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1.
Sci Rep ; 13(1): 153, 2023 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599871

RESUMO

Pre-eclampsia is associated with postnatal cardiac dysfunction; however, the nature of this relationship remains uncertain. This multicentre retrospective cohort study aimed to determine the prevalence of pre-eclampsia in women with pre-existing cardiac dysfunction (left ventricular ejection fraction < 55%) and explore the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] vs. population prevalence of 4.6% [95% C.I. 2.7-8.2], p = 0.99); 12/13 women had concurrent obstetric/medical risk factors for pre-eclampsia. The prevalence of preterm pre-eclampsia (< 37 weeks) and fetal growth restriction (FGR) was increased (1.8% vs. 0.7%, p = 0.03; 15.2% vs. 5.5%, p < 0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome. Antenatal ß blockers (n = 116) were associated with lower birthweight Z score (adjusted difference - 0.31 [95% C.I. - 0.61 to - 0.01], p = 0.04). To conclude, this study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with pre-existing cardiac dysfunction. Our results do not necessarily support a causal relationship between cardiac dysfunction and pre-eclampsia, especially given the population's background risk status. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.


Assuntos
Cardiomiopatias , Cardiopatias , Pré-Eclâmpsia , Humanos , Gravidez , Feminino , Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda , Retardo do Crescimento Fetal/epidemiologia , Cardiomiopatias/complicações , Cardiomiopatias/epidemiologia
2.
Heart ; 105(5): 391-398, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30242140

RESUMO

OBJECTIVE: To assess median and percentile birthweight distribution in women with various groups of heart disease relative to a contemporaneous comparison group. METHODS: Data on birth weight and gestational age were collected from 1321 pregnancies ≥24 weeks' gestation in 1053 women with heart disease from seven UK maternity units. Women were assigned to one of 16 groups according to their cardiac lesion. In units where it was possible, data on two births, one delivering before and one after index cases, were collected, giving 2307 comparators. Birthweight percentiles (corrected for gestational age, sex and parity) were calculated using Aberdeen norms. We assessed the association of birth weight with cardiac lesion, maternal hypoxaemia (saturations <90%), systemic ventricular function and beta-blockers. RESULTS: 1321 pregnancies in women with heart disease and 2307 comparators were studied. Almost all groups with heart disease had lower median and percentile birth weights than comparators, significantly in 10 groups, the biggest effect seen in women with Fontan circulation, pulmonary hypertension, prosthetic heart valves, systemic right ventricle, Marfan syndrome, repaired tetralogy of Fallot and cardiomyopathy (in that order). In 307 pregnancies, women took beta-blockers; median birth weight adjusted for maternal age, parity and the effect of the cardiac lesion was 3116.7 g (IQR 790.4) when beta-blockers were used and 3354.3 g (IQR 634.1) when they were not (p<0.001). 17 women had saturations <90%, and median birth weight was significantly lower, 3105.4 g (IQR 1288.9) versus 3387.7 g (IQR 729.8) (p=0.006). CONCLUSION: Our findings identify specific groups of women with heart disease at risk of having a small baby.


Assuntos
Desenvolvimento Fetal , Cardiopatias , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez
3.
Clin Transplant ; 30(6): 673-81, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26992458

RESUMO

Female renal transplant recipients of childbearing age may ask what the outcomes are for pregnancy and whether pregnancy will affect graft function. We analyzed obstetric and transplant outcomes among renal transplant recipients in our center who have been pregnant between 1973 and 2013. A case-cohort study was performed identifying 83 pairs of pregnant and non-pregnant controls matched for sex, age, transplant vintage, and creatinine. There were 138 pregnancies reported from 89 renal transplant recipients. There were live births in 74% of pregnancies with high prevalence of prematurity (61%), low birth weight (52%), and pre-eclampsia (14%). Lower eGFR (OR 0.98; p = 0.05) and higher uPCR (OR 1.86; p = 0.02) at conception were independent predictors for poor composite obstetric outcome. Lower eGFR (OR 0.98; p = 0.04), higher uPCR (OR 1.50; p = 0.04), and live organ donation (OR 0.35; p = 0.02) were predictors of ≥20% loss of eGFR between immediately pre-pregnancy and one yr after delivery. There was no difference in eGFR at one, five, and 10 yr in pregnant women compared with non-pregnant controls and a pregnancy was not associated with poorer 10-yr transplant or 20-yr patient survival. Despite high rates of obstetric complications, most women had successful pregnancies with good long-term transplant function.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Transplante de Rim , Rim/fisiopatologia , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Adulto , Estudos de Casos e Controles , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Recém-Nascido , Gravidez , Estudos Retrospectivos , Transplantados , Reino Unido/epidemiologia
4.
J Hypertens ; 30(5): 954-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22441350

RESUMO

OBJECTIVE: Circulating biomarkers of endothelial dysfunction and inflammation are elevated in late pregnancy in women with preeclampsia. We examined plasma levels of inflammatory cytokines and adhesion molecules in early pregnancy, to assess their ability to predict preeclampsia. METHODS: In a prospective longitudinal study, 2600 women with singleton pregnancies and no history of hypertension were recruited at their antenatal hospital (booking) visit at gestational week 12-16. Of these, 49 (1.9%) developed preeclampsia, whereas 74 women matched for age and BMI with uncomplicated pregnancies were selected as controls. A subset of women with risk factors for preeclampsia were sampled again at gestational weeks 16 and 28 (11 cases, 39 controls) and postnatally (six cases, 36 controls). RESULTS: From multiplex analysis, soluble E-selectin concentrations were higher at 12-16 weeks in women who subsequently developed preeclampsia (15.1 ±â€Š4.9 versus 12.9 ±â€Š4.5  ng/ml, P = 0.02). At gestational week 28, E-selectin concentrations were again higher in women who went on to develop preeclampsia compared with controls (14.4 ±â€Š5.6 versus 10.7 ±â€Š3.5  ng/ml, P = 0.010), whereas levels were not different between the two groups in postpartum samples. CONCLUSION: Changes in soluble E-selectin concentration in early pregnancy may reflect underlying pathophysiological processes, potentially providing mechanistic insights into preeclampsia.


Assuntos
Selectina E/sangue , Pré-Eclâmpsia/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Adesão Celular , Estudos de Coortes , Citocinas/metabolismo , Feminino , Humanos , Estudos Longitudinais , Projetos Piloto , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos
5.
Br J Haematol ; 154(2): 208-15, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21554256

RESUMO

Evidence-based guidelines are presented for the management of haemophilia in the fetus and neonate. This includes information regarding the management of pregnancy and delivery as well as aspects of management during the early neonatal period. Specific issues regarding the mode of delivery and the risk of intra-cranial and extra-cranial haemorrhage are discussed.


Assuntos
Doenças Fetais/terapia , Hemofilia A/terapia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiologia , Parto Obstétrico/métodos , Diagnóstico Precoce , Medicina Baseada em Evidências/métodos , Feminino , Hemofilia A/complicações , Hemofilia A/diagnóstico , Humanos , Recém-Nascido , Masculino , Assistência Perinatal/métodos , Gravidez , Cuidado Pré-Natal/métodos
6.
Hypertension ; 57(3): 561-9, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21199994

RESUMO

Preeclampsia is a major determinant of fetal and maternal morbidity and mortality. We used a proteomic strategy to identify urinary biomarkers that predict preeclampsia before the onset of disease. We prospectively collected urine samples from women throughout pregnancy. Samples from gestational weeks 12 to 16 (n=45), 20 (n=50), and 28 (n=18) from women who subsequently had preeclampsia develop were matched to controls (n=86, n=49, and n=17, respectively). We performed capillary electrophoresis online coupled to micro-time-of-flight mass spectrometry. Disease-specific peptide patterns were generated using support vector machine-based software. Candidate biomarkers were sequenced by liquid chromatography-tandem mass spectrometry. From comparison with nonpregnant controls, we defined a panel of 284 pregnancy-specific proteomic biomarkers. Subsequently, we developed a model of 50 biomarkers from specimens obtained at week 28 that was associated with future preeclampsia (classification factor in cases, 1.032 ± 0.411 vs controls, -1.038 ± 0.432; P<0.001). Classification factor increased markedly from week 12 to 16 to 28 in women who subsequently had preeclampsia develop (n=16; from -0.392 ± 0.383 to 1.070 ± 0.383; P<0.001) and decreased slightly in controls (n=16; from -0.647 ± 0.437 to -1.024 ± 0.433; P=0.043). Among the biomarkers are fibrinogen alpha chain, collagen alpha chain, and uromodulin fragments. The markers appear to predict preeclampsia at gestational week 28 with good confidence but not reliably at earlier time points (weeks 12-16 and 20). After prospective validation in other cohorts, these markers may contribute to better prediction, monitoring, and accurate diagnosis of preeclampsia.


Assuntos
Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/urina , Adulto , Biomarcadores/análise , Biomarcadores/urina , Cromatografia Líquida , Feminino , Humanos , Espectrometria de Massas , Valor Preditivo dos Testes , Gravidez , Proteômica
7.
Australas J Ultrasound Med ; 12(3): 35-38, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28191060
8.
Best Pract Res Clin Obstet Gynaecol ; 22(1): 15-29, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17904904

RESUMO

Fetal anaemia can by treated by in-utero therapy, which results in a significant improvement in perinatal outcome. The important causes of fetal anaemia are rhesus alloimmunisation, kell alloimmunisation and parvovirus infection. At-risk pregnancies require serial monitoring to ensure timely intervention with intrauterine transfusion. Non-invasive testing with middle cerebral artery Doppler is becoming the monitoring modality of choice.


Assuntos
Anemia/diagnóstico , Anemia/terapia , Doenças Fetais/diagnóstico , Doenças Fetais/terapia , Anemia/etiologia , Transfusão de Sangue Intrauterina/métodos , Feminino , Doenças Fetais/etiologia , Humanos , Sistema do Grupo Sanguíneo de Kell/imunologia , Artéria Cerebral Média/diagnóstico por imagem , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/diagnóstico , Parvovirus B19 Humano , Gravidez , Diagnóstico Pré-Natal/métodos , Isoimunização Rh/complicações , Ultrassonografia Pré-Natal/métodos
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