Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups.

Hypertension ◽  
2021 ◽  
Author(s):  
Erica P. Gunderson ◽  
Mara Greenberg ◽  
Mai N. Nguyen-Huynh ◽  
Cassidy Tierney ◽  
James M. Roberts ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Early Pregnancy ◽  
Latent Class ◽  
Gestational Hypertension ◽  
Individual Risk ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Race Ethnicity ◽  
Trajectory Group ◽  
Blood Pressure Patterns

Background: Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality and 4-fold higher perinatal mortality in Black women. Early pregnancy blood pressure patterns may differentiate risk of hypertensive disorders of pregnancy. Methods: This study identified distinct blood pressure trajectories from 0 to 20 weeks’ gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174 925 women with no prior hypertension or history of preeclampsia, prenatal care entry ≤14 weeks, and a stillborn or live singleton birth delivered at Kaiser Permanente Northern California hospitals in 2009 to 2019. We used electronic health records to obtain clinical outcomes, covariables, and longitudinal outpatient blood pressure measurements ≤20 weeks’ gestation (mean 4.1 measurements). Latent class trajectory modeling identified 6 blood pressure groups: ultra-low-declining(referent), low-declining, moderate-fast-decline, low-increasing, moderate-stable, and elevated-stable. Multivariable logistic regression evaluated trajectory group-associations with odds of preeclampsia and gestational hypertension and effect modification by race-ethnicity and prepregnancy body size. Results: Compared with ultra-low-declining, adjusted odds ratios (95% CIs) for low-increasing, moderate-stable, and elevated-stable groups were 3.25 (2.7–3.9), 5.3 (4.5–6.3), and 9.2 (7.7–11.1) for preeclampsia, and 6.4 (4.9–8.3), 13.6 (10.5–17.7), and 30.2 (23.2–39.4) for gestational hypertension. Race/ethnicity, and prepregnancy obesity modified the trajectory-group associations with preeclampsia (interaction P <0.01), with highest risks for Black, then Hispanic and Asian women for all blood pressure trajectories, and with increasing obesity class. Conclusions: Early pregnancy blood pressure patterns revealed racial and ethnic differences in associations with preeclampsia risk within equivalent levels and patterns. These blood pressure patterns may improve individual risk stratification permitting targeted surveillance and early mitigation strategies.

scholarly journals Furosemide for Accelerated Recovery of Blood Pressure Postpartum in Women with a Hypertensive Disorder of Pregnancy

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1517-1524 ◽  
Author(s):  
Joana Lopes Perdigao ◽  
Jennifer Lewey ◽  
Adi Hirshberg ◽  
Nathanael Koelper ◽  
Sindhu K. Srinivas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Gestational Hypertension ◽  
Controlled Trial ◽  
Severe Disease ◽  
Hypertensive Disorder ◽  
Adjusted Relative Risk ◽  
Hypertensive Disorders Of Pregnancy ◽  
Double Blind ◽  
Hypertensive Disorders

Persistent postpartum hypertension is a significant cause of maternal morbidity. Our objective was to study the effect of furosemide on postpartum blood pressure recovery in women with hypertensive disorders of pregnancy. We performed a randomized, double-blind, placebo-controlled trial of a 5-day course of 20 mg oral furosemide versus placebo in women with gestational hypertension and preeclampsia with/without severe features from June 2018 to October 2019. Primary outcomes were persistent hypertension at 7 days postpartum (using generalized linear models to calculate adjusted relative risk) and days to resolution of hypertension (Kaplan-Meier curves), stratified by severe/nonsevere hypertensive disease. Secondary outcomes included readmissions and need for additional hypertensive medication.We randomized 384 women (192 per group). Baseline characteristics were similar except cesarean delivery rate was higher in the furosemide group (29% versus 20%; P =0.04). In women randomized to furosemide, there was a 60% reduction in the prevalence of persistently elevated blood pressure at 7 days when controlling for cesarean (adjusted relative risk, 0.40 [95% CI, 0.20–0.81]). The magnitude of reduction was greater in women with nonsevere disease (adjusted relative risk, 0.26 [95% CI, 0.10–0.67]). Number of days to blood pressure resolution was significantly shorter among women with nonsevere disease randomized to furosemide (8.5 versus 10.5; P =0.001). There were no significant differences in readmissions or need for additional antihypertensive medication postpartum between groups. In this double-blinded randomized trial, a short course of postpartum furosemide significantly improved blood pressure control in women with hypertensive disorders of pregnancy, mostly among women without severe disease. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT035556761.

scholarly journals Associations of Maternal Early-Pregnancy Glucose Concentrations With Placental Hemodynamics, Blood Pressure, and Gestational Hypertensive Disorders

2020 ◽  
Vol 33 (7) ◽  
pp. 660-669
Author(s):  
Jan S Erkamp ◽  
Madelon L Geurtsen ◽  
Liesbeth Duijts ◽  
Irwin K M Reiss ◽  
Annemarie G M G J Mulders ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Confidence Interval ◽  
Early Pregnancy ◽  
Fasting Glucose ◽  
Gestational Hypertension ◽  
Late Pregnancy ◽  
Population Based ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Maternal Glucose

Abstract BACKGROUND Gestational diabetes mellitus is associated with increased risks of gestational hypertension and preeclampsia. We hypothesized that high maternal glucose concentrations in early pregnancy are associated with adverse placental adaptations and subsequently altered uteroplacental hemodynamics during pregnancy, predisposing to an increased risk of gestational hypertensive disorders. METHODS In a population-based prospective cohort study from early pregnancy onwards, among 6,078 pregnant women, maternal early-pregnancy non-fasting glucose concentrations were measured. Mid and late pregnancy uterine and umbilical artery resistance indices were assessed by Doppler ultrasound. Maternal blood pressure was measured in early, mid, and late pregnancy and the occurrence of gestational hypertensive disorders was assessed using hospital registries. RESULTS Maternal early-pregnancy glucose concentrations were not associated with mid or late pregnancy placental hemodynamic markers. A 1 mmol/l increase in maternal early-pregnancy glucose concentrations was associated with 0.71 mm Hg (95% confidence interval 0.22–1.22) and 0.48 mm Hg (95% confidence interval 0.10–0.86) higher systolic and diastolic blood pressure in early pregnancy, respectively, but not with blood pressure in later pregnancy. Also, maternal glucose concentrations were not associated with the risks of gestational hypertension or preeclampsia. CONCLUSIONS Maternal early-pregnancy non-fasting glucose concentrations within the normal range are associated with blood pressure in early pregnancy, but do not seem to affect placental hemodynamics and the risks of gestational hypertensive disorders.

scholarly journals Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

2021 ◽  
Author(s):  
Emmanouil Kountouris ◽  
Katherine Clark ◽  
Polly Kay ◽  
Nadia Roberts ◽  
Kate Bramham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Protein Excretion ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. Methods All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. Results Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. Conclusions Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review. Graphic abstract

Early Pregnancy Blood Pressure Trajectories and Hypertensive Disorders: Differences by Pre-pregnancy BMI and Race/Ethnicity

2022 ◽  
Vol 226 (1) ◽  
pp. S266-S267
Author(s):  
Mara Greenberg ◽  
Stacey Alexeeff ◽  
Mai Nguyen-Huynh ◽  
Christopher Toretsky ◽  
Wei Tao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Early Pregnancy ◽  
Hypertensive Disorders ◽  
Race Ethnicity

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

scholarly journals Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xin Li ◽  
Xiaojing Wu ◽  
Muyin Zhang ◽  
Lili Xu ◽  
Guohui Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
High Altitude ◽  
Kidney Injury ◽  
Hypertensive Disorders Of Pregnancy ◽  
Fetal Outcomes ◽  
Uncontrolled Blood Pressure ◽  
Logistic Regression Models ◽  
Hypertensive Disorders ◽  
Term Delivery

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

Association Between Longitudinal Blood Pressure Trajectory and the Progression of Chronic Kidney Disease: Results From the KNOW-CKD

Hypertension ◽  
2021 ◽  
Author(s):  
Young Su Joo ◽  
Hyung Woo Kim ◽  
Ki Heon Nam ◽  
Jee Young Lee ◽  
Tae Ik Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Latent Class ◽  
Mixed Model ◽  
Hazards Model ◽  
Trajectory Group ◽  
End Stage

Studies on the longitudinal temporal trend of blood pressure (BP) and its impact on kidney function are scarce. Here, we evaluated the association of dynamic changes in systolic blood pressure (SBP) over time with adverse kidney outcomes. We analyzed 1837 participants from the KNOW-CKD (Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease). The main exposure was 3 distinct SBP trajectories determined by the latent class mixed model (decreasing, stable, and increasing) using 3 SBP measurements at 0, 6, and 12 months. The primary outcome was CKD progression, defined as a composite of halving estimated glomerular filtration rate from baseline value or onset of end-stage kidney disease. SBP declined from 144 to 120 mm Hg in the decreasing SBP trajectory group and rose from 114 to 136 mm Hg in the increasing trajectory group within 1 year. During 6576 person-years of follow-up (median, 3.7 years), the composite outcome occurred in 521 (28.4%) participants. There were fewer primary outcome events in the decreasing (30.6%) and stable (26.5%) SBP trajectory groups than in the increasing trajectory group (33.0%). In the multivariable-adjusted cause-specific hazards model, increasing SBP trajectory was associated with a 1.28-fold higher risk for adverse kidney outcome compared with stable SBP trajectory. However, the risk for the primary outcome did not differ between the decreasing and stable SBP trajectory groups. In this longitudinal CKD cohort study, compared with stable SBP trajectory, increasing SBP trajectory was associated with higher risk for adverse kidney outcome, whereas decreasing SBP trajectory showed similar risk.

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