Family History Of Preeclampsia Research Articles

Demographic Factors, Biochemical Markers, and Obstetric History Associated with the Risk of Preeclampsia in a Sudanese Population Sample

Background: Preeclampsia significantly contributes to maternal and perinatal illness and death, particularly in low and middle-income countries like Sudan. It is classified by onset timing (early vs. late) and severity (mild vs. severe) and is one of the four hypertensive disorders in pregnancy, including chronic hypertension, gestational hypertension, and chronic hypertension with superimposed preeclampsia. This study aimed to evaluate the demographic, clinical, and biochemical predictors of preeclampsia among Sudanese women. Methods: This case-control study involved 100 women diagnosed with preeclampsia and 100 healthy pregnant women who acted as the control group at Omdurman Maternity Hospital in Khartoum State, Sudan, from 2019 to 2021. Data on sociodemographic characteristics, obstetric history, and biochemical markers, including platelet counts, were collected using a comprehensive questionnaire and blood sample analysis. Results: Women with preeclampsia were more frequently over the age of 40 (OR=9.33, 95% CI: 4.54-19.19, p < 0.001) and had a longer median duration of marriage (OR=2.9, 95% CI: 1.51-5.58, p=0.001). Lower educational levels (p=0.008) and being housewives (p=0.024) were also more prevalent in the preeclampsia group. Clinically, headache (OR=18.98, 95% CI: 2.44-147.5, p=0.005) and blurring of vision (OR=25.83, 95% CI: 1.17-572.6, p=0.04) were more prevalent in women with preeclampsia. Biochemical markers showed lower platelet counts (p=0.002), higher levels of alanine aminotransferase (ALT) (OR=2.23, 95% CI: 1.51-3.28, p < 0.001) and creatinine (OR=16.76, 95% CI: 2.31-121.5, p=0.005), while aspartate aminotransferase (AST) was not significantly associated with preeclampsia. Conclusion: Family history of preeclampsia was the most significant predictor. Other important risk factors included older age, longer duration of marriage, lower education levels, headache, blurring of vision, and higher levels of alanine aminotransferase (ALT) and creatinine.

Evidence that systemic vascular resistance is increased before the development of gestational diabetes mellitus

The ophthalmic artery, which is the first branch of the internal carotid artery, has a Doppler velocity waveform with two systolic peaks. The ratio of the peak systolic velocity (PSV) of the second wave divided by that of the first wave, reflects increased peripheral resistance. Previous studies in the first, second and third trimesters of pregnancy have reported that in pregnancies that subsequently develop preeclampsia (PE) the PSV ratio is increased. Both PE and gestational diabetes mellitus (GDM) are associated with endothelial dysfunction and an increased risk of cardiovascular diseases during the first decade following pregnancy. To compare the ophthalmic artery PSV ratio at 11-13 weeks' gestation in women who subsequently develop GDM to unaffected pregnancies and those who develop PE. This was a prospective observational study in women attending for a routine hospital visit at 11+0 - 13+6 weeks' gestation at King's College Hospital, London, UK. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the PSV ratio, and measurement of mean arterial pressure (MAP). Linear regression was performed for the prediction of ophthalmic artery PSV ratio, from maternal characteristics and MAP. The PSV ratio in the group with GDM was compared to that of PE and unaffected pregnancies. 3999 women were included in the study, including 375 (9.8%) who developed GDM and 101 (2.5%) who developed PE. In the GDM group, 161 (43.3%) were treated by diet alone, 130 (34,1%) were treated with metformin and 84 (22.6%) received insulin ± metformin. Significant prediction of PSV ratio was provided by development of PE, maternal age, body mass index, MAP, first degree family history of diabetes mellitus, family history of PE, Asian ethnicity, and smoking. There was no significant contribution from GDM. In women who developed GDM requiring insulin treatment, ophthalmic artery PSV ratio (0.67 ± 0.09) was higher (p <0.001) than in unaffected pregnancies (0.63 ± 0.10), but it was not significantly different from that in the PE group (0.69 ± 0.10; p=0.90). In women who develop severe GDM, requiring insulin treatment, there is evidence of increased peripheral resistance which is apparent from the first-trimester of pregnancy.

Externally validated prediction models for pre-eclampsia: systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the performance of existing externally validated prediction models for pre-eclampsia (PE) (specifically, any-onset, early-onset, late-onset and pretermPE). A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta-analysis of discrimination and calibration performance was conducted when appropriate. Twenty-three studies reported 52 externally validated prediction models for PE (one preterm, 20 any-onset, 17 early-onset and 14 late-onset PE models). No model had the same set of predictors. Fifteen any-onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing-risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy-associated plasma protein-A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver-operating-characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76-0.96), and was well calibrated. The other models generally had poor-to-good discrimination performance (median AUC, 0.66 (range, 0.53-0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any-onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66-0.76) and 0.73 (95% PI, 0.55-0.86). Existing externally validated prediction models for any-, early- and late-onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple-test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high-resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The association between diet quality index-international and dietary diversity score with preeclampsia: a case–control study

BackgroundPreeclampsia is a significant complication that occurs during the second half of pregnancy. Recent studies have indicated that dietary factors play a crucial role in the development of preeclampsia. The Diet Quality Index-International (DQI-I) and Dietary Diversity Score (DDS) are appropriate indices for assessing the quality of foods, meals, and diets. This study aimed to investigate the relationship between DQI-I, DDS, and preeclampsia.MethodsThis study utilized a case-control design. A total of 90 newly diagnosed preeclampsia cases and 90 healthy controls were included from a referral hospital in Tabriz, Iran. DQI-I and DDS were calculated based on information obtained from a reliable Food Frequency Questionnaire consisting of 168 food items, which assessed participants’ usual diet. Logistic regression analysis adjusted for age, body mass index, education, family history of preeclampsia, and total energy intake was used to estimate odds ratios (ORs).ResultsThe mean age and pre-pregnancy body mass index of the participants were: 27.14 ± 4.40 years and 26.09 ± 3.33 kg/m2, respectively. After adjusting for various confounders, we found significant inverse association between the risk of developing preeclampsia and both DQI-I and DDS. The highest quartile of DQI-I had a significantly lower risk of developing preeclampsia compared to the first quartile (OR = 0.02, 95% CI [0.005, 0.08]) (P < 0.001). Similarly, the highest quartile of DDS had a significantly lower risk of developing preeclampsia compared to the first quartile (OR = 0.09, 95% CI [0.03, 0.31]) (P = 0.001).ConclusionsOur findings suggest that maintaining a high-quality and diverse diet is associated with a lower risk of preeclampsia. Further studies are needed to confirm these associations and explore potential causal relationships.

Socio-demographic Characteristics of a Cross-section of Pre-eclamptic Women in Yenagoa, Nigeria

Pre-eclampsia (PE) is a multifactorial disorder that ultimately manifests as hypertension in the pregnant woman. This study was aimed at determining socio-demographic characteristics of PE among pregnant women attending tertiary Hospitals in Yenagoa, Bayelsa State, Nigeria. A total of 182 pregnant women, consisting of 91 women with PE (gestation &gt; 20 weeks, blood pressure ≥ 140/90 mmHg) and 91 normotensive pregnant women at gestation &gt; 20 weeks were enrolled in the study by consent. These respondents filled out structured questionnaires that obtained data on sociodemographic variables (which are maternal age, parity, body mass index [BMI], systolic and diastolic blood pressure [SBP and DBP], educational level, family history of PE, occupation, the severity of PE, primipaternity, and gestational age of PE. Data was grouped into PE cases and control. Chi-square was used to determine associations between PE and sociodemographic variables for categorical data, whereas the independent T-test was used to determine differences between groups for parametric data. Data was considered significant at p &lt; .05. Results showed that BMI (X^2 = 21.01, p = .00), SBP (T = 27.06, p = 0.00), DBP (T = 29.75, p = 0.00), educational level (X^2 = 14.15,p = .00), family history of pre-eclampsia (X^2 = 33.09,p = .00), and primipaternity (X^2 = 21.01,p= .00) showed significant associations with pre-eclampsia (p &lt; .05). It is recommended that healthy weight management, blood pressure monitoring, adequate antenatal care, and family history counselling be promoted in health facilities in our setting.

Relationship between Serum Magnesium Status and the Incidence of Preeclampsia at 8 Padang Primary Health Care

Introduction: Preeclampsia is one of the main causes of maternal morbidity and mortality, with its etiology and pathophysiology not fully understood. Several studies have shown that magnesium plays an important role in preeclampsia. Magnesium plays a role in modulating endothelial function. Decreased serum magnesium levels in pregnancy can trigger endothelial dysfunction that has an impact on the occurrence of preeclampsia.Objective: Determine the relationship between serum magnesium status with incidence of preeclampsia in pregnant women at 8 Padang Primary Health Care.Method: An observational analytic with cross-sectional design. Sampling was carried out using total sampling technique from research master data at 8 Padang Primary Health Care for period June 2019 – May 2020. The total sample was 45 pregnant women who met the inclusion and exclusion criteria. Data were analyzed using Fisher’s.Result: The serum magnesium status of pregnant women in the 8 Padang Primary Health Care was dominated by normal serum magnesium status (91.1%) and only 8.9% of pregnant women had preeclampsia. Fisher’s test showed that there was a significant relationship between serum magnesium status and the incidence of preeclampsia (p-value = 0,034).Conclusion: There is a significant relationship between serum magnesium status and preeclampsia (with overlook the factors of previous preeclampsia history, family history of preeclampsia, and magnesium intake during pregnancy). Hypomagnesemia status in pregnant women can exacerbate the occurrence of preeclampsia.

Role of Shear Wave Elastography of Placenta in Prediction of Preeclampsia in High-Risk Pregnancy.

The aim of our study was to compare the placental elasticity values between normal pregnancies and preeclamptic pregnancies and evaluate the utility of shear-wave elastography of the placenta as a predictor for preeclampsia in high-risk pregnancy. A prospective study was performed with 90 singleton high-risk pregnancies having any of the 7 risk factors for developing preeclampsia (primigravida, history of preeclampsia, family history of preeclampsia, history of pregestational diabetes, chronic hypertension, advanced maternal age [≥40 years], and body mass index ≥26 kg/m 2 ) were enrolled in the study. Shear-wave elastography was performed in all patients at 20 to 24 weeks' gestation and at 34 to 36 weeks' gestation, at 2 sites: center and edge of the placenta. The patients were divided into 2 groups: normal pregnancies (group A) or developed preeclampsia (group B). Women with posterior placentation, obstetric disorders other than preeclampsia, or multiple gestation were excluded from the study. Group comparisons were done using the χ2 test or Fisher exact test. Shear-wave elasticity values at 20 to 24 weeks' gestation for group B at the center of the placenta (21.73 vs 9.72 kPa) and at the edge of the placenta (21.6 kPa vs 10.15 kPa) were significantly higher than those for group A ( P < 0.05). Similar results were seen at 34 to 36 weeks' gestation. With a cutoff of 13.1 kPa, we attained sensitivity of 95.2%, specificity of 92.8% and diagnostic accuracy of 93.3% for predicting development of preeclampsia. Patients with preeclampsia have a significantly higher stiffness of the placenta. Shear-wave elastography is useful to evaluate placental function. Elastography can be used as a supplementary tool for prediction of preeclampsia.

Awareness and Knowledge of Pre-eclampsia Among Saudi Women of Reproductive Age.

Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia. It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables. Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia. This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions.

Pregnancy-An Ideal Period to Identify Women at Risk for Chronic Hypertension.

Cardiovascular disease is the leading cause of mortality in women. Pregnancy is an ideal period to implement cardiovascular prevention strategies as women seek medical help. We aimed to develop a predictive model to identify women at increased risk for chronic hypertension (CH) based on information collected in the index pregnancy. Cohort of 26 511 women seen in 2 consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure at 11 to 13 weeks' gestation, and the development of preeclampsia or gestational hypertension (GH) in the index pregnancy. Logistic regression models were fitted for the prediction of the development of future CH by the 20th week of the subsequent pregnancy. The performance of screening and risk calibration of the model were assessed. In this study 1560 (5.9%) women developed preeclampsia or GH (index pregnancy), and 215 (0.8%) developed future CH, with a median of 3.0 years later. Predictors of development of future CH were maternal age, weight, and blood pressure; Black and South Asian ethnicity; family history of preeclampsia; parity; and development of preeclampsia or GH. Preeclampsia or GH detected 52.1% (45.2%-58.9%) of future CH. At a screen-positive rate of 10%, a model including maternal characteristics, early pregnancy blood pressure, and development of preeclampsia or GH detected 73.5% (67.1-79.3) of future CH. Early pregnancy maternal characteristics, blood pressure, and development of preeclampsia or GH identify three-fourths of women at risk for future CH. Our results offer an important preventative strategy for identifying women at increased risk of future CH, which is applicable worldwide.

Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies

Background: Human placenta is a diary of all the prenatal events and it’s study may provide valuable insight into pathophysiology of many diseases. One such disease preeclampsia (PE) is a leading contributor of maternal/fetal mortality and morbidity. In a quest to improve the treatment protocols, newer etiologies are researched, the latest being Androgen Receptor (AR) expression in PE placentae. Methodology: Study was conducted in a tertiary care hospital in Bengaluru over a period of 18 months. Placentae (15) from singleton pregnancies with PE formed the study group while placentae (5) from normotensive pregnancies were the control group. Gross and histopathological findings followed by immunohistochemistry of AR was performed on all placentae and categorized based on the percentage of villi stained. Intracellular localisation and the type of cells staining were also recorded. Results: Mean age was 28 years, majority (73%) of PE were in 28-32 weeks gestation group, with 46% being primigravidae. Past history of PE was observed in 75% while 53% had family history of PE. Decreased placental weight, increased syncytial knots, accelerated villous maturation and stromal fibrosis, fibrinoid necrosis and mural hypertrophy of arterioles were statistically significant findings in PE group. AR staining was seen in 16/20 (80%) with 11/15 PE cases showing 2+ and 3+ staining. Cytoplasmic staining was commonly seen in Syncytiotrophoblast, Cytotrophoblast &amp; stromal cells in both groups. Conclusion: AR expression was seen both in PE and non-PE placentae, although AR expression is increased in the former. Stillbirths were associated with positive AR despite clinically classified as mild PE, while negative AR was associated with live births. AR expression could be a new marker for PE with adverse outcome especially in recurrent cases.

Risk Factors of Body Mass Index and Hypertension on Preeclampsia during the Covid-19 Pandemic

Preeclampsia, known as the "new onset of persistent hypertension," can increase the morbidity and mortality of mothers and fetus. The Indonesian Health Profile shows that the maternal mortality rate (MMR) due to preeclampsia in Indonesia reaches 25%. The Corona Virus Disease 2019 impacted the access to, and quality health services, including for maternal and neonatal. This study aim to determine the risk factors for preeclampsia at Budhi Asih Hospital during the Covid-19 pandemic. This was a retrospective, observational case-controlled study, using medical records of woman on antenatal care from March 2020 – March 2022. Samples size was 128 participants (64 cases and 64 controls) using a simple random technique. Data analysis used the Chi-square test and logistic regression. The results showed that the variables associated with the incidence of preeclampsia were maternal age (p=0.049), parity status (p=0.041), chronic hypertension (p=0.000), and BMI (p=0.003). Variables that were not related to the incidence of preeclampsia were previous history of preeclampsia (p=0.094), pregnancy interval (p=0.367), and family history of preeclampsia (p=0.154). The most dominant variable was chronic hypertension (OR 36.162; 95% CI 4.453-293.655). This study concludes that chronic hypertension, obesity, age at risk (&lt;20 years or &gt;35 years), and nullipara or primipara are risk factors for preeclampsia at Budhi Asih Hospital during the Covid-19 pandemic.

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

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

STUDY OF MATERNAL AND FETAL OUTCOME IN PATIENTS OF ECLAMPSIA

Background: Eclampsia is still a major cause of maternal morbidity and mortality in India and across the globe. Material &amp; Methods: This was a descriptive cross-sectional study conducted at Government Medical College, LaturMaharashtra in 240 eclamptic patients admitted from 1st January 2019 to 30th June 2020, included after permission from the Institutional Ethics Committee &amp; were evaluated regarding eclampsia, its sociodemographic presentation, risk factors, and fetomaternal complications. Epi- info 7.2.5 &amp; SPSS version 2.0 was used for statistical analysis. The incidence Results: of eclampsia in the study was 1.64%. The mean age of eclampsia cases was 21.25 ± 2.47 years. 71.66% of cases were primiparous, 61.25% of cases of eclampsia had no education at all, and 13.33% of cases had a family history of preeclampsia.70% of patients were unbooked, 68.33% of cases were from rural residence while 78.34% cases were referred from different hospitals. 87.50% cases had antepartum eclampsia, 66.98% presented at gestational age less than 37 weeks, and 65.84% presented with severe hypertension with blood pressure &gt;160/110 mm Hg on admission. 63.75% of cases had 2-4 convulsions before the start of anticonvulsant therapy. 67.91% of cases were delivered by lower segment cesarean section while 32.09% of cases had delivered vaginally. 9.17% of cases had HELLP syndrome, 7.5% cases had PRES, 5% cases required ventilatory support, and 2.92% cases developed pulmonary edema. Maternal death occurred in 9 cases. Pulmonary edema was the commonest cause of death in 44.44% of cases of eclampsia. 56.67% of cases of eclampsia had LBW babies, 85% of babies were born alive and there were 15% perinatal deaths. Eclampsia is still major Conclusion: contributor for maternal and perinatal mortality and morbidity. The incidence of eclampsia and maternal deaths are higher in developing countries due to lack of education and lack of antenatal care. Proper antenatal care, early detection of pre-eclampsia, health education about imminent symptoms to patients, and proper management of pre-eclampsia are essential steps for the prevention of eclampsia. The maternal and fetal outcomes can be improved by the better provision of health care facilities, antenatal care, and improvement of socioeconomic conditions.

Ведение беременности у женщины с генетической тромбофилией, преэклампсией в личном анамнезе и эклампсией в семейном анамнезе

One of the most important aspects of reducing the incidence of preeclampsia is the most complete and timely assessment of risk factors for each patient. One of the well-known, but often overlooked, risk factors is a family history of preeclampsia. In the history of our patient during her first pregnancy the fact of her mother’s eclampsia was ignored, antithrombotic medication were not prescribed, and the pregnancy has ended in premature birth due to severe preeclampsia. The examination confirmed inherited thrombophilia – Leiden mutation. The next pregnancy was managed with appointment of antithrombotic medication – low molecular weight heparin and low doses of acetylsalicylic acid, without complications and ended in timely delivery.

Edukasi Bahaya dan Pencegahan Preeklampsia Pada Kehamilan

Background: There are many risk factors that influence the occurrence of preeclampsia, such as primigravida, hyperplacentosis, extreme maternal age (less than 20 years and more than 35 years), a family history of preeclampsia or eclampsia, kidney disease, diabetes mellitus, chronic hypertension already suffered before pregnancy superimposed preeclampsia and obesity. This devotion aims to overcome the problem of possible low knowledge about the dangers and ways of preventing preeclampsia. The implementation method of conducting education and evaluating pregnant women the extent of knowledge and awareness of the dangers of preeclampsia and prevention that can be done during pregnancy, preparation for childbirth to the puerperium. Results: From the results of the pretest analysis, more mothers do not know about Preeclampsia during pregnancy, dangers and how to prevent it, but after being given education on the dangers and how to prevent preeclampsia, the posttest results show that almost all mothers understand about preeclampsia during pregnancy, dangers and how to prevent it. Conclusion: Counseling participants, namely pregnant women who attend the activity, can understand the importance of knowing the dangers of preeclampsia and how to prevent it and are willing to regularly control blood pressure and urine protein regularly.

Maternal and fetal morbidity and mortality among pregnancies complicated by pre-eclampsia in Omdurman Maternity hospital, Sudan

Background: Maternal mortality and morbidity are one of the biggest problems worldwide. Every day approximately 830 women die from preventable causes related to pregnancy and child birth. Ninety nine percent of these deaths occur in developing countries of which more than half are in sub Saharan Africa and one third in South Asia. Preeclampsia may lead to prematurity, still birth, intrauterine growth retardation and perinatal death. Consequently early diagnosis of preeclampsia and close observation are imperative. Despite advances in medical practice pre-eclampsia still remains a leading cause of maternal and prenatal morbidity and mortality.This study was conducted at Omdurman Maternity Hospital (OMH) in Sudan to assess the mortality and morbidity among the pre-eclampsia mothers admitted for delivery and among the babies delivered to them Material and methods: It was a prospective cross sectional hospital based study conducted at Omdurman Maternity Hospital (OMH) in Sudan. All the pregnant women with preeclampsia who delivered during June – December 2020 in the hospital were the study population. Sample size was calculated by using this equation, N = Z2X P (1-P)\ e2, Where N = Sample Size. Z = Value 1.96., P = Prevalence. Total 97 women meeting the inclusion criteria was the sample size. Systematic sampling method was applied to collect the files of women admitted in preeclampsia ward. Data were retrieved from the files of the patients which consisted of sociodemographic information, medical and obstetric history, family history, factors associated with preeclampsia and the outcome of the treatment, maternal and prenatal morbidity and mortality. The data were entered and analyzed by using SPSS, version 21 .Descriptive statistics were presented using counts, proportions (%), and mean ± standard deviation whenever appropriate. The comparison study was done by using chi square. A p-value cut off point of 0.05 at 95% CI was used to determine statistical significance. Results: The data from the files of 97 patients with preeclampsia were retrieved for the analysis. Majority of them were in the age group of 20 years or less Almost fifty percent (N=48) were nulliparous while 20.6 %( N=20) were having 2 children, 12.4% having three children and 17.5% had 4 and more children. The gestational age of majority of the patients (64.9%) attending the hospital was between 36-38 weeks. Only 19.6% of the patients were having past history of pre-eclampsia. Ninety nine percent of the patients did not have the family history of preeclampsia. Thirty seven percent of the patients were suffering from severe hypertension at admission while thirty eight percent were suffering from moderate hypertension and only 24.7% were suffering from mild hypertension. The blood pressure at the time of delivery was recorded as normal among the 9.30% of the patients, while mild among 26.80% moderately high among 29.9% and very high among 33% of the patients. As far as the investigations are concerned the vast majority of the patients (96.9%) had 1+ to 3+ protein Urea while 3.1% were having more than 3+ protein Urea in the urine. The majority of the pregnant women (59.8%) had blood hemoglobin level higher than 11 gm. /dl while 35.1% had between 9-11 mg/dl and only 4.1% with blood hg level less than 9gm/dl. Most of the patients (84.5%) underwent caesarian section for delivery. Almost eighty nine percent of the mothers totally recovered after delivery while 9.3% suffered temporal disability and 2.1% by permanent disability. As far as the infant outcome is concerned 68% were born on term while 18.6% as preterm, 8.2% IUFD and 5.2% as term +A life. Thirty three percent of the baby born was of normal weight while majority of them (64.90%) were underweight and only 2.10% were overweight. Conclusion: As far as mortality and morbidity among the mothers and the newborn baby is concerned, though no mortality was reported among the baby and the mothers. Morbidity such as IUFD and low birth weight were reported among babies while majority of the patients with pre-eclampsia underwent caesarian section for delivery and very few mothers suffered from temporal and permanent disability. However the more investment must be made in women’s health needs to reduce the problem and health service providers need to give due attention to high-risk women.

Determination of Risk Factors for Pre-eclampsia in a Tertiary Hospital of Bangladesh: A Descriptive Study

Background: Pre-eclampsia (PE), a hypertensive disorder of pregnancy is estimated to complicate 2%-8% of pregnancies and remains a principal cause of maternal and fetal morbidity and mortality. The identification of its predisposing factors in the pre-pregnancy and initial stage of pregnancy will help in reducing the morbidity and mortality. Aim: The aim of this study is to determine the risk factors for PE among pregnant women in a tertiary level hospital. Methods: This study was conducted in the Department of Obstetrics and Gynaecology of Shaheed Suhrawardy Medical College &amp; Hospital, a tertiary care hospital in Dhaka, Bangladesh, from January to December 2019. A total number of 50 pregnant women with pre-eclampsia, who got admitted in this hospital were selected as study group. This was a hospital based descriptive study. Results: Most of the participants were within 35-45 years of age group and mean age 38.92 ± 2.21. The factors that were found to be significant predictors of risk for development of PE were primigravida, inadequate education, low socio-economic status, past history of PE or hypertension and family history of PE or hypertension. J Shaheed Suhrawardy Med Coll 2021; 13(1): 3-7

Determinants of pre-eclampsia among women attending delivery services in public health institutions of Debre Tabor Town: a case–control study

BackgroundThe burden of pre-eclampsia has been continued as a public health importance in both developed and developing countries. However, the consequence of the disease is significantly high in developing countries, where treatment may be unsuccessful due to unclear etiology and late presentation of cases. The determinants of pre-eclampsia are not well known in the Ethiopian population specifically in the study area. Therefore, this study was aimed to identify the determinant factors of pre-eclampsia among women attending delivery services in public health institutions of Debre Tabor Town.MethodsUnmatched case–control study was conducted from December 1, 2020, to January 15, 2021, among 264 mothers (88 cases and 176 controls). A case–control incidence density sampling technique was applied and data were collected using an interviewer-administered pre-tested questionnaire. Data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. Bivariate and multivariable logistic regression analyses were conducted. Finally, a significant association was declared at a p-value of ≤ 0.05 with 95% CI.ResultsYoung age at menarche (10–15 years) (AOR: 7.69; 95% CI: 3.10–25.29), status of the current pregnancy (AOR: 5.88; 95% CI:2.93–22.42), new partner (AOR: 4.16; 95% CI: 3.49–17.03), family history of pre-eclampsia (AOR: 1.52; 95% CI: 1.40–4.18), and alcohol drinking (AOR: 2.18; 95% CI: 2.04–11.79) were found to be significantly associated with pre-eclampsia.ConclusionsThe current study identified that young age at menarche, the status of current pregnancy, new partner, family history of pre-eclampsia, and alcohol drinking were some of the determinant factors of pre-eclampsia. We suggested that health care providers should use these identified factors as a screening means for prediction, early diagnoses, and timely interventions of pre-eclampsia. Health care professionals should also deliver information regarding the risk of alcohol drinking during pregnancy in the preconception period and at early antenatal care services.

Medications for preventing hypertensive disorders in high-risk pregnant women: a systematic review and network meta-analysis

ObjectivesTo determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis.MethodsAll randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth’s Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review.ResultsThis network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found.ConclusionAntiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate.Systematic review registrationPROSPERO CRD42018096276

FEASIBILITY, ACCEPTANCE AND SAFETY OF A HOME BASED TELEMONITORING STRATEGY IN WOMEN WITH POSTPARTUM HYPERTENSION. INTERIM ANALYSIS OF THE SWISS REGISTER FOR WOMEN WITH PPHT

Objective: Postpartum hypertension (PPHT) is elevated blood pressure that persists or develops after pregnancy. PPHT affects 10% of all pregnancies and is the most common cause for re-hospitalization. PPHT stems from hypertensive disorders of pregnancy (HDP) which include preexisting and gestational hypertension, preeclampsia (PE), and eclampsia. Although the National Institute for Health and Care Excellence suggests tight controls there is no global consensus. The aim of the current analysis was to determine the feasibility, acceptance, and safety of a home-based telemonitoring strategy in women with PPHT. Design and method: Enrollment began in June 2020 at the University Hospital Basel Maternity Ward and Hypertension Clinic. Those with preexisting hypertension, HDP, and de novo PPHT were enrolled. A nested substudy allowed the participants to choose either a home-based telemonitoring approach or standard of care. The telemonitoring strategy was defined as a smartphone application provided by the study team or a programmed spreadsheet to report blood pressure followed by telephone consultations. Standard of care was hospital-based visits after discharge. All participants were assessed three months postpartum with a standardized hospital visit including a 24-hour blood pressure measurement, blood, biomarker and urine analysis. Results: 112 participants were prospectively enrolled from Jun 2020. Mean age was 33.5 ± 5.1 years, 8.9% had preexisting hypertension, 26.8% gestational hypertension, 55.4% preeclampsia (PE) 0.9% eclampsia, 6.9% HELLP and 17.9% had de novo PPHT. Family history of cardiovascular disease was seen in 50%, 8.9% had a family history of PE, and 20.5% were high risk for PE. The most common type of delivery was C-Section (74%), mean hospital stay was 6 days (±2.88) and IUGR was seen in 75.9% of the newborn babies. 98% of participants choose a home-based strategy. At 3 months, 97.8% reported a feeling of safety with home-based telemonitoring and would use the same approach in the future. There were zero re-hospitalizations due to high blood pressure. Conclusions: This analysis demonstrated that a home-based telemonitoring plan is feasible, well-accepted, and safe in terms of re-hospitalizations or blood pressure complications. This is relevant for the direct postpartum period and even more pertinent during a pandemic.