Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension

Lin, Lie Chwen; Tsui, Kuan‐Hao; Cheng, Jiin‐Tsuey; Cheng, Jin‐Shiung; Huang, Wei-Chun; Liou, William W.; Tang, Pei-Ling

doi:10.1097/md.0000000000003732

Cited by 27 publications

(17 citation statements)

References 41 publications

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“…The hemodynamic changes in obese pregnant women include higher arterial blood pressure, hemoconcentration, and altered cardiac function, resulting in prevalent hypertensive disorders, [ 14 ] and subsequently contributing to poor maternal and perinatal outcomes. [ 15 – 17 ] A recent nationwide population-based retrospective cohort study in Taiwan showed that obesity (hazard ratio [HR] 7.21, 95% confidence interval [CI] 1.58–32.84) was an independent risk factor for the development of intracranial hemorrhage later among pregnant women. [ 15 ] In addition, these hypertensive disorders during pregnancy also increased the risk of placental abruption, small-for-gestational age (SGA) newborns, lower Apgar scores, and perinatal mortality.…”

Section: Introductionmentioning

confidence: 99%

“…[ 15 – 17 ] A recent nationwide population-based retrospective cohort study in Taiwan showed that obesity (hazard ratio [HR] 7.21, 95% confidence interval [CI] 1.58–32.84) was an independent risk factor for the development of intracranial hemorrhage later among pregnant women. [ 15 ] In addition, these hypertensive disorders during pregnancy also increased the risk of placental abruption, small-for-gestational age (SGA) newborns, lower Apgar scores, and perinatal mortality. [ 18 – 20 ]…”

Section: Introductionmentioning

confidence: 99%

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Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan

Horng

Huang²,

et al. 2018

Medicine

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Pregnancy weight gain may be associated with adverse pregnancy outcomes. The article aims to explore the relationship between weight change and pregnancy outcome in the Taiwanese pregnant women.The retrospective cohort study enrolled women with vertex singleton pregnancy at University-associated Hospital between 2011 and 2014. Pregnancy weight change was separated into 3 groups, based on the Institute of Medicine (IOM) guidelines: below (n = 221); within (n = 544); and above (n = 382). Analysis of variance, χ2 tests, generalized linear models, and logistic regression models were used for statistical comparisons.Pregnant women with weight change above IOM guidelines had a significant increase in both maternal and perinatal complications compared with normal controls (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.03–1.98; P = .043; OR 1.45, 95% CI 1.01–1.87; P = .049, respectively). This finding was not found in pregnant women with weight gain below IOM guidelines. Moreover, age (OR 1.08, 95% CI 1.02–1.15; P = .0011), pre-pregnancy weight (OR 1.04, 95% CI 1.01–1.09; P = .0008), pre-pregnancy body mass index (BMI; OR 1.15, 95% CI 1.06–1.30; P < .0001), weight at the time of delivery (OR 1.05, 95% CI 1.02–1.13; P < .0001) and BMI at the time of delivery (OR 1.15, 95% CI 1.06–1.39; P < .0001), all contributed to increased maternal complications but not perinatal complications, whereas parity (OR 0.23, 95% CI 0.12–0.41; P < .0001) and gestational age (OR 0.50, 95% CI 0.35–0.62; P < .001) were associated with fewer maternal complications.Our study reconfirmed that for Taiwanese pregnant women, the approximate pregnancy weight gain recommended by IOM in 2009 was associated with the fewest maternal and perinatal complications. If approximate pregnancy weight gain cannot be attained, even less weight gain during pregnancy is still reasonable without significantly and adversely affecting maternal and perinatal outcomes in Taiwan.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan

Horng

Huang²,

et al. 2018

Medicine

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“…Hypertensive disorders of pregnancy contribute to a large number of maternal and fetal deaths, not only in developing countries, but also nations like the United States (16). Preeclampsia (PE) is particularly dangerous, as it presents with new-onset hypertension Ն20 wk of gestation along with a number of systemic cardiovascular comorbidities, including endothelial and vascular dysfunction in the kidneys and the brain (3,54). Human and experimental animal studies support that placental ischemia and hypoxia drive the release of antiangiogenic and proinflammatory factors from the placenta into the maternal circulation (93).…”

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confidence: 99%

Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

Spradley

2017

American Journal of Physiology-Regulatory, Integrative and Comp

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Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.

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“…9 Pregnancy induced hypertension or pre-eclampsia is a well-known causative factor for intracerebral haemorrhage. 10 However not many spontaneous extra- Present case was a multigravida young lady with stage 5 chronic kidney disease, with grossly deranged renal function test. The presence of significant proteinuria, vomiting, raised liver enzymes, borderline INR levels and overshoot of blood pressure up to 220/110mmHg denoted superadded pre-eclampsia.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous subdural hematoma in a multigravida with chronic kidney disease and superadded pre-eclampsia detected by MRI: a case report

Yadav¹,

Mukherjee²,

Kumar³

2019

Int J Res Med Sci

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Chronic kidney disease and pre-eclampsia are both known individual culprits for significant morbidity and mortality of mother and child worldwide. Non traumatic spontaneous subdural hematoma in pregnancy is a rare scenario, however stage 5 chronic kidney disease with superadded pre-eclampsia can be contributory factor for spontaneous extra axial bleed. Our patient was 25-year-old with history of end stage renal disease and chronic hypertension admitted with superadded pre-eclampsia. She had 1 living issue and 2 stillbirths. There was sudden deterioration of mental status as well as motor performance, the patient turned stupurous and was not following verbal commands. Patient was sent for MRI evaluation of brain and diagnosed as right sided subdural hematoma with significant midline shift towards the contralateral side. No intraparenchymal haemorrhage was noted.

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Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension

Cited by 27 publications

References 41 publications

Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan

Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan

Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

Spontaneous subdural hematoma in a multigravida with chronic kidney disease and superadded pre-eclampsia detected by MRI: a case report

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