On behalf of the Editorial Team of Hypertension Research in Pregnancy, I am pleased to announce the Journal Awards for the Year 2016.
The aim of these Awards is to recognize papers published in 2016, both clinical and experimental studies, that were highly appreciated by the Editorial Team.
In the year of 2016, following paper has been selected for the Hypertension Research in Pregnancy Awards.
Maternal blood pressure before the onset of eclampsia and stroke during labor at term.
Shunji Suzuki, Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
Aim: We examined women complicated by stroke or eclampsia occurring in our institute during labor at term, with particular attention to changes in their blood pressure.
Methods: We identified all pregnant women who were hospitalized for labor and delivery between April 1, 2002, and November 30, 2015.
Results: During this period, there were 14 cases of eclampsia and 3 cases of stroke associated with hypertensive disorders of pregnancy. In 16 (94%) of these cases, systolic blood pressure was normal (<140 mmHg) at 3–7 days before admission for delivery at term. In 6 of these cases (35%), systolic blood pressure was normal (<140 mmHg) at admission. Severe hypertension (systolic blood pressure ≥160 mmHg) was observed immediately after the onset of eclampsia or stroke in all cases.
Conclusions: Regular measurement of blood pressure in all women during labor is important.
Aim: This study aimed to determine the normal range of the lectin-like oxidised LDL receptor (LOX) index during pregnancy and investigate whether the index can be used as a biomarker of maternal endothelial function.
Methods: We conducted a prospective pilot study consisting of 12 pregnant women without obstetric or medical complications and eight non-pregnant women at Kyoto University Hospital between March 2011 and March 2012. Endothelial function was evaluated by the reactive hyperaemia index (RHI) using Endo-PAT2000 in early, mid-, and late gestation. Plasma levels of soluble LOX-1 (sLOX-1) and LOX-1 ligand containing apolipoprotein B (LAB) in each gestation period were measured by ELISA. The LOX index was obtained by multiplying plasma levels of LAB with those of sLOX-1.
Results: The LOX index increased significantly as gestational age advanced. The LOX index, but not LAB or sLOX-1, was correlated with RHI in mid-gestation (R=0.3352, P=0.0486).
Conclusions: The LOX index during mid-gestation may be a useful biomarker of maternal endothelial function.
Aim: This study aimed to clarify the appropriate management of hypertensive disorders of pregnancy (HDP) and establish a long-term follow-up system for women with HDP after delivery. We investigated issues relating to HDP management approaches by evaluating blood pressure measurement at the time of medical examination, home blood pressure measurement (HBPM) penetration rate, timing of blood pressure measurement during labor, and follow-up procedures after delivery in women with HDP.
Methods: We distributed questionnaire forms on blood pressure management during pregnancy, at delivery, and after delivery to obstetrics and gynecology departments of 52 professional medical institutions in Aomori prefecture, Japan, in 2013.
Results: We retrieved completed questionnaires from 52 institutions and analyzed responses from 39 institutions. Some institutions responded that antihypertensive medication was administered for mild hypertension (140/90 mmHg); these institutions had a lower target blood pressure. Only 56% of institutions measured blood pressure after the onset of labor pains. Postpartum follow-up was carried out not only by obstetric and gynecologic clinics, but also by many institutions. However, sufficient education on the risk of recurrence in subsequent pregnancy and lifestyle guidance were not provided.
Conclusions: There is little consensus on the timing of initiating antihypertensive medication, or appropriate levels of blood pressure control. Labor-onset hypertension might have been overlooked. Short-term follow-up of women with HDP was frequently carried out, whereas long-term follow-up was not. We will continue to investigate the appropriate follow-up duration and approach for women with a history of HDP and proactively engage in lifestyle interventions with the aim of improving longevity.
Aim: Weight gain during the 2–4 weeks before the onset of preeclampsia was assessed to examine the effects of edema on weight gain in women with preeclampsia.
Methods: Weight gain up to 4 weeks, from 2–4 weeks, and from 2 weeks before the diagnosis of preeclampsia (preeclampsia group; n=77) was retrospectively examined. Weight gain during the same period of gestational age in women with the same age, parity, height, and weight at prepregnancy (control group; n=77) was also examined. The χ2 test was used to examine categorical variables.
Results: Average weight gain up to 4 weeks before the diagnosis of preeclampsia did not differ from that of subjects with the same period of gestational age in the control group (6.1±2.0 vs. 6.5±2.6 kg, P=0.25). However, average weight gain from 4 weeks before the diagnosis of preeclampsia was significantly greater than that of subjects with the same gestational age in the control group (weight gain from 2–4 weeks before the diagnosis of preeclampsia: 0.9±0.4 vs. 1.6±0.8 kg, P<0.01; weight gain from 2 weeks before the diagnosis of preeclampsia: 0.8±0.4 vs. 2.1±1.5 kg, P<0.01). The percentage of women with systemic edema in the preeclampsia group was significantly higher than that in the control group (53 vs. 4%, P<0.01). In the preeclampsia group, average weight gain from 2 weeks before the diagnosis of preeclampsia in women with systemic edema was significantly higher than that in women without general edema (3.0±1.1 vs. 1.1±0.5 kg, P<0.01).
Conclusion: Maternal weight gain associated with preeclampsia may be due to systemic edema that precedes the onset of preeclampsia.
We observed a case of eclampsia suddenly occurring at 22 weeks’ gestation, which progressed to placental abruption and intrauterine fetal death. At 22 weeks’ gestation, the patient’s blood pressure increased, and she had convulsions and lost consciousness. The patient was transferred to the tertiary center and a course of observation was chosen due to the prematurity of the fetus. However, 2 days after onset of eclampsia, the patient experienced acute abdominal pain, and retro-placental hematoma and fetal death were confirmed on ultrasonography. In addition, findings typical of posterior reversible encephalopathy syndrome were demonstrated on MRI. Although labor was induced, the patient’s condition worsened and emergency cesarean section was performed. After the operation, the patient’s clinical course was good and she was discharged without any complications. Eclampsia onset at such an early gestational age is quite rare. We must be cognizant that the outcome of the disease may be poor.
Twin gestation consisting of complete hydatidiform mole with coexistent fetus (CHMCF) is a very rare entity. CHMCF is associated with serious complications, such as vaginal bleeding, intrauterine death, preterm birth, preeclampsia, and persistent gestational trophoblast disease (pGTD). Thus, management of this type of pregnancy is challenging. Here we report a case of CHMCF complicated with hypertension and acute heart failure. A 33-year-old primigravida female was clinically diagnosed with CHMCF at 12 weeks of gestation and then developed hypertension and proteinuria at 14 weeks of gestation. Elective termination of pregnancy was performed at 15 weeks of gestation and, following the procedure, she suffered from acute heart failure, suggesting peripartum cardiomyopathy. She subsequently developed pGTD, and methotrexate treatment was initiated. Since CHMCF can cause a variety of complications, its clinical management should be performed with discretion after obtaining informed consent.