Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health最新文献

Introduction and objective: As thresholds for the diagnosis of gestational diabetes mellitus (GDM) become lower, and the prevalence of obesity in society rises, more pregnant women will be diagnosed with GDM and hypertension. Both conditions hold dangers for mother and baby. Our objective was to properly describe this association.

Study design and outcome measures: This retrospective audit was conducted at the Obstetric High-Risk Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. All patients diagnosed with GDM from 01/01/19 - 31/12/19 were included. The primary aim was to determine the incidence, and different classes of hypertensive disease associated with GDM in this population. The secondary aims were to evaluate associations with the development of hypertensive disorders in women with GDM and to include descriptions of the management, course and complications during the pregnancies, including the early neonatal period. The research was approved by the Ethics Committee of Stellenbosch University.

Results: Of the 274 women with GDM, included in the analysis, 204 (75 %) had concomitant hypertension. Classes of hypertension were chronic hypertension 21 % (58/274), gestational hypertension 26 % (71/274), and pre-eclampsia (de novo and super-imposed) 27 % (75/275). Those without hypertension had significantly lower BMIs: 35 [29-42] vs 41 [34-45] kg/m² (median [IQR]; p < 0.001). Using ROC curves, BMI at booking had strong associations with chronic and gestational hypertension (p = 0,002; p = 0,001), and pre-eclampsia (p = 0,002). All three intra-uterine deaths (two spontaneous and one iatrogenic) occurred in the GDM + hypertension group.

Conclusion: Hypertensive conditions of pregnancy were common amongst a referral-based population with GDM, with BMI being the strongest predictor.

Objective: To evaluate the incidence of hypertension and blood pressure (BP) phenotypes using 24-hour ambulatory BP (24hr-ABP) in women with past pregnancy complications who were recruited into a Women's Heart Clinic (WHC).

Study design: We recruited 156 women aged 30-55 years with past hypertensive disorders of pregnancy (HDP) and/or gestational diabetes (GDM) to a multidisciplinary six-month WHC that provided cardiovascular risk management in Melbourne, Australia. Women were referred for 24 hr-ABP monitoring if clinic BP was ≥130/80 mmHg.

Main outcome measures: Primary outcome was incident hypertension, defined by 24 hr-ABP monitoring as daytime hypertension ≥135/85 mmHg, nocturnal hypertension ≥120/70 mmHg, and/or 24hr-average hypertension ≥130/80 mmHg.

Results: From 156 women, 54 women underwent 24hr-ABP monitoring (mean age 41.3 ± 4.5 years; 3.9 ± 2.6 years post-partum), with 64.8 % HDP and 45.2 % GDM. Incidence of hypertension was 61.1 % [95 % CI 48.2 %-74.0 %]. Higher proportion of women with past HDP had daytime hypertension compared to those with GDM only (57.1 % vs. 26.3 %; p = 0.05) and higher nocturnal mean systolic-BP [116.0 ± 11.2 mmHg vs. 109.6 ± 8.7 mmHg; p = 0.04]. Women with HDP had increased odds of hypertension [adjusted-OR 5.26 95 % CI (1.07-32.76); p = 0.05]. Following management at the WHC, women diagnosed with hypertension had significantly improved BP control (6.1 % at baseline vs. 75.8 % at six-month follow-up; p < 0.001).

Conclusion: Women with past HDP had five-fold increased incidence of hypertension, with higher daytime hypertension and nocturnal systolic-BP, compared to women with GDM. After attending WHC, BP control significantly improved. Our findings suggest routine postpartum follow-up with 24hr-ABP monitoring, through a WHC, may be useful in early detection and management of hypertension in these women.

Background: Preeclampsia is a key cause of prematurity in the U.S. and incurs significant healthcare costs. An imbalance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) predicts severe preeclampsia and aids in its management.

Objective: This study aimed to assess the cost-effectiveness of the sFlt-1/PlGF test as an addition to standard care for patients at risk of developing preeclampsia.

Study design: A decision tree analysis was conducted to assess the cost effectiveness of the ratio test in the United States, using data from Preeclampsia Risk Assessment: Evaluation of Cut-offs to Improve Stratification [PRAECIS] and from a real-world evidence study conducted after the implementation of sFlt-1/PlGF testing into routine clinical practice (Biomarker Examination and Analysis for Clinical Obstetrical Navigation Study [BEACON]). The model compared standard of care alone versus a biomarker-based approach utilizing the sFlt-1/PlGF test for managing patients at risk of preeclampsia with severe features. Published data was used to estimate theoretical cost values of infants for their first six months of life.

Results: The analysis indicated potential total neonatal cost savings of nearly $10,595,332 (95% CI: $6,555,439 to $14,730,536) per 1,000 patients using the sFlt-1/PlGF ratio test, translating to about $10,595 saved per patient. The incremental cost-effectiveness ratio (ICER) analysis showed a mean cost savings of $62,572 for each pregnancy prolonged by two weeks.

Conclusion: The sFlt-1/PlGF test, when used alongside standard care, enhances risk stratification for severe preeclampsia and may lead to significant neonatal cost savings by reducing preterm deliveries and neonatal intensive care admissions.

Background: Oral health may influence blood pressure control by modulating the abundance and activity of nitrate-reducing bacteria, which are essential for enhancing nitrite and nitric oxide (NO) bioavailability. This study aimed to investigate the oral health and microbiome composition of women with pre-eclampsia (PET) compared to healthy controls (CN).

Methods: Ten PET and eleven CN women participated in this study, respectively. An oral health examination was conducted in all the participants. Saliva and blood samples were collected for analysis of the oral microbiome and NO biomarkers.

Results: Higher plaque levels were observed in the PET group compared to the CN group (P = 0.038). The relative abundance of oral bacteria at the genus level did not differ between groups, however, the activity of oral nitrate-reducing bacteria (P = 0.088) and salivary nitrite levels (P = 0.100) appeared lower in the PET group, though not statistically significant. Plasma nitrate levels were significantly lower in the PET group compared to the CN group (P = 0.024).

Conclusion: Women with PET showed poorer oral health and potential lower activity of nitrate-reducing bacteria and salivary nitrite, indicating a need for further investigation into treatments targeting oral health and the microbiome in women with PET.

Preeclampsia (PE) is a pregnancy-specific vascular disorder associated with endothelial dysfunction, hypertension, and proteinuria. The methylenetetrahydrofolate reductase (MTHFR) enzyme regulates essential cellular functions in pregnancy owing to its effects on folate metabolism and DNA methylation. Previous studies implicated the association of rs1801133 (C677T; Ala222Val) and rs1801131 (A1298C; Glu429Ala) in the MTHFR gene with PE in different ethnic groups, but with mixed outcomes.

Methods: Study cases comprised 675 Tunisian pregnant women, of whom 350 PE presented with PE, and the remaining 325 normotensive women served as controls. Genotyping of C677T and A1298C variants was performed by real-time PCR.

Results: There was no statistically significant difference in the minor allele frequencies of C677T and A1298C between preeclampsia cases and controls after adjusting for key covariates. In addition, the prevalence of MTHFR C677T and A1298C minor allele homozygote genotypes was significantly higher in PE cases. The association of 1298C/C, but not 677T/T, with PE persisted after adjusting for the main covariates. Carrying the (minor) 677T allele was associated with marginally higher BMI, significantly higher sFlt-1 serum levels, and median sFlt-1/PlGF ratio and sFlt-1/PlGF ratio ≥ 85. Setting the major allele homozygotes (C677/A1298) as a reference, haplotype analysis demonstrated a higher prevalence of C677/C1298 and T677/C1298 haplotypes (P = 0.03) in PE cases compared to controls, which persisted for C677/C1298, but not T677/C1298 after controlling for key covariates.

Discussion: Our results support an association between MTHFR polymorphisms and increased risk of PE, and an imbalance of PE-associated sFLT-1/PlGF.

Objectives: Eclampsia remains a principal cause of maternal mortality, especially in low- and middle-income countries. The frequent association with Posterior Reversible Encephalopathy Syndrome (PRES) underscores the critical role of neuroimaging in clinical assessment. We aimed to evaluate tomographic findings in women with eclampsia and analyze clinical factors associated with these abnormalities.

Study design: This descriptive, retrospective study was conducted at the Hospital Universitario San Vicente Fundación in Medellín, Colombia. A mandatory registry identified women diagnosed with eclampsia between 2011 and 2023. Non-contrast cranial tomography results and clinical data were analyzed using univariate and multivariate logistic regression to determine factors associated with imaging abnormalities.

Main outcome measures: The primary outcomes were the presence of abnormalities on non-contrast cranial CT scans and their association with clinical factors such as antepartum eclampsia and HELLP syndrome.

Results: Of the eighty-one women with eclampsia, sixty-seven underwent non-contrast cranial tomography. Abnormal findings were observed in 52% of cases, with 74% consistent with PRES and 22% showing evidence of hemorrhage. Antepartum eclampsia and HELLP syndrome are significantly associated with abnormal imaging findings, with odds ratios of 11,72 (2.34 - 106,23) and 9,14 (1.72 - 85,72), respectively, after adjusting for potential confounding variables.

Conclusion: Given the high prevalence of tomographic abnormalities, non-contrast cranial tomography should be considered for all women with eclampsia, particularly those with antepartum presentations or HELLP syndrome. These findings support the need for revising neuroimaging guidelines to improve the diagnosis and management of neurological complications associated with eclampsia, especially in resource-limited settings.

Objectives: We investigated whether a smaller reduction in 2nd trimester blood pressure (BP) is associated with the development of gestational hypertensive disease.

Study design: We conducted a retrospective cohort study utilizing a clinical database at an urban safety-net hospital. Individuals ages 18-40 with a singleton gestation and 1st trimester prenatal care were included. Those with chronic hypertension were excluded. Systolic BP (SBP), diastolic BP (DBP), & mean arterial pressure (MAP) decrease were calculated. The outcome variable, gestational hypertensive disease (GHDP) included gestational hypertension and preeclampsia with and without severe features.

Results: Of N = 3,355 individuals that met inclusion criteria, 18 % had GHDP. The mean gestational age of 1st trimester and 2nd trimester BP values were 9.8 ± 2.1 and 23.5 ± 2.3 weeks. Those with GHDP compared to those without GHDP had a significantly higher mean 1st trimester SBP (p < 0.01), DBP (p < 0.01), and MAP (p < 0.01). Those with GHDP compared to those without GHDP had a significantly smaller decrease between 1st and 2nd trimester SBP (-1.7 ± 12.3 vs -2.9 ± 11.8, p < 0.001) and MAP (-2.1 ± 8.4 vs -2.7 ± 7.9, p = 0.01). Those with GHDP compared to those without GHDP had a smaller DBP decrease but it was not statistically significant (-2.3 ± 8.7 vs -2.7 ± 8.2, p = 0.19).

Conclusions: Pregnant individuals who experienced a smaller decrease in SBP and MAP were more likely to develop GHDP. A reduced physiologic drop in 2nd trimester BP may suggest underlying vascular dysregulation. Future studies investigating biological mechanisms driving diminished 2nd trimester BP decline, utilizing non-invasive hemodynamic monitoring, are necessary.

Objective: This study evaluates the effectiveness of calcium supplementation as a preventive measure for pregnant women with insufficient calcium intake, examining adherence to the recommended 1000 mg daily intake and identifying influencing factors.

Methods: A survey (Expect cohort II, n = 823) evaluated calcium adherence among pregnant women, followed by interviews with sixteen purposefully selected participants. Verbatim transcripts were independently analyzed to identify key themes.

Results: Among survey participants, 82 % discussed the importance of calcium intake, with 83 % expressing intent to improve intake. Of those counselled on calcium, 48 % had insufficient intake, compared to 64 % without counseling. Facilitators included perceived safety, maternal motivation to keep child safe, trust in professionals, supportive environments, and increased awareness. Obstacles included lack of knowledge on calcium sources, pill dosage, low intrinsic motivation, information comprehension and novelty of the advice.

Conclusion: Despite of awareness raising efforts through counseling, only half of the women reached adequate calcium levels, with interviews revealing limited understanding. Clear messages on calcium benefits, dispelling concerns about potential harm, and offering concrete guidance can improve intake. Repetition of advice and increase publicity can normalize and enhance acceptability of calcium consumption during pregnancy.

Objectives: Over the last decades, there has been a rising number of randomised controlled trials (RCTs) on pre-eclampsia. We investigated pre-eclampsia RCTs between 1987 and 2021 and reported on trustworthiness, risk of biases, p-values, transparency, and usefulness.

Methods: We searched PubMed for RCTs containing "pre-eclampsia" or "hypertensive disorders of pregnancy" in the title between 1987 and 2021. We created a transparency, trustworthiness and usefulness checklist, and recorded the characteristics of p-value reporting, RCT characteristics including registration, journal of publication, and outcomes.

Results: We found 202 RCTs, with the median number of authors increasing from four in 1987 to 12 in 2021. Trial registration increased nearly seven-fold from 17/93 between 1987-2010 to 79/109 RCTs registered between 2011-2021. Between 2010-2021, 338 p-values were published in the abstract with a rise in non-significant p-values (significant vs non-significant: 214/338, 63% vs 124/338, 37%). The number of effect sizes published increased by 58% from 659 in 1987-2010 to 1,038 in 2011-2021. The median of combined transparency and usefulness scores of RCTs improved from 6 to 9 out of 13, between 1987-1991 and 2017-2021. From the trustworthiness checklist, trials performed worst at adequate registration (43/202, 21%). Risk of reporting, performance, and detection biases were detected in most RCTs (166/202, 82%, 131/202, 65% and 141/202, 70% respectively).

Conclusion: The reporting of non-significant p-values and effect sizes increased after mandatory trial registration in 2010, along with the transparency and trustworthiness of most trials. RCTs need to be more transparent, trustworthy, and useful to increase the value of research.