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

{"title":"Cardiovascular risk management after hypertensive disorders and diabetes during pregnancy, in a multi-ethnic population: A qualitative study among women and healthcare providers","authors":"Annemarie Y.A.M. Reilingh ,&nbsp;Renée J. Burger ,&nbsp;Souraya el Bachiri ,&nbsp;Stephen McCarthy ,&nbsp;Sanne J. Gordijn ,&nbsp;Wessel Ganzevoort ,&nbsp;Irene G.M. Valkengoed van ,&nbsp;on behalf of the project group: ’Obstetric history and cardiovascular health across ethnicity, in The Netherlands’","doi":"10.1016/j.preghy.2025.101203","DOIUrl":"10.1016/j.preghy.2025.101203","url":null,"abstract":"<div><h3>Background</h3><div>Pregnancy complications like gestational diabetes and hypertensive disorders increase maternal cardiovascular risk. However, evidence on how to best implement cardiovascular risk management (CVRM) in multi-ethnic contexts remains limited. Existing studies primarily focus on white populations, despite disparities in CVD risk and the risk of pregnancy complications across ethnic groups.</div></div><div><h3>Objective</h3><div>This study explores experiences, barriers, and improvements in postpartum CVRM from women’s and healthcare providers’ perspectives, aiming to enhance cardiovascular disease prevention in multi-ethnic contexts.</div></div><div><h3>Study Design</h3><div>We conducted semi-structured interviews with 25 postpartum women who experienced hypertensive disorders of pregnancy or gestational diabetes, recruited to reflect diverse ethnic and socioeconomic backgrounds. Using a narrative approach, interviews covered CVRM experiences and preferences. Themes were triangulated with findings from 16 healthcare providers, including general practitioners, midwives, and specialists, discussing care delivery, optimal practices, and multi-ethnic considerations. Results were integrated in a patient journey map.</div></div><div><h3>Results</h3><div>Significant dropout occurred at the transition from obstetric to primary care and during long-term monitoring, especially among ethnic minorities and women with lower socioeconomic status and disease severity. Women often lacked risk awareness and missed follow-ups when self-scheduling was required. Most supported tailored cardiovascular risk education, lifestyle interventions, and proactive outreach. Healthcare providers emphasized the need for interdisciplinary communication, regional protocols, and clearer guidelines, noting variability in general practitioners’ support for routine monitoring.</div></div><div><h3>Conclusion</h3><div>Postpartum CVRM in multi-ethnic contexts could be improved with active outreach, better follow-up utilization, culturally tailored interventions, and regional multidisciplinary protocols to streamline care and address guideline inconsistencies.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101203"},"PeriodicalIF":2.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A quality improvement intervention to optimize the management of severe hypertension during pregnancy and postpartum","authors":"Marie-Julie Trahan ,&nbsp;Marianne Plourde ,&nbsp;Ana Clouatre ,&nbsp;Karen Wou ,&nbsp;Antonina Pavilanis ,&nbsp;Ruth-Lynn Fortune ,&nbsp;Sabrina Haas ,&nbsp;Jennifer Pepin ,&nbsp;Sophia Kapellas ,&nbsp;Anne-Maude Morency ,&nbsp;Ginette Aucoin ,&nbsp;Alexandria Flannery ,&nbsp;Pierre-Olivier Monast ,&nbsp;Noura Hassan ,&nbsp;Maral Koolian ,&nbsp;Thiphavone Oudanonh ,&nbsp;Nisha Almeida ,&nbsp;Eva Suarthana ,&nbsp;Stella S. Daskalopoulou ,&nbsp;Isabelle Malhamé","doi":"10.1016/j.preghy.2025.101192","DOIUrl":"10.1016/j.preghy.2025.101192","url":null,"abstract":"<div><h3>Objective</h3><div>Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.</div></div><div><h3>Study design</h3><div>We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.</div></div><div><h3>Main outcome measures</h3><div>Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.</div></div><div><h3>Results</h3><div>Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).</div></div><div><h3>Conclusion</h3><div>Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101192"},"PeriodicalIF":2.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a relationship between visit-to-visit blood pressure variability and adverse perinatal outcomes?","authors":"Laura Ormesher ,&nbsp;Jill Stewart ,&nbsp;Beth Renwick ,&nbsp;Emma Shawkat ,&nbsp;Jenny E Myers","doi":"10.1016/j.preghy.2025.101200","DOIUrl":"10.1016/j.preghy.2025.101200","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the relationship between blood pressure (BP) variability and perinatal outcomes.</div></div><div><h3>Study design</h3><div>This was a retrospective study of 996 pregnant women with hypertension/risk factors for hypertension in pregnancy. BP variability was calculated by visit-to-visit standard deviation (SD) and mean difference (MD). Logistic regression explored the relationship between BP variability and perinatal outcome, adjusting for confounders.</div></div><div><h3>Main Outcome Measures</h3><div>Correlation between BP variability and i) fetal growth restriction (FGR) and ii) preterm birth (PTB).</div></div><div><h3>Results</h3><div>FGR and PTB complicated 128/996 (13 %) and 233/996 (23 %) pregnancies. At visit 1, 61 (6 %) women were taking labetalol, 125 (13 %) were taking calcium channel blockers and 780 (78 %) were not taking antihypertensives. Increased BP variability was associated with FGR and PTB. These relationships persisted after adjustment for number of antihypertensives, pre-pregnancy BP, BMI, ethnicity and previous FGR for systolic but not diastolic BP variability (adjusted OR for FGR: 1.16 [95 % C.I. 1.03–1.30]; PTB: 1.16 [1.05–1.29]). However, statistical significance was lost after adjustment for maximum BP. Nifedipine was associated with increased BP variability, compared with labetalol, despite adjustment for ethnicity and pre-existing hypertension (adjusted difference: 1.93 mmHg [0.13–3.73], p = 0.04).</div></div><div><h3>Conclusions</h3><div>Increased visit-to-visit systolic but not diastolic BP variability is associated with adverse perinatal outcomes. Nevertheless, it is unclear whether BP lability directly influences perinatal outcome, or merely reflects peak BP. The difference in BP variability between antihypertensives may reflect varying effectiveness or factors influencing antihypertensive choice. Prospective research is needed to investigate any potential link between antihypertensive medications, BP variability and perinatal outcome.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101200"},"PeriodicalIF":2.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnocultural status and risk of preeclampsia in a Canadian setting","authors":"Nathalie Auger ,&nbsp;Aimina Ayoub ,&nbsp;Marianne Bilodeau-Bertrand ,&nbsp;Nahantara Lafleur ,&nbsp;Shu Qin Wei","doi":"10.1016/j.preghy.2025.101202","DOIUrl":"10.1016/j.preghy.2025.101202","url":null,"abstract":"<div><h3>Objectives</h3><div>Disparities in hypertensive disorders of pregnancy are prevalent in the U.S., but are understudied in other settings. Our objective was to determine if ethnocultural disparity in the risk of preeclampsia was present in Canada.</div></div><div><h3>Study design</h3><div>We carried out a retrospective cohort study of 862,759 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was the ethnocultural status of women, defined by linguistic origin (Anglophone or Francophone).</div></div><div><h3>Main outcome measures</h3><div>The outcome was preeclampsia, including severity (severe, superimposed, mild), presence of fetal growth restriction, and gestational onset time (early or late onset of hypertension). We estimated risk ratios (RR) and 95 % confidence intervals (CI) for the association between ethnocultural status and risk of preeclampsia adjusted for maternal characteristics.</div></div><div><h3>Results</h3><div>In adjusted models, Anglophones had a slightly elevated risk of preeclampsia compared with Francophones (40.5 vs. 37.2 per 1000 pregnancies; RR 1.03, 95 % CI 1.00–1.07). Associations were stronger for selected subtypes of preeclampsia, with Anglophones at greater risk of mild preeclampsia (RR 1.09, 95 % CI 1.04–1.13), preeclampsia without fetal growth restriction (RR 1.04, 95 % CI 1.00–1.08), and late onset preeclampsia (RR 1.04, 95 % CI 1.01–1.08). An association with severe preeclampsia was less apparent, although Anglophones lacking a high school diploma (RR 1.46, 95 % CI 1.12–1.90) or who were younger than 25 years (RR 1.19, 95 % CI 1.01–1.40) had a greater risk of severe preeclampsia compared with Francophones.</div></div><div><h3>Conclusions</h3><div>Anglophones, especially Anglophones in vulnerable subgroups, have a slightly elevated risk of preeclampsia compared with Francophones.</div><div>Abbreviations: CI, confidence interval; HELLP, hemolysis, elevated liver enzymes, and low platelets; ICD-10-CA, International Classification of Diseases, 10th revision; mmHg, millimeter of mercury; No., number; RR, risk ratio; U.S., United States.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101202"},"PeriodicalIF":2.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143334198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self antenatal monitoring of blood pressure at home as interVention ( SAMBHAV) in hypertensive women: Challenges in the developing country","authors":"Bhawana Meena,&nbsp;Manju Puri,&nbsp;Reena Yadav,&nbsp;Manisha Kumar","doi":"10.1016/j.preghy.2025.101201","DOIUrl":"10.1016/j.preghy.2025.101201","url":null,"abstract":"<div><h3>Objective</h3><div>To find the feasibility of home BP monitoring (HBPM) in hypertensive disorders of pregnancy (HDP) in a developing country setting.</div></div><div><h3>Methods</h3><div>In this randomized control trial 170 women with HDP between 32–36 week gestation were recruited. HBPM was done in cases and controls underwent biweekly blood pressure (BP) monitoring by clinician, randomization was done by computer-generated numbers in 1:1 ratio. The BP levels, frequency of antenatal visits, duration of hospital stay and delivery outcome of cases and controls were compared. Adherence to BP charting among the subjects was also observed.</div></div><div><h3>Results</h3><div>The mean gestational age of study subjects was 34 ± 1.32 weeks. PE developed in 75/170 (44.1 %) subjects. A total of 148/170 (87.0 %) cases were found to be ≥ 80 % compliant in taking BP recordings and attending weekly antenatal checkup. The comparison of outcome in compliant and noncompliant women showed that the incidence of preeclampsia and its complications were significantly higher among non-compliant group (p &lt; 0.001). The mean systolic and diastolic BP in the HBPM cases were marginally higher than controls, but the difference was not statistically significant. The duration of hospital stay in was significantly less in HBPM group compared to controls (4.0 ± 1.49 versus 4.14 ± 1.12) (p = 0.015). The incidence of PE and its complications were comparable in both the groups.</div></div><div><h3>Conclusion</h3><div>The optimum BP control in women could be achieved on HBPM, and was as effective as the standard care protocol. Adherence to BP monitoring was the most important factor in preventing complications and providing benefits of HBPM.</div></div><div><h3>Clinical trial registry details</h3><div>clinical trial registry-India; Registration no CTRI/2022/09/045801, https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzQ0OTA=&amp;Enc=&amp;userName=home%20blood%20pressure%20monitoring.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101201"},"PeriodicalIF":2.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102795","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":"Home blood pressure monitoring and mobile health application practices among pregnant persons with and at risk of hypertensive disorders of pregnancy","authors":"Mawulorm KI Denu ,&nbsp;Cassie Shao ,&nbsp;Katherine Tak ,&nbsp;Sanjna Iyengar ,&nbsp;Kelton Do ,&nbsp;Nouran Y. Nagy ,&nbsp;Ganeev Singh ,&nbsp;Katherine Anais Sadaniantz ,&nbsp;Sravya Shankara ,&nbsp;Lara C. Kovell","doi":"10.1016/j.preghy.2025.101197","DOIUrl":"10.1016/j.preghy.2025.101197","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine training in and current home blood pressure monitoring (HBPM) practices in pregnancies with hypertensive disorders of pregnancy (HDP) or risk factors for HDP; and to explore interest in using mHealth applications for communicating with healthcare providers.</div></div><div><h3>Study design</h3><div>A cross-sectional survey was conducted on HBPM practices/training and interest in using mobile health (mHealth) applications among pregnant persons at an academic medical center.</div></div><div><h3>Outcome measures</h3><div>The main outcomes measured were the proportion of participants who received training for HBPM, and the proportion interested in using mHealth applications for communication with providers related to managing HDP.</div></div><div><h3>Results</h3><div>Of the 103 participants, 41 (39.8%) used HBPM. Of those who did HBPM, 36.6% received training from their healthcare providers. Training more often included instructions on positioning and how to perform HBPM, and rarely included advice on validated HBPM devices. Nearly all participants (98.1%) owned a smartphone, and 19.4% had a smartwatch. A significant majority expressed interest in using a secure mobile app for communication with providers (78.6%), and 88.3% were interested in wearing a smartwatch for remote monitoring. There were no significant differences in interest levels based on race, age, residence, or education, while there was higher interest (100% vs. 67%) in mobile apps for communication among those with HDP vs. risk factors for HDP.</div></div><div><h3>Conclusions</h3><div>Despite a low level of training for HBPM, there was high interest in using mHealth applications. Leveraging mHealth technology could help overcome the challenges of providing training for HBPM.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101197"},"PeriodicalIF":2.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076010","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":"Preeclampsia biomarkers (sFlt-1/PlGF) dynamics are not disrupted by SARS-CoV-2 infection during pregnancy in a hypertensive disorder SARS-CoV-2 vaccinated cohort","authors":"Guilherme Moraes Nobrega ,&nbsp;Luciana Pietro ,&nbsp;Sarah Luiza Dariva ,&nbsp;Isabella Ally Vasconcelos-Silva ,&nbsp;Monique Possari Manari ,&nbsp;Barbara Polli ,&nbsp;Arthur Becker Simões ,&nbsp;Julia Stucker de Almeida ,&nbsp;Roberta Moschetta ,&nbsp;Carolina Carvalho Ribeiro-do-Valle ,&nbsp;Jose Paulo Siqueira Guida ,&nbsp;Renato Teixeira Souza ,&nbsp;Jose Guilherme Cecatti ,&nbsp;Indira U Mysorekar ,&nbsp;Ana Selma Picoloto ,&nbsp;Maria Laura Costa","doi":"10.1016/j.preghy.2025.101196","DOIUrl":"10.1016/j.preghy.2025.101196","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze maternal and perinatal outcomes and serum levels of the preeclampsia (PE) biomarkers sFlt-1 and PlGF in pregnant women with hypertensive disorders vaccinated against SARS-CoV-2, with or without confirmed COVID-19 during pregnancy.</div></div><div><h3>Methods</h3><div>Multicenter (two-center) prospective cohort study secondary analysis. The cohort comprised pregnant women with hypertensive disorders who received SARS-CoV-2 vaccination, assessed from August 2021 to December 2022. Key variables included sociodemographic information, clinical background, maternal and perinatal outcomes, and biomarkers serum concentrations. A sFlt-1/PlGF ratio ≥ 38 was the threshold for predicting PE. The study compared outcomes based on the timing of SARS-CoV-2 infection and PE clinical onset.</div></div><div><h3>Results</h3><div>For biomarker analysis, 170 women provided serum samples: 31 had a confirmed COVID-19 during pregnancy, while 139 did not. Among these 170 women, 86 had chronic hypertension, and 100 developed PE. There were no significant differences in sociodemographic characteristics and gestational outcomes between the groups. The dynamics of the sFlt-1/PlGF ratio were similar regardless of COVID-19. Cesarean delivery was the most common delivery method in both groups, and there was a high rate of preterm births. No neonatal or maternal deaths were recorded.</div></div><div><h3>Conclusions</h3><div>The study suggests that pregnant women with hypertensive disorders who have been vaccinated against SARS-CoV-2 and subsequently infected show comparable maternal and perinatal outcomes and PE biomarker levels to those who were not infected. These results suggest that SARS-CoV-2 vaccination is protective for pregnant women, potentially reducing the association with a <em>PE-like</em> syndrome in severe cases of COVID-19 among those who are unvaccinated.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101196"},"PeriodicalIF":2.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076011","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":"Construction and evaluation of machine learning-based predictive models for early-onset preeclampsia","authors":"Bohan Lv ,&nbsp;Gang Wang ,&nbsp;Yueshuai Pan ,&nbsp;Guanghui Yuan ,&nbsp;Lili Wei","doi":"10.1016/j.preghy.2025.101198","DOIUrl":"10.1016/j.preghy.2025.101198","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the influencing factors of early-onset preeclampsia (EOPE). And to construct and validate the prediction model of EOPE using machine learning algorithm.</div></div><div><h3>Study design</h3><div>Based on Python system, the data profile of 1040 pregnant women was divided into 80% training set and 20% test set. Logistic regression algorithm, XGBoost algorithm, random forest algorithm, support vector machine algorithm and artificial neural network algorithm were used to construct the EOPE prediction model, respectively, and the resulting model was validated by resampling method. Accuracy, sensitivity, specificity, F1 score, and area under the ROC curve were used to evaluate the resulting models and screen the optimal models.</div></div><div><h3>Main outcome measures</h3><div>EOPE in pregnant women.</div></div><div><h3>Results</h3><div>The results of binary logistic regression showed that the influencing factors of EOPE included six indicators: pre-pregnancy BMI, number of pregnancies, mean arterial pressure, smoking, alpha-fetoprotein, and methods of conception. Among them, the prediction model of EOPE constructed based on the XGBoost algorithm performed the best in the training and test sets, with an F1 score of 0.554 ± 0.068 and an AUC of 0.963 (95 % CI: 0.943 ∼ 0.983) in the training set, and an F1 score of 0.488 ± 0.082 and an AUC of 0.936 (95 % CI: 0.887 ∼ 0.983).</div></div><div><h3>Conclusion</h3><div>Our prediction model for EOPE constructed based on the XGBoost algorithm has superior disease prediction ability and can provide assistance in predicting the disease risk of EOPE.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101198"},"PeriodicalIF":2.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076008","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":"Management of hypertension in the early postpartum: A randomized controlled trial","authors":"Rossana M.C.P. Marques ,&nbsp;Sabina B. Maia ,&nbsp;André T.V. Araújo ,&nbsp;Lara M.C. Araújo ,&nbsp;Thereza V.Q. Dias ,&nbsp;Gabriela T.B.R. Nogueira ,&nbsp;Luiz A. Bortolotto","doi":"10.1016/j.preghy.2025.101195","DOIUrl":"10.1016/j.preghy.2025.101195","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate blood pressure control during the immediate postpartum period in hypertensive women who had used methyldopa during pregnancy, comparing continuation of that drug with switching it for captopril.</div></div><div><h3>Study design</h3><div>A single-blind, randomized clinical trial involving 172 postpartum women with hypertension who had previously used methyldopa during pregnancy at a minimum dose of 750 mg/day for at least one week prior to delivery. The subtypes of hypertension included were gestational hypertension, chronic hypertension, preeclampsia, superimposed preeclampsia, HELLP syndrome and eclampsia. Following delivery, the patients were randomized either to continue with methyldopa at a minimum dose of 250 mg, three times a day (methyldopa group, n = 88) or to switch to captopril at an initial dose of 25 mg, three times a day (captopril group, n = 84).</div></div><div><h3>Main outcome measures</h3><div>Logistic regression was used to compare the groups regarding the potential to maintain blood pressure below 140/90 mmHg at over 50 % of measurements postpartum.</div></div><div><h3>Results</h3><div>In the 48 h following delivery, no significant differences were found between the groups regarding blood pressure control (methyldopa 92.0% versus captopril 95.2%), side effects, postpartum depression (Edinburgh Postnatal Depression Scale) or other clinical outcomes (hypertensive peaks, time to blood pressure control, additional medication use, or maternal and neonatal complications).</div></div><div><h3>Conclusion</h3><div>Continuation of antihypertensive treatment with methyldopa in the postpartum period yielded similar results to switching it for captopril, both with regard to the efficacy in controlling blood pressure and the safety of the treatment.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101195"},"PeriodicalIF":2.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068680","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":"Effect of postpartum oral furosemide use on postpartum readmissions and blood pressure trends","authors":"Sandhya Chandrasekaran ,&nbsp;Marly Azzi ,&nbsp;Sanela Potchileev ,&nbsp;Easha Patel ,&nbsp;Courtney Bisson ,&nbsp;Ariel Mueller ,&nbsp;Colleen Duncan ,&nbsp;Sarosh Rana","doi":"10.1016/j.preghy.2025.101199","DOIUrl":"10.1016/j.preghy.2025.101199","url":null,"abstract":"<div><h3>Background</h3><div>Oral furosemide postpartum improves the time to hypertension resolution in randomized control trials. Further investigation is needed to determine the impact of furosemide in routine clinical practice.</div></div><div><h3>Objective</h3><div>Real world study to assess impact of furosemide on rates of postpartum hypertension and readmissions for patients with hypertensive disorders of pregnancy.</div></div><div><h3>Study Design</h3><div>A prospective cohort study of postpartum patients with hypertensive disorders of pregnancy at a single institution between October 2021 and April 2022. Patients were enrolled in the remote postpartum blood pressure monitoring program (RPM) as standard of care. Use of oral furosemide for 5 days postpartum was implemented per protocol for all patients with gestational hypertension and preeclampsia. Data was obtained until six weeks postpartum. Exclusion criteria included age less than 18 years old, patients with chronic hypertension alone without superimposed preeclampsia, and patients who did not provide consent for data collection. The primary outcome was hospital readmission within six weeks postpartum. The secondary outcome was blood pressure values across those six weeks. Hypertension was defined as any blood pressure value with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg.</div></div><div><h3>Results</h3><div>Overall, 545 patients were enrolled in the RPM program during the study period, 306 of them consented to data collection and 258 patients were ultimately included after meeting all inclusion criteria with no exclusions. Of these, 203 patients received furosemide. Overall, 47.7 % of patients had gestational hypertension, 40.3 % of patients had preeclampsia with or without severe features, and 12.0 % of patients had superimposed preeclampsia with or without severe features. In total, 24.2 % of patients were discharged home on an antihypertensive medication in addition to furosemide. The overall rate of readmission was 13.2 %. There was no difference between patients who received oral furosemide versus those who did not (12.8 % vs 14.6 %, p = 0.74). Rates of hypertension at the one-week postpartum visit between those two groups did not differ significantly (32.8 % [oral furosemide] vs 36.2 % [no furosemide], p = 0.66). Diastolic blood pressures at the six-week follow-up visit were lower in the furosemide group (74 [69,81] vs 82 [76,89]; p = 0.02) among patients registered to care who completed the six-week visit.</div></div><div><h3>Conclusion</h3><div>The addition of furosemide did not result in improved blood pressure control by the first week postpartum or fewer hospital readmissions. However, diastolic blood pressure trended lower at the six-week visit in patients who received furosemide.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101199"},"PeriodicalIF":2.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068524","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}