Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery. Nearly half of all US pregnancy-associated stroke hospitalizations occur in the setting of hypertensive disorders. Primary stroke prevention strategies include risk factor modification, aggressive hypertension management and prompt treatment of severe hypertension in pregnancy and postpartum, and antithrombotic therapy in some high-risk groups. Secondary stroke prevention strategies in pregnancy depend on the mechanism of the prior stroke. Pregnancy should not delay evidence-based treatments for acute stroke. The use of telemedicine can facilitate early consultation with a vascular neurologist and a maternal-fetal medicine specialist in cases of acute pregnancy-related stroke, helping to guide initial decision-making. Computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are all safe neuroimaging modalities for rapid evaluation of pregnant patients with acute stroke symptoms. Acute stroke alone is not an indication for immediate delivery, and stabilization of the mother should come first. Vaginal delivery after stroke is preferred when feasible because it avoids the surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and breastfeeding and require support from a multidisciplinary rehabilitation team. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.

Semaphorin 3A (SEMA3A), a neurovascular guidance molecule, is increasingly recognized for its roles in angiogenesis and immune regulation, yet its impact on vascular dysfunction during pregnancy remains uncertain. We examined circulating and placental SEMA3A levels in women with healthy pregnancies, those with hypertensive disorders of pregnancy with appropriate-for-gestational-age fetuses, and hypertensive pregnancies complicated by fetal growth restriction, supplementing these analyses with in vitro endothelial assays. In maternal plasma and placental tissues, SEMA3A levels were elevated in hypertensive pregnancies, peaking in cases with fetal growth restriction. In cultured endothelial cells, SEMA3A disrupted cytoskeletal organization, compromised barrier stability, and altered cellular morphology. These changes were linked to lysosomal accumulation of its receptor Neuropilin-1 and altered lysosomal function. Collectively, these findings identify SEMA3A as a regulator of endothelial cytoskeletal and lysosomal dynamics. By connecting in vitro mechanistic studies with in vivo pregnancy samples, this work underscores a novel role for SEMA3A that may be pertinent to hypertensive pregnancy and its complications.

This study aims to develop a prediction model to identify individuals at risk of hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, by integrating epigenetic biomarkers and clinical factors in the first trimester of pregnancy. A 2-stage nested case-control study, matched by age and body mass index, was conducted with 618 pregnant women in China, with peripheral blood samples collected in the first trimester to evaluate the average methylation levels of differentially methylated regions (DMRs) between controls and HDP cases. In stage 1 (discovery set), 24 controls and 27 cases were used to identify the differential DMRs. In stage 2, 294 controls and 273 cases were used to validate the previously identified DMRs. DMRs selected from the intersectional results of lasso regression, XGBoost, random forest, and Shapley Additive Explanations models were further combined with women's clinical risk factors to construct prediction models using logistic regression. In stage 1, 52 differential DMRs were identified with a false-positive rate <0.05. In stage 2, 12 differential DMRs were consistently observed, and 3 DMRs located in the CTSA, HMGB1, and miR1908/FADS2 genes were selected to construct a prediction model for HDPs. After combining the selected DMRs with clinical factors, the model achieved an area under the curve of 0.863 (95% CI, 0.826-0.901) in the training set and 0.757 (95% CI, 0.686-0.828) in the test set. Findings of this study offer potential opportunities to identify high-risk patients with HDP in early pregnancy through DMRs identified in peripheral blood and provide new insights into the epigenetic cause of HDP.

The timing of chronic hypertension onset in pregnancy was not associated with the severity of superimposed preeclampsia.

Placental anti-angiogenic and inflammatory markers and postpartum cardiovascular risk following preeclampsia.

Background Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, are associated with an increased risk of cardiovascular disease (CVD) later in life. Mechanisms that link HDP to CVD, however, remain unclear. Methods We used a high-dimensional single-cell mass cytometry approach to profile the distribution and functional responses of maternal immune cells in three separate groups of HDP cases and normotensive controls, sampled antepartum, postpartum, and several years postpartum (midlife). We used multivariable sparse modeling to distinguish HDP cases from controls. Results We accurately distinguished HDP cases from controls at all three study timepoints, with area under the receiver operator characteristic (AUROC) curve values of 0.814 for the antepartum group, 0.757 for the postpartum group, and 0.692 for the midlife group. Distinct immune signatures for each model underscore the dynamic dysregulation of the immune system throughout life. In addition, we identified a persistent immune dysregulation signal among HDP cases at all three timepoints, characterized by increased B cell frequency and decreased pSTAT3 response upon cytokine stimulation in classical monocytes. Conclusions Persistent immune dysregulation among women with a history of an HDP may contribute to elevated long-term risk of CVD development.

Diurnal variation in urine protein-to-creatinine ratio among pregnant women with and without hypertensive disorders: A retrospective clinical study.

Metabolomics reveals pre-eclamptic-protective mechanisms within individuals.

Imperfect first-trimester screening for hypertensive disorders of pregnancy (HDP) means many high-risk women miss the window for preventive aspirin, and the biological heterogeneity of HDPs is overlooked. This study aimed to leverage first-trimester serum proteomics to create a more precise tool for predicting preeclampsia (PE) and differentiating it from other HDPs. A prospective nested case-control study (n = 172) was conducted using targeted liquid chromatography-multiple reaction monitoring-mass spectrometry (LC-MRM-MS) proteomic profiling of 115 proteins. Machine learning (ML) methods were used to develop classifiers from the proteomic data. The signature predictive of PE was characterized by dysregulation of the complement and coagulation cascades (F10, C8A, C1QA, SERPING1, VTN). The profile differentiating gestational hypertension (GAH) from chronic hypertension (CAH) was linked to lipid metabolism (HRG, APOA4, APOC2). An 18-protein support vector machine (SVM) model for predicting PE demonstrated exceptional performance, with 94% sensitivity and 100% specificity, significantly outperforming the standard Fetal Medicine Foundation (FMF) screening algorithm. Pathway analysis confirmed that PE is associated with early activation of innate immunity and coagulation pathways, while GAH is linked to a pregnancy-induced metabolic response. A targeted serum proteomic combined with ML approach represents a new perspective diagnostic tool with strong potential to personalize monitoring for women at the highest risk for specific hypertensive pregnancy complications.

Hypertensive disorders during pregnancy increase the risk of long-term cardiovascular disease in postpartum women. Exercise-based rehabilitation may help manage blood pressure (BP) and improve physical activity levels in this population, but supporting evidence remains limited. This pre-post single-arm proof-of-concept study aimed to assess the feasibility of a 4-week cardio-obstetrics rehabilitation program for women following hypertensive pregnancy. Women 3-6 months postpartum with a history of gestational hypertension or pre-eclampsia were recruited. The intervention combined exercise and educational components delivered through in-person, live virtual, and independent sessions. Feasibility was evaluated through recruitment, retention, adherence, acceptability, and safety. Outcomes included BP, six-minute walk distance, body weight and BMI, physical activity levels, health-related quality of life, and depressive symptoms. Six of 20 screened participants (30% recruitment) completed the intervention (100% retention). Overall adherence to scheduled sessions was 71%. All participants expressed high satisfaction, and no adverse events were reported. Descriptive analysis indicated improvements across all measured outcomes after the intervention. A cardio-obstetrics rehabilitation program for postpartum women after hypertensive pregnancy is feasible. Improvements in cardiovascular, anthropometric, behavioral, and psychosocial outcomes suggest potential efficacy and support further investigation.

Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery. Nearly half of all US pregnancy-associated stroke hospitalizations occur in the setting of hypertensive disorders. Primary stroke prevention strategies include risk factor modification, aggressive hypertension management and prompt treatment of severe hypertension in pregnancy and postpartum, and antithrombotic therapy in some high-risk groups. Secondary stroke prevention strategies in pregnancy depend on the mechanism of the prior stroke. Pregnancy should not delay evidence-based treatments for acute stroke. The use of telemedicine can facilitate early consultation with a vascular neurologist and a maternal-fetal medicine specialist in cases of acute pregnancy-related stroke, helping to guide initial decision-making. Computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are all safe neuroimaging modalities for rapid evaluation of pregnant patients with acute stroke symptoms. Acute stroke alone is not an indication for immediate delivery, and stabilization of the mother should come first. Vaginal delivery after stroke is preferred when feasible because it avoids the surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and breastfeeding and require support from a multidisciplinary rehabilitation team. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.

Pulmonary arterial hypertension (PAH) is associated with high rates of maternal and neonatal mortality. This review analyzes current data on PAH-specific therapy during pregnancy. The authors propose an optimal approach to managing patients with PAH before, during, and after pregnancy.

Preeclampsia (PE) is the onset of hypertension in pregnancy with systemic involvement; PE poses significant risks of cerebral complications, including eclampsia and long-term cognitive impairment. This review explores the potential of neurological biomarkers-neurofilament light chain (NfL), neuron-specific enolase (NSE), S100 Calcium Binding Protein B (S100B), and tau-as indicators of cerebral injury in PE. A literature search identified studies comparing biomarker levels in preeclamptic and healthy pregnancies. Findings reveal elevated plasma levels of NfL, NSE, S100B, and Tau in PE, with NfL showing the strongest association with blood-brain barrier dysfunction, cognitive symptoms, and disease severity. Variations between plasma and cerebrospinal fluid levels suggest impaired BBB integrity rather than increased central nervous system production. Despite promising correlations, limitations include small sample sizes, lack of standardized thresholds, and limited CSF data. While NfL emerges as a particularly promising marker for risk stratification, further research is needed to validate the clinical utility of these biomarkers in routine PE management.

Hypertensive pregnancy increases risk of cognitive decline, stroke, and dementia, especially after preeclampsia. Women with prior hypertensive pregnancy show lower brain volumes, but it was unknown whether early postpartum blood pressure optimization could alter these outcomes. To evaluate whether an intervention designed to achieve better postpartum blood pressure control after a hypertensive pregnancy is associated with differences in brain volumes around 9 months post partum compared with usual care. This randomized clinical trial, the Physician Optimized Postpartum blood pressure self-management trial (POP-HT), was a prospective, open-label, blinded end-point study conducted at a single tertiary center in the UK. Participants were older than 18 years and had preeclampsia or gestational hypertension requiring antihypertensive treatment at hospital discharge. Enrollment began February 21, 2020; the last follow-up was on November 2, 2021; and the mean follow-up time was approximately 9 months. Secondary outcome analyses (primary results published 2022) were conducted May 2025. Telemonitored self-management with research physician-guided titration or usual postnatal care. This substudy analyzed the secondary outcomes T1-weighted magnetic resonance imaging (MRI) brain volumes (gray matter, white matter, cerebrospinal fluid, subcortical structures) acquired approximately 9 months post partum. Analyses used linear regression models adjusted for total intracranial volume. Of 252 eligible participants, 32 declined, and 220 were randomized (mean [SD] age, 33.4 [5.1] years). The T1 brain MRI of 157 participants was available for analysis; 96 participants (63%) had preeclampsia, and 56 (37%) had gestational hypertension. The intervention group (n = 81) had larger total white matter volumes (adjusted mean difference, 11.50 cm3; 95% CI, 2.04 to 20.96; P = .02) compared with the usual care group (n = 71). In usual care, participants with preeclampsia had smaller putamen (adjusted mean difference, -0.83 cm3; 95% CI, -1.20 to -0.46; P < .001), accumbens (adjusted mean difference, -0.15 cm3; 95% CI, -0.24 to -0.05; P = .003), and pallidum (adjusted mean difference, -0.13 cm3; 95% CI, -0.26 to -0.01; P = .04) volumes compared with those with gestational hypertension. These differences were not observed in the intervention group. This study found that short-term postpartum optimization of blood pressure control after hypertensive pregnancy was associated with larger brain volumes during the first year post partum. Because brain volume is a surrogate of brain health linked to tissue preservation and cognitive outcomes, these findings suggest potential neurovascular benefits that were most pronounced among women with preeclampsia. ClinicalTrials.gov Identifier: NCT04273854.

Maternal ophthalmic artery doppler velocimetry in normotensive pregnancies and hypertensive pregnancies: A comparative study

Postpartum health-care utilization and blood pressure control by antihypertensive agent in hypertensive disorders of pregnancy.

Background: Hypertension in pregnancy is one of the complications that increases the risk of low birth weight (LBW) due to impaired placental perfusion. At Bungkal Health Center, cases of hypertension among pregnant women and LBW incidence remain relatively high. This study aims to analyze differences in maternal blood pressure between LBW and non-LBW cases at Bungkal Health Center. Methods: This study employed an analytical observational design with a case–control approach. A total of 94 respondents were included, consisting of 47 mothers who delivered low birth weight infants (case group) and 47 mothers who delivered non–low birth weight infants (control group), selected using simple random sampling. Data were obtained from medical records and analyzed using the Chi-square test and the Independent Sample t-test. Results: The mean birth weight of infants born to mothers with high blood pressure was 2,282.25 grams, whereas infants born to mothers with normal blood pressure had a mean birth weight of 2,857.74 grams. Statistical analysis showed a p-value &lt; 0.001, indicating a significant difference between the two groups. Conclusion: There was a significant difference in birth weight between infants born to mothers with high blood pressure and those born to mothers with normal blood pressure. Pregnant women with hypertension had nearly a 40-fold higher risk of delivering low birth weight infants compared with women with normal blood pressure.

Objective: Hypertension affects approximately 10% of pregnancies worldwide, contributing significantly to maternal morbidity and mortality. Severe hypertension in pregnancy is defined as systolic blood pressure exceeding 160 mmHg and diastolic blood pressure greater than 110 mmHg, persisting for more than 15 minutes. This condition represents an obstetric emergency that necessitates immediate and appropriate management. Methods: A quasi-experimental study was conducted at a tertiary care centre in Rawalpindi. The study included 70 patients, divided into two groups: Group 1 (n = 35) received oral nifedipine, while Group 2 (n = 35) was treated with intravenous labetalol. Treatment was initiated with 5 mg of oral nifedipine and 20 mg of intravenous labetalol as part of a gradual dose-escalation protocol designed to reduce pharmacological risks while ensuring effective blood pressure control. Results: The findings revealed that therapeutic blood pressure was achieved significantly faster in the nifedipine group (mean time: 22.3 ± 11.5 minutes) compared to the labetalol group (mean time: 33.5 ± 13.3 minutes, p=0.03). Additionally, fewer doses were required in the nifedipine group than in the labetalol group. The rate of treatment failure was notably higher among patients treated with intravenous labetalol. Conclusion: Oral nifedipine proved to be as efficacious and safe as intravenous labetalol, with the added advantage of convenience in low-resource settings. Keywords: Pregnancy-induced hypertension, nifedipine, labetalol, failed treatment, Preeclampsia

Preeclampsia is a condition with increased blood pressure in pregnant women that occurs after 20 weeks of gestation. Maternal behaviour in pregnancy care is important to study to prevent the risk of preeclampsia, such as knowledge, attitudes and actions. This study aims to identify the relationship between the behaviour of pregnant women in knowing hypertension with the incidence of eclampsia in pregnant women in the working area of Puskesmas Kampung Baru Medan. A quantitative, descriptive-correlational design was employed using a cross-sectional approach. Data were analyzed using frequency distribution and percentage tables. The data in this study are presented in the form of frequency distribution tables and percentages. The findings revealed that the majority of respondents demonstrated adequate knowledge (55%), positive attitudes (62.5%), and appropriate preventive actions (82%). A moderately strong correlation was found between maternal knowledge and the incidence of preeclampsia (p = 0.00; r = 0.398). However, no significant associations were observed between attitudes (p = 0.204) or preventive actions (p = 0.117) and preeclampsia occurrence These results underscore the need to enhance maternal knowledge regarding pregnancy-related hypertension to effectively prevent preeclampsia. Keyword: Preeclampsia, Behaviour, Care, Pregnancy

Hypertension in pregnancy is defined as an increase in systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg according to the criteria of the World Health Organization (WHO) and the American College of Obstetricians and Gynecologists (ACOG). This condition requires appropriate management to prevent complications in both the mother and the fetus. This study aimed to evaluate the appropriateness of antihypertensive drug use among pregnant women receiving outpatient care at the Obstetrics and Gynecology Clinic of RS Kartini Lebak. The study employed a descriptive non-experimental design with a quantitative approach. Data were collected retrospectively from the medical records of pregnant women diagnosed with hypertension who received antihypertensive therapy during the study period. A total of 29 patients who met the inclusion criteria were included in the analysis. The results showed that the majority of patients were aged 24–35 years (58.62%). Based on diagnosis, preeclampsia was the most common condition (41.38%), followed by chronic hypertension (37.93%) and gestational hypertension (20.69%). The most frequently prescribed antihypertensive therapy was nifedipine monotherapy (82.76%), while combination therapy with nifedipine and methyldopa was used in 17.24% of patients. Evaluation of drug use appropriateness demonstrated 97% appropriate indication, 97% appropriate drug selection, and 100% appropriate dosage.