Pregnancy Gestational Hypertension Research Articles

Comparing the occurrence rate of gestational hypertension during pregnancy with frozen embryo transfer and natural pregnancy.

Recent researches have indicated that pregnancies with frozen embryo transfer are associated with the increment of risk of maternal and neonatal complications, especially hypertension during pregnancy. The present study aimed to compare the occurrence rate of gestational hypertension in pregnancy with frozen embryo transfer and normal pregnancy. This research, as a retrospective cross-sectional study, was performed on pregnant women with frozen embryo transfer (n = 97) and women with normal pregnancies (n = 164) referring to medical centers under the supervision of Ahvaz University of Medical Sciences in 2021. Women aged 18-35 were included in the study after week 20th of pregnancy. Maternal and neonatal outcomes including hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), preterm birth (before the week 37th), low birth weight (lower than 2500 g), neonatal asphyxia (Apgar score >7 in minute 5th), intrauterine growth restriction (IUGR) and bleeding in the first trimester of pregnancy were evaluated. The association between frozen embryo transfer and pregnancy outcomes was evaluated using multiple logistic regressions. The findings of this study indicated that pregnancy hypertension was observed in 23 people (23.7%) from the frozen embryo transfer group vs. 18 people (11.0%) from the normal pregnancy group (P = 0.006). Frozen embryo transfer pregnancy has a higher risk of gestational hypertension (OR = 2.521, 95% CI: 1.281-4.962; P = 0.007), preterm birth (OR = 2.264, 95% CI: 1.335-3.840; P = 0.002), and low birth weight (OR = 2.017, 95% CI: 1.178-3.455; P = 0.011). However, the incidence of birth asphyxia (P = 0.850), intrauterine growth restriction (P = 0.068), first-trimester bleeding (P = 0.809), and placenta accreta (P = 0.143) did not show a significant difference between two types of normal pregnancy and frozen embryo transfer pregnancy. Frozen embryo transfer pregnancy was associated with a higher risk of maternal and neonatal complications, hypertension, preterm birth, and low birth weight compared to natural and spontaneous pregnancies.

Pregnancy-induced hypertension: risk factors and current treatment strategies

Hypertensive disorders during pregnancy are a major public health concern in both developed and developing countries. Early detection and treatment of maternal health issues reduce the severity of these issues. This study set out to identify possible risk factors of these conditions and evaluate current methods of treatment. Throughout the research (6 months), 80 PIH women who met the inclusion criteria were studied in an observational study. Women in their twenties and thirties are more likely to have pregnancy-induced hypertension. Preeclampsia and gestational hypertension in pregnancy are the most common types. Hypertension issues are more common among pregnant women who are more likely to be obese, have had previous pregnancies, and reside in rural areas. Medication for the treatment of pregnancy-induced hypertension is prescribed and administered regarding drugs used for primary hypertension. Methyldopa and labetalol are examples of first-line treatments. Patients with PIH who are about to give birth are given hydralazine intravenously (IV) or nifedipine orally (P.O.) as a second-line treatment. When providing antihypertensive medicines or any other medications, the well-being of both maternal and fetal is taken into consideration. The risks to both mother and child may be reduced with prompt treatment with additional, safe medications.

Quantitative Analysis of Placental Mitochondrial DNA in Severe Hypertensive Pregnancies: A Cross-sectional Study

Introduction: To address the causes of maternal mortality and morbidity, reproductive health and related disabilities is a motto of World Health Organisation (WHO). Gestational hypertension constitutes as one of the main cause for maternal morbidity and mortality. Aetiology of gestational hypertension- remains a mystery. Mitochondrial dysfunction, particularly in trophoblastic cells, could play an important role in causing gestational hypertension and is postulated to be associated with oxidative stress, impaired differentiation and invasion of trophoblastic tissue. Alterations in peripheral blood mitochondrial Deoxyribonucleic Acid (DNA) copy numbers have been thought as a possible biomarker for mitochondrial dysfunction in disorders induced by oxidative stress. Aim: To estimate, evaluate and compare the mitochondrial copy numbers between placenta of severe gestational hypertensive pregnancies and normotensive pregnancies. Materials and Methods: A cross-sectional study was conducted at Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India, with 25 clinically proven cases of severe gestational hypertensive pregnancies and 25 normotensive pregnancies, for a period of one year (August 2020 to July 2021). The placenta were collected from the Department of Obstetrics, in containers within two hours of delivery and frozen in liquid nitrogen. Relative quantitative analysis of placental mitochondrial DNA (mtDNA), were done by calculating the copy number value by comparing the levels of two nuclear genes viz., BECN1 and NEB to two mitochondrial genes viz., ND1 and ND6 by using real time quantitative Polymerase Chain Reaction (PCR). Results: The placental mitochondrial DNA copy number was higher in severe gestational hypertensive patients than in normotensive pregnancies. A total of 21 (84%) cases of the severe hypertensive placenta had higher copy numbers 100-110 vs only 13 (52%) cases had copy numbers 100-105 in the normotensive group. The difference in copy number value between them was statistically significant with p-value of 0.03. Conclusion: Present study findings suggest significant alterations at the level of the mitochondria in placenta from women with gestational hypertension, which may well contribute to gestational hypertension pathophysiology. Future research should include direct measure of placental and maternal whole body mitochondrial function, and assays that elucidate the potential modifiers of this association.

Comparison of Uterine Artery Dynamics in Normotensive and Hypertensive Pregnancies on Doppler Ultrasound

Background: Hypertension during pregnancy is a common disease that can alter the health of both mothers and fetus. It is a leading cause of maternal, fetal, and neonatal death, as well as an increased risk of having an undesirable pregnancy outcome. Objective: To compare uterine artery dynamics in normotensive and gestational hypertensive pregnancies on Doppler ultrasound. Methodology: A cross-sectional case control study was carried out in Radiology department of District Head Quarter (DHQ) hospital, Faisalabad. Written consent was taken from all patients before the ultrasound examination. The calculated sample size was 98. Patients were assessed for eligibility in inclusion criteria. Confirmation of intrauterine living pregnancy and gestational age was done with routine obstetric ultrasound. Enrolled pregnant patients both normal and hypertensive were assessed for uterine artery Doppler ultrasound examination. Results: Ninety eight women, forty-nine with hypertension and forty-nine normal women participated in the investigation. The comparison of data showed that pre pregnancy weight and mean blood pressure were significantly high in hypertensive group when compared to the normotensive group (P <0.05). Doppler ultrasound also showed that the values of uterine artery parameters such as S/D Ratio, PI, RI was significantly high in hypertensive group when compared to the normotensive group (P <0.05). Conclusion: The Uterine artery Doppler parameters are significantly higher in hypertensive patients as compared to normotensive patients. According to the findings of our study, notching on the right, left, or bilateral, as well as Pulsatility index and Resistivity Index, are diagnostic parameters for evaluating the complications before they worsen. Keywords: Uterine artery, Gestational hypertension, Doppler Ultrasound, Doppler Indices, Pre-Eclampsia

Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension

Introduction: Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. Objective: The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. Setting: Mexico City, Mexico. Material and Methods: We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (n = 36), and controls were those who did not (n = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) <37 and <34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). Results: Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp­ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery <37 and <34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). Conclusions: In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.

A PROSPECTIVE STUDY TO EVALUATE THE ROLE OF URIC ACID FOR PROGRESSION TO PREECLAMPSIA IN GESTATIONAL HYPERTENSIVE PREGNANCIES IN THE DEPARTMENT OF OBSTRETICS AND GYNECOLOGY, SMS MEDICAL COLLEGE

Background: The purpose of this study was to study the role of serum uric acid level in progression to preeclampsia in gestational hypertensive pregnancies.&#x0D; Methods: Hospital based comparative study was conducted at Department of Obstetrics and Gynaecology, SMS medical college, Jaipur.&#x0D; Results: Uric acid level was significantly higher in with PIH (6.68±0.36 mg/dl) as compared to without PIH (4.92±0.57 mg/dl). Receiver-operator characteristic curve showed relatively poor sensitivity and specificity performance (area under the curve= 1.00) of serum uric acid level at the initial presentation of gestational hypertension for predicting the progression to preeclampsia The best cut-off revealed from the curve was 6.18 mg/dl.&#x0D; Conclusion: In conclusion, higher serum uric acid levels at the initial presentation of gestational hypertension may indicate heightened risk of progression to preeclampsia and development of adverse maternal/ infant conditions.&#x0D; Keywords: Eclampsia, Uric acid, Hypertension

Anti-hypertensive use for non-severe gestational hypertension in Botswana: A case-control study.

The fetal risks and benefits of antihypertensives to treat gestational hypertension in pregnancy are understudied, particularly in low- and middle-income countries. We performed a nested case-control study within a retrospective cohort of obstetrical patients in Botswana from 2014 to 2019. We included women carrying singletons who developed new onset non-severe hypertension (140-159mmHg systolic or 90-109mmHg diastolic blood pressure) after 20weeks of pregnancy. Cases were defined as women with either small-for-gestational-age (SGA) infants or stillbirth, analyzed separately; controls were otherwise similar women without the adverse outcome in each analysis. We identified 1932 cases of SGA (7925 controls) and 316 cases of stillbirth (9619 controls). Cases with SGA were more likely to have used an anti-hypertensive than controls (33% vs 29%, adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 1.15-1.43). Cases with stillbirth were more likely to have used an anti-hypertensive than controls (42% versus 29%, aOR 1.45, 95% CI 1.14-1.83). Anti-hypertensive use for new-onset gestational hypertension was associated with an increased risk of having an SGA infant or a stillbirth among women who never developed severe hypertension. These data support conduct of a randomized clinical trial to determine the appropriate use of anti-hypertensives in non-severe gestational hypertension.

Prevalence of Gestational Hypertension and Pregnancy Outcome

Introduction Hypertension during pregnancy is considered as one the high risk as it is one of the cause for maternal and neonatal mortality and morbidity. Aims: This study is aimed to find the prevalence of gestational hypertension and to understand the pregnancy outcome. Settings and Design: Study conducted at tertiary care hospital and descriptive research design was used for the study Methods and Material: Sample size was 366 women with gestational hypertension were included. Data was collected by using investigator prepared self-administered questionnaire Statistical analysis used: inferential statistics analytical methods Results: Results revealed that prevalence of gestational hypertension 9.8%. Maternal outcome 53% delivered at 34 to 38 weeks, mode of delivery (52.5%) were delivered by C-section, 56.3% women were induced, 97.3% were singleton pregnancy, About the gender of new-born 51.9% were male, 67.2% were born with Normal (&gt;2500g) weight, NICU admission 20.5% and reason for NICU admission was prematurity. Conclusions: The knowledge of risk factors for gestational hypertension in pregnancy may give tracks for prevention in this population.

Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study

BackgroundChorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5–7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes.MethodsIn this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests.ResultsPreeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%.ConclusionAlthough chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.

Risk of gestational hypertension in pregnancies complicated with ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is the most common iatrogenic complication due to ovulation stimulation during assisted reproductive technology. Pathophysiology of this syndrome is not completely clarified, and there is no some specific treatment. Human chorionic gonadotropin is considered as the most significant factor in etiopathogenesis of OHSS. The results of some clinical studies related to influence of OHSS on pregnancy are variable. The aim of this study was to investigate hypertensive disease of pregnancies in patients admitted to hospital due to severe forms of OHSS with reference to maternal characteristics. A case control study was conducted at the Obstetrics and Gynaecology Clinic "Narodni Front" and involved 50 patients admitted to hospital due to severe form of OHSS during a period from January 2008 to March 2015. A control group was created based on age and it involved 59 patients with pregnancy achieved with IVF/ICSI during the same period, but in which OHSS did not occur. For comparing mean values of continuous variables, Independent samples t test was applied. Patients with pregnancy complicated by OHSS, had considerably higher rate of hypertension (14% vs. 3.2 %, p=0.046). Pregnancies achieved by IVF/ICSI, being complicated with severe OHSS could be related to gestational hypertension.

Abstract P106: Elevated Fasting Glucose and Proteinuria in Offspring Born to Gestational Hypertensive African Green Monkeys

Preeclampsia (PreE), or gestational hypertension (GH) concurrent with proteinuria, is a leading cause of maternal and fetal mortality worldwide. PreE often leads to fetal growth restriction resulting in low birth weight offspring. Low birth weight infants are at higher risk of developing cardiovascular disease later in life. The African Green Monkey (AGM; Chlorocebus aethiops sabaeus ) develops spontaneous GH with proteinuria and fetal growth restriction. We hypothesize that GH will developmentally program offspring to reduced kidney function and metabolic disease. Maternal systolic arterial pressure (SAP) was measured via forearm plethysmography prior to pregnancy and during the 3 rd trimester of pregnancy. At 1-3 years of age, offspring were single-housed for water intake and urine flow rate collections followed by blood pressure measurement and venous blood sampling. Animals were grouped by pregnancy phenotype. SAP for normotensive (NT, n=23) mothers did not change in pregnancy, but increased during third trimester for GH (Δ=35 ± 7 mmHg, n=34). NT pregnancies resulted in a 4% stillbirth rate (1/23) compared with 29% in GH (10/34). Surviving GH offspring had reduced birth weight (NT 336 ± 11g vs. GH 295 ± 8g, p&lt;0.05). Fasting glucose was higher in progeny born to GH pregnancies (NT 69 ± 8 mg/dl, n=13; GH 92 ± 6 mg/dl, n=20). Urinary protein excretion was higher in offspring born to GH pregnancies (NT 152 ± 27 mg/day; GH 318 ± 46 mg/day). SAP of offspring was similar between maternal phenotype (NT 107 ± 8 mmHg; GH 109 ± 5 mmHg). Juvenile SAP was unrelated to fasting glucose or urinary protein excretion, indicating that these factors are determined by maternal SAP during pregnancy, rather than juvenile phenotype. Thus, GH is associated with fetal growth restriction in the form of high stillbirth rates and lower surviving-offspring birth weights in the AGM. GH offspring have elevated fasting glucose and possible decreased kidney function as evidenced by proteinuria. GH could be programming offspring for early life metabolic risk factors and declining renal function. Future studies include oral glucose tolerance tests and additional markers of renal dysfunction to further assess in utero programming of the pathogenesis of cardiovascular and metabolic disease.

Abstract 018: High Stillbirth Rate and Altered Maternal Renal Function and Water Balance are Associated With Spontaneous Gestational Hypertension in Nonhuman Primates

Gestational hypertension (GH) is new-onset hypertension specific to pregnancy (PG) that may precede preeclampsia (PE). While the specific etiology of PE is unclear, defective fluid and electrolyte balances have been implicated. The African Green Monkey (AGM; Chlorocebus aethiops sabaeus ) is a novel model of spontaneous GH with pathophysiological consequences of PE. Systolic blood pressure (SBP; forearm plethysmography) was measured in AGMs pre-PG, during each trimester, and postpartum (PP). Gestational age was estimated by fetal lengths at 7 weeks/trimester (21 week gestation). Animals were characterized as normotensive (NT; SBP &lt; 120 mmHg in PG and PP) or gestational hypertensive (GH; SBP ≥ 140 mmHg during PG). SBP was unchanged in NT PG (pre-PG 110 ± 5 mmHg; 1 st trimester 101± 6 mmHg; 3 rd 107 ± 7 mmHg; n = 27). In GH AGMs, SBP increased in the 3 rd trimester from 115 ± 6 mmHg (1 st ) and 117 ± 25 mmHg (2 nd ) to 152 ± 7 mmHg (3 rd ; p&lt;0.05; n = 16). Plasma osmolality did not change during PG for NT AGMs but declined in GH (NT pre-PG 305 ± 5 mOsm/kg; PG 299 ± 5 mOsm/kg; n = 6; GH pre-PG 313 ± 6; PG 293 ± 4 mOsm/kg; p&lt;0.05 ANOVA; n = 15). Maternal body weight increased in GH by the 1 st trimester, while NT body weight did not change until the 3 rd trimester (NT pre-PG 3.8 ± 0.2 kg; 1 st trimester 3.8 ± 0.3 kg; 3 rd 4.4 ± 0.2 kg; GH pre-PG 3.7 ± 0.1 kg; 1 st trimester 4.4 ± 0.2 kg; 3 rd 4.7 ± 0.1 kg; p&lt;0.05). Protein excretion was unchanged in NT AGMs but increased with GH compared to pre-PG and NT PG (NT pre-PG 365 ± 45 mg/day; 3 rd trimester 466 ± 84 mg/day; GH pre-PG 346 ± 138 mg/day; 3 rd trimester 702 ± 69 mg/day; p&lt;0.05). Third trimester estimated GFR (eGFR) did not change in NT AGMs but declined in GH (NT 5.0 ± 0.7 ml/min vs GH 2.5 ± 0.5 ml/min; p&lt;0.05). Infants from GH pregnancies were smaller (NT 327.4 ± 13.7 g, n = 5, vs GH 290.0 ± 8.5 g n = 15; p&lt;0.05) and GH increased fetal stillbirth rate to 40% (6/15). Thus, GH in AGMs has early PG water retention, decreased plasma osmolality and excess weight gain preceding GH. GH AGMs have smaller infants and increased stillbirth rates, showing fetal growth restriction. Elevated SBP during GH may lead to renal dysfunction, proteinuria and reduced eGFR. Thus, the AGM is a novel, translational model of hypertensive pregnancy disorders for the study of acute and long-term effects on fetal development.

Risk of pre-eclampsia after fresh or frozen embryo transfer in patients undergoing oocyte donation

ObjectivesDifferent perinatal and neonatal adverse outcomes have been reported to be increased in frozen embryo transfer pregnancies compared with fresh embryo transfer with patient’s own oocytes. Concerning preeclampsia, it has also been reported to be increased after frozen embryo transfer.The objective of this study is to asses if there is an increased risk of preeclampsia and gestational hypertension in pregnancies achieved with oocyte donation after frozen embryo transfer compared to fresh embryo transfer. Study designRetrospective cohort study of 433 patients who underwent a cycle with donated oocytes either after fresh (n = 353) or frozen embryo transfer (n = 80) between March 2013 and April 2016 at a large fertility clinic. Participants are pregnant patients who reached the 20th week of gestation. The risk of preterm preeclampsia (presenting before 37 weeks of gestation), term preeclampsia (presenting at or after 37 weeks of gestation) and gestational hypertension are presented as unadjusted and adjusted odds ratio (OR). ResultsFrozen embryo transfer have similar risk for developing preterm preeclampsia compared to fresh embryo transfer, with an OR of 1.95 (CI 95% 0.72, 5.26, p = 0.18), as well as term preeclampsia (OR 0.3, 95%CI 0.04, 2.35, p = 0.25), and gestational hypertension (OR 1.45, 95% CI 0.75, 2.81, P = 0.27). ConclusionsDespite a high prevalence of preeclampsia in pregnancies achieved by oocyte donation, the freezing-thawing process does not confer more risk than the fresh embryo transfers in preterm preeclampsia, term preeclampsia or gestational hypertension.

Abstract 035: Fetal Growth Restriction is Associated with Spontaneous Gestational Hypertension in African Green Monkeys

Hypertensive pregnancy disorders, including gestational hypertension (GH) and preeclampsia (PE), are a major cause of worldwide maternal and fetal mortality. The only treatment for PE is delivery of the infant and placenta. Elucidating the cause of GH and PE is critical for improving diagnosis and therapy. This study provides the pregnant African Green Monkey (AGM; Chlorocebus aethiops sabeus ) as the first known nonhuman model of spontaneous GH with pathophysiological characteristics of PE. Here, maternal blood pressures, water balance, renal electrolyte excretion, and fetal birth weight are characterized in AGMs. Following ketamine sedation (15 mg/kg i.m.), systolic blood pressures (SBP) were obtained in AGMs using forearm plethysmography. Animals were defined as normotensive (NT; SBP &lt; 120 mmHg), hypertensive (HT; SBP ≥ 140 mmHg), or GH (SBP increased from non-HT to ≥15 mmHg in 3 rd trimester). Nonpregnant SBP for NT AGMs was 98.7 ± 3.7 mmHg (n = 18), for HT AGMs was 154.7 ± 5.7 mmHg (n = 6), and for GH AGMs was 111.3 ± 6.1 mmHg (n = 7). Third trimester SBP for NT AGMs was 102.9 ± 4.0 mmHg (n = 13), and for GH AGMs was 146.3 ± 4.6 mmHg (n = 7). SBP decreased by 5.2 ± 8.1 mmHg in NT pregnancies (n = 5) and increased 35.0 ± 8.1 mmHg in GH pregnancies (n = 6).There were no differences in water intake or 24-hour urinary Na + /K + excretions among AGMs regardless of group. Infant birth weight was lower in GH AGMs than that of NT AGMs (GH 233.1 ± 27.0 g, n = 5; NT 314.5 ± 16.7 g, n = 7; p&lt;0.05). These data show GH in the AGM is associated with fetal growth restriction, decreased late pregnancy SBP in controls, and increased SBP in GH, similar to human pregnancies. Future studies include examination of renal glomerular structure, placental histopathology and transcriptomics, protein excretions, and plasma PE biomarkers to further establish this animal as a spontaneous model of GH and possibly PE. The AGM, having diverged from the human lineage approximately 29 million years ago, has close genetic homology to humans. This evolutionary history has led to a shared organ physiology, circadian rhythmicity, upright posture, and complex familial and behavior systems with humans, making it a highly translational animal model of hypertensive pregnancy disorders critical to cardiovascular research.

DESIGN AN “IN HOUSE” SOFTWARE FOR SCREENING PREECLAMPSIA BY MATERNAL FACTORS AND MEAN ARTERIAL PRESSURE AT 11 – 13 WEEKS IN COMMUNE HEALTH CENTERS.

Objective: Design an “in house” software for screening preeclampsia by maternal factors and mean arterial pressure at 11 – 13 gestational weeks in commune health centers. Methods: Based on the algorithms for calculating the risk of preeclampsia (PE) by maternal factors and mean artirial pressure at 11 - 13 gestational weeks in the study results of the authors, an “in house” software was deigned in Excel. The results of prediction preeclampsia by The Fetal Medicine Foundation (FMF)(version 2.3) were compared with the results by “in house” software in 1110 singleton pregnant women. Results: The “in house” software met the requirements for calculating the risks of PE and save data. FMF risk for gestational hypertension disorder in pregnancy by maternal factors, mean arterial pressure,uterine artery Doppler and PAPP-A has an area under the curve of 0.68 (95%CI: 0.59 – 0.78). The “in house” software risk for gestational hypertension in pregnancy by maternal factors, mean arterial pressure has an area under the curve of 0.643 (0.55 – 0.73) There was no statistically significant different between two programs (p:0.52). The risk cut-off 1:50 in the prediction of gestational hypertension of the “in house” software was used to identify the group of high risk with detetion rate (DR) 28.6% (95%CI: 14.9-42.2) comparing to 40.5% (95%CI:25.6-55.3) of FMF. Conclusion: The FMF version 2.3 is better but in the absence of Doppler ultrasound and PAPP-A test in the commune health cares, the “in house” software for screening PE is a good tool for councelling, following up and early intervention for PE.

Quantitative analysis of fetal DNA in maternal plasma in gestational diabetes mellitus, iron deficiency anemia and gestational hypertension pregnancies

Objective: To quantify circulating fetal DNA (fDNA) levels in the second and third trimesters of normal healthy pregnant individuals and pregnant women with the following clinical conditions: gestational diabetes mellitus (GDM), iron deficiency anemia and gestational hypertension (GHT).Methods: The SRY gene located on the Y chromosome was used as a unique fetal marker. The fDNA was extracted from maternal plasma and the SRY gene concentrations were measured by quantitative real-time polymerase chain reaction (PCR) amplification using TaqMan dual labeled probe system.Results: No significant differences were observed in the mean fDNA concentration between normal and GDM pregnancy samples (p > 0.05) and also between normal and anemic pregnancy samples (p > 0.05) in both trimesters, but significant differences were observed between the third trimester normal and GHT pregnancy samples (p = 0.001). GDM and iron deficiency anemia do not affect the levels of fDNA in maternal plasma while GHT significantly elevates the levels of fDNA in maternal plasma.Conclusions: Increased amount of circulating fDNA in maternal plasma could be used for early identification of adverse pregnancies. GDM and anemia do not affect the levels of fDNA in maternal plasma while GHT significantly elevates the levels of fDNA in maternal plasma. Hence, the elevated fDNA values could be used as a potential screening marker in pregnancies complicated with GHT but not with GDM and iron deficiency anemia.

Association of uric acid with progression to preeclampsia and development of adverse conditions in gestational hypertensive pregnancies

Preeclampsia is a serious pregnancy complication. Gestational hypertension is a common first clinical presentation of preeclampsia. Little is known about which clinical risk factors are associated with the progression from gestational hypertension to preeclampsia. In a retrospective cohort study of 249 singleton pregnant women with an initial presentation of gestational hypertension in an obstetric hospital, we assessed which routinely available clinical risk factors are associated with the progression to preeclampsia and the development of adverse maternal or infant conditions. The mean serum uric acid level at the initial presentation of gestational hypertension was significantly higher comparing patients who later progressed to preeclampsia to those who did not (5.06 vs. 4.59 mg/dl, P < 0.01). Lower gestational age and higher serum uric acid level at the initial presentation of gestational hypertension and subsequent need for antihypertensive drug treatment for blood pressure (BP) control were associated with significantly increased risks of progression to preeclampsia, and development of adverse maternal or infant conditions. One standard deviation (s.d.) increase in serum uric acid level was associated with 2.3-fold increased odds of progression to preeclampsia (adjusted odds ratio (aORs) 2.33 (95% confidence interval (CI) 1.45-3.74)), and 1.5-fold increased odds of developing clinically significant adverse maternal or infant conditions (aOR 1.49 (1.03-2.17)) irrespective of the progression to preeclampsia. Higher serum uric acid levels at the initial presentation of gestational hypertension may indicate heightened risk of progression to preeclampsia and development of adverse maternal/infant conditions.

Hypertension in Pregnancy and Later Cardiovascular Risk

Background— Preeclampsia and gestational hypertension are associated with increased risk for cardiovascular disease later in life. We have assessed whether the effect can be attributed to factors that operate in pregnancy or to prepregnancy risk factors that are shared by both disorders. Methods and Results— Longitudinal data from 2 consecutive waves of a Norwegian population-based study (the Nord-Trøndelag Health Study [HUNT]) were combined with data from the Medical Birth Registry of Norway. Among 24 865 women who had participated in both HUNT 1 and 2, we indentified 3225 women with a singleton birth between the 2 studies who had standardized measurements of blood pressure, serum lipids, and body mass index. The crude results showed that women who experienced preeclampsia or gestational hypertension in pregnancy had substantially higher levels of body mass index and systolic and diastolic blood pressures and unfavorable lipids compared with other women. However, after adjustment for prepregnancy measurements, the difference in body mass index was attenuated by &gt;65%, and the difference in blood pressure was attenuated by ≈50%. In relation to high-density lipoprotein cholesterol and triglycerides, differences between the groups were attenuated by 40% and 72%, respectively. Conclusions— These results suggest that the positive association of preeclampsia and gestational hypertension with postpregnancy cardiovascular risk factors may be due largely to shared prepregnancy risk factors rather than reflecting a direct influence of the hypertensive disorder in pregnancy.

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department

The aim of the present prospective multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease (COPD) exacerbations in a real-life setting. All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included, except those who immediately required intensive care unit admission and/or ventilatory support. The data collected included patient characteristics, in-hospital outcomes (mortality and length of stay) and mode of discharge (unsupported or need for post-hospital assistance). The in-hospital mortality rate was 7.4% (59 out of 794). Independent prognostic factors were age, number of clinical signs of severity (among cyanosis, impaired neurological status, lower limb oedema, asterixis and use of accessory inspiratory or expiratory muscles) and dyspnoea grade in the stable state. The need for post-hospital support was also predicted by female sex. In order to construct and validate a prediction score for mortality based on these items, patients were randomly allocated to a derivation and a validation cohort. The prediction score showed good discrimination, with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort. Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease. Their use needs to be prospectively validated.

A randomized trial of tight vs. less tight control of mild essential and gestational hypertension in pregnancy

To assess the effects of applying a tight vs. a less tight control of mild chronic essential or gestational non-proteinuric hypertension in pregnancy. A randomized trial was conducted in 2006-2007 in the University of Ain Shams, Egypt. Eligible participants (n=125) were randomly assigned to either tight or less tight control of mild chronic (essential) or gestational (non-proteinuric) hypertension. The primary outcome measure was the development of severe hypertension during follow-up. Analysis was by intention-to-treat. In the tight target group, adjustment of the dose with an increment of 191 mg yielded a mean dose of methyldopa of 1267+/-406 mg. Both systolic and diastolic BP levels were significantly less than in the tight target group. More women in the less tight group had severe hypertension during follow up (RR 3.167 and 95% CI 1.36-7.37). The rate of antenatal hospitalization was significantly higher in the less tight target group with a relative risk of 2.57 and 95% CI 1.16-5.70. The gestational age at delivery was significantly better in the tight target group. Preterm delivery and birth weight were not significantly different between the study groups. Tight control of blood pressure reduces the rate of antenatal hospitalization and does not adversely affect perinatal outcomes in women with mild essential or gestational hypertension.