We estimated changes in the prevalence of chronic hypertension among pregnant women and evaluated the extent to which changes in obesity and smoking were associated with these trends. We designed a population-based cross-sectional analysis of over 151 million women with delivery-related hospitalizations in the United States, 1970 to 2010. Maternal age, year of delivery (period), and maternal year of birth (birth cohort), as well as race, were examined as risk factors for chronic hypertension. Prevalence rates and rate ratios with 95% CIs of chronic hypertension in relation to age, period, and birth cohort were derived through age-period-cohort models. We also examined how changes in obesity and smoking rates influenced age-period-cohort effects. The overall prevalence of chronic hypertension was 0.63%, with black women (1.24%) having more than a 2-fold higher rate than white women (0.53%; rate ratio, 2.31; 95% CI, 2.30–2.32). In the age-period-cohort analysis, the rate of chronic hypertension increased sharply with advancing age and period from 0.11% in 1970 to 1.52% in 2010 (rate ratio, 13.41; 95% CI, 13.22–13.61). The rate of hypertension increased, on average, by 6% (95% CI, 5–6) per year, with the increase being slightly higher among white (7%; 95% CI, 6%–7%) than black (4%; 95% CI, 3%–4%) women. Adjustments for changes in rates of obesity and smoking were not associated with age and period effects. We observed a substantial increase in chronic hypertension rates by age and period and an over 2-fold race disparity in chronic hypertension rates.

Cesarean scar ectopic pregnancy is becoming increasingly common at tertiary care hospitals around the world. It is a condition in which the embryo implants within the myometrium at the site of a previous cesarean hysterotomy, and it can occur in women with only one prior cesarean delivery. We present four cases of cesarean scar ectopic pregnancy diagnosed within a 6-month period between 2007 and 2008. Their initial presentations and management are discussed, followed by a review of the published literature summarizing both diagnostic and management recommendations.

Objectives-Preimplantation factor (PIF) is a novel embryo-derived peptide which influences key processes in early pregnancy implantation, including immunity, adhesion, remodeling and apoptosis. Herein, we explore the effects of synthetic PIF (sPIF) on trophoblast invasion.Methods-Invasion patterns of immortalized cultured HTR-8 trophoblast cells were analyzed through Matrigel extracellular matrix +/− sPIF (25-100nM) in a transwell assay. Effects were compared with epidermal growth factor (EGF) 10μg/mL, scrambled aminoacid sequence of PIF, or media alone as controls.Results-sPIF enhances trophoblast invasion at physiologic doses [at 50nM 260% (174-346% 95% CI, p=0.05); 100nM 178% (170-184%, p<0.02)], compared to scrambled amnioacid sequence PIF or control media. EGF added to sPIF does not further enhance trophoblast invasion [sPIF 50nM +EGF,[238][239] p<0.03); sPIF 100nM+EGF 269% (265-273%, p<0.04)].Conclusion-PIF should be further investigated as it shows a potential preventative or therapeutic role for pregnancy complications associated with inadequate trophoblast invasion.