Hypertensive Disease Of Pregnancy Research Articles

Diagnostic value of sFlt-1/PlGF-1 ratio and plasma PROK1 for adverse pregnancy outcomes in women with hypertensive disease of pregnancy.

Hypertensive disease of pregnancy (HDP) is one of the most important causes of increased maternal mortality and perinatal complications during pregnancy. We investigated the pregnancy outcomes of 156 HDP patients (65 gestational hypertension [GH], 13 chronic hypertension [CH], 74 preeclampsia-eclampsia [PE-EC], and 4 superimposed on PE [CH with PE]). In patients with different types of HDP, levels of soluble fms like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF)-1, and prokinin-1 (PROK1) were measured and compared. The predictive efficacy of these indicators was evaluated using receiving operating characteristics curves and area under the curve. Results showed that the PE cohort had a higher sFlt-1/PlGF ratio (46.12 [39.24, 68.85]) and PROK1 (498.84 [213.67, 678.30] pg/mL) level than the GH (sFlt-1/PlGF, 32.3 [21.98, 58.00], PROK1 300.77[250.0, 345.29]pg/mL) and CH cohort (sFlt-1/PlGF, 37.49 [32.68, 39.68], PROK1, 281.48 [229.25, 453.94]pg/mL). In the HDP cohort, 54 patients experienced adverse pregnancy events, and the sFlt-1/PlGF ratio, PROK1, and the combined indicators (sFlt-1/PlGF ratio and PROK1) were excellent predictors of adverse pregnancy events, especially for PE patients.

Exploring genetic associations between immune cells and hypertensive disorder of pregnancy using Mendelian randomization

BackgroundObservational epidemiological studies suggested that immunological dysregulation and inflammation play a significant role in the placental and renal dysfunction that leads to maternal hypertension. The immunophenotypes' possible causalities with hypertensive disease of pregnancy remain ambiguous. We performed two-sample Mendelian randomization (MR) analyses to comprehensively investigate the causal effect of immunophenotypes on hypertensive disorder of pregnancy (HDP).MethodsThe large-scale genome-wide association studies (GWASs) data on immunological traits was taken from public catalog for 731 immunophenotypes. The summarized GWAS data in 4 types of HDP were retrieved from FinnGen database, including 811,605 Finnish individuals. The primary analysis was the inverse variance weighted (IVW) method, supplemented by conducting sensitivity analysis. To confirm whether cardiovascular proteins mediated the causal effect of immune cells on HDP, we additionally executed a mediation MR study.ResultsAfter looking into genetically predicted immunophenotype biomarkers, we discovered 14 highly correlative immunophenotypes and 104 suggestive possible factors. The IVW analysis indicated that HLA DR on myeloid DC, HLA DR on plasmacytoid DC, and HLA DR on DC had a significant association with pre-eclampsia/eclampsia (PE), whereas CD4+ CD8dim AC and CD4+ CD8dim % leukocyte were protective against gestational hypertension (GH). All of HDP in our study had no statistically significant impact on immune cells, according to reverse MR analysis. The mediating role of LOX-1between HLA DR on plasmacytoid DC and chronic hypertension prior to pregnancy was validated.ConclusionThis study showed that many immunophenotypes are implicated in HDP. Furthermore, the level of LOX-1 mediated the pathophysiology relationship between HLA DR on plasmacytoid dendritic cells and chronic hypertension prior to pregnancy.

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

ObjectivesMaternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.Study design and methodsData on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.ResultsA 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from − 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.ConclusionsGlobal and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

AN ORGAN-SPECIFIC APPROACH TO THE MANAGEMENT OF GESTATIONAL HYPERTENSION - EVIDENCE VS. TRADITION.

The management of hypertensive disease in pregnancy is currently guided by practice recommendations based largely on observational data from a half century ago and has changed only superficially since that time. These recommendations are both narrowly prescriptive (women without traditional features of severe disease should all be delivered at exactly 37 weeks and 0 days,) and at the same time frustratingly ambiguous (the presence of epigastric pain unresponsive to repeat analgesics precludes expectant management at any gestational age, regardless of laboratory studies.) Guidelines which ignore recent data from the obstetric, pediatric and internal medicine literature too often lead practitioners to be more aggressive than necessary in the delivery of very premature pregnancies, and, conversely, more complacent than patient safety would support in prolonging pregnancy with advanced fetal maturity. We present here an alternative, organ-specific based approach to the management of gestational hypertension which allows and encourages practitioners to formulate a management plan based on a thoughtful and, when possible, evidence- based synthesis of the continuous variables of blood pressure, degree of organ dysfunction and response to treatment, gestational age, and patient balancing of maternal and fetal/neonatal risks. Such clinical care is more complex and nuanced than simply basing life-altering critical management decisions, including timing of delivery, on whether the patient does, or does not have any one of the conditions described by box 4 of the current American College of Obstetricians and Gynecologists practice guidelines. Nonetheless, we believe this approach will not only improve care but will also open the door to useful investigations into prevention and management of the various entities traditionally considered as the same disease process.

Determinants of Hypertension in Pregnancy (HDK) Disorders

Background: Hypertensive Disease in Pregnancy (HDK) is a vascular disorder that occurs during pregnancy, arises during pregnancy or in the postpartum periode, and is one of the most common causes of maternal death. Objective: this study was to determine how factors of having a history of hypertension, obesity, and using hormonal birth control impact the incidence of hypertension Disease in pregnancy (HDK). Metodes: the research approach used was analytic observation with a croos sectional design. This study involved 332 pregnant women who come to the Health Center. A sampel random sampling technique, with a sample size of 183 was used. In this study, the independent variables were history of hypertension, obesity, and hormonal birth control use; the incidence of HDK was the dependent variable. Data was collected using a documention study approach with an observation sheets. To analyse the data, a logistic regression statistical test was used with an error rate of α 0.05. The results showed that pregnant women with HDK were exposed to hypertension 45.6%, and hormonal birth control by 36.3%. The result of bivariate analysis of hypertension history with HDK is o.o1 < α 0.05, and the variable of obesity with HDK is 0.024 < α 0.05 and the variable of hormonal birth control history with HDK is 0.21% < α 0.05. The conclusion of the results showed that of the three factors contributing to the incidence of HDK, only the history of hypertension and obesity had a significant influence, with a history of hypertension accounting for 9.9% of HDK cases. Therefore, it is recommended that Strengthing Integrated Antenatal care for increasing the role of mindwives and general practitioners in better screening of pregnant women at risk.

Developing an effective and simple digital screening tool to identify inadequate calcium intake in pregnant women: A prediction model in the Rotterdam periconception cohort

ObjectivesAn inadequate intake of calcium in pregnancy is associated with higher risks of maternal hypertensive pregnancy disorders, premature birth and intrauterine growth restriction. An evidence based and clinically applicable tool to efficiently estimate the adequacy of calcium intake in pregnant women currently does not exist. The aim of this study is to develop an effective and simple digital screening tool for calcium intake in pregnancy. Study DesignWe extracted all data from the Rotterdam Periconceptional cohort (PREDICT study) conducted at the Erasmus MC, University Medical Centre in Rotterdam, the Netherlands, between November 2014 and December 2020. Data was extracted from food frequency questionnaires. The estimated average requirement of 750 m/day was defined as the lower limit for an adequate calcium intake. We created a prediction model, using multivariable binary logistic regression with backward stepwise selection, predicting the probability of adequate calcium intake. We developed a simple screening tool based on the prediction model. Results694 participants are included, of which 201 (29 %) had an adequate calcium intake. Total daily or weekly intakes of cheese, milk, and yogurt or curd were selected as predictors for the prediction model. The model had excellent discrimination (AUC 0.858), a good fit (Brier score 0.136, HL statistic p = 0.499) and satisfactory calibration. The test accuracy measures were: sensitivity 80.9 %, specificity 77.1 %, PPV 89.7 %, NPV 62.2 %. A colour coded digital screening tool was developed for use in clinical practice. ConclusionsThis evidence-based and simple screening tool is a reliable and efficient instrument to predict inadequate calcium intakes in pregnancy, which can easily be incorporated in daily clinical practice and existing pregnancy coaching platforms.

Relationship between hypertensive disease stages of pregnancy and plateletcrit values: A retrospective cohort study

ObjectiveThe aim of this study was to investigate the correlation between plateletcrit (PCT) and stages of hypertensive disease of pregnancy by comparing values in groups with healthy pregnancies, gestational hypertension [GHT], preeclampsia with proteinuria [PE + P] and severe preeclampsia with proteinuria [sPE + P]. The secondary aim was to investigate how proteinuria affects PCT values in these patients. Materials and methodsThis was a retrospective cohort study. Patients who had been hospitalized for labor were included in the study. The following groups were created: healthy pregnancies (n = 36), [GHT] (n = 36), [PE + P] (n = 36) and [sPE + P] (n = 36). PCT and platelet values from blood tests performed immediately after hospitalization were compared among the four groups. Additionally, the PCT and platelet values in the early pregnancy period of same patients were determined and compared. ResultsThere were no statistically significant differences among the groups in terms of age, gravidity or parity (p > 0.05). The mean platelet counts of the groups ranged from 219,250/mm3 to 241,310/mm3. There were no significant differences among the groups (with or without proteinuria) in terms of the platelet counts or PCT values (p > 0.05). A reducing or enhancing effect of proteinuria on the PCT value was not observed. Additionally, based on data from the early weeks of pregnancy, there were no significant differences among the groups in terms of the platelet counts or PCT values (p > 0.05). ConclusionsPCT may not be appropriate to use for the diagnosis or prediction of sPE in patients whose platelet counts have not decreased. A normal PCT value should not be interpreted as the absence of progression to sPE. There is a need for new PCT and PE studies that take platelet counts into account and include women in the early weeks of pregnancy.

Parental axial lengths and prenatal conditions related to child axial length: the TMM BirThree Cohort Study

PurposeWe investigated the association between actual parental axial length, prenatal conditions, and the axial length in preschool children. DesignCohort study MethodsThis study included 1,819 children (mean age: 4.2 ± 0.4 years, 50.1% girls) and their parents enrolled in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. Axial length was measured using OA-1000 Optical Biometer. A marginal model with generalized estimating equations was used for association analysis. Variables included the child's age, sex, height at the second wave, prenatal conditions (large for gestational age [LGA], resuscitation, acidosis, small placenta at birth, multiple pregnancies, maternal hypertensive disorders of pregnancy), parental age, and the mean axial length of both parents’ eyes at the second wave. Path analysis was performed to investigate the relationships among the variables. ResultsAxial length was shorter in girls than in boys (regression coefficient (β) [95% confidence interval] -0.52 [-0.57, -0.47]). Age and height were associated with longer axial lengths (0.10 [0.022, 0.18] and 0.025 [0.019, 0.031], respectively). Parental axial lengths were positively associated with children's axial lengths (0.12 [0.10, 0.14] for fathers and 0.12 [0.094, 0.14] for mothers). LGA was associated with longer axial lengths (0.12 [0.033, 0.20]), whereas small placenta and multiple pregnancies were associated with shorter axial lengths (-0.11 [-0.17, -0.045] and -0.21 [-0.33, -0.091], respectively). The path coefficient for both parents’ axial lengths in relation to their children's axial lengths was 0.23. ConclusionParental axial lengths and prenatal conditions may determine axial length during early life.

Bidirectional Mendelian Randomization Analysis of Genetic Proxies of Plasma Fatty Acids and Pre-Eclampsia Risk.

Previous studies have reported associations between fatty acids and the risk of pre-eclampsia. However, the causality of these associations remains uncertain. This study postulates a causal relationship between specific plasma fatty acids and pre-eclampsia or other maternal hypertensive disorders (PE-HTPs). To test this hypothesis, two-sample bidirectional Mendelian randomization (MR) analyses were employed to determine the causality effects. Single-nucleotide polymorphisms associated with PE-HTPs and fatty acids were obtained from a genome-wide association study (GWAS) of European ancestry. Bidirectional MR analyses were conducted using methods such as inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses, including tests for heterogeneity, horizontal pleiotropy, and co-localization, were conducted to assess the robustness of MR results. The analyses revealed causal relationships between PE-HTPs and several fatty acids, including monounsaturated fatty acid (MUFA), omega-6 fatty acid (n-6 FA), linoleic acid (LA), docosahexaenoic acid (DHA), and the PUFA/MUFA ratio. Genetically predicted higher risk of PE-HTPs was significantly associated with lower plasma n-6 FA (OR = 0.96, 95% CI: 0.93-0.99), particularly LA (OR = 0.95, 95% CI: 0.92-0.98). Conversely, increased DHA (OR = 0.86, 95% CI: 0.78-0.96) and a higher PUFA/MUFA ratio (OR = 0.86, 95% CI: 0.76-0.98) were associated with a reduced risk of PE-HTPs. Elevated MUFA levels (OR = 1.12, 95% CI: 1.00-1.25) were related to an increased risk. This study provides robust genetic evidence supporting bidirectional causal relationships between PE-HTPs and specific plasma fatty acids, underscoring the critical role of fatty acid metabolism in maternal hypertensive disorders.

Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants

BackgroundThe objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).MethodThe data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.ConclusionMaternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.

Association of abruptio placentae with hypertension in pregnancy: Analysis of risk factors in Nigerian women

AbstractObjectiveThe incidence of abruptio placentae complicating hypertensive diseases of pregnancy is high in Nigerian referral hospitals. We conducted a retrospective case‐control study to identify the socio‐demographic, behavioural, and clinical risk factors associated with abruptio placentae in women with hypertensive diseases of pregnancy.MethodsThe 41 cases of hypertensive diseases complicated by abruptio placentae identified in the records of the University of Benin Teaching Hospital over 2 years (January 2021–December 2022) were compared with 208 women (controls) who had hypertensive diseases without developing abruptio placentae. Multiple regression analysis was used to develop maximum likelihood estimates of the adjusted odds ratios and 95% confidence intervals to predict the likelihood of the association between the exposure factors and the risk of abruptio placentae.ResultsHigh blood pressure levels at presentation, when managed, can decrease the odds for abruptio placentae by 9% OR 0.91, CI:0.83–0.9, but smoking and alcohol intake were not significantly associated with abruptio placentae. A higher haemoglobin concentration decreased the likelihood of abruptio placentae by 60% OR 0.40, (CI 0.24– 0.68), while higher birth weight babies minimally decreased the odds for abruptio placentae, OR 1.01 (CI 0.08–12.49).ConclusionWe conclude that abruptio placentae is most likely to complicate hypertensive diseases of pregnancy in Nigerian women when there are concurrent pregnancy anaemia and low birth weight babies, while higher blood pressure levels at presentation, when promptly managed, can reduce the risk of abruptio placentae. Efforts to address the concurrent management of anaemia associated with hypertensive diseases in pregnancy will most likely reduce the incidence of abruptio placentae in this population.

Maternal adiposity measures and hypertensive disorders of pregnancy: a meta-analysis

BackgroundHypertensive disorders of pregnancy (HDP) are a prevalent complication during pregnancy with significant implications for maternal and perinatal health globally. Maternal obesity is a known risk factor for HDP. This review sought to identify adiposity indicators in early pregnancy that are linked to the development of HDP.MethodsWe conducted a systematic search of the PubMed, Science Citation Index (Web of Science), and Embase databases. Screening and quality evaluation of studies was conducted independently by two reviewers. Both random effects meta-analysis and narrative synthesis were performed.ResultsThirty-one studies were included with a pooled sample of 81,311 women. The meta-analysis showed that the odds of HDP were significantly increased by higher pregnancy measures of adiposity (pre-pregnancy body mass index (OR = 2.14, 95%CI: 1.67–2.75), visceral adipose tissue (OR = 1.79, 95%CI: 1.01–3.16), subcutaneous adiposity thickness (OR = 1.67, 95%CI: 1.36–2.05), waist circumference (OR = 2.20, 95%CI: 1.37–3.54), waist to-hip ratio (OR = 3.08, 95% CI: 1.38–6.87), weight gain (OR = 1.69, 95%CI: 1.42–2.02) and percentage body fat (OR = 1.71, 95%CI: 1.16–2.53)). Epicardial fat thickness was significantly associated with HDP, although limited data were available.ConclusionsThe results of our study highlight the importance of investigating the predictive value of adiposity measures in identifying the risk of HDP to tailor care towards women at the highest risk.

Subsequent high blood pressure and hypertension by hypertensive disorders of pregnancy: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

Hypertensive disorders of pregnancy can cause hypertension in the future. Understanding how the blood pressure values of women with and without hypertensive disorders of pregnancy differ will facilitate follow-up blood pressure monitoring in clinical settings. This study investigated the association between hypertensive disorders of pregnancy and subsequent high blood pressure and hypertension. This study used Japanese data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Follow-up systolic and diastolic blood pressures in normotensive women during pregnancy and those with hypertensive disorders of pregnancy were estimated using analysis of covariance adjusted for women with low birthweight, history of gestational diabetes mellitus, age, body mass index, pulse rate, smoking and drinking at the follow-up assessment, paternal hypertension history, and maternal hypertension or hypertensive disorders of pregnancy history. Finally, we performed a multiple logistic regression analysis. In total, 7343 women were included in the analysis. Women with a history of hypertensive disorders of pregnancy had higher blood pressure approximately three years postpartum compared with normotensive women. Hypertensive disorders of pregnancy in the most recent pregnancy in different subgroups, such as nulliparous women, multiparous women without a history of hypertensive disorders of pregnancy, and multiparous women with a history of hypertensive disorders of pregnancy, were associated with an increased risk of subsequent hypertension. Women's birthweight was also weakly associated with hypertension. Even one experience of hypertensive disorders of pregnancy may contribute to elevated blood pressure and hypertension approximately three years postpartum. In addition, women's birthweights may have a weak relationship with increasing blood pressure.

Tasks and responsibilities of clinical midwives in Dutch hospitals.

The number of Dutch clinical midwives has increased substantially over the last 20 years, but their tasks, responsibilities, and formal positions remain unclear. This study aimed to gain insight into the current tasks and responsibilities of clinical midwives in Dutch hospitals. We also aimed to determine whether these tasks varied among three types of hospitals in the Netherlands: secondary nonteaching hospitals, secondary teaching hospitals, and tertiary hospitals. A cross-sectional national survey in which a questionnaire was sent to 810 clinical midwives from 78 hospitals was conducted. Responses from 412 (51%) clinical midwives from 77 hospitals were included in the analysis. Most respondents (97%) provided care in the delivery wards. They were often involved in the induction of labor (88%), requests for pain relief (87%), cases of meconium-stained fluid (59%), prolonged first-stage labor (56%), and maternal hypertensive disorders (43%). Daily tasks and responsibilities were determined by the type of pathology (60%), caseload in the ward (48%), and years of work experience (28%). The tasks varied according to hospital type, and the majority also conducted non-care-related tasks, such as auditing (83%) and teaching (67%). Dutch clinical midwives play important roles in obstetric care. They provide care for women with a wide range of pathologies they are not always trained for. In addition, they perform non-care-related tasks. Their tasks varied according to hospital type. To ensure that they are both skilled and authorized, compulsory training and formalization of their profession are possible interventions.

Maternal blood endometase level as a predictive biomarker for hypertensive disorders during pregnancy: a prospective cohort study

Preeclampsia (PE) occurs due to inadequate spiral artery/trophoblast remodeling in early pregnancy. Endometases are involved in the remodeling of spiral arteries and placental trophoblasts. This study aimed to investigate differences in blood endometase levels between pregnant women with hypertensive disorders (PE and gestational hypertension [GHT]) and healthy pregnant women and to evaluate whether plasma endometase values ​​could play a predictive role in PE or GHT diagnosis. A total of 90 pregnant women (n(PE) = 30, n(GHT) = 30, n(healthy pregnant) = 30) who presented at the hospital between December 2023 and May 2024 and were 26–32 years of age and > 20 weeks pregnant were included in the study. The endometase levels in all pregnant women were determined in maternal blood plasma via enzyme-linked immunosorbent assay. The endometase values were recalculated according to albumin values, and corrected endometase (cEndo) values were determined. No significant differences in blood endometase levels were observed between the groups (p > 0.05). The cEndo value was significantly lower in the PE and GHT groups than in the control group (p < 0.05). There was no statistically significant difference in the cEndo values between the PE and GHT groups (p > 0.05). A statistically significant negative linear relationship was detected between cEndo values and mean systolic blood pressure and mean diastolic blood pressure (p < 0.05). The cEndo values in the PE and GHT groups at early (≤ 32 weeks 3 days) and late pregnancy were compared, and no statistically significant difference was detected (p > 0.05). Maternal blood cEndo values may play a successful role in distinguishing hypertensive diseases of pregnancy (PE + GHT) from healthy pregnant women. cEndo does not play an effective role in the differential diagnosis between pregnant women with PE and those with GHT. Studies with larger patient populations are needed.

The Contribution of Hypertensive Disorders of Pregnancy to Neonatal Unit Admissions and Iatrogenic Preterm Delivery at < 34+0 Weeks' Gestation in the UK: A Population-Based Study Using the National Neonatal Research Database.

The objectives of this study were to (i) quantify the contribution of maternal hypertensive disorders of pregnancy (HDP) to iatrogenic preterm birth (PTB) and neonatal unit (NNU) admissions < 34+0 weeks and (ii) describe short-term population-level outcomes for HDP infants, exploring ethnic disparities and comparing outcomes by HDP exposure. Retrospective population-based study using the National Neonatal Research Database. England and Wales. Infants born < 34+0 weeks and admitted to NNU 2012-2020. Descriptive statistics, linear and logistic regression models to compare outcomes between groups. Survival to discharge with/without comorbidity. 122 228 infants met inclusion criteria. Where collected, 49 839/114 164 (43.7%, 95% CI 43.4%-43.9%) of infants had an iatrogenic PTB. HDP was recorded in 16 510/122 228 (13.5%) of all infants and 13 560/49 839 (27.2%) of iatrogenic PTBs. HDP and/or foetal growth restriction (FGR) were recorded in 24 124/49 839 (48.4%) of iatrogenic PTBs. Singleton HDP infants < 10th BWC had ≥ 90% survival to discharge from 28 weeks' gestation, versus from 26 weeks' gestation for those born ≥ 10th BWC. In extreme preterm HDP infants (< 27 weeks), 27.3% of infants < 10th BWC died compared to 15.2% of those ≥ 10th BWC. Survival without comorbidity was ≥ 90% from 32 weeks' gestation in HDP infants across BWC. These contemporaneous population-level data show that almost one in two PTB < 34+0 weeks' gestation are iatrogenic, with HDP and/or FGR being the major contributors to iatrogenic prematurity. This has substantial implications for strategies to reduce preterm birth in the UK and internationally. The data further inform antenatal and at-birth counselling of HDP-exposed infants.

Maternal hypertensive disorders of pregnancy and electrocardiographic findings among newborns: The Copenhagen Baby Heart Study.

Maternal preeclampsia is associated with both congenital heart defects and changes in left ventricular structure and function in the offspring. Whether preeclampsia and gestational hypertension also affect the offspring's cardiac conduction system is unknown. This study assesses whether infants exposed to maternal hypertensive disorders of pregnancy (HDPs) exhibit changes in their electrocardiogram (ECG) compared with infants unexposed to HDPs. This population-based cohort study included newborns from the Copenhagen Baby Heart Study who had an ECG performed within 30 days of birth and had available obstetric information. ECG parameters of newborns exposed to maternal HDPs were compared with those of unexposed newborns using linear regression. Our study cohort included 11,826 newborns, including 441 exposed to maternal preeclampsia and 320 exposed to gestational hypertension. Infants exposed to preeclampsia had prolonged QRS durations (adjusted mean difference 0.6 ms, 95% confidence interval [CI] 0.04, 1.16) and lower maximum amplitudes of the R-wave in V1 (adjusted mean difference, linear scale 0.95, 95% CI 0.90, 1.00), compared with unexposed infants. Exposure to maternal preeclampsia was not associated with changes in other ECG parameters. Exposure to gestational hypertension was associated with increased QT interval durations (QTc Bazett, adjusted mean difference 2.48 ms, 95% CI -0.23, 5.20; QTc Fridericia, adjusted mean difference 2.32 ms, 95% CI -0.19, 4.83). Our findings suggest that the newborn cardiac conduction system is affected by exposure to maternal preeclampsia. This could reflect the previously described thickening of the left ventricular myocardium in infants exposed to preeclampsia.

Gestational diabetes complicated with preterm birth: a retrospective cohort study

ObjectiveTo delineate the clinical characteristics of preterm birth (PTB) in the context of gestational diabetes mellitus (GDM).MethodsA retrospective cohort study was conducted, including 14,314 pregnant women with GDM who delivered at Fujian Provincial Maternity and Children’s Hospital from January 1, 2018, to December 31, 2021. PTB was stratified into late PTB (34–36 weeks of gestation) and early PTB (< 34 weeks) and pregnancy complications were analyzed.ResultsCompared to the term birth (TB) cohort, a higher prevalence of premature rupture of membranes, hypertensive diseases of pregnancy (HDP), intrahepatic cholestasis of pregnancy (ICP), anemia and cervical insufficiency was observed in the PTB cohort. Notably, early PTB increased the incidence of HDP, ICP, anemia and cervical insufficiency compared to late PTB. In the early stages of pregnancy, early PTB was characterized by elevated triglyceride (TG) levels and decreased high-density lipoprotein cholesterol (HDL-C) levels compared to late PTB. In the late pregnancy stages, early PTB was associated with increased white blood cell (WBC) and neutrophil counts. No disparities were observed in 75 g oral glucose tolerance test (OGTT) between early and late PTB.ConclusionEnhanced surveillance and management of GDM, particularly in the presence of HDP, ICP and anemia, are imperative to mitigate the risk of PTB. The lipid profile may serve as a predictive tool for early PTB in the early stages of pregnancy, warranting further studies.

Association of Maternal Hypertensive Disorders in Pregnancy and Offspring Kidney Function from Adolescence into Young Adulthood

Association of Maternal Hypertensive Disorders in Pregnancy and Offspring Kidney Function from Adolescence into Young Adulthood

Global Modelling Links Maternal Hypertensive Disorders to Early Childhood Allergic Disease Burden.

Global Modelling Links Maternal Hypertensive Disorders to Early Childhood Allergic Disease Burden.