Hypertensive disorders in pregnancy: A population-based study

Centre for Perinatal Health Services Research, University of Sydney, NSW, Australia.
The Medical journal of Australia (Impact Factor: 4.09). 05/2005; 182(7):332-5.
Source: PubMed


To determine population-based rates and outcomes of hypertensive disorders in pregnancy.
Cross-sectional study using linked population databases.
All women, and their babies, discharged from hospital following birth in New South Wales, between 1 January 2000 and 31 December 2002.
Rates of hypertensive disorders in pregnancy, maternal and infant morbidity and mortality, and level of hospital care for the birth admission.
250 173 women and their 255 931 infants were included in the study. Overall, 24 517 women (9.8%) had a hypertensive disorder in pregnancy, including 1411 (0.6%) with chronic hypertension, 10 379 (4.2%) with pre-eclampsia, 731 (0.3%) with chronic hypertension with superimposed pre-eclampsia, and 10 864 (4.3%) with gestational hypertension. Women with, and infants exposed to, hypertension were more likely to suffer death or major morbidity than those without hypertension. Infants of mothers with hypertension were more likely to be to born preterm and small for gestational age. Just over half the women with major morbidity or mortality delivered in hospitals with a high level of medical care. In contrast, most infants with major morbidity or mortality were delivered in hospitals with neonatal intensive care units.
Hypertension is a common complication of pregnancy, and adverse outcomes are increased among hypertensive women and their babies. Clinicians appear to be better at identifying and seeking an appropriate level of care for pregnancies where the infant is at risk of a poor outcome than when the mother is at risk. More specific antenatal indicators of poor maternal outcome would help guide the referral of hypertensive women to higher levels of care.

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    • "Pre-eclampsia with a frequency of 3-7% is a pregnancy related disorder constituting one of the leading causes of fetal and maternal morbidity and mortality world-wide.[12] It is more frequent in nulliparous young women and in older multiparous women.[3] "
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    ABSTRACT: Background:Evidence of increased oxidative stress due to endothelial dysfunction in pre-eclampsia has been well-established. Increase in the oxidative stress is associated with abnormal lipid profile.Aim:The aim of the study is to compare serum lipids in pre-eclamptic women and healthy pregnant women.Subjects and Methods:In this case-control study, blood samples were collected from 40 pregnant females diagnosed as pre-eclampsia and 80 normal pregnant females at the Department of Obstetrics and Gynecology at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia between February 2009 and January 2010. We evaluated serum levels of total cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglyceride in women with pre-eclampsia and those of women with normal pregnancies. Data was analyzed using SPSS for Windows (version 17.0, SPSS Inc., Chicago, Illinois, USA). The data is presented descriptively and test for significance was done using the student t-test for continous data.Results:Women with pre-eclampsia exhibited higher serum triglyceride levels compared with normal pregnant women (P < 0.01). Other measured serum lipids did not differ significantly in the two groups.Conclusion:We recommend that any pregnant female with higher serum triglyceride concentrations may be further investigated for pre-eclampsia. Further large scale multicenter studies are required to establish the use of measuring serum triglyceride levels to screen the pregnant females for pre-eclampsia.
    No preview · Article · Jul 2014
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    • "Hypertensive disorders complicate 5-10% of pregnancies and contribute greatly to maternal and fetal morbidity and mortality throughout the world [1-3]. Population-based Australian studies undertaken in Victoria [4] and South Australia [5] have shown a prevalence of 9.8% and 9.2% respectively, however, Australian Indigenous women have been reported as having 66% greater risk for pregnancy-induced hypertension when compared with non-Indigenous women [6]. Australian Aboriginal and Torres Strait Islander women are also at comparatively higher risk for developing chronic hypertension and cardiovascular disease at a younger age than other Australian women [7,8]. "
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    ABSTRACT: Background Compared to other Australian women, Indigenous women are frequently at greater risk for hypertensive disorders of pregnancy. We examined pre-pregnancy factors that may predict hypertension in pregnancy in a cohort of Aboriginal and Torres Strait Islander women in north Queensland. Methods Data on a cohort of 1009 Indigenous women of childbearing age (15–44 years) who participated in a 1998–2000 health screening program in north Queensland were combined with 1998–2008 Queensland hospitalisations data using probabilistic data linkage. Data on the women in the cohort who were hospitalised for birth (n = 220) were further combined with Queensland perinatal data which identified those diagnosed with hypertension in pregnancy. Results Of 220 women who gave birth, 22 had hypertension in the pregnancy after their health check. The mean age of women with and without hypertension was similar (23.7 years and 23.9 years respectively) however Aboriginal women were more affected compared to Torres Strait Islanders. Pre-pregnancy adiposity and elevated blood pressure at the health screening program were predictors of a pregnancy affected by hypertension. After adjusting for age and ethnicity, each 1 cm increase in waist circumference showed a 4% increased risk for hypertension in pregnancy (PR 1.04; 95% CI; 1.02-1.06); each 1 point increase in BMI showed a 9% adjusted increase in risk (1.09; 1.04-1.14). For each 1 mmHg increase in baseline systolic blood pressure there was an age and ethnicity adjusted 6% increase in risk and each 1 mmHg increase in diastolic blood pressure showed a 7% increase in risk (1.06; 1.03-1.09 and 1.07; 1.03-1.11 respectively). Among those free of diabetes at baseline, the presence of the metabolic syndrome (International Diabetes Federation criteria) predicted over a three-fold increase in age-ethnicity-adjusted risk (3.5; 1.50-8.17). Conclusions Pre-pregnancy adiposity and features of the metabolic syndrome among these young Aboriginal and Torres Strait Islander women track strongly to increased risk of hypertension in pregnancy with associated risks to the health of babies.
    Full-text · Article · Feb 2013 · BMC Public Health
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    • "Pregnancy-induced hypertension (PIH) occurs in approximately 6 to 20% of pregnant women1). In hypertensive pregnancies, the risk of cesarean delivery, abruption of placenta, preterm delivery, and intrauterine growth restriction (IUGR) are increased, and the perinatal outcome of mothers and infants can become worse2-4). Infants born to mothers with PIH have a higher incidence of neutropenia and thrombocytopenia in the early postnatal days5,6). Although the exact underlying mechanisms are unclear, it is thought to be associated with decreased hematogenesis in the bone marrow or immunological destruction5,7). "
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    ABSTRACT: In this study, we aimed to investigate the perinatal clinical conditions of very low birth weight (VLBW) infants born to mothers with pregnancy-induced hypertension (PIH) focusing on the effects of early postnatal neutropenia. We reviewed the medical records of 191 VLBW infants who were born at Konyang University Hospital, between March 2003 and May 2011. We retrospectively analyzed the clinical characteristics of the infants and their mothers and compared the incidence of perinatal diseases and mortality of the infants according to the presence or absence of maternal PIH and neutropenia on the first postnatal day. Infants born to mothers with PIH showed an increased incidence of neutropenia on the first postnatal day (47.4%), cesarean delivery, and intrauterine growth restriction. When the infants born to mothers with PIH showed neutropenia on the first postnatal day, their incidence of respiratory distress syndrome (RDS) was increased (P=0.031); however, the difference was not found to be significant through logistic regression analysis. In all the VLBW infants, neutropenia on the first postnatal day was correlated with the development of RDS. The incidence of the other perinatal diseases involving sepsis and mortality did not significantly differ according to the presence or absence of neutropenia in infants born to mothers with PIH. In VLBW infants born to mothers with PIH, the incidence of neutropenia on the first postnatal day was increased and it was not significantly correlated with the development of perinatal diseases involving RDS, sepsis, and mortality.
    Full-text · Article · Dec 2012 · Korean Journal of Pediatrics
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