The long‐term cardiovascular impact of hypertension in pregnancy – A missed opportunity

Davis, Gregory K.; Henry, Amanda; Arnott, Clare; Brown, Mark

doi:10.1111/ajo.13335

Cited by 12 publications

(10 citation statements)

References 19 publications

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“…The uterine spiral artery has not experienced the changes of normal pregnancy, but still maintains the sensitivity to vasoconstrictive substances and relatively narrow diameter. This will lead to shallow placenta implantation than normal pregnancy, decreased blood perfusion, and a series of clinical symptoms of HDCP [ 21 ]. The increase of blood pressure after pregnancy will lead to the damage of vascular endothelium and the release of endogenous vasodilator factor, vasodilator factor, and NO.…”

Section: Discussionmentioning

confidence: 99%

Effects of Nifedipine and Labetalol Combined with Magnesium Sulfate on Blood Pressure Control, Blood Coagulation Function, and Maternal and Infant Outcome in Patients with Pregnancy-Induced Hypertension

Yu-ping

Zhang

2022

Computational and Mathematical Methods in Medicine

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Objective. The purpose is to investigate the influence of nifedipine, labetalol, and magnesium sulfate on blood pressure control, blood coagulation, and maternal and infant outcome in those suffering from pregnancy-induced hypertension (PIH). Methods. From January 2019 to April 2021, 100 participants with PIH in our center were randomly assigned to a control group and a research group. As a control, nifedipine combined with magnesium sulfate was administered. Nifedipine, labetalol, and magnesium sulfate were administered to the research group. The curative effect, blood pressure level, blood coagulation function, vascular endothelial function, and pregnancy comparisons were made between the two groups. Results. Based on the results of the study, the effective rate totaled 92.00%, while as for the control group, it was 80.0%, which indicates that there was a statistically significant difference between the effective rates of the research group and that of the control group, and the difference was statistically significant ( P < 0.05 ). Blood pressure and blood coagulation function did not differ significantly between the two groups before treatment, and the difference was not statistically significant ( P > 0.05 ). After treatment, both groups experienced a significant drop in systolic and diastolic blood pressure. After treatment, a higher PT index was found in the research group than in the control group. Likewise, the Fbg, D-D, and PLT were lower compared to those in the control group, and the difference was statistically significant ( P < 0.05 ). Neither group had significantly different vascular endothelial function before treatment, and the difference was not statistically significant ( P > 0.05 ). After treatment, the ET-1 of the two groups decreased, and the level of NO increased. There was a lower ET-1 in the research group than in the control group as well as a higher NO level in the research group than in the control group, and the difference was statistically significant ( P < 0.05 ). Compared with the pregnancy outcome, in comparison to the controls, the research group had a higher vaginal delivery rate. Significantly, fewer cases of fetal distress, intrauterine asphyxia, and placental abruption were reported in the research group than in the control group, and the difference was statistically significant ( P < 0.05 ). Conclusion. Nifedipine, in combination with magnesium sulfate and labetalol, is effective at treating PIH, reducing blood pressure, improving blood coagulation, preventing cardiovascular events and vascular endothelial function, and further improve the pregnancy outcome.

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Section: Discussionmentioning

confidence: 99%

Effects of Nifedipine and Labetalol Combined with Magnesium Sulfate on Blood Pressure Control, Blood Coagulation Function, and Maternal and Infant Outcome in Patients with Pregnancy-Induced Hypertension

Yu-ping

Zhang

2022

Computational and Mathematical Methods in Medicine

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“…In contrast, several in Groups 2 and 3 who visited the clinicians at six months clearly absorbed the significance of the condition for their future health, and two described the revelation as a “wake-up call” (M01 and M10). This finding has implications not only for future interventions, but for general antenatal, birthing and primary health services that have not, to date, conveyed the seriousness of HDP for women’s ongoing health [ 18 ]. This may be particularly important for women who experienced fewer HDP complications, with prior research demonstrating better risk perception among women with severe disease or whose infants were born preterm [ 31 ], and among those with a family history of CVD [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the established link with subsequent CVD, there is limited evidence from interventions aimed at women following HDP [ 16 ]. Moreover, Australian women have limited knowledge of how to maintain health after HDP [ 13 , 17 ] and follow-up programs are inadequate in helping them address risk factors and adopt healthier lifestyles [ 18 ]. Previous studies have identified that participants were generally eager to increase their understanding of HDP, and several expressed interest in lifestyle interventions to reduce their risk of future HDP and ongoing CVD [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Optimising mothers’ health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention

et al. 2022

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Background Hypertensive disorders of pregnancy have longer-term implications, increasing women’s lifetime cardiovascular disease risk. The Blood Pressure Postpartum study is a multi-centre randomised three-arm trial of interventions, ranging in intensity and including education and lifestyle coaching, to support women to maintain or adopt healthy eating and physical activity during the first postpartum year. This qualitative sub-study nested within the main trial aimed to investigate whether and how women adopted healthy behaviours after a pregnancy complicated by a hypertensive disorder. Methods Semi-structured telephone interviews were recorded, transcribed and analysed thematically, following Braun and Clarke principles. They explored behaviour change among new mothers following their hypertensive pregnancy, and the intervention’s effect on their capacity and motivation to pursue healthy lifestyles. Results Thirty-four women from all three trial arms participated at 10–12 months postpartum. The three main themes were 1) Awareness of cardiovascular risk: some did not acknowledge the health risks, whereas others embraced this information. 2) Sources of motivation: while the majority were motivated to make a concerted effort to adapt their health behaviour, motivation often centred on their baby and family rather than their own needs. 3) Sustaining behaviour change with a new baby: women in the more intensive intervention arm demonstrated increased recognition of the importance of reducing cardiovascular health risks, with greater motivation and guidance to change their health behaviour. There was minimal evidence of crossover amongst groups, with women largely accepting their randomised level of intervention and not seeking additional help when randomised to minimal intervention. Conclusions Among women participating in an early post-hypertensive disorders of pregnancy randomised controlled trial aimed at improving their cardiovascular disease risk profile, the majority recognised the future health risks and appeared motivated to improve their lifestyle, particularly women in the highest-intensity intervention group. This highlights the importance of structured support to assist women embrace healthy lifestyles especially during the challenges of new parenthood. Trial registration The Blood Pressure Postpartum study was prospectively registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (anzctr.org.au) on 13 December 2018 (registration number: ACTRN12618002004246).

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“…1 Despite awareness about HDP women continue to develop complications/die as a result of hypertension more so in low and middle income countries (LMIC). 2 Evidence is building to suggest that lifestyle interventions are useful in reducing the risk of cardiovascular disease in women whose pregnancy was complicated by hypertension. 3 Consensus on diagnostic criteria, classification of HDP, when to treat hypertension in pregnancy and timing of delivery has been difficult to achieve.…”

Section: Overview and Guideline Development Methodologymentioning

confidence: 99%

Society of Obstetricians and Gynaecologists Pakistan (SOGP) Hypertensive Disorders in Pregnancy Guidelines- 2022

Baqai

Rahim²,

Ala³

et al. 2022

PAFMJ

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The Society of Obstetricians & Gynecologist Pakistan Hypertensive Disorders of Pregnancy (SOGP- HDP) guideline is evidence based practical clinical guide to the management of pregnant women with hypertension. It defines hypertension, preeclampsia & severe hypertension, encourages measuring blood pressure (BP) accurately, preferably by automated/mercury blood pressure monitors. The guideline gives an approach to screening, risk prediction and prevention of preeclampsia and management of hypertensive disorders of pregnancy. The guideline emphasizes experienced team management approach and mandatory hospital protocols for the management of pregnant women with hypertension. The aim is to have locally tailored easy to follow protocols for preconception care, screening, prevention and management of women at risk of preeclampsia; management of chronic hypertension in pregnancy, antihypertensive therapy for severe and non-severe hypertension. In addition, it discusses post-partum management, contraception, follow-up, discusses risk of recurrence and long-term follow up for women with preeclampsia to mitigate future cardio-metabolic risks to maternal health associated with hypertensive disorders of pregnancy

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The long‐term cardiovascular impact of hypertension in pregnancy – A missed opportunity

Cited by 12 publications

References 19 publications

Effects of Nifedipine and Labetalol Combined with Magnesium Sulfate on Blood Pressure Control, Blood Coagulation Function, and Maternal and Infant Outcome in Patients with Pregnancy-Induced Hypertension

Effects of Nifedipine and Labetalol Combined with Magnesium Sulfate on Blood Pressure Control, Blood Coagulation Function, and Maternal and Infant Outcome in Patients with Pregnancy-Induced Hypertension

Optimising mothers’ health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention

Society of Obstetricians and Gynaecologists Pakistan (SOGP) Hypertensive Disorders in Pregnancy Guidelines- 2022

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