Hypertensive Disorders Research Articles

Evaluating causal associations of chronotype with pregnancy and perinatal outcomes and its interactions with insomnia and sleep duration: a mendelian randomization study

BackgroundObservational studies suggested chronotype was associated with pregnancy and perinatal outcomes. Whether these associations are causal is unclear. Our aims are to use Mendelian randomization (MR) to explore (1) associations of evening preference with stillbirth, miscarriage, gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, preterm birth and offspring birthweight; and (2) differences in associations of insomnia and sleep duration with those outcomes between chronotype preferences.MethodsWe conducted two-sample MR using 105 genetic variants reported in a genome-wide association study (N = 248,100) to instrument for lifelong predisposition to evening- versus morning-preference. We generated variant-outcome associations in European ancestry women from UK Biobank (UKB, N = 176,897), Avon Longitudinal Study of Parents and Children (ALSPAC, N = 6826), Born in Bradford (BiB, N = 2940) and the Norwegian Mother, Father and Child Cohort Study (MoBa, N = 57,430), and extracted equivalent associations from FinnGen (N = 190,879). We used inverse variance weighted (IVW) as main analysis, with weighted median and MR-Egger as sensitivity analyses. Relying on the individual participant data from UKB, ALSPAC, BiB and MoBa, we also conducted IVW analyses of insomnia and sleep duration on the pregnancy and perinatal outcomes, stratified by genetically predicted chronotypes.ResultsIn IVW and sensitivity analyses, we did not find robust evidence of associations of chronotype with the outcomes. Insomnia was associated with a higher risk of preterm birth among evening preference women (odds ratio 1.61, 95% confidence interval: 1.17, 2.21), but not among morning preference women (odds ratio 0.87, 95% confidence interval: 0.64, 1.18), with an interaction P-value = 0.01. There was no evidence of interactions between insomnia and chronotype on other outcomes, or between sleep duration and chronotype on any outcomes.ConclusionsThis study raises the possibility of a higher risk of preterm birth among women with insomnia who also have an evening preference. Our findings warrant replications due to imprecise estimates.

Hellp’s Syndrome – Maternal Morbimortality, Clinical Case Report

Introduction: HELLP syndrome is a hypertensive disorder of pregnancy associated with severe maternal-fetal complications and representing high morbidity and mortality. Objective: A clinical history of HELLP syndrome as a complication of severe preeclampsia was analyzed, highlighting the importance of early detection and appropriate treatment. Clinical case: A young 26-year-old multi-gestation patient from the city of Loja, with a family history of arterial hypertension, was diagnosed with HELLP syndrome and severe preeclampsia in the 33rd week of gestation after five prenatal check-ups and due to the severity of her condition, it was decided to terminate the pregnancy by cesarean section. Conclusion: The importance and urgency of early identification and treatment of HELLP syndrome and its complications, highlighting the need for an individualized approach based on the patient’s laboratory studies and the importance of management in primary care and the patient’s care.

Defining normal serum creatinine in pregnancy -results from the AKID UK prospective cohort study

Abstract Background Abnormal kidney function in pregnancy may represent chronic kidney disease or pregnancy-associated acute kidney injury - both associated with adverse outcomes during and after pregnancy. Serum creatinine remains the standard biomarker for kidney function in pregnancy but normal levels change dynamically through pregnancy and at term. Existing gestation-specific reference ranges for serum creatinine, and recommendations to investigate for abnormal kidney function in pregnancy are based on limited data. Data describing trajectories of serum creatinine through pregnancy and the normal, physiological increase in serum creatinine at term are also lacking. Methods We recruited 476 healthy pregnant individuals aged 16 years or over, 2019-21, measuring serum creatinine in the first, second and third trimesters of pregnancy, , at birth and postpartum. Clinical data were abstracted. Gestation-specific reference ranges for serum creatinine were defined as mean±1.96 x SD, after excluding those with adverse pregnancy outcomes. Trajectories of serum creatinine through pregnancy, and the change in serum creatinine at delivery were described. Results 1875 creatinine measurements were recorded. Reference ranges for serum creatinine in the first, second and third trimesters of healthy pregnancy were 37-67μmol/L (0.42-0.75mg/dl), 34-63μmol/L (0.38-0.71mg/dl), and 34-66μmol/L (0.39-0.75mg/dl). Increasing serum creatinine in early pregnancy was more common in those with hypertensive disorders of pregnancy, prior to disease onset. In healthy participants, median serum creatinine increase from 36 weeks to birth was 6.8% (95% CI 4.5%, 9.1%). Conclusions Investigation for abnormal kidney function in pregnancy should be considered at a lower creatinine threshold than currently recommended. Detecting abnormal creatinine trajectories may help early identification of high-risk pregnancies.

Health care concerns in women at midlife: differences by race, ethnicity, and neighborhood socioeconomic status.

The aims of the study were to identify conditions diagnosed in at least 10% of midlife women living in the US upper midwest and to assess prevalence by age, race, ethnicity, and sociodemographic status. The Rochester Epidemiology Project was used to conduct a cross-sectional prevalence study of 86,946 women between 40 and 59 years residing in a 27-county region of the United States on January 1, 2020. Diagnostic billing codes were extracted and grouped into broader condition categories using the Clinical Classification System Refined. The prevalence of 424 conditions was calculated by age, race, ethnicity, and area deprivation index quartiles. Logistic regression was used to examine associations between participant characteristics and conditions that affected 10% or more of the study population. Twenty-eight conditions affected ≥10% of women, and eight conditions increased by ≥45% between the ages of 40 and 59 (disorders of lipid metabolism, hypertension, sleep/wake disorders, thyroid disorders, esophageal disorders, osteoarthritis, tendon and synovial disorders, and menopausal disorders; all test for trend P < 0.01). Black women had a significantly higher prevalence of hypertension and esophageal disorders at all ages (adjusted P values <0.05). Women living in more deprived areas had a significantly higher prevalence of hyperlipidemia, hypertension, sleep/wake disorders, and esophageal disorders (adjusted P values <0.05). Women living in less deprived areas had a significantly higher prevalence of thyroid disorders at age 40 to 44 and menopausal disorders at ages 50 to 59 (adjusted P values <0.05). These data suggest that additional attention should focus on Black women and women with a lower socioeconomic status to ensure that common midlife conditions are diagnosed and treated.

Potential Causal Association Between Atrial Fibrillation/Flutter and Primary Open-Angle Glaucoma: A Two-Sample Mendelian Randomisation Study

Background: A few studies have reported controversial relationships between atrial fibrillation/flutter (AF/L) and primary open-angle glaucoma (POAG). This study aimed to investigate the potential causal relationship between AF/L and POAG. Methods: Single-nucleotide polymorphisms associated with exposure to AF/L were selected as instrumental variables with significance (p &lt; 5.0 × 10−8) from a genome-wide association study (GWAS) by FinnGen. The GWAS summary of POAG from the UK Biobank was used as the outcome dataset. A two-sample Mendelian randomisation (MR) study was performed to assess the causal effects of AF/L on POAG. In addition, potential confounders, including hypertension, autoimmune hyperthyroidism, sleep apnoea, and alcohol use disorder, were assessed using multivariable MR analysis. Results: There was a significant causal association of AF/L with POAG (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.07–1.48, p = 0.005 using inverse-variance weighting [IVW]). Multivariable MR analysis confirmed a causal association of AF/L with POAG (OR = 1.24, 95% CI = 1.02–1.51, p = 0.034 using IVW), but hypertension, hyperthyroidism, sleep apnoea and alcohol use disorder did not show significant causal associations with POAG (all p &gt; 0.05). Conclusions: This established causal relationship between AF/L and POAG supports the need for further investigation into the role of AF/L as a possible risk factor for POAG. Further research is required to confirm these findings.

Patient awareness of long-term cardiovascular and metabolic disease risks after hypertensive disorders of pregnancy in Japan.

Given the increasing recognition of the importance of postpartum follow-up care for women with a history of hypertensive disorders of pregnancy (HDP) to mitigate their future risk of cardiovascular and metabolic diseases, here we aimed to evaluate the current status of postpartum follow-up care in Japan and explore the challenges to its implementation. A web-based survey was conducted using a smartphone application among postpartum women between March and May 2024 to assess their knowledge of HDP-related future risk and postpartum follow-up care. A total of 880 valid responses were obtained, 73 (8.3%) of which were from women with a history of HDP. Of them, 56.2% were aware of the heightened risk of cardiovascular disease and even fewer knew about the risks of metabolic syndrome (37.0%) and the preventive use of low-dose aspirin (12.3%); in fact, 31.5% reported receiving no information about their risk or preventive measures from healthcare providers. Furthermore, 43.8% did not consult specialists or attend regular checkups after their 1-month checkup. Among women with a history of HDP, those who received information and guidance were more likely to implement behavioral changes than those who did not. Patient awareness level of HDP-related risk was low and the information provided by their healthcare professionals was insufficient, indicating that postpartum follow-up care in Japan is not satisfactory. This study highlights the need for improved educational strategies and systematic follow-up protocols to ensure that women are adequately informed and supported in managing their long-term health risks.

Impaired maternal central hemodynamics precede the onset of vascular disorders of pregnancy at high altitude.

Hypertensive disorders of pregnancy represent an escalating global health concern with increasing incidence in low- to middle-income countries and high-income countries alike. The current lack of methods to detect the subclinical stages of preeclampsia (PE) and fetal growth restriction (FGR), two common vascular disorders of pregnancy, limits treatment options to minimize acute- and long-term adverse outcomes for both mother and child. To determine whether impaired maternal cardiovascular or uteroplacental vascular function precedes the onset of PE and/or FGR (PE-FGR), we used non-invasive techniques to obtain serial measurements of maternal cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), as well as uterine and fetal arterial resistance at gestational weeks 10-16, 20-24 and 30-34 for 79 maternal-infant pairs in La Paz-El Alto, Bolivia (3850 m), where the chronic hypoxia of high altitude increases the incidence of PE and FGR. Compared to controls (n=55), PE-FGR cases (n=24) had lower SV, higher SVR, and greater uterine artery resistance at 10-16 weeks. In addition, fetuses of women with lower SV and higher SVR at 10-16 weeks showed evidence of brain sparing at 30-34 weeks and had lower birth weights, respectively. While the trajectory of SV and SVR across pregnancy was similar between groups, PE-FGR cases had a comparatively blunted rise in CO from the first to the third visit. Impaired maternal central hemodynamics and increased uteroplacental resistance precede PE-FGR onset, highlighting the potential use of such measures for identifying high-risk pregnancies at high altitudes.

Dietary Inflammatory Index Is Differentially Associated With Cardiometabolic Health After Pregnancy on the Basis of Adverse Pregnancy Outcome Exposure.

Inflammatory diets may influence risk of cardiovascular disease. Subsequent cardiovascular disease is also influenced by adverse pregnancy outcomes (APOs) such as preterm birth, small-for-gestational-age birth, gestational diabetes, and hypertensive disorders of pregnancy. However, the associations between inflammatory diet, APOs, and cardiometabolic health remain unclear. We used data from the nuMoM2b (Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be) HHS (Heart Health Study) to assess the relationship between dietary quality and cardiometabolic health. We calculated Energy-Adjusted Dietary Inflammatory Index scores representing the inflammatory burden in a person's diet. We used linear regression to determine the association between Energy-Adjusted Dietary Inflammatory Index score and cardiometabolic outcomes. We performed stratified analyses for outcomes with a significant interaction between Energy-Adjusted Dietary Inflammatory Index and APO. Data were available from 3249 participants at a median of 3.1 years after delivery. Higher Energy-Adjusted Dietary Inflammatory Index scores were associated with higher body mass index (B=0.29 kg/m2 [95% CI, 0.16-0.42]), waist circumference (0.66 cm [95% CI, 0.39-0.93]), diastolic blood pressure (0.26 mm Hg [95% CI, 0.09-0.44]), mean arterial pressure (0.23 mm Hg [95% CI, 0.06-0.40]), triglycerides (2.11 mg/dL [95% CI, 1.05-3.18]), creatinine (2.78 mg/dL [95% CI, 1.13-4.44]), insulin (exp[B]=1.04 [95% CI, 1.03-1.05]) and C-reactive protein (exp[B]=1.07 [95% CI, 1.04-1.10]), and lower high-density lipoprotein cholesterol (-0.41 mg/dL [95% CI, -0.66 to -0.37]) (all P<0.01). Significant interactions with APO (P<0.05) were identified for body mass index and waist circumference, with stratified analysis revealing stronger associations for individuals with APOs. A more proinflammatory diet was associated with worse cardiometabolic health measures, and these relationships differed by a person's APO history. Further investigation should establish how dietary modifications after pregnancy may potentially mitigate cardiovascular disease risk.

An endogenous aryl hydrocarbon receptor ligand induces preeclampsia-like phenotypes in rats.

Preeclampsia (PE) is a hypertensive disorder during human pregnancy. Aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor. Exogenous and endogenous AhR ligands can induce hypertension in male rats and mice. Herein, using rats as a model, we tested the hypothesis that over-regulation of endogenous AhR ligands during pregnancy impairs vascular functions by disrupting the transcriptome in the placenta, contributing to the development of PE. Pregnant rats were injected daily with an endogenous AhR ligand, 2-(1'H-indole-3'-carbonyl)-thiazole-4-carboxylic acid methyl ester (ITE), from gestational day (GD) 10 to 19. Maternal mean blood pressure was measured on GD16-20. Proteinuria and uteroplacental blood flow were monitored on GD20. Placentas collected on GD20 were used to determine changes in vascular density and transcriptome. Compared with the vehicle control, ITE elevated maternal mean blood pressure by 22% and 16% on GD16 and 17, respectively. ITE increased proteinuria by 50% and decreased uteroplacental blood flow by 26%. ITE reduced the placental vascular density by 18%. RNA sequencing analysis revealed that ITE induced 1316 and 2020 differentially expressed genes (DEGs) in female and male placentas, respectively. These DEGs were enriched in pathways relevant to heart diseases, vascular functions and inflammation. Bioinformatics analysis also predicted that ITE altered immune cell infiltration in placentas depending on fetal sex. These data suggest that over-regulation of endogenous AhR ligands may lead to PE with impaired vascular functions and disrupted fetal sex-specific transcriptomes and immune cell infiltration in placentas. These AhR ligand-induced DEGs and pathways may represent promising therapeutic targets for PE-induced cardiovascular dysfunctions. KEY POINTS: An endogenous AhR ligand (ITE) elevated maternal blood pressure and proteinuria in pregnant rats, and decreased uteroplacental blood flow and fetal and placental growth, all of which are hallmarks of preeclampsia. ITE reduced vascular density and altered immune cell distribution in rat placentas. ITE dysregulated transcriptomes in rat placentas in a fetal sex-specific manner. These ITE-dysregulated genes and pathways are highly relevant to diseases of heart, vascular functions and inflammatory responses.

Blood Pressure Monitoring and Knowledge in the First Year after a Hypertensive Disorder of Pregnancy.

Introduction: In the first year postpartum, hypertension is a leading cause of morbidity and mortality, particularly for those with hypertensive disorders of pregnancy (HDPs). Given that timely recognition of hypertension is key to reducing short- and long-term cardiovascular risk, we assessed knowledge of when to seek medical attention for blood pressure (BP) elevations and rates of BP measurement in the first year postpartum. Methods: This was a secondary analysis of a cohort of 405 primiparas who enrolled in a randomized trial during pregnancy. We calculated the proportion who stated they would contact a clinician for a systolic BP above 140 and a diastolic BP above 90 at 3 months postpartum, and the frequency and location of BP checks reported from 2 to 12 months postpartum by HDP status. Results: HDPs were reported by 16% of participants. Mean age was 32 ± 5 years; 40% identified as non-White, and 25% had public insurance. At 3 months postpartum, 44.6% with HDPs and 23.5% without identified a systolic BP of 140 as the threshold above which to contact a clinician (p < 0.01); 52.4% with HDPs and 28.5% without identified a diastolic BP threshold of 90 (p < 0.01). From 3 to 12 months postpartum, people with HDPs were more likely to report a BP check (83.1% versus 59.4%, p < 0.01) and home BP monitoring (41.6% versus9.7%, p < 0.01). Home monitoring was not associated with awareness of when to seek help for hypertension among those with HDPs. Conclusions: Efforts are needed to improve awareness of when to seek medical attention for postpartum hypertension.

Stringent Regulations of Oocyte Donation Among Jewish Women in Israel: Characteristics and Outcomes of the National Oocyte Donation Program in One Central IVF Unit.

On September 5, 2010, the Israeli Parliament passed a law that allows Israeli female residents to donate their oocytes to infertile Israeli female residents. This law includes unique restrictions that do not exist in other countries. Our aim was to characterize Israeli oocyte donors and recipients and the outcomes of the oocyte donation program as regulated by national law. This retrospective study included 26 financially compensated volunteer donors (mean age 29 ± 3.52 years) and 69 recipients (mean age 44.6 ± 3.53 years) who underwent 30 intracytoplasmic sperm injection cycles and 166 embryo transfers (ETs) in our unit between March 2016 and November 2020. Stringent legal caveats unique to Israel (e.g., Jewish/Moslem donor only to Jewish/Moslem recipient, only unmarried donor, eggs in one cycle restricted to ≤ 3 recipients, donated sperm only from non-Jewish donors, and more) were meticulously applied. Sociodemographic characterizations of donors and recipients were reviewed, and pregnancy and obstetric outcomes were determined. Variables that were significant in achieving live births among the recipients were examined. Twenty-five donors and all 69 recipients were Jewish, and most were unmarried and childless. The main indication for seeking egg donation was age ≥ 40 years/perimenopause (80%). One-half of the recipients used donor sperm and one-half used partner sperm. The pregnancy, clinical pregnancy, live birth, and miscarriage rates were 28.6%, 19.2%, 18.2%, and 2.8%. The live birth rate was negatively associated with multiple ETs. Maternal complications included hypertensive disorders of pregnancy (18.2%), gestational diabetes mellitus (32.3%), and caesarean sections(78.8%). There were no adverse neonatal outcomes. In conclusion, few young women are interested in donating oocytes in Israel. Pregnancy and live birth rates are lower than published values in other egg donation programs.

Determinants of Hypertensive Disorders in Pregnant Women Attended at Parirenyatwa Group of Hospitals in Zimbabwe from January - December 2022

Background: Globally 2.73% of pregnant women suffer from hypertension. Currently, there is still a gap of knowledge in Zimbabwe on hypertensive disorders of pregnancy hence the present study. Methods: An analytical cross-sectional study was conducted. The structured checklist was used to extract data. HBP was measured two times on the right arm using an electronic device (OMRON HEM-7261) with an average of two readings. Patient records were used to collect secondary data from prenatal care visits and laboratory tests. We used simple random sampling methods to screen prenatal care records for pregnant women. All pregnant women at Parirenyatwa Group of Hospitals in 2022 were eligible and constituted our study population. The sample size was determined statistically by power analysis using epidemiological information, this yielded a sample of 240. The Prevalence of HBP in pregnancy and risk factors were determined by Fisher exact test Graph Pad (Prism version6.0), P &lt; 0.05 was set as statistically significant. Results: 240 pregnant women were enrolled given a prevalence of HBP of 25%. Most pregnant women having HBP are 36 to 40 years old and located in urban areas (92%, n = 55). Gestational age 33 % (n = 5), Gravida 3-4 (33%, n = 13) Parity 3-4 (74%, n = 25), and Multiple Pregnancy (25%, n = 5) were the most associated with HBP. Pre-existing hypertension was the most common comorbidity 92%.Family history of HBP (OR = 4.62, 95%, CI = 1.4-15.1), p = 0.016) and age being &lt; 30 years OR= 0.26, 95%, CI = 0.14-0.49), p = 0.0001) were associated with HBP. Conclusions: The prevalence of HBP in pregnancy was higher (25%) than the worldwide prevalence of 2.7% and risk factors are mainly age and family history of HBP.

AI-Powered Wearables for Continuous Patient Monitoring: Improving Chronic Disease Management and Preventive Care

AI-powered wearables, including smartwatches and fitness trackers, are now revolutionizing patient care with the ability to monitor patients' vital signs continuously in real-time. Such wearables monitor all important parameters of a patient, including heart rate, blood pressure, glucose level, and physical activity, thereby providing health professionals with invaluable insights into the condition of a patient. This continuous data allows for early detection of abnormalities, personalized treatment, and adjustments, hence better management of disease in patients suffering from chronic diseases like diabetes, hypertension, and cardiovascular disorders. AI algorithms scan this data in pursuit of foreseeing possible health risks to avoid acute medical events such as heart attacks or diabetic crises. Thus, AI-driven wearables would empower patients in the active management of their health condition, reduce hospital readmissions, and generally improve patient outcomes. This article describes the applications, benefits, and challenges of AI-integrated wearable systems for healthcare, focusing on chronic disease management and prevention of health strategies. Keywords: Wearables using Artificial Intelligence, Continuous Patient Monitoring, Chronic Disease Management, Diabetes, Heart Disease, Preventive Care, Smart Watches, Fitness Trackers, Vital Signs, Analytics of Health Data, Real-time Monitoring, Machine Learning, Personalized Treatment, Predictive Analytics.

The effect of anxiety levels in women with hypertensive disorders on the pregnancy course and outcome

Aim. To analyze the influence of anxiety levels in women with hypertensive disorders on the pregnancy course and outcome in order to identify the relationship between the psycho-emotional state of pregnant women and the probability of developing complications or adverse consequences. Materials and methods. 120 pregnant women were examined and divided into three groups: group 1 – pregnant women with chronic arterial hypertension (CAH), n = 40; group 2 – pregnant women who developed gestational hypertension, n = 40; group 3 – pregnant women without hypertensive disorders, n = 40. The women underwent specialized psychometric testing to assess anxiety/stress levels. The analysis was carried out using the Spielberger–Hanin Scale, the Psychological Stress Scale (PSM-25) and the Impact of Traumatic Event Rating Scale (IES-R). Statistical processing of the results and graphic design were performed using a Microsoft Excel 2016 spreadsheet and the comprehensive data analysis program Statistica 10 for Windows. Results. An elevated level of state and trait anxiety according to the Spielberger–Hanin scale prevailed in pregnant women with CAH, which was an additional stress factor and required continuous monitoring even before the pregnancy onset. Evaluating the IES-R scale results, high levels of the intrusion subscale in all studied groups could be caused directly by pregnancy as a stressful factor. According to the avoidance subscale, we have seen similar results, so, pregnancy contributed to overstraining psychological defense mechanisms. However, the predominance in the group of women with gestational hypertension have suggested that high blood pressure after 20 weeks of pregnancy was one of the contributory factors in the activation of mechanisms for avoiding anxiety. The results of the hyperarousal subscale have demonstrated that the presence of hypertensive disorders (before or during pregnancy) caused the autonomic nervous system activation with the body hyperreactivity. The absence of a high level of stress according to the PSM-25 in all studied groups has demonstrated that women did not experience mental discomfort, which required the use of a wide range of methods to reduce it. Cesarean section was the prevailing delivery mode, the highest percentage was among women with CAH. This group also had the highest number of premature births and the maximum proportion of complications in newborns, indicating the influence of CAH as a negative factor in pregnancy outcomes. Conclusions. The results of this study have demonstrated that an increased level of anxiety in pregnant women could negatively affect their health, as well as the fetal development. In addition, concomitant hypertensive disorders in pregnancy could significantly complicate the pregnancy course, increasing the risk for premature birth and complications in newborns. Therefore, in today’s realities, it is extremely necessary to assess the psycho-emotional state of women in advance, involve specialist physicians, develop and implement a set of psycho-prophylactic measures to increase the neuropsychological stability of pregnant women and reduce the number of negative perinatal outcomes.

PATHOGENETIC MECHANISMS OF PAPILLEDEMA DEVELOPMENT ON PREECLAMPSIA

Preeclampsia is a multisystem disease that can include cardiovascular changes, hematological disorders, liver and kidney failure, cerebral and visual symptoms. Currently, the presence of papilledema in preeclampsia characterizes the disease as severe. However, it is likely that the presence of papilledema does not always characterize vasogenic cerebral edema with increased intracranial pressure. The formation of blurred borders and papilledema may also be associated with impaired autoregulation in the head of the optic disc due to increased blood pressure and the presence of endothelial dysfunction in preeclampsia. It is also important to differentiate the true papilledema from the pseudopapilledema. The study carried out a detailed systematic analysis of modern domestic and foreign literature, devoted to the pathogenetic mechanisms of papilledema development in preeclampsia. The study used such information databases as: eLibrary, PubMed, Scopus, Cochrane Library, MEDLINE for the period from 2015 to May 2024. This literature review presents possible pathogenetic mechanisms of the development of papilledema against on preeclampsia, as well as modern approaches to the differential diagnosis of papilledema from pseudopapilledema. Further study of the pathogenetic mechanisms of papilledema development in hypertensive pregnancy disorders is necessary to identify high-risk patients and optimize their management and treatment tactics.

Structures of TASK-1 and TASK-3 K2P channels provide insight into their gating and dysfunction in disease.

TASK-1 and TASK-3 are pH-sensitive two-pore domain (K2P/KCNK) K+ channels. Their functional roles make them promising targets for treatment of multiple disorders including sleep apnea, pain, and atrial fibrillation. Mutations in these channels are also associated with neurodevelopmental and hypertensive disorders. A previous crystal structure of TASK-1 revealed a lower "X-gate" as a hotspot for missense gain-of-function (GoF) mutations associated with DDSA (developmental delay with sleep apnea). However, the mechanisms of gating in TASK channels are still not fully understood. Here, we resolve structures for both human TASK-1 and TASK-3 by cryoelectron microscopy (cryo-EM), as well as a recurrent TASK-3 variant (G236R) associated with KCNK9 imprinting syndrome (KIS) (formerly known as Birk-Barel syndrome). Combined with functional studies of the X-gating mechanism, we provide evidence for how a highly conserved gating mechanism becomes defective in disease, and also provide further insight into the pathway of conformational changes that underlie the pH-dependent inhibition of TASK channel activity.

NAD+ depletion is central to placental dysfunction in an inflammatory subclass of preeclampsia.

Preeclampsia (PE) is a hypertensive disorder of pregnancy and a major cause of maternal/perinatal adverse health outcomes with no effective therapeutic strategies. Our group previously identified distinct subclasses of PE, one of which exhibits heightened placental inflammation (inflammation-driven PE). In non-pregnant populations, chronic inflammation is associated with decreased levels of cellular NAD+, a vitamin B3 derivative involved in energy metabolism and mitochondrial function. Interestingly, specifically in placentas from women with inflammation-driven PE, we observed the increased activity of NAD+-consuming enzymes, decreased NAD+ content, decreased expression of mitochondrial proteins, and increased oxidative damage. HTR8 human trophoblasts likewise demonstrated increased NAD+-dependent ADP-ribosyltransferase (ART) activity, coupled with decreased mitochondrial respiration rates and invasive function under inflammatory conditions. Such adverse effects were attenuated by boosting cellular NAD+ levels with nicotinamide riboside (NR). Finally, in an LPS-induced rat model of inflammation-driven PE, NR administration (200 mg/kg/day) from gestational days 1-19 prevented maternal hypertension and fetal/placental growth restriction, improved placental mitochondrial function, and reduced inflammation and oxidative stress. This study demonstrates the critical role of NAD+ in maintaining placental function and identifies NAD+ boosting as a promising preventative strategy for PE.

Derivation and external validation of prediction model for hypertensive disorders of pregnancy in twin pregnancies: a retrospective cohort study in southeastern China

ObjectiveWe aimed to develop and validate an effective prediction model for hypertensive disorder of pregnancy (HDP) in twin pregnancies after 28 weeks of gestation.DesignRetrospective cohort study.SettingMaternity hospital.ParticipantsWe recruited twin pregnancies...

Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort.

To investigate associations between assisted reproductive technology (ART) -induced alterations in corpus luteum (CL) number during implantation, and maternal pregnancy and birth outcomes. Pregnancies conceived through ART are associated with increased risks of adverse obstetric and perinatal outcomes, with discrepancies in outcomes between different ART treatment protocols. We hypothesize this is due to the periconceptional hormonal environment regulated by the CL. ART protocols affect CL quantity at conception resulting in CL absence or a supraphysiological number of CL. This study is embedded in the Rotterdam Periconceptional Cohort, an ongoing tertiary center prospective cohort at the Erasmus University Medical Center in Rotterdam, the Netherlands. Women with a singleton pregnancy with data on CL. The number of CL, based on mode of conception: 0 CL (artificial cycle frozen embryo transfer (AC-FET), n=72); >1 CL (ovarian stimulated fresh embryo transfer, n=462) and 1 CL (natural cycle frozen embryo transfer (NC-FET) and natural conceptions, n=1327). Hypertensive disorders of pregnancy, gestational diabetes, gestational age at birth and birthweight, derived from medical records. We included 1,861 pregnancies. The results were adjusted for maternal age, maternal body mass index, nulliparity and obstetric history. In comparison with natural conceptions (1 CL), a pregnancy with CL absence (0 CL) was associated with a higher risk of gestational diabetes (aOR 2.59 [95% CI 1.31;5.15]), and a higher risk of preeclampsia, albeit non-significantly (aOR 2.02 [95% CI 0.91;4.51]). In comparison with pregnancies with >1 CL the risk of preeclampsia was significantly lower (aOR 0.36 [95% CI 0.18;0.72]). Post hoc analyses revealed that in male neonates, >1 CL was associated with a lower birthweight percentile (aβ -6.18 [95% CI -11.16;-1.20]). In contrast, female neonates showed no association with >1 CL, whereas CL absence was associated with a higher birthweight percentile (aβ 12.93 [95% CI 2.52;23.34]). Risks of hypertensive disorders of pregnancy, gestational diabetes and relative birthweight differ between CL groups. These findings support the hypothesis that an aberrant number of CL impacts maternal pregnancy and or birth outcomes. Additional studies need to be conducted to investigate causes and underlying pathophysiology.

Maternal and fetal outcomes in those with autoimmune connective tissue disease.

Autoimmune CTDs like systematic lupus erythematosus (SLE), systemic sclerosis (SSc), and rheumatoid arthritis (RA)predominantly affect women during reproductive years and are linked to maternal and fetal complications. We conducted a population-based, retrospective cohort study using the national inpatient data sample to compare maternal and fetal outcomes in patients with and without CTD delivering between October 2015 and December 2020. Regression analysis was performed and adjusted for multiple patient characteristics to compare outcomes. Our study comprised of 18,866,050 deliveries, of which 50,450 (0.02%) had autoimmune CTD, including 25,340 with SLE, 23,945 with RA, and 1,165 with SSc. Patients with CTDs had significantly higher odds of maternal death (aOR 3.898; 95% CI: 1.462-10.389, p = 0.007), hypertensive disorders (aOR 1.554; 95% CI: 1.456-1.659, p < 0.001), acute kidney injury (aOR 4.886; 95% CI: 3.934-6.069, p < 0.001), blood transfusions (aOR 1.853; 95% CI: 1.628-2.109, p < 0.001), peripartum cardiomyopathy (aOR 2.709; 95% CI: 1.492-4.917, p = 0.001), sepsis (aOR 2.112; 95% CI: 1.430-3.119, p < 0.001), and ARDS (aOR 1.623; 95% CI: 1.076-2.449, p = 0.021). Fetal outcomes were also worse, with higher odds of small for gestational age fetuses (aOR 1.926; 95% CI: 1.779-2.086, p < 0.001), stillbirth (aOR 1.644; 95% CI: 1.352-2.000, p < 0.001), and preterm labor (aOR 1.702; 95% CI: 1.574-1.841, p < 0.001). Patients with RA, SS, and SLE experience varying degrees of complications. Our study shows that pregnant patients with autoimmune CTDs have worse maternal and fetal outcomes compared to those without CTDs. The rates of adverse outcomes varies among CTD subtypes. Comprehensive preconception counseling and tailored management strategies are essential for optimizing outcomes in these patients. Key Points • Increased Maternal Complications: Patients with autoimmune CTDs had significantly higher odds of maternal death, hypertensive disorders, acute kidney injury, blood transfusions, peripartum cardiomyopathy, sepsis, and ARDS. • Adverse Fetal Outcomes: Higher odds of small for gestational age fetuses, stillbirth, and preterm labor were observed in patients with CTDs compared to those without. • CTD Subtype Variations: Complication rates varied among CTD subtypes, with SLE, RA, and SSc each presenting varying risks and outcomes.