Gestational hypertension and pre‐eclampsia and risk of spontaneous premature rupture of membranes: A population‐based cohort study

Abstract

Objective: To examine whether gestational hypertension and pre-eclampsia are associated with spontaneous premature rupture of membranes (PROM). Methods:A retrospective, population-based cohort study was conducted in Hebei, Zhejiang, and Jiangsu provinces in China from 1993 to 1995. After excluding women with missing data of exposure and outcome, history of chronic hypertension, multiple births, and babies with major birth defects and ambiguous sex, this study comprised 199 231 singleton live births. Logistic regression was used to evaluate the association, adjusting for potential confounders.Results: The incidence of PROM was 17.7% and 8.9% in women with gestational hypertension and pre-eclampsia, respectively, and 5.9% for the normotensive group.Compared with normotension, gestational hypertension was associated with an increase in the odds of PROM of 4.21 times (95% confidence interval [CI] 3.77-4.70), while pre-eclampsia had an increase of 2.27 times (95% CI 1.78-2.88). Additionally, women with hypertensive disorders of pregnancy had higher risks for term PROM (adjusted risk ratio [RR] 3.83, 95% CI 3.43-4.27) than preterm PROM (adjusted RR 3.10, 95% CI 2.18-4.41). Consistent results of the association were also observed in the sensitivity analyses. Conclusion:Gestational hypertension and pre-eclampsia were associated with an increased risk for PROM. Increased odds were observed for term PROM compared with preterm PROM. K E Y W O R D SChinese women; Cohort study; Gestational hypertension; Pre-eclampsia; Premature rupture of membranes; Preterm; Term Gestational hypertension 1589 (19.8) 3.72 (3.50-3.95) 4.28 (3.40-5.39) Pre-eclampsia 239 (8.9) 1.46 (1.27-1.67) 2.12 (1.28-3.50) Abbreviations: CI, confidence interval; RR, risk ratio; PROM, premature rupture of membranes. a Adjusted for maternal age, BMI, gestational week, sex of infants, parity, ethnicity, education, occupation, history of abortion, and history of cesarean delivery. | 201Liu ET AL.

Preterm prelabor rupture of membranes prior to early preterm delivery elevates the risk of later respiratory‐related hospitalizations in the offspring

“…A higher rate of maternal hypertensive disorders was noted in the unexposed group. On one hand, this is surprising because prelabor rupture of membranes (whether at term or preterm) was previously reported to be associated with pre‐eclampsia 41 . On the other hand, we believe the reason is that in the group of unexposed cases, the reason for preterm delivery may have been induced preterm delivery due to pre‐eclampsia, as opposed to spontaneous preterm delivery in PPROM exposed cases.…”

“…On one hand, this is surprising because prelabor rupture of membranes (whether at term or preterm) was previously reported to be associated with pre-eclampsia. 41 On the other hand, we believe the reason is that in the group of unexposed cases, the reason for preterm delivery may have been induced preterm delivery due to pre-eclampsia, as opposed to spontaneous preterm delivery in PPROM exposed cases. Of note, in total, there were no significant differences in rates of labor induction between the two groups ( Table 1).…”

Single Nucleotide Polymorphisms from CSF2, FLT1, TFPI and TLR9 Genes Are Associated with Prelabor Rupture of Membranes

“…Considering hypertensive disorders, gestational hypertension was found to be associated with an approximately four-fold increased risk of PROM, while preeclampsia was correlated with about two-fold higher risk [70]. Moreover, hypertension was associated with an increased risk of term rather than preterm PROM [70]. In turn, hypothyroidism in pregnancy was correlated with a slight FGR, a higher risk of PROM and the development of hypertension and GDM [62].…”

“…In turn, vaginal bleeding has been shown to correlate with a shorter gestational age at membrane rupture and delivery, as well as lower birth weight, more frequent placental abruption, RDS, IVH and perinatal death [69]. Considering hypertensive disorders, gestational hypertension was found to be associated with an approximately four-fold increased risk of PROM, while preeclampsia was correlated with about two-fold higher risk [70]. Moreover, hypertension was associated with an increased risk of term rather than preterm PROM [70].…”

Urine Routine Test has Potential Predictive Value in Premature Rupture of the Membranes

“…Premature rupture of membranes (PROM) refers to rupture of membranes before delivery, which is one of the common complications in obstetrics, with an incidence of 8%-10% [1]. Complications such as infection, trauma increased pressure of amniotic cavity and gestational diabetes may lead to rupture of membranes [2][3]. Preterm premature rupture of the membranes (PPROM) means the rupture of the membranes before labor starts prior to 37 weeks of gestation, which remains a signi cant obstetric problem that affects 3-4% of all pregnancies and precedes 40-50% of all preterm births [4].…”