The clinical utility of routine urinalysis in pregnancy: A prospective study

Objectives: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinue in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Design: Prospective observational study. Setting: A metropolitan public hospital and a private hospital in Sydney (NSW). Participants: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. Outcome measures: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampasia, or pre-eclampsia superimposed on chronic hypertension). Results: Thirty-five women had dipstick proteinuria at the first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. Conclusion: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women

Growth from birth to 6 months of infants with and without intrauterine preeclampsia exposure

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease

Postpartum physiology, psychology and paediatric follow up study (P4 Study) – Study protocol

© 2016 International Society for the Study of Hypertension in Pregnancy Background Women who have had hypertension in pregnancy are at greater risk of long term cardiovascular disease (CVD). Little is known about their cardiovascular risk postpartum or the effects on the woman's mental health and the outcomes of their infants. In this project we will study the physiological and psychological health of women and the physical health and development of their infants six months, two years and five years after birth. We will establish normal blood pressure (BP) and metabolic function for women who were normotensive in pregnancy and use these to assess women who had gestational hypertension (GH) or preeclampsia (PE). Design/methods Women will be asked to participate if they have given birth in the preceding six months. They will be excluded if they had diabetes, hypertension, renal or other serious maternal disease prior to pregnancy or congenital anomaly in the pregnancy. We will recruit 292 women who were normotensive and their babies, 100 who had GH and 100 who had PE and their babies. They will be assessed at six months, two and five years after birth. At each assessment mothers will have their blood pressure (BP) assessed peripherally with a liquid crystal sphygmomanometer and 24 h ambulatory blood pressure monitoring (ABPM), and centrally with non-invasive applanation tonometry. Additional physiological testing will include: body composition; energy balance; vascular compliance; cardiac function; liver and renal function, lipids and biochemistry; glucose and insulin; and urinalysis. Psychological status will be assessed with validated self-report questionnaires for depression, anxiety, post-traumatic stress disorder (PTSD) and mother-infant bonding. The babies will have a medical examination by a paediatrician at each assessment. Their behavioural development will be assessed with an Ages and Stages Questionnaire completed by their mother at each assessment and a developmental assessment by a child psychologist at two and five years. Conclusions This study will re-define normal BP and other physiological parameters for young parous women thereby permitting a more sensitive assessment of post-partum BP and other cardiovascular risk markers in women who have had GH or PE. It will also determine the extent, if any, of psychological disorders in these women and developmental or other concerns in their babies. Trials registration Australian and New Zealand Clinical Trials Registry Number: ACTRN12613001260718

Effect of acute copper sulfate exposure on olfactory responses to amino acids and pheromones in goldfish (Carassius auratus)

Exposure of olfactory epithelium to environmentally relevant concentrations of copper disrupts olfaction in fish. To examine the dynamics of recovery at both functional and morphological levels after acute copper exposure, unilateral exposure of goldfish olfactory epithelia to 100 μM CuSO4 (10 min) was followed by electro-olfactogram (EOG) recording and scanning electron microscopy. Sensitivity to amino acids (L-arginine and L-serine), generally considered food-related odorants, recovered most rapidly (three days), followed by that to catecholamines(3-O-methoxytyramine),bileacids(taurolithocholic acid) and the steroid pheromone, 17,20 -dihydroxy-4-pregnen- 3-one 20-sulfate, which took 28 days to reach full recovery. Sensitivity to the postovulatory pheromone prostaglandin F2R had not fully recovered even at 28 days. These changes in sensitivity were correlated with changes in the recovery of ciliated and microvillous receptor cell types. Microvillous cells appeared largely unaffected by CuSO4 treatment. Cilia in ciliated receptor neurones, however, appeared damaged one day post-treatment and were virtually absent after three days but had begun to recover after 14 days. Together, these results support the hypothesis that microvillous receptor neurones detect amino acids whereas ciliated receptor neurones were not functional and are responsible for detection of social stimuli (bile acidsandpheromones).Furthermore, differences in sensitivity to copper may be due to different transduction pathways in the different cell types

Vascular Dysfunction in Horses with Endocrinopathic Laminitis

Endocrinopathic laminitis (EL) is a vascular condition of the equine hoof resulting in severe lameness with both welfare and economic implications. EL occurs in association with equine metabolic syndrome and equine Cushing's disease. Vascular dysfunction, most commonly due to endothelial dysfunction, is associated with cardiovascular risk in people with metabolic syndrome and Cushing's syndrome. We tested the hypothesis that horses with EL have vascular, specifically endothelial, dysfunction. Healthy horses (n = 6) and horses with EL (n = 6) destined for euthanasia were recruited. We studied vessels from the hooves (laminar artery, laminar vein) and the facial skin (facial skin arteries) by small vessel wire myography. The response to vasoconstrictors phenylephrine (10-9-10-5M) and 5-hydroxytryptamine (5HT; 10-9-10-5M) and the vasodilator acetylcholine (10-9-10-5M) was determined. In comparison with healthy controls, acetylcholine-induced relaxation was dramatically reduced in all intact vessels from horses with EL (% relaxation of healthy laminar arteries 323.5 ± 94.1% v EL 90.8 ± 4.4%, P = 0.01, laminar veins 129.4 ± 14.8% v EL 71.2 ± 4.1%, P = 0.005 and facial skin arteries 182.0 ± 40.7% v EL 91.4 ± 4.5%, P = 0.01). In addition, contractile responses to phenylephrine and 5HT were increased in intact laminar veins from horses with EL compared with healthy horses; these differences were endothelium-independent. Sensitivity to phenylephrine was reduced in intact laminar arteries (P = 0.006) and veins (P = 0.009) from horses with EL. Horses with EL exhibit significant vascular dysfunction in laminar vessels and in facial skin arteries. The systemic nature of the abnormalities suggest this dysfunction is associated with the underlying endocrinopathy and not local changes to the hoof

The natural history of white coat hypertension during pregnancy

Objective: White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. Design: Prospective observational study. Setting: St George Hospital, a teaching and University hospital. Population: Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). Methods: Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. Main outcome measure: The development of PE in women with WCH or EH. Results: The overall prevalence of WCH was 32%. Half retained this phenomenon throughout pregnancy and had good pregnancy outcomes. Forty percent developed (benign) gestational hypertension and also had good pregnancy outcomes while 8% developed proteinuric PE, significantly fewer than in women with confirmed EH (22%), P = 0.008. No BP parameter at study entry permitted discrimination between those women with WCH who retained this phenomenon and those who developed GH or PE. Conclusion: WCH is a common phenomenon in pregnant women who appear to have EH according to routine BP measurement early in pregnancy. Antihypertensives may be withheld from this group initially and they can be advised they will have better pregnancy outcomes than women with true EH. However, continued monitoring throughout pregnancy remains important to detect the small group of white coat hypertensives who develop PE. © RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology

Cardiovascular consequences of cortisol excess.

Cushing's syndrome is a consequence of primary or, more commonly, secondary oversecretion of cortisol. Cardiovascular disease is the major cause of morbidity and mortality in Cushing's syndrome, and excess risk remains even in effectively treated patients. The cardiovascular consequences of cortisol excess are protean and include, inter alia, elevation of blood pressure, truncal obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and dyslipidemia. This review analyses the relationship of cortisol excess, both locally and at tissue level, to these cardiovascular risk factors, and to putative mechanisms for hypertension. Previous studies have examined correlations between cortisol, blood pressure, and other parameters in the general population and in Cushing's syndrome. This review also details changes induced by short-term cortisol administration in normotensive healthy men

Non-proteinuric pre-eclampsia: A novel risk indicator in women with gestational hypertension

OBJECTIVE: To determine whether outcomes differed for women with pre-eclampsia according to the presence of proteinuria and whether non-proteinuric pre-eclampsia is similar to gestational hypertension. DESIGN: From 1987 to 2005, at three hospitals in Sydney, Australia, women referred to the obstetric medicine team were recruited. Outcomes for three groups were compared: proteinuric pre-eclampsia, non-proteinuric pre-eclampsia and gestational hypertension. RESULTS: Women with proteinuric pre-eclampsia were more likely to have severe hypertension (39 versus 30%, P = 0.003), deliver preterm infants (39 versus 30%, P = 0.007) and had a higher perinatal mortality rate (25.2 versus 5.7 per 1000, P = 0.02) than those with non-proteinuric pre-eclampsia, who were more likely to have thrombocytopenia and liver disease. Women with non-proteinuric pre-eclampsia were more likely to have multiple pregnancies (3.9 versus 9.9%, P < 0.001), experience severe hypertension (8.9 versus 29.7%, P < 0.001), and deliver preterm infants (11.3 versus 30.2%, P < 0.001) who were small for gestational age (12.7 versus 20.9%, P < 0.001) than those with gestational hypertension. CONCLUSION: This study highlights differences between non-proteinuric pre-eclampsia and gestational hypertension. The subclassification of 'non-proteinuric pre-eclampsia' should be added to existing classification systems to alert clinicians to potential risks. © 2008 Lippincott Williams & Wilkins, Inc