scholarly journals Screening Echocardiogram in High-Risk Women with Class III Obesity to Predict the Risk of Preeclampsia

2021 ◽  
Author(s):  
Maeve K. Hopkins ◽  
Lisa D. Levine ◽  
Nathanael C. Koelper ◽  
Celeste Durnwald
Keyword(s):  
Gestational Hypertension ◽  
Severe Preeclampsia ◽  
Chronic Hypertension ◽  
Class Iii ◽  
Medical Comorbidities ◽  
High Risk Women ◽  
Increased Risk ◽  
Class Iii Obesity ◽  
Echocardiographic Findings ◽  
Risk Of Preeclampsia

Objective Women with obesity and other comorbidities such as hypertension and diabetes are at an increased risk of preeclampsia and perinatal morbidity. This study evaluates whether screening echocardiogram can identify women with obesity at a higher risk of preeclampsia. Methods We conducted a retrospective cohort study of women with class III obesity (body mass index [BMI] ≥40 kg/m2) and one or more medical comorbidities associated with an increased risk of preeclampsia (such as diabetes, hypertension, and rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as the presence of one or more of the following: diastolic dysfunction, ejection fraction of ≤45%, or cardiac chamber enlargement or hypertrophy. Multivariable logistic regression was used to estimate the odds ratio (OR) of gestational hypertension/mild preeclampsia, severe preeclampsia, and any preterm delivery <37 weeks associated with abnormal echocardiographic findings when controlling for potential confounders. Results Of 267 eligible women, 174 (64%) underwent screening echocardiograms. Sixty-nine women (40%) had abnormal echocardiograms. Maternal clinical characteristics were similar between women with normal echocardiographic findings and women with abnormal findings. Women with abnormal echocardiograms were more likely to have chronic hypertension (78 vs. 62%, p = 0.04) and a history of preeclampsia (27 vs. 10%, p = 0.02). After controlling for confounders, women with abnormal echocardiogram were at an increased risk of hypertensive disorders of pregnancy, OR 6.80 (95% confidence interval [CI] 3.32–13.93, p = 0.01), and in particular severe preeclampsia, OR 8.77 (95% CI 3.90–19.74, p = 0.01). Conclusion Among pregnant women with class III obesity and medical comorbidities, screening echocardiogram may help identify a subset of women at the highest risk of developing preeclampsia. Key Points

scholarly journals Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 157-166 ◽  
Author(s):  
Sonia Johnson ◽  
Becky Liu ◽  
Erkan Kalafat ◽  
Basky Thilaganathan ◽  
Asma Khalil
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Risk Ratio ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Hypertension ◽  
White Coat Hypertension ◽  
Chronic Hypertension ◽  
Increased Risk ◽  
Risk Of Preeclampsia

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE, www.Clinicaltrials.gov , and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00–14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21–5.05], P =0.013) and preterm birth (RR, 2.86 [95% CI, 1.44–5.68], P =0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23–0.78], P =0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26–0.82], P =0.008), preterm birth (RR, 0.47 [95% CI, 0.31–0.71], P <0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered ≈1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44–1.67 weeks]; P <0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.

Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor

2018 ◽  
Vol 36 (05) ◽  
pp. 449-454
Author(s):  
Daniel Pasko ◽  
Kathryn Miller ◽  
Victoria Jauk ◽  
Akila Subramaniam
Keyword(s):  
Cesarean Delivery ◽  
Pregnancy Outcomes ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Obese Women ◽  
Class Iii ◽  
Membrane Rupture ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Class Iii Obesity

Objective We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m2) undergoing induction of labor. Study Design This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates. Results Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21–3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47–6.58) only in nulliparous women. Conclusion Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.

scholarly journals Genetic Association of ERAP1 and ERAP2 With Eclampsia and Preeclampsia in Northeastern Brazilian Women

2021 ◽  
Author(s):  
LEONARDO CAPISTRANO FERREIRA ◽  
CARLOS EDUARDO MAIA GOMES ◽  
PRIYA DUGGAL ◽  
INGRID DE PAULA HOLANDA ◽  
AMANDA SAMARA DE LIMA ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Genetic Variants ◽  
Antigen Processing ◽  
P Value ◽  
Chronic Hypertension ◽  
Ang Ii ◽  
Small Peptides ◽  
Increased Risk ◽  
Genotype C ◽  
Risk Of Preeclampsia

Abstract The clinical spectrum of hypertensive disorders of pregnancy (HDP) is determined by the interplay between environmental and genetic factors, most of which remains unknown. ERAP1, ERAP2 and LNPEP genes code for multifunctional aminopeptidases involved with antigen processing and degradation of small peptides such as angiotensin II (Ang II), vasopressin and oxytocin. We aimed to test for associations between genetic variants in aminopeptidases and HDP. A total of 1282 pregnant women (normotensive controls, n=693; preeclampsia, n=342; chronic hypertension with superimposed preeclampsia, n=61; eclampsia, n=74; and HELLP syndrome, n=112) were genotyped for variants in LNPEP (rs27300, rs38034, rs2303138), ERAP1 (rs27044, rs30187) and ERAP2 (rs2549796 rs2927609 rs11135484). We also evaluated the effect of ERAP1 rs30187 on plasma Ang II levels in an additional cohort of 65 pregnant women. The genotype C/C, in ERAP1 rs30187 variant (c.1583T>C, p.Lys528Arg), was associated with increased risk of eclampsia (OR=1.85, p=0.019) whereas ERAP2 haplotype rs2549796(C)-rs2927609(C)-rs11135484(G) was associated with preeclampsia (OR=1.96, corrected p-value=0.01). Ang II plasma levels did not differ across rs30187 genotypic groups (p=0.895). In conclusion, ERAP1 gene is associated with eclampsia whereas ERAP2 is associated with preeclampsia, although the mechanism by which genetic variants in ERAPs influence the risk of preeclampsia and eclampsia remain to be elucidated.

scholarly journals Hypertensive Disorders during Pregnancy and Risk of Bronchopulmonary Dysplasia in Very Preterm Infants

2018 ◽  
Vol 36 (02) ◽  
pp. 176-183
Author(s):  
Filipa de Lima ◽  
Ana Machado ◽  
Hercília Guimarães ◽  
Gustavo Rocha ◽  
Keyword(s):  
Arterial Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Hypertension ◽  
Newborn Infants ◽  
Chronic Hypertension ◽  
Very Preterm Infants ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Preterm Babies

Introduction It is not yet fully known whether hypertensive disorders (HTD) during pregnancy impose an increased risk of development of bronchopulmonary dysplasia (BPD) in preterm newborn infants. Objective To test the hypothesis that preeclampsia and other HTD are associated with the development of BPD in preterm infants. Materials and Methods Data on mothers and preterm infants with gestational age 24 to 30 weeks were prospectively analyzed in 11 Portuguese level III centers. Statistical analysis was performed using IBM SPSS statistics 23. Results A total of 494 preterm infants from 410 mothers were enrolled, and 119 (28%) of the 425 babies, still alive at 36 weeks, developed BPD. The association between chronic arterial hypertension, chronic arterial hypertension with superimposed preeclampsia, and gestational hypertension in mothers and BPD in preterm infants was not significant (p = 0.115; p = 0.248; p = 0.060, respectively). The association between preeclampsia–eclampsia and BPD was significant (p = 0.007). The multivariate analysis revealed an association between preeclampsia–eclampsia and BPD (odds ratio [OR] = 4.6; 95% confidence interval [CI] 1.529–13.819; p = 0.007) and a protective effect for BPD when preeclampsia occurred superimposed on chronic arterial hypertension in mothers (OR = 0.077; 95%CI 0.009–0.632; p = 0.017). Conclusion The results of this study support the association of preeclampsia in mothers with BPD in preterm babies and suggest that chronic hypertension may be protective for preterm babies.

scholarly journals Impact of Excess Weight Gain on Risk of Postpartum Infection in Class III Obesity

2020 ◽  
Vol 10 (03) ◽  
pp. e213-e216
Author(s):  
Courtney J. Mitchell ◽  
LaMani Adkins ◽  
Ann Tucker ◽  
Haywood Brown ◽  
Anne Siegel ◽  
...  
Keyword(s):  
Weight Gain ◽  
Wound Infection ◽  
Multiple Gestation ◽  
Institute Of Medicine ◽  
Class Iii ◽  
Infectious Morbidity ◽  
Increased Risk ◽  
Significant Difference ◽  
Class Iii Obesity ◽  
The Impact

Abstract Objective To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity. Methods This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, and delivery characteristics of women exceeding IOM guidelines (GT20) with those who did not (LT20). Regression models were used to estimate adjusted odds of outcomes. Results Of 374 women, 144 (39%) gained GT20 and 230 (62%) gained LT20. Primiparous, nonsmokers more likely gained GT20 (p < 0.05). No significant difference in other demographics. Among women who gained GT20, 10.4% had postpartum infectious morbidity compared with 3.0% in LT20 (p < 0.01). Wound infection is more common in the GT20 group (7.6 vs. 2%, p = 0.02). After adjustment, women who gained GT20 had threefold higher odds of postpartum infectious morbidity (adjusted odds ratio: 3.17, 95% confidence interval: 1.17, 8.60). Conclusion Women with class III obesity who gain more than the IOM recommends are at increased risk for postpartum infectious morbidity.

Maternal Height and Risk of Preeclampsia among Race/Ethnic Groups

2018 ◽  
Vol 36 (08) ◽  
pp. 864-871 ◽  
Author(s):  
Ivana Marić ◽  
Jonathan A. Mayo ◽  
Maurice L. Druzin ◽  
Ronald J. Wong ◽  
Virginia D. Winn ◽  
...  
Keyword(s):  
Severe Preeclampsia ◽  
Maternal Height ◽  
Inverse Relation ◽  
Independent Contribution ◽  
Live Births ◽  
Prepregnancy Weight ◽  
Increased Risk ◽  
Autoimmune Conditions ◽  
Race Ethnicity ◽  
Risk Of Preeclampsia

Objective Shorter maternal height has been associated with preeclampsia risk in several populations. It has been less evident whether an independent contribution to the risk exists from maternal height consistently across different races/ethnicities. We investigated associations between maternal height and risk of preeclampsia for different races/ethnicities. Study Design California singleton live births from 2007 to 2011 were analyzed. Logistic regression was used to estimate adjusted odds ratios for the association between height and preeclampsia after stratification by race/ethnicity. To determine the contribution of height that is as independent of body composition as possible, we performed one analysis adjusted for body mass index (BMI) and the other for weight. Additional analyses were performed stratified by parity, and the presence of preexisting/gestational diabetes and autoimmune conditions. Results Among 2,138,012 deliveries, 3.1% preeclampsia/eclampsia cases were observed. The analysis, adjusted for prepregnancy weight, revealed an inverse relation between maternal height and risk of mild and severe preeclampsia/eclampsia. When the analysis was adjusted for BMI, an inverse relation between maternal height was observed for severe preeclampsia/eclampsia. These associations were observed for each race/ethnicity. Conclusion Using a large and diverse cohort, we demonstrated that shorter height, irrespective of prepregnancy weight or BMI, is associated with an increased risk of severe preeclampsia/eclampsia across different races/ethnicities.

scholarly journals Hypertensive Disorders in Pregnancy

2018 ◽  
Vol 03 (02/03) ◽  
pp. 068-078
Author(s):  
Lalita Nemani
Keyword(s):  
Blood Pressure ◽  
Gestational Hypertension ◽  
Stress Test ◽  
Later Life ◽  
Chronic Hypertension ◽  
Prevention Measures ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Abstract Hypertension in pregnancy is defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or both on two different occasions at least 6 hours apart. Severe hypertension is SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg. Hypertension is the most common medical problem in pregnancy and one of the major causes of maternal and perinatal mortality and morbidity. Hypertensive disorders in pregnancy (HDP) are classified as (1) chronic hypertension, (2) chronic hypertension with superimposed preeclampsia, (3) preeclampsia-eclampsia, and (4) gestational hypertension. HDP contributes to increased risk of hypertension, stroke, and maternal cardiovascular disease (CVD) in later life. HDP can be considered as a failed cardiovascular stress test identifying women susceptible to CVD in later life. Further research is required to identify the mechanisms in HDP that contribute to CVD in later life so as to initiate appropriate prevention measures.

scholarly journals Genetic association of ERAP1 and ERAP2 with eclampsia and preeclampsia in northeastern Brazilian women

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Leonardo Capistrano Ferreira ◽  
Carlos Eduardo Maia Gomes ◽  
Priya Duggal ◽  
Ingrid De Paula Holanda ◽  
Amanda Samara de Lima ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Genetic Variants ◽  
Antigen Processing ◽  
Genetic Factors ◽  
Chronic Hypertension ◽  
Ang Ii ◽  
Small Peptides ◽  
Increased Risk ◽  
Genotype C ◽  
Risk Of Preeclampsia

AbstractThe clinical spectrum of hypertensive disorders of pregnancy (HDP) is determined by the interplay between environmental and genetic factors, most of which remains unknown. ERAP1, ERAP2 and LNPEP genes code for multifunctional aminopeptidases involved with antigen processing and degradation of small peptides such as angiotensin II (Ang II), vasopressin and oxytocin. We aimed to test for associations between genetic variants in aminopeptidases and HDP. A total of 1282 pregnant women (normotensive controls, n = 693; preeclampsia, n = 342; chronic hypertension with superimposed preeclampsia, n = 61; eclampsia, n = 74; and HELLP syndrome, n = 112) were genotyped for variants in LNPEP (rs27300, rs38034, rs2303138), ERAP1 (rs27044, rs30187) and ERAP2 (rs2549796 rs2927609 rs11135484). We also evaluated the effect of ERAP1 rs30187 on plasma Ang II levels in an additional cohort of 65 pregnant women. The genotype C/C, in ERAP1 rs30187 variant (c.1583 T > C, p.Lys528Arg), was associated with increased risk of eclampsia (OR = 1.85, p = 0.019) whereas ERAP2 haplotype rs2549796(C)–rs2927609(C)–rs11135484(G) was associated with preeclampsia (OR = 1.96, corrected p-value = 0.01). Ang II plasma levels did not differ across rs30187 genotypic groups (p = 0.895). In conclusion, ERAP1 gene is associated with eclampsia whereas ERAP2 is associated with preeclampsia, although the mechanism by which genetic variants in ERAPs influence the risk of preeclampsia and eclampsia remain to be elucidated.

scholarly journals Hipertensi pada Kehamilan

2019 ◽  
Vol 2 (2) ◽  
pp. 27
Author(s):  
Haidar Alatas
Keyword(s):  
Gestational Hypertension ◽  
Organ Damage ◽  
Antihypertensive Drug Therapy ◽  
Chronic Hypertension ◽  
First Line ◽  
Hypertension In Pregnancy ◽  
Increased Risk ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Hipertensi pada kehamilan sering terjadi (6-10 %) dan meningkatkan risiko morbiditas dan mortalitas pada ibu, janin dan perinatal. Pre-eklampsia/eklampsia dan hipertensi berat pada kehamilan risikonya lebih besar. Hipertensi pada kehamilan dapat digolongkan menjadi pre-eklampsia/ eklampsia, hipertensi kronis pada kehamilan, hipertensi kronis disertai pre-eklampsia, dan hipertensi gestational. Pengobatan hipertensi pada kehamilan dengan menggunakan obat antihipertensi ternyata tidak mengurangi atau meningkatkan risiko kematian ibu, proteinuria, efek samping, operasi caesar, kematian neonatal, kelahiran prematur, atau bayi lahir kecil. Penelitian mengenai obat antihipertensi pada kehamilan masih sedikit. Obat yang direkomendasikan adalah labetalol, nifedipine dan methyldopa sebagai first line terapi. Penatalaksanaan hipertensi pada kehamilan memerlukan pendekatan multidisiplin dari dokter obsetri, internis, nefrologis dan anestesi. Hipertensi pada kehamilan memiliki tingkat kekambuhan yang tinggi pada kehamilan berikutnya. Hypertension complicates 6% to 10% of pregnancies and increases the risk of maternal, fetal and perinatal morbidity and mortality. Preeclampsia / eclampsia and severe hypertension in pregnancy are at greater risk. Four major hypertensive disorders in pregnancy have been described by the American College of Obstetricians and Gynecologists (ACOG): chronic hypertension; preeclampsia-eclampsia; chronic hypertension with superimposed preeclampsia; and gestational hypertension. The current review suggests that antihypertensive drug therapy does not reduce or increase the risk of maternal death, proteinuria, side effects, cesarean section, neonatal and birth death, preterm birth, or small for gestational age infants. The quality of evidence was low. Recommendations for treatment of hypertension in pregnancy are labetalol, nifedipine and methyldopa as first line drugs therapy. Although the obstetrician manages most cases of hypertension during pregnancy, the internist, cardiologist, or nephrologist may be consulted if hypertension precedes conception, if end organ damage is present, or when accelerated hypertension occurs. Women who have had preeclampsia are also at increased risk for hypertension in future pregnancies.

scholarly journals Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Tahmina Nasrin Poly ◽  
Md. Mohaimenul Islam ◽  
Hsuan Chia Yang ◽  
Ming Chin Lin ◽  
Wen-Shan Jian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Ratio ◽  
Web Of Science ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Class Iii ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Class Iii Obesity

Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24–1.63, p &lt; 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05–1.54, p = 0.01), 1.56 (95%CI: 1.11–2.19, p &lt; 0.01), and 1.92 (95%CI: 1.50–2.47, p &lt; 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89–3.64, p = 0.10), 1.57 (95%CI: 1.57–1.91, p &lt; 0.001), 1.34 (95%CI: 1.18–1.52, p &lt; 0.001), and 1.19 (1.07–1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62–3.67, p &lt; 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

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