The association of first trimester uterine arteries Doppler velocimetry with different clinical phenotypes of hypertensive disorders of pregnancy: a longitudinal study

Objective:To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS.Methods:We performed a retrospective population-based cohort study and nested case-control study in Finland 1987-2016. The Medical Birth Register (MBR) was linked with the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period, in 5-year age groups and pregnancy/postpartum period were calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors.Results:After chart review, 29.6% (257/868) of cases were PAS. The incidence of PAS was 14.5 (95%CI: 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987-1991 to 2012-2016 (p<0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from ages 20-24 to ages >40 (p<0.0001). During early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95%CI: 1.2-2.7), migraine (OR 16.3, 95%CI: 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95%CI: 2.5-6.3) were the most important risk factors for PAS.Conclusion:PAS incidence is increasing stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.Classification of Evidence:This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

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Maternal Serum EG-VEGF as A First Trimester Predictor of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study

10.21203/rs.3.rs-156363/v1 ◽

2021 ◽

Author(s):

Shiyu Zeng ◽

Ling Yu ◽

Yiling Ding ◽

Mengyuan Yang

Keyword(s):

Cohort Study ◽

Growth Factor ◽

Prediction Model ◽

Pregnant Women ◽

Predictive Value ◽

Prospective Cohort ◽

First Trimester ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Sensitivity Specificity

Abstract Background This study aims to explore whether plasma endocrine gland-derived vascular endothelial growth factor (EG-VEGF) in the first trimester can be used as a predictor of hypertensive disorders of pregnancy (HDP), and compare it with placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) to evaluate its prediction of HDP value. Methods This is a prospective cohort study that records the medical history of the pregnant women included in the study at 11–13 weeks’ gestation, and analyzes serum biochemical markers including EG-VEGF, PIGF, sFlt-1 and sFlt-1/PIGF. The predictive values of these tests were determined. We used the receiver operating characteristic (ROC) curve to find the optimal cut-off value for each biomarker and compare the operating characteristics (sensitivity, specificity). Logistic regression analysis was used to create a prediction model for HDP based on maternal characteristics and maternal biochemistry. Results Data were obtained from 205 pregnant women. 17 cases were diagnosed with HDP, the incidence rate was 8.2% (17/205). Women who developed HDP had a significantly higher body mass index (BMI) and mean arterial pressure (MAP). Serum EG-VEGF levels in the first trimester are significantly higher in pregnant women with HDP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value(NPV) of serum EG-VEGF levels more than 227.83 pg/ml for predicting HDP were 43%, 93%, 86% and 62%, respectively. We established a prediction model in the first trimester include maternal BMI, MAP, and EG-VEGF, with an AUC of 0.8861 (95%CI: 0.7905–0.9818), which is better than using EG-VEGF alone (AUC: 0.66). Conclusion This study demonstrated that serum EG-VEGF is a promising biomarker for predicting HDP in the first trimester. It has better predictive performance compared with the currently used biomarkers like PIGF and sFlt-1. Combining maternal clinical characteristics and biochemical tests at 11–13 weeks can effectively identify women at high risk of HDP.

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High Fetal Fraction on First Trimester Cell-Free DNA Aneuploidy Screening and Adverse Pregnancy Outcomes

American Journal of Perinatology ◽

10.1055/s-0039-1694005 ◽

2019 ◽

Vol 37 (01) ◽

pp. 008-013 ◽

Cited By ~ 4

Author(s):

Lydia L. Shook ◽

Mark A. Clapp ◽

Penelope S. Roberts ◽

Sarah N. Bernstein ◽

Ilona T. Goldfarb

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

First Trimester ◽

Hypertensive Disorders Of Pregnancy ◽

Aneuploidy Screening ◽

Hypertensive Disorders ◽

Increased Risk ◽

Adverse Pregnancy ◽

Fetal Fraction

Abstract Objective To test the hypothesis that high fetal fraction (FF) on first trimester cell-free deoxyribonucleic acid (cfDNA) aneuploidy screening is associated with adverse perinatal outcomes. Study Design This is a single-institution retrospective cohort study of women who underwent cfDNA screening at <14 weeks' gestation and delivered a singleton infant between July 2016 and June 2018. Women with abnormal results were excluded. Women with high FF (≥95th percentile) were compared with women with normal FF (5th–95th percentiles). Outcomes investigated were preterm birth, small for gestational age, and hypertensive disorders of pregnancy. Results A total of 2,033 women met inclusion criteria. The mean FF was 10.0%, and FF >16.5% was considered high (n = 102). Women with high FF had a greater chance of delivering a small for gestational age infant <fifth percentile, with an adjusted odds ratio of 2.4 (95% confidence interval: 1.1–4.8, p = 0.039). There was no significant association between high FF and either preterm birth or hypertensive disorders of pregnancy. Conclusion Women with a high FF in the first trimester are at increased risk of delivering a small for gestational age infant <fifth percentile. Further investigation into the clinical implications of a high FF is warranted.

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Cardiovascular biomarkers and vascular function during childhood in the offspring of mothers with hypertensive disorders of pregnancy: findings from the Avon Longitudinal Study of Parents and Children

European Heart Journal ◽

10.1093/eurheartj/ehr300 ◽

2011 ◽

Vol 33 (3) ◽

pp. 335-345 ◽

Cited By ~ 77

Author(s):

D. A. Lawlor ◽

C. Macdonald-Wallis ◽

A. Fraser ◽

S. M. Nelson ◽

A. Hingorani ◽

...

Keyword(s):

Longitudinal Study ◽

Vascular Function ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Parents And Children ◽

Avon Longitudinal Study ◽

Cardiovascular Biomarkers

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Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy

Journal of Clinical Ultrasound ◽

10.1002/jcu.22823 ◽

2020 ◽

Vol 48 (7) ◽

pp. 388-395 ◽

Cited By ~ 1

Author(s):

Denise S. Matias ◽

Rebeca Santos ◽

Tatiana Ferreira ◽

Bruno S. Matias ◽

Luis Cláudio L. Correia

Keyword(s):

Predictive Value ◽

Ophthalmic Artery ◽

Doppler Velocimetry ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders

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A risk model of prenatal screening markers in first trimester for predicting hypertensive disorders of pregnancy

The EPMA Journal ◽

10.1007/s13167-020-00212-3 ◽

2020 ◽

Vol 11 (3) ◽

pp. 343-353

Author(s):

Yiming Chen ◽

Zhen Xie ◽

Xue Wang ◽

Qingxin Xiao ◽

Xiao Lu ◽

...

Keyword(s):

Prenatal Screening ◽

Risk Model ◽

First Trimester ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders

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Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

10.21203/rs.2.24053/v1 ◽

2020 ◽

Author(s):

Xiujuan Su ◽

Yan Zhao ◽

Yingying Yang ◽

Jing Hua

Keyword(s):

Particulate Matter ◽

Fine Particulate Matter ◽

First Trimester ◽

Antenatal Clinic ◽

Hypertensive Disorders Of Pregnancy ◽

Singleton Pregnancy ◽

Pm 2.5 ◽

Hypertensive Disorders ◽

Fine Particulate ◽

Nulliparous Women

Abstract Background Association between fine particulate matter (PM 2.5 ) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM 2.5 in early pregnancy with HDP. A retrospective cohort study was performed among 8,776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women’s hospital during 2014 - 2015. Land use regression models were used to predict individual levels of PM 2.5 exposure. Results The average PM 2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m -3 [median, 51.4 μg m -3 ; interquartile range, 47.3 - 57.8 μg m -3 ]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed an exposure-response relationship between the PM 2.5 concentration and risk of HDP. We observed an association between PM 2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m -3 , 95% CI: 1.45 - 10.43), but not during the second trimester (RR = 0.71 per 10 μg m -3 , 95% CI: 0.40 - 1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM 2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46 - 1.38)]. Conclusion Our findings suggest that PM 2.5 exposure during the first trimester is associated with the development of HDP, and the association is modified by parity.

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