Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study

Abstract

Objectives This study aims at identifying associations between therapeutics used during labor and the occurrence of postpartum preeclampsia (PPPE), a poorly understood entity. Study Design and Main Outcome Measures This is a case-control study of women who received an ICD-9 code for PPPE (cases) during the years 2009–2011, compared to women with a normotensive term pregnancy, delivery and postpartum period until discharge (controls), matched on age (±1 year) and delivery date (± 3 months). Cases were defined as women having a normotensive term pregnancy, delivery and initial postpartum period (48 hrs post-delivery) but developing hypertension between 48 hrs and 6 weeks postpartum. Single variable and multiple variable models were used to determine significant risk factors. Results Forty-three women with PPPE were compared to 86 controls. Use of vasopressors and oxytocin did not differ between cases and controls, but rate of fluids administered during labor (OR= 1.68 per 100cc/h; 95% CI: 1.09–2.59, p=0.02) and an elevated pre-pregnancy/first trimester BMI (OR=1.18 per kg/m2, 95% CI: 1.07–1.3, p=0.001) were identified as significant risk factors in multivariate analysis. Conclusions We identified two potentially modifiable risk factors for PPPE; further studies are needed to better define the role of these two variables in the development of PPPE.

RETRACTED ARTICLE: Human Umbilical Cord Mesenchymal Stem Cells-Derived Exosomal MicroRNA-18b-3p Inhibits the Occurrence of Preeclampsia by Targeting LEP

“…The etiology and pathogenesis of PE are not clear [ 3 ], which has been reported to be associated with abnormal trophoblast invasion resulting in maternal endothelial dysfunction, chronic placental malperfusion and hypertension with adverse outcomes [ 4 ]. With the exception of fetal and placental delivery, there is no specific therapy for PE [ 5 ]. Therefore, it is urgent to explore the therapeutic targets to improve the prognosis of this disease.…”

Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy

“…Overall, studies have not shown an increased risk of postpartum PE associated with the use of epidural anesthesia and pharmacologic agents that might be hypothesized to raise BP, such as vasopressors or ergot derivatives in labor or after delivery. 14,15 Clinical Presentation As noted earlier, postpartum PE can develop after a pregnancy with no antecedent diagnosis of a hypertensive disorder of pregnancy or after a pregnancy complicated by gestational hypertension or in women with underlying chronic hypertension. Approximately 60% of patients with new, delayed-onset postpartum PE have no antecedent diagnosis of a hypertensive disorder of pregnancy.…”

“…8,13e16 Higher rates of intravenous (IV) fluid infusion on labor and delivery are also associated with an increased risk of postpartum PE. 15 To the best of our knowledge, published studies do not distinguish between prelabor cesarean deliveries and intrapartum cesarean deliveries, which would likely affect the amount of IV fluids administered. Women who receive greater volumes of IV crystalloids during labor and delivery may shift more fluid to the interstitial compartment and may subsequently be more likely to develop volume overload and hypertension when the fluid is remobilized to the intravascular space after delivery.…”

“…Black women have a 2-to 4-fold increased risk of postpartum PE compared with women of other races. 8,15 Unlike antepartum PE, postpartum PE does not seem to be more common among primiparous women. 8,16 Postpartum PE develops more commonly among women with a history of a hypertensive disorder in a previous pregnancy.…”

Does body mass index impact assisted reproductive technology treatment outcomes in gestational carriers

“…Elevated maternal pre-pregnancy BMI can lead to a higher risk of maternal and fetal morbidities and mortality [7][8][9][10][11][12][13]. It is controversial whether or not obesity impacts the response to assisted reproductive technology (ART) treatments [14][15][16][17][18].…”