Circadian melatonin concentration rhythm is lost in pregnant women with altered blood pressure rhythm.

We assessed the correlation between the rhythm of melatonin concentration and circadian blood pressure patterns in normal and hypertensive pregnancy. Ambulatory 24-h blood pressure and blood samples every 4 h were monitored in 16 primigravidae who had shown an abnormal circadian blood pressure pattern (eight pre-eclamptic and eight normotensive) in pregnancy and 6-12 months after pregnancy. The circadian rhythm was analyzed by chronobiological measures. Eight normotensive women with maintained blood pressure rhythm served as controls. During pregnancy, melatonin concentration was significantly higher in pre-eclamptic than in normotensive women (pre-eclampsia, 29.4 +/- 1.9 pg/ml, normotensin, altered rhythm, 15.6 +/- 2.1; controls, 22.7 +/- 1.8; p < 0.001). This difference faded after pregnancy, owing to the fall observed in pre-eclampsia (11.8 +/- 3.2 pg/ml, 9.8 +/- 2.1, and 11.1 +/- 2.0, respectively; NS). The rhythm of melatonin concentration was lost in all pregnant women with loss of blood pressure rhythm. After pregnancy, normotensive women showed a reappearance of both melatonin and blood pressure rhythm, whereas pre-eclamptic women showed a reappearance of blood pressure but not melatonin rhythm. The loss of blood pressure rhythm in pregnancy is consistent with the loss of melatonin concentration rhythm. In pre-eclamptic women, the normalization of blood pressure rhythm, while melatonin rhythm remained altered, suggests a temporal or causal priority of circadian concentration of melatonin in the determination of blood pressure trend.

[The relative weight of Doppler of the uterine artery and 24-h ambulatory blood pressure monitoring in predicting hypertension in pregnancy and preeclampsia]. / Il peso relativo del Doppler delle arterie uterine e del monitoraggio ambulatoriale 24-h della pressione arteriosa nella predittività dell'ipertensione in gravidanza e della preeclampsia.

OBJECTIVE: To assess the combined use and the "relative weight" of Uterine Artery Doppler Velocimetry and 24-h Ambulatory Blood Pressure Monitoring (ABPM) to predict Gestational Hypertension (GH) and Preeclampsia (PE). METHODS: The predictivity of Doppler of uterine artery flow at 24 weeks and of ABPM at 24-30 weeks was assessed in 75 normotensive primigravidae, considering the subsequent onset of GH and/or PE. RESULTS: In our series the sensitivity of Doppler versus GH is 62%, and 57% vs PE. The altered ABPM shows a sensitivity of 97% vs GH and 99% vs PE. In the cases with the both tests positive it was 97% vs GH, and 99% vs PE. In the subgroup of patients with altered Doppler velocimetry and normal ABPM, the sensitivity vs GH and PE is 12% (PPV = 12%). A second subgroup with normal Doppler velocimetry and altered ABPM shows a sensitivity of 94% vs GH (PPV = 88%), and 99% vs PE (PPV = 33%). CONCLUSIONS: Uterine Artery Doppler Velocimetry and 24-h Ambulatory Blood Pressure Monitoring (ABPM) have a good predictive power for GH and PE, but the combined use improves the efficacy to identify an abnormal outcome of pregnancy. When evaluating for relative weight, the ABPM is more powerful in predicting for GH and PE than Doppler assessment. However, the high specificity of Doppler velocimetry reduces the false-positive ratio in the combined screening during the 2nd trimester of pregnancy.

Prediction of the need for insulin therapy in pregnant women with impaired gestational glucose tolerance (IGGT).

OBJECTIVE: Our aim was identify pregnant women with impaired gestational glucose tolerance (IGGT) at risk for more severe gluco-metabolic alterations who could require subsequent insulin therapy during pregnancy. METHODS: We studied 78 pregnant women with IGGT after a 100 g glucose oral tolerance test. Patients were divided into two groups based on a cut-off value of a 15% reduction from normal values of the glucose load. Sixty-three patients had at least one value above this cutoff point, while 15 had all residual values below the cut off. All patients were put on a diet and glycemia reassessed: those who showed pre-prandial blood glucose higher than or equal to 90 mg/dl and/or 2-h post-prandial higher than or equal to 120 mg/dl underwent insulin therapy. We matched the presence of at least one residual value in the oral glucose tolerance test above the limit used with the subsequent need for insulin treatment. RESULTS: The presence of at least one residual value above the "-15%" cutoff in the glucose tolerance test was associated with high risk (positive predictive value 79%), whereas normality of the residual values indicated low risk (negative predictive value 80%), of insulin need during the rest of pregnancy. CONCLUSIONS: Pregnant women with IGGT definitely do not have a normal metabolic condition, sometimes even requiring diet and insulin treatment. From our results, the need for more accurate monitoring and insulin treatment may be predicted by simply looking at the residual values in the glucose tolerance test.