Neonatal outcomes of pregnancy in women with congenital heart disease.

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

Objective Our study aimed to assess whether maternal cardiac disease is an independent risk factor for postpartum mood and anxiety disorders (PPMADs) and whether higher cardiac risk scores are associated with higher risk of PPMAD. Methods This was a retrospective matched cohort study of patients who delivered between June 2019 and February 2024 and completed PPMAD screening at a tertiary care institution. The cardiac cohort was managed by a multidisciplinary cardio-obstetrics team, and the non-cardiac cohort was identified through matching on important demographic factors. The primary outcome was a positive PPMAD screen, defined as Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7) score ≥10. Relative risks (RRs) for positive PPMAD screen were obtained using binomial regression. Results The prevalence of positive PPMAD screening was 18.2% (27/148) in the cardiac cohort and 16.2% (24/148) in the non-cardiac cohort. Cardiac disease alone did not increase risk of positive PPMAD screening (RR 1.13, 95% confidence interval (CI) 0.68–1.86). New York Heart Association class ≥ II (RR 3.12, 95% CI 1.80–5.41) and pre-pregnancy diuretic use (RR 2.98, 95% CI 1.08–8.20) were associated with increased PPMAD. Other factors that increased PPMAD risk included being from a neighborhood with greater socioeconomic disadvantage (RR 1.18, 95% CI 1.03–1.34), unplanned pregnancy (RR 2.42, 95% CI 1.46–4.0), history of antidepressant use (RR 2.19, 95% CI 1.33–3.61), and history of interpersonal violence (RR 3.05, 95% CI 1.72–5.4). Adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (RR 2.60, 95% CI 1.59–4.27), peripartum transfusion (RR 2.61, 95% CI 1.39–4.9), and preterm birth (RR 2.00, 95% CI 1.09–5.43) were also associated with positive PPMAD screening. Conclusions Cardiac disease alone was not independently associated with positive PPMAD screening, while poorly optimized cardiac status, social history, and adverse pregnancy outcomes were. Our findings stress the importance of optimizing early cardiac status and providing full-scope prenatal care to patients with cardiac disease to reduce PPMAD risk.

Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis. PubMed and Embase were systematically searched (inception - July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252). Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth. Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.

Hypertensive disorders of pregnancy (HDP) comprise a spectrum of 4 subtypes: chronic hypertension (cHTN), gestational hypertension (gHTN), preeclampsia, and superimposed preeclampsia (siPE). Although often characterized as a spectrum of disease severity, there have been limited comparative studies of detailed clinical and molecular characteristics of these disorders. We hereby evaluate HDP subtypes using clinical, placental histopathologic, and molecular data to compare similarities and differences between HDP subtypes. We used data from an over 10-year-long pregnancy cohort with detailed clinical and placental pathology, as well as placental tissue RNA-sequencing, to compare findings between HDP subtypes using a nested case-control design. Clinical diagnosis was based on current ACOG criteria, and placental gross and histological examination was based on the Amsterdam consensus statement. Clinical data analysis showed cHTN and gHTN to be more likely to have normal placental pathology, while preeclampsia and siPE were more enriched in maternal vascular malperfusion. RNA-seq showed distinct gene expression signatures and pathway activation across HDP subgroups. We could not identify any molecular evidence that preeclampsia (preeclampsia or siPE) was an advanced stage of hypertensive disorder (gHTN or cHTN), but rather identified distinct gene expression profiles between these entities, suggesting preeclampsia (preeclampsia or siPE) and hypertension (gHTN or cHTN) are distinct pathophysiological conditions. Finally, we found that, in the presence of maternal vascular malperfusion, siPE and preeclampsia share significant gene expression profiles and pathway activation. Our findings suggest that maternal vascular malperfusion specifically differentiates pregnancies that progress to preeclampsia and siPE. Maternal vascular malperfusion is thought to initiate in early gestation, indicating the cascade to preeclampsia/siPE may be differentiated from gHTN/cHTN early in pregnancy. Incorporating placental histopathologic evaluation is an essential future avenue in probing the cause of HDP.

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening cause of heart failure occurring in late pregnancy or the early postpartum period. Physiological cardiovascular adaptation and pregnancy-related complications may mimic PPCM, leading to diagnostic overestimation. This prospective cohort study included 60 pregnant women with clinically and echocardiographically suspected PPCM, stratified by gestational trimester, and 15 healthy pregnant controls. All participants underwent transthoracic echocardiography with assessment of left ventricular ejection fraction (LVEF), chamber dimensions, and diastolic function. True PPCM was confirmed in 4 women (6.7%), predominantly in the third trimester. Compared with earlier gestational groups, women evaluated in the third trimester more frequently demonstrated symptoms of heart failure, significantly reduced LVEF, progressive ventricular dilatation, and marked diastolic dysfunction. In most cases, echocardiographic abnormalities were attributable to physiological cardiac adaptation, anaemia, or hypertensive pregnancy disorders rather than true PPCM. In healthy controls, changes in LVEF remained within physiological limits. These findings indicate that the majority of suspected PPCM cases represent reversible pregnancy-related conditions. Strict diagnostic criteria and dynamic echocardiographic monitoring are essential to prevent overdiagnosis and unnecessary treatment.

A Review of the Long-Term Cardiovascular Consequences of Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy are a leading cause of postpartum readmissions, with poor medication adherence contributing to adverse outcomes. This quality improvement initiative aimed to evaluate the impact of pharmacy resident-led counseling on medication adherence and 30-day readmission rates among postpartum patients with hypertensive disorders of pregnancy. A quality improvement initiative was conducted in a tertiary care center in which a pharmacy resident was integrated into the inpatient obstetrics team to provide targeted antihypertensive counseling at discharge. The primary objective was to evaluate the impact of counseling on medication adherence and 30-day readmission rates. During the pilot phase, 77% of eligible patients received counseling and no hypertension-related readmissions occurred within 30 days, compared to an 8.3% readmission rate in the baseline phase. In follow-up telephone surveys conducted 4 to 6 weeks after discharge counseling, most patients reported adherence to antihypertensive medications; however, knowledge gaps regarding prescription refill procedures were identified. Pharmacy resident-led counseling at discharge may reduce the number of hypertension-related readmissions and appears beneficial in supporting medication adherence. This intervention highlights the opportunities for expanding pharmacy roles in obstetric care.

Adverse pregnancy outcomes (APOs) and low socioeconomic status (SES) are both associated with an increased long-term risk of atherosclerotic cardiovascular disease (ASCVD). In this analysis, we evaluated whether the association between a history of APO and ASCVD risk varies across different SES groups. We conducted this analysis using data from the UK Biobank, a large prospective cohort including participants aged 40 years to 69 years recruited between 2006 and 2010, with ongoing follow-up. APOs included hypertensive disorders of pregnancy, gestational diabetes mellitus, low birth weight (<2.5 kg), and stillbirth. At enrollment, SES was assessed using the following indicators: household income, education, employment, and Townsend Deprivation Score. The hazard ratio (HR) for new-onset ASCVD was analyzed according to history of APO and SES categories. Among 146,064 women, those with a history of APO had a higher risk of new-onset ASCVD and overall lower SES-including lower income, less education, higher unemployment, and greater deprivation-compared with those without APO (p<0.001). The increased ASCVD risk associated with APO history was significant only in the low SES group (adjusted HR, 1.26; 95% confidence interval [CI], 1.16 to 1.36), but not in the high SES group (adjusted HR, 1.07; 95% CI, 0.74 to 1.55, p=not significant). We found that women with low SES were more vulnerable to the adverse effects of APO history, resulting in a greater increase in ASCVD risk. This study highlights the need for SES-tailored preventive policies to reduce long-term cardiovascular disease in women with a history of APO.

A bstract Background: Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal mortality globally and are also recognized causes of adverse fetal outcomes. Objectives: We aimed to determine and quantify the risk of adverse fetal outcomes associated with HDP. Materials and Methods: A 5-year retrospective study was conducted at the Delta State University Teaching Hospital from May 2019 to April 2024. Cases included all deliveries that met the criteria for HDP during the study period, whereas controls comprised normotensive mothers without any comorbidities. Data on maternal age, parity, mode of delivery, place of delivery, supervised/unsupervised delivery, birth weight, Apgar score, gestational age, and delivery outcomes were collected. The prevalence and odds ratios of stillbirth, low birth weight (LBW), preterm delivery, and birth asphyxia were determined. Results: Out of 826 deliveries, 134 (16.2%) met the criteria for HDP, whereas 408 (49.4%) were classified as controls. The incidence of stillbirth was significantly higher among women with HDP ( P = 0.0004; AOR = 4.16; 95% CI = 1.89–9.13). Similarly, the incidence of LBW was significantly higher in women with HDP ( P &lt; 0.0001; AOR = 10.19; 95% CI = 6.53–15.92), as was the incidence of preterm delivery ( P &lt; 0.0001; AOR = 4.86; 95% CI = 3.17–7.40). Additionally, the incidence of birth asphyxia was significantly higher in newborns delivered to mothers with HDP ( P &lt; 0.0001; AOR = 3.4; 95% CI = 2.06–5.07). Conclusion: The HDP significantly contributed to the incidence of stillbirths, LBW, preterm deliveries, and birth asphyxia in Delta state, Nigeria.

Preeclampsia is a hypertensive disorder of pregnancy with major maternal and fetal consequences. While the molecular basis of early-onset preeclampsia is well studied, the mechanisms underlying late-onset disease-and how they differ by fetal sex-remain poorly understood. Placental transcriptomic profiling at term can reveal persistent molecular alterations reflecting cumulative disease processes. We conducted a cross-sectional observational analysis of placental gene expression using RNA sequencing in a subset of 58 term placentas (21 male-bearing and 37 female-bearing pregnancies) drawn from two large prospective birth cohorts. Pregnancies were classified based on a clinical diagnosis of late-onset preeclampsia (diagnosed ≥ 20 weeks' gestation according to ISSHP criteria) or as uncomplicated pregnancies. We then assessed for differential gene expression. Cell type proportions were estimated using CIBERSORTx from a placenta-specific reference single-cell dataset. Weighted gene co-expression network analysis identified modules of co-expressed genes associated with late-onset preeclampsia and fetal sex. Differential gene expression analysis identified 150 genes with altered expression in male-bearing placentas from pregnancies with late-onset preeclampsia compared to those from uncomplicated pregnancies. No differentially expressed genes were identified in female-bearing placentas. Cell type deconvolution revealed increased abundance of CD14 + monocytes and CD8 + activated T cells (log odds of 1.42 and 1.44 respectively) and reduced fetal GZMK natural killer cells (log odds of 0.60) in male-bearing placentas from affected pregnancies. In female-bearing placentas, late-onset preeclampsia was associated with increased fetal nucleated red blood cells and maternal plasma cells (log odds of 1.33 and 1.40 respectively). Male-specific co-expression analysis identified gene modules enriched for biological processes including RNA processing, immune regulation, and metabolism. Placental transcription and cellular responses to late-onset preeclampsia differ by fetal sex. Evidence of altered immune cell composition and gene co-expression in male-bearing placentas suggests a sex-specific vulnerability. These findings highlight the importance of considering fetal sex in molecular investigation and clinical management of preeclampsia. Preeclampsia is a common pregnancy complication marked by high blood pressure, but how it affects the placenta, especially in later pregnancy and depending on the baby's sex, is not well understood. In this study, we analysed placental tissue from pregnancies with and without late-onset preeclampsia using RNA sequencing. By separating the data based on whether the neonate was male or female, we found striking differences in gene expression. Only placentas from male-bearing pregnancies showed significant changes in gene expression linked to preeclampsia. These changes involved genes related to immune response, metabolism and vascular function. We also used computational tools to estimate what types of cells were present in each placental sample. In male-bearing pregnancies affected by late-onset preeclampsia, there was a notable increase in certain immune cells, suggesting an altered immune response and increased inflammation. In contrast, female-bearing pregnancies affected by late-onset preeclampsia showed an increase in cell composition for two blood related cell types, but no significant gene expression differences. By grouping genes that worked together into networks, we identified several groups, especially in placentas from male-bearing pregnancies, that were strongly associated with biological processes known to be disrupted in preeclampsia, such as blood vessel formation, extracellular matrix remodelling, and hormone regulation. These findings emphasise the importance of considering fetal sex in pregnancy research and could help guide future sex-specific diagnostic or treatment strategies.

Thrombocytopenia in preterm infants born to mothers with systemic lupus erythematosus (SLE) is poorly characterized, despite its potential link to adverse outcomes. Our understanding of platelet dynamics, risk factors, and clinical outcomes in this population is limited, necessitating further investigation. This study aimed to characterize the incidence, timing, and severity of thrombocytopenia in this population; to identify associated maternal and neonatal risk factors; and to evaluate its association with adverse outcomes. We included 154 preterm infants born to mothers with SLE who were admitted to Shanghai Children's Medical Center within 24 hours of birth between 2014 and 2024. Logistic regression was used to identify risk factors and outcomes associated with neonatal thrombocytopenia. Thrombocytopenia (platelet count < 150 ×109/L) occurred in 32.5% of infants, and severe form (< 50 ×109/L) occurred in 4.6%. The condition peaked on postnatal days 4-5, and 16% of affected infants required intervention. Late preterm infants (adjusted odds ratio [aOR], 0.15; 95% confidence interval [CI], 0.05-0.42), moderate preterm infants (aOR, 0.26; 95% CI, 0.09-0.76), and maternal hydroxychloroquine use (aOR, 0.19; 95% CI, 0.07-0.52) were protective factors. In contrast, maternal hypertensive disorders of pregnancy (HDP; aOR, 3.41; 95% CI, 1.06-10.93) increased the risk. Infants with thrombocytopenia had significantly higher risks of intracranial hemorrhage (aOR, 4.27; 95% CI, 1.65-11.00) and late-onset sepsis (aOR, 11.00; 95% CI, 1.23-98.14). Preterm infants exposed to maternal SLE frequently developed thrombocytopenia, but most cases were self-limited. Key risk modulators included gestational age, maternal HDP, and hydroxychloroquine use. Furthermore, thrombocytopenia was significantly associated with neonatal morbidity.

This study evaluated the effectiveness of different obstetric nursing intervention models for Hypertensive Disorders of Pregnancy (HDP). A total of 120 pregnant women with HDP were randomly assigned to a predictive (anticipatory) intervention group, a comprehensive intervention group, or a control group receiving routine care (n=40 per group). Outcomes included delivery mode, anxiety/depression scores (SAS/SDS), and adverse maternal/neonatal outcomes. The predictive intervention group demonstrated a significantly higher vaginal delivery rate (75.00%) than both the comprehensive (65.00%) and control (47.50%) groups (P&lt;0.05). Both intervention groups showed significantly lower pre-delivery SAS and SDS scores compared to the control group (P&lt;0.05), with no significant difference between the two intervention groups. The incidences of adverse maternal (7.50%) and neonatal (5.00%) outcomes were lowest in the predictive group, followed by the comprehensive group. In conclusion, compared to routine care, both nursing models improve psychological outcomes, but the predictive intervention model appears more effective in optimizing delivery mode and reducing clinical complications.

Background and Objective: Preeclampsia (PE), a hypertensive disorder of pregnancy, is a leading cause of maternal morbidity and mortality globally. Low-dose aspirin (LDA) is recommended for PE prevention in high- and moderate-risk women. Despite clinical trial evidence, adherence to LDA guidelines and disparities in usage remain underexplored in real-world settings. This study assesses LDA initiation rates among high- and moderate-risk pregnant women, examining disparities by race, geography, and hospital characteristics. Methods: We conducted a retrospective cross-sectional analysis of the U.S. Nationwide Inpatient Sample (2016-2021). Pregnancy-associated hospitalizations were identified using International classification disease-10 (ICD-10) codes, and PE risk factors were classified as high or moderate based on the United States Preventive Services Task Force and American College of Obstetricians and Gynecologists criteria. Statistical analyses included descriptive statistics, bivariate analyses, and joinpoint regression to evaluate temporal trends and disparities in LDA use. Results: Among 23,163,717 hospitalizations, 8.2% were high-risk and 13.3% moderate-risk for PE. LDA use increased across all groups from 2016 to 2021, but remained lower among moderate-risk women. Racial disparities were evident, with Black and Hispanic women in the moderate-risk group demonstrating lower LDA utilization compared with White women. Geographic disparities revealed the Midwest and Northeast leading in LDA use, whereas rural hospitals consistently reported the lowest rates. Urban teaching hospitals had higher LDA use compared with rural and nonteaching hospitals. Conclusion: LDA use for PE prevention has improved, but significant disparities persist by race, region, and hospital type. Provider education, capacity-building in underserved areas, and enhanced documentation are essential to ensure equitable access to this evidence-based intervention.

Cerebral edema is a severe neurological complication of preeclampsia and eclampsia, and continues to be a major contributor to maternal morbidity and mortality worldwide. Conventional methods for monitoring intracranial pressure (ICP) are invasive and unsuitable for obstetric patients, creating a need for a safe, non-invasive tool for early detection. In this prospective observational study, we evaluated the clinical utility of daily optic nerve sheath diameter (ONSD) monitoring using bedside ultrasonography in 50 women admitted to a tertiary ICU within 24 hours of symptom onset. Patients who developed eclampsia (n = 20) exhibited significantly higher mean ONSD values (5.66 ± 0.20 mm) compared with those with preeclampsia (4.61 ± 0.18 mm; p &lt; 0.001). Notably, elevated ONSD consistently preceded overt neurological deterioration by 24–48 hours, showed a strong correlation with symptom severity (r = 0.76, p &lt; 0.001), and was associated with longer ICU stays (7.8 ± 1.2 vs. 3.7 ± 0.8 days; p &lt; 0.01). ROC curve analysis identified an optimal cutoff of 5.27 mm with 100% sensitivity and 100% specificity for detecting neuroimaging-confirmed cerebral edema. These findings indicate that daily ONSD measurement is a practical, reliable, and low-cost method for early identification of cerebral edema in hypertensive pregnancy disorders. By integrating ONSD into maternal ICU protocols, as summarized in our proposed monitoring algorithm, clinicians can anticipate neurological deterioration and implement timely interventions, particularly in settings where access to neuroimaging is limited. Beyond its immediate clinical value, this study underscores the potential role of ONSD monitoring in global maternal health strategies and highlights the need for multicenter trials to establish obstetric-specific cutoff values and validate its incorporation into international guidelines. Keywords: preeclampsia, eclampsia, cerebral edema, optic nerve sheath diameter (ONSD), intracranial pressure, ultrasonography, critical care obstetrics, non-invasive neurodiagnostics, maternal morbidity

Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study.

BackgroundThe concept of small vulnerable newborns has been proposed, including preterm birth, low birth weight, and small for gestational age, leading causes of perinatal mortality. We aimed to identify high-risk factors for small vulnerable newborns and develop a predictive model through a retrospective analysis.MethodsWe collected clinical data from pregnant women who met inclusion criteria between January 2015 and December 2023 and divided them into training and validation cohorts. We used univariate analysis and mean decreases in the Gini index to screen for potential risk factors. We applied the least absolute shrinkage and selection operator regression to select final predictors and construct a nomogram. We assessed model performance using receiver operating characteristic curves, calibration curves, and clinical decision analysis, with internal validation via 10-fold cross-validation and temporal internal validation.ResultsAmong 129 554 women, 13 801 (10.66%) had small vulnerable newborn, with the incidence increasing from 2015 (10.15%) to 2023 (11.61%). Key risk factors included multiple pregnancies (odds ratio (OR) = 37.2), pre-pregnancy body mass index (BMI) of <18.5 (OR = 8.61) and ≥25 kg/m2 (OR = 6.40), maternal age of <25 (OR = 6.81) and ≥35 years (OR = 3.72), hypertensive disorders of pregnancy (OR = 2.81), and placental disorders (OR = 3.03). Other significant factors were assisted reproductive technology, mycoplasma/chlamydia infection, and elevated bile acids. The nomogram demonstrated strong predictive performance (area under the curve = 0.873).ConclusionsThe incidence of small, vulnerable newborns rose notably during 2021–2023. The developed model, incorporating age, pre-pregnancy BMI, multiple pregnancies, hypertensive disorders of pregnancy, and placental disorders, is designed to be applied in the third trimester and enables risk identification, facilitating targeted interventions to reduce neonatal mortality and complications.RegistrationChinese Clinical Trial Registry, ChiCTR2400093923

Chronic hypertension in pregnancy is a risk factor for offspring long-term neurological morbidity.

The Strain of Pregnancy: Left Atrial Mechanics in Hypertensive Disorders of Pregnancy.

Immune thrombocytopenia (ITP) often presents for the first time in pregnancy, or, in patients with a history of ITP, pregnancy can trigger a relapse. ITP in pregnancy is often mild, leading to minimal or no symptoms; however, treatment may be needed if thrombocytopenia becomes severe, if bleeding occurs, or in anticipation of delivery and neuraxial analgesia. To facilitate the diagnosis of ITP in pregnancy, we present a systematic approach that allows clinicians to first consider urgent pregnancy-related thrombocytopenic conditions such as hypertensive disorders of pregnancy or thrombotic thrombocytopenic purpura; exclude other causes of thrombocytopenia; and determine the need for treatment. We review options for first-line therapies for ITP in pregnancy, including corticosteroids (prednisone or methylprednisolone) and intravenous immune globulin, which has a favorable safety profile in pregnancy, and second-line therapy options that have been used in pregnancy including thrombopoietin receptor agonists, rituximab, and certain immunosuppressant medications such as azathioprine. We summarize the recommendations for platelet targets for delivery, recognizing that the evidence is limited, including a platelet count of 50 × 109/L or higher for caesarean delivery and 70 × 109/L or higher for neuraxial anesthesia. Treatment decisions for ITP in pregnancy should be informed by patients' values and preferences along with a multidisciplinary team that includes hematologists, obstetricians, and anesthesiologists.