Management of pregnancy-related hypertensive disorders in patients infected with SARS CoV-2: pharmacological and clinical issues

Abstract Coronavirus-19 disease (COVID-19) continues to spread throughout the world. It is known that among patients with hypertension, diabetes, chronic respiratory disease, or cardiovascular diseases, COVID-19 is associated with greater morbidity and mortality compared with patients without these conditions. This correlation is of great importance in pregnant women affected by COVID-19, since it usually leads to the development of a serious clinical complication. In particular, managing hypertensive disorders in pregnancy can be problematic because antihypertensive medications may interact pharmacologically with drugs used to treat COVID-19. This review focuses on the safety of drug treatment for COVID-19 in pregnant women treated with antihypertensive medication. Several databases were searched to identify relevant literature. A few antihypertensive drugs and antithrombotic treatments are known for having a beneficial effect in the management of hypertension and hypertensive disorders in pregnancy. In this review, we focus on the expected drug–drug interactions with the experimental agents most often used to treat COVID-19. The current indications for the management of hypertension-related disorders in pregnancy maintain their validity, while the risk of pharmacological interaction with the currently tested anti-SARS-CoV-2 medications is relatively low.

Download Full-text

Kasus Hipertensi pada Kehamilan di Indonesia

Berita Kedokteran Masyarakat ◽

10.22146/bkm.12414 ◽

2018 ◽

Vol 32 (9) ◽

pp. 295

Author(s):

Novi Kartika Sari ◽

Theodola Baning Rahayujati ◽

Mohammad Hakimi

Keyword(s):

Pregnant Women ◽

Gestational Hypertension ◽

Sampling Technique ◽

Chronic Hypertension ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

Cross Sectional Design ◽

In Pregnancy

Determinants of pregnancy hypertensive disorders in Indonesia PurposeThis study aimed to assess the determinant factors of gestational hypertension (HDP) in Indonesia.MethodsThis research was an observational analytic study using a cross-sectional design. Sampling was calculated using consecutive sampling technique. The subjects were all pregnant women aged 15-54 years old in 33 provinces in Indonesia and 9024 women were selected as subjects. Chi-square and binomial regression tests were used to analyze the determinants of HDP to see the value of the Ratio Prevalence (RP). ResultsThe prevalence of hypertension among pregnant women was 6.18% (558 people) after being adjusted with external variables which were potentially confounders. The highest of hypertension was found in West Java with 59 pregnant women (10.57%). Overweight and chronic hypertension were related to hypertensive disorders in pregnancy with RP: 2.13 (95% CI: 1.80-2.51); and in overweight with RP: 4.36 (95% CI: 3.6-5.26) in hypertension assessments. The use of contraceptives was not a risk factor for hypertensive disorders in Indonesia with RP 0.92 (95% CI: 0.76-1.10). ConclusionOverweight and chronic hypertension are risk factors for the incidence of hypertensive disorders in pregnancy in Indonesia.

Download Full-text

Alpha-Methyldopa May Attenuate Insulin Demand in Women with Gestational Diabetes Treated with Betamethasone

Healthcare ◽

10.3390/healthcare10010135 ◽

2022 ◽

Vol 10 (1) ◽

pp. 135

Author(s):

Ioannis Kakoulidis ◽

Costas Thomopoulos ◽

Ioannis Ilias ◽

Stefanos Stergiotis ◽

Stefanos Togias ◽

...

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Insulin Treatment ◽

Insulin Dose ◽

Exogenous Insulin ◽

Third Trimester ◽

The Third ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Gestational diabetes mellitus (GDM) is associated with hypertensive disorders in pregnancy. Alpha-methyl-DOPA (αMD) is a commonly used medication for hypertension in pregnant women. This medication may be associated with alteration in insulin resistance and glucose homeostasis. The aim of the present study was to investigate in 152 pregnant women whether the demands of exogenous insulin in glucocorticoid-treated women during pregnancy are different between those with GDM and hypertension treated with αMD and those without hypertension. In the group of women with GDM under insulin treatment, who received αMD for hypertension, the increase in insulin needs was relatively lower by at least 30% of the pre-admission insulin dose compared to all of the remaining women not receiving αMD in the same group (9 women vs. 50 women, p = 0.035). Our work raises the hypothesis that αMD can favorably modulate insulin sensitivity in the third trimester of pregnancy in previously insulin-treated women with gestational diabetes who receive glucocorticoids.

Download Full-text

Proportion of pregnant women screened for hypertensive disorders in pregnancy and its associated factors within antenatal clinics of Kinshasa, Democratic Republic of Congo

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2435-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Dalau Mukadi Nkamba ◽

John Ditekemena ◽

Gilbert Wembodinga ◽

Pierre Bernard ◽

Antoinette Tshefu ◽

...

Keyword(s):

Pregnant Women ◽

Associated Factors ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Republic Of Congo ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

Antenatal Clinics ◽

In Pregnancy

Download Full-text

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

Nigerian Medical Journal ◽

10.4103/0300-1652.140377 ◽

2014 ◽

Vol 55 (5) ◽

pp. 384 ◽

Cited By ~ 15

Author(s):

Swati Singh ◽

EkeleBissallah Ahmed ◽

ShehuConstance Egondu ◽

NwobodoEmmanuel Ikechukwu

Keyword(s):

Pregnant Women ◽

Teaching Hospital ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Download Full-text

Feto-maternal outcome in COVID-19 positive patients with hypertensive disorders in pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211499 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1846

Author(s):

Niranjan N. Chavan ◽

Hera S. Mirza ◽

Priyanka Sonawane ◽

Umme Ammara Iqbal

Keyword(s):

Pregnant Women ◽

Neonatal Intensive Care ◽

Severe Infection ◽

Risk Groups ◽

Current Data ◽

Nasopharyngeal Swab ◽

Hypertensive Disorders ◽

Increased Risk ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Background: Since the first confirmed case in December 2019, the data pertaining to the COVID-19 pandemic has been rapidly evolving. In current study, the relation of COVID-19 and its effect on pregnant women with hypertensive disorders in pregnancy, including symptoms and foetomaternal outcome were studied.Methods: Women with hypertensive disorders in pregnancy consecutively admitted for delivery and tested via nasopharyngeal swab for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR) from 1 April 2020 to 30 September 2020 were included in the study.Results: In our study, 56 women having hypertensive disorders in pregnancy with COVID-19 infections delivering 60 babies (4 twins), 46.43% were in the age group of <25 years, 51.78 % were <37 weeks gestation. Delivery was by caesarean section in 76.78%. Out of these, 33.92% patients required ICU admission. 40% babies delivered had birth weight of <2.5 kg out of which 13.33% had IUGR and 26.66% were preterm. There was 13.33% stillbirth and 6.66% neonatal deaths. 4 maternal death has been reported.Conclusions: With the current data available it does not appear that pregnant women are at increased risk of severe infection than the general population, but clinicians should be aware of high-risk groups. Women will need to be monitored in their booking maternity units and should be transferred to centres with appropriate neonatal intensive care facilities for delivery. In pregnant women with COVID-19 infection, if maternal illness is not severe, the considerations should be based more on obstetric indications for delivery.

Download Full-text

Urinary placental growth factor as a predictor of complications in hypertensive disorders in pregnancy: a protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-046005 ◽

2021 ◽

Vol 11 (4) ◽

pp. e046005

Author(s):

Camille Francoeur ◽

Julie Moreau ◽

Samuel Lemaire-Paquette ◽

Marie-Claude Battista ◽

Marie-Eve Roy-Lacroix ◽

...

Keyword(s):

Systematic Review ◽

Growth Factor ◽

Pregnant Women ◽

Meta Analysis ◽

Placental Growth Factor ◽

Study Quality ◽

Hypertensive Disorders ◽

Hypertensive Disorders In Pregnancy ◽

Study Quality Assessment ◽

In Pregnancy

IntroductionPreeclampsia is an important cause of maternal and fetal morbidity and mortality. Although the diagnostic and prognostic values of circulating placental growth factor (PlGF) have been extensively studied, urinary PlGF represents an excellent alternative to facilitate sample collection in the follow-up of pregnant women. The aim of this study is to determine whether urinary PlGF levels throughout pregnancy can predict severe maternal, fetal/placental and neonatal complications in women with hypertensive disorders in pregnancy.Methods and analysisStudies that evaluated pregnant women with hypertensive disorders and at least one measurement of urinary PlGF will be included. Studies that measure urinary PlGF after the occurrence of the complications will be excluded. The main outcome will consist of severe maternal complications in women with hypertensive disorders in pregnancy. Secondary outcomes will consist of severe fetal/placental and neonatal complications as defined by the International Collaboration to Harmonize Outcomes for Pre-eclampsia. Prospective cohort studies and case–controls studies reporting original data will be included. Studies will be identified by searching MEDLINE and SCOPUS databases. The first literature search was conducted on 2 March 2020, and another search will be performed before analyses. All eligible studies will be assessed for risk of bias with a standardised 10-items study quality assessment tool adapted from the Study Quality Assessment tools developed by the National Institutes of Health (NIH). Summary of ORs and 95% CIs will be reported to evaluate the association between urinary PlGF levels and hypertensive disorders in pregnancy and its complications. A random-effect meta-analysis will also be performed.Ethics and disseminationReview by an ethics committee will not be required for this systematic review. This study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be submitted for publication in a peer-reviewed journal as well as for presentation at conferences targeting different stakeholders, including researchers, physicians and patients.PROSPERO registration numberCRD42020186313.

Download Full-text