Neurodevelopmental assessment of infants born to mothers with hypertensive disorder of pregnancy at six months of age

Abstract Infant neurodevelopment is a complex process which may be affected by different events during pregnancy, such as hypertensive disorders of pregnancy (HDP). We conducted a prospective cohort study to compare the prevalence of neurodevelopmental disorders in infants born to mothers with and without HDP at six months of age. Participants attended the Health Observatory of Instituto de Desarrollo e Investigaciones Pediátricas “Prof. Dr. Fernando E. Viteri” during 2018 and 2019. Infant neurodevelopment was assessed with the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III). Data were analyzed using Chi-square, Student’s t-test and Mann–Whitney test. Of the 132 participating infants, 68 and 64 were born to mothers with and without HDP, respectively. At six months, the prevalence of risk of neurodevelopmental delay was significantly higher in infants born to mothers with than without HDP (27.9% vs. 9.4%; p = 0.008) (odds ratio, 3.71; 95% confidence interval, 1.30; 12.28). In conclusion, infants born to mothers with HDP had three times increased risk of neurodevelopmental delay at six months of age.

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Coronavirus Disease 2019 (COVID-19) And The Risk of Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

10.21203/rs.3.rs-583136/v1 ◽

2021 ◽

Author(s):

Michael Baracy ◽

Fareeza Afzal ◽

Susanna Szpunar ◽

MaKenzie Tremp ◽

Karlee Grace ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk ◽

Hypertensive Disorders In Pregnancy ◽

Hypertensive Disorder Of Pregnancy ◽

The Impact

Abstract Purpose: To evaluate the association of hypertensive disorders of pregnancy with SARs-CoV-2 infection in pregnant women.Methods: We conducted a retrospective cohort study of all pregnant patients with positive SARs-CoV-2 molecular test at four participating hospitals located in a large metropolitan city and who delivered between February 1st and November 24th, 2020. Patients who tested positive during their pregnancy and delivered (index cases) were compared to the three subsequent deliveries of patients who tested negative (controls) at the same institution. We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy.Results: A total of 280 patients were included in the study: 70 patients who tested positive for Coronavirus Disease-2019 and 210 matched controls. Compared with pregnancies negative for SARS-CoV-2 infection, COVID-19 was associated with an increased risk of developing a hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were significantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). Of COVID-19 positive patients, an early SARS-CoV-2 infection (prior to 32 week’s gestation) conferred a higher risk of hypertensive disorders in pregnancy (OR=6.29, CI 1.64-24.07; p=0.007). There was no difference in route of delivery, preterm birth, intrauterine growth restriction, intrauterine fetal demise, or pregnancy and fetal outcomes.Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy.Tweetable AbstractPatients who test positive for COVID-19 during their pregnancy are at increased risk of developing a hypertensive disorder of pregnancy compared to pregnant patients who test negative for COVID-19. Earlier SARs-CoV-2 infection results in increased risk of developing a hypertensive disorder. Furthermore, even patients who are asymptomatic but positive for SARs-CoV-2 during their pregnancy have a higher risk of developing a hypertensive disorder of pregnancy.

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Adverse Perinatal Outcomes Associated with Stage 1 Hypertension in Pregnancy: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0041-1739470 ◽

2021 ◽

Author(s):

Elizabeth Norton ◽

Frances Shofer ◽

Hannah Schwartz ◽

Lorraine Dugoff

Keyword(s):

Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Hypertensive Disorder ◽

Hypertension In Pregnancy ◽

Increased Risk ◽

Hypertensive Disorder Of Pregnancy ◽

Adverse Perinatal Outcomes ◽

Stage 1 ◽

In Pregnancy

Objective To determine if women who newly met criteria for stage 1 hypertension in early pregnancy were at increased risk for adverse perinatal outcomes compared with normotensive women. Study Design We conducted a retrospective cohort study of women who had prenatal care at a single institution and subsequently delivered a live infant between December 2017 and August 2019. Women with a singleton gestation who had at least two prenatal visits prior to 20 weeks of gestation were included. We excluded women with known chronic hypertension or other major maternal illness. Two groups were identified: (1) women newly diagnosed with stage 1 hypertension before 20 weeks of gestation (blood pressure [BP] 130–139/80–89 on at least two occasions) and (2) women with no known history of hypertension and normal BP (<130/80 mm Hg) before 20 weeks of gestation. The primary outcome was any hypertensive disorder of pregnancy; secondary outcomes were indicated preterm birth and small for gestational age. Generalized linear models were used to compare risk of adverse outcomes between the groups. Results Of the 1,630 women included in the analysis, 1,443 women were normotensive prior to 20 weeks of gestation and 187 women (11.5%) identified with stage 1 hypertension. Women with stage 1 hypertension were at significantly increased risk for any hypertensive disorder of pregnancy (adjusted risk ratio [aRR]: 1.86, 95% confidence interval [CI]: 1.12–3.04) and indicated preterm birth (aRR: 1.83, 95% CI: 1.12–3.02). Black women and obese women with stage 1 hypertension were at increased for hypertensive disorder of pregnancy compared with white women and nonobese women, respectively (aRR: 1.32, 95% CI: 1.11–1.57; aRR: 1.69, 95% CI: 1.39–2.06). Conclusion These results provide insight about the prevalence of stage 1 hypertension and inform future guidelines for diagnosis and management of hypertension in pregnancy. Future research is needed to assess potential interventions to mitigate risk. Key Points

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Hypertension, pregnancy and weather: is seasonality involved?

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.02.006 ◽

2014 ◽

Vol 60 (2) ◽

pp. 105-110 ◽

Cited By ~ 3

Author(s):

Brena Melo ◽

Melania Amorim ◽

Leila Katz ◽

Isabela Coutinho ◽

José Natal Figueiroa

Keyword(s):

Relative Humidity ◽

Correlation Coefficient ◽

Pearson Correlation ◽

Hypertensive Disorder ◽

Air Humidity ◽

Hypertensive Disorders Of Pregnancy ◽

Monthly Temperature ◽

Hypertensive Disorders ◽

Relative Air Humidity ◽

Hypertensive Disorder Of Pregnancy

Objective: The present study aimed at assessing the association between environmental temperature and the relative humidity of the air with frequency of hypertensive disorders of pregnancy. Methods: A prospective and retrospective, descriptive, ecological study was held at a teaching maternity in Recife, Brazil. Data from all 26.125 pregnant women admitted between 2000 and 2006 were analysed and 5.051 had the diagnosis of hypertensive disorder of pregnancy. The incidence percentages were calculated monthly per deliveries. Data on mean monthly temperature and relative humidity of the air were collected and monthly comparisons were conducted. February was chosen as the reference month due to its lowest incidence of the disease. The relative chance of hypertensive disorders of pregnancy for each other month was estimated by odds ratio and Pearson's correlation coefficient was used to calculate the relation between the incidence of hypertensive disorders of pregnancy and the mean monthly temperature and relative air humidity. Results: February presented the lowest mean monthly incidence (9.95%) and August the highest (21.54%). Pearson correlation coefficient revealed a higher incidence of hypertensive disorders of pregnancy in the cooler months (r= -0.26; p=0.046) and no significant effect of relative air humidity (r=0.20; p=0.128). Conclusion: The incidence of hypertensive disorders of pregnancy may be affected by variations in temperature, increasing during cooler periods.

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Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00440.2016 ◽

2017 ◽

Vol 312 (1) ◽

pp. R5-R12 ◽

Cited By ~ 26

Author(s):

Frank T. Spradley

Keyword(s):

Pregnant Women ◽

Vascular Dysfunction ◽

Hypertensive Disorder ◽

Metabolic Abnormalities ◽

Obese Women ◽

Maternal Circulation ◽

Increased Risk ◽

Tnf Α ◽

Hypertensive Disorder Of Pregnancy ◽

Factor Α

Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.

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Neurodevelopmental delay in normocephalic children with in utero exposure to Zika virus

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000486 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000486 ◽

Cited By ~ 11

Author(s):

Adriana Virginia Faiçal ◽

Juliana Cabral de Oliveira ◽

João Vitor Vieira Oliveira ◽

Breno Lima de Almeida ◽

Iluska Andrade Agra ◽

...

Keyword(s):

Early Detection ◽

Zika Virus ◽

In Utero ◽

In Utero Exposure ◽

Neurodevelopmental Delay ◽

Toddler Development ◽

Bayley Scales

Neurodevelopment in 29 normocephalic children with in utero exposure to Zika virus (ZIKV) was evaluated by the Bayley Scales of Infant and Toddler Development-Third Edition. Ten (35%) infants presented neurodevelopment delay. Language, cognitive and motor delays were identified in 9 (31%), 4 (14%) and 1 (3%) infants, respectively. Children exposed to ZIKV in utero must undergo careful evaluations for the early detection of any neurodevelopment delays in order to implement prompt intervention.

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Association between legal status, prenatal care utilization, severe perinatal and maternal morbidity

European Journal of Public Health ◽

10.1093/eurpub/ckz185.273 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Eslier ◽

T Schmitz ◽

D Luton ◽

L Mandelbrot ◽

C Estellat ◽

...

Keyword(s):

Prenatal Care ◽

Maternal Morbidity ◽

Legal Status ◽

Severe Maternal Morbidity ◽

Care Utilization ◽

Hypertensive Disorder ◽

Prenatal Care Utilization ◽

Increased Risk ◽

Hypertensive Disorder Of Pregnancy ◽

Inadequate Prenatal Care

Abstract Background Some groups of migrant women have a higher risk of inadequate prenatal care utilization (PCU), severe maternal morbidity (SMM) and severe perinatal morbidity (SPM). To better understand this association, our aim was to assess the association between the legal status and PCU, SMM and SPM during pregnancy. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort. All pregnant women registered for delivery in 4 university hospital maternity units in Paris north area from October 2010 to May 2012 were included (N = 10 419). Women whose pregnancies ended before 22 weeks of gestation or who delivered in another maternity unit were excluded (N = 820). Women were distributed according to legal status in 4 groups: non-migrants, migrants with French or European nationality, legal migrants and undocumented migrants. The associations between the legal status and the composite variables of prenatal care utilization, SMM and SPM were tested through multivariate logistic regressions also adjusted for maternal characteristics. Results The illegal status was associated with increased risk of inadequate prenatal care utilization [adjusted odds ratio (aOR) 2,52 (2,10 - 3,01)]. Overall, the prevalence of SMM was 3,2 % and SPM 7,0 %. The illegal status was associated with higher risk of SMM [aOR 1,84 (1,21 - 2,79)], especially severe hypertensive disorder of pregnancy [aOR 2,29 (1,19 - 4,40)]. However, no significant association with SPM was found [aOR 1,29 (0,95 - 1,74)]. The sensitivity analysis demonstrates that results do not change after exclusion of women who arrived less than 12 months before delivery and those who started their follow-up after 14 weeks of gestation. Conclusions The illegal status was associated with an inadequate prenatal care utilization and a higher risk of SMM, especially severe hypertensive disorder of pregnancy. Key messages The illegal status was associated with increased risk of inadequate prenatal care utilization. The illegal status was associated with higher risk of severe maternal morbidity during pregnancy.

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Maternal Serum Uric Acid as a Predictor of Severity of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study

Current Hypertension Reviews ◽

10.2174/1573402114666181112141953 ◽

2019 ◽

Vol 15 (2) ◽

pp. 154-160

Author(s):

Naina Kumar ◽

Amit K. Singh

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Gestational Hypertension ◽

Tertiary Care ◽

Mode Of Delivery ◽

Maternal Serum ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Tertiary Care Centre ◽

Hypertensive Disorder Of Pregnancy

Objective: To assess the relationship between maternal serum uric acid and severity of Hypertensive disorders of pregnancy in a rural tertiary care centre. Materials and Methods: Present study was conducted in Obstetrics and Gynaecology department of rural tertiary care centre of Northern India over seven months (October 2016-May 2017) on 110 women admitted with a Hypertensive disorder of pregnancy (Gestational hypertension, Preeclampsia, Eclampsia) at ≥;34 weeks gestation. Maternal serum uric acid levels were compared in three groups in relation to disease severity, mode of delivery, maternal outcome. Results: Of total 110 women with a Hypertensive disorder of pregnancy; 35 (31.81%) had Gestational Hypertension, 49 (44.54%) preeclampsia and 26 (23.63%) had eclampsia. Mean±SD values for serum uric acid were 5.47±1.93 mg/dl in women with Gestational Hypertension; 6.72±2.15 mg/dl in Pre-eclampsia and 8.71±2.97 mg/dl in the eclamptic group. Of 110 women 34(97.14%) with gestational hypertension, 27(55.10%) with pre-eclampsia and one (3.85%) with eclampsia remained stable in post-partum period, 17 (34.69%) women with severe pre-eclampsia and 15 (57.69%) with eclampsia required intensive care in postpartum period and one (2.86%) women with gestational hypertension, five (10.20%) with pre-eclmapsia and ten (38.46%) with eclampsia required ventilator support and high dependency unit care. Of these 16 women with the severe disease, ten succumbed to death. Also, in women with serum uric acid,>6mg/dl, most common mode of delivery was a lower segment cesarean section (50.90%). Conclusion: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome.

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Incidence of Hypertensive Disorders of Pregnancy in Women with COVID-19

American Journal of Perinatology ◽

10.1055/s-0041-1727167 ◽

2021 ◽

Author(s):

Rebecca Chornock ◽

Sara N. Iqbal ◽

Tiffany Wang ◽

Samantha Kodama ◽

Tetsuya Kawakita ◽

...

Keyword(s):

Task Force ◽

Chronic Hypertension ◽

Hypertensive Disorder ◽

Washington Dc ◽

Labor And Delivery ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Universal Testing ◽

Hypertensive Disorder Of Pregnancy ◽

Time Of Admission

Objective The study aimed to examine the incidence of hypertensive disorders of pregnancy in women diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, also known as COVID-19). Study Design This was a retrospective cohort study of all women who delivered at MedStar Washington Hospital Center in Washington, DC from April 8, 2020 to July 31, 2020. Starting April 8, 2020, universal testing for COVID-19 infection was initiated for all women admitted to labor and delivery. Women who declined universal testing were excluded. Hypertensive disorders of pregnancy were diagnosed based on American College of Obstetricians and Gynecologists Task Force definitions.1 Maternal demographics, clinical characteristics, and labor and delivery outcomes were examined. Neonatal outcomes were also collected. Laboratory values from admission were evaluated. Our primary outcome was the incidence of hypertensive disorders of pregnancy among women who tested positive for COVID-19. The incidence of hypertensive disorders of pregnancy was compared between women who tested positive for COVID-19 and women who tested negative. Results Of the 1,008 women included in the analysis, 73 (7.2%) women tested positive for COVID-19, of which 12 (16.4%) were symptomatic at the time of admission. The incidence of hypertensive disorders of pregnancy was 34.2% among women who tested positive for COVID-19 and 22.9% women who tested negative for COVID-19 (p = 0.03). After adjusting for race, antenatal aspirin use, chronic hypertension, and body mass index >30, the risk of developing any hypertensive disorder of pregnancy was not statistically significant (odds ratio: 1.58 [0.91–2.76]). Conclusion After adjusting for potential confounders, the risk of developing a hypertensive disorder of pregnancy in women who tested positive for COVID-19 compared with women who tested negative for COVID-19 was not significantly different. Key Points

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Isolated CHDs and neurodevelopmental follow-up using the Bayley Scales of Infant and Toddler Development and the Ages and Stages Questionnaire at 18 and 36 months

Cardiology in the Young ◽

10.1017/s1047951121002195 ◽

2021 ◽

pp. 1-8

Author(s):

Mette Marie Baunsgaard ◽

Tine B. Henriksen ◽

Charlotte K. Gilberg ◽

Dorthe B. Wibroe ◽

Trine Haugsted ◽

...

Keyword(s):

Fetal Brain ◽

Fetal Mri ◽

Z Score ◽

Gross Motor ◽

Score Difference ◽

Increased Risk ◽

Ages And Stages Questionnaire ◽

Toddler Development ◽

Bayley Scales

Abstract Objectives: To compare early neurocognitive development in children born with and without isolated CHD using the Bayley Scales of Infant and Toddler Development (3rd edition) and the Ages and Stages Questionnaire (3rd edition). Methods: Recruitment took place before birth. Women expecting fetuses with and without CHD causing disturbances in the flow of oxygenated blood to the fetal brain were included in a prospective cohort study comprising fetal MRI (previously published) and neurodevelopmental follow-up. We now present the 18- and 36-month neurodevelopmental follow-up using the Bayley Scales according to age and the 6-month-above-age Ages and Stages Questionnaire in 15 children with and 27 children without CHD. Results: Children with CHD had, compared with the children without CHD, an increased risk of scoring ≤ 100 in the Bayley Scales cognition category at 18 and 36 -months; relative risk 1.7 (95% confidence interval (CI): 1.0–2.8) and 3.1 (CI: 1.2–7.5), respectively. They also achieved lower scores in the 6-month-above-age Ages and Stages Questionnaires (24 and 42 months) communication; mean z-score difference −0.72 (CI: −1.4; −0.1) and −1.06 (CI: −1.8; −0.3) and gross motor; mean z-score difference: −0.87 (CI: −1.7; −0.1) and −1.22 (CI: −2.4; −0.02) categories. Conclusions: The children with CHD achieved lower scores in the Bayley Scales cognition category and the Ages and Stages Questionnaire communication and gross motor categories possibly indicative of early neurodevelopmental deficiencies. We recommend early screening and monitoring for neurodevelopmental delays in children with CHD in order to improve further neurodevelopment and educational achievements.

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COMPARATIVE STUDY OF FIBRINOGEN LEVEL IN NORMAL PREGNANCY, HYPERTENSIVE DISORDERS OF PREGNANCY AND INTRAUTERINE FOETAL DEATH.

10.36106/ijar/8702219 ◽

2021 ◽

pp. 69-71

Author(s):

Saloni Saloni ◽

Sarita Tirkey ◽

Prashant Raman

Keyword(s):

Normal Pregnancy ◽

Blood Parameters ◽

Control Group ◽

Total Leucocyte Count ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Foetal Death ◽

Mortality And Morbidity ◽

Hypertensive Disorders ◽

Hypertensive Disorder Of Pregnancy

Introduction: Haemostatic failure as a result of Obstetric complication of hypertensive disorders of pregnancy and intrauterine foetal death is an important cause of maternal mortality and morbidity. The assessment of the coagulation parameters is important to diagnose the severity of the disease. To compare Aims and Objectives- serum brinogen in normal pregnancy and in hypertensive disorder of pregnancy and intrauterine foetal death. This study was conducte Materials and Methods: d in the department of Obstetrics and Gynaecology, RIMS, Ranchi during the period of April'16 to September'17. A total of 450 patients after 28 weeks of gestation were taken for the study. 150 were cases of hypertensive disorder of pregnancy and 150 were intrauterine foetal death. 150 patients were taken as control for the comparative analysis. The brinogen levels in present study decrea Results: sed signicantly in patients with hypertensive disorder of pregnancy and IUD. The mean value of brinogen in normal patient was 446.72±38.35 mg/dl, in patients with hypertensive disorder of pregnancy was 413.96±74.07 mg/dl and in patients with IUD was 360.07±95.23mg/dl. There was a signicant difference noted in routine blood parameters such as Haemoglobin, Platelets and Total Leucocyte count in study group. The coagulation prole was also found to be deranged in the study population. The maternal and perinatal outcome in PIH and IUD was worse than in control group. The Conclusion: estimation of plasma brinogen is helpful not only in the early diagnosis of haemostatic failure but also to guide replacement therapy during the brinogen depletive state.

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