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Latest & greatest articles for preeclampsia
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Protein/Creatinine ratio in preeclampsia: a systematic review To estimate the accuracy of the protein/creatinine ratio in predicting 300 mg of protein in 24-hour urine collection in pregnant patients with suspected preeclampsia.Articles were identified through electronic databases (MEDLINE, CINHAL, and Cochrane) using the terms "preeclampsia," "protein/creatinine ratio," and "diagnosis," during the period January 1966 to October 2007. The relevant citations were hand searched.Included studies (...) evaluated patients for suspected preeclampsia with a 24-hour urine sample and a protein/creatinine ratio. Only English-language articles were included. Studies including patients with only chronic illness such as chronic hypertension, diabetes mellitus, or renal impairment were excluded. Using the Quality Assessment of Diagnostic Accuracy Studies questionnaire, we created group 1 satisfying all the required criteria and group 2 not satisfying all of it. Two researchers independently extracted
Maternal infection and risk of preeclampsia: systematic review and metaanalysis. There are lingering questions regarding the association between maternal infection and preeclampsia. Systematic review and metaanalysis was conducted of observational studies that examined the relationship between maternal infection and preeclampsia. Forty-nine studies met the inclusion criteria. The risk of preeclampsia was increased in pregnant women with urinary tract infection (pooled odds ratio, 1.57; 95% CI (...) , 1.45-1.70) and periodontal disease (pooled odds ratio, 1.76; 95% CI, 1.43-2.18). There were no associations between preeclampsia and presence of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus, treated and nontreated HIV infection, and malaria. Individual studies did not find a relationship between herpes simplex virus type 2, bacterial vaginosis, and Mycoplasma hominis and preeclampsia. Urinary tract infection and periodontal disease during pregnancy are associated
Alternative complement pathway activation fragment Bb in early pregnancy as a predictor of preeclampsiaPreeclampsia is a multisystem disease classically defined on the basis of hypertension and proteinuria. As shown in animal studies, complement activation is associated with inflammation in the placenta and adverse pregnancy outcomes. The association between complement activation in humans and adverse pregnancy outcomes is unclear. The purpose of this study was to determine whether elevated (...) levels of the activation fragment Bb in early pregnancy are predictive of preeclampsia.This prospective study of 701 women was conducted in Denver, CO. A single plasma sample was obtained from each woman before 20 weeks' gestation. The cohort was followed up throughout pregnancy for the development of preeclampsia. Analysis included multivariate logistic regression to adjust for established risk factors for preeclampsia.Preeclampsia developed in 4.6% of the cohort. Women with elevated Bb (90th
Antioxidant Therapy to Prevent Preeclampsia: A Randomized Controlled Trial. OBJECTIVE: To study whether antioxidant supplementation will reduce the incidence of preeclampsia among patients at increased risk. METHODS: A randomized, placebo-controlled, double-blind clinical trial was conducted at four Brazilian sites. Women between 12 0/7 weeks and 19 6/7 weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomly assigned to daily treatment (...) with both vitamin C (1,000 mg) and vitamin E (400 International Units) or placebo. Analyses were adjusted for clinical site and risk group (prior preeclampsia, chronic hypertension, or both). A sample size of 734 would provide 80% power to detect a 40% reduction in the risk of preeclampsia, assuming a placebo group rate of 21% and alpha=.05. The alpha level for the final analysis, adjusted for interim looks, was 0.0458. RESULTS: Outcome data for 707 of 739 randomly assigned patients revealed
Combined vitamin C and E supplementation during pregnancy for preeclampsia prevention: a systematic review Combined vitamin C and E supplementation during pregnancy for preeclampsia prevention: a systematic review Combined vitamin C and E supplementation during pregnancy for preeclampsia prevention: a systematic review Polyzos N P, Mauri D, Tsappi M, Tzioras S, Kamposioras K, Cortinovis I, Casazza G CRD summary This review assessed the effects of combined vitamin C and E supplementation during (...) , Cortinovis I, Casazza G. Combined vitamin C and E supplementation during pregnancy for preeclampsia prevention: a systematic review. Obstetrical and Gynecological Survey 2007; 62(3): 202-206 PubMedID DOI Indexing Status Subject indexing assigned by NLM MeSH Antioxidants /therapeutic use; Ascorbic Acid /therapeutic use; Dietary Supplements; Female; Humans; Pre-Eclampsia /prevention & Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk /drug effects; Randomized Controlled Trials as Topic; Risk Assessment
Trends in fetal and infant survival following preeclampsia. Management of preeclampsia often culminates in induced delivery of a very preterm infant. While early termination protects the fetus from an intrauterine death, the newborn then faces increased risks associated with preterm delivery. This practice has increased in recent decades, but its net effect on fetal and infant survival has not been assessed.To assess the effect on fetal and infant survival of increased rates of early delivery
Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. Alterations in circulating soluble fms-like tyrosine kinase 1 (sFlt1), an antiangiogenic protein, and placental growth factor (PlGF), a proangiogenic protein, appear to be involved in the pathogenesis of preeclampsia. Since soluble endoglin, another antiangiogenic protein, acts together with sFlt1 to induce a severe preeclampsia-like syndrome in pregnant rats, we examined whether it is associated with preeclampsia (...) in women.We performed a nested case-control study of healthy nulliparous women within the Calcium for Preeclampsia Prevention trial. The study included all 72 women who had preterm preeclampsia (<37 weeks), as well as 480 randomly selected women--120 women with preeclampsia at term (at > or =37 weeks), 120 women with gestational hypertension, 120 normotensive women who delivered infants who were small for gestational age, and 120 normotensive controls who delivered infants who were not small
Vitamins C and E and the risks of preeclampsia and perinatal complications. Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain.We conducted a multicenter, randomized trial of nulliparous women between 14 and 22 weeks of gestation. Women were assigned to daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or placebo (microcrystalline cellulose) until (...) delivery. Primary outcomes were the risks of maternal preeclampsia, death or serious outcomes in the infants (on the basis of definitions used by the Australian and New Zealand Neonatal Network), and delivering an infant whose birth weight was below the 10th percentile for gestational age.Of the 1877 women enrolled in the study, 935 were randomly assigned to the vitamin group and 942 to the placebo group. Baseline characteristics of the two groups were similar. There were no significant differences
Urinary placental growth factor and risk of preeclampsia. Preeclampsia may be caused by an imbalance of angiogenic factors. We previously demonstrated that high serum levels of soluble fms-like tyrosine kinase 1 (sFlt1), an antiangiogenic protein, and low levels of placental growth factor (PlGF), a proangiogenic protein, predict subsequent development of preeclampsia. In the absence of glomerular disease leading to proteinuria, sFlt1 is too large a molecule to be filtered into the urine, while (...) PlGF is readily filtered.To test the hypothesis that urinary PlGF is reduced prior to onset of hypertension and proteinuria and that this reduction predicts preeclampsia.Nested case-control study within the Calcium for Preeclampsia Prevention trial of healthy nulliparous women enrolled at 5 US university medical centers during 1992-1995. Each woman with preeclampsia was matched to 1 normotensive control by enrollment site, gestational age at collection of the first serum specimen, and sample
Prevention of preeclampsia with low-dose aspirin: a systematic review and meta-analysis of the main randomized controlled trials Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Circulating angiogenic factors and the risk of preeclampsia. The cause of preeclampsia remains unclear. Limited data suggest that excess circulating soluble fms-like tyrosine kinase 1 (sFlt-1), which binds placental growth factor (PlGF) and vascular endothelial growth factor (VEGF), may have a pathogenic role.We performed a nested case-control study within the Calcium for Preeclampsia Prevention trial, which involved healthy nulliparous women. Each woman with preeclampsia was matched to one (...) . These changes occurred earlier and were more pronounced in the women in whom preeclampsia later developed. The sFlt-1 level increased beginning approximately five weeks before the onset of preeclampsia. At the onset of clinical disease, the mean serum level in the women with preeclampsia was 4382 pg per milliliter, as compared with 1643 pg per milliliter in controls with fetuses of similar gestational age (P<0.001). The PlGF levels were significantly lower in the women who later had preeclampsia than
Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan K S CRD summary This review examined the effectiveness of aspirin in preventing perinatal death and pre-eclampsia in women with predisposing factors (...) should be considered in women with risk factors. Research: The authors stated that research is needed to address the possible cost-benefits of implementing this strategy to health care systems and society. Bibliographic details Coomarasamy A, Honest H, Papaioannou S, Gee H, Khan K S. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstetrics and Gynecology 2003; 101(6): 1319-1332 PubMedID Other publications of related interest 1. Knight M, Duley L
The interval between pregnancies and the risk of preeclampsia. The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation is that the risk is reduced with repeated maternal exposure and adaptation to specific antigens from the same partner. However, the difference in risk might instead be explained by the interval between births. A longer interbirth interval may be associated (...) . The risk in a second or third pregnancy was directly related to the time that had elapsed since the preceding delivery, and when the interbirth interval was 10 years or more, the risk approximated that among nulliparous women. After adjustment for the presence or absence of a change of partner, maternal age, and year of delivery, the odds ratio for preeclampsia for each one-year increase in the interbirth interval was 1.12 (95 percent confidence interval, 1.11 to 1.13). In unadjusted analyses
Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Coomarasamy A, Papaioannou S, Gee H, Khan K S Authors' objectives To assess the effect of aspirin in preventing pre-eclampsia in women identified as being at high risk (...) , Khan K S. Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis. Obstetrics and Gynecology 2001; 98(5 Part 1): 861-866 PubMedID Other publications of related interest 1. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness. CRD's guidance for those carrying out or commissioning reviews. York: University of York, NHS Centre for Reviews and Dissemination; 2001. Report No.: CRD report 4 (2nd ed.). 2
Magnesium sulfate therapy in preeclampsia and eclampsia Magnesium sulfate therapy in preeclampsia and eclampsia Magnesium sulfate therapy in preeclampsia and eclampsia Witlin A G, Sibai B M Authors' objectives To review the available evidence regarding efficacy, benefits and risks of magnesium sulphate seizure prophylaxis in women with pre-eclampsia or eclampsia. Searching MEDLINE (1966 to February, 1998). The search terms are given. Bibliographies of retrieved articles were scanned and experts (...) details Witlin A G, Sibai B M. Magnesium sulfate therapy in preeclampsia and eclampsia. Obstetrics and Gynecology 1998; 92(5): 883-889 PubMedID Other publications of related interest 1. Fisher M (ed). Guide to clinical preventive service: an assessment of the effectiveness of 169 interventions. Report of the U.S. Preventive Services Task Force. Baltimore (MD): Williams & Wilkins; 1989. Indexing Status Subject indexing assigned by NLM MeSH Anticonvulsants /adverse effects /pharmacology /therapeutic use
Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Whether low-dose aspirin prevents preeclampsia is unclear. It is not recommended as prophylaxis in women at low risk for preeclampsia but may reduce the incidence of the disease in women at high risk.We conducted a double-blind, randomized, placebo-controlled trial in four groups of pregnant women at high risk for preeclampsia (...) , including 471 women with pregestational insulin-treated diabetes mellitus, 774 women with chronic hypertension, 688 women with multifetal gestations, and 606 women who had had preeclampsia during a previous pregnancy. The women were enrolled between gestational weeks 13 and 26 and received either 60 mg of aspirin or placebo daily.Outcome data were obtained on all but 36 of the 2539 women who entered the study. The incidence of preeclampsia was similar in the 1254 women in the aspirin group and the 1249
Trial of calcium to prevent preeclampsia. Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations studied limit acceptance of the data.We randomly assigned 4589 healthy nulliparous women who were 13 to 21 weeks pregnant to receive daily treatment with either 2 g of elemental calcium or placebo for the remainder of their pregnancies. Surveillance (...) for preeclampsia was conducted by personnel unaware of treatment-group assignments, using standardized measurements of blood pressure and urinary protein excretion at uniformly scheduled prenatal visits, protocols for monitoring these measurements during the hospitalization for delivery, and reviews of medical records of unscheduled outpatient visits and all hospitalizations.Calcium supplementation did not significantly reduce the incidence or severity of preeclampsia or delay its onset. Preeclampsia occurred
Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials Bucher H C, Guyatt G H, Cook R J, Hatala R, Cook D J, Lang J D, Hunt D L Authors' objectives (...) Interest no.4). In addition, this meta-analysis employs stricter inclusion criteria and quality assessments. Funding National Dairy Council; Swiss National Research Foundation, grant number 32-38793.93. Bibliographic details Bucher H C, Guyatt G H, Cook R J, Hatala R, Cook D J, Lang J D, Hunt D L. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. JAMA 1996; 275(14): 1113-1117 PubMedID Other publications of related
Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. To review the effect of calcium supplementation during pregnancy on blood pressure, preeclampsia, and adverse outcomes of pregnancy.We searched MEDLINE and EMBASE for 1966 to May 1994. We contacted authors of eligible trials to ensure accuracy and completeness of data and to identify unpublished trials.Fourteen randomized trials involving 2459 women were (...) ratio for preeclampsia in women with calcium supplementation compared with placebo was 0.38 (95% CI, 0.22 to 0.65).Calcium supplementation during pregnancy leads to an important reduction in systolic and diastolic blood pressure and preeclampsia. While pregnant women at risk of preeclampsia should consider taking calcium, many more patient events are needed to confirm calcium's impact on maternal and fetal morbidity.
Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Although low-dose aspirin has been reported to reduce the incidence of preeclampsia among women at high risk for this complication, its efficacy and safety in healthy, nulliparous pregnant women are not known.We studied 3135 normotensive nulliparous women who were 13 to 26 weeks pregnant to determine (...) whether treatment with aspirin reduced the incidence of preeclampsia. Of this group, 1570 women received 60 mg of aspirin per day and 1565 received placebo for the remainder of their pregnancies. We also evaluated the effect of aspirin on maternal and neonatal morbidity.Of the original group of 3135 women, 2985 (95 percent) were followed throughout pregnancy and the immediate puerperium. The incidence of preeclampsia was lower in the aspirin group (69 of 1485 women [4.6 percent]) than in the placebo