Incidence Of Preeclampsia Research Articles

Pregnancy outcomes in patients with IgA vasculitis with nephropathy (Henoch–Schönlein purpura nephritis) and those with IgA nephropathy: Childhood purpura nephritis is high risk for preeclampsia

Objective: Childhood IgA vasculitis in remission is not a known risk factor for pregnancy but can lead to complications such as preeclampsia, even in women with a low risk of kidney function decline.Methods: This retrospective study compared pregnancy outcomes between patients with IgA vasculitis with nephropathy (Henoch–Schönlein purpura nephritis) and those with IgA nephropathy who delivered at Osaka University Hospital between 2010 and 2020.Results: Seven patients with purpura nephritis and 37 patients with IgA nephropathy had a total of 9 and 53 pregnancies, respectively. Purpura nephritis patients had an earlier gestational age at delivery and higher frequency of preterm birth, fetal growth restriction, and preeclampsia than IgA nephropathy patients, although differences were not significant. Among pregnancies at low risk of kidney function decline, 35 were with IgA nephropathy and 9 were with purpura nephritis. The incidence of preeclampsia was significantly higher with purpura nephritis (44%: 4/9) than with IgA nephropathy (9%: 3/35 including 2 with oocyte donation). Severe and early-onset preeclampsia was noted in 2 pregnancies with purpura nephritis.Conclusion: Patients with childhood purpura nephritis in remission may develop preeclampsia, with a higher risk of severe and early-onset preeclampsia than patients with IgA nephropathy.

Pregnancy outcomes of normal karyotype fetuses with increased nuchal translucency.

Although the association between first-trimester increased nuchal translucency (NT) and chromosomal defects is well-defined, there is little knowledge about the importance of increased NT in fetuses with normal karyotypes. Hence, this study was designed to evaluate outcomes of normal karyotype fetuses with increased NT. This observational retrospective study was conducted on 720 pregnancies with increased NT (>3mm) at 11 to 13 weeks of gestational age in Yas Hospital, Tehran, Iran, from 2016 to 2020. Study outcomes were incidence of preeclampsia, intrauterine growth restriction) IUGR (, preterm labor, fetal anomaly, cardiac malformations, hydrops fetalis, abortion, and intrauterine fetal death (IUFD) in pregnancies without evident chromosomal karyotype abnormalities. Out of 720 participants who underwent karyotyping in the study center, 523 fetuses had normal karyotype results. In the pregnancies assessed for outcome, 357 (68.3%) reached live birth, 104 (19.9%) aborted, and 62 (11.9%) resulted in IUFD. Study outcomes including preeclampsia (<0.001), IUGR (<0.001), preterm labor (<0.001), fetal anomaly (<0.001), cardiac malformations (<0.001), hydrops fetalis (0.017), abortion (<0.001), and IUFD (<0.001) resulted in a statistically significant difference in the distribution of cases across NT intervals. This study demonstrated adverse pregnancy outcomes increased with increasing NT despite normal karyotyping. Hence, tight observation of mothers and fetuses should be done in normal karyotype fetuses with increased NT.

Systematic review and meta-analysis of nutritional interventions to prevent of gestational hypertension or/and preeclampsia among healthy pregnant women.

Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies. However, very few randomized-controlled trials have systematically summarized. Thus, we reviewed and meta-analyzed the effects of nutritional interventions on risks of gestational hypertension (GH) or/and preeclampsia (PE). A systematic search was performed using Medline, Cochrane library, Google Scholar, ISI Web of Science, Scopus, and ProQuest to find randomized clinical trials assessing the effect of nutritional interventions on incidences of GH or/and PE compared to control or placebo interventions. After considering duplicates, 1066 articles were screened from the database searches. Full-text articles were retrieved for 116 records, while 87 did not have the inclusion criteria and were later omitted. Twenty-nine studies were eligible, but 8 studies were not included in the meta-analysis due to insufficient data. Finally, seven studies were included in qualitative analysis. Furthermore, 7 studies (693 in intervention vs. 721 in control) were pooled for managed nutritional interventions, three (1255 vs. 1257) for a Mediterranean-style diet, and 4 (409 vs. 312) for sodium restricted. Our results revealed that managed nutritional programs were effective in reducing the incidence of GH (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15, 0.92); I2 = 66.9%; P = 0.010), but not for PE (OR = 0.50; 95% CI = 0.23, 1.07); I2 = 58.9%; P = 0.032. The Mediterranean-style diets in three trials (1255 vs. 1257) did not reduce the risk of PE (OR = 1.10; 95% CI = 0.71, 1.70); I2 = 2.3%; P = 0.359). Likewise, sodium-restricted interventions in four trials (409 vs. 312) did not decrease total risk of GH (OR = 0.99; 95% CI = 0.68, 1.45); I2 = 0%; P = 0.520). Meta-regression did not indicate any significant association between maternal age, body mass index, gestational weight gain, and start time of all interventions with the incidence of GH or/and PE (P > 0.05). The present meta-analysis showed that Mediterranean-style diets and sodium-restriction interventions did not decrease the incidence of GH or/and PE in healthy pregnancies; however, managed nutritional programs reduced the risk of GH, the total incidence of GH and PE, but not PE.

SARS-CoV-2 infection during pregnancy and risk of hypertensive disorders of pregnancy and preterm birth

Although recent research supports an increased incidence of preeclampsia and preterm birth and COVID-19 disease during pregnancy, more high quality evidence is needed to further elucidate this association. The objective of this study is to further assess the relationship between SARS-CoV-2 infection and the risk of preeclampsia and preterm birth.

JS-HR-4: PREECLAMPSIA UP TO DATE; WHAT WE SHOULD KNOW FOR MOTHER AND CHILD.

Preeclampsia (PE) is a systemic hypertensive disorder of pregnancy thought to arise from placental maladaptation and subsequent systemic inflammatory processes. PE is associated with significant maternal and fetal mortality with hypertensive disorder of pregnancy accounting for -14% of maternal deaths globally and also with increased maternal risks for chronic diseases in later life. In 2017, the American College of Cardiology/American Heart Association hypertension treatment guidelines identified hypertension as blood pressure (BP) 130/80 mmHg. The reference BP for hypertension during pregnancy as specified in international guidelines is still &gt; 140/90 mmHg. Also, recommended target BP level differs between these guidelines. A large number of studies have been examining the incidence of PE and fetal outcomes according to BP levels to figure out the optimal level for pregnant women. Given only termination of pregnancy has been proved to initiate the resolution of PE once it has developed, prevention of PE is a health care priority. However, the predictive value of BP and other clinical characteristics for PE is relatively low, and therefore, improved method for the prediction of PE and associated adverse outcomes is required. Past history of PE is now widely known to link with major chronic diseases such as hypertension, type 2 diabetes mellitus, dyslipidemia, cardiovascular disease in later life. Since many cardiovascular risk factors are modifiable and related to lifestyle, all women with prior PE should be followed-up by physician even after resolution of PE (eg. hypertension, proteinuria). However, no long-term follow-up strategy for former-PE patient has yet been established. The 2019 Maternal Mortality update from the WHO report indicated the major contribution of PE and eclampsia to worldwide maternal deaths. Further investigation is needed to decrease PE related maternal and fetal deaths and also to reduce maternal risks for chronic diseases in later life. Participation of physicians is necessary to offer appropriate medical care to women with prior PE.

Особенности течения многоплодной беременности после экстракорпорального оплодотворения

Objective. To study the course of multiple pregnancy after the use of different methods of assisted reproductive technologies. Patients and methods. A total of 234 patients with multiple pregnancy developed through in vitro fertilization (IVF) were examined: 99 patients under the surrogate motherhood program (IVF-SM), 68 women after IVF with donor oocytes (IVF-DO), and 67 patients after IVF with own oocytes (IVF-OO). Patient subgroups were formed based on the presence or absence of obstetric complications. Results. Univariate analysis of pregnancy course showed that the incidence of gestational hypertension was significantly higher in the IVF-DO group than in the IVF-SM and IVF-OO groups. Pre-eclampsia (PE) in patients in the IVF-DO group was significantly more common than in the IVF-SM group (OR: 5.87; 95% CI: 1.94–17.74, p &lt; 0.0005). Intrahepatic cholestasis (11.7%) and gestational diabetes (7.3%) were also more common in the IVF-DO group, but these data were not statistically significant. In multivariate analysis adjusted for maternal age, the incidence of PE remained significantly higher in the IVF-DO group compared with the IVF-SM group (OR: 7.68; 95% CI: 1.64–35.84, p &lt; 0.0055). There were no significant differences between the IVF-DO and IVF-OO groups (OR: 2.8; 95% CI 0.77–10.22, p &lt; 0.1487) and the IVF-OO and IVF-SM groups (OR: 0.36; 95% CI 0.11–1.24, p &lt; 0.1305). Conclusion. Multiple pregnancy following IVF-DO is significantly associated with a higher risk of pre-eclampsia and fetal growth restriction compared with the IVF-OO and IVF-SM groups. Key words: multiple pregnancy, oocyte donation, pre-eclampsia, surrogacy, in vitro fertilization

Профилактика преэклампсии ацетилсалициловой кислотой: краткий курс истории применения и современные подходы к профилактике

By preeclampsia (PE) we mean hypertension, which first occurred after 20 weeks pregnant in combination with proteinuria or other signs of target organ damage. PE is accompanied by high maternal and perinatal mortality, and these indicators are the higher the earlier the disease onset is. Despite the presence of seemingly effective methods for the PE prevention, this pathology incidence has practically not changed in recent decades. This may be due to the fact that the PE pathogenesis is complex and has not been fully studied. We are still continuing to look for new prognostic markers that would allow us to select high-risk patients. In the high-risk group, acetylsalicylic acid (ASA) intake reduces the PE incidence, but the overall picture does not change significantly. Besides, ASA long-term use may increase the risks of some pregnancy complications. Differential treatment tactics for prevention in different risk groups is likely to be effective. The article summarizes the confirmed data on ASA used for the PE prevention and its complications, as well as promising areas for further research. KEYWORDS: preeclampsia, acetylsalicylic acid, pregnancy-associated plasma protein A, PAPP-A, placental growth factor, PlGF, placental abruption, first trimester screening, calcium. FOR CITATION: Osipov R.S., Dzhokhadze L.S., Kuznetsov P.A., Shamugiya V.V. Prevention of preeclampsia with acetylsalicylic acid: a brief history of use and modern prevention methods. Russian Journal of Woman and Child Health. 2023;6(4):368–373 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-7.

Determinants Factors of Pre-Eclampsia Incidence

Maternal Mortality Rate (MMR) is one indicator in describing the welfare of society in a country. MMR in Indonesia in 2020 has increased compared to 2019. In 2019, MMR in East Java Province reached 89.81 per 100,000 live births. This figure will increase in 2020 to 98.39 per 100,000 live births. An important issue in Malang Regency related to maternal and child health is the high MMR. Preeclampsia is the 3rd largest case along with cases of infection and postpartum bleeding. The purpose of this research was to see a description of the determinants associated with the incidence of preeclampsia and to find the most dominant determinants causing preeclampsia in Kanjuruhan Hospital, Malang Regency. The type of the research was descriptive with a documentation study approach from the medical records of RSUD Kanjuruhan Malang. The analysis technique used descriptive analysis. The results of the research showed that the age data of most of the pregnant women were in high risk age (more than 35 years) as many as 28 mothers (56%), the distance between pregnancies in pregnant women with preeclampsia was mostly more than 2 years (64%), the highest parity of women with preeclampsia was multipara (68%), most of the women had never had an abortion (72%) and the gestational age of most women with preeclampsia was term (76%). Factors that determine the incidence of preeclampsia are age, gestation interval, parity and gestational age. Further research is needed to determine other factors that cause preeclampsia.

Risk Factors of Preeclampsia in Raden Mattaher Hospital, Jambi

Preeclampsia is the major cause of maternal-neonatal death, with an estimated incidence 2-8% of pregnancies. The purpose of this study was to determine risk factors that most influence the incidence of preeclampsia in pregnant women in Jambi province. This study used an analytic observational method with a case-control study design. By using purposive sampling, 125 pregnant women with preeclampsia were found as a case group at Raden Mattaher Hospital and 125 normal pregnant women as a control group at Lambur Health Center. The results showed there was a significant difference between age (p-value 0.002), parity (p-value 0.073), gestational interval (p-value 0.0001), hypertension history (p-value 0.0001), Multiple Pregnancy (p-value 0.366), BMI (p-value 0.0001 ) and hemoglobin levels (p-value 0.003) with incidence of preeclampsia. Then multiple logistic regression analysis showed that hemoglobin level (OR 23.5/CI 3.5-157.3), hypertension history (OR 13.2/CI 4.4- 39.5) and BMI (OR1 6.1 CI 2.5-15.3/ OR2 5.0 CI 2.1-12.0) are the most dominant risk factor that causes preeclampsia. The conclusion there are relationship between age, gestational age, hypertension history, BMI and hemoglobin levels with the incidence of preeclampsia

The Effect of Assessment Mean Arterial Pressure and Body Mass Index as an Early Detection of Pre-Eclampsia

Pre-eclampsia or hypertension in pregnancy is a disease that can be detected early so that prevention can be done so that complications do not occur. One way to detect the presence of eclampsia is to carry out early detection using measurements of Body Mass Index (BMI) and blood pressure of pregnant women on a regular basis. Examination of mean arterial pressure in pregnant women with age in the first trimester as a strong predictor in cases of hypertension in pregnancy and preeclampsia. To determine the effect of the assessment of body mass index and mean arterial pressure as early detection of hypertension in pregnancy in the work area of the Trauma Center Health Center, Samarinda City. The method in this study combines two cross-sectional and prospective cohort time approaches. Sampling technique with Accidental Sampling as many as 50 people. Results: The results of this study indicate that there is an effect of MAP and BMI assessment with the incidence of Pre-Eclampsia and Eclampsia with a value (p-value = 0.000 = 0.05). There is an effect of the assessment of Mean Arterial Pressure (MAP) and Body Mass Index with the incidence of Pre-Eclampsia and Eclampsia in the work area of the Trauma Center Health Center in Samarinda City.

Pregnancy outcomes after living kidney donation from a nationwide population-based cohort study from Korea

While most living kidney donors experience good outcomes and high rates of satisfaction, kidney donation can increase the risk of gestational hypertension or preeclampsia. However, pregnancy outcomes in non-white donors are limited. We conducted a nationwide cohort study of 112 living kidney donors and 672 matched healthy non-donors using the Korean National Health Insurance Claims Database. Donors and healthy non-donors were matched according to age, year of cohort entry, residency, income, number of pregnancies, and the time to the first pregnancy after cohort entry. We assessed pregnancy outcomes of live kidney donors compared with matched healthy non-donors using the nationwide database. Gestational hypertension or preeclampsia was more common in kidney donors than in non-donors (8.9% vs. 1.8%; adjusted odds ratio, 2.68; 95% confidence interval, 1.11–6.50). However, the incidence of severe gestational hypertension or preeclampsia that required antihypertensive medication was comparable (2.7% vs. 0.9%; P = 0.121). The time from donation to delivery within 5 years and primiparity were risk factors for preeclampsia in donors. Low birth weight, stillbirth, and ectopic pregnancy were not significantly different between the two groups. Maternal death occurred in two non-donor cases, but none occurred in donors compared to non-donors. Our findings indicate that kidney donors are associated with an increased risk of gestational hypertension or preeclampsia than matched healthy non-donors. However, the probabilities of serious maternal and fetal outcomes remained low and are not increased significantly after kidney donation.

PREGNANCY COMPLICATIONS AND MODE OF DELIVERY IN COVID-19 WOMEN PERFORMING DELIVERY IN THE DISTRICT CLINICAL HOSPITAL IN KHANTY-MANSIYSK

The aim of the study is to assess the frequency of pregnancy complications and the mode of delivery in COVID-19 women performing delivery in the district clinical hospital in the city of Khanty-Mansiysk.&#x0D; Materials and Methods. The authors retrospectively analyzed 148 medical histories of COVID-19 women, who delivered in Khanty-Mansiysk perinatal center. All patient medical records were divided into 4 subgroups depending on the delivery term, and 3 subgroups depending on the disease severity. Statistical analysis was carried out using analytics software packages Statistica 10 (USA) and StatTech v. 2.8.4 (Stattech, Russia, 2020). Given group heterogeneity, non-parametric statistical methods were used to calculate quantitative and qualitative parameters. Fisher Z transformation and the Mann-Whitney test were used to compare the parameters. Differences were considered statistically significant at p≤0.05, CI 95 %.&#x0D; Results. In all subgroups the most common pregnancy complication in COVID-19 patients was anemia. It was observed in 50.8 % to 74.3 % of cases. The maximum incidence of moderate preeclampsia was 2.7 %, that is below the average population value. Most placental abnormalities were detected in subgroups of women who gave birth during 3rd and 4th waves of COVID-19 (37.1 % and 33.8 % respectively). In the same subgroups, fetal growth retardation (28.6 % and 32.3 %), statistically significant increase in the proportion of preterm births (34.3 % and 38.5 %) and transfers to the neonatal intensive care unit (28.6 % and 26.2 %) were often observed.

Comparison of clinical features in antepartum and postpartum HELLP syndrome

Objective: To analyze the clinical features and pregnancy outcomes in antepartum and postpartum hemolysis, elevated live enzymes, and low platelet count syndrome(HELLP syndrome). Methods: A retrospective study was conducted to collect maternal and neonatal information of pre-eclampsia complicated with HELLP syndrome in Peking University First Hospital during the ten years from April 2009 to March 2019. A total of 83 pregnant women were included according to the Tennessee Classification System. They were then allocated into two groups based on the onset time of HELLP syndrome: antepartum HELLP syndrome group (n=70) and postpartum HELLP syndrome group (n=13). The clinical features, symptoms, laboratory biomarkers, and pregnancy outcomes were compared between the two groups. Results: Among the 83 pregnant women with HELLP syndrome, 70 occurred prenatally (84%, 70/83) and 13 occurred postpartum (16%, 13/83). The twin or triplet pregnancy rate in the postpartum HELLP syndrome group was significantly higher than that in the antepartum HELLP syndrome group [6/13 vs 6% (4/70), P=0.001]. The gestational weeks for HELLP onset and delivery in the postpartum HELLP syndrome group were significantly later than those in the antepartum HELLP syndrome group [(35.8±3.0) vs (31.5±5.2) weeks, P=0.025; (36.7±2.3) vs (32.2±5.0) weeks, P=0.002]. The incidence of early-onset pre-eclampsia in the antepartum HELLP syndrome group was significant higher than that in the postpartum HELLP syndrome group [64% (45/70) vs 2/13, P=0.002]. The quantitative of 24-hour proteinuria was significant higher in the antepartum HELLP syndrome group than that in the postpartum HELLP syndrome group [(4.8±5.1) vs (1.8±1.6) g, P=0.002]. But there were no statistical significances in the comparison of other laboratory test indexes (all P>0.05). There were no significant differences between the two groups in clinical symptoms, severe maternal complications, transfusion or adverse maternal outcomes (all P>0.05). Conclusions: Antepartum and postpartum HELLP syndrome have similar clinical symptoms and laboratory characteristics. Both antepartum and postpartum HELLP syndrome could lead to severe maternal complications, which should be paid special attention in clinical practice, especially to the postpartum HELLP syndrome.

A Study Of Incidence Of Pre-Eclampsia In Relation To Parity

The glory of attaining motherhood is often associated with shadows of life threatening dangers to the mother and the unborn child, even though pregnancy and childbirth is purely a physiological process.&#x0D; Pre-eclampsia is one of the complication of pregnancy and contributes significantly maternal as well as perinatal morbidity and mortality(1,2). This disorder is characterised by involvement of cardiovascular, coagulation, renal and hepatic system(3,4). This is a life threatening complication of pregnancy and is characterised by high blood pressure and proteinuria(5).&#x0D; Extensive studies have been made to detect the aetiology and pathogenesis of the condition. But despite decade of research, the aetiology of PIH has remained elusive and no definite and universally accepted conclusion has been reached(6). During normal pregnancy, renal blood flow and glomerular filtration increases appreciably. With the development of pre-eclampsia renal perfusion and glomerular filtration are reduced, resulting in impairment of renal function. The main characteristic feature of pre-eclampsia i.e. edema, proteinuria and hypertension are due to renal involvement. There occurs renal vasospasm which eventually produce endothelial damage, proteinuria and hypertension(7,8,9).&#x0D; So considering the mater related to our country an attempt has been made to study the incidence of pre-eclampsia in relation to parity.

Comparison of Maternal and Perinatal Outcomes of Pregnancy with Systemic Lupus Erythematosus in Planned Referrals Compared to Emergency Referrals Based on the Maternal Fetal Triage Index at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that attacks the skin and the musculoskeletal, kidney, neuropsychiatric, hematological, cardiovascular, pulmonary, and reproductive systems. In pregnancies with SLE, early referral to the hospital with the involvement of obstetricians and rheumatologists, and other specialists as needed, as well as individual management plans, regular reviews, and early recognition of flares and complications, are important. This study aimed to determine the differences in maternal and perinatal outcomes referred by planned referrals compared to emergency referrals, especially in pregnant patients with SLE.&#x0D; Methods: This study was an analytic observational study with a retrospective cohort approach. A total of 40 subjects participated in this study. Data analysis using SPSS software was carried out univariate and bivariate to examine the relationship between types of referrals and maternal and perinatal outcomes.&#x0D; Results: There were significant differences between the types of emergency referrals and planned referrals in the variable incidence of preeclampsia and SLE exacerbations. There were no significant differences between the types of emergency referrals and planned referrals on the variable incidence of lupus nephritis, maternal death, premature delivery, fetal growth restriction, fetal death, and the incidence of neonatal lupus syndrome.&#x0D; Conclusion: The incidence of severe preeclampsia and SLE exacerbation was lower in planned referrals compared to emergency referrals in pregnant patients with SLE at Dr. Kariadi General Hospital, Semarang, Indonesia.

COVID-19 Not Hypertension or Diabetes Increases the Risk of Preeclampsia among a High-Risk Population

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been associated with greater morbidity and increased mortality in certain populations, such as those with chronic medical conditions, the elderly, and pregnant women. Our goal was to determine if COVID-19 infection during pregnancy increased the risk of preeclampsia in a population of women with increased risk factors for preeclampsia. We present a prospective observational matched case-control study of 100 deliveries with confirmed SARS-CoV2. Specifically, we investigated the maternal and neonatal outcomes in a high-risk population of pregnant women. Among women with COVID-19, the severity of symptoms was associated with the incidence of preeclampsia, but not with pre-existing diabetes or hypertension. Women with more severe symptoms were more likely to delivery pre-term with smaller babies. After adjusting for diabetes, hypertensive women with COVID-19 had an increased risk of preeclampsia aOR4.3 [1.5,12.4] compared to non-hypertensive women with COVID-19. After adjusting for hypertension, women with diabetes and COVID-19 had an increased risk of preeclampsia aOR3.9 [1.2,12.5]. This relationship was not seen among women without COVID-19. For women who had pre-existing diabetes or hypertension, the risk of developing preeclampsia was only increased if they were also diagnosed with COVID-19, suggesting that in our population of women the risk of preeclampsia is not associated with pre-existing diabetes or hypertension.

In utero exposure to per-/polyfluoroalkyl substances (PFASs): Preeclampsia in pregnancy and low birth weight for neonates

Per-/polyfluoroalkyl substances (PFASs) have been linked to preeclampsia with inconsistent directions for outcomes. However, information regarding the joint effects of PFASs mixtures on preeclampsia as well as their associations with the low birth weight (LBW) and small for gestational age (SGA) is nascent. The present study included 82 women with preeclampsia and 169 healthy participants from Hangzhou, China. Fifteen PFASs were analyzed in maternal serum before delivery. PFOA and 6:2Cl-PFESA were associated with higher incidence of preeclampsia both linearly and by tertile. Each log-unit increase in serum PFOA (OR:5.29, 95% CI: 1.05, 26.7, p = 0.044) and 6:2 Cl-PFESA (OR:1.02, 95%CI: 1.00, 1.48, p = 0.045) concentrations were associated with increased risks of preeclampsia. These effects were more profound among primiparous women carrying female fetuses. Both PFOA and PFUnDA concentrations were significantly associated with higher odds of early-onset preeclampsia, but the associations tended to be null for late-onset. In addition, each logarithmic increment in PFOA concentrations were significantly associated with a 0.262 and 0.224 mmHg increase in systolic (95% CI: 0.147, 0.377) and diastolic (95% CI: 0.133, 0.314) blood pressures. Using Bayesian kernel machine regressions (BKMR), the overall effects of PFASs mixture concentrations on preeclampsia showed an increasing trend, with PFOA being the largest contributor. With regard to birth weight, the Cox proportional hazards model indicated that significantly higher risks of the LBW were associated with preeclampsia than normal pregnancy (OR: 4.56, 95% CI: 2.44, 6.68, p = 0.000). Increased LBW risks were found for the higher PFOA exposure both linearly and by tertile. Besides, serum PFOA and PFUnDA concentrations were significantly associated with higher odds of SGA development. Nevertheless 4:2 FTS and ADONA were inversely associated with LBW and SGA incidences. Further adverse birth outcomes should be explored to elucidate the health implications of PFASs exposure and preeclampsia development.

An evidence review and nutritional conceptual framework for pre-eclampsia prevention.

Pre-eclampsia is a serious complication of pregnancy, and maternal nutritional factors may play protective roles or exacerbate risk. The tendency to focus on single nutrients as a risk factor obscures the complexity of possible interactions, which may be important given the complex nature of pre-eclampsia. An evidence review was conducted to compile definite, probable, possible and indirect nutritional determinants of pre-eclampsia to map a nutritional conceptual framework for pre-eclampsia prevention. Determinants of pre-eclampsia were first compiled through an initial consultation with experts. Second, an expanded literature review was conducted to confirm associations, elicit additional indicators and evaluate evidence. The strength of association was evaluated as definite relative risk (RR) < 0·40 or ≥3·00, probable RR 0·40-0·69 or 1·50-2·99, possible RR 0·70-0·89 or 1·10-1·49 or not discernible RR 0·90-1·09. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation. Twenty-five nutritional factors were reported in two umbrella reviews and twenty-two meta-analyses. Of these, fourteen were significantly associated with pre-eclampsia incidence. Higher serum Fe emerged as a definite nutritional risk factors for pre-eclampsia incidence across populations, while low serum Zn was a risk factor in Asia and Africa. Maternal vitamin D deficiency was a probable risk factor and Ca and/or vitamin D supplementation were probable protective nutritional factors. Healthy maternal dietary patterns were possibly associated with lower risk of developing pre-eclampsia. Potential indirect pathways of maternal nutritional factors and pre-eclampsia may exist through obesity, maternal anaemia and gestational diabetes mellitus. Research gaps remain on the influence of household capacities and socio-cultural, economic and political contexts, as well as interactions with medical conditions.

Risk Factors Associated With the Occurrence of Preeclampsia in Southern Iran

Background: Hypertension during pregnancy, along with proteinuria and organ dysfunction, causes preeclampsia, which can lead to several complications, even death in some cases for both the mother and her fetus. This study aimed to compare the risk factors of preeclampsia incidence in multipara women in Bandar Abbas. Methods: This case-control study reviewed 215 medical records of pregnant women referring to the Persian Gulf Hospital of Bandar Abbas, Iran from April 2019 to March 2020. They reviewed the records after their classification into the case (with preeclampsia) and control (without preeclampsia) groups. Both groups were matched, and after gathering the main variables and demographic factors, the data were analyzed by SPSS, version 22. Results: The mean age of the participants was 31.43 ± 5.04 years. There was a significant relationship between preeclampsia and chronic blood pressure (BP) (P=0.0001) with an odds ratio of 14.77. However, no significant association was found between liver disease (P=1.00), heart disease (P=0.095), diabetes (P=0.053), and kidney disease (P=0.76) with preeclampsia. In addition, the comparison results revealed a significant relationship between demographic variables and preeclampsia, systolic blood pressure (SBP) (P=0.001), and diastolic blood pressure (DBP) (P=0.001) with the incidence of preeclampsia. Conclusion: The results showed that even though there was no significant relationship between diabetes, heart disease, and kidney disease with preeclampsia, patients with these diseases were 2.27, 1.21, and 6.3 times more likely to develop preeclampsia, respectively.

Clinical factors associated with preeclampsia recurrence.

Preeclampsia is associated with immediate and long term offspring and maternal morbidities and mortality. Incidence of preeclampsia has increased and recurrent preeclampsia has not decreased in recent decades. The aim of the current study was to identify risk factors for recurrent preeclampsia among women with a history of preeclampsia. A population-based nested case- control study was performed at the Soroka University Medical Center. Included were all women with at least two pregnancies, with preeclampsia diagnosis in their first pregnancy. Cases were defined as women with recurrent preeclampsia and the controls as women with preeclampsia in their first but not in their second pregnancy. First pregnancy characteristics were compared among women with and without recurrent preeclampsia in subsequent pregnancy. A sub-analysis was conducted among women with first pregnancy preeclampsia with early onset. A multivariable logistic model was used to identify independent risk factors for recurrent preeclampsia, and to study whether the risk increased with each additional complication. The models adjusted for maternal age and ethnicity. A total of 2899 women who had preeclampsia in their first pregnancy were included in the study, 496 of them had recurrent preeclampsia (17.1%) in subsequent pregnancy. Maternal age, cesarean and preterm deliveries were significant independent risk factors for recurrent preeclampsia. These factors were not associated with early onset recurrent preeclampsia. Cesarean and preterm deliveries are significant risk factors for recurrent preeclampsia. Different etiologies and risk factors are possibly involved in preeclampsia recurrence following early versus late first preeclampsia onset.