Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health最新文献_第3页

Smaller decrease in late second trimester blood pressure is associated with gestational hypertensive disease development 妊娠中期晚期血压下降幅度较小与妊娠期高血压疾病的发展有关。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2025-01-10 DOI: 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.

目的：我们研究妊娠中期血压（BP）下降幅度较小是否与妊娠期高血压疾病的发生有关。研究设计：我们利用一家城市安全网医院的临床数据库进行了一项回顾性队列研究。年龄在18-40岁的单胎妊娠和孕早期产前护理的个体被包括在内。排除慢性高血压患者。计算收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）下降。结局变量，妊娠期高血压病（GHDP）包括妊娠期高血压和先兆子痫，伴有或不伴有严重特征。结果：N = 3355例符合纳入标准的个体中，18%患有GHDP。孕早期和妊娠中期的平均胎龄分别为9.8±2.1和23.5±2.3周。与没有GHDP的孕妇相比，有GHDP的孕妇妊娠早期平均收缩压明显更高(p)。结论：收缩压和MAP下降较小的孕妇更有可能发生GHDP。孕中期生理性血压下降减少可能提示潜在的血管失调。未来有必要利用无创血流动力学监测来研究妊娠中期血压下降的生物学机制。

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引用次数: 0

Association of MTHFR C677T and A1298C variants with preeclampsia risk and angiogenic imbalance in Tunisian women 突尼斯妇女MTHFR C677T和A1298C变异与子痫前期风险和血管生成失衡的关系

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2025-01-09 DOI: 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.

子痫前期（PE）是一种与内皮功能障碍、高血压和蛋白尿相关的妊娠特异性血管疾病。亚甲基四氢叶酸还原酶（MTHFR）通过对叶酸代谢和DNA甲基化的影响来调节妊娠期细胞的基本功能。先前的研究表明rs1801133 (C677T；Ala222Val)和rs1801131 (A1298C；gl429ala)在MTHFR基因中的表达与PE在不同种族中存在差异，但结果不一。方法：研究病例包括675名突尼斯孕妇，其中350名PE表现为PE，其余325名血压正常的妇女作为对照。采用实时荧光定量PCR对C677T和A1298C变异进行基因分型。结果：经关键协变量调整后，子痫前期病例与对照组C677T、A1298C的次要等位基因频率差异无统计学意义。此外，MTHFR C677T和A1298C小等位基因纯合子基因型在PE病例中的患病率明显较高。在调整了主要协变量后，1298C/C与PE的相关性仍然存在，而677T/T与PE无关。携带（次要的）677T等位基因与BMI略微升高、血清sFlt-1水平显著升高、sFlt-1/PlGF比值中位数和sFlt-1/PlGF比值≥85相关。以主要等位基因纯合子（C677/A1298）为参照，单倍型分析显示，PE病例中C677/C1298和T677/C1298的单倍型发生率高于对照组（P = 0.03），在控制关键协变量后，C677/C1298的单倍型持续存在，T677/C1298的单倍型不存在。讨论：我们的研究结果支持MTHFR多态性与PE风险增加以及PE相关的sFLT-1/PlGF失衡之间的关联。

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引用次数: 0

Barriers and facilitators for adequate calcium intake during pregnancy: A mixed methods study 怀孕期间摄入充足钙的障碍和促进因素：一项混合方法研究。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2025-01-08 DOI: 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。

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引用次数: 0

Transparency, trustworthiness and usefulness in pre-eclampsia randomised controlled trials in the last three decades 过去三十年子痫前期随机对照试验的透明度、可信度和有效性。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-24 DOI: 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。

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引用次数: 0

Systematic treatment and management of postpartum hypertension using remote patient monitoring 产后高血压远程监护的系统治疗与管理。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-21 DOI: 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}

引用次数: 0

Letter to the editor: Signs or symptoms of suspected preeclampsia – A retrospective national database study of prevalence, costs, and outcomes 致编辑的信：疑似子痫前期的体征或症状--关于患病率、费用和结果的全国性回顾性数据库研究。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-12 DOI: 10.1016/j.preghy.2024.101176

Ramsha Naeem , Mahima Khatri , Satesh Kumar

引用次数: 0

Inpatient versus outpatient management of gestational hypertension or preeclampsia without severe features 无严重特征的妊娠高血压或先兆子痫的住院与门诊管理。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-11 DOI: 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。

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引用次数: 0

Glycosylated fibronectin as a biomarker for preeclampsia and preeclampsia-related complications 糖基化纤维连接蛋白作为子痫前期和子痫前期相关并发症的生物标志物。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-10 DOI: 10.1016/j.preghy.2024.101177

Anna C.M. Kluivers , Rugina I. Neuman , Bhanu Kalra , Ajay Kumar , Willy Visser , A.H. Jan Danser , Langeza Saleh

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.

目的：评估糖基化纤维连接蛋白（GlyFn）作为子痫前期和子痫前期相关并发症的新型生物标志物，并将GlyFn与传统生物标志物（包括可溶性fms样酪氨酸激酶-1 （sFlt-1）和胎盘生长因子（PlGF））进行比较。研究设计：对疑似子痫前期（对照组）、妊娠期高血压（GH）或确诊子痫前期/溶血、肝酶升高和低血小板综合征（PE/HELLP）的前瞻性队列研究（n = 524）进行二次分析。主要结局指标：PE/HELLP患者与对照组和GH患者的GlyFn水平。它与子痫前期相关并发症的关联，以及它在结合胎龄、蛋白尿、胎次和血压的传统模型之上的附加价值。所有glyfn相关性能与sFlt-1和PlGF的比较。结果：与对照组相比，GH和PE/ help患者的GlyFn水平显著升高。值得注意的是，GlyFn与sFlt-1和sFlt-1/PlGF比值呈正相关，与PlGF呈负相关。GlyFn在预测母体并发症而非胎儿并发症方面优于传统模型。在sFlt-1、PlGF及其比值中也观察到这种模式。GlyFn与传统模型结合，可提高产妇并发症的c指数。然而，当将GlyFn/PlGF比例添加到传统模型中时，在整个队列中预测胎儿并发症的结果最好。结论：GlyFn是一种新的PE诊断及其并发症的生物标志物，特别是GA

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引用次数: 0

Effectiveness of calcium supplementation in the prevention of gestational hypertension: A systematic review and meta-analysis of randomised controlled trials 补钙预防妊娠期高血压的有效性：随机对照试验的系统回顾和荟萃分析

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-01 DOI: 10.1016/j.preghy.2024.101174

Qing Zhu, Qin Yu, Mengyao Liu, Yongqing Wei

Background

Gestational hypertension and related disorders, such as preeclampsia, pose significant risks to maternal and foetal health. Calcium supplementation has been proposed as a preventive measure, but its effectiveness remains debated. This review assess the impact of calcium supplementation in prevention of gestational hypertension.

Methods

A comprehensive literature search was conducted across multiple databases, including Scopus, EMBASE, PubMed, Web of Science, CINAHL, Cochrane CENTRAL, from inception to July 2024. Eligibility criteria included studies involving pregnant women at risk of gestational hypertension, comparing calcium supplementation to control group, and reporting on outcomes such as preeclampsia, pregnancy-induced hypertension, HELLP syndrome, preterm birth, and maternal mortality. Data were analysed using a random-effects inverse-variance model to calculate pooled risk ratios (RRs) and assess heterogeneity using Cochran’s Q and I2 statistics. Publication bias was evaluated using funnel plots and Egger’s test.

Results

22 studies with 39,270 individuals were included. Most studies had higher risk of bias. Calcium supplementation significantly reduced the risk of preeclampsia (pooled RR = 0.606, 95 %CI: 0.483–0.761, p < 0.001) and pregnancy-induced hypertension (pooled RR = 0.870, 95 %CI: 0.759–0.996, p = 0.044). However, it showed no significant effect on HELLP syndrome, preterm birth, or mortality. Heterogeneity was moderate to substantial across outcomes, and publication bias was detected for preterm birth and pregnancy-induced hypertension.

Conclusion

Calcium supplementation during pregnancy significantly reduces the risk of preeclampsia and pregnancy-induced hypertension, highlighting its value as a cost-effective intervention for improving maternal health. These findings support integrating calcium supplementation into prenatal care strategies, particularly for populations with low dietary calcium intake.

背景：妊娠期高血压及相关疾病，如先兆子痫，对母婴健康构成重大风险。补钙作为一种预防措施已被提出，但其有效性仍存在争议。本综述评估补钙对预防妊娠期高血压的影响。方法对Scopus、EMBASE、PubMed、Web of Science、CINAHL、Cochrane CENTRAL等数据库自成立至2024年7月进行综合文献检索。入选标准包括有妊娠高血压风险的孕妇，比较补钙与对照组的差异，报告子痫前期、妊娠高血压、HELLP综合征、早产和孕产妇死亡率等结局。数据分析采用随机效应反方差模型计算合并风险比（rr），并采用Cochran’s Q和I2统计量评估异质性。采用漏斗图和Egger检验评价发表偏倚。结果共纳入22项研究，共39,270人。大多数研究有较高的偏倚风险。补钙显著降低先兆子痫的风险(合并RR = 0.606, 95% CI: 0.483-0.761, p <；0.001)和妊娠高血压（合并RR = 0.870, 95% CI: 0.759-0.996, p = 0.044）。然而，它对HELLP综合征、早产或死亡率没有显著影响。结果的异质性为中度至重度，在早产和妊娠高血压中发现了发表偏倚。结论妊娠期补钙可显著降低子痫前期和妊高征的发生风险，是改善孕产妇健康的一种经济有效的干预措施。这些发现支持将钙补充纳入产前护理策略，特别是对于饮食钙摄入量低的人群。

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引用次数: 0

Aspirin resistance in pregnancy is associated with reduced interleukin-2 concentration in maternal serum: A letter 妊娠期阿司匹林抵抗与母体血清白细胞介素-2浓度降低有关：一个字母。

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health

Pub Date : 2024-12-01 DOI: 10.1016/j.preghy.2024.101175

Avir Sarkar, Kritika Singh, Madhav Raheja, Prathamesh Lanjewar

引用次数: 0