Gestational Hypertension Women Research Articles

Association of ACE*(Insertion/Deletion) Variant with the Elevated Risk of Preeclampsia Among Gestational Women.

The renin-angiotensin-aldosterone system has an indispensable function in the uteroplacental circulation, placental growth, and blood pressure optimization. The angiotensin I converting enzyme (ACE) gene is a critical integrator for electrolyte balance, and water retention, along with inhibiting preeclampsia. The main goal of this pertaining study is to assess the contribution of ACE*(Ins/Del) variant with the susceptibility for preeclampsia with focus on the severity of the disease among gestational hypertensive women. This retrospective study included 225 participants [125 PE gestational women, and 100 normotensive healthy controls] matching with age, and geographical region. PE women classified into 82 early-onset PE women, accompanied with 43 late-onset PE women. Additionally, PE women categorized into 59 mild PE women, together with 66 severe PE women. The genotyping and characterization of ACE*(Ins/Del) variant were applied using the PCR technique. Our findings indicated higher frequency of the ACE*(Del/Del) genotype and ACE*(D allele) with elevated risk of preeclampsia compared to normotensive controls under recessive (OR = 2.09, and p-value = 0.007), and allelic (OR = 1.75, and p-value = 0.012) models. In addition, testing logistic regression revealed that the levels of endothelin-1 and malondialdehyde exposed significant difference for the ACE*(Del/Del) genotype among early-onset and late-onset PE women (p-value = 0.024, and 0.23, respectively). Furthermore, carriers of the ACE*(Del/Del) genotype observed statistically significant with lower sodium concentrations among severe PE women (p-value = 0.034). The ACE*(Del/Del) genotype and ACE*(D allele) were associated with increased risk preeclampsia among gestational women. Furthermore, early-onset PE and late-onset PE were correlated with endothelin-1 and malondialdehyde concentrations among Egyptian women.

Assessment of Correlation of Serum Lipid Profile and Urinary Protein Creatinine Ratio with Occurrence of Gestational Hypertension in Pregnant Mothers in a Tertiary Care Hospital, Kolkata

After 18 months study from 1st April, 2021 to 30th September, 2022 on the pregnant mothers in a tertiary care hospital, i.e., in R.G. Kar Medical College & Hospital, Kolkata, we have observed that there is significant rise of Urinary Protein Creatinine ratio in spot urine sample of Gestational hypertensive women in comparison to normotensive pregnant women. We may opine that, measurement of Spot Urinary Protein Creatinine Ratio as well as Serum Triglyceride, Total Cholesterol, different components of Cholesterol and calculation of their ratios may be used as precautionary steps, to take the necessary actions to prevent the complications of Gestational hypertension, i.e., graver grades of Pregnancy Induced Hypertension (PIH), namely, Preeclampsia and Eclampsia.

Cadmium inhibits differentiation of human trophoblast stem cells into extravillous trophoblasts and disrupts epigenetic changes within the promoter region of the HLA-G gene.

Cadmium (Cd) is a toxic heavy metal widely distributed in the environment. Maternal whole-blood Cd levels during pregnancy are positively associated with the risk of early preterm birth. We hypothesized that Cd inhibits trophoblast differentiation, resulting in the development of hypertensive disorders of pregnancy and a high risk of early preterm birth. Using the CT27 human trophoblast stem cell line, we found that exposing these cells to 0.1-0.4 µM Cd inhibited their differentiation into extravillous cytotrophoblasts (EVTs). Supporting this finding, we found that expression of the metal-binding protein metallothionein, which suppresses the toxicity of Cd, is low in EVTs. We also found that Cd exposure changes the methylation status of the promoter region of the HLA-G gene, which is specifically expressed in EVTs. Together, these results suggest that Cd inhibits placental formation by suppressing trophoblast differentiation into EVTs. This suppression may underlie the increased risk of gestational hypertension in women with high whole-blood Cd levels.

Evaluation of Lactate Dehydrogenase and Gamma Glutamyl Transferase Among Pregnant Women with Hypertensive Disorders and Their Association with Disease Severity in Jimma Medical Center, Ethiopia

Background & Objective: Pregnancy-induced hypertensive disorders (PIHD) are the main reasons for maternal and perinatal mortality, as they complicate 10% of pregnancies worldwide. Serum lactic acid dehydrogenase (LDH) and gamma-glutamyl transferase (GGT) are possible markers reflecting the occurrence of pregnancy-associated complications like preeclampsia and eclampsia. There is a paucity of data with conflicting results showing serum LDH and GGT on PIHD in Ethiopia. This investigation aimed to assess the serum LDH and GGT levels in pregnant women with PIHD along with their correlation with the severity of the disease at Jimma Medical Center (JMC), Ethiopia.Materials & Methods: This hospital-based comparative cross-sectional study was undertaken from August 03 to September 27, 2020, in JMC. A total of 97 study participants were recruited. Serum GGT and LDH levels were determined using a fully automated Roche Cobas 6000 chemistry analyzer. The data were analyzed using SPSS 25.0. One-way ANOVA and independent samples t-test were employed to compare serum GGT and LDH levels with categories of PIHD.Results: The significantly highest mean serum levels of LDH (580.9±193.8 U/L) and GGT (86.1±29.2 U/L) were observed in eclamptic women compared to gestational hypertensive (276.7±60.7 and 38.3±16.9 U/L) and preeclamptic patients (353±132.8 and 48.8±29.9 U/L), respectively. Both serum GGT and LDH levels were found to correlate with the severity of preeclampsia, respectively significantly.Conclusion: Serum LDH and GGT were found to be at the highest levels in eclamptic than preeclamptic and gestational hypertensive women. Blood pressure, gestational age, and severity of hypertensive disorders of pregnancy were predictor variables associated with serum GGT and LDH.

Increased Expression of NLRP3 Inflammasome in Placentas of Gestational Hypertension

Node like receptor pyrin 3 is a tripartite protein composed an amino terminal pyrin domin (PYD), nucleotide binding NACHT domine and a carboxy terminal leucinerich repeat (LRR) domine, and consider an intracellular sensor that detects a broad range signal and resulting in the formation and activation the NLRP3 inflammasome. This complex lead to release of the inflammatory cytokines IL-1β, IL-18 which is important for host defense against invading pathogen. Modern evidence indicates that the NLRP3 inflammasome involved in gestational hypertension. This study was conducted on fifty pregnant women and divided into two groups, 25 placentas from normotensive mother having no hypertension before as control group and 25 from gestational hypertension women as gestational hypertension group, obtained from Department of Obstetrics and Gynecology in Almosil El Aam Hospital and Alkhanssa Teaching Hospital, Mosul city, Iraq. The placental tissue samples were collected from central region and processed for immunohistochemical technique to expression of NLRP3 in placental tissue. The immunohistochemical study of placenta of gestational hypertension group showed the localization of NLRP3 protein and staining intensity in trophoblast, stroma and endothelium villi were high quantification compared with placenta from control group.

Increased Expression of NLRP3 Inflammasome in Placentas of Gestational Hypertension

Node like receptor pyrin 3 is a tripartite protein composed an amino terminal pyrin domin (PYD), nucleotide binding NACHT domine and a carboxy terminal leucinerich repeat (LRR) domine, and consider an intracellular sensor that detects a broad range signal and resulting in the formation and activation the NLRP3 inflammasome. This complex lead to release of the inflammatory cytokines IL-1β, IL-18 which is important for host defense against invading pathogen. Modern evidence indicates that the NLRP3 inflammasome involved in gestational hypertension. This study was conducted on fifty pregnant women and divided into two groups, 25 placentas from normotensive mother having no hypertension before as control group and 25 from gestational hypertension women as gestational hypertension group, obtained from Department of Obstetrics and Gynecology in Almosil El Aam Hospital and Alkhanssa Teaching Hospital, Mosul city, Iraq. The placental tissue samples were collected from central region and processed for immunohistochemical technique to expression of NLRP3 in placental tissue. The immunohistochemical study of placenta of gestational hypertension group showed the localization of NLRP3 protein and staining intensity in trophoblast, stroma and endothelium villi were high quantification compared with placenta from control group.

Effect of aerobic exercise versus device-guided breathing on gestational hypertension hypertension

IntroductionGestational hypertension is a prevalent condition, occurring in 10% of pregnancies. Physical exercise has a valuable effect on lowering blood pressure. Device-guided breathing is a beneficial strategy for treating high blood pressure. The purpose of this study was to compare aerobic exercise vs. device-guided breathing in gestational hypertension.MethodsThe study included 90 singleton pregnant women (at the 21st week of gestation) diagnosed with gestational hypertension. They were randomly divided into 3 groups. The aerobic exercise group (<i>n</i> = 30) received aerobic exercise until the 36th week of gestation. The device-guided breathing group (<i>n</i> = 30) received device-guided breathing until the 36th week of gestation. The third group was a control group. All groups received the same antihypertensive medications. They were assessed before and after treatment with a mercury column sphygmomanometer to measure systolic and diastolic blood pressure.ResultsAll groups showed a significant reduction in their systolic and diastolic blood pressure values after the end of the training program. However, the comparison with the corresponding values measured before treatment revealed that the participants in the device-guided breathing group exhibited a greater reduction in the systolic and diastolic blood pressure values than those in the aerobic exercise and control groups.ConclusionsDevice-guided breathing is more effective than aerobic exercise in decreasing systolic and diastolic blood pressure in gestational hypertensive women.

Maternal race and pre-eclampsia: Cohort study and systematic review with meta-analysis.

To examine the association between race and pre-eclampsia and gestational hypertension after adjustment for factors in maternal characteristics and medical history in a screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on pre-eclampsia. Prospective observational study and systematic review with meta-analysis. Two UK maternity hospitals. A total of 168 966 women with singleton pregnancies attending for routine ultrasound examination at 11-13 weeks of gestation without major abnormalities delivering at 24 weeks or more of gestation. Regression analysis examined the association between race and pre-eclampsia or gestational hypertension in the FMF data. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and pre-eclampsia. Relative risk of pre-eclampsia and gestational hypertension in women of black, South Asian and East Asian race by comparison to white women. In black women, the respective risks of total-pre-eclampsia and preterm-pre-eclampsia were 2-fold and 2.5-fold higher, respectively, and risk of gestational hypertension was 25% higher; in South Asian women there was a 1.5-fold higher risk of preterm pre-eclampsia but not of total-pre-eclampsia and in East Asian women there was no statistically significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contributions on different racial groups to the prediction of pre-eclampsia. In women of black and South Asian origin the risk of pre-eclampsia, after adjustment for confounders, is higher than in white women.

Efficacy of Benson Relaxation Technique on Physiological Parameters, Anxiety and Sleep Quality among Gestational Hypertensive Women

Efficacy of Benson Relaxation Technique on Physiological Parameters, Anxiety and Sleep Quality among Gestational Hypertensive Women

Pregnancy Complications in Women with Weight Loss Surgery Compared to a Non-Surgical Population of Women with Obesity.

The objective of this study was to assess the effect of WLS on pregnancy and delivery complications in women who had WLS compared to women with obesity who did not undergo WLS. We used the National Inpatient Sample data from 2012 to 2017, with a study population of women between the ages of 20 and 44 who had a maternal admission code in the NIS data (n = 663,795). Weighted logistic regression models were fitted and the models were stratified by race. Covariates included age, race, primary payer, previous cesarean delivery, physical health comorbidities, and depression. There were decreased odds of gestational diabetes in women of all races (aORall = 0.47, 95% CIall = 0.44-0.49). There were decreased odds for gestational hypertension in women of all races (aORall = 0.55, 95% CIall = 0.51-0.59). Compared to women who did not have WLS, there were lower odds of cesarean delivery among women with a history of WLS (aORall = 0.62, 95% CIall = 0.60-0.65), which was true for White women, Black women, and Latinas with a history of WLS (aORWhite = 0.57, 95% CIWhite = 0.53-0.60; aORBlack = 0.67, 95% CIBlack = 0.61-0.74; aORLatina = 0.71, 95% CILatina = 0.64-0.78). Overall, women with history of WLS had lower odds of most of the pregnancy outcomes (gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia, and cesarean delivery) with results mediated by race.

Is new onset hypertension in obese women more likely to be Gestational Hypertension? - A retrospective study.

New onset hypertension is more common in antenatal women with increased Body Mass Index (BMI). This may be due to either gestational hypertension (GH) or pre-eclampsia (PE). GH unlike PE is not associated with poor perinatal outcomes and would not require interventions such as increased antenatal visits and induction of labour. Our study assessed the prevalence of GH and PE in women with increased BMI as compared to women with normal BMI. Historical cohort of a large tertiary centre. Data from the electronic birth registry of the labour room was used to identify women who had a BMI ≥ 35 kg/m2 at delivery. Women with a normal BMI matched for the mode of delivery was taken as control. 148 women with BMI ≥ 35 kg/m2 were compared with 140 women of normal BMI. New onset hypertension was seen in 41.2% (61/148) and 8.6% (12/140) in the non-obese group RR 4.81 (2.7-8.54) P (<0.001). GH was seen in 24.3% in obese women and 2.9% in normal controls, RR (9.65 (3.54,26.34)), P (<0.001). PE was seen in 16.9% of obese women and 5.7% of women with normal BMI, RR (3.79 (1.78,8.08)) P (<0.001). Proportion of GH in women with new onset hypertension was seen in 59% of obese women with new onset hypertension and 33% of normal controls. This clinically relevant trend towards an increased proportion of GH highlights the importance of identifying pathophysiological mechanism for high BP in obesity when there is new onset hypertension.

Circulating levels of hydrogen sulphide negatively correlate to nitrite levels in gestational hypertensive and preeclamptic pregnant women.

Endothelial dysfunction is a hallmark of preeclampsia and the role of nitric oxide (NO) has been extensively studied in this pregnancy complication. In recent years, hydrogen sulphide (H2 S) has arisen as a new gasotransmitter with an impact on endothelial function. However, the involvement of H2 S in the pathophysiology of preeclampsia is not fully understood, and only a few studies with limited sample size have investigated circulating levels of H2 S in preeclamptic patients. Moreover, H2 S levels have not been previously evaluated in gestational hypertension. Furthermore, the relationship between H2 S and NO in these hypertensive disorders of pregnancy has yet to be determined. We measured H2 S levels in plasma of 120healthy pregnant women, 88gestational hypertensive and 62 preeclamptic women. We also measured plasma nitrite in a subset of patients and carried out correlation analysis between plasma H2 S and nitrite in these three groups. We found that plasma H2 S was elevated in preeclampsia and further increased in gestational hypertension compared to healthy pregnancy. Plasma nitrite was reduced in gestational hypertension and preeclampsia, and these levels were negatively correlated with H2 S in both gestational hypertension and preeclampsia, but not in healthy pregnancy. Our results indicate that increases in H2 S may represent a mechanism triggered as an attempt to compensate reduced NO in gestational hypertension and preeclampsia. Future studies are warranted to investigate the mechanisms underlying H2 S/NO interaction on mediating endothelial dysfunction in these hypertensive disorders of pregnancy.

Prenatal Exercise and Cardiovascular Health (PEACH) Study: Impact on Muscle Sympathetic Nerve (Re)Activity.

Women who develop gestational hypertension have evidence of elevated muscle sympathetic nerve activity (MSNA) in early pregnancy, which continues to rise after diagnosis. Exercise has been shown to play a preventative role in the development of gestational hypertension and has been shown to reduce resting and reflex MSNA in nonpregnant populations. We sought to investigate whether aerobic exercise affected the sympathetic regulation of blood pressure between the second and third trimesters of pregnancy. We conducted a randomized controlled trial of structured aerobic exercise (n = 31) compared with no intervention (control, n = 28) beginning at 16-20 wk and continuing until 34-36 wk of gestation (NCT02948439). Women in the exercise group were prescribed aerobic activity at 50%-70% of their heart rate reserve, on 3-4 d·wk-1 for 25-40 min with a 5-min warm-up and 5-min cool-down (i.e., up to 160 min total activity per week). At preintervention and postintervention assessments, data from ~10 min of quiet rest and a 3-min cold pressor test were analyzed to determine sympathetic nervous system activity and reactivity. MSNA was obtained in 51% of assessments. Resting MSNA burst frequency and burst incidence increased across gestation (main effect of gestational age, P = 0.002). Neurovascular transduction was blunted in the control group (P = 0.024) but not in exercisers (P = 0.873) at the postintervention time point. Lastly, MSNA reactivity during the cold pressor test was not affected by gestational age or exercise (P = 0.790, interaction). These data show that exercise attenuates both the rise in MSNA and the blunting of neurovascular transduction. This may partially explain the lower risk of developing gestational hypertension in women who are active during their pregnancies.

Pattern of Pro-Angiogenic Serum Placental Growth Factor in Gestational Hypertensive Women

Objective: The aim of this study was to investigate maternal serum levels of an angiogenic factor called Placental Growth Factor (PLGF) at different ages of pregnancy in gestational hypertensive women residing in Raiwind Lahore, Pakistan. Methods: The analytical cross-sectional study was conducted at the Department of Obstetrics and Gynecology Sharif Medical City Hospital, Lahore from January 2015 - April 2015. Serum levels of PLGF were measured and compared between 22 control normotensive subjects (Group A) and 18 gestational hypertensive (Group B). Moreover, comparison was also made among different gestational weeks groups (I, II and III). Results: Serum PLGF levels were raised in gestational hypertensive (Group B) compare to normotensive (Group A) [366 (185-695) vs. 156 (132-319) ng/L], (P= 0.024). Serum PLGF levels were 156 (132-319) in gestational hypertensive individuals and 366 (185-695) ng/L in normotensive individuals. Serum levels PLGF of 18 -28 (I), 29-35 gestational weeks (II) were raised [425 (197-452) vs. 163 (91-332)], [546 (309-1519) vs. 137 (86-147)]. While in last 36- 40 weeks group (III) levels were decreased [216 (136-881) vs. 315 (185-612)] in comparison of normotensive subjects. Conclusion: It is concluded from this research that placental–derived angiogenic biomarker PLGF plays a significant role in gestational hypertension. The pattern of the PLGF marker in various intervals of pregnancy may provide information for the management of hypertension in pregnancy.

SIRT1-dependent effects of resveratrol and grape juice in an in vitro model of preeclampsia

Preeclampsia (PE) is a multifactorial hypertensive disorder of pregnancy that is partly responsible for both maternal and fetal morbidity and mortality levels worldwide. It has been recently discovered that sirtuin-1 (SIRT1) is reduced in the circulation and in an in vitro model of PE. Therefore, in this study, we investigated the effects of trans-resveratrol, a potent antioxidant and activator of SIRT1, on oxidative stress and nitric oxide (NO) production in an in vitro model of PE compared to gestational hypertensive (GH) and healthy pregnant (HP) women. Furthermore, we also evaluated the effects of an acute intake of grape juice on women with PE to assess whether it could mimic in vitro trans-resveratrol supplementation.(1) In the GH group, resveratrol decreased intracellular reactive oxygen species (ROS) and increased their antioxidant capacity, while inhibiting SIRT1 reestablished previous levels. (2) In PE, inhibition of SIRT1 increased antioxidant activity. (3) Intracellular NO and supernatant nitrite levels were increased by inhibiting SIRT1 in the PE group. (4) Grape juice intake increased intracellular NO levels versus before grape juice intake control; however, the inhibition of SIRT1 before grape juice intake initially increased NO, but decreased it 1 h after grape juice intake.In conclusion, activating SIRT1 by using resveratrol alone may not be beneficial to women with PE, and GH and PE seem to have different responsive mechanisms to this molecule. Furthermore, grape juice intake seems to have different effects compared to resveratrol supplementation alone in this in vitro model of PE, demonstrating the potential of the combination of other biologically active molecules from grape juice over the SIRT1-eNOS-NO in PE treatment.

Maternal haemodynamic function differs in pre‐eclampsia when it is associated with a small‐for‐gestational‐age newborn: a prospective cohort study

To describe maternal haemodynamic differences in gestational hypertension with small-for-gestational-age babies (HDP+SGA), gestational hypertension with appropriate-for-gestational-age babies (HDP-only) and control pregnancies. Prospective cohort study. Tertiary Hospital, UK. Women with gestational hypertension and healthy pregnant women. Maternal haemodynamic indices were measured using a non-invasive Ultrasound Cardiac Output Monitor (USCOM-1A® ) and corrected for gestational age and maternal characteristics using device-specific reference ranges. Maternal cardiac output, stroke volume, systemic vascular resistance. We included 114 HDP+SGA, 202 HDP-only and 401 control pregnancies at 26-41weeks of gestation. There was no significant difference in the mean arterial blood pressure (110 versus 107mmHg, P=0.445) between the two HDP groups at presentation. Pregnancies complicated by HDP+SGA had significantly lower median heart rate (76 versus 85bpm versus 83bpm), lower cardiac output (0.85 versus 0.98 versus 0.97MoM) and higher systemic vascular resistance (1.4 versus 1.0 versus 1.2MoM) compared with control and HDP-only pregnancies, respectively (all P<0.05). Women with HDP+SGA present with more severe haemodynamic dysfunction than HDP-only. Even HDP-only pregnancies exhibit impaired haemodynamic indices compared with normal pregnancies, supporting a role of the maternal cardiovascular system in gestational hypertension irrespective of fetal size. Central haemodynamic changes may play a role in the pathogenesis of pre-eclampsia and should be considered alongside placental aetiology. Hypertensive disorders of pregnancy are associated with worse maternal haemodynamic function when associated with small-for-gestational-age birth.

Dental amalgams and risk of gestational hypertension in the MIREC study.

The potential association between the presence or replacement of dental amalgams and gestational hypertension (GH) is unclear. To assess the association between the presence or replacement of dental amalgams and the risk of GH in a prospective cohort study. We assessed dental amalgam status (presence or replacement), blood mercury concentrations, and measured blood pressure (BP) in 1817 pregnant women recruited in 10 Canadian cities. BP was assessed in each trimester of pregnancy and mercury concentrations in 1st and 3rd trimesters. Logistic regression analysis was performed to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the associations between dental amalgam status and GH. Concurrent measures with systolic BP (SBP) and diastolic BP (DBP) were assessing through linear generalized estimating equations. Dental amalgam status was weakly statistically correlated with mercury concentrations but there was no evidence of an association with GH in women having 1-4 (aOR=1.31 (0.92, 1.85)) or≥5 dental amalgams (aOR=1.32 (0.86, 2.04)), compared to women without amalgam reported at first trimester. Dental amalgam replacement reported in the first or third trimester was similarly not associated with GH (aOR=0.75 (0.40, 1.42) and 0.73 (0.39, 1.34), respectively) but with SBP (beta=-1.58 (-2.95, -0.02)). We found weak correlations between dental amalgams and blood mercury among pregnant women. However, the presence of dental amalgams or their replacement was not associated with GH but with decreased SBP for the replacement. Further studies are required.

Analysis of SIRT1 Expression in Plasma and in an In Vitro Model of Preeclampsia.

Preeclampsia (PE) is a pregnancy-specific disorder that affects 3–8% expecting mothers worldwide being one of the main causes of maternal and fetal morbidity and mortality. The search for altered circulating molecules in PE is an important target to better understand the pathophysiology of this disease. Therefore, we evaluated Sirtuin-1 (SIRT1) concentration in plasma from healthy pregnant (HP) women, gestational hypertensive women (GH), and preeclampsia women (PE) via enzyme-linked immunosorbent assay (ELISA). We also measured intracellular SIRT1 in HUVECs incubated with plasma from PE patients compared to HP and GH via Western Blot Assay. Statistical differences were considered when p < 0.05. SIRT1 was downregulated in PE compared to HP and GH, both in plasma and in in vitro assay. Similarly, SIRT1 was also reduced in pregnant women who subsequently developed PE (case) compared to women who had healthy pregnancies (control). This reduction may be indicative of possible underlying pathophysiology mechanisms in PE.

Uric acid levels in gestational hypertensive women predict preeclampsia and outcome of small-for-gestational-age infants

Objective This study aims to ascertain whether serum uric acid is a suitable predictor of preeclampsia and/or the delivery of small-for-gestational-age infants for women with gestational hypertension. Methods 364 singleton pregnant women with initial presentation of gestational hypertension were recruited and followed up until 6 weeks after delivery. Uric acid z score and binary logistic regression analysis were applied to establish the relationship between serum uric acid and the chance of progression to preeclampsia and giving birth to a small-for-gestational-age infant. Furthermore, receiver operating characteristic (ROC) analysis was used to evaluate the prediction value of serum uric acid. Results Uric acid z score and binary logistic regression analysis indicated that elevated serum uric acid increased the chances of gestational hypertension progression to preeclampsia and subsequent delivery of small-for-gestational-age infants. ROC analysis showed that serum uric acid at a cutoff value of 303μmol l-1, moderately predict the development of preeclampsia and the delivery of small-for-gestational age infants. The prediction values of preeclampsia were 90.7% sensitivity, 69.4% specificity, 97.7% negative predictor values and 34.0% positive predictor values, comparatively, the prediction value for small-for-gestational age infant was low. The ROC curve improved with 95.8% sensitivity, 86.7% specificity, 98.1% NPV, and 74.2% PPV in the Chinese Han women with early onset of gestational hypertension thus the diagnosis of gestational hypertension before 34 weeks. Conclusions Elevated serum uric acid in Chinese Han women with gestational hypertension indicated an increased risk of their progression to preeclampsia and the further delivering of small-for-gestational-age infants.

Are Preeclampsia and Adverse Obstetrical Outcomes Predictors of Cardiovascular Disease? A Case-Control Study of Women With Heart Disease.

This study sought to determine whether preeclampsia; gestational diabetes; and adverse obstetrical outcomes such as placental abruption, intrauterine growth restriction, and preterm delivery are independent risk factors for cardiovascular disease later in life. This was a retrospective, age-matched, case-control study that surveyed 244 cases (women with confirmed coronary artery disease) and 246 controls (women who did not have coronary artery disease) on their obstetrical history and outcomes, as well as traditional cardiovascular risk factors. Analyses were performed using SAS software version 9.1.3. (Canadian Task Force Classification II-2). Women with coronary artery disease had significantly higher rates of maternal complications such as gestational hypertension (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.03-10.9), as well as conventional vascular risk factors such as dyslipidemia (OR 5.38; 95% CI 2.70-10.7), hypertension (OR 2.40; 95% CI 1.23-4.70), diabetes (OR 2.32; 95% CI 1.07-5.01), and smoking (current smoker: OR; 4.82 95% CI 1.66-14.00; former smoker: OR 2.86; 95% CI 1.43-5.71). There were more cases with preeclampsia (9.8%, vs. 5.4% in controls); however, the difference was not statistically significant. Among the adverse maternal conditions, there was more gestational hypertension in women with coronary artery disease. In this study, hypertensive disorders of pregnancy were the most important maternal risk factors for cardiovascular disease later in life and should be flagged early for close monitoring and/or intervention.