const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Hypertensive Disorders of Pregnancy";
pres.author = "Orris AI";

// ─── COLOR PALETTE ───
// Deep navy dominates, crimson accent, clean white text, soft teal highlights
const C = {
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  crimson:    "B22234",   // accent / headings
  gold:       "D4AF37",   // highlight
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  white:      "FFFFFF",
  lightGray:  "EEF2F7",
  midGray:    "7A8FA6",
  softNavy:   "1B3A6B",
  paleBlue:   "D0DAEA",
};

const FONT = "Calibri";

// ─── HELPERS ───
function darkSlide(slide) {
  slide.background = { color: C.navy };
}
function lightSlide(slide) {
  slide.background = { color: C.lightGray };
}

function sectionHeader(slide, text) {
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function bulletList(slide, items, opts) {
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}

// ══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  darkSlide(s);

  // Top crimson band
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.1, fill: { color: C.crimson } });
  s.addText("HYPERTENSIVE DISORDERS OF PREGNANCY", {
    x: 0.4, y: 0.18, w: 9.2, h: 0.75,
    fontSize: 28, bold: true, color: C.white, fontFace: FONT,
    align: "center", charSpacing: 2, margin: 0
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  s.addText("Etiopathogenesis · Clinical Features · Complications", {
    x: 0.5, y: 1.5, w: 9, h: 0.55,
    fontSize: 17, color: C.gold, fontFace: FONT, align: "center", italic: true, margin: 0
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  // Subtitle box
  s.addShape(pres.ShapeType.roundRect, { x: 2.5, y: 2.3, w: 5, h: 1.0, fill: { color: C.softNavy }, rectRadius: 0.1 });
  s.addText("A Comprehensive Review with\nRecent Literature (2023–2026)", {
    x: 2.5, y: 2.3, w: 5, h: 1.0,
    fontSize: 14, color: C.paleBlue, fontFace: FONT, align: "center", valign: "middle"
  });

  s.addText("For Postgraduate Residents", {
    x: 0.5, y: 3.6, w: 9, h: 0.4,
    fontSize: 13, color: C.midGray, fontFace: FONT, align: "center", italic: true, margin: 0
  });

  // Stat boxes at bottom
  const stats = [
    { label: "of pregnancies\naffected", val: "5–10%" },
    { label: "leading cause of\nmaternal mortality", val: "#1" },
    { label: "cases with severe\nfeatures", val: "25%" },
  ];
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  });

  footerLine(s, "Creasy & Resnik's MFM | Braunwald's Heart Disease | ACOG Practice Bulletin 222 | Bajpai et al. Kidney360, 2023");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 2 — CLASSIFICATION (ACOG)
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionHeader(s, "Classification of Hypertensive Disorders of Pregnancy (ACOG)");

  const cats = [
    { label: "1. Gestational Hypertension", color: C.teal, details: "New-onset BP ≥140/90 mmHg after 20 wks | No proteinuria | No end-organ damage | Resolves by 12 wks postpartum" },
    { label: "2. Preeclampsia / Eclampsia", color: C.crimson, details: "Gestational HTN + proteinuria (>0.3 g/24h) OR end-organ damage | ± severe features | Eclampsia = preeclampsia + seizures" },
    { label: "3. Chronic Hypertension", color: C.softNavy, details: "HTN diagnosed before pregnancy or <20 wks gestation | Persists >12 wks postpartum | Affects ~3-5% pregnancies" },
    { label: "4. Superimposed Preeclampsia", color: C.navy, details: "Preeclampsia developing on background of chronic HTN | Higher risk of adverse outcomes | Earlier onset, more severe course" },
  ];

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    s.addShape(pres.ShapeType.rect, { x: 0.35, y: yPos, w: 9.3, h: 0.97, fill: { color: cat.color } });
    s.addText(cat.label, {
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  });

  footerLine(s, "ACOG Practice Bulletin No. 222 (2020) | Bajpai et al. Kidney360, 2023 [PMID: 37526641]");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 3 — DIAGNOSTIC CRITERIA (Severe Features)
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionHeader(s, "Diagnostic Criteria & Severe Features of Preeclampsia");

  // Left box: diagnostic criteria
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.1, w: 4.35, h: 4.2, fill: { color: C.softNavy } });
  s.addText("DIAGNOSTIC CRITERIA", {
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    fontSize: 13, bold: true, color: C.gold, fontFace: FONT, align: "center", margin: 0
  });
  bulletList(s, [
    { text: "BP ≥140/90 mmHg on ≥2 occasions, 4h apart, after 20 wks" },
    { text: "PLUS proteinuria >0.3 g/24h OR protein:creatinine >0.3", sub: false },
    { text: "OR any end-organ damage (even without proteinuria):" },
    { text: "Platelets <100 × 10⁹/L", sub: true },
    { text: "Creatinine >1.1 mg/dL or doubling", sub: true },
    { text: "Liver enzymes ≥2× ULN", sub: true },
    { text: "Pulmonary edema", sub: true },
    { text: "New headache / visual symptoms", sub: true },
  ], { x: 0.45, y: 1.62, w: 4.15, h: 3.55 });

  // Right box: severe features
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  s.addText("SEVERE FEATURES", {
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    fontSize: 13, bold: true, color: C.gold, fontFace: FONT, align: "center", margin: 0
  });
  bulletList(s, [
    { text: "SBP ≥160 OR DBP ≥110 mmHg (×2, ≥4h apart)" },
    { text: "Platelets <100,000/μL" },
    { text: "Impaired liver function (AST/ALT ≥2× ULN) + severe RUQ/epigastric pain" },
    { text: "Progressive renal insufficiency (Cr >1.1 mg/dL)" },
    { text: "New-onset headache unresponsive to analgesia" },
    { text: "Visual disturbances" },
    { text: "Pulmonary edema" },
    { text: "HELLP syndrome" },
  ], { x: 5.0, y: 1.62, w: 4.55, h: 3.55 });

  footerLine(s, "ACOG 2020 | Braunwald's Heart Disease, 15e | Creasy & Resnik's MFM, 9e");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 4 — RISK FACTORS
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionHeader(s, "Risk Factors for Preeclampsia");

  // 3 column layout
  const cols = [
    {
      title: "HIGH RISK", color: C.crimson,
      items: ["Nulliparity", "Previous preeclampsia", "Multiple gestation", "Chronic HTN / CKD", "Diabetes (T1DM/T2DM)", "Antiphospholipid syndrome", "Obesity (BMI >30)"]
    },
    {
      title: "MODERATE RISK", color: C.teal,
      items: ["Age >35 years", "ART / IVF pregnancy", "Family history of preeclampsia", "African American ethnicity", "Interpregnancy interval >10 yrs", "Thrombophilia", "Pregestational HTN"]
    },
    {
      title: "PLACENTAL FACTORS", color: C.softNavy,
      items: ["Molar pregnancy", "Hydrops fetalis", "Triploidy", "Large placental mass", "Partial mole", "Placental insufficiency", "Umbilical artery Doppler abnormality"]
    }
  ];

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    const xPos = 0.35 + i * 3.22;
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.1, w: 3.0, h: 0.45, fill: { color: col.color } });
    s.addText(col.title, {
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      fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle"
    });
    s.addShape(pres.ShapeType.rect, { x: xPos, y: 1.55, w: 3.0, h: 3.85, fill: { color: "FFFFFF" }, line: { color: col.color, width: 1.5 } });
    const textArr = col.items.map((item, j) => ({
      text: item,
      options: { bullet: { type: "bullet" }, breakLine: j < col.items.length - 1, fontSize: 13, color: C.navy, fontFace: FONT }
    }));
    s.addText(textArr, { x: xPos + 0.1, y: 1.6, w: 2.8, h: 3.75, valign: "top", margin: 3 });
  });

  // Note at bottom
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 5.1, w: 9.3, h: 0.3, fill: { color: C.gold } });
  s.addText("★  Honigberg et al. (Nat Med 2023): Polygenic risk scores can predict gestational HTN and preeclampsia — opens door for genomic screening [PMID: 37248299]", {
    x: 0.45, y: 5.1, w: 9.1, h: 0.3,
    fontSize: 9.5, color: C.navy, fontFace: FONT, valign: "middle", margin: 2
  });

  footerLine(s, "Creasy & Resnik's MFM 9e | Honigberg et al. Nat Med 2023 [PMID: 37248299]");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 5 — ETIOPATHOGENESIS (Two-Stage Model)
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "0F2642" };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.crimson } });
  s.addText("ETIOPATHOGENESIS — The Two-Stage Model", {
    x: 0.3, y: 0.08, w: 9.4, h: 0.6,
    fontSize: 22, bold: true, color: C.white, fontFace: FONT, align: "center", margin: 0
  });

  // Stage 1 box
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.4, h: 4.55, fill: { color: C.softNavy } });
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.9, w: 4.4, h: 0.48, fill: { color: C.teal } });
  s.addText("STAGE 1 — Placental (Before 20 wks)", {
    x: 0.3, y: 0.9, w: 4.3, h: 0.48,
    fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle"
  });
  const stage1 = [
    "Inadequate EVT (extravillous trophoblast) invasion",
    "Failure of spiral artery remodeling → retained musculoelastic walls",
    "High-resistance, low-flow uteroplacental circulation",
    "Placental ischemia & oxidative stress",
    "Reduced PlGF, increased sFlt-1 (antiangiogenic shift)",
    "Fetal microchimerism amplifies maternal immune activation",
  ];
  const arr1 = stage1.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < stage1.length - 1, fontSize: 12, color: C.white, fontFace: FONT } }));
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  // Arrow
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  // Stage 2 box
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  s.addShape(pres.ShapeType.rect, { x: 5.35, y: 0.9, w: 4.4, h: 0.48, fill: { color: C.crimson } });
  s.addText("STAGE 2 — Maternal Syndrome (After 20 wks)", {
    x: 5.4, y: 0.9, w: 4.3, h: 0.48,
    fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle"
  });
  const stage2 = [
    "Placental factors released into maternal circulation",
    "Generalized endothelial dysfunction",
    "Systemic vasoconstriction → hypertension",
    "Increased vascular permeability → proteinuria, edema",
    "Activation of coagulation cascade",
    "Inflammation: cytokines, complement activation",
    "Multi-organ involvement: brain, liver, kidneys, lungs",
  ];
  const arr2 = stage2.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < stage2.length - 1, fontSize: 12, color: C.white, fontFace: FONT } }));
  s.addText(arr2, { x: 5.45, y: 1.45, w: 4.2, h: 3.85, valign: "top", margin: 3 });

  footerLine(s, "The Developing Human, Moore 11e | Yang et al. Arch Gynecol Obstet 2024 [PMID: 38421424] | Chiang et al. Int J Mol Sci 2024 [PMID: 38674114]");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 6 — MOLECULAR MECHANISMS (detailed)
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionHeader(s, "Molecular & Immunological Mechanisms (Recent Evidence)");

  const boxes = [
    {
      title: "Angiogenic Imbalance", color: C.teal, x: 0.35, y: 1.15,
      text: "↑ sFlt-1 (soluble FMS-like tyrosine kinase-1) sequesters VEGF & PlGF\n↓ PlGF → endothelial dysfunction\nsFlt-1:PlGF ratio >38 predicts preeclampsia within 4 wks (NPV 95%)"
    },
    {
      title: "Immune Dysregulation", color: C.softNavy, x: 5.1, y: 1.15,
      text: "Reduced NK cell tolerance at implantation site\n↓ Soluble HLA-G (maternal-fetal immune tolerance)\nTh1/Th2 imbalance; excessive pro-inflammatory cytokines (TNF-α, IL-6, IL-17)\nComplement pathway activation"
    },
    {
      title: "Epigenetic & Genetic Factors", color: C.crimson, x: 0.35, y: 3.05,
      text: "CircRNA_06354 → influences trophoblast invasion via hsa-miR-92a-3p/VEGF-A\nDysregulation of C19MC cluster (miR-519d, miR-517-5p)\nlncRNAs (IGFBP1, EGFR-AS1) impair trophoblast function\nPolygenic risk scores now predictive (Honigberg, Nat Med 2023)"
    },
    {
      title: "Gut Microbiome", color: C.teal, x: 5.1, y: 3.05,
      text: "Gut dysbiosis → increased intestinal permeability\nSystemic LPS and pro-inflammatory mediators\nAltered short-chain fatty acid production → vascular tone\nTarget for future therapeutic strategies (Yang et al. 2024)"
    }
  ];

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    s.addShape(pres.ShapeType.rect, { x: box.x, y: box.y, w: 4.6, h: 0.38, fill: { color: box.color } });
    s.addText(box.title, { x: box.x, y: box.y, w: 4.6, h: 0.38, fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x: box.x, y: box.y + 0.38, w: 4.6, h: 1.7, fill: { color: "FFFFFF" }, line: { color: box.color, width: 1.5 } });
    s.addText(box.text, { x: box.x + 0.1, y: box.y + 0.44, w: 4.4, h: 1.58, fontSize: 12, color: C.navy, fontFace: FONT, valign: "top" });
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  footerLine(s, "Chiang et al. Int J Mol Sci 2024 [PMID: 38674114] | Yang et al. Arch Gynecol Obstet 2024 [PMID: 38421424] | Honigberg et al. Nat Med 2023 [PMID: 37248299]");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 7 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  sectionHeader(s, "Clinical Features of Preeclampsia");

  // Symptoms column
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.1, w: 2.95, h: 0.44, fill: { color: C.teal } });
  s.addText("SYMPTOMS", { x: 0.35, y: 1.1, w: 2.95, h: 0.44, fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 1.54, w: 2.95, h: 4.0, fill: { color: "FFFFFF" }, line: { color: C.teal, width: 1.5 } });
  const symptoms = ["Severe headache (occipital/frontal)", "Visual disturbances (scotomata, blurring, photophobia)", "Epigastric / RUQ pain", "Nausea and vomiting", "Rapidly progressive edema (face, hands)", "Oliguria / decreased urine output", "Dyspnea (pulmonary edema)", "Altered consciousness (severe)"];
  s.addText(symptoms.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < symptoms.length - 1, fontSize: 12, color: C.navy, fontFace: FONT } })), { x: 0.42, y: 1.6, w: 2.8, h: 3.85, valign: "top", margin: 3 });

  // Signs column
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 1.1, w: 2.9, h: 0.44, fill: { color: C.softNavy } });
  s.addText("SIGNS", { x: 3.5, y: 1.1, w: 2.9, h: 0.44, fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 1.54, w: 2.9, h: 4.0, fill: { color: "FFFFFF" }, line: { color: C.softNavy, width: 1.5 } });
  const signs = ["BP ≥140/90 mmHg (×2, ≥4h apart)", "Severe HTN ≥160/110 mmHg", "Generalized edema", "Hyperreflexia / clonus", "Papilledema (rare)", "Pulmonary crackles", "Jaundice (hepatic involvement)", "Retinal hemorrhages (severe)"];
  s.addText(signs.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < signs.length - 1, fontSize: 12, color: C.navy, fontFace: FONT } })), { x: 3.57, y: 1.6, w: 2.75, h: 3.85, valign: "top", margin: 3 });

  // Investigations column
  s.addShape(pres.ShapeType.rect, { x: 6.6, y: 1.1, w: 3.05, h: 0.44, fill: { color: C.crimson } });
  s.addText("INVESTIGATIONS", { x: 6.6, y: 1.1, w: 3.05, h: 0.44, fontSize: 12, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
  s.addShape(pres.ShapeType.rect, { x: 6.6, y: 1.54, w: 3.05, h: 4.0, fill: { color: "FFFFFF" }, line: { color: C.crimson, width: 1.5 } });
  const ix = ["Urinalysis & 24h urine protein", "Urine P:Cr ratio", "CBC (platelets <100k = severe)", "LFTs (AST/ALT >2× ULN)", "Renal function (Cr, uric acid)", "LDH, serum bilirubin, haptoglobin", "Coagulation profile (PT, APTT)", "Uterine artery Doppler", "sFlt-1:PlGF ratio (NPV 95%)", "Fetal biometry & CTG"];
  s.addText(ix.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < ix.length - 1, fontSize: 11.5, color: C.navy, fontFace: FONT } })), { x: 6.67, y: 1.6, w: 2.9, h: 3.85, valign: "top", margin: 3 });

  footerLine(s, "ACOG 2020 | Bajpai et al. Kidney360, 2023 | Creasy & Resnik's MFM 9e");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 8 — COMPLICATIONS (Maternal)
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: "F5F5F7" };
  sectionHeader(s, "Maternal Complications");

  const compData = [
    { sys: "Neurological", icon: "🧠", items: ["Eclampsia (seizures)", "Cerebrovascular accident (stroke)", "Hypertensive encephalopathy", "Cortical blindness (amaurosis)", "Posterior reversible encephalopathy (PRES)"], color: C.softNavy },
    { sys: "Hepatic", icon: "🟤", items: ["Hepatic necrosis (periportal)", "Hepatic rupture / hematoma", "HELLP syndrome", "Acute fatty liver overlap", "Liver failure"], color: C.teal },
    { sys: "Renal", icon: "🔵", items: ["Acute tubular necrosis", "Renal cortical necrosis", "Acute kidney injury (1–5%)", "Chronic kidney disease (long-term)", "Proteinuria resolution delayed"], color: C.crimson },
    { sys: "Cardiovascular", icon: "❤️", items: ["Pulmonary edema (<0.5%)", "Heart failure / cardiomyopathy", "Aortic / coronary dissection (rare)", "Future cardiovascular disease risk ×2", "Future vascular dementia ×1.9 (Carey 2024)"], color: C.gold },
  ];

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    const xPos = 0.35 + (i % 2) * 4.8;
    const yPos = 1.1 + Math.floor(i / 2) * 2.2;
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    s.addText(`${c.sys}`, { x: xPos, y: yPos, w: 4.5, h: 0.42, fontSize: 13, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
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  footerLine(s, "Comprehensive Clinical Nephrology 7e | Carey et al. Am J Obstet Gynecol 2024 [PMID: 38278201] | Bajpai et al. Kidney360 2023");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 9 — HELLP SYNDROME
// ══════════════════════════════════════════════════════════════
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  darkSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: C.crimson } });
  s.addText("HELLP Syndrome — A Severe Variant of Preeclampsia", {
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  // Acronym
  const hellp = [
    { letter: "H", full: "Hemolysis", detail: "Microangiopathic hemolytic anemia\nSchistocytes on blood film\nElevated LDH, bilirubin\nLow haptoglobin" },
    { letter: "EL", full: "Elevated Liver Enzymes", detail: "AST >70 U/L or >2× ULN\nALT elevation\nRUQ/epigastric pain\nRisk of hepatic rupture" },
    { letter: "LP", full: "Low Platelets", detail: "Platelets <100 × 10⁹/L\nDIC risk when <50 × 10⁹/L\nThrombocytopenic purpura-like picture" },
  ];

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  s.addText("Incidence: 0.5–0.9% of pregnancies | Maternal mortality ~1% | Perinatal mortality 7–34%", {
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    { text: "Management: Stabilize BP (IV labetalol/hydralazine), MgSO₄ for seizure prophylaxis", color: C.white },
    { text: "Steroids (dexamethasone/betamethasone) for fetal lung maturity if <34 wks", color: C.white },
    { text: "Platelet transfusion if <50 × 10⁹/L (prior to cesarean)", color: C.white },
    { text: "Definitive treatment: DELIVERY (delay only for fetal immaturity <34 wks under strict monitoring)", color: C.gold, bold: true },
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  footerLine(s, "Comprehensive Clinical Nephrology 7e | ACOG 2020 | Bajpai et al. Kidney360 2023");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 10 — FETAL COMPLICATIONS
// ══════════════════════════════════════════════════════════════
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  sectionHeader(s, "Fetal & Neonatal Complications");

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  const fetalComp = [
    "Intrauterine growth restriction (IUGR) — 10–25%",
    "Placental abruption — 1–4%",
    "Oligohydramnios",
    "Non-reassuring fetal status (CTG changes)",
    "Fetal distress → emergency LSCS",
    "Fetal death in utero",
    "Abnormal umbilical artery Doppler waveforms",
  ];
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  s.addText("NEONATAL COMPLICATIONS", { x: 5.1, y: 1.1, w: 4.5, h: 0.44, fontSize: 13, bold: true, color: C.white, fontFace: FONT, align: "center", valign: "middle" });
  const neoComp = [
    "Prematurity (most significant — iatrogenic)",
    "Respiratory distress syndrome (RDS)",
    "Necrotizing enterocolitis (NEC)",
    "Intraventricular hemorrhage (IVH)",
    "Sepsis",
    "Small for gestational age (SGA)",
    "Neonatal seizures (maternal MgSO₄ effect)",
  ];
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  footerLine(s, "Creasy & Resnik's MFM 9e | ACOG 2020 | Comprehensive Clinical Nephrology 7e");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 11 — MANAGEMENT OVERVIEW
// ══════════════════════════════════════════════════════════════
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  sectionHeader(s, "Management Overview");

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      text: "Acute severe (>160/110): IV Labetalol 20mg → up to 80mg | IV Hydralazine 5-10mg | Oral Nifedipine 10-20mg\nChronic management: Methyldopa, Labetalol, Nifedipine (all safe in pregnancy)\n2025 Network meta-analysis: Labetalol favored over nifedipine (↓ preeclampsia RR 0.50, ↓ preterm birth RR 0.68) [Hup et al., AJOG 2025]"
    },
    {
      title: "MgSO₄ for Seizure Prophylaxis / Eclampsia", color: C.crimson,
      text: "Loading dose: 4g IV over 15-20 min | Maintenance: 1-2g/hr IV infusion\nMonitor: Respiratory rate, urine output, patellar reflex\nAntidote: Calcium gluconate 1g IV\nDuration: 24h after delivery or last seizure"
    },
    {
      title: "Prevention — Low-Dose Aspirin", color: C.softNavy,
      text: "60-162mg daily (ideally before 16 wks) for high-risk women\nReduces preeclampsia by ~18-24% (Cochrane evidence)\nCochrane 2025: Calcium supplementation (≥1g/day) prevents HDP in low-calcium populations [Cluver et al. PMID: 41330480]\nSMFM/ACOG/ADA endorse LDA for T1DM/T2DM (↓ PE by 50%)"
    },
    {
      title: "Definitive Treatment — Delivery", color: C.gold,
      text: "Gestational HTN/mild PE without severe features: Deliver ≥37 wks\nPreeclampsia with severe features: Delivery ≥34 wks (stabilize first)\nEclampsia: Delivery after maternal stabilization (not immediately)\nHELLP: Delivery recommended (any GA if ≥34 wks; individualize <34 wks)"
    },
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  footerLine(s, "Hup et al. AJOG 2025 [PMID: 40216176] | Cluver et al. Cochrane 2025 [PMID: 41330480] | ACOG 2020 | Bajpai et al. Kidney360 2023");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 12 — LONG-TERM CONSEQUENCES
// ══════════════════════════════════════════════════════════════
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  lightSlide(s);
  sectionHeader(s, "Long-Term Consequences & Future Health Risks");

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    { risk: "Cardiovascular Disease", stat: "2× risk of IHD, stroke, heart failure in later life", color: C.crimson, ref: "ACOG / AHA consensus" },
    { risk: "Chronic Hypertension", stat: "3–4× increased risk within 5–10 years post-delivery", color: C.softNavy, ref: "Comprehensive Nephrology 7e" },
    { risk: "Chronic Kidney Disease", stat: "↑ risk of end-stage renal disease; proteinuria persists in some", color: C.teal, ref: "Bajpai et al. Kidney360 2023" },
    { risk: "Vascular Dementia", stat: "HR 1.89 (95% CI 1.47–2.43); Alzheimer's in women ≥65 yrs: HR 1.92", color: C.gold, ref: "Carey et al. AJOG 2024 [PMID: 38278201]" },
    { risk: "Fetal Programming", stat: "Offspring at ↑ risk of HTN, metabolic syndrome, cardiovascular disease in adulthood", color: C.navy, ref: "Developmental Origins of Health and Disease (DOHaD)" },
  ];

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  footerLine(s, "Carey et al. Am J Obstet Gynecol 2024 [PMID: 38278201] | Bajpai et al. Kidney360 2023 [PMID: 37526641]");
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// ══════════════════════════════════════════════════════════════
// SLIDE 13 — RECENT LITERATURE REVIEW
// ══════════════════════════════════════════════════════════════
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  s.addText("Recent Literature Review (2023–2026)", {
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    fontSize: 22, bold: true, color: C.white, fontFace: FONT, align: "center", margin: 0
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  const papers = [
    {
      ref: "Chiang et al. (2024). Int J Mol Sci. PMID 38674114",
      title: "Pathophysiological, Genetic & Hormonal Changes in Preeclampsia",
      finding: "Systematic review: Fetal microchimerism links placental dysfunction to maternal complications. Identified novel biomarkers (MMPs, HLA-G) and therapeutic targets (PPAR-γ, endothelin receptors).",
      color: C.teal
    },
    {
      ref: "Yang et al. (2024). Arch Gynecol Obstet. PMID 38421424",
      title: "Advances in Pathogenesis of Preeclampsia",
      finding: "Six pathogenic models: uteroplacental ischemia, inflammation, immune imbalance, epigenetic dysregulation, angiogenic imbalance, and gut microbiome disruption — all contributing.",
      color: C.softNavy
    },
    {
      ref: "Carey et al. (2024). Am J Obstet Gynecol. PMID 38278201",
      title: "HDP and Risk of Maternal Dementia",
      finding: "Meta-analysis of 2.5M women: Preeclampsia → vascular dementia HR 1.89; Alzheimer's in women ≥65 yrs HR 1.92 — reinforces importance of long-term neurological follow-up.",
      color: C.crimson
    },
    {
      ref: "Hup et al. (2025). Am J Obstet Gynecol. PMID 40216176",
      title: "Oral Antihypertensives in Pregnancy — Network Meta-analysis",
      finding: "Labetalol vs. nifedipine: Labetalol reduces preeclampsia (RR 0.50) and preterm birth (RR 0.68). All three agents (methyldopa, labetalol, nifedipine) remain acceptable first-line choices.",
      color: C.gold
    },
    {
      ref: "Cluver et al. (2025). Cochrane Database. PMID 41330480",
      title: "Calcium Supplementation for Preventing HDP",
      finding: "Updated Cochrane review: Calcium ≥1g/day significantly reduces preeclampsia risk in low-calcium populations — key preventive strategy in resource-limited settings.",
      color: C.teal
    },
    {
      ref: "Honigberg et al. (2023). Nat Med. PMID 37248299",
      title: "Polygenic Prediction of Preeclampsia",
      finding: "Polygenic risk scores significantly predict gestational HTN and preeclampsia — potential future tool for early risk stratification and personalized prevention.",
      color: C.softNavy
    },
  ];

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// ══════════════════════════════════════════════════════════════
// SLIDE 14 — PREVENTION & SCREENING
// ══════════════════════════════════════════════════════════════
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  lightSlide(s);
  sectionHeader(s, "Prevention & Screening Strategies");

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    { text: " → 50% detection of early-onset PE | + Biochemical (PlGF, PAPP-A) → 75% | + Biophysical (UtA PI, MAP) → 90% | + Both bio → 95%", options: { color: C.white } }
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  s.addText("PlGF <100 pg/mL before 35 wks predicts delivery for PE within 2 wks with 98% probability | sFlt-1:PlGF <38 → NPV 99% within 1 wk", {
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    { strat: "Calcium Supplementation", detail: "≥1 g/day where dietary calcium is low | Cochrane 2025 confirms benefit | Especially resource-limited settings", color: C.teal },
    { strat: "Weight Optimization", detail: "Pre-conception BMI management | ↓ obesity-related PE risk", color: C.softNavy },
    { strat: "Control Comorbidities", detail: "Optimal glycemic control in diabetes | BP control in chronic HTN | Anticoagulation in APS", color: C.navy },
  ];

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  footerLine(s, "Cluver et al. Cochrane 2025 [PMID: 41330480] | Comprehensive Clinical Nephrology 7e (Prediction section) | ACOG 2020");
}

// ══════════════════════════════════════════════════════════════
// SLIDE 15 — SUMMARY & KEY TAKEAWAYS
// ══════════════════════════════════════════════════════════════
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    fontSize: 24, bold: true, color: C.white, fontFace: FONT, align: "center", charSpacing: 1, margin: 0
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    { n: "01", text: "HDP affects 5-10% of pregnancies and is the leading direct cause of maternal mortality worldwide — early identification is critical.", color: C.teal },
    { n: "02", text: "Core pathogenesis: Inadequate trophoblast invasion → placental ischemia (Stage 1) → systemic endothelial dysfunction (Stage 2). New models add immune, epigenetic, and microbiome dimensions.", color: C.softNavy },
    { n: "03", text: "Diagnose preeclampsia by BP ≥140/90 + proteinuria OR end-organ damage. Identify severe features urgently (BP ≥160/110, platelets <100k, creatinine elevation, HELLP).", color: C.crimson },
    { n: "04", text: "HELLP syndrome = severe preeclampsia variant. Delivery is the only cure. MgSO₄ prevents seizures. IV labetalol/hydralazine for acute severe HTN.", color: C.gold },
    { n: "05", text: "Screen high-risk women with combined first-trimester screen (PlGF + UtA Doppler). Prevent with LDA and calcium supplementation started before 16 weeks.", color: C.teal },
    { n: "06", text: "Long-term: Preeclampsia doubles lifetime cardiovascular risk. Vascular dementia risk 1.89× (Carey 2024). Lifelong follow-up is warranted after HDP.", color: C.crimson },
  ];

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  footerLine(s, "Sources: Creasy & Resnik MFM 9e | Braunwald Heart Disease 12e | ACOG PB 222 | Bajpai 2023 | Chiang 2024 | Yang 2024 | Carey 2024 | Hup 2025 | Cluver 2025 | Honigberg 2023");
}

// ── Save ──
pres.writeFile({ fileName: "/home/daytona/workspace/hdp-presentation/HDP_Presentation.pptx" })
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