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

Objective: To comparematernal and neonatal outcomes in patients diagnosed with gestational hypertension or preeclampsia without severe features by outpatient versus inpatient management.

Materials and methods: This was a single center, retrospective, cohort study of patients with hypertensive disorder of pregnancy (HDP) before 37 weeks' gestation from January 2014 to March 2022. Patients were triaged to inpatient or outpatient management at the discretion of their obstetrician. Patients with an initial presentation of severe features were excluded. Bivariate and multivariate analyses were used to compare the primary outcome, severe maternal morbidity (SMM) as defined by one or more of the 21 CDC maternal morbidity identifiers, and the secondary outcomes of maternal ICU admission, development of severe features, placental abruption, time from diagnosis to giving birth, preterm birth < 37 weeks, low birthweight (<2500 g), 5-minute Apgar score < 7, and stillbirth.

Results: A total of 272 patients met the inclusion criteria with 229 (84.2 %) being managed outpatient and 43 (15.8 %) managed inpatient. In univariate analysis, outpatient management was associated with lower incidence of SMM, an increased interval from diagnosis of HDP to giving birth, an increased interval to onset of severe features, and a lower incidence of maternal ICU admission. In multivariate analysis, outpatient management remained associated with lower odds of SMM, (aOR 0.18, 95 % CI 0.05-0.59) and improved neonatal outcomes with lower incidence of 5-minute APGAR score less than 7 (aOR 0.32, 95 % CI 0.13-0.82), low birth weight (aOR 0.37 95 % CI 0.17-0.79), and preterm birth (aOR 0.31, 95 % CI 0.15-0.67).

Conclusion: Outpatient management of HDP was associated with lower rates of SMM and adverse maternal and neonatal outcomes. While not all confounding factors were measured, the clinical decision regarding HDP management settings was associated with good diagnostic capability.

Objectives: To evaluate glycosylated fibronectin (GlyFn) as a novel biomarker for preeclampsia and preeclampsia-related complications, and to compare GlyFn to traditional biomarkers, including soluble Fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF).

Study design: Secondary analysis of a prospective cohort study (n = 524) with suspected preeclampsia (control), gestational hypertension (GH), or confirmed preeclampsia/hemolysis, elevated liver enzymes and low platelets syndrome (PE/HELLP).

Main outcome measures: GlyFn levels in PE/HELLP versus control and GH. Its association with preeclampsia-related complications, and its added value on top of a traditional model incorporating gestational age, proteinuria, parity, and blood pressure. A comparison of all GlyFn-related performances versus those of sFlt-1 and PlGF.

Results: A significant elevation in GlyFn levels in patients with GH and PE/HELLP was observed versus control. Notably, GlyFn displayed positive correlations with sFlt-1 and the sFlt-1/PlGF ratio, and a negative correlation with PlGF. GlyFn alone outperformed the traditional model in predicting maternal but not fetal complications. This pattern was also observed for sFlt-1, PlGF and their ratio. Combining GlyFn with the traditional model, enhanced the C-index for maternal complications. However, the GlyFn/PlGF ratio, when added to the traditional model, yielded the best results for predicting fetal complications in the overall cohort. In women with a GA < 37 weeks, the latter combination also showed the best predictive value for predicting maternal complications.

Conclusions: GlyFn is a novel biomarker for PE diagnosis and its complications, particularly at GA < 37 weeks. Prospective studies should evaluate to what degree it outperforms traditional biomarkers.