Pregnancy-induced Hypertension Group Research Articles

Validity of ductus arteriosus indices added to other ultrasound and Doppler parameters as markers of fetal lung maturity in pregnancy-induced hypertension

Abstract Aim of work To determine the relationship between the gestational age and the (PSV, RI and PI) of the ductus arteriosus and lung maturity and to determine the effect of pregnancy-induced hypertension on these parameters. Material and methods A prospective cohort study was carried out, in which 90 pregnant women at gestational age 34–40 weeks were selected, 50 as a control and 40 with pregnancy-induced hypertension (PIH). They underwent measurement of ductus arteriosus (DA) (PSV, RI and PI) and observing the percentage of the development of neonatal RDS in control and PIH cases. Results There was a direct correlation between the PSV, PI, RI of ductus arteriosus and development of neonatal RDS. A cutoff value for GA, PSV, RI and PI for prediction of the subsequent development of RDS was determined in control ((35.7, 89.9, 0.80, 2.14), with sensitivity (71.4, 100, 85.7, 85.7%) and specificity (93, 97.7, 97.7, 93%), respectively), and PIH (35.7, 91.1, 0.80, 2.14), with sensitivity (71.4, 100, 85.7, 100%) and specificity (71.7, 100, 85.7, 100%), respectively). Conclusions We concluded from our study that for the detection of fetal lung maturity in fetuses of GA from 34 to 40 weeks, it is better to combine GA, PSV, RI and PI of DA to detect lung maturity in control and PIH groups to get more accurate results.

Investigation of the effects of gestational diabetes and hypertension on retinal and choroidal microvascular circulation using swept-source optical coherence tomography angiography

PurposeThe aim of this study was to investigate the microvascular changes in the retina and choroid in gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) and to compare the results with those of healthy pregnant subjects. MethodsTwenty-nine pregnant subjects with coexisting GDM and PIH (group 1) and 36 healthy pregnant subjects (group 2) were enrolled in the study. All subjects were examined by optical coherence tomography (OCT) and angiography (OCTA). The retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), choroidal thickness (CT), superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) vascular density (VD), and foveal avascular zone (FAZ) were measured. ResultsWe observed that the values of CT and VD were lower in group 1 than in group 2. No significant difference was found between groups in RT, FAZ area and CC VD. SCP and DCP VD values were higher in group 2 in all quadrants. We observed a significant increase in FAZ area and CC VD with increasing systolic blood pressure. No correlation was observed between diastolic blood pressure and FBS with other parameters. In group 1, FAZ area was significantly higher in the diet-treated group than in the insulin-treated group. ConclusionMonitoring and treatment of pregnant women with PIH and GDM is important because of the risks that may occur during pregnancy. We believe that changes in microvascular circulation can be detected noninvasively with OCTA, even in the absence of clinical or retinal findings.

SERUM ACTIVIN A & INHIBIN A: POSSIBLE BIOCHEMICAL MARKERS OF PREECLAMPSIA & PREGNANCY INDUCED HYPERTENSION

Objective: The objective of this study was to compare the levels of Serum Activin A and Inhibin A in Pregnancy induced hypertension, Preeclampsia & Normal Pregnancy Material and Methods: An analytical, cross-sectional study conducted at Chemical Pathology Laboratory Collaborating with Gynae/Obstetric Department of Pakistan Railway Teaching Hospital, Rawalpindi over the period of one year (18 Sep 2019 to 18 March 2020). The study started after the approval of Ethical Review Committee, Riphah International University Islamabad. The sample size was calculated using WHO sample size calculator. Taking Prevalence of PIH and PE is 8%.3 Non probability convenient sampling technique was used. An overall 100 pregnant women with gestation of 20 – 25 weeks, were included. Patients of UTI, Carcinomas, Diabetes Mellitus and other chronic disorders were not included. The subjects were divided into three groups. Group I PIH: This group included 30 pregnant women of PIH; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions without proteinuria. Group II PE: This group included 20 pregnant women of preeclampsia; 20 - 25 weeks of gestation, BP: ≥140/90 mmHg on two separate occasions with proteinuria (>0.3 g protein/24 hours Urine). Group III Control Group: This group included 50 pregnant women with gestational age of 20 – 25 weeks without any complication as healthy controls. Results: It was determined that Serum Activin A and Serum Inhibin A levels were significantly increased in PIH and PE groups as compared to healthy group. Mean of Serum Activin A in PIH, PE and Control group was (251.53+200.23 pg/ml), (466.95 + 237.40 pg/ml) and (43.35 + 85.22 pg/ml) respectively. Similarly Mean and Standard Deviation of Serum Inhibin A levels in PIH, PE and Control group was (194.78 + 173.00 pg/ml), (349.20 + 190.30 pg/ml) and (17.27 + 44.33 pg/ml) respectively. One-way ANOVA and post-hoc Tukey analysis was conducted to compare the mean of Serum Activin A and Serum Inhibin A levels among three different groups i.e Group 1(PIH and PE), Group 2(PIH and Control) and Group 3 (PE and Control). p-value< 0.05 was considered as statistically significant. Conclusion: It can be concluded that Serum Activin A and Serum Inhibin A can be used as biochemical markers of PIH and PE. Estimation of Serum Activin A and Inhibin A at an early stage can detect PIH and PE early and further prevents their complications such as Eclampsia and HELLP syndrome. Keywords: Pregnancy induced hypertension (PIH), Pre-eclampsia (PE), HELLP syndrome (H – Hemolysis, EL- Elevated Liver Enzymes, LP – Low platelets count), Serum activin A, Serum inhibin A.

First-trimester serum antiphosphatidylserine antibodies serve as candidate biomarkers for predicting pregnancy-induced hypertension.

The aim of this study was to explore whether antiphosphatidylserine (aPS) antibodies play roles in the early prediction of pregnancy-induced hypertension (PIH). The serum levels of different isotypes of aPS antibodies were compared in women diagnosed with PIH (PIH group, n = 30) and 1 : 1 matched normotensive controls (control group, n = 30). All patients underwent frozen embryo transfer (FET) cycles, and all serum samples were collected during 11-13 weeks of gestation. Receiver operating characteristic (ROC) curves were drawn to analyze the predictive values of aPS antibodies for PIH. The women who developed PIH after FET had higher serum optical density values (450 nm) of aPS immunoglobulin (Ig) A (1.31 ± 0.43 vs. 1.02 ± 0.51, P = 0.022), aPS IgM (1.00 ± 0.34 vs. 0.87 ± 0.18, P = 0.046), and aPS IgG (0.50 ± 0.12 vs. 0.34 ± 0.07, P < 0.001) compared with the normotensive controls. The serum concentration of total IgG [48.29 ± 10.71 (g/dl) vs. 34.39 ± 11.62 (g/dl), P < 0.001] was also higher in the PIH group compared with that in the control group. The aPS IgG alone [area under the curve (AUC): 0.913, 95% confidence interval (CI): 0.842-0.985, P < 0.001] and the combined analysis of aPS IgA, aPS IgM, aPS IgG, and total IgG (AUC: 0.944, 95% CI: 0.888-1.000, P < 0.001) had high predictive values for PIH. Serum aPS autoantibody levels during the first trimester of pregnancy are positively associated with the development of PIH. Further validation is needed to clearly identify the distinct contributions and underlying mechanisms for diagnostic applications of aPS autoantibodies in PIH prediction.

Gut Microbiota Dysbiosis and Increased NLRP3 Levels in Patients with Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is one of the most common diseases, causing high maternal morbidity and mortality. However, the correlation of gut microbiota in PIH has not been reported. Our aim was to characterize the intestinal microbiota of patients with PIH compared with healthy people. We analyzed and compared the gut microbiota communities in the feces of 28 PIH patients with pregnancy(not pre-pregnancy) body mass index (including height and weight)-matched healthy controls using 16S rRNA gene sequencing and then investigate the relationships among gut microbiota, cytokines, and PIH. Compared with the healthy group, microbial α diversity was lower in the PIH group, but not statistically significant different. At the phylum level, Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria exhibited obvious differences between the PIH and control groups. LEfSe analysis found 33 differentially abundant taxa between the two groups. The production of pro-inflammatory cytokines in PIH serum or placenta tissues was higher than that of the control group. In addition to alterations in gut microbiota composition, we also found that the Bac_Prevotellaceae, Pre_Prevotella bacteria were positively correlated with NLRP3 level, but negatively correlated with Bac_Bacteroidaceae, Bac_Bacteroides. PIH patients had gut microbiota dysbiosis and increased NLRP3 levels, which will lead to a better understanding of the relationship between the gut microbiota and PIH.

Impact of Pregnancy Induced Hypertension on Babies

Background: Pregnancy-induced hypertension (PIH) is a relatively common pregnancy disorder that causes variable maternal and fetal problems. This may increase the number of perinatal asphyxia, sepsis, still birth etc. It also has a significant affect on birth weight which is also related to gestational age. Objectives: To observe the impact of pregnancy induced hypertension on their newborn babies and compare the findings with the babies of normotensive mother. Materias and Methods: This case control study was conducted from July 2016 to December 2016. The study group was selected from the babies of pregnancy induced hypertension (PIH) mothers and control group selected from babies of a normotensive mother attending in Obstetrics department of Dhaka Medical College Hospital, Dhaka having the inclusion and exclusion criteria. The total number of 100 neonates were included consecutively in this study. 50 neonates born to mothers with pregnancy-induced hypertension were grouped as cases and 50 neonates born to normotensive mothers were grouped as control. Results: The study revealed that, the highest frequency of neonatal morbidities were perinatal asphyxia (22%) among the babies of PIH mother. Stillbirth it was found 12 % . The duration of pregnancy were also affected by PIH where most of the babies were preterm (88%) and complete-term pregnancy found only (12%). It should be mentioned that those mother having history of preeclampsia delivered more premature babies (p &lt;0.001). Another important outcome birth weight related to gestational age was also very important which were measured as the highest for SGA 92% and AGA 8%. The weight of the baby were significantly (p&lt;0.001) reduced in those who had a history of PIH and the mean weight was 1592.78 ± 470.06. Conclusion: Prematurity, Small for gestational-age babies and perinatal asphyxia are more common in Pregnancy induced hypertension group than in the normotensive group.&#x0D; KYAMC Journal Vol. 13, No. 04, January 2023: 204-207

Interrelation among one-carbon metabolic (OCM) pathway-related indicators and its impact on the occurence of pregnancy-induced hypertension disease in pregnant women supplemented with folate and vitamin B12: Real-world data analysis.

A considerable number of pregnant women who were supplemented with folate and vitamin B12 were selected as major participants in studying the one-carbon metabolic (OCM) pathway. Our study aimed to explore the effects of OCM-related indicators on pregnancy-induced hypertension (PIH) and preeclampsia (PE) in pregnant women with folate and vitamin B12 supplementation. A total of 1,178 pregnant women who took multivitamin tablets containing 800 μg folate and 4 μg vitamin B12 daily from 3 months before pregnancy to 3 months after pregnancy were enrolled in this study. These pregnant women were classified into three groups: the normotensive group (n = 1,006), the PIH group (n = 131), and the PE group (n = 41). The information on age, weight, body mass index (BMI), number of embryos, gravidity, parity, and OCM-related indicators (serum level of homocysteine, folate, and vitamin B12; MTHFR C677T genotype) was collected. The accuracy of the prediction model based on the screened independent risk factors (hyperhomocysteine, OR = 1.170, 95% CI = 1.061-1.291; high folate status, OR = 1.018, 95% CI = 0.999-1.038; and high BMI, OR = 1.216, 95% CI = 1.140-1.297) for PIH in subjects with MTHFR CC genotype (AUC = 0.802) was obviously higher than that in subjects with MTHFR CT, TT genotype (AUC = 0.684,0.685, respectively) by receiver operating characteristic curve analysis. The homocysteine level of the PIH group was significantly higher than that of the normotensive group only in subjects with the MTHFR CC genotype (p = 0.005). A negative correlation between homocysteine and folate appeared in subjects with MTHFR CT + TT genotype (p = 0.005). A model including multiple embryos, nulliparas, and lower folate could predict the process from PIH to PE (AUC = 0.781, p < 0.0001). The prediction model composed of homocysteine, folate, and BMI for PIH was suitable for subjects with MTHFR CC genotype in pregnant women with supplementation of folate and vitamin B12. Lower folate levels could be an independent risk factor in developing the process from PIH to PE.

Association between dietary patterns and pregnancy induced hypertension: a case control study from Sudan.

Dietary patterns and its associated factors and can play an essential role in development of preeclampsia and implication in pregnancy-induced hypertension (PIH). This study was performed to determine nutritional factors associated with PIH among pregnant women in Khartoum, Sudan. This study was a case-control involving 100 women with PIH and 200 normotensive pregnant women. The mean current weight in the control and PIH groups was 70.25 ± 12.35 and 72.42 ± 12.33 kg; whereas the mean energy intake in the control and PIH groups was 1991.58 ±140.72 and 2154.37 ± 130.85 kcal, respectively. The study results indicated a significantly lower risk of PIH among women ingesting fruits and legumes (odds ratio, 8.44 and 4.07, respectively; 95% confidence interval; P < 0.05). PIH was positively associated with higher energy, fat, and protein intake. A lower risk of PIH was calculated for women whose dietary habits included fruits and legumes. Measures with which to ensure proper nutrition education are needed to obtain good health and pregnancy outcomes. PIH is a multifactorial disease with an unclear etiology, and the findings of this study will serve as a baseline for future studies in this field.

Comparative evaluation of placental elasticity in normal pregnancy and pregnancy-induced hypertension and its association with uterine artery pulsatility index and fetal outcome

Background: Pregnancy-induced hypertension (PIH) is associated with significant maternal as well as fetal morbidity and untreated cases may be associated with poor pregnancy outcomes. It brings about various histological and morphological changes in the placenta such as infarcts, fibrosis, and calcification thereby affecting the well-being of fetus. Detection of it at an early stage is important from the point of view of management as early intervention is associated with improved maternal and fetal outcome. Shear wave elastography (SWE) of placenta is a non-invasive investigation that can detect changes in placental elasticity during the pregnancy. Aims and Objectives: The aim of the study was to assess and compare the difference in values of placental elasticity in normal pregnancy and in clinically diagnosed cases of PIH and to study its association with uterine artery-pulsatility index (UtA-PI) and fetal outcome. Materials and Methods: This was a prospective and observational study in which pregnant females with gestational age of 20–34 weeks who were referred to radiology department for routine sonography including the clinically diagnosed pregnancies with PIH were included on the basis of a predefined inclusion and exclusion criteria. A total of 106 individuals were included in the study, B-mode sonography, uterine artery Doppler, and placental SWE were performed in all these patients. All these pregnancies were followed up for the fetal outcome. Results: The mean gestational age of the studied cases was found to be 26.51±4.415 weeks. Higher SWE values were found, as compared to the normal pregnancies, in pregnancies complicated by PIH and the difference was found to be statistically highly significant (P&lt;0.001). Placental SWE showed a strong association with UtA-PI and fetal outcome. Incidence of adverse fetal outcome such as preterm deliveries, intrauterine death, stillbirths, and small for gestational age babies was more commonly seen in PIH group and the difference was statistically significant (P&lt;0.005). Incidence of birth asphyxia (as determined by low APGAR score) and neonatal intensive care unit admissions was more in neonates born to patients with PIH as compared to those in healthy women and the difference was statistically significant (P&lt;0.005). Conclusion: SWE has the potency to detect the changes in placental morphology and can help with diagnosis of pregnancies complicated with PIH. It does have a synergistic role to play alongside the uterine artery Doppler and clinical parameters to predict the pregnancies with PIH.

Platelet function in newborns and the women affected by pregnancy-induced hypertension

Background Platelet dysfunction is one of the serious and common complications associated with pregnancy-induced hypertension (PIH). Nevertheless, the role of platelet dysfunction in the newborns of PIH mothers is unclear. This study aimed to study platelet problems in infants and women affected by PIH. Methods A prospective cohort study was conducted on singleton pregnancies who delivered at a gestation age of 32 weeks or more. The women were divided into the PIH group and the normal control group. The blood tests for maternal and neonatal platelet evaluation such as platelet concentration, mean platelet volume (MPV), and clotting time were performed for comparisons between both groups. Results A total of 106 cases were recruited for the study (55 cases in the PIH group and 51 cases in the control group). Hematologic studies showed a significant increase in the incidence of thrombocytopenia and platelet dysfunction (increased MPV) in women affected with PIH when compared with those in the control group (p = .028 and p = .001). However, the platelet study in newborns was not significantly different between both groups (p = .680 and p = .265). Conclusions This study supports the theory that endothelial cell damage and platelet aggregation as indicated by thrombocytopenia together with increased MPV levels in maternal affected with PIH. Importantly, this study provides new insight into that these problems in mothers with PIH do not occur in their neonatal vessels, as indicated by normal platelet counts and MPV levels.

Analysis of the characteristics of blood lipid metabolism in twin pregnancy

To investigate the characteristics of blood lipid metabolism in twin pregnancy combined with gestational diabetes mellitus (GDM) or pregnancy-induced hypertension (PIH). This study retrospectively analyzed 96 cases of twin pregnancy...

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

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

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.

Increased Cardiac Arrhythmia After Pregnancy-Induced Hypertension: A South Korean Nationwide Database Study.

BackgroundAlthough pregnancy‐induced hypertension (PIH) is associated with an elevated cardiovascular risk, long‐term studies or prepregnancy baseline data are scarce. Therefore, using a large nationwide cohort with prepregnancy periodic health screening data, we investigated whether clinically significant arrhythmia incidence increases after PIH.Methods and ResultsData were extracted from the Korea National Health Insurance database and combined with the National Health Screening Examination database; women who gave birth between 2007 and 2015 and underwent the national health screening test within a year before pregnancy were followed up until 2016. We excluded women who had a diagnosis of arrhythmia within 1 year before pregnancy. The primary outcome was significant arrhythmia during the year after delivery. Secondary analysis included only specific diagnostic codes of arrhythmia with clinical significance. Additionally, the risk of arrhythmia was stratified by the use of magnesium sulfate. Of 2 035 684 women (PIH; n=37 297 versus normotensive pregnancy; n=1 998 387), the PIH group had a higher prepregnancy risk profile and showed a higher incidence of arrhythmia than women with normotensive pregnancies within 1 year. Women with PIH had a significantly higher risk of atrial flutter/fibrillation and atrioventricular block, but not lethal arrhythmias. Other predictors of arrhythmia development included advanced maternal age and cesarean section. Stratified analysis showed a higher risk of arrhythmia with magnesium sulfate use.ConclusionsPIH was significantly associated with the development of arrhythmia within 1 year after delivery. Nevertheless, the incidence of lethal arrhythmias was not increased by PIH. Arrhythmia, especially atrial fibrillation, may largely contribute to increasing the future cardiovascular risk in women with a PIH history.

A Cross-Sectional Study Investigating the Association of Serum Iron Concentration and Platelet Count as a Risk Biomarker among the Pregnancy-Induced Hypertensive Women in the Highlands Western Ghats of Nilgiris.

Background:The elevated serum iron levels and reduced platelet count at 20–24th week of gestation period cause oxidative stress that leads to the pregnancy-induced hypertension (PIH).Objectives:The objective is to determine the prevalence of serum iron concentration, decrease in platelet count, and its association with PIH.Methods:A cross-sectional study was conducted in the secondary care hospital of Udhagamandalam. A total of 150 study participants were enrolled. Descriptive analysis was performed for demographic characteristics. The Pearson Chi-square test was performed for categorical variables. To measure the strength of the association between the two variables, Pearson's correlation test and logistic regression analysis were performed.Results:The mean serum iron levels in both the groups were 99.01 ± 12.86 ug/dL and 82.76 ± 18.95 ug/dL, respectively, at a P value of 0.005. The platelet count (96.34 ± 9.77 vs. 116.68 ± 23.55) was significantly lower in PIH group. A moderate and weak correlation was seen between serum iron levels and systolic blood pressure (SBP) (r = 0.435; P = 0.01) and diastolic blood pressure (DBP) (r = 0.435; P = 0.01). Moderate negative correlation was observed between SBP, DBP, and platelet count. The risk of developing PIH is 6.76 times due to increased serum iron levels and 3.67 due to decreased platelet count.Conclusion:The serum iron levels were elevated, and the platelet indices were reduced in the PIH group. This should be considered a possible risk biomarker for PIH.

Comparisons of urine protein-to-creatinine ratios and their dynamic change patterns during labor at term between normal pregnant women and women with pregnancy induced hypertension.

Introduction: To evaluate patterns of change in the urine protein-to-creatinine ratios (uPCRs) during labor at term between normal and women with pregnancy-induced hypertension (PIH).Methods: This is an observational study in tertiary referral hospital, recruiting 269 women at term delivery in Taiwan from April 19, 2019 to April 18, 2021. uPCRs in four phases (latent, active, recovery and early postpartum) and related clinical data at delivery were collected. Multivariate analyses with a linear regression model were performed to analyze continuous variables after adjusting for clinical data between two groups.Results: Based on exclusion criteria, 68 normal and 24 pregnant women with PIH were included. There were no differences in the uPCR or the proportion cases of uPCRs ≥ 300 mg/g between normal and PIH group in the four phases. There was a statistically significant tendency for the proportion of uPCRs ≥ 300 mg/g to increase from the latent to the early postpartum phase in both groups. The proportion of uPCRs ≥ 300 mg/g significantly increased from the active to the recovery phase and then declined from the recovery to the early postpartum phase in the normal group. Thus no differences in uPCRs cases change between any two phases in women with PIH, except the duration above stated.Conclusion: This is the first study to demonstrate that uPCRs data are not different between normal pregnant and PIH groups during the course of labor, but it did show different dynamic change patterns throughout the labor phases.

Umbilical Artery Flow Velocity in Pregnancy Induced Hypertension at Third Trimester

Background: Doppler ultrasound of umbilical vessels is a technique for evaluating fetoplacental blood flow which is very important in high risk pregnancies like hypertensive pregnancies and can predict both fetal and maternal morbidity and mortality. Since the traditional methods are not good enough to assess uteroplacental and fetoplacental circulation, blood flow studies are used to assess fetal well-being in normal and hypertensive pregnancies. Aim: To measure the blood flow indices of umbilical artery using Doppler ultrasound in patients with pregnancy induced hypertension (PIH) and healthy pregnant women. Methods: This is a case control study at which 60 participants, 40 with PIH and 20 with normal pregnancy at the third trimester were studied in Al Najaf Governorate. Doppler ultrasound of umbilical artery was performed for both, the patient and the control groups in which Resistive Index (RI), Pulsatility Index (PI) and Systolic to Diastolic ratio (S/D ratio) were calculated. Results: The mean ±SD of RI, PI and S/D of the umbilical artery were 0.63±0.11, 0.97± 0.33 and 2.9±1.38 respectively in the PIH group, they were higher than those of the control group (0.62±0.06, 0.91± 0.17 and 2.72 ± 0.41 respectively) at 33-36 weeks. However, differences were found to be insignificant as well as they were higher at 37-40 weeks. Conclusion: There are insignificant elevations of indices of the umbilical artery in PIH women with respect to those of normal pregnancy.

PLACENTAL DIAMETER AND THICKNESS AND NUMBER OF COTYLEDONS IN MILD AND SEVERE PREGNANCY INDUCED HYPERTENSIVE WOMEN VERSUS NORMOTENSIVE WOMEN OF DISTRICT D.I.KHAN, PAKISTAN

Background: Pregnancy induced hypertension (PIH) adversely affects the development of placenta and growth of fetus. The objectives of this study were to compare the placental diameter, placental thickness and number of cotyledons in mild PIH and severe PIH women versus normotensive women of District D.I.Khan, Pakistan.Material Methods: This comparative cross-sectional study was conducted in Department of Anatomy, Gomal Medical College, D.I.Khan, Pakistan from January to October 2014. Three samples were selected; each of size 50, group 1 normotensive/ control, group 2 with mild PIH and group 3 with severe PIH. Three research variables; placental diameter (cm), thickness (mm) and number of cotyledons were measured on ratio scale for three groups. Descriptive analysis included mean± SD with 95% confidence intervals for each group separately. With three groups on ratio data, one way-ANOVA test was applied to see significance of difference between three groups. Post hoc Dunnett’s t test was applied at alpha 0.05 to see difference of mild PIH group 2 to normotensive/ control group 1 and of severe PIH group 3 to normotensive/ control group 1separately.Results: Mean placental diameter was 18.28±2.15, 16.57±1.94 and 16.18±1.75 cm and mean placental thickness was 19.33 ±3.70, 19.18±2.78 and 17.60±3.52 mm in group 1, 2 and 3 respectively. Mean number of cotyledons was 14.42±2.25, 14.08±2.30 and 13.16±2.15 in group 1, 2, and 3 respectively. Placental diameter was statistically significantly lower in group 2 (p=.00001) and 3 (p=.00001) than group 1. Placental thickness in group 2 (p=.957) was similar to group 1, while in group 3 (p=.019) it was lower than group 1. Number of cotyledons in group 2 (p=.666) was similar to group 1, while in group 3 (p=.011) it was lower than group 1.Conclusion: In mild pregnancy induced hypertension (PIH), placental diameter was lower than normotensives, while placental thickness and number of cotyledons were similar to normotensives. In severe PIH, placental diameter, placental thickness and number of cotyledons were all lower than normotensives. It is concluded that in mild PIH, the development of placenta is mildly affected, while in severe PIH, the development of placenta is severely affected.

Copeptin in Patients with Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH) occurs in 6–8% of pregnancies, and increases the risk of many severe obstetric complications. The etiology of PIH has not been fully explained, and hence, treatment is only palliative in nature, and prevention is not fully effective. It has been proposed that PIH development is influenced by the arginine vasopressin pathway, whose surrogate biomarker is copeptin. The aim of this study is a prospective assessment of the relationship between the level of copeptin in pregnant women and the occurrence of PIH, and to identify its usefulness in predicting complications. The study involved a group of 21 pregnant women who developed PIH and 37 women with uncomplicated pregnancies as a control group. Blood samples were collected at the three trimesters of gestation (<13 HBD, between 13 and 26 and >26 HBD) and then frozen. Copeptin levels [pg/mL] were measured in serum samples obtained in the first, second and third trimesters of gestation from women in the PIH and control groups. The concentration of copeptin in the second and third trimesters of pregnancy was statistically significantly higher in the PIH group (p < 0.05). For copeptin determined in the first trimester, which could be used to screen for PIH, the area under the ROC curve was 0.650. The highest risk of PIH occurred in patients with high concentrations of copeptin in the first trimester of pregnancy and obesity OR = 5.5 (95% CI 1.0–31.3). The risk of PIH was augmented in patients with high levels of copeptin and an abnormal Doppler result of the uterine arteries OR = 28.4 (95% CI 5.3–152). In conclusion, copeptin levels were found to be elevated in pregnant women before the diagnosis of PIH; however, copeptin should not be used as a stand-alone marker. The combination of copeptin concentration with the other risk factors (diabetes, maternal age and preeclampsia in previous pregnancy) did not improve the diagnostic values of the use of copeptin in the PIH risk assessment, but the combination of copeptin concentration with BMI may be useful in clinical practice. Measurement of copeptin together with a Doppler examination of uterine arteries in the first trimester of pregnancy may be a useful marker in predicting the development of PIH.

The cerebroplacental ratio: association with maternal hypertension and proteinuria

ObjectiveTo evaluate the resistive indices (RIs) of the fetal umbilical and middle cerebral arteries, as well as to determine the cerebroplacental ratio (CPR), in fetuses of women with hypertension.Materials and MethodsThis was a comparative cross-sectional study involving 75 pregnant women with pregnancy-induced hypertension (PIH) and 75 apparently healthy pregnant women (control group), all of whom were submitted to Doppler ultrasound examination of the fetal middle cerebral and umbilical arteries between 20 and 40 weeks of gestation. The two groups were compared in terms of the RI of the middle cerebral and umbilical arteries, as well as the CPR. The level of statistical significance was set at p ≤ 0.05.ResultsThe mean age was 32.4 ± 4.6 years in the PIH group and 32.6 ± 4.6 years in the control group (p = 0.633). The mean umbilical artery RI was significantly higher in the PIH group than in the control group (0.67 ± 0.14 vs. 0.61 ± 0.08; p = 0.012), whereas the mean middle cerebral artery RI was significantly higher in the control group (0.80 ± 0.05 vs. 0.76 ± 0.08; p = 0.001). Among the women in the PIH group, the mean CPR was significantly lower for those with proteinuria than for those without (1.07 ± 0.26 vs. 1.27 ± 0.22; p = 0.001).ConclusionMaternal hypertension during pregnancy appears to be associated with increased fetal umbilical artery RI and reduced fetal middle cerebral artery RI, as well as with a low CPR. In pregnant women, the combination of PIH and proteinuria is also apparently associated with an increased risk of a low CPR.