Hypertensive Disorders Of Pregnancy Research Articles

Association Between Periconceptional Diet Quality and Hypertensive Disorders of Pregnancy: The Japan Environment and Children's Study.

Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non-Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women. Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country-specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73-0.94). The DASH score and HDP risk were inversely associated in a monotonic dose-response manner (aOR per 1-quintile increase in the DASH score, 0.92 [95% CrI, 0.89-0.95]). A high-quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

Maternal vascular indices at 36 weeks' gestation in pregnancy with small or growth-restricted fetus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by delivery of a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate. This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics, medical history, vascular indices and hemodynamic parameters, which were obtained using a non-invasive operator-independent device and included pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. Women with hypertensive disorders of pregnancy were excluded. SGA was diagnosed if birth weight was < 10th percentile. FGR was diagnosed if, in addition to birth weight < 10th percentile, at the 35-37-week scan, uterine artery or umbilical artery pulsatility index (PI) was > 95th percentile or fetal middle cerebral artery PI was < 5th percentile. Among the 6413 women included in the study, there were 605 (9.4%) cases of SGA, 133 (2.1%) cases of FGR and 5675 (88.5%) cases that were unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were increased in the FGR group compared with the unaffected group. Aortic stiffness, as assessed by pulse-wave velocity, and augmentation index did not differ between affected and unaffected pregnancies. In the FGR group, compared with the SGA group, central systolic and diastolic blood pressure were higher, whereas heart rate was lower. SGA and FGR pregnancies exhibit deranged maternal hemodynamic responses compared with unaffected pregnancies. Pregnancies with FGR have higher central blood pressure compared to those with SGA, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Development and child health in a world of synthetic chemicals.

Chemical pollution is one of today's most significant threats to the developmental potential of children worldwide. Maternal exposure to toxicants can perturb sensitive windows of fetal development, indirectly through promoting antenatal disorders, abnormal placental adaptation, or directly through maternal-fetal transport. Current evidence clearly shows that persistent organic chemicals promote hypertensive disorders of pregnancy, placental abnormalities, and fetal growth restriction, whereas findings are less consistent for phthalates and bisphenols. Prospective birth cohorts strongly support a link between adverse neurodevelopmental outcomes and prenatal exposure to flame retardants and organophosphate pesticides. Emerging evidence reveals a potential association between in utero exposure to bisphenols and childhood behavioral disorders, while childhood metabolic health is more consistently associated with postnatal exposure to phthalates and bisphenols. IMPACT: Synthesizes emerging evidence linking modern forms of chemical pollution to antenatal disorders, fetal growth restriction and childhood disorders. Highlights potential developmental impacts of emerging pollutants of concern now ubiquitous in our environment but without regulatory restrictions.

A Population-Based Linked Cohort Study of Maternal Exposure to Bioclimatic Stress and Hypertensive Disorders of Pregnancy in Australia.

ObjectiveTo identify critical susceptible periods for the associations between bioclimatic exposure (Universal Thermal Climate Index, UTCI) and the risks of gestational hypertension and preeclampsia. ApproachWe linked 415,091 singleton pregnancies of 20–42 weeks’ gestation between 1st January 2000 and 31st December 2015 to UTCI exposure in Western Australia. Distributed lag nonlinear logistic regressions were used to estimate weekly-specific adjusted odds of gestational hypertension and preeclampsia for UTCI exposure from twelve weeks of preconception through pregnancy. ResultsThe analysed pregnancies included 3.7% and 2.8% cases of gestational hypertension and preeclampsia, respectively. Exposures from early pregnancy up to 30th gestational weeks were associated with greater odds of hypertensive disorders of pregnancy (HDPs) with critical susceptible periods at all exposure thresholds, particularly elevated at the 1st (10.2 °C) and 99th (26.0 °C) exposure centiles as compared to the median (14.2 °C). The most elevated weekly OR and 95% CI estimated at 99th exposure centile was 1.07 (95% CI 1.06, 1.08) in gestational weeks 8–18 for gestational hypertension and 1.10 (95% CI 1.08, 1.11) in gestational weeks 11–16 for preeclampsia. Cumulative exposures associated with HDPs with relatively higher ORs, but less precise than weekly exposures. The effects of high exposure were disproportionately elevated in both HDPs for Caucasians, non-smokers, multiparous, and mothers in moderate/low SES residences. Conclusions and ImplicationsMaternal bioclimatic exposure increases the risk of HDPs, suggesting potentially susceptible periods and populations for climate-related targeted interventions. It highlights the need for advising women on environmental risks in early pregnancy.

Arterial stiffness after 6 weeks postdelivery in women with a history of hypertensive disorders of pregnancy: a systematic review protocol

IntroductionHypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality. The risk of developing cardiovascular diseases following HDP is high. Arterial stiffness is a...

Global Blood Pressure Screening During and After Pregnancy: May Measurement Month 2019.

Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality. There are limited global data on the characteristics of women during and after pregnancy hypertension. May Measurement Month is a global campaign to raise awareness of the importance of blood pressure. Adults (≥18 years) recruited through opportunistic sampling during May 2019 had blood pressure measured and comorbidities and lifestyle data collected. This secondary analysis included 16 519 pregnant women and 529 172 nonpregnant women (16 457 with previous raised blood pressure in pregnancy) from 64 countries. Almost half of the pregnant women (43.3%) reported not having had their blood pressure measured in the past year, and 14.3% (95% CI, 12.1-16.6) had hypertension (blood pressure ≥140/90 mm Hg or taking antihypertensive medication). Diabetes was self-reported in 7.6% (5.9-9.3) of pregnant women with hypertension and 2.8% (1.9-3.6) of pregnant women without hypertension. In nonpregnant women with and without a history of pregnancy hypertension, age-standardized proportions with current hypertension were 53.2% (50.8-55.7) versus 33.3% (29.3-37.3); with diabetes were 14.4% (11.8-17.0) versus 8.5% (6.3-10.9); and with body mass index ≥30 kg/m2 were 28.4% (23.5-33.3) versus 16.6% (13.0-20.2). Hypertension in pregnancy was common in this global sample but many cases had not previously been identified. There was a clustering of cardiovascular risk factors in both pregnant women with current hypertension and previously raised blood pressure in pregnancy. This work highlights the importance of screening pregnant women for hypertension, which remains a challenge in large parts of the world.

Maternal Health During the COVID-19 Pandemic in the United States: An Interrupted Time-series Analysis.

The COVID-19 pandemic, and subsequent policy responses aimed at curbing disease spread and reducing economic fallout, had far-reaching consequences for maternal health. There has been little research to our knowledge on enduring disruptions to maternal health trends beyond the early pandemic and limited understanding of how these impacted pre-existing disparities in maternal health. We leveraged rigorous interrupted time-series methods and US National Center for Health Statistics Vital Statistics Birth Data Files of all live births for 2015-2021 (N = 24,653,848). We estimated whether changes in maternal health trends after the onset of the COVID-19 pandemic (March 2020) differed from predictions based on pre-existing temporal trends. Outcomes included gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and adequacy of prenatal care. We found an increased incidence of gestational diabetes (December 2020 peak: 1.7 percentage points (pp); 95% confidence interval [CI]: 1.3, 2.1), hypertensive disorders of pregnancy (January 2021 peak: 1.3 pp; 95% CI: 0.4, 2.1), and gestational weight gain (March 2021 peak: 0.1 standard deviation; 95% CI: 0.03, 0.1) and declines in inadequate prenatal care (January 2021 nadir: -0.4 pp; 95% CI: -0.7, -0.1). Key differences by subgroups included greater and more sustained increases in gestational diabetes among Black, Hispanic, and less educated individuals. These patterns in maternal health likely reflect not only effects of COVID-19 infection but also changes in healthcare access, health behaviors, remote work, economic security, and maternal stress. Further research about causal pathways and longer-term trends will inform public health and clinical interventions to address maternal disease burden and disparities.

Assessing Placental Shear Wave Elastography as a Tool for Evaluating Preeclampsia.

Background Hypertensive disorders of pregnancy, especially its dreaded complication preeclampsia, remain a major cause of morbidity and mortality for both the mother and the fetus. Existing tools for the prediction of preeclampsia remain inadequate in their sensitivity and specificity. Hence, there is an urgent need for a reliable, economically feasible, and objective marker for its diagnosis/early prediction. In this regard, shear wave elastography has shown great promise. Shear wave elastography is a novel method to quantify tissue stiffness, which is objective and has significantly lower inter-observer variability. Objectives We aim to quantify the tissue elasticity using point shear wave elastography (pSWE) in the placentas of diagnosed cases of preeclampsia and to compare them with the placentas of healthy controls in order to evaluate if there is a significant statistical difference between the two. Materials and methods This comparative study was conducted at the Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from August 2022 to July 2024. The study included 60 participants, divided into two groups: 30 patients with preeclampsia and 30 healthy pregnancies. Placental stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data was analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the significance of differences between the two groups was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean placental stiffness, measured in kilopascals (kPa), was significantly higher in the preeclampsia group (11.71 ± 1.52 kPa) in comparison to the healthy group (3.36 ± 0.66 kPa) (p = 0.001). Patients suffering from preeclampsia were found to have significantly higher levels of placental stiffness. Conclusion Early diagnosis remains key to managing preeclampsia so that adequate monitoring and treatment could be provided to the patients. Our study showed that there is a significant statistical difference in the placental stiffness in patients with preeclampsia in comparison to a healthy placenta. Hence, shear wave elastography can be used as a supplementary tool to aid in the diagnosis/prediction of preeclampsia.

Emergency Department Utilization for Hypertensive Disorders of Pregnancy and Post Partum, 2006-2020

Emergency Department Utilization for Hypertensive Disorders of Pregnancy and Post Partum, 2006-2020

Demographic Factors, Biochemical Markers, and Obstetric History Associated with the Risk of Preeclampsia in a Sudanese Population Sample

Background: Preeclampsia significantly contributes to maternal and perinatal illness and death, particularly in low and middle-income countries like Sudan. It is classified by onset timing (early vs. late) and severity (mild vs. severe) and is one of the four hypertensive disorders in pregnancy, including chronic hypertension, gestational hypertension, and chronic hypertension with superimposed preeclampsia. This study aimed to evaluate the demographic, clinical, and biochemical predictors of preeclampsia among Sudanese women. Methods: This case-control study involved 100 women diagnosed with preeclampsia and 100 healthy pregnant women who acted as the control group at Omdurman Maternity Hospital in Khartoum State, Sudan, from 2019 to 2021. Data on sociodemographic characteristics, obstetric history, and biochemical markers, including platelet counts, were collected using a comprehensive questionnaire and blood sample analysis. Results: Women with preeclampsia were more frequently over the age of 40 (OR=9.33, 95% CI: 4.54-19.19, p &lt; 0.001) and had a longer median duration of marriage (OR=2.9, 95% CI: 1.51-5.58, p=0.001). Lower educational levels (p=0.008) and being housewives (p=0.024) were also more prevalent in the preeclampsia group. Clinically, headache (OR=18.98, 95% CI: 2.44-147.5, p=0.005) and blurring of vision (OR=25.83, 95% CI: 1.17-572.6, p=0.04) were more prevalent in women with preeclampsia. Biochemical markers showed lower platelet counts (p=0.002), higher levels of alanine aminotransferase (ALT) (OR=2.23, 95% CI: 1.51-3.28, p &lt; 0.001) and creatinine (OR=16.76, 95% CI: 2.31-121.5, p=0.005), while aspartate aminotransferase (AST) was not significantly associated with preeclampsia. Conclusion: Family history of preeclampsia was the most significant predictor. Other important risk factors included older age, longer duration of marriage, lower education levels, headache, blurring of vision, and higher levels of alanine aminotransferase (ALT) and creatinine.

Exposure to organophosphate ester flame retardants and plasticizers and associations with preeclampsia and blood pressure in pregnancy

BackgroundOrganophosphate esters (OPEs), flame retardants and plasticizers found widely in consumer products, may impact vascularization processes in pregnancy. Yet, the association between maternal exposure to OPEs and both preeclampsia and blood pressure during pregnancy remains understudied. MethodsWithin the LIFECODES Fetal Growth Study (N = 900), we quantified 8 OPE metabolites from maternal urine collected at up to 3 time points during pregnancy and created within-subject geometric means. Outcomes included diagnosis of preeclampsia and longitudinal systolic (SBP) and diastolic (DBP) blood pressure measurements (mean = 14 per participant). Cox proportional hazards models were used to estimate associations between OPE metabolites and preeclampsia. Associations between average OPE metabolite concentrations and repeated blood pressure measurements were estimated using generalized estimating equations. ResultsFive OPE metabolites were detected in at least 60% of samples; 3 metabolites detected less frequently (5–39%) were examined in an exploratory analysis as ever vs. never detectable in pregnancy. There were 46 cases of preeclampsia in our study population. Associations between OPE metabolites and preeclampsia were null. We noted several divergent associations between OPE metabolites and longitudinal blood pressure measurements. An interquartile range (IQR) difference in average bis(2-chloroethyl) phosphate concentrations was associated with a decrease in SBP (−0.81 mmHg, 95% confidence interval [CI]: −1.62, 0.00), and, conversely, bis(1-chloro-2-propyl) phosphate was associated with a slight increase in SBP (0.94 mmHg, 95% CI: 0.28, 1.61). We also noted a decrease in SBP in association with several metabolites with low detection frequency. ConclusionsWe observed null associations between OPE metabolites and preeclampsia, but some positive and some inverse associations with blood pressure in pregnancy. While our study was well-designed to assess associations with blood pressure, future studies with a larger number of preeclampsia cases may be better poised to investigate the association between OPE metabolites and phenotypes of this heterogenous hypertensive disorder of pregnancy.

Abstract P190: Blood pressure monitoring and knowledge in the first year after a hypertensive disorder of pregnancy

Introduction: In the first year postpartum, hypertension (HTN) is a leading cause of morbidity and mortality, particularly for those with hypertensive disorders of pregnancy (HDP). Timely recognition of HTN is key to reducing short- and long-term cardiovascular risk among birthing people. Therefore, we assessed knowledge of when to seek medical attention for blood pressure (BP) elevations and rates of BP measurement in the first year postpartum among those with and without HDP. Methods: This was a secondary analysis of primiparas who participated in a randomized trial of prenatal counseling to improve postpartum health. We included 405 participants who self-reported information on postpartum BP assessment. We calculated (1) the proportion of participants who stated they would contact a clinician for a systolic BP above 140 and a diastolic BP above 90 at 3-months postpartum and (2) the frequency and location of BP checks reported from 3-12 months postpartum among those with and without HDP. Subgroup analyses compared BP knowledge by sociodemographic and health-related factors. Results: Participants were 32 +/-5 years, 16% reported a HDP, 60% identified as White, 75% had private insurance, and 84% had ≥ college education. For systolic BP, 44.6% with HDP and 23.5% without HDP identified a BP of 140 as the threshold above which they would contact a clinician (p&lt;0.01); for diastolic BP, 52.4% with HDP and 28.5% without identified a BP threshold of 90 (p&lt;0.01).From 3-12 months postpartum, 83.1% with HDP and 59.4% without HDP had a BP check (p &lt; 0.01); 41.6% with HDP and 9.7 % without HDP checked their BP at home (p&lt;0.01). Home monitoring was not associated with awareness of when to contact a physician for hypertension among those with HDP (TABLE). BP awareness was higher among people who had private health insurance, ≥ college education and were non-smokers. Conclusions: Efforts are needed to improve postpartum BP assessment, self-monitoring, and awareness of when to seek medical attention for HTN, among birthing people with and without HDP.

Abstract 48: Cardiovascular Health Modifies Genetic Risk for the Hypertensive Disorders of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal/perinatal mortality. In recent work, a genetic risk score improved prediction of HDPs beyond standard clinical risk factors, but the extent to which cardiovascular health (CVH) modifies HDP genetic risk is unknown. Hypothesis: First-trimester CVH can offset genetic risk for HDPs. Methods: We examined genotyped participants of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b). Individual HDP genetic risk was calculated using a validated polygenic score. A composite first-trimester CVH score was adapted from the Life’s Essential 8 model; cholesterol was incorporated in a subset (47%) with available first-trimester values. Genetic risk and CVH were each grouped as low (bottom quintile), intermediate (Q2-4), and high (top quintile). Logistic regression tested the joint association of CVH and genetic risk with HDP, adjusted for age and sociodemographic covariates. Results: Among 5,446 participants (mean age 27.5 years), 1,339 (24.6%) developed HDP (344 [6.3%] preeclampsia, 995 [18.3%] gestational hypertension [GH]). Higher genetic risk and lower CVH were additively associated with risk of HDP ( Figure 1A-B ) with no significant interaction (P[interaction] &gt;0.05). HDP incidence ranged from 11% (low genetic risk, favorable CVH) to 37% (high genetic risk, unfavorable CVH) ( Figure 1C ). Favorable vs. unfavorable CVH was associated with 35-62% lower risk of HDPs across genetic risk groups. Findings were broadly consistent when examining preeclampsia and GH separately and when incorporating cholesterol (i.e., using a complete Life’s Essential 8 score). Among CVH components, nonideal BMI, blood pressure, and diet conferred highest population attributable HDP risk (25%, 14%, and 12%, respectively). Conclusion: Higher genetic risk and lower first trimester CVH were additively associated with risk of developing HDP. Favorable CVH in early pregnancy may partially offset a higher genetic risk for HDP.

P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY

Background and objective: Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia. Methods: Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development. Results: The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP. Conclusions: The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.

Pulse Wave Velocity as a Tool for Cardiometabolic Risk Stratification in Individuals With Hypertensive Disorders of Pregnancy and Increased BMI

ObjectivesObesity is one of the most prevalent risk factors for hypertensive disorders of pregnancy (HDP); however, the role of pre-pregnancy cardiometabolic health in the development of these conditions is not well understood. Carotid-femoral pulse wave velocity (PWV) is an established measure of arterial stiffness and cardiovascular health and is validated in pregnancy. Our objective was to examine the obesity-related changes in PWV in pregnant individuals with and without HDP. MethodsOverall, 87 individuals with singleton pregnancies were recruited and classified into 2 groups: cases (HDP: including pre-existing/chronic hypertension, gestational hypertension, preeclampsia, or intrauterine growth restriction; n = 39) and normotensive controls (no HDP or intrauterine growth restriction; n = 48). Patient data, including BMI, were collected from patient charts. Measurements of PWV were performed weekly until discharge or delivery (gestational age 24–37 weeks) and placental growth factor (PlGF) was measured at routine blood draws. ResultsPWV did not significantly change over gestation for either group. Cases had significantly increased PWV and decreased PlGF compared to normotensive controls. An elevated BMI was associated with higher PWV in both cases and controls. Once grouped based on BMI, PWV was only significantly higher in cases with a BMI ≥25 kg/m2 compared to controls, whereas PlGF was less affected by BMI. As PWV increased, PlGF decreased; however, after controlling for BMI, there was no relationship between PWV and PlGF. ConclusionsPWV measurements in early pregnancy may be useful as an additional independent marker to PlGF for risk-stratifying for HDP, especially in individuals with increased BMI.

Abstract P107: Training for home blood pressure monitoring among women with a diagnosis or risk factors for hypertensive disorders of pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are leading causes of morbidity and mortality among pregnant women. Despite the potential benefits of home blood pressure monitoring (HBPM) for early diagnosis and monitoring of patients with HDP, its utilization is limited by inconsistent training by healthcare providers. This study sought to examine the use of and training for HBPM in those at risk for HDP. Methods: Pregnant women, aged 20-50 (N = 103), diagnosed with either hypertension, HDP, or risk factors for HDP, were recruited from a large academic medical center to complete a survey on HBPM practices from June 2020 to January 2024. Thisincluded questions about HBPM, frequency of HBPM, and prior HBPM training provision by providers. Statistical analysis was performed using STATA/BE 18.0. Results: Of the 103 participants, 41 (39.8%) did HBPM and the most common frequency was daily (70.7%). Of those who did HBPM, 36.6% had received training from their healthcare providers and 31.7% had their BP monitors calibrated in the clinic. There was a trend towards Hispanic women being less likely to receive training compared to white women ( p =0.07). There were no significant differences in training across categories of education and location of residence. Conclusion: In this sample where nearly 40% of pregnant women used HBPM, we observed that only 1 in 3 received training for HBPM with little difference observed across demographic categories. Given the time constraints in clinic visits hindering appropriate training for HBPM, exploring alternative methods of HBPM training such as leveraging mobile health applications may be beneficial to ensure that pregnant women receive necessary training to effectively conduct HBPM.

Perinatal Remote Blood Pressure Monitoring.

Perinatal mortality and severe maternal morbidity among individuals with hypertensive disorders of pregnancy (HDP) are often driven by persistent, uncontrolled hypertension. Whereas traditional perinatal blood pressure (BP) ascertainment occurs through in-person clinic appointments, self-measured blood pressure (SMBP) programs allow individuals to measure their BP remotely and receive remote management by a medical team. Though data remain limited on clinically important outcomes such as maternal morbidity, these programs have shown promise in improving BP ascertainment rates in the immediate postpartum period and enhancing racial and ethnic equity in BP ascertainment after hospital discharge. In this narrative review, we provide an overview of perinatal SMBP programs that have been described in the literature and the data that support their efficacy. Furthermore, we offer suggestions for practitioners, institutions, and health systems that may be considering implementing SMBP programs, including important health equity concerns to be considered. Last, we discuss opportunities for ongoing and future research regarding SMBP programs' effects on maternal morbidity, long-term health outcomes, inequities that are known to exist in HDP and HDP-related outcomes, and the cost effectiveness of these programs.

Abstract P414: Association between postpartum sleep and blood pressure reduction in women with hypertensive disorders of pregnancy

Importance: It is anticipated that many women do not get enough sleep after delivery. However, it is unclear how poor sleep affects postpartum blood pressure. Objective: To investigate the relationship between postpartum blood pressure and sleep habits, we examined women who developed hypertensive disorders of pregnancy by using automated blood pressure monitors and accelerometers. Setting: The blood pressure, pulse rate, and sleep were monitored at home. Total sleep time, sleep efficiency, sleep fragmentation coefficient, and wake after sleep onset were measured. Participants completed a behavior chart including breastfeeding frequency. The 24-hour, awake time and sleep time mean blood pressures were calculated for each participant as well as the change in blood pressure between postpartum days 7 and 14. Participants: We recruited 11 women who delivered singletons and developed hypertensive disorders of pregnancy at the National Center for Child Health and Development from April to September 2021. Intervention or Exposure: None Main Outcomes: The relationship between the change in blood pressure and sleep measurements and frequency of breastfeeding were analyzed. Results: Seven participants were included in the final analysis. The mean total sleep time was 5.3 hours, and the mean breastfeeding frequency was 6.1 times per day. Mean systolic and diastolic blood pressure and pulse rate during sleep periods tended to be lower than those during awake periods (-8.5±4.5 mmHg, -8.8±2.7 mmHg, -8.7±2.7 bpm, respectively). Lower sleep time was significantly correlated with smaller 24h-systolic and diastolic blood pressure drop (correlation coefficient r=-0.823, p=0.023 and r=-0.812, p=0.026, respectively. No association was found between other sleep measurements and the change in 24h-blood pressure. The blood pressure and pulse rate values in six of the seven participants during the early sleep phase (≤30 min) were similar to those in later sleep phases (&gt;30 min), showing that beneficial effects of sleep on blood pressure were apparent throughout the sleep phases. Conclusions and Relevance: Our results suggest that longer total sleep time, even if sleep is fragmented, is associated with a greater decrease in postpartum blood pressure among women who developed hypertensive disorders of pregnancy.

Hypertensive Disorders of Pregnancy in Saudi Arabia: Evaluating Maternal and Neonatal Risks, Outcomes, and Aspirin Prophylaxis: A Review Article.

Hypertensive disorders during pregnancy, including pre-eclampsia and eclampsia, pose significant risks to both maternal and neonatal health. This review article evaluates the prevalence, maternal and neonatal outcomes, and the efficacy of aspirin prophylaxis in managing these conditions in Saudi Arabia. Utilizing data from multiple retrospective studies and recent guidelines, we highlight the regional variations in the outcomes of hypertensive disorders of pregnancy. Severe complications such as Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome occurred in 6.6% of cases, while eclampsia was reported in 6.7% of cases. Cesarean sections were notably high, with rates reaching up to 79% among affected pregnancies. Maternal risk factors identified include chronic hypertension (prevalence 17%), diabetes (ranging from 10.4% to 26.3%), and advanced maternal age. Neonatal complications often involve preterm birth, reported in 26.5% to 26.7% of cases, intrauterine growth restriction (ranging from 15.7% to 25%), and increased NICU admissions, reported in 2.4% of cases. No data were found in the included studies to evaluate the prophylactic use of low-dose aspirin in reducing the incidence of pre-eclampsia or improving fetomaternal outcomes. Despite the effectiveness of aspirin, awareness and implementation of prophylaxis guidelines remain suboptimal among healthcare providers in Saudi Arabia. A national survey revealed that only a fraction of obstetrical care providers were fully knowledgeable about aspirin prophylaxis guidelines. This review underscores the necessity for enhanced educational programs and standardized guidelines to improve maternal and neonatal outcomes in hypertensive pregnancies within the region.

Abstract P196: Association between Preeclampsia and Risk of Arrhythmias and Stroke: A Meta-analysis of 3,871,787 women patients.

Background: Preeclampsia, a hypertensive disorder of pregnancy has been known to be associated with adverse outcomes including cardiovascular complications. However, data on the association between preeclampsia and the incidence of arrhythmias are sparse with limited literature to date. Objective: We sought to evaluate the association between preeclampsia and the risk of arrhythmias. Methods: We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant studies from inception until April 2024 without any language restrictions. Adjusted Hazard ratios (aHR) and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 4 studies with 3,871,787 women patients (86,452 women in the preeclampsia group and 3,785,245 women in non preeclampsia) were included in the analysis. Pooled analysis showed that women with preeclampsia were having a higher incidence of arrhythmias (aHR, 1.71 (95%CI:1.24-2.18), P&lt;0.001), and stroke (aHR, 1.72(95%CI: 1.25-2.19), P&lt;0.001) when compared with the non preeclampsia group of women. Conclusion: Our study shows that women with Preeclampsia were having a higher incidence of arrhythmias and stroke. Proper and timely cardiovascular assessment may benefit from morbidity and mortality.