Pregnancy Induced Hypertension Mothers Research Articles

Association between dietary calcium and pregnancy induced hypertension

Background: Pregnancy induced hypertension (PIH) is one of the major complications of pregnancy. Inadequate calcium (Ca) intake is considered a public health problem in some vulnerable groups, especially pregnant women. A balanced diet during pregnancy with adequate Ca should be the ideal solution, and to proceed in this direction, evidence is required on the nature and extent of Ca deficiency in the diet of PIH mothers. Objectives: To assess the dietary intake of Ca in PIH (compared to non-PIH) mothers and to explore the factors affecting the intake of those nutrients. Methods: Under an observational case-control design, we recruited 300 Bangladeshi pregnant women in two groups (150 with and 150 without PIH), aged between 20-40 years (from 3 hospitals in Dhaka) at the 3rd trimester of pregnancy. A pre-tested questionnaire was used to collect the data. The first part of the questionnaire was allocated to general socio-demographic and clinical characteristics. Secondly, a food frequency questionnaire was used to estimate individual dietary Ca intake. Results: The dietary Calcium intake [(mg/day), median (range)] was significantly lower [265(111-487)] (p<0.001) in the PIH compared to the non-PIH [350(201-984) ;(p<0.001)] group. On bivariate analysis, the dietary Calcium intakes had a significantly negative correlation with mean blood pressure which was considered an indicator of the severity of PIH (r=-0.276; p<0.001) for Ca. On regression analysis, PIH was found to be significantly associated with a lower intake of Ca (b=-0.009; p<0.001) when the effects of age, family history of HTN and family income were adjusted. Conclusion: Dietary consumption of Calcium during pregnancy is much lower than those recommended in our population, PIH seems to have an association with dietary deficiency of Calcium in pregnant women. Bioresearch Commu. 10(2): 1612-1618, 2024 (July)

Outcome of neonates born to mothers with pregnancy induced hypertension/preeclampsia: a systematic review

Preeclampsia affects 3-10% of pregnancies worldwide. It has significant adverse effect on both the fetus and the neonate. Hence there is a need to study the impact of pregnancy induced hypertension (PIH) on the fetus and the neonate. Databases like PubMed and Cochrane are searched independently by two authors to identify relevant studies. Data were collected for outcomes like birth weight, gestational age, fetal death/stillbirth and intrauterine growth retardation (IUGR). Preeclampsia is associated with significant increase in the incidence of low birth weight (LBW), IUGR and prematurity compared to normotensive women. Also, there is an increased rate of fetal death/ stillbirths in preeclampsia. In addition, there is an increased need for neonatal intensive care unit (NICU) admission in neonates born to PIH mothers. Maternal preeclampsia results in significant adverse effect on the fetus and neonate. There is an increased incidence of stillbirth, LBW, IUGR and preterm deliveries in neonates born to preeclamptic mothers. There is an overall increase in the composite outcomes of neonates of PIH mothers. The objective of the study is to compare the neonatal outcomes of preeclamptic or women with gestational hypertension with that of normotensive women.

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.

Placental morphological features of small for gestational age preterm neonates born to mothers with pregnancy-induced hypertension.

Small for gestational age (SGA) neonates are often born to mothers with pregnancy-induced hypertension (PIH). Here, we aimed to explore the morphometric characteristics of the placenta during the perinatal period associated with SGA risk in mothers with PIH and identify the risk factors related to SGA. The medical records of 134 neonates born between 28- and 32-weeks' gestation to PIH mothers were retrospectively analyzed. Placental morphology and umbilical cord (UC) length were compared between the SGA and appropriate for gestational age (AGA) groups. The placenta of the SGA group had a shorter major (15.00 vs. 18.00 cm; z = -6.04, p < 0.01) and minor placenta axes (13.00 vs. 15.00 cm; z = -4.59, p < 0.01), lower weight (300.00 vs. 420.00 g; z = -7.21, p < 0.01), smaller volume (282.00 vs. 396.00 cm3; z = -5.00, p < 0.01), and smaller area (141.00 vs. 212.00 cm2; z = -5.96, p < 0.01) than the AGA group. The UC was significantly shorter (39.00 vs. 44.00 cm; z = -3.68, p < 0.01). Short placental major axis [p = 0.03; odds ratio (OR): 2.16; 95% confidence interval (CI): 1.84 - 2.63] and low placental weight (p < 0.01; OR: 2.68; 95% CI: 2.66 - 2.70) were independent risk factors for SGA in premature newborns of PIH mothers. A major axis shorter than 15.5 cm or placental weight lower than 347.50 g at birth was related to a greater risk of SGA infants born to PIH mothers. As a predictor in prenatal ultrasound, the major axis is more helpful for precise prenatal pre-evaluation of vulnerable SGA preterm neonates with PIH mothers.

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.

A Study to Assess the Prevalence of Levels of Stress Among Pregnancy Induced Hypertension Mothers Attending OBG OPD at Selected Hospitals of Bagalkot, Karnataka

Background of the study: PIH and its management are critical and should be essential part of nursing concern for continuous improvement and enhanced fetal outcomes. Pregnancy induced hypertension (PIH) is one of the leading cause of maternal and fetal morbidity and mortality. stress is considered as one of the etiological factor in PIH. Preeclampsia might be the result of inadequate maternal care and this may advance to eclampsia if proper care is not taken, resulting in various maternal complications. Endothelial dysfunction is considered as one of the etiological factor for the development of preeclampsia. PIH can be referred to a type of increased blood pressure of greater or equal 140mmHg that is associated with excess protein in urine or may not have elevated amount of protein in urine (that is more than or equal to 300mg over a 24 hour period) which begins at twenty weeks of conception, however it can clear up in 12 weeks postnatal,It also refers to a new onset of excessive protein in urine for the first 24 hour period in women who are hypertensive and who do not have excess protein in urine before 20 weeks of gestation MATERIAL AND METHODS: The research approach adopted for this study was quantitative research approach and the design used was descriptive research design. The convenience sampling technique was used to select 100 subjects. The tool used for data collection was Cohen’s perceived stress scale. Paper pencil technique was used for data collection and data obtained were analyzed using both descriptive and inferential statistics. Results: result indicates that majority 70% of respondent had high level of stress, 25% of respondent had moderate level of stress and 5% of respondent had mild level of stress. The overall mean level of stress score was found to be 28.74% with SD as 3.31 %. Chi-square test was calculated to assess the association between socio demographic variables and levels of stress among infertile women. There is no significant association found between levels of stress among infertile women with their socio demographic variables such as Age in years , Types of family, Religion, Duration of marriage in year, Educational Qualification, Occupation, Monthly income of family, Family support, Source of information regarding health, weeks of gestation, PIH in previous pregnancy Conclusion: Thousands of women and babies die or get very sick from a dangerous condition called pregnancy induced hypertension. The present study was conducted to assess the stress regarding PIH, Study concluded that Most of mother having high level of stress and moderate level of stress. Keywords: PIH (pregnancy induced hypertension) mothers, Stress levels, Cohen’s perceived stress scale, Socio demographic variables.

Correlation of Severity of Maternal Hypertension and Birth Weight of Neonates- A Longitudinal Study

Introduction: Pregnancy Induced Hypertension (PIH) can lead to intrauterine growth restriction resulting in Low Birth Weight (LBW) neonates. LBW remains a significant cause of under-five mortality in India and Asia. Aim: To calculate the prevalence of PIH and to study the correlation between Birth Weight (BW) of neonates and severity of maternal hypertension; and compare the incidence of neonatal morbidities across varying severity of maternal hypertension. Materials and Methods: A longitudinal study was conducted among 153 pregnant mothers, diagnosed with PIH. They were classified into mild {Systolic Blood Pressure (SBP) ≥140- 149 mmHg or Diastolic Blood Pressure (DBP) ≥90-99 mmHg}, moderate (SBP ≥150-159 mmHg or DBP ≥100-109 mmHg) and severe (SBP ≥160 mmHg or DBP ≥110 mmHg) hypertension. A total of 142 neonates, born to PIH mothers, were included. The neonates were followed-up for seven days to check for early neonatal outcomes and deaths. Correlation between maternal blood pressure (systolic and diastolic) and BW of the neonates was assessed using Pearson’s correlation coefficient (r). Binary Logistic Regression (BLR) was performed to analyse the impact of confounders on BW. Results: The prevalence of PIH was 7.76% (153/1972). The mean BW of neonates born to mothers with moderate (2.435 kg) and severe hypertension (2.342 kg) was significantly lower than that of neonates born to mothers with mild hypertension (2.828 kg) (p&lt;0.00001). 1SD increase in SBP resulted in 0.245 kg decrease in BW, while an 1SD increase in DBP resulted in 0.312 kg decrease in BW. After accounting for confounders using BLR, maternal DBP still had a significant negative correlation with BW (r=-0.663; p&lt;0.001). The incidence of prematurity (p&lt;0.0001), small for Gestational Age (GA) (p=0.0283), Respiratory Distress (RD) (p=0.002), Neonatal Hyperbilirubinemia (NNH) (p=0.033) and Neonatal Intensive Care Unit (NICU) admissions (p=0.003) were significantly higher among neonates born to mothers with moderate and severe hypertension than those born to mothers with mild hypertension. Three neonatal deaths (all due to perinatal asphyxia) were observed in this study and there was no statistical significance with respect to deaths across neonates of the three groups (p=0.219). Conclusion: Maternal DBP had a significant negative correlation with BW. The mean BW of neonates born to mothers with severe hypertension was significantly lower compared to those born to mild hypertension.

The influence of pregnancy-induced hypertension syndrome on the metabolism of newborns.

BackgroundPregnancy-induced hypertension (PIH) is associated with an increased number of neonatal complications, but its impact on neonatal metabolism remains unclear. This study aimed to investigate the differential metabolomics of infants born to mothers with and without PIH.MethodsBlood samples of a total of 115 infants born to mothers with (n=56) and without (n=59) PIH were collected and assigned to two groups, respectively, from the neonatal department of Sixth Affiliated Hospital of Sun Yat-Sen University. A tandem mass spectrometer was used to generate metabolic profiling of amino acid, free carnitine, and acyl-carnitines. The resulting data were analyzed using orthogonal partial least squares discriminant analysis based on the difference between infants born to mothers with or without PIH.ResultsA significant relationship was observed between the two groups (with and without PIH) in the metabolic fingerprint. According to the pattern recognition analysis combined with variance importance, 25 metabolites with high importance were found. The top ten substances were selected for analysis. Compared with infants born to mothers without PIH, glycine levels increased, and C14DC, C22, C4DC, C5:1, C6DC, C5-OH, proline, C14-OH, and C20 decreased in infants born to mothers with PIH.ConclusionsUsing liquid chromatography (LC)-MS/MS metabolomics, a significant relationship was detected between neonatal metabolism and maternal hypertension. It is important to correct the subsequent infantile metabolic disorder by balancing the biomarker metabolites and suppling adequate nutrition to improve the health and growth of newborns of PIH mothers.

Gross Changes of Placenta in Pregnancy Induced Hypertension and its Clinical Relevance: A Cross-sectional Study

Introduction: Placenta establishes connection between mother and foetus through umbilical cord. Pregnancy Induced Hypertension (PIH) is one of the most common complication of pregnancy. Gross study of placenta in PIH gives an insight into prenatal health of baby and mother, thereby preventing maternal as well as foetal morbidity and mortality. Aim: To study the gross changes of placenta in PIH cases with its clinical relevance. Materials and Methods: A prospective cross-sectional study was done at tertiary care hospital of Osmania and Gandhi Medical College, Telangana, India. The study was carried over for a period of six months (from October 2019 to March 2020) with a sample size of 50 placentae in PIH mothers aged between 20-35 years who were inpatients at the Obstetrics Department. They were followed until delivery. Postdelivery, the gross anatomy of the collected placentas was studied. Varied parameters of placenta, data of newborn and clinical picture of mother were compared with normal standards and statistically analysed by using Unpaired t-test. Results: Significant reduction of mean placental weight and mean foetal weight (p-value&lt;0.0001) and significant increase in foetoplacental weight ratio was found. There was an average reduction of number of cotyledons by 23% in PIH cases when compared to normal placentae. An incidence of mean infarct areas of 9.6 and mean calcified areas of 13 were found on the maternal surface of placenta in PIH. An incidence of 68% of marginal type of placenta was observed in patients with PIH. Clinically, incidence of headache, pedal oedema, convulsions, visual disturbances and proteinuria were found. Conclusion: Gross study of placenta in PIH reflects maternal and foetal status and can be taken as confirmative evidence by radiologists to prevent Intra Uterine Growth Retardation (IUGR) and guide obstetricians during management of pregnant mother with PIH. Thereby, preventing the maternal and foetal morbidity and mortality.

Detection of Serum Vascular Endothelial Growth Factors (VEGF) And Soluble Vascular Endothelial Growth Factors (sVEGF / sflt-1) of Pregnancy Induced Hypertension Mothers (PIH) With pathological changes of Placenta In a Tertiary Care Hospital of West Bengal.

Introduction:Pregnancy Induced Hypertension (PIH) results from imbalance between pro-angiogenic factors (VEGF &amp; PIGF) and antiangiogenic factors (sVEGFR-1/sflt- 1)Subjects and methodology: A mixed random study comprising of random cases of different gestational ages 28-36 wks of PIH mothers along with control cases till completion of pregnancy after delivery. Age of enrolled mothers and their gestational age, blood pressure, serum free VEGF and sVEGFR-1(sflt1) were compared in both groups (control n=36, PIH n=36). Blood pressure of both control and PIH mothers just before and after delivery showed significant correlation (p&lt;0.0001). Serum levels of free VEGF were lower among PIH mothers at 28-36 wks (p &lt;0.0001) and just before delivery (JBD) (p &lt;0.0001) than normal control antenatal mothers and more or less similar in both groups at just after delivery (p &lt;0.390). Serum sflt1 level (6459.81 ±1811.07 pg/ml) of PIH mothers showed higher value than control mothers (1062.19 ± 165.98 pg/ml) at the time of presentation and also just before delivery(JBD) &amp; after delivery(JAD) and was highly significant ( p &lt; 0.0001). Serum free VEGF level of PIH mothers was negatively correlated with systolic r= - 0.247, p = 0.147) and diastolic (r =-0.220, p =0.197) blood pressure. The increased serum sflt1 level of PIH mothers was positively correlated with systolic (r = 0.299, p = 0.07) and diastolic (r = 0.309, p = 0.067) blood pressure. Semi quantitative expression of VEGF R1 and PCNA LI of placenta showed increased (3+) expression of VEGF R1 of 13 (43.33%) and &gt; 50% PCNA LI expression of 12 (40%) cases than control.Discussion &amp;Conclusion:The elevated levels of systolic and diastolic blood pressure along with alteration of proangiogenic and angiogenic growth factors among PIH mothers than normotensive control may help to identify PIH mothers as early as possible and referring them to higher/tertiary centers for better management and prevention of its grave complications of PIH.International Journal of Human and Health Sciences Vol. 02 No. 01 Jan’18. Page : 25-30

Placental Weight and Fetal Outcome in Pregnancy Induced Hypertension

Placenta is a vital organ for maintaining normal pregnancy and promote normal foetal development. Being an organ of vital importance for continuation of pregnancy and foetal nutrition, it has evoked great interest among pathologist, anatomist and obstetrist to study this organ in various pregnancy induced abnormalities. Placenta reflects maternal and foetal status. So the complete examination of placenta reflects about causes of change in placenta and causes of maternal and foetal morbidity and mortality. Toxemia of pregnancy / pregnancy induced hypertension(PIH) is one of the leading cause of death among mothers and foetuses. Various studies on placenta have shown that placental weight is directly related to foetal weight. Placenta in PIH mothers is irregular, small in size with marginal attachment of umbilical cord. So the present study shall be done to record data on morphology, morphometry of placenta and its correlation with birth weight in normal and PIH patients in Raichur urban.

A Comparative Study of Maternal Outcome in Booked and Unbooked Pregnancy Induced Hypertension Mothers in a Tertiary Care Hospital, Rajahmundry

A Comparative Study of Maternal Outcome in Booked and Unbooked Pregnancy Induced Hypertension Mothers in a Tertiary Care Hospital, Rajahmundry

Study of Gross Anatomy of Human Placenta in Pregnancy Induced Hypertension

Introduction: Pregnancy induced hypertension (PIH), also referred to as Gestational hypertension is a condition of high blood pressure during pregnancy. Progression the disease causes preeclampsia and eclampsia, which are the commonest causes of maternal and fetal morbidity and mortality.Objective: The objectives of the study were to observe and measure the macroscopic changes in the placenta in pregnancy induced hypertension and to compare the placental findings of the control group. .Method: This descriptive observational study was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU). Forty placentas were collected from Bangladesh Institute of Research &amp; Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) and Bangabandhu Sheikh Mujib Medical University. Out of forty placentas, twenty were from non-hypertensive mother considered as controls and twenty from PIH mothers. Mother who had Rh-negative blood group, positive for VDRL and HbsAg and mother delivered multiple babies or babies with any visible congenital malformation were excluded. All women included in the study gave birth to a live born baby after 35 weeks of gestation by caesarian section. The macroscopic features of placentas were recorded and after that specimen was fixed in 10% formol saline. After two week of fixation, a point counting method was used on placental slices for estimation of the volume of parenchyma and non-parenchyma.Results: The general features of the control and PIH mother were statistically matched. As compared with the control group, PIH group showed no statistically significant difference in values of placental weight, volume and diameter.Mean placental weight (gm), mean volume (ml) and the mean diameter (cm) of the placental, mean absolute volume of parenchyma, mean proportional and mean absolute volume of non-parenchyma were lower in PIH group than the control group. The mean number of cotyledon of the placenta and mean proportional volume of parenchyma were higher in PIH group than control group and. These differences did not reach statistically significant level.Conclusion: Several authors has concluded that the changes in the placenta in diabetic and toxaemic mother are the reflection of some compensatory mechanism, but the present study fails to identify any statistically significant changes in PIH group in favour of such statement.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

English

BACKGROUND: Pregnancy induced Hypertension (PIH) is one of the common complications which contributes to significant maternal and perinatal morbidity and mortality. Effective management improves outcome of both mother and the baby OBJECTIVES: To study the morbidity and mortality in babies born to mothers with pregnancy induced hypertension, assess the reasons for the outcome of the baby and monitor the growth and development till the age of 6 months. METHODS: This study was conducted at Niloufer Institute of Child Health, Hyderabad a teaching institution which caters to high risk obstetric patients and also has a tertiary level NICU care. Study was conducted over a period of 9 months and 100 cases of PIH were included over a period of 3 months and the babies were followed up till the age of 6 months. A structured proforma was designed and analyzed using Epi info for window statistical software. RESULTS: Out of 1461 deliveries, we enrolled 100 PIH cases as per inclusion criteria and studied during 3 months period. Of the study group, 48% were with mild PIH (n=48) and 52% were with severe PIH (n=52). When compared to mild PIH, severe PIH was associated with higher rates of preterm deliveries and it was statistically significant (P 2). In NICU admissions Meconium aspiration syndrome (MAS), Hyaline membrane disease (HMD), Birth asphyxia (BA) and sepsis were observed. All the complications were more in severe PIH than mild PIH. After discharge infants were fallowed up till the age of 6 months. Out of 75 babies discharged, 24 cases were lost to follow up and in the remaining 51 babies, 33 were born to mild PIH mothers, 18 were born to severe PIH mothers. CONCLUSION: PIH is one of the major causes of morbidity and mortality in the fetus and newborn. The more severe the PIH, the more adverse is the outcome. Our goal is early detection and prompts Management.

ESTIMATION OF AVERAGE BIRTH WEIGHT IN TERM NEWBORNS: A HOSPITAL BASED STUDY IN COASTAL KARNATAKA

Introduction: Average birth weight (BW) of Indian babies is believed to be 2.8-3 kg. BW is a key predictor of newborn outcome and indicator of health trend of a child. This study gives an insight into BW in coastal Karnataka. The objective of the present study was to estimate the average BW in term newborns and to study its correlation with sex of the newborn and maternal conditions. Methods: The retrospective study of data from medical records of births during May 2012-April 2014 in the Medical College Hospital. Multiple pregnancy, preterm and post-term were excluded. Parameters such as BW, gender, maternal age, parity, history of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH) were noted. Data were analyzed using Chi-square test. Results: A data of 3882 babies was included. BW ranged from 1.92 kg to 4.45 kg. The mean BW was 3.07 ± 0.455 kg. Mean BW of male babies was 3.09 ± 0.41 and female babies was 3.03 ± 0.4 kg. Average BW in primi mothers was 3.02 kg, multipara was 3.08 kg and grand multipara was 3.18 kg. In babies of PIH and GDM mothers, BW was 2.87 and 3.48 kg respectively. BW was not related to age of the mother or gender of the baby. Anomalous babies were found more in small for gestational age and large for gestational age rather than appropriate for gestational age. Conclusions: Average BW of term newborns is estimated as 3.07 kg. BW increased with parity of the mother and not with age of the mother or sex of the baby.

Hypertensive disorders affecting the morphometry of placenta

The placenta reflects the changes due to maternal hypertension, as it is a mirror of the maternal and fetal status. The study of a hundred placentae was conducted, to find out the morbid changes in the placentae of hypertensive mothers, in comparison to those of mothers with normal pregnancies. In gross appearance the placentae of mothers with PIH (Pregnancy-Induced Hypertension) were smaller and irregular. Surface area and volume showed reduction in the placentae of PIH mothers. Thus, the severity of hypertension adversely affects both fetal and placental outcome.

Pathophysiology of placentation abnormalities in pregnancy-induced hypertension

During embryogenesis and development, the fetus obtains oxygen and nutrients from the mother through placental microcirculation. The placenta is a distinctive organ that develops and differentiates per se, and that organizes fetal growth and maternal condition in the entire course of gestation. Several life-threatening diseases during pregnancy, such as pregnancy-induced hypertension (PIH) and eclampsia, are closely associated with placental dysfunction. Genetic susceptibilities and poor placentation have been investigated intensively to understand the pathophysiology of PIH. It is currently thought that "poor placentation hypothesis", in which extravillous trophoblasts fail to invade sufficiently the placental bed, explains in part maternal predisposition to this disease. Cumulative studies have suggested that hypoxic micromilieu of fetoplacental site, shear stress of uteroplacental blood flow, and aberrantly secreted proinflammatory substances into maternal circulation synergistically contribute to the progression of PIH. For example, soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1) and soluble form of CD105 are elevated in circulation of PIH mothers. However, it remains to be poorly understood the pathological events in the placenta during the last half of gestation as maternal systemic disorders get worse. For better understanding and effective therapeutic approaches to PIH, it is important to clarify pathological course of PIH-associated changes in the placenta. In this review, current understanding of placental development and the pathophysiology of PIH placenta are summarized. In addition, recent findings of vasoactive signalings in PIH and rodent PIH models are discussed.

Neonatal thrombocytopenia associated with maternal pregnancy induced hypertension

To evaluate the prevalence of thrombocytopenia in neonates born to mothers with pregnancy induced hypertension (PIH) and identify the associated material and neonatal characteristics. In the current, prospective study, platelet counts were assessed serially. Maternal and neonatal characteristic were recorded in pre-designed proforma. Primary outcome measures were thrombocytopenia defined as platelet count of <150,000/mm(3) and severe thrombocytopenia if counts were <30,000/mm(3) or <50,000/mm(3) with bleeding. Of 97 neonates born to PIH mothers 35 (36.1%) had thrombocytopenia. In 20 (20.6%) thrombocytopenia was severe. Higher percentage of thrombocytopenia was associated with male gender (47.7%), low birth weight (71.4%) and prematurity (67.4%). Severe thrombocytopenia was significantly associated with low birth weight (OR: 4.58; 95% CI: 0.98-21.3; p<0.03) and prematurity (OR: 2.52; 95% CI: 0.87-7.24; p<0.05). Material parity, onset of PIH, and medications did not seem to be associated significantly. Premature and low birth weight neonates born to mothers with pregnancy induced hypertension would require scrutiny for thrombocytopenia during early neonatal period.

Serum lecithin:cholesterol acyltransferase activity, HDL2 and HDL3 composition in hypertensive mothers and their small for gestational age newborns

The aim of this study was to determine serum lecithin:cholesterol acyltransferase (LCAT) activity in parallel with HDL2 and HDL3 amounts and composition in pregnancy induced hypertension (PIH) and chronic hypertensive (CH) mothers and in their small for gestational age (SGA) newborns. LCAT activity was assayed by conversion of [3H] cholesterol to labelled cholesteryl ester. HDL2 and HDL3 were separated by ultracentrifugation. At term, cholesterol values were similar in PIH, CH and controls. However, higher levels of triglycerides were observed in PIH and CH (+20% and +21%, respectively) as compared with normotensive control mothers (NC). HDL2 and HDL3-phospholipids, HDL2-cholesterol concentrations and LCAT activity were lower in PIH and CH mothers than in NC mothers. Similar changes were also observed in SGA newborns of PHI mothers and in SGA newborns of CH mothers when compared to appropriate for gestational age newborns of control mothers (AGA-NC). In addition, SGA newborns showed low HDL2 and HDL3 apoA-I contents. Maternal hypertension and foetal intrauterine growth retardation are associated with profound abnormalities in HDL metabolism, consistent with an atherogenic risk. SGA lipoprotein profiles appear to implicate later metabolic diseases.

Hematologic Status of Newborn Infants of Mother with Pregancy-induced Hypertension

To evaluate the effects of pregnancy-induced hypertension (PIH) to the iron status of fetuses, umbilical cord blood of 35 newborn infants borne by PIH mothers and of 37 normal term infants delivered at Yeungnam University Hospital from September 1, 1993 to September 30, 1994, were studied. The serum hemoglobin concentration of women with PIH was significantly higher than normal full-term pregnant women. There was no significant difference in serum hemoglobin concetration between women with PIH and normal full-term pregnant women and their newborn infants. There was no significant difference in serum hemoglobin concentration beween infants of women with PIH and normal full-term infants. The serum iron concentration of newborn infants of women with PIH was higher and the serum ferritin concentration of newborn infants of women with PIH was lower than normal full-term infants, but there were no significant difference between the two groups. The serum total iron-binding capactity and unsaturated iron-binding capacity of infants of women with PIH were significantly higher than normal full-term infants. The newborn infants of PIH women seemed that they might have occult depletion of iron store and need meticulous follow up during early neonatal period.