Hypertensive Disease Of Pregnancy Research Articles

The Association between Low Fetal Fraction of Non-Invasive Prenatal Testing and Adverse Pregnancy Outcomes for Placental Compromise

(1) Background: Non-invasive prenatal testing (NIPT) is a screening test for fetal aneuploidy using cell-free fetal DNA. The fetal fragments (FF) of cell-free DNA (cfDNA) are derived from apoptotic trophoblast of the placenta. The level of fetal cfDNA is known to be influenced by gestational age, multiple pregnancies, maternal weight, and height. (2) Methods: This study is a single-center retrospective observational study which examines the relationship between the fetal fraction (FF) of cell-free DNA in non-invasive prenatal testing (NIPT) and adverse pregnancy outcomes in singleton pregnancies. A total of 1393 samples were collected between 10 weeks and 6 days, and 25 weeks and 3 days of gestation. (3) Results: Hypertensive disease of pregnancy (HDP) occurred more frequently in the low FF group than the normal FF group (5.17% vs. 1.91%, p = 0.001). Although the rates of small for gestational age (SGA) and placental abruption did not significantly differ between groups, the composite outcome was significantly higher in the low FF group (7.76% vs. 3.64%, p = 0.002). Furthermore, women who later experienced complications such as HDP or gestational diabetes mellitus (GDM) had significantly lower plasma FF levels compared to those without complications (p < 0.001). After adjustments, the low FF group exhibited a significantly higher likelihood of placental compromise (adjusted odds ratio: 1.946). (4) Conclusions: Low FF in NIPT during the first and early second trimesters is associated with adverse pregnancy outcomes, particularly HDP, suggesting its potential as a predictive marker for such outcomes.

Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial.

To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low-dose oral misoprostol is superior to intravenous oxytocin. Open-label, superiority randomised trial. Government hospitals in India. Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Participants received misoprostol (25 micrograms, orally, 2-hourly) or titrated oxytocin through an infusion pump. All women had one-to-one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Caesarean birth. A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81-1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207-244 min, vs 194 min, 179-210 min; aOR 1.137; 95% CI 1.023-1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203-1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial.

Postpartum length of hospital stay among obstetric patients in Ibadan, Nigeria

BackgroundPostpartum Length of hospital stay (PLOHS) is an essential indicator of the quality of maternal and perinatal healthcare services. Identifying the factors associated with PLOHS will inform targeted interventions to reduce unnecessary hospitalisations and improve patient outcomes after childbirth. Therefore, we assessed the length of hospital stay after birth and the associated factors in Ibadan, Nigeria.MethodsWe used the Ibadan Pregnancy Cohort Study (IbPCS) data, and examined the 1057 women who had information on PLOHS the mode of delivery [spontaneous vagina delivery (SVD) or caesarean section (C/S)]. The outcome variable was PLOHS, which was described as the time interval between the delivery of the infant and discharge from the health facility. PLOHS was prolonged if > 24 h for SVD and > 96 h for C/S, but normal if otherwise. Data were analysed using descriptive statistics, a chi-square test, and modified Poisson regression. The prevalence-risk ratio (PR) and 95% confidence interval (CI) are presented at the 5% significance level.ResultsThe mean maternal age was (30.0 ± 5.2) years. Overall, the mean PLOHS for the study population was 2.6 (95% CI: 2.4–2.7) days. The average PLOHS for women who had vaginal deliveries was 1.7 (95%CI: 1.5–1.9) days, whereas those who had caesarean deliveries had an average LOHS of 4.4 (95%CI: 4.1–4.6) days. About a third had prolonged PLOHS: SVD 229 (32.1%) and C/S 108 (31.5%). Factors associated with prolonged PLOHS with SVD, were high income (aPR = 1.77; CI: 1.13, 2.79), frequent ANC visits (> 4) (aPR = 2.26; CI: 1.32, 3.87), and antenatal admission: (aPR = 1.88; CI: 1.15, 3.07). For C/S: maternal age > 35 years (aPR = 1.59; CI: 1.02, 2.47) and hypertensive disease in pregnancy (aPR = 0.61 ; CI: 0.38, 0.99) were associated with prolonged PLOHS.ConclusionThe prolonged postpartum length of hospital stay was common among our study participants occurring in about a third of the women irrespective of the mode of delivery. Maternal income, advanced maternal age, ANC related issues were predisposing factors for prolonged LOHS. Further research is required to examine providers’ perspectives on PLOHS among obstetric patients in our setting.

The Role of Regulatory T Cells and Their Therapeutic Potential in Hypertensive Disease of Pregnancy: A Literature Review.

Hypertensive disorders of pregnancy (HDP), including preeclampsia (PE) and gestational hypertension (GH), are major causes of maternal and foetal morbidity and mortality. This review elucidates the role of regulatory T cells (Tregs) in the immunological aspects of HDP and explores their therapeutic potential. Tregs, which play a critical role in maintaining immune homeostasis, are crucial in pregnancy to prevent immune-mediated rejection of the foetus. The review highlights that Tregs contribute to immunological adaptation in normal pregnancy, ensuring foetal acceptance. In contrast, HDP is associated with Treg dysfunction, which is marked by decreased numbers and impaired regulatory capacity, leading to inadequate immune tolerance and abnormal placental development. This dysfunction is particularly evident in PE, in which Tregs fail to adequately modulate the maternal immune response against foetal antigens, contributing to the pathophysiology of the disorder. Therapeutic interventions aiming to modulate Treg activity represent a promising avenue for HDP management. Studies in animal models and limited clinical trials suggest that enhancing Treg functionality could mitigate HDP symptoms and improve pregnancy outcomes. However, given the multifactorial nature of HDP and the intricate regulatory mechanisms of Tregs, the review explores the complexities of translating in vitro and animal model findings into effective clinical therapies. In conclusion, while the precise role of Tregs in HDP is still being unravelled, their central role in immune regulation during pregnancy is indisputable. Further research is needed to fully understand the mechanisms by which Tregs contribute to HDP and to develop targeted therapies that can safely and effectively harness their regulatory potential for treating hypertensive diseases of pregnancy.

Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study.

Women with cardiovascular disease may be at increased risk of hypertensive disorders of pregnancy (HDP). We aimed to: (1) Investigate the occurrence of HDP in a cohort of pregnant women with cardiovascular disease and compare it with the occurrence in the general population. (2) Assess the association between maternal cardiovascular risk and risk of HDP. We reviewed clinical data on a cohort of 901 pregnancies among 708 women with cardiovascular disease who were followed at the National Unit for Pregnancy and Heart Disease and gave birth at Oslo University Hospital between 2003 and 2018. The exposure under study was maternal cardiovascular risk, classified as low, moderate, or high based on a modified classification by the World Health Organization. The main outcome of interest was HDP, which included pre-eclampsia and gestational hypertension. The proportion of HDP cases in the general population in the same period was extracted from the Medical Birth Registry of Norway. We used logistic regression to estimate crude and adjusted odds ratios (OR) of HDP, with associated 95% confidence intervals (CIs), for women with moderate- and high cardiovascular risk compared to women with low risk. The occurrence of HDP in the study cohort was 12.1% (95% CI: 10.0%-14.4%) and varied between 8.7% (95% CI: 6.5%-11.3%) in the low-risk group, 15.7% (95% CI: 11.1%-21.4%) in the moderate-risk group, and 22.2% (95% CI: 15.1%-30.8%) in the high-risk group. By contrast, the nationwide occurrence of HDP was 5.1% (95% CI: 5.1%-5.2%). In the study cohort, the proportions of pregnancies with gestational hypertension and pre-eclampsia were similar (6.3% and 5.8%, respectively). Compared to pregnancies with low cardiovascular risk, the adjusted OR of HDP was 2.04 (95% CI: 1.21-3.44) in the moderate-risk group and 2.99 (95% CI: 1.73-5.18) in the high-risk group. The occurrence of hypertensive disease of pregnancy in the study cohort was more than doubled compared to the general population in Norway. The risk of HDP increased with maternal cardiovascular risk group. We recommend taking into account maternal cardiovascular risk group when assessing risk and prophylaxis of HDP.

Magnesium sulfate and risk of hypoxic ischemic encephalopathy in a high-risk cohort

Hypoxic ischemic encephalopathy contributes to morbidity and mortality among neonates ≥ 360 weeks' gestation. Evidence of preventative antenatal treatment is limited. Magnesium sulfate has neuroprotective properties among preterm fetuses. Hypertensive disorders of pregnancy are a risk factor for hypoxic ischemic encephalopathy and magnesium sulfate is recommended for maternal seizure prophylaxis among patients with pre-eclampsia with severe features. 1) Determine trends in incidence of hypertensive disorders of pregnancy, antenatal magnesium sulfate and hypoxic ischemic encephalopathy, 2) evaluate the association between hypertensive disorders of pregnancy and hypoxic ischemic encephalopathy and 3) evaluate if, among patients with hypertensive disorders of pregnancy, the odds of hypoxic ischemic encephalopathy is mitigated by receipt of antenatal magnesium sulfate. STUDY DESIGN: We conducted an analysis of a prospective cohort of live births ≥360 weeks' gestation between 2012-2018 within the California Perinatal Quality Care Collaborative registry, linked with the California Department of Health Care Access and Information files. We used Cochran-Armitage tests to assess trends in hypertensive disorders, encephalopathy diagnoses, and magnesium sulfate utilization, and compared demographic factors between patients with or without hypertensive disorders of pregnancy or treatment with magnesium sulfate. Hierarchical logistic regression models were built to explore if hypertensive disorders of pregnancy were associated with any severity and moderate/severe hypoxic ischemic encephalopathy. Separate hierarchical logistic regression models were built among those with hypertensive disorders of pregnancy to evaluate the association of magnesium sulfate with hypoxic ischemic encephalopathy. Among 44,314 unique infants, the diagnosis of hypoxic ischemic encephalopathy, maternal hypertensive disorders of pregnancy and the use of magnesium sulfate increased over time. Compared to patients with hypertensive disorders of pregnancy alone, patients with hypertensive disorders treated with magnesium sulfate represented a higher risk population. They were more likely to be publicly insured, born 36-38 weeks' gestation, be small for gestational age, have lower Apgar scores, require a higher level of resuscitation at delivery, have prolonged rupture of membranes, preterm labor, fetal distress, and undergo operative delivery (all p-values <0.002). Hypertensive disorders of pregnancy were associated with hypoxic ischemic encephalopathy (aOR 1.26, 95% CI 1.13-1.40, p-value <.001) and specifically moderate/severe hypoxic ischemic encephalopathy (aOR 1.26, 95% CI 1.11-1.42, p-value <.001). Among patients with hypertensive disorders of pregnancy, treatment with magnesium sulfate was associated with 29% reduction in the odds of neonatal hypoxic ischemic encephalopathy (aOR 0.71, 95% CI 0.52-0.97, p-value= 0.03) and a 37% reduction in the odds of moderate/severe neonatal hypoxic ischemic encephalopathy (aOR 0.63, 95% CI 0.42-0.94, p-value=0.03). Hypertensive disorders of pregnancy are associated with hypoxic ischemic encephalopathy and specifically, moderate/severe disease. Among people with hypertensive disorders, receipt of antenatal magnesium sulfate is associated with significant reduction in the odds of hypoxic ischemic encephalopathy and moderate/severe disease in a neonatal cohort admitted to the NICU ≥360 weeks' gestation. The findings of this observational study cannot prove causality and are intended to be hypothesis generating for future clinical trials on MgSO4 in term infants.

Obstetric and maternal outcomes of IVF and oocyte donation pregnancies among women ages 40-45-a large cohort study.

To analyze the perinatal and maternal outcomes of women ranging in age from 40 to 45 years who gave birth after in vitro fertilization or oocyte donation, compared to spontaneous conception. This retrospective cohort study used electronic data from a national healthcare service from 2000 through 2019. Three groups were compared: spontaneous pregnancy (SC), in vitro fertilization (IVF) utilizing autologous oocytes, and pregnancies resulting from oocyte donation (OD). The primary study outcomes were preterm labor (PTL) before 37 weeks of gestation, and infants classified as small for gestational age (SGA). The cohort included 26,379 SC, 2237 IVF pregnancies, and 300 OD pregnancies for women ages 40-45 years at delivery. Women with OD or IVF had a higher incidence of PTL < 37 weeks compared to women with SC (19.7% vs. 18% vs. 6.9%, p = 0.001), PTL < 34 (7% vs. 4.5% vs. 1.4%, p = 0.001), PTL < 32 (3.7 vs. 2.1 vs. 0.6, p = 0.001). A multivariable logistic regression for PTL < 37 weeks demonstrated that age (OR = 1.18) and hypertensive diseases (OR = 3.4) were statistically significant factors. The OD group had a lower rate of SGA compared to SC (1% vs. 4.3%, p = 0.001), while the IVF group had a higher rate of SGA compared to SC (9.1% vs. 4.3%, p = 0.001). Hypertensive diseases in pregnancy were significantly higher among the OD group and the IVF group compared to SP pregnancies (3.3% vs. 1%, p = 0.002; 2.3% vs. 1%, p = 0.001, respectively). Women ages 40-45 undergoing IVF or OD have a greater risk of PTL, possibly due to higher rates of hypertensive disorders of pregnancy.

Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes.

Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m2 (interquartile range 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. · Sixty-one percent of delivering patients had a BMI330 kg/m2 at delivery.. · There was a higher cesarean rate with increasing delivery BMI.. · For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g..

Pregnancy in myeloproliferative neoplasms.

Myeloproliferative neoplasms (MPN) are associated with a significant risk of thrombosis and the hypercoagulable environment of pregnancy increases this risk. The most frequent gestational complications consist of spontaneous abortion, thrombosis, bleeding, and hypertensive disease of pregnancy. Treatment depends on thrombotic risk, gestational trimester, and myeloproliferative neoplasm.

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

IntroductionIt is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood.MethodsRetrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders.ResultsPregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147).Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069).ConclusionPregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies.Graphical

The relationship between severe hypertensive diseases of pregnancy and moderate-severe bronchopulmonary dysplasia.

Determine the association between severe hypertensive disease of pregnancy (HDP) with moderate-severe bronchopulmonary dysplasia (BPD) in preterm infants (< 31 weeks' gestation). Preterm birth cohort study of 693 mother-infant dyads. Severe HDP was defined as severe preeclampsia, HELLP syndrome or eclampsia. The outcome was moderate-severe BPD classified at 36 weeks corrected gestational age, per the NICHD Consensus statement. 225 (32%) mothers developed severe HDP and 234 (34%) infants had moderate-severe BPD. There was an interaction between severe HDP and gestational age (p = 0.03). Infants born at < 25 weeks gestation to mothers with HDP had increased odds for moderate-severe BPD compared to infants of normotensive mothers delivering at the same gestational age. Infants born > 28 weeks to mothers with severe HDP had decreased odds for the outcome, though not statistically significant. Severe HDP has a differential effect on the development of moderate-severe BPD based on gestational age.

Postnatal Genetic and Neurodevelopmental Assessment in Infants Born at Term With Severely Low Birth Weight of Non-placental Origin

ABSTRACT Small for gestational age (SGA) newborns are generally defined as those with a birth weight below the 10th percentile. Fetuses diagnosed with fetal growth restriction (FGR) are usually evaluated to determine if there is a pathological cause and thus a higher risk for adverse outcomes due to being small. Often when this diagnosis is made early in the third trimester, chromosomal microarray analysis is recommended to detect genetic disease. This study was designed to determine the frequency of monogenic disorders in term infants with severely low birth weight but normal Doppler results, as well as to estimate the frequency of neurodevelopmental impairment when a genetic etiology was ruled out. Inclusion criteria for this study were singleton pregnancy; term delivery; birth weight more than 2.5 SDs below the mean; normal Doppler studies of the umbilical artery, fetal middle cerebral artery, cerebroplacental ratio, and uterine artery; no maternal hypertensive disease; and no prenatal fetal structural or identified genetic anomalies or fetal infection. Exclusion criteria included incomplete data. Exome sequencing was completed using saliva sampling and blood sampling, and standard neurodevelopmental assessment techniques were used for children 2 to 3.5 and 6 to 8 years old. Children aged between 3.5 and 6 years were not included because of lack of standardized neurodevelopmental testing. A total of 63 families were contacted, and 7 (11%) reported that a genetic disorder had been diagnosed after birth. In addition, 18 individuals without a known genetic disorder who met all the criteria underwent exome sequencing and neurodevelopmental testing. Of the 7 who reported a postnatally diagnosed genetic syndrome, 5 were Mendelian monogenetic and 2 were epigenetic, including Cockayne syndrome; short stature, microcephaly, and endocrine dysfunction syndrome; Renpenning syndrome; Noonan syndrome; Russell-Silver syndrome; and Prader-Willi syndrome. Median birth weight among the children with genetic disorders was not different from children without. Exome sequencing was normal in the 18 children who were tested and who had not been previously diagnosed with a genetic syndrome. None of the children showed less than average neurodevelopment on overall assessment in the lower age group. In the higher age group, 2 children were classified as having low IQ, with one borderline and one extremely low, with low scores in all other domains as well. In addition, 6 individuals showed a low score in at least 1 of the 5 domains, with the largest deviations showing in the domains of verbal comprehension and working memory. Clinicians should be aware of the potential outcomes of FGR even when other complications are not present. Counseling about genetic analysis prenatally or within a short postnatal timeframe could save a lot of time and effort in evaluating children later. In addition, children should be carefully assessed in later childhood for neurodevelopmental differences that are treatable or that may require different resources. Future research should focus on further homogenizing the population to get more accurate results, as well as dealing with potential biases in this study.

Maternal sepsis - challenges in diagnosis and management: A mini-summary of the literature

Abstract Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

Heterogeneity in the risk of cardiovascular disease mortality after the hypertensive disorders of pregnancy across mothers' lifetime reproductive history.

Prior studies on maternal cardiovascular disease (CVD) mortality and hypertensive disorders of pregnancy (HDP) have focused only on a woman's first birth and have not accounted for successive affected pregnancies. The objective of this study is to identify mothers' risk of CVD mortality considering lifetime reproductive history. We used data from the Medical Birth Registry of Norway, the Norwegian Cause of Death Registry, and the Norwegian National Population Register to identify all mothers who gave birth from 1967 to 2020. Our outcome was mothers' CVD death before age 70. The primary exposure was the lifetime history of HDP. The secondary exposure was the order of HDP and gestational age at delivery of pregnancies with HDP. We used Cox regression models to estimate hazard ratio (HR) and 95% confidence interval (CI), adjusting for education, mother's age, and year of last birth. These models were stratified by the lifetime number of births. Among 987,378 mothers, 86,294 had HDP in at least one birth. The highest CVD mortality, relative to mothers without HDP, was among those with a pre-term HDP in their first two births, although this represented 1.0% of mothers with HDP (HR 5.12, 95% CI 2.66, 9.86). Multiparous mothers with term HDP in their first birth only had no increased risk of CVD relative to mothers without HDP (36.9% of all mothers with HDP; HR 1.12, 95% CI 0.95, 1.32). All other mothers with HDP had a 1.5- to 4-fold increased risk of CVD mortality. This study identified heterogeneity in the risk of CVD mortality among mothers with a history of HDP. A third of these mothers are not at higher risk compared to women without HDP, while some less common patterns of HDP history are associated with severe risk of CVD mortality.

Pregnancy Outcomes of Women With Hypertensive Disease in Lagos State, Nigeria

This study investigates the differences in pregnancy outcomes among women with hypertensive disease in pregnancy, with and without mental health disorders, in Lagos State, Nigeria. Utilizing a longitudinal research design, data was collected from pregnant women in their 20-24 weeks of gestation through delivery and postpartum. The sample size of 300 was determined using the Cochran formula, with participants selected from six maternal and child health centers across three senatorial districts. A validated questionnaire comprising fifteen questions assessed pregnancy outcomes, and statistical analyses included descriptive and inferential statistics. Results revealed no significant associations between mental health status and gestational age, mode of delivery, duration of labor, or delivery period. Apgar scores at 1 and 5 minutes also showed no significant association with mental health status. However, a notable association was found between mental health status and birth weight, indicating a higher prevalence of low-birth-weight infants among women with mental health disorders. Other factors, including estimated blood loss, postpartum packed cell volume, blood transfusion, duration of hospital admission, and NICU admission, showed no significant associations with mental health status. In conclusion, birth weight is significantly associated with the mental status of pregnant women with hypertensive disease, while other factors appear to have negligible impact. Recommendations include routine mental health assessments, early detection, and intervention for better maternal mental health outcomes. Midwives are advised to implement early monitoring of fetal growth, emphasizing closer prenatal care and nutritional counseling to reduce the risk of mental health disorders in pregnant women.

Incidence of hypertensive disorders of pregnancy and causes of maternal deaths due to hypertensive disorders of pregnancy: A Restrospective cohort study

Abstract Background: Maternal mortality is one of the prime health-care level and quality indicators of a country. The causal changing trends of maternal mortality demand a fair and constant revision of facilities provided to new mothers. We need an in-detail analysis of the recent trends and causes and the entire spectrum of it. Objective: The objective is to study the incidence of hypertensive disorders of pregnancy (HDP) and the causes of maternal deaths due to HDP. Materials and Methods: A retrospective cohort study was carried out over 3 years. Maternal death and hypertensive disorder of pregnancy were defined as per standard guidelines. The obstetric and demographic variables were recorded. The risk ratio with its 95% confidence interval was calculated. Results: The incidence of HDP was 33.8% in a total of 29,125 deliveries that took place in 3-year period. Total maternal deaths were 222 (0.76%), and among these, 78 cases (35.1%) had HDP. HDP had a significant effect on intrauterine deaths and hospital stays. The most common form of HDP was preeclampsia in 57.7%. The most common complication that occurred in HDP maternal deaths was pulmonary edema in 21.5% of the cases. Conclusion: The incidence of HDP was high in the present study center. The deaths due to HDP are also high owing to the maximum number of patients being referred from other places in late stages. Regular antenatal care, educating the society, early diagnosis of risk factors, and early referral forms are the important factors to be considered to prevent maternal death.

Evaluation of postpartum shock index in hypertensive diseases of pregnancy: acase-control study from a tertiary reference center.

To compare the postpartum shock index (SI) values between pregnant women with hypertensive disease of pregnancy (HDP) and normotensive controls. The present study was conducted in Ankara City Hospital Perinatology Clinic. Postpartum SI was compared between the pregnant women with HDP (n=217) and normotensive controls (n=219). A logistic regression analysis was performed to assess the independent predictors of maximum SI≥1. Finally, a ROC analysis was performed to calculate optimal cut-off values for postpartum SI's measured at different periods in the prediction of postpartum Hb (hemoglobin) decrease≥2 g/dL. Peripartum SI (p<0.001), 15th min SI (p<0.001), 30th min SI (p<0.001), 2nd h SI (p<0.001), 6th h SI (p)of the HDP group (p<0.001) and max SI (p<0.001) values were found to be significantly lower in the study group. A weak positive and statistically significant correlation was found between the maximum SI and the decrease in Hb≥2 g/dL (r=0.209; p=0.002). Optimal cutoff values for SI were; 0.7 at peripartum 0.7 at 15 min, 0.73 at 30 min, 0.6 at 2 h, and 0.7 at 6 h, respectively. Clinically significant blood loss may develop at lower SI values in hypertensive pregnant women.

Nutritional support during pregnancy

Aim: to summarize new data regarding the effectiveness of nutritional support during pregnancy.Materials and Methods. A search for publications was carried out in the PubMed/MEDLINE, Scopus, Web of Science, RSCI databases by retrieving queries for the following keywords: nutritional support, pregnancy, micronutrients, vitamins, macronutrients, without language restrictions. 71 sources with full text access were selected for analysis.Results. Nutritional status during pregnancy markedly impacts on mother's and neonate’s health. During pregnancy, requirements for macro- and micronutrients increase to maintain maternal homeostasis and support fetal growth. Increasing calorie intake in general female population demonstrates modest effects on pregnancy and fetal outcomes, whereas for pregnant women in poor income countries it results in no long-term benefits for children by assessing their anthropometric parameters and neurocognitive development. Despite the lack of conclusive evidence, in many countries sensible calorie restriction during pregnancy is recommended. Some micronutrients are vital for mother and fetus, because their deficiency is accompanied by increased risk of adverse pregnancy outcomes. For instance, folic acid deficiency is associated with the risk of developing fetal neural tube defects, iodine deficiency is coupled to the risk of emerging pediatric intellectual development disorders associated with congenital hypothyroidism, and calcium deficiency is related to a high risk of maternal hypertensive disorders. Therefore, micronutrient supplementation represents a technology with good potential in fighting for maternal and child health. Nonetheless, despite some advances in understanding nutritional support in pregnant women, many studies provide controversial data substantiating a need to conduct further investigations.Conclusion. Overall, recent year research confirms that the supplementation of micro- and macronutrients during pregnancy is an effective tool for “fetal programming” allowing to impact on maternal and fetal health. At the same time, an analysis of the literature showed a significant lack of research in the field of creating individual nutrition programs and nutritional support for pregnant women belonging to different segments of the population, living in different geographical regions, etc.

Routine first-trimester pre-eclampsia screening and maternal left ventricular geometry.

Pre-eclampsia (PE) is a pregnancy complication associated with premature cardiovascular disease morbidity and mortality (i.e. before 60 years of age or in the first year postpartum). PE is associated with adverse left ventricular (LV) remodeling in the peri- and postpartum periods, an independent risk factor for cardiovascular disease. This study aimed to compare LV geometry by LV mass (LVM) and LVM index (LVMI) between participants with a high vs low screening risk for preterm PE in the first trimester. This was a prospective cohort study of singleton pregnancies between 11 + 0 and 13 + 6 weeks' gestation that underwent screening for preterm PE as part of their routine first-trimester ultrasound assessment at a tertiary center in London, UK, from February 2019 until March 2020. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm. Participants with a screening risk of ≥ 1 in 50 for preterm PE were classified as high risk and those with a screening risk of ≤ 1 in 500 were classified as low risk. All participants underwent two-dimensional and M-mode transthoracic echocardiography. A total of 128 participants in the first trimester of pregnancy were included in the analysis, with 57 (44.5%) participants screened as low risk and 71 (55.5%) participants as high risk for PE. The risk groups did not vary in maternal age and gestational age at assessment. Maternal body surface area and body mass index were significantly higher in the high-risk group (all P < 0.05). The high-risk participants were significantly more likely to be Afro-Caribbean, nulliparous and have a family history of hypertensive disease in pregnancy as well as other cardiovascular disease (all P < 0.05). In addition, mean arterial blood pressure (P < 0.001), mean heart rate (P < 0.001), median LVM (130.06 (interquartile range, 113.62-150.50) g vs 97.44 (81.68-114.16)g; P < 0.001) and mean LVMI (72.87 ± 12.2 g/m2 vs 57.54 ± 12.72 g/m2 ; P < 0.001) were significantly higher in the high-risk group. Consequently, those in the high-risk group were more likely to have abnormal LV geometry (37.1% vs 7.0%; P < 0.001). Early echocardiographic assessment in participants at high risk of preterm PE may unmask clinically healthy individuals who are at increased risk for future cardiovascular disease. Adverse cardiac remodeling in the first trimester of pregnancy may be an indicator of decreased cardiovascular reserve and subsequent dysfunctional cardiovascular adaptation in pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Hypertensive states of pregnancy and maternal-perinatal complications at the Regional Hospital of Ciudad del Este

Introducción: Los estados hipertensivos del embarazo son un conjunto de patologías que puede producir muerte o discapacidad crónica en las madres, en los fetos y recién nacidos. Objetivo: Determinar la frecuencia de los estados hipertensivos del embarazo y las complicaciones materno-perinatales en el Hospital Regional de Ciudad del Este. Materiales y métodos: Estudio transversal descriptivo con muestreo no probabilístico. Se estudiaron a todas las mujeres embarazadas con estados hipertensivos del embarazo o asociado al mismo que tuvieron eventos obstétricos en el Hospital Regional de Ciudad del Este en los años 2018 al 2020. Los datos fueron analizados en el Software Stata 12.0. Resultados: Se estudiaron a 7056 pacientes. Se encontraron 11,9% participantes con estados hipertensivos del embarazo, 55,3% con mayor frecuencia entre los 20 a 35 años, el 71,3% tuvieron control prenatal de mala calidad, se encontraron el 42,8% con preeclampsia. El 65,2% terminaron por cesárea, 27,8% Síndrome de HELLP, el 1,4% presentaron requerimiento de terapia intensiva y 0,6% muerte materna. Con respecto a las complicaciones perinatales se encontraron bajo peso al nacer en 30,2% y muerte del 2%. Conclusión: Se registró alta frecuencia de estados hipertensivos del embarazo con alto porcentaje de complicaciones, mala calidad de control prenatal. Entre las complicaciones perinatales más frecuentes fueron el bajo peso al nacer y la más grave es la muerte.