Relative Risk Of Preeclampsia Research Articles

Effect of Reduced INR in Early Pregnancy on the Occurrence of Preeclampsia: A Retrospective Cohort Study.

To investigate the effect of reduced early-pregnancy activated partial thrombin time (APTT), prothrombin time (PT), and international standardized ratio (INR) on the risk of preeclampsia. A total of 8549 pregnant women with singleton births were included. Early pregnancy APTT, PT, and INR levels, with age, birth, prepregnancy body mass index, fibrinogen (FBG), thrombin time (TT), D-dimer (DD2), antithrombin III (ATIII), fibrin degradation products (FDP) as confounders, generalized linear model of APTT, the relative risk of PT and INR when INR reduction. After adequate adjustment for confounders, the relative risk of preeclampsia was 0.703 for every 1 s increase in plasma PT results in early pregnancy, and for every 0.1 increase in plasma INR results, the relative risk of preeclampsia was 0.767. With a PT less than the P25 quantile (<11 s), the relative risk of preeclampsia was 1.328. The relative risk of preeclampsia at an INR less than the P25 quantile (<0.92) was 1.24. There was no statistical association between APTT on the risk of preeclampsia. The relative risk of preeclampsia is strongly associated with a decrease in PT and INR in early pregnancy. PT and INR in early pregnancy were a potential marker in the risk stratification of preeclampsia. Focusing on reduced PT and INR levels in early pregnancy can help to identify early pregnancies at risk for preeclampsia.

Short-term effects of ambient temperature on the risk of preeclampsia in Nanjing, China: a time-series analysis

ObjectivesPrevious studies on the association between temperature and preeclampsia mainly considered temperature on a monthly or seasonal time scale. The objective of this study was to assess the preeclampsia risk associated with short-term temperature exposure using daily data.Study designDaily preeclampsia hospitalization data, daily meteorological data and daily air pollutant data from Nanjing were collected from 2016 to 2017. Both the T test and distributed lag nonlinear model (DLNM) were applied to assess the short-term effect of temperature on preeclampsia risk. Three kinds of daily temperature, including the daily mean temperature, daily minimum temperature and daily maximum temperature, were analysed.ResultsWhen the daily number of preeclampsia hospital admissions was divided into two subgroups based on temperature, it was significantly larger on cold days than on hot days. Regarding the mean temperature, a very low level of mean temperature (4.5 °C, lag = 0–20) and a low level of mean temperature (9.1 °C, lag = 0–20) increased the cumulative relative risk of preeclampsia by more than 60%. At the same time, a very high level of mean temperature (28.7 °C, lags = 0–10, 0–15, 0–20) and a high level of mean temperature (24.1 °C, lags = 0–10, 0–15) decreased the cumulative relative risk of preeclampsia by more than 35%. At a minimum temperature, a very low level of minimum temperature (0.9 °C, lag 0–5) and a low level of minimum temperature (5.6 °C, lag 0–5) increased the cumulative relative risk of preeclampsia by more than 55%. At the same time, a high level of mean temperature (20.9 °C, lags = 0, 0–5) decreased the cumulative relative risk of preeclampsia by more than 20%. The maximum temperature result was similar to the mean temperature result.ConclusionsBoth direct and lag effects of low temperature on preeclampsia were demonstrated to be significant risk factors. These results could be used to help pregnant women and the government reduce preeclampsia risk.

The comparison of side effects of methyldopa, amlodipine, and metoprolol in pregnant women with chronic hypertension

ABSTRACT Objective The aim of the study was to compare the complication of Antihypertensive drug; in pregnant women with chronic hypertension. Method This retrospective cohort study was performed on 300 pregnant women with chronic hypertension. Results: a relative risk of preeclampsia among methyldopa group was 3.45 times higher than the metoprolol, the relative risk of preterm labor was not significantly between methyldopa and metoprolol group, LBW, and IUGR in methyldopa and amlodipine groups . Conclusion Methyldopa and amlodipine are associated with the least side effects in pregnant women treated for chronic hypertension.the incidence of preeclampsia was greater in methyldopa group.

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

IntroductionPre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Although subclinical hypothyroidism (SCH) in pregnancy is one of the established risk factors for pre-eclampsia,...

Vitamin D and risk of pregnancy related hypertensive disorders: mendelian randomisation study

ObjectiveTo use mendelian randomisation to investigate whether 25-hydroxyvitamin D concentration has a causal effect on gestational hypertension or pre-eclampsia.DesignOne and two sample mendelian randomisation analyses.SettingTwo European pregnancy cohorts (Avon Longitudinal...

Role of Aspirin in High Pulsatility Index of Uterine Artery: A Consort Study.

Preeclampsia is a heterogeneous disorder prevalent in 3-10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group. Both components have independent therapeutic effects on anti-inflammatory pathway and proresolving pathway. This study was designed to assess the effectiveness and safety of aspirin in prevention and treatment of symptoms and complications of preeclampsia in women at high risk of preeclampsia. This is a prospective experimental study to evaluate the effectiveness of aspirin versus placebo in the prevention of maternal syndrome of preeclampsia in women with high risk of preeclampsia (G1=97, G2=92). Patients with age≥34, chronic hypertension, multiple pregnancies, gestational diabetes, and high pulsatility index of uterine artery were enrolled between 12 and 20weeks of gestation and prescribed 75mg aspirin daily till 34weeks of gestation. Control group was not prescribed aspirin. There was a reduction in relative risk of preeclampsia in aspirin group as compared with control group. There was no significant increase in the number of cases of abruption placenta, preterm delivery, neonatal intraventricular hemorrhage, patent ductus arteriosus, and postpartum hemorrhage following aspirin therapy. In patients with high mean pulsatility index of uterine arteries, low dose aspirin can be a useful intervention. Uterine artery Doppler is a simple and noninvasive test which can be used safely for the prediction of preeclampsia. Aspirin is safe, economical, and easily available commercially.

Dietary supplements and drugs for preeclampsia prophylaxis

Pre-eclampsia (PE) is a major cause of mortality and morbidity during pregnancy. Many different strategies to prevent PE have been investigated in randomized controlled trials, but none have been found to be widely effective and this is not surprising given the complexities in pathogenesis. Low-dose aspirin, diminishing platelet thromboxane synthesis, seems to prevent or delay PE. A meta-analysis of individual patient data from 32,217 women (PARIS collaborative group) asses that low-dose aspirin during pregnancy is associated with moderate reduction in the relative risk of PE (RR 0.90 95%CI 0.84–0.97), of birth before 34 weeks’ gestation (RR 0.90 95%CI 0.83–0.98), and of having a pregnancy with a serious adverse outcome (RR 0.90 95%CI 0.85–0.96). This effect seems to be more significant in women at high risk of developing PE. Regarding diet and nutrients, there does not appear to be any clear benefit for prevention of PE from routine dietary supplementation. There is high quality evidence that vitamin C and vitamin E are not effective for prevention or treatment of PE. Actually a meta-analyses found that supplementation with these antioxidants is associated with a slightly increased risk of gestational hypertension and premature rupture of membranes. Also there is not enough high-quality evidence to show that dietary magnesium or omega-3 fatty acids supplementation during pregnancy is beneficial. Calcium supplementation instead appears to reduce the risk of PE and the rare occurrence of the composite outcome ’death or serious morbidity’ specially in women with a low baseline calcium intake. Some studies assess that preeclamptic women may be deficient in nitric oxide, which mediates vasodilatation and inhibits platelet aggregation. For this reason NO donors, such as isosorbide dinitrate, glyceryl trinitrate and S-Nitroglutathione, were used in some trials as treatment in preeclamptic women. Despite the reduction in blood pressure and in uterine artery pulsatility index, these substances were rarely used in clinical practice because of adverse effects such as headache or preoxynitrite production. Also l -arginine, the substrate for synthesis of nitric oxide, has been investigated as a mean of preventing PE. Even though a dysfunction of the l -arginine-NO pathway that seems to be present in preeclamptic women, l -arginine load appears to be associated with increased nitric oxide (NO) production, hypotension and reduction of PE/eclampsia rate. Also in obese women there is a dysfunction of the l -arginine-NO pathway that causes a decrease of endothelial-dependent vasodilatation. In these women a l -arginine supplement could be helpful. Conclusion Aspirin proven to be of some help provided dose and timing are adequate. Impact on PE is limited, and its use is better in high-risk. Calcium supply could be helpful in population with low dietary intake. l -Arginine supplementation is worth to receive the same attention aspirin had also considering that biological activity seems wider. Actual evidences are more robust than the ones that allows wasting time and money for Vitamins C and E.

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Objective To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia.Design...

Selenium and Preeclampsia: a Systematic Review and Meta-analysis.

Conflicting results exist between selenium concentration and preeclampsia. The role of selenium in the development of preeclampsia is unclear. We conducted a meta-analysis to compare the blood selenium level in patients with preeclampsia and healthy pregnant women, and to determine the effectiveness of selenium supplementation in preventing preeclampsia. We searched PubMed, ScienceDirect, the Cochrane Library, and relevant references for English language literature up to November 25, 2014. Mean difference from observational studies and relative risk from randomized controlled trials were meta-analyzed by a random-effect model. Thirteen observational studies with 1515 participants and 3 randomized controlled trials with 439 participants were included in the meta-analysis. Using a random-effect model, a statistically significant difference in blood selenium concentration of -6.47μg/l (95% confidence interval (CI) -11.24 to -1.7, p=0.008) was seen after comparing the mean difference of observational studies. In randomized controlled trials, using a random-effect model, the relative risk for preeclampsia was 0.28 (0.09 to 0.84) for selenium supplementation (p=0.02). Evidence from observational studies indicates an inverse association of blood selenium level and the risk of preeclampsia. Supplementation with selenium significantly reduces the incidence of preeclampsia. However, more prospective clinical trials are required to assess the association between selenium supplementation and preeclampsia and to determine the dose, beginning time, and duration of selenium supplementation.

Trends in the incidence of pre-eclampsia and eclampsia in Taiwan between 1998 and 2010

ObjectiveThe aim of our study was to determine the relationship between age and the incidence of pre-eclampsia and eclampsia. Materials and MethodsWe analyzed data collected by the National Health Insurance Bureau between 1998 and 2010. Data were obtained from the Taiwanese Department of Health website and the Department of Internal Affairs. ResultsThe incidence of pre-eclampsia increased significantly (from 0.87% to 1.21%), but the incidence of eclampsia did not change significantly (from 0.04% to 0.05%) between 1998 and 2010. The incidence of pre-eclampsia in the 20–24-year age group was 0.60 ± 0.09%. The relative risk of pre-eclampsia in the different age groups was as follows: aged <20 years, 1.02-fold (p = 1.0); 25–29 years, 1.35-fold (p = 0.041); 30–34 years, 1.79-fold (p < 0.001); 35–39 years, 2.99-fold (p < 0.001); and ≥40 years, 5.13-fold (p < 0.001). The incidence of eclampsia in the 20–24-year age group was 0.04 ± 0.01%. The incidence of eclampsia in only the ≥40-years age group significantly increased by 2.49-fold (p = 0.001). ConclusionThe incidence of pre-eclampsia was correlated with maternal age. The incidence of pre-eclampsia was the lowest in the 20–24-year age group and soared in the >35-year age groups.

Preeclampsia and preeclampsia superimposed on chronic hypertension in Buenos Aires

Preeclampsia and preeclampsia superimposed on chronic hypertension in Buenos Aires

Maternal Vitamin D Status and the Risk of Mild and Severe Preeclampsia

We sought to determine the association between maternal vitamin D status at ≤26 weeks' gestation and the risk of preeclampsia by clinical subtype. We conducted a case-cohort study among women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project. In serum collected at ≤26 weeks' gestation (median 20.9 weeks) from 717 women who later developed preeclampsia (560 mild and 157 severe cases) and from 2986 mothers without preeclampsia, we measured serum 25-hydroxyvitamin D, over 40 years later, using liquid chromatography-tandem mass spectrometry. Half of women in the subcohort had 25-hydroxyvitamin D (25(OH)D) >50 nmol/L. Maternal 25(OH)D 50 to 74.9 nmol/L was associated with a reduction in the absolute and relative risk of preeclampsia and mild preeclampsia compared with 25(OH)D <30 nmol/L in the crude analysis but not after adjustment for confounders, including race, prepregnancy body mass index, and parity. For severe preeclampsia, 25(OH)D ≥50 nmol/L was associated with a reduction in three cases per 1000 pregnancies (adjusted risk difference = -0.003 [95% confidence interval = -0.005 to 0.0002]) and a 40% reduction in risk (0.65 [0.43 to 0.98]) compared with 25(OH)D <50 nmol/L. Conclusions were unchanged (1) after restricting to women with 25(OH)D measured before 22 weeks' gestation or (2) with formal sensitivity analyses for unmeasured confounding. Maternal vitamin D deficiency may be a risk factor for severe preeclampsia but not for its mild subtypes. Contemporary cohorts with large numbers of severe preeclampsia cases would be needed to confirm or refute these findings.

Consumption of chocolate in pregnant women and risk of preeclampsia: a systematic review.

BackgroundPrevious studies have been limited in reporting the association between chocolate consumption, measured by interviewer-administered questionnaire or serum theobromine, a biomarker for cocoa, and risk of preeclampsia, and have showed somewhat conflicting results.Methods/DesignA systematic review of observational and experimental studies will be carried out. We will examine PubMed, Embase, and the entire Cochrane Library. Studies of chocolate consumption compared or not with placebo or low flavanol chocolate during pregnancy will be evaluated to investigate the effect of chocolate consumption in pregnant women on the risk of preeclampsia or pregnancy-induced hypertension. Screening for inclusion, data extraction, and quality assessment will be performed independently by two reviewers in consultation with a third reviewer. Validity of the studies will be ascertained by using the Cochrane Collaboration’s tool. Relative risk of preeclampsia will be the primary measure of treatment effect. Heterogeneity will be explored by subgroup analysis according to confounding factors and bias.DiscussionThis systematic review will contribute to establish the current state of knowledge concerning the possible association between chocolate consumption and prevention of preeclampsia. Furthermore, it will justify if additional experimental trials are necessary to better evaluate the benefits of chocolate consumption on the risk of preeclampsia.Trial registrationThis systematic review has been registered in the PROSPERO international prospective register of systematic reviews. The registration number is: CRD42013005338

Influence of Oral Calcium Intake During Pregnancy on Blood and Urine Calcium Levels of Newborns

Dear Editor, Pregnancy is a time of increased need for supplementations like calcium. This theory was already supported that maternal calcium supplements during pregnancy was found to bring about a remarkable increase in the density of all the bones in the neonates; this suggests the fact that increased calcium had been actively transferred to the fetus via the placenta (1). In recent years, use of calcium supplements during pregnancy, especially in the last trimester have been recommended to prevent disadvantages of calcium loss by mother and also providing sufficient calcium supplement for the fetus (2, 3). There is a theoretical concern that the excessive consumption of calcium supplements may induce hypocalcaemia in the fetus and neonate, that can be a cause of hypercalciuria, which may be followed by urinary calculi and nephrocalcinosis (4). Recently, we experienced noticeable incidence of hypercalciuria, nephrolithiasis and nephrocalcinosis in healthy newborns. In the present study we investigated the influence of mother’s calcium supplementation in generating hypocalcaemia and hypercalciuria in neonates that were born in hospitals of Yasuj University of medical sciences (south-west of Iran). Between September 2010 and June 2011, seventy pregnant women and their healthy full term newborns were recruited. Mothers were randomly divided into two groups of thirty-five cases while those with any systemic diseases such as diabetes, hypertension, renal or liver diseases, and those who had used medication that would affect calcium metabolism were excluded. The case group received 1000 mg calcium carbonate daily in the last month of pregnancy; the control group with similar conditions consumed their usual diet. At the time of delivery, cord blood was collected to check for total calcium. First urine, in healthy newborns was checked for Ca/Cr ratio by the cresolphthalein complexone spectrophotometric method and kinetic jaffe reaction, respectively (5). Automated analyzer (Hitachi™ 704) was used, and then urinary Ca/Cr (mg/mg) ratio was calculated. Quantitative values between the two groups were determined by Student t tests by SPSS® software (version 17.0, IBM®, USA). Results were reported as Mean ± standard deviation (SD). Values of P ≤ 0.05 were considered as statistically significant. Results demonstrated that average serum calcium in case group was 9.92 ± 1.07 mg/dl (normal level: 8.5-12 mg/dl) and in the control group was 10.05 ± 0.81 mg/dl (normal level: 8.5 - 12.5 mg/dl) which had insignificant difference (P = 0.565) (Table 1). Table 1. Average Serum Calcium (mg/dl; Mean ± SD) of Newborns With and Without Maternal Calcium Supplementation Calcium to creatinin ratio in case group was at a range of 0.05 to 0.21 with average of 0.11 ± 0.05. This ratio in control group was from 0.05 to 0.19 with average of 0.10 ± 0.036, respectively (P = 0.35) (Table 2). Table 2. Urinary Calcium to Creatinin Ratio (mg/mg; Mean ± SD) in Newborns With and Without Maternal Calcium Supplementation Calculated relative risk test of increasing serum calcium was 1.07 with confidence interval of 95%: (0.35, 2.12), and for calcium to creatinin ratio of serum was 1.03 with confidence interval of 95%: (0.21, 2.67). Maternal and fetal skeletal benefits of calcium supplementation, many other advantages have been linked to adequate calcium intake, such as reduced risk of pregnancy-induced hypertension and relative risk of preeclampsia, a decrease in maternal circulating lead, higher newborn weight and bone mineralization (6-9). Literature and clinical experiences declare the fact that investigations are still needed to prove the safety and to find out the possible disadvantages of maternal calcium supplementation in the neonates. Likely, as results of this study revealed, calcium supplementation had no significant impact in increasing the risk of hypercalciuria and hypocalcaemia occurrence in neonates. The present findings imply that percentage of neonates of case-group with normal calcium level was almost similar to control group and no one in both groups had low calcium level. Moreover, high calcium level proportion in both groups was not noticeably different. Percentage of Ca/Cr ratio within and higher than normal range in case group was not remarkably different from that of control group respectively; thus, this was not a causative factor of the recently observed hypercalciuria in our experiences.

Antidepressant use and gestational hypertension: does evidence support causality?

We read with interest the paper by De Vera and Berard [1] evaluating the association between antidepressant use during pregnancy and pregnancy-induced hypertension. While this study adds to a growing body of evidence surrounding such an association [2, 3], there are a number of issues that require further clarification before causation can be established. Firstly, there may be limitations in identifying outcomes according to International Classification of Diseases (ICD-9) codes. The authors cite one validation study, which reported positive predictive values of 93% for diagnostic codes for gestational hypertension with pre-eclampsia and 84% for gestational hypertension without pre-eclampsia [1]. This study was undertaken using deliveries recorded in the Swedish Medical Birth Register during 1987–1993. A more recent study also evaluated the accuracy of ICD-9 coding for pre-eclampsia, using data from births at a US hospital during 1999–2000, reporting a lower overall positive predictive value of 54% [4]. This ranged from 45.3% for cases of mild pre-eclampsia to 84.8%, for cases of severe pre-eclampsia. Low correlation between the disease and ICD-9 codes could lead to an underestimation of reported associations, assuming the degree of correlation is not associated with the underlying disease. Importantly, and of more serious concern, is the potential for differential misclassification of outcomes, because the direction and magnitude of the bias would largely be unknown. Such differential outcome misclassification could occur if there are differences in the recording of outcomes according to additional factors that are also associated with the use of antidepressants or are directly associated with the underlying disease. For example, women using antidepressants may be more likely to visit medical practitioners and subsequently more likely to be diagnosed with gestational hypertension. Secondly, it would be useful to have data on the type and severity of the gestational hypertension, including the proportion of women with pre-eclampsia. Toh et al. [3] previously identified a stronger association with prenatal selective serotonin reuptake inhibitor (SSRI) exposure and gestational hypertension with pre-eclampsia (3.91; 95% confidence interval 2.39–6.39) than with gestational hypertension without pre-eclampsia (1.61; 95% confidence interval 1.03–2.53). Whether the risk of pre-eclampsia differs from the risk of gestational hypertension without pre-eclampsia requires further clarification, but would be of clinical relevance in the management of this condition and women taking antidepressants during pregnancy. It would also contribute towards improving our understanding of the underlying mechanisms explaining associations with such outcomes. Importantly, the management of psychiatric illness during pregnancy is extremely complex; the degree of illness can only be approximated by the presence of a prior diagnosis of depression and/or anxiety and health care utilization (i.e. psychiatrist visits) prior to pregnancy. Therefore, while adjustment for these factors may account to some degree for confounding due to underlying maternal illness, the potential for residual confounding remains. Pregnant women who continue their antidepressant therapy throughout pregnancy may differ from those who stop prior to or during the first trimester. It is noted that within both groups of cases and controls, only 32 women (7.7%) of 414 continued their antidepressant beyond the first trimester (12 weeks). Palmsten et al. [2] recently demonstrated that within prepregnancy antidepressant users, the relative risk for pre-eclampsia among continuers compared with discontinuers was 1.32 (95% confidence interval 0.95–1.84) for SSRIs 3.43 (95% confidence interval 1.77–6.65) for serotonin–norepinephrine reuptake inhibitors (SNRIs) and 3.26 (95% confidence interval 1.04–10.24) for tricyclic antidepressant (TCA) monotherapy. These findings either point to a direct effect of antidepressant exposure during the second/third trimester on the risks of gestational hypertension, which is in line with the proposed biological mechanism reported [1–3], or they are reflective of differences in underlying disease pathology between continuers and discontinuers and therefore the potential for confounding by maternal illness. We feel that given the above and, in particular, due to the difficulties involved in differentiating the underlying effects of maternal depression from that of antidepressant use, current evidence should be viewed cautiously and that it is premature to use this evidence to guide obstetric management of women with depression during pregnancy. It is important to stress the significance of adequately treating maternal psychiatric illness during pregnancy, because this may not only play an important role in the pathogenesis of gestational hypertension, but may also be associated with a range of harmful effects on maternal and offspring health.

Maternal sugar consumption and risk of preeclampsia in nulliparous Norwegian women

Dietary factors have been hypothesized to influence the risk of preeclampsia. The aim of this study was to investigate the association between maternal intake of sugar and foods with a high content of added or natural sugars and preeclampsia. A prospective study of 32,933 nulliparous women in the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health. Participants answered a general health questionnaire and a validated food frequency questionnaire during pregnancy. Information about preeclampsia was obtained from the Medical Birth Registry of Norway. The relative risk of preeclampsia was estimated as odds ratios (OR) and 95% confidence intervals (CIs) and adjusted for known confounders. The intake of added sugar was higher in women who developed preeclampsia than in healthy women in the unadjusted analysis, but not in the adjusted model. Of food items with a high content of added sugar, sugar-sweetened carbonated and non-carbonated beverages were significantly associated with increased risk of preeclampsia, both independently and combined, with OR for the combined beverages 1.27 (95% CIs: 1.05, 1.54) for high intake (> = 125 ml/day) compared with no intake. Contrary to this, intakes of foods high in natural sugars, such as fresh and dried fruits, were associated with decreased risk of preeclampsia. These results suggest that foods with a high content of added sugar and foods with naturally occurring sugars are differently associated with preeclampsia. The findings support the overall dietary advice to include fruits and reduce the intake of sugar-sweetened beverages during pregnancy.

Elevated Risk of Preeclampsia in Pregnant Women With Depression: Depression or Antidepressants?

A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997-2006), the authors conducted a study of 69,448 pregnancies in women with depression. They compared risk of preeclampsia in women using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) between gestational weeks 10 and 20 with risk in depressed women not using antidepressants. Among prepregnancy antidepressant users, the authors compared the risk in women who continued antidepressants between gestational weeks 10 and 24 with the risk in those who discontinued. Relative risks and 95% confidence intervals were estimated. The risk of preeclampsia in depressed women not treated with antidepressants (2.4%) was similar to that in women without depression (2.3%). Compared with women with untreated depression, women treated with SSRI, SNRI, and TCA monotherapy had adjusted relative risks of 1.22 (95% confidence interval (CI): 0.97, 1.54), 1.95 (95% CI: 1.25, 3.03), and 3.23 (95% CI: 1.87, 5.59), respectively. Within prepregnancy antidepressant users, the relative risk for preeclampsia among continuers compared with discontinuers was 1.32 (95% CI: 0.95, 1.84) for SSRI, 3.43 (95% CI: 1.77, 6.65) for SNRI, and 3.26 (95% CI: 1.04, 10.24) for TCA monotherapy. Study results suggest that women who use antidepressants during pregnancy, especially SNRIs and TCAs, have an elevated risk of preeclampsia. These associations may reflect drug effects or more severe depression.

Prepregnancy obesity and the risk of gestational diabetes mellitus

BackgroundPrepregnancy obesity is associated with increased risk for adverse pregnancy outcome such as gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, fetal macrosomia and the need for cesarean delivery. The objectives of this study assessed whether Thai women classified as obese according to WHO's recommended body mass index (BMI) for Asians were at risk for developing gestational diabetes mellitus (GDM) and other complications such as preeclampsia, gestational hypertension and fetal macrosomia.MethodsTwo hundred and forty women participated in this study and followed prospectively until delivery. Half of the women (n = 120) were obese (BMI ≥ 27.5 kg/m2) and the other half (n = 120) had normal weight (BMI > 18.5-23 kg/m2). Maternal demographic data, obstetric and neonatal outcomes from both groups were compared to each other. Relative risk and 95% confidence interval (CI) were calculated.ResultsCompared to normal weight women, obese Thai women were not at increased risk for gestational diabetes mellitus (RR = 0.9 [95% CI 0.6-1.4]). Relative risk of preeclampsia and fetal macrosomia in obese women were 0.7 [95% CI 0.2-3.3] and 1.4 [95% CI 0.5-4.3], respectively. Relative risk of gestational hypertension in obese women was 12 [95% CI 1.6-90.8].ConclusionWhen WHO's classification of obesity was used for Asian populations, prepregnancy obesity without metabolic problems did not increase the risk for GDM, preeclampsia and fetal macrosomia in Thai women. But, prepregnancy obesity continued to increase the risk for developing gestational hypertension.

Relationship Between Maternal Obesity And Increased Risk Of Preeclampsia

Introduction: The incidence of obesity has risen over the past several decades and in spite of advancement in modern medicine, it remains a risk factor for maternal morbidity and mortality. Objective: To determine the association between obesity (increased body mass index) and increased risk of preeclampsia. The possible role of serum leptin was also evaluated. Methods: 250 pregnant women were included in this study. They were selected according to their BMI at 20 weeks of gestation and allocated into 5 study groups (each n= 50). At 20 weeks of gestation, BMI, mean arterial blood pressure was calculated. Proteinuria, serum uric acid and leptin were measured. At 28 weeks of gestation reevaluation of BMI, mean arterial blood pressure and serum uric acid were done. While serum leptin estimation was only reevaluated on the 37 weeks. Cases of preeclampsia were diagnosed and classified either mild or severe. Results: It was found that preeclampsia was diagnosed in 20 cases. Among them 12 cases were diagnosed as mild preeclampsia in group A , 2 cases ( 4% of normal BMI) , 2 cases in group C ( 4% of obese class 1 ) , 6 cases in group D ( 12 % of obese class 11 ) and 2 cases in group E ( 4 % of obese class 111). Severe preeclampsia was diagnosed in 4 cases of group C ( 8 % of obese class 1 ) , 2 cases of group D ( 4% of obese class 11 ) and 2 cases of group E ( 4 % of obese class 111 ) . The relative risk of preeclampsia in cases of increased BMI was 2.25. The cases that developed preeclampsia had statistically significant elevated serum uric acid when compared to the normotensive cases at 28 and 37 weeks of gestation. Serum leptin level increased significantly with the increase in BMI and preeclamptic cases had statistically significant higher mean serum leptin at 28 and 37 weeks than normotensive cases. Conclusion: Maternal obesity is associated with a higher risk of adverse maternal and perinatal outcomes including preeclampsia.The dyslipidemia and the exaggerated inflammatory response associated with maternal obesity are thought to contribute to widespread endothelial dysfunction and the subsequent maternal syndrome in preeclampsia. Obesity is associated with higher mean serum leptin level. The levels of serum leptin are significantly higher in pre-eclampsia when compared to normotensive pregnant women and may contribute to endothelial dysfunction involved in the pathogenesis of preeclampsia. Keywords: preeclampsia –maternal obesity

Ethnic Differences in the Monthly Variation of Preeclampsia Among Bedouin and Jewish Parturients in the Negev

Objective. To assess seasonal patterns and monthly variations in the incidence of preeclampsia in the Jewish and Bedouin population in Israel, assuming that ethnicity and environmental factors may have a role in the causal mechanism. Methods. A retrospective population-based study comparing all singleton pregnancies of patients with and without preeclampsia was performed. The study included all deliveries between and including 1988 and 2007. For each month, the percentage of births complicated by preeclampsia was calculated. The relative risks of preeclampsia by month of delivery were estimated as odds ratios, using the month of August as the reference category. Results. During the study period, 203,461 deliveries took place, of which 8,421 (4.1%) were complicated with preeclampsia (either mild or severe). Significantly higher incidence of preeclampsia was demonstrated in the Jewish population: 4.7% (n = 4,783 deliveries) versus 3.6% in the Bedouin population (n = 3,683), (p < 0.001). A similar U shaped trend in the incidence of preeclampsia was noted in both populations: the incidence was highest in the winter months and reached its nadir in August, with subsequent increase through the fall months (p < 0.001). Using August as the reference month, odds ratios were 1.32 (95% CI 1.19–1.48) for January, 1.38 (95% CI 1.24–1.54) for February and 1.33 (95% CI 1.19–1.48) for March. Time series analysis demonstrated a difference in the behavior of the 2 populations. Whereas the Jewish population had demonstrated a Gregorian-month cycle, the Bedouin population had demonstrated a lunar-month cycle. Conclusion. Preeclampsia is significantly more common in the Jewish population. However, both populations demonstrate the same seasonal pattern, with higher incidence of preeclampsia in the winter months. Our findings suggest that climate and environmental exposure may have an important role in the pathophysiology of preeclampsia.