Racial disparities in maternal hypertension (i.e., prepregnancy and gestational) due to experiences of racism may contribute to ongoing racial disparities in US birth outcomes, including low birth weight and preterm birth. Despite evidence linking racism and adverse birth outcomes, no studies have examined the plausible association between area-level negative racial sentiment and disparities in maternal hypertension. To address this gap, we used 2016-2021 US birth certificate data to examine the associations between state-level Twitter-derived negative sentiments toward racial/ethnic minorities and maternal hypertension. We further examined if these associations increased during periods of heightened racial discrimination. We used 2016-2021 US natality data with geographic identifiers for pregnancy data for singleton births (n = 22,618,566) and a random sample of 1% of publicly available tweets from 2016-2021 (n = 56,400,097) using Twitter's Academic Application Programming Interface. We calculated annual state-level negative racial sentiment by averaging sentiment scores of all posts referencing a racial category. These scores, divided into quartiles, included five sentiment measures: one toward all racially minoritized groups and four race-specific (Black, Asian, Latinx, and White). We merged data for each year and used log-binomial regression to estimate prevalence rate ratios (PRRs) for prepregnancy and gestational hypertension, adjusting for individual maternal characteristics and state-level demographics. We additionally stratified analyses into time periods before and during the COVID-19 pandemic and Black Lives Matter movement (2016-2019 and 2020-2021, respectively). In our sample, 2.2% of individuals had prepregnancy hypertension and 7.7% had gestational hypertension. From 2016-2021, the prevalence of both types of maternal hypertension increased for individuals across all racial and ethnic groups. Individuals in states with the highest quartile of negative racial minority sentiment had a 36% higher (95% CI: 1%-83%) prevalence of prepregnancy hypertension and a 20% higher (95% CI: 0%-45%) prevalence of gestational hypertension compared to those in the lowest quartile. In 2020 and 2021, the prevalence of prepregnancy hypertension among individuals in racially minoritized groups was 51% greater (95% CI:12%-103%) in the 4th quartile compared to the 1st quartile and showed a higher magnitude of association compared to 2016-2019. In 2020-2021, among Black individuals, those in the highest quartile of anti-Black sentiment had a 31% higher (95% CI: 2%-69%) prevalence of prepregnancy hypertension, and the 19% increase in prepregnancy hypertension among Asian individuals in the highest quartile of anti-Asian sentiment was borderline significant (95% CI: 0%-44%). Patterns for gestational hypertension were not consistent across time and when examining race-specific sentiment. Higher levels of state-level negative racial sentiment are associated with increased prevalence of prepregnancy and gestational hypertension among racially minoritized groups, and the association with prepregnancy hypertension appears to strengthen during periods of heightened racial tension and discrimination. These findings highlight the role of area-level racism as a contributor to maternal health disparities.
Early identification of pregnancies at risk for gestational hypertension (gHTN) and preeclampsia (PE) remains a major clinical challenge. We investigated whether early‑pregnancy serum metabolomic profiles differentiate gHTN and PE prior to clinical onset. High-resolution metabolomics (HRM) analysis was performed on 126 early-pregnancy serum samples collected at ≤ 20 weeks' gestation from 97 pregnant women enrolled in the Placental Assessment in Response to Environmental Pollution study (PARENTs) cohort at UCLA. Metabolic profiles were compared among pregnancies that later developed gestational hypertension (gHTN; n = 14 mothers, 20 samples), preeclampsia (PE; n = 9 mothers, 11 samples), and pregnancies without ischemic placental disease (non-IPD; n = 74 mothers, 95 samples). Untargeted metabolome-wide association studies (MWAS) and pathway enrichment analyses were conducted. Multivariable linear regression models adjusted for key maternal and pregnancy characteristics such as maternal age, race/ethnicity, early-pregnancy BMI, fetal sex, and parity were used to evaluate associations. Distinct metabolic profiles differentiated gHTN and PE from non-IPD pregnancies. Alterations in the tryptophan metabolism pathway were observed in both gHTN and PE, with a significant dose-response relationship across groups (non-IPD > gHTN > PE, p = 0.008). Key metabolites, including tryptophan and its derivatives, were progressively depleted in association with increasing disease severity. Additionally, urea cycle metabolism was altered in gHTN, with higher levels of arginine and citrulline linked to nitric oxide production and vascular tone regulation. Comparisons between PE and gHTN revealed additional differences, including lower concentration of phenylalanine and pantothenic acid in PE, suggesting distinct metabolic alteration. Early‑pregnancy metabolomic signatures reveal both shared and condition‑specific metabolic pathways underlying gHTN and PE, with tryptophan metabolism showing a dose-response relationship indicative of disease severity. These early gestational alterations may serve as biomarkers for hypertensive disorders of pregnancy (HDP), enabling closer monitoring and stratification in high-risk pregnancies. Further studies in larger cohorts are needed to validate these findings and explore therapeutic implications.
Assessment of cardiovascular health (CVH) during may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the AHA's Life's Essential 8 (LE8) framework during pregnancy remains uncertain. To evaluate CVH during using a modified Life's Essential 8 (mLE8) score in association with time to incident cardiometabolic disease. Prospective cohort study with electronic medical record (EMR) surveillance for 7 years postpartum (August 2018-March 2026). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. A population-based prenatal cohort recruited from a large academic medical system in South Carolina. Singleton pregnancies in individuals aged 18 to 44 years without pre-existing diabetes or cardiovascular disease (CVD). A 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50-g glucose tolerance test results, pre-pregnancy body mass index, smoking status, sleep adequacy, diet quality, and physical activity. Scores ranged from 0 to 100, with higher scores indicating more favorable CVH. Post-delivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (e.g., dyslipidemia, impaired glucose regulation), and CVD (e.g. cardiac arrest, cardiomyopathy). Time to incident diagnosis was measured in days from delivery. Among 1,225 pregnancies (mean age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median follow-up of 6.2 (2.8) years. Each 10-point higher mLE8 score was associated with a longer time to incident diagnosis of chronic hypertensive conditions (time ratio [TR], 1.26; 95% CI, 1.11-1.42) and chronic metabolic conditions (TR, 1.20; 95% CI, 1.11-1.29). Healthier HDP, glucose, BMI, and sleep scores were most strongly associated with longer time to diagnosis of chronic metabolic disease. Results were robust to sensitivity analyses excluding individuals who developed gestational diabetes or HDP. In this racially diverse, low-income cohort study of 1,225 pregnancies, better CVH during pregnancy was associated with a longer time to incident post-delivery diagnosis of cardiometabolic conditions. Pregnancy-based CVH assessment may help identify individuals with elevated and emerging cardiometabolic risk who could benefit from early, targeted intervention and enhanced longitudinal surveillance. Question : Is cardiovascular health during pregnancy, assessed using a modified Life's Essential 8 score (LE8), associated with time to incident cardiometabolic disease after pregnancy? Findings : In a racially diverse prospective pregnancy cohort with 7 years of electronic medical record follow-up, healthier mLE8 scores were associated with a significantly longer time to diagnosis of chronic hypertension and metabolic conditions. Associations persisted after excluding individuals with gestational diabetes or hypertensive disorders of pregnancy. Meaning : Pregnancy cardiovascular health assessment using LE8 may identify individuals with elevated risk and latent vulnerability, and support earlier intervention during a sensitive window for prevention of long-term cardiometabolic disease.
Based on the Actor-Partner Interdependence Model, this study longitudinally explores the dynamic interactions between dyadic coping and health behaviors among patients with gestational hypertension and their spouses, providing a basis for promoting health behaviors in both partners. Using the convenience sampling method, 260 cases of patients with gestational hypertension were selected. Dyadic Coping Inventory (DCI) and the Health Promoting Lifestyle Profile (HPLP) were used to conduct investigations at 20-21+6 weeks of gestation (T1), 28 weeks of gestation (T2), and 36 weeks of gestation (T3). The actor effects of dyadic coping between patients with gestational hypertension and their spouses on health behaviors were significant. That is, the dyadic coping of both patients (T1→T2: β = 0.11, T2→T3: β = 0.10, all p < 0.01) and spouses (T1→T2: β = 0.09, T2→T3: β = 0.08, all p < 0.01) could be positively and prospectively associated with their own health behaviors at the next time point. The actor effects of health behaviors of patients and spouses on dyadic coping were also significant. Specifically, the health behaviors of both patients (T1→T2: β = 0.14, T2→T3: β = 0.11, all p < 0.001) and spouses (T1→T2: β = 0.12, P < 0.001; T2→T3: β = 0.10, p < 0.01) could be positively and prospectively associated with their own dyadic coping at the next time point. Furthermore, significant partner effects of health behaviors were found: the health behaviors of both patients (T1→T2: β = 0.13, T2→T3: β = 0.12, all p < 0.001) and spouses (T1→T2: β = 0.09, T2→T3: β = 0.07, all p < 0.01) could be positively and prospectively associated with the other's health behaviors at the next time point. Dyadic coping and health behaviors interact between patients with gestational hypertension and their spouses.
Hypertensive disorders of pregnancy (HDP) are a prevalent complication and a leading cause of maternal and perinatal mortality. While vaginal delivery is generally possible for most women with HDP, there is no standardized framework detailing variations in vaginal delivery outcomes across different HDP classifications or identifying the factors influencing emergency cesarean section (EmCS). To explore the vaginal trial outcomes and risk factors associated with emergency cesarean section among women with different classifications of HDP. This was a single-center retrospective cohort study of 894 pregnant women with HDP who underwent a vaginal trial. Of these, 584 were diagnosed with gestational hypertension, 216 with pre-eclampsia, and 94 with chronic hypertension. The study collected and compared detailed maternal and perinatal outcomes. (1) The success rate of vaginal delivery ranged from 85.1% to 90.8% across various classifications of HDP without significant differences. (2) Chronic hypertension was four times more likely to lead to intrapartum poorly controlled blood pressure than gestational hypertension. (3) Factors influencing EmCS in HDP included parity, antepartum BMI, labor induction, intrapartum fever, intrapartum antihypertensive use, and oxytocin during stages of labor. Parity served as an independent protective factor across all HDP classifications. Stratified analysis revealed that for gestational hypertension, risk factors included antepartum BMI ≥ 30 kg/m2, labor induction, and intrapartum antihypertensive use. For pre-eclampsia, oxytocin and intrapartum fever were risk factors. In chronic hypertension, antepartum BMI ≥ 30 kg/m2 and intrapartum fever were identified as risk factors, although the former was not significant. The success rate of vaginal trials across various classifications of HDP is high. Vaginal trial can impact intrapartum blood pressure, particularly for women with chronic hypertension. Tailored management strategies should include encouraging vaginal trial for multiparous women, control of antepartum BMI, judicious use of labor induction, and vigilant monitoring of hypertension and fever, with individualized evaluation and treatment based on HDP classification.
Intrahepatic cholestasis of pregnancy (IHCP) is the most common pregnancy-specific liver disease. This study aimed to determine the prevalence of proteinuria in patients with IHCP and to evaluate its association with adverse pregnancy outcomes. This retrospective cohort study included pregnant patients with gestational age > 24 weeks who were diagnosed with IHCP and completed 24-hour urine protein collection at Haseki Training and Research Hospital (January 2018-December 2024). Proteinuria was defined as ≥300 mg/24-h urine collection. Patients were categorized into 3 groups: non-proteinuric, isolated proteinuria (proteinuria ≥ 300 mg/24 h in the absence of hypertension), and preeclampsia (defined according to the American College of Obstetricians and Gynecologists [ACOG] criteria). The primary outcome was a composite adverse pregnancy outcome, including preterm delivery at <34 weeks, umbilical artery pH < 7.1, and emergency cesarean delivery due to fetal distress. Group comparisons were performed using the Kruskal-Wallis test for continuous variables and the chi-square or Fisher exact test for categorical variables. Multivariate logistic regression was performed adjusting for maternal age, twin gestation, and in vitro fertilization conception. Among 341 patients, 207 (60.7%) had no proteinuria, 105 (30.8%) had isolated proteinuria, and 29 (8.5%) had preeclampsia. Overall, 39.3% of IHCP patients demonstrated proteinuria. The distribution of IHCP severity, as classified by maximum total bile acid (TBA) concentration, was comparable among the 3 groups (P = .976). The demographic parameters were comparable between the groups. The preeclampsia group exhibited significantly higher composite adverse outcome rates (P < .001). Multivariate logistic regression demonstrated that preeclampsia was independently associated with composite adverse outcomes (adjusted odds ratio: 6.96, 95% confidence interval: 2.69-18.01; P < .001), whereas isolated proteinuria showed no significant association (adjusted odds ratio: 1.54, 95% confidence interval: 0.95-2.50; P = .079). Approximately 39% of IHCP patients exhibited proteinuria. Isolated proteinuria without hypertension was not an independent predictor of adverse pregnancy outcomes. In the absence of hypertension or other features of preeclampsia, the presence of proteinuria alone may not warrant escalation of care or accelerated delivery decisions in IHCP. However, prospective validation of these findings is needed before definitive clinical recommendations can be established.
As the traditional risk factors cannot account for all hypertension (HTN) incidents, it is of great importance to determine other risk factors. This study aimed to identify long-term HTN risk associated with annual change of estimated glomerular filtration rate (eGFR) and prior adverse pregnancy outcomes (APOs) among women participating in a population-based study of Tehran Lipid and Glucose Study (TLGS). This study was performed using prospectively ascertained data of TLGS. A total of 2,404 women with recorded data of eGFR measurements and APO status participated. Data collection was conducted according to the standard guide of TLGS. Cox proportional-hazards regression models were used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for the incidence of HTN. A total of 2,404 women were enrolled. Adjusted model shows that, a one z-score positive eGFR change was associated with a reduced risk of developing HTN among women with a history of APOs (HR= 0.816, 95% CI: 0.708-0.939, p = 0.005). In contrast, no significant association was observed among women without a history of APOs (HR= 1.027, 95% CI: 0.913-1.156, p = 0.645). We also observed a statistically significant interaction between APO status and annual eGFR change for HTN incidence in total population (interaction p = 0.02). The history of APOs is accompanied by alterations in kidney function in the long term. In women with a history of APOs, a positive change in eGFR levels was independently associated with a lower risk of HTN.
Hypertensive disorders of pregnancy (HDP) constitute a group of conditions characterized by elevation of blood pressure detected for the first time after 20 weeks of gestation, with a global prevalence estimated at nearly 10% of all pregnant women. To evaluate the clinical evolution and perinatal outcomes of pregnant women identified with a first elevation of blood pressure after 20 weeks of gestation, from the diagnostic confirmation of the type of HDP, until the termination of pregnancy under conservative management in the hospital. Observational analytical cohort study in pregnant women attended at the Social Security Fund hospital of Panama, from July 1, 2023, to December 31, 2024. Pregnant women ≥20 weeks of gestation were included, identified for presenting a first elevation of blood pressure (140/90 mmHg), who were subsequently confirmed with an HDP diagnosis through a second elevated blood pressure measurement found in a minimum of 4 hours or a maximum of 7 days. During the 18 months of the study, 191 pregnant women were admitted to confirm or rule out HDP. It was confirmed that 20 (10.4%) had white coat hypertension, in 11 (5.8%), chronic hypertension without superimposed preeclampsia was diagnosed, confirming pregnancy-associated hypertensive disorder in 160 (83.8%). 51.2% with a diagnosis of HDP without severity criteria under conservative management developed severity criteria. The pregnancy prolongation time with conservative management was 3 weeks. The average gestational age at the time of termination was 35 weeks, and 30% of the newborns were admitted to the intensive care unit. There were 8 (5%) perinatal deaths: one in utero and 7 neonatal deaths associated with prematurity. This study shows that one in 10 patients with an initial elevation in blood pressure ultimately has a diagnosis of white-coat hypertension, and that nearly half of pregnant women identified with a first elevation in blood pressure after 20 weeks of gestation develop severe features during conservative inpatient management. HDP are dynamic and evolving entities that may progress unpredictably, leading to high rates of prematurity and maternal and perinatal complications.
Maternal smoking is a major preventable cause of fetal growth restriction (FGR). Although cessation reduces risk, the benefit depends on its timing, and the role of preexisting hypertension-sharing vascular-placental mechanisms-remains underexplored. We conducted a population-based retrospective cohort study using US birth data (2020-2024). Maternal smoking was divided as nonsmokers, quit before pregnancy, quit in the first trimester, quit in the second trimester, or persistent smokers. FGR was defined using birth-weight-based percentiles derived from the NICHD fetal growth standards (<3rd, <5th, and <10th). Poisson regression with inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk ratios (aRRs). Effect modification by preexisting hypertension was examined on multiplicative and additive scales. Among 17,381,709 singleton live births, FGR-3rd incidence increased across groups (3.3%, 4.5%, 6.1%, 7.5%, and 10.0%, respectively), showing a dose-response gradient. Compared with nonsmokers, the IPTW-aRRs for FGR-3rd were 1.20 (95% CI:1.17-1.23), 1.61 (1.57-1.66), 2.03 (1.95-2.11) and 2.01 (1.99-2.04) for women who quit before pregnancy, in the first trimester, in the second trimester, and persistent smokers. Preexisting hypertension increased absolute FGR risk but modified associations on the multiplicative scale, with attenuated relative risks among hypertensive women. No meaningful interaction was observed on additive scale. Notably, hypertensive women who quit before pregnancy achieved FGR risks comparable to hypertensive nonsmokers (aRR=0.98, 0.88-1.08). Similar patterns were observed for <5th and <10th percentiles. Earlier smoking cessation is associated with lower risk of FGR. Preexisting hypertension modifies associations on the multiplicative scale, where relative risks were attenuated among hypertensive women, but not on the additive scale, suggesting the independence on the additive scale (a lack of departure from risk additivity). These findings support integrating smoking cessation into preconception and antenatal care, especially for high-risk women.
Pregnancy is generally well tolerated in patients with arrhythmogenic cardiomyopathy (AC), but there are limited data comparing right-dominant AC (ARVC) and left-dominant AC (ALVC), as well as gene-positive but phenotype-negative (G+/P-) individuals. Recent guidelines have also introduced the non-dilated left ventricular cardiomyopathy (NDLVC). This study examines disease expression in pregnant women with AC and family members with pathogenic genetic variants but a negative phenotype (G+/P-). We also included those with NDLVC. We reviewed data from 22 patients diagnosed with definite AC and 9 G+/P- patients. Four patients meeting criteria for NDLVC were also analyzed. Each underwent at least one cardiovascular evaluation during pregnancy, which included a 12-lead ECG, echocardiography, and 24-h ambulatory monitoring. Events were defined as new or worsening arrhythmias, heart failure, or thromboembolic events. All AC patients, including those with ARVC and ALVC, tolerated pregnancy well. None of the G+/P- patients was diagnosed with AC during pregnancy. One G+/P- patient had ECG changes, while three with PKP2 mutations experienced mild left ventricular dysfunction but fully recovered postdelivery. Among the four NDLVC patients, only one developed left ventricular dysfunction. There was no increase in arrhythmias, and 31% of the cases required caesarean sections. All pregnancies resulted in live births, and no major maternal complications were reported. Pregnancy is typically safe for women with AC and G+/P- individuals, provided that they are hemodynamically stable. Patients with NDLVC also manage pregnancy well. However, careful monitoring during and after pregnancy is essential, even without obvious clinical signs of the disease.
Background: Pregnancy in women with liver cirrhosis is considered a rare clinical condition due to the decreased fertility commonly associated with chronic liver disease. Hormonal disturbances, anovulation and impaired hepatic function contribute to the lower conception rates observed in this population. However, when pregnancy occurs, it is associated with a significantly increased risk of maternal and fetal complications. Maternal risks include hepatic decompensation, variceal bleeding, ascites, coagulopathy and a higher rate of hypertensive disorders during pregnancy and related complications. Fetal complications involve prematurity, intrauterine growth restriction, and increased perinatal mortality. Methods: We present the clinical case of a woman with idiopathic liver cirrhosis who experienced four consecutive pregnancies with different clinical courses and outcomes. Results: The case highlights the complexity of managing pregnancy in patients with chronic liver disease and underscores the importance of individualized clinical assessment and multidisciplinary management. This report also reviews current management strategies and discusses key considerations for optimizing care in pregnant women with liver cirrhosis. Conclusions: Advances in multidisciplinary care and improved management strategies have contributed to better pregnancy outcomes in recent years. Careful monitoring during pregnancy, appropriate management of portal hypertension, and coordinated care between obstetricians, hepatologists, and neonatologists are essential to minimizing potential complications, ensuring favorable maternal and fetal outcomes.
The global incidence of obesity during pregnancy is increasing, and this poses a significant challenge in the appropriate management of pregnancy and childbirth. The aim of our study was to analyze the effect of maternal obesity as a risk factor on hemodynamic parameter changes during pregnancy. From the 557 investigated cases, the body mass index was normal in 326 cases and obesity was detected in 121 cases. Our measurements were classified into 6-6 groups based on gestational weeks (<14, 14-18, 19-23, 24-28, 29-34, >34). The following hemodynamic parameters were measured: mean arterial pressure, systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate. We examined the changes in these values as the effect of gestational age in normal and obese pregnant women. A comparative study between the individual groups was also conducted. In pregnant women with normal body mass index, mean arterial pressure did not change significantly (p = 0.25), but there was a non-significant decrease (p = 0.38) at the 15th and a positive non-significant (p = 0.47) spike at the 28th gestational week. The systolic value significantly decreased continuously (p = 0.008), and there was no significant change in the diastolic value (p = 0.86). Pulse pressure decreased significantly (p = 0.0001), whereas the pulse rate (p = 0.01) increased significantly in the first and second trimesters, but in the group with 29-33 weeks of gestation we have experienced a significant increase with regard to both values. In obese pregnant women, mean arterial pressure decreased significantly (p = 0.0001), a significant decrease (p = 0.004) was observed in the 15th week and a significant increase in the 24-28th week of pregnancy (p = 0.0001). Systolic, diastolic and pulse pressure also decreased significantly (p = 0.001). We did not detect any significant change in heart rate (p = 0.53). Comparing the results of the two groups, the measured mean arterial pressure, systolic and diastolic blood pressure, and pulse pressure values were significantly higher in the obese group (p = 0.0001). It would be advisable to monitor blood pressure at least monthly under validated conditions, with particular attention to mean arterial pressure, systolic blood pressure, and pulse pressure between 28 and 32 weeks of gestation. Our results suggest that obesity is a significant risk factor for the development of hypertension during pregnancy. Orv Hetil. 2026; 168(18): 702-713. Bevezetés: A terhesség alatti elhízás globális előfordulása növekedésben van, és ez jelentős kihívást jelent a terhesség, illetve a szülés megfelelő kezelésében. Célkitűzés: Vizsgálatunk célja annak elemzése volt, hogy az anyai elhízás mint rizikófaktor milyen hatással van a hemodinamikai paraméterek terhesség során bekövetkező változásaira. Módszer: Az 557 vizsgált páciensből 326 normális testtömegindexszel rendelkező és 121 elhízott pácienst vettünk figyelembe. Méréseinket a terhességi hetek alapján 6-6 csoportba soroltuk (<14., 14–18., 19–23., 24–28., 29–34., >34. terhességi hét). A következő hemodinamikai paramétereket mértük: artériás középnyomás, systolés vérnyomás, diastolés vérnyomás, pulzusnyomás, pulzusszám. Ezen értékek változását követtük nyomon a terhességi kor függvényében normális testtömegű, illetve elhízott páciensek esetében. Az egyes csoportok között összehasonlító elemzés is készült. Eredmények: A normális testtömegű várandósoknál az artériás középnyomás nem változott szignifikánsan (p = 0,25), viszont volt egy nem szignifikáns (p = 0,38) csökkenés a 15. terhességi héten és egy pozitív nem szignifikáns (p = 0,47) kiugrás a 28. terhességi héten. A systolés érték folyamatosan szignifikánsan csökkent (p = 0,008), a diastolés értékben viszont nem történt szignifikáns változás (p = 0,86). A pulzusnyomás szignifikánsan csökkent (p = 0,0001), míg a pulzusszám (p = 0,01) szignifikánsan emelkedett az első és második trimeszterben, de a 29–33. héten szignifikáns mértékben csökkent (p = 0,0001), és megfigyelhető volt egy szignifikáns (p = 0,004) csökkenés a 15. héten és egy szignifikáns mértékű pozitív kiugrás a 24–28. terhességi héten (p = 0,0001). A systolés, a diastolés érték, illetőleg a pulzusnyomás is szignifikánsan csökkent (p = 0,001). A pulzusszám esetében szignifikáns változást a terhesség során nem észleltünk. Megbeszélés: A két csoport eredményeit összehasonlítva, elhízás esetén szignifikánsan magasabbak voltak a mért artériás középnyomás, systolés és diastolés vérnyomás, illetve a pulzusnyomás értékei (p = 0,0001). Javasolt lenne legalább havi rendszerességgel, validált körülmények között ellenőrizni a vérnyomást, különös tekintettel a 28–32. terhességi hét közötti artériás középnyomásra, a systolés vérnyomásra, illetőleg a pulzusnyomásra. Következtetés: Eredményeinkből arra következtethetünk, hogy az elhízás a terhesség alatti magas vérnyomás kialakulásában jelentős rizikófaktort képvisel a harmadik trimeszterben. Orv Hetil. 2026; 167(18): 702–713.
Obesity is a major global health issue associated with comorbidities, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease. Bariatric surgery is effective, but its outcomes vary. Obstetric history may influence results, as pregnancy induces lasting metabolic and hormonal changes, though current evidence remains unclear. This study aimed to evaluate whether preoperative pregnancy history affects weight loss outcomes after bariatric surgery. A retrospective multicenter analysis was conducted within the Maternal Outcomes of Bariatric Surgery and Pregnancy Study project, including 1399 women from 11 Polish bariatric centers. The participants were divided into 2 groups: women with a history of pregnancy (n=1061) and nulliparous women (n=338). Primary outcomes included percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and overall weight reduction. Women with prior childbirth were older (42 vs 32.5 y; P <⁠0.001) and more frequently had T2DM (22% vs 12%; P <⁠0.001) and hypertension (44.9% vs 23.4%; P <⁠0.001) than the nulliparous participants. Median postoperative body mass index (BMI) was similar in both groups (29 kg/m²), but weight loss differed considerably. Women with childbirth history achieved lower %TWL (28.57% vs 33.85%; P <⁠0.001) and %EWL (72.17% vs 78.44%; P =0.001), as compared with those who never gave birth. Multivariate regression identified age, preoperative BMI, hypertension, and dyslipidemia as independent factors affecting weight loss. Women with a history of childbirth achieve poorer weight loss outcomes after bariatric surgery; however, it is not an independent factor influencing bariatric results.
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Pregnant women need enough vitamin D for healthy pregnancies, but many women in Iran's Khuzestan province don't get sufficient sunlight to produce vitamin D naturally. In this study, we aimed to determine how many pregnant women have low vitamin D levels and to test different methods of providing vitamin D supplements. We also sought to assess whether our new algorithm model, called Irregular Fuzzy Cellular Automata (IFCA), performs better than older methods for predicting pregnancy complications. We examined 2,481 pregnant women who participated in this study in two Iranian cities between 2014 and 2016. Women with vitamin D blood levels below 20 ng/mL were considered to have low vitamin D. We selected 800 women with moderate or severe vitamin D deficiency (25(OH)D < 50 nmol/L) and assigned them to eight groups receiving different combinations of injectable and oral supplementation regimens. We assessed maternal complications such as gestational hypertension, diabetes, preterm birth, and premature rupture of membranes. For babies, we evaluated their weight, length, head size, and vitamin D levels in their cord blood. We compared how well our new IFCA model worked against older methods by evaluating its accuracy compared to them. Our results indicate that 85% of the women had low vitamin D levels, with approximately 38% exhibiting severe deficiency. After taking supplements, the average vitamin D level in mothers went up to 24.1 ± 3.2 ng/mL (p < 0.001). Mothers' vitamin D levels matched closely with their babies' levels (r = 0.82, p < 0.001). Only 0.6% of women developed high blood pressure during pregnancy, but we found that being overweight and having high blood pressure were bigger problems (OR = 2.3, p = 0.032) than low vitamin D alone. Our IFCA model worked better than older methods, achieving an accuracy of 89% with an AUC of 0.92 (p < 0.01). Low vitamin D is very common in pregnant women who don't get much sunlight, but providing them with supplements can address this issue. Both injection and pill forms of vitamin D helped bring levels back to normal. Our new IFCA model was better at finding women who might have pregnancy problems than older methods. Doctors should monitor vitamin D levels early in pregnancy and utilize improved tools to help ensure the health of mothers and babies. This study was registered in the Iranian Registry of Clinical Trials (IRCT) under the code IRCT2014102519660N1. Registered on 15 January 2014 at www.irct.ir.
Plant-based diets are increasingly popular and may improve cardiometabolic health, but their association with adverse pregnancy outcomes (APOs) is unclear; and dietary patterns are influenced by food access. We investigated whether adherence to plant-based dietary patterns were associated with APOs and whether the association varied by neighborhood food access. This is a secondary analysis using data from the Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) cohort. Diet scores for the newer Healthy Plant-Based Diet Index (hPDI) and more established Dietary Approaches to Stop Hypertension (DASH) were derived from first-trimester Block Food Frequency Questionnaires and assessed in tertiles (T1= "low", T3= "high"). APOs included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and stillbirth. Modified Poisson regression models were used, adjusting for age, income, education, and health insurance. Among 7,981 nulliparous individuals, higher hPDI scores were associated with lower risk of HDP (T3 vs. T1: aRR: 0.77; 95% CI: 0.64 to 0.92; T2 vs. T1 aRR: 0.82; 95% CI: 0.70 to 0.97) and GDM (T3 vs. T1: aRR: 0.55; 95% CI: 0.39 to 0.76; T2 vs. T1: aRR: 0.71; 95% CI: 0.54 to 0.95). Higher DASH scores were associated with lower risk of HDP (T3 vs. T1: aRR 0.83; 95% CI: 0.70 to 0.98); and GDM, albeit for the second tertile only (T2 vs. T1: aRR 0.69; 95% CI 0.52 to 0.90). Neither diet was associated with PTB, SGA, or LGA. The frequency of low food access decreased across tertiles for both the hPDI and DASH (p<0.05), but the associations between diet and APOs did not vary by food access (p>.05). A healthy plant-based diet in early pregnancy was associated with a lower risk of developing HDP and GDM in nulliparous individuals, which was similar with a DASH diet.
Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and death. There is an urgent need to improve early identification of women at risk of HDP, and assessment of pregestational cardiometabolic biomarkers is a potential way forward. To investigate pregestational cardiometabolic disturbances with regard to risk of HDP. This prospective cohort study used data from the Apolipoprotein-Related Mortality Risk (AMORIS) cohort, a population-based study set in the greater Stockholm area of Sweden, linked to the Swedish Medical Birth Register from January 1, 1985, to December 31, 2020. Participants were nulliparous women 18 years of age or older with blood biomarker data obtained before their first completed pregnancy. Data analyses were conducted from January 1 to October 31, 2025. Pregestational cardiometabolic disturbances, identified through biomarkers of lipid and glucose metabolism and low-grade inflammation. Median time between blood sampling and the start of pregnancy was 4 to 6 years (range, 0-31 years). HDP, defined as gestational hypertension, preeclampsia, or superimposed preeclampsia. Of 35 189 women included (mean [SD] age at delivery, 30.9 [4.8] years), 1938 (5.5%) had HDP. In groups identified with pregestational cardiometabolic disturbances, the percentages with HDP were between 5.5% and 12.8%, whereas the percentages in the comparison categories were between 4.1% and 5.3%. In multivariable logistic regression models, associations with increased risk of HDP were observed for quartile (Q) 4 (vs Q1) for total cholesterol (adjusted odds ratio [AOR], 1.23 [95% CI, 1.06-1.41]), low-density lipoprotein cholesterol (AOR, 1.41 [95% CI, 1.05-1.89]), triglycerides (AOR, 1.19 [95% CI, 1.03-1.37]), haptoglobin (AOR, 1.20 [95% CI, 1.02-1.42]), apolipoprotein (Apo) B (AOR, 1.90 [95% CI, 1.36-2.65]), ApoB/ApoA1 ratio (AOR, 1.59 [95% CI, 1.10-2.30]), and the triglyceride-glucose index (AOR, 1.21 [95% CI, 1.04-1.40]). For C-reactive protein (AOR, 0.97 [95% CI, 0.80-1.17]) and leukocyte counts (AOR, 0.98 [95% CI, 0.80-1.20]), there was no association with HDP risk. In this cohort study, pregestationally assessed cardiometabolic biomarkers were associated with increased risk of HDP in nulliparous women. For some biomarkers, the increased risk was observed below standard cutoff levels for a clinical diagnosis, that is, at subclinical levels. These results suggest that assessment of cardiometabolic biomarkers may improve identification of women at risk of HDP, both in preconceptional counseling settings and at enrollment in antenatal health care.
Hypertensive disorders of pregnancy (HDP) may cause lasting vascular, cardiac, and renal damage, potentially increasing the risk of postpartum cardiovascular disease. This study aimed to examine the association between gestational blood pressure (BP) trajectories in HDP and the risk of unrecovered BP at 6 weeks post partum. A total of 3162 women with HDP were obtained from the antenatal care and the postpartum follow-up information system, between January 1, 2018, and December 31, 2024. Of the 3162 women included, 1674 had gestational hypertension, 607 had preeclampsia, 246 had chronic hypertension with superimposed preeclampsia, and 635 had chronic hypertension. Group-based trajectory modeling was used to fit systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) trajectories during pregnancy. Modified Poisson regression was used to assess the association between gestational BP trajectories and the risk of unrecovered BP at 6 weeks post partum. Trajectories of SBP, DBP, and MAP during pregnancy were significantly associated with unrecovered BP at 6 weeks post partum. For gestational hypertension, those with the high-consistent rise (adjusted relative risk [aRR] 2.493, 95% CI 1.093-5.689) and high-late surge SBP trajectories (aRR 4.535, 95% CI 1.884-10.917) were associated with a significantly increased risk of BP nonrecovery at 6 weeks post partum. Similar associations were observed for DBP and MAP. For chronic hypertension with superimposed preeclampsia, women with high-late surge in SBP (aRR 2.792, 95% CI 1.081-7.214), DBP (aRR 4.043, 95% CI 1.327-12.324), or MAP (aRR 4.018, 95% CI 1.462-11.045) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with chronic hypertension, those with the high-consistent rise trajectories of SBP (aRR 2.557, 95% CI 1.256-5.207), DBP (aRR 3.862, 95% CI 1.673-8.913), and MAP (aRR 3.714, 95% CI 1.682-8.201) had a significantly increased risk of BP nonrecovery at 6 weeks post partum. Among women with preeclampsia, only high-consistent rise SBP trajectory remained significantly associated with unrecovered BP post partum (aRR 3.355, 95% CI 1.140-9.873). The high-consistent rise and high-late surge trajectories of SBP, DBP, and MAP in gestational hypertension started at similar initial levels and crossed at approximately 22 weeks of gestation. The gestational BP trajectories in women with HDP are positively associated with the risk of unrecovered BP at 6 weeks post partum. Early identification of women at high risk for poor postpartum BP recovery through BP trajectory analysis may have important clinical implications for improving long-term cardiovascular outcomes in this population.
Recent previous studies have revealed outcomes of higher risk of low birth weight, small for gestational age, and pre-eclampsia for vegan pregnant women compared to other diets. This review examined if patients with vegan diet in our tertiary hospital had similar outcomes. A retrospective cohort study was conducted for 2022-2024 examining the factors of those who ate an unrestricted diet versus vegan diet (10 270 vs 68 women). Data included maternal demographics, clinical factors and pregnancy outcomes. Statistical analysis was performed using SPSS version 29. Vegans demonstrated a lower body mass index (BMI) than those with an unrestricted diet (P < 0.05). There was no difference in reported anemia in vegans versus those with unrestricted diets (17.6% vs 16.1%, P = 0.73) and no significant risk for requiring a blood transfusion either (2.9% vs 3.4%, P = 0.84), respectively. There was no statistically significant difference between the outcomes of those with a vegan versus unrestricted diet in median birth weight (3390 vs 3410 g, P = 0.77) or rate of premature delivery <37 weeks (7.4% vs 9.5%, P = 0.55). There was also no statistically significant difference for developing gestational diabetes (8.8% vs 9.9%, P = 0.77), or gestational hypertension (0% vs 3.5%, P = 0.12) for vegans versus unrestricted diets, respectively. The outcome in pregnancy for women with vegan and unrestricted diets was equivalent in our cohort. There is limited research on the consequences of vegan diets in pregnancy and further observational longitudinal studies are required for more robust data. Socioeconomic factors should be taken into consideration.
Pregnancy in women with autosomal dominant polycystic kidney disease (ADPKD) complicated by significant cardiovascular disease is high risk. We report a multiparous woman in her late 30s with ADPKD, chronic hypertension and prior anterior wall myocardial infarction who was found to have a left ventricular mural thrombus at 12 weeks' gestation. She was managed with anticoagulation, pregnancy-adjusted antihypertensive therapy and multidisciplinary care. Fetal growth restriction developed at 32 weeks, and emergency caesarean delivery was performed at 35 weeks for absent end-diastolic flow in the umbilical artery. A live infant was delivered with good neonatal outcome. The mother had an uncomplicated postpartum recovery, and follow-up echocardiography showed partial thrombus resolution. This case highlights the complex interaction between ADPKD, cardiovascular disease and pregnancy and underscores the importance of individualised anticoagulation, strict blood pressure control and coordinated multidisciplinary management to optimise maternal and fetal outcomes.