Gestational Hypertensive Disorders Research Articles

An Enhanced Postpartum Transition Program to Primary Care.

Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are risk factors for future cardiovascular disease, yet few individuals receive postpartum care with primary care clinicians (PCP). To facilitate transitions of care to PCPs and improve cardiovascular health monitoring within the first 13 months postpartum, we developed and piloted an enhanced postpartum referral pathway for patients with GDM or HDP. Methods: Eligible patients included those who received perinatal care at a large, urban, academic medical center, experienced GDM or HDP during their most recent pregnancy, and lacked an existing PCP. Resident, faculty, and advanced practitioners referred patients during antenatal, delivery-related, or postpartum visits. A dedicated scheduler contacted patients to schedule an appointment with a women's health-focused resident or faculty PCP. The percent of patients who attended a postpartum PCP visit, who had an HbA1c and cholesterol panel checked within the first 13 months postpartum, were compared between patients referred and not referred to the program using adjusted odds ratios (aOR). Results: Of 129 individuals referred, 48.1% attended a PCP visit, 31.8% completed cholesterol screening, and 41.9% completed HbA1c screening within 13 months postpartum. After adjusting for age, parity, insurance, and referral indication, referred individuals had greater odds for each outcome (PCP visit: aOR = 6.0, 95% CI 4.0-9.0; cholesterol: aOR = 2.4, 95% 1.6-3.9; HbA1c: aOR = 2.5, 95% CI 1.7-3.7) compared with nonreferred individuals in the same time period. Discussion: A enhanced postpartum PCP referral pathway pilot for birthing individuals was associated with improved follow-up in the first year postpartum.

The relationship between preeclampsia risk and SENCR rs555172 gene polymorphism and expression.

Preeclampsia, the more severe manifestation of gestational hypertensive disorders, is a major cause of maternal and perinatal morbidity and mortality worldwide. Genetic polymorphisms in long non-coding RNAs (lncRNAs) are considered as potential genetic preeclampsia. This study aimed to explore the association between SENCR rs555172 SNP and PE risk in healthy pregnant women compared to women with preeclampsia. A total of 140 healthy pregnant women and 130 preeclampsia cases were included in the study. The rs555172 genotype was determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and the expression of the SENCR gene was analyzed in 40 placenta tissue samples from both groups. Various statistical approaches were employed to assess the genotypic and allelic frequencies. The results showed no significant difference in the frequency of the rs555172 polymorphism between healthy pregnant women and those with preeclampsia in terms of the dominant (p=0.82), recessive (p=0.39), and over-dominant (p=0.42) models. Additionally, the analysis of SENCR relative expression revealed no significant difference between the two groups (p=0.48). In conclusion, the LncRNA SENCR rs555172(G/A) seems not associated with an increased risk of Preeclampsia in pregnant women.

Natural proliferative phase frozen embryo transfer-a new approach which may facilitate scheduling without hindering pregnancy outcomes.

How does a natural proliferative phase (NPP) strategy for frozen embryo transfer (FET) compare with the conventional artificial (AC) and natural (NC) endometrial preparation protocols in terms of live birth rates (LBR)? This study supports the hypothesis that, just as for NC, NPP-FET may be a superior alternative to AC in terms of LBR. Although FETs are increasing worldwide, the optimal FET protocol is still largely controversial. Despite recent evidence supporting a possibly higher efficacy and safety of NC FETs, their widespread use is limited by the difficulties encountered during cycle monitoring and scheduling. In this single center retrospective cohort study, we describe the NPP-FET protocol, in which vaginal progesterone is initiated during the proliferative phase as soon as an endometrium with a thickness of at least 7 mm is identified and ovulation is ruled out, regardless of mean diameter of the dominant follicle. For comparison, we considered all blastocyst stage FET cycles preformed at a private infertility center between January 2010 and June 2022, subdivided according to the following subgroups of endometrial preparation: AC, NPP, and NC. We performed multivariable generalized estimating equations regression analysis to account for the following potential confounding variables: oocyte age at retrieval, oocyte source (autologous without preimplantation genetic testing for aneuploidies (PGT-A) versus autologous with PGT-A versus donated), number of oocytes retrieved/donated, embryo developmental stage (Day 5 versus Day 6), number of embryos transferred, quality of the best embryo transferred, and year of treatment. The main outcome measure was LBR. The secondary outcomes included hCG positive, clinical pregnancy and miscarriage rates, and the following perinatal outcomes: first trimester bleeding, second/third trimester bleeding, preterm rupture of membranes, gestational diabetes, gestational hypertensive disorders (GHD), and gestational age at delivery. A total of 5791 FET cycles were included in this analysis (2226 AC, 349 NPP, and 3216 NC). The LBR for FET was lower in the AC subgroup when compared to the NPP and NC (38.4%, 49.1%, and 45.2%, respectively; P < 0.01 AC versus NPP and AC versus NC). The rates of miscarriage were also lower in the NPP and NC subgroups when compared to AC (19.7%, 25.0%, and 34.9%, respectively; P < 0.01 NPP versus AC and NC versus AC). Considering perinatal outcomes, NPP-FET and NC were associated with a significantly lower first trimester bleeding compared to AC (17.3%, 14.7%, and 37.6%, respectively; P < 0.01 NPP versus AC and NC versus AC). Additionally, NC was associated with a lower rate of GHD when compared with AC (8.6% versus 14.5%, P < 0.01), while the rate following NPP-FET was 9.4%. This study is limited by its retrospective design. Moreover, there was also a low number of patients in the NPP subgroup, which may have led the study to be underpowered to detect clinically relevant differences between the subgroups. Our study posits that the NPP-FET protocol may be an effective and safe alternative to both NC and AC, while still allowing for enhanced practicality in patient follow-up and FET scheduling. Further investigation on NPP-FET is warranted, with prospective studies including a larger and more homogeneous subsets of patients. This research was supported by the IVI-RMA-Lisbon (2008-LIS-053-CG). The authors did not receive any funding for this study. The authors have no competing interests. Not applicable.

Gestational weight trajectory and risk of adverse pregnancy outcomes among women with gestational diabetes mellitus: A retrospective cohort study.

The aim of this study was to explore gestational weight gain (GWG) trajectoriesand their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectorymodelwas used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared withpregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio[AOR]: 1.29, 95% confidence interval [CI]: 1.12-1.48)but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95%CI: 0.57-0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95%CI: 1.62-2.78), low birthweight (AOR: 1.49, 95%CI: 1.07-2.08), preterm birth (AOR: 1.28, 95%CI: 1.05-1.63), caesarean section (AOR: 1.26, 95%CI: 1.112-1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95%CI: 1.82-2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass indexand GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high-risk groups to minimise adverse outcomes.

Caring for Patients with Gestational Hypertensive Disorders: Essential Takeaways.

Hypertensive disorders in pregnancy (HDP) are a group of conditions-including chronic hypertension, gestational hypertension, preeclampsia with and without end-organ damage, and acute complications, which include HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and eclampsia-that could lead to severely adverse outcomes for both mother and fetus. The incidence of HDP has increased, affecting one out of seven delivery hospitalizations. Physicians should be aware of HDP for early identification and proper treatment to improve patient outcomes.

The simultaneous occurrence of gestational diabetes and hypertensive disorders of pregnancy affects fetal growth and neonatal morbidity

Gestational diabetes (GDM) is associated with an increased risk of hypertensive disorders of pregnancy (HDP), but there are limited data on fetal growth and neonatal outcomes when both conditions are present. We evaluated the risk of abnormal fetal growth and neonatal morbidity in pregnancies with co-occurrence of GDM and HDP. In a retrospective study of 47,093 singleton pregnancies, we compared the incidence of appropriate for gestational age birthweight (AGA) in pregnancies affected by GDM alone, HDP alone, or both GDM and HDP (GDM/HDP) to that in pregnancies affected by neither disorder using generalized estimating equations (covariates: maternal age, nulliparity, BMI, insurance type, race, marital status and prenatal care site). Secondary outcomes were large for gestational age birthweight (LGA), small for gestational age birthweight (SGA), and a neonatal morbidity composite outcome (stillbirth, hypoglycemia, hyperbilirubinemia, respiratory distress, encephalopathy, preterm delivery, neonatal death, neonatal intensive care unit admission). The median [IQR] birthweight percentile in GDM/HDP (50 [24.0, 78.0], N=179) was similar to unaffected pregnancies (50 [27.0, 73.0], N=35,833). Yet, the absolute rate of AGA was lower for GDM/HDP (78.2% versus 84.9% for unaffected pregnancies). Adjusted analyses showed decreased odds of AGA in GDM/HDP pregnancies compared to unaffected pregnancies (aOR 0.72, 95% confidence interval [0.52, 1.00], P=0.049), and in pregnancies complicated by GDM alone (aOR 0.78 [0.68, 0.89], P<0.001), or HDP alone (aOR 0.73 [0.66, 0.81], P<0.001). The absolute risk of LGA in GDM/HDP pregnancies (14.5%) was greater than in unaffected pregnancies (8.2%) without apparent difference in the risk of SGA (7.3% vs 6.9%). However, in adjusted models comparing GDM/HDP to unaffected pregnancies, neither an association with LGA (aOR 1.33 [0.88, 2.00], P=0.171) nor SGA (aOR 1.32 [0.80, 2.19], P=0.293) reached statistical significance. GDM/HDP carried an increased risk of neonatal morbidity that was greater than that seen in either condition alone (GDM/HDP: aOR 3.13 [2.35, 4.17], P<0.001; GDM alone: aOR 2.01 [1.78, 2.27], P<0.001, HDP alone: aOR 1.38 [1.26, 1.50], P<0.001). While GDM/HDP pregnancies have a similar median birthweight percentile to those affected by neither condition, pregnancies concurrently affected by both conditions have a higher risk of abnormal fetal growth and neonatal morbidity.

Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus?

Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus. a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords. in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others. up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.

Obesity-related maternal complications during the COVID-19 pandemic

Objectives To compare gestational weight gain (GWG) during pregnancy and obesity-related maternal morbidity between three months of the first year of the COVID-19 pandemic and three months of the previous year. Methods A retrospective comparative study was conducted in a tertiary university-affiliated hospital. GWG, obesity rates and pregnancy complications were compared between the time periods. Results Among women with class I obesity, GWG was higher during the pandemic ( n = 1071) than the previous year ( n = 1194): 11.16 vs. 8.69 kg, p = 0.04. Women during the pandemic compared to the previous year were less likely to be diagnosed with gestational diabetes (odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47–0.91, p = 0.01) or hypertensive disorders of pregnancy (OR = 0.63, 95% CI 0.35–1.0, p = 0.05) after adjustment for parity, mode of conception and advanced maternal age. Conclusions Gestational weight gain increased during the pandemic, yet rates of obesity-related complications were notably fewer. This is likely attributed to decreased detection consequent to limited antenatal care.

Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms

BackgroundFetal cardiology has shown a rapid development in the last decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly at second and third trimester. The study of fetal cardiac function at the end of first timester has not been properly investigated and there is a lack of reference values at early gestational weeks. ObjectiveTo assess whether the measurement of time related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13.6 gestational weeks. Study designWe conducted a prospective observational study from March to September 2022. The study was carried out in two hospitals (Hospital Universitari Dexeus, Barcelona and Hospital VITAHS 9 Octubre, Valencia). The scans were performed by 3 specialists in fetal medicine. Exclusion criteria were: fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight< 10 centile, diabetes and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were: isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction and filling time fraction. We study the feasibility and intra- and inter-observer reproducibility of this parameters using the interclass correlation coefficient (ICC). Nomograms were made and the percentiles of the values of the different parameters were calculated. Results409 cases were recruited but only 296 could be included in the statistical analysis once exclusion criteria were applied. The intra-observer reproducibility study was excellent (ICC>0.900) and the inter-observer reproducibility study was good (ICC>0.700). Data regression analysis showed that cycle time, filling time, isovolumetric contraction time and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean 0.43±0.08), isovolumetric relaxation time (mean 0.04±0.01) and ejection time (mean 0.16±0.01) remained constant from 11 to 13 weeks. ConclusionsThe study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.

Integrating evidence and causal mapping of factors that influence medication decision-making by pregnant women at risk of hypertensive disorder: protocol for a scoping review

IntroductionIn 2018, the American College of Obstetricians and Gynecologists recommended low-dose aspirin to prevent the onset of pre-eclampsia among women who were at high risk. Factors influencing women’s acceptance of...

Fruits and vegetables intake improves birth outcomes of women with gestational diabetes mellitus and hypertensive disorders of pregnancy

BackgroundDisorders of pregnancy such as hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) have been associated with adverse birth outcomes. However, the ameliorating role of maternal nutrition in the relationship between disorders of pregnancy and adverse birth outcomes has received very little attention. We investigated the relationship between HDP and GDM, and adverse birth outcomes in a Ghanaian population and evaluated the effect modifying role of fruits and vegetables consumption in the relationship.MethodsWe conducted a cross-sectional study among 799 mothers who had recently delivered singletons in the Cape Coast Metropolis, Ghana. Information on HDP, GDM and birth outcomes were retrieved from the maternal health book of the mothers. A food frequency questionnaire was used to assess fruits and vegetables intake during pregnancy. Modified Poisson regression was used to investigate the association between pregnancy disorders, and preterm birth (PTB) and low birth weight (LBW). Stratified analysis was used to assess the effect modifying role of fruits and vegetables consumption in the relationship.ResultsThe proportion of mothers with HDP and GDM was 11.3% and 7.5%, respectively. The proportion of the mothers with both conditions was 0.9%. The prevalence of PTB and LBW in the population was 27.9 and 7.3%, respectively. These disorders of pregnancy were associated with increased risk of PTB (Adjusted Prevalence Ration [APR] = 3.02; 95% CI: 2.42, 3.77) and LBW (APR = 5.32; 95% CI: 3.19, 8.88). In the stratified analysis, risk of PTB was higher among mothers classified in tertile I compared to mothers classified in tertiles II and III. For LBW, the risk increased with increasing fruits and vegetables consumption. The interaction p values were 0.0043 and 0.1604 for PTB and LBW, respectively.ConclusionsWe found mothers who were diagnosed with GDM and HDP to have increased risk of delivering a PTB and LBW baby. We also found fruits and vegetables consumption to modify the observed relationship. Mothers diagnosed with GDM and HDP should be advised during antenatal care visits to increase intake of fruits and vegetable consumption to help safeguard their health and that of the developing foetus.

Improvement of Placentaly Mediated Maternal Medical Disorders before the Delivery - An Alarming Sign from the Fetus

Both gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDIP-gestational hypertension, preeclampsia, eclampsia and HELLP syndrome) can be considered as placentally mediated disorders. That is the reason for all most complete cure in such disorders after the delivery. Improvement of such disorders before the delivery can be considered as failing of the placenta. Urgent delivery of the fetus should be considered in such occasions after considering the fetal maturity. This article attempts to highlight the importance of this through three case reports.

441 Association of nocturnal heart rate and development of gestational diabetes and hypertensive disorders of pregnancy

441 Association of nocturnal heart rate and development of gestational diabetes and hypertensive disorders of pregnancy

Perinatal outcomes and long-term infectious morbidity of offspring born to mothers with familial Mediterranean fever.

To investigate perinatal outcomes and long-term infectious morbidity in children of mothers with familial Mediterranean fever (FMF). A population-based cohort study comparing perinatal outcomes and long-term infectious morbidity of offspring of mothers with and without FMF was conducted. All singleton deliveries between the years 1991-2021 in a tertiary medical center were included. The study groups were followed until 18years of age for long-term infectious morbidity. A Kaplan-Meier survival curve was used to compare the cumulative incidence of long-term infectious morbidity, and generalized estimation equation (GEE) models as well as Cox proportional hazards models were constructed to control for confounders. During the study period, 356,356 deliveries met the inclusion criteria. 411 of them were women with FMF. The mean follow-up period interval was 9.7years (SD = 6.2) in both study groups. Using GEE models, preterm delivery, cesarean delivery, and low birth weight were independently associated with maternal FMF. The total infectious-related hospitalization rate was significantly higher in offspring born to mothers with FMF compared to the comparison group (Kaplan-Meier survival curve, log-rank p < 0.001). Using a Cox proportional hazards model, controlling for gestational age, maternal age, diabetes mellitus, cesarean delivery, and hypertensive disorders, being born to a mother with FMF was found to be an independent risk factor for long-term infection-related hospitalization of the offspring. Maternal FMF was found to be independently associated with long-term infection-related hospitalization of the offspring. This positive correlation may reflect an intra-uterine pro-inflammatory environment which may result in the offspring's long-term susceptibility to infection.

Impact of Antenatal Care Modifications on Gestational Diabetes Outcomes During the COVID-19 Pandemic

BackgroundMany of the adverse outcomes of gestational diabetes mellitus (GDM) are linked to excessive fetal growth, which is strongly mediated by the adequacy of maternal glycemic management. The COVID-19 pandemic led to a rapid adoption of virtual care models. We aimed to compare glycemic management, fetal growth, and perinatal outcomes before and during the COVID-19 pandemic. MethodsA retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into “before” and “during” COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre–COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes. ResultsSeven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index, gestational weight gain, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5). ConclusionsAfter adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM.

Correlation between ABO blood group and gestational hypertensive disorder among pregnant women in Abuja, Nigeria

Gestational hypertensive disorder (GHD) is among the major health problems in pregnant women. In this study, we assessed the relationship between gestational hypertensive disorder and ABO blood groups among women who attended the antenatal clinic at the University of Abuja Teaching Hospital, Abuja, Nigeria. Correlational study design was used on a total of 138 patients with sociodemographic characteristics and clinical data such as blood group, gestational hypertensive disorder status, maternal age at pregnancy, and parity were extracted. Descriptive statistics was carried out on the collected data and chi-square test for the test of association or Fisher’s exact where necessary. The maternal age of the women ranged from fifteen to fifty-one years old with a mean age of 30.7 ± 9.8. Clinical information revealed that 17 (12.3%) primigravida and 121 (87.7%) non-primigravida patients. The patients’ distribution by blood group revealed that 33 (23.9%), 32 (23.2%), 47 (34.1%) and 26 (18.8%) belonged to blood group A, B, AB, and O respectively. Our results showed a relationship between blood pressure and the ABO blood group but not significant with χ2 = 12.31 and p = 0.421 with blood pressure of 150/100–154/104 mmHg ranked highest in frequency among all the blood groups. Also, we observed a non- significant relationship between maternal age and the occurrence of GHD at χ2 =19.81 and p = 0.229 which implies that GHD is not associated with age but that blood pressure increases with gestational age. Interestingly, a significant relationship exists between gestational hypertension and parity at χ2 = 26.71 and p = 0.045. Blood group AB was more susceptible to gestational hypertensive disorder whereas blood groups O, A and B were less susceptible to it. We recommend increased awareness of GHD among pregnant women, all health workers, and the general public about its danger to pregnant mothers and fetuses.

The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal-perinatal outcomes among singleton and twin pregnancies: a retrospective cohort study (2011-2019).

Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal-perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal-perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal-perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal-perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. In conclusion, GDM showed an increased risk of a few adverse maternal-perinatal outcomes and HDP is associated with a higher risk of several adverse maternal-perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal-neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.

Factors Associated with Progression to Preeclampsia with Severe Features in Pregnancies Complicated by Mild Hypertensive Disorders.

In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. All women admitted due to hypertensive disorders were included. Data collected was compared between parturients who progressed and did not progress to preeclampsia with severe features. Among 359 women presenting without severe features, 18 (5%) developed severe features, delivered smaller babies at lower gestational age, and with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, any previous gestational hypertensive disorder, gestational diabetes, number of hospitalizations, earlier gestational age at initial presentation, and superimposed preeclampsia as the preliminary diagnosis were all associated with preeclampsia progression to severe features. Previous delivery within 2-5 years was a protective variable from preeclampsia progression. Following regression analysis and adjustment to confounders, only gestational age at initial presentation and superimposed preeclampsia remained significant variables associated with progression to severe features (aOR 0.74 (0.55-0.96) and 34.44 (1.07-1111.85), aOR (95% CI), respectively, p < 0.05 for both) with combined ROC-AUC prediction performance of 0.89, 95% CI 0.83-0.95, p < 0.001. In conclusion, according to our study results, early gestational age at presentation and superimposed preeclampsia as the preliminary diagnosis are the only independent factors that are associated with progression to severe features in women already diagnosed with mild hypertensive disorders during pregnancy.

A descriptive study on the risk factors of preterm birth with its maternal and fetal outcomes at a tertiary care hospital

Background: India contributes to greatest number of preterm births all over the world. The global annual prevalence of preterm birth ranges from 9-12%. It is the most common indication for antenatal hospitalization and is the leading cause for under-five mortality. Aims and objectives were to study the incidence, risk factors, clinical presentation, effectiveness of timely intervention and, maternal and fetal outcomes of preterm birth. Methods: A Prospective hospital based cross-sectional study was done from February 2021 to February 2022. Results: The incidence of preterm labour in the study was 24%. Majority of cases presented with symptoms of UTI (47%), vaginal discharge (43%) and leaking per vagina (13%). Infections were the most common aetiology, 40% of cases had positive urine and vaginal swab culture. The most common neonatal complications were respiratory distress syndrome (7%) and neonatal sepsis (7%), others included seizures (2%), birth asphyxia (1%), enterocolitis (1%), hypoxic ischemic encephalopathy (1%), intracranial hemorrhage (1%), meningitis (1%) and pulmonary hemorrhage (1%). 5% of neonatal deaths were noted. Conclusions: Urogenital infections were the commonest etiology for the onset of preterm labour, followed by gestational hypertensive disorders, previous history of preterm birth and anaemia in pregnancy. We conclude that in established preterm labour, aggressive management with antenatal corticosteroids, Magnesium sulphate for neuroprotection when indicated, antibiotic coverage and use of tocolytics with early in-utero transfer of mother to centres with equipped neonatal care units will improve the neonatal outcome.  

Alterations in the von Willebrand factor/ADAMTS-13 axis in preeclampsia

BackgroundPreeclampsia is a gestational hypertensive disorder characterized by maternal endothelial activation and increased ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) inhibitor to placental growth factor (PlGF). The von Willebrand factor (VWF)/ADAMTS-13 axis is of interest because of the underlying endothelial activation and clinical overlap with pregnancy-associated thrombotic thrombocytopenic purpura. ObjectivesTo assess VWF, ADAMTS-13, and VWF/ADAMTS-13 ratio in preeclampsia and look for associations with sFlt-1/PlGF ratio and clinical features. MethodsThirty-four preeclampsia cases and 48 normal pregnancies were assessed in a case-control study. Twelve normal pregnancies in women with a history of preeclampsia formed an additional comparator group. VWF antigen (VWF:Ag) and VWF activity (VWF:Ac [VWF:glycoprotein IbM]) were measured via automated immunoturbidimetric assay, ADAMTS-13 activity was measured via fluorescence resonance energy transfer–VWF73 assay, and sFlt-1 and PlGF were measured via enzyme-linked immunosorbent assay. ResultsVWF:Ag was higher in preeclampsia than in normal pregnancy (median, 3.07 vs 1.87 IU/mL; P < .0001). ADAMTS-13 activity was slightly lower (median, 89.6 vs 94.4 IU/dL; P = .02), with no severe deficiencies. Significant elevations in VWF:Ac were not observed in preeclampsia, resulting in reduced VWF:Ac/VWF:Ag ratios (median, 0.77 vs 0.97; P < .0001). VWF:Ag/ADAMTS-13 ratios were significantly higher in preeclampsia (median, 3.42 vs 2.06; P < .0001), with an adjusted odds ratio of 19.2 for a ratio of >2.7 (>75th centile of normal pregnancy). Those with a history of preeclampsia had similar ratios to normal pregnant controls. VWF:Ag/ADAMTS-13 and sFlt-1/PlGF were not correlated. However, percentage reduction in platelets correlated positively with VWF:Ac (P = .01), VWF:Ac/VWF:Ag ratio (P = .004), and sFlt-1/PlGF ratio (P = .01). ConclusionThe VWF/ADAMTS-13 axis is significantly altered in preeclampsia. Further investigation of potential clinical utility is warranted.