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

{"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}

{"title":"LEANBH study: Device satisfaction study for the use of a novel connected home blood pressure system in pregnancy; a prospective cohort study","authors":"Laura J. O’Byrne ,&nbsp;Gillian M. Maher ,&nbsp;Rebecca Hunter ,&nbsp;Mike Cunneen ,&nbsp;Simon Woodworth ,&nbsp;Frederic Adam ,&nbsp;Fergus P. McCarthy","doi":"10.1016/j.preghy.2025.101191","DOIUrl":"10.1016/j.preghy.2025.101191","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate patients’ perspectives on using the LEANBH app (home Blood Pressure BP monitoring system) and the Microlife Watch BP home monitor in a tertiary maternity hospital setting during the COVID-19 pandemic.</div></div><div><h3>Study design</h3><div>134 Participants were asked to complete an anonymous usability questionnaire on their experience of LEANBH and the Microlife Watch. The questionnaire consisted of 5 background demographics, 9 items from the system usability scale (SUS), 14 items on the usability of the LEANBH app, and 6 on the acceptability of Microlife.</div></div><div><h3>Results</h3><div>The usability questionnaire for the LEANABH app suggested 69% (93) of respondents reported a very good initial impression of the app, while 29% agreed and 70% strongly agreed that it was easy to use. The Microlife Watch was tolerated very well with 42% agreeing and 56% strongly agree they would use it again. Only 8 (6%) reported it to be an inconvenience to take their own BP at home. Nearly all users (97%) agreed that the knowledge their BP was being monitored at home gave them a sense of safety.</div></div><div><h3>Conclusion</h3><div>Patients’ experience of the LEANBH app and Microlife Watch BP Home monitor were very reassuring and suggest it is an acceptable way of monitoring home BP in pregnant women who are at risk of rapid changes in health status. Women reported feeling a greater sense of health and safety with the use of this device. Further work remains to be done for the widespread validation and implementation of the LEANBH platform and application.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101191"},"PeriodicalIF":2.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068651","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":"Hypertensive disorders in a gestational diabetes cohort from Cape Town, South Africa","authors":"L. May ,&nbsp;D. Mason ,&nbsp;M. van de Vyver ,&nbsp;M. Conradie ,&nbsp;D.R. Hall","doi":"10.1016/j.preghy.2025.101185","DOIUrl":"10.1016/j.preghy.2025.101185","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>As thresholds for the diagnosis of gestational diabetes mellitus (GDM) become lower, and the prevalence of obesity in society rises, more pregnant women will be diagnosed with GDM and hypertension. Both conditions hold dangers for mother and baby. Our objective was to properly describe this association.</div></div><div><h3>Study design and outcome measures</h3><div>This retrospective audit was conducted at the Obstetric High-Risk Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. All patients diagnosed with GDM from 01/01/19 – 31/12/19 were included. The primary aim was to determine the incidence, and different classes of hypertensive disease associated with GDM in this population. The secondary aims were to evaluate associations with the development of hypertensive disorders in women with GDM and to include descriptions of the management, course and complications during the pregnancies, including the early neonatal period. The research was approved by the Ethics Committee of Stellenbosch University.</div></div><div><h3>Results</h3><div>Of the 274 women with GDM, included in the analysis, 204 (75 %) had concomitant hypertension. Classes of hypertension were chronic hypertension 21 % (58/274), gestational hypertension 26 % (71/274), and pre-eclampsia (<em>de novo</em> and super-imposed) 27 % (75/275). Those without hypertension had significantly lower BMIs: 35 [29–42] vs 41 [34–45] kg/m² (median [IQR]; p &lt; 0.001). Using ROC curves, BMI at booking had strong associations with chronic and gestational hypertension (p = 0,002; p = 0,001), and pre-eclampsia (p = 0,002). All three intra-uterine deaths (two spontaneous and one iatrogenic) occurred in the GDM + hypertension group.</div></div><div><h3>Conclusion</h3><div>Hypertensive conditions of pregnancy were common amongst a referral-based population with GDM, with BMI being the strongest predictor.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101185"},"PeriodicalIF":2.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042155","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":"Detection of hypertension and blood pressure phenotypes using ambulatory blood pressure monitoring in women with past hypertensive disorders of pregnancies","authors":"Anushriya Pant ,&nbsp;Swati Mukherjee ,&nbsp;Monique Watts ,&nbsp;Simone Marschner ,&nbsp;Anastasia S. Mihailidou ,&nbsp;Jessica O’Brien ,&nbsp;Anna Beale ,&nbsp;Clara K. Chow ,&nbsp;Sarah Zaman","doi":"10.1016/j.preghy.2025.101193","DOIUrl":"10.1016/j.preghy.2025.101193","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence of hypertension and blood pressure (BP) phenotypes using 24-hour ambulatory BP (24hr-ABP) in women with past pregnancy complications who were recruited into a Women’s Heart Clinic (WHC).</div></div><div><h3>Study design</h3><div>We recruited 156 women aged 30–55 years with past hypertensive disorders of pregnancy (HDP) and/or gestational diabetes (GDM) to a multidisciplinary six-month WHC that provided cardiovascular risk management in Melbourne, Australia. Women were referred for 24 hr-ABP monitoring if clinic BP was ≥130/80 mmHg.</div></div><div><h3>Main outcome measures</h3><div>Primary outcome was incident hypertension, defined by 24 hr-ABP monitoring as daytime hypertension ≥135/85 mmHg, nocturnal hypertension ≥120/70 mmHg, and/or 24hr-average hypertension ≥130/80 mmHg.</div></div><div><h3>Results</h3><div>From 156 women, 54 women underwent 24hr-ABP monitoring (mean age 41.3 ± 4.5 years; 3.9 ± 2.6 years post-partum), with 64.8 % HDP and 45.2 % GDM. Incidence of hypertension was 61.1 % [95 % CI 48.2 %–74.0 %]. Higher proportion of women with past HDP had daytime hypertension compared to those with GDM only (57.1 % vs. 26.3 %; p = 0.05) and higher nocturnal mean systolic-BP [116.0 ± 11.2 mmHg vs. 109.6 ± 8.7 mmHg; p = 0.04]. Women with HDP had increased odds of hypertension [adjusted-OR 5.26 95 % CI (1.07–32.76); p = 0.05]. Following management at the WHC, women diagnosed with hypertension had significantly improved BP control (6.1 % at baseline vs. 75.8 % at six-month follow-up; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Women with past HDP had five-fold increased incidence of hypertension, with higher daytime hypertension and nocturnal systolic-BP, compared to women with GDM. After attending WHC, BP control significantly improved. Our findings suggest routine postpartum follow-up with 24hr-ABP monitoring, through a WHC, may be useful in early detection and management of hypertension in these women.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101193"},"PeriodicalIF":2.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014619","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":"Neonatal cost savings in hypertensive disorders of pregnancy: Economic evaluation of the sFlt-1/PlGF test with real world implementation of biomarkers","authors":"Marly Azzi ,&nbsp;Michelle Silasi ,&nbsp;Sanela Potchileev ,&nbsp;Padmashree C. Woodham ,&nbsp;Amalia Brawley ,&nbsp;Ariel Mueller ,&nbsp;Teofilo Borunda Duque ,&nbsp;Sarosh Rana","doi":"10.1016/j.preghy.2025.101190","DOIUrl":"10.1016/j.preghy.2025.101190","url":null,"abstract":"<div><h3>Background</h3><div>Preeclampsia is a key cause of prematurity in the U.S. and incurs significant healthcare costs. An imbalance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) predicts severe preeclampsia and aids in its management.</div></div><div><h3>Objective</h3><div>This study aimed to assess the cost-effectiveness of the sFlt-1/PlGF test as an addition to standard care for patients at risk of developing preeclampsia.</div></div><div><h3>Study design</h3><div>A decision tree analysis was conducted to assess the cost effectiveness of the ratio test in the United States, using data from <em>Preeclampsia Risk Assessment: Evaluation of Cut-offs to Improve Stratification [PRAECIS]</em> and from a real-world evidence study conducted after the implementation of sFlt-1/PlGF testing into routine clinical practice (Biomarker Examination and Analysis for Clinical Obstetrical Navigation Study [BEACON]). The model compared standard of care alone versus a biomarker-based approach utilizing the sFlt-1/PlGF test for managing patients at risk of preeclampsia with severe features. Published data was used to estimate theoretical cost values of infants for their first six months of life.</div></div><div><h3>Results</h3><div>The analysis indicated potential total neonatal cost savings of nearly $10,595,332 (95% CI: $6,555,439 to $14,730,536) per 1,000 patients using the sFlt-1/PlGF ratio test, translating to about $10,595 saved per patient. The incremental cost-effectiveness ratio (ICER) analysis showed a mean cost savings of $62,572 for each pregnancy prolonged by two weeks.</div></div><div><h3>Conclusion</h3><div>The sFlt-1/PlGF test, when used alongside standard care, enhances risk stratification for severe preeclampsia and may lead to significant neonatal cost savings by reducing preterm deliveries and neonatal intensive care admissions.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101190"},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014622","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}