Evaluación del riesgo de alteración de presión diastólica en las variables metabólicas en el embarazo

[Evaluation of the risk of diastolic pressure alteration in metabolic variables in pregnancy]

Hugo Mendieta Zerón1, Miriam Deyanira Rodríguez Piña2, Blanca Estela Díaz Castañeda2, Araceli Consuelo Hinojosa Juárez3, María del Carmen García García4, Betsy Corina Sosa Garcia5

1. Profesor de Tiempo Completo Facultad de Medicina, Universidad Autónoma del Estado de México Jefe de Investigación Hospital Materno-Perinatal "Mónica Pretelini Sáenz"; 2. Alumnas de la Licenciatura en Medicina, Universidad Autónoma del Estado de México; 3. Profesora de Tiempo Completo, Facultad de Medicina, Universidad Autónoma del Estado de México; 4. Lab CITOBES Investigadora del Centro de Medicina Molecular y Enfermedades Crónicas (CIMUS) / Dept de Fisiología, Universidad de Santiago de Compostela, España; 5. MSc, Doctora en Ciencias de la Salud, Facultad de Ciencias de la Conducta, Universidad Autónoma del Estado de México;

Publicado: 2021-10-15

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Resumen

OBJETIVO: Evaluar la asociación de la presión diastólica (PAD) y variables metabólicas en embarazadas.

METODOLOGÍA: Estudio retrospectivo, transversal en embarazadas de término, mayores de 25 años, con embarazo único, agrupadas por Índice de Masa Corporal (IMC). A todas se les midieron lípidos, glucosa y PAD. Se calculó Odds Ratio (IC 95 %), correlación de Spearman entre variables y Kruskal Wallis utilizando SPSS v21.0.

RESULTADOS: Se incluyeron 60 embarazadas normoevolutivas, edad promedio 30.9 ± 4.5 años, obteniendo una prevalencia de 41.6 % para sobrepeso y 31.6 % para obesidad. Los valores de glucemia en ayuno fueron de 102.2 ± 49.8 mg/dL en obesidad, 89.8 ± 28.7 mg/dL en sobrepeso y 84.5 ± 12.3 mg/dL en normopeso. Los valores medios de la PAD y PAS mostraron una correlación positiva con el valor medio de IMC pregestacional y gestacional. Mientras que, para las concentraciones de glucosa y lípidos, se obtuvo una correlación positiva con el valor medio de la PAD.

CONCLUSIÓN: Se confirma asociación de la PAD con el IMC pregestacional.

 

 


Abstract

OBJECTIVE: To evaluate the association of diastolic pressure (DBP) and metabolic variables in pregnant women.

METHODOLOGY: Retrospective, cross-sectional study in full-term pregnant women, older than 25 years, with a single pregnancy, grouped by Body Mass Index (BMI). Lipids, glucose and DBP were measured in all of them. Odds Ratio (95% CI), Spearman's correlation between variables and Kruskal Wallis were calculated using SPSS v21.0.

RESULTS: 60 normodevelopmental pregnant women were included, mean age 30.9 ± 4.5 years, obtaining a prevalence of 41.6% for overweight and 31.6% for obesity. Fasting blood glucose values ​​were 102.2 ± 49.8 mg / dL in obesity, 89.8 ± 28.7 mg / dL in overweight, and 84.5 ± 12.3 mg / dL in normal weight. The following ORs were obtained for DBP> 80 mmHg with SBP> 130 mmHg (1,571; 95% CI: 0.490-5.037), glucose> 90 mg/dL (1.052; 95% CI: 0.451-2.453), cholesterol > 200 mg / dL (1.667; 95% CI: 0.694-4.004), triglycerides> 150 mg/dL (1.2; 95% CI: 0.243-1.832), platelets <150 thousand / µL (1.072; 95% CI: 0.220-2.974) and lymphocytes <1000 /µL (1.145; 95% CI: 0.168-2.405).

CONCLUSION: The association of DBP disorders with pre-pregnancy BMI is confirmed.

 

Citas

[1] Gaillard R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol. 2015;30(11):1141–52.

[2] Pacheco-Romero J. Gestación en la mujer obesa: consideraciones especiales TT- Pregnancy in the obese woman: special considerations. An Fac Med. 2017;78(2):207–14.

[3] Bello NA, Miller E, Cleary K, Wapner R, Shimbo D, Tita AT. Out of Office Blood Pressure Measurement in Pregnancy and the Postpartum Period. Curr Hypertens Rep. 2018;20(12).

[4] Sarka Lisonkova, Giulia M. Muraca, Jayson Potts, Jessica Liauw, Wee-Shian Chan, Amanda Skoll, Kenneth I. Lim. Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. JAMA. 2017;318(18):1777–1786. doi:10.1001/jama.2017.16191

[5] Campos CAS, Malta MB, Neves PAR, Lourenço BH, Castro MC, Cardoso MA. Gestational weight gain, nutritional status and blood pressure in pregnant women. Rev Saude Publica. 2019;53:57.

[6] Ngene NC, Moodley J. Blood pressure measurement in pregnancy and in hypertensive disorders of pregnancy: Devices, techniques and challenges. Cardiovasc J Afr. 2019;30(2):120–9.

[7] Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines. Hypertension. 2018.71:13–115.

[8] Nadruz W, Shah A, Solomon S. Diastolic Dysfunction and Hypertension. Med Clin North Am.2017;101(81):7-17

[9] MSP/INEC. Encuesta Nacional de Salud y Nutrición. Ensanut [Internet]. 2018;1:47. https://www.ecuadorencifras.gob.ec/documentos/web-inec/Estadisticas_Sociales/ENSANUT/ENSANUT_2018/Principales resultados ENSANUT_2018.pdf

[10] Szczepaniak-Chicheł L, Markwitz W, Tykarski A. Difference between central and peripheral blood pressure in healthy and hypertension-complicated pregnancy. Blood Press Monit. 2016;21(2):103–10.

[11] Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C et al. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2017;10(2).

[12] Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017;40(3):213-220. doi: 10.1038/hr.2016.126.

[13] Fernández Alba JJ, Mesa Páez C, Vilar Sánchez Á, Soto Pazos E, González Macías M del C, Serrano Negro E, et al. Sobrepeso y obesidad como factores de riesgo de los estados hipertensivos del embarazo: estudio de cohortes retrospectivo. Nutr Hosp. 2018;35(4):874.

[14] Espinoza J, Vidaeff A, Pettker C SH. Gestational Hypertension and Preeclampsia. MCN Am J Matern Nurs. 2019;44(3):e237–60.

[15] Sutton, A. L. M., Harper, L. M., & Tita, A. T. N. (2018). Hypertensive Disorders in Pregnancy. Obstetrics and Gynecology Clinics of North America, 45(2), 333–347. doi:10.1016/j.ogc.2018.01.012 ].

[16] Gomez-Arango LF, Barrett HL, McIntyre HD, Callaway LK, Morrison M, Dekker Nitert M. Increased Systolic and Diastolic Blood Pressure is Associated with Altered Gut Microbiota Composition and Butyrate Production in Early Pregnancy. Hypertension. 2016;68(4):974–81.

[17] Lei Q, Zhou X, Duan DM, Lv LJ, Lin XH, Ji WJ, et al. Trimester-specific weight gain and midpregnancy diastolic blood pressure rebound during normotensive pregnancy. Hypertension. 2017;70(4):804–12.

[18] Tovar Rodríguez JM, Valle Molina L, Vargas Hernández VM, Hernández Aldana FJ, Hernández Vivar LE. Difference of the arterial pressure between arms in a group of pregnant and puerperal women with and without arterial hypertension and its impact on the newborn person. Clin Invest Ginecol Obstet. 2019;46(2):69–76. Available from: https://doi.org/10.1016/j.gine.2018.09.002.

[19] McCall SJ, Li Z, Kurinczuk JJ, Sullivan E, Knight M. Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study. PLoS One. 2019;14(2):1–11.

[20] Cervantes-Ramírez DL, ME HA, Ayala-Figueroa RI, Haro-Estrada I, Fausto-Pérez JA. Prevalencia de obesidad y ganancia de peso en mujeres embarazadas. Atención Fam. 2019;26(2):43–7.

[21] Moftakhar L, Solaymani-Dodaran M, Cheraghian B. Role of obesity in gestational hypertension in primigravidae women: A case control study in Shadegan, Iran. Med J Islam Repub Iran. 2018; (32): 104-10.

[22] Piedra-Digournay C, Simonó-Digournay N. Influencia del sobrepeso y obesidad en el embarazo. Panor Cuba y Salud. 2019; 14 (1): 28-33.

[23] Rosado-Yépez PI, Chávez-Corral DV, Reza-López SA, Fierro-Murga R, Caballero-Cummings S, Levario-Carrillo M. Relation between pregestational obesity and characteristics of the placenta. J Matern Neonatal Med 2019;21(3):1-6. https://doi.org/10.1080/14767058.2019.1573222

[24] Donoso E, Pérez A., Embarazo de Alto Riesgo. 2da. Ed. Santiago de Chile: Edit. Técnicas Mediterráneo; 2001:315-19.

[25] Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician. 2016;93(2):121–7

[26] Steer PJ, Little MP, Kold-Jensen T, Chapple J, Elliott P. Maternal blood pressure in pregnancy, birth weight, and perinatal mortality in first births: Prospective study. Br Med J. 2004;329(7478):1312-4.

[27] Warrington NM, Beaunmont RN, Horikoshi M, Day FR, Helgeland O, Laurin C, Bacelis J. Maternal and fetal genetic effects on birth weight and their relevance to cardio-metabolic risk factors. Nat Genet. 2019;51(5):804–14.

[28] Rivera-Pírela R, Reyna-Villasmil E, Mejia-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N. et al . Serum cholesterol in the second trimester of pregnancy as a predictor of preeclampsia. Rev. peru. ginecol. obstet. 2017; 63(2): 163-169.

[29] Do Nascimento IB, Dienstmann G, De Souza MLR, Ribeiro E, Fleig RQ, Silva JC. Dyslipidemia and maternal obesity: Prematurity and neonatal prognosis. Rev Assoc Med Bras. 2018;64(3):264–71.

[30] Eley VA, Christensen R, Kumar S, Callaway LK. A review of blood pressure measurement in obese pregnant women. Int J Obstet Anesth [Internet]. 2018;35:64–74. https://doi.org/10.1016/j.ijoa.2018.04.004.

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