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(searched for: Hypertension in Pregnancy)
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Published: 16 September 2020
by MDPI
Nutrients, Volume 12; doi:10.3390/nu12092838

Abstract:
As mothers age, the risk of adverse pregnancy outcomes may increase, but the results so far are controversial and several issues remain unknown, such as the impact of maternal weight on the effects associated with older age. In a prospective cohort of 912 Polish women with singleton pregnancies (recruited in 2015–2016), we assessed the pregnancy outcomes depending on the mother’s age (18–24, 25–29, 30–34, 35–39, and ≥40 years). Women aged ≥35 years (vs. p = 0.034), gestational diabetes mellitus GDM-1 (AOR = 7.06, p = 0.016), cesarean section (AOR = 6.97, p p = 0.033) as well as macrosomia >4000 g (AOR = 8.95, p = 0.048). We found that older age ≥35 years (vs.
Omid Safa, Mehdi Hassani-Azad, Mehdi Farashahinejad, Parivash Davoodian, Habib Dadvand, Soheil Hassanipour, Sciprofile linkMohammad Fathalipour
Published: 15 September 2020
Trials, Volume 21, pp 1-3; doi:10.1186/s13063-020-04706-3

Abstract:
Objectives We investigate the effects of Licorice (Glycyrrhiza glabra L.) root extract, an anti-inflammatory natural medicine, compared to the usual therapeutic regimen on clinical symptoms and laboratory signs in patients with confirmed COVID-19 that are moderately ill. Trial design This is a single-center, open-label, randomized, clinical trial with parallel-group design. This study is being conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran. Participants Both male and female patients with ≥18 years of age (≥ 35 kg of weight), admitted at the Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas for treatment, screened for the following criteria. Inclusion criteria: 1. Confirmed diagnosis of SARS-CoV-2 infection (via polymerase chain reaction [PCR] and/or antibody test). 2. Presenting as moderate COVID-19 pneumonia (via chest computed tomography (CT) and/or X-ray) requiring hospitalization. 3. Hospitalized ≤48 hours. 4. Signing informed consent and willingness of study participant to accept randomization to any assigned treatment arm. Exclusion criteria: 1. Underlying diseases, including chronic heart disease, chronic hypertension, severe renal failure, severe liver failure, and thyroid disorders. 2. Severe and critical COVID-19 pneumonia. 3. Use of warfarin, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), diuretics, corticosteroids, and antiarrhythmic drugs. 4. Treatment with Investigational and antiviral therapy in a clinical study within one month before randomization. 5. History of allergy to Licorice. 6. Pregnancy and breastfeeding. Intervention and comparator Intervention group: The standard treatment regimen for COVID-19 along with a Licorice-based herbal preparation (D-Reglis ®, Irandarouk Pharmaceutical Company, Iran) at a dose of 760 mg three times a day for a period of seven days. Control group: The standard treatment for COVID-19 based on the Iranian Ministry of Health and Medical Education's protocol for a period of seven days. Main outcomes The recovery rate of clinical symptoms, including fever, dry cough, and tiredness, as well as paraclinical features, including thrombocytopenia, lymphocytopenia, and C-reactive protein, are evaluated as primary outcomes within seven days of randomization. Time to improvement of clinical and paraclinical features and length of stay in a hospital, along with the incidence of adverse reactions are also evaluated as the secondary outcomes within seven days of randomization. Randomization An electronic table of random numbers will be used to allocate the included participants into either control or intervention groups (in a 1:1 ratio) using the simple randomization method. Blinding (masking) This is an open-label trial without blinding and placebo control. Numbers to be randomized (sample size) A total of 60 participants randomizes (30 patients allocated to the intervention group and 30 patients allocated to the control group). Trial Status The protocol is Version 1.0, May 31, 2020. Recruitment began July 30, 2020, and is anticipated to be completed by October 30, 2020. Trial registration This clinical trial has been registered in the Iranian Registry of Clinical Trials (IRCT). The registration number is “IRCT20200506047323N2”, https://www.irct.ir/trial/47990. The registration date is 31 May 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
V Mallikarjuna Reddy, Obstetrics And Gynaecology, Pavitra Reddy Nalamaru, Pediatrics
Indian Journal of Obstetrics and Gynecology Research, Volume 7, pp 364-368; doi:10.18231/j.ijogr.2020.078

Abstract:
Introduction: High risk pregnancies are these that result in maternal or fetal morbidity or mortality. These may include conditions such as pre-eclampsia, eclampsia, oligohydramnios, anemia. Therefore, it becomes very important for early identification of the risk so that immediate treatment can be given. In order to reduce the morbidity and mortality of both the mother and child. the non stress test and NST with the amniotic fluid volume (Modified biophysical profile) are some of the tests used for this purpose. Materials and Methods: After the demographic details and clinical evaluation, Non stress test (NST) was done for all the patients. The fetal heart rate, movements and tone was measured along with the uterine contractions. If there were more than 2 fetal movements with two accelerations of 15 beats / minute or more within 10 mintues of monitoring, the test was rendered reactive. The amniotic fluid volume and Index were measured. Results: The mean age of the women was 23.3 + 5.1 years and the mean gestational age of them was 34.87 + 3.91 weeks. The most predominant risk factors which was present in the expectant mothers was decreased movements of the fetus, followed by hypertension and Oligohydramnios. 27% of the patients had to be induced for vaginal delivery while spontaneous delivery was seen in 22% of the cases. 24% of the patients elected to go in for LSCS delivery while emergency LSCS was done on 14% of the patients. 68 (46.9%) mothers with high risk pregnancy had a normal NST and AFI, while 43 (29.7%) of them had an Abnormal NST with Abnormal AFI. 11 (7.6%) of them had Normal NST but an Abnormal AFI and 23 (15.9%) had and Abnormal NST with a Normal AFI. Conclusion: The overall sensitivity and the specificity of NST, AFI and MBPP are comparable to each other in the detection of fetal distress, though MBPP is marginally better. Keywords: Modified biophysical profile, Non-stress test, Amniotic fluid index.
Rathnamma P, Obstetrics And Gynaecology
Indian Journal of Obstetrics and Gynecology Research, Volume 7, pp 415-420; doi:10.18231/j.ijogr.2020.087

Abstract:
Objective: To determine the existence of associations between significance of age at first pregnancy and its effect on maternal and perinatal outcome. Materials and Methods: A prospective study conducted in the department of OBG on all 2100 primi gravida women admitted in labour ward and they were divided into three groups: adolescent ( elderly group (> 30years) and control group (20-29 years). The adolescent and elderly group were compared with the control group for the maternal and perinatal outcomes. Results: Rate of abortions, gestational diabetes, gestational hypertension, hypothyroidism and still birth were more common in elderly group, preterm deliveries, IUGR, foetal malpresentations, IUD and neonatal death were common in adolescent group as compared to control group. There was statistical significant difference regarding APGAR scores and admission to neonatal intensive care unit. Conclusion: Maternal age has significant role in the pregnancy outcome. Adolescent and elderly maternal age is a risk factor for adverse pregnancy outcomes. Early booking, close supervision in the antenatal and intrapartum period, appropriately timed obstetric intervention may contribute to good maternal and perinatal outcome. Keywords: Maternal age, Primigravida, Pregnancy outcomes, Adolescent.
Yaguang Li, Ning Yang, Binsu Wang, Xiulong Niu, Wei Cai, Yuanbin Li, Yuming Li, Sciprofile linkShaobo Chen
Published: 15 September 2020
Placenta, Volume 99, pp 35-44; doi:10.1016/j.placenta.2020.06.015

Abstract:
Preeclampsia (PE) is a serious maternal inflammatory disease with endothelial cell dysfunction, and there is a lack of effective treatment and prevention. Tadalafil is considered to be a promising drug for PE. This study aimed to determine whether and how tadalafil use during early pregnancy alleviates PE induced by N-nitro-l-arginine-methyl-ester (l-NAME), an antagonist of nitric oxide synthase, in rats. Twenty-eight Sprague-Dawley (SD) rats were randomly divided into 4 equal groups on gestational day 0 (GD0): a pregnant control group, an l-NAME-treated PE group and two prophylactic low-dose and high-dose tadalafil groups. Blood pressure was measured on GD0, 5, 10, 15 and 20. Proteinuria was assessed on GD0 and 18. Femoral artery ultrasound was performed on GD19. Tissue sampling was performed on GD20. The perinatal outcomes, placenta and kidney tissue morphology, and endothelial and inflammatory markers were examined. Prophylactic administration of low and high doses of tadalafil improved l-NAME induced hypertension, proteinuria, maternal weight loss during pregnancy, fetal growth restriction and flow-mediated dilatation, balanced endothelial-relative factors, and alleviated inflammation activation in placenta and kidney tissue. What's more, in some results, the HT group performed better than the LT group. Our results indicate that prophylactic use of tadalafil in l-NAME-induced PE-like rat models alleviates PE symptoms, promotes fetal growth, protects endothelial function and reduces inflammation, suggesting that tadalafil may be a potential drug for the prevention of PE.
Sciprofile linkMulugeta Woldu Abrha, Alemnesh Abarha, Ataklty Gebretsadik, Brhane Ayele, Haylay Gebretensae, Equbay Gebre-Egziabher, Tsegay Hadgu, Afework Mulugeta
Published: 14 September 2020
Abstract:
Background: Investigating effects of calcium diets on blood pressure can contribute to development of diet based recommendations for health. Epidemiologic data suggest contradicting evidence relationship between dietary calcium intake and pregnancy-induced hypertension. So, this study aimed to determine the effect of calcium nutrition education on blood pressure variability among pregnant mother.Method: Single center, two-arm, main individual randomized trial parallel design; single blinded was conducted among 415 pregnant mothers. Bi-variable tabulations were computed to identify the distributions of the outcome variables by selected background characteristics. We estimated a multilevel model that assessed the relation of individual and community level factors (fixed effects) as well as community level random effects. All analysis was conducted using STATA 14 software.Result: Blood pressure variability during pregnancy after 28 gestational age was significantly associated with weekly calcium nutrition education [AOR=0.38; 95% CI: 0.19, 0.5], pregnant mothers who attained secondary school [AOR=0.21, 95%CI: 0.20, 0.70], employed pregnant women [AOR=9.05; 95% CI: 1.95, 14.02] , Antenatal Care [AOR=1.82; 95% CI: 1.01, 2.22], supplemented iron/folic acid [AOR=6.32; 95% CI: 1.09, 36.59], food craving [AOR=0.78; 95% CI: 0.20, 0.98], reading newspaper [AOR=9.05; 95% CI: 1.95, 14.02], place of residence [AOR=2.11; 95% CI: 1.36, 3.26]. Conclusion: Individual level factors (Calcium nutrition education, maternal educational status, maternal occupation, Antenatal care during last pregnancy and current pregnancy, iron/folic acid supplementation, food craving, dietary calcium level and reading newspaper) and community level factors (place of residence) were significant predictors of blood pressure variability. During antenatal visits, pregnant women should be made aware of some dietary practices which are harmful during pregnancy, and increase education regarding the benefit of adequate nutrition. Trail Registration: PACTR, PACTR202009693949631 and Registered 02 September 2020- Retrospectively registered
Sciprofile linkTetsuya Kawakita, Sarah K. Downs, Stephanie Franco, Atoosa Ghofranian, Alexandra Thomas
The Journal of Maternal-Fetal & Neonatal Medicine pp 1-6; doi:10.1080/14767058.2020.1817371

Abstract:
Hypertensive disorders are a common cause of maternal mortality. Whether interpregnancy BMI (body mass index kg/m2) gain is associated with hypertensive disorders in a subsequent pregnancy is not unclear. To examine the association between interpregnancy BMI and hypertensive disorders in women without a history of hypertensive disorders in pregnancy. This was a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks’ gestation or greater at a single academic institution. Only the second pregnancy in the dataset was analyzed. We excluded women who had any hypertensive disorder in the index pregnancy. Interpregnancy BMI change was calculated by the change of early pregnancy BMI (within 14 weeks’ gestation) measured in the office between the index pregnancy compared to that of the subsequent pregnancy. Women were categorized according to interpregnancy BMI change (BMI loss greater than 2 kg/m2, BMI change ±2 kg/m2, and BMI gain greater than 2 kg/m2). The primary outcome was any hypertensive disorder (chronic hypertension and pregnancy-associated hypertension). Multivariable logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence interval (95%CI) after adjusting for predefined covariates. Of 3068 women who were analyzed, 342 (11%), 1698 (55%), and 1028 (34%) had interpregnancy BMI loss greater than 2 kg/m2, interpregnancy BMI change ±2 kg/m2, and interpregnancy BMI gain greater than 2 kg/m2, respectively. Interpregnancy BMI gain greater than 2 kg/m2 compared to interpregnancy BMI loss more than 2 kg/m2 was associated with increased odds of hypertensive disorders (8.3% vs. 4.0%; adjusted odds ratio 2.20 [95% confidence interval 1.55–3.13]) and pregnancy-associated hypertension (adjusted odds ratio 2.25 [95% confidence interval 1.54–3.27]). Interpregnancy BMI loss greater than 2 kg/m2 compared to interpregnancy BMI change ±2 kg/m2 was not associated with increased odds of any hypertensive disorders (5.3% vs. 4.0%; adjusted odds ratio 0.58 [95% confidence interval 0.32–1.05]). Compared to interpregnancy BMI change ±2 kg/m2, interpregnancy BMI gain greater than 2 kg/m2 was associated with increased odds of any hypertensive disorder. Weight control after pregnancy could be a potentially modifiable factor that may reduce the risk of hypertensive disorders.
Leila Magistrado, Mary C. Tolcher, Anju Suhag, Sonal Zambare, Sciprofile linkKjersti M. Aagaard
Case Reports in Obstetrics and Gynecology, Volume 2020, pp 1-6; doi:10.1155/2020/9801565

Abstract:
There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae>45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.
Ronald H. Silverman, Raksha Urs, Ronald J. Wapner, Srilaxmi Bearelly
Translational Vision Science & Technology, Volume 9, pp 14-14; doi:10.1167/tvst.9.10.14

Abstract:
Purpose: Pre-eclampsia (PE) is a serious complication of pregnancy characterized by high blood pressure, proteinuria, compromised fetal blood supply, and potential organ damage. The superficial location of the eye makes it an ideal target for characterization hemodynamics. Our aim was to discern the impact of PE on ocular blood flow. Methods: 18 MHz plane-wave ophthalmic ultrasound scanning was performed on subjects with PE (n = 26), chronic or gestational hypertension (n = 8), and normal controls (n = 19) within 72 hours of delivery. Duplicate three-second long scans of the posterior pole including the optic nerve were acquired at 6000 images/sec for evaluation of the central retinal artery and vein and the short posterior ciliary arteries. The choroid was scanned at 1000 images/sec. Doppler analysis provided values of pulsatile flow velocity and resistance indexes. Results: End diastolic velocity was higher, and pulsatility and resistive indexes were significantly lower in the choroid, central retinal artery and short posterior ciliary arteries in PE than in controls. Blood pressure was elevated in PE with respect to controls and was negatively correlated with resistance. Conclusions: Although vasoconstriction is considered characteristic of PE, we found reduced resistance in the orbital vessels and choroidal arterioles, implying vasodilation at this level. Future studies incorporating optical coherence tomography angiography for characterization of the retina and choriocapillaris in conjunction with plane-wave ultrasound scanning, particularly in late pregnancy, might address this conundrum. Translational Relevance: Use of plane-wave ultrasound scanning for evaluation ocular blood flow in women at risk for PE may offer an avenue towards early detection and clinical intervention.
Lirui Zhang, Wei Zheng, Cheng Liu, Xin Liang, Li Zhang, Zhihong Tian, Sciprofile linkGuanghui Li
Published: 14 September 2020
Abstract:
Background: The influence of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on perinatal outcomes of women with polycystic ovary syndrome (PCOS) remains unclear. Therefore, we explored how the above indicators influence pregnancy outcomes in women with PCOS. Methods: A retrospective study was conducted involving the baseline characteristics, laboratory data, and pregnancy outcomes of 722 pregnant women with PCOS. Subjects were grouped in a way to find out risks in their pregnancy outcomes. Multivariable logistic regression analysis was performed to investigate how BMI and GWG were associated with perinatal outcomes.Results:Among women with PCOS, underweight increased the risk of small for gestational age (SGA) (OR 12.35, 95% CI 3.56-42.82), but reduced the risk of large for gestational age (LGA). Overweight but not obese women were more susceptible to developing preeclampsia (PE) than women with normal weight. In PCOS women with BMI<25 kg/m2 before pregnancy, inadequate GWG was a protective factor for gestational hypertension (GH) and postpartum hemorrhage (PPH), excessive GWG exhibited a positive correlation with LGA. But in PCOS women with BMI ≥25 kg/m2, excessive GWG increased the probability of undergoing a cesarean section. Inadequate GWG did not reduce the likelihood of LGA in women with BMI ≥ 25 kg/m2, and excessive GWG did not reduce the probability of SGA in women with BMI<25 kg/m2.Conclusion: The impacts of pre-pregnancy BMI, GWG on maternal and infant outcomes among PCOS women are similar to reported results in general pregnant women. However, some unique trends were also observed in PCOS women. While the underweight factor significantly increased the risk of SGA birth, overweight but not obesity was correlated with the risk of PE. Inadequate GWG was a protective factor for GH and PPH only in women with pregestational BMI<25 kg/m2. Inadequate GWG did not reduce the probability of LGA in women with BMI ≥ 25 kg/m2, and similarly, excessive GWG did not reduce the probability of SGA in women with BMI<25 kg/m2. Overall, these findings indicate that women with PCOS should begin weight management before pregnancy.
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