Hypertensive disorders of pregnancy and cardiometabolic outcomes in childhood: A systematic review

Background Hypertensive disorders of pregnancy (HDPs) are among the leading causes of maternal and perinatal morbidity and mortality worldwide and have been suggested to increase long-term cardiovascular disease risk in the offspring. Objective The objective of this study was to investigate whether HDPs are associated with cardiometabolic markers in childhood. Search strategy PubMed, The Cochrane Library and reference lists of included studies up to January 2019. Selection criteria Studies comparing cardiometabolic markers in 2–18-year-old children of mothers with HDP in utero, to children of mothers without HDP. Data collection and analysis Sixteen studies reported in 25 publications were included in this systematic review, of which three were considered as having high risk of bias. Thus 13 studies were included in the evidence synthesis: respectively two and eight reported pregnancy induced hypertension and preeclampsia, and three studies reported on both HDPs. Main results Most studies ( n = 4/5) found a higher blood pressure in children exposed to pregnancy induced hypertension. Most studies ( n = 7/10) found no statistically significantly higher blood pressure in children exposed to preeclampsia. No association was found between exposure to HDP and levels of cholesterol, triglycerides or glucose ( n = 5/5). No studies investigated an association with (carotid) intima-media thickness, glycated haemoglobin or diabetes mellitus type 2. Conclusions Most studies showed that exposure to pregnancy induced hypertension is associated with a higher offspring blood pressure. There is no convincing evidence for an association between exposure to preeclampsia and blood pressure in childhood. Based on current evidence, exposure to HDP is not associated with blood levels of cholesterol, triglycerides and glucose in childhood.

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PREGNANCY INDUCED HYPERTENSION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.10.1720 ◽

2016 ◽

Vol 23 (10) ◽

pp. 1187-1193

Author(s):

Nadia Sharif ◽

Irum Usman ◽

Tasneem Azhar

Keyword(s):

Blood Pressure ◽

Mean Blood Pressure ◽

Outpatient Basis ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Normal Limits ◽

Hypertensive Disorders ◽

Group I ◽

Induced Hypertension ◽

Group A

Introduction: The hypertensive Disorders of pregnancy are major contributors tomaternal and perinatal morbidity and mortality. The aim of hypertensive therapy is to preventcomplications associated with hypertensive disorders of pregnancy. Objective: To compareefficacy of methyldopa and labetalol in management of pregnancy induced hypertension.Study Design: Randomized control trial. Setting: Punjab medical college and affiliatedhospitals Faisalabad. Methods: Patient were be randomly assigned to either group A or Groupby lottery method. Each group included 157 patients. In group A: labetalol was started at 100mg three or four times a day and increased up to 1200 mg a day in divided doses. In group B:methyldopa was started at 250mg per day 3 to 4 divided doses and increased up to 500 mg in 3to 4 divided doses. Blood pressure was recorded by sphygmomanometer. Blood pressure wasrecorded after 48 hours and then weekly till term on outpatient basis. Results: The treatmentof methyldopa in group I was proved to successful in lowering the mean blood pressure andmaintaining mean blood pressure within normal limits in 142 of 155 patients. It can be said itwas successful in 91.61% cases. 8.39% cases progressed to severe hypertension or eclampsiabecause methyldopa was unsuccessful to prevent progress of disease. Conclusion: It isconcluded that antihypertensive therapy such as methyldopa and labetalol are successful inlowering blood pressure in patient with pregnancy induced hypertension.

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Prevention of Hypertensive Disorders of Pregnancy—Is There a Place for Metformin?

Journal of Clinical Medicine ◽

10.3390/jcm10132805 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2805

Author(s):

Elżbieta Poniedziałek-Czajkowska ◽

Radzisław Mierzyński ◽

Dominik Dłuski ◽

Bożena Leszczyńska-Gorzelak

Keyword(s):

Risk Factors ◽

Risk Groups ◽

Trophoblast Invasion ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Induced Hypertension ◽

Endothelium Function ◽

Hypoglycemic Drug ◽

The Ideal

The possibility of prophylaxis of hypertensive disorders of pregnancy (HDPs) such as preeclampsia (PE) and pregnancy-induced hypertension is of interest due to the unpredictable course of these diseases and the risks they carry for both mother and fetus. It has been proven that their development is associated with the presence of the placenta, and the processes that initiate it begin at the time of the abnormal invasion of the trophoblast in early pregnancy. The ideal HDP prophylaxis should alleviate the influence of risk factors and, at the same time, promote physiological trophoblast invasion and maintain the physiologic endothelium function without any harm to both mother and fetus. So far, aspirin is the only effective and recommended pharmacological agent for the prevention of HDPs in high-risk groups. Metformin is a hypoglycemic drug with a proven protective effect on the cardiovascular system. Respecting the anti-inflammatory properties of metformin and its favorable impact on the endothelium, it seems to be an interesting option for HDP prophylaxis. The results of previous studies on such use of metformin are ambiguous, although they indicate that in a certain group of pregnant women, it might be effective in preventing hypertensive complications. The aim of this study is to present the possibility of metformin in the prevention of hypertensive disorders of pregnancy with respect to its impact on the pathogenic elements of development

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Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy

Gender and the Genome ◽

10.1177/2470289720948076 ◽

2020 ◽

Vol 4 ◽

pp. 247028972094807

Author(s):

Margaret H. Bublitz ◽

Myriam Salameh ◽

Laura Sanapo ◽

Ghada Bourjeily

Keyword(s):

Gestational Diabetes ◽

Pregnancy Complications ◽

Sleep Disordered Breathing ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Fetal Sex ◽

Hypertensive Disorders ◽

Induced Hypertension ◽

In Pregnancy ◽

Disordered Breathing

Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09-1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51 [95% CI: 1.08-2.11]). Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.

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Migraine-Asthma Comorbidity and Risk of Hypertensive Disorders of Pregnancy

Journal of Pregnancy ◽

10.1155/2012/858097 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Stefanie Czerwinski ◽

Jolana Gollero ◽

Chunfang Qiu ◽

Tanya K. Sorensen ◽

Michelle A. Williams

Keyword(s):

Medical Records ◽

Symptom Management ◽

Perinatal Outcomes ◽

Reproductive Age ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Reproductive Age Women ◽

Asthma Status ◽

Induced Hypertension

Background. To evaluate the association of migraine and asthma and to estimate the risk of hypertensive disorders of pregnancy in relation to maternal comorbid migraine and asthma.Methods. Reproductive age women (N=3.731) were interviewed during early pregnancy. At the time of interview, we ascertained participants’ migraine and asthma status. From medical records, we collected information to allow the diagnosis of pregnancy-induced hypertension (PIH) and preeclampsia. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression procedures.Results. After adjusting for confounders, migraineurs had 1.38-fold increased odds of asthma as compared with nonmigraineurs (95% CI 1.09–1.38). The odds of hypertensive disorders of pregnancy were highest among women with comorbid migraine-asthma. The ORs for PIH preeclampsia and the two disorders combined were 2.53 (95% CI 1.39–4.61), 3.53 (95% CI 1.51–8.24), and 2.64 (95% CI 1.56–4.47), respectively, for women with comorbid migraine-asthma as compared with those who had neither disorder.Conclusion. These findings confirm prior reports and extend the literature by documenting particularly high odds of pregnancy-induced hypertension and preeclampsia among women with comorbid migraine-asthma. Increased knowledge about the prevalence and sequelae of comorbidities during pregnancy may lead to improved symptom management and perinatal outcomes.

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Exploring the Use of Telemonitoring for Patients at High Risk for Hypertensive Disorders of Pregnancy in the Antepartum and Postpartum Periods: Scoping Review

JMIR mhealth and uhealth ◽

10.2196/15095 ◽

2020 ◽

Vol 8 (4) ◽

pp. e15095 ◽

Cited By ~ 3

Author(s):

Maria Aquino ◽

Sarah Munce ◽

Janessa Griffith ◽

Maureen Pakosh ◽

Mikayla Munnery ◽

...

Keyword(s):

Blood Pressure ◽

High Risk ◽

Scoping Review ◽

Underserved Populations ◽

Current Evidence ◽

Future Research ◽

Control Group ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Risk Pregnancy

Background High blood pressure complicates 2% to 8% of pregnancies, and its complications are present in the antepartum and postpartum periods. Blood pressure during and after pregnancy is routinely monitored during clinic visits. Some guidelines recommend using home blood pressure measurements for the management and treatment of hypertension, with increased frequency of monitoring for high-risk pregnancies. Blood pressure self-monitoring may have a role in identifying those in this high-risk group. Therefore, this high-risk pregnancy group may be well suited for telemonitoring interventions. Objective The aim of this study was to explore the use of telemonitoring in patients at high risk for hypertensive disorders of pregnancy (HDP) during the antepartum and postpartum periods. This paper aims to answer the following question: What is the current knowledge base related to the use of telemonitoring interventions for the management of patients at high risk for HDP? Methods A literature review following the methodological framework described by Arksey et al and Levac et al was conducted to analyze studies describing the telemonitoring of patients at high risk for HDP. A qualitative study, observational studies, and randomized controlled trials were included in this scoping review. Results Of the 3904 articles initially identified, 20 met the inclusion criteria. Most of the studies (13/20, 65%) were published between 2017 and 2018. In total, there were 16 unique interventions described in the 20 articles, all of which provide clinical decision support and 12 of which are also used to facilitate the self-management of HDP. Each intervention’s design and process of implementation varied. Overall, telemonitoring interventions for the management of HDP were found to be feasible and convenient, and they were used to facilitate access to health services. Two unique studies reported significant findings for the telemonitoring group, namely, spontaneous deliveries were more likely, and one study, reported in two papers, described inductions as being less likely to occur compared with the control group. However, the small study sample sizes, nonrandomized groups, and short study durations limit the findings from the included articles. Conclusions Although current evidence suggests that telemonitoring could provide benefits for managing patients at high risk for HDP, more research is needed to prove its safety and effectiveness. This review proposes four recommendations for future research: (1) the implementation of large prospective studies to establish the safety and effectiveness of telemonitoring interventions; (2) additional research to determine the context-specific requirements and patient suitability to enhance accessibility to healthcare services for remote regions and underserved populations; (3) the inclusion of privacy and security considerations for telemonitoring interventions to better comply with healthcare information regulations and guidelines; and (4) the implementation of studies to better understand the effective components of telemonitoring interventions.

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Depression, Antidepressants and Hypertensive Disorders of Pregnancy: A Systematic Review

Current Drug Safety ◽

10.2174/1574886314666190121144711 ◽

2019 ◽

Vol 14 (2) ◽

pp. 102-108 ◽

Cited By ~ 1

Author(s):

Sabrina Youash ◽

Verinder Sharma

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Gestational Hypertension ◽

Research Question ◽

Current Evidence ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

The Relationship ◽

In Pregnancy

Background: Hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia are conditions that cause significant perinatal and maternal morbidity and mortality. Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-related hypertensive conditions. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, six databases were searched for articles published between January 1990 and December 2017 (PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, MEDLINE and ClinicalTrials. gov). Randomized control trials, cohort studies and case-control studies were included in this review. Studies that measured the following exposures were included: Antidepressant exposure or diagnosis of depression. Studies that measured the following outcomes were included: Gestational hypertension, preeclampsia or eclampsia. A combination of keywords, as well as Medical Subject Headings (MeSH) index terms, was used for three general categories: antidepressants, depression and hypertensive disorders of pregnancy. A total of 743 studies were identified and 711 were excluded based on relevance to the research question. Twenty studies were included in the final systematic review. Results: Of the twenty relevant studies, ten specifically examined the relationship between depression and hypertension in pregnancy. Only two of these did not find a significant association. Of the ten studies that concentrated on antidepressant medications, all except one found an association with hypertension in pregnancy to varying degrees. Conclusion: Review of the literature suggests a possible association between depression and antihypertensive medications with pregnancy-related hypertension, but further studies are needed.

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Maternal Early-Pregnancy Thyroid Function Is Associated With Subsequent Hypertensive Disorders of Pregnancy: The Generation R Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-1505 ◽

2014 ◽

Vol 99 (12) ◽

pp. E2591-E2598 ◽

Cited By ~ 44

Author(s):

Marco Medici ◽

Tim I. M. Korevaar ◽

Sarah Schalekamp-Timmermans ◽

Romy Gaillard ◽

Yolanda B. de Rijke ◽

...

Keyword(s):

Thyroid Function ◽

Early Pregnancy ◽

Pregnancy Induced Hypertension ◽

Hypertensive Disorders Of Pregnancy ◽

Normal Range ◽

Free T4 ◽

Hypertensive Disorders ◽

Increased Risk ◽

Wide Range ◽

Induced Hypertension

Context: Hypertensive disorders during pregnancy are associated with a wide range of maternal and fetal complications, and only a few risk factors are known for the development of these disorders during pregnancy. Conflicting and limited data are available on the relationship between thyroid (dys)function and the risk of hypertensive disorders of pregnancy. Objective: The objective of the investigation was to study the associations between early-pregnancy thyroid dysfunction, thyroid function within the normal range, and the risk of hypertensive disorders. Design, Setting, and Participants: In early pregnancy, serum TSH, free T4 (FT4), and thyroperoxidase antibody (TPOAb) levels were determined in 5153 pregnant women. No interventions were done. The associations of thyroid function with the risk of hypertensive disorders were studied. Main Outcome Measures: Mean blood pressures and hypertensive disorders, including pregnancy-induced hypertension (n = 209) and preeclampsia (n = 136), were measured. Results: Hyperthyroid mothers had a higher risk of hypertensive disorders [odds ratio (OR) 3.40 [95% confidence interval (CI) 1.46–7.91], P = .005], which was mainly due to an increased risk of pregnancy-induced hypertension [OR 4.18 (95% CI 1.57–11.1), P = .004]. Hypothyroidism and hypothyroxinemia were not associated with hypertensive disorders. Within the normal range, the high-normal FT4 levels were associated with an increased risk of hypertensive disorders [OR 1.62 (95% CI 1.06–2.47), P = .03], which was mainly due to an increased risk of preeclampsia [OR 2.06 (95% CI 1.04–4.08), P = .04]. The TPOAb status was not associated with hypertensive disorders. Conclusions: We show that biochemical hyperthyroidism and also high-normal FT4 levels during early pregnancy are associated with an increased risk of hypertensive disorders. These data demonstrate that these associations are even seen for a mild variation in thyroid function within the normal range.

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Postpartum NSAID Use and Adverse Outcomes among Women with Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis

American Journal of Perinatology ◽

10.1055/s-0040-1713180 ◽

2020 ◽

Vol 38 (01) ◽

pp. 001-009

Author(s):

Ashish Premkumar ◽

Nina K. Ayala ◽

Corinne H. Miller ◽

William A. Grobman ◽

Emily S. Miller

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Meta Analysis ◽

Statistical Significance ◽

Random Effect ◽

Hypertensive Disorders Of Pregnancy ◽

Inclusion Criteria ◽

Hypertensive Disorders ◽

Blood Pressures ◽

Secondary Outcomes

Objective This study was aimed to perform a systematic review and meta-analysis of the association between postpartum nonsteroidal anti-inflammatory drug (NSAID) use among women with hypertensive disorders of pregnancy (HDP) and risks of adverse postpartum outcomes. Study Design Studies were eligible if they included women who had been diagnosed with HDP and were postpartum, reported exposure to NSAIDs, were written in English, and were published between January 2000 and November 2019. Assessment of bias was performed using the Newcastle–Ottawa scale for observational studies or the Cochrane Collaborative tool for randomized trials. The primary outcome was maternal blood pressure ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic. Secondary outcomes were persistent blood pressures ≥ 160 mm Hg systolic and/or 110 mm Hg diastolic, mean arterial pressure (MAP), initiation or up-titration of antihypertensive medication, length of hospital stay, rehospitalization for blood pressure control, and postpartum opioid use. A random-effect meta-analysis was performed using RevMan, with a p-value < 0.05 used to indicate statistical significance (PROSPERO CRD no.: 42019127043). Results Among 7,395 abstracts identified, seven studies (four randomized and three cohort studies, n = 777 patients) met inclusion criteria. All cohort analyses exhibited low levels of bias, while two randomized controlled trials exhibited a high risk of bias in blinding and inclusion criteria. There was no association between NSAID use and blood pressures ≥ 150 mm Hg systolic and/or 100 mm Hg diastolic (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 0.89–1.64). Conversely, NSAID use was associated with a statistically significant, but clinically insignificant, increase in length of postpartum stay (0.21 days, 95% CI: 0.05–0.38). No other secondary outcomes were significantly different between groups. Conclusion Postpartum NSAID use among women with HDP was not associated with maternal hypertension exacerbation. These findings support the recent American College of Obstetricians and Gynecologists' guideline change, wherein preeclampsia is no longer a contraindication to postpartum NSAID use. Key Points

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The Association Between the Risk of Hypertensive Disorders of Pregnancy and Folic Acid: A Systematic Review and Meta-Analysis

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/jpps31500 ◽

2021 ◽

Vol 24 ◽

pp. 174-190

Author(s):

Yahui Yu ◽

Ximu Sun ◽

Xinrui Wang ◽

Xin Feng

Keyword(s):

Systematic Review ◽

Folic Acid ◽

Cohort Studies ◽

Assessment Tool ◽

Gestational Hypertension ◽

Meta Analysis ◽

Cochrane Library ◽

Hypertensive Disorders Of Pregnancy ◽

Cardiovascular Risks ◽

Hypertensive Disorders

Purpose: Although folic acid (FA) supplementation has been shown to reduce general cardiovascular risks, its impact on hypertensive disorders of pregnancy (HDP) is unclear. We performed a systematic review and meta-analysis to clarify the association between FA and the risk of HDP (pre-eclampsia (PE) and gestational hypertension (GH)). Methods: PubMed, EmBase, and Cochrane Library were searched up to June 18, 2020, stratified by type of disease, initiation time of FA, form of FA and pre-conception Body Mass Index (BMI). The quality assessment of included studies was evaluated using Newcastle-Ottawa Scale (NOS) for cohort studies and Cochrane Collaboration’s Risk of Bias Assessment Tool for randomized controlled trials (RCTs). Between-study heterogeneity was quantified using Cochran’s Q-statistic and I2 statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed using funnel plots. Results: Twenty studies with 359041 patients were identified for inclusion in the meta-analysis which included 3 RCTs and 17 cohort studies. Pooled estimates showed RR of 0.83 (95%CI 0.74-0.93, P=0.0008) for association between low dose FA (LD-FA) and the risk of PE, but LD-FA was not associated with GH (RR 1.05, 95% CI 0.97-1.13, P=0.20). In addition, the results of subgroup analysis showed that post-conception LD-FA had a 31% decreased risk of PE (RR 0.69, 95% CI 0.59-0.80, P<0.00001), and LD-FA in patients with pre-conception BMI<25 kg/m2 had a 32% decreased risk of PE (RR 0.68, 95% CI 0.56-0.81, P<0.0001) Conclusions: LD-FA significantly decreased the risk of PE but not GH, and post-conception LD-FA and pre-conception BMI<25 kg/m2 were considered as protective factors to reduce the risk of PE.

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Safety and efficacy of methyldopa and labetalol in controlling blood pressure in hypertensive disorders of pregnancy

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20171109 ◽

2017 ◽

Vol 6 (4) ◽

pp. 942 ◽

Cited By ~ 2

Author(s):

Mary Rohini Pentareddy ◽

Shailendra D. ◽

Prasuna G. ◽

Subbaratnam Y. ◽

Naresh D.T. V. ◽

...

Keyword(s):

Medical Complication ◽

Pregnancy Induced Hypertension ◽

Effective Management ◽

Efficacy And Safety ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Vaginal Deliveries ◽

Induced Hypertension ◽

Blood Pressures ◽

New Onset

Background: Hypertensive disorders represent the most common medical complication of pregnancy, with a reported incidence of 6-10% and accounts for 15% of maternal mortality. Effective management of pregnancy induced hypertension is vital to improve maternal and foetal outcomes. As data are scarce on comparison of labetolol and methyldopa this study was undertaken. The objective of present study is compare the efficacy and safety of Labetalol versus Methyldopa in the management of Mild to Moderate pregnancy induced hypertension. To evaluate effect of both drugs on maternal and foetal outcomes.Methods: A comparative observational study is designed. 30 patients who received methyldopa and 30 patients who received labetalol were included in the study. Methyldopa was started at a dose of 250-500 mg thrice daily while labetalol was started at a dose of 100-400 mg twice daily. Patients were followed up during antenatal, intrapartum and postpartum period for efficacy, safety, maternal, and perinatal outcomes.Results: Methyldopa and Labetalol reduced mean systolic and mean diastolic blood pressures significantly. safety profile of both drugs was similar. Spontaneous vaginal deliveries were observed more with labetolol significantly.Conclusions: Labetalol is equally efficacious as methyldopa and well tolerated in the treatment of new onset hypertension during pregnancy.

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