Blood Pressure In Pregnant Women Research Articles

Foot Massage Modification to Reduce Blood Pressure in Pregnant Woman with Preeclampsia

The Maternal Mortality Ratio (MMR) in Indonesia remains high, including in West Java province. One of the MMR causes is preeclampsia (24%). Currently, the management of preeclampsia is focused on pharmacological therapy. Preeclampsia is characterized by high blood pressure. Some studies revealed that non-pharmacological therapy was effective in dealing high blood pressure including foot massage. Foot message has benefits both physiologically and psychologically. However limited study applied this massage among pregnant women with preeclamsia. The aim of this study was to determine the effectiveness of as a complementary therapy: foot massage to reduce of blood pressure among pregnant women with preeclampsia. The study applied quasi experimental design with time series approach. The samples were chosen using consecutive sampling technique. This study involved 30 pregnant women with preeclampsia. There were two steps of data collection. First, respondents’ blood pressure was measured by researchers without any interventions for 6 days. Second, the 7th -12th respondents had 20 minutes message, and observed blood pressure at the first minute before massage (pr-etest), and the 30th minutes after massage (post-test). Data were analyzed using Friedman Test.The result showed that there were no significant differences of mean systolic and diastolic blood pressure between pre-test and post-test (p> 0.05) in control period. Whereas, in the treatment period showed that there were a significant differences of mean systolic blood pressure between pre-test and post-test on the seventh day until twelfth day (p < 0.05). While, the significantly differences in mean of diastolic blood pressure between pre-test and post-test were present during the eighth until twelfth in treatment period (p < 0.05). This study revealed that there were significant differences in decreasing of blood pressure among pregnant women with preeclampsia after treatment by foot massage. The foot massage techniques can be used as one of the interventions to lower blood pressure in pregnant women with preeclampsia, however further research is needed to support the evidence based for nursing intervention especially in complementary therapies.

The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India

BackgroundHypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.MethodsThis study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.ResultsThere was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.ConclusionTask-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.

KADAR KALSIUM DARAH DAN TEKANAN DARAH PADA IBU HAMIL

Hypertension in pregnancy is a complication of 5- 0% of pregnancies and can lead to serious complications of illness and death. Imbalances of calcium in the body have an important role to increase blood pressure. The purpose of this study was to determine the relationship of blood calcium levels with blood pressure in pregnant women with analytic correlation research design using cohort approach. Population in this research is second trimester pregnant woman counted 36 responden. The sampling technique used is Simple Random Sampling with a sample of 32 respondents. Through statistical test of Product Moment correlation with level of significance 0,05. R calculated = 0.633 greater than rtable = 0.361, then Ho is rejected which means there is a relationship between blood calcium levels with blood pressure in pregnant women Keywords: total calcium level, blood tension, pregnant mother in trimester II

Changes in endothelial function, arterial stiffness and blood pressure in pregnant women after consumption of high-flavanol and high-theobromine chocolate: a double blind randomized clinical trial

ABSTRACTObjectives: The aim of this 2-group, parallel, double blind single-centre RCT was to evaluate the acute and chronic impacts of high flavanol high theobromine (HFHT) chocolate consumption on endothelial function, arterial stiffness and blood pressure (BP) in women at risk of preeclampsia.Methods: 131 pregnant women considered at risk of preeclampsia based on uterine artery Doppler ultrasound were divided into two groups (HFHT or low flavanol and theobromine chocolate (LFLT). Acute changes in plasma flavanol and theobromine, peripheral arterial tonometry and BP were evaluated at randomization (0, 60 and 120 min after a single 40-g dose of chocolate) and again 6 and 12 weeks after daily 30-g chocolate intake. The EndoPAT 2000 provided reactive hyperemia index (RHI) and adjusted augmentation index (AIx) as markers for endothelial function and arterial stiffness, respectively. Results: Compared with LFLT, acute HFHT intake significantly increased plasma epicatechin and theobromine (p < 0.0001), decreased AIx (p < 0.0001) and increased diastolic BP (3.49 ± 3.40 mmHg increase in HFHT group vs 1.55 ± 2.59 mmHg increase in LFLT group, p = 0.0008). Chronic HFHT compared with LFLT intake significantly increased plasma theobromine (p < 0.0001). No other significant within group or between group changes were observed. Conclusions: Acute consumption of HFHT, compared to LFLT, increased plasma epicatechin and theobromine concentrations and decreased arterial stiffness, with no effect on endothelial function and a marginal increase in diastolic BP. Chronic HFHT intake increased plasma theobromine, though it did not have positive impacts on endothelial function, arterial stiffness or BP when compared to LFLT in pregnant women at risk of PE.

EFFECTIVENESS OF LAVENDER AROMATHERAPY AND CLASSICAL MUSIC THERAPY IN LOWERING BLOOD PRESSURE IN PREGNANT WOMEN WITH HYPERTENSION

Background: Hypertension during pregnancy remains high in Indonesia. It is a major cause of maternal death. Aromatherapy lavender and classical music therapy are considered effective in lowering blood pressure in hypertension.&#x0D; Objective: To examine the effect of lavender aromatherapy and classical music therapy in lowering blood pressure in pregnant women with hypertension.&#x0D; Methods: A quasi-experimental study with pretest-posttest control group design. There were 52 pregnant women selected using simple random sampling, divided into lavender aromatherapy group, classical music group, combination of aromatherapy and music group, and control group. Sphygmomanometer was used to measure blood pressure. Mann Whitney and Post Hoc test were used for data analysis.&#x0D; Results: Results showed that four groups had a significant decrease in systolic blood pressure after given intervention with p-value &lt;0.05. The mean decrease of systolic blood pressure among four groups was: lavender group (5.77 mmHg), music group (7.23 mmHg), combination group (9.54 mmHg), and control group (3.67 mmHg); and the mean decrease of diastolic blood pressure was: the lavender group (2.77 mmHg), music group (0.61 mmHg), combination group (8.23 mmHg), and control group (3.42 mmHg).&#x0D; Conclusion: There was a significant effect of lavender aromatherapy and classical music therapy in lowering blood pressure in pregnant women with hypertension. However, the combination of both interventions was more effective than lavender aromatherapy or music therapy alone.

EFFECT OF CONSUMING TOMATO (LYCOPERSIUM COMMUNE) JUICE IN LOWERING BLOOD PRESSURE IN PREGNANT MOTHERS WITH HYPERTENSION

Background: High blood pressure during pregnancy can pose significant problems such as preeclampsia, eclampsia, and premature birth. Thus, early prevention is needed. Consuming tomato (lycopersium commune) juice is considered effective to reduce blood pressure in pregnant women.&#x0D; Objective: This study aims to examine the effect of tomato juice on the decrease in blood pressure of pregnant women with hypertension in pregnancy.&#x0D; Methods: This study was a quasi-experiment with pretest-posttest control group. This research was conducted at the working area of the Community Health Center of Magelang Indonesia in July 2016 - January 2017. The target population of this study was pregnant women in trimester I, II, and III with high blood pressure. There were 30 samples selected using consecutive sampling, with 15 assigned in the experiment and control group. Wilcoxon test was performed for data analysis.&#x0D; Results: There was a statistically significant difference in systolic and diastolic blood pressure before and after given tomato juice with p = 0.001 (&lt;0.05).&#x0D; Conclusion: Consuming tomato juice can be one of the efforts to reduce blood pressure in pregnant women with hypertension.

Effect of Egg Whites on Decreasing Blood Pressure in Pregnant Women with Hypertension

Effect of Egg Whites on Decreasing Blood Pressure in Pregnant Women with Hypertension

Ventricular dyssynchrony in pregnant women: A tissue Doppler study.

The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women. One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated. Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP). Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.

Efektivitas Buah Pisang Untuk Menurunkan Tekanan Darah Diastolik Pada Wanita Hamil Dengan Hipertensi

Hypertension in pregnancy is increased blood pressure ≥ 140/90 mmHg. Hypertension is the beginning of a sign of eclampsia in pregnancy. In the initial survey of 10 pregnant women found that 40% had hypertension. The research objective to analyze the effectiveness of bananas to the reduction of blood pressure in pregnant women with hypertension. The study design using pre-experimental design approach to one group pre post test design. Samples were taken at 18 people with simple random sampling technique. Instrument used SOP and observation sheet before and after the action. The results showed nearly all pregnant women decreased diastolic blood pressure by 77.8% given bananas for 7 days with a dose three times a day. The results of analysis by Wilcoxon signed rank test p value = 0.001 (p <0.05), the H1 accepted, meaning that there is the influence of bananas to the decline in diastolic blood pressure in pregnant women with hypertension. Based on the results of this study are expected of hypertensive patients that eating bananas to lower blood pressure.

Longitudinal Patterns of Glycemic Control and Blood Pressure in Pregnant Women with Type 1 Diabetes Mellitus: Phenotypes from Functional Data Analysis

Objective To identify phenotypes of type 1 diabetes control and associations with maternal/neonatal characteristics based on blood pressure (BP), glucose, and insulin curves during gestation, using a novel functional data analysis approach that accounts for sparse longitudinal patterns of medical monitoring during pregnancy. Methods We performed a retrospective longitudinal cohort study of women with type 1 diabetes whose BP, glucose, and insulin requirements were monitored throughout gestation as part of a program-project grant. Scores from sparse functional principal component analysis (fPCA) were used to classify gestational profiles according to the degree of control for each monitored measure. Phenotypes created using fPCA were compared with respect to maternal and neonatal characteristics and outcome. Results Most of the gestational profile variation in the monitored measures was explained by the first principal component (82-94%). Profiles clustered into three subgroups of high, moderate, or low heterogeneity, relative to the overall mean response. Phenotypes were associated with baseline characteristics, longitudinal changes in glycohemoglobin A1 and weight, and to pregnancy-related outcomes. Conclusion Three distinct longitudinal patterns of glucose, insulin, and BP control were found. By identifying these phenotypes, interventions can be targeted for subgroups at highest risk for compromised outcome, to optimize diabetes management during pregnancy.

Drinking Water Sodium and Elevated Blood Pressure of Healthy Pregnant Women in Salinity-Affected Coastal Areas.

Coastal areas in Southeast Asia are experiencing high sodium concentrations in drinking water sources that are commonly consumed by local populations. Salinity problems caused by episodic cyclones and subsequent seawater inundations are likely (partly) related to climate change and further exacerbated by changes in upstream river flow and local land-use activities. Dietary (food) sodium plays an important role in the global burden of hypertensive disease. It remains unknown, however, if sodium in drinking water-rather than food-has similar effects on blood pressure and disease risk. In this study, we examined the effect of drinking water sodium on blood pressure of pregnant women: increases in blood pressure in this group could severely affect maternal and fetal health. Data on blood pressure, drinking water source, and personal, lifestyle, and environmental confounders was obtained from 701 normotensive pregnant women residing in coastal Bangladesh. Generalized linear mixed regression models were used to investigate association of systolic and diastolic blood pressure of these-otherwise healthy-women with their water source. After adjustment for confounders, drinkers of tube well and pond water (high saline sources) were found to have significantly higher average systolic (+4.85 and +3.62 mm Hg) and diastolic (+2.30 and +1.72 mm Hg) blood pressures than rainwater drinkers. Drinking water salinity problems are expected to exacerbate in the future, putting millions of coastal people-including pregnant women-at increased risk of hypertension and associated diseases. There is an urgent need to further explore the health risks associated to this understudied environmental health problem and feasibility of possible adaptation strategies.

778: Tight versus less tight control of blood pressure in pregnant women with chronic hypertension--a cost-effective analysis

778: Tight versus less tight control of blood pressure in pregnant women with chronic hypertension--a cost-effective analysis

PP.24.13

Objective: Blood pressure (BP) changes across pregnancy are well known. These changes were studied mainly by the BP measurement at brachial artery. Several guidelines on hypertension indicate good diagnostic characteristics of 24-h BP in pregnant women. In recent years the technique of non-invasive measurement of central aortic BP (BPao) was developed. Also 24-h BPao measurement technique appeared. Thus, the aim of our study is to assess the distribution of the 24-h BPao according to the gestational age. Design and method: Every trimester 40 non-complicated pregnant women were examined for 24-h sampling within a period from the first obstetric examination until delivery. 120 ABPM profiles (e.g. BPW-files) were assessed in total. Oscillometric BPLab system for monitoring BP and Vasotens technology to analyze brachial cuff blood pressure waves (BPW) and to obtain 24-h BPao and BPStat software to tabulate all BPW data were used. Descriptive statistics: median [25th, 75th percentiles] mmHg. Results: First trimester: total BPW-files – 40, awake systolic BPao – 104.0 [99.0, 106.0], asleep systolic BPao – 89.5 [87.0, 96.5]; second trimester: total BPW – 40, awake systolic BPao – 103.0 [96.5, 104.5], asleep systolic BPao – 88.0 [85.5, 91.5]; third trimester: total BPW – 40, awake systolic BPao – 107.0 [99.0, 111.0], asleep systolic BPao – 95.0 [92.0, 99.5] mmHg. Conclusions: Distribution of 24-h BPao according to the gestational age may be characterized by the tendency of BPao decreasing in second trimester and by increasing of BPao in third trimester. Diurnal BPao patterns were identified in pregnant women.

Temporal variation in the acute effects of air pollution on blood pressure measured at admission to labor/delivery

Same day or recent air pollution exposure increases blood pressure in pregnant women. Temporal blood pressure variation associated with hourly air pollution is unstudied. We randomly selected 500 women (249 normotensive, 191 with hypertensive disorders, and 60 with chronic hypertension) with singleton pregnancies and blood pressure measured at labor/delivery admission from a large cohort, the Consortium on Safe Labor. Community multiscale air quality models estimated hourly air pollutant exposures for the admission hour (lag 0) and for the 24 h preceding labor/delivery admission (lags 1–24). Linear regression estimated the effect of 10 % increase in pollutants on blood pressure at each time point, adjusting for maternal characteristics, labor type, and time of day. Women with chronic hypertension had higher systolic blood pressure with exposure to particulate matter <10 μm (by 1.0–1.3 mmHg at 0–4 h), sulfur dioxide (by 0.7–0.9 mmHg at 0–3, 16–20, and 22–23 h) and with some air toxics. Diastolic blood pressure was higher in normotensive women with ozone exposure (by 0.1–0.4 mmHg at 0–1 and 23–24 h). Similar effects for systolic blood pressure were seen among women with hypertensive disorders (by 0.6 mmHg at 19–20 h), but most pollutants were associated with lower blood pressure in these women. Substantial variation in the impact of hourly air pollutant measures on blood pressure was observed during the day prior to labor/delivery admission, both by mothers’ hypertensive status and by the lag time prior to BP measurement. Effects were largest near admission (lags 0–4) and among women with chronic hypertension.

Serum Vitamin D Insufficiency Is Related to Blood Pressure in Diabetic Pregnancy

Vitamin D deficiency in pregnancy has been associated with an increased risk of preeclampsia. However, the association between serum vitamin D and blood pressure in pregnant women has been scarcely evaluated, particularly in women with a high risk of developing hypertensive disorders of pregnancy. We sought to evaluate the association between serum 25-hydroxyvitamin D and blood pressure in pregnant women with gestational diabetes mellitus (GDM). A cohort of 184 pregnant women with GDM was followed during the third trimester of pregnancy and early puerperium. Blood pressure was recorded in all prenatal visits, and serum vitamin D was measured by chemiluminescence immunoassay. Pearson's coefficients and multiple linear regressions were used to study predictors of blood pressure levels. Women with vitamin D insufficiency (<30ng/mL; n = 159) had higher systolic and diastolic blood pressure than the remaining participants. In white women (n = 136), serum vitamin D levels presented a significant negative correlation with systolic blood pressure at the beginning (r = -0.268; P = 0.002) and at the end of the third trimester (r = -0.203; P = 0.02), and vitamin D significantly affected systolic blood pressure after adjusting for confounders. This was not observed in women of other ethnicities. In this cohort of pregnant women with GDM, vitamin D insufficiency was associated with higher blood pressure, and in white women, serum vitamin D was an independent predictor of systolic blood pressure during pregnancy.

Blood pressure and endothelial function in healthy, pregnant women after acute and daily consumption of flavanol-rich chocolate: a pilot, randomized controlled trial

BackgroundSeveral randomized clinical trials (RCTs) indicate that flavanol-rich chocolate has beneficial effects on flow-mediated dilation (FMD) and blood pressure (BP). However, no RCTs have evaluated these outcomes in pregnant women. The objective of this 2-group, parallel, double-blind RCT was to examine the effects of flavanol-rich chocolate on FMD and BP in pregnant women with normal BP.MethodsForty-four healthy, pregnant women were randomized to the high-flavanol (n = 23) or low-flavanol (n = 21) chocolate consumption for 12 weeks. At randomization (0, 60, 120 and 180 min after a single 40-g dose of chocolate), 6 and 12 weeks after daily 20-g chocolate intake, we evaluated plasma concentrations of flavanols and theobromine, as well as the FMD and BP.ResultsPlasma epicatechin was significantly increased (p < 0.001) 180 min after the consumption of 40-g high-flavanol chocolate compared to low-flavanol chocolate. Theobromine concentrations were significantly higher 180 min and 12 weeks after the intake of experimental chocolate or low-flavanol chocolate (p < 0.001). FMD was not different between the 2 groups at all pre-defined time periods. No other significant within-group or between-group changes were observed.ConclusionThese results confirm the feasibility of a large-scale RCT comparing daily consumption of flavanol-rich chocolate to an equivalent placebo during pregnancy and demonstrate higher plasma epicatechin and theobromine concentration in the intervention group after acute ingestionTrial registrationClinicalTrials.gov Identifier: NCT01659060

PP058. Cradle: Community blood pressure monitoring in rural Africa: Detection of underlying pre-eclampsia

In many developing countries pre-eclampsia is under-detected partly due to inadequate training in accurate blood pressure (BP) measurements and insufficient, poorly functioning equipment. To evaluate whether the introduction of easy to use, low cost novel BP devices (Microlife 3AS1-2; designed by our research group specifically for use in developing countries and validated in pregnancy (B/A grade) according to BHS criteria) into rural clinics in Tanzania, Zimbabwe and Zambia increases referrals for suspected pre-eclampsia to a central referral hospital (as reflected by an increase in mean BP in pregnant women seen in the central referral site). International prospective longitudinal pre- and post-intervention pilot study. BP measurements were taken from consecutive women ⩾20 weeks' gestation who accessed care at a referral site (N=694). 20 BP devices were distributed to 20 rural antenatal clinics in each country. Post-intervention data was collected the following year (N=547). After adjustment for confounders, there was a significant increase in primary outcome; post-intervention mean diastolic BP for all women (2.39mmHg, p<0.001, 95% CI 0.97-3.8), implying an increased proportion of referred hypertensive women; and a reduction in proportion of women (median gestation 35 weeks') who had never previously had a BP taken in pregnancy (25.1% to 16.9%, OR 0.58, p=0.001, CI 0.42-0.79). Equipping community healthcare providers with this novel validated BP device is feasible, widely accepted and results in increased referrals for suspected pre-eclampsia. A cluster RCT to evaluate the effect of these monitors equipped with a traffic-light 'early warning system' is planned.

PM.53 CRADLE: Community Blood Pressure Monitoring in Rural Africa: Detection of underLying Pre-Eclampsia

IntroductionIn developing countries pre-eclampsia is under-detected partly due to inadequate training in accurate blood pressure (BP) measurements and insufficient equipment. CRADLE is an international study to evaluate whether the introduction...

Selected polymorphisms of Renin-Angiotensin System in the pathology of hypertensive disorders of pregnancy

Pregnancy induced hypertension and pre-eclampsia, defined as hypertension and proteinuria after 20 weeks of pregnancy with no history of such symptoms, are a great challenge in the field of perinatology They are a serious threat to the mother and the child. Regardless of numerous studies on the subject, the pathogenesis of pregnancy-induced hypertension and pre-eclampsia is still unknown, although a crucial role of genetic factors combined with environmental factors has been confirmed. New theory based on genetic analysis of Renin-Angiotensin System and its impact on blood pressure in pregnant women, has been subject to much debate recently Numerous genes have been studied but angiotensinogen remains to be the best known. Little is known about angiotensin receptor type 1 and 2. This paper presents the knowledge about selected genes of RAS and their impact on pregnancy

Effect of l-Arginine Supplementation on Blood Pressure in Pregnant Women: A Meta-Analysis of Placebo-Controlled Trials

Objective. A meta-analysis of placebo-controlled trials was conducted to evaluate the effect of l-arginine supplementation on blood pressure (BP) in pregnancy. Methods. Trials were searched in PubMed, Embase, and Cochrane Library. A total of five trials were included in the meta-analysis. Results. l-Arginine supplementation exhibited a mean decrease of 3.07 mmHg (p = 0.004) for diastolic blood pressure and a mean increase of 1.23 weeks (p = 0.002) for gestation age at delivery in pregnancy, but did not reduce systolic BP (p = 0.19) as compared to placebo. Conclusion. l-Arginine supplementation had a significant effect of lowering diastolic blood pressure and prolonging gestation age in pregnancy.