Objective
To assess the frequency of obstructive sleep apnoea among women with and without hypertensive disorders of pregnancy.
Design
Cohort study.
Setting
Obstetric clinics at an academic medical ...centre.
Population
Pregnant women with hypertensive disorders (chronic hypertension, gestational hypertension, or pre‐eclampsia) and women who were normotensive.
Methods
Women completed a questionnaire about habitual snoring and underwent overnight ambulatory polysomnography.
Main outcome measures
The presence and severity of obstructive sleep apnoea.
Results
Obstructive sleep apnoea was found among 21 of 51 women with hypertensive disorders (41%), but in only three of 16 women who were normotensive (19%, chi‐square test, P = 0.005). Author correction added on 16 June 2014, after first online publication: Results mentioned in the were amended. Non‐snoring women with hypertensive disorders typically had mild obstructive sleep apnoea, but >25% of snoring women with hypertensive disorders had moderate to severe obstructive sleep apnoea. Among women with hypertensive disorders, the mean apnoea/hypopnoea index was substantially higher in snorers than in non‐snorers (19.9 ± 34.1 versus 3.4 ± 3.1, P = 0.013), and the oxyhaemoglobin saturation nadir was significantly lower (86.4 ± 6.6 versus 90.2 ± 3.5, P = 0.021). Among women with hypertensive disorders, after stratification by obesity, the pooled relative risk for obstructive sleep apnoea in snoring women with hypertension compared with non‐snoring women with hypertension was 2.0 (95% CI 1.4–2.8).
Conclusions
Pregnant women with hypertension are at high risk for unrecognised obstructive sleep apnoea. Although longitudinal and intervention studies are urgently needed, given the known relationship between obstructive sleep apnoea and hypertension in the general population, it would seem pertinent that hypertensive pregnant women who snore should be tested for obstructive sleep apnoea, a condition believed to cause or promote hypertension.
Editorial: Women facing crises Endler, Margit; Ramirez‐Negrin, Atziri; Johnson, Timothy R. B.
International journal of gynaecology and obstetrics,
11/2023, Letnik:
163, Številka:
2
Journal Article
Summary
Background
Striae gravidarum (SG), or stretch marks of pregnancy, begin as erythematous streaks and mature into hypopigmented atrophic bands.
Objectives
In order to investigate molecular ...alterations that may promote atrophy of SG, we investigated dermal type I collagen fibrils, which provide human skin with support.
Methods
We obtained skin samples of recently developed, erythematous abdominal SG from pregnant women. To examine the organization of collagen fibrils, second‐harmonic generation imaging was performed using multiphoton microscopy. Immunostaining was used to determine protein expression and localization of type I procollagen, the precursor of type I collagen fibrils. Real‐time polymerase chain reaction was used to determine gene expression levels.
Results
In control (hip) and stretched normal‐appearing perilesional abdominal skin, dermal collagen fibrils were organized as tightly packed, interwoven bundles. In SG, collagen bundles appeared markedly separated, especially in the mid‐to‐deep dermis. In the spaces separating these bundles, loosely packed wavy collagen fibrils lacking organization as bundles were present. These disorganized fibrils persisted into the postpartum period and failed to form densely packed bundles. Numerous large fibroblasts displaying type I procollagen expression were in close proximity to the disorganized fibrils, suggesting that the fibrils are newly synthesized. Supporting this possibility, immunostaining and gene expression of type I procollagen were increased throughout the dermis of SG.
Conclusions
Early SG display marked separation of collagen bundles and emergence of disorganized collagen fibrils that fail to form bundles. These alterations may reflect ineffective repair of collagen bundles disrupted by intense skin stretching. Persistent disruption of the collagenous extracellular matrix likely promotes formation and atrophy of SG.
What's already known about this topic?
Dermal collagen fibrils are organized as densely packed bundles that provide support to human skin.
Little is known about alterations involving collagen fibrils in striae gravidarum (SG), also known as stretch marks of pregnancy.
What does this study add?
In recently developed SG, collagen bundles become markedly separated, and disorganized collagen fibrils emerge and fail to form bundles.
What is the translational message?
These alterations of collagen fibril organization likely promote atrophy.
Therapies promoting organization of collagen fibrils into densely packed bundles may improve SG.
Linked Comment: Sambi and Watson. Br J Dermatol 2018; 178:590–591.
Plain language summary available online
Recent data from the World Health Organization demonstrates significant declines in maternal mortality ratios, with a 49% reduction in sub-Saharan Africa (SSA), from 990 in 1990 to 510 per 100 000 ...live births in 2013. Still, Millennium Development Goal (MDG) targets for maternal mortality in SSA will not be reached. Post 2015 reductions in maternal, perinatal and early neonatal mortality will only be realised when the most severe maternal complications can be comprehensively addressed and obstetric interventions that identify and deliver the at-risk fetus can be provided to all pregnant women.
Summary
Stretch marks affect 50‐90% of pregnant women and can cause emotional distress. Stretch marks initially appear reddish, and mature over months to years, becoming permanent white streaks with ...a depressed, scar‐like appearance. As little is known about how stretch marks develop, this study, from the University of Michigan in the US, aimed to examine the molecular changes occurring in early stretch marks, with the reasoning that findings may explain the appearance of mature stretch marks. For the study, women in their second or third trimester of pregnancy provided skin samples of recently developed, reddish stretch marks on the abdomen; additionally, some women provided skin samples after delivery. The skin samples were analyzed using laboratory techniques to examine the appearance, organization and production of collagen, the main protein that provides strength and support to the skin. The authors found that collagen appeared abnormal in early stretch marks. In particular, collagen bundles, which are normally densely packed, appeared markedly separated, as if “pulled apart” by extreme skin stretching. The skin attempts to repair these separated, damaged collagen bundles by making more collagen. However, this reparative process is inadequate, and produces abnormally thin, disorganized collagen strands that fail to form normal bundles. These changes persisted in stretch marks after delivery, and likely explain why mature stretch marks appear depressed and lacking in structural support. The study's findings suggest that methods of preserving the normal organization and structure of collagen may prevent stretch marks. Once stretch marks have formed, treatments that stimulate the production of collagen that is properly organized as densely packed bundles may improve the appearance of stretch marks. Many treatments available for improving stretch marks are not effective, likely because they do not stimulate normal collagen rebuilding. As such, the authors’ findings not only provide insight into how stretch marks develop at the molecular level, but also provide a therapeutic strategy for improving stretch mark appearance.
Linked Article: Wang et al. Br J Dermatol 2018; 178:749–760
Discusses results of information-gathering by the Association of American Medical Colleges' (AAMC's) Increasing Women's Leadership Project Implementation Committee and offers several recommendations, ...such as: (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; and (2) target women's professional development needs within the context of helping all faculty maximize their appointments, including helping men become more effective mentors of women. (EV)
To evaluate the effects of medical legal risk on practice location of obstetrician-gynecologists.
We used the American College of Obstetricians and Gynecologists (ACOG) Membership Record to determine ...the number of Fellows and Junior Fellows by state. We obtained state malpractice premiums from the Medical Liability Monitor and state birth rates from the National Center for Health Statistics. The American Medical Association (AMA) "Crisis" and ACOG "Red Alert" designations, as well as state malpractice premium levels, were used to approximate malpractice risk. We examined the changes in state births to obstetrician-gynecologist rates from 1995 to 2003 by using the Student t test and Mann-Whitney tests. Comparisons were made between states of different risk levels.
We found no significant difference in the percentage changes in births per Fellow or births per Junior Fellow between AMA "Crisis" and remaining states, nor between ACOG "Red Alert" and Safe states. The percentage changes in births per Fellow were similar in the 10 highest-premium states and the 10 lowest-premium states. The percentage increase in births per Junior Fellow in the 10 highest-premium states was significantly greater than the 10 lowest-premium states (median 28.5% versus 5.0%, P = .03).
Malpractice premiums appear to influence practice location of new obstetrician-gynecologists. Neither the AMA designation of "Crisis" nor the ACOG designation of "Red Alert" had supply implications in the analysis. More research on the interaction of malpractice rates and obstetrician-gynecologist supply is needed for informed decisions regarding malpractice premium management.
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