BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy

HDP (hypertensive diseases in pregnancy) are one of the leading causes of maternal and fetal mortality and morbidity. BMI (body mass index) is an established risk factor for pre-eclampsia, but its role in HELLP syndrome is unknown. We therefore investigated BMI as a risk factor in the development of HELLP syndrome. At the beginning of pregnancy, BMI was measured in 1067 women with a history of HDP and 1063 controls. Diagnoses of HDP were classified according to ISSHP (International Society for the Study of Hypertension in Pregnancy) and BMI according to WHO (World Health Organization) criteria. After verification of exclusion criteria and matching for confounders, 687 women with hypertensive diseases in pregnancy and 601 controls remained for statistical evaluation by χ2 test and multiple logistic regressions. As a continuous variable, the increase in BMI was associated with an increase in the development of gestational hypertension {OR (odds ratio), 1.1 [95% CI (confidence interval) 1.062–1.197]} and pre-eclampsia [OR, 1.1 (95% CI, 1.055–1.144)]}, but not for HELLP syndrome. According to WHO definitions, overweight women (BMI ≥25 and <30 kg/m2) had a 2-fold (95% CI, 1.365–2.983) risk and obese women (BMI ≥30 kg/m2) had a 3.2-fold (95% CI, 1.7–5.909) risk of developing pre-eclampsia when compared with women of normal weight (BMI ≥15.5 and <25 kg/m2). Being overweight or having obesity had no effect on the risk of HELLP syndrome. As an increased BMI is correlated with the risk of developing pre-eclampsia but not HELLP syndrome, both diseases have a different risk profile. This finding supports that underlying physiological mechanisms in pre-eclampsia vary from those in HELLP syndrome.

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Evaluation of maternal and fetal outcome in pregnancies complicated by jaundice-an observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210995 ◽

2021 ◽

Author(s):

Ruchi Kishore ◽

Neha Thakur ◽

Mitali Tuwani

Keyword(s):

Mortality Rate ◽

Observational Study ◽

Maternal Mortality ◽

Viral Hepatitis ◽

Hellp Syndrome ◽

Fetal Outcome ◽

Maternal Outcome ◽

Fetal Mortality ◽

Maternal Mortality Rate ◽

In Pregnancy

Background: The spectrum of jaundice in pregnancy varies from a benign condition with good maternal and fetal outcome to a severe form resulting in liver failure and maternal and fetal mortality. Jaundice may complicate 3-5% of pregnancies. Present study was aimed to analyze the cause, course and impact of jaundice during pregnancy so as to have better understanding and hence better feto-maternal outcome. The present study aimed to analyze the various causes of hepatic dysfunction in pregnancy, maternal and fetal outcome in pregnancies complicated by jaundice and various hematological and liver function variables for predicting maternal and fetal outcome.Methods: The present study was an observational study conducted in the department of obstetrics and gynecology, Pt. JNM medical college and associated Dr. BRAM hospital, Raipur (CG) over period of 2 year from September 2018 to September 2020.Results: Total 0.72% pregnancies were complicated by jaundice. HELLP syndrome was the commonest cause of jaundice in pregnancy (36.7%), followed by viral hepatitis (32.7%). Hepatitis E was the most common type of viral hepatitis (91.8%). Hemolytic jaundice presented with best maternal outcome (maternal mortality rate 8.6%). Worst maternal outcome was seen in AFLP (maternal mortality rate 100%). Best fetal outcome was seen in viral hepatitis (live birth rate 67.6%), whereas worst noted with AFLP (fetal death rate 66.6%). Higher total serum bilirubin, higher serum AST, anemia and deranged INR had significant correlation with maternal mortality.Conclusions: HELLP syndrome and viral hepatitis are preventable causes of jaundice yet it contributed to significant proportion of maternal deaths in 26.5 and 18.5% cases respectively. AFLP is often under diagnosed and had a fulminant course in pregnancy causing maternal and fetal mortality.

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High BMI: an important health risk factor among older adults in Ghana

Public Health Nutrition ◽

10.1017/s1368980020003717 ◽

2020 ◽

pp. 1-8

Author(s):

E Yorke ◽

J Tetteh ◽

Vincent Boima ◽

AE Yawson

Keyword(s):

Risk Factor ◽

Health Risk ◽

Prevalence Rate ◽

Chronic Conditions ◽

Communicable Disease ◽

Normal Weight ◽

Overweight And Obesity ◽

World Health ◽

Health Risk Factor ◽

The Individual

Abstract Objective: We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above. Design: We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined. Setting: Households from all the administrative regions of Ghana. Participants: Included 3350 adults aged 50 years and older. Results: The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants. Conclusion: Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative.

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Hypertension in Pregnancy, Gestational Hypertension, Pre Eclampsia, Eclampsia and HELLP Syndrome

Lectures in Obstetrics, Gynaecology and Women’s Health ◽

10.1007/978-3-319-14863-2_27 ◽

2015 ◽

pp. 129-130

Author(s):

Gab Kovacs ◽

Paula Briggs

Keyword(s):

Hellp Syndrome ◽

Gestational Hypertension ◽

Hypertension In Pregnancy ◽

In Pregnancy

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Pheochromocytoma in pregnancy: a case report and review of literature

Obstetric Medicine ◽

10.1258/om.2010.090063 ◽

2010 ◽

Vol 3 (2) ◽

pp. 83-85 ◽

Cited By ~ 3

Author(s):

J George ◽

J Y L Tan

Keyword(s):

Gestational Hypertension ◽

Beta Blockers ◽

Cardiovascular Complications ◽

Definitive Treatment ◽

Fetal Mortality ◽

Optimal Timing ◽

Tumour Resection ◽

Urinary Catecholamines ◽

Operative Control ◽

In Pregnancy

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although phaeochromocytoma is a rare cause of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. The diagnosis can be confirmed by measurement of plasma and urinary catecholamines and their metabolities followed by radiological localization of the tumour. Surgical resection of the tumour after adequate pre-operative control of hypertension using sequential alpha- followed by beta-blockers is the definitive treatment. In pregnancy, depending on the gestation at which diagnosis is made, the optimal timing for surgery is during the late first or early second trimester. When the pregnancy is more advanced, medical management followed by combined caesarean section and tumour resection closer to term is preferred.

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Obesity-associated cardiovascular risk in women: hypertension and heart failure

Clinical Science ◽

10.1042/cs20210384 ◽

2021 ◽

Vol 135 (12) ◽

pp. 1523-1544

Author(s):

Jessica L. Faulkner

Keyword(s):

Heart Failure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

Cardiovascular Event ◽

African Ancestry ◽

Obese Women ◽

Prevalence Of Obesity ◽

Female Specific ◽

In Pregnancy

Abstract The pathogenesis of obesity-associated cardiovascular diseases begins long prior to the presentation of a cardiovascular event. In both men and women, cardiovascular events, and their associated hospitalizations and mortality, are often clinically predisposed by the presentation of a chronic cardiovascular risk factor. Obesity increases the risk of cardiovascular diseases in both sexes, however, the clinical prevalence of obesity, as well as its contribution to crucial cardiovascular risk factors is dependent on sex. The mechanisms via which obesity leads to cardiovascular risk is also discrepant in women between their premenopausal, pregnancy and postmenopausal phases of life. Emerging data indicate that at all reproductive statuses and ages, the presentation of a cardiovascular event in obese women is strongly associated with hypertension and its subsequent chronic risk factor, heart failure with preserved ejection fraction (HFpEF). In addition, emerging evidence indicates that obesity increases the risk of both hypertension and heart failure in pregnancy. This review will summarize clinical and experimental data on the female-specific prevalence and mechanisms of hypertension and heart failure in women across reproductive stages and highlight the particular risks in pregnancy as well as emerging data in a high-risk ethnicity in women of African ancestry (AA).

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Smoking and the risk of developing hypertensive diseases in pregnancy: what is the effect on HELLP syndrome?

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1080/00016340600804670 ◽

2006 ◽

Vol 85 (10) ◽

pp. 1217-1224 ◽

Cited By ~ 6

Author(s):

Brigitte Leeners ◽

Peruka Neumaier-Wagner ◽

Sabine Kuse ◽

Werner Rath

Keyword(s):

Hellp Syndrome ◽

Hypertensive Diseases ◽

In Pregnancy

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Pre-Pregnancy Obesity vs. Other Risk Factors in Probability Models of Preeclampsia and Gestational Hypertension

Nutrients ◽

10.3390/nu12092681 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2681 ◽

Cited By ~ 2

Author(s):

Małgorzata Lewandowska ◽

Barbara Więckowska ◽

Stefan Sajdak ◽

Jan Lubiński

Keyword(s):

Risk Factors ◽

Maternal Obesity ◽

Gestational Hypertension ◽

Continuous Variable ◽

Vitamin Supplementation ◽

Extended Model ◽

Probability Models ◽

Hypertension In Pregnancy ◽

Net Reclassification Improvement ◽

In Pregnancy

In the face of the obesity epidemic around the world, attention should be focused on the role of maternal obesity in the development of pregnancy. The purpose of this analysis was to evaluate the prediction of preeclampsia (PE) and isolated gestational hypertension (GH) for a number of maternal factors, in order to investigate the importance of pre-pregnancy obesity (body mass index, BMI ≥ 30 kg/m2), compared to other risk factors (e.g., prior PE, pregnancy weight gain (GWG), infertility treatment, interpregnancy interval, family history, the lack of vitamin supplementation, urogenital infection, and socioeconomic factors). In total, 912 women without chronic diseases were examined in a Polish prospective cohort of women with a single pregnancy (recruited in 2015–2016). Separate analyses were performed for the women who developed GH (n = 113) vs. 775 women who remained normotensive, as well as for those who developed PE (n = 24) vs. 775 controls. The probability of each disease was assessed for the base prediction model (age + primiparity) and for the model extended by one (test) variable, using logistic regression. Three measures were used to assess the prediction: area under curve (AUC) of the base and extended model, integrated discrimination improvement (IDI) (the index shows the difference between the value of the mean change in the predicted probability between the group of sick and healthy women when a new factor is added to the model), and net reclassification improvement (NRI) (the index focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including results for healthy and sick women). In the GH prediction, AUC increased most strongly when we added BMI (kg/m2) as a continuous variable (AUC = 0.716, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.068, p < 0.001). The addition of BMI as a continuous variable or BMI ≥ 25 kg/m2 improved the classification for healthy and sick women the most (NRI = 0.571, p < 0.001). In the PE prediction, AUC increased most strongly when we added BMI categories (AUC = 0.726, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.050, p = 0.080). The addition of BMI categories improved the classification for healthy and sick women the most (NRI = 0.688; p = 0.001). After summing up the results of three indexes, the probability of hypertension in pregnancy was most strongly improved by BMI, including BMI ≥ 25 kg/m2 for the GH prediction, and BMI ≥ 30 kg/m2 for the PE prediction. Main conclusions: Pre-pregnancy BMI was the most likely factor to increase the probability of developing hypertension in pregnancy, compared to other risk factors. Hierarchies of PE and GH risk factors may suggest different (or common) mechanisms of their development.

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Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China?

BMJ Open ◽

10.1136/bmjopen-2020-037095 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037095

Author(s):

Yunhui Tang ◽

Mingzhi Zhao ◽

Luling Lin ◽

Yifei Gao ◽

George Qiaoqi Chen ◽

...

Keyword(s):

Body Mass Index ◽

Risk Factor ◽

Body Mass ◽

Case Control Study ◽

Case Control ◽

Normal Weight ◽

Reproductive Age ◽

Obese Patients ◽

Obese Women ◽

Control Study

ObjectiveEndometriosis is considered as a serious gynaecological disease in women at a reproductive age. Lower body mass index (BMI) is thought to be a risk factor. However, recent studies indicated that women with normal BMI were also more likely to develop endometriosis, suggesting the association with BMI is controversial. We therefore investigated the association of BMI and surgically diagnosed endometriosis in a cohort of Chinese women.DesignRetrospective case–control study.SettingTertiary hospital.Patients709 women with endometriosis and 807 age matched controls between January 2018 and August 2019.InterventionAge at diagnosis, parity, gravida, BMI and self-reported dysmenorrhoea status were collected and the association of BMI and endometriosis was analysed.Measurement and main resultsOverall, the median BMI was not different between patients and controls (21.1 kg/m2 vs 20.9 kg/m2, p=0.223). According to the BMI categories for Asians/Chinese by WHO (underweight: <18.5 kg/m2, normal weight: 18.5–22.99 kg/m2, overweight: 23–27.49 kg/m2, obese: ≥27.50 kg/m2), overall, there was no difference in the association of BMI and endometriosis (p=0.112). 60% of patients were of normal weight. However, the OR of obese patients (BMI over 27.50 kg/m2) having endometriosis was1.979 (95% CI 1.15 to 3.52, p=0.0185), compared with women with normal weight. 50.3% patients reported dysmenorrhoea, and the OR of developing severe dysmenorrhoea in obese patients (BMI over 27.50 kg/m2) was 3.64 (95% CI 1.195 to 10.15, p=0.025), compared with patients with normal weight.ConclusionOur data demonstrate that overall there was no association between BMI and the incidence of endometriosis, but there was a significant increase in the incidence of endometriosis in obese women, compared with women with normal weight. Obesity was also a risk factor for severe dysmenorrhoea.

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Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

10.21203/rs.2.15750/v1 ◽

2019 ◽

Author(s):

Qiang Liu ◽

Guan-jun LING ◽

Shao-quan ZHANG ◽

Wen-qing ZHAI ◽

Yi-juan CHEN

Keyword(s):

Acute Kidney Injury ◽

Cohort Studies ◽

Pregnancy Outcomes ◽

Hellp Syndrome ◽

Meta Analysis ◽

Kidney Injury ◽

Fetal Mortality ◽

Infant Outcomes ◽

Maternal And Infant Outcomes ◽

In Pregnancy

Abstract Background HELLP syndrome is a common complication during pregnancy,especially among those who with gestational hypertension. At present, the impact of HELLP syndrome on AKI（acute kidney injury） and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and acute kidney injury during pregnancy and pregnancy outcomes. Methods We systematically searched PubMed , Embase and Cochrane Databases for cohort studies to assess the effect of HELLP syndrome on P-AKI(acute kidney injury in pregnancy) and maternal and infant outcomes. Using odds ratio (OR) with 95% confidence interval (CI) were pooled with a random- or fixed-effect models when appropriate. Results This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome has been associated with relatively higher risk of AKI during pregnancy（OR4.87 95% CI 3.31～7.17，P＜0.001）, fetal mortality（OR1.56 95% CI 1.45～2.11，P＜0.001） and Maternal death（OR3.70 95% CI 1.72～7.99，P＜0.001）. Conclusions HELLP syndrome has been associated with relatively higher risk of P-AKI, fetal mortality and Maternal death .

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