Prevention of Hypertensive Disorders of Pregnancy—Is There a Place for Metformin?

The possibility of prophylaxis of hypertensive disorders of pregnancy (HDPs) such as preeclampsia (PE) and pregnancy-induced hypertension is of interest due to the unpredictable course of these diseases and the risks they carry for both mother and fetus. It has been proven that their development is associated with the presence of the placenta, and the processes that initiate it begin at the time of the abnormal invasion of the trophoblast in early pregnancy. The ideal HDP prophylaxis should alleviate the influence of risk factors and, at the same time, promote physiological trophoblast invasion and maintain the physiologic endothelium function without any harm to both mother and fetus. So far, aspirin is the only effective and recommended pharmacological agent for the prevention of HDPs in high-risk groups. Metformin is a hypoglycemic drug with a proven protective effect on the cardiovascular system. Respecting the anti-inflammatory properties of metformin and its favorable impact on the endothelium, it seems to be an interesting option for HDP prophylaxis. The results of previous studies on such use of metformin are ambiguous, although they indicate that in a certain group of pregnant women, it might be effective in preventing hypertensive complications. The aim of this study is to present the possibility of metformin in the prevention of hypertensive disorders of pregnancy with respect to its impact on the pathogenic elements of development

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Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy

Gender and the Genome ◽

10.1177/2470289720948076 ◽

2020 ◽

Vol 4 ◽

pp. 247028972094807

Author(s):

Margaret H. Bublitz ◽

Myriam Salameh ◽

Laura Sanapo ◽

Ghada Bourjeily

Keyword(s):

Gestational Diabetes ◽

Pregnancy Complications ◽

Sleep Disordered Breathing ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Fetal Sex ◽

Hypertensive Disorders ◽

Induced Hypertension ◽

In Pregnancy ◽

Disordered Breathing

Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09-1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51 [95% CI: 1.08-2.11]). Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.

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Migraine-Asthma Comorbidity and Risk of Hypertensive Disorders of Pregnancy

Journal of Pregnancy ◽

10.1155/2012/858097 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Stefanie Czerwinski ◽

Jolana Gollero ◽

Chunfang Qiu ◽

Tanya K. Sorensen ◽

Michelle A. Williams

Keyword(s):

Medical Records ◽

Symptom Management ◽

Perinatal Outcomes ◽

Reproductive Age ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Reproductive Age Women ◽

Asthma Status ◽

Induced Hypertension

Background. To evaluate the association of migraine and asthma and to estimate the risk of hypertensive disorders of pregnancy in relation to maternal comorbid migraine and asthma.Methods. Reproductive age women (N=3.731) were interviewed during early pregnancy. At the time of interview, we ascertained participants’ migraine and asthma status. From medical records, we collected information to allow the diagnosis of pregnancy-induced hypertension (PIH) and preeclampsia. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression procedures.Results. After adjusting for confounders, migraineurs had 1.38-fold increased odds of asthma as compared with nonmigraineurs (95% CI 1.09–1.38). The odds of hypertensive disorders of pregnancy were highest among women with comorbid migraine-asthma. The ORs for PIH preeclampsia and the two disorders combined were 2.53 (95% CI 1.39–4.61), 3.53 (95% CI 1.51–8.24), and 2.64 (95% CI 1.56–4.47), respectively, for women with comorbid migraine-asthma as compared with those who had neither disorder.Conclusion. These findings confirm prior reports and extend the literature by documenting particularly high odds of pregnancy-induced hypertension and preeclampsia among women with comorbid migraine-asthma. Increased knowledge about the prevalence and sequelae of comorbidities during pregnancy may lead to improved symptom management and perinatal outcomes.

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

European Journal of Preventive Cardiology ◽

10.1177/2047487319852716 ◽

2019 ◽

Vol 26 (16) ◽

pp. 1718-1747 ◽

Cited By ~ 6

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.

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Maternal Early-Pregnancy Thyroid Function Is Associated With Subsequent Hypertensive Disorders of Pregnancy: The Generation R Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-1505 ◽

2014 ◽

Vol 99 (12) ◽

pp. E2591-E2598 ◽

Cited By ~ 44

Author(s):

Marco Medici ◽

Tim I. M. Korevaar ◽

Sarah Schalekamp-Timmermans ◽

Romy Gaillard ◽

Yolanda B. de Rijke ◽

...

Keyword(s):

Thyroid Function ◽

Early Pregnancy ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Normal Range ◽

Free T4 ◽

Hypertensive Disorders ◽

Increased Risk ◽

Wide Range ◽

Induced Hypertension

Context: Hypertensive disorders during pregnancy are associated with a wide range of maternal and fetal complications, and only a few risk factors are known for the development of these disorders during pregnancy. Conflicting and limited data are available on the relationship between thyroid (dys)function and the risk of hypertensive disorders of pregnancy. Objective: The objective of the investigation was to study the associations between early-pregnancy thyroid dysfunction, thyroid function within the normal range, and the risk of hypertensive disorders. Design, Setting, and Participants: In early pregnancy, serum TSH, free T4 (FT4), and thyroperoxidase antibody (TPOAb) levels were determined in 5153 pregnant women. No interventions were done. The associations of thyroid function with the risk of hypertensive disorders were studied. Main Outcome Measures: Mean blood pressures and hypertensive disorders, including pregnancy-induced hypertension (n = 209) and preeclampsia (n = 136), were measured. Results: Hyperthyroid mothers had a higher risk of hypertensive disorders [odds ratio (OR) 3.40 [95% confidence interval (CI) 1.46–7.91], P = .005], which was mainly due to an increased risk of pregnancy-induced hypertension [OR 4.18 (95% CI 1.57–11.1), P = .004]. Hypothyroidism and hypothyroxinemia were not associated with hypertensive disorders. Within the normal range, the high-normal FT4 levels were associated with an increased risk of hypertensive disorders [OR 1.62 (95% CI 1.06–2.47), P = .03], which was mainly due to an increased risk of preeclampsia [OR 2.06 (95% CI 1.04–4.08), P = .04]. The TPOAb status was not associated with hypertensive disorders. Conclusions: We show that biochemical hyperthyroidism and also high-normal FT4 levels during early pregnancy are associated with an increased risk of hypertensive disorders. These data demonstrate that these associations are even seen for a mild variation in thyroid function within the normal range.

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PREGNANCY INDUCED HYPERTENSION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.10.1720 ◽

2016 ◽

Vol 23 (10) ◽

pp. 1187-1193

Author(s):

Nadia Sharif ◽

Irum Usman ◽

Tasneem Azhar

Keyword(s):

Blood Pressure ◽

Mean Blood Pressure ◽

Outpatient Basis ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Normal Limits ◽

Hypertensive Disorders ◽

Group I ◽

Induced Hypertension ◽

Group A

Introduction: The hypertensive Disorders of pregnancy are major contributors tomaternal and perinatal morbidity and mortality. The aim of hypertensive therapy is to preventcomplications associated with hypertensive disorders of pregnancy. Objective: To compareefficacy of methyldopa and labetalol in management of pregnancy induced hypertension.Study Design: Randomized control trial. Setting: Punjab medical college and affiliatedhospitals Faisalabad. Methods: Patient were be randomly assigned to either group A or Groupby lottery method. Each group included 157 patients. In group A: labetalol was started at 100mg three or four times a day and increased up to 1200 mg a day in divided doses. In group B:methyldopa was started at 250mg per day 3 to 4 divided doses and increased up to 500 mg in 3to 4 divided doses. Blood pressure was recorded by sphygmomanometer. Blood pressure wasrecorded after 48 hours and then weekly till term on outpatient basis. Results: The treatmentof methyldopa in group I was proved to successful in lowering the mean blood pressure andmaintaining mean blood pressure within normal limits in 142 of 155 patients. It can be said itwas successful in 91.61% cases. 8.39% cases progressed to severe hypertension or eclampsiabecause methyldopa was unsuccessful to prevent progress of disease. Conclusion: It isconcluded that antihypertensive therapy such as methyldopa and labetalol are successful inlowering blood pressure in patient with pregnancy induced hypertension.

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Safety and efficacy of methyldopa and labetalol in controlling blood pressure in hypertensive disorders of pregnancy

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20171109 ◽

2017 ◽

Vol 6 (4) ◽

pp. 942 ◽

Cited By ~ 2

Author(s):

Mary Rohini Pentareddy ◽

Shailendra D. ◽

Prasuna G. ◽

Subbaratnam Y. ◽

Naresh D.T. V. ◽

...

Keyword(s):

Medical Complication ◽

Pregnancy Induced Hypertension ◽

Effective Management ◽

Efficacy And Safety ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Vaginal Deliveries ◽

Induced Hypertension ◽

Blood Pressures ◽

New Onset

Background: Hypertensive disorders represent the most common medical complication of pregnancy, with a reported incidence of 6-10% and accounts for 15% of maternal mortality. Effective management of pregnancy induced hypertension is vital to improve maternal and foetal outcomes. As data are scarce on comparison of labetolol and methyldopa this study was undertaken. The objective of present study is compare the efficacy and safety of Labetalol versus Methyldopa in the management of Mild to Moderate pregnancy induced hypertension. To evaluate effect of both drugs on maternal and foetal outcomes.Methods: A comparative observational study is designed. 30 patients who received methyldopa and 30 patients who received labetalol were included in the study. Methyldopa was started at a dose of 250-500 mg thrice daily while labetalol was started at a dose of 100-400 mg twice daily. Patients were followed up during antenatal, intrapartum and postpartum period for efficacy, safety, maternal, and perinatal outcomes.Results: Methyldopa and Labetalol reduced mean systolic and mean diastolic blood pressures significantly. safety profile of both drugs was similar. Spontaneous vaginal deliveries were observed more with labetolol significantly.Conclusions: Labetalol is equally efficacious as methyldopa and well tolerated in the treatment of new onset hypertension during pregnancy.

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Hypertensive disorders of pregnancy

10.1093/med/9780198754787.003.0013 ◽

2017 ◽

Author(s):

Janet Medforth ◽

Linda Ball ◽

Angela Walker ◽

Sue Battersby ◽

Sarah Stables

Keyword(s):

Essential Hypertension ◽

Hellp Syndrome ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Induced Hypertension ◽

Definition Of ◽

In Pregnancy

A definition of hypertension and its significance in pregnancy introduce this chapter. The latest recommendations on the diagnosis, management, and treatment of essential hypertension, pregnancy-induced hypertension, pre-eclampsia, eclampsia, and HELLP syndrome are included.

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Pregnancy Induced Hypertension (PIH): Beyond Pregnancy

International Journal of Women’s Health Care ◽

10.33140/ijwhc.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Stress Test ◽

Published Data ◽

Chronic Hypertension ◽

Atherosclerotic Cardiovascular Disease ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Induced Hypertension

Contrary to the belief that pregnancy-induced hypertension (PIH, or hypertensive disorders of pregnancy, HDP) and preeclampsia are benign conditions that do not extend harm past pregnancy, the evidence is growing that preeclampsia is a risk factor for future cardiovascular disease. Although most published data indicate that proteinuria during pregnancy does no long-term harm to the mother, more recent reports indicate that preeclampsia increases the risk of cardiovascular disease [1-7]. Recent research published on November 11, 2019 in the Journal of the American College of Cardiology confirms that women who have gestational hypertension or preeclampsia in at least one pregnancy have a higher cardiovascular risk than women without this history [7]. The authors conclude that a history of HDP can be a useful tool to refine atherosclerotic cardiovascular disease risk assessments. They added “However, future risk of diverse cardiovascular conditions in asymptomatic middle-aged women with prior HDP remains unknown”. They also argued that “hypertensive disorders of pregnancy are associated with accelerated cardiovascular aging and more diverse cardiovascular conditions than previously appreciated”, and commented that the cardiovascular risk after HDP is largely but not solely mediated by the development of chronic hypertension. Many authorities now regard pregnancy as a “cardiovascular stress test” [8].

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