Severe Hypertensive Disorders Research Articles

D Vitamini Seviyesi Preeklampsinin Şiddetini Değiştirir mi? Tek Merkezli Vaka Kontrol Çalışması

Aim: We aimed to investigate the association between vitamin D deficiency and severity of preeclampsia.
 Material and Methods: We conducted a case-control study aiming to evaluate vitamin D serum levels in patients with preeclampsia(PE), severe preeclampsia, eclampsia and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). Total number of 69 patients between the ages of 18 and 40 either had a spontaneous vaginal delivery or C-section were included in the study. 
 Results: The demographic data of the patients were similar, and age was higher in severe PE than in the other groups. When body mass index (BMI) was evaluated, the average BMI of the patients in the severe PE group was found to be significantly higher than PE and similar to the other groups. The average vitamin D levels of all groups was 8.75±3.5 and the mean of severe PE was 6.69±3, which was significantly lower than the other groups. The average vitamin D level in PE was 10.99±2.91, and it was higher than all groups and was significantly higher than patients with severe PE and HELLP syndrome.
 Conclusion: We think that there is a significant relationship between the severity of hypertensive disorders that begin during pregnancy and the degree of vitamin D deficiency. We think that the control of vitamin D level and its addition to the treatment will positively affect the course of the disease in order to prevent hypertensive disorders and reduce the severity of disease.

Postpartum Readmission for Hypertension After Discharge on Labetalol or Nifedipine.

To assess whether readmission for hypertension by 6 weeks postpartum differed between patients discharged on nifedipine or labetalol. This cohort study included patients with delivery admissions from 2006 to 2017 who were discharged from the hospital on nifedipine or labetalol and were included in a large, national adjudicated claims database. We identified patients' discharge medication based on filled outpatient prescriptions. We compared rates of hospital readmission for hypertension between patients discharged postpartum on labetalol alone, nifedipine alone, or combined nifedipine and labetalol. Patients with chronic hypertension without superimposed preeclampsia were excluded. Comparisons based on medication were performed using logistic regression models with adjustment for prespecified confounders. Comparisons were also stratified by hypertensive disorder of pregnancy severity. Among 1,582,335 patients overall, 14,112 (0.89%) were discharged postpartum on labetalol, 9,001 (0.57%) on nifedipine, and 1,364 (0.09%) on both medications. Postpartum readmissions for hypertension were more frequent for patients discharged on labetalol compared with nifedipine (641 patients vs 185 patients, 4.5% vs 2.1%, adjusted odds ratio [aOR] 1.63, 95% CI 1.43-1.85). Readmissions for hypertension were more frequent for patients discharged on labetalol compared with nifedipine for both mild (4.5% vs 2.7%, aOR 1.57, 95% CI 1.29-1.93) and severe hypertensive disorders of pregnancy (261 patients vs 72 patients, 5.7% vs 3.2%, aOR 1.63, 95% CI 1.43-1.85). Readmissions for hypertension were more frequent on combined nifedipine and labetalol compared with nifedipine (3.1% vs 2.1%), but the odds were lower after confounder adjustment (aOR 0.80, 95% CI 0.64-0.99). Postpartum discharge on labetalol was associated with increased risk of readmission for hypertension compared with discharge on nifedipine.

Abstract P346: Cardiac Arrest During Delivery Hospitalization And Severe Hypertensive Disorders Of Pregnancy, United States, 2017-2019

Background: Cardiac arrest is a rare and sometimes fatal maternal complication. Severe hypertensive disorders of pregnancy (HDP) including preeclampsia with severe features, eclampsia, and Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome are risk factors for maternal cardiac events. Surveillance on cardiac arrest and severe HDP during delivery is critical to informing evidence-based strategies to reduce pregnancy-related death. Methods: Using pooled data from the National Inpatient Sample from 2017-2019, we identified delivery hospitalizations among women aged 12-55 years. Delivery hospitalizations, cardiac arrest, and maternal medical conditions were identified using ICD-10-CM codes. Survival to hospital discharge was based on patient discharge disposition. Prevalence of cardiac arrest, severe HDP, and survival following cardiac arrest were calculated. We estimated the prevalence of severe HDP among delivery hospitalizations with cardiac arrest, cardiac arrest frequency among delivery hospitalizations with severe HDP, and survival to hospital discharge with co-occurring cardiac arrest and severe HDP. All estimates were weighted to account for complex sampling. Results: During 2017-2019, an estimated 10,921,784 delivery hospitalizations among which 1,465 cardiac arrests were identified. Overall cardiac arrest prevalence was 13.4 per 100,000 delivery hospitalizations (95% CI, 11.9-14.9). Of these, 1,005 (68.6% [95% CI, 63.2-74.0]) survived to hospital discharge. Overall prevalence of severe HDP was 2.7% (95% CI, 2.6-2.7) compared with 15.4% (95% CI 11.2-19.5) of delivery hospitalizations with cardiac arrest. Frequency of cardiac arrest per 100,000 delivery hospitalizations with severe HDP was 76.9 (95% CI, 54.6-99.2). Survival to hospital discharge with co-occurring cardiac arrest and severe HDP was 77.8% (95% CI, 65.6-89.9). Conclusion: Delivery hospitalizations affected by cardiac arrest are rare, and over two thirds survived to hospital discharge. Cardiac arrest disproportionately affected delivery hospitalizations among patients who had severe HDP.

Analysis of treatment for 360 critically ill pregnant and parturient women in intensive care unit

To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics. The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized. A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation II (APACHE II) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360). The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

Association Between Preeclampsia in Prior Pregnancy and Attendance Rates of Postpartum Blood Pressure–Monitoring Appointments After a Subsequent Pregnancy

Preeclampsia complicates approximately 5% of pregnancies and accounts for 10%–15% of maternal deaths. Sixteen percent of patients experience recurrence of preeclampsia in subsequent pregnancies. It is recommended that patients whose pregnancies are complicated by preeclampsia attend a postpartum blood pressure–monitoring appointment at 7–10-days postpartum. Although there are multiple known factors that influence postpartum appointment attendance rates, including race–ethnicity, insurance status, parity, severity of hypertensive disorder, and method of birth, little is known about the effects of preeclampsia in a woman’s prior pregnancy on her blood pressure–appointment attendance rates in a subsequent pregnancy.

Clinical outcomes in pregnant women with coronavirus disease 2019 in a perinatal medical centre in Japan: a retrospective study of the first 1 year of the pandemic

In this retrospective study, we analysed clinical and demographic data from the medical records of 31 pregnant women with coronavirus disease 2019 (COVID-19) who were treated at our hospital between April 2020 and April 2021. The most common symptom was a fever; ∼10% of patients were asymptomatic. One patient with rapidly worsening pneumonia needed a Caesarean Section at 30 weeks and was admitted for intensive care. Twelve patients received perinatal care in our hospital (10 live births, one stillbirth, and one artificial abortion). Six patients delivered vaginally; the others delivered via caesarean section. Two patients had complications, including severe hypertensive disorders and preeclampsia. All patients recovered from COVID-19. Severe acute respiratory syndrome coronavirus 2 was not detected in the placenta, umbilical cord, cord blood, amniotic fluid, vaginal fluid, or breast milk in any patient. There were no neonatal adverse outcomes. The possibility of transmitting the coronavirus to pregnancy-related samples was low. IMPACT STATEMENT What is already known on the subject? COVID-19 has been affecting different countries in diverse ways, and the incidence, mortality, and morbidity rates of patients with COVID-19 vary widely by country or region and race. These differences in results may reflect racial differences and differences in national health care systems. Moreover, the information about the perinatal outcomes of pregnant women with COVID-19 and their newborns from Japan is limited. What do the results of this study add to what is known? We described the perinatal outcomes of 31 Japanese pregnant women with COVID-19 who were managed safely in a perinatal medical centre in Tokyo Japan, during the first 1 year of the pandemic. What are the implications of these findings for clinical practice and/or further research? Severe pneumonia and perinatal complications may occur, although no maternal and neonatal deaths were observed for COVID-19-positive pregnant women in our facility. Therefore, it is important to prevent this infection during pregnancy with the provision of effective medical care.

Ambient temperature during pregnancy and risk of maternal hypertensive disorders: A time-to-event study in Johannesburg, South Africa

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22–43 weeks' gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017–June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low and high temperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively. Of 7986 women included, 844 (10.6%) had a hypertensive disorder of which 432 (51.2%) had high blood pressure/hypertension/gestational hypertension and 412 (48.8%) had pre-eclampsia/eclampsia/HELLP. High temperature in early pregnancy was associated with an increased risk of pre-eclampsia/eclampsia/HELLP. High temperature (23 °C vs 18 °C) in the third and fourth weeks of pregnancy posed the greatest risk, with hazard ratios of 1.76 (95% CI 1.12–2.78) and 1.79 (95% CI 1.19–2.71), respectively. Whereas, high temperatures in mid-late pregnancy tended to protect against pre-eclampsia/eclampsia/HELLP. Low temperature (11°) during the third trimester (from 29 weeks’ gestation) was associated with an increased risk of high blood pressure/hypertension/gestational hypertension, however the strength and statistical significance of low temperature effects were reduced with model adjustments. Our findings support the hypothesis that high temperatures in early pregnancy increase risk of severe hypertensive disorders, likely through an effect on placental development. This highlights the need for greater awareness around the impacts of moderately high temperatures in early pregnancy through targeted advice, and for increased monitoring of pregnant women who conceive during periods of hot weather.

Differences in disease severity and delivery gestational age between black and white patients with hypertensive disorders of pregnancy.

We sought to quantify racial differences in disease severity and delivery gestational age among Black and White patients with a diagnosis of a hypertensive disorder of pregnancy. This was a retrospective cohort of all Black and White pregnant patients carrying non-anomalous singleton or twin gestations at a single tertiary healthcare system who were diagnosed with a hypertensive disorder of pregnancy, 2014-2020. The primary outcome was delivery<34weeks' gestation. Secondary outcomes were delivery<28weeks', preeclampsia with severe features, acute renal insufficiency, HELLP syndrome, cesarean delivery, classical cesarean delivery, small for gestational age, severe maternal morbidity, and severe composite neonatal morbidity. Outcomes were compared by race. Data were analyzed using chi square, t-test, and logistic regression. 3,522 patients (29.8% Black) met inclusion criteria. Black patients had a higher odds of delivery<34weeks' [adjusted odds ratio (aOR) 2.22, 95% CI 1.7-2.89] and<28weeks' (aOR 2.39, 95% CI 1.43-3.99) and developing preeclampsia with severe features (aOR 1.92, 95% CI 1.62-2.29) than White patients. Black patients also had higher aOR of classical cesarean, severe maternal morbidity, and a small for gestational age neonate. Black patients are more likely to experience severe hypertensive disorders of pregnancy and preterm delivery compared to White patients. These findings suggest that Black-White disparities in preterm birth may be partially attributable to disparities in onset and severity of hypertensive disorders of pregnancy.

Deliveries Among Patients Aged 11-19 Years and Risk for Adverse Pregnancy Outcomes.

To characterize delivery hospitalization trends of patients aged 11-19 years and associated comorbidities and outcomes. For this repeated cross-sectional analysis, deliveries to patients aged 11-54 years were identified in the 2000-2018 National Inpatient Sample. Temporal trends in deliveries to patients aged 11-14 years and 15-19 years were analyzed using joinpoint regression to estimate average annual percent change with 95% CIs. The association of deliveries among patients aged 11-19 years with other comorbid conditions was analyzed. The relationship between delivery among patients aged 11-19 years and adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted and adjusted odds ratios (aORs) as measures of effect. An estimated 73,198,153 delivery hospitalizations from 2000 to 2018 were included, of which 88,363 were to patients aged 11-14 years and 6,359,331 were to patients aged 15-19 years. The proportion of delivery hospitalizations among patients aged 11-14 years decreased from 2.1 to 0.4 per 1,000 from 2000 to 2018 (average annual percent change -7.8%, 95% CI -8.5% to -7.2%). Deliveries to patients aged 15-19 years decreased from 2000 to 2018, from 11.5% to 4.8% of all deliveries (average annual percent change -4.9%, 95% CI -5.6% to -4.3%). For deliveries among patients aged 11-19 years, rates of obesity, mental health conditions, substance use disorder, asthma, and pregestational and gestational diabetes all significantly increased over the study period. From 2000 to 2018, rates of severe maternal morbidity (average annual percent change 2.4%, 95% CI 1.6-3.1%), postpartum hemorrhage (average annual percent change 2.4%, 95% CI 1.4-3.4%), cesarean delivery (average annual percent change 1.3%, 95% CI 0.9-1.7%), and hypertensive disorders of pregnancy (average annual percent change 3.3%, 95% CI 2.8-3.8%) all increased significantly among deliveries to patients aged 11-19 years. Compared with deliveries to patients aged 20-54 years, deliveries to patients aged 11-14 years were associated with increased risk for severe maternal morbidity (aOR 1.73, 95% CI 1.49-2.00), hypertensive disorders of pregnancy (aOR 1.79, 95% CI 1.71-1.88), and postpartum hemorrhage (aOR 1.37, 95% CI 1.27-1.49). Deliveries among patients aged 11-19 years have decreased, but both comorbidity and risk for adverse outcomes increased among this age group.

Progesterone Attenuates SIRT1-Deficiency-Mediated Pre-Eclampsia.

Pre-eclampsia is a severe hypertensive disorder of pregnancy (HDP), mainly characterized by new-onset hypertension with proteinuria after 20-week gestation. Sirtuin1 (SIRT1), a class III histone deacetylase, is associated with the regulation of various pathophysiological processes, including inflammation, immune response, metabolism, and autophagy. However, the effect of SIRT1 in the pathogenesis of pre-eclampsia remains to be elucidated. In this study, we found that the expression of SIRT1 was relatively lower in the placentas and serum samples of pre-eclampsia patients. Typical pre-eclampsia-like symptoms, such as hypertension, proteinuria, fetal growth restriction, kidney injury, and a narrow placental labyrinth layer, were observed in SIRT1 knockdown (SIRT1+/−) mice. Of note, these performances could be improved after the intraperitoneal injection of SIRT1 agonist SRT2104. More importantly, we found that the efficacy of progesterone on attenuating symptoms of PE was profoundly better than that of metformin in SIRT1+/− mice. In addition, our results suggested that progesterone can promote the invasion and inhibit the apoptosis of trophoblasts. These data suggest that SIRT1 plays an important role in pre-eclampsia and that progesterone alleviates pre-eclampsia-like symptoms mediated by SIRT1 deficiency.

Antenatal fetal surveillance of women with severe obesity

Objective To estimate the impact of body mass index (BMI) categories on duration of the nonstress test (NST), and the need for additional tests of fetal wellbeing or interventions. Methods We conducted a retrospective cohort study of women with singleton pregnancies who had an NST for the indications of severe obesity (BMI ≥40 kg/m2), diabetes (pre-gestational or gestational), hypertensive disorders (chronic, gestational, and preeclampsia), and others between 1 January 2015 until 31 December 2016. NST durations (<30 and ≥30 min) were compared between groups first based on BMI (kg/m2) categories (<30, 30–39, 40–49, and ≥50) and then based on BMI and comorbidities: (1) severe obesity alone, (2) severe obesity and comorbidities, and (3) comorbidities alone. We compared the results of the NSTs, any subsequent fetal testing or interventions, and pregnancy outcomes among groups. Demographic information was compared using t-tests for continuous data and χ 2 analyses or Fisher’s exact test, if the cells sizes were small, for categorical data. NST durations based on BMI groups, as well as BMI and comorbidities groups, were compared using linear mixed models and ANOVA. Results Three hundred and fifty-one women underwent 1665 NSTs during the study period. After excluding women <18 and >50 years, gestational age <30 weeks, fetal anomalies, and NSTs lasting longer than 60 min, the study population included 313 women and 1471 NSTs. The mean NST duration in minutes of the BMI ≥50 (32.2 ± 9.6) category was significantly longer than the NST duration of the other BMI categories (BMI <30: 29.4 ± 8.3; BMI 30–39: 29.7 ± 8.9; BMI 40–49: 29.9 ± 8.3) (p=.05). Additionally, there was an increased percentage of NSTs lasting ≥30 min as the BMI category increased (p=.005). Women in the severe obesity and comorbidities group (n = 79) were less likely to have a reactive NST than women with severe obesity alone (n = 56) or comorbidities alone (n = 178) (92% vs. 97% vs. 98%, p<.0001). They were also more likely to need a biophysical profile (BPP) (8% vs. 3% vs. 2%, p<.0001). Of the 25 women that were sent to the labor and delivery unit for evaluation, 20 (80%) were admitted and delivered. The reasons for delivery were hypertension (n = 9, 45%), an abnormal NST (n = 5, 25%), oligohydramnios (n = 4, 20%), and labor (n = 2, 10%). Conclusions We found an increase in NST duration as the BMI increased. Women with severe obesity and a comorbidity were more likely to have a nonreactive NST and require a subsequent BPP. Of the 20 patients delivered due to NST surveillance, the most common indication for delivery was hypertension.

The burden of severe hypertensive disorders of pregnancy on perinatal outcomes: a nationwide case-control study in Suriname

BACKGROUNDLatin America and the Caribbean is the region with the highest prevalence of hypertensive disorders of pregnancy worldwide. In Suriname, where the stillbirth rate is the second highest in the region, it is not yet known which maternal factors contribute most substantially.OBJECTIVEThe aims of this study in Suriname were to (1) study the impact of different types of maternal morbidity on adverse perinatal outcomes and (2) study perinatal birth outcomes among women with severe hypertensive disorders of pregnancy.STUDY DESIGNA case-control study was conducted between March 2017 and February 2018 during which time all hospital births (86% of total) in Suriname were included. We identified babies with adverse perinatal outcomes (perinatal death or neonatal near miss) and women with severe maternal morbidity (according to the World Health Organization Near Miss tool). Stillbirths and early neonatal deaths (<7 days) were considered perinatal death. We defined a neonatal near miss as a birthweight below 1750 g, gestational age <33 weeks, 5-minute Apgar score <7, and preterm intrauterine growth restriction <p3. Descriptive statistics and multivariate binary logistic regression analyses were conducted.RESULTSIn the 1-year study period, adverse perinatal outcomes were reported for 638 singleton births of which 120 (18.8%) involved women with severe maternal morbidity. In most of these cases, the mother suffered severe hypertensive disorders of pregnancy (n=95/120, 79.2%). Severe hypertensive disorders of pregnancy were strongly associated with adverse perinatal outcomes (adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9). The prevalence of severe hypertensive disorders of pregnancy in Suriname was 2.5% (234/9197). Of the 215 singleton pregnancies complicated by severe hypertensive disorders, adverse perinatal outcomes were reported for 44.2% of them (n=95/215; adjusted odds ratio, 11.1; 95% confidence interval, 8.3–14.9); perinatal death accounted for 18.1% of these cases (n=39/215; adjusted odds ratio, 8.6; 95% confidence interval, 5.8–12.7) and neonatal near miss accounted for another 26.0% (n=56/215). Women with severe hypertensive disorders of pregnancy had a preterm birth (<37 weeks) in 67.1% of the cases (n=143/215; adjusted odds ratio, 14.1; 95% confidence interval, 10.5–19.0), a baby with a low birthweight (<2500 g) in 62.2% of the cases (n=130/215; adjusted odds ratio, 10.8; 95% confidence interval, 8.1–14.5), and a baby with a low 5-minute Apgar score in 20.5% of the cases (n=43/215; adjusted odds ratio, 6.9; 95% confidence interval, 4.8–10.0).CONCLUSIONIn Suriname, severe hypertensive disorders of pregnancy are strongly associated with adverse perinatal outcomes, with an increased risk for preterm birth, low birthweight, low Apgar score, and perinatal mortality. Prevention, early diagnosis, and management of hypertensive disorders of pregnancy are expected to reduce perinatal deaths substantially. Recommendations to reduce perinatal deaths in Suriname include the establishment of a national health plan for the management of severe hypertensive disorders of pregnancy and the introduction of perinatal death and neonatal near miss reviews.

Cardiovascular Risk Reduction in Women Following Hypertensive Disorders of Pregnancy - a Prospective, Randomised, Controlled Interventional Study.

Background Women have a markedly increased lifetime risk for cardiovascular morbidity and mortality following hypertensive disorders of pregnancy. Arterial stiffness is regarded as a target parameter for reducing cardiovascular risk and can be modified by lifestyle changes. Methods In a prospective, randomised, controlled interventional study, starting 6 weeks postpartum, the effect of nutritional intervention combined with an intensive 6-month cardiovascular exercise programme on arterial stiffness was investigated by means of pulse wave velocity (PWV) in 38 women with severe hypertensive disorder of pregnancy (preeclampsia with or without pre-existing hypertension and/or HELLP syndrome). A reference group was formed with postpartum women without pregnancy complications or known cardiovascular risk and the arterial stiffness was studied by means of PWV at the time of delivery. The PWV was measured in the intervention and control groups within a week after delivery and after 32 weeks (6 weeks + 6 months). A feasibility analysis was performed in addition. Results 29 of 38 women with severe hypertensive disorder of pregnancy and 38 postpartum women in the reference group were included in the analysis (intervention group n = 14; control group n = 15; reference group n = 38). Adherence to a) the nutritional counselling and b) the intensive cardiovascular exercise programme was 73% and 79% respectively. A clinically significant difference (d = 0.65) in pulse wave velocity between the intervention and control groups was found after 6 months (6.36 ± 0.76 vs. 7.33 ± 2.25 m/s; group × time: p = 0.632). The PWV of the intervention group corresponded to that of the reference group at the end of the study (6.36 ± 0.76 m/s vs. 6.5 ± 0.70; d = 0.19), while the results in the control group differed markedly from this (7.33 ± 2.25 m/s; d = 0.56). Conclusion The study documents the feasibility of lifestyle intervention with physical exercise after delivery (starting 6 weeks postpartum). The intervention showed a significant clinical effect by reducing arterial stiffness to the level of the reference group. Before this intervention can be included in the standard of care and prevention, follow-up studies must confirm these results and the medium-term effects on cardiovascular risk.

Aspirin facilitates trophoblast invasion and epithelial-mesenchymal transition by regulating the miR-200-ZEB1 axis in preeclampsia

Preeclampsia is a severe gestational hypertensive disorder that occurs after 20 weeks’ of gestation. It involves several maternal systems, such as cardiovascular, renal, coagulatory systems, and poses a major threat to the maternal and fetal health. Recent clinical evidence showed that aspirin is an effective preventative treatment for reducing the incidence of premature preeclampsia among high-risk pregnant women, however, the mechanism of drug action is not clear. miR-200 family has been shown to be associated with preeclampsia and upregulated in the plasma and placenta of preeclamptic patients. Here we revealed that miR-200 family inhibited trophoblast invasion and epithelial-mesenchymal transition (EMT) process by stimulating epithelial marker expression (E-cadherin and ZO-1) and repressing mesenchymal marker expression (ZEB1 and TGFβ1). Similarly, EMT markers in the placenta of preeclamptic patients showed higher E-cadherin and lower ZEB1 and TGF-β1 protein expression. Moreover, aspirin was shown to suppress miR-200 family and these miR-200 family-mediated cell functions, including cell invasion and EMT changes, were completely reversed. In conclusion, this study demonstrates the effect of miR-200 family on trophoblast invasion and EMT. For the first time, aspirin was shown to fully reverse miR-200-mediated trophoblast biology and act through the network signaling of TGF-β1/ZEB1/miR-200. These results provide a plausible mechanism explaining aspirin’s effect on preeclampsia prevention and a therapeutic target for disease intervention.

Morbidity and maternal and infant outcomes of hypertensive disorder in pregnancy in China in 2018.

Hypertensive disorder in pregnancy is a disease that occurs during pregnancy. We aimed to analyze the morbidity and maternal and infant outcomes with respect to the hypertensive disorder in pregnancy in China in 2018. Clinical data of 38 590 cases from 161 hospitals were retrospectively collected. The differences in morbidity and maternal and infant mortality among the major regions and provinces were compared. The overall national average morbidity was 4.74%, and the ratios of gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 29.17%, 55.02%, 0.66%, 6.53%, and 8.62%, respectively. The overall maternal mortality was 0.61/100 000, and the case fatality was 0.13%. Morbidity associated with hypertensive disorder in pregnancy was 7.74% in North China, 6.62% in Northwest China, 6.40% in Central China, 5.83% in Northeast China, 4.28% in East China, 3.85% in South China, and 2.88% in Southwest China. The morbidity in each province was 1.62‐11.28%. The overall perinatal mortality was 3.59% (81.09% for stillbirths; 18.91% for neonatal deaths). Perinatal mortality decreased with increasing gestational weeks from 24 to 37 + 6 weeks. Perinatal mortality for delivery at 32 weeks of gestation in all regions of the country was <10%. Morbidity varied across regions in China, with the lowest in Southwest and the highest in North China. The low maternal mortality is related to the large‐scale development of standardized maternal health care in China. For severe hypertensive disorder patients, gestation should be prolonged to 32 weeks as often as possible for better neonatal survival rates.

717 Shorter exposure to hypertensive disorders at delivery associated with progression to more severe disease

Evidence supports delivery of non-severe hypertensive disorders of pregnancy at 37 weeks gestation. However, the clinical importance of disease duration at delivery is unclear. We explored whether the duration of exposure to gestational hypertension (gHTN) and preeclampsia without severe features (PEC) in term deliveries affects outcomes. This is a secondary analysis of an NIH-funded retrospective cohort study in which eligible patients delivered at a tertiary-care hospital from 01/2002 - 03/2013 with hypertensive disorders, diabetes and/or fetal growth restriction. For this analysis, patients delivering at 37+ weeks with a diagnosis of gHTN or PEC were included. Exposure duration was confirmed by trained research nurses. Our primary outcome was a maternal composite (progression to more severe hypertensive disorders, eclampsia, HELLP, pulmonary edema, ICU admission and mortality). Secondary outcomes included composite neonatal morbidity, progression to more severe hypertensive disorders, cesarean or assisted delivery, NICU admission, oligohydramnios and abruption. 3457 women met inclusion criteria. Patients were frequency matched by delivery GA (Table 1a,b). Shorter gHTN/PEC duration was associated with the maternal outcomes composite at all GAs [37’0-37’6, OR 2.2 (95% CI 1.5-3.4); 38’0-38’6, OR 5.8 (3.5-9.7); 39’0-39’6, OR 2.9 (1.9-4.5); 40’0+, OR 4.5 (2.2-9.0)] (Table 1a,b). Among secondary outcomes, shorter gHTN/PEC duration was associated with progression to more severe disease at all GAs [37’0-37’6, OR 2.5 (1.6-3.8); 38’0-38’6, OR 7.3 (4.1-12.9); 39’0-39’6, OR 4.0 (2.5-6.5); 40’0+, OR 18.2 (4.4-74.8)] (Table 1a,b). These associations persisted when duration of exposure was considered as a continuous variable. Shorter exposure to non-severe hypertensive disorders at time of delivery was associated with the maternal morbidity composite and progression to severe hypertensive disorders. This supports the clinical observation that some cases of pregnancy-induced hypertension are indolent, while others progress rapidly.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pregnancy Induced Hypertension in Women and its associated Complications and Counter Measures: A Detailed Analysis

Hypertension has become common disorder in almost in human beings. Due to several factors such as mental tension, smoking, drug addiction, work pressure etc., humans are beings suffered from many hypertensions related disorders. One of the most common yet severe hyper tension disorders is PIH (Pregnancy induced hypertension). Many women all over the world are being suffered from this disorder. In this article, preliminary overview on PIH along with its complications associated has been described. Further, several counter measures are described for preventing this severe PIH.

Development and validation of a prediction model on severe maternal outcomes among pregnant women with pre-eclampsia: a 10-year cohort study

Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death. Our study aimed to develop and validate a prognostic prediction model for severe maternal outcomes among Chinese population with pre-eclampsia. We conducted a 10-year cohort study in a referral center by collecting all pregnant women who diagnosed as pre-eclampsia and delivered from 2005 to 2014. A composite of severe maternal outcomes, including maternal near-miss defined by World Health Organization, cortical blindness/retinal detachment, temporary facial paralysis and maternal death, were adopted. We used logistic regression model to develop Model 1 by retaining the predictors of p < 0.05, and further conducted Model 2 by adding quadratic terms and interaction terms to Model 1. We undertook a bootstrapping validation and estimated the model performance. A total of 397 pregnant women suffered from severe maternal outcomes among 2,793 eligible participants, with an incidence of 14.21% (95% confidence interval (CI) 12.91%–15.51%). Of 13 predictors were finally selected in Model 1. Combined with quadratic and interactive terms, the Model 2 showed higher area under the ROC curve (82.2%, 95% CI 79.6%–84.7%) and good calibration. By the bootstrapping validation, similar model performances were present.

Rates of and Reasons for Revisits after Deliveries with and without Severe Maternal Morbidity

Understanding the frequency of and reasons for postpartum revisits, which occur more often for women with delivery complications than for those without, can help identify risk and inform discharge care. The objective of this study was to examine the rate of and reasons for inpatient and emergency department (ED) revisits 7 days and 42 days following deliveries with and without severe maternal morbidity (SMM).Retrospective conveys the intended meaning. cohort study using data from the Agency for Healthcare Research and Quality’s 2016‐2017 Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 14 states with de‐identified patient linkage numbers and adequate race/ethnicity coding (AR, FL, GA, IA, MD, MS, MO, NV, OR, SC, SD, TN, VT, and WI).The analysis consisted of delivery hospitalizations and postpartum inpatient and ED revisits for women aged 12‐55 years. SMM conditions at delivery were grouped into eight types: severe cardiac conditions, sickle cell disease with crisis, severe hypertensive disorders, severe respiratory conditions, sepsis, severe hemorrhage, other severe obstetric conditions, and other severe medical conditions. Outcomes included 7‐day and 42‐day inpatient and ED age‐adjusted revisit rates and the reason for the revisit.A total of 9164 index deliveries with an SMM condition and 1 406 582 deliveries without an SMM condition at delivery were included. Of those deliveries with an SMM condition, 35.0% were for black women and 23.1% were for women aged 35 years and older compared with 22.4% and 15.2% of deliveries without an SMM condition, respectively. Overall, 73.2 per 1000 deliveries with an SMM condition had an inpatient or ED revisit within 7 days and one in five women returned within 42 days postpartum (207.0 revisits per 1000 deliveries). These rates were more than twice as high as those for deliveries without an SMM condition (32.1 and 87.7 per 1000, respectively). Among women with only one SMM type at delivery, the 42‐day revisit rate for inpatient or ED care was as high as 445.5 per 1000 deliveries with sickle cell disease with crisis, followed by 250.9 per 1000 deliveries with severe cardiac conditions. An additional 2400 women without an SMM condition diagnosed at delivery had an inpatient readmission within 7 days for an SMM‐related condition.Women with the highest postpartum revisit rates included those with a diagnosis of SMM at delivery overall and specifically those with sickle cell disease with crisis and severe cardiac conditions. A number of women with SMM conditions were diagnosed at a postpartum readmission and not at the delivery. Examining revisits during the postpartum period is an important consideration when studying SMM.This study can help identify women at high risk of postpartum revisits. The data can be used to inform the scheduling and content of coordinated discharge care, assist with resource allocation, and identify research priorities for maternal care. Future research is needed to examine the contributions of clinical factors at delivery, expected payer, and hospital and community characteristics in explaining disparities in the risk of postpartum readmission.Agency for Healthcare Research and Quality.

Haemodynamic changes and peripheral vascular characteristics associated with pathophysiological alterations in Preeclampsia patients at the University Teaching Hospital, Lusaka, Zambia

Background: The circadian blood pressure changes in pregnancy are poorly documented though the severity of hypertensive disorders especially in pregnancy is said to be better detected by 24hour blood pressure monitoring. The contribution of peripheral vascular variations to these alterations is yet to be elicited. The association of these changes to the renal pathological dysfunction is also not fully understood.Materials and method: Ambulatory blood pressure measurements and kidney function tests (i.e. creatinine, protein, sodium and uric acid) were done in patients admitted to UTH for hypertension in second and third trimesters of pregnancy. The Complior was used to determine the pulse waveform, pulse wave velocity (PWV) and augmentation index (Aix) as surrogate parameters for peripheral vascular compliance.Results: Twenty-six (26) women, between 22-42 years old and 24-36 gestational weeks, participated in this study. The majority of our population were either non- or reverse dippers (91.6%). The type A pulse waveform was dominant in all three groups indicating endothelial dysfunction. Dippers had a higher creatinine concentration in both urine and serum and uric acid in serum than non-dippers (7.051mmol/24hrs; 108.703ìmol/L;0.507mmol/L; respectively p&lt;0.0001). The observed association of diurnal variations inhemodynamic parameters and dipping status indicates significant vascular pathology that may herald these individuals' increased risk of cardiovascular complications. The dominance of the type A pulse waveform in this population is indicative of significant endothelial dysfunction.Conclusion: The association seen between elevated blood pressure readings and proteinuria indicates a possible common pathophysiological process that leads to increased porosity at the glomeruli.