Hypertensive Syndrome Of Pregnancy Research Articles

Clinical Effect of Magnesium Sulfate Combined with Nifedipine on Hypertensive Syndrome of Pregnancy

Clinical Effect of Magnesium Sulfate Combined with Nifedipine on Hypertensive Syndrome of Pregnancy

314. Maternally sequestered biologics for treatment of preeclampsia

Introduction Preeclampsia is a hypertensive syndrome of pregnancy with few pharmacological treatment options. The risk of for adverse fetal effects is a major limitation for drug development. Our lab has developed a protein-based drug carrier called elastin-like polypeptide (ELP) that is capable of stabilizing therapeutic proteins or peptides in the maternal circulation while preventing their placental transfer. Objective/Hypothesis We hypothesize that ELP can be optimized for maternally sequestered drug delivery by altering the polymer length. We further hypothesize that ELP can be fused to vascular endothelial growth factor (VEGF) to restore angiogenic balance while preventing fetal exposure to the therapeutic. Methods A library of ELP carriers ranging in size from 25 to 110 kDa was created. The pharmacokinetics, biodistribution, and placental transfer of each agent were determined in a rat pregnancy model. A 60 kDa ELP domain was fused to human VEGF-A121, and the pharmacokinetics were determined following repeat dosing intravenous or subcutaneous administration. Results The plasma half-life of ELP was inversely related to its molecular weight. As the size of the molecule increased, the renal ELP deposition decreased and the placenta and other maternal organ levels increased. Within the placenta, ELP was localized broadly in the labyrinth and along the chorionic plate. No ELP crossed the placental barrier at any size tested. When fused to VEGF, daily IV dosing lead to a 2.1 +/- 1.1 h half-life after each injection. SC administration lead to an increase in plasma ELP-VEGF levels over the first three hours, followed by a slow clearance phase over 24 h that was accompanied by dispersal of the protein from the SC injection site. Discussion This work demonstrates the utility of ELP as a tunable, long-circulating, non-toxic, maternally sequestered drug carrier. The ELP-VEGF fusion protein has potential as a novel biologic for treatment of preeclampsia.

Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group.

The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health. A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1year (T1) or over 1year (T2), during a maximum of 2years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p<0.05). RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene. Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.

Increase of placental sensitivity to melatonin and the alteration to its local synthesis in hypertensive syndromes in pregnancy

Objective: To evaluate the relation between hypertensive syndromes and melatonin, and its possible protective role against lesions due to hypertension. Methods: Placentas were classified into gestational hypertension (GH), chronic hypertension (CH), pre-eclampsia (PE) and pre-eclampsia superimposed on chronic hypertension, and morphologically examined by hematoxylin–eosin and periodic acid Schiff methods. Immunohistochemistry was performed to detect tryptophan hydroxylase (TH) and melatonin receptor 1A (MR-1A). Results: MR-1A expression was higher in all types of hypertensive syndromes in pregnancy (HSP), mainly in cases with GH, in Caesarean section delivery, preterm placentas and in the cases with alterations in the placental morphology, particularly those presenting inflammation. The expression of TH was higher in cases with CH when compared with the control. This expression was lower in primigestas, in the cases of inflammation and with PE. Conclusions: HSP therapies should be considered and studied, especially in the cases of HSP associated with PE, in which the placenta is more sensitive as it has more receptors, but its synthesis ability is reduced. As for GH and CH, the possible benefits should be evaluated, since the local placental ability to produce melatonin still exists.

Influence of inflammatory infiltrate and alterations of the blood flow in the etiopathogenesis of the basement membrane of the amniotic epithelium (BMAE) thickening in patients with hypertensive syndromes in pregnancy

To evaluate the mechanisms involved in the etiology of the basement membrane of the amniotic epithelium (BMAE) thickening in patients with hypertensive syndromes in pregnancy (HSP). Eighty placentas from patients presenting HSP were morphologically examined in staining through hematoxylin-eosin and periodic acid Schiff method. Placental morphological changes were classified into: diagnostic of low placental blood flow, characterized by a larger number of syncytial knots, fibrin deposits, and a larger number of vessels in terminal villi; and placentas with inflammation that presented inflammatory infiltrate in membranes or placental villi. Measurements of thickness were made with an automatic image analyzing software. BMAE thickness was higher in the group with HSP, particularly in cases with gestational hypertension and pre-eclampsia superimposed on chronic hypertension (PSCH). In the placentas of the HSP group, the thickness of the BMAE was higher in cases with inflammatory infiltrate. There was a positive and significant correlation between the BMAE thickness and the thickness of the amniotic epithelium. The BMAE thickening areas were associated with hyperplasia and edema of the amniotic epithelium. BMAE thickening in cases with HSP is more evident when there is an interaction between the severe effects of uteroplacental hypoxia, with consequent death and remodelling of the amniotic epithelium cells, as in PSCH, with local inflammatory processes that make this thickening much more evident.

Estudo dos principais fatores de risco maternos nas síndromes hipertensivas da gestação

There are several risk factors for hypertensive syndromes in pregnancy (HSP), and these can be related to regional and ethnic factors. Studies on this issue are scarce in the State of Goiás. To investigate maternal risk factors for HSP. Case-control study based on the analysis of medical records of parturients from the Maternity Service of Hospital das Clínicas da Universidade Federal de Goiás (HC-UFG) in 2005. Risk factors were analyzed using Logistic Regression Analysis and Fisher's Exact Test. In 2005, there were 890 deliveries in the Maternity Service of HC-UFG, and 129 pregnant women were diagnosed with HSP (14.5%). The multivariate analysis identified obesity as a risk factor both for gestational hypertension--GH (OR: 17.636; 95% CI: 2.859 to 108.774) and for preeclampsia superimposed on chronic hypertension--PESCH (OR: 27.307; 95% CI: 4.453 to 167.440). Primiparity was a risk factor for GH (OR: 5.435; 95% CI: 1.923 to 15.385). Age above 30 years was a risk factor for PESCH (OR: 5.218; 95% CI: 1.873 to 14.536) and a protective factor against preeclampsia--PE (OR: 0.035; 95% CI: 0.003 to 0.364). Non-white race was an independent risk for PE (OR: 13.158; 95% CI: 1.672 to 100.000) and previous PE for PESCH (OR: 4.757; 95% CI: 1.261 to 17.938). Of the pregnant women with chronic hypertension (CH), 73.5% developed PESCH (p < 0.001). The factors identified--obesity, non-white race, previous PE, age above 30 years and CH, were similar to those found in the majority of studies in the literature.

Placental morphometrical and histopathology changes in the different clinical presentations of Hypertensive Syndromes in Pregnancy

Even though there are clinical studies emphasizing the diagnosis and the perinatal intercurrent diseases of the Hypertensive Syndromes in Pregnancy, few of these studies establish the clinical forms of the specific hypertensive syndromes with the associated morphological placental alterations. The lack of studies on placental morphology and the etiopathogenesis of the different clinical standards for HSP, together with the need to objectively characterize these morphological placental lesions justify this study. A retrospective study was carried out with 91 placentas examined throughout the period from 2000 to 2003. All placentas from patients presenting HSP in this period were included in the study. These were classified according to features well established by the literature such as laboratory and clinical criteria into: gestational hypertension (GH), chronic hypertension (CH), pre-eclampsia (PE) and pre-eclampsia superimposed on chronic hypertension (PSCH). The number of knots presented a positive correlation with the length of time and severity of the hypertension during gestation (Spearman correlation: 0.253; P = 0.0158). The fibrin deposit was greater in all HSP groups but the pattern of distribution changes in the most severe cases from perivillous to intravillous as in the PSCH group (P = 0.002). There was no statistically significant difference in the area of the stem vessel walls among the groups. The cases with PE and CH presented a larger number of terminal villi vessels (P < 0.001). This report suggests, that although they could be different types of hypertension or an evaluation of the same disease, the final pathway that leads to microscopic lesions in the placenta is the same, with only different intensity due to the severity of the disease.

Proteinuria in hypertensive syndrome of pregnancy: maternal and perinatal outcome

The purpose of this study was to determine the role of proteinuria on pregnancy outcome in hypertensive syndrome with singleon pregnancies. Transversal study with retrospective data of 334 pregnancies complicated by hypertensive syndromes who were delivered in the Department of Obstetrics of UNIFESP/EPM from January 1, 1999 to December 31, 2002. The patients were divided into four groups: (I) without proteinuria (n-203); (II) with proteinuria of 0.3 to 1.0g (n-39); (III) 1.0 to 2.0g (n-45); and (IV) 2.0g or more. Without proteinuria there was one case of placental abruption. The presence of proteinuria predicted adverse maternal outcome with increase of complications proportional to his elevation; among them, HELLP syndrome was the most frequent with 30.5% (40/131) followed by eclampsia with 3.8% (5/131), DPP 3.1% (4/131) and renal insufficiency with 0.7% (1/131). It was confirmed one maternal death in that group, when Maternal Mortality of 763/100.000nv was added up. As to the perinatal effects there was not increase of adverse effects without proteinuria. In the presence of proteinuria and its levels was observed the worst perinatal outcome with the elevation of the following indicatives: increase prematurely (62.2% vs 11.5%), newborn with weight < 2500g (6.5% vs 1.5%), newborn with Apgar < 7 in the 5th minute (30.4% vs 3.5%), concepts with growing restriction of intrauterine (41.9% vs 6.5%), newborn interned in the neonatal undid, (59.8% vs 15.5%) stillborn (14.4% vs 1.4%), neonatal deaths (6.1% vs 0.98%). The Perinatal Mortality was greater with proteinúria (175 vs 19,7) and, when = 2.0g (297.8 vs 19.6). The presence of proteinuria in the hipertensives syndromes during gestation and the elevation of their levels increase the risks of maternal complications, especially HELLP syndromes and eclampsia. Besides, it was observed a significative incidence of premature birth, newborn with Apgar < 7, weight < 2500g, IUGR, stillborn and neonatal deaths.

Impacto de la violencia doméstica sobre la salud reproductiva y neonatal

Domestic violence can have an important influence on mother and child health. To assess the consequences of remote and actual, emotional or physical, domestic violence on the reproductive and newborn health in pregnant women. A longitudinal epidemiological observation from an Urban Primary Health Care Center from Valdivia, Chile, in 1998. Two cohorts were studied: Pregnant women that experienced domestic violence (index group) and pregnant women not exposed to domestic violence (control group). Women were followed during pregnancy and at labor. The newborn was also assessed. The index group had a higher relative risk (RR) for impending abortion (RR 1.44, 95% confidence interval (CI): 1.07-1.93), hypertensive syndrome of pregnancy (RR 1.5, 95% CI: 1.18-1.96), intrahepatic cholestasis (RR 1.5, 95% CI: 1.1-1.94). Women that experienced violence during pregnancy had a higher risk of urinary tract infection (RR 2.88, 95% CI: 1.28-6.43), intrauterine growth retardation (RR 3.7, 95% CI: 1.77-7.93) and intrahepatic cholestasis. Newborns from the index group had lower weight, size and gestational age. Domestic violence is associated with hypertension during pregnancy and intrauterine growth retardation. The incorporation of bio-psychological evaluation and monitoring systems could attenuate the consequences of domestic violence.

The relation of retinal changes to the severity of the acute toxic hypertensive syndrome of pregnancy

The relation of retinal changes to the severity of the acute toxic hypertensive syndrome of pregnancy