Preeclampsia,gestational hypertension and subsequent hypothyroidism

ObjectivesTo evaluate the effect of preeclampsia (PE) and gestational hypertension (GH) on subsequent hypothyroidism. Recent studies suggest that women with PE have increased risk for reduced thyroid function, but the association between PE and GH with overt hypothyroidism has not been examined.Study designTwo prospective population-based cohort studies, the Northern Finland Birth Cohorts 1966 and 1986, followed women who had PE (N = 955), GH (N = 1449) or were normotensive (N = 13531) during pregnancy. Finnish national registers were used to confirm subsequent hypothyroidism. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) estimated hypothyroidism risk when comparing women with PE or GH with normotensive women.Main outcome measuresPrimary hypothyroidism during follow-up of 20–40 years.ResultsThe subsequent prevalence of hypothyroidism was higher among women with PE (4.0%) and GH (4.5%) compared with normotensive women (3.5%), but the risk increase was not significant (aHR for PE 1.13, 95% CI 0.80–1.59 and aHR for GH 1.11, 95% CI 0.85–1.45).Subgroup analysis among nulliparous women revealed a significant association between late PE and subsequent hypothyroidism (aHR 1.82, 95% CI 1.04–3.19).Early or recurrent PE was not associated with hypothyroidism (aHR 0.93, 95% CI 0.46–1.81 and aHR 1.35, 95% CI 0.63–2.88, respectively).ConclusionsOverall, PE or GH during pregnancy was not significantly associated with subsequent hypothyroidism in Finnish women after 20–40 years of follow-up. However, late PE in nulliparous women was associated with a 1.8-fold increased risk of subsequent hypothyroidism, a finding that merits further study in other populations.     

Body mass index and hypertensive disorders of pregnancy

ObjectivesWe compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI).Study designProspective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy.Main outcome measuresIncidence of pre-eclampsia and gestational hypertension.ResultsIn 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n = 74) and gestational hypertension in 3.0% (n = 67). Both pre-eclampsia (p = 0.01) and gestational hypertension (p < 0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p = 0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia.ConclusionsObese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.     

Transient gestational hypertension: Not always a benign event

ObjectivePregnancy outcome in women with transient gestational hypertension (TGH);defined as de novo blood pressure elevation after 20 weeks gestation that normalizes by subsequent evaluation in a Day Assessment Unit.Study designRetrospective cohort analysis of hypertensive pregnancies between 2003 and 2008.Main outcome measuresFinal hypertensive delivery diagnosis and composites of adverse maternal and fetal outcome.ResultsOverall 1417 women were referred; 890 met criteria; 41% (65% of study population) had TGH. Twenty percent with TGH developed gestational hypertension and 19% preeclampsia. Women with TGH who developed preeclampsia had similar composite adverse maternal outcomes to other preeclamptic women (51% vs. 63%; p = 0.24) but fewer adverse fetal outcomes (50% vs. 71%; p < 0.01) due to less prematurity (30% vs. 45%; p = 0.02) and small for gestational age babies (33% vs. 51%; p = 0.02). Within the TGH population;developing gestational hypertension or preeclampsia was associated with referral at gestation <33 weeks (RRR 2.8; p < 0.01);initial average systolic blood pressure 130–139 mmHg (RRR 2.1; p < 0.01) and initial average diastolic blood pressure 80–89 mmHg (RRR 3.2; p < 0.01).ConclusionTGH after 20 weeks is common in pregnancy. Although initial assessment implies low risk;the risk of progression to gestational hypertension or preeclampsia is substantial and warrants appropriate clinical surveillance.     

Hypertensive disorders of pregnancy and risk of screening positive for Posttraumatic Stress Disorder: A cross-sectional study

ObjectivesHypertensive Disorders of Pregnancy (HDP) encompass a spectrum of disorders that affect 6–8% of US pregnancies. We aim to determine the impact of self-reported history of HDP as a risk factor for screening positive for Posttraumatic Stress Disorder (PTSD), which results from exposure to a traumatic event, and to evaluate whether the risk of PTSD differed by severity of HDP.Study designWe conducted an online survey on the Preeclampsia Foundation website that is accessed worldwide by women who have experienced HDP, as well as their friends and family. 1448 women in total responded to the survey, including 1076 women who reported a history of HDP in at least one prior pregnancy and 372 women who reported no history of HDP during any prior pregnancy.Main outcome measuresWe measured PTSD outcome with the Breslau Short Screening Scale for DSM-IV PTSD. We used logistic regression to model the relationship between PTSD and HDP.ResultsWomen who reported a history of HDP were more than four times as likely to screen positive for PTSD than women who reported having a normotensive pregnancy history (OR_adj = 4.46, 95% CI: 3.20–6.20). In addition, there was a marked trend toward increasing risk of screening positive for PTSD as the severity of HDP increased from gestational hypertension to eclampsia (p < 0.001).ConclusionsWomen with a history of HDP may be at increased risk of PTSD, with severe cases most likely to suffer from symptoms. Clinicians should consider implementing routine screenings during post-partum visits in this vulnerable population.     

Maternal hypertensive diseases negatively affect offspring motor development

ObjectiveHypertension in pregnancy and preeclampsia have been linked to poor outcomes in cognitive, mental and psychomotor development; however, few longitudinal studies have researched their effect on offspring motor development, particularly in late childhood and adolescence. The purpose of this study was to determine if maternal hypertensive diseases during pregnancy are a risk factor for compromised motor development at 10, 14, and 17 years.Study designLongitudinal cohort study using data from the Western Australian Pregnancy Cohort Study (Raine).Main outcome measureOffspring (n = 2868) were classified by their maternal blood pressure profiles during pregnancy: normotension (n = 2133), hypertension (n = 626) and preeclampsia (n = 109). Offspring motor development, at 10, 14, and 17 years was measured by the Neuromuscular Developmental Index (NDI) of the McCarron Assessment of Motor Development (MAND).MethodsLinear mixed models were used to compare outcomes between pregnancy groups.ResultsOffspring from pregnancies complicated by preeclampsia had poorer motor outcomes at all ages than offspring from either normotensive mothers (p ⩽ 0.001) or those with hypertension (p = 0.002).ConclusionHypertensive diseases during pregnancy, in particular preeclampsia, have long term and possibly permanent consequences for motor development of offspring.     

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.     

First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy

ObjectiveTo assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-eclampsia; and compare with the accuracy of routinely collected maternal and clinical risk factors.Study designIn this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia.Main outcome measuresPrediction of pregnancy hypertension and pre-eclampsia.ResultsThere were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-eclampsia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P = 0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC = 0.64, P < 0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC = 0.70, P < 0.001 for pregnancy hypertension and AUC = 0.74, P < 0.001 for pre-eclampsia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-eclampsia.ConclusionsMaternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk.     

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

BackgroundSerum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women.Material and methodsSerum S100B protein was measured in normotensive pregnant women (n = 15) and in women with mild PE (n = 12) or severe PE (n = 34). The serum S100B level (μg/L) was determined by an luminometric assay.ResultsSixty-one expectant mothers were studied, aged 26.6 ± 8.7 (mean ± SD) years and with a gestational age of 33.3 ± 4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20 ± 0.19), as compared with mild PE (0.07 ± 0.05) or normotensive groups (0.04 ± 0.05).ConclusionElevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.     

Pre-eclampsia and gestational hypertension are less common in HIV infected women

ObjectiveTo determine whether pre-eclampsia and gestational hypertension are less common in HIV infected women.MethodsThis prospective cohort study was performed in the Western Cape province of South Africa. HIV negative and positive pregnant women without chronic renal or chronic hypertensive disease were continuously recruited. During the study period HIV positive patients received either mono- or triple (HAART) antiretroviral therapy for prevention of vertical transmission or maternal care. Only routine clinical management was performed. The development of hypertensive disease during pregnancy was recorded.Results1093 HIV positive and 1173 HIV negative cases were identified during pregnancy and evaluated again after delivery. Significantly fewer cases of pre-eclampsia n = 35 (3.2%) were recorded in the HIV positive group than in the HIV negative group, n = 57 (4.9%) (p = 0.045; OR 0.65 95% CI 0.42–0.99). There were also significantly fewer cases of gestational hypertension recorded in the HIV positive group compared to the HIV negative group (p = 0.026; OR 0.53 95% CI 0.30–0.94). Multiple logistic regression analysis confirmed the reductive effect of HIV on pre-eclampsia and gestational hypertension.ConclusionPre-eclampsia and gestational hypertension are less common in HIV infected women being managed with mono- or triple anti-retroviral therapy.     

Characteristics of hypertensive disorders in twin versus singleton pregnancies

ObjectiveTo determine the characteristics of hypertensive disorders of pregnancy in twin compared with singleton pregnancies.Study designAnalysis of a prospectively recorded database of 4976 hypertensive pregnancies.Main outcome measuresComparison of progression to pre-eclampsia and maternal and neonatal outcomes.ResultsThere were 3942 singleton and 214 twin pregnancies. De novo hypertension in twin pregnancy was diagnosed earlier (p < 0.001). In singleton pregnancies with de novo hypertension (n = 3161), 60% had an initial diagnosis of gestational hypertension (GH) and 40% had pre-eclampsia (PE). In twin pregnancies with de novo hypertension (n = 199), 35% of women were initially diagnosed with GH and 65% with PE (p < 0.001). At delivery, 46% of the singletons had GH and 54% had PE, compared with twin pregnancies where 23% had GH and 77 % had PE (p < 0.001). The progression from GH to PE for twins was twice that of singleton pregnancies (p < 0.001).There were 781 singleton and 15 twin pregnancies with chronic hypertension (CH). Twin pregnancies complicated by CH were more likely to progress to PE than singletons (p < 0.01). The gestation at delivery was earlier for twin pregnancies (p < 0.001) and there were more twins that were smaller for gestational age (p < 0.001). There were no differences in maternal outcomes.ConclusionWomen carrying twins with de novo hypertension are more likely to present earlier, have initial PE and to subsequently progress from GH to PE. Neonatal outcomes are worse in such pregnancies.     

Lipid concentration in small for gestational age (SGA)pregnancies and hypertensive disorders

ObjectiveLow maternal serum lipid and high maternal serum lipid have both been associated with some complications in pregnancy. The lipid profiles in pregnancies complicated by small for gestational age (SGA) or hypertension disorders have been compared with those of normal pregnancies.MethodIn a prospective study, 900 pregnant women between 13 and 23 weeks of pregnancy were studied. Primarily, serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, were measured. Ultimately, the serum lipid levels at 13–23 weeks of pregnancies were compared between the women who later suffered from hypertension disorders or SGA and the matched women with normal pregnancies.ResultsAt 13–23 weeks of pregnancy, the mean triglyceride levels were significantly higher in the women who later experienced preeclampsia when compared with normal, matched pregnancies with an appropriate weight for gestational age and women who had gestational hypertension (p = 0.001 and p = 0.014, respectively). Also, triglyceride levels were significantly higher in women with neonates with large for gestational age (LGA) in comparison with those who gave birth to neonates with SGA (p = 0.012) and with uncomplicated matched pregnant women who gave birth to neonates with weight >10th and <90th percentile for their gestational age (p = 0.007).ConclusionOnly the levels of TG and not any other lipids evaluated were found to be different in pregnancies complicated by preeclampsia when compared to pregnancies complicated by SGA.     

Maternal hemodynamics influence fetal hemodynamics in normal and hypertensive pregnancy

ObjectivesThis observational case-control study aims to test whether there is a relationship between maternal systemic hemodynamics, maternal renin-angiotensin system and fetal hemodynamics in normal and hypertensive pregnancy.Study designFour groups of non-pregnant women (n = 18), pregnant controls (n = 25), women with gestational hypertension (n = 21) and preeclampsia (n = 10) were included.Main outcome measuresMaternal echocardiography parameters, plasma renin and aldosterone were correlated with fetal Doppler parameters in third trimester pregnancy.ResultsHigher maternal mean arterial pressure and total peripheral vascular resistance were associated with lower fetal middle cerebral artery pulsatility index (PI) (r = ?.51, p < 0.01 and r = ?.49, p < 0.01, respectively); mean arterial pressure correlated negatively with ductus venosus PI (r = ?.35, p = 0.01); higher maternal plasma aldosterone levels were associated with lower maternal uterine artery resistance (r = ?0.33, p = 0.03).ConclusionsIt seems that maternal hemodynamics influence fetal hemodynamics with protective adaptation in fetal cerebral and ductus venosus blood flow observed as maternal blood pressure and vascular resistance increase.     

Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS)

BackgroundRecurrent miscarriage affects 1–2% of women. Thrombophilia included antiphospholipid syndrome has been identified in about 50% of women with recurrent miscarriage. Aspirin and heparin therapy is frequently prescribed for APS, yet there is no robust evidence for the most efficacious regime.ObjectiveTo determine maternal and foetal outcomes in women with APS managed with aspirin or enoxaparin plus aspirin during pregnancy.DesignProspective non randomized study.SettingHigh-risk pregnancy unit-Benha University Hospital.MethodsSeventy selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome were divided into two Groups: Group A (n = 47) had received aspirin (81 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day) while Group B (n = 23) had received low-dose aspirin (81 mg day orally).Main outcome measuresMaternal outcomes included thromboembolic, haemorrhagic complications and pregnancy-induced hypertension. Prematurity, intrauterine growth restriction and neonatal death were considered as foetal complications.ResultsThere were significant differences between Groups A and B in the rate of miscarriages (4 in Group A (9%) versus 8 in Group B (35%); p = 0.02), number of live births (43/47(91%) versus 15/23(65%); p = 0.02), mean gestational age (37.86 ± 1.8 versus 36.13 ± 2.39 weeks; p = 0.005), neonatal birth weight (3252 ± 459 versus 2907 ± 618 g; p = 0.03) and rate of pre-eclampsia (3/43 (7%) versus 6/15 (40%); p = 0.009). Although not statistically significant, women in Group A tended to have lower rates of preterm births (6/43 (14%) versus 3/15 (20%); p = 0.89) and IUGR (5/43 (12%) versus 5/15 (33%); p = 0.13) than in Group B.ConclusionsUse of low dose aspirin and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates compared to low dose aspirin alone. Solid conclusions from this study are limited due to the small number of patients, non-randomization of groups and discrepancy in number between groups because the choice of the interventional drug was left to patient’s preference after counselling. A larger RCT is needed.     

Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia

IntroductionPre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern.ObjectiveThe purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimesters of pregnancy for the prediction of pre-eclampsia.MethodA prospective nested case–control study was performed on pregnant women who were at 9–12 weeks of pregnancy. In the first trimester and again in 26–28 weeks, MPV was calculated. All eligible women were then monitored to delivery and the MPV of women who were pre-eclamptic was compared with the MPV of normotensive women.ResultsPre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2 ± 1.06 fl VS 9.68 ± 1.09 fl, P = 0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives (10.16 ± 1.23 fl VS 9.62 ± 1.12 fl, P = 0.009).Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.64 for the predictive value of MPV at the first and third trimesters of pregnancy, which showed a low value of this test for predicting of pre-eclampsia.ConclusionMPV at the first and third trimesters of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.     

Plasma antithrombin levels correlate with albumin and total protein in gestational hypertension and preeclampsia

ObjectiveTo analyze the antithrombin-III (AT-III) activity in the plasma in relation to the serum albumin and total protein in preeclampsia and gestational hypertension.Study designThe medical records of 139 patients who were diagnosed with gestational hypertension (n = 33) and preeclampsia (n = 106) were reviewed, and the relationships between the activity of AT-III and serum albumin or total protein were evaluated.Main outcome measuresThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels.ResultsThere were significant correlations between AT-III activity and albumin in gestational hypertension (r = 0.504, p = 0.003) and preeclampsia (r = 0.343, p = 0.003). There were also significant correlations between AT-III activity and TP in gestational hypertension (r = 0.619, p = 0.001) and preeclampsia (r = 0.366, p = 0.001). Regression coefficients between AT-III and albumin and between AT-III and TP in gestational hypertension (23.7 and 14.0, respectively) were significantly steeper than those in preeclampsia (14.6 and 9.6, respectively).ConclusionsThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels. This suggests that AT-III activity is more likely to decrease in gestational hypertension than in preeclampsia.     

Microalbuminuria is a predictor of adverse pregnancy outcomes including preeclampsia

ObjectivesAbnormal urinary protein loss is a marker associated with a diverse range of renal diseases including preeclampsia. Current measures of urine protein used in the diagnostic criteria for the diagnosis of preeclampsia includes urine protein:creatinine ratio and 24-h urine protein. However very little is known about the value of urine albumin:creatinine ratio (uACR) in pregnancy. In this study we examined the prognostic value of microalbuminuria detected antepartum to predict adverse pregnancy outcomes.DesignThis is a single-centre retrospective analysis of 84 pregnant women over the age of 16 attending a tertiary ‘high-risk’ pregnancy outpatient clinic between July 2010 and June 2013. Utilising medical records, antepartum peak uACR level and pregnancy maternal and fetal outcomes were recorded.FindingsThe primary outcome was a composite of poor maternal and fetal outcomes including preeclampsia, maternal death, eclampsia, stillbirth, neonatal death, IUGR, premature delivery and placental abruption. As the antepartum peak uACR level (in mg/mmol) increased from normoalbuminuria (uACR < 3.5) to microalbuminuria (uACR 3.5–35) to macroalbuminuria (>35), the percentage of women with the primary composite outcome increased in a stepwise fashion (13.8% to 24.1% to 62.1% respectively, p < 0.001). After adjusting for covariates including history of hypertension, chronic kidney disease and aspirin therapy during pregnancy, micro- and macroalbuminuria remained significant predictors of the primary outcome.ConclusionsWe have shown that antepartum peak uACR is a useful simple marker to help predict adverse maternal and fetal outcomes. Further studies are required to utilise uACR as a prognostic tool in pregnancy before it can be applied in clinical practice.     

Impact of non-steroidal anti-inflammatory drugs on hypertensive disorders of pregnancy

ObjectiveNon-steroidal anti-inflammatory drug (NSAID) use has the potential to adversely affect blood pressure in women with hypertensive disorders of pregnancy. We sought to evaluate this association.Study designWomen affected with severe hypertensive disorders of pregnancy were identified by retrospective chart review. The medication administration record was then used to identify controls (no NSAID exposure) until a sufficient number of patients were obtained, after which the cases (NSAID exposed) were identified in a chronological manner during the same study period until a 2:1 ratio was achieved. The primary outcome was the change in mean of all postpartum mean arterial pressures (MAP) throughout the hospital stay. Power analysis showed that 146 exposed and 73 unexposed subjects were necessary to obtain 90% power to detect a MAP difference of 10 mmHg between the groups. Secondary outcomes included: initiation of anti-hypertensive medication, need for increased doses of anti-hypertension medication, and adverse events related to hypertension.Results223 women had severe hypertensive disorders of pregnancy, of whom 75 (34%) were not exposed to NSAIDs and 148 (66%) were exposed. NSAID exposure was not associated with a difference in the average MAP postpartum (p = 0.70), nor any of the secondary outcomes evaluated. Exposure to NSAIDs was less likely as serum creatinine increased (p = 0.012).ConclusionIn women with severe hypertensive disorders of pregnancy, NSAIDs did not appear to increase the average postpartum MAP, increase the requirement for anti-hypertensive medications, or increase the rate of adverse postpartum events.     

Long-term follow up of couples initially randomized between immobilization and immediate mobilization subsequent to IUI

A previous randomized clinical trial compared immobilization for 15 min with immediate mobilization subsequent to intrauterine insemination (IUI) and showed higher ongoing pregnancy rates in couples immobilizing subsequent to IUI. The current study compared the long-term effectiveness of immobilization subsequent to IUI. All couples (n = 391) included in the trial were followed for 3 years after randomization and pregnancies and treatments were recorded. After the initial trial period, couples in both groups were offered treatment according to local protocol. The primary outcome was an ongoing pregnancy during the 3 years after the initial trial. In this time period, there were 143 ongoing pregnancies in the immobilization group (n = 199 couples) and 112 ongoing pregnancies in the immediate mobilization group (n = 192). The ongoing pregnancy rates were 72% and 58%, respectively (relative risk 1.2, 95% CI 1.1–1.4). The persistent significant difference in ongoing pregnancy rates underpins the importance of immobilization after IUI. There is no valid reason to withhold women from immobilizing for 15 min after IUI.     

The brain study: Cognition,quality of life and social functioning following preeclampsia; An observational study

ObjectivesPreviously preeclamptic women may express cognitive difficulties, which have largely been unappreciated or attributed to stresses of a complicated pregnancy. This study aimed to explore the scope of perceived neurocognitive and psychosocial problems as well as quality of life following preeclampsia.Study designObservational study. Through website promotion and e-mail, registrants of the USA-based Preeclampsia Foundation who experienced preeclampsia in the past 20 years were invited to complete a web-based survey. Participants were requested to ask an acquaintance that had a normotensive pregnancy to also complete the survey (controls).Main outcome measuresThe Cognitive Failures Questionnaire (CFQ), abbreviated WHO Quality Of Life questionnaire (WHOQOL-BREF), Social Functioning Questionnaire (SFQ) and Breslau Short Screening Scale for DSM-IV Posttraumatic Stress Disorder were used in the survey. Analysis was performed using Mann–Whitney U tests and linear regression.Results966 cases and 342 controls completed the survey (median age 34, median time since first pregnancy 4 vs. 5 years). Cases scored significantly worse on CFQ (median 35 vs. 27), WHOQOL-BREF domains physical health (15 vs. 17), psychological (13 vs. 15), social relationships (13 vs. 15) and environment (15 vs. 16), and SFQ (8 vs. 7). All p < 0.001. Multivariable analysis showed an independent significant effect of eclampsia on CFQ and of migraine on all questionnaires and the effect of preeclampsia was still present after adjustment for confounders. Posttraumatic stress symptoms accounted for part of the relationships.ConclusionsPreviously preeclamptic women appear to perceive more cognitive and social problems, and report poorer quality of life compared to a group of women with normotensive pregnancies. Research relating to the origin and management of these issues is needed.     

Obstetric implications of fetal inherited thrombophilia in thrombophilic women

ObjectivesThe relationship between fetal thrombophilic polymorphism and adverse pregnancy outcomes is still unclear. The aim of this study is to evaluate if fetal thrombophilia may affect obstetric and perinatal outcomes in thrombophilic women.Study designFrom 2007 to 2011 all patients with a known inherited thrombophilic mutation consecutively admitted to our labor ward at ⩾25 weeks of gestation with a singleton viable pregnancy were considered eligible for the purpose of the study. At the age of 1 year, the infants were tested for inherited thrombophilic mutations. Patients were then divided into two groups according to the presence or absence of any neonatal mutation.Main outcome measuresThe following outcome variables were then compared between the two groups: gestational age at delivery, birth weight, incidence of hypertensive disorders of pregnancy and SGA neonates.ResultsOverall, 67 pregnancies of 49 women were studied. Among them, the G20210A Prothrombin (32/67 or 47.7%) mutation and the Factor V Leiden mutation (31/67 or 46.3%) were the commonest findings, with a single patient presenting both. A thrombophilic mutation was found in 38 mother–infant pairs. The risk of all maternal and perinatal events including the incidence of hypertensive disorders disorders (5/29 or 17.2% vs 6/38 or 15.7% p = 1.00) and of SGA neonates (3/29 or 10.3% vs 7/38 or 18.4%, p = 0.49) was comparable between the two groups irrespective of the associated fetal thrombophilia.ConclusionsOur data suggest that women with inherited thrombophilia carrying a thrombophilic fetus are not at increased risk of adverse pregnancy outcomes.