertension doubles when lead increases from 2 to 15 {mu}g/dl. The effect is statistically strong, with a magnitude of about 3 mm for a 10 {mu}g/dl range, about the same magnitude associated with diabetes. At these observed levels (mean blood lead = 6.0 {mu}g/dl, SD = 3.3, range 0 > 35), not currently recognized as overtly toxic, lead has a small but demonstrable association with pregnancy hypertension and blood pressure at the time of delivery, but not with pre-eclampsia nor toxemia. Although this association is not likely to influence the clinical management of hypertension, it indicates that lead at typical contemporary urban levels, does effect multiple physiological functions.

  17. Management of severe hypertension in pregnancy.

    Science.gov (United States)

    Moroz, Leslie A; Simpson, Lynn L; Rochelson, Burton

    2016-03-01

    While hemorrhage is the leading cause of maternal death in most of the world, hypertensive disorders of pregnancy are the leading cause of maternal mortality in the United States. The opportunity to improve outcomes lies in timely and appropriate response to severe hypertension. The purpose of this article is to review the diagnostic criteria for severe hypertension, choice of antihypertensive agents, and recommended algorithms for evaluation and management of acute changes in clinical status. Adhering to standard practices ensures that care teams can timely and appropriate care to these high risk patients. With heightened surveillance and prompt evaluation of signs and symptoms of worsening hypertension, maternal morbidity and mortality can be decreased.

  18. Renal disease and hypertension in pregnancy.

    Science.gov (United States)

    Palma-Reis, Ines; Vais, Alina; Nelson-Piercy, Catherine; Banerjee, Anita

    2013-02-01

    Because women are becoming pregnant at a later age, hypertension is more commonly encountered in pregnancy. In addition, with increasing numbers of young women living with renal transplants and kidney disease, it is important for physicians to be aware of the effects of pregnancy on these diseases. A multidisciplinary approach is essential to assess and care for pregnant women with kidney disease. Pre-pregnancy counselling should be offered to all women with chronic kidney disease. A review of medication to avoid teratogenicity and optimise the disease prior to conception is the ideal. Pregnancy may be the first medical review for a young woman, who may present with a previously undiagnosed renal problem.

  19. [Pregnancy in pulmonary arterial hypertension patients].

    Science.gov (United States)

    Rosengarten, Dror; Kramer, Mordechai R

    2013-09-01

    Pulmonary arterial hypertension (PAH) is a disorder defined by elevated mean pulmonary arterial pressure. PAH can be idiopathic or associated with a variety of medical conditions such as scleroderma, congenital heart disease, left heart failure, lung disease or chronic pulmonary thromboembolism. This progressive disease can cause severe right heart failure and death. Normal physiologic changes that occur during pregnancy may produce fatal consequences in PAH patients. Current guidelines recommend that pregnancy be avoided or terminated early in women with PAH. During the past decade, new advanced therapies for PAH have emerged gathering reports of successful pregnancies in patients with pulmonary hypertension. Substantial risk still exists and current recommendations have not changed. Nevertheless, in selected cases, if a patient insists on continuing the pregnancy, being fully aware of the risks involved, an intensive treatment approach should be implemented in experienced centers. This is necessary in order to control pulmonary hypertension during pregnancy and reduce the risk so as to improve outcomes. This review will focus on the pathophysiology of PAH in pregnancy and appropriate management during pregnancy, delivery and the post-partum period.

  20. Thyroid Dysfunction and Autoantibodies Association with Hypertensive Disorders during Pregnancy

    Directory of Open Access Journals (Sweden)

    Azin Alavi

    2012-01-01

    Full Text Available Background. Thyroid dysfunction and autoimmunity are relatively common in reproductive age and have been associated with adverse health outcomes for both mother and child, including hypertensive disorders during pregnancy. Objective. To survey the relation between thyroid dysfunction and autoimmunity and incidence and severity of pregnancy-induced hypertensive disorders. Method. In this case control study 48 hypertensive patients in 4 subgroups (gestational hypertension, mild preeclampsia, severe preeclampsia, eclampsia and 50 normotensive ones were studied. The samples were nulliparous and matched based on age and gestational age and none of them had previous history of hypertensive or thyroid disorders and other underlying systemic diseases or took medication that might affect thyroid function. Their venous blood samples were collected using electrochemiluminescence and ELISA method and thyroid hormones and TSH and autoantibodies were measured. Results. Hypertensive patients had significant lower T3 concentration compared with normotensive ones with mean T3 values 152.5±48.93 ng/dL, 175.36±58.07 ng/dL respectively. Anti-TPO concentration is higher in control group 6.07±9.02 IU/mL compared with 2.27±2.94 IU/mL in cases. Conclusion. The severity of preeclampsia and eclampsia was not associated with thyroid function tests. The only significant value was low T3 level among pregnancy, induced hypertensive patients.

  1. Induced hypertensive disorders of pregnancy related factors%妊娠高血压综合征的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    侯涛; 丘媚妮; 唐乔飞; 李境; 李晓辉

    2010-01-01

    Objective To investigate the cause of hypertensive disorders of pregnancy-related factors.Methods A retrospective survey investigated 3120 cases of maternal clinical data and 90 pregnant women with hypertensive disorder were the observation group. Non-pregnant women 3030 cases of hypertension were a control group. Two groups were compared with age, occupation, body mass index before pregnancy, pregnancy induced hypertension, family history, regular antenatal care, emotional status during pregnancy, differences in serum calcium concentration. Results The average age of the two groups observed a large group [ ( 28.89 ± 3.22 ) years ], a high proportion of farmers (47 cases) , BMI higher [ (27.93 ± 1.16 ) kg/m2 ], there were more family history of PIH ( 23 cases) regular prenatal care less (44 cases), negative mood, low serum calcium concentration (27 cases) , as risk factors for hypertensive disorders in pregnancy, compared with the control group, the difference was statistically significant (P < 0.05 ). Conclusion Hypertensive disorder of pregnancy is due to multiple factors. These factors should be used for the appropriate measures to reduce the incidence of hypertensive disorders of pregnancy.%目的 调查引起妊娠高血压综合征(PIH)的相关因素.方法 采用回顾性调查法调查3120例产妇临床资料,其中90例PIH产妇作为观察组;非PIH产妇3030例作为对照组.比较2组年龄、职业、孕前BMI、PIH家族史、定期产前检查、孕期情绪状况差异等.结果 观察组平均年龄大[(28.9±3.2)岁]、BMI高[(27.93±1.16)kg/m2]、有PIH家族史者较多[23例(25.6%)]、定期产前检查少[44例(48.9%)]、孕期情绪不佳[27例(30.O%)],与对照组上述各项指标相比[分别为:(26.27±3.45)岁、(26.13±1.02)kg/m2、245例(8.1%)、2387例(78.8%)、239例(7.89%)],差异均有统计学意义(均P<0.05).结论 PIH是多因素共同作用的结果,应针对上述因素采用相应的措施降低PIH的发生.

  2. Clinico-Epidemiological Study Of Factors Associated With Pregnancy Induced Hypertension

    Directory of Open Access Journals (Sweden)

    Amir Ali

    1998-01-01

    Full Text Available Research Question: What are the factors responsible for pregnancy induced hypertension. Objectives: To determine whether maternal, demographic, clinical and socio-economic characteristics are predictive of hypertension associated with pregnancy. Study design: Cross â€" Sectional. Participants: 728 hypertensive pregnant mothers attending the ante-natal clinic and admitted to the inpatient department of obstetric unit. Study Variables: Maternal, demographic and socio-economic characteristics. Outcome variable: Hypertension associated with pregnancy. Statistical analysis: Percentages and proportions. Results: The relative incidence of pregnancy induced hypertension was 71.29%. The critical evaluation of social and demographic characteristics of 519 cases of pregnancy induced hypertension revealed that nulliparous, young women (15-25 years belonging to low socio-economic group with lower literacy status and higher house hold work load are more vulnerable to develop pregnancy induced hypertension. Inadequate diet having low protein, rich carbohydrate and extra salt intake played a crucial role in the development of pregnancy induced hypertension. Conclusions: i since the nulliparous and younger women are vulnerable to develop pregnancy induced hypertension, the age at first pregnancy be reasonably delayed. ii Balanced diet is to be ensured through appropriate nutrition education and within t he resources of the family. iii The heavy household work is to be avoided and adequate rest and sleep be ensured in those who are at risk of developing pregnancy induced hypertension.

  3. Hypertensive disorders of pregnancy: what the physician needs to know

    OpenAIRE

    Anthony, John; Damasceno, Albertino; Ojjii, Dike

    2016-01-01

    Abstract Hypertension developing during pregnancy may be caused by a variety of different pathophysiological mechanisms. The occurrence of proteinuric hypertension during the second half of pregnancy identifies a group of women whose hypertensive disorder is most likely to be caused by the pregnancy itself and for whom the risk of complications, including maternal mortality, is highest. Physicians identifying patients with hypertension in pregnancy need to discriminate between pre-eclampsia a...

  4. Hypertension in pregnancy: The endocrine and metabolic aspect

    Directory of Open Access Journals (Sweden)

    Navneet Magon

    2011-01-01

    Full Text Available Hypertension is the most common medical disorder complicating pregnancy. However, how pregnancy incites or aggravates hypertension remains unsolved despite decades of intensive research. Various endocrine and metabolic mechanisms have been postulated to contribute to the pathogenesis of hypertension in pregnancy. Understanding the endocrine aspect of the possible pathophysiological mechanism might open new vistas in prediction, prevention and management of this condition.

  5. Subclinical hypothyroidism causing hypertension in pregnancy.

    Science.gov (United States)

    Ramtahal, Rishi; Dhanoo, Andrew

    2016-09-01

    This is a case of a 25-year-old primigravida who was referred to the hypertension specialist for elevated blood pressures. The patient had an elevated thyroid-stimulating hormone with normal free thyroxine (T4) levels and was positive for thyroid peroxidase antibodies resulting in a diagnosis of subclinical hypothyroidism. The patient was successfully treated with levothyroxine which normalized the blood pressure without the need for antihypertensive treatment. This case illustrates a cause of secondary hypertension that is not always considered in the differential diagnosis of a patient with hypertension in pregnancy.

  6. Cerebral autoregulation in different hypertensive disorders of pregnancy

    NARCIS (Netherlands)

    van Veen, Teelkien R.; Panerai, Ronney B.; Haeri, Sina; Singh, Jasbir; Adusumalli, Jasvant A.; Zeeman, Gerda G.; Belfort, Michael A.

    2015-01-01

    OBJECTIVE: Cerebrovascular complications that are associated with hypertensive disorders of pregnancy (preeclampsia, chronic hypertension [CHTN], and gestational hypertension [GHTN]) are believed to be associated with impaired cerebral autoregulation, which is a physiologic process that maintains bl

  7. Related factors and pregnancy outcomes of hypertensive disorders in pregnancy%妊娠期高血压疾病的相关因素与妊娠结局

    Institute of Scientific and Technical Information of China (English)

    姜波玲; 卢媛

    2014-01-01

    目的:分析妊娠高血压疾病的相关因素及其妊娠结局。方法采用回顾性调查法,通过病例对照分析,调查其相关因素及妊娠结局,最后进行单因素方差分析和Logistics多元回归分析。结果年龄、家庭收入、孕前体重指数、孕期不良环境暴露、孕期不良心理、孕期生活事件、孕期不良生活习惯等方面具有统计学差异(χ2值分别为6.13、11.20、26.19、12.23、13.16、6.35、8.47,均P<0.05),而文化程度、早孕反应、先兆流产、既往不良妊娠史无显著性差异(χ2值分别为3.06、2.56、0.03、1.13,均P>0.05)。家庭收入、孕前体重指数、孕期不良心理与妊娠期高血压疾病呈显著正相关(P<0.05),研究组中不良妊娠结局发生率显著高于对照组(χ2=94.911,P<0.001)。结论年龄、家庭收入、孕前体重指数、孕期生活事件、孕期不良环境暴露、孕期不良心理、孕期不良生活习惯会增加妊娠期高血压疾病的发生率,而妊娠期高血压疾病会增加不良妊娠结局风险。%Objective To analyze the related factors and pregnancy outcomes of hypertensive disorders in pregnancy . Methods Retrospective case-control study was applied to explore the related factors and pregnancy outcomes of hypertensive disorders in pregnancy . Chi-square test and logistic regression analysis were conducted .Results There were significant differences in age , family income, BMI, adverse environmental exposure , adverse psychology , life events and bad living habits during pregnancy between two groups (χ2 value was 6.13, 11.20, 26.19, 12.23, 13.16, 6.35 and 8.47, respectively, all P0.05).There was significantly positive correlation between hypertensive disorders in pregnancy and family income , BMI and adverse psychology (P<0.05).The incidence of adverse pregnancy outcomes in study group was significantly higher than that in control

  8. Homocysteinemia After Hypertensive Pregnancy Disorders at Term

    NARCIS (Netherlands)

    Visser, Sanne; Hermes, Wietske; Blom, Henk J.; Heijboer, Annemieke C.; Franx, Arie; Van Pampus, Maria G.; Bloemenkamp, Kitty W. M.; Koopmans, Corine; Mol, Ben Willem J.; De Groot, Christianne J. M.

    2015-01-01

    Background: Results from a number of long-term follow-up studies have suggested that hypertensive disorders in pregnancy are associated with increased risk of cardiovascular disease later in life. More recently, this putative relationship has been substantiated with findings of elevated cardiovascul

  9. Homocysteinemia after hypertensive pregnancy disorders at term

    NARCIS (Netherlands)

    Visser, Sanne; Hermes, Wietske; Blom, Henk J.; Heijboer, Annemieke C.; Franx, Arie; Van Pampus, Maria G.; Bloemenkamp, Kitty W M; Koopmans, Corine; Mol, Ben Willem J; De Groot, Christianne J M

    2015-01-01

    Background: Results from a number of long-term follow-up studies have suggested that hypertensive disorders in pregnancy are associated with increased risk of cardiovascular disease later in life. More recently, this putative relationship has been substantiated with findings of elevated cardiovascul

  10. Pregnancy in women with pulmonary hypertension

    NARCIS (Netherlands)

    Pieper, P. G.; Hoendermis, E. S.

    2011-01-01

    Women with pulmonary hypertension have a high risk of morbidity and mortality during pregnancy. The inability to increase cardiac output leads to heart failure while further risks are introduced with hypercoagulability and decrease in systemic vascular resistance. There is no proof that new advanced

  11. Pregnancy in women with pulmonary hypertension

    NARCIS (Netherlands)

    Pieper, P. G.; Hoendermis, E. S.

    2011-01-01

    Women with pulmonary hypertension have a high risk of morbidity and mortality during pregnancy. The inability to increase cardiac output leads to heart failure while further risks are introduced with hypercoagulability and decrease in systemic vascular resistance. There is no proof that new advanced

  12. Microalbuminuria and hypertension in pregnancy: role of aldosterone and inflammation.

    Science.gov (United States)

    Armanini, Decio; Ambrosini, Guido; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2013-09-01

    Women with a history of hypertension in pregnancy are at increased risk of microalbuminuria later in life. Microalbuminuria is a marker of kidney dysfunction frequently related to an inflammatory event. Pregnancy is a dynamic process characterized by immune tolerance, angiogenesis, and hormonal regulation. Menstruation and pregnancy are associated with a physiological inflammation, which is altered in preeclampsia and probably in other hypertensive situations of pregnancy. An imbalance between pro-oxidant factors and the ability to scavenge these factors produces oxidative stress, which has been evaluated in many cells, but leukocytes are the main source of inflammatory cytokines and experimental and clinical evidence support a possible role of aldosterone as a mediator of placental and renal damage mediated by growth factors, reactive oxygen species, and cytokines. Angiotensin-converting enzyme inhibitors and aldosterone receptor blockers are frequently effective in reducing the risk of progression of cardiovascular and renal disease.

  13. Hypertensive Disorders of Pregnancy Appear Not to Be Associated with Alzheimer's Disease Later in Life

    Directory of Open Access Journals (Sweden)

    Carolien N.H. Abheiden

    2015-09-01

    Full Text Available Background: After hypertensive disorders of pregnancy, more subjective cognitive complaints and white matter lesions are reported compared to women after normal pregnancies. Both have a causal relationship with Alzheimer's disease (AD. Aim: To investigate if women whose pregnancy was complicated by hypertensive disorders have an increased risk of AD. Methods: A case-control study in women with AD from the Alzheimer Center of the VU University Medical Center Amsterdam and women without AD. Paper and telephone surveys were performed. Results: The response rate was 85.2%. No relation between women with (n = 104 and without AD (n = 129 reporting pregnancies complicated by hypertensive disorders (p = 0.11 was found. Women with early-onset AD reported hypertensive disorders of pregnancy more often (p = 0.02 compared to women with late-onset AD. Conclusion: A reported history of hypertensive disorders of pregnancy appears not to be associated with AD later in life.

  14. [The recurrence of hypertensive disorders during pregnancy between 34 and 37 weeks of gestation

    NARCIS (Netherlands)

    Oostwaard, M.F. van; Langenveld, J.; Bijloo, R.; Wong, K.M.; Scholten, I.; Loix, S.; Hukkelhoven, C.W.; Vergouwe, Y.; Papatsonis, D.N.; Mol, B.W.; Ganzevoort, W.

    2012-01-01

    OBJECTIVE: To assess the recurrence risk of late preterm hypertensive disease of pregnancy and to determine whether potential risk factors are predictive. DESIGN: Retrospective cohort study. METHODS: Our study cohort included 425 women with a pregnancy-related hypertensive disorder who had delivered

  15. [Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes].

    Science.gov (United States)

    Alvarez-Alvarez, B; Martell-Claros, N; Abad-Cardiel, M; García-Donaire, J A

    Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Cranial Imaging Findings of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    Yusuf Tamam

    2005-01-01

    Full Text Available The aim of this study was to find out the cranial imaging findings of complicated hypertensive disorders of pregnancy. Forty two patients with preeclampsia, eclampsia and HELLP syndrome were admitted to the study at Obstetrics Division of Dicle University from January 2001 to December 2004. Computed Tomography was made to the forty two patients. The Computed Tomograpy findings of 20 (47.62% patients were normal whereas computed Tomograpy findings of 22 (52.28% patients were pathological. Eight patients (19% had intracranial hemorrhage, 5 (11.9 % patients had infarct, 9 (21.42% patients had specific lesions. A wide imaging spectrum from ischemic area to intracranial hemorrhages can be detected in hypertensive disorders of pregnancy. Thus it is essential to make cranial imaging in patients with symptoms and neurological deficit.

  17. Hypertension in Pregnancy and Future Cardiovascular Event Risk in Siblings.

    Science.gov (United States)

    Weissgerber, Tracey L; Turner, Stephen T; Mosley, Thomas H; Kardia, Sharon L R; Hanis, Craig L; Milic, Natasa M; Garovic, Vesna D

    2016-03-01

    Hypertension in pregnancy is a risk factor for future hypertension and cardiovascular disease. This may reflect an underlying familial predisposition or persistent damage caused by the hypertensive pregnancy. We sought to isolate the effect of hypertension in pregnancy by comparing the risk of hypertension and cardiovascular disease in women who had hypertension in pregnancy and their sisters who did not using the dataset from the Genetic Epidemiology Network of Arteriopathy study, which examined the genetics of hypertension in white, black, and Hispanic siblings. This analysis included all sibships with at least one parous woman and at least one other sibling. After gathering demographic and pregnancy data, BP and serum analytes were measured. Disease-free survival was examined using Kaplan-Meier curves and Cox proportional hazards regression. Compared with their sisters who did not have hypertension in pregnancy, women who had hypertension in pregnancy were more likely to develop new onset hypertension later in life, after adjusting for body mass index and diabetes (hazard ratio 1.75, 95% confidence interval 1.27-2.42). A sibling history of hypertension in pregnancy was also associated with an increased risk of hypertension in brothers and unaffected sisters, whereas an increased risk of cardiovascular events was observed in brothers only. These results suggest familial factors contribute to the increased risk of future hypertension in women who had hypertension in pregnancy. Further studies are needed to clarify the potential role of nonfamilial factors. Furthermore, a sibling history of hypertension in pregnancy may be a novel familial risk factor for future hypertension.

  18. DOPPLER ANALYSIS IN PREGNANCY INDUCED HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Tushar

    2014-12-01

    Full Text Available A study of 50 cases was conducted to evaluate the role of Colour Doppler imaging in pregnancy induced hypertension with women over 28 weeks of gestation, the initial scan was performed immediately after the diagnosis of PIH to avoid any influence of treatment on Doppler evaluation. This study was aimed to analyze the blood flow in umbilical artery, maternal uterine artery & fetal middle cerebral artery using Doppler ultrasound.

  19. Pregnancy-induced hypertension in a rat heterogeneity model.

    NARCIS (Netherlands)

    J.W.M. Hutten

    1988-01-01

    textabstractThis thesis presents an approach to develop pregnancy-induced hypertension (PIH) in animals by means of an immunologic model. Hypertensive pregnancy disorders in man may be considered a clinical expression of maladaptation in pregnancy. Maladaptation disease develops early in

  20. Risk of hypertensive disorders in pregnancies following assisted reproductive technology

    DEFF Research Database (Denmark)

    Opdahl, S; Henningsen, A A; Tiitinen, A

    2015-01-01

    STUDY QUESTION: Is the risk of hypertensive disorders in pregnancies conceived following specific assisted reproductive technology (ART) procedures different from the risk in spontaneously conceived (SC) pregnancies? SUMMARY ANSWER: ART pregnancies had a higher risk of hypertensive disorders......, in particular following cryopreservation, with the highest risk seen in twin pregnancies following frozen-thawed cycles. WHAT IS KNOWN ALREADY: The risk of hypertensive disorders is higher in ART pregnancies than in SC pregnancies. The increased risk may be partly explained by multiple pregnancies...... twin pregnancies (46 674). We used logistic regression to estimate adjusted odds ratios and risk differences for hypertensive disorders in pregnancies following IVF, ICSI and fresh or frozen-thawed cycles. We also compared fresh and frozen-thawed cycles within mothers who had conceived following both...

  1. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2015-09-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  2. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  3. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    OpenAIRE

    O. V. Gaisenok; O. A. Zamyatina; N. Yu. Denisova; A. S. Leonov

    2015-01-01

    Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  4. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    OpenAIRE

    O. V. Gaisenok; O. A. Zamyatina; N. Yu. Denisova; A. S. Leonov

    2014-01-01

    Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  5. Pregnancy-related osteoporosis and spinal fractures

    Science.gov (United States)

    Yun, Ka Yeong; Han, Si Eun; Kim, Seung Chul; Lee, Kyu Sup

    2017-01-01

    Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review. PMID:28217686

  6. Coagulation and Fibrinolytic System Protein Profiles in Women with Normal Pregnancies and Pregnancies Complicated by Hypertension.

    Science.gov (United States)

    Hale, Sarah A; Sobel, Burton; Benvenuto, Anna; Schonberg, Adrienne; Badger, Gary J; Bernstein, Ira M

    2012-04-01

    OBJECTIVE: The current study longitudinally evaluated concentrations of fibrinogen (Fib), D-Dimer, plasminogen activator type-1 (PAI-1) and tissue type plasminogen activator (T-Pa) before pregnancy and in the first and third trimesters of pregnancy with a focus on the pregnancy transition. STUDY DESIGN: Twenty healthy, nonsmoking, nulliparous women, aged 29.8 ± 3.0 years, BMI 23.3 ± 3.2 kg/m(2) were studied during menstrual cycle day 8 ± 4 and again in early (11 - 15 wks) and late (31 - 34 wks) pregnancy. Seventeen women had singleton conceptions and delivered at term with uncomplicated pregnancies (CTL) and three women developed complicated hypertension (CH) during pregnancy after the third trimester (late pregnancy) evaluation. Data are means ± SEM, Significance was based on p < 0.05. RESULTS: Fib was the only protein evaluated that increased in early pregnancy relative to the prepregnancy assessment. D-dimer, PAI-1 and T-Pa increased in the third trimester compared with prepregnant and early pregnant values (p < .001). T-PA was significantly higher during late pregnancy in CH subjects compared with CTL (8.1 ± 0.7 ng/ml vs. 5.0 ± 0.2 ng/ml, p = .02). There were no other differences between groups. CONCLUSIONS: Increases in fibrinogen are evident in early pregnancy whereas fibrinolysis, perhaps in response to the procoagulant environment of pregnancy, is increased during late pregnancy. Before development of clinically overt hypertension, T-Pa is increased without concomitant changes in other proteins assessed. This is consistent with altered endothelial function with preeclampsia that may contribute to, or reflect, the vasculopathy accompanying this disorder.

  7. Antidepressant medication and the risk of pregnancy-induced hypertension

    NARCIS (Netherlands)

    Ter Heijne, Loes F.; Zakiyah, Neily; Bos, Jens H.J.; Hak, Eelko; Schuiling-Veninga, Catharina C.M.

    2016-01-01

    Background: Increased activity of the sympatic nervous system could possibly cause pregnancy-induced hypertension (PIH). Previous studies have suggested that antidepressants could contribute to this increased activity. Objectives: To examine whether the use of antidepressants during pregnancy

  8. Quantifying Proteinuria in Hypertensive Disorders of Pregnancy

    Directory of Open Access Journals (Sweden)

    Sapna V. Amin

    2014-01-01

    Full Text Available Background. Progressive proteinuria indicates worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in decision making and treatment planning. Objective. To evaluate the efficacy of spot dipstick analysis and urinary protein-creatinine ratio (UPCR in hypertensive disease of pregnancy for predicting 24-hour proteinuria. Subjects and Methods. A total of 102 patients qualifying inclusion criteria were evaluated with preadmission urine dipstick test and UPCR performed on spot voided sample. After admission, the entire 24-hour urine sample was collected and analysed for daily protein excretion. Dipstick estimation and UPCR were compared to the 24-hour results. Results. Seventy-eight patients (76.5% had significant proteinuria of more than 300 mg/24 h. Dipstick method showed 59% sensitivity and 67% specificity for prediction of significant proteinuria. Area under curve for UPCR was 0.89 (95% CI: 0.83 to 0.95, P<0.001 showing 82% sensitivity and 12.5% false positive rate for cutoff value of 0.45. Higher cutoff values (1.46 and 1.83 predicted heavy proteinuria (2 g and 3 g/24 h, resp.. Conclusion. This study suggests that random urinary protein : creatine ratio is a reliable investigation compared to dipstick method to assess proteinuria in hypertensive pregnant women. However, clinical laboratories should standardize the reference values for their setup.

  9. PLACENTAL PATHOLOGY IN PREGNANCY INDUCED HYPERTENSION

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    Sreechithra

    2014-08-01

    Full Text Available BACKGROUND: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad along with hemorrhage and infection, that results in a large number of maternal deaths and there of fetal deaths. Since all anabolites needed for foetal metabolism come from the mothers blood and foetal catabolites are passed back into the mothers circulation through the placenta, the examination of placenta gives a clear idea of what had happened with it, when it was in the mother, s womb and what is going to happen with the foetus in future. With this objective the present study was carried out. MATERIALS AND METHODS: Retrospective study was done for a period of 21 months from April1st 2008 to December 31st 2009..Fifty mothers with uncomplicated pregnancy (control group and 100 mothers (test group diagnosed as having pregnancy induced hypertension were selected from patients of our institution of the age range from 20-40 years, and parity –primi, para2 and 3.Placental morphometric parameters, gross and histopathological features were examined in both test and control groups. STATISTICAL ANALYSIS USED: Fishers exact test RESULTS: Placental morphometric parameters were significantly reduced in the control group. Acute atherosis, endothelial proliferation and fibrinoid necrosis were the significant histological findings noted in our study. CONCLUSION: Placental findings can be confirmatory of PIH, but its absence does not exclude the diseases. These findings will become more evident only when there is significant reduction in the uteroplacental bloodflow

  10. Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension.

    Science.gov (United States)

    Chandi, Anadeep; Sirohiwal, Daya; Malik, Roopa

    2015-11-01

    Hypertensive diseases are directly responsible for 24 % of maternal deaths in India. A screening method is yet to be discovered to reduce the morbidity and mortality related to it. Serum triglyceride (TG) levels are reported to increase in hypertensive pregnant women. To predict pregnancy-induced hypertension (PIH) by serum triglyceride values. This study is a prospective cohort study that was conducted over three hundred normotensive, primigravida women with singleton pregnancy at 14-20 weeks of gestation. These were divided into two groups on the basis of their TG concentration estimated at 14-20 weeks of gestation. The pregnancy was then followed till delivery and, signs and symptoms of PIH were noted in both the groups. Out of 300 women, 210 women completed the study. Fifty-nine women developed PIH and 151 women remained normotensive. Among 59 women, 45 women had raised TG values i.e., ≥160 mg/dL and 14 women were with normal TG levels i.e., hypertriglyceridemia were found to be at higher risk of developing early-onset PIH. Our study supports the evidence that early pregnancy hypertriglyceridemia is associated with an increased risk of PIH.

  11. Hypertension in pregnancy: A community-based study

    Directory of Open Access Journals (Sweden)

    Bharti Mehta

    2015-01-01

    Full Text Available Background: Hypertensive disorders during pregnancy occur in women with preexisting primary or secondary chronic hypertension, and in women who develop new-onset hypertension in the second half of pregnancy. The present study was undertaken to study the prevalence and correlates of hypertension in pregnancy in a rural block of Haryana. Materials and Methods: This cross-sectional study was carried out in the all 20 subcenters under Community Health Center (CHC Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Appropriate statistical tests were used for analysis. Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Maternal age ΃25 years, gestational period ͳ20 weeks, history of cesarean section, history of preterm delivery, and history of hypertension in previous pregnancy were found to be significantly associated with prevalence of hypertension in pregnancy. Conclusion: Nearly one in 14 pregnant women in rural areas of Haryana suffers from a hypertensive disorder of pregnancy. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

  12. [Hypertension during pregnancy--how to manage effectively?].

    Science.gov (United States)

    Klocek, Marek; Czarnecka, Danuta

    2015-01-01

    Arterial hypertension affects 5-10% of all pregnant women and may be present in women with pre-existing primary or secondary chronic hypertension, and in women who develop newonset hypertension in the second half of pregnancy. Hypertensive disorders during pregnancy carry risks for the woman and the baby. Hypertension in pregnancy is diagnosed when SBP is > or = 140 or/and DBP > or = 90 mmHg. According to the guidelines, the decision to start pharmacological treatment of hypertension in pregnancy depends on the type of hypertension: in pregnancy-induced hypertension, developing after 20 weeks of pregnancy (with or without proteinuria) drug treatment is indicated when BP is > or = 140/90 mmHg, in chronic hypertension observed before pregnancy pharmacotherapy is indicated when BP is > or = 150/95 mmHg. For pregnant women with severe hypertension (> or =160 / 110 mmHg) antihypertensive therapy should be initiated immediately. Oral methyldopa, labetalol, other beta-adrenoreceptor blockers and calcium channel blockers are used most commonly. In pre-eclampsia parental labetalol, nitroglycerine, urapidyl and other drugs may also be needed.

  13. Retinal changes in pregnancy-induced hypertension

    Directory of Open Access Journals (Sweden)

    Akash Pankaj Shah

    2015-01-01

    Full Text Available Aims: The aim was to determine the prevalence of retinal changes in pregnancy-induced hypertension (PIH and any association between the retinal changes and age, parity, blood pressure, proteinuria, and severity of the disease. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: All the patients admitted with a diagnosis of PIH were included in this study. Age, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. Fundus examination was done with a direct ophthalmoscope. The findings were noted and were analyzed using SPSS program. Results: A total of 150 patients of PIH were examined. The mean age of patients was 25.1 years. The gestation period ranged from 27 weeks to 42 weeks; 76 (50.67% were the primi gravida. 92 (61.33% patients had gestational hypertension, 49 (32.67% patients had preeclampsia, and 9 (6% had eclampsia. Retinal changes (hypertensive retinopathy were noted in 18 (12% patients - Grade 1 in 12 (8% and Grade 2 in 6 (4%. Hemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P = 0.037, proteinuria (P = 0.0005, and severity of the PIH (P = 0.004. Conclusions: Retinal changes were seen in 12% of patients with PIH. Occurrence of hypertensive retinopathy in PIH cases has been decreased due to better antenatal care and early detection and treatment of PIH cases. There is a greater chance of developing retinopathy with increase in blood pressure, severity of PIH, and proteinuria in cases of PIH.

  14. Ambient air pollution and pregnancy-induced hypertensive disorders

    DEFF Research Database (Denmark)

    Pedersen, Marie; Stayner, Leslie; Slama, Rémy

    2014-01-01

    to ambient air pollution and pregnancy-induced hypertensive disorders including gestational hypertension and preeclampsia. We searched electronic databases for English language studies reporting associations between ambient air pollution and pregnancy-induced hypertensive disorders published between December.......5), carbon monoxide (CO), ozone (O3), proximity to major roads, and traffic density met our inclusion criteria. Most studies reported that air pollution increased risk for pregnancy-induced hypertensive disorders. There was significant heterogeneity in meta-analysis, which included 16 studies reporting......-analysis combined odds ratio associated with a 5-μg/m3 increase in PM2.5 was 1.57 (95% confidence interval, 1.26-1.96) for combined pregnancy-induced hypertensive disorders and 1.31 (95%confidence interval, 1.14-1.50) for preeclampsia [corrected]. Our results suggest that exposure to air pollution increases...

  15. Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension

    NARCIS (Netherlands)

    Veerbeek, Jan H. W.; Hermes, Wietske; Breimer, Anath Y.; van Rijn, Bas B.; Koenen, Steven V.; Mol, Ben W.; Franx, Arie; de Groot, Christianne J. M.; Koster, Maria P. H.; Koster, M.P.H. (Wendy)

    2015-01-01

    Observational studies have shown an increased lifetime risk of cardiovascular disease (CVD) in women who experienced a hypertensive disorder in pregnancy. This risk is related to the severity of the pregnancy-related hypertensive disease and gestational age at onset. However, it has not been investi

  16. Physical activity, sedentary behavior and risk of hypertensive disorders of pregnancy in Hispanic women.

    Science.gov (United States)

    Chasan-Taber, Lisa; Silveira, Marushka; Pekow, Penelope; Braun, Barry; Manson, JoAnn E; Solomon, Caren G; Markenson, Glenn

    2015-02-01

    Prior studies of the association between physical activity and hypertensive disorders of pregnancy have been conflicting; the majority focused on leisure-time activity only, did not use physical activity questionnaires validated for pregnancy, and were conducted in primarily non-Hispanic white populations. We prospectively evaluated this association among 1240 Hispanic women in Proyecto Buena Salud. The Pregnancy Physical Activity Questionnaire, validated for use in pregnancy, was used to assess pre- and early pregnancy sports/exercise, household/caregiving, occupational and transportation activity. Diagnoses of hypertensive disorders of pregnancy were based on medical record abstraction and confirmed by the study obstetrician. A total of 49 women (4.0%) were diagnosed with a hypertensive disorder of pregnancy, including 32 women (2.6%) with pre-eclampsia. In age-adjusted analyses, high levels of early pregnancy household/caregiving activity were associated with reduced risk of total hypertensive disorders (OR = 0.4, 95% CI 0.1-0.9) and pre-eclampsia (OR = 0.3, 95% CI 0.1-0.9) relative to low levels; however, these findings were no longer statistically significant in multivariable models. Pre-pregnancy activity and pattern of activity from pre- to early-pregnancy were not significantly associated with risk. Finally, sedentary behavior was not significantly associated with hypertensive disorders. Findings from this prospective study of Hispanic women were consistent with those of prior prospective cohorts indicating that physical activity prior to and during early pregnancy does not significantly reduce risk of hypertensive disorders of pregnancy.

  17. Gestational diabetes, pregnancy hypertension, and late vascular disease.

    Science.gov (United States)

    Carpenter, Marshall W

    2007-07-01

    The complexity of the several pathogenic pathways that cause hypertension and vascular disease and the prolonged interval that appears to predate clinical morbidity have hindered inquiry into the association between GDM and vascular disorders. As a forme fruste of later type 2 diabetes, GDM-affected gravidas are identified as at risk of diabetes-related atherosclerosis, glomerular disruption, and pathogenic retinal angio-genesis. That GDM is evidence for underlying chronic conditions such as dysregulation of innate immune response that, independent of the diabetic state, produces vascular disease is difficult state, produces vascular disease is difficult to assert with the present published literature. Cross-sectional studies of patients with established gestational hypertension or preeclampsia are ambiguous as to the possible pathogenic effect of insulin resistance. Cohort studies initiated in early and mid-pregnancy show evidence that both gestational hypertension and preeclampsia may be more prevalent in gravidas with greater insulin resistance. The association of gestational glucose intolerance with gestational hypertension appears to be independent of obesity and ambient glycemia but explained in part by insulin resistance. Late pregnancy preeclampsia is associated with elevated mid-pregnancy BMI, blood pressure, fasting glucose and insulin, urate, and C-reactive protein, suggestive of metabolic and immune dysregulation. GDM appears to be associated with overexpressed innate immune response, which, in turn, is associated with vascular dysfunction and vascular disease. Among women with GDM, markers of insulin resistance do not appear to correlate with hypertension in short-term cohort studies. However, when non-GDM subjects are compared with subjects with GDM, postpregnancy studies do show an associated with vascular dysfunction and vascular disease. Among women with GDM, markers of insulin resistance do not appear to correlate with hypertension in short

  18. Hypertension in pregnancy: natural history and treatment options.

    Science.gov (United States)

    Foo, L; Tay, J; Lees, C C; McEniery, C M; Wilkinson, I B

    2015-05-01

    Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and pre-eclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the aetiology of hypertension in pregnancy have largely been focused on pre-eclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental-derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly pre-eclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarised, with a brief focus on post-partum considerations and long-term health implications. Novel therapeutic options for the management of pre-eclampsia are also explored.

  19. Preeclampsia and hypertensive disease in pregnancy: their contributions to cardiovascular risk.

    Science.gov (United States)

    Valdiviezo, Carolina; Garovic, Vesna D; Ouyang, Pamela

    2012-03-01

    More women than men die each year of cardiovascular disease, which remains the leading cause of death in the United States. Sex-specific factors, including pregnancy-related disorders, should be considered when assessing cardiovascular (CV) risk in women. Hypertensive disorders of pregnancy have been associated with CV risk later in life and may identify women in whom earlier primary prevention may reduce their risk. This article reviews the physiologic changes in blood pressure during pregnancy, current definitions of hypertensive diseases of pregnancy and preeclampsia, and postulated pathophysiologic mechanisms leading to preeclampsia that might contribute to later CV risk. Also summarized are studies providing evidence on the association between hypertensive diseases of pregnancy and future CV risk.

  20. Obesity-Related Hypertension

    OpenAIRE

    Re, Richard N.

    2009-01-01

    Obesity-associated arterial hypertension is characterized by activation of the sympathetic nervous system, activation of the renin-angiotensin system, and sodium retention, among other abnormalities. In this review, the following 3 facets of the obesity/hypertension nexus will be discussed: the potential mechanisms by which obesity can lead to elevated arterial pressure, the interaction of obesity with the sequelae of hypertension, and the therapies that are believed to optimally treat obesit...

  1. Hypertension in pregnancy: a review of therapeutic options.

    Science.gov (United States)

    Kernaghan, D; Duncan, A C; McKay, G A

    2012-06-01

    Hypertensive disorders in pregnancy are common and can occur as a result of pre-existing hypertension or as new onset hypertension usually in the second half of pregnancy. In either situation there is potential for considerable perinatal and maternal morbidity and mortality. This review article aims to compare therapeutic options outlined in a selection of national guidelines and to look in more detail at the most commonly prescribed drugs - labetalol, methyldopa and nifedipine - with respect to their pharmacology and the evidence for their use in pregnancy. We will also consider the rationale for identifying and treating hypertension in pregnancy and the effect this can have on short- and long-term maternal and neonatal outcomes.

  2. Ketanserin and hydralazine in hypertension in pregnancy - a ...

    African Journals Online (AJOL)

    treatment of hypertension in late pregnancy. Study design. ... pressure, maternal and fetal heart rate and umbilical and arcuate artery ... role in the pathophysiology of pre-eclampsia. ... hydralazine and ketanserin and to study their effects on.

  3. Pharmacotherapy of Hypertension in Pregnancy in a Secondary ...

    African Journals Online (AJOL)

    Nigerian Journal of Pharmaceutical Research ... A retrospective study of five years of the management of hypertension in pregnancy at Adeoyo ... Although not statistically significant (P>0.05), patients' response to methyldopa appeared better ...

  4. Hypertensive diseases in pregnancy and breast cancer risk

    OpenAIRE

    Opdahl, S.; Romundstad, P R; Alsaker, M D K; Vatten, L. J.

    2012-01-01

    Background: Hypertensive diseases in pregnancy may be associated with a reduced risk of breast cancer. Most previous studies are small and have shown conflicting results. Methods: In a cohort of 919 712 women who gave their first birth between 1967 and 2008, with linkage of information from two national registries, we assessed whether women with pregnancy hypertensive diseases are at reduced breast cancer risk. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence interva...

  5. Developmental origins of obesity-related hypertension.

    Science.gov (United States)

    Henry, Sarah L; Barzel, Benjamin; Wood-Bradley, Ryan J; Burke, Sandra L; Head, Geoffrey A; Armitage, James A

    2012-09-01

    1. In the past 30 years the prevalence of obesity and overweight have doubled. It is now estimated that globally over 500 million adults are obese and a further billion adults are overweight. Obesity is a cardiovascular risk factor and some studies suggest that up to 70% of cases of essential hypertension may be attributable, in part, to obesity. Increasingly, evidence supports a view that obesity-related hypertension may be driven by altered hypothalamic signalling, which results in inappropriately high appetite and sympathetic nerve activity to the kidney. 2. In addition to the adult risk factors for obesity and hypertension, the environment encountered in early life may 'programme' the development of obesity, hypertension and cardiovascular disease. In particular, maternal obesity or high dietary fat intake in pregnancy may induce changes in fetal growth trajectories and predispose individuals to develop obesity and related sequelae. 3. The mechanisms underlying the programming of obesity-related hypertension are becoming better understood. However, several issues require clarification, particularly with regard to the role of the placenta in transferring fatty acid to the fetal compartment, the impact of placental inflammation and cytokine production in obesity. 4. By understanding which factors are most associated with the development of obesity and hypertension in the offspring, we can focus therapeutic and behavioural interventions to most efficiently reduce the intergenerational propagation of the obesity cycle.

  6. Body Mass Index, Smoking and Hypertensive Disorders during Pregnancy: A Population Based Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Thuridur A Gudnadóttir

    Full Text Available While obesity is an indicated risk factor for hypertensive disorders of pregnancy, smoking during pregnancy has been shown to be inversely associated with the development of preeclampsia and gestational hypertension. The purpose of this study was to investigate the combined effects of high body mass index and smoking on hypertensive disorders during pregnancy. This was a case-control study based on national registers, nested within all pregnancies in Iceland 1989-2004, resulting in birth at the Landspitali University Hospital. Cases (n = 500 were matched 1:2 with women without a hypertensive diagnosis who gave birth in the same year. Body mass index (kg/m2 was based on height and weight at 10-15 weeks of pregnancy. We used logistic regression models to calculate odds ratios and corresponding 95% confidence intervals as measures of association, adjusting for potential confounders and tested for additive and multiplicative interactions of body mass index and smoking. Women's body mass index during early pregnancy was positively associated with each hypertensive outcome. Compared with normal weight women, the multivariable adjusted odds ratio for any hypertensive disorder was 1.8 (95% confidence interval, 1.3-2.3 for overweight women and 3.1 (95% confidence interval, 2.2-4.3 for obese women. The odds ratio for any hypertensive disorder with obesity was 3.9 (95% confidence interval 1.8-8.6 among smokers and 3.0 (95% confidence interval 2.1-4.3 among non-smokers. The effect estimates for hypertensive disorders with high body mass index appeared more pronounced among smokers than non-smokers, although the observed difference was not statistically significant. Our findings may help elucidate the complicated interplay of these lifestyle-related factors with the hypertensive disorders during pregnancy.

  7. Hypertensive disorders of pregnancy, respiratory outcomes and atopy in childhood.

    Science.gov (United States)

    Shaheen, Seif O; Macdonald-Wallis, Corrie; Lawlor, Debbie A; Henderson, A John

    2016-01-01

    Few epidemiological studies have investigated the role of hypertensive disorders of pregnancy in the aetiology of childhood respiratory and atopic outcomes.In the Avon Longitudinal Study of Parents and Children we examined associations of maternal gestational hypertension, hypertension before pregnancy and pre-eclampsia with wheezing at 18 months, wheezing and asthma at 7 years and lung function at 8-9 years, after controlling for potential confounders (n=5322-8734, depending on outcome).Gestational hypertension was not associated with any of the outcomes. There was weak evidence for a positive association between pre-eclampsia and early wheezing (adjusted OR 1.31, 95% CI 0.94-1.82, compared to normotensive pregnancies) and for negative associations between pre-eclampsia and forced expiratory volume in 1 s (adjusted mean difference in sd score -0.14, 95% CI -0.33-0.06) and maximal mid-expiratory flow (-0.15, 95% CI -0.34-0.04). Hypertension before pregnancy was positively associated with wheezing (OR 1.63, 95% CI 1.16-2.31) and asthma (OR 1.34, 95% CI 1.00-1.79).Gestational hypertension is unlikely to be a risk factor for childhood respiratory disorders; hypertension before pregnancy may be a risk factor for childhood wheezing and asthma, but this finding needs replication. Larger studies are needed to confirm whether pre-eclampsia is associated with impaired childhood lung function.

  8. Pulmonary Hypertension in Pregnancy: Critical Care Management

    OpenAIRE

    Bassily-Marcus, Adel M.; Carol Yuan; John Oropello; Anthony Manasia; Roopa Kohli-Seth; Ernest Benjamin

    2012-01-01

    Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Im...

  9. Endogenous Ouabain in Hypertensive Disorder Complicating Pregnancy

    Institute of Scientific and Technical Information of China (English)

    WU Li; XIONG Chengliang; SU Ping

    2007-01-01

    Expression of endogenous ouabain in placenta and the concentrations of serum ET-1 and NO were examined in 30 patients with hypertensive disorder complicating pregnancy (HDCP) and 30 healthy pregnant women to investigate the effect of endogenous ouabain on HDCP. Compared with the healthy pregnant group, the expression of endogenous ouabain dramatically increased in the HDCP groups (P<0.01). There was a significantly positive correlation between the expression of en- dogenous ouabain with ET-1 (r=0.5567, P<0.01), while the correlation of endogenous ouabain and NO was significantly negative (r=-0.6895, P<0.01). As expected, the correlation between ET-1 and NO was negative (r=-0.7796, P<0.01). ET-1 concentrations of maternal and cord sera in HDCP groups were significantly higher in comparison with healthy pregnant group (P<0.01). On the con- trast, NO concentrations were much lower in the maternal and cord sera of HDCP groups as com- pared with healthy pregnant group (P<0.01). Our data suggest that endogenous ouabain is directly involved in the nosogenesis of HDCP, with accompanying decreased NO and the elevated of ET-1.

  10. Severe hypertension in pregnancy: Using dynamic checklists to save lives.

    Science.gov (United States)

    Moodley, Jack; Ngene, N C

    2016-07-01

    Severe hypertension is a major cause of morbidity and mortality. The South African Saving Mothers report (2011 - 2013) indicates that cerebral injury due to severe hypertension is resulting in avoidable maternal deaths. This demands that management of severe hypertension in pregnancy needs to be improved. A rapid-acting antihypertensive is recommended for the initial management of severe hypertension during pregnancy. A single dose of a rapid-acting agent may be ineffective, in which case incremental doses of the same medication or another antihypertensive may be required for adequate blood pressure control. To ensure that appropriate antihypertensives at the correct doses are administered, the use of a guideline in a dynamic checklist format is advocated and discussed in this article. It is envisaged that the use of dynamic checklists will be valuable to all healthcare professionals providing care during pregnancy and the puerperium.

  11. Magnesium supplement in pregnancy-induced hypertension. A clinicopathological study

    DEFF Research Database (Denmark)

    Rudnicki, M; Junge, Jette; Frølich, A;

    1990-01-01

    The placenta and the umbilical cord obtained from 18 women with pregnancy-induced hypertension were investigated by light microscopy. The umbilical artery was studied by electron microscopy. 10 placentae and umbilical cords from normal pregnancies served as controls. The study was performed...... fibrosis or intervillous fibrin. Ultrastructurally, the endothelial cells of the umbilical arteries from women with pregnancy-induced hypertension showed a significant increase in the amount of dilated endoplasmic reticulum and basal laminae thickness when all 18 cases were compared with the controls....... There was no significant difference when the magnesium group, the placebo group and the control group were compared separately. The present study suggests that magnesium supplement has a beneficial effect on fetal growth in pregnancy-induced hypertension. With regard to the light and electron microscopic changes we were...

  12. Associations between Ambient Air Pollution and Hypertensive Disorders of Pregnancy

    Science.gov (United States)

    Mobasher, Zahra; Salam, Muhammad T.; Goodwin, T. Murphy; Lurmann, Frederick; Ingles, Sue A.; Wilson, Melissa L.

    2015-01-01

    Background Exposure to ambient air pollution is linked to adverse pregnancy outcomes. Previous reports examining the relationship between ambient air pollution and Hypertensive Disorders of Pregnancy have been inconsistent. Objectives We evaluated the effects of ambient air pollution on the odds of Hypertensive Disorder of Pregnancy and whether these associations varied by body mass index (BMI). Methods We conducted a retrospective, case-control study among 298 predominantly Hispanic women (136 clinically-confirmed cases) who attended the Los Angeles County + University of Southern California Women’s and Children’s Hospital during 1996–2008. Trimester-specific carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and particulate matter with aerodynamic diameter <10µm and <2.5µm (PM10, PM2.5) exposure were estimated based on 24-hr exposure level at residential address. Logistic regression models were fitted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for 2 standard deviation increase in exposure levels. Results Exposures to CO and PM2.5 in the first trimester were significantly associated with Hypertensive Disorders of Pregnancy, and these associations were modified by BMI. In non-obese women (BMI <30), first trimester exposures to PM2.5 and CO were significantly associated with increased odds of Hypertensive Disorder of Pregnancy (ORs per 2-standard deviation increase in PM2.5 (7µg/m3) and CO (1ppm) exposures were 9.10 [95% CI: 3.33–24.6] and 4.96 [95% CI: 1.85–13.31], respectively). Additionally, there was a significantly positive association between exposure to O3 in the second trimester and Hypertensive Disorder of Pregnancy (OR per 15ppb=2.05; 95% CI: 1.22–3.46). Conclusion Among non-obese women, first trimester exposure to PM2.5 and carbon monoxide are associated with increased odds of Hypertensive Disorder of Pregnancy. PMID:23522615

  13. E1. Risk of chronic hypertension in women with a history of hypertensive disorders of pregnancy - a nationwide cohort study

    DEFF Research Database (Denmark)

    Behrens, I; Basit, S; Melbye, M;

    2016-01-01

    BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are known to have an increased risk of hypertension years after their pregnancy. However, how soon after an affected pregnancy the risk of hypertension increases and how/whether this risk evolves over time, is unclear....... METHOD: Using national health register data, we identified all women giving birth in Denmark from 1978 to 2011. Cox regression analysis was used to compare the rates of incident post-pregnancy hypertension requiring treatment with medication after pregnancy in women with and without a history of HDP......, by the number of years since pregnancy. FINDINGS: In the first 3 years after a woman's latest pregnancy, rates of chronic hypertension were 4- to 9-fold higher in women with an HDP in that pregnancy than in women with a normotensive pregnancy. The difference in rates between the two groups declined...

  14. The study of serum calcium and serum magnesium in pregnancy induced hypertension and normal pregnancy

    Directory of Open Access Journals (Sweden)

    Jagannath Pairu

    2015-02-01

    Full Text Available Background: Preeclampsia along with its complications is one of the major causes of maternal and fetal mortality and morbidity. Association of calcium and magnesium with pregnancy induced hypertension is known since decades. Evidence of decreased serum calcium and decreased serum magnesium has been observed in patients with pregnancy induced hypertension and has been implicated in the etiopathogenesis of preeclampsia. Methods: The present study was undertaken in 100 pregnant women. Data for the study was collected from 50 normotensive pregnant women with more than 20 weeks of gestational age (control group and 50 pregnancy induced hypertension patients (study group attending for the antenatal care in department of obstetrics and gynaecology in Vanivilas hospital, Bowring and Lady Curzon hospital attached to Bangalore medical college and research institute. Cases and controls were matched. Serum calcium and serum magnesium levels were estimated by spectrophotometry method. Results: The mean serum calcium is significantly lower in pregnancy induced hypertension group (8.15 +/- 0.37 mg/dl compared to normal pregnancy (9.16 +/- 0.82 mg/dl. The mean serum magnesium is lower in pregnancy induced hypertension group (1.78 +/- 0.70 mEq/L than normal pregnancy (2.08 +/- 0.46 mEq/L which is moderately significant. Conclusions: The serum calcium and serum magnesium levels are decreased in pregnancy induced hypertension patients compared to normotensive normal pregnant women, suggesting the possible role of calcium and magnesium in etiopathophysiology of pregnancy induced hypertension. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 30-34

  15. [Hypertension in the course of primary aldosteronism during pregnancy].

    Science.gov (United States)

    Wyskida, Magdalena; Wyskida, Katarzyna; Olszanecka-Glinianowicz, Magdalena; Maruniak-Chudek, Iwona; Sikora, Jerzy; Chudek, Jerzy

    2015-02-15

    Hypertension is one of the most common cardiovascular diseases during pregnancy. Primary hyperaldosteronism (PHA) is the most frequent endocrinological, secondary cause of hypertension, rarely diagnosed in pregnant women. In the available literature about 50 cases of PHA in pregnant women have been described. PHA is often a cause of resistant hypertension. PHA can cause life-threatening complications both for the pregnant woman and the fetus. Diagnosis of PHA in pregnancy is difficult due to the antagonistic effect of progesterone on aldosterone, physiological increase of aldosterone release during gestation and frequent normokalaemic clinical course. Typical pharmacological treatment of PHA is limited due to the anti‑androgenic effect of spironolactone, lack of data concerning the safety of eplerenone and limited access to amiloride in Poland. Surgical treatment is a therapeutic option only in early pregnancy. This paper presents the current state of knowledge on diagnostic methods and treatment of PHA in pregnant women and a systematic review of cases described in the literature.

  16. Intravenous Epoprostenol for Management of Pulmonary Arterial Hypertension during Pregnancy

    Directory of Open Access Journals (Sweden)

    Julia Timofeev

    2013-10-01

    Full Text Available Background - Pulmonary arterial hypertension carries a high risk of mortality in pregnancy. Recent advances in treatment may improve disease course and allow for successful management of the pregnancy. Case Report - We present the case of a 20-year-old gravida 1, para 0 with diagnosis of severe primary pulmonary hypertension. The patient was managed with epoprostenol (prostacyclin infusion via an indwelling catheter, which was initiated at 23 weeks' gestation. The dose was adjusted to the patient's symptoms and a successful vaginal delivery was achieved at 36 weeks' gestation. Although maternal postpartum course was uncomplicated, unexplained neonatal demise occurred at 11 days of life. Conclusion - Successful management of pulmonary hypertension in pregnancy can be accomplished with a multidisciplinary approach and intensive therapy. Long-term effects of epoprostenol on fetal or neonatal well-being are unknown.

  17. Intravenous Epoprostenol for Management of Pulmonary Arterial Hypertension during Pregnancy.

    Science.gov (United States)

    Timofeev, Julia; Ruiz, George; Fries, Melissa; Driggers, Rita W

    2013-10-01

    Background Pulmonary arterial hypertension carries a high risk of mortality in pregnancy. Recent advances in treatment may improve disease course and allow for successful management of the pregnancy. Case Report We present the case of a 20-year-old gravida 1, para 0 with diagnosis of severe primary pulmonary hypertension. The patient was managed with epoprostenol (prostacyclin) infusion via an indwelling catheter, which was initiated at 23 weeks' gestation. The dose was adjusted to the patient's symptoms and a successful vaginal delivery was achieved at 36 weeks' gestation. Although maternal postpartum course was uncomplicated, unexplained neonatal demise occurred at 11 days of life. Conclusion Successful management of pulmonary hypertension in pregnancy can be accomplished with a multidisciplinary approach and intensive therapy. Long-term effects of epoprostenol on fetal or neonatal well-being are unknown.

  18. Does a history of hypertensive disorders of pregnancy help predict future essential hypertension? Findings from a prospective pregnancy cohort study.

    Science.gov (United States)

    Callaway, L K; Mamun, A; McIntyre, H D; Williams, G M; Najman, J M; Nitert, M D; Lawlor, D A

    2013-05-01

    Hypertensive disorder of pregnancy (HDP) is considered an important determinant in the prediction of future hypertension. The aim of this study is to examine whether HDP improves prediction of future hypertension, over prediction based on established risk factors measured during pregnancy. We used a community based cohort study of 2117 women who received antenatal care at a major hospital in Brisbane between 1981 and 1983 and had blood pressure assessed 21 years after the index pregnancy. Of these 2117 women, 193 (9.0%) experienced HDP and 345 (16.3%) had hypertension at 21 years postpartum. For women with HDP, the odds of being hypertensive at 21 years postpartum were 2.46 (95% CI 1.70, 3.56), adjusted for established risk factors including age, education, race, alcohol, cigarettes, exercise and body mass index. Addition of HDP did not improve the prediction model that included these established risk factors, with the area under the curve of receiver operator (AUROC) increasing from 0.710 to 0.716 (P-value for difference in AUROC=0.185). Our findings suggest that HDP is strongly and independently associated with future hypertension, and women who experience this condition should be counselled regarding lifestyle modification and careful ongoing blood pressure monitoring. However, the development of HDP during pregnancy does not improve our capacity to predict future hypertension, over risk factors identifiable at the time of pregnancy. This suggests that counseling regarding lifestyle modification and ongoing blood pressure monitoring might reasonably be provided to all pregnant and postpartum women with identifiable risk factors for future hypertension.

  19. Previous Heart Disease Complications And Hypertension In Pregnancy

    Directory of Open Access Journals (Sweden)

    Nayer Pishnamaz

    2013-05-01

    Full Text Available Objective(sHypertensive disorders in pregnancy with incidence of 3/7% are one of the most severe complications. Cardiovascular diseases are apparent in 2% of the pregnancies. Physiologic changes during pregnancy intensify the underlying disorders and the severity of this problem. Researches indicate that pregnant women with heart disease greatly confront unfavorable maternal and fetal outcomes with increased risk of abortion, intra uterine fetal death, preterm labor and intra uterine growth retardation. This study aim was to magnify the outcomes of pregnancy accompaniment with cardiovascular diseases and hypertension.Materials and Methods: This is a retrospective descriptive study in which patient records of 2500 pregnant women referring to Alzahra hospital from 2006 to 2008 were assessed. Data was gatherated by medical files and analyzed by SPSS soft ware.Results: In this study incidence of moderate Aorta Stenosis (AS was about 45.5 % (10cases, Mitral valvuloplasty (MVP was about 22/73% (5cases and Mitral stenosis (MS was 18/18% (4 cases; two patient with MR(mitral regurgitation+MS had underwent valvuloplasty. 72/7% (16 of the mothers were hospitalized due to hypertension, 9/1% due to tachycardia and dyspnea and 18/2% showed mixed form of theses complains. They were using hydralazine and methyldopa as anti hypertensive drugs. Only 10% of the patients had history of anticoagulant using during pregnancy. We found only one patient with pulmonary stenosis (PS in these patients.Conclusion: Women with hypertension and previous heart disease showed many serious complications and high fetal mortality during pregnancy. Proper and on time care giving and support during pregnancy is dependent on the accurate diagnosis of the heart disease; any health problem should be seriously noted.

  20. Pulmonary Hypertension in Pregnancy: Critical Care Management

    Directory of Open Access Journals (Sweden)

    Adel M. Bassily-Marcus

    2012-01-01

    Full Text Available Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

  1. Hypertension complicating diabetic pregnancies: pathophysiology, management, and controversies.

    Science.gov (United States)

    Sullivan, Shannon D; Umans, Jason G; Ratner, Robert

    2011-04-01

    Hypertensive disorders of pregnancy (HDP), including pre-existing hypertension, gestational hypertension, and preeclampsia, further complicate already high-risk pregnancies in women with diabetes mellitus (DM). Women with both pre-existing and gestational diabetes are at increased risk for HDP, leading to higher maternal and fetal morbidity. Further, particularly in diabetic women and women with a history of gestational diabetes, HDP significantly increases the risk for future cardiovascular events. For clinicians, women with hypertension and diabetes during pregnancy pose a management challenge. Specifically, preconception management should stress strict control of glycemia, blood pressure, and prevention of diabetic complications, specifically nephropathy, which specifically increases the risk for preeclampsia. During gestation, clinicians must be aware of potential maternal and fetal complications associated with various anti-hypertensive therapies, including known fetotoxicity of ACE inhibitors and ARBs when given in the 2nd or 3rd trimester, and the risks and benefits of expectant management versus delivery in cases of severe gestational hypertension or preeclampsia. Indeed, diabetic women must be followed closely prior to conception and throughout gestation to minimize the risk of HDP and its associated complications. © 2011 Wiley Periodicals, Inc.

  2. Specialized Diagnostic Investigations to Assess Ocular Status in Hypertensive Diseases of Pregnancy

    Directory of Open Access Journals (Sweden)

    Rahul Navinchandra Bakhda

    2016-04-01

    Full Text Available This review describes specialized diagnostic investigations to assess ocular status in hypertensive diseases of pregnancy. Ocular assessment can aid in early detection for prompt multidisciplinary treatment, obstetric intervention and follow-up. The investigations accurately predict the possible causes of blindness in hypertensive diseases of pregnancy. The investigations include fluorescein angiography, ophthalmodynamometry, fluorophotometry, imaging modalities, OCT, ultrasonography, doppler velocimetry and blood chemistry analysis. The review includes a summary of imaging techniques and related recent developments to assess the neuro-ophthalmic aspects of the disease. The imaging modalities have been instrumental in understanding the complex neuropathophysiological mechanisms of eclamptic seizures. The importance of blood chemistry analysis in hypertensive diseases of pregnancy has been emphasized. The investigations have made a significant contribution in improving the standards of antenatal care and reducing maternal and fetal morbidity and mortality.

  3. [Arterial hypertension during pregnancy: Always preeclampsia?

    Science.gov (United States)

    Torres-Courchoud, I; Alastrue-Del Castaño, V; Cebollada-Del Hoyo, J; Bielsa-Rodrigo, M A; Sancho-Serrano, M A

    Cushing's syndrome is a rare condition during pregnancy, but it is associated with serious maternal and fetal complications. The most common etiology during pregnancy is the presence of an adrenocortical adenoma. Urinary free cortisol over 3 times the upper limit of normal usually indicates Cushing's syndrome during pregnancy. The treatment of choice is surgical, and the ideal time for surgery is before the third trimester. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Magnesium supplement in pregnancy-induced hypertension. A clinicopathological study

    DEFF Research Database (Denmark)

    Rudnicki, M; Junge, Jette; Frølich, A

    1990-01-01

    The placenta and the umbilical cord obtained from 18 women with pregnancy-induced hypertension were investigated by light microscopy. The umbilical artery was studied by electron microscopy. 10 placentae and umbilical cords from normal pregnancies served as controls. The study was performed...... weight and placental weight significantly. Light microscopic study of the placentae and the umbilical cord arteries showed no difference between the three groups concerning the occurrence of infarctions, cytotrophoblastic hyperplasia, vasculo-syncytial membranes, basement membrane thickening, stromal...... fibrosis or intervillous fibrin. Ultrastructurally, the endothelial cells of the umbilical arteries from women with pregnancy-induced hypertension showed a significant increase in the amount of dilated endoplasmic reticulum and basal laminae thickness when all 18 cases were compared with the controls...

  5. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014.

    Science.gov (United States)

    Lowe, Sandra A; Bowyer, Lucy; Lust, Karin; McMahon, Lawrence P; Morton, Mark; North, Robyn A; Paech, Michael; Said, Joanne M

    2015-10-01

    This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.

  6. Hypertensive disorders in pregnancy and cognitive decline in the offspring up to old age

    Science.gov (United States)

    Tuovinen, Soile; Kajantie, Eero; Henriksson, Markus; Leskinen, Jukka T.; Pesonen, Anu-Katriina; Heinonen, Kati; Lahti, Jari; Pyhälä, Riikka; Alastalo, Hanna; Lahti, Marius; Osmond, Clive; Barker, David J.P.; Eriksson, Johan G.

    2012-01-01

    Objective: We tested whether maternal hypertensive disorders in pregnancy predict age-related change in cognitive ability in the offspring up to old age. Methods: Using mothers' blood pressure and urinary protein measurements from the maternity clinics and birth hospitals, we defined normotensive or hypertensive pregnancies in mothers of 398 men, who participated in the Helsinki Birth Cohort 1934–1944 Study. The men underwent the Finnish Defence Forces basic ability test twice: first during compulsory military service at age 20.1 (SD = 1.4) years and then in a retest at age 68.5 (SD = 2.9) years. The test yields a total score and subscores for tests measuring verbal, arithmetic, and visuospatial reasoning. Results: Men born after pregnancies complicated by a hypertensive disorder, compared with men born after normotensive pregnancies, scored 4.36 (95% confidence interval, 1.17–7.55) points lower on total cognitive ability at 68.5 years and displayed a greater decline in total cognitive ability (2.88; 95% confidence interval, 0.07–5.06) after 20.1 years. Of the subscores, associations were strongest for arithmetic reasoning. Conclusion: Maternal hypertensive disorders in pregnancy predict lower cognitive ability and greater cognitive decline up to old age. A propensity to lower cognitive ability and decline up to old age may have prenatal origins. PMID:23035059

  7. Circulating and Vascular Bioactive Factors during Hypertension in Pregnancy.

    Science.gov (United States)

    Tanbe, Alain F; Khalil, Raouf A

    2010-03-01

    Normal pregnancy is associated with significant vascular remodeling in the uterine and systemic circulation in order to meet the metabolic demands of the mother and developing fetus. The pregnancy-associated vascular changes are largely due to alterations in the amount/activity of vascular mediators released from the endothelium, vascular smooth muscle and extracellular matrix. The endothelium releases vasodilator substances such as nitric oxide, prostacyclin and hyperpolarizing factor as well as vasoconstrictor factors such as endothelin, angiotensin II and thromboxane A(2). Vascular smooth muscle contraction is mediated by intracellular free Ca(2+) concentration ([Ca(2+)](i)), and [Ca(2+)](i) sensitization pathways such as protein kinase C, Rho-kinase and mitogen-activated protein kinase. Extracellular matrix and vascular remodeling are regulated by matrix metalloproteases. Hypertension in pregnancy and preeclampsia are major complications and life threatening conditions to both the mother and fetus, precipitated by various genetic, dietary and environmental factors. The initiating mechanism of preeclampsia and hypertension in pregnancy is unclear; however, most studies have implicated inadequate invasion of cytotrophoblasts into the uterine artery, leading to reduction in the uteroplacental perfusion pressure and placental ischemia/hypoxia. This placental hypoxic state is thought to induce the release of several circulating bioactive factors such as growth factor inhibitors, anti-angiogenic proteins, inflammatory cytokines, reactive oxygen species, hypoxia-inducible factors, and vascular receptor antibodies. Increases in the plasma levels and vascular content of these factors during pregnancy could cause an imbalance in the vascular mediators released from the endothelium, smooth muscle and extracellular matrix, and lead to severe vasoconstriction and hypertension. This review will discuss the interactions between the various circulating bioactive factors and

  8. Advice on exercise for pregnant women with hypertensive disorders of pregnancy.

    Science.gov (United States)

    Chawla, Shalini; Anim-Nyame, Nick

    2015-03-01

    Reports on advice about exercise for women with hypertensive disorders of pregnancy are reviewed and how exercise could influence long-term cardiovascular risk is assessed. Exercise in pregnancy seems to be beneficial in pregnancies complicated by hypertension. However, the intensity of the exercise to be recommended remains unclear. Further research is required to inform national and international guidelines for women who develop hypertension during pregnancy.

  9. HYPERTENSION IN PREGNANCY: A STUDY IN A TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Shiva

    2016-05-01

    Full Text Available BACKGROUND In pregnant women, hypertension is one of the common causes of mortality and morbidity in Indian women. METHODS We conducted a study on four hundred and sixteen pregnant women consisting of 202 primigravidae, 148 gravidae 2 and 66 multigravidae. We screened these pregnant women for hypertension between January 2015 to July 2015 at Kamineni Institute of Medical Sciences and Fathima Institute of Medical Sciences(FIMS, which are tertiary care hospitals catering most of the rural areas of Hyderabad & Kadapa Districts. RESULT Hypertension was noted in 34 (8.2% of pregnant women. Majority of pregnant women in the study population were primigravidae (48.56%. Nearly 80% of hypertensive pregnant women were primigravidae. 88.24% developed hypertension in III trimester. Complication like preeclampsia was seen in 23.52%. CONCLUSION We conclude that pregnancy-induced hypertension is the common variety of hypertension in pregnant women. It is commonly seen in primigravidae who are exposed to the trophoblastic tissue for the first time.

  10. Associations of maternal and paternal blood pressure patterns and hypertensive disorders during pregnancy with childhood blood pressure

    NARCIS (Netherlands)

    K. Miliku (Kozeta); N.E. Bergen (Nienke); H. Bakker (Hanneke); A. Hofman (Albert); E.A.P. Steegers (Eric); R. Gaillard (Romy); V.W.V. Jaddoe (Vincent)

    2016-01-01

    textabstractBackground-Hypertensive disorders in pregnancy may affect the cardiovascular risk of offspring. We examined the associations of maternal blood pressure throughout pregnancy and hypertensive disorders in pregnancy with childhood blood pressure of offspring. Specific focus was on the

  11. Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question).

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Loi, Valentina; Gerbino, Martina; Biolcati, Marilisa; Pani, Antonello; Todros, Tullia

    2016-04-01

    Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3%, while the prevalence of chronic hypertension is about 5-8%. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.

  12. Validation of hospital discharge diagnoses for hypertensive disorders of pregnancy

    DEFF Research Database (Denmark)

    Møller Luef, Birgitte; Andersen, Louise B; Renault, Kristina Martha

    2016-01-01

    by discharge diagnosis was 55.8%; severe preeclampsia 18.6%; gestational hypertension 39.1%. Corresponding positive predictive values were 80.5, 92.9 and 29.0%. Misclassification occurred in 4.3, 2.7 and 3.3%, respectively. Misclassification was more prevalent in obese compared to lean women (10% vs. 3.6%, p...... obese preeclamptic women. These findings depict the limitations associated with the direct use of discharge diagnoses...... of hypertensive disorders in pregnancy for research purposes....

  13. Successful pregnancy in pulmonary arterial hypertension associated with systemic lupus erythematosus: a case report

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    Streit Michael

    2009-06-01

    Full Text Available Abstract Introduction Pulmonary arterial hypertension is a complication of systemic lupus erythematosus. Mortality in pregnant patients with pulmonary arterial hypertension related to connective tissue disease is as high as 56%. The authors report the first case of a successful maternal-fetal outcome in a pregnant patient with systemic lupus erythematosus-associated pulmonary arterial hypertension treated with sildenafil and inhaled iloprost during pregnancy and until several weeks after caesarean section. Case presentation The case presented is of a 29-year-old woman with systemic lupus erythematosus and associated severe pulmonary arterial hypertension. Vasodilator therapy with bosentan and sildenafil, immunosuppressive therapy with prednisone, hydroxychloroquine and azathioprine and oral anticoagulation (phenprocoumon had normalized her right ventricular over right atrial pressure when she was diagnosed in her 5th week of pregnancy. The teratogenic drugs bosentan and phenprocoumon were stopped, the latter replaced by low molecular weight heparin. During the 35th week, a slight increase in pulmonary pressure was found. Therapy with inhaled iloprost was established. A caesarean section was performed in the 37th week and a healthy baby was delivered. The patient remained stable until 11 weeks after delivery, when an increase in right ventricular over right atrial pressure was noted. Bosentan was reintroduced and prednisone and azathioprine doses were increased. The patient has remained stable until the present time. Conclusion Pulmonary arterial hypertension has been considered a contraindication for pregnancy. Novel vasodilator therapy, combined with immunosuppressants in this patient with systemic lupus erythematosus, may "cure" pulmonary arterial hypertension and permit pregnancy with successful outcome. However, postpartum exacerbation of systemic lupus erythematosus and pulmonary arterial hypertension have to be considered.

  14. A review of oral labetalol and nifedipine in mild to moderate hypertension in pregnancy.

    Science.gov (United States)

    Clark, Shannon M; Dunn, Holly E; Hankins, Gary D V

    2015-11-01

    Hypertension is the most commonly encountered medical condition in pregnancy, contributing significantly to maternal and perinatal morbidity and mortality. Mild to moderate hypertension in pregnancy is defined as systolic blood pressure of 140-159 mmHg or diastolic blood pressure of 90-109 mmHg (7-9% of pregnancies). When treating hypertension in pregnancy, not only do physiologic changes of pregnancy have an effect on the pharmacokinetics and pharmacodynamics of the drugs used, but the pathophysiology of hypertensive disorders of pregnancy also have an effect. To date, evidence is lacking on the pharmacokinetics and pharmacodynamics of commonly used antihypertensive drugs, which often times leads to suboptimal treatment of hypertensive pregnant women. When considering which agents to use for treatment of mild to moderate hypertension, specifically in gestational and chronic hypertension, oral labetalol and nifedipine are valid options. An overview of the profile for use, safety, and current pharmacokinetic data for each agent is presented here.

  15. Clinical assessment of retinopathy post management of pregnancy induced hypertension

    Directory of Open Access Journals (Sweden)

    Rahul Navinchandra Bakhda

    2015-07-01

    Full Text Available Pregnancy induced hypertension (PIH is a multi-system disorder and common complication occurring during pregnancy responsible for maternal and fetal mortality and morbidity. PIH also exerts its influence on the eye and visual pathways. Common ocular symptoms being blurring of vision, photopsias, scotomas, diplopia and in severe cases blindness. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent PIH and its complications. The review discusses the after effects of medical management of PIH on the retina.

  16. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension

    NARCIS (Netherlands)

    Visser, V. S.; Hermes, W.; Franx, A.; Koopmans, C. M.; van Pampus, M. G.; Mol, B. W.; de Groot, C. J. M.

    2013-01-01

    Objectives: Hypertension in pregnancy is associated with cardiovascular disease (CVD) later in life. Blood pressure monitoring in women who experienced hypertension in pregnancy after puerperium has been suggested to be important for early detection and prevention of CVD. The aim of this study is to

  17. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension

    NARCIS (Netherlands)

    Visser, V. S.; Hermes, W.; Franx, A.; Koopmans, C. M.; van Pampus, M. G.; Mol, B. W.; de Groot, C. J. M.

    2013-01-01

    Objectives: Hypertension in pregnancy is associated with cardiovascular disease (CVD) later in life. Blood pressure monitoring in women who experienced hypertension in pregnancy after puerperium has been suggested to be important for early detection and prevention of CVD. The aim of this study is to

  18. Hypertension, pre-eclampsia and eclampsia: Monitoring and outcome of pregnancy

    Directory of Open Access Journals (Sweden)

    Grujić Ilija

    2006-01-01

    Full Text Available Introduction. Pregnancy-induced hypertension, pre-eclampsia and eclampsia are parts of the hypertensive syndrome which is a life-threatening condition both for mother and fetus. Apart from being associated with unpredictable onset, it is incurable, except by ending the pregnancy. Its incidence is approximately between 6 - 10% of pregnant women. There is no unique definition and classification of the hypertensive syndrome in pregnancy, i.e. they differ from one expert group to another. Risks of pregnancy-induced hypertension. Pregnancy-induced hypertension syndrome can cause placental abruption, intracranial hemorrhage, liver lesions, acute renal disorders and disseminated intravascular coagulation (DIC, adult respiratory distress syndrome (ARDS, hypervolemia and inhalation of gastric content, due to deep sedation. Treatment of pregnancy-induced hypertension. Delivery is always appropriate therapy for the mother, but may not be a good solution for the fetus. Standard treatment of pre-eclampsia includes: anticonvulsive therapy, antihypertensive therapy, excessive fluid administration, and if necessary, management of oliguria, DIC, pulmonary edema and recovery of liver function. The outcome of pregnancy-induced hypertension (perinatal and maternal mortality. Maternal mortality due to pregnancy-induced hypertension is 15 - 33% out of the total number of maternal deaths. Newborn infants of mothers with pregnancy-induced hypertension present with intrauterine growth retardation, prematurity, dysmaturity and necrotizing enterocolitis. Pregnancy-induced hypertension is one of the major causes of maternal and fetal/neonatal morbidity and mortality. .

  19. The Effect of Early Excessive Weight Gain on the Development of Hypertension in Pregnancy.

    Science.gov (United States)

    Ruhstaller, Kelly E; Bastek, Jamie A; Thomas, Ann; Mcelrath, Thomas F; Parry, Samuel I; Durnwald, Celeste P

    2016-10-01

    hypertension even after adjusting for relevant confounders (12.5 vs. 8.6%; p = 0.02; adjusted odds ratio [OR] = 1.70; 95% confidence interval [CI]: 1.18-2.44; p < 0.01). Obese women had a 2.4-fold increased risk of developing hypertension, even after controlling for excessive weight gain (adjusted OR = 2.44; 95% CI: 1.66-3.59; p < 0.01) Conclusions Early excessive maternal weight gain and initial BMI are independently associated with the diagnosis of a hypertensive disorder of pregnancy. Women should be counseled regarding the benefits of achieving a normal BMI prior to pregnancy and appropriate weight gain during pregnancy, as well as the potential harms of excessive weight gain related to perinatal outcomes.

  20. Role of dyslipidaemia and lipid peroxidation in pregnancy induced hypertension

    Directory of Open Access Journals (Sweden)

    Saxena S

    2015-07-01

    Full Text Available Background: Pregnancy induced hypertension (PIH contributes greatly to maternal morbidity and mortality. Altered lipid profile and increased lipid peroxidation activate endothelial dysfunction and atherothrombosis leading to PIH. Therefore, estimation of lipid profile with serum malondialdehyde (MDA in pregnancy may be helpful in predicting the development of PIH and further progression. Material and methods: In this prospective case-control study, serum lipid profile and MDA were estimated in 70 PIH subjects with gestational hypertension, pre-eclampsia, eclampsia; and 70 normotensive pregnant women aged 18 - 40 years, with gestational age of over 20 weeks. Results: A statistically significant higher serum total cholesterol, very low density lipoprotein cholesterol (VLDL-C, low density lipoprotein cholesterol (LDL-C, triglycerides (TG, TC/HDL-C, LDL-C/HDL-C and MDA, and a significantly lower HDL-C was noted in PIH subjects as compared to control subjects. When compared with the severity of PIH, all the lipoproteins (except HDL-C along with MDA were found to be higher in women with eclampsia when compared with gestational hypertension, pre-eclampsia and normotensive pregnant women. Conclusions: An abnormal lipid metabolism along with oxidative stress may add to the promotion of vascular dysfunction leading to PIH. Lipoproteins and MDA alter significantly in eclampsia. Therefore, during pregnancy, early diagnosis and management of dyslipidaemia may prevent lipid peroxidation and progression of PIH thereby preventing obstetric complications.

  1. CALCIUM ANTAGONISTS IN THE TREATMENT OF ARTERIAL HYPERTENSION DURING PREGNANCY

    Directory of Open Access Journals (Sweden)

    R. I. Striuk

    2006-01-01

    Full Text Available According to WHO data, arterial hypertension (HT is revealed in 15-20% of pregnant women. In different regions of Russia the incidence of pregnancy HT varies from 7 to 29%. In women with HT started before pregnancy , perinatal losses are observed in 3, 8%, premature births – in 15, 3% and intrauterine growth retardation - in 16, 6%. Physiological gestational changes of hemodynamics are described. Hypertensive pregnant patients of high and low risk are defined. Non-pharmacological treatment of pregnant women with HT is presented in details. Antihypertensive therapy may not be used in hypertensive patients of low risk with blood pressure (BP of 140-160\\90-110 mm Hg. If BP is higher antihypertensive therapy should be used immediately. Dihydropyridine calcium antagonists (CA is drugs of choice for HT treatment during pregnancy , especially “advanced” CA of the third generation. They have predictable efficacy. It is possible to use short-acting nifedipine for treatment of acute HT in pregnant patients.

  2. Use of antidepressants during pregnancy and the risk of pregnancy-induced hypertension

    NARCIS (Netherlands)

    Van Loveren, Fianne MAM; Boekema, Monique; Hak, Eelko; Bos, Jens HJ; Aarnoudse, Jan G; Schuiling-Veninga, Catharina CM

    2014-01-01

    Background: Pregnancy-induced hypertension (PIH) is possibly caused by an increased activity of the sympatic nervous system. Previous studies have suggested that inhibition of the re-uptake of serotonin and norepinephrine by selective serotonin re-uptake inhibitors (SSRIs) and tricyclic

  3. Use of antidepressants during pregnancy and the risk of pregnancy-induced hypertension

    NARCIS (Netherlands)

    Van Loveren, Fianne MAM; Boekema, Monique; Hak, Eelko; Bos, Jens HJ; Aarnoudse, Jan G; Schuiling-Veninga, Catharina CM

    2014-01-01

    Background: Pregnancy-induced hypertension (PIH) is possibly caused by an increased activity of the sympatic nervous system. Previous studies have suggested that inhibition of the re-uptake of serotonin and norepinephrine by selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressa

  4. Cardiovascular disease risk factors after early-onset preeclampsia, late-onset preeclampsia, and pregnancy-induced hypertension.

    Science.gov (United States)

    Veerbeek, Jan H W; Hermes, Wietske; Breimer, Anath Y; van Rijn, Bas B; Koenen, Steven V; Mol, Ben W; Franx, Arie; de Groot, Christianne J M; Koster, Maria P H

    2015-03-01

    Observational studies have shown an increased lifetime risk of cardiovascular disease (CVD) in women who experienced a hypertensive disorder in pregnancy. This risk is related to the severity of the pregnancy-related hypertensive disease and gestational age at onset. However, it has not been investigated whether these differences in CVD risk factors are already present at postpartum cardiovascular screening. We evaluated postpartum differences in CVD risk factors in 3 subgroups of patients with a history of hypertensive pregnancy. We compared the prevalence of common CVD risk factors postpartum among 448 women with previous early-onset preeclampsia, 76 women with previous late-onset preeclampsia, and 224 women with previous pregnancy-induced hypertension. Women with previous early-onset preeclampsia were compared with women with late-onset preeclampsia and pregnancy-induced hypertension and had significantly higher fasting blood glucose (5.29 versus 4.80 and 4.83 mmol/L), insulin (9.12 versus 6.31 and 6.7 uIU/L), triglycerides (1.32 versus 1.02 and 0.97 mmol/L), and total cholesterol (5.14 versus 4.73 and 4.73 mmol/L). Almost half of the early-onset preeclampsia women had developed hypertension, as opposed to 39% and 25% of women in the pregnancy-induced hypertension and late-onset preeclampsia groups, respectively. Our data show differences in the prevalence of common modifiable CVD risk factors postpartum and suggest that prevention strategies should be stratified according to severity and gestational age of onset for the hypertensive disorders of pregnancy.

  5. 妊娠高血压综合征视网膜病变相关危险因素分析%Analysis of related risk factors of retinopathy in pregnancy induced hypertension syndrome

    Institute of Scientific and Technical Information of China (English)

    高新宇

    2015-01-01

    目的:分析妊娠高血压综合征( pregnancy induced hypertension syndrome ,PIHS)视网膜病变相关危险因素。  方法:选取PIHS视网膜病变患者262例,观察PIHS分期、年龄、体质量、蛋白尿、平均动脉压、红细胞比容与PIHS视网膜病变的相关性。  结果:视网膜分期随着 PIHS 级别的增高而增高(χ2回归=52.13, P0.05);体质量越大,视网膜病变程度越高(χ2回归=22.97, P  结论:PIHS分期、体质量、蛋白尿、平均动脉压、红细胞比容均是PIHS视网膜病变的相关危险因素。%•AlM:To analyze the related risk factors of retinopathy in pregnancy induced hypertension syndrome ( PlHS) . •METHODS:Two hundred and sixty-two cases with the PlHS retinal lesions were selected, and the correlation between PlHS stage, age, body mass, albuminuria, mean arterial blood pressure, hematocrit value and retinopathy in PlHS were observed. •RESULTS: Retinal stage increased with the increase of the grade of PlHS (χ2regression=52. 13, P0. 05);the greater body mass was, the higher the degree of retinopathy was (χ2regression=22. 97, P •CONCLUSlON: PlHS stage, body mass, albuminuria, mean arterial blood pressure, hematocrit value are the related risk factors of retinopathy in PlHS.

  6. Comparison of magnesium and methyldopa for the control of blood pressure in pregnancies complicated with hypertension

    DEFF Research Database (Denmark)

    Rudnicki, M; Frølich, A; Pilsgaard, K;

    2000-01-01

    OBJECTIVES: Although magnesium is now the drug of choice for the prevention of eclamptic seizures only few studies have evaluated whether magnesium may reduce blood pressure in pregnancies complicated with hypertension. METHODS: A total of 33 patients with pregnancy-induced hypertension were...... demonstrates that magnesium treatment lowers blood pressure in pregnancies complicated with hypertension. The effect is without any adverse effect on maternal and neonatal well-being....

  7. Increased Oxidative Stress in Women With Pregnancy-induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    JUN-FU ZHOU; XIN-YU WANG; XUE-JUN SHANGGUAN; ZU-MING GAO; SHU-MEI ZHANG; WEI-QIANG XIAO; CHANG-GUI CHEN

    2005-01-01

    Objective To investigate whether pregnancy-induced hypertension (PIH) may increase oxidative stress in women with PIH, and to explore the mechanisms by which PIH may increase oxidative stress and potential free radical damage. Methods Seventy women with PIH and seventy women with uncomplicated normotensive pregnancy (UNP) whose age, nutritional conditions, levels of hemoglobin and albumin were all matched, were enrolled in a randomized controlled trial. Their plasma concentrations of nitric oxide (NO), vitamin C (VC), vitamin E (VE), and β-carotene (β-CAR) as well as their erythrocyte malondialdehyde (MDA), and activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX)were determined by spectrophotometry. Results Compared with average values of the above experimental parameters in the women with UNP, the average value of erythrocyte MDA in the women with PIH significantly increased (P<0.0001), while the average values of plasma NO, VC, VE, and β-CAR as well as those of erythrocyte SOD, CAT, and GPX in the women with PIH significantly decreased (P<0.0005-0.0001). The findings from partial correlation analysis (controlling for age) for 70women with PIH showed that with elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP), MDA value gradually increased (P<0.001), and NO, VC, VE, β-CAR, SOD, CAT, and GPX values gradually decreased (P<0.02-0.001).The fmdings from reliability analysis for NO, VC, VE, β-CAR, SOD, CAT, GPX, and MDA values used to reflect increased oxidative stress and potential free radical damage in women with PIH showed that the reliability coefficients (alpha, 8 items) =0.7062, P< 0.0001, and the standardized item alpha = 0.9116, P< 0.0001. Conclusion The findings in the present research suggest that pregnancy-induced hypertension can increase oxidative stress and potential free radical damage in women with pregnancy-induced hypertension.

  8. Dietary determinants of pregnancy induced hypertension in Isfahan

    Directory of Open Access Journals (Sweden)

    Zamzam Paknahad

    2008-02-01

    Full Text Available

    • BACKGROUND: Pregnancy-induced hypertension (PIH is a pregnancy-specific condition that occurs after the 20th week of gestation. These physiologic changes can be aggravated by undernutrition. There are some evidence based on the importance of nutrient deficiency in developing this syndrome. Therefore, the aim of present study was to determine the nutritional risk factors for pregnancy induced hypertension in a group of pregnant women in Isfahan.
    • METHODS: In this case-control study, we recruited 46 Isfahanian pregnant women in two groups (with and without PIH. They were 19 to 45 year-old and they did not consume any antihypertensive or diuretic medications. Demographic questionnaire and food frequency questionnaire were filled in both groups.
    • RESULTS: There were no significant differences in energy and vitamin E and C intakes between the two groups. Zinc and calcium intakes were lower in women with PIH compared to those without PIH (P = 0.04 and P = 0.007, respectively. Riboflavin and protein intakes were lower in women with PIH compared to subjects without PIH (P = 0.03 and P = 0.01, respectively.
    • CONCLUSIONS: Lower intake of calcium, zinc, riboflavin and protein should be considered as possible risk factors for PIH. Adequate intake of dairy products which are good sources of mentioned nutrients are recommended to prevent PIH.
    • KEYWORDS: Pregnancy induced hypertension, diet, nutrient.

  9. A longitudinal study of antioxidant status during uncomplicated and hypertensive pregnancies.

    NARCIS (Netherlands)

    Roes, E.M.; Hendriks, J.C.M.; Raijmakers, M.; Steegers-Theunissen, R.P.M.; Groenen, P.; Peters, W.H.M.; Steegers, E.A.P.

    2006-01-01

    BACKGROUND: To study the possible involvement of an (im)balance between oxidants and antioxidants in pre-eclampsia concentrations of intra- and extracellular blood antioxidants in women with uncomplicated and hypertensive pregnancies, they were studied preconceptionally and throughout pregnancy.

  10. Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy.

    Science.gov (United States)

    Winkel, Susanne; Einsle, Franziska; Pieper, Lars; Höfler, Michael; Wittchen, Hans-Ulrich; Martini, Julia

    2015-06-01

    The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [β] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, β = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (β = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for

  11. Relation between acute kidney injury and pregnancy-related factors

    Institute of Scientific and Technical Information of China (English)

    Monchai Siribamrungwong; Pawadee Chinudomwong

    2016-01-01

    Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it brings about devastating maternal and fetal outcomes. Among developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains one of the major health problems in the developing countries. Though some improvements have been observed, PRAKI still causes high maternal morbidity and mortality, leading to fetal losses. This article aims to review current studies with regards to obstetrics related AKI. Most of the studies in this review were carried out in observational, both prospective and retrospective, studies. Results demonstrated a variety of major PRAKI causes such as hypertensive disorders in pregnancy, obstetric hemorrhage, sepsis, thrombotic micro-angiopathy and acute fatty liver in pregnancy. Aside from awareness of the etiologies of PRAKI, understanding the physiological renal adaptation during pregnancy is crucial for early detection, diagnosis, and proper management to prevent the obstetric complications.

  12. Relation between acute kidney injury and pregnancy-related factors

    Directory of Open Access Journals (Sweden)

    Monchai Siribamrungwong

    2016-01-01

    Full Text Available Acute kidney injury (AKI is a serious problem during pregnancy. Once occurred, it brings about devastating maternal and fetal outcomes. Among developed nations, the trend of pregnancy-related AKI (PRAKI is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains one of the major health problems in the developing countries. Though some improvements have been observed, PRAKI still causes high maternal morbidity and mortality, leading to fetal losses. This article aims to review current studies with regards to obstetrics related AKI. Most of the studies in this review were carried out in observational, both prospective and retrospective, studies. Results demonstrated a variety of major PRAKI causes such as hypertensive disorders in pregnancy, obstetric hemorrhage, sepsis, thrombotic microangiopathy and acute fatty liver in pregnancy. Aside from awareness of the etiologies of PRAKI, understanding the physiological renal adaptation during pregnancy is crucial for early detection, diagnosis, and proper management to prevent the obstetric complications.

  13. Antenatal coffee and tea consumption and the effect on birth outcome and hypertensive pregnancy disorders.

    Science.gov (United States)

    van der Hoeven, Timothy; Browne, Joyce L; Uiterwaal, Cuno S P M; van der Ent, Cornelis K; Grobbee, Diederick E; Dalmeijer, Geertje W

    2017-01-01

    Coffee and tea are commonly consumed during pregnancy. While several of their components, like caffeine, have strong pharmacological effects, the effect on the unborn fetus remains unclear. Caffeine intake has been associated with abortion, preterm birth and fetal growth restriction, but a general consensus on caffeine restriction is still lacking. We aimed to investigate antenatal coffee, tea and caffeine consumption and the effect on birth weight and length, gestational age at birth and hypertensive disorders in pregnancy. A total of 936 healthy pregnancies from the WHISTLER birth cohort with data on coffee and tea consumption were included. Maternal and child characteristics as well as antenatal coffee and tea consumption were obtained through postpartum questionnaires. Reported consumption was validated using available preconceptional data. Caffeine intake was calculated from coffee and tea consumption. Linear and logistic regression was used to assess the association with birth outcome and hypertensive disorders. After adjustment for smoking and maternal age, a daily consumption of more than 300mg of caffeine compared to less than 100mg of caffeine was significantly associated with an increased gestational age (linear regression coefficient = 2.00 days, 95%CI = 0.12-4.21, P = 0.03). Tea consumption was significantly related to a higher risk of pregnancy induced hypertension (OR = 1.13, 95%CI = 1.04-1.23, P = 0.004). No associations concerning coffee consumption or birth weight and birth length were observed. Daily caffeine consumption of more than 300mg is possibly associated with an increase in gestational age at birth. A possible relation between high tea consumption and increased risk for pregnancy induced hypertension warrants further research. For most outcomes, we found no significant associations with coffee or tea intake.

  14. Pregnancy-related characteristics and breast cancer risk.

    Science.gov (United States)

    Brasky, Theodore M; Li, Yanli; Jaworowicz, David J; Potischman, Nancy; Ambrosone, Christine B; Hutson, Alan D; Nie, Jing; Shields, Peter G; Trevisan, Maurizio; Rudra, Carole B; Edge, Stephen B; Freudenheim, Jo L

    2013-09-01

    Breast tissues undergo extensive physiologic changes during pregnancy, which may affect breast carcinogenesis. Gestational hypertension, preeclampsia/eclampsia, gestational diabetes, pregnancy weight gain, and nausea and vomiting (N&V) during pregnancy may be indicative of altered hormonal and metabolic profiles and could impact breast cancer risk. Here, we examined associations between these characteristics of a woman's pregnancy and her subsequent breast cancer risk. Participants were parous women that were recruited to a population-based case-control study (Western New York Exposures and Breast Cancer Study). Cases (n = 960), aged 35-79 years, had incident, primary, histologically confirmed breast cancer. Controls (n = 1,852) were randomly selected from motor vehicle records (pregnancy experiences. Multivariable-adjusted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). N&V during pregnancy was inversely associated with breast cancer risk. Relative to those who never experienced N&V, ever experiencing N&V was associated with decreased risk (OR 0.69, 95% CI 0.56-0.84) as were increased N&V severity (p trend pregnancies (p trend pregnancies. Associations were stronger for more recent pregnancies (breast cancer subtype including estrogen receptor and HER2 expression status. Other pregnancy characteristics examined were not associated with risk. We observed strong inverse associations between pregnancy N&V and breast cancer risk. Replication of these findings and exploration of underlying mechanisms could provide important insight into breast cancer etiology and prevention.

  15. An evaluation of human placental lactogen levels in hypertension of pregnancy.

    Science.gov (United States)

    Kelly, A M; England, P; Lorimer, J D; Ferguson, J C; Govan, A D

    1975-04-01

    Maternal plasma levels of human placental lactogen (HPL) are decreased in hypertensive pregnancies and the concentration is related to the severity of the condition. Of infants who had HPL concentrations in the fetal danger zone (more than 2 SD's below normal mean) 75 per cent developed fetal distress, neonatal asphyxia or were light for dates. Patients who are identified in this way have lighter infants and placentae than their unidentified counterparts with normal HPL levels.

  16. STUDY ON PLATELET INDICES IN PREGNANCY INDUCED HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Rabi a Parveen

    2015-10-01

    Full Text Available INTRODUCTION : Pregnancy induced hypertension includes gestational hypertension, preeclampsia, and eclampsia. In PIH, lower the platelet count, greater are maternal and fetal morbidity and mortality. Recent studies suggest that platele t parameters like platelet indices are most simple and cost effective method for prediction of PIH, way before the appearance of derangements in PT, APTT, TT values so we undertook this study with an aim to see an association between platelet indices and pregnancy induced hypertension. MATERIAL AND METHOD : This was prospective analytical case control study. Study included 125 cases, who were diagnosed as PIH with B.P. > 140/90 mmHg, detected after 20 weeks of pregnancy. Under all aseptic precautions samples were collected randomly in EDTA vials . Samples were analysed for platelet indices . RESULT : Maximum number of cases of Preeclampsia (88.57% & Eclampsia (87.5% were fo und in age group of 21 to 25 . Controls were of same age group i.e. 21 to 25 years. It was observed that platelet count showed gradual decrease in eclampsia (1.44580± 36,210 & pre - e clampsia patients (1.97850± 39,010 as compared to normotensive subjects (2.42620± 40,412. MPV showed gradual increase in eclampsia ( 10.49 ±1.12 & pre - eclampsia ( 9.14 ±0.612 patients as compared to normotensive subjects ( 8.422 ±0.743. PDW value also shows gradual increase in eclampsia ( 18.39 ±2.62 & pre - eclampsia ( 16.29 ±2.34 p atients as compared to normotensive subjects ( 12.09 ±2.53. CONCLUSION : Study showed that platelet indices were important, simple, effortless and cost effective investigations which can be used for early recognition of preventable eclampsia complications.

  17. Magnesium supplement in pregnancy-induced hypertension. A clinicopathological study

    DEFF Research Database (Denmark)

    Rudnicki, M; Junge, Jette; Frølich, A;

    1990-01-01

    as a double-blind randomized controlled study in which 11 women were allocated to magnesium and 7 to placebo treatment. The treatment comprised a 48-hour intravenous magnesium/placebo infusion followed by daily oral magnesium/placebo intake until one day after delivery. Magnesium supplement increased birth....... There was no significant difference when the magnesium group, the placebo group and the control group were compared separately. The present study suggests that magnesium supplement has a beneficial effect on fetal growth in pregnancy-induced hypertension. With regard to the light and electron microscopic changes we were...... unable to demonstrate any significant difference between the magnesium, placebo and control groups....

  18. Pregnancy related symptomatic vertebral hemangioma

    Directory of Open Access Journals (Sweden)

    Meena Gupta

    2014-01-01

    Full Text Available Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.

  19. Pregnancy related symptomatic vertebral hemangioma.

    Science.gov (United States)

    Gupta, Meena; Nayak, Rajeev; Singh, Hukum; Khwaja, Geeta; Chowdhury, Debashish

    2014-01-01

    Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.

  20. Uric acid as an important biomarker in hypertensive disorders in pregnancy

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    Triveni Kondareddy

    2016-12-01

    Conclusions: A positive correlation was observed between rise in uric acid and severity of hypertension in pregnancy. Hyperuricemia in patients with hypertensive disorders of pregnancy is a strong risk factor for several maternal and perinatal complications. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4382-4384

  1. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

    NARCIS (Netherlands)

    Schutte, J. M.; Schuitemaker, N. W. E.; van Roosmalen, J.; Steegers, E. A. P.

    2008-01-01

    Objective To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting Confidenti

  2. Substandard care in maternal mortality due to hypertensive disease in pregnancy in the Netherlands

    NARCIS (Netherlands)

    Schutte, J. M.; Schuitemaker, N. W. E.; van Roosmalen, J.; Steegers, E. A. P.

    Objective To review the standard of care in cases of maternal mortality due to hypertensive diseases in pregnancy and to make recommendations for its improvement. Design Care given to women with hypertensive disease in pregnancy was audited and substandard care factors identified. Setting

  3. A STUDY OF PLACENTAL WEIGHT AND FETAL OUTCOME IN DIFFERENT GRADES OF PREGNANCY INDUCED HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Raghavendra. A. Y

    2014-10-01

    Full Text Available Introduction and Objectives: Placenta is a feto-maternal organ which is vital for maintaining pregnancy and promoting normal development of the fetus. The weight of the placenta is functionally significant because it is related to villous surface area and to fetal metabolism. Present study has done to record the placental weight and co-relate with the corresponding fetal weight. Materials and Methods: A total of 100 placentae were studied, out of which 50 placentae belong to pregnancy induced hypertension and 50 placentae were of normotensive pregnant mothers. The weight of placenta and weight of fetus were compared between normotensive (Control and hypertensive mothers (Cases. Results: The mean weight of placenta in study group was low as compared to that in the control group. The birth weight of newborn was low with increasing grades of hypertension compared to control groups. The feto- placental weight ratio was higher in case of mild and severe preeclampsia. The incidence of stillbirth was 0.5%, 12.5% and 20% in mild pre-ecampsia, severe preeclampsia and eclampsia respectively. Conclusion: In present study, the birth weight was low with increasing grades of hypertension compared to control groups. The fetal: placental weight ratio was higher in case of mild and severe preeclampsia. The incidence of eclampsia was more common in primigravida where as mild preeclampsia was more common in multigravida. The mean weight of placenta in study group was low compared to control group. Thus study of placental changes in pregnancy induced hypertension may help us to understand patho-physiological mechanisms and design treatment plans for better maternal and foetal outcome. Modern sophisticated techniques like ultrasonography have made it possible to study the necessary placental parameters in utero. This helps in assessing the foetal outcome and management.

  4. No Hypertensive Disorder of Pregnancy; No Preeclampsia-eclampsia; No Gestational Hypertension; No Hellp Syndrome. Vascular Disorder of Pregnancy Speaks for All

    OpenAIRE

    Berhan, Yifru

    2016-01-01

    Hypertensive disorders complicate 5%-10% of pregnancies with increasing incidence mainly due to upward trends in obesity globally. In the last century, several terminologies have been introduced to describe the spectrum of this disease. The current and widely used classification of hypertensive pregnancy disorders was introduced in 1972 and in 1982, but has not been free of controversy and confusion. Unlike other diseases, the existing terminology combines signs and symptoms, but does not des...

  5. [Clinical guideline for detection and diagnosis of hypertensive pregnancy disease].

    Science.gov (United States)

    Lagunes-Espinosa, Alma Luisa; Ríos-Castillo, Brenda; Peralta-Pedrero, María Luisa; del Rocío Cruz-Cruz, Polita; Sánchez-Ambríz, Slivia; Sánchez-Santana, Joaquín Renato; Ramírez-Mota, Carolina; Zavaleta-Vargas, Norma Octavia; López-Cisneros, Gabriela

    2011-01-01

    Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.

  6. Comparison of foetomaternal circulation in normal pregnancies and pregnancy induced hypertension using color Doppler studies.

    Science.gov (United States)

    Gupta, Shikha; Misra, R; Ghosh, U K; Gupta, V; Srivastava, D

    2014-01-01

    The aim of present study was to assess fetomaternal blood flows in normal and abnormal pregnancies using color Doppler indices. Subjects were divided into two groups as: Group A of 25 subjects of normal pregnancy as controls and group B of 25 subjects of pregnancy induced hypertension. All the subjects were lying in the age-group of 25-35 years and having 28 to 34 weeks of gestation; the patients were evaluated by detailed history and were subjected to complete general examination. Blood pressure was taken on two occasions at least 6 hours apart. Systemic examination and obstetrical examination was done in all subjects. All cases were subjected to pathological tests- Haemogram, Test for proteins in urine. Ultrasound assessment of fetal growth was done by measuring BPD (Biparietal diameter), HC (Head circumference), FL (Femur length) and AC (Abdominal circumference): Average gestational age and effective fetal weight was then calculated by ultrasound machine. Color Doppler was used to assess the various Doppler indices indices: Pulsatility index (PI), Resistive index (RI) and Systolic diastolic ratio (S/D ratio) in bilateral uterine, umbilical and middle cerebral arteries and compared to the standard normograms. Percentage of subjects having abnormal Doppler indices were calculated. Assessment of percentage of SGA (small for gestational age) fetuses was done in all the three groups. Decline in mean values of all Doppler indices was found with advancing gestational age in normal pregnancy suggesting decreased vascular resistance and increased blood flow in fetomaternal circulation. In pregnancy induced hypertensives, the mean values of Doppler indices showed a decline as in normal pregnancy but showed an increase (more than 2 S.D. of the mean) for that gestational age in comparison to the control group suggesting increased impedance to blood flow in uteroplacental and fetomaternal circulation. Umbilical artery Doppler indices were found to be the most sensitive

  7. Hypertension

    OpenAIRE

    2016-01-01

    Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types...

  8. Anaesthetic management of splenectomy in Evan′s syndrome during pregnancy with pregnancy induced hypertension.

    Directory of Open Access Journals (Sweden)

    Sherke R

    2001-07-01

    Full Text Available The management of idiopathic thrombocytopenic purpura (ITP during pregnancy, especially with ongoing bleeding diathesis, has not been highlighted sufficiently in the literature. Aortocaval compression and reduction in uteroplacental circulation resulting in foetal hypoxia and acidosis, Mendelson′s syndrome due to gravid uterus, trauma to airway with resultant haemorrhage and aspiration into lungs, compromised airway due to short neck, anasarca and heavy breast, limitation in using invasive monitoring and regional anaesthesia and uncontrolled bleeding leading to placental hypoperfusion and foetal hypoxia are some of the important risks. In the present case report, anaesthetic management for splenectomy during pregnancy complicated with pregnancy induced hypertension and bleeding diathesis secondary to ITP is described with reference to above risks.

  9. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review.

    Science.gov (United States)

    Firoz, T; Magee, L A; MacDonell, K; Payne, B A; Gordon, R; Vidler, M; von Dadelszen, P

    2014-09-01

    Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings. To review systematically, the effectiveness of oral antihypertensive agents for treatment of severe pregnancy/postpartum hypertension. A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed. Randomised controlled trials in pregnancy and postpartum with at least one arm consisting of a single oral antihypertensive agent to treat systolic BP ≥ 160 mmHg and/or diastolic BP ≥ 110 mmHg. Cochrane RevMan 5.1 was used to calculate relative risk (RR) and weighted mean difference by random effects. We identified 15 randomised controlled trials (915 women) in pregnancy and one postpartum trial. Most trials in pregnancy compared oral/sublingual nifedipine capsules (8-10 mg) with another agent, usually parenteral hydralazine or labetalol. Nifedipine achieved treatment success in most women, similar to hydralazine (84% with nifedipine; relative risk [RR] 1.07, 95% confidence interval [95% CI] 0.98-1.17) or labetalol (100% with nifedipine; RR 1.02, 95% CI 0.95-1.09). Less than 2% of women treated with nifedipine experienced hypotension. There were no differences in adverse maternal or fetal outcomes. Target BP was achieved ~ 50% of the time with oral labetalol (100 mg) or methyldopa (250 mg) (47% labetelol versus 56% methyldopa; RR 0.85 95% CI 0.54-1.33). Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum. © 2014 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  10. Type-specific orthostatic hemodynamic response of hypertensive diseases in pregnancy.

    Science.gov (United States)

    Staelens, Anneleen S; Vonck, Sharona; Mesens, Tinne; Tomsin, Kathleen; Molenberghs, Geert; Gyselaers, Wilfried

    2015-10-01

    Posture changes may differ between types of hypertensive disease. The aim is to evaluate the orthostatic response of impedance cardiography (ICG) measurements in uncomplicated and hypertensive pregnancies. Measurements were performed in supine and standing position in 202 women: 41 uncomplicated pregnancies (UP), 59 gestational hypertension (GH), 35 early-onset (EPE, hypertensive complicated gestations in the orthostatic change of the aortic acceleration. In contrast to patients with preeclampsia, those with GH had an increased blood pressure and Heather index, and stable pre-ejection period after posture change. EPE differed from LPE by change in blood pressure and aortic flow parameters. In addition to static ICG-measurements, orthostatic shifts improved group characterization from 57.4% to 65.8%. The orthostatic response is altered in hypertensive pregnancies. ICG measurements in the upright as well as during an orthostatic test might have the potential to improve the discriminative yield between hypertensive diseases in pregnancy.

  11. MATERNAL OUTCOME IN PREGNANCY INDUCED HYPERTENSION IN A TEACHING HOSPITAL IN A RURAL AREA IN TELANGANA

    Directory of Open Access Journals (Sweden)

    Kavitha Reddy Kothapally

    2016-09-01

    Full Text Available AIM To analyse the maternal outcome in pregnancy induced hypertension and improve the management strategies. INTRODUCTION Pregnancy induced hypertension is a medical disease peculiar to pregnancy, making pregnancy a high risk condition. Among medical disorders complicating pregnancy, it stands next to anaemia in prevalence. It is responsible for majority of the maternal morbidity and mortality. It also has an adverse perinatal outcome. Hence, early detection and timely intervention of women with pregnancy induced hypertension is important for good maternal and perinatal outcome. MATERIAL & METHODS The present Prospective Observational study was done from April 2015 to February 2016 in the department of obstetrics & gynaecology at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana. A total of 102 pregnant women with pregnancy induced hypertension were enrolled into the study. Demographic details like age, parity, previous obstetric history of pregnancy induced hypertension and diabetes, past history of polycystic ovarian disease, treatment for infertility, gestational age at which hypertension developed in the present pregnancy were noted. Relevant investigations were performed. Gestational age of delivery, mode of delivery and maternal complications were noted. RESULTS The incidence of pregnancy induced hypertension was 4% in the study population. About 59.8% developed pregnancy induced hypertension in the third trimester. Out of this, 64.7% cases were gestational hypertension and 35.3% cases were preeclampsia. Nearly half (41.7% of preeclampsia cases were severe preeclampsia. Postpartum haemorrhage is the commonest complication (13.7%, next being imminent eclampsia (7.8%, abruption (4.9%, eclampsia (3.9% and HELLP syndrome (0.98%. 80% of cases could be delivered beyond 37 weeks of gestational age. 71.57% of cases had lower segment caesarean section for indicated conditions. More than half of pregnancy induced

  12. Hypertensive Disorders of Pregnancy Appear Not to Be Associated with Alzheimer's Disease Later in Life

    OpenAIRE

    Abheiden, Carolien N.H.; Rebecca van Doornik; Aukes, Annet M.; van der Flier, Wiesje M.; Philip Scheltens; de Groot, Christianne J M

    2015-01-01

    BACKGROUND: After hypertensive disorders of pregnancy, more subjective cognitive complaints and white matter lesions are reported compared to women after normal pregnancies. Both have a causal relationship with Alzheimer's disease (AD). AIM: To investigate if women whose pregnancy was complicated by hypertensive disorders have an increased risk of AD. METHODS: A case-control study in women with AD from the Alzheimer Center of the VU University Medical Center Amsterdam and women without AD. Pa...

  13. Changes and significance of coagulation function, hemodynamics and blood rheology in women with pregnancy induced hypertension

    Institute of Scientific and Technical Information of China (English)

    Bang-Zhi Zeng; Bo Zhang; Yu-Na Wang

    2016-01-01

    Objective:To observe the changes of coagulation function, hemodynamics and blood rheology in patients with pregnancy induced hypertension, and to explore its clinical significance. Methods: A total of 88 cases of women with pregnancy induced hypertension who were admitted in our hospital from July 2011 to February 2016 were selected as the research objects, at the same time, 90 normal pregnant women were selected as normal late pregnancy group. The coagulation parameters, hemodynamics, blood rheology indexes were detected in the two groups.Results:Before delivery, values of the PT and AT-Ⅲ in pregnancy induced hypertension group were significantly lower than those in the normal late pregnancy group, and the values of D-D and FIB were significantly higher than those in the normal late pregnancy group. After delivery, values of the PT and AT-Ⅲ in pregnancy induced hypertension group were significantly higher, and the FIB value was significantly lower, there were no significant differences between the two group. But the D-D value was still significantly higher than that in the normal late pregnancy group. The blood flow dynamics parameter in pregnancy induced hypertension group were significantly higher than that in the normal late pregnant group, the differences were statistically significant. The whole blood high and low shear viscosity, plasma viscosity, low shear reduction viscosity, hematocrit, erythrocyte deformation index, erythrocyte electrophoresis time and fibrinogen in pregnancy induced hypertension group were significantly higher than those in normal late pregnancy group.Conclusion:The blood indexes in patients with pregnancy induced hypertension showed a high coagulation state compared with the normal late pregnancy women. Timely detection of patients’ coagulation function, hemodynamics, and blood rheology indexes has important significance for the detection, auxiliary diagnosis and prevention of the disease.

  14. FUNDUS CHANGES IN PREGNANCY INDUCED HYPERTENSION: A CLINICAL STUDY

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    Rama Bharathi

    2015-01-01

    Full Text Available PURPOSE: To estimate the prevalence of fundus changes in Pregnancy Induced Hypertension (PIH and to find the correlation of the findings with the levels of hypertension and with the severity of the disease. METHODS: This was a hospital based cross section al study conducted over a period of one year from July 2012 to June 2013. 150 patients with diagnosed PIH and admission into wards at King George Hospital, Visakhapatnam, with 36 weeks period of gestation and above, were included in the study. Those with p re - existing hypertension, coexisting diabetes mellitus, severe anaemia, renal disease and ocular diseases like cataract or corneal opacities were excluded from the study. After taking consent and ocular history, anterior segment was evaluated. Pupils were dilated with 0.5% tropicamide eye drops and fundus examination was done with direct ophthalmoscope. Information like age, para, BP etc., was noted down from case sheets. RESULTS: Total number of patients studied was 150.Mean age was 23.06+ 3.03years. 105 ( 70% were primigravidae and 45(30% were multigravidae. Fundus findings were seen in 35 cases (23.33%. 26 (17.33% had Grade I changes, 1 (0.66% had grade II changes, 6 (3.9% had grade III changes 2 (1.3% had serous retinal detachment/grade - IV. The de gree of retinopathy was correlating with the severity of the disease and levels of hypertension. CONCLUSION: The prevalence of fundus changes in PIH is 23.33%. Most of the fundus changes in PIH are underdiagnosed. Timely ophthalmoscopy should be called for in all cases of PIH as it would affect the decision of induction of delivery, thereby preventing other complications.

  15. Hypertension in pregnancy is a risk factor for microalbuminuria later in life.

    Science.gov (United States)

    Kattah, Andrea G; Asad, Reem; Scantlebury, Dawn C; Bailey, Kent R; Wiste, Heather J; Hunt, Steven C; Mosley, Thomas H; Kardia, Sharon L R; Turner, Stephen T; Garovic, Vesna D

    2013-09-01

    The authors aimed to compare renal function by estimated glomerular filtration rate and albuminuria in 3 groups of women: nulliparous women, women with a history of normotensive pregnancies, and women with a history of at least one hypertensive pregnancy. Women who participated in the second Family Blood Pressure Program Study visit (2000-2004) and had serum creatinine and urine albumin measurements (n=3015) were categorized as having had no pregnancy lasting >6 months (n=341), having had only normotensive pregnancies (n=2199), or having had at least 1 pregnancy with hypertension (n=475) based on a standardized questionnaire. Women who reported having had at least one pregnancy with hypertension were significantly more likely to be hypertensive (75.6% vs 59.4%, Ppregnancies. There was a significantly greater risk of microalbuminuria (urine albumin-creatinine ratio >25 mg/g) in those who reported at least one pregnancy with hypertension (odds ratio, 1.37; confidence interval, 1.02-1.85; P=.04) than in those with normotensive pregnancies, after adjusting for risk factors for chronic kidney and cardiovascular disease. Hypertension in pregnancy is associated with an increased risk of future microalbuminuria.

  16. Bioactive proteins in healthy pregnancies and preeclampsia: relevance to hypertension and proteinuria

    Institute of Scientific and Technical Information of China (English)

    WANG Tao; WANG Yan-yun; ZHOU Rong; SONG Chang-ping; LIN Wei; NIU Xiao-yu; ZHANG Lin

    2013-01-01

    Background Bioactive proteins,such as cytokines and chemokines,have not been systematically evaluated in healthy and preeclamptic pregnancies.We aimed to investigate the difference of these proteins between healthy and preeclamptic pregnancies in order to help clarify their potential roles in the pathogenesis of hypertension and proteinuria in preeclampsia.Methods Samples of amniotic fluid and maternal/umbilical cord blood were collected from normal pregnancies and women with preeclampsia for examination of bioactive proteins.Fifty-three pregnant women were enrolled in this study.Of them,30 pregnant women were recruited as healthy controls,and 23 pregnant women were diagnosed with preeclampsia.An antibody array was used to screen for higher levels of cytokines and related proteins in amniotic fluid than in the blood samples,and these proteins were then selected for quantification by immunoassay.Results Interleukin-1 receptor 4,hepatocyte growth factor,and urokinase plasminogen activator receptor were significantly elevated in the blood of preeclampsia patients.In particular,interleukin-1 receptor 4 was 8-fold higher in preeclampsia patients than in the healthy pregnancies.Moreover,in cord blood samples hepatocyte growth factor and interleukin-8 were significantly higher in preeclampsia patients.Conclusions Because of the biologic activities,Interleukin-1 receptor 4,hepatocyte growth factor,urokinase plasminogen activator receptor and interleukin-8 in maternal and/or cord blood could play a role in the pathogenesis of hypertension and proteinuria in preeclampsia.

  17. Incidence and prevalence of pregnancy-related heart disease.

    Science.gov (United States)

    Sliwa, Karen; Böhm, Michael

    2014-03-15

    Worldwide, the numbers of women who have a pre-existing cardiovascular disease or develop cardiac problems during pregnancy are increasing and, due to the lack of evidenced-based data, this provides challenges for the treating physician. Cardiovascular disease in pregnancy is a complex topic as women can present either pre- or post-partum, due to a pre-existing heart disease such as operated on or unoperated on congenital heart disease, valvular heart disease, chronic hypertension, or familial dilated cardiomyopathy. Women often present with symptoms and signs of acute heart failure. On the other hand, there are diseases which are directly related to pregnancy, such as hypertensive disorders of pregnancy and peripartum cardiomyopathy, or where pregnancy increases risk of a disease as, for example, the risk of myocardial infarction. These diseases can have long-term implications to the life of the affected women and their families. There is, in particular, a paucity of data from developing countries of this unique disease pattern and its presentations. This review summarizes the current knowledge of the incidence and prevalence of pregnancy-related cardiovascular disease in women presenting pre- or post-partum.

  18. Hypertensive Disorders of Pregnancy Appear Not to Be Associated with Alzheimer's Disease Later in Life

    NARCIS (Netherlands)

    Abheiden, C.N.; Doornik, R. van; Aukes, A.M.; Flier, W.M. van der; Scheltens, P.; Groot, C.J. de

    2015-01-01

    BACKGROUND: After hypertensive disorders of pregnancy, more subjective cognitive complaints and white matter lesions are reported compared to women after normal pregnancies. Both have a causal relationship with Alzheimer's disease (AD). AIM: To investigate if women whose pregnancy was complicated by

  19. Relation between time to pregnancy and pregnancy outcome

    Directory of Open Access Journals (Sweden)

    Hatave Ghasemi Tehrani

    2014-01-01

    Full Text Available Background: Studies have shown significant correlation between time to pregnancy (TTP and pregnancy  outcomes. But  understanding of these mechanisms may not be facilitated. The aim of this study was to determine the relation between TTP and pregnancy outcome. Materials and Methods: This study was a case cohort study that was done in Shahid Beheshti Educational Hospital during 2006-2007. Women aged 18-35 years, who had only one pregnancy without using any contraception method before pregnancy and delivered their first child, were enrolled in this study. Thus, 801 women were selected and followed up for pregnancy outcome and TTP until the end of pregnancy. All the participants filled in a special questionnaire. Finally the collected data were entered into computer and analyzed by SPSS ver. 20 software. Results: The frequency distribution of TTP-based pregnancy outcome showed that TTP >48 weeks was higher in normal delivery than in abnormal delivery (5.6% vs. 19.4%. According to Chi-square test, the frequency distribution of pregnancy outcome was related to TTP (P < 0.001. Conclusion: According to the results of this study, there is a significant relationship between TTP and pregnancy outcome, and TTP may lead to unwanted complications such as ectopic pregnancy, preterm labor, and abortion. Thus, all women with a long time of contraception, especially in the rural areas, mast be controlled.

  20. 10-Year cardiovascular event risks for women who experienced hypertensive disorders in late pregnancy: the HyRAS study

    Directory of Open Access Journals (Sweden)

    Ponjee Gabrielle

    2010-06-01

    Full Text Available Abstract Background Cardiovascular disease is the cause of death in 32% of women in the Netherlands. Prediction of an individual's risk for cardiovascular disease is difficult, in particular in younger women due to low sensitive and specific tests for these women. 10% to 15% of all pregnancies are complicated by hypertensive disorders, the vast majority of which develop only after 36 weeks of gestation. Preeclampsia and cardiovascular disease in later life show both features of "the metabolic syndrome" and atherosclerosis. Hypertensive disorders in pregnancy and cardiovascular disease may develop by common pathophysiologic pathways initiated by similar vascular risk factors. Vascular damage occurring during preeclampsia or gestational hypertension may contribute to the development of future cardiovascular disease, or is already present before pregnancy. At present clinicians do not systematically aim at the possible cardiovascular consequences in later life after a hypertensive pregnancy disorder at term. However, screening for risk factors after preeclampsia or gestational hypertension at term may give insight into an individual's cardiovascular risk profile. Methods/Design Women with a history of preeclampsia or gestational hypertension will be invited to participate in a cohort study 2 1/2 years after delivery. Participants will be screened for established modifiable cardiovascular risk indicators. The primary outcome is the 10-year cardiovascular event risk. Secondary outcomes include differences in cardiovascular parameters, SNP's in glucose metabolism, and neonatal outcome. Discussion This study will provide evidence on the potential health gains of a modifiable cardiovascular risk factor screening program for women whose pregnancy was complicated by hypertension or preeclampsia. The calculation of individual 10-year cardiovascular event risks will allow identification of those women who will benefit from primary prevention by tailored

  1. Outcomes in hypertensive disorders of pregnancy in the North Indian population

    Directory of Open Access Journals (Sweden)

    Sachan R

    2013-03-01

    Full Text Available Rekha Sachan,1 Munna Lal Patel,2 Pushpalata Sachan,3 Amrita Gaurav,1 Meenakshi Singh,1 Bhumika Bansal11Department of Obstetrics and Gynecology, 2Department of Medicine, 3Department of Physiology, King George's Medical University, Lucknow, Uttar Pradesh, IndiaIntroduction: Hypertensive disorders complicating pregnancy seriously endanger the safety of the mother and fetus during pregnancy. Very few studies have explored hypertensive disorders of pregnancy in India, even though this disease has been associated with adverse maternal and perinatal outcomes. This study aimed to analyze the disease pattern and risk factors associated with the disorder and assess the maternal and fetal outcomes in cases of hypertensive disorders of pregnancy.Subjects and methods: This case-control study was carried out over 1 year from 2011 to 2012 at the Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 149 patients were enrolled in the study. As seven were lost to follow-up, analysis was carried out on 142 cases. Patients were further classified according to the National High Blood Pressure Education Program Working Group (2000 as having mild preeclampsia (65 cases, severe preeclampsia (32 cases, or eclampsia (45 cases. Thirty-one healthy pregnant non-hypertensive women were enrolled into the study as controls.Results: The most common manifestation was edema, seen in 90% of cases. Proteinuria was also relatively common, 26.76% of patients with proteinuria of ≥300 mg/24 hours, 47.88% with proteinuria of ≥2 g/24 hours, and 25.35% with a urinary protein excretion of 3–5 g/24 hours. Central nervous system involvement was observed in 42.2% of cases, elevated bilirubin levels in 47.0%, visual symptoms in 6.4%, vaginal bleeding in 11.3%, and HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome was reported in 2.80%. Maternal deaths occurred in 2.8% of cases, all of which were from

  2. Association Between Hypertensive Disorders of Pregnancy and Later Risk of Cardiomyopathy

    DEFF Research Database (Denmark)

    Behrens, Ida; Basit, Saima; Lykke, Jacob Alexander

    2016-01-01

    disorder of pregnancy. During follow-up, 1577 women (mean age, 48.5 years at cardiomyopathy diagnosis; 2.6% with multiple pregnancies) developed cardiomyopathy. Compared with women with normotensive pregnancies (18,211,603 person-years of follow-up; n = 1408 cardiomyopathy events, 7.7/100,000 person......-years [95% CI, 7.3-8.2]), women with a history of hypertensive disorders of pregnancy had significantly increased rates of cardiomyopathy (in 173,062 person-years of follow-up among women with severe preeclampsia, n = 27 cardiomyopathy events; 15.6/100,000 person-years [95% CI, 10.7-22.7]; adjusted hazard......IMPORTANCE: Women with hypertensive disorders of pregnancy, preeclampsia in particular, have an increased risk of cardiomyopathy during the peripartum period. Whether hypertensive disorders of pregnancy are also associated with cardiomyopathy later in life is unknown. OBJECTIVE: To determine...

  3. Hydrogen inhibits cytotrophoblast cells apoptosis in hypertensive disorders complicating pregnancy.

    Science.gov (United States)

    Guo, L; Guan, Z; Li, H; Yang, X

    2016-05-30

    Hypertensive disorders complicating pregnancy (HDCP) is one of the most serious medical disorders during pregnancy. Hydrogen is a therapeutic antioxidant and used to treat HDCP effectively. However, the molecular mechanism about the effect of hydrogen on HDCP still remains unclear. In this study, we found ROS content in HDCP group was significantly higher than that in the control and was reduced markedly in the presence of 100μmol/L hydrogen. IL6, Caspase3, Bax1, P-JAK2, P-Stat3 and P-p38 expression was much higher than the control, and was notably decreasedby the application of 100μmol/L hydrogen. Bcl2 expression in HDCP group was notably lower than the control and was increased by 100 μmol/L hydrogen. The apoptosis rate of cytotrophoblast cells was decreased, andratio of cytotrophoblast cells at G1 and G2 phase was increased and decreased by hydrogen, respectively. All those data indicated a potential molecular mechanism of hydrogen-mediated treatment in HDCP.

  4. Oral beta-blockers for mild to moderate hypertension during pregnancy.

    Science.gov (United States)

    Magee, L A; Duley, L

    2000-01-01

    Hypertension is a common complication of pregnancy. Antihypertensive drugs are widely used in the belief these will improve outcome for both the woman (such as decreasing the risk of stroke or eclampsia) and her baby (such as decreasing the risk of preterm birth and its complications). Beta-blockers are a popular choice of antihypertensive agent during pregnancy; other choices include methyldopa and calcium channel blockers. The aim of this review is to assess whether oral beta-blockers are overall better than placebo, or no beta-blocker, for women with mild-moderate hypertension during pregnancy, and to assess whether oral beta-blockers have any advantages over other antihypertensive agents for women with mild-moderate hypertension during pregnancy. Both maternal outcomes (e.g., the incidence of severe hypertension) and perinatal outcomes (e.g., mortality) were of interest. Register of trials maintained by the Cochrane Pregnancy and Childbirth Group, MEDLINE 1966-97, bibliographies of retrieved papers, personal files. Date of last search: June 2000. Trials comparing beta-blockers with (i) placebo or no therapy, or (ii) other antihypertensive agents, for women with mild-moderate pregnancy hypertension (i.e., blood pressure under 170 mm Hg systolic, or 110 mm Hg diastolic). All data were extracted independently by two investigators, who were not blinded to outcome or other trial characteristics. Whenever possible, missing data were obtained by personal communication with authors. Discrepancies were resolved by discussion. The overview was divided into two comparisons: (i) beta-blockers versus placebo or no therapy, and (ii) beta-blockers versus other antihypertensives. Twenty-seven trials, involving just under 2400 women, are included in this review. Fourteen trials (1516 women) compared beta-blockers with placebo/no beta blocker. Oral beta-blockers decrease the risk of severe hypertension (relative risk (RR) 0.37, 95% confidence interval (CI) 0.26-0.53) and the

  5. Obesity-Related Hypertension: Focus on Leptin

    DEFF Research Database (Denmark)

    Asferg, Camilla Lundegaard

    suggested to play a role in obesity-related hypertension such as the renin-angiotensin-aldosterone system, the sympathetic nervous system, inflammation, insulin resistance, physical inactivity, and abnormal production of adipocytokines. Of all adipocytokines, leptin and adiponectin have received most...... attention and both hormones are considered as candidate intermediaries between adipose tissue and overweight and obesity-related disorders. Objectives: To study obesity-related hypertension with special focus on the hormone leptin. As obesity-related hypertension is multifactorial, other biological systems...... proposed to play a major role were also studied. Primary hypotheses: 1. leptin is a significant mediator of overweight- and obesity-related hypertension. 2. by investigating several biological systems involved in blood pressure regulation, it would be possible to identify specific factors which would...

  6. Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes

    Science.gov (United States)

    Domaracki, Piotr; Sadlecki, Pawel; Odrowaz-Sypniewska, Grazyna; Dzikowska, Ewa; Walentowicz, Pawel; Siodmiak, Joanna; Grabiec, Marek; Walentowicz-Sadlecka, Malgorzata

    2016-01-01

    Background: An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH) vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM). Moreover, we analyzed an association between maternal serum 25(OH)D and the risk of gestational hypertension, preeclampsia and GDM. Material and Methods: The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45), preeclampsia (n = 23) or GDM (n = 103). The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OH)D were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OH)D concentrations (18.20 vs. 22.10 ng/mL, p = 0.15). Highly significant differences were found in 25(OH)D concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021). GDM was not associated with significant differences in 25(OH)D concentration. A low level of 25(OH)D turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic) analysis (AUC = 0.70, p < 0.01). Conclusions: 25(OH)D deficiency is common among pregnant Polish women. Low concentrations of 25(OH)D may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OH)D level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia. PMID:27690002

  7. Three-Dimensional Segmented Poincaré Plot Analyses SPPA3 Investigates Cardiovascular and Cardiorespiratory Couplings in Hypertensive Pregnancy Disorders.

    Science.gov (United States)

    Fischer, Claudia; Voss, Andreas

    2014-01-01

    Hypertensive pregnancy disorders affect 6-8% of gestations representing the most common complication of pregnancy for both mother and fetus. The aim of this study was to introduce a new three-dimensional coupling analysis methods - the three-dimensional segmented Poincaré plot analyses (SPPA3) - to establish an effective approach for the detection of hypertensive pregnancy disorders and especially pre-eclampsia (PE). A cubic box model representing the three-dimensional phase space is subdivided into 12 × 12 × 12 equal predefined cubelets according to the range of the SD of each investigated signal. Additionally, we investigated the influence of rotating the cloud of points and the size of the cubelets (adapted or predefined). All single probabilities of occurring points in a specific cubelet related to the total number of points are calculated. In this study, 10 healthy non-pregnant women, 66 healthy pregnant women, and 56 hypertensive pregnant women (chronic hypertension, pregnancy-induced hypertension, and PE) were investigated. From all subjects, 30 min of beat-to-beat intervals (BBI), respiration (RESP), non-invasive systolic (SBP), and diastolic blood pressure (DBP) were continuously recorded and analyzed. Non-rotated adapted SPPA3 discriminated best between hypertensive pregnancy disorders and PE concerning coupling analysis of two or three different systems (BBI, DBP, RESP and BBI, SBP, DBP) reaching an accuracy of up to 82.9%. This could be increased to an accuracy of up to 91.2% applying multivariate analysis differentiating between all pregnant women and PE. In conclusion, SPPA3 could be a useful method for enhanced risk stratification in pregnant women.

  8. The Role of Headache in the Classification and Management of Hypertensive Disorders in Pregnancy.

    Science.gov (United States)

    Sperling, Jeffrey D; Dahlke, Joshua D; Huber, Warren J; Sibai, Baha M

    2015-08-01

    Hypertensive disorders of pregnancy remain among the leading causes of maternal morbidity and mortality. The onset of headaches in patients with hypertensive disorders of pregnancy has been considered as a premonitory symptom for eclampsia and other adverse maternal outcomes. Headaches are very common symptoms during pregnancy and the postpartum period with a reported incidence of 39%; however, headache is absent in 30-50% of women before the onset of eclampsia and is a poor predictor of eclampsia and adverse maternal outcomes. If included in the definition of cerebral or visual disturbances, headache may be considered a symptom of preeclampsia, a diagnostic feature of preeclampsia with severe features, a premonitory symptom of eclampsia, and an indication for delivery. Inclusion of this nonspecific symptom in the diagnosis and management of hypertensive disorders of pregnancy in the absence of an evidence basis may lead to unintended consequences including excessive testing, visits to outpatient offices or emergency departments, additional hospitalization, and iatrogenic preterm delivery without proven benefit. If a cerebral disturbance such as severe or persistent headache presents for the first time during pregnancy or postpartum, an evaluation should be performed that considers a broad differential diagnosis, including but not limited to hypertensive disorders of pregnancy, and the diagnostic evaluation is similar to that in nonpregnant adults. This commentary draws attention to the implications of considering the cerebral disturbance of headache as a symptom that portends adverse pregnancy outcome in the current recommendations for diagnosing and managing hypertensive disorders of pregnancy.

  9. Pregnancy-related myocardial infarction

    NARCIS (Netherlands)

    Lameijer, H.; Lont, M. C.; Buter, H.; van Boven, A. J.; Boonstra, P. W.; Pieper, P. G.

    Introduction The risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but

  10. Risk Prediction Models for Hypertensive Disorders of Pregnancy: Role of 12-Lead Electrocardiography

    Directory of Open Access Journals (Sweden)

    Angeli Fabio

    2016-06-01

    Full Text Available Hypertensive disorders represent the most common medical complications of pregnancy, affecting 6 to 8 percent of gestations. They may lead to severe maternal and fetal complications.

  11. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens; Sibai, Baha M;

    2009-01-01

    Minimal data exist concerning the relationship between hypertensive pregnancy disorders and various subsequent cardiovascular events and the effect of type 2 diabetes mellitus on these. In a registry-based cohort study, we identified women delivering in Denmark from 1978 to 2007 with a first...... for the development of type 2 diabetes mellitus. The end points were subsequent hypertension, ischemic heart disease, congestive heart failure, thromboembolic event, stroke, and type 2 diabetes mellitus. The risk of subsequent hypertension was increased 5.31-fold (range: 4.90 to 5.75) after gestational hypertension...... preeclampsia. Women having 2 pregnancies both complicated by preeclampsia had a 6.00-fold (range: 5.40 to 6.67) increased risk of subsequent hypertension compared with 2.70-fold (range: 2.51 to 2.90) for women having preeclampsia in their first pregnancy only and 4.34-fold (range: 3.98 to 4.74) for women...

  12. Oxidative stress markers in hypertensive states of pregnancy: preterm and term disease.

    Science.gov (United States)

    Kurlak, Lesia O; Green, Amanda; Loughna, Pamela; Broughton Pipkin, Fiona

    2014-01-01

    Discussion continues as to whether de novo hypertension in pregnancy with significant proteinuria (pre-eclampsia; PE) and non-proteinuric new hypertension (gestational hypertension; GH) are parts of the same disease spectrum or represent different conditions. Non-pregnant hypertension, pregnancy and PE are all associated with oxidative stress. We have established a 6 weeks postpartum clinic for women who experienced a hypertensive pregnancy. We hypothesized that PE and GH could be distinguished by markers of oxidative stress; thiobarbituric acid reactive substances (TBARS) and antioxidants (ferric ion reducing ability of plasma; FRAP). Since the severity of PE and GH is greater pre-term, we also compared pre-term and term disease. Fifty-eight women had term PE, 23 pre-term PE, 60 had term GH and 6 pre-term GH, 11 pre-existing (essential) hypertension (EH) without PE. Limited data were available from normotensive pregnancies (n = 7) and non-pregnant controls (n = 14). There were no differences in postpartum TBARS or FRAP between hypertensive states; TBARS (P = 0.001) and FRAP (P = 0.009) were lower in plasma of non-pregnant controls compared to recently-pregnant women. Interestingly FRAP was higher in preterm than term GH (P = 0.013). In PE and GH, TBARS correlated with low density lipoprotein (LDL)-cholesterol (P = 0.036); this association strengthened with inclusion of EH (P = 0.011). The 10 year Framingham index for cardiovascular risk was positively associated with TBARS (P = 0.003). Oxidative stress profiles do not differ between hypertensive states but appear to distinguish between recently-pregnant and non-pregnant states. This suggests that pregnancy may alter vascular integrity with changes remaining 6 weeks postpartum. LDL-cholesterol is a known determinant of oxidative stress in cardiovascular disease and we have shown this association to be present in hypertensive pregnancy further emphasizing that such a pregnancy may be revealing a pre

  13. 高尿酸血症与妊娠高血压的关系研究%Study the Relationship between Hyperuricemia and Pregnancy-Induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    马莉

    2013-01-01

    Objective:To study the relationship between hyperuricemia and pregnancy-induced hypertension and evaluation of uric acid detection predict perinatal outcome in patients with pregnancy-induced hypertension clinical value. Methed:356 cases of pregnancy-induced hypertension in patients for the study, and 89 cases of normal pregnant women as controls. compared pregnancy-induced hypertension group of patients with different levels of uric acid in perinatal outcome.Result:There was a statistically significant difference between the control group and pregnancy-induced hypertension group with the mean level of serum uric acid and uric acid increased rate comparison. Elevated levels of uric acid with pregnancy-induced hypertension condition serious.Conclusion:High uric acid level is closely related to pregnancy-induced hypertension, uric acid test is a good indicator in the evaluation of fetal prognosis of patients with pregnancy-induced hypertension.%  目的:研究高尿酸血症(HUA)与妊娠高血压(PIH)的关系,评价尿酸检测在PIH患者围产期结局预测的临床价值。方法:选择我院356例PIH患者为研究对象,并以89例正常妊娠妇女为对照。评价PIH组中不同尿酸水平患者围产儿预后比较。结果:对照组、PIH组平均血清尿酸水平、尿酸增高率比较有统计学差异,尿酸水平随PIH病情严重而升高。结论:高尿酸水平与妊娠高血压关系密切,尿酸检测是评价PIH患者胎儿预后的一个良好指标。

  14. Hypertension in pregnancy: the most recent findings in pathophysiology, diagnosis and therapy.

    Science.gov (United States)

    Zezza, L; Ralli, E; Conti, E; Passerini, J; Autore, C; Caserta, D

    2014-02-01

    Hypertension in pregnancy is a major cause of maternal, fetal and neonatal morbidity and mortality, both in developing and developed countries. That is because it is the most common pathological condition during pregnancy and its development is associated with high risk of severe complications: mother could be affected by placental abruption, cerebrovascular events, organ dysfunction and could develop disseminated intravascular coagulation, instead the foetus could be affected by intrauterine growth retardation, premature birth and intrauterine death. Aware that preeclampsia still remains an enigma for different aspects, this review aims to provide a comprehensive update of all the current literature regarding this disease. In particular, the main purpose of this review is to emphasize the most recent findings about the pathophysiology, diagnosis and submit a revision of the most recent guidelines in relation to drug therapy, with particular attention to the evaluation of risks and benefits associated with the use of various classes of the currently available drugs.

  15. The relationship between catecholamines levels in mother and fetus, and pathogenesis of pregnancy-induced hypertension

    Institute of Scientific and Technical Information of China (English)

    张为远; 赵艳辉; 殷艳玲

    2003-01-01

    Objective To study the relationship between pregnancy-induced hypertension (PIH) and catecholamine levels.Methods Catecholamines levels in maternal and fetal blood were determined in 116 patients with PIH and 40 normal control subjects using high performance liquid chromatography. The normal control subjects and PIH cases were selected from patients at term pregnancy receiving elective cesarean section. Results Plasma norepinephrine (NE) levels were significantly higher in patients with severe PIH than those in control subjects (P<0.05). Both patients and control subjects had higher NE levels in the umbilical artery blood than in the umbilical vein blood (P<0.05). NE levels in the umbilical artery blood were five times higher than those in the maternal blood.Conclusion The pathogenesis of PIH may relate to catecholamine concentrations in fetus.

  16. Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort

    DEFF Research Database (Denmark)

    Jørgensen, Kristian Tore; Nielsen, Nete Munk; Pedersen, Bo Vestergaard

    2012-01-01

    between the RRs for groups of female predominant ADs and other ADs. Strong and potentially biological associations were observed for a number of specific ADs; including systemic lupus erythematosus, Graves' disease, type 1 diabetes mellitus and pernicious anemia, and for some specific ADs associations......The risk of some female predominant autoimmune diseases (ADs) has previously been shown to be higher in women who experience hyperemesis, gestational hypertensive disorders and idiopathic pregnancy losses. This study assessed the association between such pregnancy-related experiences...... and the subsequent risk of female predominant and other ADs. Our study cohort comprised 1.6 million Danish women born since 1955 for whom we had information about hyperemesis, gestational hypertensive disorders and pregnancy losses and subsequent hospital contacts for 31 ADs between 1982 and 2008. Ratios of first...

  17. Beat-to-beat heart rate and blood pressure variability and hypertensive disease in pregnancy.

    Science.gov (United States)

    Flood, Pamela; McKinley, Paula; Monk, Catherine; Muntner, Paul; Colantonio, Lisandro D; Goetzl, Laura; Hatch, Maureen; Sloan, Richard P

    2015-09-01

    The aim of this study is to determine the relationship between heart rate and/or blood pressure variability, measured at 28 weeks' gestation, and the incidence of pregnancy-induced hypertension or preeclampsia. Secondary analysis of data from a prospectively enrolled cohort of 385 active military women in whom spectral analysis of continuous heart rate and variability was measured at 28 weeks' gestation. The primary outcome was the predictive value of spectral analysis of heart rate and blood pressure for hypertensive diseases of pregnancy. High-frequency heart rate variability was reduced and low-frequency variability of systolic and diastolic blood pressure increased in women who would develop pregnancy-induced hypertension but not preeclampsia. Low-frequency variability of diastolic blood pressure remained a significant predictor of pregnancy-induced hypertension but not preeclampsia after adjustment for age, weight, and blood pressure in a multivariate model. Early identification of pregnancy-induced hypertension can facilitate treatment to avoid maternal morbidity. Understanding the physiological underpinnings of the two very different diseases may lead to improved treatment and prevention. If proven effective in a broader population, the ability to differentiate pregnancy-induced hypertension from preeclampsia may reduce unnecessary iatrogenic interventions or inappropriate preterm delivery. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. The 2011 survey on hypertensive disorders of pregnancy (HDP in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes.

    Directory of Open Access Journals (Sweden)

    Chun Ye

    Full Text Available Hypertensive disorders of pregnancy (HDP are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44% and Central China showed the lowest (1.23%. Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.

  19. Obesity-Related Hypertension in Children

    Directory of Open Access Journals (Sweden)

    Tammy M. Brady

    2017-09-01

    Full Text Available Obesity and hypertension have both been on the rise in children. Each is associated with increased cardiovascular disease risk and both track into adulthood, increasing the prevalence of heart disease and related morbidity and mortality. All children should be screened for hypertension, but children with comorbid obesity may not only particularly benefit from the screening but may also prove the most challenging to screen. Increased arm circumference and conical arm shape are particularly problematic when attempting to obtain an accurate blood pressure (BP measurement. This review focuses on the unique aspects of hypertension evaluation and management in the child with comorbid obesity. Specific traditional and non-traditional risk factors that may contribute to elevated BP in children with obesity are highlighted. Current proposed pathophysiologic mechanisms by which obesity may contribute to elevated BP and hypertension is reviewed, with focus on the role of the sympathetic nervous system and the renin–angiotensin–aldosterone system. This review also presents a targeted treatment approach to children with obesity-related hypertension, providing evidence for the recommended therapeutic lifestyle change that should form the basis of any antihypertensive treatment plan in this population of at-risk children. Advantages of specific pharmacologic agents in the treatment of obesity-related hypertension are also reviewed.

  20. Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting

    NARCIS (Netherlands)

    Browne, J. L.; Vissers, K. M.; Antwi, E.; Srofenyoh, E. K.; Van der Linden, E. L.; Agyepong, I. A.; Grobbee, D. E.; Klipstein-Grobusch, K.

    2015-01-01

    Objective: The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting. Methods: A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal cli

  1. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy : a cohort study

    NARCIS (Netherlands)

    Hermes, Wietske; Franx, Arie; van Pampus, Maria G.; Bloemenkamp, Kitty W. M.; Bots, Michiel L.; van der Post, Joris A.; Porath, Martina; Ponjee, Gabrielle A. E.; Tamsma, Jouke T.; Mol, Ben Willem J.; de Groot, Christianne J. M.

    2013-01-01

    OBJECTIVE: The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. STUDY DESIGN: In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular r

  2. Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders: A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Hermes, W.; Ket, J.C.; Pampus, M.G. van; Franx, A.; Veenendaal, M.V.; Kolster, C.; Tamsma, J.T.; Bloemenkamp, K.W.; Ponjee, G.; Hout, E. van der; Ten Horn, H.; Loix, S.; Mol, B.W.; Groot, C.J. de

    2012-01-01

    The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inc

  3. Biochemical Cardiovascular Risk Factors After Hypertensive Pregnancy Disorders : A Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Hermes, Wietske; Ket, Johannes C. F.; van Pampus, Maria G.; Franx, Arie; Veenendaal, Marjolein V. E.; Kolster, Clara; Tamsma, Jouke T.; Bloemenkamp, Kitty W. M.; Ponjee, Gabrielle; van der Hout, Evelien; ten Horn, Hilde; Loix, Stephanie; Mol, Ben Willem; de Groot, Christianne J. M.

    2012-01-01

    The objective of this study was to perform a systematic review and meta-analysis of studies assessing biochemical cardiovascular risk factors in women with previous hypertensive pregnancy disorders and women with previous normotensive pregnancies. Data were collected from PubMed and EMBASE (from inc

  4. Parent-offspring conflict and the persistence of pregnancy-induced hypertension in modern humans

    DEFF Research Database (Denmark)

    Hollegaard, Birgitte; Byars, Sean Geoffrey; Lykke, Jacob;

    2013-01-01

    Preeclampsia is a major cause of perinatal mortality and disease affecting 5-10% of all pregnancies worldwide, but its etiology remains poorly understood despite considerable research effort. Parent-offspring conflict theory suggests that such hypertensive disorders of pregnancy may have evolved ...

  5. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy : a cohort study

    NARCIS (Netherlands)

    Hermes, Wietske; Franx, Arie; van Pampus, Maria G.; Bloemenkamp, Kitty W. M.; Bots, Michiel L.; van der Post, Joris A.; Porath, Martina; Ponjee, Gabrielle A. E.; Tamsma, Jouke T.; Mol, Ben Willem J.; de Groot, Christianne J. M.

    2013-01-01

    OBJECTIVE: The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. STUDY DESIGN: In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular r

  6. Posterior Reversible Encephelopathy Syndrome Presenting as Quadriparesis in Pregnancy Induced Hypertension

    Science.gov (United States)

    Pranita; Kumar, Ajit; Shahi, Seema

    2015-01-01

    Pregnancy Induced Hypertension (PIH) is a condition characterised by raised blood pressure in pregnancy. It affects approximately one out of every 14 pregnant women. Although PIH more commonly occurs during first pregnancy, it can also occur in subsequent pregnancies. It can present with variable complications related to vasospasm. But focal neurologic deficits are extremely rare in patients with PIH. We report a case of quadriparesis due to posterior reversible encephalopathy syndrome (PRES). A 36 year old full term pregnant female was admitted for emergency lower segment caesarean section (LSCS) as a result of uncontrolled PIH with early clinical signs of left ventricular failure. She was recovering well from pulmonary oedema after being provided with mechanical ventilation. However on 4th day she developed sudden onset quadriparesis without any alteration in sensorium, bladder & bowel disturbance or any sensory deficit. Diffusion weighted neuroimaging (DWI) was carried out which revealed finding suggestive of PRES. The patient was treated with antihypertensive which followed improvement in neurological deficit. Although rare, PRES should be considered as a potential cause of acute onset focal neurological deficit in pregnant females with PIH. With this case report we have tried to create awareness and vigilance about rare but potentially serious yet salvageable condition like PRES. PMID:26023585

  7. Obesity-related hypertension: possible pathophysiological mechanisms.

    Science.gov (United States)

    Vaněčková, Ivana; Maletínská, Lenka; Behuliak, Michal; Nagelová, Veronika; Zicha, Josef; Kuneš, Jaroslav

    2014-12-01

    Hypertension is one of the major risk factors of cardiovascular diseases, but despite a century of clinical and basic research, the discrete etiology of this disease is still not fully understood. The same is true for obesity, which is recognized as a major global epidemic health problem nowadays. Obesity is associated with an increasing prevalence of the metabolic syndrome, a cluster of risk factors including hypertension, abdominal obesity, dyslipidemia, and hyperglycemia. Epidemiological studies have shown that excess weight gain predicts future development of hypertension, and the relationship between BMI and blood pressure (BP) appears to be almost linear in different populations. There is no doubt that obesity-related hypertension is a multifactorial and polygenic trait, and multiple potential pathogenetic mechanisms probably contribute to the development of higher BP in obese humans. These include hyperinsulinemia, activation of the renin-angiotensin-aldosterone system, sympathetic nervous system stimulation, abnormal levels of certain adipokines such as leptin, or cytokines acting at the vascular endothelial level. Moreover, some genetic and epigenetic mechanisms are also in play. Although the full manifestation of both hypertension and obesity occurs predominantly in adulthood, their roots can be traced back to early ontogeny. The detailed knowledge of alterations occurring in the organism of experimental animals during particular critical periods (developmental windows) could help to solve this phenomenon in humans and might facilitate the age-specific prevention of human obesity-related hypertension. In addition, better understanding of particular pathophysiological mechanisms might be useful in so-called personalized medicine.

  8. Dramatic response of a patient with pregnancy induced idiopathic pulmonary arterial hypertension to sildenafil treatment.

    Science.gov (United States)

    Taçoy, Gülten; Ekim, Numan Nadir; Cengel, Atiye

    2010-04-01

    Idiopathic pulmonary arterial hypertension (IPAH) is characterized by a progressive increase in pulmonary vascular resistance, which may lead to right ventricular failure and death. Major cardiovascular and pulmonary alterations occur during pregnancy and therefore worsen or increase the complications of pulmonary arterial hypertension (PAH). A patient diagnosed with IPAH after a successful full-term pregnancy and cesarean section with epidural anesthesia is presented. The postoperative course was complicated by progressive dyspnea, and lower limb edema. The outcome of treatment with sildenafil during puerperium was favorable in this patient. The clinical course was complicated by an unexpected spontaneous pregnancy after primary infertility.

  9. Transcatheter therapy for aortic coarctation with severe systemic hypertension during pregnancy.

    Science.gov (United States)

    Assaidi, Anass; Sbragia, Pascal; Fraisse, Alain

    2013-10-01

    Aortic coarctation is an unusual cause of hypertension during pregnancy and its management is not clarified. We report transcatheter balloon dilatation and stenting for native aortic coarctation in a 22-year-old pregnant woman with severe and uncontrolled systemic hypertension. Arterial blood pressure could be successfully controlled with medical treatment during the rest of the pregnancy and the patient underwent uneventful delivery. No adverse events or recoarctation was observed during 24 months clinical follow-up. In conclusion, native aortic coarctation can be successfully treated during pregnancy with transcatheter therapy. More experience is needed to confirm the safety and efficacy of such management.

  10. [Hypertension and pregnancy. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology].

    Science.gov (United States)

    Mounier-Vehier, Claire; Amar, Jacques; Boivin, Jean-Marc; Denolle, Thierry; Fauvel, Jean-Pierre; Plu-Bureau, Geneviève; Tsatsaris, Vassilis; Blacher, Jacques

    2016-01-01

    High blood pressure in pregnancy remains, by its complications, the leading cause of morbidity and maternal and fetal mortality. The frequency (5 to 10% of pregnancies) and the potential severity of this disease, both for mother and child, encourage to standardize and to optimize our medical practices. This is the main objective of this work. If the short-term complications for the mother and child are well known, long-term ones for the mother beginning to be better identified (in particular, the risk of recurrence in a subsequent pregnancy, the risk of chronic hypertension and the increased risk of cardiovascular events). The occurrence of hypertension during pregnancy disturbs the "classic" organization of care. Several health professionals are involved, the general practitioner, obstetrician, gynecologist, midwife, cardiologist, nephrologist… There is not always a care coordinator and decisions are sometimes taken with delay. These data encouraged the French Society of Hypertension to write a consensus offering easy and efficient recommendations. Educate women and all health professionals to hypertension and its management, in line with current scientific data, is one of the major challenges of this consensus.

  11. Pregnancy hypertension and the risk for neuropsychological difficulties across early development: A brief report.

    Science.gov (United States)

    Wade, Mark; Jenkins, Jennifer M

    2016-01-01

    Despite documented effects on fetal brain development, little is currently known about the relationship between maternal pregnancy hypertension and child neuropsychological outcomes. This brief report examined the association between maternal hypertension during pregnancy and children's social cognition and executive functioning when children were 18 months, 3 years, and 4.5 years. A community sample of 501 families (23 hypertensive mothers; 478 nonhypertensive) was recruited when children were newborns. Social cognition (including theory of mind [ToM]) and executive functioning (EF) were measured using a battery of age-appropriate standardized and/or observational tasks. Information on pregnancy and prenatal factors were measured via maternal report when children were newborns. After controlling for prenatal and demographic covariates, the presence of hypertension difficulties during pregnancy was associated with all measures of social cognition, ToM, and EF. A secondary analysis comparing the hypertension group (n = 23) to a nonhypertensive matched control group (n = 23) supported the effect of pregnancy hypertension on children's social-cognitive and EF development. Future studies using obstetrical records are encouraged based on these preliminary findings.

  12. [Successful pregnancy in a patient with idiopathic pulmonary arterial hypertension. Case report].

    Science.gov (United States)

    Szenczi, Orsolya; Karlócai, Kristóf; Bucsek, László; Rigó, János

    2016-04-10

    Idiopathic pulmonary arterial hypertension is characterized by progressive increase in pulmonary arterial pressure and pulmonary vascular resistance which lead to right ventricular failure and death. Pregnancy in patients with idiopathic pulmonary arterial hypertension is contraindicated because of the high maternal and fetal mortality. The authors present a case of successful pregnancy and delivery of a patient with idiopathic pulmonary arterial hypertension in Hungary for the first time. The aim of the report was to demonstrate that management and treatment of idiopathic pulmonary arterial hypertension in a pregnant woman is a complex and multidisciplinary task that should involve obstetrician, cardiologist and anesthesiologist. Those patients who become pregnant and do not wish to terminate the pregnancy must be referred to obstetric centers where a multidiciplinary approach is taken.

  13. Parent-offspring conflict and the persistence of pregnancy-induced hypertension in modern humans

    DEFF Research Database (Denmark)

    Hartsteen, Birgitte Hollegaard; Byars, Sean Geoffrey; Lykke, Jacob;

    2013-01-01

    Preeclampsia is a major cause of perinatal mortality and disease affecting 5-10% of all pregnancies worldwide, but its etiology remains poorly understood despite considerable research effort. Parent-offspring conflict theory suggests that such hypertensive disorders of pregnancy may have evolved...... through the ability of fetal genes to increase maternal blood pressure as this enhances general nutrient supply. However, such mechanisms for inducing hypertension in pregnancy would need to incur sufficient offspring health benefits to compensate for the obvious risks for maternal and fetal health...... that offspring exposed to pregnancy-induced hypertension (PIH) in trimester 1 had significantly reduced overall later-life disease risks, but increased risks when PIH exposure started or developed as preeclampsia in later trimesters. Similar patterns were found for first-year mortality. These results suggest...

  14. Incidence and pregnancy outcomes of superimposed preeclampsia with or without proteinuria among women with chronic hypertension.

    Science.gov (United States)

    Nakanishi, Sayuri; Aoki, Shigeru; Nagashima, Ami; Seki, Kazuo

    2017-01-01

    To investigate the incidence and pregnancy outcomes of superimposed preeclampsia (PE) with or without proteinuria among women with chronic hypertension. This retrospective study included 142 women with essential hypertension diagnosed at ⩽20weeks of gestation, managed at a tertiary center. They were divided into three groups (non-PE, PE with proteinuria, and PE without proteinuria) to compare pregnancy outcomes. The non-PE group was further divided into two subgroups (controlled and uncontrolled hypertension). There were 87 women in the non-PE group, 47 in the PE with proteinuria group, and 8 in the PE without proteinuria group. Median gestational age at delivery was 38.7weeks in the non-PE group, 30.4 in the PE with proteinuria group, and 28.4 in the PE without proteinuria group. In three of the women in the PE without proteinuria group, the diagnostic criteria were fulfilled by liver involvement (complicated by thrombocytopenia in one woman). The remaining five women had uteroplacental dysfunction. The 87 women in the non-PE group were divided into a controlled hypertension subgroup of 75 women and uncontrolled hypertension subgroup of 12. The median gestational age at delivery was 39.1weeks in the controlled HT subgroup and 34.1weeks in the uncontrolled hypertension subgroup. The pregnancy outcomes were significantly poorer in the latter group. Pregnancy outcomes were unfavorable in both the PE without proteinuria and PE with proteinuria groups. Women with non-PE uncontrolled hypertension also had poor pregnancy outcomes, although their outcomes were better than those of women with PE. Copyright © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  15. No Hypertensive Disorder of Pregnancy; No Preeclampsia-eclampsia; No Gestational Hypertension; No Hellp Syndrome. Vascular Disorder of Pregnancy Speaks for All.

    Science.gov (United States)

    Berhan, Yifru

    2016-03-01

    Hypertensive disorders complicate 5%-10% of pregnancies with increasing incidence mainly due to upward trends in obesity globally. In the last century, several terminologies have been introduced to describe the spectrum of this disease. The current and widely used classification of hypertensive pregnancy disorders was introduced in 1972 and in 1982, but has not been free of controversy and confusion. Unlike other diseases, the existing terminology combines signs and symptoms, but does not describe the underlying pathology of the disease itself. In this commentary, a detailed account is given to vascular disorder of pregnancy (VDP) as an inclusive terminology taking into account the underlying pathology of the disease on affected organs and systems. A simple and uniform classification scheme for VDP is proposed.

  16. [Pregnancy-related acute kidney injury].

    Science.gov (United States)

    Filipowicz, Ewa; Staszków, Monika

    Acute kidney injury (AKI) in obstetrics may be caused by the same disorders that are observed in the general population or may be specific for a pregnancy such as: preeclampsia, HELLP syndrome or acute fatty liver of pregnancy. The renal changes may be only temporary, and resolve within a few weeks postpartum, or may become irreversible leading to a progression of chronic kidney disease (CKD). In the article the most important pregnancy related syndromes associated with AKI have been shortly reviewed.

  17. The Risk Factors That Predict Chronic Hypertension After Delivery in Women With a History of Hypertensive Disorders of Pregnancy.

    Science.gov (United States)

    Hwang, Ji-Won; Park, Sung-Ji; Oh, Soo-Young; Chang, Sung-A; Lee, Sang-Chol; Park, Seung Woo; Kim, Duk-Kyung

    2015-10-01

    Hypertensive disorders of pregnancy (HDP) is one of the most important lethal complications in pregnant mothers. It is also associated with the subsequent development of chronic hypertension. The objective of this study was to identify the clinical risk factors of postpartum chronic hypertension in women diagnosed with HDP.Six hundred patients as HDP, who diagnosed and followed-up at least 6 month after delivery, were included in the study. We divided the included subjects in 2 groups based on the development of postpartum chronic hypertension: presenting with the chronic hypertension, "case group" (n = 41) and without chronic hypertension, "control group" (n = 559).Clinical and demographic factors were evaluated. By multiple regression analysis, early onset hypertension with end-organ dysfunction, smoking, higher prepregnancy body mass index (BMI), and comorbidities, systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APLS), were associated with progression to chronic hypertension in the postpartum period. The value of area under the curves (AUC) for the 5 models, that generated to combine the significant factors, increased from 0.645 to 0.831, which indicated improved prediction of progression to the chronic hypertension. Additional multivariate analysis revealed significant specific risk factors.This retrospective single hospital-based study demonstrated that the clinical risk factors, that is early onset hypertension with end-organ dysfunction, smoking, and higher prepregnancy BMI, were significant independent predictors of chronic hypertension in women after delivery. Identification of risk factors allowed us to narrow the subject field for monitoring and managing high blood pressure in the postpartum period.

  18. More vasomotor symptoms in menopause among women with a history of hypertensive pregnancy diseases compared with women with normotensive pregnancies

    NARCIS (Netherlands)

    Drost, J.T.D.; Schouw, Y.T. van der; Herber-Gast, G.C.; Maas, A.H.E.M.

    2013-01-01

    OBJECTIVE: Cardiovascular disease is the major cause of mortality in women worldwide. In recent years, several female-specific cardiovascular risk factors, such as hypertensive pregnancy diseases (HPDs) and vasomotor menopausal symptoms (VMS), have been identified. In this study, we evaluated the as

  19. Hypertensive disorders of pregnancy and subsequent risk of solid cancer--A nationwide cohort study.

    Science.gov (United States)

    Behrens, Ida; Basit, Saima; Jensen, Allan; Lykke, Jacob Alexander; Nielsen, Lars Peter; Wohlfahrt, Jan; Kjær, Susanne K; Melbye, Mads; Boyd, Heather Allison

    2016-07-01

    Women with hypertensive disorders of pregnancy (HDP) have higher levels of antiangiogenic growth factors during pregnancy than women with normotensive pregnancies. Since angiogenesis is necessary for solid cancer growth and spread, we hypothesized that women with a history of HDP might have a reduced risk of solid cancers (cancers other than lymphomas, hematologic cancers and nonmelanoma skin cancers) later in life. In a register-based cohort study of 1.08 million women giving birth at least once between 1978 and 2011, we used Cox regression to estimate hazard ratios (HRs) comparing solid cancer rates for women with and without a history of HDP. In this cohort, 68,236 women (6.3%) had ≥1 pregnancy complicated by HDP and 42,236 women (3.9%) developed solid tumors during follow-up. A history of HDP was not associated with a clinically meaningful reduction in the overall rate of solid cancer (HR 0.96, 95% confidence interval 0.92-1.00), regardless of HDP severity or time since HDP, nor was there a general tendency toward reduced solid cancer rates across organ sites. A history of HDP was only significantly associated with decreased rates of breast and lung cancers and with increased rates of endometrial and urinary tract cancers. Overall, our results do not support the hypothesis that women with a history of HDP have a reduced overall risk of solid cancer due to a persistent post-HDP antiangiogenic state or an innate tendency toward antiangiogenesis. Observed associations with specific cancers may instead be due to other pregnancy-related mechanisms or to residual/unmeasured confounding.

  20. Maternal Hypertension During Pregnancy and the Risk of Congenital Heart Defects in Offspring: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Ramakrishnan, Anushuya; Lee, Laura J; Mitchell, Laura E; Agopian, A J

    2015-10-01

    Maternal hypertension is common during pregnancy, and multiple studies have reported on an association between maternal hypertension and congenital heart defects (CHDs) in offspring; however, there is variability in the quality of these studies. A systematic review and meta-analysis was conducted on the associations between untreated and treated maternal hypertension and the risk of CHDs, evaluating CHDs overall as well as specific CHD subtypes. A systematic search of peer-reviewed articles published before August 2013 identified 16 studies evaluating the associations between untreated and treated maternal hypertension and CHDs. Summary relative risk (RR) estimates were calculated using fixed-effects models and random-effects models. Significant associations were observed between maternal hypertension and overall CHDs, for both treated [RR 2.0; 95 % confidence interval (CI) 1.5, 2.7] and untreated (RR 1.4; 95 % CI 1.2, 1.7) hypertension, as well as for overall hypertension regardless of treatment status (RR 1.8; 95 % CI 1.5, 2.2). The magnitude of effect was similar for the majority of CHD subtypes evaluated. The effects were also similar among women with hypertension who used one of multiple specific hypertension medications. There was no evidence of publication bias, and our results were robust to several factors considered in sensitivity analyses (e.g., source of exposure data, adjustment for potential confounders, and study design). Maternal hypertension was associated with CHDs. By understanding the specific mechanisms involved, appropriate strategies may be developed to reduce this risk, in order to prevent CHDs.

  1. Change of pulsatility index of the fetal middle cerebral artery after auditory stimulation in no risk pregnancies and in pregnancies with gestational hypertension.

    Science.gov (United States)

    Plesinac, Snezana; Jankovic, Svetlana; Plecas, Darko; Antonovic, Olga; Adamovic, Tatijana; Sovilj, Mirjana

    2013-01-01

    An aim was to determine the degree and the mode of variation of PI of middle cerebral artery in no risk pregnancies and in pregnancies with gestational hypertension, after the constant sound stimuli. Study included 343 patients divided in two groups. Group 1: low risk pregnancies and group 2: gestational hypertension. Ultrasound prenatal auditory screening was performed after the 27th week of gestation. The percentage of fetuses with increase of cerebral blood flow was slightly higher in the pregnancies with hypertension. An average change of PI of median cerebral artery was higher in this group.

  2. Intensive care management and outcome of women with hypertensive diseases of pregnancy

    Directory of Open Access Journals (Sweden)

    Charles Osalumese Imarengiaye

    2015-01-01

    Full Text Available Introduction: The burden of hypertensive diseases on the health care is enormous given to the high population in Sub-Saharan Africa and related disproportionate representation in global maternal mortality. Materials and Methods: All women with hypertensive diseases of pregnancy who got admitted into the general ICU of the University of Benin Teaching Hospital between January 2006 and December 2010 were studied. Only the records of women who completed 28 weeks of gestation and were admitted during labour and delivery or puerperium to the ICU were examined. Results: There were 13061 deliveries within the 5-year study period; 9301 by vaginal delivery and 3860 through Caesarean section. 52 (51.5% of the obstetric patients had hypertensive diseases of pregnancy. Of 52 women with pre-eclampsia and eclampsia, 45/52 had caesarean section and 7/52 had SVD. Admission was mainly postpartum 48/52 (92.3%. 35/52 (67.3% were transferred to the ward and 17 died (32.7%, giving the ICU maternal mortality rate of 307/1000 deliveries. 30 women developed pulmonary oedema alone or with renal impairment; 14 women were transferred and 16 died while 21 other patients who had renal impairment alone, HELLP, sepsis, etc were transferred out.There was about a 12-fold risk of death in the unit if the patient developed pulmonary oedema when compared to the other factors combined (p = 0.0002, RR = 11.7, 95%CI = 1.7 – 82.. Conclusion: Primiparity, unbooked status and caesarean delivery were leading factors for ICU admission in women with preeclampsia/eclampsia. The women who developed pulmonary oedema in the course of treatment had poor outcome and avoidance of pulmonary oedema may improve ICU outcome in women with preeclampsia/eclampsia.

  3. [Maternal metabolic diseases related to pre-pregnancy overweight and obesity in mexican women with high risk pregnancy].

    Science.gov (United States)

    Hernández-Higareda, Salvador; Pérez-Pérez, Omar-Alejandro; Balderas-Peña, Luz-Ma-Adriana; Martínez-Herrera, Brenda-Eugenia; Salcedo-Rocha, Ana-Leticia; Ramírez-Conchas, Rosa-Emilia

    Pre-pregnancy obesity has been proposed as a risk factor related to gestational diabetes and hypertensive disorders during pregnancy. Identify pregnancy related diseases associated with pre-pregnancy obesity as a risk factor ina high risk preganancy patient population. 600 patients whose pre-pregnancy obesity had been assessed as a high risk factor were included in the study. The means, standard deviation, median, interquartile intervals, Pearson and Spearman correlation and logistic regression to estimate risk with the odds ratio and 95% confidence intervals were calculated. The mean pre-pregnancy body mass index was 29.59 ± 6.42 kg/m(2). The mean for recommended pregnancy weight gain was 2.31 ± 1.03 kg, but the mean of real weight gain was 8.91 ± 6.84 kg. A significant correlation between pre-pregnancy obesity and family history of diabetes mellitus (p=0.000), systemic hypertension (p=0.003), cardiac diseases (p=0.000), dyslipidemia (p=0.000) and obesity (p=0.000) was identified. Pre-pregnancy obesity was identified as a risk factor for the development of gestational diabetes (OR: 1.95; IC95%: 1.39 to 2.76; p=0.000) in this kind of patient. 75% of high risk pregnancy women in a high specialty hospital in West Mexico are overweight or obese when they become pregnant. These are risk factors in the development of gestational diabetes. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  4. Lack of Thromboxane Synthase Prevents Hypertension and Fetal Growth Restriction after High Salt Treatment during Pregnancy.

    Directory of Open Access Journals (Sweden)

    Chen-Hsueh Pai

    Full Text Available Preeclampsia (PE is a potentially fatal pregnancy-related hypertensive disorder characterized by poor placenta development that can cause fetal growth restriction. PE-associated pathologies, including thrombosis, hypertension, and impaired placental development, may result from imbalances between thromboxane A2 (TXA2 and prostacyclin. Low-dose aspirin, which selectively inhibits TXA2 production, is used to prevent high-risk PE. However, the role of TXA2 in aspirin-mediated protective effects in women with PE is not understood fully. In this study, we examined the role of prostanoids in PE using human samples and an induced PE mouse model. We demonstrated that the administration of salted drinking water (2.7% NaCl to wild-type mice resulted in elevated placental TXA2 synthase (TXAS and plasma TXA2, but not prostacyclin, levels, which was also found in our clinical PE placenta samples. The high salt-treated wild-type pregnant mice had shown unchanged maternal body weight, hypertension (MAP increase 15 mmHg, and decreased pup weight (~50% and size (~24%, but these adverse effects were ameliorated in TXAS knockout (KO mice. Moreover, increased expression of interleukin-1β and downstream phosphorylated-p38-mitogen-activated protein kinase were concordant with apoptosis induction in the placentas of salt water-treated wild-type mice. These alterations were not observed in TXAS KO mice. Together, our data suggest that TXA2 depletion has anti-PE effects due to the prevention of hypertension and placental damage through downregulation of the interleukin-1β pathway.

  5. Lack of Thromboxane Synthase Prevents Hypertension and Fetal Growth Restriction after High Salt Treatment during Pregnancy.

    Science.gov (United States)

    Pai, Chen-Hsueh; Yen, Ching-Tzu; Chen, Chie-Pein; Yu, I-Shing; Lin, Shu-Wha; Lin, Shu-Rung

    2016-01-01

    Preeclampsia (PE) is a potentially fatal pregnancy-related hypertensive disorder characterized by poor placenta development that can cause fetal growth restriction. PE-associated pathologies, including thrombosis, hypertension, and impaired placental development, may result from imbalances between thromboxane A2 (TXA2) and prostacyclin. Low-dose aspirin, which selectively inhibits TXA2 production, is used to prevent high-risk PE. However, the role of TXA2 in aspirin-mediated protective effects in women with PE is not understood fully. In this study, we examined the role of prostanoids in PE using human samples and an induced PE mouse model. We demonstrated that the administration of salted drinking water (2.7% NaCl) to wild-type mice resulted in elevated placental TXA2 synthase (TXAS) and plasma TXA2, but not prostacyclin, levels, which was also found in our clinical PE placenta samples. The high salt-treated wild-type pregnant mice had shown unchanged maternal body weight, hypertension (MAP increase 15 mmHg), and decreased pup weight (~50%) and size (~24%), but these adverse effects were ameliorated in TXAS knockout (KO) mice. Moreover, increased expression of interleukin-1β and downstream phosphorylated-p38-mitogen-activated protein kinase were concordant with apoptosis induction in the placentas of salt water-treated wild-type mice. These alterations were not observed in TXAS KO mice. Together, our data suggest that TXA2 depletion has anti-PE effects due to the prevention of hypertension and placental damage through downregulation of the interleukin-1β pathway.

  6. A randomized trial of intravenous labetalol AND oral nifedipine in severe pregnancy induced hypertension

    OpenAIRE

    2012-01-01

    Background: Hypertension is the most frequently encountered medical disorder in obstetrics practice & remain a major cause of maternal, fetal & neonatal morbidity & mortality. The present study was undertaken to compare the time taken to reach the therapeutic goal blood pressure after using intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension. Methods: Randomly allocated patients received labetalol 20 mg initially, followed by escalating doses of 40, 80, 80 & 80 mg...

  7. Drug treatment of hypertension in pregnancy: a critical review of adult guideline recommendations.

    Science.gov (United States)

    Al Khaja, Khalid A J; Sequeira, Reginald P; Alkhaja, Alwaleed K; Damanhori, Awatif H H

    2014-03-01

    This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice.

  8. Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy.

    Science.gov (United States)

    Rezaei, Zahra; Sharbaf, Fatemeh Rahimi; Pourmojieb, Mino; Youefzadeh-Fard, Yashar; Motevalian, Manijeh; Khazaeipour, Zahra; Esmaeili, Sara

    2011-01-01

    Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy. Oral nifedipine is an alternative in management of these patients. In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients. Fifty hypertensive pregnant women were enrolled in the study. A randomized clinical trial was performed, in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction. The primary outcomes measured were the time and doses required for desired blood pressure achievement. Secondary measures included urinary output and maternal and neonatal side effects. The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group (24.0 ± 10.0 min) than intravenus Hydralazine group (34.8 ± 18.8 min) (P ≤ 0.016). Less frequent doses were required with oral nifedipine (1.2 ± 0.5) compared to intravenus hydralazine (2.1 ± 1.0) (P ≤ 0.0005). There were no episodes of hypotension after hydralazine and one after nifedipine. Nifedipine and hydralazine are safe and effective antihypertensive drugs, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. Both drugs reduce episodes of persistent severe hypertension. Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action, the good oral bioavailability and less frequent side effects, it looks more preferable in hypertension emergencies of pregnancy than hydralazine.

  9. Oxidative stress markers in hypertensive states of pregnancy: preterm and term disease.

    Directory of Open Access Journals (Sweden)

    Lesia Olha Kurlak

    2014-08-01

    Full Text Available Discussion continues as to whether de novo hypertension in pregnancy with significant proteinuria (pre-eclampsia; PE and non-proteinuric new hypertension (gestational hypertension; GH are parts of the same disease spectrum or represent different conditions. Non-pregnant hypertension, pregnancy and PE are all associated with oxidative stress. We have established a 6 weeks post-partum clinic for women who experienced a hypertensive pregnancy. We hypothesized that PE and GH could be distinguished by markers of oxidative stress; thiobarbituric acid reactive substances (TBARS and antioxidants (ferric ion reducing ability of plasma; FRAP. Since the severity of PE and GH is greater pre-term, we also compared pre-term and term disease. Fifty-eight women had term PE, 23 pre-term PE, 60 had term GH and 6 pre-term GH, 11 pre-existing (essential hypertension (EH without PE. Limited data were available from normotensive pregnancies (n=7 and non-pregnant controls (n=14. There were no differences in postpartum TBARS or FRAP between hypertensive states; TBARS (P=0.001 and FRAP (P=0.009 were lower in plasma of non-pregnant controls compared to recently-pregnant women. Interestingly FRAP was higher in preterm than term GH (P=0.013. In PE and GH, TBARS correlated with low density lipoprotein (LDL-cholesterol (P=0.036; this association strengthened with inclusion of EH ((P=0.011. The 10 year Framingham index for cardiovascular risk was positively associated with TBARS (P=0.003.Oxidative stress profiles do not differ between hypertensive states but appear to distinguish between recently-pregnant and non-pregnant states. This suggests that pregnancy may alter vascular integrity with changes remaining 6 weeks postpartum. LDL-cholesterol is a known determinant of oxidative stress in cardiovascular disease and we have shown this association to be present in hypertensive pregnancy further emphasizing that such a pregnancy may be revealing a pre-existing cardiovascular

  10. Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension: A Case Report.

    Science.gov (United States)

    de Macedo, José Fernando; de Macedo, Gustavo Capinzaiki; Campos, Luciana Aparecida; Baltatu, Ovidiu Constantin

    2015-09-01

    Patients with systemic lupus erythematosus have a poor prognosis of pregnancy, since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, pre-eclampsia, intrauterine growth restriction, fetal death and pre-term delivery. We report a case with successful pregnancy in a patient with systemic lupus erythematosus and hypertension. A 39-year-old nulliparous woman presented with systemic lupus erythematosus with antinuclear and antiphospholipid antibodies, hypertension and recurrent pregnancy loss presented for assisted reproduction. The patient responded well to enoxaparin and prednisone during both assisted reproduction and prenatal treatment. This case report indicates that prescription of immunosuppressant and blood thinners can be safely recommended throughout the whole prenatal period in patients with systemic lupus erythematosus. Enoxaparin and prednisone may be prescribed concurrently during pregnancy.

  11. Parent-offspring conflict and the persistence of pregnancy-induced hypertension in modern humans

    DEFF Research Database (Denmark)

    Hartsteen, Birgitte Hollegaard; Byars, Sean Geoffrey; Lykke, Jacob

    2013-01-01

    Preeclampsia is a major cause of perinatal mortality and disease affecting 5-10% of all pregnancies worldwide, but its etiology remains poorly understood despite considerable research effort. Parent-offspring conflict theory suggests that such hypertensive disorders of pregnancy may have evolved...... through the ability of fetal genes to increase maternal blood pressure as this enhances general nutrient supply. However, such mechanisms for inducing hypertension in pregnancy would need to incur sufficient offspring health benefits to compensate for the obvious risks for maternal and fetal health...... towards the end of pregnancy in order to explain why these disorders have not been removed by natural selection in our hunter-gatherer ancestors. We analyzed >750,000 live births in the Danish National Patient Registry and all registered medical diagnoses for up to 30 years after birth. We show...

  12. Ambulatory blood pressure monitoring for the early identification of hypertension in pregnancy.

    Science.gov (United States)

    Ayala, Diana E; Hermida, Ramón C

    2013-03-01

    Gestational hypertension and preeclampsia are major contributors to perinatal morbidity and mortality. The diagnosis of gestational hypertension still relies on conventional clinic blood pressure (BP) measurements and thresholds of ≥140/90 mm Hg for systolic (SBP)/diastolic (DBP) BP. However, the correlation between BP level and target organ damage, cardiovascular disease risk, and long-term prognosis is greater for ambulatory BP monitoring (ABPM) than clinic BP measurement. Accordingly, ABPM has been suggested as the logical approach to overcoming the low sensitivity and specificity of clinic BP measurements in pregnancy. With the use of ABPM, differing predictable BP patterns throughout gestation have been identified for clinically healthy and hypertensive pregnant women. In normotensive pregnancies, BP steadily decreases up to the middle of gestation and then increases up to the day of delivery. In contrast, women who develop gestational hypertension or preeclampsia show stable BP during the first half of pregnancy and a continuous linear BP increase thereafter until delivery. Epidemiologic studies have also consistently reported sex differences in the 24-h patterns of ambulatory BP and heart rate. Typically, men exhibit a lower heart rate and higher BP than women, the differences being larger for SBP than DBP. Additionally, as early as in the first trimester of gestation, statistically significant increased 24-h SBP and DBP means characterize women complicated with gestational hypertension or preeclampsia compared with women with uncomplicated pregnancies. However, the normally lower BP in nongravid women as compared with men, additional decrease in BP during the second trimester of gestation in normotensive but not in hypertensive pregnant women, and significant differences in the 24-h BP pattern between healthy and complicated pregnancies at all gestational ages have not been taken into consideration when establishing reference BP thresholds for the

  13. 妊娠期高血压疾病患者外周血凋亡相关因子浓度变化研究%Study on Apoptosis-Related Factors in Peripheral Serum of Patients with Hypertensive Disorder Complicating Preg-nancy

    Institute of Scientific and Technical Information of China (English)

    孔祥玲; 吴维光; 初巍巍

    2014-01-01

    Objective To investigate the changes of apoptosis-related factors in peripheral serum of patients with hy-pertensive disorder complicating pregnancy. Methods A total of 38 patients who suffered from gestational hypertension were chosen as hypertensive disorder complicating pregnancy group and 24 normal pregnant women were chosen as normal pregnancy group. The patients in hypertensive disorder complicating pregnancy group were divided into three groups: gestational hyper-tension group (14 patients), mild preeclampsia group (14 patients) and severe preeclampsia group (10 patients). Before ce-sarean section, vascular endothelial growth factor ( VEGF) , placenta growth factor ( PLGF) and GATA-3 in the normal preg-nancy group and hypertensive disorder complicating pregnancy group were detected for comparisons. Results The concentra-tions of VEGF and PLGF were markedly lower in hypertensive disorder complicating pregnancy group than those in normal pregnancy group, but GATA-3 was higher than that in normal pregnancy group, and the differences were all significant ( P<0. 05 ) . Peripheral blood concentrations of VEGF and PLGF in the 3 groups of gestational hypertension disease decreased with the degree of the disease, but GATA-3 concentration increased, and the differences among the three groups showed signifi-cance (P<0. 05). Correlation analysis results showed that GATA-3 was negatively related to VEGF between the mild and se-vere preeclampsia group (r= -0. 681, P=0. 044; r= -0. 741, P=0. 041). Conclusion Unbalanced peripheral blood concentration of apoptosis-related factors may be related to gestational hypertension disease.%目的:探讨妊娠期高血压疾病患者外周血凋亡相关因子浓度的变化情况。方法选择我院妊娠期高血压疾病38例作为妊娠期高血压组,选择同期正常妊娠期妇女24例作为正常妊娠组;另根据病情严重程度将妊娠期高血压疾病患者分为妊娠期高血压组(14

  14. NLRP3 Deficiency Improves Angiotensin II-Induced Hypertension But Not Fetal Growth Restriction During Pregnancy.

    Science.gov (United States)

    Shirasuna, Koumei; Karasawa, Tadayoshi; Usui, Fumitake; Kobayashi, Motoi; Komada, Tadanori; Kimura, Hiroaki; Kawashima, Akira; Ohkuchi, Akihide; Taniguchi, Shun'ichiro; Takahashi, Masafumi

    2015-11-01

    Preeclampsia is a pregnancy-specific syndrome characterized by elevated blood pressure, proteinuria, and intrauterine growth restriction (IUGR). Although sterile inflammation appears to be involved, its pathogenesis remains unclear. Recent evidence indicates that sterile inflammation is mediated through the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasomes, composed of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and caspase-1. Here we investigated the role of the NLRP3 inflammasomes in the pathogenesis of preeclampsia using Nlrp3(-/-) and Asc(-/-) (Nlrp3 and Asc deficient) pregnant mice. During pregnancy in mice, continuous infusion of high-dose angiotensin II (AngII) induced hypertension, proteinuria, and IUGR, whereas infusion of low-dose AngII caused hypertension alone. AngII-induced hypertension was prevented in Nlrp3(-/-) mice but not in Asc(-/-), indicating that NLRP3 contributes to gestational hypertension independently of ASC-mediated inflammasomes. Although NLRP3 deficiency had no effect on IUGR, it restored the IL-6 up-regulation in the placenta and kidney of AngII-infused mice. Furthermore, treatment with hydralazine prevented the development of gestational hypertension but not IUGR or IL-6 expression in the placenta and kidney. These findings demonstrate that NLRP3 contributes to the development of gestational hypertension independently of the inflammasomes and that IUGR and kidney injury can occur independent of blood pressure elevation during pregnancy.

  15. Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension

    OpenAIRE

    de Macedo, José Fernando; de Macedo, Gustavo Capinzaiki; Campos, Luciana Aparecida; Baltatu, Ovidiu Constantin

    2015-01-01

    Abstract Patients with systemic lupus erythematosus have a poor prognosis of pregnancy, since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, pre-eclampsia, intrauterine growth restriction, fetal death and pre-term delivery. We report a case with successful pregnancy in a patient with systemic lupus erythematosus and hypertension. A 39-year-old nulliparous woman presented with systemic lupus erythematosus with antinuclear and antiphospholipid...

  16. Effect of serum alpha-fetoprotein and uric acid levels on pregnancy outcome in late pregnancy women with hypertensive disorder

    Institute of Scientific and Technical Information of China (English)

    Xian-Feng Tan; Yu-Xiu Zhang

    2016-01-01

    Objective:To investigate the effects of serum alpha-fetoprotein and uric acid levels on pregnancy outcome in late pregnancy women with hypertensive disorder.Methods: One hundred and twenty-six cases of hypertensive disorder complicating pregnancy were rolled into the observation group, and 80 healthy pregnant women were rolled into the as control group. The relationship between serum alpha-fetoprotein and uric acid levels and adverse pregnancy outcomes were compared between the two groups.Results: Compared with the control group, the serum levels of AFP and serum uric acid were significantly higher in the observation group, and the differences were statistically significant (P<0.01). In the observation group, with the increase of blood pressure, the serum AFP and uric acid levels were increased, which in the moderate sub-group and severe sub-group were significantly higher than those in mild sub-group, and the severe sub-group was significantly higher than that in the moderate sub-group (allP<0.05). The rate of preterm birth, premature rupture rate, placental abruption rate, fetal distress rate and cesarean section rate in the pregnant women with abnormal serum AFP and uric acid level were significantly higher than that of the normal serum AFP and uric acid group (P<0.05).Conclusions:The serum AFP and uric acid levels in the late pregnancy women with hypertensive disorder are significantly higher than those of the normal pregnant women, and are elevated remarkably as the blood pressure rising. When the serum AFP and uric acid levels are abnormal, the adverse outcomes of pregnancy and cesarean section rate increase significantly. Monitoring of serum AFP and uric acid levels is of importance.

  17. Previous hypertensive disease of pregnancy is associated with alterations of markers of insulin resistance.

    Science.gov (United States)

    Girouard, Joël; Giguère, Yves; Moutquin, Jean-Marie; Forest, Jean-Claude

    2007-05-01

    Insulin resistance syndrome has been observed in women with hypertensive disease of pregnancy, but few studies evaluated the presence of the syndrome a few years after delivery. The objective of this study was to evaluate the presence of insulin resistance and its metabolic alterations in these women compared with those who had a normal pregnancy. We performed an observational study in 168 women with previous hypertensive disease of pregnancy and 168 control subjects with normal pregnancy contacted, on average, 7.8 years after their first delivery (mean age: 34.8 years). Complete blood lipid profile, insulin, glucose, homocysteine, adipokins, and markers of inflammation were measured. Also, an oral glucose tolerance test was performed in 146 case and 135 control subjects. Case subjects were more overweight compared with control subjects. We found significantly lower high-density lipoprotein cholesterol and adiponectin levels and higher apolipoprotein (apo) apoB/apoA1 ratio, homocysteine, leptin, and insulin levels among case subjects compared with control subjects (Phypertensive disease of pregnancy show signs of insulin resistance within the first decade after delivery. These findings suggest that insulin resistance may be the link between hypertensive disease of pregnancy and increased cardiovascular risk later in life.

  18. Pregnancy and delivery in women with renovascular hypertension due to multiple intrarenal microaneurysms: a report of two cases.

    Science.gov (United States)

    Miyagawa, Kazuya; Iwasa, Naoko; Nakayama, Kazuhiko; Hirata, Ken-ichi; Emoto, Noriaki

    2014-01-01

    We herein report two cases of pregnant women who had chronic hypertension caused by renovascular hypertension due to multiple intrarenal microaneurysms from unknown causes, who had similar clinical courses. During the first pregnancy, both women developed uncontrollable severe hypertension that finally led to superimposed preeclampsia; however, during the second pregnancy, the blood pressure was controlled well, and the clinical courses were uneventful. These cases suggest that an uneventful term delivery may be achieved with adequate blood pressure control in pregnant women with chronic hypertension caused by renovascular hypertension, and a prior eventful clinical course of delivery does not affect the subsequent clinical course.

  19. Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort.

    Science.gov (United States)

    Jørgensen, Kristian Tore; Nielsen, Nete Munk; Pedersen, Bo Vestergaard; Jacobsen, Søren; Frisch, Morten

    2012-05-01

    The risk of some female predominant autoimmune diseases (ADs) has previously been shown to be higher in women who experience hyperemesis, gestational hypertensive disorders and idiopathic pregnancy losses. This study assessed the association between such pregnancy-related experiences and the subsequent risk of female predominant and other ADs. Our study cohort comprised 1.6 million Danish women born since 1955 for whom we had information about hyperemesis, gestational hypertensive disorders and pregnancy losses and subsequent hospital contacts for 31 ADs between 1982 and 2008. Ratios of first hospitalization rates (RRs) with 95% confidence intervals (CIs) were calculated using Poisson regression, adjusting for age, birth cohort, calendar period, marital status and childbirths. During 27.0 million person-years of follow-up 51,732 women were hospitalized with one or more ADs. Overall, compared with women without the specific pregnancy experiences, the risk of any AD was significantly increased for women with hyperemesis (RR = 1.41; 95% CI 1.30-1.51), gestational hypertensive disorders (1.21; 1.16-1.26), spontaneous abortions (1.10; 1.07-1.14), missed abortions (1.09; 1.04-1.13), stillbirths (1.25; 1.12-1.40), ectopic pregnancies (1.08; 1.02-1.14) and induced abortions (1.07; 1.04-1.09). Associations with female predominant ADs (i.e., ADs with a female:male ratio >2:1) were strongest in the first five years after the studied pregnancy experiences, but overall there was little difference between the RRs for groups of female predominant ADs and other ADs. Strong and potentially biological associations were observed for a number of specific ADs; including systemic lupus erythematosus, Graves' disease, type 1 diabetes mellitus and pernicious anemia, and for some specific ADs associations persisted even more than five years after the abnormal pregnancy experience. Abnormal pregnancies are associated with increased risk of certain ADs, possibly because of underlying

  20. Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status.

    Directory of Open Access Journals (Sweden)

    Linnea Bärebring

    Full Text Available Every tenth pregnancy is affected by hypertension, one of the most common complications and leading causes of maternal death worldwide. Hypertensive disorders in pregnancy include pregnancy-induced hypertension and preeclampsia. The pathophysiology of the development of hypertension in pregnancy is unknown, but studies suggest an association with vitamin D status, measured as 25-hydroxyvitamin D (25(OHD. The aim of this study was to investigate the association between gestational 25(OHD concentration and preeclampsia, pregnancy-induced hypertension and blood pressure trajectory. This cohort study included 2000 women. Blood was collected at the first (T1 and third (T3 trimester (mean gestational weeks 10.8 and 33.4. Blood pressure at gestational weeks 10, 25, 32 and 37 as well as symptoms of preeclampsia and pregnancy-induced hypertension were retrieved from medical records. Serum 25(OHD concentrations (LC-MS/MS in T1 was not significantly associated with preeclampsia. However, both 25(OHD in T3 and change in 25(OHD from T1 to T3 were significantly and negatively associated with preeclampsia. Women with a change in 25(OHD concentration of ≥30 nmol/L had an odds ratio of 0.22 (p = 0.002 for preeclampsia. T1 25(OHD was positively related to T1 systolic (β = 0.03, p = 0.022 and T1 diastolic blood pressure (β = 0.02, p = 0.016, and to systolic (β = 0.02, p = 0.02 blood pressure trajectory during pregnancy, in adjusted analyses. There was no association between 25(OHD and pregnancy-induced hypertension in adjusted analysis. In conclusion, an increase in 25(OHD concentration during pregnancy of at least 30 nmol/L, regardless of vitamin D status in T1, was associated with a lower odds ratio for preeclampsia. Vitamin D status was significantly and positively associated with T1 blood pressure and gestational systolic blood pressure trajectory but not with pregnancy-induced hypertension.

  1. Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status.

    Science.gov (United States)

    Bärebring, Linnea; Bullarbo, Maria; Glantz, Anna; Leu Agelii, Monica; Jagner, Åse; Ellis, Joy; Hulthén, Lena; Schoenmakers, Inez; Augustin, Hanna

    2016-01-01

    Every tenth pregnancy is affected by hypertension, one of the most common complications and leading causes of maternal death worldwide. Hypertensive disorders in pregnancy include pregnancy-induced hypertension and preeclampsia. The pathophysiology of the development of hypertension in pregnancy is unknown, but studies suggest an association with vitamin D status, measured as 25-hydroxyvitamin D (25(OH)D). The aim of this study was to investigate the association between gestational 25(OH)D concentration and preeclampsia, pregnancy-induced hypertension and blood pressure trajectory. This cohort study included 2000 women. Blood was collected at the first (T1) and third (T3) trimester (mean gestational weeks 10.8 and 33.4). Blood pressure at gestational weeks 10, 25, 32 and 37 as well as symptoms of preeclampsia and pregnancy-induced hypertension were retrieved from medical records. Serum 25(OH)D concentrations (LC-MS/MS) in T1 was not significantly associated with preeclampsia. However, both 25(OH)D in T3 and change in 25(OH)D from T1 to T3 were significantly and negatively associated with preeclampsia. Women with a change in 25(OH)D concentration of ≥30 nmol/L had an odds ratio of 0.22 (p = 0.002) for preeclampsia. T1 25(OH)D was positively related to T1 systolic (β = 0.03, p = 0.022) and T1 diastolic blood pressure (β = 0.02, p = 0.016), and to systolic (β = 0.02, p = 0.02) blood pressure trajectory during pregnancy, in adjusted analyses. There was no association between 25(OH)D and pregnancy-induced hypertension in adjusted analysis. In conclusion, an increase in 25(OH)D concentration during pregnancy of at least 30 nmol/L, regardless of vitamin D status in T1, was associated with a lower odds ratio for preeclampsia. Vitamin D status was significantly and positively associated with T1 blood pressure and gestational systolic blood pressure trajectory but not with pregnancy-induced hypertension.

  2. Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study

    OpenAIRE

    Van Eerden, Leonoor; Van Oostwaard, Miriam F.; Zeeman, Gerda G.; Page-Christiaens, Godelieve C. M.; Pajkrt, Eva; Duvekot, Johannes J.; Vandenbussche, Frank P; Oei, Swan G.; Scheepers, Hubertina C. J.; van Eyck, Jim; Middeldorp, Johanna M; Koenen, Steven V.; de Groot, Christianne J. M.; Bolte, Antoinette C

    2016-01-01

    Objective: To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. Study design: Retrospective cohort study in all Dutch tertiary perinatal care centres (n = 10), between January 2000 and January 2014. All women who underwent termination of pregnancy, without fetal surveillance or intention to intervene for fetal reasons, for early-onset hypertensive disorders in pregnancy, were analyzed. Women el...

  3. HYPERTENSION IN PREGNANCY: A STUDY IN A TEACHING HOSPITAL

    OpenAIRE

    Shiva; Abdul; Ilyas; Krishna; Prabhakar

    2016-01-01

    BACKGROUND In pregnant women, hypertension is one of the common causes of mortality and morbidity in Indian women. METHODS We conducted a study on four hundred and sixteen pregnant women consisting of 202 primigravidae, 148 gravidae 2 and 66 multigravidae. We screened these pregnant women for hypertension between January 2015 to July 2015 at Kamineni Institute of Medical Sciences and Fathima Institute of Medical Sciences(FIMS), which are tertiary care hospitals catering most ...

  4. Functional polymorphisms in the CYP3A4, CYP3A5, and CYP21A2 genes in the risk for hypertension in pregnancy.

    Science.gov (United States)

    Coto, Eliecer; Tavira, Beatriz; Marín, Rafael; Ortega, Francisco; López-Larrea, Carlos; Ruiz-Ortega, Marta; Ortiz, Alberto; Díaz, Marta; Corao, Ana I; Alonso, Belén; Alvarez, Victoria

    2010-07-02

    An intronic single nucleotide polymorphism (SNP) in the CYP3A5 gene (CYP3A5*3; SNP rs776746) affects RNA splicing and enzymatic activity. The CYP3A5*3 frequency increased with distance from the equator and natural selection has been proposed to explain the worldwide distribution of this allele. CYP3A activity has been related with the risk for hypertension in pregnancy, a major cause of morbidity and mortality among women, and CYP3A5*3 could reduce the risk for this disease in populations from regions with high sodium and water availability. The CYP3A5 genotype was related with blood pressure in the general population, but the effect on the risk for hypertension in pregnancy has not been evaluated.We compared the allele and genotype frequencies of three functional SNPs in the CYP3A5 (rs776746), CYP3A4 (rs2740574), and CYP21A2 (rs6471) genes between pregnant women who developed hypertension (n = 250) or who remained normotensive (control group, n = 250). In addition, we sequenced the full CYP3A5 coding sequence in 40 women from the two groups to determine whether some gene variants could explain the risk for hypertensive pregnancies in our population.Allele and genotype frequencies did not differ between hypertensive and normotensive women for the three CYP variants. We did not find CYP3A5 nucleotide changes that could explain a higher risk for hypertension in pregnancy. Our data suggests that the variation in CYP3A5, CYP3A4, and CYP21A2 did not contribute to the risk for hypertension in pregnancy in our population.

  5. Changes of Umbilical Artery Blood Flow Due to Pregnancy Induced Hypertension in the Third Trimester of Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah Hashemi

    2010-05-01

    Full Text Available Background/Objective: Doppler ultrasound of umbilical vessels is a method of evaluating fetoplacental blood flow which is very important in high risk pregnancies including pregnancy induced hypertension and may predict both the duration of maternal hospitalization and fetal mortality rates in IUGR. In this study, Doppler indices of blood flow through the umbilical artery were measured in patients with pregnancy induced hypertension."nPatients and Methods: This study was a cross-sectional study which was carried out on 101 preg-nant women: 35 patients with pregnancy induced hypertension were in the case group that had no symptoms or signs of pre-eclampsia, eclampsia or diabetes melitus. 61 normal pregnant women were as the control group. All the patients were studied in their third trimester of pregnancy. Doppler ultrasound of the umbilical artery was performed for both the case and the control groups. Peak Systolic Velocity (PSV, End Diastolic Velocity (EDV and mean velocity were measured. The Resistive Index (RI, Pulsatility Index (PI and Systolic to diastolic ratio (S/D ratio were calculated. The statistical analysis was performed on the obtained recorded data, using SPSS software."nResults: The calculated mean values of spectral Doppler indices in the case group were: 0.77 for RI; 1.39 for PI and 4.88 for S/D ratio while in the control group they were calculated as 0.64, 1.08 and 2.97, respectively. Altogether, comparison of the mean values of the mentioned indices revealed a significant difference between the two groups (P<0.01. The case group was significantly rated higher in terms of the above mentioned indices."nConclusion: In patients with pregnancy induced hypertension without any complications (such as pre-eclampsia or eclampsia or without any other risk factors (such as diabetes mellitus and IUGR, Doppler ultrasound should be used for evaluating the degree of fetoplacental blood flow in order to decrease the risk of pregnancy

  6. Prevention of Hypertensive Disorders of Pregnancy : a Novel Application of the Polypill Concept

    NARCIS (Netherlands)

    Browne, J L; Klipstein-Grobusch, K; Franx, A; Grobbee, D E

    2016-01-01

    Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to

  7. Prevention of Hypertensive Disorders of Pregnancy : a Novel Application of the Polypill Concept

    NARCIS (Netherlands)

    Browne, J L; Klipstein-Grobusch, K; Franx, A; Grobbee, D E

    Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to

  8. Parental smoking in pregnancy and the risks of adult-onset hypertension

    NARCIS (Netherlands)

    L.L. de Jonge (Layla); H.R. Harris (Holly); J.W. Rich-Edwards (Janet); C. Willett (Chris); M.R. Forman (Michele); V.W.V. Jaddoe (Vincent); K.B. Michels (Karin)

    2013-01-01

    textabstractFetal exposure to parental smoking may lead to developmental adaptations and promote various diseases in later life. This study evaluated the associations of parental smoking during pregnancy with the risk of hypertension in the daughter in adulthood, and assessed whether these associati

  9. Magnesium supplement in pregnancy-induced hypertension: effects on maternal and neonatal magnesium and calcium homeostasis

    DEFF Research Database (Denmark)

    Rudnicki, M; Frølich, A; Fischer-Rasmussen, W

    1991-01-01

    The objective of this study was to evaluate the effect of low dose magnesium supplement upon maternal and fetal serum levels of mineral status in pregnancies complicated with hypertension (PIH). Twenty-five patients with PIH agreed to participate and were randomly allocated, in a double...

  10. Guideline-based development of quality indicators for hypertensive diseases in pregnancy

    NARCIS (Netherlands)

    Luitjes, S.H.; Wouters, M.G.A.J.; Franx, A.; Bolte, A.C.; Groot, C.J. de; Tulder, M.W. van; Hermens, R.P.M.G.

    2013-01-01

    Objective. Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this group of p

  11. Prevention of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation

    NARCIS (Netherlands)

    van Kesteren, Floortje; Visser, Sanne; Hermes, Wietske; Franx, Arie; van Pampus, Maria G.; Poppel, Mireille N. M.; Tamsma, Jouke T.; Mol, Ben W.; de Groot, Christianne J.

    2015-01-01

    Objective: To analyse preventive interventions of women with cardiovascular risk factors postpartum. Methods: 3.5 years postpartum, women with history of hypertension in pregnancy were invited for a questionnaire, 1 year after a cardiovascular risk assessment. Results: Two hundred and fifty-seven wo

  12. Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension

    NARCIS (Netherlands)

    Payne, Beth A.; Groen, Henk; Ukah, U. Vivian; Ansermino, J. Mark; Bhutta, Zulfiqar; Grobman, William; Hall, David R.; Hutcheon, Jennifer A.; Magee, Laura A.; von Dadelszen, Peter

    2015-01-01

    Objective: To develop and internally validate a prognostic model for perinatal death that could guide community-based antenatal care of women with a hypertensive disorder of pregnancy (HDP) in low-resourced settings as part of a mobile health application. Study design: Using data from 1688 women (11

  13. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Swati Singh

    2014-01-01

    Full Text Available Background: Hypertensive disorders in pregnancy (HDP represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH Sokoto. Materials and Methods: A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS statistical package. Results: The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR 4.2; conficence interval (CI 2.144-6.812, multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235, gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751 and obesity (P < 0.002; RR 2.7; CI 1.373-5.511 were the significant risk factors in the development of HDP among the study population. Conclusion: The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae.

  14. Ambient air pollution and hypertensive disorders of pregnancy: A systematic review and meta-analysis

    Science.gov (United States)

    Hu, Hui; Ha, Sandie; Roth, Jeffrey; Kearney, Greg; Talbott, Evelyn O.; Xu, Xiaohui

    2014-11-01

    Hypertensive disorders of pregnancy (HDP, including gestational hypertension, preeclampsia, and eclampsia) have a substantial public health impact. Maternal exposure to high levels of air pollution may trigger HDP, but this association remains unclear. The objective of our report is to assess and quantify the association between maternal exposures to criteria air pollutants (ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matter ≤10, 2.5 μm) on HDP risk. PubMed, EMBASE, MEDLINE, Current Contents, Global Health, and Cochrane were searched (last search: September, 2013). After a detailed screening of 270 studies, 10 studies were extracted. We conducted meta-analyses if a pollutant in a specific exposure window was reported by at least four studies. Using fixed- and random-effects models, odds ratios (ORs) and 95% CIs were calculated for each pollutant with specific increment of concentration. Increases in risks of HDP (OR per 10 ppb = 1.16; 95% CI, 1.03-1.30) and preeclampsia (OR per 10 ppb = 1.10; 95% CI, 1.03-1.17) were observed to be associated with exposure to NO2 during the entire pregnancy, and significant associations between HDP and exposure to CO (OR per 1 ppm = 1.79; 95% CI, 1.31-2.45) and O3 (OR per 10 ppb = 1.09; 95% CI, 1.05-1.13) during the first trimester were also observed. Our review suggests an association between ambient air pollution and HDP risk. Although the ORs were relatively low, the population-attributable fractions were not negligible given the ubiquitous nature of air pollution.

  15. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes

    Science.gov (United States)

    Yanit, Keenan E.; Snowden, Jonathan M.; Cheng, Yvonne W.; Caughey, Aaron B.

    2013-01-01

    OBJECTIVE The objective of the study was to examine the impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. STUDY DESIGN This was a retrospective cohort study of 532,088 women undergoing singleton births in California in 2006. Women were categorized into chronic hypertension, pregestational diabetes, both, or neither. Pregnancy outcomes were compared using the χ2 test and multivariable logistic regression to control for potential confounders. RESULTS We identified differences in perinatal outcomes between the groups. The rate of preterm birth in women with both conditions was 35.5% versus 25.5% in women with chronic hypertension versus 19.4% in women with pregestational diabetes (P < .001). The rate of small for gestational age was 18.2% in women with both versus 18.3% in women with chronic hypertension versus 9.7% in women with pre-gestational diabetes (P <.001). CONCLUSION The impact of having both chronic hypertension and pregestational diabetes in pregnancy varies, depending on the outcome examined. Although some had an additive effect (eg, stillbirth), others did not (eg, preeclampsia). PMID:22892187

  16. Parent-offspring conflict and the persistence of pregnancy-induced hypertension in modern humans.

    Directory of Open Access Journals (Sweden)

    Birgitte Hollegaard

    Full Text Available Preeclampsia is a major cause of perinatal mortality and disease affecting 5-10% of all pregnancies worldwide, but its etiology remains poorly understood despite considerable research effort. Parent-offspring conflict theory suggests that such hypertensive disorders of pregnancy may have evolved through the ability of fetal genes to increase maternal blood pressure as this enhances general nutrient supply. However, such mechanisms for inducing hypertension in pregnancy would need to incur sufficient offspring health benefits to compensate for the obvious risks for maternal and fetal health towards the end of pregnancy in order to explain why these disorders have not been removed by natural selection in our hunter-gatherer ancestors. We analyzed >750,000 live births in the Danish National Patient Registry and all registered medical diagnoses for up to 30 years after birth. We show that offspring exposed to pregnancy-induced hypertension (PIH in trimester 1 had significantly reduced overall later-life disease risks, but increased risks when PIH exposure started or developed as preeclampsia in later trimesters. Similar patterns were found for first-year mortality. These results suggest that early PIH leading to improved postpartum survival and health represents a balanced compromise between the reproductive interests of parents and offspring, whereas later onset of PIH may reflect an unbalanced parent-offspring conflict at the detriment of maternal and offspring health.

  17. A LONGITUDINAL STUDY OF SERUM URIC ACID LEVEL IN NORMAL PREGNANCY AND PREGNANCY INDUCED HYPERTENSION AMONG PATIENTS ATTENDING ANTENATAL OUTPATIENT DEPARTMENT OF GA UHATI MEDICAL COLLEGE, GUWAHATI

    Directory of Open Access Journals (Sweden)

    Santana

    2015-07-01

    Full Text Available AIMS AND OBJECTIVES: To estimate serum uric acid level in normal pregnancy and pregnancy induced hypertension at different duration as pregnancy advances and to evaluate its place in determining severity of pregnancy induced hypertension. MATERIALS AND METHODS: A longitudinal study was carried out among forty cases of normal pregnancy and forty cases of pregnancy induced hypertension attending antenatal outpatient department of Gauhati Medical College and Hospital. Serum uric acid level was estimated colorimetrically by using Uricase method in the Department of Physiology, Gauhati Medical College. Statistical analysis was carried out applying ANOVA test using IBM SPSS 16. RESULTS: Serum Uric Acid level was found to be significantly higher in study group as compared to control g roup. The mean values of serum uric acid level in study group were 4.07 mg/dl, 4.44 mg/dl and 5.27mg/dl as compared to 3.14mg/dl, 3.11 mg/dl and 3.71 mg/dl in control group at 20 - 24 weeks, 24 - 28 weeks and 32 - 40 weeks of gestation respectively. Also, the leve l of serum uric acid was found to be increased with increasing severity of pregnancy induced hypertension. CONCLUSION: A definite rise in serum uric level was found in cases of pregnancy induced hypertension and its level increases with increasing severity of the disease.

  18. Successful pregnancy outcome in a case of Swyer Syndrome with hypertension and morbid obesity

    Directory of Open Access Journals (Sweden)

    Aradhana Kalra

    2016-06-01

    Full Text Available To report a case of Swyer syndrome with hypertension and morbid obesity with successful pregnancy and live birth after assisted reproductive technology. 27 year old morbidly obese female with essential hypertension who had been on HRT for 10 years with well-developed secondary sexual characters with primary infertility. After adequate development of the uterus and the endometrial preparation, Patients with Swyer syndrome conceive with oocyte donation and ICSI. Caesarean section rate is high due to multiple pregnancies and other obstetric complications. Early detection of these cases would help in timely development of their secondary sexual characters and restoration of menses and gonadectomy for prevention of malignancy as its propensity is high. Multidisciplinary approach is required including counseling and management of long term health problems. Pregnancy is feasible but caesarean rate is high. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2061-2064

  19. Parental smoking in pregnancy and the risks of adult-onset hypertension.

    Science.gov (United States)

    de Jonge, Layla L; Harris, Holly R; Rich-Edwards, Janet W; Willett, Walter C; Forman, Michele R; Jaddoe, Vincent W V; Michels, Karin B

    2013-02-01

    Fetal exposure to parental smoking may lead to developmental adaptations and promote various diseases in later life. This study evaluated the associations of parental smoking during pregnancy with the risk of hypertension in the daughter in adulthood, and assessed whether these associations are explained by birth weight or body weight throughout life. We used data on 33086 participants of the Nurses' Health Study II and the Nurses' Mothers' Cohort. Cox proportional hazards models were used to examine the associations of maternal and paternal smoking during pregnancy with the nurse daughter, with self-reported physician-diagnosed hypertension from 1989 until 2007. Overall, 8575 (25.9%) mothers and 18874 (57.0%) fathers smoked during pregnancy. During follow-up, 7825 incident cases of adult-onset hypertension were reported. Both maternal and paternal smoking of ≥ 15 cigarettes/d during pregnancy were associated with increased risks of hypertension (rate ratio, 1.19; 95% CI, 1.09-1.29; and rate ratio, 1.18; 95% CI, 1.12-1.25, respectively) in the age-adjusted models. Further adjustment for birth weight did not affect the effect estimates appreciably, whereas additional adjustment for body shape and weight until age 18, or current body mass index, attenuated the associations with both maternal and paternal smoking (rate ratio, 1.07; 95% CI, 0.98-1.16; and rate ratio, 1.06; 95% CI, 1.01-1.12, respectively). The associations of parental smoking during pregnancy with the risk of hypertension in the offspring were largely explained by body weight throughout life, suggesting that these associations may not reflect direct intrauterine mechanisms.

  20. Maternal hyperinsulinism and glycaemic status in the first trimester of pregnancy are associated with the development of pregnancy-induced hypertension and gestational diabetes.

    LENUS (Irish Health Repository)

    Kayemba-Kay's, Simon

    2013-03-01

    To evaluate the relationships across a range of glucose and insulin measures at 12 weeks of gestation with the development of pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM) and birth size.

  1. Relevance of individual participant data meta-analysis for studies in obstetrics : delivery versus expectant monitoring for hypertensive disorders of pregnancy

    NARCIS (Netherlands)

    Broekhuijsen, Kim; Bernardes, Thomas; van Baaren, Gert-Jan; Tajik, Parvin; Novikova, Natalia; Thangaratinam, Shakila; Boers, Kim; Koopmans, Corine M.; Wallace, Kedra; Shennan, Andrew H.; Langenveld, Josje; Groen, Henk; van den Berg, Paul P.; Mol, Ben Willem J.; Franssen, Maureen T. M.

    Like many other research subjects in obstetrics, research on immediate delivery versus expectant monitoring for women with hypertensive disorders of pregnancy faces certain challenges when it comes to interpretation and generalisation of the results; relatively rare outcomes are studied, in a

  2. Cardiovascular risk factors in women who had hypertensive disorders late in pregnancy: a cohort study.

    Science.gov (United States)

    Hermes, Wietske; Franx, Arie; van Pampus, Maria G; Bloemenkamp, Kitty W M; Bots, Michiel L; van der Post, Joris A; Porath, Martina; Ponjee, Gabrielle A E; Tamsma, Jouke T; Mol, Ben Willem J; de Groot, Christianne J M

    2013-06-01

    The purpose of this study was to determine cardiovascular risk factors in women with a history of hypertensive pregnancy disorders at term (HTP) 2.5 years after pregnancy. In a multicenter cohort study in The Netherlands from June 2008 through November 2010, cardiovascular risk factors were compared between women with a history of HTP (HTP cohort, n = 306) and women with a history of normotensive pregnancies at term (NTP cohort, n = 99). HTP women had participated in a randomized, longitudinal trial assessing the effectiveness of induction of labor in women with hypertensive pregnancy disorders at term. All women were assessed 2.5 years after pregnancy for blood pressure, anthropometrics, glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, high-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and microalbumin and metabolic syndrome. After a mean follow-up period of 2.5 years, hypertension (HTP, 34%; NTP, 1%; P HTP, 25%; NTP, 5%; P HTP women compared with NTP women. HTP women had significantly higher systolic and diastolic blood pressure, higher body mass index, and higher waist circumference. Glucose, glycosylated hemoglobin, insulin, homeostatic model assessment score, total cholesterol, triglycerides, and high-sensitivity C-reactive protein levels were significantly higher and high-density lipoprotein cholesterol was significantly lower in HTP women. In women with a history of HTP, hypertension and metabolic syndrome are more common, and they have higher levels of biochemical cardiovascular risk factors 2.5 years after pregnancy. Copyright © 2013 Mosby, Inc. All rights reserved.

  3. Earlier Age of Onset of Chronic Hypertension and Type 2 Diabetes Mellitus After a Hypertensive Disorder of Pregnancy or Gestational Diabetes Mellitus

    NARCIS (Netherlands)

    Heida, Karst Y.; Franx, Arie; Van Rijn, Bas B.; Eijkemans, Marinus J C; Boer, Jolanda M A; Verschuren, W.M. Monique; Oudijk, Martijn A.; Bots, Michiel L.; Van Der Schouw, Yvonne T.

    2015-01-01

    A prospective cohort study was conducted to assess the impact of a history of hypertensive disorder of pregnancy (HDP) or gestational diabetes mellitus (GDM) on the risk and age of onset of hypertension, type 2 diabetes mellitus (T2D), and cardiovascular disease (CVD) later in life, independent of

  4. The investigation for the relationship among serum leptin, erythrocyte membrane Ca2+-ATPase activity and hypertensive disorder complicating pregnancy

    Institute of Scientific and Technical Information of China (English)

    Chunfang Li; Wenli Gou; Xuelian Chen; Shuping Zhang

    2007-01-01

    Objective: To study the significance of Leptin and the activity of erythrocyte membrane Ca2+-ATPase (EMCA) in the development of hypertensive disorder complicating pregnancy. Methods: Radioimmunoassay was used to test the level of serum Leptin,and the activity of EMCA was determined chemically in 38 pregnant women with hypertensive disorder complicating pregnancy and 36 normotensive pregnant women. Results: The level of serum Leptin in hypertensive disorder complicating pregnancy(gestational hypertension: 13.76 ± 3.46 ng/ml; preeclampsia:15.76 ± 5.47 ng/ml; eclampsia: 18.32 ± 6.38 ng/ml)was significantly higher than that in normotensive pregnant women (11.33 ± 2.93 ng/ml), respectively. The average EMCA activity of patients with hypertensive disorder complicating pregnancy (gestational hypertension: 1.65 ± 0.24 μmol· pi/mg·h; preeclampsia: 1.37 ± 0.19 μmol·pi/mg·h; eclampsia:1.12 ± 0.14 μ mol·pi/mg·h) was significantly lower than that of normotensive pregnant women(1.83 ±0.38 μ mol·pi/mg·h),respectively. There was a negative correlation between the level of serum Leptin and the activity of RMCA in hypertensive disorder complicating pregnancy (r = -0.63). Conclusion: Inhibition of EMCA activity of erythrocyte in hypertensive disorder complicating pregnancy may increase cytoplasmic free calcium, which contributes to the development of hypertensive disorder complicating pregnancy. The negative correlation between the level of serum Leptin and the activity of EMCA, also suggested that serum Leptin and the activity of EMCA may play a role in the development of hypertensive disorder complicating pregnancy.

  5. Do hypertension and diuretic treatment in pregnancy increase the risk of schizophrenia in offspring?

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik L; Reinisch, June M

    2003-01-01

    OBJECTIVE: Diuretics prescribed after the first trimester for treatment of hypertension in pregnant women may interfere with normal plasma volume expansion and cause volume depletion. The authors hypothesized that prenatal exposure to diuretics and maternal hypertension might disrupt fetal...... neurodevelopment and increase the risk of schizophrenia in offspring. METHOD: Using data from the Copenhagen Perinatal Cohort of individuals born between 1959 and 1961, the authors studied the relationship of maternal hypertension and diuretic treatment during pregnancy with the risk of schizophrenia (ICD-8 code...... 295) in the offspring. Prenatal medical information was linked to the Danish National Psychiatric Register. The effects of maternal hypertension and diuretic treatment were adjusted for the maternal history of schizophrenia, social status of the family breadwinner, mother's age, and concomitant drug...

  6. Do hypertension and diuretic treatment in pregnancy increase the risk of schizophrenia in offspring?

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik Lykke; Reinisch, June M;

    2003-01-01

    295) in the offspring. Prenatal medical information was linked to the Danish National Psychiatric Register. The effects of maternal hypertension and diuretic treatment were adjusted for the maternal history of schizophrenia, social status of the family breadwinner, mother's age, and concomitant drug......OBJECTIVE: Diuretics prescribed after the first trimester for treatment of hypertension in pregnant women may interfere with normal plasma volume expansion and cause volume depletion. The authors hypothesized that prenatal exposure to diuretics and maternal hypertension might disrupt fetal...... neurodevelopment and increase the risk of schizophrenia in offspring. METHOD: Using data from the Copenhagen Perinatal Cohort of individuals born between 1959 and 1961, the authors studied the relationship of maternal hypertension and diuretic treatment during pregnancy with the risk of schizophrenia (ICD-8 code...

  7. Selenium status in U.K. pregnant women and its relationship with hypertensive conditions of pregnancy.

    Science.gov (United States)

    Rayman, Margaret P; Bath, Sarah C; Westaway, Jacob; Williams, Peter; Mao, Jinyuan; Vanderlelie, Jessica J; Perkins, Anthony V; Redman, Christopher W G

    2015-01-28

    Dietary intake/status of the trace mineral Se may affect the risk of developing hypertensive conditions of pregnancy, i.e. pre-eclampsia and pregnancy-induced hypertension (PE/PIH). In the present study, we evaluated Se status in U.K. pregnant women to establish whether pre-pregnant Se status or Se supplementation affected the risk of developing PE/PIH. The samples originated from the SPRINT (Selenium in PRegnancy INTervention) study that randomised 230 U.K. primiparous women to treatment with Se (60 μg/d) or placebo from 12 weeks of gestation. Whole-blood Se concentration was measured at 12 and 35 weeks, toenail Se concentration at 16 weeks, plasma selenoprotein P (SEPP1) concentration at 35 weeks and plasma glutathione peroxidase (GPx3) activity at 12, 20 and 35 weeks. Demographic data were collected at baseline. Participants completed a FFQ. U.K. pregnant women had whole-blood Se concentration lower than the mid-range of other populations, toenail Se concentration considerably lower than U.S. women, GPx3 activity considerably lower than U.S. and Australian pregnant women, and low baseline SEPP1 concentration (median 3.00, range 0.90-5.80 mg/l). Maternal age, education and social class were positively associated with Se status. After adjustment, whole-blood Se concentration was higher in women consuming Brazil nuts (P= 0.040) and in those consuming more than two seafood portions per week (P= 0.054). A stepwise logistic regression model revealed that among the Se-related risk factors, only toenail Se (OR 0.38, 95% CI 0.17, 0.87, P= 0.021) significantly affected the OR for PE/PIH. On excluding non-compliers with Se treatment, Se supplementation also significantly reduced the OR for PE/PIH (OR 0.30, 95% CI 0.09, 1.00, P= 0.049). In conclusion, U.K. women have low Se status that increases their risk of developing PE/PIH. Therefore, U.K. women of childbearing age need to improve their Se status.

  8. Helicobacter pylori and pregnancy-related disorders

    Science.gov (United States)

    Cardaropoli, Simona; Rolfo, Alessandro; Todros, Tullia

    2014-01-01

    Helicobacter pylori (H. pylori) infection is investigated in gastric diseases even during pregnancy. In particular, this Gram-negative bacterium seems to be associated with hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. During the last decade, the relationship among H. pylori and several extra-gastric diseases strongly emerged in literature. The correlation among H. pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia, thrombocytopenia, fetal malformations, miscarriage, pre-eclampsia and fetal growth restriction. H. pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms: depletion of micronutrients (iron and vitamin B12) in maternal anemia and fetal neural tube defects; local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia; cross-reaction between specific anti-H. pylori antibodies and antigens localized in placental tissue and endothelial cells (pre-eclampsia, fetal growth restriction, miscarriage). Since H. pylori infection is most likely acquired before pregnancy, it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H. pylori with a negative impact not only on maternal health (nutritional deficiency, organ injury, death), but also on the fetus (insufficient growth, malformation, death) and sometime consequences can be observed later in life. Another important issue addressed by investigators was to determine whether it is possible to transmit H. pylori infection from mother to child and whether maternal anti-H. pylori antibodies could prevent infant’s infection. Studies on novel diagnostic and therapeutic methods for H. pylori are no less important, since these are particularly sensitive topics in pregnancy conditions. It could be interesting to study the possible correlation between H

  9. Folic acid supplementation during early pregnancy and the risk of gestational hypertension and preeclampsia.

    Science.gov (United States)

    Li, Zhiwen; Ye, Rongwei; Zhang, Le; Li, Hongtian; Liu, Jianmeng; Ren, Aiguo

    2013-04-01

    Emerging evidence has suggested that folic acid-containing multivitamins may markedly reduce the risk of gestational hypertension or preeclampsia. We examined whether maternal supplementation with folic acid alone during early pregnancy can prevent the occurrence of gestational hypertension and preeclampsia. The data are from a large population-based cohort study established to evaluate the effectiveness of the campaign to prevent neural tube defects with folic acid supplementation in China. We selected participants who were registered in 2 southern provinces, had exact information on folic acid use, and were not affected by chronic hypertension or diabetes mellitus before 20 weeks gestation. A logistic regression model was used to adjust for the effects of the main potential confounders, including age, body mass index, education, occupation, parity, and multiple births. The study size had 99.9% power (α=0.05) to detect a decrease of 10% over the unexposed rate of 9.4% for gestational hypertension. Among the 193 554 women (47.9% took folic acid, 52.1% did not), the overall incidence of gestational hypertension and preeclampsia was 9.5% and 2.5%, respectively. The incidence of gestational hypertension and preeclampsia was 9.7% and 2.5% for women who took folic acid, and 9.4% and 2.4% for women who did not use it. The adjusted risk ratio associated with folic acid use was 1.08 (95% confidence interval, 1.04-1.11) for gestational hypertension and 1.11 (95% confidence interval, 1.04-1.18) for preeclampsia. Our findings suggest that daily consumption of 400 μg folic acid alone during early pregnancy cannot prevent the occurrence of gestational hypertension and preeclampsia.

  10. Prostaglandins, catecholamines, renin and aldosterone during hypertensive and normotensive pregnancy.

    Science.gov (United States)

    Pedersen, E B; Christensen, N J; Christensen, P; Johannesen, P; Kornerup, H J; Kristensen, S; Lauritsen, J G; Leyssac, P P; Rasmussen, A B; Wohlert, M

    1982-01-01

    Urinary excretion of prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha), plasma concentrations of renin (PRC), aldosterone (PAC), noradrenaline (PNA) and adrenaline (PA) were determined in the third trimester of pregnancy, 5 days and 3 months after delivery in preeclampsia and normotensive pregnant and non-pregnant control subjects. PGE2 was higher in pregnant control subjects than in non-pregnant subjects, but reduced to non-pregnant level in preeclampsia. PGF2 alpha was the same in preeclampsia and normotensive pregnancy but higher than in the non-pregnant group. PRC and PAC were increased during pregnancy, but considerably lesser in preeclampsia than during normotensive pregnancy. PNA and PA were the same in all three groups. All parameters were normal 3 months after delivery. There were no correlations between any of the hormones and blood pressure in any of the groups. PGE2 was positively correlated to PRC. The lack of renal PGE2 in preeclampsia might be responsible for the decrease in renal blood flow and sodium excretion, and the changes in PRC and PAC are supposed to be secondary to changes in PGE2. It is hypothesised that preeclampsia is a state of prostaglandin deficiency.

  11. Major flood related strains and pregnancy outcomes.

    Science.gov (United States)

    Hilmert, Clayton J; Kvasnicka-Gates, Lexi; Teoh, Ai Ni; Bresin, Konrad; Fiebiger, Siri

    2016-11-01

    To assess the impact of experiencing a major flood during pregnancy on fetal growth and length of gestation, and to consider how flood-related strains might contribute to these effects. The Red River Pregnancy Project was a prospective study carried out for 3 months immediately after the historic 2009 crest of the Red River in Fargo, North Dakota. Pregnant community residents who were at least 18 years old with a singleton, intrauterine pregnancy participated in the study (N = 169). Analyses examined if birth weight and length of gestation were associated with residential distance from flooding and gestational age at time of the flood crest. For pregnancies earlier in gestation during the crest (-1 SD = 12 weeks), birth weight decreased as distance from flooding decreased (-42.29 g/mi, p .10). Biparietal growth trajectories showed a decrease in growth after the crest of the flood but only for women early in pregnancy. However, various measures of flood related and general stress or strain did not explain these effects. Length of gestation was not associated with distance from or the timing of the flood. Pregnant women in the first trimester who experience a major flood near their homes are at risk of having lower birth weight neonates due to a reduction in fetal growth. The mechanisms of this effect deserve further attention in rapidly mounted investigations after disaster. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. Genetic admixture and risk of hypertensive disorders of pregnancy among Latinas in Los Angeles County.

    Science.gov (United States)

    Shahabi, Ahva; Wilson, Melissa L; Lewinger, Juan Pablo; Goodwin, T Murphy; Stern, Mariana C; Ingles, Sue A

    2013-03-01

    Latinos are a heterogeneous population in terms of demographics, culture, and genetic admixture from three racial groups (white, African, and Native American). This study examines the role of genetic ancestry and environmental risk factors in the risk of hypertensive disorder of pregnancy among Latinas in Los Angeles County. Gestational hypertension, preeclampsia, eclampsia, or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome cases (n = 125), plus unaffected controls (n = 161), were recruited from Los Angeles County + University of Southern California Women's and Children's Hospital from 1999 through 2008. Diagnoses were confirmed with extensive chart review. Personal information, demographics, and biospecimens were collected from all participants. Ancestry informative markers were used to estimate genetic ancestry proportions. After adjusting for European ancestry and key risk factors, African ancestry was positively associated with hypertensive disorders of pregnancy risk for the highest vs. the lowest quartiles of African ancestry (odds ratio = 2.6 [95% confidence interval = 1.1-6.1]). This association was stronger among women born in Mexico with parents born in Mexico (4.3 [1.4-13]). The results from generalized additive models showed a positive association between joint European/African ancestry and hypertensive disorders of pregnancy risk and an inverse association between Native American ancestry and risk. These associations were stronger among women of Mexican origin. Our findings suggest that higher Native American ancestry among Latinas may protect against hypertensive disorders of pregnancy. Further studies are needed to determine whether this protective effect is driven by specific alleles present in this population or by other risk factors that correlate with Native American ancestry.

  13. Comparison of the Efficacy of Nifedipine and Hydralazine in Hypertensive Crisis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Yashar Youefzadeh-Fard

    2011-11-01

    Full Text Available Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy. Oral nifedipine is an alternative in management of these patients. In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients. Fifty hypertensive pregnant women were enrolled in the study. A randomized clinical trial was performed, in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction. The primary outcomes measured were the time and doses required for desired blood pressure achievement. Secondary measures included urinary output and maternal and neonatal side effects. The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group (24.0±10.0 min than intravenus Hydralazine group (34.8±18.8 min (P≤0.016. Less frequent doses were required with oral nifedipine (1.2±0.5 compared to intravenus hydralazine (2.1±1.0 (P≤0.0005. There were no episodes of hypotension after hydralazine and one after nifedipine. Nifedipine and hydralazine are safe and effective antihypertensive drugs, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. Both drugs reduce episodes of persistent severe hypertension. Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action, the good oral bioavailability and less frequent side effects, it looks more preferable in hypertension emergencies of pregnancy than hydralazine.

  14. Hypertensive disorders of pregnancy and subsequent risk of solid cancer--A nationwide cohort study

    DEFF Research Database (Denmark)

    Behrens, Ida; Basit, Saima; Jensen, Allan

    2016-01-01

    cancer rates for women with and without a history of HDP. In this cohort, 68,236 women (6.3%) had ≥1 pregnancy complicated by HDP and 42,236 women (3.9%) developed solid tumors during follow-up. A history of HDP was not associated with a clinically meaningful reduction in the overall rate of solid cancer...... (HR 0.96, 95% confidence interval 0.92-1.00), regardless of HDP severity or time since HDP, nor was there a general tendency toward reduced solid cancer rates across organ sites. A history of HDP was only significantly associated with decreased rates of breast and lung cancers and with increased rates......Women with hypertensive disorders of pregnancy (HDP) have higher levels of antiangiogenic growth factors during pregnancy than women with normotensive pregnancies. Since angiogenesis is necessary for solid cancer growth and spread, we hypothesized that women with a history of HDP might have...

  15. A cohort evaluation on arterial stiffness and hypertensive disorders in pregnancy

    Directory of Open Access Journals (Sweden)

    Lim Wai Yee

    2012-12-01

    Full Text Available Abstract Background Hypertensive disorders in pregnancy are associated with systemic endothelial dysfunction leading to impaired physiological vasodilation. Recent evidence has shown central aortic pressures obtained through pulse wave analysis, at less than 14 weeks of gestation, to be predictive of pre-eclampsia. In light of this, we aimed to evaluate the role of central aortic stiffness in the prediction and discrimination of hypertensive disorders in pregnancy. Methods A cohort study of women with viable, singleton pregnancies at less than 14 weeks of amenorrhoea, and without multiple pregnancies, autoimmune or renal disease, diagnosed with aneuploidy or fetal anomaly will be recruited from a single maternity hospital and followed up till delivery and puerperium. A targeted sample size of 1000 eligible pregnant women will be enrolled into the study from antenatal clinics. Main exposure under study is central aortic pulse pressure using radial pulse wave recording, and the outcomes under follow-up are gestational hypertension and pre-eclampsia. Other measures include lifestyle factors such as smoking, physical exercise, psychometric evaluations, vasoactive factors, uterine artery pulsatility index, height and weight measurements. These measures will be repeated over 4 antenatal visits at 11-14, 18-22, 28-32 and above 34 weeks of gestation. Double data entry will be performed on Microsoft Access, and analysis of data will include the use of random effect models and receiver operating characteristic curves on Stata 11.2. Discussion The proposed study design will enable a longitudinal evaluation of the central aortic pressure changes as a marker for vascular compliance during pregnancy. As measures are repeated over time, the timing and severity of changes are detectable, and findings may yield important information on how aberrant vascular responses occur and its role in the early detection and prediction of hypertensive disorders.

  16. The Effect of Pregnancy Induced Hypertension on Complete Blood Count of Newborn

    Directory of Open Access Journals (Sweden)

    Abdul-karem Al-bahadily

    2017-09-01

    Full Text Available Background: Pregnancy induced hypertension is one of the most common causes of maternal and neonatal mortality and morbidity. New born delivered to mothers with hypertension are more liable for intrauterine growth retardation and may be delivered prematurely. We aimed to determine the effect of pregnancy-induced hypertension on complete blood count, gestational age and birth weight of newborn. Materials and Methods: This study includes 200 neonates, 100 neonates born to mothers diagnosed as having pregnancy induced hypertension this is considered as the study group and 100 neonates born in the same period to healthy mothers considered as the control group, the study conducted in the neonatal unit of the department of pediatrics and gynecological ward in AL-Imamein Al-Kadhimein Medical city, Iraq, from 1st August 2015 to 30th May 2016. Details of the baby including gender, Apgar score, birth weight and gestational age were recorded and hematological parameters (complete blood count of both babies and mothers have been studied. Results: The study showed the significant difference between the two groups regarding mode of delivery, 94% of mothers in study group delivered by cesarean section while 60% of control group, delivered by cesarean section. There was the significant effect of gestational hypertension on gestational age, birth weight, need for resuscitation, Apgar score, mean WBC count and mean platelet count since (P< 0.05. There were no significant differences between two groups regarding another element of complete blood count. Conclusion: At current study, gestational hypertension affects adversely growth parameter, wellbeing and both WBC and platelet count of a newborn.

  17. Homeostatic model assessment and risk for hypertension during pregnancy: a longitudinal prospective study.

    Science.gov (United States)

    Romero-Gutiérrez, Gustavo; Malacara, Juan Manuel; Amador, Norma; Fierro-Martínez, César; Muñoz-Guevara, Luis Manuel; Molina-Rodríguez, Roberto

    2004-11-01

    The purpose of this study was to determine the association between insulin resistance and hypertension during pregnancy with the homeostatic model assessment (HOMA-IR). A longitudinal prospective study was carried out. One hundred sixty normotensive pregnant women were followed from the first trimester until delivery. HOMA-IR levels were determined each trimester. Statistical analysis included one-way analysis of variance and multivariate logistic regression. At follow-up, 134 women (83.8%) remained normotensive, 18 (11.2%) developed gestational hypertension, and 8 (5%) developed preeclampsia. At first trimester, HOMA-IR levels were higher in women who developed gestational hypertension (2.1 +/- 0.2) than in women who developed preeclampsia (1.2 +/- 0.0), or remained normotensive (1.2 +/- 0.3); p < 0.01. In the logistic regression analysis, HOMA-IR levels at first trimester were statistically significant ( p = 0.03) to predict development of gestational hypertension. Our results support the use of the HOMA-IR as an alternative index for the assessment of the risk for hypertension during pregnancy.

  18. The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel.

    Science.gov (United States)

    Chodick, Gabriel; Porath, Avi; Alapi, Hillel; Sella, Tal; Flash, Shira; Wood, Francis; Shalev, Varda

    2010-05-01

    The aim of this study was to assess the direct medical cost of treating major chronic illnesses in Maccabi Healthcare Services, a 1.8 million member health maintenance organization in Israel. Direct medical costs were calculated for each member in 2006. We used multiple linear regression models to evaluate the overall costs of chronic conditions (cardiovascular diseases, diabetes mellitus, hypertension, female infertility treatments, and cancer), pregnancy and treatments for female infertility. According to the study model, hypertension was associated with the largest direct medical costs in both sexes. Cardiovascular diseases accounted for 9.5% of the total direct medical costs in men, but only 5.9% in women. Diabetes mellitus accounted for 3.5% of the total medical costs both in men and women and is comparable to the total pregnancy-related costs in women. The findings indicate that hypertension, diabetes mellitus and female infertility treatments impose a considerable economic burden on public healthcare services in Israel which is comparable with the costs of cancer and cardiovascular diseases. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  19. Impact of road traffic pollution on pre-eclampsia and pregnancy-induced hypertensive disorders

    DEFF Research Database (Denmark)

    Pedersen, Marie; Halldorsson, Thorhallur I; Olsen, Sjurdur F

    2016-01-01

    BACKGROUND: Road traffic is a majorsource of air pollution and noise. Both exposures have been associated with hypertension in adults, but pregnant womenhave been less studied. METHODS: We examined single and joint effects of ambient air pollution and road traffic noise on preeclampsia...... increase the risk of preeclampsia and hypertensive disorders in pregnancy through exposure to both ambient air pollution and noise, although associations with the two exposures were generally not found to be independent of one another. See video abstract, http://links.lww.com/EDE/B112...

  20. Study of Risk Factors of Perinatal Death in Pregnancy Induced Hypertension (PIH

    Directory of Open Access Journals (Sweden)

    Mehul T Parmar, Harsha M Solanki, Vibha V Gosalia

    2012-01-01

    Full Text Available Background: Hypertensive disorders are common complication occurring during pregnancy responsible for maternal & fetal mortality & morbidity. Though the condition is on decline, still stands a public health problem. Objectives: To determine risk factors of perinatal death in women with pregnancy induced hypertension. Materials & Method: A cross-sectional study was conducted over period of one year in the department of Obstetrics & Gynecology in NHL municipal college, Ahmadabad. A total of 100 pregnant women with PIH were enrolled in the study. A pre-tested structured Performa was prepared & women were interviewed to collect necessary information such as detailed history, clinical examination findings & investigations performed. Results were analyzed using MS Excel & Epi Info. Results: In the present study, 29%, 21% & 50 % were of mild PIH, moderate PIH & severe PIH respectively. The incidence of PIH was found more among teenage pregnancy, among primigravidas, those from low socio-economic status, those with history of PIH in previous pregnancy, having family history of PIH & those who were found obese. Emergency delivery, having diastolic blood pressure > 90 mm Hg, higher degree of proteinuria & low birth weight among PIH cases had an adverse perinatal outcome in terms of higher perinatal death. The findings were statistically significant On Univariate analysis; diastolic blood pressure & degree of proteinuria were found to be significant risk factors responsible for perinatal mortality among PIH women. Conclusion: Pregnancy induced hypertension is a common medical disorder associated with pregnancy. In the present study, PIH cases who delivered in emergency, with raised diastolic blood pressure & more proteinuria & neonate with low birth weight were found risk factors for perinatal death. Fetal morbidity & mortality can be reduced by early recognition & institutional management.

  1. Platelet aggregation and serum adenosine deaminase (ADA) activity in pregnancy associated with diabetes, hypertension and HIV.

    Science.gov (United States)

    Leal, Claudio A M; Leal, Daniela B R; Adefegha, Stephen A; Morsch, Vera M; da Silva, José E P; Rezer, João F P; Schrekker, Clarissa M L; Abdalla, Faida H; Schetinger, Maria R C

    2016-07-01

    Platelet aggregation and adenosine deaminase (ADA) activity were evaluated in pregnant women living with some disease conditions including hypertension, diabetes mellitus and human immunodeficiency virus infection. The subject population is consisted of 15 non-pregnant healthy women [control group (CG)], 15 women with normal pregnancy (NP), 7 women with hypertensive pregnancy (HP), 10 women with gestational diabetes mellitus (GDM) and 12 women with human immunodeficiency virus-infected pregnancy (HIP) groups. The aggregation of platelets was checked using an optical aggregometer, and serum ADA activity was determined using the colorimetric method. After the addition of 5 µM of agonist adenosine diphosphate, the percentage of platelet aggregation was significantly (p < 0·05) increased in NP, HP, GDM and HIP groups when compared with the CG, while the addition of 10 µM of the same agonist caused significant (p < 0·05) elevations in HP, GDM and HIP groups when compared with CG. Furthermore, ADA activity was significantly (p < 0·05) enhanced in NP, HP, GDM and HIP groups when compared with CG. In this study, the increased platelet aggregation and ADA activity in pregnancy and pregnancy-associated diseases suggest that platelet aggregation and ADA activity could serve as peripheral markers for the development of effective therapy in the maintenance of homeostasis and some inflammatory process in these pathophysiological conditions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Lower segment cesarean section in a patient with severe thrombocytopenia and pregnancy induced hypertension

    Directory of Open Access Journals (Sweden)

    Minal Harde

    2013-01-01

    Full Text Available Thrombocytopenia in pregnancy carries a major risk of feto-maternal morbidity and mortality. We present a case of hypocellular bone marrow with severe thrombocytopenia with pregnancy induced hypertension (PIH for emergency lower segment cesarean section (LSCS. This disease is characterized by pancytopenia and hypocellular bone marrow with impaired morphology and maturation. Causes of death due to this disease include hemorrhage and infection secondary to thrombocytopenia and neutropenia especially following surgery. We report successful management of emergency LSCS with severe thrombocytopenia with severe PIH.

  3. Feto-maternal interaction: a mathematical model simulating placental response in hypertensive disorders of pregnancy.

    Science.gov (United States)

    Luria, Oded; Bar, Jacob; Kovo, Michal; Golan, Abraham; Barnea, Ofer

    2010-10-01

    Elevated maternal blood pressure (BP) is common in pregnancies complicated by hypertensive disorders. In response, increased production and accumulation of elastin occurs in the feto-placental blood vessels. This results in increased vascular wall stiffness that increases the resistance to flow. To study the interaction between the stiffness of the fetoplacental blood vessels, fetoplacental blood flow and BP, a mathematical model of the fetoplacental vascular tree was developed. The model describes an elastic structure exposed to external pressure. Model results indicate that increased vascular stiffness in the fetal blood vessels may contribute to optimizing fetoplacental blood flow in hypertensive pregnancies. According to model predictions, uncontrolled lowering of BP following vascular adaptation may adversely affect fetoplacental blood flow.

  4. Association between adverse pregnancy outcome and imbalance in angiogenic regulators and oxidative stress biomarkers in gestational hypertension and preeclampsia.

    Science.gov (United States)

    Turpin, Cornelius A; Sakyi, Samuel A; Owiredu, William K B A; Ephraim, Richard K D; Anto, Enoch O

    2015-08-25

    Gestational hypertension (GH) and Preeclampsia, (PE) are the most complicated amongst hypertensive disorders of pregnancy. The mechanism that links hypertension in pregnancy to adverse maternal outcomes is not fully understood though some relate this to endothelial dysfunction originating from an imbalanced angiogenic regulators and oxidative stress biomarkers. This study assessed the correlation between angiogenic regulators and oxidative stress biomarker levels with adverse pregnancy outcomes among GH and PE participants. A cohort of pregnant women who received antenatal care at the Obstetrics and Gynaecology department of the Komfo Anokye Teaching Hospital (KATH) were followed. During their antenatal visits, 100 developed PE and 70 developed GE, of these, 50 PE and 50 GH gave informed consent. Their blood samples were taken at time of diagnosis and 48 h post-partum. 50 other aged-matched women who did not develop neither GH nor PE were selected as controls. Placental growth factor (PLGF), soluble fms-like tyrosine kinase 1 (sFlt-1) and 8-epi-prostaglandin F2alpha (8-epi-PGF2α) levels were estimated by ELISA and total antioxidant capacity (T-AOC) was measured spectrophotometrically. Graphpad Prism was used for data analysis. Median levels of sFlt-1, 8-epi-PGF2α and sFlt-1/PLGF were elevated among participants with PE co-existing with intrauterine fetal death (IUFD), placental abruptio, placental previa, HELLP syndrome and intrauterine growth restriction (IUGR) compared to PE without adverse outcomes (p = 0.041, p = 0.005, p = 0.0002). Levels of PLGF, T-AOC and PLGF/sFlt-1 were significantly reduced among participants with PE co-existing with IUFD, placental abruptio, placental previa, HELLP syndrome and IUGR compared to PE without adverse outcomes (p = 0.0013, p = 0.006, p stress biomarkers correlates with adverse pregnancy outcomes among PE participants. Early identification of these imbalance would alert health care givers in

  5. Significance and changes of peripheral blood, placental tissue cytokines and NO in patients with hypertensive disorders of pregnancy

    Institute of Scientific and Technical Information of China (English)

    Jie-Ning Zou; Li Xiong; Jin-Tao Zhou

    2015-01-01

    Objective:To investigate significance and changes of placental tissue cytokines and NO levels in peripheral blood of patients with hypertensive disorders of pregnancy and their relationship. Methods: A total of 75 cases of hypertensive disorders of pregnancy were selected as researching objects, including 26 cases of pregnancy-induced hypertension subgroup, 29 cases of patients with mild preeclampsia and 20 cases of subgroups severe preeclampsia subgroups;another 45 cases of healthy pregnant women were also selected as the control group. The maternal blood and placental tissue factor (TNF-α, IL-6, hs-CRP) and NO levels of the four groups were compared.Results:Peripheral blood and placental tissue cytokine levels of patients with hypertensive disorders of pregnancy were significantly higher, NO levels were significantly lower than the control group (P<0.01). In subgroups peripheral blood and placenta cytokine levels were gradually increased, NO levels were increased with gestational hypertension disease degree (P<0.05); NO was significantly negatively correlated with TNF-α, IL-6, hs-CRP levels (P<0.01).Conclusions: During pregnancy, monitoring of TNF-α, IL-6, hs-CRP and NO in placental tissue is helpful in prediction and evaluation of early hypertensive disorders of pregnancy, and is also helpful in treatment.

  6. PP142. Independent effects of pregnancy induced hypertension on childhood development: A retrospective cohort study.

    Science.gov (United States)

    Campbell, D; Love, E; Crum, J; Bhattacharya, S

    2012-07-01

    The effect of maternal pre-eclampsia on neurological and cognitive development of children is not well known. A literature search of Ovid MEDLINE, EMBASE and CINAHL revealed differing opinions in the current literature. It would appear that there is uncertainty regarding the independent effects of preterm birth, birth weight and pre-eclampsia on early childhood development, complicated by the fact that most pre-eclamptic mothers are delivered preterm, and many such babies are growth restricted. To assess whether maternal hypertension in pregnancy was independently associated with additional support needs in children Retrospective cohort study Setting: Grampian region of Scotland Main outcome measure: The primary outcome of interest was whether a child had developed a record in the Support Needs System (Grampian). Secondary outcomes included the development of a particular disorder or deficiency for example, autism. Linkage of birth records of all singleton deliveries occurring in primigravidae between 1995 and 2008 in Aberdeen Maternity and Neonatal Databank with the Support Needs System (SNS) dataset in Grampian. The database from which the study population is derived - the Aberdeen Maternity and Neonatal Databank (AMND) has been in existence since 1950 The Support Needs System (SNS) is part of a Scottish-wide database recording information about children who have additional support needs for more than six months and has been utilised in Grampian since 1998. The first exposed cohort comprised children whose mothers had pre-eclampsia or eclampsia and the second, those whose mothers had gestational hypertension. Children with normotensive mothers formed the unexposed cohort. Hypertensive status in pregnancy was based on Davey and MacGillivray's classification of hypertensive disorders of pregnancy. Crude and adjusted odds ratios with 95% confidence Intervals of having a record in SNS in the presence of maternal pregnancy induced hypertension were calculated using

  7. Nitric oxide-mediated changes in vascular reactivity in pregnancy in spontaneously hypertensive rats.

    OpenAIRE

    Chu, Z. M.; Beilin, L J

    1993-01-01

    1. To examine the mechanisms which may account for pregnancy-induced vasodilatation in spontaneously hypertensive rats (SHR), we have investigated the changes in vascular reactivity and the effects of endothelial nitric oxide (NO) inhibition in the in situ blood-perfused, mesenteric resistance vessels of 18-20 day pregnant SHR. The effects of NG-nitro-L-arginine (L-NOARG) were compared in pregnant and nonpregnant SHR and gestation matched normotensive Wistar-Kyoto (WKY) rats. 2. Intra-arteria...

  8. Hypertensive Disorders of Pregnancy and Offspring Cardiac Structure and Function in Adolescence

    OpenAIRE

    Timpka, Simon; Macdonald-Wallis, Corrie; Hughes, Alun D.; Chaturvedi, Nish; Franks, Paul; Lawlor, Debbie; Fraser, Abigail

    2016-01-01

    BACKGROUND: Fetal exposure to preeclampsia is associated with higher blood pressure and later risk of stroke. We aimed to investigate the associations of maternal preeclampsia, gestational hypertension, and maternal blood pressure change in pregnancy with offspring cardiac structure and function in adolescence. METHODS AND RESULTS: Using data from a prospective birth cohort study, we included offspring who underwent echocardiography (mean age, 17.7 years; SD, 0.3; N=1592). We examined whether...

  9. Comparison Of Serum Calcium, Phosphorus And Total Protein Levels, In Pregnancy With Or Without Hypertensive Disorders

    Directory of Open Access Journals (Sweden)

    Rashid Pooraei M

    2005-06-01

    Full Text Available Background: Pre-eclampsia is characterized by hypertension development and proteinuria during pregnancy. Hypertension disorder is a leading cause of maternal and fetal morbidity and death in worldwide. Although the pathophysiology of hypertension during pregnancy is unclear, but there is consensus that early diagnosis and aggressive treatment is warranted to prevent complicated to both fetus and mother. The changes of serum trace elements during pregnancy are paramount important to predict and good understanding the situation of patients. The aim of this study was about this issue. Materials and Methods: In a case-control study we investigated the possible differences in the level of serum calcium, phosphorus and total protein in 55 healthy pregnant and 52 pregnant with hypertensive disease at 32-40 weeks of gestational age during the recent two years in Loghman hospital of Tehran. Some information such as age, blood group, parity number and blood pressure was taken from patients by a questionnaire. Results: The case population consisted of 22 sever preeclampsia, 15 mild preeclampsia, 8 eclampsia, and 7 chronic hypertensive. The mean serum calcium concentration (mg/dl was 9.180.74 in control group, 8.810.9 in mild preeclampsia, 7.850.38 in sever preeclampsia, 7.83 0.47 in eclampsia, 8.91 0.3 in chronic blood pressure. The mean serum phosphorus (mg/dl level observed, 4.27 in sever preeclampsia, 3.74 in eclampsia, 3.59 in mild eclampsia, 4.09 in chronic blood pressure, and 3.43 in control pregnant women. The mean serum total protein concentration level in sever preeclampsia and eclampsia was 5.46 and 5.04 mg/dl respectively. Conclusion: In conclusion, sever preeclampsia and eclampsia are associated with decreased level of calcium, total protein, and increased concentration of phosphorus.

  10. Relation between acute kidney injury and pregnancy-related factors

    OpenAIRE

    Monchai Siribamrungwong; Pawadee Chinudomwong

    2016-01-01

    Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it brings about devastating maternal and fetal outcomes. Among developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains one of the major health problems in the developing countries. Though some improvements have been observed, PRAKI still causes high maternal morbidity and mortality, le...

  11. The Association between Polymorphism of TNF-α Gene and Hypertensive Disorder Complicating Pregnancy

    Institute of Scientific and Technical Information of China (English)

    ZHAO Yin; XIA Shu; ZOU Li

    2007-01-01

    To study whether the development of hypertensive disorder complicating pregnancy is associated with -308G→A, -850C→T mutation at promoter of TNF-α gene, the -308G→A, -850C→T polymorphism was examined in patients and healthy pregnant women by PCR-RFLP technique. The frequencies of genotype and allele were compared between the two groups. The re- sults showed that with -308G→A polymorphism distribution, the allele frequency of TNF2 and the frequency of the genotype TNF2/1 in the patient group was significantly higher in the patient group than in control group (P<0.05). A significant difference in genotype distribution of -850C→T poly- morphism was observed between the two groups. The allele frequencies of T in patient group was higher in the control group as compared with the patient group. The frequencies of CT and TT geno- types were lower in the patient group. It is concluded that the TNF2 allele of -308 is associated with the occurrence of hypertensive disorder complicating pregnancy, while T allele of -850 may be the protective factor against the development of the disease. TNF2/1 CC may be susceptibility genotype of hypertensive disorder complicating pregnancy.

  12. Comparative study of labetalol and nifedipine in management of hypertensive disorders in pregnancy

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    U. S. Hangarga

    2016-12-01

    Full Text Available Background: Hypertensive disorders complicate 5 to 10 percent of all pregnancies, and together they are one member of the deadly triad, of haemorrhage and infection. Methods: The Present study was conducted at Navodaya Medical College, Hospital and Research Centre, Raichur from January 2014 to December 2015. The efficacy of labetalol verses nifedipine in management of hypertensive disorders of pregnancy was studied. The study consisted of 100 antenatal patients irrespective of parity and gestational age from 20-40weeks patients, with severe PIH with imminent eclampsia. Heart diseases, Hematological disorders, Liver diseases renal diseases and Bronchial asthma were excluded from the study. Results: In the study, fall in mean arterial pressure of >20mm Hg was noted 6hrs after initiation of treatment in nifedipine group which is statistically significant; no statistical significance was observed in both groups at 12hrs. A fall of mean arterial pressure to normal was noted at 48hrs and 72 hrs in labetalol, which is statistically highly significant. Conclusions: The present study indicates labetalol to be a better anti-hypertensive in terms of control of hypertension, mode of vaginal delivery and fetal outcome.

  13. Hypertensive disorders of pregnancy and risk of screening positive for Posttraumatic Stress Disorder : A cross-sectional study

    NARCIS (Netherlands)

    Porcel, Jacqueline; Feigal, Christine; Poye, Laney; Postma, Ineke R.; Zeeman, Gerda G.; Olowoyeye, Abiola; Tsigas, Eleni; Wilson, Melissa

    2013-01-01

    Objectives: Hypertensive Disorders of Pregnancy (HDP) encompass a spectrum of disorders that affect 6-8% of US pregnancies. We aim to determine the impact of self-reported history of HDP as a risk factor for screening positive for Posttraumatic Stress Disorder (PTSD), which results from exposure to

  14. Hypertensive disorders of pregnancy and risk of screening positive for Posttraumatic Stress Disorder : A cross-sectional study

    NARCIS (Netherlands)

    Porcel, Jacqueline; Feigal, Christine; Poye, Laney; Postma, Ineke R.; Zeeman, Gerda G.; Olowoyeye, Abiola; Tsigas, Eleni; Wilson, Melissa

    2013-01-01

    Objectives: Hypertensive Disorders of Pregnancy (HDP) encompass a spectrum of disorders that affect 6-8% of US pregnancies. We aim to determine the impact of self-reported history of HDP as a risk factor for screening positive for Posttraumatic Stress Disorder (PTSD), which results from exposure to

  15. Successful pregnancy with scleroderma renal disease and pulmonary hypertension in a patient using angiotensin converting enzyme inhibitors.

    OpenAIRE

    Baethge, B A; Wolf, R E

    1989-01-01

    A patient with scleroderma renal disease and pulmonary hypertension who had a successful pregnancy with the use of angiotensin converting enzyme inhibitors is presented. The routine use of these inhibitors during pregnancy is not recommended, however, owing to the reported potential risks to the fetus.

  16. Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries

    Directory of Open Access Journals (Sweden)

    Bhutta Zulfiqar A

    2011-04-01

    Full Text Available Abstract Background Hypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries. Methods A literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data were extracted into a standardized excel sheet. Identified studies were graded based on strengths and limitations of studies. All the included studies were from developing countries. Meta-analyses were generated where data were available from more than one study for an outcome. Primary outcomes were maternal mortality, eclampsia, pre-eclampsia, and severe preeclampsia. Neonatal outcomes like neonatal mortality, preterm birth, small for gestational age and low birth weight were also evaluated. We followed standardized guidelines of Child Health Epidemiology Reference Group (CHERG to generate estimates of effectiveness of calcium supplementation during pregnancy in reducing maternal and neonatal mortality in developing countries, for inclusion in the Lives Saved Tool (LiST. Results Data from 10 randomized controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy was associated with a significant reduction of 45% in risk of gestational hypertension [Relative risk (RR 0.55; 95 % confidence interval (CI 0.36-0.85] and 59% in the risk of pre-eclampsia [RR 0.41; 95 % CI 0.24-0.69] in developing countries. Calcium supplementation during pregnancy was also associated with a significant reduction

  17. Newly diagnosed hyperthyroidism in the 25th gestational week of pregnancy presenting with systolic arterial hypertension only.

    Science.gov (United States)

    Zaveljcina, Janez; Legan, Mateja; Gaberšček, Simona

    2016-05-01

    We present a case of a 30-year-old woman diagnosed with arterial hypertension in the 25th week of pregnancy. Our search for secondary causes of arterial hypertension revealed hyperthyroid Hashimoto's thyroiditis (HT), which was treated with propilthiouracil. Three weeks after delivery, she was normotensive without medication. In the next four months, she developed hypothyroidism and treatment with L-thyroxine was started. In conclusion, in the second half of pregnancy, a hyperthyroid HT can occur - in spite of the well-known amelioration of autoimmune thyroid disorders in that period, and can be the only cause of arterial hypertension.

  18. Correlation of serum neutrophil gelatinase associated lipocalin with disease severity in hypertensive disorders of pregnancy

    Directory of Open Access Journals (Sweden)

    Rekha Sachan

    2014-01-01

    Full Text Available Background: Vascular endothelial dysfunction is considered central to the pathogenesis of hypertensive disorders of pregnancy (HDP. Serum level of neutrophil gelatinase-associated lipocalin (NGAL is closely related to endothelial injury. The aim of this study was to examine the correlation of serum NGAL with disease severity in HDP. Materials and Methods: This prospective case-control study was carried out for one year. After informed consent, ethical clearance, total 1,850 pregnant women were screened. Analysis was performed on 142 cases of HDP and 31 healthy controls. Quantitative measurement of serum NGAL levels was done by the enzyme linked immunosorbent assay (ELISA technique, by using sandwich ELISA kit. Results: Mean serum NGAL value in patients with oliguria was significantly higher when compared with non-oliguric patients (P < 0.001. Serum NGAL had a positive correlation with systolic blood pressure (r ~ 0.5973, diastolic blood pressure (r ~ 0.6195, blood urea (r ~ 0.4392, serum creatinine (r ~ 0.6112, serum uric acid (r ~ 0.3878. Sensitivity and specificity of serum NGAL using a cut-off value of 545 pg/ml, for the diagnosis of HDP, was 97.89% and 93.55% respectively, using 95% confidence interval. Conclusion: Between the two groups, we found that serum NGAL had a positive correlation with disease severity and better sensitivity and specificity in the evaluation of HDP.

  19. Analysis of mineral elements in hair samples for pregnancy-induced hypertension patients%人发中矿质元素与妊高征关系分析

    Institute of Scientific and Technical Information of China (English)

    张建平; 赵莹; 赵永光; 吴萍

    2008-01-01

    采用等离子体质谱法、等离子体光谱法和原子荧光光谱法测定头发微量元素的含量,对20~25岁妊娠30周的妊娠高血压患者和正常妊娠者头发中微量元素的含量和元素问的相关关系进行分析比较.数据表明:妊娠高血压患者的K和Na元素偏高尤为突出,而se和Mn元素含量低于正常妊娠者;且妊娠高血脏患行Ca-Se、Cu-K之间的相关关系极为密切.为妊娠高血压的预防与治疗提供了科学依据.%In this paper,the contents of mineral element in hair samples for pregnancy-induced hypertension patients with 30 weeks gestation were measured by ICP-MS,ICP-OES and AFS method and controlled by healthy pregnancy persons with different age from 20 to 25.The correlation of mineral elements and pregnancyinduced hypertension preliminarily studied.It was shown that the contents of K and Na for pregnancy-induced hypertension patients were higher than healthy pregnancy persons.While the contents of Mn and Se are lower than healthy pregnancy persons.The highly relation between Ca-Se,Cu-K were also found.The paper provides guide for prevention and clinical treatment of pregnancy-induced hypertension.

  20. Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women’s Health

    NARCIS (Netherlands)

    Schoenaker, D.A.J.M.; Soedamah-Muthu, S.S.; Callaway, L.K.; Mishra, G.D.

    2015-01-01

    Background: Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. Objective: We investigated

  1. Pregnancy outcomes in patients with pulmonary arterial hypertension associated with congenital heart disease.

    Science.gov (United States)

    Ladouceur, Magalie; Benoit, Louise; Radojevic, Jelena; Basquin, Adeline; Dauphin, Claire; Hascoet, Sébastien; Moceri, Pamela; Bredy, Charlene; Iserin, Laurence; Gouton, Marielle; Nizard, Jacky

    2017-02-15

    There is growing evidence that maternal mortality in pregnant women with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is lower than that in available data. In order to evaluate this hypothesis, we collected data of pregnancies in women with PAH-CHD. Women with PAH-CHD followed in seven French referral centres were retrospectively included from 1997 to 2015. All pregnancies were recorded. We collected data on maternal, obstetrical and neonatal outcomes. 28 pregnancies in 20 women (26±6 years old) with PAH-CHD were managed during this period. There were 18 complete pregnancies (≥20 weeks' gestation (WG)), 8 abortions and 2 miscarriages. Six (33%, 95% CI (11.9 to 54.3)) patients experienced severe cardiac events. The concerned women had lower resting oxygen saturation (79.6±4.1% vs 89.3±3.8%, pheart failure (n=4) and severe hypoxaemia (n=5). Heart failure was overall severe, requiring inotropic treatment in three patients, mechanical circulatory support in one and led to one maternal death (mortality=5.0% 95% CI (0.1 to 24.9)). Obstetrical complications occurred in 25% of pregnancies. Small for gestational age was diagnosed in 39% (7/18) of fetuses. 12/18 (67%) pregnancies were delivered by caesarean section, of which 10 in emergency for obstetrical reason. Prematurity was frequent (78%), but no neonatal death occurred. Outcome of pregnancy in women with PAH-CHD is better than previously reported, with only 5% maternal mortality in our cohort. However, because of the severity of heart failure and the high rate of neonatal complications, patients should still be advised against pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. A retrospective study of the health profile of neonates of mothers with anemia in pregnancy and pregnancy induced hypertension in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Olusola Funmilayo Sotunde

    2014-07-01

    Full Text Available Our study assessed the health profile of neonates in relation to anemia in pregnancy and pregnancy induced hypertension (PIH. This was a retrospective study where a systematic random sampling technique was used to select a total of 1046 case records of pregnant women registered for ante-natal care at Lagos Island Maternity Hospital, Lagos, Nigeria, between 2005 and 2009. Socio-demographic characteristics of the mothers, prevalence of anemia and PIH, and neonatal health profile were obtained from the case records and were analyzed using both descriptive and inferential statistics. Pearson product moment correlation was used to show the relationship (P≤0.05 between maternal complications and neonatal health profile. Majority (68.8% of the mothers had anemia and 6.7 % had PIH. Majority (97.12% of the neonates were live births and 2.88% of the neonates were still births, 65.4% of the women with still birth pregnancy outcome had anemia, and 34.6% had PIH. Majority (74% of the neonates had birth weight within normal range (2.5-4.0 kg and majority (68% had normal Apgar score at 5 min of birth (7- 10. A positive correlation existed between the packed cell volume of the mother and the birth weight of the neonates (r=0.740, P≤0.05. A negative correlation existed between the incidence of PIH and the birth weight of the neonates (r=

  3. VEGF and eNOS Expression in Umbilical Cord from Pregnancy Complicated by Hypertensive Disorder with Different Severity

    Directory of Open Access Journals (Sweden)

    K. Bhavina

    2014-01-01

    Full Text Available Background. Reduced blood flow in hypertensive pregnancy may influence the production vasoconstrictors; subsequently the vessel remains in highly contracted state. NO is a vasodilator; VEGF influences its synthesis by regulating eNOS production. Aim of our study was to evaluate the expression of VEGF and eNOS in different severity of hypertensive pregnancy. Methods. Study was conducted in 4 groups with 40 members: group 1—control, group 2—gestational hypertension, group 3—mild preeclampsia, and group 4—severe preeclampsia. Fetal end of umbilical cord was taken and follows IHC staining protocol for VEGF and eNOS antibody. Staining intensity were measured by semiquantitative scoring method. Mann Whitney U test was used to compare each group. Results. Decreased expression of both VEGF and eNOS was found in hypertensive condition than in normal condition. Among hypertensive group, severe preeclamptic group showed more intensity in staining than gestational hypertension and mild preeclampsia. Conclusion. Reduction of VEGF and eNOS in gestational hypertension may lead to hypoperfusion and subsequent hypoxia of fetus in hypertensive pregnancy. The developed hypoxic state may upregulate the synthesis of VEGF and thereby eNOS. Increased expression of VEGF and eNOS in severe group may be a compensatory mechanism to dilate the blood vessels and to improve blood flow of fetus.

  4. Effect of exercise on the maternal outcome in pregnancy of spontaneously hypertensive rats.

    Science.gov (United States)

    Rocha, Renato; Peraçoli, José Carlos; Volpato, Gustavo Tadeu; Damasceno, Débora Cristina; Campos, Kleber Eduardo de

    2014-09-01

    To evaluate the effect of exercise (swimming) on pregnancy in spontaneously hypertensive rats (SHR). Thirty three pregnant female SHR were distributed into three groups (n=11 animals/group): SHR Control=non-exercised (sedentary); SHR Ex0 = exercised from day zero to day 20 of pregnancy; and SHR Ex7 = exercised from day 7 to 20 of pregnancy. Body weight and systolic blood pressure were indirectly measured during pregnancy. On gestational day 21, the rats were anaesthetized and uterine content was withdrawn for analysis of maternal reproductive outcome parameters and fetal development. The reduced blood pressure percentage was higher in SHR Ex0 and SHR Ex7 compared to SHR Control group. Weight gain was present in all pregnancy periods, but it was lower in SHR Ex7 than in SHR Control dams. The exercise increased the pre-implantation loss rate. The post-implantation loss rate was lower in SHR Ex0 group. SHR Ex7 group showed a significantly higher percentage of fetuses classified as small for gestational age as compared to others groups. The exercise contributed to lowering gestational blood pressure in SHR rats, but had a negative impact on the developing embryo.

  5. Association between placenta previa and risk of hypertensive disorders of pregnancy: a meta-analysis based on 7 cohort studies.

    Science.gov (United States)

    Yin, X-A; Liu, Y-S

    2015-06-01

    The aim of this research is to evaluate the association between placenta previa and hypertensive disorders of pregnancy (HDP). A computerized literature search was carried out on PubMed to collect relevant articles on the association between placenta previa and HDP before November 2013. Pooled relative risk (RR) and 95% confidence intervals (CIs) were used to assess the strength of the associations. A total of 7 cohort studies were identified according to the inclusion criteria. Overall, a significantly inverse correlation between placenta previa and HDP was found when all study results were pooled into the meta-analysis (RR = 0.55, 95% CI: 0.32-0.97). For subgroup analyses, the same results were found in pregnancy-induced hypertension (PIH) group (RR = 0.36, 95% CI: 0.23-0.57) but not in other HDPs group (RR = 0.94, 95% CI: 0.44-2.00). This meta-analysis suggested a reduced risk for PIH in women with placenta previa.

  6. Pregnancy-related low back pain.

    Science.gov (United States)

    Katonis, P; Kampouroglou, A; Aggelopoulos, A; Kakavelakis, K; Lykoudis, S; Makrigiannakis, A; Alpantaki, K

    2011-07-01

    Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.

  7. Pregnancy related acute kidney injury: nondialytic management

    Directory of Open Access Journals (Sweden)

    Kaliki Hymavathi Reddy

    2015-04-01

    Full Text Available Acute Kidney Injury (AKI is associated with increased mortality and morbidity unless timely diagnosed and promptly managed. An understanding of the renal physiologic changes that occur during pregnancy is essential for Proper evaluation, diagnosis, and management of Pregnancy Related AKI (PRAKI. In the general population, AKI can occur from prerenal, intrinsic/renal, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management and prevention of adverse maternal/fetal outcomes. Sometimes PRAKI may require intensive management and even dialysis adding additional economical burden to the patient. We here, with report an interesting case of PRAKI diagnosed and managed in time by simple medical measures thus delivering an effective treatment at a much lesser cost. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 486-489

  8. Pre-eclampsia renamed and reframed: Intra-abdominal hypertension in pregnancy.

    Science.gov (United States)

    Sawchuck, Diane J; Wittmann, Bernd K

    2014-11-01

    This hypothesis proposes pre-eclampsia is caused by intra-abdominal hypertension in pregnancy. Sustained or increasing intra-abdominal pressure ⩾12mmHg causes impaired venous return to the heart, systemic vascular resistance, ischemia reperfusion injury, intestinal permeability, translocation of lipopolysaccharide endotoxin to the liver, cytotoxic immune response, systemic inflammatory response, pressure transmission to thoracic and intra-cranial compartments, and multi-organ dysfunction. This hypothesis is predicated on Pascal's law, evidence founded in the intra-abdominal hypertension literature, and the adapted equation ΔIAP-P=ΔIAVF/Cab, where ΔIAP-P=change in intra-abdominal pressure in pregnancy, ΔIAVF=change in intra-abdominal vector force (volume and force direction) and Cab=abdominal compliance. Factors causing increased intra-abdominal pressure in pregnancy include: progressive uterine expansion, obstetrical factors that increase intra-uterine volume excessively or acutely, maternal anthropometric measurements that affect intra-abdominal pressure thresholds, maternal postures that increase abdominal force direction, abdominal compliance that is decreased, diminished with advancing gestation, or has reached maximum expansion, habitation at high altitude, and rapid drops in barometric pressure. We postulate that the threshold for lipopolysaccharide translocation depends on the magnitude of intra-abdominal pressure, the intestinal microbiome complex, and the degree of intestinal permeability. We advance that delivery cures pre-eclampsia through the mechanism of abdominal decompression.

  9. Endogenous biosynthesis of arachidonic acid epoxides in humans: Increased formation in pregnancy-induced hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Catella, F.; Lawson, J.A.; Fitzgerald, D.J.; FitzGerald, G.A. (Vanderbilt Univ., Nashville, TN (USA))

    1990-08-01

    Arachidonic acid is metabolized by means of P450 isoenzyme(s) to form epoxyeicosatrienoic acids (EETs) and their corresponding dihydroxy derivatives (DHETs). In the present study, we established the presence in human urine of 8,9-, 11,12-, and 14,15-EETs and their corresponding DHETs by developing quantitative assays and using negative ion, chemical ionization GC/MS and octadeuterated internal standards. Urinary excretion of 8,9- and 11,12-DHET increased in healthy pregnant women compared with nonpregnant female volunteers. By contrast, excretion of 11,12-DHET and 14,15-DHET, but not the 8,9-DHET regioisomer, increased even further in patients with pregnancy-induced hypertension. Intravenous administration of (3H)14,15-EET to three dogs markedly increased its DHET in plasma. The terminal half-life ranged from 7.9-12.3 min and the volume of distribution (3.5-5.3 liters) suggested limited distribution outside the plasma compartment. Negligible radioactivity was detected in urine; this fact infers that under physiological circumstances, urinary DHETs largely derive from the kidney. That P450 metabolites of arachidonic acid are formed in humans supports the hypothesis that these metabolites contribute to the physiological response to normal pregnancy and the pathophysiology of pregnancy-induced hypertension.

  10. Glucocorticoid Metabolism in Hypertensive Disorders of Pregnancy: Analysis of Plasma and Urinary Cortisol and Cortisone.

    Science.gov (United States)

    Kosicka, Katarzyna; Siemiątkowska, Anna; Krzyścin, Mariola; Bręborowicz, Grzegorz H; Resztak, Matylda; Majchrzak-Celińska, Aleksandra; Chuchracki, Marek; Główka, Franciszek K

    2015-01-01

    The aim of the study was to analyze the plasma and urinary cortisol (F) and cortisone (E) levels in normotensive and hypertensive pregnant women. The parameters known to reflect the function of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) were calculated to verify the changes in glucocorticoid balance over the course of gestational hypertension (GH) and pre-eclampsia (PE). This retrospective case-control study included women in the third trimester of pregnancy, diagnosed with: GH (n = 29), PE (n = 26), or chronic hypertension (CH; n = 22). Normotensive women in their third trimester of pregnancy were also included (controls; n = 43). The plasma and urinary F and E levels were measured with the HPLC-FLD method. The 11β-HSD2 function was estimated by calculating the following ratios: plasma F/E and urinary free F to urinary free E (UFF/UFE). A statistical analysis was performed based on case-control structure. PE was characterized by lower plasma F levels (639.0 nmol/L), UFF/Cr levels (3.80 μg/mmol) and F/E ratio (3.46) compared with that of the controls (811.7 nmol/L, 6.28 μg/mmol and 5.19, respectively) with marked abnormalities observed in the changes of F/E and UFF/UFE ratios with advancing gestation. GH patients showed significant disparities in the urinary steroid profile with lower UFF/UFE ratio (0.330 vs. 0.401) compared with the normotensive controls and abnormal changes in the UFF/UFE throughout pregnancy. The observed tendency towards lower F/E and UFF/UFE ratios in PE and GH patients may reflect more intensive F metabolism over the course of those disorders. In the normal pregnancy group, the plasma F/E and UFF/UFE ratios tended to present inverse correlations with advancing gestation. This trend was much less marked in PE and GH patients, suggesting that the abnormalities in 11β-HSD2 functions progressed with the GA. The birth weights of neonates born from pre-eclamptic pregnancies were lower than those from uncomplicated pregnancies

  11. Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial

    Directory of Open Access Journals (Sweden)

    Mol Ben WJ

    2007-07-01

    Full Text Available Abstract Background Hypertensive disorders, i.e. pregnancy induced hypertension and preeclampsia, complicate 10 to15% of all pregnancies at term and are a major cause of maternal and perinatal morbidity and mortality. The only causal treatment is delivery. In case of preterm pregnancies conservative management is advocated if the risks for mother and child remain acceptable. In contrast, there is no consensus on how to manage mild hypertensive disease in pregnancies at term. Induction of labour might prevent maternal and neonatal complications at the expense of increased instrumental vaginal delivery rates and caesarean section rates. Methods/Design Women with a pregnancy complicated by pregnancy induced hypertension or mild preeclampsia at a gestational age between 36+0 and 41+0 weeks will be asked to participate in a multi-centre randomised controlled trial. Women will be randomised to either induction of labour or expectant management for spontaneous delivery. The primary outcome of this study is severe maternal morbidity, which can be complicated by maternal mortality in rare cases. Secondary outcome measures are neonatal mortality and morbidity, caesarean and vaginal instrumental delivery rates, maternal quality of life and costs. Analysis will be by intention to treat. In total, 720 pregnant women have to be randomised to show a reduction in severe maternal complications of hypertensive disease from 12 to 6%. Discussion This trial will provide evidence as to whether or not induction of labour in women with pregnancy induced hypertension or mild preeclampsia (nearly at term is an effective treatment to prevent severe maternal complications. Trial Registration The protocol is registered in the clinical trial register number ISRCTN08132825.

  12. Relationship between serum trace elements and antioxidant capacity indexes in women of hypertensive disorder complicating pregnancy

    Institute of Scientific and Technical Information of China (English)

    Yang Liu; Mei Xu; Ying Jiang; Yan Zhang

    2016-01-01

    Objective:To analyze the relationship between serum trace elements, antioxidant capacity index and hypertensive disorder complicating pregnancy (HDCP). Methods: Forty cases of normal healthy pregnant women, twenty-one pregnant women with high blood pressure, twenty-eight pregnant women with early stage of mild preeclampsia and twenty-two pregnant women with early stage of severe preeclampsia were selected respectively. Then, the differences of blood routine examination and blood coagulation function of the four groups were compared. At the same time, the levels of the serum trace elements and oxidative stress related indexes in the placental villi tissue were determined by flame atomic absorption spectrometry. Results:The white blood cells and hematocrit of HDCP pregnant women were significantly higher than those of normal healthy pregnant women;platelet and fibrinogen levels were obviously lower than those of normal healthy pregnant women, while thrombin time was shorter than that of normal healthy pregnant women;levels of serum copper, zinc and manganese were also significantly lower than whose of normal healthy pregnant women, while iron level was distinctly higher than that of normal healthy pregnant women. The differences between groups were statistically significant. The activities of SOD and GSH-PX in the placental villi tissue of HDCP pregnant women were significantly smaller than those of normal healthy pregnant women, while the Hcy level was higher than that of normal healthy pregnant women. The differences between groups were statistically significant. Conclusions:Pregnant women with HDCP has both imbalance of trace elements and redox system equilibrium, so we should strengthen the determination of the trace elements and redox related indexes of HDCP pregnant women to ensure health of maternal and child.

  13. Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study.

    Science.gov (United States)

    Van Eerden, Leonoor; Van Oostwaard, Miriam F; Zeeman, Gerda G; Page-Christiaens, Godelieve C M; Pajkrt, Eva; Duvekot, Johannes J; Vandenbussche, Frank P; Oei, Swan G; Scheepers, Hubertina C J; Van Eyck, Jim; Middeldorp, Johanna M; Koenen, Steven V; De Groot, Christianne J M; Bolte, Antoinette C

    2016-11-01

    To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. Retrospective cohort study in all Dutch tertiary perinatal care centres (n=10), between January 2000 and January 2014. All women who underwent termination of pregnancy, without fetal surveillance or intention to intervene for fetal reasons, for early-onset hypertensive disorders in pregnancy, were analyzed. Women eligible for this study were identified in the local delivery databases. Medical records were used to collect relevant data. Between January 2000 and January 2014, 2,456,584 women delivered in The Netherlands, of which 238,448 (9.7%) in a tertiary care centre. A total of 161 pregnancy terminations (11-12 per year) for severe early-onset preeclampsia were identified, including 6 women with a twin pregnancy. Mean gestational age at termination was 172 days (GA 24(4/7))±9.4 days. In 70% of cases termination was performed at or shortly after 24 weeks' gestation. 74.5% of women developed HELLP syndrome (n=96), eclampsia (n=10) or needed admission to an ICU (n=14). Birth weight was below 500g in 64% of cases. In 69% of the cases the estimated fetal weight was within a 10% margin of the actual birth weight. Termination of pregnancy for early-onset hypertensive disorders without intervention for fetal indication occurs approximately 12 times per year in The Netherlands. More data are needed to investigate contemporary best practice regarding termination of pregnancy for early-onset hypertensive indications at the limits of fetal viability. Considering the frequency of maternal complications, termination of pregnancy and not expectant management should be considered for all women presenting with severe early onset hypertensive disorders at the limits of fetal viability. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  14. SMFM Statement: benefit of antihypertensive therapy for mild-to-moderate chronic hypertension during pregnancy remains uncertain.

    Science.gov (United States)

    2015-07-01

    Chronic hypertension is present in up to 5% of pregnant women and constitutes a major cause of maternal and neonatal morbidity and mortality. The purpose of this document is to summarize the current recommendations regarding use of antihypertensive medications during pregnancy for women with mild-to-moderate chronic hypertension in the setting of the recently published Control of Hypertension in Pregnancy Study (CHIPS). The recently published CHIPS trial was a multicenter international randomized controlled trial comparing "less tight control" to "tight control" of blood pressure for pregnant women with hypertension. The most updated recommendations regarding management of pregnant women with hypertension are found from the American Congress of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy, which are endorsed by the Society of Maternal-Fetal Medicine (SMFM). SMFM recommends that clinicians continue to follow existing guidelines for management of pregnant women with mild-to-moderate chronic hypertension due to the fact that the benefits and risks of pharmacologic treatment for these women remain uncertain, and adequately powered randomized controlled trials are needed to address the less common but clinically significant nonsurrogate perinatal outcomes.

  15. Hypertension, diuretics and antihypertensives in relation to bladder cancer

    Science.gov (United States)

    Jiang, Xuejuan; Castelao, J.Esteban; Yuan, Jian-Min; Groshen, Susan; Stern, Mariana C.; Conti, David V.; Cortessis, Victoria K.; Coetzee, Gerhard A.; Pike, Malcolm C.; Gago-Dominguez, Manuela

    2010-01-01

    The aim of this study is to investigate the relationships between hypertension, hypertension medication and bladder cancer risk in a population-based case–control study conducted in Los Angeles. Non-Asians between the ages of 25 and 64 years with histologically confirmed bladder cancers diagnosed between 1987 and 1996 were identified through the Los Angeles County Cancer Surveillance Program. A total of 1585 cases and their age-, gender- and race-matched neighborhood controls were included in the analyses. Conditional logistic regression models were used to examine the relationship between history of hypertension, medication use and bladder cancer risk. A history of hypertension was not related to bladder cancer; however, among hypertensive individuals, there was a significant difference in bladder cancer risk related to the use of diuretics or antihypertensive drugs (P for heterogeneity = 0.004). Compared with individuals without hypertension, hypertensive individuals who regularly used diuretics/antihypertensives had a similar risk [odds ratio (OR) 1.06; 95% confidence interval (CI) 0.86–1.30], whereas untreated hypertensive subjects had a 35% reduction in risk (OR: 0.65; 95% CI: 0.48–0.88). A greater reduction in bladder cancer risk was observed among current-smokers (OR: 0.43; 95% CI: 0.27–0.71) and carriers of GSTM1-null (homozygous absence) genotypes (OR: 0.43; 95% CI: 0.22–0.85). Similarly, among smokers with GSTM1-null genotype, levels of 4-aminobiphenyl-hemoglobin adducts were significantly lower among untreated hypertensive individuals (45.7 pg/g Hb) compared with individuals without hypertension (79.8 pg/g Hb) (P = 0.009). In conclusion, untreated hypertension was associated with a reduced risk of bladder cancer. PMID:20732908

  16. Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence.

    Science.gov (United States)

    Nerenberg, Kara; Daskalopoulou, Stella S; Dasgupta, Kaberi

    2014-07-01

    The occurrence of common pregnancy-related medical disorders identifies women at high risk of developing future vascular disease. Systematic reviews of cohort studies demonstrate that gestational diabetes confers a 7-fold risk increase for type 2 diabetes, and preeclampsia confers a 1.8-fold risk increase for type 2 diabetes and 3.4-fold risk increase for hypertension. Gestational diabetes and hypertensive disorders of pregnancy (HDP) increase the risk of premature vascular disease, but the 2-fold risk increase associated with preeclampsia is only partially explained by the development of traditional vascular risk factors. Despite the compelling evidence for gestational diabetes and HDP as vascular risk indicators, there are no published Canadian vascular prevention guidelines that recognize these postpartum women. In contrast, the 2011 American Heart Association guidelines on cardiovascular disease in women include gestational diabetes and HDP in their vascular risk assessment. Studies indicate that the importance surveillance of vascular risk factors in these women after pregnancy is underappreciated by the women themselves and their physicians. Although a prudent diet and physically active lifestyle were demonstrated to reduce diabetes risk in women with a gestational diabetes history in the American Diabetes Prevention Program trial, adoption of these health behaviours is low; qualitative studies confirm a need for tailored strategies that address barriers and provide social support. Further research is also needed on approaches to reduce vascular risk in women with a history of gestational diabetes and HDP. Otherwise, an early window of opportunity for chronic disease prevention in young, high-risk women will be missed.

  17. Hypertension

    Science.gov (United States)

    ... Hypertension Triglycerides Featured Resource Find an Endocrinologist Search Hypertension March 2010 Download PDFs English Espanol Editors Robert ... Additional Resources MedlinePlus (NIH) Mayo Clinic What is hypertension? Hypertension, or chronic (long-term) high blood pressure, ...

  18. Pitfalls With the New American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy.

    Science.gov (United States)

    Pauli, Jaimey M; Repke, John T

    2017-03-01

    The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy was created to evaluate the existing literature, develop practice guidelines, and identify areas for future research focus. Several issues were identified that may not have been initially obvious during the process of developing this document, including limited practical use, a lack of high quality literature, conflicting recommendations, a potential for high resource utilization, need for continually updated information, and little headway in research that is clinically useful. The purpose of this review was to make suggestions to improving these guidelines' overall usefulness and consistency for the busy clinician.

  19. Complement split product C4d deposition in placenta in systemic lupus erythematosus and pregnancy-induced hypertension.

    Science.gov (United States)

    Minamiguchi, Sachiko; Mikami, Yoshiki; Nakajima, Naoki; Salah, Adeeb; Kondoh, Eiji; Tatsumi, Keiji; Konishi, Ikuo; Haga, Hironori

    2013-03-01

    Systemic lupus erythematosus (SLE) and pregnancy-induced hypertension (PIH) are related to premature delivery and intrauterine growth restriction (IUGR), and share histological findings of the placenta. Association with complement dysregulation has been reported in pregnancy for both disorders. The purpose of this study was to investigate the utility of C4d immunohistochemistry for placentas with SLE- and PIH-associated pregnancy. C4d staining was performed on paraffin-embedded tissue of placentas from 26 patients with SLE, 26 with PIH, and 25 control cases. We used the H-score with a range of 0-300 for the evaluation of C4d immunoreactivity. Placentas of SLE and PIH cases showed a higher H-score than control cases (average, SLE, 38.3 (P < 0.05); PIH, 17.8; control, 1.68), with linear staining on the membrane of syncytiotrophoblast. C4d-high groups comprised 50% (12/26) of SLE and 35% (9/26) of PIH cases, with H-scores ranging 14-270 and 15-170. C4d-high groups were significantly associated with low-placental weights and low birth weight in both SLE and PIH (P < 0.05), and lower gestational age (P < 0.05) in PIH cases. These results suggest that C4d might be utilized as a biomarker evaluating the subsequent risk for IUGR and disease control during the gestation period in these patients.

  20. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study

    Directory of Open Access Journals (Sweden)

    Magee Laura A

    2004-08-01

    Full Text Available Abstract Background Hypertensive disorders in pregnancy are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. However, studies attempting to quantify the effect of hypertension on adverse perinatal outcomes have been mostly conducted in tertiary centres. This population-based study explored the frequency of hypertensive disorders in pregnancy and the associated increase in small for gestational age (SGA and stillbirth. Methods We used information on all pregnant women and births, in the Canadian province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if delivery occurred Results The study population included 135,466 pregnancies. Of these, 7.7% had mild pregnancy-induced hypertension (PIH, 1.3% had severe PIH, 0.2% had HELLP (hemolysis, elevated liver enzymes, low platelets, 0.02% had eclampsia, 0.6% had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. Women with any hypertension in pregnancy were 1.6 (95% CI 1.5–1.6 times more likely to have a live birth with SGA and 1.4 (95% CI 1.1–1.8 times more likely to have a stillbirth as compared with normotensive women. Adjusted analyses showed that women with gestational hypertension without proteinuria (mild PIH and with proteinuria (severe PIH, HELLP, or eclampsia were more likely to have infants with SGA (RR 1.5, 95% CI 1.4–1.6 and RR 3.2, 95% CI 2.8–3.6, respectively. Women with pre-existing hypertension were also more likely to give birth to an infant with SGA (RR 2.5, 95% CI 2.2–3.0 or to have a stillbirth (RR 3.2, 95% CI 1.9–5.4. Conclusions This large, population-based study confirms and quantifies the magnitude of the excess risk of small for gestational age and stillbirth among births to women with hypertensive disease in pregnancy.

  1. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.

    Science.gov (United States)

    Kotchen, Theodore A

    2010-11-01

    The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.

  2. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Ntobeko B A Ntusi

    Full Text Available There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM, as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP (i.e., peripartum cardiac failure associated with any form of hypertension and PPCM have similar or different clinical features and outcome.We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years and PPCM (n = 30; age 31.5 ± 7.5 years. The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001. PPCM was more significantly associated with the following features than HHFP (p<0.05: twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05 to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05. There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005 during follow-up.There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.

  3. Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years

    Directory of Open Access Journals (Sweden)

    John Monagle

    2015-01-01

    Full Text Available Background: Pulmonary hypertension (PH in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. Results: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.

  4. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde;

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy...... physical workload). The adverse outcomes considered are: miscarriage, preterm delivery, small for gestational age, low birth weight, pre-eclampsia and gestational hypertension. Systematic review of the literature indicates that these exposures are unlikely to carry much of an increased risk for any...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  5. Osteonecrosis of the humerus related to pregnancy.

    OpenAIRE

    McGuigan, L; Fleming, A

    1983-01-01

    A case of osteonecrosis of the head of the humerus is described in which the only likely precipitant was pregnancy. The association of pregnancy and osteonecrosis is reviewed. This is the first reported case of osteonecrosis of the humerus alone associated with pregnancy.

  6. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study)

    Science.gov (United States)

    von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen; Koren, Gideon; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean-Marie

    2016-01-01

    To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight <10th percentile, preeclampsia, delivery at <34 or <37 weeks, platelets <100×109/L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight <10th percentile, preeclampsia, preterm delivery, elevated liver enzymes (all P<0.001), platelets <100×109/L (P=0.006), and prolonged hospital stay (P=0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (P<0.001), birth weight <10th percentile (P=0.005), delivery at <37 (P<0.001) or <34 weeks (P<0.001), or elevated liver enzymes with symptoms (P=0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. Clinical Trial Registration— URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN

  7. Sleep quality and stress in women with pregnancy-induced hypertension and gestational diabetes mellitus.

    Science.gov (United States)

    Hayase, Mako; Shimada, Mieko; Seki, Hiroyuki

    2014-09-01

    Pregnant women with complications including pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) often experience disrupted sleep patterns because of activation of the sympathetic nervous system. These pathologies are aggravated by sympathetic nervous system activation and may be related to stress. The present study aimed to clarify the characteristics of and changes in sleep quality and stress in pregnant women with PIH and GDM during the second and third trimesters. We enrolled 56 women in their second or third trimesters who were diagnosed with PIH or GDM. Participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS). Secretory immunoglobulin A (SlgA) concentrations were measured as a biological indicator of stress. PSS scores and subjective stress parameters were significantly higher than those reported from previous studies of healthy pregnant women (15.2 points and 15.1 points for the second and third trimesters, respectively). Mean one-day values for SIgA were 168.3 and 205.7 μg/mL for the second and third trimesters, respectively. During the second and third trimesters, SIgA scores were higher than those reported for healthy pregnant women in previous studies. The PSQI component scores sleep disturbance (C5) and sleep duration (C3) in follow up case were significantly higher in the third trimester than in the second trimester. This investigation suggests that pregnant women with PIH and GDM experience higher stress levels than do non-pregnant women and healthy pregnant women. Further, our results indicate that sleep quality worsens during the third trimester compared with the second trimester. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  8. Transforming growth factor-beta 1 does not relate to hypertension in pre-eclampsia.

    Science.gov (United States)

    Hennessy, A; Orange, S; Willis, N; Painter, D M; Child, A; Horvath, J S

    2002-11-01

    1. Pre-eclampsia is a human disease of pregnancy characterized by high blood pressure, proteinuria and end-organ damage, if severe. Pre-eclampsia is thought to be related to changes in early placental development, with the formation of a shallower than normal placental bed. 2. Transforming growth factor (TGF)-beta1 is a multifunctional fibrogenic growth factor involved in immune regulation that is elevated in some populations with a high risk of hypertensive end-organ disease related to increases in endothelin release. Transforming growth factor-beta1 is also an important factor in placental implantation. Alterations in TGF-beta1 may be related to abnormal placental development in early pregnancy and, thus, are a candidate for the development of hypertension in pre-eclampsia. 3. The aim of the present study was to examine the placental distribution and serum concentration of TGF-beta1 in patients with pre-eclampsia compared with normal pregnancy. 4. Patients with pre-eclampsia (n = 12) were compared with patients with normal pregnancy (n = 14). Transforming growth factor-beta1 was determined by TGF-beta1 Max ELISA (Promega, Madsion, WI, USA) after serum dilution (1/150) and acid activation. Placental distribution was determined by immunostaining with TGF-beta1 (Santa Cruz, Santa Cruz, CA, USA; 20 ng/mL) and the villi and decidual trophoblast were scored for intensity and extent of staining. 5. Patients with pre-eclampsia had a mean gestational age of 36 weeks, whereas those with a normal pregnancy had a mean gestational age of 39.0 +/- 0.4 weeks. There was no difference in TGF-beta1 concentration between the two groups (mean (+/-SEM) 27.1 +/- 1.0 vs 26.4 +/- 0.7 pg/mL for normal pregnancy and pre-eclampsia, respectively; P = 0.73, Mann-Whitney U-test). There was no correlation between systolic or diastolic blood pressure and TGF-beta1 concentration (regression analysis P = 0.4 and 0.2). Immunostaining was absent in the villous trophoblast cells and endovascular and

  9. Earlier Age of Onset of Chronic Hypertension and Type 2 Diabetes Mellitus After a Hypertensive Disorder of Pregnancy or Gestational Diabetes Mellitus.

    Science.gov (United States)

    Heida, Karst Y; Franx, Arie; van Rijn, Bas B; Eijkemans, Marinus J C; Boer, Jolanda M A; Verschuren, Monique W M; Oudijk, Martijn A; Bots, Michiel L; van der Schouw, Yvonne T

    2015-12-01

    A prospective cohort study was conducted to assess the impact of a history of hypertensive disorder of pregnancy (HDP) or gestational diabetes mellitus (GDM) on the risk and age of onset of hypertension, type 2 diabetes mellitus (T2D), and cardiovascular disease (CVD) later in life, independent of hypertension and T2D. Between 1993 and 1997, 22 265 ever-pregnant women were included from the European Prospective Investigation into Cancer and Nutrition-NL study, aged 20 to 70 years at baseline. Details on complications of pregnancy and known hypertension were obtained by questionnaire. Blood pressure was measured at enrollment. Participants were followed for the occurrence of CVD events. Data were analyzed using ANCOVA, multivariable logistic regression, and Cox proportional hazard (with HDP and GDM as time-dependent variables for T2D and CVD) models. At enrollment, women with a HDP reported diagnosis of hypertension 7.7 years earlier (95% confidence interval [CI] 6.9-8.5) and women with GDM reported diagnosis of T2D 7.7 years earlier (95% CI 5.8-9.6) than women without pregnancy complications. After adjustment for potential confounders, HDP was associated with presence of hypertension at enrollment (odds ratio 2.12, 95% CI 1.98-2.28) and onset of CVD later in life (hazard ratio 1.21, 95% CI 1.10-1.32). After including the intermediates hypertension and T2D in the model, the risk of CVD later in life decreased (hazard ratio 1.09, 95% CI 1.00-1.20). GDM was associated with an increased risk of developing T2D later in life (hazard ratio 3.68, 95% CI 2.77-4.90), but not with risk of CVD. HDP and GDM have a substantial impact on the risk of CVD and are potentially important indicators for preventive cardiovascular risk management. © 2015 American Heart Association, Inc.

  10. Association of Maternal Antiangiogenic Profile at Birth With Early Postnatal Loss of Microvascular Density in Offspring of Hypertensive Pregnancies

    Science.gov (United States)

    Yu, Grace Z.; Aye, Christina Y.L.; Lewandowski, Adam J.; Davis, Esther F.; Khoo, Cheen P.; Newton, Laura; Yang, Cheng T.; Al Haj Zen, Ayman; Simpson, Lisa J.; O’Brien, Kathryn; Cook, David A.; Granne, Ingrid; Kyriakou, Theodosios; Channon, Keith M.; Watt, Suzanne M.

    2016-01-01

    Offspring of hypertensive pregnancies are more likely to have microvascular rarefaction and increased blood pressure in later life. We tested the hypothesis that maternal angiogenic profile during a hypertensive pregnancy is associated with fetal vasculogenic capacity and abnormal postnatal microvascular remodeling. Infants (n=255) born after either hypertensive or normotensive pregnancies were recruited for quantification of postnatal dermal microvascular structure at birth and 3 months of age. Vasculogenic cell potential was assessed in umbilical vein endothelial cells from 55 offspring based on in vitro microvessel tube formation and proliferation assays. Maternal angiogenic profile (soluble fms-like tyrosine kinase-1, soluble endoglin, vascular endothelial growth factor, and placental growth factor) was measured from postpartum plasma samples to characterize severity of pregnancy disorder. At birth, offspring born after hypertensive pregnancy had similar microvessel density to those born after a normotensive pregnancy, but during the first 3 postnatal months, they had an almost 2-fold greater reduction in total vessel density (−17.7±16.4% versus −9.9±18.7%; P=0.002). This postnatal loss varied according to the vasculogenic capacity of the endothelial cells of the infant at birth (r=0.49; P=0.02). The degree of reduction in both in vitro and postnatal in vivo vascular development was proportional to levels of antiangiogenic factors in the maternal circulation. In conclusion, our data indicate that offspring born to hypertensive pregnancies have reduced vasculogenic capacity at birth that predicts microvessel density loss over the first 3 postnatal months. Degree of postnatal microvessel reduction is proportional to levels of antiangiogenic factors in the maternal circulation at birth. PMID:27456522

  11. Pregnancy-induced hypertension and infant growth at 28 and 42 days postpartum

    Directory of Open Access Journals (Sweden)

    Piedboeuf Bruno

    2005-05-01

    Full Text Available Abstract Background No previous studies have examined the effect of pregnancy-induced hypertension (PIH on early infant growth. The objective was to study infant growth patterns of babies born to mothers with PIH at 28 and 42 days postpartum. Methods: Design We conducted a population-based retrospective cohort study of 16,936 pregnancies delivered between January 1, 1989 through December 31, 1990 in Suzhou, China. PIH was classified as gestational hypertension, preeclampsia and severe preeclampsia. Infant Growth Percentage (IGP was calculated as the weight gain from birth to infant weight at 28 or 42 days postpartum divided by the birth weight. Univariate analysis and multivariate linear regression were performed to compare the infant weight as well as IGP at 28 and 42 days postpartum between various types of PIH and the normotensive group. Results Infant weights at 28 and 42 days postpartum were significantly lower in severe preeclampsia (e.g., 4679.9 g at 42 days and preeclampsia (e.g., 4763.8 g at 42 days groups than in the normotensive group (e.g., 4869.1 g at 42 days, p Conclusion Infants born to mothers with PIH but without IUGR have normal early infant growth. IUGR secondary to PIH is associated with significant catch-up growth at 28 and 42 days postpartum.

  12. Onset of hypertension during pregnancy is associated with long-term worse blood pressure control and adverse cardiac remodeling.

    Science.gov (United States)

    Mesquita, Roberto F; Reis, Muriel; Beppler, Ana Paula; Bellinazzi, Vera Regina; Mattos, Sandra S; Lima-Filho, José L; Cipolli, José A; Coelho-Filho, Otavio R; Pio-Magalhães, José A; Sposito, Andrei C; Matos-Souza, José R; Nadruz, Wilson

    2014-11-01

    Up to 20% of women with hypertensive pregnancy disorders might persist with chronic hypertension. This study compared clinical and echocardiographic features between women whose hypertension began as hypertensive pregnancy disorders (PH group) and women whose diagnosis of hypertension did not occur during pregnancy (NPH group). Fifty PH and 100 NPH women were cross-sectionally evaluated by clinical, laboratory, and echocardiography analysis, and the groups were matched by duration of hypertension. PH exhibited lower age (46.6 ± 1.4 vs. 65.3 ± 1.1 years; P < .001), but higher systolic (159.8 ± 3.9 vs. 148.0 ± 2.5 mm Hg; P = .009) and diastolic (97.1 ± 2.4 vs. 80.9 ± 1.3 mm Hg; P < .001) blood pressure than NPH, although used more antihypertensive classes (3.4 ± 0.2 vs. 2.6 ± 0.1; P < .001). Furthermore, PH showed higher left ventricular wall thickness and increased prevalence of concentric hypertrophy than NPH after adjusting for age and blood pressure. In conclusion, this study showed that PH may exhibit worse blood pressure control and adverse left ventricular remodeling compared with NPH.

  13. The Role of Aldosterone in Obesity-Related Hypertension.

    Science.gov (United States)

    Kawarazaki, Wakako; Fujita, Toshiro

    2016-04-01

    Obese subjects often have hypertension and related cardiovascular and renal diseases, and this has become a serious worldwide health problem. In obese subjects, impaired renal-pressure natriuresis causes sodium retention, leading to the development of salt-sensitive hypertension. Physical compression of the kidneys by visceral fat and activation of the sympathetic nervous system, renin-angiotensin systems (RAS), and aldosterone/mineralocorticoid receptor (MR) system are involved in this mechanism. Obese subjects often exhibit hyperaldosteronism, with increased salt sensitivity of blood pressure (BP). Adipose tissue excretes aldosterone-releasing factors, thereby stimulating aldosterone secretion independently of the systemic RAS, and aldosterone/MR activation plays a key role in the development of hypertension and organ damage in obesity. In obese subjects, both salt sensitivity of BP, enhanced by obesity-related metabolic disorders including aldosterone excess, and increased dietary sodium intake are closely related to the incidence of hypertension. Some salt sensitivity-related gene variants affect the risk of obesity, and together with salt intake, its combination is possibly associated with the development of hypertension in obese subjects. With high salt levels common in modern diets, salt restriction and weight control are undoubtedly important. However, not only MR blockade but also new diagnostic modalities and therapies targeting and modifying genes that are related to salt sensitivity, obesity, or RAS regulation are expected to prevent obesity and obesity-related hypertension.

  14. Adipocytes, aldosterone and obesity-related hypertension

    OpenAIRE

    Nguyen Dinh Cat, Aurelie; Friederich-Persson, Malou; White, Anna; Rhian M Touyz

    2016-01-01

    Understanding the mechanisms linking obesity with hypertension is important in the current obesity epidemic as it may improve therapeutic interventions. Plasma aldosterone levels are positively correlated with body mass index and weight loss in obese patients is reported to be accompanied by decreased aldosterone levels. This suggests a relationship between adipose tissue and the production/secretion of aldosterone. Aldosterone is synthesized principally by the adrenal glands, but its product...

  15. Awareness Regarding Anemia, Gestational Diabetes and Pregnancy Induced Hypertension among Antenatal Women Attending Outpatient Department in a Rural Hospital

    OpenAIRE

    George M; George N; Ramesh N

    2016-01-01

    "Introduction: Antenatal mothers should not only be aware of normal antenatal care but also be aware about common morbidities like anemia, gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), etc., which can have adverse pregnancy outcomes. This study was conducted to assess the awareness regarding anemia, GDM and PIH among antenatal women attending outpatient clinic in a rural hospital. Methods: This was a cross sectional study done during the period of October-Novem...

  16. Pregnancy-related issues in women with systemic lupus erythematosus.

    Science.gov (United States)

    Singh, Abha G; Chowdhary, Vaidehi R

    2015-02-01

    While fertility is preserved in females with systemic lupus erythematosus (SLE), it is well established that pregnancy in these patients is associated with adverse maternal and fetal outcomes, including pregnancy loss, pre-eclampsia, preterm delivery and intrauterine growth retardation, as well as neonatal mortality. Mechanisms underlying these adverse outcomes are poorly understood, and better understanding of these would allow development of targeted and personalized treatment strategies. Established risk factors for adverse pregnancy outcomes include active disease within 6 months prior to conception and during pregnancy, active nephritis, maternal hypertension, antiphospholipid antibodies and hypocomplementemia. While intensive monitoring is recommended, the comparative effectiveness of appropriate management strategies is unclear. While current strategies are able to achieve live births in 85-90% of pregnancies, certain aspects such as prevention of preterm birth, treatment of congenital heart block due to neonatal lupus and recurrent pregnancy loss despite best management, remains challenging. Pregnancy is also associated with an increased risk of flare of lupus, particularly in patients with active disease at time of conception or within 6 months prior to conception. Pregnant patients with SLE should be followed in a high-risk obstetric clinic, and care should be closely coordinated between the obstetrician and rheumatologist.

  17. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial)

    Science.gov (United States)

    Ahmed, Rashid J.; Gafni, Amiram; Hu, Zheng Jing; Pullenayegum, Eleanor; von Dadelszen, Peter; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, J. Johanna; Ganzevoort, Wessel; Helewa, Michael; Lee, Shoo K.; Lee, Terry; Logan, Alexander G.; Moutquin, Jean-Marie; Singer, Joel; Thornton, Jim G.; Welch, Ross; Magee, Laura A.

    2016-01-01

    The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned “less tight” (target diastolic 100 mm Hg) and “tight” (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman–infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, −$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, −$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, −$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412. PMID:27550914

  18. Knowledge of midwives about hypertensive disorders during pregnancy in primary healthcare

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2016-03-01

    Full Text Available Background: Many factors or medical conditions may influence the outcome of pregnancy,which in turn, may increase infant and maternal morbidity and mortality. One such condition is an increase in blood pressure (BP.Setting: The study was conducted in maternity obstetrical units (MOUs in primary healthcare clinics (PHCs in the Eastern Cape, South Africa.Objectives: To determine the knowledge about hypertensive disorders during pregnancy (HDPs of registered midwives working in MOUs in PHCs.Methods: A quantitative descriptive correlation research design was applied. A simple random sample of 43 (44% rural and urban clinics was selected, and all registered midwives (n = 101 working in these clinics completed a self-administered questionnaire. Data were collected over a period of 1 month. The reliability and validity of the methodology were supported by experts and a pilot study. Descriptive statistics including various statistical tests to determine any associations between variables using a 95% confidence interval were applied.Results: A gap in the knowledge of midwives about HDPs was identified. Only 56.4% of the participants correctly answered the questions on the clinical manifestations of severe pre-eclampsia and 68.3% on the factors affecting BP, whereas 27.7% had no understanding about pre-eclampsia. Significant statistical differences were identified in the knowledge of staff in clinics where doctors visit regularly versus those in clinics where there are no visits (p = 0.04, and between experience of midwives and management of HDPs (p = 0.02.Conclusion: The knowledge of midwives is deficient regarding HDPs. Continuous professional development is critical in midwifery both in theory and in clinical practice.Keywords: Midwives; Hypertension; Eclampsia; Pre-eclampsia; Pregnancy

  19. Knowledge of midwives about hypertensive disorders during pregnancy in primary healthcare

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2016-03-01

    Full Text Available Background: Many factors or medical conditions may influence the outcome of pregnancy,which in turn, may increase infant and maternal morbidity and mortality. One such condition is an increase in blood pressure (BP.Setting: The study was conducted in maternity obstetrical units (MOUs in primary healthcare clinics (PHCs in the Eastern Cape, South Africa.Objectives: To determine the knowledge about hypertensive disorders during pregnancy (HDPs of registered midwives working in MOUs in PHCs.Methods: A quantitative descriptive correlation research design was applied. A simple random sample of 43 (44% rural and urban clinics was selected, and all registered midwives (n = 101 working in these clinics completed a self-administered questionnaire. Data were collected over a period of 1 month. The reliability and validity of the methodology were supported by experts and a pilot study. Descriptive statistics including various statistical tests to determine any associations between variables using a 95% confidence interval were applied.Results: A gap in the knowledge of midwives about HDPs was identified. Only 56.4% of the participants correctly answered the questions on the clinical manifestations of severe pre-eclampsia and 68.3% on the factors affecting BP, whereas 27.7% had no understanding about pre-eclampsia. Significant statistical differences were identified in the knowledge of staff in clinics where doctors visit regularly versus those in clinics where there are no visits (p = 0.04, and between experience of midwives and management of HDPs (p = 0.02.Conclusion: The knowledge of midwives is deficient regarding HDPs. Continuous professional development is critical in midwifery both in theory and in clinical practice.Keywords: Midwives; Hypertension; Eclampsia; Pre-eclampsia; Pregnancy

  20. A Retrospective Study of the Health Profile of Neonates of Mothers with Anemia in Pregnancy and Pregnancy Induced Hypertension in Lagos, Nigeria

    Science.gov (United States)

    Sanni, Silifat Ajoke; Onabanjo, Oluseye Olusegun; Olayiwola, Ibiyemi O.; Agbonlahor, Mure

    2014-01-01

    Our study assessed the health profile of neonates in relation to anemia in pregnancy and pregnancy induced hypertension (PIH). This was a retrospective study where a systematic random sampling technique was used to select a total of 1046 case records of pregnant women registered for ante-natal care at Lagos Island Maternity Hospital, Lagos, Nigeria, between 2005 and 2009. Socio-demographic characteristics of the mothers, prevalence of anemia and PIH, and neonatal health profile were obtained from the case records and were analyzed using both descriptive and inferential statistics. Pearson product moment correlation was used to show the relationship (P≤0.05) between maternal complications and neonatal health profile. Majority (68.8%) of the mothers had anemia and 6.7 % had PIH. Majority (97.12%) of the neonates were live births and 2.88% of the neonates were still births, 65.4% of the women with still birth pregnancy outcome had anemia, and 34.6% had PIH. Majority (74%) of the neonates had birth weight within normal range (2.5-4.0 kg) and majority (68%) had normal Apgar score at 5 min of birth (7-10). A positive correlation existed between the packed cell volume of the mother and the birth weight of the neonates (r=0.740, P≤0.05). A negative correlation existed between the incidence of PIH and the birth weight of the neonates (r= 0.781, P≤0.05), head circumference (r=–0.491, P≤0.05) and the length of the neonates(r=–0.480, P≤0.05). We conclude that nutritional and health care intervention programmes for pregnant women should be intensified especially during ante-natal visits to hospitals.

  1. Hyperbaric index in the primary prevention of hypertensive complications in high-risk pregnancy.

    Science.gov (United States)

    Otero González, Alfonso; Uribe Moya, Silvia; Arenas Moncaleano, Ivan Gilberto; Borrajo Prol, María Paz; García García, María Jesús; López Sánchez, Luis

    2015-01-01

    Preeclampsia (PE) is a major cause of fetal morbidity and mortality. In the Western World, PE affects 2-7% of pregnancies and is responsible for 50,000 deaths annually. Early detection is a priority as it can change the clinical course, but there are no biomarkers or instrumental methods with high sensitivity and specificity. Only the hyperbaric index has a sensitivity and specificity of 99% for early identification of pregnant women at risk of developing PE, but its use is not widespread. To assess the usefulness of the hyperbaric index in the primary prevention of hypertensive pregnancy complications in a public healthcare area. This is a retrospective study of pregnancies that occurred in our area during the period 2007-2012 (N=11,784). The diagnosis was established by the hyperbaric index and pregnant women at risk were treated with ASA at night. In pregnant patients referred to the nephrology clinic (38.2%), diagnosed as high-risk for PE, and treated with 100mg ASA/night (from week 17), the incidence of PE episodes was reduced by 96.94. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  2. The decrease of serum vascular endothelial growth factor concentration in patients with pregnancy induced hypertension

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objectives:To detect the concentration of serum vascular endothelial growth factor (VEGF) in patients with pregnancy induced hypertension (PIH) as well as to explore the role of VEGF in the pathogenesis of PIH.Methods:Serum VEGF concentrations in 23 healthy nonpregnant women (normal group),30 normal pregnant women (control group) and 37 women with PIH (PIH group) were measured by sandwich enzyme-linked immunoadsorbent assay (ELISA).Results:Serum concentrations of VEGF in control group were significantly higher (149.39±27.15ng/L) than those in normal group (11.98±3.99ng/L) (P<0.001),peaking in the second trimester of pregnancy (183.84±49.02ng/L) and decreasing in the third trimester (118.37±34.29ng/L).Serum VEGF concentrations (64.45±24.33ng/L) in PIH group were significantly lower than those in normal late pregnancy women of control group (118.37±34.29ng/L) (P<0.01).There was a trend that serum VEGF concentrations in PIH group decreased with the severity of PIH (P<0.05).Conclusion:The serum VEGF concentration in PIH women are significantly decreased,which suggests that VEGF may play an important role in the pathogenic mechanism of PIH.

  3. SUDEP and epilepsy-related mortality in pregnancy.

    Science.gov (United States)

    Edey, Stephan; Moran, Nicholas; Nashef, Lina

    2014-07-01

    Although data are limited, research in 2004 estimated a 10-fold increase in mortality in pregnancy in the United Kingdom in women with epilepsy (WWE) compared to women without epilepsy. We highlight epilepsy mortality in pregnancy based on the 2011 report of the United Kingdom Confidential Enquiries into Maternal Deaths, relating its findings to previous reports and epilepsy-rates in pregnancy. Among 2,291,493 maternities (2006-2008), we estimated 0.6% or 13,978 were in WWE. Fourteen deaths were epilepsy-related, of which 11 (79%) were sudden and unexpected (SUDEP). Nine occurred during pregnancy and five were postpartum. Nine (64%) were in women taking lamotrigine, seven as monotherapy. We estimated that 1:1,000 women died from epilepsy (mostly SUDEP) during or shortly after pregnancy. Epilepsy-related mortality is a significant risk in pregnancy. Antiepileptic drug-related factors may be relevant. The high proportion of women taking lamotrigine may reflect United Kingdom prescribing practice. Recent observations from the European and International Registry of Antiepileptic Drugs and Pregnancy (EURAP), whereby women on lamotrigine, the levels of which significantly decrease in pregnancy, had more difficulties with epilepsy control, argue against this being the sole explanation. Given the potential risks, every attempt should be made to prevent seizures, particularly convulsive, during pregnancy and postpartum. This, we believe, includes being proactive in maintaining lamotrigine levels during pregnancy.

  4. Maternal chronic HBV infection would not increase the risk of pregnancy-induced hypertension--results from pregnancy cohort in Liuyang rural China.

    Directory of Open Access Journals (Sweden)

    Xin Huang

    Full Text Available The relationship between maternal HBV (hepatitis B virus infection and pregnancy-induced hypertension (PIH is inconclusive. Few studies have been conducted in rural areas of China. In order to examine the association between maternal chronic HBV infection and risk of PIH in Liuyang rural area China, we enrolled 6,195 eligible pregnant women in 2010-2011 in selected 14 towns of Liuyang on their first prenatal visit to local maternity care unit. A total of 461 subjects (7.44% (95%CI: 6.79%, 8.10% were identified with positive HBsAg status (exposed group and 5734 were non-HBV carriers (unexposed group. Multivariate log-binomial regression models were used to estimate the risk of PIH, gestational hypertension (GH, and preeclampsia (PE in relation to maternal chronic HBV infection. There are total of 455 subjects diagnosed with PIH (7.34% (95%CI: 6.70%, 7.99%, including 371 GH (5.99% (95%CI: 5.40%, 6.58% and 81 PE (1.31% (95%CI: 1.07%, 1.64%. The crude risk ratio between PIH, GH, PE and maternal HBV infection were 1.20 (95%CI: 0.88, 1.64, 1.30(95%CI: 0.93, 1.81 and 0.79 (95%CI: 0.32, 1.93, respectively. After adjustment for gravidity history, abortion history, family history of Diabetes Mellitus (DM and family history of hypertension, positive HBsAg status was still not significantly associated with PIH (RR = 1.18, 95%CI: 0.87, 1.62, GH (RR = 1.27, 95%CI: 0.91, 1.78 or PE (RR = 0.79, 95%CI: 0.32, 1.95. Additional adjustment for maternal age, marital status, parity history, family history of DM, Body Mass Index at first antenatal visit, folic acid supplementation, smoking status during pregnancy and economic status of living area, multivariate analysis provided similar results. In conclusion, our study found that maternal chronic HBV infection prevalence rate is 7.4% among Liuyang rural area and there is no significant association between maternal HBV infection and the risk of PIH, GH or PE.

  5. Relation between arterial hypertension and hearing loss

    Directory of Open Access Journals (Sweden)

    Mondelli, Maria Fernanda Capoani Garcia

    2009-03-01

    Full Text Available Objective: To verify the relationship between systemic arterial hypertension (SAH and hearing loss in middle-aged patient. Method: This study was carried out in the period from January to December 2007. The research was composed by 392 patients of both genders, aged from 45 to 60 years old. Anamnesis and threshold tonal audiometry data were analyzed. Results: There was a significant association between SAH and hearing loss. Conclusion: The results showed an evident association between SAH and hearing loss, which requires the disclosure of a preventive process.

  6. THE EFFECTS OF 3G EICOSAPENTAENOIC ACID DAILY ON RECURRENCE OF INTRAUTERINE GROWTH-RETARDATION AND PREGNANCY-INDUCED HYPERTENSION

    NARCIS (Netherlands)

    BULSTRARAMAKERS, MTEW; HUISJES, HJ; VISSER, GHA

    1995-01-01

    Objective To study the effects of addition of 3 g eicosapentaenoic acid daily to the diet, on recurrence rate of intrauterine growth retardation and pregnancy induced hypertension in a high risk population. Design Prospective, double blind, randomised multicentre study, Eicosapentaenoic acid or plac

  7. Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term : a longitudinal follow-up study

    NARCIS (Netherlands)

    Hermes, Wietske; Tamsma, Jouke T.; Grootendorst, Diana C.; Franx, Arie; van der Post, Joris; van Pampus, Maria G.; Bloemenkamp, Kitty W. M.; Porath, Martina; Mol, Ben W.; de Groot, Christianne J. M.

    2013-01-01

    Background: Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developi

  8. Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term : a longitudinal follow-up study

    NARCIS (Netherlands)

    Hermes, Wietske; Tamsma, Jouke T.; Grootendorst, Diana C.; Franx, Arie; van der Post, Joris; van Pampus, Maria G.; Bloemenkamp, Kitty W. M.; Porath, Martina; Mol, Ben W.; de Groot, Christianne J. M.

    2013-01-01

    Background: Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developi

  9. Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study

    NARCIS (Netherlands)

    Eerden, L. van; Oostwaard, M.F. Van; Zeeman, G.G.; Page-Christiaens, G.C.; Pajkrt, E.; Duvekot, J.J.; Vandenbussche, F.P.H.A.; Oei, S.G.; Scheepers, H.C.; Eyck, J. van; Middeldorp, J.M.; Koenen, S.V.; Groot, C.J. de; Bolte, A.C.

    2016-01-01

    OBJECTIVE: To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. STUDY DESIGN: Retrospective cohort study in all Dutch tertiary perinatal care centres (n=10), between January 2000 and January 2014. All

  10. Prediction of recurrence of hypertensive disorders of pregnancy between 34 and 37 weeks of gestation: a retrospective cohort study

    NARCIS (Netherlands)

    Oostwaard, M.F. van; Langenveld, J.; Bijloo, R.; Wong, K.M.; Scholten, I.; Loix, S.; Hukkelhoven, C.W.; Vergouwe, Y.; Papatsonis, D.N.; Mol, B.W.; Ganzevoort, W.

    2012-01-01

    OBJECTIVE: To assess the recurrence risk of late-preterm hypertensive disease of pregnancy, and to determine whether potential risk factors are predictive. DESIGN: Retrospective cohort study. SETTING: Three secondary and three tertiary care hospitals in the Netherlands. POPULATION: We identified wom

  11. FATTY-ACID COMPOSITION OF SERUM-LIPIDS OF MOTHERS AND THEIR BABIES AFTER NORMAL AND HYPERTENSIVE PREGNANCIES

    NARCIS (Netherlands)

    VANDERSCHOUW, YT; AL, MDM; HORNSTRA, G; BULSTRARAMAKERS, MTEW; HUISJES, HJ

    1991-01-01

    The biochemical essential fatty acid (EFA) status of neonates born after normal and hypertensive pregnancies (PIH) and that of their mothers was assessed by measuring the fatty acid composition of phospholipids (PL), triglycerides (TG) and cholesterol esters (CE) of umbilical cord serum and maternal

  12. Terminating pregnancy for severe hypertension when the fetus is considered non-viable : a retrospective cohort study

    NARCIS (Netherlands)

    Van Eerden, Leonoor; Van Oostwaard, Miriam F.; Zeeman, Gerda G.; Page-Christiaens, Godelieve C. M.; Pajkrt, Eva; Duvekot, Johannes J.; Vandenbussche, Frank P.; Oei, Swan G.; Scheepers, Hubertina C. J.; Van Eyck, Jim; Middeldorp, Johanna M.; Koenen, Steven V.; De Groot, Christianne J. M.; Bolte, Antoinette C.

    2016-01-01

    Objective: To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. Study design: Retrospective cohort study in all Dutch tertiary perinatal care centres (n = 10), between January 2000 and January 2014.

  13. Terminating pregnancy for severe hypertension when the fetus is considered non-viable : a retrospective cohort study

    NARCIS (Netherlands)

    Van Eerden, Leonoor; Van Oostwaard, Miriam F.; Zeeman, Gerda G.; Page-Christiaens, Godelieve C M; Pajkrt, Eva; Duvekot, Johannes J.; Vandenbussche, Frank P.; Oei, Swan G.; Scheepers, Hubertina C J; Van Eyck, Jim; Middeldorp, Johanna M.; Koenen, Steven V.; De Groot, Christianne J M; Bolte, Antoinette C.

    2016-01-01

    Objective To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. Study design Retrospective cohort study in all Dutch tertiary perinatal care centres (n = 10), between January 2000 and January 2014. All

  14. Comparison of efficacy of labetalol and methyldopa in patients with pregnancy-induced hypertension

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    Vaidehi Subhedar

    2013-02-01

    Full Text Available Background: In a country like India, where maternal mortality rate is still very high despite progress and development which has consistently been made in the health services, a big proportion is still deprived of it. Hypertension is the most common medical problem encountered during pregnancy. It is estimated that globally 6-8% of pregnancies are complicated by hypertension. Antihypertensive drugs are often used to lower blood pressure with the aim of preventing its progression to adverse outcomes for the mother and the fetus. The risk of developing severe hypertension is reduced to half by using antihypertensive medications. Hence, this study was planned to assess and compare efficacy of labetalol and methyldopa in controlling blood pressure in patients with PIH and to study maternal and perinatal outcome in rural Indian population. Methods: 180 patients with PIH were divided in to two groups randomly. After randomization, group A received methyldopa 250 mg tid and group B received labetalol 100mg tid. Mean Arterial pressure (MAP was calculated according to formula systolic BP +/-2 diastolic BP /3. Patients were subjected to 6 hrly BP monitoring. Comparison of two drugs was done daily by calculating MAP of two groups. Following Observations were made as regards Fall in BP with Labetalol/ Methyldopa, Time required to control BP, Average dose of drugs required to control BP, Onset of labour-spontaneous/induced, Bishop score at induction of labour, Side effects of drugs. Results: Significant fall in MAP was seen in patients receiving Labetalol. Mean time required to control B.P in group A was 42.22 hours and in group B it was 36.97 hours. Mean Bishop score at induction in present study in group A was 8.27 and in group B was 9.33 with a statistically significant p<0.05. (33.33% patients went in spontaneous labour in group A while in group B, 23 patients i.e. (48.94% patients went in spontaneous labour. Conclusions: The freedom from maternal and

  15. Conducta ante los estados hipertensivos del embarazo Management of hypertension in pregnancy

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    M. Huarte

    2009-01-01

    Full Text Available Los estados hipertensivos del embarazo son un conjunto de desórdenes que acontecen durante la gestación cuyo nexo común es la hipertensión. Deben ser destacados dada su implicación en la morbimortalidad materna y neonatal. Se realiza una clasificación de los diferentes estados hipertensivos poniendo especial interés en la preeclampsia. En el texto se definen los síntomas y signos de la enfermedad y se realiza un diagnóstico diferencial entre enfermedades que debemos descartar. Es de interés identificar las gestantes con preeclampsia y todavía resulta de mayor interés descartar en ellas algún criterio de gravedad ya que esto nos obligará a realizar un manejo diferente. A lo largo del texto, se adjuntan las indicaciones y el momento de finalización de la gestación. De igual forma se detallan los controles que deben realizarse si se opta por una conducta expectante en beneficio del prematuro. Se detallan las diferentes opciones terapeúticas antihipertensivas así como el tratamiento profiláctico de la eclampsia con sulfato de magnesio. Destacamos por su interés el Síndrome de HELLP y la eclampsia como complicaciones. Se describe el tratamiento y la conducta que se debe tomar en la gestación.Hypertensive states of pregnancy are a set of disorders that occur during gestation whose common nexus is hypertension. They must be given special emphasis due to their implication in maternal and neonatal morbidity and mortality. A classification is made of the different hypertensive states, with special emphasis placed on preeclampsia. This article defines the symptoms and signs of the disease and a differential diagnosis is made amongst diseases that must be ruled out. It is important to identify expectant mothers with preeclampsia, and it is of even greater importance in such cases to rule out some criterion of seriousness, as this will enable a different management to be carried out. The article includes the indications and the moment

  16. A randomized trial of intravenous labetalol AND oral nifedipine in severe pregnancy induced hypertension

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    Mousumi Mondal

    2012-12-01

    Full Text Available Background: Hypertension is the most frequently encountered medical disorder in obstetrics practice & remain a major cause of maternal, fetal & neonatal morbidity & mortality. The present study was undertaken to compare the time taken to reach the therapeutic goal blood pressure after using intravenous labetalol & oral nifedipine in severe pregnancy induced hypertension. Methods: Randomly allocated patients received labetalol 20 mg initially, followed by escalating doses of 40, 80, 80 & 80 mg & a placebo tablet every 20 minutes or initially nifedipine tablet 10 mg orally with repeated doses of 20 mg every 20 minutes up to 5 doses & intravenous placebo 0.9% isotonic saline until the therapeutic goal blood pressure, Systolic ≤ 150 mmHg & diastolic ≤ 100 mmHg was achieved. Primary and secondary outcomes like the time interval required to achieve a blood pressure of ≤150/100 mmHg and urinary output, agent failure & adverse effects respectively were reported. Results: Patients received oral nifedipine achieved the goal therapeutic blood pressure more rapidly in 28.2±11.7 minutes (mean±SD as compared with 48.4±23.5 minutes in those received intravenous labetalol (p=0.001. The nifedipine group also required significantly fewer doses (3.5±0.5 vs 4.5±1.5; p=0.001 to reach the goal blood pressure. Urine output was significantly increased (p<0.001 at one hour after nifedipine therapy (95.6±1.2 compared with labetalol (41.9±1.6 ml & remained significantly increased at 4,8,16&24 hours after initial therapy. Few adverse effects were reported but not significant. No patients required cross over therapy. Conclusions: Oral nifedipine & intravenous labetalol regimens are effective in the management of severe hypertension in pregnancy; however nifedipine controls hypertension more rapidly & is associated with a significant increase in urinary output. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000: 42-46

  17. Analysis of Placental Growth Factor in Placentas of Normal Pregnant Women and Women with Hypertensive Disorders of Pregnancy

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    To investigate the expressions of placental growth factor (PLGF) in placenta with hypertensive disorders of pregnancy (HDP), 45 women with HDP and 20 normally pregnant women were studied. Among 45 women with HDP, there were 23 cases of severe preeclampsia and one case of eclampsia. The location and level of PLGF proteins was determined by immunohistochemistry and Western blot. The expression of PLGF mRNA in placenta was assessed by reverse transcriptionalpolymerase chain reaction (RT-PCR). The results showed that: (1) The distribution of PLGF in placenta with HDP was similar to normal one, which was mainly in the cytoplasm of villous syncytiotrophoblast and villous stroma; (2) The expression of PLGF protein was significantly decreased in placentas with mild and severe preeclampsia compared to the normal ones (0.3±0.4 vs 0.6± 0.4, 0.2±0.5 vs 0.6±0. 4, P<0.01). There were no differences between the gestational hypertension placenta and normal one (0.5±0.6 vs 0.6±0.4, P>0. 05); (3) The transcription levels of the PLGF mRNA in placentas with preeclampsia were significantly lower than in normal groups (3.33±0.39 vs4.87±0.60, 1.97±0.29 vs 4.87±0. 60, P<0.01), and no differences were found between the gestational hypertension placenta and normal groups. These findings suggest that the abnormal expression of PLGF in placentas is related to the pathogenesis of HDP.

  18. Gestational Weight Gain, Body Mass Index, and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population.

    Science.gov (United States)

    Chasan-Taber, Lisa; Silveira, Marushka; Waring, Molly E; Pekow, Penelope; Braun, Barry; Manson, JoAnn E; Solomon, Caren G; Markenson, Glenn

    2016-09-01

    Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46-10.00; ptrend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00-8.71, ptrend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34-2.27) and 1.86 odds of preeclampsia (95 % CI 1.37-2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.

  19. The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study.

    Science.gov (United States)

    Ekiz, Ali; Kaya, Basak; Polat, Ibrahim; Avci, Muhittin Eftal; Ozkose, Burak; Kicik Caliskan, Raziye; Yildirim, Gokhan

    2016-01-01

    The aim of this study was to evaluate preeclampsia progression of isolated proteinuria and associations with pregnancy outcome. We performed a retrospective analysis in patients who were hospitalized for evaluation of new onset proteinuria without hypertension after 20 weeks of gestation between January 2012 and January 2014. One hundred fifty-seven patients who met the inclusion criteria were enrolled the study. After detection of new onset proteinuria, 53 of 157 (33.7%) patients developed preeclampsia and the incidence of gestational proteinuria was found to be 0.33%. Twenty-four hours urine proteinuria testing results were significantly higher in preeclampsia (PE) group compared with the gestational proteinuria (GP) group (p delivery time and birth weight in their infants. Therefore, patients with new onset proteinuria should be followed-up for preeclampsia development and associated morbidities.

  20. Pregnancy related listeriosis: treatment and control.

    Science.gov (United States)

    Allerberger, Franz; Huhulescu, Steliana

    2015-03-01

    Listeriosis during pregnancy usually presents as an unremarkable febrile illness in the mother but can be fatal for the fetus and newborn. Reliable laboratory testing for early diagnosis is lacking. Serological antibody tests and bacteriological stool tests are not helpful since Listeria-specific antibodies and stool cultures yielding the organism can be found in healthy pregnant women. Because early diagnosis is difficult, diagnosis is usually made by culturing the pathogen from blood, cerebrospinal fluid, placenta or meconium. The mortality rate for fetal and newborn listeriosis remains approximately 20%. Two to three cases of pregnancy-associated listeriosis are reported annually in Austria among approximately 79,000 births, 20-30 cases are reported annually in Germany among approximately 680,000 births and 50-100 cases are reported annually in the USA among approximately 4 million births. Although Listeria infections in pregnancy are rare, they should be considered as a cause of fever of unknown origin during pregnancy.

  1. Relationship between expression of hepatocyte grow factor and apoptosis of trophoblasts in hypertensive disorder complicating pregnancy

    Institute of Scientific and Technical Information of China (English)

    OUYANG Shan; QIAO Fuyuan; ZHANG Qinghua

    2007-01-01

    The aim of this study was to investigate the expression of hepatocyte growth factor(HGF)and Fas in placentas of uncomplicated pregnant women and those with hypertensive disorder complicating pregnancy(HDCP),and elucidate the possible relationship between HGF and apoptosis of trophoblasts.Reverse transcription-polymerase chain reaction(RT-PCR)was undertaken to examine the concentration of HGF mRNA and Fas mRNA obtained from 34 cases of HDCP and 30 cases of uncomplicated pregnancy.The expression of HGF mRNA in mild preeclampsia,severe preeclampsia and eclampsia cases was significantly lower than that in the uncomplicated cases(0.43±0.12,0.38±0.09,0.19±0.17 versus 0.67±0.19,P<0.05),while the expression of Fas mRNA in mild preeclampsia,severe preeclampsia and eclampisa cases was significantly higher than that in the uncomplicated cases(1.58±0.26,2.96±0.14,5.98±1.17versus 1.01±0.36,P<0.05).For HGF mRNA and Fas mRNA,there was no difference between gestational hypertension cases and control cases.Decreased HGF mRNA or increased Fas mRNA was found along with the progress of HDCP.Negative correlation was found between the expressions of HGF and Fas.These results indicate that HGF inhibits the apoptosis mediated by Fas,and the reduced expression of HGF in HDCP may be responsible for the apoptosis of trophoblasts.

  2. [How to manage a patient with chronic arterial hypertension during pregnancy and the postpartum period].

    Science.gov (United States)

    Pourrat, O

    2015-03-01

    The management of chronic arterial hypertension during pregnancy and postpartum requires first to estimate the risk of the pregnancy, linked with the severity of hypertension, with cardiac and renal involvement, with its cause as well as with the background (obesity, diabetes, possible history of placental vascular pathology). On a very practical approach, antihypertensive drug has to be started or increased if systolic pressure reaches or exceeds 160 mmHg or if diastolic pressure reaches or exceeds 105 mmHg. Below this level, there are no evidence-based medicine data, but it seems reasonable to treat if pressure increases over 150/100 mmHg (140/90 mmHg in case of ambulatory monitoring). Excessive pressure figures control must be avoided as much as insufficient ones: in practice, it is necessary to decrease the treatment dose if figures are below 130/80 mmHg. Three antihypertensive drugs are consensually recommended today: alphametyldopa, calcium-channel blockers and labetalol. Monotherapy is most often sufficient; if needed, two of these drugs can easily be associated, and even three if necessary. Converting enzyme inhibitors and angiotensin receptor II antagonists should not be prescribed to pregnant women. Betablockers and diuretics are not recommended. Whatever is the antihypertensive drug used, it is necessary to detect the signs of bad placenta blood circulation with uterine Doppler ultrasound and regular controls of fetal growth, and to check for appearance of proteinuria, defining then over-imposed pre-eclampsia needing immediate admission to the maternity. After delivery, lacatation suppresion with bromocriptin should not be prescribed.

  3. Spectrum of renal injury in pregnancy-induced hypertension: Experience from a single center in India

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    Mahesh Eswarappa

    2017-01-01

    Full Text Available Pregnancy-induced hypertension (PIH is a known complication of late pregnancy and is an important cause of maternal and fetal morbidity and mortality. Data on clinical profile, especially renal profile of preeclampsia and eclampsia in Indian women are lacking. The aim of our study was to examine the renal profile and clinical outcomes of patients diagnosed with PIH in our institution with a focus on the spectrum of acute kidney injury (AKI. In this prospective, observational study, 347 patients with a diagnosis of preeclampsia-eclampsia, who were undergoing treatment at the M. S. Ramaiah Medical College, were included in the study. The study duration was from 2010 to 2014. Details regarding epidemiologic data, obstetric data, laboratory parameters as well as maternal, renal, and fetal outcomes were noted. Patients with preexisting hypertension, diabetes mellitus, or chronic kidney disease were excluded from analysis. The overall incidence of preeclampsia was 3.4%. Hemolysis, elevated liver enzymes, and low platelets syndrome was seen in 31 patients (9%; 56 patients (19% had AKI with a mean serum creatinine of 3.2 mg/dL and mean proteinuria of 2.8 g/24 h. Nineteen patients required dialysis. Persistent renal failure was seen in 2.5% of the cohort. Maternal mortality was 2.5%, largely secondary to sepsis. Primiparity was a major risk factor. In this study, we found a low rate of preeclampsia in a low-to-moderate risk cohort, with an incidence of AKI and maternal mortality consistent with reported literature.

  4. Assessment of Serum Vascular Endothelial Growth Factor Levels in Pregnancy-Induced Hypertension Patients

    Science.gov (United States)

    Tandon, Vibha; Hiwale, Swati; Amle, Dnyanesh; Nagaria, Tripti

    2017-01-01

    Objective. The objective of the study was to assess the serum vascular endothelial growth factor (VEGF) levels in peripheral blood of patients with pregnancy-induced hypertension (PIH) and find association between serum VEGF levels and PIH. Methods. Thirty-five PIH subjects, 35 normal pregnant females, and 20 normal healthy females were included in the study. Detailed history, clinical examination, and relevant biochemical parameters were assessed; serum VEGF levels were estimated using Double-antibody enzyme-linked immunosorbent assay. Results. The study groups were found to be age matched (p = 0.38). VEGF level in the pregnancy-induced hypertensive group (median = 109.19 (3.38 ± 619)) was significantly higher than the normal pregnant (median = 20.82 (1.7–619)) and control (median = 4.92 (1.13–13.07)) group and the difference between these three groups was significant (p < 0.0001). The 3 groups are found to be significantly different in terms of RBS (p = 0.01), urea (p < 0.0001), creatinine (p = 0.0005), AST (p = 0.0032), ALT (p = 0.0007), total protein (p = 0.0004), albumin (p < 0.0001), calcium (p = 0.001), and sodium (p = 0.02), while no statistically significant difference was found between total bilirubin (p = 0.167), direct bilirubin (p = 0.07), uric acid (p = 0.16), and potassium (p = 0.14). Conclusion. Significantly higher levels of serum VEGF were noted in PIH subjects compared to normal pregnant and control subjects. PMID:28133548

  5. NEONATAL MORTALITY AND MORBIDITY IN PREGNANCY INDUCED HYPERTENSION: A PROSPECTIVE OBSERVATIONAL STUDY

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    George

    2014-05-01

    Full Text Available BACKGROUND: Pregnancy induced Hypertension (PIH is one of the common complications which contributes to significant maternal and perinatal morbidity and mortality. Effective management improves outcome of both mother and the baby OBJECTIVES: To study the morbidity and mortality in babies born to mothers with pregnancy induced hypertension, assess the reasons for the outcome of the baby and monitor the growth and development till the age of 6 months. METHODS: This study was conducted at Niloufer Institute of Child Health, Hyderabad a teaching institution which caters to high risk obstetric patients and also has a tertiary level NICU care. Study was conducted over a period of 9 months and 100 cases of PIH were included over a period of 3 months and the babies were followed up till the age of 6 months. A structured proforma was designed and analyzed using Epi info for window statistical software. RESULTS: Out of 1461 deliveries, we enrolled 100 PIH cases as per inclusion criteria and studied during 3 months period. Of the study group, 48% were with mild PIH (n=48 and 52% were with severe PIH (n=52. When compared to mild PIH, severe PIH was associated with higher rates of preterm deliveries and it was statistically significant (P 2. In NICU admissions Meconium aspiration syndrome (MAS, Hyaline membrane disease (HMD, Birth asphyxia (BA and sepsis were observed. All the complications were more in severe PIH than mild PIH. After discharge infants were fallowed up till the age of 6 months. Out of 75 babies discharged, 24 cases were lost to follow up and in the remaining 51 babies, 33 were born to mild PIH mothers, 18 were born to severe PIH mothers. CONCLUSION: PIH is one of the major causes of morbidity and mortality in the fetus and newborn. The more severe the PIH, the more adverse is the outcome. Our goal is early detection and prompts Management

  6. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.

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    Tessa E R Gillon

    Full Text Available Clinical practice guidelines (CPGs are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy to inform clinical practice.MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface, Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13 in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii antihypertensive treatment of severe hypertension; (iv MgSO4 for eclampsia and severe pre-eclampsia; (v antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i definitions of pre-eclampsia and severe pre-eclampsia; (ii target BP for non-severe hypertension; (iii timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv MgSO4 for non-severe pre-eclampsia, and (v postpartum maternal monitoring.Existing international HDP CPGs have areas of consistency with which clinicians and

  7. Effect of antioxidants on amelioration of high-risk factors inducing hypertensive disorders in pregnancy

    Institute of Scientific and Technical Information of China (English)

    LIN Jian-hua; YANG Yi-ke; LIU Hua; LIN Qi-de; ZHANG Wei-yuan

    2010-01-01

    Background This is a prospective clinical study based on a large sample gathered from multiple centers in China,subordinating to 10th Five-Year Plan of National Science & Technology Progression. We analyzed the high-risk factors inducing hypertensive disorders in pregnancy (HDP) and estimated the potential effect of anti-oxidants administration,including vitamin C (VC), vitamin E (VE) and Salvia Miltiorrhiza L (SML), a Chinese herb medicine, in amelioration of the high-risk factors in pregnancy.Methods From April 2005 to July 2006, 4814 pregnant women from 24 national wide cooperative hospitals were involved in this prospective research. The participants were randomly divided into two groups: 1607 cases were in anti-oxidants group with administration of vitamins and SML; 3207 cases were in control group without any medicine given. Every participant was under monitoring for the morbidity of HDP and the high-risk factors were investigated in HDP cases in each group.Results (1)The morbidity of HDP was 3.55% in anti-oxidants group vs. 4.18% in control group. No statistical difference existed between the two groups (P>0.05). (2) In anti-oxidants group, the HDP morbidities among three subgroups: VC +VE + SML, VC + VE and SML only, were 5.51%, 3.05% and 5% respectively. It showed no statistical difference among three remedies (P>0.05). (3) The related index of factors affecting HDP showed in intensity sequence as follows: family HDP history > profession > education level > age > body weight. The incidence of HDP in normal population was 3.51%,and the incidence of HDP in high-risk pregnant women (family HDP history, heavy physical labor, low education level (middle school and below), age >40, body mass index ≥24) was 5.84%, which was obviously higher than that in normal population (P <0.01). In anti-oxidants group, the probability of HDP in women with high-risk factors was 3.81%, which was obviously lower than that in control group with high-risk factors at 7.14% (P<0

  8. Functional changes in the uterine artery precede the hypertensive phenotype in a transgenic model of hypertensive pregnancy

    Science.gov (United States)

    Yamaleyeva, Liliya M.; Varagic, Jasmina; McGee, Carolynne; Bader, Michael; Dechend, Ralf; Brosnihan, K. Bridget

    2015-01-01

    The pregnant female human angiotensinogen (hAGN) transgenic rat mated with the male human renin (hREN) transgenic rat is a model of preeclampsia (TgA) with increased blood pressure, proteinuria, and placenta alterations of edema and necrosis at late gestation. We studied vascular responses and the role of COX-derived prostanoids in the uterine artery (UA) at early gestation in this model. TgA UA showed lower stretch response, similar smooth muscle α-actin content, and lower collagen content compared with Sprague-Dawley (SD) UA. Vasodilation to acetylcholine was similar in SD and TgA UA (64 ± 8 vs. 75 ± 6% of relaxation, P > 0.05), with an acetylcholine-induced contraction in TgA UA that was abolished by preincubation with indomethacin (78 ± 6 vs. 83 ± 11%, P > 0.05). No differences in the contraction to phenylephrine were observed (159 ± 11 vs. 134 ± 12 %KMAX, P > 0.05), although in TgA UA this response was greatly affected by preincubation with indomethacin (179 ± 16 vs. 134 ± 9 %KMAX, P 0.05). Plasma thromboxane levels were similar between groups. In summary, TgA UA displays functional alterations at early gestation before the preeclamptic phenotype is established. Inhibition of COX enzymes normalizes some of the functional defects in the TgA UA. An increased role for COX-derived prostanoids in this model of preeclampsia may contribute to the development of a hypertensive pregnancy. PMID:26394667

  9. Hypertension in postmenopausal women: how to approach hypertension in menopause.

    Science.gov (United States)

    Modena, Maria Grazia

    2014-09-01

    During fertile life women are usually normo or hypotensive. Hypertension may appear during pregnancy and this represents a peculiar phenomenon increasing nowadays for delay time of pregnancy. Gestational hypertension appears partially similar to hypertension in the context of metabolic syndrome for a similar condition of increased waste circumference. Parity, for the same pathogenesis, has been reported to be associated to peri and postmenopausal hypertension, not confirmed by our study of parous women with transitional non persistent perimenopausal hypertension. Estrogen's deficiency inducing endothelial dysfunction and increased body mass index are the main cause for hypertension in this phase of life. For these reasons lifestyle modification, diet and endothelial active drugs represent the ideal treatment. Antioxidant agents may have a role in prevention and treatment of hypertension. In conclusion, hypertension in women represents a peculiar constellation of different biological and pathogenic factors, which need a specific gender related approach, independent from the male model.

  10. Influence Of Sympathetic Hyperactivity And Levels Of Endothelin-1 In Hypertension To Pregnancy And Small For Gestational Age SGA

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    Pesta Corry Sihotang

    2015-05-01

    Full Text Available Abstract Pesta Corry Sihotang. Effect of sympathetic hyperactivity Endothelial Dysfunction Due to Hypertension and Small for gestational age SGA. In Indonesia hypertension due to pregnancy Pregnancy Induced Hypertension range from 5-10 of all pregnancies. This is a major cause of death after bleeding. Hypertension due to pregnancy can be Preeclampsia and eclampsia if not handled appropriately. This study aimed to prove the influence of the sympathetic hyperactivity endothelial dysfunction on the incidence of PIH and SGA. The study design is nested cohort. Methods and ways of working 30 pregnant women who were willing to participate in this study examined after signing the agreement informed consent. Research subjects are grouped into groups of PIH and Normal and followed until delivery. In conclusion there was a significant difference between the incidence hype-reactor and hypo-reactor second trimester with the incidence of PIH and normotensive with Chi-Square P 0.05 against the incidence of hypertension. While the risk of PIH on hype-reactor group in the second trimester has RR 3.66 CI 1.04 to 12.9 while the results of the third trimester there is a difference between having hype-reactor and hypo-reactor with RR of 5.83 CI 1.37 to 24.6. Results ET-1 shows the differences in levels of endothelin in the third trimester with PIH and normotensive patients namely R 0.38 p 0.038 and R 0.49 p 0.005. Furthermore in the third trimester relationship with the incidence of PIH R 0.74 or 0.01 p in the end there are differences between the mean levels of ET-1 in the third trimester between PIH and normotensive group p 0.05. Recommendations CPT Cord Pressure Test is a tool that can be used to predict the incidence of hypertension in pregnancy especially in the second trimester while the results of Elisa can predict the incidence of hypertension in pregnancy.

  11. Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study.

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    Védís Helga Eiríksdóttir

    Full Text Available Data on the potential influence of macroeconomic recessions on maternal diseases during pregnancy are scarce. We aimed to assess potential change in prevalence of pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension during the first years of the major national economic recession in Iceland, which started abruptly in October 2008.Women whose pregnancies resulted in live singleton births in Iceland in 2005-2012 constituted the study population (N = 35,211. Data on pregnancy-induced hypertensive disorders were obtained from the Icelandic Medical Birth Register and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Register. With the pre-collapse period as reference, we used logistic regression analysis to assess change in pregnancy-induced hypertensive disorders and use of antihypertensives during the first four years after the economic collapse, adjusting for demographic and pregnancy characteristics, taking aggregate economic indicators into account. Compared with the pre-collapse period, we observed an increased prevalence of gestational hypertension in the first year following the economic collapse (2.4% vs. 3.9%; adjusted odds ratio [aOR] 1.47; 95 percent confidence interval [95%CI] 1.13-1.91 but not in the subsequent years. The association disappeared completely when we adjusted for aggregate unemployment rate (aOR 1.04; 95% CI 0.74-1.47. Similarly, there was an increase in prescription fills of β-blockers in the first year following the collapse (1.9% vs.3.1%; aOR 1.43; 95% CI 1.07-1.90, which disappeared after adjusting for aggregate unemployment rate (aOR 1.05; 95% CI 0.72-1.54. No changes were observed for preeclampsia or use of calcium channel blockers between the pre- and post-collapse periods.Our data suggest a transient increased risk of gestational hypertension and use of β-blockers among pregnant women in Iceland in the

  12. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when.

    Science.gov (United States)

    Groenhof, T Katrien J; van Rijn, Bas B; Franx, Arie; Roeters van Lennep, Jeanine E; Bots, Michiel L; Lely, A Titia

    2017-01-01

    Background Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized. Design Systematic review and meta-regression analysis. Methods The aim of our study was to provide an overview of existing knowledge on the changes over time in three major modifiable components of cardiovascular risk assessment after HDP: blood pressure, glucose homeostasis and lipid levels. Data from 44 studies and up to 6904 women with a history of a HDP were compared with risk factor levels reported for women of corresponding age in the National Health And Nutrition Examination Survey, Estudio Epidemiólogico de la Insuficiencia Renal en España and Hong Kong cohorts ( N = 27,803). Results Compared with the reference cohort, women with a HDP presented with higher mean blood pressure. Hypertension was present in a higher rate among women with a previous HDP from 15 years postpartum onwards. At 15 years postpartum (±age 45), one in five women with a history of a HDP suffer from hypertension. No differences in glucose homeostasis parameters or lipid levels were observed. Conclusions Based on our analysis, it is not possible to point out a time point to commence screening for cardiovascular risk factors in women after a HDP. We recommend redirection of future research towards the development of a stepwise approach identifying the women with the highest cardiovascular risk.

  13. Cardiovascular and metabolic characteristics 40 years after hypertensive pregnancies: a long-term follow-up study of mothers.

    Science.gov (United States)

    Collén, Anna-Clara; Hellgren, Margareta; Gustafsson, Helena; Johansson, Magnus C; Manhem, Karin

    2013-04-01

    Maternal cardiovascular morbidity is increased after hypertensive pregnancies (HTP). The pathways from complicated pregnancies to future cardiovascular disease are complex. The aim of the present study was to test the hypothesis that different cardiovascular mechanisms are changed in women who experienced HTP four decades earlier in comparison to women with normotensive pregnancies. One hundred and five women (50 with hypertensive and 55 with normal pregnancies) were examined with anthropometric measurements; office blood pressure, ambulatory blood pressure and central blood pressure, pulse wave velocity, augmentation index, intimal-media thickness, echocardiography and laboratory measurements. In addition another 204 women were followed-up by a questionnaire regarding their pregnancy 40 years ago, as well as their present health status and medications. Women with HTP had more often diagnosed hypertension when compared with women with normal pregnancies (50 vs. 31%, respectively; P = 0.046), but the groups did not differ in any blood pressure levels. HTP were associated with higher pulse wave velocity (8.8 m/s vs. 7.8 m/s, P = 0.021), and higher levels of P-glucose (5.7 mmol/l vs. 5.2 mmol/l, P = 0.022), P-HbA1c (4.4% vs. 4.2%, P = 0.010) and noradrenaline (2.45 mmol/l vs. 2.11 mmol/l, P = 0.040) when compared with normotensive pregnancies. Women followed up with a questionnaire reported deteriorated cardiovascular health compared to women attending the clinical investigations of the study. HTP are associated with impairment in vascular function and metabolic status 40 years postpartum despite well controlled blood pressure levels.

  14. Residential traffic exposure and pregnancy-related outcomes: a prospective birth cohort study

    Directory of Open Access Journals (Sweden)

    Hofman Albert

    2009-12-01

    Full Text Available Abstract Background The effects of ambient air pollution on pregnancy outcomes are under debate. Previous studies have used different air pollution exposure assessment methods. The considerable traffic-related intra-urban spatial variation needs to be considered in exposure assessment. Residential proximity to traffic is a proxy for traffic-related exposures that takes into account within-city contrasts. Methods We investigated the association between residential proximity to traffic and various birth and pregnancy outcomes in 7,339 pregnant women and their children participating in a population-based cohort study. Residential proximity to traffic was defined as 1 distance-weighted traffic density in a 150 meter radius, and 2 proximity to a major road. We estimated associations of these exposures with birth weight, and with the risks of preterm birth and small size for gestational age at birth. Additionally, we examined associations with pregnancy-induced hypertension, (preeclampsia, and gestational diabetes. Results There was considerable variation in distance-weighted traffic density. Almost fifteen percent of the participants lived within 50 m of a major road. Residential proximity to traffic was not associated with birth and pregnancy outcomes in the main analysis and in various sensitivity analyses. Conclusions Mothers exposed to residential traffic had no higher risk of adverse birth outcomes or pregnancy complications in this study. Future studies may be refined by taking both temporal and spatial variation in air pollution exposure into account.

  15. 肾脏相关标志物在评估妊娠高血压综合征肾损伤的研究%Clinica value of markers related kidney in assessing renal dysfunction in pregnancy induced hypertension women

    Institute of Scientific and Technical Information of China (English)

    陈志晓; 谢淑贤; 陈金玲; 陈国卫; 利定建; 吴修宇

    2015-01-01

    目的 评价胱抑素C(Cys C)、同型半胱氨酸(Hcy)、24小时尿蛋白定量(24 h-UPE)、尿素(UREA)、肌酐(Scr)在妊娠高血压综合征(PIH)早期肾损伤及损伤程度应用的价值.方法 检测133例PIH患者的Cys C、Hcy、24 h-UPE、UREA、Scr等指标 ;PIH患者分为轻度、中度重度组并与30例健康妊娠者(健康对照组)作比较.结果 轻度PIH组各项指标均高于健康对照组 ,中度、重度PIH组显著高于健康对照组、轻度PIH组 ,差异有统计学意义(P<0 .05);Cys C和24 h-UPE具有高度的相关性(r=0 .780 ,P<0 .01).结论 联合检测Cys C、Hcy、24 h-UPE、UREA、Scr能更准确和客观地反映PIH患者肾脏损伤程度 ,有利于早期诊断与治疗.%Objective To evaluate the significance of the serum cystatin C (Cys-C) Homocysteine(Hcy) ,24 h urinary protein excretion(24 h-UPE) ,UREA and Scr in assessing renal dysfunction in Pregnancy induced hyperten-sion(PIH) women .Methods Biochemistry was used to evaluate the level of Cys-C ,Hcy ,24 h-UPE ,UREA and Scr in 133 PIH patients (study group) who were divided into 3 groups ,the low group ,medium group and severe group , compared with 30 normal pregnant women(control group) .Results The concentrations of Cys-C ,Hcy ,24 h-UPE , UREA and Scr were significantly higher in the low PIH group than in the control group ,all in the medium PIH group and severe PIH group higher in the control group and low PIH group .Correlation analyses demonstrated significant correlations between Cys-C and 24 h-UPE in all the 133 pregnant women ,r=0 .780(P<0 .01) .Conclusion Cys-C , Hcy ,24 h-UPE ,UREA and Scr can reflect the degree of renal function damage in patients with PIH .

  16. Cardiovascular risk estimation in women with a history of hypertensive pregnancy disorders at term: a longitudinal follow-up study.

    Science.gov (United States)

    Hermes, Wietske; Tamsma, Jouke T; Grootendorst, Diana C; Franx, Arie; van der Post, Joris; van Pampus, Maria G; Bloemenkamp, Kitty Wm; Porath, Martina; Mol, Ben W; de Groot, Christianne J M

    2013-06-04

    Cardiovascular disease is associated with major morbidity and mortality in women in the Western world. Prediction of an individual cardiovascular disease risk in young women is difficult. It is known that women with hypertensive pregnancy complications have an increased risk for developing cardiovascular disease in later life and pregnancy might be used as a cardiovascular stress test to identify women who are at high risk for cardiovascular disease. In this study we assess the possibility of long term cardiovascular risk prediction in women with a history of hypertensive pregnancy disorders at term. In a longitudinal follow-up study, between June 2008 and November 2010, 300 women with a history of hypertensive pregnancy disorders at term (HTP cohort) and 94 women with a history of normotensive pregnancies at term (NTP cohort) were included. From the cardiovascular risk status that was known two years after index pregnancy we calculated individual (extrapolated) 10-and 30-year cardiovascular event risks using four different risk prediction models including the Framingham risk score, the SCORE score and the Reynolds risk score. Continuous data were analyzed using the Student's T test and Mann-Whitney U test and categorical data by the Chi-squared test. A poisson regression analysis was performed to calculate the incidence risk ratios and corresponding 95% confidence intervals for the different cardiovascular risk estimation categories. After a mean follow-up of 2.5 years, HTP women had significantly higher mean (SD) extrapolated 10-year cardiovascular event risks (HTP 7.2% (3.7); NTP 4.4% (1.9) (pHTP 11% (7.6); NTP 7.3% (3.5) (p<.001, IRR 2.7, 95% CI 1.6 to 4.5)) as compared to NTP women calculated by the Framingham risk scores. The SCORE score and the Reynolds risk score showed similar significant results. Women with a history of gestational hypertension or preeclampsia at term have higher predicted (extrapolated) 10-year and 30-year cardiovascular event risks as

  17. Age at menarche and pregnancy-related pelvic pain

    DEFF Research Database (Denmark)

    Kirkeby, Mette J; Biering, Karin; Olsen, Jørn

    2013-01-01

    AIM: Menarcheal age is a predictor of several complications related to pregnancy and diseases later in life. We aimed to study if menarcheal age is a risk factor for pregnancy-related pelvic pain. MATERIAL AND METHODS: A nested case-control study was conducted within the Danish National Birth...... Cohort, a cohort of pregnant women, recruited during 1996-2002, and their children. In the second trimester of pregnancy the women provided information about age at menarche and potential confounders. Selection of cases (n = 2227) was based on self-reported pelvic pain during pregnancy from an interview...... done 6 months post-partum. The controls (n = 2588) were randomly selected among women who did not report pelvic pain. We used logistic regression analysis to calculate odds ratios (OR) for pregnancy-related pelvic pain according to age at menarche. RESULTS: In the cohort, 18.5% of all pregnant women...

  18. How I treat pregnancy-related venous thromboembolism

    NARCIS (Netherlands)

    Middeldorp, S.

    2011-01-01

    Venous thromboembolism (VTE) complicates ~ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related

  19. Objective Measures for Pregnancy Related Low Back and Pelvic Pain

    NARCIS (Netherlands)

    M. de Groot (Mirthe)

    2005-01-01

    textabstractPain in the lumbar spine and pelvic region is a frequent complication of pregnancy and delivery. The prevalence of pregnancy related low back and pelvic pain (PLBP) varies between 14.2 and 56%. In 6 to 15% the pain is so severe that it impedes daily life activities. The symptoms of PL

  20. How I treat pregnancy-related venous thromboembolism

    NARCIS (Netherlands)

    S. Middeldorp

    2011-01-01

    Venous thromboembolism (VTE) complicates ~ 1 to 2 of 1000 pregnancies, with pulmonary embolism being a leading cause of maternal mortality and deep vein thrombosis an important cause of maternal morbidity, also on the long term. However, a strong evidence base for the management of pregnancy-related

  1. Specific hypertensive disorders of pregnancy in a tertiary hospital in northeastern brazil epidemiological profile

    Directory of Open Access Journals (Sweden)

    Zélia Maria de Sousa Araújo Santos

    2015-12-01

    Full Text Available Objective: To describe the epidemiological profile of women admitted to a tertiary hospital in Northeastern Brazil with Hypertensive Disorders of Pregnancy (HDP. Methods: A retrospective cross-sectional study was carried out at the Hospital Geral César Cals (César Cals General Hospital, a tertiary care center of the Sistema Único de Saúde – SUS (Brazil’s National Health System in Fortaleza, Ceará, Brazil. The study included 1,865 pregnant women admitted with HDP from January 2006 to December 2013 regardless of age, education, marital status, place of birth, place of residence and outcome (discharge, death and ongoing pregnancy. Results: Pregnant women were predominantly aged 17-35 years (n=1484, 79.6%, mixed-race (n=1464, 78.5%, single (n= 775, 41.6%, housewives (n=1269, 68.0%, lived in Fortaleza (n=1198, 64.3% and had complete elementary education (n=766, 41%. Overweight (n= 1408, 75.4%, first pregnancy (n=827, 44.3% and multiparity (n=686, 36.7% were the main risk factors for HDP. Regarding fetal status, 30.9% (n=576 were preterm. The main HDP complications were: HELLP syndrome (n=60, 3.2%, bleeding disorders (n=15, 0.8% and acute respiratory failure (n=13, 0.6%. Conclusion: The pregnant women assessed presented risk factors for HDP, reinforcing the idea that the health status and the disease and health process are directly influenced by socioeconomic and demographic characteristics of the population.

  2. Hypertension in Pregnancy and Offspring Cardiovascular Risk in Young Adulthood: Prospective and Sibling Studies in the HUNT Study (Nord-Trøndelag Health Study) in Norway.

    Science.gov (United States)

    Alsnes, Ingvild V; Vatten, Lars J; Fraser, Abigail; Bjørngaard, Johan Håkon; Rich-Edwards, Janet; Romundstad, Pål R; Åsvold, Bjørn O

    2017-04-01

    Women with hypertensive disorders in pregnancy are at increased lifetime risk for cardiovascular disease. We examined the offspring's cardiovascular risk profile in young adulthood and their siblings' cardiovascular risk profile. From the HUNT study (Nord-Trøndelag Health Study) in Norway, 15 778 participants (mean age: 29 years), including 210 sibling groups, were linked to information from the Medical Birth Registry of Norway. Blood pressure, anthropometry, serum lipids, and C-reactive protein were assessed. Seven hundred and six participants were born after exposure to maternal hypertension in pregnancy: 336 mothers had gestational hypertension, 343 had term preeclampsia, and 27 had preterm preeclampsia. Offspring whose mothers had hypertension in pregnancy had 2.7 (95% confidence interval, 1.8-3.5) mm Hg higher systolic blood pressure, 1.5 (0.9-2.1) mm Hg higher diastolic blood pressure, 0.66 (0.31-1.01) kg/m(2) higher body mass index, and 1.49 (0.65-2.33) cm wider waist circumference, compared with offspring of normotensive pregnancies. Similar differences were observed for gestational hypertension and term preeclampsia. Term preeclampsia was also associated with higher concentrations of non-high-density lipoprotein cholesterol (0.14 mmol/L, 0.03-0.25) and triglycerides (0.13 mmol/L, 0.06-0.21). Siblings born after a normotensive pregnancy had nearly identical risk factor levels as siblings born after maternal hypertension. Offspring born after maternal hypertension in pregnancy have a more adverse cardiovascular risk profile in young adulthood than offspring of normotensive pregnancies. Their siblings, born after a normotensive pregnancy, have a similar risk profile, suggesting that shared genes or lifestyle may account for the association, rather than an intrauterine effect. All children of mothers who have experienced hypertension in pregnancy may be at increased lifetime risk of cardiovascular disease.

  3. Treatment of pregnancy related venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Mitić Gorana

    2009-01-01

    Full Text Available Introduction. Prevention and treatment of venous thromboembolism during pregnancy are complicated since the use of antithrombotic drugs carries a certain risk to the mother, the fetus or both. Coumarins cross the placental barrier and may be responsible for bleeding, teratogenicity and central nervous system abnormalities. The risk of embriopathy is particularly high between 6 and 12 weeks of gestation. Treatement. Heparin is the treatment of choice for thrombosis during pregnancy because it is entirely safe for the fetus, unlike oral anticoagulants. The frequency of heparin-induced thrombocytopenia and osteoporosis is significantly lower if LMWH is applied, so this heparin type is preferable to UFH during pregnancy. Treatment of women with VTE during pregnancy, especially those with thrombophilia, requires individualized dosing and duration of antithrombotic thrapy. Peripartal management. In order to avoid the peripartum anticoagulant heparin effect and possible bleeding, heparin should be discontinued prior to the delivery and reintroduced after the parturition. PROPHYLACTIC REGIMEn. Prophylactic antithrombotic regimen during subsequent pregnancies should also be individualized. The use of low molecular weight heparins is becoming more widespread. They have reliable pharmacokinetics, require less frequent injections than unfractionated heparin and carry a lower risk of treatment complications. LMW heparins are safe and effective and they are replacing UFH as the anticoagulant of choice during pregnancy. Both UFH and LMWH are not secreted into breast milk and can be safely given to nursing mothers. Warfarin does not induce an anticoagulant effect in the breast-fed infant, so it can be safely used in women who require postpartum anticoagulant therapy.

  4. Risk Factors for Hypertensive Disorder during Pregnancy in Pudong New Area%浦东新区妊娠期高血压疾病的相关高危因素分析

    Institute of Scientific and Technical Information of China (English)

    吴建发; 吴素勤

    2014-01-01

    Objective To investigate the epidemiological status and risk factors in hypertensive disorder during pregnancy in Pudong New Area in Shanghai. Methods The retrospective study analyzed data of 4 056 maternal residents in the region from 2009 to 2012. The prevalence of hypertensive disorders in pregnancy was analyzed. The related factors for the hypertensive disorder during pregnancy were evaluated by multivariate unconditional logistic analysis. Results The in-cidence of hypertensive disorder during pregnancy was 5.18%, including gestational hypertension 2.49%, preeclampsia-mild 0.64%, preeclampsia-severe 1.85%, eclampsia 0.05%and pregnancy with chronic hypertension 0.15%. The multivari-ate unconditional logistic regression analysis showed that the advanced age (OR=7.610, OR95%CI:2.322-24.936), the high body mass index (BMI) before pregnancy (OR=120.715,OR 95%CI:61.867-235.540) and the excessively increased BMI during pregnancy (OR=16.219,OR 95%CI:6.219-42.316) were risk factors for hypertensive disorder during pregnancy. Conclusion The risk factors for hypertensive disorder during pregnancy are advanced age, the high BMI before pregnancy and the excessively increased BMI during pregnancy. The hypertensive disorder during pregnancy has no relation with the number of pregnancies.%目的:探讨浦东新区妊娠期高血压疾病的发病状况及相关危险因素。方法通过对2009-2012年4056例本地区常住产妇资料的回顾性分析,研究本地区妊娠期高血压疾病的患病情况,并通过多因素非条件Logis-tic回归分析影响本地区妊娠期高血压疾病发病的高危因素。结果妊娠期高血压疾病的发生率5.18%,其中妊娠期高血压的发生率2.49%,子前期-轻度发生率0.64%,子前期-重度发生率1.85%,子发生率0.05%,妊娠合并慢性高血压的发生率0.15%。多因素分析显示年龄大(OR=7.610,95%CI:2.322~24.936)、孕前体质量指数高(OR=120.715,95%CI:61.867~235.540

  5. A complex network analysis of hypertension-related genes

    Science.gov (United States)

    Wang, Huan; Xu, Chuan-Yun; Hu, Jing-Bo; Cao, Ke-Fei

    2014-01-01

    In this paper, a network of hypertension-related genes is constructed by analyzing the correlations of gene expression data among the Dahl salt-sensitive rat and two consomic rat strains. The numerical calculations show that this sparse and assortative network has small-world and scale-free properties. Further, 16 key hub genes (Col4a1, Lcn2, Cdk4, etc.) are determined by introducing an integrated centrality and have been confirmed by biological/medical research to play important roles in hypertension.

  6. Treatment of obesity-related hypertension in children and adolescents.

    Science.gov (United States)

    Halbach, Susan M; Flynn, Joseph

    2013-06-01

    The obesity epidemic has become a common concern among pediatricians, with an estimated 32 % of US children and adolescents classified as overweight and 18 % as obese. Along with the increase in obesity, a growing body of evidence demonstrates that chronic diseases, such as Type 2 diabetes, primary hypertension, and hyperlipidemia, once thought to be confined solely to adulthood, are commonly seen among the obese in childhood. Following a brief summary of the diagnosis and evaluation of hypertension in obese children and adolescents, this review will highlight recent research on the treatment of obesity-related hypertension. Pharmacologic and non-pharmacologic treatment will be discussed. Additionally, current and emerging therapies for the primary treatment of obesity in children and adolescents, which have been gaining in popularity, will be reviewed.

  7. Pregnancy-induced hypertension and diabetes and the risk of cardiovascular disease, stroke, and diabetes hospitalization in the year following delivery.

    Science.gov (United States)

    Savitz, David A; Danilack, Valery A; Elston, Beth; Lipkind, Heather S

    2014-07-01

    Although pregnancy events predict the long-term risk of chronic disease, little is known about their short-term impact because of the rarity of clinical events. We examined hospital discharge diagnoses linked to birth certificate data in the year following delivery for 849,639 births during 1995-2004 in New York City, New York. Adjusted odds ratios characterized the relationship between pregnancy complications and subsequent hospitalization for cardiovascular disease, stroke, and diabetes. Gestational hypertension was related to heart failure (adjusted odds ratio = 2.6, 95% confidence interval: 1.5, 4.5). Preeclampsia was related to all of the outcomes considered except type 1 diabetes, with adjusted odds ratios ranging from 2.0 to 4.1. Gestational diabetes was strongly related to the risk of subsequent diabetes (for type 1 diabetes, adjusted odds ratio = 40.4, 95% confidence interval: 23.8, 68.5; for type 2 diabetes, adjusted odds ratio = 22.6, 95% confidence interval: 16.9, 30.4) but to no other outcomes. The relationship of pregnancy complications to future chronic disease is apparent as early as the year following delivery. Moreover, elucidating short-term clinical outcomes offers the potential for etiological insights into the relationship between pregnancy events and chronic disease over the life course.

  8. 妊娠期高血压与妊娠结局的相关性研究%Study on the Correlation between Hypertension in Pregnancy and Pregnancy Outcome

    Institute of Scientific and Technical Information of China (English)

    夏三红

    2013-01-01

      目的分析妊娠期高血压的相关因素,并探讨探讨影响妊娠结局的相关性。方法回顾性分析我院2010年1月至2010年12月之间收治的200例妊娠期高血压患者的高危因素,并进行探讨妊娠期高血压与妊娠结局之间的相关性。结果通过本次的临床研究分析,肥胖、高龄和精神紧张以及双胎与营养差均是影响妊娠期高血压患者的高危因素。其中,从不产检组产妇并发症的发生率与胎儿的并发症发生率均明显高于不定期产检组和定期产检组产妇并发症的发生率与胎儿的并发症发生率,两组的数据比较具有明显的差异(P <0.05),统计学有意义。结论妊娠期高血压与妊娠结局之间有着紧密的联系,加强孕妇的保健知识宣传,并加强定期的正规产检,从而降低相关并发症的发生,从而有效的改善妊娠结局。%Objective To analyze the related factors of gestational hypertension, and to explore the correlation effect of pregnancy outcome. Methods The method of analysis of risk factors for 200 cases of patients with pregnancy induced hypertension in our hospital from 2010 January to 2010 December were reviewed, and investigate the correlation between hypertension in pregnancy and pregnancy outcome. Results Through the analysis of the clinical research, obesity, older age and mental tension and twins and poor nutrition are high risk factors of hypertension of pregnancy. Among them, never check group of maternal complications and fetal complications occurrence rate and fetal complications rate was obviously higher than the irregular prenatal examination group and the regular prenatal examination team maternal complications, compared two groups of data with a significant difference (P<0.05), statistically significant. Conclusion There is close relation between hypertension in pregnancy and pregnancy outcome in pregnant women, to strengthen the health knowledge

  9. 血清胰岛素样生长因子相关指标及白细胞介素与妊娠高血压疾病的关系研究%Study of the relationship of serum insul in-l ike growth factor-related indicators and interleu-kins with pregnancy-induced hypertension

    Institute of Scientific and Technical Information of China (English)

    米娜瓦尔•艾则孜

    2016-01-01

    目的::探讨血清胰岛素样生长因子相关指标及白细胞介素与妊娠高血压疾病的关系.方法:选择妊娠期高血压患者34例,轻度子痫前期患者27例,重度子痫前期患者18例,健康产妇50例作为研究对象,采集血清并测定胰岛素样生长因子(IGF)-Ⅰ、IGF-Ⅱ、胰岛素样生长因子结合蛋白(IGFBP)-1、白介素(IL)-6、IL-8、IL-18含量,收集胎盘并测定 IGF-Ⅰ、IGF-Ⅱ、IGFBP-1、IL-6、IL-8、IL-18含量.结果:妊娠期高血压组、轻度子痫前期组、重度子痫前期组胎盘组织和血清中 IGF-Ⅰ、IGF-Ⅱ含量均显著低于健康对照组(P <0.05),IGFBP-1、IL-6、IL-8、IL-18含量均显著高于对照组(P <0.05);血清 IGF-Ⅰ、IGF-Ⅱ含量与 IL-6、IL-8、IL-18含量呈负相关,血清 IGFBP-1含量与 IL-6、IL-8、IL-18含量呈正相关.结论:血清 IGF-Ⅰ、IGF-Ⅱ含量降低以及 IL-6、IL-8、IL-1、IGFBP-1含量升高与妊娠高血压疾病的发生有关,IGF-I、IGF-II 含量降低以及 IGFBP-1含量升高与白细胞介素含量的升高密切相关.%Objective:To study the relationship of serum insulin-like growth factor-related indicators and interleukins with pregnancy-induced hypertension.Methods:A total of 34 patients with gestational hypertension,27 patients with mild pre-eclampsia,18 patients with severe preeclampsia and 50 healthy women were selected as the research subjects,serum was col-lected to determine serum insulin-like growth factor (IGF)-Ⅰ,IGF-Ⅱ,insulin-like growth factor binding proteins (IGFBP)-1,interleukin (IL)-6,IL-8 and IL-18 content,and the placenta was collect to determine IGF-Ⅰ,IGF-Ⅱ,IGFBP-1,IL-6,IL-8 and IL-18 content.Results:IGF-Ⅰ and IGF-Ⅱ levels in placenta tissue and serum of gestational hypertension group,mild preeclampsia group and severe preeclampsia group were significantly lower than those of control group,and IGFBP-1,IL-6, IL-8 and IL-18 levels were significantly higher than those of control

  10. Human chorionic somatommamotropin (HCS) and pregnancy. Its relation with insulin.

    Science.gov (United States)

    Prieto Villapun, J C; Cifuentes de Castro, I; Serrano Rios, M

    1976-01-01

    Plasma HCS levels have been measured in normal and pathological pregnant women. In the normal group HCS levels increased from 6--8 weeks till 33-34 weeks and then felt significantly. HCS pattern in prediabetic and chemical diabetic pregnant women was similar to the normal group. However HCS levels in chemical diabetics were significantly higher during the first two trimesters. HCS levels increased in twin pregnancy, diminished in cases of eclampsia, hypertension, fetal growth retardation, mole and blighted ovum, and disappeared after intrauterine death. Nothing could be deduced from the obese and Rh-isoimmunization groups. It is confirmed the value of HCS determination as an index of placental maturation. Also, insulin/HCS ratio may be of some aid in the study of carbohydrate intolerance in pregnancy.

  11. 妊高征对母婴的影响%Effects of Pregnancy Induced Hypertension on Mothers and Their Babies

    Institute of Scientific and Technical Information of China (English)

    胡冰梅

    2002-01-01

    Objective To explore the effects of pregnancy induced hypertension(PIH) on mothers and their babies.Mothods 76 cases of PIH were retrospectively reviewed. Results There was significant difference in the ratio of difficultlabor, SGA, the neonatal suffocation,neonatal mortality, matenral complications and the time for resuming blood pressure aftergiving a new birth between severe PIH and moderate and light PIH. Conclusions PIH, especially severe one posts criticalthreats to the safety of the mothers and their babies, therefore, positive prevention measures and treatment should be adopted orterminate the pregnancy at right time.

  12. 妊高征血清催乳素水平变化%Prolactin in normal pregnancy and severe pregnancy-induced hypertension

    Institute of Scientific and Technical Information of China (English)

    谌兵来; 张志华; 刘年彬; 黄开淑

    2001-01-01

    目的:检测催乳素在妊高征中的水平及与妊高征的关系。方法:选择正常妊娠妇女89例及妊高征患者52例,分区方法,按妊娠每2周分为8组,按正常妊娠每组的催乳素均值划分3区,即A区(高值区)(x>+s);B区(中值区)(x+s)~;C区(低值区)~(x+s);利用放射免疫分析法测定正常妊娠中晚期及妊高征催乳素水平。结果:正常妊娠第24周催乳素均值为270mg.L-1,随孕周增加而升高,第34~37周达高峰,峰值为440mg.L-1,后逐渐下降。妊高征组血清催乳素显著高于正常妊娠组;其中31例(59.6%)催乳素在A区,10例(19.3%)在B区,11例(21.1%)在C区。结论:高催乳素水平可能与妊高征发病有关。%Objective: This study was to investigate the relationship betweenserum prolactin and pregnancy-induced hypertension. Method: Maternal serum prolactin was estimated by radioimmunoassay in 89 normal pregnant women and 52 patients with severe pregnancy-induced hypertension at 28 to 42 week gestation. Results: In normal pregnancy, prolactin level increased progressively from a mean value of 270 mg.L-1 in the 24th week to 440 mg.L-1 in the 34th week and decreased progressively from the 38th week to the 40th week. In severe pregnancy-induced hypertension increased progressively too;31 of 52 patients with severe prolactin showed high prolactin levels in zone A(>mean value + standard of prolactin values in the normal pregnancy),10 patients in zone B(mean+standard to mean )and 11 patients in zone C(pregnancy-induced hypertension.

  13. Preconception and early pregnancy maternal haemodynamic changes in healthy women in relation to pregnancy viability.

    Science.gov (United States)

    Foo, F L; Collins, A; McEniery, C M; Bennett, P R; Wilkinson, I B; Lees, C C

    2017-05-01

    . Similarly, between the groups, there were no differences in pregnancy adaptation with similar trends in cardiovascular function changes from pre-pregnancy to 6 weeks gestation. Whilst this is the first study to investigate preconception and early pregnancy haemodynamic and arterial function in relation to viability, the relatively modest number of miscarriages may not be sufficient to show subtle differences in haemodynamic changes if these were present. This study suggests that pre-pregnancy haemodynamic and arterial function is unlikely to be the causal link between miscarriages and future cardiovascular disease. Our findings suggests that factors other than the presence of a viable embryo drive cardiovascular changes in early pregnancy. This study raises new questions about miscarriages as an independent risk event which predisposes women to increased cardiovascular risk later in life. The investigators are funded by NIHR Imperial BRC, NIHR Cambridge BRC, Action Medical Research, Imperial College Healthcare Charity and Tommy's Charity. We acknowledge the loan of ultrasound equipment from Samsung Medison (South Korea)/MIS Ltd and provision of fertility monitors from SPD Development Company Ltd (Bedford, UK). There are no competing interests. C.C.L. is supported by the UK National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare National Health Service Trust and Imperial College London. N/A.

  14. Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China.

    Directory of Open Access Journals (Sweden)

    Aifen Zhou

    Full Text Available Hypertensive disorders of pregnancy (HDP are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG, and GWG during early pregnancy as risk factors for HDP among Chinese women.The study was conducted between 2011-2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP.Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32-3.05; obese: OR = 5.53, 95% CI = 4.28-7.13 compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM recommendation had an adjusted OR of 1.72 (95% CI = 1.54-1.93 for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89-3.89 for HDP, compared to women with a gestational BMI gain 600g/wk: adjusted OR = 1.48, 95% CI = 1.19-1.84.The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.

  15. Pregnancy hypertensive disease and risk of dementia and cardiovascular disease in women aged 65 years or older: a cohort study

    OpenAIRE

    Nelander, Maria; Cnattingius, S; Åkerud, Helena; Wikström, Johan; Pedersen, N.L.; Wikström, Anna-Karin

    2016-01-01

    OBJECTIVE: The primary aim was to study pregnancy hypertensive disease and subsequent risk of dementia. The second aim was to study if the increased risks of cardiovascular disease (CVD) and stroke after pregnancy hypertensive disease persist in an elderly population. DESIGN: Cohort study. SETTING: Sweden. POPULATION OR SAMPLE: 3232 women 65 years or older (mean 71 years) at inclusion. METHODS: Cox proportional hazards regression analyses were used to calculate risks of dementia, CVD and/or s...

  16. Hydralazine is involved in tele-methylhistamine metabolism by inhibiting monoamine oxidase B in pregnancy-associated hypertensive mice.

    Science.gov (United States)

    Kawasaki, Shohei; Kako, Koichiro; Nagashima, Yusuke; Kanou, Akihiko; Ishida, Junji; Fukamizu, Akiyoshi

    2017-01-07

    Hypertensive disorders of pregnancy globally affect 6-8% of gestation and remain a major cause of both foetal and maternal morbidity and mortality. However, the antihypertensive medications for the patients of this disease are strictly limited due to the teratogenic potentials. Here, we found that tele-methylhistamine (tMH) increased in response to the administration of hydralazine (Hdz), a vasodilative agent, in the pregnancy-associated hypertensive (PAH) mice. Hdz abrogated the degradation of tMH catalyzed by monoamine oxidase B (MAO-B) in vitro These results suggested that Hdz inhibited the MAO-B activity and consequently tMH increased in the maternal circulation of PAH mice.

  17. PC02 Beta3-adrenoceptor agonist-induced relaxation of human placental arteries is reduced in pregnancy-induced hypertension

    Institute of Scientific and Technical Information of China (English)

    0BARTHEZ; CROUGET; PGUERARD; MJLEROYZAMIA; MBREUILLER-FOUCHE; EJMORCILLO; TCRPCO; PSAGOT; MDUMAS; MBARDOU

    2004-01-01

    AIM: Preeclampsia is one of the leading causes of neonatal and maternal morbidity and mortality. The purpose of this study is to investigate the functionality of β2- and 133-adrenoreceptors(β-ARs) in human placental arteries and to assess the influence of pregnancy-induced hypertension on β-ARs responsiveness.METHODS: We performed in vitro functional and biochemical studies as well as RT-PCR experiments. RESULTS: SR59119

  18. Clinical Experience of Treating Hypertension of Pregnancy%妊娠高血压临床治疗体会

    Institute of Scientific and Technical Information of China (English)

    杜晓丹

    2014-01-01

    Objective To explore the clinical treatment of patients with gestational hypertension and experience. Methods A retrospective analysis between January 2012 and December 2012, the diagnosis and treatment of obstetrics and gynecology hospital clinical data of 92 patients with pregnancy-induced hypertension disease. Results 92 cases of pregnancy-induced hypertension patients after taking sedative, spasmolysis, step-down, active treatment of postpartum hemorrhage, the ef ective control condition, al safe delivery, no maternal death and other serious complications. Conclusion Gestational hypertension early found its incentive and carries on the positive and ef ective prevention, spasmolysis, calm, reasonable treatment, such as hypertension, when necessary, timely termination of pregnancy. Can ef ectively reduce the high stretch marks to pregnant women.%目的探讨妊娠期高血压患者的临床治疗方法及体会。方法回顾性分析2012年1月~2013年12月我院妇产科诊治的92例妊娠高血压疾病患者的临床资料。结果92例妊娠高血压患者经过采取镇静、解痉、降压,积极治疗产后出血等措施,病情得到有效控制,全部安全分娩,无孕产妇死亡等严重并发症。结论妊娠高血压早期发现其诱因并进行积极有效预防,解痉,镇静,降压等合理治疗,必要时适时终止妊娠。可有效降低妊高征给孕妇带来的损害。

  19. Impedance Cardiographic (ICG) Assessment of Pregnant Women With Severe Hypertension to Assess Impact of Standard Therapy

    Science.gov (United States)

    2013-12-11

    Pregnancy; Proteinuria, With Hypertension (Severe Pre-eclampsia); Delivery; Proteinuria, With Gestational Hypertension (Pre-eclampsia, Severe); Pregnancy; Hypertension, Gestational Hypertension, With Albuminuria (Severe Pre-eclampsia)

  20. Improving the accuracy of maternal mortality and pregnancy related death.

    Science.gov (United States)

    Schaible, Burk

    2014-01-01

    Comparing abortion-related death and pregnancy-related death remains difficult due to the limitations within the Abortion Mortality Surveillance System and the International Statistical Classification of Diseases and Related Health Problems (ICD). These methods lack a systematic and comprehensive method of collecting complete records regarding abortion outcomes in each state and fail to properly identify longitudinal cause of death related to induced abortion. This article seeks to analyze the current method of comparing abortion-related death with pregnancy-related death and provide solutions to improve data collection regarding these subjects.

  1. The change and significance of platelet parameters and blood coagulation function index in patients with hypertensive disorder complicating pregnancy

    Institute of Scientific and Technical Information of China (English)

    Yu-Xia Shi; Yi-Xin Yang; Qian Xu; Yanhua Zhu

    2015-01-01

    Objective:To explore the change and significance of platelet parameters and blood coagulation function index in patients with hypertensive disorder complicating pregnancy.Methods: Chose 89 patients with HDCP, they were set as HDCP group, chose another 60 cases health late pregnancy women and 42 cases non pregnant female, they were set as late pregnant group and non-pregnant control group, detected the platelet parameters: the average blood platelet count (PLT), platelet volume (MPV), platelet distribution width (PDW) and blood coagulation indexes, plasma prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), D-dimer (D-D), activated partial blood coagulation time (APTT) live enzymes in three groups.Results: (1) Compared with the non-pregnant group and late pregnant group, PLT was significantly lower, while the MPV and PDW were significantly higher in HDCP group; PLT in late pregnant group was significantly lower than that in non-pregnant group, and there were no significantly difference of MPV and PDW in the two groups; (2) Compared with the non-pregnant group and late pregnant group, PT and APTT levels were significantly lower, while FIB and D-D were significantly higher in HDCP group; The level of PT and APTT in late pregnant group were significantly lower, and FIB and D-D levels were significantly higher than that in non-pregnant group, However, The level of TT were no statistical significance difference among the three groups.Conclusion: HDCP existence phenomenon of platelet activation and apparent high coagulation state, dynamic detection of HDCP patients platelet parameters and blood coagulation indexes to prevent related complications, improve obstetrics safety is of great significance.

  2. Pregnancy prevents hypertensive remodeling and decreases myogenic reactivity in posterior cerebral arteries from Dahl salt-sensitive rats : a role in eclampsia?

    NARCIS (Netherlands)

    Aukes, Annet M.; Vitullo, Lisa; Zeeman, Gerda G.; Cipolla, Marilyn J.

    2007-01-01

    Previous studies have demonstrated that pregnancy prevents protective hypertension-induced remodeling of cerebral arteries using nitric oxide synthase (NOS) inhibition to raise mean arterial pressure (MAP). In the present study, we investigated whether this effect of pregnancy was specific to NOS in

  3. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II) : An open-label, randomised controlled trial

    NARCIS (Netherlands)

    Broekhuijsen, Kim; Van Baaren, Gert Jan; Van Pampus, Maria G.; Ganzevoort, Wessel; Sikkema, J. Marko; Woiski, Mallory D.; Oudijk, Martijn A.|info:eu-repo/dai/nl/246958898; Bloemenkamp, Kitty W M; Scheepers, Hubertina C J; Bremer, Henk A.; Rijnders, Robbert J P; Van Loon, Aren J.; Perquin, Denise A M; Sporken, Jan M J; Papatsonis, Dimitri N M; Van Huizen, Marloes E.; Vredevoogd, Corla B.; Brons, Jozien T J; Kaplan, Mesrure; Van Kaam, Anton H.; Groen, Henk; Porath, Martina M.; Van Den Berg, Paul P.; Mol, Ben W J; Franssen, Maureen T M; Langenveld, Josje

    2015-01-01

    Patients with hypertensive disorders of pregnancy usually have the 2 treatment options, either immediate delivery or continuing the pregnancy. Although immediately delivery of the placenta is seen as the more definitive of the 2 treatments, it does carry the potentially higher risks of an earlier bi

  4. Hypertension hos gravide

    DEFF Research Database (Denmark)

    Mathiesen, Elisabeth R; Johansen, Marianne; Kamper, Anne Lise;

    2009-01-01

    There are four major hypertensive disorders in pregnancy: chronic hypertension, gestational hypertension, preeclampsia and chronic hypertension with superimposed preeclampsia. The indications and efficacy of antihypertensive treatment of the different hypertensive disorders are assessed. Advantages...... and disadvantages of different classes of antihypertensive drugs during pregnancy and lactation are described....

  5. Does Chocolate Intake During Pregnancy Reduce the Risks of Preeclampsia and Gestational Hypertension?

    Science.gov (United States)

    Saftlas, Audrey F.; Triche, Elizabeth W.; Beydoun, Hind; Bracken, Michael B.

    2010-01-01

    Purpose Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine if regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). Methods Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at Chocolate consumption (servings/week) during the 1st and 3rd trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of Chocolate intake was more frequent among normotensives (80.7%) than preeclamptics (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (1st trimester: aOR=0.55, 95% CI: 0.32-0.95; 3rd trimester: aOR=0.56, 95% CI: 0.32-0.97). Only 1st trimester intake was associated with reduced odds of GH (aOR=0.65, 95% CI: 0.45-0.87). Conclusions These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia. PMID:20609337

  6. Effect of Prepared Rhubarb on Insulin Resistance in Patients With Pregnancy Induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    WANGZi-fen; SHIShao-lan; 等

    2003-01-01

    Objective:To investigate the effect of prepared rhubarb on insulin resistance in patients with pregnancy induced hypertension(PIH)and its mechanism.Methods:All the 92 patients accepted 75 g oral glucose tolerance test(OGTT)and insulin release test before and after treatment.These patients were divided into two groups(treated group and control group).Prepared rhubarb and nifedipine were given to the treated group,while nifedipine was given to the control group alone.Circulating endothelial cell(CEC),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)were measured and glucose area under curve(GAUC),insulin area under curve(IAUC),insulin sensitivity index(ISI)were calculated.And 30 normal pregnant women were selected as the healthy group.Results:CEC,TNF-α,IL-6,GAUC and IAUC of PIH patients were significantly higher than those of the normal healthy group; while ISI of PIH patients was significantly lower than that of the healthy group.ISI was significantly negatively correlated to CEC, TNF-α and IL-6.After treatment,CEC,TNF-α,IL-6,GAUC decreased and ISI increased sig-nificantly in the treated group;while in the control group,all above-mentioned parameters showed no change.Conclusion:Prepared rhubarb can improve insulin resistance of PIH by reducing vascular endothe-lial cells damage.

  7. Effect of Prepared Rhubarb on Insulin Resistance in Patients With Pregnancy Induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    王子芬; 石绍兰; 宋海翔

    2003-01-01

    Objective: To investigate the effect of prepared rhubarb on insulin resistance in patients with pregnancy induced hypertension (PIH) and its mechanism. Methods: All the 92 patients accepted 75 g oral glucose tolerance test (OGTT) and insulin release test before and after treatment. These patients were divided into two groups (treated group and control group). Prepared rhubarb and nifedipine were given to the treated group, while nifedipine was given to the control group alone. Circulating endothelial cell (CEC), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were measured and glucose area under curve (GAUC), insulin area under curve (IAUC), insulin sensitivity index (ISI) were calculated. And 30 normal pregnant women were selected as the healthy group. Results: CEC, TNF-α, IL-6, GAUC and IAUC of PIH patients were significantly higher than those of the normal healthy group; while ISI of PIH patients was significantly lower than that of the healthy group. ISI was significantly negatively correlated to CEC, TNF-α and IL-6. After treatment, CEC, TNF-α, IL-6, GAUC decreased and ISI increased significantly in the treated group; while in the control group, all above-mentioned parameters showed no change. Conclusion: Prepared rhubarb can improve insulin resistance of PIH by reducing vascular endothelial cell's damage.

  8. Microarray analysis of genes differentially expressed in placentas of pregnancy-induced hypertension patients

    Institute of Scientific and Technical Information of China (English)

    李东红; 黄飞; 郑维国; 姜锋; 高平

    2003-01-01

    Objective: To uncover new clue for the research of the etiology of pregnancy-induced hypertension (PIH) by testing the gene expression difference between preeclamptic placentas and normal ones. Methods: mRNA level of 4 PIH placentas were examined using 4000 feature cDNA microarray in comparison with the pooled control consisting of total RNA from 4 cases of PIH placentas after the control cDNA and experimental cDNA were labeled by cy3 and cy5 respectively. Results: Fifty-eight to 131 genes were found down or up-regulated in 4 runs of hybridization. Among the differentially expressed genes, 22 genes, including genes encoding secreted protein ADRP, CYR61, EPI and HIF2, had the concordance in at least 2 cases were up-regulated or down-regulated. Conclusion: cDNA microarray is a high throughput and time-saving method to monitor the altered gene expression and the result could provide interesting clue and strategy for the etiological research of PIH.

  9. Fetal Growth Retardation And Its Relationship To Maternal Blood Lead Levels, Antioxidants And Pregnancy Induced Hypertension

    Directory of Open Access Journals (Sweden)

    Ragab H. EL-Yamani* and Ahmed E. Karim

    2004-03-01

    Full Text Available Lead intoxication in human being has been documented since the second century BC and its deleterious effects continue to be a major health hazard for the population, it is demonstrated that lead exposure might decrease the defense mechanism of the cell to the oxidative stress, and therefore, elevate the reactive oxygen species (ROS generation which enhance vascular reactivity. Since vitamin E (Vit. E and vitamin C (Vit. C are natural antioxidants, changes in their status may reflect alterations in free radical production rate and their concentrations are biological markers of oxidative stress. This study was conducted to determine the relationship between maternal blood lead levels and the antioxidants Vit.E and Vit.C in a step to understand the mechanism of action of lead and its possible influence on maternal blood pressure and fetal growth at the lower community exposure levels. The study included, 42 patients with pregnancy induced hypertension (PIH with or without proteinuria, 31 patients with fetal growth retardation (FGR and 23 women with uncomplicated pregnancy. We demonstrated that, the maternal blood lead levels were significantly high in the PIH (30.5 ±0.978 µg/dl and FGR groups (28.87 ±1.21 µg/dl as compared with the uncomplicated pregnancy group (17.82 ±110µg/dl at P0.00l Vit.E concentrations were significantly lower in both PIH and FGR (0.941 ±0.033 mg/dl and 0.866 ± 0.055 mg/dl respectively when compared with normal group (2.00±0.085 mg/dl. Regarding Vit.C in the 2 studied groups there was significantly low levels in PIH group (0.772 ±0.030 mg/dl and FGR (0.847 ±0.039 mg/dl in comparison with control group (l.23 ±0.06 mg/dl. We observed significant negative correlation between maternal blood lead levels and Vit.E in PIH and FGR group. A significant negative correlation was also observed between maternal lead levels and Vit.C in both studied groups. We concluded that high blood lead levels in pregnancy are associated

  10. Factors related to adherence to treatment for systemic hypertension

    Directory of Open Access Journals (Sweden)

    Silvana Maria Coelho Leite Fava

    2014-06-01

    Full Text Available This study aimed to seek the evidence available in the literature regarding the factors related to adherence to treatment for systemic hypertension. It used the method of integrative review in the databases MEDLINE, CINAHL, and LILACS, using the keywords: hypertension, compliance, non-compliance, adherence, non-adherence, patient compliance, in the period 2004 – 2008, and articles in Portuguese, English and Spanish, with the use of a validated instrument and content analysis. 28 studies were selected, 64.3% of which had level of evidence VI. The following were identified as factors related to adherence to treatment: treatment costs, educational activities, sex, physician-patient relationship, physiological and behavioral aspects, drug therapy, attending checkups and lifestyle. The use of combined strategies is suggested in order to increase the individuals’ adherence to the treatment. Gaps point to the valorization of dialogic relationships for integrated and more efficacious health practices.

  11. Prediction of pregnancy-induced hypertension by a shift of blood pressure class according to the JSH 2009 guidelines.

    Science.gov (United States)

    Jwa, Seung Chik; Arata, Naoko; Sakamoto, Naoko; Watanabe, Noriyoshi; Aoki, Hiroaki; Kurauchi-Mito, Asako; Dongmei, Qiu; Ohya, Yukihiro; Ichihara, Atsuhiro; Kitagawa, Michihiro

    2011-11-01

    Elevated blood pressure (BP) at early or mid pregnancy is a known risk factor for pregnancy-induced hypertension (PIH). However, the association between BP changes during the first half of pregnancy and subsequent PIH development is unknown. We used changes in maternal BP between 16 and 20 weeks of gestation to evaluate the risk of PIH. A total of 976 pregnant women with BP estimations recorded before 16 weeks and at 20 weeks of gestation participated in this study. BPs were classified by the Japanese Society of Hypertension 2009 Hypertension Treatment Guidelines (JSH 2009). There was a significant trend for future PIH in women whose JSH 2009 BP class increased between 16 and 20 weeks of gestation, and the risk of PIH was highest among women whose BP was Class IV Hypertension (systolic BP≥140 mm Hg and/or diastolic BP≥90 mm Hg). The risk of PIH increased in women whose BPs shifted from Classes I Optimal (systolic BP<120 mm Hg and diastolic BP<80 mm Hg) and II Normal (systolic BP 120-129 mm Hg and/or diastolic BP 80-84 mm Hg) before 16 weeks to Class III High-Normal (systolic BP 130-139 mm Hg and/or diastolic BP 85-89 mm Hg) at 20 weeks of gestation. These shifts in BP class were significantly correlated with the risk of PIH after adjustments for variables (P-value for trend <0.05). Within JSH 2009 Classes I, II and III, a shift in BP from a low to a high class between 16 and 20 weeks of gestation predicts the subsequent development of PIH.

  12. Correlation of serum neutrophil gelatinase-associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy.

    Science.gov (United States)

    Patel, Ml; Sachan, Rekha; Gangwar, Radheyshyam; Sachan, Pushpalata; Natu, Sm

    2013-01-01

    Hypertensive disorders of pregnancy (HDP) remain one of the largest single causes of maternal and fetal morbidity and mortality, accounting for 16.1% of maternal deaths in developed countries. The aim of the study was to evaluate acute kidney injury (AKI) in hypertensive disorders of pregnancy and to examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with acute kidney injury. This prospective case control study was carried out over a period of 1 year. After written, informed consent and ethical clearance, 149 cases of hypertensive disorders of pregnancy were screened, and seven were lost to follow-up. Acute kidney injury was detected in 88 cases and acute renal failure in 30 cases of HDP. Thirty-one healthy pregnant nonhypertensive women were enrolled as controls. Quantitative measurement of serum NGAL levels was done by enzyme linked immunosorbent assay technique using a sandwich enzyme-linked immunosorbent assay kit. As per the Kidney Diseases Improving Global Outcomes International guidelines acute kidney injury network (AKIN), 50 cases (42.37%) of AKI stage I, 38 (32.2%) cases of AKI stage II, and 30 (25.42%) cases of renal failure were detected. Serum NGAL had a positive association with increasing proteinuria. It also had a positive correlation with systolic blood pressure (r∼0.36), diastolic blood pressure (r∼0.37), and serum creatinine (r∼0.4). NGAL was found to be significantly correlated with creatinine in the cases with the value of the correlation coefficient being 0.4. This direct correlation might be a consequence of endothelial dysfunction on which hypertension and proteinuria probably depends.

  13. [Hypertension].

    Science.gov (United States)

    Ohishi, Mitsuru

    2014-04-01

    Hypertension is well known to one of the risk factors to reduce cognitive function, however, it is still unclear whether anti-hypertensive therapy is effective to prevent development of dementia or Alzheimer's disease. Epidemiological studies suggested antihypertensive therapy from the middle-age could reduce risk of dementia. The meta-analysis including HYVET also suggested blood pressure lowering from the elderly might be also effective to prevent development of dementia. The network meta-analysis and the cohort study using mega-data bank suggested ARB might be effective to prevent development of dementia or Alzheimer's disease compared to administration with other anti-hypertensive drugs. Although the further major clinical investigation is required, anti-hypertensive treatment might be useful to manage hypertensive patients with dementia.

  14. Correlation of serum neutrophil gelatinase-associated lipocalin with acute kidney injury in hypertensive disorders of pregnancy

    Directory of Open Access Journals (Sweden)

    Patel ML

    2013-10-01

    Full Text Available ML Patel,1 Rekha Sachan,2 Radheyshyam Gangwar,3 Pushpalata Sachan,4 SM Natu51Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India; 2Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India; 3Department of Critical Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; 4Department of Physiology, King George's Medical University, Lucknow, Uttar Pradesh, India; 5Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, IndiaAbstract: Hypertensive disorders of pregnancy (HDP remain one of the largest single causes of maternal and fetal morbidity and mortality, accounting for 16.1% of maternal deaths in developed countries. The aim of the study was to evaluate acute kidney injury (AKI in hypertensive disorders of pregnancy and to examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL with acute kidney injury. This prospective case control study was carried out over a period of 1 year. After written, informed consent and ethical clearance, 149 cases of hypertensive disorders of pregnancy were screened, and seven were lost to follow-up. Acute kidney injury was detected in 88 cases and acute renal failure in 30 cases of HDP. Thirty-one healthy pregnant nonhypertensive women were enrolled as controls. Quantitative measurement of serum NGAL levels was done by enzyme linked immunosorbent assay technique using a sandwich enzyme-linked immunosorbent assay kit. As per the Kidney Diseases Improving Global Outcomes International guidelines acute kidney injury network (AKIN, 50 cases (42.37% of AKI stage I, 38 (32.2% cases of AKI stage II, and 30 (25.42% cases of renal failure were detected. Serum NGAL had a positive association with increasing proteinuria. It also had a positive correlation with systolic blood pressure (r~0.36, diastolic blood pressure (r~0.37, and serum creatinine (r~0

  15. Proteomic analysis of pregnancy-related proteins from pig uterus endometrium during pregnancy

    Directory of Open Access Journals (Sweden)

    Kang Sunghyun

    2011-07-01

    Full Text Available Abstract Many important molecular events associated with implantation and development occur within the female reproductive tract, especially within the uterus endometrium, during pregnancy periods. The endometrium includes the mucosal lining of the uterus, which provides a suitable site for implantation and development of a fertilized egg and fetus. To date, the molecular cascades in the uterus endometrium during pregnancy periods in pigs have not been elucidated fully. In this study, we compared the functional regulated proteins in the endometrium during pregnancy periods with those in non-pregnant conditions and investigated changes in expression patterns during pregnancy (days 40, 70, and 93 using two-dimensional gel electrophoresis (2-DE and western blotting. The functional regulated proteins were identified and discovered from differentially expressed proteins in the uterus endometrium during pregnancy. We discovered 820 protein spots in a proteomic analysis of uterus endometrium tissues with 2-DE gels. We identified 63 of the 98 proteins regulated differentially among non-pregnant and pregnant tissues (matched and unmatched spots. Interestingly, 10 of these 63 proteins are development-, cytoskeleton- and chaperon-related proteins such as transferrin, protein DJ-1, transgelin, galectin-1, septin 2, stathmin 1, cofilin 1, fascin 1, heat shock protein (HSP 90β and HSP 27. The specific expression patterns of these proteins in the endometrium during pregnancy were confirmed by western blotting. Our results suggest that the expressions of these genes involved in endometrium function and endometrium development from early to late gestation are associated with the regulation of endometrium development for maintaining pregnancy.

  16. Establishment of a model for pregnancy-induced hypertension syndrome resuiting from cold-stress in rats

    Institute of Scientific and Technical Information of China (English)

    俞丽丽; 李力; 陈鸣; 吴国萍; 史景泉; 祝之明

    2004-01-01

    Objective: To establish a model for pregnancy-induced hypertension syndrome in rats. Methods: Adult female Wistar rats were randomized into non-pregnant control (NN), non-pregnant cold-stress control (NC), pregnant control (PN) and pregnant cold-stress (PC) groups. The rats of NN and PN groups were put under 25 ℃ and those of NC and PC groups under (4±2) ℃ for 4 h every morning respectively in the whole experimental period. The blood pressure, urine protein, body weight, haematocrit, weight of the placenta and weight and length of the fetus were recorded and the histological changes of the placenta and the kidneys were also studied. Results: The blood pressure and urine protein of the rats of the NC and PC groups after 2 weeks of cold-stress were more significantly increased than the rats of the NN and PN groups. In addition, the weight of the placenta and the weight and length of the fetus were more significantly lower in the former than the latter. Obvious changes of anoxia and ischemia were observed in the tissues of the kidneys and every layer of the placenta.Conclusion: Our findings of hypertension syndrome induced with repeated cold-stress in pregnant rats can be applied to illustrate the pathogenesis of pregnancy-induced hypertension syndrome in human beings.

  17. Hypertension

    OpenAIRE

    2012-01-01

    Hypertension is responsible for roughly one-in-six adult deaths annually in the United States and is associated with five of the top nine causes of death. 1 Ten trillion dollars is the estimated annual cost worldwide of the direct and indirect effects of hypertension. 2,3 In the U.S. alone, costs estimated at almost $74 billion in 2009 placed a huge economic burden on the health care system. 4 The prevalence of hypertension increases with advancing age to the point where more than half of peo...

  18. Expression of Endothelial Nitric Oxide Synthase Traffic Inducer in the Placenta of Pregnancy Induced Hypertension

    Institute of Scientific and Technical Information of China (English)

    XIANG Wenpei; CHEN Hanping; GUO Yuzhen; SHEN Hongling

    2006-01-01

    The expression of endothelial nitric oxide synthase traffic inducer (NOSTRIN) in the placenta of the patients with pregnancy induced hypertension (PIH) was detected and its role in the pathogenesis of PIH was studied. The pathological changes in placental vessels were observed by HE staining. NO2-/NO3- , the stable metabolic end products of NO, was measured with nitrate reductase. The eNOS activity in placental tissues was assayed by spectrophotometry. Western blot analysis was applied to detect NOSTRIN expression. The incidence of thickening and fibronoid necrosis of placental vessels was significantly higher in women with PIH than in the normal group (P<0.01). The levels of placental NO2-/NO3- in PIH patients (27.53±7.48 μmol/mg) were significantly lower than in normal group (54.27±9.53 μmol/mg, P<0.01). The activity of eNOS was significantly decreased in PIH group (12. 826±3.61 U/mg) as compared with that in normal group (21. 72±3.83 U/mg, P<0.01). Western blot analysis revealed that both groups expressed 58 kD NOSTRIN, but the protein level was significantly higher in women with PIH than in the normal group (P<0.01). A significant negative correlation existed between the expression of NOSTRIN protein and the activity of eNOS in placental tissue of women with PIH (r=-0. 57, P<0. 01). It was concluded that the level of NOSTRIN expression in placenta of women with PIH was increased, which may play an important role in the pathogenesis of PIH.

  19. Relation Between Night Urinary Free Cortisol and Hypertension in Youth

    Institute of Scientific and Technical Information of China (English)

    叶涛; 刘治全; 傅毅; 牟建军; 傅西汉; 高保林; 张晓红

    2003-01-01

    Objectives To study the relation between night urinary free cortisol (UFC) ex-cretion and hypertension in youth. Methods Nighturinary free cortisol excretion and blood pressure & itsrelated factor were measured in 188 young people.Results In young men with hypertension the 8 h'snight UFC excretion was significantly higher than thatin the group with normal blood pressure 21.57 ± 6.28μg/8hvs 10. 54 ± 5. 46μg/8 h (P <0.05). Inagroup of young people with positive family history ofhypertension, the night UFC excretion was much higherthan that in the group with negative family history ofhypertension. Men excrete much more night UFC thanwomen (12.73±5.85 μg/8hvs7.80±4.15 μg/8h, P < 0. 05). Conclusions There is an associationbetween hypertension and high 8h's night UFC excre-tion; furthermore, there is gender difference in nightUFC excretion.

  20. The Role of Colour Doppler And Spectral Flow Analysis In Pregnancy Induced Hypertension: A Case Control Study

    Directory of Open Access Journals (Sweden)

    Hinal Bhagat

    2015-03-01

    Full Text Available Background: The use of Doppler ultrasound to study blood flow in Obstetrics is of major importance because fetal inaccessibility precludes many other methods of study of fetal circulation. This study was undertaken to assess the role of Doppler in management of Pregnancy induced Hypertension. Methodology: The present case-control study was conducted in the department of Radiology, Govt. Medical College and New Civil Hospital, Surat. Details of obstetric history, age, last menstrual date and underlying risk factor, Doppler study of umbilical artery, fetal middle cerebral artery, both maternal uterine arteries and Ductus venosus was done. Parameters in form of Resistive index (RI, Pulsatility index (PI and systolic/diastolic ratio (S/D of all four arteries were taken. Results: It was observed that 55% cases with pregnancy induced hypertension developed IUGR fetuses while 2% of the IUGR fetus was present in control group. There were 41 (54% cases with IUGR fetuses. Out of which 28 (68% cases with IUGR had fetoplacental Doppler abnormality. 13 cases had abnormally low PI of MCA with normal umbilical arterial Doppler indices, out of which 12 patients had abnormal fetal outcome. Conclusion: By examining the maternal vessels using Doppler ultrasound it is possible to determine, the risk of complication developing in the course of pregnancy long before clinical signs of preeclampsia appear so that therapeutic measures may be undertaken early. [Natl J Med Res 2015; 5(1.000: 57-60

  1. Hypertension

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

  2. Obesity-related complications in Danish single cephalic term pregnancies

    DEFF Research Database (Denmark)

    Rode, Line; Nilas, Lisbeth; Wøjdemann, Karen

    2005-01-01

    OBJECTIVE: Our objective was to investigate the relationship between prepregnancy and obstetric body mass index (BMI) as well as fetal complications in a large, unselected cohort of Danish women with single cephalic pregnancies. METHODS: A cohort of 8,092 women from the Copenhagen First Trimester...... Study with a registered prepregnancy BMI and a single cephalic term delivery were stratified into 3 BMI groups: normal weight (BMI obese (BMI >/= 30 kg/m(2)). The effects of BMI and parity on the outcome were analyzed using multivariate logistic...... regression analyses. RESULTS: Overweight women had an odds ratio (OR) of 3.4 for diabetes, 1.9 for hypertension, 1.7 for preeclampsia, and 1.5 for cesarean delivery. The corresponding figures for obese women were 15.3, 4.8, 2.7, and 1.7, respectively. No relationship was found between BMI and vacuum...

  3. Discussion on the risk factors of pregnancy induced hypertension%妊娠高血压的危险因素探讨

    Institute of Scientific and Technical Information of China (English)

    杨艾芳

    2016-01-01

    目的:探讨妊娠高血压的危险因素,为预防干预措施提供科学依据。方法:对妊娠期高血压患者126例和正常孕产妇132例两组进行相关性分析。结果:孕产妇年龄偏大、学历低下、不能定期产检、经济状况不佳等均为妊娠高血压的危险因素。结论:评估妊娠高血压的患病风险,采用有效干预措施,能减少妊娠期高血压疾病的发生。%Objective:To explore the risk factors of hypertension in pregnancy,providing scientific basis for prevention and intervention measures.Methods:We analyzed the correlation between the two groups of 126 cases of pregnancy-induced hypertension patients and 132 cases of normal maternal.Results:The risk factors of pregnancy induced hypertension were the older age of pregnant women,the lower degree of education,the lack of regular examination,poor economic conditions and so on. Conclusion: Assess the risk of pregnancy induced hypertension and use effective interventions to reduce the incidence of hypertensive disorder complicating pregnancy.

  4. 胎盘早剥合并妊高症的诊疗分析%Analysis of diagnosis and treatment of pregnancy induced hypertension in placental early pregnancy

    Institute of Scientific and Technical Information of China (English)

    王新菊; 王晓丽

    2016-01-01

    目的:分析胎盘早剥合并妊高症的临床诊治措施和治疗效果。方法回顾分析2012年1月至2015年1月期间我院收治的30例胎盘早剥合并妊高症产妇的临床资料,总结产妇的临床诊治措施和治疗效果。结果在本次研究的30例胎盘早剥合并妊高症的患者中,通过常规的治疗和密切监护,30例患者中11例产妇为自然分娩,19例产妇进行剖宫产。其中2例因子宫胎盘卒中而行子宫切除术,2例产妇因胎儿宫内窘迫出现死胎,其余产妇经过治疗后病情得到控制,顺利手术或生产。结论妊高症中最危险的并发症是胎盘早剥,及时有效的治疗措施在胎盘早剥合并妊高症产妇的恢复过程中有着非常重要的作用,临床医师必须做到早发现、早诊断以及早治疗,以使产妇、胎儿转危为安。%Objective to analyze the clinical diagnosis and treatment of placental early pregnancy complicated with pregnancy induced hypertension.Methods the clinical data of 30 cases of early pregnancy associated with pregnancy induced hypertension in our hospital from January 2012 to January 2015 were analyzed retrospectively,and the clinical diagnosis and treatment measures were summarized.Results in this study,30 cases of patients with pregnancy induced hypertension were treated by routine treatment and close monitoring,30 cases of 1 1 cases of ma-ternal natural childbirth,19 cases of maternal cesarean section.Of which 2 cases of uteroplacental apoplexy underwent hysterectomy,2 cases of maternal fetal distress occurred after treatment of maternal fetal death,the disease under control,operation or production.Conclusion the risk of pregnancy induced hypertension in the complications of placental abruption,timely and ef ective measures in the treatment of placental abruption has a very important role in the recovery process with rengaozheng maternal,clinicians must be total =early discovery,early diagnosis and ear

  5. Sustained Endocrine Gland-Derived Vascular Endothelial Growth Factor Levels Beyond the First Trimester of Pregnancy Display Phenotypic and Functional Changes Associated With the Pathogenesis of Pregnancy-Induced Hypertension.

    Science.gov (United States)

    Sergent, Frédéric; Hoffmann, Pascale; Brouillet, Sophie; Garnier, Vanessa; Salomon, Aude; Murthi, Padma; Benharouga, Mohamed; Feige, Jean-Jacques; Alfaidy, Nadia

    2016-07-01

    Pregnancy-induced hypertension diseases are classified as gestational hypertension, preeclampsia, or eclampsia. The mechanisms of their development and prediction are still to be discovered. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor secreted by the placenta during the first trimester of human pregnancy that was shown to control trophoblast invasion, to be upregulated by hypoxia, and to be abnormally elevated in pathological pregnancies complicated with preeclampsia and intrauterine growth restriction. These findings suggested that sustaining EG-VEGF levels beyond the first trimester of pregnancy may contribute to pregnancy-induced hypertension. To test this hypothesis, osmotic minipumps delivering EG-VEGF were implanted subcutaneously into gravid OF1 (Oncins France 1) mice on day 11.5 post coitus, which is equivalent to the end of the first trimester of human pregnancy. Mice were euthanized at 15.5 and 18.5 days post coitus to assess (1) litter size, placental, and fetal weights; (2) placental histology and function; (3) maternal blood pressure; (4) renal histology and function; and (5) circulating soluble fms-like tyrosine kinase 1 and soluble endoglin. Increased EG-VEGF levels caused significant defects in placental organization and function. Both increased hypoxia and decreased trophoblast invasion were observed. Treated mice had elevated circulating soluble fms-like tyrosine kinase 1 and soluble endoglin and developed gestational hypertension with dysregulated maternal kidney function. EG-VEGF effect on the kidney function was secondary to its effects on the placenta as similarly treated male mice had normal kidney functions. Altogether, these data provide a strong evidence to confirm that sustained EG-VEGF beyond the first trimester of pregnancy contributes to the development of pregnancy-induced hypertension.

  6. [Non-Pharmacological Interventions for Pregnancy-Related Sleep Disturbances].

    Science.gov (United States)

    Hung, Hsuan-Man; Chiang, Hsiao-Ching

    2017-02-01

    Most women experience the worse sleep quality of their life during pregnancy and the early postpartum period. Although pregnancy typically accounts for a relatively short part of a woman's life, the related sleep disturbances may have a significant and negative impact on her long-term health. Approximately 78-80% of pregnant women experience sleep disturbances, including interruptions in deep sleep, decreased total sleep time, poor subjective sleep quality, frequent night waking, and reduced sleep efficacy. Sleep disturbances during pregnancy start during the first trimester and become prevalent during the third trimester. Related factors include physiological and psychosocial changes and an unhealthy lifestyle. As non-pharmacological interventions have the potential to improve sleep quality in 70% to 80% of patients with insomnia, this is the main approached that is currently used to treat pregnancy-related sleep disturbances. Examples of these non-pharmacological interventions include music therapy, aerobic exercise, massage, progressive muscle relaxation, multi-modal interventions, and the use of a maternity support belt. The efficacy and safety of other related non-pharmacological interventions such as auricular acupressure, cognitive therapy, tai chi, and aromatherapy remain uncertain, with more empirical research required. Additionally, non-pharmacological interventions do not effectively treat sleep disturbances in all pregnant women.

  7. 疤痕子宫再次妊娠并发妊娠期高血压疾病的妊娠结局分析%Again uterine scar pregnancy complicated by hypertensive disorders in pregnancy Pregnancy Outcome

    Institute of Scientific and Technical Information of China (English)

    韩秀燕; 郑海霞

    2016-01-01

    Objective:To explore the analysis of uterine scar pregnancy complicated by gestational hypertension again pregnancy outcomes.Methods:June 2010 -June 2015 period,the hospital treated 60 cases of maternal hypertension during pregnancy was observed object,of which 28 cases of maternal history of cesarean section surgery,alternatively the same period 60 cases of normal birth mothers as controls group observed object.Observe and compare the three groups of mothers in the postpartum hemorrhage,mode of delivery,neonatal complications,differences on maternal complications.Results:postpartum hemorrhage and maternal hypertension during pregnancy maternal uterine scar,cesarean section rate,maternal complication rate was significantly higher (P <0.05 ).Conclusions:Maternal uterine scar with hypertension during pregnancy can adversely affect pregnancy outcomes,should strengthen surveillance in the perinatal period,select the appropriate mode of delivery,prevent complications.%目的:探究分析疤痕子宫再次妊娠并发妊娠期高血压疾病的妊娠结局。方法:选取2010年6月至2015年6月该院收治的60例妊娠期高血压产妇为观察对象,其中28例产妇有剖宫产手术史,另选同期60例正常分娩产妇为对照组观察对象。观察并对比三组产妇在产后出血、分娩方式、新生儿并发症、产妇并发症上的差异。结果:妊娠期高血压产妇及疤痕子宫产妇的产后出血量、剖宫产率、并发症发生率明显高于对照组产妇(P<0.05)。结论:疤痕子宫产妇在妊娠期间并发高血压,能够对妊娠结局产生不利影响,应在围产期加强观察,选择合适的分娩方式,预防并发症的发生。

  8. Decreased baroreflex sensitivity is linked to sympathovagal imbalance, low-grade inflammation, and oxidative stress in pregnancy-induced hypertension.

    Science.gov (United States)

    Subha, M; Pal, Pravati; Pal, G K; Habeebullah, S; Adithan, C; Sridhar, M G

    Pregnancy-induced hypertension (PIH) has been reported as a cardiovascular (CV) risk. We assessed the sympathovagal imbalance (SVI) and the association of inflammation and oxidative stress (OS) with CV risks in PIH. A total of 125 pregnant women having a risk factor for PIH were followed till term and the incidence of PIH was observed. Retrospectively, they were divided into two groups: Group I (those who did not develop PIH, n = 82) and Group II (those who developed PIH, n = 43). Blood pressure variability (BPV) parameters including baroreflex sensitivity (BRS), spectral heart rate variability (HRV), autonomic function tests (AFTs), inflammatory markers (interleukin-6, TNF-α, interferon-γ), and OS markers were measured in both the groups. Alterations in parasympathetic and sympathetic components of AFTs were analyzed. Link of various parameters to BRS was assessed by correlation and multiple regression analysis. Parasympathetic components of AFTs were decreased from the early part of pregnancy and sympathetic components were increased toward the later part of pregnancy. Decreased BRS, the marker of CV risk, was more prominent in Group II subjects. Independent contribution of interleukin-6 (β = 0.276, P = 0.020), TNF-α (β = 0.408, P = 0.002), interferon-γ (β = 0.355, P = 0.008), and thiobarbituric-acid reactive substance (β = 0.287, P = 0.015) to BRS was found to be significant. It was concluded that sympathetic overactivity that develops more in the later part (third trimester) of pregnancy contributes to SVI and genesis of PIH. In PIH women, CV risks are present from the beginning of pregnancy that intensifies in the later part of pregnancy. Retrograde inflammation and oxidative stress contribute to the decreased BRS in PIH.

  9. Vascular related pregnancy complications: genetics and remote cardiovascular risk

    NARCIS (Netherlands)

    A.L. Berends (Anne)

    2008-01-01

    textabstractPreeclampsia and intrauterine growth restriction (IUGR) are common vascular related pregnancy syndromes of unknown cause. Both preeclampsia and IUGR are responsible for a significant maternal and perinatal morbidity and mortality worldwide. Preeclampsia affects approximately 2.5-3.0% of

  10. A study of prevalence and association of fundus changes in pregnancy induced hypertension

    Directory of Open Access Journals (Sweden)

    Varija T.

    2016-05-01

    Results: Out of the total 423 patients of PIH examined, the retinal changes (hypertensive retinopathy changes were noted in 181 (42.7% patients. The prevalence of retinopathy changes was more among patients with imminent Eclampsia (76.5% and eclampsia patients (50%. As the severity of the PIH increased the Odds of women developing retinopathy also increased substantially from OR: 17.6; 95% CI: 3.1-136.3 in severe PIH to OR: 253; 95% CI: 47.2-1935 in Imminent eclampsia and this association between the severity of PIH and the development of retinopathy changes was found to be statistically significant. Conclusions: Fundus examination in cases of PIH is of paramount importance in monitoring and managing cases as it co-relates with the severity of PIH. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1375-1379

  11. Use of Rapid Ascertainment Process for Institutional Deaths (RAPID) to identify pregnancy-related deaths in tertiary-care obstetric hospitals in three departments in Haiti.

    Science.gov (United States)

    Boyd, Andrew T; Hulland, Erin N; Grand'Pierre, Reynold; Nesi, Floris; Honoré, Patrice; Jean-Louis, Reginald; Handzel, Endang

    2017-05-16

    Accurate assessment of maternal deaths is difficult in countries lacking standardized data sources for their review. As a first step to investigate suspected maternal deaths, WHO suggests surveillance of "pregnancy-related deaths", defined as deaths of women while pregnant or within 42 days of termination of pregnancy, irrespective of cause. Rapid Ascertainment Process for Institutional Deaths (RAPID), a surveillance tool, retrospectively identifies pregnancy-related deaths occurring in health facilities that may be missed by routine surveillance to assess gaps in reporting these deaths. We used RAPID to review pregnancy-related deaths in six tertiary obstetric care facilities in three departments in Haiti. We reviewed registers and medical dossiers of deaths among women of reproductive age occurring in 2014 and 2015 from all wards, along with any additional available dossiers of deaths not appearing in registers, to capture pregnancy status, suspected cause of death, and timing of death in relation to the pregnancy. We used capture-recapture analyses to estimate the true number of in-hospital pregnancy-related deaths in these facilities. Among 373 deaths of women of reproductive age, we found 111 pregnancy-related deaths, 25.2% more than were reported through routine surveillance, and 22.5% of which were misclassified as non-pregnancy-related. Hemorrhage (27.0%) and hypertensive disorders (18.0%) were the most common categories of suspected causes of death, and deaths after termination of pregnancy were statistically significantly more common than deaths during pregnancy or delivery. Data were missing at multiple levels: 210 deaths had an undetermined pregnancy status, 48.7% of pregnancy-related deaths lacked specific information about timing of death in relation to the pregnancy, and capture-recapture analyses in three hospitals suggested that approximately one-quarter of pregnancy-related deaths were not captured by RAPID or routine surveillance. Across six

  12. Analysis of 105 cases of pregnancy -induced hypertension patients with Ⅲphase of retinopathy%Ⅲ期妊娠高血压综合征视网膜病变105例临床分析

    Institute of Scientific and Technical Information of China (English)

    邱晓云; 郭建玲; 余凤慈; 梁淑贞; 李振安; 何清泉

    2014-01-01

    To explore the related risk factors and outcome in pregnancy- induced hypertension patients with Ⅲ phase of retinopathy. ●METHODS: A total of 105 pregnancy - induced hypertension patients with Ⅲ phase of retinopathy in our hospital from Januany 2012 to December 2013 were enrolled. Clinical date of them were collected to analyze. ●RESULTS: The occurrence of pregnancy - induced hypertension patients with Ⅲ phase of retinopathy were positively correlated with the course of the disease, blood pressure, proteinuria, and it was higher occurred in cold winter and spring, timely termination of pregnancy and appropriate hormone therapy can promote the recovery of vision, and improve outcomes of pregnancy. ●CONCLUSlON: The occurrence of pregnancy - induced hypertension patients with Ⅲ phase of retinopathy associated with season and disease severity. Timely treatment can restore normal vision, improve maternal and neonatal prognosis. Routine examination of fundus examination should be used as the pregnancy induced hypertension syndrome.%目的:探讨妊娠高血压患者并发Ⅲ期视网膜病变的相关发病因素及结局。  方法:收集我院2012-01/2013-12Ⅲ期妊娠高血压综合征视网膜病变患者105例的临床资料。  结果:Ⅲ期妊娠高血压综合征视网膜病变的发生与妊娠高血压综合征病程、血压、蛋白尿呈正相关,在冬春寒冷季节发病率高,及时终止妊娠及适当用激素治疗可促进孕妇视力恢复,改善孕产妇及围产儿预后。  结论:Ⅲ期妊娠高血压综合征视网膜病变与冬春季节、妊高征病情严重程度相关,及时治疗可恢复正常视力,改善母子预后,眼底检查应作为妊娠高血压综合征的常规检查。

  13. PREVALENCE, CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT OF ACUTE PULMONARY OEDEMA IN SEVERE PREGNANCY-INDUCED HYPERTENSION AND ECLAMPSIA CASES IN TRIBAL POPULATION OF SOUTH RAJASTHAN

    Directory of Open Access Journals (Sweden)

    (Brig. Pradeep Kuma

    2016-05-01

    Full Text Available BACKGROUND Pulmonary oedema in severe pregnancy-induced hypertension is a life threatening complication with high maternal mortality, particularly in tribal population of South Rajasthan. METHODS Thirteen cases which occurred in the duration of two and half years were analysed through medical records and findings were recorded. RESULTS Maximum cases 10(76.92% were in less than 20 years of age. 12 (92.30% cases were nulliparous. Out of 13 cases of PIH, pulmonary oedema developed in 5 (38.46% cases of eclampsia and 8 (61.54% cases of severe pregnancy-induced hypertension. 10 (76.92%cases were 28 to 30 weeks of gestation and 3 (23.08% were 31 to 34 weeks of gestation. 8 (61.54% cases were severely anaemic. 12 (92.30% were unbooked cases. CONCLUSION Regular antenatal checkups, early diagnosis, prompt treatment of hypertension and pulmonary oedema and termination of pregnancy is required to prevent maternal death.

  14. Progress Review of the Diagnosis and Management of Hypertensive Disorder During Pregnancy%妊娠期高血压疾病诊断及治疗进展

    Institute of Scientific and Technical Information of China (English)

    余秀琼; 戴玫

    2012-01-01

    Hypertensive disorders in pregnancy remain a major cause of maternal, fetal, and neonatal morbidity and mortality in China. Hypertension in China is the most common and severe medical problem to occur during pregnancy. This article reviews recent progress made in diagnosis and management of hypertensive disorders during pregnancy.%妊娠期高血压疾病目前仍然是我国孕产妇死亡的主要原因之一,是威胁母婴健康最常见最严重的一种疾病.但由于妊娠期的特殊性,缺乏前瞻性随机大规模的循证证据.现综述近年妊娠期高血压疾病的诊断及治疗进展.

  15. Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial

    NARCIS (Netherlands)

    S.H.E. Luitjes (Susanne); M.G.A.J. Wouters (Maurice); A. Franx (Arie); H.C.J. Scheepers (Hubertina); V.M.H. Coupé (Veerle); H. Wollersheim (Huub); R.P.M. Steegers-Theunissen (Régine); M.P. Heringa (Martijn); R.P.M.G. Hermens (Rosella); M.W. van Tulder (Maurits)

    2010-01-01

    textabstractBackground: Hypertensive disease in pregnancy remains the leading cause of maternal mortality in the Netherlands. Seventeen percent of the clinical pregnancies are complicated by hypertension and 2% by preeclampsia. The Dutch Society of Obstetrics and Gynaecology (NVOG) has developed evi

  16. Endometrial vascularity is lower in pregnancies with pregnancy-induced hypertension or small-for-gestational-age fetus in live birth after in-vitro fertilization.

    Science.gov (United States)

    Lai, C W S; Yung, S S F; Ng, E H Y

    2014-10-01

    To assess the relationship between endometrial/subendometrial vascularity and the risk of pregnancy-induced hypertension (PIH) or small-for-gestational-age (SGA) fetuses in women who had a live birth following in-vitro fertilization (IVF). This was a retrospective study of women who had a live birth after IVF from November 2002 to December 2004. Only women with a singleton pregnancy (n = 104) were included for analysis. Three-dimensional ultrasound measurement with power Doppler of the endometrial and subendometrial regions was performed on the day of oocyte retrieval in stimulated IVF cycles or on luteinizing hormone surge + 1 day in frozen-thawed embryo transfer cycles to measure the endometrial volume and the vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of the endometrial and subendometrial regions. Pregnancy outcomes were also reviewed. Eight women (7.7%) had PIH or an SGA fetus. Women in the PIH/SGA group had significantly lower endometrial VI (0.504 vs 1.051; P = 0.023) and VFI (0.121 vs 0.253; P = 0.023) than those in the non-PIH/SGA group. However endometrial FI was significantly higher in the PIH/SGA group (23.04 vs 22.71; P = 0.028). There were no significant differences in subendometrial indices between the two groups. Women who had a live birth following IVF and whose pregnancy was complicated by PIH or an SGA fetus had significantly lower endometrial vascularity in terms of VI and VFI than did women without PIH or SGA. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  17. Nursing intervention for hypertension of pregnancy in labor%妊娠高血压疾病的待产期护理干预

    Institute of Scientific and Technical Information of China (English)

    胡秀敏

    2014-01-01

    Objective:To study and explore the methods and effects of nursing intervention for patients with hypertension of pregnancy in labor.Methods:122 cases of patients with hypertension of pregnancy in labor from May 2012 to May 2014 were treated with comprehensive nursing intervention from the aspects of psychology,physiology,environment and social relations.Then we analyzed the life quality of patients before and after the nursing intervention.Results:Through the determination of quality of life scale test,it was found that psychology score,physiology score,environment score,and social relations score in patients after comprehensive nursing intervention were significantly better than before,and the differences were statistically significant(P<0.05).Conclusions:Comprehensive nursing intervention can improve patients' quality of life with hypertension of pregnancy effectively,and it is beneficial to the safety of pregnant women in labor and improving the prognosis of patients.%目的:研究和探索待产期妊娠高血压患者的护理干预方法及效果。方法:2012年5月-2014年5月收治待产期妊娠高血压患者122例,对其从心理、生理、环境及社会关系等方面实施全面护理干预,对护理前后患者生命质量情况进行比较分析。结果:经生存质量测定量表测试,全面护理干预后患者心理、生理、环境及社会关系方面均明显优于全面护理干预前,差异具有统计学意义(P<0.05)。结论:对妊娠高血压疾病待产期患者实施全面护理干预可有效提升患者生命质量,有利于保证待产期孕妇安全,改善患者预后。

  18. Síndromes hipertensivas da gestação e repercussões perinatais Hypertensive syndromes during pregnancy and perinatal outcomes

    Directory of Open Access Journals (Sweden)

    Cristiane Alves de Oliveira

    2006-03-01

    Full Text Available OBJETIVOS: avaliar repercussões perinatais nas síndromes hipertensivas em gestações. MÉTODOS: estudo observacional e retrospectivo, realizado em hospital terciário, entre janeiro de 1996 e outubro de 2003. Um total de 12.272 gestações preencheu critérios de inclusão. Dois tipos de hipertensão foram considerados: hipertensão gestacional (HG e hipertensão arterial crônica (HAC. Variáveis estudadas: fetos pequenos para idade gestacional (PIG, Apgar baixo no 1º e 5º minutos, infecção neonatal, síndrome de aspiração meconial (SAM, prematuridade, síndrome de angústia respiratória (SAR. RESULTADOS: 1259 (10,26% gestantes tinham hipertensão; 344 (2,80% foram classificadas como HG, 915 (7,45% como HAC, havendo 11.013 (89,74% gestantes normotensas. HG constituiu risco elevado para: PIG, Apgar baixo no 1º e 5º minutos, infecção neonatal e prematuridade, mas não para SAM e SAR. HAC constituiu risco elevado para: PIG, Apgar baixo no 1º minuto, SAM, prematuridade e SAR, mas não para Apgar baixo no 5º minuto e infecção neonatal. Quando comparamos os riscos relativos dos grupos de HAC e HG, houve maior risco de prematuridade no grupo de HAC. CONCLUSÕES: dados sugerem que tanto HAC quanto HG aumentaram risco para PIG, Apgar baixo no 1º e 5º minutos, infecção neonatal, SAM, prematuridade e SAR. HAC apresentou maior risco relativo para prematuridade.OBJECTIVES: to assess perinatal effects of pregnancy hypertensive syndromes. METHODS: hospital-based observational and retrospective study of a tertiary Brazilian center, from January, 1996 to October, 2003. Twelve thousand and two hundred and seventy two (12.272 pregnancies met the inclusion criteria. Two types of hypertension were considered: gestational hypertension (GH and chronic hypertension (CH. Results of the study demonstrated that newborns of mothers with gestational hypertension and chronic hypertension were small for gestational age (SGA, had low Apgar score in the 1

  19. 妊娠高血压的治疗进展%Progress in Therapy for Hypertension in Pregnancy

    Institute of Scientific and Technical Information of China (English)

    韩治伟; 范书英; 李菁; 王勇

    2012-01-01

    Hypertensive disorder of pregnancy, a major cause of maternal mortality in developing world, holds a central public health concern. This paper presents the progress in understanding of various hypertensive disorders of pregnancy and their treatment options. The diagnostic tools and the tests for screening preeclampsia are described, and the current management guidelines, goals of treatment, the pros and cons of various antihypertensive drugs reviewed.%目前妊娠期高血压疾病仍然是重要的公共卫生问题,是发展中国家孕妇死亡的主要原因之一.本文总结了目前对妊娠期各种高血压疾病诊断和治疗的进展,介绍了可以用于早期诊断先兆子痫的一些检验、检查手段,并结合相关指南和文献总结了妊娠期高血压疾病的治疗目标和各种降压药的利弊.

  20. Folic acid alone or multivitamin containing folic acid intake during pregnancy and the risk of gestational hypertension and preeclampsia through meta-analyses

    OpenAIRE

    Shim, Sang-Min; Yun, Yeo-Ul; Kim, Yun Sook

    2016-01-01

    Objective The objective of this study was to assess the effect of folic acid and multivitamin use during pregnancy on the risk of developing of hypertensive disorder of pregnancy. Methods Two reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, placebo-controlled, randomized clinical trial published using PubMed Medline database, KERIS (Korea Education and Researc...

  1. Pregnancy outcome in pulmonary hypertension complication pregnancy%妊娠合并肺动脉高压妊娠结局分析

    Institute of Scientific and Technical Information of China (English)

    陈一红; 胡继芬; 陈丽红; 吴建波

    2012-01-01

    目的 分析妊娠合并肺动脉高压(PH)临床特点,探讨其围生期监护及妊娠终止时机、方式.方法 收集福建医科大学附属第一医院2005年1月至2011年4月37例妊娠合并PH患者的临床资料,根据肺动脉压力情况分为轻度组19例[30~ <50 mmHg(1 mmHg=0.133 kPa)],中度组10例(50~<80 mmHg),重度组8例(≥80mmHg).分析心脏病情况及母婴结局.结果 (1)37例肺动脉高压患者中,风湿性心脏病18例,先天性心脏病11例,围生期心肌病5例,肥厚型心肌病1例,特发性肺动脉高压1例,未发现心脏器质性改变1例.(2)轻度组心功能Ⅰ~Ⅱ级占68.4%(13/19).中度组心功能Ⅱ~Ⅲ级占70%(7/10).重度组心功能Ⅲ~Ⅳ级占75%(6/8).(3)32例患者(86.5%)行剖宫产术.1例轻度肺动脉高压孕妇经阴道分娩.1例产妇死亡(2.7%).4例中期引产(12.1%).7例早产,新生儿窒息3例,低出生体重儿4例,新生儿死亡1例.结论 妊娠合并肺动脉高压属于高危妊娠,随着肺动脉压力升高心功能衰竭的发生率增加,围生儿疾病发生率和胎儿丢失率也明显增加,母儿预后取决于孕期是否伴有合并症.晚期妊娠患者以剖宫产终止妊娠为宜.%Objective To analysis the clinical characteristics of pulmonary hypertension( PH) complicating pregnancy,to explore the monitoring as well as the treatment during perinatal period, the delivery time and the way. Methods Clinical data of 37 cases of pregnant women with pulmonary hypertension between Jan. 2005 and Apr. 2011 were analyzed and theywere divided into three groups; 19 cases of slight group [ pulmonary hypertension from 30 mmHg (1 mmHg = 0. 133 kPa) to 49 mmHg] , 10 cases of moderate group ( pulmonary hypertension from 50 mmHg to 79 mmHg) and 8 cases of severe group (pulmonary hypertension equal to or higher than 80 mmHg). To analysis the heart condition and the maternal and fetal outcomes. Results (1) In these cases, 18 cases were rheumatic heart disease

  2. The relation of hypertension to changes in ADL/IADL limitations of Mexican american older adults.

    Science.gov (United States)

    Caskie, Grace I L; Sutton, Maryann C; Margrett, Jennifer A

    2010-05-01

    Hypertension, highly prevalent and often undiagnosed among older Mexican Americans, is associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that can lead to greater dependency for older adults. Using data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly study, the rate of increase in ADL/IADL limitations for a 7-year period was examined for 3,046 older Mexican Americans classified either as reporting hypertension at baseline, first reporting hypertension at subsequent waves, or never reporting hypertension. Latent growth models indicated increased ADL/IADL limitations over time; individuals with hypertension evidenced greater increases than those without hypertension. Age, comorbidities, and depression were positively related to greater ADL/IADL limitations at baseline for all groups; only age was consistently related to ADL/IADL change over time. Development of hypertension may increase the risk of ADL/IADL decline, but early diagnosis and treatment may attenuate this effect.

  3. Management of hypertensive disorders in pregnancy%妊娠期高血压疾病的处理

    Institute of Scientific and Technical Information of China (English)

    何娅妮; 刘佳睿

    2015-01-01

    妊娠期高血压疾病(HDP)是妊娠期常见的以高血压、肾功能损害、神经系统症状为主要表现的严重临床综合征,是导致妊娠期死亡的首要原因。根据2013美国妇产科医师协会指南 HDP可分为妊娠期高血压、子痫前期-子痫、慢性高血压及慢性高血压并发子痫前期。妊娠期血压≥160/110 mmHg 应给予降压治疗。钙离子拮抗剂、交感神经抑制剂应作为降压药物的首选,由于肾素血管紧张素受体抑制剂的潜在致畸性不建议早期使用。单纯子痫前期患者可给予期待治疗,包括降压、对症和营养支持等。妊娠期高血压疾病通常在分娩12周内自发缓解,如持续存在,应诊断慢性高血压,特别是分娩6个月后仍有蛋白尿的患者,建议行肾活检明确是否患有慢性肾脏疾病。%Hypertensive disorders in pregnancy (HDP)is a common and serious clinical syndrome, characterized by hypertension,renal injury,and neurological symptoms in pregnancy,and is a major cause for maternal death.According to 201 3 ACOG (American College of Obstetricians and Gynecologists) guideline,HDP is categorized as gestational hypertension,preeclamsia-eclamsia,chronic hypertension,and chronic hypertension complicated with preeclamsia.Patients with blood pressure of ≥1 60 /1 1 0 mmHg need antihypertensive therapy of which the first-line drugs are calcium channel blockers and adrenoceptor blocking agents.Renin and angiotensin receptor blockers are contraindicated in the first trimester of pregnancy due to their potential teratogenicity. Patients with mild preeclampsia are suggested to receive expectant management,including antihypertensive medication,symptomatic treatment,and nutritional supportive treatment.HDP has a tendency to spontaneous remission within 1 2 weeks after delivery.Diagnosis of chronic hypertension is considered if hypertension persists.Renal biopsy should be advised to investigate the underlying

  4. Air pollution, blood pressure, and the risk of hypertensive complications during pregnancy: The generation r study

    NARCIS (Netherlands)

    Hooven, E.H. van den; Kluizenaar, Y. de; Pierik, F.H.; Hofman, A.; Ratingen, S.W. van; Zandveld, P.Y.J.; MacKenbach, J.P.; Steegers, E.A.P.; Miedema, H.M.E.; Jaddoe, V.W.V.

    2011-01-01

    Exposure to air pollution is associated with elevated blood pressure and cardiovascular disease. We assessed the associations of exposure to particulate matter (PM10) and nitrogen dioxide (NO2) levels with blood pressure measured in each trimester of pregnancy and the risks of pregnancy-induced hype

  5. Air pollution, blood pressure, and the risk of hypertensive complications during pregnancy: The generation r study

    NARCIS (Netherlands)

    Hooven, E.H. van den; Kluizenaar, Y. de; Pierik, F.H.; Hofman, A.; Ratingen, S.W. van; Zandveld, P.Y.J.; MacKenbach, J.P.; Steegers, E.A.P.; Miedema, H.M.E.; Jaddoe, V.W.V.

    2011-01-01

    Exposure to air pollution is associated with elevated blood pressure and cardiovascular disease. We assessed the associations of exposure to particulate matter (PM10) and nitrogen dioxide (NO2) levels with blood pressure measured in each trimester of pregnancy and the risks of pregnancy-induced

  6. Pregnant adolescent self-care in the prevention of risk factors of Hypertensive Disorders in Pregnancy (HDP - doi:10.5020/18061230.2007.p173

    Directory of Open Access Journals (Sweden)

    Zélia Maria de Sousa Araújo Santos

    2012-01-01

    Full Text Available Adolescent pregnancy is considered a problem for public health, due to the high mortality related to hypertensive disorders in pregnancy – HDP. This was a descriptive study with the aim of analyzing the pregnant adolescent self-care in the prevention of HDP risk factors. It was carried out in the Nucleus of Integrated Medical Attention – NAMI, in Fortaleza – Ceará, with twenty women from the Dendê Community, taken care of in the prenatal ambulatory of that institution, during the months of September and October, 2005. The data were collected by means of interview. The pregnant adolescents informed precarious socio-economic conditions, low schooling and other risk factors for HDP, beyond the age: black color, familiar history, arterial hypertension (AH, diabetes mellitus, renal illness and emotional conflicts. The knowledge on the prevention of risk factors was restricted to five (25% pregnant adolescents; however it was reduced to fragmented information, and the preventive behaviors related to feeding habit, smoke and alcoholism cessation, and physical exercise. Therefore, it was evidenced among the adolescents the unsatisfactory exercise of self-care activities, aiming at preventing HDP risk factors; that beyond the age, they presented other predisposing factors to this disorders; that they were susceptible to preventive behaviors and/or control, as in the case of chronic-degenerative illnesses – AH and diabetes mellitus. Probably, this behavior was associated to the elementary and fragmented knowledge, and the absence or the deficiency of family participation in health promotion actions, mainly in those inherent to the prenatal follow-up.

  7. Analysis of D-dimer level of normal pregnancy and pregnancy hypertension syndrome pregnant woman%正常妊娠与妊娠高血压综合征孕妇D-二聚体水平分析

    Institute of Scientific and Technical Information of China (English)

    李明兰

    2014-01-01

    Objective:To analyze the difference of D-dimer level of normal pregnancy and pregnancy hypertension syndrome pregnant woman,and to explore the influence of hypertension on D-two dimer level of pregnant women.Methods:128 pregnant women were selected from March 2010 to October 2013.According to with hypertension or not,they were divided into the pregnancy induced hypertension syndrome group(60 cases) and the normal pregnancy group(68 cases),at the same time,70 healthy women were selected as the control group.We compared the plasma D-dimer level of the three groups.Results:The D-dimer level of pregnancy induced hypertension group and normal pregnancy group were significantly higher than those of the control group(P<0.05,P<0.01).The D-dimer level of pregnancy induced hypertension group were significantly higher than that of normal pregnancy group(P<0.05);between the different degree pregnancy induced hypertension,the plasma D-dimer level had significant difference(P<0.05).Conclusion:The plasma D-dimer content of normal pregnancy is increased,and the blood is become hypercoagulable state.Patients with hypertensive disorders in pregnancy have the pathological changes of the coagulation system,and the plasma D-dimer level is higher than that of normal pregnancy.We suggest that we should examine the plasma D-dimer level of patients with hypertension of pregnancy,and understand the existence of thrombotic diseases,to protect the health of mother and infant.%目的:分析正常妊娠与妊娠高血压综合征孕妇血浆D-二聚体水平差异,探讨高血压对妊娠期妇女D-二聚体水平的影响。方法:2010年3月-2013年10月收治妊娠期孕妇128例,按照是否合并高血压分为妊娠期高血压综合征组(60例)和正常妊娠组(68例),另选择同期健康女性70例作为对照组。对比3组血浆D-二聚体水平。结果:妊娠高血压组、正常妊娠组D-二聚体水平显著高于对照组(P<0.05,P<0.01)。妊娠高血压

  8. Further Evidence for the Role of Pregnancy-induced Hypertension and Other Early Life Influences in the Development of ADHD

    DEFF Research Database (Denmark)

    Pohlabeln, Hermann; Rach, Stefan; De Henauw, Stefaan

    2017-01-01

    -deficit/hyperactivity disorders (ADHD). In the IDEFICS study more than 18,000 children, aged 2–11.9 years, underwent extensive medical examinations supplemented by parental questionnaires on pregnancy and early childhood. The present analyses are restricted to children whose parents also completed a supplementary medical...... during pregnancy and a child’s risk of ADHD. In addition, our study showed that children born to mothers younger than 20 years old were 3–4 times more likely to develop ADHD as compared to children born to mothers aged 25 years and older. Moreover, we found that children whose mothers suffered from...... pregnancy-induced hypertension had an approximately twofold risk of ADHD (OR 1.95; 95% CI 1.09–3.48). This also holds true for infections during the first 4 weeks after birth (OR 2.06; 95% CI 1.05–4.04). In addition, although not statistically significant, we observed a noticeable elevated risk estimate...

  9. Hypertensive disorders of pregnancy are an evolutionary adaptation to mitigate the reproductive consequences of the human physique.

    Science.gov (United States)

    Ayuk, Paul T-Y

    2006-01-01

    The aetiology of hypertensive disorders of pregnancy remains unknown, despite over 30 years of research. The prevalence and natural history of these disorders and the lack of progress in identifying a cause calls for a radical new approach. It is hypothesised that these disorders arise as a consequence of abnormal maternal regulatory mechanisms. The evolution of the physical characteristics unique to humans (bi-pedal gait and a large brain) resulted in a narrow pelvis and a large head. Such a physique is not conducive to viviparity and caused difficult, prolonged and obstructed labour with post-partum haemorrhage--the commonest causes of maternal mortality in the absence of modern medical care. In such circumstances, up to 6.5% of pregnant women will die as a direct consequence of pregnancy, mainly as a result of obstructed labour and haemorrhage. The death toll would have been much higher over millions of years of evolution. These conditions exerted significant adaptive and evolutionary pressure on our species. The adaptations necessary to mitigate the reproductive consequences of the human physique include activation of the coagulation system to reduce post-partum haemorrhage, increased blood pressure to peak after delivery and maintain cerebral perfusion in the face of post-partum blood loss and restriction of fetal growth to prevent obstructed labour. These adaptations must be regulated to guarantee their occurrence but limit their extent to prevent disease. Evidence for blood pressure regulation during pregnancy and a proposed mechanism to achieve this are presented. Regulation requires a redundant feto-placental signal and a single tightly controlled regulator. To guarantee that blood pressure rises, the feto-placental signal is predicted to be conveyed by several different molecules and to be produced in excess in all pregnancies. Normality is then maintained by a single tightly controlled regulator. This model predicts that the feto-placental factors that

  10. Prediction and prevention of pregnancy-induced hypertensive disorders : a clinical and pathophysiologic study

    NARCIS (Netherlands)

    G.A. Dekker

    1989-01-01

    textabstractpregnancyinduced hypertensive disease depends on a functional imbalance between two eicosanoid substances with opposing physiologic effects, it may be attempted to correct the putative imbalance by means of pharmacologic manipulation. The demonstration that such a pharmacologic intervent

  11. Use of antihypertensive medications in pregnancy and the risk of adverse perinatal outcomes: McMaster Outcome Study of Hypertension In Pregnancy 2 (MOS HIP 2

    Directory of Open Access Journals (Sweden)

    Vermeulen Marian J

    2001-11-01

    Full Text Available Abstract Background Uncertainty remains about the potential harmful effects of antihypertensive therapy on the developing fetus, especially for beta-blockers (βb. Methods We prospectively enrolled all singleton women with a blood pressure ≥ 140/90 mm Hg during pregnancy. The main analysis included 1948 women with all forms of hypertension and compared the use of βb drugs, non-βb drugs or a combination of both, to no treatment. The primary study outcome was a composite of the diseases of prematurity, need for assisted ventilation for greater than 1 day, or perinatal death. A sub-group analysis evaluated the four treatment options among 583 singleton women with chronic hypertension before 20 weeks gestation. Results In the main analysis, no association was observed between βb use and the primary composite outcome [adjusted odds ratio (OR 1.4, 95% CI 0.9–2.2], while an association was seen with non-βb therapy (OR 5.0, 95% CI 2.6–9.6 and combination therapy (OR 2.9, 95% CI 1.8–4.7. In the sub-group of 583 women with hypertension before 20 weeks, use of a non-βb drug (OR 4.9, 95% CI 1.7–14.2 or combination therapy (OR 2.9. 95% CI 1.1–7.7 was significantly associated with the primary composite outcome, while βb monotherapy was not (OR 1.4, 95% CI 0.6–3.4. Conclusions Maternal use of antihypertensive medications other than βbs was associated with both major perinatal morbidity and mortality, while βb monotherapy was not. The combined use of βb and non-βb medications demonstrated the strongest association. Before definitive conclusions can be drawn, a large multicentre randomized controlled trial is needed to address the issues of both maternal efficacy and fetal safety with the use of one or more antihypertensive agents in pregnancy.

  12. Uncontrolled hypertension and orthostatic hypotension in relation to standing balance in elderly hypertensive patients.

    Science.gov (United States)

    Shen, Shanshan; He, Ting; Chu, Jiaojiao; He, Jin; Chen, Xujiao

    2015-01-01

    To investigate the associations among uncontrolled hypertension, orthostatic hypotension (OH), and standing balance impairment in the elderly hypertensive patients referred to comprehensive geriatric assessment (CGA). In a cross-sectional study, a total of 176 elderly hypertensive patients who underwent CGA were divided into OH group (n=36) and non-OH group (n=140) according to blood pressure measurement in the supine position, after immediate standing up, and after 1 minute and 3 minutes of standing position. Uncontrolled hypertension was defined as blood pressure of ≥140/90 mmHg if accompanied by diabetes mellitus (DM) or chronic kidney disease (CKD), or ≥150/90 mmHg if no DM and no CKD. Standing balance, including immediate standing balance and prolonged standing balance, was assessed in side-by-side and tandem stance. Neither uncontrolled hypertension nor OH was associated with prolonged standing balance impairment in elderly hypertensive patients (P>0.05). Blood pressure decrease after postural change was significantly associated with immediate standing balance impairment in side-by-side and tandem stance (Pbalance impairment in both side-by-side and tandem stance than those without OH (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.26-9.33, Pbalance impairment in side-by-side stance (OR 2.96, 95% CI 1.31-6.68, Pbalance impairment, and therefore, a better understanding of the underlying associations might have major clinical value.

  13. Measuring Regional and District Variations in the Incidence of Pregnancy-induced Hypertension (PIH) in Ghana : Challenges, Opportunities and Implications for Maternal and Newborn Health Policy and Programs

    NARCIS (Netherlands)

    Antwi, Edward; Klipstein-Grobusch, Kerstin; Asare, Gloria Quansah; Koram, Kwadwo A; Grobbee, Diederick; Agyepong, Irene Akua

    2016-01-01

    OBJECTIVES: The objectives were to assess the quality of health management information system (HMIS) data needed for assessment of local area variation in pregnancy induced hypertension (PIH) incidence and to describe district and regional variations in PIH incidence. METHODS: A retrospective review

  14. Pregnancy Hypertension Induced Factors Compared and Analysis%浅析妊娠高血压病诱发因素比对与分析

    Institute of Scientific and Technical Information of China (English)

    郑庆红

    2013-01-01

    At present, maternal pregnancy induced hypertension by many factors, on the summary and the large amount of experimental analysis, obtained from the analysis of contact strength of the risk of hypertension during pregnancy maternal factors: mental stress, uterine tension increases is the main factor to induce pregnancy induced hypertension, their significant dif erence (P<0.006);age, occupation and the pregnancy induced hypertension syndrome has no obvious correlation in this case.%目前,诱发孕产妇妊娠期高血压发病因素很多,通过大量的临场总结和实验分析,从妊娠期高血压发病危险因素的联系强度分析得出:孕产妇的精神紧张、子宫张力增大是诱发妊娠期高血压的主要因素,其差异显著性(P<0.006);年龄、职业与妊高征在本案例中无明显相关性。

  15. Clinical study on the influence of phloroglucinol on plasma angiotensin II and D-Dimer index in patients with severe pregnancy-induced hypertension.

    Science.gov (United States)

    Ai, Liang; Lan, Xinzhi; Wang, Limin; Xu, Yanjie; Zhang, Bin

    2016-07-01

    To observe the effect of phloroglucinol on plasma angiotensin II and D-dimer index when it was applied to patients with severe pregnancy-induced hypertension. 212 cases of severe pregnancy-induced hypertension patients diagnosed clinically were selected to be randomly divided into the research group and the control group. The research groups were given phloroglucinol, while the control groups were given magnesium sulfate. The plasma angiotensin II and D-dimer index in patients were detected before treatment and after 7 days respectively with statistical analysis of results. The diffidence after treatment was statistically significant (P0.05). It showed that the research group could reduce the plasma D-dimer and angiotensin II index in severe pregnancy-induced hypertension patients, and its effect was significantly better than the control group according to the plasma D-dimer and angiotensin II index changes in patients, it indicated that it was effective of phloroglucinol treatment for patients with pregnancy-induced hypertension disease and superior to the western medicine conventional treatment, worth clinical promotion.

  16. Assessment of serum β-hCG and lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy.

    Science.gov (United States)

    Revankar, Vijaya M; Narmada, Lavu

    2017-09-01

    To assess and compare the ability of serum β-human chorionic gonadotropin (β-hCG) and serum lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy. The present hospital-based prospective study was conducted between November 24, 2012, and April 30, 2014, at a tertiary hospital in Mangalore, India. Women of any parity with a pregnancy of 14-20 weeks were included. Venous blood (3 mL) was collected, and serum β-hCG and lipid profile were estimated by enzyme-linked immunosorbent assay and an enzymatic colorimetric test with lipid clearing factor, respectively. A cutoff value of β-hCG for predicting hypertensive disorders was obtained by receiver operating curve analysis. Serum β-hCG was significantly higher among women who subsequently developed hypertension (71 142 IU/L [n=27]) than among those who did not (20 541 IU/L [n=137]; PhCG to predict hypertension were 92.6% and 94.9% respectively. The positive and negative predictive values were 78.1% and 98.5%, respectively. Serum β-hCG might be used as a predictor of hypertensive disorders that complicate pregnancy. Dyslipidemia was not found to be a useful marker. © 2017 International Federation of Gynecology and Obstetrics.

  17. Renal markers in normal and hypertensive disorders of pregnancy in Indian women: a pilot study

    Directory of Open Access Journals (Sweden)

    Padma Y

    2013-08-01

    Conclusion: The maternal serum cystatin C, creatinine and uric acid were all significantly elevated at the end of pregnancy in pre-eclampsia compared to those of healthy pregnant women. If this rise in the above markers during early pregnancy could predict the onset of PIH/PE, needs to be investigated. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 514-520

  18. Increasing pregnancy-related use of prescribed opioid analgesics

    Science.gov (United States)

    Epstein, Richard A.; Bobo, William V.; Martin, Peter R.; Morrow, James A.; Wang, Wei; Chandrasekhar, Rameela; Cooper, William O.

    2013-01-01

    Purpose To quantify the prevalence of prescribed opioid analgesics among pregnant women enrolled in Tennessee Medicaid from 1995 to 2009. Methods Retrospective cohort study of 277,555 pregnancies identified from birth and fetal death certificates, and linked to previously-validated computerized pharmacy records. Poisson regression was used to estimate trends over time, rate ratios and 95% confidence intervals. Results During the study period, 29% of pregnant women filled a prescription for an opioid analgesic. From 1995 to 2009, any pregnancy-related use increased 1.90-fold (95% CI = 1.83, 1.98), first trimester use increased 2.27-fold (95% CI = 2.14, 2.41), and second or third trimester use increased 2.02-fold (95% CI = 1.93, 2.12), after adjusting for maternal characteristics. Any pregnancy-related, first trimester, and second or third trimester use were each more likely among mothers who were at least 21 years old, white, non-Hispanic, prima gravid, resided in non-urban areas, enrolled in Medicaid due to disability, and who had less than a high school education. Conclusions Opioid analgesic use by Tennessee Medicaid-insured pregnant women increased nearly 2-fold from 1995 to 2009. Additional study is warranted in order to understand the implications of this increased use. PMID:23889859

  19. Vaginitis in pregnancy is related to adverse perinatal outcome.

    Science.gov (United States)

    Xu, Fengqiu; Du, Xiaodong; Xie, Lili

    2015-01-01

    To determine whether education level and occupation are risk factors of vaginitis in pregnant women and to investigate relationship between vaginitis occurrence during pregnancy and perinatal mortality rates. A total of 319 women of early pregnancy or mid-pregnancy were enrolled. Six specimens were collected from posterior fornix of each pregnant woman and then cultured for identification of Neisseria gonorrhoeae, intestinal bacteria, general bacteria, fungi, mycoplasma, and chlamydia, respectively. The pregnant women in the "elementary school or below" group and the "middle school" group had significantly higher incidences of vaginitis compared with the pregnant women in the groups of "high school", "skill education", and "college or above". The pregnant women in the groups of "Worker", "Government employee", "Company employee", and "Professionals" had significantly lower vaginitis incidences. The women with infections of Neisseria gonorrhoeae, intestinal bacteria, and general bacteria had higher perinatal mortalities (0.063 ± 0.011, 0.052 ± 0.012, and 0.017 ± 0.008, respectively) than women with infections of fungi, mycoplasma, and Chlamydia (0.002 ± 0.007, 0.003 ± 0.004, and 0.001 ± 0.001, respectively). Education level and occupation are risk factors related to incidences of vaginitis in pregnant women. The bacteria-related vaginitis is a major reason of perinatal mortality.

  20. Relationship between pregnancy associated plasma protein A,VEGF and hypertension during pregnancy%妊娠相关血浆蛋白A、VEGF与妊高症关系

    Institute of Scientific and Technical Information of China (English)

    李巧红; 侯爱琴

    2015-01-01

    Objective: To investigate the relationship between PAPP-A and VEGF in pregnancy induced hypertension syndrome.Methods:50 cases of PIH pregnant women as the study group, while 50 healthy pregnant women as control group. The patients with hypertension were divided into three groups according to the severity of the disease, in which the contents of VEGF and PAPP-A were compared.Results: PAPP-A was signiifcantly higher in the patients with pregnancy induced hypertension than in the control group, the difference was statistically signiifcant, with the increase of the degree of pregnancy induced hypertension, PAPP-A was also increased. VEGF was significantly higher in the patients with pregnancy induced hypertension than in the control group, the difference was statistically signiifcant, but there was no signiifcant difference between the groups in the three groups, no signiifcant change trend.Conclusion: The contents of PAPP-A and VEGF in pregnant women with pregnancy induced hypertension, and PAPP-A was positively correlated with the severity of hypertension. VEGF and PAPP-A were used as the indexes for the monitoring of pregnancy induced hypertension.%目的:探讨妊娠相关血浆蛋白A(PAPP-A)、VEGF对妊娠高血压综合症关系诊断价值。方法:选择50例妊高症孕妇为研究组,另选50例正常孕妇为对照组。妊高症组按照严重程度分为轻、中、重三组,比较各组PAPP-A、VEGF含量。结果:妊高症组PAPP-A显著高于对照组,组间比较差异有统计学意义,随妊高症程度升高,PAPP-A亦呈增高趋势。妊高症组VEGF显著高于对照组,组间比较差异有统计学意义,但轻中重三组VEGF组间比较差异无统计学意义,无明显变化趋势。结论:妊娠高血压综合症孕妇其PAPP-A、VEGF含量升高,且PAPP-A与妊高症严重程度呈正相关,PAPP-A、VEGF含量可以作为妊高症监测指标。

  1. Hypertension-related alterations in white matter microstructure detectable in middle age.

    Science.gov (United States)

    McEvoy, Linda K; Fennema-Notestine, Christine; Eyler, Lisa T; Franz, Carol E; Hagler, Donald J; Lyons, Michael J; Panizzon, Matthew S; Rinker, Daniel A; Dale, Anders M; Kremen, William S

    2015-08-01

    Most studies examining associations between hypertension and brain white matter microstructure have focused on older adults or on cohorts with a large age range. Because hypertension effects on the brain may vary with age, it is important to focus on middle age, when hypertension becomes more prevalent. We used linear mixed-effect models to examine differences in white matter diffusion metrics as a function of hypertension in a well-characterized cohort of middle-aged men (n=316; mean, 61.8 years; range, 56.7-65.6). Diffusion metrics were examined in 9 tracts reported to be sensitive to hypertension in older adults. Relative to normotensive individuals, individuals with long-standing hypertension (>5.6 years) showed reduced fractional anisotropy or increased diffusivity in most tracts. Effects were stronger among carriers than among noncarriers of the apolipoprotein E ε4 allele for 2 tracts connecting frontal regions with other brain areas. Significant differences were observed even after adjustment for potentially related lifestyle and cardiovascular risk factors. Shorter duration of hypertension or better blood pressure control among hypertensive individuals did not lessen the adverse effects. These findings suggest that microstructural white matter alterations appear early in the course of hypertension and may persist despite adequate treatment. Although longitudinal studies are needed to confirm these findings, the results suggest that prevention-rather than management-of hypertension may be vital to preserving brain health in aging.

  2. HYPERTENSION-RELATED ALTERATIONS IN WHITE MATTER MICROSTRUCTURE DETECTABLE IN MIDDLE AGE

    Science.gov (United States)

    McEvoy, Linda K.; Fennema-Notestine, Christine; Eyler, Lisa T.; Franz, Carol; Hagler, Donald J.; Lyons, Michael J.; Panizzon, Matthew S.; Rinker, Daniel A; Dale, Anders M.; Kremen, William S.

    2015-01-01

    Most studies examining associations between hypertension and brain white matter microstructure have focused on older adults or on cohorts with a large age range. Since hypertension effects on the brain may vary with age it is important to focus on middle age, when hypertension becomes more prevalent. We used linear mixed effect models to examine differences in white matter diffusion metrics as a function of hypertension in a well-characterized cohort of middle-aged men (N=316, mean 61.8 years; range 56.7–65.6). Diffusion metrics were examined in nine tracts reported to be sensitive to hypertension in older adults. Relative to normotensive individuals, individuals with longstanding hypertension (> 5.6 years) showed reduced fractional anisotropy or increased diffusivity in most tracts. Effects were stronger among carriers than non-carriers of the apolipoprotein E ε4 allele for two tracts connecting frontal regions with other brain areas. Significant differences were observed even after adjustment for potentially-related lifestyle and cardiovascular risk factors. Shorter duration of hypertension or better blood pressure control among hypertensive individuals did not lessen the adverse effects. These findings suggest that microstructural white matter alterations appear early in the course of hypertension and may persist despite adequate treatment. Although longitudinal studies are needed to confirm these findings, the results suggest that prevention—rather than management—of hypertension may be vital to preserving brain health in aging. PMID:26056337

  3. 妊娠高血压综合征病人的护理进展%Nursing Progress in Pregnancy-induced Hypertension Syndrome

    Institute of Scientific and Technical Information of China (English)

    庞陆运

    2015-01-01

    Pregnancy-induced hypertension syndrome is a specific pregnancy disease, with high mortality rate. It is essential of providing overall and systematic high quality nursing during delivery period of parturient with pregnancy-induced hypertension syndrome to reduce maternal and neonatal morbidity and mortality, control disease development and improve the clinical treatment efficiency.%妊娠高血压综合征是妊娠期特有的疾病,死亡率较高。在妊娠高血压综合征产妇分娩期提供全面系统的优质护理,降低产妇和新生儿的发病率和死亡率,控制疾病发展,提高临床治疗效率至关重要。

  4. Associations of MTHFR gene polymorphisms with hypertension and hypertension in pregnancy: a meta-analysis from 114 studies with 15411 cases and 21970 controls.

    Directory of Open Access Journals (Sweden)

    Boyi Yang

    Full Text Available BACKGROUND: Several epidemiological studies have investigated the associations of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C polymorphisms with hypertension (H or hypertension in pregnancy (HIP. However, the results were controversial. We therefore performed a comprehensive meta-analysis to provide empirical evidences on the associations. METHODOLOGIES: The English and Chinese databases were systematically searched to identify relevant studies. Odds ratios (ORs and 95% confidence intervals (CIs were calculated to evaluate the strength of the associations. Meta-regression, subgroup analysis, sensitivity analysis, cumulative meta-analysis and assessment of publication bias were performed in our study. PRINCIPAL FINDINGS: A total of 114 studies with 15411 cases and 21970 controls were included, 111 studies with 15094 cases and 21633 controls for the C677T polymorphism and 21 with 2533 cases and 2976 controls for the A1298C polymorphism. Overall, the C677T polymorphism was significantly associated with H and HIP (H & HIP: OR = 1.26, 95% CI = 1.17-1.34; H: OR = 1.36, 95% CI = 1.20-1.53; HIP: OR = 1.21, 95% CI = 1.08-1.32. Stratified analysis by ethnicity revealed a significant association among East Asians and Caucasians, but not among Latinos, Black Africans, and Indians and Sri Lankans. In the stratified analyses according to source of controls, genotyping method, sample size and study quality, significant associations were observed in all the subgroups, with the exception of population based subgroup in H studies and large sample size and "others" genotyping method subgroups in HIP studies. For the A1298C polymorphism, no significant association was observed either in overall or subgroup analysis under all genetic models. CONCLUSIONS: This meta-analysis suggests that the MTHFR C677T rather than A1298C polymorphism may be associated with H & HIP, especially among East Asians and Caucasians.

  5. 妊娠高血压疾病患者的心电图分析%Analysis of electrocardiogram in patients with pregnancy induced hypertension

    Institute of Scientific and Technical Information of China (English)

    王应米; 王玉祥; 敖慧玲

    2016-01-01

    目的:探讨妊娠高血压患者的心电图。方法:收治妊娠高血压患者120例,所有患者接受心电图检查,观察患者及围产儿情况。结果:在120例患者中,心电图变化44例(36.67%),轻度、中度和重度妊高征患者心电图改变发生率分别是28.07%、30.95%和71.43%,重度与轻度、中度相比,差异有统计学意义(P<0.05)。结论:在妊娠高血压患者中,部分患者出现心电图变化,重度妊高征患者心电图改变发生率较高,与病情严重程度有相关性。%Objective:To explore the electrocardiogram in patients with pregnancy induced hypertension.Methods:120 patients with pregnancy induced hypertension were selected.All patients underwent ECG examination,and we observed the patients and perinatal situation.Results:In 120 patients,44 patients(36.67%) had electrocardiogram change.The incidences of ECG changes in mild,moderate and severe patients with pregnancy induced hypertension were 28.07% ,30.95% and 71.43% respectively.The difference was statistically significant compared severe with mild and moderate(P<0.05).Conclusion:In patients with pregnancy induced hypertension,some patients had ECG changes.In severe patients with pregnancy induced hypertension,ECG change rate was higher,and it was correlated with the severity of the disease.

  6. Angiogenic factors in superimposed preeclampsia: a longitudinal study of women with chronic hypertension during pregnancy.

    Science.gov (United States)

    Perni, Uma; Sison, Cristina; Sharma, Vijay; Helseth, Geri; Hawfield, Amret; Suthanthiran, Manikkam; August, Phyllis

    2012-03-01

    Imbalances in circulating angiogenic factors contribute to the pathogenesis of preeclampsia. To characterize levels of angiogenic factors in pregnant women with chronic hypertension, we prospectively followed 109 women and measured soluble fms-like tyrosine kinase 1 (sFlt1), soluble endoglin, and placental growth factor at 12, 20, 28, and 36 weeks' gestation and postpartum. Superimposed preeclampsia developed in 37 (34%) and was early onset (hypertension. We conclude that alterations in angiogenic factors are detectable before and at the time of clinical diagnosis of early onset superimposed preeclampsia, whereas alterations were observed only at the time of diagnosis in women with late-onset superimposed preeclampsia. Longitudinal measurements of angiogenic factors may help anticipate early onset superimposed preeclampsia and facilitate diagnosis of superimposed preeclampsia in women with chronic hypertension.

  7. INVESTIGATION OF THROMBOMODULIN AND PLASMINOGEN ACTIVATOR INHIBITOR TYPE-I IN PREGNANCY INDUCED HYPERTENSION AND ITS CLINICAL SIGNIFICANCE

    Institute of Scientific and Technical Information of China (English)

    马水清; 白春梅; 边旭明

    2001-01-01

    Objective. To measure tbe circulating levels of thrombomodulin (TM) and plasminogen activator inhibitor type-Ⅰ(PAI-I) in women with pregnancy induced hypertension (PIH).``Methods. Blood samples were drawn from 97 pregnant women in their third trimester, grouped as 25 mild PIH, 26 moderate PIH, 22 severe PIH and 24 normotensive healthy pregnant women for determining levels of TM by ELISA, PAI-I by colorimetric assay methods, and creatinine (Cr) in serum by biochemical method.``Results. Circulating levels of TM, PAId and TM/Cr ratio increased with increasing severity of PIH. There were no significant differences between mild and normotensive pregnant women. The parameters were significantly changed in the moderate and severe PIH groups.``Conclv, sion. TM and PAI-Ⅰ may serve as meaningful clinical markers for the assessment of the endothelial damage in PIH,which is very important in evaluating and following the development of PIH.

  8. INVESTIGATION OF THROMBOMODULIN AND PLASMINOGEN ACTIVATOR INHIBITOR TYPE-I IN PREGNANCY INDUCED HYPERTENSION AND ITS CLINICAL SIGNIFICANCE

    Institute of Scientific and Technical Information of China (English)

    马水清; 白春梅; 边旭明

    2001-01-01

    Objective. To measure the circulating levels of thrombomodulin (TM) and plasminogen activator inhibitor type-I (PAI-I) inwomen with pregnancy induced hypertension (PIH). Methods. Blood samples were drawn from 97 pregnant women in their third trimester, grouped as 25 mild PIH, 26 moderate PIH, 22 severe PIH and 24 normotensive healthy pregnant women for determining levels of TM by ELISA, PAI-I by colorimetric assay methods, and creatinine (Cr) in serum by biochemical method. Results. Circulating levels of TM, PAI-I and TM/Cr ratio increased with increasing severity of PIH. There were no significant differences between mild and normotensive pregnant women. The parameters were significantly changed in the moderate and severe PIH groups. Conclusion. TM and PAI-I may serve as meaningful clinical markers for the assessment of the endothelial damage in PIH,which is very important in evaluating and following the development of PIH.

  9. Pregnancy related pelvic pain is more frequent in women with increased body mass index

    DEFF Research Database (Denmark)

    Biering, Karin; Nøhr, Ellen Aagaard; Olsen, Jørn

    2011-01-01

    Objective. To investigate the association between pre-pregnancy overweight/obesity and pregnancy-related pelvic pain. Design: Nested case-control study. Setting and population. The Danish National Birth Cohort, a cohort of pregnant women and their children recruited 1996–2002. Methods. The women...... had not given birth before. Conclusion. The risk of pregnancy-related pelvic pain increasedwith pre-pregnancy BMI in an exposure–response relation and potentially adds another maternal complication to obesity....... were interviewed twice during pregnancy and twice after childbirth. The first pregnancy interview provided information on self-reported pre-pregnancy body mass index (BMI) and possible confounders, while data on pregnancy-related pelvic pain came from an interview sixmonths postpartum. Cases (n=2 271...

  10. [Pregnancy-associated hormones and fetal-maternal relations].

    Science.gov (United States)

    Gailly-Fabre, E; Kerlan, V; Christin-Maitre, S

    2015-10-01

    Pregnancy is an immunological paradox that implies that a semi-allogeneic fetus is not rejected by the maternal immune system, from implantation of the embryo to delivery. Progesterone (P4), estradiol (E2) and human chorionic gonadotropin (hCG), contribute to the transformation of immune cells in a transient tolerance state, necessary to the maintenance of pregnancy. The effects of pregnancy hormones depend probably of their maternal plasma level. hCG is dangerous at high concentrations because it can stimulate autoantibodies production, whereas in physiological concentrations, hCG, P4 and E2 upregulate immune response expanding regulatory T and B cells, allowing the fetus to grow within the maternal uterus in a protective environment. A second example of fetal-maternal relation found recently is the role of maternal nutrition on development of the fetal hypothalamic neurons. Experiments in mice fed on a high fat diet reveal a critical timing when altered maternal metabolism affect formation of hypothalamic neurocircuits of the offspring and predispose him to long-term metabolic disorders.

  11. Validation of Iranian Version of Pregnancy Related Anxiety Questionnaire

    Science.gov (United States)

    Askarizadeh, Ghasem; Karamoozian, Mahsa; Darekordi, Ali

    2017-01-01

    Background: Pregnancy is an acute period in the lifetime of women, during which numerous excitatory physical and social changes occur. The purpose of this study is confirmatory factor analysis of Pregnancy Related Anxiety Questionnaire (PRAQ) that is designed in Iranian pregnant women population. Methods: A total of 170 pregnant women in health centers of Kerman city were chosen through random sampling method and completed PRAQ questionnaire and Beck Anxiety Inventory (BAI). In this study, confirmatory factor analysis and concurrent validity are used to evaluate the validity of models; and to test-retest and Cronbach alpha were used for evaluating external and internal reliability in SPSS-19 and the AMOS software to evaluate reliability of models. Results: Confirmatory factor analysis gave an acceptable value for the latent PRAQ in the question scale and 5 micro-scale level. Furthermore, significant correlation between the components and the overall scale of the PRAQ questionnaire with the BAI confirmed concurrent validity of questionnaire. The reliability of questionnaire is confirmed based on Cronbach's alpha coefficient value of 0.78 that calculated 0.69–0.76 for the five-factors. A month later, reliability coefficient amplitude of test-retest on forty pregnant women was between 0.65 and 0.72 which shows the reliability of PRAQ over time. Conclusions: The short form of anxiety during pregnancy questionnaire has the essential psychometric properties. In this study, five-factors extracted in the PRAQ were adapted with the factors extracted from the original version. This study introduces an instrument that can be benefit in measuring anxiety and concerns of women during pregnancy.

  12. Hypertension and hypertension-related disease in Mongolia; findings of a national knowledge, attitudes and practices study

    DEFF Research Database (Denmark)

    Demaio, Alessandro R; Otgontuya, Dugee; de Courten, Maximilian

    2013-01-01

    Mongolia has a high and increasing burden of hypertension and related disease, with cardiovascular diseases among the leading causes of death. Yet little is known about the knowledge, attitudes and practices of the Mongolian population with regards to blood pressure. With this in mind, a national...

  13. Expression of MMPP -9 and IL - 12 in the placenta of pregnancy induced hypertension%MMP -9和IL-12在妊娠期高血压疾病胎盘上的表达

    Institute of Scientific and Technical Information of China (English)

    孟庆英; 尹成芳; 周明慧; 袁春红; 王丽; 陈萱

    2012-01-01

    目的 通过分析子痫前期患者与正常晚孕妇女胎盘组织中基质金属蛋白酶一9和白介素12的表达,探讨其在妊娠期高血压疾病(HN)中的作用及两者的相关性.方法 采用免疫组织化学染色法测定MMP -9和IL - 12在28例妊娠期高血压疾病患者(10例为子痫前期轻度;18例为子痫前期重度)和10例正常妊娠患者胎盘上的表达.结果 妊娠期高血压疾病组胎盘MMP -9的表达明显低于正常妊娠组(P<0.01);妊娠高血压疾病组胎盘IL - 12的表达明显高于正常妊娠组(P>0.01),随病情加重MMP -9的表达有下降趋势;IL- 12的表达有升高趋势,有统计学意义.结论 与正常妊娠相比妊娠期高血压疾病组胎盘IL - 12表达明显增加,MMP -9表达明显下降,且两因子表达与病情正相关.表明两因子参与了妊娠期高血压疾病的发生与发展.%Objective; To investigate the pathogenesis of preeclampsia by analyzing the expression of MMP -9and IL - 12 in pla-cental of women with preeclampsia and normal pregnance. Methods; Immunohi9tochemical method was used to detect the expression of IL - 12 and MMP -9 of placenta in 28 cases pregnancy induced hypertension and lOcases normal pregnancies. Results; The expression of MMP - 9 in the placenta of pregnancy induced hypertension was significantly lower than that in the normal pregnance (P < 0.01). Accompanying the aggravation of pathogenetic condition the expression of MMP - 9 in pregnancy induced hypertension had a decreased tendency (P < 0.01). The expression of IL -12 in the placenta of pregnancy induced hypertension was significantly higher than that of the normal pregnance. And accompanying the aggravation of pathogenetic condition the expression of IL -12 in pregnancy induced hypertension had a increased tendency. Conclusion; The increased IL -12 and decreased MMP -9 are related to the pregnancy induced hypertention with the result of the experiment.

  14. Pregnancy

    DEFF Research Database (Denmark)

    Palmer, Keith T; Bonzini, Matteo; Bonde, Jens Peter Ellekilde

    2013-01-01

    Most pregnant women are exposed to some physical activity at work. This Concise Guidance is aimed at doctors advising healthy women with uncomplicated singleton pregnancies about the risks arising from five common workplace exposures (prolonged working hours, shift work, lifting, standing and heavy...... on pregnancy. Moreover, moderate physical exercise is thought to be healthy in pregnancy and most pregnant women undertake some physical work at home. The guidelines provide risk estimates and advice on counselling....

  15. A retrospective study of HIV, antiretroviral therapy, and pregnancy-associated hypertension among women in Lusaka, Zambia.

    Science.gov (United States)

    Stoner, Marie C D; Vwalika, Bellington; Smid, Marcela C; George, Shalin; Chi, Benjamin H; Stringer, Elizabeth M; Stringer, Jeffrey S A

    2016-09-01

    To investigate the association between HIV, antiretroviral therapy (ART), and pregnancy-associated hypertension (PAH) in an HIV-endemic setting. A retrospective cohort study was undertaken of pregnant women for whom information was recorded between February 2006 and December 2012 in the Zambia Electronic Perinatal Record System, which captures data from 25 facilities in Lusaka, Zambia. PAH was defined as eclampsia, pre-eclampsia, hypertension, or elevated blood pressure (>140/80mm Hg) during delivery admission. Logistic regression estimated the odds of PAH among women by HIV serostatus, and by most recent CD4 T lymphocyte count and ART status among women with HIV infection. Among 249 771 women included in the analysis, 5354 (2.1%) had PAH. Compared with women without HIV infection, women with HIV infection not receiving ART had lower odds of PAH (adjusted odds ratio [AOR] 0.86, 95% confidence interval 0.78-0.95), whereas those with HIV infection who had initiated ART had higher odds of PAH (AOR 1.15, 95% CI 1.01-1.32). No association was found between PAH and timing of ART initiation or CD4 lymphocyte count. In a large African urban cohort, women with untreated HIV infection had the lowest odds of PAH. Treatment with ART could increase PAH risk beyond that of women without HIV infection and those with untreated infection. Published by Elsevier Ireland Ltd.

  16. Bioactive factors in uteroplacental and systemic circulation link placental ischemia to generalized vascular dysfunction in hypertensive pregnancy and preeclampsia.

    Science.gov (United States)

    Shah, Dania A; Khalil, Raouf A

    2015-06-15

    Preeclampsia is a pregnancy-associated disorder characterized by hypertension, and could lead to maternal and fetal morbidity and mortality; however, the pathophysiological mechanisms involved are unclear. Predisposing demographic, genetic and environmental risk factors could cause localized abnormalities in uteroplacental cytoactive factors such as integrins, matrix metalloproteinases, cytokines and major histocompatibility complex molecules leading to decreased vascular remodeling, uteroplacental vasoconstriction, trophoblast cells apoptosis, and abnormal development of the placenta. Defective placentation and decreased trophoblast invasion of the myometrium cause reduction in uteroplacental perfusion pressure (RUPP) and placental ischemia/hypoxia, an important event in preeclampsia. RUPP could stimulate the release of circulating bioactive factors such as the anti-angiogenic factors soluble fms-like tyrosine kinase-1 and soluble endoglin that cause imbalance with the pro-angiogenic factors vascular endothelial growth factor and placental growth factor, or cause the release of inflammatory cytokines, reactive oxygen species, hypoxia-induced factor-1 and AT1 angiotensin receptor agonistic autoantibodies. The circulating bioactive factors target endothelial cells causing generalized endotheliosis, endothelial dysfunction, decreased vasodilators such as nitric oxide and prostacyclin and increased vasoconstrictors such as endothelin-1 and thromboxane A2, leading to increased vasoconstriction. The bioactive factors also stimulate the mechanisms of VSM contraction including Ca(2+), protein kinase C, and Rho-kinase and induce extracellular matrix remodeling leading to further vasoconstriction and hypertension. While therapeutic options are currently limited, understanding the underlying mechanisms could help design new interventions for management of preeclampsia.

  17. Risk Factors of Superimposed Preeclampsia in Women with Essential Chronic Hypertension Treated before Pregnancy

    OpenAIRE

    2013-01-01

    OBJECTIVE: To determine risk factors of superimposed preeclampsia in women with essential chronic hypertension receiving antihypertensive therapy prior to conception. METHODS: A retrospective study of 211 patients that analyzed risk factors of superimposed preeclampsia at first prenatal visit. Variables with a p

  18. Are Alzheimer's disease, hypertension, and cerebrocapillary damage related?

    NARCIS (Netherlands)

    Farkas, E; De Vos, RAI; Steur, ENHJ; Luiten, PGM

    2000-01-01

    Alzheimer's disease (AD) patients are often subject to vascular dysfunction besides their specific CNS pathology, which warrants further examination of the interaction between vascular factors and the development of dementia. The association of decreased cerebral blood flow (CBF) or hypertension

  19. Organic food consumption during pregnancy and its association with health-related characteristics: the KOALA Birth Cohort Study.

    Science.gov (United States)

    Simões-Wüst, Ana Paula; Moltó-Puigmartí, Carolina; Jansen, Eugene Hjm; van Dongen, Martien Cjm; Dagnelie, Pieter C; Thijs, Carel

    2017-08-01

    To investigate the associations of organic food consumption with maternal pre-pregnancy BMI, hypertension and diabetes in pregnancy, and several blood biomarkers of pregnant women. Prospective cohort study. Pregnant women were recruited at midwives' practices and through channels related to consumption of food from organic origin. Pregnant women who filled in FFQ and donated a blood sample (n 1339). Participant groups were defined based on the share of consumed organic products; to discriminate between effects of food origin and food patterns, healthy diet indicators were considered in some statistical models. Consumption of organic food was associated with a more favourable pre-pregnancy BMI and lower prevalence of gestational diabetes. Compared with participants consuming no organic food (reference group), a marker of dairy products intake (pentadecanoic acid) and trans-fatty acids from natural origin (vaccenic and rumenic acids) were higher among participants consuming organic food (organic groups), whereas elaidic acid, a marker of the intake of trans-fatty acids found in industrially hydrogenated fats, was lower. Plasma levels of homocysteine and 25-hydroxyvitamin D were lower in the organic groups than in the reference group. Differences in pentadecanoic acid, vaccenic acid and vitamin D retained statistical significance when correcting for indicators of the healthy diet pattern associated with the consumption of organic food. Consumption of organic food during pregnancy is associated with several health-related characteristics and blood biomarkers. Part of the observed associations is explained by food patterns accompanying the consumption of organic food.

  20. Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleep-Related Breathing Disorders

    Directory of Open Access Journals (Sweden)

    Ayodeji Adegunsoye

    2012-01-01

    Full Text Available Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

  1. 早发型妊高症的围产期管理及妊娠结局%Early-onset perinatal management of pregnancy-induced hypertension and its pregnancy outcomes

    Institute of Scientific and Technical Information of China (English)

    刘彩平

    2014-01-01

    Objective to discuss and analyze the early-onset perinatal management of pregnancy-induced hypertension and its pregnancy outcomes. Methods 30 cases of patients with early onset pregnancy-induced hypertension admitted in our hospital from May 2011 to May 2012 were selected. and their clinical data were analyzed to discuss the perinatal management and pregnancy outcomes. Results the analysis results revealed that in 30 cases of early-onset patients with pregnancy-induced hypertension, 26 cases of perinatal deaths, the mortality rate was 86.7%, four cases of neonatal survival, and the survival rate was 13.3%. and there were no maternal mortality or other serious concurrent disease.Conclusions early-onset pregnancy-induced hypertension would seriously endanger the lives and health of pregnant women and newborns, and conducting appropriate perinatal management and termination of pregnancy in the case of pregnant women in the right time can effectively treat patients with early-onset pregnancy-induced hypertension, and thereby protecting the health of pregnant women and newborns.%目的:对早发型妊高症的围产期管理及妊娠结局进行探讨及分析。方法抽取我院在2011年5月至2012年5月收治的早发型妊高症患者30例,对这些患者的临床资料进行分析,从而对围产期管理以及妊娠结局进行分析。结果通过分析发现在30例早发型妊高症患者中围产儿死亡26例,死亡率为86.7%,新生儿存活4例,存活率为13.3%,均未出现孕妇死亡或者出现其他严重的并发症。结论早发型妊高症会严重危害了孕妇以及新生儿的生命健康,而进行恰当的围产期管理并在合适的时间内终止孕妇的妊娠情况可以有效的对早发型妊高症患者进行治疗,进而保护孕妇以及新生儿的健康。

  2. Ultrasonic evaluation of central retinal artery hemodynamics in patients with hypertensive disorder complicating pregnancy and the correlation with disease

    Institute of Scientific and Technical Information of China (English)

    Chen-Xia Liu; Jing-Mian Zhou

    2017-01-01

    Objective:To study the correlation between central retinal artery hemodynamic characteristics in patients with hypertensive disorder complicating pregnancy and endothelial injury molecules as well as trophoblast cell apoptosis molecules.Methods: 45 healthy pregnant women, 37 patients with gestational hypertension and 24 patients with preeclampsia who gave birth in Obstetrics Department of our hospital between May 2013 and December 2015 were selected and included in the control group, GH group and PE group respectively. Central retinal artery ultrasonography was done to determine peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI), serum was collected to determine interleukin-6 (IL-6), IL-17, IL-24, chemokine ligand 10 (CXCL10) and cartilage glycoprotein 40 (YKL40) content, and placenta tissue was collected to determine Fas, FasL, Bax, Caspase-3, Caspase-9, XIAP, Survivin and Livin expression.Results: Central retinal artery PSV and EDV as well as XIAP, Survivin and Livin expression in placenta of GH group and PE group were significantly lower than those of control group (P<0.05) while central retinal artery RI, serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of control group (P<0.05). Central retinal artery PSV and EDV as well as XIAP, Survivin and Livin expression in placenta of PE group were significantly lower than those of GH group (P<0.05) while central retinal artery RI, serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were significantly higher than those of GH group (P<0.05). Serum IL-6, IL-17, IL-24, CXCL10 and YKL40 content as well as Fas, FasL, Bax, Caspase-3 and Caspase-9 expression in placenta were negatively correlated with PSV and EDV, and positively correlated with RI; XIAP, Survivin and Livin expression in placenta were positively

  3. Antenatal coffee and tea consumption and the effect on birth outcome and hypertensive pregnancy disorders