Impact of pregnancy-induced hypertension on fetal growth

Xiong, Xu; Mayes, Damon C.; Demianczuk, Nestor; Olson, David M.; Davidge, Sandra T.; Newburn‐Cook, Christine; Saunders, L. Duncan

doi:10.1016/s0002-9378(99)70176-6

Cited by 158 publications

(107 citation statements)

References 14 publications

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“…Prematurity, restricted intrauterine growth, and low birth weight were the outcomes found in a retrospective cohort study among 1308 hypertensive pregnant women. Premature delivery was more frequent among women with severe pre-eclampsia (15) . There was a significant association (p=0.013) between DBP levels and gestational age.…”

Section: Discussionmentioning

confidence: 95%

Pregnancy-induced hypertension and the neonatal outcome

2008

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Objectives:This cross-sectional study were to identify the prevalence of pregnancy-induced hypertension and to verify diastolic blood pressure (DBP) association with type of birth and perinatal outcome. Methods: The data were collected from the mothers' records, in the governmental maternity hospital indicated for high-risk pregnancies, in São Paulo city. Results: During hospitalization, 62.1% had systolic blood pressure > 160 mmHg and 49.6% had a DBP < 110 mmHg. There was no significant association of DBP (p=0.799). The frequency of caesarean section was 64.5%, 28.9% for normal birth, and 6.6% for forceps; 93.4% were live born, 81.0% weighed ≥ 2,500 g, 10.6% were premature, 68.1% were born with adequate gestational age, 84.0% and 99.2% had APGAR score ≥7 at 1st and 5th minutes, respectively. Conclusion: The DBP e" 110 mmHg was associated with low birth weight (p=0.002) and prematurity (p=0.013). Keywords: Hypertension; Pregnancy complications; Pregnancy outcome; Pre-eclampsia; Infant, newborn RESUMOObjetivos: Identificar a prevalência da hipertensão arterial na gravidez e associar a pressão arterial diastólica (PAD) materna com tipo de parto e condições do neonato ao nascimento. Métodos: Estudo transversal, retrospectivo realizado por meio de análise de dados de prontuários de parturientes internadas em uma maternidade pública, da cidade de São Paulo, referência para gestação de alto risco. Resultados: A prevalência de hipertensão foi de 13,9%. Verificou-se que 62,1% das parturientes apresentaram pressão arterial sistólica > 160mmHg; 49,6% PAD > 110mmHg na internação. A PAD não apresentou associação significativa com o tipo de parto (p=0,799). A freqüência de cesárea foi 64,5%, normal 28,9% e fórcipe 6,6%. Dos recém-nascidos, 93,4% foram nativivos, 81% apresentaram pêso > 2.500g, 10,6% eram prematuros, 68,1% adequados para idade gestacional, índice de APGAR 1. 0 e 5. 0 minutos > 7 em 84,0% e 99,2%, respectivamente. Conclusão:A PAD > 110mmHg apresentou associação significativa com baixo peso (p=0,002) e prematuridade (p=0,013). Descritores: Hipertensão; Complicações na gravidez; Resultado da gravidez; Pré-eclâmpsia; Recém-nascido RESUMEN Objetivos: Identificar la prevalencia de la hipertensión arterial en el embarazo y asociar la presión arterial diastólica (PAD) materna con el tipo de parto y condiciones del neonato al nacer. Métodos: Estudio transversal, retrospectivo realizado por medio del análisis de datos de historias clínicas de parturientas internadas en una maternidad pública, de la ciudad de Sao Paulo, referencia para la gestación de alto riesgo. Resultados: La prevalencia de hipertensión fue de 13,9%. Se verificó que 62,1% de las parturientas presentaron presión arterial sistólica > 160mmHg; 49,6% PAD > 110mmHg en el internamiento. La PAD no presentó asociación significativa con el tipo de parto (p=0,799). La frecuencia de cesárea fue 64,5%, normal 28,9% y con forcep 6,6%. De los recién nacidos, 93,4% fueron nativivos, 81% presentaron peso > 2.500g, 10,6% eran prematuros, 68,1% adecuados para ...

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Section: Discussionmentioning

confidence: 95%

Pregnancy-induced hypertension and the neonatal outcome

2008

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“…58 In preeclamptic pregnancies terminating after 37 weeks of gestation, there is actually an excess of large infants. 59 The maternal/fetal/placental interaction model proposes that the contribution of maternal and fetal/placental factors may vary in proportion. Thus, in the woman with abundant predisposing factors, even minor reduction in placental perfusion is sufficient for stage 2, whereas profound reductions in placental perfusion will result in the preeclampsia syndrome even in a woman with minimal predisposing factors.…”

Section: Maternal Fetal/placental Interactions In Preeclampsiamentioning

confidence: 99%

Preeclampsia

2005

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Abstract-Preeclampsia is a pregnancy complication with serious consequences for mother and infant. The disorder is diagnosed by gestational hypertension and proteinuria but is far more than pregnancy induced hypertension. Preeclampsia is proposed to occur in 2 stages. Key Words: preeclampsia Ⅲ hypertension, pregnancy Ⅲ oxidative stress Ⅲ endothelium P reeclampsia is a pregnancy complication recognized by new-onset gestational hypertension and proteinuria (see definitions below). The disorder affects both mothers and their infants. Once the disease is evident clinically, it can be cured only by delivery. In developed countries, surveillance for preeclampsia through prenatal care allows for early identification and intervention via delivery. This management has changed little in the last 100 years, and it is very effective at reducing maternal mortality. However, maternal morbidity remains great with preeclampsia, which continues to be one of the leading causes for the admission of pregnant women to intensive care units in the developed world. 1 Furthermore, fetal mortality and morbidity is considerable, related to the effects of the disease on the fetus as well as prematurity. The indicated delivery of women to prevent the progression of preeclampsia is responsible for 15% of all preterm births. 2 In developing countries, where inadequate prenatal care limits preeclampsia surveillance, maternal mortality is common, accounting for 50 000 deaths yearly. 3 The hypertensive disorders of pregnancy include hypertension that antedates pregnancy, chronic hypertension, and gestational hypertension occurring uniquely during pregnancy. When the gestational hypertension is accompanied by new-onset proteinuria, the disorder is termed preeclampsia, and when not associated with proteinuria, transient hypertension of pregnancy. If the woman with chronic hypertension also manifests evidence of preeclampsia, this is classified chronic hypertension with superimposed preeclampsia. Eclampsia is the occurrence of seizures in women with preeclampsia. 4 These criteria have been extraordinarily useful to aid in recognizing pregnant women at risk. Greatest risk for mother and baby is present with preeclampsia, and the risk for chronic hypertensive pregnancy is primarily with superimposed preeclampsia. However, the attention to hypertension has, for many years, limited research attention to primarily mechanisms of hypertension. This has not been helpful. In the last 2 decades, appreciation that preeclampsia is a multisystemic syndrome characterized by vasoconstriction, metabolic changes, endothelial dysfunction, activation of the coagulation cascade, and increased inflammatory response, to mention only some of the organ systems involved, has redirected research. 5 As a result, progress in understanding the disorder has accelerated greatly, with attendant optimism for potentially effective treatments. 5 In this article, we consider this recent progress and its clinical implications.

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“…During pregnancy, high maternal BP values are reported to adversely affect fetal growth and to be associated with an increased risk of intrauterine growth restriction, more so in the presence of pre-eclampsia than in the presence of gestational hypertension [3]. BP-lowering therapy could also negatively affect fetal growth, a larger treatment-associated decrease in BP corresponding to a higher odds ratio of impaired fetal growth [4].…”

Section: Introductionmentioning

confidence: 99%

Circadian rhythm of maternal blood pressure and fetal growth

Maggioni¹,

Cornelissen²,

Otsuka³

et al. 2005

Biomedicine & Pharmacotherapy

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This study aimed at examining any relation between the circadian variation in blood pressure (BP) in human pregnancy and fetal growth. A prospective study included 52 pregnant women monitored during the third trimester of pregnancy. There were 33 uncomplicated pregnancies with normal fetal growth (Group 1) and 19 pregnancies complicated by intrauterine growth retardation (IUGR), confirmed at birth (Group 2). Ten women (five in each group) had pregnancy-induced hypertension. All women were hospitalized and followed a similar daily routine. BP was recorded with an automatic wearable device. Measurements were obtained every 20 min for 24 ± 1 h. BP profiles were analyzed by conventional statistical methods and by cosinor, involving the least squares fit of cosine curves with an anticipated period (24 h) to the data. BP parameters, fetal outcome, demographic and obstetric characteristics were compared between the two groups. Logistic regression and multivariate analyses were used to assess factors putatively associated with fetal outcome. The circadian amplitude of diastolic BP was found to be larger in normotensive women with IUGR. As gauged by odds ratios (OR), the circadian amplitude of diastolic BP (OR = 1.7, 95% CI: 1.1-2.8; P = 0.03) and hematocrit (OR = 1.4, 95% CI: 1.0-1.9; P = 0.04) were the only variables positively and independently associated with IUGR. In the presence of maternal hypertension, the circadian amplitude of systolic BP was negatively associated with IUGR (OR = 0.7, 95% CI: 0.5-1.0; P = 0.03). A larger circadian variation in diastolic BP, rather than a difference in the mean value of systolic or diastolic BP, was found to be statistically significantly associated with IUGR. This study adds another condition in which the circadian BP amplitude constitutes a harbinger of elevated risk, apart from an association with a shortened lifespan in the absence or presence of malignant hypertension and with an increased risk of stroke and nephropathy reported earlier.

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Impact of pregnancy-induced hypertension on fetal growth

Cited by 158 publications

References 14 publications

Pregnancy-induced hypertension and the neonatal outcome

Pregnancy-induced hypertension and the neonatal outcome

Preeclampsia

Circadian rhythm of maternal blood pressure and fetal growth

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