Associations of Maternal Early-Pregnancy Glucose Concentrations With Placental Hemodynamics, Blood Pressure, and Gestational Hypertensive Disorders

Abstract BACKGROUND Gestational diabetes mellitus is associated with increased risks of gestational hypertension and preeclampsia. We hypothesized that high maternal glucose concentrations in early pregnancy are associated with adverse placental adaptations and subsequently altered uteroplacental hemodynamics during pregnancy, predisposing to an increased risk of gestational hypertensive disorders. METHODS In a population-based prospective cohort study from early pregnancy onwards, among 6,078 pregnant women, maternal early-pregnancy non-fasting glucose concentrations were measured. Mid and late pregnancy uterine and umbilical artery resistance indices were assessed by Doppler ultrasound. Maternal blood pressure was measured in early, mid, and late pregnancy and the occurrence of gestational hypertensive disorders was assessed using hospital registries. RESULTS Maternal early-pregnancy glucose concentrations were not associated with mid or late pregnancy placental hemodynamic markers. A 1 mmol/l increase in maternal early-pregnancy glucose concentrations was associated with 0.71 mm Hg (95% confidence interval 0.22–1.22) and 0.48 mm Hg (95% confidence interval 0.10–0.86) higher systolic and diastolic blood pressure in early pregnancy, respectively, but not with blood pressure in later pregnancy. Also, maternal glucose concentrations were not associated with the risks of gestational hypertension or preeclampsia. CONCLUSIONS Maternal early-pregnancy non-fasting glucose concentrations within the normal range are associated with blood pressure in early pregnancy, but do not seem to affect placental hemodynamics and the risks of gestational hypertensive disorders.

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Associations of dietary glycemic index and load during pregnancy with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders

European Journal of Nutrition ◽

10.1007/s00394-021-02670-5 ◽

2021 ◽

Author(s):

Clarissa J. Wiertsema ◽

Rama J. Wahab ◽

Annemarie G. M. G. J. Mulders ◽

Romy Gaillard

Keyword(s):

Blood Pressure ◽

Glycemic Index ◽

Glycemic Load ◽

Late Pregnancy ◽

Population Based ◽

Hemodynamic Parameters ◽

High Risk Women ◽

Dietary Glycemic Load ◽

Hypertensive Disorders ◽

Dietary Glycemic Index

Abstract Purpose The aim of this study was to examine the associations of dietary glycemic index and load with gestational blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Methods In a population-based cohort among 3378 pregnant Dutch women, dietary glycemic index and load were assessed from food frequency questionnaires at median 13.4 (95% range 9.9–22.9) weeks gestation. Blood pressure was measured in early-, mid- and late-pregnancy. Placental hemodynamic parameters were measured in mid- and late-pregnancy by ultrasound. Data on gestational hypertensive disorders was acquired from medical records. Results Mean dietary glycemic index (SD) was 58 (3) and mean dietary glycemic load (SD) was 155 (47). Dietary glycemic index was not associated with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Higher dietary glycemic load SDS was associated with a higher diastolic blood pressure in early-pregnancy, remaining after adjustment for socio-demographic and lifestyle factors ((0.98 (95% CI 0.35–1.61) mmHg per SDS increase in glycemic load). No other associations of glycemic load with blood pressure or placental hemodynamic parameters and the risk of gestational hypertensive disorders were present. No significant associations of dietary glycemic index and load quartiles with longitudinal blood pressure patterns from early to late-pregnancy were present. Conclusion Within this low-risk pregnant population, we did not find consistent associations of dietary glycemic index and load with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Further studies need to assess whether the effects on gestational hemodynamic adaptations are more pronounced among high-risk women with an impaired glucose metabolism.

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Hypertensive Disorders in Pregnancy

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1677626 ◽

2018 ◽

Vol 03 (02/03) ◽

pp. 068-078

Author(s):

Lalita Nemani

Keyword(s):

Blood Pressure ◽

Gestational Hypertension ◽

Stress Test ◽

Later Life ◽

Chronic Hypertension ◽

Prevention Measures ◽

Hypertensive Disorders ◽

Increased Risk ◽

Hypertensive Disorders In Pregnancy ◽

In Pregnancy

Abstract Hypertension in pregnancy is defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg or both on two different occasions at least 6 hours apart. Severe hypertension is SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg. Hypertension is the most common medical problem in pregnancy and one of the major causes of maternal and perinatal mortality and morbidity. Hypertensive disorders in pregnancy (HDP) are classified as (1) chronic hypertension, (2) chronic hypertension with superimposed preeclampsia, (3) preeclampsia-eclampsia, and (4) gestational hypertension. HDP contributes to increased risk of hypertension, stroke, and maternal cardiovascular disease (CVD) in later life. HDP can be considered as a failed cardiovascular stress test identifying women susceptible to CVD in later life. Further research is required to identify the mechanisms in HDP that contribute to CVD in later life so as to initiate appropriate prevention measures.

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Association between maternal hypertensive disorders of pregnancy and child neurodevelopment at 3 years of age: a retrospective cohort study

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420000586 ◽

2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Masahiro Noda ◽

Satomi Yoshida ◽

Hiroki Mishina ◽

Keisuke Matsubayashi ◽

Koji Kawakami

Keyword(s):

Confidence Interval ◽

Gestational Hypertension ◽

Exposed Group ◽

Control Group ◽

Developmental Abnormality ◽

Hypertensive Disorders Of Pregnancy ◽

Developmental Abnormalities ◽

Hypertensive Disorders ◽

Increased Risk ◽

Child Neurodevelopment

Abstract Hypertensive disorders of pregnancy (HDP) affect up to 10% of women during pregnancy and influence child neurodevelopment, including mental and motor function. We assessed whether HDP, including gestational hypertension, preeclampsia, superimposed preeclampsia, and eclampsia, correlate with motor and mental developmental abnormalities in 3-year-old children, using data obtained between April 2004 and March 2013 through a mandatory population-based health checkup of mothers and children in Kobe city, Japan. The primary outcome was motor and mental developmental abnormalities at 3 years of age; parental-reported questionnaires and physician’s medical examinations were evaluated. The association between maternal HDP and child neurodevelopmental abnormality was evaluated using a logistic regression model. Of the 43,854 participating children, 1120 were born to women with HDP and 42,734 were born to women without HDP. The prevalence of motor developmental abnormality was 1.7% in the exposed group and 0.95% in the control group; the prevalence of mental developmental abnormality was 2.41% in the exposed group and 1.22% in the control group. Children born to mothers with HDP did not have an increased risk of motor developmental abnormality at the age of 3 years [adjusted odds ratio (OR) 1.17, 95% confidence interval 0.72–1.91], but had an increased risk of mental developmental abnormality (adjusted OR 1.80, 95% confidence interval 1.21–2.69). Maternal HDP were associated with mental development abnormality in 3-year-old children. These findings may be clinically relevant; mental abnormality in children born to women with HDP could be detected during early stages, which would facilitate early intervention.

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Abstract MP68: Association of Clinical and Subclinical Blood Pressure Elevation During Pregnancy With Maternal Health and Risk of Neonatal Low Birth Weight

Circulation ◽

10.1161/circ.137.suppl_1.mp68 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Jie Hu ◽

Jun Li ◽

Yang Peng ◽

Yuanyuan Li

Keyword(s):

Blood Pressure ◽

Birth Weight ◽

Maternal Health ◽

Low Birth Weight ◽

Gestational Hypertension ◽

Late Pregnancy ◽

Blood Pressure Elevation ◽

Pressure Elevation ◽

Elevated Liver Enzymes ◽

Increased Risk

Introduction: Gestational hypertension is a leading cause of maternal mortality and fetal growth restriction (FGR). However, elevated maternal blood pressure at which trimester contributes to FGR is unknown, and whether gestational prehypertension (a systolic blood pressure [SBP] of 120 - 139 mmHg or a diastolic blood pressure [DBP] of 80 - 89 mmHg) is related with FGR and maternal health is not fully studied. Methods: We analyzed the relation of elevated gestational blood pressure with risk of neonatal low-birth-weight (LBW, birth weight < 2,500 g) and maternal health throughout pregnancy in 21,620 women from a birth cohort in Wuhan, China. Maternal health indicators, including SBP and DBP, were clinically measured during up to 22 antenatal visits. LBW were acquired from medical records. Linear mixed models were used to evaluate the relations of maternal SBP and DBP with LBW. Logistic regressions were used to assess the associations of SBP and DBP in late pregnancy (38.3 weeks) with LBW. Linear regressions were used to evaluate the association of prehypertension/hypertension with indicators of maternal health. Results: Gestational blood pressure increases throughout pregnancy, but a significant elevation of SBP and DBP between 15 and 25 gestational weeks were only observed for women who later delivered LBW newborns. High gestational SBP (≥ 140 mmHg) or DBP (≥ 90 mmHg) was associated with a 220% or 98% higher risk of LBW ( P < 0.03). Notably, preclinical high SBP (120 - 139 mmHg) was also associated with a 40% higher risk of LBW ( P = 0.036). At late pregnancy, elevated gestational SBP and DBP were associated with elevated liver enzymes, blood urea nitrogen, creatinine, and uric acid levels, and decreased activated partial thromboplastin time and prothrombin time. Conclusions: A fast blood pressure elevation in the second trimester may relate with increased risk of LBW. Pregnancy prehypertension was associated with not only LBW risk, but also impaired maternal liver, kidney, and coagulation functions.

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Associations of DASH Diet in Pregnancy With Blood Pressure Patterns, Placental Hemodynamics, and Gestational Hypertensive Disorders

Journal of the American Heart Association ◽

10.1161/jaha.120.017503 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Clarissa J. Wiertsema ◽

Sara M. Mensink‐Bout ◽

Liesbeth Duijts ◽

Annemarie G. M. G. J. Mulders ◽

Vincent W. V. Jaddoe ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Vascular Function ◽

Resistance Index ◽

Late Pregnancy ◽

Population Based ◽

Dash Score ◽

Dash Diet ◽

Hypertensive Disorders ◽

Diet Score

Background The Dietary Approaches to Stop Hypertension (DASH) diet improves blood pressure in nonpregnant populations. We hypothesized that adherence to the DASH diet during pregnancy improves hemodynamic adaptations, leading to a lower risk of gestational hypertensive disorders. Methods and Results We examined whether the DASH diet score was associated with blood pressure, placental hemodynamics, and gestational hypertensive disorders in a population‐based cohort study among 3414 Dutch women. We assessed DASH score using food‐frequency questionnaires. We measured blood pressure in early‐, mid‐, and late pregnancy (medians, 95% range: 12.9 [9.8–17.9], 20.4 [16.6–23.2], 30.2 [28.6–32.6] weeks gestation, respectively), and placental hemodynamics in mid‐ and late pregnancy (medians, 95% range: 20.5 [18.7–23.1], 30.4 [28.5–32.8] weeks gestation, respectively). Information on gestational hypertensive disorders was obtained from medical records. Lower DASH score quartiles were associated with a higher mid pregnancy diastolic blood pressure, compared with the highest quartile ( P <0.05). No associations were present for early‐ and late pregnancy diastolic blood pressure and systolic blood pressure throughout pregnancy. Compared with the highest DASH score quartile, the lower DASH score quartiles were associated with a higher mid‐ and late pregnancy umbilical artery pulsatility index ( P ≤0.05) but not with uterine artery resistance index. No associations with gestational hypertensive disorders were present. Conclusions A higher DASH diet score is associated with lower mid pregnancy diastolic blood pressure and mid‐ and late pregnancy fetoplacental vascular function but not with uteroplacental vascular function or gestational hypertensive disorders within a low‐risk population. Further studies need to assess whether the effects of the DASH diet on gestational hemodynamic adaptations are more pronounced among higher‐risk populations.

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Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups.

Hypertension ◽

10.1161/hypertensionaha.121.18568 ◽

2021 ◽

Author(s):

Erica P. Gunderson ◽

Mara Greenberg ◽

Mai N. Nguyen-Huynh ◽

Cassidy Tierney ◽

James M. Roberts ◽

...

Keyword(s):

Blood Pressure ◽

Early Pregnancy ◽

Latent Class ◽

Gestational Hypertension ◽

Individual Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Race Ethnicity ◽

Trajectory Group ◽

Blood Pressure Patterns

Background: Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality and 4-fold higher perinatal mortality in Black women. Early pregnancy blood pressure patterns may differentiate risk of hypertensive disorders of pregnancy. Methods: This study identified distinct blood pressure trajectories from 0 to 20 weeks’ gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174 925 women with no prior hypertension or history of preeclampsia, prenatal care entry ≤14 weeks, and a stillborn or live singleton birth delivered at Kaiser Permanente Northern California hospitals in 2009 to 2019. We used electronic health records to obtain clinical outcomes, covariables, and longitudinal outpatient blood pressure measurements ≤20 weeks’ gestation (mean 4.1 measurements). Latent class trajectory modeling identified 6 blood pressure groups: ultra-low-declining(referent), low-declining, moderate-fast-decline, low-increasing, moderate-stable, and elevated-stable. Multivariable logistic regression evaluated trajectory group-associations with odds of preeclampsia and gestational hypertension and effect modification by race-ethnicity and prepregnancy body size. Results: Compared with ultra-low-declining, adjusted odds ratios (95% CIs) for low-increasing, moderate-stable, and elevated-stable groups were 3.25 (2.7–3.9), 5.3 (4.5–6.3), and 9.2 (7.7–11.1) for preeclampsia, and 6.4 (4.9–8.3), 13.6 (10.5–17.7), and 30.2 (23.2–39.4) for gestational hypertension. Race/ethnicity, and prepregnancy obesity modified the trajectory-group associations with preeclampsia (interaction P <0.01), with highest risks for Black, then Hispanic and Asian women for all blood pressure trajectories, and with increasing obesity class. Conclusions: Early pregnancy blood pressure patterns revealed racial and ethnic differences in associations with preeclampsia risk within equivalent levels and patterns. These blood pressure patterns may improve individual risk stratification permitting targeted surveillance and early mitigation strategies.

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Dietary Intake in Early Pregnancy and Glycemia in Late Pregnancy among Women with Obesity

Nutrients ◽

10.3390/nu14010105 ◽

2021 ◽

Vol 14 (1) ◽

pp. 105

Author(s):

Kirsti Krohn Garnæs ◽

Trude Elvebakk ◽

Øyvind Salvesen ◽

Signe Nilssen Stafne ◽

Siv Mørkved ◽

...

Keyword(s):

Dietary Intake ◽

Early Pregnancy ◽

Dairy Products ◽

Fasting Glucose ◽

Late Pregnancy ◽

Future Studies ◽

Randomized Controlled ◽

Nutritional Recommendations ◽

Increased Risk ◽

Mother And Child

Women with obesity have increased risk for hyperglycemia during pregnancy, with negative health consequences for mother and child. We aimed to investigate adherence to nutritional recommendations in early pregnancy and to examine associations between early pregnancy dietary intake and late pregnancy glycemia among women with obesity. We included 120 women with pre-pregnancy body mass index (BMI) ≥30 kg/m2 who participated in one of two randomized controlled trials. The participants completed a food frequency questionnaire in early pregnancy (gestational weeks 12–22). Fasting and 120 min glucose tolerance after ingestion of 75 g glucose were assessed in late pregnancy (gestational weeks 32–37). About 90% of the participants reported early pregnancy diary intake within the recommendations. Average intakes of vitamin D, iron, and folate were below recommended levels. High intakes of dairy products and protein in early pregnancy were associated with lower fasting glucose in late pregnancy, whereas high intake of bread was associated with lower 120 min glucose. There were no clear associations between single dietary variables and gestational diabetes mellitus (GDM) diagnosis in late pregnancy. In conclusion, some early pregnancy dietary variables were associated with late pregnancy glycemia. Potential causality of these findings should be investigated in future studies.

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Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2738 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Kim ◽

H Jung ◽

P.S Yang ◽

H.T Yu ◽

T.H Kim ◽

...

Keyword(s):

Blood Pressure ◽

Pulse Pressure ◽

Middle Age ◽

Population Based ◽

Entire Cohort ◽

Incident Dementia ◽

Increased Risk ◽

Diagnosis Of Dementia ◽

History Of ◽

The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p<0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p<0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

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Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

Journal of Scleroderma and Related Disorders ◽

10.1177/23971983211034074 ◽

2021 ◽

pp. 239719832110340

Author(s):

Yasser A Radwan ◽

Reto D Kurmann ◽

Avneek S Sandhu ◽

Edward A El-Am ◽

Cynthia S Crowson ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Systemic Sclerosis ◽

Confidence Interval ◽

Cumulative Incidence ◽

Disease Onset ◽

Population Based ◽

Hazard Ratio ◽

Conduction Disorders ◽

Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

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Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

Psychological Medicine ◽

10.1017/s0033291704002740 ◽

2004 ◽

Vol 34 (8) ◽

pp. 1431-1441 ◽

Cited By ~ 133

Author(s):

ULRIKA KREICBERGS ◽

UNNUR VALDIMARSDÓTTIR ◽

ERIK ONELÖV ◽

JAN-INGE HENTER ◽

GUNNAR STEINECK

Keyword(s):

Psychological Distress ◽

Relative Risk ◽

Confidence Interval ◽

Stressful Life Event ◽

Population Based ◽

Anxiety And Depression ◽

Control Group ◽

Bereaved Parents ◽

Increased Risk ◽

Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

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