Dear Colleagues,

On behalf of the Editorial Team of Hypertension Research in Pregnancy, I am pleased to announce the Journal Awards for the Year 2019.

The aim of these Awards is to recognize papers published in 2019, both clinical and experimental studies, that were highly appreciated by the Editorial Team.

In the year of 2019, following paper has been selected for the Hypertension Research in Pregnancy Awards.

Tight systolic blood pressure control early in pregnancy improves pregnancy outcomes in women with chronic hypertension

Akihiko Ueda, Baku Nakakita, Yoshitsugu Chigusa, Haruta Mogami, Asako Inohaya, Ken Yamaguchi, Akihito Horie, Junzo Hamanishi, Masaki Mandai, Eiji Kondoh

Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan

2019 Volume 7 Issue 2 Pages 75–81

Objectives: To clarify the effects of tight blood pressure control on pregnancy outcomes.

Methods: This retrospective study included 38 cases of singleton pregnancies which were diagnosed with essential hypertension either before pregnancy or during the first trimester of pregnancy. Patients were subdivided according to systolic blood pressure (<130 mmHg, 130–139 mmHg, ≥140 mmHg) between 8–11, 12–15, and 16–19 weeks’ gestation, respectively. The influence of systolic blood pressure in each gestational period was assessed with regard to the risk of preterm birth, foetal growth restriction, and superimposed preeclampsia.

Results: At 16–19 weeks’ gestation, systolic blood pressure ≥140 mmHg and in the range of 130–139 mmHg was strongly linked to a shorter gestational period and lower z-scores for birth weight. The incidence of early onset superimposed preeclampsia was lower in women who had systolic blood pressure <130 mmHg at 16–19 weeks’ gestation (11%) compared with those with a systolic blood pressure of 130–139 mmHg (27%) and ≥140 mmHg (75%).

Conclusions: Tight control of blood pressure, with a target systolic blood pressure <130 mmHg early in pregnancy improves pregnancy outcomes in patients with chronic hypertension.

Dear Colleagues,

The Editorial Team of Hypertension Research in Pregnancy would like to acknowledge all those who have kindly given their precious time to referee submitted papers. We know that reviewing manuscripts is not easy task and they need to have the critical adequate evaluation and the latest scientific knowledge. This prize is awarded biannually to reviewers who reviewed a number of manuscripts submitted to Journal of Hypertension Research in Pregnancy with high quality, speed and impartialness. I would like to thank you for the efforts and contributions.

I am pleased to announce the Best Reviewer Awards for 2016–2017.

Best Reviewer Award of 2016–2017

* Gen Ishikawa, MD, PhD.

Department of Obstetrics and Gynecology, Chiba Hokusoh Hospital,

Nippon Medical School, Chiba

Number of Reviews: 6

It was decided that these research awards 2020 would not be selected this year, because the annual congress of JSSHP 2020 was postponed for a COVID-19 pandemic.

Rapid progress in perinatal care in recent decades has led to a dramatic decline in perinatal, neonatal, and maternal mortality (excluding suicides), and achieved remarkable improvements in obstetrical outcomes in Japan. However, while maternal mortality had been on a continuous and steady decline up until 2007 (3.1/100,000 total births), the rate has been fluctuating since then (e.g., 2.7/100,000 in 2014, 3.4/100,000 in 2016). This is likely attributed to a variety of factors that have emerged in the past 20 years due to changes in the environment and social situation surrounding women, such as later marriage and rise in maternal age.

In Western countries, “late maternal deaths” occurring between 42 days and one year after delivery are considered to be just as important as “maternal deaths,” i.e., deaths during pregnancy or within 42 days of termination of pregnancy. In particular, suicides attributable to psychiatric disorders have become a serious issue among women less than one year postpartum. However, in Japan, the actual number of deaths by suicide is unknown, since neither death certificates nor postmortem certificates include information on pregnancy and delivery. Despite the fact that the total number of suicide deaths in Japan is known, whether such deaths are associated with perinatal mental issues or not is unclear, and thus, no measures have been taken. Untreated perinatal depression and psychiatric disorders not only cause issues such as suicide, but are also related to pediatric developmental and mental disorders, neglect, and/or child abuse due to impaired nurturing ability. Suicide rates among pregnant and parturient women in Osaka, Tokyo, and Mie are much higher than those of the UK, the US, and Sweden. There is an urgent need to establish a regional support system that facilitates interactions among the obstetrical, pediatric, psychiatric field, and local administrations for monitoring and supporting mothers and infants, as well as a system that allows families, schools, and society to support young people, in order to realize improved preconception health care.

Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal and neonatal morbidity and mortality. Studies conducted over the last decade have improved our understanding of the potential mechanisms underlying HDP pathogenesis. The first step in HDP is reduced uteroplacental perfusion as a result of abnormal extravillous trophoblast invasion of spiral arterioles. Subsequent placental ischemia leads to maternal vascular endothelial dysfunction that may be caused by an imbalance between pro- and anti-angiogenic factors, enhanced formation of vasocontractile factors such as endothelin and thromboxane, increased vascular sensitivity to angiotensin II, and/or decreased formation of vasodilators such as nitric oxide (NO) and prostaglandin I2. NO is one of the major mediators from the endothelium, and its production is modified by endogenous NO synthase inhibitors such as asymmetric dimethylarginine (ADMA). ADMA levels are generally higher in patients with cardiovascular and metabolic diseases and widely recognized as a prognostic marker for major cardiovascular events and mortality. Recent studies have found ADMA levels to be higher in patients with preeclampsia. In addition, multiple studies indicate that elevated ADMA in early stages of pregnancy might predict the development of preeclampsia. Finally, ADMA has been found to be associated with uterine artery flow disturbance. Collectively, these findings strongly suggest that elevated ADMA-mediated endothelial dysfunction could be a causative factor for HDP. In this review, we discuss the biology of ADMA, with a particular focus on its potential role in HDP.

Aim: External cephalic version (ECV) is the main intervention for facilitating vaginal birth without increasing intrapartum mortality and neonatal morbidity in term breech pregnancies. We appraise the hypothesis that the introduction of a specialised ECV clinic reduces preventable caesareans without compromising neonatal well-being.

Methods: This is a prospective cohort study over a period of 3 years. Data were collected via attendance in the ECV clinic and women were followed up until the delivery and the postnatal period. Obstetric and neonatal notes were reviewed in order to assess obstetric data and fetal outcomes.

Results: 181 suitable women with singleton pregnancy were included in our sample, from which 28 opted for elective caesarean delivery. 81% of the eligible women underwent an ECV. From the 120 ECVs performed, 78 women were nulliparous and 42 multiparous. The ECV was successful in a total of 64 cases (54%), 49% in nulliparous and 62% in multiparous women. Following that, 78% delivered vaginally of which 25% needed instrumental delivery. There were not any adverse events during the ECVs and no woman underwent emergency caesarean section for fetal distress due to the procedure.

Conclusion: Our experience favours the ECV clinic, as it improves vaginal delivery rates with no obvious maternal and neonatal compromise. Cost-effectiveness and maternal satisfaction levels remain unknown. There is still room for improvement in detection, uptake and success ECV rates.

Aim: This study aimed to clarify indications under insurance coverage for measuring the serum ratio of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF ratio), and to construct a flow diagram for the short-term prediction of preeclampsia (PE) using the sFlt-1/PlGF ratio in women at imminent/basal risk of preeclampsia.

Methods: Indications for measuring the serum sFlt-1/PlGF ratio were selected, and a flow diagram for predicting PE using the ratio in women at imminent/basal risk of PE at 18–36 weeks of gestation was constructed, based on the consensus of 6 experts at the “sFlt-1/PlGF Advisory Web Meeting” held after the PROGNOSIS Asia study.

Results: Based on expert consensus, appropriate perinatal care under close observation is recommended for women at imminent/basal risk of PE who have an sFlt-1/PlGF ratio >38 at recruitment. For women at imminent risk of PE who have an sFlt-1/PlGF ratio ≤38 at recruitment, shortening the interval between maternal check-ups is recommended, along with re-evaluation of the sFlt-1/PlGF ratio 1–4 weeks after initial blood sampling, based on patient/fetal condition.

Conclusions: The indications and screening strategy for PE using the serum sFlt-1/PlGF ratio under insurance coverage in women at imminent/basal risk of PE will help prevent unnecessary hospitalization and intervention, assist in the triage of women at imminent/basal risk of PE, and allow for the provision of appropriate perinatal care under close observation.

Aim: This study aimed to evaluate the effectiveness of intrauterine gauze or balloon tamponade for the management of postpartum hemorrhage due to uterine atony during maternal transportation from private clinics to higher-level facilities.

Methods: A total of 1,428 patients were transported to the Department of Obstetrics, Juntendo University Shizuoka Hospital, between January 2008 and December 2019. Among these, 42 patients had postpartum hemorrhage due to uterine atony. Of the 42 patients, 29 (69.0%) were treated with intrauterine gauze or balloon tamponade before transportation (tamponade group); no intrauterine packing was performed in the remaining 13 (31.0%) (non-tamponade group). The primary outcome was the rate of critical obstetrical hemorrhage at hospital arrival. Secondary outcomes were blood loss before and after transportation, hemoglobin, platelets, fibrinogen, amount of blood transfusion, and rate of transfusion.

Results: The rate of critical obstetrical hemorrhage was significantly lower in the tamponade group (34.5% (10/29)) compared to the non-tamponade group (76.9% (10/13)). Moreover, total blood loss during transportation and after hospital arrival was significantly lower in the tamponade group (487±331 g) compared to the non-tamponade group (1,199±1,012 g).

Conclusion: Intrauterine gauze or balloon tamponade before transportation to higher-level facilities is effective for managing postpartum hemorrhage due to uterine atony.