Chronic Hypertension In Pregnancy Research Articles

Clinical Trials That Have Changed Obstetric Practice: The Chronic Hypertension and Pregnancy (CHAP) Trial.

We describe the evolution of treatment recommendations for chronic hypertension (CHTN) in pregnancy, the CHTN and pregnancy (CHAP) trial, and its impact on obstetric practice. The US multicenter CHAP trial showed that antihypertensive treatment for mild CHTN in pregnancy [blood pressures (BP)<160/105mmHg] to goal<140/90mmHg, primarily with labetalol or nifedipine compared with no treatment unless BP were severe reduced the composite risk of superimposed severe preeclampsia, indicated preterm birth <35 weeks, placental abruption, and fetal/neonatal death. As a result of this trial, professional societies in the United States recommended treatment of patients with CHTN in pregnancy to BP goal<140/90mmHg.

Preterm birth increases cerebral palsy hazards in children of mothers with chronic hypertension in pregnancy

BackgroundChildren of mothers with chronic-hypertension in pregnancy have high rates of preterm-birth (<37 weeks of gestation) and small-for-gestational-age (SGA), both of which are risk factors of cerebral palsy (CP). This study investigated the cumulative risks of CP in children exposed to maternal chronic-hypertension vs. other types of hypertensive-disorders-of-pregnancy (HDP), and whether preterm-birth and SGA potentiate the antenatal impact of chronic-hypertension to increase CP hazards. MethodsThis population-based cohort study enrolled 1,417,373 mother-child pairs with singleton live births between 2004 and 2011 from the Taiwan Maternal and Child Health Database. A total of 19,457 pairs with HDP were identified and propensity-score-matched with 97,285 normotensive controls. Children were followed up for CP outcome until age 6–13 years. HDP were classified into chronic-hypertension, gestational-hypertension, preeclampsia, and preeclampsia-with-chronic-hypertension. Using the normotensive group as the reference, the associations between chronic-hypertension and CP hazard were assessed with adjusted hazard ratios (HR) and 95% confidence intervals (CI) in Cox proportional hazards regression models, and the effects of preterm-birth and SGA on the associations were examined. ResultsThe HDP group had higher rates of CP (0.8%) than the normotensive group (0.5%), particularly the subgroup of preeclampsia-with-chronic-hypertension (1.0%), followed by preeclampsia (0.9%), chronic-hypertension (0.7%) and gestational-hypertension (0.6%). Preterm-birth, but not SGA, exerted moderating effects to increase CP risks in children exposed to maternal chronic-hypertension. Before adjustments, chronic-hypertension alone had no substantial contribution to CP hazard (HR 1.35, 95% CI 1.00–1.83), while preeclampsia alone (1.64, 1.28–2.11) or with superimposed-chronic-hypertension (1.83, 1.16–2.89) had significant effects. After including preterm-birth in the multivariable model, the CP hazard for chronic-hypertension alone rather than other types of HDP was raised and became significant (1.56, 1.15–2.12), and the significance remained after stepwise adjustments in the final model (1.74, 1.16–2.60). ConclusionsPreterm-birth might potentiate CP hazards in children of mothers with chronic-hypertension in pregnancy.

Treating Mild Chronic Hypertension During Pregnancy: A Cost-Effectiveness Analysis.

To assess the cost effectiveness of targeting a blood pressure of less than 140/90 mm Hg compared with 160/105 mm Hg. A decision-analytic model was constructed to compare the treatment of chronic hypertension in pregnancy at mild-range blood pressures (140/90 mm Hg) with the treatment of chronic hypertension before 20 weeks of gestation at severe-range blood pressures (160/105 mm Hg) in a theoretical cohort of 180,000 patients with mild chronic hypertension. Probabilities, costs, and utilities were derived from literature and varied in sensitivity analyses. Primary outcomes included incremental cost per quality-adjusted life-year (QALY), cases of preeclampsia, preeclampsia with severe features, severe maternal morbidity (SMM), preterm birth, maternal death, neonatal death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000 per QALY. Treating chronic hypertension in a population of 180,000 pregnant persons at mild-range blood pressures, compared with severe-range blood pressures, resulted in 14,177 fewer cases of preeclampsia (43,953 vs 58,130), 11,835 of which were cases of preeclampsia with severe features (40,530 vs 52,365). This led to 817 fewer cases of SMM (4,375 vs 5,192), and 18 fewer cases of maternal death (102 vs 120). Treating at a lower threshold also resulted in 8,078 fewer cases of preterm birth (22,000 vs 30,078), which led to 26 fewer neonatal deaths (276 vs 302) and 157 fewer cases of neurodevelopmental delay (661 vs 818). Overall, treating chronic hypertension at a lower threshold was a dominant strategy that resulted in decreased costs of $600 million and increased effectiveness of 12,852 QALYs. Treating chronic hypertension at a threshold of mild-range blood pressures is a dominant (lower costs, better outcomes) and cost-effective strategy that results in fewer neonatal and maternal deaths compared with the standard treatment of treating at severe range blood pressures.

Chronic Hypertension in Pregnancy and Placenta-Mediated Complications Regardless of Preeclampsia.

The prevalence of chronic hypertension in women of reproductive age is on the rise mainly due to delayed childbearing. Maternal chronic hypertension, prevailing prior to conception or manifesting within the early gestational period, poses a substantial risk for the development of preeclampsia with adverse maternal and fetal outcomes, specifically as a result of placental dysfunction. We aimed to investigate whether chronic hypertension is associated with placenta-mediated complications regardless of the development of preeclampsia in pregnancy. This was a population-based, retrospective cohort study from 'Soroka' university medical center (SUMC) in Israel, of women who gave birth between 1991 and 2021, comparing placenta-mediated complications (including fetal growth restriction (FGR), placental abruption, preterm delivery, and perinatal mortality) in women with and without chronic hypertension. Generalized estimating equation (GEE) models were used for each outcome to control for possible confounding factors. A total of 356,356 deliveries met the study's inclusion criteria. Of them, 3949 (1.1%) deliveries were of mothers with chronic hypertension. Women with chronic hypertension had significantly higher rates of all placenta-mediated complications investigated in this study. The GEE models adjusting for preeclampsia and other confounding factors affirmed that chronic hypertension is independently associated with all the studied placental complications except placental abruption. Chronic hypertension in pregnancy is associated with placenta-mediated complications, regardless of preeclampsia. Therefore, early diagnosis of chronic hypertension is warranted in order to provide adequate pregnancy follow-up and close monitoring for placental complications, especially in an era of advanced maternal age.

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

Chronic Hypertension in Pregnancy and Racial–Ethnic Disparities in Complications

Chronic hypertension diagnosed by the American Heart Association and American College of Cardiology criteria is associated with increased risk of developing hypertensive disorders of pregnancy

ACOG uses a systolic blood pressure (SBP) ≥140 or diastolic blood pressure (DBP) ≥90 documented at <20 weeks of gestation to define chronic hypertension. In the nonpregnant state, the American Heart Association (AHA) and the American College of Cardiology (ACC) define chronic hypertension using lower diagnostic thresholds of SBP ≥130 or DBP ≥80. It remains unclear whether using more conservative guidelines in pregnancy improves identification of those at risk for gestational hypertension (GHTN) or preeclampsia (PRE). We sought to investigate whether subjects with chronic hypertension (CHTN) based on AHA/ACC criteria had an increased risk for GHTN and PRE compared to those without CHTN. We conducted a retrospective cohort study utilizing a clinical database at a diverse, large urban, safety-net hospital. Subjects ages 18-40 with singleton gestations and 1st trimester prenatal care were included. We defined subjects that met criteria for Stage 1 Chronic Hypertension based on 1st trimester SBP and DBP cutoffs satisfying the AHA/ACC criteria (SBP ≥130 or DBP ≥80). Those who did not meet these criteria had an SBP<130 and a DBP <90. We did not include those with CHTN based on ACOG criteria in this cohort (SBP ≥140 or DBP ≥90 at <20 weeks); as such those who met the AHA/ACC criteria solely consisted of subjects with SBP=130-139 and DBP=80-89. By doing this, we were able to specifically investigate the increased risk for this specific population which remains unclear. Diagnoses of GHTN and PRE were based on established ACOG criteria. PRE included those with and without severe features. Tests for normality were performed. Student t-tests or Rank sum tests were performed as appropriate for continuous variables; Chi-square or Fisher's exact tests were performed for categorical variables. Generalized linear models were performed to calculate risk ratios while controlling for appropriate confounders. Of N=3,354 subjects, 18% (n=629) were diagnosed with Stage 1 CHTN based on AHA/ACC criteria. Those with AHA/ACC Stage 1 CHTN had increased rates of GHTN (35.4% vs 20%, p<0.001) and PRE (22.3% vs 10%, p<0.001) compared to those without Stage 1 CHTN based on these criteria. When controlling for maternal age, race 1st trimester body mass index (BMI), pregestational diabetes and substance use, those with AHA/ACC Stage 1 CHTN had an almost 1.5-fold higher adjusted risk ratio (ARR) of experiencing GHTN (ARR 1.49 ± 0.10, p<0.001) and almost 2-fold increased ARR of experiencing PRE (ARR 1.98 ±0.19, p<0.001). Our data suggest an increased risk for developing GHTN and PRE for subjects satisfying the AHA/ACC cutoff for Stage 1 CHTN. Future studies need to consider whether diagnosis of CHTN in pregnancy should conform with AHA/ACC criteria, and if those with Stage 1 CHTN based on AHA/ACC criteria require the same preventative measures and interventions utilized by those diagnosed by ACOG criteria.

Chronic Hypertension and the Risk of Readmission for Postpartum Cardiovascular Complications.

Preeclampsia is an important risk factor for cardiovascular disease (CVD, including heart disease and stroke) along the life course. However, whether exposure to chronic hypertension in pregnancy, in the absence of preeclampsia, is implicated in CVD risk during the immediate postpartum period remains poorly understood. Our objective was to estimate the risk of readmission for CVD complications within the calendar year after delivery for people with chronic hypertension. The Healthcare Cost and Utilization Project's Nationwide Readmission Database (2010-2018) was used to conduct a retrospective cohort study of patients aged 15-54 years. International Classification of Diseases codes were used to identify patients with chronic hypertension and postpartum readmission for CVD complications within 1 year of delivery. People with CVD diagnosed during pregnancy or delivery admission, multiple births, or preeclampsia or eclampsia were excluded. Excess rates of CVD readmission among patients with and without chronic hypertension were estimated. Associations between chronic hypertension and CVD complications were determined from Cox proportional hazards regression models. Of 27,395,346 delivery hospitalizations that resulted in singleton births, 2.0% of individuals had chronic hypertension (n=544,639). The CVD hospitalization rate among patients with chronic hypertension and normotensive patients was 645 (n=3,791) per 100,000 delivery hospitalizations and 136 (n=37,664) per 100,000 delivery hospitalizations, respectively (rate difference 508, 95% CI 467-549; adjusted hazard ratio 4.11, 95% CI 3.64-4.66). The risk of CVD readmission, in relation to chronic hypertension, persisted for 1 year after delivery. The heightened CVD risk as early as 1 month postpartum in relation to chronic hypertension underscores the need for close monitoring and timely care after delivery to reduce blood pressure and related complications.

Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications.

To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial-ethnic groups. This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008-2018), Michigan (2008-2020), Oregon (2008-2020), Pennsylvania (2008-2014), and South Carolina (2008-2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial-ethnic groups. The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2-22.6), acute renal failure (13.6; 95% CI 12.6-14.6), and pulmonary edema (10.7; 95% CI 8.9-12.6). Estimated RRs overall were similar across racial-ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity-a widely used composite of acute severe events-for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1-8.8), 3.7 (3.0-4.3), 9.0 (8.2-9.8), 3.9 (3.6-4.3), 11.6 (6.4-16.5), 3.2 (2.9-3.5), and 5.5 (4.2-6.9), respectively. Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.

Penyuluhan Penyakit Tidak Menular (Hipertensi) Pada Ibu Hamil Di Kelurahan Bonto Kio Kecamatan Minasatene

Hypertension in pregnancy can be classified into pre-eclampsia, eclampsia, chronic hypertension in pregnancy, chronic hypertension with preeclampsia and gestational hypertension. The purpose of holding PkM is to increase public awareness of hypertension in order to prevent further complications and prevent an increase in the incidence of hypertension sufferers, especially in pregnant women in Bonto Kio Village, Minasatene District. The method used is the Socialization of Non-Communicable Diseases and Early Detection of Hypertension through the Community Service Team through Socialization Non-communicable diseases are diseases that cannot be transmitted from person to person, whose development progresses slowly over a long period of time (chronic) and health screening is carried out. including blood pressure, blood sugar check, cholesterol check, uric acid check, height, abdominal circumference and weight. If the screening is complete, counseling is given one by one regarding the results of the screening. Therefore it can be concluded that a significant increase is related to knowledge of pregnant women about hypertension and behavior to control blood pressure before and after community service activities in Bonto Kio Village, Minasatene District.

Effect of pregnancy and hypertension on kidney function in female rats: Modeling and functional implications.

Throughout pregnancy, the kidneys undergo significant adaptations in morphology, hemodynamics, and transport to achieve the volume and electrolyte retention required to support a healthy pregnancy. Additionally, during pregnancies complicated by chronic hypertension, altered renal function from normal pregnancy occurs. The goal of this study is to analyze how inhibition of critical transporters affects gestational kidney function as well as how renal function is affected during chronic hypertension in pregnancy. To do this, we developed epithelial cell-based multi-nephron computational models of solute and water transport in the kidneys of a female rat in mid- and late pregnancy. We simulated the effects of key individual pregnancy-induced changes on renal Na+ and K+ transport: proximal tubule length, Na+/H+ exchanger isoform 3 (NHE3) activity, epithelial Na+ channel activity (ENaC), K+ secretory channel expression, and H+-K+-ATPase activity. Additionally, we conducted simulations to predict the effects of inhibition and knockout of the ENaC and H+-K+-ATPase transporters on virgin and pregnant rat kidneys. Our simulation results predicted that the ENaC and H+-K+-ATPase transporters are essential for sufficient Na+ and K+ reabsorption during pregnancy. Last, we developed models to capture changes made during hypertension in female rats and considered what may occur when a rat with chronic hypertension becomes pregnant. Model simulations predicted that in hypertension for a pregnant rat there is a similar shift in Na+ transport from the proximal tubules to the distal tubules as in a virgin rat.

Don't wait! Treatment for mild chronic hypertension in pregnancy

1University of Missouri Family and Community Medicine, Columbia, MO The Corresponding author is Laura Morris; [email protected]. The authors declare no conflicts of interest.

Thyroid disease, Hypertension and Pregnancy: The need for balance illustrated in 2 cases.

Abstract Thyroid dysfunction in pregnancy has been associated with hypertensive disorders of pregnancy and poor maternal and fetal outcomes. In this article, we describe two cases of significant thyroid dysfunction leading to new diagnoses of chronic hypertension in pregnancy and review physiologic changes in the thyroid gland, placenta and maternal cardiovascular system during pregnancy.

Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention.

Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.

Abstract 58: Timing of Outpatient Postpartum Care Utilization Among Women With Chronic Hypertension and Hypertensive Disorders of Pregnancy

Objectives: The postpartum period represents an opportunity to intervene on the cardiovascular health of women who experience chronic hypertension in pregnancy or hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with superimposed preeclampsia. This study sought to determine whether women who experience chronic hypertension or HDP access timely postpartum care compared to women with no documented hypertension. Methods: We used insurance claims data from the IBM MarketScan® Commercial Claims and Encounters Database. We included n=274,714 women 12-55 years old with a delivery hospitalization between 2017-2018 with continuous insurance enrollment from 3 months before the estimated start of pregnancy to 6 months after delivery discharge. Chronic hypertension and HDP were identified using International Classification of Diseases 10th Revision Clinical Modification codes. Distributions of time-to-event survival curves (time to first outpatient postpartum visit with a women’s health, primary care, or cardiology provider) were compared between the hypertension types using Kaplan-Meier estimators and logrank tests. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Time points of interest (3, 6, and 12 weeks) were consistent with visit benchmarks in traditional and updated postpartum care guidelines. Results: The prevalences of HDP, chronic, and no documented hypertension were 11.7%, 2.6%, and 85.7%, respectively. The proportions of women with a visit within 3 weeks of delivery discharge were 28.0%, 26.8%, and 15.8% for HDP, chronic, and no documented hypertension, respectively. By 12 weeks, the proportions increased to 59.6%, 61.3%, and 51.5%, respectively. Kaplan-Meier analyses indicated significant differences in utilization by hypertension type and interaction between hypertension type and time before and after 6 weeks. In adjusted Cox proportional hazards models, the utilization rate before 6 weeks among women with HDP was 1.42 times the rate for women with no documented hypertension (aHR=1.42, 95% CI: 1.40, 1.45). Women with chronic hypertension had similarly higher rates compared to women with no documented hypertension (aHR=1.29, 95% CI: 1.24, 1.35). There were no significant associations by hypertension type after 6 weeks. Conclusions: Women with HDP and chronic hypertension attend outpatient postpartum care visits faster than women with no documented hypertension. However, there were no significant associations by hypertension type after 6 weeks due to interaction with time before and after the traditional 6-week visit. Overall, utilization remains low in all groups. Addressing barriers to postpartum care attendance can ensure timely care for women at high risk for cardiovascular disease.

Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes.

We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend. Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score <5 at 5 minutes, assisted ventilation> 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09-1.11), Hispanic (aRR = 1.04, 95% CI = 1.02-1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05-1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37-1.41), Hispanic (aRR = 1.15, 95% CI = 1.13-1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31-1.37), and American Indian (aRR = 1.12, 95% CI = 1.07-1.17). The racial and ethnic disparity remained unchanged during the study period. We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period. · Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased.. · Among people with chronic hypertension, there are racial and ethnic disparities in adverse outcomes.. · Black, Hispanic, and Asian/Pacific Islander have a higher risk of the adverse neonatal outcomes..

Outcomes of nifedipine versus labetalol for oral treatment of chronic hypertension in pregnancy

A recent randomized trial showed that treating chronic hypertension (CHTN) in pregnancy reduced risks of adverse outcomes including preeclampsia and preterm birth (PTB). We tested whether maternal and neonatal outcomes differ by use of labetalol vs. nifedipine for antihypertensive therapy in pregnancy. Planned secondary analysis of an open label RCT of antihypertensive treatment (vs. none) in pregnancy in patients with mild CHTN (BPs < 160/105 mmHg) and singleton pregnancies < 23 weeks’ gestation. Those randomized to treatment received labetalol or nifedipine. We compared outcomes of each medication vs. the no treatment and also labetalol vs. nifedipine based on initial treatment. The primary outcome was a composite of severe preeclampsia, PTB < 35weeks, placental abruption, fetal/neonatal death. Secondary outcomes included small for gestational age (SGA). Relative risks were estimated via log binomial regression. Of 2374 patients analyzed, 744 (31.3%) initially received labetalol, 430 (18.1%) nifedipine and 1200 (50.5%) no treatment. No baseline characteristics differed for labetalol vs. none, race differed for nifedipine vs. none, and race, type of CHTN and aspirin use differed for labetalol vs. nifedipine. The primary composite outcome occurred in 217(30.1%), 130(31.2%), 427(37.0%), and SGA < 10th in 85(12.0%), 41(10.0%), 117(10.4%) in the labetalol, nifedipine and no treatment groups respectively. Labetalol use (vs. none) was associated with a reduced risk of the primary composite, severe preeclampsia and PTB < 35 weeks. Nifedipine use (vs. none) was associated with reduced risks of the primary composite and PTB < 35weeks (Figure 1, Table 2; p< 0.05. No outcomes significantly differed by assignment to labetalol vs. nifedipine. No differences were observed in SGA rates (Table 2). Adjustment for baseline differences between groups did not change the results. Antihypertensive treatment with either labetalol or nifedipine appears equally effective for mild chronic hypertension in pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mean arterial pressure and neonatal outcomes in pregnancies complicated by mild chronic hypertension

To examine the relationship between mean arterial pressure (MAP) during pregnancy and neonatal outcomes in women with chronic hypertension (cHTN). A secondary analysis of the Chronic Hypertension and Pregnancy (CHAP) Trial, an open-label, multicenter, randomized treatment trial of cHTN in pregnancy, was conducted. Patients in the active treatment group (Active) were given antihypertensive medication to maintain a blood pressure (BP) of < 140/90mmHg; patients in the standard treatment group (Control) were withheld antihypertensive treatment unless BP reached ≥160mmHg systolic or ≥105mmHg diastolic. Logistic regression assessed associations between average and highest MAP on neonatal outcomes. Odds ratios of primary neonatal composite outcome [bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), or intraventricular hemorrhage (IVH) 3 or 4] and individual secondary outcomes [neonatal intensive care unit admission (NICU), low birth weight (LBW) < 2500g, and small for gestational age (SGA)] were calculated. A total of 2,284 patients were included: 1155 Active and 1129 Control. Average MAP was lower in Active compared to Control (95.9±7.3 vs 98.6±7.8, p< 0.0001). Average MAP≥107 (i.e.,BP >140/90) occurred less commonly in Active vs Control (7% vs 13%, p< 0.0001). Results were consistent when analyses were repeated using highest MAP (Table 1). Adjusted models controlling for randomization group demonstrated that average MAP was positively associated with each neonatal outcome examined except NEC, specifically: neonatal composite [aOR 1.24 (95% CI 1.09–1.16)], NICU admission [aOR 1.07 (1.06–1.08)], LBW [(aOR 1.12 (1.11–1.14)], SGA< 5th% [aOR 1.03 (1.01–1.06)] and SGA< 10th% [aOR 1.02 (1.01–1.04)]. Models using highest MAP demonstrated consistent associations except IVH 3/4. Treatment of chronic hypertension in pregnancy to < 140/90mmHg resulted in lower MAP, and MAP was positively associated with most adverse neonatal outcomes. The long-term effect of MAP on childhood outcomes is important to consider in future CHAP analyses.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Implementation of a novel shared decision-making intervention in women with chronic hypertension in pregnancy: multiple-site multiple-method investigation.

Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication. Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension. Pregnant women with chronic hypertension and their principal healthcare professionals (obstetricians, midwives, and physicians), at three National Health Service hospital trusts with different models of care. The RE-AIM framework guided the evaluation. Primary: Decisional conflict scale, medication intention survey and women's acceptability. Secondary: Healthcare professionals' acceptability and the barriers and facilitators to SDM implementation with pregnant women with chronic hypertension. Fifty women participated. Nearly half (46%; n=23) of women were from Black and Asian backgrounds. The SDM intervention was effective at reducing decisional conflict (mean reduction from baseline 42%, 95% CI 35-49, p≤0.05). In 36 women (72%), the reduction was of clinical importance. 24 women (48%) were uncertain about or planned not to take antihypertensives prior to the SDM intervention, compared to two women (4%) after the intervention. The intervention was acceptable to women and healthcare professionals. 10 of 14 healthcare professionals felt that the in-consultation aid facilitated SDM in current antenatal contexts, a similar proportion (10/14) felt the length of consultations hindered SDM. A novel codesigned SDM intervention reduced decisional conflict and increased women's intention to take antihypertensive agents during pregnancy. This intervention could be adopted into practice for women making pregnancy decisions where there is uncertainty around the medication management option.

Treatment of Chronic Hypertension in Pregnancy: Is It Time for a Change?

HomeCirculationVol. 146, No. 6Treatment of Chronic Hypertension in Pregnancy: Is It Time for a Change? No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextTreatment of Chronic Hypertension in Pregnancy: Is It Time for a Change? C. Edward Wells, MD and F. Gary Cunningham, MD C. Edward WellsC. Edward Wells Correspondence to: C. Edward Wells, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1386-9971 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas. Search for more papers by this author and F. Gary CunninghamF. Gary Cunningham Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas. Search for more papers by this author Originally published8 Aug 2022https://doi.org/10.1161/CIRCULATIONAHA.122.060548Circulation. 2022;146:433–434"Treatment of Chronic Hypertension in Pregnancy: Is It Time for a Change?." Circulation, 146(6), pp. 433–434FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Circulation is available at www.ahajournals.org/journal/circFor Sources of Funding and Disclosures, see page 434.Correspondence to: C. Edward Wells, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032. Email edward.[email protected]edu

Change in prevalence of chronic hypertension in pregnancy after the updated ACC/AHA hypertension guidelines.

The objective of this population-based retrospective study was to determine the effect of the updated hypertension definition by the American College of Cardiology (ACC) and the American Heart Association (AHA) on the prevalence of chronic hypertension (CHTN) diagnosis in pregnancy. The pre-ACC/AHA group (N=14,505,399) consisted of births between 2013 and 2016 and the post-ACC/AHA group (N=7,269,010) consisted of births between 2018 and 2019. After adjusting for differences between groups, CHTN diagnosis was more common in the post-ACC/AHA group (p<0.001). In conclusion, the prevalence of CHTN diagnosis in pregnancy increased after the new ACC/AHA guidelines publication.