Signs or symptoms of suspected preeclampsia - A retrospective national database study of prevalence, costs, and outcomes.

BACKGROUND: Most patients with signs or symptoms (s/s) of suspected preeclampsia are not diagnosed with preeclampsia. We sought to determine and compare the prevalence of s/s, pregnancy outcomes, and costs between patients with and without diagnosed preeclampsia. METHODS: This retrospective cohort study analyzed a large insurance research database. Pregnancies with s/s of preeclampsia versus a confirmed preeclampsia diagnosis were identified using International Classification of Diseases codes. S/s include hypertension, proteinuria, headache, visual symptoms, edema, abdominal pain, and nausea/vomiting. Pregnancies were classed as 1) s/s of preeclampsia without a confirmed preeclampsia diagnosis (suspicion only), 2) s/s with a confirmed diagnosis (preeclampsia with suspicion), 3) diagnosed preeclampsia without s/s recorded (preeclampsia only), and 4) no s/s, nor preeclampsia diagnosis (control). RESULTS: Of 1,324,424 pregnancies, 29.2 % had ≥1 documented s/s of suspected preeclampsia, and 14.2 % received a preeclampsia diagnosis. Hypertension and headache were the most common s/s, leading 20.2 % and 9.2 % pregnancies developed to preeclampsia diagnosis, respectively. Preeclampsia, with or without suspicion, had the highest rates of hypertension-related severe maternal morbidity (HR [95 % CI]: 3.0 [2.7, 3.2] and 3.6 [3.3, 4.0], respectively) versus controls. A similar trend was seen in neonatal outcomes such as preterm delivery and low birth weight. Cases in which preeclampsia was suspected but not confirmed had the highest average total maternal care costs ($6096 [95 % CI: 602, 6170] over control). CONCLUSION: There is a high prevalence but poor selectivity of traditional s/s of preeclampsia, highlighting a clinical need for improved screening method and cost-effectiveness disease management.

Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura.

OBJECTIVE: To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP) or chronic ITP (cITP) diagnosed before or during pregnancy. METHODS: A linkage of mothers and babies within a large U.S. health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. RESULTS: Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live births were preterm. CONCLUSIONS: The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy.

Impact of maternal nutrition and metabolism on health of the offspring.

Since the original publication of the theory of the fetal origins of adult diseases more than 15 years ago, extensive epidemiological studies have linked the environment in utero to adult health. Maternal nutrition and metabolism are major mechanisms by which the intrauterine environment programs the health of the offspring. Both growth-restricted and overgrown fetuses are at risk for postnatal disease. This paper summarizes the nutritional and metabolic causes of both these conditions and also reviews the interventions that have been tested to mitigate these effects.

Increased incidence of cardiac anomalies in pregnancies complicated by gastroschisis.

OBJECTIVE: The purpose of this study was to determine the incidence of congenital heart defects (CHD) in infants with gastroschisis. STUDY DESIGN: Infants with gastroschisis repair were identified from California hospital discharge data during the years 1992 to 1997. The frequency of concomitant diagnosis of CHD and other demographic, neonatal, and pregnancy outcomes were examined. RESULTS: Sixty-nine of the 621 infants had a diagnosis of CHD, with 16 having more than 1 lesion. Excluding cases possibly attributable to persistent fetal circulation, 25 infants with CHD remained, for an incidence rate of 4%. There was a significant (P = .014) increase in incidence of CHD in cases of gastroschisis complicated by bowel atresia. African American infants with gastroschisis had an increased risk of CHD (P = .009) compared with infants of other ethnicities. CONCLUSION: Contrary to conventional teaching that gastroschisis is an isolated anomaly, we found an increased incidence of concomitant CHD. Our data would suggest that detailed antepartum and/or postnatal cardiac evaluations are indicated in fetuses identified with gastroschisis.