Introduction: Gestational Hypertensive Syndromes (SHG) continue to be a major cause of direct morbidity and mortality in Brazil, with a high proportion in the North. Even with several health policies created to try to curb maternal morbidity and mortality, scientific data indicate that there is still a need for scientific studies, especially histopathological ones. Objective: To evaluate the histopathological changes in human placentas and umbilical cords, of parturients with SHG. Methodology: The research was carried out at the High-risk Maternity Our Lady of Lourdes, Aracaju-SE. The sample consisted of 28 pregnant women with SHG, distributed in 4 groups: Normotensive Pregnant Women, Gestational Hypertension, Chronic Hypertension and the group with Pre-eclampsia, totaling 7 pregnant women per group. The data were analyzed by the statistical program Grad pad prism, with significant data (<0.05), using the one-way Anova and Tukey's multiple comparison test. The placentas and umbilical cords were submitted to 4 different methodologies, beginning with the histological processing - light microscopy, then histopathological analyzes of placentas by Hematoxylin and Eosin - HE, histopathological analyzes of the placentas following the staining technique with Masson and histopathological analyzes of the placentas. placentas following the Coloring Technique - PAS. Results: After analyzing the histological images, it was possible to identify in the placentas of normotensive pregnant women the mature and flat decidua with eosinophilic tissue and presence of fibrin, with dense epithelium and intact villi. The chorionic villi presented quite vascularization, with knots and scions. The umbilical cord presented an artery with an intimate and muscular layer of usual thickness. As for the placentas of patients with gestational hypertension, the smooth muscle thickening of the placental vessels, microcalcifications and vessel hyalinization were observed, in addition it was observed aged areas and areas with hyaline degeneration in the villi. In the placentas of pregnant women with chronic hypertension, hyalinization and aging of the villi were found, with microcalcification and hemorrhagic foci. The umbilical cord of pregnant women with chronic hypertension presented thick muscle wall, vessel hyalinization and cell degeneration. In the placentas of pregnant women with mild preeclampsia it was possible to observe intense groupings of degenerated and hyalinized villi. The umbilical cord presented thickening of the muscular layer. The placentas of pregnant women with severe pre-eclampsia were able to observe hyalinization of the villi, severe groupings with focus of calcification and hemorrhagic areas. Finally, it was identified that pregnant women in adulthood acquired SHG; the newborns of pregnant women with chronic hypertension were those that suffered the greatest impact of the syndrome, presenting slight decrease in weight, height, thoracic perimeter and cephalic perimeter. The placentas and umbilical cords of pregnant women with SHG presented structural changes and involvement of the tissue structures when compared to the normotensive pregnant women group. Conclusion: In this sense, it is concluded that the gestational annexes with SHG have structural and cellular changes at the placental and umbilical cord level, chronic hypertension is called attention, the data are conclusive, in addition, the placenta and umbilical cord of pregnant women with SGH, are an inexhaustible source of important scientific production on gestational development, and may contribute actively to the clinical findings of pregnant women and the newborn. / Introdução: As Síndromes Hipertensivas Gestacionais (SHG) continuam sendo uma das principais causas de morbimortalidade direta no Brasil, apresentando proporção elevada nas regiões Norte. Mesmo com diversas políticas de saúde criadas para tentar frear a morbimortalidade materna, os dados científicos apontam que ainda há necessidade de estudos científicos, em especial os histopatológicos. Objetivo: Avaliar as alterações histopatológicas em placentas humanas e cordões umbilicais, de parturientes com SHG. Metodologia: A pesquisa foi realizada na Maternidade de alto risco Nossa Senhora de Lourdes, Aracaju-SE. A amostra foi constituída por 28 gestantes com SHG, distribuídas em 4 grupos dentre eles: Gestantes Normotensas, Hipertensa Gestacional, Hipertensa Crônica e o grupo com Pré-eclâmpsia, totalizando 7 gestantes por grupo. Os dados foram analisados pelo programa estatístico Grad pad prism, com dados significativos (<0,05), utilizando o one-way Anova e teste de comparação múltipla de Tukey. As placentas e cordões umbilicais foram submetidos a 4 metodologias distintas, tendo como início o processamento Histológico - microscopia de luz, depois análises histopatológicas das Placentas por Hematoxilina e Eosina - HE, análises histopatológicas das placentas seguindo a técnica de coloração com Masson e análises histopatológica das placentas seguindo a Técnica de coloração - PAS. Resultado: Após análise das imagens histológicas foi possível identificar nas placentas de gestantes normotensas, a decídua madura e plana com tecido eosinófilo e presença de fibrina, com epitélio denso e vilosidades íntegras. As vilosidades coriônicas apresentaram bastante vascularizadas, com nós e brotos sinciciais. O cordão umbilical apresentou artéria com camada intima e muscular de espessuras habituais. Quanto às placentas de pacientes que cursaram com hipertensão gestacional, notou-se o espessamento da camada muscular lisa dos vasos placentários, microcalcificações e hialinização dos vasos, além disso foi observado áreas envelhecidas e áreas com degeneração hialina nas vilosidades. Já nas placentas de gestantes com hipertensão crônica foram encontradas hialinização e envelhecimento das vilosidades, com microcalcificação e focos hemorrágicos. O cordão umbilical de gestante com hipertensão crônica, apresentou a parede muscular espessa, hialinização do vaso e degeneração celular. Já nas placentas de gestantes com pré-eclâmpsia leve foi possível observar agrupamentos intensos de vilosidades degeneradas e hialinizadas. O cordão umbilical apresentou espessamento da camada muscular. As placentas de gestantes com pré-eclâmpsia grave foram possíveis observar hialinização das vilosidades, agrupamentos severos com foco de calcificação e áreas hemorrágicas. Por fim, identificou-se que as gestantes em idade adulta adquiriram SHG; os recém-nascidos de gestantes com hipertensão arterial crônica foram os que sofreram o impacto maior da síndrome, apresentando leve diminuição do peso, estatura, perímetro torácico e perímetro cefálico. As placentas e cordões umbilicais de gestantes com SHG apresentaram mudanças estruturais e acometimento das estruturas teciduais quando comparados ao grupo das gestantes normotensas. Conclusão: Neste sentido, conclui-se que os anexos gestacionais com SHG possuem alterações estruturais e celulares a nível placentário e de cordão umbilical, chama-se atenção a hipertensão crônica, os dados são conclusivos, além disso, a placenta e cordão umbilical de gestantes com SGH, são fonte inesgotável de produção científica importantes sobre o desenvolvimento gestacional, podendo contribuir de forma ativa para os achados clínicos das gestantes e do recém-nascido. / Aracaju

Orientador: Marilda Mazzali / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T09:11:43Z (GMT). No. of bitstreams: 1 Nicolielo_RenatoLuizCursino_M.pdf: 2896438 bytes, checksum: 3df4ea3bde6ce115708b78e7b010be98 (MD5) Previous issue date: 2009 / Resumo: Hiperuricemia é associada ao desenvolvimento de remodelamento vascular e hipertensão arterial em modelos experimentais. Por outro lado, o uso de agentes redutores dos níveis de ácido úrico (hipouricemiantes) proporciona a normalização pressórica e proteção contra o desenvolvimento de doença renal. Objetivo: Determinar o efeito de agentes hipouricemiantes sobre a pressão arterial de animais SHR. Métodos: ratos machos SHR e WKY, com 4 semanas de idade, acompanhados durante 9 semanas. Os animais SHR foram tratados com alopurinol (SHRALP) ou benzbromarona (SHRBENZ). Pressão arterial de cauda, função renal e histologia renal foram comparados aos animais SHR não tratados (SHRCT) e aos controles normotensos WKY (WKYCT). Pressão arterial de cauda foi medida no período inicial e semanalmente até o sacrifício. Resultados: Tratamento com agentes hipouricemiantes reduziu a PA em animais SHR, com melhor controle no grupo SHRALP (SHRCT 214±7,7; SHRALP 164±3,5; SHRBENZ 179±2,3 mmHg, p<0,05). O tratamento foi associado com redução significativa dos níveis de ácido úrico comparado aos controles SHR (SHRCT 1,6±0,6; SHRALP 0,9±0,2*; SHRBENZ 1,0±0,4* mg/dl, *p<0.05). A função renal permaneceu inalterada em todos os grupos durante o acompanhamento. Análise histológica dos fragmentos renais mostrou redução significativa do percentual de arteríolas pré-glomerulares remodeladas nos animais tratados, em comparação aos controles SHR (84,3±8,5%SHRCT; 66,4±20,1%SHRALP*; 71,6±15,3% SHRBENZ* p<0,05). Espessamento de arteríolas pré-glomerulares, quantificada por método de captura de imagem computadorizada mostrou redução significativa da área de parede arteriolar nos animais tratados em comparação aos SHR não tratados (SHRCT). A espessura arteriolar do grupo SHRALP foi compatível a dos animais controles WKY. Conclusão: O uso de agentes hipouricemiantes foi associado com redução de PA e de remodelamento vascular de arteríolas préglomerulares em animais SHR. Como esses animais já apresentam nível sérico de ácido úrico mais elevado que os WKY com 4 semanas de vida, apesar de níveis pressóricos normais, intervenção em idades mais precoces talvez possa prevenir o desenvolvimento de hipertensão arterial e remodelamento vascular nestes animais. / Abstract: Hyperuricemia is associated with vascular remodeling and hypertension in experimental models, and use of uric acid (UA) lowering agents is associated with BP normalization and protection of renal disease. Aim: To determine the effect of UA lowering agents on BP in SHR animals. Methods: Male SHR and WKY rats, 4 weeks old, were followed for 9 weeks. SHR animals received allopurinol (SHRALP) or benzbromarone (SHRBENZ) and BP, renal function, and renal histology were compared to untreated SHR (SHRCT) and WKY controls (WKYCT). Blood pressure was measured at baseline and every week until sacrifice. Results: Treatment with UA lowering agents reduced BP in SHR, with better control in SHRALP group (SHRCT 214±7.7, SHRALP 164±3.5, SHRBENZ 179±2.3 mmHg, p<0.05). Treatment was associated with a significant reduction in serum UA levels compared to SHRCT (SHRCT 1.6±0.6, SHRALP 0.9±0.2*, SHRBENZ 1.0±0.4* mg/dl, *p<0.05). Renal function remained unchanged in all groups. Histological analysis showed a significant reduction in vascular remodeling in SHR treated with UA-lowering agents compared to SHRCT (84.3±8.5%SHRCT, 66.4±20.1%SHRALP*, 71.6±15.3% SHRBENZ* p<0.05). Pre-glomerular arterial thickness, measured by computer assisted analysis, showed a reduction in arteriolar wall area in SHR treated compared to SHRCT. Arteriolar thickness in SHRALP group was comparable to WKYCT. Conclusion: The use of UA lowering agents was associated with a reduction in BP and pre glomerular arteriolopathy in SHR. As SHR rats already had higher UA than WKY controls at 4 weeks of life, despite normal BP, an earlier intervention might prevent the development of hypertension and vascular remodeling in these animals. / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Background. Developing countries are undergoing a process of epidemiological transition from infectious to non-communicable diseases, described by the United Nations Secretary General Ban Ki-Moon as “a public health emergency in slow motion”. One of the most prevalent of these diseases, in sub-Saharan Africa, is hypertension, which is a complex chronic condition often referred to as the “silent killer” and a key contributor to the development of cardiovascular and cerebrovascular diseases. Hypertensive patients in this setting are estimated to increase from 74.7 million in 2008 to 125.5 million in 2025, a 68% increase. There is however an important gap between emerging high-level policies and recommendations, and the near-absence of practical guidance and experience delivering long-term medical care for non-communicable diseases within resources-limited health systems. To address this gap, our study consisted of field investigations to determine the minimum health systems requirements necessary to ensure successful delivery of anti-hypertensive medications when scaling-up interventions. Methods/Design. A cross-sectional analytic study was conducted in the Western Cape Province of South Africa using a mixed method approach with two sets of semi-structured interviews and simulation modeling. One set of interviews was conducted with health professionals involved in the care of hypertensive patients within nine community health centers (five urban and four rural) to understand the challenges associated with their care. The other set was used to map and assess the current supply chain management system of antihypertensive medications and involved key informants at different levels of the process. Finally, modeling and simulation tools with ARENA Software were used to estimate minimum numbers of health workers required to ensure successful delivery of medications when scaling up interventions. Results. The study found numerous challenges affecting the care of hypertensive patients in primary health care facilities and categorized these into five interconnected dimensions: Management of the visits within the PHC facility, Adequacy of human resources, Standardization of patients’ care, Infrastructure limitations, and Patients’ responsibilities. Potential solutions to overcome these challenges were explored in order to improve the care of the hypertensive patients in the PHC facilities. Mapping of the drug supply chain management system highlighted the complexity of the system. In fact many of the issues reported fell outside of the control of the provincial health department. The need for a more single comprehensive computer system to handle most of the functions of the drug supply management system was heavily emphasized. The modeling and simulation tool with ARENA Software estimated the type and number of health care professionals needed to provide appropriate services to a certain patient population based on the set targets. The sample data used showed how one can test the impact of various changes in the processes and staffing levels to minimize waiting times while increasing the daily patients’ intake at the facility. We found that with few additional nursing staff, that are more affordable and quicker to train than medical doctors and pharmacists, one can considerably improve the performance of the facilities in the care of hypertensive patients. Discussion. This investigation has highlighted the detailed processes in place for the care of hypertensive patients in primary health care facilities, identifying the challenges in providing such care. The potential solutions suggested by the study results, if implemented, should help improve services offered and ensure that the system remains sustainable when patients’ intake increases exponentially as a result of scaled up interventions. The weaknesses of the drug supply chain management system demand immediate action. The modeling and simulation tools used in this study, if used on an ongoing basis, could create more effective planning of needed resources, although their proper utilization will require extra training for managers. Whether there is sufficient political support to ensure the resources necessary to reach the provincial health department’s hypertension target remains to be seen, and would benefit with further economic studies to estimate the cost associated with tackling the hypertension epidemic.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T14:59:47Z No. of bitstreams: 1 Josiane Motta e Motta.pdf: 1112413 bytes, checksum: 56336232aa8fd9a87ed00d49c5689dd5 (MD5) / Made available in DSpace on 2015-07-27T14:59:47Z (GMT). No. of bitstreams: 1 Josiane Motta e Motta.pdf: 1112413 bytes, checksum: 56336232aa8fd9a87ed00d49c5689dd5 (MD5) Previous issue date: 2013-01-13 / The scientific literature confirms that metabolic, autonomic and anthropometric changes are commonly present in patients with arterial hypertension (AH). Offspring of hypertensive parents show since childhood some metabolic and autonomic changes, like glucose intolerance, increased lipid and catecholamines levels and a higher blood pressure than offspring of normotensive parents. Few studies have evaluated the heart rate variability in sons of hypertensive parents.Objective. The aim of this prospective randomized study was to assess anthropometric, hemodynamic and metabolic changes as well as changes in sympathetic-vagal imbalances after carbohydrate overload in offspring of hypertensive parents. Methods. In phase one, 200 volunteers were prospectively evaluated. Their hemodynamic variables were probed with HDI (Hypertension Diagnosis Incorporation, CR2000, Eagan, USA), a stress analysis was done through social readjustment scale of Holmes-Rahe and anthropometric assessment included measurement of cervical and abdominal circumferences, evaluation of lean and fat body mass and metabolic rate through bioimpedance. Part of the group as submitted to a carbohydrates overload to evaluate the autonomic imbalance. Results. Data did not meet statistical differences in lean and fat mass as well as in neck circumference and stress evaluation for offspring of hypertensive parents and the control group. However, offspring of hypertensive parents showed higher (p<0.05) casual systolic anddiastolic pressure, abdominal circumference, body mass index pulse pressure, and basal metabolic rate. For the younger cohort, we found a positive correlation between neck circumference and pulse pressure, basal metabolic rate, uric acid, and triglycerides, as well as a negative correlation between neck circumference and HDL- cholesterol. Those correlations were stronger for neck circumference than for waist circumference. In offspring of hypertensive parents we found higher blood pressure, pulse pressure, abdominal circumference, body mass index, and an increase in sympathetic-vagal imbalance after carbohydrate overload. / A literatura confirma que alterações antropométricas, metabólicas e autonômicas com freqüência estão presentes nos portadores de hipertensão arterial. Filhos de hipertensos já apresentam desde a infância alterações como intolerância à glicose, aumento dos níveis de lípides, de catecolaminas e níveis pressóricos mais altos comparados aos filhos de normotensos. O objetivo deste trabalho prospectivo caso controle foi avaliar alterações hemodinâmicas, antropométricas, metabólicas e do balanço simpato-vagal em filhos de hipertensos em condições basais e após sobrecarga de carboidratos. Métodos: Na primeira fase do estudo foram investigados prospectivamente 200 voluntários em relação ao estresse psicossocial (escala de reajustamento social de Holmes-Rahe), dados antropométricos (medidas das circunferências abdominal e cervical, índice de massa corpórea) percentual de gordura corpórea, massa magra e a taxa metabólica com a bioimpedância. As variáveis hemodinâmicas foram avaliadas de forma não invasiva com o H.D.I. (Hypertension DiagnosisIncorporation, CR2000, Eagan, USA). Não se encontrou diferenças estatísticas na massa magra, massa gorda, circunferência cervical e na avaliação de estresse entre os grupos. Em uma segunda fase um subgrupo foi submetido à sobrecarga de carboidratos e foi avaliado o balanço autonômico após a sobrecarga. Os filhos de hipertensos têm maior (p<0,05) pressão arterial sistólica e diastólica de consultório, pressão de pulso(PP),taxa metabólica basal (TMB), circunferência abdominal e índice de massa corpórea. Para a população com idade média de 28 anos investigada encontrou-se correlação positiva entre circunferência cervical e valores de PP, TMB, ácido úrico, triglicerídios e correlação negativa com fração HDL-colesterol. As correlações da circunferência cervical com PP, triglicérides, HDL-colesterol, ácido úrico e TMB foram melhores do que com a circunferência abdominal. Após sobrecarga de carboidratos houve aumento do componente LF, redução do componente HF e aumento da relação LF/HF no grupo HF+ em relação ao grupo HF-. Os filhos de hipertensos, comparados com filhos de normotensos tem maior pressão arterial, índice de massa corpórea, taxa metabólica basal, circunferência de cintura e apresentaram maior resposta simpática (componente LF) após sobrecarga de carboidratos.

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第21973号 / 農博第2363号 / 新制||農||1071(附属図書館) / 学位論文||R1||N5224(農学部図書室) / 京都大学大学院農学研究科食品生物科学専攻 / (主査)教授 井上 和生, 教授 谷 史人, 准教授 大日向 耕作 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

Die Präeklampsie als schwangerschaftsspezifische Erkrankung zählt unverändert weltweit zu den Hauptursachen fetaler und maternaler Morbidität und Mortalität. Ungeachtet vieler Forschungsbestrebungen fehlt bisher vor allem eine effiziente Früherkennung sowie daraus ableitbare kausale Therapieoptionen. Obgleich Ätiologie und Pathogenese nach wie vor als ungeklärt gelten, existieren zunehmend überzeugende Hinweise, welche einer Dysbalance von angiogenen Faktoren, wie VEGF und PlGF, und antiangiogenen Faktoren, wie sFlt1 und sEng, eine zentrale Rolle in der Entstehung der Erkrankung zuschreiben. Mehrere Studiengruppen konnten in diesem Zusammenhang veränderte Plasmakonzentrationen antiangiogener Proteine noch vor der eigentlichen Manifestation der Erkrankung nachweisen. Ziel dieser Studie war es zu klären, ob eine pathologisch uterine Perfusion im 2. Trimenon mit erhöhten sFlt1-Werten assoziiert ist und in einem prospektiven Ansatz die prädiktive Wertigkeit der antiangiogenen Faktoren sFlt1 und sEng, in einem durch Dopplersonografie vorselektierten Risikokollektiv zu bestimmen. Dazu wurden im retrospektiven Teil von 39 und im prospektiven Teil von 77 Einlingsschwangerschaften im 2. Trimester in venös entnommenen Blutproben mit Hilfe des ELISA - Tests die maternalen sFlt1- und sEng- Konzentrationen gemessen. Es konnte gezeigt werden, dass in einem durch Dopplersonografie vorselektierten Patientenkollektiv die maternale sFlt1-Konzentration bei Patientinnen mit späteren Schwangerschaftskomplikationen signifikant erhöht ist. Zusätzlich konnte belegt werden, dass die sEng - Konzentration in einem dopplersonografisch vorselektierten Risikokollektiv ebenfalls als unabhängiger prädiktiver Marker zur Vorhersage einer späteren Präeklampsie genutzt werden kann. Vielmehr ist es sogar möglich, Hochrisikopatientinnen mit Manifestation der Erkrankung vor der 34. SSW durch ausgesprochen hohe Sensitivität und Spezifität zu identifizieren.

Background In South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia (SpO2<90%) during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation. Methods Data from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO2<90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO2 nadir was performed to identify confounding variables associated with, and mediators of hypoxaemia.Results In the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO2 nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship. Conclusions Clinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified.

Intravenous injection of substance P (SP) increases renal nerve firing and heart rate in spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats (WKYs) by stimulating sympathetic ganglia. Blood pressure is increased in SHRs but lowered in WKYs. This study assesses the role of neurokinin-1 (NK1) receptors in mediating the ganglion actions of SP. Rats for functional studies were anesthetized and then treated with chlorisondamine. Renal nerve, blood pressure, and heart rate responses to intravenous injection of the NK1 receptor agonist GR-73632 were similar but less than those to equimolar doses of SP in SHRs. GR-73632 only slightly increased renal nerve firing and heart rate and lowered blood pressure in WKYs. The NK1 receptor antagonist GR-82334 (200 nmol/kg iv) blocked the ganglionic actions of GR-73632 and the pressor response to SP in SHRs. It reduced the renal nerve and heart rate responses by 52 and 35%. This suggests that the pressor response to SP is mediated by ganglionic NK1 receptors and that NK1 receptors also have a prominent role in mediating the renal nerve and heart rate responses to SP. Quantitative autoradiography showed that NK1 receptors are more abundant in the superior cervical ganglia of SHRs. RT-PCR showed increased abundance of NK1 receptor mRNA in SHRs as well. These observations suggest that the greater ganglionic stimulation caused by SP in SHRs is due to upregulation of NK1 receptors.

Infant mortality (IM) rates in the United States remains high. The higher rates of IM among specific groups in the United States is believed to be fueled by the high rates of adverse birth outcomes including low birthweight (LBW) and preterm births (PTB) among these groups. Adverse birth outcomes have also been linked to the presence of hypertensive disorders during pregnancy. The purpose of this cross-sectional study was to explore the association between hypertensive disorders during pregnancy and adverse birth outcomes and the impact of the residential neighborhood of expectant mothers on this association. The life course health development theory guided the framework for this study. Study data were obtained from the 2010 New York City birth records and the 2010 US Census. Descriptive statistics and logistic regression analysis were used to address the 3 research hypotheses of the study. The study found that prepregnancy hypertension (HTN) (AOR: 2.84 & 3.25), gestational HTN (AOR: 2.28 & 3.33) and eclampsia (AOR: 4.41 & 6.70) were significantly associated with PTB and LBW respectively. Neighborhood segregation was not significant for PTB (AOR: 1.01) or LBW (AOR: 1.03). Neighborhood poverty was significant for PTB (AOR: 0.86) but not for LBW (AOR: 1.05). Neighborhood segregation and poverty had significant moderating effects on the prepregnancy HTN (p = 0.00), gestational HTN (p = 0.00), eclampsia (p = 0.00) and PTB and LBW association. Results from this study can help to address disparities in birth outcomes among women of differing races and ethnicities and thereby contribute to positive social change.

Background: The pervasiveness of hypertension (HTN), morbidity, and mortality in Haitians immigrants are frightening. Nonadherence with hypertensive medications, disease management, lifestyle modifications, and cultural and spiritual beliefs, including prayer; faith healing; use of herbal teas; and a diet that is deficient in potassium, rich in sodium, high in fat, cholesterol, and carbohydrates result in increased prevalence of HTN and disability in the Haitian community. Purpose: The purpose of this quality improvement project was to examine the existing system for adherence to hypertensive medications, standardized clinical practice guidelines, identify patients at risk for nonadherence to hypertensive medications, disease management, medical follow-up, and incorporate standardized clinical guidelines into existing medical practice at a primary care office. Theoretical Framework: Theory of transnationalism was used. The transnationalism theoretical framework presents the impact of migration and transnational activities on the health of immigrants. Methods: The mixed model research with exploratory design was used. Results: The implementation of the resource guide was effective as evidenced by improved blood pressure readings and increase adherence to hypertensive medications as well as follow-up appointments. Conclusion: The prevalence of HTN in Haitian immigrants necessitate a different approach to health care delivery. Health care providers need to be aware of Haitian culture to deliver culturally competent care to improve health outcomes in Haitian immigrants.