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Latest & greatest articles for preeclampsia
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The effect of recurrent miscarriage and infertility on the risk of pre-eclampsiaPre-eclampsia, recurrent miscarriage and infertility may all partly be caused by unsuccessful placentation early in pregnancy. If so, one will expect these disorders to be associated in population studies. The aim of the present investigation was to estimate the risk of pre-eclampsia in women with recurrent miscarriage and infertility.Cohort study.The Norwegian Mother and Child Cohort Study (MoBa), a large (...) population-based pregnancy cohort.The sample consisted of 20,846 singleton pregnancies to nulliparous women participating in the MoBa, 1999-2005.Information on miscarriage, infertility and potential confounders was self-reported in postal questionnaires, whereas the diagnosis of pre-eclampsia was retrieved from the Medical Birth Registry of Norway. Risk estimation and confounder control was performed with multiple logistic regression.Pre-eclampsia according to history of miscarriage and infertility.An
Does leisure time physical activity in early pregnancy protect against pre-eclampsia? Prospective cohort in Danish women To examine the association between physical activity in early pregnancy and risk of pre-eclampsia.Prospective cohort.Denmark.A total of 85,139 pregnant Danish women, recruited between 1996 and 2002.The authors assessed leisure time physical activity in first trimester by a telephone interview and categorised women a priori into seven groups: 0 (reference), 1-44, 45-74, 75-149 (...) , 150-269, 270-419 and 420+ minutes/week. Pre-eclampsia diagnoses were extracted from the Danish National Patient Registry. A number of potential confounders were adjusted for by logistic regression.Pre-eclampsia and severe pre-eclampsia.The two highest physical activity levels were associated with increased risk of severe pre-eclampsia compared with the nonexercising group, with adjusted odds ratios of 1.65 (95% CI: 1.11-2.43) and 1.78 (95% CI: 1.07-2.95), whereas more moderate levels of physical
and preeclampsia with respect to preterm delivery and birth weight; smokers who developed preeclampsia had a lower risk of preterm delivery, and a lower adjusted mean difference in birth weight, than would have been expected based on the independent effects of smoking and preeclampsia. These data suggest that smoking is only protective against preeclampsia without pre gestational hypertension, and even then principally among younger women. Additionally, smokers who develop these disorders have no increased (...) Maternal smoking, preeclampsia, and infant health outcomes in New York City, 1995-2003 A number of previous studies have reported an inverse association between maternal smoking and preeclampsia. Additionally, some have suggested that smokers who develop preeclampsia have worse maternal and fetal outcomes than nonsmokers who develop preeclampsia. The authors examined the relation of smoking to preeclampsia among 674,250 singleton pregnancies in New York City between 1995 and 2003. Although
Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce. We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity.We undertook a multicentre (...) , parallel, open-label randomised controlled trial in six academic and 32 non-academic hospitals in the Netherlands between October, 2005, and March, 2008. We enrolled patients with a singleton pregnancy at 36-41 weeks' gestation, and who had gestational hypertension or mild pre-eclampsia. Participants were randomly allocated in a 1:1 ratio by block randomisation with a web-based application system to receive either induction of labour or expectant monitoring. Masking of intervention allocation
2009LancetControlled trial quality: predicted high
: a systematic review and meta-analysis Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Giguere Y CRD summary The authors concluded that low-dose acetylsalicylic acid treatment initiated early in pregnancy reduced the incidence of pre-eclampsia and its consequences in women with ultrasonographic evidence of abnormal placentation. The findings reflected the evidence, but as acknowledged by the authors they were limited by a lack of studies and the small numbers of women recruited at less than 20 weeks (...) ' gestation. Authors' objectives To assess the influence of gestational age at the time of introduction of low-dose acetylsalicylic acid (ASA) on the incidence of pre-eclampsia and intrauterine growth restriction (IUGR) in women at increased risk on the basis of abnormal uterine artery Doppler. Searching MEDLINE, EMBASE and The Cochrane Library were searched without language restrictions from 1965 to 2008. Search terms were reported. Bibliographies of recent two meta-analyses were handsearched
Expectant management of severe preeclampsia remote from term: a structured systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Correlation of catheterized and clean catch urine protein/creatinine ratios in preeclampsia evaluation To examine whether clean catch urine specimens correlate with catheterized specimens for determination of protein/creatinine ratios in pregnant women being evaluated for preeclampsia.Sixty pregnant women who were at least at 20 weeks of gestation were enrolled. Patients with ruptured membranes, vaginal bleeding, or urinary tract infections were excluded. Midstream clean catch urine specimens (...) , with a correlation coefficient of 0.897 (P<.001). When results were categorized by degree of proteinuria using a cutoff of 0.3, sensitivity and specificity of the clean catch protein/creatinine ratios were 95.2% and 97.4%. When using a more conservative cutoff of 0.19, sensitivity and specificity of the clean catch protein/creatinine ratios were 96.4% and 75.0%.Clean catch and catheterized urine specimens correlate well in women with suspected preeclampsia. Routine catheterization of pregnant women
Interactions between smoking and weight in pregnancies complicated by preeclampsia and small-for-gestational-age birth Cigarette smoking protects against preeclampsia but increases the risk of small-for-gestational-age birth (SGA). Regarding body weight, the converse is true: obesity elevates rates of preeclampsia but reduces rates of SGA. The authors assessed the combined effects of smoking and weight among US women developing preeclampsia or SGA, studying 7,757 healthy, primigravid women (...) with singleton pregnancies in 1959-1965. Smoking (never, light, heavy), stratified by prepregnancy body mass index (BMI (weight (kg)/height (m)(2)); underweight, overweight, obese), was examined in relation to preeclampsia and SGA. Among underweight (BMI <18.5) and normal-weight (BMI 18.5-24.9) women, smoking decreased the risk of preeclampsia (for heavy smoking, light smoking, nonsmoking, test for trend p = 0.002 for underweight and p = 0.009 for normal weight) after adjustment for age, race
Preeclampsia and the Risk of End-Stage Renal Disease. It is unknown whether preeclampsia is a risk marker for subsequent end-stage renal disease (ESRD).We linked data from the Medical Birth Registry of Norway, which contains data on all births in Norway since 1967, with data from the Norwegian Renal Registry, which contains data on all patients receiving a diagnosis of end-stage renal disease (ESRD) since 1980, to assess the association between preeclampsia in one or more pregnancies (...) and the subsequent development of ESRD. The study population consisted of women who had had a first singleton birth between 1967 and 1991; we included data from up to three pregnancies.ESRD developed in 477 of 570,433 women a mean (+/-SD) of 17+/-9 years after the first pregnancy (overall rate, 3.7 per 100,000 women per year). Among women who had been pregnant one or more times, preeclampsia during the first pregnancy was associated with a relative risk of ESRD of 4.7 (95% confidence interval [CI], 3.6 to 6.1
Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis Cnossen J S, Vollebregt K C, de Vrieze N, ter Riet G, Mol B W, Franx A, Khan K S, van der Post J A CRD (...) summary This review concluded that when blood-pressure is measured in the first or second trimester, the mean arterial pressure is a better predictor for pre-eclampsia than systolic or diastolic blood-pressure, or an increased blood-pressure. The authors acknowledged the limitations of the evidence available. However, this was a generally well-conducted review and the results seem reliable. Authors' objectives To evaluate the accuracy of systolic and diastolic blood-pressure (BP), mean arterial
Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, ter Riet G, Duley L, et al Record (...) Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, ter Riet G, Duley L, et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling. Southampton: NIHR Health Technology Assessment programme. Health Technology Assessment
Alternative complement pathway activation fragment Bb in early pregnancy as a predictor of preeclampsiaPreeclampsia is a multisystem disease classically defined on the basis of hypertension and proteinuria. As shown in animal studies, complement activation is associated with inflammation in the placenta and adverse pregnancy outcomes. The association between complement activation in humans and adverse pregnancy outcomes is unclear. The purpose of this study was to determine whether elevated (...) levels of the activation fragment Bb in early pregnancy are predictive of preeclampsia.This prospective study of 701 women was conducted in Denver, CO. A single plasma sample was obtained from each woman before 20 weeks' gestation. The cohort was followed up throughout pregnancy for the development of preeclampsia. Analysis included multivariate logistic regression to adjust for established risk factors for preeclampsia.Preeclampsia developed in 4.6% of the cohort. Women with elevated Bb (90th
Antioxidant Therapy to Prevent Preeclampsia: A Randomized Controlled Trial. OBJECTIVE: To study whether antioxidant supplementation will reduce the incidence of preeclampsia among patients at increased risk. METHODS: A randomized, placebo-controlled, double-blind clinical trial was conducted at four Brazilian sites. Women between 12 0/7 weeks and 19 6/7 weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomly assigned to daily treatment (...) with both vitamin C (1,000 mg) and vitamin E (400 International Units) or placebo. Analyses were adjusted for clinical site and risk group (prior preeclampsia, chronic hypertension, or both). A sample size of 734 would provide 80% power to detect a 40% reduction in the risk of preeclampsia, assuming a placebo group rate of 21% and alpha=.05. The alpha level for the final analysis, adjusted for interim looks, was 0.0458. RESULTS: Outcome data for 707 of 739 randomly assigned patients revealed
Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study. To examine the effect of cardiovascular risk factors before pregnancy on risk of pre-eclampsia.Population based prospective study.Linkage between a Norwegian population based study (Nord-Trøndelag health study, HUNT-2) and Norway's medical birth registry.3494 women who gave birth after participating in the Nord-Trøndelag health study at baseline; of whom 133 (3.8%) delivered after a pre (...) -eclamptic pregnancy.Odds ratio of developing pre-eclampsia.After adjustment for smoking; previous pre-eclampsia; parity; maternal age, education, and socioeconomic position; and duration between baseline measurements and delivery, positive associations were found between prepregnancy serum levels of triglycerides, cholesterol, low density lipoprotein cholesterol, non-high density lipoprotein cholesterol, and blood pressure and risk of pre-eclampsia. The odds ratio of developing pre-eclampsia for women
WITHDRAWN: Antiplatelet agents for preventing and treating pre-eclampsia. Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a platelet-derived vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, and low dose aspirin in particular, might prevent or delay the development of pre-eclampsia.To assess the effectiveness and safety (...) of antiplatelet agents when given to women at risk of developing pre-eclampsia, and to those with established pre-eclampsia.This review drew on the search strategy developed for the Pregnancy and Childbirth Group as a whole. The Cochrane Controlled Trials Register was also searched, The Cochrane Library 1999 Issue 1, Embase was searched from 1994-1999 and hand searches were performed of the congress proceedings of the International and European Societies for the Study of Hypertension in Pregnancy.All
Low-dose dopamine for women with severe pre-eclampsia. Hypertensive disorders during pregnancy are important causes of maternal mortality and morbidity worldwide. The long-term outcome of surviving mothers will depend largely on whether intracranial haemorrhage or renal failure developed. Low-dose dopamine is used for the prevention and treatment of acute renal failure, but its role in the management of pregnant women with severe pre-eclampsia is unclear.To assess the effects of low-dose (...) dopamine used for oliguria in severe pre-eclampsia on mothers and their children.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2006).Randomised trials comparing low-dose dopamine (dosages not higher than 5 microgram/kg/minute) with either placebo or no dopamine in women with severe pre-eclampsia and acute renal failure, or who are considered to be at risk of acute renal failure.The two review authors assessed trial quality and data independently.Only one randomised
Diuretics for preventing pre-eclampsia. Diuretics are used to reduce blood pressure and oedema in non-pregnant individuals. Formerly, they were used in pregnancy with the aim of preventing or delaying the development of pre-eclampsia. This practice became controversial when concerns were raised that diuretics may further reduce plasma volume in women with pre-eclampsia, thereby increasing the risk of adverse effects on the mother and baby, particularly fetal growth.To assess the effects (...) of diuretics on prevention of pre-eclampsia and its complications.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 2) and EMBASE (2002 to April 2005).Randomised trials evaluating the effects of diuretics for preventing pre-eclampsia and its complications.Three review authors independently selected trials for inclusion and extracted data. We analysed and double checked data