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Floortje van Kesteren HyRAS studiegroep: Wietske Hermes; Sanne Visser; Arie Franx; Kitty W Bloemenkamp; Maria G van Pampus; Ben W Mol; Mireille N.M. Poppel;

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Presentatie over: "Floortje van Kesteren HyRAS studiegroep: Wietske Hermes; Sanne Visser; Arie Franx; Kitty W Bloemenkamp; Maria G van Pampus; Ben W Mol; Mireille N.M. Poppel;"— Transcript van de presentatie:

1 Floortje van Kesteren HyRAS studiegroep: Wietske Hermes; Sanne Visser; Arie Franx; Kitty W Bloemenkamp; Maria G van Pampus; Ben W Mol; Mireille N.M. Poppel; Joris A van der Post; Martina Porath; Gabrielle Ponjee; Jouke T Tamsma; Christianne JM de Groot Hypertension Risk Assessment Study

2 Introductie (1) The heart truth and red dress are trademarks 2005, NHS 2009

3 Introductie (2) Hypertensie in zwangerschap – Geassocieerd met hart en vaatziekten – Meeste studies ernstige vroege pre-eclampsie

4 Endothelial dysfunction in pregnancy Fetal outcome =IUGR Acute maternal syndrome =PRE-ECLAMPSIA Late morbidity =ATHEROSCLEROSIS  Maternal factors:  genetic predisposition  obesitas  chronic hypertension  dyslipidemia  hyperhomocysteinemia  insulin resistance  etc. Hypothese (1) Abnormal placentation ?

5 Hypothese (2) Clinical threshold Women with preeclampsia Women with normal pregnancies Neonatal life 1st pregnancy 2nd pregnancy 60 years80 years Endothelial activation Course of life Sattar et al, BMJ 2002

6 Doel (1) Cardiovasculaire risicofactoren van vrouwen met een voorgeschiedenis van aterme pre-eclampsie of zwangerschapshypertensie versus controles

7 Methode (1)

8 Methode (2) 1.Medische vragenlijst 2. Bloeddruk meting 3. Antropometrie 4. Nuchtere Bloedafname + Urine

9 Resultaten (1)

10 Resultaten (2) Characteristics Cases: PE and GH (N=306) Controls (N=99) P Value Index Pregnancy Age (years)31 (28-35)31 (28-34).82 Nulliparous211 (69%)30 (30%)<.001 Systolic blood pressure at booking120 ( )110 ( )<.001 Diastolic blood pressure at booking75 (68-80)65 (60-70)<.001 BMI at booking (kg/m 2 )25.2 ( )22.7 ( )<.001

11 Resultaten (3) Characteristics Cases: PE and GH (N=306) Controls (N=99) P Value 2 ½ years post partum (HyRAS) Age at follow up (years)34 (30-37)34 (31-37).80 Time elapsed since delivery (days)888 ( )897 ( ).54 Primiparous134 (44%)21 (22%)<.001 Family history of cardiovascular disease <60 years in 1st degree relative 48 (16%)11 (11%).21

12 Resultaten (4) Characteristics Cases: PE and G (N=306) Controls (N=99) P Value 2 ½ years post partum (HyRAS) Antihypertensive medication use29 (10%)0 (0%)<.001 BMI at follow up (kg/m 2 )26.6 ( )23.2 ( )<.001 Smoking60 (20%)19 (19%).82 Waist circumference88 (80-99)79 (73-85)<.001 Hip circumference107 ( )103 (97-107)<.001 Systolic blood pressure124 ( )110 ( )<.001 Diastolic blood pressure80 (78-90)74 (66-80)<.001

13 Resultaten (5) Cardiovascular Biomarker Cases: GH and PE (N=306) Controls (N=99) P Value Microalbumin urine †, mg/l5.0 ( )4.0 ( ).06 Fasting blood glucose ‡, mg/dl84.7 ( )84.7 ( ).01 HbA1c §, %5.3 ( )5.3 ( ).04 Insulin ¶, mU/l4.4 ( )2.9 ( ).003 HOMA score †† 1.0 ( )0.6 ( ).001 HsCRP ‡‡, mg/l2.2 ( )0.9 ( )<.001

14 Resultaten (6) Plasma lipid profile: Cases: GH and PE (N=306) Controls (N=99) P Value Total cholesterol, mg/dl181.8 ( )177.9 ( ).02 HDL-cholesterol, mg/dl54.1 ( )58.0 ( ).03 Triglycerids, mg/dl80.6 ( )62.9 ( )<.001

15 Resultaten (7) Cases (n=306) Controls (n=99) Unadjusted OR (95% CI) Adjusted OR (95% CI) P Value Blood Pressure, ≥140/90 mmHg 105 (34%) 1 (1%) 51.5 (7.1 to 374.2) 47.5 (6.5 to 350.0) <0.001 Metabolic Syndrome 73 (25%) 5 (5%) 6.0 (2.3 to 15.3) 5.9 (2.3 to 15.3) <0.001

16 Secundaire preventie Huisartsen en patiënten op de hoogte gesteld Beleid door huisarts

17 Doel (2) Analyseren van de secundaire preventieve interventies ondernomen door vrouwen uit de HyRAS

18 Methode (3)

19 Results (8)

20 Results (9) Table 2. Secondary preventive interventions of cardiovascular risk Intervention/Risk FactorOverall effect Cases: PE and GH Controls Differences cases/controls (RR) 3 ½ years postpartum Antihypertensive medication used by women with hypertension 36% (33/92)36% (33/91)0% (0/1)- BMI reduction ≥ 5% of women with BMI≥25 30% (56/187)31% (50/163)25% (6/24)1.22 [.59 to 2.55] Smoking cessation of women smoking 35% (22/62)42% (20/48)14% (2/14)2.92 [.77 to 10.98]

21 Conclusies (1) Hypertensie in de zwangerschap – ↑ Kans hypertensie later in het leven – ↑ Glucose levels – ↑ Insuline levels en HOMA scores – ↑ Lipiden – ↑ HsCRP – ↑ Kans metabool syndroom

22 Conclusies (2) Hypertensie in de zwangerschap – Stress test for life – Secundaire preventie door 1/3 van de vrouwen – Kans voor secundaire preventie – Veel mogelijkheden voor verbetering preventie

23 Met dank aan:  Clara Kolster LUMC  Wietske Hermes  Sanne Visser  Consortium for Women’s Health and Reproductive Studies  Leiden: Clara Kolster, Marjolein Verhart, Sanne Visser, Jouke Tamsma  Amsterdam: Jannet Bakker, Birgit van der Goes, Hilde ten Horn, Evelien van der Hout  Groningen : Corine Koopmans, Lida Ulkeman, Jose Keurentjes, Femke de Bok  Brabant: Corine Verhoeven, Stephanie Loix, Corinne vd Griendt  HyRAS Project group:  Christianne de Groot,  Ben Willem Mol,  Marielle van Pampus  Arie Franx  Joris van der Post  Kitty Bloemenkamp  Martina Porath  NutsOhra Foundation  Laboratory of Medical Centre Haaglanden, The Hague: Piet Sturm, Gabrielle Ponjee

24 Correspondence:

25

26 Low birth weight Preterm delivery Preeclampsia Smith et al. Preeclampsia, low birth weight, preterm delivery Preeclampsia Jonsdottir et al. Preeclampsia Irgens et al. Preeclampsia and preterm delivery 3 4 Vascular Pregnancy Complications and Cardiovascular Maternal Mortality 567 HR


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