Prevalence Of Hypertensive Disorders Of Pregnancy Research Articles

Luteal phase support of intramuscular progesterone associated with lower hypertensive disorders of pregnancy as compared to vaginal progesterone: A cohort study.

To compare the hypertensive disorders of pregnancy (HDP) risk between vaginal and intramuscular (IM) progesterone in programmed frozen-thawed embryo transfer (FET) cycles. This was a retrospective cohort study at a tertiary hospital, and only women who achieved ongoing pregnancy after programmed FET between January 2018 and June 2022 were included. Women with chronic hypertension before pregnancy or with history of gestational hypertension or pre-eclampsia in previous pregnancies were excluded. All women were divided into IM progesterone or vaginal progesterone groups according to the route of progesterone supplementation. Follow-up information on obstetric complications and neonatal outcomes were obtained by telephonic interviews. The primary outcome was HDP. Association between routes of progesterone supplementation and HDP was assessed by subgroup analysis and multivariable logistic regression. A total of 5891 programmed FET cycles (3196 IM progesterone cycles and 2695 vaginal progesterone cycles) were included in the analysis. The prevalence of HDP in the IM progesterone group was significantly lower than that of the vaginal progesterone group (6.54% vs 9.17%, P < 0.001). Therein, the prevalence of gestational hypertension (3.57% vs 4.94%, P = 0.009) and pre-eclampsia (2.97% vs 4.23%, P = 0.009) in the IM progesterone group were all significantly lower as compared to the vaginal progesterone group. According to subgroup analysis, IM progesterone was associated with lower HDP risk in all subgroups. The logistic regression analysis showed that the IM progesterone cycles were associated with lower risk of HDP compared to vaginal progesterone cycles (adjusted odds ratio 0.66, 95% CI: 0.54-0.80, P < 0.001). Among women undergoing programmed FET cycles, progesterone supplementation with IM progesterone was associated with reduced HDP risk compared to vaginal progesterone.

Hypertensive disorders of pregnancy in Western Brazilian Amazon: Associated factors and neonatal outcomes.

Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. This is a population-based cross-sectional study with 1521 mother-child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA-Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. The prevalence of HDP was 11.0% (95% CI: 9.5-12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), primigravida status (PR: 2.0; 95% CI: 1.5-2.7), pre-pregnancy obesity (PR: 2.7; 95% CI: 1.9-4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6-3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7-4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1-3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes.

A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial.

Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952. RR2-10.3389/fgwh.2021.620759.

Relation of Disaster Exposure With Maternal Characteristics and Obstetric Outcomes: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

The present study analyzed the relation of disaster exposure prior to pregnancy with maternal characteristics and obstetric outcomes. The participants were 13,148 pregnant women recruited from 2013 to 2017. The women were classified into three groups by the severity of housing damage caused by the Great East Japan Earthquake of 2011: group A, house was not destroyed/did not live in the disaster area; group B, half/part of the house was destroyed; and group C, house was totally/mostly destroyed. Maternal characteristics, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and gestational weeks were obtained using questionnaires and medical records. Multiple logistic regression analyses were performed to investigate the relation between disaster exposure and maternal characteristics, HDP, and GDM. A structural equation model was applied to investigate the relation of disaster exposure with HDP and gestational weeks. The homes of about 11% of the women were totally/mostly destroyed. For groups B and C compared with those in group A, the adjusted ORs for HDP were 1.04 and 1.26 (P for trend = 0.01), and for GDM were 0.89 and 1.14 (P for trend = 0.9), respectively. Pre-pregnancy body mass index (BMI) mediated 23.2% of the relation between disaster exposure and HDP. Disaster exposure was associated with gestational weeks. Disaster exposure at least 2.5 years before pregnancy was found to be associated with maternal characteristics and the prevalence of HDP. Pre-pregnancy BMI mediated the relation between disaster exposure and the prevalence of HDP, and gestational weeks were reduced through HDP.

The effect of maternal hypertension and maternal mental illness on adverse neonatal outcomes: A mediation and moderation analysis in a U.S. cohort of 9 million pregnancies

BackgroundWhile hypertensive disorders of pregnancy (HDP) coexist with maternal anxiety and depression, it is unclear how these conditions affect neonatal outcomes. We evaluated the prevalence as well as associations and potential mechanisms between HDP, maternal anxiety and depression, preterm birth (PTB), and small for gestational age (SGA). MethodsWe conducted a retrospective population-based study using the Healthcare Cost and Utilization Project (HCUP) database from 2004 to 2014. Preterm birth (<37 weeks), SGA (<10th percentile for gestational age and sex), HDP, and mental disorders (anxiety and depression) were extracted using the International Classification of Diseases, Ninth Revision (ICD-9). Mediation and moderation models were constructed separately to evaluate potential mechanisms between maternal anxiety and depression, HDP, and adverse neonatal outcomes. Multivariate logistic regressions were used to determine their associations. ResultsOf 9,097,355 pregnant women, the prevalence of HDP was 6.9 %, anxiety 0.91 %, depression 0.36 %, preterm birth 7.2 %, and SGA 2.1 %. Anxiety increased the probability of having HDP (OR = 1.242, 95 % CI 1.235–1.250), and HDP mediated the association between anxiety and preterm birth (mediation effect = 0.048, p-value<0.001). Depression significantly moderated the effect of HDP on preterm birth (moderation effect = −0.126, p-value = 0.027). HDP also mediated the association between anxiety and SGA (mediation effect = 0.042, p-value<0.001), but depression did not moderate the association between HDP and SGA (p-value = 0.29). ConclusionOur study suggests that women with anxiety are more likely to have HDP, and HDP mediates the associations between anxiety and adverse neonatal outcomes. Depression moderates associations between HDP and preterm birth but not between HDP and SGA.

Risk Factors and Outcomes Associated With Hypertensive Disorders of Pregnancy in Maternal Congenital Heart Disease

BackgroundAmong women with congenital heart disease (CHD), risk factors for hypertensive disorders of pregnancy (HDP) and the association of HDP with adverse outcomes are unknown. ObjectivesThe purpose of this study was to identify risk factors for HDP among women with and without CHD and to assess the association of HDP with adverse events. MethodsThis retrospective cohort study included the first live birth for each woman who was pregnant in Alberta, Canada, between January 1, 2005, and December 31, 2018. The prevalence of HDP among women with and without CHD was compared. Multivariable models were used to determine the independent associations between maternal characteristics and HDP and to assess the strength of associations between HDP and CHD with adverse events. ResultsOf the total birth events, 0.6% (N = 2,575) occurred in women with CHD. HDP were more common among women with CHD (11.2% vs 8.1%, P < 0.0001). Chronic hypertension and diabetes mellitus were strongly associated with HDP among women with CHD (adjusted odds ratio [aOR]: 4.56; 95% confidence interval [CI]: 2.95-7.03; and aOR: 3.33; 95% CI: 1.48-7.49, respectively). Coarctation of the aorta was the only CHD lesion independently associated with increased risk for HDP (aOR: 1.76; 95% CI: 1.02-3.02). HDP, as opposed to CHD, was more strongly associated with having a complicated delivery admission, preterm delivery, and small for gestational age infant. ConclusionsHDP were more common among women with CHD. The strongest risk factors for HDP among women with CHD were acquired. The presence of HDP, rather than CHD, was more strongly associated with certain adverse outcomes.

Polycystic ovary syndrome is an independent risk factor for hypertensive disorders of pregnancy: A systematic review, meta-analysis, and meta-regression.

The risk of hypertensive disorders of pregnancy (HDP) in women with polycystic ovary syndrome (PCOS) is inconsistent in some studies. The aim of this meta-analysis was to examine the evidence regarding the strength of the association between PCOS and HDP. PubMed, Web of Science, Embase, and the Cochrane Library were systematically searched to identify observational studies investigating HDP in patients with PCOS. The primary outcome was the pooled odds ratio (OR) of HDP, including pregnancy-induced hypertension (PIH) and pre-eclampsia (PE), in women with PCOS compared with the non-PCOS population. A total of 30 studies were eligible for meta-analysis. PCOS was associated with a higher risk of HDP (OR 2.02, 95CI% 1.83-2.22), including PIH (OR 1.94, 95CI% 1.70-2.21), and PE (OR 2.07, 95CI% 1.91-2.24). The association remained significant after adjusting for age, body mass index (BMI), and nulliparity (HDP: OR 1.48, 95CI% 1.48-1.60; PIH: OR 1.42, 95%CI 1.29-1.57; PE: OR 2.07, and 95%CI 1.91-2.24). The increased risk of HDP for the PCOS group remained significant in subgroups of BMI, Age, singleton pregnancy, multiple pregnancy, gestational diabetes mellitus (GDM), hyperandrogenism, and nulliparity, while the finding was not observed in subgroups of nonhyperandrogenic and non-GDM. In the meta-regression, BMI contributed significantly to the heterogeneity in the prevalence of HDP. PCOS is independently associated with a significantly increased risk of HDP. To prevent HDP during pregnancy, our findings highlight the importance of establishing supervision guidelines for PCOS patients, especially in the population with hyperandrogenism and GDM.

241 Hypertensive disorders of pregnancy at term: timing of development versus indication for delivery

The ARRIVE trial found that low-risk women randomized to expectant management (EM) had a higher risk of developing hypertensive disorders of pregnancy (HDP) compared to women randomized to elective induction at 39 weeks. A subsequent secondary analysis of the ARRIVE trial comparing outcomes of women undergoing EM found that HDP decreased with advancing gestational age (GA) at delivery. Thus, the aim of this study was to verify the timing of HDP diagnosis and prevalence at delivery. Secondary analysis of a multicenter, prospective cohort study of nulliparous women with singleton gestations (nuMoM2b). Women who delivered at ≥370 weeks gestation were included. The primary outcome was HDP, defined as gestational hypertension or preeclampsia ± severe features. Descriptive statistics were used to evaluate HDP in two ways: Analysis 1) incidence of HDP (by GA week) among all ongoing pregnancies, i.e. women with HDP at 370-6/7wk divided by women who delivered at ≥370wk and Analysis 2) the prevalence of HDP (by GA week) among deliveries at that GA week, i.e. women with HDP at 370-6/7wk divided by women who delivered at 370-6/7wk. We assumed that HDP was not expectantly managed at term. Of the 8,011 women included in this analysis, 1,003 (12.5%) had HDP: 162 delivered at 370-6/7wk, 232 delivered at 380-6/7wk, 310 delivered at 390-6/7wk, 207 delivered at 400-6/7wk, and 92 delivered at ≥410wk. In Analysis 1, the incidence of HDP among all ongoing pregnancies increased with advancing GA (Figure 1). In Analysis 2, the prevalence of HDP among deliveries at each GA week decreased with advancing GA. (Figure 2). Our results confirm the findings from both the primary ARRIVE trial and ARRIVE secondary analysis. The risk of HDP increases as pregnancy progresses, but HDP is less common among deliveries at later GA. This study further demonstrates the importance of selecting the appropriate analytic strategy to answer the specific question of interest and the limitations of comparing maternal outcomes by delivery GA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Life stressors, hypertensive disorders of pregnancy, and preterm birth

Background Stress-induced pregnancy complications are thought to represent a significant cause of maternal morbidity and mortality; little is known regarding types of stress most predictive of adverse outcomes. Methods We used Utah PRAMs 2012–2014 data to evaluate links between preconception life stressors and prevalence of hypertensive disorders of pregnancy (HDP) and pre-term labor (PTB) (births <37 weeks gestational age, and very PTB <33 weeks). We categorized 12 specific stressful events into 4 groups: partner, traumatic, financial, and emotional. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated controlling for important sociodemographic, lifestyle, and pregnancy history factors. Results 4,378 mothers completed the survey. 26.6%, 12.2%, 32.2%, and 28.4% reported partner, traumatic, financial, and emotional-related stress. Reporting any of the 4-types of life stress was linked with increased prevalence of HDP (aPR: 1.46 [95% CI: 0.96, 2.22]) after adjusting for age, race/ethnicity, BMI, education, prior diagnosis of high blood pressure, and prior history of preterm labor. The strongest association was observed for financial stress (aPR: 1.50 [95% CI: 1.03, 2.18]). Financial stress was also associated with increased prevalence of very PTB (aPR: 1.61 [95% CI: 1.03, 2.51]) after adjustment. Conclusion Women reporting financial stress, including job loss, pay reduction, or difficulty paying bills, had increased prevalence of HDP and very PTB.

Racial Disparity in Pregnancy Risks and Complications in the US: Temporal Changes during 2007-2018.

Maternal race and ethnicity have been associated with differences in pregnancy related morbidity and mortality. We aimed to evaluate the trends of several pregnancy risk factors/complications among different maternal racial/ethnic groups in the US between 2007 and 2018. Specifically, we used the Center for Disease Control and Prevention (CDC) natality files for these years to assess the trends of hypertensive disorders of pregnancy (HDP), chronic hypertension (CH), diabetes mellitus (DM), advanced maternal age (AMA) and grand multiparity (GM) among non-Hispanic Whites, non-Hispanic Blacks and Hispanics. We find that the prevalence of all of these risk factors/complications increased significantly across all racial/ethnic groups from 2007 to 2018. In particular, Hispanic women exhibited the highest increase, followed by non-Hispanic Black women, in the prevalence of HDP, CH, DM and AMA. However, throughout the entire period, the overall prevalence remained highest among non-Hispanic Blacks for HDP, CH and GM, among Hispanics for DM, and among non-Hispanic Whites for AMA. Our results point to significant racial/ethnic differences in the overall prevalence, as well as the temporal changes in the prevalence, of these pregnancy risk factors/complications during the 2007–2018 period. These findings could potentially contribute to our understanding of the observed racial/ethnic differences in maternal morbidity and mortality.

Prevalence of Hypertensive Disorder of Pregnancy in North India

Aims and Objective: Hypertensive disorders of pregnancy (HDP) are among the commonest medical disorders during pregnancy constituting one of the greatest causes of maternal and perinatal morbidity and mortality worldwide . This study aimed to analyze the prevalence of hypertensive disorder of pregnancy in North India&#x0D; Material and Method: The study group consisted of a total of 150 pregnant women attending Maharaja Agrasen hospital OPD/IPD during their second trimester (14-20 weeks) of pregnancy from Dec 2016 to Nov 2017.&#x0D; Results: Out of 146 cases studied , 129 cases remained normotensive and 17 cases developed HDP. Out of 17 cases ,8 cases had mild HDPs and 9 cases had severe HDPs. The prevalence of HDP was 11.7% in present study.&#x0D; Conclusion: The study concluded that the incidence of hypertensive disorders in pregnancy was higher than worldwide average and hence early diagnosis and intervention through regular antenatal checkup is pivotal to prevent hypertensive disorders of pregnancy and its complications.

Prevalence and Risk Factors of Hypertensive Disorders in Pregnancy: Case of Mezam Division, NWR Cameroon

Background: Hypertensive disorders of pregnancy (HDP) are a global public health concern both in developed and developing countries. Evidence regarding the risk factors of HDP are limited in Cameroon. The aim of the study was to determine the prevalence and risk factors of HDP in Mezam Division. Methods: A cross sectional study conducted between April-July, 2018 in Mezam Division. Consecutive sampling was used to recruit 1210 pregnant women. Descriptive statistics, chi-square (χ2) test and multivariate logistic regression were used for analysis. Results: The prevalence of HDP was 14.5%; of which 3.4% chronic HTN (CH), 31.8% gestational HTN (GH), 48.3% preeclampsia (PE), 5.7% PE superimpose on CH and 10.8% severe PE. Risk factors of CH were: Family history HTN [Adjusted Odd Ratio (AOR), 95%Confidence Interval (CI): 3.70 (1.7-11.6)], stress [2.80 (1.1-10.9)] and overweight/obese [2.6 (1.3-6.7)]. For GH, Single/separated [2.7 (1.5-4.7)], family history [4.4 (1.5-13.1)], alcohol [2.8 (1.1-5.4)] and previous history of HDP [4.9 (1.5-10.2)] were significant. For PE, overweight/obese [2.7 (1.4-7.1)], previous history of HDP [3.5 (1.6-7.1)], smoking [5.1 (1.3-9.3)], mode of delivery (CS) [3.2 (1.4-6.3)], age at first pregnancy (≥35 years) [7.4 (1.9-28.4)], blood group (AB) [3.3 (1.3-5.9)], gestational age (> 40 weeks) [3.1 (1.3-5.9)] and birth spacing (> 108 months) [4.8 (1.3-61.1)] were significant. Conclusion: There is a significant burden of HDP (14.5%). PE and GH represented the highest followed by severe PE. A number of independent risk factors were identified and will help in screening women at higher risk of HDP.

Risk factors for hypertensive disorders of pregnancy in Abuja, Nigeria: A prospective case-control study

Background: Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries like Nigeria. The study determined the risk factors for the development of HDP among women who booked early for antenatal care.Materials and Methods: This was a prospective case-control study conducted from March 2015 to March 2016 involving pregnant women with gestational age less than 20 weeks at booking and were followed up until delivery and 6 weeks postpartum. Information on gestational age at recruitment, at diagnosis of HDP, mode of delivery, and fetal outcome were recorded. Risk factors for HDP were compared between women who developed HDP (cases) and those who did not develop HDP (controls) by Fisher's exact test, Chi-square, and student's t-tests. Univariate and multivariate logistic regression analysis was used to test the relationship between certain risk factors and the development of HDP. A P value of less than 0.05 was considered statistically significant.Results: The prevalence of HDP in the study was 19.4%. Family history of preeclampsia (OR: 5.339, 95% CI: 1.149–24.818, P = 0.033); previous history of preeclampsia (OR: 10.819, 95% CI: 3.570–32.792, P < 0.001); multifetal gestation (OR: 13.275, 95% CI: 2.899–38.127, P = 0.010); chronic hypertension (OR: 3.431, 95% CI: 1.778–8.710, P < 0.001) and diabetes; (OR: 2.846 95% CI: 0.460–17.584, P < 0.251) were the risk factors associated with the development of HDP among the study population while nulliparity (OR: 0.726, 95% CI 0.366–1.440, P = 0.395); body mass index (BMI) (mean ± SD), (OR: 0.405, 95% CI: 0.173–0.945, P < 0.037);and low educational level (OR: 0.582, 95% CI: 0.070–4.857, P = 0.613) were not.Conclusion: The prevalence of HDP in the study group was high. Risk factors for HDP included family history of hypertension, previous history of preeclampsia, multifetal gestation, and chronic hypertension.

Perinatal Outcomes of Hypertensive Pregnancy: A Case Control Study

Background: Hypertensive disorders of pregnancy (HDP) are one of the maternal diseases that cause the most detrimental effects to the mother and the fetus.&#x0D; Objective: This study was conducted to compare the perinatal outcomes of neonates delivered by hypertensive mothers and normal mothers.&#x0D; Methods: This comparative hospital based study was conducted in Nepalgunj Medical College Teaching Hospital, Kohalpur from December 2014 to December 2015. Fifty mothers fulfilling the inclusion criteria and their fetal outcome in form of still birth and newborn babies were taken for the study and 50 healthy mothers with normotensive pregnancies and their newborn babies or fetal outcome were taken as control. They were followed up till their hospital stay in NICU or postnatal ward and final outcomes were noted.&#x0D; Results: The prevalence of HDP in our hospital was 2.16%. Among neonates, 27(54%) in case group and 9(18%) in control group were low birth weight which is statistically significant. It was found that 18(36%) neonates in case group and 7(14%) neonates in control group were IUGR(Intrauterine growth retardation). Seventeen (34%) neonates in case group were preterm as compared to 2(4%) neonates in control group (p value &lt; 0.001).&#x0D; Conclusion: Pregnancies complicated by hypertension were characterized by an increase in the rate of preterm delivery and low birth weight infants compared with normal pregnancies.

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta-analysis.

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Little is known about the magnitude of HDP in Africa. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. We did a comprehensive literature search to identify review paper published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved review paper. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854304 women during pregnancy or puerperium. Most studies were hospital-based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95% CI: 81.4-121.2). The prevalence was 49.8‰ (95% CI: 32.3-70.7) for gestational hypertension, 14.7‰ (95% CI: 11.6-18.2) for chronic hypertension, 9.2‰ (95% CI: 4.2-16.0) for superimposed preeclampsia, 44.0‰ (95% CI: 36.7-52.0) for preeclampsia, 22.1‰ (95% CI: 14.8-30.8) for severe preeclampsia, 14.7‰ (95% CI: 8.1-23.2) for eclampsia and 2.2‰ (95% CI: 1.2-3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; there was a consistent tendency of increasing HDP prevalence with income at the country level. In conclusion, the burden of HDP in Africa is high, with about one in 10 pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality is a major concern in the region.

257. Risk ok maternal near miss with elective caesarean delivery in women with hypertension in pregnancy in Brazil

Introduction Hypertensive disorders of pregnancy (HDP) contribute significantly to maternal near miss (MNM), most of them are preventable and associated with some delay in obstetric care little use of evidence-based guidelines. Objective The aim of this study is to analyse the association between elective caesarean section (CS) and MNM in women with HDP. Methodology This study is based on data from Birth in Brazil Survey, a nationwide hospital-based study conducted between 2011 and 2012, including 23,894 women. The women selected had 34–42 weeks, and were attended in public hospitals. Cases of placenta previa, HIV, multiple pregnancy, foetal distress before labour and non-cephalic presentation were excluded. A directed acyclic graph was constructed to select the variables for minimum adjustment. Multiple logistic regression analysis was performed to evaluate the association between MNM and elective CS. Results The prevalence of HDP was 12.6% (2999). After exclusions, 1950 women were analyzed, 54% had an elective CS and 10.5% induction of labour. MNM was associated with elective CS (OR 2.2, 95% CI 1.1–4.5), age ⩾ 35 years (OR 2.0, CI 95% 1.0–4.1), and nullipara (OR 2.0, 95% CI, 1.1–3.9). In the multiple logistic regression woman undergoing elective CS had as odds ratio of 2.13 (95% CI 1.02–4.43) for MNM, even controlled by maternal age, parity, gestational age at birth, schooling and other comorbidities. Discussion HDP represents a high prevalence and is the main cause of maternal morbidity and mortality in the country. The rate of induction of labour was low comparing with developed countries, where rates as high as 70–80% are observed. The option for elective CS by providers and/or women rather than induction of labour may be associated with a higher risk for women’s health. Women with HDP should be counselled that elective CS could lead to MNM.

Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia.

We sought to estimate the prevalence of hypertensive disorders of pregnancy (HDP) in Saudi Arabia as well as the risk factors of HDP, and maternal and fetal outcomes. We retrospectively evaluated the medical records of 9493 women who delivered at King Abdulaziz University Hospital, a tertiary care center, between January 2015 and June 2017. All cases of HDP were included. We identified 224 pregnant women with HDP in our patient cohort, giving a prevalence of 2.4%. Their mean age was 31.3±6.7 years, with an average gravidity of 4.0 and average parity of 3.0. The most prevalent subtype of HDP was preeclampsia (54.9%) while 29.5% of the women had gestational hypertension, and 8.0% had eclampsia. The prevalence of subtypes of HDP differed significantly with gravidity, and mean age differed significantly with HDP subtype. Personal and family histories of preeclampsia and the presence of diabetes were more prevalent in women with preeclampsia and gestational hypertension; however, only the difference in diabetes prevalence was significant. The overall prevalence of maternal complications was 9.4% and the prevalence of maternal mortality was 1.3%. Multigravid women and women with chronic hypertension were at increased risk of prematurity compared to other pregnant women, but not significantly. The prevalence of HDP was relatively low in our cohort. However, to prevent harmful impacts on both the mother and fetus, screening for this disorder is recommended early in pregnancy.

Night work and hypertensive disorders of pregnancy: a national register-based cohort study.

Objective The aim of this study was to investigate whether night work expressed by number and duration of night shifts, number of consecutive night shifts, and number of quick returns during the first 20 weeks of pregnancy is a risk factor for hypertensive disorders of pregnancy (HDP). Methods The study population comprised Danish workers in public administration and hospitals who gave birth between 2007 and 2013. Exposure was assessed objectively through payroll data. Information on the outcome was retrieved from the National Patient Register. We performed logistic regression on the risk for HDP according to night work adjusted for age, body mass index (BMI), parity, socioeconomic status, and sickness absence prior to pregnancy. Results Among 18 724 workers, 60% had at least one night shift during the first 20 weeks of pregnancy. The prevalence of HDP was 3.7%. Among night workers, the risk of HDP grew with increasing number of consecutive night shifts [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.01-1.98) and of quick returns after night shifts (OR 1.28, 95% CI 0.87-1.95). Among obese women (body mass index ≥30 kg/m 2), those who worked long night shifts and longer spells of consecutive night shifts, and had the highest number of quick returns after night shifts, had a 4-5 fold increased risk of HDP compared to day workers. Conclusion Working consecutive night shifts and quick returns after night shifts during the first 20 pregnancy weeks was associated with an increased risk of HDP, particularly among obese women.

The Burden of Hypertensive Disorders of Pregnancy in Africa: A Systematic Review and Meta-Analysis

Background: Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Although Africa has the highest burden of hypertension in the general adult population worldwide and exhibits a high rate of risk factors for HDP, little is known about the magnitude of HDP in the region. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. Methods: We did a comprehensive literature search to identify articles published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. Heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. Findings: We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854,304 women during pregnancy or puerperium. Most studies were hospital-based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95%CI: 81.4-121.2). Specifically, we found a prevalence of 49.8‰ (95%CI: 32.3-70.7) for gestational hypertension, 14.7‰ (95%CI: 11.6-18.2) for chronic hypertension, 9.2‰ (95%CI: 4.2-16.0) for superimposed pre-eclampsia, 44.0‰ (95%CI: 36.7-52.0) for pre-eclampsia, 22.1‰ (95%CI: 14.8-30.8) for severe pre-eclampsia, 14.7‰ (95%CI: 8.123.2) for eclampsia and 2.2‰ (95%CI: 1.2-3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; and there was a consistent tendency of increasing HDP prevalence with income at the country level. Interpretation: The burden of HDP in Africa is high, with about one in ten pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality, is a major concern in the region. These findings call for a rapid implementation of culturally appropriate strategies for primary prevention, early detection and adequate management of women with HDP in Africa. Such interventions would contribute to curb the alarming maternal and perinatal mortality rates in this region. Funding Statement: There was no funding source for this study. Declaration of Interests: The authors declare no competing interests.

Hypertensive disorders in pregnancy.

Hypertensive disorders of pregnancy (HDP) remain among the most significant and intriguing unsolved problems in obstetrics. In India, the prevalence of HDP was 7.8% with pre-eclampsia in 5.4% of the study population. The anaesthetic problems in HDP may be due to the effects on the cardiovascular, respiratory, neurologic, renal, haematologic, hepatic and uteroplacental systems. The basic management objectives should be facilitating the birth of an infant who subsequently thrives and completes restoration of health to the mother, or the termination of pregnancy with the least possible trauma to mother and foetus in severe pre-eclampsia. This comprises obstetric management, adequate foetal surveillance, antihypertensive management, anticonvulsant therapy, safe analgesia for labour and management of anaesthesia for delivery.