Incidence Rate Of Preeclampsia Research Articles

Regional analysis of high risk factors of hypertensive disorders in pregnancy with organ or system impairment

Objective: To explore the influencing factors of pregnancy-induced hypertensive disorders in pregnancy (HDP) with organ or system impairment in pregnant women, and to analyze and compare the differences of HDP subtypes in different regions of China. Methods: A total of 27 680 pregnant women with HDP with complete data from 161 hospitals in 24 provinces, autonomous regions and municipalities were retrospectively collected from January 1, 2018 to December 31, 2018. According to their clinical manifestations, they were divided into hypertension group [a total of 10 308 cases, including 8 250 cases of gestational hypertension (GH), 2 058 cases of chronic hypertension during pregnancy] and hypertension with organ or system impairment group [17 372 cases, including 14 590 cases of pre-eclampsia (PE), 137 cases of eclampsia, 2 645 cases of chronic hypertension with PE]. The subtype distribution of HDP in East China (6 136 cases), North China (4 821 cases), Central China (3 502 cases), South China (8 371 cases), Northeast China (1 456 cases), Southwest China (2 158 cases) and Northwest China (1 236 cases) were analyzed. By comparing the differences of HDP subtypes and related risk factors in different regions, regional analysis of the risk factors of HDP pregnant women with organ or system impairment was conducted. Results: (1) The proportions of HDP pregnant women with organ or system impairment in Northeast China (79.05%, 1 151/1 456), Central China (68.42%, 2 396/3 502) and Northwest China (69.34%, 857/1 236) were higher than the national average (62.76%, 17 372/27 680); the proportions in North China (59.18%, 2 853/4 821), East China (60.85%, 3 734/6 136) and South China (59.56%, 4 986/8 371) were lower than the national average, and the differences were statistically significant (all P<0.05). (2) Univariate analysis showed that the proportions of primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history in the hypertension with organ or system impairment group were higher than those in the hypertension group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that primiparas, non-Han, non-urban household registration, irregular prenatal examination and PE history were independent risk factors for HDP pregnant women with organ or system impairment (all P<0.05). (3) Primipara: the rates of primipara in Northeast China, North China and Southwest China were higher than the national average level, while those in South China, Central China and Northwest China were lower than the national average level. Non-Han nationality: the rates of non-Han nationality in Northeast China, North China and Northwest China were higher than the national average, while those in East China, South China and Central China were lower than the national average. Non-urban household registration: the rates of non-urban household registration in Northeast China, North China, and Southwest China were lower than the national average, while those in East China, Central China were higher than the national average. Irregular prenatal examination: the rates of irregular prenatal examination in North China, South China and Southwest regions were lower than the national average level, while those in Northeast China, Central China and Northwest China were higher than the national average level. History of PE: the incidence rates of PE in Northeast China, North China, South China and Southwest China were lower than the national average level, while those in Central China and Northwest China were higher than the national average level. Conclusions: Primiparas, non-Han, non-urban household registration, irregular prenatal examination, and PE history are risk factors for HDP pregnant women with organ or system impairment. Patients in Northeast, Central and Northwest China have more risk factors, and are more likely to be accompanied by organ or system function damage. It is important to strengthen the management of pregnant women and reduce the occurrence of HDP.

Insufficient iodine nutrition status and the risk of pre-eclampsia: a systemic review and meta-analysis

BackgroundAlthough subclinical hypothyroidism in pregnancy is one of the established risk factors for pre-eclampsia, the link between iodine deficiency, the main cause of hypothyroidism, and pre-eclampsia remains uncertain. We conducted...

&lt;p&gt;Incidence and Predictors of Pre-Eclampsia Among Pregnant Women Attending Antenatal Care at Debre Markos Referral Hospital, North West Ethiopia: Prospective Cohort Study&lt;/p&gt;

BackgroundPre-eclampsia is a pregnancy-induced hypertension that occurs after 20 weeks of gestation. It is the leading cause of maternal and perinatal morbidity and mortality globally, but it is higher in developing countries. In Ethiopia, conducting research on the incidence and predictors of pre-eclampsia is crucial due to the paucity of information.MethodsA prospective cohort study was undertaken using 242 pregnant women between November 1, 2018 and March 30, 2019 at Debre Markos Referral Hospital. All eligible women who fulfilled the inclusion criteria were included in this study. Data were entered into the epic-data Version 4.2 and analyzed using the STATA Version 14.0 software. The Cox-proportional hazard regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Pre-eclampsia free survival time was estimated using the Kaplan–Meier survival curve. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of pre-eclampsia.ResultsThe overall incidence rate of pre-eclampsia was 3.35 per 100 person-years. Having a pre-existing history of diabetes mellitus [AHR=2.7 (95% CI=1.43–8.81)], having a history of multiple pregnancy [AHR=3.4 (95% CI=2.8–6.9)] and being ≥35 years old age [AHR=2.5 (95% CI=1.42–3.54)] were the significant predictors of pre-eclampsia.ConclusionThe incidence of pre-eclampsia was high in this study. Having (pre-existing diabetes and multiple pregnancy) and being ≥35 years old age were the significant predictors of pre-eclampsia. Inspiring pregnant women’s health-seeking behavior should provide a chance to diagnose pre-eclampsia early to prevent the medical complication of pre-eclampsia.

Association of an Increased Risk of Pre-eclampsia and Fetal Growth Restriction in Singleton and Twin Pregnancies with Female Fetuses

Abstract Objective: To investigate whether the fetal gender affects the incidence of pre-eclampsia (PE) and fetal growth restriction (FGR) in singleton and twin pregnancies. Methods: This was a 10-year single-center, retrospective, cohort study from January 2009 to January 2019. A total of 57,129 singleton and 3699 twin pregnancies aged between 18–55 years old were recruited at the Third Affiliated Hospital of Guangzhou Medical University, China. We used multivariable logistic regression to analyze the effect of fetal gender on the incidence of PE and FGR. Results: In singleton pregnancies, the incidence rates of PE and FGR with a female fetus were higher than those with a male fetus (6.4% (1713/26,793) vs. 5.9% (1803/30,336), P &lt; 0.05 and 3.5% (932/26,793) vs. 2.4% (745/30,336), P &lt; 0.05, respectively). A female fetus was an independent risk factor for either PE or FGR (adjusted odds ratio: 1.169 or 1.563; 95% confidence interval: 1.036–1.319 or 1.349–1.810, respectively). In twin pregnancies, the incidence of early-onset PE was greater in pregnancies with two females compared with two males or one male plus one female (4.6% (46/1003) vs. 4.1% (54/1305) vs. 2.4% (33/1391), P &lt; 0.05). Female-female twins was an independent risk factor for PE (adjusted odds ratio: 1.367, 95% confidence interval: 1.011–1.849), especially early-onset PE. Conclusion: The female fetus was associated with PE in both singleton and twin pregnancies and was also a risk factor of FGR in singleton pregnancies.

Incidence and Risk Factors of Pre-Eclampsia in the Paropakar Maternity and Women’s Hospital, Nepal: A Retrospective Study

This study aims to determine the incidence of pre-eclampsia and distribution of risk factors of pre-eclampsia at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. A retrospective study included 4820 pregnant women from 17 September to 18 December 2017. Data were obtained from the medical records of the hospital’s Statistics Department. Associations between the risk factors and pre-eclampsia were determined using logistic regression analysis and expressed as odds ratios. The incidence rate of pre-eclampsia in the study population was 1.8%. Higher incidence of pre-eclampsia was observed for women older than 35 years (Adjusted Odds Ratio, AOR)= 3.27; (Confidence Interval, CI 1.42–7.52) in comparison to mothers aged 20–24 years, primiparous women (AOR = 2.12; CI 1.25–3.60), women with gestational age less than 37 weeks (AOR = 3.68; CI 2.23–6.09), twins pregnancy (AOR = 8.49; CI 2.92–24.72), chronic hypertension (AOR = 13.64; CI 4.45–41.81), urinary tract infection (AOR = 6.89; CI 1.28–36.95) and gestational diabetes (AOR = 11.79; CI 3.20–43.41). Iron and calcium supplementation appear to be protective. Age of the mothers, primiparity, early gestational age, twin pregnancy, chronic hypertension, urinary tract infection and gestational diabetes were the significant risk factors for pre-eclampsia. Iron and calcium supplementation and young aged women were somewhat protective.

Association between placental insufficiency and manifestations of preeclampsia

Aim. Provide evidence for the connection between placental insufficiency and preeclampsia and rationalize a unified approach to the prevention of placenta associated disorders. Materials and methods. The study was carried out in two stages. At the first (clinical statistical) stage, the incidence rates of preeclampsia (PE) and placental insufficiency (PI) were compared based on the data from Rosstat and from a regional perinatal center for the past 25 years; the most informative predictors of PI and PE were compared using the known clinical epidemiological tests. At the second stage, a prospective study of 140 high-risk pregnant patients with severe PI was carried out to confirm and generalize the hypothesis on the common predictors of PI and PE. Two groups of patients were compared: I – 68 women with isolated PI and II – 72 women with PI combined with earlyor late-onset PE. The control group included 30 women with uncomplicated pregnancy. Immunoenzyme assays, immunofluorescence, biochemical analyses, and morphological studies of placenta were used. Results. The incidence rates of PI and PE, both in the communities and in the tertiary care hospital, pointed to their intercorrelation. This similarity of informative values of PI and PE predictors related to the most important operational characteristics of clinical epidemiology indicates the lack of pathognomonic significance of the early predictors and, on the other hand, supports the concept of the common mechanisms of placenta-associated pregnancy complications. In pregnant women with a high risk of PI decompensation, PE developed in 51% of cases (early-onset – 72%, late-onset – 28%); of those, 18% were diagnosed with severe PE, and 33% – with moderate PE. The obtained data confirm that the manifestation of early-onset PE is pathogenetically related to structural and functional disorders of the early fetoplacental complex (FPC), while late-onset PE is associated with FPC changes in the subsequent stages of pregnancy, and with a synergistic effect of extragenital and obstetrical pathology. The proposed predictive model of PE connects the manifestation of PE with the status of the placenta. Conclusion. The knowledge of pathogenetically significant risk factors allows for stratifying pregnant women in order to conduct a common preventive monotherapy of placenta associated disorders. The present approach to the management of high-risk pregnancy is in line with the principles of 4Р-medicine.

Preeclampsia in Jordan: incidence, risk factors, and its associated maternal and neonatal outcomes

Objectives: To estimate the incidence of preeclampsia among Jordanian pregnant women, determine its risk factors and its associated neonatal morbidity and mortality.Methods: The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared between women who developed preeclampsia and who did not.Results: This study included a total of 21,928 women. The overall incidence rate of preeclampsia was 1.3%. Obesity (OR = 2.6) and high blood pressure (OR = 11.9) were significantly associated with increasing odds of preeclampsia. The risk of preeclampsia was 2.3 times higher in first pregnancies than that in second or more pregnancies. The rates of low birth weight (LBW) delivery (32.5% vs. 8.3%), and prematurity (30.8% vs. 7%), and the neonatal mortality rate (81 vs. 12 per 1000 live births) were significantly higher among women with preeclampsia.Conclusions: The overall incidence rate of preeclampsia was 1.3%. Preeclampsia was significantly associated with maternal and neonatal morbidity and mortality as well as increasing vaginal operative delivery, cesarean section, LBW, and birth asphyxia.

21 White coat hypertension in pregnancy: High incidence rates of gestational hypertension and preeclampsia

Aim (1) To investigate what fraction of hypertension (HT) is white coat hypertension (WCH) in pregnant women without a past history of HT, (2) to compare the incidence rates of preeclampsia (PE) among normal pregnant women showing normal blood pressure (controls), WCH, and chronic hypertension (CH), and (3) to compare the incidence rates of gestational hypertension (GH) between controls and WCH. Methods This is a retrospective cohort study in 2934 pregnant women, who sought maternal checkup at Results (1) In 2934 women, 41 women had a past history of WCH ( n =3), and CH ( n =38). In the remaining 2893 women, 2837 women (98.1%) were normal blood pressure, 36 women (1.2%) were WCH, and 20 women (0.7%) were CH, thus, the prevalence of WCH in newly diagnosed HT in pregnancy was 64% (36/56). (2) The incidence rates of PE in controls, WCH, and CH were 1.7% (48/2,837), 15% (6/39), and 21% (12/58), respectively; the incidence rates of PE in WCH and CH were significantly higher than in controls ( p p p =0.600). (3) The incidence rate of GH in WCH was significantly higher than in controls (23% (9/39) vs. 1.3% (37/2,837), p Conclusions Almost two-third of the newly diagnosed HT in pregnancy was WCH. Therefore, the precise diagnosis of WCH is essential to avoid unnecessary anti-hypertensive therapy. The incidence rate of hypertensive disorders of pregnancy (PE plus GH) in women with WCH was 38%. Therefore, we should recognize WCH as very high risk for GH or PE, and should monitor women with WCH by HBP very carefully.

Comparison of high dose and low dose folic acid supplementation on prevalence, onset and severity of preeclampsia.

Background:Folic acid supplementation had previously mentioned as a protective factor against the onset of preeclampsia (PE). In this study, we aimed to compare the effect of high dose (5 mg daily) and low dose (1 mg daily) of folic acid supplementation on prevalence, onset and severity of PE.Materials and Methods:Pregnant women who were in the first trimester and referred to prenatal care university hospitals of Isfahan, Iran during October 2013–May 2015 were included in this study, then they were randomly divided into two groups of 5 mg and 1 mg (treated with daily 5 mg and 1 mg of folic acid, respectively), both groups received folic acid from the first trimester of pregnancy to 42 days after termination. Blood pressure, body mass index (BMI), and some urine and blood biochemistry parameters were measured. SPSS-22 used for statistical analysis.Results:A total of 943 pregnant women participated in the study (450 women in 1 mg group and 450 women in 5 mg group). Incidence rate of PE was 3.8% in 1 mg group and 2.4% in 5 mg group. In a comparison of preeclamptic patients in 1 mg and 5 mg group, no significant differences were seen regarding age, BMI, laboratory data, the severity of the disease, and onset (early or late) (P > 0.05).Conclusion:Although our findings support that administration of high dose folic acid may decrease the prevalence of PE, there is not enough data to support that higher amount of folic acid administration can reduce the severity of presentation's signs or ameliorate the laboratory data and the onset of PE.

Assessment of prevalence of preeclampsia from Dilla region of Ethiopia.

BackgroundPreeclampsia is a multi-organ system disorder that occurs after the 20th week of gestation in pregnancy and is characterized by hypertension and proteinuria. In Africa more than 270,000 women die from maternal deaths, worldwide approximately 76,000 women and 500,000 babies die yearly due to preeclampsia. It affects about 8–10 % of all pregnancies. Studies have shown that up to 77 % women affected with preeclampsia lack knowledge about preeclampsia, and therefore cannot take preventative measures. The aim of study is to evaluate the outcomes and quality of care given to preeclamptic patients treated in Dilla University Referral Hospital.MethodsThe study is a retrospective, hospital based study. One hundred and seventy two records of women were retained for final study out of 7702 patients from January 2009 to December 2012.ResultsThe incidence rate of preeclampsia in Dilla University Referral Hospital was found to be 2.23 %. The common mean ages found to be affected for preeclampsia were 19.2, 22.5 and 27.8 and 31.5 with a trend towards increasing severity with younger age population.ConclusionA guideline on the management and prevention of preeclampsia needs to be produced for Ehiopia.

O30. Diet and preeclampsia: A prospective multicentre unmatched case control study in Ethiopia

Background Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20–80% of maternal mortality in developing countries, including Ethiopia. For many years diet have been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results across studies, and this has not been studied in Ethiopia Objectives The objective of this study was to determine the effect of dietary habits on the incidence of preeclampsia Bahir Dar, Ethiopia Methods A prospective multicentre unmatched case- control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City Administration. Interviewer administered face to face interview, measurement of mid-arm circumference (MUAC) and document review were conducted using a standardized and pretested questionnaire. Data entry and cleaning was done by Epi.info version 3.5.3.The data were transported to SPSS version 20 for analysis. Both bivariate and multivariate logistic regression analyses were applied. Backward stepwise unconditional logistic regression analysis was employed to determine the putative association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P -value 0.05 was considered to declare statistically significant throughout the study. Result For every 1-cm increase of MUAC, there was an increase in the incidence rate of preeclampsia by a factor of 1.35 ( AOR = 1.35, 95%CI:1.21, 1.51). A higher incidence of preeclampsia was found in women who reported to have consumed coffee daily during pregnancy ( AOR = 1.78, 95%CI: 1.20, 3.05). Similarly for women who had anemia during the first trimester the incidence of preeclampsia 2.5 times higher than their counterparts ( AOR = 2.47, 95%CI: 1.12,7.61). This study also revealed consumption of fruit or vegetables at least three times a week during pregnancy to be protective against preeclampsia ( AOR = 0.51, 95%CI: 0.29, 0.91; AOR = 0.46, 95%CI: 0.24, 0.90, respectively). In addition compliance with IFA during pregnancy has shown a significant independent effect on the prevention of preeclampsia in this study ( AOR = 0.16, 95%CI: 0.08, 0.29) Conclusion and recommendation Adequate vegetable and fruit consumption and compliance to folate intake during pregnancy are independent protective factors of preeclampsia. On the other hand, higher mid upper arm circumference, anemia and daily coffee intake during pregnancy are risk factors for the development of preeclampsia. Audience specific education and promotion for the use of the protective factors identified in this study should be strengthened. The risk factors identified can be used for prediction and early diagnoses of preeclampsia allowing timely interventions to be performed to minimize deaths associated with severe preeclampsia/eclampsia.

Diet and Pre-eclampsia: A Prospective Multicentre Case–Control Study in Ethiopia

IntroductionPre-eclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20–80% of maternal mortality in developing countries, including Ethiopia. For many years, diet has been suggested to play a role in pre-eclampsia. However, the hypotheses have been diverse with inconsistent results across studies, and this has not been studied in Ethiopia. ObjectivesThe objective of this study was to determine the effect of dietary habits on the incidence of pre-eclampsia in Bahir Dar, Ethiopia MethodsA prospective multicentre unmatched case–control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City from June to September 2014. The interviewer conducted a face-to-face interview, measured the mid-upper arm circumference (MUAC) and collected the mid-pregnancy haemoglobin level from clinical notes using a standardized and pretested questionnaire. Epi Info 3.5.3 was used for data entry and cleaning, while IBM SPSS Statistics 20 was used for data analysis. Backward stepwise unconditional logistic regression analysis was employed to determine the strength of association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P-value ≤0.05 was considered statistically significant. ResultFor every 1-cm increase of MUAC, there was an increase in the incidence rate of pre-eclampsia by a factor of 1.35 (adjusted odds ratio (AOR)=1.35, 95% confidence interval (CI): 1.21, 1.51). A higher incidence of pre-eclampsia was found in women who reported to have consumed coffee daily during pregnancy (AOR=1.78, 95% CI: 1.20, 3.05). Similarly, for women who had anaemia during the first trimester, the incidence of pre-eclampsia was 2.5 times higher than their counterparts (AOR=2.47, 95% CI: 1.12, 7.61). This study also revealed consumption of fruit or vegetables at least three times a week during pregnancy to be protective against pre-eclampsia (AOR=0.51, 95% CI: 0.29, 0.91; AOR=0.46, 95% CI: 0.24, 0.90, respectively). In addition, compliance with folate intake during pregnancy has shown a significant independent effect on the prevention of pre-eclampsia in this study (AOR=0.16, 95% CI: 0.08, 0.29). Conclusion and recommendationAdequate vegetable and fruit consumption and compliance with folate intake during pregnancy are independent protective factors against pre-eclampsia. On the other hand, higher MUAC, anaemia and daily coffee intake during pregnancy are risk factors for the development of pre-eclampsia. Audience-specific education and promotion of the use of the protective factors identified in this study should be prioritized. The risk factors identified can be used for prediction and early diagnoses of pre-eclampsia allowing timely interventions to be performed to minimize deaths associated with severe pre-eclampsia/eclampsia.

Investigating antioxidant effect of vitamins e, c on the incidence rate of preeclampsia and maternal and fetal prognosis in patients with increased risk of preeclampsia

Disorders of hypertension in pregnancy are a component of the triple causes related to the morbidity and mortality of mother and baby. In the investigations, the role of oxidative stress has been proven in the pathophysiology of preeclampsia and the effect of free radicals in endothelial dysfunction. Essential nutrients such as vitamins C and E are able to eliminate free radicals that lead to cellular damage. Due to the cases above, this study was conducted to investigate the antioxidant effect of vitamins E&C on the incidence of Preeclampsia in pregnant women with high risk in terms of the incidence of this disease. The present study is a clinical trial. The statistical population includes 700 at risk women in terms of preeclampsia (nuliparas women). Subjects were in the age range of 20 to more than 35 years, with insulin-dependent diabetes, multiple pregnancies, overweight, previous preeclampsia history, chronic hypertension, vascular disease, collagen disease and renal disease. Patients were divided into two groups of 350 persons including the control group that just received Iron and folic acid and treatment group that received the antioxidant (E & C) in addition to iron and folic acid, afterwards the incidence rate of preeclampsia and its intensity was investigated in the two groups. Analysis was conducted by the chi-square method. The incidence rate of preeclampsia had no significant difference in the two groups of control and treatment but the incidence severity was less in the treatment than control group (P< 0.001) and also weight less than 2500 grams and gestational age less than 37 weeks was more in the control than treatment group. This difference was statistically significant (P< 0.001). According to the above-mentioned cases, consumption of antioxidants in patients with high risk in terms of preeclampsia can decrease severity of illness, reduce and improve neonatal and maternal outcome. Therefore, the use of these antioxidants is recommended during pregnancy in patients with preeclampsia.

Association of meteorological factors and seasonality with preeclampsia: a 5-year study in northeast of Iran

Background: Preeclampsia is one of the common causes of maternal and fetal mortality, and an important problem of pregnancy. This disorder can cause intracranial hemorrhage, intravascular coagulation, pulmonary edema, liver and renal failures and placental abruption.Objective: To evaluate the effects of seasonal and monthly changes of weather, humidity and temperature on the incidence rate of preeclampsia according to the conception and delivery times.Materials and methods: Retrospective analysis of hospital records of 20 520 consecutive singleton live birth pregnancies of 20–42 weeks of gestation during 2002–2008 was performed. After including preeclamptic cases, on the basis of American College of obstetricians and gynecologists (ACOG) criteria, gestational age and time of conception was estimated and the mean relative temperature and humidity of each month was derived from monthly climatological data collection of IRAN METEOROLOGICAL ORGANIZATION (IRIMO) between 22 June 2002 and 19 March 2008 (68 months). Statistics of each month’s births were registered separately.Results: Mean maternal age of 262 qualified singleton pregnant women with preeclampsia out of 20 520 deliveries were 26.48 years old and 85.9% of deliveries were done by cesarean section method. Based on time of conception, the highest prevalence was detected in summer, especially in September (11.06875%) and August (10.3053%) and the lowest prevalence was found in winter and early spring, especially in January (5.7552%) and April (5.7252%).Conclusion: Seasonal (monthly) variations of the weather (humidity and temperature) have a significant impression on preeclampsia prevalence.

Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

Ducarme, G.; Revaux, A.; Rodrigues, A.; Aissaoui, F.; Pharisien, I.; Uzan, M. Author Information

Secular Trends in the Rates of Preeclampsia, Eclampsia, and Gestational Hypertension, United States, 1987-2004

Few studies have reported on population-level incidence of or trends in the hypertensive disorders of pregnancy, and none report on data through 2004. We describe population trends in the incidence rates of preeclampsia, eclampsia, and gestational hypertension in the United States for 1987-2004. We analyzed public-use data from the National Hospital Discharge Survey (NHDS), which has been conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics since 1965. We calculated crude and age-adjusted incidence rates and estimated the risk associated with available demographic variables using Cox regression modeling. Rates of preeclampsia and gestational hypertension increased significantly (by 25 and 184%, respectively) over the study period; in contrast, the rate of eclampsia decreased by 22% (nonsignificant). Women under the age of 20 were at significantly greater risk for all three outcomes. Women in the south of the country were at significantly greater risk for preeclampsia and gestational hypertension when compared to those in the Northeast. The increase in gestational hypertension may be exaggerated because of the revised clinical guidelines published in the 1990s; these same revisions would likely have reduced diagnoses of preeclampsia. Therefore, our observation of a small but consistent increase in preeclampsia is a conservative indication of a true population-level change.

Primary Preeclampsia in the Second Pregnancy

To examine the association between changes in prepregnancy body mass index (BMI) between a woman's first two pregnancies and incidence of preeclampsia in the second pregnancy. We performed a population-based retrospective cohort analysis using data on women's first two singleton pregnancies (n=136,884) in Missouri (1989-1997). The study was restricted to women without preeclampsia in the first pregnancy. Prepregnancy BMI (kg/m(2)) was categorized as underweight (less than 18.5), normal (18.5-24.9), overweight (25-29.9), and obese (30 or greater). Analyses were adjusted for confounders through multivariable logistic regression. The incidence rate of preeclampsia in the second pregnancy was 2.0%. In comparison with women who were of normal BMI in both pregnancies, the risk for preeclampsia increased when BMI changed between the first two pregnancies from underweight to obese (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.7-18.2), normal to overweight (OR 2.0, 95% CI 1.7-2.3), normal to obese (OR 3.2, 95% CI 2.5-4.2), and overweight to obese (OR 3.7, 95% CI 3.1-4.3). Being obese or overweight in both pregnancies was associated with increased risk of preeclampsia in the second pregnancy. Women who increased their BMI from underweight to normal or overweight between pregnancies had risks of preeclampsia comparable with those with normal BMI in both pregnancies. African-American, but not white, women who had a reduction in BMI from obese or overweight to normal between pregnancies remained at increased risk for preeclampsia. Increases in prepregnancy BMI from normal weight to overweight or obese between pregnancies are associated with increased risk of preeclampsia in the subsequent pregnancy. II.

Obstetric Outcome Following Laparoscopic Adjustable Gastric Banding

The bariatric procedure laparoscopic adjustable gastric banding (LAGB) was introduced in the 1980s. Since then, it has been used in young obese women who wish to become pregnant and also to lower their risk of complications, even though there is not much data on its effects on maternal and fetal morbidity. This retrospective case-control study enrolled 427 obese women whose prepregnancy body mass index (BMI) was 30 or greater. Thirteen of these women underwent LABG. The interval from LAGB to conception averaged 17 months, and these women lost a mean of 24 kg body weight before becoming pregnant. Mean body weight and BMI at the outset of pregnancy were 95 kg and 34.8, respectively. The LAGB and control groups did not differ with regard to maternal age at the time of conception. Women in the LAGB group gained significantly less weight during pregnancy than did control women (5.5 vs. 7.1 kg). Incidence rates of preeclampsia, gestational diabetes, low birth weight, and fetal macrosomia all were less for women having LAGB than for obese control women. There were, however, no significant differences in rates of induced labor for obstetrical complications or the use of epidural anesthesia. Overall, cesarean deliveries were significantly more frequent in control women than in study cases (34.4% vs. 15.3%). However, this difference was largely due to an increased number of prelabor cesareans in the control group; the rate of cesareans during labor was not different between the groups. The investigators believe that the increased number of prelabor cesareans in the control women was due to higher rates of preeclampsia, gestational diabetes, and low birth weight in this group. Among women having a previous cesarean delivery, the chance of requiring a repeat cesarean was significantly less in the study group. There was no significant group difference in mean birth weight, but low birth weight and macrosomia both were significantly more frequent in control women. Preterm births, 5-minute Apgar scores, and umbilical arterial blood gas values were comparable in the study and control groups. It appears that LAGB lowers the risk of adverse obstetrical complications in obese women. It is a safe procedure and is well tolerated by pregnant women.

Lifestyles and pre-eclampsia with special attention to cigarette smoking.

Cigarette smoking has been reported to protect women against pre-eclampsia. We conducted a cohort study of 493 women whose first antenatal visits were between September 1997 and April 1998 at Osaka Prefectural General Hospital, Japan. A self-administered questionnaire survey for lifestyles was carried out during pregnancy, and pregnancy outcome information was taken from medical record data. Of 493 subjects, 82 cases (16.6%) developed mild pre-eclampsia and 3 cases (0.6%) developed severe one. The prevalence of cigarette smokers decreased from 21.3% to 8.6% during early pregnancy. The incidence rate of pre-eclampsia among smokers was slightly greater than that among non-smokers (19.4% vs 17.1%), the incidence rate among cases exposed from household smoking was greater than that among no exposed cases (19.6% vs 14.3%), and the incidence rate among alcohol-drinkers was greater than that among non-drinkers (21.1% vs 15.1%). However, there were no statistically significant differences. Larger body mass index before pregnancy tended to be associated with the increased incidence rate of pre-eclampsia (p = 0.160). Pregnant women with smoking had a statistically higher frequency of household smoking exposure and having drinking alcohol. Household smoking exposure and drinking alcohol status adjusted hazard rate ratio was 1.1 for smokers (95% confidence interval 0.6-1.7) as compared with that for non-smokers. Our results did not support the proposition that cigarette smoking protected women against pre-eclampsia.