Influence of non-dipping pattern of blood pressure in gestational hypertension on maternal cardiac function, hemodynamics and intrauterine growth restriction

Ilić, Aleksandra; Ilić, Djordje; Tadić, Snežana; Stefanović, Maja; Stojsic-Milosavljevic, Anastazija; Pavlović, Katica; Redžek, Aleksandar; Velicki, Lazar

doi:10.1016/j.preghy.2017.05.003

Cited by 14 publications

(16 citation statements)

References 34 publications

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“…To our knowledge, this is the first study looking comprehensively at biventricular function and utilizing speckle-tracking assessment. Obesity in pregnancy is a strong risk factor for the development of hypertensive disorders of pregnancy, fetal growth restriction and gestational diabetes, all of which have been shown to be associated with significant deficits in maternal cardiovascular function [28][29][30][31][32][33] . By excluding from our prospective study obese women who developed these complications, we may have inadvertently introduced exclusion bias by not studying obese women who developed cardiac dysfunction as a consequence of these pregnancy complications.…”

Section: Discussionmentioning

confidence: 99%

Cardiac maladaptation in obese pregnant women at term

Buddeberg

Sharma

O’Driscoll

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Obesity is an increasing problem worldwide, with well recognized detrimental effects on cardiovascular health; however, very little is known about the effect of obesity on cardiovascular adaptation to pregnancy. The aim of the present study was to compare biventricular cardiac function at term between obese pregnant women and pregnant women with normal body weight, utilizing conventional echocardiography and speckle-tracking assessment. Methods This was a prospective case-control study of 40 obese, but otherwise healthy, pregnant women with a body mass index (BMI) of ≥ 35 kg/m 2 and 40 healthy pregnant women with a BMI of ≤ 30 kg/m 2. All women underwent a comprehensive echocardiographic examination and speckle-tracking assessment at term. Results Obese pregnant women, compared with controls, had significantly higher systolic blood pressure (117 vs 109 mmHg; P = 0.002), cardiac output (6.73 vs 4.90 L/min; P < 0.001), left ventricular (LV) mass index (74 vs 64 g/m 2 ; P < 0.001) and relative wall thickness (0.43 vs 0.37; P < 0.001). Diastolic dysfunction was present in five (12.5%) controls and 16 (40%) obese women (P = 0.004). In obese women, compared with controls, LV global longitudinal strain (-15.59 vs-17.61%; P < 0.001), LV endocardial (-17.30 vs-19.84%; P < 0.001) and epicardial (-13.10 vs-15.73%; P < 0.001) global longitudinal strain as well as LV early diastolic strain rate (1.05 vs 1.24 /s; P = 0.006) were all significantly reduced. No differences were observed in the degree of LV twist and torsion between the two groups. Conclusions Morbidly obese, but otherwise healthy, pregnant women at term had significant LV hypertrophy with evidence of diastolic dysfunction and impaired

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Section: Discussionmentioning

confidence: 99%

Cardiac maladaptation in obese pregnant women at term

Buddeberg

Sharma

O’Driscoll

et al. 2019

Ultrasound in Obstet & Gyne

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“…Similarly, we have revealed that longitudinal systolic function is significantly reduced in women with GH and non-dipping pattern of BP, compared with both, normotensive pregnant women and those who developed GH with dipping pattern of Blood Pressure -From Bench to Bed BP, without the difference between normotensive and dippers in GH, as well as Vcf. Also, CO index was the most reduced, while Ees was the most increased in non-dippers [56].…”

Section: Systolic Function In Gestational Hypertension/preeclampsiamentioning

confidence: 87%

“…It is well known that nocturnal hypertension is associated with an exacerbation of endothelial damage in PE [55]. On the other hand, recent study has shown that the non-dipping pattern of BP in GH is associated with IUGR, preterm delivery and with the deterioration of maternal hemodynamics [56].…”

Section: Role Of 24-h Ambulatory Blood Pressure Monitoringmentioning

confidence: 99%

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Non-Dipping Patten of Blood Pressure and Gestational Hypertension

Ilić¹,

Ilić²,

Papović³

et al. 2018

Blood Pressure - From Bench to Bed

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Gestational hypertension (GH) is one of the entities of the hypertensive disorders in pregnancy (HDP), a major cause of maternal, fetal, and neonatal morbidity and mortality. Also, the HDP have been recognized as an important risk factor for cardiovascular diseases. Thus, women who develop GH or preeclampsia (PE) are at increased risk of hypertension, ischemic heart disease and stroke in later life. An ambulatory blood pressure monitoring (ABPM) takes an important role in diagnosing of hypertension in pregnancy. Also, it has been shown that ABPM had higher accuracy in the prediction of GH, premature childbirth and low birth weight, compared with the conventional blood pressure (BP) measurements. In addition, we have found that non-dipping pattern of BP is very highly related with worse pregnancy outcome in a term of preterm delivery and intrauterine growth restriction. Also, it is associated with worse maternal hemodynamics, more impaired systolic function and more pronounced cardiac remodeling compared to women with GH and dipping pattern of BP. This review aimedtoexplorethe(a)currentclassificationsoftheHDP;(b)pathogenesisofGHandPE;(c) physiological changes of BP and maternal hemodynamics in pregnancy; and (d) pathophysiological changes of BP and maternal cardiac function, especially in a term on BP pattern.

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“…Hypertension in pregnancy is often related to preeclampsia and eclampsia, however in this case it was present from before and there was no proteinuria [9]. The latest discoveries suggest that the loss of nocturnal BP drop (the so called non-dipping pattern) may be the main cause of cardiovascular dysfunction and hemodynamic impairment in pregnancy, rather than just hypertension by itself [10].…”

Section: Discussionmentioning

confidence: 99%

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

et al. 2019

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Introduction The incidence of aortic dissection ranges 3-5 cases per 100,000 person-years. In women under the age of 40 who acquire aortic dissection, almost half of the cases happen during pregnancy. Case outline We report a case of a 22-year-old pregnant woman in the 16th gestational week with a history of arterial hypertension and known aortic dilatation, who was admitted with aortic dissection. She underwent the Bentall procedure, in which her aortic valve, ascending aorta, and proximal part of the aortic arch were replaced using valved composite graft. On the next day, the evacuation abortion was made, since the fetus didn't survive the operation. Six years later, the patient stopped taking anticoagulation therapy and was admitted for prosthetic valve thrombosis, which was successfully treated with intravenous heparin. One year later, the patient died of a myocardial infarction due to coronary thromboembolism, confirmed on autopsy. Conclusion Preconceptional counseling in women with a known aortic disease is of the utmost importance. Aortic dissection in pregnant women is an acute life-threatening condition for both mother and fetus that should be managed by a multidisciplinary team. After a mechanical heart valve implantation, lifetime oral anticoagulants are mandatory.

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Influence of non-dipping pattern of blood pressure in gestational hypertension on maternal cardiac function, hemodynamics and intrauterine growth restriction

Cited by 14 publications

References 34 publications

Cardiac maladaptation in obese pregnant women at term

Cardiac maladaptation in obese pregnant women at term

Non-Dipping Patten of Blood Pressure and Gestational Hypertension

Pregnant woman survives aortic dissection, dies later of coronary embolism - a unique case of a non-compliant patient

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