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Abstract(s)
Os distúrbios hipertensivos complicam 12-22% da totalidade das gravidezes e são, actualmente, subdivididos em quatro categorias: hipertensão crónica; pré-eclâmpsia/eclâmpsia; hipertensão crónica com pré-eclâmpsia sobreposta e hipertensão gestacional. A pré-eclâmpsia, objecto de análise deste trabalho, ocorre em 5% das grávidas, ainda que este percentual possa subir exponencialmente se forem considerados apenas alguns sub-grupos definidos como sendo de risco. Exemplos são as nulíparas, as de raça negra ou as portadoras de doença crónica. Trata-se de uma patologia com etiologia pouco clara, que surge, regra geral, após a 20ª semana gestacional e que, de um modo geral, se define com base em dois critérios: valores tensionais e quantificação de proteinúria. São sugestivos de pré-eclâmpsia, valores de PAS≥140mmHg e de PAD≥90mmHg associados a excreção renal proteica ≥300mg, quantificada em urina de 24 horas. Existem, contudo, uma variedade de outros sintomas ou alterações laboratoriais que corroboram o diagnóstico desta síndroma e que, quando presentes, podem reflectir agravamento do quadro clínico. A associação deste quadro com actividade convulsiva, tipicamente tónico-clónica, recebe a designação de eclâmpsia.
Uma gravidez complicada por um quadro de pré-eclâmpsia deve ser considerada como de alto risco obstétrico e a conduta clínica irá depender da idade gestacional e da gravidade da síndroma aquando do diagnóstico. Recomenda-se uma abordagem não farmacológica, visando a monitorização dos parâmetros vitais fetais e maternos. Não existem alternativas terapêuticas válidas que influenciem ou alterem a fisiopatologia da pré-eclâmpsia, sendo o parto o único meio curativo definitivo. Ainda assim, pode considerar-se a prevenção da actividade convulsiva e o controlo da hipertensão arterial para protecção materna.
O facto de se tratar de uma síndroma com fisiopatologia incerta limita o desenvolvimento de estudos que visem identificar quais as melhores estratégias preventivas, porém, dos desenvolvidos nas últimas três décadas têm insistido em esclarecer uma possível relação entre um aporte diminuído de cálcio e o desenvolvimento de estados hipertensivos, com ênfase na gravidez. Neste sentido propomo-nos desenhar um estudo prospectivo, multicêntrico, aleatorizado, em dupla ocultação e placebo-controlado que esclareça esta possível relação. Calculou-se que, com um erro tolerável de 5%, tal estudo deva ser aplicado a uma amostra de 400 grávidas, sendo que a metade será fornecido um suplemento de cálcio (Calcitab 1500mg duas vezes/dia) e às restantes placebo.
Hypertensive disorders complicate 12-22% of all pregnancies. They can be subdivided in four different categories: chronic hypertension; preeclampsia-eclampsia; preeclampsia superimposed on chronic hypertension; gestational hypertension. In this study preeclampsia will be analysed. This syndrome occurs in 5% of pregnant women, although, this percentage exponentially rises in sub-groups defined as being at risk, like nulliparity, multifetal gestations or African race. Preeclampsia is a syndrome, with unclear etiology that usually appears after week 20, and is defined based on two criteria: blood pressure and urinary proteins. Therefore, SBP≥140mmHg, DBP≥90mmHg in association with proteinuria greater than 300mg per 24 hours suggest preeclampsia. However, there are other clinical or laboratorial findings that confirm the diagnosis and, if present, may reflect worsening, like, epigastric or hipocondralgia, persistent headache, visual and behavioural changes, renal or hepatic alterations and thrombocytopenia. In the presence of a new-onset grand-mal seizure this syndrome receives the designation of eclampsia. Usually, in a pregnant woman, diagnosed with preeclampsia, two different approaches are recommended: nonpharmacological, for fetal and maternal evaluation and pharmacological, for seizure and blood pressure control for maternal protection. The uncertain pathophysiology of this syndrome limits the development of studies that aim to identify the best preventive strategies. Despite that, in the last three decades, several investigators have insisted on clarifying the relationship between a decreased dietary intake of calcium and the development of hypertensive disorders during pregnancy. As such, in this work, we propose to design a prospective, multicenter, randomized, double blind and placebo-controlled study to clarify this relationship. It was calculated that, with a tolerable error of 5%, the study must be applied to a sample of 400 pregnant women. Half will be given a calcium supplement (Calcitab 1500mg) and the other placebo.
Hypertensive disorders complicate 12-22% of all pregnancies. They can be subdivided in four different categories: chronic hypertension; preeclampsia-eclampsia; preeclampsia superimposed on chronic hypertension; gestational hypertension. In this study preeclampsia will be analysed. This syndrome occurs in 5% of pregnant women, although, this percentage exponentially rises in sub-groups defined as being at risk, like nulliparity, multifetal gestations or African race. Preeclampsia is a syndrome, with unclear etiology that usually appears after week 20, and is defined based on two criteria: blood pressure and urinary proteins. Therefore, SBP≥140mmHg, DBP≥90mmHg in association with proteinuria greater than 300mg per 24 hours suggest preeclampsia. However, there are other clinical or laboratorial findings that confirm the diagnosis and, if present, may reflect worsening, like, epigastric or hipocondralgia, persistent headache, visual and behavioural changes, renal or hepatic alterations and thrombocytopenia. In the presence of a new-onset grand-mal seizure this syndrome receives the designation of eclampsia. Usually, in a pregnant woman, diagnosed with preeclampsia, two different approaches are recommended: nonpharmacological, for fetal and maternal evaluation and pharmacological, for seizure and blood pressure control for maternal protection. The uncertain pathophysiology of this syndrome limits the development of studies that aim to identify the best preventive strategies. Despite that, in the last three decades, several investigators have insisted on clarifying the relationship between a decreased dietary intake of calcium and the development of hypertensive disorders during pregnancy. As such, in this work, we propose to design a prospective, multicenter, randomized, double blind and placebo-controlled study to clarify this relationship. It was calculated that, with a tolerable error of 5%, the study must be applied to a sample of 400 pregnant women. Half will be given a calcium supplement (Calcitab 1500mg) and the other placebo.
Description
Keywords
Pré-eclâmpsia Pré-eclâmpsia - Prevenção Pré-eclâmpsia - Diagnóstico Pré-eclâmpsia - Hipertensão
Citation
Publisher
Universidade da Beira Interior