Abstract

Introduction: Globally hypertensive disorders during pregnancy (HDsP), affect around 10% pregnancies, with high chances of dangerous complications, even death during pregnancy birth and postpartum. They also cause fetal growth restriction (FGR), preterm births, low birth weight (LBW) and Perinatal deaths. Attempts need to be made to predict, prevent which presently have limitations.

Objectives: To look into challenges in prevention of HDsP, prevention of complications, mortality in mothers, babies.

Materials and Methods: Studies, reviews were looked into by available search engines to know what is being tried, challenges in prevention of HDsP, severity. Opinions were also looked into. Experiences were added.

Results: Etiology of HDsP is not yet fully understood, though literature indicates up regulation of inflammatory mediators produced by placenta. Many risk factors have been associated but many women do not have any obvious risk factor. Occurrence of HDsP one pregnancy does not predict HDsP in subsequent pregnancy but very preterm gestation at HDsP is associated with higher probability of HDsP in subsequent pregnancy. HDsP associated mortality is much higher in low income settings compared to high income. Quest for biomarkers for prediction continues. Various preventive mortalities are being tried.

Conclusion: Prevention of HDsP remains a great challenge, more so in developing countries with great need of low cost means for prevention. More research useful for global use is needed. Best of management is also a challenge and research needs to continue.

Keywords: Prevention; Hypertensive Disorders during Pregnancy; Challenges

References

1. WHO MEM and Count C. “The world health report”. Geneva: World Health Organization (2005).
2. Tuffnel lD., et al. “Outcomes of severe pre-eclampsia/clampsia in Yorkshire 1999/2003”. BJOG: An International Journal of Obstetrics and Gyaecology7 (2005): 875-880.
3. Engender Health. “Balancing the Scales: Expanding Treatment for Pregnant Woman with Life-threatening Hypertensive Conditions in Developing Countries. A Report on Barriers and Solutions to Treat Pre-eclampsia and Eclampsia”. New York: Engender Health (2007).
4. Subramaniam V. “Seasonal variation in the incidence of preeclampsia and eclampsia in tropical elimatic conditions”. BMC Womens Health 7 (2007): 18.
5. Khan KS., et al. “WHO analysis of causes o maternal death: a systematic review”. Lancet9516 (2006): 1066-1074.
6. Berhan Y and Berhan A. “Commentary: Actions in the pipeline and the way forward to reduce maternal and perinatal mortality in Ethiopia”. Ethiopian Journal of Health Sciences 24 (2014): 149-168.
7. Rudra P., et al. “Recent advances in management of pre-eclampsia”. British Journal of Medical Practitioners3 (2011): 14-22.
8. Delisle H., et al. “Should adolescents be specifically targeted for nutrition in developing countries? To address which problems, and how”. Bulletin of the World Health Organization (2001): 1-26.
9. Steegers EA., et al. “Pre- eclampsia”. Lancet9741 (2010): 631-644.
10. Staff AC., et al. “Pregnancy and long-term maternal cardiovascular health: progress through harmonization of research cohorts and biobanks”. Hypertension 67 (2016): 251-260.
11. Hung JY., et al. “Organization communication, job stress, organizational commitment, and job performance of accounting professionals in Taiwan and America”. Leadership and Organization Development Journal 27 (2006): 242-249.
12. Sason I and Shamai S. “Performance analysis of linear codes under maximum-likelihood decoding: A tutorial”. Foundations and Trends^® in Communications and Information Theory1-2 (2017): 1-222.
13. Roberts JM and Hubel CA. “The two stage model of preeclampsia: variations on the theme”. Placenta 30 (2009): 32-37.
14. Lecarpentier E., et al. “Urinary Placental Growth Factor for Prediction of Placental Adverse Outcomes in High-Risk Pregnancies”. Obstetrics and Gynecology6 (2019): 1326-1332.
15. Sasan SB., et al. “The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia”. Obstetrics and Gynecology International (2017): 8249264.
16. Hofmeyr GJ and Lawrie TA. “Pregnancy for preventing hypertensive disorders and related problems”. The Cochrane Database of Systematic Reviews 6 (2014): CD001059.
17. Cormick C. “Ultrasound guided therapeutic injections of the cervical spine and brachial plexus”. Australasian Journal of Ultrasound in Medicine 1 (2014): 11-19.
18. Sibai BM., et al. “Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother”. Hypertension6 (2009): 944-951.
19. Hofmeyr GJ., et al. “Prepregnancy and early pregnancy Calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial”. The Lancet10169 (2019): 330-339.
20. Hellmeyer L., et al. “Biochemical markers of bone turnover during pregnancy: a longitudinal study”. Experimental and Clinical Endocrinology and Diabetes09 (2006): 506-510.
21. Garg S., et al. “Inventors; Siebel Systems Inc, assignee”. Modeling of Order Data (2014).
22. Singh MC., et al. “The building information modelling trajectory in facilities management: A review”. Automation in Construction 75 (2017): 45-55.
23. Bujold D., et al. “The epiGenomic Efficient Correlator (epiGeEC) tool allows fast comparison of user datasets with thousands of public epigenomic datasets”. Bioinformatics 4 (2019): 674-676.
24. Tran NT., et al. “Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial”. The Lancet Global Health8 (2019): e1109-e1117.
25. Navaratnam K., et al. “Aspirin non-responsiveness in pregnant women at high-risk of pre-eclampsia”. European Journal of Obstetrics and Gynecology and Reproductive Biology 221 (2018): 144-150.
26. Mone F., et al. “Preeclampsia Prevention Using Routine Versus Screening Test–Indicated Aspirin in Low-Risk Women: A Cost-Effectiveness Analysis”. Hypertension6 (2018): 1391-1396.
27. Askieet P and Nahamya D. “Assessment of essential drug management in the public health facilities in Uganda”. (Doctoral dissertation, University of Cape Town) (2007).
28. Villar J., et al. “World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women”. American Journal of Obstetrics and Gynecology3 (2006): 639-649.
29. Chen J., et al. “PubChem 2019 update: improved access to chemical data”. Nucleic Acids Research1 (2019): D1102-D1109.
30. Der Simonian R., et al. “Prostacyclin and thromboxane changes predating clinical onset of preeclampsia: a multicenter prospective study”. The Journal of the American Medical Association 4 (1999): 356-362.
31. Trumbo PR and Ellwood KC. “Supplemental calcium and risk reduction of hypertension, pregnancy-induced hypertension, and preeclampsia: an evidence-based review by the US Food and Drug Administration”. Nutrition Reviews2 (2007): 78-87.
32. Xu Y., et al. “Self-assembled graphene hydrogel via a one-step hydrothermal process”. ACS Nano7 (2010): 4324-4330.
33. Purswani JM., et al. “The role of vitamin D in pre-eclampsia: a systematic review”. BMC Pregnancy Childbirth 1 (2017): 231.
34. Meher S and Duley L. “Nitric oxide for preventing pre‐eclampsia and its complications”. Cochrane Database of Systematic Reviews 2 (2007): CD00649.
35. Nahamya D. “Assessment of essential drug management in the public health facilities in Uganda” (2007).
36. Stephanie Braunthal and Andrei Brateanu. “Hypertension in pregnancy: Pathophysiology and treatment”. SAGE Open Medicine 7 (2019): 2050312119843700.
37. Hassan SS and Gomez-Lopez N. “Reducing maternal mortality: can elabela help in this fight?” Lancet10192 (2019): 8-9.
38. Liu Z., et al. “Soluble fms-like tyrosine kinase 1 and soluble endoglin are elevated circulating anti-angiogenic factors in pre-eclampsia”. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health4 (2012): 358-367.
39. Abera M “Effect of community level intervention on maternal health care utilization” (Doctoral dissertation (2015).
40. Bonzini M., et al. “Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review”. Occupational and Environmental Medicine4 (2007): 228-243.
41. Villar J., et al. “World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women”. American Journal of Obstetrics and Gynecology3 (2006): 639-649.
42. Miller D. “The generic strategy trap”. Journal of Business Strategy (1992).
43. Poon LC., et al. “The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention”. International Journal of Gynecology and Obstetrics 145 (219): 1-33.
44. Duley L. “The global impact of pre-eclampsia and eclampsia”. Seminars in Perinatology3 (2009): 130-137.
45. Redman CW and Sargent IL, “Staff AC IFPA Senior Award Lecture. Making sense of pre-eclampsia-two placental causes of preeclampsia?”. Placenta 35 (2014): S20-S25.
46. Rolnik DL., et al. “Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia”. The New England Journal of Medicine 377 (2017): 613-622.
47. Ziad M., et al. “Protective role of interleukin-10 in atherosclerosis”. Circulation Research8 (2019): e17-e24.