FILE PHOTO: A pregnant woman is seen in a handout photo. REUTERS/Newscom
(Reuters Health) – Women who develop high blood pressure during pregnancy may have the condition reappear within a year of delivery, and many of them may go undiagnosed because the problem only surfaces at night, a new study suggests.
Preeclampsia, or high blood pressure that develops during pregnancy, is common. In severe cases, it can become fatal or result in serious complications for babies like organ damage or stunted growth. While the condition has also long been linked to an increased risk of women developing high blood pressure later in life, the current study offers fresh insight into why it might go undetected.
For the study, researchers focused on 200 women with severe preeclampsia that resolved after the women gave birth. In 24-hour home blood pressure testing done one year after these women gave birth, 42 percent of them had developed high blood pressure.
But only 24 percent of these cases would have been caught by a quick blood pressure check at the doctor’s office, researchers report in Hypertension. That’s because in many instances, women had high blood pressure at night.
“Our findings suggest that women who have high blood pressure during pregnancy should continue to monitor their blood pressure long after they’ve delivered their babies,” said lead study author Dr. Laura Benschop of Erasmus Medical Center in the Netherlands.
“Women with previous severe preeclampsia should also receive 24-hour blood pressure monitoring one year after pregnancy to diagnose any type of hypertension that cannot be diagnosed with a single office blood pressure measurement,” Benschop said by email.
Most of the women were around 32 years old when pregnant, and they were typically first-time mothers. On average, they were diagnosed with preeclampsia at around 30 weeks’ gestation, during the third trimester.
By one year after delivery, roughly one in five of the women had already been diagnosed with hypertension and been given medication to treat it.
During the home-based tests, 43 percent of the women had high blood pressure at night and 32 percent had it during the day.
Beyond its small size, another limitation of the study is that it included mostly white and highly educated women, and results from this group may not represent what would happen for other patients, the authors note.
“The study itself is not sufficient to directly recommend specialist screening for all women with previous preeclampsia,” Dr. Simon Timpka, a researcher at Lund University and Skane University Hospital in Malmo, Sweden, who wasn’t involved in the study, said by email.
However, the results do suggest women should get annual blood pressure checks from their general practitioners, advised Heather Boyd, a researcher at the Statens Serum Institut in Copenhagen, Denmark.
“We might need to think about expanding annual blood pressure checks to include home monitoring for a 24-hour period, at least for women with a history of severe preeclampsia,” Boyd, who wasn’t involved in the study, said by email.
Beyond getting their blood pressure checked, women can also take steps to prevent it from becoming elevated, noted Dr. Nieca Goldberg, medical director of the Joan H. Tisch Center for Women’s Health at New York University Langone Medical Center.
“They should also follow a healthy diet . . . and lower their salt intake,” Goldberg, who wasn’t involved in the study, said by email. “Exercise and stress reduction are also good ways to keep your blood pressure in the healthy range.”
SOURCE: bit.ly/2Eo2BA0 Hypertension, online February 5, 2018.
Drinking in pregnancy tied to subtle changes in babies’ faces
A pregnant woman is seen in a handout photo. REUTERS/Newscom
(Reuters Health) – Women who drink even a little bit of alcohol during pregnancy may be more likely than other mothers to have babies with slight facial abnormalities that have been linked to developmental problems, a recent study suggests.
When researchers examined data from facial images for 415 one-year-old children, they found subtle changes in babies’ faces mostly around the nose, eyes and lips associated with almost all levels of alcohol exposure regardless of whether drinking occurred only in the first trimester or throughout the pregnancy.
“We are surprised to see these differences in facial shape with low doses of alcohol exposure, which in our study was defined as two standard drinks on any one occasion and no more than seven in a week,” said lead study author Evelyne Muggli of the Murdoch Children’s Research Institute and the University of Melbourne in Australia.
“This means that any level of alcohol contributes to the way the face is formed and raises questions about the possible impact on brain development, which is the subject of further research,” Muggli said by email.
The facial changes found in the study are so subtle they aren’t visible to the naked eye, Muggli said. They can only be seen with sophisticated three-dimensional facial shape analysis, and they don’t necessarily mean that unborn babies have been harmed if mothers consumed some alcohol while pregnant, Muggli added.
But differences around the middle of the face and nose seen with alcohol exposure during pregnancy in the study resemble anomalies associated with fetal alcohol spectrum disorder, researchers report in JAMA Pediatrics.
Differences were most pronounced between children with no exposure to alcohol in utero and children with low exposure in the first trimester, particularly in the forehead, the study found.
Compared to children not exposed to any alcohol when their mothers were pregnant, kids with moderate to high exposure in the first trimester had differences in their eyes, mid-face and chin. Changes in the chin were also seen with binge drinking in the first trimester
Most women who do drink during pregnancy only drink a little bit and often stop once they realize they’re pregnant, limiting fetal alcohol exposure to the first trimester, Carol Bower of the University of Western Australia writes in an accompanying editorial.
Up to about one in 20 children may be affected by fetal alcohol spectrum disorder (FASD), which can lead to cognitive impairment including irreversible brain damage.
Children exposed to alcohol in the womb may have learning challenges such as deficits in memory or speech as well as behavior problems like hyperactivity.
The study wasn’t a controlled experiment designed to prove how or if different levels of alcohol exposure at different points in pregnancy might impact children’s faces, or cause specific developmental problems.
In addition, all of the children in the study were white, and it’s possible facial changes associated with alcohol exposure during pregnancy might look different in children from other racial or ethnic groups, the researchers note.
Even so, the findings add to a growing body of evidence on the fetal development effects of even low levels of alcohol consumption during pregnancy, said Heather Carmichael Olson, of the University of Washington School of Medicine.
“It is a substance that can change fetal development, and can be associated with lifelong changes in learning and behavior,” Carmichael Olson, who wasn’t involved in the study, said by email.
“If any amount of prenatal alcohol exposure can lead to physical changes in fetal development, as the current study suggests, so that it’s not just high doses or long-term drinking that have measurable effects, the safest advice that providers can give is that women who want a healthy pregnancy should avoid this biological risk factor if they are considering pregnancy or are pregnant,” Carmichael Olson added. — By Lisa Rapaport
SOURCE: bit.ly/2rv58kQ JAMA Pediatrics, online June 5, 2017.
Pregnant women need routine blood pressure checks
A child touches her pregnant mother’s stomach at the last stages of her pregnancy in Bordeaux April 28, 2010. REUTERS/REGIS DUVIGNAU
(Reuters Health) – Pregnant women should get their blood pressure checked at each prenatal visit to screen for preeclampsia, a potentially fatal complication that can damage the kidneys, liver, eyes and brain, new U.S. guidelines say.
While many doctors already monitor blood pressure throughout pregnancy, the U.S. Preventive Services Task Force (USPSTF) updated its guidelines for the first time since 1996 to stress that screening at every visit can help doctors catch and treat preeclampsia before it escalates from a mild problem to a life-threatening one.
“Preeclampsia is one of the most serious health problems affecting pregnant women,” task force member Dr. Maureen Phipps, a women’s health researcher at Brown University in Providence, Rhode Island, said by email.
“Because this condition is common and critical, the Task Force offers two separate recommendations to help women lower the risk associated with preeclampsia – screening for preeclampsia is recommended for all pregnant women, and women at high risk of developing the condition can take low-dose aspirin to help prevent it,” Phipps added by email.
The screening recommendations, published on Tuesday in JAMA, apply to women without a history of preeclampsia or high blood pressure. Separate guidelines advise low-dose aspirin after the first 12 weeks of pregnancy for women with a history of elevated blood pressure. (bit.ly/2oIwP5B)
Preeclampsia can progress quickly, and typically develops after 20 weeks of pregnancy. Blood pressure screening earlier in pregnancy can show normal results for women who go on to develop preeclampsia.
In addition to elevated blood pressure, women with preeclampsia may also have excess amounts of protein in their urine, as well as swelling in the feet, legs and hands.
Women may suffer from stroke, seizures, organ failure and in rare cases, death. For babies, complications include slower growth inside the uterus, low birth weight and death.
Risks for preeclampsia include a history of obesity, diabetes, kidney disease, lupus or rheumatoid arthritis, as well as a mother or sister who has experienced the condition.
Because the risks of preeclampsia increase with age, women may be able to lower their chances of developing this complication by having babies sooner, said Dr. Dana Gossett, an obstetrics and gynecology researcher at the University of California, San Francisco, and co-author of an accompanying editorial in JAMA.
“Beyond that, it is also important to ensure that all health problems are well managed prior to pregnancy,” Gossett said by email. “High blood pressure should be under good control, other diseases like kidney disease or lupus should be well controlled, and women should try to be close to their ideal body weight prior to conception.”
Checking blood pressure at every prenatal visit can help prevent complications for mothers and babies alike, said Dr. Martha Gulati, chief of cardiology at the University of Arizona College of Medicine in Phoenix and author of a separate editorial in JAMA Cardiology.
“This is something that should be provided to every woman as part of preventive care,” Gulati said by email. “We will save lives and prevent complications and death in pregnant women with this simple, cost-effective” test that doesn’t take much time.
SOURCE: bit.ly/2oGYMKe and bit.ly/2peNbnM JAMA, online April 25, 2017; and bit.ly/2q1qDH4 JAMA Cardiology, online April 25, 2017.
Smoking during pregnancy tied to eye damage in kids
A woman is silhouetted as she smokes a cigarette in central Sydney August 1, 2013. REUTERS/Daniel Munoz
(Reuters Health) – When women smoke during pregnancy or have underweight babies their children have a greater risk of developing a type of retina damage, a Danish study suggests.
Researchers focused on the thickness of what’s known as the retinal nerve fiber layer, made of fibers in the optic nerve that transmit visual information from the eye to the brain. When the retinal nerve fiber layer is too thin, people may have an increased risk of vision impairment and glaucoma, an eye disease that can lead to blindness.
Previous studies have linked maternal smoking to underweight babies, researchers note in JAMA Ophthalmology. Because low birth weight is also associated with having a thinner retinal nerve fiber layer, smoking could have a direct and indirect effect on the optic nerve and its connections to the retina, researchers note.
In the current study, researchers examined data from eye exams on 1,323 children at age 11 or 12 and found both smoking and low birth weight independently associated with thinner retinal nerve fiber.
“Smoking for a relatively short time interval during pregnancy can have lifelong consequences to the exposed fetus,” said Dr. Christopher Kai-Shun Leung, a researcher at the Chinese University of Hong Kong and author of an editorial accompanying the study.
In the study, 80 percent of the mothers didn’t smoke during pregnancy. Another 2 percent of mothers stopped smoking during pregnancy and about 18 percent continued to smoke throughout pregnancy.
Roughly 4 percent of their babies were born at a low birth weight.
Eye exams for all of the kids found they had an average retinal nerve fiber thickness of 104 micrometers.
Children of mothers who smoked during pregnancy had retinal nerve fiber that was typically 5.7 micrometers thinner than in kids whose mothers didn’t smoke at all while pregnant.
There wasn’t a difference between children of nonsmoking mothers and kids born to women who stopped smoking during pregnancy.
In low birth weight children, average retinal nerve fiber was 3.5 micrometers thinner than with kids born at a normal weight.
The study wasn’t a controlled experiment designed to prove that either smoking or low birth weight cause eye damage.
Another limitation of the study is the lack of data on socioeconomic status of the mothers, which can influence tobacco use and the risk of pregnancy complications, the authors note. Researchers also lacked data on alcohol use during pregnancy, a habit that often accompanies smoking and that can independently impact fetal development.
For women who did smoke during pregnancy, researchers didn’t know how many cigarettes they smoked or how often they smoked.
Lead study author Hakan Ashina of Righospitalet in Copenhagen didn’t respond to emails seeking comment.
The differences in retinal nerve fiber layer thickness found in the study aren’t big enough to produce detectable eye problems, Leung said by email.
“However, a thinner retinal nerve fiber layer has been connected to a higher risk of development of glaucoma,” Leung added. “Monitoring the retinal nerve fiber layer in children with history of maternal smoking and/or low birth weight would be important.”
SOURCE: bit.ly/2mmxNWz and bit.ly/2lEDnoB JAMA Ophthalmology, online March 2, 2017.