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Fentie A, Fetene G, Kassahun Z, Ambachew S. Prevalence and associated factors of metabolic syndrome among pregnant Ethiopian women: a hospital-based cross-sectional study. Sci Rep 2024; 14:14424. [PMID: 38909078 PMCID: PMC11193719 DOI: 10.1038/s41598-024-65107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/17/2024] [Indexed: 06/24/2024] Open
Abstract
Metabolic syndrome (MetS) poses a significant public health challenge globally, including in Ethiopia, with risks for both mothers and children. Unfortunately, there is limited data on MetS in pregnant Ethiopian women. This study aims to evaluate the prevalence and factors associated with MetS in this population. A cross-sectional study was conducted using a systematic random sampling technique. Data were collected through face-to-face interviews using a structured questionnaire adapted from the World Health Organization Steps Survey Tool for Non-communicable Diseases. About five ml of fasting peripheral blood samples were collected from each participant. The Beckman Coulter DXC 700 AU clinical chemistry analyzer was employed for lipid profile and glucose analysis. Subsequently, data were inputted into Epi Data and later exported to SPSS Version 20 for further analysis. Bivariable and multivariable binary logistic regression analyses were carried out, with a predefined level of statistical significance at p < 0.05. A total of 318 pregnant women were included in this study. The prevalence of MetS was 13.2% (95% CI: 9.7, 17.0) based on the American Heart Association/National Heart Lung and Blood Institute definition. The most prevalent components of MetS were elevated triglyceride levels, reduced high-density lipoprotein levels, and elevated blood pressure. Unhealthy sleep duration (AOR = 5.6, 95% CI (2.4, 13.1), p < 0.001), high daily salt intake (AOR = 4.2, 95% CI (1.8, 9.5), p = 0.001), and alcohol consumption [AOR = 4.2, 95% CI (1.6, 10.9), p = 0.003] were significantly associated with MetS. The study reported a high prevalence of MetS in pregnant Ethiopian women. Factors including alcohol, high salt intake, and sleep disturbances were associated with MetS. Policymakers might utilize this data to create targeted interventions and public health policies for MetS among pregnant women, focusing on nutrition, sleep, and alcohol consumption during pregnancy to safeguard maternal and fetal health.
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Affiliation(s)
- Alemie Fentie
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getnet Fetene
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Zeleke Kassahun
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Sintayehu Ambachew
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
- Adelaide Medical School, University of Adelaide, Adeliade, SA, Australia.
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Natenzon A, Parrott CW, Manem N, Zelig CM. Stage 1 Hypertension in Nulliparous Pregnant Patients and Risk of Unplanned Cesarean Delivery. Am J Perinatol 2023; 40:235-242. [PMID: 35777733 DOI: 10.1055/a-1889-6292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of the study is to determine whether stage 1 hypertension is a risk factor for cesarean at ≥390/7 weeks. STUDY DESIGN This is a retrospective cohort study of nulliparas delivering at ≥390/7weeks. Exposure was defined as stage 1 hypertension and compared with normotension. The primary outcome was unplanned cesarean. Statistical analysis was performed using SPSS 27. RESULTS Two hundred and fifty patients had stage 1 hypertension and 250 had normotension. Thirty-eight percent of the patients with stage 1 hypertension required cesarean as did 22% of controls (risk ratio [RR]=1.55, 95% confidence interval [CI]: 1.23-1.96, p <0.001). This remained significant after controlling for confounders in a logistic regression (odds ratio [OR]=1.61, 95% confidence interval [CI]: 1.02-2.55, p <0.040). Upon secondary analysis, these results were statistically significant for gestational age ≥395/7 weeks (adjusted odds ratio [AOR]=1.89, 95% CI: 1.05-3.39, p=0.033) but not from 390/7 to 394/7weeks (AOR=0.68, 95% CI: 0.31-1.50, p=0.34). CONCLUSION In nulliparas, stage 1 hypertension is an independent risk factor for unplanned cesarean. KEY POINTS · Stage 1 hypertension correlates with more cesareans.. · Unplanned cesarean for nonreassuring fetal status correlates with impaired placental function.. · Stages 1 and 2 hypertension carry similar risks..
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Affiliation(s)
- Anna Natenzon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Francis Hospital, Trinity Health of New England, Hartford, Connecticut
| | - Caitlin W Parrott
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Nihita Manem
- Albany Medical College, Albany Medical Center, Albany, New York
| | - Craig M Zelig
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
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Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients. BMC Pregnancy Childbirth 2023; 23:4. [PMID: 36600195 DOI: 10.1186/s12884-022-05335-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pre-eclampsia (PE) is a pregnancy disorder that is related to an enhanced immune response. Immune cell characteristics such as neutrophil or monocyte to lymphocyte ratios (NLR, MLR) are known to be related to kidney and liver dysfunction in hypertensive patients. Here, we aimed to analyze the correlations between NLR, MLR and platelet to lymphocyte ratio (PLR) and liver, renal and coagulation functional parameters and the impacts of these immune cell profiles to the prognostic significance in PE patients. METHODS Pre-delivery hematological and biochemical parameters of 320 first-time pregnant women registered at the Obstetrics Department of Yanbian University Hospital from 2016 to 2019 were analyzed retrospectively. Patients were divided into normal pregnancy (normal, n = 161), mild PE (mPE, n = 28) and severe PE (sPE, n = 131) groups according to diagnostic criteria. Pearson correlation analysis were performed and area under the curve (AUC) were conducted for the diagnostic values of NLR, MLR and PLR. Results were validated with data from the Department of Obstetrics and Gynecology of Seoul National University Hospital (SNUH). RESULTS Kidney functional indexes were adversative in mPE and sPE and liver and coagulation indexes were worse in sPE compared to normal groups. Among immune cells, lymphocytes were increased in mPE and sPE patients, resulted in reduced NLR, MLR and PLR in PE groups, more significant difference were shown in sPE. NLR and PLR were associated with CREA and/or BUN negatively and positive associations were observed with total protein (TP) and albumin (ALB) in sPE. Only NLR showed positive associations with coagulation indexes (PT and APTT) in sPE. AUC analysis for NLR, MLR and PLR were 0.700, 0.656, 0.643, respectively, and NLR < 3.7 predicted hypertension (95% CI in all participants: 0.647-0.749, p < 0.001). Blood pressure, liver, kidney and coagulation indexes were worse at cut off value (NLR < 3.7), and this was validated with the data from SNUH. CONCLUSION NLR could be used as an independent predictor of liver and coagulation dysfunction in PE patients. Our results may provide non-invasive and efficient way of the risk assessment among PE patients.
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Elevated Blood Pressure and Stage 1 Hypertension in Pregnancy: A Review of the Literature. Obstet Gynecol Surv 2022; 77:415-422. [DOI: 10.1097/ogx.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kahramanoglu Ö, Schiattarella A, Demirci O, Sisti G, Ammaturo FP, Trotta C, Ferrari F, Rapisarda AMC. Preeclampsia: state of art and future perspectives. A special focus on possible preventions. J OBSTET GYNAECOL 2022; 42:766-777. [PMID: 35469530 DOI: 10.1080/01443615.2022.2048810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.
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Affiliation(s)
- Özge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Giovanni Sisti
- Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY, USA
| | - Franco Pietro Ammaturo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Trotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ferrari
- Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, Obstetrics and Gynecology Unit, University of Catania, Catania, Italy
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Tanner MS, Davey MA, Mol BW, Rolnik DL. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol 2022; 226:S835-S843. [PMID: 35177221 DOI: 10.1016/j.ajog.2021.11.1371] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 01/01/2023]
Abstract
As the understanding of the pathophysiology of preeclampsia has improved, its diagnostic criteria have evolved. The classical triad of hypertension, edema, and proteinuria has become hypertension and organ dysfunction-renal, hepatic, neurologic, hematological, or uteroplacental. However, the most recent definitions have largely been based off consensus and expert opinion, not primary research. In this review, we explore how the criteria have evolved, particularly through the second half of the 20th and the beginning of the 21st century and offer a critical appraisal of the evidence that has led the criteria to where they stand today. Some key themes are the following: the debate between having a simple and convenient blood pressure cutoff vs a blood pressure cutoff that accounts for influencing factors such as age and weight; whether a uniform blood pressure threshold, a rise in blood pressure, or a combination is most discriminatory; whether existing evidence supports blood pressure and proteinuria thresholds in diagnosing preeclampsia; and whether using flow-charts and decision trees might be more appropriate than a single set of criteria. We also discuss the future of a preeclampsia diagnosis. We challenge the move toward a broad (vs restrictive) diagnosis, arguing instead for criteria that directly relate to the prognosis of preeclampsia and the response to treatments.
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Suzuki H, Takagi K, Matsubara K, Mito A, Kawasaki K, Nanjo S, Mimura K, Bokuda K, Makino S, Nakamoto O, Ichihara A, Seki H. Maternal and perinatal outcomes according to blood pressure levels for prehypertension: A review and meta-analysis. HYPERTENSION RESEARCH IN PREGNANCY 2022. [DOI: 10.14390/jsshp.hrp2021-018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine
| | - Kenjiro Takagi
- Perinatal Center, Division of Maternal and Fetal Medicine, Jichi Medical University, Saitama Medical Center
| | - Keiichi Matsubara
- Department of Obstetrics and Gynecology, Ehime University School of Medicine
| | - Asako Mito
- Department of Obstetric Medicine, Center for Maternal-Fetal and Reproductive Medicine, National Center for Child Health and Development
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, Kyoto University
| | - Sakiko Nanjo
- Department of Obstetrics and Gynecology, Wakayama Medicine University
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine
| | - Kanako Bokuda
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University
| | - Osamu Nakamoto
- Department of Obstetrics and Gynecology, Osaka City General Hospital
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University
| | - Hiroyuki Seki
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University
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Postpartum Hypertension and the Role of Postpartum Clinics and Digital Health. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00937-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Revisiting blood pressure thresholds to define hypertension during pregnancy: is 140/90 mmHg too high? LANCET GLOBAL HEALTH 2021; 9:e1041-e1042. [PMID: 34237264 DOI: 10.1016/s2214-109x(21)00285-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023]
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Blood pressure thresholds in pregnancy for identifying maternal and infant risk: a secondary analysis of Community-Level Interventions for Pre-eclampsia (CLIP) trial data. LANCET GLOBAL HEALTH 2021; 9:e1119-e1128. [PMID: 34237265 PMCID: PMC8295039 DOI: 10.1016/s2214-109x(21)00219-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
Background Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings. Methods We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15–49 years (12–49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP] <120 mm Hg and diastolic blood pressure [dBP] <80 mm Hg), elevated blood pressure (sBP 120–129 mm Hg and dBP <80 mm Hg), stage 1 hypertension (sBP 130–139 mm Hg or dBP 80–89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140–159 mm Hg or dBP 90–109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties. Findings Between Nov 1, 2014, and Feb 28, 2017, 21 069 women (6067 in India, 4163 in Mozambique, and 10 839 in Pakistan) contributed 103 679 blood pressure measurements across the three CLIP trials. Only women with non-severe or severe stage 2 hypertension, as discrete diagnostic categories, experienced more adverse outcomes than women with normal blood pressure (risk ratios 1·29–5·88). Using blood pressure categories as diagnostic thresholds (women with blood pressure within the category or any higher category vs those with blood pressure in any lower category), dose-response relationships were observed between increasing thresholds and adverse outcomes, but likelihood ratios were informative only for severe stage 2 hypertension and maternal CNS events (likelihood ratio 6·36 [95% CI 3·65–11·07]) and perinatal death (5·07 [3·64–7·07]), particularly stillbirth (8·53 [5·63–12·92]). Interpretation In low-resource settings, neither elevated blood pressure nor stage 1 hypertension were associated with maternal, fetal, or neonatal mortality or morbidity adverse composite outcomes. Only the threshold for severe stage 2 hypertension met diagnostic test performance standards. Current diagnostic thresholds for hypertension in pregnancy should be retained. Funding University of British Columbia, the Bill & Melinda Gates Foundation.
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Stage 1 hypertension defined by the 2017 ACC/AHA guidelines and neonatal outcomes: Systematic review and meta-analysis. Pregnancy Hypertens 2021; 25:204-212. [PMID: 34246173 DOI: 10.1016/j.preghy.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2017, the American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefined the threshold of high blood pressure (BP) for non-pregnant adults. Several studies aimed to determine whether lowering these thresholds should be considered for pregnancies to prevent poor neonatal outcomes, but the results were inconclusive. METHODS We perform a systematic review and meta-analysis to evaluate the association between BP groups defined by the 2017 ACC/AHA guidelines and pregnancy outcomes. Relevant literature was searched in PubMed, Google Scholar, Embase, and Web of Science up to 18 May 2021. RESULTS Sixteen eligible studies from twelve articles with a total of 303,131 pregnancies were identified, encompassing 233,084, 20,859, 39,379 individuals with normal BP, elevated BP, and stage 1 hypertension, respectively. When compared with normal BP, the combined odds ratio (95% confidence interval) of elevated BP for adverse pregnancy outcomes was not significant; whereas, that of stage 1 hypertension were 1.25 (1.13-1.39), 1.16 (1.03-1.31), 1.50 (1.28-1.77) and 1.12 (1.00-1.25) for preterm delivery, small for gestational age, low birth weight, and early-term delivery, respectively. CONCLUSION Our results indicated that stage 1 hypertension increased the risk of poor neonatal outcomes, highlighting the importance of recognition of stage 1 hypertension as a risk indicator for poor pregnancy outcomes.
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Pregnancy Outcomes Associated With a Single Elevated Blood Pressure Before 20 Weeks of Gestation. Obstet Gynecol 2021; 138:42-50. [PMID: 34259462 DOI: 10.1097/aog.0000000000004422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate maternal and fetal outcomes among women with a single elevated blood pressure before 20 weeks of gestation. METHODS We conducted a retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals between January 1, 2008, and December 31, 2019. Participants were divided into two groups: normotensive (all systolic blood pressures lower than 130 mm Hg and diastolic pressures lower than 80 mm Hg) compared with single elevated blood pressure (single systolic pressure 130 mm Hg or higher, diastolic pressure 80 mm Hg or higher, or both). Women with chronic hypertension were excluded. Maternal comorbidities and maternal and neonatal outcomes were extracted from electronic health records using International Classification of Diseases codes. Adjusted odds ratios (aORs) derived from logistic regression were used to describe the magnitude of association. RESULTS Of 303,689 women who delivered during the study period, 23% had a single elevated blood pressure. Rates of hypertensive disorders of pregnancy differed between the two groups (10.6% for single elevated blood pressure, 4.5% for normotensive group; aOR 2.06, 95% CI 2.00-2.13), as did iatrogenic preterm delivery (3.7% vs 2.7%, respectively; aOR 1.27, 95% CI 1.21-1.33). DISCUSSION Women with a single elevated blood pressure before 20 weeks of gestation are at increased risk for hypertensive disorders of pregnancy and iatrogenic preterm delivery.
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Greenberg VR, Silasi M, Lundsberg LS, Culhane JF, Reddy UM, Partridge C, Lipkind HS. Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension. Am J Obstet Gynecol 2021; 224:521.e1-521.e11. [PMID: 33157064 DOI: 10.1016/j.ajog.2020.10.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/25/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypertension was redefined in 2017 with lower diagnostic thresholds; elevated blood pressure is defined as systolic blood pressure of 120 to 129 mm Hg with diastolic blood pressure of <80 mm Hg and stage 1 hypertension as systolic blood pressure of 130 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg. These guidelines did not include pregnant women. There is limited information on stage 1 hypertension and pregnancy outcomes. OBJECTIVE This study aimed to determine whether elevated blood pressure and stage 1 hypertension as newly defined by the 2017 American College of Cardiology and the American Heart Association guidelines are associated with an increased risk of hypertensive disorders of pregnancy and other adverse maternal and neonatal outcomes. STUDY DESIGN In this retrospective cohort study, 18,801 women with singletons from 2013 to 2019 were categorized as normotensive, prehypertensive (elevated blood pressure), stage 1 hypertensive, or chronic hypertensive. Women with ≥2 systolic blood pressures of 120 to 129 mm Hg before 20 weeks' gestation were classified into the elevated blood pressure group. Women with ≥2 systolic blood pressures of 130 to 139 mm Hg or ≥2 diastolic blood pressures of 80 to 89 mm Hg before 20 weeks' gestation were assigned to the stage 1 hypertension group. Women were classified as chronic hypertensives if they had any of the following: ≥2 systolic blood pressure of ≥140 mm Hg or ≥2 diastolic blood pressure of ≥90 mm Hg before 20 weeks' gestation, a history of chronic hypertension, or antihypertensive medication use before 20 weeks' gestation. Women with pregestational diabetes, lupus, or <2 blood pressures before 20 weeks' gestation were excluded. The association of stage 1 hypertension with the risk of developing hypertensive disorders of pregnancy was estimated using multivariate logistic regression controlling for maternal sociodemographic characteristics, gestational weight gain by prepregnancy body mass index, parity, and aspirin use. Secondary outcomes included subgroups of hypertensive disorders (gestational hypertension, preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count syndrome), gestational diabetes, placental abruption, intrauterine growth restriction, preterm birth, neonatal intensive care unit admission, stillbirth and neonatal death, and maternal intensive care unit admission. All outcomes were adjusted for potential confounders. RESULTS Of the 18,801 women, 13,478 (71.7%) were normotensive, 2659 (14.1%) had elevated blood pressure, 1384 (7.4%) were stage 1 hypertensive, and 1280 (6.8%) were chronic hypertensive. A dose-response relationship was observed: the risk of hypertensive disorders of pregnancy increased from 4.2% in normotensive women to 6.7% (adjusted odds ratio, 1.50; 95% confidence interval, 1.26-1.79) in women with elevated blood pressure, to 10.9% (adjusted odds ratio, 2.54; 95% confidence interval, 2.09-3.08) in women with stage 1 hypertension, and 28.4% (adjusted odds ratio, 7.14; 95% confidence interval, 6.06-8.40) in women with chronic hypertension. Compared with normotensive women, women with stage 1 hypertension had an increased risk of neonatal intensive care unit admissions (15.8% vs 13.0%; adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42), preterm birth at <37 weeks' gestation (7.2% vs 5.2%; adjusted odds ratio, 1.45; 95% confidence interval, 1.16-1.81), and gestational diabetes (14.8% vs 6.8%; adjusted odds ratio, 2.68; 95% confidence interval, 2.27-3.17). CONCLUSION Our study demonstrates that elevated blood pressure and stage 1 hypertension, using the 2017 American College of Cardiology and the American Heart Association guideline definition, are associated with increased maternal and neonatal risk. This group of women warrants further investigation to determine whether pregnancy management can be altered to reduce maternal and neonatal morbidity.
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Drummond N, Carver A, Bailey J. Evaluation of Implementation and Unit Impact of a Hypertensive Disorder of Pregnancy Guideline: A Model-Based Approach. J Dr Nurs Pract 2021; 14:JDNP-D-20-00028. [PMID: 33468618 DOI: 10.1891/jdnp-d-20-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived. OBJECTIVE Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest. METHODS Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline. RESULTS The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission. CONCLUSIONS Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach. IMPLICATIONS FOR NURSING PRACTICE Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.
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