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

2019 ◽  
Vol 14 (2) ◽  
pp. 102-108 ◽  
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. </P><P> Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-related hypertensive conditions. </P><P> 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. </P><P> 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. </P><P> Conclusion: Review of the literature suggests a possible association between depression and antihypertensive medications with pregnancy-related hypertension, but further studies are needed.</P>

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

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
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.

scholarly journals Hypertension in pregnancy: Pathophysiology and treatment

2019 ◽  
Vol 7 ◽  
pp. 205031211984370 ◽  
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.

scholarly journals Hypertensive disorders of pregnancy and cardiometabolic outcomes in childhood: A systematic review

2019 ◽  
Vol 26 (16) ◽  
pp. 1718-1747 ◽  
Author(s):  
Maria AC Jansen ◽  
Linda PM Pluymen ◽  
Geertje W Dalmeijer ◽  
T Katrien J Groenhof ◽  
Cuno SPM Uiterwaal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Evidence Synthesis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Pregnancy Induced Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Induced Hypertension ◽  
Cardiometabolic Markers

Background Hypertensive disorders of pregnancy (HDPs) are among the leading causes of maternal and perinatal morbidity and mortality worldwide and have been suggested to increase long-term cardiovascular disease risk in the offspring. Objective The objective of this study was to investigate whether HDPs are associated with cardiometabolic markers in childhood. Search strategy PubMed, The Cochrane Library and reference lists of included studies up to January 2019. Selection criteria Studies comparing cardiometabolic markers in 2–18-year-old children of mothers with HDP in utero, to children of mothers without HDP. Data collection and analysis Sixteen studies reported in 25 publications were included in this systematic review, of which three were considered as having high risk of bias. Thus 13 studies were included in the evidence synthesis: respectively two and eight reported pregnancy induced hypertension and preeclampsia, and three studies reported on both HDPs. Main results Most studies ( n = 4/5) found a higher blood pressure in children exposed to pregnancy induced hypertension. Most studies ( n = 7/10) found no statistically significantly higher blood pressure in children exposed to preeclampsia. No association was found between exposure to HDP and levels of cholesterol, triglycerides or glucose ( n = 5/5). No studies investigated an association with (carotid) intima-media thickness, glycated haemoglobin or diabetes mellitus type 2. Conclusions Most studies showed that exposure to pregnancy induced hypertension is associated with a higher offspring blood pressure. There is no convincing evidence for an association between exposure to preeclampsia and blood pressure in childhood. Based on current evidence, exposure to HDP is not associated with blood levels of cholesterol, triglycerides and glucose in childhood.

scholarly journals Occupational Risk Factors and Hypertensive Disorders in Pregnancy: A Systematic Review

2021 ◽  
Vol 18 (16) ◽  
pp. 8277
Author(s):  
Emanuela Spadarella ◽  
Veruscka Leso ◽  
Luca Fontana ◽  
Angela Giordano ◽  
Ivo Iavicoli
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Job Strain ◽  
Gestational Hypertension ◽  
Occupational Risk Factors ◽  
Occupational Risks ◽  
Hypertensive Disorders ◽  
Evidence Quality ◽  
Hypertensive Disorders In Pregnancy ◽  
In Pregnancy

Hypertensive disorders in pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), characterize a major cause of maternal and prenatal morbidity and mortality. In this systematic review, we tested the hypothesis that occupational factors would impact the risk for HDP in pregnant workers. MEDLINE, Scopus, and Web of Knowledge databases were searched for studies published between database inception and 1 April 2021. All observational studies enrolling > 10 pregnant workers and published in English were included. Un-experimental, non-occupational human studies were excluded. Evidence was synthesized according to the risk for HDP development in employed women, eventually exposed to chemical, physical, biological and organizational risk factors. The evidence quality was assessed through the Newcastle–Ottawa scale. Out of 745 records identified, 27 were eligible. No definite conclusions could be extrapolated for the majority of the examined risk factors, while more homogenous data supported positive associations between job-strain and HDP risk. Limitations due to the lack of suitable characterizations of workplace exposure (i.e., doses, length, co-exposures) and possible interplay with personal issues should be deeply addressed. This may be helpful to better assess occupational risks for pregnant women and plan adequate measures of control to protect their health and that of their children.

scholarly journals Frequent Placental SARS-CoV-2 in Patients with COVID-19-Associated Hypertensive Disorders of Pregnancy

2021 ◽  
pp. 1-11
Author(s):  
Marta Fabre ◽  
Pilar Calvo ◽  
Sara Ruiz-Martinez ◽  
Maria Peran ◽  
Daniel Oros ◽  
...  
Keyword(s):  
Viral Load ◽  
Gestational Hypertension ◽  
Group Versus ◽  
Control Group ◽  
Hypertensive Disorders Of Pregnancy ◽  
Rt Pcr ◽  
Third Trimester ◽  
Hypertensive Disorders ◽  
The Moment ◽  
The Relationship

<b><i>Introduction:</i></b> Studies described an increased frequency of hypertensive disorders of pregnancy (HDP) after a COVID-19 episode. There is limited evidence about SARS-CoV-2 viral load in placenta. This study aimed to investigate the relationship between SARS-CoV-2 viral load in the placenta and clinical development of HDP after COVID-19 throughout different periods of gestation. <b><i>Methods:</i></b> This is a case-control study in women with and without gestational hypertensive disorders after SARS-CoV-2 infection diagnosed by RT-PCR during pregnancy. Patients were matched by gestational age at the moment of COVID-19 diagnosis. We performed an analysis of SARS-CoV-2 RNA levels in placenta. <b><i>Results:</i></b> A total of 28 women were enrolled. Sixteen patients were diagnosed with COVID-19 during the third trimester and the remaining 12 patients in the other trimesters. Ten placentas (35.7%) were positive for SARS-CoV-2, 9 of them (9/14, 64.3%) belonged to the HDP group versus 1 (1/14, 7.2%) in the control group (<i>p</i> = 0.009). Those cases with the highest loads of viral RNA developed severe preeclampsia (PE). <b><i>Conclusion:</i></b> Among women diagnosed with COVID-19 during pregnancy, the presence of SARS-CoV-2 in the placenta was more frequent among women suffering from PE or gestational hypertension. Furthermore, the most severe cases of HDP were associated with high placental viral load, not necessarily associated with a positive nasopharyngeal RT-PCR at delivery. Our data suggest that SARS-CoV-2 infection during pregnancy could trigger gestational hypertensive disorders through persistent placental infection and resulting placental damage.

scholarly journals The Association Between the Risk of Hypertensive Disorders of Pregnancy and Folic Acid: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 24 ◽  
pp. 174-190
Author(s):  
Yahui Yu ◽  
Ximu Sun ◽  
Xinrui Wang ◽  
Xin Feng
Keyword(s):  
Systematic Review ◽  
Folic Acid ◽  
Cohort Studies ◽  
Assessment Tool ◽  
Gestational Hypertension ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cardiovascular Risks ◽  
Hypertensive Disorders

Purpose: Although folic acid (FA) supplementation has been shown to reduce general cardiovascular risks, its impact on hypertensive disorders of pregnancy (HDP) is unclear. We performed a systematic review and meta-analysis to clarify the association between FA and the risk of HDP (pre-eclampsia (PE) and gestational hypertension (GH)). Methods: PubMed, EmBase, and Cochrane Library were searched up to June 18, 2020, stratified by type of disease, initiation time of FA, form of FA and pre-conception Body Mass Index (BMI). The quality assessment of included studies was evaluated using Newcastle-Ottawa Scale (NOS) for cohort studies and Cochrane Collaboration’s Risk of Bias Assessment Tool for randomized controlled trials (RCTs). Between-study heterogeneity was quantified using Cochran’s Q-statistic and I2 statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed using funnel plots. Results: Twenty studies with 359041 patients were identified for inclusion in the meta-analysis which included 3 RCTs and 17 cohort studies. Pooled estimates showed RR of 0.83 (95%CI 0.74-0.93, P=0.0008) for association between low dose FA (LD-FA) and the risk of PE, but LD-FA was not associated with GH (RR 1.05, 95% CI 0.97-1.13, P=0.20). In addition, the results of subgroup analysis showed that post-conception LD-FA had a 31% decreased risk of PE (RR 0.69, 95% CI 0.59-0.80, P<0.00001), and LD-FA in patients with pre-conception BMI<25 kg/m2 had a 32% decreased risk of PE (RR 0.68, 95% CI 0.56-0.81, P<0.0001) Conclusions: LD-FA significantly decreased the risk of PE but not GH, and post-conception LD-FA and pre-conception BMI<25 kg/m2 were considered as protective factors to reduce the risk of PE.

scholarly journals What are Systematic Reviews?

2020 ◽  
Vol 7 (1) ◽  
pp. 5
Author(s):  
Jack Nunn ◽  
Steven Chang
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Research Question ◽  
Secondary Data ◽  
Current Evidence ◽  
Economic Evaluations ◽  
Environmental Interventions

Systematic reviews are a type of review that uses repeatable analytical methods to collect secondary data and analyse it. Systematic reviews are a type of evidence synthesis which formulate research questions that are broad or narrow in scope, and identify and synthesize data that directly relate to the systematic review question. While some people might associate ‘systematic review’ with 'meta-analysis', there are multiple kinds of review which can be defined as ‘systematic’ which do not involve a meta-analysis. Some systematic reviews critically appraise research studies, and synthesize findings qualitatively or quantitatively. Systematic reviews are often designed to provide an exhaustive summary of current evidence relevant to a research question. For example, systematic reviews of randomized controlled trials are an important way of informing evidence-based medicine, and a review of existing studies is often quicker and cheaper than embarking on a new study. While systematic reviews are often applied in the biomedical or healthcare context, they can be used in other areas where an assessment of a precisely defined subject would be helpful. Systematic reviews may examine clinical tests, public health interventions, environmental interventions, social interventions, adverse effects, qualitative evidence syntheses, methodological reviews, policy reviews, and economic evaluations. An understanding of systematic reviews and how to implement them in practice is highly recommended for professionals involved in the delivery of health care, public health and public policy.

scholarly journals Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time

Stroke ◽  
2022 ◽  
Author(s):  
Shih-Kai Hung ◽  
Moon-Sing Lee ◽  
Hon-Yi Lin ◽  
Liang-Cheng Chen ◽  
Chi-Jou Chuang ◽  
...  
Keyword(s):  
Time Trends ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
History Of ◽  
The Relationship

Background and Purpose: Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study. Methods: Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited. Results: HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively ( P <0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47−2.83, P <0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36–3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47−8.73) after 10 to 15 years of childbirth (both P <0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91−7.82, P <0.001), followed by preeclampsia–eclampsia (aHR=2.00, 1.63−2.45, P <0.001), and gestational hypertension (aHR=1.68, 1.13−2.52, P <0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97−1.68, P >0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14−26.42, P <0.05). Conclusions: The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.

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