Wessel Ganzevoort

University of Amsterdam, Amsterdamo, North Holland, Netherlands

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Publications (56)358.5 Total impact


  • No preview · Article · Jul 2015
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    ABSTRACT: Background Strong associations have been established in nationwide registry studies between hypertensive disorders of pregnancy (HDP) and later vascular morbidities and mortality. The aim of this case-control study is to examine the interdependent relationships of different predictive factors for vascular disease and HDP, because they are not clearly elucidated due to lack of detail in registries. Methods and results We assembled three different case groups of women who had cerebrovascular, cardiovascular, or hypertensive kidney disease before the age of 55. The control group consisted of age-matched women who underwent hysterectomy for benign reasons. We assessed the occurrence of HDP in previous pregnancies. The strength of the association with vascular morbidities was tested with multivariable logistic regression in comparison with classic vascular risk factors. In all case groups, previous HDP occurred more frequent than in the control group. In logistic regression analysis, previous HDP were the strongest predictor in the cerebrovascular group (OR 4.2; 95% confidence interval [CI] 1.6-11.0). In the cardiovascular group and the kidney failure group a similar association was found, however, this was not statistically significant (OR 4.4 (95% CI 0.82-4) and 2.9 (95% CI 0.61-14), respectively). Conclusions Previous hypertensive disorders of pregnancy are a strong predictor for later vascular morbidity. This is partially mediated through the presence of classic vascular risk factors, but our data suggest it is also an independent predictor. © 2015 International Society for the Study of Hypertension in Pregnancy.
    No preview · Article · Jun 2015 · Pregnancy Hypertension
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    Full-text · Dataset · Apr 2015
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    ABSTRACT: There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women. We did an open-label, randomised controlled trial, in seven academic hospitals and 44 non-academic hospitals in the Netherlands. Women with non-severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation were randomly allocated to either induction of labour or caesarean section within 24 h (immediate delivery) or a strategy aimed at prolonging pregnancy until 37 weeks of gestation (expectant monitoring). The primary outcomes were a composite of adverse maternal outcomes (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption, or maternal death), and neonatal respiratory distress syndrome, both analysed by intention-to-treat. This study is registered with the Netherlands Trial Register (NTR1792). Between March 1, 2009, and Feb 21, 2013, 897 women were invited to participate, of whom 703 were enrolled and randomly assigned to immediate delivery (n=352) or expectant monitoring (n=351). The composite adverse maternal outcome occurred in four (1·1%) of 352 women allocated to immediate delivery versus 11 (3·1%) of 351 women allocated to expectant monitoring (relative risk [RR] 0·36, 95% CI 0·12-1·11; p=0·069). Respiratory distress syndrome was diagnosed in 20 (5·7%) of 352 neonates in the immediate delivery group versus six (1·7%) of 351 neonates in the expectant monitoring group (RR 3·3, 95% CI 1·4-8·2; p=0·005). No maternal or perinatal deaths occurred. For women with non-severe hypertensive disorders at 34-37 weeks of gestation, immediate delivery might reduce the already small risk of adverse maternal outcomes. However, it significantly increases the risk of neonatal respiratory distress syndrome, therefore, routine immediate delivery does not seem justified and a strategy of expectant monitoring until the clinical situation deteriorates can be considered. ZonMw. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · The Lancet
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    ABSTRACT: BACKGROUND: No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). METHODS: In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. FINDINGS: Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 29·1-32·1) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 140, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. INTERPRETATION: Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age.
    Full-text · Article · Mar 2015 · The Lancet
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    ABSTRACT: No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography short-term variation (STV). In this prospective, European multicentre, unblinded, randomised study, we included women with singleton fetuses at 26-32 weeks of gestation who had very preterm fetal growth restriction (ie, low abdominal circumference [<10th percentile] and a high umbilical artery Doppler pulsatility index [>95th percentile]). We randomly allocated women 1:1:1, with randomly sized blocks and stratified by participating centre and gestational age (<29 weeks vs ≥29 weeks), to three timing of delivery plans, which differed according to antenatal monitoring strategies: reduced cardiotocograph fetal heart rate STV (CTG STV), early DV changes (pulsatility index >95th percentile; DV p95), or late DV changes (A wave [the deflection within the venous waveform signifying atrial contraction] at or below baseline; DV no A). The primary outcome was survival without cerebral palsy or neurosensory impairment, or a Bayley III developmental score of less than 85, at 2 years of age. We assessed outcomes in surviving infants with known outcomes at 2 years. We did an intention to treat study for all participants for whom we had data. Safety outcomes were deaths in utero and neonatal deaths and were assessed in all randomly allocated women. This study is registered with ISRCTN, number 56204499. Between Jan 1, 2005 and Oct 1, 2010, 503 of 542 eligible women were randomly allocated to monitoring groups (166 to CTG STV, 167 to DV p95, and 170 to DV no A). The median gestational age at delivery was 30·7 weeks (IQR 26·1-40·6) and mean birthweight was 1019 g (SD 322). The proportion of infants surviving without neuroimpairment did not differ between the CTG STV (111 [77%] of 144 infants with known outcome), DV p95 (119 [84%] of 142), and DV no A (133 [85%] of 157) groups (ptrend=0·09). 12 fetuses (2%) died in utero and 27 (6%) neonatal deaths occurred. Of survivors, more infants where women were randomly assigned to delivery according to late ductus changes (133 [95%] of 144, 95%, 95% CI 90-98) were free of neuroimpairment when compared with those randomly assigned to CTG (111 [85%] of 131, 95% CI 78-90; p=0.005), but this was accompanied by a non-significant increase in perinatal and infant mortality. Although the difference in the proportion of infants surviving without neuroimpairment was non-significant at the primary endpoint, timing of delivery based on the study protocol using late changes in the DV waveform might produce an improvement in developmental outcomes at 2 years of age. ZonMw, The Netherlands and Dr Hans Ludwig Geisenhofer Foundation, Germany. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · The Lancet
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    No preview · Article · Jan 2015
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    ABSTRACT: For women who suffered hypertensive disorders of pregnancy (HDP), information on recurrence rates is crucial in the decision to conceive again. Recurrence rates vary from a few percent up to 65%. We used Individual Participant Data (IPD) meta-analysis to assess the recurrence of HDP, thus increasing statistical power. We aim to calculate the absolute recurrence risk of HDP and to determine risk factors of recurrence. We searched Pubmed and Embase for studies with a cohort design that included women with a history of a HDP. We approached principal investigators for original patient data that were merged into one database. Adverse outcome was defined as recurrence of a HDP in the subsequent pregnancy. We obtained data of 99,415 women that had been included in 22 studies. The recurrence rate of a HDP was 20.7% (95%CI: 20.4-20.9). Concomitant HELLP syndrome and a SGA child in the first pregnancy increased recurrence of HDP (Fig. 1). Furthermore decreasing gestational age in the index pregnancy increased the chance recurrence and recurrent premature delivery. Multiple pregnancy at the index pregnancy was protective for recurrence as compared to singleton pregnancy (OR 0.53; 95%CI 0.40-0.70). In general, if HDP recurred it was milder. Previously normotensive women had a fourfold risk of developing chronic hypertension after recurrence of HDP. Among women that suffer hypertension in pregnancy, the recurrence rate in a next pregnancy is low and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision making in women who consider a new pregnancy after a pregnancy complicated by hypertension. M.F. van Oostwaard: None. J. Langenveld: None. E. Schuit: None. D.N. Papatsonis: None. B.J. Mol: None. W. Ganzevoort: None. Copyright © 2014.
    Full-text · Article · Jan 2015

  • No preview · Article · Jan 2015 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: Nearly 10% of pregnant women have hypertension, which can increase both perinatal and maternal risk. While there have been several randomized controlled trials examining hypertension in pregnant women, they were not consistent enough to determine blood-pressure targets for pregnant women experiencing hypertension. Current guidelines are debated over treatment goals between less-tight control (blood pressure elevated but not threatening) and tight control. The Control of Hypertension in Pregnancy Study evaluated perinatal and maternal outcomes of nonsevere hypertension in pregnancy by comparing less-tight control and tight control. This study was an open, multicenter, international, randomized controlled trial that included women with nonsevere, nonproteinuric preexisting hypertension/gestational hypertension. All women had gestational periods of 14 weeks 0 days to 33 weeks 6 days with preexisting hypertension with a diastolic blood pressure of 90 mm Hg or higher at 20 weeks. Women were randomized 1:1 to less-tight control group (100 mm Hg) or tight control group (85 mm Hg). Primary outcomes focused on pregnancy loss or need for high-level neonatal care more than 48 hours to 28 days after birth. The secondary outcomes focused on “serious” maternal complications up to 6 weeks after birth and was defined as conditions such as stroke, uncontrollable hypertension, or death. Of the women who met the criteria, 497 women were randomly assigned to the less-tight control group, and 490 were assigned to the tight control group. Results for the primary outcome were found to be similar between the 2 groups, with 31.4% for the less-tight control and 30.7% tight control (adjusted odds ratio [aOR], 1.02; 95% confidence interval, 0.77–1.35). Similarities were also found in the secondary outcomes as well with maternal complications at 3.7% and 2.0% (aOR, 1.74; 95% confidence interval, 0.79–3.84). However, results revealed that less-tight control had higher rates of severe maternal hypertension (40.6%) compared with the tight control (27.5%). In addition, there were more patients in the less-tight control group with thrombocytopenia or elevated transaminases; however, the rate of HELLP syndrome was not statistically significantly increased (aOR, 4.35; 0.93–20.35). With regard to the rate of small-for-gestational-age neonates, this was examined both at the less than the 10th percentile and less than the third percentile. For the less than the 10th percentile, the absolute percentage was lower in the less-tight control group (16.1% vs 19.7%); however, this was not statistically significant, with an aOR of 0.78 (0.56–1.08). Similarly, the less than the third percentile rates were not different with an aOR of 0.92 (0.51–1.63) when comparing the less-tight control group with the tight control group. This randomized trial revealed that there was no significant difference between less-tight control and tight control in regard to the primary perinatal or maternal outcomes examined. However, less-tight control was found to have a higher rate of severe maternal hypertension.
    Full-text · Dataset · Jan 2015
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    ABSTRACT: BACKGROUND The effects of less-tight versus tight control of hypertension on pregnancy complications are unclear. METHODS We performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later. RESULTS Included in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (>= 160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P<0.001). CONCLUSIONS We found no significant between-group differences in the risk of pregnancy loss, high-level neonatal care, or overall maternal complications, although less- tight control was associated with a significantly higher frequency of severe maternal hypertension.
    Full-text · Article · Jan 2015 · New England Journal of Medicine
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    ABSTRACT: We performed an Individual Participant Data (IPD) meta-analysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. We performed an electronic literature search for cohort studies that reported on women suffering from HDP and who had a subsequent pregnancy. The principal investigators were contacted, informed and requested for their original study data. The obtained data were merged to form one combined database. The results will be presented as % with 95% confidence interval (CI) and odds ratios (OR) with 95% CI. Out of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies using published data (IPD where available) showed a recurrence rate of 18.1% (N=152,213, 95% CI: 17.9 - 18.3). In the 22 studies included in our IPD, the recurrence rate of a HDP was 20.7% (95%CI: 20.4 - 20.9). Recurrence manifested as preeclampsia (PE) in 13.8% (95%CI: 13.6 - 14.1), gestational hypertension (GH) in 8.6% (95%CI: 8.4 - 8.8) and Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome in 0.2% (95%CI: 0.16 - 0.25). The delivery of a small for gestational age (SGA) child accompanied the recurrent HDP in 3.4% (95%CI: 3.2 - 3.6). Concomitant HELLP syndrome or delivery of a SGA child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, it was in general milder, regarding maximum diastolic blood pressure, proteinuria, use of oral antihypertensive and anticonvulsive medication, delivery of a SGA child, premature delivery and perinatal mortality. Normotensive women developed chronic hypertension after pregnancy more often after experiencing recurrence (OR 3.7 95% CI: 2.3 - 6.1). Among women that suffer hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision making in women who consider a new pregnancy after a pregnancy complicated by hypertension. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Jan 2015 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: The CHIPS Trial (ISRCTN 71416914, http://pre-empt.cfri.ca/CHIPS) randomized women with non-severe pregnancy hypertension to a diastolic blood pressure (dBP) target of 100mmHg ['less tight' (LT) control] vs. 85mmHg ['tight' (T) control]. LT was associated with no perinatal benefit, but more severe maternal hypertension. Labetalol was the recommended post-randomization antihypertensive. We aimed to: (1) determine whether the difference in outcomes between LT vs. T control depended on antihypertensive used; and (2) compare pregnancy outcomes, taking into account allocated group, between women taking methyldopa and those taking labetalol, the two most commonly used antihypertensives in CHIPS. Logistic regression was used for comparisons outlined in objectives (1) and (2). Both analyses adjusted for the influence of baseline factors, including use of any antihypertensive therapy at randomization. Of 987 women in CHIPS, labetalol (but not methyldopa) was taken by 433/837 women on antihypertensive therapy [186 (LT) vs. 247 (T)] and methyldopa (but not labetalol) by 223/837 [98 (LT) vs. 125 (T)]. Following adjustment: (1) ORs for outcomes in LT vs. T control were similar between antihypertensive groups, but (2) methyldopa use was associated with a reduction in some outcomes (Table). Additional sensitivity analyses had a trivial impact on results. In this secondary analysis of CHIPS data, outcomes for LT vs. T control were not dependent on use of methyldopa or labetalol. The non-randomized comparisons between methyldopa and labetalol are subject to residual confounding, but there is no evidence that women treated with methyldopa (vs. labetalol) had inferior outcomes. L.A. Magee: Research Support Recipient; Commercial Interest: BMGF. P. von Dadelszen: Consultant, Commercial Interest: Alere International. E. Rey: None. S. Ross: None. E. Asztalos: None. K.E. Murphy: None. J. Menzies: None. J. Sanchez: None. J. Singer: None. A. Gafni: None. A. Gruslin: None. M. Helewa: None. E. Hutton: None. S.K. Lee: None. A.G. Logan: None. W. Ganzevoort: None. R. Welch: None. J.G. Thornton: None. J. Moutquin: None. Copyright © 2014.
    No preview · Article · Jan 2015
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    ABSTRACT: Objective. To compare birth weight ratio and birth weight percentile to express infant weight when assessing pregnancy outcome. Study Design. We performed a national cohort study. Birth weight ratio was calculated as the observed birth weight divided by the median birth weight for gestational age. The discriminative ability of birth weight ratio and birth weight percentile to identify infants at risk of perinatal death (fetal death and neonatal death) or adverse pregnancy outcome (perinatal death + severe neonatal morbidity) was compared using the area under the curve. Outcomes were expressed stratified by gestational age at delivery separate for birth weight ratio and birth weight percentile. Results. We studied 1,299,244 pregnant women, with an overall perinatal death rate of 0.62%. Birth weight ratio and birth weight percentile have equivalent overall discriminative performance for perinatal death and adverse perinatal outcome. In late preterm infants (33+0–36+6 weeks), birth weight ratio has better discriminative ability than birth weight percentile for perinatal death (0.68 versus 0.63, P 0.01 ) or adverse pregnancy outcome (0.67 versus 0.60, P < 0.001 ). Conclusion. Birth weight ratio is a potentially valuable instrument to identify infants at risk of perinatal death and adverse pregnancy outcome and provides several advantages for use in research and clinical practice. Moreover, it allows comparison of groups with different average birth weights.
    Full-text · Article · Aug 2014 · Obstetrics and Gynecology International
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    ABSTRACT: Objective To explore hospital costs by pregnant women with a history of early-onset preeclampsia or HELLP syndrome, managed according to customary, but non-standardized prenatal care, by relating maternal and child outcome to maternal health care expenditure. Study design This was a cohort study, in women of 18 years or older who suffered from early-onset preeclampsia or HELLP syndrome in their previous pregnancy (n = 104). We retrieved data retrospectively from hospital information systems and medical records of patients who had received customary, non-standardized prenatal care between 1996 and 2012. Our analyses focused on the costs generated between the first antenatal visit at the outpatient clinic and postpartum hospital discharge. Outcome measures were hospital resource use, costs, maternal and child outcome (recurrence of preeclampsia or HELLP syndrome, incidence of eclampsia, gestational age at delivery, intrauterine fetal demise, small-for-gestational-age birth and low 5 minutes’ Apgar score). We used linear regression analyses to evaluate whether maternal and child outcome and baseline characteristics correlated with hospital costs. Results Maternal hospital costs per patient averaged € 8047. Main cost drivers were maternal admissions and outpatient visits, together accounting for 80% of total costs. Primary cost drivers were preterm birth and recurrent preeclampsia or HELLP syndrome. Conclusion Hospital costs in the next pregnancy of formerly preeclamptic women varied widely with over 70% being medically unexplainable. The results of this study support the view that care standardization in these women can be expected to improve costs and efficacy of care without compromising outcome.
    Full-text · Article · Aug 2014 · European Journal of Obstetrics & Gynecology and Reproductive Biology
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    ABSTRACT: Objective The internally validated fullPIERS model predicts adverse maternal outcomes in women with pre-eclampsia within 48 h after eligibility. Our objective was to assess generalizability of this prediction model. Study design External validation study using prospectively collected data from two tertiary care obstetric centers. Methods The existing PETRA dataset, a cohort of women (n = 216) with severe early-onset pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction was used. The fullPIERS model equation was applied to all women in the dataset using values collected within 48 h after inclusion. The performance (ROC area and R-squared) of the model, risk stratification and calibration were assessed from 48 h up to a week after inclusion. Results Of 216 women in the PETRA trial, 73 (34%) experienced an adverse maternal outcome(s) at any time after inclusion. Adverse maternal outcome was observed in 32 (15%) cases within 48 h and 62 (29%) within 7 days after inclusion. The fullPIERS model predicted adverse maternal outcomes within 48 h (AUC ROC 0.97, 95% CI: 0.87–0.99) and up to 7 days after inclusion (AUC ROC 0.80, 95% CI: 0.70–0.87). Conclusions The fullPIERS model performed well when applied to the PETRA dataset. These results confirm the usability of the fullPIERS prediction model as a ‘rule-in’ test for women admitted with severe pre-eclampsia, eclampsia, HELLP syndrome or hypertension-associated fetal growth restriction. Future research should focus on intervention studies that assess the clinical impact of strategies using the fullPIERS model.
    Full-text · Article · Aug 2014 · European Journal of Obstetrics & Gynecology and Reproductive Biology
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    ABSTRACT: To assess the recurrence risk of term hypertensive disease of pregnancy and to determine which potential risk factors are predictive of recurrence. We performed a retrospective cohort study in two secondary and one tertiary care hospitals in the Netherlands. We identified women with a hypertensive disorder in the index pregnancy and delivery after 37weeks of gestation between January 2000 and December 2002. Data were extracted from medical files and women were approached for additional information on subsequent pregnancies. Adverse outcome was defined as recurrence of a hypertensive disorder in the next subsequent pregnancy. The absolute risk of recurrence and a prediction model containing demographic and clinical factors predictive of recurrence. We identified 638 women for potential inclusion, of whom 503 could be contacted. Of these women, 312 (62%) had a subsequent pregnancy. Hypertensive disorders recurred in 120 (38%, 95% CI 33-44) women, of whom 15 (5%, 95% CI 3-7) delivered preterm. Women undergoing recurrence were more at risk to develop chronic hypertension after pregnancy (35% versus 16%, OR 2.8, 95% CI 1.5-5.3). Body mass index, non-White European origin, chronic hypertension, maximum diastolic blood pressure, no use of anticonvulsive medication and interpregnancy interval were predictors for recurrence. Women with hypertensive disorders and term delivery have a substantial chance of recurrence, but a small risk of preterm delivery. A number of predictors for recurrence could be identified and women with a recurrence more often developed chronic hypertension. Copyright © 2014 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
    No preview · Article · Jul 2014 · Pregnancy Hypertension
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    ABSTRACT: In pregnancies complicated by early-onset extreme fetal growth restriction, there is a high risk of preterm birth and an overall dismal fetal prognosis. Sildenafil has been suggested to improve this prognosis. The first aim of this review is to assess whether sildenafil benefits or harms these babies. The second aim is to analyse if these effects are modified in a clinically meaningful way by factors related to the women or the trial protocol. The STRIDER (Sildenafil Therapy In Dismal prognosis Early-onset intrauterine growth Restriction) Individual Participant Data (IPD) Study Group will conduct a prospective IPD and aggregate data systematic review with meta-analysis and trial sequential analysis. The STRIDER IPD Study Group started trial planning and funding applications in 2012. Three trials will be launched in 2014, recruiting for three years. Further trials are planned to commence in 2015.The primary outcome for babies is being alive at term gestation without evidence of serious adverse neonatal outcome. The latter is defined as severe central nervous system injury (severe intraventricular haemorrhage (grade 3 and 4) or cystic periventricular leukomalacia, demonstrated by ultrasound and/or magnetic resonance imaging) or other severe morbidity (bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, or necrotising enterocolitis requiring surgery). The secondary outcomes are improved fetal growth velocity assessed by ultrasound abdominal circumference measurements, gestational age and birth weight (centile) at delivery, and age-adequate performance on the two-year Bayley scales of infant and toddler development-III (composite cognitive score and composite motor score). Subgroup and sensitivity analyses in the IPD meta-analysis include assessment of the influence of several patient characteristics: an abnormal or normal serum level of placental growth factor, absent/reversed umbilical arterial end diastolic flow at commencement of treatment, and other patient characteristics available at baseline such as gestational age and estimated fetal weight. The secondary outcomes for mothers include co-incidence and severity of the maternal syndrome of pre-eclampsia, mortality, and other serious adverse events. Trials are expected to start in 2013-2014 and end in 2016-2017. Data analyses of individual trials are expected to finish in 2019. Given the pre-planned and agreed IPD protocol, these results should be available in 2020.
    Full-text · Article · Mar 2014 · Systematic Reviews

  • No preview · Article · Jan 2014 · American Journal of Obstetrics and Gynecology

  • No preview · Article · Jan 2014 · American Journal of Obstetrics and Gynecology

Publication Stats

505 Citations
358.50 Total Impact Points

Institutions

  • 2010-2015
    • University of Amsterdam
      • Department of Obstetrics and Gynaecology
      Amsterdamo, North Holland, Netherlands
  • 2003-2015
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Department of Obstetrics & Gynecology
      Amsterdamo, North Holland, Netherlands
  • 2012
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 2004
    • VU University Medical Center
      • Department of Obstetrics and Gynecology
      Amsterdamo, North Holland, Netherlands