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In the U.S., deaths due to pulmonary embolism (PE) account for 9.2% of all pregnancy-related deaths or approximately 1.5 deaths per 100,000 live births. Maternal deaths and maternal morbidity due to PE are more common among women who deliver by cesarean section. In the past decade, the clinical community has increasingly adopted venous thromboembolism (VTE) guidelines and thromboprophylaxis recommendations for pregnant women. Although deep vein thrombosis rates have decreased during this time-period, PE rates have remained relatively unchanged in pregnancy hospitalizations and as a cause of maternal mortality. Changes in the health profile of women who become pregnant, particularly due to maternal age and co-morbidities, needs more attention to better understand the impact of VTE risk during pregnancy and the postpartum period. [ABSTRACT FROM AUTHOR]

A history of preterm birth (PTB) may be an important lifetime risk factor for cardiovascular disease (CVD) in women. We identified all peer-reviewed journal articles that met study criteria (English language, human studies, female, and adults ≥19 years old), that were found in the PubMed/MEDLINE databases, and that were published between Jan. 1, 1995, and Sept. 17, 2012. We summarized 10 studies that assessed the association between having a history of PTB and subsequent CVD morbidity or death. Compared with women who had term deliveries, women with any history of PTB had increased risk of CVD morbidity (variously defined; adjusted hazard ratio [aHR] ranged from 1.2–2.9; 2 studies), ischemic heart disease (aHR, 1.3–2.1; 3 studies), stroke (aHR, 1.7; 1 study), and atherosclerosis (aHR, 4.1; 1 study). Four of 5 studies that examined death showed that women with a history of PTB have twice the risk of CVD death compared with women who had term births. Two studies reported statistically significant higher risk of CVD–related morbidity and death outcomes (variously defined) among women with ≥2 pregnancies that ended in PTBs compared with women who had at least 2 births but which ended in only 1 PTB. Future research is needed to understand the potential impact of enhanced monitoring of CVD risk factors in women with a history of PTB on risk of future CVD risk. [ABSTRACT FROM AUTHOR]

Background: The American Heart Association (AHA), Institute of Medicine (IOM), and US Departments of Health and Human Services and Agriculture (USDA) Dietary Guidelines for Americans all recommend that Americans limit sodium intake and choose foods that contain potassium to decrease the risk of hypertension and other adverse health outcomes. Objective: We estimated the distributions of usual daily sodium and potassium intakes by sociodemographic and health characteristics relative to current recommendations. Design: We used 24-h dietary recalls and other data from 12,581 adults aged ≥20 y who participated in NHANES in 2003-2008. Estimates of sodium and potassium intakes were adjusted for within- individual day-to-day variation by using measurement error models. SEs and 95% CIs were assessed by using jackknife replicate weights. Results: Overall, 99.4% (95% CI: 99.3%, 99.5%) of US adults consumed more sodium daily than recommended by the AHA (<1500 mg), and 90.7% (89.6%, 91.8%) consumed more than the IOM Tolerable Upper Intake Level (2300 mg). In US adults who are recommended by the Dietary Guidelines to further reduce sodium intake to 1500 mg/d (ie, African Americans aged ≥51 y or persons with hypertension, diabetes, or chronic kidney disease), 98.8% (98.4%, 99.2%) overall consumed >1500 mg/d, and 60.4% consumed >3000 mg/d-more than double the recommendation. Overall, <2% of US adults and ~5% of US men consumed ≥4700 mg K/d (ie, met recommendations for potassium). Conclusion: Regardless of recommendations or sociodemographic or health characteristics, the vast majority of US adults consume too much sodium and too little potassium. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of the present study were to determine whether an optimal low-density lipoprotein cholesterol (LDL-C) combined with hypertriglyceridemia was associated with cardiovascular disease (CVD) mortality and whether these associations differ by gender. Methods: A cohort of 2903 U.S. adults aged ≥45 years (men) and ≥55 years (women) at baseline (1988–1994) was followed through December 2006 for CVD mortality. Baseline data were collected through the Third National Health and Nutrition Examination Survey (NHANES III). The definitions of high LDL-C and high triglycerides (TG) (hypertriglyceridemia) levels were based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of death. Results: After adjusting for age, race/ethnicity, and traditional CVD risk factors, the risk of CVD death was approximately two times as high among women with optimal LDL-C/hypertriglyceridemia (2.42, 95% CI = 1.35–4.33) compared to women with optimal LDL-C/normal TG. In contrast, no significant difference was found among men on this comparison. Conclusions: Judging from this study, hypertriglyceridemia is associated with an increased risk of CVD mortality in women but not in men. The association is independent of abnormal LDL-C effect. [ABSTRACT FROM AUTHOR]

Abstract: Background: Small size at birth and in early childhood has been associated with impaired neurodevelopment in studies from developing countries, but few have examined associations with growth. Aims: The objective of this study was to assess the relationship between growth and neurodevelopment during early childhood (birth–36 months). Design: Multivariate regression models were used to analyze the data collected in the course of a study of pregnancy outcomes and early childhood growth and development carried out in rural Guatemala in 1991–1999. Motor and mental development scores were based on the Psychomotor and Mental Development Indices, respectively, derived from the administration of an adapted version of the Bayley Scales of Infant Development (Second Edition, 1993) at 6, 24 and 36 months. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and head circumference-for-age (HCZ) were used as indicators of attained size; changes in these Z-scores over time represent growth. Results: Birth size was significantly associated with child development at 6 and 24 months. Gains in length and weight during the first 24 months were positively associated with child development, whereas growth from 24 to 36 months age was not associated with child development at 36 months. Motor development was more strongly and consistently related to child growth than was mental development. Head circumference gain after 6 months was not a significant predictor of child development at 24 and 36 months. Conclusions: Small size at birth and poor physical growth during the first 24 months are related to neurodevelopmental delays. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent neurodevelopmental delay in early childhood. [Copyright &y& Elsevier]

The attainment of gross motor milestones is an important indicator of motor development in early life; however, little is known about factors affecting gross motor development in children from developing countries. The purpose of this study was to examine the relation of nutritional factors (physical growth and dietary intake) and morbidity during the first year of life to the age of walking without support. Multivariate regression models were used to analyze data collected prospectively between 1991 and 1999 in rural Guatemala. Attainment of children's gross motor milestones was assessed monthly by trained field workers using the 17-milestone Gross Motor Development Scale, morbidity was assessed by biweekly recall, and dietary intakes were measured at 9 and 12 mo of age using repeated 24-h dietary recalls. Median age of walking was 15 mo (range 10-24 mo; n = 174) with no differences by gender. Models were adjusted for birth order, gender, gestational age, maternal age and education, socioeconomic status, and community. Growth in length (-0.57 +/- 0.27 mo length for age Z-score; P = 0.04) and weight (-0.54 +/- 0.19 mo weight for age Z-score, P = 0.005) during the first year of life, rather than size at birth, predicted age of walking. Animal protein intake from complementary foods, while low (mean < 1 g/d) overall, was positively associated with earlier age of walking (P = 0.02). Morbidity during infancy was not associated with age of walking. These findings indicate the importance of prevention of postnatal growth retardation and improvement of diet quality for children's gross motor development. [ABSTRACT FROM AUTHOR]

Hypertension is a risk factor for cardiovascular disease, a leading cause of death among women of reproductive age (women aged 18–44 years). This study estimated hypertension prevalence and control among women of reproductive age at the national and state levels using electronic health record data. Nonpregnant women of reproductive age were included in this cross-sectional study using 2019 IQVIA Ambulatory Electronic Medical Records – U.S. national data (analyzed in 2023). Suspected hypertension was identified using any of these criteria: ≥1 hypertension diagnosis code, ≥2 blood pressure readings ≥140/90 mmHg on separate days, or ≥1 antihypertensive medication. Among women of reproductive age with hypertension, the latest blood pressure in 2019 was used to identify hypertension control (blood pressure <140/90 mmHg). Estimates were age standardized and stratified by race or Hispanic ethnicity, region, and states with sufficient data. Tukey tests compared estimates by race or Hispanic ethnicity, region, and comorbidities. Among 2,125,084 women of reproductive age (62.1% White, 8.8% Black, and 29.1% other [including Hispanic, Asian, other, or unknown]) with a mean age of 31.7 years, hypertension prevalence was 14.5%. Of those with hypertension, 71.9% had controlled blood pressure. Black women of reproductive age had a higher hypertension prevalence (22.3% vs 14.4%, p <0.05) but lower control (60.6% vs 74.0%, p <0.05) than White women of reproductive age. State-level hypertension prevalence ranged from 13.7% (Massachusetts) to 36% (Alabama), and control ranged from 82.9% (Kansas) to 59.2% (the District of Columbia). This study provides the first state-level estimates of hypertension control among women of reproductive age. Electronic health record data complements traditional hypertension surveillance data and provides further information for efforts to prevent and manage hypertension among women of reproductive age. [ABSTRACT FROM AUTHOR]

Background: Stroke, which is a rare but devastating event during pregnancy, occurs in 34 of every 100,000 deliveries; obstetricians are often the first providers to be contacted by symptomatic patients. At least one-half of pregnancy-related strokes are likely to be of the ischemic stroke subtype. Most pregnant or newly postpartum women with ischemic stroke do not receive acute stroke reperfusion therapy, although this is the recommended treatment for adults. Little is known about these therapies in pregnant or postpartum women because pregnancy has been an exclusion criterion for all reperfusion trials. Until recently, pregnancy and obstetric delivery were specifically identified as warnings to intravenous alteplase tissue plasminogen activator in Federal Drug Administration labeling.Objective: The primary study objective was to compare the characteristics and outcomes of pregnant or postpartum vs nonpregnant women with ischemic stroke who received acute reperfusion therapy.Study Design: Pregnant or postpartum (<6 weeks; n = 338) and nonpregnant (n = 24,303) women 18-44 years old with ischemic stroke from 1991 hospitals that participated in the American Heart Association's Get With the Guidelines-Stroke Registry from 2008-2013 were identified by medical history or International Classification of Diseases, Ninth Revision, codes. Acute stroke reperfusion therapy was defined as intravenous tissue plasminogen activator, catheter-based thrombolysis, or thrombectomy or any combination thereof. A sensitivity analysis was done on patients who received intravenous tissue plasminogen activator monotherapy only. Chi-square tests were used for categoric variables, and Wilcoxon Rank-Sum was used for continuous variables. Conditional logistic regression was used to assess the association of pregnancy with short-term outcomes.Results: Baseline characteristics of the pregnant or postpartum vs nonpregnant women with ischemic stroke revealed a younger group who, despite greater stroke severity, were less likely to have a history of hypertension or to arrive via emergency medical services. There were similar rates of acute stroke reperfusion therapy in the pregnant or postpartum vs nonpregnant women (11.8% vs 10.5%; P = .42). Pregnant or postpartum women were less likely to receive intravenous tissue plasminogen activator monotherapy (4.4% vs 7.9%; P = .03), primarily because of pregnancy and recent surgery. There was a trend toward increased symptomatic intracranial hemorrhage in the pregnant or postpartum patients who were treated with tissue plasminogen activator, yet no cases of major systemic bleeding or in-hospital death occurred, and there were similar rates of discharge to home. Data on the timing of pregnancy, which were available in 145 of 338 cases, showed that 44.8% of pregnancy-related strokes were antepartum, that 2.8% occurred during delivery, and that 52.4% were during the postpartum period.Conclusions: Using data from the Get With the Guidelines-Stroke Registry to assemble the largest cohort of pregnant or postpartum ischemic stroke patients who had been treated with reperfusion therapy, we observed that pregnant or postpartum women had similarly favorable short-term outcomes and equal rates of total reperfusion therapy to nonpregnant women, despite lower rates of intravenous tissue plasminogen activator use. Future studies should identify the characteristics of pregnant and postpartum ischemic stroke patients who are most likely to safely benefit from reperfusion therapy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine racial and ethnic disparities in severe maternal morbidity during delivery hospitalizations in the United States. Study Design: We identified delivery hospitalizations from 2008-2010 in State Inpatient Databases from 7 states. We used International Classification of Diseases, 9th Revision, codes to create severe maternal morbidity indicators during delivery hospitalizations. We calculated the rates of severe maternal morbidity that were measured with and without blood transfusion for 5 racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women. Poisson regression models were fitted to explore the associations between race/ethnicity and severe maternal morbidity after we controlled for potential confounders. Results: Overall, severe maternal morbidity rates that were measured with and without blood transfusion were 150.7 and 64.3 per 10,000 delivery hospitalizations, respectively. Non-Hispanic black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women had 2.1, 1.3, 1.2, and 1.7 times (all P < .05), respectively, higher rates of severe morbidity that were measured with blood transfusion compared with non-Hispanic white women; similar increased rates were observed when severe morbidity was measured without blood transfusion. Other significant positive predictors of severe morbidity were age <20 and ≥30 years, self-pay or Medicaid coverage for delivery, low socioeconomic status, and presence of chronic medical conditions. Conclusion: Severe maternal morbidity disproportionally affects racial/ethnic minority women, especially non-Hispanic black women. There is a need for a systematic review of severe maternal morbidities at the facility, state, and national levels to guide the development of quality improvement interventions to reduce the racial/ethnic disparities in severe maternal morbidity. [Copyright &y& Elsevier]

Objective: We sought to define the prevalence, trends, and outcomes of primary and secondary chronic hypertension in a population-based sample of deliveries. Study Design: An estimated 56,494,634 deliveries were identified from the 1995 through 2008 Nationwide Inpatient Sample. The association of primary and secondary chronic hypertension with adverse fetal and maternal outcomes was evaluated using regression modeling and adjusted population-attributable fractions were calculated. Results: During the study period, the prevalence of primary and secondary hypertension increased from 0.90% in 1995 through 1996 to 1.52% in 2007 through 2008 (P for trend < .001) and from 0.07% to 0.24% (P for trend < .001), respectively. The population-attributable fraction for chronic hypertension was considerable for many maternal adverse outcomes, including acute renal failure (21%), pulmonary edema (14%), preeclampsia (11%), and in-hospital mortality (10%). Conclusion: Primary and secondary chronic hypertension were both strongly associated with adverse pregnancy outcomes and accounted for a substantial fraction of maternal morbidity. Prioritizing research efforts in this area is needed. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to examine the trends in the rate of peripartum hysterectomy and the contribution of changes in maternal characteristics to these trends. Study Design: This was a cross-sectional study of peripartum hysterectomy identified from hospitalizations for delivery recorded in the 1994-2007 Nationwide Inpatient Sample. Results: The overall rate of peripartum hysterectomy increased by 15% during the study period. The rate of hysterectomy for abnormal placentation increased by 1.2-fold; adjustment for previous cesarean delivery explained nearly all of this increase. The rate of hysterectomy for uterine atony following repeat cesarean delivery increased nearly 4-fold, following primary cesarean delivery approximately 2.5-fold, and following vaginal delivery about 1.5-fold. This fast growing trend in peripartum hysterectomy secondary to uterine atony was also largely explained by increasing rates of primary and repeat cesareans. Conclusion: Rates of peripartum hysterectomy increased substantially in the United States from 1994 to 2007; much of this increase was due to rising rates of cesarean delivery. [ABSTRACT FROM AUTHOR]