Impact of pregnancy-induced hypertension on fetal growth

Rima Irwinda, Raymond Surya, Lidia F. Nembo



DOI: https://doi.org/10.13181/mji.v25i2.1381

Abstract


Background: Pregnancy-induced hypertension (PIH) is still a major cause of maternal and infant morbidity and mortality worldwide. The aim of this study to investigate the impact of PIH on fetal growth.

Methods: A longitudinal cross-sectional study was conducted by 2,076 obstetric patients registered in the book of delivery emergency room BLUD RSUD Ende/ Ende hospital from September 1st 2014 to August 31st 2015. Pregnancy-induced hypertension was classified into gestational hypertension, preeclampsia, and severe preeclampsia. Categorical comparative chi-square continued by logistic regression analysis were performed to examine the effect of PIH to infants’ growth outcome.

Results: Women with preeclampsia had higher number of preterm delivery (26.7%). Infants born from preeclamptic women had lower birth weight (median 2,575 gram; p<0.001), birth length (median 49 cm; p<0.001), and also head circumference (median 32 cm; p<0.001). Severe preeclampsia contributed statistically significance to SGA (OR=1.90; 95% CI=1.20-3.01; adjusted OR=1.91; 95% CI=1.20-3.01) and LGA (OR=2.70; 95% CI=1.00-7.29; adjusted OR=2.92; 95% CI=1.07-8.00). Based on birth weight independent of gestational age, severe preeclampsia had an impact to VLBW (OR=11.45; 95% CI=2.77-47.38; adjusted OR=8.68; 95% CI=1.57-48.04) and LBW (OR=6.57; 95% CI=4.01-10.79; adjusted OR=5.71; 95% CI=3.33-9.78) where it showed statistical significance.

Conclusion: PIH women who had SGA or VLBL or LBW infants were caused by the hypoperfusion model as the pathogenesis of preeclampsia. Meanwhile, LGA infants born by preeclamptic women were due to the compensation of the decrease from uteroplacental perfusion or other diseases such as obese mother or gestational.diabetes mellitus.


Keywords


fetal growth; pregnancy-induced hypertension

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References


  1. Roberts JM, Redman CW. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet. 1993;341(8858):1447-51. http://dx.doi.org/10.1016/0140-6736(93)90889-O
  2. Hermes W, Van Kesteren F, De Groot CJ. Preeclampsia and cardiovascular risk. Minerva Gynecol. 2012;64(4):281-92.
  3. Sirait AM. Prevalensi hipertensi pada kehamilan di Indonesia dan berbagai faktor yang berhubungan (Riset Kesehatan Dasar 2007). Buletin Penelitian Sistem Kesehatan. 2012;15(2):103-9. Indonesian.
  4. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. National high blood pressure education program working group report on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-22. http://dx.doi.org/10.1067/mob.2000.107928
  5. Lin S, Leonard D, Co MA, Mukhopadhyay D, Giri B, Perger L, et al. Pre-eclampsia has an adverse impact on maternal and fetal health. Transl Res. 2015;165(4):449-63. http://dx.doi.org/10.1016/j.trsl.2014.10.006
  6. Grisaru-Granovsky S, Halevy T, Eidelman A, Elstein D, Samueloff A. Hypertensive disorders of pregnancy and the small for gestational age neonate: not a simple relationship. Am J Obstet Gynecol. 2007;196(4):335.e1-5. http://dx.doi.org/10.1016/j.ajog.2006.11.003
  7. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014;36(5):416-38. http://dx.doi.org/10.1016/S1701-2163(15)30588-0
  8. Haelterman E, Bréart G, Paris-Llado J, Dramaix M, Tchobrousky C. Effect of uncomplicated chronic hypertension on the risk of small-for-gestational age birth. Am J Epidemiol. 1997;145(8):689-95. http://dx.doi.org/10.1093/aje/145.8.689
  9. Xiong X, Mayes D, Demianczuk N, Olson DM, Davidge ST, Newburn-Cook C, et al. Impact of pregnancy-induced hypertension on fetal growth. Am J Obstet Gynecol. 1999;180(1Pt1):207-13. http://dx.doi.org/10.1016/S0002-9378(99)70176-6
  10. Fatemeh T, Marziyeh G, Nayereh G, Anahita G, Samira T. Maternal and perinatal outcome in nulliparious women complicated with pregnancy hypertension. J Pak Med Assoc. 2010;60(9):707-10.
  11. Buchbinder A, Sibai BM, Caritis S, Macpherson C, Hauth J, Lindheimer MD, et al. Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia. Am J Obstet Gynecol. 2002;186(1):66-71. http://dx.doi.org/10.1067/mob.2002.120080
  12. Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA. Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort. Hypertension. 2014;64(1):36-44. http://dx.doi.org/10.1161/HYPERTENSIONAHA.113.02766
  13. Zhang J, Villar J, Sun W, Merialdi M, Abdel-Aleem H, Mathai M, et al. Blood pressure dynamics during pregnancy and spontaneous preterm birth. Am J Obstet Gynecol. 2007;197(2):162.e1-6. http://dx.doi.org/10.1016/j.ajog.2007.03.053
  14. Gofton EN, Capewell V, Natale R, Gratton RJ. Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension. Am J Obstet Gynecol. 2001;185(4):798-803. http://dx.doi.org/10.1067/mob.2001.117314
  15. Eskenazi B, Fenster L, Sidney S, Elkin EP. Fetal growth retardation in infants of multiparous and nulliparous women with preeclampsia. Am J Obstet Gynecol. 1993;169(5):1112-8. http://dx.doi.org/10.1016/0002-9378(93)90265-K
  16. Gallery ED, Hunyor SN, Györy AZ. Plasma volume contraction: a significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy. Q J Med. 1979;48(192):593-602.
  17. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005;308(5728):1592-4. http://dx.doi.org/10.1126/science.1111726
  18. Ferrazzani S, Caruso A, De Carolis S, Martino IV, Mancuso S. Proteinuria and outcome of 444 pregnancies complicated by hypertension. Am J Obstet Gynecol. 1990;162(2):366-71. http://dx.doi.org/10.1016/0002-9378(90)90387-M
  19. von Dadelszen P, Magee LA, Taylor EL, Muir JC, Stewart SD, Sherman P, et al. Maternal hypertension and neonatal outcome among small for gestational age infants. Obstet Gynecol. 2005;106(2):335-9. http://dx.doi.org/10.1097/01.AOG.0000171121.31564.14
  20. Xiong X, Demianczuk NN, Buekens P, Saunders LD. Association of preeclampsia with high birth weight for age. Am J Obstet Gynecol. 2000;183(1):148-55. http://dx.doi.org/10.1016/S0002-9378(00)24793-5
  21. Chen XK, Wen SW, Smith G, Yang Q, Walker M. Pregnancy-induced hypertension and infant mortality: roles of birthweight centiles and gestational age. BJOG. 2007;114(1):24-31. http://dx.doi.org/10.1111/j.1471-0528.2006.01177.x
  22. Naeye RL. Maternal blood pressure and fetal growth. Am J Obstet Gynecol. 1981;141(7):780-7. http://dx.doi.org/10.1016/0002-9378(81)90704-3
  23. Lim WY, Lee YS, Tan CS, Kwek K, Chong YS, Gluckman PD, et al. The association between maternal blood pressures and offspring size at birth in Southeast Asian women. BMC Pregnancy and Childbirth. 2014;14:403. http://dx.doi.org/10.1186/s12884-014-0403-1





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