Higher Rates Of Preeclampsia Research Articles

Early diabetes treatment is associated with improved outcomes in pregnant women with a first antenatal HbA1c of 41-46mmol/mol.

It is unclear whether early treatment of women with a first antenatal HbA1c of 41-46mmol/mol improves pregnancy outcomes. Our Hospital Guideline (HG) recommends early treatment, but the New Zealand GDM Guideline (NG) recommends lifestyle advice and a 75g OGTT at 24-28weeks' gestation. The aim of this study was to compare, at a single centre, pregnancy outcomes in women who were treated before 24weeks (HG group) with women who were managed according to the NG. Our hypothesis was that earlier treatment was associated with lower rates of pre-eclampsia and preterm birth. Women who had a first antenatal HbA1c of 41-46mmol/mol between January 2016 and December 2019 and delivered at our institution before August 2020 were included. Baseline characteristics, management of GDM and pregnancy outcomes were collected. Univariable and multivariable analyses were performed. There were 141 women in the HG group and 67 women in the NG group. The NG group had fewer Indian/Chinese/Other Asian women (P=0.004) and BMI was higher (P=0.05). Women in the NG group, compared with the HG group, had more infants with a customised birthweight >90th centile (19.4% vs 7.8%, P=0.014). In addition, after adjusting for ethnicity and BMI, women in the NG group had higher rates of pre-eclampsia (ORa (95th CI), 3.7 (1.1-13.3), P=0.04) and preterm birth (2.8 (1.1-7.0), P=0.03). Management according to our Hospital Guideline, compared with the National GDM Guideline, was associated with lower rates of pre-eclampsia, preterm birth and infants with a customised birthweight >90th centile.

Aspirin in the prevention of preeclampsia: A protocol for systematic review and meta analysis.

Introduction:Aspirin is widely used to prevent pregnancy related vascular disorders such as preeclampsia (PE), intrauterine growth restriction and maternal disorders. However, the indications for the use of aspirin during pregnancy is currently controversial because the dosage of aspirin used and the sample sizes in various studies differ considerably. Furthermore, women of African ancestry are more likely to have higher rates of PE and more severe cases than those of their Caucasian counterparts. Yet, there are very few studies in this population group. Therefore, the aim of this review will be to determine the effect of low-dose aspirin (LDA) for prevention of PE in women of African ancestry.Methods and Analysis:This is a protocol for a systematic review and meta-analysis of published studies on the effect of LDA for prevention of PE. Relevant information will be accessed from the following databases; PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, Google, EBSCO Host, and the Web of Science. The studies will be mapped in 2 stages: stage 1 will map studies descriptively by focus and method; stage 2 will involve additional inclusion criteria, quality assessment and data extraction undertaken by 2 reviewers in parallel. Evidence will be synthesized using relevant systematic research tools. Meta-analysis and subgroup analysis will be conducted using RevMan whilst Stata 13 will be used for meta-regressions. We will follow recommendations described in the preferred reporting items for systematic reviews and meta-analyses statement and the Cochrane Handbook for Intervention Reviews.Discussion:The use of LDA as a prophylactic treatment has been considered for the prevention of PE. However, studies evaluating the use of LDA in women of African ancestry are few. Therefore, with the increase in the prevalence of PE in the African population, it is critical to further investigate the use of LDA in pregnant women of African ancestry.Ethics and dissemination:The review and meta-analysis will not require ethical approval and the findings will be published in peer-reviewed journals and presented at local and international conferences. The findings of this review will inform all stakeholders on current and future guidelines on the use of aspirin in pregnancy, especially in populations of African ancestry.Systematic review registration:International prospective Register of Systematic Reviews (PROSERO) number: (CRD42020213213).

Outcomes of pregnancy and delivery following in vitro fertilization

Outcomes of pregnancy and delivery following in vitro fertilization Vytautas Abraitis1, Saulė Kržčonavičiūtė2, Marija Vaitkevičiūtė2 1Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Eivenių g. 2, LT-50161 Kaunas, Lithuania 2Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307 Kaunas, Lithuania Abstract. Background: Researchers discuss the influence of in vitro fertilization (IVF) on outcomes of pregnancy and delivery. The aim of the study was to evaluate the most frequent complications after IVF. Materials and methods: A retrospective analysis was conducted at LSMU Kaunas Clinics. The sample consisted of 69 IVF pregnant women registered in LSMU Kaunas Clinics in 2019-2020. The results were compared to the control group (n=174). Differences were considered significant when p<0.05. Results: The frequency of miscarriage after IVF was 14.5% (4.6% in the control group) (p<0.05). Preterm labor was detected in 20.3% of IVF subjects (14.9% in the control group) (p>0.05). Higher rates of preeclampsia, gestational anaemia and obstetric cholestasis were found in the IVF group (7.2%, 8.7%, 5.8%) (2.9%, 6.9%, 0.57% in the control group) (p>0.05). A difference was found in both Apgar scores – 1st and 5th minute. IVF newborn average scores were 8.77 and 9.33, respectively (8.96 and 9.58 in the control group, respectively). 52.2% of IVF subjects had Caesarean section (CS) (26.4% in the control group) (p<0.05). 75.8% of CSs in the study group were performed on multiparous pregnancies (14.3% in the control group) (p<0.05). Conclusions: Our study revealed an increased risk of miscarriage and premature delivery after IVF. IVF pregnant women are more likely to be diagnosed with preeclampsia, gestational anaemia and obstetric cholestasis. There is a higher probability to have a CS after IVF compared to natural conception. IVF newborns are rated with lower Apgar scores in comparison to those conceived naturally. Keywords: IVF, preganancy, delivery, outcomes.

Intrahepatic cholestasis of pregnancy - prevalence and ethnic distribution in northern Israel.

Intrahepatic cholestasis of pregnancy (ICP) is charachterized by pruritis and elevated serum bile acids (BA) and is associated with adverse obstetrical outcomes. ICP etiology is poorly understood and its incidence varies with ethnicity and geographical distribution. Explore the prevalence and characteristics of ICP in the different Northern Israeli ethnic groups and compare maternal and perinatal outcomes according to disease severity. Single-center retrospective study. Women who were diagnosed with ICP based on clinical presentation and elevated fasting BA (≥ 10 μmol/L) were included. Disease incidence, maternal and neonatal complications were explored according to ethnic subgroups analysis and obstetrical complications were examined according to disease severity. The incidence of ICP in the study population was 0.58%. Higher ICP incidence was found in our cohort compared with other reports arising from Central Israel (p < 0.001). The Christian patients had a higher incidence of ICP (1.1%) and preeclampsia (23.1%). A higher rate of neonatal intensive care unit (NICU) admissions was found in the Arab Muslim and Christian groups compared with the Jewish and Druze groups (p = 0.007). A higher rate of preeclampsia was found in the severe (BA ≥ 40 μmol/L) ICP group (p < 0.001). Patients in the severe ICP group had earlier gestational age at delivery (37 versus 38.14 weeks, p < 0.001). Birth weight was significantly lower in the severe ICP group (p = 0.018). The incidence of ICP at our institution was 0.58%, which is higher compared with previous reported Israeli incidence. Higher ICP and preeclampsia incidence were found among Arab Christian patients.

Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption?

This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140–4.600) and 3.918 (1.517–9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.

Comparison of maternal and neonatal outcomes between acute fatty liver of pregnancy and hemolysis, elevated liver enzymes and low platelets syndrome: a retrospective cohort study

BackgroundAcute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.MethodsThis retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were compared. We analyzed the categorical variables with Chi-square test or Fisher’s exact test and continuous variables with Student’s t test or Mann-Whitney U test. Subsequent logistic regression analyses adjusting by potential confounding factors with significant difference were analyzed.ResultsDuring the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0 % versus 23.8 %) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7 % versus 13.8 %), acute kidney injury (61.9 % versus 15.0 %), disseminated intravascular coagulopathy (66.7 % versus 8.8 %), and sepsis (47.6 % versus 10.0 %) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1 % versus 33.3 %), neonatal respiratory distress syndrome (39.2 % versus 8.3 %) and neonatal sepsis (34.2 % versus 12.5 %) were noted in the HELLP syndrome group.ConclusionsAFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

COVID-19 під час вагітності. Аналітичний огляд

The cause of the current pandemic was the rapid spread of the coronavirus SARS-CoV-2 and the development of respiratory syndrome with significant morbidity and mortality. Pregnant women have the higher risk of morbidity and mortality than non-pregnant women. Pregnancy is the vulnerable condition that may contribute to a higher risk of infection due to the change in physiology during gestation. Physiologic, metabolic, and vascular changes in normal and high-risk pregnancies may affect risks for severe acute respiratory syndrome SARS-CoV-2 infection. The pathogenesis of COVID-19 during pregnancy explains the functioning of the renin-angiotensin-aldosterone system. SARS-CoV-2 uses angiotensin-converting enzyme-2 receptors to enter target cells. Its regulation during pregnancy may increase the risk of respiratory syndrome with COVID-19. The virus, by binding to receptors, causes decreasing its regulation and can lead to increasing angiotensin II, relative to angiotensin 1, 7, which is manifested by vasoconstriction and vascular dysfunction in preeclampsia. Coronavirus disease and preeclampsia have partially the same pathophysiological mechanism, which includes endothelial dysfunction and coagulation disorders. There is systemic inflammation or microcirculation disorders, which is characterized by vasoconstriction and ischemia, hypercoagulation. Thus, abnormalities that are characteristic of COVID-19 infection are similar to those that occur with preeclampsia during pregnancy. In addition, the known pathological mechanism of COVID-19 is an excessive anti-inflammatory response called the cytokine storm. The immune response is sufficiently altered during pregnancy, which can significantly alter the laboratory and clinical manifestations of COVID-19 during pregnancy. Therefore, the combination of these conditions can potentially lead to vascular damage. Currently, there are very limited data on the course, clinic and consequences of infection during pregnancy. This literature review combines various high-level studies that indicate higher rates of preeclampsia and other complications associated with pregnancy and SARS-CoV-2 infection. Studies to date have reported higher risks of pregnancy complications, including preterm birth and preeclampsia, as well as higher rates of cesarean delivery. For the fetus were recorded isolated cases of stillbirth, which was less than &lt;1%. Accordingly, this signals needs to increase attention to the course of infection during pregnancy, and the optimal treatment of COVID-19, as well as prevention strategies during pregnancy. Pharmacologic therapy is limited to medications with proven safety during pregnancy and lactation. No conflict of interest was declared by the authors. Key words: COVID-19, pregnancy, newborns, pregnancy complications.

Should the interval between doses of antenatal corticosteroids be shortened in certain cases? Factors predicting preterm delivery < 48h from presentation.

Treatment with antenatal corticosteroids (ACS) to women at risk for preterm birth (PTB) is associated with a reduction in adverse neonatal outcomes. Obstetricians occasionally shorten the interval between the doses of steroids if delivery is predicted to occur before ACS are fully administered. In this study, we aimed to investigate predicting factors to identify patients that will deliver prematurely, less than 48h from presentation. The computerized medical files of all PTBs (< 34weeks) were reviewed. Maternal demographics, pregnancy and delivery characteristics were compared between PTB that occurred < 48h vs. > 48h from triage presentation. In total, 494 PTB cases were included: 302 women in the study group (PTB < 48h) and 192 women in the control group (PTB > 48h). No significant differences were found in demographic characteristics between the groups. At presentation, the study group had higher rates of uterine contractions (p < 0.001) and cervical length < 25mm (p < 0.001) as well as a higher rate of non-reassuring fetal (NRFHR) monitor (p < 0.001). In contrast, the control group presented with higher rates of preeclampsia (p = 0.003) and preterm premature rupture of membranes (p = 0.038). In multivariable analysis, all of the above factors remained significant after controlling for background confounders. Various factors at presentation can predict delivery < 48h. These factors can be used to predict patients to whom the ACS interval should be shortened. Future prospective studies should investigate the effect of this shortening on neonatal outcomes.

A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established. Aims To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention. Methods All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin &amp;gt; 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant. Results 127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception. Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005). 13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830). Conclusions Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding. Funding Agencies None

476 Should the interval between doses of antenatal corticosteroids be shortened?

Treatment with antenatal corticosteroids (ACS) to women at risk for preterm birth (PTB) is associated with a reduction in adverse neonatal outcomes. Obstetricians occasionally shorten the interval between the doses of steroids if delivery is predicted to occur before ACS are fully administered. In this study we aimed to investigate predicting factors to identify patients that will deliver prematurely, less than 48 hours from presentation. The computerized medical files of all PTBs were reviewed. Maternal demographics, pregnancy and delivery characteristics were compared between PTB that occurred < 48 hours vs. > 48 hours from triage presentation. In total, 494 PTB cases were included: 302 women in the study group (PTB < 48 hours) and 192 women in the control group (PTB > 48 hours). No significant differences were found in demographic characteristics between the groups. At presentation, the study group had higher rates of uterine contractions (p<0.001) and cervical length <25 mm (p<0.001) as well as a higher rate of non-reassuring fetal (NRFHR) monitor (p<0.001). In contrast, the control group presented with higher rates of preeclampsia (p=0.003) and preterm premature rupture of membranes (p=0.038). In multivariable analysis All of the above factors remained significant after controlling for background confounders. Various factors at presentation can predict delivery <48 hours. These factors can be used to predict patients to whom the ACS interval should be shortened. Future prospective studies should investigate the effect of this shortening on neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Diabetic nephropathy in type 1 diabetes and pregnancy. Modern view of the problem

Diabetic nephropathy (DN) is specific kidney damage in patients with diabetes mellitus. DN develops relatively often in pregestational diabetes patients (5,9-26%) and stills one of the main limitations for successful pregnancy in this patients’ group. Advanced DN increases risks of poor pregnancy outcomes for women and fetuses including chronic kidney disease (CKD) progression, high rate of preeclampsia, preterm deliveries, Cesarean sections, perinatal mortality and neonatal morbidity. At the same time there are more and more successful pregnancies with advanced DN in the wold.In our paper we systematize global experience of planning and management pregnancies with type 1 diabetes and DN in different stages of renal impairment. We discuss role of nephroprotective therapy in preconception care, achievement and maintaining blood pressure goals, multidisciplinary team care for improvement pregnancy outcomes in type 1 diabetic women with DN.

Gestational Outcomes of Pregnant Women with Unilateral Congenital Renal Agenesis

Objective We evaluated if there were more adverse gestational outcomes of pregnant women with unilateral congenital renal agenesis (UCRA). Study design: This single center retrospective case–control study compared maternal complications and neonatal outcomes from 25 women with UCRA to the outcomes of 125 women with two kidneys. Results: UCRA women had lower gestational weeks at birth and higher rates of preterm delivery (p = 0.004 and <0.001; respectively). Mothers had higher rates of preeclampsia and newborns with congenital anomalies and neonatal intensive care unit (NICU) admission (p = 0.009, 0.042, and 0.039; respectively). Unadjusted odds ratios were significantly higher for preterm delivery and for any APGAR score of <7 at the first 10 min and preeclampsia [OR (95% CI):13.5 (4.66–39.05), 31 (3.44–279.32) and 5.76 (1.33–24.84), respectively]. Conclusion: Maternal UCRA is a risk factor for less optimal obstetric and neonatal outcomes.

Prevalence of early-onset GDM and associated risk factors in a university hospital in Thailand

This retrospective cohort study aimed to determine prevalence of GDM diagnosed before 24 weeks of gestation (early-onset GDM) and evaluate associated risk factors and compare pregnancy outcomes between different GDM status. A total of 1200 pregnant women attending antenatal clinic before 24 weeks of gestation were included. GDM screening was offered during first visit and repeat during 24–28 weeks of gestation, using 50-g GCT and 100-g OGTT. GDM was diagnosed in 110 women (13.9%) and early-onset GDM was found in 57 women (9.2%), which accounted for 65.9% of all GDM. Early-onset GDM had significant lower gestational weight gain and higher rates of preeclampsia, LGA infants, and NICU admission. Independent associated factors for early-onset GDM were age ≥30 years (aOR 4.89, 95%CI: 2.08–11.50, p < .001), and previous GDM (aOR 12.26, 95%CI: 3.86–38.93, p < .001) while DM in family was the only independent factor for late-onset GDM (aOR 2.53, 95%CI: 1.42–4.51, p = .002). IMPACT STATEMENT What is already known on this subject? Reported prevalence of early-onset GDM varies between studies, depending on the screening strategy and criteria used. Despite treatment, early-onset GDM has been associated with increased adverse maternal and neonatal outcomes in many previous studies. The risks associated with early-onset GDM and the evidence for benefit of early treatment are still unclear. What do the results of this study add? The results showed that early-onset GDM accounted for majority (65.9%) of all GDM. Despite treatment, early-onset GDM increased risk of preeclampsia, LGA infants, and NICU admission. Independent associated factors for early-onset GDM were age ≥30 years, and previous GDM while DM in family was the only independent factor for late-onset GDM. What are the implications of these findings for clinical practice and/or further research? Early GDM screening and intensive management, especially in high-risk women, should be implemented to minimise the risks of adverse outcomes. Further studies are needed to determine appropriate criteria to define early-onset GDM and to identify women at higher risk in different population and settings with different screening strategies. Effective management and approaches for this subgroup of GDM should also be further investigated.

ACC-AHA Diagnostic Criteria for Hypertension in Pregnancy Identifies Patients at Intermediate Risk of Adverse Outcomes.

The aim of the study is to compare maternal and neonatal outcomes among patients who are normotensive, hypertensive by Stage I American College of Cardiology-American Heart Association (ACC-AHA) criteria, and hypertensive by American College of Obstetricians and Gynecologists (ACOG) criteria. Secondary analysis of a prospective first trimester cohort study between 2007 and 2010 at three institutions in Baltimore, MD, was conducted. Blood pressure at 11 to 14 weeks' gestation was classified as (1) normotensive (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] <80 mm Hg); (2) hypertensive by Stage I ACC-AHA criteria (SBP 130-139 mm Hg or DBP 80-89 mm Hg); or (3) hypertensive by ACOG criteria (SBP ≥140 mm Hg or DBP ≥90 mm Hg). Primary outcomes included preeclampsia, small for gestational age (SGA) neonate, and preterm birth. Among 3,422 women enrolled, 2,976 with delivery data from singleton pregnancies of nonanomalous fetuses were included. In total, 20.2% met hypertension criteria (Stage I ACC-AHA n = 254, 8.5%; ACOG n = 347, 11.7%). The Stage I ACC-AHA group's risk for developing preeclampsia was threefold higher than the normotensive group (adjusted relative risk [aRR] 3.70, 95% confidence interval [CI] 2.40-5.70). The Stage I ACC-AHA group had lower preeclampsia risk than the ACOG group but the difference was not significant (aRR 0.87, 95% CI 0.55-1.37). The Stage I ACC-AHA group was more likely than the normotensive group to deliver preterm (aRR 1.44, 95% CI 1.02-2.01) and deliver an SGA neonate (aRR 1.51, 95% CI 1.07-2.12). The Stage I ACC-AHA group was less likely to deliver preterm compared with the ACOG group (aRR 0.65, 95% CI 0.45-0.93), but differences in SGA were not significant (aRR 1.31, 95% CI 0.84-2.03). Pregnant patients with Stage I ACC-AHA hypertension in the first trimester had higher rates of preeclampsia, preterm birth, and SGA neonates compared with normotensive women. Adverse maternal and neonatal outcomes were numerically lower in the Stage I ACC-AHA group compared with the ACOG group, but these comparisons only reached statistical significance for preterm birth. Optimal pregnancy management for first trimester Stage I ACC-AHA hypertension requires active study. · Women with first trimester American College of Cardiology-American Heart Association (ACC-AHA) Stage I hypertension were more likely to develop preeclampsia, deliver preterm, and deliver a small-for-gestational age neonate than normotensive women.. · Women with first trimester American College of Obstetricians and Gynecologists (ACOG) hypertension (consistent with stage II ACC-AHA hypertension) had the highest numeric rate of adverse outcomes; however, compared with Stage I ACC-AHA hypertension, there was only statistically significant difference for preterm delivery.. · The risk profile for pregnant women with Stage I ACC-AHA hypertension and women with hypertension by conventional ACOG criteria may be more similar than previously understood..

Influence of Socioeconomic Status on Adverse Outcomes in Pregnancy [15C

INTRODUCTION: Lower socioeconomic status (SES) has been associated with adverse pregnancy outcomes. We determined whether ZIP-code level-based SES indicator was associated with adverse pregnancy outcomes. METHODS: Retrospective study of OHSU births from 2009–2014 compared adverse pregnancy outcomes among women living in 88 Portland metro-area ZIP-codes stratified into 3 median household income groups: Low (below 10th percentile), medium (10th-90th percentile), and high (above 90th percentile) socioeconomic status (SES). Perinatal outcomes were compared by univariate analysis; multivariable logistical regression determined strength of association of low and high SES with adverse outcomes (medium SES=reference group), adjusting for significant variables. RESULTS: Of 8,118 deliveries included, 1,654 (20%) were in low SES, 5,856 (72%) were in medium SES, and 608 (8%) were in high SES. Women in low SES were more likely to be younger, have higher BMI and tobacco use, and have less private insurance. Lower SES was associated with higher rates of preeclampsia (PEC) (9.02% vs 7.48% vs 5.93%, P&lt;.028) and small for gestational age (SGA) (10.7% vs 9.34% v 6.61%, P&lt;.012), and lower birth weights (mean 3,280 g vs 3,340 g vs 3,592 g, P&lt;.001). High SES was associated with lower gestational diabetes mellitus (GDM) rates (10.8% vs 11.0% vs 7.58%, P&lt;.036), even after adjusting for confounders (aRR high SES 0.710, 95% CI 0.507–0.995). CONCLUSION: In the Portland metro-area, low SES is associated with higher rates of PEC and SGA. High SES is associated with lower rates of GDM. ZIP-code level SES indicator detects perinatal outcome differences and may be useful for identifying healthcare disparities.

Clinical Influence of Nonadherence With Prophylactic Aspirin in Preventing Preeclampsia in High-Risk Pregnancies: A Multicenter, Prospective, Observational Cohort Study.

Aspirin nonadherence and its associated increase in cardiovascular and cerebrovascular events is well described; however, the prevalence of aspirin nonadherence among high-risk pregnant women at risk of preeclampsia and its influence on clinical outcomes remains unclear. Our study examined the prevalence of aspirin nonadherence and resistance among high-risk pregnant women quantitatively (platelet function analyzer 100 and plasma salicylic acid) and clinical outcomes relative to adherence. High-risk pregnant women were recruited across 3 centers in the South West Sydney Local Health District. Simultaneous clinic data, blood sample, and self-reported adherence assessment were prospectively collected at 4-week intervals from 12 to 36 weeks of gestation. Nonadherence was defined as normal platelet function analyzer 100 and nondetectable plasma salicylic acid in <90% of time points. Value of <90% is based on current data. Two hundred twenty women were recruited over 25 months. No woman was aspirin resistant, and 63 (44%) women demonstrated inadequate adherence. Women with inadequate adherence had higher incidence of early-onset preeclampsia (17% versus 2%; odds ratio [OR], 1.9 [95% CI, 1.1-8.7]; P=0.04), late-onset preeclampsia (41% versus 5%; OR, 4.2 [95% CI, 1.4-19.8]; P=0.04), intrauterine growth restriction (29% versus 5%; OR, 5.8; [95% CI, 1.2-8.3]; P=0.001), preterm delivery (27% versus 10%; OR, 5.2 [95% CI, 1.5-8.7]; P=0.008), and higher likelihood of increase in antihypertensives antenatally (60% versus 10%; OR, 4.6 [95% CI, 1.2-10.5]; P=0.003). Kaplan-Meier analysis demonstrated lower incidence of premature delivery in the ≥90% adherent group (HR, 0.3 [95% CI, 0.2-0.5]; P<0.001).Kappa coefficient agreement between qualitative and quantitative assessment of adherence was moderate (κ=0.48; SE=0.029; P<0.0001). Our data demonstrates that aspirin is an effective prophylactic agent with an absolute risk reduction of 51% (number needed to treat, 2) when adherence is ≥90%, compared with women with inadequate adherence. Women who were <90% adherent had higher rates of preeclampsia, intrauterine growth restriction, preterm delivery, and increase in antenatal antihypertensive requirements. Self-reported adherence does not accurately reflect actual adherence.

The predictive value of sonographic placental markers for adverse pregnancy outcome in women with chronic kidney disease.

To determine the rate of sonographic placental markers and their predictive value for preeclampsia and fetal growth restriction in women with chronic kidney disease (CKD). A retrospective cohort study of women with CKD followed at a tertiary referral center between 2016 and 2019 (n=86). All women underwent 2nd trimester sonographic placental examinations that included assessment of placental morphology, umbilical cord, and uterine artery Doppler. Continuous placental markers were converted to multiples on medians (MoM). Predictive value of sonographic markers for preeclampsia and birthweight<10th percentile. Women in the cohort had a high rate of preeclampsia (24.4%), birthweight<10th% (26.7%), and preterm birth (30.2%). The most important markers were placental volume and uterine artery Doppler: the risk of preeclampsia was elevated in women with low placental volume (51.7% vs. 10.9%; OR=8.79 [2.70-28.59] for preeclampsia; and 40.0% vs. 9.1%; OR=6.67 [1.85-24.04] for preterm preeclampsia), and in women with bilateral uterine artery notching (62.5% vs. 20.8%; OR=6.35 [1.37-29.45] for preeclampsia; and 62.5% vs. 10.4%; OR=14.38 [1.29-71.75] for preterm preeclampsia). The combination of both markers had the strongest predictive value for preeclampsia (positive likelihood ratio=8.25 [6.84-9.95]). Low placental volume and bilateral uterine notching were also associated with birthweight<10th percentile. A 2nd-trimester sonographic placental study can identify a subgroup of women with CKD who are at most risk of preeclampsia and fetal growth restriction. Such data may inform their subsequent perinatal care and assist care providers in the often challenging distinction between preeclampsia flare of underlying CKD.

Diabetes during pregnancy and perinatal outcomes among First Nations women in Ontario, 2002/03-2014/15: a population-based cohort study.

In Canada, increasing numbers of women, especially First Nations women, are affected by diabetes during pregnancy, which is a major risk factor for adverse maternal and neonatal outcomes. The aim of this study was to examine temporal trends in pregnancy outcomes and use of health care services in a population-based cohort of First Nations women compared to other women in Ontario according to diabetes status during pregnancy. Using health administrative databases, we created annual cohorts of pregnant women from 2002/03 to 2014/15 and identified those with preexisting diabetes and gestational diabetes. We used the Indian Register to identify First Nations women. We estimated rates of adverse maternal and infant outcomes, and measures of use of health care services in each population. There were 1 671 337 deliveries among 1 065 950 women during the study period; of these deliveries, 31 417 (1.9%) were in First Nations women, and 1 639 920 (98.1%) were in other women. First Nations women had a higher prevalence of preexisting diabetes and gestational diabetes than other women in Ontario. First Nations women with preexisting diabetes had higher rates of preeclampsia (3.2%-5.6%), labour induction (33.4%-42.9%) and cesarean delivery (47.8%-53.7%) than other women in Ontario, as did First Nations women with gestational diabetes (3.2%-4.7%, 38.5%-46.9% and 41.4%-43.4%, respectively). The rate of preterm birth was similar between First Nations women and other women in Ontario. Although First Nations women had a higher rate of babies who were large for gestational age than other women, regardless of diabetes status, obstructed labour rates were similar for the 2 cohorts. Almost all First Nations women, regardless of diabetes status, were seen by a primary care provider during their pregnancy, but rates of use of specialty care were lower for First Nations women than for other women. Fifteen percent of all pregnant women with preexisting diabetes visited an ophthalmologist during their pregnancy. Our results confirm disparities in maternal and neonatal outcomes between First Nations women and other women in Ontario. Access to primary care for pregnant women seemed adequate, but access to specialized care, especially for women with preexisting diabetes, needs to improve.

Preeclampsia features in pregnancy with gestational diabetes mellitus

Hypothesis/aims of study. The high prevalence of gestational diabetes mellitus (GDM) and the social importance of preeclampsia (PE) due to massive perinatal morbidity and mortality, as well as the high rate of PE in GDM pregnancy define the need to study the characteristics of pregnancy course in these women to develop the prevention and management of pregnancy complication. This study aimed at evaluating clinical and laboratory features of PE in GDM pregnancy.&#x0D; Study design, materials and methods. According to the inclusion criteria, 112 pregnant women were enrolled in this prospective cohort study after 24 weeks of gestation: with GDM and PE (n = 24), with PE (n = 22); with GDM (n = 37), without studied pregnancy complications (n = 37). We assessed serum levels of placental growth factor (PIGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1). Pregnancy course and labour were evaluated using medical history.&#x0D; Results. Severe PE developed more often (p = 0.0014, Chi-square test) in the PE group (59%, n = 13) compared to the GDM + PE group (13%, n = 3). Elective preterm labour occurred more often in the PE group compared to other study groups (PE: 23%, n = 5; GDM + PE: 9%, n = 2; p 0.0001, Chi-square test with Yates correction), which is in line with the severity of PE in this group. The rate of preterm labour did not differ between the GDM + PE group and the group without studied pregnancy complications. Moreover, the mean fasting glucose level was higher in the GDM group compared to the GDM + PE group (p = 0.01, MannWhitney test). The GDM + PE group was characterized by fasting hyperglycemia episodes and a basal insulin regimen, while the GDM group by postprandial glucose peaks, and a bolus insulin regimen. Women with GDM + PE were notable for the high pre-pregnancy body mass index (29.0 6.58 kg/m2), and a family history of DM was more typical for women with GDM without PE (59%, n = 19). The sFlt-1/PIGF ratio did not differ between the GDM + PE, GDM and control groups and was lower compared to the PE group (p 0.0001, Fishers LSD test). PIGF level was not different in the GDM + PE and GDM groups, but was lower compared to the control group.&#x0D; Conclusion. Our study showed that PE in women with GDM is more benign than in patients without GDM, taking into account both clinical and laboratory signs. At the same time, obesity appears to be one of the most important risk factors for the both pregnancy complications. The data of this study, in addition to those described in the literature, suggest that initial carbohydrate disorders play a disease-limiting, protective role in a vicious cycle of PE due to angiogenesis stimulation. The use of angiogenesis factors as markers of PE in GDM patients is limited, which requires further research.

Association between insulin and post-caesarean resuscitation rates in infants of women with GDM: A retrospective study.

Gestational diabetes mellitus (GDM) and caesarean deliveries independently increase the risk of postoperative complications. There are limited data on the influence of insulin use on the outcomes of neonates who were delivered via caesarean section. We sought to investigate the impact of insulin use in women with GDM on resuscitation rates of infants post caesarean delivery. A retrospective database review of women with singleton term (≥ 37 weeks) pregnancies who were on insulin for GDM delivering between January 2005 and December 2014 at a major metropolitan hospital in Sydney. One thousand eight hundred and fifty-seven women with GDM were identified. The mean age was 31.01 ± 5.63 years and mean gestational period of 39.07 ± 1.00 weeks. 31.0% received insulin treatment for GDM. Women who were on insulin were older (31.9 ± 5.7 vs 30.6 ± 5.6 years, P < 0.001), had a higher body mass index (BMI) (31.2 ± 7.7 vs 29.0 ± 7.4 kg/m2, P < 0.001), higher rates of preeclampsia (7.3% vs 4.1%, P = 0.004), lower rates of alcohol consumption (0.4% vs 1.7%, P = 0.014), and had infants with lower resuscitation rates (21.2% vs 28.6%, P = 0.001). Infants who required resuscitation had a lower gestational age, lower five-minute APGAR score, and lower birth weight, length, and head circumferences. On multivariate analysis, women with GDM treated with insulin (odds ratio [OR] = 0.69, CI = 0.54-0.89, P = 0.004), higher gestational age (OR = 0.88, CI = 0.78-0.99, P = 0.032), higher maternal BMI (OR = 1.02, CI = 1.01-1.04, P = 0.005), and emergency caesarean (OR = 2.33, CI = 1.74-3.12, P < 0.001) independently predicted incidence of resuscitation. The findings suggest a relationship between insulin use and reduced resuscitation rates of infants born from mothers with GDM. Further studies investigating the role, dosage, and criteria for insulin use in women with GDM are required.