搜索结果：Pregnancy hypertension

Hypertensive disorders complicate approximately 5-10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induced hypertension (PIH) on foeto-maternal health, this review delineated their associated distinct risk factors and diagnostic markers, providing evidence-based insights to guide targeted, patient-centred management of hypertensive pregnancies. A systematic search of Web of Science, PubMed, and SCOPUS was conducted using predefined criteria. Observational studies were rigorously screened and quality assessed. Data were extracted and narratively synthesised, with an emphasis on maternal and foetal outcomes, diagnostic modalities, and risk modifiers. The analysis confirmed that intrauterine foetal demise, intrauterine growth restriction, low birth weight, and neonatal as well as maternal mortality are major adverse outcomes of hypertensive pregnancies. The evidence demonstrates that whilst chronic hypertension and PIH confer considerable risk, PIH often results in more sudden and severe clinical deterioration, especially in the absence of vigilant prenatal monitoring and timely intervention. The findings underscored the value of targeted, patient-centred care: women with chronic hypertension benefit from early and sustained surveillance, whereas those with PIH require prompt escalation of monitoring following diagnosis, especially in the second trimester. Notably, comorbid systemic illnesses and advanced maternal age compound risks across hypertension categories, and diagnostic modalities, particularly ultrasound Doppler, are pivotal for early risk stratification and management. Effective management of hypertensive pregnancies requires early identification and individualised monitoring, recognising that chronic hypertension and pregnancy-induced hypertension differ in onset and progression, but both pose significant risks to maternal and foetal health.

Hypertensive disorders of pregnancy are among the leading causes of maternal and neonatal morbidity and mortality worldwide. Labetalol and nifedipine are two of the most common oral antihypertensives used to manage these conditions; however, it is not clear whether one medication may offer greater benefit to mothers and babies than the other. The aim of this study was to compare the risks of adverse maternal and neonatal outcomes for oral labetalol versus nifedipine among women with hypertension in pregnancy. This was a target trial emulation using linked data, including pregnancy episodes between January 1, 2009 and December 31, 2020 in Victoria, Australia. We included pregnant women with a hypertensive disorder (chronic hypertension, gestational hypertension, or preeclampsia) and prescribed oral labetalol or nifedipine between 11+0- and 36+6- weeks' gestation. Our co-primary outcomes were: 1) a composite of maternal mortality or serious morbidity; and 2) a composite of neonatal mortality or serious morbidity. All outcomes were assessed from first prescription until 28 days postpartum. Analyses used a doubly robust inverse probability-weighted regression adjustment (IPWRA) model and are reported as adjusted risk ratios (aRR) and risk differences (aRD) with 95% confidence intervals (95% CI). Analyses were based on intention-to-treat approach. 7416 pregnancies were eligible for inclusion. Of these, 6745 (91.0%) pregnancies received labetalol as a first-line treatment and 671 (9.0%) received nifedipine. After adjusting for confounding factors, nifedipine was associated with a 33% increased risk of the composite maternal outcome (6.6% versus 9.4%; aRR 1.33, 95% CI 1.07, 1.64), and no difference in the risk of the composite neonatal outcome (43.0% versus 46.1%; aRR 0.97, 95% CI 0.89, 1.06). This was largely driven by increased rates of eclampsia (1.6% versus 3.0%), haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome (3.0% versus 4.3%), and renal failure (1.0% versus 1.5%) in the nifedipine group. Among secondary outcomes, nifedipine use was associated with an increased risk of iatrogenic preterm birth and need for additional antihypertensives. Among women with hypertension in pregnancy, nifedipine was associated with an increased risk of poor maternal outcomes and iatrogenic preterm birth when compared with labetalol. Labetalol may have a better safety profile as a first-line therapy for pregnant women with hypertension. Future clinical trials are required to validate these findings. This work was supported by a Trevor B Kilvington Bequest, awarded by the University of Melbourne.

Primary care after pregnancy allows for cardiovascular risk factor modification amidst rising rates of cardiometabolic complications in pregnancy. However, postpartum primary care utilization is understudied, with few national studies among the privately insured. In response to updated professional guidelines and expanded insurance access, we conducted a nationally representative, multipayer study among privately and publicly insured individuals with cardiometabolic complications to explore primary care utilization after pregnancy. Using Medical Expenditure Panel Survey (MEPS) data from 2016 to 2022, we conducted a retrospective cohort study examining primary care and other health care utilization (obstetrics/gynecology [OB/GYN], emergency room [ER], hospitalizations) after pregnancy among individuals with hypertension, pregestational diabetes, or gestational diabetes, which we collectively defined as "medically complicated pregnancy." We used multivariable regression models to test for differences among individuals with medically complicated and uncomplicated pregnancy. Among 696 postpartum individuals, 13% had a medically complicated pregnancy. In the 1 year after pregnancy, 33.3% had one or more primary care visits and 58.2% had any OB/GYN visits. Individuals with medically complicated pregnancies had a significantly higher number of ER visits by .2 visit (95% confidence interval [.1, .3]); there were no other significant differences in primary care or other health care utilization in the postpartum year. Primary care utilization in the year after pregnancy remains suboptimal, even among individuals with medically complicated pregnancy. These findings highlight a key missed opportunity after pregnancy for cardiovascular risk factor modification and underscore the need for interventions aimed at improving postpartum transitions to primary care.

Management of chronic hypertension in pregnancy remains uncertain, and current guidelines do not address whether the prognostic significance of blood pressure (BP) varies across gestation. To evaluate gestational age-specific associations between maternal BP in the first half of pregnancy and adverse maternal and neonatal outcomes. We conducted a multicenter registry-based cohort study from April 2022 to March 2023 at 65 tertiary referral centers in Japan. A total of 273 women with chronic hypertension and singleton pregnancies were enrolled before 14 weeks' gestation (median age, 37 years; IQR, 34-40). Systolic and diastolic BP were assessed at three gestational windows (8-9, 10-13, and 14-18 weeks). Aspirin exposure was treated as time-dependent. The primary outcome was a composite of adverse maternal and neonatal events. Cox proportional hazards models and restricted cubic spline analyses were used. Adverse outcomes occurred in 32.6% (89/273). BP-risk associations differed by timing. No association was observed at 8-9 weeks. At 10-13 weeks, risk increased progressively with higher systolic BP, including excess risk in the moderate range (120-134 mmHg) and the highest risk at ≥135 mmHg (HR, 4.11; 95% CI, 1.14-14.82). At 14-18 weeks, a threshold pattern emerged, with increased risk above 140 mmHg (HR, 2.19; 95% CI, 1.40-3.43). Associations were weaker among women who initiated aspirin before 10 weeks, although interaction was not statistically significant. In chronic hypertension, maternal BP during 10-13 weeks of gestation carries heightened prognostic relevance. These findings support gestational age-specific risk assessment and motivate evaluation of early preventive strategies.

Hypertension can be both a cause and a consequence of preeclampsia, complicating diagnosis and postpartum management. Placental histopathology has been proposed as a tool to distinguish preeclampsia superimposed on chronic hypertension from de-novo disease, yet specific and reliable markers remain poorly defined. To evaluate the association between placental histological features and preexisting hypertension in a cohort of patients who developed preeclampsia. We conducted a retrospective analysis of 321 preeclamptic pregnancies at a tertiary center between January 1, 2020, and October 31, 2023. Preexisting hypertension was defined as the use of antihypertensive medication at the beginning of pregnancy. Placental histopathological evaluation was available for 223 patients. Histological lesions were classified according to established guidelines, with a focus on maternal vascular malperfusion features. Associations between placental lesions and preexisting hypertension were assessed using univariate and multivariate analyses. The absence of placental infarction (47.4 vs. 61.1%, P&#x200a;=&#x200a;0.02) and the presence of decidual arteriopathy (31.6 vs. 16.8%, P&#x200a;=&#x200a;0.03) were significantly associated with preexisting hypertension. The combination of these two features was independently associated with preexisting hypertension (odds ratio&#x200a;=&#x200a;5.90; 95% confidence interval 1.88-18.60; P&#x200a;<&#x200a;0.01). This pattern demonstrated high specificity (96.2%) but low sensitivity (18.4%) for identifying preexisting hypertension. The presence of decidual arteriopathy in the absence of placental infarction is strongly associated with preexisting hypertension in preeclamptic patients. Although its low sensitivity limits its use as a screening tool, its high specificity suggests that it may serve as a useful indicator of underlying chronic hypertension when present. These findings support the potential role of placental histopathology as an adjunct to clinical evaluation in the postpartum assessment of hypertensive disorders.

Postpartum hypertension (HTN) clinics may improve cardiovascular (CV) prevention care for individuals with hypertensive disorders of pregnancy (HDPs) at an increased risk of CV disease. This study compares rates of CV screening and engagement in postpartum care between postpartum HTN clinic attendees and nonattendees. We compiled a retrospective cohort of patients with HDP who participated in remote blood pressure (BP) monitoring and remained hypertensive at 6 weeks postpartum. Our exposure was attending a postpartum HTN clinic within 1 year of delivery. We compared outcomes (1-year completion rates of outpatient BP ascertainment, lipid screening, hemoglobin A1c [HbA1c], and primary care physician [PCP] follow-up) using multivariate logistic regression adjusting for relevant demographic and clinical covariates. Among 2,816 patients with HDP and persistent hypertension at 6 weeks postpartum, 7.6% (n = 213) had a clinic visit. Clinic attendees were more likely to be self-identified Black race (31.0% vs 20.9%; P = 0.004) and have chronic HTN (20.1% vs 13.3%; P = 0.008) or superimposed preeclampsia (5.5% vs 2.2%; P = 0.003). In adjusted analyses, for every 100 patients seen in clinic, there were 10.7 more BPs recorded (95% CI: 4.1-17.3), 26.8 more lipid panels (20.3-33.3), 22.5 more HbA1c screenings (16.4-28.7), and 10.8 more PCP follow-ups (3.9-17.6) for clinic attendees compared with non-attendees. Attendees at a postpartum HTN clinic had higher rates of CV risk factor screening, including lipid, HbA1c, and BP ascertainment, and PCP follow-up. These results demonstrate the importance of increasing access to postpartum HTN clinics to manage CV risk after HDP.

Severe hypertension (HTN) during pregnancy is highly associated with adverse perinatal outcomes, yet many cases occur in outpatient settings where standardized management is lacking. We used a community-engaged approach to adapt an evidence-based inpatient HTN bundle for outpatient care, creating the Outpatient HTN (O-HTN) Bundle. This study aimed to evaluate the feasibility, acceptability, and impact of three implementation strategies (1) identifying and preparing champions, (2) providing ongoing training, and (3) simulation. We conducted a pre-post pilot study in three Federally Qualified Health Centers (FQHCs) from 9/2021-6/2022. Multidisciplinary clinical teams comprised of a medical assistant, nurse, provider (midwife or physician), and pharmacy staff received training on the O-HTN Bundle and participated in pre- and post-training simulations. Simulations involved a patient actor presenting with severe HTN during a prenatal visit. Trained observers used a checklist to evaluate clinical team fidelity to the O-HTN Bundle algorithm. Observers, clinical team members, and the patient actor assessed provision of respectful care via a Respectful Care Reflection Tool. The primary outcome was fidelity to the O-HTN Bundle; secondary outcomes included respectful care and feasibility and acceptability of the implementation strategies. Feasibility was defined by engagement in trainings/simulations. Acceptability was assessed with a study-specific survey. Paired t-tests compared fidelity and respectful care scores pre- and post-training. Descriptive statistics summarized acceptability and feasibility data. The implementation strategies were feasible; 19 clinical teams participated, representing 59% of all prenatal providers across the three FQHCs. All 19 teams participated in the O-HTN Bundle training and pre- and post-training simulations. The strategies were also effective: mean fidelity scores improved from 78% pre-training to 95% post-training (p&#x2009;=&#x2009;0.006). Significant gains were made on severe HTN identification, treatment, and escalation to higher level of care. Respectful care scores also improved, though not significantly. Survey results indicated acceptability of the training and simulation model. In this pilot study, clinic champions, training, and simulation were feasible, acceptable, and effective strategies to improve fidelity to the O-HTN Bundle and thus response to severe HTN in pregnancy. These findings support broader implementation of the O-HTN Bundle.

Pregnancy complications pose a major hazard to maternal and fetal health and increase the global burden of disease. Phthalates are extensively encountered by pregnant women. To estimate associations of individual phthalate or mixture exposure in early pregnancy with pregnancy complications, a nested case-control study was conducted, in which cases with gestational diabetes mellitus (GDM), gestational hypertension (PIH), premature rupture of membranes (PROM), placental abnormality (PA), intrauterine distress (IUD), insufficient amniotic fluid (IAF), anemia and preterm birth (PB) were matched with controls by fetal sex, maternal age, sampling year and season, and measured urinary phthalate metabolites in the first trimester. Conditional logistic regression and quantile g-computation models were employed to assess associations of individual phthalate and mixture exposure with pregnancy complications. The conditional logistic regression revealed that certain phthalate exposure in early pregnancy was notably associated with higher risks of pregnancy complications, especially GDM, PIH, and IAF. For example, compared with the 1st tertile, the 2nd and 3rd tertiles of exposure were significantly associated with elevated odds of GDM, PIH, and IAF, with ORs of 1.40-1.76 and 1.38-2.98, 1.41-1.67 and 1.36-2.05, and 2.17-3.17 and 1.97-2.54, respectively. Moreover, these associations varied by fetal sex. Additionally, quantile g-computation models showed that phthalate mixture exposure was significantly associated with elevated ORs of GDM (OR = 1.32; 95% CI: 1.09, 1.74), PIH (OR = 1.49; 95% CI: 1.04, 1.78), and IAF (OR = 1.73; 1.06, 2.47). MBP and DEHP metabolites were likely the major contributors to the joint effects. Prenatal phthalate exposure during early pregnancy may serve as a potential risk factor for pregnancy complications. Further studies are essential to validate these findings.

Observational studies have suggested that a younger age at menarche is associated with increased risks of adverse pregnancy and perinatal outcomes. However, it is unclear whether these relationships are causal. We estimated the associations between age at menarche and 13 pre-specified pregnancy outcomes by using two approaches. We estimated observational associations in the Avon Longitudinal Study of Parents and Children (N&#x2009;=&#x2009;9441) using multivariable regression accounting for educational attainment, ethnicity, maternal age, parity, offspring sex, and adiposity. We conducted two-sample Mendelian randomization (MR) using data from the Mendelian Randomization in Pregnancy (MR-PREG) collaboration (77&#x2009;683-707&#x2009;797 pregnancies) and multivariable MR (MVMR) accounting for genetically-proxied adiposity. Older age at menarche was associated with lower risks of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia, but accounting for adiposity attenuated these effects across approaches. For example, per 1-year older age at menarche, the odds ratio (OR) for hypertensive disorders of pregnancy was 0.88 (95% confidence interval (CI) : 0.84, 0.93) in inverse variance weighted MR and 0.95 (95% CI: 0.90, 1.01) in MVMR, while the observational association attenuated from OR&#x2009;=&#x2009;0.91 (95% CI: 0.87, 0.94) to OR&#x2009;=&#x2009;0.97 (95% CI: 0.93, 1.01). No clear evidence was found for the effects of age at menarche on small-for-gestational-age, low birthweight, post-term birth, or perinatal depression from either approach. For other outcomes evidence was limited by imprecision (very preterm birth, gestational diabetes) or inconsistent effects in sensitivity analyses (offspring birthweight, large-for-gestational-age, high birthweight, preterm birth). We find little robust evidence for causal effects of age at menarche on pregnancy outcomes. Effects of younger menarche on increased risks of hypertensive disorders of pregnancy may be driven by adiposity.

The purpose of this review is to describe the intersection between pediatric hypertension and advancing stages of cardiovascular, kidney metabolic syndrome in children and adolescents. Cardiovascular-kidney-metabolic syndrome is highly prevalent in the pediatric population. The onset of CKM in childhood is influenced by the presence of antenatal risk factors such as maternal hypertensive disorders of pregnancy. Advancing stages of CKM in children and adolescents are strongly influenced by food insecurity and social determinants of health that impact the risk for childhood obesity. Activation of the renin-angiotensin-aldosterone system is a key mediator in the relationship between antenatal risk, early life course exposure and hypertension in children and adolescents. Effective strategies for slowing the rate of advancement of CKM staging in children and adolescents require attention to early course factors that influence the development of hypertension and obesity. Likewise, management strategies and therapeutic interventions that address these factors are critical to mitigating CKM stage advancement. Although hypertension is a component of the CKM framework, the presence of hypertension in children and adolescents drives higher CKM staging. Together, hypertension and higher CKM staging are associated with increased atherosclerotic cardiovascular disease risk. Social factors, including access to healthy foods and attention to early life course nutrition are critical strategies to improving CKM and hypertension related outcomes in children and adolescents.

Cardiometabolic health across the reproductive lifespan is a critical determinant of short-term pregnancy outcomes and long-term cardiovascular risk for both mother and offspring. Pregnancy serves as a unique physiological stress test and a key opportunity for primordial and primary prevention. Cardiometabolic risk factors-including hypertension, dyslipidemia, obesity, and hyperglycemia-are strongly associated with adverse pregnancy outcomes, such as hypertensive disorders of pregnancy and gestational diabetes, which confer substantial lifelong cardiovascular risk. This review provides a clinically actionable framework for optimizing cardiometabolic health before, during, and after pregnancy. We highlight evidence-based strategies for risk factor modification, including blood pressure control, glycemic management, lipid optimization, nutrition, physical activity, sleep health, and substance cessation, while addressing physiologic adaptations, therapeutic limitations, and care fragmentation. Emphasis is placed on multidisciplinary, life-course approaches and integration of emerging care models. Bridging gaps across preconception, pregnancy, and postpartum care is essential to improving maternal outcomes and long-term cardiovascular health.

Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without an identifiable cause and typically presents with headache, papilledema, and transient visual obscurations (TVOs). Fulminant IIH is a rare, rapidly progressive subtype that can lead to permanent visual loss. Although visual field defects are common in IIH, bitemporal hemianopia is an uncommon and diagnostically challenging presentation that may initially suggest chiasmal compression. A 29-year-old woman with no significant medical history presented with two weeks of progressive peripheral visual loss, headache, dizziness, and gait imbalance. Examination revealed bitemporal hemianopia and severe papilledema. She was subsequently found to be in the very early stages of pregnancy. Urgent neuroimaging revealed radiological signs of increased intracranial pressure, without evidence of a chiasmal or sellar mass. Lumbar puncture confirmed markedly elevated opening pressure (>40 cmH&#x2082;O) with normal cerebrospinal fluid (CSF) composition. She underwent serial CSF drainage, received acetazolamide, and subsequently required ventriculoperitoneal shunt insertion, resulting in significant improvement in visual and gait symptoms. This case demonstrates an atypical presentation of fulminant IIH, where bitemporal hemianopia, which is typically associated with chiasmal lesions, occurred secondary to severe papilledema rather than structural compression. Although rare in IIH, such visual field patterns necessitate prompt differentiation from chiasmal pathology. Rapid diagnosis and early intervention are crucial for preventing irreversible visual loss in fulminant IIH. The patient's pregnancy raises the possibility that it may have precipitated the development of fulminant IIH.

The postpartum period represents a critical window for women with pulmonary arterial hypertension (PAH), who face substantial risks of severe complications. However, effective biomarkers for postpartum risk stratification remain scarce. Secreted phosphoprotein 1 (SPP1), a key mediator of vascular remodeling and inflammation, may serve as a potential predictor in this context. Differential expression of SPP1 was validated using sequencing data from PAH patients. Plasma SPP1 concentrations were measured in an independent clinical cohort by ELISA. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of SPP1 alone and in combination with clinical parameters for postpartum adverse outcomes. SPP1 expression was markedly upregulated in PAH patients. Postpartum adverse events were observed in 21 participants (34.4&#xa0;%). Plasma SPP1 levels were significantly higher in the PAH group than in controls (49.16 vs. 22.69&#xa0;ng/mL, p&#xa0;<&#xa0;0.001) and in patients with adverse events compared to those without (63.56 vs. 39.61&#xa0;ng/mL, p&#xa0;<&#xa0;0.001). Elevated SPP1 concentrations correlated with disease severity (p&#xa0;=&#xa0;0.0102). Incorporating SPP1 with clinical indicators such as BNP, NYHA class, and SPAP improved predictive accuracy (AUC&#xa0;=&#xa0;0.761) compared with clinical markers alone (AUC&#xa0;=&#xa0;0.698). Increased SPP1 levels are associated with heightened postpartum risk in women with PAH. Combining SPP1 with conventional clinical measures enhances prognostic performance and may provide a valuable tool for individualized postpartum risk assessment and management.

Budd-Chiari syndrome (BCS) is a rare hepatic vascular disorder frequently associated with prothrombotic conditions such as myeloproliferative neoplasms. Pregnancy and assisted reproductive technologies further increase thrombotic and portal-hypertensive risk. We report a successful in vitro fertilization-conceived pregnancy in a 35-year-old woman with chronic BCS secondary to JAK2-positive polycythemia vera. The pregnancy was complicated by ovarian hyperstimulation syndrome and severe intrahepatic cholestasis of pregnancy. Progressive portal hypertension with worsening esophageal varices prompted planned preterm delivery at 34 weeks' gestation. A multidisciplinary team performed cesarean delivery under epidural anesthesia with prophylactic perioperative terlipressin administration and thromboprophylaxis. Maternal and neonatal outcomes were favorable. With careful multidisciplinary management, pregnancy in women with stable BCS is feasible.

We evaluated associations between untreated mild hyperglycemia and hypertensive disorders of pregnancy. In this retrospective study at a US academic medical center practicing universal 2-step gestational diabetes (GD) testing, we defined normal glucose tolerance as a normal screening 50-g, 1-hour glucose load test (<140&#x2009;mg/dL). If the glucose loading test was abnormal, a diagnostic 100-g, 3-hour oral glucose tolerance test was performed. We defined GD as &#x2265;2 abnormal oral glucose tolerance test values (Carpenter-Coustan criteria) and gestational glucose intolerance (GGI, untreated subclinical hyperglycemia) as 0 (GGI-0) or 1 (GGI-1) abnormal oral glucose tolerance test value. We divided GD into treated and untreated (given use of older diagnostic criteria in the study period). We examined associations between GGI or GD and hypertensive disorders of pregnancy (primary outcome) or its subtypes (gestational hypertension, preeclampsia) using generalized estimating equations with confounder adjustment. Among 41&#x2009;484 pregnancies, 84% had normal glucose tolerance, 12% had GGI (GGI-0: 9.0%, GGI-1: 3.0%) and 3.5% had GD. There was greater risk of hypertensive disorders of pregnancy in GGI compared with normal glucose tolerance (adjusted odds ratio [aOR], 1.24 [95% CI, 1.11-1.38]). This was attributable to increased risk in GGI-1 (aOR, 1.53 [95% CI, 1.27-1.85]), similar to untreated GD (aOR, 1.76 [95% CI, 1.37-2.26]). The risk of gestational hypertension was increased in GGI-1 (aOR, 1.66 [95% CI, 1.30-2.12]) and untreated GD (aOR, 1.89 [95% CI, 1.36-2.63]) but not in treated GD (aOR, 0.84 [95% CI, 0.58-1.23). The risk of preeclampsia was similarly increased in GGI-1, treated GD, and untreated GD (aOR, 1.46-1.75). Mild untreated hyperglycemia in pregnancy is associated with hypertensive disorders of pregnancy; hyperglycemia treatment is associated with reduced gestational hypertension risk.

Women display retinal vessel caliber abnormalities after hypertensive pregnancy, but whether these predate or reflect vascular aging is unknown. Retinal imaging was performed in 2 cohorts: 196 women at 6 to 12 months postpartum (167 hypertensive, 29 normotensive), and 105 women at 15 to 25 years postpartum (64 hypertensive, 41 normotensive), using identical imaging/analysis protocols (Imedos Health, GmbH). Central retinal arteriolar and venular equivalents were calculated, corrected for mean arterial pressure at the time of imaging, and compared across hypertensive and normotensive pregnancy groups using multivariable linear regression models adjusted for body mass index and time postpartum. Z tests were used to compare effect sizes across time points. At both time points, corrected central retinal arteriolar and venular equivalents were lower after hypertensive pregnancies compared with normotensive pregnancies (P<0.001). Between-group differences were larger at 6 to 12 months than 15 to 25 years postpartum for both arteriolar (&#x3b2;=-0.53 versus -0.15; Z=-4.19; P<0.001) and venular calibers (&#x3b2;=-0.50 versus &#x3b2;=-0.18, Z=-3.83; P<0.001), consistent with age-related reductions after normotensive pregnancy. Arteriovenous ratio was significantly different at 6 to 12 months postpartum (P<0.001), but not at 15 to 25 years postpartum. Differences were not explained by blood pressure at the time of imaging, but 6 to 12 months postpartum, related to early pregnancy blood pressure (&#x3b2;=0.01; P<0.001). Hypertensive pregnancy is associated with retinal vessel changes up to 25 years postpartum that predate age-related reductions and are associated with early pregnancy blood pressure. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04273854 and NCT05434195.

Hypertensive disorders of pregnancy (HDP) are associated with elevated long-term risks of cerebrovascular disease. Emerging data suggest a link between HDP and dementia, potentially mediated by cerebral small vessel disease. We aimed to evaluate whether women with a history of HDP have more cerebral small vessel disease compared with women without HDP. This retrospective cohort study included 1602 women from the Utah Population Database who underwent brain magnetic resonance imaging after their index pregnancy. Magnetic resonance imaging scans were evaluated for white matter hyperintensities, remote brain infarctions, cerebral microhemorrhages, enlarged perivascular spaces, acute infarction, and cerebral volume loss. Multivariable regression models assessed the association between HDP and imaging findings, adjusting for confounding factors. Interrater reliability was evaluated using Cohen's kappa. Women with a history of HDP had higher white matter hyperintensities burden (adjusted mean difference, 0.57 [95% CI, 0.25-0.90]; P=0.001), more total remote brain infarctions (adjusted mean difference, 0.11 [95% CI, 0.00-0.21]; P=0.05) and enlarged perivascular spaces (adjusted mean difference, 0.14 [95% CI, 0.01-0.27]; P=0.03) compared with women without an HDP history. No significant differences were found in microhemorrhages or cerebral volume loss. Subgroup analysis revealed stronger associations between HDP and cerebral small vessel disease markers among women without history of midlife hypertension or stroke, and those in the earlier index pregnancy cohort; though, effect modification was not statistically significant (all Wald interaction tests P>0.10). Interrater agreement was high across imaging measures (weighted kappa range: 0.89-1.00). Women with prior HDP show greater imaging evidence of cerebral microvascular injury decades after pregnancy, supporting HDP as a risk factor for later-life cerebrovascular health.

Hyperemesis gravidarum (HG)-severe nausea and vomiting during pregnancy-affects 1-3% of pregnancies and is the leading cause of early pregnancy hospitalization. Significant maternal undernutrition in HG pregnancy is hypothesized to lead to abnormal placental development and function, resulting in higher risk for select adverse pregnancy outcomes (APOs). Population data investigating this association are largely from Europe; the only prior US population-based study (1999) did not adjust for confounding. We evaluated the association between HG and APOs in a US population-based cohort of 2.5 million singleton live births in California (2007-2011). We defined HG based on primary diagnosis codes present in prenatal hospitalization or emergency department records (n&#xa0;=&#xa0;53&#x2009;681; 2.2%). After adjusting for confounders, HG was associated with higher risks of preeclampsia (aRR 1.18, 95% CI 1.13-1.23), gestational hypertension (1.15, 1.09-1.22), preterm birth (1.25, 1.22-1.29), small for gestational age (1.19, 1.16-1.22), placental abruption (1.14, 1.05-1.25), and anemia (1.37, 1.33-1.40). Risks were generally higher among women with first HG hospitalization in the second trimester (eg, preeclampsia: 1.41, 1.30-1.52), and elevated risks were observed across nearly all strata examined. In this large US population-based cohort, HG was associated with increased risk of multiple APOs.

To compare adverse pregnancy outcomes (APOs) between subtypes of hypertensive disorders of pregnancy (HDP). Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012-2022. HDP was classified into four subtypes: preeclampsia-eclampsia (PE), chronic hypertension (CH), chronic hypertension with superimposed preeclampsia (CHSP), and gestational hypertension (GH). Pearson's chi-square tests were used to determine if there were significant differences in the prevalence of APOs between HDP subtypes. A total of 780,359 pregnant women were included, and 38,397 HDPs were identified, including 17,782 PEs (46.31%), 15,889 GHs (41.38%), 3,340 CHs (8.70%), and 1,386 CHSPs (3.61%). The overall prevalence of APOs among pregnant women with HDP was as follows: anemia (30.78%), diabetes mellitus (20.33%), preterm birth (19.53%), low birthweight (18.74%), hemorrhage disorder (9.07%), infection (4.71%), liver disease (2.55%), stillbirth and neonatal death (2.38%), maternal near-miss (1.57%), kidney disease (0.98%), heart disease (0.65%), pulmonary disease (0.11%), embolism (0.03%), and maternal death (0.02%). There were significant differences in the prevalence of all APOs between HDP subtypes, except for pulmonary disease, embolism, and maternal death (p&#x202f;<&#x202f;0.05). Compared with other subtypes, anemia was more common in PE (32.97%), diabetes mellitus was more common in CH (25.27%) and CHSP (25.11%), preterm birth was more common in CHSP (37.01%) and PE (27.76%), low birthweight was more common in CHSP (31.39%) and PE (27.72%), hemorrhage disorder was more common in PE (9.86%), infection was more common in PE (5.20%) and CHSP (5.05%) than other subtypes; liver disease was more common in CHSP (4.11%), stillbirth and neonatal death were more common in CHSP (6.64%) and PE (3.18%), maternal near-miss was more common in PE (2.47%) and CHSP (2.31%), kidney disease was more common in CHSP (3.97%) and CH (1.44%), heart disease was more common in CHSP (1.15%) and CH (0.96%). Most APOs were more common in both CHSP and PE than other subtypes, including preterm birth, low birthweight, infection, stillbirth and neonatal death, and maternal near-miss; diabetes mellitus, liver disease, kidney disease, and heart disease were common in CHSP but not PE; anemia and hemorrhage disorder were common in PE but not CHSP; diabetes mellitus, kidney disease and heart disease were common in CH. Our finding is useful for clinical counseling and future in-depth studies.