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Maternal Hypertension (maternal + hypertension)
Selected AbstractsRisk factors associated with preterm birth according to gestational age at birth,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2008Benjamin D. Ofori PhD Abstract Purpose To identify and quantify risk factors associated with preterm birth, stratified by gestational age at birth. Methods Three case-control analyses were done. Controls were pregnancies of ,37,weeks of gestational age at birth. Cases were defined as: <28, 28,32, 33,,<37,weeks of gestational age at birth respectively in the three case-control analyses. Women were categorized according to whether they carried single or multiple infants. Results Obstetrical conditions (placenta previa, placental abruption), and maternal hypertension were significantly associated with preterm delivery in all case-control analyses (adjusted OR between 1.34,19.56, p,<,0.05). Leading risk factors for preterm delivery in singleton pregnancies were placental abruption and placenta previa (adjusted ORs 4.85 and 4.13, p,<,0.05). For multiple pregnancies they were polyhydramnios and maternal hypertension (adjusted ORs 4.39 and 2.45, p,<,0.05). Conclusions Obstetrical conditions during the pregnancy and maternal hypertension are important risk factors for preterm birth. Copyright © 2008 John Wiley & Sons, Ltd. [source] Second trimester amniotic fluid annexin A5 levels and subsequent development of intrauterine growth restrictionPRENATAL DIAGNOSIS, Issue 10 2008Ozgur Dundar Abstract Objective The purpose of this study was to investigate the levels of annexin A5 in second trimester amniotic fluid, and evaluate its correlation with subsequent development of intrauterine growth restriction (IUGR). Method A total of 264 women undergoing mid-trimester amniocentesis between January 2007 and December 2007 were enrolled for the study. Amniocentesis was performed for routine indications. After delivery, outcome data were obtained. Results Maternal age, frequency of nulliparity, fetal sex and gestational week at amniocentesis were similar between groups. As expected, prevalence of smoking was higher in IUGR developing mothers. Significant positive correlations were present between annexin A5 levels and gestational age at amniocentesis (P = 0.02) and maternal age (P = 0.01). Linear regression analysis revealed that annexin A5 levels were positively correlated with patient's age. Smoking women had significantly lower annexin A5 levels in the mid-trimester amniotic fluid (9.9 ± 2.3 and 10.7 ± 1.3 ng/mL, P = 0.01). Logistic regression analysis demonstrated that after controlling for gestational age at amniocentesis, smoking, maternal age, and maternal hypertension, annexin A5 was not significantly associated with IUGR (P = 0.07). Conclusion Amniotic fluid annexin A5 levels in the mid-trimester are not associated with IUGR at birth after controlling for maternal smoking and other confounders. Copyright © 2008 John Wiley & Sons, Ltd. [source] Do maternal- or pregnancy-associated disease states affect blood pressure in the early neonatal period?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Alison L. KENT Background: Placental vascular changes associated with maternal disease states may affect fetal vascular development. There is evidence suggesting that being born prematurely is associated with a higher blood pressure (BP) in later life. Aim: To determine whether maternal disease state affects BP in the early neonatal period. Methods: Cohort study of neonates admitted to neonatal intensive care unit with exposure to maternal hypertension and diabetes. Inclusion criteria were neonates greater than 27 weeks gestation not ventilated or requiring inotropes for more than 24 h, materna l hypertension (pregnancy induced or essential) or diabetes of any kind requiring treatment, and spontaneous delivery. Exclusion criteria included chromosomal or congenital anomaly and illicit maternal drug use. Oscillometric BP measurements taken until discharge on days 1, 2, 3, 4, 7, 14, 21 and 28. Placental histopathology was performed. Results: One hundred and ninety infants enrolled, 104 in the control and 86 in the study group. Sixty-five infants were born between 28,31 weeks and 125 infants between 32,41 weeks gestation. Those born between 28,31 weeks with a history of diabetes had a statistically higher systolic, mean and diastolic BP throughout the first 28 days of life (P = 0.001; P = 0.007; P = 0.02). Those born between 32,41 weeks gestation with placental pathology associated with altered uteroplacental perfusion had a higher systolic BP (P = 0.005). Conclusions: Maternal- or pregnancy-associated disease states appear to influence BP in the early neonatal period. Diabetes and altered placental perfusion were associated with higher BP readings. Clinical significance of these statistically elevated BPs in the early neonatal period is unknown. [source] Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the motherBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2010JA Lykke Please cite this paper as: Lykke J, Paidas M, Damm P, Triche E, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2010;117:274,281. Objective, Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. Design, National registry-based retrospective cohort study. Setting, Women delivering in Denmark from 1978 to 2007. Population, Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419). Methods, Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. Main outcome measures, Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. Results, After a first delivery at 32,36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69,2.10) and the risk of thromboembolism increased 1.42-fold (1.24,1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34,1.86) increased risk of type-II diabetes and a 1.18-fold (0.96,1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71,3.10) increased risk of type-II diabetes and a 1.80-fold (1.29,2.50) increased risk of thromboembolism. Conclusions, Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks. [source] Nifedipine trials: effectiveness and safety aspectsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2005Herman P. van Geijn Nifedipine (Adalat) is marketed as an anti-hypertensive agent. Nifedipine inhibits voltage-dependent L-type calcium channels, which leads to vascular (and other) smooth muscle relaxation and negative inotropic and chronotropic effects on the heart. Vasodilation, followed by a baroreceptor-mediated increase in sympathetic tone then results in indirect cardiostimulation. Nifedipine was introduced as a tocolytic agent at a time when ,-agonists and magnesium sulphate dominated the arena for the prevention of preterm birth. The oral administration route, the availability of immediate and slow-release preparations, the low incidence of (mild) side effects, and its limited costs explain the attraction to this medication from the obstetric field and its rapid and widespread distribution. Currently, over 40 studies have been published on nifedipine's tocolytic effectiveness, including seven meta-analyses. The quality of the studies suffers particularly from performance bias because the majority of them failed to ensure adequate blinding to treatment both for providers and patients. Concerns about other methodological flaws include measurements, outcome assessment and attrition bias. In particular, the safety aspects of nifedipine for tocolysis have been underassessed. Conclusions from the meta-analyses, favouring the use of nifedipine as a tocolytic agent, are not supported by close examination of the data. The tocolytic effectiveness and ,safety' of nifedipine has been studied primarily in normal pregnancies. Based on its pharmacological properties, one should be cautious to administer nifedipine when the maternal cardiovascular condition is compromised, such as with intrauterine infection, twin pregnancy, maternal hypertension, cardiac disease, etc. Life-threatening pulmonary oedema and/or cardiac failure are definite risks and have been reported. Under such circumstances, the baroreceptor-mediated increase in sympathetic tone may not balance the cardiac-depressant activity of nifedipine. [source] | ||||||||||