Lipotoxicity is a consequence from low grade inflammation caused by obesity. Women presenting body mass index (BMI) above 35 kg/mb have four times higher risk of preeclampsia development (Bianco, ...1998).
To characterize the association of BMI and maternal and perinatal variables between puerperas with and withoutpreeclampsia.
transversal study, Hospital Guilherme Álvaro-Santos/Brazil, (January/2015-March/2016). Antropometric data was collected from 160 women (immediate postpartum), 75 patients without preeclampsia (control group) and 85 with preeclampsia (case group). Variables: blood pressure (hospital admission), gestational age at childbirth and immediate perinatal outcome.
Average mother age and BMI were 25 years and 26 kg/mb for the control group, in the group case: 29 years and 35 kg/mb. Patients with pre-eclampsia showed higher blood pressure: medium level of 136 mmHg (sistolyc) and 85 mmHg (diastolic). 84% of the deliveries in the case group were cesarean sections and the majority of these women had gestation resolution above 37 weeks. Newborns out of pre-eclampsia mothers weighed among 2685 g and five-minute Apgar score was 8,7. Those neonates presented higher admission rates in a ICU (36.5%) and 12% were small for gestational age. Cesarean in 84% of births in the case group and 40% case of births occurred in prematurity. Newborns of mothers with preeclampsia weighed on average 2685 g, average 5’ Apgar score of 8,7, higher rates of admission to ICU (36.5%) and 12% were small for gestational age.
Was observed in women with preeclampsia higher average BMI and blood pressure values and their newborns showed smaller weight and 5’ Apgar score, need frequent admission to ICU and prematurity. Reproductive counseling appears to be relevant to the obese women to warn about potential complications, it’s important to adopt strategies for assistance to this population to qualify the attendance, particularly in actions preventive and possible reduction in the rate of cesarean section that could magnify risks.
Possible markers of severity in hypertensive syndromes of the pregnancy-puerperal cycle could be identify and guide conduct timely in order to reduce maternal and perinatal risks.
To analyze the ...relationship between the anthropometric aspects and the hematimetric parameters comparing in pregnant women with preeclampsia(PE), hypertension chronic(HC) and without comorbidities.
Cross-sectional study developed at Hospital Guilherme Alvaro, Santos/Brazil and at Municipal Maternity of Sao Vicente/Brazil (May-September 2017). Group PE: pregnant women with PE and HC Group: pregnant women with HC (NHBPEP, 2000). Control group(C): healthy pregnant women. Variables analyzed: body mass index(BMI), abdominal circumferences(CA), complete blood count. Exclusion criteria: diabetes, collagenosis, smoking, twin pregnancy and fetal abnormalities. Fisher’s exact test was used and was considered as the significance p < 0.05.
68 pregnant women were selected. The mean BMI found in group C was 29.45, in the HC group of 35.5 and in the PE group 38.8. We also observed that pregnant women in the PE group had an average CA19.21 cm higher than pregnant women in group C. It was identified that CHCM is superior in the PE group. There was statistical significance in the levels of neutrophils and lymphocytes in the groups with hypertensive syndromes.
Elevation of BMI/CA in PE patients are risk factors for cardiovascular diseases according to the literature (Rezende, 2006). There was an increase in CHCM in cases of endolymphatic injury related hemolysis (HC and PE). Considering the exclusion of patients with other comorbidities, capable of influencing CHCM, this one presented as a potential marker of abnormalities. The increase in the level of lymphocytes in the PE group found in the study, with statistical significance, opposes the literature reporting otherwise (Vázquez, 2004). The increase in neutrophils found in group C (p = 0.007), especially at the end, is consistent with the literature (Souza, 2002).
Laboratory abnormalities and obesity may be associated with perinatal outcomes in patients with pre-eclampsia. Analysis of these factors may guide damage prevention strategies.
To associate ...laboratory variables and maternal body mass index (BMI) with childbirth outcome before 34 and 37 weeks and perinatal outcomes in cases of pre-eclampsia.
Cohort study. Location: Guilherme Álvaro Hospital, Santos/Brazil; (May/2017–April/ 2018). Inclusion: women with pre-eclampsia (NHBPEP; 2000) and preterm delivery. Group 1: delivery < 34 weeks. Group 2: childbirth < 37 weeks. Measured at admission: uric acid (> 6 mg/dl), liver enzymes (AST> 34 U/I and ALT> 35 U/I), obesity (BMI> 30), neonatal ICU admission. Statistical analysis: Fisher’s exact test (significance p < 0.05). The work has ethical approval.
Sample size: 90 patients. Group 1: AST elevation in 53.3% of the pacients (p = 0.001); ALT elevation in 46.7% (p = 0.001), uric acid elevation in 28.6% (p = 0.068) and 12.5% were obese (p = 0.044). Group 2: AST elevation in 30.2% of the pacients (p = 0.001); ALT elevation in 23.3% (p = 0.004); uric acid elevation in 20% (p = 0.085) and 24.4% were obese (p = 0.047). Of the total sample, 45.6% of newborns were admitted to the neonatal ICU.
In Group 1, with more severe prematurity, hepatic damage and elevated uricemia were more frequent. In Group 2, obesity was more prevalent, corroborating with the literature (Chaemsaithong P, 2018). The neonatal ICU admission of the total sample was significantly elevated. This behavior of the indirectly recognized target organ damage and lipotoxicity, associated with the severity of prematurity, may represent indicators regarding the higher expression of preeclampsia causing preterm delivery, the need to guide prophylaxis strategies and eventually prognostic counseling. Enlarging the sample may add information.
Introduction Possibly the nitric oxide production is decreased in patients with preeclampsia. Therefore this molecule could be used as a potential marker. Objective Identify differences in nitric ...oxide serum levels between postpartum women with and without preeclampsia and non pregnant women. Methods Cross-sectional study developed any Hospital Guilherme Álvaro Santos/Brazil and the University Hospital Antonio Pedro, Niterói/Brazil, between (December/2015 and May/2016). Were collected 106 blood samples in the mediate postpartum (32 study group, 42 control group and 42 non pregnant women). The study group was composed by pregnants with preeclampsia according to criteria of NHBPEP (2000) and gave birth to a single newborn. Control group: spontaneous vaginal delivery, term newborn, without hypertension and/or any other comorbidities. The group of non-pregnant women was included healthy volunteers, between 20 and 40 years old, without any contagious infectious, genetic or metabolic disease. Exclusion criteria: collagen disease, smoking, twin pregnancy, fetal malformations and fetal death. Initially it was measured serum value of nitric oxide in these three groups. Then it was analyzed the levels of this metabolic only in women who have had preeclampsia to correlate to the following variables: maternal age, gestational age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, neck, arm and abdominal circumferences, newborn weight, first and fifth minute Apgar score, somatic Capurro, adequacy weight for gestation age, newborn ICU admission and association with diabetes mellitus and arterial hypertension. This research has ethical approval. The statistical analysis was performed using Fisher’s exact test to the comparisons between two groups the Man–Whitney test. After all, for to comparisons between two groups were used Kruskal–Wallis test and for the correlations the Pearson’s test. The significance level is p < 0.05. Results Comparison of nitric oxide results concentration in the preeclampsia group – average (* p < 0,05). Dosing nitric oxide serum levels in women with preeclampsia ( n = 32) the value was 30,15 μ M, without preeclampsia ( n = 42) 30,03 μ M and non pregnant women ( n = 32) was 17,23 μ M. We could identify a significant statistical difference between the postpartum women compared to the non-pregnant, but not among themselves. Comparing variables and serum levels of nitric oxide from women with preeclampsia, we observed that the value is directly proportional to the age of the patient, with statistical significance. Other variables such as body mass index, gestational age, systolic blood pressure, diastolic blood pressure, cervical, brachial and abdominal circumferences, newborn weight, first and fifth minute Apgar and somatic Capurro did not present statistical significance. Conclusion We identified a significant difference in serum levels of nitric oxide between groups of patients with and without preeclampsia and non-pregnant women, but it was not found when we considered only the post partum women with and without hypertension. In preeclampsia group nitric oxide levels were significantly higher in those with advanced age. But there was no significant difference in maternal variables: body mass index, blood pressure, measurements of body circumferences and association with comorbidities. Neither in the neonatal variables: gestational age at delivery, Apgar score, care unit intensive admission and birth weight.
Introduction Electronic methods are adopted for the evaluation of fetal vitality in hypertensive syndromes, comparing pros and cons to contribute when choosing one. Objective Compare two resources of ...study of fetal vitality: cardiotocography and fetal monitor AN24 (Monica Health Care) in hypertensive pregnancies. Methods This is a study control case with a sample of 22 patients in which we compare the tracing using the conventional cardiotocography, and transabdominal fetal electrocardiography by choice of the fetal monitor AN24. The study was conducted with pregnant women equal or above 34 weeks, alive fetus and single, with hypertensive disorders according to the criteria NHBPEP – 2000 at Hospital Guilherme Álvaro-Santos/SP-Brazil from june to october of 2015. The study had 22 patients with diagnosis of hypertensive syndrome. The applicability of both methods was performed according to the standardized recommendations. The variables examined in the study were: gestational age, analyzed in weeks; number of pregnancies; parity; body mass index (BMI), which was divided into 3 criteria (BMI less than 30; BMI ⩾ 30 and less than 35; BMI ⩾ 35); preparation time, which means the time (in minutes) since the starting of local asepsis up to the beginning of the record of cartography. Also was analyzed the success in capturing, which was defined as the successful capture of the signal to execute the cardiotocography; signal loss, defined as any interruption of cardiotocographic tracing. Finally, it was analyzed the concordance in categorical classification in both methods. Following the criterias divided in class I, II and III (ACOG, 2009).1 Results Afterwards analysed 22 patients, were obtained: average of the gestational age 36,71 weeks, average of pregnancies 2,14, average of births 1,09 and average of BMI 34,17. This study has shown 100% of agreement in categorical classification in both procedures. The success capitation between the methods was similar ( p = 0,999). In AN24 monitor, six tracings has showed signal loss, while in the CTB only three has shown this loss ( p = 0,505). The monitor AN24 have showed a bigger preparation time than the other method, analysed in 1,94 min. The CTB method showed better results when comparing the variable preparation time in patients with BMI > 35 ( p = 0,094). Conclusion No differences were identified concerning the quality of analysis of fetal viability between the resources and were also in agreement on the categorical analysis of each tracing. Both methods showed agreement in the variables: success of capturing in the whole sample and in BMI between 30 and 35. The AN24 showed better results than the CTB, when analyzing the variables: success of capturing in BMI higher than 35 and signal loss, in the whole sample and in BMI between 30 and 35. On the other hand, CTB had more success in capturing only in BMI less than 30, and showed faster preparation time in the whole sample and in all BMI groups. Further studies may broaden the comparison between these current methods. 1. American College of Obstetricians and Gynecologists, ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, Obstet Gynecol. 114(1) (2009) 192–202.
Know the additional risks associated with hypertensive disorders in pregnancy, such as the use of licit and illicit substances, may contribute to the adoption of strategies that minimize adverse ...outcomes.
Estabilish the prevelence of the use of harmful substances such as alcohol, tobacco and ilicit drugs in pregnant women in relation to healthy pregnant women.
A transversal study has been conducted in the prenatal and maternity of the Hospital Guilherme Álvaro from April to June 2016. 61 patients were selected, 34 from the study group and 27 from de control group. Among the patients in the study group, are included pregnant or postpartum women with hypertensive disorders, according NHBPEP 2000. In the control group, are included only pregnant or postpartum women without previous comorbidity, which gave birth to one healthy live newborn, vaginal delivery.
It was applied two questionnaires, ASSIST, screening test of involvement with alcohol, tobacco and illicit substances, developed by WHO, useful for health professionals to identify the use and dependence on psychoactive substances, evaluated through a score, the answer ranges from 0 to 4 points, and the sum can range from 0 to 20, it is considered casual use 0 to 3, 4 suggestive of abuse 4–15 and suggestive of addiction 16–20. And another that evaluates epidemiological woman information, current and obstetric pregnancy as well as age, color, living city, number of consultations prenatal, site of consultations, among others.
The data were passed to the Excel program and analyzed quantitatively, to compare Study and Control groups on the ASSIST score related to each psychoactive drug, we used the Student’s T Test for unrelated samples. It was considered significant samples where p<0.05.
The obtained results, shown below, do not allow to say that the groups differ, although the sample size and the low frequency of drug use in the groups studied compromise the accuracy of information.
In percentage, 80.32% of all pregnant women have proved any drugs. Among the groups, the Study 70.83% have used drugs and in the control group 81.48% have used drugs.
Psychoactive drugs most used by pregnant women are: alcohol 77,0% and tobacco 42,6%.
In the correlation between the use of each type of drug with additional information about pregnancy and previous pregnancies
– The use of tobacco, the less prenatal consultations, higher the score, in the Study group
– The use of marijuana, the number of children who died (fetal or neonatal previous) was higher in the Study group
– The use of cocaine, the number of children who died (fetal or neonatal previous) was higher in the Study group
– The use of sedatives, the number of prenatal consultations, the highest score in the Study group
SUBSTANCE Study % Control % Total % P Tobacco Alcohol Marijuana Cocaine Amphetamine Inalants Sedatives Hallucinogens Opiates.
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Distribution ASSIST score among these drugs was more abuse and addiction to alcohol and tobacco in the Control group compared to the Study group. Although we saw that the Hypertensive group made greater use of cocaine, amphetamine and opioids than those of the Control group.
The other comparisons were not significant and the larger sample can clear the results.
Introduction Know the additional risks associated with hypertensive disorders in pregnancy, such as the use of licit and illicit substances, may contribute to the adoption of strategies that minimize ...adverse outcomes. Objective Estabilish the prevelence of the use of harmful substances such as alcohol, tobacco and ilicit drugs in pregnant women in relation to healthy pregnant women. Methodology A transversal study has been conducted in the prenatal and maternity of the Hospital Guilherme Álvaro from April to June 2016. 61 patients were selected, 34 from the study group and 27 from de control group. Among the patients in the study group, are included pregnant or postpartum women with hypertensive disorders, according NHBPEP 2000. In the control group, are included only pregnant or postpartum women without previous comorbidity, which gave birth to one healthy live newborn, vaginal delivery. It was applied two questionnaires, ASSIST, screening test of involvement with alcohol, tobacco and illicit substances, developed by WHO, useful for health professionals to identify the use and dependence on psychoactive substances, evaluated through a score, the answer ranges from 0 to 4 points, and the sum can range from 0 to 20, it is considered casual use 0 to 3, 4 suggestive of abuse 4–15 and suggestive of addiction 16–20. And another that evaluates epidemiological woman information, current and obstetric pregnancy as well as age, color, living city, number of consultations prenatal, site of consultations, among others. The data were passed to the Excel program and analyzed quantitatively, to compare Study and Control groups on the ASSIST score related to each psychoactive drug, we used the Student’s T Test for unrelated samples. It was considered significant samples where p < 0.05. Results The obtained results, shown below, do not allow to say that the groups differ, although the sample size and the low frequency of drug use in the groups studied compromise the accuracy of information. In percentage, 80.32% of all pregnant women have proved any drugs. Among the groups, the Study 70.83% have used drugs and in the control group 81.48% have used drugs. Psychoactive drugs most used by pregnant women are: alcohol 77,0% and tobacco 42,6%. In the correlation between the use of each type of drug with additional information about pregnancy and previous pregnancies – The use of tobacco, the less prenatal consultations, higher the score, in the Study group – The use of marijuana, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of cocaine, the number of children who died (fetal or neonatal previous) was higher in the Study group – The use of sedatives, the number of prenatal consultations, the highest score in the Study group SUBSTANCE Study % Control % Total % P Tobacco Alcohol Marijuana Cocaine Amphetamine Inalants Sedatives Hallucinogens Opiates. Conclusion Distribution ASSIST score among these drugs was more abuse and addiction to alcohol and tobacco in the Control group compared to the Study group. Although we saw that the Hypertensive group made greater use of cocaine, amphetamine and opioids than those of the Control group. The other comparisons were not significant and the larger sample can clear the results.
Electronic methods are adopted for the evaluation of fetal vitality in hypertensive syndromes, comparing pros and cons to contribute when choosing one.
Compare two resources of study of fetal ...vitality: cardiotocography and fetal monitor AN24 (Monica Health Care) in hypertensive pregnancies.
This is a study control case with a sample of 22 patients in which we compare the tracing using the conventional cardiotocography, and transabdominal fetal electrocardiography by choice of the fetal monitor AN24. The study was conducted with pregnant women equal or above 34weeks, alive fetus and single, with hypertensive disorders according to the criteria NHBPEP – 2000 at Hospital Guilherme Álvaro-Santos/SP-Brazil from june to october of 2015. The study had 22 patients with diagnosis of hypertensive syndrome. The applicability of both methods was performed according to the standardized recommendations. The variables examined in the study were: gestational age, analyzed in weeks; number of pregnancies; parity; body mass index (BMI), which was divided into 3 criteria (BMI less than 30; BMI⩾30 and less than 35; BMI⩾35); preparation time, which means the time (in minutes) since the starting of local asepsis up to the beginning of the record of cartography. Also was analyzed the success in capturing, which was defined as the successful capture of the signal to execute the cardiotocography; signal loss, defined as any interruption of cardiotocographic tracing. Finally, it was analyzed the concordance in categorical classification in both methods. Following the criterias divided in class I, II and III (ACOG, 2009).1
Afterwards analysed 22 patients, were obtained: average of the gestational age 36,71weeks, average of pregnancies 2,14, average of births 1,09 and average of BMI 34,17. This study has shown 100% of agreement in categorical classification in both procedures. The success capitation between the methods was similar (p=0,999). In AN24 monitor, six tracings has showed signal loss, while in the CTB only three has shown this loss (p=0,505). The monitor AN24 have showed a bigger preparation time than the other method, analysed in 1,94min. The CTB method showed better results when comparing the variable preparation time in patients with BMI>35 (p=0,094).
▪
No differences were identified concerning the quality of analysis of fetal viability between the resources and were also in agreement on the categorical analysis of each tracing. Both methods showed agreement in the variables: success of capturing in the whole sample and in BMI between 30 and 35. The AN24 showed better results than the CTB, when analyzing the variables: success of capturing in BMI higher than 35 and signal loss, in the whole sample and in BMI between 30 and 35. On the other hand, CTB had more success in capturing only in BMI less than 30, and showed faster preparation time in the whole sample and in all BMI groups. Further studies may broaden the comparison between these current methods.
1. American College of Obstetricians and Gynecologists, ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, Obstet Gynecol. 114(1) (2009) 192–202.
Possibly the nitric oxide production is decreased in patients with preeclampsia. Therefore this molecule could be used as a potential marker.
Identify differences in nitric oxide serum levels between ...postpartum women with and without preeclampsia and non pregnant women.
Cross-sectional study developed any Hospital Guilherme Álvaro Santos/Brazil and the University Hospital Antonio Pedro, Niterói/Brazil, between (December/2015 and May/2016). Were collected 106 blood samples in the mediate postpartum (32 study group, 42 control group and 42 non pregnant women). The study group was composed by pregnants with preeclampsia according to criteria of NHBPEP (2000) and gave birth to a single newborn. Control group: spontaneous vaginal delivery, term newborn, without hypertension and/or any other comorbidities. The group of non-pregnant women was included healthy volunteers, between 20 and 40years old, without any contagious infectious, genetic or metabolic disease. Exclusion criteria: collagen disease, smoking, twin pregnancy, fetal malformations and fetal death. Initially it was measured serum value of nitric oxide in these three groups. Then it was analyzed the levels of this metabolic only in women who have had preeclampsia to correlate to the following variables: maternal age, gestational age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, neck, arm and abdominal circumferences, newborn weight, first and fifth minute Apgar score, somatic Capurro, adequacy weight for gestation age, newborn ICU admission and association with diabetes mellitus and arterial hypertension. This research has ethical approval. The statistical analysis was performed using Fisher’s exact test to the comparisons between two groups the Man–Whitney test. After all, for to comparisons between two groups were used Kruskal–Wallis test and for the correlations the Pearson’s test. The significance level is p<0.05.
Comparison of nitric oxide results concentration in the preeclampsia group – average (*p<0,05).
▪
Dosing nitric oxide serum levels in women with preeclampsia (n=32) the value was 30,15μM, without preeclampsia (n=42) 30,03μM and non pregnant women (n=32) was 17,23μM. We could identify a significant statistical difference between the postpartum women compared to the non-pregnant, but not among themselves. Comparing variables and serum levels of nitric oxide from women with preeclampsia, we observed that the value is directly proportional to the age of the patient, with statistical significance. Other variables such as body mass index, gestational age, systolic blood pressure, diastolic blood pressure, cervical, brachial and abdominal circumferences, newborn weight, first and fifth minute Apgar and somatic Capurro did not present statistical significance.
We identified a significant difference in serum levels of nitric oxide between groups of patients with and without preeclampsia and non-pregnant women, but it was not found when we considered only the post partum women with and without hypertension. In preeclampsia group nitric oxide levels were significantly higher in those with advanced age. But there was no significant difference in maternal variables: body mass index, blood pressure, measurements of body circumferences and association with comorbidities. Neither in the neonatal variables: gestational age at delivery, Apgar score, care unit intensive admission and birth weight.
Introduction Preeclampsia (PE) affects 5–8% of pregnant women, it is a multi-systemic damage which obesity is a predisposing factor and may be recognized by anthropometric measurements. The increased ...adiposity results in tissue necrosis and release of fatty acids, promoting metabolic changes known as lipotoxicity that causes endothelial damage. This immune disorder causes: vascular reactivity, vasospasm, alterations in capillary permeability and coagulation system. Resulting in anatomical/functional damage such as brain, cardio-pulmonary, renal, hepatic, hematological and utero-placental. This research project is part of a line of research that will assess the long-term values of the selected indicators in the remote postpartum period, thus seeking to observe the behavior of these effectors in the mother’s body. Objective To evaluate possible laboratory and anthropometric markers in selected mothers with PE in the immediate postpartum compared to women without this complication. Methods Case-control study developed at the Hospital Guilherme Álvaro, Santos/Brazil. Blood samples and anthropometric data from 15 mothers were collected in the period from January to May/2015 in the immediate postpartum and analyzed selected laboratory and nutritional markers, possibly related to PE. Case group: women with PE according to the NHBPEP (2000). Control group: women with vaginal birth and newborn full-term, without hypertension and other comorbidities. Variables analyzed: maternal age, gestational age at birth, body mass index (BMI), neck, arm and abdominal circumferences, total cholesterol, HDL (high density lipoprotein), LDL (low-density lipoprotein), VLDL (very low- density lipoprotein), triglycerides, fasting glucose and insulin levels to calculate HOMA-IR index, C-reactive protein. Exclusion terms: collagen disease, smoking, twin pregnancy and fetal malformations. Results The total of 15 blood samples (09 – study group and 06 – control group). Conclusion This study showed that potential markers lipotoxicity and anthropometric data can relate to the PE, possibly indicating probable risk factors, contributing to the understanding of certain clinical expressions and possibly correlate with prognostic factors. More studies are needed to expand the preliminary information of the present study.
