Risk Of Gestational Hypertension Research Articles

Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes.

Background: An association between the level of vitamin D and the risk of pregnancy-related complications remains unclear. The aim of this study was to examine concentrations of 25(OH) vitamin D in Polish women with normal pregnancies and pregnancies complicated by gestational hypertension, preeclampsia or gestational diabetes mellitus (GDM). Moreover, we analyzed an association between maternal serum 25(OH)D and the risk of gestational hypertension, preeclampsia and GDM. Material and Methods: The study included 207 pregnant women, among them 171 with pregnancy-related complications: gestational hypertension (n = 45), preeclampsia (n = 23) or GDM (n = 103). The control group consisted of 36 women with normal pregnancies. Concentrations of serum 25(OH)D were measured at admission to the hospital prior to delivery Results: Patients with hypertension did not differ significantly from the controls in terms of their serum 25(OH)D concentrations (18.20 vs. 22.10 ng/mL, p = 0.15). Highly significant differences were found in 25(OH)D concentrations of women with preeclampsia and the controls (14.75 vs. 22.10 ng/mL, p = 0.0021). GDM was not associated with significant differences in 25(OH)D concentration. A low level of 25(OH)D turned out to be associated with an increased risk of preeclampsia during pregnancy on both univariate and multivariate regression analysis, and was a significant predictor of this condition on ROC (receiver operating characteristic) analysis (AUC = 0.70, p < 0.01). Conclusions: 25(OH)D deficiency is common among pregnant Polish women. Low concentrations of 25(OH)D may play a role in the etiopathogenesis of preeclampsia. Routine assessment of the 25(OH)D level during pregnancy may be crucial for the identification of women at increased risk of preeclampsia.

Folic acid alone or multivitamin containing folic acid intake during pregnancy and the risk of gestational hypertension and preeclampsia through meta-analyses

ObjectiveThe objective of this study was to assess the effect of folic acid and multivitamin use during pregnancy on the risk of developing of hypertensive disorder of pregnancy.MethodsTwo reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, placebo-controlled, randomized clinical trial published using PubMed Medline database, KERIS (Korea Education and Research Information Service), Scopus, and the Cochrane Central Register of controlled trials comparing before conception throughout pregnancy intake oral multivitamin containing folic acid or folic acid alone. Meta-analyses were estimated with odds ratios and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies.ResultsData from six effect sizes from six studies involving 201,661 patients were enrolled. These meta-analyses showed multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence (odds ratio, 0.91; 95% CI, 0.81 to 1.03) than the placebo. And the difference of effective sizes of preeclampsia and gestational hypertension according to two dependent variables, multivitamin and folic acid were not significant, respectively (point estimate, 0.66; 95% CI, 0.46 to 0.96).ConclusionThese meta-analyses demonstrate multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence.

693: Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy

693: Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy

Ambient Fine Particulate Matter, Nitrogen Dioxide, and Hypertensive Disorders of Pregnancy in New York City.

Previous studies suggested a possible association between fine particulate matter air pollution (PM2.5) and nitrogen dioxide (NO2) and the development of hypertensive disorders of pregnancy, but effect sizes have been small and methodologic weaknesses preclude firm conclusions. We linked birth certificates in New York City in 2008-2010 to hospital discharge diagnoses and estimated air pollution exposure based on maternal address. The New York City Community Air Survey provided refined estimates of PM2.5 and NO2 at the maternal residence. We estimated the association between exposures to PM2.5 and NO2 in the first and second trimester and risk of gestational hypertension, mild preeclampsia, and severe preeclampsia among 268,601 births. In unadjusted analyses, we found evidence of a positive association between both pollutants and gestational hypertension. However, after adjustment for individual covariates, socioeconomic deprivation, and delivery hospital, we did not find evidence of an association between PM2.5 or NO2 in the first or second trimester and any of the outcomes. Our data did not provide clear evidence of an effect of ambient air pollution on hypertensive disorders of pregnancy. Results need to be interpreted with caution considering the quality of the available exposure and health outcome measures and the uncertain impact of adjusting for hospital. Relative to previous studies, which have tended to identify positive associations with PM2.5 and NO2, our large study size, refined air pollution exposure estimates, hospital-based disease ascertainment, and little risk of confounding by socioeconomic deprivation, does not provide evidence for an association.

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.

Long-term medical risks to the living kidney donor.

Living kidney donation benefits recipients and society but carries short-term and long-term risks for the donor. This Review summarizes the studies that underlie our current understanding of these risks in the first decade after donation, with a view to improving the informed consent process. Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation. Some evidence suggests that the 20-year incidence of gout is slightly higher among donors than among healthy nondonors. The risks of gestational hypertension or pre-eclampsia seem to be 6% higher in pregnancies among donors than in pregnancies among healthy nondonors. The incidences of acute kidney injury, kidney stones that require surgical intervention, gastrointestinal bleeding and fractures seem no higher among donors than among healthy nondonors, although some of these conclusions are based on a small number of events. Future studies must clarify the lifetime incidence of long-term outcomes, particularly in relation to a donor's age, race, and history of comorbidities.

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Objectives Assessing risk of developing a hypertensive disorder of pregnancy (HDP) in nulliparous women is imprecise. Previous evidence suggests that self-reported family history of cardiovascular disease and risk (in particular risk in the woman’s father) may improve identification of preeclampsia (Parker, ISOM 2012). The aim of this study was to evaluate maternal report of paternal family history of cardiovascular disease (CVD) or risk (CVR) as a risk factor for HDP including preeclampsia. Methods Women were recruited prospectively and reported on cardiovascular health in themselves, their partners and first degree relatives (n = 997). HDP diagnoses were assigned using SOMANZ (2008) criteria. Results Preeclampsia was diagnosed in 12.6% of women, gestational hypertension in 6.2%. CVD/CVR was reported by 22.3% of mothers (1.7% CVD alone) and 9.3% of partners (1.7% CVD alone). Median age of the women was 27 years (range 16–45), median age of the partners was 30 years (range 26–34). All partners with CVD were under 45 years old (median 32, range 24–39). The median age of men with risk alone was 33 years (range 29–38). Partners’ CVD increased risk of preeclampsia (5.6% vs. 1.7%; OR = 5.07, 95% CI 1.72–14.94, p = .003) adjusted for maternal age, BMI, smoking and maternal CVD/CVR. No increase in risk of gestational hypertension was evident. Partners’ CVR did not appear to increase risk of HDP. Conclusions History of CVD in the woman’s partner may indicate elevated risk of preeclampsia however, the low frequency of CVD in partners at this young age impacts on the sample size and should be examined in future research. Disclosures C.E. Parker: None. D.A. Doherty: None. B.N. Walters: None.

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Objectives To compare the relative risk of eclampsia and frequency of prenatal visits. Methods We evaluated the risk of gestational hypertension with the number of prenatal visits in 4,247,694 delivered women included in the CDC 2008 Vital Stats dataset. The incidence of eclampsia among subgroups of women defined by their number of prenatal visits was calculated. Relative risks were determined for each subgroup by comparing the incidence of eclampsia in each subgroup compared to those women with 13–14 visits (reference group). These groups were (1) no visits, (2) 1–2 visits, (3) 3–4 visits, (4) 5–6 visits, (5) 7–8 visits, (6) 9–10 visits, (7) 11–12 visits, (8) 13–14 visits {reference group}, (9) 15–16 visits, (10) 17–18 visits, (11) 19 or more visits. Results The relative risk of eclampsia increased as the number of prenatal visits decreased, with the highest risk among those women who had no prenatal visits (RR = 2.16, 95% CI = 1.90–2.45). The relative risk of eclampsia also increased as the number of prenatal visits increased above 13–14 visits. The highest risk was for those women with 19 or more visits (RR = 2.34, 95%, CI = 2.13–2.58). Conclusions Fewer prenatal visits may be associated with a higher risk of eclampsia. This may be due to iatrogenic preterm delivery or poor patient compliance. Eclampsia may also be associated with an increased number of prenatal visits. This may be due to close monitoring of a high risk patient. Disclosures E.T. Greeley: None. K.L. Terry: None. J.V. Spencer: None.

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Objectives To compare the relative risk of gestational hypertension and frequency of prenatal visits. Methods We estimated the incidence of gestational hypertension among subgroups of women defined by their number of prenatal visits. Relative risks were determined for each subgroup by comparing the incidence of gestational hypertension in each subgroup compared to those women with 13–14 visits. These groups were (1) no visits, (2) 1–2 visits, (3) 3–4 visits, (4) 5–6 visits, (5) 7–8 visits, (6) 9–10 visits, (7) 11–12 visits, (8) 13–14 visits {reference group}, (9) 15–16 visits, (10) 17–18 visits, (11) 19 or more visits. Results The relative risk of gestational hypertension decreased as the number of prenatal visits decreased, with the lowest risk being those women who had no prenatal visits (Relative Risk (RR) = 0.72, 95% Confidence Interval (CI) = 0.69–0.76). The relative risk continued to increase as the number of prenatal visits continued past the reference range of 13–14 visits. The highest risk was for those women with 19 or more visits (RR = 1.76, 95% CI = 1.72–1.80). Conclusions Surprisingly, fewer prenatal visits are associated with a diagnosis of gestational hypertension. This may be due to women with gestational hypertension delivering earlier and therefore having fewer prenatal visits. The increasing risk for gestational hypertension beyond 13–14 visits may indicate a patient that is being observed more closely with more scheduled visits. Limitations of this study include lack of standardized data collection across institutions and inability to control for confounding, particularly the length of gestation. However, this is a large and diverse dataset allowing robust estimates of the association. Disclosures E.T. Greeley: None. K.L. Terry: None. J.V. Spencer: None.

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Objectives Magnesium (Mg) is the generally accepted treatment in pre-eclampsia and has been shown to reduce medical complications in the mother and fetus in around 50% of the cases. In view of this, attempts have been made to prevent gestational hypertension, pre-eclampsia, and other pregnancy complications by supplementation with magnesium during pregnancy. Methods A review of previous studies showed an effect of Mg on blood pressure in three studies and no effect in one. The latter was, however, an intervention with two doses of Mg with a narrow therapeutic range. In our study we selected 60 primapara women who were given Mg-citrate from week 25 in a double-blind, placebo controlled design. Blood pressure was measured at regular visits to the maternity clinic and the expression of Mg responsive genes (MgRG) was determined. Results At pregnancy weeks 35 and 37, the systolic and diastolic blood pressures were lower in the Mg supplemented group. The number of women who had an increase in diastolic pressure ⩾15 mmHg was significantly lower in the supplemented group. At week 37 the MgRG TRPM7 was related to the systolic and diastolic blood pressure and the expression was higher among those with a diastolic blood pressure increase of ⩾15 mmHg. Conclusions The results support the hypothesis that supplementation with Mg during pregnancy decreases the risk of gestational hypertension. Further studies in other population groups are required before general recommendations can be made. Disclosures R. Rylander: None. M. Bullarbo: None.

Maternal obesity and energy intake as risk factors of pregnancy-induced hypertension among Iranian women.

Pregnancy-induced hypertension is causing striking maternal, foetal and neonatal mortality and morbidity in the world. A case-control study was conducted on 113 women with gestational hypertension and 150 healthy pregnant women at Shahid Akbarabadi Hospital of obstetrics and gynaecology in south of Tehran. Women who were obese (OR 4.44; 95% CI 1.84-10.72) before pregnancy were more likely to develop gestational hypertension. Proportion of having excessive gestational weight gain was positively and significantly associated with development of gestational hypertension (OR 2.70; 95% CI 1.19-6.13). Furthermore, findings revealed that women who were in the highest quartile of mid-arm-circumference had a 3-fold increased risk of gestational hypertension compared to women in the lowest quartile (OR 8.93; 95% CI 2.16-36.93). We found that having been in the highest quartile of energy intake positively correlated with increased risk of gestational hypertension (OR 9.66; 95% CI 3.30-28.21). The results suggest pre-pregnancy obesity, excessive gestational weight gain, and increased intake of energy as potential risk factors of developing gestational hypertension.

Persistent organochlorines and hypertensive disorders of pregnancy

Although there is indirect evidence to suggest that persistent organochlorines might increase risk of hypertensive disorders of pregnancy, there are no epidemiologic studies directly addressing this question. In this cohort study, sampled from the Collaborative Perinatal Project, 1933 women had complete data on organochlorine measurements, covariates, and pregnancy outcomes. Exposures to organochlorines were divided into quintiles, and levels were much higher in these patients recruited from 1959 to 1965 compared to levels in the general population at present. Among included women, 364 developed gestational hypertension (hypertension without proteinuria) and 131 developed preeclampsia (hypertension with proteinuria). We found essentially no association between serum DDE and total PCBs and risk of either gestational hypertension or preeclampsia. Results for other organochlorines showed varying patterns of results: DDT was inversely associated with risk of gestational hypertension (p for trend <0.001), B-Hexachlorocyclohexane and heptachlor epoxide were inversely related to gestational hypertension (p trend <0.01 and 0.10, respectively), dieldrin had a modestly positive association with gestational hypertension (p for trend=0.12), and hexachlorobenzene, trans-nonachlor, and oxychlordane yielded results close to the null. Hexachlorobenzene showed an inverse association with preeclampsia (p for trend <0.001). The study suggests that persistent organochlorines present at historically high level are not likely to increase the risk of hypertensive disorders of pregnancy, suggesting that other toxicants that have similar biologic effects are also unlikely to do so.

HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia

The objective of this study was to evaluate the association between HIV infection and hypertensive disorders of pregnancy, comparing the rates of preeclampsia and gestational hypertension in a HIV-infected pregnant group and in a HIV-negative control pregnant group matched for age and parity. Furthermore, we aimed to compare the rates of hypertensive disorders in a subgroup of HIV-positive and HIV-negative African-American Black women. Patients and Methods: This was a prospective observational cohort study conducted at two University Departments of Obstetrics and Gynecology, Salesi Hospital, Ancona, and Sant’Orsola Hospital, Bologna. The HIV-infected patients’ group consisted of 126 pregnant women; 140 HIV-negative pregnant women matched for age and parity served as controls. Gestational hypertension and preeclampsia were diagnosed according to NHBPEP-ISSHP criteria. Categorical data were analyzed using the Fisher exact test. Statistical significance was set at a p value < 0.05. Results: Gestational hypertension and preeclampsia were diagnosed in 3 of 126 HIV-positive patients (2.38%) and in 14 of 140 HIV-negative patients (10%), with a relative risk of 0.24 (p = 0.0112). In the subgroup of African-American Black women, gestational hypertension and preeclampsia were diagnosed in 2 out of 43 HIV-positive (4.7%) and in 3 out of 18 HIV-negative patients (16.7%) with a relative risk of 0.28, not statistically significant (p = 0.1887). Conclusion: Pregnant women with HIV infection seem to be protected against gestational hypertension and preeclampsia and this protective effect remains also in a high risk population, such as African-American Black ethnic group. The effect is present independently from treatment received and virus copies. The lack of immune response present since the conception period should account for unopposed trophoblast invasion resulting in a better placentation.

Nutritional status of women with gestational hypertension compared with normal pregnant women

Background: Some evidence indicated the role of nutrition in the development of hypertensive disorders of pregnancy. Methods: This case–control study was conducted on 113 women with gestational hypertension and 150 healthy pregnant women referred to Shahid Akbarabadi Hospital in Tehran. A demographic questionnaire was filled out for all participants. A validated semi-quantitative food frequency questionnaire was used to assess the dietary intakes of the study subjects. All nutrients were adjusted for total energy intake. Logistic regression was used to find the association of energy and nutrient intakes with gestational hypertension. Results: We found that higher intakes of energy (OR, 1.33; 95% CI: 1.17–1.52), monounsaturated fatty acids (OR, 1.34; 95% CI: 1.03–1.74) and polyunsaturated fatty acids (OR, 1.26; 95% CI: 1.00–1.54) were positively associated with the risk of gestational hypertension after adjustment for confounders. We also observed decreased odds of gestational hypertension with increased intakes of vitamin C (OR, 0.87; 95% CI: 0.81–0.94), potassium (OR, 0.45; 95% CI: 0.28–0.71) and magnesium (OR, 0.68; 95% CI: 0.51–0.89). Conclusion: This study demonstrates higher intakes of energy, monounsaturated fatty acids and polyunsaturated fatty acids as well as lower intakes of vitamin C, potassium and magnesium are positively correlated with the risk of developing gestational hypertension.

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.

PP030. Cardiovascular disease and risk in a pregnant woman’s father as a risk factor for preeclampsia

In women experiencing their first pregnancy the assessment of risk of developing a hypertensive disorder of pregnancy (HDP) including preeclampsia is imprecise. Identification of women at higher than normal risk of developing preeclampsia may improve pregnancy management and lead to better outcomes. Previous studies, mostly retrospective, have indicated a possible link between cardiovascular history and risk of preeclampsia. To evaluate the self-reported family history of cardiovascular disease and risk (CVD/R) during an antenatal interview as a means of screening for risk of developing preeclampsia or other HDP. Nulliparous women were recruited prospectively in early pregnancy before diagnosis of any HDP. Women reported on their maternal characteristics and the history of cardiovascular health in themselves, their parents and siblings and the father of the baby and his parents and siblings. Cardiovascular health was assessed as cardiovascular risk (high blood pressure, high cholesterol and diabetes) and cardiovascular disease (heart attack, stroke, angina and any major vascular surgery). Pregnancy outcomes were recorded after delivery, the diagnoses of gestational hypertension, preeclampsia and superimposed preeclampsia being assigned according to the criteria defined by SOMANZ, 2008. A nominal logistic regression analysis was used to evaluate the effects of family history on risk of developing HDP while adjusting for clinical risk factors known at the time of recruitment. Nine hundred and ninety-seven women completed the study. Median gestational age at recruitment was 31.3weeks (Interquartile range [IQR] 24.4-35.9, range 5.6-39.1). Median age was 27.0years (IQR 23.0-32.0, range 16.0-45.0), median BMI was 28.6 (IQR 24.8-36.4, range 16.7-64.4) and 76.4% of the women did not smoke during the pregnancy. Preeclampsia was diagnosed in 12.6% of the women (103/997 preeclampsia, 23/997 superimposed) and 6.2% developed gestational hypertension (62/997). CVD/R was reported by 22.3% of mothers (including 1.7% of CVD alone) and in 9.3% of the partners (including 1.7% of CVD alone). Women reported CVD/R in 39.1% of their mothers (including 6.5% CVD alone) and in 42.2% (including 13.3% CVD alone) of their fathers. Women reported CVD/R in 30.3% (including 6.1% CVD alone) of the partners' mothers and in 38.9% (including 15.0% CVD alone) of the partners' fathers. Women who knew of CVD/R in their fathers had increased risk of preeclampsia (16.2% vs. 10.1%; Odds Ratio [OR]=.66 95% Confidence Interval [CI] 1.16-2.36, p=.005) that remained elevated after adjustments for maternal age, BMI, smoking in pregnancy and maternal CVD/R. No similar increase in risk of gestational hypertension was evident (7.4% vs. 5.4%; OR=1.31 95% CI0.81-2.10,p=0.272). CVD/R reported for any other family member did not significantly alter the woman's risk of developing preeclampsia or any other HDP. The presence of a history of CVD/R in the father of the pregnant woman indicated an increased risk of developing preeclampsia. The possibility of a similar association between CVD/R in other family members and HDP may exist however women in their first pregnancy may not have sufficient knowledge of family history. This lack of comprehensive information may limit the potential value of family history in determining the risk of preeclampsia and other hypertensive disorders in pregnancy.

Hemodynamic Adaptations in Different Trimesters Among Nulliparous and Multiparous Pregnant Women; The Generation R Study

It has been suggested that maternal vascular adaptations during pregnancy differ between nulliparous and multiparous women. Therefore, we examined the associations of parity with blood pressure and hemodynamic placental function during pregnancy and risks of gestational hypertensive disorders. The study was embedded in a population-based prospective cohort study among 8,377 pregnant women. Information about parity and gravidity was obtained at enrollment. Blood pressure was repeatedly measured in each trimester and mean pulsatility and resistance indexes of uterine artery were measured in second and third trimesters. Information on gestational hypertension and preeclampsia was available from medical records. As compared with nulliparous women, multiparous women had a lower systolic and diastolic blood pressure in each trimester of pregnancy and a slightly higher second and third trimester uterine artery resistance and pulsatility indexes (all P values < 0.05), but a lower risk of third trimester uterine artery notching (odds ratio (OR) 0.67 (95% confidence interval (CI):0.53, 0.84)). The risks of gestational hypertension and preeclampsia were lower among multiparous women as compared with nulliparous women (OR 0.32 (95% CI: 0.24, 0.43) and OR 0.24 (95% CI: 0.16, 0.37), respectively). Among multiparous women only, we did not observe associations of parity with hemodynamic parameters. Nulliparous pregnant women have higher blood pressure levels throughout pregnancy and higher risks of notching and gestational hypertensive disorders. The first pregnancy might be a major risk factor for maternal hemodynamic maladaptations and vascular complications. Further studies are needed to explore the underlying mechanisms and consequences for fetal growth and development.

Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries

BackgroundHypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries.MethodsA literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data were extracted into a standardized excel sheet. Identified studies were graded based on strengths and limitations of studies. All the included studies were from developing countries. Meta-analyses were generated where data were available from more than one study for an outcome. Primary outcomes were maternal mortality, eclampsia, pre-eclampsia, and severe preeclampsia. Neonatal outcomes like neonatal mortality, preterm birth, small for gestational age and low birth weight were also evaluated. We followed standardized guidelines of Child Health Epidemiology Reference Group (CHERG) to generate estimates of effectiveness of calcium supplementation during pregnancy in reducing maternal and neonatal mortality in developing countries, for inclusion in the Lives Saved Tool (LiST).ResultsData from 10 randomized controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy was associated with a significant reduction of 45% in risk of gestational hypertension [Relative risk (RR) 0.55; 95 % confidence interval (CI) 0.36-0.85] and 59% in the risk of pre-eclampsia [RR 0.41; 95 % CI 0.24-0.69] in developing countries. Calcium supplementation during pregnancy was also associated with a significant reduction in neonatal mortality [RR 0.70; 95 % CI 0.56-0.88] and risk of pre-term birth [RR 0.88, 95 % CI 0.78-0.99]. Recommendations for LiST for reduction in maternal mortality were based on risk reduction in gestational hypertensive related severe morbidity/mortality [RR 0.80; 95% CI 0.70-0.91] and that for neonatal mortality were based on risk reduction in all-cause neonatal mortality [RR 0.70; 95% CI 0.56-0.88].ConclusionCalcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertension, pre-eclampsia neonatal mortality and pre-term birth in developing countries.

A Meta-Analysis on the Efficacy and Safety of Combined Vitamin C and E Supplementation in Preeclamptic Women

Objective: To evaluate whether vitamin C and E co-supplementation of women at risk of preeclampsia can reduce maternal and neonatal disorders. Method: Electronic databases were searched up to May 2008 to find studies investigating pregnancy outcomes in women at risk of preeclampsia following exposure to combined vitamin C and E supplementation. The outcomes of interest were gestational hypertension, preeclampsia, preterm delivery, small for gestational age, and low birth weight. The relative risk (RR) and confidence interval (CI) for the individual studies were pooled and heterogeneity analysis was performed. Results: Seven studies involving 5969 pregnant women at risk of preeclampsia were included: 2982 received vitamin C and E and 2987 received placebo. The RRs are 1.3 (95% CI of 1.08–1.57, p = 0.0066) for gestational hypertension, 0.7 (95% CI of 0.58–1.08, P = 0.1653) for preeclampsia, 1.12 (95% CI of 0.96–1.32, p = 0.141) for preterm delivery, 1.04 (95% CI of 0.94–1.15, p = 0.4789) for small for gestational age, and 1.13 (95% CI of 1.004–1.27, p = 0.0429) for low birth weight. Conclusion. Combined vitamin C and E supplementation not only have no potential benefit in improvement of maternal and neonatal outcome but increase the risk of gestational hypertension in women at risk of preeclampsia and low birth weight in neonates.

Folic acid is positively associated with uteroplacental vascular resistance: The Generation R Study

Background and aims Periconception folic acid supplementation may influence early placentation processes and thereby the occurrence of hypertensive pregnancy disorders. For this reason we examined the associations between periconception folic acid supplementation and uteroplacental vascular resistance, blood pressure, and the risks of gestational hypertension and preeclampsia, in 5993 pregnant women, participating in a population-based cohort study. Methods and results Folic acid supplementation was assessed by questionnaire. Mean pulsatility index (PI) and resistance index (RI) of the uterine (UtA) and umbilical arteries (UmA) were measured by Doppler ultrasound in mid- and late pregnancy. Systolic and diastolic blood pressures (SBP, DBP) were measured in early, mid- and late pregnancy. Compared to women who did not use folic acid, preconception folic acid users had a slightly lower UtA-RI in mid-pregnancy [β −0.02, 95% confidence interval (CI) −0.03, −0.01] and late pregnancy [β −0.02, 95% CI −0.03, −0.001], a lower UtA-PI in mid-pregnancy [β −0.06, 95% CI −0.1, −0.03] and late pregnancy [β −0.03, 95% CI −0.05, −0.01], as well as tendencies towards a lower UmA-PI in mid-pregnancy [β −0.02, 95% CI −0.04, −0.001] and late pregnancy [β −0.01, 95% CI −0.02, 0.01]. Additionally, these women had slightly higher SBP and DBP throughout pregnancy. Neither the patterns of blood-pressure change during pregnancy, nor the risk of gestational hypertension and preeclampsia differed between the folic acid categories. Conclusion Periconception folic acid supplementation is associated with lower uteroplacental vascular resistance and higher blood pressures during pregnancy. The effects are small and within physiologic ranges and seem not associated with the risk of hypertensive pregnancy disorders.