Hypertensive Mothers Research Articles

Infants born to hypertensive mothers treated by acebutolol. Pharmacological studies in the perinatal period.

Infants born to hypertensive mothers treated by acebutolol. Pharmacological studies in the perinatal period.

Somatomedin-like activity in cord blood from infants of hypertensive mothers.

Somatomedin-like activity (SLA) was measured by bioassay in cord serum from infants of hypertensive mothers. Levels of SLA were lowest in "light for date' infants with birth weights below the 3rd centile, but did not correlate with birth weight, placental weight or maturity at delivery. Cord serum from female infants had significantly (P less than 0.001) higher levels of SLA than male infants. No differences in SLA were found between infants born after spontaneous labor or following induction.

1260 NEONATAL EFFECTS OF SEVERE MATERNAL HYPERTENSION BEFORE 36 WEEKS GESTATION

Neonatal problems associated with an abnormal fetal environment have been well documented for infants of diabetic mothers, but the effects of severe hypertension upon the infant have not been well defined. Twenty-eight infants 27-35 weeks of gestation, delivered of mothers with diastolic hypertension ≥ 110 mmHg (IHM) and 28 gestational age-matched control infants (CI) delivered of normotensive mothers without tocolytic therapy were compared to determine the effects of severe hypertension and its therapy on the preterm neonate. Eight hypertensive mothers (HM) were eclamptic; all HM received magnesium sulfate; 32% sedatives; and 79% antihypertensive medications. Thrombocytopenia and marked LDH elevation occurred in 50% of hypertensive mothers. 39% of IHM and 0% CI were small for gestational age (p < .001); 29% and 0% were microcephalic at birth (p < .01). Other significant differences between the two groups of infants were noted in the incidence of hypotonia, ileus, delayed stooling, delayed respiratory adaptation, thrombocytopenia, leukopenia, neutropenia, patent ductus arteriosus and birth asphyxia. Maternal thrombocytopenia and enzyme elevations were significantly associated with growth retardation, microcephaly, thrombocytopenia, neutropenia and birth asphyxia in the infant. Gastrointestinal hypomotility and hypotonia were probably drug related. Severe maternal hypertension has unique and significant effects upon the preterm neonate which reflect the severity of the maternal disease process.

Spontaneous hypertension ion cross-suckled rats.

Genetically normotensive Sprague-Dawley rats nursed by spontaneously hypertensive foster mothers develop sustained high blood pressure. Some factor related to the genetically programmed hypertension of the foster mother is probably transmitted to the infant rats through her milk. Alternatively, the hyperkinetic behavior of the mother may activate a hypertensinogen in young having the proper constellation of genes.

The relationship of parental history of myocardial infarction, hypertension, diabetes and stroke to coronary heart disease risk factors in their adult progeny.

Laskarzewski P., J. A. Morrison, R. Horvitz, P. Khoury, K. Kelly, M. Mellles and C. J. Glueck (U. of Cincinnati, College of Medicine, Cincinnati, OH 45267). The relationship of parental history of myocardial infarction, hypertension, diabetes and stroke to coronary heart disease risk factors In their adult progeny. Am J Epidemiol 1981; 113: 290–306. Both univariate and multivariate analysis of covariance were used to assess the relationships of parental history of myocardial infarction (Ml), hypertension, stroke, and diabetes to coronary heart disease (CHD) risk factors of their 556 adult progeny (≧24 years old) including 200 white males, 257 white females, 30 black males, and 69 black females in the Princeton School study. The CHD risk factors considered were plasma cholesterol (CHOL), tri-glycerlde (TG), high and low density lipoprotein cholesterol (C-HDL, C-LDL), Quetelet index, and systolic and diastolic blood pressure (SBP and DBP). Fewer than half of the univariate comparisons appeared to be consistent with the hypothesis that positive family history is associated with a greater tendency toward CHD as measured by known risk factors. By univariate analysis, a history of paternal, but not maternal Ml was associated with higher C-LDL and TG in their offspring. There were also several significant univariate interactions of risk factors with age in progeny of fathers with Ml; the offsprings' increase in C-LDL and total CHOL with age was greater than that observed in subjects whose fathers did not have a Ml. By multlvariate analysis, neither paternal nor maternal history of Ml played a significant role relative to risk factor levels in their progeny. By multivariate analysis, maternal history of stroke was significant when all seven risk factors in their off-spring were viewed collectively, including higher CHOL, TG, C-LDL, and, in black kindreds, higher SBP and DBP. By multivariate analysis, maternal history of hypertension was significant; offspring of hypertensive mothers had Increased TG and Quetelet levels, lower C-HDL, and higher SBP and DBP. While parental diabetes had few significant univariate and no multivariate relationships with CHD risk factors in their progeny, parental history of diabetes had considerable interaction with other parental history information (parental stroke, Ml and hypertension). Using multivariate analysis, the existence of two affirmative answers to parental history questions did not cause a difference in their offspring's risk factors above that difference caused by the existence of one affirmative answer. In the multivariate model, the significance of interaction terms between covariables and main effects implies that the offspring's characteristics, such as race group, are more important in detecting differences in risk factors than one piece of additional information of parental history. Univariate and multivariate analysis of covariance may provide for somewhat different patterns of risk factor aggregations; the differing results can probably be attributed to the correlations which exist between the CHD risk factors themselves. In a cohort of adults, average age 40 years, while parental health history of Ml, hypertension, stroke and diabetes may facilitate identification of CHD risk factors in progeny, its utility will be circumscribed for primary care physicians who must rely on univariate comparisons.

Immunoglobulin Levels in Apparently Normal and Hypertensive Nigerian Mothers at Delivery

Immunoglobulin (Ig) levels in 68 apparently normotensive and 29 hypertensive mothers were estimated at parturition. There was a significantly higher incidence of elevated IgG levels in the hypertensive group (p less than 0.005) even though there were no differences in their mean concentrations. The mean IgA levels were not different in the two groups. IgM levels were higher in the hypertensive than in the normotensive mothers. The significance of these findings is discussed.

Effects of maternal medical diseases on the newborn.

The effects of maternal diseases on neonates have been analysed. Maternal anaemia leads to an increased incidence of low bith weight and preterm babies. The morbidity rate was high in these newborns with an increased incidence of hypoglycamia and scleraema. The perinatal loss was quite high. Hypertensive mothers as well as mothers suffering from chronic urinary tract infection or tuberculosis or cardiac disease also gave rise to low birth weight and preterm babies in greater proportion as compared to the normal. There was an increased morbidity and high perinatal loss in these groups. An increased awareness of the effects of maternal disease states on foetal growth and development will improve both the ability to make prenatal diagnosis of diseases and to plant for improved antenatal care and appropriant care of those newborns who are at hight risk, which in turn will definitely improve the outcome of the progeny and reduce perinatal loss.

Erythrocyte 2,3-diphosphoglycerate in normal and hypertensive gravid women and their newborn infants

Red blood cell 2,3-diphosphoglycerate (2,3-DPG) levels were studied in 227 normal gravid women in all stages of pregnancy, active labor, and early post partum. An increase to peak levels was observed at 19 to 22 weeks followed by a gradual fall toward normal. During labor and early post partum, 2,3-DPG again rose significantly above levels observed at term. Serial 2,3-DPG values through the third trimester, labor, and postpartum period in 11 hypertensive mothers and 20 normal gravid control subjects and their newborn infants were studied. Maternal 2,3-DPG levels were significantly higher in the hypertensive mothers when compared to control mothers at similar gestational stages. However, no difference in 2,3-DPG levels was observed when newborn infants of hypertensive mothers were compared with those of normal control subjects.

Serum cystine aminopeptidase and the small-for-dates baby in hypertensive pregnancy.

Serum cystine aminopeptidase levels and gradients have been assessed retrospectively in hypertensive mothers delivering small-for-dates babies, compared with those delivering normal weight babies. The average accuracy of predicting the weight range of the infant (normal or small-for-dates) would have been about 82 per cent.

Expansion of intravascular volume and fetal outcome in patients with chronic hypertension and pregnancy

Measurements of blood volume were carried out between 24 and 40 weeks of gestation in 20 multiparous patients with chronic hypertension and pregnancy. Hypertensive patients had both reduced blood volume and infants of smaller weight (p < 0.01) than nonhypertensive control subjects. There was a significant difference (p < 0.01) in the degree of blood volume expansion in hypertensive mothers who were delivered of infants who were adequate for gestational age (AGA), term, or premature, compared to those who were delivered of infants who were small for gestational age (SGA) or stillborn. Classification of chronic hypertension during pregnancy according to the American Committee on Maternal Welfare classification or according to severity of the hypertension was of no value in identifying the mothers at risk of delivering intrauterine growth-retarded infants. However, failure in achieving a blood volume expansion of at least 60 c.c. per kilogram clearly identified those pregnancies leading to growth retardation and fetal death. The decrease or lack of intravascular volume expansion was reflected in the presence of creatinine clearance values at nonpregnant levels in the mothers who were delivered of SGA infants and in a significant reduction below the nonpregnant levels in those who were delivered of stillborn infants. These data suggest that measurement of blood volume and endogenous creatinine clearance in patients with chronic hypertension and pregnancy is a useful parameter in the identification of those patients who will have a poor fetal outcome.

Serum cystine aminopeptidase and the normal weight baby in normotensive and hypertensive pregnancy.

The levels of serum cystine aminopeptidase have been studied serially in normotensive and hypertensive mothers who delivered healthy, normal weight-for-dates babies. A normal range, both for enzyme level and maximum and minimum rates of increase of the enzyme during gestation, was established for each group, those of the hypertensive patients exhibiting different characteristics from the curves in normotensive patients. It is suggested that such differences be considered when assessing pregnancies complicated by hypertension.

PLASMA OESTRIOL IN RETARDED INTRAUTERINE FETAL GROWTH

To determine the relationship of plasma estriol and retarded intrauterine fetal growth 14 primiparous and 4 multiparous pregnant women with suspected intrauterine growth retardation were studied by radioimmunoassay of weekly blood samples and compared with 25 normal pregnant women as controls. The plasma estriol levels in all 4 hypertensive mothers who gave birth to infants of low birthweight were all much less than the normal averages. Estriol levels were also less than average though not as significantly in 7 of the 9 normotensive patients with low birthweight infants and in the 5 patients with low weight gain but normal-weight infants. Thus a dramatic reduction in estriol concentration occurs in hypertensive patients with intrauterine fetal growth retardation. No correlation was found between predelivery plasma estriol concentration and infant birthweight or incidence of fetal distress. Though both have growth retardation hypertensive patients have a much higher incidence of fetal distress (75%) than normotensive patients (29%). Further research is being conducted on the relationship of plasma estriol and blood pressure in this regard.

The placenta and newborn infant in hypertensive conditions

The pregnancy outcome was studied in 57 hypertensive and 19 normal patients. The infants were weighed at birth, and the weight curves were followed in the nursery. The placentas were studied immediately after expulsion and weighed, and several specimens from different areas were studied under phase-contrast microscopy to assess the capillaries and the trophoblast. In addition, the water content of the placentas was studied by drying small specimens in triplicate at 100° C. and reweighing after 24 hours. The hypertensive patients were grouped as toxemia (pre-eclampsia or eclampsia) or pre-existing hypertension, as well as moderate or severe hypertension. The data were programmed and comparisons were made. The results indicate that the fetuses and placentas of hypertensive mothers were significantly lighter than normal. Furthermore, there was a significant gradient when comparing pure hypertensive, toxemic, and normal patients. The placental villi in hypertensive patients have an abnormally high number of terminal “syncytial buds” which are proportional to the intensity and particularly to the duration of the hypertension. The neonatal weight curve of “intrauterine growth-retarded” infants was markedly different from the average standard of true premature babies.

Micro Vascular Changes in the Placenta of Bangladeshi Overt Diabetic Mothers and Hypertensive Diabetic Mothers

It is a significant medical problem when Pregnancy is complicated by diabetes and/or hypertension which affect not only affecting maternal health, but also jeopardizing fetal normalcy? The placenta being the bridge between maternal fetal activities, this structure is considered as a window through which understanding of maternal dysfunctions as well as of their impacts on fetal wellbeing can be obtained. And as it is an almost all-vessel organ, its functional status depends primarily on the structural status of its vessels. To observe vascular changes in the placenta, a study was carried out on 44 placentas.19 from overt diabetic mothers having no hypertension and 5 from hypertensive diabetic mothers, and 20 from control group having no hypertension or diabetes. These were collected just after delivery though caesarian section. Microscopic findings of the study were that there was a trend of greater intimal thickness at the second branching site in the overt diabetes group than the control group. But at the first and last branching site this tendency was reversed. But none of these tendencies reached statistical significance. In case of the hypertensive diabetes group, there was a tendency of greater intimal thickness at the first, second and last branching sites as compared to the control group. Hypertensive diabetes group also showed significantly greater intimal thickness at first and last branching sites than the overt diabetes group. &#x0D; &#x0D; Key words: Placenta, diabetes, blood vessels, hypertension&#x0D; &#x0D; J Bangladesh Soc Physiol. 2006 Dec;(1):27-34

Antihypertensives in Hypertensive Disorders of Pregnancy

Hypertension is the most common medical disorder in pregnancy. It complicates about 15% of all pregnancies and is an important cause of maternal and foetal morbidity and mortality. Hypertension is diagnosed from an absolute rise in blood pressure at or above 140/90 mm of Hg. There is general consensus that severe hypertension should receive pharmacological treatment but the value of treating mild hypertension is controversial. The threshold for treatment is 140-150 mm of Hg systolic and/ or 95-100 mm of Hg diastolic to prevent worsening complications of hypertensive mother. Opinions differ as to which is the best antihypertensive during pregnancy. All antihypertensives are either shown or assumed to cross the placenta and reach foetal circulation. While the goal of treatment is to reduce maternal risk, agents selected must be efficacious and safe for the foetus. Methyldopa and labetolol are considered as the first line antihypertensives. As second line therapy, calcium channel blocker, oral hydralazine are recommended. As third line agent, beta-adrenergic blockers are used. For immediate lowering of blood pressure sublingual Nifidipine , parenteral or oral Labetolol, parenteral Hydralazine are used. Atenolol use should probably be avoided in pregnancy because of its association with low birth weight. Both Angiotensin converting enzymes and Angiotensin receptor blockers are fetotoxic and contraindicated during pregnancy. This review article was done with the aim to update knowledge regarding indication, safety, side effects as well as impact of anti-hypertensives on the foetus. DOI: 10.3329/bjog.v23i2.4963 Bangladesh J Obstet Gynaecol, 2008; Vol. 23(2) : 65-77

18 New Form of Congenital Adrenal Hyperplasia

A new form of adrenal hyperplasia in a 12-year-old boy is being described. The unique features are: 1. classical signs of primary hyperaldosteronism, i.e. mild hypertension, hypokalemic alkalosis, low plasma renin, hypervolemia and fixed hyperaldosteronism unaffected by sodium restriction or excess; 2. low normal plasma levels of cortisol, corticosterone but elevated plasma aldosterone; 3. elevated plasma ACTH; 4. low normal urinary free cortisol, 17OH, 17KS, pregnanetriols which respond poorly to ACTH; 5. normal rise of plasma testosterone to chorionic gonadotrophin; 6. marked decrease of aldosterone production and marked fall in elevated blood pressure following treatment with glucocorticoids; 7. after 6 months of prednisone therapy blood pressure and aldosterone response to restriction and administration of sodium remain normal. Turnover rates of corticosterone (B), desoxycorticosterone (DOC), cortisol (F), and desoxycortisol (S) studied under conditions of: sodium restriction and excess; ACTH stimulation; Metyrapone inhibition and Decadron suppression in 2 normotensive siblings and father reveal that only the patient demonstrates deficiency in cortisol secretion but the hypertensive mother has an abnormal aldosterone regulation. On the basis of steroidal data obtained, a partial 17-hydroxylase defect in the adrenal and not the gonad appears to explain the syndrome best. This form of hypertension is noteworthy because it is alleviated by medical treatment and may be misdiagnosed as primary hyperaldosteronism.