Gestational hypertension

Gestational hypertension may predict maternal neurocognitive decline later in life

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Key takeaways:

  • Gestational hypertension was tied to maternal decline in processing speed and executive functioning after age 45 years.
  • Preeclampsia and eclampsia were not associated with any type of neurocognitive decline.

Among Hispanic women, gestational hypertension was associated with decreased processing speed and executive functioning after age 45 years, according to results of an analysis published in Obstetrics & Gynecology.

“Women who experienced gestational hypertension during pregnancy showed decreased processing speed/executive functioning later in life, suggesting that gestational hypertension may be an independent risk factor for maternal cognitive decline later in life,” Shathiyah Kulandavelu, PhD, research assistant professor in the department of pediatrics at the Interdisciplinary Stem Cell Institute at the University of Miami Miller School of Medicine, told Healio. “Women with pregnancies complicated by hypertensive disorders of pregnancy, especially those with gestational hypertension, could benefit from closer monitoring of cognitive status, along with promotion of greater education attainment and healthy lifestyles changes to prevent and/or delay future cognitive impairment.”

Shathiyah Kulandavelu, PhD, quote

Kulandavelu, along with co-author Tali Elfassy, PhD, a research assistant professor in the department of medicine at the Peggy and Harold Katz Family Drug Discovery Center at the University of Miami Miller School of Medicine, and colleagues conducted an analysis of 3,554 parous women (mean age, 56.2 years) aged 45 years or older from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective population-based study of Hispanic/Latino women from four communities in the U.S. All women completed the neurocognitive assessment from 2008 to 2011 and a repeat assessment from 2015 to 2018 and self-reported any gestational hypertension, preeclampsia or eclampsia. Researchers measured cognitive functioning with the Brief Spanish-English Verbal Learning Test (B-SEVLT), Digit Symbol Substitution Test (DSST) and Word Fluency Test.

Of the 13.4% of women who reported at least one hypertensive disorder of pregnancy, 11% had gestational hypertension, 4.9% had preeclampsia and 1.2% had eclampsia.

Tali Elfassy

Women with hypertensive disorders of pregnancy were more likely to have higher mean systolic blood pressure (129.8 vs. 127 mm Hg; P = .03), fasting glucose (115.6 vs. 105.5 mg/dL; P = .02) and BMI (32.3 vs. 30.2 kg/m2; P < .01) compared with women without. After an average of 6.9 years of follow-up, gestational hypertension was associated with a 0.17 standard deviation decline in DSST scores, which measures processing speed and executive functioning. Gestational hypertension was not associated with changes in B-SEVLT or Word Fluency Test scores.

Both preeclampsia and eclampsia were not associated with differences in neurocognition over time.

“The next step will be to elucidate different mechanisms that may be involved during pregnancy and/or postdelivery, which may contribute to faster cognitive decline in these women later in life,” Kulandavelu said. “Also, as cognitive decline is a process that can take decades, a longer follow-up of these women may identify further cognitive decline.”

Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia

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Question  Can mendelian randomization identify associations between circulating cardiovascular disease–related proteins and hypertensive disorders of pregnancy (HDPs)?

Findings  In this genetic association study including data from 21 758 participants for cardiovascular disease–related proteins, 393 238 female individuals for gestational hypertension, and 606 903 female individuals for preeclampsia, using genetic variants associated with circulating proteins as instrumental variables, 6 biomarkers with robust genetic associations with gestational hypertension and/or preeclampsia representing different pathways (eg, natriuretic peptide signaling, inflammation) were identified. Observational data were consistent with mendelian randomization results for several proteins, with dynamic associations of these proteins with HDPs throughout gestation.

Meaning  This study highlights novel biological mechanisms and identifies potential therapeutic targets for HDPs.

Abstract

Importance  Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, are important contributors to maternal morbidity and mortality worldwide. In addition, women with HDPs face an elevated long-term risk of cardiovascular disease.

Objective  To identify proteins in the circulation associated with HDPs.

Design, Setting, and Participants  Two-sample mendelian randomization (MR) tested the associations of genetic instruments for cardiovascular disease–related proteins with gestational hypertension and preeclampsia. In downstream analyses, a systematic review of observational data was conducted to evaluate the identified proteins’ dynamics across gestation in hypertensive vs normotensive pregnancies, and phenome-wide MR analyses were performed to identify potential non-HDP–related effects associated with the prioritized proteins. Genetic association data for cardiovascular disease–related proteins were obtained from the Systematic and Combined Analysis of Olink Proteins (SCALLOP) consortium. Genetic association data for the HDPs were obtained from recent European-ancestry genome-wide association study meta-analyses for gestational hypertension and preeclampsia. Study data were analyzed October 2022 to October 2023.

Exposures  Genetic instruments for 90 candidate proteins implicated in cardiovascular diseases, constructed using cis-protein quantitative trait loci (cis-pQTLs).

Main Outcomes and Measures  Gestational hypertension and preeclampsia.

Results  Genetic association data for cardiovascular disease–related proteins were obtained from 21 758 participants from the SCALLOP consortium. Genetic association data for the HDPs were obtained from 393 238 female individuals (8636 cases and 384 602 controls) for gestational hypertension and 606 903 female individuals (16 032 cases and 590 871 controls) for preeclampsia. Seventy-five of 90 proteins (83.3%) had at least 1 valid cis-pQTL. Of those, 10 proteins (13.3%) were significantly associated with HDPs. Four were robust to sensitivity analyses for gestational hypertension (cluster of differentiation 40, eosinophil cationic protein [ECP], galectin 3, N-terminal pro–brain natriuretic peptide [NT-proBNP]), and 2 were robust for preeclampsia (cystatin B, heat shock protein 27 [HSP27]). Consistent with the MR findings, observational data revealed that lower NT-proBNP (0.76- to 0.88-fold difference vs no HDPs) and higher HSP27 (2.40-fold difference vs no HDPs) levels during the first trimester of pregnancy were associated with increased risk of HDPs, as were higher levels of ECP (1.60-fold difference vs no HDPs). Phenome-wide MR analyses identified 37 unique non-HDP–related protein-disease associations, suggesting potential on-target effects associated with interventions lowering HDP risk through the identified proteins.

Conclusions and Relevance  Study findings suggest genetic associations of 4 cardiovascular disease–related proteins with gestational hypertension and 2 associated with preeclampsia. Future studies are required to test the efficacy of targeting the corresponding pathways to reduce HDP risk.

Postpartum management of hypertension.

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Hypertension in the postpartum period affects several groups of women, including those with previous chronic hypertension, gestational hypertension, pre-eclampsia, and eclampsia. In addition, pre-eclampsia may present for the first time in the postnatal period. Although the underlying causes and clinical presentation of these types of hypertension vary, patients can be investigated and treated in a similar manner. This review covers management of postpartum hypertension and its future consequences. Hypertension affects 6-10% of pregnancies,1 but few studies have reported the incidence of postpartum hypertension. This review is relevant to general practitioners, obstetricians, and specialists in secondary care who may see women with postpartum hypertension.

 

Source:BMJ

 

Hemodynamic Adaptations in Different Trimesters Among Nulliparous and Multiparous Pregnant Women; The Generation R Study.

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It has been suggested that maternal vascular adaptations during pregnancy differ between nulliparous and multiparous women. Therefore, we examined the associations of parity with blood pressure and hemodynamic placental function during pregnancy and risks of gestational hypertensive disorders.

Methods

 

The study was embedded in a population-based prospective cohort study among 8,377 pregnant women. Information about parity and gravidity was obtained at enrollment. Blood pressure was repeatedly measured in each trimester and mean pulsatility and resistance indexes of uterine artery were measured in second and third trimesters. Information on gestational hypertension and preeclampsia was available from medical records.

Results

As compared with nulliparous women, multiparous women had a lower systolic and diastolic blood pressure in each trimester of pregnancy and a slightly higher second and third trimester uterine artery resistance and pulsatility indexes (all P values < 0.05), but a lower risk of third trimester uterine artery notching (odds ratio (OR) 0.67 (95% confidence interval (CI):0.53, 0.84)). The risks of gestational hypertension and preeclampsia were lower among multiparous women as compared with nulliparous women (OR 0.32 (95% CI: 0.24, 0.43) and OR 0.24 (95% CI: 0.16, 0.37), respectively). Among multiparous women only, we did not observe associations of parity with hemodynamic parameters.

Conclusions

 

Nulliparous pregnant women have higher blood pressure levels throughout pregnancy and higher risks of notching and gestational hypertensive disorders. The first pregnancy might be a major risk factor for maternal hemodynamic maladaptations and vascular complications. Further studies are needed to explore the underlying mechanisms and consequences for fetal growth and development.

Source: American Journal of Hypertension