Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study

Silva, Lindsay M.; Coolman, Marianne; Steegers, Eric A.P.; Jaddoe, Vincent W. V.; Moll, Henriëtte A.; Hofman, Albert; Mackenbach, Johan P.; Raat, Hein

doi:10.1097/hjh.0b013e3282fcc36e

Cited by 201 publications

(159 citation statements)

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“…This may be related to the stress that women get during work. Our study similar to a study done in a semi urban setting [32] showed significant association between maternal education, income and pre-eclampsia.…”

Section: Resultssupporting

confidence: 77%

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

Gandhi

Rao

2014

JCDR

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Background: Pre-eclampsia is one of the leading causes of maternal and infant morbidity and mortality worldwide. The aetiopathogenesis of this condition involves combination of genetic predisposition and environmental factors. The aim of the study was to determine the socio demographic and other risk factors of pre-eclampsia. Materials and Methods:A case control study was conducted at a tertiary care hospital, Karnataka among 100 cases of pre-eclampsia and 200 controls without pre eclampsia. Non probability purposive sampling technique was adopted to select the study subjects. Data was collected by using a pre tested semi structured questionnaire which included information related to socio-demographic and other known risk factors of pre eclampsia. Primary data was collected by interviewing study subjects and secondary data of cases was obtained from case records. Data was analysed using SPSS. Results:Study subjects included 100 cases and 200 controls. Age of less than 20 y (OR=3.8), monthly income of less than Rs4000 (OR=6.8), age of menarche of less than 12 y (OR=13.1), family h/o pre eclampsia (OR=36.0), family h/o Diabetes (OR=44.9), family h/o hypertension (OR=16.7) and previous h/o PIH (OR=58.5) are found to be significant risk factors of pre eclampsia. Conclusion:The significant risk factors may be used for screening pre-eclampsia during registration of pregnancy.

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Section: Resultssupporting

confidence: 77%

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

Gandhi

Rao

2014

JCDR

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“…Their previous articles also showed that maternal socioeconomic status is associated with a risk of gestational hypertension and preeclampsia. 2 However, they did not demonstrate a midpregnancy fall in systolic BP in all of the educational subgroups. This might be attributable to few measurement points being obtained during pregnancy or to some other confounding factors.…”

Section: To the Editormentioning

confidence: 99%

Detection of Midpregnancy Fall in Blood Pressure by Out-of-Office Monitoring

et al. 2009

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Silva et al 1 have demonstrated the absence of a midpregnancy fall in diastolic blood pressure (BP) in women with a low educational level. Their previous articles also showed that maternal socioeconomic status is associated with a risk of gestational hypertension and preeclampsia. 2 However, they did not demonstrate a midpregnancy fall in systolic BP in all of the educational subgroups. This might be attributable to few measurement points being obtained during pregnancy or to some other confounding factors.Ambulatory BP measurement is one way to resolve inferior results from isolated BP measurements. Hermida et al 3 measured ambulatory BP in 403 pregnant women for 48 consecutive hours every 4 weeks from the first obstetric visit until delivery. They found that BP steadily decreased up to 20 weeks of pregnancy and increased up to the day of delivery. Conversely, in women with gestational hypertension and preeclampsia, BP remained stable until the 22nd week of gestation and then linearly increased for the remainder of the pregnancy.The American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association scientific statements indicate that home BP monitoring might overcome many of the limitations of traditional office BP measurements, and it is less expensive and easier to perform than ambulatory BP monitoring. 4 Home BP measurements are theoretically ideal for monitoring changes in BP during pregnancy, because home measurement is the optimal way to record multiple readings taken at the same time of day over prolonged periods. 4 We recently conducted a prospective observational study (Babies and Their Parents' Longitudinal Observation in Suzuki Memorial Hospital on Intrauterine Period Study), in which we averaged 100 BP measurement points during pregnancy in 101 normotensive pregnant women. 5 We found that BP during pregnancy is associated with both seasonal effects and gestational age. We found that the gestational week when BP reached the nadir differed according to the season in which delivery was predicted.As Silva et al 1 commented in their Discussion, the absence of a midpregnancy fall in BP is reportedly associated with preeclampsia, according to a population study, and may be a sign of latent endothelial dysfunction. However, the amplitude of the fall in midpregnancy BP seems smaller than that of circadian, daily, and seasonal BP variations. Home BP measurement would be a good tool with which to detect such small changes in BP during early pregnancy.

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“…6,7 Previous studies have shown that the risk for preeclampsia is also higher in women of low SES. 8,9 However, the pathways underlying this association remain unclear. 9 Although the exact etiology of preeclampsia is unknown, it is known that an important role in its pathophysiology is played by endothelial cell dysfunction.…”

mentioning

confidence: 99%

No Midpregnancy Fall in Diastolic Blood Pressure in Women With a Low Educational Level

et al. 2008

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Abstract-Low socioeconomic status has been associated with preeclampsia. The underlying mechanism, however, is unknown. Preeclampsia is associated with relatively high blood pressure levels in early pregnancy and with an absent midpregnancy fall in blood pressure. At present, little is known about the associations among socioeconomic status, blood pressure level in early pregnancy, blood pressure change during pregnancy, and preeclampsia. We studied these associations in 3142 pregnant women participating in a population-based cohort study. Maternal educational level (high, midhigh, midlow, and low) was used as an indicator of socioeconomic status. Systolic and diastolic blood pressure was measured in early, mid-, and late pregnancy. Relative to women with high education, those with low and midlow education had higher mean systolic and diastolic blood pressure levels in early pregnancy; this was explained largely by a higher prepregnancy body mass index. Although women with high, midhigh, and midlow education had a significant midpregnancy fall in diastolic blood pressure, those with low education did not (change from early to midpregnancy: Ϫ0.38 mm Hg; 95% CI: Ϫ1.33 to 0.58). The latter could not be explained by prepregnancy body mass index, smoking, or alcohol consumption during pregnancy. The absence of a midpregnancy fall also tended to be related to the development of preeclampsia, especially among women with a low educational level (OR: 3.8; 95% CI: 0.80 to 18.19). The absence of a midpregnancy fall in diastolic blood pressure in women with a low education level may be a sign of endothelial dysfunction that is manifested during pregnancy. This might partly explain these women's susceptibility to preeclampsia. Key Words: blood pressure Ⅲ education Ⅲ hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ socioeconomic factors C ardiovascular disease is the leading cause of death in Western countries. 1 One important determinant of cardiovascular disease is socioeconomic status (SES) as indicated by educational level, occupational class, or income level. Cardiovascular disease and its risk factors, including hypertension, are more common in people of low SES than in those of high SES. 2-4 These socioeconomic differences appear to be stronger in women than in men. 2 The mechanisms underlying the socioeconomic differences in cardiovascular health have not been completely elucidated. 5 Research indicates that hypertensive diseases of pregnancy, including preeclampsia, may be early manifestations of essential hypertension and cardiovascular disease in later life. It has therefore been postulated that pregnancy may be a "stress test" that reveals women with hypertensive tendencies. 6,7 Previous studies have shown that the risk for preeclampsia is also higher in women of low SES. 8,9 However, the pathways underlying this association remain unclear. 9 Although the exact etiology of preeclampsia is unknown, it is known that an important role in its pathophysiology is played by endothelial cell dysfunction. 10,11 It has been sugges...

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Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study

Cited by 201 publications

References 48 publications

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

Detection of Midpregnancy Fall in Blood Pressure by Out-of-Office Monitoring

No Midpregnancy Fall in Diastolic Blood Pressure in Women With a Low Educational Level

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