Longitudinal changes in vascular function parameters in pregnant women with chronic hypertension and association with adverse outcome: a cohort study

Webster, Louise; Myers, Jenny; Nelson‐Piercy, Catherine; Mills, Charlotte; Watt-Coote, Ingrid; Khalil, Asma; Seed, Paul; Cruickshank, J.; Chappell, Lucy C

doi:10.1002/uog.19021

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…Moreover, AS is significantly higher in women with HDPs compared to normotensive pregnancies and further increases with disease severity [52] . In recent studies, we and others have demonstrated that AS measurements can detect altered hemodynamic responses in the first trimester of pregnancy in women who subsequently develop HDPs [53] , [54] , [55] , [56] , [57] , [58] . PWA parameters, CO, and FMD are also outcomes of interest in our study as they provide complementary information regarding overall vascular function and have been reported to be associated with HDPs.…”

Section: Discussionmentioning

confidence: 99%

Arterial stiffness measurements in pregnancy as a predictive tool for hypertensive disorders of pregnancy and preeclampsia: Protocol for a systematic review and meta-analysis

Forrest

Bourgeois

Pichette

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Discussionmentioning

confidence: 99%

Arterial stiffness measurements in pregnancy as a predictive tool for hypertensive disorders of pregnancy and preeclampsia: Protocol for a systematic review and meta-analysis

Forrest

Bourgeois

Pichette

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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“…In this line, Webster L. et al performed a longitudinal assessment of BP and vascular function parameters in 97 pregestational hypertensive pregnancies. They demonstrated that those who subsequently developed superimposed PE and SGA, SBP and DBP were significantly higher from the first trimester to delivery (23).…”

Section: Discussionmentioning

confidence: 99%

Perinatal outcomes of pregestational hypertension according to blood pressure range at 11–14 week scan: Impact of the 2017 ACC/AHA guidelines

et al. 2022

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ObjectiveThe aim of this study was to evaluate the impact on perinatal outcomes related to placental insufficiency with the application of the new 2017 ACC/AHA guidelines to a group of chronic hypertensive pregnancies during their first-trimester assessment.Study designThis retrospective cohort study included pregnancies with preconceptional hypertension and known perinatal outcomes. In the first trimester, a combined screening for preterm preeclampsia (p-PE) was performed, including blood pressure (BP), mean uterine artery Doppler, and maternal characteristics. Patients were divided, according to the 2017 ACC/AHA consensus, into the following groups: elevated or less, Stage 1, and Stage 2. For adverse perinatal outcome assessment, univariate and multivariate regression analyses were performed, considering the “elevated or less” group as a reference. Odds ratios (OR) were compared with linear trend analysis. The main outcomes measured were preterm PE and FGR < 3rd percentile.ResultsOf the 130 included patients, 59 (45.4%) were classified as elevated or less, 47 (36.2%) as Stage 1, and 24 (18.4%) as Stage 2. p-PE showed a significant increase according to BP range [7% (OR = 1.0), 19.6% (OR = 3.2), and 21.7% (OR = 3.7)]; trend p = 0.02, for elevated or less, Stage 1, and Stage 2, respectively. There was a non-significant increased trend of FGR < 3rd percentile according to the BP stage. The best multivariate predictive model for p-PE included a previous PE background (OR = 15) and mean arterial pressure in mmHg (OR = 1.1).ConclusionThe use of the 2017 ACC/AHA consensus in pregnancies with chronic hypertension identifies an intermediate risk group for placental-mediated diseases.

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“…A calibrated cuff-based blood pressure instrument, the arteriograph, will be used to obtain vascular readings, as recently used in a maternal hypertension trial [ 50 ]. Vascular health is included as a secondary outcome, as arterial function measures are more powerful than, and independent of, standard blood pressure for later prognosis [ 51 – 53 ].…”

Section: Interventionsmentioning

confidence: 99%

A multi-centered trial investigating gestational treatment with ursodeoxycholic acid compared to metformin to reduce effects of diabetes mellitus (GUARD): a randomized controlled trial protocol

Lovell

Mitchell

Ovadia

et al. 2022

Trials

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Background Each year in the UK, approximately 35,000 women develop gestational diabetes mellitus (GDM). The condition increases the risk of obstetric and neonatal complications for mother and child, including preeclampsia, preterm birth, and large for gestational age babies. Biochemical consequences include maternal hyperglycemia, neonatal hypoglycemia, and dyslipidemia. Metformin is the most commonly used firstline pharmacological treatment. However, there are concerns about its widespread use during pregnancy, due to its limited efficacy and potential safety concerns. Therefore, there is a need for additional therapies that improve both maternal–fetal glucose and lipid metabolism. Ursodeoxycholic acid (UDCA) is not currently used for treatment for GDM. However, it can improve glucose control in type 2 diabetes, and it improves fetal lipid profiles in gestational cholestasis. Consequentially, it is hypothesized that treatment with UDCA for women with GDM may improve both maternal metabolism and neonatal outcomes. The primary outcome of this trial is to assess the efficacy of UDCA compared with metformin to improve glucose levels in women with GDM. Methods The trial is a two-armed, open-label, multi-center, randomized controlled trial. Women are eligible if they have been diagnosed with GDM by an oral glucose tolerance test between 24 + 0 and 30 + 6 weeks’ gestation, and if they require pharmacological intervention. In total, 158 pregnant women will be recruited across seven NHS Trusts in England and Wales. Women who consent will be recruited and randomized to either metformin or UDCA, which will be taken daily until the birth of their baby. Maternal and neonatal blood samples will be taken to evaluate the impact of the treatments on maternal glucose control, and maternal and neonatal lipid metabolism. Maternal and fetal outcomes will be evaluated, and acceptability of UDCA compared with metformin will be assessed. Discussion This trial has the potential to identify a potential new treatment for women with GDM. If successful, a future large multi-center trial will be designed to investigate where decisions can be personalized to identify which women will respond more effectively to UDCA than alternatives to improve maternal and baby outcomes. Trial registration ClinicalTrials.gov NCT04407650.

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Longitudinal changes in vascular function parameters in pregnant women with chronic hypertension and association with adverse outcome: a cohort study

Abstract: There are persistent differences in vascular function parameters and brachial blood pressure through pregnancy in women with chronic hypertension who later develop adverse maternal and perinatal outcome. Further investigation of the possible clinical use of these findings is warranted.

Cited by 6 publications

References 41 publications

Arterial stiffness measurements in pregnancy as a predictive tool for hypertensive disorders of pregnancy and preeclampsia: Protocol for a systematic review and meta-analysis

Arterial stiffness measurements in pregnancy as a predictive tool for hypertensive disorders of pregnancy and preeclampsia: Protocol for a systematic review and meta-analysis

Perinatal outcomes of pregestational hypertension according to blood pressure range at 11–14 week scan: Impact of the 2017 ACC/AHA guidelines

A multi-centered trial investigating gestational treatment with ursodeoxycholic acid compared to metformin to reduce effects of diabetes mellitus (GUARD): a randomized controlled trial protocol

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