Disorders Of Pregnancy Research Articles

Hypertensive Disorders in Pregnancy: Differences by Hispanic Ethnicity and Black Race.

Black individuals carry the greatest burden of maternal mortality, with hypertensive disorders during pregnancy being a significant driving force to this disparity. However, research on maternal health disparities predominantly groups Hispanic Black individuals with all other individuals of Hispanic ethnicity. We hypothesized that this aggregation might obscure the risk patterns of hypertensive disorders in pregnancy for Hispanic-Black and non-Hispanic Black individuals. We analyzed a California statewide dataset of vital records linked to hospitalization discharge data for births from 2007 to 2018. Using multivariable logistic regression models adjusted for age, pre-pregnancy BMI, parity, smoking status, diabetes, and chronic renal disease, we compared the odds of hypertensive disorders in pregnancy between Hispanic Black, non-Hispanic Black, and non-Black Hispanic racial-ethnic groups. Hypertensive disorders were categorized into two groups: (1) any hypertensive disorder and (2) chronic hypertension alone, non-severe hypertensive disorders, and severe hypertensive disorders in pregnancy. Non-Hispanic Black people had 75% increased odds of developing a hypertensive disorder during pregnancy (adjusted odds ratio (aOR); 95% confidence interval (CI): 1.74, 1.78) and Hispanic-Black individuals had a 31% increased odds (95% CI: 1.24, 1.38) as compared with non-Black Hispanic individuals. When considering hypertensive disorders separately, the race-associated differences were largest for chronic hypertension alone, with non-Hispanic Black individuals showing an aOR of 2.35 (95% CI: 2.32, 2.38) and Hispanic-Black individuals an aOR of 1.80 (95% CI: 1.66, 1.95). Compared with non-Black Hispanic individuals, the prevalence of hypertensive disorders in pregnancy was higher in Black-Hispanic individuals and highest in non-Hispanic Black individuals. Racial/ethnic differences were larger for chronic hypertension alone than for preeclampsia.

Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin pregnancies are lacking. The primary goal of this systematic review and meta-analysis was to assess the potential value of low PAPP-A levels in the prediction of the subsequent development of hypertensive disorders of pregnancy (HDPs), PTB, and small for gestational age (SGA)/FGR fetuses in twin pregnancies and investigate its association with the development of gestational diabetes, intrauterine death (IUD) of at least one twin, and birth weight discordance (BWD) among the fetuses. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 July 2024. All observational studies reporting low PAPP-A levels after the performance of the first-trimester combined test as part of the screening for chromosomal abnormalities with reported adverse pregnancy outcomes were included. Results: The current systematic review encompassed a total of 11 studies (among which 6 were included in the current meta-analysis) that enrolled a total of 3741 patients. Low PAPP-A levels were not associated with HDPs (OR 1.25, 95% CI 0.78, 2.02, I-square test: 13%). Low PAPP-A levels were positively associated with both the development of preterm birth prior to 32 (OR 2.85, 95% CI 1.70, 4.77, I-square test: 0%) and 34 weeks of gestational age (OR 2.09, 95% CI 1.34, 3.28, I-square test: 0%). Furthermore, low PAPP-A levels were positively associated with SGA/FGR (OR 1.58, 95% CI 1.04, 2.41, I-square test: 0%). Prediction intervals indicated that the sample size that was used did not suffice to support these findings in future studies. Conclusions: Our study indicated that low PAPP-A levels are correlated with an increased incidence of adverse perinatal outcomes in twin pregnancies. Identifying women at elevated risk for such adversities in twin pregnancies may facilitate appropriate management and potential interventions, but additional studies are required to identify the underlying mechanism linking PAPP-A with those obstetrical complications.

Perinatal outcomes in pregnancies achieved after fertility treatments with and without diet-controlled GDM.

To evaluate the rates of adverse perinatal outcomes among women who conceived after fertility treatments with and without diet-controlled GDM. In this retrospective population-based cohort study, all pregnancies of non-diabetic and diet-controlled GDM women who conceived after fertility treatments (in-vitro fertilization - IVF and ovulation induction - OI) and delivered between the years 1996-2016 in a tertiary medical center, were included. Pregnancies of women with pre-gestational diabetes mellitus, and those complicated with gestational diabetes mellitus A2, multiple pregnancies, congenital malformations and those lacking prenatal care, were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. Multivariate logistic regression models were used to control for confounders. Statistical analyses were performed using logistic regression to control for potential confounders. A p-value of < 0.05 was considered statistically significant. During the study period, 6254 deliveries met the inclusion criteria, 10.23% of them (n = 640) had diet-controlled GDM. Pregnancies with diet-controlled GDM were found to be associated with significantly higher rates of hypertensive disorders of pregnancy (15.6% vs. 9.8%, p < 0.001), polyhydramnios (5.9% vs. 2.7%, p < 0.001), and cesarean deliveries (40.8% vs. 31.9%, p < 0.001). Diet-controlled GDM was also found to be an independent protective factor against perinatal mortality (aOR = 0.22, 95% Cl 0.05-0.92, P = 0.04) possibly due to the more intensive monitoring and management typically provided to women undergoing fertility treatments. This close care may mitigate some of the risks associated with ART, leading to improved perinatal outcomes. Among pregnancies achieved after fertility treatments, diet-controlled GDM was associated with reduced perinatal mortality and higher rates of certain pregnancy complications. These findings highlight the importance of close monitoring and careful management of women with diet-controlled GDM, as it may help mitigate risks associated with ART pregnancies. Further research is needed to understand the mechanisms behind these outcomes and to optimize management strategies for this specific population.

Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines

BackgroundGestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.MethodsWe searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.ResultsTwenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.ConclusionsMost of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.Protocol RegistrationThis review was registered in PROSEPRO (CRD42023454900).

The ABCs of post-preeclampsia outpatient nephrology care: the Le Mans strategy.

Preeclampsia and hypertensive disorders of pregnancy complicate 3 to 5% of all pregnancies. Chronic kidney disease (CKD), at any stage, reportedly affects 3% of women in childbearing age but most of the time is underdiagnosed, especially in asymptomatic early stages. The link between preeclampsia/hypertensive disorders of pregnancy and CKD is bidirectional and women experiencing a preeclampsia/hypertensive disorder of pregnancy episode are at higher risk for developing CKD later in life, as well as metabolic and cardiovascular diseases. In turn, CKD is a risk factor for preeclampsia/hypertensive disorders of pregnancy. Thus, it is important to follow up patients after an episode of preeclampsia/hypertensive disorders of pregnancy in order to make a timely diagnosis of CKD or reduce the risk of another episode of preeclampsia/hypertensive disorder of pregnancy during a subsequent pregnancy. In Le Mans, we set up a dedicated outpatient clinic for women who experienced an episode of preeclampsia/hypertensive disorder of pregnancy. Inthis point of view paper, we present how we manage post-preeclampsia, in the hope that sharing this experience can promote the creation of dedicated outpatient clinics in other settings that will contribute to women's health.

Kefir peptides mitigate L-NAME-induced preeclampsia in rats through modulating hypertension and endothelial dysfunction

AimPreeclampsia is a complex and serious pregnancy disorder that leads to maternal and neonatal mortality worldwide. Kefir peptides (KPs), derived from various prebiotic fermentations in whole milk by kefir grains, were investigated for their potential therapeutic effects. In this study, we used the L-NAME in drinking water to induce a preeclampsia-like condition in spontaneous hypertension stroke-prone (SHRSP) pregnant rats. Main methodsThe rats were assigned to five groups: the normal group (WKY rats), the untreated group (SHRSP rat control pregnant), the L-NAME/Mock group (SHRSP rats fed with L-NAME water), the L-NAME/KPs-LD group (SHRSP rats fed with L-NAME water and low-dose KPs diets), and the L-NAME/KPs-HD group (SHRSP rats fed with L-NAME water and high-dose KPs diets) for a 20-day experiment. Chorioallantois membrane (CAM) assay was applied for ex vivo angiogenesis study of KPs treatment. Key findingsData showed that rats in the L-NAME group developed severe hypertension, proteinuria, placental damage, and embryo resorption. Pre-administration of KPs significantly reduced hypertension, proteinuria, improved generalized endothelial dysfunction, and decreased levels of anti-HIF-1α, sFLT1, anti-TNF-α, and IL-6 in the placenta of SHRSP rats. In ex vivo CAM study, L-NAME administration in chicken embryos resulted in lower vessel density and hemorrhage; however, angiogenesis was observed after KPs-HD treatment. SignificanceThe results indicate that kefir peptides improve renal lesions, prevent renal parenchyma damage, and balance endothelial and angiogenic dysfunction in both maternal and fetal sites in L-NAME-induced SHRSP pregnant rats.

Comparison of Second-Trimester Uterine Artery Doppler Indices between Pregnant Women with and without Prior Cesarean Delivery and Effect on Perinatal Outcomes

Objective: To evaluate the effects of prior cesarean delivery on second-trimester Uterine Artery (UtA) Doppler and its effect on perinatal outcomes. Materials and Methods: This study was conducted at the Maternal Fetal Medicine unit of Bhumibol Adulyadej Hospital, Thailand between June 2023 and January 2024. Healthy pregnant women aged between 18 and 45 years old were recruited and divided into prior (PCD) and non-prior cesarean delivery (non-PCD) groups. Both groups underwent UtA Doppler study from 18 to 24 weeks of gestation. UtA Doppler indices consisted of pulsatility index (UtA-PI), resistance index (UtA-RI) and systolic/diastolic ratio (S/D). Demographics, maternal and neonatal outcomes were collected. Results: Total of 416 participants were recruited and divided equally. The mean age of participants was 30.5 years old. Diabetes mellitus in pregnancy and hypertensive disorder were reported as 18.9 (79/416) and 5.5 (23/416) percent, respectively. From univariate analysis, subjects in the PCD group had higher UtA-PI, UtA-RI and UtA S/D than the non-PCD group with statistical significance. After multiple logistic regressions, only UtA-RI was greater in the PCD group with any statistical significance. The mean gestational age at delivery was 38.41 weeks. Prevalence of small for gestational age deliveries, preeclampsia, and preterm birth were 4.4 (17/376), 3.1 (12/376) and 10 percent (38/376), respectively. Maternal and neonatal outcomes of both groups were comparable. Number of cesarean deliveries, parity, miscarriage, and anterior placentation were not associated with UtA Doppler indices. Conclusion: UtA-RI of prior cesarean delivery participants were higher than non-prior cesarean delivery participants and not associated with maternal and neonatal adverse outcomes.

Hypertensive Disorders of Pregnancy Increase the Risk for Myocardial Infarction: APopulation-Based Study.

Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented. This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography. This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease. A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P=0.030). There was a strong association between HDP and ACS (unadjusted P=0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95%CI: 1.02-5.12; P=0.046), and MINOCA (OR: 2.08; 95%CI: 1.02-4.25; P=0.044). A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors.

The prospective associations of fetal growth-related pregnancy complications with subsequent breastfeeding duration and markers of human milk production.

The development of the breast for lactation occurs throughout pregnancy. It is unknown whether pregnancy complications resulting in poor fetal growth can affect breastfeeding success. We examined whether fetal growth-related pregnancy complications were associated with earlier breastfeeding cessation and changes in the concentrations of human milk biomarkers of low milk production. We used data from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) study (n=954). Human milk concentrations of protein, lactose, citrate, sodium, potassium and zinc at 3 weeks postpartum were available for 180 mother-infant dyads. We examined the associations of fetal growth measures, including term infants born small-for-gestational-age (SGA) (<10th percentile), pregnancies complicated by fetal growth deceleration (FGD) (2nd - 3rd trimester fetal growth dropped between major centiles), elevated umbilical artery resistance (UAR) (> 90th percentile) or hypertensive disorders of pregnancy (HDP) with (i) risk of ceasing breastfeeding (Cox regression) and (ii) concentrations of human milk components (weighted linear regression). Adjusting for maternal education, smoking exposure, breastfeeding intentions and pre-pregnancy BMI, individuals who delivered SGA infants, and those with HDP were more likely to breastfeed for a shorter duration when compared to those with uncomplicated pregnancies (adjusted hazard ratio [95% CI]: 1.45 [1.11, 1.89] and 1.61 [1.14, 2.29], respectively); associations were not significant for FGD and UAR. SGA was not associated with concentrations of human milk biomarkers, but compared to participants with uncomplicated pregnancies, milk produced by those with HDP contained lower zinc concentrations (adjusted beta coefficient [95% CI]: -0.56 mg/L [-1.08, -0.04]). Individuals with HDP and those with SGA infants tend to breastfeed for a shorter duration; however, only HDP appeared to be associated with biomarkers of compromised milk production. Further research and support are needed to help individuals with HDP and SGA achieve their breastfeeding goals. This study was registered as NCT01174875, and can be accessed at https://clinicaltrials.gov/study/NCT01174875.

Association between urinary cotinine level and hypertensive disorders of pregnancy in women with uterine myoma: findings from the Japan Environment and Children's Study.

The effect of smoking on hypertensive disorders of pregnancy is a public concern. Recent evidence suggests that the risk of hypertensive disorders of pregnancy is influenced by the presence of uterine fibroids. We explored the association between maternal smoking exposure and the risk of hypertensive disorders of pregnancy in relation to the presence of uterine fibroids using data from Japan's largest birth cohort study. This study focused on first-time mothers, and the study population comprised 2752 and 35,294 first-time mothers with and without uterine fibroids, respectively. Hypertensive disorders of pregnancy was categorized as early-onset (before 34 weeks) and late-onset (after 34 weeks). Maternal smoking exposure was assessed by measuring the urinary cotinine concentration during the mid-trimester. Participants were classified into four quartiles based on their urinary cotinine levels as follows: Q1 (low concentration) to Q4 (high concentration). Multivariate analysis adjusted for potential confounders revealed that in women without uterine fibroids, the Q3 urinary cotinine level was associated with a modified risk of early-onset hypertensive disorders of pregnancy (adjusted odds ratio: 0.63, 95% confidence interval: 0.44-0.89). Conversely, for women with uterine fibroids, Q4 urinary cotinine level was associated with an increased risk of hypertensive disorders of pregnancy (adjusted odds ratio: 1.68, 95% confidence interval: 1.05-2.72). In conclusion, this study indicated that the impact of maternal smoking exposure varied based on the presence of uterine fibroids, underscoring the importance of personalized preconception care.

The association of higher offspring early-childhood weight gain with prepregnancy metabolic and bariatric surgery.

The objective of this study was to assess maternal gestational outcomes and offspring growth trajectories following prepregnancy metabolic and bariatric surgery (MBS) compared with non-MBS controls. Single-center deliveries between January 2020 and March 2023 with prepregnancy Roux-en-Y gastric bypass (herein referred to as "bypass"), sleeve gastrectomy (herein referred to as "sleeve"), and non-MBS controls were included. Offspring growth trajectories were compared with the World Health Organization child growth standards. Linear mixed models assessed MBS-bypass and MBS-sleeve offspring weight, length, and BMI trajectories with a prepregnancy BMI 27 to 37 kg/m2 and propensity score-matched controls. The study included 440 participants with prepregnancy MBS (MBS-bypass, 185; MBS-sleeve, 225; 76% Hispanic/Latino) and 13,434 non-MBS controls. Gestational weight gain and gestational diabetes mellitus were similar, whereas hypertensive disorders of pregnancy were more common after MBS. The post-MBS offspring had lower birth weight but higher weight gain at 24 months (sleeve, +1.4 kg [95% CI: 1.0-1.9]; bypass, +0.5-0.7 kg [95% CI: 0.0-1.2]) compared with non-MBS groups. Male children had higher weight gain than females. The post-MBS-sleeve but not the post-MBS-bypass offspring had higher BMI z scores. The higher early-life weight gain and sex differences in the post-MBS-sleeve group compared with the post-MBS-bypass group provide a window toward elucidating pathways to mitigate intergenerational metabolic risk transfer.

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

FOXP2 overexpression upregulates LAMA4 expression and thereby alleviates preeclampsia by regulating trophoblast behavior

Preeclampsia (PE) is a common pregnancy disorder characterized by hypertension and proteinuria. Trophoblast behavior severely affect PE progression. Transcription factor Forkhead box protein P2 (FOXP2) was involved in cell migration and invasion, but its role in PE progression remains unknown. Laminin subunit alpha 4 (LAMA4) was predicted as a downstream gene of FOXP2 and related to PE. Thus, we supposed that FOXP2 might regulate PE by regulating LAMA4. We found the decreased FOXP2 expression in patients with PE compared with healthy pregnant women. The rat model of PE was induced by L-NAME oral gavage. FOXP2 overexpression lowered systolic and diastolic blood pressure and restored pathological changes of rats with PE. Trophoblasts under the hypoxia/reoxygenation (H/R) treatment were used to mimic PE in vitro. The results revealed that FOXP2 overexpression inhibited apoptosis but promoted migration, invasion, and angiogenesis of H/R-treated trophoblasts. Dual luciferase and chromatin immunoprecipitation-polymerase chain reaction assays confirmed that FOXP2 transcriptionally upregulated the LAMA4 expression in trophoblasts. LAMA4 knockdown reversed the migration and invasion-promoting role of FOXP2 overexpression in trophoblasts with H/R treatment. Collectively, our findings suggest that the FOXP2/LAMA4 axis regulates PE by suppressing trophoblast apoptosis and promoting its migration, invasion, and angiogenesis.

Antepartum Wernicke’s Encephalopathy: Common, and Yet Rarely Diagnosed. Discussion on the Disease and Its Treatment

This review article presents a comprehensive discussion on antepartum Wernicke’s encephalopathy (WE), a serious neurological disorder. This disorder stems from thiamine (Vitamin B1) deficiency, which is critical for normal metabolism and neuronal integrity. During pregnancy, women are more susceptible to this condition due to increased nutritional requirement and metabolic changes. In WE, inadequate thiamine (Vitamin B1) causes disruption of metabolism in cells and impedes neurotransmitter synthesis in the brain, ultimately causing adverse neural consequences. Key risk factors contributing to antepartum WE include conditions that hinder thiamine absorption or increase metabolic demand, such as hyperemesis gravidarum (intense antepartum vomiting), malnutrition, alcoholism, and post-bariatric surgery states. WE's classic triad of symptoms, confusion, ataxia (loss of balance and coordination), and ophthalmoplegia (occlumotor incoordination), are not commonly seen in antepartum WE. Therefore, diagnosing the disorder in pregnancy is challenging and the condition is often misdiagnosed. Pregnancy symptoms like nausea, vomiting, and fatigue often overlap with WE's presentation, complicating diagnosis and confounding treatment. While magnetic resonance imaging (MRI) can reveal characteristic lesions in brain areas such as the thalamus and mammillary bodies, these may not always appear in early stages, adding further diagnostic difficulty. Effective management of antepartum WE relies on early recognition and timely administration of high-dose thiamine, particularly parenteral administration for affected pregnant women. Prompt treatment is critical to preventing irreversible sequalae, neurological and otherwise in both the woman and the child. Once acute symptoms are managed, transitioning to oral thiamine supplementation is the norm to prevent recurrence and maintain normal thiamine levels. Balanced diet of macro-nutrients and maintaining fluid and electrolyte balance, also plays an essential role in recovery. In severe or treatment-resistant cases, more intensive, prolonged thiamine therapy and regular monitoring of maternal and fetal health are necessary, usually managed by a multidisciplinary medical team. This coordinated care approach aims to prevent recurrence and minimize risks associated with WE. The article emphasizes following clinical guidelines, which recommend regular thiamine monitoring and preventive measures in high-risk pregnancies, to improve maternal and fetal outcomes. By adhering to established protocols, healthcare providers can reduce the likelihood of severe complications associated with WE, ensuring better care and recovery for affected pregnant women. Categories: Pregnancy, Neurology, Nutrition.

Breastfeeding in patients with peripartum cardiomyopathy: clinical outcomes and physician counseling

BackgroundPeripartum cardiomyopathy (PPCM) is a form of heart failure occurring towards the end of pregnancy or in the months following delivery. Concerns regarding the role of prolactin (the polypeptide hormone responsible for lactation) driving the pathogenesis of PPCM have led experts to discourage patients from breastfeeding; however, limited clinical data exist. We sought to (1) determine whether lactation was associated with less cardiac recovery and (2) assess the counseling about breastfeeding given to patients at the time of their initial diagnosis.MethodsPatients diagnosed with PPCM from 1999 to 2019 were identified through detailed chart review and demographic characteristics, comorbidities, outcomes, and lactation status were collected. Cardiac recovery was defined as left ventricular ejection fraction (LVEF) 55% or higher. A survey about breastfeeding and patient experience was administered by mail. Patients were only included in this analysis if definitive information about lactation status was documented.ResultsOf 220 patients with confirmed PPCM, lactation status was known definitively in 54 patients; of these, 18 (33%) had breastfed for at least 6 weeks and 36 (67%) did not breastfeed. There were no significant differences in the breastfeeding and non-breastfeeding groups related to baseline LVEF, age, race, gestational diabetes, smoking, hypertensive disorders of pregnancy, and medication treatments. Despite similar baseline LVEF at the time of diagnosis, there was no statistically significant difference in cardiac recovery based on lactation status. In a subset of patients with severe cardiac dysfunction at the time of diagnosis, there remained no significant differences in recovery based on lactation status. Of the 34 survey respondents, 62% were told not to breastfeed due to their diagnosis or concerns regarding safety of medications, and none were encouraged to breastfeed.ConclusionIn this retrospective cohort, lactation was not associated with lower rates of myocardial recovery. Importantly, a majority of patients had received counseling that they should not breastfeed. Future studies of the role of lactation in PPCM are needed in order to better understand the impact of breastfeeding and improve patient counseling.

History of Hypertension is The Most Influential Factor in Increasing The Occurrence of Preeclampsia in Lumajang Regency

Hypertensive disorders of pregnancy, including preeclampsia, are significant contributors to maternal mortality and morbidity globally. The study's objective was to investigate the most important factors that contribute to preeclampsia. in Lumajang Regency. The research design is a case-control study. The research location is at Rogorunan Health Center and Kunir Health Center. The sample in this study was determined using saturated sample techniques or total sampling. samples at the Rogotrunan Health Center totaled 80 respondents and the Kunir Health Center which amounted to 75 respondents, totaling 155 respondents. Data collection using questionnaires. Analysis using logistic regression. The results of the study of variables that have a significant influence are on the variables of age (p-value = 0.070), history of hypertension (p-value = 0.000), pregnancy pause (p-value = 0.002), body mass index (p-value = 0.045), and hereditary hypertension (p-value = 0.000). A history of preeclampsia (p-value = 0.255) on the variable was excluded. Multivariate results between preeclampsia occurrence and history of hypertension obtained a value of p = 0.000, OR = 6.004 (1.549-5.065) meaning that The incidence of preeclampsia is influenced by a history of hypertension and history of hypertension affects 6.004 times the incidence of preeclampsia. Conclusion A history of hypertension is the most significant risk factor for preeclampsia, so the recommended advice is the importance of a healthy lifestyle, a balanced diet, exercise regularly, avoiding stress, avoiding smoking, not consuming harmful substances, monitoring blood pressure regularly, and regular treatment. All of these actions are a preventive effort so that during pregnancy preeclampsia does not occur.

Pregnancy in women with congenital heart disease : new insights into neonatal risk predictioc

Abstract Background Advances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are (1) to assess neonatal outcomes in a CHD women population, (2) to identify their predictive factors and (3) to propose a new risk score for predicting neonatal complications. Methods This registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. Results Analysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.9, 95%CI [4.6-64.3]), hypertensive disorders of pregnancy (OR 10.4, 95%CI [3.4-39.5]), smoking during pregnancy (OR 10.3, 95% CI [3.0-44.9]), and pre-pregnancy BMI &amp;lt; 18.5 kg/m² (OR 6.2, 95% CI [2.6-16.5]). The risk model demonstrated an AUC of 0.70 (95% CI [0.65-0.75), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising 5 risk categories. Conclusion One third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by 4 independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.Offspring scores: performance comparisonNew risk score for neonatal outcome

Cardiovascular outcomes in pregnant women with congenital heart disease

Abstract Background Individuals with congenital heart disease (CHD) are at increased risk of cardiovascular complications. There is limited available data on burden of acute cardiovascular complications in pregnant women with CHD. Purpose To study the acute cardiovascular complications in pregnant women with CHD. Methods We conducted a retrospective observational analysis using the Nationwide Inpatient Sample (NIS) database. Using ICD-9 and ICD-10-CM codes, we identified pregnant women aged 18 years or older with and without CHD hospitalized between January 1st, 2010, and December 31st, 2019. The outcomes of the study were peripartum cardiomyopathy, hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia, and eclampsia), acute myocardial infarction, cardiac arrhythmias, cardiac arrest, stroke or transient ischemia, and in hospital mortality. Results During the study period, there were a total of 41,114,105 hospitalizations for pregnancy. Of these, 43,131 (0.1%) had CHD. The mean age of the population was 28 years in both CHD and non-CHD groups. The majority were white patients, followed by black patients and then Asians in both groups. There was a higher proportion of white patients in the CHD group compared to the non-CHD group. Comorbidities including diabetes mellitus, chronic pulmonary disease, chronic kidney disease, hyperlipidemia, smoking, depression, and drug abuse were higher in the CHD group compared to the non-CHD group (Table 1). Pregnant women with CHD had a significantly higher incidence of peripartum cardiomyopathy (1905 vs 89 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001), hypertensive disorders of pregnancy (9332 vs 7802 per 100,000 pregnancy hospitalizations ; p&amp;lt;0.001), acute coronary syndrome (253 vs 12 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001), cardiac arrhythmias (3480 vs 176 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001), cardiac arrest (127 vs 6 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001), stroke or transient ischemic attack (1648 vs 32 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001), and venous thromboembolism (816 vs 124 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001) (Table 2). Similarly, pregnant women with CHD had significantly higher in hospital mortality compared to pregnant women with no CHD (116 vs 11 per 100,000 pregnancy hospitalizations; p&amp;lt;0.001). Conclusion Pregnant women with CHD are at significantly increased risk of acute cardiovascular complications compared to those without CHD. Our study underscores the importance of close monitoring and specialized care for this high-risk population during pregnancy and delivery. Further research is warranted to better understand the risks associated with these complications and to optimize management strategies for pregnant women with CHD.Baseline CharacteristicsOutcomes

Worse ischemic symptoms and cardiac function in women with suspected ischemia with no obstructive coronary artery disease and adverse pregnancy outcomes history

Abstract Background Adverse pregnancy outcomes (APO) are associated with increased maternal risk of cardiovascular disease (CVD) and mortality. Ischemia with no obstructive coronary artery disease (INOCA) is predominant in women, however the association of APO history with INOCA is poorly understood. Purpose To compare clinical characteristics, symptoms, cardiac structure and function and coronary microvascular dysfunction in women suspected to have INOCA with or without a history of APO. Methods Women’s Ischemia Syndrome Evaluation (WISE) CVD (NCT00832702) and WISE pre-HFpEF (NCT02582021) prospective cohorts of women with suspected INOCA were merged and utilized to determine among women with at least 1 prior pregnancy whether a history of APO was associated with ischemic symptoms, and to characterize CMRI measured left ventricle (LV) structure and function, myocardial deformation (systolic and diastolic strain) and coronary microvascular dysfunction on invasive coronary functional testing (CFT). Self-reported APO was defined as hypertensive disorder of pregnancy (HDP), gestational diabetes, preterm birth (&amp;lt;37-week gestation), low birth weight (&amp;lt;5lbs). Results In a cohort of 469 women with suspected INOCA, (mean average age 55 [SD 10.2] years) and at least 1 prior pregnancy, 138 (29%) had history of at least 1 APO. Among women with history of APO, 78 reported HDP, 50 gestational diabetes, 27 pre-term birth, 8 low birth weight. Women with a history of APO were younger, had higher rates of hypertension and diabetes, higher BMI and lower SAQ and DASI scores compared to those with no history of APO (Table). LV ejection fraction (EF) was lower and early diastolic strain rate/LVEDP was higher in women with APO history compared to those without APO history. Conclusion(s) In cohort of women with INOCA, history of APO was highly prevalent. Despite younger age, women with history of APO had higher rates of CVD risk factors, worse ischemic symptoms and functional capacity, lower EF, and higher filling pressures. Our findings suggest a potential for APO history to better identify women with worse prognosis that warrants further investigation and aggressive management.

Bibliographic update about hypertensive disorders of pregnancy intervention studies and their importance

Introduction: cardiovascular diseases represent one of the main causes of death and disability in women, in turn, multicausal hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia/eclampsia, and chronic hypertension with overlapping preeclampsia/eclampsia. The objective was to describe the importance of the intervention studies about hypertensive disorders of pregnancy. Methods: a bibliographic review of 28 articles in Spanish and English, related to the subject, from databases such as SciELO, Pubmed, Scopus, Springer, where more than 60% are from the last 6 years, was carried out.Results: epidemiological data show the high negative impact on obstetric and neonatal health in these entities, emerging as a problem that has continued to affect the good health results in the sector. Added to the neglect of prenatal care, the lack of preparation/skills for the detection and treatment of these pathologies in health personnel, and the lack of knowledge of the pathologies by patients negatively influences the diagnosis. Education is an important means to address reproductive health problems; the proper understanding of a disorder contributes to its prevention, control and management.Conclusions: hypertensive disorders of pregnancy constitute a diverse group of diseases that cause maternal and fetal death. Health education through population-based interventions contributes to reproductive health care and the early detection and treatment of hypertensive disorders