Lower Risk Of Preeclampsia Research Articles

Intake of Probiotic Food and Risk of Preeclampsia in Primiparous Women: The Norwegian Mother and Child Cohort Study

Probiotics have been suggested to modify placental trophoblast inflammation, systemic inflammation, and blood pressure, all potentially interesting aspects of preeclampsia. The authors examined the association between consumption of milk-based probiotic products in pregnancy and development of preeclampsia and its subtypes. The study was performed in the Norwegian Mother and Child Cohort Study by using a prospective design in 33,399 primiparous women in the years 2002-2008. The intake of milk-based products containing probiotic lactobacilli was estimated from a self-reported food frequency questionnaire. Preeclampsia diagnoses were obtained from the Norwegian Medical Birth Registry. Intake of probiotic milk products was associated with reduced risk of preeclampsia. The association was most prominent in severe preeclampsia (adjusted odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.66, 0.96). With probiotic intakes divided into categories representing no, monthly, weekly, or daily intake, a lower risk for preeclampsia (all subtypes) was observed for daily probiotic intake (OR = 0.80, 95% CI: 0.66, 0.96). Lower risks for severe preeclampsia were observed for weekly (OR = 0.75, 95% CI: 0.57, 0.98) and daily (OR = 0.61, 95% CI: 0.43, 0.89) intakes. These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.

Maternal Caffeine Intake, Blood Pressure, and the Risk of Hypertensive Complications During Pregnancy. The Generation R Study

Caffeine intake has been suggested to be associated with the risk of hypertension. Less is known about the associations of caffeine intake on maternal cardiovascular adaptations during pregnancy. We examined the associations of caffeine intake in different trimesters of pregnancy with repeatedly measured blood pressure and the risks of pregnancy-induced hypertension and pre-eclampsia in a population-based cohort of 7,890 pregnant women. In each trimester caffeine intake and systolic and diastolic blood pressure were assessed by questionnaires and physical examinations, respectively. Information about hypertensive complications was obtained from medical records. Our longitudinal analyses revealed no significant differences for both systolic and diastolic blood pressure. The cross-sectional analyses showed that higher caffeine intake tended to be associated with higher systolic blood pressure in first and third trimester (P trend <0.05), but not in second trimester. Caffeine intake was not consistently associated with diastolic blood pressure levels, or the risk of pregnancy-induced hypertension. As compared to women with caffeine intake of <2 units/day, those using 2-3.9 units/day had a lower risk of pre-eclampsia (odds ratio 0.63 (95% confidence interval: 0.40, 0.96)). Higher caffeine intake during pregnancy seems to be associated with elevated systolic blood pressure levels in first and third trimester, but not with diastolic blood pressure levels. We did not find evidence of significant adverse associations of caffeine intake on maternal cardiovascular adaptations during pregnancy. The unexpected finding of a possible protective association with moderate caffeine intake deserves further investigation.

A Medical Nutrition Therapy Program Improves Perinatal Outcomes in Mexican Pregnant Women With Gestational Diabetes and Type 2 Diabetes Mellitus

Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied. The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City. Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated. Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes. An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.

Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis

Objective To determine the accuracy of using systolic and diastolic blood pressure, mean arterial pressure, and increase of blood pressure to predict pre-eclampsia.Design Systematic review with meta-analysis of data on...

Preconception Period of Seminal Fluid Exposure and Prevalence of Preeclampsia in Primigravida Women

Preeclampsia is a major cause of morbidity and mortality in mothers fetuses and neonates worldwide. We conducted a case-control study on 100 preeclamptic women (Case Group) and 100 normotensive pregnant women (Control Group) to investigate that if preconception period of seminal fluid exposure affects the prevalence of preeclampsia in primigravida women. The relation of use of barrier contraceptive method and preeclampsia in primigravida women was significant so that primigravida women using the condom or withdrawal method are in higher risk of being preeclamptic (p = 0.007). There was significant relation between weekly number of coitus before conception and preeclampsia so that the women with more frequent coitus before conception are at lower risk of preeclampsia (p = 0.000). The average age of primigravida preeclamptic women was 24 +or- 3.33 years in comparison with 22.92 +or- 3.80 years in control group. Our data suggest that prevalence of preeclampsia in primigravida women is associated with weekly number of coitus before conception and the use of barrier contraceptive method. (authors)

The combined effect of maternal smoking and obesity on the risk of preeclampsia

Cigarette smoking during pregnancy is associated with a lower risk of preeclampsia, whereas obesity increases the risk of preeclampsia. We sought to assess the combined effect of smoking and obesity on the risk of preeclampsia. We conducted a population-based cohort study of 129,674 women who delivered singleton infants during 2000-2001. Data for cigarette use, pre-pregnancy body mass index (BMI), preeclampsia, and potential confounders were obtained from birth certificate files. Mantel-Haenszel stratified analysis and logistic regression were used to analyze the data. The preeclampsia risk was 3.1, 4.5, 7.6 and 8.8% for normal weight (BMI 18.5-24.9), overweight (25.0-29.9), obese (30.0-39.9) and morbidly obese (>or=40.0 kg/m2) women, respectively, who smoked cigarettes while pregnant. The preeclampsia risk was 3.9, 6.2, 9.0 and 12.3% for the same groups of women, respectively, who did not smoke during their pregnancy. Compared to non-smokers, the relative risk of preeclampsia for women who smoked cigarettes was 0.78 (95% confidence interval 0.73-0.83) before and after adjusting for pre-pregnancy BMI and other factors associated with preeclampsia. The risk of preeclampsia is lower for women who smoke cigarettes while pregnant regardless of their pre-pregnancy BMI.

Effect of subsequent pregnancy on vascular function in endothelial nitric oxide synthase (NOS3) knockout mice

Nitric oxide is involved in gestational vascular adaptation and its deficiency has been implicated in preeclampsia, and the endothelial nitric oxide synthase (NOS3) inhibition results in a preeclampsia-like condition in various animal models.Our objective was to test the hypothesis that the lower risk of preeclampsia after the first pregnancy is related to improved vascular adaptation. Female NOS3 knockout (C57BL/6J-NOS3−/−KO) and wild-type (NOS3+/+WT) were sacrificed at day 18 of gestation in their first (P0) or second (P1) pregnancy. The carotid arteries were placed in a wire myograph for isometric tension recording. Maximal relaxation to acetylcholine (Ach), maximal contraction to KCl, and vascular responses to cumulative concentrations of phenylephrine (PE) and serotonin (5-HT) were determined. One-way ANOVA followed by Neuman-Keuls post hoc test were used for statistical analysis (significance: p<0.05). The maximal contraction to KCl and vascular response to PE were significantly higher in knockout P0 females when compared to all other groups. Interestingly the responses to KCl in the knockout P1 females were not significantly different from wild-type P0 and P1 females. Similarly, the vascular sensitivity to 5-HT was significantly increased in knockout P0, while was similar between knockout P1 females and the wild type P0 and P1 pregnant female. Relaxation to Ach was absent in knockout P0 females, but was partially regained in knockout P1 females. These findings support that mice lacking NOS3 function have altered vascular adapatation to pregnancy in their first but not second pregnancy. The normalizaton of vascular function with subsequent pregnancy may underly the mechanism responsible for decreased risk of preeclampsia after the first pregnancy. Elucidation of these mechanisms may be important for understanding the etiology of preeclampsia.

Risk factors for preeclampsia in multiparous women: Primipaternity versus the birth interval hypothesis

Introduction. To determine whether the risk of preeclampsia in multiparous women with a previous normal pregnancy is related to changing paternity or to prolonged birth interval, a retrospective study was conducted at the Lyell McEwin Health Service (University of Adelaide).Methods. The study included all multiparous women known to the hospital because of their preceding 1st delivery in the same hospital followed by their 2nd and/or 3rd ongoing pregnancy resulting in a delivery in the period 2001 – 2003. Case records were analyzed for birth interval, pregnancy interval, paternity and recognized risk factors such as booking weight and smoking. For the analysis both the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition and the more recently introduced classification by the Australian Society for the Study of Hypertension in Pregnancy (ASSHP) were used.Results. In the 656 women in this study cohort, 148 (26.2%) women had a different partner in their 2nd and/or 3rd ongoing pregnancy. Using the ISSHP definition for preeclampsia, changing partners had an odds ratio (OR) of 1.304 (95% CI 0.43 – 3.99); using ASSHP criteria an OR of 1.556 (95% CI 0.6506 – 3721); and looking at the combined group of pregnancy-induced hypertensive disorders an OR of 1.99 (95% CI 1.01 – 3.89). A longer birth interval if anything was associated with a lower risk of preeclampsia (non-significant), whatever definition was used. Also the inter-pregnancy interval did not show a consistent relation with the risk for developing a hypertensive complication.Conclusions. The results of this study on risk factors for preeclampsia in multiparous women appear to be in line with the primipaternity hypothesis, but are in direct contrast with the so-called birth interval hypothesis.

PREVENTION OF PREECLAMPSIA WITH LOW-DOSE ASPIRIN – A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE MAIN RANDOMIZED CONTROLLED TRIALS

The purpose of this paper is to evaluate the effectiveness of low-dose aspirin in the prevention of preeclampsia in low-risk and high-risk women. We identified randomized clinical trials of the use of low-dose aspirin to prevent preeclampsia through the PUBMED search engine, and through the Cochran Library database. Twenty-two studies met our inclusion criteria, and were divided according to the studied population into 2 groups: trials with women at low risk for preeclampsia and trials with women at high risk. Effects were measured through the incidence of preeclampsia in women taking either placebo or aspirin, in studies where the relative risks and the 95% confidence intervals were calculated for both groups. A total of 33,598 women were studied, comprising 5 trials with 16,700 women at low-risk and 17 trials including 16,898 women at high risk. The incidence of preeclampsia was 3.75% (626/17,700), in the low-risk group, 9.01% (1,524/16,898) in the high-risk group, and 6.40% (2,150/33,598) overall. Low-dose aspirin had no statistically significantly effect on the incidence of preeclampsia in the low-risk group (RR = 0.95, 95% CI = 0.81-1.11), but had a small beneficial effect in the high-risk group (RR = 0.87, 95% CI = 0.79-0.96). Therefore, low-dose aspirin is mildly beneficial in terms of reducing the incidence of preeclampsia in women at high risk of developing preeclampsia.

Vitamin C and E supplementation in women at risk of preeclampsia is associated with changes in indices of oxidative stress and placental function

Objective: We have previously reported a reduced incidence of preeclampsia in women who were at risk and were taking vitamin C (1000 mg/d) and vitamin E (400 IU/d) supplements. In this study, we determined whether supplementation in the same cohort was associated with an improvement in indices of placental dysfunction and oxidative stress toward values determined in women who were at low risk of preeclampsia. Study Design: Seventy-nine women who were at high risk and who were taking vitamin supplements and 81 who were taking placebos were compared with 32 women who were at low risk and who were not taking supplements who were studied simultaneously. Results: Indices of oxidative stress and placental function were abnormal in the placebo group. When the placebo group was compared with the women who were at low risk, ascorbic acid, plasminogen activator inhibitor-2, and placenta growth factor concentrations were decreased; and 8-epi-prostaglandin F2α,leptin, and the plasminogen activator inhibitor-1/-2 ratio were increased. In the group that received vitamin supplements, ascorbic acid, 8-epi-prostaglandin F2α, leptin, and plasminogen activator inhibitor-1/-2 values were similar to women who were at low risk. Conclusion: Antioxidant supplementation in women who were at risk of preeclampsia was associated with improvement in biochemical indices of the disease. (Am J Obstet Gynecol 2002;187:777-84.)

Review: antiplatelet drugs reduce pre-eclampsia, preterm birth, and stillbirth or neonatal death

(2001) BMJ 322, 329. Duley L, Henderson-Smart D, Knight M, et al. . Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. . Feb 10; . : ....

Obstetric complications in women with schizophrenia

It is not known whether schizophrenic women have increased incidence of complications during pregnancy and delivery. Data from the Danish Medical Birth Register were used to compare 2212 births to 1537 schizophrenic women in Denmark with a random sample of all deliveries in Denmark during 1973–1993 (122 931 births to 72 742 women). The schizophrenic women had fewer antenatal care visits. They were at lower risk of pre-eclampsia, but tended to have lower Apgar scores. There were no other differences in the incidence of specific complications such as placenta previa, placental abruption, and abnormal fetal presentation. Schizophrenic women were at increased risk of interventions such as Cesarean section, vaginal assisted delivery, amniotomy, and pharmacological stimulation of labor. There were no important differences between the deliveries to schizophrenic women who gave birth before and after their first admission to a psychiatric department. These results show no evidence that schizophrenic women have a greater frequency of specific obstetric complications than non-schizophrenic women. Nevertheless, they are at increased risk for interventions during delivery.

Low-Dose Aspirin to Prevent Preeclampsia in Women at High Risk

Caritis, Steve; Sibai, Baha; Hauth, John; Lindheimer, Marshall D; Klebanoff, Mark; Thom, Elizabeth; VanDorsten, Peter; Landon, Mark; Paul, Richard; Miodovnik, Menachem; Meis, Paul; Thurnau, Gary Author Information