Risk Prediction Model for Hypertensive Disorders of Pregnancy Based on Routine Laboratory Indicators and Risk Factors: A Retrospective Analysis

Background: Hypertensive disorder of pregnancy (HDP) is a group of diseases in which pregnancy and elevated blood pressure coexist. There is still a lack of reliable clinical tools to predict the incidence of HDP. The purpose of this study was to establish and validate a nomogram prediction model for assessing the risk of HDP in pregnant women based on laboratory indicators and HDP risk factors. Method: A total of 307 pregnant women who were hospitalized in the obstetrics and gynecology department of our hospital were included in this study, and were randomly divided into a training cohort and validation cohort at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for the development of HDP on laboratory indicators as well as risk factors for HDP in the training cohort of patients. The results of the multivariate regression model were visualized by forest plots. A nomogram was constructed based on the results of multivariate logistic regression to predict the risk of HDP in pregnant women. The validity of the risk prediction model was evaluated by the area under the receiver operating characteristic curve (AUC), the consistency index (C-index), the calibration curve and the decision curve analysis (DCA). Results: BMI ≥ 25 Kg/m2, total cholesterol in early pregnancy, uric acid and proteinuria in late pregnancy were independent risk factors for HDP. The AUC and C-index of the nomogram constructed by the above four factors were both 0.848. The calibration curve is closely fitted with the ideal diagonal, showing a good consistency between the nomogram prediction and the actual observation of HDP. The DCA has demonstrated the great clinical utility of nomogram. Internal verification proves the reliability of the predicted nomograms. Conclusion: The BTUP nomogram model based on laboratory indicators and risk factors proposed in this study showed good predictive value for the risk assessment of HDP. It is expected to provide evidence for clinical prediction of the risk of HDP in pregnant women.

Prevalence of hypertensive disorders of pregnancy,associated factors and pregnancy complications in a primigravida population

Background:Hypertensive disorders of pregnancy(HDP)are among obstetrics'most intriguing and yet unsolved problems.It is one of the major causes of maternal and perinatal morbidity and mortality.This study estimates the prevalence of hypertensive disorders of pregnancy,their associated risk factors and pregnancy complications in primiparous women.Methods:All primigravida who gave birth in our hospital from December 2020 to December 2021 were included in the study.The prevalence,risk factors,mode of delivery,and maternal and fetal outcomes of hypertensive disorders of pregnancy in primigravidae were collected from the patient's medical records.Statistical analysis was done using the SPSS 18.0 software package.The Chi-square test was used to analyse the association between the risk factors and hypertensive disorders of pregnancy in primigravida.Results:A total of 807 women were included in the study,and the mean age was 26.34±3.84 years.The prevalence of hypertensive disorders of pregnancy in primigravidae was found to be 18.6%.Among the prevalent population,79.3%of women had gestational hypertension.The findings indicate that hypertension in pregnancy has a significant relationship with risk factors such as increased maternal age(p<0.004),family history of hypertension in pregnancy(p<0.001),body mass index>30 kg/m^(2)(p<0.001),hyperglycaemia in pregnancy(p<0.001),IVF pregnancy(p<0.004)and polycystic ovary syndrome(p<0.001).The most reported adverse maternal and perinatal outcomes were placental abruption(p<0.001),postpartum haemorrhage(p<0.001),prematurity(p<0.001),and fetal growth restriction(p<0.001).Conclusion:The study emphasises the importance of knowledge and timely assessment of risk factors of HDP.It also highlights the need for pre-conceptional counselling,which includes early detection,careful monitoring and treatment of HDP for preventing morbidity and mortality related to this disorder and it should be followed up even in the postpartum period.

Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

Background： Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy （HDP） can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy （GDFT） with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods： Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer＇s solution （LR）, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume （ASV） provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results： The severity of HDP was similar between two groups. The total LR infusion （P 〈 0.01） and urine output （P 〈 0.05） were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group （P 〈 0.01）. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased （P 〈 0.05）, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased （P 〈 0.05） than in the GDFT group. Conclusions： Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to stable HDP parturient and their babies.

Prognosis of Patients with Pregnancy Hypertensive Disorders Followed in University Hospital to Parzakou in 2020

Introduction: Hypertensive disorders of pregnancy (HDP) are often accompanied by cardiovascular sequelae. The objective of this study was to describe the prognosis in the postpartum period of patients with HDP in Departmental University Hospital of Borgou CHUD-B from Parakou in 2020. Methods: The study was prospective with a descriptive and analytical design and was conducted from January 2020 to September 2020. Patients with HDP were recruited from the gynecology-obstetrics department and each followed for 3 months in the cardiology department. HDP was classified according to the International Society for the Study of Hypertension in Pregnancy, and blood pressure (BP) was taken according to WHO recommendations. Self-measurement of BP at home was performed to assess blood pressure control outside the hospital. Epidata 3.1 and SPSS 21 software were used for data processing and analysis. P values < 5% were considered statistically significant. Results: During the study period, the hospital frequency of HDP was 15.6%. The frequency of maternal complications in the postpartum period was 28% (severe hypertension: 23.2%;eclampsia: 3.6%;puerperal psychosis: 1.2%). At the end of the three-month follow-up, blood pressure returned to normal in 73.2% of cases;it persisted in 26.8% of women. Factors associated with persistence of hypertension after multivariate analysis were, overweight/obesity RRa 8.664 [1.566 - 47.941], (p = 0.013);family history of hypertension RRa 6.499 [1.493 - 28.289], (p = 0.013);history of hypertension in previous pregnancies RRa 7.764 [1.561 - 38.601], (p < 0.012). Conclusion: The frequency of HDP is not negligible at CHUD-B/A. The evolution of these HDP was marked in more than a quarter of cases by complications in the postpartum period followed by a persistence of hypertension 3 months after childbirth predicted by cardiovascular risk factors.

Hypertension and associated complications in pregnant women with chronic kidney disease

The growing incidence of obesity and the rising trend of increased age during pregnancy have led to a high number of pregnant women with chronic kidney disease(CKD).Chronic hypertension is commonly associated with CKD and is not only the result of renal damage but is also the cause of declining renal function.Pregnancy and its unique physiological adaptations are affected by a decrease in the filtration capacity of the kidneys.Preeclampsia is a disorder of the vascular endothelium and is exacerbated by endothelial dysfunction resulting from CKD.Blood pressure targets must be strictly maintained owing to overlapping disease pathogenesis and to minimize cardiovascular damage.Moreover,preexisting renal dysfunction poses a challenge in identifying superimposed preeclampsia,which alters the management strategies in pregnancy.Fetal outcomes in patients with CKD are considerably affected by the presence of hypertension.This review is expected to aid in developing a focused and individualized treatment plan for hypertension in pregnant women with CKD to improve pregnancy outcomes and preserve postpartum renal function.

Adverse Effects of Exposure to Fine Particulate Matters and Ozone on Gestational Hypertension

Gestational hypertension(GH)is a common complication during pregnancy.GH is regarded as a potential public health challenge for pregnant women and infants.Limited evidence has linked ambient air pollution to an increased GH risk.However,most of the studies were conducted in developed countries,with inconsistent results obtained.The present study was performed to explore whether exposure to particulate matters with an aerodynamic diameter≤2.5(PM2.5)and ozone(O3)was related to elevated odds of GH in a Chinese population.This population-based cohort study involved 38115 pregnant women in Wuhan,China.All information was collected from the Wuhan Maternal and Child Health Management Information System,using standardized quality control.The daily air pollutant data for PM2.5 and O3 were obtained from the 20 monitoring stations of the Wuhan Environmental Monitoring Center during 2014.The nearest monitor approach was applied to individual exposure assessment of PM2.5 and O3 for each participant.After adjusting for major confounders and other air pollutants,a 10μg/m^3 increase in PM25 and O3 concentrations was found to correlate to a 1.14-fold[95%confidence interval(95%CI):1.09,1.20]and a 1.05-fold(95%CI:1.02,1.07)increase in GH risk,respectively.Additionally,stronger relationships between GH risk and PM25 and O3 exposure were observed in women who conceived in winter and summer,respectively.These findings suggest that air pollutants may contribute to the development of GH.

Effect of antioxidants on amelioration of high-risk factors inducing hypertensive disorders in pregnancy

Background This is a prospective clinical study based on a large sample gathered from multiple centers in China, subordinating to 10th Five-Year Plan of National Science ＆ Technology Progression. We analyzed the high-risk factors inducing hypertensive disorders in pregnancy （HDP） and estimated the potential effect of anti-oxidants administration, including vitamin C （VC）, vitamin E （VE） and Salvia Miltiorrhiza L （SML）, a Chinese herb medicine, in amelioration of the high-risk factors in pregnancy. Methods From April 2005 to July 2006, 4814 pregnant women from 24 national wide cooperative hospitals were involved in this prospective research. The participants were randomly divided into two groups： 1607 cases were in anti-oxidants group with administration of vitamins and SML; 3207 cases were in control group without any medicine given. Every participant was under monitoring for the morbidity of HDP and the high-risk factors were investigated in HDP cases in each group. Results （1）The morbidity of HDP was 3.55% in anti-oxidants group vs. 4.18% in control group. No statistical difference existed between the two groups （P〉0.05）. （2） In anti-oxidants group, the HDP morbidities among three subgroups： VC ＋ VE ＋ SML, VC ＋ VE and SML only, were 5.51%, 3.05% and 5% respectively. It showed no statistical difference among three remedies （P 〉0.05）. （3） The related index of factors affecting HDP showed in intensity sequence as follows： family HDP history 〉 profession 〉 education level 〉 age 〉 body weight. The incidence of HDP in normal population was 3.51%, and the incidence of HDP in high-risk pregnant women （family HDP history, heavy physical labor, low education level （middle school and below）, age 〉40, body mass index 〉24） was 5.84%, which was obviously higher than that in normal population （P 〈0.01）. In anti-oxidants group, the probability of HDP in women with high-risk factors was 3.81%, which was obviously lower than that in control group with high-risk factors at 7.14% （P〈0.01）. （4） In control group, the morbidity of HDP in women with family HDP history （especially with sisters＇）, heavy physical labor, middle school and below, age 〉35 was： 50.00%, 15.22%, 6.33%, 26.28% and 5.75%, respectively, and that in anti-oxidants group was 0, 7.69%, 3.74%, 9.27% and 2.67%, respectively, which was obviously lower than that in control group. Conclusions The high-risk factors prone to induce HDP included： family history of HDP, heavy physical labor, low education level, aging and obesity. No impressive effect of anti-oxidants application was found in preventing HDP in general population but the remedy demonstrated positive effect on preventing HDP in pregnant women with high-risk factors.