Effect of daily physical activity on ambulatory blood pressure in pregnant women with chronic hypertension: A prospective cohort study protocol.

BACKGROUND: Physical activity, a first-line approach for the treatment of non-gestational hypertension globally, has been shown to benefit most pregnant women in many respects. The benefits and risks of prenatal physical activity in complicated pregnancies, such as preeclampsia and chronic hypertension, require further investigation. It is worth conducting studies to address questions about physical activity during pregnancy in women with chronic hypertension, such as the benefits and risks, frequency, duration, and intensity. This prospective cohort study aims to investigate whether moderate-intensity daily physical activity reduces ambulatory blood pressure in pregnant women with chronic hypertension. METHODS: Pregnant women with chronic hypertension at 11+0 to 13+6 gestational weeks will be recruited from the outpatient clinic and divided into moderate- and light-intensity physical activity groups according to the intensity of the 7-day physical activity monitored using the model wGT3X-BT accelerometer. 24-h ambulatory blood pressure monitoring will be performed at enrollment as a baseline and will be repeated in the second and third trimesters. The primary outcome is the difference in the change in 24-h ambulatory systolic blood pressure from the first to the third trimester between the groups. Secondary outcomes include the difference of change in other ambulatory (24-h diastolic, daytime, and nighttime) and office blood pressure variables from the first to the second and third trimesters, the incidence of severe hypertension (≥160/110 mmHg), and changes in the type and dosage of antihypertensive medication. The primary and secondary outcomes related to changes in blood pressure from baseline to the second and third trimesters between the groups will be analyzed using Student's independent t-test or the Mann-Whitney U test. DISCUSSION: This cohort study will provide a basis for randomized controlled trials and verify an easily achieved, economical, and non-fetotoxic approach for adjuvant blood pressure management in pregnant women with chronic hypertension. REGISTRY: This study is registered with the Chinese Clinical Trials Registry (NO. ChiCTR2200062094). Date Registered: 21/07/2022.

Association between hypoproteinaemia with massive proteinuria and small for gestational age in pre-eclampsia: a single-centre, retrospective cohort study using propensity score matching.

OBJECTIVE: To investigate the association between hypoproteinaemia with massive proteinuria and the incidence of small for gestational age in pre-eclampsia. DESIGN: Retrospective cohort study using propensity score matching. SETTING: Northwest Women's and Children's Hospital in Shaanxi Province, China, using data from January 2016 to December 2021. PARTICIPANTS: Patients diagnosed with pre-eclampsia were grouped into the massive proteinuria group if the maximum proteinuria was >3.5 g/day and the minimum serum albumin was <30 g/L; otherwise, they were placed in the control group. OUTCOME MEASURES: The primary outcome was the incidence of small for gestational age infants. Secondary outcomes included fetal death, admission to the neonatal intensive care unit, a 5 min APGAR score <7, severe small for gestational age, fetal growth restriction, birth weight, premature birth, and maternal outcomes such as eclampsia, encephalopathy, placental abruption, haemolysis, elevated liver enzymes and low platelet syndrome, heart failure and retinal detachment. RESULTS: In total, 468 patients (234 from each group) were included, and the groups were well matched. The incidences of small for gestational age (33.76% vs 20.51%, OR 1.646, 95% CI 1.208 to 2.243, p=0.001), severe small for gestational age (14.70% vs 7.69%, OR 1.833, 95% CI 1.063 to 3.162, p=0.026), fetal growth restriction (23.93% vs 16.24%, OR 1.474, 95% CI 1.018 to 2.133, p=0.038), and the numbers of infants admitted to the neonatal intensive care unit (67.52% vs 58.55%, OR 1.153, 95% CI 1.003 to 1.326, p=0.044) were significantly higher in patients with hypoproteinaemia and massive proteinuria than in the control group. In addition, the median birth weight was significantly lower in the massive proteinuria group. There were no significant differences in maternal outcomes except for renal parameters, which were worse in the massive proteinuria group. CONCLUSION: Hypoproteinaemia with massive proteinuria was associated with fetal growth and a higher incidence of small for gestational age infants in pre-eclampsia.

Effect of Dexmedetomidine on Cardiac Output among Parturient with Severe Preeclampsia after Cesarean Section.

This study was to investigate the hemodynamic effect of dexmedetomidine among parturient with severe preeclampsia after cesarean section. Parturient with severe preeclampsia were randomly allocated to receive dexmedetomidine (0.2-0.7 µg/kg/h) or equivalent volumes of 0.9% saline as control after cesarean section, respectively. A total of 36 parturient with severe preeclampsia were enrolled, including 18 in the dexmedetomidine (DEX) group and 18 in the saline group. Compared with the saline group, among those in the DEX group, CO was reduced by 1.30 L/min (95% CI: -2.36 to 0.25; P = 0.019). Additionally, HR (-13.79 bpm, 95% CI: -22.02 to -5.58; P = 0.002), SBP (-16.11 mmHg, 95% CI: -30.56 to -1.66; P = 0.030), DBP (-10.48 mmHg, 95% CI: -18.27 to -2.69; P = 0.002), and MAP (-12.36 mmHg, 95% CI: -22.05 to -2.66; P = 0.014) were reduced in the DEX group compared with the saline group. In contrast, there were no changes observed in SV and ICON between groups. In conclusion, dexmedetomidine reduces cardiac output by inhibiting the acceleration of heart rate without sacrificing myocardial contractility and stroke volume.

lncRNA FAM99A is downregulated in preeclampsia and exerts a regulatory effect on trophoblast cell invasion, migration and apoptosis.

Preeclampsia (PE) is a complication of pregnancy, and a leading cause of maternal mortality and morbidity worldwide. Recently, the dysregulation of long non­coding RNAs (lncRNAs) has been reported to contribute to the pathogenesis and progression of PE. This study aimed to examine the alterations in the lncRNA family with sequence similarity 99 member A (FAM99A) in PE and its effects on trophoblasts. The results of reverse transcription­quantitative PCR indicated that the expression levels of FAM99A were downregulated in placental tissues from women with severe PE compared with in those from controls. A Transwell invasion assay and wound healing assay revealed that overexpression of FAM99A promoted invasion and migration of HTR­8/SVneo cells; conversely, knockdown of FAM99A suppressed the invasive and migratory abilities of HTR­8/SVneo cells. Flow cytometry demonstrated that FAM99A overexpression induced a decrease in the apoptotic rate of cells, whereas knockdown of FAM99A increased the apoptotic rate of HTR­8/SVneo cells. Western blot analysis revealed that overexpression of FAM99A decreased the protein expression levels of cleaved caspase­3, cleaved caspase­9 and Bax, and increased Bcl­2 protein expression, whereas knockdown of FAM99A had the opposite effects on these protein levels. Overexpression of FAM99A also decreased caspase­3 activity in HTR­8/SVneo cells; however, knockdown of FAM99A increased caspase­3 activity. In addition, overexpression of FAM99A enhanced Wnt/ß­catenin signaling activity, whereas FAM99A knockdown exerted an inhibitory effect on the Wnt/ß­catenin signaling activity in HTR­8/SVneo cells. In conclusion, these results indicated that FAM99A may serve a role in modulating the functions of trophoblasts, partially via targeting Wnt/ß­catenin signaling.