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In this study, hospital discharge data from the 2016–2017 Healthcare Cost and Utilization Project were analyzed to describe national and, where data were available, state-specific prevalences of chronic hypertension and pregnancy-associated hypertension at delivery hospitalization. In 2016–2017, the prevalence of chronic hypertension was 216 per 10,000 delivery hospitalizations nationwide, ranging from 125 to 400 per 10,000 delivery hospitalizations in individual states. The prevalence of pregnancy-associated hypertension was 1021 per 10,000 delivery hospitalizations nationwide, ranging from 693 to 1382 per 10,000 delivery hospitalizations in individual states. The burden of hypertensive disorders in pregnancy remains high and varies considerably by jurisdiction.

Objective To examine the association between mid-pregnancy dietary patterns and pregnancy-associated hypertension (PAH). Design A prospective longitudinal cohort study. Setting Denmark. Population About 55 139 Danish women with single enrolments and recorded food frequency questionnaire dates with complete information on dietary intake. Methods Women were eligible if they could speak Danish and were planning to carry to term. Diet was assessed using a validated semi-quantitative 360-item food frequency questionnaire and dietary patterns were derived using factor analysis. Main outcome measures Gestational hypertension (GH) and pre-eclampsia (PE). Results Disease prevalence was 14% for GH (5491/39 362); 2% for PE (1168/54 778), and 0.4% for severe PE (234/55 086). Seven dietary patterns were characterised in the population, of which two were associated with PAH. The Seafood diet characterised by high consumption of fish and vegetables was inversely associated with the odds of developing GH [odds ratio (OR) 0.86; 95% CI 0.77-0.95)] and PE (OR 0.79; 95% CI 0.65-0.97). The Western diet characterised by high consumption of potatoes (including French fries), mixed meat, margarine and white bread increased the odds of developing GH (OR 1.18; 95% CI 1.05-1.33) and PE (OR 1.40; 95% CI 1.11-1.76). No association was seen with severe PE. Conclusions We found protective associations of Seafood diet and harmful associations of Western diet with PAH. Dietary interventions encouraging the reduction of Western diet may contribute to a decrease of PAH. Tweetable abstract Western diet increases (Seafood diet decreases) the likelihood of developing pre-eclampsia among Danish pregnant women.

Women in our cohort had significantly lower incidence of preeclampsia than the estimated global incidence, but consistent with findings from a retrospective cohort of approximately 250,000 urban Zambian women attending ANC, which reported 2.1% with PAH, defined as eclampsia, pre-eclampsia, hypertension, or elevated blood pressure (> 140/80 mmHg) at delivery.

Purpose To describe the incidence of pregnancy associated hypertension and eclampsia from adolescence through the fifth decade of life, including the effect of parity and race, in the United States. Methods Data were evaluated from the National Center for Health Statistics (vital statistics section). The data were stratified by maternal age group, parity (G1, first pregnancy; G2+, second or higher pregnancy), and racial group. Results The incidence of pregnancy associated hypertension (PAH) decreased with increased age in late adolescence in the G2+ group but not the G1 group (total and all racial groups). The incidence of PAH was significantly greater for non-Hispanic black or non-Hispanic white than Hispanic groups for all age groups ( P ⩽ .02) except age ⩽15 years (G2+ group) and 45–54 years (both G1 and G2+ groups). The incidence of eclampsia decreased with increased age in late adolescence in the G2+ group (total and all racial groups) and the G1 group (total and non-Hispanic black groups). The incidence of eclampsia was significantly greater for non-Hispanic black than non-Hispanic white and for non-Hispanic white than Hispanic groups for all age groups except age ⩽15 years in the G2+ group. The incidence of PAH and eclampsia increased substantially in both G1 and G2+ groups in the fifth decade of life (total and all racial groups). Conclusions The incidence of PAH (G2+ group) and eclampsia (G1 and G2+ groups) decreased with increased age during adolescence and increased in the fifth decade (G1 and G2+ groups).

Background: Impact of cardiac disease on pregnancy is significant. Impact of hypertension on pregnancy is also significant. “Does occurrence of hypertension along with cardiac disease worsen the outcomes?” forms the crux of this study. The aim of the present study was to determine the impact of pregnancy-associated hypertension on the clinical outcomes of pregnant patients with cardiac disease.Methods: Retrospective, observational, comparative, case control study of one and half year duration conducted in a tertiary care referral hospital. The various medical and obstetric parameters were studied and compared.Results: Among 143 patients studied, 36 were hypertensive and 107 were non-hypertensive. Non-severe hypertension was seen in 17%, severe hypertension in 4% and eclampsia in 4%. Average age was 26 years and majority were first or second gravida. Valvular heart disease was the most common cardiac disease encountered. Gestational age at delivery, perinatal outcome and occurrence of pulmonary hypertension were all similar in both the hypertensive and non-hypertensive groups. The most common mode of delivery was vaginal delivery. The cesarean section rate was 29% and was similar among both hypertensive and non-hypertensive groups. Requirement for induction of labor, occurrence of small-for- gestational age among the newborns, intensive care unit admission due to heart failure and maternal death was higher (statistically significant (p

To estimate the frequency of abnormal laboratory test results in pregnancy-associated hypertension and the relationship with pregnancy outcomes.This was a secondary analysis of a multicenter trial of vitamin C and E for prevention of pregnancy-associated hypertension in low-risk nulliparous women. Laboratory abnormalities included: platelets less than 100,000/mm, aspartate aminotransferase 100 units/L or greater, creatinine 1.5 mg/dL or greater, lactate dehydrogenase 600 units/L or greater, total bilirubin 1.2 mg/dL or greater, or evidence of hemolysis on peripheral smear. Mild pregnancy-associated hypertension was defined as blood pressure 140-159/90-109 mm Hg. Severe pregnancy-associated hypertension was defined as persistent blood pressure 160/110 mm Hg or greater, acute antihypertensive treatment, or any blood pressure elevation associated with clinical signs of end-organ dysfunction (one or more of headache, epigastric pain, blurred vision, pulmonary edema, eclampsia, or oliguria). Pregnancy outcomes were compared across four groups: I, mild hypertension alone; II, mild hypertension+abnormal laboratory values; III, severe pregnancy-associated hypertension alone; and IV, severe pregnancy-associated hypertension+abnormal laboratory values.Of 9,969 women, 2,752 (27.9%) developed pregnancy-associated hypertension and of these, laboratory abnormalities occurred in 7.3%. Laboratory abnormalities increased with severity of hypertension: mild hypertension alone (4.9%), severe hypertension alone (8.9%), and mild or severe hypertension with clinical signs of end-organ dysfunction (12.2%) (P for trend.001). Compared with women with mild hypertension alone, the adjusted odds for the perinatal composite (2-fold to 4.8-fold in Category III-IV), preterm birth (2.1-fold to 7.8-fold in Category II-IV), and other adverse perinatal outcomes increase with disease severity, particularly with laboratory abnormalities and severe clinical signs.The frequency of abnormal laboratory values in women with pregnancy-associated hypertension increases with disease severity. Adverse perinatal outcomes increase in the presence of abnormal laboratory values, particularly in those with clinical signs, likely atttributable in part to the decision to deliver early.

Erythrocyte intracellular sodium [Na]i and potassium [K]i concentrations, maximum specific ouabain binding (OBmax), and Na+, K+ ATPase-dependent (ouabain-sensitive) rubidium influx (OSRb influx) were measured in women with pregnancy-associated hypertension (P-AH, pre-eclampsia) and compared with values for normotensive women in the third trimester of pregnancy.OBmax was significantly lower in women with P-AH compared with normotensive pregnant women, with a trend to higher [Na]i. There was a significant (p < 0.001) inverse relationship between OBmax and [Na]i. Although mean values for ouabain-sensitive rubidium influx in buffer were slightly lower in women with P-AH, this difference was not statistically significant. Lowest values were observed in women with proteinuric P-AH. There was no inhibition of OSRb influx by homologous plasma in groups of women with any severity of P-AH. Such inhibition was seen only in normotensive women with peripheral oedema.P-AH is associated with an abnormality of cellular N...

because of contractions was performed at 32/6 weeks of gestation. A viable 1840 g female infant with Apgar scores of 8, 8 and 9 and umbilical artery pH 7.32 was delivered. At the time of delivery, approximately 600 mL of fresh blood gushed from the uterine incision before amniotomy. The total estimated blood loss from the surgery was 500 mL. The mother had an unremarkable postoperative course and was discharged in stable condition on postpartum day 8. The neoanate was admitted to the neonatal intensive care unit for prematurity and respiratory distress syndrome.

Montgomery AA, Fahey T, Peters TJ. A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract 2003;53:446–53. [OpenUrl][1][Abstract/FREE Full Text][2] Q Do simple or complex decision aids assist patients with newly diagnosed hypertension in deciding whether to start drug treatment? ### ![Graphic][3] Design: randomised controlled 2 x 2 factorial trial. ### ![Graphic][4] Allocation: concealed. ### ![Graphic][5] Blinding: unblinded. ### ![Graphic][6] Follow up period: 2 weeks and 3 months. ### ![Graphic][7] Setting: 21 general practices in Avon, UK. ### ![Graphic][8] Patients: 217 patients aged 30–80 years (mean age 58 y, 52% men) who had sustained high blood pressure (BP) requiring discussion of drug treatment with a general practitioner and were not taking antihypertensive medication. Exclusion criteria: severe hypertension requiring immediate treatment, secondary hypertension, pregnancy associated hypertension, inability to understand English, and dementia or learning difficulties. ### ![Graphic][9] Interventions: decision analysis (computerised utility assessment interview with individualised risk assessment and decision analysis) (n = 103) or no decision analysis (n = 114) and an information video plus leaflet (n = 106) or no video plus leaflet (n = 111). Interventions lasted 1 hour. ### ![Graphic][10] Outcomes: degree of uncertainty about treatment course of action (total score on the 16 item Decisional Conflict Scale … [1]: {openurl}?query=rft.jtitle%253DBritish%2BJournal%2Bof%2BGeneral%2BPractise%26rft.stitle%253Dbjgp%26rft.issn%253D0960-1643%26rft.aulast%253DMontgomery%26rft.auinit1%253DA.%2BA.%26rft.volume%253D53%26rft.issue%253D491%26rft.spage%253D446%26rft.epage%253D453%26rft.atitle%253DA%2Bfactorial%2Brandomised%2Bcontrolled%2Btrial%2Bof%2Bdecision%2Banalysis%2Band%2Ban%2Binformation%2Bvideo%2Bplus%2Bleaflet%2Bfor%2Bnewly%2Bdiagnosed%2Bhypertensive%2Bpatients.%26rft_id%253Dinfo%253Apmid%252F12939889%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bjgp&resid=53/491/446&atom=%2Febnurs%2F7%2F1%2F17.atom [3]: /embed/inline-graphic-1.gif [4]: /embed/inline-graphic-2.gif [5]: /embed/inline-graphic-3.gif [6]: /embed/inline-graphic-4.gif [7]: /embed/inline-graphic-5.gif [8]: /embed/inline-graphic-6.gif [9]: /embed/inline-graphic-7.gif [10]: /embed/inline-graphic-8.gif

Intravenous diazoxide was given to 8 patients with severe pregnancy-associated hypertension (diastolic pressure greater than or equal to 110) in the antepartum period. Maternal hypertension was rapidly controlled in all patients; the diastolic blood pressure fell to less than or equal to 100 in all patients and to less than or equal to 85 in 7. Diazoxide had no significant effect on the basal fetal heart rate (FHR) or on the latency period or amplitude of late decelerations in the 3 patients with abnormal (positive) stress cardiotocographs (SCTG) and abnormal (unreactive) non-stress cardiotocographs (NSCTG). In the 5 patients with reactive NSCTGs, diazoxide had no significant effect on the basal FHR or on the frequency of fetal movement-induced FHR accelerations. Thus, diazoxide did not adversely affect fetal well-being in these patients with severe pregnancy-associated hypertension as assessed by cardiotocography.

The majority of infants being delivered in the British Military Hospital, Hong Kong are of British, Chinese or Nepalese origin. This paper compares perinatal data from these three groups of mothers and their babies, and in particular looks at the variations in perinatal mortality rates over the 10 year period 1976-1985. Mortality among the British babies has declined in a way similar to many areas of Britain. The Chinese have a very low perinatal mortality rate probably due to fewer preterm, multiple and abnormal births, but mortality has increased over the last 10 years and there is evidence that the rise may be due to changes in maternal health. The incidence of pregnancy associated hypertension has increased threefold among the Chinese. The Nepalese have a perinatal mortality similar to that of the British, much lower than that expected had they delivered in Nepal, and this probably reflects the application of modern obstetric care to these mothers. In all groups there has been a rise in instrumental deliveries but this is most marked among the Chinese in whom there has also been a significant increase in infants with low apgar scores. The Nepalese have the lowest incidence of forceps and operative deliveries and possible reasons for these differences are discussed.

SUMMARY 1. Capillary permeability (CP) is elevated in late normal pregnancy, when compared to postpartum values. 2. In women with pregnancy associated hypertension (PAH), pregnancy CP levels are not different from postpartum and are less than in normal pregnancy. 3. These changes in capillary permeability are not explained by alterations in serum albumin.

The effect of an isotonic saline infusion on urinary sodium excretion and plasma renin activity (PRA) has been studied in 11 normotensive patients with a previous history of pregnancy-associated hypertension. The results have been compared with a group of controls matched for age, sex and parity. The results demonstrate an exaggerated natriuresis and a suppressed PRA response in the patients with a previous history or pregnancy-associated hypertension which is similar to those reported in patients with established 'essential' hypertension.

82 initially normotensive pregnant women with no known history of renal disease were seen at monthly intervals from 16 weeks' amenorrhoea onwards, and their blood-pressure (B.P.) was measured sitting and lying on their left side. 15 developed hypertension (B.P. greater than 135/85 mm Hg lying on the left side) in late pregnancy. When these women were compared with the 67 who remained normotensive throughout, their B.P.s were found to be significantly higher even in early pregnancy, although individual patients were not always separable in this way. When B.P. measured in this rigidly standardised manner was compared with routine antenatal clinic values, it was apparent that the latter did not detect the difference between the two groups. Women who develop hypertension in the third trimester of pregnancy (pre-eclampsia) may represent a separate group from entirely normal pregnant women from the beginning of pregnancy.

A 24-year-old patient was treated using hypnotic intervention for acute pregnancy-associated hypertension. The patient displayed evidence of secondary arrest of labor and acute onset of signs and symptoms of pre-eclampsia. Hypnotic intervention resulted in normal vaginal delivery without complications or further evidence of morbidity secondary to a hypertensive episode. Hypnosis as an adjunct in the treatment of pre-eclampsia should be investigated further.

The role of plasma volume in hypertension in pregnancy (pre-eclampsia) was investigated. Significant volume expansion from non-pregnant levels (16.5 +/- 1.60 ml/cm height) was present throughout pregnancy in 189 normal women, reaching 23.1 +/- 1.21 ml/cm at 33-36 weeks amenorrhoea. In another 40 initially normotensive pregnant women who developed hypertension, similar early volume expansion was followed by significant volume contraction in the third trimester, before evaluation of blood pressure in 29 (20.6 +/- 1.26 ml/cm), after it in 11 (18.6 +/- 1.27 ml/cm). Equivalent volume contraction was present in another 44 women studied only after hypertension developed in the third trimester. Oedema had no value as a clinical sign. In another 30 women with chronic hypertension, blood pressure was inversely related to plasma volume (r = 0.822) and to fetal growth (r = -0.710), which was directly related to plasma volume (r = 0.701). Plasma volume depletion plays a significant role in hypertension in pregnancy.

1. Because hypertension is the central feature of pre-eclampsia, and because plasma renin activity is known to be elevated in normal pregnancy (with conflicting results published for pre-eclampsia), a prospective study of plasma renin activity was conducted in pregnancy, under conditions of a fixed sodium intake, in 178 initially normotensive volunteer subjects. Thirty of these women developed pregnancy-associated hypertension (pre-eclampsia) in the third trimester. 2. There was a significant elevation of plasma renin activity from the published values for non-pregnant women, throughout gestation in normotensive women. There was no significant difference, at any stage of gestation, between the values for normal women and those who developed pregnancy-associated hypertension. 3. The extent of cryoactivation of renin, produced by usual collection procedures, was investigated in a subgroup of the total population. It was highly significant and quite variable, but was similar in those who developed pregnancy-associated hypertension and in normal pregnant women. The mean increase in plasma renin concentration in maximally cryoactivated samples was 16-fold. 4. Neither measurement of peripheral plasma renin activity nor of cryoactivatable plasma renin concentration is of value in distinguishing between normal pregnant women and those destined for, or with pregnancy-associated, hypertension.

Corticosteroid binding globulin (CBG) was purified by one step positive immunospecific affinity chromatography and antibody to human CBG produced in goats. The goat anti-human CBG was used in the development of a precise rocket immunoelectrophoresis for CBG quantification. CBG levels measured by this assay were found to increase from 30 AU/ml to 100 AU/ml during pregnancy. There was no statistically significant association observed between levels of CBG, or circulating estriol, or pregnancy zone protein. Circulating CBG was estimated in 32 women with pregnancy associated hypertension, the levels were all within the normal range, and not significantly different from those seen in matched controls.

Atenolol was compared with placebo in a randomised and double-blind prospective study of 120 women with mild to moderate pregnancy-associated hypertension who were also initially managed conventionally by bed rest. Atenolol given once daily significantly reduced blood-pressure, prevented proteinuria, and reduced the number of hospital admissions. Loss of blood-pressure control leading to withdrawal from the study was commoner among the placebo group, whose babies had a high morbidity. Respiratory distress syndrome occurred only in the placebo group. Intrauterine growth retardation, neonatal hypoglycaemia, and hyperbilirubinaemia occurred with the same frequency in the two groups. Neonatal bradycardia was more common after atenolol but the systolic blood-pressure of the babies was the same in both groups. There was no difference between the groups in maternal symptoms which could have been attributed to beta-blocker therapy. Thus atenolol is more effective than conventional obstetric management in this form of hypertension and does not adversely affect mother or baby.

One hundred primigravidae had a 'roll-over test' between 28 and 32 weeks of gestation. Of the 10 women with positive results (a rise of greater than or equal to 20 mmHg in diastolic blood pressure after roll-over) only two later developed diastolic blood pressures greater than 90 mmHg. Of the 90 patients with a negative result, 17 subsequently sustained diastolic pressures of greater than 90 mmHg. The change in plasma noradrenaline levels measured before and after roll-over, in all patients, did not distinguish between those patients who remained normotensive and those who subsequently developed hypertension. At 28-32 weeks gestation, those patients who subsequently developed hypertension had a higher mean plasma noradrenaline level and a higher systolic blood pressure than the patients who remained normotensive.