Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study

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Fältnamn	Indikatorer	Metadata
000		04758naa a2200457 4500
001		oai:DiVA.org:uu-320672
003		SwePub
008		170423s2019 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
009		oai:prod.swepub.kib.ki.se:141037222
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3206722 URI
024	7	a https://doi.org/10.1186/s12884-019-2319-22 DOI
024	7	a http://kipublications.ki.se/Default.aspx?queryparsed=id:1410372222 URI
040		a (SwePub)uud (SwePub)ki
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Gunnarsdóttir, Jóhanna,d 1978-u Uppsala universitet,Klinisk obstetrik4 aut0 (Swepub:uu)johgu685
245	1 0	a Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth :b a population-based register study
264		c 2019-05-28
264	1	b Springer Science and Business Media LLC,c 2019
338		a electronic2 rdacarrier
520		a Background: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). Methods: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to midgestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg) in early gestation was estimated. Results: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6–2.0]) and SGA birth (aOR: 1.3 [1.2–1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8–2.8] and 2.3 [1.8–3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. Conclusion: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Reproduktionsmedicin och gynekologi0 (SwePub)302202 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Obstetrics, Gynaecology and Reproductive Medicine0 (SwePub)302202 hsv//eng
653		a Blood pressure
653		a Preeclampsia
653		a Foetal growth restriction
653		a Small-for-gestational-age
700	1	a Akhter, Tansim,d 1967-u Uppsala universitet,Klinisk obstetrik4 aut0 (Swepub:uu)tanak729
700	1	a Högberg, Ulf,d 1949-u Uppsala universitet,Obstetrisk och reproduktiv hälsoforskning4 aut0 (Swepub:uu)ulfho102
700	1	a Cnattingius, Svenu Karolinska Institutet4 aut
700	1	a Wikström, Anna-Karin,d 1965-u Karolinska Institutet,Uppsala universitet,Klinisk obstetrik,Department of Clinical Sciences, Danderyds sjukhus, Karolinska Institutet4 aut0 (Swepub:uu)annwi179
710	2	a Uppsala universitetb Klinisk obstetrik4 org
773	0	t BMC Pregnancy and Childbirthd : Springer Science and Business Media LLCg 19, s. 1-8q 19<1-8x 1471-2393x 1471-2393
856	4	u https://doi.org/10.1186/s12884-019-2319-2y Fulltext
856	4	u https://uu.diva-portal.org/smash/get/diva2:1090192/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
856	4	u https://bmcpregnancychildbirth.biomedcentral.com/track/pdf/10.1186/s12884-019-2319-2
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-320672
856	4 8	u https://doi.org/10.1186/s12884-019-2319-2
856	4 8	u http://kipublications.ki.se/Default.aspx?queryparsed=id:141037222

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