Pregnancy with gestational hypertension or preeclampsia: A qualitative exploration of women's experiences

© 2017 Elsevier Ltd Background Hypertension complicates 10% of pregnancies and involves specialised care of the woman and her baby, a longer stay in hospital, and an increased risk of physical and mental morbidity. There is limited research reporting the woman's perspective on her experience, how she coped with it psychologically, and whether the care she received influenced her experience. Aim To gain insight into women's experience of hypertension in pregnancy and to report on what mediating factors may help improve their experience. Methods A qualitative descriptive study was undertaken. Data were collected through a semi-structured, face to face interview at 10–12 months postpartum. In total, 20 women who had experienced hypertension in their pregnancy were interviewed. Thematic analysis was used to analyse the data. Findings Four main themes were identified. These were: Reacting to the diagnosis, Challenges of being a mother, Processing and accepting the situation, and Moving on from the experience. The mediating factors that improved the experience were Feeling safe and trusting the care providers, Having continuity of care and carer, and Valuing social support from partner, family and friends. Conclusion The diagnosis of hypertension in pregnancy has a significant impact on women. This affects their pregnancy and birth experience and their pathway to motherhood. The implications of the findings for midwifery practice include having access to multidisciplinary continuity models of care and facilitating the support for these women

The Effect of Focal Damage to the Right Medial Posterior Cerebellum on Word and Sentence Comprehension and Production

Functional imaging studies of neurologically intact adults have demonstrated that the right posterior cerebellum is activated during verb generation, semantic processing, sentence processing, and verbal fluency. Studies of patients with cerebellar damage converge to show that the cerebellum supports sentence processing and verbal fluency. However, to date there are no patient studies that investigated the specific importance of the right posterior cerebellum in language processing, because: (i) case studies presented patients with lesions affecting the anterior cerebellum (with or without damage to the posterior cerebellum), and (ii) group studies combined patients with lesions to different cerebellar regions, without specifically reporting the effects of right posterior cerebellar damage. Here we investigated whether damage to the right posterior cerebellum is critical for sentence processing and verbal fluency in four patients with focal stroke damage to different parts of the right posterior cerebellum (all involving Crus II, and lobules VII and VIII). We examined detailed lesion location by going beyond common anatomical definitions of cerebellar anatomy (i.e., according to lobules or vascular territory), and employed a recently proposed functional parcellation of the cerebellum. All four patients experienced language difficulties that persisted for at least a month after stroke but three performed in the normal range within a year. In contrast, one patient with more damage to lobule IX than the other patients had profound long-lasting impairments in the comprehension and repetition of sentences, and the production of spoken sentences during picture description. Spoken and written word comprehension and visual recognition memory were also impaired, however, verbal fluency was within the normal range, together with object naming, visual perception and verbal shortterm memory. This is the first study to show that focal damage to the right posterior cerebellum leads to language difficulties after stroke; and that processing impairments persisted in the case with most damage to lobule IX. We discuss these results in relation to current theories of cerebellar contribution to language processing. Overall, our study highlights the need for longitudinal studies of language function in patients with focal damage to different cerebellar regions, with functional imaging to understand the mechanisms that support recovery

Preferences of Australian healthcare providers regarding education on long-term health after hypertensive disorders of pregnancy: A qualitative study

Objectives) To explore Australian healthcare providers' (HCPs') preferred content, format and access to education regarding long-term health after hypertensive disorder of pregnancy (HDP), in order to guide the development of education programmes. Design and setting A qualitative study using a framework analysis was undertaken. Registered HCP who were practising in Australia and previously completed a survey about long-term health after HDP were invited to participate. Participants Twenty HCP were interviewed, including midwives, specialist obstetrician/gynaecologists, general practitioners with a diploma in obstetrics and gynaecology, and cardiologists. Primary and secondary outcome measures Exploration of preferred content, format and distribution of educational material post-HDP. Results Twenty HCP were interviewed in April to May 2020. Four main categories were identified. Obtaining evidence-based information for own learning' addressing own learning with preference for multi-disciplinary education, preferably endorsed or facilitated by professional organisations. Optimising the referral process from hospital to community health services' was about the need for structured long-term follow-up to transition from hospital to community health and align with HDP guidelines. Facilitating women's health literacy' addressed the need for evidence-based, print or web-based material to assist risk discussions with women. Seizing educational opportunities' addressed the responsibility of all HCP to identify education opportunities to initiate key health discussions with women. Conclusion(s HCP provided ideas on content, format and access of education regarding long-term health post-HDP within the parameters of the Australian healthcare context. This evidence will guide educational developments for HCP on post-HDP health to ensure they can better care for women and families

Assessing Australian women's knowledge and knowledge preferences about long-term health after hypertensive disorders of pregnancy: a survey study.

OBJECTIVES: To (1) assess women's current knowledge regarding long-term cardiovascular health after hypertensive disorders of pregnancy (2) elicit women's preferred educational content and format regarding health after hypertensive disorders of pregnancy. DESIGN AND SETTING: A custom-created online survey exploring Australian women's knowledge about long-term health after hypertensive disorders of pregnancy, distributed through consumer groups and social media. PARTICIPANTS: 266 women with (n=174) or without (n=92) a history of hypertensive disorders of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Proportion of women identifying long-term health risks after hypertensive disorder of pregnancy using a 10-point risk knowledge score with 0-4 'low', 4.1-7.0 'moderate' and 7.1-10 'high'. (2) Exploration of preferred content, format and distribution of educational material post hypertensive disorder of pregnancy. RESULTS: Knowledge scores about health after hypertensive disorder of pregnancy were moderate in groups with and without a history of the disorder. Knowledge was highest regarding risk of recurrent hypertensive disorders in a subsequent pregnancy, 'moderate' for chronic hypertension and heart attack, 'moderate' and 'low' regarding risk of heart disease and 'low' for diabetes and renal disease. Only 36% of all participants were aware that risks start within 10 years after the affected pregnancy. The majority of respondents with a history of hypertensive disorder of pregnancy (76%) preferred receiving information about long-term health 0-6 months post partum from a healthcare provider (80%), key organisations (60%), social media (47%) and brochures/flyers (43%). CONCLUSIONS: Women's knowledge regarding health risks after hypertensive disorder of pregnancy was 'moderate', although with important disease-specific gaps such as increased risk of diabetes. Most women wanted to be informed about their long-term health from a healthcare provider

Scale Dependence of Dark Energy Antigravity

We investigate the effects of negative pressure induced by dark energy (cosmological constant or quintessence) on the dynamics at various astrophysical scales. Negative pressure induces a repulsive term (antigravity) in Newton's law which dominates on large scales. Assuming a value of the cosmological constant consistent with the recent SnIa data we determine the critical scale $r_c$ beyond which antigravity dominates the dynamics ($r_c \sim 1Mpc$) and discuss some of the dynamical effects implied. We show that dynamically induced mass estimates on the scale of the Local Group and beyond are significantly modified due to negative pressure. We also briefly discuss possible dynamical tests (eg effects on local Hubble flow) that can be applied on relatively small scales (a few $Mpc$) to determine the density and equation of state of dark energy.Comment: Contributed talk at the 2nd Hellenic Cosmology Workshop at NOA (Athens) Jan. 2001.To appear in the proceedings. Based on work done in collaboration with M. Axenides and E. Florato

Preeclampsia-Associated Cardiovascular Risk Factors 6 Months and 2 Years After Pregnancy: The P4 Study

BACKGROUND: Increased cardiovascular risk following preeclampsia is well established and there are signs of early cardiovascular aging 6 months postpartum. This study assessed whether blood pressure (BP) and other cardiovascular measures are abnormal 2 years postpartum in the same cohort to determine ongoing risk markers. METHODS: Six months and 2 years postpartum, BP was measured using sphygmomanometry, 24-hour ambulatory BP monitoring, and noninvasive central BP. Anthropometric measures, blood, and urine biochemistry were performed. Cross-sectional comparisons between preeclampsia and normotensive pregnancy (NP) groups and longitudinal comparisons within each group were made at 6 months and 2 years. RESULTS: Two years postpartum, 129 NP, and 52 preeclampsia women were studied who also had 6 months measures. At both time points, preeclampsia group had significantly higher BP (office BP 2 years, 112±12/72±8 versus 104±9/67±7 mm Hg NP; [P120/80 mm Hg) classified 25% versus 8% (P<0.002), as did our reference range threshold of 122/79 mm Hg. American Heart Association criteria classified 60% post-preeclampsia versus 16% after NP with above-normal ambulatory BP monitoring (P<0.001). Other cardiovascular risk markers more common 2 years post-preeclampsia included higher body mass index (median 26.6 versus 23.1, P=0.003) and insulin resistance. CONCLUSIONS: After preeclampsia, women have significantly higher BP 6 months and 2 years postpartum, and have higher body mass index and insulin-resistance scores, increasing their future cardiovascular risk. Regular cardiovascular risk screening should be implemented for all who have experienced preeclampsia

Corrigendum: The P4 Study: Postpartum Maternal and Infant Faecal Microbiome 6 Months After Hypertensive Versus Normotensive Pregnancy(Front. Cell. Infect. Microbiol., (2022), 12, (646165), 10.3389/fcimb.2022.646165)

In the original article within Discussion, paragraph 6, sentence 4, the incorrect citation of “Getahun et al., 2017” was used instead of the correct citation “Maher et al., 2018” and the word “preeclampsia” was used instead of “hypertensive disorder”. The corrected sentence reads: “Wang et al. found increased Sutterella species in children who went on to develop autism spectrum disorder (Wang et al., 2013) and a meta-analysis performed by Maher et al. showed a 35% increase in the odds of having a child with autism in hypertensive disorder exposed pregnancies (Maher et al., 2018)”. The full reference for “Getahun et al., 2017” has been removed from the reference list andreplaced with “Maher, G. M., O’Keeffe, G. W., Kearney, P. M., Kenny, L. C., Dinan, T. G., Mattsson, M., et al. (2018). Association of Hypertensive Disorders of Pregnancy With Risk ofNeurodevelopmental Disorders in Offspring: A Systematic Review and Meta-analysis. JAMA psychiatry, 75(8), 809–819. https://doi.org/10.1001/jamapsychiatry.2018.0854”.The authors apologize for this error and state that this does not change the scientific conclusionsof the article in any way. The original article has been updated. In the original article, there was an error in the spelling of several bacterial names which mayimpair the clear interpretation of findings A correction to the spelling of Barnesiella and Bifidobacterium sp. has beenmadeto Abstract, sub-sectionResults, sentence 8.Theupdated sentence reads: “It was also found that at a genus and species level, the gut microbiota of HP women was enriched with Bifidobacterium and Bifidobacterium sp. and depleted in Barnesiella and Barnesiella intestinihominis when compared to NP women (P > 0.05)”. A correction to the spelling of Bifidobacterium sp. has been made to Results, sub-section Changes in Gut Microbiota Composition Between Women After HP and NP, sentence 3. The updated sentence reads: “The gut microbiota of HP women was enriched in phylum Actinobacteria, order Bifidobacteriales, family Bifidobacteriaceae, genus Bifidobacterium and species Bifidobacterium sp. compared to NP women (LDA > 2, P > 0.05)”. A correction to the spelling of Streptococcus infantis has been made to Discussion, paragraph 6, sentence 1. The updated sentence reads: “In this study, one enriched species of bacteria from the Firmicutes phylum, Streptococcus infantis was found in the infants born from HP mothers”.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated