Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy

Obstetrics and gynecology 11/2013; 122(5):1122-1131.
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    ABSTRACT: Pregnancy may precipitate acute episodes of thrombotic thrombocytopenic purpura (TTP), but pregnancy outcomes in women who have recovered from acquired TTP are not well documented. We analyzed pregnancy outcomes following recovery from TTP associated with acquired, severe ADAMTS13 deficiency (ADAMTS13 activity <10%) in women enrolled in the Oklahoma TTP-HUS (hemolytic-uremic syndrome) Registry, 1995-2012. We also systematically searched for published reports on outcomes of pregnancies following recovery from TTP associated with acquired, severe ADAMTS13 deficiency. Ten women in the Oklahoma Registry had 16 subsequent pregnancies, 1999-2013. Two women had recurrent TTP, which occurred nine and 29 days postpartum. Five of 16 pregnancies (31%, 95% confidence interval, 11-59%) in three women were complicated by preeclampsia, a frequency greater than US population estimates (2.1 - 3.2%). Thirteen (81%) pregnancies resulted in normal children. The literature search identified 382 articles. Only six articles reported pregnancies in women who had recovered from TTP associated with acquired, severe ADAMTS13 deficiency, describing 10 pregnancies in eight women. TTP recurred in six pregnancies. Conclusions: With prospective complete follow-up, recurrent TTP complicating subsequent pregnancies in Oklahoma patients is uncommon, but the occurrence of preeclampsia may be increased. Most pregnancies following recovery from TTP in Oklahoma patients result in normal children.
    Blood 01/2014; 123(11). DOI:10.1182/blood-2013-11-538900 · 10.43 Impact Factor
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    ABSTRACT: Heart disease is the leading cause of death in women in all countries. A history of pre-eclampsia, one of the most deadly hypertensive complications of pregnancy, increases cardiovascular risk by two to four times, which is comparable with the risk induced by smoking. Substantial epidemiological data reveal that pregnancy-related hypertensive complications are associated with a predisposition to chronic hypertension, premature heart attacks, strokes, and renal complications. In this review, we summarize clinical studies that demonstrate this relationship and also discuss the pathogenesis of these long-term complications of pre-eclampsia. Future studies should focus on strategies to prevent the progression of cardiovascular disease in women exposed to pre-eclampsia, thereby improving long-term cardiovascular health in women.
    Cardiovascular Research 02/2014; 101(4). DOI:10.1093/cvr/cvu018 · 5.81 Impact Factor
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    ABSTRACT: Objective To compare infant outcomes between mothers with hypertension treated by beta-blockers alone and by methyldopa alone during pregnancy.DesignHistorical cohort study.SettingSaskatchewan, Canada.PopulationWomen who delivered a singleton birth in Saskatchewan during the periods from 1 January 1980 to 30 June 1987 or from 1 January 1990 to 31 December 2005 (women who delivered between 1 July 1987 and 31 December 1989 were excluded because the information recorded on maternal drug use during pregnancy is incomplete) with a diagnosis of a hypertensive disorder during pregnancy, and who were dispensed only beta-blockers (n = 416) or only methyldopa (n = 1000).Methods Occurrences of adverse infant outcomes were compared between women who received beta-blockers only and women who received methyldopa only during pregnancy, first in all eligible women, and then in women with chronic hypertension and in women with gestational hypertension or pre-eclampsia/eclampsia, separately. Multiple logistic regression analyses were performed to adjust for potential confounding. Main outcome measuresSmall for gestational age (SGA) < 10th percentile, SGA < 3rd percentile, preterm birth, stillbirth, institutionalisation for respiratory distress syndrome (RDS), sepsis, seizure during infancy, and infant death.ResultsAdjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for infants born to mothers with chronic hypertension who were dispensed beta-blockers only, as compared with infants born to mothers who were dispensed methyldopa only, during pregnancy were: 1.95 (1.21–3.15), 2.17 (1.06–4.44), and 2.17 (1.09–4.34), respectively, for SGA < 10th percentile, SGA < 3rd percentile, and being institutionalised during infancy.Conclusions For infants born to mothers with chronic hypertension, compared with those treated by methyldopa alone, those treated by beta-blockers appear to be at increased rates of SGA and hospitalisation during infancy.
    BJOG An International Journal of Obstetrics & Gynaecology 03/2014; 121(9). DOI:10.1111/1471-0528.12678 · 3.86 Impact Factor
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