Concentric Cardiac Remodeling and Hypertrophy in Pregnant Individuals with Chronic Hypertension.

OBJECTIVE: This study aimed to evaluate rates of superimposed preeclampsia in pregnant individuals with echocardiography-diagnosed cardiac geometric changes in the setting of chronic hypertension. STUDY DESIGN: This was a retrospective study of pregnant individuals with chronic hypertension who delivered singleton pregnancies at 20 weeks' gestation or greater at a tertiary care center. Analyses were limited to individuals who had an echocardiogram during any trimester. Cardiac changes were categorized as normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy according to the American Society of Echocardiography guidelines. Our primary outcome was early-onset superimposed preeclampsia defined as delivery at less than 34 weeks' gestation. Other secondary outcomes were also examined. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for prespecified covariates. RESULTS: Of the 168 individuals who delivered from 2010 to 2020, 57 (33.9%) had normal morphology, 54 (32.1%) had concentric remodeling, 9 (5.4%) had eccentric hypertrophy, and 48 (28.6%) had concentric hypertrophy. Non-Hispanic black individuals presented over 76% of the cohort. Rates of the primary outcome in individuals with normal morphology, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were 15.8, 37.0, 22.2, and 41.7%, respectively (p = 0.01). Compared with individuals with normal morphology, individuals with concentric remodeling were more likely to have the primary outcome (aOR: 3.28; 95% CI: 1.28-8.39), fetal growth restriction (crude OR: 2.98; 95% CI: 1.05-8.43), and iatrogenic preterm delivery <34 weeks' gestation (aOR: 2.72; 95% CI: 1.15-6.40). Compared with individuals with normal morphology, individuals with concentric hypertrophy were more likely to have the primary outcome (aOR: 4.16; 95% CI: 1.57-10.97), superimposed preeclampsia with severe features at any gestational age (aOR: 4.75; 95% CI: 1.94-11.62), iatrogenic preterm delivery <34 weeks' gestation (aOR: 3.60; 95% CI: 1.47-8.81), and neonatal intensive care unit admission (aOR: 4.82; 95% CI: 1.90-12.21). CONCLUSION: Concentric remodeling and concentric hypertrophy were associated with increased odds of early-onset superimposed preeclampsia. KEY POINTS: · Concentric remodeling and concentric hypertrophy were associated with an increased risk of superimposed preeclampsia.. · Concentric hypertrophy was associated with an increased risk of delivery at less than 34 weeks.. · Two-thirds of the individuals in our study had concentric hypertrophy and concentric remodeling..

Real-Time Continuous Glucose Monitoring in Gestational Diabetes: A Randomized Controlled Trial.

OBJECTIVE: To evaluate whether real-time continuous glucose monitoring improves glycemic control over intermittent self-monitoring of blood glucose in gestational diabetes. STUDY DESIGN: We performed a single-institution randomized controlled trial. Patients with gestational diabetes were randomized to use either real-time or blinded continuous glucose monitoring. The primary outcome was mean sensor glucose level during the fourth week of continuous glucose monitoring use. Secondary outcomes included glycemic control and a composite of obstetric and neonatal outcomes. RESULTS: Of the 40 enrolled patients, 12 (60%) patients in the blinded continuous glucose monitoring group and 11 (55%) in the real-time continuous glucose monitoring group completed 4 weeks of monitoring and were included in the final analysis. There was no significant difference in mean sensor glucose level between the blinded continuous glucose monitoring group (98.9 ± 8.9 mg/dL) and the real-time continuous glucose monitoring group (107.5 ± 11.4 mg/dL). There were also no significant differences in the time spent in glycemic target, maternal, or neonatal outcomes. CONCLUSION: Our study shows that the use of continuous glucose monitoring with real-time feedback did not significantly decrease mean glucose values compared with intermittent self-monitoring of blood glucose after 4 weeks of continuous glucose monitoring use.