Diagnosis Of Hypertensive Disorders Research Articles

The Impact of Food Insecurity on Maternal and Neonatal Outcomes

Purpose: The purpose of this study was to examine the relationship between food security status and pregnancy outcomes. Methods: This was a single-center cross-sectional cohort study of postpartum women in Indianapolis, IN. A validated 10 question Household Food Security Survey module was used to assess food security for patients who spoke English, Spanish, or Haitian-Creole. Correlating with the USDA definitions of food security, total scores were “high,” “marginal,” “low,” and “very low.” Scores were analyzed as inadequate (marginal, low, or very low) vs. adequate (high) food security. If a score fell within any category but “adequate” food security, patients were provided with information on community resources. Prenatal and postpartum data were abstracted via chart review, collecting: standard demographics, language, parity, diagnosis of diabetes, diagnosis of hypertensive disorder(s), pre-pregnancy weight, weight at time of delivery, BMI at time of delivery, gestational age at delivery, Edinburgh Postnatal Depression Scale (EPDS) score, and delivery mode. Neonatal variables included: weight and sex. The primary outcome was occurrence of gestational diabetes (GDM). These outcomes were compared between patients who had adequate vs. inadequate food security. Logistic regression was used to examine the association between food insecurity and each of the dichotomous outcomes. Linear regression was used to model the relationship between sex-specific birthweight z-scores and food insecurity. All adjusted models included language and maternal age. The Indiana University institutional review board approved the study (IRB# 14116). Results: Two hundred six surveys were completed from June 2022 through December 2022. Ninety-three participants (45.4%, 95% CI 38.4-52.4%) were categorized as inadequate food security. The incidences of marginal, low, and very low food security were similar with 31, 30, and 28 participants, respectively. Race/ethnicity and language were different between adequate and inadequate groups (p=0.006 and <0.001 respectively). The incidence of GDM was 7.9% and was not different for those with inadequate food security (OR 0.96 95% CI 0.33-2.68). Food insecurity was protective against delivery via C-section (aOR 0.50 95% CI 0.25-0.98). Food insecurity increases odds of EPDS > 9 (aOR 4.32 95% CI 1.41-16.2). Conclusions: Inadequate food security status is highly prevalent in our patient population and was associated with racial/ethnic minority status and non-English speaking populations. Inadequate food security was found to be associated with a decreased odds of cesarean delivery and higher odds of postpartum depression.

PlGF Levels and Blood Pressure in Pregnant Women with Hypertension

Hypertension in pregnancy is one of the causes of morbidity and mortality in mothers and babies. PlGF has been shown to be associated with the diagnosis of hypertensive disorders in pregnancy. Pregnant women with hypertension are characterized by reduced circulating PlGF levels, even before clinical signs and symptoms. A decrease in the amount of PlGF is positively correlated with the severity of disease progression This study aimed to analyze the relationship between PlGF levels and blood pressure in pregnant women with hypertension. Observational analytic with cross sectional study design. Sampling was total sampling. The number of subject were 34 peoples. The results showed that there was no significant correlation between PlGF levels and blood pressure in pregnant women with hypertension. PlGF levels have no relationship with blood pressure.

Pregestational body mass index and weight gain during pregnancy associated with epidemiological variables and socio-demographic

Objective To correlate the pregestational Body Mass Index and weight gain during pregnancy with various epidemiological variables. Methodology A cross-sectional study was carried out in a third level hospital in Cali, Colombia. Socioeconomic and anthropometric data, obstetric history and general medical history was collected from 300 pregnant women aged between 18 and 37. BMI was calculated at the beginning and end of pregnancy. Statistical analysis of multiple linear regression was performed. Results An increased BMI at the beginning and end of gestation positively correlated with age (Coefficient = 0.156; p=0.013, Coefficient = 0.153; p=0.011), diagnosis of gestational diabetes (Coefficient = 2.264, p=0.018, Coefficient = 0.153; p=0.011) and concern about weight gain during pregnancy (Coefficient=1.226; p=0.038, Coefficient=1.568; p=0.004). A low BMI correlated negatively with Intrauterine Growth Restriction (Coefficient=-3.208; p=0.005). Furthermore, a higher final BMI positively correlated with a diagnosis of hypertensive disorder (Coefficient=2.733; p≤0.001) and negatively with socioeconomic status (Coefficient=2.239; p=0.045). Conclusion Excessive weight gain before and during pregnancy is a predictive factor in the appearance of gestational diabetes and hypertensive disorders, differentially affecting women from low socioeconomic backgrounds. While pregnancy is a critical period in a woman’s life which may motivate positive lifestyle changes, excessive weight gain is still not perceived as a health problem.

Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana.

Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.

Machine learning-based evaluation of application value of pulse wave parameter model in the diagnosis of hypertensive disorder in pregnancy.

Hypertensive disorder in pregnancy (HDP) remains a major health burden, and it is associated with systemic cardiovascular adaptation. The pulse wave is an important basis for evaluating the status of the human cardiovascular system. This research aims to evaluate the application value of pulse waves in the diagnosis of hypertensive disorder in pregnancy.This research a retrospective study of pregnant women who attended prenatal care and labored at Beijing Haidian District Maternal and Child Health Hospital. We extracted maternal hemodynamic factors and measured the pulse wave of the pregnant women. We developed an HDP predictive model by using support vector machine algorithms at five-gestational-week stages.At five-gestational-week stages, the area under the receiver operating characteristic curve (AUC) of the predictive model with pulse wave parameters was higher than that of the predictive model with hemodynamic factors. The AUC values of the predictive model with pulse wave parameters were 0.77 (95% CI 0.64 to 0.9), 0.83 (95% CI 0.77 to 0.9), 0.85 (95% CI 0.81 to 0.9), 0.93 (95% CI 0.9 to 0.96) and 0.88 (95% CI 0.8 to 0.95) at five-gestational-week stages, respectively. Compared to the predictive models with hemodynamic factors, the predictive model with pulse wave parameters had better prediction effects on HDP.Pulse waves had good predictive effects for HDP and provided appropriate guidance and a basis for non-invasive detection of HDP.

Study of Histopathological Changes in the Placenta in Preeclampsia

Pregnancy disorders include, most commonly, hypertensive disorders, which include gestational hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. Various etiological factors prove to be both risks as well as protective factors, which include genetic factors, maternal smoking (it is inversely related to preeclampsia; that is, smoking decreases the incidence of preeclampsia), and other medical comorbidities such as hypertension, diabetes, asthma, and others, including older maternal age and high body mass index. Usually, high maternal and fetal mortality rates are seen with the diagnosis of hypertensive disorders in pregnancy, and severe morbidity is seen in cases of preeclampsia, eclampsia, and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), along with raised levels of liver enzymes and blood disorders such as low platelet counts. Preeclampsia is considered one of the most serious consequences of pregnancy. These disorders are often presented as newly diagnosed high blood pressure and proteinuria during the last trimester. But it can prove to be fatal for both the mother and the fetus. Though the causative factors of preeclampsia are still unknown, specific clinical and histopathological researchers propose that preeclampsia can be due to pathological changes in the placenta. The basic aim of this article is to discuss various histopathological changes in the placenta due to preeclampsia, but minor topics that affect the pathophysiology of the placenta due to preeclampsia are also mentioned. Furthermore, the effective management of maternal syndrome complications in pregnancy has also been discussed.

Neighborhood disadvantage and the racial disparity in postpartum hypertension

Postpartum hypertension is the leading cause of postpartum readmission and has long-lasting cardiovascular effects. Black patients have higher incidence rates of hypertensive disorders after delivery and subsequent severe maternal morbidity. Neighborhood advantage, a marker of social determinants of health, has not been studied concerning postpartum hypertension. Moreover, the interplay between race and neighborhood advantage and their effect on postpartum hypertension have not been previously explored. This study aimed to evaluate the association between neighborhood-level social determinants of health and postpartum hypertension and explore whether these factors explain previously documented racial disparities. This study included a retrospective cohort of people enrolled in a remote monitoring program of postpartum hypertension at the time of delivery within 1 health network from March 2019 to September 2021. Patients were eligible for enrollment after a diagnosis of hypertensive disorder during pregnancy or delivery. We further limited the cohort to self-reported Black and White patients with blood pressures recorded at 3 weeks and 6 weeks postpartum. The neighborhood advantage for each person at the time of delivery was classified using the area deprivation index, an accepted surrogate of social determinants of health and our primary exposure. The secondary exposure was self-reported race. Study outcomes of interest were hypertensive status (stage 1 hypertension: ≥130 to 139/80 to 89 mm Hg; stage 2 hypertension: ≥140/90 mm Hg) at 3 and 6 weeks after delivery. In addition, hypertensive status by neighborhood area deprivation index using logistic regression was molded. In secondary analyses, a case-control cohort matched on the area deprivation index was created, and conditional logistic regression was used to evaluate race. Finally, mixed-effects models modeling hypertension by race and clustering within the area deprivation index were used. Of 4193 people enrolled, 2722 were Black or White and had blood pressure data recorded at 3 weeks after delivery, and 1126 had blood pressure data recorded at 6 weeks after delivery. After accounting for prenatal body mass index, smoking status, type of hypertension, and antihypertensives prescribed at discharge, persons living in the most disadvantaged neighborhoods were twice as likely (adjusted odds ratio, 2.03; 95% confidence interval, 1.53-2.69) to develop stage 2 hypertension at 21 days after delivery and 1.67 times more likely (95% confidence interval, 1.06-2.64) to develop stage 2 hypertension at 6 weeks after delivery than persons living in the most advantaged neighborhoods. Both associations were attenuated after adjusting for race. When people with stage 2 hypertension were matched on area deprivation index with normotensive counterparts, Black patients were still 3 to 4 times more likely to develop stage 2 hypertension at 3 (adjusted odds ratio, 3.00; 95% confidence interval, 1.95-4.63) and 6 (adjusted odds ratio, 4.61; 95% confidence interval, 2.05-10.36) weeks after delivery. This association remained after clustering within a neighborhood at 3 (adjusted odds ratio, 3.12; 95% confidence interval, 2.41-4.06) and 6 (adjusted odds ratio, 2.99; 95% confidence interval, 1.96-4.54) weeks after delivery. There was no significant difference in stage 1 hypertension. Neighborhood advantage was associated with the development of persistent hypertension at 3 and 6 weeks after delivery. This association did not explain the racial disparity in sustained high blood pressure.

Difference in Blood Pressure Measurements in Pregnant Women when using the Gold Standard Method versus Clinical Measurements

BackgroundThe World Health Organization lists hypertensive disorders in pregnancy as one of the leading causes of maternal death. It is also known that each year more than 10 million women worldwide suffer from preeclampsia, one of the hypertensive disorders in pregnancy. The accuracy of blood pressure measurement is crucial to making the correct diagnosis and treatment of hypertensive disorders of pregnancy. Taking a BPM is one of the most basic clinical assessments that is done by members of the healthcare team. However, it is often one of the most inaccurately performed assessments. Accurate measurement is critical for proper diagnosis, assess risk, and correct treatment. Inaccurate assessments can cause delay in diagnosis of a hypertensive disorder and increase risks to the mother and child. Conversely, falsely elevated measurements can lead to unnecessary treatments that may be harmful. The American College of Cardiology/American Heart Association recommended guidelines for performing Blood Pressure Measurements that include not smoking, exercising, or drinking caffeinated beverages for 30 minutes prior to measurement. Measurements are taken after 5‐minutes rest in a seated position with arms at the level of the heart without talking. Two measurements, one minute apart, should be taken, preferably with a stethoscope and manual blood pressure cuff, with the average of the values recorded as the blood pressure measurement. Our study aimed to fill a critical gap in knowledge of how blood pressure measurement using the ACC/AHA gold standard guideline compared to routinely taken clinical blood pressures of pregnant women.MethodsWe performed blood pressure measurements on 44 pregnant women following ACC/AHA guidelines. These results were compared to the closest clinical blood pressure measurement that we extracted from the medical record. Duplicate measurements were averaged and Student's t‐test was used to compare the measurement types. P<0.05 was considered significant.ResultsOur results demonstrated a significant statistical difference between blood pressure measurements taken using the AHA/ACC guidelines (N=44, systolic= 108.14 + 11.75 mmHg, diastolic = 66.93 + 8.81 mmHg,) compared to measurements recorded at clinic appointments (systolic = 116.29 + 9.47 mmHg (P<0.001), diastolic = 71.11 + 9.47 mmHg, P=0.004). The average maternal age was 32.2 +/‐ 4.1 years. The average gestational age of participants was 25.8 +/‐ 7.9 weeks, and the average body mass index was 26.7 +/‐ 4.2 kg/m2.ConclusionThese results reinforce the importance of following the ACC/AHA guidelines for blood pressure measurement in clinical practice. Clinic measurements may be falsely elevated in pregnancy.

Technology for early differential diagnosis of hypertensive disorders during pregnancy

BACKGROUND: To date, no test provides sufficient sensitivity and specificity for the early diagnosis of severe preeclampsia. Meanwhile, severe preeclampsia is a condition that threatens the life of not only the mother, but also the fetus, and requires a solution to the issue of delivery. Therefore, the search for markers of severe preeclampsia is still relevant today.
 AIM: The aim of this study was to create a technology that allows for early differential diagnosis of hypertensive disorders during pregnancy based on a comprehensive analysis of echocardiographic data.
 MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 112 cases of labor was carried out. The total sample was divided into five study groups: 30 relatively healthy women (group 1); 25 patients with chronic arterial hypertension (group 2); 21 patients with gestational arterial hypertension (group 3); 13 patients with moderate preeclampsia (group 4); and 23 patients with severe preeclampsia (group 5). The groups were formed in accordance with current clinical guidelines. Echocardiographic examination in all cases was carried out upon admission to the hospital. Statistical processing of the results was performed using the IBM SPSS Statistics Version 25.0 program.
 RESULTS: The technology for early differential diagnosis of hypertensive disorders during pregnancy is implemented based on a multilayer perceptron, the percentage of incorrect predictions being 20.5 %. The structure of the trained neural network included six input neurons: gestational age, left atrium size in the parasternal position, right ventricular size, interventricular septal thickness, systolic blood flow velocity, and pressure gradient in the pulmonary artery.
 CONCLUSIONS: Comprehensive analysis of echocardiographic data allows for early differential diagnosis of hypertensive disorders during pregnancy, while considering the result of neural network analysis as an additional criterion for severe preeclampsia. In the future, the use of this technology in clinical practice will not only optimize the tactics of managing patients with hypertensive disorders at admission to the hospital, but also reduce the incidence of adverse obstetric and perinatal outcomes.

An hypothetical external validation of the ARRIVE trial in a European academic hospital

Background Recent evidence supports elective induction of labor at 39 weeks in low-risk pregnancies to improve maternal and perinatal outcomes. This evidence includes the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management). However, concerns have been raised on the external validity of the ARRIVE trial, especially with regard to the demographic and clinical characteristics of the pregnant women recruited. Objective This study compared the outcomes in a cohort of consecutive pregnant women, who fulfilled the criteria of the ARRIVE trial and were managed expectantly in an Italian referral academic hospital, with those reported in the expectant and induction arms of the ARRIVE trial. Study design This was a retrospective single-center study. Consecutive low-risk nulliparous women who fulfilled the ARRIVE trial criteria were evaluated for eligibility at 36-38 weeks of gestation. Those who neither developed complications nor delivered spontaneously before 39 weeks were eligible for this comparative analysis. Maternal and fetal growth and wellbeing were screened and monitored from 36 to 38 weeks of gestation Results A total of 1696 patients met the established criteria at recruitment. Of these, 343 spontaneously delivered in <39 weeks, 82 delivered because of maternal indication, and 37 for fetal indication. A total of 1234 pregnant women were eligible for comparison with the elective induction and the expectant management groups of the ARRIVE trial. The socioeconomic status was significantly better, maternal age was significantly higher, and body mass index was significantly lower in our cohort. Cesarean section rate in our cohort was lower than that of the expectant group of the ARRIVE trial (18.7 vs. 22.2%; p = 0.02) and similar to that of the elective induction group (18.7 vs. 18.6%). A new diagnosis of hypertensive disorders during expectant management was noted in 1.6% in our cohort vs. 14.1% in the ARRIVE arm. Among the different obstetric outcomes, only the prevalence of postpartum hemorrhage was not significantly lower in our cohort. The primary perinatal composite outcome was significantly better in our cohort than in both arms of the ARRIVE trial (2.1 vs. 5.4% in the expectant group and 4.3% in the induction group). We did not record cases with an Apgar score ≤ 3 or hypoxic-ischemic encephalopathy. Conclusion In our cohort, expectant management in low-risk pregnancies with late preterm screening of feto-maternal well-being seemed to achieve better maternal and perinatal outcomes than a universal policy of induction at 39 weeks. The results of the ARRIVE trial should be carefully evaluated in different demographic and clinical settings and cannot be extended to the general population.

Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes.

Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.

Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders.

Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, constituting one of the most significant causes of maternal morbidity and mortality. Hypertensive disorders, specifically gestational hypertension, chronic hypertension, and preeclampsia, throughout pregnancy are contributors to the top causes of maternal mortality in the United States. Diagnosis of hypertensive disorders throughout pregnancy is challenging, with many disorders often remaining unrecognized or poorly managed during and after pregnancy. Moreover, the research has identified a strong link between the prevalence of maternal hypertensive disorders and racial and ethnic disparities. Factors that influence the prevalence of maternal hypertensive disorders among racially and ethnically diverse women include maternal age, level of education, United States-born status, nonmetropolitan residence, prepregnancy obesity, excess weight gain during pregnancy, and gestational diabetes. Examination of the factors that increase the risk for maternal hypertensive disorders along with the current interventions utilized to manage hypertensive disorders will assist in the identification of gaps in prevention and treatment strategies and implications for future practice. Specific focus will be placed on disparities among racially and ethnically diverse women that increase the risk for maternal hypertensive disorders. This review will serve to promote the development of interventions and strategies that better address and prevent hypertensive disorders throughout a pregnant woman's continuum of care.

Association of fetal gender and the onset and severity of hypertensive disorders of pregnancy

Objective It was reported that fetal gender was associated with gestational-age related incidence of preeclampsia. However, there is no study to date to evaluate the association of fetal gender differences with all hypertensive disorders of pregnancy. The present study aimed to evaluate the association, if any, between fetal gender differences and the disposition to develop hypertensive disorders of pregnancy and the risk of developing severe features. Methods This was a single site retrospective cohort that included patients who were diagnosed with either gestational hypertension, preeclampsia without severe features, severe preeclampsia, superimposed preeclampsia, or superimposed preeclampsia with severe features. Patients were divided into two groups based on male versus female fetal gender. Our primary outcome was gestational age (GA) at diagnosis of hypertensive disorder. GA ranges evaluated were <28 weeks, 28–34 weeks, 34–37 weeks, and >37 weeks. Secondary outcomes were maternal morbidity (severe features at delivery, HELLP syndrome, placental abruption, eclampsia, maternal death, and maternal intensive care unit (ICU) admission), GA range at delivery, indication for delivery, and fetal outcomes. Continuous data were analyzed using an unpaired t-test and categorical data was analyzed using Chi-square test. A probability level was <.05 was set as statistically significant. Results A total of 597 patients were included, 275 with male fetus and 322 with female fetus. Demographic comparison between the two groups showed similar rates in patients complicated with chronic hypertension, but a higher incidence of antihypertensive medication used in the male fetus group, p < .05. All other demographics were similar between the two groups. There were no significant differences in maternal primary and secondary outcomes, including GA range at diagnosis and severe features at delivery, and fetal outcomes, including neonatal intensive care unit (NICU) admission, evaluated between the two groups. Conclusion Our study did not find significant differences between fetal gender and GA at the diagnosis of hypertensive disorders of pregnancy or development of severe features in the study subjects.

Characteristics of Postpartum Patients Readmitted for Management of Hypertensive Disorders of Pregnancy [09M

INTRODUCTION: To identify risk factors of patients who are readmitted in the immediate postpartum period for management of hypertensive disorders. METHODS: Retrospective cohort study from 2012-2019 at a tertiary care academic center of all women with a diagnosis of hypertensive disorders during the delivery admission. Maternal characteristics for women readmitted within 30 days postpartum were compared to those not readmitted. RESULTS: Of 40,124 deliveries, 8361 were identified as having a hypertensive disorder (20.8%). 85 were subsequently readmitted for management of hypertension in the postpartum period (1%). Maternal age was significantly correlated with a higher rate of readmission (P&lt;.001). No differences were noted among BMI, gestational age, race/ethnicity, chronic hypertension diagnosis, nulliparity, or multiple gestations. Readmitted patients showed a significantly higher rate of antihypertensive use during the delivery admission (1.33% vs 0.95%, P=.049) and those discharged on labetalol had a higher rate of readmission when compared to those discharged on nifedipine (1.51% vs 0.63%, P=.058). Patients with private insurance were more likely to be readmitted versus those with Medicaid insurance (1.25% vs 0.59%, P=.012). CONCLUSION: Women with hypertensive disorders discharged home on antihypertensive medication are more likely to be readmitted during the postpartum period and may benefit from increased vigilance during this time period. Further investigation is needed to determine the effect of insurance on readmission rate and if social determinants of health impact postpartum hypertension follow up visits. The use of nifedipine versus labetalol also warrants further investigation as there appears to be a trend towards improved blood pressure control with nifedipine.

The maternal and perinatal implications of hypertensive disorders of pregnancy in a multiple pregnancy cohort.

Hypertensive disorders of pregnancy are common and may result in increased maternal and neonatal morbidity and mortality. Multiple pregnancies confer an increased risk of development of a hypertensive disorder of pregnancy. The purpose of this study was to examine a large cohort of women delivering a multiple pregnancy in a single large tertiary unit, and to evaluate the implications of hypertensive disorders of pregnancy on both maternal and perinatal outcomes. Retrospective study of all twin pregnancies delivered at Cork University Maternity Hospital, Ireland over a 9-year period (2009-2017). The twin pregnancies were divided according to the presence or absence of hypertensive disorder of pregnancy and the two groups were compared. Maternal age >40years, nulliparity, conception through use of a donor oocyte, and presence of obstetric cholestasis are all risk factors for the development of hypertensive disorders of pregnancy in women with a multiple pregnancy. When a hypertensive disorder complicates a twin pregnancy, it increases the incidence of iatrogenic late prematurity and neonatal hypoglycemia. This study is informative for clinicians caring for women with a multiple pregnancy with its relevant data on perinatal outcomes following a diagnosis of hypertensive disorder in pregnancy.

Diagnosis of hypertensive disorders in pregnancy: an update

Hypertensive disorders occur in up to 10% of pregnancy and can seriously affect the mother and fetal health. Pre-eclampsia (PE) and eclampsia are the most severe forms of hypertensive disorders and are associated with short- and long-term sequelae. PE is defined by the presence of blood pressure elevation (>140/90 mmHg) and relevant proteinuria (more than 300 mg/24 h) or, in the absence of proteinuria, the increase of creatinine concentration or a low platelet count or the increase of liver transaminases or presence of pulmonary edema, visual disturbances, neurological signs or utero-placental dysfunctions that lead to felt growth retardation. Eclampsia is a convulsive condition associated with PE or haemolysis, elevated liver enzymes, and low platelet count syndrome. This review aimed at focusing on the correct classification and at accurately describing clinical and biochemical features of PE. Early detection of PE/eclampsia and accurate prediction of maternal risk of developing PE is crucial in the management of this threatening condition.

Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study.

ObjectivesA diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks.DesignQualitative study using modified grounded theory.SettingTwo states in rural India: Haryana and Andhra Pradesh.PopulationPregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials.MethodsIn‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken.ResultsSeven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal.ConclusionsThere is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings.Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India.Tweetable abstractImproved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.

Differential diagnosis of hypertensive disorders in pregnancy using urine peptidome profiling

Differential diagnosis of hypertensive disorders in pregnancy using urine peptidome profiling

27. Associations between postpartum depression and hypertensive disorders of pregnancy

Objectives To identify the possible relationships between PPD and HDP in women in a public maternity, and the associated factors. Study design Prospective cross-sectional study with 168 puerperal women diagnosed with HDP (hypertensive women) and their controls (normotensive women) and their newborns. Diagnosis of SAH was indicated when systolic pressure was 140 mmHg or higher or diastolic pressure was 90 mmHg or higher; the diagnosis and severity of the disease were based on blood pressure, proteinuria, and clinical and laboratory findings. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the risk of postpartum depression. Scores ⩾12 were considered to indicate the presence of depressive symptomatology. Main outocome measures Probability of depressive symptoms according to the EPDS. Results The probability of postpartum depressive symptoms was positively related with the diagnosis of hypertensive disorders of pregnancy (rS = 0.219, p ⩽ 0.004), premonitory signs (rS = 0.171, p = 0.027), use of magnesium sulfate (rS = 0.199, p = 0.010), and DBP (rS = 0.165, p = 0.033), and use of milk formula during hospitalization (rS = 0.152, p = 0.048). Conclusions Puerperal women diagnosed with HDP are more likely to have depressive symptoms.

Applications of Surface Enhanced Raman Scattering toward the Detection of the Bioactive Lipid 20-HETE

The detection and analysis of lipids in biological matrices for clinical applications poses many challenges, but rapid and reliable detection will prove invaluable for clinical diagnosis. Herein, we report the application of drop-cast triangular Ag nanoplatelets as surface enhanced Raman scattering (SERS) substrates for qualitative detection of 20-hydroxyeicosatetraenoic acid (20-HETE), which is a potential biomarker for diagnosis of hypertensive disorders. The substrates were modified to increase SERS signal enhancement of 20-HETE, both by itself and in combination with structurally similar lipids that are known to exist in significantly high concentrations in human blood, simulating an ethanol extract of plasma, and analyzed with a Raman system employing a 532 nm laser excitation source. Biomarker peaks of 20-HETE can be reliably detected and differentiated from those of the structurally similar lipids (arachidonic acid, eicosapentaenoic acid, and docosahexaenoic acid) commonly found in human blood, eve...