Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes

Nørgaard, Sidse Kjærhus; Vestgaard, Marianne; Jørgensen, Isabella L.; Àsbjörnsdóttir, Björg; Ringholm, Lene; McIntyre, H. David; Damm, Peter; Mathiesen, Elisabeth R.

doi:10.1016/j.diabres.2018.02.014

Cited by 32 publications

(22 citation statements)

References 38 publications

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“…Other components such as elevated BP and low HDL cholesterol yield similar effect on prevalence of DM, and a previous studies have shown that elevated BP and low HDL cholesterol were associated with insulin resistance [28] and therefore may contributed to the occurrence of DM. The results also indicated the importance of blood pressure in the prevention and management of DM [29, 30]. It was consistent with a previous longitudinal study [31], which showed the incidence of T2DM was higher among individuals with higher BP and low HDL cholesterol level.…”

Section: Discussionsupporting

confidence: 90%

The association of metabolic syndrome components and diabetes mellitus: evidence from China National Stroke Screening and Prevention Project

Wang

et al. 2019

BMC Public Health

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Background The metabolic syndrome (MetS) is related with cardiovascular disease. However, its relationship with diabetes mellitus (DM) has not been examined in Chinese population with a larger sample. We aimed to assess the relationship between metabolic syndrome (MetS) and its components, and DM, and to determine the best one from the available definitions of Mets when assessing the risk of DM. Methods This was a cross-sectional survey in a nationally representative sample of 109,551 Chinese adults aged ≥40 years in 2014–15. MetS was defined according to three criteria including the updated International Diabetes Federation (IDF) criterion, the National Cholesterol Education Program Third Adult Treatment Panel (NCEP ATP III) criterion and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criterion. Logistic regression models were used to estimate the odds of DM. Results MetS as defined by three criteria including IDF, NCEP ATP III,and AHA/NHLBI all increased the prevalence of DM, and the adjusted ORs with 95% CI was more higher using NCEP ATP III (3.65, 3.52–3.79) than IDF (2.50, 2.41–2.60) and AHA/NHLBI (3.03, 2.92–3.24). The odds of DM was highest in hyperglycemia with cut-off glucose≥6.1 mmol/L (14.55, 13.97–15.16), and other components were also associated significantly with DM. There was heterogeneity for OR of DM associated with various trait combinations. Conclusions The NCEP ATPIII MetS definition may be more suitable for assessment of DM risk in Chinese population. Hyperglycemia, as previous study reported, are important risk factors of DM. Besides, other traits of Mets are also significantly associated with DM and should therefore be of greater concern.

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Section: Discussionsupporting

confidence: 90%

The association of metabolic syndrome components and diabetes mellitus: evidence from China National Stroke Screening and Prevention Project

Wang

et al. 2019

BMC Public Health

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“…Twenty-one features were significant predictors in all three periods, and 42, 30 and 15 features, respectively, were specific to antepartum, intrapartum and postpartum. Among the 21 common features, which were enriched for patient demographics and baseline characteristics, we identified 48% features supported in the literature as associating with PE risk, including systolic blood pressure (SBP) 12, 16 , diastolic blood pressure (DBP) 17 , weight 16 , maternal age 18 , hemoglobin 19 , white blood cell count 20 , gestational hypertension 12 , PE history 21 , chronic hypertension 20 and headache (including migraine) 22 (Table 1-19 in the Supplement). Features specific to antepartum were enriched with CBC findings that suggest inflammation and/or infection, such as elevated neutrophil, monocyte, eosinophil, and lymphocyte levels.…”

Section: Resultsmentioning

confidence: 99%

Improving Pre-eclampsia Risk Prediction by Modeling Individualized Pregnancy Trajectories Derived from Routinely Collected Electronic Medical Record Data

Wang

Vieira

et al. 2021

Preprint

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Preeclampsia (PE) is a heterogeneous and complex disease associated with rising morbidity and mortality in pregnant women and newborns in the US. Early recognition of patients at risk is a pressing clinical need to significantly reduce the risk of adverse pregnancy outcomes. We assessed whether information routinely collected and stored on women in their electronic medical records (EMR) could enhance the prediction of PE risk beyond what is achieved in standard of care assessments today. We developed a digital phenotyping algorithm to assemble and curate 108,557 pregnancies from EMRs across the Mount Sinai Health System (MSHS), accurately reconstructing pregnancy journeys and normalizing these journeys across different hospital EMR systems. We then applied machine learning approaches to a training dataset from Mount Sinai Hospital (MSH) (N = 60,879) to construct predictive models of PE across three major pregnancy time periods (ante-, intra-, and postpartum). The resulting models predicted PE with high accuracy across the different pregnancy periods, with areas under the receiver operating characteristic curves (AUC) of 0.92, 0.83 and 0.89 at 37 gestational weeks, intrapartum and postpartum, respectively. We observed comparable performance in two independent patient cohorts with diverse patient populations (MSH validation dataset N = 38,421 and Mount Sinai West dataset N = 9,257). While our machine learning approach identified known risk factors of PE (such as blood pressure, weight and maternal age), it also identified novel PE risk factors, such as complete blood count related characteristics for the antepartum time period and ibuprofen usage for the postpartum time period. Our model not only has utility for earlier identification of patients at risk for PE, but given the prediction accuracy substantially exceeds what is achieved today in clinical practice, our model provides a path for promoting personalized precision therapeutic strategies for patients at risk.

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“…This corroborates the findings from another multi-country study that showed unexpected high proportions of isolated diastolic hypertension among pregnant women using a similar BP-measuring device [ 64 ]. The diastolic blood pressure in early pregnancy is an important risk factor for pre-eclampsia and small for gestational age babies [ 65 ]. Between 9 and 30% of the isolated diastolic hypertension cases were later associated with systolic hypertension in the multi-country study [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

Shobo

Okolo

Longtoe

et al. 2020

Implement Sci Commun

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Introduction Hypertensive disorders in pregnancy result in about 76,000 maternal deaths per year worldwide. Pre-eclampsia and eclampsia cause the most deaths. Interventions for managing these disorders are available in health facilities. We assess the effect of monitoring pregnant women’s blood pressure (BP) in their homes using village health workers (VHWs) equipped with a BP-measuring device on hypertension in pregnancy, in a resource-poor setting. Also, we assess the VHWs’ competence with the BP device, acceptability and appropriateness of the intervention, and factors that affect the implementation of the intervention. Method This is a mixed method study comprising quantitative and qualitative data collection. We implemented the intervention over 6 months across three local government areas in Gombe state, northeast Nigeria. The Replicating Effective Program (REP) framework guided the development of the implementation strategy. The quantitative data include routine measurement of pregnant women’s blood pressure and observation of 118 VHW-client interactions. The routine data collection occurred between February and June 2019, and the observation occurred in January and June 2019. The qualitative data collection occurred via six focus group discussions with VHWs and ten in-depth interviews with community health extension workers in June 2019. We analyzed the data from the quantitative arm with SPSS version 23. For the qualitative arm, we transcribed the audio files, coded the texts, and categorized them using thematic analysis. Result Nine thousand pregnant women were recruited into the program. We observed a significant reduction in the prevalence of hypertension in pregnancy from 1.5 to 0.8% (Z = 4.04; p < 0.00001) after starting the program. Also, we found that VHWs can assess pregnant women’s BP using a semi-automatic BP-measuring device. The intervention is acceptable and appropriate in resource-poor settings. Poor payment of VHW stipend and cooperation of local health staff are barriers to sustaining the intervention. Conclusion In resource-poor settings, health systems can train and equip non-technical people to identify and refer cases of high blood pressure in pregnancy to local health facilities on time. This may contribute to reducing maternal mortality and morbidity in these settings.

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Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes

Abstract: At the first antenatal visit, diastolic BP was the only independent, potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes in the context of tight glycemic and BP control. One out of four women had hypertensive disorders during pregnancy.

Cited by 32 publications

References 38 publications

The association of metabolic syndrome components and diabetes mellitus: evidence from China National Stroke Screening and Prevention Project

The association of metabolic syndrome components and diabetes mellitus: evidence from China National Stroke Screening and Prevention Project

Improving Pre-eclampsia Risk Prediction by Modeling Individualized Pregnancy Trajectories Derived from Routinely Collected Electronic Medical Record Data

Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

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