Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines

Gillon, Tessa; Pels, Anouk; Dadelszen, Peter von; MacDonell, Karen L.; Magee, Laura A.

doi:10.1371/journal.pone.0113715

Cited by 177 publications

(156 citation statements)

References 34 publications

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“…Antihypertensives are used routinely to prevent malignant hypertension and seizures in pregnant women. 31 A meta-analysis (23 randomized trials) concluded that antihypertensive therapies in pregnant women do not lower the incidence of preeclampsia; however, they may reduce the risk of uncontrolled hypertension, which itself may be an indication for preterm delivery. 32 Although women with preeclampsia are intravascular volume depleted, the use of diuretics in preeclampsia may be beneficial, especially in the setting of cerebral or pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

227

145

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Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasmaspecific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP $140 mmHg or diastolic BP $90 mmHg, new onset protein/creatinine ratio .0.30 g/g, and sFlt-1/placental growth factor ratio .85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

227

145

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“…Quanto ao consumo de leite e derivados, especificamente para a população gestante, as recomendações do Ministério da Saúde brasileiro são para o consumo de três porções diárias destes e nas versões integrais, salvo orientações de nutricionistas ou outros profissionais da saúde 3 . Deste modo, também deve ser visto como um possível movimento em direção a comportamentos mais saudáveis o maior percentual das gestantes com consumo regular de leite integral, sendo o leite uma importante fonte de cálcio, micronutriente relacionado à proteção de hipertensão na gestação 34 . A orientação para o consumo da versão integral justifica-se já que as vitaminas lipossolúveis (A, D, E e K) presentes no leite estão associadas aos glóbulos de gordura presentes nestes alimentos 35 .…”

Section: Discussionunclassified

Práticas alimentares de gestantes e mulheres não grávidas: há diferenças?

Gomes¹,

Malta²,

Martiniano³

et al. 2015

Rev. Bras. Ginecol. Obstet.

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ResumoOBJETIVOS: Conhecer o comportamento alimentar de gestantes assistidas pela atenção primária à saúde e compará-lo ao de mulheres em idade fértil das capitais brasileiras. MÉTODOS: Estudo transversal realizado no segundo trimestre gestacional com 256 gestantes, sorteadas dentre as assistidas pelas unidades de atenção primária à saúde de um município do interior paulista em 2009/2010. As práticas alimentares foram investigadas utilizando questionário adaptado do sistema Vigitel, composto por questões acerca de comportamentos alimentares em geral e frequência e características de consumo de grupos alimentares/alimentos específicos. Para a comparação foram utilizados os indicadores reportados pelo sistema Vigitel para as mulheres em idade fértil das capitais brasileiras no ano de 2010. As análises envolveram a apresentação de distribuição de frequências e estatísticas descritivas (distribuição de frequências ou médias e respectivos intervalos de confiança) com comparações de acordo com faixa etária. RESULTADOS: A maioria das gestantes consumia o café da manhã todos os dias (86,7%); a troca da refeição principal por lanche uma ou duas vezes por semana era o hábito de 45,7%. O consumo diário de frutas, salada crua, verduras e legumes não ocorria, respectivamente, em 48,8, 41,8 e 55,1% das gestantes. Peixe foi relatado como nunca ou quase nunca consumido por 64,4% das gestantes. Pelo menos uma vez por semana, 69,9% delas relataram consumo de refrigerante e 86,4% de bolacha/biscoito. Comparando as gestantes e mulheres em idade fértil das capitais brasileiras, a prevalência de excesso de peso foi bastante parecida e não houve diferenças entre o consumo regular de frutas e hortaliças. Carne com excesso de gordura e leite integral foram mais consumidos pelas gestantes, com diferenças em todas as faixas etárias analisadas. Por outro lado, gestantes tiveram menor ingestão regular de refrigerantes. CONCLUSÕES: Devem ser variadas e de grande importância as ações a serem praticadas na atenção pré-natal, desde promover o consumo de alimentos específicos até orientações sobre comportamentos alimentares, não deixando de reforçar os hábitos alimentares saudáveis já concretizados. Abstract PURPOSE:To determine the eating behavior of pregnant women assisted by primary health care and to compare it with women at childbearing age in Brazilian capitals. METHODS: A cross-sectional study conducted on 256 pregnant women in the second trimester of gestation, selected by drawing lots from those assisted by primary health care units of a municipality in the state of São Paulo in 2009/2010. Eating habits were investigated via a questionnaire adapted from the VIGITEL system, consisting of questions about eating habits in general and the frequency and consumption characteristics of food groups/specific foods. For tis comparison, we used the indicators reported by the VIGITEL system for women at childbearing age in Brazilian capitals in 2010. The analyses involved the presentation of frequency distribution and descriptive statistics with com...

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“…3 Identify and treat diseases and complications (e.g., preexisting diabetes, renal insufficiency, hypertension, anemia, and infections) that may affect maternal, fetal, and neonatal health before conception [121,269,277,278,279,280,281]. …”

Section: Consensus Recommendationsmentioning

confidence: 99%

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

124

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Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

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Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines

Cited by 177 publications

References 34 publications

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Práticas alimentares de gestantes e mulheres não grávidas: há diferenças?

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

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