Risk factors for cardiovascular disease ten years after preeclampsia / Fatores de risco para doença cardiovascular dez anos após pré-eclâmpsia

CONTEXT AND OBJECTIVE: Preeclampsia is a gestational disease that occurs mainly among nulliparous women after the 20th week of gestation, and frequently close to delivery. The effects of preeclampsia on women's blood pressure over the long term are still controversial. Patients with recurrent preeclampsia or preeclampsia in the early stages of pregnancy appear to present higher risk of hypertension. The aim of this study was to determine the risk factors for cardiovascular disease among women with preeclampsia 10 years earlier. DESIGN AND SETTING: Cross-sectional study at Hospital de Clínicas de Porto Alegre (HCPA). METHODS: Forty women with preeclampsia and 14 normotensive pregnant women followed up 10 or more years earlier at HCPA underwent clinical and laboratory examinations. Spearman's correlation coefficient was used to correlate body mass index (BMI) and systolic and diastolic pressures. The risk of developing hypertension was measured using the chi-square test. P < 0.05 was considered significant. RESULTS: The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure (P = 0.047), BMI (P = 0.019) and abdominal circumference (P = 0.026). They presented positive correlations between BMI and diastolic blood pressure (0.341; P = 0.031) and between BMI and systolic blood pressure (0.407; P = 0.009). CONCLUSION: The patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure, BMI and abdominal circumference than did the control group. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors among patients with preeclampsia.

CONTEXTO E OBJETIVO: Pré-eclâmpsia é uma doença gestacional que ocorre principalmente em mulheres nulíparas, após a vigésima semana de gestação e frequentemente próximo do parto. Os efeitos da pré-eclâmpsia sobre a pressão sanguínea das mulheres a longo prazo ainda são controversos. Pacientes com pré-eclâmpsia recorrente ou pré-eclâmpsia na fase inicial da gestação parecem apresentar maior risco para hipertensão. O objetivo foi determinar os fatores de risco para doença cardiovascular em mulheres com pré-eclâmpsia há 10 anos. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado no Hospital de Clínicas de Porto Alegre (HCPA). MÉTODO: Quarenta mulheres com pré-eclâmpsia e 14 mulheres grávidas com pressão arterial normal acompanhadas há 10 anos ou mais no HCPA foram submetidas a exames clínicos e laboratoriais. Para se encontrar a correlação entre índice de massa corporal (IMC) e as pressões sistólica e diastólica, foi calculado o coeficiente de correlação de Spearman. O risco de desenvolvimento de hipertensão foi calculado através do teste de qui-quadrado. P < 0,05 foi considerado significante. RESULTADOS: Pacientes com pré-eclâmpsia há 10 anos ou mais tiveram pressão arterial diastólica (PAD) (P = 0,047), IMC (P = 0,019) e circunferência abdominal (P = 0,026) mais elevadas e apresentaram correlações positivas entre IMC e PAD (0,341, P = 0,031) e sistólica (0,407, P = 0,009). CONCLUSÃO: As pacientes com pré-eclâmpsia há 10 anos ou mais apresentaram pressão arterial diastólica, IMC e circunferência abdominal mais elevadas que o grupo controle. Isso enfatiza a importância de acompanhamento por longo tempo para avaliar fatores de risco cardiovascular em pacientes com pré-eclâmpsia prévia.

Prevalence of acute toxoplasmosis infection among 41112 pregnant women and the mother-to-child transmission rate in a public hospital in South Brazil

Untreated acute toxoplasmosis among pregnant women can lead to serious sequelae among newborns, including neurological impairment and blindness. In Brazil, the risk of congenital toxoplasmosis (CTox) has not been fully evaluated. Our aim was to evaluate trends in acute toxoplasmosis prevalence from 1998-2005, the incidence of CTox and the rate of mother-to-child transmission (MTCT). A cross-sectional study was undertaken to dentify patients who fit the criteria for acute toxoplasmosis during pregnancy. Exposed newborns were included in a historical cohort, with a median follow-up time of 11 months, to establish definite diagnosis of CTox. Diagnoses for acute infection in pregnancy and CTox were based on European Research Network on Congenital Toxoplasmosis criteria. In 41,112 pregnant women, the prevalence of acute toxoplasmosis was 4.8/1,000 women. The birth prevalence of CTox was 0.6/1,000 newborns [95 percent confidence interval (CI): 0.4-0.9]. During the follow-up study, 12 additional cases were detected, increasing the CTox rate to 0.9/1,000 newborns (95 percent CI: 0.6-1.3). Among the 200 newborns exposed to Toxoplasma gondii,there were 37 babies presenting diagnostic criteria of CTox, leading to an MTCT rate of 18.5 percent (95 percent CI: 13.4-24.6 percent). The additional cases identified during follow-up reinforce the need for serological monitoring during the first year of life, even in the absence of evidence of congenital infection at birth.