| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.03 MB | Adobe PDF |
Authors
Abstract(s)
Introdução: As doenças hipertensivas da gravidez complicam até 10% das gestações, sendo
a principal causa de morbimortalidade materno-fetal no mundo desenvolvido, quer por
restrição do crescimento intrauterino quer pelas complicações secundárias à
prematuridade. Este grupo heterogéneo de distúrbios inclui a hipertensão crónica,
hipertensão gestacional (HG), pré-eclâmpsia (PE) e eclâmpsia. Dada a alta prevalência e
complicações associadas, a identificação das grávidas em risco é crucial para uma vigilância
intensiva e instituição de medidas profiláticas. Sendo a gravidez um estado de stress
inflamatório controlado, alguns marcadores inflamatórios têm sido, recentemente,
associados ao desenvolvimento de patologias obstétricas. Contudo, o papel da inflamação
na HG e PE permanece pouco estudado.
Objetivos: Este estudo pretende investigar as complicações materno-fetais associadas à HG
e à PE e estudar o valor dos marcadores inflamatórios como fatores preditores destes
distúrbios, numa fase inicial da gravidez.
Métodos: Estudo transversal, retrospetivo, de todas as primigestas cujo parto ocorreu no
Centro Hospitalar Universitário Cova da Beira, desde janeiro de 2015 a dezembro de 2019.
Foram excluídas grávidas com doença prévia ou ausência de informação sobre a gravidez.
Com recurso aos processos clínicos, foram obtidos os valores do hemograma completo do
primeiro trimestre e informação referente à evolução da gravidez. Calculou-se o rácio
neutrófilos-linfócitos (NLR), rácio plaquetas-linfócitos (PLR), rácio neutrófilos-plaquetas
(NPR) e o índice inflamatório sistémico (SII). O grupo controlo de normotensas (n=514) foi
comparado ao grupo de grávidas com HG isolada (n=20) e ao grupo de grávidas com PE
(n=15). A análise estatística foi efetuada com recurso ao software SPSS 25.0, ao nível de
significância de 0,05.
Resultados: Em 6,4% (n=35) das grávidas foi documentada doença hipertensiva. A HG
isolada ocorreu em 3,6% (n=20) das grávidas e a PE em 2,7% (n=15) e associaram-se, de
forma independente, a piores outcomes materno-fetais. No grupo de grávidas com HG, o
valor dos leucócitos (P=0,02) e neutrófilos (P=0,01) foi significativamente maior, assim
como o NPR (P=0,04). No grupo com PE, os leucócitos (P=0,005), neutrófilos (P=0,004),
NLR (P=0,04) e SII (P=0,02) mostraram-se significativamente mais elevados. Não foi
encontrada associação significativa entre o PLR e o desenvolvimento de HG ou PE. Conclusões: Índices inflamatórios elevados estão significativamente associados ao
desenvolvimento de HG e PE e podem ser marcadores úteis, com bom custo-benefício, para
identificar, precocemente, mulheres de alto risco. São, no entanto, necessários estudos com
maior robustez científica para verificar estas correlações.
Introduction: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies, being the leading cause of maternal-fetal morbimortality in the developed world, due to either intrauterine growth restriction or complications secondary to prematurity. This heterogeneous group of disorders includes chronic hypertension, gestational hypertension (GH), pre-eclampsia (PE), and eclampsia. Given the high prevalence and complications associated, identifying women at risk is crucial for intensive surveillance and prophylactic interventions. Being pregnancy a state of controlled inflammatory stress, some inflammatory markers have recently been correlated with obstetric pathologies. However, the role of inflammation in GH and PE remains little explored. Objectives: This study aims to investigate the adverse maternal-fetal outcomes of GH and PE and study the value of inflammatory markers in predicting these disorders at early stages. Methods: Retrospective, cross-sectional, study of all primigravidas given birth at Universitary Hospital Centre of Cova da Beira, from January 2015 until December 2019. Women with pre-pregnancy diseases or missing information were excluded. First-trimester complete blood count results, routine blood pressure and perinatal outcomes were assessed through hospital records. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR) and systemic immune-inflammation index (SII) were calculated. Normotensive controls (n=514) were compared to isolated GH cases (n=20) and PE cases (n=15). Statistical analysis was performed using SPSS 25.0 software, with a significance level of 0,05. Results: Hypertensive disorders were documented in 6,4% (n=35) of all pregnancies. GH occurred in 3,6% (n=20) of pregnancies and PE in 2,7% (n=15) and both were independently associated with adverse maternal-fetal outcomes. Leukocytes (P=0.02) and neutrophils (P=0.01) were significantly increased in the GH group, as well as NPR (P=0.04). In the PE group, leukocytes (P=0,005), neutrophils (P=0,004), NLR (P=0.04) and SII (P=0.02) were significantly higher. No statistically significant difference was found between PLR and the development of GH or PE. Conclusions: Higher inflammatory indices were associated with both GH and PE and might be useful, cost-effective, markers for early identification of higher-risk women. Nonetheless, more robust studies are needed to assure these correlations.
Introduction: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies, being the leading cause of maternal-fetal morbimortality in the developed world, due to either intrauterine growth restriction or complications secondary to prematurity. This heterogeneous group of disorders includes chronic hypertension, gestational hypertension (GH), pre-eclampsia (PE), and eclampsia. Given the high prevalence and complications associated, identifying women at risk is crucial for intensive surveillance and prophylactic interventions. Being pregnancy a state of controlled inflammatory stress, some inflammatory markers have recently been correlated with obstetric pathologies. However, the role of inflammation in GH and PE remains little explored. Objectives: This study aims to investigate the adverse maternal-fetal outcomes of GH and PE and study the value of inflammatory markers in predicting these disorders at early stages. Methods: Retrospective, cross-sectional, study of all primigravidas given birth at Universitary Hospital Centre of Cova da Beira, from January 2015 until December 2019. Women with pre-pregnancy diseases or missing information were excluded. First-trimester complete blood count results, routine blood pressure and perinatal outcomes were assessed through hospital records. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR) and systemic immune-inflammation index (SII) were calculated. Normotensive controls (n=514) were compared to isolated GH cases (n=20) and PE cases (n=15). Statistical analysis was performed using SPSS 25.0 software, with a significance level of 0,05. Results: Hypertensive disorders were documented in 6,4% (n=35) of all pregnancies. GH occurred in 3,6% (n=20) of pregnancies and PE in 2,7% (n=15) and both were independently associated with adverse maternal-fetal outcomes. Leukocytes (P=0.02) and neutrophils (P=0.01) were significantly increased in the GH group, as well as NPR (P=0.04). In the PE group, leukocytes (P=0,005), neutrophils (P=0,004), NLR (P=0.04) and SII (P=0.02) were significantly higher. No statistically significant difference was found between PLR and the development of GH or PE. Conclusions: Higher inflammatory indices were associated with both GH and PE and might be useful, cost-effective, markers for early identification of higher-risk women. Nonetheless, more robust studies are needed to assure these correlations.
Description
Keywords
Doenças Hipertensivas da Gravidez Gravidez de Alto Risco Hipertensão Gestacional Marcadores Inflamatórios Préeclâmpsia