Moderate to severe thrombocytopenia during pregnancy

OBJECTIVE: The objective was to investigate obstetric risk factors, complications, and outcomes of pregnancies complicated by moderate to severe thrombocytopenia. MATERIALS AND METHODS: A retrospective case-control study comparing 199 pregnant women with moderate to severe thrombocytopenia (platelet count below 100x10(9)/l) with 201 pregnant women without thrombocytopenia, who delivered between January 2003 to April 2004. Stratified analysis, using the Mantel-Haenszel procedure was performed in order to control for confounders. RESULTS: The main causes of thrombocytopenia were gestational thrombocytopenia (GT) (59.3%), immune thrombocytopenic purpura (ITP) (11.05%), preeclampsia (10.05%), and HELLP (Hemolysis, elevated liver enzymes and low platelet count) syndrome (12.06%). Women with thrombocytopenia were significantly older (30.7+/-5.9 versus 28.7+/-5.7; p=0.001) compared with patients without thrombocytopenia, and had higher rates of labor induction (OR=4.0, 95% CI=2.2-7.6, p<0.001) and preterm deliveries (OR=3.5, 95% CI=1.9-6.5, p<0.001). Even after controlling for labor induction, using the Mantel-Haenszel technique, thrombocytopenia was significantly associated with preterm delivery (weighted OR=3.14, 95% CI=1.7-6.0, p<0.001). Higher rates of placental abruption were found in pregnant women with thrombocytopenia (OR=6.2, 95% CI=1.7-33.2, p=0.001). In a comparison of perinatal outcomes, higher rates of Apgar scores <7 at 5 min were noted in infants of mothers with thrombocytopenia (OR=6.3, 95% CI=1.8-33.8, p=0.001), intrauterine growth restriction (IUGR; OR=4.6, 95% CI=1.5-19.1, p=0.003), and stillbirth (65/1000 versus 0 p<0.001). These adverse perinatal outcomes were found in rare causes of thrombocytopenia such as disseminated intravascular coagulation (DIC), familial thrombotic thrombocytopenic purpura (TTP), anti-phospholipid antibodies (APLA) syndrome, and myeloproliferative disease, and not among patients with GT. CONCLUSIONS: Moderate to severe maternal thrombocytopenia points to a higher degree of severity of the primary disease, which increases perinatal complications. However, the adverse outcome is specifically attributed to preeclampsia, HELLP syndrome, and rare causes, while the perinatal outcome of GT and ITP is basically favorable. Special attention should be given to patients with thrombocytopenia due to preeclampsia, HELLP syndrome, and rarer causes during pregnancy.     

Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis

Background: Low-dose aspirin can reduce the incidence of preeclampsia and intrauterine growth restriction (IUGR). However, the effects of ethnicity upon low-dose aspirin’s efficacy has not been analyzed. Here, we comparatively evaluated the efficacy of low-dose aspirin in preventing preeclampsia and related fetal complications in East Asian and non-East Asian pregnant women at risk for preeclampsia. Methods: Several databases were searched for randomized controlled trials (RCTs) comparing low-dose aspirin with either placebo or no treatment in pregnant women at risk for preeclampsia. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for preeclampsia and related fetal outcomes were tabulated. Results: Low-dose aspirin significantly reduced preeclampsia risk in both East Asians (OR = 0.20, 95% CI: 0.11–0.35) and non-East Asians (OR = 0.84, 95% CI: 0.77–0.92). Low-dose aspirin significantly reduced IUGR risk in East Asians (OR = 0.36, 95% CI: 0.20–0.67) but not in non-East Asians (OR = 0.85, 95% CI: 0.41–1.77). Low-dose aspirin did not significantly reduce the risk of cesarean section in either East Asians (OR = 0.67, 95% CI: 0.14–3.22) or non-East Asians (OR = 1.01, 95% CI: 0.86–1.19). Conclusions: Low-dose aspirin is effective in reducing preeclampsia risk in both East Asians and non-East Asians and has differential effects in East Asians and non-East Asians with respect to IUGR.     

Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia

ObjectivesTo evaluate clinical risk factors for the development of gestational hypertensive disorders in a group of pregnant women at high risk for developing preeclampsia. Secondly we evaluated the incidence and recurrence rate of preeclampsia and pregnancy-induced hypertension.Study designA prospective analysis of data obtained from a cohort study was performed. Pregnant women were included who had at least one of the following risk factors for preeclampsia: previous history of preeclampsia, previous history of HELLP syndrome, chronic hypertension, diabetes mellitus, multiple pregnancy, obesity, or autoimmune disease. Univariate and multivariate logistic regression analyses were used to evaluate the role of clinical characteristics and risk factors in the development of hypertensive disorders.Main outcome measuresDevelopment of gestational hypertensive disorders.ResultsThirty-five percent (36/103) developed a hypertensive disorder. The univariate analysis identified preeclampsia in a previous pregnancy (OR 2.94, 95% CI: 1.25–6.91, p = 0.013) as a significant risk factor. Multivariate logistic regression revealed that a previous history of preeclampsia was the only significant independent risk factor for gestational hypertensive disorders (OR 2.89, 95% CI: 1.17–7.08, p = 0.021). Women with a previous history of PE had the highest incidence rate of 51.4% for hypertensive disorders compared to the incidence rates of other risk factors (20.8%–38.5%).ConclusionA previous history of preeclampsia proves to be a strong independent clinical risk factor for gestational hypertensive disorders in high-risk pregnant women, even in our relatively small cohort study.     

Thromboembolic risk in pregnant women with SARS-CoV-2 infection – A systematic review

The infection by SARS-CoV-2 is associated with a thromboembolic complications risk theoretically increased. Pregnancy, isolated, is considered a pro-thrombotic state.This systematic review has the main goal to evaluate the thromboembolic risk in pregnant women with COVID-19 disease, namely for pulmonary embolism (PE) and deep vein thrombosis (DVT). The secondary goal is the evaluation of the need for thromboprophylaxis in these cases.Three databases - PubMed, Scopus and Web of Science – were searched on October 2021, using the following Mesh terms and keywords: “(covid-19 OR SARS-CoV-2 OR Covid) AND (pregnancy) AND (coagulopathy OR blood coagulation disorders OR thrombotic complications OR thromboembolic risk OR venous thromboembolism OR venous thrombosis)”. Information about thrombotic complications in pregnancy and thromboprophylaxis was collected, by two independent reviewers.In total, 12 articles were analyzed, corresponding to 18205 pregnant women with SARS- CoV-2 infection. A total of 85 cases of thromboembolic events were diagnosed (0.46%, 95% CI 0.37–0.58%), of which only 17 reported the use of thromboprophylaxis (20.00%, 95% CI 12.10–30.08%). There were 3 deaths due to thromboembolic complications (3.53%, 95% CI 0.73–9.97%).In conclusion, in pregnant women, the SARS-CoV-2 infection increases the risk of thromboembolic complications. However, the risk is not greater than in the general population. It is recommended thromboprophylaxis with low molecular weight heparin for hospitalized pregnant women, and in groups with moderate to high thromboembolic risk at home self-isolation.     

Plasma total homocysteine in uncomplicated pregnancy and in preeclampsia

OBJECTIVES: (a) To establish the reference values for plasma total homocysteine in our pregnant population. (b) To determine the possible association between hyperhomocysteinemia and preeclampsia in our geographical area. STUDY DESIGN: Control-case study with 32 preeclamptic patients and 64 controls without pregnancy complications. Plasma total homocysteine, determined by HPLC (fluorescence detection), was correlated with serum folate and Vitamin B(12) (analyzed by competitive protein binding chemiluminescent assay). Statistical analyses: Mann-Whitney, Wilcoxon and Spearman test (SPSS, 10.0). RESULTS: Homocysteine concentrations in the controls were significantly higher while folate was significantly lower in the third trimester of pregnancy when compared with the second (P<0.0001). Homocysteine and folate values were significantly higher in patients compared with controls in the third trimester (P=0.005 and 0.005, respectively). The OR for preeclampsia in hyperhomocysteinemia was 7.7 (95% CI: 1.7-34.8). CONCLUSION: Pregnant women with hyperhomocysteinemia have a 7.7-fold risk for preeclampsia (CI 95%: 1.7-34.8) compared with normal controls.     

Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome. A study in 453 consecutive pregnancies

OBJECTIVE: To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome. STUDY DESIGN: Retrospective analysis of 453 patients. The main outcome measures were maternal complications during post-partum period: fever >38.5 degrees C with proved infection, abdominal or perineal abscess, thrombo-embolic events, reoperation, need for blood transfusion, acute renal failure, eclampsia or disseminated intravascular coagulation. Statistic tests included univariate and multivariate analysis with stepwise descending logistic regression. RESULTS: Patients were divided into 305 preeclampsia (67.3%) and 20 HELLP syndrome (4.4%), 128 (28.3%) had both. Eighty-five patients (18.8%) had at least one post-partum complication. The most frequent complication was infection: fever (41 patients, 9.1%) and abscess (30 patients, 6.6%). Twenty-six transfusions (5.7%), 10 disseminated intravascular coagulation (2.2%), seven thromboembolic events (1.5%), seven reoperations (1.5%) and one eclampsia (0.2%) were observed. There was no acute renal failure, no pulmonary oedema and no maternal death. Stepwise logistic regression showed five independent risk factors associated with post-partum complications: ascites or pulmonary oedema (OR: 1.84, 95% CI: 1.01-3.37), platelet count <100000/mm3 (OR: 1.96, 95% CI: 1.18-3.26), serum acid uric >360 micromol/l (OR: 2.36, 95% CI: 1.22-4.52), serum creatinine >120 micromol/l (OR: 2.99, 95% CI: 1.32-6.78), and proteinuria >5 g/l (OR: 1.80, 95% CI: 1.06-3.05). CONCLUSION: We conclude that severity criteria for preeclampsia or HELLP syndrome combined with caesarean section increased the risk of complication during the post-partum period.     

Maternal asthma and risk of preeclampsia: a case-control study

OBJECTIVE: To quantify the associations between asthma characteristics and the risk of preeclampsia. STUDY DESIGN: In this case-control study, asthma history among 286 preeclampsia cases and 470 normotensive controls in Seattle was assessed by postpartum interview and medical record abstraction. OR and 95% CI were estimated using logistic regression. The sample size was adequate to detect unadjusted asthma history with ORs of > or =1.6 at a power of 80%. RESULTS: After adjustment, women with a history of prepregnancy asthma diagnosis were not at increased preeclampsia risk (OR 0.94, 95% CI 0.58-1.52). Women experiencing asthma symptoms during pregnancy were more likely than pregnant nonasthmatics to have preeclampsia (OR 2.20, 95% CI 0.79-6.10). Those with long-term pre-pregnancy asthma and symptoms during pregnancy were at particularly increased risk (OR 9.09, 95% CI 1.02-81.6). Point estimates were generally higher after restriction to women withfull-term deliveries. CONCLUSION: This analysis suggests that asthmatics, particularly those who are symptomatic during pregnancy, may be at higher risk of developing preeclampsia.     

Intimate partner violence (IPV) and preeclampsia among Peruvian women

OBJECTIVE: Mounting evidence supports the view that intimate partner violence (IPV) is an important cause of maternal mortality. Some, but not all, prior studies suggest that IPV is associated with increased risks of maternal medical conditions such as hypertensive disorders of pregnancy which are leading causes of maternal mortality worldwide. We assessed the relation between IPV and risk of preeclampsia among Peruvian women. STUDY DESIGN: We conducted a case-control study at two large hospitals in Lima, Peru. Preeclampsia cases were 339 women with pregnancy-induced hypertension and proteinuria (i.e., preeclampsia). Controls were 337 normotensive women. Information concerning women's exposure to physical and emotional violence during pregnancy was collected during in-person interviews conducted after delivery and while patients were in hospital. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from logistic regression models. RESULTS: The prevalence of IPV was 43.1% among cases and 24.3% among controls. Compared with those reporting never exposure to IPV during pregnancy, women reporting any exposure had a 2.4-fold increased risk of preeclampsia (OR=2.4; 95% CI: 1.7-3.3). The association was strengthened slightly after adjusting for maternal age, parity and pre-pregnancy adiposity (OR=2.7; 95% CI: 1.9-3.9). Emotional abuse in the absence of physical violence was associated with a 3.2-fold (95% CI: 2.1-4.9) increased risk of preeclampsia. Emotional and physical abuse during pregnancy was associated with a 1.9-fold increased risk of preeclampsia (95% CI: 1.1-3.5). CONCLUSIONS: IPV among pregnant women is common and is associated with an increased risk of preeclampsia. These data support recent calls for coordinated global health efforts to prevent violence against women.     

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Objective?To investigate the maternal and neonatal outcomes of pregnancies with primary immune thrombocytopenia (ITP) and also to identify risk factors that predicts neonatal-thrombocytopenia (NT). Methods?This retrospective study was performed in a single academic center from October 2015 to December 2020. Pregnant women with ITP and their babies were included. Medical records of 111 neonates born from 105 mothers were analyzed. Results?A total of 41 (36.9%) of neonates were thrombocytopenic (<150×109/L) and in 21 (51.2%) platelet count was below 50×109/L, but none of them presented with severe bleeding. The lowest platelet count before and during pregnancy in NT group was lower than control group. However, there was no significant difference in maternal platelet count at the time of delivery and ITP history. Previous delivery history of NT had high predictive value for the possible occurrence of NT in this pregnancy (OR=8.070, 95% CI: 1.686~38.633). Conclusion?Neonates born to mothers with ITP have an increased tendency to develop thrombocytopenia, but the incidence of poor neonatal outcomes is extremely low. The occurrence of NT may be associated with the lowest platelet count before and during pregnancy in ITP pregnant women. The presence of an older sibling with neonatal thrombocytopenia may be a risk factor for neonatal thrombocytopenia in subsequent pregnancies.     

Elevated nucleated red blood cell count: a population-based study

OBJECTIVE: To assess the prevalence and causes of elevated nucleated red blood cell (NRBC) count. STUDY DESIGN: We conducted a 1-year, population-based surveillance study that included pregnant women and their infants from our medical center, which serves as a tertiary referral hospital. Outcome measures included NRBC count, gestational age, mode of delivery, birth weight, Apgar scores, cord blood gasses, rate of neonatal intensive care unit admission. Statistical analyses were performed with Mann-Whitney U-test, independent samples t test, chi2 test, Fisher's exact test and Spearman's correlation test, as appropriate. RESULTS: NRBC count obtained from 423 women had a median of 4 (0-163). A cutoff point of 13.5 for predicting fetal acidosis had the highest combined sensitivity (77.8%) and specificity (84%). Three hundred forty-nine neonates had a NRBC count < or = 13.5, whereas 73 had > 13.5. Logistic regression analysis revealed that preeclampsia (OR = 5.9, 95% CI = 2.8-12.3) remained the most prominent risk factor for elevated NRBC count. CONCLUSION: Elevated NRBC appears to be associated with preeclampsia.     

Racial Disparities in Comorbidities,Complications, and Maternal and Fetal Outcomes in Women With Preeclampsia/eclampsia

Objective: The mechanisms leading to worse outcomes in African-American (AA) women with preeclampsia/eclampsia remain unclear. Our objective was to identify racial differences in maternal comorbidities, peripartum characteristics, and maternal and fetal outcomes. Methods/Results: When compared to white women with preeclampsia/eclampsia, AA women had an increased unadjusted risk of inpatient maternal mortality (OR 3.70, 95% CI: 2.19–6.24). After adjustment for covariates, in-hospital mortality for AA women remained higher than that for white women (OR 2.85, 95% CI: 1.38–5.53), while the adjusted risk of death among Hispanic women did not differ from that for white women. We also found an increased risk of intrauterine fetal death (IUFD) among AA women. When compared to white women with preeclampsia, AA women had an increased unadjusted odds of IUFD (OR 2.78, 95% CI: 2.49–3.11), which remained significant after adjustment for covariates (adjusted OR 2.45, 95% CI: 2.14–2.82). In contrast, IUFD among Hispanic women did not differ from that for white women after adjusting for covariates. Conclusions and Relevance: Our data suggest that African-American women are more likely to have risk factors for preeclampsia and more likely to suffer an adverse outcome during peripartum care. Future research should examine whether controlling co-morbidities and other risk factors will help to alleviate racial disparities in outcomes in this cohort of women.     

The Pulmonary Edema Preeclampsia Evaluation (PEPE) Study

BackgroundWomen with preeclampsia may develop pulmonary edema, but the reasons for this are largely unknown.MethodsWe performed a case–control study of women with preeclampsia at two major obstetrical centres in Toronto, ON, between 2005 and 2012. Cases (n = 28) were women with preeclampsia who had pulmonary edema on a chest CT or plain X-ray during the index delivery hospitalization. Control subjects (n = 64) were those with preeclampsia but no diagnosis of pulmonary edema or heart failure in the index hospitalization for delivery. Study variables were abstracted from each woman’s paper chart and electronic medical record. Multivariable logistic regression with backward elimination was used to select a final set of significant predictors.ResultsApproximately one half of the cases of pulmonary edema occurred antepartum. Each 10 × 10⁹/L reduction in platelet count (OR 1.32; 95% CI 1.06 to 1.65) or 10 μmol/ L increase in peak serum uric acid concentration (OR 1.19; 95% CI 1.06 to 1.34) was significantly associated with pulmonary edema, as was receiving magnesium sulphate (OR 10.42; 95% CI 1.39 to 78.22). Multiparity (OR 0.03; 95% CI 0.004 to 0.29) and each 500 mL increase in the volume of intravenous crystalloids received (OR 0.60; 95% CI 0.37 to 0.98) were associated with a lower risk of pulmonary edema.ConclusionWe identified several preliminary risk factors for pulmonary edema in women with preeclampsia. Additional work is needed to better understand the role of these and other factors predicting the development of pulmonary edema in women with preeclampsia.     

Maternal complications in women with chronic hypertension: a population-based cohort study

BACKGROUND: The aim of the study was to determine if pregnant women with chronic hypertensive disease have an independent risk for preeclampsia, gestational diabetes or placental abruption. To examine if superimposed preeclampsia in this group of women is related to an increased risk of placental abruption. METHODS: This study is a population-based cohort study using the Swedish Medical Birth Register 1992-98. A population of 681 515 women aged between 15-44 years with singleton pregnancies, excluding women with systemic lupus erythematosus (SLE), diabetes mellitus and chronic renal disease were studied. Among these, 3374 women were diagnosed with chronic hypertensive disease. Multiple logistic regression analysis was performed and the outcome measures of crude and adjusted odds ratios (OR) were presented with 95% confidence intervals (CI). RESULTS: Chronic hypertensive disease is associated with multiparity, age, high body mass index and Nordic ethnicity. After controlling for confounders, chronic hypertensive disease is an independent risk factor for preeclampsia (OR 3.8; 95% CI 3.4-4.3), gestational diabetes (OR 1.8; 95% CI 1.4-2.4) and placental abruption (OR 2.3; 95% CI 1.6-3.4). CONCLUSION: Chronic hypertensive disease is independently associated with an increased incidence of preeclampsia, gestational diabetes and placental abruption.     

The role of platelet counts in the assessment of inpatient women with preeclampsia

ObjectivePlatelet count has been proposed as a screening test for generalized coagulopathy in women with preeclampsia. We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preeclampsia.MethodsWe used data from women in the PIERS (Pre-eclampsia Integrated Estimate of RiSk) database. Abnormal coagulation was defined as either an international normalized ratio result greater than and/or a serum fibrinogen level less than the BC Women’s Hospital laboratory’s pregnancy-specific normal range. The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculated.ResultsAbnormal coagulation occurred in 105 of 1405 eligible women (7.5%). The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10⁹/L (OR 7.78; 95% CI 3.36 to 18.03) and between 50 and 99 × 10⁹/L (OR 2.69; 95% CI 1.44 to 5.01) compared with women who had platelet counts above 150 × 10⁹/L. Platelet counts < 100 × 10⁹/L were associated with significantly increased odds of adverse maternal outcomes, most specifically blood transfusion. A platelet count of < 100 × 10⁹/L had good specificity in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively).ConclusionA platelet count < 100 × 10⁹/L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preeclampsia. However, the platelet count should not be used in isolation to guide care because of its poor sensitivity. Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed.     

The effect of prepregnancy body mass index on birth weight,preterm birth,cesarean section,and preeclampsia in pregnant women

Objective: The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth.

Methods: A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI?2), normal (BMI 18.5–25?kg/m²), overweight (BMI 25–30?kg/m²) and obese (BMI >30?kg/m²), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression.

Results: Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR)?=?1.47, 95% CI?=?1.06–2.02; OR?=?3.67, 95% CI?=?2.57–5.24, respectively) and cesarean section (OR?=?1.21, 95% CI?=?1.04–1.41; OR?=?1.35, 95% CI?=?1.06–1.72, respectively). Infants of obese women were more likely to be macrosomic (OR?=?2.43, 95% CI?=?1.55–3.82).

Conclusion: Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.     

Incidence of superimposed preeclampsia among pregnant Asian women with chronic hypertension

Objective: To determine the incidence and associated factors of superimposed preeclampsia among pregnant women with chronic hypertension.

Methods: A total of 300 pregnant women diagnosed with chronic hypertension were reviewed. Data were retrieved from medical records, including obstetric data, characteristics of hypertension, and pregnancy outcomes. Incidence of superimposed preeclampsia was estimated. Various characteristics were compared to determine associated risk factors.

Results: Mean age of the cohort was 34.3 years, 47% were nulliparous, 50% had hypertension before pregnancy, and the others presented with hypertension before 20 weeks. Incidence of superimposed preeclampsia was 43.3% (95% confidence interval (CI) 37.8–48.9). Women with superimposed preeclampsia were significantly more likely to have mean arterial pressure (MAP) ≥105 mmHg at 18–20 and 24–28 weeks. Adverse neonatal outcomes were significantly more common among women with superimposed preeclampsia, including small for gestational age, low birth weight, asphyxia, and neonatal intensive care unit admission. Logistic regression analysis demonstrated that only MAP ≥105 mmHg at 24–28 weeks was independently associated with the increased risk of superimposed preeclampsia by 1.8-fold (adjusted OR 1.8, 95% CI 1.1–3.1, p = 0.031).

Conclusion: Incidence of superimposed preeclampsia was 43.3% among pregnant women with chronic hypertension, with increased adverse neonatal outcomes. High MAP ≥105 mmHg during late second trimester might be an important predictor of the condition.     

Risk of preeclampsia in relation to maternal history of migraine headaches.

OBJECTIVE: We examined the relationship between migraines and preeclampsia risk. STUDY DESIGN: Cases were 244 women with preeclampsia and controls were 470 normotensive women. Women were asked if a physician had ever told them that they had migraines. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: A history of migraines was associated with a 1.8-fold increased risk of preeclampsia (95% CI 1.1-2.7). Women who were 30+ years old when diagnosed with migraines had the highest risk (OR 2.8, 95% CI 0.8-9.0). The migraine-preeclampsia association appeared to be modified by pre-pregnancy overweight status (p = 0.06). Overweight migrainous women, compared with lean nonmigrainous women, had a 12-fold increased preeclampsia risk (95% CI 5.9-25.7). CONCLUSION: Our findings are consistent with reports from six of eight previous studies on the topic. Nevertheless, prospective cohort studies are needed to further evaluate the extent to which migraines and/or its treatments are associated with preeclampsia risk.     

Pregnancy outcomes in HIV-positive women: a retrospective cohort study

Purpose

In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women.

Methods

A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003–2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes.

Results

Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p < 0.001). Upon adjustment for baseline characteristics, HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14–1.60) and urinary tract infections (OR 3.02, 95% CI 2.40–3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79–3.36), postpartum sepsis (OR 8.05, 95% CI 5.44–11.90), venous thromboembolism (OR 2.21, 95% CI 1.46–3.33), blood transfusions (OR 3.67, 95% CI 3.01–4.49), postpartum infection (OR 3.00, 95% CI 2.37–3.80), and maternal mortality (OR 21.52, 95% CI 12.96–35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction.

Conclusion

Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.

     

Ten-Year,Thirty-Year,and Lifetime Cardiovascular Disease Risk Estimates Following a Pregnancy Complicated by Preeclampsia

ObjectivesTo calculate the cardiovascular disease (CVD) risk estimates for women following a pregnancy with or without preeclampsia.MethodsWe calculated 10-year, 30-year, and lifetime CVD risk estimates at one year postpartum for women recruited into the Pre-Eclampsia New Emerging Team’s prospective cohort.ResultsComplete CVD risk screening data were obtained from 118 control women and 99 preeclamptic women. A total of 18.2% of preeclamptic women and 1.7% of control women had a high 10-year risk (OR 13.08; 95% CI 3.38 to 85.5), 31.3% of preeclamptic women and 5.1% of control women had a high 30-year risk (OR 8.43; 95% CI 3.48 to 23.23), and 41.4% of preeclamptic women and 17.8% of control women had a high lifetime risk for CVD (OR 3.25; 95% CI 1.76 to 6.11).ConclusionThe association of preeclampsia with the future development of CVD makes pregnancy an early window of opportunity for the preservation of health and prevention of CVD.     

Significance of high-normal blood pressure during early second trimester for predicting the onset of hypertensive disorders in pregnancy

Objective: The aim of this study was to determine the predictive value of high-normal blood pressure (HNBP) during the early second trimester for hypertensive disorders in pregnancy, including gestational hypertension (GH) and preeclampsia (PE). Methods: This was a retrospective single-center cohort study of 2143 singleton pregnant women. The association of HNBP, ranging from 130/85 to 139/89 mmHg between 14 and 19 weeks of gestation, with the development of hypertensive disorders was assessed by multivariable logistic regression analyses. Results: In a cohort of 2102 pregnant women, 93 (4.4%) pregnancies had HNBP during early second trimester. Pregnant women with HNBP more frequently developed hypertensive disorders than normotensive women (20.4% vs. 8.2%, p < 0.001). HNBP was significantly associated with the development of GH (adjusted odds ratio (aOR): 1.81; 95% confidence interval (CI): 1.16–3.25, p = 0.015) and PE (aOR: 6.05; 95% CI: 3.46–12.6, p = 0.013) after adjustment for confounders. Conclusion: HNBP during the early second trimester is an independent risk factor for both GH and PE.