FACTORES DE RIESGO PARA PREECLAMPSIA EN LA POBLACION COLOMBIANA
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FACTORES DE RIESGO PARA PREECLAMPSIA EN LA POBLACION COLOMBIANA. Patricio López-Jaramillo, MD. PhD. Director de Investigaciones, Facultad de Medicina, Universidad de Santander UDES. Director de Investigaciones de la Fundación Oftalmológica de Santander FOSCAL, Bucaramanga. ETIOLOGY.

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FACTORES DE RIESGO PARA PREECLAMPSIA EN LA POBLACION COLOMBIANA

Patricio López-Jaramillo, MD. PhD.

Director de Investigaciones, Facultad de Medicina, Universidad de Santander UDES.

Director de Investigaciones de la Fundación Oftalmológica de Santander FOSCAL,

Bucaramanga.


ETIOLOGY COLOMBIANA

We propose that the endothelial dysfuction observed in pre-eclamptic women from developing countries seems to be mainly related to nutritional deficiencies as calcium intake, subclinical infections and metabolic disorders, while in developed countries the genetic and immunological alterations seem to be the most probable factors responsible for the development of PE, and it is related with the quality of the prenatal care system.

Lopez-Jaramillo et al. J Hypertens 23 : 1121-1129,2005


SOCIOECONOMIC SITUATIÓN COLOMBIANA

SANITARY

SOCIAL

INSECURITY

NUTRITIONAL

HEALTH

INFRASTRUCTURE

STATUS

SERVICES

DEFICIENT CALCIUM AND ANTIOXIDANT VITAMIN INTAKE AND HIGH FAT INTAKE

INADEQUATE PRENATAL CONTROL SYSTEM AND DELIVERY

ANXIETY

PSYCHOSOCIAL

STRESS

HIGH PREVALENCE OF SUBCLINICAL CHRONIC INFECTIONS

DECREASED LEVELS OF SERUM IONIC CALCIUM AND INCREASED LEVELS OF CHOLESTEROL, INSULINE, TRIGLYCERIDES, LDL, oxo-LDL

HIGH LEVELS OF PROINFLAMMATORY CYTOKINES

TNF-,IL-6, CRP

NAD (P) H OXIDASE

O -

XANTHINE OXIDASE

2

NO

NO SYNTHASE

-

ONOO

PGI

2

NO

ENDOTHELIAL DYSFUNCTIÓN

-

O

TXA

2

2

HYPERTENSION

PROTEINURIA

EDEMA

PLATELET ACTIVATION

PREECLAMPSIA

López-Jaramillo et al. Braz J Med Biol Res 2001;34:227-235


NUTRIENT INTAKE IN ECUADORIAN PREGNANT TEENAGERS COLOMBIANA

López-Jaramillo et al. Obstet Gynecol, 1997;90:162-167


EFFECT OF CALCIUM SUPPLEMENTATION ON THE OUTCOMES OF ECUADORIAN PREGNANT WOMEN

a) López-Jaramillo et al. Br J Obstet Gynaecol 1989,96:648-655; b) Lancet 1991,335:293; c) Obstet Gynecol, 1997;90:162-167


Calcium supplementation reduces the risk of PE in populations with low-dietary calcium intake

Atallah et al. The Cochrane Library, Issue 1. Chichester; John Wiley;2004


NO is the responsible for the hemodynamic changes in normal pregnancy ?

It is altered in preeclampsia ?

López-Jaramillo P and Moncada S. Medical Hypotheses 1995;45:68-72.


BALANCE BETWEEN PRODUCTION AND INACTIVATION OF NO pregnancy ?

Production

Inactivation

-

O2

VasodilatorAntiatherogenicAntithrombotic

NO

NO

VasoconstrictorProatheroscleroticProthrombotic

-

O2

López-Jaramillo and Casas. J Hum Hypertens 2002; 16 : S34- S37


O pregnancy ?

/NADH

2

NO2

OH*

*NO2

+

Respiration

mythochondrial

RSNO

RSH

O

/NADH

2

-

ONOO

NADPH

Oxidase

-

NO

Arg

/O2

*

O

Xhantine

2

oxidase

NO

synthase

O

/Xhantine

2

*

Oxidation of

Endogenous

Biomolecules

LOO

LOONO

ORIGINS AND INTERACTIONS BETWEEN ROS AND RNS

  • Ang II

  • LDL

  • TNF alpha

López-Jaramillo and Casas. J Human Hypertension 2002; 16 : S100-S103


Is an Inflammatory State secondary to infection the responsible for the Oxidative stress observed in Preeclamptic women ?

Lopez-Jaramillo P. Seminars Perinatol 2000;24:33-36


C-REACTIVE PROTEIN CONCENTRATIONS responsible for the Oxidative stress observed in Preeclamptic women ?

Teran et al. Int J Gynecol Obstet 2001;75:243-249


TUMOUR NECROSIS FACTOR ALPHA CONCENTRATIONS responsible for the Oxidative stress observed in Preeclamptic women ?

Teran et al. Int J Gynecol Obstet 2001;75:243-249


INTERLEUKIN 6 CONCENTRATIONS responsible for the Oxidative stress observed in Preeclamptic women ?

Teran et al. Int J Gynecol Obstet 2001;75:243-249


IS INFECTION A MAYOR RISK FACTOR responsible for the Oxidative stress observed in Preeclamptic women ?

FOR PREECLAMPSIA?

15.354 pregnant women, low socioeconomic status, 14-20 weeks of gestation, 25 years old.

Herrera et al. Medical Hypotheses 2001;57:393-397


RESULTS responsible for the Oxidative stress observed in Preeclamptic women ?

Bacteriuria 1.766 (11.5%)

Vaginal Infections 2.150 (14%)

Bacterial Vaginosis 49.4%

Chlamydia Trachomatis 22.5%

Trichomona Vaginalis 14.6%

Group B Streptococci 13.5%

Bacteriuria and Vaginal Infections 783 ( 5.1%)

Herrera et al. Medical Hypotheses 2001;57:393-397


RESULTS responsible for the Oxidative stress observed in Preeclamptic women ?

__________________________________________________

Incidence Preceeding 5 years % reduction

__________________________________________________

Preeclampsia

277 (1.8%) 5.1% 64.7

Preterm birth

476 (3.8%) 8.0% 52.5

Low birthweight

952 (6.2%) 13.2% 53

__________________________________________________

Herrera et al. Medical Hypotheses 2001;57:393-397


FMD, CRP CONCENTRATIONS AND LEUKOCYTE COUNT responsible for the Oxidative stress observed in Preeclamptic women ?

Garcia et al. Am J Hyperten. 2007;20:98-103.


PERIODONTITIS IS ASSOCIATED WITH PREECLAMPSIA IN PREGNANT WOMEN

In our population we have demostrated that after adjusting for other risk factors, chronic periodontal disease was significantly associated with preeclampsia

Contreras A et al. J Periodontol. 2006;77: 182-188.


C reactive protein in preeclampsia according to periodontal condition
C-REACTIVE PROTEIN IN PREECLAMPSIA ACCORDING TO PERIODONTAL CONDITION

Herrera et al. Journal of Hypertension 2007; 25: 1459-1464.


FREQUENCY DETECTION OF PERIODONTOPATHIC BACTERIA CONDITION

Herrera et al. Journal of Hypertension 2007; 25: 1459-1464.


Homeostatic model assessment log homa in pregnancy
HOMEOSTATIC MODEL ASSESSMENT (LOG- HOMA) IN PREGNANCY CONDITION

Sierra-Laguado et al. Am J Hypertens. 2007; 20: 437-442.


METABOLIC SYNDROME CONDITION

These results support the proposal that in Andean women at high risk of PE, after the calcium deficit is resolved and the subclinical infections are treated, the metabolic syndrome can be, together with genetic and immunological factors, the responsible cause for the remainder incidence of PE

Lopez-Jaramillo et al. J Hypertens 23 (5) : 1121-1129,2005


12 CONDITION

23:1121-1129

23:1121-1129


FMD AND ADMA IN PREGNANT WOMEN WITH BILATERAL NOTCHES WHO DEVELOPED PREECLAMPSIA

Savvidou, Lancet 2003; 361:1511-1517


ADMA CONCENTRATIONS IN ECUADORIAN PREGNANT WOMEN DEVELOPED PREECLAMPSIA

López-Jaramillo et al. Br J Obstet Gynaecol 1996,103,33-38


Plasma concentrations of adma l arginine and sdma
PLASMA CONCENTRATIONS OF ADMA, L-ARGININE, AND SDMA DEVELOPED PREECLAMPSIA

Mass et al. JAMA, 2004; 291: 823- 824


Mass et al jama 2004 291 823 824

PLASMA CONCENTRATIONS OF ADMA, L-ARGININE, AND SDMA DEVELOPED PREECLAMPSIA

Mass et al. JAMA, 2004; 291: 823-824


L arginine and adma plasma concentrations in normal pregnancy and preeclampsia
L-ARGININE AND ADMA DEVELOPED PREECLAMPSIAPLASMA CONCENTRATIONS IN NORMAL PREGNANCY AND PREECLAMPSIA

López-Jaramillo et al. J Hypertens. 23:1121-1129, 2005


PREDICTED DEVELOPED PREECLAMPSIA

PREECLAMPSIA INTERNATIONAL CASE -CONTROL STUDY TO IDENTIFY RISK FACTORS DIFFERENCES IN DEVELOPED AND DEVELOPING COUNTRIES


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