Cardiovascular Health in the Postpartum Period

Khan, Sadiya S.; Grobman, William A.; Cameron, Natalie A.

doi:10.1001/jama.2023.19192

JAMA

2023

DOI: 10.1001/jama.2023.19192

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Cardiovascular Health in the Postpartum Period

Sadiya S. Khan,

William A. Grobman,

Natalie A. Cameron

Abstract: This article in the Women’s Health series discusses recent increases in US maternal death rates, disparities in rates by race and ethnicity, poor cardiovascular health (CVH) as one of the multifactorial causes, and clinical approaches to assessing and treating poor CVH postpartum.

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2024

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Cited by 3 publications

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Early postpartum blood pressure screening is associated with increased detection of cardiovascular risk factors in women with hypertensive disorders of pregnancy

Daubert,

Stebbins,

Peragallo-Urrutia

et al. 2024

American Heart Journal

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Early postpartum blood pressure screening is associated with increased detection of cardiovascular risk factors in women with hypertensive disorders of pregnancy

Daubert,

Stebbins,

Peragallo-Urrutia

et al. 2024

American Heart Journal

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Treatment of Obesity Before, During, and After Pregnancy: Time for Obstetricians to Get Involved

Gustafson,

Al-Sayyed,

Minkoff

2024

Obstetrical &Amp; Gynecological Survey

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Importance Obesity is a major public health concern that is associated with serious health risks and consequences for people who want to be, are, or have been pregnant. Objective We will describe the implications and consequences of obesity, and describe the factors fueling obesity’s escalating prevalence. We will describe new treatment approaches including glucagon-like peptide-1 agonists, which may be an effective strategy for achieving weight loss and for improving the health of people who have been, are, or want to be pregnant. Evidence Acquisition Existing literature on obesity consequences, treatment options, and pregnancy implications was reviewed through a PubMed search Results Obesity has dire pregnancy-related health consequences and leads to multiple barriers to healthcare. Traditional interventions related to diet and exercise have fallen short, and newer medical therapies are emerging. Relevance The periods before, during, and after pregnancy are crucial to mitigate potential morbidities of pregnancy pre, peri, and post. Obstetricians have a unique opportunity to tackle the problem of obesity at those times. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner will be better able to identify health consequences associated with obesity before, during, and after pregnancy including maternal and fetal complications; discuss the factors contributing to the escalating prevalence of obesity in the United States; and explain therapeutic options and their efficacy in treating individuals with obesity who have been, are, or may become pregnant.

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Intact NOX2 in T Cells Mediates Pregnancy-Induced Renal Damage in Dahl SS Rats

Dasinger,

Abais-Battad,

Walton

et al. 2024

Hypertension

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BACKGROUND: Hypertensive disorders of pregnancy are associated with increased risk for cardiovascular disease, renal disease, and mortality. While the exact mechanisms remain unclear, T cells and reactive oxygen species have been implicated in its pathogenesis. We utilized Dahl salt-sensitive (SS), SS CD247 −/− (Dahl SS CD247 knockout rat; lacking T cells), and SS p67phox−/− (Dahl SS p67 phox [NOX2 (NADPH oxidase 2)] knockout rat; lacking NOX2) rats to investigate these mechanisms in primigravida and multigravida states. METHODS: We assessed blood pressure and renal damage phenotypes in SS, SS CD247−/− , and SS p67phox−/− rats during primigravida and multigravida states. To investigate the contribution of NOX2 in T cells, we performed adoptive transfers of splenocytes or CD4 + T cells from either SS or SS p67phox−/− donors into SS CD247−/− recipients to determine pregnancy-specific alterations in phenotype. RESULTS: Multigravida SS rats developed significant pregnancy-induced renal damage and renal functional impairment associated with elevated maternal mortality rates, whereas deletion of T cells or NOX2 garnered protection. During primigravida states, this attenuation in renal damage was observed, with the greatest protection in the SS p67phox−/− rat. To demonstrate that NOX2 in T cells contributes to adverse pregnancy phenotypes, adoptive transfer of SS splenocytes into SS CD247−/− rats resulted in significant pregnancy-induced renal damage, whereas transfer of SS p67phox−/− splenocytes garnered protection. Specifically, the transfer of SS CD4 + T cells resulted in pregnancy-induced proteinuria and increases in uterine artery resistance index, an effect not seen with the transfer of SS p67phox−/− CD4 + T cells. CONCLUSIONS: T cells and NOX2-derived reactive oxygen species, thus, contribute to end-organ damage in both primigravida and multigravida pregnancies in the SS rat leading to increases in maternal mortality.

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Cardiovascular Health in the Postpartum Period

Abstract: This article in the Women’s Health series discusses recent increases in US maternal death rates, disparities in rates by race and ethnicity, poor cardiovascular health (CVH) as one of the multifactorial causes, and clinical approaches to assessing and treating poor CVH postpartum.

Cited by 3 publications

References 7 publications

Early postpartum blood pressure screening is associated with increased detection of cardiovascular risk factors in women with hypertensive disorders of pregnancy

Early postpartum blood pressure screening is associated with increased detection of cardiovascular risk factors in women with hypertensive disorders of pregnancy

Treatment of Obesity Before, During, and After Pregnancy: Time for Obstetricians to Get Involved

Intact NOX2 in T Cells Mediates Pregnancy-Induced Renal Damage in Dahl SS Rats

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