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Aim: We examined the heart failure biomarker mid‐regional pro‐atrial natriuretic peptide during the first trimester of pregnancy in relation to early‐onset preeclampsia <34 weeks. Materials and Methods: This case–control study included 34 women with singleton pregnancies with a preeclampsia diagnosis and delivery before 34 weeks of gestation who had attended the routine first‐trimester ultrasound scan at 11–13+6 weeks of gestation between August 2010 and October 2015 at the Copenhagen University Hospital Rigshospitalet, Denmark, and 91 uncomplicated singleton pregnancies matched by time of the routine first‐trimester blood sampling at 8–13+6 weeks. Descriptive statistical analyses were performed for maternal characteristics and obstetric and medical history for the case versus the control group. Concentrations of mid‐regional pro‐atrial natriuretic peptide, placental growth factor, soluble fms‐like tyrosine kinase‐1, and pregnancy‐associated plasma protein A between early‐onset preeclampsia cases and the control group were compared using Students t‐test and the Mann–Whitney U test. Biochemical marker concentrations were converted into multiples of the expected median values after adjustment for gestational age. Results: Mid‐regional pro‐atrial natriuretic peptide levels were not significantly different between early‐onset preeclampsia cases and the control group in the first trimester of pregnancy. As expected, both placental growth factor and pregnancy‐associated plasma protein A levels were significantly lower in early‐onset preeclampsia, whereas soluble fms‐like tyrosine kinase‐1 levels were not statistically significantly different. Conclusion: The maternal first‐trimester concentration of mid‐regional pro‐atrial natriuretic peptide, a peptide with multiple biological functions including a relation to cardiovascular disease, was not significantly different in women with early‐onset preeclampsia. [ABSTRACT FROM AUTHOR]

Objectives: To explore the impact of anti‐hypertensive treatment of pregnancy‐induced hypertension on foetal growth and hemodynamics in women with pre‐existing diabetes. Methods: A prospective cohort study of 247 consecutive pregnant women with pre‐existing diabetes (152 type 1 diabetes; 95 type 2 diabetes), where tight anti‐hypertensive treatment was initiated and intensified (mainly with methyldopa) when office blood pressure (BP) ≥135/85 mmHg and home BP ≥130/80 mmHg. Foetal growth was assessed by ultrasound at 27, 33 and 36 weeks and foetal hemodynamics were assessed by ultrasound Doppler before and 1–2 weeks after initiation of anti‐hypertensive treatment. Results: In 215 initially normotensive women, anti‐hypertensive treatment for pregnancy‐induced hypertensive disorders was initiated in 42 (20%), whilst 173 were left untreated. Chronic hypertension was present in 32 (13%). Anti‐hypertensive treatment for pregnancy‐induced hypertensive disorders was not associated with foetal growth deviation (linear mixed model, p = 0.681). At 27 weeks, mainly before initiation of anti‐hypertensive treatment, the prevalence of small foetuses with an estimated foetal weight <10th percentile was 12% in women initiating anti‐hypertensive treatment compared with 4% in untreated women (p = 0.054). These numbers were close to the prevalence of birth weight ≤10th percentile (small for gestational age (SGA)) (17% vs. 4%, p = 0.003). Pulsatility index in the umbilical and middle cerebral artery remained stable after the onset of anti‐hypertensive treatment in a representative subgroup (n = 12, p = 0.941 and p = 0.799, respectively). Conclusion: There is no clear indication that antihypertensive treatment causes harm in this particular at‐high‐risk group of pregnant women with diabetes, such that a larger well‐designed study to determine the value of tight antihypertensive control would be worthwhile. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to assess the incidence, the prenatal detection rate by ultrasound, and the pregnancy outcome of spina bifida (SB) in Denmark (DK) in 2008–2015 and to compare results to national data from Sweden. Methods. Data were retrieved from the Danish Fetal Medicine Database, which includes International Classification of Diseases- (ICD-) 10 codes for pre- or postnatally diagnoses and pregnancy outcome. Missing data were obtained from the National Patient Register. Livebirth data with myelomeningocele (MMC) in Sweden were obtained from different databases. Results. There were 234 cases with SB in DK in 2008–2015. The incidence of SB was 4.9 : 10,000; 89% were detected with ultrasound prior to week 22; 90% of these pregnancies were terminated (ToP); 91% were isolated malformations of which 11% showed abnormal karyotype. The incidence of newborns with MMC was 1.3 : 10,000 in Sweden. Conclusions. Ultrasound screening has a major impact on the epidemiology of SB. The prenatal detection rate of SB was high, and most SB cases were isolated and had a normal karyotype. Among women with a prenatal fetal diagnosis of SB, 90% chose to have ToP. The incidence of newborns with SB was higher in Sweden than in DK. [ABSTRACT FROM AUTHOR]

Objective: To study the possible associations between advanced maternal age and risk of selected adverse pregnancy outcomes.Methods: The study used a nationwide cohort of 369,516 singleton pregnancies in Denmark followed from 11-14 weeks of gestation to delivery or termination of pregnancy. Pregnant women aged 35 years or older were divided into two advanced maternal age groups, 35-39 years and 40 years or older, and compared with pregnant women aged 20-34 years. Adverse pregnancy outcomes were chromosomal abnormalities, congenital malformations, miscarriage, stillbirth, and birth before 34 weeks of gestation. Multivariable logistic regression analyses were performed to investigate associations between advanced maternal age and adverse pregnancy outcomes. Furthermore, a risk prediction model for a composite adverse pregnancy outcome was made with prespecified predicting factors.Results: Among the pregnant women aged 40 years or older, 10.82% experienced one or more of the selected adverse pregnancy outcomes compared with 5.46% of pregnant women aged 20-34 years (odds ratio [OR] 2.02, 99.8% CI 1.78-2.29). When pregnant women 40 years or older were compared with women aged 20-34 years, they had a higher risk of chromosomal abnormalities (3.83% vs 0.56%, OR 7.44 [CI 5.93-9.34]), miscarriage (1.68% vs 0.42%, OR 3.10 [CI 2.19-4.38]), and birth before 34 weeks of gestation (2.01% vs 1.21%, OR 1.66 [CI 1.23-2.24]), but no increased risk of congenital malformations and stillbirth. The risk prediction chart showed that advanced maternal age, use of assisted reproductive technology, nulliparous pregnancy, smoking during pregnancy, and obesity increased the absolute predictive risk of an adverse pregnancy outcome.Conclusion: Women older than 40 years have a higher risk of chromosomal abnormalities, miscarriage, and birth before 34 weeks of gestation than younger women and should be monitored accordingly. No increased risk was observed for stillbirth and other congenital malformations. Several factors increase the risk of adverse pregnancy outcomes, but advanced maternal age drives a high proportion of the total risk score. [ABSTRACT FROM AUTHOR]