Risk Factor For Preeclampsia Research Articles

MIDWIVES' PERCEPTIONS OF PREECLAMPSIA SCREENING

Background: Preeclampsia-related maternal mortality is a persistent issue globally, including in Indonesia. The International Federation of Gynecology and Obstetrics (FIGO) recommends universal preeclampsia screening in obstetric services. In Indonesia's NTT Province, pregnant women are screened based on guidelines in the MCH book. Sikka Regency mandates midwives to use the KSPR and MCH manuals for risk factor screening In 2022, 154 out of 9,685 screened pregnant women exhibited signs of preeclampsia risk factors. Despite the reduction in maternal deaths in Sikka Regency, the number of deaths directly linked to preeclampsia increased from one in 2021 to four in 2022. Notably, at Watubaing Public Health Center, two cases of maternal death were specifically attributed to preeclampsia. This underscores a significant gap in midwives' perceptions and clinical practices, elevating maternal mortality risk. This study explores midwives' perceptions of preeclampsia screening. Method: Qualitative research with a phenomenological approach at Watubaing Public Health Center involved three informants selected through purposive sampling, meeting the inclusion criteria. Data collection, conducted from April to July 2023, comprised in-depth semi-structured interviews that were subsequently analyzed thematically. Results: Midwives’ expressed divergent opinions on preeclampsia screening, yet a consensus prevailed on its crucial importance. Conclusion: Midwives' perceptions of preeclampsia screening in ANC services are significantly shaped by internal and external factors, including knowledge and experience.

Comparison of Pre-eclampsia Screening Algorithms in the First Trimester of Pregnancy Being Used in Thai Nguyen Province.

Objective To compare the rates of pregnancies in high-risk groups for preeclampsia recommended for aspirin prophylactic when screened using various common algorithms. Methods This cross-sectional study was conducted on 1726 pregnant women from 11 to 13 weeks six days of gestation receiving antenatal care at two hospitals: Thai Nguyen National Hospital and a hospital in Thai Nguyen Province from October 2022 to October 2023. All participants provided consent for the study. We collected maternal characteristics, obstetric history,mean arterial pressure (MAP), mean uterine artery-PI (UtA-PI), and placental growth factor serum (PLGF). Screening performance estimates were calculated using the Fetal Medicine Foundation (FMF) and National Institute for Health and Care Excellence (NICE) guidelines. All pregnant women in the study had their preeclampsia risk assessed using all three algorithms with two cut-off points.Our data was collected, entered and analyzed using SPSS software 20.0 (IBM Corp., Armonk, NY). Categorical data was reported as frequency and percentage. McNemar's test was used for analyzing differences in the sizes of individual groups. Results In our study, the most common high-risk factor identified was the history of preeclampsia, 132 cases (7.6%). According to the NICE guideline, BMI ≥ 35 (kg/m²) is considered a moderate risk factor for preeclampsia. Several risk factors, such as BMI ≥ 35 kg/m² and history of diabetes mellitus type 1, were not present in any participants. Only one pregnant woman had chronic kidney disease (0.06%). Out of the 1726 pregnant women surveyed, the rates of high-risk preeclampsia were as follows: 9.9% (171 cases) based on algorithm 1; 10.8% (187 cases) based on algorithm 2 with a cut-off point > 1/100, 11.8% (203 cases) with a cut-off point > 1/150; 10.3 % (178 cases) based on algorithm 3 with a cut-off point > 1/100, and 11.6% (201 cases) with a cut-off point > 1/150. Among these algorithms, pregnant women in the high-risk preeclampsia group were advised to consider taking low-dose aspirin. Conclusion Screening for pre-eclampsia based on NICE recommendations resulted in a lower number of high-risk pregnant women requiring prophylactic aspirin use compared to other algorithms. This means that some pregnant women at risk of developing preeclampsia are not recommended to use aspirin as a preventive measure. Adding PLGF to the screening strategy will help us get closer to pregnant women who are truly at risk of progressing to preterm preeclampsia.

Analysis of risk factors of preeclampsia in pregnant women with chronic hypertension and its impact on pregnancy outcomes

ObjectiveTo investigate the risk factors and maternal and fetal outcomes of preeclampsia after pregnancy in patients with primary chronic hypertension.MethodsA total of 500 singleton pregnant women with a history of hypertension who were admitted for delivery at our Hospital from March 2015 to May 2022 were retrospectively collected by random sampling and divided into the non-occurrence group (n = 200) and the occurrence group (n = 300) according to whether they were complicated by preeclampsia. Afterward, the general data and the pregnancy-related data of patients were collected for comparison.ResultsThe univariate analysis showed significant differences between the non-occurrence group and the occurrence group in terms of the proportion of preeclampsia history (4.00% VS 24.67%, χ2 = 37.383, P < 0.001), duration of hypertension > 3 years (18.00% VS 31.67%, χ2 = 11.592, P < 0.001), systemic therapy (20.50% VS 10.00%, χ2 = 10.859, P < 0.001), gestational age at admission [37.72 (34.10, 38.71) VS 35.01 (31.91, 37.42) weeks, Z = -9.825, P < 0.001]. Meanwhile, the multivariate analysis showed that a history of preeclampsia (OR = 6.796, 95% CI: 3.575 ∼ 10.134, χ2 = 8.234, P < 0.001), duration of hypertension > 3 years (OR = 3.456, 95% CI: 2.157 ∼ 5.161, χ2 = 9.348, P < 0.001), and a lack of systemic antihypertensive treatment (OR = 8.983, 95% CI: 7.735 ∼ 9.933, χ2 = 9.123, P < 0.001) were risk factors for chronic hypertension complicated by preeclampsia during pregnancy.ConclusionA history of preeclampsia, a longer duration of hypertension, and a lack of systematic antihypertensive treatment are risk factors for chronic hypertension complicated by preeclampsia during pregnancy. The occurrence of preeclampsia in pregnant women with chronic hypertension increases the incidence of maternal HELLP syndrome and fetal distress.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

High Sensitivity C-Reactive Protein as an Independent Risk Factor for Preeclampsia with Severe Features

Background: One of the most dangerous complications of pregnancy and a major contributor to maternal and perinatal morbidity and death is preeclampsia. The goal of the current study was to measure the level of inflammation in severe preeclampsia by measuring serum high-sensitive C-reactive protein (hs-CRP) and establishing a relationship between hs-CRP and blood pressure. Objective: The aim of this study is to evaluate the impact high sensitivity C-reactive protein as an independent risk factor for preeclampsia with severe features. Methods: The cross-sectional study was carried out in the Department of Obstetrics &amp; Gynecology of Dhaka Medical College Hospital, Dhaka, from July 2022 to June 2023. A total of 200 patients were enrolled and analyzed in this study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, majority 95 (47.5%) of the patients were in 21 – 30 years age group and 60 (30.00%) patients were in &gt;30 years age group, Mean±SD of age was 27.12 ± 4.12 years. Most of the patients 150 (75.00%) were housewife and 50 (25.00%) patients were service holder. About 55 (27.5) patients were completed their graduation, 50 (25.00%) were completed higher secondary and 20 (10) were illiterate, most of the patients 145 (72.5%) came from rural area and 55(27.5) patients came from urban area. Nullipara was found in 75 (37.5%) patients and multigravida was found in most of the patients 110 (55.00%). Antenatal care was found irregular in 105 (52.5%) patients. Preterm pregnancy was found in majority 145 (72.5%) of the patients. Systolic and diastolic blood pressure were found higher and hsCRP was also found higher in PE with severe features. APGAR score was found less in 65 (32.5%) neonate at birth and APGAR score was found good in 55 (27.5%) neonate at 5 minutes. Average birth weight was found in 75 (37.5%) neonates, LBW was found in 85 (42.5) neonates and very LBW was found in 40 (20.00%) neonates of PE with severe features patients. Intrauterine growth retardation and prematurity were found in 75 (37.5%) and 20 (10.00%) neonates, admission to NICU was needed for 45 (22.5%) neonates, birth asphyxia was found in 15 (7.5%) neonates and stillbirth was occured in 35 (17.5%) cases. Conclusion: An exaggerated systemic inflammatory response, which may produce reactive oxygen species and worsen endothelial dysfunction, is present in preeclampsia. Clinical signs of hypertension and proteinuria in preeclampsia result from this. Preeclampsia-related maternal mortality and systemic complications may be reduced with early identification. hsCRP may therefore be a valuable gauge of preeclampsia severity.

Asuhan Kebidanan Komprehensif Pada Ny. S Umur 43 Tahun Dengan Preeklamsia dan Faktor Resiko Tinggi di BPM Ny. R Wilayah Kerja Puskesmas Bumiayu Kabupaten Brebes Tahun 2023

According to WHO (2022) the MMR in the world is 91.46/100,000 live births, the MMR in ASEAN (2022) is 235/100,000 live births (ASEAN secretariat, 2022). In Indonesia, the MMR in 2022 is 230/100,000 live births (Indonesian Ministry of Health, 2022). The MMR in Central Java in 2022 was 98.6/100,000 live births (Central Java Health Office, 2022) and the MMR at the Bumiayu health center in 2022 was 2 cases (Bumiayu Health Center, 2020-2022). Objective : To reduce morbidity and mortality rates of mothers and infants in Brebes district, especially the working area of Puskesmas Bumiayu. this research is a qualitative descriptive study, the type of research used in this study is using a comprehensive case study approach. Comprehensive case study research is a method for understanding individuals that is carried out interactively (Notoadmojo, 2019). Research Results : This comprehensive care found a gap in theory and practice in pregnancy and childbirth care. Conclusion: Comprehensive Midwifery Care for Mrs. S aged 43 years with preeclampsia and high risk factors at BPM Mrs. R in the working area of the bumiayu health center from third trimester pregnancy, childbirth, newborns, postpartum and family planning with the Varney and soap midwifery approach.

Investigating genetic links between blood metabolites and preeclampsia

BackgroundObservational studies have revealed that metabolic disorders are closely related to the development of preeclampsia (PE). However, there is still a research gap on the causal role of metabolites in promoting or preventing PE. We aimed to systematically explore the causal association between circulating metabolites and PE.MethodsSingle nucleotide polymorphisms (SNPs) from genome-wide association study (GWAS) of 486 blood metabolites (7,824 participants) were extracted as instrumental variables (P < 1 × 10− 5), GWAS summary statistics for PE were obtained from FinnGen consortium (7,212 cases and 194,266 controls) as outcome, and a two-sample Mendelian randomization (MR) analysis was conducted. Inverse variance weighted (IVW) was set as the primary method, with MR–Egger and weighted median as auxiliary methods; the instrumental variable strength and confounding factors were also assessed. Sensitivity analyses including MR-Egger, Cochran’s Q test, MR-PRESSO and leave-one-out analysis were performed to test the robustness of the MR results. For significant associations, repeated MR and meta-analysis were performed by another metabolite GWAS (8,299 participants). Furthermore, significantly associated metabolites were subjected to a metabolic pathway analysis.ResultsThe instrumental variables for the metabolites ranged from 3 to 493. Primary analysis revealed a total of 12 known (e.g., phenol sulfate, citrulline, lactate and gamma-glutamylglutamine) and 11 unknown metabolites were associated with PE. Heterogeneity and pleiotropy tests verified the robustness of the MR results. Validation with another metabolite GWAS dataset revealed consistency trends in 6 of the known metabolites with preliminary analysis, particularly the finding that genetic susceptibility to low levels of arachidonate (20:4n6) and citrulline were risk factors for PE. The pathway analysis revealed glycolysis/gluconeogenesis and arginine biosynthesis involved in the pathogenesis of PE.ConclusionsThis study identifies a causal relationship between some circulating metabolites and PE. Our study presented new perspectives on the pathogenesis of PE by integrating metabolomics with genomics, which opens up avenues for more accurate understanding and management of the disease, providing new potential candidate metabolic molecular markers for the prevention, diagnosis and treatment of PE. Considering the limitations of MR studies, further research is needed to confirm the causality and underlying mechanisms of these findings.

Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features.

To analyze the differences in risk factors and pregnancy outcomes between recurrent and initial pre-eclampsia(PE) with severe features. Data from recurrent (n = 128) and initial (n = 904) PE with severe features who terminated their pregnancy or gave birth at 20weeks of gestation or later at the tertiary teaching hospital (Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital) from January 2016 to December 2022 were collected. Risk factors for recurrent PE with severe features and differences in pregnancy outcomes between the two groups were assessed using the chi-square test, student t-test, or nonparametric test. Independent risk factors for recurrent PE with severe features were further analyzed by logistic regression. (1) Logistic regression analysis identified 3 independent risk factors for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. In addition, assisted reproductive technology (ART) is an independent risk factor for initial PE with severe features; (2) The incidence of oligohydramnios, chorioamnionitis, preterm birth, stillbirth, fetal growth restriction (FGR) and abnormal umbilical blood flow was higher in the recurrent PE with severe features group than in the initial PE with severe features group(P < 0.05). In contrast, the incidence of premature rupture of membrane (PROM) and postpartum hemorrhage (PPH) was higher in the group of initial PE with severe features(P < 0.05); (3) In the recurrent PE with severe features group, gestational age(GA) of birth and birth weight were lower than those in the initial PE with severe features group(P < 0.05). Also, the incidence of mild asphyxia, the rate of neonatal intensive care unit (NICU) hospitalization, length of stay in NICU, and the rate of abandoning treatment in the recurrent PE with severe features group were higher than those in the initial PE with severe features group(P < 0.05). 3 independent risk factors was identified for recurrent PE with severe features: history of cesarean section, rural residence and chronic hypertension. Women with recurrent PE with severe features are more likely to have adverse perinatal outcomes than those with initial PE with severe features.

Subclinical Metabolic and Cardiovascular Factors and Brain White Matter Microstructural Integrity in Young Women.

Women who have experienced pregnancy complications, specifically preeclampsia and gestational diabetes, have well documented increased risks of cardiovascular, metabolic, and neurological disease later in life. This study examined how specific cardiovascular and metabolic risk factors for preeclampsia assessed in a non-pregnant state were associated with brain white matter microstructural integrity. This study examined sixty-two healthy women (mean age 31 ± 5years) who received metabolic and cardiovascular assessments as well as multiple modality MRI imaging. Participants were either nulliparous (n = 31) or had a history of preterm preeclampsia (n = 31). Imaging included acquisition Diffusion Tensor Imaging (DTI) to assess white matter integrity within the brain. We hypothesized that healthy, young, non-pregnant women with cardiovascular and metabolic profiles suggesting elevated risk would have decreased white matter integrity, represented by lower Fractional Anisotropy (FA) and increased Mean Diffusivity (MD) estimates in the posterior cortical areas of the brain. We observed increased white matter degradation (lower FA and increased MD) in posterior and occipital tracts, commissural fibers, and subcortical structures in women with increased adiposity, worse measures of cardiovascular and metabolic function, including greater insulin resistance (HOMA-IR), hyperlipidemia, elevated blood pressure, and increased arterial stiffness. The relationships detected between subclinical cardiovascular and metabolic phenotypes and increased white matter disruption at a young age, outside of pregnancy, are indicative that adverse changes are detectable long before cognitive clinical presentation. This may suggest that many of the long-term cardiovascular and metabolic risks of aging are influenced by physiologic aging trajectories rather than damage caused by pregnancy complications.

Predictive Factors for the Common Adverse Maternal and Fetal Outcomes in Pregnancies Complicated by Systemic Lupus Erythematosus.

This study aimed to evaluate the outcomes of pregnancy in patients with systemic lupus erythematosus (SLE). It focused on identifying clinical and laboratory markers that could predict the common adverse pregnancy outcomes (APOs) after 20 weeks of gestation, namely preeclampsia (PE) and preterm birth (PTB) in them. Pregnant SLE women who delivered at the study center from 2010 to 2023 were retrospectively analyzed. Categorical variables were evaluated using the chi-square test or Fisher's exact test, while continuous variables underwent Mann-Whitney U testing. Stepwise regression was used to assess the predictors of pregnancy outcomes. The study enrolled 445 pregnancies in 408 women diagnosed with SLE. Of these, 202 pregnancies (45.4%) resulted in at least one APO. Disease flare-ups, hypertension, and proteinuria during the first trimester were primary predictors of at least one APO and PTB. The most frequently recorded maternal adverse outcome was PE (14.6%), while PTB accounted for 32.6% of fetal adverse outcomes. Multivariate regression analysis identified hypertension, history of PE, associated antiphospholipid syndrome (APS), proteinuria, and low serum C4 in the first trimester as independent risk factors for PE. Regular follow-ups at our center correlated with lower risks of APOs, PE, and PTB. APS also emerged as a risk factor for PTB, whereas the use of hydroxychloroquine (HCQ) during pregnancy seemed to protect against PTB. For pregnancies complicated by SLE, we recommend early pregnancy screening for proteinuria-even in the absence of lupus nephritis-as well as continued use of HCQ and routine prenatal care throughout pregnancy.

Body mass index, lipid profile, and endothelial dysfunction gene polymorphism in women with early-onset and late-onset preeclampsia

The aim: to investigate and analyze clinical parameters, laboratory biomarkers of lipid metabolism and endothelial dysfunction gene polymorphisms in early-onset and late-onset preeclampsia and to identify potential risk factor(s) for the development of early-onset preeclampsia. Materials and methods: a prospective case-control study included 133 women in the second half of pregnancy, including 46 with early-onset (EOP) and 87 with late-onset preeclampsia (LOP) and 34 conditionally healthy pregnant women with an uncomplicated obstetric history and no risk factors for preeclampsia. Concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides in blood plasma were determined. Genetic polymorphisms of endothelial dysfunction (192 Q→R PON-1, 677 C→ T MTHFR) were studied using allele-specific polymerase chain reaction. Results: Early-onset preeclampsia is associated with an increased relative risk: preterm delivery by 2.08 times (95 % CI 1.48-2.93), operative delivery by 2.2 times (95 % CI 1.46-3.33), early operative delivery by 2.9 times (95 % CI 1.5-5.5), fetal distress during delivery by 3.78 times (95 % CI 1.2-11.9), a low score on the Apgar scale on the 1st minute, less than 6 points, by 2.59 times (95 % CI 1.84-3.66), on the 5th minute – 5.04 times (95 % CI 1.41-18.11), Grade III prematurity – 13.24 times (95 % CI 3.14-55.78) compared to women with late-onset preeclampsia. The study found that overweight was more often observed in patients with EOP (34.8 %) than in those with normal pregnancy (15.9 %) (p=0.02; OR=2.8; 95 % CI 1.03-7.7), obesity (BMI &gt; 30 kg/m2) was more often recorded in those with LOP (33.33 %) than in the control group (3 (6.8 %)) (p=0.02; OR=6.8; 95 % CI 1.9-23.9). Patients in both groups with preeclampsia showed signs of dyslipidemia, but its significance in the development of early-onset or late-onset preeclampsia has not been separately proven. The study found that the number of carriers of MTHFR 677 TT in the group with EOP prevailed over the indicator of C group where there were no carriers of the pathological homozygote 677TT (p&lt;0.05, OR= 20.73 95 % CI 1.16-371.28), and the T allele in the EOP group occurs 1.78 times more often than in the LOP group (p&lt;0.05, OR=2.22; 95 % CI 1.26-3.88) and 2.43 times more often than in the C group (P&lt;0.05, or= 3.15; 95 % CI 1.54-6.45). Conclusions: Factors of early onset of PE include pre-pregnancy, overweight, first pregnancy, a history of preeclampsia, and carrier of the 677T allele of the MTHFR gene

Risk Factors for Pre-Eclampsia in Pregnant Women at RSUD dr. ABDUL Rivai Berau

Based on medical record data from RSUD dr. Abdul Rivai Berau is known to have 395 cases of pre-eclampsia pregnant women in January-October 2023. Risk factors that play an important role in the occurrence of pre-eclampsia: To determine risk factors for pre-eclampsia in pregnant women was age, parity, history contraceptives and multiple pregnancies. Type of research carried out was quantitative research with an analytical survey research design and a retrospective design. The population is all data pre-eclampsia cases in pregnant women January to October 2023 totaling 395 people, the Slovin formula sample of 199 people was obtained. The sampling technique uses simple random sampling. Data analysis using ch square. Age not at risk 57.8%, multigravida parity 55.3%, no history of using hormonal contraceptives 54.3%, no multiple pregnancies 51.8% and classification of mild pre-eclampsia 54.3%. There is a relationship between age and incidence of pre-eclampsia (p value = 0.009). There is a relationship between parity and incidence of pre-eclampsia (p value = 0.026). There is a relationship between a history of hormonal contraceptive use and the incidence of pre-eclampsia (p value = 0.011). There is a relationship between multiple pregnancies and incidence of pre-eclampsia (p value = 0.014). Age, parity, history of using hormonal contraceptives and multiple pregnancies as risk factors for pre-eclampsia in pregnant women. It is hoped RSUD dr. Abdul Rivai Berau provides health counseling or education to pregnant women preventing pre-eclampsia by providing material related to risk factors for pre-eclampsia in pregnant women along with their treatment and prevention

Does Developing Interpregnancy Hypertension Affect the Recurrence Risk of Preeclampsia? A Population-Based Cohort Study.

Preeclampsia in a first pregnancy is a strong risk factor for preeclampsia in a second pregnancy. Whether chronic hypertension developed after a first pregnancy (interpregnancy hypertension) affects the recurrence risk of preeclampsia is unknown. This is a population-based cohort study of 391,645 women with their first and second singleton births between 2006 and 2017. Exposure groups were women with preeclampsia in their first pregnancy, interpregnancy hypertension, or both risk factors. Women with neither risk factor were used as a reference group. We calculated the adjusted relative risk (aRR) with 95% confidence intervals (CIs) for overall preeclampsia in the second pregnancy as well as preterm (<37 gestational weeks) and term (≥37 gestational weeks) subgroups of the disease. Women with preeclampsia in their first pregnancy who did or did not develop interpregnancy hypertension had rates of preeclampsia in their second pregnancy of 21.5% and 13.6%, respectively. In the same population, the corresponding rates of preterm preeclampsia were 5.5% and 2.6%, respectively. After adjusting for maternal factors, women with preeclampsia in their first pregnancy who developed interpregnancy hypertension and those who did not have almost the same risk of overall preeclampsia in their second pregnancy (aRRs with 95% CIs: 14.51; 11.77-17.89 and 12.83; 12.09-13.62, respectively). However, preeclampsia in the first pregnancy and interpregnancy hypertension had a synergistic interaction on the outcome of preterm preeclampsia (aRR with 95% CI 26.66; 17.44-40.80). Women with previous preeclampsia who developed interpregnancy hypertension had a very high rate of preterm preeclampsia in a second pregnancy, and the two risk factors had a synergistic interaction.

Low-Dose Aspirin Use Does Not Increase Disease Activity in Pregnant Patients with Inflammatory Bowel Disease.

The adverse effects of non-steroidal anti-inflammatory (NSAID) drugs on the gastrointestinal system are well recognized, but the effect of NSAID use on disease activity patients with inflammatory bowel disease (IBD) remains unresolved. Low-dose aspirin (LDA) is recommended for all pregnant patients with risk factors for developing preeclampsia, including autoimmune conditions. As recognition of risk factors for preeclampsia improves, the preventative use of LDA is likely to increase. To investigate if LDA use for prevention of preeclampsia increases the risk of disease activity in pregnant women with IBD. Single-center retrospective cohort study of pregnant patients with IBD who delivered from 2012 to 2020, comparing those with and without LDA use. Primary outcome was odds of clinical IBD activity in patients in remission at time of conception. Secondary outcomes were rate of elevated inflammatory biomarkers, defined as C-reactive protein > 5ug/mL or fecal calprotectin > 250ug/g, and rate of preeclampsia. Univariate analyses tested for associations. Patients taking LDA were older (p = 0.003) and more likely to have chronic hypertension (p = 0.002), to have undergone in vitro fertilization (p < 0.001), and to be on biologics (p = 0.03). Among patients in remission at conception, there was no difference in clinical disease activity or biomarker elevation during pregnancy based on LDA use (OR 1.27, 95% CI [0.55-2.94], p = 0.6). Rates of preeclampsia were similar between groups. LDA use for preeclampsia prevention did not increase the incidence of disease activity in pregnant patients with IBD.

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

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

Risk Factors For Occurring Preeclampsia In Pregnant Women : Literature Review

Preeclampsia is a potentially dangerous pregnancy complication characterized by high blood pressure. This condition usually occurs when the gestational age reaches 20 weeks. Preeclampsia has an impact when pregnant and giving birth also results in postpartum problems due to endothelial dysfunction in various organs. Long-term effects can also occur in babies born to mothers with preeclampsia. With the high rate of preeclampsia in Indonesia and globally, this study aims to determine the risk factors for preeclampsia in pregnant women. The form of this research is Literature Review using a journal search on Google Scholar. The keywords used are Preeclampsia; Cause; and Pregnancy. After being selected, five journals will be reviewed, four journals are cross-sectional studies and one other journal is a case control study. The conclusion of this study The risk factors for preeclampsia in pregnant women include history of hypertension, history of preeclampsia, age, Body Mask Index (BMI), parity, stress, knowledge, completeness of Antenatal care (ANC), diet and exposure to cigarette smoke.

Preeclampsia and Preterm Delivery Risk: The Significance of Obesity in Pregnancy

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; A significant proportion of women globally, consti tuting 38%, are obese, among whom 24.5% reside in Europe. Obe sity elevates the risk of premature birth due to associated maternal conditions, such as preeclampsia. The objectives were to assess: variations in demographic and clinical characteristics among preg nant women across groups; the impact of obesity on the incidence of preeclampsia and preterm delivery; and the influence of obesity on newborn characteristics.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods. &amp;lt;/strong&amp;gt;One-year prospective study included 133 pregnant wom en gestational age 11-14 gestational week (GW), divided into two groups: OB (41.35%) and CG (58.65%). The data were analyzed using IBM SPSS version 23.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results. &amp;lt;/strong&amp;gt;There is statistically significant difference in average body mass index (BMI) (22.01 &amp;amp;plusmn; 1.83 vs. 30.26 &amp;amp;plusmn; 4.52; p &amp;amp;lt; 0.001) and de livery time (37.94 &amp;amp;plusmn; 2.05 vs. 36.87 &amp;amp;plusmn; 2.45; p = 0.003) between CG and OB. Obese pregnant women developed preeclampsia significantly more often than normal weight (61.82% vs. 28.21%; p &amp;amp;lt; 0.001). Body mass index has significant moderate predictive ability to predict preeclampsia (AUC 0.696 (95% CI: [0.601; 0.79]). Higher BMI (OR = 1.19, [1.09; 1.29], p &amp;amp;lt; 0.0001) was associated with higher rates of pre eclampsia. Overweight (OR = 2.41, [1.07; 5.43], p = 0.0335), obesity class I, II and III (OR = 20.36, [4.32; 95.99], p = 0.0001) were associated with higher rates of preeclampsia. A poor negative correlation was found between BMI and GW of pregnancy outcome (p = -0.24; r2 = 0.104; p = 0.006). Higher BMI (&amp;amp;beta; = -0.14, [-0.21; -0.07], p = 0.0002) was associated with lower values of GW of pregnancy outcome.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusions.&amp;lt;/strong&amp;gt; Presence of obesity or overweightness in the first tri mester of pregnancy poses a significant risk factor for preeclampsia and preterm delivery.&amp;lt;/p&amp;gt;

Mendelian randomization supports genetic liability to hospitalization for COVID-19 as a risk factor of pre-eclampsia.

Pre-eclampsia and eclampsia are among the major threats to pregnant women and fetuses, but they can be mitigated by prevention and early screening. Existing observational research presents conflicting evidence regarding the causal effects of coronavirus disease 2019 (COVID-19) on pre-eclampsia risk. Through Mendelian randomization (MR), this study aims to investigate the causal effect of three COVID-19 severity phenotypes on the risk of pre-eclampsia and eclampsia to provide more rigorous evidence. Two-sample MR was utilized to examine causal effects. Summary-level data from genome-wide association studies (GWAS) of individuals of European ancestry were acquired from the GWAS catalog and FinnGen databases. Single-nucleotide polymorphisms associated with COVID-19 traits at p < 5 × -8 were obtained and pruned for linkage disequilibrium to generate instrumental variables for COVID-19. Inverse variance weighted estimates were used as the primary MR results, with weighted median and MR-Egger as auxiliary analyses. The robustness of the MR findings was also evaluated through sensitivity analyses. Bonferroni correction was applied to primary results, with a p < 0.0083 considered significant evidence and a p within 0.083-0.05 considered suggestive evidence. Critical ill COVID-19 [defined as hospitalization for COVID-19 with either a death outcome or respiratory support, OR (95% CI): 1.17 (1.03-1.33), p = 0.020] and hospitalized COVID-19 [defined as hospitalization for COVID-19, OR (95% CI): 1.10 (1.01-1.19), p = 0.026] demonstrated suggestive causal effects on pre-eclampsia, while general severe acute respiratory syndrome coronavirus 2 infection did not exhibit a significant causal effect on pre-eclampsia. None of the three COVID-19 severity phenotypes exhibited a significant causal effect on eclampsia. Our investigation demonstrates a suggestive causal effect of genetic susceptibility to critical ill COVID-19 and hospitalized COVID-19 on pre-eclampsia. The COVID-19 severity exhibited a suggestive positive dose-response relationship with the risk of pre-eclampsia. Augmented attention should be paid to pregnant women hospitalized for COVID-19, especially those needing respiratory support.

Relationship between Androgens and Vascular and Placental Function during Pre-eclampsia.

Hypertensive disorders of pregnancy (HDP) represent a substantial risk to maternal and fetal health. Emerging evidence suggests an association between testosterone and pre-eclampsia (PE), potentially mediated through androgen receptors (AR). Nevertheless, the mechanism driving this association is yet to be elucidated. On the other hand, reports of transgender men's pregnancies offer a limited and insightful opportunity to understand the role of high androgen levels in the development of HDP. In this sense, a literature review was performed from a little over 2 decades (1998-2022) to address the association of testosterone levels with the development of HDP. Furthermore, this review addresses the case of transgender men for the first time. The main in vitro outcomes reveal placenta samples with greater AR mRNA expression. Moreover, ex vivo studies show that testosterone-induced vasorelaxation impairment promotes hypertension. Epidemiological data point to greater testosterone levels in blood samples during PE. Studies with transgender men allow us to infer that exogenous testosterone administration can be considered a risk factor for PE and that the administration of testosterone does not affect fetal development. Overall, all studies analyzed suggested that high testosterone levels are associated with PE.

A235 INFLAMMATORY BOWEL DISEASE AND PREECLAMPSIA: A PHYSICIAN SURVEY

Abstract Background Preeclampsia is a disorder of pregnancy recognized as the second cause of maternal mortality worldwide. The association between IBD and preeclampsia remains unclear, but the significant comorbid profile, and lack of treatment aside from urgent delivery, make primary prevention a priority. Aspirin was shown to halve preeclampsia rates and is recommended for primary prevention for women at risk. Despite high-quality evidence supporting Aspirin use and its well tolerated side effect profile, studies in non-IBD patients have demonstrated a knowledge-to-practice gap. Aims While there are no studies reported in women with IBD, prescribing rates may be even lower in this population, given that it may be incorrectly perceived to increase the risk of an IBD flare. Understanding physician perceptions could allow for a targeted educational approach to increase patient and physician awareness of the indications for Aspirin prophylaxis and its safety profile. Methods This is a cross-sectional survey study assessing physician perceptions and Aspirin prescribing patterns for preeclampsia prevention conducted from Mount Sinai Hospital. Demographic information, information on perceptions of preeclampsia risk in pregnant women with IBD, and on the perceived clinical benefit and risk of Aspirin prescribing were collected. Results A total of 38 Canadian healthcare professionals (HCPs) (15 Gastroenterologists, 14 Obstetricians, 5 General Practitioners, 2 General Internists, 1 nurse practitioner, and 1 midwife) were surveyed. Most HCPs were practicing for over 10 years (71%). In total, 68% of HCPs were comfortable with pregnancy-specific management of IBD. Most HCPs correctly identified all comorbidities associated with a high risk of preeclampsia including a history of preeclampsia (95%), renal disease (87%), and autoimmune disease (68%). A total of 55% of HCPs believed that pregnant patients with IBD were at increased risk of placental related diseases, and 56% agreed that these patients were at increased risk of preeclampsia specifically. Thirty-five percent of HCPs believed that IBD in remission, in the absence of other risk factors, was an indication for Aspirin prophylaxis. More so, 45% believed that IBD, with poor disease control, was an indication. Only 8% of HCPs believed that Aspirin, when used for preeclampsia prevention, was associated with an IBD flare. In patients whom Aspirin prophylaxis was indicated, 77% agreed with its use, even in patients in whom disease control was poor. Finally, 63% agreed that the Aspirin dose should be 162 mg daily, and more than half (58%) agreed that the prescriber should be the patient’s obstetrician. Conclusions Most HCPs agreed that IBD was a risk factor for preeclampsia and that Aspirin prophylaxis was effective and safe for primary prevention. High quality studies are needed to evaluate risk of preeclampsia in IBD, especially in patients with active disease. Funding Agencies CAG