Hypertension in Pregnancy最新文献

Objective: Preeclampsia is a serious pregnancy complication associated with substantial maternal and infant morbidity worldwide. The adverse outcomes related to preeclampsia increase healthcare costs, highlighting the importance of quantifying its economic burden to inform healthcare policy and resource allocation. This systematic review aimed to synthesize evidence on the economic burden of preeclampsia and identify key cost drivers.

Methods: MEDLINE, PubMed, Web of Science, and the Cochrane Library were searched for English-language studies published between 2014 and 2024. Studies reporting healthcare resource utilization or costs associated with preeclampsia were included. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025650091).

Results: Of 3,107 records identified, 12 studies were included; most were conducted in high-income countries. All cost estimates were converted to 2024 US dollars for comparability. Direct medical costs ranged from US$109.84 to US$87,339.71, with a mean cost of US$33,585.48 per patient. National healthcare system costs were estimated at €6.5-€9.1 million in Ireland and US$2.18 billion in the United States.

Conclusion: Preterm birth was identified as a major driver of economic burden, with earlier gestational age significantly increasing maternal and infant costs. Indirect costs and regional disparities remain underexplored, highlighting important gaps for future research.

Gestational diabetes mellitus (GDM) poses a significant threat to perinatal health. Diagnosis based solely on glycemic parameters shows limited accuracy. The Systemic Immune-Inflammation Index (SII), a quantitative marker of inflammation, may improve diagnostic precision. This study analyzed clinical data stratified by GDM and obesity status to evaluate the diagnostic utility of SII and its underlying mechanisms involving placental NF-κB and 5-hydroxytryptamine (5-HT) signaling. We observed elevated SII levels in GDM patients, which correlated positively with glucose levels and inflammatory indicators (white blood cell count, fasting blood glucose, postprandial blood glucose). Logistic regression and receiver operating characteristic analyses confirmed the diagnostic value of SII, which was further enhanced when combined with clinical covariates. Placental expression of tryptophan hydroxylase 1 (TPH1) and NF-κB was significantly increased in GDM and closely linked to SII levels. Dysregulation of placental 5-HT signaling, characterized by increased TPH1 and monoamine oxidase A (MAO-A) expression alongside reduced serotonin transporter (SERT), was associated with maternal overweight. Moreover, SII, BMI, TPH1, and NF-κB all correlated with insulin resistance (IR). These results support SII as a non-invasive diagnostic indicator for GDM and highlight the role of placental 5-HT/NF-κB signaling in its pathogenesis, providing insights for early diagnosis and targeted therapy.

Objective: The systemic inflammatory response index (SIRI), a novel and integrated hematological index calculated as (neutrophil count × monocyte count)/lymphocyte count, has been recognized as a reliable marker of systemic inflammation. This article undertakes an analysis of clinical data from preeclampsia (PE) patients, aiming to comprehensively assess the relationship between SIRI, PE, and the severity of PE.

Methods: A total of 783 pregnant women in their third trimester were divided into severe preeclampsia (SP) (n = 275), non-SP (n = 273), and control (n = 235) groups. Pearson correlation analysis was performed to investigate the relationship between SIRI and blood pressure. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive ability of SIRI. Multivariate logistic regression analysis was used to assess the association between SIRI and the severity of PE.

Results: There was a significant relationship between SIRI and systolic blood pressure (r = 0.488, p < 0.001) as well as diastolic blood pressure (r = 0.462, p < 0.001). ROC curve revealed that pregnant women with SIRI ≥ 1.84 × 10⁹/L were more likely to experience non-SP (AUC: 0.662; 95% CI: 0.615-0.710; p < 0.001), and those with SIRI ≥ 2.45 × 10⁹/L were prone to SP (AUC: 0.879; 95% CI: 0.850-0.910; p < 0.001). Multivariate logistic regression analysis demonstrated that SIRI served as an independent risk factor for both non-SP and SP (p < 0.001).

Conclusion: There is a strong correlation between SIRI and the severity of PE, and SIRI shows potential in predicting the severity of PE.

Posterior reversible encephalopathy syndrome (PRES) is a neurological complication linked to preeclampsia and eclampsia. This study compared the clinical and radiological features of PRES in patients with these conditions. This retrospective single-center cohort study from 2010 to 2024 included patients diagnosed with preeclampsia and eclampsia who underwent MRI due to neurological symptoms. Two radiologists, blinded to the clinical data, re-evaluated the MRIs twice. PRES cases were assessed based on the sites and patterns of involvement. Maternal and perinatal outcomes, along with laboratory characteristics, were reviewed through medical records. The study included 157 patients with preeclampsia and eclampsia who underwent MRI for neurological symptoms. PRES was diagnosed in 55 patients (35.0%), with a higher incidence of eclampsia (64.71%) compared to preeclampsia (20.75%). Patients with PRES were younger, had lower gravidity and parity, and were at an earlier gestational age than those with normal MRI findings. The parietal and occipital regions were the most affected in both preeclampsia and eclampsia patients with PRES. Parietal lobe and bilateral involvement were more common in the eclampsia group. Atypical involvement, including brainstem and cerebellar lesions, was observed in both groups. These findings suggest that eclampsia may represent a neurological manifestation of PRES.

Objective: This study aimed to examine the associations between hypertensive disorders during pregnancy and intelligence quotient (IQ) in children at the ages of 8 and 16 years.

Methods: Our study sample comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, an ongoing population-based longitudinal birth cohort in Bristol, Avon, United Kingdom. Offspring IQ was assessed using a shortened version of the Wechsler Intelligence Scale for Children (WISC-III) at age 8 and the Wechsler Abbreviated Scale of Intelligence (WASI) at approximately age 16. This study included over 4900 and 3300 mother‒child pairs at ages 8 and 16, respectively. Binary and multinomial logistic regression models were used to estimate odds ratios and 95% confidence intervals for the associations.

Results: Hypertensive disorders of pregnancy were not associated with lower offspring IQ at ages 8 or 16. Although gestational hypertension, but not pre-eclampsia, was associated with higher odds of above-average IQ compared with average IQ at age 16 in the multinomial logistic regression model, this association was not observed at age 8 or replicated in the sensitivity analysis using age-specific IQ tertiles.

Conclusion: We found no evidence that hypertensive disorders of pregnancy were associated with lower offspring IQ at ages 8 or 16. Further studies are warranted to confirm these findings.

Objective: This study aimed to identify which subtypes of preeclampsia and fetal growth restriction (FGR) are associated with the greatest maternal cardiovascular strain, as indicated by laboratory biomarkers of cardiac dysfunction.

Methods: Women were recruited at diagnosis and serum levels of NT-proBNP, troponin T, and copeptin were analyzed. The cohort comprised 35 women with early-onset FGR, 54 with late-onset FGR, 53 with early-onset preeclampsia, and 29 with late-onset preeclampsia. Among preeclamptic patients, 58 had and 24 lacked concomitant FGR. Biomarkers were normalized for gestational age relative to uncomplicated pregnancies using Z-scores from log-transformed values.

Results: All biomarkers showed a consistent pattern across pregnancy pathologies. The highest Z-scores for NT-proBNP (2.70, p < 0.001) and troponin T (3.25, p < 0.001) were found in early-onset preeclampsia, followed by preeclampsia with and without FGR, with no significant difference between these subgroups. Lower values occurred in late-onset preeclampsia and early-onset FGR, with the lowest in late-onset FGR.

Conclusion: All forms of preeclampsia and early-onset FGR demonstrated increased cardiovascular strain, whereas late-onset FGR showed minimal involvement. In preeclampsia, earlier disease manifestation was more closely associated with higher cardiovascular burden than concomitant FGR. Although cardiomarkers were elevated in pathological pregnancies, their utility for routine monitoring or postpartum follow-up appears limited.

Objective: Early diagnosis of preeclampsia (PE) remains challenging. We previously linked the long non-coding (lnc) RNA MIR210HG to pathological placental development. Here, we investigated its differential expression, pathophysiological phenotypic specificity, and non-invasive diagnostic potential for PE in the peripheral blood and placental tissue.

Methods: We enrolled 88 PE patients (case group) and 81 normal pregnant women (control group) from the Affiliated Hospital of Qingdao University during January 2020-December 2021. MIR210HG expression was detected via RT-PCR and western blotting, and was modulated using siRNA/overexpression plasmid transfection in human trophoblasts and vascular endothelial cells.

Results: MIR210HG expression was specifically upregulated in the peripheral blood of patients with early-onset PE, with superior diagnostic efficacy for the PE-fetal growth restriction subtype. Additionally, CDHR5 was upregulated in PE-associated placental tissues (P = 0.004). Cellular assays confirmed that MIR210HG knockdown reduced CDHR5 expression in trophoblasts and endothelial cells (Bewo: P = 0.019; JEG3: P = 0.006), and CDHR5 knockdown also downregulated MIR210HG expression (Bewo: P = 0.023).

Conclusion: Therefore, MIR210HG may contribute to placental pathological injury by regulating CDHR5, though the pathogenic mechanism remains unclear. In contrast to the invasive and lagging placental-derived lncRNA biomarkers reported in previous studies, peripheral blood MIR210HG allows for non-invasive monitoring during pregnancy, making it more clinically applicable for early screening and phenotypic stratification of PE.

Objective: Hypertensive disorders of pregnancy (HDP) are a major cause of illness and death and it can be prevented.

Methods: We analysed Global Burden of Disease (GBD) 2023 estimates for maternal hypertensive disorders (ICD-10 O10-O16) in six locations (China, Japan, Democratic People's Republic of Korea [DPRK], Republic of Korea, Mongolia, and Taiwan [Province of China]) from 1990-2023 among women aged 20-54 years, reporting counts and age-standardised rates (per 100 000 population) for incidence, deaths and disability-adjusted life years (DALYs), and the maternal mortality ratio (MMR; per 100 000 live births), with 95% uncertainty intervals (UIs).

Results: In 2023, incident HDP cases were highest in China (654 396; 95% UI 446 312-949 988), while the age-standardised incidence rate peaked in Mongolia (419.03; 388.67-450.37). Mortality and disability burden were greatest in DPRK (age-standardised death rate 0.393; 0.184-0.749; DALY rate 25.73; 12.92-48.12; MMR 31.61; 13.23-60.86), followed by Mongolia, and lowest in Japan and the Republic of Korea. Across 1990-2023, rates declined markedly in all locations; for example, China's age-standardised death rate fell from 1.15 (0.82-1.57) to 0.03 (0.02-0.05) and its DALY rate from 80.08 (58.66-106.68) to 4.73 (3.04-6.87).

Conclusion: With the increasing proportion of advanced maternal age, we must optimize antenatal risk stratification, adopt context-appropriate prevention and treatment, strengthen emergency obstetric care, and establish systematic postpartum cardiovascular follow-up to reduce HDP incidence.

Objective: To quantify extracellular fluid expansion in preeclampsia using bioelectrical impedance analysis (BIA) and to evaluate whether BIA-derived extracellular water (ECW) indices are associated with perinatal outcomes.

Methods: In this prospective cohort study, 16 hospitalized women with high-risk pregnancies (7 with preeclampsia and 9 normotensive controls) underwent segmental BIA at a mean gestational age of 32 weeks. Total body water (TBW), intracellular water (ICW), ECW, and ECW/TBW were compared between groups. Fluid indices were additionally expressed as weight-adjusted and height-indexed measures. Associations between ECW/TBW and perinatal outcomes were reviewed and analyzed.

Results: Compared with normotensive controls, women with preeclampsia had higher TBW, ICW, ECW, and ECW/TBW (all p < 0.05), with consistent segmental elevations most prominent in the lower extremities. Weight adjustment eliminated between-group differences in absolute fluid volumes, whereas height-indexing preserved significant elevations across compartments (all p ≤ 0.002). In the overall high-risk cohort, higher ECW/TBW was associated with earlier gestational age at delivery and lower 1-minute Apgar scores (both p < 0.05).

Conclusion: Preeclampsia is characterized by measurable extracellular fluid expansion on bedside BIA. Elevated ECW/TBW is associated with adverse perinatal outcomes among hospitalized high-risk pregnancies, supporting the potential clinical utility of non-invasive fluid assessment for risk stratification in hypertensive disorders of pregnancy.