2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T40f,270 women were included in the final analysis (intervention n=132, usual care n=138; mean age 34, 60.4% from a self-reported non-Caucasian ethnic group). There was no difference in the primary outcome [hazard ratio (HR) 1.0, 95%CI 0.57-1.76; p=0.99]. There was also no difference in secondary fetal and maternal outcomes. The intervention group had fewer total antenatal attendances (median [inter-quartile range (IQR)]: 14 [10-17]) compared to usual care (16 [13-20]; p< 0.01), as well as fewer planned outpatient appointments (median [IQR]: 10 [8-12] vs. 13 [10-16]; p<0.01), without an associated increase in unscheduled hospital presentations. Women undertaking remote blood pressure monitoring were less likely to be admitted to hospital for any cause [HR 0.54, 95% confidence interval (CI) 0.30-0.97; p=0.04], as well as specifically for hypertension [HR 0.41, 95%CI 0.19-0.88, p=0.02]. More antihypertensive prescriptions filled per patient in the intervention arm compared to usual care (median [IQR]: 5 [3-9] vs. 3 [2-5]; p<0.01).31:Tc90,Women at high risk for developing preeclampsia are recommended to have additional blood pressure surveillance, but frequent outpatient attendances are demanding for patients and the healthcare system. It is unclear whether remote blood pressure monitoring can replace conventional office-based monitoring and improve healthcare utilisation without increasing the signal for harm. To evaluate the effects of substituting clinic blood pressure monitoring with remote blood pressure monitoring on fetal and maternal outcomes, and healthcare utilisation, in pregnant women at high risk of developing preeclampsia. Unblinded, non-inferiority, multicentre randomized controlled trial, with recruitment between July 2022 and February 2024 from 3 metropolitan hospitals in Australia. Participants were pregnant women at high-risk of developing preeclampsia based on clinical risk factors or combined first trimester screening tests, who are routinely referred to a specialist hypertension service for extra blood pressure surveillance, in addition to standard antenatal care. Women randomised to usual care attended these specialist hypertension clinics in-person, with frequency of appointments dictated by clinical need. Women randomised to remote blood pressure monitoring, in addition to receiving routine antenatal care, measured their own blood pressure using an automated blood pressure machine with data transmitted via a smartphone application for specialist review. The primary outcome was a perinatal composite of adverse events of at least one of perinatal loss, high-level neonatal care for over 48 hours or a small-for-gestational age baby (<10th centile for fetal weight). The primary outcome was assessed in the intention-to-treat population. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p). 270 women were included in the final analysis (intervention n=132, usual care n=138; mean age 34, 60.4% from a self-reported non-Caucasian ethnic group). There was no difference in the primary outcome [hazard ratio (HR) 1.0, 95%CI 0.57-1.76; p=0.99]. There was also no difference in secondary fetal and maternal outcomes. The intervention group had fewer total antenatal attendances (median [inter-quartile range (IQR)]: 14 [10-17]) compared to usual care (16 [13-20]; p< 0.01), as well as fewer planned outpatient appointments (median [IQR]: 10 [8-12] vs. 13 [10-16]; p<0.01), without an associated increase in unscheduled hospital presentations. Women undertaking remote blood pressure monitoring were less likely to be admitted to hospital for any cause [HR 0.54, 95% confidence interval (CI) 0.30-0.97; p=0.04], as well as specifically for hypertension [HR 0.41, 95%CI 0.19-0.88, p=0.02]. More antihypertensive prescriptions filled per patient in the intervention arm compared to usual care (median [IQR]: 5 [3-9] vs. 3 [2-5]; p<0.01). Compared to usual care, remote blood pressure monitoring reduced antenatal outpatient appointments and the likelihood of inpatient admissions, without increasing adverse fetal and maternal outcomes. Women undertaking remote monitoring were also more likely to fill antihypertensive medication scripts.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Preeclampsia: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Preeclampsia (condition). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/condition/Preeclampsia\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Conditions\",\"item\":\"https://www.reachrx.ai/hub/tag/condition\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Preeclampsia\",\"item\":\"https://www.reachrx.ai/hub/tag/condition/Preeclampsia\"}]}}"}}]],["$","$L2f",null,{"title":"Preeclampsia: Research & Clinical Takeaways","description":"Discover peer-reviewed research on Preeclampsia with concise clinician summaries and next-step guidance.","papers":[{"doi":"10.5603/gpl.110960","pmid":"42720199","title":"COVID-19 and pregnancy: is a “forgotten” disease still a threat?","journal_title":"Ginekologia Polska","journal_issn":"2543-6767","published_at":"2026-09-10T00:00:00.000Z","url":"https://doi.org/10.5603/gpl.110960","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-13T06:22:03.487Z","updated_at":"2026-09-13T06:22:03.487Z","tags":[{"paper_doi":"10.5603/gpl.110960","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"COVID-19","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"COVID-19 Placentitis","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"HELLP Syndrome","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"Preterm Birth","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"condition","value":"Stillbirth","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"generic","value":"SARS-CoV-2 vaccine","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"modality","value":"mRNA Vaccine","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"warning","value":"Evidence spans multiple pandemic phases and viral variants; applicability to post-2025 circulating strains may be limited.","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"warning","value":"No specific sample size is reported — this is a narrative review synthesizing multiple studies, so no single N applies.","value_numeric":null},{"paper_doi":"10.5603/gpl.110960","tag_type":"warning","value":"Study design is narrative rather than systematic; risk of selection bias in literature cited cannot be assessed from the abstract alone.","value_numeric":null}],"summaries":{"what_studied":"This narrative review evaluates the clinical course, complications (maternal and perinatal), and prevention strategies of SARS-CoV-2 infection during pregnancy, with a focus on whether COVID-19 remains a relevant obstetric concern in the post-acute pandemic era.","key_result":"Pregnancy raises the risk of severe COVID-19, ICU admission, mechanical ventilation, and maternal mortality — especially in older, obese, or unvaccinated women. Infection is consistently linked to higher rates of preeclampsia (including eclampsia and HELLP syndrome), cesarean delivery, preterm birth, and stillbirth. COVID-19 placentitis can cause placental insufficiency and fetal hypoxia. Vaccination before, during, and after pregnancy is safe and reduces severe maternal disease, preterm birth, emergency cesarean delivery, stillbirth, and neonatal hospitalization, while also providing passive infant protection.","limitations":"Review is narrative rather than systematic or meta-analytic, limiting the ability to quantify pooled risk estimates. Evidence is drawn across heterogeneous pandemic phases and variants, which may affect generalizability to current circulating strains. Vertical transmission rates and vaccination coverage data may vary by population studied.","practice_takeaway":"Counsel pregnant and preconception patients that COVID-19 remains a meaningful obstetric risk, particularly for those who are unvaccinated, obese, or have comorbidities. Ensure up-to-date COVID-19 vaccination before conception, during pregnancy, and during breastfeeding to reduce severe maternal and neonatal outcomes."}},{"doi":"10.1055/a-2949-9626","pmid":"42686037","title":"Transforming Obstetric Care Through an MFM-led Architectural System: A Proposed Model for High-value Care","journal_title":"American Journal of Perinatology","journal_issn":"0735-1631","published_at":"2026-09-08T00:00:00.000Z","url":"https://doi.org/10.1055/a-2949-9626","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-10T06:20:04.297Z","updated_at":"2026-09-10T06:20:04.297Z","tags":[{"paper_doi":"10.1055/a-2949-9626","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"condition","value":"Gestational Diabetes","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"condition","value":"Maternal Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"condition","value":"Neonatal Opioid Withdrawal Syndrome","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"condition","value":"Preterm Birth","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"generic","value":"aspirin","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"modality","value":"Integrated Care Model","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"modality","value":"Subspecialist-Led Protocol Governance","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"sample_size","value":"n=3500","value_numeric":3500},{"paper_doi":"10.1055/a-2949-9626","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"study_design","value":"Descriptive Single-System Analysis","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"warning","value":"Benchmark comparisons use regional (Clark County, Nevada) and published national figures rather than a concurrent matched control group, limiting interpretability of between-group differences.","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"warning","value":"LDASA adherence is self-reported, which may overestimate true adherence rates.","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"warning","value":"Sample size reflects annual delivery volume, not a discrete study cohort; the exact number of patients analyzed per domain is not reported.","value_numeric":null},{"paper_doi":"10.1055/a-2949-9626","tag_type":"warning","value":"The impact_flag 'practice_changing' is assigned cautiously — the study is descriptive and single-site; broader generalizability is unconfirmed.","value_numeric":null}],"summaries":{"what_studied":"A single-system descriptive analysis of a moderately sized, MFM-led integrated women's health organization (>3,500 annual deliveries, 2024–2025) evaluated outcomes across five domains: preterm birth (PTB) prevention, low-risk cesarean reduction, diabetes management, maternal opioid use disorder (OUD), and low-dose aspirin (LDASA) use for preeclampsia prevention.","key_result":"PTB rate was 10.0% vs. 11.4% (Clark County); NTSV cesarean rate was 24.6% vs. 28.5% (Clark County); SMFM cesarean rate was 12.0% vs. 16.7% (Nevada); blood glucose self-monitoring adherence was 96% vs. 68% nationally; pharmacologic treatment for neonatal opioid withdrawal syndrome was 11.1% vs. 50–85% published rates; LDASA use was 95% among eligible patients; estimated annual savings from PTB and cesarean reduction were $4.03 million.","limitations":"Single-system, non-randomized descriptive design limits causal inference; comparisons rely on regional and published benchmarks rather than a matched control group; LDASA adherence is self-reported, introducing potential bias.","practice_takeaway":"An MFM-led governance model using standardized protocols across all OB provider types can meaningfully improve outcomes in PTB, cesarean rates, diabetes, OUD, and preeclampsia prevention while generating substantial cost savings. Practices and health systems seeking value-based maternity care transformation may consider embedding MFM subspecialists in system-level protocol design and oversight roles."}},{"doi":"10.1111/birt.70102","pmid":"42702923","title":"Increased Pregnancy Complications Among Mothers With Adverse Childhood Experiences: Findings From a Cross‐Sectional Study","journal_title":"Birth","journal_issn":"0730-7659","published_at":"2026-09-06T00:00:00.000Z","url":"https://doi.org/10.1111/birt.70102","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-16T06:22:58.377Z","updated_at":"2026-09-16T06:22:58.377Z","tags":[{"paper_doi":"10.1111/birt.70102","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Adverse Childhood Experiences","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Gestational Diabetes","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Gestational Hypertension","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Pregnancy Complications","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"condition","value":"Premature Rupture of Membranes","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"sample_size","value":"n=793","value_numeric":793},{"paper_doi":"10.1111/birt.70102","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"study_design","value":"Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.1111/birt.70102","tag_type":"warning","value":"The study is cross-sectional, so causal direction cannot be established. The impact flag 'confirms_prior' was applied as findings align with existing literature on ACEs and pregnancy complications, though this specific Dutch preventive-care context adds nuance. The p-value for continuous ACE score analysis (p=0.069) approached but did not meet conventional significance thresholds, suggesting modest evidence for a dose-response relationship.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cross-sectional study examined the association between maternal adverse childhood experiences (ACEs, scored via ACE-10) and perinatal outcomes—including pregnancy complications and birth outcomes—in 793 Dutch mothers of singleton children under 2 years old. Adjusted models accounted for maternal birth year, country of birth, and benevolent childhood experiences.","key_result":"Mothers with ≥4 ACEs had 1.70 times higher odds of pregnancy complications (gestational hypertension, gestational diabetes, preeclampsia, or premature rupture of membranes) compared to those with fewer ACEs (aOR = 1.70, 95% CI: 1.05–2.74, p = 0.031). No significant associations were found for prematurity, small for gestational age, NICU admission, birth weight, or gestational age.","limitations":"Cross-sectional design prevents causal inference. ACE scores and pregnancy complications were self-reported, introducing recall bias. The sample was drawn from the Dutch preventive healthcare context, limiting generalizability to other health systems or populations.","practice_takeaway":"Screen pregnant patients for a history of ACEs, as ≥4 ACEs are linked to a 70% higher odds of pregnancy complications. Strengthening psychosocial risk detection in prenatal care—even without formal ACE screening protocols—may help reduce intergenerational adversity."}},{"doi":"10.1016/j.preghy.2026.101505","pmid":"42632340","title":"Phosphorylated MLKL is increased in urinary extracellular vesicles of women with preeclampsia","journal_title":"Pregnancy Hypertension","journal_issn":"2210-7789","published_at":"2026-08-22T00:00:00.000Z","url":"https://doi.org/10.1016/j.preghy.2026.101505","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-31T06:18:39.507Z","updated_at":"2026-08-31T06:18:39.507Z","tags":[{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"generic","value":"MLKL","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"generic","value":"phosphorylated MLKL","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"modality","value":"Biomarker","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"sample_size","value":"n=48","value_numeric":48},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"study_design","value":"Case-Control Study","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"warning","value":"PALP and NKCC2 organ-origin markers were tested in only a subset of participants (12 per group), limiting conclusions about uEV tissue source.","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"warning","value":"The study design is observational and cross-sectional; 'case-control' is an approximation — the paper uses gestation-matched controls but does not explicitly label itself as a case-control study.","value_numeric":null},{"paper_doi":"10.1016/j.preghy.2026.101505","tag_type":"warning","value":"Total cohort size is 48 (22 PE + 22 NP in Cohort A; 4 PE + 4 NP implied in Cohort B), but Cohort B controls are not explicitly enumerated in the abstract — sample_size tag reflects the primary cohort plus Cohort B as described.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated whether necroptosis-associated proteins — total MLKL and phosphorylated MLKL (pMLKL) — are elevated in urinary extracellular vesicles (uEVs) from 22 women with preeclampsia (PE) vs. 22 gestation-matched normotensive pregnant controls, with a secondary cohort of 4 heavily proteinuric PE cases.","key_result":"pMLKL was detected in uEVs significantly more often in PE than controls (6/22 vs. 0/22, P = 0.021); total MLKL showed a non-significant trend (10/22 vs. 5/22, P = 0.203). In the heavily proteinuric PE subcohort, pMLKL was found in 3/4 samples. PALP (placental marker) appeared in 2/12 PE and 1/12 NP uEV samples, suggesting occasional placental origin.","limitations":"- Very small sample sizes (n=22 per group; n=4 in the proteinuric subcohort) limit statistical power and generalizability.\n- Cross-sectional design cannot establish whether uEV pMLKL is a cause, consequence, or biomarker of PE progression.\n- PALP and NKCC2 origin markers were only assessed in a subset (12/22 per group), leaving uEV tissue source largely unresolved.","practice_takeaway":"uEV pMLKL is a promising, non-invasive urinary biomarker candidate for preeclampsia, but findings are preliminary given the small cohort. Clinicians should await validation in larger studies before considering this in practice."}},{"doi":"10.1097/aog.0000000000006398","pmid":"42623674","title":"Risk of Recurrent Severe Preeclampsia, HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome, and Eclampsia in a Subsequent Pregnancy","journal_title":"Obstetrics & Gynecology","journal_issn":"0029-7844","published_at":"2026-08-20T00:00:00.000Z","url":"https://doi.org/10.1097/aog.0000000000006398","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-04T06:22:18.980Z","updated_at":"2026-09-04T06:22:18.980Z","tags":[{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"condition","value":"Eclampsia","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"condition","value":"HELLP Syndrome","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"condition","value":"Hypertensive Disorders of Pregnancy","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"sample_size","value":"n=560295","value_numeric":560295},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"warning","value":"ICD-10 code–based classification of HELLP syndrome and eclampsia subtypes may lead to diagnostic misclassification; clinical severity gradations within 'severe features' are not distinguishable.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"warning","value":"No modality, brand, or generic drug tags were applied as the study is observational and does not evaluate a specific treatment intervention.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006398","tag_type":"warning","value":"The study captures only patients with two or more pregnancies observed within the same hospital system database, which may underrepresent patients who delivered at different institutions or had pregnancy losses not captured in the Premier database.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used the Premier Inpatient database (Oct 2015–Dec 2020) to estimate recurrence risk of severe hypertensive disorders of pregnancy (HDP)—including preeclampsia with severe features, HELLP syndrome, and eclampsia—in a subsequent pregnancy among 560,295 U.S. patients with two or more observed deliveries.","key_result":"Overall recurrence of severe HDP was 14.9% (RR 16.0, 95% CI 15.2–17.0) vs. no prior HDP. Early-onset severe HDP (<28 weeks) carried the highest risk (22.9%, RR 23.1); prior HELLP conferred a 4.6% risk of recurrent HELLP (RR 61.0), and prior eclampsia a 1.1% risk of recurrent eclampsia (RR 40.1).","limitations":"Retrospective design with ICD-10 code–based identification risks misclassification of HDP subtypes. Only patients with two or more *observed* pregnancies in the same database were included, which may introduce selection bias. Outpatient care and long-term follow-up data were not captured.","practice_takeaway":"Counsel patients with prior severe HDP—especially early-onset (<28 weeks)—that their recurrence risk is substantially elevated (up to ~23%), warranting close surveillance in subsequent pregnancies. Prior HELLP or eclampsia also meaningfully raises risk of recurrent severe disease, even if absolute recurrence rates are lower."}},{"doi":"10.1016/j.ajog.2026.08.004","pmid":"42567393","title":"What does uterine artery Doppler reflect in late pregnancy? Insights from angiogenic, hemodynamic, and vascular markers in preeclampsia","journal_title":"American Journal of Obstetrics and Gynecology","journal_issn":"0002-9378","published_at":"2026-08-07T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajog.2026.08.004","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-12T13:26:18.736Z","updated_at":"2026-08-12T13:26:18.736Z","tags":[{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"generic","value":"placental growth factor","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"generic","value":"soluble fms-like tyrosine kinase-1","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"modality","value":"Angiogenic Biomarker","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"modality","value":"Doppler Ultrasound","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"modality","value":"Pulse Wave Velocity","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"sample_size","value":"n=11962","value_numeric":11962},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"study_design","value":"Prospective Observational Study","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"warning","value":"Level of evidence assigned as 2 (prospective cohort); formal grading may vary depending on the classification system used.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"warning","value":"The mediation proportions (~40% for PlGF, ~9% for sFlt-1, ~15% for ophthalmic artery ratio) are approximations as reported in the abstract; exact confidence intervals are not provided in the source text.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.08.004","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — this is a single-center observational study and mediation analysis does not establish causality.","value_numeric":null}],"summaries":{"what_studied":"This prospective observational study examined what uterine artery pulsatility index (UtA-PI) at 35–36 weeks reflects biologically in 11,962 singleton pregnancies, using mediation analysis to quantify contributions of placental angiogenic markers (PlGF, sFlt-1), hemodynamic indices (ophthalmic artery peak systolic velocity ratio), and arterial stiffness (cfPWV) to the UtA-PI–preeclampsia association.","key_result":"Preeclampsia occurred in 349 pregnancies (2.9%). PlGF mediated ~40% and sFlt-1 ~9% of the UtA-PI–preeclampsia association; ophthalmic artery ratio mediated ~15%; cfPWV showed no significant mediation. In multivariable models, UtA-PI was no longer independently associated with preeclampsia (β=0.11, p=0.13), while higher sFlt-1, higher ophthalmic artery ratio, and greater arterial stiffness each independently raised risk, and higher PlGF was strongly protective (all p<0.001).","limitations":"Single tertiary center in London limits generalizability. Observational design precludes causal inference despite mediation framing. Preeclampsia rate of 2.9% may reflect referral bias at a specialist center.","practice_takeaway":"In late pregnancy, UtA-PI alone adds little independent predictive value for preeclampsia once angiogenic and hemodynamic markers are available — clinicians should prioritize PlGF, sFlt-1, and ophthalmic artery ratio for risk stratification at 35–36 weeks. High sFlt-1, elevated ophthalmic artery ratio, and increased arterial stiffness signal independent risk even when UtA-PI appears unremarkable."}},{"doi":"10.1093/eurheartj/ehag564","pmid":"42554048","title":"Adverse pregnancy outcomes in successive pregnancies and maternal cardiovascular mortality: a Norwegian nationwide study","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-08-05T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag564","source_score":8,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-11T13:26:21.274Z","updated_at":"2026-08-11T13:26:21.274Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Cardiovascular Disease Mortality","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Gestational Hypertension","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Perinatal Loss","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Placental Abruption","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Preterm Delivery","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"condition","value":"Small For Gestational Age","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"sample_size","value":"n=1001409","value_numeric":1001409},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"study_design","value":"Nationwide Cohort Study","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"warning","value":"Individual APO subtypes (e.g., placental abruption, perinatal loss) are analyzed separately but specific HRs for each subtype by sequence are not reported in the abstract — only composite APO results are detailed here.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"warning","value":"The cohort spans over 50 years (1967–2020); secular trends in obstetric and cardiovascular care may limit direct applicability to contemporary patients.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag564","tag_type":"warning","value":"The 'practice_changing' impact flag is applied because the study reframes how APO history should be taken (sequence-based rather than binary), but the observational design means clinical guidelines would need formal endorsement before changing protocols.","value_numeric":null}],"summaries":{"what_studied":"This Norwegian nationwide cohort study evaluated how the **sequence** of adverse pregnancy outcomes (APOs) across complete pregnancy histories — rather than simple presence/absence — relates to premature CVD mortality (≤70 years) in 1,001,409 women followed from 1967 to 2020.","key_result":"Women with APOs in their **first pregnancy and no further pregnancies** had the highest CVD mortality risk (aHR 3.30, 95% CI 2.97–3.66). APOs in both first and later pregnancies carried aHR 2.41 (95% CI 2.16–2.69). Women with APOs in first pregnancy followed by uncomplicated pregnancies had the lowest risk (aHR 1.39, 95% CI 1.27–1.53). Binary classification (APO yes/no) yielded only an overall 1.73-fold higher CVD mortality — masking substantial variation.","limitations":"- Observational design limits causal inference.\n- Registry-based data may lack granularity on comorbidities, lifestyle factors, or treatment received after APO diagnosis.\n- Study spans 1967–2020; management of APOs changed substantially over this period, which may affect generalizability to current practice.","practice_takeaway":"Ask about the **full obstetric history** — not just whether a patient ever had an APO, but when and how often. Women who had APOs only in a first pregnancy and never became pregnant again carry the steepest CVD mortality risk and may warrant the most proactive cardiovascular surveillance."}},{"doi":"10.1007/s12020-026-04701-9","pmid":"42536323","title":"Hypertensive disorders of pregnancy and GLP-1 receptor agonist timing: a systematic review and meta-analysis","journal_title":"Endocrine","journal_issn":"1559-0100","published_at":"2026-07-31T00:00:00.000Z","url":"https://doi.org/10.1007/s12020-026-04701-9","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-06T13:22:05.398Z","updated_at":"2026-08-06T13:22:05.398Z","tags":[{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"condition","value":"Hypertensive Disorders of Pregnancy","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"condition","value":"Type 2 Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"albiglutide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"dulaglutide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"exenatide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"liraglutide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"lixisenatide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"semaglutide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"generic","value":"tirzepatide","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"sample_size","value":"n=10880","value_numeric":10880},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"warning","value":"Only 3 retrospective cohort studies were pooled; high statistical heterogeneity across studies makes the pooled OR unreliable as a definitive estimate. The result should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"warning","value":"The PROSPERO registration number (CRD420251273858) appears to contain a formatting irregularity in the source text; the actual registration may differ.","value_numeric":null},{"paper_doi":"10.1007/s12020-026-04701-9","tag_type":"warning","value":"Tirzepatide is a dual GIP/GLP-1 receptor agonist, not a pure GLP-1 RA; its inclusion alongside GLP-1 RAs may introduce additional heterogeneity.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis examined whether periconceptional or first-trimester exposure to GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, albiglutide) was associated with hypertensive disorders of pregnancy (HDP), pooling data from 3 retrospective US cohort studies (2014–2025) covering 10,880 pregnancies (4,942 exposed, 5,938 unexposed).","key_result":"Pooled analysis showed no statistically significant association between GLP-1 RA exposure and HDP risk (OR 0.91, 95% CI 0.57–1.47); 2 of 3 studies found lower HDP risk in exposed women (ORs 0.56 and 0.84), while 1 found higher risk, with high heterogeneity across studies.","limitations":"- Only 3 retrospective cohort studies were available, all from the US, limiting generalizability.\n- Two studies relied on ICD-10 codes for HDP diagnosis, which may underreport or misclassify cases.\n- Abrupt GLP-1 RA discontinuation before conception may cause gestational weight rebound, confounding the HDP risk estimate.","practice_takeaway":"Current evidence does not support a significant protective or harmful effect of periconceptional or first-trimester GLP-1 RA use on HDP risk; clinicians should counsel patients that data are insufficient to guide decisions, and large prospective studies are needed before changing practice."}},{"doi":"10.1016/j.ajog.2026.07.008","pmid":"42431247","title":"Ischemic Placental Disease and Hospitalization for Neurological and Psychiatric Disorders","journal_title":"American Journal of Obstetrics and Gynecology","journal_issn":"0002-9378","published_at":"2026-07-10T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajog.2026.07.008","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:45.287Z","updated_at":"2026-07-25T13:57:45.287Z","tags":[{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Fetal Growth Restriction","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Ischemic Placental Disease","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Neurological Disorders","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Placental Abruption","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Postpartum Depression","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Post-Traumatic Stress Disorder","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Psychiatric Disorders","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"condition","value":"Stroke","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"sample_size","value":"n=17368071","value_numeric":17368071},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"warning","value":"Brain disorder diagnoses are based on administrative ICD codes, which may undercount or misclassify conditions; the authors applied quantitative bias analysis but residual misclassification is possible.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"warning","value":"The 'impact_flag' of practice_changing reflects the large sample size and dose-response finding, but causality cannot be established from this observational design.","value_numeric":null},{"paper_doi":"10.1016/j.ajog.2026.07.008","tag_type":"warning","value":"The study uses calendar-year follow-up rather than a fixed postpartum window (e.g., 12 months from delivery date), which may introduce variability in follow-up duration across patients.","value_numeric":null}],"summaries":{"what_studied":"This population-based retrospective cohort study used the US Nationwide Readmissions Database (2010–2020) to examine whether ischemic placental disease (preeclampsia, placental abruption, and/or fetal growth restriction) is associated with postpartum hospitalization for neurological and psychiatric disorders in women aged 15–54, within the calendar year of delivery.","key_result":"Among 17,368,071 deliveries, 10.7% had ischemic placental disease. Brain disorder hospitalization rates were 1,219 vs. 730 per 10,000 deliveries (with vs. without ischemic placental disease; adjusted HR 1.50, 95% CI 1.48–1.51). Risk rose in a dose-dependent fashion: HR 1.47 with 1 condition, 1.66 with 2, and 1.85 with all 3.","limitations":"- Administrative claims data rely on coded diagnoses, introducing potential outcome misclassification (though quantitative bias analysis was applied).\n- Unmeasured confounding cannot be fully excluded despite bias corrections.\n- Follow-up was limited to the calendar year of delivery, so longer-term outcomes are not captured.","practice_takeaway":"Women with ischemic placental disease face a ~50% higher risk of hospitalization for brain disorders—including stroke, depression, PTSD, and suicide attempt—within the postpartum year. Clinicians should treat ischemic placental disease as a neurological and psychiatric risk signal, prompting closer postpartum mental health and neurological surveillance."}},{"doi":"10.1177/09612033261469025","pmid":"42420832","title":"Navigating the therapeutic landscape: Biologics and immunosuppressive therapy in lupus nephritis during pregnancy","journal_title":"Lupus","journal_issn":"0961-2033","published_at":"2026-07-08T00:00:00.000Z","url":"https://doi.org/10.1177/09612033261469025","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-16T13:37:19.857Z","updated_at":"2026-07-16T13:37:19.857Z","tags":[{"paper_doi":"10.1177/09612033261469025","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"brand","value":"Benlysta","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"brand","value":"Gazyva","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"brand","value":"Lupkynis","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"brand","value":"Rituxan","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"brand","value":"Saphnelo","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"condition","value":"Lupus Nephritis","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"condition","value":"Systemic Lupus Erythematosus","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"anifrolumab","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"azathioprine","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"belimumab","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"hydroxychloroquine","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"mycophenolate mofetil","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"obinutuzumab","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"rituximab","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"tacrolimus","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"generic","value":"voclosporin","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"Anti-CD20 Monoclonal Antibody","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"Antimalarial","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"BAFF Inhibitor","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"Calcineurin Inhibitor","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"Immunosuppressant","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"modality","value":"Interferon Receptor Antagonist","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"warning","value":"Narrative review design — no systematic search protocol or formal evidence grading reported; findings reflect expert synthesis rather than meta-analytic conclusions.","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"warning","value":"Pregnancy safety data for voclosporin, obinutuzumab, and anifrolumab are entirely absent; any guidance on these agents is extrapolated from mechanism of action or animal data.","value_numeric":null},{"paper_doi":"10.1177/09612033261469025","tag_type":"warning","value":"Sample size tag omitted — this is a review article with no primary patient cohort.","value_numeric":null}],"summaries":{"what_studied":"This narrative review evaluated the safety and clinical use of all current immunosuppressive and biologic therapies for lupus nephritis (LN) during pregnancy, lactation, and the periconceptional period, incorporating evidence from January 2000 to May 2025, including 2024 EULAR, 2025 EULAR LN update, and 2024 KDIGO guidelines.","key_result":"Hydroxychloroquine and azathioprine remain the safest options for pregnancy-compatible LN management; tacrolimus is acceptable with monitoring; mycophenolate mofetil is absolutely contraindicated in the first trimester; voclosporin and obinutuzumab lack any pregnancy safety data; belimumab's pregnancy registry has not raised major signals (selective use in refractory cases); rituximab may be used cautiously for life-threatening disease but should be avoided in the third trimester due to neonatal B-cell depletion; anifrolumab has no pregnancy data.","limitations":"Narrative review design limits systematic evidence grading; pregnancy safety data for newer biologics (voclosporin, obinutuzumab, anifrolumab) are entirely absent; most available data come from registries and case series rather than controlled trials.","practice_takeaway":"Use hydroxychloroquine and azathioprine as the backbone of LN therapy during pregnancy, and switch patients off mycophenolate mofetil before conception. For refractory or life-threatening disease, belimumab or rituximab may be cautiously considered, but voclosporin, obinutuzumab, and anifrolumab should be avoided until dedicated pregnancy safety data are available."}},{"doi":"10.1093/ndt/gfag142","pmid":"42335947","title":"Pathophysiology of pregnancy-associated acute kidney injury","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-06-23T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag142","source_score":34,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-28T13:27:17.791Z","updated_at":"2026-06-28T13:27:17.791Z","tags":[{"paper_doi":"10.1093/ndt/gfag142","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"condition","value":"Pregnancy-Associated Acute Kidney Injury","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"condition","value":"Thrombotic Microangiopathy","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"generic","value":"soluble endoglin","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"generic","value":"soluble fms-like tyrosine kinase-1","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"modality","value":"Angiogenic Biomarker","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"warning","value":"No sample size is applicable — this is a narrative review with no primary dataset or patient cohort.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"warning","value":"Study design tagged as Narrative Review based on abstract content; no systematic search methodology is described, but this cannot be fully confirmed without the full text.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag142","tag_type":"warning","value":"The incidence figure of 40–100 per 10,000 pregnancies is cited as an estimate in the abstract; the underlying sources are not evaluable from the abstract alone.","value_numeric":null}],"summaries":{"what_studied":"This review examines the pathophysiology of pregnancy-associated acute kidney injury (PrAKI), covering hemodynamic, immunologic, placental, and metabolic mechanisms that drive renal injury during pregnancy, as well as downstream consequences for maternal and fetal health.","key_result":"PrAKI affects an estimated 40–100 per 10,000 pregnancies and is disproportionately prevalent in low- and middle-income countries; key mechanisms include placental ischemia-driven release of antiangiogenic factors (sFlt-1, soluble endoglin), glomerular endotheliosis, complement dysregulation, and reduced renal functional reserve — with lasting sequelae including CKD, cardiovascular risk, fetal growth restriction, prematurity, and reduced nephron mass in offspring.","limitations":"This is a narrative review without systematic search or meta-analytic methods, limiting the strength of evidence synthesis. Molecular and mechanistic data are largely derived from preclinical or small observational studies. Global registry data are sparse, especially from low- and middle-income countries where burden is highest.","practice_takeaway":"Clinicians should consider angiogenic biomarkers (sFlt-1, soluble endoglin) in the workup of PrAKI, particularly when preeclampsia or placental dysfunction is suspected. Targeted hemodynamic strategies are important, as pregnancy-reduced renal reserve makes these patients especially vulnerable to hypovolemia and sepsis."}},{"doi":"10.1177/15409996261454984","pmid":"42272165","title":"Gynecological and Obstetrical Issues Experienced by Women Diagnosed with Myotonic Dystrophy Type 1: A Scoping Review","journal_title":"Journal of Women's Health","journal_issn":"1540-9996","published_at":"2026-06-10T00:00:00.000Z","url":"https://doi.org/10.1177/15409996261454984","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-14T13:34:54.931Z","updated_at":"2026-06-14T13:34:54.931Z","tags":[{"paper_doi":"10.1177/15409996261454984","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"condition","value":"Myotonic Dystrophy Type 1","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"condition","value":"Pelvic Floor Disorders","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"condition","value":"Polyhydramnios","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"condition","value":"Preterm Labor","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"sample_size","value":"n=36","value_numeric":36},{"paper_doi":"10.1177/15409996261454984","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"study_design","value":"Scoping Review","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"warning","value":"Level of evidence assigned as 3 (systematic review of heterogeneous studies); a scoping review does not synthesize evidence to the standard of a systematic review or meta-analysis.","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"warning","value":"Sample size (n=36) refers to included studies, not individual patients — no aggregate patient-level N is reported.","value_numeric":null},{"paper_doi":"10.1177/15409996261454984","tag_type":"warning","value":"The scoping review design means no quality appraisal or pooled effect sizes are provided; findings are descriptive only.","value_numeric":null}],"summaries":{"what_studied":"This scoping review mapped existing research on gynecological and obstetrical issues in women with myotonic dystrophy type 1 (DM1), searching PubMed, CINAHL, ProQuest Central, and Google Scholar from inception to December 2023.","key_result":"36 studies were included; gynecological issues identified included fertility problems, genital malignancies, and pelvic floor disorders, while obstetrical complications included miscarriage, ectopic pregnancy, preeclampsia, hypertensive disease, polyhydramnios, preterm labor, and nonvertex presentation.","limitations":"The review highlights a sparse evidence base — few studies specifically document these issues in DM1 women, limiting the ability to quantify frequency or severity. No meta-analysis or pooled estimates were possible given the scoping design.","practice_takeaway":"Clinicians managing women with DM1 should proactively screen for pelvic floor disorders, fertility issues, and obstetrical complications (especially polyhydramnios and preterm labor), as these are under-documented but clinically relevant. Referral to high-risk obstetrics is warranted given the range of identified pregnancy risks."}},{"doi":"10.1111/1471-0528.70278","pmid":"42252605","title":"Association Between Lateral Placenta and Adverse Maternal and Perinatal Outcomes: A Systematic Review and Meta‐Analysis","journal_title":"BJOG: An International Journal of Obstetrics & Gynaecology","journal_issn":"1470-0328","published_at":"2026-06-07T00:00:00.000Z","url":"https://doi.org/10.1111/1471-0528.70278","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-18T13:24:24.570Z","updated_at":"2026-06-18T13:24:24.570Z","tags":[{"paper_doi":"10.1111/1471-0528.70278","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"condition","value":"Lateral Placenta","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"condition","value":"Preterm Birth","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"condition","value":"Retained Placenta","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"condition","value":"Small for Gestational Age","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"sample_size","value":"n=162727","value_numeric":162727},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"warning","value":"High heterogeneity (I²=87.7%) in the retained placenta analysis suggests results should be interpreted with caution despite the large pooled effect size.","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"warning","value":"The adjusted odds ratio estimates for preeclampsia came from only 2 individual studies and were not pooled, limiting confidence in the independent association for this outcome. The overall strength of adjusted evidence remains limited across outcomes.","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70278","tag_type":"warning","value":"The definition and assessment method for 'lateral placenta' may vary across included studies, which could contribute to heterogeneity and limit comparability.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and meta-analysis examined the association between lateral placenta location and adverse maternal and perinatal outcomes — including preeclampsia, SGA, preterm birth, retained placenta, and non-vertex fetal presentation — across 21 studies involving 162,727 singleton pregnancies.","key_result":"Lateral placenta was associated with significantly increased odds of preeclampsia (OR 1.65), SGA (OR 1.40; aOR 1.84), preterm birth <34 weeks (OR 2.10; aOR 2.14), preterm birth <37 weeks (OR 1.50; aOR 1.54), retained placenta (OR 2.52; aOR 4.43), and non-vertex fetal presentation (OR 1.50). Adjusted estimates confirmed independent associations for SGA, preterm birth, and retained placenta.","limitations":"- High statistical heterogeneity for several outcomes (e.g., retained placenta I²=87.7%, SGA I²=69.0%), limiting precision of pooled estimates.\n- Only a small number of studies provided confounder-adjusted estimates, weakening conclusions about independent associations.\n- All analyses were restricted to singleton pregnancies, limiting generalizability.","practice_takeaway":"Clinicians should consider lateral placenta on ultrasound as a marker for elevated risk of preeclampsia, SGA, preterm birth, and retained placenta, and may warrant closer surveillance for these complications. Routine documentation of placental laterality during antenatal imaging could help stratify obstetric risk."}},{"doi":"10.1016/j.mucimm.2026.100353","pmid":"42219085","title":"Learning immunology from mothers and babies","journal_title":"Mucosal Immunology","journal_issn":"1933-0219","published_at":"2026-05-30T00:00:00.000Z","url":"https://doi.org/10.1016/j.mucimm.2026.100353","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-09T13:25:03.707Z","updated_at":"2026-08-09T13:25:03.707Z","tags":[{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"condition","value":"Maternal-Fetal Immune Tolerance","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"condition","value":"Microchimerism","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"condition","value":"Preterm Birth","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"condition","value":"Stillbirth","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"modality","value":"Immunotherapy","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"modality","value":"Passive Immunization","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"study_design","value":"Perspective / Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"warning","value":"No specific drugs, biologics, or interventional modalities are evaluated; 'modality' tags reflect the broader immunological themes discussed.","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"warning","value":"Study design labeled 'Perspective / Narrative Review' based on abstract content; the journal classifies it as a perspective article.","value_numeric":null},{"paper_doi":"10.1016/j.mucimm.2026.100353","tag_type":"warning","value":"This is an expert perspective piece, not an empirical study — no sample size, control group, or primary data are present. Tags and summaries reflect conceptual framing only.","value_numeric":null}],"summaries":{"what_studied":"This perspective examines the immunology of pregnancy, focusing on how maternal-fetal immune tolerance is achieved, including maternal immune memory, microchimerism (bidirectional transfer of intact cells), and vertical transfer of maternal IgG antibodies — and how these mechanisms may inform broader immunological contexts.","key_result":"The paper highlights that key questions remain unresolved: why mothers do not reject allogeneic fetal tissue, and why fetal immune cells do not reject maternal tissue. It frames pregnancy as a model for studying expanded immune tolerance with translational relevance to stillbirth, preeclampsia, and preterm birth.","limitations":"This is a perspective/opinion piece, not an original research study, so no primary data or statistical results are reported. The translational applications discussed remain largely speculative and hypothesis-generating.","practice_takeaway":"Clinicians managing high-risk pregnancies should be aware that immune tolerance mechanisms — including microchimerism and maternally transferred IgG — are active research targets that may eventually yield therapies for preeclampsia, preterm birth, and stillbirth. This framework also has potential relevance to transplant immunology and other settings where expanded tolerance is clinically desirable."}},{"doi":"10.1097/aog.0000000000006318","pmid":"42166772","title":"Prepregnancy Insulin Resistance and Fertility and Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome","journal_title":"Obstetrics & Gynecology","journal_issn":"0029-7844","published_at":"2026-05-22T00:00:00.000Z","url":"https://doi.org/10.1097/aog.0000000000006318","source_score":14,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:57.503Z","updated_at":"2026-06-20T13:24:57.503Z","tags":[{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"brand","value":"Femara","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"condition","value":"Gestational Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"condition","value":"Infertility","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"condition","value":"Insulin Resistance","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"condition","value":"Polycystic Ovary Syndrome","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"generic","value":"clomiphene citrate","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"generic","value":"letrozole","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"modality","value":"Ovulation Induction","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"sample_size","value":"n=746","value_numeric":746},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"study_design","value":"Secondary Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — the finding is clinically significant but based on a secondary analysis; prospective validation is needed.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"warning","value":"The 'Femara' brand tag is inferred for letrozole; the paper does not specify brand names.","value_numeric":null},{"paper_doi":"10.1097/aog.0000000000006318","tag_type":"warning","value":"This is a secondary analysis of the PPCOS II RCT (NCT00719186); causal inference is limited.","value_numeric":null}],"summaries":{"what_studied":"This secondary analysis of the PPCOS II multicenter RCT examined whether prepregnancy insulin resistance (measured by HOMA-IR, QUICKI, and glucose-to-insulin ratio) and its improvement during ovulation induction (clomiphene citrate or letrozole) were linked to fertility and pregnancy outcomes in 746 women aged 18–40 with PCOS.","key_result":"Higher prepregnancy HOMA-IR quartile was associated with lower ovulation rates (93.5% → 73.8%), lower live-birth rates (35.5% → 18.2%), and markedly higher gestational diabetes risk (13.8% → 45.7%); improvement in HOMA-IR during treatment increased odds of clinical pregnancy and reduced preeclampsia risk (all P<.005).","limitations":"- Secondary analysis of an RCT, so findings are hypothesis-generating rather than confirmatory.\n- HOMA-IR cutoffs for quartiles are not explicitly defined, limiting direct clinical application.\n- The original trial was not powered for subgroup analyses by insulin resistance category.","practice_takeaway":"Screen women with PCOS for insulin resistance (HOMA-IR) before starting ovulation induction — those with higher HOMA-IR have substantially lower live-birth rates and much higher gestational diabetes risk. Targeting insulin resistance improvement prior to or during treatment may improve reproductive outcomes and reduce obstetric complications."}},{"doi":"10.1016/j.jacc.2025.11.001","pmid":"42171544","title":"Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus Decision Pathway","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-05-22T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2025.11.001","source_score":55,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-27T15:43:03.282Z","updated_at":"2026-05-27T15:43:03.282Z","tags":[{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Gestational Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Hypertensive Disorders of Pregnancy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Postpartum Hypertension","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"amlodipine","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"enalapril","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"labetalol","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"generic","value":"nifedipine","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Beta Blocker","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Calcium Channel Blocker","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"modality","value":"Remote Blood Pressure Monitoring","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"study_design","value":"Expert Consensus / Clinical Practice Toolkit","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2025.11.001","tag_type":"warning","value":"This document is a clinical toolkit and expert consensus statement, not a primary research study; level of evidence reflects expert opinion throughout. No sample size is applicable. The publication date in the DOI (2026-05-22) is consistent with the 2026 ACC Expert Consensus designation, though PDF metadata shows a 2024 creation date, suggesting the document was in preparation for some time before publication. BP titration targets in the fourth trimester are explicitly acknowledged by the authors as lacking high-quality trial evidence.","value_numeric":null}],"summaries":{"what_studied":"This ACC expert consensus toolkit provides a practical framework for establishing and operating postpartum hypertension clinics for individuals with hypertensive disorders of pregnancy (HDP), covering clinic models, staffing, BP management protocols, medication titration, remote monitoring, contraception, and cardiovascular risk counseling.","key_result":"Key guidance includes: start antihypertensives when BP ≥140/90 mmHg on 2+ occasions; target BP <140/90 mmHg early postpartum, then <130/80 mmHg long-term; first-line agents are nifedipine XL 30 mg daily, enalapril 5 mg daily, or amlodipine 5 mg daily (all safe with breastfeeding). Over 40% of patients with severe preeclampsia remain hypertensive at 1 year postpartum; the POP-HT RCT showed improved BP control with remote monitoring. HDP recurrence risk is ~21%.","limitations":"This is a consensus-based toolkit, not a systematic review or RCT; most specific numerical recommendations (e.g., BP titration intervals) are expert opinion, not derived from high-quality postpartum-specific trial data. Optimal BP targets throughout the fourth trimester are described as an 'evidence-free space.'","practice_takeaway":"Clinicians should schedule a BP check within 7–10 days of delivery for all HDP patients, initiate antihypertensives at BP ≥140/90 mmHg, and counsel every patient that HDP carries a cardiovascular risk comparable to smoking or diabetes. Telemedicine and remote BP monitoring improve retention and BP control; avoid combined hormonal contraceptives (estrogen-containing) in patients with uncontrolled hypertension (BP ≥160/100 mmHg)."}},{"doi":"10.1111/1471-0528.70265","pmid":"42152801","title":"Proteinuria in Preeclampsia and Long‐Term Risk of Maternal Kidney and Cardiovascular Disease: A Population‐Based Cohort Study","journal_title":"BJOG: An International Journal of Obstetrics & Gynaecology","journal_issn":"1470-0328","published_at":"2026-05-19T00:00:00.000Z","url":"https://doi.org/10.1111/1471-0528.70265","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-03T13:44:35.218Z","updated_at":"2026-06-03T13:44:35.218Z","tags":[{"paper_doi":"10.1111/1471-0528.70265","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"condition","value":"Hypertension","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"sample_size","value":"n=286078","value_numeric":286078},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"study_design","value":"Population-Based Cohort Study","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"warning","value":"All data are from Denmark — findings may not generalize to populations with different baseline CKD prevalence or healthcare access.","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"warning","value":"CVD outcomes at 10 years were low in absolute terms (~1.2% across groups), so the study may be underpowered to detect UPE-related differences in CVD risk.","value_numeric":null},{"paper_doi":"10.1111/1471-0528.70265","tag_type":"warning","value":"The study uses clinical UPE cutoffs (no/mild vs. moderate/severe) rather than continuous quantitative measurements, which may obscure dose-response granularity.","value_numeric":null}],"summaries":{"what_studied":"This nationwide Danish cohort study (1998–2018, follow-up through 2021) examined whether the level of urinary protein excretion (UPE) during preeclampsia modifies the long-term 10-year risk of hypertension, chronic kidney disease (CKD), and cardiovascular disease (CVD) among 286,078 pregnant women.","key_result":"Preeclampsia with moderate/severe UPE carried a 10-year CKD risk of 5.1% vs. 1.2% with no/mild UPE — a fourfold difference. Hypertension risk was also higher (16.0% vs. 11.9%), but CVD risk was similar across UPE levels (~1.2% in both groups).","limitations":"Observational design limits causal inference; UPE was measured using routine clinical cutoffs rather than standardized quantitative assays; residual confounding (e.g., pre-existing subclinical kidney disease) cannot be excluded.","practice_takeaway":"Women who had preeclampsia with heavy proteinuria face a substantially higher long-term CKD risk and warrant closer post-pregnancy kidney function monitoring. All women with any history of preeclampsia should be counseled about elevated risks of hypertension and CVD."}},{"doi":"10.1093/ndt/gfag108","pmid":"42148809","title":"Kidney biopsy during pregnancy: indications, complications, results and therapeutic impact","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-05-18T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag108","source_score":14,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-21T13:21:04.574Z","updated_at":"2026-05-21T13:21:04.574Z","tags":[{"paper_doi":"10.1093/ndt/gfag108","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"brand","value":"Benlysta","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Focal Segmental Glomerulosclerosis","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"IgA Nephropathy","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Kidney Disease In Pregnancy","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Lupus Nephritis","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Membranous Nephropathy","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Minimal Change Disease","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Nephrotic Syndrome","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"condition","value":"Preeclampsia","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"generic","value":"azathioprine","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"generic","value":"belimumab","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"generic","value":"hydroxychloroquine","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"generic","value":"rituximab","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Anti-CD20 Monoclonal Antibody","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Antimalarial","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"BLyS Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Calcineurin Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Corticosteroid","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Diagnostic Procedure","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"modality","value":"Immunosuppressant","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"sample_size","value":"n=76","value_numeric":76},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"warning","value":"No control group of pregnant women with similar kidney disease who did not undergo biopsy was available, so the independent effect of KB on outcomes cannot be isolated.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"warning","value":"The high rates of adverse obstetric outcomes (e.g., preterm birth 65%, intrauterine fetal death 9%) likely reflect the severity of the underlying kidney diseases rather than a complication of the biopsy itself — clinicians should not interpret these as procedural risks.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag108","tag_type":"warning","value":"The study is limited to French centers; practice patterns and case selection may not generalize to other health systems.","value_numeric":null}],"summaries":{"what_studied":"A French nationwide retrospective survey evaluated the indications, complications, histological diagnoses, treatments initiated, and obstetric outcomes of 76 pregnant women who underwent native kidney biopsy (KB) between 2006 and 2025, with KB performed at a median gestational age of 13.5 weeks.","key_result":"KB yielded a diagnosis in 94.7% of cases; the most common diagnoses were lupus nephritis (43%), FSGS (13%), membranous nephropathy (13%), and IgA nephropathy (12%). Only 1 patient had a major bleeding complication requiring transfusion. Specific treatment was started in 63.2% of patients post-biopsy. Adverse obstetric outcomes were frequent: preterm birth 65.0%, low birth weight 56.7%, small for gestational age 21.3%, preeclampsia 16.4%, and intrauterine fetal death 9.0%.","limitations":"- Retrospective, observational design with no control group, limiting causal inference about KB-related versus disease-related obstetric outcomes.\n- Small sample size (n=76) with likely selection bias, as only cases where clinicians judged KB necessary were included.\n- No standardized follow-up protocol across participating French centers.","practice_takeaway":"Kidney biopsy in the first two trimesters of pregnancy appears safe (low procedural complication rate) with a high diagnostic yield (~95%), and directly changes management in nearly two-thirds of cases. Clinicians should weigh this favorable risk/benefit profile when KB is needed to guide treatment of nephrotic syndrome or significant proteinuria in pregnancy."}},{"doi":"10.1016/j.preghy.2026.101473","pmid":"42105509","title":"Are we overlooking ultra-processed foods in preeclampsia?","journal_title":"Pregnancy Hypertension","journal_issn":"2210-7789","published_at":"2026-05-10T00:00:00.000Z","url":"https://doi.org/10.1016/j.preghy.2026.101473","source_score":3,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-11","doi":"10.1016/j.preghy.2026.101473","days":"7","issn":"2210-7789","rank":"8","field":"Clinical Medicine","score":"3","category":"Obstetrics & Gynecology","categories":["Obstetrics & Gynecology"],"_categories":["Obstetrics & Gynecology"]},"pubmed":{"doi":"10.1016/j.preghy.2026.101473","title":"Are we overlooking ultra-processed foods in preeclampsia?","journal":"Pregnancy hypertension","methods":"","results":"","abstract":"Ultra-processed foods (UPFs) are a hallmark of unhealthy dietary patterns and have been linked to chronic low-grade inflammation, insulin resistance, and obesity - key risk factors for preeclampsia (PE). Growing epidemiological evidence associates UPF-rich dietary patterns with increased risk of hypertensive disorders of hypertension (HDP), including PE. UPFs may promote PE pathophysiology through inflammation, gut microbiota dysbiosis, immune dysregulation, oxidative stress, endothelial dysfunction, and angiogenic imbalance. In this narrative review we synthesize the epidemiological and mechanistic evidence linking UPF consumption to PE and claim that recognizing UPFs as a modifiable dietary risk factor represents a meaningful and underexplored opportunity for PE prevention.","keywords":["Dietary pattern","Hypertensive disorders of pregnancy","Nutrition","Preeclampsia","Ultra-processed foods"],"pubmed_id":"42105509","conclusions":"","publication_date":"2026-05-10T00:00:00"},"crossref":{"DOI":"10.1016/j.preghy.2026.101473","URL":"https://doi.org/10.1016/j.preghy.2026.101473","ISSN":["2210-7789"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S2210778926000619?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S2210778926000619?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"101473","type":"journal-article","issue":null,"score":1,"title":["Are we overlooking ultra-processed foods in preeclampsia?"],"author":[{"given":"Priscila Oliveira","family":"Barbosa","sequence":"first","affiliation":[]},{"given":"Aline Souza","family":"Costa","sequence":"additional","affiliation":[]},{"given":"Priscila Rezeck","family":"Nunes","sequence":"additional","affiliation":[]},{"given":"Andrew","family":"Shennan","sequence":"additional","affiliation":[]},{"given":"Ricardo Carvalho","family":"Cavalli","sequence":"additional","affiliation":[]},{"given":"Valeria Cristina","family":"Sandrim","sequence":"additional","affiliation":[]}],"funder":[{"id":[{"id":"10.13039/501100001807","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100001807","name":"State of Sao Paulo Research Foundation","doi-asserted-by":"publisher"},{"id":[{"id":"10.13039/501100003593","id-type":"DOI","asserted-by":"publisher"}],"DOI":"10.13039/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"publisher"}],"issued":{"date-parts":[[2026,6]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":"44","created":{"date-time":"2026-05-08T13:50:46Z","timestamp":1778248246000,"date-parts":[[2026,5,8]]},"indexed":{"date-time":"2026-05-08T22:11:58Z","timestamp":1778278318100,"date-parts":[[2026,5,8]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000,"date-parts":[[2026,6,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000,"date-parts":[[2026,6,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"http://creativecommons.org/licenses/by/4.0/","start":{"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000,"date-parts":[[2026,4,22]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S2210778926000619"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"Are we overlooking ultra-processed foods in preeclampsia?"},{"name":"journaltitle","label":"Journal Title","value":"Pregnancy Hypertension"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.preghy.2026.101473"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2026 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy."}],"deposited":{"date-time":"2026-05-08T21:51:36Z","timestamp":1778277096000,"date-parts":[[2026,5,8]]},"issn-type":[{"type":"print","value":"2210-7789"}],"published":{"date-parts":[[2026,6]]},"publisher":"Elsevier BV","reference":[{"DOI":"10.1161/HYPERTENSIONAHA.117.10803","key":"10.1016/j.preghy.2026.101473_b0005","year":"2018","issue":"1","author":"Brown","volume":"72","first-page":"24","unstructured":null,"article-title":"Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice","journal-title":"Hypertension","doi-asserted-by":"crossref"},{"DOI":"10.1038/s41572-023-00417-6","key":"10.1016/j.preghy.2026.101473_b0010","year":"2023","issue":"1","author":"Dimitriadis","volume":"9","first-page":"8","unstructured":null,"article-title":"Pre-eclampsia","journal-title":"Nat. Rev. Dis. Primers.","doi-asserted-by":"crossref"},{"DOI":"10.1097/AOG.0000000000003891","key":"10.1016/j.preghy.2026.101473_b0015","year":"2020","issue":"6","author":"Gestational Hypertension and Preeclampsia","volume":"135","first-page":"e237","unstructured":null,"article-title":"ACOG Practice Bulletin, Number 222","journal-title":"Obstet. 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Remote monitoring reduced total antenatal visits (median 14 vs. 16; p<0.01), planned outpatient appointments (10 vs. 13; p<0.01), any-cause hospital admission (HR 0.54, 95% CI 0.30–0.97; p=0.04), and hypertension-specific admission (HR 0.41, 95% CI 0.19–0.88; p=0.02). More antihypertensive prescriptions were filled in the remote arm (median 5 vs. 3; p<0.01).","limitations":"- Unblinded design may introduce performance or detection bias.\n- Single-country, 3-centre metropolitan sample (60% non-Caucasian) limits global generalisability.\n- Non-inferiority margin and statistical power assumptions are not detailed in the abstract, making it hard to assess whether the trial was adequately sized for the primary composite.","practice_takeaway":"For pregnant women at high risk of preeclampsia, remote BP monitoring can safely replace frequent specialist clinic visits — reducing office attendances and hospital admissions without worsening fetal or maternal outcomes. 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