scholarly journals 1241Alcohol and hypertensive disorders of pregnancy: a negative control analysis

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Flo Martin ◽  
Abigail Fraser ◽  
Luisa Zuccolo
Keyword(s):  
Alcohol Intake ◽  
Gestational Hypertension ◽  
Negative Control ◽  
Sensitivity Analyses ◽  
Control Analysis ◽  
Hypertensive Disorders Of Pregnancy ◽  
Multinomial Regression ◽  
Alcohol Sensitivity ◽  
Hypertensive Disorders ◽  
Parents And Children

Abstract Background Alcohol increases blood pressure, yet estimates of its association with pre-eclampsia range from positive to negative. Here we estimated the association of maternal drinking during pregnancy with preeclampsia and gestational hypertension, separately and jointly as hypertensive disorders of pregnancy (HDP). We also used partner’s alcohol intake as a negative control exposure to strengthen causal inference. Methods We used data on self-reported alcohol intake in the Avon Longitudinal Study of Parents And Children (ALSPAC, N∼9,000). HDP was ascertained from obstetric notes. Multivariable multinomial regression models were adjusted for confounders and mutually-adjusted for partner’s or maternal alcohol. Sensitivity analyses assessed the robustness of results to assumptions of no selection bias, no reporting bias, and no residual confounding (e.g. comparing estimates for beer and wine separately, which have different socioeconomic patterning). Results In mutually-adjusted analyses, maternal and partner’s drinking were associated with decreased HDP odds (OR(95% CI): 0.86(0.77–0.96) and 0.82(0.70-0.97)) respectively. In contrast, the negative control design confirmed the expected associations for maternal but not partner’s smoking (figure), demonstrating the validity of this approach. Multiple sensitivity analyses did not alter results. Estimates were more extreme for increasing levels of wine compared to increasing levels of beer drinking. Conclusions Our extensive negative control and sensitivity analyses point at confounding mechanisms shared between mothers and partners as the most plausible explanation for the alcohol-HDP association. Key messages It is unlikely that alcohol intake in pregnancy reduces the risk of HDP.

scholarly journals Alcohol intake and hypertensive disorders of pregnancy: a negative control analysis in the ALSPAC cohort

2021 ◽  
Author(s):  
Florence Z Martin ◽  
Abigail Fraser ◽  
Luisa Zuccolo
Keyword(s):  
Alcohol Intake ◽  
Causal Effect ◽  
Negative Control ◽  
Sensitivity Analyses ◽  
Mendelian Randomisation ◽  
Control Analysis ◽  
Inverse Association ◽  
Hypertensive Disorders Of Pregnancy ◽  
Beverage Type ◽  
Hypertensive Disorders

AbstractIntroductionAlcohol intake increases blood pressure, yet estimates of associations between maternal intake and hypertensive disorders of pregnancy (HDP) are sparse and range from null to a protective effect. Here we estimated the association of maternal drinking during pregnancy with preeclampsia and gestational hypertension (separately and jointly, as HDP). We used partner’s alcohol intake as a negative control exposure, beverage type-specific models, and a range of sensitivity analyses to strengthen causal inference and reduce the influence of bias.MethodsWe performed a prospective cohort study using data on self-reported alcohol intake in the UK Avon Longitudinal Study of Parents And Children (ALSPAC) and HDP ascertained from obstetric notes. Multivariable multinomial regression models were adjusted for confounders and mutually adjusted for partner’s or maternal alcohol intake in the negative control analysis. We also performed a beverage type analysis of the effect of beer and wine separately on HDP risk, due to different social patterning associated with different drinks. Sensitivity analyses assessed the robustness of results to assumptions of no recall bias, no residual confounding, and no selection bias.ResultsOf the 8,999 women eligible for inclusion, 1,490 developed HDP (17%). Both maternal and partner’s drinking were associated with decreased HDP odds (mutually adjusted odds ratio 0.86, 95% confidence interval 0.77 to 0.96, P-value=0.008 and 0.82, 0.70 to 0.97, P=0.018, respectively). We demonstrate the validity of the negative control analyses using the same approach for smoking as the exposure. This confirmed an inverse association for maternal but not partner’s smoking, as expected. Estimates were more extreme for increasing levels of wine intake compared to increasing levels of beer. Multiple sensitivity analyses did not alter our conclusions.ConclusionWe observed an inverse relationship between alcohol intake during pregnancy and risk of HDP for both maternal and, more surprisingly, partner’s drinking. We speculate that this is more likely to be due to common environmental exposures shared between pregnant women and their partners, rather than a true causal effect. This warrants further investigation using different study designs, including Mendelian randomisation.

scholarly journals Hypertensive disorders of pregnancy, respiratory outcomes and atopy in childhood

2015 ◽  
Vol 47 (1) ◽  
pp. 156-165 ◽  
Author(s):  
Seif O. Shaheen ◽  
Corrie Macdonald-Wallis ◽  
Debbie A. Lawlor ◽  
A. John Henderson
Keyword(s):  
Risk Factor ◽  
Lung Function ◽  
Gestational Hypertension ◽  
Positive Association ◽  
Epidemiological Studies ◽  
Forced Expiratory Volume ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Parents And Children ◽  
Respiratory Outcomes

Few epidemiological studies have investigated the role of hypertensive disorders of pregnancy in the aetiology of childhood respiratory and atopic outcomes.In the Avon Longitudinal Study of Parents and Children we examined associations of maternal gestational hypertension, hypertension before pregnancy and pre-eclampsia with wheezing at 18 months, wheezing and asthma at 7 years and lung function at 8–9 years, after controlling for potential confounders (n=5322–8734, depending on outcome).Gestational hypertension was not associated with any of the outcomes. There was weak evidence for a positive association between pre-eclampsia and early wheezing (adjusted OR 1.31, 95% CI 0.94–1.82, compared to normotensive pregnancies) and for negative associations between pre-eclampsia and forced expiratory volume in 1 s (adjusted mean difference in sd score −0.14, 95% CI −0.33–0.06) and maximal mid-expiratory flow (−0.15, 95% CI −0.34–0.04). Hypertension before pregnancy was positively associated with wheezing (OR 1.63, 95% CI 1.16–2.31) and asthma (OR 1.34, 95% CI 1.00–1.79).Gestational hypertension is unlikely to be a risk factor for childhood respiratory disorders; hypertension before pregnancy may be a risk factor for childhood wheezing and asthma, but this finding needs replication. Larger studies are needed to confirm whether pre-eclampsia is associated with impaired childhood lung function.

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

Basal Plate Myometrial Fibers and Hypertensive Disorders of Pregnancy: A Case–Control Study

2017 ◽  
Vol 21 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Ann A Wang ◽  
Linda M Ernst ◽  
Emily S Miller
Keyword(s):  
Case Control Study ◽  
Gestational Hypertension ◽  
Case Control ◽  
Basal Plate ◽  
Common Finding ◽  
Pathological Examination ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Control Study

Introduction Basal plate myometrium (BPMYO), the pathological presence of myometrial fibers in the basal plate, is a common finding on pathological examination of the placenta, yet its clinical correlates are not well studied. As myometrial fibers are frequently located in proximity to poorly converted maternal spiral arteries, our objective was to determine whether BPMYO is associated with hypertensive disorders of pregnancy (HDP), a well-known clinical sequela of abnormal maternal artery remodeling. Methods This case–control study included women who delivered a live-born singleton gestation whose placentas were sent for pathological examination. Cases were women with HDP (gestational hypertension, preeclampsia, or HELLP syndrome) as defined by American College of Obstetricians and Gynecologists. Controls were women without HDP. Women with chronic hypertension were excluded. The primary outcome was the presence of BPMYO. Secondary outcomes included the pathologic stage of BPMYO and the incidence of pathologically defined accreta. Each outcome was compared between cases and controls in bivariable and multivariable analyses. Results Of the 306 women who met inclusion criteria, 230 (75%) had HDP. BPMYO was present in 99 (32%) of placentas. Compared to controls, cases were younger, had higher body mass index, and were more likely to have diabetes, be nulliparous, deliver preterm, and have had a prior cesarean. There were no differences in the incidence of BPMYO, stage of BPMYO, or incidence of pathologically defined accreta between cases and controls. These findings persisted after controlling for potential confounders. Conclusions Although BPMYO may be more common in the setting of abnormal placental vasculature, there is no significant association between BPMYO and HDP.

scholarly journals Dopamine in the Pathophysiology of Preeclampsia and Gestational Hypertension: Monoamine Oxidase (MAO) and Catechol-O-methyl Transferase (COMT) as Possible Mechanisms

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Wendy N. Phoswa
Keyword(s):  
Monoamine Oxidase ◽  
Gestational Hypertension ◽  
Morbidity And Mortality ◽  
Therapeutic Interventions ◽  
Hypertensive Disorders Of Pregnancy ◽  
Methyl Transferase ◽  
Hypertension In Pregnancy ◽  
Health Burden ◽  
Hypertensive Disorders ◽  
In Pregnancy

Purpose of the Review. Hypertension in pregnancy is the global health burden. Amongst the hypertensive disorders of pregnancy, preeclampsia and gestational hypertension are the world’s leading disorders that lead to both maternal and fetal morbidity and mortality. Recent Findings. Dopamine inactive metabolites, namely, monoamine oxidase (MAO) and catechol-O-methyl transferase (COMT), have been reported to be associated with hypertensive disorders of pregnancy such preeclampsia and gestational hypertension. Summary. This review discusses the involvement of MAO and COMT in the pathophysiology of both conditions in order to have a better understanding on the pathogenesis of both conditions, suggesting promising therapeutic interventions and subsequently reducing maternal and fetal morbidity and mortality.

scholarly journals Heart Failure in Women With Hypertensive Disorders of Pregnancy

Hypertension ◽  
2020 ◽  
Vol 76 (5) ◽  
pp. 1506-1513 ◽  
Author(s):  
Michael C. Honigberg ◽  
Hilde Kristin Refvik Riise ◽  
Anne Kjersti Daltveit ◽  
Grethe S. Tell ◽  
Gerhard Sulo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gestational Hypertension ◽  
Hazard Ratio ◽  
Hypertensive Disorders Of Pregnancy ◽  
First Birth ◽  
Hypertensive Disorders

Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84–2.35], P =0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50–2.68, P <0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery ( P interaction =0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.

scholarly journals A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy

2020 ◽  
Vol 37 (08) ◽  
pp. 837-844 ◽  
Author(s):  
John R. Barton ◽  
George R. Saade ◽  
Baha M. Sibai
Keyword(s):  
Pregnant Women ◽  
Disease Progression ◽  
Complete Blood Count ◽  
Gestational Hypertension ◽  
Epigastric Pain ◽  
Signs And Symptoms ◽  
Health Care Facilities ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. Key Points

scholarly journals Hypertension in pregnancy: Pathophysiology and treatment

2019 ◽  
Vol 7 ◽  
pp. 205031211984370 ◽  
Author(s):  
Stephanie Braunthal ◽  
Andrei Brateanu
Keyword(s):  
Gestational Hypertension ◽  
Severe Hypertension ◽  
Organ Damage ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
In Pregnancy ◽  
The Ideal

Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.

scholarly journals Fetal Outcome in Hypertensive Disorders of Pregnancy.

2013 ◽  
Vol 12 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Arju Chand Singh ◽  
Sadikchya Singh Rana
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Antihypertensive Drugs ◽  
Gestational Hypertension ◽  
Fetal Outcome ◽  
Intrauterine Fetal Death ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Study Results ◽  
Low Birth Weight Babies

Introduction: Hypertensive disorders are the most common medical complications of pregnancy, affecting approximately 5-10% of pregnancies and the major cause of maternal and infant disease and death worldwide. Very few researches have been done in Nepal to analyze the effect of hypertension in fetus. The aim of this study was to determine the incidence and perinatal morbidity of hypertensive disorders of pregnancy. Methods: This was a hospital based prospective observational study conducted at Paropakar Maternity and Women’s hospital. The study was conducted from 18th October to 22nd December 2007. All primi and multigravid patient with BP ≥140/90 mmHg after 28 weeks of pregnancy were included in the study. Women with a blood pressure ≥140/90mmHg at or before 20 weeks of gestation, previous hypertension or women on antihypertensive drugs and Intrauterine fetal death (IUFD) were excluded from the study. Results: A total of 126 cases of hypertensive disorders of pregnancy were identifi ed among 3819 obstetric cases. The incidence of hypertensive disorders of pregnancy was 3.3%. Among 100 cases who were included in the study, 42 had pre eclampsia and 58 had gestational hypertension. Among 42 preeclamptic patients, 15(35.71%) had low birth weight babies, and 9(15.5%) babies had low birth weight among 58 gestational hypertensive mothers. Conclusions: Preeclampsia increases the risk of intrauterine growth restriction, low birth weight and stillbirth.Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/8-10DOI:http://dx.doi.org/10.3126/mjsbh.v12i1.9083  

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