Hypertension during pregnancy increases the risk of adverse maternal and fetal outcomes, but the mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define the features of the renin–angiotensin–aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of 74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, 27 patients) versus those remaining normotensive (NT, 47 patients). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of Angiotensin I + Angiotensin II) and aldosterone concentrations significantly increased from the first to the third trimester, accompanied by a modest increase in the concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies, PRA-S and angiotensin peptides were largely unchanged over gestation, and third-trimester aldosterone concentrations were significantly lower compared with those in NT pregnancies. The results indicated that the predominant features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and the attenuated secretion of aldosterone.

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specificity of 70% (95%CI 50.6-85.2%) and 86.2% (95%CI 68.3-96.1%) for PAS. PPV and NPV were 84% (95%CI 67.2-93%) and 73.5% (95%CI 61.2-83%), superior to ultrasound and MRI, from previously published data. In addition, VEGF identified 65% (9/14) of patients transfused >4 units of blood, 74% (22/30) with a length of stay >4 days and 65% (9/14) admitted to the ICU. CONCLUSION: In this large cohort, urine VEGF was associated with PAS as well as maternal morbidity. VEGF warrants further evaluation as a biomarker for diagnosis of PAS and prediction of PAS associated morbidity.

INTRODUCTION: This study evaluates the impact of gestational weight gain (GWG) on the risk for operative vaginal delivery across the spectrum of maternal pre-pregnancy body mass index (PPBMI). METHODS: Vital statistics data collected by the National Center for Health Statistics (NCHS) were utilized. Using the 2015 data, GWG was calculated and the birth cohort consisting of singleton gestations delivering vaginally was classified into inadequate, adequate and excess GWG categories as per the 2009 Institute of Medicine (IOM) guidelines. Each PPBMI category was further stratified based on the adequacy of GWG. Multivariate logistic regression analyses were used to predict the risk for operative vaginal delivery in each PPBMI and GWG group while adjusting for age, race, ethnicity, education, marital status, insurance and smoking status. RESULTS: The rate of operative vaginal delivery in this study cohort was 4.63% (116,610/2,517,605 singleton vaginal deliveries). Excess GWG significantly increased the risk for an operative vaginal delivery (OR 1.074 [95% CI 1.060 - 1.089]) irrespective of the PPBMI, in the adjusted regression analyses. In the PPBMI specific analyses - the risk for operative vaginal delivery was significantly increased in women with excess GWG in women classified as underweight OR 1.118 (95% CI 1.047-1.194), normal weight OR 1.112 (95% CI 1.092-1.134), overweight OR 1.145 (95% CI 1.112-1.179), and obese OR 1.148 (95% CI 1.108-1.189) as compared to those in the same weight categories with adequate GWG. CONCLUSION: Our findings demonstrate that women with excess GWG, regardless of their pre-pregnancy maternal weight category, are at increased risk of undergoing operative vaginal delivery.