Women with a history of a hypertensive disorder of pregnancy (HDP) are at increased risk of premature cardiovascular disease. Cardiovascular risk management guidelines emphasize the need for prevention of cardiovascular disease in these women but fail to provide uniform recommendations on when and how to start cardiovascular risk assessment. The aim of this study was to identify a window of opportunity in which to start cardiovascular risk factor assessment by investigating changes in blood pressure, lipids, and fasting glucose levels over time in women with a history of an HDP. We identified women with a history of a normotensive pregnancy (n=1811) or an HDP (n=1005) within a high-risk population-based cohort study. We assessed changes in blood pressure, lipids, glucose, 10-year cardiovascular risk and the occurrence of hypertension, dyslipidemia, and diabetes mellitus longitudinally using 5 measurements at 3-year intervals. Generalized estimating equations were used for statistical analysis, with age as the time variable, adjusting for multiple comparisons using the least significant differences method. In women with an HDP, the overall prevalence of hypertension ( P <0.0001), dyslipidemia ( P =0.003), and diabetes mellitus ( P <0.0001) was significantly higher. They also developed hypertension and diabetes mellitus earlier. At age 35, few women with HDP need to be screened to detect clinically relevant hypertension: 9 need to be screened to detect 1 woman with a treatment indication as opposed to 38 women with history of a normotensive pregnancy. Our data supports cardiovascular follow-up of women with a history of an HDP starting within the fourth decade of life.

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Low birth weight is associated with hypertension. Low birth weight can result from fetal growth restriction (FGR) or prematurity. FGR is postulated to impact blood pressure (BP) by developmental programming. This systematic review and meta-analysis studies BP in human and animal offspring following FGR. Pubmed and Web of Science were searched for studies reporting on BP after placental insufficiency induced FGR compared with normal growth controls. Primary outcome was mean absolute BP difference (ΔBP mm Hg [95% CI]). Meta-analysis was performed using random-effects models. Subgroup analyses were executed on species, sex, age, pregnancy duration, and stress during BP readings. Due to large interspecies heterogeneity, analyses were performed separately for human (n=41) and animal (n=31) studies, the latter restricted to rats (n=27). Human studies showed a ΔBP between FGR and controls of −0.6 mm Hg ([95% CI, −1.7 to 0.6]; I 2 =91%). Mean ΔBP was −2.6 mm Hg (95% CI, −5.7 to 0.4) in women versus −0.5 mm Hg (95% CI, −3.7 to 2.7) in men. Subgroup analyses did not indicate age, gestational age, and stress during measurements as sources of heterogeneity. In rats, mean BP was 12.0 mm Hg ([95% CI, 8.8–15.2]; I 2 =81%) higher in FGR offspring. This difference was more pronounced in FGR males (13.6 mm Hg [95% CI, 10.3–17.0] versus 9.1 mm Hg [95% CI, 5.3–12.8]). Subgroup analyses on age showed no statistical interaction. BP readings under restrained conditions resulted in larger BP differences between FGR and control rats (15.3 mm Hg [95% CI, 11.6–18.9] versus 5.7 mm Hg [95% CI, 1.1–10.3]). Rat studies confirm the relation between FGR and offspring BP, while observational studies in humans do not show such differences. This may be due to the observational nature of human studies, methodological limitations, or an absence of this phenomenon in humans. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: CRD42018091819.

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Liquid-based perinatal life support (PLS) technology will probably be applied in a first-in-human study within the next decade. Research and development of PLS technology should not only address technical issues, but also consider socio-ethical and legal aspects, its application area, and the corresponding design implications. This paper represents the consensus opinion of a group of healthcare professionals, designers, ethicists, researchers and patient representatives, who have expertise in tertiary obstetric and neonatal care, bio-ethics, experimental perinatal animal models for physiologic research, biomedical modeling, monitoring, and design. The aim of this paper is to provide a framework for research and development of PLS technology. These requirements are considering the possible respective user perspectives, with the aim to co-create a PLS system that facilitates physiological growth and development for extremely preterm born infants.

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Introduction:Haemophilia carriers (HCs) face considerable haemostatic and psychological challenges during reproduction.Aim: To explore the perspectives of HCs on healthcare in the current standard of haemophilia treatment during all reproductive phases: preconception, pregnancy, childbirth and the postpartum period. In addition, we examined the psychological impact of haemophilia during these phases.Material and methods: Focus group discussions (FGDs) and semi-structured interviews were conducted with HCs in January/February 2020 until data saturation was reached. All sessions were recorded, transcribed verbatim and analysed by two independent researchers through thematic content analysis using MAXQDA® software.The results were then discussed within the research team until consensus was reached.The constructed themes were shared with and reviewed by the HCs.Results: Fifteen HCs were included in three FGDs and four interviews. Five central themes were constructed: (1) communication by healthcare professionals, (2) lack of knowledge, (3) feeling insecure, (4) autonomy and (5) family experiences with haemophilia. Desired improvements in care mainly concerned counselling during preconception and pregnancy. This included timely access to comprehensive information during each consecutive phase, acceptance of HCs' choices by healthcare providers and healthcare tailored to the HC's family experience with haemophilia. Conclusions:In recent years, haemophilia treatment has seen major advances, which could impact general and reproductive care for HCs. HCs indicated that reproductive care would benefit from a more personal and informative approach. Healthcare professionals could use these insights to adapt their consultations to meet the needs of these women when they are preparing for having children.