Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps.

Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.

Long-term impact of COVID-19 on nursing and care delivery: A national survey among anaesthetic and critical care nurses.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has put an exceptional strain on intensive care delivery and has significantly impacted nursing practice in the intensive care unit, consequently affecting nurses' working environment and health. Little is known about the long-term impact on the nursing workforce and care delivery in intensive care and anaesthetic departments. AIM/OBJECTIVE: This cross-sectional study aimed to describe the long-term impact of the COVID-19 pandemic on the nursing profession and nursing care from the perspectives of anaesthetic and critical care nurses. METHODS: In this study, an online questionnaire with open- and close-ended questions was distributed to registered nurses working in anaesthesia and intensive care between February 8 and March 7, 2022. The data were analysed using content analysis and descriptive statistics. RESULTS: Of the 514 registered nurses who responded to the questionnaire, 256 (50%) worked in anaesthesia care and 215 (42%) in intensive care. The long-term impact of COVID-19 was expressed in three categories: nursing care on hold, insights and experiences forming a new professional identity, and the impact of organisational conditions on the profession. Critical care nurses considered nursing care comparable to that before the COVID-19 pandemic. Nurse anaesthetics experienced changes in nursing tasks and activities compared to that before the COVID-19 pandemic. CONCLUSIONS: Nursing care is still influenced by the pandemic due to the lack of resources and persistent high workload and needs to be reclaimed and prioritised. Re-establishing high-quality nursing care is a shared responsibility of the organisation and nursing profession, and the organisation needs to create prerequisites for this. Furthermore, nurses' views and insights into their profession developed both positively and negatively during the pandemic, which must be further considered, including the profession's values.

Novel Associations Between Mid-Pregnancy Cardiovascular Biomarkers and Preeclampsia: An Explorative Nested Case-Control Study.

Prediction of women at high risk of preeclampsia is important for prevention and increased surveillance of the disease. Current prediction models need improvement, particularly with regard to late-onset preeclampsia. Preeclampsia shares pathophysiological entities with cardiovascular disease; thus, cardiovascular biomarkers may contribute to improving prediction models. In this nested case-control study, we explored the predictive importance of mid-pregnancy cardiovascular biomarkers for subsequent preeclampsia. We included healthy women with singleton pregnancies who had donated blood in mid-pregnancy (~ 18 weeks' gestation). Cases were women with subsequent preeclampsia (n = 296, 10% of whom had early-onset preeclampsia [< 34 weeks]). Controls were women who had healthy pregnancies (n = 333). We collected data on maternal, pregnancy, and infant characteristics from medical records. We used the Olink cardiovascular II panel immunoassay to measure 92 biomarkers in the mid-pregnancy plasma samples. The Boruta algorithm was used to determine the predictive importance of the investigated biomarkers and first-trimester pregnancy characteristics for the development of preeclampsia. The following biomarkers had confirmed associations with early-onset preeclampsia (in descending order of importance): placental growth factor (PlGF), matrix metalloproteinase (MMP-12), lectin-like oxidized LDL receptor 1, carcinoembryonic antigen-related cell adhesion molecule 8, serine protease 27, pro-interleukin-16, and poly (ADP-ribose) polymerase 1. The biomarkers that were associated with late-onset preeclampsia were BNP, MMP-12, alpha-L-iduronidase (IDUA), PlGF, low-affinity immunoglobulin gamma Fc region receptor II-b, and T cell surface glycoprotein. Our results suggest that MMP-12 is a promising novel preeclampsia biomarker. Moreover, BNP and IDUA may be of value in enhancing prediction of late-onset preeclampsia.

Comparing analog and digital neurocognitive tests with older adults: a study of the ISPOCD battery vs. a digital test battery from Mindmore.

BACKGROUND: Delayed neurocognitive recovery and neurocognitive disorder are common postoperative complications among older adults. The assessment of these complications traditionally relies on analog neurocognitive tests, predominantly using the test battery from the ISPOCD-study as the standard approach. However, analog tests are time-consuming and necessitate trained staff which poses limitations. The potential availability of a digital neurocognitive test as an alternative to the ISPOCD remains unknown. We conducted a comparative study between the analog test battery from ISPOCD and the self-administrated digital test battery developed by Mindmore. METHODS: We conducted a crossover study with 50 cognitively healthy older adults ≥ 60 years of age recruited in Stockholm Sweden, between February and April 2022. The primary outcome focused on measuring comparability between the two test batteries. Our secondary outcomes included assessing participants' perceptions and attitudes about the tests with qualitative interviews and their usability experiences. RESULTS: Fifty older adults, mean age 76, female 56%, with a university or college degree 48% participated in the study. The sub tests in two test batteries demonstrated a medium-large correlation (r = 0.3-0.5), except for one measure. For four out of six measures, significant differences were found with medium to large effect sizes, ranging from 0.57-1.43. Two categories were recognized in the qualitative analysis: self-competing in a safe environment, and experience with technology. Participants expressed feeling safe and at ease during the assessment, with some preferring the digital test over the analog. Participants reported a high level of usability with the digital test and a majority participants (n = 47) reported they would undergo the digital test for a potential future surgery. CONCLUSIONS: The digital test battery developed by Mindmore offers several advantages, including rapid access to test results, easy comprehension, and use for participants, thereby increased accessibility of cognitive screening. TRIAL REGISTRATION NUMBER: NCT05253612; ClinicalTrials.gov, 24/02/2022.

Pregnancy-associated cardiovascular risks and postpartum care; an opportunity for interventions aiming at health preservation and disease prevention.

Cardiovascular disease (CVD) is the leading cause of premature death and disability for female individuals around the world and the rates are increasing in those aged 35-44 years. Certain pregnancy complications (Pregnancy-associated Cardiovascular Risks (P-CVR))are linked to an increased risk of future CVD making pregnancy and the postpartum period as an ideal time to screen individuals for underlying, often unrecognized, cardiovascular risk factors. Pregnancy complications associated with an increased risk of future CVD including the hypertensive disorders of pregnancy, gestational diabetes, idiopathic preterm birth, delivery of a growth restricted baby and a placental abruption that leads to delivery. A number of guidelines and research groups recommend postpartum CVR screening, counseling and lifestyle intervention for all those who have had one or more of P-CVRs starting within the first six months postpartum. An individualized plan for postpartum screening should be created with the individual and lifestyle interventions discussed.

Can single-cell and spatial omics unravel the pathophysiology of pre-eclampsia?

Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality. Characterised by the onset of hypertension and proteinuria in the second half of pregnancy, it can lead to maternal end-organ injury such as cerebral ischemia and oedema, pulmonary oedema and renal failure, and potentially fatal outcomes for both mother and fetus. The causes of the different maternal end-organ phenotypes of pre-eclampsia and why some women develop pre-eclampsia condition early in pregnancy have yet to be elucidated. Omics methods include proteomics, genomics, metabolomics, transcriptomics. These omics techniques, previously mostly used on bulk tissue and individually, are increasingly available at a single cellular level and can be combined with each other. Multi-omics techniques on a single-cell or spatial level provide us with a powerful tool to understand the pathophysiology of pre-eclampsia. This review will explore the status of omics methods and how they can and could contribute to understanding the pathophysiology of pre-eclampsia.

Usability and feasibility of a digital cognitive screening tool measuring older adults' early postoperative neurocognitive recovery: a protocol for a pilot study.

INTRODUCTION: Delayed neurocognitive recovery, also identified as early postoperative cognitive decline (POCD), is a common complication after surgery, with advanced age being the most important risk factor. As the geriatric population is increasing worldwide, and number of older adults undergoing surgery continues to rise, so will the incidence of POCD. Only a small proportion use digital cognitive tests for measuring postoperative neurocognitive performance compared with analogue tests. This study aims to evaluate a digital cognitive screening tool, Mindmore Postoperative version (Mindmore-P), in a perioperative setting to determine its feasibility and usability, and to compare preoperative cognition with early postoperative neurocognitive performance. Further, to determine associations between neurocognitive performance and perioperative factors as well as to explore patients' experiences of early neurocognitive recovery. METHODS AND ANALYSIS: We will include 50 patients (aged ≥60 years) undergoing elective abdominal surgery under general anaesthesia. Cognitive functions will be measured with Mindmore-P preoperatively and on postoperative day (POD) 1 or 2 as well as 2-3 weeks after surgery. Preoperatively, frailty, (Clinical Frailty Scale), depression (Geriatric Depression Scale-15), functional status (12-item WHO Disability Assessment Schedule 2.0) and pre-recovery status (Swedish web version Quality of Recovery Scale, SwQoR) will be measured. Delirium will be assessed by Nu-DESC (Nursing Delirium Screening Scale) twice a day, with start on POD 1 and until the patient is discharged from the hospital. Outcomes at 2-3 weeks postoperatively are postoperative recovery (SwQoR), depression, functional status and usability (System Usability Scale) of Mindmore-P. Postoperative recovery will also be measured POD 1 or 2. We will also explore feasibility and experience of early postoperative neurocognitive recovery with interviews approximately 1 month after surgery. ETHICS AND DISSEMINATION: This study is approved by the Swedish Ethical Review Authority (REC Reference: 2022-03593-01) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and in social media. TRIAL REGISTRATION NUMBER: NCT05564195.

Comparing the results from a Swedish pregnancy cohort using data from three automated placental growth factor immunoassay platforms intended for first-trimester preeclampsia prediction.

INTRODUCTION: Risk evaluation for preeclampsia in early pregnancy allows identification of women at high risk. Prediction models for preeclampsia often include circulating concentrations of placental growth factor (PlGF); however, the models are usually limited to a specific PlGF method of analysis. The aim of this study was to compare three different PlGF methods of analysis in a Swedish cohort to assess their convergent validity and appropriateness for use in preeclampsia risk prediction models in the first trimester of pregnancy. MATERIAL AND METHODS: First-trimester blood samples were collected in gestational week 11+0 to 13+6 from 150 pregnant women at Uppsala University Hospital during November 2018 until November 2020. These samples were analyzed using the different PlGF methods from Perkin Elmer, Roche Diagnostics, and Thermo Fisher Scientific. RESULTS: There were strong correlations between the PlGF results obtained with the three methods, but the slopes of the correlations clearly differed from 1.0: PlGFPerkinElmer = 0.553 (95% confidence interval [CI] 0.518-0.588) * PlGFRoche -1.112 (95% CI -2.773 to 0.550); r = 0.966, mean difference -24.6 (95% CI -26.4 to -22.8). PlGFPerkinElmer = 0.673 (95% CI 0.618-0.729) * PlGFThermoFisher -0.199 (95% CI -2.292 to 1.894); r = 0.945, mean difference -13.8 (95% CI -15.1 to -12.6). PlGFRoche = 1.809 (95% CI 1.694-1.923) * PlGFPerkinElmer +2.010 (95% CI -0.877 to 4.897); r = 0.966, mean difference 24.6 (95% CI 22.8-26.4). PlGFRoche = 1.237 (95% CI 1.113-1.361) * PlGFThermoFisher +0.840 (95% CI -3.684 to 5.363); r = 0.937, mean difference 10.8 (95% CI 9.4-12.1). PlGFThermoFisher = 1.485 (95% CI 1.363-1.607) * PlGFPerkinElmer +0.296 (95% CI -2.784 to 3.375); r = 0.945, mean difference 13.8 (95% CI 12.6-15.1). PlGFThermoFisher = 0.808 (95% CI 0.726-0.891) * PlGFRoche -0.679 (95% CI -4.456 to 3.099); r = 0.937, mean difference -10.8 (95% CI -12.1 to -9.4). CONCLUSION: The three PlGF methods have different calibrations. This is most likely due to the lack of an internationally accepted reference material for PlGF. Despite different calibrations, the Deming regression analysis indicated good agreement between the three methods, which suggests that results from one method may be converted to the others and hence used in first-trimester prediction models for preeclampsia.

Validity and reliability of the swedish versions of the HLS-EU-Q16 and HLS-EU-Q6 questionnaires.

BACKGROUND: Health Literacy is a crucial factor for health. In Europe, many people have limited health literacy (i.e. difficulties with accessing, understanding, appraising and using health information). This study aimed to evaluate the psychometrics of the Swedish versions of the HLS-EU-Q16 and HLS-EU-Q6, instruments that aims to assess health literacy. METHODS: In this prospective psychometric study convenience sampling was used, which gave a study population of 347 Swedish-speaking adults. The psychometric evaluation included item distributional statistics, construct validity testing, and principal component analysis to assess structural validity. Internal consistency and test-retest reliability was also investigated. RESULTS: For the Swedish version of HLS-EU-Q16, no floor effects were detected but a ceiling effect was noted among 28% of the respondents. Construct validity was supported as four out of five expected correlations was confirmed (educational level, self-perceived health, electronic health literacy and HLS-EU-Q6). In terms of structural validity, the principal component analysis yielded a four-factor structure with most items loading significantly only to one factor. The Swedish version of HLS-EU-Q16 had acceptable internal consistency (Cronbach's α = 0.89, split-half reliability = 0.93) and test-retest reliability showed stability over time (Cohen's κ = 0.822). For the Swedish version of HLS-EU-Q6, neither floor nor ceiling effects were observed. Construct validity was supported as HLS-EU-Q6 correlated as our a priori stated hypothesis. The principal component analysis did not support the unidimensionality of the scale as a two-factor structure was identified. The Swedish version of HLS-EU-Q6 had acceptable internal consistency (Cronbach's α = 0.77, split-half reliability = 0.80) and test-retest reliability showed stability over time (Cohen's κ = 0.812). According to the Swedish version of the HLS-EU-Q16, 71% of the participants were classified as having sufficient comprehensive health knowledge (CHL), while only 33% were classified as having this when the HLS-EU-Q6 was used. CONCLUSIONS: The Swedish versions of the HLS-EU-Q16 and HLS-EU-Q6 have acceptable psychometric properties, and based on the results we recommend its use to measure CHL. However, we are hesitant to use Sw-HLS-EU-Q6 in estimating different CHL levels and further studies need to be conducted to establish validity and accuracy of the thresholds of HLS-EU-Q6.

The experience of being a partner to a childbearing woman whose pregnancy is complicated by pre-eclampsia: A Swedish qualitative study.

BACKGROUND: Pre-eclampsia affects 3-5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia. AIM: To describe partners' experience of having a spouse whose pregnancy was complicated by pre-eclampsia. METHODS: A qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis. FINDINGS: Partners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced. CONCLUSION: Having a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.

Circulating Chemerin Is Elevated in Women With Preeclampsia.

BACKGROUND: Preeclampsia is a severe complication of pregnancy. Chemerin is an adipokine secreted from adipose tissue and highly expressed in placenta. This study evaluated the biomarker potential of circulating chemerin to predict preeclampsia. METHODS: Maternal plasma and placenta were collected from women with early-onset preeclampsia (<34 weeks), with preeclampsia and eclampsia, or before preeclampsia diagnosis (36 weeks). Human trophoblast stem cells were differentiated into syncytiotrophoblast or extravillous trophoblasts across 96 hours. Cells were cultured in 1% O2 (hypoxia) or 5% O2 (normoxia). Chemerin was measured by enzyme-linked immunosorbent assay (ELISA) and RARRES2 (gene coding chemerin) by reverse transcription-quantitative polymerase chain reaction. RESULTS: Circulating chemerin was increased in 46 women with early-onset preeclampsia (<34 weeks) compared to 17 controls (P < .0006). Chemerin was increased in placenta from 43 women with early-onset preeclampsia compared to 24 controls (P < .0001). RARRES2 was reduced in placenta from 43 women with early-onset preeclampsia vs 24 controls (P < .0001). Chemerin was increased in plasma from 26 women with established preeclampsia (P = .006), vs 15 controls. Circulating chemerin was increased in 23 women who later developed preeclampsia vs 182 who did not (P = 3.23 × 10-6). RARRES2 was reduced in syncytiotrophoblast (P = .005) or extravillous trophoblasts (P < .0001). Hypoxia increased RARRES2 expression in syncytiotrophoblast (P = .01) but not cytotrophoblast cells. CONCLUSIONS: Circulating chemerin was elevated in women with early-onset preeclampsia, established preeclampsia, and preceding preeclampsia diagnosis of preeclampsia. RARRES2 was dysregulated in placenta complicated by preeclampsia and may be regulated through hypoxia. Chemerin may have potential as a biomarker for preeclampsia but would need to be combined with other biomarkers.

Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies - A systematic review and meta-analyses.

Background: Preterm birth is the leading cause of childhood mortality and morbidity. We aimed to provide a comprehensive systematic review on randomized controlled trials (RCTs) on progesterone, cerclage, pessary, and acetylsalicylic acid (ASA) to prevent preterm birth in asymptomatic women with singleton pregnancies defined as risk of preterm birth and multifetal pregnancies. Methods: Six databases (including PubMed, Embase, Medline, the Cochrane Library) were searched up to February 2022. RCTs published in English or Scandinavian languages were included through a consensus process. Abstracts and duplicates were excluded. The trials were critically appraised by pairs of reviewers. The Cochrane risk-of-bias tool was used for risk of bias assessment. Predefined outcomes including preterm birth, perinatal/neonatal/maternal mortality and morbidity, were pooled in meta-analyses using RevMan 5.4, stratified for high and low risk of bias trials. The certainty of evidence was assessed using the GRADE approach. The systematic review followed the PRISMA guideline. Results: The search identified 2,309 articles, of which 87 were included in the assessment: 71 original RCTs and 16 secondary publications with 23,886 women and 32,893 offspring. Conclusions were based solely on trials with low risk of bias (n = 50).Singleton pregnancies: Progesterone compared with placebo, reduced the risk of preterm birth <37 gestational weeks: 26.8% vs. 30.2% (Risk Ratio [RR] 0.82 [95% Confidence Interval [CI] 0.71 to 0.95]) (high certainty of evidence, 14 trials) thereby reducing neonatal mortality and respiratory distress syndrome. Cerclage probably reduced the risk of preterm birth <37 gestational weeks: 29.0% vs. 37.6% (RR 0.78 [95% CI 0.69 to 0.88]) (moderate certainty of evidence, four open trials). In addition, perinatal mortality may be reduced by cerclage. Pessary did not demonstrate any overall effect. ASA did not affect any outcome, but evidence was based on one underpowered study.Multifetal pregnancies: The effect of progesterone, cerclage, or pessary was minimal, if any. No study supported improved long-term outcome of the children. Conclusion: Progesterone and probably also cerclage have a protective effect against preterm birth in asymptomatic women with a singleton pregnancy at risk of preterm birth. Further trials of ASA are needed. Prevention of preterm birth requires screening programs to identify women at risk of preterm birth. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234946].

Validity and reliability of the arabic version of the HLS-EU-Q16 and HLS-EU-Q6 questionnaires.

BACKGROUND: Health literacy is an important social determinant of health and affects the ability to make decisions and take action to manage one's health. The purpose of this study was to psychometrically examine the Arabic versions of HLS-EU-Q16 and HLS-EU-Q6 and their response patterns among Arabic-speaking persons in Sweden. METHODS: By convenience sampling from a variety of settings, a total of 335 participants were invited to participate. The participants completed a self-assessment of comprehensive health literacy by answering the Ar-HLS-EU-Q16 questionnaire, also including the six items for Ar-HLS-EU-Q6. Statistical analysis was guided by The COnsensus-based Standards for the selection of health Measurement Instruments. Floor/ceiling effects, construct, structural and criterion validity, test-retest reliability and internal consistency reliability were analysed. RESULTS: In total, 320 participants were included in the psychometric evaluation. Mean age was 42.1 (SD 12.5), 63% (n = 199) were females and 53% (n = 169) had at least 10 years of education. No floor or ceiling effect were found for the Ar-HLS-EU-Q16 or Ar-HLS-EU-Q6. For both instruments, construct validity was confirmed in four out of five expected correlations (weak positive correlation to educational level, self-perceived health, and years in Sweden; moderate positive correlation with higher sum score on the Arabic electronic health literacy scale, and strong positive correlation to higher Ar-HLS-EU-Q16/Ar-HLS-EU-Q6). For Ar-HLS-EU-Q16, the principal component analysis resulted in a three-factor model with all items significantly correlating to only one factor. For Ar-HLS-EU-Q6, the principal component analysis supported a one-factor solution. Criterion validity showed poor agreement between the two questionnaires with a Cohen κ 0.58 (p < 0.001). Test-retest reliability showed a substantial agreement, Cohen's κ for Ar-HLS-EU-Q16 and Ar-HLS-EU-Q6 were both 0.89. The internal consistency of both versions was acceptable, Cronbach alpha for Arabic-HLS-EU-Q16 was 0.91 and for Arabic-HLS-EU-Q6, 0.79. Split-half reliability was 0.95 and 0.78, respectively. CONCLUSION: The Arabic version of HLS-EU-Q16 shows good psychometric properties, validated in a Swedish setting. The findings can further inform and guide future validation studies in other settings worldwide. Furthermore, the results of the present study did not support criterion validity of Ar-HLS-EU-Q6.

Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice.

Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

Management of obesity across women's life course: FIGO Best Practice Advice.

Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.

Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals.

The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.