Pregnancy-induced Hypertensive Disease Research Articles

Factors Associated with Maternal Morbidity among Black Women in the United States.

Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). This is a population-based retrospective case-control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. · The rate of SMM in NHBP may be modifiable.. · NHBP have a three-fold higher rate of maternal mortality.. · Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity..

Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes.

To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.

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.

CORD BLOOD IGG ANTIBODIES AGAINST SARS COV-2 IN PREGNANT WOMEN AT A RURAL TEACHING HOSPITAL

Introduction: The significant risks posed to mothers and fetus by COVID-19 in pregnancy have sparked a worldwide debate surrounding the antenatal SARS-CoV-2 infection and vaccination.ACOG and CDC recognize pregnancy as a risk factor,Recent data demonstrated that pregnant women with COVID-19 infection are at increased risk for intensive care unit (ICU) admission, mechanical ventilation, and death, compared with properly matched nonpregnant women. Moreover,COVID-19 illness increases the risk for pregnancy complications such as preterm birth,pregnancy-induced hypertensive diseases, and thromboembolic diseases. Maternal IgG antibodies to SARS-CoV-2 where transferred across the placenta after asymptomatic as well as symptomatic infection during pregnancy. Proper transfer of neutralizing antibodies may be critical during pregnancy,as a greater proportion of neonates and infants have severe or critical illness upon COVID-19 infection than older pediatric counterparts. Aims and Objectives: To detect cord blood IgG antibodies against SARS CoV-2 in pregnant women.To assess the association between maternal and fetal SARS-CoV2 specific antibodies.Methods:A brief questionnaire was administered to 42 antenatal women attending for delivery at Mediciti Institute of Medical Sciences, Hyderabad, Telangana State. The questionnaire included information such as vaccination status, previous history of Covid infection, presence of any symptoms at the time of admission, comorbid conditions like DM, HTN,Thyroid disorders, etc. Following delivery, 2ml cord blood sample has been collected. Serum has been separated and used for detection of SARS CoV-2 IgG antibody titers by quantitative ELISA. Results: Among 42 antenatal cases,4 were controls among them two were positive control and two were negative controls.Out of remaining 38, the SARS-CoV-2 IgG antibodies are detected in 14 cases. IgG was detected in the cord blood for 33.3% of the total cases. Among those detected positive for antibodies, 50% had preterm deliveries. Conclusion: IgG antibodies have been detected in the cord blood collected from the vaccinated women as well as the women affected with SARS-Co-2 and even increased the risk for pregnancy complications such as preterm birth, pregnancy-induced hypertensive diseases,Gestational Diabetes.

Modified lung ultrasound scoring system to evaluate the feasibility of pregnant women with COVID-19 pneumonia

Objective To investigate whether physicians with short-term training can use a modified lung ultrasound scoring system for coronavirus disease 2019 (COVID-19) pneumonia to assess lung damage in pregnant women. Methods Sixteen consecutively hospitalized third-trimester pregnant women with pregnancy-induced hypertension, preeclampsia, rheumatoid arthritis or connective tissue disease were selected as the study subjects for the simulation of COVID-19 pneumonia. Two physicians (imaging and internal medicine) without ultrasonic experience performed lung examinations on pregnant women after six days of lung ultrasound training, and their consistency with examinations by the expert was assessed. In addition, 54 healthy third-trimester pregnant women and 54 healthy nonpregnant women of the same age who were continuously treated in the outpatient clinic of this hospital were selected for comparisons of abnormalities on lung ultrasound. Results (1) Third trimester pregnant women with pregnancy-induced hypertension, preeclampsia, rheumatoid arthritis or connective tissue disease had the same lung ultrasound patterns as those associated with COVID-19 pneumonia. (2) There was no statistically significant difference between the scores of the two trained doctors and the expert when the modified ultrasound scoring system was used (p > .05). (3) The evaluations of the two trained doctors and the expert showed good consistency (kappa value = 0.833–0.957). (4) The incidence of abnormal ultrasound manifestations of the pleura and lung parenchyma was higher among healthy third-trimester pregnant women than among healthy women of the same age (p < .001). Conclusions After receiving short-term training, imaging and internal medicine physicians can use the modified lung ultrasound scoring system to evaluate pregnant women’s pulmonary damage, but caution is needed to avoid false-positive results among pregnant women with suspected COVID-19 pneumonia.

Preeclampsia and Its Complications Exacerbate Development of Postpartum Depression: A Retrospective Cohort Study.

Background Hypertensive disorders were proved to be associated with the development of depression. But it is unclear if pregnancy-induced hypertensive diseases, especially preeclampsia (PE), will affect postpartum moods. We aimed to determine the incidence rate of postpartum depression (PPD) in PE patients and comprehensively evaluate the association between PPD and PE, including its severity and complications. Methods 425 participants including 130 PE mothers were enrolled in this retrospective cohort study. Each woman was asked to complete a questionnaire integrating the Edinburgh Postnatal Depression Scale (EPDS), the Leakage Index Questionnaire, and a pain scale questionnaire within 6 weeks after delivery. The EPDS cut-off score above 13 was recognized as screening positive for PPD. Data between groups were compared by bivariate analysis. Results PE mothers showed a direct tendency to PPD development. The positive screening for PPD in the PE group was significantly higher than that of the control group (30.77% vs. 14.58%). Based on the results of the regression model, women diagnosed with severe PE and fetal growth restriction were more inclined to develop PPD than normal ones (AOR: 2.759, 95% CI: 1.206-6.315 and AOR: 3.450, 95% CI: 1.596-7.458). It is also indicated that postpartum pain exacerbated the odds of PPD in PE patients (AOR: 1.509, 95% CI: 1.078-2.114). Conclusions PE was an independent risk factor for PPD. Its severity and complications exacerbate the development of PPD. Doctors and society should pay more attention to PE patients after delivery against the development of PPD.

Gestational exposure to organophosphate esters (OPEs) and maternal blood pressure during pregnancy: The HOME Study

Background: After the phase-out of polybrominated diphenyl ethers, exposure to organophosphate esters (OPEs), which are potential endocrine disruptors, is ubiquitous. No study has examined the associations between gestational exposure to OPEs and blood pressure and the risk of pregnancy-induced hypertensive diseases.Methods: We used data from 333 women who had liveborn singletons without congenital abnormalities in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective birth cohort. We quantified maternal urinary OPE metabolites at 16 weeks of gestation. Outcomes included the highest maternal blood pressure measurement at ≥20 weeks of gestation and pregnancy-induced hypertensive diseases (gestational hypertension, preeclampsia, and eclampsia) from medical chart review. We used linear regression and modified Poisson regression with covariate adjustment to estimate the associations of exposure with blood pressure and the risk of pregnancy-induced hypertensive diseases, respectively.Results: Diphenyl phosphate (DPHP) had the highest geometric mean urinary concentrations (1.65 µg/g creatinine), followed by bis(1,3-dichloro-2-propyl) phosphate (BDCIPP; 0.76 µg/g creatinine), bis(2-chloroethyl) phosphate (BCEP; 0.70 µg/g creatinine), and dibutyl phosphate (DBUP; 0.25 µg/g creatinine). There were 29 (8.7%) women diagnosed with pregnancy-induced hypertensive diseases. Average systolic and diastolic blood pressure, measured at an average of 31 weeks gestation (range: 20-41), were 117±13 and 72±9 mmHg, respectively. None of the urinary OPE metabolites were significantly associated with the highest maternal blood pressure at ≥20 weeks of gestation, nor were they strongly associated with an increased risk of pregnancy-induced hypertensive diseases. The relative risk (RR; 95% confidence interval) of pregnancy-induced hypertensive diseases by a 10-fold increase in exposure was 1.31 (0.66, 2.59) for DPHP, 1.36 (0.51, 3.67) for BDCIPP, 0.63 (0.16, 2.39) for BCEP and 2.13 (0.78, 5.77) for DBUP.Conclusion: This study suggests no associations between maternal urinary OPE metabolite concentrations and blood pressure or an increased risk of pregnancy-induced hypertensive diseases during pregnancy.

Comparison between fractionated dose with bolus dose in Spinal Anaesthesia for haemodynamic stability and duration of analgesia in patients undergoing elective Lower Segment Caesarean Section (LSCS)

Background: Elective or emergency caesarean sections are routinely done under spinal anaesthesia (SA) with bolus dose of local anaesthetic drugs. Objective: To compared fractionated dose with bolus dose in SA for haemodynamic stability and duration of analgesia in patients undergoing elective lower segment caesarean section (LSCS).&#x0D; Methods: The present study was carried out in the Department of Anaesthesiology, Ad-din Akij Medical College Hospital, Khulna from January 2018 to December 2018 on sixty female patients (thirty in each group) of the American Society of Anesthesiologists physical status I–III, age from 18 to 40 years, height from 140 to 180 cm, singleton pregnancies scheduled for elective LSCS under SA. Patients with pre-existing diseases or pregnancy-induced hypertension, cardiovascular or cerebrovascular disease, any contraindication to SA, those weighing &lt;50 kg or &gt;110 kg and those taller than 180 cm or shorter than 140 cm and severely altered mental status, spine deformities or history of laminectomy were excluded from the study.&#x0D; Results: The mean duration of analgesia was statistically significant (p&lt;0.05) between two groups. Mean pulse rate- after 5 min, after 10 min, after 15 min, after 30 min, after 45 min and after 60 min were significantly (p&lt;0.05) higher in group F than group B. Mean arterial pressure- before given study drug, after 0 min, after 5 min, after 10 min, after 15 min, after 30 min, after 45 min and after 60 min were not significantly (p&gt;0.05) between two group. 14 patients (46.7%) in group B and 5 patients (16.7%) in group F required vasopressor. The difference was significant (p&lt;0.05) between two groups.&#x0D; Conclusion: Separation process in which a certain quantity of a mixture dose of SA provides better haemodynamic stability and longer period of analgesia compare to bolus dose in patients undergoing elective caesarean section.&#x0D; Mediscope Vol. 7, No. 2: July 2020, Page 95-102

A meta-analysis of the vascular endothelial growth factor polymorphisms associated with the risk of pre-eclampsia.

Backgroud: Pre-eclampsia (PE) is a common pregnancy-induced hypertension disease. Some case–control studies reported the association between vascular endothelial growth factor (VEGF) gene polymorphisms (rs3025039, rs2010963) and PE risk. However, these associations were inconsistent in several studies. Therefore, we conducted this meta-analysis to assess the role of VEGF gene polymorphisms in PE more precisely.Methods: Eligible studies were searched in PubMed, Embase, Web of Science and Chinese (Chinese National Knowledge Infrastructure (CNKI) and WanFang) databases. Statistical analyses were performed by Stata 12.0 software. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of the association. In addition, subgroup analyses, sensitive analyses and publication bias analyses were performed to further assess this meta-analysis.Results: In total, 21 studies were included in the meta-analysis covering 2018 cases and 2632 controls. There were significant associations between VEGF polymorphisms (rs3025039, rs2010963) and PE risk in the overall populations. In the subgroup analyses, we found that rs3025039 polymorphism was associated with the increased risk of PE among Chinese. As for rs2010963 polymorphism, a significant association was observed in subgroup of Caucasian.Conclusion: The present study suggested that the two VEGF gene polymorphisms (rs3025039, rs2010963) are associated with increased risk of PE in different ethnic groups, which means that the targets may be useful genetic markers for early prediction of PE.

The association between maternal urinary phthalate concentrations and blood pressure in pregnancy: The HOME Study.

BackgroundExposure to phthalates, a class of endocrine disrupting chemicals, is ubiquitous. We examined the association of urinary phthalate metabolite concentrations during pregnancy with maternal blood pressure and risk of pregnancy-induced hypertensive diseases.MethodsWe used data from the Health Outcomes and Measures of the Environment Study, a prospective birth cohort of low-risk pregnant women recruited between March 2003 and January 2006. We analyzed maternal urine samples collected at 16 and 26 weeks gestation for 9 phthalate monoester metabolites reflecting exposure to 6 phthalate diesters. Outcomes included maternal blood pressure at <20 and ≥20 weeks gestation and pregnancy induced hypertensive diseases (gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome).ResultsData were available for 369 women who gave birth to singleton, live-born infants without congenital anomalies. Of the phthalate metabolites evaluated, only mono-benzyl phthalate (MBzP) concentrations were significantly associated with maternal diastolic blood pressure at <20 weeks gestation. Women in the third MBzP tercile at 16 weeks gestation had diastolic blood pressure 2.2 (95 % CI: 0.5–3.9) mm Hg higher at <20 weeks gestation and 2.8 (95 % CI: 0.9–4.7) mm Hg higher at ≥20 weeks gestation compared to women in the first tercile. Compared to women in the first tercile, women in the top MBzP tercile at 16 weeks had an increased risk of developing pregnancy-induced hypertensive diseases (RR = 2.92, 95 % CI 1.15–7.41, p-value for trend = 0.01). MBzP concentrations at 26 weeks gestation were not as strongly associated with blood pressure at ≥20 weeks gestation or risk of pregnancy-induced hypertensive diseases.ConclusionThis study suggests that maternal urinary MBzP concentrations may be associated with increased diastolic blood pressure and risk of pregnancy-induced hypertensive diseases.

Psoriasis in pregnancy: challenges and solutions.

The available information about the effects of pregnancy on psoriasis and those of psoriasis on pregnancy is almost limited, despite the high frequency of the disease in the general population, as well as in women in reproductive years. Considering the existing evidence, pregnancy does not tend to have a negative influence on psoriasis, as in most women who experience a change in the severity and course of their psoriasis during pregnancy, the change is more likely to be reported as an improvement. This assumption can be applied more convincingly to plaque-type psoriasis, while an exception may be represented by generalized pustular psoriasis, which has been somehow linked to impetigo herpetiformis. Conflicting findings emerged from the few available studies that explored the effect of psoriasis on pregnancy outcomes. Recent studies found an association between moderate-to-severe psoriasis and some pregnancy complications, including pregnancy-induced hypertensive diseases, and have emphasized a trend toward a newborn with low birth weight in patients with psoriasis, especially in those suffering from severe forms. The safety profile during pregnancy is not completely known for many drugs used to treat psoriasis. Moisturizers and low- to moderate-potency topical steroids or ultraviolet B phototherapy represent the first-line therapy for pregnant patients. Many dermatologists may, however, recommend discontinuing all drugs during pregnancy, in consideration of medico-legal issues, and also taking into account that common forms of psoriasis do not compromise the maternal and fetal health. Anyway, for those women whose psoriasis improves during pregnancy, the interruption of any therapy for psoriasis can be a reasonable strategy. The objective of this paper was to review the most relevant literature data on psoriasis in pregnancy, trying to give concurrently practical information about clinical and prognostic aspects, as well as counseling and management.

Risk factors and placental histopathological findings of term born low birth weight neonates

IntroductionLow birth weight (LBW) is associated with increased neonatal morbidity and mortality. Hence, this condition should be well studied. The aims of this study were to identify the risk factors for term born LBW, as well as the placental histopathological lesions observed. MethodsThis case control study was carried out in the University Teaching Hospital and the Central Maternity, both of Yaoundé, Cameroon, from November 1st, 2013 to April 30th, 2014. Maternal medical records and placentas of term born (≥37 completed weeks) LBW (<2500 g at birth) or normal weight (3000–3500 g) were compared. The main variables recorded included maternal age and parity, maternal height, complications that occurred during pregnancy, maternal pre-gestational body mass index, the number of antenatal visits, the sex and birth weight of the newborn, the umbilical cord length, the placental weight and placental histology. Data were analyzed using Epi info 3.5.4. Fisher exact test, t-test and logistic regression were used for comparison. P < 0.05 was considered statistically significant. Resultsand Discussion: A total of 30 cases of LBW and the same number of controls were examined. Significant risk factors for LBW were primiparity (aOR 14.0, 95%CI 2.1–92.7), hypertensive diseases of pregnancy (aOR 18.1, 95%CI 1.02–322.5) and <4 antenatal visits (aOR 9.5, 95%CI 1.3–67.5). Significant placental lesions were placental infarction (aOR 19.5, 95%CI 2.9–130.1) and chronic villitis (aOR 35.9, 95%CI 1.2–1034.3). Our study showed that primiparous women, those with pregnancy-induced hypertensive diseases and those with <4 antenatal visits were more at risk for LBW. Significant placental lesions observed among LBW were placental infarcts and chronic villitis. Since LBW has the tendency to recur, and given that some causes such as placental infarcts are preventable, we recommend that a histological examination of the placenta should always be carried out in cases of LBW.

Pregnancy outcomes in women with moderate‐to‐severe psoriasis

The association between psoriasis and pregnancy outcomes has not been adequately examined, although psoriasis onset is common in the reproductive period. To evaluate the association between moderate-to-severe psoriasis and pregnancy complications. A retrospective, matched cohort study of 68 deliveries in 35 women with moderate-to-severe psoriasis compared to 237 deliveries in 236 women without psoriasis randomly selected after matching for age, parity and gestational age. The psoriasis patients had higher mean of past spontaneous (0.42±0.58 vs. 0.26±0.63, P=0.002) and induced (0.32±0.60 vs. 0.06±0.25, P=0.001) abortions than controls. They had a higher percentage of pregnancy-induced hypertensive diseases (7.4% vs. 2.1%, P<0.05) and premature rupture of membranes (16% vs. 5.5%, P<0.008). Newborns to women with psoriasis had higher birth weight (3375±543 g vs. 3247±460 g, P=0.03), increased percentage of large-for-gestational age (24% vs. 12%, P=0.02), and macrosomia (13% vs. 4.2%P=0.02). In multivariate analysis, moderate-to-severe psoriasis was an independent risk factor for previous spontaneous abortions, induced abortions, premature rupture of membranes (PROM), and newborn macrosomia. Moderate-to-severe psoriasis is associated with spontaneous and induced abortions, pregnancy-induced hypertensive diseases, premature rupture of membranes, large-for-gestational age newborns, and macrosomia.

Maternal and Fetal Thrombophilia in Intrauterine Growth Restriction in the Presence or Absence of Maternal Hypertensive Disease

Intrauterine growth restriction (IUGR) depends on the placental capacity to transfer oxygen and nutrients from the maternal to the fetal circulation. Placental insufficiency may be caused by impairment of the maternal or fetal circulation by a thrombotic event, possibly associated with thrombophilic disorders. The goals of our study were to define the role of maternal/fetal gain-of-function factor V Leiden and prothrombin G20210A mutations in the development of IUGR and to evaluate whether maternal pregnancy-induced hypertensive diseases would modify any such association. This is a case-control study: controls were 259 normal pregnancies, cases were 77 IUGR, 28 with and 49 without preeclampsia (PE) or pregnancy-induced hypertension (PIH). An association was found between IUGR and fetal thrombophilia (OR 2.09 CI 95% 1-4.5). The association was stronger in IUGR without PE and PIH (OR 2.9 CI 95% 1.3-6.6). This suggests a role for the fetal genotype in the development of IUGR.

Analysis of 290 cases with hypertensive disorders during pregnancy

Objective To investigate the relationship of risk factors with mother and neonate in the pregnancy-induced hypertension disease. Methods 290 cases with pregnancy-induced hypertension were retrospectively analyzed. Results In 290 cases with hypertensive disorder during pregnancy,185 cases of primipara (63.8%),105 cases of multipara (36.2%),the difference was statistically significant(x2=5.84,P＜0.05＝.City residents 98 cases (33.8%),farmers and foreign workers 192 cases (66.2%),the difference was statistically significant(x2=98.5,P ＜0.05＝.Low educational level,more non-system prental care(F=13.8,P＜0.05＝,the incidence of severe preeclampsia and elampia were significantly higher.In severe preeclampsia and elampia group,the incidence of various complications and cesarean section rate was significantly higher than gestational hypertension(x2=11.7,30.6,23.6,17.7,P＜0.05＝and mild preeclampsiagroup (x2=8.0,5.7,11.8,5.27,P＜0 05＝.Severe preeclampsia and eclampsia with fetal growth restriction,fetal distress neonatal asphyxia premature birth perinatal death,children had higher incidence of gestational hypertension(x2=29.5,14.7,12.0,29.3,P＜0.05＝and mild preeclampsia (x2=20.1,10.8,14.4,4.6,P＜0.05＝. Conclusion The key to reduce the mortality of pregnant women puerperant and neonate was to strengthen health care during pregnancy,prevent and treat the complications and allow optimail timing of delivery. Key words: Hypertension,pregnancy-induced; Factor analysis,statistical

Adolescent pregnancies and deliveries: problems encountered

Teenage pregnancies are increasing and need special attention. The aim of this retrospective study, conducted from 1 January 2004 to 31 December 2004 at the maternity department of the Yaoundé University Teaching Hospital, Cameroon, was to analyze the evolution of pregnancy and delivery in primiparous teenagers. The medical files of 190 teenagers and 403 patients aged between 20 and 25 years were analyzed and compared. Mean gestational age, the rate of pregnancy-induced hypertensive disease and the caesarean section rate were similar in both groups. However, there were a greater number of low Apgar scores, vaginal tears and instrumental deliveries in teenagers. Those aged 15 years or less had the additional risk of an increased rate of preterm labour, low birth weight and early neonatal death. Therefore, pregnancies and deliveries among teenagers, especially those aged 15 years or less, should be monitored regularly.

Snoring, Witnessed Sleep Apneas, and Pregnancy-induced Hypertension

Pérez-Chada, D.; Videla, A.J.; O'Flaherty, M.E.; Majul, C.; Catalini, A.M.; Caballer, C.A.; Franklin, K.A. Author Information

Snoring, Witnessed Sleep Apneas, and Pregnancy-Induced Hypertension

As many as 1 in 4 pregnant women snore habitually in the last week of pregnancy, and a study from Sweden has claimed an increased risk of both pregnancy-induced hypertension and fetal growth retardation in such women. The present study examined the association between self-reported snoring and witnessed sleep apneas on the one hand and pregnancy-induced hypertensive disease on the other in an Argentinian population of 447 women with singleton pregnancies who responded to a questionnaire administered on the day of delivery. Habitual snoring was reported by 7% of respondents, whereas more than one-fourth of those questioned (28%) acknowledged snoring at some time during pregnancy. Women who snored were more obese before pregnancy, gained more weight during gestation, and reported more frequently witnessed apnea than women who did not snore. In addition, snorers more often experienced daytime sleepiness. None of the women had used sedatives while pregnant. Pregnancy-induced hypertensive disease was documented in 42% of women who had snored at some time during pregnancy and in 27% of those who had never snored. The crude odds ratio (OR) for pregnancy-induced hypertensive disease in snorers was 2.01 (95% confidence interval [CI], 1.33–3.06), and increased with the frequency of snoring. The OR was 1.82 (95% CI, 1.16–2.84) when adjusting for prepregnancy body mass index, weight gain, smoking, alcohol use, and age. Witnessed sleep apneas also were associated with pregnancy-induced hypertension (OR, 8.00; 95% CI, 1.72–23.55). No relationship was found between snoring and delivery of a small-for-gestational-age infant. These findings lead the investigators to believe that snoring or sleep apnea could help to explain the development of pregnancy-induced hypertensive disorders in obese women.

Snoring, witnessed sleep apnoeas and pregnancy‐induced hypertension

Snoring is common in pregnancy, but there are only a few studies that have investigated the relationship of snoring and pregnancy complications. We aimed to investigate the relationship of snoring and witnessed sleep apnoeas with pregnancy-induced hypertension. A questionnaire was administered on the day of delivery to 456 women at the Department of Obstetrics, Hospital Donación F. Santojanni, Buenos Aires, Argentina. Pregnancy complications and blood pressure measurements were recorded from each woman's medical chart. Some 156 (35%) of 447 women with singleton pregnancies who answered the questionnaire, snored at some time during their pregnancy. Snoring was related to pregnancy-induced hypertension and pre-eclampsia combined, with an adjusted odds ratio of 1.82 (95% CI: 1.16-2.84; p <0.01), independent of body mass index before pregnancy, weight gain during pregnancy, neck circumference, smoking, alcohol and age. Witnessed sleep apnoeas were also related to pregnancy-induced hypertensive disease, with an adjusted odds ratio of 8.00 (95% CI: 2.71-23.55; p <0.001). Daytime sleepiness was more prevalent in snoring women. Snoring and witnessed sleep apnoeas are independently related to pregnancy-induced hypertensive disease.

Sekretion und Regulation von Zytokinen in der Gravidität und bei Gestose

Pregnancy-induced hypertension is still a common cause for fetal morbidity and mortality besides causing life-threatening diseases for the mother. The aethiology of this disease is still unclear. Some research support the theory of an immunological genesis. 32 patients were treated for gestosis or HELLP-Syndrome in our clinic. A number of data, blood samples as well as the immunological status (IL-6, Interferon-gamma. TNF-alpha und TNF-alpha-receptores p 55/p 75) of every patient were taken into consideration and compared to the results of 44 pregnant women in good health. Predisposing factors seem to have an crucial impact on the development of PIH. Under stimulation of peripheral blood monocytes the immunological results and the measurement of cytokines showed a significantly higher concentration of TNF-alpha compared to the results of the control group. The tendency of an increase of TNF-alpha-receptors p 75 was observed however it proved to have no statistical relevant when comparing the results of both groups. An new approach to examine the aethiology of pregnancy-induced hypertensive diseases consists in measuring immunotransmitters such as interferon, Interleukin and the tumor necrosis factor. The increased concentration of TNF-alpha and TNF-alpha-receptor shows the involvement of the cytokines thus supporting the hypothesis of an immunological genesis.