Types Of Hypertensive Disorders Research Articles

Racial Disparity in Severe Maternal Morbidity Associated with Hypertensive Disorders in Washington State: A Retrospective Cohort Study.

To evaluate the relationship between hypertensive (HTN) disorders and severe maternal morbidity (SMM). To understand whether there is differential prevalence of HTN disorders by race and whether the relationship between HTN disorders and SMM is modified by race and ethnicity. We performed a retrospective cohort study using patient-level rates of SMM for pregnancies at all 61 non-military hospitals in Washington State from 10/2015 to 9/2016. Data were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association of HTN disorders and SMM (with and without transfusion) overall and by race. The population-attributable fraction of HTN disorders on SMM within each racial/ethnic group was calculated. Of 76,965 deliveries, 864 (1.1%) had any SMM diagnosis or procedure. All racial and ethnic minorities, except white and Asian, were disproportionally affected by preeclampsia with severe features (SF) and SMM. Overall, and within each racial/ethnic group, the SMM rate was higher among pregnancies with any HTN disorder compared to no HTN disorder (2.8 vs. 0.9%, OR 3.1, 95% CI 2.7-3.6). Race and ethnicity significantly modified the association. Overall and within each racial/ethnic group, there was a dose-response relationship between the type of HTN disorder and SMM, with more severe HTN disorders leading to a greater risk of SMM. The population-attributable fraction of HTN disorders on SMM was 20.6% for Black individuals versus 17.5% overall. The findings were similar when reclassifying transfusion-only SMM as no SMM. In Washington, HTN disorders are associated with SMM in a dose-dependent fashion with the greatest impact among Black individuals.

Dynamic gestational week prediction model for pre-eclampsia based on ID3 algorithm.

Pre-eclampsia (PE) is a type of hypertensive disorder during pregnancy, which is a serious threat to the life of mother and fetus. It is a placenta-derived disease that results in placental damage and necrosis due to systemic small vessel spasms that cause pathological changes such as ischemia and hypoxia and oxidative stress, which leads to fetal and maternal damage. In this study, four types of risk factors, namely, clinical epidemiology, hemodynamics, basic biochemistry, and biomarkers, were used for the initial selection of model parameters related to PE, and factors that were easily available and clinically recognized as being associated with a higher risk of PE were selected based on hospital medical record data. The model parameters were then further analyzed and screened in two subgroups: early-onset pre-eclampsia (EOPE) and late-onset pre-eclampsia (LOPE). Dynamic gestational week prediction model for PE using decision tree ID3 algorithm in machine learning. Performance of the model was: macro average (precision = 76%, recall = 73%, F1-score = 75%), weighted average (precision = 88%, recall = 89%, F1-score = 89%) and overall accuracy is 86%. In this study, the addition of the dynamic timeline parameter "gestational week" made the model more convenient for clinical application and achieved effective PE subgroup prediction.

GLOBAL LOGITUDINAL STRAIN IN HYPERTENSIVE DISORDERS DURING PREGNANCY AS A PREDICTOR FOR EARLY DETECTION OF SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION

Objective: To identify the role of left ventricular (LV) global longitudinal strain (GLS) in the early diagnosis of LV dysfunction among pregnant women with hypertensive disorders. Design and method: Cross-sectional study was conducted at one of the heart centers in Iraq from November 2020 – July 2021, included pregnant women with hypertensive disorder. Echocardiographic data was collected using GE (Vivid E9) diagnostic ultrasound equipment with (M5ScD) MHz transducer. Pregnant women were classified into three groups according to the hypertensive disorders: chronic hypertension (HTN), gestational HTN, and preeclampsia (PE). Results: A 60 pregnant women were enrolled in the study, mean age (32.7 ± 5.8) years, 25% with chronic HTN, 33% with gestational HTN, and 42% with PE. The mean of systolic and diastolic blood pressure were (130.1 ± 10.8) mmHg and (79 ± 7.9) mmHg; respectively, 90% were on medication, and 18% were diabetic. See Table 1. Conclusions: Echocardiography is a valuable tool in diagnosis of LV hypertrophy and diastolic dysfunction in all types of hypertensive disorders during pregnancy. Subclinical cardiac dysfunction in pregnancy related hypertension and preeclampsia can be early detected by impaired GLS.

Determinants of preeclampsia among mothers attending perinatal care in Gurage zone public hospitals, Ethiopia, matched case control study

BackgroundPreeclampsia is the commonest and most serious type of hypertensive disorder during pregnancy. It is the cause of 10% – 15% of maternal death worldwide. Though maternal mortality in Ethiopia is decreasing, deaths related to pregnancy-induced hypertension is increasing. Identifying the factors associated with preeclampsia helps reduce the incidence of the disease and its adverse outcomes. Therefore, this study aims to assess determinants of preeclampsia among mothers attending perinatal care in Gurage zone public hospitals, Ethiopia, 2020. MethodInstitution-based matched case-control study design was used to assess determinants of preeclampsia among 426 mothers, 142 cases, and 284 controls. The study was conducted in three public hospitals in Gurage Zone. Cases were preeclamptic mothers and Controls were non-preeclamptic mothers. EPI INFO was used to enter the data and then SPSS was used to analyze the data. Bivariate and multivariate logistic regression was used. ResultSignificantly associated factors on multivariate analysis in this study are nulliparity with AOR 3.81; 95% CI (1.55,9.34); multiplicity of pregnancy AOR 3.62; 95%CI (1.08,12.13) having preeclampsia history AOR 10.11; 95%CI (4.06, 25.21); parents history of hypertension had AOR 2.95; 95%CI; (1.11,7.68); and drinking alcohol AOR 4.42; 95%CI (2.15,9.08) ConclusionIn this study determinants’ of preeclampsia are nulliparity, multiplicity of pregnancy, previous history of preeclampsia, family history of hypertension, and alcohol consumption. Providing health education about risk factors of preeclampsia, early initiation, and increased frequency of antenatal follow-up will help early identification of these risk factors, diagnosis of preeclampsia, and preventing its complications.

Increased Homocysteine Level and Risk of Gestational Hypertension in South East Algerian population

The objective of this study is to target the effect, in the South East Algerian population, of homocysteine level on gestational hypertension (GH) in wom-en. We also aim to study if gestational hypertension and preeclampsia (PE), two types of hypertensive disorders, share the same risk factors. The case-control study has been undertaken in Ouargla maternity hospital. Homocys-teine (Hcy) levels have been measured using an automated chemilumines-cence method. Creatinine and total protein have been determined using a colorimetric method, while an enzymatic technique has been employed to estimate the aspartate aminotransferase (AST) and the alanine aminotrans-ferase (ALT). The mean concentration of homocysteine was significantly higher for PE (14.90±8.54 μmol/l) and GH (11.10±5.13 μmol/l) compared to that of normotensive women (6.85±3.23 μmol/l) p≤ 0.01. Besides, hyperho-mocysteinemia (Hhcy) was detected with 70% of mothers with PE and with 40% of mothers with GH compared to only 11.53 % of controls. These values show the correlation between the rate of Hcy and hypertension during preg-nancy aetiology and severity. The other metabolites showed a significant increase in total protein level in PE and GH women compared to controls (p≤0.01). A significant increase in creatinine level is observed for patients with preeclampsia (p<0.05). There were no differences among patients and controls concerning AST nor ALT. Results show that homocysteine is an im-portant risk factor as for gestational hypertension as for preeclampsia. Com-plications have similar biochemical profiles leading GH to be given as much attention as PE.

The fetal cerebroplacental ratio in pregnancies complicated by hypertensive disorders of pregnancy.

Hypertensive disorder in pregnancy is common and the optimal ultrasound surveillance of the fetus in this setting is unclear. The aim of this study is to assess the relationship between the fetal cerebroplacental ratio (CPR) and perinatal outcomes in pregnancies complicated by maternal hypertension. A retrospective cohort study was performed over tenyears at a single centre. All women who had an ultrasound scan between 34 and 37weeks gestation with a non-anomalous singleton pregnancy were included. The hypertensive cohorts were compared to a non-hypertensive cohort. Each cohort was divided into low CPR for gestational age, or normal/high CPR and these were correlated with intrapartum and perinatal outcomes. A low CPR in a hypertensive pregnancy is associated with an increased risk of induction of labour, emergency caesarean section and poor perinatal outcome. This significance persists when adjusted for gestational age and birth weight. The diagnosis of pre-eclampsia combined with a low CPR markedly increases the risk of poor perinatal outcome, with 52.6% (P<0.001) of fetuses in this group having either neonatal intensive care unit admission, respiratory distress, low Apgar score, or acidosis. The odds ratio of a fetus with low CPR in a woman with pre-eclampsia having a poor composite outcome is 4.09 (95% CI: 1.85-9.06). There is an association between low CPR and the perinatal outcomes of pregnancies complicated by a hypertensive disorder. This association appears to be stronger in pregnancies complicated by pre-eclampsia than in other types of hypertensive disorders.

1092 Blood pressure pattern pre-pregnancy through 42-day postpartum of women with preeclampsia, gestational, and chronic hypertension

Demonstrate the difference in blood pressure (BP) patterns of women with gestational hypertension (GHTN), preeclampsia (PE), chronic hypertension (CHTN), and superimposed preeclampsia (SIPE). A retrospective cohort study of women delivered at a midwestern academic hospital between 3/1/2017 and 8/31/2019. We included all women who were ≥15 years old, had HTN identified in the ante/postnatal period, and enrolled into home BP monitoring. BPs were collected from 47 time points: pre-pregnancy, each trimester, delivery day, and 42-days postpartum. The primary outcome was the estimated average BP pattern from a mixed-effects longitudinal data analysis stratified by types of hypertensive disorders. Data from 619 women were analyzed. Of these, 38% had GHTN, 21% CHTN, 8% SIPE, 50% PE, and 32% PE with SF. Women with CHTN had significantly higher systolic BP pre-pregnancy through 42-days postpartum. Diastolic and mean arterial pressures of women with CHTN were significantly higher pre-pregnancy thought 3rd trimester and postpartum day 14 onward; no significant differences were observed on delivery day and 1st week postpartum (All p<0.05; Figure 1A). A similar BP trajectory was observed in women who developed SIPE (Figure 1B). Overall BPs were higher pre-pregnancy and during pregnancy compared to women with only CHTN. Women with GHTN had lower BPs pre-pregnancy and during pregnancy compared to other hypertensive disorders (All p<0.05; Figure 2A). Women with PE with SF demonstrated significantly higher BPs starting from 1st trimester until delivery day (All p<0.05; Figure 2B). Postpartum BPs of women with GHTN and PE either with or without SF were not significantly different compared to other hypertensive disorders. Our findings demonstrate significant differences in BP patterns among women with different hypertensive disorders even pre-pregnancy. Recognition of these patterns is necessary for identifying women at risk, providing closer surveillance, and preventing hypertension-related morbidity later in pregnancy and postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Medical expenditures for hypertensive disorders during pregnancy that resulted in a live birth among privately insured women.

To estimate the excess maternal health services utilization and direct maternal medical expenditures associated with hypertensive disorders during pregnancy and one year postpartum among women with private insurance in the United States. We used 2008-2014 IBM MarketScan® Commercial Databases to identify women aged 15-44 who had a pregnancy resulting in live birth during 1/1/09-12/31/13 and were continuously enrolled with non-capitated or partially capitated coverage from 12months before pregnancy through 12months after delivery. Hypertensive disorders identified by diagnosis codes were categorized into three mutually exclusive types: preeclampsia and eclampsia, chronic hypertension, and gestational hypertension. Multivariate negative binomial and generalized linear models were used to estimate service utilization and expenditures, respectively. Per person excess health services utilization and medical expenditures during pregnancy and one year postpartum associated with hypertensive disorders (in 2014 US dollars). Women with preeclampsia and eclampsia, chronic hypertension, and gestational hypertension had $9,389, $6,041, and $2,237 higher mean medical expenditures compared to women without hypertensive disorders ($20,252), respectively (ps<0.001). One-third (36%) of excess expenditure associated with hypertensive disorders during pregnancy was attributable to outpatient services. Hypertensive disorders during pregnancy were associated with significantly higher health services utilization and medical expenditures among privately insured women with hypertensive disorders. Medical expenditures varied by types of hypertensive disorders. Stakeholders can use this information to assess the potential economic benefits of interventions that prevent these conditions or their complications.

Особенности секреторной активности тромбоцитов и компонентов фибринолитической системы у женщин с различными формами гипертензивных расстройств в III триместре беременности.

Введение. Гипертензивные расстройства при беременности характеризуются нарушением адаптационных механизмов в системе свертывания крови и фибринолиза, важными участниками которой являются тромбоциты и эндотелий. Выраженность нарушений в тромбоцитарном звене гемостаза и системе фибринолиза при гипертензивных расстройствах при беременности различна. Цель исследования: изучить особенности секреторной активности тромбоцитов и компонентов фибринолитической системы у женщин с гипертензивными расстройствами различного генеза в III триместре беременности. Материалы и методы. Обследовано 238 женщин в III триместре беременности: 70 нормотензивных женщин, 32 — с умеренной преэклампсией (ПЭ), 47 — с тяжелой ПЭ, 58 — с хронической артериальной гипертензией (АГ) и 30 — с ПЭ на фоне хронической АГ. Проведен анализ количества и средней концентрации компонентов тромбоцитов, индуцированной секреции тромбоцитами АТФ, уровня бета-тромбоглобулина и тромбоцитарного фактора 4 в плазме крови. Фибринолитическую систему оценивали путем определения уровня лизиса сгустка, концентраций тканевого активатора плазминогена (t- PA) и ингибитора активатора плазминогена 1-го типа (PAI-1) в плазме крови. Результаты. Полученные данные свидетельствуют о различной степени выраженности нарушений в системе гемостаза при гипертензивных расстройствах различного генеза. При умеренной и тяжелой ПЭ выявлено повышение уровней t- PA и PAI-1, дополнительно при тяжелой ПЭ установлено снижение количества тромбоцитов и секреции активированными тромбоцитами АТФ на фоне повышения их гранулоцитарности. При ПЭ на фоне хронической АГ определено снижение секреции активированными тромбоцитами АТФ на фоне повышения их гранулоцитарности и базальной секреции β-тромбоглобулина и увеличение содержания в плазме крови t- PA и PAI-1. При хронической АГ обнаружено повышение количества тромбоцитов. Заключение. Выявлен- ные изменения позволили сделать вывод о неоднородности изменений в системе гемостаза у беременных с различными формами гипертензивных расстройств в III триместре беременности. Background. Hypertensive disturbances during pregnancy are jointly with the adaptive disorders of both blood coagulation and fibrinolysis, and platelets and endothelium plays important role for that. The disorders severity of platelet hemostasis and fibrinolysis is various in pregnant women with hypertensive disturbances. Objectives: to study the platelets secretory activity and some fibrinolytic components in women with hypertensive disturbances of various genesis in the III trimester of pregnancy. Patients / Methods. We examined 238 women in the III trimester of pregnancy: 70 normotensive women, 32 with moderate preeclampsia (PE), 47 with severe PE, 58 with chronic arterial hypertension (AH), and 30 with PE joint with chronic AH. The lab testing included the number and average concentration of platelet components, platelet-induced secretion of ATP, the β-thromboglobulin and platelet factor 4 in blood plasma. Fibrinolytic system was tested with determining of clot lysis level, tissue plasminogen activator (t- PA) and plasminogen activator inhibitor type 1 (PAI-1) in plasma. Results. Obtained data showed different severity of hemostasis disturbances in hypertensive disturbances of various genesis. In moderate and severe PE increased levels of t- PA and PAI-1 were revealed; in addition, in severe PE, decreased platelets number and ATP secretion by activated platelets was detected with increasing of their granulocyticity. In PE with chronic AH, decreased ATP secretion by activated platelets with increasing of their granulocyticity and basal secretion of beta-thromboglobulin was found, also increased t- PA and PAI-1 plasma content was determined. Increased platelet count was detected in chronic AH. Conclusions. Revealed changes led to the conclusion about the heterogeneity of hemostasis changes in pregnant women with various forms of hypertensive disturbances in the III trimester of pregnancy.

Hypertensive disorders in pregnancy and timing of pubertal development in daughters and sons.

Do maternal hypertensive disorders affect pubertal development in daughters and sons? Pubertal development tended to occur earlier in daughters of mothers with 'preeclampsia, eclampsia or HELLP syndrome' (hemolysis, elevated liver enzymes and low blood platelets) or hypertension in pregnancy compared to daughters born of normotensive mothers. The existing literature suggests some or no association between preeclampsia and pubertal development in daughters, but not in sons. None of the previous studies has investigated the possible association between other types of hypertensive disorders (hypertension, eclampsia or HELLP syndrome) and pubertal timing in children. Longitudinal cohort study consisting of 15 819 mother-child pairs with information on maternal hypertensive disorders collected during pregnancy and information on pubertal development collected half-yearly from the age of 11 years and until fully developed or 18 years of age. Participants are children from the Puberty Cohort nested within the Danish National Birth Cohort. The exposure was register-based and self-reported information on maternal hypertensive disorders during pregnancy. The outcomes were children's self-reported information on pubertal development, including Tanner stage 1-5 (pubic hair (both daughters and sons) and breast development (daughters) or genital development (sons)), first menstrual bleeding (daughters) or first ejaculation (sons), voice break episode (sons), axillary hair development and acne occurrence (both daughters and sons). The main outcome was mean difference in age at attaining each pubertal milestone and a combined pubertal marker in children of mothers with hypertensive disorders in pregnancy (either hypertension (n = 490), 'preeclampsia, eclampsia or HELLP syndrome' (n = 419) or 'unspecific hypertensive disorders' (n = 334) with unexposed children as reference (n = 14 576)). In daughters of mothers with 'preeclampsia, eclampsia or HELLP syndrome', we observed tendencies of earlier pubertal timing (combined marker: -2.0 (95% CI: -3.9; 0.0) months). In daughters of mothers with hypertension, several pubertal milestones tended to occur earlier than in daughters of normotensive mothers; however, all 95% CIs overlapped the null resulting in a combined pubertal marker of -1.0 (95% CI: -3.2; 1.1) months. In sons of mothers with any of the hypertensive disorders, we observed no difference in pubertal timing (combined markers: 'preeclampsia, eclampsia or HELLP syndrome': 0.1 (95% CI: -2.0; 2.1) months; hypertension: -0.6 (95% CI: -2.3; 1.1) months; 'unspecific hypertensive disorders': 0.2 (95% CI: -1.9; 2.2) months). The study is subject to non-differential misclassification of self-reported information on maternal hypertensive disorders in pregnancy and current pubertal status; possibly causing bias toward the null. Hypertensive disorders in pregnancy might accelerate pubertal timing in daughters; however, more studies are needed for causal conclusions. The study was funded by the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose. N/A.

DIFFERENTIATED APPROACH TO RISK ASSESSMENT OF DEVELOPING PLACENTA-ASSOCIATED COMPLICATIONS IN PREGNANT WOMAN WITH PREECLAMPSIA

Preeclampsia remains the main cause of maternal and perinatal morbidity and mortality. It was shown that the developments of complications from the mother and fetus side or their absence in women with preeclampsia have different pathophysiological mechanisms. It is necessary to distinguish two types of hypertensive disorders during pregnancy: the first one is severe preeclampsia, which has an early onset and is accompanied by complications that threaten the life of the mother and child. Second – it is a mild pre-eclampsia, that specificfor the late stages of pregnancy and occurs without significant associated complications. It has been shown that the markers of the propensity to develop obstetric and perinatal complications in pregnant women with preeclampsia are the following gene polymorphisms: 1691 GA in gene factor V Leiden – increases the risk in 2.9 times (95 % CI 1.94–4.33), 20210 GA in prothrombin gene – 2.36 times (95 % CI 1.54–3.6), 20210 AA in prothrombin gene – 3.12 times (95 % CI 2.4–4.0). Pregnancy on the background of these gene polymorphisms is associated with severe pre-eclampsia, early onset and development of life-threatening maternal and fetal complications.

Potential urine biomarkers for gestational hypertension and preeclampsia.

Differential proteomic technology was used to identify urine proteomic profile of gestational hypertension and preeclampsia. Urine samples were collected from 10 patients with gestational hypertension, 10 patients with mild preeclampsia, 10 patients with severe preeclampsia and 10 normal pregnancies and analyzed by 2-D difference gel electrophoresis, then matrix assisted laser desorption ionization mass spectrometry was used to identify differential proteins. Subsequently, ELISA was used to verify the content variation of the identified proteins in 200 urine samples. In total, 30 differential proteins were identified. For prostaglandin-H2 D-isomerase (L-PGDS), perlecan and other 15 proteins, the contents in patients with gestational hypertension were higher than that of normal pregnancies, but lower in mild and severe preeclampsia. By contrast, serum albumin and α-1-antitrypsin was lower in samples from patients with gestational hypertension and higher in patients with mild and severe preeclampsia compared with normal pregnancies. ELISA verified that the urinary concentration of L-PGDS and perlecan were significantly lower in patients with preeclampsia than in normal pregnancies (P<0.05). Urine proteomics is a useful tool to identify potential biomarkers to distinguish between different types of hypertensive disorders in pregnancy. L-PGDS and perlecan could potentially be used as markers to reflect the state of renal function, and may participate in the genesis and development of renal injury during preeclampsia.

Serum endocan concentration and its correlation with severity of hypertensive disorders in pregnancy

Introduction: Endocan plays a role in the development of vascular tissue in health and disease and is an indicator of endothelial cells activation and angiogenesis.Objective: The aim of this study was to investigate the relationship between endocan serum levels and various types of hypertensive disorders in pregnant women.Patients and methods: We created three study groups (preeclampsia [n = 60], chronic hypertension [n = 39], gestational hypertension [n = 58]) and the control group consisting of 59 healthy pregnant women. The endocan serum concentration was assessed using commercially available ELISA kit.Results: There were no statistically significant differences in endocan serum levels (pg/mL) in each study group compared to controls. The multiple regression did not reveal significant differences between endocan levels in each study group after adjustment for prepregnancy BMI. We did not find any significant correlations between the endocan serum level and patients’ age, gestational age (GA) at sample collection, prepregnancy BMI, systolic blood pressure, diastolic blood pressure, and 24-hour urinary protein excretion in each analyzed group. Moreover, in the preeclamptic participants, we did not observe a significant relationship between the endocan concentration and the features indicating the severity of the disease other than elevated blood pressure. There were no differences in endocan serum level in preeclampsia subgroups: early-onset versus late-onset and mild versus severe preeclampsia.Conclusions: Endocan is not involved in the pathogenesis of hypertensive disorders in pregnant women and could not be regarded as a marker of endothelial dysfunction in these cases.

95. Defective angiogenic markers and poor pregnancy outcomes in patients with hypertensive disorders of pregnancy: A pilot study in an Indian Population

Objectives To assess angiogenic factors, matrixmetalloproteinases, and their inhibitors and cell adhesion molecules in maternal blood and placenta of various types of hypertensive disorders of pregnancy and to correlate with the pregnancy outcomes. Methods Plasma levels of soluble Vascular Endothelial Growth Factor Receptor 1 (sVEGFR1), soluble Endoglin (sENG), Transforming Growth factor beta (TGF-b), VEGF, Placental Growth Factor (PLGF), Matrixmetalloproteinases (MMPs), Tissue inhibitors of Matrixmetalloproteinases (TIMPs) and Cell adhesion molecules were analysed by ELISA kits in Gestational hypertension (GH), Late onset preeclampsia (LOPE), Early onset preeclampsia (EOPE), Eclampsia (E) and Control pregnant women (CPW) during third trimester. The mRNA/ protein expressions were assessed by RT-PCR/westernblot/IHCp respectively. The Pregnancy outcomes like the gestational age at the time of delivery (GA) and birthweight (BW) and APGAR score of the baby also were measured. Results The GA, BW, APGAR score of the baby were found to be significantly lower in EOPE and Eclampsia compared to CPW. The angiogenic factors, PLGF, TGF-b were significantly decreased in EOPE and Eclampsia compared to CPW, GH. Besides, the antiangiogenic factors sVEGFR1 and sEng were found to be elevated in HDP when compared to CPW. A significant correlation was observed between the angiogenic factors and the pregnancy outcome in HDP. Conclusions A defective angiogenic profile and poor birth outcomes were observed in Hypertensive disorders of pregnancy.

8. Maternal recall of a history of early-onset preeclampsia, late-onset preeclampsia or gestational hypertension: a questionnaire study

Objective: This study assessed women’s ability to recall different types of hypertensive disorders of pregnancy because of its disproportionate cardiovascular risk later in life. Methods: Participa...

Body mass index and the risk of hypertensive disorders of pregnancy: the great obstetrical syndromes (GOS) study

Objective To estimate the association between first-trimester body mass index (BMI) and the different types of hypertensive disorders of pregnancy (HDP). Methods A prospective cohort of nulliparous women recruited at 11–13 weeks. Height and weight were measured and BMI was reported as binary (more or less than 30 kg/m2), categorical (World Health Organization classification), and continuous variables. Participants were followed for development of any HDP, including preeclampsia and preterm preeclampsia. Receiver operating characteristic curves and their area under the curve (AUC) were used along with multivariate logistic regressions to develop predictive models combining BMI with other maternal characteristics. Results We recruited 4683 eligible participants including 645 (14%) affected by obesity. Obesity was associated with greater risks of HDP (22.5 versus 8.5%, p < .0001), preeclampsia (10.2 versus 4.3%, p < .0001), and preterm preeclampsia (1.6 versus 0.6%, p = .006). BMI categories (AUC: 0.65; 95%CI: 0.56–0.74) and BMI combined with maternal characteristics (AUC: 0.76; 95%CI: 0.69–0.83) were better predictors of preterm preeclampsia than BMI as binary variable (AUC: 0.58; 95%CI: 0.50–0.66). Conclusions Obesity and BMI are associated with the risk of all types of HDP. Optimal prediction of preterm preeclampsia is achieved by using BMI as a continuous variable combined with other maternal characteristics.

ОСОБЛИВОСТІ ПЕРЕБІГУ ГЕСТАЦІЇ У ЖІНОК ІЗ ГІПЕРТЕНЗИВНИМИ РОЗЛАДАМИ (РЕТРОСПЕКТИВНИЙ АНАЛІЗ)

Недостатня ефективність існуючих методів лікування гіпертензивних станів під час вагітності обґрунтовує доцільність пошуку нових антигіпертензивних засобів та методик їх застосування у вагітних, що дозволить попередити розвиток прееклампсії та еклампсії у значної кількості випадків, і, таким чином, знизити частоту розвитку ускладнень вагітності та перинатальних втрат.Мета дослідження – виявити фактори, що впливають на розвиток прееклампсії у вагітних з різними видами гіпертензивних розладів.Матеріали і методи. Проведено ретроспективний аналіз і багатопланову розробку 564 карт спостереження за вагітними та жінками з гіпертензивними розладами.Результати досліджень та їх обговорення. Хронічну артеріальну гіпертензію під час вагітності слід розглядати як один із факторів ризику виникнення прееклампсії та поєднаного гестозу, а низьку ефективність антигіпертензивної терапії або відсутність комплаєнсу можна вважати передвісником розвитку цих ускладнень. Наявність нелікованої хронічної артеріальної гіпертензії провокує маніфестацію прееклампсії та поєднаного гестозу у вагітних на 2–3 тижні раніше, ніж у жінок без артеріальної гіпертензії або при її адекватній терапії.Висновки. Наявність некорегованої хронічної артеріальної гіпертензії у вагітних суттєво підвищує частоту розвитку в них пізніх гестозів і значно погіршує прогноз виношування вагітності. Застосування адекватної антигіпертензивної терапії вазодилатуючими бета-адреноблокаторами сприяє достовірному зниженню частоти розвитку прееклампсії та тяжкості її перебігу.

P 36 Association of placental oxidative stress and pregnancy outcome in patients with hypertensive disorders of pregnancy – A pilot study in an Indian population

Objectives To assess the placental oxidative stress factors in various types of hypertensive disorders of pregnancy and to correlate with the pregnancy outcome. Methods Placental samples from Hypertensive disorders of pregnancy (HDP) patients and the control pregnant women (CPW) were collected. The levels of oxidative stress parameters MDA, Total antioxidant status (TAS) and protein carbonylation (PCO) were assessed in the placental lysates. Also the placental expression of antioxidant enzymes superoxide dismutase (SOD), Glutathione peroxidase (GPX1), Glutathione Reductase (GSH), catalase and stress sensitive serine kinase proteins ERK, p38-MAPK, JNK, IKBα and NOX-4 were found out by western blotting in HDP (gestational hypertension, Preeclampsia- eclampsia) and CPW. The Pregnancy outcomes like the gestational age at the time of delivery (GA) and birthweight (BW) and APGAR score of the baby also were measured. Results The GA, BW and APGAR score of the baby were found to be significantly lower in Preeclampsia and Eclampsia compared to CPW. The levels oxidative stress parameters MDA and PCO were elevated and the TAS were decreased in HDP compared to CPW. The placental expression of pERK, pNrf-2/Nrf-2, NOX-4 and IkBα were found to be elevated whereas the expression of CAT, JNK, pP38MAPK were found to be decreased in HDP when compared to CPW. Also a negative correlation was observed between the o0xidative stress markers and the pregnancy outcome in HDP. Conclusions An increased placental oxidative stress and a poor birth outcome were observed in hypertensive disorders of pregnancy. Download : Download high-res image (419KB) Download : Download full-size image Download : Download high-res image (231KB) Download : Download full-size image Download : Download high-res image (723KB) Download : Download full-size image

12 Expression of corticotropin-releasing hormone in the placentas of pregnant women with hypertensive disorders

Introduction the human placenta is an extrahypothalamic site for the synthesis and secretion of corticotropin-releasing hormone (CRH). Receptors CRH-R1 and CRH-R2 are expressed in the syncytiotrophoblast, in the cytotrophoblast, in the decidua, and in the vascular endothelium. Studies have showed an increased expression of CRH in cases with preeclampsia. Objective this study aimed to evaluate the expression of CRH in the chorionic villi and in the decidua of human placentas of women with different types of hypertensive disorders of pregnancy (HDP). Methods 116 placental biopsies collected from 2013 to 2014 were analyzed, and they were grouped as follows: (a) control group (C): 12 cases; (b) gestational hypertension (GH): 23 cases; (c) preeclampsia/eclampsia (PE): 30 cases; (d) chronic hypertension (CH) 25 cases and (e) preeclampsia superimposed on chronic hypertension (PSCH): 26 cases. Of these cases, 54 biopsy samples were from preterm deliveries ( ⩾ 37 weeks). The expression of CRH in the chorionic villi and in the decidua was assessed by immunohistochemistry; the immunostained areas were quantified using Leica Qwin Plus® image analysis software and expressed as percentage of positive area per field. ANOVA (F) followed by Tukey’s test was used for statistical analysis; p 0.05. Results 33.33% (18) of preterm pregnancies were diagnosed with PE, 20.37% (11) were diagnosed with GH, 20.37% (11) had CH, and 25.93% (14) had PSCH; whereas 19.35% (12) of term pregnancies had PE, 19.35% (12) were diagnosed with GH, 22.58% (14) had CH, 19.35% (12) PSCH, and 19.35% (12) were control cases. In term pregnancies, cases with PE, GH, CH and PSCH showed an increased expression of CRH in the chorionic villi and in the decidua than group C (p 0.0001). In the preterm group, the expression was higher in cases associated with PE and PSCH in both regions. Conclusions altered expression of CRH is observed in HDP, and it occurred in all types of term HDP in both regions analyzed. In preterm pregnancies, expression was more prominently increased in the decidua of the PE and PSCH cases. Therefore, CRH expression behaved similarly in term pregnancy cases with HDP, but the expression varied in the preterm cases associated with PE, thus demonstrating that the levels of placental oxidative stress were higher in these cases. Download : Download high-res image (372KB) Download : Download full-size image

Hypertension in pregnancy

Hypertension is the most common medical disorder encountered in pregnancy, complicating 5% to 10% of all pregnancies. It is a major cause of maternal, fetal and newborn morbidity and mortality, increasing the risk of cerebrovascular events, organ failure and placenta abruptio in mothers and the risk of intrauterine growth restriction, prematurity and intrauterine death in fetuses. There are four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia and eclampsia syndrome, chronic hypertension of any etiology, and Preeclampsia superimposed on chronic hypertension. The decision to treat hypertension in pregnancy should consider the benefit-harm balance for both mother and fetus, and depends on gestational age, blood pressure levels, and presence of preeclampsia. As termination of pregnancy is the only cure for preeclampsia, there is general agreement that delivery rather than observation is suggested in women with severe preeclampsia, eclampsia, or mild hypertension at term. However, it is not clear whether women with mild hypertension at near term can be managed expectantly as well as whether antihypertensive therapy for mild to moderate hypertension should be initiated. In 2013, the American College of Obstetricians and Gynecologists provided evidence-based recommendations for the management of patients with hypertension during and after pregnancy, but it concluded that the final decision should be individualized and made by the health care provider and patient in all instances. Therefore, well-designed large trials are needed to clarify the indication for antihypertensive use and the selected population who would benefit from expectant management for mild to moderate hypertension at preterm.