Disorders In Pregnant Women Research Articles

86. Metformin for the prevention of hypertensive disorders of pregnancy in women with gestational diabetes and obesity: A systematic review and meta-analysis

Objectives Metformin has been reported to reduce the risk of preeclampsia. It is also known to influence soluble fms-like tyrosine kinase-1 (sFlt-1) levels, which correlate significantly with the gestation of onset and severity of preeclampsia. The main aim of thismeta-analysis was to determine whether metformin use is associated with the risk of hypertensive disorders of pregnancy (HDP). Methods MEDLINE, Scopus and the Cochrane Library were searched for relevant citations. Randomized controlled trials on metformin use, reporting the incidence of HDP were included. Studies on populations with a high probability of metformin use prior to randomization were excluded. Random-effects models with Mantel–Haenszel were used for subgroup analyses. Moreover, a Bayesian random-effects meta-regression was used to synthesize the evidence. Results In total, 3337 citations matched the search criteria. After evaluating the abstracts and full text review, 15 studies were included in the review. Metformin use was associated with a reduced risk of PIH when compared to insulin (RR: 0.56, 95% CI: 0.37–0.85, I2 = 0, 1260 women) and a non-significantly reduced risk of preeclampsia (RR: 0.83, 95% CI: 0.60–1.14, 1724 women). When compared to placebo, metformin use was associated with a non-significant reduction of preeclampsia (RR: 0.74, 95% CI: 0.09–6.28). Metformin use was also associated with a non-significant reduction of any HDP (RR: 0.71, 95% CI: 0.41–1.25, I2 = 0, 556 women) when compared to glyburide. When studies were combined with Bayesian random-effects meta-regression, the posterior probabilities of metformin having a beneficial effect for the prevention of preeclampsia, PIH and any HDP were 92.7%, 92.8% and 99.2%, respectively when compared to any other treatment or placebo. Conclusions There is a high probability that metformin use is associated with a reduced HDP incidence when compared to other treatments and placebo.

335. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable thrombophilia, preliminary results

Introduction Women who develop hypertensive disorders of pregnancy (HD) are at increased risk for cardiovascular disease later in life. Presence of inheritable thrombophilia is associated with poor placentation in HD. It is unknown whether the combination of inheritable thrombophilia and early-onset HD (HD Objective To compare cardiovascular risk factors 12.5 years in women after early-onset HD with and without inheritable thrombophilia. Methods We compared two prospective cohorts of women with a history of early-onset of HD. Women with inheritable thrombophilia (protein C deficiency, protein S deficiency, heterozygous factor V Leiden mutation and heterozygous prothrombin gene G20210A mutation) were compared to women without thrombophilia. Women with pre-existing hypertension were excluded. Physical examination was performed and cardiovascular parameters in serum were measured. Results Sixteen women with inheritable thrombophilia and 98 without thrombophilia were included. Seventy-five percent of all women developed one or more cardiovascular risk factor(s). Hypertension was present in 31.3% of women with thrombophilia and 33.7% without (p = 1.000), increased body mass index >25 kg/m[b] in 43.8% with thrombophilia and 53.1% without (p = 0.593) and hypercholesterolemia in 31.3% with thrombophilia and 43.9% without (p = 0.420). Differences were not significant. Discussion Our preliminary findings demonstrated similar cardiovascular risk factors in women after early-onset HD with and without inheritable thrombophilia. It raises the question whether there is a difference between the pathophysiological origin of HD between women with and without thrombophilia. In general, the role of thrombophilia in the development of cardiovascular risk factors is unclear. However, in this subgroup of women with a history of early-onset HD, thrombophilia does not modify the development of cardiovascular risk factors.

A comparison of the interviewer-administered phone and self-complete online versions of the computerized eMINI 6.0 in a sample of pregnant women

BackgroundThis study compares the prevalence rates of depressive and anxiety disorders identified during pregnancy using an interviewer-administered phone version and a self-complete online version of the computerized eMINI 6.0. Methods888 pregnant women completed the computerized eMINI 6.0 (interviewer-administered phone, n = 253; self-complete online, n = 635). ResultsThere were no significant differences in the proportions of women meeting eMINI 6.0 criteria for current major depression, any current anxiety disorder, or lifetime panic or depressive disorder, by mode of administration. However, a greater proportion of women in the interviewer-administered phone group than in the self-complete online group met criteria for current minor depression (2.0% vs 0.2%, p = .008). LimitationsStudy limitations include its non-randomized design, overall low prevalence of depressive and anxiety disorders in the sample and inclusion of only a select number of eMINI 6.0 modules. ConclusionsThis study demonstrated few differences in the rates of DSM-IV depressive and anxiety disorders identified between the interviewer-administered and self-administered versions of the eMINI 6.0. Findings provide preliminary support the practical value of self-completed computerized interviews in large scale studies examining common mental disorders in pregnant women.

Changes of the sleep in pregnant women with intrauterine fetal growth restriction

Objective – to study the reasons of appearance, terms of manifestation and types of the sleep disorders in pregnant women with intrauterine growth restriction of fetus. 80 pregnant women with placental insufficiency, manifesting as intrauterine fetal growth restriction (IUGR) of II–III degree in the 3rd pregnancy trimester (study group) and 30 women with normal clinical flow of pregnancy (control group) were questioned. They were asked about pregnancy term when the complains of the sleep disorders were firstly expressed, as well as about types of the sleep disorders and their frequency (in times per week). Questioning showed that pregnant women with IUGR in 86% cases experience the sleep disorders starting from pregnancy term 12–22 weeks (healthy pregnant women — mostly after 30 weeks, 57% cases), more commonly wake up 2 or more times per night (71% of positive answers, in control group – 23%), and 3 or more times per week (78% of positive answers, in control group – 17%). Thus, sleep disorders in pregnant women with IUGR appear earlier and seem to be more expressed then in pregnant women with normal fetal growth. Expression of the complains of insomnia, in our opinion, might be considered as an early diagnostic sign of forming of placental insufficiency, which is later realized as IUGR.

Determining the Initiation of Opiate Misuse Resulting in Opioid Use Disorder in Pregnant Women

ABSTRACTThe aim of this study was to explore the “opiate misuse footprint” made by obstetrics and gynecology physicians in prescribing opioid medications for postpartum pain control that led to opioid misuse and opioid use disorder. Data were collected using intake information and anonymous surveys administered to pregnant women at local methadone clinics in Indianapolis, Indiana, in 2016–2017. Results from this study revealed that 40% of the 33 participants stated that the first drug they became addicted to was prescription opioids; 71% stated that the first opiate they became addicted to was a prescription pain medication. Prescription opioids were mainly obtained from emergency medicine physicians and friends. Reported use of opioids within the past four months was high, with the most commonly used drugs being methadone (57.6%) and heroin (42.4%). A majority of participants also endorsed a history of sexual and physical abuse, recent incarceration, and mental health disorders. As a large number of pregnant women with opioid use disorder reported their initial drug of misuse as prescription pain medications, it is important to avoid overprescribing opioids in reproductive-age women.

Autonomic and psychosomatic disorders in women during pregnancy

The article describes the subjective and objective signs of autonomic violations from the standpoint of neurological status and psychosomatic disorders.The objective: is to improve the quality of autonomic dysfunction diagnosis in pregnant women by the results of the autonomic and psychosomatic state study.Materials and methods. 487 pregnant women of all gestation periods registered in women’s consultations, in the Ivano-Frankivsk City Clinical Maternity Hospital and the Kyiv City Center of Reproductive and Perinatal Medicine were examined. The study design contained a full range of clinical, laboratory and instrumental methods.Results. From all 487 examined women 172 (35,31%) pregnant had autonomic dysfunction. Depending on the changes in autonomic homeostasis and psychosomatic symptoms, autonomic dysfunction syndrome in 112 (22,99%) pregnant women and somatoform dysfunction of the autonomic nervous system in 60 (12,32%) pregnant women were diagnosed with available psychosomatic symptoms and functional changes of heart and vessels. Hypertonic form of autonomic dysfunction wasdiagnosed in 72 (41,86%) pregnant women, hypotonic – in 61 (35,46%) cases and cardiac type – in 39 (22,67%) patients. Pregnant women with SD ANShave an increased level of personal anxiety – 62,0±4,44 points, that was significantly higher than in the control group 22,0±2,88.Conclusions. The conducted studies allowed to confirm a high percentage of autonomic disorders in pregnant women at different periods of gestation. The presence of autonomic imbalance during pregnancy can be considered as autonomic visceral dysfunction and psychosomatic pathology, which arises due to the suprasegmental autonomic structures regulatory violations. Pregnant women with autonomic dysfunction are characterized by an increased level of anxiety, which may be a risk factor for the perinatal complications.

Prévention de la pré-éclampsie en 2018 en population générale et chez la femme lupique : à l’aube d’une médecine personnalisée ?

Pre-eclampsia prevention represents a major public health issue, as this vasculo-placental disorder generates a great burden of foeto-maternal morbi-mortality. Aspirin has proved its efficacy in primary and secondary pre-eclampsia prevention, especially when it is given at 150mg per day bedtime before 15 weeks of gestation to high-risk women. In the English trial ASPRE, high-risk women were identified by an algorithm taking into account angiogenic biomarkers ascertained at the end of first trimester of pregnancy. This article focuses on physiopathological mechanisms and risk factors of pre-eclampsia and on the interest of early angiogenic biomarkers dosing during pregnancy, for the assessment of pre-eclampsia risk. Unlike Great Britain or Israel, cost-effectiveness of this algorithm in general population has not been assessed in France. Finally, systemic lupus erythematous is at high risk of vasculo-placental disorders. Although few studies of angiogenic biomarkers dosing during lupus pregnancies identified a correlation between high sFlt1 levels at the end of first trimester and subsequent onset of severe vasculo-placental disorders, with a very good negative predictive value of sFtl1. Angiogenic biomarkers ascertainment for screening of vasculo-placental disorders in pregnant women with systemic lupus erythematous could allow targeting at best women needing an aspirin treatment and a closer monitoring.

CHANGES OF THE SLEEP, HORMONAL BALANCE AND PROFILE OF CYTOKINES IN PREGNANT WOMEN WITH PLACENTAL INSUFFICIENCY

Objective – to establish the correlation between the placental insufficiency, sleep disorders and pro- and anti-inflammatory part of the immune system by questioning, studying of the levels of melatonin, placental hormones and pro- and anti-inflammatory cytokines in pregnant women with placental insufficiency.Materials and methods. 80 pregnant women with placental insufficiency, manifesting as intrauterine fetal growth restriction (IUGR) of II-III degree in the 3rd pregnancy trimester (study group) and 30 women with normal clinical flow of pregnancy (control group) were questioned. 46 patients from study group and 20 patients from control group women were examined further: the studying of the blood plasma concentrations of melatonin, placental hormones (placental lactogen, free estriol), pro-inflammatory cytokines, such as tumor necrotizing factor-α (TNF-α), interleukin-1-β (IL-1-β), interleukin-6 (IL-6), and anti-inflammatory cytokines, such as interleukin-4 (IL-4) and interleukin-10 (IL-10), was conducted.Results and the discussion. Questioning showed that pregnant women with placental insufficiency (PI) in 86% cases experience the sleep disorders starting from pregnancy term 12-22 weeks (healthy pregnant women – mostly after 30 weeks, 57% cases), more commonly wake up 2 or more times per night (71% of positive answers, in control group – 23%), and 3 or more times per week (78% of positive answers, in control group – 17%). It also has been established that concentration of melatonin significantly decreases, if the pregnancy is complicated by intrauterine fetal growth restriction (study group – 126,87±14,87 pg/ml, control group – 231,25±21,56 pg/ml, p<0,001). The levels of pro-inflammatory cytokines in the study group were significantly higher, comparing with the control group (TNF-α: study group – 10,05±1,35 pg/ml, control group – 5,60±1,50 pg/ml, p<0,05; IL-1-β: study group – 14,67±2,13 pg/ml, control group – 3,96±0,92 pg/ml, p<0,001; IL-6: study group – 6,91±0,99 pg/ml, control group – 2,69±0,99 pg/ml, p<0,05). The same is true about anti-inflammatory cytokines (IL-4: study group – 5,97±0,50 pg/ml, control group – 3,74±0,62 pg/ml, p<0,05; IL-10: study group – 11,40±1,50 pg/ml, control group – 4,70±3,20 pg/ml, p<0,001). We did not find significant difference in hormonal concentrations between groups.Conclusions. Sleep disorders in pregnant women with placental insufficiency appear earlier and seem to be more expressed then in healthy pregnant women. The blood level of melatonin significantly decreases in case of placental insufficiency, manifested as intrauterine fetal growth restriction. The strengthening of the pro-inflammatory immunity, shown as the increasing of the levels of TNF-α, IL-1-β and IL-6, is also present in case of IUGR. The rising of the plasma concentration of the anti-inflammatory cytokines, such as IL-4 and IL-10, in our opinion, can be explained by activation of the mechanisms of compensation, which decrease the risk of premature labor.

An analysis of whether sleep disorder will result in postpartum depression.

Postpartum depression has become an important topic of concern in recent years. However, very few studies on the causes of postpartum depression exist, and the effects of prenatal sleep disorders on the development of postpartum depression among pregnant women have not been elucidated. This study aimed to understand the association between prenatal sleep disorders and postpartum depression. The National Health Insurance Research Database of Taiwan (between 2000 and 2010) was used to assess the effects of prenatal sleep disorder on the risk of postpartum depression using Cox regression analyses. Prenatal sleep disorder in pregnant women increased the risk of developing postpartum depression (the risk in the sleep disorder cases was 5.359-fold increased compared with control cases). In addition, regardless of postpartum week (≤ 6 weeks, 6–12 weeks, or > 12weeks), the risk of developing postpartum depression in pregnant women with prenatal sleep disorders were increased, by 5.461-fold (P < 0.001), 3.490-fold (P = 0.010), and 3.416-fold (P = 0.015), respectively, compared with pregnant women without sleep disorders. Pregnant women with prenatal sleep disorders exhibited increased risks of developing postpartum depression. For pregnant women with prenatal sleep disorder, postpartum intervention measures should be provided as early as possible to reduce the risk of developing postpartum depression.

Diabetes and Pregnancy

Diabetes and Pregnancy

Hypertensive Disorders in Pregnant Women Receiving Fertility Treatments.

Hypertensive disorders (HDs) as the most prevalent medical problem during pregnancy, predispose the patient to a lot of comorbidities and may even cause maternal or fetal death. The rate of infertility has been increasing in recent decades. So, we collected and summarized data about the co-existence of these two entities and found that HDs are somewhat more common in women receiving fertility treatments regardless of pathophysiologic correlation of infer- tility and hypertension or older age and chance of multiple pregnancies.

Prevalence and pattern of anxiety and depressive disorders in pregnant women attending antenatal clinic

Prevalence and pattern of anxiety and depressive disorders in pregnant women attending antenatal clinic

EFFECT OF ROSELLE (HIBISCUS SABDARIFFA) ON CHANGES IN HEMOGLOBIN LEVELS IN PREGNANT WOMEN WITH ANEMIA TAKING IRON SUPPLEMENT

Background: Anemia during pregnancy is one of the most common disorders in pregnant women in Indonesia. The Government has made efforts to overcome this problem, however, the rate of anemic mothers remains high. Rosella (Hibiscus Sabdariffa) is considered able to increase the hemoglobin levels in pregnant mothers.&#x0D; Objective: To analyze the effect of Rosella flower extract (Hibiscus Sabdariffa) on the increase of Hemoglobin level in pregnant women with anemia receiving Fe tablet.&#x0D; Methods: This study was a quasi-experiment with pretest-posttest control group design conducted in November - December 2016 in the working area of Tlogosari Wetan Community Health Center. Forty-two participants were selected using accidental sampling, which 21 assigned in the experiment and control group. All samples were pregnant women in the second trimester suffering from anemia and receiving iron tablets. Hemoglobin levels were measured using hematology analyzer in laboratory. Independent t-test and paired t-test were used for data analysis.&#x0D; Results: Paired t-test obtained p-value 0.00 (&lt;0.05) indicated that there was an increase of hemoglobin levels in both experiment and control group. The mean increase of hemoglobin levels in the control group was 0.61 gr/dl and in the experiment group was 1.08 gr/dl. The hemoglobin levels in the experiment group were higher than the levels in the control group. Independent t-test obtained p-value 0.000 (&lt;0.05) indicated that there was a significant difference of mean of hemoglobin levels between the control group and the treatment group.&#x0D; Conclusion: The consumption of rosella extract combined with Fe tablet showed a significant increase of hemoglobin levels compared with the consumption of Fe tablet alone. Therefore, it is suggested for midwife to use the result of this research as evidence practice through counseling for pregnant mother about utilization of rosella extract that can increase hemoglobin level in pregnant woman with anemia.

Prevalence of and risk factors for eclampsia in pregnant women in India

Objective Eclampsia is a potentially fatal disorder in pregnant women and remains an important cause of maternal and perinatal child morbidity and death worldwide. We aimed to assess the prevalence of and risk factors for convulsions (not occurring from fever) during pregnancy in Indian women. Convulsion is a key symptom suggestive of eclampsia. Methods Cross-sectional data from India’s third National Family Health Survey, conducted during 2005–2006 were used. Self-reported information on convulsions during pregnancy was obtained from 39,657 women aged 15–49 years who had a live birth in the 5 years preceding the survey. Multiple logistic regression analysis was used to explore risk factors for convulsion in pregnancy. Results Overall, 1 in 10 women reported having convulsions in their most recent pregnancy. The prevalence was significantly higher in women living in rural areas compared with those living in urban areas (11.3% vs. 7.4%; P Conclusion Our findings from a large population-based nationally representative sample of Indian women indicate a high prevalence of convulsions, a symptom suggestive of eclampsia, and its association with several maternal, lifestyle risk factors and sociodemographic characteristics.

Prevalences of inherited red blood cell disorders in pregnant women of different ethnicities living along the Thailand-Myanmar border.

Background: Inherited red blood cell disorders are prevalent in populations living in malaria endemic areas; G6PD deficiency is associated with oxidant-induced haemolysis and abnormal haemoglobin variants may cause chronic anaemia. In pregnant women, microcytic anaemia caused by haemoglobinopathies mimics iron deficiency, complicating diagnosis and treatment. Anaemia during pregnancy is associated with morbidity and mortality. The aim of this study was to characterise the prevalence of G6PD deficiency and haemoglobinopathies among the pregnant population living along the Thailand-Myanmar border. Pregnant women attending antenatal clinics in this area belong to several distinct ethnic groups. Methods: Data were available for 13,520 women attending antenatal care between July 2012 and September 2016. Screening for G6PD deficiency was done by fluorescent spot test routinely. G6PD genotyping and quantitative phenotyping by spectrophotometry were analysed in a subsample of women. Haemoglobin variants were diagnosed by HPLC or capillary electrophoresis and molecular methods. The prevalence and distribution of inherited red blood cell disorders was analysed with respect to ethnicity. Results: G6PD deficiency was common, especially in the Sgaw Karen ethnic group, in whom the G6PD Mahidol variant allele frequency was 20.7%. Quantitative G6PD phenotyping showed that 60.5% of heterozygous women had an intermediate enzymatic activity between 30% and 70% of the population median. HbE, beta-thalassaemia trait and Hb Constant Spring were found overall in 15.6% of women. Only 45.2% of women with low percentage of HbA 2 were carriers of mutations on the alpha globin genes. Conclusions: Distribution of G6PD and haemoglobin variants varied among the different ethnic groups, but the prevalence was generally high throughout the cohort. These findings encourage the implementation of an extended program of information and genetic counselling to women of reproductive age and will help inform future studies and current clinical management of anaemia in the pregnant population in this region.

Prevalences of inherited red blood cell disorders in pregnant women of different ethnicities living along the Thailand-Myanmar border

Background: Inherited red blood cell disorders are prevalent in populations living in malaria endemic areas; G6PD deficiency is associated with oxidant-induced haemolysis and abnormal haemoglobin variants may cause chronic anaemia. In pregnant women, microcytic anaemia caused by haemoglobinopathies mimics iron deficiency, complicating diagnosis and treatment. Anaemia during pregnancy is associated with morbidity and mortality. The aim of this study was to characterise the prevalence of G6PD deficiency and haemoglobinopathies among the pregnant population living along the Thailand-Myanmar border. Pregnant women attending antenatal clinics in this area belong to several distinct ethnic groups. Methods: Data were available for 13,520 women attending antenatal care between July 2012 and September 2016. Screening for G6PD deficiency was done by fluorescent spot test routinely. G6PD genotyping and quantitative phenotyping by spectrophotometry were analysed in a subsample of women. Haemoglobin variants were diagnosed by HPLC or capillary electrophoresis and molecular methods. The prevalence and distribution of inherited red blood cell disorders was analysed with respect to ethnicity. Results: G6PD deficiency was common, especially in the Sgaw Karen ethnic group, in whom the G6PD Mahidol variant allele frequency was 20.7%. Quantitative G6PD phenotyping showed that 60.5% of heterozygous women had an intermediate enzymatic activity between 30% and 70% of the population median. HbE, beta-thalassaemia trait and Hb Constant Spring were found overall in 15.6% of women. Only 45.2% of women with low percentage of HbA 2 were carriers of mutations on the alpha globin genes. Conclusions: Distribution of G6PD and haemoglobin variants varied among the different ethnic groups, but the prevalence was generally high throughout the cohort. These findings encourage the implementation of an extended program of information and genetic counselling to women of reproductive age and will help inform future studies and current clinical management of anaemia in the pregnant population in this region.

Obstructive sleep apnea in pregnancy. Is it a new syndrome in obstetrics?

BackgroundSleep disordered breathing (SDB) is a frequent disorder and its severity superfats as pregnancy progresses. The exact prevalence or incidence of such disorder in pregnant women is still unknown. ObjectivesTo assess the incidence and severity of OSA in pregnant women and to discover the risk factors for OSA during pregnancy. MethodsA total of 30 pregnant women and 30 age matched controls completed Epworth Sleepiness Scale and Stop-Bang questionnaire. SDB diagnosis was based on polysomnography. ResultsThe incidence of OSA among our studied pregnant women was 36.7% and 53.3% of pregnant women were snorers. They demonstrated significantly higher AHI (4.38 ± 4.45) and ODI (3.72 ± 4.03). There was a significant positive correlation between gestational age and ESS, BMI, AHI and ODI, as they are of their highest levels among cases in the third trimester. Binary logistic regression analysis showed that gestational age and body mass index were independent risk factors with odds ratio (2.23 & 4.99) and 95% CI (1.05–5.32 & 1.75–33.28) respectively while the neck circumference and ESS were considered as dependent risk factors. ConclusionPregnancy is a risk condition for OSA which aggravated by neck circumference and base line BMI. The susceptibility and severity increase by increasing gestational age.

Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome

ObjectiveWomen with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA. MethodsWe included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed. ResultsComparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=−418.0, P=0.01).Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=−0.02, P=0.01, resistance index at 20 and 32weeks β=−0.01, P=0.02 and β=−0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=−0.02, P=0.05 and β=−0.01, P=0.02). ConclusionsWomen with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.

Folic acid supplement use and the risk of gestational hypertension and preeclampsia.

Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality. Studies suggest that the use of folic acid may lower the risk of hypertensive disorders in pregnant women. The aim of this study was to assess the effects of timing and duration of folic acid-containing supplement use on the risk for gestational hypertension and preeclampsia. Exposures and outcomes data were obtained through interviews and review of participant's medical records from the MotherToBaby cohort studies across the United States and Canada. Demographics, medical history, lifestyle factors, substance use, and fetal sex were assessed as potential confounders. Unadjusted and adjusted risks for gestational hypertension and preeclampsia were examined using odds ratios and 95% confidence intervals. 3247 women were included in the study. Compared to non-supplement use, early and late supplement use were not significantly associated with the development of gestational hypertension or preeclampsia. The odds of developing gestational hypertension and preeclampsia were significantly reduced as the duration of folic acid-containing supplement use increased. Findings from this study suggest that the use of folic acid-containing supplements may mitigate the risk for gestational hypertension and preeclampsia.

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

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