Pregnancy-related Hypertensive Disorders Research Articles

Economic analysis of the use of the Flt-1/PlGF preeclampsia ratio compared to the standard of care in Uruguay

Preeclampsia (PE) is a pregnancyrelated hypertensive disorder that can lead to severe complications and adverse maternal and fetal outcomes. This study aimed to estimate the economic impact of integrating the sFlt-1/PlGF ratio into Uruguay's healthcare system as part of routine clinical practice for diagnosing. A decision tree model was used to estimate the annual economic impact on the Uruguayan healthcare system for a hypothetical cohort of women with suspected PE. This included relevant costs associated with diagnosis, monitoring, and treatment from the initial presentation of suspected PE until childbirth. The study analyzed the annual costs under two scenarios: the standard of care and a scenario incorporating the sFlt-1/PlGF ratio for PE, using 2022 as the reference year. Various deterministic and probabilistic sensitivity analyses were performed. The economic model estimated that the implementation of the sFlt-1/PlGF ratio could save the Uruguayan healthcare system $95,432,678 Uruguayan pesos (2,320,269 United States Dollars [USD]) annually, representing a 5 % reduction in costs compared with the standard of care. These savings were primarily due to a reduction in hospitalizations of women with suspected PE. The estimated economic impact equated to an annual net saving of approximately $10,602 Uruguayan pesos (258 USD) per patient. The introduction of the sFlt-1/PlGF ratio into the Uruguayan healthcare system is likely to generate savings due to the optimization of the management of hospitalizations for women with suspected preeclampsia (PE). However, the potential for savings will primarily depend on the current hospitalization rate of these women (the efficiency of managing high-risk PE pregnancies) and the length of stay for hospitalized women.

The Roles of Obesity and ASB4 in Preeclampsia Pathogenesis.

Preeclampsia is a complex pregnancy-related hypertensive disorder which poses significant risks for both maternal and fetal health. Preeclampsia affects 5-8% of pregnancies in the United States, causing a significant public health and economic burden. Despite extensive research, the etiology and pathogenesis of preeclampsia remain elusive, but have been correlated with maternal conditions such as obesity. In recent decades, the incidence of preeclampsia increased along with the prevalence of obesity among women of reproductive age. Maternal obesity has been shown to negatively affect pregnancy in almost all aspects. However, the precise mechanisms by which obesity influences preeclampsia are unclear. Ankyrin repeat and SOCS Box Containing protein 4 (ASB4) is an E3 ubiquitin ligase that can promote the degradation of a wide range of target proteins. ASB4-null mice display a full spectrum of preeclampsia-like phenotypes during pregnancy including hypertension, proteinuria, and decreased litter size. Furthermore, maternal obesity induced by a high-fat diet aggravates preeclampsia-like phenotypes in pregnant mice lacking ASB4. Variants in the ASB4 gene have been associated with obesity in humans, and a functional connection between the ASB4 gene and obesity has been established in mice. This review discusses the connections between preeclampsia, obesity, and ASB4.

Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging

More than 30% of pregnant people have at least 1 chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face major barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition. To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps. An individual-level randomized clinical trial was conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based and 5 community-based outpatient obstetric clinics affiliated with a large academic medical center. Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes, chronic hypertension, gestational diabetes, or pregnancy-related hypertension and a primary care practitioner (PCP) listed in their electronic health record. A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages. Completion of a PCP visit for routine or chronic condition care within 4 months of delivery was the primary outcome, ascertained directly by reviewing the patient's electronic health record approximately 5 months after their estimated due date. Intention-to-treat analysis was conducted. A total of 360 patients were randomized (control, 176; intervention, 184). Individuals had a mean (SD) age of 34.1 (4.9) years and median gestational age of 36.3 (IQR, 34.0-38.6) weeks at enrollment. The distribution of self-reported race and ethnicity was 6.8% Asian, 7.4% Black, 68.6% White, and 15.0% multiple races or other. Most participants (75.4%) had anxiety or depression, 16.1% had a chronic or pregnancy-related hypertensive disorder, 19.5% had preexisting or gestational diabetes, and 40.8% had a prepregnancy body mass index of 30 or greater. Medicaid was the primary payer for 21.2% of patients. Primary care practitioner visit completion within 4 months occurred in 22.0% (95% CI, 6.4%-28.8%) of individuals in the control group and 40.0% (95% CI, 33.1%-47.4%) in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95% CI, 9.1-28.2 percentage points). Intervention participants also had fewer postpartum readmissions (1.7% vs 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8% vs 28.3%), weight assessment (42.8% vs 27.7%), and depression screening (32.8% vs 16.8%). The findings of this randomized clinical trial suggest that the current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and well-being. ClinicalTrials.gov Identifier: NCT05543265.

P-724 Long-term health outcomes of 19 years follow-up of mothers conceived after oocyte donation based on the registry of a large healthcare organization

Abstract Study question Short term outcomes of oocyte donation (OD) pregnancies are known. Yet, long term effect of OD pregnancies on mother’s health are lacking. Summary answer Comparing women after OD pregnancies to spontaneous pregnancies or nulliparous women, a higher risk of thyroid diseases was found (1.41, p < 0.0001 and 2.13, p < 0.0001, respectively) What is known already Short term outcomes of oocyte donation pregnancies show increased risk of placental disease and pregnancy-related hypertensive disorders. Study design, size, duration This retrospective cohort study, conducted from 2000 to 2018, utilized the computerized records of a major healthcare provider. It compared the demographic data and long-term health outcomes of mothers who had undergone OD pregnancies with three groups: In Vitro Fertilization using autologous oocytes, spontaneously pregnancies, and nulliparous women. Participants/materials, setting, methods The study tracked the onset of chronic diseases from the date of delivery to the diagnosis of any chronic disease. The risk of various diseases and mortality among these groups was assessed using a Cox proportional hazards model. This model adjusted for variables such as age at the index date, number of children, body mass index (BMI), and smoking habits. Statistical significance was determined using two-sided p-values, with a threshold of P < 0.05. Main results and the role of chance Regarding long-term outcomes, no difference was found between mothers after oocyte donation comparted to mothers after IVF (See table 1).. When comparing oocyte donation pregnancies to mothers after spontaneous conception, mothers after oocyte donation had less lower prevalence of rheumatology diseases (6% vs 8.9%) and more higher prevalence of thyroid diseases (21.9% vs. 17.6%). However, in cox regression, taking into account smoking, number of birth and mom’s age, we only found a higher risk of thyroid diseases (OD 1.41, p < 0.0001). Lastly, oocyte donation pregnancies compared to nulliparous had more thyroid diseases (21.9% vs. 6.7%, p < 0.001), also in cox regression (OD 2.13, p < 0.0001) Limitations, reasons for caution The temporal aspect of chronic disease diagnosis; a diagnosis made at a specific point does not preclude the presence of the disease at an earlier time. Also, the infrequency of some conditions within our study population could have reduced the statistical power to detect differences or associations. Wider implications of the findings The longer-term health outcome for women conceiving after OD is reassuring, and is very similar to that of IVF children and naturally conceived children, exempt for higher risk of thyroid disease. The main recommendation should be a yearly surveillance of thyroid function. Trial registration number 0046-18-BBL

Gestational diabetes mellitus, hypertension, and dyslipidemia as the risk factors of preeclampsia

Gestational diabetes mellitus (GDM) is a known risk factor for gestational hypertension which further progress toward conditions like proteinuria, dyslipidemia, thrombocytopenia, pulmonary edema leading to Preeclampsia (PE). Pregnancy can be a challenging time for many women, especially those diagnosed with GDM and PE. Thus, the current prospective study investigates the association of OGTT glucose levels with systolic and diastolic blood pressure and lipid profile parameters in pregnant women diagnosed with GDM and PE. A total of 140 pregnant women were stratified into GDM (n = 50), PE (n = 40) and controls (n = 50). Two hour 75 g oral glucose tolerance test (OGTT) was performed for screening GDM. Biochemical parameters analysis of OGTT, total cholesterol (TC), triglyceride (Tg), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), urinary albumin and creatinine were tested to find urinary albumin creatinine ratio (uACR). Statistical analysis was performed using ANOVA followed by post hoc test and regression analysis. Among the studied groups, GDM and PE groups showed no significant difference in age and increased BMI. Increased 2 h OGTT & TC in GDM group; elevated uACR, systolic/diastolic blood pressure, Tg, HDL-C, LDL-C in PE group was observed and differ significantly (p < 0.0001) with other groups. A significant positive effect of 2 h OGTT was observed on blood pressure (R2: GDM = 0.85, PE = 0.71) and lipid profile determinants (R2: GDM = 0.85, PE = 0.33) at p < 0.0001. The current study concludes that glucose intolerance during the later weeks of pregnancy is associated with gestational hypertension and hyperlipidemia as a risk factor for PE. Further research is needed for a detailed assessment of maternal glucose metabolism at various pregnancy stages, including the use of more sensitive markers such as C-peptide and their relation to pregnancy-related hypertensive disorders.

A RETROSPECTIVE STUDY ON MATERNAL AND FETAL OUTCOMES ASSOCIATED WITH ASSISTED REPRODUCTIVE TECHNOLOGIES

Assisted Reproductive Technologies (ART) have revolutionized the landscape of reproductive medicine, offering hope to couples facing infertility challenges. The study's main objective is to find the maternal and fetal outcomes associated with assisted reproductive technologies. This retrospective cohort study was conducted in Lady Reading Hospital Peshawar from July 2019 to June 2023. The study includes 850 participants who underwent ART procedures between 2021 and 2022. Details of the ART procedures, such as the technique employed, the number of embryos transferred, and the utilization of preimplantation genetic testing, were meticulously documented. Maternal outcomes were a focal point, with a comprehensive assessment of pregnancy-related hypertensive disorders, gestational diabetes, mode of delivery, and any postpartum complications. Data was collected from 850 participants. The mean maternal age was 33.5 years (SD = 4.2), and the mean BMI was 25.8 (SD = 3.5). The primary causes of infertility varied, with male factor infertility being the most prevalent at 40%, followed by ovulatory dysfunction at 30% and unexplained infertility at 20%. The ART procedures in the study cohort comprised In Vitro Fertilization (IVF) at 60%, followed by Intracytoplasmic Sperm Injection (ICSI) at 25%, and other ART techniques at 15%. Regarding the number of embryos transferred, the majority received a single source (70%), with 20% receiving two starts and 10% receiving three or more. It is concluded that pregnancies conceived through Assisted Reproductive Technologies (ART) exhibit a higher prevalence of pregnancy-related hypertensive disorders and gestational diabetes compared to naturally conceived pregnancies.

Endothelial Nitric Oxide synthase (eNOS) in Preeclampsia: An Update.

Preeclampsia (PE) is a common pregnancy-related hypertensive disorder and is a leading cause of maternal and perinatal morbidity and mortality. The incidence of PE and its associated health care costs have been increasing in the United States over the past three decades. Pregnancies complicated by PE put both the mother and child at increased risk for chronic illnesses such as cardiovascular disease, cerebrovascular disease, and cognitive impairment later in life. To date, there is no effective treatment for PE and the etiology of PE is largely unknown. While human epidemiological studies have established an association between various genetic factors and PE, a causative link between genes associated with PE and PE development has been difficult to establish. Human studies have shown that variants in eNOS (endothelial nitric oxide synthase, also known as NOS3) gene are associated with PE, and animal experimental studies have provided evidence to show the potential functional connection between the eNOS gene and PE. Here we review several studies that investigated the role of eNOS in PE, as well as studies that described how manipulating the eNOS/NO pathway could aid in disease intervention.

Shock Index and Modified Shock Index Might be Reliable for Predicting Morbitidy in Pregnancy-Related Hypertensive Disorders

Shock Index and Modified Shock Index Might be Reliable for Predicting Morbitidy in Pregnancy-Related Hypertensive Disorders

The Impact of Irregular Menstruation on Health: A Review of the Literature.

Women are considered to have an irregular menstrual cycle if their cycle length is less than 21 days or more than 35 days, accompanied by less or very severe blood flow. The prevalence of menstrual cycle irregularities varies across countries. Irregular periods can occur due to changes in the body's levels of estrogen and progesterone hormones, which disrupt the normal pattern of the period. Menstrual irregularity has been found to be associated with various diseases and medical conditions, such as metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis. Anemia, osteoporosis, psychological problems, impaired quality of life, and infertility have also been recorded. Moreover, a significant correlation between irregular periods and the risk of developing pregnancy-related hypertensive disorders, as well as an increased risk of adverse obstetric and neonatal outcomes, has been proven. Therefore, irregular menstruation is considered an important health indicator among women. Physical, mental, social, psychological, and reproductive problems are often associated with menstrual irregularities. Thus, evaluating the factors associated with irregular menstruation is necessary to determine appropriate preventive and treatment strategies and to decrease the associated health problems. The aim of this review was to define normal and irregular menstruation, their types, and prevalence, to recognize the risk factors and causes of irregular menstruation, and to understand their impact on women's health.

Pre-eclampsia among Pregnant Women Admitted to the Department of Obstetrics and Gynaecology of a Tertiary Care Centre.

Pre-eclampsia is a pregnancy-related hypertensive disorder with maternal and neonatal complications. Many studies are done regarding the prevalence of pre-eclampsia in Nepal but ascertaining the maternal risk factors and fetal outcomes are important. The aim of this study was to find out the prevalence of pre-eclampsia among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care centre. A descriptive cross-sectional study was conducted among pregnant women admitted to the Department of Obstetrics and Gynaecology of a tertiary care hospital from 13 July 2023 to 29 September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling method was used. Point estimate was calculated at a 95% Confidence Interval. Among 5065 patient, pre-eclampsia was seen in 44 (0.87%) (0.61-1.13, 95% Confidence Interval). A total of 16 (36.36%) cases of pre-eclampsia were in the age group 25-29 years and 30 (68.18%) of them were nulliparous. A total of 38 (86.36%) of the newborns of the pre-eclamptic cases had low birth weight. The APGAR score of newborns at the 1 minute after birth was 26 (59.09%) followed by the newborns who needed re-evaluation 16 (36.36%). The APGAR score recorded at 5 minutes showed maximum newborns with normal APGAR score 40 (90.90%). The prevalence of pre-eclampsia among pregnant women was found to be lower than other studies done in similar settings. maternity; Nepal; pre-eclampsia; prevalence.

Single-cell transcriptomic architecture and cellular communication circuits of parametrial adipose tissue in pregnant mice

AimsThe activity and interactions of cellular subpopulations in the adipose tissue microenvironment are critical for the coordination of local and systemic adaptation during pregnancy. With a particular interest in parametrial adipose tissue (PmAT), single-cell RNA-sequencing (scRNA-seq) was utilized to unveil the gestative cellular composition and functional shift. Materials and methodsTo identify cell-type-enriched transcriptome profiles, a total of 18,074 cells in adipose tissue were studied. The cell populations were cataloged, and signaling crosstalk between adipocytes and other composition factions via soluble and membrane-bound factors were evaluated. Key findingsA marked decline of pregnancy adipocytes and relative elevation of non-adipocyte fractions were observed. A subpopulation of adipocytes, Adipo_5, with unique properties in the response to estrogen and the embryonic processes involved in pregnancy, was defined. Interactome analysis revealed the potential contribution of PmAT to the establishment of maternal-fetal immune tolerance. During gestation, adipocytes shut down outgoing signaling, resulting in deterioration of the resistin-related incoming signaling network in B cells, which would therefore benefit tissue-specific maternal-fetal tolerance. Furthermore, a subpopulation of adipocytes, Aipo_2, was also considered to take part in a paradigm shift in the process of pregnancy-induced chemical stiffness-triggered vesicular remodeling via the THBS signaling pathway network. SignificanceThese data-derived findings will encourage investigation into the role of pregnant PmTA in pregnancy-related immunological, hypertensive and metabolic disorders, with the ultimate goal of establishing preventive strategies to mitigate these pregnancy-related health challenges. This translational aspect of our work holds significant promise for improving maternal and fetal well-being.

Correlation between serum ferritin in early pregnancy and hypertensive disorders in pregnancy.

To explore the correlation between serum ferritin (SF) in early pregnancy and the risk of hypertensive disorders in pregnancy (HDP). A retrospective cohort study was conducted on 43,421 pregnant women with singleton pregnancies who underwent antenatal checkups at Fujian Provincial Maternal and Child Health Hospital from January 2018 to December 2020. Based on pregnancy records, women were classified as non-hypertensive, having gestational hypertension, preeclampsia and preeclampsia with severe features according to the degree of the disease. General baseline data, and SF levels in the early (up to 12 gestational weeks) and late (after 28 weeks of gestation) stages of pregnancy were collected. The significance of the characteristic variables was assessed using a random forest algorithm, and the correlation between early pregnancy SF levels and the incidence of HDP was further analyzed using logistics regression adjusted for confounders. A generalized additive model (GAM) was fitted to a smoothed graph of the relationship between early pregnancy SF levels and HDP, and a threshold effect analysis was performed to find the threshold values of early pregnancy SF for iron supplementation therapy. A total of 30,703 pregnant women were included. There were 1,103 women who were diagnosed with HDP. Of them, 418 had gestational hypertension, 12 had chronic hypertension without SPE, 332 - preeclampsia and 341 women had preeclampsia with severe features. Levels of SF in early and late pregnancy were significantly higher (p < 0.001) in women with HDP compared to non-hypertensive women and the difference was more pronounced in early pregnancy. The random forest algorithm showed that early pregnancy SF was more effective in predicting HDP compared to late pregnancy SF levels and was also an independent risk factor for HDP (adjusted odds ratio (AOR) = 1.07, 95% CI [1.05,1.09]) after correction for confounding factors. Early pregnancy SF >64.22 mg/l was associated with higher risk of developing hypertensive disorders. Risk of pregnancy-related hypertensive disorders increases with increasing early pregnancy SF levels. SF levels may therefore be used to further develop guidelines for iron supplementation therapy in pregnant women.

Adverse pregnancy, delivery and neonatal outcomes across different advanced maternal ages: A population-based retrospective cohort study.

Characterize the risk for adverse pregnancy, delivery and neonatal outcomes among different advanced maternal ages (AMA). We conducted a population-based retrospective cohort study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample to characterize adverse pregnancy, delivery and neonatal outcomes among different AMA groups. Patients aged 44-45 (n=19,476), 46-49 (n=7528) and 50-54 years (n=1100) were compared to patients aged 38-43 years (n=499,655). A multivariate logistic regression analysis adjusted for statistically significant confounding variables. With advancing age, rates of chronic hypertension, pregestational diabetes, thyroid disease and multiple gestation increased (p<0.001). The adjusted risk of hysterectomy and need for blood transfusion substantially increased with advancing age, reaching up to an almost 5-fold (aOR, 4.75, 95% CI, 2.76-8.19, p<0.001) and 3-fold (aOR, 3.06, 95% CI, 2.31-4.05, p<0.001) increased risk, respectively, in patients aged 50-54 years. The adjusted risk of maternal death increased 4-fold in patients aged 46-49 years (aOR, 4.03, 95% CI, 1.23-13.17, p=0.021). Adjusted risks of pregnancy-related hypertensive disorders, including gestational hypertension and preeclampsia, increased by 28-93% across advancing age groups (p<0.001). Adjusted neonatal outcomes demonstrated up to a 40% elevated risk of intrauterine fetal demise in patients aged 46-49 years (aOR, 1.40, 95% CI, 1.02-1.92, p=0.04) and a 17% increased risk of having a small for gestational age neonate in patients aged 44-45 years (aOR, 1.17, 95% CI, 1.05-1.31, p=0.004). Pregnancies at AMA are at increased risk for adverse outcomes, particularly for pregnancy-related hypertensive disorders, hysterectomy, blood transfusion, and maternal and fetal mortality. Although comorbidities associated with AMA influence the risk of complications, AMA was demonstrated to be an independent risk factor for major complications, with its impact varying across ages. This data imparts clinicians with the ability to provide more specific counseling to patients of varied AMA. Older patients seeking to conceive must be counseled regarding these risks in order to make well-informed decisions.

The Role of Peroxisome Proliferator-Activated Receptors in Preeclampsia.

Preeclampsia is a common pregnancy-related hypertensive disorder. Often presenting as preexisting or new-onset hypertension complicated by proteinuria and/or end-organ dysfunction, preeclampsia significantly correlates with maternal and perinatal morbidity and mortality. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptor proteins that regulate gene expression. In order to investigate the role of PPARs in the pathophysiology of preeclampsia, we conducted a literature review using the MEDLINE and LIVIVO databases. The search terms "peroxisome proliferator-activated receptor", "PPAR", and "preeclampsia" were employed and we were able to identify 35 relevant studies published between 2002 and 2022. Different study groups reached contradictory conclusions in terms of PPAR expression in preeclamptic placentae. Interestingly, PPARγ agonists alone, or in combination with well-established pharmaceutical agents, were determined to represent novel, potent anti-preeclamptic treatment alternatives. In conclusion, PPARs seem to play a significant role in preeclampsia.

Association between maternal epicardial adipose tissue, gestational diabetes mellitus, and pregnancy-related hypertensive disorders: a systematic review and meta-analysis.

Several small studies have evaluated the association between epicardial adipose tissue (EAT) and pregnancy-related cardiovascular risk factors such as gestational diabetes mellitus (GDM) or hypertensive disorders. The objective of this study was to quantitatively compare EAT thickening between patients with GDM or pregnancy-related hypertensive disorders and healthy controls. This systematic review and meta-analysis were performed according to PRISMA guidelines. A literature search was performed to detect studies that have quantified EAT in women with GDM and pregnancy-related hypertensive disorders compared to a control group. The primary outcome was EAT thickening estimated by ultrasound expressed in millimeters. Random or fixed effects models were used. Nine observational studies including 3146 patients were identified and considered eligible for this systematic review. The quantitative analysis showed that patients with GDM have a higher EAT thickness (mean difference: 1.1mm [95% confidence interval: 1.0-1.2]; I2 = 24%) compared to the control group. Moreover, patients with pregnancy-related hypertensive disorders showed higher EAT thickness (mean difference: 1.0mm [95% confidence interval: 0.6-1.4]; I2 = 83%) compared to the control group. In conclusion, this study demonstrated that EAT thickening is increased in patients with GDM and pregnancy-related hypertensive disorders compared with healthy controls. Whether or not this association is causal should be evaluated in prospective studies.

Evaluation of Klotho gene expression and NGAL levels following acute kidney injury during pregnancy hypertensive disorders.

This study examined the relationship between hypertensive disorders and acute kidney injury (AKI) during pregnancy by evaluating Klotho (KL) gene expression and Neutrophil gelatinase-associated lipocalin (NGAL) levels in pregnant women. Pregnant women were divided into 3 groups: (1) Pregnancy related hypertensive disorders with AKI (PR-AKI) (9 cases), (2) hypertensive disorders pregnancy (HDP) (40 cases), and (3) normal pregnancy (30 cases). For each group, Klotho gene transcription levels in the blood, Klotho and NGAL proteins levels, Malondialdehyde (MDA) and superoxide dismutase (SOD) activity levels were measured in serum. Statistical comparisons were made among the three groups. Klotho/β-actin transcript levels and serum KL protein concentrations were significantly decreased in hypertensive disorder pregnancies with AKI complications. Serum NGAL protein levels were significantly increased in the hypertensive disorder pregnancies with AKI complications. Total serum Klotho protein was negatively correlated with creatinine, while serum NGAL was positively correlated with serum creatinine, urea nitrogen, uric acid, systolic blood pressure, diastolic blood pressure and 24h urine protein levels. Serum levels of MDA and SOD were significantly increased in the hypertensive disorder pregnancy with AKI and the overall MDA concentration was negatively correlated with Klotho protein concentration. Klotho protein was found to have a direct effect on creatinine, and a mediating effect of MDA was found. Decreased expression of Klotho protein in correlation with increased levels of oxidative stress are found during of AKI complications in pregnancy hypertensive disorders.

Therapeutic value of dietary nitrate supplementation in pregnancy-related hypertensive disorders

Therapeutic value of dietary nitrate supplementation in pregnancy-related hypertensive disorders

Fundoscopic Findings in Pregnancy Related Hypertensive Disorders and Its Association with Maternal and Fetal Outcomes

Objectives: To determine the prevalence of retinal changes in pregnancy-related hypertensive disorders and their association with maternal and fetal outcomes. Introduction: There is a grave risk to both mother and child when hypertensive problems complicate pregnancy. However, hypertensive sort of disorders during pregnancy have been allied to poor maternal and also neonatal outcomes. This research aimed to evaluate effects of hypertensive sort of disorders of pregnancy on both mothers and their unborn children by analyzing the prevalence, causes, and treatment of these conditions. Subjects and methods: BBH Rawalpindi, Inpatient Department of Gynecology and Obstetrics conducted the case-control research during the period from January 2021 to June 2021. In all, 149 patients participated in the research. Because seven patients could not be located, 142 cases were analyzed. Mild class preeclampsia (65.0 instances), severe class preeclampsia (32.0 hot cases), and also eclampsia (one case) were the subcategories used to categorize patients further, according to research. Thirty-one women who were not hypertensive throughout pregnancy were enlisted as controls. Results: Ninety percent of cases manifested with some edema. About a quarter basically patients had proteinuria above 300.0 mg/24 hours (26.76%), nearly half had proteinuria over two g/24 hours (47.18%), and about a quarter had urine protein based excretion of 3.0-5.0 g/24 hours (25.35%). Usually, incidence of specially HELLP (normally hemolysis, increased liver based special enzymes, and also squat platelet tot up) set of symptoms was 2.80%, raised bilirubin levels were seen in 47%, illustration symptoms occurred in 6.4%, vaginal based hemorrhage occurred in 11.30%, in addition to 42.2% of cases involved the central nervous system. It was shown that eclampsia was the cause of mortality in 2.8% of all maternal deaths. 16.9 percent of births were stillbirths, while 4.23 percent of newborns died. Conclusion: Compared to pregnant women with normal blood pressure, those who suffer from hypertensive disorders of pregnancy have a higher risk of having a baby born with complications. Our research did find a declining trend, although it was less than those seen in other studies; this may be because more of our study's births occurred in hospitals. Keywords: Neonatal outcome, maternal outcome, acute renal failure, and the HELLP syndrome

Coronary artery disease in women.

Cardiovascular disease is the leading global cause of death in women but remains underdiagnosed and undertreated. Health professionals play an important role in improving the heart health of Australian women. Routine heart health checks should be offered to all women 45 years of age and older and to all Aboriginal and Torres Strait Islander women 30 years of age and older. Cardiovascular risk assessment in women must include traditional and sex-specific risk factors, including their pregnancy history and early-onset menopause. Women with pregnancy-related hypertensive and metabolic disorders have an increased long-term cardiovascular risk and require close monitoring. Women with acute coronary syndrome may not experience classical chest pain. More often, they experience cardiovascular events in the absence of obstructive coronary disease and have poorer cardiovascular outcomes. The recognition of sex-specific differences and more sex-specific trials are key to improving clinical outcomes.

Increased Ca2+-dependent intrinsic tone and arterial stiffness in mesenteric microvessels of hypertensive pregnant rats

Preeclampsia is a pregnancy-related hypertensive disorder (HTN-Preg) with unclear mechanisms. We have shown increased vascular reactivity to extrinsic vasoconstrictors in HTN-Preg rats. Here, we test whether microvascular intrinsic tone and arterial stiffness could contribute to HTN-Preg, and examined the underlying cellular mechanisms. On gestational day 19, BP was recorded in normal pregnant (Preg) rats and Preg rats with reduced uterine perfusion pressure (RUPP), and mesenteric microvessels were mounted on a pressure myograph for measurement of intrinsic tone, simultaneous changes in [Ca2+]i (fura-2 340/380 ratio), and arterial stiffness. Arteries were incubated in Ca2+-containing and 0 Ca2+ (2 mM EGTA) Krebs, pressurized at 10 to 110 mmHg in 10 mmHg increments, and the % change in vessel diameter from initial diameter at 10 mmHg was analyzed for measurement of total (active + passive) intrinsic tone and passive intrinsic response, respectively. The passive response was then subtracted from the total intrinsic tone to determine the active myogenic tone. The strain–stress relationship was also constructed as a measure of arterial stiffness. BP was higher in RUPP vs Preg rats. In Ca2+-containing Krebs, increases in intraluminal pressure caused smaller increases in diameter and greater increases in [Ca2+]i in microvessels of RUPP vs Preg rats, suggesting increased Ca2+-dependent myogenic tone. In 0 Ca2+ Krebs, increases in pressure also caused less increases in diameter in microvessels of RUPP vs Preg rats, but with no changes in [Ca2+]i, suggesting changes in the structure and mechanics of the arterial wall. The total and passive strain–stress relationship was shifted to the left in microvessels of RUPP vs Preg rats, suggesting increased arterial wall stiffness. Histology and immunohistochemistry showed greater vascular wall thickness and collagen-I staining in RUPP vs Preg rats, supporting changes in the wall architecture and structural proteins. The increased active myogenic tone and underlying increases in Ca2+ signaling as well as the increased passive intrinsic response, arterial stiffness and collagen-I in the mesenteric microvessels could play a role in the regulation of blood flow to the splanchnic region and the increased vascular resistance and BP in HTN-Preg.