Cases Of Gestational Hypertension Research Articles

Hypertensive disorders in pregnancy: problems of classification, differential diagnosis and management

Objective. To study the features of hypertensive disorders formation in pregnancy depending on the period and clinical form on the example of the population of Sverdlovsk region.
 Materials and methods. The outcomes of 217 pregnant women with moderate and severe preeclampsia and gestational hypertension were analyzed (41, 74, and 102 cases, respectively).
 Results. The severe preeclampsia group had the highest rate of fetal growth restriction (14.6 %), low birth weight -2045 g (1640–2650), preterm delivery (63.4 %), and cesarean delivery (87.8 %). A detailed analysis of 28 cases of gestational hypertension lasting up to 34 weeks was performed. The analysis revealed significant challenges in the differential diagnosis of this pregnancy complication, not only in terms of clinical manifestations, but also in terms of timely diagnosis in general.
 Conclusions. The findings of this study spark a debate over the use of severity-based classification in clinical practice, which lessens the doctor's vigilance in milder forms that, however, result in equally serious complications. This raises the question of whether unified tactical approaches should be used in this pathology.

Prediction of preeclampsia from retinal fundus images via deep learning in singleton pregnancies: a prospective cohort study.

Early prediction of preeclampsia (PE) is of universal importance in controlling the disease process. Our study aimed to assess the feasibility of using retinal fundus images to predict preeclampsia via deep learning in singleton pregnancies. This prospective cohort study was conducted at Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Eligible participants included singleton pregnancies who presented for prenatal visits before 14 weeks of gestation from September 1, 2020, to February 1, 2022. Retinal fundus images were obtained using a nonmydriatic digital retinal camera during their initial prenatal visit upon admission before 20 weeks of gestation. In addition, we generated fundus scores, which indicated the predictive value of hypertension, using a hypertension detection model. To evaluate the predictive value of the retinal fundus image-based deep learning algorithm for preeclampsia, we conducted stratified analyses and measured the area under the curve (AUC), sensitivity, and specificity. We then conducted sensitivity analyses for validation. Our study analyzed a total of 1138 women, 92 pregnancies developed into hypertension disorders of pregnancy (HDP), including 26 cases of gestational hypertension and 66 cases of preeclampsia. The adjusted odds ratio (aOR) of the fundus scores was 2.582 (95% CI, 1.883-3.616; P  < 0.001). Otherwise, in the categories of prepregnancy BMI less than 28.0 and at least 28.0, the aORs were 3.073 (95%CI, 2.265-4.244; P  < 0.001) and 5.866 (95% CI, 3.292-11.531; P  < 0.001). In the categories of maternal age less than 35.0 and at least 35.0, the aORs were 2.845 (95% CI, 1.854-4.463; P  < 0.001) and 2.884 (95% CI, 1.794-4.942; P  < 0.001). The AUC of the fundus score combined with risk factors was 0.883 (sensitivity, 0.722; specificity, 0.934; 95% CI, 0.834-0.932) for predicting preeclampsia. Our study demonstrates that the use of deep learning algorithm-based retinal fundus images offers promising predictive value for the early detection of preeclampsia.

The PREDG study: A randomised controlled trial testing whether an educational intervention can prevent gestational weight gain in women with obesity

The PREDG trial was designed to study the influence of an educative program on gestational weight gain in women with pregestational obesity. Randomized controlled clinical trial (https://www.isrctn.com/ISRCTN61793947) in 169 women with pregestational obesity (BMI ≥30kg/m2). Women were randomized to participate in a group education program in nutrition and physical activity or conventional follow-up in a specialized Unit of Obesity and Pregnancy. The nutritional intervention was adjusted to prepregnancy BMI and to the physical activity intensity. Quality was based on the Mediterranean diet. Macronutrients were distributed as follows: 50% carbohydrates, 20% protein and 30% fat. Adequate gestational weight gain was defined between 5 and 9kg (IOM 2009). Mean gestational weight gain was compared between groups by using the T Student test and frequencies of adequate gestational weight gain were compared by using ꓫ2. Gestational weight gain was lower in the intervention group: 8 (4-11) vs 9.2 (6-13) kg, p 0.026. Gestational weight gain was below 9kg in 24 of 39 (61.5%) women of the intervention vs 10 of 41 (24.4%) of the control group (p 0.001). Regarding obstetric complications, there were 15 (8.3%) cases of gestational diabetes with no differences between the groups. There were 14 of 85 (18.2%) cases of gestational hypertension or preeclampsia in the intervention group compared with 26 of 84 (32.5%) in the control group (p 0.040). With reference to neonatal weight, there were 7 of 82 (8.5%) large for gestational age neonates in the intervention group compared with 15 of 79 (19.2%) in the control group (p 0.050). A group-based educative and structured intervention results in an adequate weight gain and lower rates of gestational hypertension, preeclampsia and large for gestational age neonates in pregnant women with obesity.

[Regional analysis of high risk factors of hypertensive disorders in pregnancy with organ or system impairment].

Objective: To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. Methods: A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. Results: (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all P<0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all P<0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Conclusions: Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.

Are There Maternal Deaths Related to Hemorrhagic Stroke Due to Hypertensive Disorder of Pregnancy That Could Be Potentially Preventable by Tight Hypertension Management in Antepartum? A Retrospective Study from the Maternal Death Exploratory Committee in Japan.

Unlike Europe and the United States, Japan has seen numerous maternal deaths from hemorrhagic strokes related to hypertensive disorders of pregnancy (HDP). This study retrospectively analyzed deaths associated with HDP-related hemorrhagic stroke in Japan to determine the number of deaths that may have been prevented with blood pressure control during pregnancy. This study included maternal deaths related to hemorrhagic stroke cases. The proportion of patients without proteinuria whose blood pressure exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation were determined. Lastly, the application of tight antihypertensive management was evaluated. Among 34 HDP-related maternal deaths, 4 cases involved patients without proteinuria whose blood pressures exceeded 140/90 mmHg between 14+0 and 33+6 weeks of gestation. These included two chronic hypertension and two gestational hypertension cases. None of the patients received antihypertensive agents, and their blood pressures were managed leniently. Among HDP-related hemorrhagic stroke deaths in Japan, only a few cases of maternal death could have been prevented with tight blood pressure management, as described in the CHIPS randomized controlled trial. Therefore, to prevent HDP-related hemorrhagic stroke in Japan, new preventive strategies during pregnancy should be established.

A PROSPECTIVE STUDY OF CASES OF PREGNANCY INDUCED HYPERTENSION AND MATERNAL AND PERINATAL OUTCOME AT TERTIARY CARE HOSPITAL

Background: Pregnancy Induced hypertension continues to be rampant globally and is associated with high perinatal and maternal mortality and morbidity. It is still one of the most important and intriguing unsolved problems in obstetrics. Hypertensive disorders in pregnancy account for approximately 7 to 15% of all pregnancies and nearly 25% of antenatal ward admissions. The condition complicates about 10% of pregnancies and is responsible for 14% of maternal deaths, 15% of perinatal deaths, and 30% of maternal near misses worldwide. Hypertensive disorders in pregnancy (PIH) are a group of disorders that range from pre-existing chronic hypertension in the index pregnancy to complex multisystem disorders such as preeclampsia, which can lead to complications such as eclampsia, HELLP syndrome, acute renal failure, pulmonary edema, stroke, and left ventricular failure. Though not preventable, early detection and proper intervention can signicantly reduce complications. This is achievable with Prenatal care at all levels. However, there is an unmet need in recognizing and managing PIH and its complications in low and middle-income countries due to pregnancy myths and misconceptions, transportation challenges, low socioeconomic status, and a lack of easy and expert antenatal care requiring a multidisciplinary approach, a lack of accurate prediction methods, and a scarcity of high dependency units (HDU). Early detection of a milder form of disease, corticosteroid administration, and careful timing of delivery can all help improve the outcome. In light of this, we designed and conceived the current study with the goal of studying the maternal and perinatal outcomes of Hypertensive Disorders of Pregnancy at a tertiary care hospital. Furthermore, data from antenatal females with PIH admitted for safe connement were collected and classied into the following categories: GHTN, Preeclampsia, Chronic Hypertension, Chronic Hypertension superimposed with preeclampsia, and eclampsia. Finally, the method of delivery (vaginal/caesarean section) in each category of patients was examined. The study's ndings will assist us in determining the scope of the problem in our area and estimating the fetal and maternal complications associated with it. Methods: All patients beyond 20 weeks of pregnancy with pregnancy induced hypertension admitted in department of Obstetrics and Gynaecology of MGM Medical College over a period of 18 months after approval from Institutional ethical committee was taken into consideration. The objective of the study was to analyze the cases of gestational hypertension, Chronic Hypertension, Chronic Hypertension superimposed with preeclampsia, pre-eclampsia and eclampsia and their maternal outcome in terms of mode of delivery and complications. Perinatal outcome in relation to neonatal complications was also studied. The frequency and percentage for socio-demographic variables, mode of delivery and complications were analyzed. Results: Pregnancy Induced Hypertension cases accounted for 415 cases were enrolled during study period; The most common PIH presentation was pre-eclampsia, followed by severe pre-eclampsia, gestational hypertension, antepartum eclampsia. Maternal morbidity and mortality were observed in 37.6% of the women and 3.6%, respectively in our study. Abruption, wound infection, and eclampsia were the most common complications, accounting for 11%, 9%, and 7.7% of all cases, respectively. 48.2% of babies were shifted to mother side, followed by 41.6% were shifted to SNCU, 7.9% were Intrauterine deaths and least 2.1% were Still birth respectively Conclusions: Though the incidence of pre-eclampsia and eclampsia is on the decline, still it remains the major contributor to poor maternal and fetal outcome. Regular antenatal checkups, early diagnosis, prompt multidisciplinary treatment, optimum timing of delivery reduces the incidence of complications and the maternal mortality. Early referral and management of these cases at centers with advanced neonatal facilities will reduce the perinatal mortality

Prenatal screening for preeclampsia: the roles of placental growth factor and pregnancy–associated plasma protein A in the first trimester and placental growth factor and soluble fms-like tyrosine kinase 1–placental growth factor ratio in the early second trimester

Professional societies have recommended universal first trimester screening for preeclampsia and a second or third trimester soluble fms-like tyrosine kinase-1-placental growth factor ratio test to assess for preeclampsia and its severity. However, it may not be feasible to implement the most optimal screening protocol for preeclampsia in the first trimester which uses a combination of maternal characteristics, maternal biophysical and biochemical markers due to limitations in the access to uterine artery doppler ultrasound. There are inconsistent findings on how early in the second trimester the fms-like tyrosine kinase-1-placental growth factor ratio begins to provide useful information in preeclampsia prediction. This study aimed to assess the accuracy of (1) a combination of maternal characteristics, maternal serum pregnancy-associated plasma protein A, and placental growth factor in the screening for preeclampsia in the first trimester; and (2) placental growth factor or soluble fms-like tyrosine kinase-1-placental growth factor ratio in the prediction of preeclampsia in the early second trimester. This retrospective case-control study used frozen residual blood samples from women who had aneuploidy screening and delivered at a tertiary center. The case group included pregnancies with gestational hypertension or preeclampsia (further classified as early-onset [birth at <34 weeks' gestation] and preterm preeclampsia [birth at <37 weeks' gestation]). Each case was matched with 3 control pregnancies by date of blood sample draw, gestational age at first blood sample draw, maternal age, maternal ethnicity, type of multiple-marker screening, and amount of residual sample. Mann-Whitney U tests were used to assess the associations between serum markers and the risk of preeclampsia. Logistic regressions were used to assess if the risk of preeclampsia can be predicted using a combination of maternal characteristics and serum markers. The case group included 146 preeclampsia and 295 gestational hypertension cases. Compared with the controls, preeclampsia cases had significantly lower first-trimester pregnancy-associated plasma protein A and placental growth factor. At a 20% false-positive rate, 71% of early-onset and 58% of preterm preeclampsia cases can be predicted using maternal characteristics, pregnancy-associated plasma protein A, and placental growth factor. Preeclampsia cases had lower second-trimester placental growth factor and a higher soluble fms-like tyrosine kinase-1-placental growth factor ratio. At a 10% false-positive rate, 80% and 53% of early-onset preeclampsia can be predicted using maternal characteristics and placental growth factor or soluble fms-like tyrosine kinase-1-placental growth factor ratio, respectively. The current first-trimester aneuploidy screening programs may be expanded to identify women at increased risk of developing preeclampsia. Early in the second trimester, placental growth factor alone provided better prediction for preeclampsia compared with the soluble fms-like tyrosine kinase-1-placental growth factor ratio.

MATERNAL MORBIDITY AND MORTALITY IN HYPERTENSIVE DISORDER COMPLICATING PREGNANCY

Introduction- hypertensive disorders complicating pregnancy is one of the extensively researched subjects in obstetrics. The pathology should be understood and involvement of multiorgan dysfunction should be taken into account Objectives- To analyse the cases of hypertensive disorder complicating pregnancy and its maternal outcome in patients admitted in government general hospital, Guntur. Methods- A total number of 250 cases of hypertensive disorder complicating pregnancy(gestational hypertension,preeclampsia, eclampsia) admitted to GGH , Guntur from august 2020-July 2021 Selection of cases- both booked and referred and all patients who were diagnosed hypertension complicating pregnancy. Results- Hypertensive cases complicating pregnancy accounted for 9.4% of deliveries.out of which gestational hypertension cases accounted for 3%,preeclampsia accounted for 5.7%,and eclampsia 0.7%.In this study, maximum cases were seen between age groups 20-30 in primigravida belonging to low socioeconomic strata. majority of patients detected to have high blood pressures at 32-36weeks of gestation,and a mean gestational age of 35 weeks.haemolysis,elevated liver enzymes,low platelet count syndrome is the most common maternal complication and intrauterine growth restriction is the most common fetal complication.22 cases followed by abruptio placentae, acute renal failure,postpartum haemorrhage and postpartum eclampsia.Maternal mortality occurred in 2 cases. ConclusionEarly use of antihypertensive drugs, optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome.Training and continuing medical education of attending staff and the structuring management protocols relevant to local needs are also an important part in the case of hypertension complicating pregnancy

A Comparative Study on Effectiveness of Oral Labetalol Versus Oral Nifedipine Used in the Treatment of Gestational Hypertension in a Tertiary Care Teaching Hospital

Background Gestational hypertension is associated with increased risk of adverse maternal and fetal outcomes. Drug treatment is generally reserved for moderate or severe cases of gestational hypertension. Nifedipine and labetalol are the drugs which are exclusively used in oral anti-hypertensives to treat gestational hypertension where both belong to Category-C. Hence a prospective observational study was designed to compare the effectiveness of oral labetalol versus oral nifedipine used in the treatment of gestational hypertension.Aim To compare the efficacy safety availability cost minimization prescribing patterns of oral labetalol and oral nifedipine in the treatment of gestational hypertension.Methodology This is a prospective observational study conducted in Chigateri district hospital Davanagere Tertiary care teaching hospital for a period of six months where data of 150 subjects diagnosed with gestational hypertension were obtained from the department of Obstetrics and Gynecology OBG from the case sheets during ward rounds. Out of this 27 cases are excluded due to insufficient data.Results Among the studied subjects only 59 47.97 were prescribed oral antihypertensive drugs either labetalol or nifedipine. 88.89 subjects treated with nifedipine showed low birth weight LBW and 51.1 subjects had preterm deliveries. Both labetalol and nifedipine were found to have similar efficacy but nifedipine was associated with low birth weight in more cases when given prenatally. Cost of generic medicines was found to be very less when compared to highly prescribed brands.Conclusion Both labetalol and nifedipine retard exhibited similar efficacy but the cost of nifedipine was less when compared to labetalol in highly prescribed brands. In generic drugs the margin of difference between the costs of both the drugs was found to be less. Among the subjects who were prescribed nifedipine prenatally low birth weight neonates and other fetal adverse effects were observed. Therefore labetalol may be prescribed prenatally while nifedipine can be prescribed postnatally considering both efficacy and cost factor.

Associations of polygenic risk scores for preeclampsia and blood pressure with hypertensive disorders of pregnancy.

Preexisting hypertension increases risk for preeclampsia. We examined whether a generic blood pressure polygenic risk score (BP-PRS), compared with a preeclampsia-specific polygenic risk score (PE-PRS), could better predict hypertensive disorders of pregnancy. Our study sample included 141 298 genotyped FinnGen study participants with at least one childbirth and followed from 1969 to 2021. We calculated PRSs for SBP and preeclampsia using summary statistics for greater than 1.1 million single nucleotide polymorphisms. We observed 8488 cases of gestational hypertension (GHT) and 6643 cases of preeclampsia. BP-PRS was associated with GHT [multivariable-adjusted hazard ratio for 1SD increase in PRS (hazard ratio 1.38; 95% CI 1.35-1.41)] and preeclampsia (1.26, 1.23-1.29), respectively. The PE-PRS was also associated with GHT (1.16; 1.14-1.19) and preeclampsia (1.21, 1.18-1.24), but with statistically more modest magnitudes of effect (P = 0.01). The model c-statistic for preeclampsia improved when PE-PRS was added to clinical risk factors (P = 4.6 × 10-15). Additional increment in the c-statistic was observed when BP-PRS was added to a model already including both clinical risk factors and PE-PRS (P = 1.1 × 10-14). BP-PRS is strongly associated with hypertensive disorders of pregnancy. Our current observations suggest that the BP-PRS could capture the genetic architecture of preeclampsia better than the current PE-PRSs. These findings also emphasize the common pathways in the development of all BP disorders. The clinical utility of a BP-PRS for preeclampsia prediction warrants further investigation.

Preeclampsia Incidence and Its Maternal and Neonatal Outcomes With Associated Risk Factors.

Background and objective Preeclampsia is a hypertensive disorder that usually arises after 20 weeks of pregnancy. It is considered a major cause of maternal and fetal mortality worldwide. High blood pressure and high proteinuria are the two main characteristics of preeclamptic patients. Preeclampsia leads to eithersevere or mild conditions, but in both cases, it affects the organs of the mother and fetus.This studywas conducted to determine the prevalence of preeclampsia and associated risk factors (family history, age, hypertension, and diabetes) and to investigateits fetal and maternal outcomes. Methodology This prospective study was conducted at three healthcare units in the Multan district and involved patients with gestational hypertension.Patients were diagnosed on the basis of blood pressure values, urine tests, and throughDoppler ultrasound. Further investigations were conducted, including a complete hemogram and a 24-hour test for proteinuria. Results for preeclampsia-related maternal and perinatal outcomes were documented andstatistical analysis was performed to analyze the data. Results A total of 142patients were diagnosed with gestational hypertension and preeclampsia during the two-year study period. Our findings showed 8.67% cases of gestational hypertension and 3%of preeclampsia. The majority of the preeclamptic patients were less than 24 years of age (33.3%), belonged to lower socioeconomic classes (44.4%), and had low educational levels (81.1%). A close association of family history (36.67%) with diabetes (15.5%)and chronic hypertension (5.55%) was observed in these patients. Maternal and fetal outcomes were relatedto maternal blood pressure.A significant incidence of premature births (45.6%) and a majority of cesarean cases(63.4%) withsevere complicationswere observed. Data from preeclamptic patients showed high albuminuria levels (42.2%) with problems like renal infection, pulmonary edema, and severe anemia. During the study period, aneonatal death rate of11.1% wasobserved as well as issues likerespiratory tract syndrome, asphyxia, and growth retardation. Conclusion This study showed that poor economic and educational levels are significantly associated with this disease. A high rate of maternal and neonatal morbidity with neonatal mortality was investigated.Mild to severe outcomes wereobserved in the form of cesarean deliveries and preterm births. Serious complications leadto ICUadmissions causing a serious burden on healthcare units. Paying more attention to the healthcare needs of pregnant women helps to identify preeclampsia earlier and also minimizes the complications associated with it.

Evaluating Ischemia-Modified Albumin as an Early Biomarker for Hypertensive Disorders During Pregnancy: A Case-Control Study.

Background Ischemia-modified albumin (IMA) is looked upon as a newer marker of myocardial ischemia. There is a paucity of literature however with regardto studies correlating levels of IMA in patients with hypertensive disorders of pregnancy. The present study therefore aimed at estimating the levels of IMA in patients with gestational hypertension and assessing its utility in predicting hypertensive disorders of pregnancy. Methods The present study was a hospital-based case-control study conducted in the Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Nagpur. IMA was estimated in 30 controls (Group I) and 20 cases of gestational hypertension (Group II) using a spectrophotometric assay detecting free unbound Cobalt left behind. The clinical data and lab results were presented as mean ± SD. Student's t-test was applied and Pearson's correlation coefficient was calculated. A value of p < 0.05 was taken as statistically significant. The ROC (Receiver Operator Characteristic) curve was used to establish the cut-off of serum IMA levels in pregnancy-induced hypertension (PIH). Results There was no significant difference in age and period of gestation (POG) at the time of sample collection between the groups. There was a significant difference in the systolic and diastolic blood pressures (BPs) of both groups. The mean level of serum IMA was significantly higher in cases of gestational hypertension (0.88 ± 0.14 absorbance units {ABSU}) as compared to controls (0.69 ± 0.08 ABSU) (p<0.001). On correlation analysis, the systolic and diastolic BPs were found to be highly positively correlated with serum IMA levels (p<0.001). ROC curve analysis suggested that at a cut-off of 0.73 ABSU, IMA has 85% sensitivity and 80% specificity for predicting gestational hypertension. Conclusion Statistically significant results of serum IMA levels obtained in gestational hypertension which falls on the lesser severe spectrum of the diseaseimply that serum IMA can be used for early diagnosis of gestational hypertension and impending Pre-eclampsia (PE) and Eclampsia.

Pre-pregnancy fat intake in relation to hypertensive disorders of pregnancy

Many studies have linked intakes of fat and of specific fatty acids during pregnancy with preeclampsia; however, information on the association of intake before pregnancy with hypertensive disorders of pregnancy (HDP) is scant. We evaluated the associations of intakes of major and specific types of fat before pregnancy with the risks of HDP, including preeclampsia and gestational hypertension (GHTN). We followed 11,535 women without chronic disease participating in the Nurses' Health Study II from 1991 and 2009. Pre-pregnancy dietary fat was assessed by an FFQ. Intakes of total fat, saturated fat, trans fatty acid (TFA), MUFAs, PUFAs, and fat subtypes (omega-3 and omega-6) were categorized into quintiles of intake. HDP were self-reported. The RRs (95% CIs) of HDP were estimated by log-binomial generalized estimating equation regression models, with an exchangeable correlation matrix to account for repeated pregnancies while adjusting for potential confounders. During 19 years of follow-up, there were 495 cases of preeclampsia (2.9%) and 561 (3.3%) cases of GHTN in 16,892 singleton pregnancies. The mean age at pregnancy was 34.6 years (SD, 3.9 years). Among major fat types, only pre-pregnancy TFA was related to a higher risk of HDP (RR, 1.32; 95% CI: 1.05-1.66), and only for preeclampsia (RR, 1.50; 95% CI: 1.07-2.10) but not for GHTN (RR, 1.21; 95% CI: 0.87-1.70). Among specific types of PUFAs, intake of arachidonic acid was positively related with GHTN (RR, 1.43; 95% CI: 1.00-2.04) but not preeclampsia (RR, 1.08; 95% CI: 0.75-1.57). In analyses restricted to pregnancies 1 year after the diet assessment, women with the highest intake of long-chain omega-3 fatty acids had a 31% lower risk of HDP (95% CI: 3%-51%), which was driven by preeclampsia (RR, 0.55; 95% CI: 0.33-0.92). Pre-pregnancy intakes of total fat, saturated fat, and MUFA were unrelated to HDP, whereas TFA was positively related to HDP. These findings highlight the importance of ongoing efforts to eliminate TFA from the global food supply.

Coagulation profile and platelet parameters in pregnancy induced hypertension cases and normotensive pregnancies: A cross-sectional study

•PIH is a leading cause of maternal and perinatal morbidity and mortality worldwide.•Hypercoagulability is constantly associated with hypertensive disorders of pregnancy and particularly associated with pre-eclampsia.•The aims and objectives of this study were to compare the platelet parameters and coagulation profile in normotensive pregnant females along with gestational hypertension cases and pre-eclamptia patients.

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome.

Pregnancy-induced hypertension syndrome (PIH) is a common pregnancy syndrome that could cause varying degrees of maternal and fetal organic damage and even endanger their lives. This study aimed to investigate ultrasound of fetal cardiac function changes in PIH. Totally 40 cases of gestational hypertension admitted to Cangzhou Central Hospital between October 2018 and September 2019 were enrolled in the hypertension group, and 40 women with healthy pregnancies during the same period were assigned to the normal group. Ultrasound results showed that PIH was associated with a significantly higher fetal cardiac septal thickness, fetal left ventricular end-diastolic area and end-systolic area, fetal right ventricular end-diastolic area and end-systolic area, fetal left ventricular systolic fraction 1 (VSF1), fetal left ventricular systolic fraction 2 (VSF2), fetal right VSF1, and fetal right VSF2 versus healthy pregnancy. The PIH fetuses had significantly lower neonatal weights versus healthy fetuses. Newborns of hypertensive pregnancies have larger hearts, faster heart rates, increased cardiac contractility, and lower weights versus newborns of healthy pregnancies.

Predicting Hypertensive Disease in the First Trimester of Pregnancy: Risk Models and Analysis of Serum D-dimer Levels Combined with Plasma Pregnancy-Associated Protein A, Free β-Subunit of Human Chorionic Gonadotropin, and Fetal Nuchal Translucency.

We aimed to investigate the predictive ability of serum levels of D-dimer (DD) in the first trimester for the occurrence of hypertensive disorders of pregnancy (HDP). In this retrospective, case-cohort study, we measured the levels of DD, plasma pregnancy-associated protein A (PAPP-A), and free β-subunit of human chorionic gonadotropin (free β-hCG) and analyzed fetal nuchal translucency (NT) in 150 healthy gravidas, 126 cases of gestational hypertension (GH), 53 cases of preeclampsia (PE), and 41 cases with severe preeclampsia (SPE). Likelihood ratio models and risk models were built using single markers (DD, PAPP-A, free β-hCG, and NT) and combinations of those markers. Analyses showed that the levels of DD multiple of the median (MoM) in the GH, PE, and SPE groups were all significantly higher than those in the control group, with significant differences between groups (χ2 = 70.325, P < 0.001). The area under curve (AUCs) for DD in the GH, PE, and SPE groups was 0.699, 0.784, and 0.893, respectively; the positive likelihood ratio (+LR) was 1.534, 1.804, and 2.941, respectively; and the negative likelihood ratio (-LR) was 0.022, 0.081, and 0, respectively. When the cut-off values of DD for the GH, PE, and SPE groups were 0.725, 0.815, and 0.945 MoM, respectively, the corresponding sensitivities were 0.992, 0.962, and 1.000, respectively. As gestational hypertension progressed, the levels of DD tended to increase gradually. The maternal serum level of DD in the first trimester had correlative and diagnostic value for HDP. The sensitivity and specificity of maternal serum levels of DD level in the first trimester for different types of HDP were significantly different; the best sensitivity and specificity were detected in the SPE group. First trimester DD level, combined with other biochemical markers, may improve our ability to diagnose HDP.

The predicted risk of adverse pregnancy outcomes as a result of treatment-associated obesity in a hypothetical population receiving tenofovir alafenamide/emtricitabine/dolutegravir, tenofovir disoproxil fumarate/emtricitabine/dolutegravir or tenofovir disoproxil fumarate/emtricitabine/efavirenz.

Integrase inhibitors, including dolutegravir (DTG), are associated with weight gain and obesity, especially when combined with tenofovir alafenamide (TAF). Obesity increases the risk of adverse pregnancy outcomes (APOs). This study aimed to predict the risk of APOs caused by treatment-associated obesity, using a hypothetical sample based on the ADVANCE trial. Risk prediction. Firstly, a meta-analysis was performed to determine the relative risk (RR) for APOs in women with obese (≥30) versus normal prepregnancy BMIs (18.5-24.9). For the hypothetical sample, 3000 nonpregnant women with normal BMIs at Week 0 of treatment were evenly allocated across the following treatment arms: TAF/FTC+DTG, TDF/FTC+DTG, TDF/FTC/EFV. The treatment-associated obesity rates from ADVANCE were used to calculate the number of women with obese and normal BMIs expected at Week 96 in our sample. This was combined with the APO RRs to predict the number of women at risk of APOs, in each treatment arm, assuming they conceived at Week 96. At Week 96, the percentage of women predicted to be obese was 14.1% with TAF/FTC+DTG, 7.9% with TDF/FTC+DTG and 1.5% with TDF/FTC/EFV. The RR in women with obese versus normal BMIs was significantly higher for most APOs. Therefore, the number of women at risk of APOs was higher with TAF/FTC+DTG than TDF/FTC+DTG and TDF/FTC/EFV. For example, 11/1000 additional gestational hypertension cases were predicted with TAF/FTC+DTG, 6/1000 with TDF/FTC+DTG and 1/1000 with TDF/FTC/EFV. Treatment-associated obesity increased the APO risk in women. This risk is likely to increase, as preliminary data from ADVANCE demonstrates ongoing weight gain beyond Week 96.

Maternal morbidity of adolescent pregnant women

Background: In Mexico, it is estimated that the adolescent population represents 29% of the population of childbearing age. The present study aimed to analyze the obstetric results of 3310 adolescent pregnant women attended in a third level hospital. Material and methods: All records of pregnant women aged 19 years or less up to the date of admission were analyzed at the Mónica Pretelini Saenz Maternal Perinatal Hospital during the period from January 2018 to June 2020, with the following variables: age, pregnancy, resolution obstetric, severe preeclampsia, preeclampsia and gestational hypertension. Results: A total of 13874 pregnant women were attended, of which 3310 (24%) patients were adolescents. The overall frequency of obstetric complications was 21%, including obstetric hemorrhage (13%) and hypertensive disorders of pregnancy (8%). Regarding postpartum obstetric hemorrhage events, classified according to the Advanced Trauma Life Support shock scale, they were categorized as Grade 1 – 338 cases, Grade II – 76 cases, Grade III – 11 cases and Grade IV – 1 case. Hypertensive disorders of pregnancy highlight preeclampsia as the most frequent with a total of 97 cases, followed by 89 cases of severe preeclampsia, 58 cases of gestational hypertension, 14 cases of chronic hypertension and 3 cases of chronic hypertension with preeclampsia. Conclusions: The main complications found in the Mexican pregnant adolescent population were obstetric hemorrhage, which was more frequent in the population aged 15 to 19 years, and hypertensive disorders, which occurred more frequently in the population aged 9 to 14 years.

Abstract 10151: Association of Polygenic Risk Scores for Pre-Eclampsia and Blood Pressure with Hypertensive Pregnancy Disorders

Introduction: Blood pressure (BP) is a known risk factor for pre-eclampsia. We examined whether a BP-polygenic risk score (PRS) as compared with a pre-eclampsia-PRS, could also predict gestational hypertension (GHT), pre-eclampsia, and eclampsia. Methods: Our study sample included 116434 genotyped, previously-pregnant participants of the FinnGen cohort who were followed up between 1969-2019. PRSs for systolic BP and pre-eclampsia were derived using UK Biobank summary statistics for &gt;1.1 million single nucleotide polymorphisms. Results: We observed 6561 cases of GHT, 5263 cases of pre-eclampsia, and 385 cases of eclampsia. As shown in the Figure, we observed that the BP-PRS was associated with GHT (multivariable-adjusted HR for 1-SD increase in PRS, 1.40; 95% CI, 1.36-1.43; p=9x10 -160 ), pre-eclampsia (HR, 1.26 (95% CI 1.23-1.30, p=1.6x10 -63 ) and with eclampsia (HR, 1.29 (95% CI, 1.16-1.42, p=8.1x10 -7 ), respectively. The pre-eclampsia-PRS was also associated with GHT (HR, 1.09; 95% CI 1.07-1.12, p=1.0x10 -12 ) pre-eclampsia (HR, 1.09; 95% CI, 1.06-1.12, p=2.2x10 -10 ) and eclampsia (HR, 1.12, 95% CI, 1.02-1.24, p=0.023), although these associations were more modest. The model c-statistic for incident pre-eclampsia increased from 0.544 to 0.591 (95% CI for difference, 0.022-0.034, p&lt;1x10 -300 ) when BP-PRS was included in a model with pre-eclampsia-PRS. Conclusions: Our study confirms that the increased risks for developing GHT, pre-eclampsia and eclampsia are strongly associated with genetic factors related to BP. A BP-PRS seems to be an even stronger predictor of hypertensive pregnancy complications than a pre-eclampsia-PRS. Our results suggest common pathways for the development of these diseases that need to be further investigated.

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and...