Risk Factor For Hypertensive Disorders Of Pregnancy Research Articles

Hormone replacement treatment regimen is associated with a higher risk of hypertensive disorders of pregnancy in women undergoing frozen-thawed embryo transfer.

In frozen-thawed embryo transfer (FET) cycles, hormone replacement treatment (HRT) was associated with a higher risk of hypertensive disorders of pregnancy (HDP) compared with natural cycles (NC). Multiple pregnancy was a risk factor for HDP and several studies did not conduct subgroup analysis of singleton pregnancy and multiple pregnancy. To investigate whether HRT regimen could be a risk factor for HDP in women undergoing FET cycles in singleton and twin pregnancies. A retrospective cohort study at a tertiary hospital, including a total of 9120 women who underwent FET and achieved ongoing pregnancy; 7590 patients underwent HRT-FET and 1530 NC-FET. The main outcome was HDP. HDP were analyzed for singleton and twin pregnancies, respectively. In the singleton pregnancy, the risk of HDP in the HRT-FET group was significantly higher than that in the NC-FET group (6.21% vs. 4.09%; P=0.003). After adjusting for female age oocyte pick up, female age at FET and body mass index (BMI), HRT was found as a risk factor for HDP (adjusted odds ration [aOR]: 1.43; 95% confidence interval [CI]: 1.07 to 1.91; P=0.017). In the multiple pregnancy, the risk of HDP in the HRT-FET and NC-FET groups was similar. HRT was associated with a higher risk of HDP in women who underwent FET and achieved singleton pregnancy.

Secondhand smoke exposure is associated with the risk of hypertensive disorders of pregnancy: the Japan Environment and Children’s Study

Hypertensive disorders of pregnancy (HDP) are associated with poor maternal and neonatal prognoses. Although several studies have indicated an effect of secondhand smoke (SHS) exposure on HDP, such evidence is lacking in Japan. Therefore, we analyzed data from the Japan Environment and Children’s Study, a large-scale epidemiological investigation, to elucidate a possible link between SHS exposure and HDP risk. Data were obtained from the all-birth fixed datasets and included information on 104,062 fetuses and their parents. SHS exposure was assessed in terms of the frequency (rarely, 1–3, or 4–7 days/week) and the daily duration of exposure (<1, 1–2, or ≥2 h(s)/day). Modified Poisson regression model analyses were performed with adjustment for known risk factors for HDP. Additionally, the population attributable fractions (PAFs) of SHS exposure and maternal smoking to HDP prevalence were estimated. The relative risks of developing HDP among individuals with SHS exposures of 4–7 days/week and ≥2 h/day were 1.18 and 1.27 (95% confidence interval: 1.02–1.36 and 0.96–1.67), respectively, compared to the reference groups (rare exposure and <1 h/day). The PAFs for the risk of HDP due to SHS exposure and perinatal smoking were 3.8% and 1.8%, respectively. Japanese women with greater exposure to SHS have a higher risk of HDP after adjustment for possible confounding factors; thus, relevant measures are required to reduce SHS exposure to alleviate HDP risk.The association between second-hand smoking exposure and hypertensive disorders of pregnancy risk was analyzed using the JECS data. The relative risks in 4–7 days/week and ≥2 h/day of SHS exposures were 1.18 and 1.27, respectively. The PAFs due to SHS exposure and maternal smoking were 3.80% and 1.81%, respectively.

Identifying barriers, facilitators, and interventions to support healthy eating in pregnant women with or at risk for hypertensive disorders of pregnancy

Heart-healthy diets are important in the prevention and treatment of hypertension (HTN), including among pregnant women. Yet, the barriers, facilitators, and beliefs/preferences regarding healthy eating are not well described in this population. To identify barriers and facilitators to healthy diet, examine the prevalence of food insecurity, and determine interest in specific healthy diet interventions. Pregnant women, aged 18-50 years (N = 38), diagnosed with HTN, hypertensive disorders in pregnancy (HDP), or risk factors for HDP, were recruited from a large academic medical center in central Massachusetts between June 2020 and June 2022. Participants completed an electronic survey using a 5-point Likert scale (strongly disagree to strongly agree). The mean age of participants was 31.6 years (SD 5.5) and 35.1% identified as Hispanic. Finances and time were major barriers to a healthy diet, reported by 42.1% and 28.9% of participants, respectively. Participants reported that their partners and families were supportive of healthy eating and preparing meals at home, though 30.0% of those with children considered their children's diet a barrier to preparing healthy meals. Additionally, 40.5% of the sample were considered food insecure. Everyone agreed that healthy diet was important for maternal and fetal health, and the most popular interventions were healthy ingredient grocery deliveries (89.4%) and meal deliveries (84.2%). Time and cost emerged as major challenges to healthy eating in these pregnant women. Such barriers, facilitators, and preferences can aid in intervention development and policy-level changes to mitigate obstacles to healthy eating in this vulnerable patient population.

Neonatal outcomes of twins &lt;29 weeks gestation of mothers with hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy (HDP) are associated with dysfunctional placentation and are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancies have a larger placental mass and are a risk factor for HDP. The effect of HDP on neonatal outcomes in twin pregnancies is unknown. Retrospective cohort study using the Canadian Neonatal Network database from 2010-2018 of twin infants &lt;29 weeks gestation born to mothers with HDP and normotensive pregnancies. Using multivariable models, we determined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis, and nosocomial infection in twin infants of mothers with HDP compared to twin infants of normotensive mothers. Of the 2414 eligible twin infants &lt;29 weeks gestational age, 164 (6.8%) were born to mothers with HDP and had higher odds of severe ROP (AOR 2.48, 95% CI 1.34-4.59). Preterm twin infants born to mothers with HDP also had higher odds of mortality (AOR 2.02, 95% CI 1.23-3.32). There was no difference in other outcomes. Preterm twin infants &lt;29 weeks gestation of HDP mothers have higher odds of severe ROP and mortality. Hypertensive disorders of pregnancy, associated with placental dysfunction, are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancy, associated with a larger placental mass, is a risk factor for hypertensive disorders of pregnancy. The effect of hypertensive disorders of pregnancy on outcomes of preterm twins is unknown. Preterm twins of mothers with hypertensive disorders of pregnancy are at higher risk of severe retinopathy of prematurity and mortality. Our data can be used to counsel parents and identify infants at higher risk of severe retinopathy of prematurity and mortality.

Abstract P052: Identifying Barriers To Healthy Eating In Pregnant Women With Hypertension, Hypertensive Disorders Of Pregnancy, Or Risk Factors For Hypertensive Disorders Of Pregnancy.

Introduction: Heart healthy diets are important in the prevention and treatment of hypertension (HTN). In pregnant women, the lifestyle barriers to healthy eating are not well-described in literature. Hypothesis: There are personal, environmental, and economic barriers impacting adherence to a healthy diet in pregnant women with HTN, hypertensive disorders of pregnancy (HDP), or risk factors for HDP. Methods: Pregnant women, aged 20-50 (N=28), diagnosed with HTN, HDP, or risk factors for HDP were recruited from a large academic medical center. Participants completed an electronic survey assessing personal, environmental, and economic barriers to healthy eating. A 5-point Likert scale was used, ranging from strongly agree to strongly disagree. Results: The average age of participants was 31.8 (SD=4.5) from urban (34.6%), suburban (34.6%), and rural (30.8%) communities. Finances and time were major barriers to healthy eating, reported by 39.3% and 28.6% of participants, respectively, with 17.8% reporting that they could not afford to eat healthy consistently for all meals (Figure 1). Additionally, 10.7% and 7.1% were unaware of factors promoting healthy eating such as awareness of outside healthy eating resources and confidence in their ability to eat healthy given a new pregnancy. Meanwhile, 28.6% and 17.9% reported ambivalence towards these factors. Conclusion: Time management and financial costs emerged as the greatest challenges to healthy eating in pregnant women with or at risk for HDP. These barriers, in addition to certain factors promoting healthy eating, may represent areas of intervention that can help mitigate the obstacles to healthy eating in this vulnerable group.

Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross-sectional study.

To analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP). Repeated cross-sectional. US delivery hospitalisations. Delivery hospitalisations in the 2000-2018National Inpatient Sample. US hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest. Prevalence of HDP, risk factors for HDP and associated adverse outcomes. Of 73.1million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8-17.1), acute renal failure (aRR 13.8, 95% CI 13.5-14.2) and acute liver injury (aRR 1.2, 95% CI 1.2-1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased. Hypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased. While hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing.

Annual body mass index gain and risk of hypertensive disorders of pregnancy in a subsequent pregnancy

Weight gain during interpregnancy period is related to hypertensive disorders of pregnancy (HDP). However, in interpregnancy care/counseling, the unpredictability of the timing of the next conception and the difficulties in preventing age-related body weight gain must be considered while setting weight management goals. Therefore, we suggest considering the annual change in the body mass index (BMI). This study aimed to clarify the association between annual BMI changes during the interpregnancy period and HDP risk in subsequent pregnancies. A multicenter retrospective study of data from 2009 to 2019 examined the adjusted odds ratio (aOR) of HDP in subsequent pregnancies. The aORs in several annual BMI change categories were also calculated in the subgroups classified by HDP occurrence in the index pregnancy. This study included 1,746 pregnant women. A history of HDP (aOR, 16.76; 95% confidence interval [CI], 9.62 − 29.22), and annual BMI gain (aOR, 2.30; 95% CI, 1.76 − 3.01) were independent risk factors for HDP in subsequent pregnancies. An annual BMI increase of ≥ 1.0 kg/m2/year was related to HDP development in subsequent pregnancies for women without a history of HDP. This study provides data as a basis for interpregnancy care/counseling, but further research is necessary to validate our findings and confirm this relationship.

The association between smoking during pregnancy and hypertensive disorders of pregnancy: A systematic review and meta-analysis.

Smoking is a major public health problem. However, its association with hypertensive disorders of pregnancy (HDP) is inconclusive. To find the association between smoking during pregnancy and HDP. We searched PubMed, Ovid and Cochrane Library up to March, 2021, using terms including "smoking" and "HDP". Observational studies that assessed the relationship between smoking during pregnancy and HDP were included. Odds ratios (OR) and 95% confidence intervals (CI), and other necessary data were extracted. Stata16.0 MP was used to analyze statistics. A total of 13 studies were included. Meta-analysis revealed that smoking during pregnancy was a protective factor for HDP (OR 0.78, 95% CI 0.67-0.92), gestational hypertension (OR 0.74, 95% CI 0.69-0.79), and pre-eclampsia (OR 0.65, 95% CI 0.58-0.73). Subgroup analysis showed that smoking during pregnancy was a risk factor for HDP in Asia but a protective factor in Europe and North America. Neither quitting smoking before pregnancy nor during pregnancy had a statistically significant association with HDP. This meta-analysis revealed that smoking during pregnancy might prevent HDP, gestational hypertension, and pre-eclampsia. Smoking during pregnancy was a risk factor for HDP in Asia but a protective factor in Europe and North America.

Thin endometrium is associated with the risk of hypertensive disorders of pregnancy in fresh IVF/ICSI embryo transfer cycles: a retrospective cohort study of 9,266 singleton births

BackgroundThin endometrial thickness (EMT) has been suggested to be associated with reduced incidence of pregnancy rate after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment, but the effect of thin endometrium on obstetric outcome is less investigated. This study aims to determine whether EMT affects the incidence of obstetric complications in fresh IVF/ICSI-embryo transfer (ET) cycles.MethodsWe conducted a retrospective cohort study collecting a total of 9266 women who had singleton livebirths after fresh IVF/ICSI-ET treatment cycles at the Center for Reproductive Medicine Affiliated to Shandong University between January 2014 and December 2018. The women were divided into three groups according to the EMT: 544 women with an EMT ≤8 mm, 6234 with an EMT > 8–12 mm, and 2488 with an EMT > 12 mm. The primary outcomes were the incidence of obstetric complications including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), placental abruption, placenta previa, postpartum hemorrhage (PPH) and cesarean section. Multivariable logistic regression analysis was performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for associations between the EMT measured on the day of human chorionic gonadotropin (HCG) trigger and the risk of the outcomes of interest.ResultsThe HDP incidence rate of pregnant women was highest in EMT ≤ 8 mm group and significantly higher than those in EMT from > 8–12 mm and EMT > 12 mm group, respectively (6.8% versus 3.6 and 3.5%, respectively; P = 0.001). After adjustment for confounding variables by multivariate logistic regression analysis, a thin EMT was still statistically significant associated with an increased risk of HDP. Compared with women with an EMT > 8–12 mm, women with an EMT ≤8 mm had an increased risk of HDP (aOR = 1.853, 95% CI 1.281–2.679, P = 0.001).ConclusionA thin endometrium (≤8 mm) was found to be associated with an increased risk of HDP after adjustment for confounding variables, indicating that the thin endometrium itself is a risk factor for HDP. Obstetricians should remain aware of the possibility of HDP when women with a thin EMT achieve pregnancy through fresh IVF/ICSI–ET treatment cycles.

Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis.

Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP. A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to 'pregnancy', 'anxiety', 'depression', and 'hypertensive disorders'. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP. In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25-1.54]. When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07-1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

Abstract P100: Geographic Disparities in Hypertensive Disorders of Pregnancy: An Environment-Wide Association Study

Hypertensive disorders of pregnancy (HDP) are significant contributor to maternal and infant morbidity and mortality, and large geographic disparities exist. Although the importance of an individual’s surrounding environment as a potentially modifiable risk factor for HDP has been recognized and multiple environmental factors have been associated with HDP, only a few components in the environment have been assessed, often separately, with no consideration of the totality of environment. To address this, we conducted an environment-wide association study (EWAS) using the Florida Vital Statistics Birth Records including 2,119,324 women with conception dates between January 1, 2005 and December 31, 2014. EWAS is an agnostic and hypothesis-free approach. A wide range of environmental data from 12 sources were collected, harmonized, integrated, and spatiotemporally linked to the women based on their geocoded residential address and pregnancy period. A total of 5,510 factors characterizing women’s surrounding natural, built, and social environment during pregnancy (i.e. climate, air pollution, noise, greenness, walkability, food access, socioeconomics, social capital, housing, and safety) were included in the analysis. A random 50:50 split divided the data into training and testing sets. Environmental factors were individually examined after adjusting for age, race/ethnicity, education, marital status, WIC (Women, Infants, and Children Nutrition Program) recipient, smoking during pregnancy, pre-pregnancy BMI, parity, season, and year of conception. Mixed-effects models were used to account for the multilevel structure. A factor is deemed as “significant” if it has a false discovery rate-adjusted p-value (or q-value)&lt;0.01 in the training set and a p-value&lt;0.01 in the testing set. We identified 1,208 factors significantly associated with HDP, with strong associations observed between HDP and three categories of environmental factors: 1) neighborhood social capital (i.e. ZIP Code-level density of fitness and recreational sports centers, OR per standard deviation increase [OR sd ]: 0.34, 99% CI: 0.25, 0.46), 2) food access (i.e. low access tract at 10 miles, OR=1.27, 99% CI: 1.17, 1.47), and 3) bikeability (OR sd =0.86, 99% CI: 0.83, 0.89). EWAS is a promising approach to identify novel environmental factors associated with cardiovascular diseases. Environmental exposures appear to play a critical role, both in identifications of pregnant women at increased risk of HDP and in determinations of potential target for public health interventions.

358. Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in South Western Sydney

The prevalence of hypertensive disorders of pregnancy (HDP) in Australia’s urban Indigenous women is unknown. To explore the risk factors associated with HDP for a cohort of urban Indigenous women in South-Western Sydney, Australia. This study was conducted in partnership with the Tharawal Aboriginal Medical Service (TAMS). Women (18–45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for Indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (S.D. 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m[b] (S.D. 9.5 kg/m2) and BMI was not related to HDP (p = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (p = 0.020) (OR 4.29; 95%CI; 1.42–12.93) and individual history of hypertension (p < 0.001) (OR 15.69; 95%CI; 4.50–54.76) were associated with HDP. There was a higher rate of HDP in urban indigenous women compared to the national Indigenous prevalence. The family history, or individual history of hypertension were the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.

Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in south western Sydney.

The prevalence of hypertensive disorders of pregnancy (HDP) in Australia's urban indigenous women is unknown. To explore the risk factors associated with HDP for a cohort of urban indigenous women in South-Western Sydney, Australia. This study was conducted in partnership with the Tharawal Aboriginal Medical Service. Women (18-45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (SD 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m2 (SD 9.5 kg/m2 ) and BMI was not related to HDP (P = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (P = 0.020) (odds ratio (OR) 4.29; 95% confidence interval (CI); 1.42-12.93) and individual history of hypertension (P < 0.001) (OR 15.69; 95% CI; 4.50-54.76) were associated with HDP. There was a higher rate of HDP in urban indigenous women compared to the national indigenous prevalence. The family history, or individual history of hypertension was the most significant risk factors and BMI was not identified as a risk factor for HDP in this population.