The relationship between impaired uteroplacental blood flow and blood pressure level in pregnant women with chronic and gestational hypertension

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Aim. To assess the relationship between impaired uteroplacental blood flow and different levels of blood pressure in pregnant women with chronic and gestational hypertension at different stages of pregnancy with the determination of the optimal systolic blood pressure.

Methods. We conducted a prospective cohort study between 2018 and 2019. The study enrolled pregnant women aged 18 to 45 years: 55 women with chronic and gestational hypertension each, as well as 80 healthy pregnant women as control. The groups were formed by the continuous method, in which all pregnant women with arterial hypertension were included in the study until the required number of subjects was obtained. Follow-up was conducted at different gestation periods (14–16, 20–22, 28–30, 34–36 weeks) until delivery. Independent groups were compared by using the Student's t-test, the Pearson’s χ2 test, the Mann–Whitney U test, the Kruskal–Wallis H test.

Results. Comparison of the groups revealed differences in blood pressure levels at different gestation periods. In chronic hypertension compared with gestational hypertension, there was an increase in the impairment of the uteroplacental blood flow in pregnant women, indicating an unfavorable prognosis. The study of impaired uteroplacental blood flow among pregnant women with various forms of arterial hypertension revealed an increase in pregnant women with chronic arterial hypertension compared with gestational (p=0.04), indicating an unfavorable prognosis. In chronic arterial hypertension, the impairment of uteroplacental blood flow was the least for systolic pressures up to 120 mm Hg (up to 0.9%) at 14–16 and 20–22 weeks of gestation, and for 130–139 mm Hg (from 1.8 to 2.7%) in later pregnancy. In gestational hypertension, the least or no impairment rate of uteroplacental blood flow was determined for blood pressures up to 129 mm Hg at all stages of pregnancy compared with chronic hypertension.

Conclusion. The optimal systolic blood pressure in chronic hypertension reducing the risk of impaired uteroplacental blood flow in pregnant women is <129 mm Hg before 20th week of pregnancy and 130–139 mm Hg in later (20–30 weeks); in gestational hypertension, blood pressure reduction to 129 mm Hg is recommended at all stage of gestation.

Full Text

Restricted Access

About the authors

M D Medubayeva

Astana Medical University

Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

A S Kerimkulova

Astana Medical University

Author for correspondence.
Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

N A Latypova

Astana Medical University

Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

V R Veber

Yaroslav-the-Wise Novgorod State University

Email: k-aiman@yandex.ru
Russian Federation, Veliky Novgorod, Russia

A S Idrisov

Astana Medical University

Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

R G Nurpeissova

Astana Medical University

Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

M A Mar­kabayeva

Astana Medical University

Email: k-aiman@yandex.ru
Kazakhstan, Nur-Sultan city, Kazakhstan

References

  1. Regitz-Zagrosek V., Roos-Hesselink J.W., Bauersachs J., Blomström-Lundqvist C., Cifkova R., De Bonis M., Iung B., Johnson M.R., Kintscher U., Kranke P., Marthe Lang I., Morais J., Pieper P.G., Presbitero P., Price S., Giuseppe M.C.R., Seeland U., Simoncini T., Swan L., Warnes C.A. ESC Scientific Document Group, 2018. ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39 (34): 3165–3241. doi: 10.1093/eurheartj/ehy340.
  2. Webster K., Fishburn S., Maresh M., Findlay S.C., Chappell L.C. Diagnosis and management of hypertension in pregnancy: summary of updated NICE guidance. BMJ. 2019; 366: 15119. doi: 10.1136/bmj.15119.
  3. Duley L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 2009; 33: 130–137. doi: 10.1053/j.semperi.2009.02.010.
  4. Steegers E.A., von Dadelszen P., Duvekot J.J., Pijnenborg R. Pre-eclampsia. Lancet. 2010; 376: 631–644. doi: 10.1016/S0140-6736(10)60279-6.
  5. Abalos E., Cuesta C., Carroli G., Qureshi Z., Widmer M., Vogel J.P., Souza J.P.; WHO Multicountry Survey on Maternal and Newborn Health Research Network. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014; 121 (Suppl. 1): 14–24. doi: 10.1111/1471-0528.12629.
  6. ACOG practice bulletin No. 202: gestational hypertension and preeclampsia. Obstet. Gynecol. 2019; 133: e1–e25. doi: 10.1097/AOG.0000000000003018.
  7. Butalia S., Audibert F., Côté A.-M., Firoz T., Logan A.G., Magee L.A., Mundle W., Rey E., Rabi D.M., Daskalopoulou S.S., Nerenberg K.A., Hypertension Canada. Hypertension Canada’s 2018 guidelines for the management of hypertension in pregnancy. Can. J. Cardiol. 2018; 34 (5): 526–531. doi: 10.1016/j.cjca.2018.02.021.
  8. Brown M.A., Magee L.A., Kenny L.C., Karumanchi S.A., McСarthy F., Saito S., Hall D.R., Warren C., Adoyi G., Ishaku S. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2018; 13: 291–310. doi: 10.1016/j.preghy.2018.05.004.
  9. Magee L.A., Pels A., Helewa M., Rey E., von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014; 4 (2): 105–145. doi: 10.1016/j.preghy.2014.01.003.
  10. Diagnosis and treatment of cardiovascular diseases during pregnancy 2018. National guidelines. Russian journal of cardiology. 2018; 155 (3): 91–134. (In Russ.) doi: 10.15829/1560-4071-2018-3-91-134.
  11. Clinical protocol of the Ministry of Health of the Republic of Kazakhstan “Arterial hypertension in pregnant women”. 2017. https://diseases.medelement.com/disease/артериальная-гипертензия-у-беременных-2017/15691 (access date: 04.08.2021). (In Russ.)
  12. Tka¬cheva O.N., Shifman E.M., Runikhina N.K., Polyanchikova O.L., Khodzhaeva Z.S., Lyashko E.S., Chukhareva N.A. Clinical protocol. Diagnostics and treatment of arterial hypertension in pregnant women. Akusherstvo i ginekologiya. 2012; (4-2-S): 10–14. (In Russ.)
  13. Von Dadelszen P., Magee L.A. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: an updated metaregression analysis. J. Obstet. Gynaecol. Can. 2002; 24 (12): 941–945. doi: 10.1016/s1701-2163(16)30592-8.
  14. Malik R., Kumar V. Hypertension in pregnancy. Adv. Exp. Med. Biol. 2017; 956: 375–393. doi: 10.1007/5584_2016_150.
  15. Gupta S., Gupta V., Gupta S., Tayal B.B. Hemodynamic changes in uteroplacental vasculature in pregnancy-induced hypertension and its effect on pregnancy outcome. National J. Physiol. Pharm. Pharmacol. 2021; 11 (3): 269–273.
  16. Ayala D.E., Hermida R.C. Ambulatory blood pressure monitoring for the early identification of hypertension in pregnancy. Chronobiol. Int. 2013; 30: 233–259. doi: 10.3109/07420528.2012.714687.
  17. Simpson L.L. Maternal medical disease: risk of antepartum fetal death. Semin. Perinatol. 2002; 26 (1): 42–50. doi: 10.1053/sper.2002.29838.
  18. Tret'yakova O.V. Fetoplacental insufficiency in hypertensive disorders during pregnancy. Vestnik of the KRSU. 2008; 8 (4): 134–136. (In Russ.)
  19. Gamzayeva S.E. Influence hypertensive mechanism of formation of the uteroplacental-fetal blood flow. Fundamentalnye issledovaniya. 2013; (9-1): 14–18. (In Russ.)
  20. Strizhakov A.N., Ignatko I.V., Timokhina E.V., Kardanova M.A. Kriticheskoe sostoyanie ploda: diagnosticheskie kriterii, akusherskaya taktika, perinatal'nye iskhody. (Cri¬tical state of the fetus: diagnostic criteria, obstetric tactics, perinatal outcomes.) M.: GEOTAR-Media. 2018; 176 p. (In Russ.)
  21. Medubayeva M.D., Latypova N.A., Kerimkulova A.S., Mar-kabaeva A.M., Kiselova N.I. Peculiarities of pregnancy course and delivery outcomes in women with various forms of arterial hypertension. Georgian medical news. 2020; (3): 26–32. (In Russ.)

Supplementary files

Supplementary Files
Action
1. Рис. 1. Распределение беременных с артериальной гипертензией (АГ) в зависимости от сроков гестации и уровня артериального давления (мм рт.ст.)

Download (20KB)
2. Рис. 2. Распределение беременных с артериальной гипертензией (АГ) и хронической артериальной гипертензией (ХАГ) в зависимости от сроков беременности; АД — артериальное давление; МПН — маточно-плацентарные нарушения

Download (32KB)
3. Рис. 3. Распределение беременных с артериальной гипертензией (АГ) и гестационной артериальной гипертензией (ГАГ) в зависимости от сроков беременности; АД — артериальное давление; МПН — маточно-плацентарные нарушения

Download (32KB)

© 2021 Eco-Vector





This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies