Analysis of factors related to postpartum depression in pregnancyinduced hypertension syndrome patients and construction and evaluation of nomograms

BACKGROUND It is positive to integrate and evaluate the risk factors for postpartum depression in patients with pregnancy-induced hypertension syndrome and to detect highrisk patients as early as possible,which has application value for the clinical development of personalized prevention programs and prognosis of patients.AIM To analyze factors related to postpartum depression in patients with pregnancyinduced hypertension and construct and evaluate a nomogram model.METHODS The clinical data of 276 patients with pregnancy-induced hypertension admitted to Huzhou Maternity and Child Health Care Hospital between January 2017 and April 2022 were retrospectively analyzed.We evaluated the depression incidence at 6 wk postpartum.The depression group included patients with postpartum depression,and the remainder were in the non-depression group.Multivariate logistic regression analysis and the LASSO regression model were applied to analyze the factors related to postpartum depression in patients with pregnancyinduced hypertension.After that,a risk prediction model nomogram was constructed and evaluated.RESULTS Multivariate logistic regression analysis showed that vitamin A deficiency(VAD)during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,eicosapentaenoic acid(EPA),and docosahexaenoic acid(DHA)were independent risk factors for postpartum depression in patients with pregnancy-induced hypertension(P<0.05).We constructed the nomogram model based on these five risk factors.The area under the curve,specificity,and sensitivity of the model in predicting postpartum depression in patients with pregnancy-induced hypertension was 0.867(95%confidence interval:0.828–0.935),0.676,and 0.889,respectively.The average absolute error was 0.037(Hosmer-Lemeshow testχ2=10.739,P=0.217).CONCLUSION VAD during pregnancy and puerperium,family history of hypertension,maternal intestinal flora imbalance,EPA,and DHA affect postpartum depression in patients with pregnancy-induced hypertension.

硫化氢在妊娠高血压综合征发病中的变化及意义

目的 研究新型气体信号分子硫化氢 (H2 S)在妊娠高血压综合征 (PIH)和正常孕妇血浆中H2 S水平的差异 ,探讨其在妊娠高血压综合征发病中可能发挥的作用。方法 重度先兆子痫组 18例 ,对照组 2 0例 ,测定产前血浆H2 S含量 ,并动态监测重度先兆子痫组产后第 3天的血浆H2 S含量 ,分析重度先兆子痫组和对照组血浆H2 S含量的差异以及与血压的关系。结果 重度先兆子痫组产前血浆中H2 S含量为 3 1.93± 8.2 3 μmol/L ,低于对照组的 5 3 .17± 9.0 4μmol/L ,差异有显著性 (P <0 .0 5 )。重度先兆子痫组产后第 3天的血浆H2 S含量为 2 6.2 3± 13 .2 6,与产前相比 ,无显著性差异 (P >0 0 5 )。血浆H2 S含量与收缩压 /舒张压呈负相关 (R值分别为 -0 .75 6和 -0 .746)。结论 H2 S下调可能与妊娠高血压综合征发病有关。

Increased apoptosis in third - trimester placental tissue from gestations complicat-ed by PIH

Objective: To investigate a possible role of apoptosis in the pathophysiologic mechanisms of PIH (pregnancy-induced hypertension syndrome).Methods: In this study, placental samples were obtained from 16 uncomplicated third-trimester pregnancies and from 16 cases of PIH.We used light microscopy, electron microscopy to identify apoptosis.Light microscopy was used to quantify their incidence of apoptosis.Electron microscopy was used to confirm the occurrence of apoptosis.Results: Apoptosis has been conclusively demonstrated within human third-trimester placental tissue.Medians and interquartile ranges of normal placenta (n=16) was 0.12% (0.08%-0.19%); Medians and interquartile ranges of PIH group (n=16) was 0.37% (0.15%-0.49%).Compared to normal placentas, the incidence of apoptosis was higher in placentas from gestations complicated by PIH (P<0.05, T'-test).Conclusion: Placental apoptosis increases significantly in PIH, and it may play a role in the pathophysiologic mechanisms of this syndrome.

Isolated proteinuria as an initial sign of severe preeclampsia

Two pregnant women who initially developed proteinuria alone followed by serious preeclampsia are presented to emphasize that there is no adequate technical term to express the period of proteinuria alone based on the current criteria of pregnancy-induced hypertension. Case 1 exhibited a urinary protein concentration of 46 mg/dL in the absence of hypertension, and abdominal pain due to placental abruption with hypertension at gestational week (GW) 29–3/7 and 29–4/7, respectively. Case 2 exhibited a urinary protein/creatinine ratio of 2.67, developed hypertension, required cesarean section, and developed posterior reversible encephalopathy syndrome at GW 28–1/7, 29–6/7, and 32–0/7, and on postpartum day 2, respectively. As women with proteinuria alone are not diagnosed as having preeclampsia and as a diagnosis of gestational proteinuria can be made only at 12 weeks postpartum, a prospective technical term applicable to the condition of proteinuria alone is needed to increase physicians’ attention to this condition.