Maternal hypertensive disorders and subtypes of hypospadias: A Dutch case-control study.

BACKGROUND: Hypospadias is a frequently occurring congenital anomaly in male infants, in which the opening of the urethra is located along the ventral side of the penis. Although various studies attempted to identify its causes, the aetiology of the majority of hypospadias cases remains poorly understood. Maternal hypertensive disorders are believed to be associated with hypospadias, but the results of previous studies are not consistent, especially for subtypes of hypospadias. OBJECTIVES: To investigate the associations between maternal hypertensive disorders, stratified by pharmacological treatment, and the occurrence of hypospadias divided into subtypes in a large population-based case-control study. METHODS: We included 887 hypospadias cases and 1005 male controls from the AGORA data- and biobank. Cases and controls were born in the periods 1975-2016 and 1990-2011, respectively. All data were collected in the period 2004-2018. Maternal questionnaires were used to obtain information on hypertensive disorders during pregnancy, antihypertensive medication treatment, and potential confounders. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for the associations between hypertensive disorders and hypospadias were estimated using logistic regression. RESULTS: Hypertensive disorders were reported by 15.3% of the women in this study. Maternal hypertensive disorders in general, chronic hypertension, and gestational hypertension were not associated with hypospadias or its subtypes. Preeclampsia was associated with posterior hypospadias (aOR 3.09, 95% CI 1.49, 6.43), whether it was untreated (aOR 2.81, 95% CI 1.24, 6.38) or pharmacologically treated preeclampsia (aOR 4.96, 95% CI 1.08, 22.80). CONCLUSIONS: Our findings indicate that preeclampsia is associated with posterior hypospadias, irrespective of pharmacological treatment. This result supports the hypothesis of aetiological heterogeneity among the subtypes of hypospadias, with pregnancy-related risk factors being associated with the more severe types of hypospadias.

Data From Web-Based Questionnaires Were Valid for Gestational Diabetes and Preeclampsia, but Not Gestational Hypertension.

OBJECTIVES: We aimed to validate Web-based questionnaires for the common pregnancy complications gestational diabetes, gestational hypertension, and preeclampsia. STUDY DESIGN AND SETTING: We included 1,809 women participating in the PRegnancy and Infant DEvelopment (PRIDE) Study who delivered in 2012-2017, for whom relevant data were complete. Sensitivity, specificity, and positive and negative predictive values of self-reported diagnoses of gestational diabetes, gestational hypertension, and preeclampsia were determined using obstetric records as reference standard. Furthermore, we assessed whether maternal characteristics affected disagreement between questionnaires and obstetric record. RESULTS: For gestational diabetes and preeclampsia, we observed very few false-positive and false-negative reports, yielding sensitivities of 93% (95% confidence interval [CI] 86-100) and 88% (95% CI 79-98), respectively, and specificities of 100%. Depending on the definition of gestational hypertension, sensitivity and positive predictive values ranged from 62% to 89% and 53% to 64%, respectively. Disagreement on gestational hypertension was associated with prepregnancy overweight and multiparity. CONCLUSION: Self-reports of gestational diabetes and preeclampsia in Web-based questionnaires were valid, but the validity of gestational hypertension seemed to be lower because of relatively high numbers of false-positive reports. However, it is questionable whether an appropriate reference standard exists to validate this pregnancy complication.

Mobile Apps for Blood Pressure Monitoring: Systematic Search in App Stores and Content Analysis.

BACKGROUND: Using a mobile app for self-management could make it easier for patients to get insight into their blood pressure patterns. However, little is known about the availability, quality, and features of mobile apps targeting blood pressure. OBJECTIVE: The goal of the research was to determine the availability, functionality, and quality of mobile apps that could be used for blood pressure monitoring purposes. METHODS: A systematic app search was performed based on the standards for systematic reviews. We searched the Dutch official app stores for Android and iOS platforms using predefined keywords and included all English and Dutch mobile apps targeting blood pressure. Two independent assessors determined eligibility and quality of the apps using the 5-point Mobile App Rating Scale (MARS). Quality scores of the apps with and without 17 a priori selected characteristics were compared using independent sample t tests. RESULTS: A total of 184 apps (104 Android, 80 iOS) met the inclusion criteria. The mean overall MARS score was 2.63 (95% CI 2.55-2.71) for Android and 2.64 (95% CI 2.56-2.71) for iOS. The apps Bloeddruk (4.1) and AMICOMED BP (3.6) had the highest quality scores on the Android and iOS platforms, respectively. Of the app characteristics recorded, only pricing, in-app advertisements, and local data storage were not associated with the quality scores. In only 3.8% (7/184) of the apps, involvement of medical experts in its development was mentioned, whereas none of the apps was formally evaluated with results published in a peer-reviewed journal. CONCLUSIONS: This study provides an overview of the best apps currently available in the app stores and important key features for self-management that can be used by health care providers and patients with hypertension to identify a suitable app targeting blood pressure monitoring. However, the majority of the apps targeting blood pressure monitoring were of poor quality. Therefore, it is important to involve medical experts in the developmental stage of health-related mobile apps to improve the quality of these apps.