Hypertensive Disorders of Pregnancy and Subsequent Risk of Premature Mortality

BackgroundHypertensive disorders of pregnancy (HDPs) are leading causes of maternal and perinatal morbidity and mortality. However, it is uncertain whether HDPs are associated with long-term risk of premature mortality (before age 70 years).ObjectivesThe objective of this study was to evaluate whether HDPs were associated with premature mortality.MethodsBetween 1989 and 2017, the authors followed 88,395 parous female nurses participating in the Nurses’ Health Study II. The study focused on gestational hypertension and pre-eclampsia within the term HDPs. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between HDPs and premature mortality were estimated by using Cox proportional hazards models, with adjustment for relevant confounders.ResultsThe authors documented that 2,387 women died before age 70 years, including 1,141 cancer deaths and 212 CVD deaths. The occurrence of HDPs, either gestational hypertension or pre-eclampsia, was associated with an HR of 1.31 (95% CI: 1.18 to 1.46) for premature death during follow-up. When specific causes of death were examined, these relations were strongest for CVD-related mortality (HR: 2.26; 95% CI: 1.67 to 3.07). The association between HDPs and all-cause premature death persisted, regardless of the subsequent development of chronic hypertension (HR: 1.20 [95% CI: 1.02 to 1.40] for HDPs only and HR: 2.02 [95% CI: 1.75 to 2.33] for both HDPs and subsequent chronic hypertension).ConclusionsAn occurrence of HDPs, either gestational hypertension or pre-eclampsia, was associated with an increased risk of premature mortality, particularly CVD mortality, even in the absence of chronic hypertension.     

妊娠合并糖尿病妊娠期患者的危险因素分析

目的分析妊娠合并糖尿病相关危险因素。方法选取从2014年7月—2015年7月收治的200例妊娠妇女,将合并糖尿病者作为研究组(100例),未合并糖尿病者作为对照组(100例),分析妊娠期合并糖尿病有关危险因素。结果两组高血压史、妊娠期感染、糖尿病史、不良孕产史、孕次、孕前月经紊乱、体重指数、文化程度以及年龄等危险因素差异有统计学意义(P0.05)。通过Logistic回归分析发现,妊娠合并糖尿病独立危险因素包含高血压史、妊娠期感染、糖尿病史、年龄。结论妊娠合并糖尿病主要独立危险因素包含妊娠期感染、糖尿病史、高血压史以及年龄,需加强妊娠健康知识宣传教育,提升育龄女性保健意识。     

妊娠期糖尿病危险因素及对妊娠结局影响的研究

目的 分析妊娠期糖尿病的危险因素及其对妊娠结局的影响.方法 选择2019年1—7月期间该院就诊的90例妊娠期糖尿病产妇为观察组,90名正常产妇为对照组.分析妊娠期糖尿病的高危因素,并比较两组产妇的妊娠结局.结果 相比对照组,观察组产妇的家族糖尿病病史比例、35岁以上比例、体质量指数超标比例和不良妊娠史比例均明显更高,差...     

Bariatric Surgery and the Pregnancy Complicated by Gestational Diabetes

Gestational diabetes mellitus (GDM) is an increasingly common obstetrical problem. Due to the global escalation in the prevalence of obesity, as many as 15 % of pregnant women may soon be classified as having GDM. While often not diagnosed until late gestation, GDM is now recognized as a disorder of glucose and lipid metabolism, systemic inflammation, and insulin resistance that begins early in pregnancy. Recent large randomized trials have clarified the risk of maternal and neonatal complications caused by GDM, as well as the potential to ameliorate these risks. There is significant interest in the potential to reduce the risk for developing GDM in obese women through the performance of bariatric surgery (BS) before pregnancy. BS significantly reduces the risk for GDM, preeclampsia, and large neonates. However, it seems that the risk for small neonates and preterm delivery is increased. No significant differences are observed in regard to cesarean section, postpartum hemorrhage, or perinatal mortality. In this article, we address the effects of GDM on the mother and child, and explore the risks and benefits of BS in the obstetrical population.     

Incidence and Long-Term Outcomes of Hypertensive Disorders of Pregnancy

BackgroundHypertensive disorders of pregnancy (HDP) are associated with increased risks for cardiovascular disease later in life. The HDP incidence is commonly assessed using diagnostic codes, which are not reliable; and typically are expressed per-pregnancy, which may underestimate the number of women with an HDP history after their reproductive years.ObjectivesThis study sought to determine the incidence of HDP expressed as both per-pregnancy and per-woman, and to establish their associations with future chronic conditions and multimorbidity, a measure of accelerated aging, in a population-based cohort study.MethodsUsing the Rochester Epidemiology Project medical record-linkage system, the authors identified residents of Olmsted County, Minnesota, who delivered between 1976 and 1982. The authors classified pregnancies into normotensive, gestational hypertension, pre-eclampsia, eclampsia, pre-eclampsia superimposed on chronic hypertension, and chronic hypertension using a validated electronic algorithm, and calculated the incidence of HDP both per-pregnancy and per-woman. The risk of chronic conditions between women with versus those without a history of HDP (age and parity 1:2 matched) was quantified using the hazard ratio and corresponding 95% confidence interval estimated from a Cox model.ResultsAmong 9,862 pregnancies, we identified 719 (7.3%) with HDP and 324 (3.3%) with pre-eclampsia. The incidence of HDP and pre-eclampsia doubled when assessed on a per-woman basis: 15.3% (281 of 1,839) and 7.5% (138 of 1,839), respectively. Women with a history of HDP were at increased risk for subsequent diagnoses of stroke (hazard ratio [HR]: 2.27; 95% confidence interval [CI]: 1.37 to 3.76), coronary artery disease (HR: 1.89; 95% CI: 1.26 to 2.82), cardiac arrhythmias (HR: 1.62; 95% CI: 1.28 to 2.05), chronic kidney disease (HR: 2.41; 95% CI: 1.54 to 3.78), and multimorbidity (HR: 1.25; 95% CI: 1.15 to 1.35).ConclusionsThe HDP population-based incidence expressed per-pregnancy underestimates the number of women affected by this condition during their reproductive years. A history of HDP confers significant increase in risks for future chronic conditions and multimorbidity.     

Environmental Toxicant Exposure and Hypertensive Disorders of Pregnancy: Recent Findings

Purpose of Review

To assess the strength of evidence for associations between environmental toxicants and hypertensive disorders of pregnancy, suggest potential biological mechanisms based on animal and in vitro studies, and highlight avenues for future research.

Recent Findings

Evidence is strongest for links between persistent chemicals, including lead, cadmium, organochlorine pesticides, and polycyclic biphenyls, and preeclampsia, although associations are sometimes not detectable at low-exposure levels. Results have been inconclusive for bisphenols, phthalates, and organophosphates. Biological pathways may include oxidative stress, epigenetic changes, endocrine disruption, and abnormal placental vascularization. Additional prospective epidemiologic studies beginning in the preconception period and extending postpartum are needed to assess the life course trajectory of environmental exposures and women’s reproductive and cardiovascular health. Future studies should also consider interactions between chemicals and consider nonlinear associations.

Summary

These results confirm recommendations by the International Federation of Gynecology and Obstetrics, the American Society for Reproductive Medicine, the American Academy of Pediatrics, and the Endocrine Society that providers counsel their pregnant patients to limit exposure to environmental toxicants.

     

Hypertensive Disorders of Pregnancy and Cardiovascular Diseases: Current Knowledge and Future Directions

Purpose of the review

Cardiovascular diseases (CVDs) are the principal killers of women. In this review, we summarize data regarding CVD and mortality after hypertensive disorders of pregnancy (HDP), and highlight clinical, research and policy needs to mitigate this risk.

Recent findings

Robust data indicate that women with HDP have substantially higher risk of future CVD, with a 3.7-fold increase in the risk of chronic hypertension, a 4.2-fold increase in the risk of heart failure, an 81% increase in the risk of stroke, and double the risk of atrial arrhythmias, coronary heart disease, and mortality when compared to women with normotensive pregnancies. Potential explanations include (1) the effect of pregnancy as a “stress test” in women destined to develop CVD, (2) mediation by conventional risk factors, (3) long-term vascular damage sustained during the preeclamptic episode, and (4) preexisting abnormalities in arterial health predisposing women to HDP, and, subsequently, CVD.

Summary

Women with HDP have significantly increased risk of CVD and mortality. Risk scores including obstetric history are necessary to better estimate a woman’s cardiovascular risk. In addition, comprehensive policies promoting systematic risk assessment and modification after HDP are critically needed to improve health, wellness, and survival of affected women.

     

Prevention of Hypertensive Disorders of Pregnancy: a Novel Application of the Polypill Concept

Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to identify eligible candidates for a polypill for the prevention of HDP. A comprehensive review of systematic reviews on drug and dietary interventions to prevent HDP was conducted. Interventions were evaluated based on efficacy, dose, route of administration, and side effects. Fourteen interventions were assessed. Low-dose aspirin and calcium were identified as candidates for a polypill, with risk reduction estimations for pregnancy-induced hypertension and preeclampsia ranging between 10 and 62 %, depending on patient population characteristics including a priori risk, and gestation age at start of intervention. Their effect may be augmented through the addition of vitamin D, vitamin B₁₂, and folic acid. The effect and optimal composition needs to be evaluated in future trials. Given the persistent burden of maternal and perinatal mortality associated with HDP, prevention of these disorders is key—especially in low-resource settings. The polypill approach with a combination of aspirin, calcium, vitamin D, vitamin B₁₂, and folic acid is a promising strategy to improve maternal and perinatal health outcomes.     

Arsenic Exposure and Cardiovascular Disorders: An Overview

The incidence of arsenic toxicity has been observed in various countries including Taiwan, Bangladesh, India, Argentina, Australia, Chile, China, Hungary, Peru, Thailand, Mexico and United States of America. Arsenic is a ubiquitous element present in drinking water, and its exposure is associated with various cardiovascular disorders. Arsenic exposure plays a key role in the pathogenesis of vascular endothelial dysfunction as it inactivates endothelial nitric oxide synthase, leading to reduction in the generation and bioavailability of nitric oxide. In addition, the chronic arsenic exposure induces high oxidative stress, which may affect the structure and function of cardiovascular system. Further, the arsenic exposure has been noted to induce atherosclerosis by increasing the platelet aggregation and reducing fibrinolysis. Moreover, arsenic exposure may cause arrhythmia by increasing the QT interval and accelerating the cellular calcium overload. The chronic exposure to arsenic upregulates the expression of tumor necrosis factor-α, interleukin-1, vascular cell adhesion molecule and vascular endothelial growth factor to induce cardiovascular pathogenesis. The present review critically discussed the detrimental role of arsenic in the cardiovascular system.     

围生期健康教育对妊娠期糖尿病妊娠结局的干预效果

目的观察围生期健康教育对妊娠期糖尿病妊娠结局的干预效果。方法将2013年1月—2015年7月年在该院妇产科进行产前检查的妊娠期糖尿病患者共95例设为观察组,选取2012年1—12月进行常规产检的妊娠期糖尿病患者95例设为对照组,对照组进行常规的产前检查,发放妊娠健康教育宣传资料。观察组在常规的产前检查的基础上,建立妊娠期糖尿病患者健康教育与管理手册,由妇保科医护人员对妊娠期糖尿病患者实施健康教育与管理。观察两组妊娠母婴并发症发生率及从孕期首次产前检查开始3个月后观察两组治疗依从性、血糖控制情况。结果观察组通过围生期健康教育干预,从孕期首次产前检查开始3个月后观察组治疗依从性(95.8%)高于对照组(75.8%),P0.05;对照组空腹血糖为(6.4±1.1)mmol/L,观察组为(5.7±0.6)mmol/L,观察组血糖控制程度优于对照组,P0.05;妊娠母婴并发症发生率(8.4%)明显低于对照组(21.1%),P0.05。结论围生期健康教育干预可降低母婴并发症的发生风险,改善妊娠结局。     

规范化治疗对妊娠糖尿病妊娠结局的影响分析

目的分析探讨规范化治疗对妊娠糖尿病妊娠结局的影响。方法将2019年2—6月在该院接受医治的妊娠糖尿病患者一共114例,进一步以随机数字分组法分成2个不同的组别,每组平均为57例;其中,对照组实行常规治疗,观察组实行规范化治疗,对比两组患者的妊娠结局及血糖指标。结果观察组羊水过多、胎膜早破、产后出血、妊高症及早产发生率均明显低于对照组,两组差异有统计学意义(P<0.05)。治疗后,观察组空腹血糖、餐后2 h血糖水平和对照组比较均显著更低(P<0.05)。结论在临床中,针对妊娠糖尿病患者采取规范化治疗方法具备显著的疗效;因此,值得在临床治疗领域中使用及推广。     

妊娠期糖尿病孕妇血糖控制与妊娠结局关系的临床探讨

目的观察妊娠期糖尿病孕妇血糖控制与妊娠结局之间的关系。方法以该院2010年1月—2014年12月围产期保健门诊筛查出的267例妊娠期糖尿病孕妇为研究对象,按治疗方法分为I组是经过单纯饮食治疗控制血糖在理想范围者170例,Ⅱ组是经过饮食控制联合胰岛素治疗控制血糖在理想范围者55例;Ⅲ组是未接受系统治疗者42例,观察并比较3组患者的妊娠结局。结果 3组患者妊高症、羊水过多、感染、产后出血、酮症酸中毒、巨大儿、FGR、早产儿、胎儿畸形、呼吸窘迫综合征和新生儿低血糖发生率和剖宫产率、围产儿死亡率之间的差异均有统计学意义(P0.01),Ⅰ组和Ⅱ组之间的差异均无统计学意义(P0.05),Ⅲ组均高于Ⅰ组和Ⅱ组(P0.05)。结论妊娠期糖尿病孕妇经过合理治疗,控制血糖在理想范围,能明显改变妊娠结局。     

The Risk Factors That Predict Chronic Hypertension After Delivery in Women With a History of Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) is one of the most important lethal complications in pregnant mothers. It is also associated with the subsequent development of chronic hypertension. The objective of this study was to identify the clinical risk factors of postpartum chronic hypertension in women diagnosed with HDP.Six hundred patients as HDP, who diagnosed and followed-up at least 6 month after delivery, were included in the study. We divided the included subjects in 2 groups based on the development of postpartum chronic hypertension: presenting with the chronic hypertension, “case group” (n = 41) and without chronic hypertension, “control group” (n = 559).Clinical and demographic factors were evaluated. By multiple regression analysis, early onset hypertension with end-organ dysfunction, smoking, higher prepregnancy body mass index (BMI), and comorbidities, systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APLS), were associated with progression to chronic hypertension in the postpartum period. The value of area under the curves (AUC) for the 5 models, that generated to combine the significant factors, increased from 0.645 to 0.831, which indicated improved prediction of progression to the chronic hypertension. Additional multivariate analysis revealed significant specific risk factors.This retrospective single hospital-based study demonstrated that the clinical risk factors, that is early onset hypertension with end-organ dysfunction, smoking, and higher prepregnancy BMI, were significant independent predictors of chronic hypertension in women after delivery. Identification of risk factors allowed us to narrow the subject field for monitoring and managing high blood pressure in the postpartum period.     

Inflammation and Cardiovascular Risk: An Overview

Endothelial dysfunction is an integral part of atherosclerosis and leads to a chronic inflammatory process within the atheromatous plaque. Measurements of inflammatory markers, particularly high-sensitivity C-reactive protein (hs-CRP), can predict future cardiovascular events in the apparently healthy population and in the cardiovascular patient irrespective of lipid levels. Also, an elevated hs-CRP was a predictor of adverse events in patients undergoing revascularization and in unstable coronary patients. The inflammatory response seems to be independent of the extent of the atherosclerotic burden and might reflect a vascular hyperresponsive state to injury that varies among individuals and could be partly genetically predetermined. Inflammatory markers are currently being incorporated in predictor models of cardiovascular risk and in the stratification of responders to therapy.     

胰岛素治疗妊娠糖尿病起始剂量与妊娠结局的相关性分析

目的探讨与分析胰岛素治疗妊娠糖尿病的起始剂量与妊娠结局的相关性。方法2015年5月—2018年12月选择诊治的106例妊娠糖尿病孕妇,根据随机数字表法分为低剂量组与高剂量组各53例。高剂量组:给予胰岛素1日多次给药治疗,门冬胰岛素注射液初始剂量0.5 U/(kg·d),低剂量组给予胰岛素泵持续治疗,门冬胰岛素注射液起始剂量0.2 U/(kg·d),两组疗程均为4周,记录两组妊娠结局。结果低剂量组的胰岛素用量显著低于高剂量组(P<0.05),两组血糖达标时间对比差异无统计学意义(P>0.05)。两组治疗后的FPG与2 hPG值都显著低于治疗前(P<0.05)。所有孕妇都顺利完成分娩,低剂量组的羊水过多、早产、妊娠期高血压、低血糖等并发症发生率为3.8%,显著低于高剂量组的24.5%(P<0.05)。低剂量组的新生儿高胆红素血症、新生儿低血糖、新生儿窒息、巨大儿等并发症发生率为3.8%,显著低于高剂量组的26.4%(P<0.05)。结论基于初始低剂量的胰岛素泵注射方式在妊娠糖尿病孕妇中的应用能减少胰岛素的应用剂量,能达到同样的降糖效果,改善孕妇与新生儿的预后。     

妊娠期糖尿病合并妊娠期高血压的临床护理对减少不良妊娠结局的价值分析

目的 分析对妊娠期糖尿病合并妊娠期高血压患者应用优质护理对减少不良妊娠结局的价值.方法 将2018年10月—2019年12月在该院高危产科接受治疗的妊娠期糖尿病合并妊娠期高血压患者纳入研究,共126例,采用随机数表法将所有对象分成对照组(n=63,常规护理)和实验组(n=63,优质护理).将两组患者的不良妊娠结局、血糖...     

Personalized Medicine for Diabetes: The Prevention of Type 2 Diabetes: An Overview

Type 2 diabetes mellitus is one of the major public health threats in the United States today, reaching epidemic rates. Epidemiological evidence suggests a strong link between obesity and the risk of developing diabetes. Increasing evidence demonstrates that lifestyle interventions can significantly delay or possibly prevent the onset of type 2 diabetes in persons with increased risk. Despite these findings, there remain important barriers to the translation of this research to the public health. These include identifying persons with an increased risk for developing the disease and the lack of easily accessible, cost-effective intervention programs. At least one study, however, has effectively implemented an evidenced-based intervention in community settings, suggesting that it may be possible to develop a model for the national scalability of primary prevention in the United States.     

早期护理干预对妊娠期糖尿病患者妊娠结局的影响研究

目的 分析妊娠期糖尿病患者行不同护理方案干预的价值.方法 该院妇产科收治2018年6月—2019年12月,选择妊娠期糖尿病患者118例,观察组(n=59)开展早期护理干预,对照组(n=59)予以妇产科常规干预,将两组患者血糖水平、产妇并发症、新生儿并发症发生情况进行对比.结果 观察组空腹血糖(4.70±0.80)mmo...