Risk Of Hypertension In Pregnancy Research Articles

Preconception diet in adolescence and its association with hypertensive disorders of pregnancy and preterm birth. Results from the HUNT study.

Our aim was to estimate associations of adolescent dietary patterns and meal habits with hypertensive disorders of pregnancy (HDP) and preterm birth. We used data from a prospective cohort study (Norwegian Young-HUNT1) where dietary information was collected during adolescence and pregnancy outcomes were obtained through record linkage to the Norwegian national birth registry. The outcomes were HDP, hypertension, pre-eclampsia/eclampsia, and preterm birth in the first pregnancy and in any pregnancy. Diet was self-reported from validated questionnaires, and exposures were dietary indexes (healthy; unhealthy; fruit and vegetable; fibre index) and meal habits. Recruitment took place in schools. Eligible participants were females aged 13-19 years at the time of dietary assessment with a subsequent singleton pregnancy (n 3622). Women who reported a higher fibre intake in adolescence had a lower risk of pre-eclampsia in the first pregnancy (Relative Risk: 0·84; 95 % CI 0·7, 1·0), although this was weaker in sensitivity analyses. Regular meal habits in mid-adolescence (aged 13-15 years), particularly breakfast and lunch, were weakly associated with a lower risk of hypertension in pregnancy. Our results are the first to indicate an association between aspects of diet and dietary behaviour in mid-adolescence and subsequent HDP. More evidence is needed from larger studies to replicate the results and from alternative study designs to disentangle causality.

Pregnancy Complications and Impact on Kidney Allograft After Kidney Transplantation in IgA Nephropathy.

Pregnancy in kidney transplantation (KT) recipients has been challenging because of the high risk of maternal, fetal, and renal complications. Although patients with immunoglobulin A nephropathy (IgAN)-chronic kidney disease (CKD) are at a high risk for hypertension in pregnancy (HIP), the maternal risk in KT recipients with IgAN as the etiology remains unclear. We retrospectively reviewed the medical records of pregnant KT recipients who delivered at our hospital. The incidence of maternal and fetal complications and the impact on kidney allografts between the group with IgAN as the primary kidney disease and the group with other primary diseases were compared. The analysis included 73 pregnancies in 64KT recipients. The IgAN group had a higher incidence of HIP than the non-IgAN group (69% vs. 40%, p = 0.02). IgAN as primary kidney disease and interval from transplantation to conception were associated with HIP (OR 3.33 [1.11-9.92], p = 0.03, OR 0.83 [0.72-0.96], p < 0.01, respectively). The 20-year graft survival or prevention of CKD stage 5 in group with IgAN was lower than that in the group with other primary disease (p < 0.01). KT recipients should be informed of the risk of HIP and possibility of long-term worsening of postpartum renal function.

Childhood obesity and hypertension in pregnancy: a two-sample Mendelian randomization analysis.

The causal relationship between childhood obesity and hypertension in pregnancy remains unclear. To examine the causal association between childhood obesity and hypertension in pregnancy, two-sample Mendelian randomization analysis was applied. Single-nucleotide polymorphisms (SNPs) associated with childhood obesity were obtained from a published genome-wide association study (GWAS) of 13 848 European individuals. Summary-level data for hypertension in pregnancy were obtained from the FinnGen consortium (11534 cases and 162212 controls). Inverse-variance weighted analysis, weighted-median analysis, and Mendelian randomization-Egger regression were conducted in this Mendelian randomization analysis. Sensitivity analyses were conducted to confirm the accuracy and robustness of our results. Genetically determined childhood obesity significantly affects hypertension in pregnancy by IVW [odds ratio (OR) = 1.161, 95% confidence interval (CI) 1.086-1.039; P = 9.92 × 10 -6 ] and weighted median (OR = 1.123, 95% CI 1.038-1.214; P = 0.004). These results were validated by multiple sensitivity analyses. A causal effect between genetically predicted childhood obesity and the risk of hypertension in pregnancy was identified. The prevention of hypertension in pregnancy should be promoted in populations with childhood obesity.

Lifestyle and the hypertensive disorders of pregnancy in nulliparous women in the United States: a secondary data analysis of the nuMom2b

BackgroundHypertensive disorders of pregnancy are a leading cause of maternal and fetal morbidity and mortality and a significant risk factor for future cardiovascular disease development in women. This study aimed to explore lifestyle wellness-related variables and how they impact the risk of hypertension in pregnancy.MethodsThis is a secondary analysis of data from the prospective cohort study Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b). Data was collected through questionnaires, clinical evaluations, and medical records review at 8 academic medical centers in the United States. Four study visits were scheduled throughout the participant’s pregnancy (visits one–four): 60–136, 160–216, and 220–296 weeks gestation and birth. A series of statistical modeling and logistical regression were performed using 15 lifestyle variables related to sleep, nutrition, resilience, illness avoidance, and physical activity were selected as predictor variables with an outcome variable of hypertension.ResultsOf 9289 nulliparous participants considered for inclusion in our analyses, 1464 had any HDP during study participation, and 554 participants had complete data available for the study and were included in our final sample. Results were statistically significant at a level of p < 0.05. Of the sleep variables, snoring at visit 1 increased the risk of hypertension in pregnancy. Greater vegetable consumption reported at visit one decreased risks of hypertension in pregnancy. Physical activity reported at visit two and visit three were associated with decreased risk of hypertension. Physical activity reported at visit three combined with more hours of sleep each night, or through napping habit reported at visit one decreased hypertension risk. Increased fish oil consumption combined with more hours of sleep at visit one increased odds of hypertension in pregnancy.ConclusionsOur results support that lifestyle wellness-related variables relating to sleep, physical activity and nutrition affect hypertension in pregnancy. The studied variables and others should be considered in future research and intervention development to reduce hypertension in pregnancy and improve maternal wellness.

Riboflavin deficiency is associated with an increased risk of hypertension in pregnancy

Riboflavin deficiency is associated with an increased risk of hypertension in pregnancy

Anemia and adverse outcomes in pregnancy: subgroup analysis of the CLIP cluster-randomized trial in India

BackgroundIron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied.MethodsThe study population was derived from the Community Level Interventions for Pre-eclampsia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb < 11.0 g/dL), moderate (7.0 g/dL ≤ Hb < 10.0 g/dL) and severe (Hb < 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding.ResultsOf 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women (> 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-eclampsia specifically, with the lowest risk seen among those with mild or moderate anemia.ConclusionIn Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preeclampsia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.

Preconception Blood Pressure and Its Change Into Early Pregnancy: Early Risk Factors for Preeclampsia and Gestational Hypertension.

Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3±6.7 mm Hg mean arterial pressure), term preeclampsia (88.3±9.8 mm Hg), and gestational hypertension (87.9±9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9±8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.

Aldosterone in Gynecology and Its Involvement on the Risk of Hypertension in Pregnancy.

Aldosterone is the main mineralocorticoid hormone, responsible of the regulation of fluid and electrolyte balance and blood pressure. It acts also as a pro-inflammatory factor responsible of an increased cardiovascular risk, independent from blood pressure values. After the discovery of mineralocorticoid receptor (MR) in mononuclear leukocytes, further studies supported its role in inflammatory and even autoimmune mechanisms underlying several diseases. In particular, recent studies reported a possible involvement of aldosterone in some gynecological conditions and diseases, characterized by inflammation, hypertension and increased cardio-metabolic risk, such as use of hormonal contraceptives, preeclampsia, polycystic ovary syndrome, uterine fibroids, and endometriosis. The aim of this mini-review is to report the possible involvement of aldosterone in all these gynecological conditions, suggesting different pathogenetic mechanisms and new target treatments of MR blockers for these diseases.

Analysis of Maternal Mortality Due to Hypertension in Pregnancy in West Bandung

Hypertension in pregnancy is one of causes in maternal mortality in West Bandung District in 2017 and there are 11 mothers (39.28%) of 28 mortality cases, which is in the highest rank. Moreover, this research aimed at analyzing maternal mortality due to hypertension in pregnancy in West Bandung District. This research was qualitative research by utilizing grounded theory approach with constructivism paradigm. Sample of this research was the closest family and health personnels who knew the cronology of maternal mortality and there were 21 people from 8 mortality cases. The sample collection utilized purposive sampling technique. Meanwhile, the instruments of this research were researchers, interview guidance, stationery, and voice recorder. Validity test utilized triangulation technique. Technique of data collection was by in depth interview and the analysis process were by transcription, reduction, coding, categorization, and theme. The result of this research was known that factors, which had contribution against maternal mortality, was such as poor access of health service and it was caused by several things: PONED function that had not been optimal in handling hypertension in pregnancy, poor quality of health service, guidance in handling hypertension in pregnancy that had not been optimal, less optimal information from health service, health personnel’s poor knowledge about hypertension in pregnancy, and delay in referring to hospital. The next factor was unhealthy living behavior, such as mother who had risk of hypertension in pregnancy did not use long-term contraception, underwent quite high failure level in the use of long-term contraception, the mother was a missing patient from the referral, and not sensitive against emergency situation. Besides that, unknown or unexpected factors also became contribution against mortality, such as unclear demographic status; undesirable pregnancy; assuming that dying in pregnancy, having birth, and in postpartum period was martyred. In conclusion, factors that contributed against maternal mortality due to hypertension in pregnancy in West Bandung District were access of health service, healthy living behavior, and unknown even unexpected factors. However, the factors that really impacted against maternal mortality were access of health service and healthy living behavior. &#x0D; &#x0D; Keywords: Maternal mortality, Hypertension in pregnancy

Does Secondary Smoking and Posyandu Affect the Risk of Hypertension in Pregnancy? Multilevel Evidence from Magelang, Central Java

Background : Pregnancy hypertension was a complication of pregnancy which became one of the causes of maternal and perinatal morbidity and mortality in the world. This study aimed to determine the effect of individual and contextual factors of integrated health post (posyandu) on hypertension in pregnancy. Subjects and Method: A case control study was conducted in 5 posyandus in Magelang, Central Java, from April to May 2019. A sample of 210 women was selected by simple random sampling. The dependent variable was hypertension in pregnancy. The independent variables were age, parity, nutritional status, family history of hypertension, history of hypertension before pregnancy, history of hormonal contraceptive, and exposure to cigarette smoke. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression. Results: Hypertension in pregnancy increased with age 35 years old (b= 2.10; 95% CI= 0.16 to 4.04; p= 0.033), parity (b= -3.81; 95% CI = - 6.31 to -1.32; p = 0.003), nutritional status (b= 3.35; 95% CI= 1.36 to 5.33; p= 0.001), family hypertension history (b= 3.35; 95% CI= 1.33 to 5.37; p= 0.001), hypertension history before pregnancy (b= 2.46; 95% CI= 1.1 to 3.81; p 35 years old, parity, nutritional status, family hypertension history, hypertension history before pregnancy, hormonal contraceptive history, and cigarette smoke exposure. Posyandu has negligible contextual effect on hypertension in pregnancy. Keywords : Hypertension, pregnancy, cigarette smoke, multilevel analysis Correspondence : Erin Rizkiana, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: erinrizkiana777@gmail.com. Mobile: 085729883106 Journal of Epidemiology and Public Health (2019), 4(3): 247-258 https://doi.org/10.26911/jepublichealth.2019.04.03.12

Maternal and fetal outcome in gestational diabetic women

Background and objective: Gestational diabetes mellitus affects 7% of all pregnancies. It is defined as glucose intolerance that begins or is first diagnosed during pregnancy. It is crucial to detect women with gestational diabetes mellitus because the condition can be associated with several maternal and fetal complications. This study aimed to determine the maternal and fetal outcome of gestational diabetes mellitus in maternity teaching hospital in Sulaimani city, Kurdistan, Iraq. Methods: This prospective observational study had involved 100 pregnant women with gestational diabetes mellitus. Data were collected from 1st January 2014 to 1st July 2014. Results: Most women were in the age group 30-39 years (57%) and were multigravida (75%). Regarding women’s BMI, 69% of women had a BMI of >30 kg/m2. Most of the women delivered by cesarean section (68%). Also, 63% delivered term baby ≥ 37weeks. Of the women who used insulin, 30.6% delivered babies >4 kg. Complications occurred in 10%, 12.9%, and 11.1% of women who treated by diet, insulin, and the group used metformin then insulin, respectively. Conclusion: The results conclude that pregnant women with gestational diabetes mellitus have increased the risk of hypertension in pregnancy, preterm delivery, and cesarean section. Increasing age, family history of diabetes, increasing parity, and increase in BMI are a risk factor for developing gestational diabetes mellitus. Also, most of the maternal complications occurred in those women who were on metformin. The occurrence of macrosomia was low in the treated cases of gestational diabetes mellitus.

Environmental Noise Pollution and Risk of Hypertension in Pregnancy

Background: A growing number of studies suggest that environmental noise pollution may impact the risk of hypertension, but the relationship during pregnancy is poorly understood. We investigated the association between environmental noise levels and preeclampsia, a hypertensive disorder of pregnancy.Methods: We undertook a retrospective cohort study of 269,263 pregnancies in Montreal, 2000-2013. Using postal codes, we assigned environmental noise pollution levels (dBA) from land use regression models to each pregnancy. We calculated odds ratios (OR) and 95% confidence intervals (CI) for the association of environmental noise with preeclampsia, adjusted for air pollutants, neighbourhood walkability, maternal age, parity, multiple pregnancy, comorbidity, socioeconomic deprivation, and year of delivery. We assessed if associations varied according to preeclampsia severity (mild and severe) and onset time (&amp;lt;34 and &amp;#8805;34 weeks of gestation).Results: Women exposed to elevated environmental noise levels (&amp;#8805;65 vs. &amp;lt;50 dBA) had a higher prevalence of preeclampsia (37.9 vs. 27.9 per 1,000). Compared with 50 dBA, exposure to a noise level of 65 dBA was associated with 1.09 times the odds of preeclampsia (95% CI 0.99-1.20). Associations were stronger for severe preeclampsia (OR 1.29, 95% CI 1.09-1.54) and preeclampsia before 34 gestational weeks (OR 1.71, 95% CI 1.20-2.43). There was no association with mild preeclampsia and preeclampsia at &amp;#8805;34 weeks.Conclusion: Environmental noise pollution may be a risk factor for preeclampsia, particularly severe or early onset preeclampsia. In light of rising levels of urban noise, these results suggest that vulnerable populations, including pregnant women, could benefit from residential noise reduction policies.

Hypertensive complications of pregnancy: A clinical overview

Hypertensive disorders in pregnancy are a worldwide health problem for women and their infants complicating up to 10% of pregnancies and associated with increased maternal and neonatal morbidity and mortality. In Europe, 2.3–3% of pregnancies are complicated by preeclampsia. Gestational diabetes, obesity, no previous or multiple births, maternal age less than 20 or greater than 35years old and thrombophilia can be some of the possible factors related to increased risk for hypertension in pregnancy. Complications of hypertension during pregnancy affect both mothers and their infants. Ambulatory blood pressure monitoring helps to distinguish true hypertension from the white coat as pregnant women with office abnormal values may have normal out of office blood pressure. Imbalance between proangiogenic and antiangiogenic factors in placenta may lead to endothelial dysfunction, vasoconstriction, activation of the coagulation system, and hemolysis. Carotid intima-media thickness, pulse wave velocity, augmentation index, and arterial wall tension were found to be significantly increased in women with preeclampsia compared to normotensive pregnant women. Uterine artery Doppler and serum biomarkers can be used to evaluate the probability of hypertension and complications during pregnancy, but further research in the field is needed. Lately, micro ribonucleic acids have also been the focus of research as potential biomarkers.

Nitric oxide synthase-mediated blood pressure regulation in obese melanocortin-4 receptor-deficient pregnant rats.

Although obesity increases the risk for hypertension in pregnancy, the mechanisms responsible are unknown. Increased nitric oxide (NO) production results in vasodilation and reduced blood pressure during normal pregnancy in lean rats; however, the role of NO is less clear during obese pregnancies. We examined the impact of obesity on NO synthase (NOS)-mediated regulation of blood pressure during pregnancy by testing the hypothesis that NOS activity, expression, and regulation of vascular tone and blood pressure are reduced in obese pregnant rats. At gestational day 19, melanocortin-4 receptor (MC4R)-deficient obese rats (MC4R) had greater body weight and fat mass with elevated blood pressure and circulating sFlt-1 levels compared with MC4R pregnant rats. MC4R pregnant rats also had less circulating cGMP levels and reduced total NOS enzymatic activity and expression in mesenteric arteries. Despite decreased biochemical measures of NO/NOS in MC4R rats, NOS inhibition enhanced vasoconstriction only in mesenteric arteries from MC4R rats, suggesting greater NOS-mediated tone. To examine the role of NOS on blood pressure regulation in obese pregnant rats, MC4R and MC4R pregnant rats were administered the nonselective NOS inhibitor NG-nitro-l-arginine methyl ester (l-NAME, 100 mg/l) from gestational day 14 to 19 in drinking water. The degree by which l-NAME raised blood pressure was similar between obese and lean pregnant rats. Although MC4R obese pregnant rats had elevated blood pressure associated with reduced total NOS activity and expression, they had enhanced NOS-mediated attenuation of vasoconstriction, with no evidence of alterations in NOS-mediated regulation of blood pressure.

Consanguinity and associated perinatal outcomes, including stillbirth

Consanguinity defined as the sexual union between two related individuals has been previously an infrequent practice in Australia, but recently there has been migration from countries with widespread practice of consanguinity. There is limited and conflicting evidence in the literature that suggests consanguinity to be associated with adverse obstetric outcomes. To assess the effect of consanguinity on perinatal outcomes. A retrospective analysis of singleton births over a ten-year period at an Australian tertiary hospital. The data were extracted from the hospital obstetric database and analysed for an association between consanguinity and perinatal outcomes, including stillbirth. Main outcome measures were stillbirth, threatened premature labour, fetal congenital abnormality, perinatal mortality and neonatal outcomes. There were 46 399 singleton births recorded over the ten-year study period, and 44 004 had consanguinity data available. The overall consanguinity rate was 5.5% (n = 2565), which remained consistent over the study period at our institution. Consanguinity was associated with higher rate of threatened premature labour (5.6% vs 4.7%, P = 0.003), fetal congenital abnormality (4.2% vs 3.1%, P = 0.004), perinatal mortality (2.4% vs 1.0%, P < 0.001) and reduced risk of hypertension in pregnancy (5.3% vs 3.4%, P < 0.001). Consanguinity was an independent risk factor for stillbirth with a relative risk of 2.88 (P < 0.001, 95% CI 1.98, 4.18). Women from consanguineous relationships are at higher risk of adverse perinatal outcomes, including stillbirth. Given the 5% prevalence of consanguinity in our obstetric population, these findings have significant implications for preconception counselling, obstetric care and health resource allocation.

DESIGN AN “IN HOUSE” SOFTWARE FOR SCREENING PREECLAMPSIA BY MATERNAL FACTORS AND MEAN ARTERIAL PRESSURE AT 11 – 13 WEEKS IN COMMUNE HEALTH CENTERS.

Objective: Design an “in house” software for screening preeclampsia by maternal factors and mean arterial pressure at 11 – 13 gestational weeks in commune health centers. Methods: Based on the algorithms for calculating the risk of preeclampsia (PE) by maternal factors and mean artirial pressure at 11 - 13 gestational weeks in the study results of the authors, an “in house” software was deigned in Excel. The results of prediction preeclampsia by The Fetal Medicine Foundation (FMF)(version 2.3) were compared with the results by “in house” software in 1110 singleton pregnant women. Results: The “in house” software met the requirements for calculating the risks of PE and save data. FMF risk for gestational hypertension disorder in pregnancy by maternal factors, mean arterial pressure,uterine artery Doppler and PAPP-A has an area under the curve of 0.68 (95%CI: 0.59 – 0.78). The “in house” software risk for gestational hypertension in pregnancy by maternal factors, mean arterial pressure has an area under the curve of 0.643 (0.55 – 0.73) There was no statistically significant different between two programs (p:0.52). The risk cut-off 1:50 in the prediction of gestational hypertension of the “in house” software was used to identify the group of high risk with detetion rate (DR) 28.6% (95%CI: 14.9-42.2) comparing to 40.5% (95%CI:25.6-55.3) of FMF. Conclusion: The FMF version 2.3 is better but in the absence of Doppler ultrasound and PAPP-A test in the commune health cares, the “in house” software for screening PE is a good tool for councelling, following up and early intervention for PE.

Calcium supplementation reducing the risk of hypertensive disorders of pregnancy and related problems: A meta-analysis of multicentre randomized controlled trials.

Hypertensive disorders of pregnancy are closely related to maternal mortality and morbidity. Calcium supplementation during pregnancy seems to reduce the risk of hypertensive disorders. No systematic review on multicentre RCTs of calcium supplementation during pregnancy has been published. The purpose of this study was to report a quantitative systematic review of the effectiveness of calcium supplementation during pregnancy on reducing the risk of hypertensive disorders of pregnancy and related problems. Publications over the years of 1991-2012 were searched through PubMed, Science Direct, EMBASE, CINAHL and Web of Science. The literatures were selected of the multicentre RCTs on calcium supplementation during pregnancy in prevention of hypertensive disorders and related problems. Reference lists from the studies were also examined for additional references. Studies were critically appraised by three independent reviewers, and the Cochrane Handbook was used to assess the quality of those included trials. Four studies were included in this systematic review. All included studies were high quality, with low risk of bias. There was an observed risk reduction in hypertension in calcium group. However, there was no reduction in the risk of severe gestational hypertension, pre-eclampsia, severe pre-eclampsia, preterm birth and low birthweight. Calcium supplementation appears to reduce the risk of hypertension in pregnancy.

Hypertension in pregnancy after Escherichia coli O157:H7 gastroenteritis: a cohort study

Background. Escherichia coli O157:H7 is a common cause of bacterial gastroenteritis and may increase the risk of hypertension. We studied the risk of hypertension in pregnancy following a large E. coli O157:H7 outbreak that occurred in Walkerton, Canada, in the year 2000. Methods: We linked data collected from Walkerton residents to provincial healthcare databases. We studied the pregnancies of three groups of women: two groups from Walkerton (those with and without acute gastroenteritis during outbreak) and a third group from neighboring rural communities unaffected by the outbreak. The primary outcome was a composite of gestational hypertension or preeclampsia. Secondary outcomes were gestational hypertension and preeclampsia examined separately. Results: The median time to pregnancy after cohort entry was five years. The composite outcome was not significantly higher among women with gastroenteritis during the outbreak compared with residents of neighboring communities (8 of 117 (6.8%) versus 96 of 2166 (4.4%) pregnancies, respectively; adjusted relative risk 1.5 (95% confidence interval (CI) 0.8 to 3.2)). When examined separately the risk of preeclampsia was significantly higher among women with gastroenteritis (4 of 117 (3.4%) versus 17 of 2166 (0.8%) pregnancies; adjusted relative risk 3.8 (95% CI 1.3 to 11.6)). However, the risk of preeclampsia was lower than expected in the referent group and overall there were a small number of events in all the groups. Conclusion: There was no significant association between E. coli O157:H7 gastroenteritis and our primary assessment of hypertension in pregnancy.

Pre-pregnancy predictors of hypertension in pregnancy among Aboriginal and Torres Strait Islander women in north Queensland, Australia; a prospective cohort study

BackgroundCompared to other Australian women, Indigenous women are frequently at greater risk for hypertensive disorders of pregnancy. We examined pre-pregnancy factors that may predict hypertension in pregnancy in a cohort of Aboriginal and Torres Strait Islander women in north Queensland.MethodsData on a cohort of 1009 Indigenous women of childbearing age (15–44 years) who participated in a 1998–2000 health screening program in north Queensland were combined with 1998–2008 Queensland hospitalisations data using probabilistic data linkage. Data on the women in the cohort who were hospitalised for birth (n = 220) were further combined with Queensland perinatal data which identified those diagnosed with hypertension in pregnancy.ResultsOf 220 women who gave birth, 22 had hypertension in the pregnancy after their health check. The mean age of women with and without hypertension was similar (23.7 years and 23.9 years respectively) however Aboriginal women were more affected compared to Torres Strait Islanders. Pre-pregnancy adiposity and elevated blood pressure at the health screening program were predictors of a pregnancy affected by hypertension. After adjusting for age and ethnicity, each 1 cm increase in waist circumference showed a 4% increased risk for hypertension in pregnancy (PR 1.04; 95% CI; 1.02-1.06); each 1 point increase in BMI showed a 9% adjusted increase in risk (1.09; 1.04-1.14). For each 1 mmHg increase in baseline systolic blood pressure there was an age and ethnicity adjusted 6% increase in risk and each 1 mmHg increase in diastolic blood pressure showed a 7% increase in risk (1.06; 1.03-1.09 and 1.07; 1.03-1.11 respectively). Among those free of diabetes at baseline, the presence of the metabolic syndrome (International Diabetes Federation criteria) predicted over a three-fold increase in age-ethnicity-adjusted risk (3.5; 1.50-8.17).ConclusionsPre-pregnancy adiposity and features of the metabolic syndrome among these young Aboriginal and Torres Strait Islander women track strongly to increased risk of hypertension in pregnancy with associated risks to the health of babies.

PP091. Prematurity and hypertensive disorders in pregnancy. A major public health problem

Around the world each year 10% to 15% of direct maternal deaths are associated with hypertensive disorders in pregnancy. Not only it can be devastating and life threatening for the mothers but also for the babies. Risks for the baby include poor growth and prematurity [1]. In low and middle income countries many public hospitals have limited access to neonatal intensive care, and so the mortality and morbidity is likely to be considerably higher than in settings where such facilities are available. Thus, the approach to the problem preeclampsia should include issues related to prematurity and its impact, since many of these babies develop definitive complications, constituting a major public health problem with social and economic repercussions. To evaluate the prevalence of preterm births in a public hospital health of the city of São Paulo, checking its main causal conditions, focusing in particular on the importance of hypertensive disorders in its determinism. This was a retrospective study of a consecutive series of preterm infants, defined as gestational age less than 37 weeks born at Maternity School Vila Nova Cachoeirinha, situated at the north of Sao Paulo City, in the period from 01/04 to 31/12/2011. The study population was classified according to three main groups of causal factors: spontaneous labor, premature rupture of membranes and elective preterm delivery. In this group was evaluated the specific participation of hypertensive disorders. The number of live births during the study period was 5302 babies. Among these 433 had gestational age less than 37 weeks, corresponding to a prematurity rate of 8.16%. Of all infants, 385 cases were included in the analysis. Regarding the causes of the onset of preterm labor found that 140 cases (36.4%) presented with spontaneous labor, 128 cases (33.2%) had premature rupture of membranes and 117 (30.4%) cases were born as a result of elective preterm delivery. In the latter group 88 cases (75.2%) had complications related to hypertensive disorders. Regarding the general population of premature infants, hypertension accounted for 22.8% of cases. We conclude that among the various obstetric problems, hypertensive disorders represent an important impact on preterm birth in our setting, considering that our institution is a reference to this type of care across the city of São Paulo. This knowledge is a fundamental tool to support the adoption of interventions that can detect groups at risk for hypertension in pregnancy, the promotion of follow-up to intercept severe cases and provide an efficient network of maternity care that may have neonatal intensive care units. This set of measures is essential to minimize the impact of this serious problem.