History Of Severe Preeclampsia Research Articles

Asuhan Kebidanan Komprehensif Pada Ny. M Umur 37 Tahun Dengan Riwayat Pre Eklampsia Berat Dan Sectio Caesarea Di Puskesmas Kaliwadas Kabupaten Brebes Tahun 2023

According to the World Health Organization (WHO) in 2020 stated that the maternal mortality rate (MMR) due to pre-eclampsia is very high, every day 810 women die due to complications of pregnancy and childbirth and around 295 000 women die after childbirth or in the postpartum period while in Indonesia 6-15%. In Central Java 98.6 per 100,000KH, while in Brebes 536 cases and in Kaliwadas Health Center 6 cases. To provide comprehensive midwifery care services for pregnant women, delivery, newborn, postpartum, and family planning. This research used descriptive qualitative method with case study approach. Comprehensive Midwifery Care for Mrs. M aged 37 years with a history of severe preeclampsia and sectio caesarea using Varrney documentation management, SOAP and there are significant similarities. Comprehensive midwifery care for Mrs. M from pregnancy, up to family planning, and using Varrney's flow of thought with SOAP documentation, mother and baby in good condition.

Intima-Media Thickness in Women with the History of Hypertensive Disorders of Pregnancy as a Risk Marker of the Occurrence of Cardiovascular Pathology in Advanced Reproductive and Perimenopausal Age

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis.
 The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age.
 Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women.
 Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia.
 Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

The effect of parity, history of preeclampsia, and pregnancy care on the incidence of subsequent preeclampsia in multiparous women with SLE

Objectives To clarify the correlation between preeclampsia and parity and to identify protective factors against preeclampsia in multiparous women with systemic lupus erythematosus (SLE). Methods We conducted a single-center, retrospective chart review study of 85 pregnant women. We used multiple logistic regression analysis to assess the association between parity and preeclampsia in women with SLE, and described the detailed clinical courses and management of four women with a history of severe preeclampsia and of a woman who experienced preeclampsia during her latest pregnancy. Results Multiparity was significantly associated with a low risk of preeclampsia (adjusted odds ratio: 0.08; 95% confidence interval: 0.01–0.95). One multiparous woman without a history of preeclampsia developed preeclampsia during her latest pregnancy; she had critical risk factors for preeclampsia, including chronic kidney disease and hypertension, and was not administered aspirin. In contrast, four multiparous women with a history of severe preeclampsia received adequate medications; they did not develop recurrent preeclampsia and delivered live newborns. Conclusions Multiparity and maintenance therapy for SLE before and during pregnancy and preventive treatment for preeclampsia may improve outcomes in subsequent pregnancies.

227. Can cardiovascular adaptation in early pregnancy predict later hypertension?

Introduction The mechanism behind the increased risk for cardiovascular disease (CVD) after preeclampsia (PE) is unclear, both preexisting cardiovascular dysfunction and harmful effects of the preeclamptic episode have been proposed. Objective To compare risk factors for CVD during pregnancy and at a later follow up in women with a history of severe PE and women without such a history. A secondary aim was to evaluate risk factors for prediction of later hypertension (HT). Methods Women treated at Danderyd University Hospital, Stockholm, Sweden between 1999 and 2004, for severe PE and controls with normal pregnancies matched for age, year of delivery and parity were contacted between 2013 and 2016. Of 148 with PE, 82 agreed to participate and 84 of 172 invited controls. Data from the index pregnancy were retrieved from medical records. At follow up blood pressure, BMI, waist measurement and level of HbA1c as well as family history of CVD and hypertensive medication were registered. Results In the group with PE three had HT before the index pregnancy versus none in the control group. At follow up 24 of 82 (29.3%) in the PE group had HT versus 9 out of 84 (10.7 %) (p = 0.003) in the control group. In women with only one episode of PE the rate of HT was 4.5% versus 52.9% (p = 0.003) in those with more than one. All variables were introduced in a logistic regression with stepwise analysis. Three variables were significantly related to HT at follow up: Systolic blood pressure ( equal to or more than 120) and BMI (equal or more than 25) in early pregnancy as well as family history of CVD. History of PE was not significantly related. Conclusion Blood pressure in early pregnancy may indicate impaired cardiovascular adaptation and be an indication of later hypertension.

Level of hsCRP Maternal Serum During Puerperium of Severe Preeclampsia

Background: Preeclampsia and eclampsia arestill major problemsin the world. Maternal mortality of severe preeclampsia at the puerperal period is likely to be greater because of the cardiovascular diseases (CVD). HsCRP (high sensitivity C-Reactive Protein) is a usefull prediction for CVD among non preeclamptic patients. Before using hsCRP as a marker for that prediction of cardiovascular event from preeclamptic patient, we should do research to know difference of hsCRP between preeclampsia and normal pregnancy.Objective: To determine the differences levels of hsCRP among severe preeclampsia and normal pregnancyMethod : A cross sectional study was conducted to severe preeclampsia. The inclusion criteria were subjects in puerperal period (2- 6 weeks) with a history of severe preeclampsia and normotensive.Exclusion criteria were puerperal infection, chronic hypertension, metabolic syndrome, caesarean section delivery and refuse to join this research. All subjects were examined the levels of hsCRP maternal serum when blood pressure £140 / 90.Result: Subjects were consist of 26 severe preeclampsia (53%) and 23 normal pregnancy (46.9%). Level of hsCRP in severe preeclampsia was 4.73 +3.57while in normotensive 2.42 +4.14 (p <0.05). Severe preeclampsia group will increase the risk of hsCRP rise as much as 2.5 times compared to the normotensive group.Conclusion:Level of hsCRP in patients with preeclampsia post partum were higher than patients with normal pregnancies.

No long-term impairment of cerebral autoregulation after preeclampsia.

Preeclampsia is a pregnancy-related hypertensive disorder with strongly impaired cerebral autoregulation in the acute stage. A history of preeclampsia is an independent cardiovascular and cerebrovascular risk factor. It is unclear whether impaired cerebral autoregulation persists after preeclampsia and thus contributes to the known increased cerebrovascular morbidity. Using transcranial Doppler, we compared cerebral hemodynamics and dynamic cerebral autoregulation of 25 women with a history of severe preeclampsia and 25 healthy mothers, on average 2-3 years postpartum. Mean arterial blood pressure (MAP) and cerebral blood flow velocities (CBFV) in the middle and posterior cerebral artery were recorded at rest, dynamic cerebral autoregulation was assessed via transfer function phase and gain between oscillations of CBFV and MAP during regular breathing at 0.1 Hz. MAP and body mass index were higher in former preeclamptic women compared with healthy mothers (p-value <0.001 and 0.006, respectively). CBFV in the middle cerebral artery was slightly increased in former preeclamptic women compared with healthy mothers (p-value 0.004), intima-media thickness (IMT) of the common carotid artery was higher by trend (p-value 0.065). Dynamic cerebral autoregulation was not impaired in women with a history of preeclampsia, phase even tended to be higher than in healthy mothers. Dynamic cerebral autoregulation is not persistently impaired in women after severe preeclampsia. Long-term cerebrovascular changes rather result from a higher incidence of cerebrovascular risk factors in women with a history of preeclampsia.

P-084: Antiphospholipid antibodies in women with history of severe preeclampsia

P-084: Antiphospholipid antibodies in women with history of severe preeclampsia

VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) C/G 405, C/A 2578, AND C/T 936 GENE POLYMORPHISMS IN CASES WITH PRE-ECLAMPSIA

Vascular Endothelial Growth Factor gene is an important signaling protein produced by cells that stimulates vasculogenesis and angiogenesis. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate. Its normal function is to create new blood vessels during embryonic development, new blood vessels after injury, muscle following exercise, and new vessels to bypass blocked vessels. It has been implicated in the pathogenesis of preeclampsia (PE). The study included 200 female subjects. Out of them, 100 had a history of PE. Their mean age ± SD was 24.48 ± 4.19 years. Seventy-nine (79%) of cases had a history of mild PE and twenty one (21%) of cases had a history of severe PE. The other 100 subjects were clinically healthy unrelated women with a history of complete successful pregnancy and no PE. Their mean age ± SD was 23.28 ± 3.80 years. VEGF C405G, C2578A, and C936T gene polymorphisms were study by using accurate methods of molecular biology techniques such as PCR-restriction fragment length polymorphisms (PCR-RFLPs). We found that PE among Egyptian women was strongly associated with pre-eclamptic mutations relayed to VEGF C405G, C2578A, and C936T gene polymorphisms. There were statistically significant low frequencies of wild homozygous genotype CC and high frequencies of both heterozygous mutant genotypes CG and CA, and homozygous mutant genotype GG and AA in pre-eclamptic cases compared to controls. In addition, there were statistically significant high frequencies of mutant G and mutant A allele in pre-eclamptic cases compared to controls.

Circulating levels of plasma lipids and cardiovascular risk in Nigerian women with severe preeclampsia

Background and Objectives: Preeclampsia has been associated with disorders of lipid metabolism. In the general population, dyslipidemia has been identified as a cause of endothelial damage and cardiovascular disease. Few studies have evaluated these relationships in Nigerian women with preeclampsia. This study aims to determine the level of plasma lipids in severe preeclampsia and assess the relationship between dyslipidemia, organ damage, and C-reactive protein (CRP) in Nigerian women with severe preeclampsia. Materials and Methods: This was a case-control study conducted on 50 women with severe preeclampsia and 50 with normal pregnancy matched for gestational age. The women were included from the antenatal clinic of the Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria. Informed consent was obtained and sociodemographic and clinical data were obtained using a questionnaire. Blood was collected from the women after an overnight (10-12 h) fast for biochemical analysis. Employing the IBM SPSS statistical software, comparisons of the continuous variables and categorical variables were done using the Student's t-test and Chi-square test, respectively. Correlation analysis was used to determine the associations between the variables. Statistical significance was set at P < 0.05. Results: The levels of high-density lipoprotein (HDL) cholesterol were significantly lower (P < 0.0003) and the levels of triglyceride (TG), low-density lipoprotein (LDL) cholesterol, and total cholesterol (TC) were significantly higher in women with severe preeclampsia compared to the controls (P < 0.0005, P < 0.007, P < 0.009, respectively). The HDL/LDL ratio was significantly lower and CRP was significantly higher in severe preeclampsia (P < 0.0001 and P ˂ 0.0002, respectively). The lipid profile parameters showed a significant association with the markers of organ dysfunction. TG showed a statistically significant correlation with uric acid, creatinine, alkaline phosphatase (ALP), systolic blood pressure (SBP), and diastolic blood pressure (DBP). HDL showed a statistically significant correlation with uric acid, ALP, aspartate aminotransferase (AST), SBP, and DBP. While TC showed a statistically significant correlation with SBP and DBP, TG, in addition, had a statistically significant correlation with CRP in women with severe preeclampsia. Conclusion: Severe preeclampsia is associated with dyslipidemia, which has been linked to organ damage and an increased cardiovascular risk in Nigerian women. Although dyslipidemia resolves with each pregnancy, risk of cardiovascular disease in the future remains. Thus, continuous monitoring of Nigerian women with a history of severe preeclampsia is suggested.

Effect of Folic Acid Adminsteration on Plasma Homocysteine Level in Preeclampsaia among Egyptian Population

Background: Hyperhomocysteinemia (HHC) appears to cause endothelial dysfunction through direct toxic and oxidative stress mechanisms. HHC was found to be seven times more common in women with history of severe preeclampsia. Objective: The aim of this study was to determine the effect of folic acid administration on the maternal serum homocysteine level in mild and severe pre-eclamptic cases between 28 and 32 weeks of gestation. Setting: The study was conducted on forty pre-eclamptic patients recruited from Elshatby Maternity University Hospital, Alexandria, Egypt over year 2012. Study design: The cases were subdivided into two groups; 20 mild and 20 severe pre-eclamptic cases. Each group was subdivided into two subgroups • Ten cases will take folic acid 5mg daily from 28 to 32 weeks. • Ten control cases (no folic acid administration). Results: The present study found that plasma homocysteine level was lowered after folic acid administration for both mild and severe cases. In the control group who did not receive folic acid, they had high homocysteine level . Conclusion: Folic acid can be administrated till the second trimester of pregnancy to decrease the risk of preeclampsia.

189-POS

Objectives To assess the cardiometabolic risk & arterial stiffness in Chinese women who had a previous history of pre-eclampsia (PE). Methods We performed a case–control study to assess 50 women with history of severe PE and 643 normal controls [from participants in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study]. All subjects underwent physical examination, 75 gram OGTT, and fasting lipid profile and assessment of Augmentation index (AI) and pulse wave velocity (PWV) of the carotid artery at 7–11 years after the index pregnancy. Results Women with PE have significantly higher AI (26.5 ± 8.5 vs 17.5 ± 8.4; p Conclusions Women with history of PE have exceedingly high cardiometabolic risk in future and warrant a comprehensive long term evaluation and primary prevention program. Disclosures W. Tam: None. R. Ma: None. R. Ozaki: None. T. Lao: None. E. Liu: None. S. Singh: None. M. Chan: None. J. Chan: None.

221-POS

Objectives Pregnancy-related vascular emergency is a rare, but severe and potentially lethal complication. More than 50% of ruptured arterial aneurysms in younger women are pregnancy related and associated with a high maternal mortality rate. Methods A 36-yr-old pregnant woman was at her 6th pregnancy with history of 4 intrauterine fetal deaths and 1 miscarriage. She also had history of severe preeclampsia at her few last pregnancies. Gestational age at first visit was 19/20 weeks. Diagnosis of abdominal aortic aneurysm was made at her first pregnancy 14 years previously. She was referred to Dr. Soetomo Hospital for tertiary level care. Sonography result showed an abdominal aortic aneurysm sized 9 × 3.7 cm, irregular border without thrombus. Echocardiography examination found a mild MR, trivial TR, and concentric LVH. Interdisciplinary team of Obstetrics and Gynecology department and Thoracic and Cardiovascular Surgery decided conservative treatment with weekly monitoring of fetal growth and wellbeing, weekly Doppler abdominal sonography and close monitoring of signs of threatened aneurysm rupture. She took β-blocker to maintain the systolic pressure within 100–110 mmHg. Aneurysm repair was planned after delivery and CTA examination before repair was required. Results After 83 days at hospital, delivery was done by caesarean surgery at 34/35 weeks, the baby weighed 1750 g and healthy. Arteriography was performed 1 week after surgery with the result aneurysm secular type (Eurostar Classification) sized 10.5 × 4 cm. CTA was performed 2 years after delivery, two aneurysms of aorta abdominal formation found, at cranial part with the size of 5.09 × 2.92 × 2.82 cm, and at caudal part, sized 11.53 × 4.32 × 3.96 cm, 0.67 cm from aorta bifurcation. Unfortunately, within 2 years follow up the patient refused to have aneurysm repair surgery performed. Conclusions Pregnancy with abdominal aortic aneurysm can succeed with close clinical follow-up of aneurysm and close monitoring of signs of threatened aneurysm rupture, along with observation of fetal growth and delivery. Disclosures E. Ernawati: None. M. Purwaningtyas: None. A. Sulistyono: None. A. Aditiawarman: None. H.T. Joewono: None. P. Puruhito: None.

Thicknesses of individual layers of artery wall indicate increased cardiovascular risk in severe pre‐eclampsia

To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.

Post-partum evaluation of maternal cardiac function after severe preeclampsia

Objective: To evaluate the post-partum maternal cardiac function in patients with history of severe preeclampsia.Methods: A series of women with previous singleton pregnancy complicated by severe preeclampsia underwent transthoracic echocardiography at 6–12 months from delivery. A group of women with previous uncomplicated pregnancy was selected as controls.Results: Sixteen women with history of severe preeclampsia were enrolled in the study group whereas 18 patients were selected as controls. In the study group systolic (p = 0.002) and diastolic blood pressure (p = 0.044) were significantly higher. Significant differences were observed in systolic left ventricular (LV) parameters, such as cardiac output (p = 0.034), LV mass indexed to BSA (p = 0.024) and longitudinal contraction, expressed by tissue Doppler (TD) S1 wave, which resulted relatively impaired in former preeclamptic women (p = 0.049). As regards as diastolic parameters, pulsed Doppler A-wave velocity was increased (p = 0.036). TD E-wave velocity was significantly lower in study group (p < 0.001) and E/E1 ratio (E = peak early diastole transmitral wave velocity/E1 = peak early diastolic velocity at mitral valve annulus at TD) was higher respect to controls (p < 0.001).Conclusions: LV contractility and diastolic function, although within normal reference ranges, show slight but significant impairment among women who experienced a severe preeclampsia. TD seems to be a sensible tool to identify these precocious signs of potential LV dysfunction.

Increased Salt Sensitivity of Ambulatory Blood Pressure in Women With a History of Severe Preeclampsia

Cardiovascular diseases are the principal cause of death in women in developed countries and are importantly promoted by hypertension. The salt sensitivity of blood pressure (BP) is considered as an important cardiovascular risk factor at any BP level. Preeclampsia is a hypertensive disorder of pregnancy that arises as a risk factor for cardiovascular diseases. This study measured the salt sensitivity of BP in women with a severe preeclampsia compared with women with no pregnancy hypertensive complications. Forty premenopausal women were recruited 10 years after delivery in a case-control study. Salt sensitivity was defined as an increase of >4 mm Hg in 24-hour ambulatory BP on a high-sodium diet. The ambulatory BP response to salt was significantly increased in women with a history of preeclampsia compared with that of controls. The mean (95% confidence interval) daytime systolic/diastolic BP increased significantly from 115 (109-118)/79 (76-82) mm Hg on low-salt diet to 123 (116-130)/80 (76-84) on a high-salt diet in women with preeclampsia, but not in the control group (from 111 [104-119]/77 [72-82] to 111 [106-116]/75 [72-79], respectively, P<0.05). The sodium sensitivity index (SSI=Δmean arterial pressure/Δurinary Na excretion×1000) was 51.2 (19.1-66.2) in women with preeclampsia and 6.6 (5.8-18.1) mm Hg/mol per day in controls (P=0.015). The nocturnal dip was blunted on a high-salt diet in women with preeclampsia. Our study shows that women who have developed preeclampsia are salt sensitive before their menopause, a finding that may contribute to their increased cardiovascular risk. Women with a history of severe preeclampsia should be targeted at an early stage for preventive measures of cardiovascular diseases.

Increased psychological trauma and decreased desire to have children after a complicated pregnancy

Information about fertility desire and psychological sequelae after high-risk pregnancies are scarce in the literature. The aim of the present study is to investigate the psychological effects of high-risk pregnancies. The patients who had a history of severe preeclampsia, eclampsia or major hemorrhage during the peripartum period were enrolled as the study group and compared with the control subjects with respect to fear about new pregnancy, anxiety/ depression and post-traumatic stress disorder (PTSD) scores. The study was carried out by submitting a questionnaire form to the participants. Numbers of planned children before and after the last delivery were evaluated in both groups. Fear about a new pregnancy was found to be significantly higher in the study group compared with the controls. There were no statistically significant difference between the two groups in terms of anxiety and depression. In terms of re-experience and avoidance in PTSD was significantly higher in the study group, however no significant difference was found for hyper-arousal. Fear regarding new pregnancy is high and planning more children is decreased after high-risk pregnancies and PTSD symptom scores were higher after high-risk pregnancies.

Avenir obstétrical après une première grossesse compliquée d’une prééclampsie sévère avec accouchement avant 34 SA

Women who had severe preeclampsia are at high risk of gestational vascular complications (preeclampsia, gestational hypertension, fetal death, small for gestational age, placenta abruptio) in subsequent pregnancies. The aim of this study was to describe outcomes of subsequent pregnancy after severe preeclampsia with delivery before 34 weeks of gestation during the first pregnancy. One hundred and thirty-four primiparous women delivered before 34 weeks of gestation resulting in severe preeclampsia between January 2002 and December 2009. The data of the index pregnancy were identified from the medical record of our maternity, those of the subsequent pregnancy from paper or computerized medical records of the hospitals where deliveries took place. Our study ended on December 31 2011 for a decrease of at least 2 years after the index pregnancy. Of the 75 subsequent pregnancies, 59 have been studied. Twenty patients (34%) had gestational vascular complications, in type of gestational hypertension alone (10%), preeclampsia (65%), isolated small for gestational age (20%) or fetal death (5%). Thirty-nine patients (66%) showed no recurrence of gestational vascular complications but only 33 patients (56%) had a pregnancy of course totally physiological. The only risk factor for recurrent gestational vascular complications in subsequent pregnancy was a long time interval between two pregnancies, with an increased risk in case of delay beyond 26 months. Women with a history of severe preeclampsia with delivery before 34 weeks of gestation during first pregnancy are at increased risk for gestational vascular complications during the next pregnancy. A close obstetrical monitoring is recommended during a subsequent pregnancy.

Hypertension and metabolic abnormalities later in life after preeclampsia

Aim: The present study examined Japanese women who had preeclampsia 10 or more years earlier, and documented the frequency of hypertension as well as their current clinical and chemical characteristics.Methods: We recruited 119 women for whom 10 or more years had passed since an indexed pregnancy (58 with a history of severe preeclampsia and 61 with normal pregnancies). A physical examination assessed blood pressure, weight, abdominal circumference (AC) and other compositional indices. Fasting blood samples were examined for glucose, total cholesterol (TCHOL), high and low density lipoprotein cholesterol (HDLC, LDLC), and triglycerides (TG). A questionnaire was used to collect demographic data. Data were analyzed using the Student’s t-test.Results: The frequency of hypertension later in life was significantly higher in the preeclampsia group compared to the control (53.4% versus 11.5%, P=0.013). Body mass index (BMI), AC, and levels of TCHOL, TG and LDLC were significantly higher in the group of patients with preeclampsia who did not have hypertension later in life (P<0.05), and there were no significant differences in the levels of glucose and HDLC. Despite the lack of evidence for hypertension, metabolic abnormalities were observed later in life in those who experienced preeclampsia during pregnancy.Conclusions: Since hypertension after preeclampsia was associated with metabolic abnormalities, those who experienced preeclampsia should schedule regular check-ups to monitor for clinical manifestations of hypertension.

Increased cardiovascular risk after pre‐eclampsia in women with dysglycaemia

Compared with women with uncomplicated pregnancies, women with a history of pre-eclampsia have two to five times the risk of cardiovascular disease. It is not known whether this risk is related to albuminuria, a known cardiovascular risk factor that is part of the definition of pre-eclampsia and that often persists after delivery. Our objective was to determine if the high risk of cardiovascular disease in women with pre-eclampsia is accounted for by known cardiovascular risk factors including albuminuria. We performed a cross-sectional analysis of 4080 dysglycaemic women enrolled in a large randomized controlled trial who provided an obstetric history and had at least one delivery. Blood pressure, height, weight, waist circumference and hip circumference were measured. An oral glucose tolerance test, lipids, an electrocardiogram and an albumin/creatinine ratio from a first morning urine sample were obtained. There were 3613 women with no history of pre-eclampsia during their pregnancies, 108 with severe pre-eclampsia and 359 with non-severe pre-eclampsia. Women with a history of severe pre-eclampsia had higher rates of previous cardiovascular disease than women with non-severe pre-eclampsia or women without pre-eclampsia (87, 72 and 72%, P = 0.0019). The high risk of previous cardiovascular disease in women with a history of severe pre-eclampsia (odds ratio 2.67, 95% CI 1.52-4.70) persisted after adjustment for albuminuria (odds ratio 2.74, 95% CI 1.55-4.83) and also after adjusting for other covariates including albuminuria (odds ratio 3.03, 95% CI 1.69-5.44). Even after accounting for cardiovascular risk factors including albuminuria, a history of severe pre-eclampsia is independently associated with a threefold higher risk of cardiovascular disease.

Influence of different intervention methods on the risk factors of cardiovascular disease for women with severe pre-eclampsia history

Objective To explore different intervention methods on the risk factors of cardiovascular disease for women with severe pre-eclampsia history.Methods 78 patients with a history of severe preeclampsia in the hospital from November 2006 to November 2008 were chosen as the research subject.They were divided into the observation group and the control group according to the adopted different methods of intervention with 39 patients in each group.The control group was taken with conventional interventions for obesity intervention,and the observation group was treated with standard behavior therapy (SBT).The improving situations of the related risk factors for cardiovascular disease after three months for the two groups were compared.The effect of different intervention methods on the risk factors of cardiovascular disease was evaluated for women with severe pre-eclampsia history.Results After the intervention,the cardiovascular risk factors (systolic blood pressure,body mass,waist circumference,fasting glucose,total cholesterol/high density lipoprotein) of the two groups improved significantly than before the intervention.But the improvement effect of the observation group was better than the control group,the differences between the two groups were significant.Conclusions The intervention effect on risk factors of cardiovascular disease by standard behavior therapy for women with severe pre-eclampsia history is better than conventional way,which is worthy of clinical application. Key words: Women with history of pre-eclampsia; Risk factors of cardiovascular disease; Standard behavior therapy