Hypertensive Disease Of Pregnancy Research Articles

Intrapartum magnesium sulfate exposure and obstetric hemorrhage risk

Background The gold standard intrapartum treatment for preeclampsia with severe features is magnesium sulfate in order to provide prophylaxis against eclampsia. However, though magnesium sulfate is known to have a relaxant effect on uterine muscle, there have been variable reports in the literature in regard to the association between magnesium and obstetric hemorrhage (OBH). Objective We aim to compare OBH incidence in patients with hypertensive disease of pregnancy (HDP) with or without exposure to intrapartum magnesium sulfate. Methods We performed a retrospective cohort study of all deliveries at our institution associated with a diagnosis of hypertensive disease of pregnancy (HDP) (e.g. chronic and gestational hypertension, preeclampsia with or without severe features, eclampsia, or HELLP) from January 1, 2018 to December 31, 2019. The category of HDP diagnosis was determined by a detailed chart review by trained chart abstractors. The primary outcome was total quantitative blood loss (QBL) and the rate of obstetric hemorrhage. Secondary outcomes included a composite of obstetric hemorrhage-related maternal morbidity outcomes (OBH-M), the individual composite components and the incidence of additional hemorrhage-related interventions (e.g. uterotonics and surgical interventions). We also examined the same primary and secondary outcomes in a stratified analysis based on delivery mode (i.e. vaginal deliveries only and cesarean deliveries only). Results Of 791 patients with a diagnosis of HDP, 411 patients received magnesium sulfate for eclampsia prophylaxis and 380 patients did not receive magnesium sulfate. For all delivery modes, there was a significantly higher QBL (p < .01), increased rate of OBH (p = .04) and increased OBH-M (p < .01) in deliveries associated with intrapartum exposure to magnesium compared to those without. However, our stratified analysis by delivery mode demonstrated that magnesium-related hemorrhage risk only persisted for vaginal deliveries (QBL p < .01; OBH aOR 1.47, 95% CI: 0.75–2.85; OBH-M aOR 1.47, 95% CI 1.00–7.55) with no significant hemorrhage-related differences among cesareans with or without magnesium exposure (QBL p = .51; OBH aOR 1.45, 95% CI: 0.85–2.47; OBH-M 1.50 95% CI: 0.70–3.23). Conclusion Intrapartum exposure to magnesium sulfate use was associated with an increase in QBL and risk of OBH-M in vaginal deliveries, but not associated with any hemorrhage-related outcome differences in cesarean deliveries. More research is needed to explore the effects of hypertensive disease, magnesium exposure, and delivery mode on obstetric hemorrhage risk.

A Prospective Clinical Study of FETO-Maternal Outcome in Pregnancies with Abnormal Amniotic Fluid Index

Background: We report a clinical study of fetomaternal outcome in pregnancies with abnormal liquor volume managed at a tertiary care hospital&#x0D; Methods: This study was conducted in the Department of Obstetrics and Gynaecology, S.P Medical College, Bikaner&#x0D; Results- In. In oligohydramnios group 90.8%babies were healthy while8.4%were died in NICU and0.8% were still birth while in polyhydramnios group 76% babies were healthy while 4% were died in NICU and20%babies were still birth. Still birth rate in very high in polyhydramnios group. This difference was found statistically highly significant (p&lt;0.001).&#x0D; Conclusion: Development of abnormal liquor volume during pregnancy signals danger to the foetus. It is associated with an increased incidence of caesarean section, labour complications and adverse perinatal outcome. But isolated oligo and polyhydramnios in term gestation has better perinatal outcome compared to early onset and with associated conditions like hypertensive diseases of pregnancy, GDM, IUGR. Ultrasound is the ideal method to detect any abnormality in liquor volume. If any abnormality is detected during the ultrasound, a careful search should be made to detect any identifiable congenital anomalies.&#x0D; Keywords: Oligohydramnios, Polyhydramnios, Fetomaternal

Perinatal risk factors for congenital hypothyroidism in very preterm infants: a multicenter prospective study

Objective: To investigate the incidence and perinatal risk factors of congenital hypothyroidism (CH) in very preterm infants. Methods: This prospective, multicenter observational cohort study was conducted at 33 neonatal intensive care units based on the data from Sina-northern Neonatal Network (SNN). Perinatal information and thyroid function of 3 179 very preterm infants with gestational age <32 weeks who were born from January 2019 to June 2021 was collected. According to the occurrence of CH during hospitalization, all the infants were assigned into CH group and non-CH group. Chi square test, Fisher exact probability method, rank sum test and multivariate Logistic regression model were tested to detect the perinatal risk factors for CH. Results: A total of 3 179 very preterm infants were enrolled with 56.4% (1 793/3 179) male. The incidence of CH was 6.9% (220/3 179), in which the incidence for extremely low birth weight infant (ELBWI) and extremely preterm infants (EPI) of gestational age <28 weeks were 13.5% (64/475) and 13.9% (66/475), respectively. On Logistic regression analysis, maternal hypertensive disorders of pregnancy (OR=1.59, 95%CI 1.14-2.23, P=0.007) and multiple birth (OR=1.60, 95%CI 1.18-2.17, P=0.003) were both significant perinatal risk factors of CH. In addition, gestational age (OR=0.81, 95%CI 0.71-0.93, P=0.002), birth weight (OR=0.99, 95%CI: 0.98-0.99, P<0.001) and 1 min Apgar score (OR=0.92, 95%CI 0.86-0.98, P=0.008) were protective factors. Conclusions: The incidence of CH is high in very preterm infants which increased with the decreased birth weight and gestational age. For very premature infants with perinatal high risk factors such as hypertensive disorders of pregnancy, attention should be paid to assess thyroid function status dynamically.

Ambient temperature during pregnancy and risk of maternal hypertensive disorders: A time-to-event study in Johannesburg, South Africa

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22–43 weeks' gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017–June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low and high temperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively. Of 7986 women included, 844 (10.6%) had a hypertensive disorder of which 432 (51.2%) had high blood pressure/hypertension/gestational hypertension and 412 (48.8%) had pre-eclampsia/eclampsia/HELLP. High temperature in early pregnancy was associated with an increased risk of pre-eclampsia/eclampsia/HELLP. High temperature (23 °C vs 18 °C) in the third and fourth weeks of pregnancy posed the greatest risk, with hazard ratios of 1.76 (95% CI 1.12–2.78) and 1.79 (95% CI 1.19–2.71), respectively. Whereas, high temperatures in mid-late pregnancy tended to protect against pre-eclampsia/eclampsia/HELLP. Low temperature (11°) during the third trimester (from 29 weeks’ gestation) was associated with an increased risk of high blood pressure/hypertension/gestational hypertension, however the strength and statistical significance of low temperature effects were reduced with model adjustments. Our findings support the hypothesis that high temperatures in early pregnancy increase risk of severe hypertensive disorders, likely through an effect on placental development. This highlights the need for greater awareness around the impacts of moderately high temperatures in early pregnancy through targeted advice, and for increased monitoring of pregnant women who conceive during periods of hot weather.

Longitudinally Tracking Maternal Autonomic Modulation During Normal Pregnancy With Comprehensive Heart Rate Variability Analyses.

Changes in the maternal autonomic nervous system are essential in facilitating the physiological changes that pregnancy necessitates. Insufficient autonomic adaptation is linked to complications such as hypertensive diseases of pregnancy. Consequently, tracking autonomic modulation during progressing pregnancy could allow for the early detection of emerging deteriorations in maternal health. Autonomic modulation can be longitudinally and unobtrusively monitored by assessing heart rate variability (HRV). Yet, changes in maternal HRV (mHRV) throughout pregnancy remain poorly understood. In previous studies, mHRV is typically assessed only once per trimester with standard HRV features. However, since gestational changes are complex and dynamic, assessing mHRV comprehensively and more frequently may better showcase the changing autonomic modulation over pregnancy. Subsequently, we longitudinally (median sessions = 8) assess mHRV in 29 healthy pregnancies with features that assess sympathetic and parasympathetic activity, as well as heart rate (HR) complexity, HR responsiveness and HR fragmentation. We find that vagal activity, HR complexity, HR responsiveness, and HR fragmentation significantly decrease. Their associated effect sizes are small, suggesting that the increasing demands of advancing gestation are well tolerated. Furthermore, we find a notable change in autonomic activity during the transition from the second to third trimester, highlighting the dynamic nature of changes in pregnancy. Lastly, while we saw the expected rise in mean HR with gestational age, we also observed increased autonomic deceleration activity, seemingly to counter this rising mean HR. These results are an important step towards gaining insights into gestational physiology as well as tracking maternal health via mHRV.

Deliveries Among Patients Aged 11-19 Years and Risk for Adverse Pregnancy Outcomes.

To characterize delivery hospitalization trends of patients aged 11-19 years and associated comorbidities and outcomes. For this repeated cross-sectional analysis, deliveries to patients aged 11-54 years were identified in the 2000-2018 National Inpatient Sample. Temporal trends in deliveries to patients aged 11-14 years and 15-19 years were analyzed using joinpoint regression to estimate average annual percent change with 95% CIs. The association of deliveries among patients aged 11-19 years with other comorbid conditions was analyzed. The relationship between delivery among patients aged 11-19 years and adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted and adjusted odds ratios (aORs) as measures of effect. An estimated 73,198,153 delivery hospitalizations from 2000 to 2018 were included, of which 88,363 were to patients aged 11-14 years and 6,359,331 were to patients aged 15-19 years. The proportion of delivery hospitalizations among patients aged 11-14 years decreased from 2.1 to 0.4 per 1,000 from 2000 to 2018 (average annual percent change -7.8%, 95% CI -8.5% to -7.2%). Deliveries to patients aged 15-19 years decreased from 2000 to 2018, from 11.5% to 4.8% of all deliveries (average annual percent change -4.9%, 95% CI -5.6% to -4.3%). For deliveries among patients aged 11-19 years, rates of obesity, mental health conditions, substance use disorder, asthma, and pregestational and gestational diabetes all significantly increased over the study period. From 2000 to 2018, rates of severe maternal morbidity (average annual percent change 2.4%, 95% CI 1.6-3.1%), postpartum hemorrhage (average annual percent change 2.4%, 95% CI 1.4-3.4%), cesarean delivery (average annual percent change 1.3%, 95% CI 0.9-1.7%), and hypertensive disorders of pregnancy (average annual percent change 3.3%, 95% CI 2.8-3.8%) all increased significantly among deliveries to patients aged 11-19 years. Compared with deliveries to patients aged 20-54 years, deliveries to patients aged 11-14 years were associated with increased risk for severe maternal morbidity (aOR 1.73, 95% CI 1.49-2.00), hypertensive disorders of pregnancy (aOR 1.79, 95% CI 1.71-1.88), and postpartum hemorrhage (aOR 1.37, 95% CI 1.27-1.49). Deliveries among patients aged 11-19 years have decreased, but both comorbidity and risk for adverse outcomes increased among this age group.

Maternal Hypertension and Offspring Cardiometabolic Disease Risk is Attenuated after Weight Loss in Obese Preeclamptic‐like BPH/5 Female Mice

Preeclampsia (PE) is a life‐threatening disorder of pregnancy that presents as late gestational hypertension and at least one other sign/symptom, such as proteinuria. It occurs in ~10% of pregnant women worldwide and the cause is unknown. Pre‐existing maternal hypertension and obesity has been associated with adverse outcomes, including PE and fetal growth restriction (FGR). To better understand the relationship of maternal PE risk (hypertension/obesity) and outcomes, we utilized the hyperphagic obese hypertensive BPH/5 mouse model of superimposed PE. We hypothesized that monitored food intake, via pair‐feeding the amount of normal chow consumed by age‐ and gestation‐matched lean normotensive C57 to BPH/5 mice, would attenuate maternal and offspring PE adverse outcomes.We have shown that adult BPH/5 female mice have an adverse cardiometabolic phenotype, hypertension, obesity with increased white adipose tissue (WAT), and dyslipidemia that is exaggerated by pregnancy. To test our hypothesis, BPH/5 and C57 females were instrumented with carotid catheters for radiotelemetric blood pressure monitoring prior to pregnancy. As previously described, pair‐feeding (PF) non‐pregnant BPH/5 female mice decreases body weight and WAT mass. When PF was performed for 10 days, we found a decrease in mean arterial pressure in BPH/5 PF versus ad libitum (AL) fed females (PF:121±2.8 vs AL:133±6 mmHg; n=3; p&lt;0.05). When PF was performed in BPH/5 beginning at copulatory plug detection, embryonic day (e) 0.5, they failed to show a late‐gestational blood pressure rise from baseline (n=3; p&gt;0.05) and attenuated proteinuria (PF: 84±15 vs AL: 177±16.5mg/dL; n=5; p&lt;0.05). The PF paradigm increased median BPH/5 litter size (PF: 7, max‐min: 3‐8 vs AL:3, max‐min: 1‐6; n=26; p&lt;0.05) and improved symmetrical FGR at e18.5 as assessed by fetal liver: body weight (PF: 13.63±0.7 vs AL:10.51±1.3; n=10; p&lt;0.05).As BPH/5 female offspring age, they exhibit excessive catch‐up growth with FGR at birth and obesity with hyperleptinemia by adulthood (8 weeks) unlike male littermates. Adult female BPH/5 have cardiomegaly, hypertension, and bradycardia (n=7; p&lt;0.05). Furthermore, adult female BPH/5 have hepatomegaly with microvesicular steatosis (p&lt;0.05, n=3‐9). Importantly, adult BPH/5 female offspring born to PF BPH/5 mothers do not display these cardiometabolic risk factors: obesity (PF: 18±1.8 vs AL: 21±0.3g; n=16; p&lt;0.05), hyperleptinemia (PF: 5.5±0.8 vs AL: 12.6±3.1ng/mL; n=6; p&lt;0.05), hepatomegaly (PF: 1178±27 vs AL: 1475±69mg; n=16; p&lt;0.05), and cardiomegaly (PF: 135.1±5.1 vs AL: 166.8±12.8mg; n=6; p&lt;0.05) with age. Further investigations are necessary to understand the mechanism whereby maternal hyperphagia prevention and weight loss in BPH/5 improves offspring cardiometabolic disease as they age in a sex‐dependent manner. Finally, we seek to determine if interventions during pregnancy not only improve maternal cardiometabolic health, but also that of subsequent generations through augmented fetal programming during PE.

Preeclampsia diagnosis and management.

Preeclampsia is a severe manifestation of maternal hypertensive disease affecting 2-8% of pregnancies. The disease places women at risk of women at risk of life-threatening events, including cerebral hemorrhage, pulmonary edema, acute kidney injury, hepatic failure or rupture, disseminated intravascular coagulation, eclampsia, and placental abruption. In addition to the maternal disease burden, increased fetal morbidity and mortality occurs due to iatrogenic preterm delivery, fetal growth restriction, and placental abruption. Magnesium therapy for seizure prophylaxis and blood pressure control to limit cardiovascular and cerebrovascular morbidity are the cornerstone of treatment. Interdisciplinary planning and management are crucial to optimizing patient outcomes.

Obstetric and Neonatal Outcomes following COVID-19 Vaccination in Pregnancy.

COVID-19 infection imposes a risk for pregnant individuals and may lead to adverse maternal and obstetric outcomes. This is a retrospective cohort study of all women giving birth between March and July 2021 at a single tertiary center. Obstetric and neonatal outcomes were compared between vaccinated and non-vaccinated pregnant women with singleton pregnancies. Women with prior COVID-19 infection, multiple gestations and stillbirth were excluded from the study. Of 4708 women who delivered during the study period, 3700 met the eligibility criteria, of whom 3240 were vaccinated during pregnancy. Compared with the non-vaccinated group, the vaccinated group was characterized by a lower rate of smoking (3.70% vs. 6.67%, p = 0.0028), whereasother maternal characteristics were not significantly different. Multivariable analysis demonstrated that COVID-19 mRNA vaccination was not significantly associated with increased risk of preterm birth as well as other adverse obstetric outcomes including hypertensive diseases of pregnancy, cesarean delivery and small for gestational age. However, a significantly lower risk for meconium-stained amniotic fluid was observed among the vaccinated group (adjusted odds ratio 0.63; 95% confidence interval, 0.46–0.86, p = 0.0039). Moreover, the vaccine was not significantly associated with increased risk of neonatal adverse outcomes including respiratory complications and NICU hospitalization. In conclusion, BNT162b2 messenger RNA vaccination during pregnancy was not associated with an increased rate of adverse obstetric and neonatal outcomes. Therefore, in view of its safety on one hand, and the risk associated with COVID-19 disease in pregnancy on the other hand, BNT 162b2 COVID-19 vaccine should be recommended for pregnant women.

Hypertensive diseases of pregnancy and risk of breast cancer in the Black Women's Health Study.

Compared to white women, Black women have increased risk of developing hypertensive diseases of pregnancy (HDOP) and have a higher incidence of aggressive breast cancer subtypes. Few studies of HDOP and breast cancer risk have included large numbers of Black women. This study examined the relation of HDOP to incidence of breast cancer overall and by estrogen receptor(ER) status in Black women. We followed 42,982 parous women in the Black Women's Health Study, a nationwide prospective study of Black women. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess associations of self-reported HDOP, including preeclampsia and gestational hypertension, with breast cancer incidence overall and by ER subtype, adjusted for age and established breast cancer risk factors. Over 20years of follow-up, we identified 2376 incident breast cancer cases. History of HDOP (11.7%) was not associated with breast cancer risk overall (HR 0.98; 95% CI 0.87, 1.11). HRs for invasive ER+ and ER- breast cancer were 1.11 (95% CI 0.93, 1.34) and 0.81 (95% CI 0.61, 1.07), respectively. HDOP was not associated with risk of overall breast cancer in Black women. A suggestive inverse association with ER- breast cancer may reflect an anti-tumorigenic hormone profile in HDOP, but those results require confirmation in other studies.

Maternal Hypertension Disorders and Neonatal Acute Kidney Injury: Results from the AWAKEN Study.

This study aimed to examine the association between maternal hypertension (HTN) exposure and neonatal acute kidney injury (AKI). Retrospective cohort study of 2,162 neonates admitted to 24 neonatal intensive care units (NICUs). Neonates were classified into the following exposure groups: any maternal HTN, chronic maternal HTN, preeclampsia/eclampsia, both, or neither. Demographics, clinical characteristics, and AKI status were compared using Chi-square and analysis of variance. General estimating logistic regression was used to estimate adjusted odds ratios and included a stratified analysis for site of delivery. Neonates exposed to any maternal HTN disorder had a tendency toward less overall and early AKI. When stratified by inborn versus outborn, exposure to both maternal HTN disorders was associated with a significantly reduced odds of early AKI only in the inborn neonates. Exposure to maternal HTN, especially preeclampsia/eclampsia superimposed on chronic HTN, was associated with less likelihood of early AKI in the inborn group. · Maternal HTN is associated with less neonatal AKI.. · Maternal HTN category is variably associated with AKI.. · Inborn status is an important contributor to this association..

Retinopathy of Prematurity: A Review of Risk Factors, Oxygen Targets, Screening Criteria

Retinopathy of Prematurity (ROP) is a disease of immature retinal tissue that is strongly associated with prematurity, low birth weight, and prolonged oxygen exposure. The purpose of this review is to evaluate published literature to determine which factors can be linked to the development of ROP, which factors are protective against ROP, and which factors are still unclear. It also sought to review the major oxygenation trials in premature infants to establish the recommended oxygen saturation targets in premature babies and what criteria are useful in evaluating infants for ROP. Databases (PubMed, Medline, PubMed Central, and Google Scholar) were used to obtain relevant literary articles. Key findings suggested that major risk factors for ROP were prematurity, low birth weight, and prolonged oxygen exposure. Evidence suggests that maternal diabetes, maternal smoking, prolonged rupture of membranes, lack of antenatal steroids, ethnicity, multiple births, low Apgar scores, and sepsis are risk factors for the development of ROP. Evidence suggests that maternal hypertensive disorders, mode of birth, and chorioamionitis are not associated with ROP. Recommendations of oxygen saturations in the neonate include targets of 90-95% and 90-94%. Screening for ROP is dependent on birth weight, gestational age, and risk factors, with recommendations varying according to pediatric societies.

Molecular Advances in Preeclampsia and HELLP Syndrome.

Preeclampsia (PE) constitutes one of the principal reasons for maternal and perinatal morbidity and mortality worldwide. The circumstance typically implicates formerly healthful normotensive women, after 20 weeks of gestation, typically withinside the third trimester, without regarded threat elements or past deliveries. PE can be further complicated with hemolysis and thrombocytopenia, leading to the emergence of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low platelets). Both conditions are classified as hypertensive diseases of pregnancy (HDP), and their pathogenesis has been linked to an excessive maternal inflammatory response, accompanied by enhanced endothelial activation. Several studies have found that in pregnancies affected by PE/HELLP, von Willebrand factor (vWF) antigen levels (vWF:Ag) are significantly elevated, while its cleaving protease (ADAMTS-13, A Disintegrin-like and Metalloprotease with Thrombospondin type 1 motif, member 13) activity is normal to decreased. Furthermore, the higher urine excretion of the terminal complement complex C5b-9, as well as its greater deposition in the placental surface in preeclamptic women, imply that the utero-placental unit’s distinctive deficits are intimately tied to disproportionate complement activation. The goal of this updated evaluation is to provide the most up-to-date molecular advances in the pathophysiology of PE/HELLP syndromes. Recent medical data on vWF:Ag levels in patients with PE, ADAMTS-13, and dysregulation of the complement system, are highlighted and evaluated. Furthermore, we discuss the relationship between those entities and the progression of the disease, as well as their significance in the diagnostic process. Finally, considering the difficulties in analyzing and controlling those symptoms in pregnant women, we can provide a current diagnostic and therapeutic algorithm.

Perinatal and neonatal outcome in patients with preeclampsia.

Preeclampsia (PE) affects 2-5% of pregnant women. Hypertensive disorders of pregnancy are associated with adverse maternal and perinatal outcomes. This study included 88 women showing gestational hypertension (GH) or PE symptoms, and their newborns. The rate of FGR was 43% for mothers with PE, compared to 8% with GH. The association was significant, p = < 0.001 but with moderate strength, Cramer's V = 0.40. The risk of FGR increased nine times when PE occurred, as the odds ratio was 9.25 (CI: 2.46-34.83), p = 0.001. PE was associated with FGR risk if delivery time was less than 34 weeks compared to a delivery time of more than 34 weeks. This was 82% of FGR cases for < 34 weeks, compared with 35% of cases in > 34 group, (p = 0.001; Cramer's V = 0.50). PE was also associated (p = 0.01, Cramer's V = 0.27) with the type of delivery, as the caesarean section rate was 74%, compared to 50% in the GH group. This made it three times higher the likelihood of delivery by caesarean section, as the odds ratio was 3.10 (CI: 1.24-7.75), p=0,02. Delivery time was significantly (p < 0.001) shortened to 38 weeks (27-41), compared to 40 weeks (38-42) GH mothers. There was no distinction in median age for PE and GH mothers (p = 0.124). The overall clinical status of neonates was proportional despite the mother's PE. The sum of Apgar points in the first, and then the second to third minute, did not differ significantly, p = 0.370 and 0.560, respectively. The number of peripheral blood platelets and leucocytes was not reduced (p = 0.821 and 0.534) in infants when the mother suffered from PE. The prediction of adverse maternal outcomes from hypertensive diseases of pregnancy is key to optimal management, including the timing of delivery and planning for the most appropriate place of care.

Analysis of the effect of the covid-19 pandemic on maternal care at the Acobamba hospital - Huancavelica, Perú 2020

o determine the effect of the COVID-19 pandemic on maternal care in the Hospital of Acobamba - Huancavelica, 2020. Methodology: The research was observational, retrospective, and longitudinal with the population being consisted of 27 and 29 pregnant women, 53 and 60 deliveries, 27 and 29 postpartum women during the second trimester of the year 2019 and 2020, respectively. Results: Analysis with pandemic (2020) and without pandemic (2019), pregnant women attended 86.6% and 114.8%; pregnant women controlled (6APN) 62.1% and 88.9%; with full laboratory set 44.8% and 88.9%. During the pandemic, each pregnant woman received 1.8 visits and 3.9 telephone follow-ups, compared to 0.9 visits and no telephone follow-ups. During the pandemic, delivery care reached 236.7% since deliveries from other jurisdictions and by returning migrants were attended and there were 5% of home deliveries, while during the non-pandemic 86.8% and no home deliveries were attended. The first puerperal check-up reached 162.1%, 137.9% compared to 66.7% and 59.3%; visits to puerperal women reached 117.2% compared to 74.1% non-pandemic. The causes of the main emergencies were abortion (22.2%), hypertensive disease of pregnancy (15.3%), fetal distress (8.3%) and hemorrhage during pregnancy (8.3%). Conclusion: COVID-19 pandemic reduced APN, increased delivery and puerperium care, strengthened follow-up of pregnant and puerperal women, increased emergencies and reduced cases of postpartum hemorrhage. The health team responded to the situation with commitment and responsibility). Keywords: COVID - 19, Maternal care, Women health, Pandemic, Pre-natal.

Associations of maternal gestational hypertension with high blood pressure and overweight/obesity in their adolescent offspring: a retrospective cohort study

Maternal hypertensive disorders during pregnancy may have an impact on fetal development and the health of the offspring in later life. The aim of the study was to evaluate the associations of maternal gestational hypertension (GH) with high blood pressure (HBP) (prehypertension/hypertension) and overweight/obesity in their adolescent offspring at the age of 12 to 15 years. We analyzed data of 4819 participants born in Kaunas city during 1995–1998 who were included in the study “Prevalence and Risk Factors of HBP in 12–15-Year-Old Lithuanian Children and Adolescents”. The diagnosis of maternal gestational hypertension was obtained from medical records. Associations of maternal GH with their offspring’s HBP and overweight/obesity in adolescence were assessed by multivariate logistic regression analysis. Among 4819 adolescents of 12–15 years of age, 25.7% had HBP, 12% had overweight, and 2.5% had obesity. Of 4819 mothers, 92.3% were normotensive during pregnancy, and 7.7% had GH. In the multivariate analysis after adjustment for age, sex, birth weight, adolescent BMI, and maternal pre/early pregnancy BMI, adolescent offspring born to mothers with GH had higher odds of prehypertension, hypertension, and prehypertension/hypertension (aOR 1.58; 95% CI 1.13–2.22; aOR 1.87; 95% CI 1.41–2.47; and aOR 1.76, 95% CI 1.39–2.24; respectively), compared to the offspring of normotensive mothers. After adjustment for age, sex, birth weight, and maternal pre/early pregnancy BMI, a significant association was found between maternal GH and the offspring’s overweight/obesity in adolescence (aOR 1.41; 95% CI 1.04–1.91). The findings of this study suggest that maternal GH is associated with an increased odds of HBP (prehypertension and hypertension, both separately and combined) and overweight/obesity in their offspring during adolescence.

Noninvasive Cardiac Imaging in Formerly Preeclamptic Women for Early Detection of Subclinical Myocardial Abnormalities: A 2022 Update.

Preeclampsia is a maternal hypertensive disease, complicating 2–8% of all pregnancies. It has been linked to a 2–7-fold increased risk for the development of cardiovascular disease, including heart failure, later in life. A total of 40% of formerly preeclamptic women develop preclinical heart failure, which may further deteriorate into clinical heart failure. Noninvasive cardiac imaging could assist in the early detection of myocardial abnormalities, especially in the preclinical stage, when these changes are likely to be reversible. Moreover, imaging studies can improve our insights into the relationship between preeclampsia and heart failure and can be used for monitoring. Cardiac ultrasound is used to assess quantitative changes, including the left ventricular cavity volume and wall thickness, myocardial mass, systolic and diastolic function, and strain. Cardiac magnetic resonance imaging may be of additional diagnostic value to assess diffuse and focal fibrosis and perfusion. After preeclampsia, sustained elevated myocardial mass along with reduced myocardial circumferential and longitudinal strain and decreased diastolic function is reported. These findings are consistent with the early phases of heart failure, referred to as preclinical (asymptomatic) or B-stage heart failure. In this review, we will provide an up-to-date overview of the potential of cardiac magnetic resonance imaging and echocardiography in identifying formerly preeclamptic women who are at high risk for developing heart failure. The potential contribution to early cardiac screening of women with a history of preeclampsia and the pros and cons of these imaging modalities are outlined. Finally, recommendations for future research are presented.

Induction of labour in low-risk pregnancies before 40 weeks of gestation: A systematic review and meta-analysis of randomized trials.

This systematic review of 16 randomized trials, which included 8796 pregnancies, did not demonstrate a reduction in caesarean births or perinatal morbidity from induction of labour (IoL) at 39-40 weeks for non-medical indications. However, IoL at 39-40 weeks may be associated with a lower incidence of maternal hypertensive disorders, a shorter duration of the first stage of labour, fewer instances of meconium-stained amniotic fluid, lower mean birth weights, longer duration of (maternal) hospitalization, and higher epidural usage. Until regional data on clinical benefits, resource implications and long-term impact are available, a prudent approach would be to encourage shared decision-making, wherein birthing persons with low-risk pregnancies are given the opportunity to assess the risks and benefits of IoL at 39-40 weeks over expectant management and allowed to consider their decision in the light of their values and preferences and local resource availability.

Association between Hypertensive Disorders in Pregnancy and Postpartum Mental Health

Aim: To determine the relation between prevalence of Postpartum Depression and varying degrees of severity of Hypertensive Disorders in Pregnancy. Study design: A cross sectional study . Place &amp; duration of study: Department of Obs. &amp; Gynae, Avicenna Hospital, Lahore from June 2020 to December 2021. Methodology: A total of 220 women with and without hypertensive disorders of pregnancy (110 in each group) delivered during this period were enrolled in the study. A survey in the post partum period from second to sixth week postpartum was carried out. It was done according to the Edinburgh Postnatal Depression Scale (EPDS) to assess the effect of severity of Hypertensive disorders of pregnancy to develop new-onset postpartum depression. Results: 220 women were enrolled in the study. Among them Forty five women showed sign and symptoms of post partum depression. On the other hand 175 had no manifestation of depression according to the scale. The prevalence of PPD was 27 % (30/110) in women with hypertensive disorders, being twice the value in normotensive subjects (13.6%). The risk of Post partum depression surged with the aggressiveness of hypertensive disease in pregnancy. Conclusion: Preeclampsia has an independent association with Post partum depression. The risk of Post partum depressive disorder seemed to increase with the rising severity of hypertension in pregnancy. Therefore support and additional preventive strategies should be planned for women with Preeclampsia to reduce the likelihood of Post partum deterioration of mental health. Keywords: Hypertensive disorders in Pregnancy, Preeclampsia , Postpartum Depression.

G-Protein Coupled Receptor Dysregulation May Play Roles in Severe Preeclampsia—A Weighted Gene Correlation Network Analysis of Placental Gene Expression Profile

Preeclampsia is one of the major hypertensive diseases of pregnancy. Genetic factors contribute to abnormal placentation. The inadequate transformation of cytotrophoblasts causes failure of maternal spiral arteries’ remodeling and results in narrow, atherotic-prone vessels, leading to relative placental ischemia. This study aims to explore the possibility of identifying dysregulated gene networks that may offer a potential target in the possible prevention of preeclampsia. We performed a weighted gene correlated network analysis (WGCNA) on a subset of gene expression profiles of placental tissues from severe preeclamptic pregnancies. We identified a gene module (number of genes = 402, GS = 0.35, p = 0.02) enriched for several G-protein-coupled receptor (GPCR)-related genes with significant protein–protein molecular interaction (number of genes = 38, FDR = 0.0007) that may play key roles in preeclampsia. Some genes are noted to play key roles in preeclampsia, including LPAR4/5, CRLR, NPY, TACR1/2, and SFRP4/5, whose functions generally relate to angiogenesis and vasodilation or vasoconstriction. Other upregulated genes, including olfactory and orexigenic genes, serve limited functions in the disease pathogenesis. Altogether, this study shows the utility of WGCNA in exploring possible new gene targets, and additionally reinforces the feasibility of targeting GPCRs that may offer intervention against development and disease progression among severe preeclampsia patients.