Independent Determinants of Maternal and Fetal Outcomes in a Sample of Pregnant Outpatients With Normal Blood Pressure, Chronic Hypertension, Gestational Hypertension, and Preeclampsia

Cicero, Arrigo F G; Esposti, Daniela Degli; Immordino, Vincenzo; Morbini, Martino; Baronio, Cristina; Rosticci, Martina; Borghi, Claudio

doi:10.1111/jch.12614

Cited by 17 publications

(24 citation statements)

References 28 publications

(49 reference statements)

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“…With or without proteinuria, pregnancy outcomes for the PE groups were poor compared with those of the GH group. Several studies have compared pregnancy outcomes in PE and GH . In a retrospective study of 579 patients with HDP (PE 213, GH 145, chronic hypertension [CH] 221), Cicero et al .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have compared pregnancy outcomes in PE and GH . In a retrospective study of 579 patients with HDP (PE 213, GH 145, chronic hypertension [CH] 221), Cicero et al . reported that, compared to other forms of hypertension or normotension, adverse maternal outcomes in PE had an OR of 2.0 (95% CI 1.3–3.1) and adverse neonatal outcomes in PE had an OR of 1.9 (95% CI 1.2–2.9), demonstrating that PE has a poorer prognosis for pregnant women and infants than GH or CH.…”

Section: Discussionmentioning

confidence: 99%

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Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Tochio

Obata

Saigusa

et al. 2019

J of Obstet and Gynaecol

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Aims: The Japanese Society for the Study of Hypertension in Pregnancy revised the diagnostic criteria for pre-eclampsia (PE) to conform to those of the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018. This study aimed to investigate whether pregnancy outcomes differ based on the presence of proteinuria and validate the adoption of the ISSHP criteria in Japan. Methods: This is a retrospective study involving 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center. They were divided into the following groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and gestational hypertension (n = 45) according to the ISSHP criteria for comparison of pregnancy outcomes. Results: Applying the ISSHP criteria increased the number of pregnant women diagnosed as having PE by 14.6% (45 women). The difference in the rate of composite maternal complications between the two groups was unremarkable, with 33 cases (15.1%) in the PE with proteinuria group and 9 cases (20%) in the PE without proteinuria group. Moreover, composite neonatal complications occurred in 37 cases (17%) of PE with proteinuria group and 6 cases (13.3%) of PE without proteinuria group, showing remarkably similar incidence rate in the two groups. Women with PE with and without proteinuria had significantly earlier deliveries and lower neonatal birth weight than those with gestational hypertension. Conclusion: Pregnancy outcomes of PE with and without proteinuria were almost similar although their incidence increased, confirming its validity for adaptation of the ISSHP criteria in Japan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Tochio

Obata

Saigusa

et al. 2019

J of Obstet and Gynaecol

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“…Moreover, identification of risk factors for each adverse outcome in preeclampsia could help target prevention and management. Earlier studies in this respect focused on certain kinds of risk factors and adverse outcomes, or investigated only one or two preeclampsia types . A comprehensive risk profile to identify the risk factor and outcome pairs in women with preeclampsia is still needed.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for adverse maternal and perinatal outcomes in women with preeclampsia: analysis of 1396 cases

Zhang

Lin

et al. 2018

J of Clinical Hypertension

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Preeclampsia is a major cause of adverse maternal and perinatal outcomes, but how to identify women and fetuses at increased risk for later adverse events is a challenge. This study aimed to investigate the risk factors for adverse maternal and perinatal outcomes in women with preeclampsia. Data from 1396 women with preeclampsia were retrospectively collected and analyzed. Eighteen candidate risk factors and 12 adverse outcomes were investigated. The following factors were found to be significantly associated with at least one adverse outcome: maternal age 35 years or older, multiple birth, the usage of assisted reproductive technology, living in a rural area, history of pregnancy‐induced hypertension, male fetus, multigravida, or having polycystic ovary syndrome, hemolysis, elevated liver enzymes, and low platelet count syndrome, intrahepatic cholestasis of pregnancy, cardiovascular disease, gestational diabetes mellitus, systemic lupus erythematosus, thyroid disease, or liver disease. Compared with patients without any identified risk factors, patients with preeclampsia with three or more risk factors were at increased risk for severe adverse outcomes. Those findings demonstrated that maternal risk factors could be used as indicators supplementary to clinical symptoms and laboratory test results for the risk assessment in women with preeclampsia.

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“…The increase in BP in the first trimester of pregnancy, as well as the finding of an increase in BP before pregnancy, require immediate treatment and monitoring . The early management in these patients reduces the rate of complications during pregnancy and could explain the reason why only PE was found to be associated with negative outcome in the study by Cicero and colleagues …”

mentioning

confidence: 98%

“…3 The early management in these patients reduces the rate of complications during pregnancy and could explain the reason why only PE was found to be associated with negative outcome in the study by Cicero and colleagues. 1 PE is the most severe form of hypertension in pregnancy, characterized by proteinuria and edema in the third trimester of pregnancy. Its pathogenesis is still debated and involves different hormonal, inflammatory, and immunologic mechanisms.…”

mentioning

confidence: 99%

Maternal and Fetal Outcomes in Preeclampsia: Interrelations Between Insulin Resistance, Aldosterone, Metabolic Syndrome, and Polycystic Ovary Syndrome

Armanini

Sabbadin

Donà

et al. 2015

J of Clinical Hypertension

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3Cicero and colleagues 1 have reported an interesting study on the independent determinants of maternal and fetal outcomes in a group of pregnant patients with different forms of hypertension. The diagnosis of preeclampsia (PE) and increased serum acid uric level have been found to be associated with negative maternal outcomes, while diagnosis of PE and pre-pregnancy maternal body mass index (BMI) were associated with negative fetal outcome. In both cases, the effective treatment of hypertension both during pregnancy and at delivery was a protective factor.Hypertension in pregnancy is a major risk factor for adverse outcomes both for the mother and for the fetus, and early therapeutic management is necessary not only to optimize blood pressure (BP) values but also to monitor and prevent the related complications such as metabolic syndrome, microalbuminuria, BMI, and gestational diabetes.Many studies recommend pre-pregnancy planning, therapeutic adjustments, and adequate care during and after pregnancy in women with chronic hypertension. 2The increase in BP in the first trimester of pregnancy, as well as the finding of an increase in BP before pregnancy, require immediate treatment and monitoring.3 The early management in these patients reduces the rate of complications during pregnancy and could explain the reason why only PE was found to be associated with negative outcome in the study by Cicero and colleagues. 1 PE is the most severe form of hypertension in pregnancy, characterized by proteinuria and edema in the third trimester of pregnancy. Its pathogenesis is still debated and involves different hormonal, inflammatory, and immunologic mechanisms.4 PE is a characteristic complication of pregnancy, which is usually reversed after delivery and can relapse in a subsequent pregnancy. An abnormal invasion of miometrium by trophoblast is an evident alteration, but the initial cause is still unknown. The evidence of early alterations of the placental vasculature suggests that the disease has a preclinical period with few symptoms and is often not treated because BP is normal. The pathogenesis of PE is promoted by genetic and epigenetic factors and is likely related to the release into the circulation of placental factors that can activate the immune cells in an inappropriate manner. A supporting feature to this hypothesis is the development of PE in patients with hydatidiform mole in the absence of a fetus. The onset of the disease in the third trimester is sometimes dramatic and frequently associated with liver, kidney, heart, coagulation, and neurological complications, which need full treatment, careful monitoring, and often an urgent cesarean section to avoid maternal and fetal complications. PE: INTERRELATIONSHIP BETWEEN INSULIN RESISTANCE, INFLAMMATION, METABOLIC SYNDROME, AND PCOSCicero and collaborators evaluated some determinants of maternal and fetal outcomes, but genetic and epigenetic factors are also involved in hypertension in pregnant women. The focus of research is to find the pathogenetic mechanism...

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Independent Determinants of Maternal and Fetal Outcomes in a Sample of Pregnant Outpatients With Normal Blood Pressure, Chronic Hypertension, Gestational Hypertension, and Preeclampsia

Cited by 17 publications

References 28 publications

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Risk factors for adverse maternal and perinatal outcomes in women with preeclampsia: analysis of 1396 cases

Maternal and Fetal Outcomes in Preeclampsia: Interrelations Between Insulin Resistance, Aldosterone, Metabolic Syndrome, and Polycystic Ovary Syndrome

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