Prevalence Of Hypertensive Disorders Research Articles

O-257 Comparing the accuracy of the novel clustering model versus phenotype classification in predicting live birth in polycystic ovary syndrome women undergoing In-Vitro fertilization

Abstract Study question Is the clustering model more accurate than phenotype classification in predicting live birth in polycystic ovary syndrome (PCOS) women undergoing in vitro fertilization (IVF)? Summary answer Novel PCOS clusters, identified by patients’ endocrine and metabolic profiles, more accurately predict live birth rates in women undergoing IVF than the traditional phenotype classification What is known already PCOS is a heterogeneous condition that affects fertility and IVF success. It is classified based on three factors: hyperandrogenism (HA), ovulatory dysfunction (OD), and polycystic ovaries (PCOM). The ESHRE/ASRM classification system identifies four phenotypes: A (including all three factors), B (HA and OD), C (HA and PCOM), and D (OD and PCOM). Although this classification is widely used, its focus solely on clinical signs and symptoms, while neglecting underlying endocrine and metabolic factors, may limit its effectiveness in predicting fertility outcomes in PCOS patients. Therefore, classifying PCOS patients may require a more comprehensive and inclusive assessment approach. Study design, size, duration This prospective cohort study was conducted from June 2020 to August 2022 at a tertiary IVF center in Ho Chi Minh City, Vietnam. Clustering models were built based on the endocrine and metabolic profiles of 731 PCOS patients. Patients were grouped into novel clusters based on their endocrine and metabolic profiles and compared with traditional phenotypes classification. The primary outcome measured was the live birth rate. Participants/materials, setting, methods Patients aged 18–45, diagnosed with PCOS according to the Rotterdam 2003 criteria, and undergoing IVF treatment were included in the study. Patients with hypothyroidism, Cushing’s syndrome, congenital adrenal hyperplasia, or contraindications to hormonal treatment were excluded. We employed Gaussian Mixture Models for clustering, using endocrine and metabolic data as the key features. We then compared the accuracy of the clustering model with phenotype classification in predicting IVF outcomes using a logistic regression model. Main results and the role of chance We identified three distinct clusters among polycystic ovary syndrome (PCOS) patients. Cluster 0 (n = 298) was characterized by significant insulin resistance and dyslipidemia. Cluster 1 (n = 219) displayed the lean PCOS phenotype, and Cluster 2 (n = 214) had moderate insulin resistance with severe hyperandrogenism. Our findings indicated that Clusters 1 and 2 had a higher cumulative live birth rate (CLBR) (39.7% and 37.9% versus 28.5% in Cluster 0, p = 0.015) and lower gestational diabetes rates (8.68% and 6.07%, respectively) compared to Cluster 0 (12.4%, p = 0.048). Additionally, the prevalence of hypertensive disorders during pregnancy showed differences across clusters (3.69% in Cluster 1, 0.46% in Cluster 2, and 2.8% in Cluster 0, p = 0.059). In contrast, the traditional phenotype classification did not demonstrate significant differences in CLBR, gestational diabetes, and hypertensive disorders. The cluster-based method provided a more accurate prediction of CLBR using logistic regression, with an AUC of 0.67 (95% CI: 0.57-0.76) compared to 0.49 (95% CI: 0.41-0.59) for traditional classifications (p = 0.001) Limitations, reasons for caution This is a single-center study conducted on Vietnamese patients. Therefore, the generalizability may be limited. The novel clustering’s predictive value for IVF outcomes in PCOS patients requires further validation in prospective studies. Wider implications of the findings This study suggests a potential shift towards personalized IVF treatment strategies for PCOS, using machine learning-based PCOS clustering identified by patients’ endocrine and metabolic profiles. Trial registration number NCT04364087

Prevalence of Hypertensive Disorders, Antihypertensive Therapy and Pregnancy Outcomes among Pregnant Women: A Retrospective Review of Cases at Tamale Teaching Hospital, Ghana.

Hypertensive disorders associated with pregnancy are a major health concern and a leading cause of maternal indisposition and transience. The main objective of this study was to assess the prevalence of hypertension in pregnancy as well as antihypertensive therapy and pregnancy outcomes among pregnant women at Tamale Teaching Hospital (TTH) in Ghana. This was a retrospective study conducted using data from the folders of pregnant hypertensive patients. The study was conducted at the maternity ward of TTH from 1 June 2018 to 31 May 2019. Participants were all pregnant women with a diagnosis of hypertensive disorders. The prevalence of hypertensive disorders in pregnancy was 12.5%. The most common antihypertensive medication prescribed was sustained-release oral nifedipine, which was prescribed for 548 (81.4%) participants either alone or with methyldopa, followed by oral methyldopa: 506 (75.2%), intravenous hydralazine: 94 (14.0%), intravenous labetalol: 28 (4.2%) and diuretics: 10 (1.5%). Thirty-eight (5.7%) babies died before delivery, whereas 635 (94.3%) babies were born alive. Twenty-six out of the 38 dead babies (68.4%) were babies of pregnant women with elevated BP, whereas 12 (31.6%) were babies of those with normal BP. There was a statistically significant association between BP control and delivery outcomes. The study observed adherence to antihypertensive medicines recommended by the standard treatment guidelines of Ghana for the management of hypertensive disorders in pregnancy. The BPs of about two-thirds of the study participants were well controlled with the antihypertensive therapy. The majority of the study participants with well-controlled BP had positive delivery outcomes.

Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Qazi Hussain Ahmed Medical Complex, Nowshera

Objectives: To determine the prevalence, risk factors with maternal and fetal outcomes of hypertension in pregnancy. Type of Study: Retrospective cross-sectional study. Place of Study: Gynae A ward,Qazi Hussain Ahmed Medical Complex, Nowshera. Duration of Study: 1 year from 1st Jan,2019 to 31st Dec, 2019. Methodology: 552 patients who had hypertensive disorders in pregnancy were recruited. Self- administered and structured questionnaire was used for data collection. The risk factors in patients and the fetomaternal outcomes were manually extracted from the history sheets and evaluated. SPSS version 22.0 was used for data analysis. Results: The prevalence of hypertensive disorders in pregnancy was 13.9% in this study. Pregnancy induced hypertension was the most frequent hypertensive disorder with a prevalence of 57.97%. 61% of the total hypertensive patients had no antenatal booking making it the most common risk factors in pregnant hypertensive patients.38% of patients had high blood pressure in previous pregnancies as well. 56.5% of patients admitted had normal vaginal delivery,4.5% of patients had instrumental deliveryand 39% had lower segment caesarean section. 17.75% of the total patientsdeveloped maternal complications and among them the most frequent maternal complication was post-partum hemorrhage (7.4%).49.3% newborns developed neonatal complications where the most common neonatal complication was preterm deliveries (21.9%). Conclusion: The prevalence of hypertensive disorders was relatively high in our cohort. However, to reduce the feto-maternal morbidities and mortalities, awareness regarding hypertensive disorders should be increased at the community and hospital level and screening of this disorder should be proposed at early gestation. Keywords: Hypertension, Pregnancy induced hypertension, Pre-eclampsia, Eclampsia, maternal complications, fetal complications.

Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study.

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow‐up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age‐adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1‐6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8‐3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.

Prevalence of hypertensive disorders in pregnancy in China: A systematic review and meta-analysis.

Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I2 statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.

Cardiovascular Morbidity and Mortality After Serious Disorders During Pregnancy

The prevalence of hypertensive disorders of pregnancy and serious maternal morbidity have been increasing in the U.S. and around the world. Two

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.

Abstract WMP54: Estimates of the U.S. Burden of Pregnancy-Associated Stroke Attributable to Common Vascular Risk Factors

Background: The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain. Methods: We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time. Results: The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period. Conclusions: Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.

Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland

Objective:We compared the prevalence of gestational diabetes and hypertensive disorders in the most recent pregnancy among women of Russian, Somali, and Kurdish origin and women in the general population in Finland.Methods:The study groups were selected from population-based samples of 18- to 64-year-old women. The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin or from the general population (n = 243), and had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. Data on gestational diabetes and hypertensive disorders were extracted based on relevant International Classification of Diseases, Tenth Revision codes. The main statistical methods were logistic regression analyses adjusted for age, parity, body mass index, socioeconomic status, and smoking.Results:The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali, 9.3% in Russian, and 11.8% in the general population. The prevalence of hypertensive disorders was 5.4% in the general population, 3.8% in Somali, 3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95% confidence interval = 1.20–3.32) compared with the general population, but the odds for hypertensive disorders did not differ between groups.Conclusion:Women of Kurdish origin were more likely to develop gestational diabetes. Studies with larger samples are required to confirm these findings to develop prevention strategies for later development of type 2 diabetes. Future research including other migrant groups is recommended to identify differences in pregnancy complications among the women in migrant and general population.

Left Ventricular Diastolic Function During the Normal Peripartum Period.

Because cardiovascular function and hemodynamics markedly change during pregnancy, our aim was to elucidate left ventricular (LV) diastolic function in pregnant women.Methods and Results:We prospectively collected the data of 397 pregnant women treated between 2012 and 2013. We evaluated their LV systolic and diastolic functions via echocardiography during the 3rd trimester (28-30 weeks' gestation) and within 4 days of delivery. Additionally, we analyzed the cardiac geometry: relative wall thickness and LV mass index (LVMI). Diastolic dysfunction was defined as early diastolic mitral annulus velocity (e') <7 cm/s and peak early filling velocity (E)/e' ratio >15. The pregnant women were 33.7±5.0 years old and the prevalence of hypertensive disorders in pregnancy (HDP) was 4.0%. LV systolic function was preserved in all pregnant women. However, diastolic function significantly decreased after delivery (mean e': 12.6 vs. 11.6 cm/s, P<0.0001; median E/e' ratio: 6.4 vs. 7.3, P<0.0001). Diastolic function after delivery was associated with the prevalence of HDP (P=0.035) and was correlated with age (R=-0.17, P=0.0009) and LVMI (R=-0.30, P<0.0001). However, these changes in diastolic function remained within the normal range and only 1 woman (1/397, 0.3%) had LV diastolic dysfunction after delivery. LV diastolic function decreased after delivery in pregnant women but was within the normal range.

Gebeliğin hipertansif bozukluklarının prevalansının mevsimsel değişimi

Gebeliğin hipertansif bozukluklarının prevalansının mevsimsel değişimi

Hypertensive disorders in pregnancy and maternal and neonatal outcomes in Haiti: the importance of surveillance and data collection

BackgroundThis study aims to determine reported prevalence of hypertensive disorders in pregnancy (HDP) and maternal and neonatal outcomes associated with these disorders among women delivering at selected hospitals across Haiti.MethodsA retrospective review of 8822 singleton deliveries between January 2012 and December 2014 was conducted at four hospitals in separate Departments across Haiti. Researchers examined the proportion of women with reported HDP (hypertension, preeclampsia, eclampsia) and the association between women with HDP and three neonatal outcomes: low birth weight, preterm birth, and stillbirths; and two maternal outcomes: placental abruption and maternal death in Hôpital Albert Schweitzer (HAS). Odds ratios for associations between HDP and perinatal outcomes at HAS were assessed using logistic regression, adjusting for potential confounders.ResultsOf the 8822 singleton births included in the study, 510 (5.8%) had a reported HDP (including 285 (55.9%) preeclampsia, 119 (23.3%) eclampsia, and 106 (20.8%) hypertension). Prevalence of HDP among each hospital was: HAS (13.5%), Hôpital Immaculée Conception des Cayes (HIC) (3.2%), Fort Liberté (4.3%), and Hôpital Sacré Coeur de Milot (HSC) (3.0%). Among women at HAS with HDP, the adjusted odds of having a low birth weight baby was four times that of women without HDP (aOR 4.17, 95% CI 3.19–5.45), more than three times that for stillbirths (aOR 3.51, 95% CI 2.43–5.06), and five times as likely to result in maternal death (aOR 5.13, 95% CI 1.53–17.25). Among the three types of HDP, eclampsia was associated with the greatest odds of adverse events with five times the odds of having a low birth weight baby (aOR 5.00, 95% CI 2.84–8.79), six times the odds for stillbirths (aOR 6.34, 95% CI 3.40–11.82), and more than twelve times as likely to result in maternal death (aOR 12.70, 95% CI 2.33–69.31).ConclusionsA high prevalence of HDP was found among a cohort of Haitian mothers. HDP was associated with higher rates of adverse maternal and neonatal outcomes in HAS, which is comparable to studies of HDP conducted in high-income countries.

319. Maternal ICU admissions at the McGill University Health Centre and impact of advanced maternal age on outcomes: Retrospective chart review

Introduction Severe maternal morbidity (SMM) necessitating intensive care unit (ICU) admission is rising. Advanced maternal age (⩾35 years, AMA) is associated with SMM, but its impact on ICU outcomes is not clear. Objectives We aimed to describe characteristics of pregnant and postpartum women admitted to the ICU at our institution, and to evaluate the impact of AMA on length of stay, need for invasive intervention, number of SMM indicators, and death. Methods We conducted a retrospective chart review of ICU admissions during, or within 42 days, of pregnancy, from January 1, 2006 to December 31, 2016. Impact of AMA on outcomes will be assessed with linear and log-linear regression. Results 205 women were admitted to the ICU during pregnancy or postpartum. We report descriptive analysis on a subset of patients (n = 97). Mean age was 32.5 ± 6 years; 39 (40.1%) had AMA. Most admissions (70.1%) occurred during postpartum period. High prevalence of hypertensive disorders of pregnancy (19.6%) and gestational diabetes (13.4%) was noted. One third delivered prematurely ( Discussion The majority of maternal ICU admissions are in the postpartum period in women with at least one maternal or fetal complication. Further analyses will explore outcomes according to maternal age.

260. The Great East Japan Earthquake and hypertensive disorders of pregnancy: The TMM BirThree Cohort Study

Introduction We experienced a devastating disaster, the Great East Japan Earthquake, in 2011. Some previous studies showed that disasters affected maternal blood pressure and their health. Its longer effect on pregnant women is necessary to investigate. Objective The purpose of this present study was to investigate if maternal disaster exposure affected their blood pressure. Methods The relationship between disaster exposure and maternal outcomes was retrospectively analyzed using the data of 4426 women who were recruited to the Tohoku Medical Megabank Birth and Three-generation Cohort Study, which was conducted in the years 2013–2017. Women were classified into three groups by the severity of the destruction of their house: group A, no destruction/did not live in the disaster-hit area; group B, half/a part of the house was destroyed; and group C, house totally/mostly destroyed. Multiple logistic regression analysis was performed to investigate the relationship between disaster exposure and hypertensive disorders of pregnancy, adjusting for body mass index, age, smoking, drinking, income, parity, and multiple pregnancy. Results Of 4,426 women eligible for the analyses, the houses of 489 women (11.0%) were totally or mostly destroyed, and the houses of 1706 women (38.5%) were half or partly destroyed. Those whose houses were not destroyed or did not live in the area affected by the disaster included 2,231 women (50.4%). The prevalence of hypertensive disorders of pregnancy in groups B and C were 0.82 and 1.47 times higher than in group A, but there was no statistical significance. Discussion Involvement in a disaster event about three to six years before pregnancy was not related to a higher prevalence of hypertensive disorders of pregnancy.

Hypertensive Disorders of Pregnancy among Mothers of Medically Fragile Infants [38R

INTRODUCTION: We sought to quantify the prevalence and early postpartum (PP) follow-up for hypertensive disorders of pregnancy among mothers of medically fragile infants (MMFI). METHODS: We conducted a retrospective cohort study of mothers delivering at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016. We defined MMFI as mothers of infants with a NICU length of stay ≥3 days and mothers of well babies (MWB) as mothers of infants not admitted to the NICU. We ascertained hypertensive disorders using blood pressures (BP) measured in routine clinical care between 20 weeks of pregnancy and PP discharge from Electronic Medical Records. Rates of mild and severe hypertension and completion of recommended follow-up among MMFI and MWB were compared with chi square test. RESULTS: Among 6,851 women who gave birth to one or more liveborn infants, 34.4% met criteria for mild hypertension, and 9.0% for severe hypertension. Hypertension was more common among MMFI; 38.2% met criteria for mild hypertension and 26.1% for severe hypertension. Among women with an indication, MMFI were more likely than MWB to have a PP BP check between discharge and 10 days PP (22.0% vs. 14.2%, p=0.01). MMFI whose infants were still hospitalized at 10 days PP were no more likely than MMFI whose infants had been discharged to have had a PP BP check (23.2 vs 22.8%, p=0.93). CONCLUSION: The prevalence of hypertensive disorders among MMFI is high, and few received indicated PP BP follow-up assessment. Evaluation of maternal health at the infant's bedside may improve follow-up and reduce maternal morbidity.

Prevalence, risk factors and associated complications of postpartum hypertension in rural Haiti.

The prevalence of hypertensive disorders during pregnancy is high in developing countries such as Haiti, however little is known about postpartum hypertension (PPHTN). This is a prospective study done at Hospital Albert Schweitzer in rural Haiti among pregnant women age 18 or older who were admitted for labor. Blood pressures were collected before and after delivery and medical charts were reviewed to gather delivery characteristics and fetal/neonatal outcomes. Differences between groups are presented based on postpartum blood pressures (BP) as mild PPHTN (systolic BP≥140 or diastolic BP≥90) and severe PPHTN (systolic BP≥160 or diastolic BP≥110). Of 175 women, the prevalence of PPHTN during the two-month study period was 57.1% (97/172) and included 56 parturients with mild and 41 with severe PPHTN. Severe PPHTN was associated with a higher proportion of complications including abruption (14.6%), fetal (14.6%) and neonatal death (7.3%). Thirty-nine (69.6%) patients with mild PPHTN and 9 (21.9%) patients with severe PPHTN did not receive any antihypertensive medications postpartum. Patients with severe PPHTN had prolonged hospitalization compared to the normal group (3.5 vs. 2.0days, p=0.0003). There was a strong correlation between antepartum and postpartum systolic and diastolic BP's (r=0.62 and 0.54, p<0.0001, respectively). In this study, we identified a high prevalence of PPHTN in rural Haiti. Severe PPHTN was associated with adverse outcomes and treatment is not universal. This data is a starting point to develop region-specific protocols to treat and control PPHTN.

OP 19 Prevalence, risk factors and associated complications of postpartum hypertension in rural Haiti

The prevalence of hypertensive disorders during pregnancy is high in developing countries such as Haiti. While there is abundant data on antepartum hypertensive disorders, postpartum hypertension (PPHTN) has been less studied. A prospective cohort study was designed to assess prevalence, risk factors, and outcomes of PPHTN at Hospital Albert Schweitzer in rural Haiti. All consecutive pregnant women age 18 or older admitted for labor were included. Blood pressures were collected before and after delivery and medical charts were reviewed to gather pregnancy history, hospital course, diagnosis, delivery characteristics and fetal/neonatal outcomes. Differences between groups are presented based on postpartum blood pressures (BP) as mild PPHTN (systolic BP ⩾140 or diastolic BP ⩾90) and severe PPHTN (systolic BP ⩾160 or diastolic BP ⩾110). Of 175 women, the prevalence of PPHTN during the three-month study period was 57.1% (97/172) and included 56 parturients with mild and 41 with severe PPHTN. In total, 45 (26.5%) women developed de novo PPHTN (development of hypertension only after delivery) and 52 (30.6%) women had persistent PPHTN (hypertension before and after delivery). Severe PPHTN was associated with a higher proportion of complications including abruption (14.6%), fetal (14.6%) and neonatal death (7.3%). Forty-four (78.6%) patients with mild PPHTN and 18 (43.9%) patients with severe PPHTN did not receive any antihypertensive medications postpartum. Patients with severe PPHTN had prolonged hospitalization compared to the normal group (3.5 vs. 2.0 days, p = 0.0003). There was a strong correlation between antepartum and postpartum systolic and diastolic BP’s (r = 0.62 and 0.54, p < 0.0001, respectively). In this study, we identified a high prevalence of PPHTN in rural Haiti. Severe PPHTN was associated with adverse outcomes and treatment is not universal. This data is a starting point to develop region-specific protocols to treat and control PPHTN.Download : Download high-res image (138KB)Download : Download full-size imageDownload : Download high-res image (91KB)Download : Download full-size image

62 Maternal and neonatal outcomes associated with hypertensive disorders during pregnancy: Data from “Birth in Brazil” study

Objectives To describe outcomes associated with hypertensive disorders during pregnancy in Brazil. Introduction Hypertensive disorders represent the major maternal morbidity in middle-income countries, which can contribute to both maternal and neonatal adverse outcomes. “Birth in Brazil” study was the first national representative survey, offering the opportunity of evaluate this relationship in the country. Methods Birth in Brazil is a national hospital-based survey of postnatal women and newborns conducted between February 2011 and October 2012. We obtained data from hospital medical records and interviews of 23,894 women and their newborns in 266 hospitals with ⩾500 deliveries per year. This sample was stratified by Brazil’s five macro-regions, location (state capital or elsewhere) and type of hospital (private, public or mixed). We compared maternal and neonatal outcomes of women with and without hypertensive disorders using Chi-square Pearson test. Results The prevalence of hypertensive disorders during pregnancy was 12.5% ( n = 2999). Considering all women with hypertensive disorders, 63.7% ( n = 1910) had pre-eclampsia/gestational hypertension, 20.5% ( n = 614) superimposed pre-eclampsia, 11.4% ( n = 342) chronic hypertension and 0.4% ( n = 133) eclampsia. Women with hypertension during pregnancy were older (17.9% vs. 9.4% with ⩾35 years, p 11 years of schooling, p = 0.02) than women without hypertensive disorders. Also, women with hypertension during pregnancy had more previous cesarean (26.2% vs. 20.7%, p p = 0.002) and more pre-gestational diabetes (4.0% vs. 0.6%, p p p p p p p p Conclusions The prevalence of hypertensive disorders in Brazil seems to be slightly higher than other countries and had significant impact on maternal and neonatal outcomes. Public policies should emphasize the proper prenatal and intrapartum care in women with hypertension during pregnancy, avoiding delays in care.

Analysis of correlation factors and pregnancy outcomes of hypertensive disorders of pregnancy – a secondary analysis of a random sampling in Beijing, China

Objective: We aimed to assess the prevalence and risk factors for hypertensive disorders and to study the main pregnancy outcomes in the Beijing area of China.Study design: This study randomly sampled 15 hospitals in Beijing from Jun 2013 to Nov 2013 and evaluated 15 194 deliveries. Logistic regression analysis was used to study the association between risk factors and hypertensive disorders. Pregnancy outcomes included preterm birth, cesarean delivery and small for gestational age (SGA).Results: The prevalence of hypertensive disorders, preeclampsia (PE) and severe PE was 4.4, 2.7 and 1.8%, respectively. The risk factors for hypertensive disorders and severe PE were maternal body mass index before pregnancy, gestational weight gain (GWG), gestational diabetes and pre-gestational diabetes, and third trimester cholesterol (CHOL) levels. First trimester high-density lipoprotein was a protective factor for severe PE. The incidence of hypertensive disorders increased with maternal age. Preterm delivery, cesarean delivery and small infant size for gestational age were more prevalent in the severe PE group compared with the non-hypertensive group.Conclusions: In the Beijing area of China, maternal body mass index before pregnancy, GWG, maternal complications of gestational diabetes and pre-gestational diabetes, and third trimester CHOL levels are risk factors for both hypertensive disorders of pregnancy and severe PE. First trimester high-density lipoprotein is a protective factor for severe PE. Severe preeclampsia leads to a higher incidence of preterm delivery, cesarean delivery and SGA infants.

Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia.

Twin gestation is known to be a risk factor for hypertensive disorders of pregnancy. However, the relationship between hypertensive disorders (pre-eclampsia (PE) and gestational hypertension (GH)) and chorionicity of twin pregnancy is unclear, and published data is conflicting. We decided to analyze the relationship between placentation and prevalence of hypertensive disorders. It was a retrospective cohort study. 312 twin pregnancies delivered between 2009 and 2014 were analyzed, 79 of which were monochorionic and 233 dichorionic. The occurrence of PE and GH was established according to American College of Obstetricians and Gynecologists' (ACOG) guidelines. Hypertensive disorders were diagnosed significantly more often in dichorionic than in monochorionic twin pregnancies (19.7% vs. 8.9%; OR = 2.53 95% CI 1.04-6.45; p = .03). PE occurred more frequently in DCP (13.3% vs. 3.8%; OR = 3.88 95% CI 1.09-16.46; p = .02). There were no differences between those two groups in the prevalence of GH (6.4% vs. 5.1%; p = .79). The logistic regression model for the occurrence of PE included chorionicity, mother's age lower than 18 or higher than 40, pre-gestational obesity, in vitro fertilization, primiparity, gestational age at delivery, gestational diabetes, and active smoking. It showed that dichorionicity remained an independent risk factor for PE (adjusted OR = 4.97.0 95% CI 1.06-23.38; p = .04). Dichorionicity seems to be a risk factor for PE but not for GH development.