Pre-eclampsia is diagnosed when a woman develops high blood pressure (over 130/80) with liver or kidney failures (protein in urine) and/or swelling of the hands, feet and/or face during pregnancy. About 3 to 7 percent of pregnant women develop pre-eclampsia, which can occur after 20 weeks of pregnancy.

Untreated pre-eclampsia can lead to serious complications because it can harm the mother’s organs and lead to seizures. If these seizures (eclampsia) left untreated, they usually could be fatal for both a woman and her fetus, (low birth weight, premature delivery or placental abruption)

Pre-eclampsia can progress to HELLP syndrome, another life-threatening condition. It is called HELLP because it is defined as the breakdown of red blood cells (Haemolysis), Elevated Liver enzymes and a Low Platelet count.

Some women with pre-eclampsia don’t have any symptoms, so it’s important to see their doctor for regular blood pressure checks and urine tests.

Ágnes Araczki, MD,

Head of the Immunochemistry Unit, Department of Laboratory Medicine, University of Szeged, Szeged, Hungary

https://labtestsonline.org.uk/conditions/pre-eclampsia

Laboratory tests for pre-eclampsia and HELLP syndrome*

Tests for diagnosing and follow up of pre-eclampsia:

• Kidney function tests: urine protein and protein to creatinine ratio (qualitative and/or quantitative tests) – protein could present in urine in pre-eclampsia
• Kidney function tests: serum urea, serum creatinine and serum uric acid determinations – elevated levels support the diagnosis of pre-eclampsia
• Liver function tests: serum alanine aminotransferase (ALT, ALAT), aspartate aminotransferase (AST, ASAT) – the levels of transaminases may be elevated in pre-eclampsia
• Blood picture (full blood count) including platelet counts – platelet counts are often low in case of pre-eclampsia
• Hemostasis: partial thromboplastin time (PTT) – elevated (extended) in case of pre-eclampsia.
• Determination of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt) – PlGF alone may be lower or the ratio of sFlt to PlGF may be increased in pre-eclampsia

Additional tests for HELLP syndrome:

• Blood smear – the shape of red blood cells should be evaluated – damage or abnormalities support the onset of HELLP syndrome.
• Serum lactate dehydrogenase (LDH) – elevated LDH levels indicate tissue or cell damage (in vivo hemolysis) in pre-eclampsia
• Total bilirubin – elevated in pre-eclampsia due to liver damage or in vivo hemolysis.

Melinda Dancs, Immunochemistry Unit, Department of Laboratory Medicine, University of Szeged, Szeged, Hungary

*All other causes of elevated tests should be excluded. The laboratory parameters alone should not be interpreted without medical history, physical examinations and considering other diagnostic tests.

https://labtestsonline.org.uk/conditions/pre-eclampsia

The demographic situation of women wishing to have children has changed in recent decades. The average age of women at first marriage increased by 8 years and the birth of their first child increased by 5.8 years. This means that the decline in fertility and the increase in childbearing age are taking place in parallel. The number of pregnancies among women aged 20-29 dropped dramatically, while it doubled among those aged 30-34 and tripled in the second half of their 30s. Social and societal trends show that women are increasingly postponing having children until the second half of their 30s and the first half of their 40s. Prolonging the childbearing age for women amplifies the problem of infertility, which affects one in three women between the ages of 35 and 39, and 90% of women between the ages of 40 and 45.

Number of children born to mothers at least 40 years old in Hungary

Department of Health Economics, University of Szeged

• Herpes simplex virus (HSV) has two types
• Both HSV type 1 and type 2 cause lifelong infection
• There are 7753 million people living on Earth
• 3752 million people have HSV-1 infection, and 491.5 million people are living with HSV-2 worldwide
• HSV-2 causes the majority of genital HSV infections
• Both HSV-1 and HSV-2 can be transmitted from the mother to the fetus and newborn child
• The highest risk for neonatal infection occurs in women with HSV infection acquired shortly before labor
• Neonatal infection can result in serious morbidity and mortality
• Antiviral therapy for pregnant women and cesarean delivery for select women can greatly reduce the risk of neonatal transmission

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265941/

https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

https://www.uptodate.com/contents/genital-herpes-simplex-virus-infection-and-pregnancy

Toxoplasmosis is an infection caused by Toxoplasma gondii, a parasite of all mammalian and bird species throughout the world, especially cats, that affects humans. Although infection with T. gondii is common, it rarely causes disease. Disease acquired during pregnancy can cause congenital infection of the child.

Human infection mainly occurs through consumption of:

• raw or undercooked meat;
• food or water contaminated with T. gondii;

Prevention of primary infection in susceptible individuals e.g. pregnant women is:

• avoid contact with cat faeces in gardens and cat litters;
• avoid ingestion of undercooked meat.

Recommended the T. gondii screening of seronegative pregnant women during pregnancy.

Source: Oxford Handbook of Infectious Diseases and Microbiology 2^nd edition 2017

Syphilis is an infectious disease caused by bacteria called Treponema pallidum subspecies pallidum. It is generally acquired by direct sexual contact and the only known hosts are human beings. T. pallidum commonly invades the central nervous system at an early stage of infection and may or may not produce symptoms. Syphilis can spread from a mother with syphilis to her unborn baby. There are four stages of syphilis (primary, secondary, latent, and tertiary) with different and specific symptoms.

For further information please visit https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

The person most widely accepted to hold this title is Beulah Hunter, who, in 1945, at the age of 25, gave birth after 375 days of being pregnant (as opposed to the average of 280 days). It was substantiated by a physician who first documented her last menstrual cycle and the first time she tested positive for pregnancy. At the time, Hunter broke the previous record by 58 days when she gave birth to her daughter, Penny Diana. According to the doctors who documented and monitored her pregnancy little Penny Diana was taking her time in the womb, developing at an extremely slow pace, which caused the lengthy pregnancy.

One of the shortest recorded pregnancies where the infant survived was just 22 weeks. The baby had a number of complications but survived. An even younger baby, born at 21 weeks, extremely preterm. The infant girl weighed less than 410 grams, when she was born in San Antonio, Texas, in 2014. The baby’s mother was 32-years-old at the time and only 21 weeks and 4 days pregnant. At birth, the newborn’s skin was thin, it was nearly see-through. The “Miracle Girl” is a little smaller in stature next to the other kids, but otherwise, she has no mental or health disabilities.

https://www.healthline.com/health/pregnancy/pregnancy-facts

A 74-year-old woman has given birth to twin girls in the southern Indian in 2019. Yaramati and her 82-year-old husband, Sitarama Rajarao, had wanted children for years, and that they had been stigmatized in their village for being childless. The pregnancy normal without any complications. The twins were conceived through in vitro fertilization. Because Yaramati had experienced menopause, a donor’s egg was fertilized with Rajarao’s sperm before it was implanted in the new mother.

In a 2016 document, the Ethics Committee of the American Society for Reproductive Medicine discouraged physicians from “providing donor oocytes or embryos to women over 55 years of age, even when they have no underlying medical problems.”

The committee cited concerns around maternal and fetal safety, longevity and “the need for adequate psychosocial supports for raising a child to adulthood.”

https://www.washingtonpost.com/world/2019/09/06/this-year-old-woman-just-gave-birth-twins/

According to Eurostat Fertility statistics, the fertility rate was in the EU member states in 2013 1.51 live births per woman. That followed by a slight increase in 2016 with 1.57 and another decrease until 2020 with 1.50. In 2021, the total fertility rate in the EU was 1.53 live births per woman.

In Hungary and Romania, there have been significant changes in the fertility rate in the last 9 years (2013-2021). While the fertility rate in both countries was much lower than the European Union average in 2013, in Romania from 2014 and in Hungary from 2018 it rose above the current fertility rate of the given year and has been increasing ever since. By 2021, they will exceed the European Union average rate of 1.53. The annual fertility rate is 1.61 in Hungary and 1.81 in Romania.

Annual fertility rates

(source: own compilation based on Eurostat data)

According to the available Eurostat data, in the European Union in the period examined between 2013 and 2021, the average age of women having their first child shifted by 0.9 years, their second child by 0.6 years, and their third, fourth or additional children shifted by 0.4 years. The average age of women at birth was 0.8 years later than in earlier times. The figure below shows the continuous increase in the age at which women have children. The trend is monotonically increasing.

Maternal age in European Union

(source: own compilation based on Eurostat data)

In Hungary in the period examined between 2013 and 2021, the average age of women having their first child shifted by 0.9 years, this is the same trend as in the European Union. The average age of women having their second child shifted in during 8 years by 0.4 years, and their third, by 0.1 years. However, in contrast to the trend observed in the European Union, the fourth or additional children in Hungary are born in 0.3 years earlier than before. The average age of women at birth was 0.5 years later than in earlier times. These data show the earlier propensity of Hungarian women to give birth compared to the European average.

Maternal age in Hungary

(source: own compilation based on Eurostat data)

In Romania, the time of having a first child shifted by 1.2 years between 2013 and 2021, which is a higher rate than in the European Union. The second and third children are born at a woman’s age 0.5 years older, which differs minimally from the European average by only 0.1 year. However, in contrast to the trend observed in the European Union, but similar in Hungary, the fourth or additional children in Romania are born in 0.3 years earlier mother’s age. The average age of women at birth was 0.8 years later than in earlier times.

Maternal age in Romania

(source: own compilation based on Eurostat data)

Nowadays, the change in childbearing trends not only affected the first child’s time but was also accompanied by a shift in maternal age in the birth of additional children, both in the EU and in Hungary and Romania.

For comparison, based on the above tables, it can be established that in the period describing the last 9 years, between 2013-2021.

• the first children are born 0.9 years later in the European Union and Hungary, and 1.2 years later in Romania,
• the birth of second children was delayed by 0.6 years in the European Union, 0.4 years in Hungary, and 0.5 years in Romania,
• the arrival of third children already shows a larger spread between the mentioned countries. In the European Union, children arrive 0.4 years later, while in Hungary this change means only 0.1 years and in Romania 0.5 years,
• the trend changes sharply when the fourth child is born. In the European Union, the arrival of the fourth child has been postponed by 0.4 years later, while in Hungary and Romania, women have it 0.3 years earlier compared to the previous period,
• in general, it can be said that while the average childbearing age of women in the European Union and in Romania shifted by 0.8 years, it was 0.5 years later in Hungary.

Changes in the age of women’s childbearing

(Source: own compilation based on Eurostat data)

Hypertensive disorders of pregnancy (HDP, ie, gestational hypertension; preeclampsia; eclampsia; and hemolysis, elevated liver enzymes, and low platelet syndrome) affect 5% to 10% of pregnancies worldwide. HDP are associated with a roughly 2-fold increase in future maternal cardiovascular disease risk. In a Norwegian study, among 508 422 women, 565 experienced incident heart failure over a median of 11.8 years of follow-up.  The largest hazards of heart failure were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. A total of 46 084 women (9.1%) experienced hypertensive disorders in any pregnancy, of whom 8827 women (1.7% of the overall cohort) experienced gestational hypertension in the first birth and 24 326 (4.8% of the overall cohort) experienced preeclampsia in the first birth. Women with a single lifetime birth complicated by preeclampsia and women with recurrent preeclampsia demonstrated further elevation in heart failure risk. Heart failure risks were largely independent of hypertensive disorders of pregnancy’s association with coronary artery disease.

Source: Honigbert et al.: Hypertension 76(5), 2020, 1506-1513