The inverse association between gastroschisis and gestational hypertension

Payne, Nathaniel R.; Pfleghaar, Kathleen M.; Blauer, C.; Finkelstein, Marsha; Olsen, Sam

doi:10.3233/npm-2011-2756

Cited by 3 publications

(3 citation statements)

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“…Researchers from the US National Birth Defects Prevention Study reported increased risks for a number of CHDs, including septal defects, and severe hypospadias for women diagnosed with unspecified hypertensive disorders . Comparable with our results, an inverse association between gestational hypertension and gastroschisis has been reported, although a different definition for this hypertensive disorder was used in the previous study. Furthermore, we observed increased ORs for having an infant with a VSD or left‐sided defect among women with late initiation of antihypertensive medication for gestational hypertension.…”

Section: Discussionsupporting

confidence: 76%

Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case–control study

Gelder

Bennekom

Louik

et al. 2014

BJOG

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Objective To study previously identified associations between specific maternal hypertensive disorders and/or prenatal exposure to antihypertensive medication and birth defects.Design Case-control study.Setting Slone Birth Defects Study, 1998-2010.Population A total of 5568 cases with birth defects and 7253 liveborn infants without malformations as controls.Methods Adjusted odds ratios (aORs) for birth defects associated with prenatal exposure to maternal hypertensive disorders and/or antihypertensive medication were calculated using multivariable logistic regression analyses.Main outcome measures Specific birth defects previously linked to maternal hypertension or antihypertensive medication use during pregnancy.Results Non-pharmacologically managed chronic hypertension was associated with a three-fold risk of oesophageal atresia (95% CI 1.2-8.3), and pre-eclampsia superimposed on nonpharmacologically managed chronic hypertension was associated with ventricular septal defects (aOR 3.9, 95% CI 1.3-11.7) and atrial septal defects (aOR 6.5, 95% CI 1.8-23.7). For chronic hypertension that was pharmacologically treated early in pregnancy, increased risks were observed for first-degree hypospadias (aOR 2.9, 95% CI 1.1-7.4). Non-pharmacologically managed pre-eclampsia was related to second-/third-degree hypospadias and ventricular septal defects. Pharmacological treatment for gestational hypertension was associated with a number of congenital heart defects.Conclusions Our results confirm some, but not all, previously identified associations between pharmacologically treated and non-pharmacologically managed hypertensive disorders and specific birth defects. They support the hypothesis that physiological changes early in pregnancy that manifest in gestational hypertension and pre-eclampsia may play a role in the aetiology of major birth defects, including congenital heart defects and hypospadias.

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Section: Discussionsupporting

confidence: 76%

Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case–control study

Gelder

Bennekom

Louik

et al. 2014

BJOG

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“…Villous edema also suggested placental dysfunction. In a separate study, we found evidence that gestational hypertension is less common in the mothers of gastroschisis patients [ 42 ]. The placenta plays a central role in the development of gestational hypertension [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause

et al. 2011

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BackgroundGastroschisis patients are commonly small for gestational age (SGA, birth weight [BW] < 10th centile). However, the extent, symmetry and causes of that growth restriction remain controversial.MethodsWe compared BW, crown-heel length (LT), occipitofrontal circumference (OFC) and ponderal index (PI) in 179 gastroschisis cases and 895 matched controls by univariate and multiple regression. Fetal ultrasounds (N = 80) were reviewed to determine onset of growth restriction. Placental histology was examined in 31 gastroschisis patients whose placental tissue was available and in 29 controls.ResultsGastroschisis cases weighed less than controls (BW = 2400 ± 502 g vs. 2750 ± 532 g, p < 0.001) and their BW frequency curve was shifted to the left, indicating lower BW as a group compared to controls (p < 0.001 by Kolmogorov-Smirnov test). BW differences varied from -148 g at 33 weeks to -616 g at 38 weeks gestation. Intrauterine growth restriction was symmetric with gastroschisis patients having a shorter LT (45.7 ± 3.3 vs. 48.4 ± 2.7 cm, p < 0.001), smaller OFC (31.9 ± 1.9 vs. 32.9 ± 1.6 cm, p < 0.001), but larger ponderal index (2.51 ± 0.37 vs. 2.40 ± 0.16, p < 0.001) compared to controls. Gastroschisis patients had a similar reduction in BW (-312 g, 95% confidence interval [CI] = -367, -258) compared to those with chromosomal abnormalities (-239 g, CI = -292, -187). Growth deficits appeared early in the second trimester and worsened as gestation increased. Placental chorangiosis was more common in gastroschisis patients than controls, even after removing all SGA patients (77% vs. 42%, p = 0.02).ConclusionsMarked, relatively symmetric intrauterine growth restriction is an intrinsic part of gastroschisis. It begins early in the second trimester, and is associated with placental chorangiosis.

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“…To assess the possibility of differences in hypertension classification between cases and controls, we repeated all of our analyses among nonsydromic cases, using logistic regression and “malformed controls.” These controls consisted of cases in the Texas Birth Defects Registry that did not have hypospadias or other birth defects that have been previously reported to be associated with maternal hypertension in >1 published study [Lebby et al, ; Banhidy et al, ; Payne et al, ; Baer et al, ; Ramakrishnan et al, ; van Gelder et al, ]. Because differences in the distribution of maternal education were observed between cases and controls (see Results section), we also conducted post hoc analyses, repeating all of the analyses (among nonsyndromic cases, including those involving malformed controls), further adjusting for maternal education.…”

Section: Methodsmentioning

confidence: 99%

Maternal hypertension and risk for hypospadias in offspring

Agopian

Hoang

Mitchell

et al. 2016

American J of Med Genetics Pt A

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Hypospadias is one of the most common birth defects in male infants. Maternal hypertension is a suspected risk factor; however, few previous studies have addressed the possibility of reporting bias, and several previous studies have not accounted for hypospadias severity. We analyzed data from the Texas Birth Defects Registry for 10,924 nonsyndromic cases and statewide vital records for deliveries during 1999-2009, using Poisson regression. After adjustment for potential confounders, hypospadias was associated with maternal hypertension (adjusted prevalence ratio: 1.5, 95% confidence interval: 1.4-1.7). Similar associations were observed with gestational and pregestational hypertension, including separate analyses restricted to the subset of cases with severe (second- or third-degree) hypospadias. All of these associations were also similar among the subset of cases with isolated hypospadias (without additional birth defects). To evaluate the potential for bias due to potential hypertension misclassification, we repeated our analyses using logistic regression, comparing the cases to controls with other birth defects. In these analyses, the associations with gestational hypertension were similar, but adjusted associations with pregestational hypertension were no longer observed. Our findings support an association between gestational hypertension and hypospadias in offspring, but also suggest that previously observed associations with pregestational hypertension may have been inflated due to differential misclassification of hypertension (e.g., reporting bias). As gestational hypertension is recognized after hypospadias development, more research is needed to determine if this association reflects an increase in gestational hypertension risk secondary to hypospadias or if both conditions have shared risk factors (e.g., precursors of gestational hypertension). © 2016 Wiley Periodicals, Inc.

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The inverse association between gastroschisis and gestational hypertension

Cited by 3 publications

References 0 publications

Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case–control study

Maternal hypertensive disorders, antihypertensive medication use, and the risk of birth defects: a case–control study

Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause

Maternal hypertension and risk for hypospadias in offspring

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