Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study

Abstract

BackgroundData on the potential influence of macroeconomic recessions on maternal diseases during pregnancy are scarce. We aimed to assess potential change in prevalence of pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension) during the first years of the major national economic recession in Iceland, which started abruptly in October 2008.Methods and FindingsWomen whose pregnancies resulted in live singleton births in Iceland in 2005–2012 constituted the study population (N = 35,211). Data on pregnancy-induced hypertensive disorders were obtained from the Icelandic Medical Birth Register and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Register. With the pre-collapse period as reference, we used logistic regression analysis to assess change in pregnancy-induced hypertensive disorders and use of antihypertensives during the first four years after the economic collapse, adjusting for demographic and pregnancy characteristics, taking aggregate economic indicators into account. Compared with the pre-collapse period, we observed an increased prevalence of gestational hypertension in the first year following the economic collapse (2.4% vs. 3.9%; adjusted odds ratio [aOR] 1.47; 95 percent confidence interval [95%CI] 1.13–1.91) but not in the subsequent years. The association disappeared completely when we adjusted for aggregate unemployment rate (aOR 1.04; 95% CI 0.74–1.47). Similarly, there was an increase in prescription fills of β-blockers in the first year following the collapse (1.9% vs.3.1%; aOR 1.43; 95% CI 1.07–1.90), which disappeared after adjusting for aggregate unemployment rate (aOR 1.05; 95% CI 0.72–1.54). No changes were observed for preeclampsia or use of calcium channel blockers between the pre- and post-collapse periods.ConclusionsOur data suggest a transient increased risk of gestational hypertension and use of β-blockers among pregnant women in Iceland in the first and most severe year of the national economic recession.

The effect of the economic collapse in Iceland on the probability of cardiovascular events

“…Even for individuals remaining employed throughout the crisis, ambient conditions of a high unemployment rate could lead to increased stress which might be a trigger for a cardiovascular event. Findings from Eiriksdottir et al (2015) would support such theory, as they attributed an increased risk of gestational hypertension to changes in aggregate unemployment rates during the economic collapse. However, when studying the probability of IHD in males, we find that a higher unemployment rate is associated with a lower probability of IHD (table 1).…”

“…Based on those results alone, one might have presumed that the Great Recession was likely to be beneficial to heart health in the Icelandic population. However, recent results on the effects of the Great Recession have shown the contrary (Asgeirsdottir et al, 2014b;Birgisdottir et al, 2017;Eiriksdottir et al, 2015;Gudjonsdottir et al, 2012). In the current study we provide an explanation for such differing results, i.e.…”

“…The health outcomes previously explored include a number of determinants of cardiovascular diseases (CVD) (Asgeirsdottir et al (2016a); Asgeirsdottir et al (2014a); Asgeirsdottir et al (2016b); Asgeirsdottir et al (2014b); Birgisdottir et al (2017); (Eiriksdottir et al, 2015); Hauksdottir et al (2013); Jonsdottir and Asgeirsdottir (2014); McClure et al (2012); Olafsdottir and Asgeirsdottir (2015); Olafsdottir et al (2014)). Using survey data from , Asgeirsdottir et al (2014b find a short-term increased risk of male hypertension following the economic collapse and with an added wave of the same data for 2012, Birgisdottir et al (2017) also show a longer-run rise in hypertension among females, and Eiriksdottir et al (2015) find an increased risk of gestational hypertension after the economic collapse. Furthermore, data from the emergency departments in Iceland's capital area indicate a considerable increase in cardiac emergency department attendance during the first week of the economic collapse, particularly among females, and particularly with IHD diagnoses (Gudjonsdottir et al, 2012).…”

Preeclampsia and academic performance in children: A nationwide study from Iceland

“…Hypertensive disorders of pregnancy, which complicate up to 10% of pregnancies [ 1 , 2 ], account for a substantial proportion of maternal and neonatal morbidity and mortality worldwide[ 3 – 7 ]. Maternal hypertension during pregnancy can be due to either pregnancy specific etiologies including gestational hypertension and preeclampsia/eclampsia or pre-existing chronic hypertension.…”

<p>Reduced Intellectual Ability in Offspring Born from Preeclamptic Mothers: A Prospective Cohort Study</p>

“…Preeclampsia, a condition characterized by high blood pressure in pregnant women, is estimated to affect 7.5% of the pregnancies worldwide. [1][2][3][4] This disorder has been found to adversely affect fetal brain development due to hypoxia, 5,6 and severe preeclampsiaaffected offspring may present poorer neurodevelopmental functions, relative to those born from normotensive mothers, such as reduced cognitive performance 7,8 and verbal ability. [9][10][11][12][13][14] However, the effect of severe preeclampsia on the development of intelligence in the offspring has not been fully demonstrated until now.…”