Aim: To evaluate postpartum blood pressure (BP) and renal function across the following subtypes of hypertensive disorders of pregnancy (HDP): gestational hypertension (GH), preeclampsia (PE) or superimposed preeclampsia (SPE), and chronic hypertension (CH). Methods: Dara from two studies in the Japan Birth Cohort Consortium were used: Tohoku Medical Megabank Project Birth and Three-Generation (TMM BirThree) Cohort Study and the Babies and their parents' longitudinal Observation in Suzuki memorial Hospital in Intrauterine period (BOSHI) study. The TMM BirThree Cohort Study measured casual BP in 2,948 women and blood urea nitrogen (BUN) and creatinine (Cr) levels in 2,937 women (7.1 +/- 1.0 years postpartum). The BOSHI study assessed home BP values obtained from 280 women and BUN and Cr levels measured in 221 women (8.0 +/- 0.7 years). BP, BUN, and Cr values were analyzed using analysis of covariance. Results: Women with CH exhibited higher casual and home systolic and diastolic BP values than women with normotension, GH, and PE/SPE. In both cohorts, women with PE/SPE maintained higher BUN and Cr levels than those with normotension, GH, or CH. Conclusions: Overall, pregnant women with CH exhibited higher casual and home BP values than those with other HDP subtypes, while those with PE/SPE showed elevated BUN and Cr levels.
Introduction: Orexin is a hypothalamic neuropeptide involved in the regulation of appetite, arousal, blood pressure, and vascular function. Psychological stress has been reported to activate the orexin system and influence cardiovascular regulation. Hypertensive disorders of pregnancy (HDP) are characterized by increased psychological stress, oxidative stress, and vascular endothelial dysfunction, making HDP a suitable clinical condition to investigate potential interactions among these factors during pregnancy. However, the relationship between orexin, psychological stress, and pregnancy-related vascular dysfunction remains unclear. This prospective observational study investigated whether plasma orexin levels are associated with psychological stress, oxidative stress, and vascular endothelial dysfunction in women with HDP. Methods: Twenty-one pregnant women diagnosed with HDP after 20 weeks of gestation and ten normotensive pregnant women were enrolled. Plasma orexin levels, psychological stress assessed by the Perceived Stress Scale (PSS), vascular oxidative stress measured using diacron-reactive oxygen metabolites (d-ROMs), and endothelial function evaluated by flow-mediated dilation (FMD) of the brachial artery were assessed. Results: Plasma orexin levels were significantly higher in the HDP group than in the Control group (median [interquartile range]: 3.26 [3.11-3.72] vs. 2.86 [2.21-2.95], P= 0.002). Plasma orexin levels were inversely correlated with FMD (R=- 0.494, P= 0.037) and positively correlated with d-ROM levels (R = 0.567, P= 0.009). Conclusions: Plasma orexin levels are elevated in pregnant women with HDP and are associated with psychological stress and vascular oxidative stress, suggesting a potential role for orexin in vascular endothelial dysfunction in HDP.
Aim: A questionnaire survey was conducted by the scientific committee of the Japan Society for the Study of Hypertension in Pregnancy (JSSHP) to identify any discrepancies or issues with actual clinical practice regarding the revised definitions and classifications of hypertensive disorders of pregnancy in Japan in 2018. Methods: We distributed anonymous questionnaires to 623 members of the JSSHP between August and September 2022, and responses were collected using Google Forms. Results: Valid responses were obtained from 193 physicians. 71.8% of physicians requested the addition of pulmonary edema to maternal organ damage. Most physicians answered that a low platelet count <100,000/mu l was appropriate as the diagnostic reference value and that the level of proteinuria was a necessary criterion for severity. Exclusion factors for fetal growth restriction (FGR) due to preeclampsia or superimposed preeclampsia varied among physicians. 74.3% of physicians responded that atypical hypertension needs to be added to the definitions. Conclusions: The inclusion of pulmonary edema in the list of maternal organ damage, the diagnostic reference value of a low platelet count, and the inclusion of proteinuria in the severe criteria need to be reconsidered. Future challenges include standardizing diagnostic methods for FGR due to preeclampsia and defining atypical preeclampsia.
In 2024, the Safe Beginnings: 1st Regional Conference on Maternal and Child Health (MCH) was held in the Calabarzon Region of the Philippines, in partnership with the 14th International Conference on the MCH Handbook. This conference emphasized the role of the MCH Handbook in ensuring continuum of care by supporting pregnant women and their families. It brought together experts and stakeholders for MCH from across the globe, where the progress of implementing the MCH handbook in 18 different countries was discussed, and the Manila Declaration was formally released as part of the mandate to strengthen collaboration towards sustainable MCH handbook programs for improved MCH outcomes. Then in May 2025, the online seminar Global Updates on Maternal and Child Health (MCH) and the MCH Handbook, and was held to follow through on the agreements reached during the 14th international conference. Developments on MCH handbook implementation were discussed by representatives from the Philippines, Japan, Indonesia and the United States. Indonesia was also announced as the venue of the 15th International Conference on the MCH Handbook.
Background: Preeclampsia is a pregnancy-related hypertensive disorder that greatly increases maternal and perinatal morbidity and mortality, especially in primigravida women. L-arginine, a nitric oxide precursor, may enhance endothelial function and reduce blood pressure. This study investigates its effectiveness in preventing preeclampsia among primigravida women at increased risk. Methods: This one-year quasi-experimental study included 100 primigravida women (aged 18-40, at 13 weeks' gestation) with a family history of hypertensive disorders. Participants were randomly divided into two groups of 50. Group A received 1,000 mg of L-arginine daily plus standard antenatal care; Group B received standard care only. Follow-up occurred every four weeks until delivery, monitoring blood pressure, urine protein, and side effects. Outcomes included preeclampsia, maternal, and neonatal complications. Statistical analysis used t-tests and Chi-square tests. Results: The incidence of preeclampsia was lower in the intervention group (12%) than in the control group (28%), though this difference did not reach statistical significance (P= 0.06). Mean gestational age at delivery was significantly higher in the intervention group (37.70 +/- 1.52 vs. 36.04 +/- 2.24 weeks; P< 0.001), with considerably lower rates of preterm birth (34% vs. 74%; P< 0.001) and higher birth weight (2,916.02 +/- 455.11 vs. 2,735.24 +/- 424.49 g; P= 0.04). Vaginal delivery was more frequent (80% vs. 60%; P= 0.04), and blood pressure at delivery was significantly lower (P< 0.001). No serious adverse effects were reported. Conclusion: L-arginine supplementation as a routine antenatal care appears to be a safe and effective approach to lowering the risk of preeclampsia in primigravida women. Its early use may provide a valuable, non-pharmacological preventive strategy within standard prenatal care practices
Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening thrombotic microangiopathy caused by dysregulated complement activation. Pregnancy-associated aHUS (p-aHUS), which frequently develops postpartum, can lead to acute kidney injury. However, long-term outcomes, including subsequent pregnancies, remain poorly described. We report a 24-year-old primiparous woman who developed p-aHUS three days after cesarean delivery at 41 weeks' gestation. She presented with thrombocytopenia, hemolytic anemia, and acute kidney injury. Plasma exchange was initiated, resulting in hematologic and renal recovery by postpartum day 12. Genetic testing revealed a heterozygous missense variant in the C3 gene, classified as a variant of uncertain significance. Despite not receiving complement inhibition therapy, her renal function remained stable. She experienced no recurrence during a subsequent pregnancy three years later and had normal renal function at 10-year follow-up. This case suggests that long-term renal preservation is achievable, with successful subsequent pregnancy, in selected p-aHUS patients even without complement inhibition.
Aim: This study aimed to determine the number and profile of traditional and alternative health care (TAHC) practitioners catering to women's need in Basilan, Philippines. Methods: A descriptive cross-sectional study design was employed, using cluster sampling to select half of Basilan's municipalities, including Lamitan City. All barangays in the selected areas were surveyed, and community health workers assisted in identifying and locating practitioners. Data collectors interviewed those who met the inclusion criteria, with this publication focusing specifically on TAHC practitioners who served women. Results: In the province of Basilan, 861 TAHC practitioners were profiled, of whom 160 (19.1%) provided services to pregnant women. They used oils, balms, and plant-based remedies to address mild conditions and positioned the fetus inside the womb. Most practitioners were females aged 50-59 years, with limited formal education and an average of 22 years of practice, primarily receiving voluntary donations for their services. Conclusions: The findings of this study highlight the significant role of TAHC practitioners in Basilan and emphasize the need for comprehensive data collection to effectively integrate their services into the public health system and address health workforce gaps.
Aim: This study aimed to assess the use of the Maternal and Child Health (MCH) handbook in Indonesia and explore its potential for promoting integrated oral health care education for pregnant women and mothers of under-five children. Methods: A survey was conducted at Puskesmas Pesanggrahan (public health center) to assess MCH handbook use, oral care behaviors, and attitudes toward oral health messages, complemented by the key informant interviews with representatives of the Ministry of Health and supporting data from relevant directorates. Descriptive and thematic analyses were used to interpret survey findings and national program insights. Results: Most respondents owned and used the MCH handbook, with pregnant women showing higher engagement than mothers of under-five children. While oral care practices were generally good among adult respondents, gaps in early childhood oral hygiene, knowledge, and dental service utilization were evident, highlighting the need for strengthened maternal awareness and health education. Conclusions: The MCH handbook is a valuable tool for promoting oral health, but its potential is not fully maximized. Strengthening its use through targeted health education may improve early childhood oral care practices and service uptake.
Aims: The place of residence influences the occurrence of adverse birth outcomes, and understanding disparities in adverse birth outcomes between rural and urban areas is crucial for designing targeted interventions and improving maternal and neonatal health outcomes. Methods: A scoping review using five databases, including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PubMed, and Web of Science, was conducted to evaluate the association between the place of residence (rural and urban areas) and adverse birth outcomes. Results: A total of 15 studies met the inclusion criteria and were included in this review. Nine adverse birth outcomes (preterm birth, low birth weight, small for gestational age, perinatal death, stillbirth, neonatal death, large for gestational age, cesarean section, and miscarriage) were reported to have higher rates in rural versus urban communities. Conclusions: Inadequate access to antenatal care services and limited healthcare facilities were identified as potential factors contributing to the higher likelihood of adverse birth outcomes in rural areas. Targeted interventions tailored to the specific challenges faced by rural communities should be implemented to ensure equitable access to healthcare services and optimal maternal and neonatal health.
Aim: The study examined the policies, systems, and procedures for pregnancy registration in 10 local government units (LGUs) within Quezon Province, a Universal Health Care (UHC) implementation site in Calabarzon. Methods: This descriptive, cross-sectional study employed a mixed quantitative and qualitative design to examine the policy environment and identify gaps in pregnancy registration in Quezon Province as a UHC implementation site. Key informant interviews, focus group discussions, and surveys were conducted to identify factors that either facilitate or impede the timing of pregnancy registration. Results: Analysis revealed deficiencies in the current pregnancy registration process. Key findings indicate that women with four or more pregnancies, or those with three or more childbirths, are more likely to delay seeking antenatal care (ANC) at healthcare facilities. Conversely, women who acknowledge significant barriers to accessing ANC tend to have a lower odds of experiencing delays. These barriers include health system-related issues, accessibility issues, and sociodemographic factors. Conclusion: The findings underscore the need to implement comprehensive policies aimed at institutionalizing and enhancing the pregnancy registration process. A streamlined and accessible process can significantly improve healthcare access for pregnant women, particularly in underserved communities. This, in turn, can foster an environment where expectant mothers receive timely prenatal care, education, and support throughout their pregnancy journey.
Introduction: Recently, pregnancy and lactation-related osteoporosis has been the focus of research because age at delivery has been increasing in developed countries and osteoporosis reduce a mother's quality of life. This study aimed to investigate bone mineral density (BMD) in women at delivery and one-month postpartum using radiofrequency echographic multi-spectrometry (REMS) and to determine the clinical factors affecting BMD. Materials and methods: Seventeen women with singleton term pregnancies who cared at Keio University Hospital between November 1 and December 31, 2022, were included. We measured the estimated BMD (eBMD) of the right femoral neck using REMS at delivery and one-month postpartum. We evaluated the association between eBMD and maternal clinical characteristics. Results: Postpartum eBMD (0.68 +/- 0.06 g/cm2) was significantly higher than antepartum eBMD (0.66 +/- 0.06 g/ cm(2)) (P= 0.02). There was a positive correlation between pre-pregnancy body mass index (BMI) and antepartum eBMD (rho = 0.85, P< 0.01). Antepartum and postpartum eBMDs were significantly lower in multiparous women than in nulliparous women (both P= 0.04). Calcium intake and breastfeeding did not affect postpartum eBMD. Conclusion: eBMD increases at the one month postpartum compared to that at delivery. Pre-pregnancy BMI is crucial for maintaining BMD during pregnancy and lactation, emphasizing the importance of pre-conception care.
Aim: Growing evidence exists on the association between hypertensive disorders of pregnancy (HDP) and long-term cardiovascular and metabolic disease risks. Here we evaluated obstetric care providers' knowledge of future HDP-related risks and their engagement in counseling women with HDP in Japan. Methods: A questionnaire-based survey regarding knowledge of HDP and counseling practices of obstetric care providers in Aichi Prefecture was conducted via a web-based platform from March to June 2024. Results: A total of 169, 402, and 135 valid responses were obtained from obstetrician-gynecologists, midwives, and nurses, respectively. While more than 80% of the obstetrician-gynecologists were aware of HDP-related risks, only 29.6% regularly provided counseling, while 24.2% rarely or never engaged in such practices. The primary reason for not providing counseling was a lack of knowledge about counseling methods and necessary content, followed by unavailability of appointment slots and time constraints. Among midwives and nurses, approximately 40% rarely or never provided counseling, while many lacked knowledge of the preventive use of low-dose aspirin (67.2%). Conclusions: This survey demonstrated that, despite a high level of knowledge among healthcare providers, there is a substantial gap between knowledge and the implementation of counseling practices. These findings highlight the need for targeted education and training programs for obstetric care providers.
Aim: To evaluate the utility of a three-dimensional (3D) labor simulation technique based on low-dose computed tomography. Methods: We obtained computed tomography data for an expectant mother who required pelvimetry to diagnose cephalopelvic disproportion at 36 weeks' gestation. Using low-dose computed tomography data, 3D models of the maternal pelvis and the fetal head were created, based on which simulations to predict labor progression were performed. The patient provided informed consent for the use of her data for research purposes. Results: Our low-dose computed tomography protocol has been demonstrated to result in lower radiation exposure (0.17 mGy) than conventional X-ray pelvimetry (0.50- 1.18 mGy). Computed tomography images clearly visualized the pelvic and fetal head dimensions. The 3D cephalopelvic model effectively demonstrated the spatial relationship between the fetal head and the maternal pelvis, allowing for a comprehensive assessment that could simulate labor progression. Conclusions: This novel 3D simulation system based on low-dose computed tomography not only offers a minimally invasive and informative means to predict labor progression but also provides a visual and tactile method for assessing fetal progression through the birth canal, potentially improving the accuracy of prediction of cephalopelvic disproportion. Further large-scale studies will be necessary to validate the clinical efficacy and safety of this 3D simulation system.
