State-of-the-Art Diagnosis and Treatment of Hypertension in Pregnancy

Magee, Laura A.; Dadelszen, Peter von

doi:10.1016/j.mayocp.2018.04.033

Cited by 52 publications

(33 citation statements)

References 85 publications

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“…Although low-risk women tend to have excellent pregnancy outcomes, high-risk women are at an increased risk for poor maternal and neonatal outcomes. Consequently, high-risk women should be considered for an increased frequency of outpatient BP monitoring and clinic visits [7,16].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a priority should be placed on the development of interventions that are accessible to women located in both resource-rich and resource-poor settings during early pregnancy to address racial bias and discrimination in both the outpatient and clinic setting [ 14 , 20 ]. Understanding the origins of these biases is an emerging public health priority considering the increasing rates of maternal mortality [ 16 ].…”

Section: Recommendations For Practicementioning

confidence: 99%

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Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders

Harris

Henke

Hearst

et al. 2020

Journal of Pregnancy

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Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman’s continuum of care.

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Section: Discussionmentioning

confidence: 99%

Section: Recommendations For Practicementioning

confidence: 99%

Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders

Harris

Henke

Hearst

et al. 2020

Journal of Pregnancy

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“…The positive group was injected with magnesium sulfate (100 mg/kg), which is an effective drug to induce hypertension in pregnancy. 21 , 22 The baicalin groups were injected with different doses of the baicalin. The blood pressure (systolic blood pressure) in the caudal artery of these pregnant rats was detected on days 8 and 18, respectively.…”

Section: Methodsmentioning

confidence: 99%

Effect of baicalin on gestational hypertension-induced vascular endothelial cell damage

et al. 2020

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Objective Baicalin is a compound extracted from the dried root of Scutellaria baicalensis Georgi. Studies have shown that baicalin has a protective effect on vascular endothelial cells, but whether baicalin could alleviate ascular endothelial cell damage in pregnancy-induced hypertensive patients remains unknown. Materials and methods We established a hypertensive pregnant rat model to study vascular endothelial injury during pregnancy-induced hypertension. Plasma epoprostenol (PGI-2), thromboxane A2 (Txa-2), β-human chorionic gonadotropin (β-HCG), and estrogen levels in rats were detected using ELISA. Vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and C-reactive protein (CRP) expression were detected using western blotting and quantitative PCR (q-PCR). Results Results showed that baicalin alleviated symptoms of pregnancy-induced hypertension. CRP, Txa-2, and β-HCG expression were significantly upregulated, while VEGF, eNOS, PGI-2, and estrogen expression was decreased in plasma and placental tissues of hypertensive rats. However, the levels of these injury indicators were significantly decreased after baicalin therapy, while the expression of protective indicators was significantly increased. Conclusion Baicalin reversed vascular endothelial cell injury in pregnant hypertensive rats by promoting VEGF, eNOS, PGI-2, and estrogen expression.

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“…Hypertensive pregnancy diseases affect up to 10 % of all pregnancies worldwide. 1,2 Among them are preeclampsia, characterized by hypertension and proteinuria as well as HELLP syndrome, a multisystemic disorder, defined by haemolysis, elevated liver enzymes and low platelet count. 3 The HELLP syndrome shares a variety of features with other liver diseases, which compromise approximately 3% of all pregnancies worldwide.…”

Section: Introductionmentioning

confidence: 99%

Soluble fms-like tyrosine kinase 1 (sFlt-1) - a novel biochemical marker for acute fatty liver of pregnancy: a prospective observational study

Trottmann¹,

Raio²,

Amylidi-Mohr³

et al. 2020

Preprint

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Objective Acute fatty liver of pregnancy (AFLP) substantially contributes to maternal and neonatal morbidity and mortality. The aim of this study was to investigate angiogenic profiles by measuring soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF) in pregnancies compromised by AFLP and to compare them to those complicated by HELLP (haemolysis, elevated liver enzyme, low platelet) syndrome. Methods In pregnant patients affected by AFLP or HELLP syndrome sFlt-1 and PLGF serum levels were measured. To assess the diagnostic potential of these angiogenic markers in AFLP as well as discriminating it from HELLP syndrome, non-parametric tests were used and receiver-operating-curves (ROC) were calculated. Results Six cases with AFLP and 48 women with HELLP syndrome were included into the study. Patients with AFLP showed significantly higher sFlt-1 levels (median: 57570pg/ml [range: 31609-147170pg/ml]) than patients with HELLP syndrome (9713pg/ml [1348-30781pg/ml ; p<0.001). PLGF serum levels were increased in patients with AFLP compared to those with HELLP syndrome (197 pg/ml [127-487pg/ml] versus 40 pg/ml [9-644pg/ml], respectively, p<0.01,). sFlt-1/PLGF-ratios were not significantly different between AFLP and HELLP syndrome patients (192 [157-1159] versus 232 [3-948], respectively, NS). A sFlt-1 cutoff value of 31100pg/ml allowed differentiating between these two diseases with a sensitivity and specificity of 100%. Conclusions AFLP is associated with very high serum levels of sFlt-1. Besides the suggested Swansea criteria to diagnose AFLP a sFlt-1 value above 31100 pg/ml may be also an additional biochemical feature improving discrimination between AFLP and HELLP syndrome.

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State-of-the-Art Diagnosis and Treatment of Hypertension in Pregnancy

Cited by 52 publications

References 85 publications

Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders

Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders

Effect of baicalin on gestational hypertension-induced vascular endothelial cell damage

Soluble fms-like tyrosine kinase 1 (sFlt-1) - a novel biochemical marker for acute fatty liver of pregnancy: a prospective observational study

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