Pre-Eclampsia – ABC CARDIOL

ABC

Research Letter

Hypertension in Pregnancy: From Guidelines to the Cardiologist's Clinical Practice

Introduction

The Brazilian Guidelines of Hypertension– 2025 of the Brazilian Society of Cardiology objectively address hypertension during pregnancy, dedicating a specific chapter to the topic. The document covers diagnostic definitions, strategies for the prediction and prevention of preeclampsia, therapeutic management during pregnancy and the postpartum period as well as the assessment of future cardiovascular risk associated with hypertensive disorders of pregnancy (HDPs).

In the international setting, the 2025 European Society of Cardiology (ESC) Guidelines for the Management of Cardiovascular Disease During Pregnancy provide detailed algorithms for proteinuria assessment, emergency management, and the treatment of hypertension and preeclampsia. Their recommendations are based predominantly on expert consensus, reflecting the scarcity of randomized clinical trials in this field.

[…]

Read Full Article

ABC

Original Article

Risk Factors Associated with Preeclampsia and Their Impact on Maternal and Neonatal Morbidity and Mortality in the Dominican Republic

Patricia Severino et al. Fulgencio Severino Rosa Cueto

Abstract

Background

Hypertensive disorders of pregnancy complicate 5%-10% of pregnancies and account for 23%-38% of maternal deaths in the Dominican Republic.

Objective

To identify factors associated with the development of preeclampsia and evaluate their relationship with maternal and perinatal morbidity and mortality.

Methods

This multicenter, prospective, observational, cross-sectional, analytical study included 469 parturients from 17 hospitals across the Dominican Republic over a 30-day period. Statistical significance was set at p < 0.05.

Results

Preeclampsia was significantly associated with chronic hypertension (44.15% vs 16.87%; odds ratio [OR], 3.91; 95%CI, 2.51-6.09), previous preeclampsia (44.64% vs 18.60%; OR, 3.53; 95%CI, 2.24-5.56), and a family history of preeclampsia (42.0% vs 19.38%; OR, 3.01; 95%CI, 1.96-4.62). Preeclampsia was also associated with prematurity (54.6% vs 33.4%; OR, 2.40; 95%CI, 1.62-3.55), low birth weight (37.6% vs 18.5%; OR, 2.65; 95%CI, 1.73-4.07), and placental abruption (5.0% vs 2.4%; OR, 2.14; 95%CI, 0.81-5.62). Maternal and fetal mortality were not significantly associated with preeclampsia. In the multivariable logistic regression analysis, chronic hypertension (adjusted OR [AOR], 3.64; 95%CI, 2.25–5.88), a family history of preeclampsia (AOR, 2.86; 95%CI, 1.85-4.42), and pregestational obesity (AOR, 2.26; 95%CI, 1.52-3.36) emerged as independent predictors of preeclampsia (all p < 0.05).

Conclusion

Preeclampsia is associated with an increased risk of adverse maternal and neonatal outcomes, particularly prematurity and low birth weight.

Read Full Article

ABC

Editorial

Short Editorial: Hydrotherapy Reduces Arterial Stiffness in Pregnant Women with Chronic Hypertension

Celso Amodeo

Increased pulse pressure is associated with aging. This is mainly caused by increased systolic pressure, but also by decreased diastolic pressure. Diastolic blood pressure below 50 mmHg has been related to increased cardiovascular risk.

With the development of devices that allow the indirect estimation of central pressure from the aortic root and analysis of arterial stiffness (another marker of cardiovascular risk), many studies have shown that changes in vascular dynamics are detected earlier using central measurements compared with peripheral blood pressure measurements.

[…]

Read Full Article

ABC

Original Article

Hydrotherapy Reduces Arterial Stiffness in Pregnant Women With Chronic Hypertension

Giovana Macêdo Linhares et al. Antonio Vieira Machado Marcus Vinícius Bolívar Malachias

Abstract

Background

Chronic hypertension (CH) and high arterial stiffness (AS) increase the risk of complications during pregnancy, such as superimposed preeclampsia and low fetal growth.

Objective

To evaluate the impact of hydrotherapy, a non-pharmacological treatment strategy, on AS in pregnant women with CH.

Methods

Cross-sectional study evaluating the effect of a standardized hydrotherapy session on AS in pregnant women with CH and controls. We used the device Mobil-O-Graph® NG to measure blood pressure (BP), heart rate (HR), and AS before and after a hydrotherapy session involving stretching, warming up, strengthening, and relaxation. The level of significance adopted in the statistical analyses was 5%.

Results

We evaluated 36 pregnant women, including 12 with hypertension (HG) and 24 controls (CG), aged 30.4 ± 4.8 years and at 29.2 ± 3.3 gestational weeks. Hydrotherapy promoted in both groups a significant reduction in AS assessed by the augmentation index at a HR of 75 bpm (AIx@75) (HG: 28.8 ± 7.3%, before; 22.4 ± 6.9%, after; p = 0.024; and CG: 29.1 ± 7.4%, before; 22.9 ± 6.6%, after; p = 0.001), as well as a reduction in HR (HG: 93.4 ± 11.8 bpm, before; 82.4 ± 10.0 bpm, after; p < 0.001; and CG: 91.4 ± 13.4 bpm, before; 81.5 ± 12.6 bpm, after; p < 0.001), but a nonsignificant reduction in BP.

Conclusion

We demonstrated that a hydrotherapy session acutely reduces AS assessed by AIx@75, and may represent a potential non-pharmacological strategy to prevent maternal and fetal complications in pregnant women with CH. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Read Full Article

ABC

Original Article

Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas

Alane Cabral Menezes de Oliveira et al. Arianne Albuquerque Santos Alexandra Rodrigues Bezerra Amanda Maria Rocha de Barros Myrian Cicyanne Machado Tavares

Abstract

Background:

Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations.

Objective:

To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió.

Methods:

Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant.

Results:

We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 – 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 – 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery.

Conclusion:

Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.

Read Full Article

ABC

Artigo Original

Endothelial function, uterine perfusion and central Flow in pregnancies complicated by Preeclampsia

Augusto Henriques Fulgêncio Brandão et al. Marcelo Araújo Cabral Henrique Vitor Leite Antônio Carlos Vieira Cabral

BACKGROUND: The physiopathology of Preeclampsia (PE) is characterized by a deficiency in the process of placentation, systemic endothelial dysfunction and Central Nervous System (CNS) hyperflow. From a clinical point of view, it would be interesting to determine the occurrence of these phenomena before the onset of clinical manifestations of the disease, raising the possibility of new methods for predicting PE. OBJECTIVE:Compare the process of placentation, endothelial function and CNS hyperflow in pregnant women at high risk for the development of PE who subsequently developed or not the syndrome. METHODS: A total of 74 pregnant women underwent the Flow-Mediated Dilation (FMD) of the brachial artery, Doppler study of uterine and ophthalmic arteries for the assessment of endothelial function, process of placentation and central hyperflow, respectively. The examinations were performed between 24 and 28 weeks of gestation and were followed until the postpartum period for data collection. RESULTS: Fifteen patients had PE and 59 remained normotensive until the puerperium. Patients who subsequently developed PE had between 24 and 28 weeks of gestation, higher pulsatility index of uterine arteries and lower values of FMD (p < 0.001 and p = 0.001, respectively). However, there was no difference in the values obtained in the resistive index in the ophthalmic artery (p = 0.08). CONCLUSION: The data obtained suggest that the deficiency in the process of placentation and endothelial dysfunction chronologically precede the clinical manifestations of PE, which does not occur with CNS hyperflow.

Read Full Article