Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health最新文献

{"title":"Health disparities in pregnancies complicated by acute-onset severe hypertension","authors":"Julio Mateus Nino ,&nbsp;Kendall Parrott ,&nbsp;Leah Ledford ,&nbsp;Gretchen Hoelscher ,&nbsp;Roger B. Newman ,&nbsp;Meikim Wong ,&nbsp;Tasha L. Gill","doi":"10.1016/j.preghy.2025.101216","DOIUrl":"10.1016/j.preghy.2025.101216","url":null,"abstract":"<div><h3>Objective</h3><div>To examine health disparities in the management and clinical outcomes of singleton pregnancies diagnosed with acute-onset severe hypertension (AOSH) during hospitalization.</div></div><div><h3>Study design</h3><div>Retrospective cohort study (2016–2021) of pregnant patients with AOSH, defined as systolic blood pressure (SBP) ≥ 160 mmHg or diastolic blood pressure (DBP) ≥ 110 mmHg ≥ 15 min apart.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was timely therapy of AOSH, defined as correctly dosed first-line antihypertensive medication administered &lt;60 min. Secondary outcomes were adverse maternal and perinatal composite outcomes. Multivariate logistic regression models were built to assess the association between patient factors, type of OBGYN practice, institutional factors, and the primary and secondary outcomes.</div></div><div><h3>Results</h3><div>Of the 732 patients, 298 (40.7 %) were non-Hispanic white, 297 (40.6 %) were non-Hispanic black, and 137 (18.7 %) were Hispanic. The primary outcome was not associated with race/ethnicity or other patient factors. The odds of timely emergent therapy of AOSH were 50 % higher in the 15:00 h–22:59 h nursing shift versus other shifts (aOR = 1.48; 95 % CI: 1.02, 2.18; <em>P</em> = 0.04). Furthermore, patients managed by private OBGYN physicians had significantly lower odds of adverse perinatal composite outcomes than those managed by academic OBGYN physicians (aOR = 0.39, 95 % CI: 0.21, 0.73; <em>P</em> = 0.003). Maternal adverse outcomes were not associated with any of the study factors.</div></div><div><h3>Conclusion</h3><div>Timely anti-hypertensive therapy for AOSH was not influenced by maternal race/ethnicity, language, or insurance status. However, timely therapy was more likely during the evening shift, and perinatal outcomes were better with private OBGYN practice.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101216"},"PeriodicalIF":2.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stage I hypertension and pregnancy: Scope of disease and pregnancy outcomes","authors":"Dana Marsh ,&nbsp;Melissa Mathes ,&nbsp;Amy Miller ,&nbsp;Kristian Menard ,&nbsp;Harlan Sayles ,&nbsp;Karen Carlson","doi":"10.1016/j.preghy.2025.101222","DOIUrl":"10.1016/j.preghy.2025.101222","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the rates of preeclampsia between obstetric patients with stage I hypertension and those who are normotensive. Secondary aims include identifying risk factors for preeclampsia within the stage I hypertension cohort and comparing the rates of other adverse pregnancy outcomes between cohorts.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of individuals who delivered from January 1, 2019 to July 31, 2019, at a single academic center. Patients were assigned to cohorts comprised of normotensive pregnant patients and those with stage I hypertension prior to 20 weeks gestation. Stage I hypertension is defined as a systolic blood pressure of 130–139 mmHg, a diastolic blood pressure of 80–89 mmHg, or both. Differences in outcomes were evaluated using t- tests and logistic regression models.</div></div><div><h3>Results</h3><div>A total of 540 patients were included, 68 of whom were identified as having stage I hypertension. Among patients with stage I hypertension in pregnancy, 19 % developed preeclampsia compared to 10 % of normotensive patients (Odds Ratio (OR) = 2.14; p = 0.028). The odds of gestational diabetes (OR = 2.65, p = 0.01) and gestational hypertension (OR = 7.99, p &lt; 0.001) were also increased in the stage I hypertension cohort. Of the patients with stage I hypertension, a history of gestational diabetes was the only risk factor associated with subsequent development of preeclampsia (OR = 7.95, p = 0.034).</div></div><div><h3>Conclusion</h3><div>In our cohort, stage I hypertension prior to 20 weeks was associated with a significant increased rate of preeclampsia, gestational hypertension and gestational diabetes compared to normotensive patients.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101222"},"PeriodicalIF":2.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal association of hypertension in family members with preeclampsia-eclampsia in pregnant women: A two-sample Mendelian randomization study","authors":"Rui Hu,&nbsp;Yan Liang,&nbsp;Tongqiang He,&nbsp;Ying Zhou,&nbsp;Yanxiang Lv","doi":"10.1016/j.preghy.2025.101223","DOIUrl":"10.1016/j.preghy.2025.101223","url":null,"abstract":"<div><h3>Objectives</h3><div>The genetic risk factors for hypertension are also high-risk factors for preeclampsia-eclampsia. This study examined the association of hypertension in family members with preeclampsia-eclampsia in pregnant women through two-sample Mendelian randomization (MR).</div></div><div><h3>Study design</h3><div>Mendelian randomization.</div></div><div><h3>Main outcome measures</h3><div>The data for hypertension in siblings, mother, and father were from the UK Biobank, including 364,661, 426,391, and 402,899 individuals, respectively. The data for preeclampsia-eclampsia were FinnGEN R9 (7217 cases and 194,266 controls). Inverse-variance weighted was used as the main analysis method. Weighted median, MR-Egger, simple mode, and weighted mode were complementary MR methods. Heterogeneity was detected using Cochran’s Q-test, horizontal pleiotropy using MR-Egger regression, and driving single-nucleotide polymorphisms (SNPs) using the leave-one-out method.</div></div><div><h3>Results</h3><div>Mendelian randomization analysis showed that hypertension in family members was positively correlated with preeclampsia-eclampsia risk. The risk of preeclampsia-eclampsia in pregnant women who have siblings with hypertension was the highest (OR = 179.41, 95 % CI: 23.10–1393.65, P = 6.98E-07), followed by hypertension in the mothers (OR = 26.83, 95 % CI: 5.42–132.87, P = 5.56E-05) and the fathers (OR = 18.97, 95 % CI: 1.28–281.29, P = 0.032). The MR-Egger regression test indicated no horizontal pleiotropy (P &gt; 0.05). Cochran’s Q-test showed that the effects of the included SNPs exhibited heterogeneity (P &lt; 0.05). The leave-one-out analysis did not reveal SNPs driving the results by themselves.</div></div><div><h3>Conclusion</h3><div>The risk of preeclampsia-eclampsia in pregnant women who have siblings with hypertension was the highest, followed by pregnant women with a mother or father with hypertension. Having siblings with hypertension should be considered as a high-risk factor for the early prediction of preeclampsia-eclampsia.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101223"},"PeriodicalIF":2.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is outpatient surveillance of preeclampsia without severe features still safe in contemporary obese Populations?","authors":"Olha Krichevskiy ,&nbsp;Luke Schuster ,&nbsp;Christina Nguyen ,&nbsp;Megan Howell ,&nbsp;Gene T Lee","doi":"10.1016/j.preghy.2025.101225","DOIUrl":"10.1016/j.preghy.2025.101225","url":null,"abstract":"<div><h3>Objective</h3><div>Outpatient surveillance of preeclamptic pregnancies was studied several decades ago when rates of obesity were lower. The rate of preeclampsia and overall morbidity are higher in contemporary obese cohorts. We sought to review the safety of outpatient management of preeclampsia without severe features in a contemporary obese population.</div></div><div><h3>Study design</h3><div>Institutional retrospective cohort study analyzing the outcomes of 183 patients diagnosed with preeclampsia without severe features from 1/1/2010 to 12/31/2020.</div></div><div><h3>Main outcome measures</h3><div>Latency in days between diagnosis and time of delivery.</div></div><div><h3>Results</h3><div>The average BMI was 35.4 (SD 8.2), and the inpatient and outpatient groups did not have differences in BMI (34.5 vs 36.5, p = 0.12). The outpatient group was found to have significantly longer latency (20.4 vs 11.8 days, p &lt; 0.01). After adjustment, differences in latency for the inpatient and outpatient group remained statistically significant (Mean Difference −7.0, 95 % CI −11.3 to −2.7). Additionally, the outpatient group had a higher gestational age at delivery (35.7 vs 34.2, p &lt; 0.01), fewer total hospital days (8.3 vs 12.1 days, p &lt; 0.01), and fewer occurrences of preterm delivery before 34 weeks gestational age (18 % vs 39 %, p &lt; 0.01). Analysis of neonatal outcomes found the outpatient group had greater birth weights (2544.8 vs 2187.6 g, p &lt; 0.01) and fewer total days in the NICU (24.9 vs 41.8 days, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Outpatient management has become the expected practice when managing preeclampsia without severe features. Our study’s findings support this management strategy in the modern obese population.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101225"},"PeriodicalIF":2.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144106689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior preterm preeclampsia and hemostatic balance in the non-pregnant state","authors":"Christine E. Horn ,&nbsp;Maria Cristina Bravo ,&nbsp;Thomas Orfeo ,&nbsp;Kelley McLean ,&nbsp;Ira Bernstein","doi":"10.1016/j.preghy.2025.101221","DOIUrl":"10.1016/j.preghy.2025.101221","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether a history of preterm preeclampsia (PreP) is associated with abnormal hemostatic features during the non-pregnant state, relative to people without a history of preeclampsia.</div></div><div><h3>Study design</h3><div>We conducted a retrospective sub-analysis of three prospective IRB approved studies in which individuals were evaluated outside of pregnancy during the follicular phase of their menstrual cycles. We compared parameters between subjects with prior PreP (n = 21) with a combined cohort (NL, n = 74) of healthy nulliparous subjects (n = 57) and subjects with a prior normotensive pregnancy (n = 17). T-tests were employed with P &lt; 0.05 accepted for significance.</div></div><div><h3>Main outcome measures</h3><div>Levels of eight coagulation factors, protein C (PC), and thrombin generation (TG) were assessed in the presence or absence of thrombomodulin (TM) to evaluate the activation of the anticoagulant PC pathway. Results: There were no differences in TG or factor composition between healthy nulliparous and healthy primiparous people. In contrast, the PreP cohort had increased levels of factors II, V, VII, IX, X, XI, and PC compared to the NL cohort without this history. In dynamic assays examining TG in the presence of TM, the PreP group had reduced rates (nM/min) of formation and diminished peak levels when compared to the NL group.</div></div><div><h3>Conclusions</h3><div>Increased procoagulant factor levels are typically associated with increased TG, suggesting here that individuals with prior PreP would have a procoagulant shift in the non-pregnant state. However, the observed concurrent increase in anticoagulant PC linked with a decrease in dynamic TG suggests a possible compensatory mechanism to maintain hemostatic balance.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101221"},"PeriodicalIF":2.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum care after preeclampsia: Lack of knowledge and inadequate counseling on long-term consequences","authors":"Ana Carolina Cavalheri ,&nbsp;Maria Laura Costa ,&nbsp;Ivan Fernandes ,&nbsp;Nelson Sass ,&nbsp;Henri Augusto Korkes","doi":"10.1016/j.preghy.2025.101220","DOIUrl":"10.1016/j.preghy.2025.101220","url":null,"abstract":"<div><h3>Background</h3><div>Preeclampsia has long-term consequences, with an increased risk of cardiovascular disease.</div><div>Objective</div><div>To assess womeńs knowledge about preeclampsia (PE) and to what extent the postpartum healthcare provided was aligned with evidence-based guidelines.</div><div>Methods</div><div>A cross-sectional study conducted between 2021 and 2022, in two referral maternity hospitals in southeast Brazil. Women diagnosed with PE in the current pregnancy were contacted by weeks after childbirth and interviewed about the length of hospital stay, use of antihypertensive drugs, scheduled visits, place of care, professionals involved in postpartum care, blood pressure monitoring and knowledge about PE. A descriptive analysis was conducted.</div><div>Results</div><div>One hundred and twenty-four women with PE were invited to the study, and 100 answered the questionnaire six weeks postpartum, with a response rate of 80 %. Most women were young (aged 20–34 years), predominantly white, multiparous, and had underlying medical conditions. Route of delivery was predominantly cesarean section (75 %), with a high preterm birth rate (75 %). Half of hospital stays lasted 3–5 days. All women were referred to primary care and 49 % had a scheduled visit recommended during the first week postpartum. Around one-third of the women were not using antihypertensive medication 6 weeks postpartum. Main counselling received: maintenance of blood pressure measurements (65 %), management of medications (53 %), follow-up visits (41 %) and lifestyle changes were encouraged (35 %). However, 98 % of the women were unaware of the long-term repercussions of PE and only 35 % felt supported during postpartum medical care.</div><div>Conclusion</div><div>Early return to specialized care was lacking and guidance on the long-term risks after preeclampsia was inadequate.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101220"},"PeriodicalIF":2.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between maternal hemodynamic and sFlt-1/PlGF ratio in pregnancies affected by hypertensive disorders and fetal growth restriction","authors":"Valeria Maggi ,&nbsp;Federica Fusè ,&nbsp;Massimo Garbin ,&nbsp;Sara Zullino ,&nbsp;Marco Parasiliti ,&nbsp;Vittoria Sterpi ,&nbsp;Giulia Zamagni ,&nbsp;Enrico Mario Ferrazzi ,&nbsp;Daniela Di Martino","doi":"10.1016/j.preghy.2025.101214","DOIUrl":"10.1016/j.preghy.2025.101214","url":null,"abstract":"<div><h3>Objectives</h3><div>Our aim was to investigate the correlation between maternal hemodynamic and sFlt1/PlGF ratio in different phenotypes of Hypertensive Disorders of Pregnancy and Fetal Growth Restriction.</div></div><div><h3>Study design</h3><div>We recruited high risk pregnancies for Hypertensive Disorders and Fetal Growth Restriction. Heart rate, cardiac output, total vascular resistance and myocardial wall relaxation were derived from transthoracic echocardiography. Doppler Velocimetry of uterine arteries and serum sFlt1/PlGF ratio were measured.</div></div><div><h3>Main outcomes measures</h3><div>The effect of maternal hemodynamic on the oxidative stress of the syncytiotrophoblast was proved by the significant correlation coefficient of the linear regression between sFlt-1/PlGF ratio with mean arterial pressure, heart rate, cardiac output, total vascular resistance, myocardial wall relaxation and uterine arteries’ pulsatility index, which showed the highest correlation coefficient.</div></div><div><h3>Results</h3><div>We identified 17 cases of Hypertensive Disorders of Pregnancy without Fetal Growth Restriction, 19 hypertensive patients with Fetal Growth Restriction, 25 cases of early Fetal Growth Restriction, 25 cases of late Fetal Growth Restriction and 16 controls. At univariate linear regression the sFlt-1/PlGF ratio significantly increased on average 85 times (+8549%) in case of hypertension associated with growth restriction, 17 times in case of isolated hypertension (+1681%), 6 times in early growth restriction (661%) and more than 5 times in the late form (542%). There was a correlation between sFlt-1/PlGF ratio and both uterine arteries’ pulsatility index (ρ=0.48) and mean arterial pressure (ρ=0.45).</div></div><div><h3>Conclusions</h3><div>There is a significant relationship between maternal hemodynamic and sFlt-1/PlGF ratio, confirming the different characteristics of patients affected by hypertension and/or fetal growth restriction.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101214"},"PeriodicalIF":2.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of maternal age and body mass index on hypertensive disorders of pregnancy: Moving beyond the cut-off effect","authors":"Cecilia Lazzari ,&nbsp;Mariachiara Bosco ,&nbsp;Simone Garzon ,&nbsp;Chiara Simonetto ,&nbsp;Jvan Casarin ,&nbsp;Sonia Paolucci ,&nbsp;Antonella Cromi ,&nbsp;Fabio Ghezzi ,&nbsp;Stefano Uccella","doi":"10.1016/j.preghy.2025.101219","DOIUrl":"10.1016/j.preghy.2025.101219","url":null,"abstract":"<div><h3>Objectives</h3><div>Maternal age (MA) and body mass index (BMI) are known risk factors for hypertensive disorders of pregnancy (HDP). Different threshold values are used to calculate preeclampsia risk scores, but the appropriateness of a cut point model has not been extensively evaluated. This is because the effects of both MA and BMI occur continuously. We aimed to investigate the relationship between MA, BMI, and HDP, respecting the continuous nature of the two independent variables.</div></div><div><h3>Study Design</h3><div>We retrospectively selected all nulliparous women with singleton pregnancies who delivered after 22 gestational weeks from January 2005 to December 2019 (25,165 women). We used univariate and multivariable logistic regression analyses implementing linear, quadratic, cubic, and penalized splines functions to test, investigate, and describe the relationship between continuous BMI, continuous MA, and risk of HDP.</div></div><div><h3>Main Outcome Measures</h3><div>MA, BMI, and infertility treatments are independently associated with the risk of developing all HDP in nulliparous women. The impacts of MA and BMI on the risk of developing HDP occur gradually, and penalized splines functions resulted in the best model to describe these associations with a different model for each HDP. No interaction factors were retained between MA, BMI, and infertility treatments.</div></div><div><h3>Conclusions</h3><div>Given the relevance of HDP on maternal mortality, an accurate identification of women at increased risk of developing the disease is crucial. In an era where technology is rapidly advancing, new models for customized risk assessment of HDP, considering the continuous nature of MA and pregestational BMI, must be implemented.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101219"},"PeriodicalIF":2.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-related Thrombotic Microangiopathy has a spectrum of underlying causes","authors":"Sivan Livson ,&nbsp;Jenni Heikkinen-Eloranta ,&nbsp;Marcel Messing ,&nbsp;A.Inkeri Lokki ,&nbsp;Seppo Meri","doi":"10.1016/j.preghy.2025.101212","DOIUrl":"10.1016/j.preghy.2025.101212","url":null,"abstract":"<div><h3>Objectives</h3><div>Pregnancy-associated Thrombotic Microangiopathy (pTMA) encompasses disorders leading to significant maternal morbidity and mortality and risks to the newborn. The complement system plays a key role in TMA pathogenesis, with pregnancy triggering susceptibility in women. Due to its rarity, timely diagnosis and management of pTMA remain challenging. This study aimed at identifying potential triggers and mechanisms in pregnant women with severe TMA, from an obstetric perspective.</div></div><div><h3>Study design</h3><div>Clinical and molecular data from 11 women with pregnancy-related TMA complications (2012–2022) were analyzed. Blood samples during acute TMA stages were tested for anti-factor H (FH) and anti-ADAMTS13 antibodies using ELISA and Western blotting. Next-generation sequencing and MLPA assays evaluated genetic variants in TMA-related genes.</div></div><div><h3>Results</h3><div>Clinical records showed similar presentations despite diverse diagnoses, including preeclampsia, HELLP syndrome, AFLP, atypical HUS, and autoimmune TTP, primarily in the third trimester. Eight patients had postpartum hemorrhage (mean blood loss 1312 ml) with normal activated partial thromboplastin times but reduced fibrinogen levels. Genetic findings included two mutations in the C3 gene in one patient, one DGKE mutation, one factor V Leiden mutation, and <em>CFHR3-1</em> gene deletions (two homozygous, one heterozygous). ADAMTS13 autoantibodies were detected in the TTP case.</div></div><div><h3>Conclusion</h3><div>The rarity and overlapping criteria of pTMA with other syndromes complicate diagnosis. Early recognition of coagulation abnormalities, hemorrhage, and cardiovascular disorders can help identify at-risk patients. Genetic mutations indicating complement dysregulation suggest that targeted therapies could improve outcomes. Comprehensive diagnostics, timely management, and close follow-up are crucial for optimizing the maternal and fetal health.</div></div><div><h3>Key Message</h3><div>Pregnancy-associated thrombotic microangiopathy is a rare life-threatening condition that requires prompt diagnosis and treatment. This study helps obstetricians to identify at-risk patients. In a proportion of cases rare complement gene variants can be identified. The broad spectrum on underlying causes highlights the need for comprehensive diagnostic testing to improve management and outcomes.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101212"},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rule-in and rule-out of pre-eclampsia using a novel point-of-care placental growth factor test","authors":"James Rogers ,&nbsp;Alice Hurrell ,&nbsp;Gaayen Ravii Sahgal,&nbsp;Louisa Samuels,&nbsp;Chileshe Mabula-Bwalya,&nbsp;Katy Kuhrt,&nbsp;Carolyn Gill,&nbsp;Anna Brockbank,&nbsp;Katie Dalrymple,&nbsp;Antonio De Marvao,&nbsp;Paul T. Seed,&nbsp;Lucy C. Chappell,&nbsp;Andrew H. Shennan ,&nbsp;Kate Bramham","doi":"10.1016/j.preghy.2025.101215","DOIUrl":"10.1016/j.preghy.2025.101215","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate test performance of the point-of-care Lepzi® Quanti placental growth factor (PlGF) test to rule-in and rule-out pre-eclampsia at various time points, in women presenting with suspected preeclampsia.</div></div><div><h3>Study design</h3><div>242 frozen plasma samples from women with suspected pre-eclampsia were analysed from a prospective cohort study. Participants were recruited from two obstetric tertiary referral centres in London.</div></div><div><h3>Main outcome measures</h3><div>PlGF concentration was quantified using the Lepzi® Quanti PlGF test, which is a point-of-care PlGF test. Test performance for diagnosis of pre-eclampsia was evaluated at various thresholds, and at different gestations. The area under the receiver operator curve (AUROC) was determined for the Lepzi® Quanti PlGF test and compared to that of the nationally recommended Delfia® Xpress PlGF1-2–3 test, in the same cohort of participants.</div></div><div><h3>Results</h3><div>The LEPZI® Quanti PlGF test showed high test performance for rule-out of pre-eclampsia within seven and 28 days. A threshold of ≥ 129 pg/ml (in plasma) had high negative predictive value (NPV) for rule out of preeclampsia within seven days of sampling: NPV 96.9 % at &lt; 34 weeks’ gestation (95 % confidence interval (CI) 91.2–99.4), NPV 97.0 %; at 34 – 37 weeks’ gestation (95 % CI 84.2–99.9), NPV 80.0 % at ≥ 37 weeks gestation (95 % CI 44.4–97.5).</div></div><div><h3>Conclusion</h3><div>The LEPZI® Quanti PlGF test demonstrates high test performance for diagnosis of pre-eclampsia, comparable to test performance for validated, nationally recommended PlGF tests. The LEPZI® Quanti PlGF test is a whole blood, point-of-care option to optimise risk stratification, enhanced surveillance, and appropriate management strategies; this would be suitable for low- and middle-income settings, as well as high-income settings.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101215"},"PeriodicalIF":2.5,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}