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Objective: Hypertensive disorders of pregnancy (HDP) are associated with impaired placentation, as evidenced by abnormal uterine artery (UtA) Doppler. In normal pregnancy, mean UtA pulsatility index (PI) shows a progressive decline with gestational age (GA). However, previous studies have reported that a proportion of pregnancies demonstrate worsening UtA Doppler in later pregnancy. The aim of this study was to investigate the incidence of HDP according to the change in mean UtA-PI between the second and third trimesters.Methods: This was a retrospective cohort study of singleton pregnancies between March 1997 and March 2016 that underwent longitudinal UtA Doppler assessment in the second and third trimesters. All parameters were converted into centiles or multiples of the median (MoM), adjusting for GA. The study cohort was divided into two groups, according to change in mean UtA-PI between the second and third trimesters (those with a decrease or no change and those with an increase). HDP included women who developed pre-eclampsia and/or gestational hypertension. Logistic regression analysis was used to adjust for potential confounders.Results: The analysis included 5887 pregnancies. The incidence of HDP was significantly higher in the group with increasing mean UtA-PI compared with those without (7.9% vs 5.8%; P = 0.002). Logistic regression analysis demonstrated that both third-trimester UtA-PI MoM (odds ratio (OR), 7.35; 95% CI, 4.66-11.6; P < 0.001) and stable or decrease in UtA-PI MoM between the second and third trimesters (OR, 0.43; 95% CI, 0.31-0.60; P < 0.001) were significant independent predictors for the development of HDP.Conclusion: Worsening of UtA Doppler is associated with HDP, independent of the value recorded in the second trimester. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background Prediction of pre-eclampsia and adverse pregnancy outcomes with biomarkers has been proposed. AMH is an ovary-specific growth factor, used to predict ovarian reserve, which changes with age similar to the change in age-related fertility. Aims The aim of the study was to determine whether AMH tested in the first trimester of pregnancy was associated with pregnancy hypertension or adverse pregnancy outcomes. Materials and Methods Retrospective cohort study of women who delivered singleton fetuses ≥20 weeks' gestation at Royal Hospital for Women, Sydney, Australia ( n = 331). AMH was tested in 2011 via Beckman-Coulter Gen II ELISA method on frozen serum collected at the time of first trimester aneuploidy screening (10-13 + 6 weeks' gestation). Outcome data were obtained from the hospital database (ObstetriX). Main outcome measures were pregnancy hypertension (pre-eclampsia and gestational hypertension) and composite adverse pregnancy outcome. Results The median AMH level was 9.7pmol/L (interquartile range ( IQR) 3.9-17.3). There was a trend towards women with pregnancy hypertension having lower AMH levels than women without pregnancy hypertension (median 5.1pmol/L, IQR 1.5-13.2 vs 9.4 IQR 3.9-17.3; P = 0.06). After adjusting for BMI ≥25, parity ≥1 and age ≥35, women with an AMH less than the 10th centile had a 3.3-fold increased risk of pregnancy hypertension ( OR 3.3, 95% CI 1.2-8.7, P = 0.01). There were no other associations between low AMH concentration and adverse maternal or neonatal outcomes. Conclusions Women with a very low AMH (1.5 pmol/L) in early pregnancy may have an increased risk of pregnancy hypertension. No other adverse pregnancy outcomes were identified. [ABSTRACT FROM AUTHOR]

The article discusses a study which evaluates the use of maternal serum in predicting if pregnant women may develop pre-eclampsia. Samples of serum inhibin-An and activin-A were collected for the first-trimester prenatal chromosomal anomaly screening program. Patients underwent uterine artery Doppler flow velocimetry to determine pulsatility index during pregnancy. Researchers found that increased level of maternal serum is seen to be too low to contribute to screening for pre-eclampsia.

Abstract : Objective: To clarify the role played by tissue factor pathway inhibitor (TFPI) in pregnancy hypertension. Methods: Using enzyme-linked immunosorbent assays, hemostatic measurements were obtained for women with pre-eclampsia (n =51), nonproteinuric hypertension of pregnancy (n =62), postpartum pre-eclampsia 24 h after childbirth (n =31), and no hypertension (healthy pregnant controls, n =100). Results: There was a significant increase in circulating free TFPI levels in women with pre-eclampsia (9.7±6.2 ng/mL) or nonproteinuric hypertension of pregnancy (8.3±5.3 ng/mL) compared with healthy controls (5.3±2.1 ng/mL). In women with pre-eclampsia the levels remained elevated after placental delivery (10.6±4.0 ng/mL). Free protein S levels were significantly higher in women with pre-eclampsia (40.0%±10.7%), nonproteinuric hypertension of pregnancy (37.1%±12.5%), or postpartum pre-eclampsia (39.3%±9.1%) than in healthy pregnant controls (32.2%±8.5%). Conclusion: Increased levels of the physiologically active free forms of TFPI and free protein S, 2 coagulation inhibitors, may protect women with pregnancy-induced hypertension from the risks of hemostatic activation. [Copyright &y& Elsevier]

There have been conflicting reports about pregnancy outcome in the hypertensive disorders of pregnancy. The present study was undertaken to examine outcomes using a population database.To examine for differences in a range of pregnancy outcomes between three different groups of hypertensive women and normotensive women in South Australia.Nine pregnancy outcomes were compared for 70 386 singleton pregnancies in the South Australian perinatal data collection in 1998–2001, consisting of 639 women with pre-existing hypertension, 5356 women with pregnancy hypertension, 448 women with superimposed pre-eclampsia and 63 943 normotensive women. Means for the four groups were calculated for birthweight, gestational age, the baby's and mother's length of stay. The groups were also compared for perinatal deaths with an earlier period, 1991–1997.While all three hypertensive groups had high incidences of induction of labour and emergency Caesarean, only pre-existing hypertension and superimposed pre-eclampsia were significantly associated with elective Caesarean section. All hypertensive groups had increased risks for low birthweight and preterm birth and special and neonatal intensive care. Uncomplicated pre-existing hypertension was not associated with small for gestational age infants, but with preterm delivery between 32 and 36 weeks’ gestation. Superimposed pre-eclampsia had the worst prognosis for perinatal and maternal morbidity. While pregnancy hypertension held the intermediate position, it was not associated with an increase in perinatal mortality. The perinatal mortality rate for women with hypertensive disorders in 1998–2001 was significantly lower than that of an earlier period and equivalent to that for normotensive women.Superimposed pre-eclampsia occurs in approximately 40% of pregnancies of women with pre-existing hypertension and has the most severe outcomes. The hypertensive disorders are associated with high levels of morbidity and intervention, but the high perinatal mortality associated with these disorders has fallen significantly. [ABSTRACT FROM AUTHOR]

Background There is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Post-Partum Physiology, Psychology and Pediatric) follow-up study. Methods and Results BP was measured by sphygmomanometer, 24-hour ambulatory BP monitoring, and non-invasive central BP at 6 months postpartum in 302 women who had normotensive pregnancy and 90 who had preeclampsia. The upper limit of normal BP (mean+2 SD) for women with normotensive pregnancy was 122/79 mm Hg for routine BP, 115/81 mm Hg for central BP, and 121/78 mm Hg for 24-hour ambulatory BP monitoring. Traditional normal values detected only 3% of women who had preeclampsia as having high BP 6 months postpartum whereas these new values detected between 13% and 19%. Women with preeclampsia had greater body mass index (27.8 versus 25.0, P <0.001) and left ventricular wall thickness but similar augmentation index. They also had lower high-density lipoprotein (59±15 versus 65±16 mg/dL, P =0.002), higher triglycerides (77±51 versus 61±35 mg/dL, P =0.005), and higher homeostatic model assessment score (2.1±1.8 versus 1.3±1.9, P <0.001). Conclusions Clinicians wishing to detect high BP in these women should be aware of the lower than usual upper limit of normal for this young cohort and where possible should use 24-hour ambulatory BP monitoring to detect these changes. This may define a subgroup of women who had preeclampsia for whom targeted BP lowering therapy would be successful. Registration URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365295&isReview=true; Unique identifier: ACTRN12613001260718.

Background Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of premature cardiovascular disease (CVD), but existing cardiovascular prediction models do not adequately capture risks in young women. We developed a model to predict the 10-year risk of premature CVD and mortality among women who have HDP. Methods and Results Using a population-based cohort of women with HDP who delivered between April 1989 and March 2017 in Quebec, Canada, we developed a 10-year CVD risk model using Cox proportional hazards regression. Women aged 18 to 45 years were followed from their first HDP-complicated delivery until March 2018. We assessed performance of the model based on discrimination, calibration, and risk stratification ability. Internal validity was assessed using the bootstrap method. The cohort included 95 537 women who contributed 1 401 084 person-years follow-up. In total, 4024 (4.2%) of women were hospitalized for CVD, of which 1585 events (1.6%) occurred within 10 years of follow-up. The final model had modest discriminatory performance (area under the receiver operating characteristic curve, 0.66; 95% CI, 0.65-0.67) and good calibration with slope of 0.95 and intercept of -0.19. There was moderate classification accuracy (likelihood ratio+: 5.90; 95% CI, 5.01-6.95) in the highest-risk group upon risk stratification. Conclusions Overall, our model had modest performance in predicting the 10-year risk of premature CVD for women with HDP. We recommend the addition of clinical variables, and external validation, before consideration for clinical use.