微量元素对妊娠期高血压疾病的预防作用

妊娠期高血压疾病是妊娠期特有的严重产科并发症,与母胎的发病率与死亡率密切相关,主要表现为孕20周后出现水肿、高血压及蛋白尿。目前发病机制并不明确,多种因素参与其发病,许多证据支持孕妇某些营养元素的缺乏及不均衡与妊娠期高血压疾病的发生及发展相关。现就孕期不同微量元素补充对妊娠期高血压疾病的预防作用予以说明。     

维生素B12与妊娠相关疾病关系的研究进展

维生素B12是人体内重要的微量元素,人体内所需要的量均从食物中摄取。维生素B12作为辅酶参与细胞内多种反应,如在哺乳动物体内,其参与同型半胱氨酸及甲基丙二酸的合成代谢,同型半胱氨酸及甲基丙二酸在人体内蓄积时,会引起机体多系统功能障碍。因此,当维生素B12缺乏或者不足时会影响机体多系统功能。在妊娠期,蛋白质合成代谢及线粒体能量转换会增强,这对维生素B12的需要量会增加,会更易引起维生素B12不足或者缺乏。在妊娠期,维生素B12缺乏可以引起妊娠期高血压疾病、妊娠期肝内胆汁淤积症等产科疾病,同时也能引起新生儿甲基丙二酸血症、胎儿生长受限等疾病。     

维生素B12与妊娠相关疾病关系的研究进展

维生素B12是人体内重要的微量元素,人体内所需要的量均从食物中摄取。维生素B12作为辅酶参与细胞内多种反应,如在哺乳动物体内,其参与同型半胱氨酸及甲基丙二酸的合成代谢,同型半胱氨酸及甲基丙二酸在人体内蓄积时,会引起机体多系统功能障碍。因此,当维生素B12缺乏或者不足时会影响机体多系统功能。在妊娠期,蛋白质合成代谢及线粒体能量转换会增强,这对维生素B12的需要量会增加,会更易引起维生素B12不足或者缺乏。在妊娠期,维生素B12缺乏可以引起妊娠期高血压疾病、妊娠期肝内胆汁淤积症等产科疾病,同时也能引起新生儿甲基丙二酸血症、胎儿生长受限等疾病。     

微量元素在现代妊娠期营养中作用的评价

随着现代科学技术的迅速发展,人们已认识到营养性微量元素在现代妊娠期营养中起重要的作用,但目前在发展中国家妊娠妇女体内多种微量元素缺乏还是较普遍现象,同时研究也证实,某些微量元素的补充确实可预防一些严重妊娠并发症的发生,其中铁、钙、碘、硒、铜及锌等元素与妊娠期营养状况关系尤其密切,本文对其作用表述如下。     

1410名孕妇微量元素检测分析

目的:了解我县孕妇妊娠期间微量元素的状况及影响因素。方法:对来我院产前门诊产捡的1410名孕妇进行了血液微量元素检测,对结果进行了分析。结果:钙元素缺乏率达26.24%、铁元素缺乏率16.32%、锌元素缺乏率12.77%、镁元素缺乏率0.71%、铜元素缺乏率0.78%。结论:加强孕期保健知识的宣传及营养指导,提高孕妇的自我保健意识,定期产前检查,监测孕期微量元素的变化,及时采取干预措施,促进胎儿健康生长发育及母体健康,提高出生人口质量,保证优生优育。     

褪黑素与妊娠期高血压疾病研究进展

近年对褪黑素生物学功能的广泛研究发现褪黑素是一种强抗氧化剂,其抗氧化和清除氧自由基作用在妊娠期高血压疾病发病病因发生发展方面可能有重要作用。进一步研究褪黑素用于预防及治疗妊娠期高血压疾病,有助于揭示妊娠期高血压发病机制,为预防治疗妊娠期高血压疾病提供新的药物选择。现将褪黑素与妊娠期高血压疾病的研究进展作一综述。     

妊娠期高血压疾病患者尿蛋白形成部位的探讨

妊娠期高血压疾病常发病于妊娠20周后，发病率约占妊娠妇女的5％～10％，严重可引起孕产妇及围产儿死亡。妊娠期高血压疾病的主要临床症状是高血压、蛋白尿和水肿，其中尿蛋白量及成分常用于评估妊娠期高血压疾病患的肾脏受损情况。本研究通过对妊娠期高血压疾病患非浓缩尿尿蛋白成分的分析，探讨妊娠期高血压疾病患尿蛋白形成的部位。     

我国针对妊娠期特发性疾病营养干预现况

某些妊娠期特发性疾病的发生与妊娠期营养状况相关;通过改善妊娠期营养状况可控制该类妊娠期特发性疾病的发生和发展。本文重点介绍了妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血的营养干预情况。目前尚未发现有关妊娠期肝内胆汁淤积症和妊娠剧吐的营养干预性研究。     

妊娠期高血压疾病孕妇体成分研究

目的 探讨孕晚期妊娠期高血压疾病孕妇体成分与正常孕妇体成分的差异及体成分检测的意义.方法 随机选取2012年7月至2012年11月于山西医科大学第二医院产检的孕晚期单活胎孕妇,根据妊娠高血压疾病分类及诊断标准,分为妊娠期高血压组20例,重度子痫前期组28例,正常妊娠对照组30例.于孕妇入组时使用个体营养检测分析仪(NQA-PⅠ)进行检测,比较三组孕妇体成分的差异.结果 三组孕妇孕前BMI及孕期体重增长比较,差异均有统计学意义(P＜0.005);重度子痫前期组孕妇TBW、ECW、肌肉重、FFM均高于妊娠期高血压和正常妊娠对照组,差异有统计学意义(P＜0.001);妊娠期高血压组FM、BF％高于重度子痫前期组和正常妊娠对照组,差异有统计学意义(P＜0.001).结论 孕期体成分的改变可作为妊娠期高血压疾病的警示信号.定期对孕妇进行体成分检测,可有效降低妊娠期高血压疾病的发病率.     

营养门诊管理对北京市怀柔区妊娠期妇女妊娠结局的影响

目的了解营养门诊管理对北京市怀柔区妊娠期妇女妊娠结局的影响。方法自孕7周开始对在产科门诊建档产检的孕妇在营养门诊进行管理,给予合理化饮食结构指导的孕妇600例作为研究组,同期未在营养门诊接受饮食指导的300例孕妇作为对照组,观察两组的妊娠结局。结果研究组孕妇妊娠期糖尿病、巨大儿、妊娠期高血压疾病的发生率及剖宫产率较对照组低(P0.05)。结论营养门诊对妊娠期妇女进行饮食结构指导可以减少围产期并发症,改善妊娠结局。     

Translational studies for exercise in high-risk pregnancy: Pre-eclampsia model

Objective: Reviewed literature regarding exercise effects on pregnancy-related hypertensive disorders, analyzing basic science perspectives and clinical studies. Methods: Scientific databases were accessed by research strategy combining Medical Subject Headings terms. Studies published between 2000 and 2015, in English, Portuguese, and Spanish language, were considered. Results: Studies were classified into: recommendations for exercise on high-risk pregnancy; animal models for hypertension in pregnancy; exercise on hypertensive disorders in animal models and pregnant women. Conclusion: There are several animal models to mimic hypertensive disorders in pregnancy; however, clinical studies are still needed for exercise recommendation in pregnant women with hypertensive disorders.     

Hypertensive disorders of pregnancy.

OBJECTIVES: This study was undertaken to determine the prevalence of hypertensive disorders of pregnancy and evaluate their effects on the mothers and fetuses at Jahrom, a city in southern Iran. METHODS: A retrospective survey was performed on 2300 pregnant women who had referred to Shahid Motahhari Hospital of Jahrom School of Medical Sciences from 22 September 2002 to 21 September 2003. Diagnosis of hypertensive disorders of pregnancy and their probable complications were made according to medical recording files. RESULTS: Among the studied patients, 3.3% were diagnosed as having hypertensive disorders of pregnancy, of which 96% were cases of preeclampsia/eclampsia or transient hypertension. In hypertensive patients, the overall maternal mortality rate was 1.3 per 10,000 and perinatal mortality rate was 53 per 1000 births. Low birth weight neonates were observed in 20% of cases. CONCLUSION: Hypertensive disorders of pregnancy commonly complicate pregnancy and have great influences on maternal and neonatal morbidity and mortality rates and more attention and precision is needed to evaluate the pregnant women for detecting and preventing the complications.     

Serum leptin levels in hypertensive disorder of pregnancy

OBJECTIVE: To determine serum leptin levels in hypertensive disorder of pregnancy. MATERIALS AND METHODS: In this prospective, cross-sectional, case control study, we measured serum leptin levels of 58 hypertensive pregnant women and 54 normal pregnant women. We also did blood and urine analysis for the evaluation of the severity of hypertensive disorder of pregnancy. The patients were followed until after delivery and information about labour was recorded. We analysed the difference and correlation between anthropometric measures, hormonal and biochemical parameters, and serum leptin levels in two groups. RESULTS: In the study group, serum leptin levels were determined to be higher than the control group. Neonatal birth weight was significantly lower in the hypertensive group. While the serum uric acid, urea, aspartate aminotransferase, fibronectin, and fasting blood glucose levels were found to be higher, serum total protein and albumin levels were significantly lower among the hypertensive pregnant women. Hypertensive pregnant women were more insulin resistant. Serum leptin levels were highly and positively correlated with serum fibronectin, and C peptide levels. A negative significant correlation was observed between maternal serum leptin levels and neonatal birth weight among the pregnant women having the hypertensive disorders. CONCLUSION: Serum leptin levels in hypertensive pregnant women appear to be higher. The determination of serum leptin levels may be as important as serum fibronectin and C peptide levels in the management of hypertensive disorder of pregnancy. C peptide and insulin may be due to hyperinsulinemia which leads to increased stimulation of leptin production by fatty tissue. Insulin resistance which appears in late pregnancy is more significant especially in pregnancies complicated by preeclampsia.     

Maternal renal artery Doppler velocimetry in normotensive pregnancies and pregnancies complicated by hypertensive disorders.

Hypertensive disorders in pregnancy contribute to substantial maternal and perinatal morbidity and mortality. Clinically, these disorders are characterized by hypertension and proteinuria. However, these signs appear some time after the physiologic derangements have been initiated. The primary objectives of this study were as follows: 1) to establish baseline values for the maternal renal artery systolic-diastolic ratio (S/D) as a function of gestational age in normal pregnancies, and 2) to determine whether renal artery blood flow indices can accurately identify those pregnancies complicated by, or destined to develop, hypertensive disorders. Using a pulsed Doppler scanner, maternal renal artery duplex evaluation was performed in four groups of women: normotensive nonpregnant, normotensive pregnant, chronic hypertensive pregnant, and preeclamptic. In 30 normotensive pregnant women followed longitudinally, no change was noted in the renal artery S/D as gestational age advanced, with mean (+/- SD) values of 2.5 +/- 0.20 and 2.6 +/- 0.21 for the left and right sides, respectively. No clinically meaningful discriminations were detected when the four groups were compared. We conclude that maternal renal artery Doppler waveforms are not significantly altered by either pregnancy or hypertensive complications in pregnancy.     

VCAM-1和PAPP-A在妊娠期高血压疾病患者中的表达及其相关性研究

目的:研究血管细胞黏附分子-1(VCAM-1)和妊娠相关血浆蛋白-A(PAPP-A)在妊娠期高血压疾病患者血清中的变化及在胎盘组织中的表达情况,探讨与妊娠期高血压疾病发病机制的关系。方法:收集2009年3月至2011年6月我院确诊为妊娠期高血压疾病的120例孕妇为实验组,正常孕妇40例为对照组。采用酶联免疫吸附法(ELISA)测定两组孕妇血清中VCAM-1和PAPP-A水平变化并进行比较。采用免疫组织化学染色方法检测VCAM-1和PAPP-A在两组胎盘组织中的表达。结果:①实验组VCAM-1和PAPP-A血清水平明显高于对照组,差异有统计学意义(P<0.05)。②VCAM-1在实验组胎盘组织中阳性表达较对照组减弱,差异有统计学意义(P<0.05)。PAPP-A在实验组胎盘组织中阳性表达较对照组明显增强,差异有统计学意义(P<0.05)。③实验组中血清VCAM-1、PAPP-A表达呈明显正相关(r=0.713,P<0.05),实验组胎盘免疫组化VCAM-1、PAPP-A表达呈负相关(r=-0.513,P<0.05)。结论:VCAM-1和PAPP-A在孕期母血清及胎盘组织中的改变与妊娠期高血压疾病的发病有明确关系。     

Serum cystatin C for assessment of glomerular filtration rate in hypertensive disorders of pregnancy.

BACKGROUND: Assessment of renal function is important in the evaluation of the pregnant hypertensive patient. The aim of this study was to evaluate the diagnostic utility of cystatin C as a marker of glomerular filtration rate in hypertensive disorders of pregnancy and to correlate this with serum creatinine and creatinine clearance. METHODS: For our study, 198 women who presented with hypertension during pregnancy were recruited at the antenatal clinic of King Edward VIII Hospital in Durban, South Africa, a tertiary referral centre. Exclusion criteria included women with eclampsia, urinary tract infection and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives to classify patients suffering from the different forms of hypertensive disorders of pregnancy and venous blood samples for determination of serum cystatin C and serum creatinine were collected. The 24-hour urine creatinine clearance was used as the "gold standard" for evaluation of glomerular filtration rate due to concerns of radiation exposure to pregnant women with the use of radio nucleotide markers. RESULTS: The results of testing the 198 women, 72 of whom had preeclampsia, were analyzed. Serum cystatin C showed a significant correlation with creatinine clearance at the 0.01 level (2-tailed) with an r-value of -0.311. Serum creatinine showed a significant correlation with creatinine clearance at the 0.01 level (2-tailed) with an r-value of -0.486. CONCLUSION: Serum cystatin C seems to reflect glomerular filtration rate reliably in hypertensive pregnant women and avoids the inaccuracy associated with the 24-hour urine collection, which is time consuming and subject to improper collection.     

Relationship between high consumption of marine fatty acids in early pregnancy and hypertensive disorders in pregnancy

OBJECTIVE: To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy. DESIGN: An observational prospective study. SETTING: Free-living conditions in a community with traditional fish and cod-liver oil consumption. POPULATION: Four hundred and eighty-eight low-risk pregnant Icelandic women. METHODS: Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins. RESULTS: The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P= 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P= 0.044). CONCLUSIONS: Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.     

Tissue kallikrein activity in pregnancy

To determine tissue kallikrein (TK) activity in black African women with hypertensive disorders of pregnancy; 140 women were recruited and divided into the following groups: group A--35 preeclamptic women, group B--35 mild to moderate hypertensive pregnant women and group C--35 normotensive pregnant women, and group D--35 normotensive non-pregnant healthy women. The activity of tissue kallikrein was determined from a random untimed urine sample using a selective, synthetic chromogenic tripeptide substrate having the sequence H-D-Val-Leu-Arg-pNA (S-2266). Urinary sodium and potassium levels was determined by flame photometry. Tissue kallikrein activity was decreased in women with preeclampsia (1.54 +/- 0.95 vs 3.05 +/- 0.83 ngTK/microg protein; p < 0.0001) and mild to moderate hypertensive group (2.03 +/- 0.76 vs 3.05 +/- 0.83 ngTK/microg protein; p < 0.0001) compared with normotensive pregnant women. There was also a significant difference in tissue kallikrein activity between the pregnancy groups (1.54 +/- 0.95 vs 2.03 +/- 0.76 ngTK/microg protein; p < 0.001). No difference in tissue kallikrein activity was observed between normotensive pregnant and normotensive non-pregnant healthy women (3.05 +/- 0.83 vs 3.14 +/- 0.88 ngTK/microg protein; p = 0.51). There was no difference in the excretion of urinary sodium and potassium in pregnancy groups compared to normotensive pregnant group. Tissue kallikrein activity is decreased in hypertensive disorders of pregnancy.     

Association between hypertensive disorders complicating pregnancy and risk of placenta accreta: a meta-analysis and systematic review

Objective: Previous studies have reported a positive association between hypertensive disorders complicating pregnancy and placenta accreta. However, whether hypertensive disorders complicating pregnancy associated with placenta accreta is still not clear. The objective was to systematically review the literature to determine a possible association between hypertensive disorders complicating pregnancy and placenta accreta. Methods: A systematic search of PubMed database, the Cochrane Library, Willy Online Library, and ScienceDirect database through 1st December 2015, was conducted. Two authors independently assessed data extraction and quality of the studies using the Newcastle-Ottawa Scale. Assessment of heterogeneity and analysis of data were operated by Review Manager 5.3.0. Results: Three studies involving 4174 patients who developed hypertensive disorders complicating pregnancy of a total of 38,004 pregnant women were selected. The result of our meta-analysis revealed that pregnancy induced hypertension was significantly associated with a reduction of placenta accreta (OR = 0.50, 95% CI: 0.30–0.82; heterogeneity: I² = 13%, p = 0.32). Conclusions: Our meta-analysis demonstrated that the risk of placenta accreta is reduced in women with hypertensive disorders complicating pregnancy. Further well-designed studies are warranted to testify the result and explored any potential mechanism association between hypertensive disorders complicating pregnancy and placenta accreta.     

Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia

ObjectivesTo evaluate clinical risk factors for the development of gestational hypertensive disorders in a group of pregnant women at high risk for developing preeclampsia. Secondly we evaluated the incidence and recurrence rate of preeclampsia and pregnancy-induced hypertension.Study designA prospective analysis of data obtained from a cohort study was performed. Pregnant women were included who had at least one of the following risk factors for preeclampsia: previous history of preeclampsia, previous history of HELLP syndrome, chronic hypertension, diabetes mellitus, multiple pregnancy, obesity, or autoimmune disease. Univariate and multivariate logistic regression analyses were used to evaluate the role of clinical characteristics and risk factors in the development of hypertensive disorders.Main outcome measuresDevelopment of gestational hypertensive disorders.ResultsThirty-five percent (36/103) developed a hypertensive disorder. The univariate analysis identified preeclampsia in a previous pregnancy (OR 2.94, 95% CI: 1.25–6.91, p = 0.013) as a significant risk factor. Multivariate logistic regression revealed that a previous history of preeclampsia was the only significant independent risk factor for gestational hypertensive disorders (OR 2.89, 95% CI: 1.17–7.08, p = 0.021). Women with a previous history of PE had the highest incidence rate of 51.4% for hypertensive disorders compared to the incidence rates of other risk factors (20.8%–38.5%).ConclusionA previous history of preeclampsia proves to be a strong independent clinical risk factor for gestational hypertensive disorders in high-risk pregnant women, even in our relatively small cohort study.