High risk and low prevalence diseases: Eclampsia

Natesan, Sreeja; Koyfman, Alex; Long, Brit

doi:10.1016/j.ajem.2022.06.004

Cited by 10 publications

(2 citation statements)

References 48 publications

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“…Studies have shown that more than one-third of eclampsia cases occur acutely (with no signs or symptoms of preeclampsia preceding the seizures), approximately 20% of eclampsia cases occur in the setting of mild hypertension, and blood pressure may be normal in 25% of patients, so the degree of hypertension may not predict eclampsia. 24,[30][31][32][33] In addition, this evaluation of in-hospital mortality likely provides more accurate CVD-related PMR than rates obtained from vital registration data which relies on the standardised pregnancy checkbox on death certificates. The NRD does not share the same potential inflation of PMRs due to the pregnancy checkbox issue previously observed with death certificate data.…”

Section: Strengths Of the Studymentioning

confidence: 99%

Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

Lee,

Brandt,

Joseph

et al. 2024

Paediatric Perinatal Epid

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BackgroundReported rates of maternal mortality in the United States have been staggeringly high and increasing, and cardiovascular disease (CVD) is a chief contributor to such deaths. However, the impact of hypertensive disorders of pregnancy (HDP) on the short‐term risk of cardiovascular death is not well understood.ObjectivesTo evaluate the association between HDP (chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia) and pregnancy‐associated mortality rates (PMR) from all causes, CVD‐related causes both at delivery and within 1 year following delivery.MethodsWe used the Nationwide Readmissions Database (2010–2018) to examine PMRs for females 15–54 years old. International Classification of Disease 9 and 10 diagnosis codes were used to identify pregnancy‐associated deaths due to HDP and CVD. Discrete‐time Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality at delivery (0 days) and at <30, <60, <90, <180, and <365 days after delivery in relation to HDP.ResultsOf 33,417,736 hospital deliveries, the rate of HDP was 11.0% (n = 3,688,967), and the PMR from CVD was 6.4 per 100,000 delivery hospitalisations (n = 2141). Compared with normotensive patients, HRs for CVD‐related PMRs increased with HDP severity, reaching over 58‐fold for eclampsia patients. HRs were higher for stroke‐related (1.2 to 170.9) than heart disease (HD)‐related (0.99 to 39.8) mortality across all HDPs. Except for gestational hypertension, the increased risks of CVD mortality were evident at delivery and persisted 1 year postpartum for all HDPs.ConclusionsHDPs are strong risk factors for pregnancy‐associated mortality due to CVD at delivery and within 1 year postpartum; the risks are stronger for stroke than HD‐related PMR. While absolute PMRs are low, this study supports the importance of extending postpartum care beyond the traditional 42‐day postpartum visit for people whose pregnancies are complicated by hypertension.

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Section: Strengths Of the Studymentioning

confidence: 99%

Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

Lee,

Brandt,

Joseph

et al. 2024

Paediatric Perinatal Epid

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“…Approximately 25% of pregnant women may develop the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) or atypical PE, which causes increased liver enzymes, thrombocytopenia, and low platelet levels [7,11,12]. Eclampsia is another severe complication of PE, which may manifest in 0.3% of live births; however, the incidence rates vary significantly based on maternal risk factors, economic disparities, and access to quality prenatal care [13]. It often manifests alongside tonic-clonic seizures in pregnant women with PE, despite the absence of other causes of seizures during the gestational period, the presence of which would cause even greater multisystem deterioration in the offspring [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental Disruptions in Children of Preeclamptic Mothers: Pathophysiological Mechanisms and Consequences

González-Rojas,

Valencia-Narbona

2024

IJMS

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Preeclampsia (PE) is a multisystem disorder characterized by elevated blood pressure in the mother, typically occurring after 20 weeks of gestation and posing risks to both maternal and fetal health. PE causes placental changes that can affect the fetus, particularly neurodevelopment. Its key pathophysiological mechanisms encompass hypoxia, vascular and angiogenic dysregulation, inflammation, neuronal and glial alterations, and disruptions in neuronal signaling. Animal models indicate that PE is correlated with neurodevelopmental alterations and cognitive dysfunctions in offspring and in humans, an association between PE and conditions such as cerebral palsy, autism spectrum disorder, attention deficit hyperactivity disorder, and sexual dimorphism has been observed. Considering the relevance for mothers and children, we conducted a narrative literature review to describe the relationships between the pathophysiological mechanisms behind neurodevelopmental alterations in the offspring of PE mothers, along with their potential consequences. Furthermore, we emphasize aspects pertinent to the prevention/treatment of PE in pregnant mothers and alterations observed in their offspring. The present narrative review offers a current, complete, and exhaustive analysis of (i) the pathophysiological mechanisms that can affect neurodevelopment in the children of PE mothers, (ii) the relationship between PE and neurological alterations in offspring, and (iii) the prevention/treatment of PE.

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Neurologic complications in the obstetric patient

Nobleza

2024

The Brain of the Critically Ill Pregnant Woman

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High risk and low prevalence diseases: Eclampsia

Cited by 10 publications

References 48 publications

Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy

Neurodevelopmental Disruptions in Children of Preeclamptic Mothers: Pathophysiological Mechanisms and Consequences

Neurologic complications in the obstetric patient

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