Sérgio Hofmeister Martins-Costa

Randomized, Controlled Trial of Hydralazine Versos Nifedipine in Preeclamptic Women with Acute Hypertension

We studied 37 nulliparous women with late-onset gestational hypertension and significant proteinuria, with a diastolic blood pressure of 110 mmHg or higher. They were randomly assigned to receive intravenous hydralazine (5 ou 10 mg) plus an oral placebo; or oral nifedipine (10 or 20 mg) plus an intravenous placebo, with the goal of maintaining diastolic blood pressure at or below 100 mmHg. All drugs were administered in a double-blind fashion. Hydralazine decreased mean arterial pressure from 136± mmHg to 106±7 mmHg, while nifedipine decreased it from 135±8 mmHg to 109±10 mmHg. The incidence of adverse maternal and fetal effects were similar in the two treatment groups. This randomized trial contained a limited number of subjects and, therefore, did not have the statistical power to detect small differences between hydralazine and nifedipine. However, we have demonstrated that a trial of drug therapies for acute hypertension in pregnancy can be successfully blinded, and this approach would be valuable in ...

Risk factors for cardiovascular disease ten years after preeclampsia

CONTEXT AND OBJECTIVEnPreeclampsia is a gestational disease that occurs mainly among nulliparous women after the 20th week of gestation, and frequently close to delivery. The effects of preeclampsia on womens blood pressure over the long term are still controversial. Patients with recurrent preeclampsia or preeclampsia in the early stages of pregnancy appear to present higher risk of hypertension. The aim of this study was to determine the risk factors for cardiovascular disease among women with preeclampsia 10 years earlier.nnnDESIGN AND SETTINGnCross-sectional study at Hospital de Clínicas de Porto Alegre (HCPA).nnnMETHODSnForty women with preeclampsia and 14 normotensive pregnant women followed up 10 or more years earlier at HCPA underwent clinical and laboratory examinations. Spearmans correlation coefficient was used to correlate body mass index (BMI) and systolic and diastolic pressures. The risk of developing hypertension was measured using the chi-square test. P < 0.05 was considered significant.nnnRESULTSnThe patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure (P = 0.047), BMI (P = 0.019) and abdominal circumference (P = 0.026). They presented positive correlations between BMI and diastolic blood pressure (0.341; P = 0.031) and between BMI and systolic blood pressure (0.407; P = 0.009).nnnCONCLUSIONnThe patients with preeclampsia 10 or more years earlier had significantly higher diastolic blood pressure, BMI and abdominal circumference than did the control group. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors among patients with preeclampsia.

Calciuria and preeclampsia

Urinary calcium excretion has been reported to be diminished in preeclampsia. The objective of the present study was to determine urinary calcium excretion in pregnant patients with chronic arterial hypertension (CAH) and preeclampsia (PE), and in normotensive patients (N). Forty-four pregnant patients (gestational age, 20-42 weeks; 18 CAH, 17 PE, 9 N) were evaluated for calciuria, proteinuria, plasma uric acid and blood pressure. Patients with PE (82 +/- 15.1 mg/24 h) showed significantly lower calciuria (P < 0.05) than the group with CAH (147 +/- 24.9 mg/24 h) and the N group (317 +/- 86.0 mg/24 h) (P < 0.05, Student t-test). Plasma uric acid was significantly higher in the PE group (6.1 +/- 0.38 mg/dl) than the CAH group (5.0 +/- 0.33 mg/dl; P < 0.05), which also presented higher proteinuria levels, although the difference was not statistically significant. Diastolic and systolic blood pressure did not differ between the PE (164 +/- 105 mmHg) and CAH (164 +/- 107 mmHg) groups. Calciuria was significantly lower in the group with preeclampsia than in the group with chronic arterial hypertension. We conclude that calciuria can be a further factor for identifying preeclampsia.

Signalization of Akt/PKB in the Placenta, Skeletal Muscle and Adipose Tissue of Preeclampsia Patients

Preeclampsia (PE) is a significant cause of fetal and maternal mortality around the world and there is evidence that insulin resistance has been implicated in the pathophysiology of PE. The Akt/PKB pathway is stimulated by insulin and performs several vital functions relative to growth, survival and cellular metabolism. Objective: To investigate the basal expression of Akt/PKB, HSP90 expression, proteins that regulate Akt/PKB activity and substrate in the placenta, skeletal muscle and adipocytes of normal and PE parturient. Method: Samples were collected from 17 normal patients and 17 PE patients, and analyzed by Western blot to quantify the protein expression involved in signaling cascade of Akt/PKB. Results: Total Akt/PKB expression for normal placentas was 1.85 (1.07–3.12) and 1.53 (1.27–3.08) in PE (p = 1.00); in the adipose tissue of normal placentas it was 1.10 (0.53–1.73) and 1.66 (0.83–2.00) in PE (p = 0.37). Conclusions: There was no difference in the Akt/PKB pathway, in basal state, in placentas and skeletal muscle of normal and PE patients. However, defects in this signaling pathway as pathophysiology of PE cannot be excluded because it is necessary to analyze this pathway during stimulation.

Are insulin resistance index, IGF-1 and metabolic syndrome components correlates with severe preeclampsia?

Objective. Analyse the relation between insulin resistance and severe preeclampsia (SPE). Methods. Case control study paired by body mass index and gestational age; including 16 patients with severe SPE and 16 normotensive controls. Insulin resistance was assessed through the HOMA-IR and QUICKI-IS indexes. Results. There was no significant difference between the groups regarding the HOMA-IR and QUICKI-IS indexes and HDL cholesterol. Triglyceride levels were higher and the IGF-1 was lower in the SPE group than in the control group. Conclusions. There were no differences in the insulin resitance indexes between the group with SPE and normal controls.

Protein Creatinine Ratio in Random Urine Sample of Hypertensive Pregnant Women: Maternal and Perinatal Outcomes

Objective. To compare protein/creatinine ratio (PCR) in random urine sample levels and adverse outcomes in hypertensive pregnant women. Methods. A total of 370 medical charts from hypertensive pregnant women were reviewed and stratified into three groups according to different PCR in random urine sample levels (group 1: PCR < 0.3 mg/mg; group 2: PCR 0.3–1.99 mg/mg; group 3: PCR ≥ 2.0 mg/mg) and compared with composite maternal and perinatal outcomes. Those outcomes were severe hypertension, thrombocytopenia, high lactate dehydrogenase count, disseminated intravascular coagulation, abruptio placentae, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, eclampsia, perinatal death, newborn cerebral hemorrhage, respiratory distress syndrome of newborn, neonatal sepsis, and newborn small for gestational age. Results. To obtain a composite maternal adverse outcome the odds ratio [ORs] between PCR groups were 1.8 (95% confidence interval [CI]: 1.1–3.2) between groups 1 and 2, and 3.1 (95% CI: 1.5–6.3) between groups 1 and 3; for composite perinatal adverse outcomes, the ORs were 3.0 (95% CI: 1.5–5.9) between groups 1 and 2, and 3.4 (95% CI: 1.6–7.5) between groups 1 and 3. Conclusions. Hypertensive pregnant women with a PCR ≥ 0.3 mg/mg, had worse maternal and perinatal outcomes than those with PCR < 0.3 mg/mg. Above the cut-off of 0.3 mg/mg, higher PCRs are not associated with a significant increase in maternal and perinatal morbidity.

Síndrome Hemolítico-Urêmica Pós-parto: Relato de Caso

The hemolytic - uremic syndrome (HUS) presents with a triad of acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia associated with high morbidity and mortality. On the differential diagnosis, other entities must be considered like preeclampsia, HELLP syndrome, acute fatty liver of pregnancy and thrombotic thrombocytopenic purpura. We report a case of HUS occurring in the immediate postpartum period in a patient initially diagnosed as having preeclampsia. The differential diagnosis was based on abrupt renal failure, blood pressure increase and clinical and laboratorial evidence of hemolysis. Attention is directed to investigation, clinical management and prognosis based on review of the literature.

Insulin stimulation of Akt/PKB phosphorylation in the placenta of preeclampsia patients

CONTEXT AND OBJECTIVEnPreeclampsia is a multi-systemic disease and one of the most frequent severe health problems during pregnancy. Binding of insulin triggers phosphorylation and activates cytoplasmic substrates such as phosphatidylinositol 3 kinase (PI3K). Phosphorylation of membrane phosphoinositide 2 (PIP2) to phosphoinositide 3 (PIP3) by PI3K starts Akt/PKB activation. Defects in phosphorylation of the insulin receptor and its substrates have an important role in insulin resistance. Studies have shown that insulin resistance is associated with preeclampsia and its pathophysiology. The aim here was to investigate insulin stimulation of the Akt/PKB pathway in the placenta, in normal and preeclampsia parturients.nnnDESIGN AND SETTINGnCross-sectional study in a tertiary public university hospital.nnnMETHODSnPlacentas were collected from 12 normal and 12 preeclampsia patients. These were stimulated and analyzed using Western blot to quantify the Akt/PKB phosphorylation.nnnRESULTSnThe insulin stimulation was confirmed through comparing the stimulated group (1.14 ± 0.10) with the non-stimulated group (0.91 ± 0.08; P < 0.001). The phosphorylation of Akt/PKB did not differ between the placenta of the normal patients (1.26 ± 0.16) and those of the preeclampsia patients (1.01 ± 0.11; P = 0.237).nnnCONCLUSIONSnIn vitro insulin stimulation of the human placenta has been well established. There was no difference in Akt/PKB phosphorylation, after stimulation with insulin, between placentas of normal and preeclampsia patients. Nevertheless, it cannot be ruled out that the Akt/PKB signaling pathway may have a role in the pathophysiology of preeclampsia, since the substrates of Akt/PKB still need to be investigated.

Comparison of serum selenium levels among hypertensive and normotensive pregnant women

ABSTRACT Objective: To correlate serum selenium levels with hypertensive disorders of pregnancy (HDP) in a selected population and evaluate this mineral as a possible protective factor. Methods: This case–control study included 32 normotensive, 20 hypertensive (chronic and gestational hypertension), and 38 preeclamptic pregnant women. All patients were recruited from antenatal or obstetric admissions of a tertiary hospital in Brazil. Serum selenium was measured at the time of inclusion. Patients were followed up until hospital discharge after delivery. Results: Groups did not differ with regard to maternal age, ethnicity, educational attainment, parity, or smoking prevalence. Normotensive patients had lower body mass index and were included in the study earlier. These patients also had a higher prevalence of comorbidities other than hypertension. Continuous use of medication and a history of HDP in previous pregnancies were more common in preeclamptic patients. Serum selenium levels were not significantly different between groups, with an average of 56.4 ± 15.3u2009μg/L in the control group, 53.2 ± 15.2u2009μg/L in the hypertension group, and 53.3 ± 16.8u2009μg/L in the preeclampsia group (pu2009=u20090.67). Among patients with preeclampsia, 52.6% had the severe form. Serum selenium levels in these patients also did not differ significantly from those of controls (pu2009=u20090.77). Preeclampsia was associated with earlier termination of pregnancy and lower birth weight (pu2009<u20090.05). There were no significant differences across groups in other outcomes of interest. Conclusion: Serum selenium levels did not differ significantly between groups. Thus, we could not establish whether selenium is a protective factor against these conditions.

Calcium-to-creatinine ratio in pregnancy-induced hypertension☆

OBJECTIVESnHypocalciuria has been correlated with preeclampsia. This study compared the calcium-to-creatinine ratio among the groups, and the correlation with the 24-h measurement of this ratio and a diagnosis of preeclampsia.nnnSTUDY DESIGNnCase-control study including mild and severe preeclampsia, chronic hypertension and normal pregnancy.nnnMAIN OUTCOME MEASUREMENTSnThe calcium-to-creatinine ratio differentiates severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy.nnnRESULTSnThere were statistically significant differences between the groups when comparing severe preeclampsia and chronic hypertension, severe preeclampsia and normal pregnancy, and mild and severe preeclampsia (p<0.0001). The Spearman index between the calcium-to-creatinine ratio and 24-h calciuria was 0.65 (high correlation).nnnCONCLUSIONSnThe calcium-to-creatinine ratio can reliably estimate 24-h calciuria, differentiating severe preeclampsia from mild preeclampsia, chronic hypertension and normal pregnancy.