Maternal High Blood Pressure and Newborn’s Blood Profile

Overview

Maternal high blood pressure remodels the intrauterine environment of the fetus by altering hormonal and cellular signaling patterns and, as a result increases the risk of fetal and neonatal mortality and morbidity. Newborns of these mothers have an increased risk of intrauterine growth restriction, premature birth and hematological abnormalities, such as thrombocytopenia, polycythemia, and neutropenia. The purpose of the article is to review neonatal thrombocytopenia and neutropenia as a consequence of maternal high blood pressure and to establish the optimal management of these cases.

Full Title of Study: “Maternal Pregnancy Induced Hypertension and Hematological Profile of Newborns”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: August 25, 2017

Detailed Description

Pregnancy induced hypertension (PIH) and preeclampsia (preE) are caused by gestation and have an onset after 20 weeks of pregnancy. Although the exact etiology of PIH and preE remains unknown, two interconnected mechanisms have been identified to play an important role in the pathogenesis: dysfunction of the placental trophoblast and endothelial dysfunction within the maternal systemic vasculature. The endothelium has been identified as the target tissue of the disease. Endothelial alterations ultimately manifest as placental hypoxia and hypoplasia. The neonatal thrombocytopenia and neutropenia after pregnancy-induced hypertension is a result of inhibition of fetal bone marrow production of the myeloid lineage due to intrauterine hypoxic environment. This study aims to investigate the hematological profile in term and preterm infants born to mothers with preeclampsia. The current retrospective observational study was conducted at the Clinic of Obstetrics, Gynecology and Neonatology of the Emergency County Hospital, Timisoara over a period of three years, from January 2014 to December 2016. All inborn patient files were analyzed as anonymised limited data sets from archived records of the Neonatology Department.

Interventions

  • Other: AGA – Control group
    • Data processing from Patient Medical Files
  • Other: SGA – Control group
    • Data processing from Patient Medical Files
  • Other: AGA-PIH Study group
    • Monitoring PIH-related changes in the newborn
  • Other: SGA-PIH Study group
    • Monitoring PIH-related changes in the newborn

Arms, Groups and Cohorts

  • AGA Neonates
    • AGA Control Group Appropriate for gestational age newborns of healthy mothers
  • SGA Neonates
    • SGA – Control Group Small for gestational age newborns of healthy mothers
  • AGA-PIH Neonates
    • AGA-PIH Study Group Appropriate for gestational age newborns of mothers with pregnancy induced hypertension
  • SGA-PIH Neonates
    • SGA-PIH Study Group Small for gestational age newborns of mothers with pregnancy induced hypertension

Clinical Trial Outcome Measures

Primary Measures

  • Hematological Changes in the Newborns of Mothers with Pregnancy Induced Hypertension
    • Time Frame: Blood profiles of newborns aged between 1-28 days were evaluated.
    • Evaluating the impact of Maternal Pregnancy Induced Hypertension on fetal and neonatal hematopoiesis with focus on the myeloid lineage.

Participating in This Clinical Trial

Inclusion Criteria

  • Age: 0-28 days – Newborns of healthy mothers; – Newborns of mothers with Pregnancy Induced Hypertension; – Inborn Patients; – Written Informed Consent signed by legal guardian. Exclusion Criteria:

  • Maternal disease other than PIH; – Syndromal, chromosomal or infectious diseases of the newborns; – Causes other then PIH for perinatal asphyxia.

Gender Eligibility: All

Minimum Age: 1 Day

Maximum Age: 28 Days

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Romanian Society of Anesthesia and Intensive Care
  • Collaborator
    • University of Medicine and Pharmacy “Victor Babes” Timisoara
  • Provider of Information About this Clinical Study
    • Principal Investigator: Alexandru Florin Rogobete, MSc, PhDs, Clinical Researcher – Romanian Society of Anesthesia and Intensive Care
  • Overall Official(s)
    • Alexandru Florin Rogobete, PhDs, Principal Investigator, Romanian Society of Anesthesia and Intensive Care
    • Dorel Sandesc, Prof, Study Chair, Romanian Society of Anesthesia and Intensive Care
    • Ovidiu Bedreag, Assoc Prof, Study Director, Romanian Society of Anesthesia and Intensive Care

References

Bhat YR, Cherian CS. Neonatal thrombocytopenia associated with maternal pregnancy induced hypertension. Indian J Pediatr. 2008 Jun;75(6):571-3. doi: 10.1007/s12098-008-0110-x. Epub 2008 Aug 31.

Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ. Maternal preeclampsia and neonatal outcomes. J Pregnancy. 2011;2011:214365. doi: 10.1155/2011/214365. Epub 2011 Apr 4.

de Zegher F, Francois I, van Helvoirt M, Van den Berghe G. Clinical review 89: Small as fetus and short as child: from endogenous to exogenous growth hormone. J Clin Endocrinol Metab. 1997 Jul;82(7):2021-6. doi: 10.1210/jcem.82.7.4007. No abstract available.

Christensen RD, Yoder BA, Baer VL, Snow GL, Butler A. Early-Onset Neutropenia in Small-for-Gestational-Age Infants. Pediatrics. 2015 Nov;136(5):e1259-67. doi: 10.1542/peds.2015-1638. Epub 2015 Oct 12.

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