The hypertensive disorders of pregnancy: ISSHP classification, diagnosis &amp; management recommendations for international practice

Brown, Mark; Magee, Laura A.; Kenny, Louise C.; Karumanchi, S. Ananth; McCarthy, Fergus P.; Saito, Shigeru; Hall, David; Warren, Charlotte E.; Adoyi, Gloria; Ishaku, Salisu Mohammed

doi:10.1016/j.preghy.2018.05.004

Cited by 1,231 publications

(1,545 citation statements)

References 103 publications

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“…systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg) is a common problem, complicating nearly 10% of pregnancies . The spectrum of HDP is categorized as follows: chronic hypertension (elevated blood pressure before 20 weeks of pregnancy or persisting beyond 12 weeks after birth); gestational hypertension (new‐onset hypertension at or beyond 20 weeks of pregnancy); pre‐eclampsia (gestational hypertension coupled with proteinuria and/or end‐organ dysfunction); superimposed pre‐eclampsia with chronic hypertension …”

Section: Placental Syndromesmentioning

confidence: 99%

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

Sheiner

Kapur

Retnakaran

et al. 2019

Intl J Gynecology & Obste

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Section: Placental Syndromesmentioning

confidence: 99%

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

Sheiner

Kapur

Retnakaran

et al. 2019

Intl J Gynecology & Obste

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“…However, preeclampsia may present with or without severe features (Brown et al, 2018). However, preeclampsia may present with or without severe features (Brown et al, 2018).…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Association between preeclampsia and autism spectrum disorder: a population‐based study

Maher

O’Keeffe

Dalman

et al. 2019

Child Psychology Psychiatry

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Background The environmental contribution of autism spectrum disorder (ASD) is approximately 17%–50%, highlighting the importance of investigating factors potentially contributing to the likelihood of its development, and of gaining a greater understanding of the pathogenesis surrounding ASD. The objective of this study was to examine the association between preeclampsia and ASD using a population‐based cohort study. Methods All singleton live births in Sweden from 1982 to 2010 were included, using data from Swedish National Registers. Exposures of interest included: (a) preeclampsia (classified according to ICD‐8, ICD‐9 and ICD‐10) and (b) preeclampsia and small for gestational age (SGA) combined, used as a proxy for preeclampsia with placental dysfunction. ASD status was based on ICD‐9 and ICD‐10. The cohort consisted of 2,842,230 children, with 54,071 cases of ASD. Follow‐up began from the child's first birthday, and data were censored at first diagnosis of ASD, death, migration or end of study period (31st December 2016). We conducted multivariate Cox proportional hazards regression analysis, adjusting for several perinatal and sociodemographic factors, selected a priori. We further controlled for shared genetic and familial confounding using sibling‐matched analysis. Results In the adjusted Cox proportional hazards regression analysis, preeclampsia was associated with a 25% increase in the likelihood of ASD (Hazard Ratio (HR): 1.25, 95% CI:1.19, 1.30) compared with those unexposed to preeclampsia, while in the sibling‐matched analysis the HR was 1.17 (95% CI: 1.06, 1.28). The HR for preeclampsia and SGA combined was 1.66 (95% CI: 1.49, 1.85) in the adjusted Cox model and 1.95 (95% CI: 1.53, 2.48) in the sibling‐matched analysis. Conclusions Exposure to preeclampsia or preeclampsia/SGA (i.e. SGA baby exposed to preeclampsia) was associated with ASD. The stronger association with preeclampsia/SGA than preeclampsia alone suggests that placental pathology may be a mechanism for the increased likelihood of ASD.

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“…There is still controversy with some studies concluding that, on the contrary, it is not a proper diagnostic test, because of poor sensitivity and specificity or poor correlation with the 24HP due to the variety of results of the PCR over a 24‐hour period . Other studies determined that a PCR can be used but only as a “rule‐out” test (as the AUC is too low when comparing the PCR to the 24HP) or to assess the magnitude of proteinuria, especially in severe pre‐eclampsia, even if the rate of the PCR does not seem to be predictive of adverse pregnancy outcome …”

Section: Discussionmentioning

confidence: 99%

Spot urine protein‐to‐creatinine ratio as a diagnostic test in pre‐eclampsia: A gold standard?

Berthet¹,

Bartolo²,

Subtil³

et al. 2020

Intl J Gynecology & Obste

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Objective To determine the diagnostic accuracy and optimal threshold of the spot protein‐to‐creatinine ratio (PCR) compared to the gold standard, 24‐hour proteinuria (24HP) in patients with suspected pre‐eclampsia. Methods A prospective observational study was performed from June 2015 to May 2017 consisting of patients hospitalized for suspected pre‐eclampsia in a tertiary care referral center. To compare the two diagnostic tests, a spot urine sample was obtained to perform the PCR before starting the collection of the 24HP. Only patients who had both tests were analyzed. Results In total, 148 patients (216 samples) were included. The two tests were highly correlated (r=0.80, P<0.001). The receiver operating characteristic curve analysis and the area under the curve (AUC=0.92) highlighted the accuracy of PCR in diagnosing significant proteinuria and thus pre‐eclampsia. The optimal cut‐off using the Liu method was 56.9 mg/mmol (sensitivity=79.3%, specificity=91.5%). Conclusion The results suggest that PCR could replace 24HP when diagnosing proteinuria in pre‐eclampsia. Moreover, it is a simple test, easy to realize and standardize, and cheap with no need for systematic hospitalization. The best cut‐off should be chosen by thinking about the risks for adverse maternal and/or fetal outcomes. The test may help to optimize medical care in pre‐eclampsia worldwide.

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The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice

Cited by 1,231 publications

References 103 publications

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

FIGO (International Federation of Gynecology and Obstetrics) Postpregnancy Initiative: Long‐term Maternal Implications of Pregnancy Complications—Follow‐up Considerations

Association between preeclampsia and autism spectrum disorder: a population‐based study

Spot urine protein‐to‐creatinine ratio as a diagnostic test in pre‐eclampsia: A gold standard?

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