Development Of Gestational Hypertension Research Articles

Evaluating the association of physical activity and weight gain in pregnancy

Previous research has shown that physical activity in pregnancy decreases the risk of poor pregnancy outcomes including development of gestational hypertension, pre-eclampsia, gestational diabetes, and the need for unplanned cesarean section. Research has also shown that excessive weight gain in pregnancy increases the risk of poor pregnancy outcomes. Tracking accurate physical activity in pregnancy is difficult using patient-reported data, however with commercially available and accurate physical activity monitors, objective data is more readily available. Our study is a feasibility study using objective data to track physical activity and weight gain in pregnancy.

Prognostic Significance of Preterm Isolated Decreased Fetal Movement

Objective: Our aim is to evaluate the prognostic significance of isolated, preterm decreased fetal movement following normal initial full diagnostic workup.Study design: A retrospective observational study was conducted at a tertiary centre. The applied protocol was approved by the Medical Research Ethics Department of the hospital where the research was conducted. Obstetrics outcomes of preterm- and term-decreased fetal movement were compared following an initial, normal diagnostic work up. Evaluated outcomes were birth weight, mode of delivery, stillbirth rate, induction of labour, development of gestational hypertension, small for gestational age and oligohydramnios, polyhydramnios during the follow up period.Result: Obstetric complications related to placental insufficiency develops more frequently for decreased fetal movement in preterm cases with respect to that of in term cases. Following the diagnosis of decreased fetal movement, pregnancy hypertension occurred in 17% of preterm decreased fetal movement cases and in 4.7% of term decreased fetal movement cases. Fetal growth restriction developed in 6.6% of preterm decreased fetal movement and in 2.3% of term decreased fetal movement. Amniotic fluid abnormalities more frequently developed in preterm decreased fetal movement.Conclusion: Following an initial normal diagnostic workup, preterm decreased fetal movement convey a higher risk for the development of pregnancy complications associated with placental insufficiency. The patient should be monitored closely and management protocols must be developed for initial normal diagnostic workups in cases of preterm decreased fetal movement.

First-trimester mean arterial blood pressure and the risk of preeclampsia: The Great Obstetrical Syndromes (GOS) study.

To estimate the predictive value of first-trimester mean arterial pressure (MAP) for the hypertensive disorders of pregnancy (HDP). We performed a prospective cohort study of nulliparous women recruited at 110/7-136/7 weeks. MAP was calculated from blood pressure measured on both arms simultaneously using an automated device taking a series of recordings until blood pressure stability was reached. MAP was reported as multiples of the median adjusted for gestational age. Participants were followed for development of gestational hypertension (GH), preeclampsia (PE), preterm PE (<37 weeks) and early-onset (EO) PE (<34 weeks). Receiver operating characteristic curves and the area under the curve (AUC) were used to estimate the predictive values of MAP. Multivariate logistic regressions were used to develop predictive models combining MAP and maternal characteristics. We obtained complete follow-up in 4700 (99%) out of 4749 eligible participants. GH without PE was observed in 250 (5.3%) participants, and PE in 241 (5.1%), including 33 (0.7%) preterm PE and 10 (0.2%) EO-PE. First-trimester MAP was associated with GH (AUC: 0.77; 95%CI: 0.74-0.80); term PE (0.73; 95%CI: 0.70-0.76), preterm PE (0.80; 95%CI: 0.73-0.87) and EO-PE (0.79; 95%CI: 0.62-0.96). At a 10% false-positive rate, first-trimester MAP could have predicted 39% of GH, 34% of term PE, 48% of preterm PE and 60% of EO-PE. The addition of maternal characteristics improved the predictive values (to 40%, 37%, 55% and 70%, respectively). First-trimester MAP is a strong predictor of GH and PE in nulliparous women.

Correlation of Maternal Serum Homocysteine in the First Trimester with the Development of Gestational Hypertension and Preeclampsia.

BackgroundThis study investigated the relationship of serum homocysteine in early pregnancy with the risk of gestational hypertension (GH) and preeclampsia (PE) and with the severity of preeclampsia.Material/MethodsIn a retrospective cohort study, we identified 147 confirmed cases of preeclampsia (103 with mild PE and 44 with severe PE) and 147 confirmed cases of GH; 4418 women who remained normotensive and nonproteinuric throughout pregnancy served as controls. Maternal blood samples were collected at between 11 and 13 weeks of gestation to test serum concentrations of homocysteine (Hcy), folic acid, and VitB12. A logistic regression model was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsWomen who subsequently developed GH and PE were older and had higher body mass indexes (BMIs) than those in the control group. Compared with the control group, women who developed PE were less educated (P=0.031), and more of those who developed GH were primiparas (P=0.012). The serum levels of Hcy in severe PE were significantly higher than those in the control group (median: 8.50 μmol/L vs. 7.33 μmol/L, P<0.001). After logistic regression analyses for potential confounding factors, the adjusted odds ratios (aORs) of Hcy was 1.12 for severe PE (95% CI 1.06–1.20). The serum concentrations of folic acid and VitB12 in those with GH and PE were not significantly different from controls.ConclusionsA high level of Hcy in the first trimester is an independent risk factor for severe PE, although it is not a useful marker for the subsequent development of GH and mild PE.

Folic acid supplement use and the risk of gestational hypertension and preeclampsia.

Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality. Studies suggest that the use of folic acid may lower the risk of hypertensive disorders in pregnant women. The aim of this study was to assess the effects of timing and duration of folic acid-containing supplement use on the risk for gestational hypertension and preeclampsia. Exposures and outcomes data were obtained through interviews and review of participant's medical records from the MotherToBaby cohort studies across the United States and Canada. Demographics, medical history, lifestyle factors, substance use, and fetal sex were assessed as potential confounders. Unadjusted and adjusted risks for gestational hypertension and preeclampsia were examined using odds ratios and 95% confidence intervals. 3247 women were included in the study. Compared to non-supplement use, early and late supplement use were not significantly associated with the development of gestational hypertension or preeclampsia. The odds of developing gestational hypertension and preeclampsia were significantly reduced as the duration of folic acid-containing supplement use increased. Findings from this study suggest that the use of folic acid-containing supplements may mitigate the risk for gestational hypertension and preeclampsia.

Risk factors of gestational hypertension development

Abstract The problem of gestational hypertension (GH) remains to be of current concern in obstetric practice. The purpose of this study, therefore, was to determine the risk factors for GH development. We examined 53 pregnant women and allocated them to 2 groups: the main group - pregnant women with gestational hypertension (n = 30) and the control group - pregnant women without the pathology (n = 23). The selection of persons for the study was carried out on the basis of detailed history taking, examination and complaints, using standard clinical, laboratory and instrumental methods of investigation. The data was processed on a PC (standard statistical package Statistica 6.0). Our results show that the gestational hypertension development is closely linked with such risk factors as: age ≤ 18 years old and over 35 years old, unmarried status, living in a city/town, post-secondary education, unemployment, obesity, first labor in consecutively pregnant women, the threat of pregnancy termination, cardiovascular system diseases, urinary tract pathology, varicose veins, as well as ABO-sensibilization.

Association between gestational weight gain and perinatal outcomes in women with chronic hypertension

Gestational weight gain above or below the 2009 National Academy of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. The objective of this study was to examine the relationship between gestational weight gain above and below National Academy of Medicine guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension. This is a population-based retrospective cohort study of women with chronic hypertension who had term, singleton, vertex births in the United States from 2012 through 2014. Prepregnancy body mass index was calculated using self-reported prepregnancy weight and height. Women were categorized into 4 groups based on gestational weight gain and prepregnancy body mass index: (1) weight gain less than, (2) weight gain within, (3) weight gain 1-19 lb in excess of, and (4) weight gain ≥20 lb in excess of the National Academy of Medicine guidelines. The χ2 tests and multivariable logistic regression analysis were used for statistical comparisons. Stratified analyses by body mass index category were additionally performed. In this large birth cohort, 101,259 women met criteria for inclusion. Compared to hypertensive women who had gestational weight gain within guidelines, hypertensive women with weight gain ≥20 lb over National Academy of Medicine guidelines were more likely to have eclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42) and cesarean delivery (adjusted odds ratio, 1.60; 95% confidence interval, 1.50-1.70). Excess weight gain ≥20 lb over National Academy of Medicine guidelines was also associated with increased odds of 5-minute Apgar <7 (adjusted odds ratio, 1.29; 95% confidence interval, 1.13-1.47), neonatal intensive care unit admission (adjusted odds ratio, 1.23; 95% confidence interval, 1.14-1.33), and large-for-gestational-age neonates (adjusted odds ratio, 2.41; 95% confidence interval, 2.27-2.56) as well as decreased odds of small-for-gestational-age status (adjusted odds ratio, 0.52; 95% confidence interval, 0.46-0.58). Weight gain 1-19 lb over guidelines was associated with similar fetal growth outcomes although with a smaller effect size. In contrast, weight gain less than National Academy of Medicine guidelines was not associated with adverse maternal outcomes but was associated with increased odds of small for gestational age (adjusted odds ratio, 1.31; 95% confidence interval, 1.21-1.52) and decreased odds of large-for-gestational-age status (adjusted odds ratio, 0.86; 95% confidence interval, 0.81-0.92). Analysis of maternal and neonatal outcomes stratified by body mass index demonstrated similar findings. Women with chronic hypertension who gain less weight than National Academy of Medicine guidelines experience increased odds of small-for-gestational-age neonates, whereas excess weight gain ≥20 lb over National Academy of Medicine guidelines is associated with cesarean delivery, eclampsia, 5-minute Apgar <7, neonatal intensive care unit admission, and large-for-gestational-age neonates.

A possible new approach in the prediction of late gestational hypertension: The role of the fetal aortic intima-media thickness.

The aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. This prospective study on singleton pregnancies was conducted at the tertiary center of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, prepregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected. The P value <0.05 was defined significant considering a 2-sided alternative hypothesis. The distribution normality of variables were assessed using Kolmogorov-Smirnoff test. Data were presented by mean (±standard deviation), median and interquartile range, or percentage and absolute values. We considered data from 1381 ultrasound examinations at 29 to 32 weeks' gestation, and in 73 cases late gestational hypertension developed after 34 weeks' gestation. The final multivariate model found that fetal aIMT as well as fetal umbilical artery pulsatility index (PI), maternal age, maternal prepregnacy BMI, parity, and mean PI of maternal UtAs, assessed at ultrasound examination of 29 to 32 weeks' gestation, were significant and independent predictors for the development of gestational hypertension after 34 weeks' gestation. The area under the curve of the model was 81.07% (95% confidence interval, 75.83%-86.32%). A nomogram was developed starting from multivariate logistic regression coefficients. Late-gestational hypertension could be independently predicted by fetal aIMT assessment at 29 to 32 weeks' gestation, ultrasound Doppler waveforms, and maternal clinical parameters.

HLA-G expression of cervical reserve cell-like cells regenerated from human induced pluripotent stem (iPS) cells and its relationship with cervical cancer stem cells in immune escape

s / Journal of Reproductive Immunology 112 (2015) 121–140 125 pregnant mice. During pregnancy in mice, continuous infusion of high-dose angiotensin II (AngII) induced hypertension, proteinuria, and IUGR, whereas infusion of low-dose AngII caused hypertension alone. AngII-induced hypertension was prevented in Nlrp3−/− mice but not in Asc−/−, indicating that NLRP3 contributes to gestational hypertension independently of ASC-mediated inflammasomes. Although NLRP3 deficiency had no effect on IUGR, it restored IL-6 upregulation in the placenta and kidney of AngIIinfused mice. These findings demonstrate that NLRP3 contributes to the development of gestational hypertension independently of the inflammasomes. http://dx.doi.org/10.1016/j.jri.2015.09.016

NLRP3 Deficiency Improves Angiotensin II-Induced Hypertension But Not Fetal Growth Restriction During Pregnancy.

Preeclampsia is a pregnancy-specific syndrome characterized by elevated blood pressure, proteinuria, and intrauterine growth restriction (IUGR). Although sterile inflammation appears to be involved, its pathogenesis remains unclear. Recent evidence indicates that sterile inflammation is mediated through the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasomes, composed of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and caspase-1. Here we investigated the role of the NLRP3 inflammasomes in the pathogenesis of preeclampsia using Nlrp3(-/-) and Asc(-/-) (Nlrp3 and Asc deficient) pregnant mice. During pregnancy in mice, continuous infusion of high-dose angiotensin II (AngII) induced hypertension, proteinuria, and IUGR, whereas infusion of low-dose AngII caused hypertension alone. AngII-induced hypertension was prevented in Nlrp3(-/-) mice but not in Asc(-/-), indicating that NLRP3 contributes to gestational hypertension independently of ASC-mediated inflammasomes. Although NLRP3 deficiency had no effect on IUGR, it restored the IL-6 up-regulation in the placenta and kidney of AngII-infused mice. Furthermore, treatment with hydralazine prevented the development of gestational hypertension but not IUGR or IL-6 expression in the placenta and kidney. These findings demonstrate that NLRP3 contributes to the development of gestational hypertension independently of the inflammasomes and that IUGR and kidney injury can occur independent of blood pressure elevation during pregnancy.

Uso de Metformina en el embarazo

La utilización de metformina en pacientes con diabetes gestacional (DG) ha mostrado efectos benéficos al disminuir la resistencia a la insulina y no rwlacionarse con teratogénesis, pero no ha sido evaluado su efecto sobre la morbilidad perinatal al utilizarlo desde las primeras semanas del embarazo. Objetivo: Demostrar que la administración de metformina desde el inicio del segundo trimestre del embarazo en pacientes obesas con diabetes gestacional (DG) disminuye la macrosomía y morbilidad neonatal. Diseño: Estudio cuasiexperimental. Lugar: Departamento de Medicina Materno-Fetal, Universidad Médica de Alta Especialidad, Instituto Mexicano del seguro Social. Participantes: Pacientes con diagnóstico de DG, cursando embarazos de 17 o menos semanas de gestación al inicio del tratamiento e índice de masa corporal de 30 o mayor. Se formó 2 grupos: el de casos, con 34 pacientes, a quienes se administró únicamente metformina durante todo el embarazo, debido a que no aceptaron el tratamiento con insulina, y el grupo control, formado por 40 pacientes, quienes utilizaron diversos esquemas de insulina. Principales medidas de resultados: Resultados perinatales, vía de nacimiento,asociación con estados hipertensivos y progresión a diabetes tipo 2 en el puerperio. Resultados: Encontramos disminución de la macrosomía en el grupo tratado con metformina, una (2%), en relación al de insulina 6 (15%), pero no fue estadísticamente significativo (p &gt; 0,05). Se obtuvo resultados similares con la morbilidad neonatal, la asociación con estados hipertensivos y la progresión a diabetes tipo 2. Conclusiones: Aunque clínica, pero no estadísticamente significativos, se obtuvo mejores resultados con el uso de metformina; éste representa una alternativa segura y confiable en el manejo de pacientes obesas con DG que no aceptan el tratamiento con insulina.

Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study.

Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes. A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis. Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS. Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.

201-POS

Objectives Disorders associated with marked liver dysfunction in late pregnancy include pre-eclampsia, HELLP syndrome, obstetric cholestasis, and acute fatty liver of pregnancy. Accurate diagnosis and appropriate timing of delivery are required in these conditions to minimize risk of maternal and fetal morbidity/mortality. We report a case series of women with significant and persistent liver dysfunction (>3-fold rise = ALT >90 IU/L) in the third trimester, where a definitive diagnosis remained obscure using accepted diagnostic tools for these and other liver conditions. Methods A retrospective audit of 341 consecutive patients referred to the Obstetric Medicine service at a single center over a 30-month period were reviewed for the prevalence of abnormal liver function tests (LFTs). Of the 56 patients ascertained, 39 were excluded with a definitive diagnosis. Of the remaining 15 patients, 10 had severe derangement with ALT elevation >90 IU/L. Results Gestation at diagnosis ranged from 26+5 to 37+1 weeks, and rationale for requesting LFTs was uniformly concern over maternal or fetal well-being. Serum bile acids and bilirubin remained in the normal range for all patients, and 1 patient received ursodeoxycholic acid empirically. Four patients had co-existing gestational hypertension, and 8 underwent planned delivery. Outcomes were reassuring; 1 neonate developed respiratory distress requiring nursery admission (delivery Conclusions This small series outlines a group of previously undescribed patients who showed a slowly-progressive clinical course with generally good neonatal and maternal outcomes. A high rate of planned delivery was contributed to by concern over persistent abnormal LFTs, and/or the development of gestational hypertension. Disclosures C. Brumby: None. I. Idel: None. R. Still: None. L. Skeat: None. L.P. McMahon: None.

First trimester screening of circulating C19MC microRNAs can predict subsequent onset of gestational hypertension.

ObjectiveThe objective of the study was to evaluate risk assessment for gestational hypertension based on the profile of circulating placental specific C19MC microRNAs in early pregnancy.Study designThe prospective longitudinal cohort study of women enrolled at first trimester screening at 10 to 13 weeks was carried out (n = 267). Relative quantification of placental specific C19MC microRNAs (miR-516-5p, miR-517*, miR-518b, miR-520a*, miR-520h, miR-525 and miR-526a) was determined in 28 normal pregnancies and 18 pregnancies which developed gestational hypertension using real-time PCR and a comparative Ct method relative to synthetic C. elegans microRNA (cel-miR-39).ResultsIncreased extracellular C19MC microRNA plasmatic levels (miR-516-5p, p<0.001; miR-517*, p = 0.007; miR-520h, p<0.001; miR-518b, p = 0.002) were detected in patients destined to develop gestational hypertension. MiR-520h had the best predictive performance with a PPV of 84.6% at a 7.1% false positive rate. The combination of miR-520h and miR-518b was able to predict 82.6% of women at the same false positive rate. The overall predictive capacity of single miR-518b (73.3% at 14.3% FPR), miR-516-5p (70.6% at 17.9% FPR) and miR-517* (57.9% at 28.6% FPR) biomarkers was lower.ConclusionThe study brought interesting finding that the up-regulation of miR-516-5p, miR-517*, miR-520h and miR-518b is associated with a risk of later development of gestational hypertension. First trimester screening of extracellular miR-520h alone or in combination with miR-518b identified a significant proportion of women with subsequent gestational hypertension.

The influence of gestational weight gain on the development of gestational hypertension in obese women.

The objective of this study was to examine the influence of gestational weight gain on the development of gestational hypertension/preeclampsia (GHTN/PE) in women with an obese prepregnancy body mass index (BMI). Obese women with a singleton pregnancy enrolled at < 20 weeks were studied. Data were classified according to reported gestational weight gain (losing weight, under-gaining, within target, and over-gaining) from the recommended range of 11 to 9.7 kg and by obesity class (class 1 = BMI 30-34.9 kg/m(2), class 2 = 35-39.9 kg/m(2), class 3 = 40-49.9 kg/m(2), and class 4 ≥ 50 kg/m(2)). Rates of GHTN/PE were compared by weight gain group overall and within obesity class using Pearson chi-square statistics. For the 27,898 obese women studied, rates of GHTN/PE increased with increasing class of obesity (15.2% for class 1 and 32.0% for class 4). The incidence of GHTN/PE in obese women was not modified with weight loss or weight gain below recommended levels. Overall for obese women, over-gaining weight was associated with higher rates of GHTN/PE compared with those with a target rate for obesity classes 1 to 3 (each p < 0.001). Below recommended gestational weight gain did not reduce the risk for GHTN/PE in women with an obese prepregnancy BMI. These data support a gestational weight gain goal ≤ 9.7 kg in obese gravidas.

CLINICAL SIGNIFICANCE OF LYMPHOCYTE-PLATELET ADHESION, CYTOKINES AND ENDOTHELIAL DYSFUNCTION IN THE DEVELOPMENT OF GESTATIONAL HYPERTENSION

The aim of our study was to determine the significance of lymphocyte-platelet adhesion (LPA), interleukins, transforming necrosis factor - α (TNF-α), and endothelial dysfunction in the development of gestational hypertension (GH). The study included 139 pregnant women aged between 17 and 27 years (21.3±4.22 years). GH was diagnosed in 119 women after 20 weeks of pregnancy. 20 patients (control group) were with physiological course of pregnancy. The distribution of patients by groups was carried out according to the level of blood pressure (BP) in accordance with ICD-10 (Geneva, WHO, 2002). The survey was conducted at the moment of detection pregnancy from 7 to 10 weeks and in dynamics of I, II and III trimesters of gestation. In the dynamics of gestation, were studied the number of desquamated endothelial cells circulating in the systemic circulation (CECs), nitrates levels, the adhesion of platelets by estimation their ability to form co-aggregates with lymphocytes by determining the percentage of lymphocytes aggregates with thrombocytes (lymphocyte-platelet plugs), the concentrations of IL-Iβ and TNF-α by immunoenzymatic method. Results of the study showed that in pregnant women at risk of hypertensive disorders, especially after 20-22 weeks of gestation and later, lymphocytes ability to platelets adhesion is rose, the concentrations of pro-inflammatory cytokines and NO level are increased. The direct relationship between DBP high level with degree of LPA, CECs, NO, IL-Iβ and TNF-α cytokines at gestation period of 20-22 weeks indicates their importance in the pathogenesis of hypertensive disorders in pregnant women.

Maternal obesity and energy intake as risk factors of pregnancy-induced hypertension among Iranian women.

Pregnancy-induced hypertension is causing striking maternal, foetal and neonatal mortality and morbidity in the world. A case-control study was conducted on 113 women with gestational hypertension and 150 healthy pregnant women at Shahid Akbarabadi Hospital of obstetrics and gynaecology in south of Tehran. Women who were obese (OR 4.44; 95% CI 1.84-10.72) before pregnancy were more likely to develop gestational hypertension. Proportion of having excessive gestational weight gain was positively and significantly associated with development of gestational hypertension (OR 2.70; 95% CI 1.19-6.13). Furthermore, findings revealed that women who were in the highest quartile of mid-arm-circumference had a 3-fold increased risk of gestational hypertension compared to women in the lowest quartile (OR 8.93; 95% CI 2.16-36.93). We found that having been in the highest quartile of energy intake positively correlated with increased risk of gestational hypertension (OR 9.66; 95% CI 3.30-28.21). The results suggest pre-pregnancy obesity, excessive gestational weight gain, and increased intake of energy as potential risk factors of developing gestational hypertension.

Expression and significance of aquaporin-8 in membranes and placenta tissue of pregnant women with hypertensive disorders

Objective To detect the expression of aquaporins-8 （ AQP-8 ） in placenta and fetal membrane tissue of pregnant women with hypertensive disorders ,and to explore the role of AQP-8 in the pathogenesis of gesta-tional hypertension .Methods 81 term pregnant women with cesarean section were selected （ including 25 cases hypertensive disorders complicating pregnancy,26 cases with preeclampsia,30 cases with normal pregnancy）,immu-nohistochemical method was used to detect AQP-8 expression in placenta ,fetal membranes tissue of those 3 groups. Results AQP-8 protein expressed in placenta ,fetal membranes of pregnant women in 3 groups.Mainly in epithelial cells of the amnion , chorionic trophoblast nucleus , syncytiotrophoblast membrane and cytoplasm of placenta .The expression levels of AQP-8 in the amnion of the control group , hypertension group and preeclampsia group were （4.78 ±2.05）,（5.45 ±2.08）,（6.18 ±2.15）,respectively.Those levels in the chorion of three groups were （4.16 ±2.13）,（5.04 ±1.92）,（5.59 ±2.39）,respectively.Those levels in the placenta of three groups were （5.62 ±2.16）,（6.01 ±2.30）,（7.61 ±2.71）,respectively.Expression of AQP-8 protein was gradually increased , and had statistical differences in different places （F=3.121,3.148,5.785,P=0.049,0.048,0.005）.The difference of AQP-8 protein expression in amnion of normal group and preeclampsia group was statistically significant （t=2.01, P=0.016）.Conclusion Expression of AQP8 protein in placenta and fetal membranes of pregnant women with hypertensive disorder was significantly increased ,and was associated with severity of disease ,it might be involved in the occurrence and development of gestational hypertension . Key words: Hypertension, pregnancy-induced ; Aquaporins-8 ; Placenta

Fetal sex and the circulating renin–angiotensin system during early gestation in women who later develop preeclampsia or gestational hypertension

There are fetal sex-specific differences in the balance between angiotensin (Ang) II and Ang-(1-7) in the maternal circulation during pregnancy. To determine whether at 15 weeks' gestation plasma levels of Ang II and Ang-(1-7), as well as levels of prorenin and Ang-converting enzyme (ACE), predicted the development of gestational hypertension (GH) or preeclampsia (PreE) and were associated with estimates of fetal and maternal health, women who later developed GH (n=50) or PreE (n=50) were compared with body mass index-matched controls (n=100). Women who subsequently developed PreE or GH had increased Ang-(1-7) levels at 15 weeks' gestation compared with women with normal pregnancies. When separated by fetal sex, this difference was seen only in women carrying a female fetus. Prorenin and ACE concentrations were not useful biomarkers for the prediction of either PreE or GH at 15 weeks' gestation. Women with a male fetus who developed PreE and women who subsequently developed GH had increased blood pressures at 15 weeks' gestation compared with women with normal pregnancies, suggesting that these women were on an early trajectory for the development of hypertension. We propose that measurement of Ang-(1-7) during early gestation could be useful in predicting, those women who will go on to develop new-onset hypertension in pregnancy.

Effects of nulliparity, maternal age, and pre-pregnancy body mass index on the development of gestational hypertension and preeclampsia

Effects of nulliparity, maternal age, and pre-pregnancy body mass index on the development of gestational hypertension and preeclampsia