Pregnant women need routine blood pressure checks

UNTV News   •   April 26, 2017   •   3043

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.

Lowering blood pressure cuts risk of memory decline: U.S. study

UNTV News   •   July 26, 2018

FILE PHOTO: A man has his blood pressure checked at the Remote Area Medical Clinic in Wise, Virginia, U.S., July 22, 2017. REUTERS/Joshua Roberts

CHICAGO (Reuters) – Aggressively lowering blood pressure significantly reduced the risk of mild cognitive impairment and dementia among hypertension patients in a large government-backed clinical trial, U.S. researchers said on Wednesday.

The results, presented at the Alzheimer’s Association International Conference in Chicago, offer some of the first tangible steps individuals can take to reduce their risk for dementia, experts said.

The results come from a landmark 2015 trial dubbed SPRINT involving of more than 9,300 hypertension patients which showed significant cardiovascular benefits in people whose systolic blood pressure – the top number in a blood pressure reading – was lowered aggressively to below 120, compared to a higher target of under 140.

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The Sprint MIND study looked specifically at the implications of aggressive blood pressure lowering on symptoms of dementia from any cause, and mild cognitive impairment, or MCI, a precursor to dementia.

It found that people whose blood pressure was lowered to below 120 had a 19 percent lower rate of new cases of mild cognitive impairment and a 15 percent reduction in MCI and dementia combined.

The takeaway of the study, said Dr. Keith Fargo, director of scientific and outreach programs at the Alzheimer’s Association, is “see your doctor and know your numbers,” and if individuals have hypertension, get it treated.

“Not only do we already know that it reduces the risk for death due to stroke and heart attacks but we now know it supports healthy brain aging,” he said in an interview.

Although the study showed effects on MCI and combined dementia plus MCI, it did not show an overall reduction in dementia alone, at least not yet.

Fargo said it takes longer for people to develop dementia, but as the study continues, he expects more people treated to the higher target of 140 will develop dementia.

“Since it’s too early, too few people have developed dementia,” he said.

The study looked at all causes of dementia, including Alzheimer’s, the most common form marked by clumps of amyloid in the brain, and vascular dementia, which is caused by blocked blood flow to the brain.

Fargo said the result most likely affects the impact of blood pressure lowering on vascular dementia but noted that many people with Alzheimer’s also have some degree of vascular disease, and reducing the total dementia risk could delay the onset of memory problems.

Reporting by Julie Steenhuysen; Editing by Bill Trott

High blood pressure in pregnancy may not disappear afterward

UNTV News   •   February 7, 2018

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.

Mom’s age at birth linked to daughter’s later childlessness

UNTV News   •   January 11, 2018

Pregnant women attend a yoga class in Madrid March 17, 2009. REUTERS/Susana Vera

(Reuters Health) — Moms who have children later in life are more likely to have daughters who don’t have kids, according to a new study.

Compared with women born to 20- to 24-year-old mothers, daughters born to mothers in their mid-20s or 30s were more likely to be childless, the study authors report in the journal Human Reproduction.

“In many countries, couples are having children later and later, and there haven’t been many studies of future reproduction,” said study author Dr. Olga Basso of McGill University in Montreal, Canada.

Basso and colleagues analyzed data from the U.S.-based Sister Study on more than 43,000 women born between 1930 and 1964.

Overall, about 7,600 women – or nearly 18 percent – hadn’t given birth. The researchers found that as maternal age at delivery went up, so did the odds that daughters would be childless.

Compared with study participants born to 20- to 24-year-old mothers, for instance, the odds of childlessness were 21 percent higher for participants born to mothers ages 25-29, 30 percent higher for women born to mothers ages 30 to 34, and 40 percent higher for women born to mothers who were 35 or older.

Basso and colleagues want to know why. They’re interested in future studies about changes in biology, behavior and socioeconomic status and how those could affect birth and childlessness.

“It could be that women who have children at an older age have daughters instilled with different behaviors,” Basso said. “They may have different ambitions and different plans.”

“I was concerned when I saw these findings because I really think women should have children when they’re ready as a matter of choice,” she told Reuters Health by phone. “I don’t want people to believe, as a result of this, that they need to have children when they’re 25.”

Additional studies are looking at the effect of father’s age on childlessness and the historical trends of childbirth.

“We’ve seen an increase in age at first birth, or when women have their first child, but the age hasn’t changed much for last birth,” said Ruben Arslan of the Max Planck Institute for Human Development in Berlin, Germany. Arslan, who wasn’t involved with this study, researches delayed childbearing.

“In past decades, women had children for longer and had more children,” Arslan told Reuters Health by phone. “What we’re seeing is not unprecedented, and it’s not a reason to get worried about childbearing now.”

The main limitation of the study is that researchers didn’t know whether women’s childlessness was by choice and intentional.

“It’s important to think about the consequences and social structures that would give women more choices,” said Dr. Sarah Hayford of Ohio State University in Columbus. Hayford, who wasn’t involved with this study, researches childlessness trends in the U.S.

“The question of childlessness is often framed as a negative outcome, without asking about whether it was voluntary or not,” Hayford told Reuters Health by phone. “But studying the voluntary nature is a complicated task, especially over a broad population, when it’s such a personal decision.”

The cultural context is key, too. A stronger family orientation, religiosity, and other cultural values may contribute to earlier childbearing, which may be passed down to children, said Dr. Martin Kolk of Stockholm University in Sweden, who studies intergenerational patterns of childbearing but wasn’t involved with this study.

“Fertility decisions are often shared between daughters (and sons) and mothers (and fathers),” Kolk told Reuters Health by email. “We’re seeing additional evidence that there is a strong familial and cultural factor affecting childbearing.”

SOURCE: bit.ly/2FnQ4dy Human Reproduction, online December 4, 2017.

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