Assessment of baseline renal function tests to predict adverse outcomes in women with chronic hypertension

Kawakita, Tetsuya; Seagraves, Elizabeth; Baraki, Dana; Donaldson, Thomas; Barake, Carole; Abuhamad, Alfred

doi:10.1016/j.ajog.2022.08.005

Cited by 3 publications

(3 citation statements)

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“…This was a secondary analysis using retrospective data from a cohort study of all pregnant women with chronic hypertension who were delivered at a tertiary care center from January 1, 2010, to October 1, 2020. 12 Chronic hypertension was defined per ACOG as hypertension being diagnosed before pregnancy or diagnosed during pregnancy before 20 weeks' gestation with a systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater. 2 The institutional review board approved this study.…”

Section: Methodsmentioning

confidence: 99%

Effect of Calcium Channel Blocker on Labor Curve in Pregnant Individuals with Chronic Hypertension

et al. 2023

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Objective: To compare the labor progress between individuals who received calcium channel blocker (CCB) and those who did not receive CCB during labor. Methods: This was a secondary analysis of a retrospective cohort study of individuals with chronic hypertension who underwent vaginal delivery at a tertiary care center from January 2010 to December 2020. We excluded individuals with prior uterine surgeries, and a 5-minute Apgar score of less than 5. We used a repeated-measures regression with a 3rd order polynomial function to compare the average labor curves according to antihypertensive medication. Estimates of the median (5th-95th percentile) traverse times between two dilations were computed using interval-censored regression. Results: Of 285 individuals with chronic hypertension, 88 (30.9%) received CCB. Individuals who received CCB during labor compared to those who did not were more likely to deliver at earlier gestational age and to have pregestational diabetes and superimposed preeclampsia (P < 0.01). The progress of labor in the latent phase was not found to be significantly different between both groups (median 11.51 hours vs. 8.74 hours; P = 0.08). However, after stratification by parity, nulliparous individuals who received CCB during labor were more likely to have a longer latent phase of labor (median 14.4 hours vs. 8.5 hours; P = 0.03) Conclusion: A calcium channel blocker may slow the latent phase of labor in individuals with chronic hypertension. Aiming to minimize intrapartum iatrogenic interventions, allowing adequate time for pregnant individuals during the latent phase of labor is especially important if individuals are on a calcium channel blocker.

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Section: Methodsmentioning

confidence: 99%

Effect of Calcium Channel Blocker on Labor Curve in Pregnant Individuals with Chronic Hypertension

et al. 2023

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“…We used a database of individuals with chronic hypertension that we previously built to examine the association between proteinuria and adverse maternal outcomes. 8 Briefly, the database included pregnant individuals with chronic hypertension at 20 weeks' gestation or greater at an academic institution from January 2010 to Decem-ber 2020. The electronic medical record was used to identify all individuals with a diagnosis of chronic hypertension based on International Classification of Diseases, 9th revision (ICD-9; 642.00-642.94) and ICD-10 (O10.011-O10.42) codes.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Adverse Maternal Outcomes between Early- and Late-Onset Superimposed Preeclampsia

Onishi

Seagraves²,

Baraki

et al. 2023

Am J Perinatol

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Background: Superimposed preeclampsia (SIPE), defined as preeclampsia in individuals with chronic hypertension, is one of the most common complications, accounting for 13-40 % of pregnancies with chronic hypertension. However, there are limited data regarding maternal outcomes of early- and late-onset SIPE in individuals with chronic hypertension. We hypothesized that early-onset SIPE was associated with increased odds of adverse maternal outcomes compared to late-onset SIPE. Therefore, we aimed to compare adverse maternal outcomes between individuals with early-onset SIPE and those with late-onset SIPE. Study Design This was a retrospective cohort study of pregnant individuals with SIPE who delivered at 22 weeks’ gestation or greater at an academic institution. Early-onset SIPE was defined as the onset of SIPE before 34 weeks’ gestation. Late-onset SIPE was defined as the onset of SIPE at or after 34 weeks’ gestation. Our primary outcome was a composite of eclampsia, HELLP syndrome, maternal death, placental abruption, pulmonary edema, SIPE with severe features, and thromboembolic disease. Maternal outcomes were compared between early-onset SIPE and late-onset SIPE. We used simple and multivariate logistic regression models to calculate crude and adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Results Of 311 individuals, 157 (50.5 %) had early-onset, 154 (49.5 %) had late-onset SIPE. There were significant differences in the proportions of obstetric complications, including the primary outcome, HELLP syndrome, SIPE with severe features, fetal growth restriction (FGR), and cesarean delivery between early- and late-onset SIPE. Compared to individuals with late-onset SIPE, those with early-onset SIPE had increased odds of the primary outcome (aOR 3.28; 95%CI 1.42-7.59), SIPE with severe features (aOR 2.72; 95%CI 1.25-5.90), FGR (aOR 6.07; 95%CI 3.25-11.36), and cesarean delivery (aOR 3.42; 95%CI 2.03-5.75). Conclusion In individuals with chronic hypertension, individuals with early-onset SIPE had higher odds of adverse maternal outcomes compared to those with late-onset SIPE.

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“…Our finding of serum creatinine being a risk factor for early-onset SIPE is consistent with previous studies that showed baseline serum creatinine ≥ 0.75 mg/dL and serum creatinine ≥ 0.63 mg/dL were associated with early-onset SIPE. 20,21…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

Onishi

Seagraves²,

Baraki

et al. 2023

Am J Perinatol

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Objective Risk factors of early- and late-onset preeclampsia among pregnant individuals with chronic hypertension are not well described in the literature. We hypothesized that early- and late-onset superimposed preeclampsia (SIPE) have different risk factors. Therefore, we aimed to examine the risk factors of early- and late-onset SIPE among individuals with chronic hypertension. Study Design This was a retrospective case-control study of pregnant individuals with chronic hypertension who delivered at 22 weeks’ gestation or greater at an academic institution. Early-onset SIPE was defined as SIPE diagnosed before 34 weeks’ gestation. To identify risk factors, we first compared individuals' characteristics between individuals who developed early- and late-onset SIPE and those who did not. We then compared characteristics between individuals who developed early-onset SIPE and late-onset SIPE. Characteristics with p-values of less than 0.05 by bivariable variables were analyzed by simple and multivariable logistic regression models to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Missing values were imputed with multiple imputation. Results Of 839 individuals, 156 (18.6%) had early-onset, 154 (18.4%) had late-onset SIPE, and 529 (63.1%) did not have SIPE. The multivariate logistic regression model showed serum creatinine ≥ 0.7 mg/dL compared to less than 0.7 mg/dL (aOR: 2.89 [95% CI: 1.63-5.13]), increase of creatinine (1.33 [1.16-1.53]), nulliparity compared to multiparity (1.77 [1.21-2.60]), and pregestational diabetes (1.70 [1.11-2.62]) were risk factors for early-onset SIPE. The multivariate logistic regression model showed nulliparity compared to multiparity (1.53 [1.05-2.22]) and pregestational diabetes (1.74 [1.14-2.64]) was a risk factor for late-onset SIPE. Serum creatinine ≥ 0.7 mg/dL (2.90 [1.36-6.15]) and increase of creatinine (1.33 [1.10-1.60]) were significantly associated with early-onset SIPE compared to late-onset SIPE. Conclusion Kidney dysfunction seemed to be associated with the pathophysiology of early-onset SIPE. Nulliparity and PDM were common risk factors for both early- and late-onset SIPE.

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Assessment of baseline renal function tests to predict adverse outcomes in women with chronic hypertension

Cited by 3 publications

References 5 publications

Effect of Calcium Channel Blocker on Labor Curve in Pregnant Individuals with Chronic Hypertension

Effect of Calcium Channel Blocker on Labor Curve in Pregnant Individuals with Chronic Hypertension

Comparison of Adverse Maternal Outcomes between Early- and Late-Onset Superimposed Preeclampsia

Risk Factors for Early- and Late-Onset Superimposed Preeclampsia

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