Hypertension In Previous Pregnancy Research Articles

Prevalence and associated risk factors of hypertension among pregnant women in rural areas of Dibrugarh District, Assam.

Hypertension is one of the most common medical disorders complicating pregnancies and complicates 5 to 10% of all pregnancies. To estimate the prevalence of hypertension among pregnant women and to determine the associated obstetric risk factors of hypertension among them in rural areas of Dibrugarh district, Assam. Community-based cross-sectional study. The present study was conducted on pregnant women of villages under two health blocks at that point of time from May 2017 to April 2018. The sample size was calculated to be 384. The estimated number of pregnant women in each block was noted, and the pregnant women to be included from each block and from each sub-centre was determined by proportional allocation. Data were collected by house-to-house survey in the villages of the respective sub-centre. A pre-designed and pre-tested proforma was used to collect the data. Data were analysed using Chi-square test, Fisher's exact test, and logistic regression. A total of 384 pregnant women gave consent for participation. The prevalence of hypertension in pregnancy was 9.1%. Among the obstetric factors, multigravidity, multiparity, period of gestation >20 weeks, history of hypertension in previous pregnancy, and history of prior still birth were statistically significant risk factors of hypertension in pregnancy. Logistic regression analysis showed period of gestation >20 weeks to be independent predictor of hypertension in pregnancy. The awareness of obstetric risk factors for hypertension in pregnancy may give ways for prevention in this population.

Medications for preventing hypertensive disorders in high-risk pregnant women: a systematic review and network meta-analysis

ObjectivesTo determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis.MethodsAll randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth’s Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review.ResultsThis network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found.ConclusionAntiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate.Systematic review registrationPROSPERO CRD42018096276

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.

Health profile of the patients with pre-eclampsia in a referral hospital in the Amazon region.

To describe the epidemiological and clinical profile of the patients with preeclampsia in a hospital in the Amazon region. Observational descriptive cross-sectional study, performed at Fundação Santa Casa de Misericórdia do Pará, a maternity hospital in Pará, Brazil. The pregnant patients admitted between July 1st and December 31st 2018 due to pre-eclampsia had their medical records researched to describe their epidemiological profile, medical history, obstetric profile and clinical manifestations of pre-eclampsia. Patients with incomplete data were not included in the missing variable's rate. 3450 pregnant patients were admitted, and 381 of them due to pre-eclampsia, revealing a 11.04% prevalence. Both arithmetic mean and median of maternal age were approximately 27 years. 94.25% of the participants were parda. Regarding medical history, 50.27% had chronic hypertension, and 37.23% had urinary tract infection during pregnancy. The obstetric profile revealed that 42.26% were primigravid, and 30% of the multigravid participants had already manifested pregnancy hypertension. 78.1% of the participants attended less than 6 prenatal consultations, and 10.03% used chemical substances during pregnancy. Twin pregnancy had a 3.14% prevalence. Beyond hypertension and proteinuria, scotoma was the most frequent (28.57%) clinical manifestation. 2.36% of the patients developed seizures, mostly (55.55%) before 37 weeks of pregnancy. The profile of the participants was mean age 27 years, parda race, with chronic hypertension, single fetus, multigravid without previous pregnancy hypertension, with less than 6 prenatal consultations, no use of chemical substances and without any manifestations of pre-eclampsia beyond hypertension and proteinuria.

Altered cardiac and vascular stiffness in pregnancy after a hypertensive pregnancy

Hypertensive disorders of pregnancy are an important cause of morbidity and mortality, impacting on both maternal and fetal wellbeing. Affected women are at higher risk of future cardiovascular morbidity and mortality. Our study objective was to assess differences in cardiovascular function in pregnant women previously affected by gestational hypertension or preeclampsia. Pregnant women diagnosed with gestational hypertension or preeclampsia in a previous pregnancy were recruited at the start of a subsequent pregnancy and compared to healthy pregnant and non-pregnant controls. All patients underwent pulse wave analysis and echocardiography. Indexes of echocardiography-derived arterial and left ventricular elastance were calculated. In our study women with prior hypertension (n = 25) were more likely to have blood pressure in the 120–139/80–99 mmHg (prehypertension) range. Women with previous hypertension in pregnancy had increased late diastolic transmitral flow velocities (A wave) and increased augmentation index. Women without prior hypertension (n = 50) demonstrated more compliance (reduced EaI and Ees) compared to the non-pregnant controls (n = 40). This adaptation was not seen in pregnancy with prior hypertension, where increased arterial stiffness was observed. In conclusion we have shown increased prevalence of prehypertension and increased arterial stiffness in pregnant women previously affected by gestational hypertensive disease. An increased atrial component to ventricular filling reflects altered diastolic function after hypertensive pregnancy. These women are at increased future cardiovascular risk due to altered cardiac and vascular function and require effective risk mitigation.

Assessment of Prevalence of Hypertension in pregnant women with its Complications: A Cross Sectional Study

Introduction: World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths. About 60% of deaths accounted of eclampsia. Aims and Objectives: To diagnose for hypertension in pregnant women. To evaluate the knowledge of pregnancy induced hypertension among the pregnant women. To investigate the complications reported in Pregnancy induced hypertension (PIH) women, during and after labor. Study area and period: The present study was conducted in Chittoor government hospital, Chittoor, during the period of Jan 2016 and Dec 2017. The information and materials required for the study have been collected from the gynecology and obstetrics departments of the respective hospital. Results: During the study period of Jan 2016 and Dec 2017, about 2234 number of pregnant women have visited the obstetrics and gynecology department. All the 2234 pregnant women were tested for blood pressure. Among which 198 women were found to have hypertension, which may be of early onset PIH or chronic hypertension (HTN). Different variables of the study population like period of gestation [&lt;20 weeks, ≥20 weeks], previous cesarean section if present, previous preterm delivery if present, hypertension in previous pregnancy, history of paternal hypertension, history of abortions if have been, history of any still births, family history of PIH have been noted and reported in table 2. More than 8% of women were found to been falling in &lt;20 weeks of gestational age (GA). Conclusion: The study included 2234 pregnant women, in which 198 women were diagnosed with hypertension. Thus, prior investigation and identification hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor. Better knowledge and treatment is required for managing hypertension in maternal women in gynecology and obstetrics department for maternal and fetal care.

May Measurement Month 2019: an analysis of blood pressure screening results from China.

To report the blood pressure (BP) data obtained in the May Measurement Month (MMM) 2019 in China. Study participants were recruited if ≥18 years of age and had ideally not had their BP measured for ≥1 year. BP was measured three times consecutively with a 1-min interval in the sitting position, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on lifestyle, medical history, and use of medications. The measurement was performed in 238 387 participants in 250 sites across 31 China provinces. The majority of screening took place in hospitals or clinics (78.7%), with 17.1% in outdoor public areas and 4.2% in other settings. The study participants included 127 853 women (53.6%) and had a mean (±SD) age of 48.9 ± 16.2 years. The mean (of readings two and three) systolic/diastolic BP was 121.8/73.8 mmHg. In all hypertensive patients (n = 66 181, 27.8%), the awareness, treatment, and control rates of hypertension were 51.5%, 48.4%, and 29.1%, respectively. Linear regression models showed differences in systolic and diastolic BP according to sex and age and several other major characteristics, such as previous stroke, myocardial infarction, and diabetes mellitus, antihypertensive medication use and known hypertension, previous hypertension in pregnancy and current pregnancy, alcohol intake and current smoking, and body mass index. The MMM 2019 campaign has been successful in measuring BP in a large member of participants in China.

May Measurement Month 2019: an analysis of blood pressure screening results from Kenya.

Elevated blood pressure (BP) is the leading cause of global mortality, but control rates remain poor because most patients, especially in Africa, are unaware. May Measurement Month (MMM) is an annual global BP screening campaign that was initiated by the International Society of Hypertension (ISH) in 2017 to raise awareness of raised BP. Following participation in 2017 and 2018, Kenya participated again in 2019 and the results are reported here. Screening was carried out in 30 sites by volunteers coordinated by the Kenya Cardiac Society. Participants had three BP readings by standard methods with the last two being averaged and recorded. Heart rate, weight, height, socio-demographic parameters, and co-morbidities were documented. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg and/or a diastolic BP (DBP) ≥90 mmHg or being on treatment with at least one antihypertensive medication. A total of 33 992 participants were screened, mean age was 42.5 (SD 16.8) years and 58.7% of participants were female. Only 27.3% had their BPs checked within the preceding 12 months. After multiple imputation, 26.1% were hypertensive, of whom 34.5% were aware of their hypertension and 31.5% were on treatment. Of those on treatment, 59.7% were controlled translating to 18.8% of all hypertensives. Being on treatment for hypertension, overweight, obese or having had hypertension in previous pregnancy were associated with increased SBP and DBP, while diabetes was associated with raised SBP. Two-thirds of hypertensives were unaware. Only a third of those aware were on treatment, with about 60% of these controlled. Lack of awareness remains a significant barrier to BP control. Programmes to raise awareness such as MMM are significant in raising population awareness.

Blood pressure screening results from May Measurement Month 2019 in Vietnam.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative to raise awareness of high BP and act as a temporary solution to the lack of screening programmes worldwide. We aimed to screen for hypertension and cardiovascular risk factors in people aged ≥18 years in the community, thereby defining the proportion of subjects with elevated BP and assess the awareness and the effectiveness of its treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2019. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. From May 2019 to June 2019, through 10 cities/provinces in Vietnam, 25 887 individuals with mean age 48.7 (SD ±17.7) years were screened. After multiple imputations, 8758 (33.8%) had hypertension. Of individuals not receiving antihypertensive medication, 3025 (15.0%) were hypertensive. Of individuals receiving antihypertensive medication, 2800 (48.8%) had uncontrolled BP. Raised BP [systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg] was also associated with additional risk factors including smoking, alcohol intake, previous hypertension in pregnancy, and obesity. May Measurement Month 2019 was the most extensive BP screening campaign ever undertaken in Vietnam. Undiagnosed and uncontrolled hypertension in Vietnam remains a substantial health problem. Local campaigns applying standardized methods such as MMM 2019 will be beneficial to screen for the significant number of individuals with raised BP and increase the awareness of hypertension.

May Measurement Month 2019: an analysis of blood pressure screening results from Brazil.

The aim of this study is to describe the results of the May Month Measurement (MMM) campaign implemented in Brazil, in 2019. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 13 476 individuals, 58.2% were white, 60.8% were women. The average age was 46.3 (18.6) years. Of all 13 476 participants, 6858 (50.9%) had hypertension defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg or being on anti-hypertensive medication. Of those with hypertension, 68.8% were aware of their diagnosis, 65.3% were on antihypertensive medication, and 36.1% had controlled BP (<140/90 mmHg). In addition, of 4479 participants on anti-hypertensive medication, 55.2% had controlled BP. The use of anti-hypertensive medication was associated with higher systolic (P < 0.001) and diastolic BP (P < 0.001) and having diabetes with higher systolic BP (P < 0.001). Previous hypertension in pregnancy was associated with higher systolic (P = 0.038) and diastolic BP (P = 0.003), and smoking was associated with higher systolic BP (P < 0.001). Lastly, obese and overweight individuals showed significantly higher systolic (P < 0.001) and diastolic (P < 0.001) BP. The Brazilian MMM19 data demonstrate that strategies to increase awareness of hypertension and a better control of the risk factors are still needed.

Is There a Role for Indoxyl Sulfate in Contributing to Impaired Cognition and Anxiety Following a Hypertensive Pregnancy?

Objective Women with hypertensive conditions of pregnancy are at an increased risk of developing Acute Kidney Injury (AKI) which can lead to the progression of chronic kidney disease (CKD). Patients with CKD have impairments in cognition and increases in anxiety and depression. Indoxyl Sulfate (I.S.), a uremic toxin associated with CKD progression, has been reported to contribute to spatial memory impairment. We hypothesized that impairments in learning and memory and anxiety among rats with a previous hypertensive pregnancy (Hemolysis elevated liver enzyme low platelet – HELLP Syndrome) and AKI are accompanied by increased levels of I.S. Study Design On gestational day (GD) 12, sFlt-1 and sEng were infused via mini-osmotic pumps into the abdomen of timed-pregnant Sprague Dawley rats to induce HELLP. A subset of rats underwent either bilateral renal ischemia-reperfusion surgery for 45 minutes on GD18 to induce AKI or a SHAM surgery. Rats were either euthanized on GD19 to assess I.S. levels during pregnancy or at post-partum week (PPW) 15. Between PPW 11-13 rats underwent Barnes Maze and anxiety testing. I.S. concentrations were measured in the circulation and brainstem of rats. Tissue concentrations were normalized to total protein and group comparisons analyzed via statistical analysis where p<0.05 was considered significant. N=9-14 rats/group. Results HELLP and AKI rats displayed hypertension (p<0.05) and kidney injury (p<0.05) relative to NP rats at both time periods. There was a significant group (p=0.04) effect in Barnes maze with NP rats finishing the test significantly faster relative to all other groups by the 5th day of testing (p<0.03). There was a significant difference between groups in anxiety where HELLP+AKI rats spent significantly less time in the open area of the zero maze compared to NP+AKI rats (p=0.02). When the groups were compared there were no changes in circulating I.S. at GD19 (p=0.06) or at PPW15 (p=0.78). Brainstem levels of I.S. during pregnancy were increased in response to AKI and were significantly increased in NP+AKI vs. HELLP rats (p=0.02). However, by PPW15 brainstem levels of I.S. were trending towards an increase among HELLP+AKI rats vs. NP+AKI rats (p=0.06). Conclusion The results from this study suggest that AKI during pregnancy contributes to behavioral deficits, hypertension and imbalances in brainstem I.S. concentrations. We are currently examining other regions of the brain and increasing the N in the I.S. studies (currently n=3-5/group). As I.S. could possibly be one the mechanisms causing impairments in learning and memory after a hypertensive pregnancy complicated by AKI, additional studies to determine if blockade of I.S. results in improvements in cognition and anxiety are planned.

Short term cardiovascular risk in normotensive women after hypertensive pregnancy

IntroductionHypertensive pregnancy was recognized as a risk factor of cardiovascular events. The aim of our study was to evaluate the short-term cardiovascular risk in normotensive females with previous hypertensive pregnancy. Material and methodsA prospective cohort study was conducted on 50 females with previous normotensive pregnancy and 50 females with previous hypertensive pregnancy. All patients were re-evaluated three months postpartum to be sure that they became normotensive. One year postpartum, all patients were subjected to renal function tests, urinary albumin/creatinine ratio for microalbuminuria, glycated hemoglobin, complete lipid profile, echocardiographic assessment of left ventricular mass index and carotid duplex for measurement of intimal–medial thickness, presence of carotid plaques and stenosis. ResultsNo significant difference between both groups regarding blood pressure level three months postpartum. No significant difference between both groups regarding serum creatinine. Patients with previous hypertensive pregnancy group had significantly higher microalbuminuria compared with previous normotensive pregnancy group (p=0.000). Serum LDL and triglycerides were significantly higher however HDL was significantly lower in those with previous hypertensive pregnancy, however all lipid profile measures were within normal range. No significant difference between both groups regarding left ventricular mass index and carotid intima-media thickness. No evidence of carotid plaques or stenosis in both groups. ConclusionsPrevious hypertensive pregnancy was associated with increased risk of microalbuminuria at short term level even after normalization of blood pressure post-partum. Longer period of follow up is required to establish the potential cardiovascular risk in these patients.

Pregnancy-Related Acute Kidney Injury in Preeclampsia: Risk Factors and Renal Outcomes.

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 μmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6-11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8-2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21-4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.

UTILITY OF THE RATIO SFLT/PIGF TO PREDICT PREECLAMPSIA IN HIGH RISK PREGNANCIES

Objective:-Describe a sample of 79 women who were followed at Internal Medicine[Combining Acute Accent]s office during the first 6 months of 2018. Women were included if they have had a previous hypertensive pregnancy disorder (HPD) or they were at high risk of developing it (chronic hypertension, a

Prevalence of gestational diabetes mellitus and associated risk factors amongst antenatal women attending urban health centre of Rajkot City, Gujarat

Background: Prevalence of gestational diabetes mellitus (GDM) vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at urban health training center in Rajkot city, Gujarat.Methods: This study enrolled women, with estimated gestational age between 24 and 28 week, attending UHC in Rajkot. After informing, women who consented to participate were given a standardized 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension was filled up. Diabetes in pregnancy study group India (DIPSI) criteria for 75 g 2-h OGTT was used for diagnosing GDM.Results: Total of 366 women participated in the study and GDM was diagnosed in 36 (9.8%) women. Age, parity, BMI, family history of DM and hypertension were accessed and found to be not significant. History of hypertension in previous pregnancy was statistically significant with occurrence of GDM in present pregnancy.Conclusions: The prevalence of GDM was found to be 9.8 per cent in a UHC, Rajkot. Appropriate interventions are required for control of GDM and modifications of risk factors.

Regulatory antibodies against GPCR in women ten years after early-onset preeclampsia.

Preeclampsia is associated with an increased cardiovascular risk later in life. Anti-GPCR autoantibodies have been shown to contribute to the development of cardiovascular disease. We investigated whether anti-GPCR autoantibodies are elevated in women with a history of early-onset preeclampsia 8-11 years postpartum, and whether they correlate with clinical outcomes. We investigated data from the Preeclampsia Risk EValuation in FEMales cohort, a retrospective matched case-control study. Anti AT1R-, beta1AR-, ETAR-, PAR1- and CXCR3- autoantibodies were determined in 485 samples by using commercially available ELISA. Women with the lowest combined levels of autoantibodies and a history of early preeclampsia had significantly higher SBP, DBP and MAP (all p<0.001) compared to the controls. The individual titer levels of autoantibodies were not different between controls and former early PE groups 8-11 years postpartum. In conclusion, regulatory autoantibodies alone are not sufficient to explain hypertension or other cardiovascular pathologic conditions, but together with other risk factors such as a previous hypertensive pregnancy, lower levels of autoantibodies are associated with increased blood pressure.

66. Generation R Study: An example of transgenerational prospective cohort studies

Generation R is a unique population-based prospective cohort study ( www.generationr.nl ). The infrastructure has been established in 2002 by recruiting the first cohort consisting of n = 10.000 pregnant women. These mothers and children are currently participating in our 14 years follow-up visit. In 2017 Generation R launched a new large cohort study: Generation R Next. This study is unique since it aims to study the health and lifestyle of mothers before pregnancy; preconceptionally. Since 2006 over 80 PhD theses and 700 peer-reviewed scientific papers have been published. Generation R represents the perfect example of this year’s theme of the ISSHP/ISOM meeting 2018. In our population based pregnancy population we have highlighted the importance of first trimester sFlt-1, PLGF and PAI-2 concentrations in relation to placental function and the risks for preeclampsia and fetal growth restriction. We were among the first to show the importance of fetal sex in placental and maternal adaptation to pregnancy with sexual dimorphic differences in the occurrence of preeclampsia. These studies were accomplished through collaboration within the Global Pregnancy Collaboration (CoLab). Our data collection extends to maternal and child follow-up’s after pregnancy which includes women with previous hypertensive pregnancy disorders. We are now conducting a brain MRI study among women who’s index pregnancy was complicated by preeclampsia 14 years ago. We previously reported on the altered microvasculature, atherogenic lipid profile, increased left ventricular mass and higher blood pressures in those women 6 years after the pregnancy which eventually lead to an almost sevenfold increased risk for chronic hypertension. This indicates that also mild hypertensive pregnancy disorders pose a risk for cardiovascular disease and therefore these women should be offered long-term cardiovascular follow-up. By this means results from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and their children.

177. The P4 study: Gaining insight into women’s mental health and birth experience 6 months after a normotensive or hypertensive pregnancy

Introduction Pregnancy and childbirth are usually positive experiences. However, when complications occur, it may be emotionally traumatic. There is limited research reporting women’s mental health after hypertensive pregnancy and their perspective on the experience. Objectives To compare depression, anxiety and PTSD symptoms between women who were normotensive (NT) and hypertensive (HT) in pregnancy and to compare their birth experience. Methods Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatric) study. Women were studied 6 months after NT or HT pregnancy. Each woman completed questionnaires comprising the Edinburgh Postnatal Depression, General Anxiety Disorder, Posttraumatic Stress Diagnostic and Maternal Infant Bonding Scales and questions, rated on a Likert Scale, regarding birth experience. Results 321 women (237 NT, 84 HT) completed the questionnaires. Both groups were similar in demographics. The HT group experienced more intervention during labour and birth; more had their labour induced (29% NT, 70% HT, p Discussion Six months postpartum, women with a previous HT pregnancy report significantly worse psychological health and birth experiences. Care providers need to include mental health support as part of routine care for women with a HT pregnancy.

Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital.

Background:Hypertensive disease in pregnancy (HDP) accounts for high mother and child morbi-mortality and predict future cardiometabolic diseases. This study aimed to identify obstetric predictors of HDP needing preventive action to reduce its consequences; when women present to antenatal clinic (ANC).Materials and Methods:Cross-sectional descriptive this was an Interviewer-administered semi-structured questionnaire-based study of the anthropometric, and blood pressure measurementsin attendees at the postnatal clinic (PNC) of Jos University with ANC records.Setting:Six weeks postnatal clinic (PNC) of Jos University Teaching Hospital (JUTH).Results:The following indices proved predictive of HDP and subsequent hypertension: weight (P = 0.009), hip circumference (P = 0.018), parity (P = 0.043), waist circumference (P = 0.00), abdominal height (P = 0.040), waist/height (P = 0.020), history of developing hypertension in previous pregnancy (P = 0.000), birth weight of baby (P = 0.02), and mode of delivery (P = 0.05).Conclusion:To initiate preventive action on ANC registration in mitigating effects of or outrightly preventing HDP, careful check on anthropometry as well as history of hypertension or operative/preterm delivery in a previous pregnancy is necessary

447: Increased in planned deliveries contribute to a reduction pregnancy hypertension rates in Australia

To explore whether increases in planned deliveries explain declining rates of pregnancy hypertension in Australia. Population-based record linkage cohort study. From 2001 through 2012, among 1,076,122 deliveries, the rate of pregnancy hypertension (including gestational hypertension, preeclampsia and eclampsia) declined by 22% from 9.9% to 7.7% and preeclampsia by 27% from 3.3% to 2.4% (trend P<0.001). Contemporaneously, planned deliveries (labor induction and prelabor cesarean) increased from 38% to 46% of all deliveries and the proportion occurring at 37-39 weeks increased from 47% to 59%. During the study period, changes in the maternal risk factors for pregnancy hypertension were mostly in a direction that would likely increase the rate of pregnancy hypertension, including increased (P<0.01) nulliparity, age ≥35 years, diabetes, overweight/obesity, and use of assisted reproductive technologies. However trends that might decrease pregnancy hypertension rates also occurred with a decrease in multi-fetal pregnancies, age <20 years, autoimmune diseases and previous pregnancy hypertension. Among women who did not develop pregnancy hypertension, the established risk factors for pregnancy hypertension were positively associated with planned births at 37-39 weeks. An overall left shift in the gestational age distribution was not observed among women with pregnancy hypertension, rather a decline in birth rates at all gestations was seen from 38 weeks. Gestational age-specific pregnancy hypertension rates declined from 38 weeks onwards, most steeply at ≥41 weeks (see Figure). Based on changes in the prevalence of maternal risk factors, the pregnancy hypertension rate was predicted to increase to 10.5%. At least 36% of the decline in pregnancy hypertension was explained by early planned births. Increases in early planned delivery for reasons other than hypertension explain part of the observed decline in pregnancy hypertension rates in Australia.