Pregnancy-induced Hypertensive Disorders Research Articles

Hypertensive Disorder of Pregnancy with Vertebral Artery Aneurysm and Vasospasm Led to Vertebral Artery Dissection – A Case Report

Hypertensive disorders of pregnancy (HDP) can lead to various complications affecting maternal and fetal health. In this case report, we present the rare occurrence of vertebral artery aneurysm leading to vasospasm with vertebral artery dissection (VAD) in a woman having pregnancy-induced hypertensive disorder. Her clinical presentation, diagnostic evaluation, and management are discussed, highlighting the importance of early recognition and appropriate intervention. This case highlights the potential link between pregnancy-induced hypertensive disorders and a rare vascular complication like vertebral artery aneurysm which may lead to vertebral artery dissection. The current literature consists of a few incidences documenting adverse outcomes and management. The incidence of recurrence of such events (arterial aneurysms and dissection) in subsequent pregnancies is unknown. Timely recognition, appropriate diagnostic evaluation, and multidisciplinary collaboration are essential for optimal management and patient outcomes. Mugda Med Coll J. 2023; 6(2): 107-109

Preeclampsia and Long-Term Risk of Venous Thromboembolism

As venous thromboembolism (VTE) remains one of the leading causes of maternal mortality, identifying women at increased risk of VTE is of great importance. Preeclampsia is a pregnancy-induced hypertensive disorder with generalized endothelial dysfunction. Some studies suggest that preeclampsia is associated with an increased risk of VTE, but much controversy exists. To examine the association between preeclampsia and the risk of VTE during pregnancy, during the puerperium, and after the puerperium. This observational cohort study used Danish nationwide registries to identify all eligible primiparous women who gave birth in Denmark from January 1, 1997, to December 31, 2016. The women were followed up from primiparous pregnancy to incident VTE, emigration, death, or the end of the study (December 31, 2016). Statistical analyses were carried out from January to May 2023. Preeclampsia during primiparous pregnancy. The main outcome was incident VTE, and the secondary outcome was all-cause mortality. A total of 522 545 primiparous women (median age, 28 years [IQR, 25-31 years]) were included, and 23 330 (4.5%) received a diagnosis of preeclampsia. Women with preeclampsia were of similar age to women without preeclampsia but had a higher burden of comorbidities. During a median follow-up of 10.2 years (IQR, 5.2-15.4 years), preeclampsia was associated with a higher incidence of VTE compared with no preeclampsia (incidence rate, 448.8 [95% CI, 399.9-503.5] vs 309.6 [95% CI, 300.6-319.9] per 1000 patient-years, corresponding to an unadjusted hazard ratio [HR] of 1.45 [95% CI, 1.29-1.63] and an adjusted HR of 1.43 [95% CI, 1.27-1.61]). When stratified according to the subcategories of VTE, preeclampsia was associated with an increased rate of deep vein thrombosis (unadjusted HR, 1.51 [95% CI, 1.32-1.72] and adjusted HR, 1.49 [95% CI, 1.31-1.70]) as well as pulmonary embolism (unadjusted HR, 1.39 [95% CI, 1.09-1.76]; adjusted HR, 1.36 [95% CI, 1.08-1.73]). These findings held true in landmark analyses during pregnancy, during the puerperium, and after the puerperium. This cohort study suggests that preeclampsia was associated with a significantly increased risk of VTE during pregnancy, during the puerperium, and after the puerperium, even after thorough adjustment. Future studies should address how to improve the clinical management of women with a history of preeclampsia to prevent VTE.

Association between preeclampsia and long-term risk of arrhythmias

Abstract Background Preeclampsia (PE), a pregnancy-induced hypertensive disorder, affects 4-5% of pregnancies worldwide. It is well known that hypertension is associated with increased risk of arrhythmias; however, data on the association between PE and arrhythmias are sparse and there is a lack of knowledge on the long-term risk of arrhythmias. Purpose To compare the incidence of arrhythmias following preeclamptic and normotensive pregnancies. Methods In this observational cohort study, we identified all primiparous women without history of arrhythmias who gave birth in Denmark from 1997 to 2016 using Danish nationwide registries. The women were stratified on whether they developed PE during their primiparous pregnancy and were followed from primiparous pregnancy to incident arrhythmia, emigration, death, or end of study (December 31, 2018). The comparative risks of arrhythmias were assessed in cause-specific Cox regression analyses adjusted for known arrhythmogenic risk factors including obesity, smoking, hypertension, coronary artery disease, cardiomyopathy, congenital heart disease, thyroid disease, diabetes, and alcohol abuse. Results A total of 521,517 primiparous women with a median age of 28 years were included and 23,523 (4.5%) were diagnosed with PE. Women with versus without PE were of similar age but had a higher burden of comorbidities. During a median follow-up period of 10.2 years, women with PE were associated with higher absolute incidences of arrhythmias (Figure 1). No statistically significant association was found for the composite of cardiac arrest, ventricular arrhythmias, or ICD-implantation nor for the composite of advanced 2nd or 3rd degree atrioventricular block, sinoatrial dysfunction, or pacemaker-implantation. However, women with PE were associated with a significant increased risk of the composite of supraventricular tachyarrhythmias and extrasystoles (p<0.01) and the composite of all included arrhythmias (p<0.01). Factors associated with arrhythmias among women with PE included obesity (HR 1.40 (95%CI 1.03-1.91), coronary artery disease (HR 2.39 (95%CI 1.14-5.00), cardiomyopathy (HR 9.65 (95%CI 3.46-26.92), and congenital heart disease (HR 5.86 (95%CI 2.59-13.28). Conclusion Preeclamptic women were associated with a significantly higher rate of arrhythmias - mainly driven by supraventricular tachyarrhythmias and extrasystoles - than normotensive women. For the purpose of primary and secondary prevention, this finding suggests that women with a history of PE may benefit from evaluation of cardiovascular risk factors, screening of and education in prevention of cardiovascular disease.Figure 1

[Regional analysis of high risk factors of hypertensive disorders in pregnancy with organ or system impairment].

Objective: To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. Methods: A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. Results: (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all P<0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all P<0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Conclusions: Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.

Pregnancy-Induced Hypertensive Disorder and Risks of Future Ischemic and Nonischemic Heart Failure

BackgroundAlthough adverse pregnancy outcomes are associated with an increased risk of cardiovascular disease, studies on timing and subtypes of heart failure after a hypertensive pregnancy are lacking. ObjectivesThe goal of this study was to assess the association between pregnancy-induced hypertensive disorder and risk of heart failure, according to ischemic and nonischemic subtypes, and the impact of disease characteristics and the timing of heart failure risks. MethodsThis was a population-based matched cohort study, comprising all primiparous women without a history of cardiovascular disease included in the Swedish Medical Birth Register between 1988 and 2019. Women with pregnancy-induced hypertensive disorder were matched with women with normotensive pregnancies. Through linkage with health care registers, all women were followed up for incident heart failure, classified as ischemic or nonischemic. ResultsIn total, 79,334 women with pregnancy-induced hypertensive disorder were matched with 396,531 women with normotensive pregnancies. During a median follow-up of 13 years, rates of all heart failure subtypes were more common among women with pregnancy-induced hypertensive disorder. Compared with women with normotensive pregnancies, adjusted HRs (aHRs) with 95% CIs were as follows: heart failure overall, aHR: 1.70 (95% CI: 1.51-1.91); ischemic heart failure, aHR: 2.28 (95% CI: 1.74-2.98); and nonischemic heart failure, aHR: 1.60 (95% CI: 1.40-1.83). Disease characteristics indicating severe hypertensive disorder were associated with higher heart failure rates, and rates were highest within the first years after the hypertensive pregnancy but remained significantly increased thereafter. ConclusionsPregnancy-induced hypertensive disorder is associated with an increased short-term and long-term risk of incident ischemic and nonischemic heart failure. Disease characteristics indicating more severe forms of pregnancy-induced hypertensive disorder amplify the heart failure risks.

Obstetric and perinatal outcomes after embryos cultured in one-step versus sequential culture media systems in vitrified–warmed single blastocyst transfer cycles

Research questionDoes type of culture medium used influence obstetric and perinatal outcomes after vitrified–warmed single blastocyst transfers? DesignRetrospective cohort study involving singletons after vitrified–warmed single blastocyst embryo transfers, using embryos cultured in either Irvine Continuous Single Culture medium (CSC) or Vitrolife G5TM PLUS medium culture system between 2013 and 2020. ResultsA total of 2475 women who had singleton deliveries were included for final analysis: 1478 had embryos cultured in CSC and 997 had embryos cultured in G5TM PLUS medium. Birth outcomes, including preterm birth, mean birth weight, gestational age- and sex-adjusted birth weight (Z-scores), rates of large-for-gestational-age, small-for-gestational-age, low birth weight and macrosomia, and the distribution of newborn gender did not differ significantly between groups in crude and adjusted analyses. Women whose embryos were cultured in G5TM PLUS frequently suffered from pregnancy-induced hypertensive disorders compared with those who had embryos cultured in CSC (4.7% versus 3.0%; P = 0.031). This difference was no longer significant after adjusting for several key confounders (adjusted odds ratio 1.49, 95% CI 0.94 to 2.38, P = 0.087). Other obstetric complications, including gestational diabetes mellitus, preterm premature rupture of membranes, abnormal placentation, postpartum haemorrhage and the mode of delivery were all similar between the two groups. ConclusionsThe present study adds new information to the current evidence by suggesting that the embryo culture medium does not affect birth outcomes and obstetric complications when comparison is limited to Irvine CSC and Vitrolife G5TM PLUS in vitrified–warmed single blastocyst transfer cycles.

Maternal and fetal outcomes in acute hepatic porphyria: A Swedish National Cohort Study.

Current knowledge of pregnancy and perinatal outcomes in women with acute hepatic porphyria (AHP) is largely based on biochemical disease models, case reports, and case series. We performed a nationwide, registered-based cohort study to investigate the association between maternal AHP and the risk of adverse pregnancy and perinatal outcomes. All women in the Swedish Porphyria Register with confirmed AHP aged 18 years or older between 1987 and 2015 and matched general population comparators, with at least one registered delivery in the Swedish Medical Birth Register were included. Risk ratios (RRs) of pregnancy complications, delivery mode and perinatal outcomes were estimated and adjusted for maternal age at delivery, area of residency, birth year and parity. Women with acute intermittent porphyria (AIP), the most common form of AHP, were further categorized according to maximal lifetime urinary porphobilinogen (U-PBG) levels. The study included 214 women with AHP and 2174 matched comparators. Women with AHP presented with a higher risk for pregnancy-induced hypertensive disorder (aRR 1.73, 95% CI 1.12-2.68), gestational diabetes (aRR 3.41, 95% CI 1.69-6.89), and small-for-gestational-age birth (aRR 2.08, 95% CI 1.26-3.45). In general, RRs were higher among women with AIP who had high lifetime U-PBG levels. Our study shows an increased risk for pregnancy induced hypertensive disease, gestational diabetes, and small for gestational age births for AHP women, with higher relative risks for women with biochemically active AIP. No increased risk for perinatal death or malformations was observed.

The Relation between Deregulated Immune Milieu and Atherogenic Lipids Might Underlie the Development of Pregnancy-induced Hypertensive Disorders

The Relation between Deregulated Immune Milieu and Atherogenic Lipids Might Underlie the Development of Pregnancy-induced Hypertensive Disorders

Pregnancy-Induced Hypertension - Ayurvedic Understanding

Pregnancy-induced hypertensive disorders are included among the most common medical complications of pregnancy with an incidence of 5–10%. Hypertension that develops as a direct result of gravid state is referred to as ‘pregnancy-induced hypertension’. The timely management of pregnancy complicated with hypertensive disorders is significant, otherwise it can lead to adverse fetal, neonatal and maternal outcomes. The basic pathology in pre-eclampsia, one of the types of hypertensive disorders is endothelial dysfunction and intense vasospasm due to abnormal placentation compromising blood flow to the foetoplacental unit. There is no direct reference of pregnancy-induced hypertension in Ayurveda classics, but the manifested symptoms can be explained within the purview of Ayurveda. Abnormality in placentation can be considered as impairment in the normal functioning of Vata dosha and when the pathology progresses further; Kapha, Pitta also play their own roles. In a woman with or without a previous history of pre-eclampsia, intervention should begin from pre-conceptional period. Planned pregnancy after pre-conceptional care followed by Garbhini paricharya along with the use of Garbhasthapaka dravya, Rasayana dravya, Masanumasika Garbhasravahara dravya can play significant roles in the prevention as well as management of pregnancy-induced hypertension thus improving the maternal and foetal outcomes.

Impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes in twin pregnancies.

To date, there have only been provisional recommendations about the appropriate gestational weight gain in twin pregnancies. This study aimed to contribute evidence to this gap of knowledge. Using a cohort of 10 603 twin pregnancies delivered between 2000 and 2015 in the state of Hessen, Germany, the individual and combined impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes was analyzed using uni- and multivariable logistic regression models. The analysis used newly defined population-based quartiles of gestational weight gain in women carrying twin pregnancies (Q1: <419.4g/week [low weight gain], Q2-Q3: 419.4-692.3g/week [optimal weight gain], Q4: >692.3g/week [high weight gain]) and the World Health Organization body mass index classification. Pre-pregnancy body mass index ≥25 kg/m2 was associated with significantly increased rates of cesarean deliveries (aOR1.2, 95% CI: 1.01-1.41) and pregnancy-induced hypertensive disorders (aOR 1.53, 95% CI: 1.11-2.1) but not with any adverse neonatal outcome. Perinatal mortality (aOR 2.23, 95% CI: 1.38-3.6), preterm birth (aOR 1.88, 95% CI: 1.58-2.25), APGAR'5 < 7 (aOR 1.61, 95% CI: 1.19-2.17) and admissions to the neonatal intensive care unit (aOR 1.6, CI: 1.38-1.85) were increased among women with low gestational weight gain. Rates of cesarean deliveries were high in both women with low (aOR 1.25, 95% CI: 1.05-1.48) and high gestational weight gain (aOR 1.17, 95% CI: 1.01-1.35). A high gestational weight gain was also associated with higher rates of hypertensive disorders in pregnancy (aOR 2.32, 95% CI: 1.79-3.02) and postpartum hemorrhage (aOR 1.72, 95%CI: 1.12-2.63). The risk of preterm birth, low Apgar scores and NICU admissions showed a converse linear relation with pre-pregnancy body mass index in women with low gestational weight gain. In twin pregnancies, nonoptimal weekly maternal weight gain seems to be strongly associated with maternal and neonatal adverse outcomes. Since gestational weight gain is a modifiable risk factor, health care providers have the opportunity to counsel pregnant women with twins and target their care accordingly. Additional research to confirm the validity and generalizability of our findings in different populations is warranted.

Evaluation of Lactate Dehydrogenase and Gamma Glutamyl Transferase Among Pregnant Women with Hypertensive Disorders and Their Association with Disease Severity in Jimma Medical Center, Ethiopia

Background & Objective: Pregnancy-induced hypertensive disorders (PIHD) are the main reasons for maternal and perinatal mortality, as they complicate 10% of pregnancies worldwide. Serum lactic acid dehydrogenase (LDH) and gamma-glutamyl transferase (GGT) are possible markers reflecting the occurrence of pregnancy-associated complications like preeclampsia and eclampsia. There is a paucity of data with conflicting results showing serum LDH and GGT on PIHD in Ethiopia. This investigation aimed to assess the serum LDH and GGT levels in pregnant women with PIHD along with their correlation with the severity of the disease at Jimma Medical Center (JMC), Ethiopia.Materials & Methods: This hospital-based comparative cross-sectional study was undertaken from August 03 to September 27, 2020, in JMC. A total of 97 study participants were recruited. Serum GGT and LDH levels were determined using a fully automated Roche Cobas 6000 chemistry analyzer. The data were analyzed using SPSS 25.0. One-way ANOVA and independent samples t-test were employed to compare serum GGT and LDH levels with categories of PIHD.Results: The significantly highest mean serum levels of LDH (580.9±193.8 U/L) and GGT (86.1±29.2 U/L) were observed in eclamptic women compared to gestational hypertensive (276.7±60.7 and 38.3±16.9 U/L) and preeclamptic patients (353±132.8 and 48.8±29.9 U/L), respectively. Both serum GGT and LDH levels were found to correlate with the severity of preeclampsia, respectively significantly.Conclusion: Serum LDH and GGT were found to be at the highest levels in eclamptic than preeclamptic and gestational hypertensive women. Blood pressure, gestational age, and severity of hypertensive disorders of pregnancy were predictor variables associated with serum GGT and LDH.

P-764 Is children’s health up to two years of age affected by embryo vitrification?

Abstract Study question Does embryo vitrification affect children’s health including growth, up to 2 years of age when compared to fresh embryo transfer? Summary answer While embryo vitrification had an impact on birth parameters, no differences in growth or health outcomes were found up to 2 years of age. What is known already Vitrification has become the preferred cryopreservation method for embryos. Frozen embryo transfer has been repeatedly associated with altered health outcomes when compared with fresh transfer including a decreased risk for small-for gestational age (SGA) and an increased risk for large-for-gestational-age (LGA) and macrosomia. Not only there is uncertainty which factors are responsible for the observed differences, also the heterogeneity among studies limits overall conclusions. Notwithstanding the observed differences at birth, little is known about growth and health of children born after embryo vitrification beyond birth while aberrant growth trajectories have been linked to cardiometabolic morbidity later in life. Study design, size, duration This single-center cohort study compared anthropometry and health outcomes in singletons conceived after cleavage-stage or blastocyst-stage embryo vitrification with results after fresh embryo transfer between 2014 and 2018. Pregnancies after PGT, IVM, oocyte vitrification or oocyte/embryo donation were excluded. Eligible singletons living in Belgium and randomly selected for continued follow-up were invited for examination in our center at 2 months (infancy) and 2 years of age (early childhood). Participants/materials, setting, methods Birth characteristics were available for 1237 and 2063 children born after embryo vitrification and fresh embryo transfer, respectively. Follow-up data were available for 582 and 757 children at 2 months and for 233 and 296 children at 2 years. Growth parameters were adjusted for neonatal, treatment and maternal characteristics. Subgroup analysis according to cycle regimen (HRT versus NC) and strategy (freeze-all versus previous fresh cycle) was performed. In addition, outcomes restricted to blastocysts are presented. Main results and the role of chance Mothers giving birth to a child conceived after embryo vitrification presented more often with pregnancy-induced hypertensive disorders than controls (P &amp;lt; 0.001). Birthweight, height and head circumference SDS of children born after embryo vitrification were higher than for children born after fresh embryo transfer (all P &amp;lt; 0.001) even after adjustment for neonatal, treatment and maternal characteristics. Embryo vitrification was also associated with a decreased risk of SGA (AOR 0.48; 0.00, 0.44) and an increased risk of macrosomia and LGA (AOR 3.59; 1.12, 11.59)(all P &amp;lt; 0.05). Restricting the sample to blastocysts (n = 1795), we found a higher birthweight SDS and increased risks of LGA, macrosomia and pregnancy-induced hypertensive disorders after vitrification (all P &amp;lt; 0.05). At infancy, weight and height SDS were larger for children born after embryo vitrification, but not after adjustment for co-variates. At childhood, no differences in anthropometrics were found between the groups. Weight and height gain from birth to infancy and from infancy to early childhood were comparable between the groups. Until 2 years, comparable rates of severe developmental problems, hospital admissions, surgical interventions and of chronic medication intake were found between the groups. Subgroup analysis showed that growth parameters at all ages were not affected by cycle regimen or cycle strategy. Limitations, reasons for caution Participation rate at 2 years was lower than expected in both groups, probably due to cancellation/postponement of the visit related to the corona pandemic. Furthermore, although cycle strategy was not found to affect growth parameters, the sample size of the subgroup analysis remains rather small to draw firm conclusions. Wider implications of the findings When adjusted for co-variates including birthweight, the observed differences in anthropometrics at birth in children born after embryo vitrification attenuated by 2 years of age. This suggests that outcomes in early childhood are determined by size at birth. Trial registration number Not applicable

Maternal HPV Infection and the Estimated Risks for Adverse Pregnancy Outcomes-A Systematic Review.

Background: Human Papilloma Virus (HPV) represents the most prevalent genital infection in young women of reproductive age. Objective: This systematic review aims to estimate the effect of HPV infection during pregnancy and assess the correlation between HPV and adverse pregnancy outcomes. Materials and methods: The search strategy has been developed based on the PICOS framework: Population (pregnant women infected with HPV), Intervention (HPV infection confirmed by molecular tests), Comparator (pregnant women without HPV infection), Outcomes (adverse pregnancy outcomes) and Study design (observational studies). We searched PubMed, Web of Science, and Scopus databases on 8 January 2022 by using the following keywords: “HPV”, “prematurity”, “preterm birth”, “miscarriage”, “premature rupture of membranes”, “adverse pregnancy outcome”, “low birth weight”, “fetal growth restriction”, “pregnancy-induced hypertensive disorders”, “preeclampsia”. Selection criteria were HPV infection confirmed within maximum 2 years before pregnancy with a molecular test and adverse pregnancy outcomes. (Results: Although numerous studies are conducted on this topic, data are still controversial regarding identifying maternal HPV infection as a risk factor for adverse pregnancy outcomes. More prospective large cohort studies are needed to prove a causative relationship.

Human Leukocyte Antigens in Pregnancy and Preeclampsia.

Preeclampsia is a pregnancy-induced hypertensive disorder, the pathophysiology of which includes underlying maternal cardiovascular disease, deficient spiral artery remodeling during placenta development, and inflammatory immune responses at the maternal-fetal interface. Human leukocyte antigens (HLA) are major histocompatibility complex molecules essential for the recognition of foreign antigens that is central to immune defense against pathogens and critical determinants for the immune system discriminating between self and non-self tissues, such as in transplantation. Pregnancy represents a naturally existing “transplantation”, where the maternal immune system must be immunologically tolerant to the developing fetus which is 50% allogeneic. It is then unsurprising that HLA also influence normal pregnancy and pregnancy complications including preeclampsia. Here we review the role of classical and non-classical HLA molecules in influencing normal physiologic function during pregnancy and describe the association of HLA with pathophysiology in preeclampsia.

Maternal HPV Infection: Effects on Pregnancy Outcome.

The human papilloma virus (HPV) infection, caused by a ubiquitous virus typically transmitted through the direct contact of infected organs, either through the skin or mucosa, is the most common sexually transmitted infection, placing young women at a high risk of contracting it. Although the vast majority of cases spontaneously clear within 1–2 years, persistent HPV infection remains a serious concern, as it has repeatedly been linked to the development of multiple malignancies, including cervical, anogenital, and oropharyngeal cancers. Additionally, more recent data suggest a harmful effect of HPV infection on pregnancy. As the maternal hormonal environment and immune system undergo significant changes during pregnancy, the persistence of HPV is arguably favored. Various studies have reported an increased risk of adverse pregnancy outcomes among HPV-positive women, with the clinical impact encompassing a range of conditions, including preterm birth, miscarriage, pregnancy-induced hypertensive disorders (PIHD), intrauterine growth restriction (IUGR), low birth weight, the premature rupture of membranes (PROM), and fetal death. Therefore, understanding the mechanisms employed by HPV that negatively impact pregnancy and assessing potential approaches to counteract them would be of interest in the quest to optimize pregnancy outcomes and improve child survival and health.

The impact of anti-hypertensive treatment on foetal growth and haemodynamics in pregnant women with pre-existing diabetes - An explorative study.

To explore the impact of anti-hypertensive treatment of pregnancy-induced hypertension on foetal growth and hemodynamics in women with pre-existing diabetes. A prospective cohort study of 247 consecutive pregnant women with pre-existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti-hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85mmHg and home BP ≥130/80mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1-2weeks after initiation of anti-hypertensive treatment. In 215 initially normotensive women, anti-hypertensive treatment for pregnancy-induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti-hypertensive treatment for pregnancy-induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p=0.681). At 27weeks, mainly before initiation of anti-hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti-hypertensive treatment compared with 4% in untreated women (p=0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p=0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti-hypertensive treatment in a representative subgroup (n=12, p=0.941 and p=0.799, respectively). There is no clear indication that antihypertensive treatment causes harm in this particular at-high-risk group of pregnant women with diabetes, such that a larger well-designed study to determine the value of tight antihypertensive control would be worthwhile.

State-of-the-Art Review of Pregnancy-Related Psoriasis.

Psoriasis is a chronic immunologic disease involving inflammation that can target internal organs, the skin, and joints. The peak incidence occurs between the age of 30 and 40 years, which overlaps with the typical reproductive period of women. Because of comorbidities that can accompany psoriasis, including metabolic syndrome, cardiovascular involvement, and major depressive disorders, the condition is a complex one. The role of hormones during pregnancy in the lesion dynamics of psoriasis is unclear, and it is important to resolve the implications of this pathology during pregnancy are. Furthermore, treating pregnant women who have psoriasis represents a challenge as most drugs generally prescribed for this pathology are contraindicated in pregnancy because of teratogenic effects. This review covers the state of the art in psoriasis associated with pregnancy. Careful pregnancy monitoring in moderate-to-severe psoriasis vulgaris is required given the high risk of related complications in pregnancy, including pregnancy-induced hypertensive disorders, low birth weight for gestational age, and gestational diabetes. Topical corticosteroids are safe during pregnancy but effective only for localised forms of psoriasis. Monoclonal antibodies targeting cytokines specifically upregulated in psoriasis, such as ustekinumab (IL-12/23 inhibitor), secukinumab (IL-17 inhibitor) can be effective for the severe form of psoriasis during pregnancy. A multidisciplinary team must choose optimal treatment, taking into account fetal and maternal risks and benefits.

Association of maternal Serum Selenium Binding protein and its effect on fetal outcomes in Pregnancy Induced Hypertensive Disorders: A case-control study.

Background: Pregnancy-induced hypertensive (PIH) disorder represented the primary cause of maternal and fetal morbidity and mortality. The cause of pre-eclampsia is unknown, but ischemic blood supply to the placenta stimulates the inflammatory process which leads to endothelial dysfunction and oxidative stress. Antioxidants like Selenium altered concentration involve in its pathogenesis. This study was proposed to find out the significance of Selenium as a biomarker in the pathophysiology of PIH disorders and its association with fetal outcomes.&#x0D; Methodology: This case-control study was conducted on 240 pregnant women, 20-40 weeks of gestation, divided into four groups equally. Normotensive control, investigational group 1 PIH, 2 Pre-eclamptic, and 3 Eclamptic. A structured questionnaire was administered and arterial blood pressure was measured and the blood sample was done for serum Selenium assessment through ELISA. A urine sample was collected and the level of proteinuria was assessed. Fetal wellbeing and signs of growth restriction were observed using ultrasound reports.&#x0D; Results: The mean age of the studied participants was 27.6 ± 5.3 years with the gestational age of 32.11 ± 4.56 weeks. The mean Serum Selenium levels (ng/ml) were significantly lower in investigational groups 67.93 ± 10.54 in PIH, 44.6 ± 13.19 in PE, and 36.38 ± 10.3 in Ec than 78.5 ± 8.2 control (p&lt;0.05). The mean systolic, diastolic blood pressure and proteinuria were significantly high in case groups (p&lt;0.05). Furthermore, we observed a significant inverse correlation of serum selenium with gestational age, systolic, diastolic blood pressure, proteinuria, fetal weight, and femur length in all four groups, whereas mainly positive significant correlation was elucidated with serum glutathione, PIH (r= 0.797, p&lt;0.001), PE (r = 0.617, p&gt;0.00), Ec (r=0.559, p=0.019) than control (r = 0.817, p&lt;0.001).&#x0D; Conclusion: It is concluded that serum selenium level is significantly reduced in Pregnancy-induced hypertensive disorders and it has markedly affected maternal and fetal outcomes.

Acute ambient air pollution exposure and placental Doppler results in the NICHD fetal growth studies – Singleton cohort

BackgroundIncreased placental vascular resistance is a proposed mechanism by which air pollution exposure during pregnancy lowers birth weight and increases pregnancy-induced hypertensive disorders. ObjectiveTo examine the impact of acute air pollution exposure during pregnancy on uterine and umbilical artery Doppler indicators of placental vascular resistance. MethodsAfter a first ultrasound to confirm gestational age, 2562 pregnant women recruited in 12 clinics throughout the United States underwent up to five standardized ultrasounds with Doppler measurements. Exposures to 11 air pollutants were estimated for the hour of ultrasound and each of the 2 h prior to ultrasound at the clinics using the National Air Quality Forecast Capability reanalysis products. We used mixed logistic regression to study the longitudinal odds ratio (OR) of any, uni- or bi-lateral systolic and diastolic uterine artery notching compared to no notching and the longitudinal OR of abnormal end diastolic flow of the umbilical artery compared to forward flow. Uterine and umbilical artery resistance indexes were studied using linear mixed models. ResultsEach inter-quartile range (IQR) increase of particulate matter < 2.5 μm, nitrate, ammonium, primary organic matter (POM) and nitrogen dioxide during the hour of ultrasound was associated with a decreased risk of unilateral systolic notch and with increased resistance index of the left uterine artery. For the umbilical artery, each IQR increase in ozone was associated with decreased resistance index (b: −0.26, 95 % CI: −0.52, −0.01) and with a decreased risk of abnormal end diastolic flow (OR: 0.36, 95 % CI: 0.14, 0.94); while each IQR increase of elemental carbon and POM was associated with increased risk of abnormal end diastolic flow (OR: 1.47, 95 % CI: 1.02, 2.13 and OR: 1.67, 95 % CI: 1.17, 2.39, respectively). DiscussionOur results suggest acute air pollution exposure may influence placental vascular resistance.

Blood pressure variability correlates with right ventricular strain in women with gestational hypertension and preeclampsia.

The aim of this study was to evaluate the short- and long-term blood pressure (BP) variability and right ventricular (RV) remodeling in women with gestational hypertension and preeclampsia, as well as their association. This cross-sectional study included 161 pregnant women (56 normotensive controls, 55 patients with gestational hypertension, and 50 patients with preeclampsia) after 20 weeks of gestation. All women underwent 24-h ambulatory BP monitoring and echocardiographic examination. Our findings showed that 24-h, daytime and nighttime systolic and diastolic BPs, as well as visit-to-visit systolic and diastolic BPs, were significantly higher in women with gestational hypertension and preeclampsia than in control group. Parameters of short- and long-term BP variability gradually increased from controls, throughout women with preeclampsia, to those with gestational hypertension. RV diameter, E/e′ and PAP were significantly higher in women with gestational hypertension and preeclampsia than in controls. Global and free wall RV longitudinal strains, as well as corresponding endo- and epicardial strains, gradually reduced from controls to women with preeclampsia. Parameters of short- and long-term BP variability were independently associated with global and free wall RV longitudinal strain. In conclusion, short- and long-term BP variability was higher in women with pregnancy-induced hypertensive disorders. RV diastolic function and mechanics were deteriorated in these women comparing with controls. A significant association between BP variability and RV longitudinal strain underlines the importance of determination of short- and long-term BP variability during pregnancy.