Maternal NT-proBNP in chronic hypertensive pregnancies and superimposed preeclampsia

Giannubilo, Stefano Raffaele; Cecchi, Stefano; Tidu, Elisa; Ciavattini, Andrea

doi:10.1016/j.ijcard.2014.07.214

Cited by 15 publications

(4 citation statements)

References 6 publications

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“…We have previously reported that the serum NT-proBNP level is elevated in preeclamptic patients as compared to controls [18]. A recent study also revealed that NT-proBNP levels in gravida with SPE were higher than in gravida with chronic hypertension [19]. In this study, we found that NT-proBNP levels are dependent on the history of uHTN in preeclamptic patients.…”

Section: Discussionsupporting

confidence: 57%

Serum NT-proBNP levels as a marker for cardiopulmonary function in preeclampsia

2020

Clinical and Experimental Obstetrics & Gynecology

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This study evaluated serum amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and echocardiography to determine their efficacy as markers for predicting postpartum pulmonary edema in patients with severe preeclampsia. Methods: We evaluated the NT-proBNP levels and echocardiographic results of 124 preeclamptic women (gestation preeclampsia (GPE) group, n = 77; superimposed preeclampsia on underlying hypertension (SPE) group n = 47). Patients were also divided into postpartum pulmonary edema (PPE, n = 28) and non-pulmonary edema (NPE, n = 96) groups. NT-proBNP levels and echocardiographic parameters were compared between groups, and their correlations were also evaluated. Statistical analysis was carried out using variance analysis, and significance was set at p < 0.05. Results: The SPE group had significantly higher NT-proBNP levels than the GPE group. They were also more likely to have PPE, but this was not significant. Echocardiography showed no significant differences in the left ventricular (LV) ejection fraction (LVEF) of the two groups, but a mild LV diastolic dysfunction was noted in the SPE group. The PPE group had significantly higher serum NT-proBNP levels and lower LVEF than the NPE group. There were no significant differences in the echocardiographic parameters of diastolic cardiac dysfunction in the two groups. The serum NT-proBNP levels were significantly negatively correlated with LVEF. Conclusions: PPE in patients with severe preeclampsia was associated with impaired cardiac function, especially LV systolic dysfunction. Serum NT-proBNP levels and echocardiography may be useful predictive markers for postpartum pulmonary edema in women with severe preeclampsia.

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Section: Discussionsupporting

confidence: 57%

Serum NT-proBNP levels as a marker for cardiopulmonary function in preeclampsia

2020

Clinical and Experimental Obstetrics & Gynecology

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“…Preeclampsia is a foremost contributor to maternal and newborn morbidity and mortality. 4 Hereditary, immunological, ecological, and vascular-mediated causes are all supposed to play a substantial role in the intensification of preeclampsia, 5 , 6 and numerous risk factors have been identified. Among those, null-parity, previous preeclampsia, high maternal weight, hypertension, diabetes, and twin pregnancy have shown a consistent association with increased risk.…”

Section: Introductionmentioning

confidence: 99%

<p>Determinants of Preeclampsia Among Pregnant Mothers Attending Antenatal Care (ANC) and Delivery Service in Gedeo Zone, Southern Ethiopia: Case Control-Study</p>

Mareg¹,

Molla²,

Dires³

et al. 2020

IJWH

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Background: The maternal morbidity and mortality related to preeclampsia are increasing in developing countries; figures have been estimated to be between 1.8% and 16.7%, including in Ethiopia. However, there is limited research regarding the determinants of preeclampsia in Gedeo Zone. Objective: The aim of the study was to determine the predictors of preeclampsia among pregnant mothers attending ANC and delivery services in southern Ethiopia. Methods: A facility-based unmatched case-control study was conducted in Gedeo Zone. Pregnant mothers attending ANC and delivery service were selected consecutively until the allotted 243 (162 controls and 81 cases) sample size was fulfilled. The collected data were checked for completeness and entered into Epi-data software version 3.1, and exported to statistical package for social science (SPSS) version 20 for analysis. Multivariable logistic regression was employed and a P-value of less than 0.05 with a 95% confidence interval was used to declare the significant association of the independent variables and the outcome variable. Results: A total of 240 mothers, 80 (33.3%) of cases and 160 (66.70%) of controls, responded, with a response rate of 98.76%. The mean age of the participants among both groups was 27.40 with a standard deviation of ±5.02. Attending education [adjusted odd ratio (AOR) = 0.49; 95% CI (0.006, 0.398)], being a house wife [AOR = 13; 95% CI (1.260, 140.15)], an age range of 20-34 years [AOR = 0.071; 95% CI (0.015, 0.32)], a family history of diabetes mellitus [AOR = 0.28.2; 95% CI (0.081, 0.985)], a family history of hypertension [AOR = 0.124; 95% CI (0.047, 0.325)], did not eat fruit during pregnancy [AOR = 3.355; 95% CI (1.112, 10.126)], and a maternal history of preeclampsia [AOR = 0.162; 95% CI (0.041, 0.640)] were found to be variables significantly associated among mothers with preeclampsia. Conclusion: The determinant factors for preeclampsia were being a housewife, having a history of hypertension, diabetes mellitus, and preeclampsia among family members. Strengthening early detection and prevention of predictors, improvement of protective factors, and further follow-up study were recommended.

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“…In women with chronic hypertension who develop superimposed PE, NT-proBNP was significantly elevated compared with those who did not at 16 weeks of gestation. 118 Another study reported that in women with superimposed PE, levels of NT-proBNP did not decrease with advancing gestation, as normally expected, compared with normotensive controls and women with chronic hypertension but no superimposed PE. 66 However, in the latter study, NT-proBNP, at any point in pregnancy, was not predictive for the development of superimposed PE.…”

Section: Cardiac Biomarkersmentioning

confidence: 67%

Chronic hypertension and superimposed preeclampsia: screening and diagnosis

Kametas

Nzelu

Nicolaides

2022

American Journal of Obstetrics and Gynecology

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Superimposed preeclampsia complicates about 20% of pregnancies in women with chronic hypertension and is associated with increased maternal and perinatal morbidity compared with preeclampsia alone. Distinguishing superimposed preeclampsia from chronic hypertension can be challenging because, in chronic hypertension, the traditional criteria for the diagnosis of preeclampsia, hypertension, and significant proteinuria can often predate the pregnancy. Furthermore, the prevalence of superimposed preeclampsia is unlikely to be uniformly distributed across this high-risk group but is related to the severity of preexisting endothelial dysfunction. This has led to interest in identifying biomarkers that could help in screening and diagnosis of superimposed preeclampsia and in the stratification of risk in women with chronic hypertension.Elevated levels of uric acid and suppression of other renal biomarkers, such as the reninangiotensin aldosterone system, have been demonstrated in women with superimposed preeclampsia but perform only modestly in its prediction. In addition, central to the pathogenesis of preeclampsia is a tendency toward an antiangiogenic state thought to be triggered by an impaired placenta and, ultimately, contributing to the endothelial dysfunction pathognomonic of the disease. In the general obstetrical population, angiogenic factors, such as soluble fms-like tyrosine kinase-1 and placental growth factor, have shown promise in the prediction of preeclampsia. However, soluble fms-like tyrosine kinase-1 and placental growth factor are impaired in women with chronic hypertension irrespective of whether they develop superimposed preeclampsia. Therefore, the differences in levels are less discriminatory in the prediction of superimposed preeclampsia compared with the general obstetrical population.Alternative biomarkers to the angiogenic and renal factors include those of endothelial dysfunction. A characteristic of both preeclampsia and chronic hypertension is an exaggerated systemic inflammatory response causing or augmenting endothelial dysfunction. Thus, proinflammatory mediators, such as tumor necrosis factor-a, interleukin-6, cell adhesion molecules, and endothelin, have been investigated for their role in the screening and diagnosis of superimposed preeclampsia in women with chronic hypertension. To date, the existing limited evidence suggests that the differences between those who develop superimposed preeclampsia and those who do not are, as with angiogenic factors, also modest and not clinically useful for the stratification of women with chronic hypertension.Finally, proeB-type natriuretic peptide is regarded as a sensitive marker of early cardiac dysfunction that, in women with chronic hypertension, may predate the pregnancy. Thus, it has been proposed that proeB-type natriuretic peptide could give insight as to the ability of women with chronic hypertension to adapt to the hemodynamic requirements of pregnancy and, subsequently, their risk of developing superimposed preeclampsia. Although hig...

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Maternal NT-proBNP in chronic hypertensive pregnancies and superimposed preeclampsia

Cited by 15 publications

References 6 publications

Serum NT-proBNP levels as a marker for cardiopulmonary function in preeclampsia

Serum NT-proBNP levels as a marker for cardiopulmonary function in preeclampsia

<p>Determinants of Preeclampsia Among Pregnant Mothers Attending Antenatal Care (ANC) and Delivery Service in Gedeo Zone, Southern Ethiopia: Case Control-Study</p>

Chronic hypertension and superimposed preeclampsia: screening and diagnosis

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