Preeclampsia (PE) is one of the leading cause of adverse maternal and perinatal outcomes. Antihypertensive treatment aims to reduce serious maternal complications such as maternal stroke, heart failure, pulmonary edema, renal injury, and eclampsia, while avoiding an excessively rapid decline in blood pressure that may compromise uteroplacental perfusion. This review addresses the therapeutic targets, timing of initiation, blood pressure goals and commonly used antihypertensive agents in the management of PE, and also discusses the management of acute severe hypertension, special clinical scenarios, and major controversies, emphasizing the importance of continuous, stable, and individualized blood pressure management.

Preeclampsia is a pregnancy-specific syndrome that may affect intrauterine fetal development through mechanisms including inadequate placental perfusion, angiogenic imbalance, inflammation, and oxidative stress. Its effects on offspring health extends beyond the perinatal period and may persist into childhood, adolescence, and even adulthood. This review discusses the associations of preeclampsia with fetal growth restriction, preterm birth, adverse perinatal outcomes, and increased long-term risks of cardiovascular, metabolic, neurodevelopmental, respiratory, and renal diseases in offspring. The management of high-risk populations and the importance of long-term follow-up are also addressed.

Preeclampsia is a multisystem progressive disease unique to pregnancy and one of the leading causes of maternal and fetal morbidity and mortality. As the core initiating organ in the pathogenesis of preeclampsia, the placenta undergoes pathological changes throughout the entire course of the disease. These changes not only serve as the pathological basis for the occurrence and progression of preeclampsia but also are closely associated with clinical diagnosis and treatment decision-making, disease severity evaluation, and prognostic judgment. Based on the Amsterdam Placental Consensus and the latest research advances, this manuscript systematically elaborates the gross and microscopic pathological features of the placenta in preeclampsia, and further analyzes the correlations between placental pathological alterations and clinical symptoms, disease severity, as well as maternal and fetal prognosis, to provide pathological evidence for the early warning, precise diagnosis, individualized treatment and prognostic assessment of preeclampsia.

To investigate the influence of different placental pathological sampling methods on the detection rate of uteroplacental vessels and the accuracy of placental pathological diagnosis.

(1) Based on the ultrasonic blood flow signals of different placental locations, a new placental sampling method was proposed (new method group) and compared with the conventional placental sampling method recommended by the Amsterdam Consensus (conventional method group), in terms of the detection rate of uteroplacental vessels and the accuracy of placental pathological diagnosis. (2) There were 176 patients in the new method group, 57 of whom were clinically diagnosed as hypertensive disorders of pregnancy (HDP); 129 patients in the conventional method group, 43 of whom were HDP. The detection rate of uteroplacental vessels and the diagnostic rate of placental maternal vascular malperfusion (MVM) were compared between the two groups.

(1) In the detection rate of uteroplacental vessels, comparison of HDP placentas showed that the new method group was significantly higher than the conventional method group (70.2% vs 39.5%, Z=-3.057, P=0.002). (2) Comparison of different placental positions showed that the detection rate of blood vessels located at the placental margin was the highest (54.4%, U=13.841, P=0.003). (3) The diagnostic rate of MVM of HDP in the new method group was higher than that in the conventional method group (59.6% vs 32.6%, Z=-2.671, P=0.008).

The new placental sampling method can obtain more uteroplacental vessels for histopathological evaluation and demonstrate more comprehensive lesion information, which improves the accuracy of placental pathological diagnosis and standardizes placental sampling criteria.

To investigate the relationship between the non-fasting triglyceride-glucose (TyG) index and macrosomia during the third trimester in pregnant women at high altitudes.

A retrospective study was conducted on singleton pregnant women who delivered at Chaya People's Hospital of Qamdo City, Xizang Autonomous Region, from January 2023 to April 2025. Participants were divided into a macrosomia group and a control group based on newborn birth weight. The non-fasting TyG index was calculated from non-fasting triglyceride (TG) and random plasma glucose (PG). Based on the tertiles of the non-fasting TyG index, participants were divided into three groups. The baseline clinical characteristics, lipid profiles, and the risk of macrosomia were compared among the three groups. Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis H test, Chi-square test, or Fisher's exact test for multi-group comparisons. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the correlation between the non-fasting TyG index and macrosomia. Subgroup analyses were also conducted.

(1) A total of 771 singleton pregnant women were included, with a mean age of 27.3±6.1 years, a proportion of 26.72% (206/771) primiparous women, a pre-pregnancy BMI of (25.1±2.3) kg/m^2, and a mean non-fasting TyG index of 9.1±0.4. Twenty-one pregnant women were diagnosed with macrosomia, with a detection rate of 2.72% (21/771). (2) Statistically significant differences in pre-pregnancy BMI, altitude, serum total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), PG, newborn birth weight, and the incidence of macrosomia were observed among the three non-fasting TyG groups (all P<0.05). Trend tests further revealed that TC, TG, LDL-C, PG, newborn birth weight, and macrosomia incidence all showed increasing trends with the elevation of the non-fasting TyG index (all P<0.001). (3) Multivariate logistic regression analysis demonstrated an independent positive association between the non-fasting TyG index and macrosomia (OR=6.64, 95%CI: 2.00-22.01, P=0.002), and the risk of macrosomia increased progressively with the non-fasting TyG index (P for trend <0.05). (4) Restricted cubic spline analysis showed a linear dose-response relationship between the non-fasting TyG index and macrosomia (P for non-linearity =0.355). (5) Subgroup analysis revealed no interaction between the non-fasting TyG index and hyperglycemia in pregnancy (HIP) in relation to macrosomia (P for interaction >0.05).

The non-fasting TyG index in the third trimester is an independent risk factor for macrosomia in singleton pregnant women at high altitudes, and the risk of macrosomia increases progressively with the elevation of the non-fasting TyG index.

To investigate the detection rate and risk factors of abnormal prethrombotic state and its association with pregnancy outcomes in pregnant women with fetal growth restriction.

A retrospective study was conducted on 182 pregnant women with FGR treated at our hospital from January to December 2024. Data collected included maternal age, pre-pregnancy body mass index (BMI), mode of conception, obstetric history, gestational age at first FGR diagnosis, gestational age at prethrombotic state testing, pregnancy complications and comorbidities, TORCH screening results, prenatal screening or diagnostic findings, medication during pregnancy, and pregnancy outcomes. Laboratory tests included antiphospholipid antibody profiles, antinuclear antibodies, protein C/S, antithrombin Ⅲ (AT-Ⅲ), and homocysteine levels. Patients were divided into an abnormal group (n=99) and a normal group (n=83) based on test results. Clinical characteristics and pregnancy outcomes were compared between the two groups.

Prethrombotic state abnormalities were detected in 54.3% of FGR pregnant women. Compared with the normal group, the abnormal group had significantly higher levels of anticardiolipin antibody IgM, anti-β2-glycoprotein I antibody IgM, lupus anticoagulant screening/confirmatory ratio, anti-phosphatidylserine/prothrombin antibody IgM, and antinuclear antibodies, along with significantly lower levels of AT-Ⅲ activity and protein S, with all differences being statistically significant (all P<0.05). Multivariate logistic regression analysis identified maternal age (OR=1.10, 95%CI: 1.01-1.20) and high pre-pregnancy BMI (OR=1.10, 95%CI: 1.00-1.22) as independent risk factors for prethrombotic state abnormalities.

Advanced maternal age and high pre-pregnancy BMI are independent risk factors for prethrombotic state abnormalities in pregnant women with FGR, with a high detection rate. Screening for prethrombotic state is recommended in FGR patients with these risk factors to improve pregnancy outcomes.

To analyze the uterine electromyography (EMG) characteristics of primiparous women with threatened preterm labor and to evaluate the value of uterine EMG combined with cervical length in predicting preterm birth.

This was a prospective observational cohort study. Primiparous women at 24-34 weeks of gestation with symptoms of threatened preterm labor who presented to the obstetrics clinic or emergency department of our hospital were enrolled. Uterine EMG and cervical length measurements were performed. Clinical characteristics, cervical length, pregnancy outcomes, and uterine EMG parameters including burst wave frequency (number of burst waves per 30 minutes), burst duration, maximum power density spectrum (PDS) frequency, and total power were recorded and analyzed. ROC curves for predicting delivery within 7 days were constructed using uterine EMG parameters and cervical length, alone and in combination.

A total of 209 pregnant women were included. Based on the time interval from enrollment to delivery, they were divided into three groups: delivery within 48 hours (n=20), delivery within 3-7 days (n=22), and delivery after more than 7 days (n=167). The total power of uterine EMG burst waves in the within-48-hours delivery group was significantly higher than that in the 3-7 days delivery group and the >7 days delivery group, with mean differences (I-J) of -3.13 and -4.47, respectively (both P<0.001). The total power in the 3-7 days delivery group was significantly higher than that in the >7 days delivery group, with a mean difference (I-J) of -1.34 (P<0.001). There were no statistically significant differences in the number of burst waves, burst duration, or maximum PDS among the three groups (all P>0.05). The AUC of total power for predicting delivery within 7 days was 0.88, with a sensitivity of 76.0% and a specificity of 86.2%. The AUC of cervical length for predicting delivery within 7 days was 0.71, with a sensitivity of 74.0% and a specificity of 63.0%. When uterine EMG total power was combined with cervical length, the AUC for predicting delivery within 7 days increased to 0.92, with a sensitivity of 81.0% and a specificity of 90.0%.

An increase in uterine EMG burst wave total power may indicate an increased risk of preterm birth. The combination of uterine EMG and cervical length can improve the accuracy of predicting delivery within 7 days in women with threatened preterm labor.

To explore the early identification, clinical characteristics, diagnosis and treatment, and pregnancy outcomes of pregnancy-related fulminant type 1 diabetes mellitus (FT1DM), in order to improve clinicians' diagnostic and therapeutic approach and increase maternal and fetal survival rates.

A retrospective analysis was conducted on the clinical data of 4 patients with pregnancy-related FT1DM. Additionally, a literature search was performed using the keyword " fulminant type 1 diabetes" in the China National Knowledge Infrastructure (CNKI) and Chinese Journal Full-text Database from January 2000 to December 2024. A total of 222 relevant articles and case reports were retrieved, including 423 patients with FT1DM. Among these, 100 cases of pregnancy-related FT1DM were further screened and analyzed.

All four patients presented with a typical acute onset, rapidly progressing from markedly elevated blood glucose (random blood glucose 18.75-38.69 mmol/L) to diabetic ketosis or ketoacidosis within a short period (1-5 days). They exhibited a " dissociation" phenomenon between extremely high random blood glucose and relatively mildly elevated glycated hemoglobin (6.1%-6.9%), with a PG/HbA1c ratio ≥3.3. Fasting serum C-peptide levels were all <100 pmol/L; pancreatic autoantibodies were negative in 3 patients and not tested in 1. Literature analysis of 100 pregnancy-related FT1DM cases showed that the condition was more common during pregnancy (96%, 96 cases), with acute onset (mean time approximately 3 days). The four patients presented with non-specific prodromal symptoms: gastrointestinal symptoms in 2 cases, respiratory symptoms in 1 case, and neurological symptoms in 1 case.Literature analysis of 100 pregnancy-related FT1DM cases showed that The most common prodromal symptoms were gastrointestinal symptoms (24%, 24 cases), followed by respiratory symptoms (16%, 16 cases). After multidisciplinary treatment, 3 neonates survived and 1 was stillborn. Literature analysis showed that the overall pregnancy outcomes were extremely poor, with a fetal loss rate as high as 60% (mainly stillbirths, accounting for 54%).

Pregnancy-related FT1DM has an acute onset and insidious symptoms, and leads to an extremely high rate of fetal loss. Clinicians should enhance their awareness and remain highly vigilant for any non-specific gastrointestinal or respiratory symptoms in pregnant women without a history of diabetes, considering them as possible prodromal signs of FT1DM. Random blood glucose, urine ketone bodies, and pancreatic function (C-peptide) should be tested immediately, and the key feature of " dissociation between blood glucose and glycated hemoglobin" should be used for early differentiation. Emergency protocols should be initiated, and multidisciplinary collaboration should be implemented to improve maternal and fetal survival.