scholarly journals Pre-Pregnancy Obesity vs. Other Risk Factors in Probability Models of Preeclampsia and Gestational Hypertension

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2681 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Barbara Więckowska ◽  
Stefan Sajdak ◽  
Jan Lubiński
Keyword(s):  
Risk Factors ◽  
Maternal Obesity ◽  
Gestational Hypertension ◽  
Continuous Variable ◽  
Vitamin Supplementation ◽  
Extended Model ◽  
Probability Models ◽  
Hypertension In Pregnancy ◽  
Net Reclassification Improvement ◽  
In Pregnancy

In the face of the obesity epidemic around the world, attention should be focused on the role of maternal obesity in the development of pregnancy. The purpose of this analysis was to evaluate the prediction of preeclampsia (PE) and isolated gestational hypertension (GH) for a number of maternal factors, in order to investigate the importance of pre-pregnancy obesity (body mass index, BMI ≥ 30 kg/m2), compared to other risk factors (e.g., prior PE, pregnancy weight gain (GWG), infertility treatment, interpregnancy interval, family history, the lack of vitamin supplementation, urogenital infection, and socioeconomic factors). In total, 912 women without chronic diseases were examined in a Polish prospective cohort of women with a single pregnancy (recruited in 2015–2016). Separate analyses were performed for the women who developed GH (n = 113) vs. 775 women who remained normotensive, as well as for those who developed PE (n = 24) vs. 775 controls. The probability of each disease was assessed for the base prediction model (age + primiparity) and for the model extended by one (test) variable, using logistic regression. Three measures were used to assess the prediction: area under curve (AUC) of the base and extended model, integrated discrimination improvement (IDI) (the index shows the difference between the value of the mean change in the predicted probability between the group of sick and healthy women when a new factor is added to the model), and net reclassification improvement (NRI) (the index focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including results for healthy and sick women). In the GH prediction, AUC increased most strongly when we added BMI (kg/m2) as a continuous variable (AUC = 0.716, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.068, p < 0.001). The addition of BMI as a continuous variable or BMI ≥ 25 kg/m2 improved the classification for healthy and sick women the most (NRI = 0.571, p < 0.001). In the PE prediction, AUC increased most strongly when we added BMI categories (AUC = 0.726, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.050, p = 0.080). The addition of BMI categories improved the classification for healthy and sick women the most (NRI = 0.688; p = 0.001). After summing up the results of three indexes, the probability of hypertension in pregnancy was most strongly improved by BMI, including BMI ≥ 25 kg/m2 for the GH prediction, and BMI ≥ 30 kg/m2 for the PE prediction. Main conclusions: Pre-pregnancy BMI was the most likely factor to increase the probability of developing hypertension in pregnancy, compared to other risk factors. Hierarchies of PE and GH risk factors may suggest different (or common) mechanisms of their development.

scholarly journals Some Risk Factors for Low Birthweight Infants at Manado Hospital

2018 ◽  
Vol 35 (3-4) ◽  
pp. 94-100
Author(s):  
S. M. Salendu W. ◽  
Sutomo Raharjo ◽  
Immanuel Mustadjab ◽  
Nan Warouw
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Intrauterine Growth Retardation ◽  
Maternal Education ◽  
Low Birthweight ◽  
Term Infants ◽  
Intrauterine Growth ◽  
Hypertension In Pregnancy ◽  
History Of ◽  
In Pregnancy

The risk factors of low birthweight infants were assessed in a retrospective study covering 3607 singleton livebirth infants at Manado Hospital from January until December 1993. The analysis confirmed that patterns of risk birthweight hypertension in pregnancy (P<0.01), maternal education (P<0.01), maternal age (P<0.05), and parity (P<0.01), marital status (P<0.01), history of abortion (P<0.05), and parity (P<0.01). Anemia in pregnancy was also associated with birthweight in low birth weight (P<0.05). Asymetric intrauterine growth retardation (Ponderal Index below 2.32) was found both in premature and term infants.

scholarly journals The XXI International Society of Hypertension in Pregnancy meeting, São Paulo, Brazil – A global health perspective

2017 ◽  
Vol 10 (1) ◽  
pp. 30-32
Author(s):  
Sumedha Sharma
Keyword(s):  
Maternal Health ◽  
International Society ◽  
Maternal Obesity ◽  
Sao Paulo ◽  
São Paulo ◽  
Hypertension In Pregnancy ◽  
Life Course Approach ◽  
Global North ◽  
Development Goals ◽  
In Pregnancy

The 21st International Society of Hypertension in Pregnancy (ISSHP) meeting was held in São Paulo, Brazil from 23 to 26 October 2016. The discourse at this Congress brought global maternal health into the foray among basic science and clinical research. In concordance with the United Nations sustainable development goals which warrant an integrated view to health with investments in adolescence and childhood, the research at Congress focussed on a ‘life course’ approach to maternal health – examining intergenerational effects of maternal obesity and hypertension on the behavioral and physical developments of infants. Bringing in research from the Global South highlighted inequities in treatment and management of women with hypertensive disorders of pregnancy, in addition to the challenges in adoption of recommendations generated in Global North. The evidence shared can serve as platform for further discourse on global maternal health and in generating accountability to close the ‘evidence to policy’ gap.

scholarly journals SAT-014 Insulin Treatment in Human Pregnancy Mitigates an Increased Risk of Postpartum Psychological Distress with Maternal Obesity in the Absence of a Pre-Existing Mood and Anxiety Disorder

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jessica S Jarmasz ◽  
Alexandrea Anderson ◽  
Margaret E Bock ◽  
Yan Jin ◽  
Peter A Cattini ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Maternal Obesity ◽  
Gestational Hypertension ◽  
Placental Lactogen ◽  
Mood And Anxiety Disorders ◽  
Increased Risk ◽  
Significant Difference ◽  
In Pregnancy

Abstract BACKGROUND: Pregnant women with obesity are at increased risk for peripartum depression. Maternal obesity is also associated with reduced human placental lactogen (hPL) levels, and decreased hPL transcripts were reported in women with clinical depression. In addition, hPL production may be rescued in women with obesity that were subsequently diagnosed with gestational diabetes and treated with insulin (INS). Objective: Study the effect of INS treatment in pregnancy on the risk for postpartum psychological distress (PPD) in women with and without obesity. Study Design: Using data housed at the Manitoba Centre for Health Policy (2002–2017), cohorts of women (ages 15+) with a single live birth with and without obesity were developed using weight (≥85 and &lt;65.6 kg, respectively) and an average (1.63 m) height. Pre-existing mood and anxiety disorders within 5 years preceding delivery as well as gestational hypertension were excluded. After randomly selecting 1 birth per mother, cohorts were stratified by INS treatment during the gestational period. The risk of PPD within 1 year of delivery was assessed by Poisson regression analysis. Models were adjusted for maternal age and area-level income at delivery. Results: The risk of PPD was 27% greater among women with obesity versus without (adjusted rate ratio (aRR)=1.27, 95% CI 1.16–1.4, p&lt;0.0001). However, women with obesity treated with INS did not have a significantly different risk of PPD compared to women without obesity whether treated with INS (aRR=0.99, 95%CI 0.48–2.02, p=0.974) or not (aRR=1.16, 95%CI 0.86–1.56, p=0.328). This suggests that the risk of PPD among women with obesity may be reduced by INS treatment; however, our ability to detect a significant difference may be limited by small cohort numbers (46 women with obesity received INS in pregnancy) or confounders for receiving INS in pregnancy. Direct comparison of INS treatment within weight groups faced the same limitations but trended toward a reduction in women with obesity who received INS (aRR=0.91, 95%CI 0.68–1.22, p=0.531). The positive association between INS treatment in pregnancy and decreased risk of PPD in women with obesity was lost when pre-existing mood and anxiety disorder was not excluded. Inclusion of pre-existing diabetes in the adjusted models did not improve model fit or contribute significantly to the differences in PPD rates. Conclusions: Maternal obesity increases the risk for PPD but this risk may be reduced by gestational INS treatment in the absence of a pre-existing mood and anxiety disorders. This correlates with the decrease and increase in hPL levels reported previously with maternal obesity without and with INS treatment (for diabetes) in pregnancy, respectively. Thus, hPL levels may serve as a possible indicator of PPD risk and a potential target for gestational INS treatment.

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 Hypertension in pregnancy in general practice

2019 ◽  
Vol 23 (2) ◽  
pp. 15-20
Author(s):  
Irina Е. Moiseeva
Keyword(s):  
Pregnant Women ◽  
Negative Impact ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Proper Treatment ◽  
Social Significance ◽  
Knowledge And Skills ◽  
Hypertension In Pregnancy ◽  
Treatment And Prevention ◽  
In Pregnancy

Hypertension occurs in 5–30% of pregnant women. Its medical and social significance is associated with the risk of a negative impact on the course of pregnancy and on the condition of the fetus and newborn.This requires from the general practitioner to have enough knowledge and skills in this area.Clinical variants of hypertension in pregnancy include pre-existing hypertension (chronic hypertension), gestational hypertension, chronic hypertension complicated by preeclampsia, and preeclampsia/eclampsia.The main tasks of general practitioners — early diagnosis, proper treatment and prevention of complications of hypertension in pregnant women.

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>

Serotonin risk factors for the development of hypertension in pregnancy

2014 ◽  
Vol 291 (4) ◽  
pp. 779-785 ◽  
Author(s):  
Senka Sabolovic Rudman ◽  
Maja Mustapic ◽  
Vesna Kosec ◽  
Nela Pivac ◽  
Franjo Rudman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hypertension In Pregnancy ◽  
In Pregnancy
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