Effectiveness of psychosocial interventions for hypertensive disorders in pregnancy: A systematic review and meta-analysis

Objective: Studies on psychosocial interventions for perinatal mental health and wellbeing are mostly limited to the postpartum period. However, the physiological changes associated with hypertensive disorders in pregnancy predisposes women to severe psychological distress and adverse birth outcomes. This review investigated the effectiveness of psychosocial interventions for hypertensive disorders during pregnancy. Methods: Cochrane CENTRAL, Embase, MEDLINE, MIDIRS, CINAHL, PsycINFO, PsycArticles, and Web of Science were searched up to 22nd August 2021. Effect sizes on relevant health outcomes were pooled in a meta‐analysis using STATA software. Results: Eight randomised trials involving 460 participants met the inclusion criteria. Included studies adopted several interventions ranging from music, exercise, cognitive behavioural therapy (CBT), spiritual care education and psychoeducation. The pooled effect showed a significant reduction in anxiety (d= −0.35 [−0.58, −0.11], p=0.004) and depression (d= −0.37 [−0.57, −0.17], p=0.0003). Spiritual care education significantly reduced postpartum stress disorder (d= −62.00 [−93.10, −30.90], p= 0.0001). However, CBT showed no effect on gestational stress (d= −2.20 [-4.89, 0.48], p= 0.11). Conclusion: This study provides satisfactory evidence that psychosocial interventions may likely reduce anxiety and depression associated with hypertensive disorders in pregnancy. However, the evidence is very uncertain about its effect on neonatal outcomes.

Alpha-Methyldopa May Attenuate Insulin Demand in Women with Gestational Diabetes Treated with Betamethasone

Gestational diabetes mellitus (GDM) is associated with hypertensive disorders in pregnancy. Alpha-methyl-DOPA (αMD) is a commonly used medication for hypertension in pregnant women. This medication may be associated with alteration in insulin resistance and glucose homeostasis. The aim of the present study was to investigate in 152 pregnant women whether the demands of exogenous insulin in glucocorticoid-treated women during pregnancy are different between those with GDM and hypertension treated with αMD and those without hypertension. In the group of women with GDM under insulin treatment, who received αMD for hypertension, the increase in insulin needs was relatively lower by at least 30% of the pre-admission insulin dose compared to all of the remaining women not receiving αMD in the same group (9 women vs. 50 women, p = 0.035). Our work raises the hypothesis that αMD can favorably modulate insulin sensitivity in the third trimester of pregnancy in previously insulin-treated women with gestational diabetes who receive glucocorticoids.

Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Care Military Hospital of Bangladesh

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. It is a major hindrance to the attainment of the Sustainable Development Goal (SDG)-3 targets given its high contribution to neonatal mortality. Early detection of its risk factors and advances in the management have ensured better survival of preterm births. This study was conducted to determine the prevalence, underlying causes, morbidity patterns and outcome of preterm admissions to a neonatal intensive care unit (NICU) of a tertiary care center in Combined Military Hospital (CMH) Sylhet. Material and Methods: A descriptive study was conducted in CMH Sylhet from July 2018 to June 2020. All live preterm babies delivered at CMH Sylhet during the study period were included. Information obtained included gestational age at birth, gender, cause for preterm birth, problems during admission and outcome. Results: During this period, a total of 662 neonates were admitted out of which 107 (16.2%) were preterm with gestational ages ranging from 27 completed weeks to less than 37 completed weeks with a mean gestational age 33.2 weeks (± 2.7 weeks) and birth weights from 800 - 2600 gm with a mean of 2100 gm (± 700 gm). There were 52 males and 55 females (M: F 0.95). One hundred and thirty three (20.1%) were delivered by normal vaginal delivery while 529 (79.9%) were delivered by Caesarean section. The duration of hospital stay ranged from 1 - 45 days, with a mean duration of 15 days (± 9.2 days). The commonest reason for prematurity was premature rupture of membrane (PROM) (39.3%) followed by gestational diabetes mellitus (GDM) (35.5%), hypertensive disorders in pregnancy (30.8%), multiple pregnancy (29.9%) and inadequate ante natal care (ANC) (20.6%). The commonest morbidity in the patients in the present study was neonatal jaundice (90.7%) followed by respiratory problems (78.5%), sepsis (17.8%) and congenital heart disease (CHD) (15.9%). Case fatality rate for patients with respiratory distress syndrome (7.7%) and sepsis (5.3%) were common. Overall survival rate was 91.6% and was significantly (p <0.001) higher in the moderate to late preterm category compared to the very preterm and extremely preterm births. Conclusion: PROM, GDM, hypertensive disorders in pregnancy, multiple pregnancy and inadequate ante natal care were significantly associated with preterm birth. Neonatal jaundice, respiratory problems, sepsis and CHD were common morbidities observed. Case fatality rate was significant in neonates with respiratory distress syndrome and sepsis and overall survival rate was 91.6%. So, at-risk mothers should receive intensified antenatal care to mitigate preterm birth. J Bangladesh Coll Phys Surg 2022; 40: 39-44

Hypertensive disorders in pregnancy and child development at 36 months in the All Our Families prospective cohort study

Hypertensive disorders in pregnancy (HDP) are associated with increased risk of offspring neurodevelopmental disorders, suggesting long-term adverse impacts on fetal brain development. However, the relationship between HDP and deficits in general child development is unclear. Our objective was to assess the association between HDP and motor and cognitive developmental delay in children at 36 months of age. We analyzed data from the All Our Families community-based cohort study (n = 1554). Diagnosis of HDP–gestational or chronic hypertension, preeclampsia, or eclampsia–was measured through medical records. Child development was measured by maternal-report on five domains of the Ages and Stages Questionnaire (ASQ-3). Standardized cut-off scores were used to operationalize binary variables for any delay, motor delay, and cognitive delay. We calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) using logistic regression, sequentially controlling for potential confounders followed by factors suspected to lie on the causal pathway. Overall, 8.0% of women had HDP and hypertension-exposed children had higher prevalence of delay than unexposed children. Hypertension-exposed children had elevated risk for developmental delay, but CIs crossed the null. The aRRs quantifying the fully adjusted effect of HDP on child development were 1.19 (95% CI 0.92, 1.53) for any delay, 1.18 (95% CI 0.86, 1.61) for motor delay, and 1.24 (95% CI 0.83, 1.85) for cognitive delay. We did not find a statistically significant association between HDP and developmental delay. Confidence intervals suggest that children exposed to HDP in utero have either similar or slightly elevated risk of any, motor, and cognitive delay at 36 months after controlling for maternal and obstetric characteristics. The observed direction of association aligns with evidence of biological mechanisms whereby hypertensive pathology can disrupt fetal neurodevelopment; however, more evidence is needed. Findings may have implications for early developmental monitoring and intervention following prenatal hypertension exposure.

Decreased Endometrial Thickness Is Associated With Higher Risk of Neonatal Complications in Women With Polycystic Ovary Syndrome

PurposeTo evaluate the association of endometrial thickness (EMT) with obstetric and neonatal outcomes in women with polycystic ovary syndrome (PCOS).MethodsA total of 1755 subfertile PCOS women with singleton livebirths after frozen-thawed embryo transfer were included between January 2009 and September 2019. Main obstetric outcomes were hypertensive disorders in pregnancy and abnormal placentation. Main neonatal outcomes were preterm birth (PTB), low birthweight (LBW) and small-for-gestational age (SGA). Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses.ResultsEach millimeter decrease in EMT was related to a 9% (adjusted OR 1.09, 95% CI 1.00–1.19; P = 0.053), 14% (adjusted OR 1.14, 95% CI 1.02–1.28; P = 0.002) and 22% (adjusted OR 1.22, 95% CI 1.07–1.38; P = 0.003) higher risk of PTB, LBW and SGA, respectively. Compared to women with EMT &gt;13 mm, women with EMT ≤8 mm also had significantly higher risk of PTB (adjusted OR 3.79, 95% CI 1.53–9.39; P = 0.004), LBW (adjusted OR 4.33, 95% CI 1.39–13.50; P = 0.012) and SGA (adjusted OR 6.38, 95% CI 1.78–22.83; P = 0.004). These associations remained consistent in further subgroup analysis by endometrial preparation regimen and in sensitivity analyses among nulligravida women or women without adverse obstetric outcomes. No significant differences were found in the incidence of several pregnancy complications across EMT categories.ConclusionDecreased EMT was independently associated with increased risk of PTB, LBW and SGA in women with PCOS.