Gestational Hypertension Research Articles

First-trimester predictive models for adverse pregnancy outcomes-a base for implementation of strategies to prevent cardiovascular disease development.

This study aimed to establish efficient, cost-effective, and early predictive models for adverse pregnancy outcomes based on the combinations of a minimum number of miRNA biomarkers, whose altered expression was observed in specific pregnancy-related complications and selected maternal clinical characteristics. This retrospective study included singleton pregnancies with gestational hypertension (GH, n = 83), preeclampsia (PE, n = 66), HELLP syndrome (n = 14), fetal growth restriction (FGR, n = 82), small for gestational age (SGA, n = 37), gestational diabetes mellitus (GDM, n = 121), preterm birth in the absence of other complications (n = 106), late miscarriage (n = 34), stillbirth (n = 24), and 80 normal term pregnancies. MiRNA gene expression profiling was performed on the whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time reverse transcription polymerase chain reaction (RT-PCR). Most pregnancies with adverse outcomes were identified using the proposed approach (the combinations of selected miRNAs and appropriate maternal clinical characteristics) (GH, 69.88%; PE, 83.33%; HELLP, 92.86%; FGR, 73.17%; SGA, 81.08%; GDM on therapy, 89.47%; and late miscarriage, 84.85%). In the case of stillbirth, no addition of maternal clinical characteristics to the predictive model was necessary because a high detection rate was achieved by a combination of miRNA biomarkers only [91.67% cases at 10.0% false positive rate (FPR)]. The proposed models based on the combinations of selected cardiovascular disease-associated miRNAs and maternal clinical variables have a high predictive potential for identifying women at increased risk of adverse pregnancy outcomes; this can be incorporated into routine first-trimester screening programs. Preventive programs can be initiated based on these models to lower cardiovascular risk and prevent the development of metabolic/cardiovascular/cerebrovascular diseases because timely implementation of beneficial lifestyle strategies may reverse the dysregulation of miRNAs maintaining and controlling the cardiovascular system.

Revolutionizing Postpartum Hemorrhage Prediction with Insights from Iraq

Background: Postpartum hemorrhage (PPH) is a severe complication affecting women with gestational hypertension or preeclampsia, yet predictive models for PPH in this population remain underdeveloped. Specific Background: Existing studies have not adequately addressed the combined influence of antepartum and intrapartum factors on the predictability of PPH. Knowledge Gap: There is a lack of comprehensive models integrating both antepartum and intrapartum variables to predict PPH risk in women with gestational hypertension or mild preeclampsia. Aims: The study investigates the predictability of preeclampsia (PPH) in women with gestational hypertension or preeclampsia at term using logistic regression models incorporating both antepartum and intrapartum factors. Methods: The study, conducted in Karbala, Iraq, involved 1252 women with hypertension or preeclampsia, developed two logistic regression models, and assessed their predictive efficacy using receiver operating characteristic analysis and calibration techniques. Results: A study found that 168 participants (10.4%) experienced preterm pregnancies, with antepartum predictors including maternal age, pre-pregnancy BMI, and preeclampsia, and intrapartum factors like gestational age and labor duration. Novelty: The study introduces a novel predictive model for Pregnancy-Positive Hypertension (PPH) that integrates antepartum and intrapartum variables for risk assessment in high-risk populations. Implications: The study suggests that combining antepartum and intrapartum variables can improve risk stratification and preventive measures, requiring further refinement for improved maternal care outcomes. Highlights: Antepartum and intrapartum variables enhance PPH prediction accuracy. Model B outperforms antepartum-only model in predicting PPH. Results stress need for improved risk stratification and prevention strategies. Keywords: postpartum hemorrhage, gestational hypertension, preeclampsia, predictive modeling, logistic regression

Demographic Factors, Biochemical Markers, and Obstetric History Associated with the Risk of Preeclampsia in a Sudanese Population Sample

Background: Preeclampsia significantly contributes to maternal and perinatal illness and death, particularly in low and middle-income countries like Sudan. It is classified by onset timing (early vs. late) and severity (mild vs. severe) and is one of the four hypertensive disorders in pregnancy, including chronic hypertension, gestational hypertension, and chronic hypertension with superimposed preeclampsia. This study aimed to evaluate the demographic, clinical, and biochemical predictors of preeclampsia among Sudanese women. Methods: This case-control study involved 100 women diagnosed with preeclampsia and 100 healthy pregnant women who acted as the control group at Omdurman Maternity Hospital in Khartoum State, Sudan, from 2019 to 2021. Data on sociodemographic characteristics, obstetric history, and biochemical markers, including platelet counts, were collected using a comprehensive questionnaire and blood sample analysis. Results: Women with preeclampsia were more frequently over the age of 40 (OR=9.33, 95% CI: 4.54-19.19, p < 0.001) and had a longer median duration of marriage (OR=2.9, 95% CI: 1.51-5.58, p=0.001). Lower educational levels (p=0.008) and being housewives (p=0.024) were also more prevalent in the preeclampsia group. Clinically, headache (OR=18.98, 95% CI: 2.44-147.5, p=0.005) and blurring of vision (OR=25.83, 95% CI: 1.17-572.6, p=0.04) were more prevalent in women with preeclampsia. Biochemical markers showed lower platelet counts (p=0.002), higher levels of alanine aminotransferase (ALT) (OR=2.23, 95% CI: 1.51-3.28, p < 0.001) and creatinine (OR=16.76, 95% CI: 2.31-121.5, p=0.005), while aspartate aminotransferase (AST) was not significantly associated with preeclampsia. Conclusion: Family history of preeclampsia was the most significant predictor. Other important risk factors included older age, longer duration of marriage, lower education levels, headache, blurring of vision, and higher levels of alanine aminotransferase (ALT) and creatinine.

Is It Possible to Prevent the Thanatogenetic Processes in Premature Babies?

Preterm births comprise all pregnancies coming to an end before the gestational age of 37 weeks and remain the leading cause of death in children under 5 years old despite efforts to reduce their occurrence. We aim to analyze all morbidity and mortality data to understand causes and risk factors, helping in prevention efforts. This study includes 140 cases collected during 2018-2022. Demographic, maternal, and thanatogenetic data were statistically analyzed. We observed an upward slope of stillborn babies. In the case of live-born premature, the average survival was 301.76 h. The multivariate analysis noted that extremely low birth weight (HR = 5.141) and very low birth weight (HR = 4.177) are risk factors involved in mortality. Increased parity was associated with premature births with low and very low birth weight (p = 0.019). We observed that a mother's age of over 30 years is predictable for the development of pregnancy-induced hypertension. Cerebral and pulmonary hemorrhages were the most common intermediate morbid conditions, with prematurity and plurivisceral hemorrhages serving as their root causes. We have identified that anthropometric measurements have a high predictability on malformed babies. The identified associations indicate a shared mechanism for certain lesion processes, which can help optimize resources for predicting and preventing preterm neonatal issues.

P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women. Methods: A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (< 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals. Results: The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p <0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p<0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)]. Conclusions: Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.

Factors related to the occurrence of fetal birth defects and the construction of a Nomogram model.

To explore the influencing factors of fetal birth defects (BD) and construct a nomogram model. A total of 341 newborns admitted to Meizhou people's hospital from September 2021 to September 2023 were randomly grouped into a modeling group (239 cases) and a validation group (102 cases). The modeling group fetuses were separated into BD and non-BD groups. Multivariate logistic regression analyzed risk factors for BD; R software constructed a nomogram model; Receiver operating characteristic (ROC) curve evaluated the model's discrimination for BD. The top 5 types of BD were congenital heart disease, polydactyly/syndactyly, cleft lip/palate, ear malformation, and foot malformation, with incidence rates of 23.81%, 20.63%, 12.70%, 11.11%, and 7.94%, respectively. BD incidence was 26.36% (63/239). Significant differences between BD and non-BD groups were found in maternal age, gestational age, history of adverse pregnancy/childbirth, gestational hypertension, adverse emotions during pregnancy, and folic acid intake duration (P<0.05). Logistic regression showed maternal age (OR: 4.125), gestational age (OR: 3.066), adverse pregnancy history (OR: 10.628), gestational hypertension (OR: 5.658), adverse emotions (OR: 5.467), and folic acid intake duration (OR: 4.586) were risk factors for BD (P<0.05). The modeling group's ROC AUC was 0.938, calibration curve slope close to 1, H-L test =8.342, P=0.692; external validation AUC was 0.961, calibration slope close to 1, H-L test =7.634, P=0.635. Identified risk factors include maternal age, gestational age, adverse pregnancy history, gestational hypertension, adverse emotions, and folic acid intake duration. The nomogram model shows good discrimination and consistency for evaluating neonatal BD risk.

Causal Association of Rheumatoid Arthritis With Adverse Pregnancy Outcomes: Genetic Evidence From Mendelian Randomization.

Although the association of rheumatoid arthritis (RA) to multiple adverse pregnancy outcomes has been well-studied, the association between serum antibody levels in patients with RA and multiple adverse pregnancy outcomes has not been conclusively demonstrated. Here, we comprehensively assessed the causal impact of RA, serologic antibody-positive RA (pRA), and serologic antibody-negative RA (nRA) on the risk of 14 adverse pregnancy outcomes. The causal impact of RA, pRA, and nRA on 14 adverse pregnancy outcomes was comprehensively assessed using two-sample Mendelian randomization (MR). Evidence maps based on the results of these two-sample MR analyses were developed. Data from the UK Biobank and FinnGen databases were utilized for this analysis. The inverse variance weighted (IVW) test was employed as the primary method to estimate causality. "TwoSampleMR" and "MR-PRESSO" packages were used for data analysis in this study. Using two-sample MR analysis, we found a significant positive causal association between RA and increased risk of cesarean section (p=0.003), gestational hypertension (p < 0.001), number of spontaneous miscarriages (p=0.041), preeclampsia (p=0.008), premature rupture of membranes (p=0.030), and preterm (p=0.010). pRA had a significant positive causal association with an increased risk of cesarean section (p=0.012), gestational hypertension (p < 0.001), preeclampsia (p=0.002), and preterm (p=0.007). A significant positive causal association was also established between nRA and gestational hypertension (p=0.010), the number of spontaneous miscarriages (p=0.024), and placental abruption (p=0.027). In addition, we found a causal association between nRA and birth weight (p=0.007), but not between RA and pRA and birth weight. The results of this study have important implications for the individualized treatment of RA patients, especially those with positive serum antibody levels.

Maternal and Fetal Health Risks Among Female Military Aviation Officers.

INTRODUCTION: Military aviation poses unique occupational risks, including exposures to intermittent hypoxia, high gravitational force, and toxic materials, in addition to circadian disruption, cosmic radiation, and ergonomic stressors also present in commercial flight. We sought to investigate whether a military aviation officer's career is associated with adverse maternal or fetal health outcomes.METHODS: We conducted a retrospective cohort study of female aviation and nonaviation officers in the Military Health System from October 2002 to December 2019. Exposure was identified as assignment of an aviation occupation code. Maternal and fetal health outcomes were identified by International Classification of Diseases codes from medical records. Regression analysis was used to estimate adjusted relative risks (aRR).RESULTS: Included in the study were 25,929 active-duty female officers, with 46,323 recorded pregnancies and 32,853 recorded deliveries; 2131 pregnancies were diagnosed in aviation officers. Pregnant aviation officers had a decreased risk of composite adverse pregnancy outcomes [aRR 0.82 (0.73-0.92)], including gestational diabetes [aRR 0.69 (0.57-0.85)] and gestational hypertension [aRR 0.84 (0.71-0.99)]. Pregnant aviation officers had a decreased risk of depression prior to delivery [aRR 0.43 (0.35-0.53)] and hyperemesis gravidarum [aRR 0.74 (0.57-0.96)], but an increased risk of placental complications [aRR 1.15 (1.02-1.30)] and fetal growth restriction [aRR 1.36 (1.16-1.60)].DISCUSSION: Pregnant military aviation officers have an increased risk of placental complications and fetal growth restriction in spite of a lower risk of gestational diabetes and gestational hypertension. Further research is needed to determine how flight-related occupations impact pregnancy.Stark CM, Sorensen IS, Royall M, Dorr M, Brown J, Dobson N, Salzman S, Susi A, Hisle-Gorman E, Huggins BH, Nylund CM. Maternal and fetal health risks among female military aviation officers. Aerosp Med Hum Perform. 2024; 95(9):675-682.

Neonatal sex and maternal factors associated with small-for-gestational-age neonates: A nationwide population-based study.

Small-for-gestational-age (SGA) newborns have a higher risk of morbidity and mortality. Recognizing the risk factors for SGA helps raise early awareness of the issue and provides valuable insights for both healthcare providers and pregnant women. We aimed to identify determinants of SGA using population-based databases in Taiwan. Data were retrieved from the National Health Insurance, Birth Reporting, and Maternal and Child Health databases for this nationwide case-control study. Live births between 20 and 44 weeks of gestation from 2005 to 2014 were enrolled and linked to their mothers to determine maternal conditions during pregnancy. For every SGA newborn, four controls matched by gestational age and birth year were randomly selected. Multivariable logistic regression was used to identify risk factors for SGA, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) accounting for potential confounders and interaction terms. A total of 158,405 live SGA births were identified, with 623,584 controls randomly selected. Independent risk factors for SGA included maternal age <20 years (aOR 1.68, 95% CI 1.62, 1.75); female sex in newborns (aOR 1.28, 95% CI 1.27, 1.30); socioeconomic deprivation (aOR 1.29, 95% CI 1.21, 1.38); hypertension (aOR 1.6, 95% CI 1.52, 1.67); kidney disorders (aOR 1.29, 95% CI 1.16, 1.44); thyroid disorders (aOR 1.13, 95% CI 1.09, 1.17); systemic lupus erythematosus (aOR 2.59, 95% CI 2.33, 2.89); antiphospholipid syndrome (aOR 2.08, 95% CI 1.64, 2.64); gestational hypertension (aOR 1.69, 95% CI 1.61, 1.76); pre-eclampsia (aOR 3.12, 95% CI 3.01, 3.25); and antepartum hemorrhage (aOR 1.05, 95% CI 1.03, 1.07) after adjustment for other covariates. SGA was associated with younger maternal age, female newborns, underlying comorbidities, and obstetric conditions. Gestational hypertension and pre-eclampsia were significant risk factors affecting infants of both sexes and all age groups and could mask the effects of maternal age and infant sex.

O22 MATERNAL AND FETAL OUTCOMES OF VARIOUS ANTIHYPERTENSIVE TREATMENT REGIMENS DURING PREGNANCY: INSIGHTS FROM THE CZECH NATIONAL REGISTRY 2012-2022

Introduction: Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. This study aimed to analyze the outcomes of pregnancy in women treated with different antihypertensive drugs. Methodology: Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy-induced hypertension. Hypoxia in the newborn was defined as pH &lt;7.1 or Apgar score &lt;8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes. Results: There were a total of 1,154,648 deliveries in the 11-year period. 95,215 women (8.2%) had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, newborn hypoxia, and pre-eclampsia in women using different antihypertensive classes and drugs are shown in the Figure. The risk of maternal and fetal complications was higher with calcium channel blockers (mainly amlodipine) compared to methyldopa and beta-blockers. Among beta-blockers, bisoprolol had the most favorable safety profile. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors and angiotensin receptor blockers (ARBs) appeared to be comparably safe to methyldopa. A combination of multiple antihypertensive drugs was associated with a higher risk of adverse outcomes. Conclusion: Bisoprolol, verapamil, and diuretics seem to have a risk of adverse maternal and fetal outcomes comparable to methyldopa. Amlodipine and multiple antihypertensive drug combinations are associated with increased risk.

Assessing the Role of Fetal Doppler in High-Risk Obstetrics: Evidence From a Comprehensive Study.

Background Colour Doppler ultrasound is pivotal in modern obstetrics for evaluating maternal and fetal health, especially in high-risk pregnancies. It enhances fetal oxygenation and nutrient delivery assessment, aiding in the early detection of adverse outcomes. However, its effectiveness is influenced by operator skill and the potential for interpretative variability. Aim This study aims to assess the utility of Doppler ultrasound in evaluating fetal status in high-risk pregnancies at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India. Materials and methods A hospital-based observational study was conducted from September 2022 to July 2024, including 145 high-risk pregnant women, of whom 120 delivered at the institute. The study included thorough maternal and fetal assessments, with regular Doppler studies starting at 28 weeks of gestation. The frequency of these studies was adjusted according to the changes and severity observed in the indices. Detailed documentation of both maternal and neonatal outcomes was meticulously maintained. Statistical analyses were performed using MS Excel (Microsoft® Corp., Redmond, WA, USA) and RStudio,Version 2023.08.0-daily+170 (RStudio, Inc., Boston, MA, USA), with a significance threshold of p < 0.05. Results The majority of participants were aged 21-30 years, with multigravida constituting 63.33%. Pregnancy-induced hypertension (PIH) and preeclampsia were the most common high-risk factors (28.33%). Abnormal umbilical artery (UA) flow patterns were observed in 58.33% of cases. Abnormal UA and middle cerebral artery (MCA) Doppler indices correlated significantly with adverse outcomes. Most deliveries were via caesarean section (82.5%), and 63.33% of neonates required Neonatal Intensive Care Unit (NICU) admission. Neonates with abnormal antenatal Doppler studies had significantly lower APGAR (appearance, pulse, grimace, activity, and respiration) scores and higher NICU admission rates. Discussion The study highlights the critical role of Doppler ultrasound in managing high-risk pregnancies, providing essential data for early interventions. Consistent with other studies, abnormal Doppler patterns were significantly associated with adverse neonatal outcomes, necessitating timely caesarean deliveries. Conclusion Fetal Doppler ultrasonography is essential for managing high-risk pregnancies, enabling timely therapeutic interventions and improving perinatal outcomes. Despite its limitations, Doppler technology remains invaluable in identifying at-risk foetuses and guiding clinical decisions for optimal pregnancy management.

Abstract 48: Cardiovascular Health Modifies Genetic Risk for the Hypertensive Disorders of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal/perinatal mortality. In recent work, a genetic risk score improved prediction of HDPs beyond standard clinical risk factors, but the extent to which cardiovascular health (CVH) modifies HDP genetic risk is unknown. Hypothesis: First-trimester CVH can offset genetic risk for HDPs. Methods: We examined genotyped participants of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b). Individual HDP genetic risk was calculated using a validated polygenic score. A composite first-trimester CVH score was adapted from the Life’s Essential 8 model; cholesterol was incorporated in a subset (47%) with available first-trimester values. Genetic risk and CVH were each grouped as low (bottom quintile), intermediate (Q2-4), and high (top quintile). Logistic regression tested the joint association of CVH and genetic risk with HDP, adjusted for age and sociodemographic covariates. Results: Among 5,446 participants (mean age 27.5 years), 1,339 (24.6%) developed HDP (344 [6.3%] preeclampsia, 995 [18.3%] gestational hypertension [GH]). Higher genetic risk and lower CVH were additively associated with risk of HDP ( Figure 1A-B ) with no significant interaction (P[interaction] &gt;0.05). HDP incidence ranged from 11% (low genetic risk, favorable CVH) to 37% (high genetic risk, unfavorable CVH) ( Figure 1C ). Favorable vs. unfavorable CVH was associated with 35-62% lower risk of HDPs across genetic risk groups. Findings were broadly consistent when examining preeclampsia and GH separately and when incorporating cholesterol (i.e., using a complete Life’s Essential 8 score). Among CVH components, nonideal BMI, blood pressure, and diet conferred highest population attributable HDP risk (25%, 14%, and 12%, respectively). Conclusion: Higher genetic risk and lower first trimester CVH were additively associated with risk of developing HDP. Favorable CVH in early pregnancy may partially offset a higher genetic risk for HDP.

Abstract 69: Female Blood Pressure High 5 Mice Display Cerebral Hypoperfusion In the Non-Pregnant and Late Pregnant State

The rates of hypertensive pregnancy disorders such as gestational hypertension, pre-eclampsia/eclampsia (PE/E), and chronic hypertension with or without superimposed PE have increased in recent years. Cerebrovascular disorders in the antenatal and postpartum period are common complications of hypertensive pregnancy disorders. Chronic hypertension is linked to cerebrovascular rarefaction, decreased regional perfusion, and cognitive decline later in life. The blood pressure high 5 (BPH/5) mouse has been characterized as a model of superimposed PE; however, cerebrovascular changes have not been described. We hypothesized that BPH/5 mice will display reduced regional cerebral perfusion regardless of pregnancy status. To test this, we used non-pregnant and timed-pregnant BPH5 mice and control SMA-GFP mice (C57/BL6 background) (n=3-4 per group). On gestational day 18.5, cerebral perfusion was measured using laser speckle imaging in different brain regions, along with general physiological characteristics (heart rate and oxygen saturation), body, heart, and brain weight, and the number and weight of live fetuses. There was a main effect of pregnancy to increase body weight (p&lt;0.01), hematocrit (p=0.04), and sPO2 (p=0.02). There was a strain effect on sPO2 (p&lt;0.01), heart rate (p&lt;0.01), perfusion of right parietal cortex (p=0.02), whole brain (p&lt;0.01), prefrontal cortex (p&lt;0.01), with significant decreases in pregnant BPH5 compared to pregnant SMA-GFP mice (p&lt;0.05). There was no difference in number (8±1 vs 6±2) and mean body weight (1021±24 vs 883±160 mg) of live fetuses between control vs. BPH5 mice (Mean ± SD). These results support the hypothesis chronic hypertension and superimposed PE lead to reduced cerebral perfusion. Future studies will determine whether reduced cerebral perfusion is associated with cerebrovascular rarefaction and whether these are blood pressure dependent.

Abstract MP27: Pregnant Women of Advanced Maternal Age Have Higher Central Artery Stiffness Than Younger Pregnant Women

The frequency of women undergoing pregnancy at advanced maternal age (AMA, ≥35 years) is increasing in developed countries, including the United States. AMA is associated with an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and preterm birth. Increased risk for adverse pregnancy outcomes at AMA may be mediated in part by altered arterial structure and function or inadequate maternal arterial adaptations during pregnancy. Therefore, we examined central artery stiffness and endothelial function across healthy pregnancy (i.e. no comorbid maternal or fetal conditions, born at term) in women who had enrolled in a longitudinal study between March 2015 and January 2020. We hypothesized that women at AMA (age ≥35 years, mean±SE: 36±0 years, n=18) would have higher arterial stiffness and lower endothelial function compared with younger women (age 21-30 years, mean±SE: 27±0 years, n=51) across pregnancy. Hemodynamic and arterial function measures were collected in the first (6-13 weeks), second (18-26 weeks), and third (27-37 weeks) trimesters and postpartum (4-14 weeks after the delivery). Brachial artery blood pressure was assessed in the supine position and central artery stiffness was assessed via carotid-femoral (aortic) pulse wave velocity (cfPWV) and carotid β-stiffness index. Endothelial function was determined via brachial artery flow-mediated dilation (FMD). Brachial artery systolic, diastolic, and mean blood pressures were not different between AMA and younger women across pregnancy or postpartum (all P &gt;0.05). The AMA group had higher cfPWV ( P &lt;0.01) and carotid β-stiffness index ( P &lt;0.01) across pregnancy and postpartum compared to the younger group. cfPWV decreased among younger women at the second and third trimesters compared with the first trimester ( P &lt;0.01), while cfPWV among women of AMA did not change ( P =0.07). There were no differences in FMD between AMA and younger women across pregnancy or postpartum ( P =0.96). These results demonstrate that healthy women of AMA have increased central artery stiffness, but no difference in endothelial function, compared to younger pregnant women across pregnancy, and that the normal decrease in aortic stiffness is blunted in pregnant women of AMA compared to younger women. The sustained higher central artery stiffness throughout pregnancy among women of AMA may contribute to increased risk of pregnancy complications and future CVD risk in these women.

Pulse Wave Velocity as a Tool for Cardiometabolic Risk Stratification in Individuals With Hypertensive Disorders of Pregnancy and Increased BMI

ObjectivesObesity is one of the most prevalent risk factors for hypertensive disorders of pregnancy (HDP); however, the role of pre-pregnancy cardiometabolic health in the development of these conditions is not well understood. Carotid-femoral pulse wave velocity (PWV) is an established measure of arterial stiffness and cardiovascular health and is validated in pregnancy. Our objective was to examine the obesity-related changes in PWV in pregnant individuals with and without HDP. MethodsOverall, 87 individuals with singleton pregnancies were recruited and classified into 2 groups: cases (HDP: including pre-existing/chronic hypertension, gestational hypertension, preeclampsia, or intrauterine growth restriction; n = 39) and normotensive controls (no HDP or intrauterine growth restriction; n = 48). Patient data, including BMI, were collected from patient charts. Measurements of PWV were performed weekly until discharge or delivery (gestational age 24–37 weeks) and placental growth factor (PlGF) was measured at routine blood draws. ResultsPWV did not significantly change over gestation for either group. Cases had significantly increased PWV and decreased PlGF compared to normotensive controls. An elevated BMI was associated with higher PWV in both cases and controls. Once grouped based on BMI, PWV was only significantly higher in cases with a BMI ≥25 kg/m2 compared to controls, whereas PlGF was less affected by BMI. As PWV increased, PlGF decreased; however, after controlling for BMI, there was no relationship between PWV and PlGF. ConclusionsPWV measurements in early pregnancy may be useful as an additional independent marker to PlGF for risk-stratifying for HDP, especially in individuals with increased BMI.

Clinical Features Between Primary Obstetric Antiphospholipid Syndrome and Non-Criteria Obstetric Antiphospholipid Syndrome and Risk Factors of Adverse Pregnancy Outcomes: A Retrospective Study of 1006 Cases.

To compare the clinical characteristics and pregnancy outcomes between patients with primary obstetric antiphospholipid syndrome (OAPS) and those with primary non-criteria obstetric antiphospholipid syndrome (NC-OAPS), and to identify the risk factors of adverse pregnancy outcomes in both groups. A retrospective single-center study was performed in a university hospital of western China, including 141 patients with OAPS and 865 patients with NC-OAPS. The clinical characteristics, pregnancy complications, and obstetric outcomes of the cohorts were collected from the hospital system and were compared by univariable analysis, and the independent risk factors for adverse pregnancy outcomes (APO) were investigated by logistic regression analysis in these two populations. The OAPS patients had a significantly higher risk for stillbirths compared to the NC-OAPS patients, while the NC-OAPS group had a significantly higher risk for preterm birth and overall APO. Double aPL positivity, triple aPL positivity, and gestational hypertension were the independent risk factors for APO in OAPS patients, whereas two of the double aPL positivity subtypes, triple aPL positivity and placenta previa were independent risk factors for APO in NC-OAPS patients. This study identified different rates in different APOs among OAPS and NC-OAPS patients. Additionally, this study revealed different risk factors for the development of APO between the two populations. These findings indicated that OAPS and NC-OAPS are two distinct entities of the same disease, providing new insights into the individualized management for patients with OAPS and NC-OAPS.

Physical Activity in Pregnancy: The Role of Exercise in Promoting Maternal and Fetal Health

Introduction and Objective: There is no doubt that engaging in regular physical activity is beneficial for individuals of all ages. Pregnancy is a special time of life for most women. This period presents a unique opportunity for them to improve their lifestyle choices and adopt healthier habits such as exercise. The aim of this article is to find out if regular physical activity during pregnancy has a positive impact for both the mother and the baby.Review and Methods: Review and summary of available studies and meta-analyses found in open-access formats on Google Scholar and PubMed.State of Knowledge: The WHO defines physical activity as any bodily movement requiring energy expenditure, including during leisure, transport, work, and domestic activities. Regular exercise reduces the risk of noncommunicable diseases (NCDs) and poor health outcomes, while sedentary behavior contributes to this and burdens healthcare systems. For pregnant and postpartum women, physical movement decreases the risk of various complications, with no negative effects on birthweight or stillbirth risk. Conclusions: Studies show that physical activity decreased risk of pre-eclampsia, gestational hypertension, gestational diabetes, excessive gestational weight gain, delivery complications, postpartum depression and newborn complications.

Association between serum hormone levels in early pregnancy and risk of hypertensive diseases of pregnancy in women undergoing assisted reproduction.

We examined the association between progesterone (P4), estradiol (E2), and human chorionic gonadotropin (hCG) levels in early pregnancy and the development of hypertensive diseases of pregnancy among women undergoing assisted reproduction. Retrospective study including patients who underwent frozen embryo transfer (FET), ovarian stimulation (OS), or unassisted conception (UC) and had a live singleton birth. The primary outcome was the development of hypertensive diseases of pregnancy (gestational hypertension, preeclampsia, HELLP, or eclampsia). Secondary outcomes were the development of fetal intrauterine growth restriction (IUGR), gestational diabetes mellitus, birth weight, and pre-term birth. Hormone levels and the development of the outcomes were correlated. A total of 681 patients were included; 189 had FET, 193 had OS, and 299 had UC. Patients undergoing FET or OS were not more likely to develop hypertensive diseases of pregnancy compared with UC patients. While median levels of E2 and P4 were significantly different between P-FET and NC-FET patients (E2: 252 vs 317pg/mL, P4: 64 vs 29ng/mL, respectively; both p < 0.01), rates of hypertensive diseases of pregnancy did not significantly differ between those two groups. In the multivariate analyses, P4, E2, and hCG were not associated with the development of hypertensive diseases of pregnancy, but progesterone levels were significantly higher among those with IUGR. This remained consistent when the analysis was limited to FET patients. P4, E2, and hCG levels did not correlate with the development of hypertensive diseases of pregnancy but elevated progesterone levels did correlate with the development of IUGR.

Research Progress on Extracellular Matrix Involved in the Development of Preeclampsia.

Preeclampsia (PE) is a serious pregnancy complication, and its primary clinical manifestations are gestational hypertension and proteinuria. Trophoblasts are responsible for the basic functions of the placenta during placental development; recent studies have revealed that placental "shallow implantation" caused by the decreased invasiveness of placental trophoblasts plays a crucial role in PE pathogenesis. The interaction between the cells and the extracellular matrix (ECM) plays a crucial role in trophoblast proliferation, differentiation, and invasion. Abnormal ECM function can result in insufficient migration and invasion of placental trophoblasts, thus participating in PE. This article summarizes the recent studies on the involvement of ECM components, including small leucine-rich proteoglycans, syndecans, glypicans, laminins, fibronectin, collagen, and hyaluronic acid, in the development of PE. ECM plays various roles in PE development, most notably by controlling the activities of trophoblasts. The ECM is structurally stable and can serve as a biological diagnostic marker and therapeutic target for PE.

P186 ASSESSMENT OF ECHOCARDIOGRAPHY INDICATORS AND ENDOTHELIAL DYSFUNCTION IN PREGNANT WOMEN WITH GESTATIONAL ARTERIAL HYPERTENSION

Background and Objective: Hypertensive disorders during pregnancy occur in 5–10% of pregnant women worldwide. In Central Asia, hypertension accounts for 14.5% of all maternal deaths. To identify the features of hemodynamic parameters in pregnant women with gestational arterial hypertension (GHTN). Methods: Study included 74 women, who were divided into 2 groups: Group I healthy pregnant women (n=44) and Group II pregnant women with HAG (n=30) according to 2018 ESC/ESH. All pregnant women underwent medical history collection, blood pressure measurement, ECG, B-mode echocardiography, 24-hour blood pressure monitoring, and endothelial function was determined based on an ultrasound cuff test. Statistical analysis of the obtained data was carried out using the STATISTICA 13 program. P &lt;0.05 was considered statistically significant Results: The compared groups were comparable in age (27.24±5.79 years vs. 29.07±6.51 years, P = 0.2085), number of pregnancies (2.55±1.63 vs. 2.5±1.35 P = 0.8901), childbirth (2.11±1.13 vs. 2.13±1.02 P = 0.9378) and gestational age (28.4±3.89 vs. 29.6±4.86 P = 0.2632). The average BP level in II group corresponded to moderately elevated BP, amounting to SBP of 153.17±8.14 mmHg vs 102.72±10.42 mmHg (P&lt;0.0001), according to DBP 96±4.62 mmHg. vs 64.77±5.9 mmHg. in group 1 (P &lt;0.0001). Body mass index was normal in 37 women (84%) with normotension, while all pregnant women (100%) with GAG were overweight (n=14; 46.6%) and obese (n=16; 53.4%) respectively. Analysis of central hemodynamic parameters did not reveal any signs of cardiac remodeling (LVH, LVDD). Echocardiography did not reveal any statistically significant deviations. But in pregnant women with GHTN, signs of endothelial dysfunction were revealed according to the results of the cuff test ^D (%) was 7.93 ± 2.03 versus 10.97 ± 2.73 (P &lt; 0.0001). Conclusion: According to the results of this study, initial manifestations of diastolic dysfunction were identified among pregnant women with GHTN who are overweight.