Rate of Gestational Diabetes Mellitus and Pregnancy Outcomes in Patients with Chronic Hypertension

Leon, M.G.; Moussa, Hind N.; Longo, Monica; Pedroza, Claudia; Haidar, Ziad A.; Mendez‐Figueroa, Hector; Sibai, Baha M.

doi:10.1055/s-0036-1571318

Cited by 28 publications

(8 citation statements)

References 13 publications

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“…The rate of C-sections (59%) is higher than reported for pregnant women with uncomplicated chronic hypertension 40 and corresponds to rates reported for severe preeclampsia. 39 The higher risk of gestational diabetes mellitus in the methyldopa group, that was also reported in other studies, 41 may be explained, at least in parts, by the higher BMI in this group.…”

Section: Pregnancy Complicationssupporting

confidence: 72%

Pregnancy Outcome After First Trimester Use of Methyldopa

et al. 2017

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Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4–4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. Clinical Trial Registration— URL: https://drks-neu.uniklinik-freiburg.de/drks_web/ . Unique identifier: DRKS00010502.

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Section: Pregnancy Complicationssupporting

confidence: 72%

Pregnancy Outcome After First Trimester Use of Methyldopa

et al. 2017

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“…[ 12 ] However, the outcome is unaffected in women with chronic HTN and GDM. [ 13 ] In the current study too, the presence of any form of HTN did not appear to affect neonatal outcome.…”

Section: Discussionsupporting

confidence: 47%

Maternal and neonatal outcome in mothers with gestational diabetes mellitus

Prakash

Das

Habeebullah

et al. 2017

Indian J Endocr Metab

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Introduction:Gestational diabetes mellitus (GDM) is common and is accompanied with other comorbidities. Challenges to treatment exist at our institute as it serves women with low income. This study assessed the burden of comorbidities and the outcome of GDM.Methods:This was a prospective, observational study of women with gestational diabetes attending the obstetrics department from September 2012 to April 2014. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Medical comorbidities were noted, and lipid profile was done. All the women were followed up till delivery, and the complications were recorded. Age- and parity-matched pregnant women with normal oral glucose tolerance test were recruited as controls.Results:One hundred and thirty-nine women were followed up till delivery. The average age was 28 years. Eighteen percent had bad obstetric history. The average body mass index was 28.8. Twenty-five percent had gestational hypertension (HTN), and 6.4% had chronic HTN. Thirty percent had hypothyroidism. 65% women received insulin. The glucose values were within the recommended range in 60% of the women. Maternal hypoglycemia occurred in 7 (5%) women. Forty-four percent of the women required cesarean section and 34% had complications either during pregnancy or labor. Three neonates had macrosomia. Twenty-six neonates (20%) required admission to the Neonatal Intensive Care Unit. Four neonates (3%) died. Newborns of mothers whose GDM optimally treated had less complications.Conclusion:Gestational diabetes is associated with HTN, hypothyroidism, obesity, and lipid abnormalities. The majority of women required insulin for treatment and optimal control of blood glucose resulted in lower neonatal complications.

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“…Pre-pregnancy hypertension has been linked consistently to pre-eclampsia (161)(162)(163), gestational and pre-existing diabetes (161,164,165), and PTB (43,163,166,167). Although good blood pressure control during the first trimester can reduce a woman's risk of PTB ( 168), Black women not only have higher rates of pre-pregnancy and pregnancy-related hypertension than White women (169), they also appear more susceptible to their adverse effects on gestational length (170).…”

Section: Pre-pregnancy (Chronic) Hypertensionmentioning

confidence: 99%

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Braveman

Dominguez

Burke

et al. 2021

Front. Reprod. Health

106

130

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In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

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Rate of Gestational Diabetes Mellitus and Pregnancy Outcomes in Patients with Chronic Hypertension

Cited by 28 publications

References 13 publications

Pregnancy Outcome After First Trimester Use of Methyldopa

Pregnancy Outcome After First Trimester Use of Methyldopa

Maternal and neonatal outcome in mothers with gestational diabetes mellitus

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

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