scholarly journals Determination of serum vitamin D status of mothers and newborns and related outcomes

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Ufuk Ayşe Kepkep ◽  
Ayla Gulden Pekcan
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Anthropometric Measurements ◽  
Health Concern ◽  
Serum Vitamin D ◽  
Severe Deficiency ◽  
Vitamin D Levels

AbstractVitamin D deficiency (VDD) has been associated with severe adverse health outcomes during pregnancy is increasingly recognised as a public health concern and maternal and infant VDD is closely associated. The aim of this study was to evaluate the magnitude of VDD and associated factors in pregnant women and newborns in the postpartum period. A cross-sectional study was carried out in a total of 66 pregnant women at > 37 weeks of gestation and newborns at the Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology in Gaziantep, Turkey. Demographic characteristics, 24-h dietary recalls, intake of food supplements were determined in pregnant women, maternal and newborn anthropometric measurements and serum (25-OHD) levels were assessed. Mean age (± SD) of pregnant women was 28.8 ± 6.9 years. Although Turkey has “National Vitamin D Supplementation Programme for Pregnant Women” only 33.3% of women had VD supplementation during pregnancy, not all in the recommended levels (1200 IU/day). Mean (± SD) serum 25(OH)D levels in pregnant women and cord blood of newborns were 17.3 ± 9.0 ng/mL [non-supplemented women (NSW): 16.5 ± 7.9 ng/mL; supplemented women (SW): 18.8 ± 11.0 ng/mL] and 16.6 ± 9.9 ng/mL [newborns of non-supplemented women (NNSW): 13.9 ± 8.7 ng/mL and newborns of supplemented women (NSW): 22.1 ± 10.1 ng/mL], respectively. Vitamin D severe deficiency (< 10 ng/dL) was noted in 22.7%, deficiency (11–19 ng/mL) 51.5%, insufficiency (20–29 ng/mL) 15.2% and sufficiency (≥ 30 ng/mL) 10.6% of the women whereas severe deficiency, deficiency, insufficiency and sufficiency respectively, were determined in 33.3%, 39.5%, 13.6% and 13.6% of newborns (NNSW vs NSW, p = 006, p < 0.05). Median serum VD levels of NSW were statistically higher than NNSW (p = 0.000, p < 0.05). Out of total, 86.4% of women were dressing traditionally covered, and had lower serum VD level (p = 0.049, p > 0.05). SW had higher median body weight (p = 0.026) and body mass index (BMI) (p = 0.036) levels than NSW (p < 0.05). No statistically significant differences were found between anthropometric measurements of NNSW and NSW groups, although birth weights of NNSW and NSW groups were determined as 3005.1 ± 456.1 g and 3153 ± 422.5 g (p > 0.05), respectively. Maternal serum vitamin D levels strongly were correlated with newborn levels. Maternal vitamin D deficiency is a great problem and “National Vitamin D Supplementation Programme for Pregnant Women and Infants” should be effectively implemented and monitored. Also fortification programme should be a national policy.

scholarly journals Prevalence of vitamin D deficiency and effect of vitamin D supplementation on feto-maternal outcome in tertiary care centre

2018 ◽  
Vol 7 (12) ◽  
pp. 4912
Author(s):  
Munmun Yadav ◽  
Mahendra Kumar Verma ◽  
Mohan Bairwa ◽  
Govardhan Meena ◽  
Lata Rajoria
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Tertiary Care ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Increased Risk ◽  
Vitamin D Levels ◽  
Risk Of Preeclampsia

Background: Vitamin D deficiency is widely prevalent throughout the world. Pregnant women, neonates and infants form most vulnerable groups for vitamin D deficiency. Hypovitaminosis D in pregnancy has been reported to cause various fetomaternal effect, i.e. increased risk of preeclampsia (PE), gestational diabetes mellitus (GDM), caesarean section, hypocalcemia, subclinical myopathy, neonatal tetany, hyperbilirubinemia congenital rickets and infantile rickets, etc. Only few Indian studies are available in this regard. The objectives are to find prevalence of vitamin D deficiency in pregnant women and to evaluate the effect of supplementation with cholecalciferol in improving vitamin D levels in pregnant women and evaluate its correlation with feto-maternal outcome.Methods: A prospective observational was conducted on 120 Pregnant women on their first visit to hospital irrespective of gestational age were offered the test and on the basis of inclusion and exclusion criteria are included in study and vitamin D level was done to know the prevalence of vitamin D deficiency. Apart from routine obstetrical investigation, serum vitamin D (total) level was estimated. All results were recorded and analyzed statically.Results: Out of 120 patients 101 (84.1%) were found to be vitamin D deficient. Mean age of vitamin D deficient group was 28.31±3.86 and sufficient group was 26.37±2.83.81 (67.5%) were vegetarian and 39 (32.5%) were nonvegetarian.75 (92.59%) vegetarian and 26 (66.66%) non-vegetarian found to be vitamin D deficient. (p<0.05). Vitamin D supplementation has been observed to reduce risk of preeclampsia. (p<0.05) and vitamin D sufficiency associated with reduced risk of low birth weight babies.Conclusions: Vitamin D supplementation reduces risk of maternal comorbidities and helps improve neonatal outcomes.

scholarly journals VITAMIN D DEFICIENCY;

2012 ◽  
Vol 19 (02) ◽  
pp. 208-213
Author(s):  
MUHAMMAD ASLAM ◽  
ZAHID MASOOD ◽  
Abdul SATTAR ◽  
Maria Qudsia
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Sampling Technique ◽  
Reproductive Age ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Vitamin D 3

Objective: To study the Prevalence of Vitamin D deficiency in pregnant women. Study Design: A Cross-sectional analyticalstudy through convenient sampling technique. Setting and duration: At a private Clinic located at East Canal Road Faisalabad, from March2011 to June 2011. Material and method: The study included consecutive 61 pregnant women of reproductive age and non-pregnant womenwere excluded. Blood samples were taken in morning i.e. overnight fasting samples, by venepuncture by disposable syringes sample weretaken and samples were stored at -20 degree centigrade till they were analyzed. Our interest was in age and serum Vitamin D 3 levels. Results:Out of 61 pregnant women results showed that 87.0% pregnant women were having Vitamin D deficiency, 10.0% were having Vitamin Dinsufficiency, 3.0% had Vitamin D sufficiency and none shows Vitamin D intoxication. Vitamin D deficiency was more prevalent in pregnantwomen of younger age group. Furthermore prevalence was higher among the pregnant mothers with high parity. Moreover, 65% women werenot exposed to sunlight properly, 60% women had muscle cramps and bony aches. 90% women never were tested for tested Vitamin D levelsbefore. Conclusions: Prevalence of Vitamin D deficiency is significant in pregnant women. It is also important for its effects on various organsand systems of body as well as on pregnancy and neonate. The different aspects of study led to conclusion to emphasize that Health educationbe imparted to pregnant women and their families in terms of diet, proper sunlight exposure and taking Vitamin D supplements in pregnancy. It isthus recommended to perform Vitamin D levels in every pregnant woman.

scholarly journals Influence of Supplementary Vitamin D on the Prognostic Pathway of Type1 Diabetes Among Children

2021 ◽  
Vol 14 (1) ◽  
pp. 303-309
Author(s):  
Mostafa Hassan Ragab ◽  
Eman Monir Sherif ◽  
Nadia Badawy Abd- El Gawad ◽  
Safaa Mohamed Elserougy ◽  
Eman Essam Shaban ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Oral Vitamin ◽  
Intake Assessment ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Egyptian Children ◽  
The Impact

Diabetes is one of the commonest chronic diseases worldwide. Vitamin D deficiency showed to be increasing, and have a potential role in autoimmune diseases among which in type 1 diabetes. The aim The aim of the study was to assess the impact of oral vitamin D supplementation on blood glucose (HbA1C) in T1DM patients and to find out the role of vitamin D as a biomarker for follow of T1DM patients compared to HbA1C. Subjects and methods: A randomized interventional clinical study was designed. The study enrolled 60 children patients with T1DM. Only 45 children continued to the end of study. Initial (pre-intake) assessment included history taking, clinical examination, and measurement of serum 25-OH vitamin D3 and serum HbA1C. These children received oral vitamin D supplements for 3 months then post-intake assessment were done again. Results: The study showed that serum vitamin D was deficient among Egyptian children and adolescents with T1DM (mean 11.4±3.4 ng/ml). , 53.33% of the patients had vitamin D deficiency with a 35.6% had insufficiency and 11.11% were VD sufficient. Patients received oral vitamin D supplementation for 3 months after which marked improvement in the levels of serum vitamin D levels and HA1C, 87.5% and 86.5% respectively.

Vitamin D status among patients with drug-resistant and non-drug-resistant epilepsy

2020 ◽  
Vol 90 (3-4) ◽  
pp. 205-209
Author(s):  
Pierre Jésus ◽  
Bertrand Godet ◽  
Lucile Darthou-Pouchard ◽  
Philippe Fayemendy ◽  
Françoise Abdallah-Lebeau ◽  
...  
Keyword(s):  
Vitamin D ◽  
Drug Resistance ◽  
Vitamin D Deficiency ◽  
Fat Mass ◽  
Serum Vitamin ◽  
Anthropometric Measurements ◽  
Drug Resistant ◽  
Vitamin D Status ◽  
Serum Vitamin D ◽  
Severe Deficiency

Abstract. Background & Aims: Epilepsy affects nearly 70 million people worldwide. Vitamin D deficiency may influence the balance of certain epilepsies. The purpose of this study was to determine the vitamin D status and anthropometric measurements of people with epilepsy (PWE), according to their pharmacosensitivity. Methods: Forty-six PWE, with or without drug resistance, underwent nutritional assessment after giving consent. Weight, body mass index (BMI), triceps skinfold thickness (TSF), fat mass (FM) and free fat mass (FFM) by bioelectrical impedance analysis were measured. Serum vitamin D was determined without supplementation. Deficiency was defined as a level < 30 ng/mL. Statistical analysis involved Student t test, ANOVA and Chi2. Results: Patients were aged 44.5 ± 14.3 years, with 60.9% of drug-resistance. BMI was 28.7 ± 7.0, 2.2% were malnourished and 30.4% obese according to the BMI. The average vitamin D level was 15.3 ± 9.9 ng/mL, with 87.0% of deficiency, and 40.0% of severe deficiency (<10 ng/mL). The TSF was higher in drug-resistant cases (p = 0.03). There was no link between drug resistance and anthropometric measurements, FM, FFM or vitamin D concentration. Conclusions: Although limited in size, this study showed that PWE are more often obese. Vitamin D deficiency is more common than in the general population, with a much higher prevalence of severe deficiency.

Vitamin D Levels in Pregnant Congolese Women and Their New-Borns, and the Association with Neonatal Outcomes – A Pilot Study

2020 ◽  
Author(s):  
Gurpreet Dhillon ◽  
Sunil Rai ◽  
Harpreet Dhillon ◽  
Shibu Sasidharan ◽  
Costa Kimweri ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Preterm Births ◽  
Maternal Serum ◽  
Neonatal Outcomes ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Sufficient Vitamin

Abstract Background: This study was thus undertaken to study the estimation of vitamin D levels in pregnant women and their newborns in DRC and to study its association with various neonatal outcomes. Methods: Observational study done on 569 pregnant women and their newborn babies. Sample obtained from maternal serum and cord blood from the placental end during peripartum period. The data was analysed to estimate the prevalence of vitamin D levels in mothers and newborns and to identify association, if any, between maternal vitamin D levels and neonatal outcomes.Results: 464 mothers had sufficient vitamin D (VDS) levels (>30 ng/dL) and 105 had vitamin D deficiency (VDD) with mean maternal serum vitamin D level of 35.63ng/ml (SD 6.18, range 9.2-39.8). All the newborns (n=569) were vitamin D deficient (<30ng/ml). The percentage of LBW babies born to VDD mothers was 18.09%, which was very similar to the percentage of LBW babies born to VDS mothers (18.31%) (p=0.76456749). The incidence of caesarean section was 58.09% in the vitamin D deficient (VDD) group as compared to 19.61% in the sufficient (VDS) group (p<0.0005). The incidence of preterm births was 10.77% in the sufficient group (VDS) as compared to 17.14% in the vitamin D deficient (VDD) group (p=0.038). Conclusion: Our findings will help health professionals, policy makers, and the general public in Africa aware of the high prevalence of vitamin D deficiency and the associated health risks.

scholarly journals Attenuation of Oxidative Stress, Interleukin-6, High-Sensitivity C-Reactive Protein, Plasminogen Activator Inhibitor-1, and Fibrinogen with Oral Vitamin D Supplementation for Six Months in Patients with Type 2 Diabetes Mellitus having Vitamin D Deficiency

2021 ◽  
Author(s):  
Pullaiah Pasupuleti ◽  
M.M. Suchitra ◽  
Aparna R. Bitla ◽  
Alok Sachan
Keyword(s):  
Oxidative Stress ◽  
Vitamin D ◽  
Cardiovascular Risk ◽  
Vitamin D Deficiency ◽  
Repeated Measures ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Pai 1

Abstract Objectives Type 2 diabetes mellitus (T2DM) associated with oxidative stress and inflammation causes endothelial dysfunction, which promotes cardiovascular risk. Vitamin D with its pleiotropic effect is said to protect against cardiovascular risk. However, with vitamin D deficiency being more prevalent in T2DM, the cardiovascular risk may get compounded. Materials and Methods An interventional study was conducted on 100 patients with T2DM having vitamin D deficiency (vitamin D < 20 ng/mL), who were given oral supplementation of 2,000 IU/day of vitamin D for a period of 6 months. Serum vitamin D, biomarkers of oxidative stress, malondialdehyde (MDA), oxidized LDL (OxLDL), ferric reducing ability of plasma (FRAP), biomarkers of inflammation, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen were measured at baseline and at the end of the third and sixth month of vitamin D supplementation. Statistical Analysis Repeated measures analysis of variance (ANOVA) was applied for comparison between baseline and third- and sixth-month data after vitamin D supplementation. Linear regression by generalized estimating equations (GEE), which grouped repeated measures for each subject and accounted for correlations that may occur from multiple observations within subjects, was applied. Results Serum vitamin D levels reached normal levels with a significant decrease in OxLDL, hsCRP, IL-6, PAI-1, and fibrinogen levels, with a significant increase in FRAP (p = 0.001) levels at the end of 6 months of vitamin D supplementation. These changes were observed even after correction with glycemic control (HbA1c). However, a significant decrease in MDA was observed only at the end of the sixth month of vitamin D supplementation. Vitamin D levels showed a significant negative association with Ox-LDL, Hs-CRP, IL-6, PAI-1, and fibrinogen, even after adjusting for BMI and statin use (p = 0.001). Conclusion Supplementation of vitamin D for a period of 6 months in patients with T2DM having vitamin D deficiency is beneficial in the attenuation of oxidative stress and inflammation.

scholarly journals Vitamin D Deficiency in South Sharqiya in Oman and its Impact in ENT Patients- A Retrospective Study

2016 ◽  
Vol 24 (3) ◽  
pp. 122-128
Author(s):  
Hasan Abdul Cader Segana ◽  
Reghunandanan Nair ◽  
Fahim Ahmed Shah
Keyword(s):  
Vitamin D ◽  
Retrospective Study ◽  
Vitamin D Deficiency ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Socioeconomic Background ◽  
Vitamin D Metabolism ◽  
Serum Vitamin D ◽  
Vitamin D Levels

Introduction Vitamin D deficiency has multitude of causes and can present with varying clinical manifestations. Studies show that it can lead on to recurrent respiratory infections, ear infections and deafness. Vitamin D also has immunomodulant action. Here we discuss the varying features concerning an Otolaryngologist in general as far as Vitamin D metabolism is concerned. Materials and Methods This retrospective study was performed on 800 patients 152 males and 648 females of different socioeconomic background at secondary level regional referral hospital under Ministry of Health in Sultanate of Oman. The patients attending the outpatient clinic with various complaints and not responding to conventional treatment were advised for assessment of vitamin D [25 (OH) D] level in blood. The patients were evaluated with general history, blood samples of serum calcium, phosphate, alkaline phosphatase and serum vitamin D level were measured by the most standardized laboratory of the country. Results Out of 800 patients, 275 cases had Vitamin D levels below 20 ng/ml and 167 patients had values greater than 30 ng/ml in serum.81% patients with vitamin D deficiency were females.56.25% patients were between third and sixth decade. Otolaryngologic manifestations were acute and recurrent URTI (n=352) 44%. 7% of the patients presented with recurrent ear infection (otitis externa). The rest of them presented to a lesser extent with deafness, otosclerosis. Discussion Vitamin D deficiency has been reported worldwide as one of the commonest deficiency diseases. It can lead to autoimmune dysfunctions, Beta cell dysfunction in pancreas, Multiple sclerosis, recurrent chest infections and congestive cardiac failure. Studies have shown the involvement of cochlea with sensorineural hearing loss and otosclerosis. Conclusion Vitamin D deficiency has multi system implications as patients presenting with different signs and symptoms. Mass level screening and vitamin D supplementation should be planned to decrease its varied and multidimensional ill effects on health. Adequate vitamin D supplementation and sensible sunlight exposure to reach optimal vitamin D status are among the front line factors of prophylaxis for spectrum of disorders.

scholarly journals Effect of hypovitaminosis D and its related factors in pregnant women and their newborns

2019 ◽  
Vol 8 (3) ◽  
pp. 1115
Author(s):  
Amrita Sandhu ◽  
Ruchira Nautiyal ◽  
Vinit Mehrotra ◽  
Sanober Wasim
Keyword(s):  
Vitamin D ◽  
Cord Blood ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Negative Correlation ◽  
Serum Vitamin ◽  
Related Factors ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
The Impact

Background: Maternal and fetal vitamin D deficiency has nowadays emerged as a frequent morbidity. Adequate vitamin D concentrations during pregnancy are necessary to maintain neonatal calcium homeostasis, bone maturation and mineralization. Objectives of this study were to evaluate serum vitamin D concentration in mothers and its correlation with neonatal cord blood vitamin D at the time of delivery and to study the impact of hypovitaminosis on neonatal anthropometry. Effect of related factors like calcium (Ca), alkaline phosphatase (ALP) and parathyroid hormone (PTH) on maternal vitamin D levels were to be evaluated.Methods: Cross sectional study was done on a total of 220 healthy uncomplicated antenatal females with singleton pregnancy attending labor room at the time of delivery. Maternal and neonatal cord blood samples were drawn in the delivery room and analyzed. Neonatal anthropometry was recorded. Correlations among various maternal and neonatal factors were studied.Results: Widespread vitamin D deficiency was observed in expectant subjects and neonates with 70.91% having deficient levels which were also reflected in newborns (71.82%). Maternal ALP (r= -0.5503, p=0.000) bears a weak negative correlation (p<0.05), maternal serum Ca positive correlation (r = 0.7486, p=0.000) and plasma PTH levels a negative correlation (r = -2.084, p=0.000) with hypovitaminosis. No significant correlation was observed between neonatal anthropometry and vitamin D levels.Conclusions: High prevalence of hypovitaminosis was observed among pregnant women and their neonates in this study. A positive linear relationship was seen between maternal and cord blood vitamin D (r 0.974, p 0.0001).

scholarly journals Association between Preeclampsia and vitamin D Deficiency

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A S Elhoussieny ◽  
M E Ibrahim ◽  
H F Gad ◽  
E H Mahdi
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Maternity Hospital ◽  
Control Group ◽  
Major Health Problem ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
25 Hydroxy Vitamin D

Abstract Background Preeclampsia is a pregnancy-specific disorder that affects 3–5% of pregnant women worldwide and is one of the most frequently encountered medical complications of pregnancy. Recent research has pointed towards some role of vitamin D deficiency in pathogenesis of preeclampsia. Vitamin D deficiency in pregnant women and their children is a major health problem, with potential adverse consequences for overall health. Aim of the Study The aim of this study is to investigate the serum vitamin D levels in preeclampsia and healthy normotensive pregnant women. Patients and Methods This case control study was conducted at Ain Shams University Maternity Hospital from November 2017. The study included pregnant women 20-35years this study will be carried out on pregnant women recruited at pre labour room (preeclamptic group) and (non preeclamptic group) at Ain Shams University Maternity Hospital, 50 women in each group. Results All samples were screened by DRG® 25-OH Vitamin D (total) ELISA (EIA-5396) and it was found that mean 25 hydroxy vitamin D levels were lower in preeclamptic group than normotensive control group. Mean level of 25 hydroxy vitamin D between preeclamptic cases was 13.98 ±4.98 ng/ml and between normotensive controls was15.62± 3.51 ng/ml. Conclusion This study has shown no association between vitamin D deficiency and pre-eclampsia, supporting no role for vitamin D as a preventative agent against preeclampsia.

scholarly journals Prevalence of vitamin D deficiency in patients of hypertensive disorders of pregnancy and normal pregnant women

2020 ◽  
Vol 8 (12) ◽  
pp. 4383
Author(s):  
Asha Sharma ◽  
Jaya Choudhary ◽  
Piyush Joshi ◽  
Neha Bardhar
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Hypertensive Disorders Of Pregnancy ◽  
Serum Vitamin D ◽  
Hypertensive Disorders ◽  
Vitamin D Levels ◽  
Study Population ◽  
Labour Room

Background: The aim of this study was to compare vitamin D level in normal pregnant women and patients of hypertensive disorders of pregnancy and to study the prevalence of vitamin D deficiency in patients of hypertensive disorders of pregnancy and normal pregnant women.Methods: 50 women affected by hypertensive disorders of pregnancy and 50 normal pregnant women more than 20 weeks of gestation, admitted to the ward or to labour room in the Obstetrics and Gynaecology Department, of Mahatma Gandhi Medical College and Hospital were enrolled in the study. Assessment of serum 25 hydroxy vitamin D was done by chemiluminescent immunoassay method.Results: Serum vitamin D levels were low in women with hypertensive disorders of pregnancy with mean serum vitamin D level 13.66±7.358 ng/ml as compared to normal normotensive pregnant women 21.14±8.241ng/ml, which is statistically significant (p=0.001). Mean vitamin D level in study population was 17.40±8.634 ng/ml. The prevalence of vitamin D deficiency in hypertensive disorders of pregnancy group was very high 88% compared to 50% in normal normotensive pregnant women group. The difference was statistically significant (p=0.001). vitamin D deficiency was found among 69% in study population.  Conclusions: Vitamin D levels are deficient in patients of hypertensive disorders of pregnancy as compared to normal pregnant women. There is increased prevalence of vitamin D deficiency with hypertensive disorders of pregnancy suggesting that vitamin D deficiency can be a risk factor for the development of hypertensive disorders of pregnancy.

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