Prediction Of Gestational Hypertension Research Articles

β-HCG and PAAP-A Levels during First Trimester as a Predictor of Gestational Hypertension and Growth-restricted Fetus

β-HCG and PAAP-A Levels during First Trimester as a Predictor of Gestational Hypertension and Growth-restricted Fetus

Evaluation of serum beta HCG levels in pregnant females as a predictor of gestational hypertension

Human β-HCG is a glycoprotein that is expressed in trophoblastic cells and various malignant tumors. Placenta is the known primary trigger of gestational hypertension. Beta HCG is secreted in abundance from placenta.The aim of the present study is to estimate the serum Beta HCG levels in study group consisting of 50 patients (Pregnant Females) of gestational hypertension and in control consisting of same age matched pregnant females.The present hospital based observational and analytical study was conducted on 80 patients out of which 50 were diagnosed with gestational hypertension and 30 constituted the control group. The Beta HCG levels were analyzed by Sandwich ELISA Method. The results of the present study showed that there was increase in Beta HCG levels in the gestational hypertensive patients with a mean value of Beta HCG was 117.79 ± 57.7mIU/ml, mean value of Systolic blood pressure was 127.3 ±13.9 mm of Hg and mean value of Diastolic blood pressure was 78.6 ±16.1 mm of Hg which were statistically significant (p=<0.001). Serum Beta HCG levels were elevated in gestational hypertension, when compared with controls. Due to trophoblast response to hypoxia there exists an abnormal secretory function of the placenta in cases of gestational hypertension which leads to development of a hypersecretory state which is seen as a rise in Beta HCG levels. This study showed that estimating serum Beta HCG levels is a useful indicator to identify women who are likely to develop gestational hypertension in the same pregnancy.

Serum Lipid Profile in Second Trimester as a Predictor of Gestational Hypertension

Serum Lipid Profile in Second Trimester as a Predictor of Gestational Hypertension

Second-Trimester Maternal Serum Beta-Human Chorionic Gonadotropin and Lipid Profile as a Predictor of Gestational Hypertension, Preeclampsia, and Eclampsia: A Prospective Observational Study.

Background:Hypertensive disorders of pregnancy are important complications of pregnancy and are associated with high maternal and perinatal mortality and morbidity. Early diagnosis may improve maternal and perinatal outcome by ensuring appropriate management.Aim:Our aim is to assess the serum beta-human chorionic gonadotropin (hCG) and serum lipid profile in the early and late trimesters of at-risk mothers and to analyze whether these parameters can be used to predict pregnancy-induced hypertension (PIH) and its time of onset.Materials and Methods:A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Tata Main Hospital, Jamshedpur, India. Two hundred antenatal women were screened for serum beta-hCG and lipid profile in their early (14–18 weeks) and late (24–28 weeks) second trimesters. All patients were followed up till delivery and observed for the development of PIH. Results were evaluated and analyzed statistically.Results:The incidence of PIH in our study was 14.67% (n = 27). Most of the patients had late-onset PIH (88.88%, n = 27), whereas 11.12% (n = 3) had an early onset of the disease. Of 27 patients, 6 patients developed preeclampsia and none had eclampsia. The mean beta-hCG level in the study population at the early second trimester was 91,723.97, whereas in the late second trimester, it was 22,456.25. In PIH patients, a significant increase in the level of serum cholesterol, triglyceride, and very-low-density lipoprotein was noted in both the early and late second trimesters.Conclusion:This study showed that serum beta-hCG and lipid profile in the second trimester are useful indicators to identify women who are likely to develop PIH, preeclampsia, or eclampsia.

To determine the efficacy of uterine artery pulsatility index and pregnancy associated plasma protein-a in the first trimester as a predictor of gestational hypertension- A prospective observational cohort study

To determine the efficacy of uterine artery pulsatility index and pregnancy associated plasma protein-a in the first trimester as a predictor of gestational hypertension- A prospective observational cohort study - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.110, I

The Prediction of Gestational Hypertension, Preeclampsia and Fetal Growth Restriction via the First Trimester Screening of Plasma Exosomal C19MC microRNAs.

The aim of the study was to verify if quantification of placental specific C19MC microRNAs in plasma exosomes would be able to differentiate during the early stages of gestation between patients subsequently developing pregnancy-related complications and women with the normal course of gestation and if this differentiation would lead to the improvement of the diagnostical potential. The retrospective study on singleton Caucasian pregnancies was performed within 6/2011-2/2019. The case control study, nested in a cohort, involved women that later developed GH (n = 57), PE (n = 43), FGR (n = 63), and 102 controls. Maternal plasma exosome profiling was performed with the selection of C19MC microRNAs with diagnostical potential only (miR-516b-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, and miR-525-5p) using real-time RT-PCR. The down-regulation of miR-517-5p, miR-520a-5p, and miR-525-5p was observed in patients with later occurrence of GH and PE. Maternal plasma exosomal profiling of selected C19MC microRNAs also revealed a novel down-regulated biomarker during the first trimester of gestation (miR-520a-5p) for women destinated to develop FGR. First trimester circulating plasma exosomes possess the identical C19MC microRNA expression profile as placental tissues derived from patients with GH, PE and FGR after labor. The predictive accuracy of first trimester C19MC microRNA screening (miR-517-5p, miR-520a-5p, and miR-525-5p) for the diagnosis of GH and PE was significantly higher in the case of expression profiling of maternal plasma exosomes compared to expression profiling of the whole maternal plasma samples.

165. Improved prediction of gestational hypertension by inclusion of placental growth factor and Pregnancy Associated Plasma Protein-A in a sample of Ghanaian women

Introduction This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Objectives We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. Methods Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight,height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models. Results Three hundred and seventy-three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64–0.86) and 0.89(0.73–1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74–0.89) and 0.95 (0.87–1.00) for multiparous and primigravid women respectively. Discussion Adding the biomarkers PAPP-A and PlGF to maternal characteristics in a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.

Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women

BackgroundWe assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women.MethodsThis study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight, height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models.ResultsThree hundred and seventy three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64–0.86) and 0.89(0.73–1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74–0.89) and 0.95 (0.87–1.00) for multiparous and primigravid women respectively.ConclusionAdding the biomarkers PAPP-A and PlGF to maternal characteristics to a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.

Blood pressure at early pregnancy and gestational hypertensive disorders: a prospective cohort study in China

BackgroundGestational hypertension and pre-eclampsia are major causes of perinatal mortality. Prediction of gestational hypertension and pre-eclampsia is of great interest because it enables early intervention, thus improving prognosis. Most existing prediction models consist of biomarkers, which might be unavailable in low-resourced countries. We aimed to establish a prediction model of gestational hypertension and pre-eclampsia using data at early pregnancy. MethodsWe studied women with singleton delivery from Born in Guangzhou Cohort Study (BIGCS), China. Predictors included maternal age, educational level, income level, prepregnancy weight, height, passive smoking, and blood pressure collected at the first antenatal-care visit (around 16 weeks' gestation). Information on diagnosis of gestational hypertension or pre-eclampsia was extracted from medical records using international classification of disease code (ICD-10). We used logistic regression to develop prediction models. Discrimination and calibration were assessed with receiver operation characteristics (ROC) and calibration plot, respectively. FindingsBetween Feb 1, 2012, and Jan 1, 2016, we recruited 12 915 women, of which 326 (2·52%) women were diagnosed with gestational hypertension and 82 (0·66%) had pre-eclampsia. The prediction model for gestational hypertension with maternal characteristics alone had an area under the ROC-curve of 0·67 (95% CI 0·62–0·72). Maternal mean arterial pressure (MAP) had an area under the curve (AUC) of 0·74 (95% CI 0·70–0·79), whereas the AUC of the model with MAP and maternal characteristic combined was 0·76 (0·72–0·81), which was slightly better than for MAP alone (p=0·03). Results for prediction of pre-eclampsia were very similar to those of gestational hypertension. Calibration plots showed that the prediction model with MAP had good fit. InterpretationOur findings show that MAP has acceptable predictive ability of gestational hypertension and pre-eclampsia and can be used to triage further care. Our relatively large sample size ensured stronger statistical power. Model validation need to be performed in a separate population. FundingNational Natural Science Foundation of China (81673181), Guangzhou Science and Technology Bureau, Guangzhou, China (2011Y2-00025, 201508030037)

Non-invasive cardiac output monitoring (NICOM®) can predict the evolution of uteroplacental disease—Results of the prospective HANDLE study

ObjectivesWe aimed to firstly identify the different haemodynamic profiles amongst nulliparous women who develop either gestational hypertension (GH), pre-eclampsia (PE), normotensive fetal growth restriction (FGR) versus unaffected pregnancies using non-invasive cardiac output monitoring (NICOM®). Our second primary objective was to assess the ability of NICOM® derived variables to predict the evolution of PE, GH and FGR. Study designLow risk nulliparous women were enrolled in a single center prospective observational study. NICOM® assessments were performed at 14, 20 and 28 weeks’ gestation and data was obtained on cardiac output (CO), total peripheral resistance (TPR), indexed TPR (adjusted for maternal body surface area; TPRi), stroke volume (SV), indexed SV (adjusted for maternal body surface area; SVi) and heart rate (HR). Logistic regression was used to model GH, PE and FGR with NICOM® measurements as predictors. Linear, non-linear and interaction terms were assessed using the Akaike Information Criterion. ResultsThe haemodynamic profile of pregnancies complicated by uteroplacental disease- GH (n=18), PE (n=6) and FGR (n=24) were compared to 318 healthy unaffected pregnant controls. Women with evolving PE have a different haemodynamic profile to those developing either GH or FGR. The best independent predictors for the evolution of uteroplacental disease at 14 weeks’ gestation were CO in the prediction of FGR (AUC=0.61; p 0.002), TPR in the prediction of GH (AUC=0.63; p<0.02) and SVi in the prediction of PE (AUC=0.62; p<0.05). The performance of haemodynamic variables was enhanced when combined in a multivariate logistic model. We demonstrated that TPR, CO and SV when combined with BP were significant predictors of pregnancies complicated by FGR (AUC=0.64, p=0.004; AUC=0.65, p=0.004; and AUC=0.65, p=0.007 respectively). Whereas in pregnancies complicated by PE, HR and SVi in combination with BP were also statistically significant predictors (AUC=0.75, p=0.017 and AUC=0.77, p=0.007 respectively). ConclusionsNICOM® derived maternal haemodynamic profile at 14 weeks’ gestation has the novel potential to identify pregnancies which will ultimately develop uteroplacental disease.

La hipertensión arterial en la embarazada

Preeclampsia (PE) is a disease unique to humans. PE complicates from 3 to 14% of pregnancies worldwide. Unknown cause yet, although part of poor placentation resulting placental ischemia release of proinfammatory cytokines and anti-angiogenic factors. Two PE types: early PE with maternal and fetal adverse events and late PE with low fetal involvement and more favorable maternal-fetal prognosis. As PE predictors being considered: increased uric acid of 3.15 mg/dl as a predictor of gestational hypertension in the first quarter and greater than 5.2 mg/dl for severe/eclampsia preeclampsia. The sFLT-1/PIGF (soluble FMS-like tyrosine kinase-1/angioge nic placental growth facto) ratio is above 85 is a marker of pregnancy complications and a good indicator that helps decision making. Hypertension in pregnancy can be the beginning of vascular and metabolic alterations future; indeed the PE/eclampsia is considered a specific risk factor in women in some guides cardiovascular risk. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

DESIGN AN “IN HOUSE” SOFTWARE FOR SCREENING PREECLAMPSIA BY MATERNAL FACTORS AND MEAN ARTERIAL PRESSURE AT 11 – 13 WEEKS IN COMMUNE HEALTH CENTERS.

Objective: Design an “in house” software for screening preeclampsia by maternal factors and mean arterial pressure at 11 – 13 gestational weeks in commune health centers. Methods: Based on the algorithms for calculating the risk of preeclampsia (PE) by maternal factors and mean artirial pressure at 11 - 13 gestational weeks in the study results of the authors, an “in house” software was deigned in Excel. The results of prediction preeclampsia by The Fetal Medicine Foundation (FMF)(version 2.3) were compared with the results by “in house” software in 1110 singleton pregnant women. Results: The “in house” software met the requirements for calculating the risks of PE and save data. FMF risk for gestational hypertension disorder in pregnancy by maternal factors, mean arterial pressure,uterine artery Doppler and PAPP-A has an area under the curve of 0.68 (95%CI: 0.59 – 0.78). The “in house” software risk for gestational hypertension in pregnancy by maternal factors, mean arterial pressure has an area under the curve of 0.643 (0.55 – 0.73) There was no statistically significant different between two programs (p:0.52). The risk cut-off 1:50 in the prediction of gestational hypertension of the “in house” software was used to identify the group of high risk with detetion rate (DR) 28.6% (95%CI: 14.9-42.2) comparing to 40.5% (95%CI:25.6-55.3) of FMF. Conclusion: The FMF version 2.3 is better but in the absence of Doppler ultrasound and PAPP-A test in the commune health cares, the “in house” software for screening PE is a good tool for councelling, following up and early intervention for PE.

Hypertensive disorders during pregnancy

Hypertensive disorders during pregnancy

OC085: Prediction of gestational hypertension by first trimester uterine artery Doppler and combined serum markers

OC085: Prediction of gestational hypertension by first trimester uterine artery Doppler and combined serum markers

Oxidative stress in midpregnancy as a predictor of gestational hypertension and pre‐eclampsia

To explore the relationship between the levels of maternal oxidative stress and glycaemia during pregnancy and to compare the predictive values of 8-epimer of prostaglandin F(2alpha) (8-isoPGF(2alpha)) and mean arterial pressure (MAP) in midpregnancy for the development of hypertensive complications in later pregnancy. Prospective observational study as an ancillary study to the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. Obstetric clinics and wards of a university teaching hospital in Hong Kong. Selected women with singleton pregnancies attending the antenatal clinic. Pregnant women who met HAPO inclusion criteria were recruited for the study. Glucose tolerance was assessed by a 75-g 2-hour oral glucose tolerance test (OGTT) at 24-32 weeks of gestation. Fasting plasma samples for 8-isoPGF(2alpha) estimation and urine samples for 8-isoPGF(2alpha) and 2,3-dinor 8-isoPGF(2alpha) assays were collected and blood pressures measured during the OGTT visit. Random plasma and urine samples were also obtained at 34-37 weeks. Glucose results were unblinded to the attending obstetrician if limits preset under the HAPO protocol were met. Maternal plasma 8-isoPGF(2alpha) and urinary 8-isoPGF(2alpha) and 2,3-dinor 8-isoPGF(2alpha) both at the time of OGTT (24-32 weeks) and at 34-37 weeks of gestation. Incidence of pre-eclampsia and gestational hypertension. Of the 408 women who attended for OGTT at 24-32 weeks, two met the glucose criteria for unblinding and 25 had missing 8-isoPGF(2alpha) values and thus were excluded from analysis. Of the 381 women, 338 (88.7%) attended for random plasma samples at 34-37 weeks. Significant correlations were observed between maternal fasting plasma isoprostane and both fasting (r= 0.20; P < 0.001) and 2-hour (r= 0.39; P < 0.001) plasma glucose levels at the time of OGTT. Gestational hypertension/pre-eclampsia occurred in 17 (4.2%) women, and at the time of OGTT, they had significantly higher fasting plasma 8-isoPGF(2alpha) (P < 0.001), urine 8-isoPGF(2alpha) (P < 0.005) and urine 2,3-dinor 8-isoPGF(2alpha) to creatinine ratios (P < 0.001), as well as higher MAP (P < 0.001) than women who remained normotensive. At 34-37 weeks, only random plasma 8-isoPGF(2alpha) was significantly higher (P < 0.001) among the women with gestational hypertension/pre-eclampsia. Plasma markers of oxidative stress were positively correlated with plasma glucose at the time of OGTT (24-32 weeks). Women who subsequently developed gestational hypertension/pre-eclampsia had significantly higher plasma and urine markers of oxidative stress at the time of OGTT but only higher plasma markers at 34-37 weeks. Plasma 8-isoPGF(2alpha) appears to be a very good predictor of subsequent gestational hypertension/pre-eclampsia when measured at the time of OGTT, but its ability to discriminate deteriorates as pregnancy advances.

Prediction of gestational hypertension or intrauterine fetal growth restriction by mid-trimester 24-h ambulatory blood pressure monitoring

Prediction of gestational hypertension or intrauterine fetal growth restriction by mid-trimester 24-h ambulatory blood pressure monitoring

Prediction of gestational hypertension or intrauterine fetal growth restriction by mid-trimester 24-h ambulatory blood pressure monitoring

Objectives: To investigate clinical impact of 24-h ambulatory blood pressure monitoring (ABPM) on the prediction of hypertensive disorders of pregnancy and IUGR. Methods: ABPM was performed in 334 normotensive non-proteinuric nulliparous women at 20 weeks’ gestation. Arterial blood pressure patterns were analyzed by chronobiometry. Results: Women who developed idiopathic IUGR (21) or PIH (33) showed a 24-h diastolic blood pressure mean significantly higher than the controls (69.2±1.8 mmHg and 73.5±6.2 vs. 62.2±1.5). Women with subsequent IUGR also showed a modification in BP rhythm. The most effective cut-off levels of 24-h diastolic blood pressure mean proved to be 67 for IUGR and 68 for hypertension. Conclusions: ABPM in the second trimester reliably predicts idiopathic IUGR and PIH. Both patients destined to develop gestational hypertension and those destined to develop IUGR show similar elevations in 24-h diastolic mean at 20 weeks’ gestation.

The predictive values of three clinical tests in prediction of gestational hypertension

The predictive values of three clinical tests in prediction of gestational hypertension

Evaluation of the roll over test as predictor of gestational hypertension in African women

Fifty-six primigravid women at 28–32 weeks gestation were studied prospectively to assess the roll over test (ROT) as a predictor of gestational hypertension in African women. Blood pressures were measured continuously in the supine and left lateral positions using an automated accutor machine. ROT was positive in only two women (3.6%). These two women later developed gestational hypertension but so did 18 others who had negative ROT. Measures that may be useful in increasing the predictive value of the ROT in these women are suggested.

Predictive value of increased plasma levels of fibronectin in gestational hypertension

Blood pressure, proteinuria, and plasma fibronectin and plasminogen activator inhibitor-1 levels were measured in 120 apparently healthy normotensive primigravid women during the first, second, and third trimesters of pregnancy and 2 days post partum. Thirty-two women developed hypertension (diastolic blood pressure ≥90 mm Hg) that in 17 women was associated with proteinuria (>0.3 gm/day). Fibronectin levels were 83% ± 22% of normal (mean ± SD) during the first trimester and 75% ± 20% at term in the healthy women but increased from 94% ± 36% to 187% ± 36% in the women who developed gestational hypertension (with or without proteinuria) ( p p 140%) were found in 31 of the 32 women with gestational hypertension with or without proteinuria and in 5 of the 88 healthy women (sensitivity 96%, specificity 94%). Fibronectin levels increased 3.6 ± 1.9 weeks earlier than the onset of hypertension and/or proteinuria. Increased levels of plasminogen activator inhibitor-1 at 25 to 32 weeks (≥280 ng/ml) were found in 16 of the 32 women who developed gestational hypertension with or without proteinuria and in 4 of the 88 healthy women (sensitivity 50%, specificity 95%). We conclude that increased fibronectin levels are the best predictor of gestational hypertension with or without proteinuria and that its level in plasma increases several weeks before the development of hypertension.