Pub Date : 2025-04-21DOI: 10.1016/j.preghy.2025.101213
Nadia Olivier , Helen McDougall , Grace Yuan , David Langsford
Introduction
To describe the characteristics of patient’s presenting with postpartum hypertension, comparing those with known hypertensive disorders of pregnancy (HDP) antenatally to patients presenting with de novo postpartum hypertension.
Methods
A retrospective audit of deliveries at Northern Health from January 2016 to December 2020. International Classification of Diseases (ICD) codes combined with a manual medical records search identified 72 records that resulted in representation to hospital with hypertension. Data was collected to observe and compare maternal, pregnancy and fetal characteristics.
Results
Of the 72 patients, 35 (48.6 %) readmissions had known HDP and 37 (51.4 %) had de novo postpartum HDP. Similarities were observed between both the patients with known HDP and de novo postpartum hypertension group, including maternal age at delivery (32.4 ± 4.9, 31.9 ± 5.6 years), BMI (32 (25–38), 31 (24–41) kg/m2) and nulliparity (48.6 %, 40.5 %). Aspirin prescription was similar in both groups (28.6 %, 27.0 %). The mean birthweight of the known HDP group was significantly less (2893.7 ± 231.4 g) compared to the de novo group (3362.4 ± 584.4 g). Differences were observed in the urine protein to creatinine ratio (uPCr) antenatally. Antenatally and postpartum the blood pressure readings for the known HDP were significantly higher than the de novo group.
Conclusions
More than 50 % of patients representing are de novo HDP. It does not appear pre-eclampsia is unrecognised antenatally in the de novo group. Our study does not highlight key factors that aid the recognition of those at risk of developing postpartum hypertension separate to the risk factors that are associated with HDP generally.
{"title":"Comparison of patients presenting with hypertensive disorders of pregnancy antenatally versus de-novo postpartum hypertension","authors":"Nadia Olivier , Helen McDougall , Grace Yuan , David Langsford","doi":"10.1016/j.preghy.2025.101213","DOIUrl":"10.1016/j.preghy.2025.101213","url":null,"abstract":"<div><h3>Introduction</h3><div>To describe the characteristics of patient’s presenting with postpartum hypertension, comparing those with known hypertensive disorders of pregnancy (HDP) antenatally to patients presenting with de novo postpartum hypertension.</div></div><div><h3>Methods</h3><div>A retrospective audit of deliveries at Northern Health from January 2016 to December 2020. International Classification of Diseases (ICD) codes combined with a manual medical records search identified 72 records that resulted in representation to hospital with hypertension. Data was collected to observe and compare maternal, pregnancy and fetal characteristics.</div></div><div><h3>Results</h3><div>Of the 72 patients, 35 (48.6 %) readmissions had known HDP and 37 (51.4 %) had de novo postpartum HDP. Similarities were observed between both the patients with known HDP and de novo postpartum hypertension group, including maternal age at delivery (32.4 ± 4.9, 31.9 ± 5.6 years), BMI (32 (25–38), 31 (24–41) kg/m<sup>2</sup>) and nulliparity (48.6 %, 40.5 %). Aspirin prescription was similar in both groups (28.6 %, 27.0 %). The mean birthweight of the known HDP group was significantly less (2893.7 ± 231.4 g) compared to the de novo group (3362.4 ± 584.4 g). Differences were observed in the urine protein to creatinine ratio (uPCr) antenatally. Antenatally and postpartum the blood pressure readings for the known HDP were significantly higher than the de novo group.</div></div><div><h3>Conclusions</h3><div>More than 50 % of patients representing are de novo HDP. It does not appear pre-eclampsia is unrecognised antenatally in the de novo group. Our study does not highlight key factors that aid the recognition of those at risk of developing postpartum hypertension separate to the risk factors that are associated with HDP generally.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101213"},"PeriodicalIF":2.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-10DOI: 10.1016/j.preghy.2025.101211
James Goadsby , Siddesh Shetty , Argyro Syngelaki , Soley-Bori Marina , Laura A. Magee , Peter von Dadelszen , Ranjit Akolekar , Sergio A. Silverio , Kayleigh Sheen , Julia Fox-Rushby , Alan Wright , David Wright , Kypros H. Nicolaides
Objectives
To evaluate whether term pre-eclampsia (PE) is reduced by screening for PE risk at 35 + 0–36 + 6 weeks’ gestation and offering risk-based, planned early term birth.
Study design: ‘PREVENT-PE’ is a multicentre, randomised trial (ISRCTN41632964).
Inclusion
Singleton pregnancy, presentation for routine fetal ultrasound at 35 + 0–36 + 6 weeks’, and can give informed consent.
Exclusion
PE, major fetal abnormality, or participation in a conflicting study. Randomisation (central, 1:1 ratio, minimised for study site, in random permuted blocks) to intervention (screening for term PE risk, and planned early term birth for PE risk ≥ 1 in 50) or control (usual care at term) arms.
Outcomes
Primary: Birth with PE (ISSHP 2021 criteria).
Key secondaries
Emergency caesarean and neonatal unit admission ≥ 48 h. Others include within-trial and intermediate-term economic evaluations, and mixed-methods surveys and interviews.
Analysis
3,201 participants/arm would be required to detect a relative risk (intervention/control) of 0.5, based on 2.0% PE incidence, 90% power, and two-tailed 2.5% significance level; an adaptive design will determine the final sample size (4000–8000) at interim analysis of the first 3,000 participants.
Analyses
Intention-to-treat. Economic evaluation will measure and value resources and health outcomes for mothers at risk of term PE and newborns (health service perspective). In within-trial cost-effectiveness analysis, the main outcome will be incremental cost per PE case averted, with costs and health outcomes calculated using patient-level data. A decision model will assess cost-utility of the intervention for one year postpartum.
Conclusions
PREVENT-PE will provide data to inform birth choices and maternity services planning.
{"title":"Prevent-PE (pre-eclampsia prevention by timed birth at term): Protocol for a randomised trial","authors":"James Goadsby , Siddesh Shetty , Argyro Syngelaki , Soley-Bori Marina , Laura A. Magee , Peter von Dadelszen , Ranjit Akolekar , Sergio A. Silverio , Kayleigh Sheen , Julia Fox-Rushby , Alan Wright , David Wright , Kypros H. Nicolaides","doi":"10.1016/j.preghy.2025.101211","DOIUrl":"10.1016/j.preghy.2025.101211","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether term pre-eclampsia (PE) is reduced by screening for PE risk at 35 + 0–36 + 6 weeks’ gestation and offering risk-based, planned early term birth.</div><div>Study design: ‘PREVENT-PE’ is a multicentre, randomised trial (ISRCTN41632964).</div></div><div><h3>Inclusion</h3><div>Singleton pregnancy, presentation for routine fetal ultrasound at 35 + 0–36 + 6 weeks’, and can give informed consent.</div></div><div><h3>Exclusion</h3><div>PE, major fetal abnormality, or participation in a conflicting study. Randomisation (central, 1:1 ratio, minimised for study site, in random permuted blocks) to intervention (screening for term PE risk, and planned early term birth for PE risk ≥ 1 in 50) or control (usual care at term) arms.</div></div><div><h3>Outcomes</h3><div>Primary: Birth with PE (ISSHP 2021 criteria).</div></div><div><h3>Key secondaries</h3><div>Emergency caesarean and neonatal unit admission ≥ 48 h. Others include within-trial and intermediate-term economic evaluations, and mixed-methods surveys and interviews.</div></div><div><h3>Analysis</h3><div>3,201 participants/arm would be required to detect a relative risk (intervention/control) of 0.5, based on 2.0% PE incidence, 90% power, and two-tailed 2.5% significance level; an adaptive design will determine the final sample size (4000–8000) at interim analysis of the first 3,000 participants.</div></div><div><h3>Analyses</h3><div>Intention-to-treat. Economic evaluation will measure and value resources and health outcomes for mothers at risk of term PE and newborns (health service perspective). In within-trial cost-effectiveness analysis, the main outcome will be incremental cost per PE case averted, with costs and health outcomes calculated using patient-level data. A decision model will assess cost-utility of the intervention for one year postpartum.</div></div><div><h3>Conclusions</h3><div>PREVENT-PE will provide data to inform birth choices and maternity services planning.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101211"},"PeriodicalIF":2.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.preghy.2025.101210
Mariam K. Ayyash , Rodney A. Mclaren Jr. , Huda B. Al-Kouatly , Majid Shaman
Objective
To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG.
Methods
A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010–2014. The post-ASA group were births between 2016–2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010–2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort.
Results
There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57–1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89–0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78–0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP < 37 weeks but was not different for preterm HPD < 34 weeks.
Conclusion
While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines.
{"title":"Hypertensive disorders of pregnancy trends in the United States post aspirin recommendation guidelines","authors":"Mariam K. Ayyash , Rodney A. Mclaren Jr. , Huda B. Al-Kouatly , Majid Shaman","doi":"10.1016/j.preghy.2025.101210","DOIUrl":"10.1016/j.preghy.2025.101210","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG.</div></div><div><h3>Methods</h3><div>A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010–2014. The post-ASA group were births between 2016–2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010–2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort.</div></div><div><h3>Results</h3><div>There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57–1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89–0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78–0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP < 37 weeks but was not different for preterm HPD < 34 weeks.</div></div><div><h3>Conclusion</h3><div>While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101210"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-12DOI: 10.1016/j.preghy.2025.101206
Junaid Nizamuddin , Elizabeth Hall , John Dreixler , Ana Palei , Joey Granger , Avery Tung , Ariel Mueller , Sarosh Rana , Sajid Shahul
Objectives
Despite postpartum cardiovascular dysfunction being the leading cause of pregnancy-related mortality in the United States, it is difficult to identify at-risk patients. The objective of this study was to determine if antepartum follistatin-like 3 levels correlate with postpartum cardiovascular dysfunction and maternal morbidity.
Study Design
This observational cohort study included pregnant patients ≥ 18 years old and singleton gestation < 41 weeks who delivered at the University of Chicago between May 2017 and November 2020.
Main Outcome Measures
The primary outcome was postpartum cardiovascular dysfunction, defined as postpartum hypertension, cardiomyopathy, and pulmonary edema. The secondary outcome was severe maternal morbidity.
Results
The final cohort included 408 women. Elevated FSTL3 levels were associated with postpartum cardiovascular dysfunction (OR per unit increase in FSTL3, 1.02 [95 % CI: 1.01, 1.04]; p < 0.001). After adjustment for gestational age at delivery, maternal age, BMI, nulliparous status, hypertensive disorders of pregnancy, smoking, and diabetes, the association between FSTL3 levels and cardiovascular dysfunction persisted (p = 0.03), with good model discrimination between events (c-statistic 0.88). FSTL3 levels were also associated with severe maternal morbidity (OR per unit increase 1.02 [95 % CI: 1.01, 1.03]; p < 0.0001). Additionally, Activin A levels were associated with cardiovascular dysfunction and severe maternal morbidity (c = 0.84, p = 0.01; c = 0.87, p = 0.02 respectively).
Conclusions
Higher follistatin-like 3 levels were associated with postpartum cardiovascular dysfunction and severe maternal morbidity. Follistatin-like 3 may be causal in cardiovascular dysfunction, and further work should define its potential as a biomarker.
{"title":"Circulating follistatin-like 3 and its association with postpartum cardiovascular dysfunction and severe maternal morbidity","authors":"Junaid Nizamuddin , Elizabeth Hall , John Dreixler , Ana Palei , Joey Granger , Avery Tung , Ariel Mueller , Sarosh Rana , Sajid Shahul","doi":"10.1016/j.preghy.2025.101206","DOIUrl":"10.1016/j.preghy.2025.101206","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite postpartum cardiovascular dysfunction being the leading cause of pregnancy-related mortality in the United States, it is difficult to identify at-risk patients. The objective of this study was to determine if antepartum follistatin-like 3 levels correlate with postpartum cardiovascular dysfunction and maternal morbidity.</div></div><div><h3>Study Design</h3><div>This observational cohort study included pregnant patients ≥ 18 years old and singleton gestation < 41 weeks who delivered at the University of Chicago between May 2017 and November 2020.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was postpartum cardiovascular dysfunction, defined as postpartum hypertension, cardiomyopathy, and pulmonary edema. The secondary outcome was severe maternal morbidity.</div></div><div><h3>Results</h3><div>The final cohort included 408 women. Elevated FSTL3 levels were associated with postpartum cardiovascular dysfunction (OR per unit increase in FSTL3, 1.02 [95 % CI: 1.01, 1.04]; p < 0.001). After adjustment for gestational age at delivery, maternal age, BMI, nulliparous status, hypertensive disorders of pregnancy, smoking, and diabetes, the association between FSTL3 levels and cardiovascular dysfunction persisted (p = 0.03), with good model discrimination between events (c-statistic 0.88). FSTL3 levels were also associated with severe maternal morbidity (OR per unit increase 1.02 [95 % CI: 1.01, 1.03]; p < 0.0001). Additionally, Activin A levels were associated with cardiovascular dysfunction and severe maternal morbidity (c = 0.84, p = 0.01; c = 0.87, p = 0.02 respectively).</div></div><div><h3>Conclusions</h3><div>Higher follistatin-like 3 levels were associated with postpartum cardiovascular dysfunction and severe maternal morbidity. Follistatin-like 3 may be causal in cardiovascular dysfunction, and further work should define its potential as a biomarker.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101206"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-28DOI: 10.1016/j.preghy.2025.101207
Guiyou Yang , Wessel Ganzevoort , Sanne J. Gordijn , Ben Mol , Gerton Lunter , Henk Groen
Objectives
To identify patterns in changes of blood pressure for women with gestational hypertension (GH) or non-severe pre-eclampsia (PE) beyond 36 gestational weeks, and assess their association with a composite adverse maternal outcome.
Study design
Secondary analysis of a randomized controlled trial (HYPITAT).
Main outcome measures
We investigated patterns of one-week blood pressure changes post-admission, explored factors contributing to diverse patterns using ANOVA and Chi-square tests, and assessed the correlation between these patterns and a composite adverse maternal outcome defined as severe maternal morbidity, mortality, post-partum hemorrhage and cesarean section. Among 384 women, 187 developed the composite outcome.
Results
We identified three and four typical patterns in systolic and diastolic blood pressure changes, respectively. Diastolic blood pressure patterns statistically significantly varied across maternal ethnicity and diagnosis at admission. Compared to a pattern of steady diastolic blood pressure, the odds ratio (95 % confidence interval) for the composite adverse maternal outcome was 2.59 (1.31, 5.13) or 2.09 (1.02, 4.26), contingent on covariates, when a pattern of increasing diastolic blood pressure was present. The results of sensitivity analysis excluding severe hypertension from the composite outcome indicated that the main findings are robust.
Conclusions
Maternal ethnicity and diagnosis may affect diastolic blood pressure patterns, and a pattern of increasing diastolic blood pressure was likely associated with elevated risk of the composite adverse maternal outcome. This underscores the potential significance of recognizing these patterns for sequential risk assessment and individualized management in late GH and non-severe PE.
{"title":"Blood pressure patterns of gestational hypertension or non-severe pre-eclampsia beyond 36 weeks’ gestation and the adverse maternal outcomes: Secondary analysis of the HYPITAT study","authors":"Guiyou Yang , Wessel Ganzevoort , Sanne J. Gordijn , Ben Mol , Gerton Lunter , Henk Groen","doi":"10.1016/j.preghy.2025.101207","DOIUrl":"10.1016/j.preghy.2025.101207","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify patterns in changes of blood pressure for women with gestational hypertension (GH) or non-severe pre-eclampsia (PE) beyond 36 gestational weeks, and assess their association with a composite adverse maternal outcome.</div></div><div><h3>Study design</h3><div>Secondary analysis of a randomized controlled trial (HYPITAT).</div></div><div><h3>Main outcome measures</h3><div>We investigated patterns of one-week blood pressure changes post-admission, explored factors contributing to diverse patterns using ANOVA and Chi-square tests, and assessed the correlation between these patterns and a composite adverse maternal outcome defined as severe maternal morbidity, mortality, post-partum hemorrhage and cesarean section. Among 384 women, 187 developed the composite outcome.</div></div><div><h3>Results</h3><div>We identified three and four typical patterns in systolic and diastolic blood pressure changes, respectively. Diastolic blood pressure patterns statistically significantly varied across maternal ethnicity and diagnosis at admission. Compared to a pattern of steady diastolic blood pressure, the odds ratio (95 % confidence interval) for the composite adverse maternal outcome was 2.59 (1.31, 5.13) or 2.09 (1.02, 4.26), contingent on covariates, when a pattern of increasing diastolic blood pressure was present. The results of sensitivity analysis excluding severe hypertension from the composite outcome indicated that the main findings are robust.</div></div><div><h3>Conclusions</h3><div>Maternal ethnicity and diagnosis may affect diastolic blood pressure patterns, and a pattern of increasing diastolic blood pressure was likely associated with elevated risk of the composite adverse maternal outcome. This underscores the potential significance of recognizing these patterns for sequential risk assessment and individualized management in late GH and non-severe PE.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101207"},"PeriodicalIF":2.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-26DOI: 10.1016/j.preghy.2025.101204
Gregory Ward , Maria Pinto Correia Watts , Stefan R. Hansson
Over the past 50 years there has been an unprecedented increase in pollution globally.
Population growth and higher standards of living have resulted in increases in global consumption facilitated by industrialisation and globalisation of goods and services thus resulting in the release of environmental pollutants on a mass scale.
This article analyses the effects and consequences of pollution on important aspects of reproductive health including fertility, pregnancy and infant health. It is a narrative review based on a search of PubMed using the terms ‘pollution and fertility,’ ‘pollution and pregnancy,’ ‘pollution and infant health,’ and ‘history of pollution.’ Additional references were identified through articles provided by the authors of related studies. Studies were included based on their relevance to the topic and were prioritized for their methodological rigour and recency. While no formal quality assessment tools were employed, the potential limitations of individual studies are discussed where applicable.
{"title":"The unintended consequences of modernity: Pollution and its effect on reproductive, maternal and fetal health","authors":"Gregory Ward , Maria Pinto Correia Watts , Stefan R. Hansson","doi":"10.1016/j.preghy.2025.101204","DOIUrl":"10.1016/j.preghy.2025.101204","url":null,"abstract":"<div><div>Over the past 50 years there has been an unprecedented increase in pollution globally.</div><div>Population growth and higher standards of living have resulted in increases in global consumption facilitated by industrialisation and globalisation of goods and services thus resulting in the release of environmental pollutants on a mass scale.</div><div>This article analyses the effects and consequences of pollution on important aspects of reproductive health including fertility, pregnancy and infant health. It is a narrative review based on a search of PubMed using the terms ‘pollution and fertility,’ ‘pollution and pregnancy,’ ‘pollution and infant health,’ and ‘history of pollution.’ Additional references were identified through articles provided by the authors of related studies. Studies were included based on their relevance to the topic and were prioritized for their methodological rigour and recency. While no formal quality assessment tools were employed, the potential limitations of individual studies are discussed where applicable.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101204"},"PeriodicalIF":2.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1016/j.preghy.2025.101205
Alexandra N. Mills , Bethany Dubois , Corina Lesseur , Anna-Sophie Rommel , Rushna Tubassum , Elianna Kaplowitz , Natalie Boychuk , Toni Stern , Jia Chen , Whitney Lieb , Teresa Janevic , Rebecca H. Jessel
Objectives
Various studies have noted an association between antenatal SARS-CoV-2 infection and increased risk for development of hypertensive disorders of pregnancy (HDP). Both disease processes have been shown to involve endothelial dysfunction systemically and in the placenta, suggesting common pathogenesis. We aim to further investigate this association in a diverse urban population.
Study Design
Generation C is a prospective pregnancy cohort study at a large academic institution in NYC established between April 2020 and February 2022. SARS-CoV-2 infection during pregnancy was ascertained using a combination of spike and nucleocapsid IgG antibodies, RT-PCR testing, and electronic medical record (EMR) diagnoses. Maternal demographic and medical data were ascertained from the EMR and/or self-report survey.
Main Outcome Measures
The primary outcome was HDP defined using the American College of Obstetrics and Gynecology diagnostic criteria. Covariates included maternal age ≥ 35 years, BMI ≥ 30, high social vulnerability index based on patient zip code, maternal chronic hypertension, pregestational diabetes, and nulliparity. Univariable and multivariable logistic regression was used to examine the association between antenatal SARS-CoV-2 infection and HDP.
Results
Among the 2402 participants, 15.4 % (369) were infected with SARS-CoV-2 during pregnancy and 18.2 % (67/369) of those exposed developed an HDP. In participants without evidence of antenatal SARS-COV-2 infection, 18.0 % (365/2033) developed an HDP. In an adjusted multivariable model, antenatal SARS-CoV-2 infection was not associated with HDP (aOR 0.89; 95 % CI, 0.65–1.22).
Conclusions
This study did not find an increased risk of HDP associated with antenatal SARS-CoV-2 infection in a diverse prospective cohort.
{"title":"Impact of antenatal SARS-CoV-2 infection on development of hypertensive disorders of pregnancy in a large, diverse, cohort","authors":"Alexandra N. Mills , Bethany Dubois , Corina Lesseur , Anna-Sophie Rommel , Rushna Tubassum , Elianna Kaplowitz , Natalie Boychuk , Toni Stern , Jia Chen , Whitney Lieb , Teresa Janevic , Rebecca H. Jessel","doi":"10.1016/j.preghy.2025.101205","DOIUrl":"10.1016/j.preghy.2025.101205","url":null,"abstract":"<div><h3>Objectives</h3><div>Various studies have noted an association between antenatal SARS-CoV-2 infection and increased risk for development of hypertensive disorders of pregnancy (HDP). Both disease processes have been shown to involve endothelial dysfunction systemically and in the placenta, suggesting common pathogenesis. We aim to further investigate this association in a diverse urban population.</div></div><div><h3>Study Design</h3><div>Generation C is a prospective pregnancy cohort study at a large academic institution in NYC established between April 2020 and February 2022. SARS-CoV-2 infection during pregnancy was ascertained using a combination of spike and nucleocapsid IgG antibodies, RT-PCR testing, and electronic medical record (EMR) diagnoses. Maternal demographic and medical data were ascertained from the EMR and/or self-report survey.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was HDP defined using the American College of Obstetrics and Gynecology diagnostic criteria. Covariates included maternal age ≥ 35 years, BMI ≥ 30, high social vulnerability index based on patient zip code, maternal chronic hypertension, pregestational diabetes, and nulliparity. Univariable and multivariable logistic regression was used to examine the association between antenatal SARS-CoV-2 infection and HDP.</div></div><div><h3>Results</h3><div>Among the 2402 participants, 15.4 % (369) were infected with SARS-CoV-2 during pregnancy and 18.2 % (67/369) of those exposed developed an HDP. In participants without evidence of antenatal SARS-COV-2 infection, 18.0 % (365/2033) developed an HDP. In an adjusted multivariable model, antenatal SARS-CoV-2 infection was not associated with HDP (aOR 0.89; 95 % CI, 0.65–1.22).</div></div><div><h3>Conclusions</h3><div>This study did not find an increased risk of HDP associated with antenatal SARS-CoV-2 infection in a diverse prospective cohort.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101205"},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.preghy.2025.101203
Annemarie Y.A.M. Reilingh , Renée J. Burger , Souraya el Bachiri , Stephen McCarthy , Sanne J. Gordijn , Wessel Ganzevoort , Irene G.M. Valkengoed van , on behalf of the project group: ’Obstetric history and cardiovascular health across ethnicity, in The Netherlands’
Background
Pregnancy complications like gestational diabetes and hypertensive disorders increase maternal cardiovascular risk. However, evidence on how to best implement cardiovascular risk management (CVRM) in multi-ethnic contexts remains limited. Existing studies primarily focus on white populations, despite disparities in CVD risk and the risk of pregnancy complications across ethnic groups.
Objective
This study explores experiences, barriers, and improvements in postpartum CVRM from women’s and healthcare providers’ perspectives, aiming to enhance cardiovascular disease prevention in multi-ethnic contexts.
Study Design
We conducted semi-structured interviews with 25 postpartum women who experienced hypertensive disorders of pregnancy or gestational diabetes, recruited to reflect diverse ethnic and socioeconomic backgrounds. Using a narrative approach, interviews covered CVRM experiences and preferences. Themes were triangulated with findings from 16 healthcare providers, including general practitioners, midwives, and specialists, discussing care delivery, optimal practices, and multi-ethnic considerations. Results were integrated in a patient journey map.
Results
Significant dropout occurred at the transition from obstetric to primary care and during long-term monitoring, especially among ethnic minorities and women with lower socioeconomic status and disease severity. Women often lacked risk awareness and missed follow-ups when self-scheduling was required. Most supported tailored cardiovascular risk education, lifestyle interventions, and proactive outreach. Healthcare providers emphasized the need for interdisciplinary communication, regional protocols, and clearer guidelines, noting variability in general practitioners’ support for routine monitoring.
Conclusion
Postpartum CVRM in multi-ethnic contexts could be improved with active outreach, better follow-up utilization, culturally tailored interventions, and regional multidisciplinary protocols to streamline care and address guideline inconsistencies.
{"title":"Cardiovascular risk management after hypertensive disorders and diabetes during pregnancy, in a multi-ethnic population: A qualitative study among women and healthcare providers","authors":"Annemarie Y.A.M. Reilingh , Renée J. Burger , Souraya el Bachiri , Stephen McCarthy , Sanne J. Gordijn , Wessel Ganzevoort , Irene G.M. Valkengoed van , on behalf of the project group: ’Obstetric history and cardiovascular health across ethnicity, in The Netherlands’","doi":"10.1016/j.preghy.2025.101203","DOIUrl":"10.1016/j.preghy.2025.101203","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy complications like gestational diabetes and hypertensive disorders increase maternal cardiovascular risk. However, evidence on how to best implement cardiovascular risk management (CVRM) in multi-ethnic contexts remains limited. Existing studies primarily focus on white populations, despite disparities in CVD risk and the risk of pregnancy complications across ethnic groups.</div></div><div><h3>Objective</h3><div>This study explores experiences, barriers, and improvements in postpartum CVRM from women’s and healthcare providers’ perspectives, aiming to enhance cardiovascular disease prevention in multi-ethnic contexts.</div></div><div><h3>Study Design</h3><div>We conducted semi-structured interviews with 25 postpartum women who experienced hypertensive disorders of pregnancy or gestational diabetes, recruited to reflect diverse ethnic and socioeconomic backgrounds. Using a narrative approach, interviews covered CVRM experiences and preferences. Themes were triangulated with findings from 16 healthcare providers, including general practitioners, midwives, and specialists, discussing care delivery, optimal practices, and multi-ethnic considerations. Results were integrated in a patient journey map.</div></div><div><h3>Results</h3><div>Significant dropout occurred at the transition from obstetric to primary care and during long-term monitoring, especially among ethnic minorities and women with lower socioeconomic status and disease severity. Women often lacked risk awareness and missed follow-ups when self-scheduling was required. Most supported tailored cardiovascular risk education, lifestyle interventions, and proactive outreach. Healthcare providers emphasized the need for interdisciplinary communication, regional protocols, and clearer guidelines, noting variability in general practitioners’ support for routine monitoring.</div></div><div><h3>Conclusion</h3><div>Postpartum CVRM in multi-ethnic contexts could be improved with active outreach, better follow-up utilization, culturally tailored interventions, and regional multidisciplinary protocols to streamline care and address guideline inconsistencies.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101203"},"PeriodicalIF":2.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.
Study design
We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.
Main outcome measures
Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.
Results
Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).
Conclusion
Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.
{"title":"A quality improvement intervention to optimize the management of severe hypertension during pregnancy and postpartum","authors":"Marie-Julie Trahan , Marianne Plourde , Ana Clouatre , Karen Wou , Antonina Pavilanis , Ruth-Lynn Fortune , Sabrina Haas , Jennifer Pepin , Sophia Kapellas , Anne-Maude Morency , Ginette Aucoin , Alexandria Flannery , Pierre-Olivier Monast , Noura Hassan , Maral Koolian , Thiphavone Oudanonh , Nisha Almeida , Eva Suarthana , Stella S. Daskalopoulou , Isabelle Malhamé","doi":"10.1016/j.preghy.2025.101192","DOIUrl":"10.1016/j.preghy.2025.101192","url":null,"abstract":"<div><h3>Objective</h3><div>Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.</div></div><div><h3>Study design</h3><div>We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.</div></div><div><h3>Main outcome measures</h3><div>Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.</div></div><div><h3>Results</h3><div>Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).</div></div><div><h3>Conclusion</h3><div>Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101192"},"PeriodicalIF":2.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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