Uterine vascular resistance and other maternal factors associated with the risk of developing hypertension during pregnancy.

L.A.B Martins,M.A Barbieri,V.C Cardoso,C.C.C Ribeiro,H Bettiol,V.M.F Simões,E.C.A Veiga,R.C Cavalli

doi:10.1590/1414-431x202010118

L.A.B Martins, M.A Barbieri + Show 6 more

Open Access

https://doi.org/10.1590/1414-431x202010118

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Abstract

Gestational hypertension and pre-eclampsia are important causes of perinatal morbidity. The objective of the present study was to determine the increase in relative risk for developing hypertensive disorders of pregnancy based on the evaluation of pregnant women between 20 and 25 weeks of gestation, and to correlate the findings at this period with the outcome of pregnancy. We conducted a prospective cohort study, with a convenience sample of 1417 patients evaluated at this gestational age, of which 1306 were contacted at childbirth. We detected an increased relative risk of 2.69 (95%CI: 1.86 to 3.89) associated with pulsatility index of the uterine arteries, a 2.8 increase (95%CI: 1.58 to 5.03) in relative risk attributed to maternal age above 35 years, a 1.68 increase (95%CI: 1.17 to 2.40) attributed to parity greater than or equal to 3, and a 5.35 increase (95%CI: 4.18 to 6.85) attributed to chronic hypertension and obesity, with a progressive increase in relative risk according to the degree of overweight, i.e., grades 1, 2, 3, and morbid obesity (2.58, 3.06, 5.84, and 7.28, respectively).

Highlights

Arterial hypertension during pregnancy is an important cause of perinatal morbidity and mortality
Several studies have suggested that endothelial factors linked to reduced uterine vascular resistance are strongly correlated with the development of gestational arterial hypertension (GAH) [4,5]
Maternal age influences the risk of developing hypertensive disorders during pregnancy, with an increase in the incidence of gestational hypertension and pre-eclampsia (PE) among pregnant women older than 35 years, and a more significant increase after 40 years of age [7]

Summary

Introduction

Arterial hypertension during pregnancy is an important cause of perinatal morbidity and mortality. Endothelial factors linked to reduced uterine vascular resistance are strongly correlated with the development of gestational hypertension [2,3]. With an incidence ranging from 4 to 10% of all pregnancies, hypertensive disorders continue to be the main cause of maternal-fetal morbidity and mortality [4]. Several studies have suggested that endothelial factors linked to reduced uterine vascular resistance are strongly correlated with the development of gestational arterial hypertension (GAH) [4,5]. Maternal age influences the risk of developing hypertensive disorders during pregnancy, with an increase in the incidence of gestational hypertension and pre-eclampsia (PE) among pregnant women older than 35 years, and a more significant increase after 40 years of age [7]. Patients who experience GAH during their first pregnancy may have a risk up to 7-fold higher of having GAH in subsequent pregnancies than women who do not have this disease [9]

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