Posterior Reversible Encephalopathy Syndrome:  Two Cases of a Rare Complication of Hypertensive Disorders in Pregnancy

Recurrence of hypertensive disorder in second pregnancy

Time trends in placenta-mediated pregnancy complications after assisted reproductive technology in the Nordic countries

BackgroundEndometriosis is a chronic and debilitating disease that can affect the entire reproductive life course of women, with potential adverse effects on pregnancy. The aim of the present study is to investigate the association between hypertensive disorders in pregnancy and endometriosis.MethodRelevant articles were searched from the Cochrane Library, PubMed, Scopus and Web of Science from inception up to December 2023. The full-text observational studies published in English that had a confirmed diagnosis of endometriosis were included. The case group included pregnant women diagnosed with endometriosis at any stage, while the control group consisted of pregnant women who had not been previously diagnosed with endometriosis. Two authors extracted and analyzed the data independently. Disagreements were reconciled by reviewing the full text by a third author. Endnote X9 was used for screening and data extraction. We used fixed and random effects models in Review Manager 5.3 to analyze the pooled data. The quality of the included studies was assessed using the Downs and Black checklist.ResultsOut of the 9863 articles reviewed, 23 were selected for meta-analysis. According to the results of this study, there was an association between endometriosis and gestational hypertension (OR = 1.11, 95% CI: 1.06, 1.16; I2 = 45%, P < 0.00001; N = 8), pre-eclampsia (OR = 1.26, 95% CI: 1.18, 1.36; I2 = 37%, P < 0.00001; N = 12), and hypertensive disorders in pregnancy (OR = 1.13, 95% CI: 1.06, 1.21; I2 = 8%, P = 0.0001; N = 8).ConclusionsThis study confirmed that endometriosis may elevate the risk of developing gestational hypertensive disorders. Raising awareness of this issue will help to identify effective strategies for screening and early diagnosis of hypertensive disorders in pregnancy.

Obese pregnant women are at high risk of adverse perinatal outcomes including hypertensive disorders of pregnancy. The most effective weight loss intervention for morbid obesity is bariatric surgery, which is associated with considerable improvement in several comorbidities. Previous studies have suggested that bariatric surgery reduces the risk of perinatal complications, but few studies have investigated the effect of this intervention using large national data sources, or examined its effect on hypertensive disorders of all severity during pregnancy. The aim of this retrospective cohort study was to determine whether women who delivered after bariatric surgery had lower rates of hypertensive disorders in pregnancy in comparison with obese women who delivered before bariatric surgery. Between 2002 and 2006, data from 7 insurance plans in the United States were analyzed to identify claims for pre-eclampsia and eclampsia, pre-eclampsia superimposed on hypertension, and gestational hypertension diagnoses among women with a history of at least 1 delivery. A total of 585 women aged 16 to 45 years who had undergone bariatric surgery and met eligibility criteria were identified. All participants had continuous insurance coverage during pregnancy and for 2 weeks after delivery. The primary study outcome measure was hypertensive disorders in pregnancy. Multiple logistic regression analysis was used to adjust for maternal age at delivery, multiple pregnancies, type of bariatric surgery, pre-existing diabetes complicating pregnancy, and insurance plan. Timing of delivery in relation to bariatric surgery (before and after surgery) was the independent variable. Of the 585 women, 269 delivered before bariatric surgery and 316 delivered after surgery. Most women underwent gastric bypass surgery (82%, 477/585). Women who delivered before bariatric surgery were slightly younger than those who delivered after surgery (mean age, 31.3 vs. 32.5 years, respectively; P < 0.002), but the other baseline characteristics of these two groups were similar. Compared with women who delivered before surgery, women who delivered after surgery had significantly lower rates of pre-existing diabetes (23.4% vs. 12.3%, P < 0.001) and gestational diabetes (25.7% vs. 13.0%, P < 0.001). Women who delivered after surgery also had substantially lower rates of chronic hypertension (adjusted odds ratio [aOR], 0.39; 95% confidence interval [CI], 0.20-0.74), gestational hypertension (aOR, 0.16; 95% CI, 0.07-0.37), and pre-eclampsia and eclampsia (aOR, 0.20; 95% CI, 0.09-0.44). These findings indicate that women who deliver after bariatric surgery have substantially lower rates of hypertensive disorders in subsequent pregnancies.

Background Hypertensive disorders in pregnancy are major causes of maternal and foetal morbidity and have also been associated with long-term maternal risk of cardiovascular diseases. Whilst many retrospective and prospective cohort studies have explored this relationship, it is difficult to make causal inferences from observational studies due to potential residual confounding and bias. Leveraging genetic data predisposing to exposures and outcomes in instrumental variable analysis, Mendelian randomisation (MR) can provide valuable information for causal inference. The aim of this study is to use MR to investigate the relationship between hypertensive disorders in pregnancy and cardiovascular diseases. Methods Uncorrelated single nucleotide polymorphisms (SNPs) were selected as instrumental variables from the FinnGen consortium summary statistics for the exposures of any hypertensive disorder in pregnancy, and its two subgroups of gestational hypertension, and pre-eclampsia or eclampsia. Genetic association estimates for outcomes were extracted from GWAS studies of 122,733 for coronary artery disease, 34,217 cases for ischaemic stroke, 47,309 cases for heart failure and 60,620 cases for atrial fibrillation. All studies included patients predominantly of European ancestry. Primary analysis was conducted using inverse-variance weighted MR. Results Hypertensive disorders in pregnancy were associated with increased risk of coronary artery disease (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.08–1.43; p=0.002); and this association was evident for both gestational hypertension (OR= 1.08; 95% CI: 1.00–1.17; p=0.040) and pre- or eclampsia (OR=1.06; 95% CI: 1.01–1.12; p=0.030). Hypertensive disorders in pregnancy were also associated with increased risk of ischaemic stroke (OR=1.27; 95% CI: 1.12–1.44; p=2.87x10–4). Neither gestational hypertension nor pre-eclampsia were independently associated with increased risk of ischaemic stroke, though effect estimates were consistent in direction. No associations were noted between the three hypertensive disorders in pregnancy and the outcomes of heart failure or atrial fibrillation. Conclusions Our findings provide genetic evidence that supports a likely causal association between hypertension in pregnancy and increased risk of coronary artery disease and stroke. This is consistent with observational evidence and supports the classification of hypertensive disorders in pregnancy as risk factors for cardiovascular disease. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council GEPSI 946647 for EAWSBritish Heart Foundation RG/16/3/32175 for FSN

Background: Hypertensive disorder of pregnancy (HDP) entails a risk of recurrence in a subsequent pregnancy. Several risk factors have been associated with recurrence of hypertensive disorder in pregnancy. There is also evidence that the different clinical forms of HDP may be related to each other. Therefore, in HDP studies, it may be preferable to include all clinical forms of the hypertensive disorder not only in the 1st pregnancy, but also in later pregnancies. Aim: To study recurrence of Hypertensive Disorder of Pregnancy in 2nd Pregnancy with regard to the type and time of onset of hypertensive disorder in 1st pregnancy. Methodology: The study was conducted at department of obstetrics &amp; gynecology Lalla Ded Hospital GMC Srinagar. 250 patients with history and maternity records of hypertensive disorder of pregnancy (HDP) in first pregnancy were followed on OPD basis till final outcome of second pregnancy to observe the recurrence of hypertensive disorder in second pregnancy with regard to type of hypertensive disorder and time of onset of hypertensive disorder in first pregnancy. Paired t-test &amp; Chi-square test was used. Recurrence rate of HDP was reported as percentage along with its 95% confidence interval. Two sided p-values were reported and a p-value of &lt;0.05 was considered statistically significant. Results: Out of 250 patients, 142 (56.8%) had gestational hypertension in 1st pregnancy with recurrence of different types of HDP of 101(71.12%) in present pregnancy. 43(17.2%) patients having preeclampsia/eclampsia in 1st pregnancy had recurrence of 25(58.13%) in present pregnancy. 55(22%) patients having Chronic hypertension in 1st pregnancy had recurrence of 49(89.09%) in present pregnancy.7(2.8%) patients diagnosed as having superimposed preeclampsia in 1st pregnancy had recurrence of 6(85.7%). Out of 3(1.2%) patients diagnosed as having HELLP syndrome in 1st pregnancy, the recurrence was 3(100%). Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas and family history of HDP. Conclusion: Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (&lt;34 weeks) of gestation and was associated independently with higher age of pregnant women (&gt; 30 years), women belonging to urban areas, women with family history of HDP and also associated with higher cases of preterm and caesarean section deliveries.

Objective To determine whether women who had a delivery after bariatric surgery have lower rates of hypertensive disorders in pregnancy compared with women who had a delivery before bariatric surgery.Design...

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

End-stage renal disease after hypertensive disorders in pregnancy

Objective To investigate the changes of serum soluble receptor for advanced glycation end products(sRAGE)in patients with hypertensive disorder in pregnancy,and analyze the relationship between serum sRAGE and hypertensive disorder in pregnancy.Methods Seventy-five patients with hypertensive disorder in pregnancy including 33 gestational hypertension cases and 42 eclampsism cases,55 normal control were selected.Morphologic changes of placenta were analyzed by means of HE staining.ELISA method was used to determine the level of serum sRAGE.Results Placentomes of cytotrophoblastic cells,nodule of syneytiotrophoblast,thickening of basement membrane,fibrinoid necrosis,villus interstitial edema,reduction in vascularity of villus were much more frequently seen in hypertensive disorder in pregnancy.There were also fabric hyperplasy of hehcine artery,narrow lumina,fibrinoid neerosi and inflammatory cell infiltrating in the uterine decidua in hypertensive disorder in pregnancy.The level of serum sRAGE was significantly decreased in patients with hypertensive disorder in pregnancy[(287.6±36.5)ng/L]when compared with normal controls[(312.8±53.7)ng/L](P<0.01).In hypertensive disorder in pregnancy,the level of serum sRAGE in patients accompanied with eclampsism[(281.9±19.7)ng/L]was lower than that in patients accompanied with gestational hypertension[(293.6±20.3)ng/L](P<0.05).Conclusions HE staining of the placenta showed vascular endothelial damage is the pathogenic basis of hypertensive disorder in pregnancy.The level of serum sRAGE is significantly decreased in patients with hypertensive disorder in pregnancy,it may be contributed to the pathogenesis and development of hypertensive disorder in pregnancy.The level of serum sRAGE may be helpful in predicting hypertensive disorder in pregnancy. Key words: Advanced glycation end products; Hypertensive disorder in pregnancy; Soluble; Receptor

ObjectiveTo explore the associations between serum pregnancy-associated plasma protein-A (PAPP-A) level, and essential hypertension (EH) and hypertensive disorders in pregnancy (HDP) in Chinese population.MethodsPertinent studies were independently searched in PubMed,...

Background Hypertensive disorders are a common cause of maternal mortality. Whether interpregnancy BMI (body mass index kg/m2) gain is associated with hypertensive disorders in a subsequent pregnancy is not unclear. Objectives To examine the association between interpregnancy BMI and hypertensive disorders in women without a history of hypertensive disorders in pregnancy. Study design This was a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks’ gestation or greater at a single academic institution. Only the second pregnancy in the dataset was analyzed. We excluded women who had any hypertensive disorder in the index pregnancy. Interpregnancy BMI change was calculated by the change of early pregnancy BMI (within 14 weeks’ gestation) measured in the office between the index pregnancy compared to that of the subsequent pregnancy. Women were categorized according to interpregnancy BMI change (BMI loss greater than 2 kg/m2, BMI change ±2 kg/m2, and BMI gain greater than 2 kg/m2). The primary outcome was any hypertensive disorder (chronic hypertension and pregnancy-associated hypertension). Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. Results Of 3068 women who were analyzed, 342 (11%), 1698 (55%), and 1028 (34%) had interpregnancy BMI loss greater than 2 kg/m2, interpregnancy BMI change ±2 kg/m2, and interpregnancy BMI gain greater than 2 kg/m2, respectively. Interpregnancy BMI gain greater than 2 kg/m2 compared to interpregnancy BMI loss more than 2 kg/m2 was associated with increased odds of hypertensive disorders (8.3% vs. 4.0%; adjusted odds ratio 2.20 [95% confidence interval 1.55–3.13]) and pregnancy-associated hypertension (adjusted odds ratio 2.25 [95% confidence interval 1.54–3.27]). Interpregnancy BMI loss greater than 2 kg/m2 compared to interpregnancy BMI change ±2 kg/m2 was not associated with increased odds of any hypertensive disorders (5.3% vs. 4.0%; adjusted odds ratio 0.58 [95% confidence interval 0.32–1.05]). Conclusions Compared to interpregnancy BMI change ±2 kg/m2, interpregnancy BMI gain greater than 2 kg/m2 was associated with increased odds of any hypertensive disorder. Weight control after pregnancy could be a potentially modifiable factor that may reduce the risk of hypertensive disorders.

Aims and objectives To determine the effect of hypertension in pregnancy To determine the maternal and fetal outcome in patients with hypertensive disorders of pregnancy. Materials and methods This is a retrospective study conducted in ESIC MC and PGIMSR, Bangalore from January 2020 to December 2020. All pregnant women who presented with Hypertensive disorder in pregnancy were included in the study. Results A total of 1503 patients who delivered during the study period were included in the study of which 172 patients had hypertensive disorder (11.44 %). Gestational hypertension occurred in 113 cases, preeclampsia in 45 cases, chronic hypertension in 8 cases, chronic hypertension with superimposed preeclampsia in 2 cases and eclampsia in 4 cases. Of these 85(49.41%) cases were primigravida and 87(50.58%) were multigravida. 38 deliveries occurred preterm and 134 were term. 4 patients had intrauterine fetal demise. Gestational diabetes occurred in 30(17.44%) cases, hypothyroidism in 45 cases(26.16%), IUGR in 11 cases(6.39%), oligohydramnios in 10 cases(5.81%). Discussion Hypertensive disorders in pregnancy is a spectrum of disease. It is one of the non communicable diseases occurring in pregnancy. It is the third most common cause of maternal mortality. By timely detection and proper management, it is possible to decrease the complications and adverse outcomes associated with this condition. Conclusion Hypertensive disorders in pregnancy is an important cause for maternal and fetal mortality and morbidity. Hence it is important to identify the risk factors and prevent it for better outcome.

Postpartum Preeclampsia—A Diagnosis Not to Be Missed

Objective: To investigate if there is an increased risk for recurrence of hypertensive disorder in pregnancy with a new partner and whether this is affected by maternal age and the interbirth interval through use of familial material. Methods: Data on 614 multiparous women, with confirmed de novo hypertensive disorder in a first pregnancy, were used to assess the effect of paternity and interbirth interval on recurrence of hypertensive disorders. Results: There were 121 women (19.7%) who had changed partner. Recurrent hypertension occurred in 318 women (64.5%) with the same partner and in 75 women (62%) with a new partner. The odds ratio (OR) for reccurrence with the same partner was 1.115 (95% CI 0.739-1.680) and with a new partner 0.897 (95% CI 0.595-1.353). The mean interbirth interval was longer for women with recurrent hypertension (4.9 vs. 4.0 years, p = 0.0002). The OR for developing recurrent hypertension disorder was 1.154 (95% CI 1.049-1.269) for every interval year with the same partner and 1.145 (95% CI 0.958-1.368) with a new partner after correction for maternal age. Conclusion: In women with a positive family history and previous hypertension in pregnancy, change of paternity does not influence the risk of recurrence. Increasing interbirth interval may account for a 15% recurrence risk for each year, independent of maternal age. There was no indication that a change of partner conferred any influence on the recurrence risk that is not explained with birth interval or age.