PRE-ECLAMPSIA AS A MARKER OF CARDIOVASCULAR DISEASE

Cardiovascular disease is the leading cause of death in women. The hypertensive disorders of pregnancy (HDP) are the most common medical complication of pregnancy, complicating up to 10% of pregnancies worldwide. They represent a leading cause of maternal mortality and morbidity in pregnancy. The most common of these disorders is gestational hypertension (5–6%). Using population-based data, approximately 1% of pregnancies are complicated by pre-existing hypertension, 5–6% by gestational hypertension without proteinuria, and 1–2% by pre-eclampsia.

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Dopamine in the Pathophysiology of Preeclampsia and Gestational Hypertension: Monoamine Oxidase (MAO) and Catechol-O-methyl Transferase (COMT) as Possible Mechanisms

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/3546294 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Wendy N. Phoswa

Keyword(s):

Monoamine Oxidase ◽

Gestational Hypertension ◽

Morbidity And Mortality ◽

Therapeutic Interventions ◽

Hypertensive Disorders Of Pregnancy ◽

Methyl Transferase ◽

Hypertension In Pregnancy ◽

Health Burden ◽

Hypertensive Disorders ◽

In Pregnancy

Purpose of the Review. Hypertension in pregnancy is the global health burden. Amongst the hypertensive disorders of pregnancy, preeclampsia and gestational hypertension are the world’s leading disorders that lead to both maternal and fetal morbidity and mortality. Recent Findings. Dopamine inactive metabolites, namely, monoamine oxidase (MAO) and catechol-O-methyl transferase (COMT), have been reported to be associated with hypertensive disorders of pregnancy such preeclampsia and gestational hypertension. Summary. This review discusses the involvement of MAO and COMT in the pathophysiology of both conditions in order to have a better understanding on the pathogenesis of both conditions, suggesting promising therapeutic interventions and subsequently reducing maternal and fetal morbidity and mortality.

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Hypertension in pregnancy: Pathophysiology and treatment

SAGE Open Medicine ◽

10.1177/2050312119843700 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984370 ◽

Cited By ~ 12

Author(s):

Stephanie Braunthal ◽

Andrei Brateanu

Keyword(s):

Gestational Hypertension ◽

Severe Hypertension ◽

Organ Damage ◽

Morbidity And Mortality ◽

Perinatal Morbidity ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

In Pregnancy ◽

The Ideal

Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.

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Prepregnancy adherence to dietary recommendations for the prevention of cardiovascular disease in relation to risk of hypertensive disorders of pregnancy

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa214 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1429-1437 ◽

Cited By ~ 1

Author(s):

Mariel Arvizu ◽

Jennifer J Stuart ◽

Janet W Rich-Edwards ◽

Audrey J Gaskins ◽

Bernard Rosner ◽

...

Keyword(s):

Cardiovascular Disease ◽

General Population ◽

Gestational Hypertension ◽

Health Study ◽

Hypertensive Disorders Of Pregnancy ◽

Dietary Recommendations ◽

Cvd Risk ◽

Adherence To Diet ◽

Hypertensive Disorders ◽

Prevention Of Cardiovascular Disease

ABSTRACT Background It is unclear whether adherence to diet recommendations for the prevention of cardiovascular disease (CVD) in the general population is also related to the risk of hypertensive disorders of pregnancy, including pre-eclampsia and gestational hypertension (GHTN). Objectives The aim was to evaluate the relation of prepregnancy adherence to the American Heart Association (AHA) diet recommendations and the Dietary Approaches to Stop Hypertension (DASH) with the risk of pre-eclampsia and GHTN. Methods Between 1991 and 2009, we prospectively followed 16,892 singleton pregnancies among 11,535 women who participated in the Nurses’ Health Study II. Prepregnancy diet was assessed every 4 y, from which we calculated dietary pattern scores from the DASH diet (8 components) and the diet recommendations from the AHA 2020 Strategic Impact Goals (primary score: 5 components; secondary score: primary score plus 3 components). Pregnancy outcomes were self-reported, and we estimated the RR (95% CI) of pre-eclampsia and GHTN with log-binomial regression using generalized estimating equations to account for repeat pregnancies and adjusting for potential confounders. Results Women had a mean (SD) age of 34.4 (34.0) y at pregnancy. Pre-eclampsia was reported in 495 (2.9%) pregnancies and GHTN in 561 (3.3%) pregnancies. The RR (95% CI) of pre-eclampsia for women in the highest quintile of the DASH was 0.65 (0.48, 0.87) compared with women in the lowest score quintile. A similar inverse trend was observed for the AHA primary (0.74; 95% CI: 0.55, 1.00) and secondary (0.81; 95% CI: 0.61, 1.07) scores comparing women in the highest versus the lowest score quintile. Neither the DASH nor the AHA scores were related to GHTN. Conclusions Women with higher adherence to dietary recommendations for the prevention of CVD in the general population had a lower risk of pre-eclampsia—a common pregnancy complication related to higher CVD risk among women—than women with lower adherence to these recommendations.

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Assessing knowledge of healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy: an Australian national survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03418-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Heike Roth ◽

Caroline S. E. Homer ◽

Clare Arnott ◽

Lynne Roberts ◽

Mark Brown ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Health ◽

Gestational Hypertension ◽

Current Knowledge ◽

Healthcare Providers ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk

Abstract Background Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnant women. Women after HDP have 2–3 times increased risk of heart attack, stroke and diabetes, as soon as 5–10 years after pregnancy. Australian healthcare providers’ knowledge of cardiovascular disease (CVD) risks for women after HDP is unknown, and this study aimed to explore their current knowledge and practice regarding long-term cardiovascular health after HDP, as a precursor to producing targeted healthcare provider education on health after HDP. Methods A custom-created, face-validated online survey explored knowledge about long-term risks after HDP. Distribution occurred from February to July 2019 via professional colleges, key organisations and social media. The objective was to assess current knowledge and knowledge gaps amongst a group of healthcare providers (HCP) in Australia, regarding long-term cardiovascular health after hypertensive disorders of pregnancy (HDP), specifically gestational hypertension or preeclampsia. Results Of 492 respondents, 203 were midwives, 188 obstetricians, 75 general practitioners (GP), and 26 cardiologists. A risk knowledge score was computed with 0–6 considered low, 6.1–8.9 moderate and 9–12 high. Most participants (85%) were aware of increased cardiovascular disease after preeclampsia and gestational hypertension (range 76% midwives to 100% cardiologists). There were significant differences in average knowledge scores regarding health after preeclampsia; high for cardiologists (9.3), moderate for GPs and obstetricians (8.2 and 7.6 respectively) and low for midwives (5.9). Average knowledge scores were somewhat lower for gestational hypertension (9.0 for cardiologists, 7.4 for obstetricians and GPs, 5.1 for midwives). Knowledge was highest regarding risk of chronic hypertension, moderate to high regarding risk of ischaemic heart disease, stroke and recurring HDP, and low for diabetes and peripheral vascular disease. Only 34% were aware that risks start < 10 years after the affected pregnancy. Conclusion(s) Participants were aware there is increased cardiovascular risk after HDP, although less aware of risks after gestational hypertension and some specific risks including diabetes. Findings will inform the development of targeted education.

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Depression, Antidepressants and Hypertensive Disorders of Pregnancy: A Systematic Review

Current Drug Safety ◽

10.2174/1574886314666190121144711 ◽

2019 ◽

Vol 14 (2) ◽

pp. 102-108 ◽

Cited By ~ 1

Author(s):

Sabrina Youash ◽

Verinder Sharma

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Gestational Hypertension ◽

Research Question ◽

Current Evidence ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

The Relationship ◽

In Pregnancy

Background: Hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia are conditions that cause significant perinatal and maternal morbidity and mortality. Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-related hypertensive conditions. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, six databases were searched for articles published between January 1990 and December 2017 (PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, MEDLINE and ClinicalTrials. gov). Randomized control trials, cohort studies and case-control studies were included in this review. Studies that measured the following exposures were included: Antidepressant exposure or diagnosis of depression. Studies that measured the following outcomes were included: Gestational hypertension, preeclampsia or eclampsia. A combination of keywords, as well as Medical Subject Headings (MeSH) index terms, was used for three general categories: antidepressants, depression and hypertensive disorders of pregnancy. A total of 743 studies were identified and 711 were excluded based on relevance to the research question. Twenty studies were included in the final systematic review. Results: Of the twenty relevant studies, ten specifically examined the relationship between depression and hypertension in pregnancy. Only two of these did not find a significant association. Of the ten studies that concentrated on antidepressant medications, all except one found an association with hypertension in pregnancy to varying degrees. Conclusion: Review of the literature suggests a possible association between depression and antihypertensive medications with pregnancy-related hypertension, but further studies are needed.

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Sodium Intake During Pregnancy, but Not Other Diet Recommendations Aimed at Preventing Cardiovascular Disease, Is Positively Related to Risk of Hypertensive Disorders of Pregnancy

Journal of Nutrition ◽

10.1093/jn/nxz197 ◽

2019 ◽

Vol 150 (1) ◽

pp. 159-166 ◽

Cited By ~ 3

Author(s):

Mariel Arvizu ◽

Anne A Bjerregaard ◽

Marie T B Madsen ◽

Charlotta Granström ◽

Thorhallur I Halldorsson ◽

...

Keyword(s):

Cardiovascular Disease ◽

Gestational Hypertension ◽

Sodium Intake ◽

Hypertensive Disorders Of Pregnancy ◽

Dietary Recommendations ◽

National Patient Registry ◽

Hypertensive Disorders ◽

Strategic Impact ◽

National Patient

ABSTRACT Background The role of diet on hypertensive disorders of pregnancy (HDPs), including preeclampsia and gestational hypertension (GHTN), remains unclear. Objectives We evaluated whether adherence during pregnancy to dietary recommendations that reduce cardiovascular disease (CVD) in the general population is related to the risk of HDPs. Methods We followed 66,651 singleton pregnancies from 62,774 women participating in the Danish National Birth Cohort. Diet was assessed during week of gestation 25 with an FFQ from which we created 2 dietary pattern scores: 1) AHA, based on the diet recommendations from the AHA 2020 Strategic Impact Goals; and 2) the Dietary Approaches to Stop Hypertension (DASH) diet. Cases of HDPs were identified through linkage with the Danish National Patient Registry. RRs and 95% CIs of HDPs were estimated by increasing quintiles of adherence to the AHA and DASH scores using log-Poisson regression models with generalized estimating equations—to account for repeated pregnancies per woman—while adjusting for potential confounders. Results We identified 1809 cases of HDPs: n = 1310 preeclampsia (n = 300 severe preeclampsia) and n = 499 cases of GHTN. Greater adherence to AHA or DASH scores was not related to the risk of HDPs. However, when each component of the scores was separately evaluated, there were positive linear relations of sodium intake with HDPs (P-linearity < 0.01). Women with the highest sodium intake [median 3.70 g/d (range: 3.52, 7.52 g/d)] had 54% (95% CI:16%, 104%) higher risk of GHTN and 20% (95% CI:1%, 42%) higher risk of preeclampsia than women with the lowest intake [median 2.60 g/d (range: 0.83, 2.79 g/d)]. In addition, intake of whole grains was positively related to the risk of GHTN but not to preeclampsia ( P-heterogeneity = 0.002). Conclusion Sodium intake during pregnancy, but no other diet recommendations to prevent CVD among nonpregnant adults, is positively related to the occurrence of HDPs among pregnant Danish women.

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Maternal mortality and morbidity: Epidemiology of intensive care admissions in pregnancy

Best Practice & Research Clinical Obstetrics & Gynaecology ◽

10.1016/j.bpobgyn.2013.07.002 ◽

2013 ◽

Vol 27 (6) ◽

pp. 811-820 ◽

Cited By ~ 11

Author(s):

H. Senanayake ◽

T. Dias ◽

A. Jayawardena

Keyword(s):

Intensive Care ◽

Maternal Mortality ◽

Mortality And Morbidity ◽

Maternal Mortality And Morbidity ◽

In Pregnancy

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Association between hypertensive disorders of pregnancy and cardiovascular disease in a population of Cameroonian women at two hospitals of yaounde : a case control study

10.31730/osf.io/t7y64 ◽

2018 ◽

Author(s):

Benedict Taa Nguimbis Esseme ◽

Mbondji Ebongué

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Gestational Hypertension ◽

Case Control ◽

Sub Saharan Africa ◽

Pediatric Care ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk ◽

History Of

AbstractBackground: Positive associations have been found between Hypertensive Disorders of Pregnancy gestational hypertension, preeclampsia and cardiovascular diseases within non-black African populations, but no data exist from sub-Saharan Africa. We aimed to assess this association in Cameroonian mothers.Methods: We used a case-control design. Cases were women diagnosed with arteriosclerotic cardiovascular disease between 2012 and 2017 at the General and the Gyneco-obstetric hospital of Yaoundé. Controls were mothers of children who seeked pediatric care at the Gyneco-obstetric hospital of Yaoundé, with no diagnosis of cardiovascular disease. We abstracted data from patient files to assess cardiovascular disease, and used phone-based questionnaires to assess prior history of Hypertensive Disorders of Pregnancy. We used logistic regression and propensity scores for adjustment. Results: Out of 1228 individuals selected, 173 cases and 339 controls participated in the study. We found no increased risk of cardiovascular diseases for women with a history of Hypertensive Disorders of Pregnancy (OR = 0.83, 95% CI, 0.51 to 1.34). Women with gestational hypertension had 2.33 (95% CI, 0.99 to 5.50) times the risk of women with no history of Hypertensive Disorders of Pregnancy, an inverse association was observed between preeclampsia and cardiovascular diseases (OR = 0.28, 95% CI, 0.10 to 0.72). Conclusions: Cameroonian women with a history of gestational hypertension may have an increased risk of cardiovascular diseases. However, population-based studies with more accurate data on the exposure are needed.

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Development and Internal Validation of a Model Predicting Premature Cardiovascular Disease Among Women With Hypertensive Disorders of Pregnancy: A Population‐Based Study in Quebec, Canada

Journal of the American Heart Association ◽

10.1161/jaha.120.017328 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

U. Vivian Ukah ◽

Natalie Dayan ◽

Nathalie Auger ◽

Siyi He ◽

Robert W. Platt

Keyword(s):

Cardiovascular Disease ◽

Risk Stratification ◽

Prediction Models ◽

External Validation ◽

Population Based ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Premature Cardiovascular Disease ◽

Increased Risk

Background Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of premature cardiovascular disease (CVD), but existing cardiovascular prediction models do not adequately capture risks in young women. We developed a model to predict the 10‐year risk of premature CVD and mortality among women who have HDP. Methods and Results Using a population‐based cohort of women with HDP who delivered between April 1989 and March 2017 in Quebec, Canada, we developed a 10‐year CVD risk model using Cox proportional hazards regression. Women aged 18 to 45 years were followed from their first HDP‐complicated delivery until March 2018. We assessed performance of the model based on discrimination, calibration, and risk stratification ability. Internal validity was assessed using the bootstrap method. The cohort included 95 537 women who contributed 1 401 084 person‐years follow‐up. In total, 4024 (4.2%) of women were hospitalized for CVD, of which 1585 events (1.6%) occurred within 10 years of follow‐up. The final model had modest discriminatory performance (area under the receiver operating characteristic curve, 0.66; 95% CI, 0.65–0.67) and good calibration with slope of 0.95 and intercept of −0.19. There was moderate classification accuracy (likelihood ratio+: 5.90; 95% CI, 5.01–6.95) in the highest‐risk group upon risk stratification. Conclusions Overall, our model had modest performance in predicting the 10‐year risk of premature CVD for women with HDP. We recommend the addition of clinical variables, and external validation, before consideration for clinical use.

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Maternal and perinatal outcome in women with hypertensive disorders in pregnancy

Women s Health ◽

10.15406/mojwh.2021.10.00287 ◽

2021 ◽

Vol 10 (2) ◽

pp. 46-49

Author(s):

Lakshmi A ◽

Akshatha DS ◽

Pooja P ◽

Prashanth FG ◽

Veena MV ◽

...

Keyword(s):

Gestational Hypertension ◽

Adverse Outcomes ◽

Fetal Mortality ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Mortality And Morbidity ◽

Hypertensive Disorders ◽

Study Results ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Aims and objectives To determine the effect of hypertension in pregnancy To determine the maternal and fetal outcome in patients with hypertensive disorders of pregnancy. Materials and methods This is a retrospective study conducted in ESIC MC and PGIMSR, Bangalore from January 2020 to December 2020. All pregnant women who presented with Hypertensive disorder in pregnancy were included in the study. Results A total of 1503 patients who delivered during the study period were included in the study of which 172 patients had hypertensive disorder (11.44 %). Gestational hypertension occurred in 113 cases, preeclampsia in 45 cases, chronic hypertension in 8 cases, chronic hypertension with superimposed preeclampsia in 2 cases and eclampsia in 4 cases. Of these 85(49.41%) cases were primigravida and 87(50.58%) were multigravida. 38 deliveries occurred preterm and 134 were term. 4 patients had intrauterine fetal demise. Gestational diabetes occurred in 30(17.44%) cases, hypothyroidism in 45 cases(26.16%), IUGR in 11 cases(6.39%), oligohydramnios in 10 cases(5.81%). Discussion Hypertensive disorders in pregnancy is a spectrum of disease. It is one of the non communicable diseases occurring in pregnancy. It is the third most common cause of maternal mortality. By timely detection and proper management, it is possible to decrease the complications and adverse outcomes associated with this condition. Conclusion Hypertensive disorders in pregnancy is an important cause for maternal and fetal mortality and morbidity. Hence it is important to identify the risk factors and prevent it for better outcome.

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