Association of maternal hypertensive disorders in pregnancy with infant neurodevelopment

Inconsistent findings have been reported regarding the associations between hypertensive disorders in pregnancy (HDP) and infant neurodevelopment. Leveraging data from the Jiangsu Birth Cohort, in the present study, we re-visited such associations in one-year-old infants from 2 576 singleton pregnancies and 261 twin pregnancies. We first assessed infant neurodevelopment by the Bayley Scales of Infant and Toddler Development Screening Test (the Third Edition), and then estimated its association with maternal HDP using general linear regression models and Poisson regression models. In singleton pregnancies, compared with mothers unexposed to HDP, infants born to mothers with chronic hypertension exhibited a lower score (β, −0.67;95% confidence interval [CI], −1.19-−0.15) and a higher risk of "non-optimal" gross motor development (risk ratio [RR], 2.21;95% CI, 1.02-4.79);in twin pregnancies, infants born to mothers with HDP exhibited lower scores in cognition (β, −0.49;95% CI, −0.96-−0.01), receptive communication (β, −0.55;95% CI, −1.03-−0.06), and gross motor (β, −0.44;95% CI, −0.86-−0.03), and at a higher risk of "non-optimal" gross motor development (RR, 2.12;95% CI, 1.16-3.88). These findings indicate that infants born to mothers with HDP may have inferior neurodevelopment outcomes at the age of one year.

Changes and Clinical Value of Serum Cortisol Levels in Patients with Hypertensive Disorder in Pregnancy

Objective:To investigate the changes and the corresponding clinical value of serum cortisol levels in patients with hypertensive disorders during pregnancy.Methods:In this study,90 patients with different degrees of hypertensive disorders during pregnancy who were admitted from August 2018 to August 2019 in our hospital were set as the research objects.90 cases were grouped according to the diagnostic criteria in Obstetrics and Gynecology,including 30 cases in each of the hypertension group,the preeclampsia group,and the eclampsia group.Another 30 healthy pregnant women were selected as the control group.The serum cortisol levels of pregnant women in the above four groups were measured.Results:Compared with the control group,the serum cortisol levels in the other three groups were significantly increased.In perinatal outcome,compared with the control group,the three groups of patients had an increase in Apgar score,preterm birth,stillbirth rate,growth restriction rate and neonatal asphyxia rate.There were significant differences between groups(P<0.05),and showed as gestational hypertension<preeclampsia<eclampsia.Conclusion:With the exacerbation of hypertensive disorders during pregnancy,the serum cortisol level continues to increase,which has a serious adverse effect on the prognosis of the perinatal infants.

Iron supplementation for non-anaemic pregnant women and the incidence of hypertensive disorders in pregnancy:A systematic review and meta-analysis

Objective:To investigate effect of iron supplementation on the risk of hypertensive disorders in pregnancy in non-anaemic pregnant women.Methods:A literature search was conducted using three categories of terms with its synonyms or related words:"iron","supplement",“hypertensive disorders in pregnancy”through MEDLINE(OVID),CINAHL,PubMed,Cochrane Library,Scopus,Web of Science,ICTRP,and ClinicalTrials.gov,and manual search of references was used in seven potential resources.The inclusion criteria were randomized control trials(RCTs),published in English,full-text available,having healthy pregnant women without anaemia for study participants,and having hypertensive disorders in pregnancy at the end of pregnancy as the outcome.The risk of bias assessment tool was used for quality appraisal.Meta-analysis was conducted by calculating the fixed and random effects of the odds ratio(OR)for iron supplementation among non-anaemic pregnant women compared with the incidence of hypertensive disorders in pregnancy.The range of the study’s estimation accuracy was reflected by a 95%confidence interval(CI).Results:Four RCTs were included in the meta-analysis.The pooled results showed that iron supplementation possibly had no effect on the incidence of hypertensive disorders in pregnancy(OR 0.93,95%CI 0.81-1.07;P=0.30),gestational hypertension(OR 1.37,95%CI 0.69-2.73;P=0.36)as well as on the development of preeclampsia(OR 1.45,95%CI 0.71-2.97;P=0.31).Conclusions:Iron supplementation has no effect on the incidence of hypertension in non-anaemic pregnant women.In general,there is a lack of evidence for the association between iron supplementation and the incidence of hypertensive disorders in pregnancy among non-anaemic pregnant women,and further studies are needed.

Qualitative Analysis of Diagnostic Value of 24-h Proteinuria for Preeclampsia

Background： Preeclarnpsia （PE） is a serious idiopathic disease posing a threat to both mothers and fetuses＇ lives during pregnancy, whose main diagnostic criteria include hypertension with proteinuria. However, American College of Obstetricians and Gynecologists （ACOG） updated the diagnostic criteria for PE and redtlced the diagnostic value of proteinuria for patients with PE. Qualitative analysis of the diagnostic value of 24-h proteinuria for patients with PE in China was conducted to evaluate the diagnostic criteria value in the latest ACOG guideline. Methods： Complete clinical data of 65 patients with hypertensive disorder in pregnancy （HDP） were collected. All patients were delivered to and hospitalized in Renji Hospital. Adverse outcome was defined in case of the emergence of any serious complication for a mother or the fetus. A retrospective study was conducted according to ACOG guideline, to analyze the relationship between each diagnostic criteria of ACOG guideline and maternal and perinatal outcomes. Spearman correlation test was used to detect the association between each diagnostic criterion, its corresponding value, and the adverse pregnancy outcome. Logistic regression was performed to verily the result of Spearman correlation test. Results： Of 65 HDP patients, the percentage of adverse pregnancy outcome was 63.1%. Adverse pregnancy outcomes constitute diversification. There were 55 cases with 24-h proteinuria value ≥0.3 g, of which the adverse outcome rate was 74.5%. While adverse pregnancy outcomes did not appear in the rest 10 HDP patients with proteinuria 〈0.3 /24 h. The statistic difference was significant （P = 0.000）. However, no significant difference was tbund in other criteria groups （impaired liver function： P = 0.417; renal insufficiency： P = 0.194; thrombocytopenia： P - 0.079： and cerebral or visual symptoms： P = 0.296）. The correlation coefficient between 24-h proteinuria ≥0.3 g and adverse pregnancy outcomes was 0.557 （P 〈 0.005）. hnpaired liver function （P = 0.180）, renal insufficiency （P =0.077） and cerebral or visual symptoms （P = 0.118） were not related to adverse outcomes, The 24-h proteinuria value （HDP： r= 0.685; PE： r= 0.521）, liver enzyme value （HDP： r= 0.519; PE： r= 0.501）, and creatinine value （HDP： r= 0.511; PE： r= 0.398） were associated with adverse pregnancy outcomes both in PE and HDP, and the corresponding logistic regression equation can be produced. Conclusions： The 24-h proteinuria value is still an important diagnostic criterion for PE, and deletion of 24-h proteinuria value from diagnostic criteria for severe PE was not recommended. The diagnostic criteria in ACOG guideline need to be verified in Chinese women.