Publications by authors named "Natalie Bello"
Background: Individuals with adverse pregnancy outcomes have an increased risk of cerebrovascular disease, but the association between adverse pregnancy outcomes and cognitive impairment and dementia is less well established. We aimed to synthesise, combine, and assess the growing body of data examining the associations between adverse pregnancy outcomes and mild cognitive impairment and dementia in parous women.
Methods: In this systematic review and meta-analysis, we searched PubMed (MEDLINE), Web of Science, and Embase from database inception up to July 18, 2024, with no language restrictions, for observational studies or clinical trials that reported mild cognitive impairment or dementia as outcomes and included female individuals or women who had an adverse pregnancy outcome, including hypertensive disorders of pregnancy, gestational diabetes, stillbirth, fetal growth restriction, preterm birth, or placental abruption.
Objective: In this study, we piloted the use of continuous 24-hour blood pressure (BP) monitoring in postpartum patients with preeclampsia with severe features.
Study Design: We measured continuous BP for up to 24 hours using finger plethysmography. We also used an oscillometric device to measure brachial BP per usual clinical protocol (intermittent BP) during the same monitoring period.
Objective: This study aimed to compare the effectiveness of oral short-acting (SA) nifedipine with intravenous (IV) labetalol for the treatment of postpartum (PP) severe hypertension.
Study Design: We conducted a retrospective cohort study of women who delivered at a tertiary care facility between January and December 2018, had not previously received antihypertensive medication, and required treatment for PP severe hypertension defined as systolic blood pressure (SBP) ≥ 160 mm Hg and/or diastolic blood pressure (DBP) ≥110 mm Hg. Exposure groups were defined by the receipt of either oral SA nifedipine or IV labetalol.
Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course.
View Article and Find Full Text PDFBackground: Activity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes.
Objective: To determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs).
Study Design: Secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort.
Importance: Hypertension is increasingly common in pregnancy capable individuals, yet there is limited data on antihypertensive medication dispensation in peripartum individuals.
Objective: To describe antihypertensive medication dispensation from preconception through the first year postpartum.
Design, Setting, And Participants: This retrospective cohort study used the Truven Health Market Scan administrative data from 2008 to 2014 to identify women in the United States with commercial or government health insurance, aged 15-54, free from heart disease, who experienced a pregnancy and filled at least 1 prescription for an antihypertensive medication between 3 months prior to conception and 12 months after the end of the pregnancy.
Article Synopsis
- - Hypertensive disorders of pregnancy (HDP) increase the risk of future cardiovascular disease (CVD), making postpartum care crucial for managing long-term health.
- - Obstetricians have a key role in CVD prevention by facilitating care transitions and using risk calculators to tailor treatment intensity for postpartum women and birthing individuals with HDP.
- - Postpartum patients should receive guidance on lifestyle changes, blood pressure control, lipid assessment, and diabetes evaluation to minimize their CVD risk after experiencing HDP.
Background: Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM.
Methods: Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies.
Introduction: Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.
View Article and Find Full Text PDFBlood pressure variability (BPV) and heart rate variability (HRV) have been associated with Alzheimer's Disease and Related Dementias (ADRD) in rigorously controlled studies. However, the extent to which BPV and HRV may offer predictive information in real-world, routine clinical care is unclear. In a retrospective cohort study of 48,204 adults (age 54.
View Article and Find Full Text PDFBackground: Life's Essential 8 (LE8) is a new metric to define cardiovascular health. We aimed to describe LE8 among Hispanics/Latinos and its association with incident hypertension.
Methods And Results: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a study of Hispanic/Latino adults aged 18 to 74 years from 4 US communities.
Article Synopsis
- Hypertensive disorders of pregnancy (HDP) are linked to long-term cardiovascular risks for women, though the reasons are not fully understood.
- A study involving 5,168 Hispanic/Latina women revealed that 14% had a history of de novo HDP, which was associated with lower left ventricle ejection fraction and higher risks of abnormal cardiac geometry.
- Findings indicate that previous HDP can lead to measurable cardiac issues in women, with current hypertension only partially explaining these effects.
Aims: We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM).
Methods And Results: We conducted a multi-centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization.
Background: Infertility has been shown to be associated with a greater risk of incident heart failure with preserved ejection fraction. We studied the association of infertility with subclinical markers of heart failure with preserved ejection fraction, including echocardiographic signs of cardiac remodeling and cardiac biomarkers.
Methods And Results: A history of infertility was ascertained in 2002 women enrolled in the Framingham Heart Study.
Objective: To evaluate risk for peripartum cardiomyopathy during delivery and postpartum hospitalizations, and analyze associated trends, risk factors, and clinical outcomes.
Methods: The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations along with postpartum readmissions occurring within five months of delivery discharge were analyzed.
The United States has the highest maternal mortality in the developed world with cardiovascular disease as the leading cause of pregnancy-related deaths. In response to this, the emerging subspecialty of cardio-obstetrics has been growing over the past decade. Cardiologists with training and expertise in caring for patients with cardiovascular disease in pregnancy are essential to provide effective, comprehensive, multidisciplinary, and high-quality care for this vulnerable population.
View Article and Find Full Text PDFArticle Synopsis
- Obesity is linked to both negative pregnancy outcomes and an increased risk of heart disease, but it's unclear if these pregnancy outcomes are a cause or a result of the obesity-heart disease connection.
- This study involved nearly 4,216 first-time pregnant women monitored over time to explore how early pregnancy body mass index (BMI) influenced cardiovascular risk factors after childbirth, considering various pregnancy complications.
- Results indicated that early pregnancy obesity was associated with higher rates of conditions like postpartum hypertension, high cholesterol, and diabetes, with pregnancy-related complications also contributing to these risks, particularly hypertensive disorders.
Article Synopsis
- The study investigates how changes in dynamic cerebral autoregulation (DCA) affect mothers after experiencing severe preeclampsia postpartum, compared to healthy postpartum and non-pregnant women.
- Researchers used techniques like transcranial Doppler and blood pressure monitoring to measure DCA parameters within a week of delivery in these groups.
- Results indicated that postpartum participants showed faster autoregulatory responses but with impaired dampening effects, suggesting a hyperdynamic state in DCA regardless of preeclampsia status.