A new definition of gestational hypertension? New onset blood pressures of 130-139/80-89 mmHg after 20 weeks of gestation.
妊娠期高血压的新定义？妊娠 20 周后新发血压 130-139/80-89 mmHg。
- 作者列表："Porcelli BA","Diveley E","Meyenburg K","Woolfolk C","Rosenbloom JI","Raghuraman N","Stout MJ","Sabol BA
BACKGROUND:Diagnostic criteria for hypertensive disorders of pregnancy have historically been based on the American Heart Association/American College of Cardiology's definition of hypertension, previously defined as a blood pressure ≥140/90 mmHg. With the recent redefinition of hypertension, blood pressures of 130-139/80-89 mmHg are now considered abnormal. OBJECTIVE:We aimed to test whether new-onset blood pressure elevations of 130-139/80-89 mmHg after 20 weeks of gestation in previously normotensive women are associated with increased risk of adverse pregnancy outcomes, specifically development of hypertensive disorders of pregnancy. STUDY DESIGN:We performed a retrospective cohort study from a single tertiary care center of all women who delivered singleton gestations after 20 weeks from January 1, 2014 to June 8, 2016. Normotensive patients were defined as having maximum blood pressure <130/80 mmHg prior to 20 weeks of gestation with no prior diagnosis of chronic hypertension. Patients that remained normotensive for the remainder of pregnancy were then compared to patients who developed new blood pressure elevations 130-139/80-89 mmHg after twenty weeks gestation but prior to admission for delivery. The primary outcome was development of a hypertensive disorder of pregnancy at or during delivery admission. Clinical outcomes were assessed using χ2and multivariable logistic regression. RESULTS:Of the 2,090 normotensive women from our cohort who were analyzed, 1318 (63.0%) remained normotensive for their entire antenatal course prior to delivery admission and 772 (37.0%) had new-onset blood pressure elevations between 130-139/80-89 mmHg. Women with new onset blood pressure elevations between 130-139/80-89 mmHg after 20 weeks have a significantly increased risk of developing a hypertensive disorder of pregnancy at or during their delivery admission (adjusted RR 2.41, 95% CI 2.02-2.85) including an almost 3-fold increased risk for preeclampsia with severe features, even after adjusting for confounders. There were no differences in other secondary obstetric outcomes. CONCLUSION:Normotensive women with newly elevated blood pressures between 130-139/80-89mmHg after 20 weeks of gestation are more likely to develop hypertensive disorders of pregnancy and preeclampsia with severe features at or during their delivery hospitalization. These more modest blood pressure elevations may be an early indicator of disease and call into question our current blood pressure threshold for diagnosis of hypertensive diseases of pregnancy.
背景: 妊娠期高血压疾病的诊断标准历来基于美国心脏协会/美国心脏病学会对高血压的定义，以前定义为血压 ≥ 140/90 mmHg。随着最近对高血压的重新定义，血压 130-139/80-89 mmHg 现在被认为是异常的。 目的: 我们旨在测试既往血压正常的妇女在妊娠 20 周后新发血压升高 130-139/80-89 mmHg 是否与不良妊娠结局风险增加相关,特别是妊娠期高血压疾病的发展。 研究设计: 我们对 2014 年 1 月 1 日至 20 16 年 6 月 8 日 20 周后分娩单胎分娩的所有女性进行了一项回顾性队列研究。血压正常的患者定义为妊娠 20 周前最大血压 <130/80 mmHg，既往未诊断为慢性高血压。然后将妊娠剩余时间血压保持正常的患者与妊娠 20 周后但入院分娩前出现新的血压升高 130-139/80-89 mmHg 的患者进行比较。主要结局是在分娩入院时或入院时发生妊娠期高血压疾病。使用 χ 2 和多变量 logistic 回归评估临床结局。 结果: 在我们队列中分析的 2,090 例血压正常的女性中，1318 例 (63.0%) 在分娩入院前的整个产前过程中血压保持正常，772 例 (37.0%) 新发血压升高在 130-139/80-89 mmHg 之间。20 周后新发血压升高在 130-139/80-89 mmHg 之间的女性在分娩入院时或分娩入院期间发生妊娠期高血压疾病的风险显著增加 (调整后 RR 2.41, 95% CI 2.02-2.85) 包括重度子痫前期特征的风险几乎增加 3 倍，即使在校正混杂因素后。其他次要产科结局无差异。 结论: 妊娠 20 周后血压新升高在 130-139/80-89mmHg 之间的血压正常的妇女，在分娩住院时或住院期间更容易发生具有严重特征的妊娠期高血压疾病和先兆子痫。这些更适度的血压升高可能是疾病的早期指标，并质疑我们目前诊断妊娠期高血压疾病的血压阈值。
METHODS::Maternal lifestyle affects both mother health and pregnancy outcome in humans. Several studies have demonstrated that interventions oriented towards reducing stress and anxiety have positive effects on pregnancy complications such as preeclampsia, excessive gestational weight, gestational diabetes and preterm birth. In this work, we showed that the environmental enrichment (EE), defined as a noninvasive and biological significant stimulus of the sensory pathway combined with voluntary physical activity, prevented preterm birth (PTB) rate in a 41% in an inflammatory mouse model induced by the systemic administration of bacterial lipopolysaccharide (LPS). Furthermore, we found that EE modulates maternal metabolism and produces an anti-inflammatory environment that contributes to pregnancy maintenance. In pregnant mice uterus, EE reduces the expression of TLR4 and CD14 (the LPS receptor and its coactivator protein), preventing the LPS-induced increase in PGE2 and PGF2α release and nitric oxide synthase (NOS) activity. In cervical tissue, EE inhibits cervical ripening events, such as PGE2 release, matrix metalloproteinase (MMP)-9 increased activity and neutrophil recruitment, therefore conserving cervical function. It seems that EE exposure could mimic the stress and anxiety-reducing techniques mentioned above, explaining, at least partially, the beneficial effects of having a healthy lifestyle before and during gestation. Furthermore, we propose that designing an EE protocol for humans could be a noninvasive and preventive therapy for pregnancy complications, averting pre-term birth occurrence and dreaded sequelae that are present in the offspring born to soon.
METHODS:PROBLEM:We aimed to investigate the main causes of recurrent miscarriage (RM) in patients with losses after spontaneous gestation (SG) and after in vitro fertilization (IVF). METHOD OF STUDY:A prospective case-control study was conducted. The eligible patients were women who had experienced two or more consecutive abortions after less than 12 weeks gestation, two consecutive losses after SG or two consecutive losses after IVF. All patients were subjected to the following evaluations: karyotyping of the aborted material, alloimmune and autoimmune marker testing, and acquired and hereditary thrombophilia marker testing. RESULTS:In total, 58 patients were eligible: 32 patients with RM after SG and 26 patients with RM after IVF. The factors associated with RM were genetic (29%), immune (14%), thrombophilic (21%), and thrombophilic and immune (24%), and only 12% of the cases were idiopathic. Comparing the two study groups (SG and IVF), all studied factors were similar, except for a higher ANA positivity observed in the SG group (SG 30.4% versus IVF 5.3%, OR 8.6 (CI 1.1 - 21.1, P 0.048). CONCLUSIONS:Our study identified the possibly factors associated with recurrent miscarriage in 86% of the cases, and these factors appear to be similar in patients with recurrent miscarriage after spontaneous gestation and IVF. This study demonstrates that IVF with PGT-A with euploid embryo transfer could reduce abortions by up to 29%, but other factors needs to be investigated even in patients undergoing in vitro fertilization.
METHODS:OBJECTIVES:To evaluate the impact of pre-operative Music Therapy (MT) on pain in first-trimester abortion under local anaesthesia (ALA). DESIGN:Randomised controlled trial comparing patients undergoing a first-trimester ALA with or without a pre-operative MT session. SETTING:University hospital of Angers from November 2016 to August 2017. POPULATION:Patients who underwent first-trimester abortion under ALA. METHODS:Patients allocated to MT group underwent a pre-operative 20 minutes session of MT. MAIN OUTCOME MEASURES:Pain was assessed using a visual analogue scale (VAS) just before the procedure, during the procedure, at the end of the procedure and upon returning to the ward. RESULTS:159 patients were randomised (80 in MT group, and 79 in the control group). 2 patients were excluded from the control group and 6 from the MT group. Therefore, 77 patients were analysed in the control group and 74 in the MT group. The intensity of pain were similar in both the MT group and the Control group just before the procedure (VAS: 4.0±2.9 vs. 3.6±2.5, p=0.78), during the procedure (VAS: 5.3±2.5 vs. 4.9±2.9, p=0.78), at the end of the procedure (VAS: 2.7±2.4 vs. 2.6±2.4, p=0.43) and upon returning to the ward (VAS:1.8±2.0 vs. 1.5±2.0, p=0.84). The difference in pain between entering the department and returning to the room after the procedure was similar between the MT and Control groups (0.3±2.5 vs. 0.3±2.4 VAS levels difference; p=0.92). CONCLUSION:Music therapy session before an ALA procedure resulted in no improvement in patient perception of pain during a first-trimester abortion.