Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study.

From Delivery to Dialysis: Does Preeclampsia Count?

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Microvascular Outcomes in Women With a History of Hypertension in Pregnancy.

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow‐up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age‐adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1‐6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8‐3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.

Recurrence of hypertensive disorder in second pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP; including gestational hypertension and preeclampsia) are associated with an increased risk of maternal cardiovascular disease (CVD). Low-dose aspirin reduces the risk of preterm preeclampsia, through proposed short-term effects on platelet and endothelial function. While low-dose aspirin is recommended for the prevention of preeclampsia in women at high risk, no recommendations exist for aspirin use following a pregnancy complicated by HDP. Hypothesis: We hypothesized that regular aspirin use after pregnancy would modify the association between HDP and CVD, lowering the magnitude of the association among aspirin users relative to non-users. Methods: Parous women free of CVD before first birth in the Nurses’ Health Study II comprised the analytic sample (n=60,392). Lifetime pregnancy history was reported in 2009. Women were followed for confirmed incident CVD (coronary heart disease [non-fatal or fatal MI, fatal CHD] or stroke [non-fatal or fatal]) from 1989 through 2013. Current regular aspirin use was self-reported at baseline in 1989 and updated every 2 years via biennial questionnaire. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the relationship between HDP in first pregnancy (using 3 mutually exclusive categories: normotension [ref], gestational hypertension, preeclampsia) and CVD, adjusted for age, race/ethnicity, parental education, family history of CVD <60y, and pre-pregnancy risk factors (smoking, physical activity, diet, alcohol intake, oral contraceptive use, BMI). Effect modification by aspirin was tested through a likelihood ratio test, comparing nested models with and without interaction terms between HDP history and time-varying aspirin use. Results: Nine percent of women (n=5,629) had HDP in first pregnancy. CVD events occurred in 657 women with normotension, 30 women with gestational hypertension, and 75 women with preeclampsia. Compared to women with normotension in first pregnancy, gestational hypertension was associated with stroke (HR=1.65; CI: 1.01-2.71) but not CHD (HR=1.21; CI: 0.70-2.12), while preeclampsia was associated with CHD (HR=2.27; CI: 1.69-3.04) but not stroke (HR=1.03; CI: 0.68-1.57). Current aspirin use was not a significant effect modifier of the relationship between HDP and CVD (p-value=0.53). Hazard ratios for the relationship between gestational hypertension and CVD were 1.58 (CI: 1.01-2.49) among aspirin non-users and 1.15 (CI: 0.61-2.18) among aspirin users. Hazard ratios for the relationship between preeclampsia and CVD were 1.52 (CI: 1.10-2.10) among aspirin non-users and 1.67 (CI: 1.16-2.40) among aspirin users. Conclusion: Aspirin use after pregnancy does not appear to modify the increased risk of CVD observed among women with a history of HDP compared to women with normotension in pregnancy.

Although certain air pollutants have been associated with adverse obstetric outcomes, evidence regarding the association of ozone (O3) exposure with the risk of hypertensive disorders in pregnancy (HDP) is limited and inconsistent. To evaluate the association between gestational O3 exposure and HDP (ie, gestational hypertension and preeclampsia) risk, and to explore the window of susceptibility for O3 exposure during pregnancy. This cohort study recruited pregnant patients from the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China, from March 2017 to December 2018. Participants were older than 18 years, had no infectious diseases or chronic noncommunicable diseases before pregnancy, were Shanghai residents with intent to participate in the study, and had plans to give birth in Shanghai. Gestational hypertension and preeclampsia were diagnosed according to the diagnostic criteria of the Chinese Society of Obstetrics and Gynecology during the study period. Data on residential addresses, demographic characteristics, and household living environments were collected from participants through a questionnaire survey. Data were analyzed from December 10, 2021, to May 10, 2022. A high temporospatial resolution model was applied to predict individual levels of daily O3 exposure during pregnancy. The outcomes were gestational hypertension and preeclampsia, and data on these diagnoses were extracted from the hospital's information system. A logistic regression model was used to estimate the associations between O3 exposure and risk of gestational hypertension or preeclampsia. Exposure-response associations were confirmed by restricted cubic spline functions. Distributed lag models were used to identify the O3 exposure window of susceptibility. Among the 7841 participants (all females; mean [SD] age, 30.4 [3.8] years), 255 (3.2%) had gestational hypertension and 406 (5.2%) had preeclampsia. Pregnant individuals with HDP had considerably higher prepregnancy body mass indexes and lower educational levels. The mean (SD) O3 exposure levels were 97.66 (25.71) μg/m3 in the first trimester and 106.13 (22.13) μg/m3 in the second trimester. Each 10-μg/m3 increment of O3 exposure during the first trimester was associated with higher gestational hypertension risk (relative risk, 1.28; 95% CI, 1.04-1.57). However, gestational O3 exposure was not associated with the risk of preeclampsia. The restricted cubic spline function analysis revealed an exposure-response association between O3 exposure and risk of gestational hypertension. Results of this study showed an association between increased gestational hypertension risk and O3 exposure during the first trimester. Furthermore, gestational weeks 1 to 9 were identified as the window of susceptibility for O3 exposure and elevated gestational hypertension risk. Sustainable O3 control is needed to reduce the disease burden of gestational hypertension.

Early-pregnancy plasma per- and polyfluoroalkyl substance (PFAS) concentrations and hypertensive disorders of pregnancy in the Project Viva cohort.

Hypertensive disorders of pregnancy are leading causes of morbidity and mortality among pregnant individuals as well as newborns, with increasing incidence during the past decade. Understanding the individual associations of advancing age of pregnant individuals at delivery, more recent delivery year (period), and more recent birth year of pregnant individuals (cohort) with adverse trends in hypertensive disorders of pregnancy could help guide public health efforts to improve the health of pregnant individuals. To clarify the independent associations of delivery year and birth year of pregnant individuals, independent of age of pregnant individuals, with incident rates of hypertensive disorders of pregnancy. This serial cross-sectional study of 38 141 561 nulliparous individuals aged 15 to 44 years with a singleton, live birth used 1995-2019 natality data from the National Vital Statistics System. Year of delivery (period) and birth year (cohort) of pregnant individuals. Rates of incident hypertensive disorders of pregnancy, defined as gestational hypertension, preeclampsia, or eclampsia, recorded on birth certificates. Generalized linear mixed models were used to calculate adjusted rate ratios (aRRs) comparing the incidence of hypertensive disorders of pregnancy in each delivery period (adjusted for age and cohort) and birth cohort (adjusted for age and period) with the baseline group as the reference for each. Analyses were additionally stratified by the self-reported racial and ethnic group of pregnant individuals. Of 38 141 561 individuals, 20.2% were Hispanic, 0.8% were non-Hispanic American Indian or Alaska Native, 6.5% were non-Hispanic Asian or Pacific Islander, 13.9% were non-Hispanic Black, and 57.8% were non-Hispanic White. Among pregnant individuals who delivered in 2015 to 2019 compared with 1995 to 1999, the aRR for the incidence of hypertensive disorders of pregnancy was 1.59 (95% CI, 1.57-1.62), adjusted for age and cohort. Among pregnant individuals born in 1996 to 2004 compared with 1951 to 1959, the aRR for the incidence of hypertensive disorders of pregnancy was 2.61 (95% CI, 2.41-2.84), adjusted for age and period. The incidence was higher among self-identified non-Hispanic Black individuals in each birth cohort, with similar relative changes for period (aRR, 1.76 [95% CI, 1.70-1.81]) and cohort (aRR, 3.26 [95% CI, 2.72-3.91]) compared with non-Hispanic White individuals (period: aRR, 1.60 [95% CI, 1.57-1.63]; cohort: aRR, 2.53 [95% CI, 2.26-2.83]). This cross-sectional study suggests that more recent birth cohorts of pregnant individuals have experienced a doubling of rates of hypertensive disorders of pregnancy, even after adjustment for age and delivery period. Substantial racial and ethnic disparities persisted across generations.

The study aimed to develop prediction algorithms for hypertensive disorders based on multivariate analysis of factors from the maternal history and compare the estimated performance of such algorithms in the prediction of early preeclampsia (PE), late-PE and gestational hypertension (GH) with that recommended by the National Institute for Clinical Excellence (NICE). Logistic regression analysis was used to determine which of the maternal characteristics and history had significant contribution in predicting early-PE, late-PE and GH. There were 37 cases with early-PE, 128 with late-PE, 140 with GH and 8061 cases that were unaffected by PE or GH. Predictors of early-PE were Black race, chronic hypertension, prior PE and use of ovulation drugs. Predictors of late-PE and GH were increased maternal age and body mass index, and family history or history of PE. Additionally, late-PE was more common in Black, Indian and Pakistani women. The detection rates of early-PE, late-PE and GH in screening by maternal factors were 37.0, 28.9 and 20.7%, respectively, for a 5% false positive rate. Screening as suggested by NICE would have resulted in a false positive rate of 64.1% with detection rates of 89.2, 93.0 and 85.0% for early-PE, late-PE and GH, respectively. Meaningful screening for hypertensive disorders in pregnancy by maternal history necessitates the use of algorithms derived by logistic regression analysis.

Background: Hypertensive disorders of pregnancy (HDP) are major global causes of maternal and fetal morbidity and mortality, particularly in developing countries like Nigeria. The spectrum of pregnancy-related hypertension encompasses preeclampsia, pregnancy-induced hypertension, chronic hypertension in pregnancy, and preeclampsia superimposed on chronic hypertension. While structural and functional cardiac changes in chronic hypertension are well-documented, data on the specific spectrum of left ventricular geometry in HDP remain limited. Aims: This study aimed to assess left ventricular geometry in women with hypertensive disorders of pregnancy. Methodology: This was a cross-sectional study. One hundred and forty pregnant women meeting the diagnostic criteria for HDP were recruited, with an equal number of normotensive pregnant women serving as controls. Echocardiography was performed on all participants. Left ventricular (LV) geometry was determined from the left ventricular mass index (LVMI) and relative wall thickness (RWT). LV geometry was categorized as: normal (LVMI ≤95 g/m2 and RWT ≤0.42), concentric remodelling (CR) (LVMI ≤95 g/m2 and RWT >0.42), eccentric hypertrophy (EH) (LVMI >95 g/m2 and RWT ≤0.42), and concentric hypertrophy (CH) (LVMI >95 g/m2 and RWT >0.42). Results: Among the 140 women with HDP, 55 (39.3%) had pregnancy-induced hypertension, 45 (32.1%) had preeclampsia-eclampsia, 20 (14.3%) had chronic hypertension with superimposed preeclampsia, and 20 (14.3%) had chronic hypertension in pregnancy. The proportion of women exhibiting abnormal Geometry was significantly higher in the HDP group (65.7%) compared to the NP group (14.3%; p < 0.001). The predominant abnormal LV geometric pattern in HDP patients with preexisting chronic hypertension was concentric LV hypertrophy (62.5%), whereas concentric remodelling was the most common abnormal LV geometry in those without preexisting chronic hypertension (29%). Conclusion: This study highlighted that HDP is significantly associated with abnormal LV geometry, a critical determinant of future cardiovascular risk. The distinct LV remodelling patterns observed underscore the need for comprehensive cardiac assessment in HDP to guide clinical interventions, facilitate further research, and inform public health strategies for improving long-term cardiovascular health in affected women.

Hypertensive disorders in pregnancy increase subsequent risk of ischaemic cardiovascular events: genetic evidence from a Mendelian randomisation study

Prevalence of an abnormal ankle-brachial index in patients with antiphospholipid syndrome with pregnancy loss but without thrombosis: a controlled study

BackgroundHypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data.MethodsThis was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies.ResultsAmongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9–58.3) per 100,000 person-years; n = 521, 85.8 (78.6–93.5) per 100,000 person-years; and n = 518, 99.3 (90.9–108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33–1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48–1.78) for women with prior pre-eclampsia.Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67–4.86), and unstable angina, aHR = 1.92 (1.33–2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49–7.19), and acute myocardial infarction, aHR = 2.46 (1.72–3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies.ConclusionsWomen with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.

Impact of type and duration of hypertensive disorders of pregnancy on the onset of permanent hypertension in France (2010–2018): The nationwide CONCEPTION study