Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines

Phipps, Elizabeth A.; Prasanna, Devika; Brima, Wunnie; Jim, Belinda

doi:10.2215/cjn.12081115

Cited by 455 publications

(330 citation statements)

References 105 publications

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“…16 This could correspond to the increase in obesity, which is an independent risk factor for OSA and pre-eclampsia. 15,17 The median BMI for a pregnant South African female is 32, which places her in the obese group and increases her risk for OSA. The prevalence of pre-eclampsia in this sample was 6.8%.…”

Section: Resultsmentioning

confidence: 99%

Obstructive sleep apnoea in pregnancy and its association with pre-eclampsia

Lintott

Zyl

Burke

2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Obstructive sleep apnoea (OSA) in pregnancy is associated with an increased morbidity and mortality to both mother and foetus. In the South African setting the proportion of pregnant females suffering from OSA has not been well studied; nor has the association with pre-eclampsia. This study aimed to determine the prevalence of OSA in females before 35 weeks gestation using the STOP-BANG questionnaire and to determine the association with pre-eclampsia in a local South African setting. Methods: A cross-sectional analytical study including 234 patients was conveniently sampled from Kalafong Hospital's antenatal ward, clinic and labour ward. Participants were of more than 20 weeks and less than 35 weeks gestation. All participants were interviewed with a modified STOP-BANG questionnaire. Patients were consecutively enrolled without prior knowledge of the presence of pre-eclampsia. At Kalafong hospital all pregnant patients are routinely screened and investigated for pre-eclampsia according to standard criteria. Results: The median gestational age in this sample was 28 weeks; 80.3% (CI 74.62-85.2%) of pregnant females had a low risk for OSA, 15.4% (CI 11.01-20.65%) had an intermediate risk and 3% (CI 6.47-14.58%) had a high risk for OSA. A modified STOP-BANG questionnaire had a sensitivity of 62.5% and a specificity of 82.1% for pre-eclampsia when a score of 3 and more was scored. Females at high risk of OSA had an OR of 8.4 (CI 2.88-24.6) for having pre-eclampsia. Conclusions: The authors report 15.4% of the study's pregnant population to be at intermediate risk and 3% at high risk of OSA. The association between the hypertensive disorders and OSA must be considered and screening implementation considered.

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Section: Resultsmentioning

confidence: 99%

Obstructive sleep apnoea in pregnancy and its association with pre-eclampsia

Lintott

Zyl

Burke

2016

Southern African Journal of Anaesthesia and Analgesia

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“…En un embarazo normotenso, los niveles de sFlt-1 se estabilizan alrededor de la mitad del embarazo, seguido de un incremento a partir de la semana 33, incremento que se corresponde con la fase en la que hay una disminución de los niveles de PIGF libre (8). En el caso de la PE, este proceso de variación de los niveles de sFlt-1 y PIGF parecen ocurrir mucho antes, lo que conllevaría a la disfunción endotelial (6,8). La PE de inicio temprano también se conoce como PE placentaria porque su etiología se asocia con una placentación anormal bajo condiciones hipóxicas con niveles elevados de sFlt-1 y bajos niveles de PIGF, y se cree que la sobre expresión de la sEng y sFlt-1 inhibe el remodelamiento de la arteria espiral en la interfase placentaria, es decir este proceso se da desde el inicio del embarazo (13,14).…”

Section: Discussionunclassified

“…La PE de inicio temprano también se conoce como PE placentaria porque su etiología se asocia con una placentación anormal bajo condiciones hipóxicas con niveles elevados de sFlt-1 y bajos niveles de PIGF, y se cree que la sobre expresión de la sEng y sFlt-1 inhibe el remodelamiento de la arteria espiral en la interfase placentaria, es decir este proceso se da desde el inicio del embarazo (13,14). En contraste la PE de inicio tardío, o PE materna, no se asocian a una placentación anormal, sino que se considera una respuesta descompensada al estrés oxidativo generado por una disfunción endotelial placentaria que hace a la mujer susceptible al daño microvascular y alteración en el desarrollo de estructuras cardiovasculares fetales (6,15).…”

Section: Discussionunclassified

“…A nivel molecular, diversos estudios han identificado un desequilibrio en los niveles de factores proangiogénicos como el factor de crecimiento endotelial vascular (VEGF), factor de crecimiento placentario (PIG) y el factor de crecimiento trofoblástico β(TGF-β); y antiangiogénicos como el receptor de VEGF-1 o quinasa de tirosina similar al FMS soluble (sFlt-1), y la forma soluble de endoglina (sEng), en la sangre umbilical de neonatos con CC similar a los hallados en la sangre de mujeres con PE (6)(7)(8).…”

Section: Introductionunclassified

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Preeclampsia y defecto cardiaco fetal: ¿existe una asociación? Revisión de la evidencia

Silva-Ocas

Galvez-Olortegui

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENIntroducción: La preeclampsia (PE) es un desorden multisistémico complejo causado por una angiogéne-sis anormal placentaria. La cardiopatía congénita (CC) es uno de los defectos estructurales más comunes en neonatos. Recientemente, diversos estudios han identificado un desequilibrio en los niveles de factores proangiogénicos y antiangiogénicos en sangre umbilical de neonatos con CC similares a los hallados en sangre de mujeres con PE, lo que sugiere una posible asociación. Objetivo: Revisar la evidencia científica disponible sobre la relación entre la PE y el desarrollo de CC en neonatos. Métodos: Se realizó una bús-queda en las bases de datos Scopus y Medline/Pubmed utilizando los términos "pre-eclampsia" y "congenital heart defects", se seleccionaron 4 artículos que relacionaban las variables PE y CC, los cuales fueron revisados a texto completo. Únicamente se encontraron trabajos de tipo observacional analítico (1 estudio de prevalencia, 1 estudio de casos y controles y 2 estudios de cohortes), publicados entre el 2014 y 2016. Resultados: La PE de inicio temprano (<34 semanas) fue el factor de riesgo más importante asociado al desarrollo de CC en neonatos. La severidad de un defecto cardiaco se asocia con la intensidad y el momento de inicio de los desequilibrios en los factores angiogénicos. Conclusión: Encontramos evidencia relevante de la asociación entre PE y CC. La condición hipertensiva y los cambios endoteliales condicionados por ésta, estarían relacionados con el aumento de riesgo para el desarrollo de la CC antes que la exposición a medicamentos antihipertensivos.PALABRAS CLAVES: Preeclampsia, hipertensión inducida en el embarazo, hipertensión, cardiopatía congénita, medicación antihipertensiva SUMMARYIntroduction: Preeclampsia (PE) is a complex multisystem disorder caused by an abnormal placental angiogenesis. Congenital heart disease (CHD) is one of the most common structural defects in newborn infants. Recently, several studies have identified an imbalance in the levels of proangiogenic and antiangiogenic factors in umbilical blood of newborn infants with CHD similar to those found in the blood of women with PE, suggesting a possible association. Objective: To review the available scientific evidence about the relationship between the PE and the development of CHD in newborn infants. Method: A search was conducted in Scopus and Medline/PubMed databases using the terms "pre-eclampsia" and "congenital heart defects". Four articles that linked PE and CHD were selected and reviewed in full text. Only analytical observational

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“…The exact etiopathogenesis of eclampsia is still a topic of much debate, but recently researches have been paying more attention to the role of damage to the vascular endothelium [21], which is especially true about the vulnerable patients with chronic kidney disease. Hypertension and proteinuria are found in the majority of the affected subjects, while immunosuppressive therapy is observed in all patients.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine growth restriction in pregnant women after kidney transplantation as a marker of preeclampsia

et al. 2016

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Objectives: Delayed motherhood is associated with an increasing number of comorbidities such as glomerulonephritis, systemic lupus erythematosus, and diabetic nephropathy. Women after renal transplant belong to the group of patients who require a highly individualized approach to treatment and diagnosis. The aim of the study was to validate the commonly used diagnostic criteria for preeclampsia which seem to be irrelevant in patients with chronic renal insufficiency. Material and methods:The course of pregnancy and delivery were retrospectively analyzed in 48 renal transplant patients. Two patients were excluded. Group I included 23 patients with eutrophic neonates, while Group II consisted of 23 patients with fetal hypotrophy (birth weight of < 10 th percentile). Results:The duration of pregnancy was 34.5 and 35 weeks in Groups I and II, respectively. Mean birth weight in Groups I and II was 2608.64 g and 2046.30 g, respectively (p = 0.002). Mean weight percentile in Groups I and II was 36.57 and 2.91, respectively (p < 0.000). Proteinuria in the first half of pregnancy occurred in 16 and 14 patients from Groups I and II, respectively, and increased in the second half of pregnancy in 6 and 6 patients from Groups I and II, respectively. Patients from Group II were more prone to urinary tract infections (0.43 vs. 0.79; p = 0.02). Conclusions:Current diagnostic criteria for preeclampsia are insufficient in case of pregnant women after kidney transplant. General criteria should be applied with special care in women with chronic kidney disease or in patients with systemic lupus erythematosus. As a predictive factor of neonatal morbidity, intrauterine growth restriction seems to be more valuable than typical markers of kidney function.

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Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines

Cited by 455 publications

References 105 publications

Obstructive sleep apnoea in pregnancy and its association with pre-eclampsia

Obstructive sleep apnoea in pregnancy and its association with pre-eclampsia

Preeclampsia y defecto cardiaco fetal: ¿existe una asociación? Revisión de la evidencia

Intrauterine growth restriction in pregnant women after kidney transplantation as a marker of preeclampsia

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