Maternal Pregnancy-induced Hypertension Research Articles

Clinical Characteristics of Hypospadias and Its Association with Very Low Birth Weight Infants with Small for Gestational Age

Purpose: To investigate the risk factors associated with hypospadias in very low birth weight (VLBW) infants (VLBWIs).Methods: We retrospectively analyzed 729 infants born at ≥24 weeks of gestational age and weighing <1,500 g from January 2012 to December 2022. We assessed the prevalence of hypospadias by birth weight percentiles and also compared the demographics and placental histopathology of the infants with hypospadias (n=52) and those without hypospadias (n=677).Results: Of the 729 patients analysed, hypospadias was recorded in 26 (20.3%), 14 (26.9%), and 12 (2.5%) infants in the <3rd, ≥3rd–<10th, and ≥10th–<90th percentiles, respectively. Of all of the patients with hypospadias, 50% had birth weights <3rd percentile (p<0.001). The hypospadias group demonstrated a longer mean gestational age (30.1 weeks vs. 27.9 weeks, p<0.001), lower incidence of maternal pregnancy-induced hypertension (48.1% vs. 17.3%, p<0.001), lower incidence of premature rupture of membrane (11.5% vs. 27.1%, p=0.013), lower acute chorioamniotic maternal response (9.1% vs. 35.2%, p<0.001), and higher maternal underperfusion (95.5% vs. 71.9%, p<0.001).Conclusion: The frequency of hypospadias was found to be the highest among VBLWIs <3rd percentile, who were severely small for their gestational age (SGA). Additionally, the incidence increased with a decreasing birth weight. Physical examination is necessary at birth for VLBWIs classified as SGA. Moreover, the data on the incidence of hypospadias among VLBWIs in neonatal intensive care units can assist in tracking counseling from the prenatal to the postnatal period for patients born <3rd percentile.

Angiotensin receptor blocker induced fetopathy: two case reports and literature review

The administration of angiotensin type 2 receptor blockers (ARBs) during pregnancy is known to cause ARB fetopathy, including renal insufficiency. We aimed to analyze the outcomes of two patients who survived ARB fetopathy and perform an accompanying literature review. Case 1 was exposed antenatally from a gestational age of 30 weeks to valsartan because of maternal pregnancy-induced hypertension. The patient presented with oliguria immediately after birth, and renal replacement therapy was administered for 24 days. Seven years after birth, renal function was indicative of stage 2 chronic kidney disease (CKD) with impaired urinary concentration. Case 2 had a maternal history of hypertension and transient ischemic attack and was treated with olmesartan until 30 weeks of pregnancy. Renal replacement therapy was performed for 4 days since birth. After 8 years, the patient is with CKD stage 2, with intact tubular function. Recent reports suggest that ARB fetopathy might manifest as renal tubular dysgenesis and nephrogenic diabetes insipidus, in contrast to mild alterations of glomerular filtration. Tubular dysfunction may induce CKD progression and growth retardation. Patients with ARB fetopathy should be monitored until adulthood. The ARB exposure period might be a critical factor in determining the severity and manifestations of fetopathy.

Outcomes of singleton preterm very low birth weight infants born to mothers with pregnancy-induced hypertension

The association between maternal pregnancy-induced hypertension (PIH) and neonatal mortality and morbidities in preterm infants has not been consistent. This study aimed to evaluate the influence of maternal PIH on mortality and morbidities in singleton infants with very low birth weight born before 30 weeks of gestational age using the Korean Neonatal Network (KNN) database. A total of 5340 singleton infants with very low birth weight were registered in the KNN registry, who were born at 23+0 to 29+6 weeks of gestational age between January 2015 and December 2020. Baseline characteristics and neonatal mortality and morbidities were compared between infants with PIH and non-PIH mothers. After adjustment for potential confounders, infants with PIH mothers had significantly higher odds of respiratory distress syndrome (OR 1.983; 95% CI 1.285–3.061, p = 0.002) and bronchopulmonary dysplasia (OR 1.458; 95% CI 1.190–1.785, p < 0.001), and severe bronchopulmonary dysplasia (OR 1.411; 95% CI 1.163–1.713, p < 0.001) than infants with non-PIH mothers, while there were no significant differences in severe intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or death during neonatal intensive care unit admission between infants with PIH and non-PIH mothers. This study showed that preterm infants with PIH mothers had an increased risk of neonatal respiratory morbidities, including respiratory distress syndrome and bronchopulmonary dysplasia.

Selenium status in term neonates, according to birth weight and gestational age, in relation to maternal hypertensive pathology.

Pregnancy represents a state of increased oxidative stress and antioxidants, in which selenium (Se) plays a pivotal role, contribute to maintain the oxidative balance. If antioxidant defenses are depleted, placental function is disrupted, resulting in pregnancy complications, including pregnancy-induced hypertension (PIH). Little is known about fetal selenium status in concomitant relation to maternal PIH, gestational age (GA) and birthweight (BW). We examined over a 3-year period the serum (SeS) and urine selenium (SeU) status in term neonates from normotensive (nonPIH) and hypertensive (PIH) mothers as clinical markers of oxidative stress. In this retrospective observational study, 72 neonates with maternal PIH were matched for GA and BW to 72 neonates of normotensive mothers. Four groups were obtained, based on maternal PIH and BW relative to GA (appropriate-for-gestational-age-AGA, small-for-gestational-age-SGA): nonPIH-AGA (control group), nonPIH-SGA, PIH-AGA, and PIH-SGA. The results showed significant differences (p < 0.001) in selenium levels among the study groups: SeS - 44.85 ± 7.56 μg/L in nonPIH-AGA, 39.62 ± 11.42 μg/L in nonPIH-SGA, 40.01 ± 10.07 μg/L in PIH-AGA, and 25.39 ± 8.99 μg/L in PIH-SGA; SeU - 27.98 ± 7.99 μg/L in nonPIH-AGA, 22.85 ± 9.48 μg/L in nonPIH-SGA, 23.44 ± 6.73 μg/L in PIH-AGA, and 13.05 ± 5.86 μg/L in PIH-SGA. Selenium depletion was more common in neonates born from hypertensive mothers and those born small for gestational age. Though moderate in intensity, selenium levels were positively correlated with BW (0.319 for SeS, 0.397 for SeU) and negatively correlated with maternal systolic blood pressure (-0.313 for SeS, -0.324 for SeU). The main independent effects on SeS and SeU of each maternal blood pressure and birth weight turned out statistically significant. In interaction, a more pronounced effect was reached in PIH-SGA neonates. Selenium status seemed to reflect the negative impact that PIH exerts in neonates during intrauterine development. Clinical markers of selenium status could thus be of great value for tracking responses of individuals to selenium supplementation as part of health improvement and harm mitigation approaches.

The Association Between Pregnancy-Induced Hypertension and Neonatal Cerebral Metabolism, Hemodynamics, and Brain Injury as Determined by Physiological Imaging

Pregnancy-induced hypertension (PIH) is common and may affect maternal and children’s healthcare. However, the neurobiological status of neonates born from mothers with PIH has yet to be elucidated. The present study employed physiological imaging to investigate the association between maternal PIH and a number of neonatal health parameters, including cerebral metabolism, hemodynamics, and pathophysiological vulnerabilities. Following the acquisition of ethical approval, we recruited 16 neonates with maternal PIH and 22 normal neonates (non-PIH) as controls. All neonates underwent magnetic resonance imaging (MRI) of the brain. Phase-contrast (PC) MRI and T2-relaxation-under-spin-tagging (TRUST) MRI were performed to determine global cerebral blood flow, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2). These physiological parameters were then compared between PIH neonates and controls. Linear regression analysis was performed to investigate the associations between maternal PIH and each of the physiological parameters. Receiver operating characteristic curves (ROCs) were used to determine whether maternal systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) which could facilitate the diagnosis of neonatal brain injuries. PIH neonates showed significantly lower OEF (25.5 ± 8.8% vs. 32.6 ± 7.3%, P = 0.01) and CMRO2 (29.7 ± 9.4 vs. 40.9 ± 15.0 μmol/100 g/min, P = 0.01) compared to the controls. Maternal blood pressure levels [PIH or non-PIH groups, each one standard deviation (SD) increase in SBP, DBP, and MAP, respectively] were negatively associated with OEF [regression coefficient (β) = −7.9, P = 0.007; β = −4.2, P = 0.004; β = −3.6, P = 0.02; β = −4.0, P = 0.008, respectively). Furthermore, each one SD increase in maternal DBP and MAP was negatively associated with CMRO2 (β = −4.7, P = 0.03; β = −4.4, P = 0.04, respectively). The areas under the curves (AUCs) with 95% confidence intervals (CIs) for maternal SBP, DBP, and MAP were 0.90 (0.80–0.97), 0.85 (0.73–0.97), and 0.89 (0.76–0.99), respectively. The AUC values for maternal SBP, DBP, and MAP indicated good diagnostic ability for identifying neonatal brain injuries. The present study demonstrated that maternal PIH may be associated with a lower oxygen extraction and lower cerebral metabolism in neonates.

Psychological Distress During Pregnancy and the Development of Pregnancy-Induced Hypertension: A Prospective Study.

Pregnancy-induced hypertension (PIH) is associated with serious complications in both the mother and the unborn child. We examined the possible association between trajectories of maternal psychological distress symptoms and PIH separately in primiparous and multiparous women. Pregnancy-specific negative affect (P-NA) and depressive symptoms were assessed prospectively at each trimester using the Tilburg Pregnancy Distress Scale pregnancy negative affect subscale (P-NA) and the Edinburgh Depression Scale (EDS). Data on PIH were collected from medical records. Growth mixture modeling analysis was used to identify trajectories of P-NA and EDS. The independent role of P-NA and EDS symptom trajectories on developing PIH was examined using multivariate logistic regression models. One hundred (7.6%) women developed PIH and were compared with 1219 women without hypertension or other complications during pregnancy. Three P-NA trajectories were identified: low stable (reference group; 90%), decreasing (5.2%), and increasing (4.8%). The latter two classes showed persistently and significantly higher P-NA symptoms during pregnancy compared with the reference group. In multiparous women, high P-NA scores (belonging to classes 2 and 3) were related to PIH (odds ratio [OR] = 6.91, 95% confidence interval [CI] = 2.26-21.2), independent of body mass index (OR = 1.17, 95% CI = 1.06-1.27) and previous PIH (OR = 14.82, 95% CI = 6.01-32.7). No associations between P-NA and PIH were found in primiparous women. EDS trajectories were not related to PIH in both primiparous and multiparous women. In multiparous women, persistently high levels of P-NA symptoms but not depressive symptoms were independently associated with development of PIH.

Prevalence and associated factors of perinatal asphyxia in newborns admitted to neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, Ethiopia

BackgroundPerinatal asphyxia is one of the leading causes of neonatal mortality and morbidity in Ethiopia. Understanding associated factors of perinatal asphyxia are important to identify vulnerable groups and to improve care during the perinatal period. Thus, this study aimed to assess the prevalence and associated factors of perinatal asphyxia among newborns admitted to NICU at the Gondar University Comprehensive Specialized Hospital Northwest Ethiopia, Ethiopia.MethodInstitutional based cross-sectional study was conducted on 364 newborns from November 2018 - August 2019. Data was collected using a structured and pre-tested questionnaire. It was then cleaned, coded, and entered using EPI INFO version 7, then analyzed with SPSS statistics version 20.0. Binary logistic regression analysis was used to identify variables with p < 0.2. An adjusted odds ratio (AOR) with a 95% CI and P-value of <0.05 was used to identify significantly associated variables with perinatal asphyxia.ResultThe prevalence of perinatal asphyxia in this study was 19.8, 95%CI (15.9, 24.2). Absence of maternal formal education (AOR = 4.09, 95%CI: 1.25, 13.38), pregnancy-induced hypertension (AOR = 4.07, 95%CI: 1.76, 9.40), antepartum hemorrhage (AOR = 6.35, 95%CI: 1.68, 23.97), prolonged duration of labor (AOR = 3.69, 95%CI: 1.68, 8.10), instrumental delivery (AOR = 3.17, 95%CI: 1.22, 8.21), and meconium-stained amniotic fluid (AOR = 4.50, 95%CI: 2.19, 9.26) were significantly associated with perinatal asphyxia.ConclusionThe prevalence rate of perinatal asphyxia in this study was comparable to other resource poor countries. The absence of maternal formal education, pregnancy-induced hypertension, and Antepartum hemorrhage, prolonged duration of labor, Instrumental assisted delivery, and meconium-stained amniotic fluid was having significant association with perinatal asphyxia in this study.

A prospective population-based multicentre study on the impact of maternal body mass index on adverse pregnancy outcomes: Focus on normal weight.

Maternal body mass index (BMI) below or above the reference interval (18.5-24.9 kg/m2) is associated with adverse pregnancy outcomes. Whether BMI exerts an effect within the reference interval is unclear. Therefore, we assessed the association between adverse pregnancy outcomes and BMI, in particular within the reference interval, in a general unselected pregnant population. Data was extracted from a prospective population-based multicentre cohort (Risk Estimation for PrEgnancy Complications to provide Tailored care (RESPECT) study) conducted between December 2012 to January 2014. BMI was studied in categories (I: <18.5, II: 18.5-19.9, III: 20.0-22.9, IV: 23.0-24.9, V: 25.0-27.4, VI: 27.5-29.9, VII: >30.0 kg/m2) and as a continuous variable within the reference interval. Adverse pregnancy outcomes were defined as composite endpoints for maternal, neonatal or any pregnancy complication, and for adverse pregnancy outcomes individually. Linear trends were assessed using linear-by-linear association analysis and (adjusted) relative risks by regression analysis. The median BMI of the 3671 included women was 23.2 kg/m2 (IQR 21.1-26.2). Adverse pregnancy outcomes were reported in 1256 (34.2%). Linear associations were observed between BMI categories and all three composite endpoints, and individually for pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes mellitus (GDM), large-for-gestational-age (LGA) neonates; but not for small-for-gestational-age neonates and preterm birth. Within the reference interval, BMI was associated with the composite maternal endpoint, PIH, GDM and LGA, with adjusted relative risks of 1.15 (95%CI 1.06-1.26), 1.12 (95%CI 1.00-1.26), 1.31 (95%CI 1.11-1.55) and 1.09 (95%CI 1.01-1.17). Graded increase in maternal BMI appears to be an indicator of risk for adverse pregnancy outcomes even among women with a BMI within the reference interval. The extent to which BMI directly contributes to the increased risk in this group should be evaluated in order to determine strategies most valuable for promoting safety and long-term health for mothers and their offspring.

Comparative analysis of cesarean section using the Robson's Ten-Group Classification System (RTCGS) in private and public hospitals, Addis Ababa, Ethiopia

Objectives: We analyzed the indications of cesarean section (CS) using Robson Ten-Group. Classification Systems (RTGCS) and comparison between private and public health facilities in Addis Abeba hospitals, Ethiopia, 2017. Methods: Facility-based retrospective cross-sectional study was carried out between January 1 and December 31, 2017, including 2411 mothers who delivered by CS were classified using the RTGCS. Data were entered into SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of the CS. Results: The overall CS rate was 41% (34.8% and 66.8% in public &amp; private respectively, p &lt; .0001). The leading contributors for CS rate in the private were Robson groups 5,1,2,3 whereas in the public 5,1,3,2 on descending order. Robson group 1 (nulliparous, cephalic, term, spontaneous labor) and group 3 [Multiparous (excluding previous cesarean section), singleton, cephalic, ≥ 37 weeks’ gestation&amp; spontaneous labor], the CS rate was over two-fold higher in the private than the public sector. Women in Robson groups 1, 2, 5 &amp; 9 are two and more times higher for the absolute contribution of CS in private than public. The top medical indications of CS were non-reassuring fetal status (NRFS, 39.1%) and repeat CS for previous CS scars (39.4%) in public and private respectively. Mothers who delivered by CS in private with history of previous CS scar (AOR 2.9, 95% CI 1.4-6.2), clinical indications of maternal request (AOR 7.7, 95% CI 2.1-27.98) and pregnancy-induced hypertension (AOR 4.2, 95% CI 1.6-10.7), induced labor (AOR 2.5, 95% CI 1.4-4.6) and pre-labored (AOR 2.2, 95% CI 1.6-3.0) were more likely to undergo CS than in public hospital. Conclusion: The prevalence of CS was found to be high, and was significantly higher in private hospitals than in a public hospital. Having CS scar [having previous CS scar, Robson group 5(Previous CS, singleton, cephalic, ≥ 37 weeks’ gestation) and an indication of repeat CS for previous CS scar] is the likely factor that increased the CS rate in private when compared within the public hospital. Recommendation: It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS, encouraging vaginal birth after CS (VBAC). Policies should be directed at the private sector where CS indication seems not to be driven by medical reasons solely.

Pregnancy-induced hypertension and retinopathy of prematurity: a meta-analysis.

Retinopathy of prematurity (ROP), one of the leading causes of childhood blindness, is a complex condition in which various antenatal and neonatal factors participate at different stages of the disease. This meta-analysis was conducted to investigate whether pregnancy-induced hypertension (PIH) was associated with ROP by summarizing all available evidence. PubMed, EMBASE, Web of Science, EBSCO and SCOPUS databases were searched for all relevant studies published from inception to April 2020. Studies investigating the association between PIH and ROP were included. A total of 29 studies were finally included for the meta-analysis after study selection. The results showed there are both no significant association between PIH and the occurrence of ROP in case-control studies (OR 0.91, 95%CI 0.59 to 1.40, I2 = 81%, p = 0.67) and cohort studies (OR 1.32, 95%CI 0.89 to 1.98, I2 = 93%, p = 0.17). The conclusion was same between pre-eclampsia and ROP (OR 0.82, 95%CI: 0.50 to 1.35, I2 = 83%, p = 0.43 in case-control studies and OR 1.70, 95%CI: 0.82 to 3.50, I2 = 95%, p = 0.15 in cohort studies). In summary, this meta-analysis did not reveal a consistent result, the conclusion remains inconclusive, and further studies will be needed to come to a conclusion for the effect of maternal PIH on ROP and foster a better understanding of the prevention of ROP.

Perinatal risk factors of symptomatic preterm patent ductus arteriosus and secondary ligation

There has been conflicting evidence for the association between antenatal factors and the development of symptomatic patent ductus arteriosus (PDA) or failure of pharmacologic treatment, especially for maternal pregnancy-induced hypertension (PIH) or chorioamnionitis. We assessed the perinatal risk factors of symptomatic PDA in preterm infants and those of secondary ligation in infants with pharmacologic treatment for symptomatic PDA using a national cohort. A total of 2961 infants with 22-29 weeks of gestation with symptomatic PDA or no PDA were included from the Korean Neonatal Network database. To identify significant perinatal risk factors associated with symptomatic PDA or secondary ligation, all perinatal factors were included in the univariate and multivariate generalized estimating equation analysis and final model was selected using backward elimination method based on Quasi-likelihood Information Criterion. Lower gestational age (GA), female gender, maternal PIH and surfactant use were significant risk factors of symptomatic PDA. Antenatal corticosteroid use decreased the risk of symptomatic PDA. For secondary ligation, lower GA and cesarean section were significant risk factors. Adjusted odds ratio (aOR) of PIH as a risk factor of symptomatic PDA was 1.56 [95% confidence interval 1.17-2.08]. In the subgroup analysis according to the GA, lower GA, female gender, multiple pregnancy, maternal PIH and surfactant use increased the risk of symptomatic PDA, and histologic chorioamnionitis and antenatal corticosteroid use decreased the risk of symptomatic PDA only in GA 26-29 weeks group. Lower GA increased the risk of symptomatic PDA and secondary ligation. Maternal PIH and surfactant use increased the risk of symptomatic PDA; however, antenatal corticosteroid use decreased it. Close observation of the clinical symptoms of PDA is needed in preterm infants with maternal PIH.

The Association of Pregnancy-induced Hypertension with Bronchopulmonary Dysplasia \u2013 A Retrospective Study Based on the Korean Neonatal Network database

The prevalence of pregnancy-induced hypertension (PIH) and preeclampsia (PE) are 5–10% and 2–4%, respectively. PIH might affect angiogenesis in preterm neonates, but its association with bronchopulmonary dysplasia (BPD) remains controversial. This study evaluated the association between PIH and BPD in very low-birth weight infants. We retrospectively analysed the maternal, perinatal, and neonatal data of preterm infants born before 30 weeks of gestation, selected from the nationwide registry of very low-birth weight infants, between January 2013 and December 2014. As a result, 1,624 infants without maternal PIH (gestational age: 27.3 ± 1.8 weeks) and 203 infants with maternal PIH (28.0 ± 1.4 weeks, p < 0.001) were included. Birth weight was higher in the non-PIH group, compared with the PIH group (1027.4 ± 250.2 vs. 876.4 ± 261.5 g, p < 0.001). Multivariate logistic regression showed that PIH was associated with BPD (adjusted OR 1.474, 95% confidence interval 1.025–2.121), after adjusting for confounders, including small-for-gestation age (SGA). The result of present study is consistent with the current concept of BPD as an early form of pulmonary vascular disease, for both PIH and BPD are attributed by abnormal vascular formation.

Analysis of perinatal risk factors for small-for-gestational-age and appropriate-for-gestational-age late-term infants.

To investigate the potential risk factors for small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) late-term infants, 100 cases of single full-term SGA infants delivered in the Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University in 2017 were enrolled as the SGA group. A total of 100 healthy AGA who were born at the same time with the same gestational age were randomly included as the control group. The perinatal and postpartum adverse conditions of the two groups were recorded, and Apgar tests were performed on all newborns at 1 min (T1), 5 min (T2) and 10 min (T3) after birth. A follow-up survey was conducted in all patients at 6 and 12 months of age. At the second follow-up, the development quotient of the children was measured using the Gesell Developmental Schedule, and the perinatal risk factors of SGA were analyzed. The incidence of intrauterine distress, respiratory distress syndrome and infectious disease in the SGA group was significantly higher compared with that in the AGA group (P<0.05). The Apgar scores at T1, T2 and T3 were significantly lower in the SGA group compared with the AGA group (P<0.05). The Apgar score at T1 was lower compared with that at T2 in the SGA group (P<0.05), and the Apgar score at T2 was lower compared with that at T3 (P<0.05). The length of hospital stay in the SGA group was significantly longer compared with that in the AGA group (P<0.05). The development quotient at the 6 and 12th month in the SGA group was significantly lower compared with that in the AGA group (P<0.05). Logistic regression analysis showed that there was no correlation between SGA and maternal age, regardless of firstborn status, neonatal sex, mode of delivery and living environment. SGA was significantly associated with umbilical cord abnormalities, maternal pregnancy-induced hypertension, gestational diabetes, pregnancy infection and intrauterine distress (P<0.05). An abnormal umbilical cord, maternal pregnancy-induced hypertension, gestational diabetes, infection during pregnancy and intrauterine distress are all perinatal risk factors for SGA. Effective interventions are needed in clinical assessment to prevent the occurrence of SGA.

Thyroid dysfunction in preterm infants born before 32 gestational weeks

BackgroundThyroid hormones are critical for growth and brain development during the newborn period and infancy. Because of delayed maturation of the hypothalamic-pituitary-thyroid axis in preterm infants, thyroid dysfunction is common, and thyroid stimulating hormone (TSH) elevation is often delayed in preterm infants. The objective of this study was to determine the incidence of thyroid dysfunction requiring levothyroxine treatment and to identify its risk factors in preterm infants.MethodsA retrospective cohort study was performed on preterm infants who were born before 32 gestational weeks and admitted to a single tertiary academic center for more than 8 weeks between January 2008 and December 2014. In these infants, serial thyroid function tests (TFTs) measuring serum TSH and free thyroxine (fT4) were routinely performed at 1, 3, and 6 weeks of postnatal age.ResultsOf the 220 preterm infants enrolled, 180 infants underwent TFTs at 1, 3, and 6 weeks of postnatal age and were included in the study. Of the 180 infants, 35 infants (19.4%) were started on levothyroxine treatment based on the results of serial TFTs. Among the 35 infants who were treated with levothyroxine, 16 infants (45.7%) had normal results on the initial TFT. Three of these 16 infants continued to have normal results on the second TFT. Thyroid dysfunction requiring levothyroxine treatment was significantly associated with maternal pregnancy-induced hypertension (adjusted odds ratio 2.64, 95% confidence interval 1.02–6.81).ConclusionsThyroid dysfunction requiring levothyroxine treatment occurred in nearly one-fifth of preterm infants born before 32 gestational weeks. Nearly half of the preterm infants who were treated with levothyroxine had normal TSH and fT4 levels at 1 week of postnatal age. The findings of the present study suggest that serial TFTs is important to find preterm infants who require levothyroxine treatment.

Maternal pregnancy-induced hypertension increases the subsequent risk of neonatal candidiasis: A nationwide population-based cohort study

ObjectiveNeonatal candidiasis is a leading infectious cause of significant morbidity and mortality in premature birth mainly due to impaired physical barriers and immature immune system of fetus. Maternal pregnancy-induced hypertension (PIH) has been reported to be able to disturb the neonatal immune system, which could cause the increased possibility of neonatal infection. Therefore, we hypothesized that maternal PIH may increase the risk of neonatal candidiasis. The aim of this study was to evaluate whether PIH increased the risk of neonatal candidiasis and identify the predictive risk factors. Materials and methodsPatients with newly diagnosed PIH between January 1, 2000, and December 31, 2013 were selected from the Taiwan National Health Insurance Research Database (NHIRD). For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. A Cox proportional regression model was used to estimate the risks of neonatal candidiasis in both cohorts. ResultsAmong the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients with PIH had a higher incidence of neonatal candidiasis than did those without PIH. According to the multivariate analysis, PIH (odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.11–3.19, p < 0.0228), single parity (OR = 1.91, 95% CI = 1.00–3.65, p < 0.0499), and preterm birth (OR = 3.57, 95% CI = 1.84–6.93, p = 0.0002) were independent risk factors for the development of neonatal candidiasis. ConclusionPatients who had a history of PIH was associated with an increased risk of having infants who develop neonatal candidiasis compared with those without PIH. Additionally, preterm birth was an independent risk factor for the development of neonatal candidiasis.

Risk Factors for Nephrocalcinosis in Very Low Birth Weight Infants

Objective: The objective was to identify risk factors for nephrocalcinosis in very low birth weight (VLBW) infants. Methods: Prospective study has done between 2014 and 2017. The study included 81 VLBW infants in the neonatal intensive care unit (NICU). Renal ultrasonography was performed at four weeks and 3 months. Baseline characteristics, complications and medication during NICU admission were collected. 25-(OH)-vitamin D, calcium, phosphorous, alkaline phosphatase, urine calcium to creatinine ratio were serially measured. Results: The incidence of nephrocalcinosis was 16.9%. On univariate analysis, gestational age, lower birth weight, maternal pregnancy-induced hypertension, neonatal sepsis, and frequency of vancomycin and caffeine citrate treatment were significantly associated with nephrocalcinosis. In addition, preterm infants with nephrocalcinosis had lower cord blood 25-(OH)-vitamin D and serum calcium levels and higher serum alkaline phosphatase levels at 2 weeks of life. Multivariate analysis showed that gestational age (P=0.042), birth weight (P=0.019), sepsis (P=0.046), small for gestational age (P=0.015), and maternal pregnancy-induced hypertension (P=0.024) were significant risk factors for nephrocalcinosis. Conclusion: This study suggests that neonatal sepsis and maternal pregnancy-induced hypertension, in addition to gestational age and birth weight are important perinatal risk factors for nephrocalcinosis.

Maternal pregnancy-induced hypertension increases subsequent neonatal necrotizing enterocolitis risk: A nationwide population-based retrospective cohort study in Taiwan.

The utero-placental ischemia induced by pregnancy-induced hypertension (PIH) could lead to fetal hypoxia and proinflammatory cytokine release, which are associated with the development of neonatal necrotizing enterocolitis (NEC). However, a few studies have investigated the relationship between PIH and neonatal NEC and have produced controversial results. Therefore, we attempted to assess the relationship between PIH and the subsequent neonatal NEC risk and identify predictive risk factors.Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database (NHIRD). For each participant, 4 age- and delivery-year-matched participants without PIH were randomly selected. A multivariable logistic regression was performed for the identification of the predictive risk factors for neonatal NEC.Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. For the multivariable analysis, maternal PIH was associated with an increased risk of subsequent neonatal NEC development (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.08–3.21, P = .026). Furthermore, single parity (OR 2.06, 95% CI 1.12–3.77, P = .019), preterm birth (OR 5.97, 95% CI 3.49–10.20, P < .001), multiple gestations (OR 2.25, 95% CI 1.22–4.14, P = .010), and intrauterine growth restriction (IUGR) (OR 3.59, 95% CI 2.06–6.24, P < .001) were independent risk factors for the development of subsequent neonatal NEC.Maternal PIH increases the risk for developing neonatal NEC. Furthermore, primiparity, preterm birth, multiple gestations, and IUGR were independent risk factors for neonatal NEC.

Maternal pregnancy-induced hypertension increases the subsequent risk of transient tachypnea of the newborn: A nationwide population-based cohort study

ObjectiveTo determine the association between pregnancy-induced hypertension (PIH) and transient tachypnea of the newborn (TTN) and to identify the predictive risk factors. Materials and MethodsPregnant women with a newly diagnosed PIH (between 2000 and 2013) from the Taiwan National Health Insurance Research Database (NHIRD) were compared with a matched (with respect to age and year of delivery) cohort of pregnant women without PIH. The occurrence of TTN was evaluated in both cohorts. ResultsAmong the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. According to a multivariate analysis, PIH (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.69–2.03, p < 0.0001), age ≥ 30 years (OR = 1.38, 95% CI = 1.26–1.51, p < 0.0001), primiparity (OR = 1.37, 95% CI = 1.24–1.5, p < 0.0001), preterm birth (OR = 3.4, 95% CI = 3.09–3.75, p < 0.0001), multiple births (OR = 2.54, 95% CI = 2.24–2.89, p < 0.0001), and cesarean section (OR = 1.71, 95% CI = 1.56–1.88, p < 0.0001) were independent risk factors for the development of TTN. ConclusionWomen with PIH have an increased risk of having infants who develop TTN compared with those without PIH. Additionally, age ≥30 years, primiparity, preterm birth, multiple births, and cesarean section were independent risk factors for the development of TTN.

Obstetric outcomes and antenatal access among adolescent pregnancies in Kwazulu-Natal, South Africa

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socioeconomic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges.&#x0D; &#x0D; Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13–16 years) at the district hospital under study was collected over 3 years (2011–2013) (n = 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation.&#x0D; &#x0D; Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (&lt; 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74; p &lt; 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits.&#x0D; &#x0D; Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge.&#x0D; &#x0D; (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)&#x0D; &#x0D; S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.133378

Pregnancy Induced Hypertension Versus Small Weight for Gestational Age: Cause of Neonatal Hematological Disorders.

Pregnancy-induced hypertension (PIH) is a multifactorial disorder that increases the risk of morbidity and mortality in both mother and newborn. Although there are many studies that track the effects of PIH on maternal and neonatal outcome, the results are contradictory. This retrospective study focuses on the effect of maternal PIH on neonatal hematological changes (thrombocytopenia and neutropenia). It also tries to determine whether neonatal thrombocytopenia and neutropenia are direct consequences of maternal PIH, rather than of the small for gestational age (SGA) status of the newborn. A three year restrospective observational study was conducted, from 1st of January 2014 to 31st of December 2016, on 6,077 newborns registered at the Neonatology Department of the Clinic of Obstetrics, Gynecology, and Neonatology, Emergency County Hospital, Timișoara, România. Selection of newborns with maternal PIH was made using the case-mix records RO DRG v1., according to which PIH was classified in gestational hypertension, preeclampsia and eclampsia. Patients were divided into four study groups, according to birth weight for gestational age and presence or absence of maternal PIH: 5,867 appropriate for gestational age (AGA) neonates form healthy mothers (AGA-Controls), 152 small for gestational age neonates from healthy mothers (SGA-Controls), 40 AGA newborns with maternal PIH (AGA-PIH) and 18 SGA newborns with maternal PIH (SGA-PIH). Regression and correlation analysis using the XLSTAT Microsoft Excel® tool pack, was performed to compare data from the study groups of neonates from mothers with PIH and the control groups of neonates from normotensive mothers. SGA-PIH neonates were the most affected with regard to the hematological abnormalities (33.3% neutropenic and 27.7% thrombocytopenic newborns) followed by AGA-PIH neonates (22.5% neutropenia and 17.5% thrombocytopenia). SGA-Controls had much lower percentages of both neutropenia and thrombocytopenia (2.63% and 1.97% respectively), whereas AGA-Controls had no record of any hematological changes. Maternal PIH has a strong influence on the development of newborn hematologic abnormalities, such as neutropenia and thrombocytopenia. The incidence and severity of these hematological changes are increased in neonates of mothers with PIH, that are born preterm and/or SGA.