Hypertensive Disorders of Pregnancy

Khedagi, Apurva; Bello, Natalie A.

doi:10.1016/j.ccl.2020.09.005

Cited by 99 publications

(65 citation statements)

References 54 publications

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“…However, we can explain our low prevalence based on having selected only women with late-onset GDM for our study, avoiding those women who might present unrecognized type 1 or 2 diabetes prior to pregnancy that show a higher risk of cardiovascular diseases, including hypertension. Secondly, based on international guidelines [ 14 , 19 ], our hospital protocol includes low-dose aspirin prophylaxis for pregnant women with risk factors for HDP development, which accounts for a lower risk of developing HDP.…”

Section: Discussionmentioning

confidence: 99%

“…Gestational hypertension was defined as hypertension (>140/90 mmHg) in a woman who was normotensive before the 20th week of gestation and whose BP returned to normal by 12 weeks after delivery. Preeclampsia was defined as the new onset of hypertension after the 20th week of gestation in a previously normotensive woman, and develops proteinuria or end-organ dysfunction [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Angiogenic Imbalance and Inflammatory Biomarkers in the Prediction of Hypertension as Well as Obstetric and Perinatal Complications in Women with Gestational Diabetes Mellitus

Lara-Barea

Sánchez-Lechuga

Campos‐Caro

et al. 2022

JCM

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Gestational diabetes mellitus (GDM) increases the risk of hypertensive disorders of pregnancy (HDP). We aimed to analyze the altered inflammatory markers and angiogenic factors among women with GDM to identify pregnant women at higher risk of developing HDP. Methods: This was a prospective study of 149 women without hypertension diagnosed in the third trimester with GDM. Inflammatory markers and angiogenic factors were measured at 28–32 weeks of pregnancy. Obstetric and perinatal outcomes were evaluated. Results: More than eight percent of the women developed HDP. Higher levels of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PIGF) ratio (4.9 ± 2.6 versus 2.3 ± 1.3, respectively; p < 0.001) and leptin (10.9 ± 0.8 versus 10.08 ± 1.1, respectively; p = 0.038), as well as lower levels of adiponectin (10.5 ± 1.3 versus 12.9 ± 2.7, respectively; p = 0.031), were seen in women who developed HDP versus normotensive women with GDM. A multivariable logistic regression analysis showed that adiponectin had a protective effect with 0.45-fold odds (0.23–0.83; p = 0.012), and that the sFlt-1/PIGF ratio was associated with 2.70-fold odds of developing HDP (CI 95%: 1.24–5.86; p = 0.012). Conclusion: An increase in angiogenic imbalance in the sFlt-1/PIGF ratio in women with GDM was detected and may be an indicator of developing HDP in addition to any subsequent obstetric and perinatal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Angiogenic Imbalance and Inflammatory Biomarkers in the Prediction of Hypertension as Well as Obstetric and Perinatal Complications in Women with Gestational Diabetes Mellitus

Lara-Barea

Sánchez-Lechuga

Campos‐Caro

et al. 2022

JCM

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“…HPD including chronic hypertension, gestational hypertension (GH), and preeclampsia (PE) complicate 5% to 10% of pregnancies. They are associated with increased maternal and perinatal morbidity and mortality and a higher risk of developing post-partum hypertension and long-term CVD [ 103 , 104 ]. Accordingly, the latest European Society of Cardiology (ESC) Guidelines for managing arterial hypertension recommend a careful follow-up to assess BP and metabolic disorders in women with a history of HPD [ 23 ].…”

Section: Cardiovascular Gender-specific Risk Factorsmentioning

confidence: 99%

Update on Management of Cardiovascular Diseases in Women

Lucà¹,

Abrignani

Parrini

et al. 2022

JCM

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Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.

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“…Common first-line outpatient anti-hypertensives with demonstrated safety in pregnant women are beta-blockers, specifically labetalols (initial dose 100–200 mg twice daily, increasing as needed to 800 mg every 8 to 12 h for a maximum 2400 mg per day), dihydropyridine calcium-channel blockers such as extended-release nifedipine (30–60 mg daily, maximum 120 mg per day) and methyldopa (250 mg twice or three times daily, to maximum dose 3000 mg per day) [ 18 , 84 ]. Hydralazine or diuretics such as hydrochlorothiazide can be considered a second-line agent [ 18 , 85 ].…”

Section: Preventive Care and Counseling Before And During Pregnancymentioning

confidence: 99%

Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention

Thakkar

Hailu

Blumenthal

et al. 2022

Curr Atheroscler Rep

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Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention. Recent Findings Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the “fourth trimester,” 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. Summary While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.

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Hypertensive Disorders of Pregnancy

Cited by 99 publications

References 54 publications

Angiogenic Imbalance and Inflammatory Biomarkers in the Prediction of Hypertension as Well as Obstetric and Perinatal Complications in Women with Gestational Diabetes Mellitus

Angiogenic Imbalance and Inflammatory Biomarkers in the Prediction of Hypertension as Well as Obstetric and Perinatal Complications in Women with Gestational Diabetes Mellitus

Update on Management of Cardiovascular Diseases in Women

Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention

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