Hypertension in Pregnancy最新文献

Introduction: Preeclampsia is a leading cause of maternal and newborn deaths. Traditionally characterized by high-blood pressure and proteinuria, organ and placental dysfunction were later proposed in some clinical practice guidelines as additional components for its definition. Variability in diagnostic criteria across international guidelines could be a barrier to harmonized and equitable care in different settings.

Methods: We reviewed current relevant clinical practice guidelines to identify similarities and differences in recommendations related to the definition and diagnosis of preeclampsia, and their supporting evidence. We also reviewed additional systematic reviews related to the diagnosis of preeclampsia. We searched different databases and websites of international and professional organizations for guidelines published or updated from 2014 to 2024. We searched databases to identify additional systematic reviews on preeclampsia diagnosis.

Results: Fifteen guidelines from 11 organizations were identified with 11 systematic reviews supporting evidence on the diagnosis of preeclampsia. We found 21 additional systematic reviews, not included in these guidelines.

Discusion: There is agreement for hypertension and proteinuria for the diagnosis of preeclampsia, without a uniform consensus on methods and devices for their assessment. Organ dysfunction is considered in eight guidelines and placental dysfunction in four, with some disagreements on their usefulness, and the methods and tools for their measurement. Few guidelines support their recommendations on preeclampsia diagnosis with systematic reviews.

Conclusion: Consensus in preeclampsia definition is needed to guide not only clinical practice but also future research and policy, particularly in global health contexts.

Importance: Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease risk. Postpartum interventions can motivate lifestyle changes but are not universally effective.

Objective: Our objective was to determine how behavioral phenotypes are associated with response to a digital health intervention designed to increase physical activity among 122 postpartum individuals with HDP.

Design and methods: We conducted a secondary analysis of the STEP UP Mom trial, comparing a wearable step tracker with team-based gamification to a wearable step tracker alone over 12 weeks. Baseline behavioral characteristics were obtained using validated surveys. We applied the k-means clustering method to identify clusters.

Main outcome and measure: Linear mixed-effects models were used to estimate mean step count difference between arms from baseline across follow-up within each cluster.

Results: We identified two distinct, non-overlapping clusters. Cluster 1 had higher baseline steps and greater psychosocial distress, without significant difference in change in step count in the intervention arm compared to the control arm. Cluster 2 had lower baseline steps and less psychosocial distress and walked 1,335 significantly more steps per day in the intervention arm compared to the control arm. Sustained engagement with the study intervention did not differ between clusters.

Conclusions and relevance: Behavioral phenotypes may help identify postpartum individuals who may benefit from tailored interventions in future studies to improve lifestyle changes.

Background: Hypertensive disorders of pregnancy (HDPs), which include gestational hypertension (GH) and preeclampsia (PE), are the primary causes of maternal morbidity and mortality worldwide. Recent studies have found a correlation between metabolic dysfunction-associated steatotic liver disease (MASLD) and HDPs, but the causality of this association remains to be identified. Therefore, this study aims to evaluate the causal relationship between MASLD and HDPs through Mendelian randomization (MR) analysis.

Methods: The summary statistics from genome-wide association studies were employed to conduct a two-sample MR analysis. Five complementary MR methods, including inverse variance weighting (IVW), MR-Egger, weighted median, simple mode and weighted mode were performed to assess the causality of MASLD on GH and PE. Furthermore, we conducted various sensitivity analyses to ensure the stability and reliability of the results.

Results: Genetically predicted MASLD significantly increased the risk of GH (IVW: OR = 1.138, 95% CI: 1.062-1.220, p < 0.001), while there was little evidence of a causal relationship between MASLD and PE (IVW: OR = 0.980, 95% CI: 0.910-1.056, p = 0.594). The sensitivity analyses indicated no presence of heterogeneity and horizontal pleiotropy.

Conclusion: This MR study provided evidence supporting the causal effect of MASLD on GH. Our findings underscore the significance of providing more intensive prenatal care and early intervention for pregnant women with MASLD to prevent potential adverse obstetric outcomes.

Background: Preeclampsia (PE) is characterized as de novo hypertension (HTN) with end-organ damage, especially in the brain. PE is hypothesized to be caused by placental ischemia. PE affects ~5-8% of USA pregnancies and increases the risk for HTN and cerebrovascular diseases (CVD) later in life. We hypothesize that blood pressure (BP), cerebral oxidative stress, and cerebral inflammation will increase in postpartum (PP) placental ischemic dams.

Methods: Placental ischemia was induced in pregnant Sprague Dawley dams, utilizing reduced uterine perfusion pressure (RUPP) surgery. At 6 weeks PP (~3 human years), BP was measured via carotid catheterization, and cerebral oxidative stress and inflammation were assessed via ELISAs, biochemical assays, and Western blots.

Results: BP, cerebral pro-inflammatory cytokines (TNF-α and IL-6), and GFAP (a marker of astrocyte activity) were increased in PP RUPP dams. Cerebral hydrogen peroxide (H₂O₂) was also increased in PP RUPP dams, and had a strong correlation with PP RUPP BP, proinflammatory cytokines (TNF- α and IL-6), and GFAP astrocyte activation.

Conclusion: PP RUPP dams have increased BP, cerebral oxidative stress, and cerebral inflammation at 6 weeks postpartum. These changes in cerebral inflammation and oxidative stress may contribute to the pathology and development of HTN and CVDs in postpartum dams.

Objective: The main objective of the study was to compare the levels of CBP and these cardiac biomarkers in women with maternal complications of hypertensive disorders of pregnancy (HDP).

Methods: This was a cross-sectional study that enrolled 270 women with HDP and 270 normotensive pregnant controls. Data on basic characteristics and incidence of maternal complications were collected among the two groups. Additionally, information on cardiac biomarkers and CBP was gathered from the women with HDP, to compare the levels of these biomarkers with maternal complications experience by this group.

Results: Non-hypertensive controls were significantly older than hypertensive cases and had a higher median gestational age at recruitment compared to hypertensive cases The median levels of CBP and cardiac biomarkers were significantly higher among hypertensive participants with maternal complications (n = 107/270) than those without complications (n = 163/270). Specifically, central systolic blood pressure (CSBP) was 133 (120-142) mmHg vs 128 (109-129) mmHg (p = 0.033) and central diastolic blood pressure (CDBP) was 75 (62-86) mmHg vs 69 (56-73) mmHg (p < 0.01), while NT-proBNP was 446 (145-1126) vs. 57 (21-167)) pg.ml^-1; p < 0.0001, and hs-cTnI was 12 (7-35) ng.L^-1 compared to 8 (3-8) ng.L^-1; p < 0.0001, in cases v. controls, respectively.

Conclusion: In conclusion, the study found that pregnant hypertensive women with maternal complications had significantly higher median values of CSBP and CDBP, NT-proBNP, and hs-cTnI in compared to those without complications. These findings suggest that measuring these vital signs and cardiac biomarkers in hypertensive pregnancies might be helpful for screening and monitoring maternal complications.

Introduction: This study aimed to evaluate the hematocrit-to-albumin ratio (HCT-ALB) as a predictor of severe maternal morbidity (SMM) in pregnancies complicated with hypertensive disorders of pregnancy (HDP).

Areas covered: This retrospective cohort study analyzed clinical data of 794 women with singleton pregnancies diagnosed with HDP at Fujian Provincial Maternal and Child Health Hospital from 1 January 2016, to 31 December 2018. HCT-ALB was a primary outcome of interest. Maternal outcomes, including SMM events (e.g. ICU admission or transfusion), were recorded. Multivariate logistic regression, threshold effect analysis, and receiver operating characteristic (ROC) curve evaluation were used to assess the predictive value of HCT-ALB and other clinical indicators. HCT-ALB was identified as an independent risk factor for SMM, with an inflection point at 6.9, beyond which the risk increased significantly. ROC curve analysis demonstrated that HCT-ALB had an area under the curve (AUC) of 0.717, outperforming other single biomarkers. When combined with gestational age, platelet index, systolic blood pressure and maternal age, the AUC improved to 0.817.

Expert opinion/commentary: HCT-ALB is a practical and scalable biomarker for predicting SMM in HDP. Its integration into clinical protocols could improve risk stratification and early intervention. Future studies should validate these findings in multi-ethnic and multi-center populations, incorporating social and economic factors to enhance predictive models and global applicability.

Background: We aimed to examine the association between maternal urine and serum L-type fatty acid-binding protein (L-FABP) levels and preeclampsia (PE) severity and their potential as predictors of maternal and fetal deterioration following PE diagnosis.

Method: A prospective cohort of women with singleton pregnancies diagnosed with PE was analyzed. Participants were classified into two groups based on the timing of delivery: PE-delivery (delivery within 1 week of sample collection) and PE-non-delivery (no delivery within 1 week). Urine and serum samples were collected at the time of PE diagnosis, and cases were classified based on the presence of maternal or fetal complications.

Results: In total, 53 singleton pregnancies were analyzed and classified into the PE-delivery (n = 32) and PE-non-delivery groups (n = 21). No significant differences in L-FABP levels were observed between severe and non-severe PE cases. However, L-FABP levels were significantly higher in cases of severe PE due to maternal factors. In the PE-delivery group, urine and serum L-FABP levels were significantly elevated in cases requiring delivery within 1 week due to maternal indications compared to the PE-non-delivery group, whereas no such differences were found in cases with fetal indications. Receiver operating characteristic analysis showed strong predictive performance of L-FABP levels for delivery within 1 week due to maternal deterioration, with areas under the curve of 0.892 (urine, cutoff: 12.3 μg/gCr) and 0.795 (serum, cutoff: 1.64 ng/mL).

Conclusion: Maternal urine and serum L-FABP levels are closely associated with PE severity due to maternal complications and may serve as reliable biomarkers for imminent maternal deterioration.