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AbstractA low eGFRcystatin C/eGFRcreatinine-ratio is characteristic of a group of serious kidney disorders called ‘Selective Glomerular Hypofiltration Syndromes’. This study examines if such a low ratio can also be used to evaluate the risk for women with hypertensive disorders in pregnancy to develop severe maternal morbidity. All women discharged from the perinatal ward at the Skåne University Hospital in Lund during the period of 1-9-2016 to 31-8-2017 under one of the diagnoses within hypertensive disorders in pregnancy were considered for inclusion in the study. After delivery and discharge from the hospital, records from included patients were reviewed and all registered measures of renal function were analysed. An eGFRcystatin C/eGFRcreatinine-ratio ≤0.60 in a sample drawn not earlier than three days before delivery was considered as defining a high risk for severe maternal morbidity. A strong association (p-value: 0.035) between severe maternal morbidity and an eGFRcystatin C/eGFRcreatinine-ratio ≤0.60 was found in a subgroup of 32 women diagnosed with ‘preeclampsia with severe features’. A total of 69 women were included in the study. Fifty were defined as high-risk and seventeen of them (34%) developed severe maternal morbidity. Among the nineteen women defined as low-risk only two (10.5%) developed severe maternal morbidity (p-value: 0.051). A low eGFRcystatin C/eGFRcreatinine-ratio seems promising as a predictive marker for maternal morbidity in hypertension in pregnancy. Its performance as a tool in the monitoring of progressing disease should be evaluated further in larger cohorts. Delivery before the eGFRcystatin C/eGFRcreatinine-ratio decreases to, or below, 0.60 might help avoid maternal complications. [ABSTRACT FROM AUTHOR]

Background: Gestational Hypertension is defined as blood pressure level of ≥140/90 mmHg recorded on two different occasions measured at 4-6hours interval between each measurement at ≥20weeks of gestation. Hypertension at <20weeks is called as Chronic hypertension. The rise in systolic and diastolic blood pressure is critical in determining whether or not someone has Gestational Hypertension. Gestational Hypertension with proteinuria is called Preeclampsia and Preeclampsia associated with seizures is called eclampsia. Materials and Methods: A total of 70 pregnant women who presented to Sree Mookambika institute of medical sciences hospital with Gestational Hypertension were enrolled using the following inclusion and exclusion criteria. Inclusion criteria: Women with ≥20 weeks of gestation(primi/multigravida) and with blood pressure recording of ≥140/90 mmHg, diagnosed as gestational hypertension and are willing to participate in this study. Exclusion criteria: Women with <20 weeks of gestation, chronic hypertensives, antenatal women without any comorbidities and those who are not willing to participate in this study. Results: Gestational hypertension was more prevalent among nulliparous 40(57. 1%). Out of 30 multiparous women,13(43. 3%)have past history of gestational hypertension,7(23. 3%)had previous preterm delivery and 21(70%)had previous lower segment caesarean section. The clinical presentation in mothers with gestational hypertension shows that 32(45. 7%)had epigastric pain and 15(21. 4%)had vomiting followed by headache, dizziness, edema of feet, blurring of vision 10(14. 2%),convulsion 2(2. 8%)and no complaint 11(15. 7%). Conclusion: Gestational hypertension is a frequent medical condition that occurs during pregnancy. We discovered that gestational hypertension is more common in young nulliparous women of 19-24years of age. Gestational hypertension causes a variety of clinical manifestations which can help in early diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP). Design: Cross‐sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD‐4‐QED) between September 2019 and August 2020. Setting: Fifty‐four referral level facilities in Nigeria. Population: Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery. Methods: Descriptive statistics and multilevel mixed‐effects logistic regression models. Main Outcome Measures: Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes. Results: Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82–2.12; p < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06–1.32; p = 0.002), primary level of education (OR 1.20, 95% CI 1.03–1.4; p < 0.002), nulliparity (OR 1.21, 95% CI 1.12–1.31; p < 0.001), grand‐multiparity (OR 1.36, 95%CI 1.21–1.52; p < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15–1.38; p < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13–1.31; p < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders. Conclusions: Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one‐quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are poor with about a quarter developing complications and about 1 in 10 having stillbirths. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP). Subjects and Methods: The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age. Results: Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73–1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45–0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49–0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58–0.98). Conclusions: Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old. [ABSTRACT FROM AUTHOR]

Hypertensive disorders in pregnancy (HDP) are the most prevalent diseases during pregnancy. In addition to the already identified risk factors, exposure to environmental contaminants has been also considered a new one. Phthalates, which are classified as priority environmental pollutants due to their ubiquitousness and endocrine disrupting properties, have been implicated in HDP in some epidemiological studies. Nevertheless, phthalates' vascular impacts still need to be clarified. Thus, we aimed to understand the connection between phthalates exposure and the occurrence of gestational hypertension, as well as the pathway involved in the pathological vascular effects. We investigated diethyl phthalate's (DEP) effect on the vascular reactivity of the human umbilical arteries (HUAs) from normotensive and hypertensive pregnant women. Both DEP's nongenomic (within minutes effect) and genomic (24 h exposure to DEP) actions were evaluated, as well as the contribution of cyclic guanosine monophosphate and Ca2+ channel pathways. The results show that short-term exposure to DEP interferes with serotonin and histamine receptors, while after prolonged exposure, DEP seems to share the same vasorelaxant mechanism as estrogens, through the NO/sGC/cGMP/PKG signaling pathway, and to interfere with the L-type Ca2+ channels. Thus, the vascular effect induced by DEP is similar to that observed in HUA from hypertensive pregnancies, demonstrating that the development of HDP may be a consequence of DEP exposure. [ABSTRACT FROM AUTHOR]

Introduction. In obstetrics, hypertensive disorders of pregnancy (HDP) including preeclampsia (РЕ) are one of the primary causes resulting in critical cases and maternal mortality. HDP prediction is a milestone that allows preventing complications as well as reducing the number of most common relevant complications of pregnancy. Existing algorithms that predict PE risk distribute the risks in such a way that a considerable number of patients fall into the category of false negative results, and, consequently, receive no timely prevention and proper follow-up. In particular, this cohort usually consists of patients with borderline high risks, who may be designated as a medium risk group or located in a “gray” zone. Aim: to develop a prognostic model for risk stratification in female patients with borderline to high developing PE risk based on combined first-trimester screening. Materials and Methods. A prospective comparative study included 1089 female patients who underwent a combined screening at 11–14 weeks of gestation. Group 1 consisted of female patients at high РЕ risk (1:100 and greater), while female patients at moderate risk (1:101–1:250) and low risk (below 1:250) were included into Group 2 and Group 3, respectively. All pregnant women underwent examination including assessed anamnestic, general clinical and laboratory data, mean blood pressure (BP), uterine artery pulsatility index, serum level of human chorionic gonadotropin beta-subunits (β-hCG), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A). Results. An impact of various factors on risk of developing hypertensive disorders in pregnancy was assessed by binary logistic regression by identifying most significant among them and generating a statistical prediction model – the prognostic index of hypertensive disorders in pregnancy. The latter included: obstetric history, body mass index, PlGF, mean ВР, and alanine aminotransferase level. The sensitivity and specificity comprised 91.2 and 53.6 %, respectively, and the method effectivenesswas 81.8 %. Conclusion. The method proposed for HDP prediction is a second-line approach that may be used in clinical practice to stratify patients with borderline high risk of developing PE.

Hypertensive disorders in pregnancy (HDP) are the most prevalent diseases during pregnancy. In addition to the already identified risk factors, exposure to environmental contaminants has been also considered a new one. Phthalates, which are classified as priority environmental pollutants due to their ubiquitousness and endocrine disrupting properties, have been implicated in HDP in some epidemiological studies. Nevertheless, phthalates’ vascular impacts still need to be clarified. Thus, we aimed to understand the connection between phthalates exposure and the occurrence of gestational hypertension, as well as the pathway involved in the pathological vascular effects. We investigated diethyl phthalate’s (DEP) effect on the vascular reactivity of the human umbilical arteries (HUAs) from normotensive and hypertensive pregnant women. Both DEP’s nongenomic (within minutes effect) and genomic (24 h exposure to DEP) actions were evaluated, as well as the contribution of cyclic guanosine monophosphate and Ca2+ channel pathways. The results show that short-term exposure to DEP interferes with serotonin and histamine receptors, while after prolonged exposure, DEP seems to share the same vasorelaxant mechanism as estrogens, through the NO/sGC/cGMP/PKG signaling pathway, and to interfere with the L-type Ca2+ channels. Thus, the vascular effect induced by DEP is similar to that observed in HUA from hypertensive pregnancies, demonstrating that the development of HDP may be a consequence of DEP exposure.

Background: Numerous observational studies have investigated the potential link between hypertensive disorders of pregnancy (HDPs) and the subsequent risks of gynecologic tumors, yet the findings have been inconsistent. In this study, we utilized Mendelian randomization (MR) approach to assess the influence of HDPs on the future risks of ovarian, cervical, endometrial, and breast cancer and uterine fibroids, controlling for confounding factors. Methods: The genome‐wide association studies (GWAS) summary data relevant to HDPs was obtained from the FinnGen databases (10,736 cases and 136,325 controls). Gynecologic tumor outcomes were extracted from the IEU Open GWAS project and UK Biobank (47,690 cases and 1, 092,073 controls). The inverse variance weighted (IVW) approach was selected as the principal method for MR analysis, supplemented by MR‐Egger, weighted median, weighted model, simple model methods, MR pleiotropy residual sum and outlier (MR‐PRESSO) test, and leave‐one‐out method. Multivariate MR (MVMR) analysis was conducted after adjusting systolic blood pressure (SBP), body mass index (BMI) and type 2 diabetes mellitus (T2DM). Results: Our univariate MR analysis (UVMR) results revealed no significant relationship between HDPs and the risks of ovarian cancer (odds ratio [OR] = 0.924, p = 0.360), cervical cancer (OR = 1.230, p = 0.738), endometrial cancer (OR = 1.006, p = 0.949), uterine fibroids (OR = 1.155, p = 0.158), and breast cancer (OR = 0.792, p = 0.241) by IVW test. Similar results were observed in gestational hypertension and preeclampsia/eclampsia. Additionally, our study detected neither heterogeneity nor pleiotropy. MVMR analysis also provided no evidence of a causal association between HDPs and common gynecologic tumors after adjusting SBP, BMI, and T2DM. Conclusion: We discovered no causal relationship between HDPs and ovarian, cervical, endometrial, breast cancer, and uterine fibroids in European populations. However, present analysis did not explore the effect of HDPs on the subtypes of gynecologic tumors across varied ethnic populations, which may require additional research. [ABSTRACT FROM AUTHOR]

Preeclampsia is one of the most common disorders that poses threat to both mothers and neonates and amajor contributor to perinatal morbidity and mortality worldwide. Viral infection during pregnancy is not typically considered to cause preeclampsia; however, syndromic nature of preeclampsia etiology and the immunomodulatory effects of viral infections suggest that microbes could trigger a subset of preeclampsia. Notably, SARS-CoV-2 infection is associated with an increased risk of preeclampsia. Herein, we review the potential role of viral infections in this great obstetrical syndrome. According to in vitro and in vivo experimental studies, viral infections can cause preeclampsia by introducing poor placentation, syncytiotrophoblast stress, and/or maternal systemic inflammation, which are all known to play a critical role in the development of preeclampsia.Moreover, clinical and experimental investigations have suggested a link between several viruses and the onset of preeclampsia via multiple pathways. However, the results of experimental and clinical research are not always consistent. Therefore, future studies should investigate the causal link between viral infections and preeclampsia to elucidate the mechanism behind this relationship and the etiology of preeclampsia itself. [ABSTRACT FROM AUTHOR]

Hypertensive disorders in pregnancy (HDP) are a group of conditions--including chronic hypertension, gestational hypertension, preeclampsia with and without end-organ damage, and acute complications, which include HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and eclampsia--that could lead to severely adverse outcomes for both mother and fetus. The incidence of HDP has increased, affecting one out of seven delivery hospitalizations. Physicians should be aware of HDP for early identification and proper treatment to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background Elevated dyslipidemia during pregnancy can adversely affect maternal and child health. It not only increases the risk of preeclampsia, gestational diabetes mellitus (GDM) , hypertriglyceridemic pancreatitis, late abortion, premature delivery and macrosomia, but also significantly increases the risk of postnatal cardiovascular disease. Objective To analyze the distributional characteristics of dyslipidemia in the first, second and third trimesters of pregnancy and the predictive value of early lipid levels for dyslipidemia in the second and third trimesters of pregnancy. Methods This was a single-center retrospective study, which included singleton pregnant women who were enrolled in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to June 2019 for obstetrics checkups until delivery. Clinical data and lipid data [total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) ] were collected in the first, second and third trimesters of pregnancy. The reference range of lipids in department of obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University was used as the diagnostic standard for dyslipidemia, including high total cholesterolemia, high triacylglycerolemia, low HDL-cholesterolemia and high LDL-cholesterolemia. The correlation between lipid levels in the first trimester of pregnancy and dyslipidemia in the second and third trimesters of pregnancy was analyzed by using binary Logistic regression, and the receiver operating characteristics (ROC) curves of the subjects were plotted to obtain the area under ROC curve (AUC) , to evaluate the predictive value of the lipid levels in the first trimester of pregnancy for dyslipidemia in the second and third trimesters of pregnancy, and to determine the optimal cut-off value according to the sensitivity and specificity. Results A total of 8 511 singleton pregnant women were included in the study, with an average age of (31.7±3.9) years and an average pre-pregnancy BMI of (21.7±3.2) kg/m2. Among them, 988 (11.6%) were of low pre-pregnancy body mass, 5 568 (65.4%) were of normal pre-pregnancy body mass, 1 271 (14.9%) were overweight, 366 (4.3%) were obese, 1 415 (16.7%) were with GDM, and 650 (7.6%) were with hypertensive disorders of pregnancy (HDP) . The levels of TC, TG and LDL-C in the second and third trimesters of pregnancy were higher than those in the first trimester of pregnancy (P0.05) . The prevalence of dyslipidemia in first and second trimesters of pregnancy in the GDM group was higher than that in the non-GDM group, and the prevalence of dyslipidemia in first, second and third trimesters of pregnancy in HDP group was higher than the non-HDP group (P

Objective: To investigate the relationship between serum vascular endothelial growth factor (VEGF), soluble Fms-like tyrosine kinase-1 (s Flt-1) and interleukin-4 (IL-4) levels and the classification and pregnancy outcome of patients with hypertensive disorders of pregnancy (HDP). Methods: A total of 204 patients with HDP admitted to our hospital from July 2019 to January 2021 (HDP group) were selected and divided into pregnancy induced hypertension group (n=88), pre-eclampsia group (n=66), and eclampsia group (n=50) according to the guideline classification, and divided into poor outcome group and good outcome group according to the pregnancy outcome, and another 100 healthy pregnant women who delivered in our hospital during the same period were selected as the control group. Univariate and multivariate Logistic regression and receiver working characteristics (ROC) curves were used to analyze the influence factors of adverse pregnancy outcomes in HDP patients and the predictive value of serum VEGF, s Flt-1 and IL-4 levels. Results: Compared with the control group, the levels of serum VEGF and IL-4 in the HDP group decreased, the level of s Flt-1 increased (P＜0.05). Serum VEGF and IL-4 levels decreased and s Flt-1 levels increased sequentially in the gestational hypertension, preeclampsia and eclampsia groups (P＜0.05). The incidence of adverse pregnancy outcomes in 204 HDP patients was 29.90% (61/204). Single factor analysis showed, poor pregnancy outcomes were associated with age, classification of disease, SBP, DBP, urinary protein, VEGF, s Flt-1,and IL-4 (P＜0.05). Multifactorial logistic regression analysis showed that eclampsia and elevated s Flt-1 were independent risk factors for poor pregnancy outcome in HDP patients, and elevated VEGF and IL-4 were independent protective factors (P＜0.05). The area under the curve (AUC) for predicting adverse pregnancy outcomes in HDP patients with serum VEGF, s Flt-1, and IL-4 levels alone and in combination were 0.766, 0.774, 0.770 and 0.905, respectively and the AUC for poor pregnancy outcomes in HDP patients of the combination of VEGF, s Flt-1, and IL-4 predicts was the highest. Conclusions: Decreased serum VEGF and IL-4 levels and increased s Flt-1 levels in HDP patients are associated with HDP classification and poor pregnancy outcome, and the combination of VEGF, s Flt-1, and IL-4 has a high predictive value for poor pregnancy outcome in HDP patients. [ABSTRACT FROM AUTHOR]

Introduction: Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. Methods: This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case–control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. Results: A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors. Conclusion: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings. [ABSTRACT FROM AUTHOR]

Background: There have been few studies reporting on maternal and neonatal events in high‐risk pregnant women receiving medications for preventing hypertensive disorders of pregnancy (HDP). Objective: To identify placental abruption, postpartum hemorrhage, neonatal intraventricular hemorrhage, and neonates with small for gestational age (SGA) or growth restriction resulting from medications for preventing HDP in high‐risk pregnant women using a network meta‐analysis. Search strategy: All randomized controlled trials comparing the most commonly used medications (antiplatelet agents, anticoagulants, antioxidants, nitric oxide, and calcium) for preventing HDP in high‐risk pregnant women were searched from the Cochrane Pregnancy and Childbirth's Specialized Register of Controlled Trials until July 31, 2020, without language restriction. Selection criteria: Two of the authors independently selected the eligible trials. Data collection and analysis: Two authors independently extracted the data and assessed the methodological quality of the included trials. Pairwise and network meta‐analyses were used to determine comparative risk ratios and 95% confidence intervals. Main results: The 51 included trials involved 69 669 pregnant women. Compared with placebo/no treatment, antioxidants slightly reduced placental abruption with high‐certainty evidence. Antiplatelet agents probably reduced SGA with low‐certainty evidence and slightly increased neonatal intraventricular hemorrhage with moderate‐certainty evidence. Conclusion: Antiplatelet agents probably reduce SGA, but neonatal intraventricular hemorrhage should be monitored. Systematic review registration: PROSPERO, CRD42018096276. Synopsis: Antiplatelet agents administered for preventing hypertengefosive disorders of pregnancy probably reduce small for gestational age in neonates, but the women should be closely monitored for neonatal intraventricular hemorrhage. [ABSTRACT FROM AUTHOR]

Abstract Background Numerous observational studies have investigated the potential link between hypertensive disorders of pregnancy (HDPs) and the subsequent risks of gynecologic tumors, yet the findings have been inconsistent. In this study, we utilized Mendelian randomization (MR) approach to assess the influence of HDPs on the future risks of ovarian, cervical, endometrial, and breast cancer and uterine fibroids, controlling for confounding factors. Methods The genome‐wide association studies (GWAS) summary data relevant to HDPs was obtained from the FinnGen databases (10,736 cases and 136,325 controls). Gynecologic tumor outcomes were extracted from the IEU Open GWAS project and UK Biobank (47,690 cases and 1, 092,073 controls). The inverse variance weighted (IVW) approach was selected as the principal method for MR analysis, supplemented by MR‐Egger, weighted median, weighted model, simple model methods, MR pleiotropy residual sum and outlier (MR‐PRESSO) test, and leave‐one‐out method. Multivariate MR (MVMR) analysis was conducted after adjusting systolic blood pressure (SBP), body mass index (BMI) and type 2 diabetes mellitus (T2DM). Results Our univariate MR analysis (UVMR) results revealed no significant relationship between HDPs and the risks of ovarian cancer (odds ratio [OR] = 0.924, p = 0.360), cervical cancer (OR = 1.230, p = 0.738), endometrial cancer (OR = 1.006, p = 0.949), uterine fibroids (OR = 1.155, p = 0.158), and breast cancer (OR = 0.792, p = 0.241) by IVW test. Similar results were observed in gestational hypertension and preeclampsia/eclampsia. Additionally, our study detected neither heterogeneity nor pleiotropy. MVMR analysis also provided no evidence of a causal association between HDPs and common gynecologic tumors after adjusting SBP, BMI, and T2DM. Conclusion We discovered no causal relationship between HDPs and ovarian, cervical, endometrial, breast cancer, and uterine fibroids in European populations. However, present analysis did not explore the effect of HDPs on the subtypes of gynecologic tumors across varied ethnic populations, which may require additional research.

BackgroundIt is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors.ObjectiveThis study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality.Study designThis was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions.ResultsWe enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32-2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25-2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17-3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99-2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99-5.49) and 6.26 (95% confidence interval, 4.35-9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63-2.86; risk ratio, 2.53; 95% confidence interval, 1.44-4.45; and risk ratio, 2.84; 95% confidence interval, 1.67-4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32-2.35), 2.07 (95% confidence interval, 1.20-3.57), and 2.77 (95% confidence interval, 1.66-4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios.ConclusionCOVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.

ABSTRACTBackground: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal mortality and morbidity. Recent studies indicated that pregnant women are the most vulnerable populations to ambient temperature influences, but it affected HDP with inconsistent conclusions. Our objective is to systematically review whether extreme temperature exposure is associated with a changed risk for HDP. Method: We searched PubMed, EMBASE, Web of Science and Cochrane Library databases. We included cohort or case control studies examining the association between extreme temperature exposure before or during pregnancy and HDP. Heat sources such as saunas and hot baths were excluded. We pooled the odds ratio (OR) to assess the association between extreme temperature exposure and preeclampsia or eclampsia. Results: Fifteen studies involving 4,481,888 patients were included. Five studies were included in the meta-analysis. The overall result demonstrated that in the first half of pregnancy, heat exposure increases the risk of developing preeclampsia or eclampsia and gestational hypertension, and cold exposure decreases the risk. The meta-analysis revealed that during the first half of pregnancy, heat exposure increased the risk of preeclampsia or eclampsia (OR 1.54, 95% confidence interval (CI): 1.10, 2.15), whereas cold exposure decreased the risk (OR 0.90, 95% CI: 0.84, 0.97). Conclusion: The ambient temperature is an important determinant for the development of HDP, especially for preeclampsia or eclampsia. The effects of extreme temperatures may be bidirectional during the different trimesters of pregnancy, which should be evaluated by future studies. This review provided hints of temperature regulation in HDP administration.

Background Hypertensive disorders in pregnancy (HDPs) are the leading causes of maternal and perinatal death worldwide, and appropriate prenatal care is beneficial toward improve pregnancy outcomes in populations at high risk of preeclampsia. Objective To describe variations in regional manifestations and outcomes of HDPs among the Chinese population to aid in the development of region-specific perinatal management guidelines. Methods This is a retrospective study. The clinical data of patients with HDP in 3 different regions were collected to explore the characteristics of HDP patients in different regions of China. Results In Peking University First Hospital, a regional rescue center for prenatal care and delivery, the proportion of patients with high-risk factors for PE was considerably high; 37.8% were of advanced maternal age, and 14.7% were obese. Among the patients, at this hospital, the proportion of comorbidities (e.g., chronic hypertension) in HDP patients was higher than that in the other 2 specialized maternal and child health care hospitals. Conclusion Targeted prenatal care procedures should be established based on regional characteristics to improve the quality of perinatal health care and reduce the incidence of HDP.

Inconsistent findings have been reported regarding the associations between hypertensive disorders in pregnancy (HDP) and infant neurodevelopment. Leveraging data from the Jiangsu Birth Cohort, in the present study, we re-visited such associations in one-year-old infants from 2 576 singleton pregnancies and 261 twin pregnancies. We first assessed infant neurodevelopment by the Bayley Scales of Infant and Toddler Development Screening Test (the Third Edition), and then estimated its association with maternal HDP using general linear regression models and Poisson regression models. In singleton pregnancies, compared with mothers unexposed to HDP, infants born to mothers with chronic hypertension exhibited a lower score (β, -0.67; 95% confidence interval [CI], -1.19--0.15) and a higher risk of "non-optimal" gross motor development (risk ratio [RR], 2.21; 95% CI, 1.02--4.79); in twin pregnancies, infants born to mothers with HDP exhibited lower scores in cognition (β, -0.49; 95% CI, -0.96--0.01), receptive communication (β, -0.55; 95% CI, -1.03--0.06), and gross motor (β, -0.44; 95% CI, -0.86--0.03), and at a higher risk of "non-optimal" gross motor development (RR, 2.12; 95% CI, 1.16-3.88). These findings indicate that infants born to mothers with HDP may have inferior neurodevelopment outcomes at the age of one year. [ABSTRACT FROM AUTHOR]

Background: several studies have demonstrated that angiogenic markers can improve the clinical management of hypertensive disorders (HDs) and fetal growth restriction (FGR) in singleton pregnancies, but few studies have evaluated the performance of these tests in multiple pregnancies. Our aim was to investigate the role of soluble fms-like tyrosine kinase 1 (sFlt-1) in predicting adverse obstetric outcomes in hospitalized multiple pregnancies with HD (preeclampsia/gestational hypertension/uncontrolled chronic hypertension) and/or FGR in one or more fetuses. Methods: A retrospective analysis of multiple pregnancies with HD/FGR occurring after the 20th gestational week. Pregnant women were divided into two groups: women with high levels of sFlt-1 and those with low levels of sFlt-1. A value of sFlt-1 greater than or equal to 15,802 pg/mL was considered arbitrarily high, as it is equivalent to two times the 90th percentile expected in an uncomplicated full-term singleton pregnancy based on data from a prospective multicenter study (7901 pg/mL). Results: The cohort included 39 multiple pregnancies. There were no cases of birth <34 weeks, HELLP syndrome, ICU admission, and urgent cesarean sections for HD/FGR complications reported among women with low levels of sFlt-1. Conclusions: A cut-off value of sFlt-1 ≥ 15,802 pg/mL could represent a valuable tool for predicting adverse obstetric outcomes in multiple pregnancies hospitalized for HD/FGR disorders, regardless of gestational age and chorionicity. [ABSTRACT FROM AUTHOR]

Early recognition of high-risk pregnancies through biochemical markers may promote antenatal surveillance, resulting in improved pregnancy outcomes. The goal of this study is to evaluate the possibilities of using biochemical markers during the first trimester of pregnancy in the prediction of hypertensive pregnancy disorders (HPD) and the delivery of small-for-gestational-age (SGA) neonates. A comprehensive search was conducted on key databases, including PubMed, Scopus, and Web of Science, for articles relating to the use of biochemical markers in the prediction of HPD and SGA. The findings show that changes in the levels of biomarkers in the early pregnancy phases could be an important indicator of adverse pregnancy outcomes. The literature shows that low PAPP-A (pregnancy-associated plasma protein A) and PlGF (placental growth factor) levels, low alkaline phosphatase (AP), higher sFlt-1 (soluble fms-like Tyrosine Kinase-1) levels, higher AFP (alfa fetoprotein) levels, and elevated levels of inflammatory markers such as β-HGC (free beta human chorionic gonadotropin), interferon-gamma (INF-γ), and tumor necrosis factor-α (TNF-α) may be associated with risks including the onset of HPD, fetal growth restriction (FGR), and delivery of SGA neonates. Comparatively, PAPP-A and PlGF appear to be the most important biochemical markers for the prediction of SGA and HPD. [ABSTRACT FROM AUTHOR]

Hypertensive disorder in pregnancy (HDP) remains a major health burden, and it is associated with systemic cardiovascular adaptation. The pulse wave is an important basis for evaluating the status of the human cardiovascular system. This research aims to evaluate the application value of pulse waves in the diagnosis of hypertensive disorder in pregnancy.This research a retrospective study of pregnant women who attended prenatal care and labored at Beijing Haidian District Maternal and Child Health Hospital. We extracted maternal hemodynamic factors and measured the pulse wave of the pregnant women. We developed an HDP predictive model by using support vector machine algorithms at five-gestational-week stages.At five-gestational-week stages, the area under the receiver operating characteristic curve (AUC) of the predictive model with pulse wave parameters was higher than that of the predictive model with hemodynamic factors. The AUC values of the predictive model with pulse wave parameters were 0.77 (95% CI 0.64 to 0.9), 0.83 (95% CI 0.77 to 0.9), 0.85 (95% CI 0.81 to 0.9), 0.93 (95% CI 0.9 to 0.96) and 0.88 (95% CI 0.8 to 0.95) at five-gestational-week stages, respectively. Compared to the predictive models with hemodynamic factors, the predictive model with pulse wave parameters had better prediction effects on HDP.Pulse waves had good predictive effects for HDP and provided appropriate guidance and a basis for non-invasive detection of HDP.

We aimed to examine the effects of various severities of hypertensive disorders in pregnancy on birthweight, blood pressure (BP), and body mass index in offspring at age 7. In the China Labor and Delivery Survey and the United States Collaborative Perinatal Project (CPP), the relationship of the severity of hypertensive disorders and nutritional and cardiovascular outcomes in offspring was assessed using a multivariable logistic and general linear regression model. In both datasets, those with gestational hypertension were more likely to deliver large for gestational age (LGA) and macrosomia (adjusted odds ratios (aOR) ranged from 1.29 to 1.91), as well as low birth weight (LBW) neonates (aOR ranged from 1.23 to 3.56), compared with normotensive mothers. In the CPP, when gestational hypertension was further stratified into mild and severe, only those with mild gestational hypertension (the mild group) were more likely to deliver macrosomia and LGA (aOR ranged from 1.25 to 1.32). Others (severe gestational hypertension and preeclampsia/eclampsia) were closely related to LBW and small for gestational age (aOR ranged from 1.27 to 2.77). Moreover, children of mothers in the mild group tended to be overweight/obese and had elevated diastolic BP. We concluded that the severity of hypertensive disorders had different effects on birthweight, childhood overweight, and BP. [ABSTRACT FROM AUTHOR]

Phthalates are commonly found in a wide range of environments and have been linked to several negative health outcomes. While earlier research indicated a potential connection between phthalate exposure and blood pressure (BP) during pregnancy, the results of these studies remain inconclusive. The objective of this meta-analysis was to elucidate the relationship between phthalate exposure and BP in pregnancy. A comprehensive literature search was carried out with PubMed, EMBASE, and Web of Science, and pertinent studies published up until 5 March 2023 were reviewed. Random-effects models were utilized to consolidate the findings of continuous outcomes, such as diastolic and systolic BP, as well as the binary outcomes of hypertensive disorders of pregnancy (HDP). The present study included a total of 10 studies. First-trimester MBP exposure exhibited a positive association with mean systolic and diastolic BP during both the second and third trimesters (β = 1.05, 95% CI: 0.27, 1.83, I2 = 93%; β = 0.40, 95% CI: 0.05, 0.74, I2 = 71%, respectively). Second-trimester monobenzyl phthalate (MBzP) exposure was positively associated with systolic and diastolic BP in the third trimester (β = 0.57, 95% CI: 0.01, 1.13, I2 = 0; β = 0.70, 95% CI: 0.27, 1.13, I2 = 0, respectively). Conversely, first-trimester mono-2-ethylhexyl phthalate (MEHP) exposure demonstrated a negative association with mean systolic and diastolic BP during the second and third trimesters (β = −0.32, 95% CI: −0.60, −0.05, I2 = 0; β = −0.32, 95% CI: −0.60, −0.05, I2 = 0, respectively). Additionally, monoethyl phthalate (MEP) exposure was found to be associated with an increased risk of HDP (OR = 1.12, 95% CI: 1.02, 1.23, I2 = 26%). Our study found that several phthalate metabolites were associated with increased systolic and diastolic BP, as well as the risk of HDP across pregnancies. Nevertheless, given the limited number of studies analyzed, additional research is essential to corroborate these findings and elucidate the molecular mechanisms linking phthalates to BP changes during pregnancy. [ABSTRACT FROM AUTHOR]

• About 10.2% of postpartum women require two or more blood pressure medications. • Chronic hypertension is a risk factor for requiring postpartum HTN medications. • Chronic kidney disease is a risk factor for postpartum HTN medication use. The objective of this study was to identify clinical characteristics of patients with hypertensive disorders of pregnancy associated with requiring multiple anti-hypertensive medications to optimize blood pressure in the postpartum setting. We performed a retrospective cohort study of all women who had a diagnosis of hypertensive disorders of pregnancy who delivered at a single institution between October 1, 2017 and May 1, 2021. Demographics and clinical characteristics including category of anti-hypertensive medication and number of medications were collected. Models were adjusted for race. A total of 1,708 women were identified for inclusion. Of this cohort, 64.9 % did not require any anti-hypertensive medications, while 24.8 % used one medication and 10.2 % required two or more medications. When comparing women by the number of medications that were required, their demographics were similar except for race (p < 0.001). Women taking two or more medications were most prescribed a beta blocker (94.9 %) followed by a calcium channel blocker (88.6 %). Women with a history of chronic hypertension had the highest risk of requiring two or more medications for blood pressure control (adjusted RR 11.19, 95 % CI 2.63–47.60). Chronic kidney disease also significantly increased the risk of requiring two or more medications (adjusted RR 3.09, 95 % CI 1.24–7.69). Women with chronic hypertension and chronic kidney disease are at increased risk for requiring multiple anti-hypertensive medications in the postpartum setting. We recommend frequent postpartum visits, either in person or implementing telemedicine platforms to optimize blood pressure control for this high-risk cohort. [ABSTRACT FROM AUTHOR]

Background Animals exposed to cold stress develop hypertension; however, the effects of cold-induced hypertension on pregnancy remain unclear. We therefore, aimed to investigate the impacts of cold-stress stimulation on mice pregnancy. Methods Four groups of mice were used in the study: non-pregnant control group (NN), non-pregnant cold-stress group (NC), pregnant control group (PN) and pregnant cold-stress group (PC). control groups were kept at 25℃, and the cold-stress groups were kept in a room for cold-stress stimulation (4 ± 2℃) for 4 hours (then back to 25℃) every day from the 1st to the 18th day. Results The blood pressure of the PC was the highest among the four groups, and the hypertensive percentage of the PC was significantly increased. However, plasma angiotensinⅡ levels of the PC were the lowest. The weights of the foetus and placenta in the PC were significantly decreased compared to the PN. More apparent changes in kidneys and placenta were observed in the PC compared to the PN. The blood pressure of pregnant mice showed no difference between the PN and PC groups 50 days after delivery. Conclusions Intermittent cold-stress stimulation had significantly adverse effects on the pregnant mice, leading to maternal hypertension, renal and placental lesions, body weight and placenta reduction in offspring. The study results may offer a non-invasive method to establish an animal model of hypertensive disorders in pregnancy. Cold-stress stimulation may be one of the inducible factors of pregnancy-induced hypertension. Cold-stress stimulation may be one of the inducible factors of pregnancy-induced hypertension. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens. [ABSTRACT FROM AUTHOR]

GoalBody mass index (BMI) in early pregnancy is a critical risk factor for hypertensive disorders of pregnancy (HDP). The pathobiology of the interplay between BMI and HDP is not fully understood and represents the focus of this investigation.MethodsBMI and 1st-trimester serum samples were obtained from the Global Alliance to Prevent Prematurity and Stillbirth repository for 154 women (105 without HDP and 49 with HDP). Metabotyping was conducted using ultra-high-performance liquid-chromatography high-resolution mass spectrometry (UHPLC HR-MS). Multivariable linear regression and logistic models were used to determine metabolites and pathway perturbations associated with BMI in women with and without HDP, and to determine metabolites and pathway perturbations associated with HDP for women in categories of obese, overweight, and normal weight based on the 1st trimester BMI. These outcome-associated signals were identified or annotated by matching against an in-house physical standards library and public database. Pathway analysis was conducted by the Mummichog algorithm in MetaboAnalyst.ResultVitamin D3 and lysine metabolism were enriched to associate with BMI for women with and without HDP. Tryptophan metabolism enrichment was associated with HDP in all the BMI categories. Pregnant women who developed HDP showed more metabolic perturbations with BMI (continuous) than those without HDP in their 1st-trimester serum. The HDP-associated pathways for women with normal weight indicated inflammation and immune responses. In contrast, the HDP-associated pathways for women of overweight and obese BMI indicated metabolic syndromes with disorders in glucose, protein, and amino acid, lipid and bile acid metabolism, and oxidative and inflammatory stress.ConclusionHigh first-trimester BMI indicates underlying metabolic syndromes, which play critical roles in HDP development. Vitamin D3 and tryptophan metabolism may be the targets to guide nutritional interventions to mitigate metabolic and inflammatory stress in pregnancy and reduce the onset of HDP.

Abstract Objectives To determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis. Methods All randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth’s Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review. Results This network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found. Conclusion Antiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate. Systematic review registration PROSPERO CRD42018096276

Background: Hypertensive disorders in pregnancy (HDP) are a major cause of maternal mortality and morbidity. Recent studies indicated that pregnant women are the most vulnerable populations to ambient temperature influences, but it affected HDP with inconsistent conclusions. Our objective is to systematically review whether extreme temperature exposure is associated with a changed risk for HDP. Method: We searched PubMed, EMBASE, Web of Science and Cochrane Library databases. We included cohort or case control studies examining the association between extreme temperature exposure before or during pregnancy and HDP. Heat sources such as saunas and hot baths were excluded. We pooled the odds ratio (OR) to assess the association between extreme temperature exposure and preeclampsia or eclampsia. Results: Fifteen studies involving 4,481,888 patients were included. Five studies were included in the meta-analysis. The overall result demonstrated that in the first half of pregnancy, heat exposure increases the risk of developing preeclampsia or eclampsia and gestational hypertension, and cold exposure decreases the risk. The meta-analysis revealed that during the first half of pregnancy, heat exposure increased the risk of preeclampsia or eclampsia (OR 1.54, 95% confidence interval (CI): 1.10, 2.15), whereas cold exposure decreased the risk (OR 0.90, 95% CI: 0.84, 0.97). Conclusion: The ambient temperature is an important determinant for the development of HDP, especially for preeclampsia or eclampsia. The effects of extreme temperatures may be bidirectional during the different trimesters of pregnancy, which should be evaluated by future studies. This review provided hints of temperature regulation in HDP administration. [ABSTRACT FROM AUTHOR]

Hypertensive disorders in pregnancy (HDPs) are the leading causes of maternal and perinatal death worldwide, and appropriate prenatal care is beneficial toward improve pregnancy outcomes in populations at high risk of preeclampsia. To describe variations in regional manifestations and outcomes of HDPs among the Chinese population to aid in the development of region-specific perinatal management guidelines. This is a retrospective study. The clinical data of patients with HDP in 3 different regions were collected to explore the characteristics of HDP patients in different regions of China. In Peking University First Hospital, a regional rescue center for prenatal care and delivery, the proportion of patients with high-risk factors for PE was considerably high; 37.8% were of advanced maternal age, and 14.7% were obese. Among the patients, at this hospital, the proportion of comorbidities (e.g., chronic hypertension) in HDP patients was higher than that in the other 2 specialized maternal and child health care hospitals. Targeted prenatal care procedures should be established based on regional characteristics to improve the quality of perinatal health care and reduce the incidence of HDP. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the perinatal outcomes by gestational weight gain (GWG) range at 30 weeks of gestation among underweight pregnant women (pre‐pregnancy body mass index ≤ 18.5 kg/m2) in Japan. Methods: This retrospective study was conducted at a hospital in Japan from 2003 to 2020. The underweight pregnant women (UPW; n = 3643) were divided into quartile groups based on the weight gain at 30 weeks of gestation: group Q1 ≤ 5.7 kg, 5.7 kg < Q2 ≤ 7.2 kg, 7.2 kg < Q3 ≤ 8.8 kg, and 8.8 kg < Q4. Clinical characteristics and outcomes were compared using the t‐test, chi‐square test, and multivariable logistic regression analysis. Results: The cumulative incidences of preterm births were 7.5% (n = 70), 5.0% (n = 45), 5.4% (n = 50), and 4.9% (n = 44), and the birth rates of small for gestational age (SGA) infants were 15.7% (n = 147), 9.6% (n = 87), 6.9% (n = 64), and 5.9% (n = 53) in Q1, Q2, Q3, and Q4, respectively. Multivariable analysis revealed that Q1 was significantly associated with preterm births (adjusted odds ratio [aOR] = 1.6; 95% confidence interval [CI] = 1.0–2.3), and Q1 and Q2 were significantly associated with SGA (adj. OR = 3.0; 95% CI = 2.2–4.3; adj. OR = 1.7; 95% CI = 1.2–2.5, respectively). None of the quartile groups were significantly associated with the incidence of primary cesarean sections, gestational diabetes mellitus, and macrosomia. Conclusions: In UPW, GWG at 30 weeks of ≤5.7 kg and ≤7.2 kg are associated with preterm birth and SGA rates, respectively. [ABSTRACT FROM AUTHOR]

Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Obstetrics & Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021. Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma. Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 µmol/L and 451.86±120.62µmol/L, with a significant difference between PIH and eclampsia (p<0.001). Mode of delivery was a vaginal, primary cesarean section, and repeat cesarean section in 31(34.4%), 38(42.2%), and 21(23.4%) patients, respectively (p<0.001). Liquor was meconium stained in 49(54.4%) while clear in 41(45.6%) births, with (p<0.001). Early neonatal deaths 6(6.7%) participants had significantly higher uric acid levels than no NICU admission 22(24.4%). In maternal outcomes, 83 patients (92.2%) required routine post-operative care, while 7(7.8 %) went to the intensive care unit. Uric acid levels had a negative correlation with gestational age. Conclusion: Maternal uric acid levels differ significantly in different hypertensive disorders of pregnancy and affect the mode of delivery and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether stage 1 hypertension and elevated blood pressure (BP), as defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, prior to pregnancy contributes to adverse pregnancy outcomes in females who conceived by in vitro fertilization and embryo transfer (IVF–ET). Methods: This retrospective cohort study involved 2239 females who conceived by IVF–ET and delivered live neonates. BPs recorded before IVF–ET were collected. Elevated BP was defined as at least two systolic BPs of 120 to 129 mmHg. Stage 1 hypertension was defined as at least two systolic BPs of 130 to 139 mmHg or diastolic BPs of 80 to 89 mmHg. Results: Among the females included in this study, 18.5% (415/2239) had elevated BP and 10.0% (223/2239) had stage 1 hypertension. Multiple logistic regression analysis showed that females with stage 1 hypertension had higher risks of hypertensive disorders in pregnancy (HDP) [adjusted odds ratio (aOR) 1.65; 95% confidence interval (CI) 1.16–2.35] and preeclampsia (aOR 1.52; 95% CI 1.02–2.26) than normotensive females. However, the risks of HDP (aOR 0.88; 95% CI 0.64–1.21) and preeclampsia (aOR 0.83; 95% CI, 0.57–1.20) in females with elevated BP were not significantly different from those in normotensive females. The females were then categorized into five groups by systolic and diastolic BP; females with systolic BP of 130 to 139 mmHg or diastolic BP of 85 to 89 mmHg had significantly increased risks of HDP and preeclampsia. Conclusion: Stage 1 hypertension before IVF–ET was an independent risk factor for HDP and preeclampsia. [ABSTRACT FROM AUTHOR]

Early recognition of high-risk pregnancies through biochemical markers may promote antenatal surveillance, resulting in improved pregnancy outcomes. The goal of this study is to evaluate the possibilities of using biochemical markers during the first trimester of pregnancy in the prediction of hypertensive pregnancy disorders (HPD) and the delivery of small-for-gestational-age (SGA) neonates. A comprehensive search was conducted on key databases, including PubMed, Scopus, and Web of Science, for articles relating to the use of biochemical markers in the prediction of HPD and SGA. The findings show that changes in the levels of biomarkers in the early pregnancy phases could be an important indicator of adverse pregnancy outcomes. The literature shows that low PAPP-A (pregnancy-associated plasma protein A) and PlGF (placental growth factor) levels, low alkaline phosphatase (AP), higher sFlt-1 (soluble fms-like Tyrosine Kinase-1) levels, higher AFP (alfa fetoprotein) levels, and elevated levels of inflammatory markers such as β-HGC (free beta human chorionic gonadotropin), interferon-gamma (INF-γ), and tumor necrosis factor-α (TNF-α) may be associated with risks including the onset of HPD, fetal growth restriction (FGR), and delivery of SGA neonates. Comparatively, PAPP-A and PlGF appear to be the most important biochemical markers for the prediction of SGA and HPD.

Abstract Background To study temporal trends of intensive care unit (ICU) admission in obstetric population after the introduction of obstetric high-dependency unit (HDU). Methods This is a retrospective study of consecutive obstetric patients admitted to the ICU/HDU in a provincial referral center in China from January 2014 to December 2019. The collected information included maternal demographic characteristics, indications for ICU and HDU admission, the length of ICU stay, the total length of in-hospital stay and APACHE II score. Chi-square and ANOVA tests were used to determine statistical significance. The temporal changes were assessed with chi-square test for linear trend. Results A total of 40,412 women delivered and 447 (1.11%) women were admitted to ICU in this 6-year period. The rate of ICU admission peaked at 1.59% in 2016 and then dropped to 0.67% in 2019 with the introduction of obstetric HDU. The average APACHE II score increased significantly from 6.8 to 12.3 (P

Objective: To investigate effect of iron supplementation on the risk of hypertensive disorders in pregnancy in non-anaemic pregnant women. Methods: A literature search was conducted using three categories of terms with its synonyms or related words: “iron”, “supplement”, “hypertensive disorders in pregnancy” through MEDLINE (OVID), CINAHL, PubMed, Cochrane Library, Scopus, Web of Science, ICTRP, and ClinicalTrials.gov, and manual search of references was used in seven potential resources. The inclusion criteria were randomized control trials (RCTs), published in English, full-text available, having healthy pregnant women without anaemia for study participants, and having hypertensive disorders in pregnancy at the end of pregnancy as the outcome. The risk of bias assessment tool was used for quality appraisal. Meta-analysis was conducted by calculating the fixed and random effects of the odds ratio (OR) for iron supplementation among non-anaemic pregnant women compared with the incidence of hypertensive disorders in pregnancy. The range of the study’s estimation accuracy was reflected by a 95% confidence interval (CI). Results: Four RCTs were included in the meta-analysis. The pooled results showed that iron supplementation possibly had no effect on the incidence of hypertensive disorders in pregnancy (OR 0.93, 95% CI 0.81-1.07; P=0.30), gestational hypertension (OR 1.37, 95% CI 0.69-2.73; P=0.36) as well as on the development of preeclampsia (OR 1.45, 95% CI 0.71-2.97; P=0.31). Conclusions: Iron supplementation has no effect on the incidence of hypertension in non-anaemic pregnant women. In general, there is a lack of evidence for the association between iron supplementation and the incidence of hypertensive disorders in pregnancy among non-anaemic pregnant women, and further studies are needed.

Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Obstetrics & Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021. Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma. Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 μmol/L and 451.86±120.62μmol/L, with a significant difference between PIH and eclampsia (p

Hypertensive disorders in pregnancy (HDIP) represent one of the leading causes of maternal and perinatal mortality. microRNA (miR)-25-3p plays roles in HDIP diagnosis. We explored miR-25-3p clinical roles in HDIP. HDIP patients [gestation hypertension (GH), mild preeclampsia (mPE), and severe preeclampsia (sPEz)], and normal pregnant women serving as the control were enrolled. Serum miR-25-3p expression patterns were detected by RT-qPCR. The diagnostic efficacy of miR-25-3p on HDIP was analyzed with a ROC curve. Patients were assigned to the high/low miR-25-3p expression groups according to the median value of miR-25-3p expression. All patients were followed up until delivery, and gestational weeks and pregnancy outcomes were recorded at delivery. The effects of miR-25-3p expression on pregnancy outcomes of GH, mPE, and sPEz patients were analyzed by Kaplan-Meier. miR-25-3p expression in GH, mPE, and sPEz patients was up-regulated. In sPEz patients, systolic and diastolic blood pressure, 24-h urine protein, AST, ALT, GGT, and SCr were increased, and PLT was decreased in the high expression group. High miR-25-3p expression was associated with an increased risk of adverse pregnancy outcomes in PE patients. Collectively, high miR-25-3p expression could aid HDIP diagnosis, and associated with an increased risk of adverse pregnancy outcomes in PE patients. [ABSTRACT FROM AUTHOR]

A low eGFR cystatin C /eGFR creatinine -ratio is characteristic of a group of serious kidney disorders called 'Selective Glomerular Hypofiltration Syndromes'. This study examines if such a low ratio can also be used to evaluate the risk for women with hypertensive disorders in pregnancy to develop severe maternal morbidity. All women discharged from the perinatal ward at the Skåne University Hospital in Lund during the period of 1-9-2016 to 31-8-2017 under one of the diagnoses within hypertensive disorders in pregnancy were considered for inclusion in the study. After delivery and discharge from the hospital, records from included patients were reviewed and all registered measures of renal function were analysed. An eGFR cystatin C /eGFR creatinine -ratio ≤0.60 in a sample drawn not earlier than three days before delivery was considered as defining a high risk for severe maternal morbidity. A strong association (p-value: 0.035) between severe maternal morbidity and an eGFR cystatin C /eGFR creatinine -ratio ≤0.60 was found in a subgroup of 32 women diagnosed with 'preeclampsia with severe features'. A total of 69 women were included in the study. Fifty were defined as high-risk and seventeen of them (34%) developed severe maternal morbidity. Among the nineteen women defined as low-risk only two (10.5%) developed severe maternal morbidity (p-value: 0.051). A low eGFR cystatin C /eGFR creatinine -ratio seems promising as a predictive marker for maternal morbidity in hypertension in pregnancy. Its performance as a tool in the monitoring of progressing disease should be evaluated further in larger cohorts. Delivery before the eGFR cystatin C /eGFR creatinine -ratio decreases to, or below, 0.60 might help avoid maternal complications.

Objectives: To investigate the role of coagulation indices in assessing the severity of hypertensive disorders in pregnancy (HDP) and their predictive value for delivery outcomes., Methods: A retrospective analysis was conducted on clinical data from 54 pregnant women with HDP who delivered at Zhoushan Hospital between June 2013 and June 2023. A control group of 42 healthy pregnant women from the same period was also included., Results: In the HDP group, activated partial thromboplastin time (APTT) and prothrombin time (PT) were significantly lower, while D-Dimer (D-D) levels were significantly higher compared to the control group (all P < 0.01). Receiver operating characteristic (ROC) curve analysis showed that the areas under the curve (AUC) for APTT, D-D, PT, and the combined assay were 0.886, 0.813, 0.830, and 0.960, respectively (all P < 0.001). The combined assay demonstrated higher predictive efficacy for HDP than that of any single assay (all P < 0.05). Furthermore, APTT, D-D, and PT showed strong correlations with systolic blood pressure and 24-hour urinary protein levels in HDP patients (all P < 0.001), indicating the corresponding HDP severity. For prediction of adverse birth outcomes (ABO), APTT, D-D, PT, and the combined test all had high predictive value (all P < 0.01). The incidence of ABO, especially neonatal ABO, increased significantly when these coagulation indices (except APTT) were at their optimal cut-off points (P < 0.05)., Conclusions: The combined testing of APTT, D-D, and PT provides high predictive efficacy for both HDP and ABO and is closely associated with the severity of HDP., Competing Interests: None., (AJTR Copyright © 2024.)

Abstract Background Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. Methods We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. Results Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. Conclusions Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

BACKGROUND: Hypertensive disorders in pregnancy are one of the most common causes of readmission in the postpartum period. Because of the COVID-19 pandemic, early hospital discharge was encouraged for patients who were medically stable, because hospitalization rates among SARS-CoV-2–infected patients steadily increased in 2020. The impact of an early discharge policy on postpartum readmission rates among patients with hypertensive disorders in pregnancy is unknown. OBJECTIVE: This study aimed to compare the postpartum readmission rates of patients with hypertensive disorders in pregnancy before and after implementation of an early discharge policy owing to the COVID-19 pandemic. STUDY DESIGN: This was a quality improvement, retrospective cohort study of postpartum patients with antenatal hypertensive disorders in pregnancy who delivered and were readmitted because of hypertensive disorders in pregnancy at the New York University Langone Health medical center from March 1, 2019 to February 29, 2020 (control cohort) and from April 1, 2020 to March 31, 2021 (COVID-19 cohort). During the pandemic, our institution introduced an early discharge policy for all postpartum patients to be discharged no later than 2 days postpartum during the delivery admission if deemed medically appropriate. The reduction in postpartum length of stay was accompanied by the continuation of patient education, home blood pressure monitoring, and outpatient follow-up. The primary outcome was the comparison of the readmission rates for patients with postpartum hypertensive disorders in pregnancy. Data were analyzed using Fisher's Exact tests, chi-square tests, and Wilcoxon rank-sum tests with significance defined as P

BackgroundHypertensive disorders in pregnancy (HDP) are diseases that coexist with pregnancy and hypertension. The pathogenesis of this disease is complex, and different physiological and pathological states can develop different subtypes of HDP.ObjectiveTo investigate the predictive effects of different variable selection and modeling methods on four HDP subtypes: gestational hypertension, early-onset preeclampsia, late-onset preeclampsia, and chronic hypertension complicated with preeclampsia.MethodsThis research was a retrospective study of pregnant women who attended antenatal care and labored at Beijing Maternity Hospital, Beijing Haidian District Maternal and Child Health Hospital, and Peking University People's Hospital. We extracted maternal demographic data and clinical characteristics for risk factor analysis and included gestational week as a parameter in this study. Finally, we developed a dynamic prediction model for HDP subtypes by nonlinear regression, support vector machine, stepwise regression, and Lasso regression methods.ResultsThe AUCs of the Lasso regression dynamic prediction model for each subtype were 0.910, 0.962, 0.859, and 0.955, respectively. The AUC of the Lasso regression dynamic prediction model was higher than those of the other three prediction models. The accuracy of the Lasso regression dynamic prediction model was above 85%, and the highest was close to 92%. For the four subgroups, the Lasso regression dynamic prediction model had the best comprehensive performance in clinical application. The placental growth factor was tested significant (P

We aimed to examine the effects of various severities of hypertensive disorders in pregnancy on birthweight, blood pressure (BP), and body mass index in offspring at age 7. In the China Labor and Delivery Survey and the United States Collaborative Perinatal Project (CPP), the relationship of the severity of hypertensive disorders and nutritional and cardiovascular outcomes in offspring was assessed using a multivariable logistic and general linear regression model. In both datasets, those with gestational hypertension were more likely to deliver large for gestational age (LGA) and macrosomia (adjusted odds ratios (aOR) ranged from 1.29 to 1.91), as well as low birth weight (LBW) neonates (aOR ranged from 1.23 to 3.56), compared with normotensive mothers. In the CPP, when gestational hypertension was further stratified into mild and severe, only those with mild gestational hypertension (the mild group) were more likely to deliver macrosomia and LGA (aOR ranged from 1.25 to 1.32). Others (severe gestational hypertension and preeclampsia/eclampsia) were closely related to LBW and small for gestational age (aOR ranged from 1.27 to 2.77). Moreover, children of mothers in the mild group tended to be overweight/obese and had elevated diastolic BP. We concluded that the severity of hypertensive disorders had different effects on birthweight, childhood overweight, and BP.

Phthalates are commonly found in a wide range of environments and have been linked to several negative health outcomes. While earlier research indicated a potential connection between phthalate exposure and blood pressure (BP) during pregnancy, the results of these studies remain inconclusive. The objective of this meta-analysis was to elucidate the relationship between phthalate exposure and BP in pregnancy. A comprehensive literature search was carried out with PubMed, EMBASE, and Web of Science, and pertinent studies published up until 5 March 2023 were reviewed. Random-effects models were utilized to consolidate the findings of continuous outcomes, such as diastolic and systolic BP, as well as the binary outcomes of hypertensive disorders of pregnancy (HDP). The present study included a total of 10 studies. First-trimester MBP exposure exhibited a positive association with mean systolic and diastolic BP during both the second and third trimesters (β = 1.05, 95% CI: 0.27, 1.83, I2 = 93%; β = 0.40, 95% CI: 0.05, 0.74, I2 = 71%, respectively). Second-trimester monobenzyl phthalate (MBzP) exposure was positively associated with systolic and diastolic BP in the third trimester (β = 0.57, 95% CI: 0.01, 1.13, I2 = 0; β = 0.70, 95% CI: 0.27, 1.13, I2 = 0, respectively). Conversely, first-trimester mono-2-ethylhexyl phthalate (MEHP) exposure demonstrated a negative association with mean systolic and diastolic BP during the second and third trimesters (β = −0.32, 95% CI: −0.60, −0.05, I2 = 0; β = −0.32, 95% CI: −0.60, −0.05, I2 = 0, respectively). Additionally, monoethyl phthalate (MEP) exposure was found to be associated with an increased risk of HDP (OR = 1.12, 95% CI: 1.02, 1.23, I2 = 26%). Our study found that several phthalate metabolites were associated with increased systolic and diastolic BP, as well as the risk of HDP across pregnancies. Nevertheless, given the limited number of studies analyzed, additional research is essential to corroborate these findings and elucidate the molecular mechanisms linking phthalates to BP changes during pregnancy.

Maternal dysglycemia and lipid metabolic dysfunction have been recognized as risk factors for pregnancy complications and adverse perinatal outcome jointly and separately, but current diagnostic window-period which is at the end of the second trimester might be late to avoid chronic adverse impacts on both mother and fetus. A retrospective cohort study involving 48,973 women with fasting blood glucose (FPG) below diagnostic thresholds and lipid screening in early pregnancy was performed. Data of pregnancy outcomes including gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP), and neonatal outcomes were obtained for multivariable logistic analysis. As a result, higher FPG (≥75th, 4.68 mM) significantly increased risks of GDM (Adjusted odds ratio (AOR), 2.81; 95% CI, 2.60 to 3.05) and HDP (1.98; 1.81 to 2.16), and slightly increased risks of large for gestational age (LGA), macrosomia births and neonatal intensive care unit (NICU) compared to women with low FPG (≤25th, 4.21 mM). High maternal triglyceride (mTG) level had higher risks of GDM and HDP in all maternal FPG strata. Further analysis showed that women of top quartile of glucose combined with upper 10 percentile triglyceride have higher risks for GDM (AOR, 5.97; 95% CI, 5.26 to 6.78; risk difference 30.8, 95% CI 29.2 to 32.3) and HDP (AOR, 2.56; 95% CI, 2.20 to 2.99, risk difference 11.3, 95% CI 9.9 to 12.7) when compared to those in women of the bottom strata after adjustment. Therefore, both the early-pregnancy FPG and mTG levels should be screened among overall population including the low-risk population to reduce the incidence of pregnancy complications. [ABSTRACT FROM AUTHOR]

Objectives: To determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis. Methods: All randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth's Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review. Results: This network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found. Conclusion: Antiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate. Systematic review registration: PROSPERO CRD42018096276 [ABSTRACT FROM AUTHOR]

Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs.