Maternal educational level and risk of gestational hypertension: the Generation R Study

Abstract

We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

An investigation into utilising gestational body mass index as a screening tool for adverse birth outcomes and maternal morbidities in a group of pregnant women in Khayelitsha

“…43 Black South Africans are particularly at risk because of a genetic susceptibility to low-renin, low-aldosterone hypertension. 44 In agreement with others, 45-47 this study found that significantly more women in the obese gestational BMI category developed pregnancy-induced hypertension. 47-49 If the women have been placed in a high-risk category, more observation, monitoring and appropriate intervention should take place.…”

“…44 In agreement with others, 45-47 this study found that significantly more women in the obese gestational BMI category developed pregnancy-induced hypertension. 47-49 If the women have been placed in a high-risk category, more observation, monitoring and appropriate intervention should take place. 45 Pregnancy-induced hypertension is frequently exposed by pregnancy and the mother often develops hypertension later in life.…”

Childhood and adulthood socio-economic position and hypertensive disorders in pregnancy: the Uppsala Birth Cohort Multigenerational Study

“…Silva et al 15 found that Dutch women with relatively low education had increased risk of gestational hypertension and in another study,16 they noted that low education was a strong determinant of pre-eclampsia. Similarly, Haelterman et al 17 found that low education increases the risk of severe pre-eclampsia in women in Belgium.…”

Impact of risk factors on hypertensive disorders in pregnancy, in primiparae and multiparae

“…However, even when considering family history of hard cardiovascular outcomes, such as stroke and myocardial infarction, we still observe a positive association with hypertensive disorders during pregnancy. Despite some contradictory results, probably due to differences in exposure or outcome definition, prospective data from a large Dutch populationbased cohort showed that women with low educational level were more likely to develop gestational hypertension (Silva et al, 2008a) and pre-eclampsia (Silva et al, 2008b) than women with a higher educational level. The association between education and pregnancy hypertension may represent an early manifestation of the socioeconomic differences in cardiovascular morbidity and mortality in women (Mackenbach et al, 2000).…”