Risks of hypertensive disorders in the second pregnancy

Zhang, J

doi:10.1016/s0029-7844(00)00761-4

Cited by 28 publications

(33 citation statements)

References 13 publications

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“…This is unfortunate because they are parts of the placental syndrome. The same applies for the (19) 153 (17) .055 0 19,21,27,29,30,[34][35][36] Maximum diastolic blood pressure, mm Hg b 331 c 107 c (11) 100 c (8.9) < .001 c 25 29,30,34,35,39 Proteinuria >300 mg/24 h 119 c 82 c (69%) 58 c (49%) .011 c 0 20,27,29,30,34,35 Thrombocytopenia <100 Â 10 9 /L 162 37 (23%) 18 (11%) .24 0 20,29,30,34,35 Use of medication [19][20][21]23,25,28,29,30,[34][35][36] Oral antihypertensive 504 c 295 c (59%) 237 c (47% 16,17,[19][20][21][22]25,26,[28][29]…”

Section: Recurrence Ratesmentioning

confidence: 96%

“…The item "selection of the nonexposed cohort" was not relevant in this individual participant data analysis and therefore was indicated as "low risk" in all studies. 17,19,20,22,24,27,[29][30][31][32]34,35,38,39 Smoking, n (%) 27,304 5654 (21) 6 17,19,20,22,26,29,30,31,[34][35][36]39 Ethnicity, n (%) 25,807 16,19,[23][24][25][26][27][28][29][30][32][33][34][35][36]39 European 20,785 (81) 17,22,23,25,29,30,[32][33]…”

Section: Risk Of Bias Graphmentioning

confidence: 99%

“…Of these, 236 women (41%) had recurrence of a hypertensive disorder in the next pregnancy. Women with recurrence experienced chronic hypertension more often than women 17,20,22,25,27,28,[30][31][32]34,35,37,38 Neonatal intensive care unit admissions, n (%) 5117 1157 (22) 1.2 20,38 Perinatal death, n (%) 98,078 1608 (1.6) 1.6 16,17,19,20,22,24,25,27,[29][30][31][32]34,35,[37][38][39] Characteristics at the subsequent pregnancy Birth interval, mo b 59,754 41 AE 25 17,20,22,[29][30][31][32]34,35,39 Change of partner, n (%) 7344 668 (9) 0.7 16,17,22,23,35,39 Use of prophy...…”

Section: Chronic Hypertension After Pregnancymentioning

confidence: 99%

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Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Oostwaard

Langenveld

Schuit

et al. 2015

American Journal of Obstetrics and Gynecology

123

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Section: Recurrence Ratesmentioning

confidence: 96%

Section: Risk Of Bias Graphmentioning

confidence: 99%

Section: Chronic Hypertension After Pregnancymentioning

confidence: 99%

See 1 more Smart Citation

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Oostwaard

Langenveld

Schuit

et al. 2015

American Journal of Obstetrics and Gynecology

123

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“…One study reported a recurrence risk of 19% for gestational hypertension, 32% for pre-eclampsia, and 46% for pre-eclampsia superimposed on pre-existing chronic hypertension. 22 In addition, severe isolated IUGR is also a risk factor for developing hypertension in a subsequent pregnancy. 22 w36…”

Section: Risk Of Recurrence Of Hypertensive Disorders In a Subsequentmentioning

confidence: 99%

Management of hypertension before, during, and after pregnancy

James

Nelson‐Piercy²

2004

Heart

205

114

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H ypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. It complicates up to 15% of pregnancies and accounts for approximately a quarter of all antenatal admissions. The hypertensive disorders of pregnancy cover a spectrum of conditions, of which pre-eclampsia poses the greatest potential risk and remains one of the most common causes of maternal death in the UK. NORMAL PHYSIOLOGICAL CHANGE IN BLOOD PRESSURE DURING PREGNANCY cEarly in the first trimester there is a fall in blood pressure caused by active vasodilatation, achieved through the action of local mediators such as prostacyclin and nitric oxide. This reduction in blood pressure primarily affects the diastolic pressure and a drop of 10 mm Hg is usual by 13-20 weeks gestation.1 Blood pressure continues to fall until 22-24 weeks when a nadir is reached. After this, there is a gradual increase in blood pressure until term when pre-pregnancy levels are attained. Immediately after delivery blood pressure usually falls, then increases over the first five postnatal days.w1 Even women whose blood pressure was normal throughout pregnancy may experience transient hypertension in the early post partum period, perhaps reflecting a degree of vasomotor instability. DEFINITION OF HYPERTENSION IN PREGNANCY AND BLOOD PRESSURE MEASUREMENTHypertension in pregnancy is diagnosed either from an absolute rise in blood pressure or from a relative rise above measurements obtained at booking. The convention for the absolute value is a systolic . 140 mm Hg or a diastolic . 90 mm Hg. However, it should be recognised that blood pressure is gestation related. A diastolic blood pressure of 90 mm Hg is 3 standard deviations (SD) above the mean for mid pregnancy, 2 SD at 34 weeks, and 1.5 SD at term. w2 The definition for a relative rise in blood pressure incorporates either a rise in systolic pressure of . 30 mm Hg or rise in diastolic pressure of . 15 mm Hg above blood pressure at booking. Blood pressure must be elevated on at least two occasions and measurements should be made with the woman seated and using the appropriate cuff size. Late in the second trimester and in the third trimester, venous return may be obstructed by the gravid uterus and, if supine, blood pressure should be taken with the woman lying on her side. Korotkoff phase I and V (disappearance) should be used, rather than phase IV (muffling), since it is more reproducible 2 and shows better correlation with true diastolic blood pressure in pregnancy.3 If phase V is not present, phase IV should be recorded. Automated systems for blood pressure measurement have been shown to be unreliable in severe pre-eclampsia w3-4 and tend to under record the true value. CLASSIFICATION OF HYPERTENSIVE DISORDERS OF PREGNANCYThere are three types of hypertensive disorders: c chronic hypertension c gestational hypertension c pre-eclampsia Chronic hypertensionChronic hypertension complicates 3-5% of pregnancies 4 although this figure may r...

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“…Two recent meta-analyses of treatment trials for mild to moderate hypertension in pregnancy showed a direct linear relationship between a treatment-induced reduction in blood pressure and the proportion of infants who were small for gestational age; treatment with all classes of antihypertensive agents was studied [19,20]. Women who have had preeclampsia are more prone to hypertensive complications in future pregnancies [21]. Those with persistent hypertension postpartum or recurrent preeclampsia should be clinically evaluated for secondary causes prior to further conception.…”

Section: Causes Of Hypertensionmentioning

confidence: 99%

Hypertension in women

Taler

2009

Current Science Inc

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Systolic blood pressure is higher in African American and Hispanic women older than 60 and in white women older than 70 than it is in men. Coupled with their longer survival, elderly women have higher hypertension prevalence rates, particularly for isolated systolic hypertension. Hemodynamic characteristics differ by sex for premenopausal women and age-matched men, but these differences lessen after menopause. This transition may result from hormonal or metabolic alterations, including weight gain and tissue adiposity, which are common after menopause. Clinical trials enrolling large numbers of women support the benefits of treatment to reduce cardiovascular events and mortality. The trend to enroll subjects with several comorbidities and thereby increase event rates may limit the applicability of trial results to healthier women. Women appear more prone to develop side effects from antihypertensive medications and may metabolize these agents differently. There is a need for additional studies regarding appropriate drug selection, dosage, and combination therapy for women.

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Risks of hypertensive disorders in the second pregnancy

Cited by 28 publications

References 13 publications

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis

Management of hypertension before, during, and after pregnancy

Hypertension in women

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