I have been appointed as new president of Japan Society of the Study of Hypertension in Pregnancy (JSSHP) on December 24, 2021. It’s truly an honor and privilege to serve as the president of this vibrant and growing organization.

In 1980, the first congress on toxemia of pregnancy in Japan was held in Tokyo with Dr. Masakuni Suzuki and Dr. Hiroshi Furuya as facilitators, and laid the foundation of this society. Later, in 1993, the society was renamed Japan Society for the Study of Toxemia of Pregnancy, and then to JSSHP in 2004. In 2017, English notation of “pregnancyinduced hypertension”was altered to hypertensive disorders of pregnancy (HDP) and subsequently, the definition and the classification were revised in 2018. In 2019, with the effort of former President Hiroyuki Seki, the Society had begun a new step as a general incorporated association and now, for the first time in its long history, a physician is going to serve as the president of this society.

HDP had been mainly managed by obstetricians, but recent advances in pathologic clarification and expanding medical needs have broaden the scope of this disease. Specific examples include the growing interest in HDP prevention (preconception care / interconception care) and prognosis (increased risk of cerebrocardiovascular events in women who had experienced HDP). Obstetricians still serve as the center of the medical care, but overtime, team-based care with physicians and medical staff is gaining even more relevance.

On the other hand, from a social point of view, since the heightened awareness of diversity and inclusion has made women to play a greater role in society, the proportion of women having health problems before pregnancy is increasing. The addition of chronic hypertension to the HDP classification also makes it easier for us to predict that the number of pregnant women diagnosed with HDP will increase in the future. In addition, the recent expansion of SNS and advances in IoT have given the medical community the mission of utilizing online and AI. We must start considering how to apply online and AI also in HDP medical care. Furthermore, from the COVID-19 pandemic, we realized that problem that happened in one country spreads all over the world in a flash. In order to prevent and control diseases, it is mandatory to cooperate internationally. At the same time, the new normal lifestyle brought about by the COVID-19 pandemic reminded us of the value of life events such as pregnancy and childbirth. It is inevitable that public interest in HDP will increase further in the future.

In order for JSSHP to keep on developing and improving, it is necessary for us to appropriately respond to these issues and to reform in response to the needs of society. I sincerely hope for JSSHP to steadily move forward by gathering our strengths.

Dear members,

From this year, I was appointed as the editorial chairman as the successor to chairman Satoru Takeda. At the time of publication in 2013, I remember having a lot of discussions with the editorial office and struggling to decide on the format and peer review systems.

At the beginning, not enough papers were collected, and with the cooperation of the members, the publication of two volumes a year were maintained. Since last year, it has been published only online, and the number of publications has increased to four volumes a year. In this way, thanks to everyone’s help, the significance of the existence of this journal has been established.

In 2022, we will feature the guidelines as a special issue, and hope that it will be useful as an opportunity to disseminate the JSSHP guidelines to the world.

We are looking forward to many submissions from our members.

All the best.

Board Members:

Atsuhiro Ichihara (Chairperson of the Executive Board)

Mineo Yamazaki (Vice Chairperson of the Executive Board, General Affairs Committee, System Reconstruction Committee)

Tomoaki Ikeda (Publicity Committee)

Keizo Kanasaki (Scientific Program Committee, System Reconstruction Committee)

Eiji Kondoh (System Reconstruction Committee)

Shintaro Makino (Editorial Committee)

Keiichi Matsubara (Clinical Guideline Development Committee)

Atsuko Murashima (Ideal JSSHP committee)

Takeshi Nagamatsu (Editorial Committee, Publicity Committee)

Osamu Nakamoto (Scientific Program Committee, Ideal JSSHP committee)

Katsuhiko Naruse (Editorial Committee, Public Relations Committee: Overseas)

Tomoyoshi Nohira (Editorial Committee)

Akihide Ohkuchi (Scientific Program Committee)

Akihiko Sekizawa (Treasurer, Public Relations Committee: Domestic)

Yusuke Suzuki (System Reconstruction Committee)

Kanji Tanaka (Clinical Guideline Development Committee, Publicity Committee)

Kazushi Watanabe (General Affairs Committee, Scientific Program Committee)

Auditors and Supervisors:

Shigeru Saito, Hiroyuki Seki

Secretary Members:

Kazuya Mimura (Secretary General),

Ikuno Kawabata (Vice Secretary General), Asako Mito (Vice Secretary General)

Kanako Bokuda, Takayuki Iriyama, Keiko Koide, Shintaro Maki, Shigetaka Matsunaga, Sakiko Nanjyo, Maika Oishi, Hirotada Suzuki, Jun Takeda, Takafumi Ushida, Munekage Yamaguchi

Delegates:

Fumihisa Chishima, Keiya Fujimori, Hiromi Hamada, Hironobu Hyodo, Atsuhiro Ichihara, Tomoaki Ikeda, Kazuhiko Ino, Takayuki Iriyama, Keisuke Ishii, Atsuo Itakura, Yoshimasa Kamei, Masato Kamitomo, Keizo Kanasaki, Kayoko Kaneko, Kiyoko Kato, Ikuno Kawabata, Gen Kobashi, Kaori Koga, Keiko Koide, Eiji Kondoh, Tomoyuki Kuwata, Kazutoshi Maeda, Shintaro Makino, Keiichi Matsubara, Hideyoshi Matsumura, Shigetaka Matsunaga, Hirohito Metoki, Kazuya Mimura, Asako Mito, Kiyonori Miura, Naoyuki Miyasaka, Mamoru Morikawa, Hiroki Morita, Atsuko Murashima, Takeshi Nagamatsu, Katsutoshi Nakahata, Akitoshi Nakajima, Osamu Nakamoto, Sakiko Nanjyo, Katsuhiko Naruse, Tomoyoshi Nohira, Masaki Ogawa, Kazuhide Ogita, Hideaki Ohkuchi, Yasumasa Ohno, Maika Oishi, Ritsuko Pooh, Akihiko Sekizawa, Koichiro Shimoya, Junichi Sugawara, Takashi Sugiyama, Hirotada Suzuki, Shynji Suzuki, Yoshikatsu Suzuki, Yusuke Suzuki, Daisuke Tachibana, Nobuyuki Takahashi, Jun Takeda, Yoshiharu Takeda, Hiroaki Tanaka, Hiroyuki Tanaka, Kanji Tanaka, Shinji Tanigaki, Kenji Tanimura, Katsuo Terui, Takuji Tomimatsu, Kiyomi Tsukimori, Kazuko Uematsu, Takafumi Ushida, Kazushi Watanabe, Hideto Yamada, Mineo Yamazaki, Jun Yoshimatsu

Honorary Chairperson:

Kazuo Satoh

Honorary Advisors:

Matsuto Mochizuki, Yuusuke Sagara

Honorary Members:

Hirofumi Asakura, Katsuto Eguchi, Atsuo Hidaka, Yuji Hiramatsu, Tsuyomu Ikenoue, Keiichi Isaka, Masaharu Ito, Hidetaka Katabuchi, Takao Kobayashi, Hideaki Masuzaki, Hisanori Minakami, Yuji Murata, Masao Nakabayashi, Youichi Noda, Kunihiro Okamura, Norimasa Sagawa, Kenjiro Takagi, Satoru Takeda, Yuji Taketani, Tatsuo Yamamoto

Aim: This study aimed to clarify whether calcium administration has a therapeutic effect against cardiac arrest resulting from magnesium toxicity in pregnant or puerperal women, and to determine whether the body of evidence published to date suggests the need for a systematic review.

Methods: This review was guided by a specific methodological framework and Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews. Literature published up to September 24, 2020 was searched using the Medline database. Eligible articles included peer-reviewed studies in humans that prospectively or retrospectively evaluated the effects of calcium therapy on clinical outcomes and had an English abstract. Two reviewers independently screened the search results and extracted data from analyzed studies.

Results: Nineteen references were screened, and nine studies were analyzed. Five studies described maternal cardiac arrest or hypotension due to hypermagnesemia, and two studies described cardiac arrest in non-pregnant women due to hypermagnesemia. The remaining two articles were guidelines that described calcium administration for hypermagnesemia. We did not identify high-quality or large-sample studies which are needed to perform a systematic review.

Conclusions: The identified studies were insufficient to change existing recommendations. However, calcium administration may be considered for cardiac arrest associated with hypermagnesemia if ready to be performed during cardiopulmonary resuscitation.

Aim: The definition and classification of hypertensive disorders of pregnancy were revised in 2018. This study aimed to evaluate the degree to which the new definition (especially that of uteroplacental dysfunction) was accepted and understood by Japanese obstetricians for the two years immediately following the revision (2018–2020).

Methods: The scientific committee of the Japan Society for the Study of Hypertension in Pregnancy (JSSHP) surveyed the current state of the diagnosis and management of uteroplacental dysfunction in hypertensive disorders of pregnancy. An online, anonymous questionnaire was distributed to 625 JSSHP members via Research Electronic Data Capture (REDCap) software in February 2020.

Results: Valid responses were obtained from 147 obstetricians. In normal pregnancies, 75% of obstetricians measured fetal growth at each visit, and the frequency of uteroplacental dysfunction increased in the order of chronic hypertension, gestational hypertension, and preeclampsia. Approximately 70% of obstetricians accepted uteroplacental dysfunction as a preeclampsia diagnostic criterion. The majority included fetal growth restriction when diagnosing uteroplacental dysfunction, but there was wide variation among obstetricians who included findings other than FGR (such as abnormal umbilical artery Doppler flow and stillbirth). Although uteroplacental dysfunction was frequently the reason for admission, criteria for determining pregnancy termination varied widely.

Conclusions: In Japan, frequent ultrasonography is performed to diagnose uteroplacental dysfunction. Many obstetricians include uteroplacental dysfunction as a diagnostic criterion for preeclampsia, and these patients are carefully managed. However, there is wide variation in diagnostic criteria and management policies.

Aim: This study aimed to clarify outcomes of pregnancies in women with previous bariatric surgery (BS).

Methods: A national questionnaire was conducted targeting all 408 perinatal institutions in Japan. Reponses were obtained from 229 institutions, of which four reported a total of five singleton pregnancies and subsequent deliveries in women with previous BS in 2018. Outcomes of these women (BS group) were investigated.

Case presentations: One woman (20.0%) delivered without preeclampsia prior to undergoing BS. Among the five women, median maternal age was 36 years, and median interval between previous BS and conception was 28 months. Mean maternal body mass index decreased by 10.5 between BS and conception and increased by 4.57 between conception and delivery. Three women (60.0%) developed preeclampsia (hypertension and proteinuria), two women had chronic hypertension at conception that developed into superimposed preeclampsia, and one woman had new-onset preeclampsia. Three women (60.0%) had type 2 diabetes mellitus (including overt diabetes in pregnancy), and none had new-onset gestational diabetes mellitus. One woman had a preterm delivery at 32 gestational weeks via cesarean section due to abruptio placentae caused by preeclampsia. All five women gave birth to live appropriate-for-gestational age infants with no abnormalities.

Conclusion: The incidence of preeclampsia is high among pregnant women with previous BS who have diabetes mellitus at conception.