Development Of Hypertensive Disorders Of Pregnancy Research Articles

Relationship between Androgens and Vascular and Placental Function during Pre-eclampsia.

Hypertensive disorders of pregnancy (HDP) represent a substantial risk to maternal and fetal health. Emerging evidence suggests an association between testosterone and pre-eclampsia (PE), potentially mediated through androgen receptors (AR). Nevertheless, the mechanism driving this association is yet to be elucidated. On the other hand, reports of transgender men's pregnancies offer a limited and insightful opportunity to understand the role of high androgen levels in the development of HDP. In this sense, a literature review was performed from a little over 2 decades (1998-2022) to address the association of testosterone levels with the development of HDP. Furthermore, this review addresses the case of transgender men for the first time. The main in vitro outcomes reveal placenta samples with greater AR mRNA expression. Moreover, ex vivo studies show that testosterone-induced vasorelaxation impairment promotes hypertension. Epidemiological data point to greater testosterone levels in blood samples during PE. Studies with transgender men allow us to infer that exogenous testosterone administration can be considered a risk factor for PE and that the administration of testosterone does not affect fetal development. Overall, all studies analyzed suggested that high testosterone levels are associated with PE.

Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic: A Population-Based Study [ID: 1380265

INTRODUCTION: We previously reported that the prevalence of hypertensive disorders of pregnancy (HDP) increased during the COVID-19 pandemic. We aimed to ascertain potential sociodemographic factors contributing to this association. METHODS: This was a retrospective analysis of the U.S. Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). The prevalence of HDP, defined as a composite of gestational hypertension, preeclampsia, and eclampsia, was compared between the COVID-19 pandemic group (births from April 1, 2020, to December 31, 2020; n=2,728,674) and the pre-pandemic group (births from January 1, 2016, to February 29, 2020; n=15,967,803). A comparison of the prevalence of HDP among maternal sociodemographic factors and pregnancy characteristics between the two groups was also performed using χ2 test. Multivariable logistic regression was used to adjust for potential confounders. Statistical significance was set at P<.05. RESULTS: We detected an overall increase in odds of HDP during the COVID-19 pandemic period (8.7% versus 7.1%, adjusted odds ratio 1.25, 95% CI 1.24–1.26). The highest prevalence of HDP during the pandemic was seen in similar sociodemographic subgroups as in the pre-pandemic group, such as older maternal age, patients with some college credit, private insurance, and non-Hispanic Black race. A marked increase in HDP prevalence was noted during the pandemic in most maternal characteristic subgroups evaluated, with the greatest noted in Asian individuals and tobacco users. Interestingly, chronic hypertension, which was more prevalent during the pandemic period (1.2% versus 0.9%, P≤.001), was associated with a lower prevalence of HDP during that time. CONCLUSION: The prevalence of HDP increased in the United States during the COVID-19 pandemic among all sociodemographic factors evaluated. Although chronic hypertension was more prevalent during the pandemic period, it had a lower effect on the development of HDP during that time.

Influence of HIV and its treatment on hypertensive disorders of pregnancy in women from a low- to middle-income country.

To establish a potential relationship between hypertensive disorders of pregnancy (HDP) and HIV infection. This cross-sectional observational study involving 300 women with HDP was undertaken from September 2018 to February 2019 in a regional hospital in Durban, South Africa, a setting with a background HIV prevalence of 45% among pregnant women. All women with new-onset elevation of blood pressure after the 20th week of pregnancy were enrolled and, following informed consent, the relevant information was extracted from their files. Of the 300 women with HDP, the HIV prevalence was 30%, compared with the historical seroprevalence of 45% within the hospital (P=0.028). For all categories of HDP, there were fewer primigravid women among women living with HIV (WLHIV), compared with those uninfected (30% vs 50.2%, respectively; P=0.001). HDP developed later in gestation in WLHIV compared with uninfected women (32.6 weeks vs 34 weeks, respectively; P=0.023), however, there were significant maternal complications of abruption and elevated liver enzymes among WLHIV (P=0.02 and P =0.014, respectively). Despite this, the perinatal outcomes were similar in both groups. HIV or its treatment seems to have a protective effect in the development of HDP; however, the complications of HDP may be significant in WLHIV receiving treatment.

Cardiac disease and risk of hypertensive disorders of pregnancy

Cardiovascular disease affects 1-4% of US pregnancies and is the leading cause of pregnancy related deaths. There are limited data on rates of hypertensive disorders of pregnancy (HDP) in this population. ACOG and USPSTF guidelines for aspirin (ASA) use for reduction of preeclampsia (PEC) do not include cardiac disease in the high or moderate risk categories. Our objective was to determine if cardiovascular disease is a risk factor for developing HDP. This was a retrospective cohort study of pregnancies complicated by maternal cardiac disease at a single academic center between 2018 and 2022. Patients with cardiac disease (congenital or acquired) who delivered after 20 weeks were included. For patients with multiple pregnancies during the timeframe, only the first pregnancy was included. Patient demographics and pregnancy outcomes were recorded. The primary outcome was development of HDP. Secondary outcomes were correlation of HDP with presence of one high or two moderate risk factors based on ACOG guidelines for ASA use and severity of cardiac disease based on modified World Health Organization (mWHO) risk class. 115 patients were included. Demographic and outcomes are shown in Table 1. 18 (15.7%) patients developed HDP and 71 patients (61.7%) were on ASA. Among the 18 patients with HDP, 55% developed PEC with severe features and 44% developed PEC post-partum. HDP was associated with multiple gestations (p< 0.01), age (p=0.04) and the combination of one high risk or two moderate risk factors for PEC (p=0.03). mWHO class was not associated with development of HDP (p=0.86). It has not been established if cardiac disease in pregnancy is an independent risk factor for developing PEC. Our study reveals high rates of HDP in this cohort (15.7% in our population compared to CDC rate of 4% of US pregnancies), even in the setting of ASA use and regardless of mWHO risk class. While more research is needed, based on our data it would be reasonable to offer patients with cardiac disease ASA for prevention of PEC.

Hypertensive disorders of pregnancy and long‐term cardiovascular health: FIGO Best Practice Advice

Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

Efficacy of Mid-Second-Trimester Serum b-HCG Levels as a Predictor of Hypertensive Disorders of Pregnancy: A Longitudinal Cohort Study

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect up to 10% of pregnancies worldwide, despite improvements in maternal and neonatal care. HDP and its sequelae are a dreaded complication of pregnancy. If prediction becomes possible, prevention will follow naturally. Aim: To study the efficacy of mid-second trimester serum b-hCG levels in the prediction of HDP. Materials and Methods: This was a longitudinal cohort study conducted in the Department of Obstetrics and Gynaecology at Shri BM Patil Medical College Hospital and Research Centre , Vijayapura, Karnataka, India, between December 2020 and June 2022. All women with gestational age between 16-20 weeks were screened, and 163 pregnant women were enrolled in the study. Serum β-hCG levels were measured at enrollment, and values were followed-up until delivery. The development of HDP was evaluated using statistical analysis, including Chi-square, Independent t-test, Receiver Operating Curve/Area under the ROC Curve (ROC/AUC), sensitivity, and specificity. A p-value of &lt;0.05 was considered significant. Results: Of the 163 pregnant women enrolled, 49 (30.1%) developed HDP, while 114 (69.9%) remained normotensive. The mean age of the study population was 24±4 years. The mean serum β-hCG level in the normotensive group was 55666 mIU/mL, while in the HDP group, it was 100124 mIU/mL, with a statistically significant p-value of 0.001. A cut-off value of 77817 mIU/mL showed 83.7% sensitivity and 92.1% specificity. Conclusion: This study suggests that serum b-hCG levels between 16-20 weeks can be used as a non-invasive predictor of HDP. It is a good predictor of HDP and could potentially improve prevention strategies.

Diet quality predicts hypertensive disorders of pregnancy in Asian and Pacific Islander Cohort.

Background: There is limited data on diet quality during pregnancy and its impact on hypertensive disorders of pregnancy (HDP). Aim: Examine the association with diet quality and development of HDP in an Asian and Pacific Islander Cohort Methods: Pregnant women from the 4 largest ethnic groups in Hawai'i were recruited for participation. Participants completed a food frequency questionnaire during each trimester. Adherence to three diet quality indices (DQIs) were scored-The Healthy Eating Index (HEI), The Alternate Mediterranean Diet score (aMED), and the Dietary approaches to Stop Hypertension (DASH) score. Mean scores were compared among those who did and did not develop HDP. Logistic Regression models were used to examine the association between diet quality and HDP accounting for confounders (age, parity, obesity, ethnicity, gestational weight gain). Results: Among 55 participants with complete follow-up, there was a high incidence of HDP (23%). There was no significant change of DQIs over time. Non-Hispanic White participants had higher DQIs than Filipinas, Japanese, or Native Hawaiians (not statistically significant). Across gestation, participants who did not have HDP had better diet quality than those who did. Logistic regression showed that HEI and DASH indices are predictive of HDP development, with the high DASH diet score having the greatest reduced odds. Every point higher of DASH diet score portended approximately 30% reduced odds of developing HDP. Conclusions: The DASH diet had the strongest association with reduced odds of HDP, but better diet quality in any of the indices was also predictive.

Endometriosis does not seem to be an influencing factor of hypertensive disorders of pregnancy in IVF / ICSI cycles

IntroductionTo evaluate whether the incidence of hypertensive disorders of pregnancy (HDP) in pregnant women was related to endometriosis (EM), ovulation and embryo vitrification technology.MethodsA retrospective cohort study was conducted on the clinical data of 3674 women who were treated with IVF / ICSI in the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University and maintained clinical pregnancy for more than 20 weeks. All pregnancies were followed up until the end of pregnancy. The follow-up consisted of recording the course of pregnancy, pregnancy complications, and basic situation of newborns.ResultsCompared with NC-FET without EM, HRT-FET without EM was found to have a higher incidence of HDP during pregnancy (2.7% V.S. 6.1%, P<0.001); however, no significant difference was found in the incidence of HDP between NC-FET and HRT-FET combined with EM (4.0% V.S. 5.7%, P>0.05). In total frozen-thawed embryo transfer (total-FET), the incidence of HDP in the HRT cycle without ovulation (HRT-FET) was observed to be higher than that in the NC cycle with ovulation (NC-FET) (2.8% V.S. 6.1%, P<0.001). In patients with EM, no significant difference was found in the incidence of HDP between fresh ET and NC-FET (1.2% V.S. 4.0%, P>0.05).ConclusionEM does not seem to have an effect on the occurrence of HDP in assisted reproductive technology. During the FET cycle, the formation of the corpus luteum may play a protective role in the occurrence and development of HDP. Potential damage to the embryo caused by cryopreservation seems to have no effect on the occurrence of HDP.

Exposure to perfluoroalkyl substances in early pregnancy and the risk of hypertensive disorders of pregnancy: A nested case-control study in Guangxi, China

BackgroundPrevious epidemiological studies have examined the associations between exposure to perfluoroalkyl substances (PFASs) and the risk of hypertensive disorders of pregnancy (HDP). However, these studies have drawn discrepant conclusions and have some limitations. MethodsA nested case-control study was conducted with the Guangxi Zhuang Birth Cohort (GZBC), a prospective, ongoing birth cohort that was implemented in Guangxi, China, in June 2015. Maternal serum concentrations of nine PFASs were measured using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS). The associations between PFAS exposure and the risk of HDP were assessed using logistic regression (single-exposure), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models. ResultsA total of 136 HDP cases and 408 controls were enrolled in this study. In logistic regression models, perfluoroundecanoic acid (PFUnA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA) and perfluorobutanesulfonic acid (PFBS) were positively associated with HDP, while perfluorohexane sulfonate (PFHxS) was inversely associated with HDP. In the BKMR analysis, the joint effect of PFASs was positively associated with HDP. PFOS and PFBS showed positive trends, while PFHxS and PFHpA showed inverse trends. In WQS regression analysis, we calculated two WQS indices that were estimated using constraints in both the positive and negative directions of effects. Both WQS indices were significantly associated with HDP (OR: 2.663, 95% CI: 1.795–3.951; OR: 0.338, 95% CI: 0.229–0.499, respectively). PFBS, PFOS and PFUnA had significant weights in the positive effect direction; PFHxS, perfluoroheptanoic acid (PFHpA) and perfluorododecanoic acid (PFDoA) had significant weights in the negative effect direction. ConclusionConsidering all model results, we found that combined exposure to nine PFASs had a positive effect on the development of HDP. Moreover, PFOS and PFBS were positively associated with the HDP risk, while PFHxS and PFHpA were negatively associated with the HDP risk in women in Guangxi, China.

Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester

BackgroundMalaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, particularly those of young, first-time mothers. Small case-control studies suggest a positive association between falciparum malaria and risk of pre-eclampsia but large prospective analyses are lacking.MethodsWe characterized the relationship between malaria in pregnancy and the development of HDoP in a large, prospectively followed cohort. Pregnant women living along the Thailand-Myanmar border, an area of low seasonal malaria transmission, were followed at antenatal clinics between 1986 and 2016. The relationships between falciparum and vivax malaria during pregnancy and the odds of gestational hypertension, pre-eclampsia, or eclampsia were examined using logistic regression amongst all women and then stratified by gravidity.ResultsThere were 23,262 singleton pregnancies in women who presented during the first trimester and were followed fortnightly. Falciparum malaria was associated with gestational hypertension amongst multigravidae (adjusted odds ratio (AOR) 2.59, 95%CI 1.59–4.23), whereas amongst primigravidae, it was associated with the combined outcome of pre-eclampsia/eclampsia (AOR 2.61, 95%CI 1.01–6.79). In contrast, there was no association between vivax malaria and HDoP.ConclusionsFalciparum but not vivax malaria during pregnancy is associated with hypertensive disorders of pregnancy.

818 Diet quality predicts hypertensive disorders of pregnancy in hawaii cohort

Data are mixed on whether diet quality in early gestation is associated with adverse pregnancy outcomes. This study aims to see if there is a correlation with diet quality and the development of hypertensive disorders of pregnancy (HDP) in Hawaii. In a longitudinal cohort study, diet quality was measured via a Food Frequency Questionnaire during each trimester in 56 healthy women. Three diet quality indices were assigned – The Healthy Eating Index (HEI), The Alternate Mediterranean Diet score (aMED), and the Dietary approaches to Stop Hypertension (DASH) score. Mean aggregate scores were compared among those who did and did not develop hypertensive disorders of pregnancy. Logistic Regression models were used or confounding demographic covariates (age, parity, BMI, ethnicity). Generalized Estimating equations were also used to see if a longitudinal change in diet quality was associated with HDP. There was a high incidence of HDP in this cohort, with 12 participants (21%) developing the condition. There was no change of diet quality scores over time from 1st to 3rd trimester. Aggregate mean diet quality scores were higher in the unaffected group versus those who developed HDP. Logistic regression models showed that all three scores were significantly associated with development of HDP, with the DASH diet score having the greatest effect, and the best fit modeling. Age and nulliparity were also independently associated with this disorder. Every point higher of DASH diet score portended a 3% less chance of developing HDP. The components of the DASH Score that contributed the most difference between the two groups were consumption of whole grains, dairy, and legumes or nuts. Diet quality can help predict risk of HDP and may be a modifiable risk factor to target. The DASH diet score may be most predictive of this condition. Further studies in a larger cohort may further identify the mechanism by which nutritional components contribute to this risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of preconception sodium intake on hypertensive disorders of pregnancy: The Japan Environment and Children's study.

Determining the appropriate preconception care to reduce the occurrence of hypertensive disorders of pregnancy (HDP) remains a challenge in modern obstetrics. We aimed to examine the association between pre-pregnancy sodium (Na) intake and the development of HDP in normotensive women. From the Japan Environment and Children's study (JECS) database, we identified 85,152 normotensive Japanese women who were recruited to the JECS between January 2011 and March 2014. Participants were categorized into five groups according to pre-pregnancy Na intake quintiles (Q1 and Q5 were the lowest and highest Na intake groups, respectively). Multiple logistic regressions were performed to identify the effect of pre-pregnancy Na intake on HDP, early-onset (<34weeks) HDP, late-onset (34≥weeks) HDP, and HDP with/without small for gestational age (SGA). Using Q3 (the middle Na intake group) as the reference, multiple logistic regression showed that both the lowest (Q1) and highest (Q5) Na intake groups had an increased risk of HDP with SGA [adjusted odds ratio (aOR): 1.50, 95% confidence interval (CI): 1.02-2.21 and aOR: 1.52, 95% CI: 1.03-2.24, respectively]. Both lower and higher Na intake before pregnancy increases the risk of HDP with SGA in normotensive Japanese women. This finding may indicate new recommendations for Na intake before pregnancy to prevent HDP.

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

BackgroundAssociation between fine particulate matter (PM2.5) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM2.5 in early pregnancy with HDP.MethodsA retrospective cohort study was performed among 8776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women’s hospital during 2014–2015. Land use regression models were used to predict individual levels of PM2.5 exposure.ResultsThe average PM2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m− 3 [median, 51.4 μg m− 3; interquartile range, 47.3–57.8 μg m− 3]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed a positive exposure-response relationship between the PM2.5 concentration and risk of HDP. We observed an association between PM2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m− 3, 95% CI: 1.45–10.43), but not during the second trimester (RR = 0.71 per 10 μg m− 3, 95% CI: 0.40–1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46–1.38)].ConclusionOur findings suggest that PM2.5 exposure during the first trimester is associated with the development of HDP. The effect estimate is more obvious for nulliparous women than multiparous women.

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed. Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. · This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..

Abstract P428: A Polyexposomic Risk Score for Hypertensive Disorders of Pregnancy Using External Exposome Data

Hypertensive disorders of pregnancy (HDP) are one of the most common pregnancy complications that lead to increased maternal and infant morbidity and mortality. While effective prevention of HDP can be attained using low-dose aspirin in high-risk pregnant women, identification of these high-risk women has been ineffective. Existing risk assessment models of HDP predominantly rely on biomarkers such as angiogenesis-related factors which are not routinely tested at the population level. The external environment has been shown to play an important role in the development of HDP, yet no predictive model of HDP has been developed considering the totality of the external environment, or the external exposome. To address this, we developed a polyexposomic risk score of HDP using external exposome-wide data among 6,989 women from the 2007-2012 linked Florida Vital Statistics Birth Records and Pregnancy Risk Assessment Monitoring System data. A total of 5,510 external exposome factors characterizing women’s surrounding natural, built, and social environment during pregnancy (i.e. climate, air pollution, noise, greenness, walkability, food access, socioeconomics, social capital, housing, and safety) were collected, harmonized, integrated, and spatiotemporally linked to pregnant women based on their geocoded residential addresses and pregnancy periods. The data were randomly divided into training (80%) and testing (20%) sets. A gradient boosting decision trees model was trained using the CatBoost library with hyper-parameters tuned by a grid search based on 5-fold cross validations. The model has a test-AUC (areas under curve) of 0.735. The most important features for predictions include neighborhood socioeconomic status, housing characteristics, meteorology factors, and air pollutants. External exposome data can provide important predictive information to identify individuals at high risk of HDP. The model is feasible for implementation at the population level to help guide precision preventions. Future efforts are warranted to integrate external exposome data with electronic health record data to further improve the model performance.

Risk factors for hypertensive disorders of pregnancy in Abuja, Nigeria: A prospective case-control study

Background: Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries like Nigeria. The study determined the risk factors for the development of HDP among women who booked early for antenatal care.Materials and Methods: This was a prospective case-control study conducted from March 2015 to March 2016 involving pregnant women with gestational age less than 20 weeks at booking and were followed up until delivery and 6 weeks postpartum. Information on gestational age at recruitment, at diagnosis of HDP, mode of delivery, and fetal outcome were recorded. Risk factors for HDP were compared between women who developed HDP (cases) and those who did not develop HDP (controls) by Fisher's exact test, Chi-square, and student's t-tests. Univariate and multivariate logistic regression analysis was used to test the relationship between certain risk factors and the development of HDP. A P value of less than 0.05 was considered statistically significant.Results: The prevalence of HDP in the study was 19.4%. Family history of preeclampsia (OR: 5.339, 95% CI: 1.149–24.818, P = 0.033); previous history of preeclampsia (OR: 10.819, 95% CI: 3.570–32.792, P < 0.001); multifetal gestation (OR: 13.275, 95% CI: 2.899–38.127, P = 0.010); chronic hypertension (OR: 3.431, 95% CI: 1.778–8.710, P < 0.001) and diabetes; (OR: 2.846 95% CI: 0.460–17.584, P < 0.251) were the risk factors associated with the development of HDP among the study population while nulliparity (OR: 0.726, 95% CI 0.366–1.440, P = 0.395); body mass index (BMI) (mean ± SD), (OR: 0.405, 95% CI: 0.173–0.945, P < 0.037);and low educational level (OR: 0.582, 95% CI: 0.070–4.857, P = 0.613) were not.Conclusion: The prevalence of HDP in the study group was high. Risk factors for HDP included family history of hypertension, previous history of preeclampsia, multifetal gestation, and chronic hypertension.

Relationship between ABO blood group phenotypes and hypertensive disorders of pregnancy: A hospital-based cross-sectional study in Kano, North-West Nigeria

Background: Hypertensive disorders of pregnancy (HDP) complicate an estimated 5%–10% of pregnancies globally. Studies have linked non-O blood group with the development of HDP, especially preeclampsia (PE). However, these reports have not been consistent. This study aimed to determine the relationship between ABO blood group and HDP among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. Materials and Methods: Two hundred and ten pregnant women with clinically diagnosed HDP and an equal number of age-matched normotensive controls were recruited for the study. Blood pressure was measured using a mercury sphygmomanometer and a Littman's stethoscope which was positioned on the medial aspect of the right arm at sitting position. Urinalysis was performed using a urine dipstick (Medi-Test Combi 9®). ABO blood groups were determined by tile agglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents (Plasmatec Lab., Bridport, UK). Data were analyzed using Statistical Package for Social Sciences version 23.0. Chi-square test of association, Student's t-test, and logistic regression were used as statistical tools, and results were presented as frequencies, percentages, mean ± standard, odds ratio (OR), and confidence interval (CI); P ≤ 0.05 was considered statistically significant. Results: The mean age of the cases and controls was 26.20 ± 6.96 and 25.90 ± 6.37, P = 0.65, respectively. The mean gestational age of the cases and controls was 32.30 ± 4.15 and 29.06 ± 4.25, P = 0.01, respectively. The mean systolic and diastolic blood pressure of the cases and controls in mmHg were 176.62 ± 32.62 and 123.08 ± 6.40, P = 0.01, and 114.20 ± 20.08 and 76.43 ± 5.07, P = 0.01, respectively. Of the 210 individuals in the HDP group (cases), 90 (42.86%) had gestational hypertension (GH), 50 (23.81%) had PE, and 70 (33.33%) had eclampsia. Type O blood group was the most common group in both cases (93 [44.3%]) and controls (98 [46.7%]). This was followed by groups A (40 [19.0%] and 45 [21.45]), B (58 [27.6%] and 53 [25.2%]), and AB (19 [9.0%] and 14 [6.7%]) for cases and controls, respectively. There was no statistically significant difference in the frequencies of ABO blood group between the cases and controls (χ2 = 1.41, P = 0.70, df = 3). Compared to type O blood group individuals, non-O blood group individuals had 1.106 times odd of developing HDP than the controls (OR: 1.106, 95% CI: 0.753–1.625, P = 0.61). Similarly, types A, B, and AB blood group individuals had 1.292, 1.492, and 1.882 times odds of developing GH compared to blood Group O and controls (OR: 1.292, 95% CI: 0.670–2.490, P = 0.45; OR: 1.492, 95% CI: 0.813–2.740, P = 0.20; and OR: 1.882, 95% CI: 0.746–4.748, P = 0.18), respectively. Equally, types A, B, and AB blood group individuals had 1.243, 0.990, and 1.699 times odds of developing PE compared to blood group O individuals and controls (OR: 1.243, 95% CI: 0.561–2.754, P = 0.59; OR; 0.990, 95% CI: 0.442–2.217, P = 0.98; and OR: 1.699, 95% CI: 0.546–5.281, P = 0.36), respectively. Compared to type O blood group individuals, types A, B, and AB blood group individuals had 0.463, 0.690, and 0.901 times odds of developing eclampsia compared to controls (OR: 0.463, 95% CI: 0.199–1.079, P = 0.74; OR: 0.960, 95% CI: 0.505–1.825, P = 0.90; and OR; 0.901, 95% CI: 0.301–2.695, P = 0.85), respectively. Primiparity (OR: 2.320, 95% CI: 1.451 – 3.711, P = 0.01, for HDP) and gestational age (OR: 1.078, 95% CI: 1.013 – 1.148, P = 0.02 – gestational hypertension; OR: 1.328, 95% CI: 1.212 – 1.456, P = 0.01 – preeclampsia; OR: 1.467, 95% CI: 1.333 – 1.614, P = 0.01 – eclampsia) were identified as pregnancy related risk factors for HDP. Conclusion: The frequencies of ABO phenotypes in women with HDP are similar to that of normotensive pregnant women. There is no relationship between ABO phenotypes and HDP as observed in this study. However, nulliparity and gestational age were identified as risk factors for HDP. Similar hospital-based and population-based studies should be conducted to further evaluate this phenomenon in this environment.

71. Altered composition of the gut microbiota in women who develop hypertensive disorders of pregnancy

Introduction Metabolites released by the gut microbiota affect host physiology. Hypertension is associated with altered composition of the gut microbiota. In early pregnancy, the abundance of bacteria producing the short-chain fatty acid butyrate, is negatively correlated with blood pressure in the mother. Butyrate may affect blood pressure through affecting GPR41 and 43 signalling. It is unclear if gut microbiota composition is altered in women who develop hypertensive disorders of pregnancy (HDP). Objective To compare the composition of the gut microbiota at 28 weeks gestation between women who do and do not develop HDP later in pregnancy. Methods Gut microbiota composition was assessed by 16S rRNA sequencing in faecal samples obtained from participants in the Study of Probiotics IN gestational diabetes (SPRING) RCT at 28 weeks gestation. In SPRING, women were randomised to a probiotics or placebo intervention from 16 weeks gestation. Gut microbiota composition was assessed using the QIIME and Calypso software suites. The composition was compared between women with future HDP (N = 32) and those who remained normotensive (N = 182). Results Rates of HDP and overall gut microbiota composition were similar between women randomised to probiotics (7.1%, N = 15) and placebo (8.0%, N = 17; P = 0.85) and the treatment groups were therefore pooled. At 28 weeks gestation, the women with future HDP already had significantly higher systolic and diastolic blood pressures than those who remained normotensive. Women with future HDP had higher abundance of Collinsella aerofasciens, Ruminococcus gnavus, Blautia producta and Bifidobacterium longum. They had lower abundance of Faecalibacterium prausnitzii, Coprococcus eutactus and Roseburia faecis, which are all known butyrate producers. Discussion The gut microbiota of women with future HDP has lower abundance of butyrate-producing bacteria at 28 weeks gestation prior to the development of overt hypertension. This may suggest that lower abundance of short-chain fatty acid producers predisposes to the development of HDP.

330: Diet pattern is associated with an increased risk of hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, remain significant contributors to maternal morbidity and preterm birth. Despite being a therapeutic target, the contribution of diet to these disorders is largely unstudied. The Diet Approach to Stop Hypertension (DASH) approach is rich in fruits, vegetables, and low fat dairy and limited in salt, saturated fat, total fat and cholesterol. DASH adherence was linked to reduced cardiovascular risk factors and blood pressure in hypertensive, non-pregnant subjects. While the DASH approach is recommended to prevent and treat hypertension, it has not been studied in HDP. The objective of this study was to evaluate the impact of DASH diet adherence obtained before the 3rd trimester on the development of HDP. A nested case-control study within a cohort of 303 nulliparous women was conducted. Mean intake from 3 dietary recalls obtained at weeks 21-26 was coded into a DASH adherence score (0-9), where higher score is a healthier dietary pattern. A diagnosis of HDP was obtained from chart review, using ACOG definitions for disorders, confirmed by a perinatologist. Cases with HDP (n= 81) were compared to controls (n=161) with no HDP or spontaneous preterm birth. Logistic regression models tested the association of DASH score or tertiles of DASH adherence score on outcomes of HDP. Models were uncontrolled or adjusted for age, BMI, insurance, and race. Racial distribution and maternal age were not significantly different between the groups but mean BMI was slightly higher in cases, mean DASH score was lower, and high DASH diet adherence was less common in cases than controls (Table 1). Greater adherence to DASH diet was associated with reduced risk of HDP (OR -0.41, 95%CI -0.69 to -0.14) even when adjusted for race, type of insurance, BMI and age (OR -0.38, 95% CI -0.69 to -0.28) (Table 2). The lowest tertile of DASH diet adherence was associated with greatest likelihood of HDP (OR 2.52, 95%CI 1.23-5.19), even in the adjusted model (OR 2.29, 95% CI 1.03-5.19). This study demonstrates that diet is associated with the development HDP. The provision of a healthy diet emphasizing fruits, vegetables, and low-fat dairy with limited salt and fat may hold promise as a therapeutic strategy towards prevention of HDP. (Penn March of Dimes Prematurity Research Center).

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus from Rio de Janeiro, Brazil.

Pregnant women with Gestational Diabetes Mellitus (GDM) have a greater chance of developing Hypertensive Disorders of Pregnancy (HDP) by the effect of insulin resistance in nitric oxide action.This study aims to describe factors associated with the development of HDP in pregnant women with GDM, assisted in a public maternity hospital in Rio de Janeiro, Brazil. This is a cross-sectional study including 292 pregnant adult women with GDM assisted at Maternidade Escola of the Universidade Federal do Rio de Janeiro. The women were examined during pregnancy and postpartum. Data were collected between 2011 and 2014 from medical records and through in-person interviews. The Student t-test and the chi-square test were applied; additionally, the magnitude of the association between independents variables and HDP was estimated by logistic regression models. The occurrence of HDP was observed in 19.5% (n=57) of the evaluated women: 9.2% had pregnancy hypertension and 10.3% had preeclampsia. The chance of HDP was higher among women with GDM in a previous pregnancy (Odds Ratio-OR=3.8; Confidence Interval of 95%-95% CI: 1.1; 12.8) and among those who were 35 years old or older (OR 3.3; 95% CI: 1.2; 8.7) after controlling the effects of pre-gestational weight and dietary ingestion of calcium, riboflavin, thiamine, vitamin A and protein. Women that had any alteration in blood pressure in a previous pregnancy and those over 35 years old were under higher risk of HDP. The findings may help in the design of interventions aiming to prevent HDP in adult women.