History Of Hypertensive Disorders Research Articles

47 Subclinical Cardiovascular Alterations and Molecular Signatures in Women with History of Hypertensive Disorders in Pregnancy

47 Subclinical Cardiovascular Alterations and Molecular Signatures in Women with History of Hypertensive Disorders in Pregnancy

Usefulness of HbA1C in differentiating Gestational Diabetes Mellitus and preexisting Diabetes Mellitus in the early stages of pregnancy

Introduction: Diabetes mellitus in pregnancy can cause several complications for the mother and the neonate if left untreated. This study identifies the proportion of undiagnosed pre-existing diabetic pregnant women and the necessity of doing an HbA1C test in the first trimester for its diagnosis.Methodology: Pregnant women in the first trimester without a history of hypertensive disorders, Diabetes Mellitus in their previous pregnancies were recruited for the studies. Then blood samples were withdrawn from them to perform OGTT and the HbA1C test on booking visit (8-12 weeks of gestation). The results were used to diagnose and find the proportions of pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus.Results: The HbA1C test was done for 428 pregnant women and among them, 25 (5.8%) had levels above ≥ 48 mmol/mol (6.5%) and were diagnosed with pre-existing diabetes. Of the 428 pregnant women, only 267 attended the OGTT. Among the 267 pregnant women, 15 had HbA1C levels equal to or more than 6.5% and they were identified to have pre-existing diabetes. Pregnant women diagnosed with gestational diabetes were 34 and the HbA1C of these women was <6.5%. However, the 15 pregnant women who were diagnosed with preexisting diabetes were not identified with gestational diabetes from the OGTT.Conclusion: HbA1C can be used as a useful tool for screening pre-existing diabetes during pregnancy. Due to the high prevalence of pregnant women with pre-existing diabetes (5.8%) found in this study, it can be recommended to perform a HbA1C test at the booking visit to identify high-risk, pregnant women.

Hypertension in Pregnancy: A Diagnostic and Therapeutic Overview.

Hypertensive disorders in pregnancy are associated with increased risk of maternal, fetal, and neonatal morbidity and mortality. It is important to distinguish between pre-existing (chronic) hypertension and gestational hypertension, developing after 20 weeks of gestation and usually resolving within 6 weeks postpartum. There is a consensus that systolic blood pressure ≥170 or diastolic blood pressure ≥110 mmHg is an emergency and hospitalization is indicated. The selection of the antihypertensive drug and its route of administration depend on the expected time of delivery. The current European guidelines recommend initiating drug treatment in pregnant women with persistent elevation of blood pressure ≥ 150/95 mmHg and at values >140/90 mmHg in women with gestational hypertension (with or without proteinuria), with pre-existing hypertension with the superimposition of gestational hypertension, and with hypertension with subclinical organ damage or symptoms at any time during pregnancy. Methyldopa, labetalol, and calcium antagonists (the most data are available for nifedipine) are the drugs of choice. The results of the CHIPS and CHAP studies are likely to reduce the threshold for initiating treatment. Women with a history of hypertensive disorders in pregnancy, particularly those with pre-eclampsia, are at high risk of developing cardiovascular disease later in life. Obstetric history should become a part of the cardiovascular risk assessment in women.

Determinants of neonatal mortality among neonates admitted to neonatal intensive care unit of Dessie comprehensive and specialized hospital, Northeast Ethiopia; An unmatched case-control study.

BackgroundAccording to the World health organization, neonatal mortality is defined as the death of babies within the first 28 days of their lives. The newborn period is the most vulnerable period for a child's survival, with the bulk of neonatal deaths occurring on the first day and week. According to a recent study, about a third of all newborn deaths occur within the first day of life, and nearly three-quarters occur within the first week. This study aimed to assess the determinants of neonatal mortality among neonates admitted to the neonatal intensive care unit in Dessie comprehensive and specialized hospital, northeast Ethiopia.MethodologyHealth institution-based unmatched case-control study was conducted among neonates admitted to Dessie comprehensive and specialized hospital, Ethiopia from February 01 up to March 30, 2020. After keeping cases and controls in separate frames, study participants were chosen using a simple random sampling procedure until the sample size was met. Epi data version 7.0 and SPSS version 25 were used for data entry and analysis respectively. P ≤ 0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.ResultsA total of 698 (233 cases and 465 controls) participated in the study. Pregnancy induced hypertension (AOR = 3.02; 95% CI; 1.47–6.17), public hospital delivery (AOR = 3.44; 95% CI; 1.84–6.42), prematurity (AOR = 2.06; 95% CI; 1.43–2.96), being referred (AOR = 4.71; 95% CI; 3.01–7.39), and hypothermia (AOR = 2.44; 95% CI; 1.56–3.82) were determinant factors of neonatal mortality.ConclusionPregnancy-induced hypertension, public hospital delivery, prematurity, referral, and hypothermia were found to be the determinant factors of neonatal mortality. It would be important to give due attention to neonates delivered from mothers with a history of hypertensive disorder. Besides better to give due attention to neonates delivered in public health institutions, prematurely delivered, referred, and hypothermic neonates. Lastly, further research should be conducted to investigate the additional determinants of neonatal mortality.

Assessment of adherence to aspirin for preeclampsia prophylaxis and reasons for nonadherence

Preeclampsia is a hypertensive disease unique to pregnancy and has a significant impact on maternal and neonatal morbidity and mortality. Daily aspirin has been demonstrated to reduce the risk of preeclampsia. The American College of Obstetricians and Gynecologists recommends daily low-dose aspirin, ideally before 16 weeks' gestation, in at-risk patients for preeclampsia risk reduction. This study examined whether patients at-risk for preeclampsia by the American College of Obstetricians and Gynecologists criteria recalled aspirin recommendation and factors associated with treatment adherence. This study examined whether patients at-risk for preeclampsia by the American College of Obstetricians and Gynecologists criteria recalled aspirin recommendation and factors associated with treatment adherence. This study used an anonymous written survey. Pregnant patients were asked to record self-reported risk factors and to recall recommendation to take aspirin for preeclampsia prophylaxis. Participants were then determined to be high-, moderate-, or low-risk on the basis of the American College of Obstetricians and Gynecologists guidelines. Self-reported adherence to recommendations and factors contributing to the patients' decisions to take or decline aspirin were assessed. Secondary outcomes included demographic characteristics of adherent patients and patients who did not recall aspirin recommendation. A total of 544 surveys were distributed and 500 were returned (91.9% response rate). Of the 104 high-risk pregnancies identified, aspirin was recommended in 60 (57.7%; 95% confidence interval, 0.48-0.67). Of the 269 patients with 2 or more moderate-risk factors, aspirin was recommended for 13 (4.8%; 95% confidence interval, 0.03-0.08). Among the participants who recalled aspirin recommendation, adherence was similar between high-risk (81.7%) and moderate-risk (76.9%) groups (P=.69). Patients with chronic hypertension, a history of preeclampsia or gestational hypertension in a previous pregnancy, and pregestational diabetes mellitus were most likely to report receiving aspirin recommendation (78.8%, 76.5%, 63.8%, and 53.3%, respectively). No high-risk factor was associated with a decreased likelihood of adherence. Nonadherent patients rarely discussed their decision with their medical provider (5.9%). In the 42.3% of high-risk participants who did not recall aspirin recommendation, autoimmune disease, multiple gestation, and kidney disease were the most prevalent risk factors (42.9%, 35.7%, and 25.0%, respectively). In the population studied, many at-risk patients, as defined by the American College of Obstetricians and Gynecologists criteria, did not recall recommendations to take aspirin for preeclampsia prophylaxis. This raises concerns for absent or ineffective counseling. Of the patients who recalled aspirin recommendation, most reported adherence, and a history of hypertensive disorders or preeclampsia, autoimmune disease, and pregestational diabetes mellitus were most often associated with adherence. There was no single factor most strongly associated with intentional nonadherence.

Sex Differences in HFpEF

Heart failure with preserved ejection fraction (HFpEF) disproportionately affects women. Though no unifying theory exists to explain this phenomenon, the purpose of this review is to explore the many factors that likely contribute to this female predominance. Inflammation and microvascular ischemia are increasingly thought to play a role in promoting HFpEF, as is the presence of cardiometabolic traits including hypertension, diabetes, and obesity. All of these factors are more common in women. Female-specific risk factors, including a history of hypertensive disorders of pregnancy and sequelae of breast cancer therapy, can further contribute to a woman’s risk. No targeted therapies exist for the management of HFpEF, but some therapies, including sacubitril/valsartan, have shown differential benefit in women. Though women with HFpEF have better outcomes than men, they have worse self-reported quality of life. More work is required to address these and other sex disparities. This review summarizes what is known about the pathophysiology of HFpEF, leading theories to explain this female predominance, sex-specific differences in the objective findings of HFpEF, outcomes, and response to therapies, and what work remains to be done.

Interpregnancy body mass index change and risk of hypertensive disorders in pregnancy

Background Hypertensive disorders are a common cause of maternal mortality. Whether interpregnancy BMI (body mass index kg/m2) gain is associated with hypertensive disorders in a subsequent pregnancy is not unclear. Objectives To examine the association between interpregnancy BMI and hypertensive disorders in women without a history of hypertensive disorders in pregnancy. Study design This was a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks’ gestation or greater at a single academic institution. Only the second pregnancy in the dataset was analyzed. We excluded women who had any hypertensive disorder in the index pregnancy. Interpregnancy BMI change was calculated by the change of early pregnancy BMI (within 14 weeks’ gestation) measured in the office between the index pregnancy compared to that of the subsequent pregnancy. Women were categorized according to interpregnancy BMI change (BMI loss greater than 2 kg/m2, BMI change ±2 kg/m2, and BMI gain greater than 2 kg/m2). The primary outcome was any hypertensive disorder (chronic hypertension and pregnancy-associated hypertension). Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. Results Of 3068 women who were analyzed, 342 (11%), 1698 (55%), and 1028 (34%) had interpregnancy BMI loss greater than 2 kg/m2, interpregnancy BMI change ±2 kg/m2, and interpregnancy BMI gain greater than 2 kg/m2, respectively. Interpregnancy BMI gain greater than 2 kg/m2 compared to interpregnancy BMI loss more than 2 kg/m2 was associated with increased odds of hypertensive disorders (8.3% vs. 4.0%; adjusted odds ratio 2.20 [95% confidence interval 1.55–3.13]) and pregnancy-associated hypertension (adjusted odds ratio 2.25 [95% confidence interval 1.54–3.27]). Interpregnancy BMI loss greater than 2 kg/m2 compared to interpregnancy BMI change ±2 kg/m2 was not associated with increased odds of any hypertensive disorders (5.3% vs. 4.0%; adjusted odds ratio 0.58 [95% confidence interval 0.32–1.05]). Conclusions Compared to interpregnancy BMI change ±2 kg/m2, interpregnancy BMI gain greater than 2 kg/m2 was associated with increased odds of any hypertensive disorder. Weight control after pregnancy could be a potentially modifiable factor that may reduce the risk of hypertensive disorders.

Acute Kidney Injury During Pregnancy Leads to Memory Impairment but not Anxiety in Rats with a History of Severe Preeclampsia/HELLP Syndrome

OBJECTIVEWomen with hypertensive conditions of pregnancy such as severe PE (preeclampsia)/HELLP (hemolysis, elevated liver enzyme, and low platelets) syndrome are at an increased risk of developing Acute Kidney Injury (AKI). New reports suggest that AKI during pregnancy can lead to the progression of chronic kidney disease (CKD). Between 27–67% of patients with CKD have evidence of depression, cognitive impairment and dementia that is directly linked to renal damage. Among these deficits are impairments in memory, orientation, reasoning and executive function. Incidentally, women with a history of hypertensive disorders with and without AKI have an increased risk of developing mental health and cognitive disorders. Using an established animal model of severe PE/HELLP syndrome we sought to test the hypothesis that AKI in the presence of severe PE/HELLP exacerbates cognitive impairment and anxiety in the postpartum period.STUDY DESIGNOn gestational day (GD) 12, sFlt‐1 and sEng was infused via mini‐osmotic pump into the abdominal space of timed‐pregnant Sprague Dawley rats to induce severe PE/HELLP. A subset of HELLP and normal pregnant (NP) rats underwent bilateral renal ischemia‐reperfusion surgery for 45 minutes on GD18 to induce AKI. All rats delivered on GD21, underwent behavioral testing between postpartum weeks (PPW) 11–13 and were euthanized at PPW15. FITC‐sinistrin which was used to assess glomerular filtration (measure of kidney function), blood pressure via carotid catheter, and urinary creatinine were all measured during PPW15. N’s per group = 7 –10.RESULTSCompared to NP rats (p=0.01), HELLP, NP+AKI and HELLP+AKI rats had significant impairments in learning and memory. HELLP rats spent significantly less time in the open arms of the zero maze compared to NP (p=0.04) and NP+AKI (p=0.04). The time in open arms for HELLP+AKI rats were significantly less, as well, compared to NP (p=0.01) and NP+AKI (p=0.01) rats. Kidney function significantly declined in H+AKI (p= 0.001) and NP+AKI (p=0.009) rats compared to NP rats, as well as HELLP+AKI (p=0.03) rats compared to HELLP rats. Urinary creatinine was significantly increased in HELLP+AKI rats compared to NP (p=0.03) and HELLP (p=0.007) rats as well as NP+AKI (p=0.01) rats to HELLP rats. Blood pressure was significantly increased in NP+AKI (p=0.003), HELLP+AKI (p=0.0007), and HELLP (p=0.02) rats compared to NP rats.CONCLUSIONThe results from this study suggest that HELLP during pregnancy impairs learning and memory and is exacerbated by AKI. Anxiety was only impaired in rats with a history of severe PE/HELLP with/without AKI suggesting that renal injury may lead to selective psychological impairments. Hypertension persisted into the post‐partum period for rats with a history of severe PE/HELLP. Renal function wasn’t recovered into the post‐partum period for rats with history of AKI.Support or Funding InformationThis work was sponsored by P20GM121334 and the UMMC Office of Sponsored Program.

Abstract MP63: Established Cardiovascular Disease Risk Factors Mediate The Relationship Between Hypertensive Disorders In First Pregnancy And Maternal Cardiovascular Disease

Introduction: Women with a history of hypertensive disorders in pregnancy (HDP; gestational hypertension [GHTN] or preeclampsia) have an increased risk of CVD risk factors and events compared to women with normotensive pregnancies. However, the extent to which the relationship between HDP and CVD events is mediated by established CVD risk factors is less clear. Hypothesis: We hypothesized that a large proportion of the HDP-CVD relationship would be mediated by subsequent CVD risk factors — chronic hypertension (CHTN), type 2 diabetes (T2D), hypercholesterolemia, and BMI. Methods: Parous women free of prior CVD events, CHTN, T2D, and hypercholesterolemia at first birth in the Nurses’ Health Study II comprised the analytic sample (n=57,974). Pregnancy history was retrospectively reported in 2009. Women were followed for confirmed CVD events (coronary heart disease [non-fatal or fatal MI, fatal CHD] or stroke [non-fatal or fatal]) from first birth through 2015. Potential mediators were self-reported on biennial questionnaires. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between HDP in first pregnancy (preeclampsia or GHTN vs. normotension [ref]) and CVD, adjusting for age, race/ethnicity, parental education, family history of CVD before age 60, and pre-pregnancy risk factors (e.g., smoking, diet, and BMI). To evaluate the proportion of the HDP-CVD association that was jointly mediated by the CVD risk factors we used the difference method, comparing a model including these four factors to a model without them. Results: Nine percent of women (n=5,306) had a history of HDP in first pregnancy (preeclampsia: 6.3%; GHTN: 2.9%). CVD events occurred in 650 women with normotension in first pregnancy, 30 with GHTN, and 81 with preeclampsia. Adjusting for pre-pregnancy confounders, women with HDP in first pregnancy had a 63% higher rate of incident CVD (CI: 1.33-2.00) compared to women with normotension in first pregnancy; in particular, the strongest association was observed between preeclampsia and CHD (HR=2.18, CI: 1.62-2.93). The overall HDP-CVD association was largely mediated by the group of four CVD risk factors (HDP: proportion mediation [PM]=65%, CI: 35-87; preeclampsia: PM=57%, CI: 21-87; GHTN: PM=99%, CI: inestimable). All CVD risk factors contributed to mediation, but chronic hypertension accounted for the largest proportion. Conclusions: While approximately 40% of the association between preeclampsia and CVD remained unexplained, almost all the increased risk of CVD conferred by a history of GHTN was jointly accounted for by the development of established risk factors postpartum. Screening for CHTN, T2D, hypercholesterolemia, and overweight/obesity after pregnancy may be especially helpful in CVD prevention among women with a history of HDP.

P3463Cardiometabolic risk factors in women with a history of hypertensive disorders of pregnancy

Abstract Introduction A history of hypertensive disorders of pregnancy (HDP) has the unique potential to identify women at higher risk of future maternal cardiovascular disease (CVD), for whom targeted risk-reduction interventions may be particularly helpful. Purpose The aim of the study was to assess the factors and biomarkers of cardiometabolic risk in women with a history of hypertensive disorders of pregnancy. Methods Cross-sectional study of risk factors and biomarkers of cardiometabolic risk among young women with a history of HDP in comparison with normotensive patients during pregnancy. 117 women were studied: gr. 1 – 33 with a history of HDP, 40 [40–43] years; gr. 2 – 44 without a history of HDP, 39 [32–43] years. The control group consisted of 40 patients, 25 [23–28] years. The time interval after delivery was on average 5 to 19 years. We measured serum glucose, insulin, HOMA-IR, lipids, leptin, adiponectin. Left ventricular mass index (LVMI) was estimated by TTE. Data are presented as M±SD and Me (Q25–Q75). Results Women with HDP more often had hypertension (n=27; 82%), obesity (n=20; 39%) and smoking (n=9; 27%), p1–2,3 <0.05. A higher plasma levels of glucose mmol/L (5.5±0.7 vs 5.2±0.6 and 5.1±0.5), leptin ng/ml (42 [30–50] vs 24 [13–32] and 19 [10–29]) and lower plasma levels of adiponectin were observed in gr.1 vs gr. 2 and controls. Mean value of LVMI (g/m2) was statistically higher in women with HDP vs. without HDP and controls (119.9±23.7 vs 85.9±15.2 and 77.6±11.3), p1–2,3 <0.05. Conclusion It is shown that in women with a history of HDP subsequent changes in carbohydrate and lipid metabolism in combination with arterial hypertension and abdominal obesity, which constitute a cluster of the metabolic syndrome, are revealed after careful examination. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance and more pronounced target organ damage.

Abstract P149: Factors Associated With Future Cardiovascular Disease in Women With Hypertensive Disorders of Pregnancy and Gestational Diabetes

Background and aim: Hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM) are common complications in pregnancy. The risk of developing premature cardiovascular disease (CVD) is increased in women with a history of these disorders. However, more nuanced risk stratification is needed to identify women who would derive the greatest benefit from early risk reduction. We investigated demographic and clinical factors associated with future CVD in women with a history of HDP or GDM. Method: Women who were aged 15 to 45 years at the time of delivery were identified from among all hospital deliveries in Quebec between 1989 and 2016. Criteria for inclusion in the study were HDP, defined as pre-existing hypertension, gestational hypertension, pre-eclampsia, and superimposed pre-eclampsia, or GDM. Women with HDP or GDM were followed until age 60 years for CVD events, death, or loss to follow-up. CVD events included heart disease, cerebrovascular disease, heart and blood vessel procedures, coronary care unit admission, or mortality prior to age 60 years. We examined the association (hazard ratio, HR; 95% confidence interval, CI) between potential predictor variables and future CVD using Cox proportional hazard regression models. Risk factor variables included sociodemographic, pregnancy-related and perinatal factors recorded at the time of delivery. Results: Hypertension in pregnancy or gestational diabetes occurred in 173,430 (14%) of 1,229,278 women admitted for hospital delivery during the study. CVD events occurred in 3.3% of women with hypertensive disorders of pregnancy or gestational diabetes, of which death occurred in 903 (0.5%) women. The median time to event was 12 years. Neonatal death and stillbirth had the strongest associations with CVD. HRs for CVD were 2.29 (95% CI: 1.62-3.25) for neonatal death vs none, and 2.01 (95% CI: 1.556-2.60) for stillbirth vs none. Maternal age, substance use, low socioeconomic status, tobacco use, and obesity were also associated with increased risk of CVD (Table 1). Conclusion: Future studies should investigate whether these identified factors can reliably predict the risk of CVD and mortality in women with a history of hypertensive disorders of pregnancy and gestational diabetes.

Prevalence and Risk Factors for New-Onset Hypertension in Labor.

Little is known about prevalence, risk factors, rate of treatment, or adverse outcomes associated with intrapartum hypertension. Thus, our objective was to describe these findings. This was a retrospective study of laboring term gestations with no history of hypertensive disorders. Intrapartum blood pressures were reviewed, and women were subdivided based on blood pressures: normal (<140 mm Hg systolic and <90 mm Hg diastolic), mild hypertension (140-159 or 90-109), and severe hypertension (≥ 160 or ≥ 110). Groups were compared using chi-square test and analysis of variance. A total of 724 women were studied during 4 months: 248 (34%) had mild and 69 (10%) had severe hypertension. Severe hypertensives were more likely to be nulliparous, obese, or have received an epidural or oxytocin. There were no cases of eclampsia, stroke, or pulmonary edema in severe hypertensives (95% confidence interval, 0-5). Despite severely elevated pressures, only 4/69 (6%) patients received intravenous antihypertensive therapy, and 3 (4%) required medications at discharge. One in 3 women exhibits mild hypertension and 1 in 10 develop severe hypertension in labor. Only 6% of patients received treatment for severe blood pressures. This study highlights lack of treatment of hypertension in labor and further investigation into causes and outcomes of intrapartum elevations of blood pressures.

Abstract P265: History of Hypertensive Disorders of Pregnancy and Early Manifestation of Vasomotor Symptoms 8-10 Years Post Delivery

Introduction: Women with hypertensive disorders of pregnancy (HDP) have excess cardiovascular disease (CVD) risk in the years following delivery compared with women with uncomplicated pregnancies, with black women having excess burden of both HDP and CVD. After pregnancy yet prior to the menopause transition, nearly 30% of women in their late reproductive years report having vasomotor symptoms (VMS) including night sweats and hot flashes. VMS, particularly, early-onset VMS, have also been associated with increases in blood pressure and subclinical CVD. However, it is unknown if underlying vascular dysfunction in women with a history of HDP may increase the risk of VMS and contribute to racial differences in symptom manifestation. Hypothesis: Women with a history of HDP will have an increased risk of VMS as compared with women without a history of HDP. Methods: Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years post-delivery (median age=37.5; interquartile range=8.0) in our ongoing prospective cohort study assessing maternal cardiometabolic and microvascular disease (n=312). Using log-binomial logistic regression, we estimated the risk of VMS associated with history of HDP, adjusting for race, body mass index, current smoking, age, and education. Additional adjustment was made for current hormonal contraceptive use. Women with single or double oophorectomy (n=7) were excluded in a sensitivity analysis. Given the excess burden of HDP and CVD, as well as early-onset VMS in black women, we also assessed effect measure modification by maternal race. Results: Thirty percent of women with a history of HDP reported having vasomotor symptoms compared with 18% of women without a history of HDP. This excess risk of VMS persisted after accounting for covariates (adjusted risk ratio (aRR) 1.61, 95% confidence interval (CI) 1.06, 2.47). Excess risk of VMS persisted in women with a history of HDP after excluding those with a single or double oophorectomy (aRR 1.60, 95% CI 1.03, 2.47). Additional adjustment for hormonal contraceptive use resulted in a non-statistically significant increased risk of VMS (aRR 1.59, 95% CI 0.98, 2.59). Race did not modify the association between history of HDP and VMS (P value for interaction = 0.79). Conclusions: History of HDP was associated with excess risk of VMS in young women prior to menopause transition. There may be common underlying vascular changes that contribute to HDP and VMS that may also place women at future risk for CVD. How these reproductive factors may converge and be related to excess cardiometabolic risk warrants additional study.

377. Hypertensive disorders in pregnancy as a predictor of cardiovascular disease in a Sri Lankan population

Introduction Women with a history of hypertensive disorders are known to be at greater risk of developing subsequent hypertension and cardiovascular disease in Caucasians. Deaths due to cardiovascular disease is a leading cause of mortality and morbidity in South Asia. We undertook this study to look at the association between hypertension in pregnancy and cardiovascular disease and its risk factors in later life in a Sri Lankan population that represents the south Asian community. Methodolgy This study was part of a large community-based investigation on non-communicable diseases, the Ragama Health Study (RHS) conducted in 2014. The study was conducted in the Ragama Medical Officer of Health (MOH) administrative area from January to September 2014. The householders list of each GN division was used for stratified sampling and the population aged 35–64 years was identified. 986 consenting women who had experienced giving birth to at least one child were recruited to this study. Results Women with a history of hypertensive disorders during pregnancy had a significantly higher risk (OR 3.31) of having hypertension and metabolic syndrome (OR 2.75) compared to women without such a history. There was also a 1.7-fold risk of having type 2 diabetes mellitus, 2.82-fold risk of having a stroke and a 2-fold risk of having a diagnosis of ischeamic heart disease. Conclusions This is the first study that has looked at the association between hypertensive disorders in pregnancy and development of cardiovascular risk factors in a South Asian population. A history of hypertensive disorder in pregnancy was found to greatly increase this risk. Women with a history of hypertensive disorder need to be regularly monitored following pregnancy, in order to detect the emergence and modify cardiovascular risk factors in a timely manner.

150. Uteroplacental acute atherosis, cardiovascular biomarkers and vasoactive hormones in pregnancy

Introduction Cardiovascular disease (CVD) is the leading cause of death for women. A history of hypertensive disorders of pregnancy increases the risk. Uteroplacental spiral arterial.acute atherosis is a pregnancy-specific lesion resembling early atherosclerosis, frequently found in preeclampsia. The renin-angiotensin-system (RAS) plays a role in atherosclerosis and is dysregulated in preeclampsia. RAS and natriuretic peptides are physiological opponents in the regulation of arterial blood pressure and intravascular volume control. We previously reported increased concentrations of the natriuretic hormone precursor midregional proatrial natriuretic peptide (MR-proANP) in preeclampsia and suggested a cardiac origin. Objective To assess whether uteroplacental acute atherosis correlates with cardiovascular biomarkers and vasoactive hormones in maternal circulation at delivery in preeclamptic and normotensive pregnancies. Methods Third trimester maternal blood samples were analyzed for renin, prorenin and MR-proANP [normotensive pregnancies n = 50, preeclampsia (PE) n = 71]. Decidua basalis tissue for acute atherosis diagnosis (immunohistochemistry) was available for 53 of these pregnancies (normotensives n = 25 and PE n = 28). Statistical analyses: Skewed data were log-transformed. Linear regression and Fisher’s Exact test were applied as appropriate. A p-value Results A negative correlation between renin and MR-proANP concentrations was confirmed for both study groups. The presence of acute atherosis was not associated with maternal levels of circulating renin, prorenin or MR-proANP. Presence of acute atherosis was neither associated with MR-proANP/renin ratio nor maternal renin in the lower 2 quartiles in combination with MR-proANP in the upper 2 quartiles (normotensives p = 1.0 and PE p = 0.7). Discussion This is the first report on RAS and vasoactive hormones in pregnancy in relation to uteroplacental acute atherosis. We find that maternal circulating biomarkers previously shown to indicate hemodynamic stress in preeclampsia are not increased in pregnancies with acute atherosis. Further studies exploring the longitudinal association between maternal circulating cardiovascular biomarkers and postpartum CVD surrogate markers are underway.

Midlife development of type 2 diabetes and hypertension in women by history of hypertensive disorders of pregnancy

BackgroundWomen with history of hypertensive disorders of pregnancy (HDP) are at increased risk of early onset cardiovascular disease and type 2 diabetes (T2D). We aimed to investigate the extent to which HDP is also associated with midlife development of T2D and hypertension above and beyond established risk factors.MethodsWe included parous women who attended population-based structured clinical visits at age 50 and 60 years in Sweden 1991–2013 (N = 6587). Women with prior diabetes mellitus, stroke, or ischemic heart disease at age 50 years were excluded. Data on reproductive history were collected from registries. To study the association between history of HDP and the between-visits development of T2D, hypertension, and clinical risk factors of cardiometabolic disease (body mass index (BMI), blood pressure, and total cholesterol), we utilized multivariable adjusted regression models (logistic, log binomial, and linear regression, respectively). Models included data on outcome risk factors at age 50 years, e.g. BMI, 75 g 2 h oral glucose tolerance test result, and mean arterial pressure, respectively.ResultsBetween ages 50 and 60 years, 5.8% of initially disease-free women developed T2D and 31.6% developed hypertension. History of HDP was associated with increased risk of developing T2D between age 50 and 60 years even when adjusting for risk factors, including BMI, at age 50 years (odds ratio (OR) 1.96, 95% confidence interval (CI) 1.29–2.98). By contrast, the higher risk of developing hypertension observed in women with history of HDP (relative risk (RR) 1.47, 95% CI 1.22–1.78) was attenuated when adjusted for risk factors (RR 1.09, 95% CI 0.94–1.25). Participants with a history of HDP had higher mean BMI and blood pressure at age 50 years, with levels roughly corresponding to those observed at age 60 years in unaffected women.ConclusionsWomen with history of HDP are not only at higher risk of cardiometabolic disease during their reproductive years, but HDP is also associated with midlife T2D development above and beyond established risk factors.

Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis.

BackgroundWomen with a history of hypertensive disorders, including pre‐eclampsia, during pregnancy have a two‐ to‐five‐fold increased risk of cardiovascular disease (CVD). In 15% of women, pre‐eclampsia recurs in the following pregnancy.ObjectivesTo evaluate all evidence on the future risk of developing hypertension and CVD after multiple pregnancies complicated by pre‐eclampsia compared with pre‐eclampsia in a single pregnancy followed by normal subsequent pregnancy.Search strategyEmbase and Medline were searched until June 2017.Selection criteriaAll relevant studies on the risk of developing hypertension, atherosclerosis, ischaemic heart disease, cerebrovascular accident (CVA), thromboembolism, heart failure or overall hospitalisation and mortality due to CVD after having had recurrent pre‐eclampsia.Data collection and analysisTwenty‐two studies were included in the review. When possible, we calculated pooled risk ratios (RR) with 95% CI through random‐effect analysis.Main resultsRecurrent pre‐eclampsia was consistently associated with an increased pooled risk ratio of hypertension (RR 2.3; 95% CI 1.9–2.9), ischaemic heart disease (RR 2.4; 95% CI 2.2–2.7), heart failure (RR 2.9; 95% CI 2.3–3.7), CVA (RR 1.7; 95% CI 1.2–2.6) and hospitalisation due to CVD (RR 1.6; 95% CI 1.3–1.9) when compared with women with subsequent uncomplicated pregnancies. Other studies on thromboembolism, atherosclerosis and cardiovascular mortality found a positive effect, but data could not be pooled.ConclusionsThis systematic review and meta‐analysis support consistent higher risk for future development of hypertension and CVD in women with recurring pre‐eclampsia as opposed to women with a single episode of pre‐eclampsia.Tweetable abstractThe risk of future cardiovascular disease increases when women have recurrence of pre‐eclampsia compared with a single episode.

The Effect of Low-Molecular-Weight Heparin Added Low Dose Aspirin in the Subsequent Pregnancy of Hypertensive Women [24J

INTRODUCTION: To investigate the effect of low-molecular-weight heparin (LMWH) added low dose aspirin (LDA) in the subsequent pregnancy of the women who have the previous history of hypertensive disorder of pregnancy. METHODS: Prophylactically adding LMWH and LDA in 33 women who has previous hypertensive disorder (HD) of pregnancy compared with 37 cases without administrate. We compared the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction (FGR), intrapartum and postpartum hemorrhage with the women were not prophylactically adding LMWH and LDA. Also compared with the pregnancy gestational age between the two pregnancies. RESULTS: There was no significant differences in recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction intrapartum and postpartum hemorrhage (P&gt;.05). There was significant differences in pregnancy gestational age between two pregnancies (P&lt;.05), the pregnancy gestational age of the subsequent pregnancy were significant longer than the previous pregnancy. CONCLUSION: Prophylactically adding LMWH and LDA doesn't reduce the recurrent rate of hypertensive disorder of pregnancy, the occurrence rate of placental abruption, intrauterine death, fetal growth restriction. However, adding LMWH and LDA does prolong pregnancy gestational age, and doesn't increase the risk of the intrapartum and postpartum hemorrhage.

Cardiovascular risk profile at the age of 40-45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: A population-based study.

To assess midlife cardiovascular risk profiles in women with a history of hyperemesis or hypertensive disorders in pregnancy compared to women with none of the studied pregnancy complications. Population-based study. Cardiovascular risk factors at the age of 40-45 among women with previous singleton births only were studied through linkage of the Norwegian Birth Registry and a Norwegian screening program (the Age 40 Program). Family history of coronary heart disease, body mass index, smoking, physical activity, systolic and diastolic blood pressure, heart rate, cholesterol, triglycerides, antihypertensive treatment and diabetes. Among 178,231 women participating in the Age 40 Program with previous singleton births; 2140 (1.2%) had experienced hyperemesis and 13,348 (7.5%) hypertensive disorders in pregnancy. Women who had suffered from hyperemesis were less physically active. The differences in mean systolic blood pressure and body mass index were probably clinically irrelevant. In women with a history of hypertensive disorders in pregnancy, systolic and diastolic blood pressure and body mass index were higher, and they were more likely to report diabetes in midlife. Women who had suffered from hyperemesis or hypertensive disorders in pregnancy were less likely to be daily smokers. Women with hypertensive disorders in pregnancy seemed to have an unfavorable cardiovascular risk profile in midlife compared to women with uncomplicated pregnancies. In contrast there was no consistent evidence of increased risk subsequent to hyperemesis gravidarum. The proportion of daily smokers was lower in women with either of the two pregnancy complications.

Increased Risk of Pregnancy Complications After Stroke: The FUTURE Study (Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation).

The study goal was to investigate the prevalence of pregnancy complications and pregnancy loss in women before, during, and after young ischemic stroke/transient ischemic attack. In the FUTURE study (Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation), a prospective young stroke study, we assessed the occurrence of pregnancy, miscarriages, and pregnancy complications in 223 women aged 18 to 50 years with a first-ever ischemic stroke/transient ischemic attack. Pregnancy complications (gestational hypertension, diabetes mellitus, preeclampsia, and hemolysis, elevated liver enzymes, low platelet count syndrome) were assessed before, during, and after stroke using standardized questionnaires. Primary outcome was occurrence of pregnancy complications and the rate of pregnancy loss compared with the Dutch population. Secondary outcome was the risk of recurrent vascular events after stroke, stratified by a history of hypertensive disorder in pregnancy. Data were available for 213 patients. Mean age at event was 39.6 years (SD=7.8) and mean follow-up 9.5 years (SD=8.5). Miscarriages occurred in 35.2% and fetal death in 6.2% versus 13.5% and 0.9% in the Dutch population, respectively (P<0.05). In nulliparous women after stroke (n=22), in comparison with Dutch population, there was a high prevalence of hypertensive disorders in pregnancy (33.3 versus 12.2%; P<0.05), hemolysis, elevated liver enzymes, low platelet count syndrome (9.5 versus 0.5%; P<0.05), and early preterm delivery <32 weeks (9.0 versus 1.4%; P<0.05). In primi/multiparous women (n=141) after stroke, 29 events occurred (20-year cumulative risk 35.2%; 95% confidence interval, 21.3-49.0), none during subsequent pregnancies, and a history of a hypertensive disorder in pregnancy did not modify this risk (log-rank P=0.62). When compared with the general population, women with young stroke show higher rates of pregnancy loss throughout their lives. Also, after stroke, nulliparous women more frequently experienced serious pregnancy complications.