Hypertension in pregnancy: Prevalence, risk factors and outcomes for women birthing in Ireland

Corrigan, Lisa; O’Farrell, Anne; Moran, Patrick; Daly, Déirdre

doi:10.1016/j.preghy.2021.02.005

Cited by 24 publications

(24 citation statements)

References 26 publications

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“…The prevalence of PE in their control group was 13.1%, which was higher than that in our review, which may be explained by the socioeconomic and demographic differences in the participants [ 47 ]. In contrast, in our review, the prevalence of PE in the control group was approximately 3%, which was lower than that reported in a previous study, probably because the included studies did not recruit pregnant women with advanced age [ 48 ]. A prospective, comparative, cross-sectional study was performed among a group of primigravidae, which concluded that dydrogesterone supplementation during the first trimester significantly reduced the incidence of hypertension in pregnancy [ 49 ].…”

Section: Discussioncontrasting

confidence: 89%

Pregnancy-related complications and perinatal outcomes following progesterone supplementation before 20 weeks of pregnancy in spontaneously achieved singleton pregnancies: a systematic review and meta-analysis

Lin

et al. 2021

Reprod Biol Endocrinol

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Background Progesterone supplementation is widely performed in women with threatened miscarriage or a history of recurrent miscarriage; however, the effects of early progesterone supplementation on pregnancy-related complications and perinatal outcomes in later gestational weeks remain unknown. Methods Ovid MEDLINE, the Cochrane Library, Embase and ClinicalTrials.gov were searched until April 3rd, 2021. Randomized controlled trials regarding spontaneously achieved singleton pregnancies who were treated with progestogen before 20 weeks of pregnancy and were compared with those women in unexposed control groups were selected for inclusion. We performed pairwise meta-analyses with the random-effects model. The risk of bias was assessed according to the Cochrane Collaboration tool. The primary outcomes included preeclampsia (PE), and gestational diabetes mellitus (GDM), with the results presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results We identified nine eligible studies involving 6439 participants. The pooled OR of subsequent PE following early progestogen supplementation was 0.64 (95% CI 0.42–0.98, moderate quality of evidence). A lower OR for PE was observed in the progestogen group when the subgroup analysis was performed in the vaginal subgroup (OR 0.62, 95%CI 0.40–0.96). There was insufficient evidence of a difference in the rate of GDM between pregnant women with early progestogen supplementation and unexposed pregnant women (OR 1.02, 95% CI 0.79–1.32, low quality of evidence). The pooled OR of low birth weight (LBW) following oral dydrogesterone was 0.57 (95% CI 0.34–0.95, moderate quality of evidence). The results were affected by a single study and the total sample size of enrolled women did not reach the required information size. Conclusion Use of vaginal micronized progesterone (Utrogestan) in spontaneously achieved singleton pregnancies with threatened miscarriage before 20 weeks of pregnancy may reduce the risk of PE in later gestational weeks. Among spontaneously achieved singleton pregnancies with threatened miscarriage or a history of recurrent miscarriage, use of oral dydrogesterone before 20 weeks of pregnancy may result in a lower risk of LBW in later gestational weeks. However, the available data were not sufficient to reach definitive conclusions, which highlighted the need for future studies.

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Section: Discussioncontrasting

confidence: 89%

Pregnancy-related complications and perinatal outcomes following progesterone supplementation before 20 weeks of pregnancy in spontaneously achieved singleton pregnancies: a systematic review and meta-analysis

Lin

et al. 2021

Reprod Biol Endocrinol

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“…We acknowledge limitations to this study include the biases implicit in retrospective study design. The initial cohort (24%) is large compared to rates of pHTN previously reported in the literature (11,12,13). Because of our method used to identify the study cohort, there is a risk of some patients being included that did not have pHTN and met criteria due to spurious blood pressure measurements.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Postpartum management of hypertension and effect on readmission rates

Lovgren

Connealy

Yao

et al. 2022

American Journal of Obstetrics & Gynecology MFM

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“…Such recruitment has not previously been reached in RCTs in this field. Considering the increasing prevalence of hypertension in pregnancy [ 2 ] and the severity of the related adverse outcomes, the lack of evidence represents a major obstacle towards optimising clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertensive disorders of pregnancy are a major cause of maternal and foetal morbidity [1][2][3]. Recent randomised clinical trial (RCT) data provide evidence that treatment of mild chronic hypertension in pregnancy reduces maternal morbidity without impacting birthweight [4].…”

Section: Introductionmentioning

confidence: 99%

Safety of beta-blocker and calcium channel blocker antihypertensive drugs in pregnancy: a Mendelian randomization study

Ardissino

Slob

Rajasundaram

et al. 2022

BMC Med

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Background Beta-blocker (BB) and calcium channel blocker (CCB) antihypertensive drugs are commonly used in pregnancy. However, data on their relative impact on maternal and foetal outcomes are limited. We leveraged genetic variants mimicking BB and CCB antihypertensive drugs to investigate their effects on risk of pre-eclampsia, gestational diabetes and birthweight using the Mendelian randomization paradigm. Methods Genetic association estimates for systolic blood pressure (SBP) were extracted from summary data of a genome-wide association study (GWAS) on 757,601 participants. Uncorrelated single-nucleotide polymorphisms (SNPs) associated with SBP (p < 5 × 10−8) in BB and CCB drug target gene regions were selected as proxies for drug target perturbation. Genetic association estimates for the outcomes were extracted from GWASs on 4743 cases and 136,325 controls (women without a hypertensive disorder in pregnancy) for pre-eclampsia or eclampsia, 7676 cases and 130,424 controls (women without any pregnancy-related morbidity) for gestational diabetes, and 155,202 women (who have given birth at least once) for birthweight of the first child. All studies were in European ancestry populations. Mendelian randomization estimates were generated using the two-sample inverse-variance weighted model. Results Although not reaching the conventional threshold for statistical significance, genetically-proxied BB was associated with reduced risk of pre-eclampsia (OR per 10 mmHg SBP reduction 0.27, 95%CI 0.06–1.19, p = 0.08) and increased risk of gestational diabetes (OR per 10 mmHg SBP reduction 2.01, 95%CI 0.91–4.42, p = 0.08), and significantly associated with lower birthweight of first child (beta per 10 mmHg SBP reduction − 0.27, 95%CI − 0.39 to − 0.15, p = 1.90 × 10−5). Genetically-proxied CCB was associated with reduced risk of pre-eclampsia and eclampsia (OR 0.62, 95%CI 0.43–0.89, p = 9.33 × 10−3), and was not associated with gestational diabetes (OR 1.05, 95% CI 0.76–1.45, p = 0.76) or changes in birthweight of first child (beta per 10 mmHg SBP reduction 0.02, 95%CI − 0.04–0.07, p = 0.54). Conclusions While BB and CCB antihypertensive drugs may both be efficacious for lowering blood pressure in pregnancy, this genetic evidence suggests that BB use may lower birthweight. Conversely, CCB use may reduce risk of pre-eclampsia and eclampsia without impacting gestational diabetes risk or birthweight. These data support further study on the effects of BBs on birthweight.

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Hypertension in pregnancy: Prevalence, risk factors and outcomes for women birthing in Ireland

Cited by 24 publications

References 26 publications

Pregnancy-related complications and perinatal outcomes following progesterone supplementation before 20 weeks of pregnancy in spontaneously achieved singleton pregnancies: a systematic review and meta-analysis

Pregnancy-related complications and perinatal outcomes following progesterone supplementation before 20 weeks of pregnancy in spontaneously achieved singleton pregnancies: a systematic review and meta-analysis

Postpartum management of hypertension and effect on readmission rates

Safety of beta-blocker and calcium channel blocker antihypertensive drugs in pregnancy: a Mendelian randomization study

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