Pub Date : 2025-01-14DOI: 10.1016/j.preghy.2025.101188
Lisa du Toit , Ifeoma Offiah , Alvaro Redondo-Rio , Tanya Kahawita , Michele Kiernan , Yen Ming Lin , Louise Belfield , Gemma Montagut , Alicia Benavente , Tomas Nicholas , Amazon Doble , Renske Dikkers , Robert Freeman , Toni Gabaldón , Zoe Brookes , Raul Bescos
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.
{"title":"A pilot and feasibility study investigating the abundance and activity of nitrate-reducing bacteria in women with pre-eclampsia","authors":"Lisa du Toit , Ifeoma Offiah , Alvaro Redondo-Rio , Tanya Kahawita , Michele Kiernan , Yen Ming Lin , Louise Belfield , Gemma Montagut , Alicia Benavente , Tomas Nicholas , Amazon Doble , Renske Dikkers , Robert Freeman , Toni Gabaldón , Zoe Brookes , Raul Bescos","doi":"10.1016/j.preghy.2025.101188","DOIUrl":"10.1016/j.preghy.2025.101188","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Higher plaque levels were observed in the PET group compared to the CN group (<em>P</em> = 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 (<em>P</em> = 0.088) and salivary nitrite levels (<em>P</em> = 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 (<em>P</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101188"},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014608","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 : 2025-01-10DOI: 10.1016/j.preghy.2024.101183
Kavia Khosla , Yue Jin , Jimmy Espinoza , Matthew Kent , Mikael Gencay , Liza H. Kunz , Ariel Mueller , Yan Xiao , W. Frank Peacock , Sean-Xavier Neath , Jennifer J. Stuart , Douglas Woelkers , James M. Harris , Sarosh Rana
{"title":"Response to the Letter to the Editor: “Signs or symptoms of suspected preeclampsia – A retrospective National database study of prevalence, costs, and outcomes”","authors":"Kavia Khosla , Yue Jin , Jimmy Espinoza , Matthew Kent , Mikael Gencay , Liza H. Kunz , Ariel Mueller , Yan Xiao , W. Frank Peacock , Sean-Xavier Neath , Jennifer J. Stuart , Douglas Woelkers , James M. Harris , Sarosh Rana","doi":"10.1016/j.preghy.2024.101183","DOIUrl":"10.1016/j.preghy.2024.101183","url":null,"abstract":"","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101183"},"PeriodicalIF":2.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972858","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 : 2025-01-10DOI: 10.1016/j.preghy.2024.101184
Jesús A. Velásquez , Ana M. Solorzano , Santiago Guerrero
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.
{"title":"High prevalence of neuroimaging abnormalities in eclampsia: Justifying the routine use of non-contrast CT in resource-limited settings","authors":"Jesús A. Velásquez , Ana M. Solorzano , Santiago Guerrero","doi":"10.1016/j.preghy.2024.101184","DOIUrl":"10.1016/j.preghy.2024.101184","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Main outcome measures</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101184"},"PeriodicalIF":2.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966772","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 : 2025-01-10DOI: 10.1016/j.preghy.2025.101189
Raina Advani , R. Shree , Catherine M. Albright , Suchitra Chandrasekaran
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.
{"title":"Smaller decrease in late second trimester blood pressure is associated with gestational hypertensive disease development","authors":"Raina Advani , R. Shree , Catherine M. Albright , Suchitra Chandrasekaran","doi":"10.1016/j.preghy.2025.101189","DOIUrl":"10.1016/j.preghy.2025.101189","url":null,"abstract":"<div><h3>Objectives</h3><div>We investigated whether a smaller reduction in 2nd trimester blood pressure (BP) is associated with the development of gestational hypertensive disease.</div></div><div><h3>Study Design</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>(p < 0.01)</em>, DBP <em>(p < 0.01)</em>, and MAP <em>(p < 0.01)</em>. Those with GHDP compared to those without GHDP had a significantly smaller decrease between 1st and 2nd trimester SBP (<em>−1.7 ± 12.3 vs −2.9 ± 11.8, p < 0.001</em>) and MAP <em>(−2.1 ± 8.4 vs −2.7 ± 7.9, p = 0.01</em>). Those with GHDP compared to those without GHDP had a smaller DBP decrease but it was not statistically significant (<em>−2.3 ± 8.7 vs −2.7 ± 8.2, p = 0.19).</em></div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101189"},"PeriodicalIF":2.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966775","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 : 2025-01-09DOI: 10.1016/j.preghy.2025.101187
Hedia Zitouni , Vera Chayeb , Nozha Raguema , Marwa Ben Ali Gannoun , Sameh Bendhaher , Ines Zouari , Fulin Liu , Kamel Gaddour , Touhami Mahjoub , Jean Guibourdenche , Wassim Y Almawi
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.
{"title":"Association of MTHFR C677T and A1298C variants with preeclampsia risk and angiogenic imbalance in Tunisian women","authors":"Hedia Zitouni , Vera Chayeb , Nozha Raguema , Marwa Ben Ali Gannoun , Sameh Bendhaher , Ines Zouari , Fulin Liu , Kamel Gaddour , Touhami Mahjoub , Jean Guibourdenche , Wassim Y Almawi","doi":"10.1016/j.preghy.2025.101187","DOIUrl":"10.1016/j.preghy.2025.101187","url":null,"abstract":"<div><div>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 <em>MTHFR</em> gene with PE in different ethnic groups, but with mixed outcomes.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 <em>MTHFR</em> 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 (<em>P</em> = 0.03) in PE cases compared to controls, which persisted for C677/C1298, but not T677/C1298 after controlling for key covariates.</div></div><div><h3>Discussion</h3><div>Our results support an association between <em>MTHFR</em> polymorphisms and increased risk of PE, and an imbalance of PE-associated sFLT-1/PlGF.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101187"},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966770","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 : 2025-01-08DOI: 10.1016/j.preghy.2024.101182
I. Mesters , J.P.M.M. Willemse , P. van Montfort , L.J.E. Meertens , J. Kruitwagen , L.J.M. Smits , H.C.J. Scheepers
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.
目的：本研究评估补钙作为钙摄入不足孕妇预防措施的有效性，检查每日推荐摄入量1000 mg的依从性，并确定影响因素。方法：一项调查（Expect队列II， n = 823）评估了孕妇的钙依从性，随后对16名有目的地选择的参与者进行了访谈。对逐字记录进行独立分析，以确定关键主题。结果：在调查参与者中，82%的人讨论了钙摄入的重要性，83%的人表示有意改善钙摄入。在接受钙质咨询的人群中，48%的人摄入不足，而没有接受咨询的人群中，这一比例为64%。促进因素包括安全感、母亲保护儿童安全的动机、对专业人员的信任、支持性环境和意识的提高。障碍包括缺乏对钙来源的了解、药片剂量、内在动机低、信息理解能力和建议的新颖性。结论：尽管通过咨询提高了人们的认识，但只有一半的女性达到了足够的钙水平，访谈显示了解有限。明确钙的益处，消除对潜在危害的担忧，并提供具体的指导，可以提高钙的摄入量。反复的建议和加大宣传力度可以使孕期钙摄入正常化并提高可接受性。
{"title":"Barriers and facilitators for adequate calcium intake during pregnancy: A mixed methods study","authors":"I. Mesters , J.P.M.M. Willemse , P. van Montfort , L.J.E. Meertens , J. Kruitwagen , L.J.M. Smits , H.C.J. Scheepers","doi":"10.1016/j.preghy.2024.101182","DOIUrl":"10.1016/j.preghy.2024.101182","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101182"},"PeriodicalIF":2.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957273","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 : 2024-12-24DOI: 10.1016/j.preghy.2024.101181
Hannah T Y Wang , Yichi Zhang , Rivani Porwal , James M. Kemper , Alston G.J. Ong , Ben W. Mol , Daniel L. Rolnik
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.
目的：在过去的几十年里，关于先兆子痫的随机对照试验（rct）越来越多。我们调查了1987年至2021年间的子痫前期随机对照试验，并报告了其可信度、偏倚风险、p值、透明度和有用性。方法：我们在PubMed检索1987年至2021年间标题中包含“先兆子痫”或“妊娠高血压疾病”的rct。我们创建了一个透明度、可信度和有用性清单，并记录了p值报告的特征、RCT特征（包括注册、发表期刊和结果）。结果：我们发现202项随机对照试验，作者中位数从1987年的4位增加到2021年的12位。试验注册从1987-2010年的17/93增加到2011-2021年的79/109，增加了近7倍。2010-2021年间，在摘要中发表了338个p值，非显著p值上升（显著vs非显著：214/338,63% vs 124/338, 37%）。发表的效应量增加了58%，从1987-2010年的659个增加到2011-2021年的1038个。1987-1991年和2017-2021年期间，随机对照试验的透明度和有用性综合得分中位数从6分（满分13分）提高到9分。从可信度检查表来看，充分登记的试验表现最差（43/ 202,21 %）。大多数rct均存在报告偏倚、表现偏倚和检测偏倚的风险（分别为166/202、82%、131/202、65%和141/202、70%）。结论：2010年强制性试验注册后，报告的非显著p值和效应量增加，同时大多数试验的透明度和可信度提高。随机对照试验需要更加透明、可信和有用，以增加研究的价值。
{"title":"Transparency, trustworthiness and usefulness in pre-eclampsia randomised controlled trials in the last three decades","authors":"Hannah T Y Wang , Yichi Zhang , Rivani Porwal , James M. Kemper , Alston G.J. Ong , Ben W. Mol , Daniel L. Rolnik","doi":"10.1016/j.preghy.2024.101181","DOIUrl":"10.1016/j.preghy.2024.101181","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101181"},"PeriodicalIF":2.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899496","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 : 2024-12-21DOI: 10.1016/j.preghy.2024.101180
Easha Patel , Courtney Bisson , Sunitha Suresh , Ariel Mueller , Colleen Duncan , Sajid Shahul , Ernst Lengyel , Sarosh Rana
Objective
To describe postpartum visit attendance and postpartum blood pressure control among patients enrolled in a remote patient monitoring program and compare these outcomes by race.
Study design
A prospective cohort study of postpartum patients with a diagnosis of hypertensive disorders of pregnancy at the University of Chicago between October 2021 and April 2022. All patients received remote patient monitoring as routine care but consented separately for the use of their data. Data were obtained from the electronic medical record for up to six weeks postpartum.
Main outcome measures
The primary outcome was attendance at the first postpartum blood pressure check visit. Secondary outcomes included postpartum blood pressure control, readmissions, and remote patient monitoring response rates. Outcomes were compared by patient-reported race.
Results
545 patients were enrolled in the remote patient monitoring program, of which 306 consented to data collection. 64.7% of patients identified as Black/African American. Attendance for first postpartum blood pressure check was high (overall 84.0%, Black 81.3% and non-Black 88.9%, p = 0.08). The rate of Stage 2 hypertension at six weeks was higher among Black patients than non-Black patients (22.4% vs 2.2%, p < 0.0001). Engagement with remote patient monitoring decreased over the 6-week period, with more attrition among Black patients.
Conclusion
There was a high follow-up rate across all patients regardless of race and a decrease in hypertension over the six-week period. However, rates of hypertension were higher, and engagement with the program lower in Black patients, suggesting further work is needed to address this gap.
目的：描述参加远程患者监测项目的患者的产后就诊率和产后血压控制情况，并按种族比较这些结果。研究设计：对芝加哥大学2021年10月至2022年4月期间诊断为妊娠期高血压疾病的产后患者进行前瞻性队列研究。所有患者接受远程患者监护作为常规护理，但单独同意使用其数据。数据从产后6周的电子病历中获得。主要结局指标：主要结局指标为首次产后血压检查的出勤率。次要结局包括产后血压控制、再入院和远程患者监测反应率。结果根据患者报告的种族进行比较。结果：545例患者参加了患者远程监护项目，其中306例患者同意收集数据。64.7%的患者为黑人/非裔美国人。产后首次血压检查的出勤率较高（总体为84.0%，黑人为81.3%，非黑人为88.9%,p = 0.08）。黑人患者6周时2期高血压的发生率高于非黑人患者（22.4% vs 2.2%, p）。结论：在所有患者中，不论种族，随访率都很高，并且在6周期间高血压有所下降。然而，黑人患者的高血压率更高，参与该计划的人数更少，这表明需要进一步的工作来解决这一差距。
{"title":"Systematic treatment and management of postpartum hypertension using remote patient monitoring","authors":"Easha Patel , Courtney Bisson , Sunitha Suresh , Ariel Mueller , Colleen Duncan , Sajid Shahul , Ernst Lengyel , Sarosh Rana","doi":"10.1016/j.preghy.2024.101180","DOIUrl":"10.1016/j.preghy.2024.101180","url":null,"abstract":"<div><h3>Objective</h3><div>To describe postpartum visit attendance and postpartum blood pressure control among patients enrolled in a remote patient monitoring program and compare these outcomes by race.</div></div><div><h3>Study design</h3><div>A prospective cohort study of postpartum patients with a diagnosis of hypertensive disorders of pregnancy at the University of Chicago between October 2021 and April 2022. All patients received remote patient monitoring as routine care but consented separately for the use of their data. Data were obtained from the electronic medical record for up to six weeks postpartum.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was attendance at the first postpartum blood pressure check visit. Secondary outcomes included postpartum blood pressure control, readmissions, and remote patient monitoring response rates. Outcomes were compared by patient-reported race.</div></div><div><h3>Results</h3><div>545 patients were enrolled in the remote patient monitoring program, of which 306 consented to data collection. 64.7% of patients identified as Black/African American. Attendance for first postpartum blood pressure check was high (overall 84.0%, Black 81.3% and non-Black 88.9%, p = 0.08). The rate of Stage 2 hypertension at six weeks was higher among Black patients than non-Black patients (22.4% vs 2.2%, p < 0.0001). Engagement with remote patient monitoring decreased over the 6-week period, with more attrition among Black patients.</div></div><div><h3>Conclusion</h3><div>There was a high follow-up rate across all patients regardless of race and a decrease in hypertension over the six-week period. However, rates of hypertension were higher, and engagement with the program lower in Black patients, suggesting further work is needed to address this gap.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101180"},"PeriodicalIF":2.5,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878231","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 : 2024-12-12DOI: 10.1016/j.preghy.2024.101176
Ramsha Naeem , Mahima Khatri , Satesh Kumar
{"title":"Letter to the editor: Signs or symptoms of suspected preeclampsia – A retrospective national database study of prevalence, costs, and outcomes","authors":"Ramsha Naeem , Mahima Khatri , Satesh Kumar","doi":"10.1016/j.preghy.2024.101176","DOIUrl":"10.1016/j.preghy.2024.101176","url":null,"abstract":"","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101176"},"PeriodicalIF":2.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819746","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 : 2024-12-11DOI: 10.1016/j.preghy.2024.101173
Blake Neuburg , Meghan Gallagher , Melodee Liegl , Amy Y Pan , Anna Palatnik
Objective
To compare maternal 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.
目的：比较门诊和住院治疗诊断为妊娠期高血压或无严重特征的子痫前期患者的孕产妇和新生儿结局。材料与方法：本研究为单中心、回顾性、队列研究，纳入2014年1月至2022年3月妊娠37周前高血压妊娠障碍（HDP）患者。病人被分类到住院或门诊管理在他们的产科医生的自由裁量权。最初表现为严重特征的患者被排除在外。采用双变量和多变量分析比较主要结局、由21种CDC孕产妇发病率标识符中的一种或多种定义的严重孕产妇发病率（SMM），以及产妇ICU入院、严重特征发展、胎盘早拆、从诊断到分娩时间、早产等次要结局。结果：共有272例患者符合纳入标准，其中门诊229例（84.2%），住院43例（15.8%）。在单因素分析中，门诊管理与较低的SMM发生率、从诊断HDP到分娩的间隔时间增加、出现严重特征的间隔时间增加以及产妇入住ICU的发生率降低相关。在多因素分析中，门诊管理仍然与SMM的低发生率（aOR 0.18, 95% CI 0.05-0.59）和新生儿结局的改善有关，5分钟APGAR评分低于7 （aOR 0.32, 95% CI 0.13-0.82）、低出生体重（aOR 0.37, 95% CI 0.17-0.79）和早产（aOR 0.31, 95% CI 0.15-0.67）的发生率较低。结论：HDP的门诊管理与较低的SMM率和不良的孕产妇和新生儿结局有关。虽然并非所有的混杂因素都被测量，但关于HDP管理设置的临床决策与良好的诊断能力相关。
{"title":"Inpatient versus outpatient management of gestational hypertension or preeclampsia without severe features","authors":"Blake Neuburg , Meghan Gallagher , Melodee Liegl , Amy Y Pan , Anna Palatnik","doi":"10.1016/j.preghy.2024.101173","DOIUrl":"10.1016/j.preghy.2024.101173","url":null,"abstract":"<div><h3>Objective</h3><div>To compare<!--> <!-->maternal and neonatal outcomes in patients diagnosed with gestational hypertension or preeclampsia without severe features by outpatient versus inpatient management.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101173"},"PeriodicalIF":2.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814275","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}
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