History Of Preeclampsia Research Articles

Implementation of aspirin use during pregnancy in community midwifery-led care in the Netherlands: A pilot survey.

Aspirin nowadays is widely used in pregnancy, but implementation among gynecologists took nearly four decades. For a complete insight in the implementation of aspirin, community midwives are to be involved. Community midwives do not have authority to prescribe aspirin and have to refer to a general practitioner or consultant obstetrician for a prescription. The study was an online, national pilot survey about the implementation of aspirin use during pregnancy among independently practicing community midwives consisting of 29 items with five categories: background, advising, prescribing, possible indications, and clinical practice. Forty-seven community midwives completed the survey between April and May 2021. All respondents had experience on advising aspirin use in pregnancy. History of preterm pre-eclampsia or HELLP syndrome was identified as a risk factor for developing utero-placental complications by 97.9% of the community midwives. Moderate risk factors in women with otherwise low-risk pregnancy were identified by >75% of the participants. Practical issues in prescribing aspirin were experienced by one-third of the respondents. Suggestions were made to obtain authority for community midwives to prescribe aspirin and improve collaboration with consultant obstetricians and general practitioners. Community midwives seem to be adequate in identifying risk factors for developing utero-placental complications in women with otherwise low-risk pregnancy. Practical issues for prescribing aspirin occur often. Obtaining authority for community midwives to prescribe aspirin after education should be considered and consulting a consultant obstetrician should become more accessible to overcome the practical issues. Further educating community midwives and general practitioners might improve implementation rates and perinatal outcomes.

Associations between first-trimester screening biomarkers and maternal characteristics with gestational diabetes mellitus in Chinese women.

Gestational diabetes mellitus (GDM) can result in adverse maternal and neonatal outcomes. Predicting those at high risk of GDM and early interventions can reduce the development of GDM. The aim of this study was to examine the associations between first-trimester prenatal screening biomarkers and maternal characteristics in relation to GDM in Chinese women. We conducted a retrospective cohort study of singleton pregnant women who received first-trimester aneuploidy and preeclampsia screening between January 2019 and May 2021. First-trimester prenatal screening biomarkers, including pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin, and placental growth factor (PLGF), along with maternal characteristics, were collected for analysis in relation to GDM. Receiver operating characteristic (ROC) curve and logistic regression analyses were used to evaluate variables associated with GDM. Of the 1452 pregnant women enrolled, 96 developed GDM. PAPP-A (5.01 vs. 5.73 IU/L, P < 0.001) and PLGF (39.88 vs. 41.81 pg/mL, P = 0.044) were significantly lower in the GDM group than in the non-GDM group. The area under the ROC curve of combined maternal characteristics and biomarkers was 0.73 (95% confidence interval [CI] 0.68-0.79, P < 0.001). The formula for predicting GDM was as follows: P = 1/[1 + exp (-8.148 + 0.057 x age + 0.011 x pregestational body mass index + 1.752 x previous GDM history + 0.95 x previous preeclampsia history + 0.756 x family history of diabetes + 0.025 x chronic hypertension + 0.036 x mean arterial pressure - 0.09 x PAPP-A - 0.001 x PLGF)]. Logistic regression analysis revealed that higher pregestational body mass index (adjusted odds ratio [aOR] 1.03, 95% CI 1.01 - 1.06, P = 0.012), previous GDM history (aOR 9.97, 95% CI 3.92 - 25.37, P < 0.001), family history of diabetes (aOR 2.36, 95% CI 1.39 - 4.02, P = 0.001), higher mean arterial pressure (aOR 1.17, 95% CI 1.07 - 1.27, P < 0.001), and lower PAPP-A level (aOR 0.91, 95% CI 0.83 - 1.00, P= 0.040) were independently associated with the development of GDM. The Hosmer-Lemeshow test demonstrated that the model exhibited an excellent discrimination ability (chi-square = 3.089, df = 8, P = 0.929). Downregulation of first-trimester PAPP-A and PLGF was associated with the development of GDM. Combining first-trimester biomarkers with maternal characteristics could be valuable for predicting the risk of GDM.

The Effect Of Giving Calcium As An Effort To Prevent Preeclampsia: A Literature Review

Preeclampsia is a pregnancy disorder accompanied by hypertension and proteinuria. Efforts to prevent preeclampsia can be made with medical prevention, namely, meeting the calcium needs of pregnant women. This research aims to determine the effect of givingcalcium to prevent preeclampsia. The method used in the literature review is a systematic mapping study obtained from 3 databases, namely Pubmed, Garuda, and Google Scholar, using inclusion and exclusion criteria. Key term used in searching literature: "Calcium for prevention of preeclampsia." from 10 journals, it was found that the correct dose of calcium and timing of giving calcium to pregnant women was found and that calcium had an effect on preventing preeclampsia. Data analysis techniques use Synthesize or compare. Conclusion: Mothers are advised to consume calcium because it can lower blood pressure. By reducing blood pressure in pregnant women, calcium can prevent the occurrence of preeclampsia, especially in pregnant women who have hypertension or a history of preeclampsia.

RISK FACTORS FOR SEVERE PREECLAMPSIA AT DR. WAHIDIN SUDIRO HUSODO HOSPITAL MOJOKERTO CITY IN 2021-2022

Background: Preeclampsia and eclampsia are major causes of morbidity and mortality during the perinatal period. The change from preeclampsia to severe preeclampsia can progress rapidly. The case of severe preeclampsia in Dr. Wahidin Sudiro Husodo Hospital, is very high. Purpose: To analyze the risk factors for severe preeclampsia at Dr. Wahidin Sudiro Husodo Hospital, Mojokerto City. Subjects and Methods: This study was conducted using an observational analytic quantitative method with an case control design. The sampling method used consecutive sampling. This study involved a total of 150 samples from two groups, consisting of pregnant women and laboring women. Results: The variables that had a significant relationship with the incidence of severe preeclampsia were age variables (p-value: 0.000; OR: 4.330; CI: 1.972-9.507), history of obesity (p-value: 0.000; OR: 15.460; CI: 5.255-45.483), history of preeclampsia (p-value: 0.001; OR: 7.579; CI: 2.127-27.006), history of diabetes mellitus (p-value: 0.012; OR: 11.385; CI: 1.419-91.352), and history of chronic hypertension (p-value: 0.000; OR: 6.945; CI: 2.931-16.456) were all significantly associated with the incidence of severe preeclamsia . the variables of age, history of obesity, and history of chronic hypertension met the final modeling in multivariate analysis. Conclusion: The history of obesity being the most dominant variable.

Experience of mothers with a history of preeclampsia in pregnancy

Pre-eclampsia is a disease that can occur in pregnancy, and is one of the causes of death in large numbers in childbirth. One indicator of a country's health status is the low maternal mortality rate, where preeclampsia is one of the main causes of maternal death. Objective this Scoping Review is to review and map research on mother's life experience with a history of preeclampsia in pregnancy. Scoping Review it uses framework PRISMA-ScR with search of articles through relevant databases Pubmed, ScienceDirect, and Willey then do Critical Appraisal use The Joanna Briggs Institute (JBI). Based on the search results of the selected 921 articles, there were 10 articles that met the inclusion criteria, and then the review process was continued to identify keywords that resulted in 3 themes, namely Mother's Experience with a history of preeclampsia in pregnancy Impacts related to preeclampsia in pregnant women and Outlook Society believes that preeclampsia is a disorder of evil spirits. History of preeclampsia in pregnancy still really need attention from families and health workers, especially from the aspect of vigilance for the symptoms that are felt and the importance of information about preeclampsia in pregnancy.

Study on clinical characteristics and some risk factors for preeclampsia

Background: Preeclampsia is a complex disease caused by pregnancy, with many complications for both mother and fetus, but there is no specific treatment. The purpose of the study is to describe clinical characteristics and survey some risk factors for preeclampsia. Materials and methods: The case-control study included 205 pregnant women with preeclampsia and 205 pregnant women without preeclampsia. Results: In the preeclampsia group, systolic blood pressure, diastolic blood pressure and BMI were 154.9 ± 15.5 mmHg, 96.0 ± 9.7 mmHg and 23.7 ± 3.5 kg/m2, respectively; edema (58.5%), history of preeclampsia (14.1%), early-onset preeclampsia (28.8%) and severe preeclampsia (42.4%). Early onset increased the risk of severe preeclampsia with OR = 3.98 (95% CI: 2.10 - 7.55). 10.8% had complications, in the mother including HELLP syndrome, eclampsia, coagulation disorders and in the fetus including fetal distress, intrauterine growth retardation and premature birth. Maternal age ≥ 35 years old, history of miscarriage, BMI were associated with preeclampsia, with OR 3.36 (95% CI: 2.06 - 5.46); 1.67 (95% CI: 1.04 - 2.67); 6.66 (95% CI: 4.19 - 10.59), respectively. Conclusion: Severe preeclampsia accounted for a high rate, was associated with early onset, and complications were recorded in both mother and fetus. Maternal age, history of miscarriage and overweight were factors that increase the risk of preeclampsia. Key words: Preeclampsia, eclampsia, blood pressure, HELLP, risk factors.

Maternal Cardiac Functional and Structural Changes in Preeclampsia: an Echocardiographic Study

Background &amp; objective: Preeclampsia is a pregnancy-induced multi-organ syndrome of acute cardiovascular manifestations with significant short and long-term sequelae. However, there is a relative lack of knowledge with respect to cardiac functional and structural changes in women with preeclampsia Therapeutic interventions used in the management of preeclampsia may cause iatrogenic adverse consequences due to this lack of knowledge. The present study was therefore designed to evaluate the echocardiographic changes in cardiac structural and functional indices in pregnant women with PE. Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH), and Shaheed Suhrawardy Medical College Hospital (SSMCH) in collaboration with National Institute of Cardiovascular Diseases (NICVD), Dhaka over a period of one year from July 2013 to June 2014. A total of 30 single-tone pregnant women of 20-40 weeks gestation with preeclampsia were taken as cases. An equal number of gestationally-matched healthy pregnant (HP) women of similar age cohorts having no history of preexisting hypertension were included as controls. Preeclampsia was defined as SBP ≥140and/or DBP ≥ 90 mmHg after 20 weeks gestation in a woman with previously normal blood pressure and with proteinuria≥1 + in the dipstick test. Pregnant women with systolic and diastolic blood pressures within the normal range (&lt; 140mmHg and &gt; 90 mmHg respectively), trace or absence of proteinuria by dipstick test were defined as controls. All thesubjects were investigated with ECG, standard two-dimensional, M-mode, and Doppler transthoracic echocardiography. The cardiac functional and structural changes were measured in terms of interventricular septal thickness (IVSTd),posterior wall thickness (PWTd), left ventricular internal diameter at the end of diastole (LVIDd), ejection fraction (EF), transmitral velocity (MV E/A ratio), MV deceleration time (MV DecT). Result: Half of the women with preeclampsia were primigravidae and there was no association between gravidity and the occurrence of preeclampsia. Prepregnancy overweight or obesity (in terms of BMI) was found to be strongly associated with preeclampsia. One in 10 PE women had a previous history of preeclampsia as opposed to none in the HP women. A substantial proportion (56.7%) of PE women had a family history of hypertension in comparison to healthy pregnant women (16.3%). The women with PE had significantly higher SBP, DBP, &amp; MAP than the HP women. Parameters of diastolic dysfunction, like mitral E/A ratio was reduced and deceleration time was prolonged in PE with diastolic dysfunction (mean E/A ratio &lt; 0.73 and mean DceT &gt;178 ms respectively) than those in PE with normal diastolic function (mean E/A ratio 1.2 and mean DceT 192.4 ms respectively) healthy pregnant women (mean E/A ratio 1.3 and mean DecT 186.5 ms respectively). Over one-third (36.7%) of women with PE met the criteria of diastolic dysfunction compared to none in healthy pregnant women. The LVH appears to be a frequent occurrence in pregnancies complicated by preeclampsia (43.3%) as compared to none in healthy pregnant women. In the present study, the systolic function was assessed with the help of EF, which was well-preserved both in PE and HP with no significant intergroup difference. Conclusion: Preeclampsia is associated with left ventricular diastolic dysfunction and hypertrophy preserving the systolic function. These structural and functional changes are primarily adaptive in nature for maintaining cardiac systolic function. Ibrahim Card Med J 2022; 12 (2): 32-39

Potential Roles of microRNAs for Assessing Cardiovascular Risk in Pre-Eclampsia-Exposed Postpartum Women and Offspring

Pre-eclampsia, which is part of the spectrum of hypertensive pregnancy disorders, poses a significant health burden, contributing to maternal and infant morbidity and mortality. Pre-eclampsia is widely associated with persistent adverse effects on the cardiovascular health of women with a history of pre-eclampsia. Additionally, there is increasing evidence demonstrating that offspring of pre-eclamptic pregnancies have altered cardiac structure and function, as well as different vascular physiology due to the decrease in endothelial function. Therefore, early detection of the likelihood of developing pre-eclampsia-associated cardiovascular diseases is vital, as this could facilitate the undertaking of the necessary clinical measures to avoid disease progression. The utilisation of microRNAs as biomarkers is currently on the rise as microRNAs have been found to play important roles in regulating various physiological and pathophysiological processes. In regard to pre-eclampsia, recent studies have shown that the expression of microRNAs is altered in postpartum women and their offspring who have been exposed to pre-eclampsia, and that these alterations may persist for several years. This review, therefore, addresses changes in microRNA expression found in postpartum women and offspring exposed to pre-eclampsia, their involvement in cardiovascular disease, and the potential role of microRNAs to be used as predictive tools and therapeutic targets in future cardiovascular disease research.

Asuhan Kebidanan Komprehensif Pada Ny. M Umur 37 Tahun Dengan Riwayat Pre Eklampsia Berat Dan Sectio Caesarea Di Puskesmas Kaliwadas Kabupaten Brebes Tahun 2023

According to the World Health Organization (WHO) in 2020 stated that the maternal mortality rate (MMR) due to pre-eclampsia is very high, every day 810 women die due to complications of pregnancy and childbirth and around 295 000 women die after childbirth or in the postpartum period while in Indonesia 6-15%. In Central Java 98.6 per 100,000KH, while in Brebes 536 cases and in Kaliwadas Health Center 6 cases. To provide comprehensive midwifery care services for pregnant women, delivery, newborn, postpartum, and family planning. This research used descriptive qualitative method with case study approach. Comprehensive Midwifery Care for Mrs. M aged 37 years with a history of severe preeclampsia and sectio caesarea using Varrney documentation management, SOAP and there are significant similarities. Comprehensive midwifery care for Mrs. M from pregnancy, up to family planning, and using Varrney's flow of thought with SOAP documentation, mother and baby in good condition.

Awareness and Knowledge of Pre-eclampsia Among Saudi Women of Reproductive Age.

Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia. It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables. Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia. This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions.

Preeclampsia and Long-Term Risk of Venous Thromboembolism

As venous thromboembolism (VTE) remains one of the leading causes of maternal mortality, identifying women at increased risk of VTE is of great importance. Preeclampsia is a pregnancy-induced hypertensive disorder with generalized endothelial dysfunction. Some studies suggest that preeclampsia is associated with an increased risk of VTE, but much controversy exists. To examine the association between preeclampsia and the risk of VTE during pregnancy, during the puerperium, and after the puerperium. This observational cohort study used Danish nationwide registries to identify all eligible primiparous women who gave birth in Denmark from January 1, 1997, to December 31, 2016. The women were followed up from primiparous pregnancy to incident VTE, emigration, death, or the end of the study (December 31, 2016). Statistical analyses were carried out from January to May 2023. Preeclampsia during primiparous pregnancy. The main outcome was incident VTE, and the secondary outcome was all-cause mortality. A total of 522 545 primiparous women (median age, 28 years [IQR, 25-31 years]) were included, and 23 330 (4.5%) received a diagnosis of preeclampsia. Women with preeclampsia were of similar age to women without preeclampsia but had a higher burden of comorbidities. During a median follow-up of 10.2 years (IQR, 5.2-15.4 years), preeclampsia was associated with a higher incidence of VTE compared with no preeclampsia (incidence rate, 448.8 [95% CI, 399.9-503.5] vs 309.6 [95% CI, 300.6-319.9] per 1000 patient-years, corresponding to an unadjusted hazard ratio [HR] of 1.45 [95% CI, 1.29-1.63] and an adjusted HR of 1.43 [95% CI, 1.27-1.61]). When stratified according to the subcategories of VTE, preeclampsia was associated with an increased rate of deep vein thrombosis (unadjusted HR, 1.51 [95% CI, 1.32-1.72] and adjusted HR, 1.49 [95% CI, 1.31-1.70]) as well as pulmonary embolism (unadjusted HR, 1.39 [95% CI, 1.09-1.76]; adjusted HR, 1.36 [95% CI, 1.08-1.73]). These findings held true in landmark analyses during pregnancy, during the puerperium, and after the puerperium. This cohort study suggests that preeclampsia was associated with a significantly increased risk of VTE during pregnancy, during the puerperium, and after the puerperium, even after thorough adjustment. Future studies should address how to improve the clinical management of women with a history of preeclampsia to prevent VTE.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis.

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia. To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model. Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia. When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

Long-term cardiovascular risk of pre-eclampsia

Abstract Background/introduction Pre-eclampsia is a complication of the second and third trimesters of pregnancy characterized by hypertension and endothelial dysfunction causing multiorgan damage. In 2017 few studies suggested an association between pre-eclampsia and long-term cardiovascular diseases. However, since those first studies, the literature has grown exponentially. Purpose To assess the association between a history of pre-eclampsia and subsequent cardiovascular diseases, including 1) cardiovascular death, 2) coronary heart disease, 3) heart failure, and 4) stroke. Methods Following PRISMA guidelines, from inception to September 2022, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort or case-control studies in English were included if fulfilling the following criteria: 1) the association between pre-eclampsia and subsequent cardiovascular disease was adjusted for at least maternal age, smoking, and obesity; 2) the presence of a control group; 3) minimum one-year follow-up. Pooled Relative Risk (RRs) and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model. The primary endpoint was cardiovascular death. The secondary endpoints were coronary heart disease, heart failure, and stroke. Results Twenty-one studies met the inclusion criteria, including 478,708 women with a history of pre-eclampsia and 10,533,530 without. Pre-eclampsia was associated with a higher risk of cardiovascular disease death (RR 1.97, 95% CI 1.64-2.35, I2 60%, p&amp;lt;0.00001), coronary heart disease (RR 2.11, 95% CI 1.60-2.77, I2 85%, p&amp;lt;0.00001), heart failure (RR 2.47, 95% CI 1.70-3.59, I2 82%, p&amp;lt;0.00001), and stroke (RR 1.64, 95% CI 1.45-1.85, I2 43%, p&amp;lt;0.00001). Sensitivity analysis excluding those studies with a follow-up of less than 10 years evidenced similar results. Conclusions Compared to women who experienced a normal pregnancy, those suffering from pre-eclampsia have about double the risk of cardiovascular disease, including cardiovascular death, coronary heart disease, heart failure, and stroke. This risk becomes evident already in the first ten years after pregnancy. As such, obstetricians should counsel pre-eclamptic women on the importance of an early assessment and risk factors management in a multidisciplinary team with cardiologists.

Abstract 16926: Associations of Preeclampsia and Preterm Delivery With Lifetime Posttraumatic Stress

Introduction: Adverse pregnancy outcomes (APOs) are female-specific CVD risk factors while posttraumatic stress disorder (PTSD) is a female-predominant CVD risk factor. Preeclampsia and preterm delivery are acute APOs with negative maternal and fetal consequences that, for some, results in trauma. Hypothesis: We hypothesized that individuals with a history of preeclampsia or preterm delivery would be more likely to screen positive for lifetime PTSD. Methods: Parous Nurses’ Health Study II participants who responded to a 2008 questionnaire ascertaining trauma (Brief Trauma Questionnaire, with targeted query of 16 event types) and PTSD (Short Screening Scale for DSM-IV PTSD) comprised the analytic sample (n=40,256). Trauma and PTSD were categorized using four categories: no trauma, trauma with no PTSD symptoms, 1-3 symptoms, or ≥4 symptoms (probable PTSD). Ordered logistic regression, using a cumulative logit link and multinomial distribution, estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for age at enrollment, race/ethnicity, and parental education. Results: Seven percent of participants had a history of preeclampsia (n=3,012) while 13.5% (n=5,418) ever delivered preterm. Twenty-one percent of participants screened positive for PTSD (n=8,336), endorsing ≥4 symptoms from their worst trauma. Among participants with PTSD, 66% of those with preterm preeclampsia in their first pregnancy endorsed having a traumatic pregnancy complication or labor/birth, compared to 23% among those who delivered normotensive first pregnancies at term. Odds of PTSD were higher with history of ever preeclampsia (OR=1.36, CI: 1.27-1.45) or preterm delivery (OR=1.41, CI: 1.34-1.48), compared to only normotensive pregnancies and term deliveries, respectively. Further adjustment for physical or sexual abuse in childhood/adolescence did not change conclusions but did attenuate the odds ratio for preeclampsia (OR=1.26, CI: 1.18-1.35). Conclusions: History of preeclampsia or preterm delivery identifies a population at higher risk for lifetime posttraumatic stress. Further studies are needed to disentangle temporality and examine to what extent subsequent mental health conditions may mediate the relationship between APOs and CVD.

Assessing awareness of long-term health risks among women with a history of preeclampsia: a cross-sectional study.

Pregnancy complications, such as hypertensive disorders, present a substantial global public health challenge, with significant long-term implications for maternal and offspring health. This cross-sectional study aims to determine the level of awareness regarding long-term health risks among women who experienced preeclampsia during pregnancy in Cyprus and Greece. The study participants included adult women with a history of preeclampsia, while women with normal pregnancies were used as the comparison group. Data collection took place between June 2021 and February 2022, utilizing an online, self-administered questionnaire. The study included 355 women, with 139 (39.2%) in the preeclampsia group and 216 (60.8%) in the comparison group. Findings revealed that more than half of the women with prior preeclampsia (55.4%) were not aware of hypertensive disorders that can occur during pregnancy before their diagnosis, and a similar percentage (45.2%) had not received information about the long-term health risks following their diagnosis. Remarkably, only 3 participants (4.7%) with a history of preeclampsia were aware of the risk of developing cardiovascular diseases. There were no statistically significant differences between the preeclampsia and the comparison group regarding their concerns about long-term health risks, frequency of health checks, perceptions of factors influencing cardiovascular disease development, and doctor communication about different health topics, except from hypertension or high blood pressure. The study underscores the low level of awareness of long-term health risks among women with prior preeclampsia in Cyprus and Greece. This emphasizes the importance of implementing public health programs aimed at promoting cardiovascular risk assessment and effective management, both for clinicians and women with have experienced preeclampsia.

Abstract 17788: Long-Term Impact of Previous Severe Preeclampsia on Heart and Large Artery Structure and Function

Introduction: Women with previous history of preeclampsia (PE) are at risk of cardiovascular events. Hypothesis: To evaluate subclinical cardiovascular repercussions by noninvasive methods in women with previous severe PE. Methods: Cross-sectional study was carried out in a tertiary hospital. Women evaluated 2 to 5 years after delivery and divided into 3 groups: isolated preeclampsia (IPE=30), superimposed preeclampsia and/or chronic hypertension (Sup/HC)=60 and normal gestation (NG) =30. Variables analyzed: age, body mass index (BMI), systolic blood pressure (SBP) and diastolic BP (DBP) by ambulatory blood pressure monitoring (ABPM-24h) and office, central pressure (BPc) by Sphigmocor®; pulse wave velocity-PWV by Complior® e echocardiogram (ViviDI-GE®). Results: Clinical : Age (years): (Sup/HC=38 vs NG=34,6 vs IPE= 31, p &lt;0,001). BMI (kg/m2): Sup/HC=32,6 vs NG=27,1 vs IPE=28,4, p&lt; 0,001); SBP (mmHg): ABPM-24h (awake): (Sup/HC=128,4 vs NG=117,5, p&lt;0,004); office: (IPE=124,8, Sup/HC=133,6 vs NG=114,6, p &lt;0,001). DBP (mmHg) : office (IPE=80,4;Sup/HC=87,8 vs NG= 73,3) and (Sup/HC=87,8 vs IPEH= 80,4), (p&lt;0,001); SBPc (IPE=115,4, Sup/HC=124,4 vs NG 105,8, p &lt; 0,001). DBPc: (Sup/HC=88,8 vs NG= 75; Sup/HC=88,8 vs IPEH=81,8, p&lt;0,001); Vascular : PWV (m/s) (Sup/HC=8,1 vs NG=6,8, IPE=7,0, p&lt;0,012); Echocardiogram : Septum wall thickness (mm) (IPE=9,2 vs Sup/HC=9,7, NG=8,4, p&lt;0,004); left atrium (mm) (Sup/HC=38 vs IPE=36 vs 34, p&lt;0,005); left ventricle mass index (g/m2) (Sup/HC=81 vs IPE=80 vs. NG=66, p&lt;0,002), Conclusions: Women with previous IPE had elevated BP values and cardiac repercussions compared to previous normal gestation while previous superimposed or chronic hypertension had also elevated BP, vascular and cardiac impairment compared to other previous gestational conditions.

Postpartum Lifestyle Behaviors among Women with Hypertensive Disorders of Pregnancy: Data from the HUNT Study.

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease later in life. Clinical guidelines for postpartum follow-up after HDP often recommend lifestyle counseling to reduce this risk. However, knowledge about lifestyle behaviors and perceptions among women with a history of HDP is limited. We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) with data from the Medical Birth Registry of Norway. The associations between HDP and postpartum lifestyle behaviors and perceptions were examined using multivariable logistic regression. In a secondary analysis, HUNT4 participants with a recent history of pre-eclampsia were compared with women with a recent history of pre-eclampsia participating in a postpartum pilot intervention study. Lifestyle behaviors and perceptions were self-reported and included diet (intake frequency of fruits, vegetables, meat, fish, and sugar-sweetened beverages), alcohol intake, physical activity, sleep, smoking, lifestyle satisfaction, and the importance of a healthy lifestyle. Among 7551 parous HUNT4 participants, 610 had a history of HDP. We found no differences in lifestyle behaviors between women with and without a history of HDP. However, women with HDP had higher odds of being unsatisfied with their lifestyle. Women with pre-eclampsia participating in a postpartum lifestyle intervention study tended to have a healthier lifestyle at baseline than women participating in HUNT4. Future studies should explore how lifestyle intervention programs could be adapted to the needs of women who have experienced HDP or other pregnancy complications that are associated with an increased risk of CVD.

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

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

Women with Preexisting CKD and a History of Preeclampsia Have a High Rate of Subsequent Pregnancy Complications but Are Seldom Linked to Adequate Care

Women with Preexisting CKD and a History of Preeclampsia Have a High Rate of Subsequent Pregnancy Complications but Are Seldom Linked to Adequate Care

Pregnancy-An Ideal Period to Identify Women at Risk for Chronic Hypertension.

Cardiovascular disease is the leading cause of mortality in women. Pregnancy is an ideal period to implement cardiovascular prevention strategies as women seek medical help. We aimed to develop a predictive model to identify women at increased risk for chronic hypertension (CH) based on information collected in the index pregnancy. Cohort of 26 511 women seen in 2 consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure at 11 to 13 weeks' gestation, and the development of preeclampsia or gestational hypertension (GH) in the index pregnancy. Logistic regression models were fitted for the prediction of the development of future CH by the 20th week of the subsequent pregnancy. The performance of screening and risk calibration of the model were assessed. In this study 1560 (5.9%) women developed preeclampsia or GH (index pregnancy), and 215 (0.8%) developed future CH, with a median of 3.0 years later. Predictors of development of future CH were maternal age, weight, and blood pressure; Black and South Asian ethnicity; family history of preeclampsia; parity; and development of preeclampsia or GH. Preeclampsia or GH detected 52.1% (45.2%-58.9%) of future CH. At a screen-positive rate of 10%, a model including maternal characteristics, early pregnancy blood pressure, and development of preeclampsia or GH detected 73.5% (67.1-79.3) of future CH. Early pregnancy maternal characteristics, blood pressure, and development of preeclampsia or GH identify three-fourths of women at risk for future CH. Our results offer an important preventative strategy for identifying women at increased risk of future CH, which is applicable worldwide.