Risk Of Hypertensive Disorders Research Articles

Sleep Quality in High-Risk Pregnancies: Mixed Methods Results from a Randomized Controlled Trial of a Mindfulness Training Intervention.

Objectives: Sleep difficulties in pregnancy are common and increase the risk for obstetric complications. Past research shows that mindfulness training (MT) is helpful for improving sleep in non-pregnant adults and may improve sleep during pregnancy. However, it is unknown if MT improves sleep among pregnant people at risk for obstetric complications. We examined the effects of MT on sleep quality in individuals at risk of developing hypertensive disorders of pregnancy. Methods: Twenty-nine participants (mean age, 32 ± 4 years; mean gestational age, 16 ± 3weeks) at risk for hypertensive disorders in pregnancy (HDP) were randomized to an 8-week phone-delivered MT intervention (n = 15) or treatment as usual (TAU; n = 14), designed to test MT feasibility and acceptability. As part of the study, participants completed the Pittsburgh Sleep Quality Index and participated in a semi-structured individual qualitative interview which queried for sleep changes over pregnancy. Results: Participants randomized to MT reported less daytime sleep dysfunction compared to TAU (F = 5.79, p = 0.03, ηp2 = 0.28). Qualitative data illustrated the common experiences of sleep disturbance across both study groups; however, MT participants reported an improved ability to initiate sleep and return to sleep using mindfulness skills. About half of the participants in the MT condition reported an improvement in overall sleep quality due to less interference related to anxiety and restlessness, while other MT participants reported no change in sleep quality. Conclusions: Results from this study confirm that pregnant individuals frequently encounter sleep challenges. Findings also suggest that MT may be a helpful tool in improving sleep quality among pregnant people at risk for obstetric complications.

Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.

Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders.

Aim: In this secondary analysis of a pilot randomized controlled trial (RCT), we sought to examine whether mindfulness training (MT) is associated with change in interoceptive awareness in pregnant people at risk for hypertension using quantitative and qualitative methods. Interoceptive awareness is the perception, regulation, and integration of bodily sensations. Interoceptive awareness increases following MT and has been proposed as a psychosomatic process underlying hypertension outside of pregnancy. Methods: Twenty-nine participants (mean age 32 ± 4 years; 67% White) with a history of hypertensive disorders of pregnancy (HDP) were enrolled at 16 weeks' gestation (SD = 3) for a RCT assessing the feasibility and acceptability of an 8-week phone-delivered MT intervention. Fifteen participants were randomized to MT, whereas 14 were randomized to usual prenatal care. Before and after the intervention, all participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA) measure and participated an individual interview, which queried for mind-body changes noticed across the study period. Results: Adjusting for baseline interoceptive awareness and gestational age, participants randomized to MT reported less worry about physical sensations on the MAIA after the intervention compared to those randomized to usual care. Qualitative data corroborated these results; MT participants described improved awareness of body and breath sensations, ability to notice blood pressure changes, non-judgmental observation of thoughts, and improved responses to interpersonal challenges. Conclusions: MT may improve the ability to notice body sensations that arise in pregnancy in a way that promotes healthy responding rather than worry. Results provide support for interoceptive awareness as a potential mechanism through which mindfulness may modulate blood pressure and potentially reduce the prevalence of HDP. Clinical Trial Registration: ClinicalTrials.gov (NCT03679117).

Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis

ObjectiveTo assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes.DesignSystematic review and meta-analysis.Data sourcesMajor databases between December 2019 and...

COVID-19 infection and hypertension disorders during pregnancy

The objective: to determine the impact of COVID-19, which occurred before or during pregnancy, on the frequency of development and features of the course of gestational hypertension and preeclampsia.Materials and methods. An observational retrospective study with parallel control one was conducted. The pregnancy course and its outcomes in 178 women during the period of the COVID-19 pandemic – from March 2020 to January 2022 – who were observed in the women’s consultation of a private medical center, were analyzed. It is important to note that the medical documentation was taken one after the other, without being specially selected according to any principle, that is, the analysis carried out had the character of continuous screening.Out of 178 pregnant women, 125 (70.2%) persons were sick with COVID-19, they were included in the main group; 53 (29.8%) women who were part of the comparison group did not get sick. The groups are comparable by age and body mass index. The age of the women was 19–51 years; in the main group – 30.5±4.9 years, in the comparison group – 30.9±5.6 years. Body mass index (kg/m2) at the beginning of pregnancy in women of the main group was 21.6±4.3; comparison group – 22.9±4.8. There were 104 (58.4%) primigravida, 74 (41.6%) – multigravida. 117 (65.7%) women were primipara, 61 (34.3%) – multipara.All pregnant women were performed with a standard examination in accordance with the Order No. 417 of the Ministry of Health of Ukraine dated 15.07.2011. Clinical and anamnestic risk factors for the development of preeclampsia were assessed in all women without exception, on the basis of which 3 women were assigned to the risk group. In addition, 158 (88.8%) pregnant women as part of the first combined screening had an additional examination to determine the risk of developing preeclampsia, as a result of which additional 23 women were included in the risk group. As a result, 26 (14.6%) pregnant women from 12 weeks of gestation were prescribed prophylaxis using acetylsalicylic acid.Results. In women who have had COVID-19, hypertensive disorders of pregnancy develop statistically significantly less often than in those who have not had the disease. After mildly symptomatic COVID-19 the risks of hypertensive disorders in pregnant women are statistically significantly reduced: gestational hypertension – RR=1.15, 95% CI: 1.0–1.3; preeclampsia – RR=1.1, 95% CI: 1.0–1.2, all hypertensive disorders – BP=1.3, 95% CI: 1.1–1.6.The groups did not differ among themselves in the prevalence of generally accepted risk factors. The frequency of hypertensive disorders depending on the vaccination was analyzed. The risk of gestational hypertension in vaccinees who did not suffer from COVID-19 is reduced by 1.4 times (RR=1.4, 95% CI: 1.0–1.9), the risk of all hypertensive disorders in pregnant women in this same group is reduced 2 times (RR=2.0, 95% CI: 1.2–3.5).The development of preeclampsia also probably depends on the vaccination status (χ2=4.0; p=0.04; φ=-0.17). In non-vaccinated persons it increases by 1.1 times (RR=1.1, 95%CI: 1.2–1.8). The risk of all hypertensive disorders is also higher in the group with a negative vaccine status (RR=1.3, 95%CI: 1.0–1.7) only at the level of significance p=0.06, that is, it appears as a certain tendency.Conclusions. Hypertensive disorders associated with pregnancy are less likely to develop in women who have experienced COVID-19 in the preconception period or during pregnancy. Vaccination against COVID-19 reduces the frequency of hypertensive disorders in pregnant women, regardless of the disease presence.Since immune mechanisms, along with placental-vascular mechanisms play a significant role in the pathogenesis of preeclampsia, let’s assume that the experienced coronavirus infection or vaccination against it disrupts certain links of immunity, which results in a decrease in the frequency of hypertensive disorders in pregnant women.

Postpartum readmission in Maryland by race and ethnicity, 2016–2019

The majority of maternal deaths occur in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand whether there are disparities in maternal health in the postpartum period as indicated by readmission to the hospital. This study aimed to use state-wide Maryland data to identify postpartum readmission rates by race and ethnicity, as well as the major risk factors, indications, and timing of readmission. In this retrospective study (2016-2019), childbirth hospitalizations for patients of childbearing age were identified from the Maryland State Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Indication for readmission was described. Multivariable logistic regression models were employed to determine racial and ethnic differences in postpartum readmissions, adjusting for maternal and obstetrical characteristics. Among total deliveries (n=260,778), 3914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% (1306/111,325) for White patients, 2.3% (1786/79,412) for Black patients, 1.2% (485/40,862) for Hispanic patients and 1.2% (337/29,179) for patients of Other race or ethnicity (P<.0001). Black patients had the highest rates of readmission for hypertensive disorders as compared with all other races (37%, P<.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio, 1.64; confidence interval, 1.52-1.77). The majority of all readmissions occurred in the first week after delivery with Black patients having higher rates of readmission in the second week relative to all other groups (P<.0001). Hypertension is a leading cause of postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race or ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.

Association Between Smoking and Hypertension in Pregnancy Among Japanese Women: A Meta-analysis of Birth Cohort Studies in the Japan Birth Cohort Consortium (JBiCC) and JECS.

Recent literature suggest the effect of maternal smoking on risk of hypertensive disorders in pregnancy (HDP) and preeclampsia may differ by ethnicity; however, studies on Asians are limited. We investigated the association of maternal smoking with HDP and preeclampsia using a common analysis protocol to analyze the association in six birth cohorts participating in a Japanese consortium of birth cohorts (JBiCC). Results were compared with-published results from cohorts not included in this consortium, and, where possible, we produced a meta-analysis including these studies. Meta-analysis of four cohort studies including 28,219 participants produced an odds ratio (OR) of 1.24 (95% confidence interval [CI], 0.88-1.87) for the effect of smoking beyond early pregnancy compared to women who did not smoke during pregnancy. These results combined with those from the Japan Environment and Children's Study (JECS) yielded an OR of 1.19 (95% CI, 1.00-1.43, P = 0.056). Meta-analysis results for categories of smoking volume were insignificant, but when combined with JECS yielded an OR of 0.86 (95% CI, 0.65-1.12) for smoking 1-4 cigarettes, 1.25 (95% CI, 0.98-1.60) for smoking 5-9 cigarettes, and 1.27 (95% CI, 1.04-1.54) for smoking 10 or more cigarettes per day. All effects were insignificant for preeclampsia. Our results suggest that the protective effects of smoking longer and smoking more on HDP and preeclampsia repeatedly observed among Europeans and North Americans likely do not hold for the Japanese.

Risk and Protective Factors Associated with Hypertensive Disorders in Ghana: The Case of the Bolgatanga Regional Hospital of the Upper East Region

Aim: The goal of this study was to identify some risk and protective factors associated with hypertensive disorders among pregnant women in the Bolgatanga Regional Hospital of Ghana's Upper East Region.&#x0D; Study Design: This study is a one case-control study design.&#x0D; Place of Study: The study was conducted in the Antenatal clinic and Maternity ward of the Upper East Regional hospital in Bolgatanga.&#x0D; Methodology: The study population consisted of pregnant women who were attending their antenatal care at the Bolgatanga regional hospital whose gestational ages were more than 20 weeks.&#x0D; Hundred (100) study participants were selected using the purposive sampling technique (a non-probability sampling technique). Data for the study was gathered from the history of the 100 pregnant women who were visiting the Bolgatanga Regional Hospital for antenatal care. The analysis was conducted using the logistic regression model of STATA 14.&#x0D; Results: The study disclosed that white blood cells (WBC), low-density lipoprotein cholesterol (LDL), placenta weight (PW), gestational weight (GW), body mass index (BMI) were statistically significant. BMI was discovered to have a positive association with hypertensive disorders (OR= 2.208, P= .025), whereas PW (OR=0.994, P= .085), GW (OR=0.815, P=.079), WBC (OR=0.719, P=.01), and LDL (OR=0.645, P= .027) were discovered to have negative associations with hypertensive disorders (odds ratios less than one). &#x0D; Conclusion: The study identified BMI as a risk factor and PW, GW, WBC, and LDL as protective factors. On the basis of the analysis it was recommended that health professionals should raise the awareness of women on the risks of hypertensive disorders even before they become pregnant, especially maintaining healthy weight.

Postpartum Readmission in Maryland by Race and Ethnicity [ID: 1358223

INTRODUCTION: In Maryland, 81% of pregnancy-related deaths occurred in the postpartum period. We sought to compare postpartum readmission by race and ethnicity to better understand disparities in maternal mortality. METHODS: In this retrospective study (2016–2019), childbirth hospitalizations from the Maryland State Inpatient Database for childbearing age patients were analyzed. Indication for readmission was described. Multivariable logistic regression models were employed to determine race and ethnicity differences in postpartum readmissions, adjusting for maternal and obstetric characteristics (Johns Hopkins IRB00320807). RESULTS: Among total deliveries (n=260,778), 3,914 patients (1.5%) were readmitted within 60 days of delivery. The most common primary diagnoses at readmission were hypertension and infection. The prevalence of readmission was 1.2% for White patients, 2.3% for Black patients, and 1.2% for Hispanic patients (P&lt;.0001). Black patients had the highest rates of readmission for hypertensive disorders (37%, P&lt;.0001). In adjusted models, Black patients were more likely to be readmitted than White patients (odds ratio 1.64, CI 1.52–1.77). The majority of readmissions occurred in the first week after delivery; however, Black patients had higher rates of readmission in the second week relative to all other groups (P&lt;.0001). CONCLUSION: Hypertension is a leading factor for postpartum readmission in Maryland. Black patients were more likely to be readmitted for hypertensive disorders of pregnancy and to have delayed readmission relative to other race/ethnic groups. Maryland public health officials should address disparities with interventions targeting racial and ethnic minorities, patients at risk for hypertensive disorders, and barriers to timely care.

Correlation between serum ferritin in early pregnancy and hypertensive disorders in pregnancy.

To explore the correlation between serum ferritin (SF) in early pregnancy and the risk of hypertensive disorders in pregnancy (HDP). A retrospective cohort study was conducted on 43,421 pregnant women with singleton pregnancies who underwent antenatal checkups at Fujian Provincial Maternal and Child Health Hospital from January 2018 to December 2020. Based on pregnancy records, women were classified as non-hypertensive, having gestational hypertension, preeclampsia and preeclampsia with severe features according to the degree of the disease. General baseline data, and SF levels in the early (up to 12 gestational weeks) and late (after 28 weeks of gestation) stages of pregnancy were collected. The significance of the characteristic variables was assessed using a random forest algorithm, and the correlation between early pregnancy SF levels and the incidence of HDP was further analyzed using logistics regression adjusted for confounders. A generalized additive model (GAM) was fitted to a smoothed graph of the relationship between early pregnancy SF levels and HDP, and a threshold effect analysis was performed to find the threshold values of early pregnancy SF for iron supplementation therapy. A total of 30,703 pregnant women were included. There were 1,103 women who were diagnosed with HDP. Of them, 418 had gestational hypertension, 12 had chronic hypertension without SPE, 332 - preeclampsia and 341 women had preeclampsia with severe features. Levels of SF in early and late pregnancy were significantly higher (p < 0.001) in women with HDP compared to non-hypertensive women and the difference was more pronounced in early pregnancy. The random forest algorithm showed that early pregnancy SF was more effective in predicting HDP compared to late pregnancy SF levels and was also an independent risk factor for HDP (adjusted odds ratio (AOR) = 1.07, 95% CI [1.05,1.09]) after correction for confounding factors. Early pregnancy SF >64.22 mg/l was associated with higher risk of developing hypertensive disorders. Risk of pregnancy-related hypertensive disorders increases with increasing early pregnancy SF levels. SF levels may therefore be used to further develop guidelines for iron supplementation therapy in pregnant women.

Ozone Exposure During Pregnancy and Risk of Gestational Hypertension or Preeclampsia in China

Although certain air pollutants have been associated with adverse obstetric outcomes, evidence regarding the association of ozone (O3) exposure with the risk of hypertensive disorders in pregnancy (HDP) is limited and inconsistent. To evaluate the association between gestational O3 exposure and HDP (ie, gestational hypertension and preeclampsia) risk, and to explore the window of susceptibility for O3 exposure during pregnancy. This cohort study recruited pregnant patients from the Obstetrics and Gynecology Hospital of Fudan University in Shanghai, China, from March 2017 to December 2018. Participants were older than 18 years, had no infectious diseases or chronic noncommunicable diseases before pregnancy, were Shanghai residents with intent to participate in the study, and had plans to give birth in Shanghai. Gestational hypertension and preeclampsia were diagnosed according to the diagnostic criteria of the Chinese Society of Obstetrics and Gynecology during the study period. Data on residential addresses, demographic characteristics, and household living environments were collected from participants through a questionnaire survey. Data were analyzed from December 10, 2021, to May 10, 2022. A high temporospatial resolution model was applied to predict individual levels of daily O3 exposure during pregnancy. The outcomes were gestational hypertension and preeclampsia, and data on these diagnoses were extracted from the hospital's information system. A logistic regression model was used to estimate the associations between O3 exposure and risk of gestational hypertension or preeclampsia. Exposure-response associations were confirmed by restricted cubic spline functions. Distributed lag models were used to identify the O3 exposure window of susceptibility. Among the 7841 participants (all females; mean [SD] age, 30.4 [3.8] years), 255 (3.2%) had gestational hypertension and 406 (5.2%) had preeclampsia. Pregnant individuals with HDP had considerably higher prepregnancy body mass indexes and lower educational levels. The mean (SD) O3 exposure levels were 97.66 (25.71) μg/m3 in the first trimester and 106.13 (22.13) μg/m3 in the second trimester. Each 10-μg/m3 increment of O3 exposure during the first trimester was associated with higher gestational hypertension risk (relative risk, 1.28; 95% CI, 1.04-1.57). However, gestational O3 exposure was not associated with the risk of preeclampsia. The restricted cubic spline function analysis revealed an exposure-response association between O3 exposure and risk of gestational hypertension. Results of this study showed an association between increased gestational hypertension risk and O3 exposure during the first trimester. Furthermore, gestational weeks 1 to 9 were identified as the window of susceptibility for O3 exposure and elevated gestational hypertension risk. Sustainable O3 control is needed to reduce the disease burden of gestational hypertension.

A Scoping Review of Perinatal Outcomes for Canadian Individuals with Obesity 1980–2020

Background: Pre-pregnancy obesity has long been associated with a higher risk of antepartum, intrapartum, and postpartum complications, leading to classifying all patients within the WHO obese body mass index range (BMI ≥30 kg/m2) as high-risk. Excessive risk classification can lead to over-treatment and iatrogenic harm. Research supporting these increased risks comes from a variety of countries with different baseline population health and perinatal health care systems. Recent research documents that parturients with high pre-pregnancy BMI can have uncomplicated pregnancies and births. Here, the relationship between obesity and perinatal outcomes in a Canadian population is investigated using Canada as a model of a country with stable nutrition sufficiency and universal access to health care. Methods: We searched electronic databases PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed articles in English that examined perinatal outcomes of singleton pregnancies in Canada between 1980 and 2020 based on pre-pregnancy obesity as the exposure of interest. Results: The search yielded 1946 results. After full-text screening, 21 articles met criteria for analysis. The impact of obesity on preterm labour, preterm birth, post-term delivery, labour induction, post-partum hemorrhage, and parturient morbidity and mortality in Canada remains inconclusive. The risk of hypertensive disorders, gestational diabetes, shoulder dystocia, and cesarean section delivery was significantly elevated as BMI increased. Operative vaginal delivery was less common in those with pre-pregnancy obesity. Conclusions: Though certain adverse perinatal outcomes are associated with increasing pre-pregnancy BMI, given the wide range of results and range of risk values, further research is required to better delineate comorbid risk factors that contribute to poorer outcomes. Nation-specific outcomes that reflect the accessibility of perinatal care and population health are a necessary baseline for the development of accurate health management guidelines.

Prenatal Exposure to PM2.5 and Its Specific Components and Risk of Hypertensive Disorders in Pregnancy: A Nationwide Cohort Study in China.

Hypertensive disorders in pregnancy (HDP) are a leading cause of maternal mortality and adverse birth outcomes. Fine particulate matter (PM2.5) has been linked to HDP risk; however, limited studies have explored the relationships between specific chemical constituents of PM2.5 and HDP risk. Based on maternal data from the China Labor and Delivery Survey (CLDS), this study included a total of 67,659 participants from 95 participant hospitals in 25 provinces of China between March 1, 2015, and December 31, 2016. Maternal exposure to total PM2.5 mass and six main components during pregestation and pregnancy were estimated using the Combined Geoscience-Statistical Method. Multilevel logistic regression models were applied to quantify the associations, controlling for sociodemographic characteristics. We found that an interquartile range (IQR) increase in PM2.5 exposure during the second trimester was associated with a 14% increase in HDP risk (95% CI: 2%, 29%). We observed that black carbon (BC) and SO42- had larger or comparable estimates of the effect than total PM2.5 mass. The association estimates were greater in the gestational hypertension group than in the group of pre-eclampsia and eclampsia. Our findings suggest that PM2.5 exposure and specific chemical components (particularly BC and SO42-) were associated with an increased HDP risk in China.

Iron supplementation for non-anaemic pregnant women and the incidence of hypertensive disorders in pregnancy

Objective: To investigate effect of iron supplementation on the risk of hypertensive disorders in pregnancy in non-anaemic pregnant women. Methods: A literature search was conducted using three categories of terms with its synonyms or related words: “iron”, “supplement”, “hypertensive disorders in pregnancy” through MEDLINE (OVID), CINAHL, PubMed, Cochrane Library, Scopus, Web of Science, ICTRP, and ClinicalTrials.gov, and manual search of references was used in seven potential resources. The inclusion criteria were randomized control trials (RCTs), published in English, full-text available, having healthy pregnant women without anaemia for study participants, and having hypertensive disorders in pregnancy at the end of pregnancy as the outcome. The risk of bias assessment tool was used for quality appraisal. Meta-analysis was conducted by calculating the fixed and random effects of the odds ratio (OR) for iron supplementation among non-anaemic pregnant women compared with the incidence of hypertensive disorders in pregnancy. The range of the study's estimation accuracy was reflected by a 95% confidence interval (CI). Results: Four RCTs were included in the meta-analysis. The pooled results showed that iron supplementation possibly had no effect on the incidence of hypertensive disorders in pregnancy (OR 0.93, 95% CI 0.81-1.07; P=0.30), gestational hypertension (OR 1.37, 95% CI 0.69-2.73; P=0.36) as well as on the development of preeclampsia (OR 1.45, 95% CI 0.71-2.97; P=0.31). Conclusions: Iron supplementation has no effect on the incidence of hypertension in non-anaemic pregnant women. In general, there is a lack of evidence for the association between iron supplementation and the incidence of hypertensive disorders in pregnancy among non-anaemic pregnant women, and further studies are needed.

P-776 Maternal and neonatal outcomes of singletons and twins after frozen-thawed embryo transfer in different cycle regimes: Increased risks of hypertensive disorders in Hormone replacement cycles

Abstract Study question What are the associations between cycle regime and maternal and neonatal outcomes after frozen-thawed embryo transfer leading to singleton or twin life birth? Summary answer Hormone replacement cycles are associated with higher and natural or low-dose stimulation with lower risks for bleeding, hypertension and preeclampsia in singleton and twin pregnancies. What is known already So far, there is no consensus on optimal cycle regimen for endometrial preparation: Frozen-thawed embryo transfers can be either performed in Natural Cycles (NC-FET), low-dose Stimulation Cycles (SC-FET) or Hormone Replacement Cycles (HRC-FET). In previous studies, HRC-FET was shown to be associated with an increase of serious maternal and neonatal complications, i.e. preeclampsia (doubled to tripled risk), postpartum hemorrhage (doubled risk), placenta accrete (sixfold risk), post-term birth (sixfold risk) and Caesarean section (doubled risk) compared to NC-FET or SC-FET. These results indicate that risks are increased in cycles in which the development of follicles and luteal bodies is medically inhibited. Study design, size, duration Retrospective cohort study analyzing a total of 4636 singletons and also 544 twins born after FET that were registered in the Swiss IVF Registry from 2014 to 2019. Participants/materials, setting, methods Women were divided into three groups according to the cycle regimes: NC-FET (n = 776), SC-FET (n = 758) and HRC-FET (n = 3646) leading to life birth. Maternal outcomes included pregnancy complications such as bleedings, isolated hypertension (&amp;gt;140/90 mmHg) and preeclampsia. Neonatal outcomes comprised gestational age and weight, mode of delivery and neonatal status. Incidences were compared using Fisher exact or Chi-square tests. Multivariate mixed model analysis was performed for singleton and twin pregnancies. Main results and the role of chance In singleton pregnancies, the incidences of bleeding in first trimester (NC: 2.8%, SC: 2.6%, HRC: 7.0%; p&amp;lt;.001), isolated hypertension (NC: 0.9%, SC: 0.2%, HRC: 1.8%; p = &amp;lt;.001) and preeclampsia (NC: 1.7%, SC: 0.3%, HRC: 2.8%, p&amp;lt;.001) were significantly higher in HRC-FET. Gestational diabetes occurred most (NC: 4.6%, SC: 7.0%, HRC: 4.5%; p = 0.032) and intrauterine growth restriction least frequently (NC: 1.9%, SC: 0.2%, HRC: 1.3%; p = 0.004) in SC-FET. Highest spontaneous birth rates were reported in NC-FET (NC: 51.2%, SC: 45.0%, HRC: 33.8%; p&amp;lt;.001). Multivariate analysis revealed doubled odds ratio of bleeding in first trimester (aOR 2.01; 95% CI 1.20-3.37; p = 0.008%) and preeclampsia (aOR 2.13; 95% CI 1.12-4.05; p = 0.021) in HRC-FET vs. NC-FET and sixfold odds ratio of preeclampsia in HRC-FET vs. SC-FET (aOR 6.37; 95% CI 1.48-27.54; p = 0.013). Outcomes of SC-FET and NC-FET were comparable. In twin pregnancies, the incidences of preeclampsia were significantly higher in HRC-FET (NC: 2.7%, SC: 1.0%, HRC: 7.2%, p = 0.026). There were no differences in delivery mode between cycle regime. Multivariate analysis revealed numerically higher odds ratio of preeclampsia in HRC-FET vs. NC-FET (aOR 2.57; 95% CI 0.55 - 12.07; p = 0.232) and in HRC-FET vs. SC-FET (aOR 4.07; 95% CI 0.47 - 34.91; p = 0.2) but without reaching significance. Limitations, reasons for caution The data were drawn from a registry analysis with limited information on patients’ characteristics. Data such as BMI were not available. As the study is based on a register analysis, some errors in data collection cannot be excluded. Wider implications of the findings This is the first large register study to demonstrate a clear association between the three different cycle regimes and pregnancy complications both in singleton and twin pregnancies. HRC-FET showed the highest maternal risks of hypertensive disorders, therefore, it should be avoided and replaced by SC-FET or NC-FET if medically possible. Trial registration number Not applicable.

Endometrial thickness is an independent risk factor of hypertensive disorders of pregnancy: a retrospective study of 13,458 patients in frozen-thawed embryo transfers

BackgroundHypertensive disorders of pregnancy (HDP) are an important cause of maternal and fetal mortality, and its potential risk factors are still being explored. Endometrial thickness (EMT), as one of the important monitoring indicators of endometrial receptivity, has been confirmed to be related to the incidence of HDP in fresh embryo transfer. Our study was designed to investigate whether endometrial thickness is associated with the risk of hypertensive disorders of pregnancy in frozen-thawed embryo transfer (FET).MethodsThis respective cohort study enrolled 13,458 women who received vitrified embryo transfer and had a singleton delivery in the Reproductive Hospital affiliated to Shandong University from January 2015 to December 2019. We set strict screening criteria and obtained the information from the hospital electronic medical system. Statistical methods including logistic regression analysis, receiver operating characteristic curve and restricted cubic spline were used to evaluate the relationship between endometrial thickness and the incidence of pregnancy-induced hypertension.ResultsThe incidences of HDP in a thin endometrial thickness group (< 0.8 cm) and a thick endometrial thickness group (> 1.2 cm) were significantly greater than in a reference group (0.8 cm–1.2 cm) (7.98 and 5.24% vs 4.59%, P < 0.001). A nonlinear relationship between endometrial thickness and risk of hypertensive disorders of pregnancy was examined by restricted cubic spline (P < 0.001). The thin endometrial thickness and thick endometrial thickness groups were significantly associated with the risk of HDP after adjusting for confounding variables by stepwise logistic regression analysis. Subsequently, subgroup logistic regression analysis based on endometrial preparation regimens showed that thin endometria were still significantly associated with a higher morbidity rate in the artificial cycle group, while in the natural cycle group, thick endometria were closely associated with increased morbidity.ConclusionOur study manifested that both the thin and thick endometria were associated with an increased risk of hypertensive disorders of pregnancy in frozen embryo transfer cycles. Reproductive clinicians should focus on adjusting endometrial thickness in different preparation regimens; and obstetricians should be mindful of the risk of hypertension during pregnancy, when women with thin (< 0.8 cm) or excessively thicker (> 1.2 cm) endometrial thickness achieve pregnancy through frozen-thawed embryo transfer.

Maternal race and pre-eclampsia: Cohort study and systematic review with meta-analysis.

To examine the association between race and pre-eclampsia and gestational hypertension after adjustment for factors in maternal characteristics and medical history in a screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on pre-eclampsia. Prospective observational study and systematic review with meta-analysis. Two UK maternity hospitals. A total of 168 966 women with singleton pregnancies attending for routine ultrasound examination at 11-13 weeks of gestation without major abnormalities delivering at 24 weeks or more of gestation. Regression analysis examined the association between race and pre-eclampsia or gestational hypertension in the FMF data. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and pre-eclampsia. Relative risk of pre-eclampsia and gestational hypertension in women of black, South Asian and East Asian race by comparison to white women. In black women, the respective risks of total-pre-eclampsia and preterm-pre-eclampsia were 2-fold and 2.5-fold higher, respectively, and risk of gestational hypertension was 25% higher; in South Asian women there was a 1.5-fold higher risk of preterm pre-eclampsia but not of total-pre-eclampsia and in East Asian women there was no statistically significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contributions on different racial groups to the prediction of pre-eclampsia. In women of black and South Asian origin the risk of pre-eclampsia, after adjustment for confounders, is higher than in white women.

The Influence of HbA1c and Gestational Weight Gain on Pregnancy Outcomes in Pregnant Women With Gestational Diabetes Mellitus.

BackgroundTo investigate the influence of HbA1c level and GWG on pregnancy outcomes in pregnant women with GDM.MethodsA total of 2,171 pregnant women with GDM were retrospectively included and categorized as follows: (1) normal (HbA1c <6%) and elevated (HbA1c ≥6%) HbA1c groups according to the HbA1c level in the second trimester, and (2) inadequate, appropriate, and excessive GWG groups according to the IOM guidelines.ResultsIn pregnant women with GDM, advanced age and high pre-pregnancy BMI were high-risk factors for elevated HbA1c. Pregnant women with elevated HbA1c had higher OGTT levels than those with normal HbA1c, and the risks of adverse pregnancy outcomes were higher (P < 0.05). The risks of primary cesarean section, hypertensive disorders during pregnancy, and macrosomia in pregnant women with excessive GWG were significantly higher than those with inadequate and appropriate GWG (P < 0.05). When GWG was appropriate, the risk of hypertensive disorders during pregnancy in the elevated HbA1c group was higher than that in the normal HbA1c group. When GWG was excessive, the risks of postpartum hemorrhage, macrosomia, and neonatal asphyxia in the elevated HbA1c group were significantly higher than in the normal HbA1c group (P < 0.05).ConclusionMonitoring and controlling blood glucose levels have shown effectiveness in reducing the adverse pregnancy outcomes in women with GDM, particularly for those who had excessive GWG.

Random Forests for Accurate Prediction of the Risk of Hypertensive Disorders of Pregnancy at Term [A208

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) complicate 10% of all pregnancies and confer elevated risks of subsequent conditions, such as chronic hypertension and diabetes. Risk models that accurately predict HDP can improve clinical management by risk stratification, allowing earlier interventions and closer interval follow-up. This study develops and internally validates a risk prediction model for the development of HDP in the third trimester. METHODS: This analysis was conducted using the Eunice Kennedy Shriver Institute of Child Health and Human Development / Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) data for approximately 9,000 low-risk nulliparous patients. HDP was the primary outcome for this analysis, defined as gestational hypertension, mild/severe preeclampsia, eclampsia, or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an indication for admission. We included 518 potential covariates of interest, including outpatient vital signs, medication usage, patient and family medical history, and laboratory information. We trained a random forest predictor model on 80% of this dataset, and further refined it using recursive feature elimination to restrict the number of input variables to 20 for a reduced model. RESULTS: Our full and reduced models predicted HDP with area under the receiver operating characteristic (AUROC) scores of 0.82 and 0.81 respectively. Performance evaluation of the reduced model by race showed poorer performance for non-Hispanic Black (0.76), Hispanic (0.79), and non-Hispanic White (0.80) patients than overall. CONCLUSION: The reduced model has been deployed for demonstration at hypertension.delfina.com. Admission for HDP can be predicted with excellent discriminative ability using random forest prediction modeling. External validation and integration with electronic health records is needed to assist providers in triaging and informing at-risk patients.

Perinatal outcomes in children born after fresh or frozen embryo transfer using donated oocytes.

Do children born after vitrified-thawed embryo transfers (ETs) using donated oocytes have worse perinatal outcomes when compared with fresh ET? No significant difference in birthweight and prematurity rates between fresh or frozen embryo transfers (FETs) in newborns after oocyte donation was found. Autologous singletons born after fresh ET have been previously associated with higher rates of preterm birth and low birthweight, while FETs seem to confer a higher risk of hypertensive disorders during pregnancy and macrosomia. However, studies comparing these outcomes using autologous oocytes are unable to adequately disentangle the putative detrimental consequences of embryo vitrification from the possible effects that ovarian stimulation and endometrial preparation may have on endometrial receptivity prior to ET. The oocyte donation model is, for this reason, a more appropriate setting to study these hypotheses; however so far, the information available regarding neonatal outcomes in this patient population is limited to either small and/or heterogeneous studies. We performed a multicentre retrospective cohort study including 5848 singletons born between 2009 and February 2020 following oocyte donation and single blastocyst transfer, subdivided according to whether a fresh ET or FET was performed. We also performed two additional sensitivity analyses, subgrouping the sample according to the type of endometrial preparation (natural versus artificial) and whether the donated oocytes had previously been vitrified or not. Patients with a first singleton livebirth after single blastocyst transfer were compared using multivariable regression analysis to account for potential confounding factors. The primary outcome was birthweight. Secondary outcomes were birthweight z-scores and percentiles, small/large for gestational age, gestational age at delivery, gender, prematurity (<37 weeks and <32 weeks), neonatal morbidity (Apgar scores and need for neonatal intensive care) and maternal morbidity (gestational hypertensive disorders, gestational diabetes and caesarean delivery). There was no significant difference between the fresh ET and FET groups in terms of mean birthweight (3215 g versus 3200 g) and birthweight z-scores (0.03 versus 0.1), in both the unadjusted and confounder-adjusted models. However, artificial endometrial preparation was associated with a higher birthweight (3220 g versus 3105 g) and birthweight z-scores (0.06 versus -0.13) when compared with a transfer in a natural cycle. Although a 1-day statistically significant difference in gestational age at birth (275 versus 274 days) was detected, premature birth rates (<37 weeks) did not vary significantly between groups (9.9% and 11.2% for fresh ET and FET, respectively). No other statistically significant differences were found in the remaining neonatal and maternal outcomes studies between the fresh ET and FET groups. This study is limited by its retrospective design and lack of information regarding congenital malformations. Moreover, the sample selection criteria that were used may limit the generalizability of our results. Perinatal outcomes did not seem to be affected significantly by the embryo vitrification process in an oocyte donation model. Hence, other factors may contribute to the hindered perinatal outcomes described in ART, particularly the potential effect that ovarian stimulation and endometrial preparation may have on endometrial receptivity. No specific funding was obtained for this study. All authors have no conflicts to declare. N/A.