Incidence Of Pregnancy-induced Hypertension Research Articles

Vitamin D May not be Crucial: Association between Serum Vitamin D Level and Pregnancy-Induced Hypertension-A Meta-Analysis

Background: The association between vitamin D and pregnancy-induced hypertension (PIH) remains contentious. The aim of our study was to evaluate the existence of an association between serum vitamin D levels and the incidence of PIH. Methods: We conducted a literature search in PubMed, the Cochrane Library, and Embase databases in June 2024 using the following search terms: 25-hydroxyvitamin D (25(OH)D), Vitamin D, 1,25(OH)2D, VD, 1,25-dihydroxyvitamin D or 25(OH)D, combined with PIH. Two reviewers independently screened the literature based on inclusion and exclusion criteria. Data were then extracted and assessed for quality. Comparisons were made between the highest and lowest categories of serum vitamin D levels. Relative risks (RRs) and 95% confidence intervals (CIs), adjusted for multivariable effects, were pooled using a random-effects model. A two-stage dose-response meta-analysis was used to evaluate the trends. Results: 17 studies met the inclusion criteria. Of these, 11 prospective studies investigated the relationship between vitamin D levels and gestational hypertension, involving 8834 events and 17,104 participants. The results showed that vitamin D was only marginally associated with hypertensive disorders in pregnancy (summary RR = 0.99; 95% CI: 0.97–1.02; I2 = 67.5%; p = 0.001). However, 6 case-control studies investigated the relationship between vitamin D levels and gestational hypertension, involving 80,814 events and 330,254 participants. The results showed that vitamin D is not associated with pregnancy hypertensive disorders (summary RR = 1.09; 95% CI: 0.84–1.41; I2 = 75.4%; p = 0.001). In the subgroup analysis, the pooled effect of 25-hydroxyvitamin D (25(OH)D) showed a slight association with gestational hypertension (pooled RR = 0.99; 95% CI: 0.96–1.02; I2 = 72.6%; p = 0.000). The dose-response analysis showed that increasing vitamin D doses are marginally associated with a decrease in the incidence rate. Conclusions: Our research suggests that the risk of PIH may not be related to the vitamin D levels. Our research supports the hypothesis that gestational hypertension may not be associated with low levels of vitamin D, indicating that the role of vitamin D may not be significant.

NIDAN PANCHAK OF GARBHA UPADRAVA SHOTHA W.S.R GESTATIONAL HYPERTENSION

Pregnancy is a crucial phase for women, characterized by numerous physiological changes. One common condition during this period is hypertension, specifically known as pregnancy-induced hypertension (PIH). The incidence of PIH is increasing due to older ages at marriage and delayed conception. PIH generally manifests after 20 weeks of gestation and significantly contributes to both maternal and fetal morbidity and mortality. Hypertensive disorders of pregnancy (HDP) remain a significant challenge in obstetrics, affecting 5-10% of pregnancies and accounting for 16% of maternal deaths worldwide. Garbha upadrava shotha which we can correlate with endothelial dysfunction which we can correlate with gestational hypertension in modern.Although Ayurveda does not classify hypertension as a conventional disease, it provides valuable insights through the evaluation of doshas (body humors), dushyas (affected entities), srotas (body channels), and other related factors. This comprehensive approach, addressing physical, mental, and spiritual aspects, offers potential in both understanding and managing hypertension effectively.

Rezultatele naşterii la vârste materne foarte avansate – experienţa unui centru de nivel 2

Background. Advanced maternal age has been linked to unfavorable perinatal outcomes. This study aimed to evaluate the perinatal outcomes in patients with very advanced maternal age. Materials and method. We retrospectively reviewed the records of patients admitted to the Obstetrics and Gynecology Clinic of the Mureş County Clinical Hospital, Romania, between 1 September 2016 and 1 September 2023. The study group comprised 17 patients, while the control group consisted of 661 patients, aged 18-44 years old, who gave birth between 1 January 2023 and 30 June 2023. Results. Patients from rural areas with very advanced maternal age had more pregnancies and births than the control group. The majority of pregnancies were achieved naturally, with a significantly higher incidence of preterm birth before 34 weeks. There were no statistically significant differences in the incidence of pregnancy-induced hypertension and intrauterine growth restriction between groups, while obesity and gestational diabetes were significantly associated with very advanced maternal age. Caesarean section was the most common mode of delivery. Newborns of mothers with very advanced age were more frequently male, had low birth weight, and were frequently admitted to the intensive care unit. Conclusions. Advanced maternal age is associated with an increased risks of gestational diabetes, premature birth, caesarean section, and delivering small-for-gestational-age newborns. Therefore, patients with advanced maternal age require careful obstetric surveillance.

A Comparison of the Umbilical Artery Doppler Indices between Pregnancies with Advanced and Normal Maternal Age in the Second Trimester

Objective: To compare the pulsatile index (UA-PI), resistance index (UA-RI), and systolic/diastolic ratio (UA-S/D) of the umbilical artery between pregnant women with advanced maternal age (AMA) and normal maternal age. Materials and Methods: Participants were pregnant women who attended antenatal care at the maternal-fetal medicine unit at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. The present study was conducted between February and December 2022. Participants who met inclusion criteria were classified as study for the patients aged 35 years and older, and control groups for the patients younger than 35 years old. All participants underwent ultrasonography for umbilical artery Doppler velocimetry measurement including UA-PI, UA-RI, and UA-S/D. Demographic characters of both study and control groups were included for statistical calculation. Results: Five hundred pregnant women with gestational age between 18 and 24 weeks were enrolled. The mean age of the study and the control group were 37.9 and 26.0 years, respectively. Participants in the study group have higher BMI than the control group. The study and the control group had comparable diastolic and systolic blood pressure. The mean (standard deviation) of UA-PI, UA-RI, and S/D ratio of the study/control group were 1.33±0.21/1.27±0.22, 0.77±0.1/0.74±0.09, and 4.24±0.98/3.95±0.97, respectively, with statistical significance. The study group had a significantly higher number of large for gestational age (LGA), pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM) than the control group. Conclusion: AMA pregnancy had higher UA-PI, UA-RI, UA-S/D, incidence of PIH, GDM, and LGA than those age less than 35 years. Keywords: Advanced maternal age; Umbilical artery Doppler indices; Second trimester

A Narrative Review on Garbhajanya Vishamayata: The Pregnancy Induced Hypertension

Gestation, also known as Pregnancy, is the period during which one or more progeny develops inside a woman's womb. It is a crucial stage for a woman as several physiological changes occur during this period in her body. Now a day's, Pregnancy induced hypertension (PIH) is becoming the primary cause of maternal and prenatal mortality and morbidity. The prevalence of PIH is 2-8% of all pregnancies. In India, PIH incidence is higher in primiparae than in multipara. Therefore, finding all possible measures to prevent this disease is essential. In Ayurveda, Acharya Harit explains these conditions under Garbhinivyadhi. Garbhajanya Vishamayata is a condition in which hypertension develops after 20 weeks of gestation. Therefore, it is a primary concern during Pregnancy and can be prevented by early detection and appropriate treatment. Our Objective isto gain knowledge of ayurvedic aspects of Pregnancy induced hypertension, its prevention and treatment. This review is emphasized the ayurvedic aspects of Pregnancy induced hypertension. Detailed information was gathered by studying related classical texts of Ayurveda, research articles and websites. Collected data was later compiled, analyzed and discussed. This review concluded that by following Antenatal care(manumatic paricharya), Dos and don'ts (Pathyapathya), this disease can be prevented and treated effectively with safe motherhood and a healthy child. Keywords: , ,, ,

The outcome of pregnancies after bariatric surgery: an observational study of pregnancies during 2004–2016 in Finland

PurposeOverweight and obesity are major risk factors for perinatal morbidity and mortality, and the need for bariatric surgery (BS) among fertile-aged women is increasing. This study evaluates the outcome of post-BS pregnancies and deliveries.MethodsAll 20–45-year-old patients delivering between 2004 and 2016 in Finland were included. Patients with previous BS were identified from the hospital discharge register, and the medical birth register was queried for data on pregnancies, deliveries, and perinatal outcomes. The data were matched using personal identification codes, and the outcomes of women with previous BS were compared with those of other pregnancies.ResultsWomen with previous BS (n = 314) constituted the bariatric group. When compared with the non-bariatric group (n = 750,019), they were older (p < 0.001), heavier (p < 0.001) and had more previous pregnancies (p < 0.001). The overall incidence of pregnancy-induced hypertension (p = 0.002), gestational diabetes (GDM) (p = 0.018), pre-term contractions (p = 0.023), pre-term delivery (p = 0.003), labour induction (p < 0.001), planned (p = 0.001) and unplanned (p = 0.036) caesarean sections and low birthweight infants (p < 0.001) were significantly higher in the bariatric group. When compared with body mass index–specific categories, the main outcomes were increased incidence of GDM and small for gestational age (SGA) newborns in the bariatric group.ConclusionBS can be considered a safe and advisable treatment for obesity among fertile-aged women. The pregnancy outcome is associated with post-BS weight, but the risk for GDM and small for gestational-age newborns is increased.

Role of vitamin D on gestational hypertension, diabetes mellitus, timing and mode of delivery.

To determine the efficacy of VD in preventing the development of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH). The secondary purpose is to investigate the effect of VD on the mode and time of delivery. A vitamin D value of <20 ng/mL during pregnancy is considered a deficiency according to the Endocrine Society, and 400-600 IU/day VD replacement is recommended. Forty patients whose serum VD levels were below 20 ng/mL during routine pregnancy follow-up and who were planned for VD replacement therapy were included in the study. They were divided into two equal groups with 20 patients in each group. Twenty pregnant women with serum VD levels greater than 20 ng/mL were considered as the control group. While 400 IU/day VD replacement was applied to the patients in Group 1, 600 IU/day VD was given to Group 2. Group 3 consisted of control patients who did not undergo VD replacement. VD replacement was continued from the 14th week of pregnancy until delivery. Each group of participants was screened with a 50-g GCT at 24-28 weeks of gestation. Following 50-g GCT if serum glucose level was found >140 mg/dL, patients underwent 100-g OGTT. GDM was diagnosed in the presence of at least two of the following results: fasting serum glucose ≥92 mg/dL and/or 1-hour glycemia ≥180 mg/dL, and/or 2-hour glycemia ≥153 mg/dL. PIH was defined as systolic blood pressure >140 mmHg and diastolic blood pressure >90 mmHg. Patients in each group delivered by cesarean section or normal vaginal route. In addition to the incidence of PIH and GDM, the time and mode of delivery were recorded. PIH was detected in two patients in each of the 400 IU/day and 600 IU/day vitamin D replacement groups (10%). In the control group, PIH developed in 3 patients (15%). Although PIH was detected in an extra case in the control group, no significant difference was found between the replacement group and the control group in terms of PIH (p<0.44). While GDM was not detected in the 400 IU/day vitamin D group, GDM was detected in one patient (5%) in the 600 IU/day vitamin D group. No case of GDM was found in the control group either. There was no significant difference between the VD replacement and the control groups in terms of GDM rates. No significant difference was found between the VD replacement and the control groups in terms of mode of delivery. While the C/S ratio was 65% in the 400 IU/day vitamin D group, this ratio was 75% in the 600 IU/day vitamin D group. There was an insignificant trend of increase in C/S ratios in the group given 600 IU/day of vitamin D. The C/S ratio of the control group, which could not be given VD replacement, was found to be 70%. VD replacement therapy during pregnancy does not prevent the development of PIH and GDM, and does not significantly contribute to the time and mode of delivery.

Importance of Low Pregnancy Associated Plasma Protein-A (PAPP-A) Levels During the First Trimester as a Predicting Factor for Adverse Pregnancy Outcomes: A Prospective Cohort Study of 2636 Pregnant Women.

The aim of this study is to investigate the predictive value of low levels of pregnancy associated plasma protein-A (PAPP-A) during the first trimester on adverse pregnancy outcomes, namely pregnancy induced hypertension (PIH), preeclampsia (PE), intrauterine growth restriction (IUGR), and fetal loss. This is a prospective cohort study including 2636 women with singleton pregnancies that attended the Prenatal Diagnosis Unit of the First Department of Obstetrics and Gynecology of National and Kapodistrian University of Athens in "Alexandra Hospital" between 2017 and 2019 for the first trimester combined screening routine scan. The study population was divided into two groups according to their PAPP-A levels. The cut-off value of the PAPP-A level was defined as the 0.4 multiple of median (MoM) which is in correspondence with the fifth centile. The women were followed-up prospectively until delivery and the primary outcome measures were the incidence of PIH, PE, IUGR (<10th centile), and fetal loss. Results: PAPP-A levels of ≤0.4 MoM were associated with increased maternal body mass index (BMI), increased uterine arteries pulsatility index (PI), and lower birth weight. Women with PAPP-A levels ≤0.4 MoM were more likely to develop PE (2.3% vs. 0.2%, p<0.001), PE or PIH (2.3% vs. 0.4%, p=0.003), IUGR (2.3% vs. 0.4%, p=0.003), and combined adverse outcome (25.5% vs. 1.9%, p<0.001) compared to women with PAPP-A>0.4 MoM. This study confirms that among women with PAPP-A levels ≤0.4 MoM in the first trimester, there are increased odds for PE or PIH, IUGR, and combined composite pregnancy outcome.

The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis.

Background The relationship among elevated serum β-human chorionic gonadotropin (β-hCG), the incidence of pregnancy complications, and adverse pregnancy outcomes has been controversial. Differences in study design, subject bias due to demographic characteristics, and differences in local medical levels could contribute to inconsistent results. Methods Literature searches were performed in PubMed, EMBASE, Medline, Central, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science Digital Library (CSDL) databases. Inclusion criteria were as follows: (1) research subjects were singleton pregnant women; (2) the study is identified as cohort study; (3) the subjects were assigned to the high β-hCG group and control group according to whether the exposure factors increased β-hCG in the second trimester; (4) the observed outcomes include at least pregnancy-induced hypertension (PIH), diabetes (gestational diabetes mellitus, GMD), preterm delivery (PD), and intrauterine growth restriction (IUGR); and (5) the odds ratio (OR) and 95% confidence interval (CI) of exposure factors are calculated based on literature dataset. To determine the risk bias of selected literatures, Newcastle-Ottawa scale was applied. The chi-square test was further used for heterogeneity analysis. If heterogeneity was identified, subgroup analyses were then performed for source investigation. Results A total of 13 literatures were included and analyzed, including 67,355 pregnant women and 5980 pregnant women assigned to the high β-HCG group and 61,375 pregnant women to the control group. The incidence of PIH in the high β-HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], Z = 13.85, P < 0.00001). There was no heterogeneity among literatures (χ2 = 8.53, P = 0.38, I2 = 6%), and thus there is no identified publication bias (P > 0.05). The incidence of preterm birth in the high β-HCG group was higher than that in the control group (OR = 2.11, 95% CI [1.90, 2.35], Z = 13.85, P < 0.00001). The analysis suggested no heterogeneity among included literatures (χ2 = 11.78, P = 0.11, I2 = 41%) and no publication bias (P > 0.05). Higher incidence of abortion was observed in the high β-HCG group compared with the control group (OR = 2.80, 95% CI [1.92, 4.09], Z = 5.32, P < 0.00001). There was no heterogeneity among literatures (χ2 = 3.43, P = 0.33, I2 = 13%) and no publication bias (P > 0.05). The incidence of gestational diabetes was higher in the high β-HCG group than in the control group (OR = 2.15, 95% CI [1.05, 4.40], Z = 2.09, P = 0.04). Heterogeneity was identified among literatures (χ2 = 47.01, P < 0.00001, I2 = 87%). Sensitivity analysis showed that the results were not robust, and there was no publication bias (P > 0.05). Compared with control, the incidence of IGUR was higher in the high β-HCG group (OR = 2.70, 95% CI [1.75, 4.19], Z = 4.45, P < 0.0001) with no heterogeneity among literatures (χ2 = 3.92, P = 0.14, I2 = 49%) and no publication bias (P > 0.05). Conclusion High levels of β-hCG during pregnancy in singleton women are associated with a high incidence of pregnancy complications and adverse pregnancy outcomes. Pregnant women with high levels of β-hCG should be monitored more closely, followed up, and given timely medical interventions to reduce the incidence of pregnancy complications and adverse outcomes.

Comparison on the Perinatal Complications for Newborns between by IVF-ET and Natural Delivery

This study was conducted to compare the perinatal complications for newborns by In vitro fertilization with embryo transfer (IVF-ET) and natural delivery. Respectively 50 cases of the IVF-ET and 50 cases of the natural delivery were selected from Hospital of Chengde Medical University as research subjects. All the recruited cases were selected with the newborns from April, 2021 to April, 2022. Defining the IVF-ET as the test group, while the natural delivery as the control group to compare and analyze the perinatal situations and the incidences of complications in both the groups. This study showed that the incidences of pregnancy-induced hypertension, diabetes, multiple pregnancy, premature delivery, and cesarean section in the test group were significantly (p&lt;0.05) higher, than the control group. In addition, the incidences of neonatal respiratory distress syndrome (NRDS) and hyperbilirubinemia of newborns in the test group were statistical (p&lt;0.05) higher, compared to the control group. In contrast, there are no statistically significant differences in terms of hypoglycemia, pneumonia, and neonatal asphyxia incidences between the two groups (p&gt;0.05). Interestingly, there is a significant difference (p&lt;0.05) in the incidences of neonatal cardiac anomalies in both groups, however, no significant differences (p&gt;0.05) were observed in terms of birth defects including hypospadias, the cleft lip and palate, polydactyly, anal atresia, and esophageal atresia in both the groups. In summary, the test tube babies of IVF-ET are more susceptible to complications in their perinatal stage compared with natural delivery newborns, therefore, during the clinical development physicians should strengthen clinical attention and take proactive healthcare management, in order to maintain the health and life of the newborns.

Calcium Supplementation For The Prevention Of Pregnancy Induced Hypertension/Preeclampsia

Background: Pregnancy induced hypertension (PIH) and preeclampsia (PE) contribute significantly to maternal and perinatal morbidity and mortality. The role of calcium supplementation towards preventing PIH/PE however remains unclear.Objective: To assess the efficacy of calcium supplementation in prevention of PIH and PE. Materials and methods: An open label, randomized controlled trial conducted at the antenatal clinic of University of Abuja Teaching Hospital between July 2014 and June 2015. A total of 484 nulliparous women 16 weeks or less gestation and with normal bloodpressures were randomly assigned to either receive 1200mg of calcium tablet daily (N=242) or not to receive calcium tablets (N=242) from 16weeks until delivery. Primary outcome measure was development of PIH or PE and secondary outcome measure was preterm birth.Results: The incidence of PIH was 7.7% among the intervention group compared to 13.7% in the control, p=0.039 and calcium supplementation reduced the risk of PIH (RR=0.56 (95% CI: 0.32-0.98)), but not PE. It also prolonged the duration of pregnancy in women who developed PIH (p=0.02). Incidence of preeclampsia was not significant, RR-0.56 (95% CI: 0.21-1.52) so also was the incidence of preterm delivery between the two groups (RR-0.65 (95% CI: 0.32-1.31)). No serious maternal side effects of treatment were recorded.Conclusion: Calcium supplementation during pregnancy reduced the risk of PIH and thus may have a role in the prevention of PIH amongst nulliparous women. Its role in the absolute prevention of PE was not demonstrated in this study.

First-Trimester Serum Cytokine Profile in Pregnancies Conceived After Assisted Reproductive Technology (ART) With Subsequent Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH) is one of the most common pregnancy complications that seriously affects the mother and fetus. The incidence of PIH is higher in pregnancies conceived after assisted reproductive technology (ART) than in spontaneous pregnancies; thus, exploring potential serum biomarkers before PIH onset is of great significance for effective early prediction and prevention of PIH in the ART population. Cytokines are involved in the inflammatory response and immune regulation, which play an essential role in the pathogenesis of PIH. A description of the cytokine profile in the first trimester of pregnancy could help identify new diagnostic tools and develop targeted therapies for PIH in the ART population. The concentrations of classical predictive markers for PIH and another 48 cytokines were measured in the first-trimester pregnancy serum samples from 33 PIH patients and 33 matched normotensive controls (NC), both of whom conceived after ART treatment. The measured values were compared and analyzed between NC and PIH, followed by comprehensive bioinformatic analysis and logistic regression analysis. There was no significant difference in classical predictive markers, including Activin A, PlGF, sFLT1 (VEGFR), and sFLT1/PlGF, between the PIH and NC groups (P > 0.05), while 29 cytokines were significantly lower in the PIH group than in the NC group (P < 0.05). Logistic regression analysis revealed that 17 cytokines (IL-2Rα, M-CSF, IL-6, IL-2, β-NGF, IL-7, IL-12 (p70), SCF, IL-10, IL-9, MIG, GM-CSF, LIF, IL-1α, MCP-3, IL-4, and HGF) in the first-trimester pregnancy serum were significantly negatively correlated with the subsequent onset of PIH. With the top 3 cytokines (IL-7, MIG, and SCF) of receiver operating characteristic (ROC) analysis, we constructed an efficient multifactor combined detection and prediction model for PIH in ART pregnancy. Classical early predictors for hypertensive disorder complicating pregnancy cannot distinguish PIH from their normal peers in ART pregnancy. In comparison, the description of the cytokine profile in the first trimester of pregnancy enables us to distinguish high-risk ART pregnancy for PIH, permitting enough time for PIH prevention therapy. The cytokine profile we described also provides immunological insight into the further mechanistic exploration of PIH.

Clinical Effect of Nimodipine Combined with Magnesium Sulfate on Pregnancy-Induced Hypertension Syndrome.

The incidence of pregnancy-induced hypertension in China is 9.4%, which is at a relatively high level. Its serious impact on maternal and infant health is the main reason for maternal and perinatal morbidity and mortality. There are many factors affecting pregnancy-induced hypertension. The incidence of pregnancy-induced hypertension is different due to different levels of cultural knowledge, health awareness, economic income, nutrition, and medical support. Since its etiology has not been elucidated thus far, there is no known treatment of the disease, and the main principles are spasmolysis, hypotension, expansion, and timely termination of pregnancy. Observe the effect of nimodipine combined with magnesium sulfate on serum heat shock protein 70 (HSP70) and pentamer 3 (PTX3) levels in patients with pregnancy-induced hypertension. Ninety-six patients with pregnancy-induced hypertension syndrome admitted to our hospital from May 2016 to February 2019 are selected and randomly divided into two groups according to the 1 : 1 principle, with 48 cases in each group. The single drug group is treated with magnesium sulfate, and the combined group is treated with nimodipine combined with magnesium sulfate. Changes in blood pressure, HSP70, PTX3, placental growth factor (PLGF), and vascular endothelial cell injury markers are recorded in the two groups, and adverse reactions and pregnancy outcomes are observed. After treatment, the blood pressure and levels of HSP70, PTX3, endothelin-1 (ET-1), and nitric oxide (NO) in the two groups decreased, and the level of PLGF increased. The diastolic blood pressure, systolic blood pressure, and levels of HSP70, PTX3, ET-1, and NO in the combined group are lower than those in the single drug group, and the level of PLGF is higher than that in the single drug group (P < 0.05). During the treatment period, the adverse reaction rate of the combined group is 6.25% compared with 8.33% of the single agent group, and the difference is not statistically significant (P > 0.05). Follow-up visits found that the cesarean section rate and abnormal fetal heart rate in the combined group are 16.67% and 4.17%, respectively, which are lower than 35.42% and 16.67% in the single drug group, and the difference is statistically significant (P < 0.05). Compared with 14.58%, 12.50%, and 2.08% in the single drug group, the neonatal asphyxia rate, premature birth rate, and stillbirth rate in the combined group are 6.25%, 4.17%, and 0.00%, respectively, and the difference is not statistically significant (P > 0.05). Nimodipine combined with magnesium sulfate can effectively control blood pressure in patients with pregnancy-induced hypertension, reduce vascular endothelial damage, regulate the expression of HSP70, PTX3, and PLGF, and improve pregnancy outcomes without increasing adverse reactions.

A Cross-Sectional Study on Current Practice of the Management of Pregnancy Induced Hypertension and Its Maternal and Foetal Complications and Outcome in the Western Part of the State of Libya

Background: Maternal and perinatal mortality and morbidity are mainly affected by hypertension during pregnancy (pre-eclampsia). Haemorrhage and cerebral bleeding are the primary and significant complications of pre-eclampsia. Abruption of the placenta and renal failure are among the major complications caused by this disease. The perinatal complications include Intrauterine Growth Restriction (IUGR), Intrauterine Foetal Death (IUFD), neonatal death, and prematurity. Objective: The purpose of the present study was to examine the incidence of Pregnancy-Induced Hypertension (PIH), pre-eclampsia, the management of PIH, including the early diagnosis, the pharmacological drug management used, and the prevalence of maternal and perinatal complications. Methods and Patients: This cross-sectional study took place in Aljalaa maternity hospital, which represented the west of the state of Libya in the period from 1st January 2012 to 31st December 2012, with patients who were diagnosed, managed, and terminated according to protocol management of the hospital. Results: In the present study, from the total deliveries in Aljalaa Maternity hospital, the incidence of PIH is 8.4% and pre-eclampsia is 5.1%. No maternal mortality, CNS haemorrhaged, hepatic failure, or renal failure. The reported maternal complications included: Eclampsia, HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low platelets), abruption placenta, and pulmonary oedema see in eighteen percent, six percent, nine percent, four percent and less than one percent, respectively. The foetal complications were preterm babies and Intrauterine Growth Restriction (IUGR) in nineteen percent, Low Birth Weight (LBW) in twenty-five percent, Intrauterine Foetal Death (IUFD) in five percent, neonatal death in two percent and, perinatal death in six percent. In the PIH patients, the presence of associated symptoms such as headache, blurred vision, irritability, and the presence of signs such as severe hypertension, generalized oedema, exaggerated reflexes, and abnormal investigations (protein urea, high uric acid, abnormal LFT, haemoconcentration, and low pits) increased the risk of maternal and foetal complications. Conclusion: To decrease mother and newborn mortality and morbidity in PIH patients, a rigorous management protocol is required to implement evidence-based guidelines.

Pregnancy, Childbirth and Puerperium Health Problems in Women Over 35 Years of Age

Background: Due to the choice of postponing motherhood, the average age of women giving birth in Poland has moved into older age groups. This study was conducted to assess pregnancy complications and birth outcomes in women of advanced maternal age (AMA, over 35 years of age) compared with women aged 35 years.&#x0D; Material and Methods: Data on births was obtained from two third-degree hospitals in Warsaw, Poland for the years 2017 – 2019. Maternal and perinatal outcomes for women of advanced maternal age (n = 3,766) were analyzed using Chi-square tests and the ANOVA Kruskal-Wallis test. Comparisons between the following age groups of women were conducted: age 35 (control group), 36 – 39, 40 – 44 and over 45 years of age. Results of the analysis are presented with unadjusted odds ratios, 95 percent confidence intervals and p-values.&#x0D; Results: The incidence of pregnancy-induced hypertension (PIH) was found to increase with age in the 36 – 39 (OR 1.76, CI 1.09 – 2.87), 40 – 44 (OR 2.72, CI 1.56 – 4.73) and in the over 45 (OR 6.34, CI 2.04 – 19.69) age groups. The risk of gestational diabetes was seen to increase in women aged 40 – 44 (OR 1.49, CI 1.13 – 1.97) and increases almost three times in women over the age of 45 (OR 2.88, CI 1.41 – 5.87). The frequency of births by Cesarean section was observed to increase by one quarter in the 36 – 39 age group (OR 1.26, CI 1.07 – 1.48), by half in the 40 – 44 age group (OR 1.5, CI 1.28 – 1.96) and almost three times in women over 45 (OR 2.88, CI 1.41 – 5.87). There was no statistical significance for the incidence of preterm delivery, induction of labor and postpartum anemia or the health status of newborns in the studied age groups.&#x0D; Conclusions: Maternal age of over 35 years old is an independent risk factor for higher rates of pregnancy and perinatal complications in the Polish population.

Low fetal fraction in cell-free DNA testing is associated with adverse pregnancy outcome: Analysis of a subcohort of the TRIDENT-2 study.

ObjectivesTo assess the association between low fetal fraction (FF) in prenatal cell‐free DNA (cfDNA) testing and adverse pregnancy outcomes.MethodsWe conducted a retrospective cohort study of participants of the TRIDENT‐2 study (Dutch nationwide government‐supported study offering cfDNA screening for fetal aneuploidies) who received a failed test result due to low FF (<4%) between April 2017 until February 2018. Outcome measures included pregnancy‐induced hypertension (PIH), pre‐eclampsia (PE), small for gestational age neonates (SGA), spontaneous preterm birth (sPTB), gestational diabetes mellitus (GDM), chromosomal aberrations, and congenital structural anomalies.ResultsTest failure due to low FF occurred in 295 women (1.12% of tests performed). Information regarding pregnancy outcomes was available for 96.3% of these women. The incidence of PIH, PE, SGA, sPTB, and GDM was 11.2%, 4.1%, 7.3%, 5.1%, and 14.8%, respectively. The prevalence of chromosomal aberrations and congenital structural anomalies was 1.4% and 4.1%, respectively. Incidences of PIH, PE ≥ 34 weeks of gestation, GDM, and prevalence of aneuploidy and congenital structural anomalies were higher in women with low FF compared to the general Dutch obstetric population.ConclusionLow FF is associated with adverse pregnancy outcomes. The value of FF in the prediction of these outcomes needs to be further established.

The Use of Frozen Embryo Transfer and the Development of Pregnancy-Induced Hypertension: A Literature Review

The use of assisted reproduction techniques has been associated with obstetric complications. An understanding about which methods and treatment protocols produce better outcomes would provide greater opportunities for a successful pregnancy. The aim of this literature review was to identify whether frozen embryo transfer (FET) leads to a greater incidence of pregnancy-induced hypertension (PIH) compared to fresh embryo transfer. Fifteen studies were identified and subsequently reviewed. Eleven studies suggested FET increased the incidence of PIH–gestational hypertension and pre-eclampsia. The evidence suggests a correlation between FET and PIH. Exploration into why this is the case should be the focus of future studies. Implications for clinical practice involve extensive preconception counselling and potentially advising prophylactic low-dose aspirin with the aim of lower the incidence of PIH.

The effects of Helicobacter pylori infection on pregnancy-related diseases and fetal development in diabetes in pregnancy

BackgroundThis study aimed to determine the association of Helicobacter pylori (H. pylori) infection with pregnancy-related diseases and fetal development in women with diabetes in pregnancy (DIP).MethodsAll the participants were recruited before 16 weeks of gestation. According to their medical history and the results of a 75-g oral glucose tolerance test at the 24th week of pregnancy, the participants were divided into a normal control group (NC group), a gestational diabetes mellitus group (GDM group), and a pre-pregnancy diabetes mellitus group (PGDM group). According to the results of an H. pylori serum antibody detection test, each group was further divided into two subgroups: an H. pylori positive subgroup (HP+ subgroup) and an H. pylori negative group (HP- subgroup). The incidences of pregnancy-related diseases, the fetal developmental status, and the newborn status were compared among the groups.ResultsThis study recruited 356 pregnant women. The infection rates of type I H. pylori were significantly higher in the GDM group and the PGDM group than in the NC group (χ2=6.949, P=0.031). With the exception of the NC-HP+ subgroup, there were higher incidences of pregnancy-related diseases in the HP+ subgroups than in the HP− subgroups (P<0.05). Furthermore, the incidences of pregnancy-induced hypertension (PIH), preeclampsia, and premature delivery were significantly higher in the GDM-HP+ subgroup and the PGDM-HP+ subgroup than in the NC-HP+ subgroup (P<0.05). At the end of pregnancy, all 3 HP− subgroups showed better fetal development than the HP+ subgroups (P<0.05), and the NC-HP+ subgroup showed better fetal development than the GDM-HP+ and PGDM-HP+ subgroups (P<0.05). Meanwhile, the PGDM-HP+ subgroup showed poor fetal development, even in the 2nd trimester of pregnancy.ConclusionsH. pylori infection is extremely common in DIP. For women with DIP, infection with H. pylori can increase the risks of pregnancy-related diseases and poor fetal development. H. pylori screening and eradication therapy before pregnancy may aid in preventing pregnancy-related diseases and improve fetal development.

Effects of prenatal micronutrients supplementation timing on pregnancy-induced hypertension: Secondary analysis of a double-blind randomized controlled trial.

In this secondary analysis of data from a double‐blind randomized controlled trial (clinicaltrials.gov identifier: NCT00133744) of micronutrient supplementation (multiple micronutrients [MMN], iron–folic acid [IFA] and folic acid [FA] alone), we examined the potential modifying effect of gestational age at enrolment on the association of antenatal supplementation and pregnancy‐induced hypertension (PIH). We included 18,775 nulliparous pregnant women with mild or no anaemia who were enrolled at 20 weeks of gestation or earlier from five counties of northern China. Women were randomly assigned to receive daily FA, IFA or MMN from enrolment until delivery. We used logistic regression to evaluate the association between PIH and timing of micronutrient supplementation. The incidence of PIH was statistically significantly lower among women who began MMN supplementation before 12 gestational weeks compared with women who began MMN supplementation at 12 weeks or later (RR = 0.74, 95% CI: 0.60–0.91). A similar protective effect was observed for both early‐onset (<28 weeks, RR 0.45, 0.21–0.96) and late‐onset of PIH (≥28 weeks, RR 0.77, 0.63–0.96). No statistically significant association was observed between PIH occurrence and timing of supplementation for FA or IFA. Maternal MMN supplementation and antenatal enrolment during the first trimester of pregnancy appeared to be of importance in preventing both early‐ and late‐onset of PIH.

Myo-inositol supplementation to prevent gestational diabetes in overweight non-obese women: bioelectrical impedance analysis, metabolic aspects, obstetric and neonatal outcomes – a randomized and open-label, placebo-controlled clinical trial

This study aims to evaluate the effects of myo-inositol supplementation on gestational diabetes mellitus (GDM) rates and body water distribution in overweight non-obese women. 223 overweight non-obese women pregnant were randomly assigned to the treatment group (2 g of myo-inositol plus 200 µg of folic acid) or to the placebo one (200 µg of folic acid). The treatment lasted until three weeks after delivery. A tetrapolar impedance analyser was used to study body composition. The incidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group. There was a significant increase in TBW, ECW and ICW values in the placebo group compared to the myo-inositol group. We have recorded a significant reduction in the overall incidence of pregnancy-induced hypertension in the myo-inositol group compared with the placebo group. Our results demonstrate the effectiveness of myo-inositol supplementation in preventing GDM in overweight non-obese pregnant women.