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Revista Brasileira de Ginecologia E... Sep 2017The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most... (Review)
Review
The authors review hypertensive disease during pregnancy with an academic and practical view, and using the best evidence available. This disease, which is the most important clinical disease in Brazilian pregnant women, may have its incidence reduced with prevention through the use of calcium and aspirin in pregnant women at risk. Previously, it was a disease that presented with but it has now been classified with new clinical parameters besides proteinuria. Morbidity and mortality should be reduced in a continental country such as Brazil using protocols for the early treatment of complications by calculating severe outcomes in preeclampsia. The early treatment of acute hypertension, use of magnesium sulfate and early hospitalization in cases of preeclampsia are concepts to pursue the reduction of our pregnant women's mortality.
Topics: Diagnosis, Differential; Female; Humans; Pre-Eclampsia; Pregnancy
PubMed: 28793357
DOI: 10.1055/s-0037-1604471 -
Acta Obstetricia Et Gynecologica... May 2023There has been increasing recognition of the association between various pregnancy complications and development of chronic disease in later life. Pregnancy has come to... (Review)
Review
There has been increasing recognition of the association between various pregnancy complications and development of chronic disease in later life. Pregnancy has come to be regarded as a physiological stress test, as the strain it places on a woman's body may reveal underlying predispositions to disease that would otherwise remain hidden for many years. Despite the increasing body of data, there is a lack of awareness among healthcare providers surrounding these risks. We performed a narrative literature review and have summarized the associations between the common pregnancy complications including gestational hypertension, pre-eclampsia, gestational diabetes, placental abruption, spontaneous preterm birth, stillbirth and miscarriage and subsequent development of chronic disease. Hypertensive disorders of pregnancy, spontaneous preterm birth, gestational diabetes, pregnancy loss and placental abruption are all associated with increased risk of various forms of cardiovascular disease. Gestational diabetes, pre-eclampsia, early miscarriage and recurrent miscarriage are associated with increased risk of diabetes mellitus. Pre-eclampsia, stillbirth and recurrent miscarriage are associated with increased risk of venous thromboembolism. Pre-eclampsia, gestational diabetes and stillbirth are associated with increased risk of chronic kidney disease. Gestational diabetes is associated with postnatal depression, and also with increased risk of thyroid and stomach cancers. Stillbirth, miscarriage and recurrent miscarriage are associated with increased risk of mental health disorders including depression, anxiety and post-traumatic stress disorders. Counseling in the postnatal period following a complicated pregnancy, and advice regarding risk reduction should be available for all women. Further studies are required to establish optimal screening intervals for cardiovascular disease and diabetes following complicated pregnancy.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pre-Eclampsia; Stillbirth; Abruptio Placentae; Diabetes, Gestational; Premature Birth; Cardiovascular Diseases; Placenta; Pregnancy Complications; Women's Health; Abortion, Habitual; Risk Factors
PubMed: 36799269
DOI: 10.1111/aogs.14523 -
Postepy Biochemii Dec 2018Preeclampsia, also known as EPH-gestosis, is a pregnancy-specific syndrome. It affects 3-5% of pregnant women and is characterized by edemas, high blood pressure and... (Review)
Review
Preeclampsia, also known as EPH-gestosis, is a pregnancy-specific syndrome. It affects 3-5% of pregnant women and is characterized by edemas, high blood pressure and proteinuria. Moreover, in women with preeclampsia dysfunction of many organs, such as kidney and liver, is diagnosed, while in the case of fetus growth restriction is observed. Preeclampsia, when left untreated, can lead to death. In low-income countries, this disorder is one of the main causes of maternal and child mortality. Preeclampsia predisposes women in later life to cardiovascular diseases. So far, in acute cases of preeclampsia stabilization of the mother and fetus and finally termination of pregnancy at a time optimal for both sides can only be considered. In this work, available literature data concerning the causes of preeclampsia, its symptoms, techniques for diagnosis, methods for prevention and new approaches to treatment were collected.
Topics: Cardiovascular Diseases; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Pre-Eclampsia; Pregnancy
PubMed: 30656917
DOI: 10.18388/pb.2018_146 -
Best Practice & Research. Clinical... May 2022Preeclampsia is a severe manifestation of maternal hypertensive disease affecting 2-8% of pregnancies. The disease places women at risk of women at risk of... (Review)
Review
Preeclampsia is a severe manifestation of maternal hypertensive disease affecting 2-8% of pregnancies. The disease places women at risk of women at risk of life-threatening events, including cerebral hemorrhage, pulmonary edema, acute kidney injury, hepatic failure or rupture, disseminated intravascular coagulation, eclampsia, and placental abruption. In addition to the maternal disease burden, increased fetal morbidity and mortality occurs due to iatrogenic preterm delivery, fetal growth restriction, and placental abruption. Magnesium therapy for seizure prophylaxis and blood pressure control to limit cardiovascular and cerebrovascular morbidity are the cornerstone of treatment. Interdisciplinary planning and management are crucial to optimizing patient outcomes.
Topics: Abruptio Placentae; Eclampsia; Female; Humans; Infant, Newborn; Placenta; Pre-Eclampsia; Pregnancy
PubMed: 35659948
DOI: 10.1016/j.bpa.2022.02.003 -
American Journal of Physiology. Renal... Jun 2020Preeclampsia is defined as new-onset hypertension after the 20th wk of gestation along with evidence of maternal organ failure. Rates of preeclampsia have steadily... (Review)
Review
Preeclampsia is defined as new-onset hypertension after the 20th wk of gestation along with evidence of maternal organ failure. Rates of preeclampsia have steadily increased over the past 30 yr, affecting ∼4% of pregnancies in the United States and causing a high economic burden (22, 69). The pathogenesis is multifactorial, with acknowledged contributions by placental, vascular, renal, and immunological dysfunction. Treatment is limited, commonly using symptomatic management and/or early delivery of the fetus (6). Along with significant peripartum morbidity and mortality, current research continues to demonstrate that the consequences of preeclampsia extend far beyond preterm delivery. It has lasting effects for both mother and child, resulting in increased susceptibility to hypertension and chronic kidney disease (45, 54, 115, 116), yielding lifelong risk to both individuals. This review discusses recent guideline updates and recommendations along with current research on these long-term consequences of preeclampsia.
Topics: Animals; Blood Pressure; Disease Models, Animal; Female; Humans; Hypertension; Maternal Health; Pre-Eclampsia; Pregnancy; Prenatal Exposure Delayed Effects; Prognosis; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Time Factors
PubMed: 32249616
DOI: 10.1152/ajprenal.00071.2020 -
Journal of Clinical Lipidology 2022Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality in the US. Preeclampsia (PreE) which includes hypertension and... (Review)
Review
Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality in the US. Preeclampsia (PreE) which includes hypertension and proteinuria during pregnancy, is thought to result from placental ischemia. Risk factors for PreE parallel those for cardiovascular disease, and recent studies point to hyperlipidemia specifically, hypertriglyceridemia, as a risk factor for PreE. Current practice does not routinely include lipid testing pre-conception or during pregnancy. Professional, societal recommendations should advocate for hyperlipidemia screening, followed by appropriate management, pre-conception and during pregnancy.
Topics: Female; Humans; Hyperlipidemias; Hypertension; Placenta; Pre-Eclampsia; Pregnancy; Proteinuria; Risk Factors
PubMed: 35260347
DOI: 10.1016/j.jacl.2022.02.005 -
Hypertension (Dallas, Tex. : 1979) May 2021The concept that preeclampsia is a multisystemic syndrome is appreciated in both research and clinical care. Our understanding of pathophysiology recognizes the role of... (Review)
Review
The concept that preeclampsia is a multisystemic syndrome is appreciated in both research and clinical care. Our understanding of pathophysiology recognizes the role of inflammation, oxidative and endoplasm reticulum stress, and angiogenic dysfunction. Yet, we have not progressed greatly toward clinically useful prediction nor had substantial success in prevention or treatment. One possibility is that the maternal syndrome may be reached through different pathophysiological pathways, that is, subtypes of preeclampsia, that in their specificity yield more clinical utility. For example, early and late onset preeclampsia are increasingly acknowledged as different pathophysiological processes leading to a common presentation. Other subtypes of preeclampsia are supported by disparate clinical outcomes, long-range prognosis, organ systems involved, and risk factors. These insights have been supplemented by discovery-driven methods, which cluster preeclampsia cases into groups indicating different pathophysiologies. In this presentation, we review likely subtypes based on current knowledge and suggest others. We present a consideration of the requirements for a clinically meaningful preeclampsia subtype. A useful subtype should (1) identify a specific pathophysiological pathway or (2) specifically indicate maternal or fetal outcome, (3) be recognizable in a clinically useful time frame, and (4) these results should be reproducible and generalizable (but at varying frequency) including in low resource settings. We recommend that the default consideration be that preeclampsia includes several subtypes rather than trying to force all cases into a single pathophysiological pathway. The recognition of subtypes and deciphering their different pathophysiologies will provide specific targets for prevention, prediction, and treatment directing personalized care.
Topics: Female; Humans; Inflammation; Pre-Eclampsia; Pregnancy; Prognosis; Risk Factors
PubMed: 33775113
DOI: 10.1161/HYPERTENSIONAHA.120.14781 -
Clinical Journal of the American... Jun 2016Preeclampsia is becoming an increasingly common diagnosis in the developed world and remains a high cause of maternal and fetal morbidity and mortality in the developing... (Review)
Review
Preeclampsia is becoming an increasingly common diagnosis in the developed world and remains a high cause of maternal and fetal morbidity and mortality in the developing world. Delay in childbearing in the developed world feeds into the risk factors associated with preeclampsia, which include older maternal age, obesity, and/or vascular diseases. Inadequate prenatal care partially explains the persistent high prevalence in the developing world. In this review, we begin by presenting the most recent concepts in the pathogenesis of preeclampsia. Upstream triggers of the well described angiogenic pathways, such as the heme oxygenase and hydrogen sulfide pathways, as well as the roles of autoantibodies, misfolded proteins, nitric oxide, and oxidative stress will be described. We also detail updated definitions, classification schema, and treatment targets of hypertensive disorders of pregnancy put forth by obstetric and hypertensive societies throughout the world. The shift has been made to view preeclampsia as a systemic disease with widespread endothelial damage and the potential to affect future cardiovascular diseases rather than a self-limited occurrence. At the very least, we now know that preeclampsia does not end with delivery of the placenta. We conclude by summarizing the latest strategies for prevention and treatment of preeclampsia. A better understanding of this entity will help in the care of at-risk women before delivery and for decades after.
Topics: Autoantibodies; Endoglin; Female; Heme Oxygenase (Decyclizing); Humans; Hydrogen Sulfide; Nitric Oxide; Oxidative Stress; Postnatal Care; Practice Guidelines as Topic; Pre-Eclampsia; Preconception Care; Pregnancy; Protein Folding; Receptor, Angiotensin, Type 1; Vascular Endothelial Growth Factor Receptor-1
PubMed: 27094609
DOI: 10.2215/CJN.12081115 -
The Journal of Maternal-fetal &... Jan 2021Preeclampsia is a multisystemic disorder which accounts for the high prevalence of maternal and perinatal morbidity and mortality, especially in middle and low-income... (Review)
Review
Preeclampsia is a multisystemic disorder which accounts for the high prevalence of maternal and perinatal morbidity and mortality, especially in middle and low-income countries. Currently, the primary intervention is the urgent delivery of the fetus, hence it would be advantageous to identify those who are likely to develop preeclampsia and the maternal and fetal outcomes. However, an array of risk factors makes these challenging. This review explores the potentials of liver biomarkers in predicting the occurrence and outcome of preeclampsia, which could be beneficial in reducing the burden of the disease. Liver dysfunction in preeclampsia results in a severe condition, hence liver function tests are specific predictors of outcome.
Topics: Female; HELLP Syndrome; Humans; Liver; Pre-Eclampsia; Pregnancy; Prenatal Care; Risk Factors
PubMed: 30704316
DOI: 10.1080/14767058.2019.1572737 -
Early Human Development Nov 2016Preeclampsia is a common pregnancy specific disease, that presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver and lungs.... (Review)
Review
Preeclampsia is a common pregnancy specific disease, that presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver and lungs. At present, the only definitive treatment of preeclampsia is end the pregnancy and deliver the neonate and placenta. For women with mild preeclampsia in the preterm phase of pregnancy, expectant management is generally indicated to improve fetal maturity, often requiring maternal medical treatment. Last decades, more evidence is available that the underlying mechanism of preeclampsia, endothelial disease, is not limited to pregnancy but increases cardiovascular risk in later life. In this review, we present the most recent insight in preeclampsia with focus on impact on the fetus, short and long-term outcome of offspring's, and long-term outcome of women with a history of preeclampsia.
Topics: Child Development; Female; Humans; Infant, Newborn; Maternal Health; Pre-Eclampsia; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 27659865
DOI: 10.1016/j.earlhumdev.2016.09.007