Chesley's Hypertensive Disorders in Pregnancy

5th Edition - December 7, 2021
Editors: Robert N. Taylor, Kirk P. Conrad, Sandra T. Davidge, Anne Cathrine Staff, James M. Roberts
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 1 8 4 1 7 - 2
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 1 8 4 1 8 - 9

Leon Chesley’s Hypertensive Disorders in Pregnancy was initially published in 1978. Four decades later, hypertension complications in pregnancy are still a major cause of fetal and… Read more

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Leon Chesley’s Hypertensive Disorders in Pregnancy was initially published in 1978. Four decades later, hypertension complications in pregnancy are still a major cause of fetal and maternal morbidity and death, especially in less developed nations. It is also a leading cause of preterm birth now known to be a risk factor in remote cardiovascular disease. Despite this, hypertensive disorders remain marginally studied and management is often controversial. Chesley’s Hypertensive Disorders in Pregnancy, Fifth Edition continues its tradition as one of the beacons to guide the field of preeclampsia research, recognized for its uniqueness and utility. This revision focuses on prediction, prevention, and management for clinicians, and is an essential reference text for clinical and basic investigators alike. It provides a superb analysis of the multiple topics that relate to hypertension in pregnancy, especially of preeclampsia.

Cover image
Title page
Table of Contents
Copyright
List of Contributors
About the Editors
Prefaces
Chapter 1. The Spectrum of Hypertensive Disorders in Pregnancy: Dr. Leon Chesley's Legacy
Introduction
History (by Leon Chesley) (Fig. 1.1)
Signs
Proteinuria
Hypertension
Hypotheses and Rational Management
Prophylaxis
Classification of the Hypertensive Disorders in Pregnancy
Denouement
False Steps in the Study of Preeclampsia (Banquet Commentary by Leon Chesley, 1975)
Chapter 2. Epidemiology of Hypertensive Disorders in Pregnancy
Introduction
Diagnostic Criteria and Research Definitions for Hypertensive Disorders of Pregnancy
Discussion of Differential Frequency Estimates
Risk Factors
Family History and Heritability
Clinical Predictors
First Birth and Other Placental Factors
Natural History
Recurrence of Preeclampsia in Subsequent Pregnancies
Impact on Children
Remote Impact of Preeclampsia on Women and Their Infants
Critique of Studies
Conclusion
Chapter 3. Genetic Factors in the Etiology of Preeclampsia/Eclampsia
Dedication
Introduction
Biological Pathways of Preeclampsia
Fetal/Placental Components of Preeclampsia
Immunogenetic Factors and Placentation (See Also Chapters 5 and 7)
Types of Genetic Studies Conducted
Twin Studies
Segregation Analyses
Linkage Analyses
Association Studies
Summary of Candidate Genes Most Frequently Studied
Genome-Wide Association Studies (GWAS)
Next-Generation Sequencing
A Genomics Approach to Preeclampsia
Essential Variables Make Preeclampsia a Challenging Subject
Interacting Genomes
Subgroup Ascertainment
Genomic Ancestry
Population Size
Gene–Gene Interactions
Epigenetics
Gene–Environment Interactions
Confounding Variables
High-Dimensional Biology
A Predictive Genetic Test
Integrated Polygenic Risk Score
Pharmacogenomics
The Future of Preeclampsia Genetic Research
Conclusions
Chapter 4. Preconceptional and Periconceptional Pathways to Preeclampsia
Evidence for Corpus Luteal and Endometrial Origins of Preeclampsia
Maternal Prepregnancy Cardiovascular and Metabolic Origins of Preeclampsia
Nutritional Contribution to the Genesis of Preeclampsia
Conclusions
Chapter 5. Placentation and Placental Function in Normal and Preeclamptic Pregnancies
Introduction
Early Placental Development
The Cytotrophoblastic Shell
The Trophoblast–Endometrial Gland Dialogue During Early Pregnancy
The Switch to Hemotrophic Nutrition
The Uteroplacental Vasculature in Normal Pregnancy
The Consequences of Deficient Remodeling for Placental Hemodynamics
Placental Oxidative Stress
Endoplasmic Reticulum Stress
Mitochondrial Stress
From Placental Stress to Preeclampsia
Overview
Chapter 6. Unbiased Approaches for Addressing the Complexities of the Placenta's Role in the Preeclampsia Syndrome
Introduction
Gestational Age-dependent Changes in Gene Expression at the Maternal Fetal Interface: 14–24 Weeks Versus Term
Gene Expression at the Maternal Fetal Interface: Preeclampsia Versus Noninfected Preterm Birth
The Effects of preeclampsia on cytotrophoblast Gene Expression Profiles
Preeclampsia-Associated Transcriptional Landscape of Trophoblasts in Situ
Preeclampsia-Associated Placental and Cytotrophoblast Chromatin Landscapes
Chapter 7. The Immunology of Preeclampsia
Introduction
The Scope of this Chapter
Placentation, Trophoblast, and Human Leukocyte Antigen
Where and when is Paternally Inherited Fetal Human Leukocyte Antigen Exposed to the Maternal Immune System?
Decidual Natural Killer Cells and Placentation
T Cells, Treg Cells, and Placentation
Effects of T Cells on Placental and Fetal Tissues
Maternal T Cell Responses in Preeclampsia: Regulated or Dysregulated?
Conclusions and Summary
Chapter 8. Trophoblast Extracellular Vesicles in Preeclampsia
Overview
Definition and Heterogeneity
Terminology and Size
STBEV Cargo
Summary
Chapter 9. Angiogenesis and Preeclampsia
Introduction
Placental Vascular Development in Health
Angiogenic Imbalance in Preeclampsia
Perspectives
Chapter 10. Vascular Endothelial Cell Dysfunction in Preeclampsia
Introduction
Part I: Endothelial Cell Dysfunction and Preeclampsia
Part II: Circulating Factors Induce Endothelial Cell Dysfunction
Part III: Oxidative Stress: a Point of Convergence for Endothelial Cell Dysfunction
Part IV: Clinical Trials
Part V: Summary, Speculations, and Directions of Future Investigations
Chapter 11. Cardiovascular Alterations in Normal and Preeclamptic Pregnancy
Introduction
Hemodynamics and Cardiac Function in Normal Pregnancy
Hemodynamics and Cardiac Function in Preeclampsia
Factors that May Explain Vascular Changes in Pregnancy
Pregnancy-Associated Responses and the Assessment of Cardiovascular Disease Risk Later in Life
Summary
Chapter 12. Cardiometabolic Antecedents of Preeclampsia
Introduction
Placental and Maternal Aspects of Preeclampsia
Pregnancy Profile—an Early Informer of Cardiometabolic Risk
Do Prepregnancy Cardiometabolic Risk Factors Foreshadow Preeclampsia?
Potential Pathways by Which Cardiometabolic Antecedents Contribute to Preeclampsia
Summary Thoughts on Cardiometabolic Antecedents
Chapter 13. Cerebrovascular Pathophysiology in Preeclampsia and Eclampsia
Introduction
Neuropathological Findings with Eclampsia
Neuroimaging Findings in Eclampsia
Pathogenesis of Cerebral Manifestations in Preeclampsia–Eclampsia
Eclampsia and Posterior Reversible Encephalopathy Syndrome (PRES)
Cerebral Blood Flow Autoregulation
Human Studies on Cerebral Hemodynamics in Preeclampsia-Eclampsia
Mechanisms of Seizure During Pregnancy and Preeclampsia
Role of Circulating Factors in Eclampsia
Blood–Brain Barrier
Effect of Magnesium Sulfate Treatment
Stroke in Pregnancy and Preeclampsia
Cortical Blindness
Visual Functioning
Future Cerebrovascular Health Following Preeclampsia and Eclampsia
Conclusion
Chapter 14. The Kidney in Normal Pregnancy and Preeclampsia
Introduction
Renal Hemodynamics and Glomerular Filtration Rate During Normal Pregnancy
Proteins
Osmoregulation
Uric Acid
Preeclampsia and the Kidney
Renal Morphology in Pregnancy and Preeclampsia
Superimposed Preeclampsia in Women with Kidney Disease
Summary
Chapter 15. Salt, Aldosterone, and the Renin–Angiotensin System in Pregnancy
Introduction
Body Fluid Volumes
Preeclampsia
“Normal Fill” or Resetting of the “Volumestat”
Primary Arterial Vasodilatation (“Underfill”)
Excessive Expansion or “Overfill”
Plasma Volume in Normal Pregnancy and Preeclampsia
Novel Salt Hypothesis
Mineralocorticoids and the Renin–Angiotensin–Aldosterone Axis
Antinaturetic Peptides
Renin–Angiotensin–Aldosterone System
Agonistic Anti-AT1 Receptor Antibodies in Preeclampsia (AT1-AA)
Signal Transduction and Pathophysiological Role of AT1-AA
AT1-AA in Animal Models of Hypertension During Pregnancy (See also Chapter 20)
AT1-AA Induced Hypertension
Interaction Between ATI-AA and sFlt-I, ET-1, and ROS
Inhibition of AT1-AA in the RUPP Rat Model
AT1-AA, Preeclampsia, and Lasting Effects
Presence of AT1-AA in Other Diseases
Concluding Perspectives
Chapter 16. Platelets, Coagulation, and the Liver
Introduction
Platelets
Platelets in Normal Pregnancies and with Preeclampsia
HELLP Syndrome
Platelet Activation and Platelet Function
Aspirin, an Antiplatelet Agent to Prevent Preeclampsia
Aspirin Nonresponsiveness
Expression of Platelet Receptors in Pregnancy and Preeclampsia
Platelet Second Messengers
Platelet Angiotensin II-Binding Sites
Coagulation
Coagulation Cascade Factors
Regulatory Proteins and Thrombophilia
Antithrombin III
Protein S
Protein C
Factor V Leiden (Activated Protein C Resistance)
Prothrombin G20210A
Antiphospholipid Syndrome
Fibrinolytic System
Fibrinolysis in Normal Pregnancy
Fibrinolysis in Preeclampsia
The Liver in Preeclampsia
Clinical Aspects of Liver Involvement
The Liver in HELLP Syndrome
Corticosteroid Therapy for HELLP Syndrome
Chapter 17. Clinical Management and Antihypertensive Treatment of Hypertensive Disorders of Pregnancy
Introduction
Diagnosis
Identifying Women with Hypertensive Disorders
Assessment for Preeclampsia
Antihypertensive Therapy—Its Goals
General Principles in the Choice of Antihypertensive Agents
Fetal Safety and Drug Use in Pregnant Women
Choice of an Antihypertensive Drug for Use in Pregnancy
Sympathetic Nervous System Inhibition
Centrally Acting α2-Adrenergic Agonists
Peripherally Acting Adrenergic-Receptor Antagonists
Diuretics
Calcium-Channel Antagonists
Direct Vasodilators
Modulators of the Renin–Angiotensin–Aldosterone Axis
Evidence for Antihypertensive Treatment in Severe Hypertension
Management of Severe Hypertension
Conclusion—Use of Antihypertensive Treatment in Pregnancy
Antihypertensive Drug Use While Breastfeeding
Treatment of Severe Forms of Preeclampsia
Prevention and Treatment of Eclampsia
Corticosteroids to Ameliorate HELLP Syndrome
Fluid Therapy
Pulmonary Edema
Plasma Volume Expansion
Glucocorticoids for Fetal Lung Maturation
Delivery—Hypertensive Disorders
Indications for Delivery
Risks Versus Benefits—Recommendations for Expectant Management
Blood Loss at Delivery
Analgesia and Anesthesia
Persistent Severe Postpartum Hypertension
In Summary: Clinical Handling of Hypertensive Pregnancies
Chapter 18. Prediction and Prevention of Preeclampsia
Introduction
Routine antenatal screening for preeclampsia
Early preeclampsia risk stratification for primary prophylaxis
Preeclampsia prevention modalities
Recommended areas of further research for preeclampsia prediction and prevention
Chapter 19. Long-Term Effects of Preeclampsia on Mothers and Offspring
Introduction
Long-Term Maternal Consequences of Hypertensive Disorders of Pregnancy
Long-Term Consequences of Hypertensive Disorders of Pregnancy in Offspring
Translating Current Knowledge into Optimal Follow-up and Preventive Strategies for Mothers and Children After Preeclampsia
Chapter 20. Animal Models Used for Investigating Pathophysiology of Preeclampsia and Identifying Therapeutic Targets
Introduction
Models Used to Study the Relationship Between Placental Ischemia and the Maternal Syndrome
Models Used to Investigate the Role of Immune Mechanisms in Preeclampsia
Model Used to Study Role of Vasopressin in Preeclampsia
Conclusion
Chapter 21. Harmonization of Data and Biobanks for Preeclampsia Research
Introduction: Why Do We Need to Harmonize?
Challenges of Dealing With Conditions Defined by Syndromes
What Has Hindered Our Ability to Unravel the Complexity of Preeclampsia?
Impediments to Collaboration and Data and Biosample
Meeting the Challenges
The Way Forward
Index

Robert N. Taylor

Robert N. Taylor, MD, PhD is Professor of Obstetrics and Gynecology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY. Previously, he was Professor of Obstetrics and Gynecology at The University of Utah, Wake Forest School of Medicine, Emory University, and Director of the Center for Reproductive Sciences at the University of California, San Francisco. Taylor received his undergraduate education at Stanford University and the combined MD-PhD at Baylor College of Medicine. He is a board-certified obstetrician-gynecologist and reproductive endocrinologist whose major research foci have included the role of placental angiogenesis and endothelial cell activation in preeclampsia, and the molecular actions of estrogen and progesterone on endometrial differentiation and neuroangiogenesis as they relate to endometriosis. Dr. Taylor served on executive committees of the American Board of Obstetrics and Gynecology, NIH Reproductive Scientist Development Program, the World Endometriosis Society and the California Institute for Regenerative Medicine.

Affiliations and expertise

Professor of Obstetrics and Gynecology and Assistant Dean for Student and Academic Affairs, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

Kirk P. Conrad

Dr. Conrad has had a longstanding research interest in the hormonal, cellular and molecular mechanisms underlying maternal renal and systemic vasodilation, and increased arterial compliance during normal pregnancy with emphasis on the ovarian hormone, relaxin. More recently, he has been PD/PI of a NIH Program Project Grant designed to explore maternal pregnancy physiology and outcome in women conceiving through in vitro fertilization with focus on the contribution of the corpus luteum. Finally, Dr. Conrad has been exploring a role for dysregulated (pre)decidualization in the genesis of preeclampsia, and in the larger context of “endometrium spectrum disorders”. Dr. Conrad has combined preclinical and clinical research throughout his career to translate findings in animal models, tissues and cells to humans or vice versa. The main disease focus of his pregnancy research has been preeclampsia—a hypertensive syndrome peculiar to human pregnancy.

Affiliations and expertise

Professor of Physiology, Department of Physiology and Functional Genomics / Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA

Sandra T. Davidge

Dr. Davidge is a Distinguished University Professor in the Faculty of Medicine & Dentistry at the University of Alberta and Executive Director of the Women and Children’s Health Research Institute, Edmonton, Alberta, Canada. Davidge received her PhD from the University of Vermont and completed her postdoctoral fellowship training at the Magee Womens Research Institute in Pittsburgh, PA, USA. Davidge’s research program is focused on understanding mechanisms for vascular dysfunction in pregnancy complications, particularly preeclampsia, and subsequent impact on later-life cardiovascular health. Her fundamental studies are currently focused on developing early intervention strategies for improving pregnancy outcomes to enhance life-long maternal and offspring cardiovascular health. Davidge is a Fellow in the Canadian Academy of Health Science and a past president of Society for Reproductive Investigation (2017-2018).

Affiliations and expertise

Executive Director, Women and Children's Health Research Institute; Distinguished University Professor, University of Alberta, Canada

Anne Cathrine Staff

Anne Cathrine (Annetine) Staff, MD, PhD, is a full-time Professor of Obstetrics and Gynaceology at the Faculty of Medicine, University of Oslo, Norway. She is also Head of Research at the Division of Obstetrics and Gynaecology at Oslo University Hospital, Norway. She obtained her Medical Degree in 1987 at The University of Oslo, where she also did her PhD in 2000 on “Preeclampsia and uteroplacental tissues: lipids, oxidative stress, and trophoblast invasion”. She is a board certified specialist in Gynecology and Obstetrics since 1996, and have worked clinically in the field since 1989. Dr. Staff is head of a research group in Oslo, where one main research area is within molecular understanding of pregnancy complications associated with placental dysfunction, including preeclampsia, and its relation to future maternal cardiovascular health. Dr. Staff was previously the EPG (European Placenta Group) Spokesperson 2011-17 and the Vice-President of the ISSHP (International Society for the Study of Hypertension in Pregnancy) 2012-16, and is currently an ISSHP Executive Committee member and part of the Global Pregnancy Collaboration team.

Affiliations and expertise

Division of Obstetrics and Gynaecology, Oslo University Hospital; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Norway

James M. Roberts

Dr. Roberts’ research is interdisciplinary and involves fundamental, clinical, behavioral and epidemiological studies. He has been involved in several seminal studies of preeclampsia including the recognition of preeclampsia as involving endothelial dysfunction and being more than hypertension in pregnancy. He currently is involved in global health research as part of the Global Pregnancy Collaboration, a consortium of 40 centers world-wide that facilitates collaborative research. He is a co-investigator on studies in Brazil and South Africa. He chaired the ACOG Hypertension Task Force and was co-chair of the NHLBI NIH workshop on research on pregnancy hypertension.

Affiliations and expertise

Senior Scientist, Magee Women’s Research Institute, Professor, Obstetrics, Gynecology, Reproductive Sciences, Epidemiology, and Clinical and Translational ResearchUniversity of Pittsburgh, Pittsburgh, PA, USA