Evaluation of a definition of pre‐eclampsia

North, Robyn A.; Taylor, Rennae S.; Schellenberg, Jean-Claude

doi:10.1111/j.1471-0528.1999.tb08396.x

Cited by 105 publications

(58 citation statements)

References 19 publications

(34 reference statements)

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“…Using the blood pressure level alone would have resulted in the inclusion of many women with chronic hypertension of 90 mmHg or more with minimal or no increase during pregnancy [16]. On the other hand, an increase of 15 mmHg alone in normotensive women has no effect on pregnancy outcome in most cases [19]. Because every definition of hypertension and pre-eclampsia is defective in some way [17,18], compromises were also unavoidable in our study.…”

Section: Discussionmentioning

confidence: 78%

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

2000

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It has long been known that Type I (insulin-dependent) diabetes mellitus considerably increases the risk of pre-eclampsia and maternal and fetal co-morbidity [1±3]. The most important risk factor of pre-eclampsia in women with diabetes is nephropathy (White's class F) [1]. Even incipient nephropathy substantially increases the risk [4]. In addition, retinopathy and long duration of diabetes also increase the risk of pre-eclampsia [5±8].Although an association between poor glycaemic control in early pregnancy and pre-eclampsia has been reported [4, 7±11], it has not been observed by all [12]. It is not clear to what extent glycaemic control in early pregnancy might exert an effect on the occurrence of pre-eclampsia. Diabetic women with HbA 1 c values greater than 8 % could be at a greater risk of pre-eclampsia than those with values less than 8 % [10]. It is not known whether the risk of pre-eclampsia in diabetic women with relatively good gly- Abstract Aims/hypothesis. To investigate the association between glycaemic control and hypertensive pregnancy complications. Methods. From 1988 to 1997, we followed up 683 consecutive non-selected pregnancies in women with Type I (insulin-dependent) diabetes mellitus. Glycaemic control was assessed by assay of HbA 1 c . Pre-eclampsia was defined as diastolic blood pressure of 90 mmHg or more at the end of pregnancy after an increase of 15 mmHg or more, combined with proteinuria of 0.3 g or more for 24 h. Pregnancy-induced hypertension was defined similarly but without proteinuria. The same criteria were applied to a control group of 854 non-selected non-diabetic women. Results. Pre-eclampsia developed in 12.8 % of the women with diabetes (excluding those with nephropathy before pregnancy) and in 2.7 % of the control women (odds ratio 5.2; 95 % CI 3.3±8.4). In multiple logistic regression, glycaemic control, nulliparity, retinopathy and duration of diabetes emerged as statistically significant independent predictors of pre-eclampsia. The adjusted odds ratios for pre-eclampsia were 1.6 (95 % CI 1.3±2.0) for each 1 % increment in the HbA 1 c value at 4±14 (median 7) weeks of gestation and 0.6 (0.5±0.8) for each 1 % decrement achieved during the first half of pregnancy. Changes in glycaemic control during the second half of pregnancy did not significantly alter the risk of pre-eclampsia. Unlike pre-eclampsia, the risk of pregnancy-induced hypertension was not associated with glycaemic control. Conclusion/interpretation. In women with Type I diabetes, poor glycaemic control is associated with an increased risk of pre-eclampsia but not with a risk of pregnancy-induced hypertension. [Diabetologia (2000

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Section: Discussionmentioning

confidence: 78%

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

2000

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“…In a study by North et al (13) GH and PE were both associated with increased SGA infants and preterm births. Outcomes such as perinatal mortality and SGA are likely to be worse in women with proteinuria and PE than in hypertensive women without n ϭ number of intrauterine deaths.…”

Section: Preeclampsia and Stillbirths At Altitudementioning

confidence: 99%

“…First, this is the definition used in Bolivia. Furthermore, the studies showing no adverse outcomes in women with the BP rise compared with women with absolute BP Ͼ 140/90 mm Hg have all been done in the United States and European countries (13,23), where socioeconomic, nutritional, and lifestyle conditions are quite different from those in Bolivia. Thus, we thought a broader definition would be more useful for studying the impact of a disease in which the functional sequelae are still not well understood, particularly in our population.…”

Section: Preeclampsia and Stillbirths At Altitudementioning

confidence: 99%

“…To our knowledge, no systematic study of its prevalence has been conducted in Bolivia or other Andean countries. Hypertensive complications of pregnancy also increase IUGR (13), and the two conditions act synergistically in the United States to raise perinatal mortality 3-fold (14). Therefore, we asked whether complications of pregnancy, including IUGR and PE, were increased at high compared with low altitude in Bolivia.…”

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confidence: 99%

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Intrauterine Growth Restriction, Preeclampsia, and Intrauterine Mortality at High Altitude in Bolivia

et al. 2003

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Infant mortality and stillbirth rates in Bolivia are high and birth weights are low compared with other South American countries. Most Bolivians live at altitudes of 2500 m or higher. We sought to determine the impact of high altitude on the frequency of preeclampsia, gestational hypertension, and other pregnancy-related complications in Bolivia. We then asked whether increased preeclampsia and gestational hypertension at high altitude contributed to low birth weight and increased stillbirths. We performed a retrospective cohort study of women receiving prenatal care at low (300 m, Santa Cruz, n ϭ 813) and high altitude (3600 m, La Paz, n ϭ 1607) in Bolivia from 1996 to 1999. Compared with babies born at low altitude, high-altitude babies weighed less (3084 Ϯ 12 g versus 3366 Ϯ 18 g, p Ͻ 0.01) and had a greater occurrence of intrauterine growth restriction [16.8%; 95% confidence interval (CI): 14.9 -18.6 versus 5.9%; 95% CI: 4.2-7.5; p Ͻ 0.01]. Preeclampsia and gestational hypertension were 1.7 times (95% CI: 1.3-2.3) more frequent at high altitude and 2.2 times (95% CI: 1.4 -3.5) more frequent among primiparous women. Both high altitude and hypertensive complications independently reduced birth weight. All maternal, fetal, and neonatal complications surveyed were more frequent at high than low altitude, including fetal distress (odds ratio, 7.3; 95% CI: 3.9 -13.6) and newborn respiratory distress (odds ratio, 7.3; 95% CI: 3.9 -13.6; p Ͻ 0.01). Hypertensive complications of pregnancy raised the risk of stillbirth at high (odds ratio, 6.0; 95% CI: 2.2-16.2) but not at low altitude (odds ratio, 1.9; 95% CI: 0.2-17.5). These findings suggest that high altitude is an important factor worsening intrauterine mortality and maternal and infant health in Bolivia. Abbreviations PE, preeclampsia GH, gestational hypertension IUGR, intrauterine growth restriction CNS, Caja Nacional de Salud (National Health Care Fund) BP, blood pressure IUM, intrauterine mortality SGA, small-for-gestational age 95% CI, 95% confidence intervals OR, odds ratio Bolivia's infant mortality is the highest in the Western Hemisphere, its maternal mortality second only to Haiti (1) and its intrauterine mortality the second highest of 19 South American countries (2). Some 75% of the Bolivian population and 140 million persons worldwide, including an appreciable fraction of the other Andean countries, reside at high altitude (Ͼ2500 m) (1, 3, 4). Within Bolivia, neonatal mortality rates rise progressively with increasing altitude, averaging 20 deaths per 1000 live births lower than 2500 m, 33 in the 2500 -3500 m region of the country, and 44 higher than 3500 m (4). Maternal mortality also rises with increasing altitude within Bolivia, averaging 110 deaths/100,000 live births at low altitude, 293 in the intermediate altitudes, and 602 in the high regions (5).A number of factors likely contribute to the altitude-related increase in infant and maternal mortality in Bolivia. A recent retrospective, stratified survey identified lack of schooling, living in a...

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“…One study reports reduced fetal growth with increasing blood pressure during pregnancy, 8 whereas other studies report no association between increasing blood pressure and adverse fetal outcome in nonhypertensive women. 13,14 We hypothesized that prehypertension in late pregnancy is associated with increased risks of adverse fetal outcomes and that these risks vary by change in blood pressure during pregnancy.…”

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confidence: 99%

Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

et al. 2016

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Abstract-It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (≥37 weeks) singleton births (n=157 446). Using normotensive (diastolic blood pressure [DBP] <80 mm Hg) women as reference, we calculated adjusted odds ratios with 95% confidence intervals between prehypertension (DBP 80-89 mm Hg) at 36 gestational weeks (late pregnancy) and risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51-1.90) and 1.70 (1.16-2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5-2.8) per each mm Hg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth. (Hypertension.

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Evaluation of a definition of pre‐eclampsia

Cited by 105 publications

References 19 publications

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

Glycaemic control is associated with pre-eclampsia but not with pregnancy-induced hypertension in women with Type I diabetes mellitus

Intrauterine Growth Restriction, Preeclampsia, and Intrauterine Mortality at High Altitude in Bolivia

Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

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