The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP

Al, Tranquilli; Dekker, Gus; Magee, Laura A.; Roberts, James M.; Sibai, Bahaeddine M; Steyn, Wilhelm; Zeeman, Gerda G.; Brown, Mark

doi:10.1016/j.preghy.2014.02.001

Cited by 1,188 publications

(1,018 citation statements)

References 50 publications

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“…Prospective registration [1] Core Outcome Measures in Effectiveness Trials (COMET) registration number: 588.…”

Section: Discussionmentioning

confidence: 99%

“…The International Society for the Study of Hypertension in Pregnancy (ISSHP) defines pre-eclampsia as new onset hypertension (≥140 mmHg systolic or ≥90 mmHg diastolic) developing after 20 weeks gestation presenting with new-onset proteinuria, other maternal organ dysfunction, and / or uteroplacental dysfunction. 1 Pre-eclampsia is associated with maternal and offspring mortality and morbidity, especially in cases where severe features are present. 2 The development of therapeutic interventions to reduce this health burden is urgently required.…”

Section: Introductionmentioning

confidence: 99%

“…The method was able to reduce 227 outcomes identified by a systematic review of the literature and 33 outcomes suggested by participants to 13 consensus 'core' outcomes. Consensus was reached on four outcomes related to pregnant women: [1] maternal mortality; [2] maternal infection or inflammation; [3] preterm rupture of membranes; and [4] harm to mother from intervention. Consensus was reached on nine outcomes related to the offspring: [1] gestational age at delivery; [2] offspring mortality; [3] birthweight; [4] early neurodevelopmental morbidity; [5] late neurodevelopmental morbidity; [6] gastrointestinal morbidity; [7] infectious morbidity; [8] respiratory morbidity; and [9] harm to offspring from intervention.…”

Section: Introductionmentioning

confidence: 99%

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A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

Duffy

Hooft

Gale

et al. 2016

Pregnancy Hypertension: An International Journal of Women's Car

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Background Pre-eclampsia is a serious complication of pregnancy and contributes to maternal and offspring mortality and morbidity. Randomised controlled trials evaluating therapeutic interventions for pre-eclampsia have reported many different outcomes and outcome measures. Such variation contributes to an inability to compare, contrast, and combine individual studies, limiting the usefulness of research to inform clinical practice. The development and use of a core outcome set would help to address these issues ensuring outcomes important to all stakeholders, including patients, will be collected and reported in a standardised fashion. Methods An international steering group including healthcare professionals, researchers, and patients, has been formed to guide the development of this core outcome set. Potential outcomes will be identified through a comprehensive literature review and semi-structured interviews with patients. Potential core outcomes will be entered into an international, multi-perspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and patients will be invited to participate. The modified Delphi method encourages whole and stakeholder group convergence towards consensus ‘core’ outcomes. Once core outcomes have been agreed upon it is important to determine how they should be measured. The truth, discrimination, and feasibility assessment framework will assess the quality of potential outcome measures. High quality outcome measures will be associated with core outcomes. Mechanisms exist to disseminate and implement the resulting core outcome set within an international context. Discussion Embedding the core outcome set within future clinical trials, systematic reviews, and clinical practice guidelines could make a profound contribution to advancing the usefulness of research to inform clinical practice, enhance patient care, and improve maternal and offspring outcomes. The infrastructure created by developing a core outcome set for pre-eclampsia could be leveraged in other settings, for example selecting research priorities and clinical practice guideline development

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“…Prospective registration [1] Core Outcome Measures in Effectiveness Trials (COMET) registration number: 588.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

Duffy

Hooft

Gale

et al. 2016

Pregnancy Hypertension: An International Journal of Women's Car

View full text Add to dashboard Cite

show abstract

“…Hypertensive pregnancy disorders complicate around 5% to 10% of pregnancies worldwide,6 and gestational hypertension (GH) and preeclampsia account for most of these cases. GH is most common and affects 5% to 8% of healthy women,6, 7, 8, 9, 10 while preeclampsia complicates 2% to 7% of all pregnancies 11. There are important similarities and differences in the causes and pathophysiology of GH and preeclampsia 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

Association Between Gestational Hypertension and Risk of Cardiovascular Disease Among 617 589 Norwegian Women

Riise

Sulo

Tell

et al. 2018

JAHA

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BackgroundPreeclampsia and gestational hypertension (GH) are the most common hypertensive pregnancy disorders. Preeclampsia has been linked to increased risk of cardiovascular disease (CVD), but a similar association for GH has not been established. We aimed to determine the association between GH and subsequent CVD, and explore the additional role of small‐for‐gestational‐age infants, preterm delivery, and parity.Methods and ResultsData from the Medical Birth Registry of Norway were linked to the Cardiovascular Disease in Norway project and the Norwegian Cause of Death Registry. Hazard ratios and 95% confidence intervals were computed using Cox proportional hazard regression, comparing women with and without GH during their first and/or second pregnancy. We included all women with a first delivery from 1980 through 2009 (n=617 589) and followed them for a median of 14.3 (quartile 1–quartile 3: 6.9–21.5) years. Women with GH in the first pregnancy had 1.8‐fold (95% confidence interval, 1.7–2.0) higher risk of subsequent CVD compared with women without any hypertensive pregnancy disorder. When GH occurred in combination with small‐for‐gestational‐age infants and/or preterm delivery, the hazard ratio was 2.6 (95% confidence interval, 2.3–3.0). When women with GH were compared with women with preeclampsia, the risk of CVD was comparable when the pregnancy complications occurred in either the first or second pregnancy but was significantly higher for preeclampsia without complications when the disorder occurred in both pregnancies.Conclusions GH was associated with increased risk of subsequent CVD, and the highest risk was observed when GH was combined with small‐for‐gestational‐age infants and/or preterm delivery.

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“…In preeclampsia, a frequent hypertensive disease in pregnancy with systemic endothelial dysfunction,16, 17 plasma volume reduction precedes the clinical onset of the disease (summarized in Luft et al18), and preventing the disease by reducing salt intake was unsuccessful 16, 19. Supporting an increased salt intake were findings of a reduced incidence of preeclampsia and perinatal complications as well as lower numbers of neonatal fetal deaths in women receiving a high Na + diet 20.…”

Section: Introductionmentioning

confidence: 99%

Physiological and Molecular Responses to Altered Sodium Intake in Rat Pregnancy

Eisele

Klossner

Escher

et al. 2018

JAHA

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BackgroundIn pregnancy, a high plasma volume maintains uteroplacental perfusion and prevents placental ischemia, a condition linked to elevated maternal blood pressure (BP). Reducing BP by increasing Na+ intake via plasma volume expansion appears contra‐intuitive. We hypothesize that an appropriate Na+ intake in pregnancy reduces maternal BP and adapts the renin‐angiotensin system in a pregnancy‐specific manner.Methods and Results BP was measured by implanted telemetry in Sprague‐Dawley rats before and throughout pregnancy. Pregnant and nonpregnant animals received either a normal‐salt (0.4%; NS), high‐salt (8%; HS), or low‐salt (0.01%; LS) diet, or HS (days 1–14) followed by LS (days 14–20) diet (HS/LS). Before delivery (day 20), animals were euthanized and organs collected. Food, water, and Na+ intake were monitored in metabolic cages, and urinary creatinine and Na+ were analyzed. Na+ intake and retention increased in pregnancy (NS, LS), leading to a positive Na+ balance (NS, LS). BP was stable during LS, but reduced in HS conditions in pregnancy. The renin‐angiotensin system was adapted as expected. Activating cleavage of α‐ and γ‐subunits of the renal epithelial Na+ channel and expression of‐full length medullary β‐subunits, accentuated further in all LS conditions, were upregulated in pregnancy.ConclusionsPregnancy led to Na+ retention adapted to dietary changes. HS exposure paradoxically reduced BP. Na+ uptake while only modestly linked to the renin‐angiotensin system is enhanced in the presence of posttranslational renal epithelial Na+ channel modifications. This suggests (1) storage of Na+ in pregnancy upon HS exposure, bridging periods of LS availability; and (2) that potentially non–renin‐angiotensin–related mechanisms participate in ENaC activation and consecutive Na+ retention.

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The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP

Cited by 1,188 publications

References 50 publications

A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

Association Between Gestational Hypertension and Risk of Cardiovascular Disease Among 617 589 Norwegian Women

Physiological and Molecular Responses to Altered Sodium Intake in Rat Pregnancy

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