hypertension Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Article

    Obesity and cardiometabolic risk factors during pregnancy

    Rev Bras Ginecol Obstet. 2014;36(10):449-455

    Summary

    Original Article

    Obesity and cardiometabolic risk factors during pregnancy

    Rev Bras Ginecol Obstet. 2014;36(10):449-455

    DOI 10.1590/SO100-720320140004946

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    PURPOSE:

    To assess cardiometabolic risk factors during normal pregnancy and the influence of maternal obesity on them.

    METHODS:

    This study included 25 healthy pregnant women with a single pregnancy and a gestational age of less than twenty weeks. Longitudinal analysis of blood pressure, body weight, body mass index (BMI), serum concentrations of leptin, adiponectin, cortisol, total cholesterol and fractions, triglycerides, uric acid, fasting glucose, oral glucose tolerance test, HOMA-IR and insulin/glucose ratio was performed each trimester during pregnancy. In order to evaluate the impact of obesity, pregnant women were divided into two groups based on BMI for the first quarter of pregnancy: Gpn for pregnant women with BMI<25 kg/m2 and Gso for BMI≥25 kg/m2. One-Way ANOVA for repeated measurements or Friedman test and Student-t or Mann-Whitney tests for statistical comparisons and Pearson correlations test were used for statistical analysis.

    RESULTS:

    The mean values for the first quarter of pregnancy for the following parameters were: age: 22 years; weight: 66.3 kg and BMI 26.4 kg/m2, with 20.2 and 30.7 kg/m2 for the Gpn and Gso groups, respectively. Mean weight gain during pregnancy was ±12.7 kg with 10.3 kg for the Gso group and 15.2 kg for the Gpn group. Regarding plasma determinations, cortisol, uric acid and lipid profile increased during all trimesters of pregnancy, except for HDL-cholesterol, which did not change. Blood pressure, insulin and HOMA-IR only increased in the third quarter of pregnancy. The Gso group tended to gain more weight and to show higher concentrations of leptin, total cholesterol, LDL-cholesterol, VLDL-cholesterol, TG, glucose, insulin, HOMA-IR, besides lower HDL-cholesterol and greater diastolic blood pressure in the 3rdquarter of pregnancy. Three pregnant women developed gestational hypertension, presented prepregnancy obesity, excessive weight gain, hyperleptinemia and an insulin/glucose ratio greater than two. Weight and BMI were positively correlated with total cholesterol and its LDL fraction, TG, uric acid, fasting blood glucose, insulin and HOMA-IR; and were negatively correlated with adiponectin and HDL-cholesterol. Leptin level was positively correlated with blood pressure.

    CONCLUSIONS:

    The metabolic changes in pregnancy are more significant in obese women, suggesting, as expected, an increased risk of cardiometabolic complications. During their first visit for prenatal care, obese women should be informed about these risks, have their BMI and insulin/glucose ratio calculated along with their lipid profile to identify pregnant women at higher risk for cardiovascular diseases.

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  • Original Article

    Factors associated with mode of delivery in women with pre-eclampsia

    Rev Bras Ginecol Obstet. 2014;36(6):259-263

    Summary

    Original Article

    Factors associated with mode of delivery in women with pre-eclampsia

    Rev Bras Ginecol Obstet. 2014;36(6):259-263

    DOI 10.1590/S0100-720320140004812

    Views1

    PURPOSE:

    To analyze the factors related to route of delivery in patients with pre-eclampsia.

    METHODS:

    A retrospective analytical study was conducted from January 2009 to January 2011, during which 250 medical records of patients diagnosed with pre-eclampsia who gave birth to live fetuses with a gestational age of 28 weeks or more were selected. The variables evaluated were: maternal age (19 years, 20−34 years and over 35 full years), gestational age at delivery (28−37 weeks and more than 37 weeks), parity (primiparous or multiparous), previous cesarean section, history of pre-eclampsia or chronic hypertension, current diagnosis of mild or severe pre-eclampsia, and birth weight of the newborn. The information was transcribed to a questionnaire based on the variables being investigated. The chi-square test was applied to identify the relationship between the variables, with the level of significance set at p<0.05, and the Odds Ratio (OR) was calculated only for the variables showing a statistically significant difference in order to determine the odds for the patient to be submitted to a cesarean section.

    RESULTS:

    In this study, we observed a 78.4% rate of cesarean delivery, with 54.1% of the patients submitted to the procedure having a gestational age of 28 to 37 weeks (OR=3.1; p<0.01). Patients with a history of pre-eclampsia were 2.5 times more likely to have cesarean delivery (OR=2.5; p<0.02). All patients who had had a previous cesarean were submitted to cesarean delivery in the current pregnancy (p<0.01). Pregnant women with severe pre-eclampsia were 3.3 times more likely to progress to cesarean delivery than those with mild pre-eclampsia (OR=3.3; p<0.01).

    CONCLUSION:

    After individual analysis, only gestational age and a diagnosis of severe pre-eclampsia showed significant differences, representing risk factors for this type of delivery.

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  • Artigos Originais

    Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

    Rev Bras Ginecol Obstet. 2014;36(4):157-162

    Summary

    Artigos Originais

    Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

    Rev Bras Ginecol Obstet. 2014;36(4):157-162

    DOI 10.1590/S0100-720320140050.0002

    Views1

    PURPOSE:

    It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).

    METHODS:

    This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).

    RESULTS:

    Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.

    CONCLUSIONS:

    These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.

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  • Original Article

    Maternal and perinatal outcomes in women with decreased amniotic fluid

    Rev Bras Ginecol Obstet. 2013;35(8):342-348

    Summary

    Original Article

    Maternal and perinatal outcomes in women with decreased amniotic fluid

    Rev Bras Ginecol Obstet. 2013;35(8):342-348

    DOI 10.1590/S0100-72032013000800002

    Views3

    PURPOSE: To determine maternal and perinatal outcomes in pregnant women with low amniotic fluid, according to the amniotic fluid index (AFI). METHODS: A cohort study conducted on 176 patients admitted to the high risk ward of Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), in Recife, Pernambuco, Brazil. Amniotic fluid was measured by the amniotic fluid index, and classified as low when between 5.1 and 7.9 cm, moderate oligohydramnios between 3.1 and 5.0 cm, and severe oligohydramnios when less than or equal to 3.0 cm. To determine the difference between the three groups of categorical variables studied the chi-square and Fisher exact tests were used, when applicable, and for the numerical variables the Mann-Whitney test was applied, with the level of significance set at 5%. RESULTS: Fetal malformation more frequently occurred when oligohydramnios was severe. Hypertensive disorders, however, were associated with moderate oligohydramnios. There was similarity between the three groups in relation to premature rupture of membranes and other causes. Low amniotic fluid was more frequently diagnosed when tested at the gestational age of 32 weeks or earlier. Regarding the perinatal outcomes, the incidence of Apgar score <7 in the 1st and 5th minutes, perinatal death, neonatal jaundice and pulmonary hypoplasia was higher when oligohydramnios was moderate to severe. CONCLUSIONS: Maternal and perinatal causes and outcomes in pregnant women with low amniotic fluid vary with respect to their AFI, severe oligohydramnios being associated with fetal malformation and other adverse perinatal outcomes.

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  • Original Article

    Changes of blood flow in the umbilical artery in hypertensive pregnancy and the implications in the neonatal outcomes

    Rev Bras Ginecol Obstet. 2013;35(2):71-77

    Summary

    Original Article

    Changes of blood flow in the umbilical artery in hypertensive pregnancy and the implications in the neonatal outcomes

    Rev Bras Ginecol Obstet. 2013;35(2):71-77

    DOI 10.1590/S0100-72032013000200006

    Views3

    PURPOSE: To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. METHODS: A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. RESULTS: We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0‒28) and Gn median 0.5 (0‒25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2‒2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). CONCLUSION: In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.

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  • Original Article

    Morbidity and associated factors in climacteric women: a population based study in women with 11 or more years of formal education

    Rev Bras Ginecol Obstet. 2012;34(5):215-220

    Summary

    Original Article

    Morbidity and associated factors in climacteric women: a population based study in women with 11 or more years of formal education

    Rev Bras Ginecol Obstet. 2012;34(5):215-220

    DOI 10.1590/S0100-72032012000500005

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    PURPOSE: To evaluate factors associated with morbidities among Brazilian women aged 40-65 years and with 11 or more years of schooling. METHODS: A secondary analysis of a cross-sectional population-based study was conducted, using an anonymous self-report questionnaire completed by 377 women. Were evaluated, with this instrument, some morbidities (hypertension, diabetes, insomnia and depression) and sociodemographic, behavioral, clinical and reproductive factors. The association between morbidities and independent variables was evaluated by the Χ2 test. Multiple logistic regression analysis with stepwise selection criteria was used to select the major factors associated with morbid conditions. RESULTS: In the multiple regression analysis, insomnia was associated with bad/fair self-perception of health (OR=2.3) and nervousness (OR=5.1). Depression was associated with bad/fair self-perception of health (OR=3.7) and bad/poor leisure (OR=2.8). Hypertension was associated with obesity (OR=3.1) and being in postmenopausal (OR=2.6). Diabetes was associated with age above 50 years (OR=3.9) and obesity (OR=12.5). CONCLUSIONS: The prevalence of morbidities was high and a worse self-perception of health and obesity were the main factors associated with morbidity.

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  • Original Article

    Genetic polymorphisms of vascular endothelial growth factor in pre-eclampsia

    Rev Bras Ginecol Obstet. 2011;33(7):158-163

    Summary

    Original Article

    Genetic polymorphisms of vascular endothelial growth factor in pre-eclampsia

    Rev Bras Ginecol Obstet. 2011;33(7):158-163

    DOI 10.1590/S0100-72032011000700007

    Views0

    PURPOSE: To identify genetic polymorphisms of endothelial growth factor (VEGF), positions +936C/T and -2578C/A, in women with pre-eclampsia. METHODS: This was a cross-sectional study conducted on 80 women divided into two groups: pre-eclampsia and control. The sample was characterized using a pre-structured interview and data transcribed from the medical records. DNA extraction, amplification of sequences by the Polymerase Chain Reaction (PCR) with specific primers and polymorphism analysis of Restriction Fragment Length Polymorphism (RFLP) were performed to identify polymorphisms. The statistical analysis was performedin a descriptive manner and using the test. The multiple logistic regression model was used to determine the effect of polymorphisms on pre-eclampsia. RESULTS:Ahigher frequency of the T allele of theVEGF +936C/T polymorphism was observedin patients with pre-eclampsia, but with no significant difference. The presence of allele A of the VEGF -2578C/A was significantly higher in the control group. CONCLUSIONS:No significant association was observed between VEGF +936C/Tpolymorphism andpre-eclampsia. For the VEGF -2578C/A polymorphism a significant differencewas observed between thecontrol and pre-eclampsia group, with allele A being the most frequent in the control, suggesting the possibility that carriers of allele A have lower susceptibility to the development of pre-eclampsia.

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    Genetic polymorphisms of vascular endothelial growth factor in pre-eclampsia
  • Original Article

    Elevated blood pressure in women with polycystic ovary syndrome: prevalence and associated risk factors

    Rev Bras Ginecol Obstet. 2011;33(1):31-36

    Summary

    Original Article

    Elevated blood pressure in women with polycystic ovary syndrome: prevalence and associated risk factors

    Rev Bras Ginecol Obstet. 2011;33(1):31-36

    DOI 10.1590/S0100-72032011000100005

    Views1

    PURPOSE: to investigate the prevalence of elevated blood pressure (BP) in patients with polycystic ovary syndrome (PCOS) and to correlate the BP levels with other cardiovascular risk factors. METHODS: a cross-sectional study was conducted on 113 PCOS women (26.2±4.3 years) and on a Control Group of 242 healthy women from the general population (26.8±5.0 years). The variables considered were: systolic and diastolic BP, anthropometric parameters and plasma levels of glucose, total cholesterol, HDL-cholesterol, and triglycerides. The BP values were classified according to the V Brazilian Guidelines of Hypertension. Statistical analysis was performed by intergroup comparison with the Student's t-test and χ2 test, and correlation analysis was performed using Pearson's coefficient. RESULTS: the PCOS Group showed a significantly higher prevalence of altered BP (>130/85 mmHg) than the Control Group (18.6 versus 9.9%, respectively; p<0.05). PCOS women had higher mean systolic BP, body mass index (BMI), waist circumference (WC), triglycerides and fasting glucose, and lower HDL-cholesterol, compared to the Control Group (p<0.01). In the PCOS Group, the values of systolic and diastolic BP showed a significant positive correlation with age, BMI, WC, and triglycerides (p<0.05). CONCLUSIONS: according to the results obtained, it is possible to conclude that the frequency of women with BP values above the normal limit was significantly higher in the PCOS Group than in the Control Group. Additionally, the BP values also correlated with other cardiovascular risk factors. These findings underscore the importance of preventive strategies in PCOS women, in order to prevent pathological events related to the cardiovascular system.

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