Hypertensive disorders of pregnancy: A UK-based perspective

Current Opinion in Obstetrics and Gynecology

Volumn 20, Issue 2, 2008, Pages 96-101

  Chandiramani, Manju ^a,b   Shennan, Andrew ^a  

^a KING'S COLLEGE LONDON   (United Kingdom)

^b ST THOMAS HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALPHA TOCOPHEROL; ANTITHROMBOCYTIC AGENT; ASCORBIC ACID; BIOCHEMICAL MARKER; CALCIUM; FISH OIL; LABETALOL; MAGNESIUM; NIFEDIPINE;

BIOPHYSICS; BRAIN HEMORRHAGE; CARDIOVASCULAR RISK; CLINICAL TRIAL; DEATH; ENDOTHELIAL DYSFUNCTION; GARLIC; HUMAN; MATERNAL HYPERTENSION; PATHOPHYSIOLOGY; PREDICTION; PREECLAMPSIA; PREVALENCE; PRIORITY JOURNAL; PROPHYLAXIS; REVIEW; RISK ASSESSMENT; SODIUM RESTRICTION; UNITED KINGDOM;

ANTICONVULSANTS; ANTIHYPERTENSIVE AGENTS; BIOLOGICAL MARKERS; FEMALE; GREAT BRITAIN; HUMANS; HYPERTENSION; HYPERTENSION, PREGNANCY-INDUCED; PRE-ECLAMPSIA; PREGNANCY; PREGNANCY COMPLICATIONS, CARDIOVASCULAR; PREGNANCY OUTCOME; PREVALENCE; RISK ASSESSMENT; RISK FACTORS;

EID: 41849097438     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/GCO.0b013e3282f7336d     Document Type: Review

References (40)

1. Poston L, Briley AL, Seed PT, et al. Vitamin C and vitamin E in pregnant women at risk for preeclampsia (VIP trial): randomised placebo-controlled trial. Lancet 2006; 367:1145-1154.
2. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367:1066-1074.
3. Lewis G, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007. The recent CEMACH report demonstrated an increase in intracranial haemorrhages as the cause of death in women with preeclampsia/eclampsia and recommended that women with a systolic blood pressure of ≥ 160 mmHg need antihypertensive treatment.
4. Knight M. Eclampsia in the United Kingdom 2005. BJOG 2007; 114:1072-1078. The incidence of preeclampsia and its complications have decreased significantly in the UK since 1992, following the introduction of management guidelines based on the evidence-based use of magnesium sulphate for eclampsia and preeclampsia, showing the practical benefits of translating research into practice.
5. Steer P. The epidemiology of preterm labour. BJOG 2005; 112 (S1):1-3.
6. Chen XK, Wen SW, Smith G, et al. Pregnancy-induced hypertension and infant mortality: role of birthweight centiles and gestational age. BJOG 2007; 114:24-31. This retrospective cohort study of linked birth and infant death data sets over a 5-year period of a total of over 17 000 000 eligible liveborn singleton births delivered after 20 weeks' gestation showed that the association between pregnancy-induced hypertension (PIH) and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIHis associated with a decreased risk of infantmortality in small-for-gestational age births, pretermappropriate-for-gestational age births and early preterm large-for-gestational age births.
7. Visser N, van Rijn BB, Rijkers GT, et al. Inflammatory changes in preeclampsia: current understanding of the maternal immune and adaptive immune response. Obstet Gynecol Surv 2007; 62:191-201. This article summarizes the newer concepts related to the pathogenesis of preeclampsia, explaining the role of the maternal immune system and the role of pro-inflammatory and regulatory cytokines and chemokines in its pathophysiology.
8. Whitley GS, Dash PR, Ayling LJ, et al. Increased apoptosis in first trimester extravillous trophoblasts from pregnancies at higher risk of developing preeclampsia. Am J Pathol 2007; 170:1903-1909. In this study, the authors correlated increased first trimester uterine artery resistance with a biological abnormality of trophoblast function. Extravillous trophoblasts derived from high-resistance pregnancies were more sensitive to apoptotic stimuli than those from normal-resistance pregnancies.
9. Moll SJ, Jones CJ, Crocker IP, et al. Epidermal growth factor rescues trophoblast apoptosis induced by reactive oxygen species. Apoptosis 2007; 12:1611-1622. This study showed that exposure to hydrogen peroxide, a potent generator of reactive oxygen species, induced apoptosis in villous trophoblast. This was reduced by treatment with epidermal growth factor, which had an antiapoptotic effect in trophoblastic tissue, the maintenance of which is essential for normal pregnancy.
10. Harris LK, Keogh RJ, Wareing M, et al. BeWo cells stimulate smooth muscle apoptosis and elastin breakdown in a model of spiral artery transformation. Hum Reprod 2007; 22:2834-2841. Segments of human spiral artery, when perfused with choriocarcinoma cell line, BeWo, demonstrated induced arterial remodelling. BeWo-derived factors upregulated protease expression in spiral artery smooth muscle cells to facilitate matrix breakdown.
11. Afzal-Ahmed I, Mann GE, Shennan AH, et al. Preeclampsia inactivates glucose-6-phosphate dehydrogenase and impairs the redox status of erythrocytes and fetal endothelial cells. Free Radic Biol Med 2007; 42:1781-1790. This was a nested case-control study to evaluate measurement of maternal serum PP-13 at 22-24 weeks of gestation, alone or in combination with second-trimester biochemical markers or Doppler pulsatility index. The test at this gestation was not useful when used alone or in combination.
12. Daher S, Sass N, Oliveira LG, et al. Cytokine genotyping in preeclampsia. Am J Reprod Immunol 2006; 55:130-135.
13. Howarth C, Gazis A, James D. Associations of Type 1 diabetes mellitus, maternal vascular disease and complications of pregnancy. Diabet Med 2007; 24:1229-1234. This study showed that women with type 1 diabetes mellitus and vascular disease are at a greater risk of preeclampsia and pathological fetal growth, which should influence counselling and merit increased pregnancy surveillance.
14. Bhattacharya S, Campbell DM, Liston WA, et al. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007; 7:168. This retrospective cohort study of nulliparous women in Aberdeen between 1976 and 2005 showed that increasing BMI was associated with an increased incidence of preeclampsia, gestational hypertension, macrosomia, induction of labour and caesarean delivery. Underweight women had better pregnancy outcomes than women with normal BMI.
15. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006; 368:1164-1170.
16. Milne F, Redman C, Walker J, et al. The preeclampsia community guideline (PRECOG): how to screen for and detect onset of preeclampsia in the community. BMJ 2005; 330:576-580.
17. Duckitt K, Harrington D. Risk factors for preeclampsia at antenatal booking: systematic review of controlled studies. BJOG 2005; 330:549-550.
18. National Institute for Health and Clinical Excellence. Antenatal care: routine care for the healthy pregnant woman. NICE clinical guideline 6. London: NICE; 2003.
19. Papageorghiou AT, Yu CKH, Bindra R, et al. Multicenter screening for preeclampsia and fetal growth restriction by transvaginal uterine artery Doppler at 23 weeks of gestation. Ultrasound Obstet Gynecol 2001; 18:441-449.
20. Plasencia W, Maiz N, Bonino S, et al. Uterine artery Doppler at 11+0 to 13+6 weeks in the prediction of preeclampsia. Ultrasound Obstet Gynecol 2007; 30:742-749. This prospective screening study of singleton pregnancies showed that the detection rate of all preeclampsia and preeclampsia leading to delivery before 34 weeks' gestation using pulsatility index and maternal characteristics is 61.7% and 81.8%, respectively with a false-positive rate of 10%.
21. Smith GC, Crossley JA, Aitken DA, et al. Circulating angiogenic factors in early pregnancy and the risk of preeclampsia, intrauterine growth restriction, spontaneous preterm birth and stillbirth. Obstet Gynecol 2007; 109:1316-1324. This prospective nested, case-control study of maternal serum levels of s-Flt-1 and PIGF at 10-14 weeks of gestation showed that higher levels of sFlt-1 were not associated with the risk of preeclampsia and in fact, higher levels of PIGF were associated with a reduced risk (OR 0.95, 95% CI 0.90-0.99).
22. +6 weeks of gestation was done to determine maternal serum levels of sICAM-1 and sVCAM-1. Pulsatility index was higher in pregnancies affected by preeclampsia but there were no significant differences in concentration of either adhesion molecule.
23. Spencer K, Cowans NJ, Chefetz I, et al. First trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of preeclampsia. Ultrasound Obstet Gynecol 2007; 29:128-134. This was a nested case-control study showing that first trimester PP-13 levels may be useful in predicting preeclampsia and the accuracy of the test increases when coupled with Doppler pulsatility index. The same is true for PAPP-A, but the test is not as good.
24. Nicolaides KH, Bindra R, Turzan OM, et al. A novel approach to first trimester screening for early preeclampsia combining serum PP-13 and Doppler ultrasound. Ultrasound Obstet Gynecol 2006; 27:12-17.
25. Spencer K, Cowans NJ, Chefetz I, et al. Second-trimester uterine artery Doppler pulsatility index and maternal serum PP13 as markers of preeclampsia. Prenat Diagn 2007; 27:258-263. This was a nested case-control study to evaluate measurement of maternal serum PP-13 at 22-24 weeks of gestation, alone or in combination with second-trimester biochemical markers or Doppler pulsatility index. The test at this gestation was not useful when used alone or in combination.
26. Askie LM, Duley L, Henderson-Smart D, et al. Antiplatelet agents for prevention of preeclampsia: a meta-analysis of individual patient data. Lancet 2007; 369:1791-1798. This was a nested case-control study to evaluate whether measurement of maternal serum PP-13 at 22-24 weeks of gestation, alone or in combination with second-trimester biochemical markers or Doppler pulsatility index. The test at this gestation was not useful when used alone or in combination.
27. Hofmeyr GJ, Duley L, Atallah A. Dietary calcium supplementation for prevention of preeclampsia and related problems: a systematic review and commentary. BJOG 2007; 114:933-943. This systematic review analysed 12 randomized trials comparing at least 1 g of calcium daily during pregnancy with placebo. The use of calcium appears promising with its ability to reduce the risk of preeclampsia and adverse outcome with no obvious evidence of harm.
28. Levine RJ, Hauth JC, Curet LB, et al. Trial of calcium to prevent preeclampsia. N Engl J Med 1997; 337:69-76.
29. Thangaratinam S, Ismail K, Sharp S, et al. Prioritisation of tests for the prediction of preeclampsia complications: a Delphi survey. Hypertens Pregnancy 2007; 26:131-138. This method was used to prioritize clinically relevant tests as there are no robust systematic reviews or large trials examining the accuracy of tests which can be used to predict complications in preeclampsia.
30. Wilton A, de Greef A, Shennan A. Rapid assessment of blood pressure in the obstetric day unit using Microlife MaM Technology. Hypertens Pregnancy 2007; 26:31-37. This study measured blood pressure in 30 hypertensive pregnant patients recruited from the obstetric day unit of a large teaching hospital, comparing MaM technology with current methods of assessing blood pressure over time.
31. de Greeff A, Reggiori F, Shennan AH. Clinical assessment of the DINAMAP ProCare monitor in an adult population according to the British Hypertension Society Protocol. Blood Press Monit 2007; 12:51-55. This automated oscillometric blood pressure device intended for hospital use was validated according to the protocol of the British Hypertension Society. Nine sequential same-arm measurements, alternating between observer and device, were taken from each patient. The monitor achieved an A grade for both systolic and diastolic pressures and thus it can be recommended for clinical use in an adult population.
32. Malin G, Bell SC, Waugh JJS. Random albumin/creatinine ratio for quantification of proteinuria in manifest preeclampsia. BJOG 2007; 114:118-119. This small prospective study of 17 women demonstrated that there is considerable variation in protein excretion throughout the 24-h period, confirming the findings of previous studies regarding inaccuracies of visual dipstick testing, while showing that random albumin/creatinine ratio testing has a high sensitivity, specificity, positive and negative predictive value for the diagnosis of proteinuria in women at risk of preeclampsia.
33. Waugh JJS, Bell SC, Kilby MD, et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy. BJOG 2005; 112:412-417.
34. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ 1994; 309:1395-1400.
35. Magpie Trial Follow-up Study Collaborative Group. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for preeclampsia. Outcome for women at 2 years. BJOG 2007; 114:300-309. This study assessed women recruited to the Magpie Trial, which compared magnesium sulphate with placebo for preeclampsia, at 2-3 years after delivery; 3.5% of women allocated to magnesium sulphate died or had serious morbidity potentially related to preeclampsia compared with 4.2% women allocated placebo (RR 0.84, 95% CI 0.60-1.18).
36. Magpie Trial Follow-up Study Collaborative Group. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for preeclampsia. Outcome for children at 18 months. BJOG 2007; 114:289-299. This study assessed children at 18 months of age whose mothers were recruited to the Magpie Trial, which compared magnesium sulphate with placebo for preeclampsia. Of those allocated magnesium sulphate, 15% were dead or had neurosensory disability compared with 14.1% allocated placebo (RR 1.06; 95% CI 0.90-1.25), and of the survivors, 1.3% had neurosensory disability at 18 months compared with 1.9% (RR 0.72; CI 0.40-1.29).
37. Tuffnell DJ, Shennan AH, Waugh JJS, et al. The management of severe preeclampsia/eclampsia. Guideline no. 10(A). London: RCOG Press; 2006 .
38. Abalos E, Duley L, Steyn DW, et al. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2007; (1):CD002252. This systematic review included 46 trials (4282 women) of which 28 compared an antihypertensive drug with placebo and 19 compared one antihypertensive drug with another. The authors concluded that it remains unclear whether antihypertensive drug therapy for mild to moderate hypertension during pregnancy is worthwhile.
39. Bellamy L, Casas JP, Hingorami AD, et al. Preeclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335:974. This systematic review and meta-analysis included prospective and retrospective cohort studies (over 3.4 million women) to quantify the risk of future cardiovascular diseases, cancer and mortality after preeclampsia. Preeclampsia was associated with an increased long-term risk of hypertension, heart disease, stroke and venous thromboembolism but not of cancer.
40. Magee L, von Dadelszen P. Preeclampsia and increased cardiovascular risk. BMJ 2007; 335:945-946. This was the accompanying editorial to the study by Bellamy and colleagues highlighting that future research must investigate whether targeting these women identifies a population that is more amenable to lifestyle changes or one that requires earlier treatment of inherent cardiovascular risk factors.