Ellen W Seely

Harvard University, Cambridge, Massachusetts, United States

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Publications (146)958.29 Total impact

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    ABSTRACT: Objective The postpartum period is a window of opportunity for diabetes prevention in women with recent gestational diabetes (GDM), but recruitment for clinical trials during this period of life is a major challenge. Methods We adapted a social-ecologic model to develop a multi-level recruitment strategy at the macro (high or institutional level), meso (mid or provider level), and micro (individual) levels. Our goal was to recruit 100 women with recent GDM into the Balance after Baby randomized controlled trial over a 17-month period. Participants were asked to attend three in-person study visits at 6 weeks, 6, and 12 months postpartum. They were randomized into a control arm or a web-based intervention arm at the end of the baseline visit at six weeks postpartum. At the end of the recruitment period, we compared population characteristics of our enrolled subjects to the entire population of women with GDM delivering at Brigham and Women's Hospital (BWH). Results We successfully recruited 107 of 156 (69 %) women assessed for eligibility, with the majority (92) recruited during pregnancy at a mean 30 (SD ± 5) weeks of gestation, and 15 recruited postpartum, at a mean 2 (SD ± 3) weeks postpartum. 78 subjects attended the initial baseline visit, and 75 subjects were randomized into the trial at a mean 7 (SD ± 2) weeks postpartum. The recruited subjects were similar in age and race/ethnicity to the total population of 538 GDM deliveries at BWH over the 17-month recruitment period. Conclusions Our multilevel approach allowed us to successfully meet our recruitment goal and recruit a representative sample of women with recent GDM. We believe that our most successful strategies included using a dedicated in-person recruiter, integrating recruitment into clinical flow, allowing for flexibility in recruitment, minimizing barriers to participation, and using an opt-out strategy with providers. Although the majority of women were recruited while pregnant, women recruited in the early postpartum period were more likely to present for the first study visit. Given the increased challenges of recruiting postpartum women with GDM into research studies, we believe our findings will be useful to other investigators seeking to study this population.
    Maternal and Child Health Journal 11/2015; DOI:10.1007/s10995-015-1825-8 · 2.24 Impact Factor
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    ABSTRACT: Background: -The pathophysiology of hypertension in the immediate postpartum period is unclear. Methods and results: -We studied 988 consecutive women admitted to a tertiary medical center for cesarean section of a singleton pregnancy. Angiogenic factors, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF), both biomarkers associated with preeclampsia, were measured on antepartum blood samples. We then performed multivariable analyses to determine factors associated with the risk of developing postpartum hypertension. Of the 988 women, 184 women (18.6%) developed postpartum hypertension. 77 out of 184 women developed de novo hypertension in the postpartum period and the remainder had a hypertensive disorder of pregnancy in the antepartum period. A higher body mass index and history of diabetes mellitus were associated with development of postpartum hypertension. The antepartum sFlt1/PlGF ratio positively correlated with blood pressures in the postpartum period [highest postpartum systolic (r=0.29; P<0.001) and diastolic (r=0.28, P<0.001)]. Moreover, the highest tertile of the antepartum sFlt1/PlGF ratio was independently associated with postpartum hypertension [OR: 2.25 (1.19, 4.25), P=0.01 in the de novo hypertensive group and 2.61 (1.12, 6.05) in the persistent hypertensive group; P=0.02] in multivariable analysis. Women developing postpartum hypertension had longer hospitalization than those who remained normotensive (6.5 ± 3.5 versus 5.7 ± 3.4 days; P<0.001). Conclusions: -Hypertension in the postpartum period is relatively common and is associated with prolonged hospitalization. Women with postpartum hypertension share similar clinical risk factors as well as a similar antepartum plasma angiogenic profile found in women with preeclampsia. These data suggest that postpartum hypertension may represent a group of women with subclinical or unresolved preeclampsia.
    Circulation 09/2015; DOI:10.1161/CIRCULATIONAHA.115.015721 · 14.43 Impact Factor
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    ABSTRACT: To assess whether maternal calcium channel blocker exposure during late pregnancy is independently associated with neonatal seizures after carefully controlling for confounding factors. Data were derived from the Medicaid Analytic eXtract for the years 2000-2007 and included 2,529,636 completed pregnancies. We compared the risk of neonatal seizures among neonates who were born to women who took calcium channel blockers in the final month of pregnancy to the risk in neonates born to women who did not use calcium channel blockers. Confounding was addressed through the use of propensity score matching. A total of 22,908 (0.91%) pregnancies included exposure to calcium channel blockers during the final month of pregnancy. Neonatal seizures occurred in 53 (0.23%) neonates born to mothers exposed to calcium channel blockers and in 4,609 (0.18%) neonates of unexposed women (unadjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 0.96-1.65). After accounting for confounders, there was no increase in risk of neonatal seizures associated with calcium channel blocker exposure (OR 0.95, 95% CI 0.70-1.30). This null finding was robust across multiple sensitivity analysis. In this large, carefully controlled, population-based cohort study, there was no significant increase in the risk of neonatal seizures in neonates attributable to maternal calcium channel blocker exposure in late pregnancy. The results suggest that calcium channel blockers can be used by obstetricians in late pregnancy without excess concern about this neonatal complication. II.
    Obstetrics and Gynecology 08/2015; 126(2):271-278. DOI:10.1097/AOG.0000000000000908 · 5.18 Impact Factor
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    ABSTRACT: To evaluate whether an electronic health record (EHR) reminder improves rates of screening for type 2 diabetes in women with prior gestational diabetes. We randomly allocated primary care providers (by clinic site) to a reminder for type 2 diabetes screening within the EHR or to usual care. Women with previous gestational diabetes mellitus were identified through an automated search of laboratory results and the problem list. We compared rates of screening during the study period (2010-2012) in women at intervention sites with those at control sites. With a sample size of 850 participants, we had 80% power to detect a 15% difference in screening rates. We included 847 individuals seen at a participating clinic during the study period, of whom 471 were at a reminder clinic and 376 were at a control clinic. A similar proportion of women were screened for type 2 diabetes in both groups (n=265, 56.3% of the reminder group compared with n=206, 54.8% of the control group, P=.67; adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.79-1.38). Patient characteristics associated with risk for diabetes including body mass index (adjusted OR per kg/m 1.05, 95% CI 1.01-1.08) and race (adjusted OR for nonwhite race 2.14, 95% CI 1.57-2.92) were significantly associated with screening. A simple EHR reminder did not increase the rate of diabetes screening in women with prior gestational diabetes mellitus. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01288144. I.
    Obstetrics and Gynecology 07/2015; 126(1). DOI:10.1097/AOG.0000000000000883 · 5.18 Impact Factor
  • Ellen W. Seely · Eleni Tsigas · Janet W Rich-Edwards ·
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    ABSTRACT: Women with a history of preeclampsia have double the risk of future heart disease and stroke, and elevated risks of hypertension and diabetes. The American Heart Association (AHA) and the American College of Obstetrics and Gynecology now include preeclampsia as a risk factor for future cardiovascular disease (CVD) with the recommendation of obtaining a history of preeclampsia and improving lifestyle behaviors for women with such a history. Research has progressed from asking whether preeclampsia is associated with CVD to how preeclampsia is associated with CVD, and the implications for prevention of CVD among women with a history of preeclampsia. A history of preeclampsia "unmasks" future CVD risk; research is inconclusive whether it also causes vascular damage that leads to CVD. For women with prior preeclampsia, the AHA recommends CVD risk reduction actions similar to those for other "at risk" groups: cessation of cigarette smoking, physical activity, weight reduction if overweight or obese and counseling to follow a "DASH" like diet. The efficacy of these lifestyle modifications to lower risk of CVD in women with prior preeclampsia remains to be determined. Barriers exist to implementing lifestyle improvement measures in this population, including lack of awareness of both patients and clinicians of this link between preeclampsia and CVD. We review patient, provider, and systems level barriers and solutions to leverage this information to prevent CVD among women with a history of preeclampsia. Copyright © 2015 Elsevier Inc. All rights reserved.
    Seminars in perinatology 06/2015; 39(4). DOI:10.1053/j.semperi.2015.05.006 · 2.68 Impact Factor
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    ABSTRACT: We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r=0.95), and gestation length (r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease.
    Journal of Women's Health 05/2015; 24(9). DOI:10.1089/jwh.2014.4953 · 2.05 Impact Factor
  • Louise Wilkins-Haug · Ann Celi · Ann Thomas · Joseph Frolkis · Ellen W. Seely ·
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    ABSTRACT: To assess health care providers' knowledge regarding pregnancy outcome as a risk factor for cardiovascular disease and evaluate the variables associated with their responses to questions about routine surveillance for cardiovascular disease. A voluntary, anonymous survey of internal medicine and obstetric and gynecologic health care providers at an academic institution. Responses to a case-based and direct inquiry questionnaire were evaluated. The overall response rate was 65% (173/265). When assessing cardiovascular risk, gynecologists compared with internists significantly more often requested a pregnancy history (44/49 [90%] compared with 56/75 [75%], P=.039) and more often attached importance to a history of preeclampsia (35/48 [73%] compared with 41/75 [55%], P=.028). When a history of preeclampsia was obtained, internists more often obtained a fasting glucose test (25/52 [48%] compared with 9/43 [20.9%], P=.009). A minority of health care providers recognized the importance of fetal growth restriction. Both health care provider groups demonstrated similar knowledge of general cardiovascular risk factors, screening tools, and interventions. Higher general cardiovascular knowledge was significantly associated with identification of pregnancy complications as cardiovascular risk factors (P=.001). When assessing cardiovascular risk, internists were less likely than gynecologists to include a pregnancy history. However, once identified as at risk for cardiovascular disease, gynecologists were less likely than internists to obtain appropriate testing. Education concerning the link between certain pregnancy complications and future cardiovascular disease is needed. Areas of opportunity for education in both medical specialties are identified.
    Obstetrics and Gynecology 05/2015; 125(6):1. DOI:10.1097/AOG.0000000000000856 · 5.18 Impact Factor
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    ABSTRACT: Chronic kidney disease affects approximately one in ten North Americans and is associated with a high risk of cardiovascular disease. Chronic kidney disease in women is characterized by an abnormal sex hormone profile and low estradiol levels. Since low estradiol levels are associated with an increased cardiovascular risk in healthy women, our objective is to determine the effect of hormone therapy on all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease. Studies examining hormone therapy for adult women with chronic kidney disease will be included. The primary outcome is all-cause or cardiovascular mortality and morbidity. We will search electronic bibliographic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL)) along with relevant conference proceedings, table of contents of journals, and review articles. Two investigators will independently screen identified abstracts and select observational cohort studies, case-control studies, and randomized controlled trials examining hormone therapy in women with chronic kidney disease. These investigators will also independently abstract data from relevant full-text journal articles and assess risk of bias. Where possible, these data will be summarized using pooled or combined estimates for the risk ratio or hazard ratio of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease with and without hormone therapy. A random effects model will be used, and meta-regression and subgroup analyses will be used to explore potential source of heterogeneity. Given the high burden of cardiovascular disease in women with chronic kidney disease, this study will help guide clinical practice by summarizing current evidence on the use of hormone therapy for prevention of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in this population. The final protocol was registered with PROSPERO ( CRD42014014566) .
    Systematic Reviews 04/2015; 4(1):44. DOI:10.1186/s13643-015-0020-8
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    ABSTRACT: Introduction: Innovative approaches are needed to reduce cardiometabolic risk among American Indian women with a history of gestational diabetes. We assessed beliefs of Oklahoma American Indian women about preventing type 2 diabetes and cardiovascular disease after having gestational diabetes. We also assessed barriers and facilitators to healthy lifestyle changes postpartum and intervention approaches that facilitate participation in a postpartum lifestyle program. Methods: In partnership with a tribal health system, we conducted a mixed-method study with American Indian women aged 19 to 45 years who had prior gestational diabetes, using questionnaires, focus groups, and individual interviews. Questionnaires were used to identify women's cardiometabolic risk perceptions and feasibility and acceptability of Internet or mobile phone technology for delivery of a postpartum lifestyle modification program. Focus groups and individual interviews were conducted to identify key perspectives and preferences related to a potential program. Results: Participants were 26 women, all of whom completed surveys; 11 women participated in focus group sessions, and 15 participated in individual interviews. Most women believed they would inevitably develop diabetes, cardiovascular disease, or both; however, they were optimistic that they could delay onset with lifestyle change. Most women expressed enthusiasm for a family focused, technology-based intervention that emphasizes the importance of delaying disease onset, provides motivation, and promotes accountability while accommodating women's competing priorities. Conclusions: Our findings suggest that an intervention that uses the Internet, text messaging, or both and that emphasizes the benefits of delaying disease onset should be tested as a novel, culturally relevant approach to reducing rates of diabetes and cardiovascular disease in this high-risk population.
    Preventing chronic disease 04/2015; 12(4). DOI:10.5888/pcd12.140566 · 2.12 Impact Factor
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    ABSTRACT: To examine the teratogenic potential of statins. Cohort study. United States. A cohort of 886 996 completed pregnancies linked to liveborn infants of women enrolled in Medicaid from 2000 to 2007. We examined the risk of major congenital malformations and organ specific malformations in offspring associated with maternal use of a statin in the first trimester. Propensity score based methods were used to control for potential confounders, including maternal demographic characteristics, obstetric and medical conditions, and use of other drugs. 1152 (0.13%) women used a statin during the first trimester. In unadjusted analyses, the prevalence of malformations in the offspring of these women was 6.34% compared with 3.55% in those of women who did not use a statin in the first trimester (relative risk 1.79, 95% confidence interval 1.43 to 2.23). Controlling for confounders, particularly pre-existing diabetes, accounted for this increase in risk (1.07, 0.85 to 1.37). There were also no statistically significant increases in any of the organ specific malformations assessed after accounting for confounders. Results were similar across a range of sensitivity analyses. Our analysis did not find a significant teratogenic effect from maternal use of statins in the first trimester. However, these findings need to be replicated in other large studies, and the long term effects of in utero exposure to statins needs to be assessed, before use of statins in pregnancy can be considered safe. © Bateman et al 2015.
    BMJ (online) 03/2015; 350(mar17 10):h1035. DOI:10.1136/bmj.h1035 · 17.45 Impact Factor
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    ABSTRACT: To determine the most accurate questions for providers to ask patients when taking a history of pregnancy complications, as recommended by the 2011 American Heart Association's (AHA) Guidelines for the Prevention of Cardiovascular Disease in Women. A pregnancy recall questionnaire was administered to 971 patients who agreed to be contacted for future research after participating in a prospective, longitudinal cohort of 1608 pregnant women, initiating care between 2006 and 2009. The survey included several questions for each pregnancy complication, informed by a literature review and pilot study. Medical records from the study pregnancy were used as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV) and/or Spearman's correlation coefficients were calculated for each question. 54% (526) of individuals re-contacted responded. Responders were more likely to be older, white, educated, nulliparous, and deliver low birthweight infants at the time of the index pregnancy than non-responders. Mean length of recall was 4.35 years (SD 0.46) postpartum. The individual, binary questions, "Did you have gestational diabetes during the study pregnancy?" and "During the study pregnancy, did you have preeclampsia?" most accurately discriminated GDM (sens 92%, spec 98 %) and preeclampsia (sens 82%, spec 96%). The continuous questions, "What was the birthweight of the baby?" and "How many weeks pregnant were you when you delivered?" out-performed categorical questions for both birthweight (r=0.95) and gestation length (r=0.85). This validated questionnaire demonstrates that the majority of women can accurately recall their pregnancy history, on average, more than 4 years post-partum. Further validation of this pregnancy recall instrument in other patient populations may be helpful for clinical application of the 2011 AHA recommendations in order to identify women at high risk of developing cardiovascular disease. E.B. Carter: None. J.J. Stuart: None. L.V. Farland: None. J. Rich-Edwards: None. C. Zera: None. T.F. McElrath: None. E.W. Seely: None. Copyright © 2014.
    01/2015; 5(1):63. DOI:10.1016/j.preghy.2014.10.124
  • Ellen W Seely · Kathy E Kram · S Jean Emans ·

    Translational Research 12/2014; 165(4). DOI:10.1016/j.trsl.2014.12.002 · 5.03 Impact Factor
  • Zeinab Issa · Ellen W Seely · Maya Rahme · Ghada El-Hajj Fuleihan ·
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    ABSTRACT: Objective: Although hormone therapy remains the most efficacious option for the management of vasomotor symptoms of menopause, its effects on blood pressure remain unclear. This review scrutinizes evidence of the mechanisms of action of hormone therapy on signaling pathways affecting blood pressure and evidence from clinical studies. Methods: Comprehensive Ovid MEDLINE searches were conducted for the terms "hypertension" and either of the following "hormone therapy and menopause" or "selective estrogen receptor modulator" from year 2000 to November 2013. Results: In vitro and physiologic studies did not reveal a clear deleterious effect of hormone therapy on blood pressure. The effect of oral therapy was essentially neutral in large trials conducted in normotensive women with blood pressure as primary outcome. Results from all other trials had several limitations. Oral therapy had a neutral effect on blood pressure in hypertensive women. Transdermal estrogen and micronized progesterone had a beneficial effect on blood pressure in normotensive women and, at most, a neutral effect on hypertensive women. In general, tibolone and raloxifene had a neutral effect on blood pressure in both hypertensive and normotensive women. Conclusions: Large randomized trials are needed to assess the effect of oral hormone therapy on blood pressure as a primary outcome in hypertensive women and the effect of transdermal preparations on both normotensive and hypertensive women. Transdermal preparations would be the preferred mode of therapy for hypertensive women, in view of their favorable physiologic and clinical profiles. The decision regarding the use of hormone therapy should be individualized, and blood pressure should be monitored during the course of treatment.
    Menopause (New York, N.Y.) 09/2014; 22(4). DOI:10.1097/GME.0000000000000322 · 3.36 Impact Factor
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    ABSTRACT: Objective: Chronic hypertension is a common medical condition in pregnancy. The purpose of the study was to examine the association between maternal chronic hypertension and the risk of congenital malformations in the offspring. Study design: We defined a cohort of 878,126 completed pregnancies linked to infant medical records using the Medicaid Analytic Extract. The risk of congenital malformations was compared between normotensive controls and those with treated and untreated chronic hypertension. Confounding was addressed using propensity score matching. Results: After matching, compared with normotensive controls, pregnancies complicated by treated chronic hypertension were at increased risk of congenital malformations (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.5), as were pregnancies with untreated chronic hypertension (OR 1.2; 95% CI, 1.1-1.3). In our analysis of organ-specific malformations, both treated and untreated chronic hypertension was associated with a significant increase in the risk of cardiac malformations (OR, 1.6; 95% CI, 1.4-1.9 and OR, 1.5; 95% CI, 1.3-1.7, respectively). These associations persisted across a range of sensitivity analyses. Conclusion: There is a similar increase in the risk of congenital malformations (particularly cardiac malformations) associated with treated and untreated chronic hypertension that is independent of measured confounders. Studies evaluating the teratogenic potential of antihypertensive medications must control for confounding by indication. Fetuses and neonates of mothers with chronic hypertension should be carefully evaluated for potential malformations, particularly cardiac defects.
    American Journal of Obstetrics and Gynecology 09/2014; 212(3). DOI:10.1016/j.ajog.2014.09.031 · 4.70 Impact Factor
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    ABSTRACT: OBJECTIVE: To test the feasibility and effectiveness of a Web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus to reduce postpartum weight retention. METHODS: We randomly allocated 75 women with recent gestational diabetes mellitus to either a Web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight; and 2) self-reported prepregnancy weight. RESULTS: There were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (n=36, three lost to follow-up) lost a mean of 2.8 kg (95% confidence interval -4.8 to -0.7) from 6 weeks to 12 months postpartum, whereas the control group (n=39, one lost to follow-up) gained a mean of 0.5 kg (-1.4 to +2.4) (P=.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change 20.7 kg; -3.5 to +2.2) compared with women in the control arm (+4.0 kg; +1.3 to +6.8) (P=.035). CONCLUSION: A Web-based lifestyle modification program for women with recent gestational diabetes mellitus decreased postpartum weight retention.
    Obstetrics and Gynecology 09/2014; 124(3):563-570. DOI:10.1097/AOG.0000000000000420 · 5.18 Impact Factor
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    ABSTRACT: Objective As obesity is a risk factor for placental dysfunction, we hypothesized that maternal body mass index (BMI) would be associated with alterations in serum angiogenic markers. Study Design We included 2399 singleton pregnancies with and without placental dysfunction in a prospective longitudinal cohort study of angiogenic markers. We modeled the relationship between categorical and continuous BMI, sFlt-1 and PlGF over gestation, stratified by pregnancy outcome. Results In women with normal pregnancies, higher BMI was associated with lower sFlt-1 values across gestation (p<0.0001), lower PlGF in the second and third trimester (p<0.0001), and rate of change in PlGF (p<0.0001). Similar relationships were seen between maternal BMI, sFlt-1 (p<0.0001) and PlGF (p=0.0005) in women with clinically evident placental dysfunction. Conclusions: sFlt-1 value is inversely associated with maternal BMI. The pattern of change in PlGF is also dependent on maternal BMI, indicating that obese women may have abnormalities in angiogenesis near term.
    American journal of obstetrics and gynecology 09/2014; 211(3). DOI:10.1016/j.ajog.2014.03.020 · 4.70 Impact Factor
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    Ellen W Seely · Jeffrey Ecker ·
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    ABSTRACT: Chronic hypertension in pregnancy is defined by the American College of Obstetrics and Gynecology (ACOG) as blood pressure ≥140 mm Hg systolic and/or 90 mm Hg diastolic before pregnancy or, in recognition that many women seek medical care only once pregnant, before 20 weeks of gestation, use of antihypertensive medications before pregnancy, or persistence of hypertension for >12 weeks after delivery.1 Chronic hypertension needs to be distinguished from new-onset hypertensive complications of pregnancy such as preeclampsia (elevated blood pressure and proteinuria often accompanied by evidence of maternal organ injury and fetal compromise from placental dysfunction)2 and gestational hypertension (elevated blood pressure alone after 20 weeks of gestation and most commonly in the mid to late third trimester without evidence or history of hypertension before pregnancy; Table 1).
    Circulation 03/2014; 129(11):1254-61. DOI:10.1161/CIRCULATIONAHA.113.003904 · 14.43 Impact Factor
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    ABSTRACT: A history of preeclampsia is a risk factor for the future development of hypertension and cardiovascular disease (CVD). The objective of this study was to assess, in women with prior preeclampsia, the level of knowledge regarding the link between preeclampsia and CVD, motivators for and barriers to lifestyle change and interest in a lifestyle modification program to decrease CVD risk following a pregnancy complicated by preeclampsia. Twenty women with a history of preeclampsia participated in 5 phone-based focus groups. Focus groups were recorded, transcribed, and analyzed. Qualitative content analysis was used to identify common themes across focus groups. Consensus was reached on a representative set of themes describing the data. Women with prior preeclampsia were in general unaware of the link between preeclampsia and future CVD but eager to learn about this link and motivated to achieve a healthy lifestyle. Major perceived barriers to lifestyle change were lack of time, cost of healthy foods and family responsibilities. Perceived facilitators included knowledge of the link between preeclampsia and CVD, a desire to stay healthy, and creating a healthy home for their children. Women with prior preeclampsia were interested in the idea of a web-based program focused on lifestyle strategies to decrease CVD risk in women. Women with prior preeclampsia were eager to learn about the link between preeclampsia and CVD and to take steps to reduce CVD risk. A web-based program to help women with prior preeclampsia adopt a healthy lifestyle may be an appropriate strategy for this population.
    BMC Pregnancy and Childbirth 12/2013; 13(1):240. DOI:10.1186/1471-2393-13-240 · 2.19 Impact Factor
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    ABSTRACT: Age, sex, hypertension and dietary sodium are proposed to affect plasma and urinary catecholamines. Yet no prior study has examined the simultaneous effects of these factors within the same study population. So results may have been confounded by factors not determined. We investigate, for the first time, the impact of simultaneously determined predictors of plasma and urinary catecholamines and the relationship of catecholamines with the diagnosis of hypertension. Hypertensive and normotensive subjects (n=308) were studied off antihypertensives in liberal and low sodium balance. 24 h urinary catecholamines (norepinephrine and epinephrine) were measured. Plasma catecholamines were measured supine after overnight fast. Repeated measures multivariate linear regression models examined the effect of sex, race, age, body mass index (BMI), dietary salt (liberal salt vs low salt), hypertension status and mean arterial pressure (MAP) on plasma and urinary catecholamines. Logistic regression determined the relationship of catecholamines with diagnosis of hypertension. Dietary sodium restriction and increasing age predicted increased plasma and urinary norepinephrine, with sodium restriction having the greatest effect. Female sex predicted lower urinary and plasma epinephrine. Neither plasma nor urinary catecholamines predicted the diagnosis of hypertension. In summary, specific demographic factors variably impact catecholamines and should be considered when assessing catecholamines in research and clinical settings.Journal of Human Hypertension advance online publication, 14 November 2013; doi:10.1038/jhh.2013.112.
    Journal of human hypertension 11/2013; 28(5). DOI:10.1038/jhh.2013.112 · 2.70 Impact Factor

Publication Stats

4k Citations
958.29 Total Impact Points


  • 1999-2015
    • Harvard University
      Cambridge, Massachusetts, United States
    • University of Nebraska at Omaha
      • Department of Obstetrics & Gynecology
      Omaha, Nebraska, United States
  • 1989-2015
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Brigham and Women's Hospital
      • • Department of Medicine
      • • Division of Endocrinology, Diabetes and Hypertension
      • • Department of Obstetrics and Gynecology
      Boston, Massachusetts, United States
  • 2011
    • Yale University
      New Haven, Connecticut, United States
  • 2009
    • Northwestern University
      • Division of Endocrinology, Metabolism and Molecular Medicine
      Evanston, IL, United States
  • 2005
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, Pennsylvania, United States
  • 2003
    • Beverly Hospital, Boston MA
      BVY, Massachusetts, United States
  • 2000
    • University of Utah
      Salt Lake City, Utah, United States
  • 1998
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1994
    • Royal North Shore Hospital
      Sydney, New South Wales, Australia
  • 1992
    • Boston University
      Boston, Massachusetts, United States