Magister Curationis - MCur / Pregnancy induced hypertension is one of the causes of maternal, fetus and neonatal morbidity and mortality. It is the condition in which a pregnant woman develops hypertension because of physiological changes that result during pregnancy and both mother and fetus can be affected. According to the World Health Organization (WHO), the first target of the third United Nations Sustainable Development Goals (SDG-3) is to reduce the maternal mortality rate (MMR) to less than 10 per 100.000 live births by 2030 (WHO, 2017). This is because globally, about 350 000 women die every year from pregnancy related causes (Hogan, Foreman, & Naghavi, 2010). According to the WHO (2015), these conditions namely post-partum hemorrhage, hypertension in pregnancy, infections, unsafe abortion and other delivery-related complications cause three quarters of all maternal deaths in the World. Hence the needs to prevent or successfully treat conditions that contribute to this scourge (WHO, 2011). The two main interventions that are used to prevent or treat hypertension in pregnancy are medication and lifestyle adjustment. However, it is important to understand the intervention that is most suited to a context and its patient and compare the effects of these interventions on management of hypertension in pregnant women as a patient outcome.

Orientador: José Carlos Peraçoli / Coorientador: Sulani Silva de Souza / Banca: Lia Lusitana Cardozo de Castro / Banca: Maria Rita Novaes Garbi / Resumo: A toxemia gravídica é uma doença multissistêmica, que ocorre principalmente no final da gravidez, caracterizada por manifestações clínicas como hipertensão, edema e proteinúria. É a complicação médica mais comum da gravidez e a principal causa de morbimortalidade materna e perinatal. O objetivo deste artigo é rever os principais aspectos concernentes ao uso de agentes anti-hipertensivos na gravidez e puerpério. Os dados foram coletados no Pubmed e Bireme, período de 2006 a 2010. O conhecimento da hipertensão durante a gestação e sua terapêutica está em evolução; a busca por medicações que possam proteger a mãe dos perigos agudos e garantir um recém nascido saudável deve ser o foco. Faltam evidências sobre a melhor terapia a ser adotada, período de início, duração e resultados. Apesar do avanço farmacológico, ainda não há fármacos totalmente isentos de compremetimento para a mãe e ao concepto / Abstract: Pregnancy toxemia is a multisystemic disease, which occurs mainly at the end of pregnancy, characterized by clinical manifestations such as hypertension, edema and proteinuria. It is the most commonly occurred medical complication in pregnancies and the main cause for perinatal and maternal morbimortalities. The purpose of this article is to review the main aspects concerning the use of antihypertensive agents during pregnancy and puerperium. The data has been collected from Pubmed and Bireme, from 2006 to 2010. The knowledge regarding hypertension during pregnancy and its therapy is evolving; the search for medication that could protect the mother from acute dangers and to ensure a healthy newborn must be the focus. Evidence is still lacking regarding the best therapy, beginning period, duration and results. In spite of the pharmacological advances, there are still no drugs completely exempt of compromises to the mother and the conceptus / Mestre

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-29Bitstream added on 2014-06-13T20:20:24Z : No. of bitstreams: 1 siqueira_f_me_botfm.pdf: 266023 bytes, checksum: 51380be93c5262da880e991be3b20608 (MD5) / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / A toxemia gravídica é uma doença multissistêmica, que ocorre principalmente no final da gravidez, caracterizada por manifestações clínicas como hipertensão, edema e proteinúria. É a complicação médica mais comum da gravidez e a principal causa de morbimortalidade materna e perinatal. O objetivo deste artigo é rever os principais aspectos concernentes ao uso de agentes anti-hipertensivos na gravidez e puerpério. Os dados foram coletados no Pubmed e Bireme, período de 2006 a 2010. O conhecimento da hipertensão durante a gestação e sua terapêutica está em evolução; a busca por medicações que possam proteger a mãe dos perigos agudos e garantir um recém nascido saudável deve ser o foco. Faltam evidências sobre a melhor terapia a ser adotada, período de início, duração e resultados. Apesar do avanço farmacológico, ainda não há fármacos totalmente isentos de compremetimento para a mãe e ao concepto / Pregnancy toxemia is a multisystemic disease, which occurs mainly at the end of pregnancy, characterized by clinical manifestations such as hypertension, edema and proteinuria. It is the most commonly occurred medical complication in pregnancies and the main cause for perinatal and maternal morbimortalities. The purpose of this article is to review the main aspects concerning the use of antihypertensive agents during pregnancy and puerperium. The data has been collected from Pubmed and Bireme, from 2006 to 2010. The knowledge regarding hypertension during pregnancy and its therapy is evolving; the search for medication that could protect the mother from acute dangers and to ensure a healthy newborn must be the focus. Evidence is still lacking regarding the best therapy, beginning period, duration and results. In spite of the pharmacological advances, there are still no drugs completely exempt of compromises to the mother and the conceptus

Background: Pregnancy associated cardiovascular pathologies have a significant impact on outcome for mother and child. Bioimpedance cardiography may provide additional outcome-relevant information early in pregnancy and may also be used as a predictive instrument for pregnancy-associated diseases. Methods: We performed a prospective longitudinal cohort trial in an outpatient setting and included 242 pregnant women. Cardiac output and concomitant hemodynamic data were recorded from 11th-13th week of gestation every 5th week as well as at two occasions post partum employing bioimpedance cardiography. Results: Cardiac output increased during pregnancy and peaked early in the third trimester. A higher heart rate and a decreased systemic vascular resistance were accountable for the observed changes. Women who had a pregnancy-associated disease during a previous pregnancy or developed hypertension or preeclampsia had a significantly increased cardiac output early in pregnancy. Furthermore, an effect of cardiac output on birthweight was found in healthy pregnancies and could be confirmed with multiple linear regression analysis. Conclusions: Cardiovascular adaptation during pregnancy is characterized by distinct pattern described herein. These may be altered in women at risk for preeclampsia or reduced birthweigth. The assessment of cardiac parameters by bioimpedance cardiography could be performed at low costs without additional risks.

Thesis (MSc)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Pre-eclampsia is a condition unique to pregnancy and primarily affects the maternal and placental vascular endothelium. It has significant morbidity and mortality consequences for both mother and infant. Despite global research into the aetiology of the condition, the cause for this condition remains unknown. Several factors, including a strong family history of hypertension in pregnancy point to a familial or genetic component in the pathophysiology of this complication. The purpose of this research project was to investigate candidate genes implicated in endothelial damage. Common methylene-tetra-hydrofolate reductase (MTHFR) gene mutations C677T and A1298C, factor V Leiden mutation R506Q and prothrombin mutation A20210G were investigated in 50 patients with an uncomplicated pregnancy outcome (controls) and 350 patients with various clinical manifestations of preeclampsia, including severe, early onset forms and abruptio placentae. Fasting homocystein levels were determined biochemically on all participants. In addition, 126 consecutive pregnant patients were recruited at booking, fasting lipograms were performed on them as well as mutation screening of 7 common mutations in the low-density lipoprotein receptor gene. This was correlated with eventual pregnancy outcome, and those with an uncomplicated outcome were selected as an additional control group. A significant association between hyperhomocysteinaemia and early onset severe pre-eclampsia could be demonstrated. Mutant allele T of the C677T mutation could be associated with hyperhomocysteinaemia but not with pre-eclampsia whilst mutant allele C of mutation A1298C demonstrated a significant correlation with diastolic blood pressure. In addition, combined heterozygosity for these mutations may serve as a marker for abruptio placentae. / ENGLISH ABSTRACT: Pre-eklampsie is 'n hipertensiewe toestand uniek aan menslike swangerskap en dit affekteer hoofsaaklik die vaskulêre endoteel. Die toestand hou ernstige morbiditeit en mortaliteit vir beide ma en baba in en na jare se navorsing is die oorsaak van hierdie toestand steeds onbekend. Epidemiologiese studies toon 'n duidelike familiële verband aan wat die vermoede laat ontstaan dat daar 'n onderliggende genetiese aspek tot die ontwikkeling van die siektetoestand is. Die doel van hierdie navorsingsprojek was om gene te ondersoek wat geïmpliseer word in endoteel skade. Twee algemene mutasies, C677T en A1298C in die MTHFR geen asook faktor V Leiden R506Q en protrombien A20210G mutasies is ontleed in 50 pasiënte met 'n ongekompliseerde swangerskapsverloop en in 350 pasiënte met 'n swangerskap gekompliseer deur verskillende kliniese manifestasies van die siekteproses, insluitende vroeë aankoms erge pre-eklampsie en abruptio placentae. Op alle pasiënte is ook 'n vastende homosistiën vlak biochemies bepaal. 'n Verdere 126 opeenvolgende pasiënte is gewerf tydens hulle eerste besoek aan die voorgeboortekliniek en vastende lipogramme is op almal uitgevoer. Mutasie sifting vir 7 algemene mutasies in die lae-digtheids lipoproteïen reseptor geen is op hierdie groep gedoen en die resultaat is met die uiteindelike swangerskapsuitkoms gekorreleer. Pasiënte met 'n uitkoms ongekompliseer deur hipertensie is gekies om deel te wees van 'n verdere kontrolegroep. Daar was 'n betekenisvolle verband tussen hiperhomositiënemie en erge, vroeë aankoms pre-eklampsie. Die T alleel van die C677T mutasie is geassosieer met hiperhomosistiënemie maar nie met pre-eklampsie nie. Die C alleel van die A 1298C mutasie toon 'n betekenisvolle verband met diastoliese bloeddruk. Gekombineerde heterosigositeit vir beide MTHFR mutasies kan 'n moontlike merker vir abruptio placentae wees.

HIV and hypertensive disorders in pregnancy, in particular pre-eclampsia, are the main causes of maternal mortality in South Africa. In HIV associated pre-eclampsia, it is biologically plausible that the immune activation associated with pre-eclampsia may be neutralised by the immune suppression of HIV infection. The precise aetiology of pre-eclampsia is unknown, however leptin has been implicated in its development. Leptin is an adipocyte hormone, also produced by the placenta. It has a role in the development of inflammation. Adipose tissue is reduced in HIV infected individuals, resulting in lower leptin levels with consequent impaired immune function. This study aimed to compare serum and placental leptin levels in HIV infected and uninfected normotensive and pre-eclamptic pregnancies. Since insulin levels may affect the secretion of leptin, the study also compared insulin levels in these pregnancies. Following ethical clearance and hospital permission, 180 participants were recruited during their antenatal period. The groups were HIV- normotensive (n = 30), HIV+ normotensive (n = 60), HIV– pre-eclamptic (n = 30) and HIV+ pre-eclamptic (n = 60). Blood samples were collected ante-natally and placental samples post delivery. Serum leptin and insulin levels were determined by ELISA. Placental leptin levels were determined by ELISA and immunohistochemistry with morphometric image analysis. The placental production of leptin was determined by RT PCR. There was a non-significant increase in serum leptin levels in HIV- pre-eclampsia compared to HIV- normotensive pregnancies (p = 0.42). However leptin was decreased significantly in HIV+ pre-eclampsia compared to HIV- normotensive (p = 0.03). Based on HIV status leptin levels were decreased in HIV+ groups compared to HIV- groups in both pre-eclamptic (p < 0.01) and normotensive pregnancies (p < 0.01). Insulin levels of the HIV positive groups were lower than those of the HIV negative groups (p < 0.001). Insulin levels were also decreased in pre-eclampsia compared to normotensive pregnancies, irrespective of HIV status (p = 0.02). Immunohistochemistry demonstrated an increase in immuno-reactivity of leptin in the exchange villi of pre-eclamptic compared to normotensive placentae, irrespective of HIV status (p < 0.001). Supporting this finding, ELISA also demonstrated elevated leptin levels in the placenta of pre-eclamptic compared to normotensive pregnancies (p < 0.001). Placental leptin levels were similar in both HIV positive and negative pregnancies (p = 0.36). However, the placental leptin mRNA expression was up-regulated in HIV negative pre-eclampsia (p = 0.04) but not in HIV positive pre-eclampsia (p = 1.00). In conclusion, the elevated placental leptin in pre-eclampsia, irrespective of HIV status, is consistent with hypoxia. These elevated levels are not reflected in the maternal serum which raises the possibility of decreased leptin expression by adipose tissue especially in HIV infection where serum leptin levels are decreased. This would negate the increased placental leptin expression in pre-eclampsia. Furthermore, the elevated placental leptin levels are suggestive of an autocrine role of leptin in the placenta. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

Background: Leptin is a new adipose-derived hormone discovered in 1994. It is vital in energy balance and weight regulation in humans. During pregnancy the placenta is an extra source of leptin. The role of leptin in pregnancy is not established. This has generated a lot of interest in leptin research in pregnancy. Leptin is being examined in pathological states that may have origin in adipose tissue and the placenta such as pre-eclampsia, intrauterine growth restriction and obesity. Aim and Method: This study measured concentrations of serum leptin in Black African women during late pregnancy in 68 women with pre-eclampsia, 92 healthy normotensive pregnant women and in 32 healthy non-pregnant women. In each group leptin levels were compared between obese (body mass index, BMI = or > than 30 kgm-2) and lean women. Serum leptin concentrations were measured by radioimmunoassay (RIA) technique. Results: Serum leptin levels were higher in pregnancy compared to non-pregnant women (26.66+/-16.13 ng/ml, 25.89+/-15.83 ng/ml vs 17.97+/-11.98 ng/ml, p=0.02). This is due to firstly, the extra fat accumulated as part of the maternal adaptation to pregnancy and secondlv, to the placenta-derived leptin. Other pregnancy hormones such as insulin, hcG, prolactin and oestrogen may modulate the serum levels of leptin in pregnancy. Simple anthropometric parameters (weight, BMI, circumferences of the mid upper arm (MAC), waist (WC), hip (HC), and thigh (TC) and waist-hip ratio (WHR)) were used to explore the relationship between leptin concentrations and obesity. All the parameters showed a positive correlation with serum leptin concentration in all the groups with the exception of WHR. Weight and BMI showed the greatest correlation both in pregnant (r=0.61 and r=0.58, respectively, p<0.001) and non-pregnant (r=0.74 and 0.79, respectively, p<0.001) women. However we did not find a significant difference in the concentrations of leptin between women with and those without pre-eclampsia (26.66 ng/ml vs 25.89 ng/ml, p=0.95). This probably means that adiposity is the predominant factor influencing levels of leptin in pregnancy. The other factors mentioned above play only a minor role. Indeed the mean serum leptin levels were higher in obese compared to lean women in both pregnant and non-pregnant women. Conclusion: Pregnancy is a hyperleptinaemic state. There is no difference in serum leptin levels between women with pre-eclampsia and healthy normotensive pregnant women. Serum leptin concentration is largely determined by the degree of adiposity both in and outside pregnancy. / Thesis (M.Med.)-University of Natal, Durban, 2001.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2012Bitstream added on 2014-06-13T20:00:44Z : No. of bitstreams: 1 leite_f_dr_botfm.pdf: 1486779 bytes, checksum: e64d28f90d859367d20b7c32dac2b0b3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo deste estudo foi analisar o efeito da anestesia no desfecho perinatal de mulheres hipertensas obesas submetidas à cesárea. Trata-se de estudo observacional prospectivo de 98 gestantes hipertensas e seus recém-nascidos, submetidas à cesárea sob anestesia subaracnoidea. As gestantes foram divididas em quatro grupos de acordo com seus índices de massa corporal (IMC): normal, sobrepeso, obesidade I e obesidade II. Dados demográficos e cirúrgicos maternos, bem como os valores de amostras de sangue venoso do cordão umbilical e características neonatais foram comparados entre os quatro grupos. Mediana e percentis foram utilizados (tendência de distribuição não-normal) e variáveis categóricas foram expressas em valores absolutos e percentuais. Quase 70% das mulheres eram brancas. A parada da dilatação como indicação para cesárea diferiu entre os grupos (p = 0,002): 33,33% do grupo obesidade II, 8,69% do grupo obesidade I, 6,66% do grupo normal e zero no grupo com sobrepeso. Pressão arterial sistólica máxima foi maior em mulheres com IMC normal (p = 0,002). Valores de peso ao nascimento, estatura, pH do sangue venoso do cordão umbilical, lactato, meta-hemoglobina, reticulócitos e eritroblastos foram semelhantes entre os grupos. Escores de New Ballard, Apgar e Silverman-Andersen não diferiram significativamente entre os grupos analisados. Somente cinco recém-nascidos foram internados na unidade neonatal, 25 foram levados para o berçário, onde permaneceram até alta para o alojamento conjunto e 68 permaneceram com suas mães após o nascimento. Não houve influência da anestesia subaracnoidea no desfecho perinatal de gestação de hipertensas obesas / The aim of this study was to analyze the effect of anesthesia on perinatal outcome of hypertensive obese women undergoing cesarean delivery. This is a prospective observational study of 98 cesarean sections in hypertensive pregnant women, and their newborns, under spinal anesthesia. Women were divided into four groups according to their body mass indices: normal, overweight, obese I, and obese II. Demographic and surgical maternal data, values of cord blood samples and neonatal outcomes were compared between the four groups. Median and percentiles were used (tendency of non-normal distribution) and categorical variables were expressed as absolute values and percentage. Almost 70% of the women were white. The arrest of dilation, which was the indication for cesarean delivery, differed between the groups (p = 0.002): 33.33% in the obese II, 8.69% in the obese I, 6.66% in the normal body mass index, and zero in the overweight group. Maximum systolic blood pressure was higher in women with normal body mass index (p = 0.002). Birth weight, height, umbilical venous cord blood pH, lactate, methemoglobin, reticulocyte, and erythroblast counts were similar between groups. New Ballard, Apgar and Silverman-Andersen scores did not differ significantly between the groups analyzed. Only five newborns were admitted to the neonatal unit, 25 were taken to the nursery, where they stayed until discharge when they joined their mothers and 68 remained with their mothers. There was no adverse effect of spinal anesthesia on neonatal outcome of hypertensive obese pregnant women

Made available in DSpace on 2016-06-07T17:12:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-25. Added 1 bitstream(s) on 2016-06-07T17:16:38Z : No. of bitstreams: 1 000860332.pdf: 691560 bytes, checksum: dbeaf85cedbc67660b6f5be6096672ed (MD5) / Introdução: Dentre as síndromes hipertensivas que acometem a gestação, a pré-eclâmpsia (PE) é a principal causa de mortalidade e morbidade materna a curto e longo prazo, e de complicações perinatais como prematuridade, restrição do crescimento e óbito. O exame de fundo de olho reflete as alterações decorrentes do vasoespasmo sistêmico, alteração básica na fisiopatologia da doença. O Doppler das artérias oftálmicas é um exame reprodutível e não invasivo, constituindo-se em um método objetivo que diferencia as formas de manifestação da hipertensão entre si, aprimora a compreensão da fisiopatologia da pré-eclâmpsia e identifica a gravidade da doença, diretamente relacionada com o comprometimento do sistema nervoso central. Objetivo: Identificar se existe relação entre as alterações verificadas no Doppler da artéria oftálmica de gestantes portadoras de PE e a ocorrência de restrição de crescimento fetal. Sujeitos e métodos: Realizou-se estudo de corte transversal em uma população de 75 gestantes com diagnóstico de PE, que tiveram a resolução da gestação no Hospital Regional do Gama - Distrito Federal e cujos recém-nascidos foram classificados de acordo com a adequação do peso para a idade gestacional (PIG - pequeno para a idade gestacional e não PIG), segundo a tabela de Lubchenco. O exame dopplervelocimétrico da artéria oftálmica foi realizado em equipamento Toshiba Nemio 17, com transdutor linear na frequência de 10 MHz, determinando-se os seguintes parâmetros: índice de resistência (IR), índice de pulsatilidade (IP), pico de velocidade sistólica (PVS), velocidade diastólica final (VDF) e razão entre picos de velocidade (RPV). A análise estatística foi realizada utilizando os métodos ANOVA e Qui-quadrado. Os resultados foram considerados estatisticamente significativos quando apresentaram valores de p <0,05. Resultados: A análise das características clínicas maternas, segundo... / Introduction: Among hypertensive disorders that affect pregnancy, preeclampsia (PE) is the leading cause of mortality in short and long-term maternal morbidity and also perinatal complications such as premature birth, growth restriction and death. The examination of eye reflects changes arising from systemic vasospasm, a basic change in the disease pathophysiology. The Doppler of ophthalmic arteries is a reproducible and noninvasive, thus becoming an objective method that sets the manifestations of hypertension among themselves, enhances the understanding of the preeclampsia pathophysiology and identifies the severity of the disease, directly related to the central nervous system compromising. Objective: To identify if there is a relationship between changes in the Doppler of the ophthalmic artery of pregnant women with PE and the occurrence of fetal growth restriction. Subjects and Methods: Across sectional study in a population of 75 pregnant women with a diagnosis of PE, who had pregnancy resolution at Regional Hospital of Gama - Federal District and whose newborns were classified according to their weight for gestational age (SGA - small for gestational age and not SGA) according to Lubchenco table. The dopplervelocimetry of the ophthalmic artery was performed in 17 Nemio Toshiba equipment with linear transducer in the frequency of 10 MHz and, the following parameters were determined: resistance index (RI), pulsatility index (PI), systolic velocity peak(SVP), end-diastolic velocity (EDV) and velocity ratio peak (VRP). Statistical analyses were performed using ANOVA and Chi-square test. The results were considered statistically significant with p values <0.05. Results: Analysis of maternal clinical characteristics, according to the newborns classification (Not SGA and SGA), showed no significant difference in maternal age (27.7+6.8 years vs 29.5+7, 4 years), parity (48.2% vs 50%) and the rate of cesarean delivery (84.7% vs 100%). ...

Made available in DSpace on 2014-12-17T14:13:45Z (GMT). No. of bitstreams: 1 EdailnaMMD_TESE.pdf: 1373416 bytes, checksum: 61f555c522f75e50207ed0ddb4253975 (MD5) Previous issue date: 2013-05-10 / OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pr?-ecl?mpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbumin?ria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (? 4.8) while this ratio in normotensive women was of 23.5 (? 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension / OBJETIVO: A pr?-ecl?mpsia ? uma doen?a que pode evoluir com alta morbimortalidde materno-fetal. No mundo, a incid?ncia dessa doen?a ? bastante vari?vel e s?o poucos os dados sobre esse dist?rbio na popula??o brasileira. Este trabalho objetivou determinar a incid?ncia e os fatores de risco envolvidos nos dist?rbios hipertensivos durante a gravidez, avaliando-se a popula??o de gestantes em um bairro de Natal. Al?m de observar a evolu??o da gravidez, avaliou-se o dano cardiovascular, um ano e cinco anos, ap?s a realiza??o do parto. M?TODOS: Estudo prospectivo, tipo coorte, para avaliar as intercorr?ncias da gesta??o de 242 mulheres que engravidaram entre 2004-2007 no bairro do Bom Pastor, em Natal RN, Brasil. Um ano ap?s o parto avaliou-se 39 mulheres e decorridos cinco (5) anos do parto, foi realizada uma busca ativa dessas mulheres, que engravidaram e apresentaram o dist?rbio hipertensivo da gravidez e ou pr?-ecl?mpsia, perfazendo 16,11% do grupo inicial do estudo. Foi aplicado um question?rio estruturado para obten??o de informa??es b?sicas sobre a situa??o cl?nica atual das pacientes e ocorr?ncia de gesta??o posterior, avalia??o do ?ndice de massa corp?rea (IMC) e presen?a de intercorr?ncias e dist?rbio hipertensivo ap?s a gravidez. Foram levantadas informa??es sobre uso de medicamentos hipotensores e m?todos contraceptivos. Foram verificados e registrados: a) peso atual; b) press?o arterial e c) ?ndice de massa corp?rea IMC, e coletadas amostras biol?gicas (sangue e urina) para mensura??o de par?metros bioqu?micos e avalia??o da microalbumin?ria. Para a avalia??o da presen?a de hipertens?o foi feita a monitoriza??o ambulatorial da press?o arterial (MAPA), que utiliza o m?todo de medi??o autom?tica da frequ?ncia card?aca, press?o arterial sist?lica e diast?lica, al?m da m?dia das duas durante o per?odo de 24 horas. RESULTADOS: De 218 mulheres que completaram o estudo a incid?ncia dos dist?rbios hipertensivos foi de 16,9% (37 de 218), enquanto a incid?ncia de pr?-ecl?mpsia foi de 13,8% (30 de 218). Mulheres com pr?-ecl?mpsia tiveram um IMC (?ndice de massa corp?rea) m?dio de 25,3 (? 4,8) enquanto que nas mulheres normotensas esse ?ndice foi de 23,5 (? 3,7), p=0,02. O risco de pr?-ecl?mpsia aumenta com a idade (OR 1.084 e p=0,0034) e com hist?rico familiar de hipertens?o (OR 2.6 p=0,01). O seguimento, um ano ap?s o parto, revelou que 50% das mulheres com dist?rbios hipertensivos na gravidez se mant?m hipertensas. IMC elevado tamb?m foi observado ap?s cinco (5) anos do parto. CONCLUS?ES: IMC elevado, idade acima de 35 anos e excessivo ganho de peso durante a gravidez foram associados com hipertens?o em longo prazo, em pacientes com pr?-ecl?mpsia pr?via. Hist?ria de pr?-ecl?mpsia aumenta o risco de hipertens?o cr?nica a longo prazo