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O22. Secondary preventive interventions of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation
Lectures / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 1 (2011) 238–272
O21. Total vascular resistance and multigate spectral doppler analysis (MSDA) as a screening tool for preeclampsia: A pilot study G.M. Tiralongo a, I. Pisani a, G. Gagliardi a, R.L. Scala a, B. Vasapollo a, G.P. Novelli c, G. Urban b, H. Valensise a (a Department of Obstetrics and Gynaecology, Tor Vergata University, Rome, b Department of Obstetrics and Gynaecology, Desio Hospital, Milan, c Ospedale di Frascati vedi tu)
A.PI < 1.5 B.PI > 1.5
267
in 19% of group A compared with the 18% of the group B. TVR values more than 1200 dyne, without MSDA profile alterations, are found in 6% of group A compared with 9% of the group B. Moreover, in group A no patients shows both TVR and flow profile alterations but, in the group B, 9% of pregnants shows both TVR and flow profile alterations. Conclusions: Even if observed in a small study population, our data confirms that uterine artery Doppler velocimetry can be usefully integrated with new important parameters
QDP N+TVR N
QDP P+TVR N
QDP N+TVR P
QDP P+TVR P
75% (27) 63% (19)
19% (7) 18% (6)
6% (2) 9% (3)
0%(0) 9% (3)
Aim of the study: Comparison between uterine artery Doppler, realized with traditional method and Multigate Spectral Doppler Analysis (MSDA), and Total Vascular Resistance (TVR), obtained with ultrasonic cardiac output monitor USCOM, in a population of healthy priimgravidae at 22–24 weeks of gestation. The study tries to identificate a normal/abnormal Z flow profile with MSDA associated with high or borderline TVR values in patients with abnormal uterine artery Doppler. This can allow us to select a group of patients with high risk of preeclampsia. Methods: A prospective observational study was conducted. 27 healthy pregnant women at 22–24 weeks of gestation were enrolled. For all patients uterine artery doppler measurements were performed using traditional method (PI and RI) and with Multigate Spectral Doppler Analysis that analyze the flow profile in the third dimension (Z-axis). During the same exame, TVR were collected for all patients with a non invasive ultrasonographic method (USCOM Spacelabs monitor). Results: After processing uterine artery Doppler measeurements, patients were divided into two groups: Group A, 36 patients with normal uterine artery resistance values and Group B, 31 patients with high uterine artery resistance values. At the same time, it was evaluate the features of the flow profile obtained with MSDA and classified in: t0 (laminar flow), t1 (least turbulent flow) and t2 (strongly turbulent flow) according to vessel wall’s tension. Results are shown in the table. Results of our pilot study shows that normal QDP profile with normal TVR values are observed in 75% of group A compared with 63% of group B. MSDA profile alterations (flow t1/t1 or at least flow t2) with normal TVR are present
such as flow profile in the third dimension and TVR. This association could bring to a significant lower false positive percentage and, on the other hand, it could allow the identification of failed placentation process early signs and so improve clinical management and plan strict checks for higher risk pregnants. doi:10.1016/j.preghy.2011.08.053
MANAGEMENT AND RECOMMENDATIONS O22. Secondary preventive interventions of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation F.v. Kesteren a, V.S. Visser b, W. Hermes c, A. Franx d, K.W.M. Bloemenkamp c, M.G.v. Pampus e, B.W. Mol f, C.J.M. deGroot g (a Obstetrics and Gynaecology, LUMC, Leiden, VUMC, Amsterdam, b Obstetrics and Gynaecology, MCHaaglanden, The Hague, c Obstetrics and Gynaecology, LUMC, Leiden, d Obstetrics and Gynaecology, UMCU, Utrecht, e Obstetrics and Gynaecology, OLVG, Amsterdam, f Obstetrics and Gynaecology, AMC, Amsterdam, g Obstetrics and Gynaecology, VUMC, Amsterdam) Objectives: Recently hypertensive disorders at term have been associated with cardiovascular disease (CVD) later in life. Overall, there is no consensus on follow up or interventions for (secondary) prevention of CVD for women who had hypertensive disorders during pregnancy. Therefore we analysed medical and lifestyle inter-
268
Lectures / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 1 (2011) 238–272
ventions in women with known increased cardiovascular risk after pregnancy complicated by hypertension versus controls. Methods: Women, with previous preeclampsia(PE) or gestational hypertension (GH) at term defined according to the ISHHP (cases) and a control group with history of uncomplicated pregnancy were included in a follow up study (Hyras).They were analyzed 212 years after index pregnancy for established modifiable cardiovascular risk factors including blood pressure, body mass index (BMI) and glucose- and lipid profile. After informed consent women and their general practitioners were informed about the risk status. A year after informing women about the follow up results, they were invited for a questionnaire concerning tailored made interventions of the risk factors (312 years post partum (pp)). BMI reduction was defined as at least 5%.We used SPSS 18.0 unpaired T-test and ANOVA as appropriate for analysis. Results: Questionnaires were completed by 243 cases (81%) and 78 controls (76%) 312 years pp. Of 86 women informed about an increased risk status about hypertension, 36% (31/86) used antihypertensive medication 312 years pp. 1 woman used antihypertensive medication while she was normotensive 212 years pp. 182 women (141 cases and 41 controls) had BMI > 25 at 212 years follow up; at 312 years follow up 19% (34/182) had achieved BMI. BMI reduction was not significantly different between cases and controls (RR = .75 [CI: 0.33–1.68]) At 212 years follow up 62 women smoked (44 cases and 16 controls); at 312 years follow up, 39% (24/62) stopped smoking. Smoking cessation rates did not differ statistically significant between cases and controls (RR = 0.49 [CI: 0.19–1.23]).
Baseline and outcome characteristics of 212 years and 312 years post partum (current study). Characteristics
Controls
Cases: GH
(N = 78)
and PE (N = 243)
Pvalue
Hypertension (n, %)
1 (1%)
85 (35%)
<0.001
Abnormal glucose or
22 (28%)
92 (38%)
0.16
BMI 25 (n, %)
41 (53%)
141 (58%)
0.51
Smoking (n, %)
16 (21%)
44 (18%)
0.64
212
years post partum
lipids level (n, %)
312 years post partum (current study) Age at follow up
35 (31–38)
36 (33-39)
0.38
Primiparous (n, %)
14 (18%)
68 (28%)
0.08
Antihypertensive
0 (0%)
32 (13%)
0.001
23.2 (21.9–25.1)
26.3 (23.7–29.7)
<0.001
14 (18%)
25 (10%)
0.07
31 (40%)
92 (38%)
0.77
(years)
medication (n, %) BMI at follow up (kg/m2) Smoking at follow up (n, %) Physical active (>150 min/week)
Of the 199 women who smoked or had a BMI > 25 at 212 years follow up, 55 (28%)stopped smoking and/or had a BMI reduction after one year; corresponding with 30% of cases (45/152) and 21% of controls (10/47); lifestyle interventions were not significantly different between cases and controls (RR = .72 [CI: 0.39–1.31]). Conclusion: Women with hypertensive disorders in pregnancy have increased risk factors of CVD. Only 37% of women with previous hypertensive disorders during pregnancy and hypertension 212 years post partum were treated appropriately after one year. Only 30% had adequate lifestyle interventions. These data support the need for awareness for tailored made intervention programs for secondary prevention of CVD after hypertensive disorders during pregnancy. Secondary preventive interventions of cardiovascular risk. Intervention/risk factor
Controls % (ni/nr)*
Cases: GH and PE% (n / n )*
Pvalue
0% (0/1)
37% (31/85)
.46
15% (6/41)
20% (28/141)
.48
25% (4/16)
46% (20/44)
0.09
i
r
312 years post partum Antihypertensive medication used (ni) by women with hypertension** (nr) BMI reduction 5% (ni) of women with BMI 25** (n ) r
Smoking cessation (ni) of women smoking**(nr) *n = number of women with intervention, n = number of women with risk i r factor **at 212 years follow up
doi:10.1016/j.preghy.2011.08.054
O23. Effects of S-nitrosoglutathione (GSNO) on arterial stiffness in severe early-onset preeclampsia Thomas R. Everett a, Amita A. Mahendru a, Ian B. Wilkinson b, Christoph C. Lees a (a Department of Fetal Medicine, Box 228, Addenbrooke’s Hospital, Cambridge, UK, b Clinical Pharmacology, Addenbrooke’s Hospital, Cambridge, UK) Objectives: Current management of severe early–onset preeclampsia primarily involves controlling hypertension, seizure prevention and delivery of the fetus and placenta. S-nitrosoglutathione, an endogenous nitric oxide donor has previous been used to treat preeclampsia. Arterial stiffness increases with endothelial dysfunction and can be measured non-invasively using pulse wave analysis. We performed dose-ranging studies to determine the dose at which optimal reduction in arterial stiffness occurred whilst maintaining a safe blood pressure. Methods: 3 women with severe preeclampsia were infused with S-nitrosoglutathione. Age range: 20–39 years, Gestation range: 25+2–30+6. Intravenous infusion of GSNO
O21. Total vascular resistance and multigate spectral doppler analysis (MSDA) as a screening tool for preeclampsia: A pilot study G.M. Tiralongo a, I. Pisani a, G. Gagliardi a, R.L. Scala a, B. Vasapollo a, G.P. Novelli c, G. Urban b, H. Valensise a (a Department of Obstetrics and Gynaecology, Tor Vergata University, Rome, b Department of Obstetrics and Gynaecology, Desio Hospital, Milan, c Ospedale di Frascati vedi tu)
A.PI < 1.5 B.PI > 1.5
267
in 19% of group A compared with the 18% of the group B. TVR values more than 1200 dyne, without MSDA profile alterations, are found in 6% of group A compared with 9% of the group B. Moreover, in group A no patients shows both TVR and flow profile alterations but, in the group B, 9% of pregnants shows both TVR and flow profile alterations. Conclusions: Even if observed in a small study population, our data confirms that uterine artery Doppler velocimetry can be usefully integrated with new important parameters
QDP N+TVR N
QDP P+TVR N
QDP N+TVR P
QDP P+TVR P
75% (27) 63% (19)
19% (7) 18% (6)
6% (2) 9% (3)
0%(0) 9% (3)
Aim of the study: Comparison between uterine artery Doppler, realized with traditional method and Multigate Spectral Doppler Analysis (MSDA), and Total Vascular Resistance (TVR), obtained with ultrasonic cardiac output monitor USCOM, in a population of healthy priimgravidae at 22–24 weeks of gestation. The study tries to identificate a normal/abnormal Z flow profile with MSDA associated with high or borderline TVR values in patients with abnormal uterine artery Doppler. This can allow us to select a group of patients with high risk of preeclampsia. Methods: A prospective observational study was conducted. 27 healthy pregnant women at 22–24 weeks of gestation were enrolled. For all patients uterine artery doppler measurements were performed using traditional method (PI and RI) and with Multigate Spectral Doppler Analysis that analyze the flow profile in the third dimension (Z-axis). During the same exame, TVR were collected for all patients with a non invasive ultrasonographic method (USCOM Spacelabs monitor). Results: After processing uterine artery Doppler measeurements, patients were divided into two groups: Group A, 36 patients with normal uterine artery resistance values and Group B, 31 patients with high uterine artery resistance values. At the same time, it was evaluate the features of the flow profile obtained with MSDA and classified in: t0 (laminar flow), t1 (least turbulent flow) and t2 (strongly turbulent flow) according to vessel wall’s tension. Results are shown in the table. Results of our pilot study shows that normal QDP profile with normal TVR values are observed in 75% of group A compared with 63% of group B. MSDA profile alterations (flow t1/t1 or at least flow t2) with normal TVR are present
such as flow profile in the third dimension and TVR. This association could bring to a significant lower false positive percentage and, on the other hand, it could allow the identification of failed placentation process early signs and so improve clinical management and plan strict checks for higher risk pregnants. doi:10.1016/j.preghy.2011.08.053
MANAGEMENT AND RECOMMENDATIONS O22. Secondary preventive interventions of cardiovascular risk in women who had hypertension during pregnancy after 36 weeks gestation F.v. Kesteren a, V.S. Visser b, W. Hermes c, A. Franx d, K.W.M. Bloemenkamp c, M.G.v. Pampus e, B.W. Mol f, C.J.M. deGroot g (a Obstetrics and Gynaecology, LUMC, Leiden, VUMC, Amsterdam, b Obstetrics and Gynaecology, MCHaaglanden, The Hague, c Obstetrics and Gynaecology, LUMC, Leiden, d Obstetrics and Gynaecology, UMCU, Utrecht, e Obstetrics and Gynaecology, OLVG, Amsterdam, f Obstetrics and Gynaecology, AMC, Amsterdam, g Obstetrics and Gynaecology, VUMC, Amsterdam) Objectives: Recently hypertensive disorders at term have been associated with cardiovascular disease (CVD) later in life. Overall, there is no consensus on follow up or interventions for (secondary) prevention of CVD for women who had hypertensive disorders during pregnancy. Therefore we analysed medical and lifestyle inter-
268
Lectures / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 1 (2011) 238–272
ventions in women with known increased cardiovascular risk after pregnancy complicated by hypertension versus controls. Methods: Women, with previous preeclampsia(PE) or gestational hypertension (GH) at term defined according to the ISHHP (cases) and a control group with history of uncomplicated pregnancy were included in a follow up study (Hyras).They were analyzed 212 years after index pregnancy for established modifiable cardiovascular risk factors including blood pressure, body mass index (BMI) and glucose- and lipid profile. After informed consent women and their general practitioners were informed about the risk status. A year after informing women about the follow up results, they were invited for a questionnaire concerning tailored made interventions of the risk factors (312 years post partum (pp)). BMI reduction was defined as at least 5%.We used SPSS 18.0 unpaired T-test and ANOVA as appropriate for analysis. Results: Questionnaires were completed by 243 cases (81%) and 78 controls (76%) 312 years pp. Of 86 women informed about an increased risk status about hypertension, 36% (31/86) used antihypertensive medication 312 years pp. 1 woman used antihypertensive medication while she was normotensive 212 years pp. 182 women (141 cases and 41 controls) had BMI > 25 at 212 years follow up; at 312 years follow up 19% (34/182) had achieved BMI. BMI reduction was not significantly different between cases and controls (RR = .75 [CI: 0.33–1.68]) At 212 years follow up 62 women smoked (44 cases and 16 controls); at 312 years follow up, 39% (24/62) stopped smoking. Smoking cessation rates did not differ statistically significant between cases and controls (RR = 0.49 [CI: 0.19–1.23]).
Baseline and outcome characteristics of 212 years and 312 years post partum (current study). Characteristics
Controls
Cases: GH
(N = 78)
and PE (N = 243)
Pvalue
Hypertension (n, %)
1 (1%)
85 (35%)
<0.001
Abnormal glucose or
22 (28%)
92 (38%)
0.16
BMI 25 (n, %)
41 (53%)
141 (58%)
0.51
Smoking (n, %)
16 (21%)
44 (18%)
0.64
212
years post partum
lipids level (n, %)
312 years post partum (current study) Age at follow up
35 (31–38)
36 (33-39)
0.38
Primiparous (n, %)
14 (18%)
68 (28%)
0.08
Antihypertensive
0 (0%)
32 (13%)
0.001
23.2 (21.9–25.1)
26.3 (23.7–29.7)
<0.001
14 (18%)
25 (10%)
0.07
31 (40%)
92 (38%)
0.77
(years)
medication (n, %) BMI at follow up (kg/m2) Smoking at follow up (n, %) Physical active (>150 min/week)
Of the 199 women who smoked or had a BMI > 25 at 212 years follow up, 55 (28%)stopped smoking and/or had a BMI reduction after one year; corresponding with 30% of cases (45/152) and 21% of controls (10/47); lifestyle interventions were not significantly different between cases and controls (RR = .72 [CI: 0.39–1.31]). Conclusion: Women with hypertensive disorders in pregnancy have increased risk factors of CVD. Only 37% of women with previous hypertensive disorders during pregnancy and hypertension 212 years post partum were treated appropriately after one year. Only 30% had adequate lifestyle interventions. These data support the need for awareness for tailored made intervention programs for secondary prevention of CVD after hypertensive disorders during pregnancy. Secondary preventive interventions of cardiovascular risk. Intervention/risk factor
Controls % (ni/nr)*
Cases: GH and PE% (n / n )*
Pvalue
0% (0/1)
37% (31/85)
.46
15% (6/41)
20% (28/141)
.48
25% (4/16)
46% (20/44)
0.09
i
r
312 years post partum Antihypertensive medication used (ni) by women with hypertension** (nr) BMI reduction 5% (ni) of women with BMI 25** (n ) r
Smoking cessation (ni) of women smoking**(nr) *n = number of women with intervention, n = number of women with risk i r factor **at 212 years follow up
doi:10.1016/j.preghy.2011.08.054
O23. Effects of S-nitrosoglutathione (GSNO) on arterial stiffness in severe early-onset preeclampsia Thomas R. Everett a, Amita A. Mahendru a, Ian B. Wilkinson b, Christoph C. Lees a (a Department of Fetal Medicine, Box 228, Addenbrooke’s Hospital, Cambridge, UK, b Clinical Pharmacology, Addenbrooke’s Hospital, Cambridge, UK) Objectives: Current management of severe early–onset preeclampsia primarily involves controlling hypertension, seizure prevention and delivery of the fetus and placenta. S-nitrosoglutathione, an endogenous nitric oxide donor has previous been used to treat preeclampsia. Arterial stiffness increases with endothelial dysfunction and can be measured non-invasively using pulse wave analysis. We performed dose-ranging studies to determine the dose at which optimal reduction in arterial stiffness occurred whilst maintaining a safe blood pressure. Methods: 3 women with severe preeclampsia were infused with S-nitrosoglutathione. Age range: 20–39 years, Gestation range: 25+2–30+6. Intravenous infusion of GSNO