Maternal Size at Birth and the Development of Hypertension During Pregnancy

Klebanoff, Mark A.; Nj, Secher; Mednick, Birgitte R.; Schulsinger, Charlotte

doi:10.1001/archinte.159.14.1607

Cited by 64 publications

(45 citation statements)

References 29 publications

(29 reference statements)

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“…This study strengthens previous findings of increased risk of pregnancy complications in women born with low birth weights. 6,[8][9][10][11][12] An inverse relation between birth weight and risk of preeclampsia and of gestational diabetes has been shown in case-control and populationbased cohort studies. 8,21,22 In a large populationbased cohort study, Zetterström and colleagues 10 found an increased risk of preeclampsia among women born small for gestational age (v. appropriate weight for gestational age).…”

Section: Discussionmentioning

confidence: 98%

“…Some reports included the concept of full-term versus preterm birth and suggested an increased risk of gestational hypertension, preeclampsia or gestational diabetes among women born preterm. 6,11,12 These studies had a number of shortcomings. For example, in the studies by Klebanoff and coauthors 12 and Pouta and colleagues, 6 the participants were born between 1959 and 1966, and their average gestational age was not specified.…”

Section: Discussionmentioning

confidence: 99%

“…6,11,12 These studies had a number of shortcomings. For example, in the studies by Klebanoff and coauthors 12 and Pouta and colleagues, 6 the participants were born between 1959 and 1966, and their average gestational age was not specified. It is thus possible to assume that the degree of prematurity was relatively mild, because these women survived at a time when neonatology in its current form did not exist.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] However, many of these studies either have not taken into account gestational age or have a number of shortcomings, such as small sample, young population (mostly teenagers), degree of prematurity not specified or study population consisting mostly of late preterm births. 6,11,12 In the province of Quebec, weight and gestational age have been recorded in a registry for all births since 1976, and data on all hospital-based diagnoses have been collected since 1987. The aim of our study was to examine the relation between preterm birth and later pregnancy complications, independently of intrauterine growth restriction, among women born preterm in Quebec between 1976 and 1995 who delivered at least 1 newborn between 1987 and 2008.…”

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confidence: 99%

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Pregnancy complications among women born preterm

Boivin

Luo

Audibert

et al. 2012

CMAJ

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Research CMAJBackground: Adults who were born with low birth weights are at increased risk of cardiovascular and metabolic conditions, including pregnancy complications. Low birth weight can result from intrauterine growth restriction, preterm birth or both. We examined the relation between preterm birth and pregnancy complications later in life. Methods:We conducted a population-based cohort study in the province of Quebec involving 7405 women born preterm (554 < 32 weeks, 6851 at 32-36 weeks) and a matched cohort of 16 714 born at term between 1976 and 1995 who had a live birth or stillbirth between 1987 and 2008. The primary outcome measures were pregnancy complications (gestational diabetes, gestational hypertension, and preeclampsia or eclampsia).Results: Overall, 19.9% of women born at less than 32 weeks, 13.2% born at 32-36 weeks and 11.7% born at term had at least 1 pregnancy complication at least once during the study period (p < 0.001). Women born small for gestational age (both term and preterm) had increased odds of having at least 1 pregnancy complication compared with women born at term and at appropriate weight for gestational age. After adjustment for various factors, including birth weight for gestational age, the odds of pregnancy complications associated with preterm birth was elevated by 1.95-fold (95% confidence interval [CI] 1.54-2.47) among women born before 32 weeks' gestation and 1.14-fold (95% CI 1.03-1.25) among those born at 32-36 weeks' gestation relative to women born at term. Interpretation:Being born preterm, in addition to, and independent of, being small for gestational age, was associated with a significantly increased risk of later having pregnancy complications. Abstract

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pregnancy complications among women born preterm

Boivin

Luo

Audibert

et al. 2012

CMAJ

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show abstract

“…14 Associations have been noted between a woman's own birth weight and her future pregnancyrelated health, including pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes. [15][16][17] This, then, predisposes to adverse outcomes for her offspring, including intrauterine growth restriction and prematurity. 18 Human studies have also shown that pregnancy-induced hypertension and/or preeclampsia are associated with increased risk for chronic hypertension and subsequent kidney disease later in life.…”

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confidence: 99%

Long-Term Alteration in Maternal Blood Pressure and Renal Function After Pregnancy in Normal and Growth-Restricted Rats

et al. 2012

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Abstract-Intrauterine growth restriction is associated with increased risk of adult cardiorenal diseases. Small birth weight females are more likely to experience complications during their own pregnancy, including pregnancy-induced hypertension, preeclampsia, and gestational diabetes. We determined whether the physiological demand of pregnancy predisposes growth-restricted females to cardiovascular and renal dysfunction later in life. Late gestation bilateral uterine vessel ligation was performed in Wistar-Kyoto rats. At 4 months, restricted and control female offspring were mated with normal males and delivered naturally (ex-pregnant). Regardless of maternal birth weight, at 13 months, ex-pregnant females developed elevated mean arterial pressure (indwelling tail-artery catheter; ϩ6 mm Hg), reduced effective renal blood flow ( 14 C-PAH clearance; Ϫ23%), and increased renal vascular resistance (ϩ27%) compared with age-matched virgins. Glomerular filtration rate ( 3 H-inulin clearance) was not different across groups. This adverse cardiorenal phenotype in ex-pregnant females was associated with elevated systemic (ϩ57%) and altered intrarenal components of the renin-angiotensin system. After pregnancy at 13 months, coronary flow (Langendorff preparation) was halved in restricted females compared with controls, and together with reduced NO excretion, this may increase susceptibility to additional lifestyle challenges. Our results have implications for aging females who have been pregnant, suggesting long-term cardiovascular and renal alterations, with additional consequences for females who were small at birth. 1 Human studies worldwide and animal models have shown that suboptimal conditions in utero alter the development of key organ systems, including reductions in nephron and cardiomyocyte number.2-5 We and others have used a rat model to induce uteroplacental insufficiency, whereby uterine vessels are bilaterally ligated during late gestation resulting in offspring born lighter than sham controls.2,3,6,7 Although growth-restricted males go on to develop elevated blood pressure in adulthood, females appear somewhat protected up to Ն18 months, despite both sexes having similar nephron deficits. 2,3,8,9 This sexual dimorphic response to disease development is commonly cited in the programming field, with females often presenting with less severe cardiovascular disease outcomes. 10Disease risk associated with programmed changes in early life may be modulated by exposures after birth and throughout life.It has been suggested that a number of lifestyle factors, including high-salt/fat diets and aging, can increase or unmask disease outcomes in susceptible offspring.11 Low nephron endowment in growth-restricted females, for example, may be adequately compensated for until a postnatal stressor or "second hit" reveals a clinically relevant phenotype. 12Pregnancy is associated with profound physiological demands that could constitute a second hit. 13 In early pregnancy, reductions in peripheral vascular tone contribute ...

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Demography and Nutrition

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Maternal Size at Birth and the Development of Hypertension During Pregnancy

Cited by 64 publications

References 29 publications

Pregnancy complications among women born preterm

Pregnancy complications among women born preterm

Long-Term Alteration in Maternal Blood Pressure and Renal Function After Pregnancy in Normal and Growth-Restricted Rats

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