Odds Of Hypertensive Disorders Of Pregnancy Research Articles

Thick endometrium is associated with hypertensive disorders of pregnancy in programmed frozen-thawed embryo transfers: a retrospective analysis of 2,275 singleton deliveries

To investigate whether endometrial thickness (EMT) acts as a contributing factor to adverse perinatal outcomes in programmed frozen-thawed embryo transfer (FET) cycles. Retrospective cohort study. University-based reproductive medical center. The study included singleton live births resulting from programmed FET cycles that took place between January 2017 and April 2022 (N = 2,275 cycles). The EMT measurement conducted on the day of progesterone initiation was utilized. Programmed FET cycles with EMT <7 mm were excluded from consideration. All included subjects were divided into 4 groups on the basis of the 10th, 50th, and 90th percentiles of EMT: group Ⅰ (EMT ≤8 mm, n = 193), group Ⅱ (EMT = 8.1-10 mm, n = 1,261), group Ⅲ (EMT = 10.1-12 mm, n = 615), and group Ⅳ (EMT >12 mm, n = 206). After adjusting for patient demographics and FET parameters, logistic regression analysis and restricted cubic spline were used to investigate the relationship between EMT and perinatal outcomes. The group Ⅱ (EMT = 8.1-10 mm) served as a reference. The primary outcome measure was the hypertensive disorders of pregnancy (HDP). Secondary outcomes included gestational diabetes mellitus, cesarean delivery, placenta previa, premature rupture of membrane, birthweight, preterm birth, low birthweight, macrosomia, small for gestational age, large for gestational age and neonatal morbidity. The incidence of HDP was substantially elevated in group Ⅳ when compared with the other groups (5.7% vs. 4.1% vs. 5.7% vs. 9.7% for groups Ⅰ-Ⅳ, respectively). In addition, group I displayed a higher incidence of cesarean deliveries, whereas both group I and group IV exhibited an elevated prevalence of placenta previa. After adjusting for confounding factors, patients in group IV exhibited a significantly increased risk of HDP (adjusted odds ratio [OR] = 2.03, 95% confidence interval [CI] 1.13-3.67) as compared with patients in the reference group. The restricted cubic spline model revealed a nonlinear association between EMT and the odds of HDP on continuous scales. In comparison to women with an EMT of 9.5 mm, there was no significant change in the risk of HDP in women with EMT between 7 and 11 mm, as indicated by adjusted ORs of 1.37 (95% CI 0.41-4.52), 1.34 (95% CI 0.73-2.47), 1.13 (95% CI 0.79-1.62), 1.04 (95% CI 0.87-1.25), and 1.46 (95% CI 0.81-2.65), respectively. However, the risk of HDP was significantly higher in women with EMT ranging from 12 to 15 mm, with adjusted ORs of 1.86 (95% CI 1.03-3.35), 2.33 (95% CI 1.32-4.12), 2.92 (95% CI 1.52-5.60), and 3.62 (95% CI 1.63-8.04), respectively. This study demonstrated a noteworthy association between EMT and adverse perinatal outcomes during the programmed FET cycles. Specifically, a thick endometrium (EMT >12 mm) was independently associated with an increased risk of developing HDP, whereas the optimal EMT for reducing the risk of HDP was at around 9-10 mm.

Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic: A Population-Based Study [ID: 1380265

INTRODUCTION: We previously reported that the prevalence of hypertensive disorders of pregnancy (HDP) increased during the COVID-19 pandemic. We aimed to ascertain potential sociodemographic factors contributing to this association. METHODS: This was a retrospective analysis of the U.S. Centers for Disease Control and Prevention Natality Live Birth database (2016–2020). The prevalence of HDP, defined as a composite of gestational hypertension, preeclampsia, and eclampsia, was compared between the COVID-19 pandemic group (births from April 1, 2020, to December 31, 2020; n=2,728,674) and the pre-pandemic group (births from January 1, 2016, to February 29, 2020; n=15,967,803). A comparison of the prevalence of HDP among maternal sociodemographic factors and pregnancy characteristics between the two groups was also performed using χ2 test. Multivariable logistic regression was used to adjust for potential confounders. Statistical significance was set at P&lt;.05. RESULTS: We detected an overall increase in odds of HDP during the COVID-19 pandemic period (8.7% versus 7.1%, adjusted odds ratio 1.25, 95% CI 1.24–1.26). The highest prevalence of HDP during the pandemic was seen in similar sociodemographic subgroups as in the pre-pandemic group, such as older maternal age, patients with some college credit, private insurance, and non-Hispanic Black race. A marked increase in HDP prevalence was noted during the pandemic in most maternal characteristic subgroups evaluated, with the greatest noted in Asian individuals and tobacco users. Interestingly, chronic hypertension, which was more prevalent during the pandemic period (1.2% versus 0.9%, P≤.001), was associated with a lower prevalence of HDP during that time. CONCLUSION: The prevalence of HDP increased in the United States during the COVID-19 pandemic among all sociodemographic factors evaluated. Although chronic hypertension was more prevalent during the pandemic period, it had a lower effect on the development of HDP during that time.

Vitamin D intake modifies the association of household air pollution exposure with maternal disorders of pregnancy.

To date, only three studies have investigated the association of household air pollution (HAP) exposure with pregnancy disorders. The ameliorating role of diet and nutrition in the association has never been explored. We conducted a cross-sectional study among 799 mothers who had recently given singleton birth in the Cape Coast Metropolis, Ghana. Structured questionnaire and semi-quantitative food frequency questionnaire were used to assess HAP exposure (from use of biomass fuels for cooking and garbage burning at home) and vitamin D (vitD) intake, respectively. Multivariable binary logistic regression was used to investigate the association between HAP exposure and pregnancy disorders. HAP exposure due to cooking with biomass fuels and garbage burning at home was associated with two fold (AOR=2.15; 95% confidence interval [CI]: 1.05, 4.43) and six fold (AOR=6.35; 95% CI: 2.43, 16.58) increased odds of hypertensive disorders of pregnancy (HDP). For gestational diabetes (GDM), the increased odds were two folds for both exposures but the 95% CI included the null value. Stove stacking was also associated with two folds increased odds of GDM (AOR=1.83; 95% CI: 0.91, 3.68). In stratified analysis, the odds of HDP and GDM associated with biomass fuels use decreased with increasing vitD intake. All the interaction p values were, however, greater than 0.05. We provide the first evidence on the ameliorating role of vitD intake on the effect of HAP exposure on pregnancy disorders. In LMICs where solid fuel use and garbage burning at home is widespread, health workers should advise mothers during antenatal care visits to increase intake of vitamin D rich foods.

O-183 Increased Risk Of Hypertensive Disorders Of Pregnancy In Hormone Replacement Therapy Cycle - A Multicenter Cohort Study In Frozen Blastocyst Transfer In Ovulatory Women

Abstract Study question Is hormone replacement therapy cycle (HRT) associated with a higher risk of adverse perinatal outcomes than natural cycle (NC) during frozen embryo transfer (FET)? Summary answer Higher rates of hypertensive disorders of pregnancy (HDPs) and macrosomia were detected in HRT-FET as compared to NC-FET in ovulatory women. What is known already Live-birth rates after HRT-FET and NC-FET are found to be comparable. Recent data showed that pregnancies following HRT-FET are associated with higher risks of HDPs. However, the results might be influenced by selection bias as patients with ovulation disorder were more prone to receive HRT than ovulatory women. As is known, patients with ovulation disorder might have more endocrine disturbances than ovulatory women, which could be associated with adverse obstetrical outcomes. Study design, size, duration Four large reproductive medical centers in Guangdong province, Southeast of China, took part in this multicenter retrospective cohort study. Patients with regular cycles (25-35 days), who underwent either HRT or NC blastocyst FET and delivered after 20 weeks of gestation between January 2017 and December 2019 were analyzed. Preimplantation genetic testing (PGT) cycles, multiple pregnancies and cases with type II diabetes or preconceptional hypertension were excluded. Each patient only contributed one cycle per cohort. Participants/materials, setting, methods Treatment cycles from each patient were linked to their obstetrical medication record and a comprehensive chart review was done to investigate their perinatal outcomes. Maternal and neonatal outcomes were compared between NC-FET and HRT-FET cycles. Multiple logistic regression analyses were performed to adjust the confounding factors including baseline demographics (maternal age, BMI, education level, parity, type of infertility and cause of infertility), as well as IVF characteristics (insemination method and embryo cryopreservation duration). Main results and the role of chance A total of 406 cases from NC-FET and 602 cases from HRT-FET were included. A multiple logistic regression analysis showed that pregnancies after HRT-FET had increased odds of HDPs [adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI), 1.39–4.29] in comparison to pregnancies after NC-FET. Singletons born after HRT-FET were at increased risk of macrosomia compared to NC group (aOR 2.74, 95%CI 1.10–6.87). No significant difference could be seen regarding other obstetrical complications including gestational diabetes, placenta previa, placental abruption and postpartum hemorrhage between HRT-FET and NC-FET. No significant differences were noticed for preterm birth and low birthweight between the different endometrial protocols. Limitations, reasons for caution Our study was retrospective in nature, and some cases were excluded due to missing data. Wider implications of the findings Pregnancies following HRT-FET are associated with higher risks of HDPs and macrosomia in ovulatory women. Physicians should be cautious on the decision of the endometrium preparation for FET, especially for those who can ovulate normally. Trial registration number 2018YFC100310

980 Low fetal fraction in IVF pregnancies associated with hypertensive disorders of pregnancy

Fetal fraction (FF) from noninvasive prenatal testing (NIPT) has been used as a predictive marker for hypertensive disorders of pregnancy (HDP) in spontaneous pregnancies. We aimed to determine if FF is predictive of HDP in in-vitro fertilization (IVF) pregnancies. Retrospective cohort study of women with singleton pregnancies who underwent IVF with fresh or frozen embryo transfer, had NIPT screening, and had a live birth > 20 weeks at a single institution from 2013-2019. Women with a vanishing twin, aneuploidy, major anomaly, or nonreportable NIPT were excluded. Fetal fraction was corrected for gestational age (GA), platform (MPSS vs SNP-based), and defined as low if <10th percentile. Normal fetal fraction was defined as FF ranging from the 10th- 90th percentile, corrected for GA. The primary outcome was HDP during delivery hospitalization. Multivariable logistic regression analysis was performed to determine the association between FF and HDP, controlling for age, pre-pregnancy body mass index (ppBMI), use of heparin-based anticoagulation, race, ethnicity, NIPT platform, chronic HTN, and pregestational diabetes. 603 women were included, 83 (13.8%) of whom had low FF. Demographic characteristics were similar between groups, although median ppBMI was higher in women with low FF (p<0.001) and chronic HTN was more common among women with low FF (6.0% vs. 2.9%, p=0.043) (Table 1). HDP was more common among women with low FF versus normal FF in univariate analysis (34.9% vs.17.8%, p=0.001). In multivariable regression analysis, the odds of HDP was significantly higher among women with low FF, with an adjusted odds ratio of 2.06 (95% CI 1.15-3.61) (Table 2). Low FF in euploid, non-anomalous pregnancies is associated with HDP in IVF pregnancies. FF has the potential to be used as a predictive marker for hypertensive disorders in IVF pregnancies and may indicate a role for additional preventive and screening strategies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Residential radon exposure and hypertensive disorders of pregnancy in Massachusetts, USA: A cohort study

BackgroundExposure to ionizing radiation has been associated with hypertension, but the relationship between residential radon exposure and hypertensive disorders of pregnancy (HDP) has not been examined. MethodsWe used the Massachusetts Birth Registry of Vital Records from 2001 to 2015 including women with a singleton pregnancy without prior hypertension. The binary outcome (HDP) included gestational hypertension and pre-eclampsia cases and was assessed using birth certificate data. We obtained 141,665 basement radon measurements from Spruce Environmental Technologies, Inc. and modeled the monthly zip code basement radon level. We used a logistic regression model adjusted for sociodemographic covariates, maternal comorbidities, PM2.5, season, temperature, and relative humidity. We examined effect modification by maternal age, race, and maternal education as an indicator of socio-economic status. ResultsOf 975,528 women, 3.7% (36,530) of them developed HDP. Zip code level radon ranged from 22 to 333 mBq/m3. An interquartile range (IQR) increase in zip code radon level throughout pregnancy was associated with a 15% increase in the odds of HDP (95% CI 13% to 18%). In women less than 20 years old, an IQR increase in zip code level radon was associated with 38% increase in the odds of HDP (95% CI 24% to 50%), while the effect was smaller in older women. There was no effect modification by maternal race or education. ConclusionsIn this cohort, higher levels of residential radon are associated with increased odds of HDP. After stratifying by age, this effect was stronger in participants younger than 20 years old. Since the burden of hypertensive disorders of pregnancy is increasing and affects women’s future cardiovascular health, identification of modifiable risk factors is of great importance.