Dear Colleagues,

On behalf of the Editorial Team of Hypertension Research in Pregnancy, I am pleased to announce the Journal Awards for the Year 2020.

The aim of these Awards is to recognize papers published in 2020, both clinical and experimental studies, that were highly appreciated by the Editorial Team.

In the year of 2020, following paper has been selected for the Hypertension Research in Pregnancy Awards.

Left ventricular hypertrophy in Japanese pregnant women with chronic hypertension predicts blood pressure elevation during pregnancy

Atsushi Nakanishi, Chizuko Kamiya, Masami Sawada, Tadasu Shionoiri, Tae Konishi, Chinami Horiuchi, Mitsuhiro Tsuritani, Naoko Iwanaga, Jun Yoshimatsu

Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan

2020 Volume 8 Issue 1 Pages 15–21

Aim: The influence of cardiovascular changes resulting from hypertension on the course of pregnancy is unclear. The purpose of this study was to evaluate the influence of cardiovascular changes as detected by echocardiography on the course of pregnancy with chronic hypertension.

Methods: This retrospective cohort study targeted women with a singleton pregnancy and chronic hypertension during the period between January 1, 2010 and December 31, 2018. We compared echocardiographic values between subjects with blood pressure (BP) elevation (BP elevation group) and normotensive subjects (control group) during pregnancy.

Results: Twenty-nine hypertensive pregnant women were eligible for this study (14 subjects in the BP elevation group and 15 subjects in the control group). Left ventricular posterior wall thickness (PWT) and left ventricular mass index (LVMI) tended to be greater in the BP elevation group compared to the control group, but the differences were not significant. In the sub-cohort of subjects aged ≥35 years, PWT and LVMI were significantly greater in the BP elevation group compared to the control group.

Conclusions: Left ventricular hypertrophy (LVH) in pregnant women with chronic hypertension may be a predictor of BP elevation during pregnancy.

JSSHP Project Research Award 2020

Effects of tight blood pressure control from early pregnancy on maternal and neonatal outcomes in pregnancies with chronic hypertension

Akihiko Ueda, MD.

Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine

JSSHP Project Research Award 2021

The relation between COMT activity and magnesium in preeclampsia

Norikazu Ueki, MD, PhD.

Department of Obstetrics & Gynaecology, Juntendo University Faculty of Medicine

Congress Chair: Shigeru Saito (University of Toyama)

Date: September 15 (Web.)–28 (Tue.), 2021

Format: Virtual on-demand conference

The 22nd World Congress of International Society for the Study of Hypertension in Pregnancy was held as the virtual on-demand conference.

We have over 200 participants from 27 countries and this meeting turns out to be successful.

Aim: Pre-eclampsia is considered a multi-factorial disease, in which both fetal and maternal factors are involved in its onset. In this study, we aimed to test the longstanding hypothesis that the immune response to bacterial endotoxin could explain the etiology of pre-eclampsia.

Methods: Serum lipopolysaccharide binding protein (LBP) concentrations and the vaginal microbiome were compared between subjects with pre-eclampsia and those with normotensive pregnancies.

Results: Serum LBP concentrations were higher in subjects with pre-eclampsia compared to those with normotensive pregnancies. LBP concentrations were poorly correlated with disease onset, blood pressure, birthweight, and placental weight. Moreover, there was no evidence of bacterial species specific to pre-eclampsia based on a comparative analysis of the vaginal microbiome of subjects with pre-eclampsia and those with normotensive pregnancies.

Conclusion: Serum LBP concentrations were significantly higher in subjects with pre-eclampsia compared to those with normotensive pregnancies. The clinical significance of high serum LBP concentrations in pre-eclampsia requires further investigation.

Aim: Urinary Na/K ratios are related to the risk of developing cardiovascular diseases. A portable device which rapidly measures urinary Na/K ratios will be useful. This study aimed to test the reliability of a portable device for measuring spot urinary Na/K ratios among pregnant women in southern Thailand.

Methods: Morning spot urine samples were examined with a portable device and automated chemical analyzer independently and blindly. Correlations and predictions were analyzed using Spearman’s correlation coefficients and linear regression, respectively. Agreement between the portable device and automated chemical analyzer was examined using the Bland-Altman method.

Results: Measurements from 1,412 specimens revealed that spot urinary Na/K ratios obtained using the portable device had an acceptable level of agreement (mean of difference=0.78) and strong positive correlation (r=0.83) with those obtained using the automated chemical analyzer. The equation of urinary Na/K ratios obtained with the portable device is required to estimate ratios obtained by the automated chemical analyzer, which had a low proportional error and small constant error.

Conclusion: Portable devices are feasible alternative tools for measuring spot urinary Na/K ratios among pregnant women in clinical settings. Further large-scale studies to assess the reproducibility of measurements from portable devices are warranted.

Aim: A questionnaire survey was conducted to establish whether opportunistic salpingectomy has been performed at cesarean delivery or is intended in the future and also to clarify the steps taken to achieve the goal of performing opportunistic salpingectomy at cesarean delivery in Japan.

Methods: We distributed anonymous questionnaires on opportunistic salpingectomy at cesarean delivery to registered physicians of the Maternal Fetal Intensive Care Unit Liaison Council of Japan using a mailing list in 2019. Answer sheets were returned by fax with an unscripted name.

Results: Valid responses were obtained from 68 physicians; 28% (n=19/68) performed opportunistic salpingectomy at cesarean delivery, while 16% (n=8/49) hoped to conduct opportunistic salpingectomy in the future. Most of the physicians performing opportunistic salpingectomy (74%: n=14/19) had conducted salpingectomy as one of the permanent surgical contraception procedures provided for by law without the approval of an Ethics Committee.

Conclusions: Opportunistic salpingectomy at cesarean delivery to reduce the risk of ovarian, fallopian tube, and peritoneal carcinoma in patients at average risk has not yet been widely practiced in Japan. Approximately 25% of physicians have performed opportunistic salpingectomy, 75% of whom conducted this procedure instead of tubal ligation for pregnant women who requested sterilization at cesarean delivery.

We examined the association between ‘specified expectant mothers (SEMs; pregnant women with social problems)’ at our institute and their mental status at one month after delivery. We examined 890 pregnant women who delivered at ≥37 weeks of gestation at our institute between January 2019 and October 2019. We excluded mothers with mental disorders requiring medication and whose children were hospitalized in the neonatal intensive care unit. During the study period, there were 148 SEMs with healthy babies (16.6%). The frequency of screening positive on the Japanese version of the Mother-to-Infant Bonding Scale and the Edinburgh Postnatal Depression Scale was higher in SEMs than in non-SEMs (P=0.04 and 0.02). In addition, there was a strong positive correlation between scores on the two scales in SEMs (r²=0.41, P<0.01). The present results indicate the quantitatively clarify of the mental vulnerabilities in SEMs.

Pseudohypoaldosteronism type 2 (PHA2) is an extremely rare autosomal dominant disease characterized by salt-sensitive hypertension with hyperkalemia which develops at a young age. This report describes for the first time the perinatal course and outcome of pregnancy in a woman and her children with PHA2. A 33-year-old woman with PHA2 presented with exacerbated hypertension and hyperkalemia from mid-pregnancy and was treated with thiazide diuretics in her two pregnancies. She developed superimposed pre-eclampsia only during her first pregnancy; fetal growth restriction was observed in both pregnancies. Both of her neonates developed hypertension and electrolyte imbalances and were diagnosed with PHA2 by genomic analysis. If a pregnant woman develops hypertension with hyperkalemia, PHA2 should be suspected, and both the mother and her infant should be managed carefully.

Super-obesity (defined as a body mass index >50 kg/m²) is quite rare in Japan, and associated with various perinatal complications. Here we report a case of a 30-year-old nulliparous woman with a body mass index of 55.2. Obstetricians, anesthesiologists, physicians, and dietitians provided information and counseling from the early stage of pregnancy, given the potential difficulties during pregnancy and labor. She gained only 2 kg during the pregnancy, and the pregnancy course was uneventful except for the emergence of gestational diabetes and initiation of insulin therapy. To address the difficulties associated with super-obesity, three fetal anatomical scans were performed, a bariatric ward bed and operating table were prepared, and an epidural catheter was inserted early in labor. At 40 weeks of gestation, a baby was delivered vaginally after spontaneous labor onset. Although uterine contractions were difficult to detect, the measures taken made it possible to manage labor without any notable complications.