INTRODUCTION: B type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and has demonstrated correlation with volume expansion and pressure overload in hypertensive disorders in pregnancy. The purpose of this study is to examine variations of BNP values in women with chronic hypertension and severe preeclampsia as indications for delivery. METHODS: Pregnant women greater than 20 weeks gestation and women up to 14 days postpartum presenting at Touro Infirmary in New Orleans between April 1, 2015 and May 30, 2017 for hypertension evaluation were eligible for inclusion. After informed consent, BNP values were collected at any evaluation for hypertension during the antepartum period, at admission for delivery and up to 14 days postpartum. 132 women were included. A BNP value above 100 pg/dL was considered elevated. Standards for hypertension and preeclampsia were determined by criteria described by the American College of Obstetrics and Gynecology. RESULTS: Of 18 women with chronic hypertension exacerbation as an indication for delivery, none had an elevated BNP, as compared to 24.6% of women without the indication (n =132, p=0.0248). Of 43 women with severe preeclampsia as an indication for delivery, 37.2% had an elevated BNP, as compared to 13.5% of women without the indication (p=0.003). CONCLUSION: Women with chronic hypertension exacerbation as an indication for delivery are not likely to have elevated BNP. Women with severe preeclampsia as an indication for delivery are more likely to have elevated BNP, which is congruent with the notion that BNP is a measure of acute stress to the heart.
INTRODUCTION: Few tests are able to determine the risk of preterm birth (PTB) in women with hypertensive disorders in pregnancy. B-type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and volume expansion in these women. The primary purpose of this study is to evaluate BNP levels in pregnant women with hypertensive disorders as a predictor of medically indicated PTB. METHODS: Pregnant women who presented at Touro Infirmary, New Orleans, LA, between April 2015 and May 2017 for hypertension evaluation were eligible for enrollment. BNP values were collected prior to and at delivery. A BNP level of >100 was considered elevated. All obstetrical and neonatal outcomes were recorded. Fisher's test was used to compare the proportion of patients with elevated BNP levels for women with versus without indicated PTB and for women with versus without newborn requiring neonatal intensive care unit (NICU) stay. Neonatal weight and Apgar scores were compared using the Wilcoxon rank sum test. RESULTS: Of 52 women with hypertensive disorders as an indication for PTB, 34.6% had an elevated BNP, as compared to 12.5% of those with hypertensive disorders that delivered at term (p=0.004). Of 41 women whose newborn required NICU stay, 34.2% had an elevated BNP, as compared to 15.4% of those whose newborn did not require NICU stay (p=0.021). Neonatal weight and Apgar scores were not different (p>0.05) for those with elevated maternal BNP levels. CONCLUSION: BNP measurement may be helpful in determining which women with hypertensive disorders are at higher risk for medically indicated PTB.
INTRODUCTION: B type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and has consistently demonstrated correlation with volume expansion and pressure overload in hypertensive disorders in pregnancy. Magnesium sulfate (MgSO4) has been shown to decrease occurrence of seizures among preeclamptic women, and some studies suggest this is mediated via a systemic vasodilatory effect. The purpose of this study is to evaluate the effect of MgSO4 on BNP values in women with severe preeclampsia. METHODS: Pregnant women greater than 20 weeks gestation and postpartum women up to 14 days after delivery with severe preeclampsia who presented at Touro Infirmary in New Orleans between April 2015 and May 2017 for hypertension evaluation and received MgSO4 were considered. After informed consent, BNP values were collected among 42 eligible patients before and after administration of MgSO4 for seizure prophylaxis. Data collection was performed as a retrospective chart review. Standards for preeclampsia diagnosis and management were defined by criteria described by the American College of Obstetrics and Gynecology. RESULTS: There was a significant reduction in BNP values after MgSO4 administration in preeclamptic women (n=42, p=0.011). The mean pre-MgSO4 BNP value was 119.6 pg/mL, and the mean post-MgSO4 BNP value was 85.2 pg/mL, for a mean decrease of 34.4 pg/mL. CONCLUSION: The data suggest that MgSO4 administration provides a beneficial effect on cardiac function in women with severe preeclampsia, potentially through a systemic vasodilatory and diuretic effect, reducing strain on the heart.
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