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

{"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}

{"title":"Letter to Editor: Glycosylated fibronectin as a biomarker for preeclampsia and preeclampsia-related complications","authors":"Farman Ullah Khan,&nbsp;Muhammad Salman,&nbsp;Muhsinullah Siddiqi,&nbsp;Muhammad Talha Hassan Khan","doi":"10.1016/j.preghy.2025.101217","DOIUrl":"10.1016/j.preghy.2025.101217","url":null,"abstract":"","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101217"},"PeriodicalIF":2.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877326","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":"Comparison of patients presenting with hypertensive disorders of pregnancy antenatally versus de-novo postpartum hypertension","authors":"Nadia Olivier ,&nbsp;Helen McDougall ,&nbsp;Grace Yuan ,&nbsp;David Langsford","doi":"10.1016/j.preghy.2025.101213","DOIUrl":"10.1016/j.preghy.2025.101213","url":null,"abstract":"<div><h3>Introduction</h3><div>To describe the characteristics of patient’s presenting with postpartum hypertension, comparing those with known hypertensive disorders of pregnancy (HDP) antenatally to patients presenting with de novo postpartum hypertension.</div></div><div><h3>Methods</h3><div>A retrospective audit of deliveries at Northern Health from January 2016 to December 2020. International Classification of Diseases (ICD) codes combined with a manual medical records search identified 72 records that resulted in representation to hospital with hypertension. Data was collected to observe and compare maternal, pregnancy and fetal characteristics.</div></div><div><h3>Results</h3><div>Of the 72 patients, 35 (48.6 %) readmissions had known HDP and 37 (51.4 %) had de novo postpartum HDP. Similarities were observed between both the patients with known HDP and de novo postpartum hypertension group, including maternal age at delivery (32.4 ± 4.9, 31.9 ± 5.6 years), BMI (32 (25–38), 31 (24–41) kg/m²) and nulliparity (48.6 %, 40.5 %). Aspirin prescription was similar in both groups (28.6 %, 27.0 %). The mean birthweight of the known HDP group was significantly less (2893.7 ± 231.4 g) compared to the de novo group (3362.4 ± 584.4 g). Differences were observed in the urine protein to creatinine ratio (uPCr) antenatally. Antenatally and postpartum the blood pressure readings for the known HDP were significantly higher than the de novo group.</div></div><div><h3>Conclusions</h3><div>More than 50 % of patients representing are de novo HDP. It does not appear pre-eclampsia is unrecognised antenatally in the de novo group. Our study does not highlight key factors that aid the recognition of those at risk of developing postpartum hypertension separate to the risk factors that are associated with HDP generally.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101213"},"PeriodicalIF":2.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852270","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":"Prevent-PE (pre-eclampsia prevention by timed birth at term): Protocol for a randomised trial","authors":"James Goadsby ,&nbsp;Siddesh Shetty ,&nbsp;Argyro Syngelaki ,&nbsp;Soley-Bori Marina ,&nbsp;Laura A. Magee ,&nbsp;Peter von Dadelszen ,&nbsp;Ranjit Akolekar ,&nbsp;Sergio A. Silverio ,&nbsp;Kayleigh Sheen ,&nbsp;Julia Fox-Rushby ,&nbsp;Alan Wright ,&nbsp;David Wright ,&nbsp;Kypros H. Nicolaides","doi":"10.1016/j.preghy.2025.101211","DOIUrl":"10.1016/j.preghy.2025.101211","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate whether term pre-eclampsia (PE) is reduced by screening for PE risk at 35 + 0–36 + 6 weeks’ gestation and offering risk-based, planned early term birth.</div><div>Study design: ‘PREVENT-PE’ is a multicentre, randomised trial (ISRCTN41632964).</div></div><div><h3>Inclusion</h3><div>Singleton pregnancy, presentation for routine fetal ultrasound at 35 + 0–36 + 6 weeks’, and can give informed consent.</div></div><div><h3>Exclusion</h3><div>PE, major fetal abnormality, or participation in a conflicting study. Randomisation (central, 1:1 ratio, minimised for study site, in random permuted blocks) to intervention (screening for term PE risk, and planned early term birth for PE risk ≥ 1 in 50) or control (usual care at term) arms.</div></div><div><h3>Outcomes</h3><div>Primary: Birth with PE (ISSHP 2021 criteria).</div></div><div><h3>Key secondaries</h3><div>Emergency caesarean and neonatal unit admission ≥ 48 h. Others include within-trial and intermediate-term economic evaluations, and mixed-methods surveys and interviews.</div></div><div><h3>Analysis</h3><div>3,201 participants/arm would be required to detect a relative risk (intervention/control) of 0.5, based on 2.0% PE incidence, 90% power, and two-tailed 2.5% significance level; an adaptive design will determine the final sample size (4000–8000) at interim analysis of the first 3,000 participants.</div></div><div><h3>Analyses</h3><div>Intention-to-treat. Economic evaluation will measure and value resources and health outcomes for mothers at risk of term PE and newborns (health service perspective). In within-trial cost-effectiveness analysis, the main outcome will be incremental cost per PE case averted, with costs and health outcomes calculated using patient-level data. A decision model will assess cost-utility of the intervention for one year postpartum.</div></div><div><h3>Conclusions</h3><div>PREVENT-PE will provide data to inform birth choices and maternity services planning.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101211"},"PeriodicalIF":2.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807359","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":"Hypertensive disorders of pregnancy trends in the United States post aspirin recommendation guidelines","authors":"Mariam K. Ayyash ,&nbsp;Rodney A. Mclaren Jr. ,&nbsp;Huda B. Al-Kouatly ,&nbsp;Majid Shaman","doi":"10.1016/j.preghy.2025.101210","DOIUrl":"10.1016/j.preghy.2025.101210","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG.</div></div><div><h3>Methods</h3><div>A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010–2014. The post-ASA group were births between 2016–2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010–2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort.</div></div><div><h3>Results</h3><div>There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57–1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89–0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78–0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP &lt; 37 weeks but was not different for preterm HPD &lt; 34 weeks.</div></div><div><h3>Conclusion</h3><div>While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101210"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761133","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":"Circulating follistatin-like 3 and its association with postpartum cardiovascular dysfunction and severe maternal morbidity","authors":"Junaid Nizamuddin ,&nbsp;Elizabeth Hall ,&nbsp;John Dreixler ,&nbsp;Ana Palei ,&nbsp;Joey Granger ,&nbsp;Avery Tung ,&nbsp;Ariel Mueller ,&nbsp;Sarosh Rana ,&nbsp;Sajid Shahul","doi":"10.1016/j.preghy.2025.101206","DOIUrl":"10.1016/j.preghy.2025.101206","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite postpartum cardiovascular dysfunction being the leading cause of pregnancy-related mortality in the United States, it is difficult to identify at-risk patients. The objective of this study was to determine if antepartum follistatin-like 3 levels correlate with postpartum cardiovascular dysfunction and maternal morbidity.</div></div><div><h3>Study Design</h3><div>This observational cohort study included pregnant patients ≥ 18 years old and singleton gestation &lt; 41 weeks who delivered at the University of Chicago between May 2017 and November 2020.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was postpartum cardiovascular dysfunction, defined as postpartum hypertension, cardiomyopathy, and pulmonary edema. The secondary outcome was severe maternal morbidity.</div></div><div><h3>Results</h3><div>The final cohort included 408 women. Elevated FSTL3 levels were associated with postpartum cardiovascular dysfunction (OR per unit increase in FSTL3, 1.02 [95 % CI: 1.01, 1.04]; p &lt; 0.001). After adjustment for gestational age at delivery, maternal age, BMI, nulliparous status, hypertensive disorders of pregnancy, smoking, and diabetes, the association between FSTL3 levels and cardiovascular dysfunction persisted (p = 0.03), with good model discrimination between events (c-statistic 0.88). FSTL3 levels were also associated with severe maternal morbidity (OR per unit increase 1.02 [95 % CI: 1.01, 1.03]; p &lt; 0.0001). Additionally, Activin A levels were associated with cardiovascular dysfunction and severe maternal morbidity (c = 0.84, p = 0.01; c = 0.87, p = 0.02 respectively).</div></div><div><h3>Conclusions</h3><div>Higher follistatin-like 3 levels were associated with postpartum cardiovascular dysfunction and severe maternal morbidity. Follistatin-like 3 may be causal in cardiovascular dysfunction, and further work should define its potential as a biomarker.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"40 ","pages":"Article 101206"},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600844","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}