The Incidence of Pregnancy-Induced Hypertension Among Patients With Carbohydrate Intolerance

Roach, Vijay; Hin, Lin-Yee; Tam, Wing Hung; Ng, Kwee Boon; Rogers, Michael S.

doi:10.1081/prg-100100134

Cited by 21 publications

(9 citation statements)

References 15 publications

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“…17 Markers of oxidative stress are also correlated with markers of vascular endothelial damage, such as N-acetylb-glucosaminidase, 18 which are known to have a predictive value for pre-eclampsia. 19 There is an established association between gestational hypertension, pre-eclampsia and gestational diabetes mellitus (GDM) 20 as pregnancy provides a stress test for both glucose intolerance and hypertension and for other abnormalities associated with insulin resistance. Oxidative stress may therefore play an important role in the development of gestational hypertension and pre-eclampsia where there is a background of glucose intolerance.…”

Section: Introductionmentioning

confidence: 99%

Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre‐eclampsia

Rogers

Wang

Tam

et al. 2006

BJOG

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Objectives To explore the relationship between the levels of maternal oxidative stress and glycaemia during pregnancy and to compare the predictive values of 8-epimer of prostaglandin F 2alpha ) and mean arterial pressure (MAP) in midpregnancy for the development of hypertensive complications in later pregnancy.Design Prospective observational study as an ancillary study to the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study.Setting Obstetric clinics and wards of a university teaching hospital in Hong Kong.Population Selected women with singleton pregnancies attending the antenatal clinic.Methods Pregnant women who met HAPO inclusion criteria were recruited for the study. Glucose tolerance was assessed by a 75-g 2-hour oral glucose tolerance test (OGTT) at 24-32 weeks of gestation. Fasting plasma samples for 8-isoPGF 2a estimation and urine samples for 8-isoPGF 2a and 2,3-dinor 8-isoPGF 2a assays were collected and blood pressures measured during the OGTT visit. Random plasma and urine samples were also obtained at 34-37 weeks. Glucose results were unblinded to the attending obstetrician if limits preset under the HAPO protocol were met.Main outcome measures Maternal plasma 8-isoPGF 2a and urinary 8-isoPGF 2a and 2,3-dinor 8-isoPGF 2a both at the time of OGTT (24-32 weeks) and at 34-37 weeks of gestation. Incidence of pre-eclampsia and gestational hypertension.Results Of the 408 women who attended for OGTT at 24-32 weeks, two met the glucose criteria for unblinding and 25 had missing 8-isoPGF 2a values and thus were excluded from analysis. Of the 381 women, 338 (88.7%) attended for random plasma samples at 34-37 weeks. Significant correlations were observed between maternal fasting plasma isoprostane and both fasting (r = 0.20; P < 0.001) and 2-hour (r = 0.39; P < 0.001) plasma glucose levels at the time of OGTT. Gestational hypertension/ pre-eclampsia occurred in 17 (4.2%) women, and at the time of OGTT, they had significantly higher fasting plasma 8-isoPGF 2a (P < 0.001), urine 8-isoPGF 2a (P < 0.005) and urine 2,3-dinor 8-isoPGF 2a to creatinine ratios (P < 0.001), as well as higher MAP (P < 0.001) than women who remained normotensive. At 34-37 weeks, only random plasma 8-isoPGF 2a was significantly higher (P < 0.001) among the women with gestational hypertension/ pre-eclampsia.Conclusions Plasma markers of oxidative stress were positively correlated with plasma glucose at the time of OGTT (24-32 weeks). Women who subsequently developed gestational hypertension/pre-eclampsia had significantly higher plasma and urine markers of oxidative stress at the time of OGTT but only higher plasma markers at 34-37 weeks. Plasma 8-isoPGF 2a appears to be a very good predictor of subsequent gestational hypertension/pre-eclampsia when measured at the time of OGTT, but its ability to discriminate deteriorates as pregnancy advances.

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Section: Introductionmentioning

confidence: 99%

Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre‐eclampsia

Rogers

Wang

Tam

et al. 2006

BJOG

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“…Both pre-gestational diabetes and gestational diabetes mellitus (GDM) are associated with a two to fourfold increased risk of developing preeclampsia in pregnancy (113)(114)(115), named superimposed preeclampsia. In this context, this includes women with diabetes mellitus (pre-existing or gestationally induced) with development of preeclampsia in the present pregnancy.…”

Section: Diabetes Mellitus and Superimposed Preeclampsiamentioning

confidence: 99%

The decidual suction method: a new way of collecting decidual tissue for functional and morphological studies

Harsem¹,

Staff²,

et al. 2004

Acta Obstet Gynecol Scand

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Background. Studies of extravillous trophoblasts and placental bed spiral arteries are essential for a better understanding of pathological pregnancies such as preeclampsia, intrauterine growth restriction and diabetes mellitus. A major challenge is to obtain representative and sufficient tissue for morphological and functional investigations. Currently, tissue material is mostly harvested by placental bed biopsy (PBB). We describe a new suction method to obtain a larger volume of decidual tissue from the placental bed. Methods. Tissue was harvested in 51 cesarean sections by vacuum suction of the placental bed. Sections from formalin‐fixed, paraffin‐embedded tissue were routinely stained with hematoxylin and eosin (H&E), immunostained with a panel of antibodies and morphologically examined for the presence of trophoblasts and spiral arteries. The results were compared with those from archive material from PBBs and placental basal plate sections (BPSs). Short‐term adverse events were registered for the study patients. Long‐term complications were registered from medical charts of 151 women having undergone the decidual suction method (DSM), with a follow‐up of 38–60 months. Results. In 86% (n = 44), one random section from the decidual suction material demonstrated at least one spiral artery. In 37% (n = 19), six or more spiral arteries were present. All sections revealed extravillous trophoblasts. No short‐ or long‐term morbidity was recorded. Conclusions. The decidual suction method represents an important improvement in the work to obtain sufficient decidual tissue for morphological and functional studies of extravillous trophoblast function and spiral artery adaptation. The method is safe, as no short‐ or long‐term complications were registered.

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“…Preeclampsia and DM share many pathophysiological features, such as inflammation, oxidative stress, insulin resistance and endothelial dysfunction . Both pre‐gestational and gestational diabetes (GDM) are associated with an increased risk of developing preeclampsia . Lykke et al.…”

Section: Resultsmentioning

confidence: 99%

Angiogenic biomarkers in pregnancy: defining maternal and fetal health

Rasmussen

Lykke

Staff

2015

Acta Obstet Gynecol Scand

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We review diagnostic and predictive roles of the angiogenic proteins placental growth factor, soluble fms-like tyrosine kinase 1, and soluble endoglin in preeclampsia, and their association with future cardiovascular disease, diabetes, and breast cancer. Specific patterns of these proteins represent preeclamptic prediction markers and combined with maternal and clinical characteristics, the predictive values increase. Women experiencing preeclampsia have increased risks of developing cardiovascular diseases and diabetes, and a decreased risk of breast cancer. High placental growth factor concentrations have, in elderly patients, been shown to predict cardiovascular events. Diabetes is also a risk factor for future cardiovascular disease. Diabetic vascular complications are associated with increased soluble endoglin concentrations, and vascular endothelial growth factor concentrations are correlated to HbA1c and fasting glucose. Hence dysregulation in angiogenic proteins may link preeclampsia and cardiovascular diseases, targeting women who could in future benefit from prophylactic programs to possibly prevent, delay or reduce cardiovascular disease.

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The Incidence of Pregnancy-Induced Hypertension Among Patients With Carbohydrate Intolerance

Abstract: Patients with carbohydrate intolerance of varying severity are at increased risk of developing PIH. Our findings lend credence to the theory that carbohydrate intolerance and PIH share a common etiology.

Cited by 21 publications

References 15 publications

Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre‐eclampsia

Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre‐eclampsia

The decidual suction method: a new way of collecting decidual tissue for functional and morphological studies

Angiogenic biomarkers in pregnancy: defining maternal and fetal health

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