Outline of the new definition and classification of “Hypertensive Disorders of Pregnancy (HDP)”; a revised JSSHP statement of 2005

Watanabe, Kazushi; Matsubara, Keiichi; Nakamoto, Osamu; Ushijima, Junko; Ohkuchi, Akihide; Koide, Kazunori; Makino, Shintaro; Mimura, Kazuya; Morikawa, Mamoru; Naruse, Katsuhiko; Tanaka, Kanji; Nohira, Tomoyoshi; Metoki, Hirohito; Kawabata, Ikuno; Takeda, Satoru; Seki, Hiroyuki; Takagi, Kenjiro; Yamasaki, Mineo; Ichihara, Atsuhiro; Kimura, Tadashi; Saito, Shigeru

doi:10.14390/jsshp.hrp2018-014

Cited by 73 publications

(60 citation statements)

References 4 publications

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“…A diagnosis of HDP was established in pregnant women with a blood pressure of ≥140/90 during pregnancy, according to the definition stipulated by the Japan Society for the Study of Hypertension in Pregnancy. 12 Macrosomia was defined as birth weight >4000 g.…”

Section: Methodsmentioning

confidence: 99%

High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy

Nakanishi

Aoki

Kasai

et al. 2020

BMJ Open Diab Res Care

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IntroductionThis study aimed to assess the validity of applying the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) at any time during pregnancy.Research design and methodsThis multicenter cohort study was conducted at five Japanese facilities from January 2018 to April 2019. The study cohort included women at a high risk of GDM who met one or more of the following IADPSG criteria during early pregnancy: fasting plasma glucose (FPG) ≥92 mg/dL and 75 g oral glucose tolerance test (OGTT) value of ≥180 mg/dL at 1 hour, or ≥153 mg/dL at 2 hour (hereafter early-onset GDM). Women diagnosed with early-onset GDM were followed up without therapeutic intervention and underwent the 75 g OGTT again during 24–28 weeks of gestation. Those exhibiting the GDM patterns on the second 75 g OGTT were diagnosed with true GDM and treated, whereas those exhibiting the normal patterns were diagnosed with false positive early GDM and received no therapeutic intervention.ResultsOf the 146 women diagnosed with early-onset GDM, 69 (47%) had normal 75 g OGTT values at 24–28 weeks of gestation, indicating a false-positive result. FPG levels were significantly higher in the first 75 g-OGTT test than in the second 75 g-OGTT test (93 mg/dL and 87.5 mg/dL, respectively; p<0.001). FPG levels were high in 86 (59%) women with early-onset GDM during early pregnancy but in only 39 (27%) women during mid-pregnancy. Compared with false positive early GDM, true GDM was more frequently associated with adverse pregnancy outcomes.ConclusionsAlthough women with early-onset GDM were followed up without treatment, the results of repeated 75 g OGTT during mid-pregnancy were normal in about 50%. Our data did not support the adoption of IADPSG thresholds for the diagnosis of GDM prior to 20 weeks of gestation.

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Section: Methodsmentioning

confidence: 99%

High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy

Nakanishi

Aoki

Kasai

et al. 2020

BMJ Open Diab Res Care

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“…The following perinatal outcomes were assessed in the present study: hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), large for gestational age (LGA), small for gestational age (SGA), macrosomia, spontaneous preterm birth, post-term birth, postpartum hemorrhage (PPH) in cesarean section (CS), PPH in vaginal delivery (VD), neonatal asphyxia (Apgar score <7 points at 5 min after delivery), neonatal acidosis (umbilical arterial pH <7.20), and total cesarean delivery (both elective and emergency). HDP was defined as hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) developing after 20 weeks of gestation 10 . GDM (by 75-g oral glucose tolerance test) was diagnosed when at least one of the following was observed: fasting blood glucose level of ≥92 mg/dL, blood glucose level at 1 h of ≥180 mg/dL, or blood glucose level at 2 h ≥153 mg/dL.…”

Section: Methodsmentioning

confidence: 99%

Comparison of three classification systems of Prepregnancy Body Mass Index with Perinatal Outcomes in Japanese Obese Pregnant Women: A retrospective study at a single center

et al. 2020

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In Japan, pregnant women are diagnosed as obese if the prepregnancy body mass index (BMI) is ≥25 kg/m 2. However, this is different from other countries. The Institute of Medicine (IOM) classifies prepregnancy BMI as underweight (BMI <18.5 kg/m 2), normal weight (BMI 18.5-24.9 kg/m 2), overweight (BMI 25.0-29.9 kg/m 2), and obese (BMI ≥30 kg/m 2). In addition to these four categories, the American College of Obstetricians and Gynecologists (ACOG) classifies prepregnancy BMI as obesity class I (BMI 30.0-34.9 kg/m 2), obesity class II (BMI 35.0-39.9 kg/m 2), and obesity class III (BMI ≥40 kg/m 2). We conducted a retrospective cohort study to compare obstetric outcomes by the three different categorizations in 6,066 pregnant women who gave birth between 2010 and 2019. According to Japanese classification, 668 (11%) pregnant women were classified as obese, and significant odds ratios (OR) were observed for hypertensive disorders of pregnancy (HDP; 3.32), gestational diabetes mellitus (GDM; 3.39), large for gestational age (LGA; 2.91), and macrosomia (4.01). According to the classification of IOM, 474 (7.8%) and 194 (3.1%) were classified as overweight and obese pregnant women, respectively. Specifically, a high OR was observed in obese pregnant women for HDP (5.85) and GDM (5.0). ACOG classification categorized 474 (7.8%) pregnant women as overweight, 141 (2.3%) as obesity class I, 41 (0.6%) as obesity class II, and 12 (0.2%) as obesity class III. In obesity class III, a significantly high OR was observed for HDP (12.89), GDM (8.37), and LGA (5.74). The Japanese classification may be useful for low-risk pregnancies, whereas IOM classification may be applicable to identify high-risk pregnancies. ACOG criteria may be useful for step-wise assessments of HDP and GDM risks in Japanese pregnant women; however, the number of class II and III obese pregnant women was small.

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“…For the New Zealand samples, preeclampsia was clinically diagnosed according to the SOMANZ guidelines (https://somanz.org), and FGR was defined as weight ≤5th centile for gestational age, as determined by the GROW-centile calculator with permission from the Perinatal Institute (http://www.perinatal.org.uk). For the cohort from Japan, growth estimates were calculated according to the standard gestational age-specific birth weight set by the Japan Pediatric Society, and preeclampsia was defined according to the guidelines of the Japanese Society of Hypertension [50].…”

Section: Sample Collectionmentioning

confidence: 99%

Human Papillomavirus E6/E7 Expression in Preeclampsia-Affected Placentae

et al. 2020

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Whether HPV is causative of pregnancy complications is uncertain. E6 and E7 affect functions underling preeclampsia (PET) in cultured trophoblasts, but whether E6 and E7 is produced in the placenta is uncertain. Here, we investigated whether E6/E7 was expressed in the placentae from pregnancies with PET, other pregnancy complications (fetal growth restriction (FGR) and diabetes mellitus), and uncomplicated pregnancies. Placental tissues collected from two geographical locations were subjected to RNAscope analyses of high- and low- risk E6/E7, and individual HPV types identified using an HPV array. High-risk E6/E7 expression was increased in both PET cohorts, (81% and 86% of patients positive for high-risk HPV DNA compared to 13% of control patients). Various HPV types were identified. Although HPV 18 was the most frequent in all cohorts, the majority of individuals had multiple HPV types (55% of the PET compared to 25% of the control cohort). Further evidence that E6 and E7 is present early when placental pathology underlying preeclampsia is established, is provided with the finding of high-risk E6/E7 in the first-trimester placenta anchoring trophoblast. In conclusion, E6/E7 expression and multiple HPV types were frequent in placentae from preeclampsia-complicated pregnancies.

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Outline of the new definition and classification of “Hypertensive Disorders of Pregnancy (HDP)”; a revised JSSHP statement of 2005

Cited by 73 publications

References 4 publications

High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy

High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy

Comparison of three classification systems of Prepregnancy Body Mass Index with Perinatal Outcomes in Japanese Obese Pregnant Women: A retrospective study at a single center

Human Papillomavirus E6/E7 Expression in Preeclampsia-Affected Placentae

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