Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study.

To evaluate maternal-fetal outcomes and therapeutic efficacy in Takayasu arteritis (TA)-complicated pregnancies through integrated retrospective analysis and meta-analytic synthesis. A dual-design study was conducted: (1) retrospective analysis of 20 pregnancies (17 patients) at West China Second Hospital (2012-2024), stratifying TA phases (acute/prolonged/stable); (2) systematic review with random-effects meta-analysis of 16 studies (568 pregnancies globally). Clinical data encompassed maternal-fetal profiles, TA-specific variables, laboratory metrics (hematologic/coagulation parameters), and therapies (glucocorticoids /immunosuppressants /antihypertensives). Outcomes were compared against normative standards using t-tests, Wilcoxon, chi-square, and meta-regression. Among 20 pregnancies (median maternal age 28.5years), 50% had at least one obstetric complication, with arterial stenosis (80%) and hypertension (40%) predominant. Meta-analysis revealed 42.6% adverse outcomes: gestational hypertension (26.1%), fetal growth restriction (17.7%), and preterm delivery (13.6%). Hematological analysis (n = 20) showed elevated WBC, PCT, TT, fibrinogen, urinary protein, and ALT (all P < 0.05), alongside reduced PT, albumin, and bilirubin (P < 0.05). Regarding the analysis results of inflammatory indicators, CRP (prepartum) (95%CI = 0.969-1.034, OR = 1.001), CRP (postpartum) (95%CI = 0.920-1.217, OR = 1.058), and ESR (95%CI = 0.952-1.101, OR = 1.024) showed no statistically significant association with pregnancy outcomes. Neither pre-pregnancy nor gestational glucocorticoids (prednisone vs methylprednisolone) or immunosuppressants significantly reduced complications (all RR 95% CI crossed 1; P > 0.05). Antihypertensive therapy showed no correlation with preeclampsia (P > 0.05). TA significantly elevates maternal-fetal risks, driving hypertension, growth restriction, and preterm birth via vasculopathic-inflammatory pathways. Postpartum hypercoagulability (↑fibrinogen, ↓prothrombin time) necessitates multidisciplinary coagulation monitoring and mandatory thromboprophylaxis.

To examine differences in pregnancy outcomes between women with type 1 (T1D) and type 2 diabetes (T2D) and assess the impact of concurrent obesity on adverse perinatal outcomes. We retrospectively analysed singleton births of nulliparous mothers with T1D and T2D from 2016 to 2020, in New South Wales, Australia. The incidence of perinatal outcomes was compared between diabetes types. Logistic regression explored the impact of BMI and diabetes type on these outcomes, adjusting for relevant maternal characteristics. In total, 568 women with T1D and 910 women with T2D were included. Women with T2D were older, had higher BMI, increased incidence of pre-existing hypertension and smoking, and higher rates of socioeconomic disadvantage (p < 0.01). After stepwise adjustment for maternal covariates, women with T1D had higher odds of preeclampsia, caesarean section, maternal length of stay (LOS) >10 days, preterm birth, large-for-gestational age (LGA) neonates, neonatal resuscitation, neonatal hypoglycaemia, NICU admission, neonatal LOS >10 days and stillbirth (aOR >1, p < 0.05). Obesity conferred an increased odds of adverse outcomes in women with T2D but not T1D; these included gestational hypertension (aOR = 5.88, CI:1.38-25.15, p = 0.02), postpartum haemorrhage (aOR = 1.95, CI:1.18-3.23, p < 0.01), caesarean section (aOR = 2.29, CI:1.59-3.30, p < 0.01), LGA (aOR = 1.82, CI:1.13-2.93, p = 0.01), neonatal hypoglycaemia (aOR = 1.53, CI:1.02-2.30, p = 0.04) and neonatal resuscitation (aOR = 1.81, CI:1.19-2.76, p < 0.01). Women with T1D had higher odds of adverse perinatal outcomes compared to those with T2D. Obesity increased risk in women with T2D, but not T1D, raising the possibility that targeted weight interventions in those with T2D may reduce the risk of adverse perinatal outcomes.

Arterial hypertension in pregnant women increases the risk of complications of pregnancy, childbirth, fetal and newborn pathology. A survey of 80 pregnant women and EMIAS data was conducted. Elevated blood pressure during office measurement was recorded in 31 patients, according to the SMAD data, 20 pregnant women with arterial hypertension were identified. According to the results of the study, in 55 % of pregnant women, gestational hypertension was confirmed in patients with office blood pressure levels within the normal range. Thus, the use of SMAD increases the detection of hypertension in pregnant women by two times. Unjustified prescribing of antihypertensive drugs to pregnant women with an office increase in blood pressure, but with unconfirmed hypertension using the SMAD method (50 %) was noted. A low level of antihypertensive drug use was revealed in pregnant women with confirmed arterial hypertension according to SMAD (35 %). The following results were obtained from the study of the daily blood pressure profile of pregnant women with hypertension: arterial hypertension was observed during the day in 26.7 %, during waking hours in 6.7 %, and at night in 66.7 %. The average daytime SAD was increased in 26.6 % of pregnant women with hypertension, and the average nighttime SAD was increased in 50 %. The average daily SAD was increased in 30 %. The average daily DBP was increased in 50 % of pregnant women, no increase in nocturnal DBP was noted. An increase in VUP SAD was noted in 3.33 %, an increase in VUP DAD – in 10 %. The rate of morning SAD rise was within the normal range in 66.7 % of pregnant women with hypertension, increased – 33.3 %, the rate of morning DBP rise was within the normal range in 53.3 % of pregnant women with hypertension, increased – 46.7 %. PAD was within the normal range in 63.3 % of pregnant women with hypertension, exceeded the norm – in 36.7 %. The variability of SAD and DBP was within the normal range (daily index of 10–20 %).Obese patients in most cases show an increase in blood pressure numbers during routine blood pressure measurements, as well as a high risk of preeclampsia. Pregnant women with hypertension have a high risk of preeclampsia, gestational diabetes mellitus, anemia, and gestational pyelonephritis. In the presence of hypertension during pregnancy, the frequency of cesarean section, premature discharge of amniotic fluid/ membranes, ruptures of the cervix/perineum, fetal distress, and the risk of having a low birth weight child increases.

Introduction: Normal pregnancy is associated with adaptive maternal haemodynamics, viz., increase in blood volume, Heart Rate (HR), cardiac output, and fall in blood pressure. Alterations in hormones and plausible autonomic modulation may regulate these haemodynamic changes and failure of such alterations could have clinical consequences like pregnancy-induced hypertension and preeclampsia. Heart Rate Variability (HRV), a non-invasive measure of cardiac autonomic activity may provide insights in pattern of cardiac autonomic modulation during pregnancy, and tracking it may be useful clinically. Aim: To evaluate the pattern of cardiac autonomic modulation assessed by HRV during the course of healthy pregnancy. Materials and Methods: The present longitudinal cohort study was conducted from August 2019 to April 2021 in SKNMC &amp; GH, Pune, Maharashtra, India. A total of 31 pregnant females who underwent repeated HRV assessment between 11th-13th, 18th to 20th, and 24th to 26th weeks of gestation and tracked for pregnancy outcome till delivery, were included. High sampled Electrocardiogram (ECG) (1Kz) for 15 minutes was recorded in supine left lateral position and HRV indices from last five minutes were measured. Multiple group comparisons and between-group comparisons were done using non parametric tests and p&lt;0.05 was considered significant. Results: The mean age of 31 pregnant females was 24.1±3.4 years. Significant increase in average HR (p=0.002)was observed from first to third trimester significant decrease in overall HRV (p=0.01), total power (ms2 ) (p=0.008), High Frequency (HF) (ms2 ) (p=0.03) and Low Frequency (LH) (ms2 ) (p=0.001) was also observed. A trend in HFnu decrement was observed. Conclusion: As pregnancy advances, (till 26 weeks) a pattern of parasympathetic withdrawal (decreased overall variability and HF (ms2 ) along with increase in average HR and reduced baroreflex sensitivity (decrease in LF power) was observed with healthy pregnancy.

Shift work is a common occupational exposure that disrupts circadian rhythms which increases the risk of unhealthy behaviours and metabolic disorders. Maternal shift work is known to increase the risk of negative pregnancy outcomes, but the health impact when combining father's shift work status remains uncertain. This study investigated the association between parental shift work before pregnancy and pregnancy outcomes, with a focus on the effect estimates of father's shift work. We analysed data from the Taiwan Birth Cohort Study, a prospective cohort of Taiwanese women who gave birth in 2005. We collected fathers' and mothers' shift work status before pregnancy and pregnancy outcomes [Caesarean section, excessive gestational weight gain (GWG), large or small for gestational age, low birth weight, nausea and vomiting, gestational hypertension, and gestational diabetes] from 13,221 families with term singletons. Multivariable linear models were used to analyse the associations between different maternal shift work statuses and pregnancy outcomes. Parental shift work before pregnancy was associated with higher odds of excessive GWG, Caesarean section, nausea and vomiting in the study population. Meanwhile, father's shift work exposure was associated with higher odds of excessive GWG among mothers not doing shift work before pregnancy, but not among mothers doing shift work. This study found that both mother's and father's shift work were associated with an increased risk of adverse pregnancy outcomes. Father's shift work may be an unconsidered risk factor for adverse pregnancy outcomes, particularly in mothers without shift work exposure.

Adverse pregnancy outcomes and development of short-term cardiovascular disease risk factors.

Obstructive sleep apnea in pregnancy: Nationwide assessment of obstetric characteristics and maternal morbidity at delivery.

Racial and ethnic disparities in environmental chemical exposures and hypertensive disorders of pregnancy: The ECHO-wide cohort study.

Background: Pregnancy-induced hypertension (PIH) remains a major obstetric complication globally. Hematological changes in PIH reflect underlying pathophysiological alterations and can aid in clinical assessment. Aims and Objectives: To evaluate the hematological profile in women with PIH during the second and third trimesters compared to normotensive pregnant women. Materials and Methods: This cross-sectional study included 120 pregnant women (60 PIH cases and 60 controls) aged 18–40 years, attending Navodaya Medical College, Karnataka. Blood samples were analyzed for hemoglobin (Hb), total leukocyte count, differential count, platelets, packed cell volume (PCV), and red cell indices using an automated hematology analyzer. Results: Hb and red blood cell indices were comparable between groups. PIH cases showed significantly reduced eosinophil counts (2.22±0.94% vs. 3.07±1.39%; P=0.001) and platelet counts (2.18±0.85 vs. 2.90±0.67 lakhs/cumm; P=0.001), and increased monocytes (2.45±1.10% vs. 1.78%±0.52; P=0.001) and PCV (36.89±7.91% vs. 30.86±3.36%; P=0.001). Neutrophils were elevated in PIH, but this was not statistically significant. Conclusion: Hematological parameters such as thrombocytopenia, elevated PCV, and altered leukocyte counts provide valuable, cost-effective tools for early detection and monitoring of PIH. Their routine assessment can aid in clinical decision-making to reduce maternal-fetal risks.

Background: Ventricular septal defect (VSD) is the most common congenital heart defect in neonates. Its association with congenital syphilis is rarely reported, although transplacental infection by Treponema pallidum can cause multisystem involvement.Objective: To report a case of VSD in a neonate with congenital syphilis and to document relevant clinical and diagnostic findings.Methods: A descriptive case report was conducted on a 14-day-old female neonate delivered via cesarean section to a mother with reactive syphilis and gestational hypertension. Congenital syphilis was confirmed by VDRL and TPHA serological testing. Clinical evaluation and echocardiography were performed to assess cardiac anomalies.Results: Echocardiography revealed a 7,6 mm VSD with bidirectional shunt involving the inlet, muscular, and subaortic regions. These findings provide a detailed description of structural heart involvement in a neonate with congenital syphilis, although a direct causal relationship cannot be established.Conclusion: This case highlights the importance of early maternal syphilis screening and neonatal cardiac evaluation. The report serves as preliminary documentation for monitoring potential cardiac anomalies in neonates with congenital syphilis and encourages further investigation into possible clinical associations.

Background: Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, affect up to 10% of pregnancies worldwide and remain a leading cause of maternal and perinatal morbidity and mortality. These conditions are associated with adverse fetal outcomes, including preterm birth, growth restriction, and maternal complications such as stroke, eclampsia, multi-organ dysfunction, and a higher risk of long-term cardiovascular complications. Current management relies largely on intermittent blood pressure monitoring and assessment of symptoms, approaches that provide limited insight into the complex hemodynamic alterations underlying HDP. Objective: This narrative review aims to synthesize the available evidence on noninvasive cardiography through thoracic electrical bioimpedance (TEB) as a tool for maternal hemodynamic monitoring in pregnancy, with a focus on hypertensive disorders. Specifically, we (1) describe maternal cardiovascular adaptations in normal gestations and their disruption in HDP, (2) provide an overview of thoracic electrical bioimpedance cardiac output (TEBCO) technology, (3) summarize validation studies in pregnant populations, (4) explore potential clinical applications, including diagnostic support, therapeutic guidance, fluid management and postpartum surveillance, and (5) identify key limitations and research priorities for future practice. Conclusions: Noninvasive cardiography through thoracic electrical bio-impedance is an underutilized tool in the medical field. As an alternative to invasive assessment, TEBCO can identify underlying pathologic hemodynamic changes susceptible to treatment and allow monitoring of hemodynamic trends. The implementation of TEBCO would allow pathophysiologic-based treatments, improve clinical response to therapy, and lead to potential prolongations of pregnancy and cost-savings in healthcare. Current evidence is limited by small sample sizes, device variability, and lack of outcome-based trials. Future research should focus on standardized validation, multicenter studies, and interventional trials to determine whether non-invasive cardiography-guided care can improve maternal and neonatal outcomes.

This study evaluates the impact of psychosomatic interventions on the immune system and microbiome composition of pregnant women diagnosed with gestational hypertension. A case-control study on 200 pregnant women diagnosed with gestational hypertension was conducted between June 2021 and December 2024. The control group (n = 100) included pregnant women diagnosed with gestational hypertension and under only pharmacological treatment with antihypertensive drugs such as labetalol. The case group (n = 100) received standard care for hypertensive disorders in pregnancy like control group, but in addition to it, we incorporated evidence based psychosomatic medicine to this group. Psychosomatic medicine included stress management, relaxation techniques, and counseling for the study group. Primary outcomes included blood pressure levels, psychological state (SAS and SDS scores), mode of delivery, incidence of complications, neonatal outcomes, patient satisfaction, reductions in inflammatory cytokines (e.g., IL-6, TNF-alpha), and improvements in microbiome diversity. Psychosomatic intervention led to a significant increase in microbiome diversity (Shannon Index, P<0.05). Beta-diversity analysis revealed a distinct separation in microbial community composition between the study and control groups (P = 0.02). The case group also showed a reduction in pro-inflammatory cytokines, IL-6 decreased from 40.0 to 28.0 pg mL-1 (P = 0.008) and TNF-alpha from 25.0 to 18.0 pg mL-1 (P = 0.004). The case group demonstrated significant improvements in systolic (P= 0.020) and diastolic (P = 0.003) blood pressures, psychological well-being (SAS, P = 0.006; SDS: P= 0.026), and delivery outcomes (P = 0.032). Complications were significantly lower in the casegroup (P = 0.013), with better neonatal outcomes, including lower rates of intrauterine distress (P= 0.011), premature birth (P = 0.003), and asphyxia (P = 0.013). Emotional resilience, coping confidence, and patient satisfaction were significantly higher in the case group (P < 0.05). These findings suggest that psychosomatic medicine may offer a novel approach for managing gestational hypertension through microbiome modulation.

Background: Glucose intolerance is a hallmark of gestational diabetes mellitus in the early stages of pregnancy. Maternal and perinatal problems such as preeclampsia, gestational hypertension, cesarean delivery, macrosomia, and still birth are frequently caused by gestational diabetes mellitus. Another treatment option for preventing gestational diabetes mellitus is exercise, both before and during pregnancy. Physical activity plays a role in regulating glucose homeostasis, indirectly or directly, and impacts insulin sensitivity through several mechanisms. Objectives: This study to assemble strong evidence regarding the relationship between a woman's preconception or prenatal physical activity and her risk of gestational diabetes mellitus. Methods: This research was conducted through a systematic literature review using Google Scholar, EMBASE, MEDLINE, ScienceDirect, and PubMed, compiled according to the PRISMA guidelines. The literature search used the PICO framework with inclusion and exclusion criteria and found seven studies that were included. Results: The results showed that physical activity before or in early pregnancy, such as walking, jogging, cycling, aerobics, swimming, yoga, etc., which routinely performed, reduced the risk of gestational diabetes mellitus. When doing physical activity, muscles will use glucose to reduce stored glucose. In filling the glucose deficiency, the muscles take blood glucose, causing blood glucose to decrease so that it can control one's blood sugar. The best strategy to reduce the risk of gestational diabetes mellitus is to be physically active both before and throughout pregnancy. Conclusions: Exercise during preconception and the first few months of pregnancy lowers the risk of developing gestational diabetes mellitus.

Background: Brain resting-state functional networks are extensively utilized in research on psychiatric disorders. Meanwhile, pregnancy promotes specific and substantial changes in neural structure and network integration, which are most prominent in the default mode network (DMN). Prior studies have established a relationship between hypertensive disorders in pregnancy (HDP) and mental disorders. Nevertheless, the causal influence of brain resting-state functional networks on HDP is poorly understood. Methods: A bidirectional two-sample Mendelian randomization (MR) framework was applied to estimate the causal effects of 191 resting-state functional magnetic resonance imaging (rsfMRI) phenotypes (sample size: 34,691) on five HDPs, and vice versa. The five HDP conditions were gestational hypertension (GH), pre-eclampsia (PE), eclampsia, chronic hypertension, and PE superimposed on chronic hypertension. Results: Forward MR estimates identified a potential causal relationship between one rsfMRI phenotype (attention, salience, and motor network) and chronic hypertension in pregnancy. The MR analysis of the reverse direction revealed that chronic hypertension in pregnancy may exert a causal influence on three rsfMRI phenotypes: the motor and subcortical-cerebellum network, the attention, salience, and motor network, and the subcortical–cerebellum and motor network. The causal relationship between the attention, salience, and the motor network and chronic hypertension in pregnancy was found to be bidirectional. Conclusions: Our findings reveal a potential causal relationship between altered patterns of intrinsic brain connectivity and chronic hypertension in pregnancy. These results provide crucial evidence for an association between chronic hypertension in pregnancy and alterations in functional brain networks.

We aim to clarify the association and strength of association between antiphospholipid syndrome (APS) and adverse pregnancy outcomes. Our study included an analysis of 191 hospitalized singleton pregnant women with APS and 984 healthy singleton pregnant women at Obstetrics and Gynecology Hospital Affiliated to Fudan University from July 2017 to September 2023. The exposure factor was diagnosed as antiphospholipid syndrome, and the main outcomes were adverse pregnancy outcomes, including miscarriage, preterm birth, low birth weight, gestational hypertension, and eclampsia. Our analysis indicated that the odds ratio (OR) for miscarriage in APS patients was 2.50 (95 % CI, 1.025±15.794; p=0.046), for preterm birth was 2.8 (95 % CI, 1.025±15.794; p=0.046), for low birth weight was 2.28 (95 % CI, 1.025±15.794; p=0.046), and for fetal growth restriction was OR=2.48 (1.45, 4.23) p<0.05. The OR for preeclampsia was 1.00, and for gestational hypertension was 0.96, p>0.05. After adjustment for confounders of age and BMI confounders, the odds ratio (OR) for miscarriage was 2.50 (95 % CI: 1.52-4.11) p<0.05. Preterm birth was 2.89 (95 % CI: 1.79-4.65) p<0.05, low birth weight was 2.28 (95 % CI: 1.52-3.55) p<0.05, intrauterine growth restriction was 2.48 (95 % CI: 1.45-4.23) p<0.05. The OR of preeclampsia was 1.00 (95 % CI: 0.59-1.71) p>0.05, and that of pregnancy-induced hypertension was 0.96 (95 % CI: 0.53-1.75) p>0.05. After adjustment for confounders of age, BMI, eclampsia and diabetes, the OR for preterm infants were 3.06 (95 % CI: 1.87-5.00) p<0.05, and those of low birth weight infants were 2.55 (95 % CI: 1.49-4.37) p<0.05. After adjustment for confounders of age, BMI, diabetes, eclampsia, and gestational week, the OR for low birth weight infants was 2.02 (95 % CI: 1.26-3.26) p<0.05. Antiphospholipid syndrome was significantly associated with the risk of miscarriage, preterm birth, low birth weight, and intrauterine growth restriction as adverse pregnancy outcomes.

Pregnancy orchestrates a rare physiological transformation across vascular, immune, and metabolic systems. When this dynamic balance is disrupted - as in hypertensive disorders of pregnancy - the consequences can be life-threatening, spanning maternal mortality, fetal growth restriction, and elevated long-term cardiovascular risk. Despite clear links to early placental dysfunction and systemic endothelial disruption, current screening remains clinically imprecise, biologically opaque, and logistically challenging. A shift is urgently needed - from detecting maternal complications late in gestation to understanding how pregnancy reshapes vascular physiology systemically and how this remodeling may go awry.Here we present Visionary AI, an artificial intelligence platform that integrates ultra-widefield retinal imaging (200 degrees) with biologically grounded vascular modeling to predict hypertensive disorders of pregnancy early in gestation. Unlike prior approaches that rely on generic deep learning models and clinical inputs, Visionary AI constructs an interpretable, graph-based representation of the maternal retinal vasculature and applies topological and geometric analysis to identify condition-specific microvascular signatures. In a prospective multiethnic U.S. cohort of 1,267 pregnancies, Visionary AI achieved high predictive performance for preeclampsia (AUC = 0.90), early-onset (AUC = 0.93), and severe preeclampsia (AUC = 0.89), outperforming current clinical paradigms. It also generalized to predict gestational hypertension (AUC = 0.91) and chronic hypertension (AUC = 0.90). Topological and geometric analyses of the vasculature revealed distinct and interpretable remodeling patterns across subtypes of hypertensive disorders of pregnancy, offering mechanistic insight into their divergent pathophysiology. These results position the maternal retina as a minimally invasive, high-fidelity biosensor of early systemic vascular health and establish Visionary AI as a clinically actionable, biologically grounded diagnostic framework with potential for broad global scalability.

Anti-Müllerian hormone (AMH) is commonly used in artificial reproductive treatments. Unfortunately, there is only limited data about AMH in adverse pregnancy outcomes. Here, we searched the role of first-trimester AMH to predict adverse pregnancy outcomes in women without polycystic ovary syndrome (PCOS).A total of 240 pregnant women were enrolled in this prospective study. The inclusion criteria were being in the first trimester of pregnancy, having AMH levels measured, not having PCOS, and having had regular antenatal visits. Adverse outcomes were preeclampsia, gestational hypertension, gestational diabetes, preterm birth, pregnancy loss, and stillbirth. Demographic features, obstetric outcomes, and AMH levels were recorded and compared for each adverse outcome. AMH levels were lower in preeclampsia, gestational hypertension, gestational diabetes, and pregnancy loss compared to the control group. In ROC analysis, a cut-off value of 2.14 ng/mL for predicting preeclampsia yielded a sensitivity of 84.2% and specificity of 55.5% (p=0.027, AUC=0.658). For gestational hypertension, a threshold of 2.65 ng/mL resulted in a sensitivity of 94.4% and specificity of 41.2% (p=0.004, AUC=0.662). In predicting gestational diabetes, a cut-off of 1.98 ng/mL achieved a sensitivity of 83.3% and specificity of 59.7% (p<0.001, AUC=0.723). For pregnancy loss, a cut-off value of 2.94 ng/mL showed a sensitivity of 93.8% and specificity of 33.6% (p=0.001, AUC=0.660). The study provides initial indications about the role of AMH in predicting adverse pregnancy outcomes in pregnant women without PCOS. We believe that our study, when supported by randomized controlled studies with a large population, could confirm first-trimester AMH as a biomarker that can be used to predict adverse pregnancy outcomes. By using this marker, patients can be informed about the complications that will develop in the later period of pregnancy and can be referred to appropriate centers.

Exposure to hypertensive disorders of pregnancy (HDP) during the fetal stage has been linked to developmental delays in children. However, the associations between HDP subtypes and longitudinal patterns in child development remain unclear. To investigate the associations of HDP subtypes with child developmental patterns. This study used data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a prospective cohort study recruiting pregnant individuals in Japan between July 2013 and March 2017. Mother-child pairs were included in the analysis. The data analysis was conducted from November 2023 to February 2024. HDP and its subtypes (gestational hypertension and preeclampsia) were identified using an algorithm applied to antenatal visit records. The latent class trajectory model was applied to child development scores at ages 6, 12, 24, 42, and 48 months to generate patterns in 5 domains (communication, gross motor, fine motor, problem solving, and personal-social). Multinomial Poisson regression analysis calculated the risk ratios (RRs) of different developmental patterns by exposure to any HDP as well as HDP subtypes. A subgroup analysis was performed by preterm birth. Among 14 023 mother-child pairs (maternal mean [SD] age, 32.5 [4.8] years; 6754 [48.2%] female children), 1406 (10.0%) were exposed to HDP. Three patterns were identified in the 5 domains: normal, delay, and catch-up. Point estimates for delays in multiple domains of development were greater for any HDP, preeclampsia, and early-onset preeclampsia, but not all findings were statistically significant. Early-onset preeclampsia was associated with a significantly higher risk of delay pattern in problem solving domain (RR, 2.90; 95% CI, 1.43-5.89; adjusted P = .047), although the risks of delay pattern were not statistically significant in communication (RR, 1.94; 95% CI, 1.14-3.29; adjusted P = .15), gross motor (RR, 2.10; 95% CI, 1.26-3.51; adjusted P = .06), or fine motor (RR, 2.68; 95% CI, 1.26-5.71; adjusted P = .11) domains. In the term-born population, children exposed to preeclampsia and had an RR greater than 1 for the delay pattern in the problem solving domain (RR, 1.67; 95% CI, 1.92-2.74; adjusted P = .60), although this finding was not statistically significant after adjusting for multiple comparisons. In this cohort study, fetal exposure to early-onset preeclampsia was associated with higher risk of a delayed child developmental pattern in the problem solving domain. The observations were modified by preterm birth. These findings suggest that children exposed to certain HDP subtypes during fetal life require developmental monitoring, especially if they were born preterm.

The burden of hypertensive disorders in pregnancy (HDP) in remote areas of Ghana remains understudied. This analytical cross sectional study investigated the prevalence, associated factors, and pharmacotherapy of HDPs in the Bono Region of Ghana. Data from labor registers of nine public hospitals, from January to December 2021, were analyzed. Guidelines for administering magnesium sulfate and antihypertensives were assessed. Associations were examined using chi-square and multivariable binomial regression with odds ratios at 95% confidence intervals. P ≤ 0.05 was statistically significant. Of 16,206 deliveries, 711 parturients (4.4%) were complicated by HDPs. Non-severe pre-eclampsia (30.5%) and gestational hypertension (28.0%) were most frequent, while eclampsia (6.2%) and superimposed pre-eclampsia (1.7%) were less common. Maternal age 15-25 years (cOR = 2.43), unemployment (cOR = 2.14), primigravidity (cOR = 2.88), and primiparity (cOR = 2.39) were significantly associated with pre eclampsia/eclampsia. After adjustment for confounding variables, primiparity remained borderline significant (aOR = 1.83; p = 0.05). Oral nifedipine and intravenous hydralazine were the primary antihypertensive therapies. Magnesium sulfate was universally administered using the Pritchard regimen, though product concentrations for intramuscular use varied slightly. Findings highlight the need to standardize magnesium sulfate formulations to optimize intramuscular dosing and enhance treatment consistency in lower-level facilities managing HDPs.