Changes in biochemical tests in pregnancy and their clinical significance

Teasdale, Stephanie; Morton, Adam

doi:10.1177/1753495x18766170

Cited by 32 publications

(36 citation statements)

References 191 publications

(238 reference statements)

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“… 10 11 The increase in plasma volume and renal excretion during normal pregnancy may affect the levels of heart biomarkers used for ruling out heart failure (NTproBNP) or myocardial ischaemia (hs-cTNT). 12 Both biomarkers are affected by age and renal function. 13 14 NTproBNP is also related to body mass index (BMI), sexual hormone binding globulin and ethnicity.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

et al. 2020

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ObjectiveTo describe the intraindividual changes of heart biomarker levels during and after pregnancy and to evaluate existing cut-off levels for heart failure or myocardial ischaemia in pregnant women.MethodA total of 196 healthy pregnant women were recruited from maternal outpatient clinics and included in the study. Blood samples were obtained on four occasions: at 10–12 gestational weeks (gw), 20–25 gw, after delivery and 6 months postpartum and analysed for N-terminal pro-brain natriuretic peptide (NTproBNP) and high sensitive cardiac troponin T (hs-cTNT). Echocardiography ruled out existing cardiac disease. Estimated glomerular filtration rate (eGFR) was calculated.ResultsThere were significant changes in NTproBNP between the measurements with the highest NTproBNP at 10–12 gw and the lowest value being at 20–25 gw, (with eGFR being the highest). Hs-cTNT was significantly higher at the peripartum measurement compared with the other measurements (p<0.05). Regardless, the 95th percentile for both biomarkers was below cut-off levels of 300 ng/L for NTproBNP and 14 ng/L for hs-cTNT. There was an association between NTproBNP above the upper limit of normal of 125 ng/L and eGFR (p=0.04) and between hs-cTNT >5.0 ng/L and time from delivery to blood sample (p=0.001) at the peripartum measurement. Both were associated with the use of oxytocin.ConclusionExisting cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischaemia (hs-cTNT <14 ng/L) are applicable during pregnancy and after delivery. Elevated levels mandate further attention on cardiac symptoms and renal function.

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Section: Introductionmentioning

confidence: 99%

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

et al. 2020

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“…Previous studies in South Africa have examined the ability of POCT to diagnose GDM, with conflicting results [15,16], but confounders that may influence glucose evaluation during gestation are absent in the post-partum period. [17,18].…”

Section: Introductionmentioning

confidence: 99%

A comparison between point‐of‐care testing and venous glucose determination for the diagnosis of diabetes mellitus 6–12 weeks after gestational diabetes

et al. 2019

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Aim To evaluate point-of-care-testing (POCT) for the diagnosis of Type 2 diabetes mellitus 6-12 weeks post-partum in women with gestational diabetes (GDM).Methods Post-partum glucose assessment (75-mg oral glucose tolerance test, OGTT) was performed prospectively in 122 women with GDM (1 November 2015 to 1 November 2017) at Tygerberg Hospital, Cape Town, South Africa. Individuals with known pre-existing diabetes were excluded. The accuracy and clinical utility of POCT (capillary fingerprick) were compared with laboratory plasma glucose (hexokinase and glucokinase methods). The OGTT consisted of two time points (fasting and 2 h) during which concurrent glucose samples (POCT and laboratory) were obtained. Bland-Altman plots and paired analysis were used to assess the analytical accuracy of POCT, whereas its diagnostic performance was determined using positive and negative predictive values to calculate specificity and sensitivity.Results Spearman's ranked correlation analysis indicated a strong association between POCT and laboratory glucose values at both OGTT time points (fasting, r = 0.95, P < 0.0001; 2 h, r = 0.88, P < 0.0001). Thirty-six women were diagnosed with Type 2 diabetes based on gold standard laboratory glucose levels (fasting > 7 mmol/l; 2 h > 11.1 mmol/ l). POCT correctly identified Type 2 diabetes in 78% of women (28 of 36) with a positive predictive value of 89.3% and a negative predictive value of 96.7% at the fasting time point. The sensitivity and specificity of POCT to diagnose Type 2 diabetes were 89% (fasting), 85.7% (2 h) and 96.7% (fasting), 98.5% (2 h) respectively. POCT proved less sensitive to diagnose pre-diabetes (69%) but displayed satisfactory specificity (92%) at both time points assessed.Conclusion POCT accurately identifies women with Type 2 diabetes 6-12 weeks after GDM.

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“…Además, el embarazo es un estado de hiperaldosteronismo hiperreninémico, dado que el llenado vascular insuficiente detectado por los riñones, resultante de la disminución de la resistencia vascular y la presión arterial, estimula al sistema reninaangiotensina-aldosterona (SRAA) aunado a la producción del precursor de renina por los ovarios y la UFP, al estímulo de los estrógenos para la síntesis de angiotensinógeno y por el aumento de la actividad de la renina plasmática (1,6). No obstante, los efectos del aumento de la aldosterona (3 a 8 veces) se atenúan durante el embarazo, ya que hay: un efecto antagonista por la progesterona, producción de prostaciclina mediada por el factor de crecimiento endotelial vascular y modificaciones en los receptores de angiotensina I (6).…”

Section: Endocrinosunclassified

La gestación humana desde una perspectiva nutricional

Eligio

́an

López-Rodríguez

2020

ICSA

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La gestación en los seres humanos es un periodo de múltiples adaptaciones fisiológicas, entre las que destacan las endocrinas, cardiovasculares, hematológicas, gastrointestinales, renales y respiratorias, a través de las cuales el organismo materno garantiza el adecuado crecimiento y desarrollo del producto, satisfacer las necesidades de nutrientes y prepararse para el parto y la lactancia. El estado nutricional de la la mujer gestante, por carencia o exceso, impactará sobre su propio estado de salud y sobre la salud del producto, tanto a corto como largo plazo, así como sobre la posterior descendencia. Dado que el estado nutricional materno es un factor de riesgo potencialmente modificable, es necesario evaluar e intervenir a través de la atención prenatal, e incluso preconcepcional. Este trabajo tiene por objetivo realizar una revisión de la evidencia reciente sobre la nutrición y los nutrientes esenciales del binomio madre-hijo.

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Changes in biochemical tests in pregnancy and their clinical significance

Cited by 32 publications

References 191 publications

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

A comparison between point‐of‐care testing and venous glucose determination for the diagnosis of diabetes mellitus 6–12 weeks after gestational diabetes

La gestación humana desde una perspectiva nutricional

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