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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Patricio l pez jaramillo md phd

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.


Patricio l pez jaramillo md phd

ETIOLOGY

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


Patricio l pez jaramillo md phd

SOCIOECONOMIC SITUATIÓN

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


Patricio l pez jaramillo md phd

NUTRIENT INTAKE IN ECUADORIAN PREGNANT TEENAGERS

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


Patricio l pez jaramillo md phd

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


Patricio l pez jaramillo md phd

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


Patricio l pez jaramillo md phd

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.


Patricio l pez jaramillo md phd

BALANCE BETWEEN PRODUCTION AND INACTIVATION OF NO

Production

Inactivation

-

O2

VasodilatorAntiatherogenicAntithrombotic

NO

NO

VasoconstrictorProatheroscleroticProthrombotic

-

O2

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


Patricio l pez jaramillo md phd

O

/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


Patricio l pez jaramillo md phd

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


Patricio l pez jaramillo md phd

C-REACTIVE PROTEIN CONCENTRATIONS

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


Patricio l pez jaramillo md phd

TUMOUR NECROSIS FACTOR ALPHA CONCENTRATIONS

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


Patricio l pez jaramillo md phd

INTERLEUKIN 6 CONCENTRATIONS

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


Patricio l pez jaramillo md phd

IS INFECTION A MAYOR RISK FACTOR

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


Patricio l pez jaramillo md phd

RESULTS

Bacteriuria 1.766 (11.5%)

Vaginal Infections2.150 (14%)

Bacterial Vaginosis 49.4%

Chlamydia Trachomatis 22.5%

Trichomona Vaginalis14.6%

Group B Streptococci13.5%

Bacteriuriaand Vaginal Infections 783 ( 5.1%)

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


Patricio l pez jaramillo md phd

RESULTS

__________________________________________________

IncidencePreceeding 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


Patricio l pez jaramillo md phd

FMD, CRP CONCENTRATIONS AND LEUKOCYTE COUNT

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


Patricio l pez jaramillo md phd

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.


Patricio l pez jaramillo md phd

FREQUENCY DETECTION OF PERIODONTOPATHIC BACTERIA

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


Homeostatic model assessment log homa in pregnancy

HOMEOSTATIC MODEL ASSESSMENT (LOG- HOMA) IN PREGNANCY

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


Patricio l pez jaramillo md phd

METABOLIC SYNDROME

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


Patricio l pez jaramillo md phd

12

23:1121-1129

23:1121-1129


Patricio l pez jaramillo md phd

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

Savvidou, Lancet 2003; 361:1511-1517


Patricio l pez jaramillo md phd

ADMA CONCENTRATIONS IN ECUADORIAN PREGNANT WOMEN

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

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


Mass et al jama 2004 291 823 824

PLASMA CONCENTRATIONS OF ADMA, L-ARGININE, AND SDMA

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


L arginine and adma plasma concentrations in normal pregnancy and preeclampsia

L-ARGININE AND ADMAPLASMA CONCENTRATIONS IN NORMAL PREGNANCY AND PREECLAMPSIA

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


Patricio l pez jaramillo md phd

PREDICTED

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


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