Effect of Vitamin A and D in Hypertensive Disorder of Pregnancy

Background: Severe preeclampsia is the main cause of maternal mortality. The correlation between vitamin D and hypertensive disorder of pregnancy is a controversial topic at present. Whether vitamin D can be used as an index to predict the risk of preeclampsia and when to supplement vitamin D in clinic has become a relatively popular research content. This study aimed to correlate vitamin A and D with hypertensive disorder of pregnancy and to reduce the risk of hypertension in pregnancy. Methods: This is a Prospective cohort study on 958 pregnant females. The patients were divided into two groups, namely, treatment group and Pregnancy Induced Hypertension (PIH) group. Liquid chromatography-tandem mass spectrometry and highperformance quid gel electrophoresis were used to find vitamin A and D in the blood of each group (HPLC). Results: There has not been a big difference in between PIH group and the placebo group (p>0.5). Preeclampsia collection and simple preeclampsia group there has been a statistical change in cesarean unit amount and impulsive transfer (p<0.05). The study further found that There is no rise in the likelihood of mild pregnancy complications, and the thing that is different would not be statistically important (p>0.05). Serum vitamin D level is less than 20 ng/ml, which is a risk factor for preeclampsia. Conclusion: The lack of vitamin A may be associated with the occurrence of hypertensive disorders during pregnancy and the progression of the disease. The lack of vitamin A may increase the risk of severe preeclampsia risk increased.

The relationship between physical activity in early pregnancy and hypertensive disorders of pregnancy: a cohort study in Chinese women / 世界急诊医学杂志（英文）

@#BACKGROUND: We aimed to examine prospective associations between different intensities and different types of physical activity (PA) in early pregnancy and hypertensive disorders of pregnancy (HDP) among Chinese women. METHODS: A total of 6,820 pregnant women from the Tongji-Shuangliu Birth Cohort were included in this study. The pregnancy physical activity questionnaire (PPAQ) was used to assess PA, including household/caregiving, occupational, sports/exercise, and transportation activities in the first trimester of pregnancy. The diagnosis of HDP was collected, including gestational hypertension (GH) and preeclampsia (PE). Data were analyzed by unconditional multivariate logistic regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 178 (2.6%) of the 6,820 women were diagnosed with HDP, of which 126 (1.8%) were GH and 52 (0.8%) were PE. Overall, we found no association between PA in early pregnancy and PE. A trend toward lower risk was found only among women with GH and among those with higher levels of moderate-to-vigorous intensity physical activity (MVPA) (adjusted OR 0.54, 95% CI 0.31-0.96). No association was observed between PA and HDP in early pregnancy, regardless of different intensities or types of PA. CONCLUSION: MVPA in the first trimester is an influencing factor of HDP. Encouraging pregnant women to engage in MVPA in the first trimester may help to prevent GH.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review / Exposição materna a mercúrio e distúrbios hipertensivos na gestação: Uma revisão sistemática

Abstract Objective The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP). Data Sources The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021. Study Selection Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction. Data Collection We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist. Data Synthesis We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies. Conclusion We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

Resumo Objetivo A presente revisão busca sintetizar as evidências em relação à exposição ao mercúrio (Hg) e os distúrbios hipertensivos da gestação (DHG). Fontes Dos Dados Os bancos de dados PubMed, BVS/LILACS, SciELO e a Biblioteca Digital da UFRJ Pantheon foram sistematicamente pesquisadas durante junho de 2021. Seleção de estudos Artigos observacionais analíticos, escritos em inglês, espanhol ou português, sem restrição temporal. Coleta de Dados A estratégia PICOS foi seguida e a qualidade metodológica foi avaliada usando o checklist Downs and Black. Síntese de dados Foram encontrados 77 artigos, dos quais 6 atenderam aos critérios da revisão. Foram 4.848 participantes, dos quais 80 (16,7%) tinham DHG e 4.724 (97,4%) estavam expostos ambientalmente ao Hg (consumo de peixe e amálgama dental). Os biomarcadores de mercúrio avaliados foram sangue (quatro estudos) e urina (dois estudos). Dois estudos encontraram associação positiva entre Hg e DHG no grupo com maior exposição e os outros quatro não a apresentaram. A avaliação de qualidade metodológica revelou 3 estudos satisfatórios e 3 bons (média: 19,3 ± 1,6 em 28 pontos). A ausência ou não de ajuste adequado para fator de confusão negativo, como consumo de pescado, foi observada em cinco estudos. Conclusão Recuperamos apenas seis estudos, embora o Hg seja um metal tóxico generalizado e a gravidez seja um período de maior suscetibilidade a ameaças ambientais e risco cardiovascular. No geral, nossa revisão mostrou resultados mistos, com dois estudos relatando associação positiva no grupo com maior exposição. No entanto, devido à importância do assunto, estudos adicionais são necessários para elucidar os efeitos do Hg sobre DHG, com atenção especial ao ajuste de confundimento negativo.

VITAMIN D DEFICIENCY IN PREGNANCY AND ITS ASSOCIATION WITH MATERNAL COMPLICATIONS

Introduction: Vitamin D de?ciency and insuf?ciency have been associated with a variety of adverse maternal and fetal outcomes, ranging from Gestational hypertension, preeclampsia, gestational diabetes, preterm delivery, intrauterine growth restriction, and cesarean section. The study was done to determine whether vitamin D de?ciency in pregnant women was associated with complications. In this prospective observational study, Methods: vitamin D levels were estimated in 100 pregnant women from gestational age 32 to 40 weeks in a teaching hospital in Delhi, India. All the subjects were further followed up for the appearance of pregnancy associated complications mostly focusing on the appearance of Gestational Hypertension, Pre-eclampsia, Gestational Diabetes, IUGR, Preterm labour or landing up in Caesarean section. 84% had suboptimal vitamin D level i.e serum vitamin D < 30ng/ml. Common complications were Results: gestational hypertension (47%), caesarean section (47%) and gestational diabetes (41%). Signi?cantly low vitamin D levels were found in women with obstetric complications as compared to controls with no complications. Also, signi?cant association was found between suboptimal vitamin D levels and complications. The routine measurement of vitamin D in Conclusion: pregnancy can be of great help in identifying patients at risk for development of these complications, early intervention and prevention of occurrence of these complications. Cost effective and timely treatment can prevent the complications in expecting mothers.

Niveles de homocisteína y factores de riesgo asociados con preeclampsia en gestantes de Santa Marta y Barranquilla (Colombia)

Fundamentos y objetivo: La preeclampsia o hipertensión arterial gestacional es una complicación del embarazo y en su etiología intervienen factores genéticos, metabólicos y ambientales. Globalmente ocurre en el 3-10 % de los embarazos, y en Colombia produce muerte materna en el 5-7 % de los embarazos. Entre las causas que favorecen su desarrollo se encuentra el estrés oxidativo generado por elevados niveles de homocisteína. El objetivo de este estudio fue establecer la relación de los niveles de homocisteína y otros factores entre gestantes con preeclampsia y sin preeclampsia en el tercer trimestre de la gestación. Método: En una población de 47 gestantes sin preeclampsia y 41 gestantes con preeclampsia se realizó una encuesta con consentimiento informado y la medición de homocisteína plasmática mediante inmunoensayo de fluorescencia polarizada en un analizador IMx-System. La edad gestacional se determinó mediante ecografía; la tensión arterial y peso materno de la historia clínica. El análisis estadístico abarcó la prueba de Kruskal-Wallis, tablas de contingencia 2x2, Chi cuadrado de Pearson y análisis multivariado, utilizando el paquete estadístico SPSS 17. Resultados: Se encontró diferencias significativas en los niveles de homocisteína entre casos y controles. Hubo correlación entre homocisteína con el índice de masa corporal y presión arterial. Se encontró que la hiperhomocisteinemia representa un riesgo para preeclampsia significativamente mayor en el grupo con antecedentes familiares en comparación con el grupo sin antecedentes. Conclusiones: En la población estudiada, la hiperhomocisteinemia, el índice de masa corporal y los antecedentes familiares de preeclampsia representan factores de riesgo para esta patología.

Fundamentals and objective: Preeclampsia, or gestational hypertension, is the most common complication of pregnancy. The etiology is affected by genetic, metabolic, and environmental factors. It occurs globally in 3-10% of pregnancies, and in Colombia it is an important cause of maternal death, occurring in 5-7 % of all pregnancies. Oxidative stress generated by high levels of homocysteine is one of the causes that contribute to the development of this complication. The objective of the present study was to establish the relationship of homocysteine levels and other factors between pregnant women with pre-eclampsia and without pre-eclampsia. Method: In a population of 47 pregnant women without pre-eclampsia and 41 pregnant women with pre-eclampsia, a survey with informed consent and measurement of plasma homocysteine that was performed by polarized fluorescence immunoassay using an IMx-System analyzer. The gestational age was determined by obstetric ultrasound and the blood pressure and weight data of the clinical history. In the statistical analysis, the Kruskal-Wallis test, 2x2 contingency tables, Pearson's Chi square and multivariate analysis were performed, using the SPSS 17 statistical package. Results: Significant differences were found between homocysteine values between cases and controls. There was a correlation between homocysteine values, body mass index, and blood pressure. It was also found that hyper-homocysteinemia represents a significantly higher risk of preeclampsia in the group with a family history, compared to the group with no history. Conclusions: In our population, hyper-homocysteinemia, body mass index, and family history of preeclampsia represent risk factors for this pathology.

Resultados perinatales tras la suplementación de una cohorte de gestantes con vitamina D / Perinatal results after vitamin D supplementation in a pregnant women cohort

INTRODUCCIÓN Y OBJETIVOS: La deficiencia de vitamina D es muy prevalente durante la gestación, siendo cada vez más numerosos los estudios que relacionan esta condición con peores resultados perinatales. El objetivo del presente trabajo es describir los resultados perinatales y el curso del embarazo de una cohorte de gestantes deficitarias en vitamina D durante el primer trimestre del embarazo, suplementándolas con colecalciferol, así como establecer una comparación entre los resultados perinatales de aquellas pacientes con déficit o insuficiencia que lograron niveles normales de vitamina D en el tercer trimestre frente a aquellas que no lo lograron. Como objetivo secundario se describe el curso del embarazo de una cohorte de pacientes que durante el mismo periodo de tiempo del estudio presentaban normovitaminosis al inicio de la gestación. MÉTODOS: La cohorte de 190 pacientes analizada procede de casos consecutivos en la primera consulta de embarazo. Se determinaron los niveles de 25-hidroxivitamina D (25-OH-D) en la analítica del primer trimestre de 190 gestantes diferenciando entre valores normales (>30ng/mL), insuficiencia (30-15 ng/mL) y deficiencia (<15 ng/mL). Las pacientes con insuficiencia se suplementaron con 1000 UI/día de colecalciferol y las pacientes con deficiencia con 2000 UI/día. En el tercer trimestre se determinaron de nuevo los niveles de 25-OH-D en las pacientes suplementadas, suspendiendo la prescripción en caso de haberse normalizado los valores. Se comparan estadísticamente los resultados perinatales entre aquellas pacientes que mejoraron con la suplementación frente a aquellas que no lo hicieron. RESULTADOS: De las 190 pacientes analizadas, un 45% presentaban insuficiencia; un 27,5% deficiencia; y un 27,5% valores normales. De forma global, un 61% de las pacientes suplementadas habían normalizado sus niveles de vitamina D en la analítica del tercer trimestre, suspendiéndose la prescripción. De ese 61% normalizado, un 63% pertenecían al grupo de insuficiencia y un 37% al de deficiencia. Dentro del grupo suplementado con colecalciferol, un 1,4% de las pacientes desarrollaron hipertensión arterial, mientras que un 33% desarrollaron diabetes en el embarazo, de las cuales un 87% la controlaron exclusivamente con dieta y un 13% precisaron insulina. Un 3,6% de las gestaciones cursaron con retraso del crecimiento y la tasa de prematuridad fue igualmente del 3,6%. La tasa de cesáreas fue del 23%, de las cuales un 77% fueron indicadas intraparto y un 23% cesáreas programadas. El peso medio al nacimiento fue 3205g. Dentro del grupo con valores normales de 25-OH-D en el primer trimestre de la gestación, ninguna paciente desarrolló hipertensión arterial, mientras que un 15% presentaron diabetes gestacional controlada con dieta. Un 3,8% de dichas gestaciones cursaron con retrasos del crecimiento y la tasa de prematuridad fue del 1,9%. La tasa de cesáreas fue del 23%, de las cuales un 50% fueron indicadas intraparto y el 50% restante programadas. El peso medio al nacimiento fue de 3280g. En el análisis comparativo de los resultados perinatales entre el grupo de pacientes suplementadas que normalizaron sus cifras de vitamina D y aquellas que no lo hicieron, no se hallan diferencias estadísticamente significativas para ninguno de los parámetros analizados. CONCLUSIONES: La elevada tasa de hipovitaminosis D en la muestra analizada apoya la extensión del cribado y suplementación a todas las embarazadas y no solamente a aquellas con factores de riesgo. Dado que no se observaron diferencias estadísticamente significativas entre los niveles de vitamina D en el tercer trimestre y las variables perinatales estudiadas, podemos concluir que en nuestro estudio la suplementación con vitamina D no se ha comportado como factor protector de eventos obstétricos adversos.

INTRODUCTION AND OBJECTIVES: Vitamin D deficiency is highly prevalent during pregnancy, with an increasing number of studies linking this condition with worse perinatal outcomes. The objective of this present work is to describe the perinatal results and the course of pregnancy in a cohort of pregnant women deficient in vitamin D during the first trimester of pregnancy, supplementing them with cholecalciferol, as well as to establish a comparison between perinatal results of those patients with deficiencnieve or insufficiency who achieved normal levels of vitamin D in the third trimester compared to those who did not. As a secondary objective, the course of pregnancy is described in a cohort of patients who presented normal levels at the beginning of gestation during the same period of time of the study. METHODS: The cohort of 190 patients analyzed comes from consecutive cases in the first pregnancy visit. The levels of 25-hydroxyvitamin D (25-OH-D) were determined in the analysis of the first trimester of 190 pregnant women, differentiating between normal values (> 30ng / mL), insufficiency (30-15 ng / mL) and deficiency (<15 ng / mL). Patients with insufficiency were supplemented with 1000 IU/day of cholecalciferol and patients with deficiency with 2000 IU/day. In the third trimester, the 25-OH-D levels were determined again in the supplemented patients, suspending the prescription if the values had normalized. Perinatal outcomes are statistically compared between those patients who improved with supplementation versus those who did not. RESULTS: Of the 190 patients analyzed, 45% had insufficiency; 27.5% deficiency; and 27.5% normal values. Overall, 61% of the supplemented patients had normalized their vitamin D levels in the third trimester analysis, suspending the prescription. Within that 61% normalized, 63% belonged to the insufficiency group and 37% to the deficiency group. In the group supplemented with cholecalciferol, 1.4% of the patients developed arterial hypertension, while 33% developed diabetes in pregnancy, of which 87% controlled it exclusively with diet and 13% required insulin. 3.6% of pregnancies had intrauterine growth restriction and the prematurity rate was also 3.6%. The caesarean section rate was 23%, of which 77% were indicated intrapartum and 23% scheduled caesarean sections. The mean weight at birth was 3205g. Within the group with normal 25-OH-D values in the first trimester of pregnancy, no patient developed hypertension, while 15% had diet-controlled gestational diabetes. 3.8% of these pregnancies had intrauterine growth restriction and the prematurity rate was 1.9%. The cesarean section rate was 23%, of which 50% were indicated intrapartum and the remaining 50% scheduled. The mean weight at birth was 3280g. In the comparative analysis of the perinatal results between the group of supplemented patients who normalized their vitamin D levels and those who did not, no statistically significant differences were found for any of the parameters analyzed. CONCLUSIONS: The high rate of hypovitaminosis D in the analyzed sample supports the extension of screening and supplementation to all pregnant women and not only to those with risk factors. Since no statistically significant differences were observed between vitamin D levels in the third trimester and the perinatal outcomes studied, we can conclude that in our study vitamin D supplementation has not behaved as a protective factor against adverse obstetric events.

Uterine vascular resistance and other maternal factors associated with the risk of developing hypertension during pregnancy

Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. The objective of the present study was to determine the increase in relative risk for developing hypertensive disorders of pregnancy based on the evaluation of pregnant women between 20 and 25 weeks of gestation, and to correlate the findings at this period with the outcome of pregnancy. We conducted a prospective cohort study, with a convenience sample of 1417 patients evaluated at this gestational age, of which 1306 were contacted at childbirth. We detected an increased relative risk of 2.69 (95%CI: 1.86 to 3.89) associated with pulsatility index of the uterine arteries, a 2.8 increase (95%CI: 1.58 to 5.03) in relative risk attributed to maternal age above 35 years, a 1.68 increase (95%CI: 1.17 to 2.40) attributed to parity greater than or equal to 3, and a 5.35 increase (95%CI: 4.18 to 6.85) attributed to chronic hypertension and obesity, with a progressive increase in relative risk according to the degree of overweight, i.e., grades 1, 2, 3, and morbid obesity (2.58, 3.06, 5.84, and 7.28, respectively).

Effect of nonalcoholic fatty liver disease on glucose and lipid metabolism during pregnancy / 中华内分泌代谢杂志

Objective:To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on glucose and lipid metabolism during pregnancy.Methods:A retrospective analysis was performed in women who gave birth in Minhang Hospital Affiliated to Fudan University from January 2013 to June 2020. The data on demographic, clinical examination, and delivery were obtained via electronic medical record abstraction. According to the ultrasound imaging, all pregnant women were divided into NAFLD group and control group. The difference of glucose and lipid metabolism indexes, incidence of gestational diabetes mellitus, and gestational hypertension between two groups were compared. Logistic regression model was used to examine potential associations between NAFLD and metabolic related adverse pregnancy outcomes.Results:A total of 14 708 pregnant women with a mean age of (29.1±4.7) years and a mean body mass index of (21.0±2.8) kg/m 2 were included in our study. Of those eligible women, 554 (3.8%) were confirmed by ultrasound as NAFLD. Pregnant women with NAFLD presented higher circulating levels of fasting glucose [(4.2±0.5)mmol/L vs (4.1±0.5)mmol/L, P<0.01], 1 h plasma glucose [(7.4±1.7)mmol/L vs (6.6±1.6)mmol/L, P<0.01] and 2 h plasma glucose [(6.2±1.4)mmol/L vs (5.7±1.3)mmol/L, P<0.01] after glucose loading, HbA 1C [(5.2±0.4)% vs (5.1±0.5)%, P<0.01], triglyceride [(2.1±1.1)mmol/L vs (1.6±0.7)mmol/L, P<0.01], total cholesterol [(4.8±0.8)mmol/L vs (4.7±0.9)mmol/L, P<0.01], low density lipoprotein-cholesterol [(2.6±0.7)mmol/L vs (2.5±0.7)mmol/L, P<0.01], uric acid [(224.1±51.8)μmol/L vs (203.0±45.9)μmol/L, P<0.01] level. After adjusting for potential confounders, NAFLD significantly increased the risk of gestational diabetes mellitus ( OR=1.722, 95% CI 1.079-2.747, P=0.023) and gestational hypertension ( OR=3.845, 95% CI 2.247-6.582, P<0.001). Conclusions:Compared to non NAFLD, women with a diagnosis of NAFLD had more significant glucose and lipid metablic aberrations during pregnancy and increased incidence of gestational diabetes and gestational hypertension. Pregnant women with NAFLD should be closely monitored on glucose and lipid metabolism and blood pressure to prevent gestational diabetes mellitus and hypertension.

Uterine artery Doppler in first trimester in prediction of adverse pregnancy outcome in Dharmapuri district of Tamil Nadu

Background: Pregnancies are complicated by hypertensive disorders of about 5-10% and hemorrhage, sepsis, and fetal growth restriction constitute a triad contributing to maternal morbidity and mortality. Hypertensive disorders in pregnancy vary from mildly elevated blood pressure to severe hypertension with multi-organ dysfunction. The study aims to evaluate the first-trimester uterine artery Doppler in the prediction of the development of adverse pregnancy outcomes.Methods: This prospective longitudinal observational was done in Dharmapuri Medical College and Hospital were selected for this study. Totally 150 pregnant women were included in the study. 75 were controls and 75 cases. The study period was from June 2018 to February 2019. Evaluating the optimal definition of abnormal first trimester.Results: Previous obstetric history in the study population. In the study group 3% of bad obstetric history (BOH) present. In the case group, 5% has BOH due to 2 neonatal death and 2 term intrauterine device (IUD), uterine artery Doppler parameters to predict adverse pregnancy outcomes, and association of gestational hypertension in the study groups. In the control group, 1%, and the case group 5% of them had gestational hypertension. Out of 4, 3 had an average uterine artery Doppler more than 2.3 (maximum of 2.7) and 1 had single uterine artery Doppler abnormality.Conclusions: The study showed that first-trimester uterine artery Doppler with single and average uterine artery pulsatility index (PI) >95th centile (2.3) has a better screening value in my population. The overall performance of the first-trimester uterine artery Doppler in the prediction of adverse pregnancy outcomes is valuable.

A study of role of doppler in gestational hypertension and perinatal outcome

Background: Hypertensive disorder of pregnancy is one of the most common complications that affect the human pregnancy. Hence it is important to identify women at risk of developing gestational hypertension or preeclampsia, its early diagnosis and subsequent consequences due to uteroplacental insufficiency with help of Doppler ultrasound, to improve perinatal outcome. The objective of this study was to study the application of Doppler ultrasound with analysis of blood flow velocity waveform in gestational hypertension and to examine and study the perinatal outcome in pregnancy with altered Doppler indices.Methods: A prospective study was carried out in 50 antenatal patients diagnosed to have gestational hypertension during a period of 12 months to evaluate the role of color Doppler imaging in gestational hypertension in patients more than 28 weeks of gestation, the initial scan was performed immediately after the diagnosis. This study analyzed the blood flow in umbilical artery, maternal uterine artery and fetal middle cerebral artery using Doppler ultrasound.Results: In this study approximately 76% of cases were found in 20-30 years group. 58% showed abnormal umbilical artery Doppler while 42% women had normal umbilical artery Doppler. In this study 23 cases had cerebro-placental index <1 and 27 cases had cerebro-placental index >1. Cases with cerebro-placental index <1 had various complications like preterm delivery, low birth weight, increased chances of still birth, intra uterine death (IUD), increased NICU admission. In this study 31 cases had abnormal uterine artery Doppler which accounts for 62% of total cases, while 38% had normal uterine artery Doppler.Conclusions: Doppler ultrasound can reliably predict any adverse fetal outcome in hypertensive pregnancies and can be a useful tool for decision making in appropriate timing of intervention for delivery.

Maternal outcome in pregnancy with thrombocytopenia

Background: Thrombocytopenia is second most common haematological abnormality in pregnancy after anemia. The aim of this study was to find out the prevalence, causative factor of thrombocytopenia and to observe the obstetrics outcome of pregnancies complicated with thrombocytopenia.Methods: This is prospective study of maternal outcome in pregnancy with thrombocytopenia carried out at tertiary care center from February 2019 to January 2020. Out of 350 antenatal screened women, 25 women who were diagnosed with thrombocytopenia, were included in the study.Results: The incidence of maternal thrombocytopenia in this study was 7.1%. 60% of the women had mild thrombocytopenia while 24% and 16% of women were moderate and severe thrombocytopenic respectively. Amongst 25 thrombocytopenic women 68% had gestational thrombocytopenia, 24% had gestational hypertensive disorder,4% had HELLP syndrome, 4% had immune thrombocytopenic purpura. 60% were delivered vaginally and 40% were delivered by LSCS. The most common indication of LSCS was acute fetal distress (40%) followed by failed induction (30%), breech (10%), and the rest (20%) for other obstetrical indications. The most common indication for induction was pre-eclampsia followed by IUGR, and post-date.Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil 4 should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, ITP).

Evaluation of the association between dyslipidemia and hypertensive disorder of pregnancy: a nested case control study

Background: Hypertensive disorders of pregnancy are an elusive group of diseases with multifactorial etiopathologies and varied manifestation. Abnormal pre pregnancy lipid profile is shown to have a positive correlation with endothelial dysfunction which in turn leads to development of hypertensive disorder of pregnancy.Methods: A total of 222 pregnant women who were aged between 18-35 years, with no obstetric and medical risk factors and less than 16 weeks of gestation who gave informed written consent were recruited for the study. Their baseline demographics and fasting blood samples were collected, blood samples were centrifuged, and serum was stored at -80-degree celsius. Patients were followed up till delivery and those with hypertensive disorders in pregnancy (n=22) was identified, defined as case. Control was selected after matching for body mass index and frozen serum samples were analyzed.Results: Overall incidence of hypertensive disorders in pregnancy in the study group was 12.4%. The mean early trimester fasting lipid values were higher in patients who developed hypertensive disorders, difference in mean between cases and controls was TC  - 16.25 mg/dl (p-0.061), TGL- 21.45 mg/dl (p-0.143),  LDL- 2.4 mg/dl (p-0.82) and for HDL 4.55 mg/dl (p-0.25). However, on stratification of early trimester fasting lipid level based on National Cholesterol Education Program (NCEP) criteria, Total cholesterol level greater than 160 mg/dl showed an odds ratio of 12.66 (p-0). Patients with early trimester fasting total cholesterol levels greater than 160mg/dl has a higher risk of developing hypertensive disorder in pregnancy.

Serum magnesium at 18-20 weeks of gestation: can it be a predictor of gestational hypertension and fetomaternal outcome?

Background: Hypertensive disorders of pregnancy (HDP) is a major cause of maternal, fetal morbidity and mortality complicating 10% of all gestations. As effective treatments are very limited, prediction of HDP occurrence is most importance. Though many biomarkers have shown relationship with HDP, serum magnesium (Mg) has shown better predictor as involved in maintaining vascular contractility, tone. This study is intended to analyse incidence of GHT and fetomaternal outcome in pregnant women with normal and low serum magnesium level measured at mid trimester (18-20 weeks).Methods: A total of 105 consecutive singleton pregnant women in between 18-20 weeks of gestation attending OBG outpatient department were enrolled. After obtaining the informed consent, structured proforma was used to collect demographic, clinical details. Serum magnesium was measured by the colorimetric method and study participants were divided into two groups based on Mg cut off 1.5 mg/dl and followed up throughout pregnancy for fetomaternal outcome.Results: This study results revealed that 35.2% (37/105) pregnant women had serum Mg level < 1.5 mg/dl and mean value of Mg of all participant is 1.7 mg/dl, just above the lower limit. During follow-up of these two groups, statistically significant correlation between serum Mg levels (< 1.5 mg/dl) with GHT (8/12) occurrence and pre term birth was found. Other fetomaternal outcome not had significant correlation.Conclusions: As per the findings, serum Mg concentration measurement in between 18-20 weeks can be considered as a one of the predictors for subsequent occurrence of maternal outcome of GHT and fetal outcome of pre-term birth.

Fibronectin as an Early Predictor of Gestational Hypertension/Preeclampsia.

Hypertensive disorders complicate 2% to 8% of pregnancies globally. They are one of the leading causes of maternal mortality responsible for 16% of maternal deaths. Preeclampsia is a pregnancy specific syndrome whose pathophysiologic features have not been clearly established, but research during past two decades has suggested that maternal endothelial damage and improper placental development are involved in the genesis of preeclampsia. Fibronectin is known to be a marker of endothelial dysfunction, which occurs in early gestation in women who develop preeclampsia in later gestation and hence levels of fibronectin may vary in first trimester itself in such women. We wanted to examine the usefulness of single biomarker ‘plasma fibronectin’ in screening of pregnant women for gestational hypertension/preeclampsia, study the difference in fibronectin levels in early versus late onset gestational hypertension/preeclampsia and evaluate its levels in preeclampsia with severe features.METHODS200 antenatal women with singleton pregnancy, who were normotensive were enrolled in the study and plasma fibronectin levels were measured at 10-12 weeks of gestation. Women were followed throughout pregnancy and 12 weeks postpartum. Plasma fibronectin levels were compared between normotensive women and women who developed gestational hypertension/preeclampsia.RESULTSThe mean values of plasma fibronectin are significantly higher in group who developed gestational hypertension/preeclampsia compared to group who remained normotensive (167+/-81 vs 114+/-58; p<0.05). The mean value in group with early onset disease as well as preeclampsia with severe features is higher than that of group with late onset disease and preeclampsia without severe features respectively. But the difference is not statistically significant.CONCLUSIONSStudy showed that plasma fibronectin could be used as a marker for early prediction of gestational hypertension/ preeclampsia.

Desenlaces materno-fetales de los embarazos con trastornos hipertensivos: un estudio transversal / Maternal and fetal outcomes of pregnancies with hypertensive disorders: a cross-sectional study

INTRODUCCIÓN Y OBJETIVO: Los trastornos hipertensivos asociados al embarazo son considerados un problema de salud pública. Se busca describir las características clínicas y desenlaces materno-fetales de las pacientes con esta patología, atendidas en el Hospital Universitario de Santander (HUS) durante el primer semestre de 2017. MÉTODOS: Estudio observacional retrospectivo de corte transversal. Se incluyeron las pacientes en estado de embarazo o puerperio con diagnóstico o sospecha de trastorno hipertensivo; se excluyeron aquellas que no pudieron ser clasificadas o no correspondían a éstos. RESULTADOS: Se analizaron 181 historias clínicas; la edad de las pacientes osciló entre 14 y 44 años; el 43,7% eran primigestantes; el 40,3% tuvo un control prenatal inadecuado y el 27,5% tenía antecedente de trastorno hipertensivo en gestaciones previas. El 75,1% de las pacientes fueron clasificadas como preeclampsia, 18,2% con hipertensión gestacional, 4,4% con hipertensión más preeclampsia sobreagregada y 2,2% con hipertensión crónica. El 16,9% de las pacientes con preeclampsia debutaron antes de la semana 34, de las cuales el 91,3% tenían criterios de severidad; mientras que entre las demás, el 84% presentaron criterios de severidad. CONCLUSIONES: La preeclampsia fue el trastorno hipertensivo más frecuente, predominó la presentación tardía y severa con importantes tasas de complicación maternas y fetales. Mediante la implementación de estrategias de detección temprana y adecuada atención de los trastornos hipertensivos asociados al embarazo podrían mejorarse los desenlaces materno-fetales.

BACKGROUND AND OBJECTIVE: Hypertensive disorders of pregnancy are considered a public health issue. The aim is to describe the clinical features, maternal - fetal outcomes of patients with this disease, who were admitted at the University Hospital of Santander (Bucaramanga, Colombia) during the first half of 2017. METHOD: Cross-sectional retrospective observational study. Patients in pregnancy or puerperium with diagnosis of hypertensive disorder were included; those who could not be classified or did not correspond were excluded. RESULTS: 181 clinical charts were analyzed, the age of the patients ranged between 14 and 44 years, 43.7% were nulliparous, 40.3% had an inadequate prenatal control and 27.5% had history of hypertensive disorder in previous pregnancies. 75.1% were classified as preeclampsia, 18.2% as gestational hypertension, 4.4% as hypertension and superimposed preeclampsia and 2.2% with chronic hypertension; 16.9% of the patients were of an early-onset preeclampsia before week 34, of which 91.3% had criteria of severity; among the others, 84% presented criteria of severity. CONCLUSION: Preeclampsia was the most frequent hypertensive disorder, late and severe presentation prevailed with important maternal and fetal complication rates. Through the implementation of early detection strategies and adequate care of hypertensive disorders associated with pregnancy maternal and fetal outcomes could be improved.

Comparison of ambulatory blood pressure monitoring and self-blood pressure monitoring for diagnosing white coat hypertension amongst pregnant women

Background: White coat hypertension (WCH) is a common and well recognized phenomenon. It is also very prevalent amongst pregnant women and is often diagnosed as chronic/ gestational hypertension leading to unnecessary medications during pregnancy. ABPM is the gold standard for diagnosis of WCH. SBPM is an easy effective and reliable method to measure blood pressure but its efficacy needs to be tested and compared with ABPM in cases of WCH. It is important to compare the two methods in assessing WCH so SBPM can be utilized in cases of WCH, if found useful and efficacious.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for ambulatory blood pressure monitoring (ABPM) for 24 hours and SBPM on 6 hourly bases for 5 days.Results: The ABPM and SBPB readings were noted, tabulated and compared. It was found that the prevalence of ‘WCH’ in this study using ABPM and SBPM were 47.368% (27/54) and 45.614% (26/54) respectively.Conclusions: The results in diagnosing WCH using ABPM and SBPM were comparable.

Prevalence of hypertensive disorders of pregnancy and its maternal outcome in a tertiary care hospital, Salem, Tamil Nadu, India

Background: Hypertensive disorders complicate 5-10% of all pregnancies and together forms the deadly triad- along with hemorrhage and heart disease that contributes greatly to maternal morbidity and mortality. Objective of this study was to determine the prevalence of hypertensive disorders of pregnancy and its maternal complications in patients attending obstetrics and gynaecology department, Government Mohan Kumaramangalam Medical College Hospital, Salem.Methods: This is a prospective study conducted from August 2018 to July 2019 in the department of obstetrics and gynaecology. Patients diagnosed with hypertensive disorders of pregnancy was evaluated and data were collected.Results: A total of 19,383 pregnant women visited obstetrics and gynaecology department over a period of one year, out of which 2028 were diagnosed with hypertensive disorders of pregnancy. Hence the prevalence of hypertensive disorders in pregnancy is 10.4%. Among 2028 hypertensive disorder cases, Gestational hypertension were 962 cases (47.4%), pre-eclampsia 661 cases (32.6%), chronic hypertension 166 cases (8.2%) and pre-eclampsia superimposed on chronic hypertension 239 cases (11.8%). The prevalence was highest among primigravida (54%) compared to multigravida (46%). Hypertensive disorders were highest among the age group of 18-22 years in our study. Most common maternal complication in our study was HELLP syndrome.Conclusions: Prevalence of hypertensive disorders was high in our study. Early detection and timely intervention decrease the maternal complications.

Maternal and perinatal outcome in pregnant women with hypertensive disorders: a population-based study

Background: Hypertension during pregnancy is one of the well-known complications of dating from ancient times. It remains as one of the leading causes of maternal mortality and morbidity through its myriad complications. To study the risk factors, prevalence and epidemiological parameters of antenatal mothers presenting with hypertension during pregnancy.Methods: This study was on hypertensive disorders of pregnancy including mild, severe preeclampsia, eclampsia, and chronic hypertension at Chengalpattu Medical College Hospital, Chengalpattu in a period of 1st year from October 2016 to September 2017.Results: Out of 450 hypertensive pregnancies, the majority were severe preeclampsia (39.6%). There were 78 women with gestational hypertension (17.3%), 125 women with mild preeclampsia (27.8%), 178 women with severe preeclampsia (39.6%), 64 women with eclampsia out of which 52 were AP eclampsia (11.6%), 1 case was IP eclampsia (0.2%) and 11 women were PP eclampsia (2.4%). 5 women were chronic hypertensives (1.1%)Conclusions: Complications can affect all maternal systems including central nervous system, renal system, and hematological systems. Apart from these, the fetus also faces the brunt of insult. Fetal complications include prematurity, low birth weight, stillbirths, intrauterine deaths, and intrauterine growth restrictions. However, such vast complications can be prevented by simple blood pressure monitoring and proper antenatal mother follow-up.

Analysis of maternal clinical risk factors for different degrees of small for gestational age infant / 上海交通大学学报（医学版）

Objective : To explore the pregestational and gestational risk factors associated with small for gestational age infant (SGA) by dif-ferent degrees. Methods ¡¤ Mothers and single newborns delivered at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2013 to December 2016 were included. Multivariate Logistic regression was used to analyze the correlation between maternal preg-nancy and pre-pregnancy risk factors and the occurrence of SGA by different degrees. Results ¡¤ There were no statistically significant differ-ences in maternal age, number of birth, education level, incidence of preterm birth and fetal sex in SGA. Maternal body mass index (BMI), gesta-tional hypertension and accepting assisted reproduction were significantly correlated with SGA (all P<0.05). The incidence of moderate SGA in mothers with low pre-pregnancy BMI and gestational hypertension were 3.6 and 4.0 times higher than that of the mothers with normal BMI and blood pressure. The incidence of severe SGA in mothers receiving assisted reproduction was 6.4 times higher than that in those who did not. Mild SGA was not associated with the above risk factors. Conclusion ¡¤ Maternal low BMI and hypertension are the risk factors of moderate SGA and accepting assisted reproduction are the risk factors of severe SGA, and the risk factors of SGA by different degrees are not the same.

Spot protein/creatinine ratio as a marker for fetomaternal outcome in hypertensive disorder of pregnancy

Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana.Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for pre-elampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed.Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day.Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.