Adrenal Steroid Metabolism and Blood Pressure in 5- to 7-Year-Old Children Born Preterm as Compared to Peers Born at Term

Background: Previous studies indicated preterm birth to be a risk factor for hypertension in adolescence and adulthood. However, studies in children investigating the underlying mechanisms are scarce.Objective: We hypothesized children born preterm to have higher excretion of cortisol and/or androgen metabolites per day concomitantly with higher blood pressure as compared to peers born at term. We thus aimed to compare urinary steroid profiles and blood pressure between 5- to 7-year-old children born preterm and peers born at term. Furthermore, aldosterone precursor excretion per day was compared between both groups.Methods: Blood pressure was measured in 236 children (preterms n = 116; gestational age 29.8 ± 2.6 (30; 24–33) weeks [mean ± standard deviation (median; range)]) using an automatic oscillometric device. Urinary steroid profiles were determined in 24-h urine samples (preterms n = 109; terms n = 113) using gas chromatographic-mass spectrometric analysis. To assess excretion of cortisol and androgen metabolites per day, major cortisol and androgen metabolites were summed, respectively. To assess aldosterone excretion per day tetrahydrocorticosterone, 5α-tetrahydrocorticosterone, and tetrahydro-11-deydrocorticosterone were summed.Results: Multiple regression analyses showed prematurity to be associated with systolic but not with diastolic blood pressure. When adjusted for potential confounders (prematurity, gender, age at day of examination, being born small for gestational age, breastfeeding, accelerated weight gain during infancy, family history of cardiovascular disease, parental hypertension, and body mass index) prematurity was shown to be associated with an increase in systolic blood pressure by 2.87 mmHg (95% confidence interval 0.48–5.27; p = 0.02). Cortisol, androgen metabolite, and aldosterone precursor excretion per day were not higher in individuals born preterm. In contrast to our hypothesis, multiple regression analysis showed prematurity to independently decrease cortisol and aldosterone precursor excretion per day (p < 0.001 and 0.04, respectively).Conclusion: This study provides further evidence for systolic blood pressure to be higher after preterm birth as early as at the age of 5 to 7 years. However, this seems not to be explained by elevated excretion of cortisol and/or androgen metabolites.

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Adverse Outcomes with Maternal Blood Pressure Less than 140/90 in Pregnancy Complicated by Hypertension

American Journal of Perinatology ◽

10.1055/s-0038-1677474 ◽

2019 ◽

Vol 36 (13) ◽

pp. 1394-1400 ◽

Cited By ~ 1

Author(s):

Courtney J. Mitchell ◽

Alan Tita ◽

Sarah B. Anderson ◽

Daniel N. Pasko ◽

Lorie M. Harper

Keyword(s):

Blood Pressure ◽

Preterm Birth ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Gestational Age ◽

Small For Gestational Age ◽

Maternal Blood ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Increased Risk

Objective We assessed the risk of small for gestational age and other outcomes in pregnancies complicated by chronic hypertension with blood pressure <140/90 mm Hg. Study Design Retrospective cohort of singletons with hypertension at a single institution from 2000 to 2014. Mean systolic blood pressure and mean diastolic blood pressure were analyzed as continuous and dichotomous variables (<120/80 and 120–139/80–89 mm Hg). The primary outcome was small for gestational age. Secondary outcomes included birth weight, preeclampsia, preterm birth <35 weeks, and a composite of adverse neonatal outcomes. Results Small for gestational age was not increased with a mean systolic blood pressure <120 mm Hg compared with a mean systolic blood pressure 120 to 129 mm Hg (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI] 0.92–2.79). Mean diastolic blood pressure <80 mm Hg was associated with a decrease in the risk preeclampsia (AOR 0.57; 95% CI 0.35–0.94), preterm birth <35 weeks (AOR 0.35; 95% CI 0.20–0.62), and the composite neonatal outcome (AOR 0.42; 95% CI 0.22–0.81). Conclusion Mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg were not associated with increased risk of small for gestational age when compared with higher, normal mean systolic and diastolic blood pressures.

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A comparison of CAT Doppler and oscillometric Memoprint machines for non-invasive blood pressure measurement in conscious cats

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2004.08.003 ◽

2005 ◽

Vol 7 (3) ◽

pp. 147-152 ◽

Cited By ~ 31

Author(s):

Rosanne E. Jepson ◽

Vivien Hartley ◽

Michael Mendl ◽

Sarah ME Caney ◽

David J Gould

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Measurement ◽

Systemic Hypertension ◽

Pressure Measurements ◽

Non Invasive ◽

Measuring Devices ◽

Oscillometric Device ◽

Significant Difference

Indirect blood pressure measurements were compared in 28 conscious cats using Doppler and oscillometric blood pressure-measuring devices. Ten cats were used to compare Doppler measurements between two examiners and 18 cats were used to compare Doppler and oscillometric measurements. The Doppler machine obtained systolic and diastolic blood pressure readings in 100% and 51% of attempts, respectively. With the oscillometric machine, systolic and diastolic blood pressure readings were obtained in 52% of the attempts. With the Doppler, measures of mean systolic blood pressure between two examiners were positively correlated, but there was no correlation for diastolic blood pressure measures. When comparing the results obtained by Doppler and oscillometric machines there was no significant difference between mean systolic blood pressure readings, but the oscillometric machine produced significantly higher estimates of diastolic blood pressure. In both cases, the standard deviations for the oscillometric machine were considerably larger than those for the Doppler machine. The first reading of systolic blood pressure obtained with the Doppler machine was an excellent predictor of the mean of five readings, but this was not so for the oscillometric machine. It took less than 5 min to obtain five readings in 37.5% of cases with the Doppler machine but this was true for only 5% of cases with the oscillometric machine. Two cats with ophthalmological lesions consistent with systemic hypertension were identified. In these two patients, systolic blood pressure measurements were between 200 and 225 mmHg when measured by Doppler, and between 140 and 150 mmHg when measured by the oscillometric machine. This suggests that a lower reference range for normal systolic blood pressure values should be used for the oscillometric device.

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40 Duration of Neonatal Oxygen Supplementation Associated with Higher Hemoglobin and Higher Blood Pressure in Young Adults Born Preterm

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.039 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e16-e17

Author(s):

Adrien Flahault ◽

Camille Girard-Bock ◽

Yves Pastore ◽

Thuy Mai Luu ◽

Anne-Monique Nuyt

Keyword(s):

Blood Pressure ◽

Young Adults ◽

Preterm Birth ◽

Bronchopulmonary Dysplasia ◽

Mediation Analysis ◽

Test Group ◽

Airflow Limitation ◽

Oxygen Supplementation ◽

Oscillometric Device ◽

Student’S T

Abstract Introduction/Background Although erythropoiesis is impaired and anemia frequent in neonates born preterm, hematopoiesis in adults born preterm has not been previously studied. We hypothesize that adverse neonatal events durably affect erythropoiesis regulation, leading to a difference in hemoglobin levels in young adults born preterm compared to those born term. Objectives We thus aimed to evaluate hemoglobin and erythropoietin levels in young adults born preterm, to identify neonatal events associated with erythropoiesis in adulthood and to examine the relationships of hemoglobin levels with respiratory function and blood pressure. Design/Methods This study included 101 young adults (ages 18-29 years) born preterm (≤29 weeks of gestation) and 105 full-term controls. We measured office blood pressure using automated oscillometric device, complete blood count, serum erythropoietin levels (ELISA) and pulmonary function test. Group comparisons were performed using Student’s t or Mann-Whitney U tests. Correlations were assessed using Pearson’s coefficient and test. We performed a mediation analysis to assess the relationship between blood pressure, hemoglobin levels and preterm birth. Results Tobacco use and sex adjusted hemoglobin levels were 5.3 (95% CI: 2.9, 7.7) g/L higher in preterm-born individuals compared to controls (Table). We did not observe a difference in erythropoietin levels (7.3±3.4 and 8.12±3.40 U/L in the term and the preterm groups, respectively, p=0.102). Duration of oxygen supplementation in the neonatal period was independently associated with higher hemoglobin levels in the preterm group. In adults born preterm with bronchopulmonary dysplasia, airflow limitation was associated with higher hemoglobin levels. Both systolic (SBP) and diastolic (DBP) blood pressure were increased in individuals born preterm (p=0.042 and p=0.0008, respectively). Higher hemoglobin levels were associated with higher SBP and DBP, independently of term or preterm status. Mediation analysis (Figure) suggests that hemoglobin increase contributes to 37% and 32% of the effect of preterm birth on SBP and DBP, respectively. Conclusion While erythropoietin levels are similar between groups, hemoglobin levels are higher in young adults born preterm, especially in cases of bronchopulmonary dysplasia and airflow limitation. Hemoglobin increase is associated with elevated blood pressure in this population. Understanding mechanisms of impaired erythropoiesis regulation in adults born preterm will be important in designing antihypertensive approaches specific to this population. Results shown as mean ± SD or medians (25%-75%) and comparisons were performed using Student’s t test or Mann-Whitney U test, when appropriate. Systolic blood pressure (SBP). B. Diastolic blood pressure (DBP). Hb: hemoglobin. ACME: Average Causal Mediation Effect. B: unstandardized regression coefficient. All estimations are adjusted for sex.

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URINARY STEROID PROFILES AND ALOCHOL-RELATED BLOOD PRESSURE ELEVATION

Clinical and Experimental Pharmacology and Physiology ◽

10.1111/j.1440-1681.1991.tb01447.x ◽

1991 ◽

Vol 18 (5) ◽

pp. 287-290 ◽

Cited By ~ 6

Author(s):

T. A. Mori ◽

I. B. Puddey ◽

S. P. Wilkinson ◽

L. J. Beilin ◽

R. Vandongen

Keyword(s):

Blood Pressure ◽

Blood Pressure Elevation ◽

Pressure Elevation ◽

Steroid Profiles ◽

Urinary Steroid

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Associations of Gestational Age and Intrauterine Growth With Systolic Blood Pressure in a Family-Based Study of 386 485 Men in 331 089 Families

Circulation ◽

10.1161/circulationaha.106.646661 ◽

2007 ◽

Vol 115 (5) ◽

pp. 562-568 ◽

Cited By ~ 40

Author(s):

Debbie A. Lawlor ◽

Anna Hübinette ◽

Per Tynelius ◽

David A. Leon ◽

George Davey Smith ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Gestational Age ◽

Intrauterine Growth ◽

Family Based

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Antenatal Markers Related to Fetal Growth Restriction Can Predict Childhood Systolic Blood Pressure

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1443 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A708-A709

Author(s):

Reena Perchard ◽

Terence Garner ◽

Andrew James Whatmore ◽

Adam Stevens ◽

Lucy Higgins ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Gestational Age ◽

Protein A ◽

Area Under The Curve ◽

Resistance Index ◽

Growth Restriction ◽

Maternal Body Mass Index ◽

Uteroplacental Blood Flow ◽

Multiple Variables

Abstract Background: Being born small for gestational age (SGA) is linked with higher systolic blood pressure (SBP). Fetuses with growth restriction (FGR) may be either SGA or appropriate size for gestational age at birth. However, it is not known which factors contributing to size at birth influence the relationship with SBP. Aim. To determine whether antenatal markers of FGR can predict the upper quartile of childhood SBP. Methods: Brachial SBP was measured for 75 children aged 3-6 years from the Manchester BabyGRO Study, using a Tensiomed®Arteriograph with a child-sized cuff. SBP quartiles were generated. Participants were born to mothers who had attended a specialised clinic, following identification of higher FGR risk based on abnormal maternal serology (pregnancy associated plasma protein-A, β-human chorionic gonadotrophin, α-fetoprotein, Inhibin-A). Antenatal ultrasound data at 23 weeks gestation were obtained. Uterine artery Doppler (UtAD) notching was assigned a rank (0=absent, 1=unilateral, 2=bilateral). Random forest (RF) is a machine learning approach that generates many independent, uncorrelated decision trees based on multiple variables. This was used to determine the relative importance of antenatal variables in prediction of upper quartile of childhood SBP. Variables included in the model were maternal body mass index (BMI), parity, ethnicity (black/white/asian/mixed), maternal SBP and diastolic BP (DBP), maternal serology relating to FGR risk, UtAD pulsatility index, resistance index and notching rank (all measures of uteroplacental blood flow resistance), placental size measurements, 23 week estimated fetal weight (EFW) centile, ∆23w EFW-birthweight centile and birthweight SDS. A receiver operating characteristic (ROC) curve was generated, providing an area under the curve (AUC). A variable of importance (VIP) score was calculated for each marker that was significant in the model. All analyses were conducted in R (version 3.6). Results: RF analysis demonstrated antenatal markers relating to FGR risk predict the upper quartile of childhood SBP with an AUC 0.97. The top five ranked variables were maternal DBP (VIP score 14.0), birthweight SDS (11.5), parity (9.9), notching rank (9.5) and ∆23w EFW-birthweight centile (9.1). Conclusion: Maternal and antenatal markers, as well as birthweight SDS are linked with the upper quartile of SBP at 3-6 years. Antenatal markers were within the top five ranked and could help identify those babies at risk of higher SBP in childhood.

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At Preeclampsia Diagnosis, Total Cell‐Free DNA Concentration is Elevated and Correlates With Disease Severity

Journal of the American Heart Association ◽

10.1161/jaha.121.021477 ◽

2021 ◽

Author(s):

Teodora R. Kolarova ◽

Hilary S. Gammill ◽

J. Lee Nelson ◽

Christina M. Lockwood ◽

Raj Shree

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Disease Severity ◽

Gestational Age ◽

Prenatal Screening ◽

Tissue Injury ◽

Screening Assay ◽

Cell Free Dna ◽

Free Dna ◽

Gestational Age At Delivery

Background Placental derived cell‐free DNA (cfDNA), widely utilized for prenatal screening, may serve as a biomarker for preeclampsia. To determine whether cfDNA parameters are altered in preeclampsia, we conducted a case‐control study using prospectively collected maternal plasma (n=20 preeclampsia, n=22 normal) using our in‐house validated prenatal screening assay. Methods and Results Isolated cfDNA was quantified, sequenced using Illumina NextSeq 500, and the placental‐derived fraction was determined. Clinical and test characteristics were compared between preeclampsia and controls, followed by comparisons within the preeclampsia cohort dichotomized by cfDNA concentration. Lastly, cfDNA parameters in preeclampsia were correlated with markers of disease severity. Maternal age, body mass index, gestational age at delivery, cesarean rate, and neonatal birthweight were expectedly different between groups ( P ≤0.05). The placental‐derived cfDNA fraction did not differ between groups (21.4% versus 16.9%, P =0.06); however, total cfDNA was more than 10 times higher in preeclampsia (1235 versus 106.5 pg/µL, P <0.001). This relationship persisted when controlling for important confounders (OR 1.22, 95% CI 1.04–1.43, P =0.01). The dichotomized preeclampsia group with the highest cfDNA concentration delivered earlier (33.2 versus 36.6 weeks, P =0.02) and had lower placental‐derived fractions (9.1% versus 21.4%, P =0.04). Among preeclampsia cases, higher total cfDNA correlated with earlier gestational age at delivery ( P =0.01) and higher maximum systolic blood pressure ( P =0.04). Conclusions At diagnosis, total cfDNA is notably higher in preeclampsia, whereas the placental derived fraction remains similar to healthy pregnancies. In preeclampsia, higher total cfDNA correlates with earlier gestational age at delivery and higher systolic blood pressure. These findings may indicate increased release of cfDNA from maternal tissue injury.

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