Does genetically-defined ancestry predict booking blood pressure in pregnant women with chronic hypertension?

Background: Hyperhomocysteinemia is an important biological marker for adverse outcome of pregnancy. Objective: The aim of the present study was to see the association of high serum homocysteine with preeclampsia (PE). Methodology: This cross sectional study was carried out in the Department of Obstetrics and Gynaecology at Sir Salimullah Medical College & Mitford Hospital, Dhaka. All pregnant women with or without eclampsia admitted at the hospital were included in this study. Pregnant women with diabetes mellitus, chronic hypertension, multiple pregnancies, chronic renal disease and patients taking anti-folate drugs were excluded from this study. Fasting serum total homocysteine (tHomocysteine) concentration was estimated by Fluorescence Polarization Immunoassay (FPIA) method. Result: A total number of 50 PE patient [Severe PE (23) & Mild PE (27)] and 50 pregnant women without PE were selected purposively. Fasting serum total homocysteine (tHomocysteine) concentration was estimated by fluorescence polarization immunoassay (FPIA) method. Mean serum homocysteine concentration in severe PE, mild PE and pregnant women without PE were 11.5 4.58 mol/L, 10.43 5.12 and 5.70 1.30 respectively. Serum homocysteine was significantly increased in severe PE and mild PE in comparison to without PE group . Howere severe PE and mild PE group cases did not differ with respect to serum homocysteine. Conclusion: Significant positive correlation was found between serum homocysteine concentration and urinary total protein, uric acid level, systolic blood pressure and diastolic blood pressure. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16200 J Shaheed Suhrawardy Med Coll, 2013;5(1):21-25

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Pregnant women’s experiences with the management of hypertensive disorders of pregnancy: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07320-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amyna Helou ◽

Kay Stewart ◽

Kath Ryan ◽

Johnson George

Keyword(s):

Blood Pressure ◽

Qualitative Study ◽

Pregnant Women ◽

Clinical Management ◽

Blood Pressure Monitoring ◽

Chronic Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Pressure Monitoring ◽

Hypertensive Disorders ◽

Management Of Complications

Abstract Background Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management. Methods A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data. Results Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition. Conclusions The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.

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Socioeconomic, demographic and obstetric profile of pregnant women with Hypertensive Syndrome in a public maternity

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2020.20190180 ◽

2020 ◽

Vol 41 ◽

Author(s):

Lia Maristela da Silva Jacob ◽

Artur Paiva Santos ◽

Maria Helena Baena de Moraes Lopes ◽

Antonieta Keiko Kakuda Shimo

Keyword(s):

High School ◽

Blood Pressure ◽

Body Mass Index ◽

Pregnant Women ◽

Body Mass ◽

Gestational Age ◽

Skin Color ◽

High School Education ◽

Chronic Hypertension ◽

Elevated Blood

ABSTRACT Objective: To describe the socioeconomic, demographic and obstetric profile of pregnant women with Gestational Hypertensive Syndrome. Methods: A descriptive and correlational study, conducted in Maternity School Assis Chateaubriand, with 120 pregnant women, through a questionnaire analyzed by descriptive and analytical statistics. Results: most women had chronic hypertension (60.83%). Regarding the socioeconomic and demographic profile, most pregnant women had a mean age of 30.9 ± 6.9 years, were Catholic, brown skin color, employed, in stable unions, complete high school education, and income of up to R$ 954.00. Regarding the obstetric profile, their Body Mass Index was up to 66, slightly elevated blood pressure, an average of five prenatal consultations, two pregnancies, one delivery and no abortions. Women with chronic hypertension were older (p = 0.0024), had lower gestational age (p = 0.0219) and a higher number of abortions (p = 0.0140). Conclusions: Pregnant women are overweight/obese, with a mean age of 30.9 years and are socially vulnerable. Pregnant women with chronic hypertension are older and have a higher number of abortions.

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Correlation Between Divided Doses of Chronic Antihypertensive Drugs and Pregnancy Outcomes

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2020.52 ◽

2017 ◽

Vol 8 (3) ◽

pp. 328-332

Author(s):

Safura Hatamipour Dehno ◽

Simin Taghavi ◽

Nayyereh Ayati

Keyword(s):

Blood Pressure ◽

Pregnant Women ◽

Antihypertensive Drugs ◽

Gestational Hypertension ◽

Blood Pressure Monitoring ◽

Perinatal Outcomes ◽

Chronic Hypertension ◽

Pressure Monitoring ◽

Fetal Complications

Objectives: Hypertension, as a common problem during pregnancy, is a major cause of maternal and fetal morbidity and mortality. Anti-hypertensive drugs are used to prolong the pregnancy or modify perinatal outcomes in pregnant women with hypertensive disorders. Severe monitoring of blood pressure is subsequently essential in these mothers. The aim of this study was to evaluate the correlation between divided doses of chronic hypertensive drugs and the end of pregnancy in mothers with gestational hypertension. Materials and Methods: In this prospective research, 99 pregnant women with chronic hypertension, who were treated with antihypertensive medicines, were studied during pregnancy. During routine follow-up of these mothers, the number of the drug and the divided doses were recorded. The incidence of maternal and fetal outcomes were evaluated according to the number of less or more than 5 divided doses. Results: Maternal and fetal-baby complications were observed in 5.50 and 5.53% cases, respectively. The incidence of maternal and fetal complications were significantly enhanced by increasing the number of up-taken anti-hypertensive drugs. The maternal and fetal-baby complications were higher in mothers who received more than five divided doses compared to those who received less than five doses. Conclusion: Based on our results, chronic hypertension was associated with maternal and fetal-baby complications in half of the cases. It is clarified that precise blood pressure monitoring and regularly taking of anti-hypertensive medicine may decrease the hypertension side effects. The awareness about this field in the pre-pregnancy consulting is considered as the patients’ rights and should be respected.

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Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study

BMJ Open ◽

10.1136/bmjopen-2019-035762 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035762

Author(s):

Rebecca Whybrow ◽

Louise Webster ◽

Joanna Girling ◽

Heather Brown ◽

Hannah Wilson ◽

...

Keyword(s):

Blood Pressure ◽

Decision Making ◽

Pregnant Women ◽

Healthcare Professionals ◽

Severe Hypertension ◽

Target Blood Pressure ◽

Barriers And Facilitators ◽

Internal Conflict ◽

Chronic Hypertension ◽

Hypertension Guidelines

ObjectiveTo evaluate the implementation of National Institute for Health and Care Excellence antenatal hypertension guidelines, to identify strategies to reduce incidences of severe hypertension and associated maternal and perinatal morbidity and mortality in pregnant women with chronic hypertension.MethodsWe used a multiple method multisite approach to establish implementation of guidelines and the associated barriers and facilitators. We used a national survey of healthcare professionals (n=97), case notes review (n=55) and structured observations (n=42) to assess implementation. The barriers and facilitators to implementation were identified from semistructured qualitative interviews with healthcare professionals (n=13) and pregnant women (n=18) using inductive thematic analysis. The findings were integrated and evaluated using the Consolidated Framework for Implementation Research.Setting and participantsPregnant women with chronic hypertension and their principal carers (obstetricians, midwives and physicians), at three National Health Service hospital trusts with different models of care.ResultsWe found severe hypertension to be prevalent (46% of case notes reviewed) and target blood pressure practices to be suboptimal (56% of women had an antenatal blood pressure target documented). Women were infrequently given information (52%) or offered choice (19%) regarding antihypertensives. Women (14/18) reported internal conflict in taking antihypertensives and non-adherence was prevalent (8/18). Women who were concordant with treatment recommendations described having mutual trust with professionals mediated through appropriate information, side effect management and involvement in decision making. Professionals reported needing updates and tools for target blood pressure setting and shared decision making underpinned by antihypertensive safety and effectiveness research.ConclusionsWomen’s non-adherence to antihypertensives is higher than anticipated. Suboptimal information provision around treatment, choice of antihypertensives and target setting practices by healthcare professionals may be contributory. Understanding the reasons for non-adherence will inform education and decision-making strategies needed to address both clinician and women’s behaviour. Further research into the effectiveness and long-term safety of common antihypertensives is also required.

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Features of prevention of fetal growth retardation in pregnant women with chronic hypertension

Biomedical and Biosocial Anthropology ◽

10.31393/bba37-2019-07 ◽

2019 ◽

pp. 44-48

Author(s):

O. V. Deinichenko ◽

Yu. Ya. Krut ◽

N. G. Izbytska ◽

O. M. Slinko ◽

N. V. Gaidai ◽

...

Keyword(s):

Blood Pressure ◽

Acetylsalicylic Acid ◽

Pregnant Women ◽

Fetal Growth ◽

Growth Retardation ◽

Chronic Hypertension ◽

Fetal Growth Retardation ◽

Clinical Protocols ◽

Group A ◽

Group B

The lack of effective methods to prevent the development of fetal growth retardation in high-risk pregnant women remains a significant problem of modern obstetrics, which determines the relevance of the study. The aim of the study was to examine the effectiveness of monoprophylaxis of fetal growth retardation using aspirin at a dose of 150 mg, starting at 12-13 weeks of gestation, pregnant women with chronic hypertension. In order to apply and implement the proposed prevention of fetal growth retardation, all pregnant women with chronic hypertension were divided into two groups. The patients were divided into groups randomly. To prevent the development of fetal growth retardation, patients in group A received acetylsalicylic acid at 150 mg/day, patients in group B received acetylsalicylic acid at 100 mg/day. Primary examination of pregnant women in a prospective study was performed during pregnancy 11-12 weeks in all groups, which included: history taking, general clinical examination, blood pressure measurement, obstetric and gynecological examination according to clinical protocols of the Ministry of Health of Ukraine № 417 from 15.07.2011, № 676 dated 31.12.2004. Clinical and instrumental examination was performed: blood pressure and ECG monitoring, Doppler examination. Childbirth and initial assessment of the condition of newborns were performed in accordance with the current orders of the Ministry of Health of Ukraine with the assessment of the condition on the Apgar scale and the result of anthropometry (determination of mass and growth rate). It was found that the age characteristics of the group of pregnant women did not differ statistically significantly: the average age of patients in group A reached 27.3±1.6 years, group B – 28.1±1.8 years. According to the obstetric and gynecological history, the women did not differ. It should be noted that statistically significant differences between the main group and the comparison group by the degree of chronic hypertension (grade 1 and 2) were not detected: 30 % of women in group A and 35 % of group B had chronic hypertension grade 1, 70 % and 65 %, respectively – chronic arterial hypertension of 2 degrees. Among the concomitant lesions in pregnant women were determined: obesity 8 women of group A (26.7 %), 8 people (25.8 %) of group B; varicose veins in 3 women (10.0 %) of group A, 4 people (12.9 %) of group B; pathology of the urinary system – in 2 cases (6.6 %) in group A and in 2 people (6.45 %) of group B; pathology of the thyroid gland – 2 women (6.6 %) of group A, and 1 person (3.22 %) of group B, anemia of pregnant women – in 4 women (13.3 %) of group A, and 4 people (12.9 %) of group B; chronic viral hepatitis C in remission in 1 woman of group B (3.22 %). As a result of the analysis of pregnancies and complications of childbirth, we found that the appointment of acetylsalicylic acid in addition to standard treatment of chronic arterial hypertension in accordance with clinical protocols at a dose of 150 mg/day helped reduce the incidence of disorders of uteroplacental and fetal circulation by 2.7 times, fetal growth retardation – by 8,8 times and small to gestational age fetus – 4.8 times compared with the results of patients who received acetylsalicylic acid at a dose of 100 mg/day.

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