Risk Of Hypertensive Disorders Of Pregnancy Research Articles

0819 Does Sleep Health Modify the Relationship Between Hypertensive Disorders of Pregnancy and Incident Cardiovascular Disease?

Abstract Introduction With pregnancy considered a cardiovascular “stress test”, adverse pregnancy outcomes (APOs), such as gestational hypertension, have been associated with higher risk of poor cardiometabolic health later in life. Sleep has been identified as a contributor to cardiometabolic health; however, few studies have considered how sleep may affect APO-associated cardiovascular disease risk. Methods To investigate sleep health during middle-to-older adulthood as a potential modifier of longitudinal associations between hypertensive disorders of pregnancy (HDP) and CVD incidence, we used data collected from 32,313 parous women (mean±SD age 55±8.9 years) without prior CVD in the Sister Study (enrollment: 2003-2009; n=1,407 Hispanic/Latina, n=2,411 non-Hispanic (NH)-Black, n=27,683 NH-White, and n=812 another race/ethnicity). Report of physician-diagnosed CVD or death from CVD (i.e., heart failure, myocardial infarction, stroke) was collected over follow-up until October 2020. At enrollment, participants reported a history of HDP (i.e., gestational hypertension, preeclampsia, eclampsia) and current sleep health characteristics (i.e., short (< 7 hours) habitual sleep duration, frequent napping, insomnia symptoms; all yes vs. no). Adjusting for sociodemographic, health behavior, and clinical characteristics, Cox proportional hazards regressions estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD among participants with vs. without history of HDP. Wald tests assessed HDP*sleep characteristics interactions. Results Overall, 11% of women reported a history of HDP, and prevalence varied by racial/ethnic group (14% among NH-Black and Latina, 12% another race/ethnicity, 11% NH-White). Poor sleep characteristics were prevalent and more frequent among participants with a history of HDP (e.g., insomnia symptoms: 46% vs. 43% [no HDP]). Over a mean±SD 12±3.0 years of follow-up, there were 1,658 new cases of CVD. After adjustment, the association between HDP and higher risk of CVD (HR=1.40 [95% CI:1.22-1.60]) did not differ between participants with poor vs. non-poor sleep (all p-interactions > 0.05; e.g., short sleep: HRyes=1.41 [1.11-1.79] and HRno=1.34 [1.13-1.59]). Conclusion Using subjective measures, poor sleep during middle-to-older age did not appear to exacerbate risk of CVD associated with HDP. Future studies that include multiple dimensions of objective sleep measured over the life course are warranted to better elucidate how sleep health among parous women may impact CVD risk. Support (if any) NIEHS (Z1AES103325[CLJ] and Z01ES044005 [DPS])

Perfluoroalkyl and polyfluoroalkyl substances and hypertensive disorders of pregnancy: A systematic review and meta-analysis

Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women. Several environmental toxins, particularly those that affect the normal function of the placenta and the endothelium, are emerging as potential risk factors for HDP. Among them, per- and polyfluoroalkyl substances (PFAS), widely used in a variety of commercial products, have been related to a variety of adverse health effects including HDP. This study was conducted by searching three databases for observational studies reporting associations between PFAS and HDP, all of which were published before December 2022. We used random-effects meta-analysis to calculate pooled risk estimates, and assessing each combination of exposure and outcome for quality and level of evidence. In total, 15 studies were included in the systematic review and meta-analysis. The results from meta-analyses showed that risk of PE was increased with exposure to PFOA (perfluorooctanoic acid) (RR = 1.39, 95% CI = 1.05, 1.85; N = 6 studies; exposure = 1 ln-unit increment; low certainty), PFOS (perfluorooctane sulfonate) (RR = 1.51, 95% CI = 1.23, 1.86; N = 6 studies; exposure = 1 ln-unit increment; moderate certainty), and PFHxS (perfluorohexane sulfonate) (RR = 1.39, 95% CI = 1.10, 1.76; N = 6 studies; exposure = 1 ln-unit increment; low certainty). PFOS was also associated with an increased risk of HDP (RR = 1.39, 95% CI = 1.10, 1.76; exposure = 1 ln-unit increment; low certainty). Exposure to legacy PFAS (PFOA, PFOS, PFHxS) is associated with an increased risk of PE, and PFOS is further associated with HDP. In view of the limitations of meta-analysis and quality of evidence, these findings should be interpreted with caution. Further research is required that assesses exposure to multiple PFAS in diverse and well-powered cohorts.

Prepregnancy Plant-Based Diets and Risk of Hypertensive Disorders of Pregnancy [ID: 1377112

INTRODUCTION: Plant-based diets have been associated with a lower risk of cardiovascular disease in adults. Specific evidence for their relationship with the risk of hypertensive disorders in pregnancy (HDP) is scarce. METHODS: We followed 11,535 healthy women (16,892 singleton pregnancies) participating in the Nurses' Health Study II (1999–2009). Diet was assessed every 4 years using a validated food questionnaire, from which we calculated a plant-based diet index (PBDI; a higher score indicates higher adherence). The women self-reported HDP including preeclampsia and gestational hypertension (GHTN). We estimated the relative risk (RR) of HDP and PBDI (in quintiles) with log-binomial regression using generalized estimating equations with adjustments for potential confounders while considering pregnancies from the same woman. RESULTS: The mean age of women at their first in-study pregnancy was 35 years. We identified 495 cases of preeclampsia (2.9%), and 561 cases of GHTN (3.3%). Women in the highest quintile of PBDI had a 28% lower risk of HDP compared to women in the lowest quartile (95% CI: −11%, −42%; P-trend=.007). The association was stronger for GHTN (RR 0.63 [0.47, 0.84], P-trend<.001) than for preeclampsia (RR 0.73 [0.53, 1.02], P-trend=.23). Mediation analysis suggested that body mass index self-reported between dietary assessment and pregnancy explained 39% (95% CI 14–70%) of the relation between PBDI and HDP and 46% (95% CI 12–84%) of the relation between PBDI and GHTN. CONCLUSION: Higher adherence to plant-based diets was associated with a lower risk of developing HDP. Much of the benefit appears to be related to improved weight control.

The Impact of Neisseria gonorrhoeae Mono- and Coinfection on Adverse Pregnancy Outcomes.

Sexually transmitted infections (STIs) have recently been linked to hypertensive disorders of pregnancy (HDP). However, the impact of Neisseria gonorrhoeae on risk of HDP is not well understood. This study determined the impact of gonorrhea and gonorrhea coinfection on HDP and other adverse pregnancy outcomes in a population with a high screening rate and presumed treatment. This retrospective study included 29 821 singleton births between 2016 and 2021. The STI testing results, demographic variables, and pregnancy outcomes were identified from electronic health records. The HDP were primary outcomes of interest including gestational hypertension, preeclampsia, and superimposed preeclampsia. We further examined preeclampsia subtypes defined by severe features and gestational age of delivery (term and preterm preeclampsia). Secondary outcomes included preterm premature rupture of membranes, chorioamnionitis, and preterm delivery. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Models were adjusted for maternal age, maternal race/ethnicity, and smoking. Gonorrhea screening occurred in 95% of the population. Gonorrhea increased the odds of preterm preeclampsia (adjusted OR [ORadj.], 1.95; 95% CI, 1.02-3.73) and preterm birth (ORadj., 1.78; 95% CI, 1.22-2.60). Furthermore, gonorrhea-chlamydia coinfection was associated with preterm birth (ORadj., 1.77; 95% CI, 1.03-3.04). However, results were similar when we examined gonorrhea monoinfection (ORadj., 1.76; 95% CI, 1.04-2.97). Among a diverse population of pregnant individuals, gonorrhea increased odds of preterm preeclampsia and preterm delivery Further research is needed to determine the burden of STIs on HDP, including investigations into biological effects during pregnancy.

Infertility Treatment and Hypertension in Pregnancy: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

Infertility treatment is a possible factor in hypertensive disorders of pregnancy (HDP). Identifying the characteristics of pregnant women who have undergone infertility treatment and have a potential risk for HDP is valuable for its prevention and treatment. Using data from 12,456 pregnant Japanese women from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, the association between infertility treatment and HDP was analyzed. A multiple logistic regression model showed an association between infertility treatment and HDP (odds ratio, 1.34; 95% confidence interval, 1.05–1.72). In vitro fertilization/intracytoplasmic sperm injection were also associated with HDP. Moreover, these associations were observed even among women who were not overweight and did not smoke. The application of infertility treatment should be carefully considered, even among women with low modifiable risk factors.

Association between Pregestational Vaginal Dysbiosis and Incident Hypertensive Disorders of Pregnancy Risk: a Nested Case-Control Study.

A balanced vaginal microbiome dominated by Lactobacillus can help promote women's reproductive health, with Lactobacillus crispatus showing the most beneficial effect. However, the potential role of vaginal microbiomes in hypertensive disorders of pregnancy (HDP) development is not thoroughly explored. In this nested case-control study based on an assisted reproductive technology follow-up cohort, we prospectively assessed the association between pregestational vaginal microbiomes with HDP by collecting vaginal swabs from 75 HDP cases (HDP group) and 150 controls (NP group) and using 16S amplicon sequencing for bacterial identification. The vaginal microbial composition of the HDP group significantly differed from that of the NP group. The abundance of L. crispatus was significantly lower, and the abundances of Gardnerella vaginalis was significantly higher, in the HDP group than in the NP group. Of note, L. crispatus-dominated vaginal community state type was associated with a decreased risk for HDP (odds ratio = 0.436; 95% confidence interval, 0.229 to 0.831) compared with others. Additionally, network analysis revealed different bacterial interactions with 61 and 57 exclusive edges in the NP and HDP groups, respectively. Compared with the HDP group, the NP group showed a higher weighted degree and closeness centrality. Several taxa, including G. vaginalis, L. iners, and bacterial vaginosis-associated bacteria (Prevotella, Megasphaera, Finegoldia, and Porphyromonas), were identified as "drivers" for network rewiring. Notable alterations of predicted pathways involved in amino acid, cofactor, and vitamin metabolism; membrane transport; and bacterial toxins were observed in the HDP group. IMPORTANCE The etiology of HDP remains unclear to date. Effective methods for the individualized prediction and prevention are lacking. Pregestational vaginal dysbiosis precedes the diagnosis of HDP, providing a novel perspective on the etiology of HDP. Early pregnancy is the critical period of placental development, and abnormal placentation initiates HDP development. Thus, disease prevention should be considered before pregnancy. Vaginal microbiome characterization and probiotic interventions before pregnancy are preferred because of their safety and potential for early prevention. This study is the first to prospectively assess associations between pregestational vaginal microbiome and HDP. L. crispatus-dominated vaginal community state type is linked to a reduced risk for HDP. These findings suggest that vaginal microbiome characterization may help identify individuals at high risk for HDP and offer potential targets for the development of novel pregestational intervention methods.

Abstract P244: Gestational Glucose Intolerance is Associated With Hypertensive Disorders of Pregnancy in a Large Hospital-Based Multiethnic Cohort

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated. Hypothesis: We tested the hypothesis that GGI pregnancies have increased odds of HDP. Methods: This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test < 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE). Results: A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1). Conclusions: The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.

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.

The effects of unexpected follicular growth and ovulation in artificial cycles: a retrospective cohort study of frozen, single-blastocyst transfer

To study the effects of unexpected follicular development and ovulation in artificial cycles (ACs) on pregnancy outcomes. A retrospective cohort study. A university-affiliated fertility center. A total of 1,427 patients who underwent a single, frozen-thawed blastocyst transfer with AC regimens from January 2014 to December 2020 at a university-affiliated fertility center were included. Unexpected follicular development and ovulation in ACs. Live birth rate (LBR), biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate. A total of 161 patients with unexpected follicular development and ovulation in ACs (ovulation group) and 1,266 patients without growing follicles in ACs (control group) were enrolled. The patients in the ovulation group were older and had higher levels of serum follicle-stimulating hormone and lower levels of serum antimüllerian hormone. After propensity score matching, the baseline characteristics between the 2 groups were comparable and no significant difference was observed in the LBR (ovulation group, 39.0% vs. control group, 39.0%), biochemical pregnancy rate (ovulation group, 60.3% vs. control group, 58.2%), clinical pregnancy rate (ovulation group, 53.4% vs. control group, 50.7%), or ongoing pregnancy rate (ovulation group, 42.5% vs. control group, 40.4%). Moreover, the patients in the ovulation group showed a lower risk of hypertensive disorders of pregnancy (HDP) (1.6% vs. 15.3%). A subgroup analysis of women who delivered singleton live-born babies also demonstrated that unexpected follicular development and ovulation in ACs was associated with a decreased risk of HDP (adjusted odds ratio, 0.070; 95% confidence interval, 0.007-0.712) and an increased risk of large-for-gestational-age infants (adjusted odds ratio, 4.046; 95% confidence interval, 1.319-12.414). Women with unexpected follicular development and ovulation during single frozen-thawed blastocyst transfer with AC regimens had a similar LBR and a reduced risk of HDP compared with those with routine AC regimens, and singleton neonates had an increased risk of being large for gestational age.

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.

Risk of De Novo Hypertensive Disorders of Pregnancy After Exposure to PM1 and PM2.5 During the Period From Preconception to Delivery: Birth Cohort Study.

Particulate matter (PM) is detrimental to the respiratory and circulatory systems. However, no study has evaluated the lag effects of weekly exposure to fine PM during the period from preconception to delivery on the risk of hypertensive disorders of pregnancy (HDPs). We set out to investigate the lag effect windows of PM on the risk of HDPs on a weekly scale. Data from women with de novo HDPs and normotensive pregnant women who were part of the Peking University Retrospective Birth Cohort, based on the hospital information system of Tongzhou district, were obtained for this study. Meteorological data and data on exposure to fine PM were predicted by satellite remote sensing data based on maternal residential address. The de novo HDP group consisted of pregnant women who were diagnosed with gestational hypertension or preeclampsia. Fine PM was defined as PM2.5 and PM1. The gestational stage of participants was from preconception (starting 12 weeks before gestation) to delivery (before the 42nd gestational week). A distributed-lag nonlinear model (DLNM) was nested in a Cox regression model to evaluate the lag effects of weekly PM exposure on de novo HDP hazard by controlling the nonlinear relationship of exposure-reaction. Stratified analyses by employment status (employed or unemployed), education level (higher or lower), and parity (primiparity or multiparity) were performed. A total of 22,570 pregnant women (mean age 29.1 years) for whom data were available between 2013 and 2017 were included in this study. The prevalence of de novo HDPs was 6.7% (1520/22,570). Our findings showed that PM1 and PM2.5 were significantly associated with an elevated hazard of HDPs. Exposure to PM1 during the 5th week before gestation to the 6th gestational week increased the hazard of HDPs. A significant lag effect of PM2.5 was observed from the 1st week before gestation to the 6th gestational week. The strongest lag effects of PM1 and PM2.5 on de novo HDPs were observed at week 2 and week 6 (hazard ratio [HR] 1.024, 95% CI 1.007-1.042; HR 1.007, 95% CI 1.000-1.015, respectively, per 10 μg/m3 increase). The stratified analyses indicated that pregnant women who were employed, had low education, and were primiparous were more vulnerable to PM exposure for de novo HDPs. Exposure to PM1 and PM2.5 was associated with the risk of de novo HDPs. There were significant lag windows between the preconception period and the first trimester. Women who were employed, had low education, and were primiparous were more vulnerable to the effects of PM exposure; more attention should be paid to these groups for early prevention of de novo HDPs.

The association of sodium intake with the development of hypertensive disorders of pregnancy

To assess the association between daily sodium intake and risk of hypertensive disorders of pregnancy. This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. In this analysis, we included those with non-anomalous, singleton pregnancies who completed food frequency questionnaires in which they recorded their sodium intake in the 3 months prior to pregnancy. Individuals who did not progress beyond 20 weeks’ gestation were excluded. Sodium intake was categorized as low (< 2g per day), medium (2g to < 3g per day), or high (≥ 3g per day). The primary outcome was development of a new-onset hypertensive disorder of pregnancy (HDP), including antenatal gestational hypertension, preeclampsia, HELLP, and superimposed preeclampsia. Other maternal and neonatal outcomes also were assessed. Kruskal-Wallis and Chi square tests were used to compare baseline characteristics. Adjusted incidence risk ratios (aIRR) with 95% confidence intervals (CIs) were estimated using Poisson regression to control for confounders. Among 7927 individuals eligible for this analysis, 2,482 (31%) reported low sodium intake, 2,978 (38%) medium sodium intake, and 2,467 (31%) high sodium intake. Baseline characteristics, including age, BMI, self-reported race and ethnicity, and tobacco use differed significantly between groups (all p< 0.01, Table 1). The risk of developing HDP was similar among groups (medium vs. low aIRR 1.03, 95% CI 0.88-1.22; high vs. low aIRR 1.13, CI 0.96-1.34). There were no differences in other adverse maternal or neonatal outcomes by sodium intake (Table 2). There was no association between sodium intake and risk of HDP. This may reflect a difference in the pathophysiology underlying pregnancy and non-pregnancy related hypertensive disorders.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

PS-C32-1: DEMOGRAPHIC, ANTHROPOMETRIC AND BIOCHEMICAL CORRELATES AS EARLY PREDICTIVE INDICES OF HYPERTENSIVE DISORDERS IN PREGNANT WOMEN FROM NIGERIA

Objective: this study was conducted to evaluate maternal demographic, anthropometric and biochemical indices to predict Hypertensive Disorders of Pregnancy (HDP) at early stage. Design and method: Non-hypertensive pregnant women (n = 521) of &lt; 20 weeks gestation, attending antenatal clinics of four different tertiary health facilities in Nigeria enrolled into this longitudinal study. From this, 471 participants were followed up to delivery. Demographic data were obtained through a semi-structured questionnaire while BMI and Percentage Body Fat (PBF) were determined using standard methods. Blood and urine samples were collected at baseline, second and third trimesters. Placental Growth Factor (PLGF), leptin and insulin were analysed in serum using ELISA. Triglycerides, total cholesterol, HDLc, uric acid, creatinine and Fasting Plasma Glucose (FPG) in plasma were analysed spectrophotometrically. Urinalysis was performed using dipstick while LDLc was calculated. Data were analysed using Chi-square, ANOVA and Cox proportional hazard model at &lt; 0.05. Results: Ten (2.1%) and 24 (5.1%) of the pregnant women developed HDP at second and third trimester. From the 34 that developed HDP, 19 (55.9%), 12 (35.3%), 2 (5.9%) and 1 (2.9%) developed Preeclampsia-Eclampsia, Gestational Hypertension, Chronic Hypertension and Preeclampsia Superimposed on Chronic Hypertension, respectively. Maternal age and marital age of HDP women (32.4 ± 5.0; 28.9 ± 4.3 years) were respectively higher than normotensive (30.5 ± 4.4; 27.2 ± 3.7 years). Risk of HDP was higher at marital age of 35–42 years compared with 13–25 years (HR = 8.44, 95% CI: 2.01–35.35). Body mass index (30.4 ± 1.6 vs. 26.6 ± 0.3Kg/m2) and PBF (40.6 ± 1.5 vs. 36.0 ± 0.5) were higher in HDP women than normotensive. Reduced PLGF level (HR = 0.77, 95% CI: 0.64–0.94) in second trimester increased risk of HDP. Leptin (6.9 ± 1.9 vs. 14.1 ± 1.5ng/mL) in first trimester and insulin (1.5 ± 0.5 vs. 10.5 ± 1.5 μIU/mL and 7.9 ± 3.2 vs. 17.5 ± 2.1 μIU/mL) in first and second trimesters were lower in HDP than normotensive women, respectively. Uric acid (2.8 ± 0.1 vs. 4.2 ± 0.8 mg/dL) and creatinine (0.8 ± 0.01 vs. 2.6 ± 1.7 mg/dL) were significantly decreased in normotensive compared with HDP women in first trimester. The FPG (78.1 ± 2.6: 73.0 ± 1.4: 71.4 ± 1.5 mg/dL) was significantly reduced from first, second to third trimesters in normotensive women. In HDP women FPG (76.1 ± 4.1; 74.5 ± 6.7 vs. 65.8 ± 5.5 mg/dL) was increased in second and third trimesters, respectively compared to first trimester. Increased LDLc (HR = 1.28, 95% CI: 1.04–1.58) was associated with increased risk of HDP in second trimester. Conclusions: Maternal age, obesity, decreased levels of placental growth factor, leptin, insulin, uric acid; increased levels of fasting plasma glucose and low density lipoprotein cholesterol are critical risk factors for early prediction of hypertensive disorders during pregnancy.

Dietary risk factors for hypertensive disorders of pregnancy

Poor diet quality, as assessed by the US Department of Agriculture’s Health Eating Index (HEI), has previously been linked with hypertensive disorders of pregnancy (HDP). We assessed specific dietary components contributing to this increased risk of HDP. This is a nested case control study in a cohort of 450 study participants with singleton pregnancies who completed the NIH Dietary Health Questionnaire II (DHQ-II) in the third trimester or within 3 months of delivery from 2017-2020. Patients with fetal anomalies, pregnancies conceived by in-vitro fertilization, and deliveries at an outside hospital were excluded. Cases were patients diagnosed with HDP and controls were patients without HDP. Cases were matched to controls by BMI class in a 1:2 ratio. The primary exposures of interest were HEI score components and other DHQ-II dietary components including minerals, caffeine, and water. These dietary components were compared between cases and controls using univariate analyses. 150 patients with HDP were matched to 300 controls without HDP. Baseline demographics were similar between groups, including BMI. Patients with HDP were less likely to have high quality diets (HEI≥70) than controls (7.3% v 15.7%, P=0.02). HDP was associated with significantly higher dairy, saturated fat, and sodium intake compared to controls. Other HEI components such as protein, vegetable, added sugar, and fatty acid uptake were similar between groups (Figure). Caffeine, water, and mineral consumption was similar between groups (Table). Patients with HDP are more likely to have consumed a diet higher in sodium, dairy, and saturated fats. Antenatal diet modification in patients at high risk of HDP should be further studied.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Quality Improvement Initiative for Aspirin Screening and Prescription Rates for Preeclampsia Prevention in an Outpatient Obstetric Clinic.

Hypertensive disorders of pregnancy (HDP) impact 10% of pregnancies in the United States and cause adverse maternal and neonatal outcomes such as prematurity and low birth weight. Aspirin administration to at-risk individuals during pregnancy can reduce risk of HDP. Define-Measure-Assess-Improve-Control methodology was utilized to improve aspirin screening in an outpatient obstetric clinic. Retrospective cohort analysis compared outcome metrics pre- and postimplementation by using logistic regression models, adjusting for race and insurance. Key informant interviews and process mapping identified barriers to aspirin screening. A multidisciplinary team implemented low-cost strategies such as provider education, additional screening by ancillary staff, automated electronic reminders, and standardized patient counseling. Over 6 months, the screening rate improved from 62.5 to 92.0% (adjusted odds ratio [aOR] = 6.89, 95% confidence interval [CI]: 3.30-14.43). The prescription rate for patients correctly identified to be eligible for aspirin improved from 66.7 to 82.4% (aOR = 1.96, 95% CI: 0.88-4.35). Comprehensive, tailored quality improvement efforts can significantly increase aspirin screening and prescription, which may decrease maternal and neonatal morbidity due to HDP. · Initiative improved overall and correct screening rates.. · Initiative increased provider knowledge of eligibility.. · Low-cost interventions can have high impact over short time interval..

Effects of fine ambient particulate matters on de novo hypertensive disorders of pregnancy and blood pressure before 20 weeks

The effects of fine particulate matter (PM) on de novo hypertensive disorders of pregnancy (HDP) were inconsistent during the first and second trimesters. This study aimed to assess the trimester-specific effects of PM2.5 and PM1 prior to diagnosis of de novo HDP. The exposure of fine PM was predicted by satellite remote sensing data according to maternal residential addresses. De novo HDP was defined as gestational hypertension and preeclampsia during the current pregnancy. A logistic regression model was performed to assess the association of PM2.5 and PM1 with HDP during the first and early second trimesters (0–13 weeks and 14–20 weeks). The generalized estimating equation model was conducted to assess the effect of PM2.5 and PM1 on blood pressure. The present study included 22,821 pregnant women (mean age, 29.1 years) from 2013 to 2017. PM2.5 and PM1 were significantly associated with an increased risk of de novo HDP during the first trimester (OR = 1.070, 95% CI: 1.013–1.130; OR = 1.264, 95% CI: 1.058–1.511 for per 10 μg/m3) and early second trimester (OR = 1.045, 95% CI: 1.003–1.088; OR = 1.170, 95% CI: 1.002–1.366 for per 10 μg/m3). Significant trends of increased de novo HDP risk was also observed with the increment of PM (all P for trend <0.05). The stratified analyses demonstrated that the associations between exposure to fine PM and the risk of HDP were more pronounced among the pregnant women with maternal age above 35 and low maternal education level (all OR >1.047). Each 10 μg/m3 increase of PM1 and PM2.5 before diagnosis of de novo HDP elevated 0.204 (95% CI: 0.098–0.310) and 0.058 (95%CI: 0.033–0.083) mmHg of systolic blood pressure. Exposure to PM2.5 and PM1 during the first and early second trimester were positively associated with the risk of de novo HDP. The fine PM before diagnosis of de novo HDP elevated the systolic blood pressure.

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children's study.

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children's Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.

Influence of preconception carbohydrate intake on hypertensive disorders of pregnancy: The Japan Environment and Children's Study.

Hypertensive disorders of pregnancy (HDP) are a crucial cause of morbidity and mortality. We aimed to examine whether preconception carbohydrate intake is associated with new-onset HDP and small for gestational age (SGA) births. We identified 93 265 normotensive (primiparous, 37 387; multiparous, 55 878) participants from the Japan Environmental Children's Study database who delivered between 2011 and 2014. After excluding participants with multiple gestations, preconception hypertension, and insufficient data, primiparous and multiparous participants were categorized into five groups according to their preconception carbohydrate-intake quintiles (Q1 and Q5 were the lowest and highest groups, respectively). Multiple logistic regression analysis was performed to identify the effect of preconception carbohydrate intake on early (<34 weeks) and late-onset (≥34 weeks) HDP and the incidence of SGA births. With the middle carbohydrate intake group (Q3) as a reference, the risk for late-onset HDP among multiparous women was higher in the Q5 group (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.02-1.69). The incidence of SGA births was higher in the Q1 group among both primiparous (aOR 1.16, 95% CI 1.01-1.33) and multiparous women (aOR 1.16, 95% CI 1.02-1.32). Excessive carbohydrate intake increases the incidence of HDP in multiparous women, while low-carbohydrate intake increases the incidence of SGA births. New recommendations for preconception carbohydrate intake are required to prevent major HDP-related complications.

Effects of obesity indices/GDM on the pregnancy outcomes in Chinese women: A retrospective cohort study.

To analyze pregnancy complications and outcomes of mothers with obesity or gestational diabetes mellitus (GDM). 15065 mothers were categorized into four and three groups by pre-pregnancy body mass index (preBMI) and abdominal circumference (AC), respectively, or divided into GDM or non-GDM groups. Logistic regression analysis was utilized to identify independent factors associated with pregnancy complications and outcomes. The overweight and obesity groups accounted for 16.0% and 4.0% of the total population, respectively. GDM incidence rate was 12.3%. The overweight and obesity groups (pre-pregnancy body mass index [preBMI] ≥ 24 kg/m2) were at higher risks for GDM, hypertensive disorders of pregnancy (HDP), gestational proteinuria, postpartum hemorrhage, preterm delivery, fetal malformation or stillbirth, neonatal asphyxia, large for gestational age (LGA), shoulder dystocia, and increased cesarean section rate. Similar results were obtained with AC grouping. GDM pregnant women had higher risks of HDP, preterm delivery, small for gestational age (SGA), LGA, and increased cesarean section rate. People with obesity had a higher risk of adverse pregnancy outcomes. The recommended preBMI is 19.2-22.7 kg/m2. The recommended AC at 11-13+6 gestational weeks is 74.0-84.0cm, and that value in normal preBMI is 74.0-82.0cm.

Donated-embryo pregnancies are associated with increased risk of hypertensive disorders even for young recipients: a retrospective matched-cohort study

To determine whether pregnancies with donated embryos are at a higher risk of complications than the pregnancies from autologous frozen-thawed embryo transfer (FET). Anonymous, multicenter, comparative, observational, retrospective, matched-cohort study. Six French assisted reproductive technique centers from 2003 to2018. Seventy-three singleton pregnancies with donated embryos (exposed) and 136 singleton pregnancies after autologous FET (nonexposed) were matched at 7-8 weeks of gestation (pregnancy date, parity, and women's age) (2:1 ratio, respectively). In accordance with French practices, all women were <44 years old and donated embryos were discarded frozen embryos from other couples. Not applicable. Percentages of hypertensive disorders of pregnancy (HDPs) with donated embryos versus autologous FET. Groups were comparable (mean age: 34.5 years) and HDPs (24.6% vs. 11.9%) were significantly more frequent among the donated-embryo pregnancies, mostly in its severe forms (17.5% vs. 4.6%). In contrast, their respective isolated hypertension frequencies were comparable (7.0% vs. 7.3%). Multivariate analysis retained increased severe HDP risk with donated embryos (odds ratio 2.08 [95% confidence interval: 1.08-4.02]). No significant effect of endometrial preparation was observed. C-sections were more frequent for donated-embryo pregnancies (47.3% vs. 29.2%). Newborns from embryo donation or autologous FET were comparable for prematurity, birth weight and length, Apgar score, small for gestational age, large for gestational age, neonatal malformations, and sex ratio. Even for young women, the risk of severe HDP was 4 times higher for donated-embryo pregnancies than for autologous-FET pregnancies. The HDP risk must be acknowledged to inform donated-embryo recipients and provide careful pregnancy monitoring.