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Maternal Cardiac Disease

Thierry Brue, Vincent Amodru, Frédéric Castinetti
With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2-3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease...
March 9, 2018: European Journal of Endocrinology
Akhabue K Okojie, O E Okobi, Hamza Dar, Hurmat Malik, Mehreen Arif, Khalid Rauf, Eghosa E Iyare
In Africa, a large number of pregnancies are exposed to Plasmodium falciparum infection. The in-utero environment extremely influences childhood neurodevelopment and behaviour. The complement 5a receptor (C5aR) is linked to several disease conditions. However, the influence of Plasmodium berghei during pregnancy on maternal complement 5a receptor and subsequently on fetal behaviour is unknown. Pregnant mice were intra-peritoneally inoculated on gestational day 13 with 1.02x105 infected red blood cells (iRBCs)...
December 30, 2017: Nigerian Journal of Physiological Sciences: Official Publication of the Physiological Society of Nigeria
Maeve K Hopkins, Sarah A Goldstein, Cary C Ward, Jeffrey A Kuller
Objective: Congenital heart defects represent the most common major congenital anomalies. The objective of this review was to define the most common forms of congenital heart disease (CHD) in pregnancy, outline preconception counseling, discuss the associated morbidity and mortality of each lesion, and review current recommendations for management of CHD in pregnancy. Evidence Acquisition: A MEDLINE search of "congenital heart disease in pregnancy" and specific conditions in pregnancy including "ventricular septal defect," "atrial septal defect," "left outflow obstruction," "right outflow obstruction," "tetralogy of Fallot," and "transposition of the great vessels" was performed...
February 2018: Obstetrical & Gynecological Survey
Jasmine Tay, Lin Foo, Giulia Masini, Phillip R Bennett, Carmel M Mceniery, Ian B Wilkinson, Christoph C Lees
BACKGROUND AND OBJECTIVES: Pre-eclampsia (PE) and fetal growth restriction (FGR) are considered to be placentally-mediated disorders. The clinical manifestations are widely held to relate to gestation age at onset with early- and late-onset PE considered to be phenotypically distinct. Recent studies have reported conflicting findings in relation to cardiovascular function, and in particular cardiac output, in PE and FGR. STUDY DESIGN: We investigated maternal cardiovascular function in relation to clinical subtype in 45 pathological pregnancies (14 'PE only', 16 'FGR only', 15 'PE and FGR') and compared these with 107 healthy person observations...
February 20, 2018: American Journal of Obstetrics and Gynecology
Irene Turrini, Flavia Sorbi, Viola Ghizzoni, Luca Mannini, Massimiliano Fambrini, Alessandro Terreni, Elisabetta Projetto, Francesca Castiglione, Ivo Noci
BACKGROUND Troponin I is the gold standard for the diagnosis of adult acute coronary syndrome. Although it is known that a hypoxic fetus may produce cTnI, fetal cTnI passage in maternal blood has never been documented. CASE REPORT We report a case where the rise of cTnI in the blood of a pregnant woman was not related to maternal heart disease. Instead, it might be suggestive of a fetal cardiac origin, as there was a severe placental insufficiency with a fetal intrauterine growth restriction. CONCLUSIONS This study suggests that the rise of cTnI in maternal blood in a cardiovascular healthy pregnant woman might have a fetal origin...
February 21, 2018: American Journal of Case Reports
Calvin Tong, Marla Kiess, Marc William Deyell, Michael Qiu, Merav Orgad, Valerie Rychel, Ariel Claman, Emma Hardwick, Beverly McCarthy, Candice K Silversides, Jasmine Grewal
OBJECTIVES: To determine cardiac and fetal/neonatal event rates among pregnant women with premature ventricular contractions (PVCs) and compare with control groups. METHODS: Prospective case-control cohort study: 53 consecutive pregnancies in 49 women referred to the St. Paul's Hospital between 2010 and 2016 with PVC burden >1% in women without underlying cardiac disease. Maternal cardiac and fetal/neonatal outcomes were compared with two pregnant control groups: (1) supraventricular tachycardia (SVT) group of 53 women referred for a history of SVT/SVT in the current pregnancy and (2) low-risk group of 53 women with no cardiac disease...
February 20, 2018: Heart: Official Journal of the British Cardiac Society
Iris M van Hagen, Sara A Thorne, Nasser Taha, Ghada Youssef, Amro Elnagar, Harald Gabriel, Yahia ElRakshy, Bernard Iung, Mark R Johnson, Roger Hall, Jolien W Roos-Hesselink
BACKGROUND: Cardiac disease is 1 of the major causes of maternal mortality. We studied pregnancy outcomes in women with rheumatic mitral valve disease. METHODS: The Registry of Pregnancy and Cardiac Disease is an international prospective registry, and consecutive pregnant women with cardiac disease were included. Pregnancy outcomes in all women with rheumatic mitral valve disease and no prepregnancy valve replacement is described in the present study (n=390). A maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, and hospitalization for other cardiac reasons or cardiac intervention...
February 20, 2018: Circulation
Zehra Nihal Dolgun, Cihan Inan, N Cenk Sayin
OBJECTIVE: Pregnancies complicated with PHT are serious debates for obstetricians due to high maternal and fetal complication potentials. The aim of the study was to present our maternofetal outcomes in pregnant women with pulmonary hypertension. MATERIALS AND METHODS: This study was performed using data extracted from the medical files of 23 pregnancies of 18 patients with PHT who were followed-up in the obstetrics and gynecology department. RESULTS: The average age was 27...
February 2018: Taiwanese Journal of Obstetrics & Gynecology
Vikas Yadav, J B Sharma, S Mishra, A Kriplani, Neerja Bhatla, Garima Kachhawa, Rajesh Kumari, Karthik, Isha Kriplani
OBJECTIVES: To study pregnancy outcomes in operated vs non-operated cases of congenital heart disease cases during pregnancy. MATERIALS AND METHODS: A total of 55 patients of congenital heart disease who delivered in the authors unit in last 10 years were taken in this retrospective study. These were divided into two groups Group 1:29 (52.7%) patient who had no cardiac surgery and Group 2: 26(47.2%) who had cardiac surgery to correct their cardiac defect before pregnancy...
January 2018: Indian Heart Journal
James William Gaynor, Samuel Parry, Julie S Moldenhauer, Rebecca A Simmons, Jack Rychik, Richard F Ittenbach, William W Russell, Erin Zullo, John Laurenson Ward, Susan C Nicolson, Thomas L Spray, Mark P Johnson
OBJECTIVES: Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). METHODS: The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes...
February 13, 2018: European Journal of Cardio-thoracic Surgery
Eileen M Condon, Lois S Sadler, Linda C Mayes
Exposure to stressful environments in early childhood can cause a toxic stress response and lead to poor health outcomes, including obesity, cardiac disease, diabetes, and mental illness. In animals and maltreated children, the presence of a nurturing caregiver can buffer against the physiological disruptions associated with a toxic stress response; however, the specific caregiver and parenting characteristics that best promote a protective relationship in humans remain largely unexplored, particularly in families living in high-risk environments...
February 14, 2018: Research in Nursing & Health
Yingying Zhang, Wei Yan, Xiaotong Ji, Huifeng Yue, Guangke Li, Nan Sang
Maternal exposure to nitrogen dioxide (NO2) poses a risk for morbidity and mortality in infantile congenital heart diseases and even adult cardiovascular diseases. However, the experimental evidence supporting these effects is insufficient, and the related regulatory mechanisms are unknown. In the present study, we aimed to determine whether maternal NO2 exposure causes cardiac hypertrophy-related consequences in offspring, and if so, how these adverse effects occur in the postnatal heart. The results indicate that in mice, maternal NO2 exposure causes cardiac hypertrophy in male offspring...
February 7, 2018: Archives of Toxicology
Kayo Tanaka, Hiroaki Tanaka, Shintaro Maki, Michiko Kubo, Masafumi Nii, Shoichi Magawa, Fumi Hatano, Makoto Tsuji, Kazuhiro Osato, Yuki Kamimoto, Takashi Umekawa, Tomoaki Ikeda
BACKGROUND: The aim of the present study was to evaluate tadalafil for the treatment of fetal growth restriction and the cardiac function in pregnant women without cardiovascular disease who used tadalafil for this reason. MATERIALS AND METHODS: We examined nine pregnant women without cardiovascular disease who were using tadalafil to treat fetal growth restriction. Maternal heart rate (HR), systolic blood pressure (BP), and echocardiographic findings were assessed before and after tadalafil use...
February 7, 2018: Journal of Maternal-fetal & Neonatal Medicine
Orli Silverberg, Alison L Park, Eyal Cohen, Deshayne B Fell, Joel G Ray
Importance: Women with an infant with preterm birth (PTB) or who was severely small for gestational age (SGA) are at higher future risk of premature cardiovascular disease and related death. Objective: To determine the risk of cardiac disease or death among women with an infant with both PTB and SGA. Design, Setting, and Participants: This population-based cohort study used electronic health records from the province of Ontario, Canada, where health care is universally available, between April 1, 2002, and March 31, 2016...
January 31, 2018: JAMA Cardiology
Yu-Ping Zhang, Yan-Li Huo, Zhi-Qin Fang, Xue-Fang Wang, Jian-Dong Li, Hai-Ping Wang, Wei Peng, Alan Kim Johnson, Baojian Xue
Accumulating evidence indicates that maternal high fat diet (HFD) is associated with metabolic syndrome and cardiovascular disease in adult offspring. The present study tested the hypothesis that maternal HFD modulates the brain renin-angiotensin system (RAS), oxidative stress and proinflammatory cytokines that alter angiotensin II and tumor necrosis factor-α (TNF-α) actions and sensitize the angiotensin II-elicited hypertensive response in adult offspring. All offspring were cross-fostered by dams on the same or opposite diet to yield 4 groups: offspring from normal fat control diet (CD)-fed dams suckled by CD-fed dams (OCC) or by HFD-fed dams (OCH), and offspring from HFD-fed dams fed HFD suckled by CD-fed dams (OHC) or by HFD-fed dams (OHH)...
January 26, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Thanh T Hoang, Elizabeth Goldmuntz, Amy E Roberts, Wendy K Chung, Jennie K Kline, John E Deanfield, Alessandro Giardini, Adolfo Aleman, Bruce D Gelb, Meghan Mac Neal, George A Porter, Richard Kim, Martina Brueckner, Richard P Lifton, Sharon Edman, Stacy Woyciechowski, Laura E Mitchell, A J Agopian
The Pediatric Cardiac Genomics Consortium (PCGC) designed the Congenital Heart Disease Genetic Network Study to provide phenotype and genotype data for a large congenital heart defects (CHDs) cohort. This article describes the PCGC cohort, overall and by major types of CHDs (e.g., conotruncal defects) and subtypes of conotrucal heart defects (e.g., tetralogy of Fallot) and left ventricular outflow tract obstructions (e.g., hypoplastic left heart syndrome). Cases with CHDs were recruited through ten sites, 2010-2014...
2018: PloS One
Marian Knight, Derek Tuffnell
The UK Confidential Enquiry into Maternal Deaths has been in operation for more than 60 years, during which time maternal mortality rates have fallen 10-fold. The program includes two aspects, surveillance and confidential case review, providing different information to aid quality improvement in maternity care. The enquiry now also reviews the care of women with specific severe morbidities. Recommendations have very clearly led to improved outcomes for women, most notably shown in the very low mortality rate due to hypertensive and related disorders of pregnancy...
January 16, 2018: Clinical Obstetrics and Gynecology
Asher Ornoy, Gideon Koren
Possible negative effects of selective serotonin reuptake inhibitors (SSRIs) in pregnancy relate to congenital anomalies, negative perinatal events and neurodevelopmental outcome. Many studies are confounded by the underlying maternal disease and by pharmacogenetic and pharmacokinetic differences of these drugs. Areas covered: The possible interactions of SSRIs and serotonin and norepinephrine reuptake inhibitors with other drugs and the known effects of SSRIs on congenital anomalies, perinatal and neurodevelopmental outcome...
January 18, 2018: Expert Opinion on Drug Metabolism & Toxicology
Agustin Avilés, Maria-Jesus Nambo, Natividad Neri
Background: To assess maternal and fetal outcome of women and newborns who received chemotherapy during pregnancy to treat Hodgkin lymphoma (HL)in early stages (IA, IIA), we performed a retrospective analysis of a cohort of 44 pregnant women with HL and early stages, diagnosed and treated between 1988 to 2013, at a tertiary reference cancer center. Methods: We analyzed data on HL characteristics and treatment, with a particular attention to maternal and fetal complications; in children, we performed a longer follow-up to detect any anomaly in physical development, scholar performance, psychological, cardiac, neurological function, and intelligence tests...
2018: Mediterranean Journal of Hematology and Infectious Diseases
Tharni Vasavan, Elisa Ferraro, Effendi Ibrahim, Peter Dixon, Julia Gorelik, Catherine Williamson
Cardiac dysfunction has an increased prevalence in diseases complicated by liver cirrhosis such as primary biliary cholangitis and primary sclerosing cholangitis. This observation has led to research into the association between abnormalities in bile acid metabolism and cardiac pathology. Approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy. Bile acids are directly implicated in this, causing QT interval prolongation, cardiac hypertrophy, cardiomyocyte apoptosis and abnormal haemodynamics of the heart...
January 6, 2018: Biochimica et Biophysica Acta
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