Higher Risk Of Gestational Hypertension Research Articles

Adverse Obstetric and Perinatal Outcomes Among Birthing People in Same-Sex and Different-Sex Relationships in Louisiana.

Purpose: We investigated sexual orientation disparities in several obstetric and perinatal outcomes in Louisiana and examined whether these disparities differed among Black, Latine, and White populations. Methods: We analyzed cross-sectional vital records data on singleton live births in Louisiana (2016-2022). Same-sex relationships (SSR) vs. different-sex relationships (DSR) were classified based on the sex of the parents listed on the birth certificate. Using modified Poisson regression, we estimated adjusted risk ratios and 95% confidence intervals among birthing persons in SSR vs. DSR for preterm birth (PTB), low birthweight (LBW), spontaneous labor, Cesarean delivery, gestational hypertension, and gestational diabetes. We examined within and across group disparities in models stratified by sexual orientation and race/ethnicity. Results: In the total birthing population, those in SSR experienced higher risk of gestational hypertension and gestational diabetes and were less likely to have spontaneous labor compared with persons in DSR. The risk of PTB and LBW was two-fold higher among Black birthing people in SSR compared with White birthing people in SSR and DSR. Latine birthing people in SSR experienced higher risk of gestational hypertension and gestational diabetes compared with their peers in DSR and White people in DSR. Some of these disparities were partially explained by including socioeconomic and health risk factors. Conclusion: Sexual orientation-related disparities exist across and within racial/ethnic groups among birthing people in Louisiana. Adopting an intersectional approach that considers the mutually constituted nature of heterosexism and racism is critical to addressing sexual orientation-related inequities in reproductive and perinatal health.

Increased Risk of Gestational Hypertension by Periconceptional Exposure to Ambient Air Pollution and Effect Modification by Prenatal Depression.

Air pollution has been associated with gestational hypertension (GH) and preeclampsia, but susceptible windows of exposure and potential vulnerability by comorbidities, such as prenatal depression, remain unclear. We ascertained GH and preeclampsia cases in a prospective pregnancy cohort in Los Angeles, CA. Daily levels of ambient particulate matters (with a diameter of ≤10 μm [PM10] or ≤2.5 μm [PM2.5]), nitrogen dioxide, and ozone were averaged for each week from 12 weeks preconception to 20 gestational weeks. We used distributed lag models to identify susceptible exposure windows, adjusting for potential confounders. Analyses were additionally stratified by probable prenatal depression to explore population vulnerability. Among 619 participants, 60 developed preeclampsia and 42 developed GH. We identified a susceptible window for exposure to PM2.5 from 1 week preconception to 11 weeks postconception: higher exposure (5 µg/m3) within this window was associated with an average of 8% (95% CI, 1%-15%) higher risk of GH. Among participants with probable prenatal depression (n=179; 32%), overlapping sensitive windows were observed for all pollutants from 8 weeks before to 10 weeks postconception with increased risk of GH (PM2.5, 16% [95% CI, 3%-31%]; PM10, 39% [95% CI, 13%-72%]; nitrogen dioxide, 65% [95% CI, 17%-134%]; and ozone, 45% [95% CI, 9%-93%]), while the associations were close to null among those without prenatal depression. Air pollutants were not associated with preeclampsia in any analyses. We identified periconception through early pregnancy as a susceptible window of air pollution exposure with an increased risk of GH. Prenatal depression increases vulnerability to air pollution exposure and GH.

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes

BackgroundHigher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear.MethodsWe explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women.ResultsAll three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation.ConclusionsOur findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications.FundingMedical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.

Comparing the occurrence rate of gestational hypertension during pregnancy with frozen embryo transfer and natural pregnancy.

Recent researches have indicated that pregnancies with frozen embryo transfer are associated with the increment of risk of maternal and neonatal complications, especially hypertension during pregnancy. The present study aimed to compare the occurrence rate of gestational hypertension in pregnancy with frozen embryo transfer and normal pregnancy. This research, as a retrospective cross-sectional study, was performed on pregnant women with frozen embryo transfer (n = 97) and women with normal pregnancies (n = 164) referring to medical centers under the supervision of Ahvaz University of Medical Sciences in 2021. Women aged 18-35 were included in the study after week 20th of pregnancy. Maternal and neonatal outcomes including hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), preterm birth (before the week 37th), low birth weight (lower than 2500 g), neonatal asphyxia (Apgar score >7 in minute 5th), intrauterine growth restriction (IUGR) and bleeding in the first trimester of pregnancy were evaluated. The association between frozen embryo transfer and pregnancy outcomes was evaluated using multiple logistic regressions. The findings of this study indicated that pregnancy hypertension was observed in 23 people (23.7%) from the frozen embryo transfer group vs. 18 people (11.0%) from the normal pregnancy group (P = 0.006). Frozen embryo transfer pregnancy has a higher risk of gestational hypertension (OR = 2.521, 95% CI: 1.281-4.962; P = 0.007), preterm birth (OR = 2.264, 95% CI: 1.335-3.840; P = 0.002), and low birth weight (OR = 2.017, 95% CI: 1.178-3.455; P = 0.011). However, the incidence of birth asphyxia (P = 0.850), intrauterine growth restriction (P = 0.068), first-trimester bleeding (P = 0.809), and placenta accreta (P = 0.143) did not show a significant difference between two types of normal pregnancy and frozen embryo transfer pregnancy. Frozen embryo transfer pregnancy was associated with a higher risk of maternal and neonatal complications, hypertension, preterm birth, and low birth weight compared to natural and spontaneous pregnancies.

Intake of Energy Drinks Before and During Pregnancy and Adverse Pregnancy Outcomes

Consumption of energy drinks has increased drastically in recent years, particularly among young people. It is unknown whether intake of energy drinks is associated with health during pregnancy. To examine associations of energy drink intake before and during pregnancy with risk of adverse pregnancy outcomes (APOs). This prospective cohort study included data from women enrolled in the Nurses' Health Study 3 (NHS3) between June 1, 2010, and September 27, 2021, and the Growing Up Today Study (GUTS) who reported 1 or more singleton pregnancy from January 1, 2011, to June 1, 2019. Data were analyzed from October 1, 2021, to September 28, 2023. Intake of energy drinks, assessed by food frequency questionnaire. The main outcomes were self-reported APOs, including pregnancy loss, gestational diabetes, gestational hypertension, preeclampsia, or preterm birth, and a composite APO, defined as development of any of the APOs. Risk of APOs was compared between consumers and nonconsumers of energy drinks. This study included 7304 pregnancies in 4736 participants with information on prepregnancy energy drink intake and 4559 pregnancies in 4559 participants with information on energy drink intake during pregnancy. There were 1691 GUTS participants (mean [SD] age, 25.7 [2.9] years) and 3045 NHS3 participants (mean [SD] age, 30.2 [4.1] years). At baseline, 230 GUTS participants (14%) and 283 NHS3 participants (9%) reported any intake of energy drinks. While no associations were found for pregnancy loss (odds ratio [OR], 0.89; 95% CI, 0.71-1.11), preterm birth (OR, 1.07; 95% CI, 0.71-1.61), gestational diabetes (OR, 0.89; 95% CI, 0.58-1.35), preeclampsia (OR, 0.73; 95% CI, 0.41-1.30), or the composite APO (OR, 1.05; 95% CI, 0.87-1.26), prepregnancy energy drink use was associated with a higher risk of gestational hypertension (OR, 1.60; 95% CI, 1.12-2.29). A significant interaction was found between age and energy drink intake in relation to hypertensive disorders (P = .02 for interaction for gestational hypertension; P = .04 for interaction for any hypertensive disorders), with stronger associations for participants above the median age. No associations of energy drink intake during pregnancy with any of the APOs were found in NHS3 (eg, any APO: OR, 0.86; 95% CI, 0.41-1.79). In this study, energy drink intake before pregnancy was associated with an elevated risk of gestational hypertension. Given the low prevalence of energy drink intake and low consumption levels among users, the results should be interpreted cautiously.

Association of Gestational Free and Total Triiodothyronine With Gestational Hypertension, Preeclampsia, Preterm Birth, and Birth Weight: An Individual Participant Data Meta-analysis.

Triiodothyronine (T3) is the bioactive form of thyroid hormone. In contrast to thyroid-stimulating hormone and free thyroxine, we lack knowledge on the association of gestational T3 with adverse obstetric outcomes. To investigate the associaiton of gestational free or total T3 (FT3 or TT3) with adverse obstetric outcomes. We collected individual participant data from prospective cohort studies on gestational FT3 or TT3, adverse obstetric outcomes (preeclampsia, gestational hypertension, preterm birth and very preterm birth, small for gestational age [SGA], and large for gestational age [LGA]), and potential confounders. We used mixed-effects regression models adjusting for potential confounders. The final study population comprised 33 118 mother-child pairs of which 27 331 had data on FT3 and 16 164 on TT3. There was a U-shaped association of FT3 with preeclampsia (P = .0069) and a J-shaped association with the risk of gestational hypertension (P = .029). Higher TT3 was associated with a higher risk of gestational hypertension (OR per SD of TT3 1.20, 95% CI 1.08 to 1.33; P = .0007). A lower TT3 but not FT3 was associated with a higher risk of very preterm birth (OR 0.72, 95% CI 0.55 to 0.94; P = .018). TT3 but not FT3 was positively associated with birth weight (mean difference per 1 SD increase in TT3 12.8, 95% CI 6.5 to 19.1 g, P < .0001) but there was no association with SGA or LGA. This study provides new insights on the association of gestational FT3 and TT3 with major adverse pregnancy outcomes that form the basis for future studies required to elucidate the effects of thyroid function on pregnancy outcomes. Based on the current study, routine FT3 or TT3 measurements for the assessment of thyroid function during pregnancy do not seem to be of added value in the risk assessment for adverse outcomes.

Maternal Cigarette and Electronic Cigarette Use Before Pregnancy Associated With the Risk of Hypertension and Gestational Hypertension [ID: 1380637

INTRODUCTION: Despite the rapid increase in electronic cigarettes (e-cigarette) use, little is known regarding its effects on maternal health. We examined the association between maternal e-cigarette use before pregnancy and hypertension (preexisting and gestational). METHODS: We obtained data from phase 8 (2016–2019) of the Pregnancy Risk Assessment Monitoring System (PRAMS; N=153,336). Postpartum mothers reported their e-cigarette and combustible cigarette use within the 3 months before pregnancy. They also reported hypertension status before pregnancy and gestational hypertension. We used multivariable logistic regression models to estimate the adjusted odds ratio (aOR) of hypertension associated with maternal e-cigarette use and cigarette use before pregnancy, controlling for sociodemographic and pregnancy confounders. RESULTS: Compared to nonusers, mothers who exclusively used cigarettes (7.0% versus 4.8%, aOR 1.33 [95% CI 1.32–1.35]) and dual users (8.4% versus 4.8%, aOR 1.98 [95% CI 1.95–2.02]) before pregnancy had an increased risk of hypertension before pregnancy, whereas exclusive e-cigarette smokers had a decreased risk of hypertension before pregnancy (4.5% versus 4.8%, aOR 0.95 [95% CI 0.92–0.98]). Exclusive cigarette users (10.1% versus 9.0%, aOR 1.03 [95% CI 1.02–1.04]), exclusive e-cigarette users (11.3% versus 9.0%, aOR 1.22 [95% CI 1.20–1.25]), and dual users (10.4% versus 9.0%; aOR 1.13 [95% CI 1.11–1.15]) in the 3 months before pregnancy had a higher risk of gestational hypertension compared to nonusers. CONCLUSION: Combustible cigarette use and dual use before pregnancy was associated with an increased risk of hypertension before pregnancy and gestational hypertension. E-cigarette use before pregnancy was associated with increased risk for gestational hypertension only.

Individual, Independent, and Joint Associations of Toxic Metals and Manganese on Hypertensive Disorders of Pregnancy: Results from the MIREC Canadian Pregnancy Cohort.

Toxic metals, such as lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg), may be associated with a higher risk of gestational hypertension and preeclampsia, whereas manganese (Mn) is an essential metal that may be protective. We estimated the individual, independent, and joint associations of Pb, Cd, As, Hg, and Mn on the risk of developing gestational hypertension and preeclampsia in a cohort of Canadian women. Metal concentrations were analyzed in first and third trimester maternal blood (). We measured blood pressure after 20 wk gestation to diagnose gestational hypertension, whereas proteinuria and other complications defined preeclampsia. We estimated individual and independent (adjusted for coexposure) relative risks (RRs) for each doubling of metal concentrations and examined interactions between toxic metals and Mn. We used quantile g-computation to estimate the joint effect of trimester-specific exposures. Each doubling of third trimester Pb (; 95% CI: 1.06, 2.22) and first trimester blood As (; 95% CI: 1.01, 1.58) was independently associated with a higher risk of developing preeclampsia. First trimester blood As (; 95% CI: 1.40, 8.28) and Mn (; 95% CI: 0.42, 0.94) concentrations were associated with a higher and lower risk, respectively, of developing gestational hypertension. Mn modified the association with As such that the deleterious association with As was stronger at lower concentrations of Mn. First trimester urinary dimethylarsinic acid concentrations were not associated with gestational hypertension (; 95% CI: 0.60, 2.85) or preeclampsia (; 95% CI: 0.68, 1.24). We did not observe overall joint effects for blood metals. Our results confirm that even low blood Pb concentrations are a risk factor for preeclampsia. Women with higher blood As concentrations combined with lower Mn in early pregnancy were more likely to develop gestational hypertension. These pregnancy complications impact maternal and neonatal health. Understanding the contribution of toxic metals and Mn is of public health importance. https://doi.org/10.1289/EHP10825.

Pre-gravid body mass index is associated with a higher risk of gestational hypertension in singleton pregnancy following frozen-thawed embryo transfer.

Although it is well-known that obesity increases the risk of gestational hypertension (GH) in both spontaneous and assisted reproductive technology (ART) pregnancies. Recent data show that, in ART pregnancies, frozen-thawed embryo transfer (FET) is associated with an even higher risk of GH compared with fresh transfer. However, the relationship between pre-gravid body mass index (BMI) and GH in FET pregnancies has seldom been reported. The aim of this study is to examine the effect of pre-gravid BMI on GH in singleton pregnancy following FET. A retrospective cohort study at a tertiary hospital, including a total of 7,502 women who achieved singleton pregnancy after FET, was included. All patients were enrolled only once. On the basis of the BMI definitions of the Working Group on Obesity in China (WGOC) and the World Health Organization, the women were divided into normal BMI, overweight, and obese groups. The main outcome was GH, and the effect of pre-pregnancy BMI on GH was assessed by generalized linear model. The risk of GH in our study population was 6.15%. According to the BMI definitions of the WGOC, the risk of GH in the obese group (15.55%) was significantly higher than that of the overweight group (8.26%, P < 0.001) and the normal BMI group (4.68%, P < 0.001). Pre-gravid overweight and obesity were associated with higher GH risk (OR, 1.77; 95% CI, 1.41-2.20; P < 0.001; OR, 3.69; 95% CI, 2.77-4.91; P < 0.001). A non-linear relationship between pre-gravid BMI and GH was observed. The risk of GH decreased with pre-gravid BMI level up to the turning point of BMI = 28.6 kg/m2 (OR, 1.16; 95% CI, 1.12-1.21; P < 0.001). Pre-gravid overweight and obesity are associated with higher GH risk among singleton pregnancy following FET. Before the turning point of BMI = 26.8 kg/m2, the risk of GH may increase 16.4% with each one-unit increment of maternal BMI. Women preparing for FET should maintain a normal BMI to lower the chances of GH.

Perinatal outcomes of singleton live births after preimplantation genetic testing during single frozen-thawed blastocyst transfer cycles: a propensity score-matched study

To determine whether singleton pregnancy achieved after preimplantation genetic testing (PGT) is associated with a higher risk of adverse perinatal outcomes than invitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) singleton pregnancy. A retrospective cohort study. A university-affiliated fertility center. This cohort study included singleton live births resulting from PGT (n = 232) and IVF/ICSI singleton pregnancies (n=2,829) with single frozen-thawed blastocyst transfer. Multiple baseline covariates were used for propensity score matching, yielding 214 PGT singleton pregnancies matched to 617 IVF/ICSI singleton pregnancies. Trophectoderm biopsy. The primary outcome was gestational hypertension, and various clinical perinatal secondary outcomes related to maternal and neonatal health were measured. Compared with IVF/ICSI singleton pregnancy, PGT singleton pregnancy was associated with a significantly higher risk of gestational hypertension (adjusted odds ratio, 2.58; 95% confidence interval, 1.32, 5.05). In the matched sample, the risk of gestational hypertension remained higher with PGT singleton pregnancy (odds ratio, 2.33; 95% confidence interval, 1.04, 5.22) than with IVF/ICSI singleton pregnancy. No statistical differences were noted in any other measured outcomes between the groups. The perinatal outcomes of PGT and IVF/ICSI singleton pregnancies were similar except for the observed potentially higher risk of gestational hypertension with PGT singleton pregnancy. However, because the data on PGT singleton pregnancies are limited, this conclusion warrants further investigation.

Pregnancy per- and polyfluoroalkyl substances (PFAS) and hypertensive disorders of pregnancy in the Project Viva cohort

BACKGROUND AND AIM: Exposure to environmental chemicals may increase the risk of cardiovascular disease. However, data on associations between per- and polyfluoroalkyl substances (PFASs) and hypertensive disorders of pregnancy (HDP) are limited and inconsistent. We sought to determine the extent to which early-pregnancy PFAS concentrations are prospectively associated with HDP risk in a large cohort. METHODS: We studied 1,537 pregnant women from the Project Viva cohort in Boston, Massachusetts, USA. Using maternal plasma samples collected from 1999-2002 at a median of 9.7 gestational weeks, we quantified concentrations of eight PFAS [perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), perfluorononanoate (PFNA), 2-(N-ethyl-perfluorooctane sulfonamide) acetate (EtFOSAA), 2-(N-methyl-perfluorooctane sulfonamide) acetate (MeFOSAA), perfluorodecanoate (PFDeA), perfluorooctane sulfonamide (FOSA)]. PFDeA and FOSA were detected in 50% of samples and were not included in further analyses. We assessed HDP using clinical data and defined preeclampsia and gestational hypertension according to the National High Blood Pressure Education Program recommendations. We used multinomial logistic regression to estimate associations of log2-transformed continuous PFAS concentrations with categories of HDP [gestational hypertension, preeclampsia, normotensive (ref)], adjusting for age, race/ethnicity, education, smoking, marital status, and parity. RESULTS:A total of 56 (4%) of women developed preeclampsia and 106 (7%) developed gestational hypertension. We observed higher risk of gestational hypertension per doubling of concentrations of PFOS (odds ratio [OR] 1.28, 95% confidence interval [CI]: 0.96, 1.70), PFOA (OR 1.36, 95% CI: 0.99, 1.86), and PFHxS (OR 1.22, 95% CI: 1.01, 1.48). Associations with other PFAS were consistent in direction but smaller in magnitude (e.g., EtFOSAA: OR 1.14, 95% CI: 0.95, 1.38). We did not observe associations between PFAS concentrations and preeclampsia. CONCLUSIONS:Our results support the hypothesis that PFAS exposure during pregnancy may increase the risk of gestational hypertension. However, we did not observe associations between PFAS exposure and preeclampsia. KEYWORDS: PFAS, hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, pregnancy

Association between obsessive-compulsive disorder and obstetrical and neonatal outcomes in the USA: a population-based cohort study.

Obsessive-compulsive disorder (OCD) is a mental disorder linked to functional impairments and adverse health outcomes. We sought to examine the association between pregnant women with OCD and obstetrical and neonatal outcomes in the USA. A retrospective population-based cohort study was conducted using data provided by pregnant women from the Nationwide Inpatient Sample, a nationally representative database of hospitalizations in the USA, from 1999 to 2015. Using diagnostic and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), we identified births and classified women by OCD status. Demographic and clinical characteristics were compared for women with and without OCD and multivariate logistic regressions were used to obtain odds ratios (OR) to compare obstetrical and neonatal outcomes between the two groups, adjusting for relevant demographic and clinical variables. Between 1999 and 2015, there were 3365 births to women with OCD, corresponding to an overall prevalence of 24.40 per 100,000 births. Women with OCD were more likely to be older than 25, Caucasian, of higher socioeconomic status, smokers or used drugs and alcohol, and have other comorbid psychiatric conditions. In adjusted models, OCD was associated with a higher risk of gestational hypertension, preeclampsia, premature rupture of membranes, caesarean and instrumental deliveries, venous thromboembolisms and preterm birth. Pregnancies in women with OCD are at high risk of adverse obstetrical and neonatal outcomes. A multidisciplinary approach should be used to identify high risk behaviours and ensure adequate prenatal follow-up and care be available for those with high risk pregnancies.

Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid.

Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016. Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.

Association of pre-pregnancy body mass index with adverse pregnancy outcome among first-time mothers.

BackgroundStudies have reported an increased risk of adverse pregnancy outcome associated with pre-pregnancy body mass index (BMI). However, the data on such associations in urban areas of southern Chinese women is limited, which drive us to clarify the associations of pre-pregnancy BMI and the risks of adverse pregnancy outcomes (preterm birth (PTB) and low birth weight (LBW)) and maternal health outcomes (gestational hypertension and cesarean delivery).MethodsWe performed a hospital-based case-control study including 3,864 Southern Chinese women who gave first birth to a live singleton infant from January 2015 to December 2015. PTB was stratified into three subgroups according to gestational age (extremely PTB, very PTB and moderate PTB). Besides, we combined birth weight and gestational age to dichotomise as being small for gestational age (SGA, less than the tenth percentile of weight for gestation) and non-small for gestational age (NSGA, large than the tenth percentile of weight for gestation), gestational week was also classified into categories of term, 34-36 week and below 34 week.. We then divided newborns into six groups: (1) term and NSGA; (2) 34–36 week gestation and NSGA; (3) below 34 week gestation and NSGA; (4) term and SAG; (5) 34–36 week gestation and SAG; (6) below 34 week gestation and SAG. Adjusted logistic regression models was used to estimate the odds ratios of adverse outcomes.ResultsUnderweight women were more likely to give LBW (AOR = 1.44, 95% CI [1.11–1.89]), the similar result was seen in term and SAG as compared with term and NSAG (AOR = 1.78, 95% CI [1.45–2.17]), whereas underweight was significantly associated with a lower risk of gestational hypertension (AOR = 0.45, 95% CI [0.25–0.82) and caesarean delivery (AOR = 0.74, 95% CI [0.62–0.90]). The risk of extremely PTB is relatively higher among overweight and obese mothers in a subgroup analysis of PTB (AOR = 8.12, 95% CI [1.11–59.44]; AOR = 15.06, 95% CI [1.32–172.13], respectively). Both maternal overweight and obesity were associated with a greater risk of gestational hypertension (AOR = 1.71, 95% CI [1.06–2.77]; AOR = 5.54, 95% CI [3.02–10.17], respectively) and caesarean delivery (AOR = 1.91, 95% CI [1.53–2.38]; AOR = 1.85, 95% CI [1.21–2.82], respectively).ConclusionsOur study suggested that maternal overweight and obesity were associated with a significantly higher risk of gestational hypertension, caesarean delivery and extremely PTB. Underweight was correlated with an increased risk of LBW and conferred a protective effect regarding the risk for gestational hypertension and caesarean delivery for the first-time mothers among Southern Chinese.

Association between thyroid hormone parameters during early pregnancy and gestational hypertension: a prospective cohort study.

ObjectiveThyroid dysfunction may play a role in the development of gestational hypertension. However, this relationship remains unclear. This study was performed to evaluate the association between thyroid hormone parameters during early pregnancy and gestational hypertension.MethodsWomen with singleton pregnancies were recruited into this prospective cohort study at 9 to 13 gestational weeks, and their serum thyroid-stimulating hormone, free thyroxine, and free triiodothyronine concentrations were measured using electrochemiluminescence immunoassays. In total, 1226 participants were included in the final analysis.ResultsOf the 1226 participants, 81 subsequently developed gestational hypertension (overall incidence of 6.6%). Compared with women with euthyroidism, both pregnant women with hypothyroidism and those with subclinical hypothyroidism had an increased risk of gestational hypertension (adjusted odds ratio [OR], 3.61; 95% confidence interval [CI], 1.52–8.57 and OR, 2.24; 95% CI, 1.06–4.72, respectively). When the thyroid-stimulating hormone and free thyroxine concentrations were analyzed by quintiles, the women in the highest thyroid-stimulating hormone quintile had a higher risk of gestational hypertension (adjusted OR, 4.22; 95% CI, 1.78–9.05) than the women in the middle quintile.ConclusionOur results suggest that hypothyroidism, subclinical hypothyroidism, and a high thyroid-stimulating hormone concentration during early pregnancy are risk factors for gestational hypertension.

Sodium Intake During Pregnancy, but Not Other Diet Recommendations Aimed at Preventing Cardiovascular Disease, Is Positively Related to Risk of Hypertensive Disorders of Pregnancy

The role of diet on hypertensive disorders of pregnancy (HDPs), including preeclampsia and gestational hypertension (GHTN), remains unclear. We evaluated whether adherence during pregnancy to dietary recommendations that reduce cardiovascular disease (CVD) in the general population is related to the risk of HDPs. We followed 66,651 singleton pregnancies from 62,774 women participating in the Danish National Birth Cohort. Diet was assessed during week of gestation 25 with an FFQ from which we created 2 dietary pattern scores: 1) AHA, based on the diet recommendations from the AHA 2020 Strategic Impact Goals; and 2) the Dietary Approaches to Stop Hypertension (DASH) diet. Cases of HDPs were identified through linkage with the Danish National Patient Registry. RRs and 95% CIs of HDPs were estimated by increasing quintiles of adherence to the AHA and DASH scores using log-Poisson regression models with generalized estimating equations-to account for repeated pregnancies per woman-while adjusting for potential confounders. We identified 1809 cases of HDPs: n=1310 preeclampsia (n=300 severe preeclampsia) and n=499 cases of GHTN. Greater adherence to AHA or DASH scores was not related to the risk of HDPs. However, when each component of the scores was separately evaluated, there were positive linear relations of sodium intake with HDPs (P-linearity<0.01). Women with the highest sodium intake [median 3.70 g/d (range: 3.52, 7.52 g/d)] had 54% (95% CI:16%, 104%) higher risk of GHTN and 20% (95% CI:1%, 42%) higher risk of preeclampsia than women with the lowest intake [median 2.60 g/d (range: 0.83, 2.79 g/d)]. In addition, intake of whole grains was positively related to the risk of GHTN but not to preeclampsia ( P-heterogeneity=0.002). Sodium intake during pregnancy, but no other diet recommendations to prevent CVD among nonpregnant adults, is positively related to the occurrence of HDPs among pregnant Danish women.

NR3C2 gene polymorphism is associated with risk of gestational hypertension in Han Chinese women.

Background:The influence of genetic polymorphisms on the development of gestational hypertension (GH) is unclear. The aim of this study was to examine whether single-nucleotide polymorphisms (SNPs) of the nuclear receptor subfamily 3, group C, member 2 (NR3C2) genes, rs5522, rs2070951, rs5534, s2248038, and s9992256 are associated with GH in Han Chinese women.Method:Sanger sequencing was used to analyze the genotypes of rs5522, rs2070951, rs5534, rs2248038, and rs9992256 loci of the NR3C2 gene in 450 patients with GH and 450 healthy controls.Results:The rs5522 dominant model (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.13–1.47, P < .001) and the recessive model (OR = 1.64, 95% CI: 1.33–1.86, P < .001) had higher GH risk. The rs2070951 dominant model (OR = 1.18, 95% CI: 1.03–1.35, P = .02) had higher risk of GH, and the recessive model (OR = 1.09, 95% CI: 0.84–1.34, P = .55) was not significant for GH risk. The rs5534 dominant model (OR = 1.25, 95% CI: 1.09–1.43, P = .001) had a higher GH risk. The rs2248038 and rs9992256 sites were not significantly related to GH risk. Gene–gene interactions at the rs5522, rs2070951, and rs5534 loci affected GH risk (OR = 1.34, 95% CI: 1.12–1.64, P < .001).Conclusion:The SNPs of the NR3C2 gene rs5522, rs2070951, and rs5534 are associated with GH in Han Chinese women.

Visit-to-visit blood pressure variability is associated with gestational hypertension and pre-eclampsia.

Visit-to-visit blood pressure variability (VVV) was an independent risk factor for cardiovascular events. In pregnant women whose hemodynamic changes are unique, the role of VVV in hypertensive disorders is still obscure. Therefore, we aimed to investigate the association of VVV with gestational hypertension (GH) and pre-eclampsia (PE). 14,702 pregnant women were recruited at around 13 weeks of their gestation. VVV during the second, third trimester and the whole pregnancy, were estimated as standard deviation (SD) or coefficient of variation (CV) of systolic blood pressure (SBP) or diastolic blood pressure (DBP). The associations between VVV, GH and PE were assessed by multivariate logistic regression models. 878 and 131 women developed GH and PE, respectively. VVV was significantly higher in GH and PE subjects than normotensive controls, regardless of whichever metric was calculated. In maximally adjusted models, odds ratio (95% confidence interval) of SBP-CV during the whole pregnancy was 1.62 (1.56-1.68) for GH, 1.14 (1.06-1.21) for PE, and 1.51 (1.47-1.56) for either GH or PE. The cooperation of SBP-CV to other risk factors could help in discriminating pregnant women at high risk of GH and PE. VVV during pregnancy, especially SBP-CV, was independently associated with GH and PE. These results suggested that VVV could provide additional information to identify pregnant women at high risk of GH or PE. Further studies exploring prospective association between VVV, GH and PE are warranted.

Obstetrics and perinatal outcome of grand multiparity in Jordan: a case-control study

Purpose of investigation: The impact of grand multiparity on perinatal outcomes remains unknown. The authors aimed to assess perinatal outcomes in grand multiparous women in Jordan. Materials and Methods: In this retrospective case-control study of 161 grand multiparous and 163 multiparous women, maternal and neonatal outcomes were assessed. Statistical analysis included logistic regression with adjustment for age and booking status. Results: The prevalence of grand multiparity was 1.8%. Grand multiparous women had a significantly higher risk of gestational hypertension, diabetes, preterm delivery, and cesarian section, but significantly lower risk of requiring labor augmentation and perineal tears. Neonates of grand multiparous had a significantly higher risk of low birth-weight (LBW) and requiring NICU admission. However, after adjustment, none of these retained statistical significance. Conclusion: Risk of gestational diabetes, hypertension, preterm labor, cesarean section, LBW, and NICU admission were primarily related to advanced maternal age rather than grand multiparity in Jordanian women.

Thyroid autoantibodies in pregnancy are associated with hypertensive disorders of pregnancy: Ma'anshan Birth Cohort Study.

Hypertensive disorders of pregnancy (HDP) have been associated with adverse health outcomes for both mothers and children. Previous studies examining associations of maternal thyroid autoantibodies with HDP indicate conflicting results. The objective of this study was to examine associations of maternal thyroid autoantibody positivity in the first and the second trimesters with the risk of HDP. In the Ma'anshan Birth Cohort study, a population-based prospective study in China, a total of 3474 pregnant women were enrolled between May 2013 and September 2014. Thyroid autoantibodies, including antithyroperoxidase autoantibody (TPOAb) and antithyroglobulin autoantibody (TgAb), as well as thyroid function tests, were measured in both the first and the second trimesters in 2893 pregnant women. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) and 95% confidence interval (CI) for the associations between thyroid autoantibodies and HDP. Multivariate logistic regression analyses showed that TPOAb positivity in the first trimester was associated with a 1.80 (95% CI=1.17-2.78) increased odds of HDP after adjustment for confounders, which was mainly due to an increased risk of gestational hypertension (OR=1.93, 95% CI=1.17-3.18). In addition, TgAb positivity in the first trimester was associated with a higher risk of HDP (OR=1.78, 95% CI=1.16-2.73) after adjustment for confounders, which was mainly due to an increased risk of gestational hypertension (OR=1.89, 95% CI=1.15-3.11). These associations were also seen among euthyroid women. Women with positive TPOAb in the second trimester seemed to have a higher risk of gestational hypertension (OR=1.87, 95% CI=1.02-3.43) after adjustment for confounders. However, among euthyroid women, TPOAb positivity in the second trimester was not associated with HDP. The TgAb status in the second trimester was not associated with HDP. Our results show that TPOAb positivity and TgAb positivity in the first trimester are associated with an increased risk of HDP. These data demonstrate that these associations are even seen among euthyroid women.