Diagnosis Of Hypertensive Disorders Of Pregnancy Research Articles

Protocol for Evaluating Remote Patient Blood Pressure Monitoring Adapted to Black Women and Birthing Persons.

Cardiovascular disease is the leading cause of maternal death among Black women in the United States. A large, urban hospital adopted remote patient blood pressure monitoring (RBPM) to increase blood pressure monitoring and improve the management of hypertensive disorders of pregnancy (HDP) by reducing the time to diagnosis of HDP. The digital platform integrates with the electronic health record (EHR), automatically inputting RBPM readings to the patients' chart; communicating elevated blood pressure values to the healthcare team; and offers a partial offset of the cost through insurance plans. It also allows for customization of the blood pressure values that prompt follow-up to the patient's risk category. This paper describes a protocol for evaluating its impact. Objective 1 is to measure the effect of the digitally supported RBPM on the time to diagnosis of HDP. Objective 2 is to test the effect of cultural tailoring to Black participants. The ability to tailor digital content provides the opportunity to test the added value of promoting social identification with the intervention, which may help achieve equity in severe maternal morbidity events related to HDP. Evaluation of this intervention will contribute to the growing literature on digital health interventions to improve maternity care in the United States.

Increased Rates of Hypertensive Disorders of Pregnancy during the COVID-19 Pandemic.

Hypertensive disorders of pregnancy (HDP) are common complications associated with severe maternal and neonatal morbidity. One goal of prenatal care, especially at term, is to screen for HDP. As treatment of HDP centers on delivery when appropriate, timely diagnosis is crucial. We postulated that reduced in-person visits during the coronavirus disease 2019 (COVID-19) pandemic may have resulted in delayed diagnosis of HDP with concomitant higher rates of maternal morbidity. We sought to investigate the prevalence of HDP during the COVID-19 pandemic, as well as median gestational age at time of delivery as compared with the prepandemic median. This was a retrospective cohort analysis comparing singleton deliveries at four large-volume hospitals during the COVID-19 pandemic (April-July 2020 during a statewide "stay-at-home" order) to those in a pre-COVID era (April-July 2019). Deliveries complicated by HDP were identified by International Classification of Disease, Tenth Revision codes. Rates of HDP and markers of severe disease were the primary outcomes compared between the groups; multivariate regression was used to calculate the odds ratio of severe disease among women with any diagnosis of HDP. The cohort included 9,974 deliveries: 5,011 in 2020 and 4,963 in 2019. Patient characteristics (age, body mass index, race, ethnicity, and insurance type) did not differ significantly between the groups. There was an increase in HDP during the COVID era (9.0 vs. 6.9%; p < 0.01), which was significant even when controlling for patient parity (odds ratio = 1.41, 95% confidence interval: 1.20-1.66). Among women with HDP, gestational age at delivery did not differ between the cohorts, nor did the proportion of patients with severe disease. We found a statistically significant increase in the rate of HDP during the COVID-19 pandemic. However, there was no change in the proportion of severe disease, suggesting that this increase did not significantly impact clinical morbidity. · Rates of HDP increased during the COVID-19 pandemic.. · There was no change in the proportion of severe HDP.. · HDP-related maternal/neonatal morbidity was unchanged..

Women's heart clinics to prevent cardiovascular disease in women with pregnancy-related risk factors: a prospective study

Abstract Background A woman’s risk of cardiovascular disease (CVD) is substantially increased after a diagnosis of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), or have had a small for gestational age (SGA) baby. However, evidence for models of care that mitigate CVD risk in women with these pregnancy-related conditions is lacking. Purpose To assess the effectiveness of a Women’s Heart Clinic (WHC) on blood pressure (BP) and lipid control in women with past pregnancy-related cardiovascular risk factors. Method A six-month prospective cohort study of women aged 30-55 years with a past pregnancy diagnosis of HDP, GDM or an SGA baby. All women attended a multidisciplinary WHC comprising a cardiologist, a cardiac nurse, and a dietician, located in three cardiovascular healthcare service centers in Australia. Women were assessed at their first attendance of the WHC and at 6 months. The co-primary endpoints were: 1) BP&amp;lt;140/90mmHg or &amp;lt;130/80mmHg if diabetes mellitus and 2) total cholesterol to high density lipoprotein-cholesterol ratio (TC:HDL-C)&amp;lt;4.5. Results 156 women were recruited with a mean age of 41.0±4.2 years, 68.6% Caucasian, 20.5% South/East Asian and 80.5% university educated. Women were a mean of 3.9±2.9 years from last delivery with 23.1% past HDP only, 60.3% GDM only, 13.5% both HDP and GDM and, 3.2% with an SGA baby. All women attended a WHC at least once, with 69.5% reviewed by a dietician. The proportion meeting BP target increased (69.2% to 80.5%, p=0.004); with no significant change in women meeting lipid targets (80.6% to 83.7%, p=0.182). Women had significant reductions in mean systolic BP (-6.9mmHg, 95% confidence interval (CI): -9.1,-4.7, p&amp;lt;0.001), body mass index (-0.6kg/m2, CI: -0.8,-0.3, p&amp;lt;0.001), LDL-cholesterol (-4.2mg/dL, CI: -8.2,-0.2, p=0.042) and total cholesterol (-4.6mg/dL, CI: -9.1,-0.2, p=0.042). Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, p=0.012) and decreased fast food consumption (33.8% to 11.0%, P&amp;lt;0.001), with more women meeting exercise recommendations (84.0% to 92.9%, p=0.025). Conclusion Women at high risk for CVD due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors, after attending a Women’s Heart Clinic. This female-specific cardiovascular healthcare model has the potential to improve long-term CVD outcomes for women.Figure 1:Visual abstract

Pregnancy outcomes and disease phenotype of hypertensive disorders of pregnancy in singleton pregnancies after in vitro fertilization: a retrospective analysis of 1130 cases

BackgroundAlthough in vitro fertilization (IVF) can increase the incidence of hypertensive disorders of pregnancy (HDP), the pregnancy outcomes and disease phenotype of HDP in singleton pregnancies conceived via IVF remain unclear.MethodsThis retrospective cohort study enrolled 1130 singleton pregnancies with HDP from 2016 to 2020. According to the mode of conception, they were allocated into IVF (n = 102) and natural conception (NC) groups (n = 1028). All IVF pregnancies were subdivided into frozen embryo transfer (FET) group (n = 42) and fresh embryo transfer (ET) group (n = 60). Demographic data, pregnancy outcomes and disease phenotypes of HDP among the groups were compared. The risk factors for severe preeclampsia (PE) and early-onset PE were analyzed.ResultsThe incidences of early-onset PE (P<0.001), severe PE (P = 0.016), cesarean section (P<0.001) and preterm births (P = 0.003) in the IVF-HDP group were significantly higher than those in the NC-HDP group, and gestational age at diagnosis of HDP (P = 0.027) and gestational age at delivery (P = 0.004) were earlier and birthweight of the neonates (P = 0.033) were lower in the IVF group. In singleton pregnancies with HDP, IVF was associated with increased risks for both severe PE and early-onset PE (aOR 1.945, 95% CI 1.256, 3.014; and aOR 2.373, 95% CI 1.537, 3.663, respectively), as well as FET, family history of preeclampsia, intrahepatic cholestasis of pregnancy, gestational hypothyroidism and multiparity were associated with increased risks of severe PE and early-onset PE.ConclusionsIn singleton pregnancies with HDP, IVF was associated with an increased incidence of the disease phenotype (severe or early-onset PE), as well as an increased incidence of pregnancy outcomes related to severe PE and early-onset PE.

Antihypertensive medication use during pregnancy in a real-world cohort of patients diagnosed with a hypertensive disorder of pregnancy.

Hypertensive disorders of pregnancy (HDP) are rising in prevalence and associated with adverse maternal and infant health outcomes. Current guidelines recommend labetalol, nifedipine, and methyldopa as acceptable first-line agents to treat HDP in outpatient settings. However, the current practice regarding antihypertensive medication usage and selection remain unclear. A retrospective, observational cohort study was conducted in 1,641 patients with a physician diagnosis of HDP who delivered at two academic medical centers in North Carolina from 2014 to 2017. Use of any antihypertensive medication, and the agent selected, at any encounter during pregnancy or on the delivery date was collected from the electronic health record. Proportions were compared across HDP diagnosis (eclampsia/severe preeclampsia, chronic hypertension with superimposed preeclampsia, preeclampsia, gestational hypertension) by Chi-square tests and multivariable logistic regression. Antihypertensive medications were used in 1,276 (77.8%) patients overall. Among treated patients, labetalol (74.9%) was the most frequently used medication followed by nifedipine (29.6%) and hydralazine (20.5%). Methyldopa was used infrequently (4.4%). HDP type was the strongest factor associated with use of an antihypertensive agent. Relative to gestational hypertension, antihypertensive use was significantly more likely [odds ratio (95% CI)] in patients with severe preeclampsia [5.94 (3.85-9.16)], chronic hypertension with superimposed preeclampsia [4.99 (3.46-7.19)], and preeclampsia [2.13 (1.61-2.82)]. In a real-world setting, antihypertensive medication use among HDP patients was common, labetalol, nifedipine, and hydralazine were the most commonly selected agents, and increasing HDP severity was associated with a higher likelihood of antihypertensive use. Future studies comparing medication effectiveness in pregnant patients with distinct HDP diagnoses are needed.

Effect of Telehealth Adaptation on the Diagnosis of Hypertensive Disorders of Pregnancy [ID: 1358276

INTRODUCTION: COVID-19 caused a rapid integration of telehealth into prenatal care. This study aims to assess the effect of telehealth adaptation on timing and severity of the diagnosis of hypertensive disorders of pregnancy (HDP). METHODS: This is an IRB-approved retrospective cohort study of patients with HDP who delivered from April to October of 2019 (pre-pandemic) and 2020 (pandemic) at one urban tertiary care center. The primary outcome was mean gestational age at diagnosis of HDP. Secondary outcomes included initial and final severity of diagnosis before delivery. Results were adjusted for baseline characteristics different at P&lt;.10, using multivariable logistic regression and ANCOVA as appropriate. RESULTS: Four hundred ninety-eight patients were included, with 231 from 2019 and 267 from 2020. 17.1% had preeclampsia with severe features initially, and 29.3% met these criteria by delivery. In 2020, 80.5% of patients used telehealth (versus 0.9% in 2019), doing so for a mean of 29% of prenatal appointments. Unadjusted and adjusted analyses showed no significant difference in gestational age at diagnosis or diagnosis severity between cohorts. In the adjusted analysis, Black race was significantly associated with initial diagnosis severity (odds ratio [OR] 1.7 [1.0–2.8], P=.046); telehealth use as represented by cohort year was not (0.9 [0.5–1.3], P=.54). Black race (OR 2.6 [1.6–4.3], P&lt;.001), non-Hispanic ethnicity (OR 0.4 [0.2–0.8], P=.04), and body mass index (OR 1.04 [1.0–1.1], P=.005) were significantly associated with final diagnosis severity; telehealth use was not (OR 1.0 [0.6–1.4], P=.87). CONCLUSION: The adaptation of telehealth is not associated with a change in timing or severity of diagnosis of HDP.

Association between Pregestational Vaginal Dysbiosis and Incident Hypertensive Disorders of Pregnancy Risk: a Nested Case-Control Study.

A balanced vaginal microbiome dominated by Lactobacillus can help promote women's reproductive health, with Lactobacillus crispatus showing the most beneficial effect. However, the potential role of vaginal microbiomes in hypertensive disorders of pregnancy (HDP) development is not thoroughly explored. In this nested case-control study based on an assisted reproductive technology follow-up cohort, we prospectively assessed the association between pregestational vaginal microbiomes with HDP by collecting vaginal swabs from 75 HDP cases (HDP group) and 150 controls (NP group) and using 16S amplicon sequencing for bacterial identification. The vaginal microbial composition of the HDP group significantly differed from that of the NP group. The abundance of L. crispatus was significantly lower, and the abundances of Gardnerella vaginalis was significantly higher, in the HDP group than in the NP group. Of note, L. crispatus-dominated vaginal community state type was associated with a decreased risk for HDP (odds ratio = 0.436; 95% confidence interval, 0.229 to 0.831) compared with others. Additionally, network analysis revealed different bacterial interactions with 61 and 57 exclusive edges in the NP and HDP groups, respectively. Compared with the HDP group, the NP group showed a higher weighted degree and closeness centrality. Several taxa, including G. vaginalis, L. iners, and bacterial vaginosis-associated bacteria (Prevotella, Megasphaera, Finegoldia, and Porphyromonas), were identified as "drivers" for network rewiring. Notable alterations of predicted pathways involved in amino acid, cofactor, and vitamin metabolism; membrane transport; and bacterial toxins were observed in the HDP group. IMPORTANCE The etiology of HDP remains unclear to date. Effective methods for the individualized prediction and prevention are lacking. Pregestational vaginal dysbiosis precedes the diagnosis of HDP, providing a novel perspective on the etiology of HDP. Early pregnancy is the critical period of placental development, and abnormal placentation initiates HDP development. Thus, disease prevention should be considered before pregnancy. Vaginal microbiome characterization and probiotic interventions before pregnancy are preferred because of their safety and potential for early prevention. This study is the first to prospectively assess associations between pregestational vaginal microbiome and HDP. L. crispatus-dominated vaginal community state type is linked to a reduced risk for HDP. These findings suggest that vaginal microbiome characterization may help identify individuals at high risk for HDP and offer potential targets for the development of novel pregestational intervention methods.

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women.

We aimed to examine prospective associations between different intensities and different types of physical activity (PA) in early pregnancy and hypertensive disorders of pregnancy (HDP) among Chinese women. A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study. The pregnancy physical activity questionnaire (PPAQ) was used to assess PA, including household/caregiving, occupational, sports/exercise, and transportation activities in the first trimester of pregnancy. The diagnosis of HDP was collected, including gestational hypertension (GH) and preeclampsia (PE). Data were analyzed by unconditional multivariate logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. A total of 178 (2.6%) of the 6,820 women were diagnosed with HDP, of which 126 (1.8%) were GH and 52 (0.8%) were PE. Overall, we found no association between PA in early pregnancy and PE. A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity (MVPA) (adjusted OR 0.54, 95% CI 0.31-0.96). No association was observed between PA and HDP in early pregnancy, regardless of different intensities or types of PA. MVPA in the first trimester is an influencing factor of HDP. Encouraging pregnant women to engage in MVPA in the first trimester may help to prevent GH.

The Association of Vitamin D and Its Pathway Genes' Polymorphisms with Hypertensive Disorders of Pregnancy: A Prospective Cohort Study.

Objective: We aimed to explore the effect of single nucleotide polymorphism (SNP) in the genes of the vitamin D (VitD) metabolic pathway and its interaction with VitD level during pregnancy on the development of hypertensive disorders of pregnancy (HDP). Methods: The study was conducted in the Zhoushan Maternal and Child Health Care Hospital, China, from August 2011 to May 2018. The SNPs in VitD metabolic pathway-related genes were genotyped. Plasma 25-hydroxyvitamin vitamin D (25(OH)D) levels was measured at first (T1), second (T2), and third (T3) trimesters. The information of systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the diagnosis of HDP were extracted from the electronic medical record system. Multivariable linear and logistic regression models and crossover analysis were applied. Results: The prospective cohort study included 3699 pregnant women, of which 105 (2.85%) were diagnosed with HDP. After adjusting for potential confounders, VitD deficiency at T2, as well as the change of 25(OH)D level between T1 and T2, were negatively associated with DBP at T2 and T3, but not HDP. Polymorphisms in CYP24A1, GC, and LRP2 genes were associated with blood pressure and HDP. In addition, VitD interacted with CYP24A1, GC, and VDR genes’ polymorphisms on blood pressure. Furthermore, participants with polymorphisms in CYP24A1-rs2248137, LRP2-rs2389557, and LRP2-rs4667591 and who had VitD deficiency at T2 showed an increased risk of HDP. Conclusions: The individual and interactive association between VitD deficiency during pregnancy and SNPs in the genes of the VitD metabolic pathway on blood pressure and HDP were identified.

Prevalence of long term metabolic, cardiovascular, cerebrovascular and renal disease in patients with hypertensive disorders in pregnancy remote from pregnancy (POMCH).

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of long-term cardiovascular, cerebrovascular, and adverse renal outcomes. Biomarkers including soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF) are predictive of the development of preeclampsia. Their long-term value in predicting which women will develop cardiovascular complications remote from pregnancy is not yet established. To determine the prevalence and incidence of Cardio-renal-metabolic outcomes at 10years follow-up in a cohort of women screened for suspected preeclampsia from 2008 to 2009 and assess the relationship between pregnancy biomarkers and long-term outcomes. A retrospective cohort study of 117 women. Outcomes were assessed by auditing medical records. The primary outcome was the prevalence of cardiovascular, cerebrovascular, metabolic and renal outcomes at 10years remote from the diagnosis of HDP. The secondary outcome was to assess the relationship of the remote from pregnancy outcomes to biomarkers (sFlt1, PlGF, soluble endoglin (sEng) and neutrophil gelatinase associated lipocalin (NGAL)) taken at the time of pregnancy comparing the results of those with adverse outcomes compared to those without. There was a 12.7% prevalence of cardiovascular and cerebrovascular disease, 44.4% prevalence of hypertension, 20.6% prevalence of chronic kidney disease and 17.5% prevalence of diabetes. Women who developed preeclampsia had an increased prevalence and incidence of adverse outcomes compared to women without preeclampsia. There was a weak relationship between sENg measured at the time of clinical suspicion of preeclampsia and the adverse outcomes 144 (139-146) months remote from pregnancy. Biomarkers taken at the time of pregnancy did not accurately predict the long-term adverse cardiometabolic outcomes.

Risk of unplanned healthcare utilization in postpartum period for patients with hypertensive disorders of pregnancy.

To determine which factors are associated with unplanned postpartum healthcare utilization, including hospital readmission and unplanned outpatient and emergency room visits, in patients with hypertensive disorders of pregnancy (HDP). This was a case control study of patients with HDP delivering at a single academic institution from 2014 through 2018. The diagnosis of HDP included chronic hypertension, gestational hypertension, preeclampsia and superimposed preeclampsia. Using bivariate and multivariate analysis, demographic and clinical characteristics were compared between patients who had unplanned healthcare utilization, defined as readmission to the hospital, emergency room visit or unplanned outpatient encounter in the first 6-weeks postpartum, and those patients who did not. Of the 1427 patients with HDP included in this analysis, 174 (12.2%) had unplanned postpartum healthcare utilization. Maternal non-Hispanic Black race and ethnicity and presence of mild blood pressures on the day of discharge after delivery were associated with higher odds of unplanned healthcare utilization (aOR 1.67, 95% CI 1.08 - 2.56 and aOR 1.59, 95% CI 1.12 - 2.27, respectively). In contrast, presence of chronic hypertension was associated with lower odds of unplanned postpartum healthcare utilization (aOR 0.47, 95% CI 0.28 - 0.79) CONCLUSION: Among postpartum patients with HDP, non-Hispanic Black race and ethnicity and discharge home with mild range blood pressures were associated with higher odds of unplanned healthcare utilization in the first 6weeks postpartum, while chronic hypertension was associated with lower odds.

Peripartum echocardiographic changes in women with hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy (HDP) are associated with significant myocardial dysfunction on echocardiography. The impact of hemodynamic changes related to volume redistribution following delivery on myocardial function in women with HDP has not been evaluated systematically. The aim of this study was to compare echocardiographic findings immediately before and after delivery in women with HDP. This was a prospective longitudinal study including 30 women with a diagnosis of HDP who underwent two consecutive transthoracic echocardiographic (TTE) examinations, before delivery and in the early postpartum period. Paired comparisons of the findings from the two assessments were performed. Left-ventricular (LV) concentric remodeling or hypertrophy was detected in 21 (70%) patients. There was no significant difference in cardiac morphology indices such as LV mass index (78.9 ± 16.3 g/m2 vs 77.9 ± 15.4 g/m2 ; P = 0.611) or relative wall thickness (0.45 ± 0.1 vs 0.44 ± 0.1; P = 0.453) before vs after delivery. LV diastolic function did not demonstrate any peripartum variation, with similar left-atrial volume (52.4 ± 15.3 mL vs 51.0 ± 15.6 mL; P = 0.433), lateral E' (0.12 ± 0.03 m/s vs 0.12 ± 0.03 m/s; P = 0.307) and E/E' ratio (7.9 ± 2.2 vs 7.9 ± 1.7; P = 0.934) before vs after delivery. Systolic function indices, such as LV ejection fraction (57.5 ± 3.4% vs 56.4 ± 2.1%; P = 0.295) and global longitudinal strain (-15.3 ± 2.6% vs-15.1 ± 3.1%; P = 0.582), also remained unchanged between before vs after delivery. Maternal hemodynamic changes associated with delivery did not influence significantly peripartum TTE indices in women with HDP. Suboptimal maternal echocardiographic findings in HDP are likely to be the consequence of chronic pregnancy cardiovascular load changes or pre-existing maternal cardiovascular impairment. Severity and persistence of myocardial dysfunction in the postpartum period may be related to the long-term maternal cardiovascular disease legacy of HDP. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross-sectional study.

To analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP). Repeated cross-sectional. US delivery hospitalisations. Delivery hospitalisations in the 2000-2018National Inpatient Sample. US hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest. Prevalence of HDP, risk factors for HDP and associated adverse outcomes. Of 73.1million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8-17.1), acute renal failure (aRR 13.8, 95% CI 13.5-14.2) and acute liver injury (aRR 1.2, 95% CI 1.2-1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased. Hypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased. While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing.

Association between Hypertensive Disorders of Pregnancy and Long-Term Neurodevelopmental Outcomes in the Offspring.

The long-term impact of hypertensive disorders of pregnancy (HDP) exposure on offspring health is an emerging research area. The objective of this study was to evaluate the association between a maternal diagnosis of HDP (gestational hypertension and preeclampsia) and adverse neurodevelopmental outcomes in the offspring. This was a secondary analysis of two parallel multicenter clinical trials of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. Women with singleton nonanomalous gestations diagnosed with subclinical hypothyroidism or hypothyroxinemia were randomized to thyroxine therapy or placebo. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures, including the Bayley-III cognitive, motor, and language scores at 12 and 24 months, Differential Ability Scales-II (DAS-II) scores at 36 months, the Conners' rating scales-revised at 48 months, and scores from the Child Behavior Checklist at 36 and 60 months. Thyroxine therapy did not influence neurodevelopment in either of the primary studies. Associations between neurodevelopment outcomes and maternal HDP were examined using univariable and multivariable analyses. A total of 112 woman-child dyads with HDP were compared with 1,067 woman-child dyads without HDP. In univariable analysis, mean maternal age (26.7 ± 5.9 vs. 27.8 ± 5.7 years, p = 0.032) and the frequency of nulliparity (45.5 vs. 31.0%, p = 0.002) differed significantly between the two groups. Maternal socioeconomic characteristics did not differ between the groups. After adjusting for potential confounders, there were no significant differences in any primary or secondary neurodevelopment outcome between offspring exposed to HDP and those unexposed. However, when dichotomized as low or high scores, we found higher rates of language delay (language scores <85: -1 standard deviation) at 2 years of age among offspring exposed to HDP compared with those unexposed (46.5 vs. 30.5%, adjusted odds ratio = 2.22, 95% confidence interval [CI]: 1.44-3.42). In this cohort of pregnant women, HDP diagnosis was associated with language delay at 2 years of age. However, other long-term neurodevelopmental outcomes in offspring were not associated with HDP. · No differences were found in neurodevelopment between offspring exposed to HDP and controls.. · Higher rates of language delay at 2 years of age were found in offspring exposed to HDP.. · The results did not differ when analysis was stratified by preterm birth..

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation.

This study aimed to assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). A retrospective case-control study of patients with HDP delivering at a single academic institution (2014-2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14-2.17), severe HDP (aOR: 1.94, 95% CI: 1.44-2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43-2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47-0.97), and public insurance (aOR: 0.65, 95% CI: 0.45-0.93) compared with private insurance. Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. · A total of 57.9% of patients with HDP attended in person postpartum blood pressure check.. · Nulliparity, severe features of HDP, and cesarean birth were associated with higher rates of attendance.. · Non-Hispanic black race and ethnicity and public insurance were associated with lower attendance..

Risk factors for needing postpartum antihypertensive medications with hypertensive disorders: Timing of diagnosis, presence of proteinuria, and severity of disease.

Evaluate the association between the need for post-partum antihypertensive medications in patients with hypertensive disorders of pregnancy (HDP) and the following: timing of disease onset (antepartum vs. intrapartum), presence of proteinuria, and severity of disease. This was a retrospective cohort study. We reviewed the charts of 204 patients diagnosed with HDP: 106 were diagnosed antepartum and 98 diagnosed intrapartum. Patients withchronichypertensionwereexcluded. The need for outpatient antihypertensive medications at time of hospital discharge was the primary outcome. We performed logistic regression of covariates and a stratified analysis for each specific HDP (gestational hypertension (GHTN), preeclampsia and preeclampsia with severe features). While the diagnosis of HDP in the antepartum period was a statistically significant risk factor for needing postpartum anti-hypertensive medications at discharge in bivariate analysis RR 2.07 (1.27-3.37), p=0.001, it did not remain significant after correction for the covariates RR 1.41 (0.45-4.49), P=0.55. However, the presence of proteinuria was an independent risk factor after logistic regression. Compared to GHTN, there was a significant difference in the need for postpartum anti-hypertensive medications in patients with preeclampsia OR 10.70 (1.54-74.42), p=0.017 and in preeclampsia with severe features OR 112.14 (20.05-627.22), p<0.001. Timing of onset of HDP (antepartum vs. intrapartum) was not an independent risk factor for needing antihypertensive medications postpartum. However, proteinuria and the presence of severe features were. Patients with proteinuria and those with severe disease may warrant closer surveillance in the post-partum period than those without proteinuria.

Association of the dysfunctional placentation endotype of prematurity with bronchopulmonary dysplasia: a systematic review, meta-analysis and meta-regression

BackgroundAntenatal pathological conditions are key in the pathogenesis of bronchopulmonary dysplasia (BPD). Pathophysiological pathways or endotypes leading to prematurity and perinatal lung injury can be clustered into two groups: infection...

562 Delivery outcomes in women with hypertensive disorders of pregnancy: comparing induction versus immediate cesarean delivery

To compare delivery outcome and associated maternal and neonatal complications in women with hypertensive disorders of pregnancy (HDP) who undergo induction of labor (IOL) versus immediate primary cesarean delivery (CD). This is a retrospective cohort study of nulliparous women with a singleton pregnancy at term delivering at NYU Langone Health and NYU Langone Hospital Brooklyn in 2018 with a diagnosis of HDP. Women who presented in labor (modified Bishop score >5) were excluded. Delivery outcomes and indication for CD were tabulated for the IOL group. A composite of maternal and fetal/neonatal complications occurring after the decision on delivery mode were compared between women who underwent IOL (defined as cervical ripening and/or oxytocin) versus immediate CD after diagnosis. Outcomes were analyzed using Chi-squared and Fischer’s exact test, with p<0.05 considered significant. 261 women met criteria for inclusion, including 241 (93.1%) who underwent IOL of labor and 18 (7.0%) with CD without labor. There was no difference between groups in severity of HDP diagnosis (p=0.66). Of those that underwent IOL, 140 (58.1%) had a vaginal delivery (VD). The most common indication for CD was labor arrest (67.9%), followed by fetal intolerance of labor (20.5%). Worsening HDP accounted for 3.6% of indications for CD. There was no difference between IOL and CD groups in rates of composite maternal complications (34.0% versus 33.3%, p=0.95, Table 1). There was no difference in fetal/neonatal composite complications between IOL and CD groups (21.2% versus 5.6%, p=0.11, Table 1). In nulliparous women with HDP at term, IOL is not associated with additional maternal or fetal/neonatal complications compared to immediate CD and is associated with a high rate of VD success. Understanding how the decision for IOL or CD influence maternal and neonatal complications in the setting of HDP will inform patient and provider counseling. Further studies should investigate how the rate of successful VD with IOL influences the risk/benefit balance for this decision.

162 Association between cardiorespiratory fitness and hypertensive disorders of pregnancy: a systematic review and meta-analysis

To review and summarize the literature to date on cardiorespiratory fitness (CRF) before, during and after hypertensive disorders of pregnancy (HDP), compared with women with no HDP. We included observational and intervention studies with a clearly defined diagnosis of HDP (gestational hypertension and/or preeclampsia) and a control group of women with no HDP. Eligible studies measured CRF including maximal or peak oxygen consumption (VO2), VO2 at anaerobic threshold or work rate at peak VO2. MEDLINE, EMBASE and Cochrane Library were searched from July 2018 to July 2019. References of included studies were hand searched to identify additional records. Risk of bias assessments used the Joanna-Briggs Institute Critical Appraisal Tools. Abstracts of 1949 records identified by the literature search were screened. Of 194 full-text articles assessed, 15 studies were included (n=2581 women). CRF was examined before, during and after pregnancy in 2, 9 and 4 studies, respectively. Although the risk of information bias was low, potential confounding variables between HDP and CRF were not examined. Nine references with HDP-specific data were included in the meta-analysis, reported as mean differences with 95% CI. Women with HDP had lower postpartum VO2max [2 studies, n=129 women; -0.39 mL/kg/min (-0.76, -0.02)] and lower antepartum VO2peak [1 study, n=140 women; -0.78 L/min (-0.99, -0.57)], compared to controls. Women with HDP did not attain a significantly lower mean work rate [2 studies, n=88 women; -0.08 watts (-1.01, 0.85)] or earlier lactate threshold [1 study, n=47 women; -0.32 mL/kg/min (-1.25, 0.61)]. Using VO2 showed significantly (p<0.05) lower CRF in women both after (Fig. 1) and during (Fig. 2) HDP. Few studies examined VO2 in relation to HDP, while the remaining studies analyzed used other CRF indices or did not directly look at CRF with respect to HDP. Additional studies using VO2 are needed to shed light on its utility as a measure of CRF and to quantify its association with HDP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

844 Characteristics of patients that attend 7-10 days postpartum visit for blood pressure check

To assess maternal characteristics that predict attendance of postpartum blood pressure visit in patients with hypertensive disorders of pregnancy (HDP). A retrospective case-control study of patients with HDP delivering at a single academic institution (2014-2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of 7-10 days postpartum blood pressure check. Of the 1,042 patients included in analysis, 603 (57.9%) attended the 7-10 days postpartum blood pressure check. Maternal sociodemographic, clinical and obstetric factors differed significantly between patients that attended the postpartum blood pressure visit and those that did not (Table). In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild range blood pressures on day of discharge and initiation of antihypertensive medication were associated with attendance of the 7-10 days postpartum visit (Table). In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (aOR 1.58; 95% CI 1.14-2.17), severe HDP (aOR 1.94, 95% CI 1.44-2.61) and cesarean birth (aOR 1.92, 95%CI 1.43 – 2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR 0.68, 95% CI 0.47 – 0.97), and public insurance (aOR 0.65, 95% CI 0.45 – 0.93) compared with private insurance (Table). Clinical factors such as nulliparity, severe HDP and cesarean birth were associated with higher rates of postpartum blood pressure check attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance.