History Of Gestational Hypertension Research Articles

Major Adverse Cardiovascular Events Following Coronary Artery Stenting by History of Hypertensive Disorder of Pregnancy.

A history of hypertensive disorders of pregnancy is associated with at least twice the risk of incident ischemic heart disease. Whether the long-term outcome following treatment with coronary artery stenting is associated to the history of hypertensive disorders of pregnancy is unknown. We included 8364 women (age ≤65 years) undergoing first coronary artery stenting 2006 to 2022 following their first delivery in 1973 or later, linking nationwide data on percutaneous coronary intervention and delivery history. In total, 1122 women (13.4%) had a history of hypertensive disorders of pregnancy. The main outcome, a major adverse cardiovascular event, was defined as any incident myocardial infarction, ischemic heart disease, cardiac arrest, arrhythmias, angina pectoris, heart failure, cerebral infarction, or sudden death. During a median follow-up time of 5 years, 258 women with a history of hypertensive disorders of pregnancy had a major adverse cardiovascular event, compared with 1465 women without a history of hypertensive disorders of pregnancy (23% versus 20.2%, P=0.028 for log-rank test). Estimates adjusted for patient- and procedural characteristics in proportional hazards regression models suggested that the hazard rate increased only after 4-8 years of follow-up (hazard ratio [HR], 1.36 [95% CI, 1.05-1.78]) and was primarily driven by women with history of gestational hypertension (HR, 2.15 [95% CI, 1.49-3.11]). Women with a history of hypertensive disorders of pregnancy have an increased risk of a major adverse cardiovascular event following coronary artery stenting compared with other parous women. A history of hypertensive disorders of pregnancy warrants further attention in the secondary prevention setting of coronary artery disease.

The impact of gestational diabetes and gestational hypertension on future cardiovascular events: A nationwide cross-sectional cohort study

ObjectivesCardiovascular disease is the leading cause of female death worldwide. The link between future cardiovascular events and a history of hypertensive disease in pregnancy or gestational diabetes (GDM) has been well established. Less well understood is the impact on future cardiovascular risk when gestational hypertension (GH) and GDM have occurred together. We assessed the association of GDM and GH with future cardiovascular events both alone and in combination. Study designAll female patients discharged from French hospitals in 2013 with 5 years of subsequent and complete follow-up were identified. They were grouped depending on their history of GDM, history of GH, history of both or history of neither. After propensity score matching, patients with GDM and/or GH were matched 1:1 with patients with no GDM or GH. Hazard ratios (HR) for cardiovascular events during follow-up were adjusted by age at baseline. ResultsWomen with a history of GH had an increased risk of cardiovascular death (HR 5.46, 95 % confidence interval [CI] 1.93–15.49). Women with a history of GDM had no significant difference in the risk of cardiovascular events such as myocardial infarction (HR 0.88, 95 %CI 0.38–2.03) and cardiovascular death (HR 1.25, 95 %CI 0.47–3.36) during the 5 year follow up. Those with a history of both GDM and GH had a significantly increased risk of myocardial infarction (HR 23.33, 95 %CI 4.84–112.39). ConclusionWomen with a history of both GH and GDM are at a 23-fold increased risk of myocardial infarction within the first 5 years of their postnatal lives.

Can heart failure phenotypes be predicted by cardiac remodelling peripartum or postpartum?

Hypertension during pregnancy affects up to 10% of pregnancies and is associated with significant cardiovascular morbidity and mortality. In the short-term it can result in pre-eclampsia, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, or even hypertension associated acute heart failure, all of which may necessitate pre-term delivery to prevent maternal or neonatal death. In the long term, a history of gestational hypertension and pre-eclampsia significantly increases the risk of future cardiovascular disease including chronic hypertension, coronary artery disease, heart failure and stroke. This review explores our current level of knowledge of the phenotypes of heart failure, paying particular attention to those specific to women, and the role of pregnancy and non-pregnancy related risk factors in the development of this condition. We discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction (HFpEF) and whether a unique phenotype of heart failure unique to hypertensive pregnancy exists. Finally, we explore how future cardiovascular risk may be predicted based on cardiac remodelling during or after pregnancy and suggest potential areas of further research in the field.

CASE OF MANAGING POSTPARTUM HYPERTENSION IN BREASTFEEDING WOMEN IN PRIMARY CARE

Postpartum hypertension requires careful management, particularly in breastfeeding women, to prevent complications like eclampsia and future cardiovascular issues. This case involves a 40-year-old Southeast Asian woman, G3P3, who presented at a primary care clinic for a 6-week postnatal check-up. The patient, with a history of gestational hypertension, managed with labetalol during pregnancy, reported elevated blood pressure (average 140/90 mmHg) while breastfeeding. Postpartum management initially included nifedipine, which was tapered due to concerns about drug transfer into breast milk. Her blood pressure was 145/95 mmHg at the clinic without significant symptoms. Guidelines suggest that beta blockers like labetalol, propranolol, metoprolol, and calcium channel blockers like nifedipine and verapamil have minimal transfer into breast milk and are generally safe. Caution is advised with atenolol and acebutolol due to higher transfer levels. ACE inhibitors like enalapril are considered safe but require monitoring of infant hemodynamics. High-dose diuretics may reduce milk production and are typically avoided. In managing postpartum hypertension in breastfeeding women, it is crucial to balance maternal health needs with infant safety. The use of antihypertensive agents with the lowest transfer into breast milk is recommended. International guidelines suggest a multidisciplinary approach involving pediatricians to monitor and ensure the well-being of both mother and infant. Individualized care and adherence to current guidelines are essential in these cases.

DEVELOPMENT AND INTERNAL VALIDATION OF A PREDICTION MODEL TO PREDICT THE PROBABILITY OF FUTURE RECURRENCE OF HYPERTENSION IN PATIENTS WITH HYPERTENSIVE DISORDERS OF PREGNANCY

Objective: This study aimed to obtain a clinical prediction model for the future recurrence of hypertension in women with a history of gestational hypertension or Preeclampsia-Eclampsia by analyzing the basic data and laboratory indicators in their pregnancy. Design and method: We retrieved hypertensive disorders of pregnancy (HDP) patients of the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University from 2001 to June 2021. After telephone follow-up, a total of 605 pregnant women with previous HDP were followed up. The baseline data of the cases were followed by binary logistic regression analysis according to the follow-up hypertension outcome, Nomogram plotted according to independent risk factors, and the model discrimination was tested by operating characteristic curve (ROC), The reproducibility of the model was verified by internal validation on the development dataset (Bootstrap self-sampling method, internal cross-validation and Jackknife validation), verify the calibration of the model through the calibration curve (Hosmer-Lemeshow goodness of fit test), and Validation of clinical predictive value by Decision Curve Analysis (DCA). Results: data analysis showed that A total of 200 (33.06%) pregnant women with a previous history of HDP had recurrent hypertension during follow-up (median follow-up time was 5 years). The predictors in the Nomogram were the highest diastolic blood pressure (DBP) during pregnancy, the highest systolic blood pressure (DBP) during pregnancy, peak Alkaline phosphatase value, age at delivery, peak uric acid value, and positive urine protein, Contrary to the remaining 5 predictors, a low level of peak alkaline phosphatase value predicted a high risk of postpartum hypertension. the Area Under Curve (AUC) of ROC about the nomogram was 0.797, and a similar C-index was obtained in the internal validation, and this model show a high fitting degree in the calibration curve and show clinical predictive value. Conclusions: The results of this study can provide predictive indicators for women with HDP to suffer from hypertension after delivery, which can be used for clinical decision-making, and aid with follow-up blood pressure monitoring and the selection of primary prevention treatment groups.

Hypertensive disorders of pregnancy and midlife maternal cognition in a prospective cohort study.

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disorders, with recent evidence linking pre-eclampsia with vascular dementia. We examined associations of HDP with cognitive performance measured in midlife, in a prospective cohort study, the Avon Longitudinal Study of Parents and Children. Six cognitive function domains were measured 20 years after pregnancy at a mean age of 51 years. The cognition tests were repeated at clinics in the following two years. Cognitive function domains measured were immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence, and verbal fluency. Exposures were pre-eclampsia, gestational hypertension (GH), and a combined category of any HDP, all compared to normotensive pregnancy. Of 3393 pregnancies included in the analysis, GH was experienced by 417 (12.3%) and pre-eclampsia by 57 (1.7%). GH was associated with lower verbal episodic memory, in the delayed logic memory test (-0.16 SDs; 95% CI -0.30, -0.03; p=.015) and there was weak evidence of an association with the immediate logic memory test (-0.13 SDs; -0.27, 0.001; p=.058). However, we did not see steeper declines by age for women with GH and there was no evidence of associations with other cognitive domains or for pre-eclampsia with any domains. Results were not substantially changed after controlling for midlife blood pressure. Our findings suggest that a history of GH is associated with slightly reduced episodic memory 20 years after pregnancy, but we found no evidence of a quicker age-related decline compared to women with normotensive pregnancies.

Luteal phase support of intramuscular progesterone associated with lower hypertensive disorders of pregnancy as compared to vaginal progesterone: A cohort study.

To compare the hypertensive disorders of pregnancy (HDP) risk between vaginal and intramuscular (IM) progesterone in programmed frozen-thawed embryo transfer (FET) cycles. This was a retrospective cohort study at a tertiary hospital, and only women who achieved ongoing pregnancy after programmed FET between January 2018 and June 2022 were included. Women with chronic hypertension before pregnancy or with history of gestational hypertension or pre-eclampsia in previous pregnancies were excluded. All women were divided into IM progesterone or vaginal progesterone groups according to the route of progesterone supplementation. Follow-up information on obstetric complications and neonatal outcomes were obtained by telephonic interviews. The primary outcome was HDP. Association between routes of progesterone supplementation and HDP was assessed by subgroup analysis and multivariable logistic regression. A total of 5891 programmed FET cycles (3196 IM progesterone cycles and 2695 vaginal progesterone cycles) were included in the analysis. The prevalence of HDP in the IM progesterone group was significantly lower than that of the vaginal progesterone group (6.54% vs 9.17%, P < 0.001). Therein, the prevalence of gestational hypertension (3.57% vs 4.94%, P = 0.009) and pre-eclampsia (2.97% vs 4.23%, P = 0.009) in the IM progesterone group were all significantly lower as compared to the vaginal progesterone group. According to subgroup analysis, IM progesterone was associated with lower HDP risk in all subgroups. The logistic regression analysis showed that the IM progesterone cycles were associated with lower risk of HDP compared to vaginal progesterone cycles (adjusted odds ratio 0.66, 95% CI: 0.54-0.80, P < 0.001). Among women undergoing programmed FET cycles, progesterone supplementation with IM progesterone was associated with reduced HDP risk compared to vaginal progesterone.

The Relationship between Prenatal Risk Factors and The Incident of Sensorineural Deafness in Children at Polyclinic ENT- Head and Neck Zainoel Abidin Hospital Banda Aceh *,

Background: Sensorineural deafness is one of congenital disorders that caused by prenatal, natal, and postnatal factors. Sensorineural deafness is a public health problem in the world due to its high prevalence and highly negative impact on child development. Objective: To determine the relation between prenatal risk factors (family history of hearing loss, ototoxic drugs consumption, history of infection, history of Diabetes Mellitus, history of gestational hypertension) with sensorineural hearing loss in children at ENT- Head and Neck Polyclinic Dr. Zainoel Abidin Hospital. Methods: This study was analytic retrospective with cross sectional design. The sampling technique used was simple random sampling. The total samples are 47 children at the ENT-Head and Neck Polyclinic of RSUDZA who has been examined with OAE, BERA and ASSR from January 2020 to December 2021 and diagnosed with sensorineural hearing loss. Data were analyzed using SPSS which bivariate analysis using Chi- square and Fisher’s exact. Results: 47 children who had been diagnosed with sensorineural hearing loss included in the inclusion criteria. The mean age of children in this study was 3.44 years with male predominance of 55.3%. The most severe degree of hearing loss was found with the percentage of weight (93.6%) in right ear and (89.4%) in left ear. A history of maternal infection during pregnancy was the most common risk factor found in this study with profound hearing loss in both ears with p value = 0.05. Conclusion: No relation between prenatal risk factors and sensorineural hearing loss in children.

GESTATIONAL HYPERTENSION AND PERIPARTUM CARDIOMYOPATHY: EPIDEMIOLOGICAL, CLINICAL AND EVOLUTIONARY PROFILE IN THE REFERENCE HOSPITALS OF YAOUNDE

Objective: peripartum objective (CMPP) is a primary dilated cardiomyopathy responsible for congestive heart failure that occurs during the last two months of pregnancy or during the first five months of postpartum. However, little is known about the data in Cameroon, justifying our descriptive study. Our main objective was therefore to describe the epidemiological, clinical and progressive symptoms of women with peripartum cardiomyopathy and the influence of gestational hypertension. Design and method: We conducted a prospective descriptive study over a six-month period. It was conducted in six referral hospitals in Yaoundé. The study population consisted of pregnant women with dyspnoea and women who had given birth with dyspnoea. All pregnant or postpartum women (from month 32 GA to month 5 postpartum) who had LVEF &lt;45% and/or FS &lt;30% with or without left ventricle dilatation were included. They were placed on treatment with a follow-up over 3 months, where they had a second cardiac ultrasound to highlight the evolutionary profile. Results: We recruited 10 patients from 26 women. The mean age was 25.9 years ± 4.9 years. The average parity was 1.6 ± 1.17 (extreme 0-3). Multiparas were the most represented. History of gestational hypertension was the main predisposing factor (50%); followed by multiparity (30%), twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. The echocardiographic regimen described hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with mean systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary oedema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and death (10%). Treatment is mainly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of patients) without forgetting anticoagulation performed with Rivaroxaban (n = 4) for some and aspirin (n = 6); and bromocriptine (initiated in 3 patients). Conclusions: MPPC is a serious disease because of its (significant morbidity and mortality rate) and its complications, both hemodynamic and thromboembolic.

Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography

Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown. To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening. Cross-sectional study of a population-based cohort of women in Sweden (n = 10 528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected. Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures. Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100. A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk. Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.

PS-C30-13: GESTATIONAL HYPERTENSION AND PERIPARTUM CARDIOMYOPATHY: EPIDEMIOLOGICAL, CLINICAL AND EVOLUTIONARY PROFILE IN THE REFERENCE HOSPITALS OF YAOUNDE

Background: Peripartum cardiomyopathy (PPCM) is a primary dilated cardiomyopathy responsible for congestive heart failure that occurs in the last two months of pregnancy or during the first five months of postpartum. It is a rare pathology with unknown etiologies. Nevertheless, several etiopathogenic factors such as an history of gestational hypertension, black race, multiparity and poverty have been incriminated. However, the epidemiological and clinical data on peripartum cardiomyopathy are little known in Cameroon, thus justifying our descriptive study. Methodology: We carried out a prospective descriptive study over a period of six months. It was conducted in six reference hospitals in Yaounde. The study population was made of pregnant women with dyspnoea and women who had given birth with dyspnoea. Were included all pregnant or postpartum women (from the 32nd WA to the 5th months of postpartum) who had a LVEF &lt; 45% and/or a SF &lt; 30% associated or not with left ventricle dilation. They were placed on treatment with a follow-up over 3 months, where they had a second cardiac ultrasound to highlight the evolutionary profile. Results: We enrolled 10 patients from 26 women who were pregnant or had given birth and presented with dyspnoea within 6 months. The average age was 25.9 ± 4.9 years (range: 16–33 years). The average parity was 1.6 ± 1.17 (extreme 0–3). Multiparas were the most represented. The history of gestational hypertension was the main predisposing factor found (50%); followed by multiparity (30%), the notion of twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. Sinus tachycardia was constant; followed by signs of left ventricular hypertrophy and repolarization disorders on ECG assessment. The echocardiographic pattern depicted a hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with an average systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary edema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and one death (10%). The treatment mostly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of the patients) without forgetting the anticoagulation made with Rivaroxaban(n = 4) for some and aspirin (n = 6); and bromocriptine (initiated in 3 patients). Conclusion: PPCM is a cause of heart failure during pregnancy. It primarily arises during the postpartum period regardless of maternal age. It is a serious disease due to its (important morbi-mortality rate) and its complications, both hemodynamic and thromboembolic.\

What subtypes are driving the association between hypertensive disorders of pregnancy and dementia? Findings from an 80‐year retrospective cohort study

AbstractBackgroundWe recently found that women with, versus without, a history of HDP had a higher hazard of all‐cause dementia, vascular dementia (VaD), and other/unspecified dementia, but not Alzheimer’s disease (AD). Here, we assess associations of HDP subtypes with later life dementias.MethodsWe performed a retrospective cohort study among women with at least 1 singleton pregnancy (1939–2019) in Utah. Classification of HDP was done via birth certificates (text string, 1939–1977; ICD9 codes, 1978–1988; and check boxes with additional text, 1989–2013) with death certificates and inpatient records used for validation. Classification of dementia was assessed using ICD 9/10 codes via death, inpatient, and Medicare records. HDP exposed women (n=19,989) were one‐to‐two matched with unexposed women (n=39,679) by 5‐year age groups, year of childbirth, and parity at the time of pregnancy (Figure 1). Cox regression models were used to estimate adjusted Hazard Ratios (aHR) and 95% CI for HDP subtypes with all‐cause and specific dementias.ResultsHDP pregnancies were comprised of preeclampsia/eclampsia (65.9%) and gestational hypertension (33.5%). The remaining HDP cases were due to HELLP syndrome (0.6%), which we did not evaluate here due to small case count. Incidence of dementia over follow‐up (1979–2019) was 4.1%; of these, 70% were other/unspecified, 24% were AD, and 6% were VaD. Women with a history of preeclampsia/eclampsia, compared to unexposed, had a 1.38 higher hazard of all‐cause dementia, while women with gestational hypertension had a 1.36 higher hazard (Table 1). Breaking down by dementia subtypes, women with a history of preeclampsia/eclampsia had a 1.51 higher hazard of other/unspecified dementia, while women with gestational hypertension had a 1.31 higher hazard. The strength of association of gestational hypertension with VaD was 2.75, nearly double that for preeclampsia/eclampsia, which was 1.58. HDP subtypes were not associated with AD.ConclusionOur results are in line with the largest study to date conducted in Denmark that found preeclampsia to be most strongly associated with VaD compared to other dementia subtypes. Our results further suggest that risk of VaD may be just as high for women with a history of gestational hypertension as for preeclampsia.

Prevalence of a History of Metabolic or Hypertensive Pregnancy Disorder in Patients With Myocardial Infarction and Non-obstructive Coronary Arteries: An Observational Cohort Study.

IntroductionMyocardial infarction with non-obstructive coronary arteries (MINOCA) predominantly affects younger females. Women with a history of gestational hypertension (GH), preeclampsia (PE), and gestational diabetes mellitus (GDM) are subjected to an elevated lifetime risk of cardiovascular disease. However, data on the potential association between these obstetric complications and MINOCA is lacking. Therefore, the current study aimed to provide insight in the prevalence of metabolic and hypertensive pregnancy disorders (MHPD) in MINOCA patients and their clinical characteristics.MethodsIn this observational cohort study conducted at the Zuyderland Medical Center and Maastricht University Medical Center in the Netherlands, patients were enrolled if they were identified as having MINOCA. Data on individual patient characteristics, laboratory results, electrocardiography as well as (non-)invasive imaging procedures were derived from the electronic health record system. Patients were asked to complete a questionnaire about prior MHPD including GDM, GH, and PE. Patients were grouped into those with MHPD and those with prior uncomplicated normotensive pregnancy (or pregnancies; NP).ResultsAfter excluding patients without 1-year follow-up (n = 53), 86 female MINOCA patients remained eligible for analysis. Of the total female population, 25 (29.1%) patients had MHPD, including GH (n = 19; 22.1%), PE (n = 4; 4.7%), and GDM (n = 7; 8.1%). The MHPD patients showed higher rates of chronic hypertension (84.0 vs. 55.7%; p = 0.013), hypercholesterolemia (64.0 vs. 34.4%; p = 0.012), a family history of CVD (84.0 vs. 45.9%; p = 0.001), gout or rheumatic arthritis (16.0 vs. 1.6%; p = 0.024), and were more often non-smokers (45.8 vs. 78.3%; p = 0.004), compared to the NP patients. Moreover, MHPD patients were more likely to use cardiovascular medications at baseline. A trend toward no specific cause found for the MINOCA event was observed in MHPD patients compared to the NP group (64.0 vs. 42.6%, p = 0.072).ConclusionA history of metabolic and hypertensive pregnancy disorders occurred in one-third of female MINOCA patients. In these patients, conventional cardiovascular risk factors were more prevalent compared to NP patients. In most MHPD patients, the specific cause for MINOCA remained unclear.

Monocytes are increased in pregnancy after gestational hypertensive disease

Monocytes derive from bone marrow and circulate in the blood. They phagocytose, produce cytokines and present antigens. Individual monocyte subsets play distinct roles in the pathogenesis of cardiovascular disease, but their implications in gestational hypertensive disease are unclear. Our objective was to examine the difference in monocyte subsets between pregnant women with or without previous hypertension in pregnancy. Women were enrolled in a prospective observational study in which monoclonal antibodies against cell surface receptors were used to detect monocytes in the peripheral blood by flow cytometry. We compared 17 pregnant women with previous hypertension in pregnancy (Group 1) and 42 pregnant women without previous gestational hypertensive disease (Group 2) with 27 healthy, non-pregnant controls (Group 3). The pregnant women were studied at 13 ± 1 weeks gestation. Monocyte subsets were quantified by flow cytometry: Mon1 (CD14++CD16-CCR2+), Mon2 (CD14++CD16+CCR2+), Mon3 (CD14+CD16+CCR2-), their aggregates with platelets and expression of the surface markers. The groups were well-matched for age, body mass index and ethnicity (P > 0.05 for all). Mon1 counts were higher in women with a history of gestational hypertension or preeclampsia compared to other groups (Group 1 = 441 per µl (376–512); Group 2 = 357 (309–457); Group 3 = 323 (277–397); P < 0.001). Mon3 was higher in both groups of pregnant women compared to non-pregnant controls (Group 1 = 51 (38–62); Group 2 = 38 (29–58); Group 3 = 26 (20–40), P = 0.002). Increased monocytes in women with a previous hypertensive pregnancy generates a hypothesis that these cells may link hypertension in pregnancy, chronic inflammation and future cardiovascular risk.

Pre-eclampsia with paradoxical polyuria: diabetes insipidus in pregnancy

A 31-year-old woman reporting a headache and epigastric pain for the past 12 h attended our unit. She had a history of gestational hypertension and 5 days earlier had a caesarean section at term; there had been no post-partum haemorrhage and she had been allowed home. The patient's haemoglobin concentration had been 11·7 g/dL (normal >10 post partum), and the serum creatinine concentration 48 μmol/L (normal <90); she was normotensive and on no medication.

Determinants for Perinatal Mortality in South China: A Prospective Cohort Study.

ObjectiveTo estimate the association of selected maternal and fetal characteristics with the risk of perinatal mortality in South China.MethodsA prospective cohort study was conducted from March 2013 to December 2019. The exposures of interest were maternal sociodemographic characteristics, lifestyle and habits during early pregnancy, and complications of pregnancy. Their effects on the development of perinatal death were analyzed in our study.ResultsA total of 44,048 eligible pregnant women were included in the analysis. Of these, 596 fetuses were perinatal deaths (perinatal mortality was 13.5 per 1,000 births). After adjustment, maternal obesity, being employed, history of gestational hypertension, taking antidepressants during early pregnancy, history of gestational diabetes mellitus, gestational diabetes mellitus, infertility drug treatment and assisted reproductive techniques, history of neonatal death, preterm birth, and congenital malformations all significantly increased the risk of perinatal death. Ethnic minority, income > 5,000, multiparous women, and cesarean section associated with reduced risk of perinatal death.ConclusionSome factors of maternal sociodemographic characteristics, abnormal pregnancy history, lifestyle and habits during early pregnancy, and complications of pregnancy were associated with the risk of perinatal death.

Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes

BackgroundHypertensive disorders of pregnancy are common pregnancy complications that are associated with greater cardiovascular disease risk for mothers. However, risk of cardiovascular disease subtypes associated with gestational hypertension or pre-eclampsia is unclear. The present study aims to compare the risk of cardiovascular disease outcomes for women with and without a history of gestational hypertension and pre-eclampsia using national hospital admissions data.MethodsThis was a retrospective cohort study of national medical records from all National Health Service hospitals in England. Women who had one or more singleton live births in England between 1997 and 2015 were included in the analysis. Risk of total cardiovascular disease and 19 pre-specified cardiovascular disease subtypes, including stroke, coronary heart disease, cardiomyopathy and peripheral arterial disease, was calculated separately for women with a history of gestational hypertension and pre-eclampsia compared to normotensive pregnancies.ResultsAmongst 2,359,386 first live births, there were 85,277 and 74,542 hospital admissions with a diagnosis of gestational hypertension and pre-eclampsia, respectively. During 18 years (16,309,386 person-years) of follow-up, the number and incidence of total CVD for normotensive women, women with prior gestational hypertension and women with prior pre-eclampsia were n = 8668, 57.1 (95% CI: 55.9–58.3) per 100,000 person-years; n = 521, 85.8 (78.6–93.5) per 100,000 person-years; and n = 518, 99.3 (90.9–108.2) per 100,000 person-years, respectively. Adjusted HRs (aHR) for total CVD were aHR (95% CI) = 1.45 (1.33–1.59) for women with prior gestational hypertension and aHR = 1.62 (1.48–1.78) for women with prior pre-eclampsia.Gestational hypertension was strongly associated with dilated cardiomyopathy, aHR = 2.85 (1.67–4.86), and unstable angina, aHR = 1.92 (1.33–2.77). Pre-eclampsia was strongly associated with hypertrophic cardiomyopathy, aHR = 3.27 (1.49–7.19), and acute myocardial infarction, aHR = 2.46 (1.72–3.53). Associations were broadly homogenous across cardiovascular disease subtypes and increased with a greater number of affected pregnancies.ConclusionsWomen with either previous gestational hypertension or pre-eclampsia are at greater risk of a range of cardiovascular outcomes. These women may benefit from clinical risk assessment or early interventions to mitigate their greater risk of various cardiovascular outcomes.

Abstract 10682: Peripartum Myocardial Strain Analysis: A Marker for Adverse Cardiovascular Outcomes?

Introduction: Hypertensive disorders of pregnancy (HDP) contribute significantly to adverse cardiovascular (CV) outcomes in peripartum women, and echocardiography helps stratify risk and guide management. Global longitudinal strain (GLS), a marker of left ventricular (LV) systolic function, has not been well-characterized in peripartum women with or without HDP. Hypothesis: We hypothesized that GLS is abnormal in women with prior HDP and may predict adverse CV outcomes. Methods: We retrospectively analyzed 141 women with echocardiograms performed during the peripartum period (6 weeks antepartum to 8 weeks postpartum). We investigated relationships between adverse CV outcomes and clinical and echocardiographic variables, including peak systolic GLS. Prior HDP was defined as a preceding diagnosis of gestational hypertension (HTN), chronic HTN or preeclampsia. Results: Women with prior HDP (72/141, 51%) were older (35 vs 32 years), more often obese (61% vs 34%) and had higher mean arterial pressure (96 vs 82 mmHg) compared to those without prior HDP (p&lt;0.01 for all). Women with prior HDP had greater LV thickness (1.0 vs 0.9 cm) and more frequently abnormal inferior vena cava (IVC) size and collapsibility (p&lt;0.01 for all), although median LV ejection fraction (64% vs 65%) and GLS (-19.6 vs -20.2) were similar. During follow-up of 2.5 years, women with prior HDP had more CV-related emergency department (ED) visits (36% vs 16%, p&lt;0.01) and hospitalizations (32% vs 12%, p&lt;0.01). Using multivariable modeling, left atrial area (LAA) and IVC size better predicted CV-related ED visits and hospitalizations when compared to age, obesity and history of gestational HTN ( Figure ). Conclusions: Although GLS did not predict CV outcomes, abnormal LAA and IVC suggest elevated left and right atrial pressure is related to HDP and CV outcomes. Further study of LV diastolic or right ventricular dysfunction may elucidate mechanisms contributing to adverse outcomes in this population.

Gestational hypertension and progression towards preeclampsia in Northern Ethiopia: prospective cohort study

BackgroundPreeclampsia (PE) is one of the main causes of medical complication of pregnancy and is the main cause of perinatal mortality and morbidity. It is one of the top causes of maternal mortality in Ethiopia. Also known as transient hypertension, gestational hypertension (GH) is increased blood pressure during pregnancy without proteinuria, which is expected to return to normal by the 12th-week postpartum visit. PE is GH with proteinuria and /or other systemic manifestations. Evidence from high income countries show that GH significantly progresses towards PE. To our knowledge, this is the first study on the progression of GH towards PE in an African setting. The objective of this study is, therefore, to assess the incidence of GH, progression towards PE and factors associated with progression in Ethiopia.MethodsThis is a prospective cohort study conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), the largest referral centers in Northern Ethiopia. Two hundred and forty women with GH were enrolled and followed up until delivery. Clinical and laboratory data at initial presentation and at follow-up were compared among women who progressed towards PE and who remained with the diagnosis of GH. Logistic regression analysis was employed to model the combined effects of the clinical and laboratory data as significant predictors of progression from GH to PE.ResultThe incidence of GH in this study was 6 % (4.9–8.5). The rate of progression was 17.1 % (13.4–23.8). Previous history of GH, anemia during pregnancy, previous second-trimester spontaneous abortion were significant predictors of progression.ConclusionsThere is a high rate of progression of GH towards PE. In a resource-limited setting where predictive and diagnostic tools are scarce, clinical profile of women should be taken into consideration for prediction and diagnosis of PE.

731 Risk factors for re-admission for postpartum hypertension

Identifying risks factors for postpartum hypertension (HTN) may lead to earlier diagnosis of the disease and improved maternal outcomes. We aimed to establish risk factors that predispose patients to readmission for postpartum HTN (regardless of their personal history of hypertension). This is a retrospective cohort study which included all deliveries at a single institution between January 1, 2012 – December 31, 2018. Case subjects included women readmitted for preeclampsia within 30 days of hospital discharge following delivery. Demographic and obstetric data were collected on all patients via data extraction and chart review. Two control groups were used for comparison: women not readmitted following delivery, and women readmitted for non-hypertensive diagnoses within 30 days of discharge following delivery. Univariable analysis were used to identify unique risk factors specific for postpartum readmission for preeclampsia. There were 46,494 women that delivered within the study window. 147 women were readmitted for postpartum HTN. 274 women were readmitted for a reason other than HTN. On univariable analysis, postpartum readmission for hypertension was significantly associated with maternal age ≥35 years (p=<0.001), black race (p=<0.001), history of gestational hypertension (p=<0.001), history of chronic hypertension (p=<0.0001), aspirin use in pregnancy (p=<0.001) and need for antihypertensive medications upon discharge (p = <0.001) compared to patients not readmitted. These same factors were also significant when the readmission for HTN group was compared to the patients admitted for another reason. Older age, black race, history of gestational hypertension and chronic hypertension, aspirin use in pregnancy, and need for antihypertensive medications upon discharge are uniquely associated with postpartum readmission for preeclampsia. Closer postpartum follow up and observation may be warranted in these patients.