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Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?
Am J Obstet Gynecol. 2006 Apr; 194(4):921-31.AJ

Abstract

OBJECTIVE

Preeclampsia, gestational hypertension, and unexplained intrauterine growth restriction may have similar determinants and consequences. In this study, we compared determinants and perinatal outcomes associated with these obstetric conditions.

STUDY DESIGN

We analyzed 39,615 pregnancies (data from the WHO Antenatal Care Trial), of which 2.2% were complicated by preeclampsia, 7.0% by gestational hypertension, and 8.1% by unexplained intrauterine growth restriction (ie, not associated with maternal smoking, maternal undernutrition, preeclampsia, gestational hypertension, or congenital malformations). We compared the risk factors associated with these groups. Fetal death, preterm delivery, and severe neonatal morbidity and mortality were the primary outcomes. Logistic regression analyses were adjusted for study site, socioeconomic status, and (if appropriate) birth weight and gestational age.

RESULTS

Diabetes, renal or cardiac disease, previous preeclampsia, urinary tract infection, high maternal age, twin pregnancy, and obesity increased the risk of both hypertensive conditions. Previous large-for-age birth, reproductive tract surgery, antepartum hemorrhage and reproductive tract infection increased the risk for gestational hypertension only. Independent of maternal age, primiparity was a risk factor only for preeclampsia. Both preeclampsia and gestational hypertension were associated with increased risk for fetal death and severe neonatal morbidity and mortality. Mothers with preeclampsia compared with those with unexplained intrauterine growth restriction were more likely to have a history of diabetes, renal or cardiac disease, chronic hypertension, previous preeclampsia, body mass index more than 30 kg/cm2, urinary tract infection and extremes of maternal age. Conversely, unexplained intrauterine growth restriction was associated with higher risk of low birth weight in previous pregnancies, but not with previous preeclampsia. Both conditions increased the risk for perinatal outcomes independently but preeclampsia was associated with considerable higher risk.

CONCLUSION

Preeclampsia and gestational hypertension shared many risk factors, although there are differences that need further evaluation. Both conditions significantly increased morbidity and mortality. Conversely, preeclampsia and unexplained intrauterine growth restriction, often assumed to be related to placental insufficiency, seem to be independent biologic entities.

Authors+Show Affiliations

United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Program of Research, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. villarj@who.intNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16580277

Citation

Villar, José, et al. "Preeclampsia, Gestational Hypertension and Intrauterine Growth Restriction, Related or Independent Conditions?" American Journal of Obstetrics and Gynecology, vol. 194, no. 4, 2006, pp. 921-31.
Villar J, Carroli G, Wojdyla D, et al. Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? Am J Obstet Gynecol. 2006;194(4):921-31.
Villar, J., Carroli, G., Wojdyla, D., Abalos, E., Giordano, D., Ba'aqeel, H., Farnot, U., Bergsjø, P., Bakketeig, L., Lumbiganon, P., Campodónico, L., Al-Mazrou, Y., Lindheimer, M., & Kramer, M. (2006). Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? American Journal of Obstetrics and Gynecology, 194(4), 921-31.
Villar J, et al. Preeclampsia, Gestational Hypertension and Intrauterine Growth Restriction, Related or Independent Conditions. Am J Obstet Gynecol. 2006;194(4):921-31. PubMed PMID: 16580277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? AU - Villar,José, AU - Carroli,Guillermo, AU - Wojdyla,Daniel, AU - Abalos,Edgardo, AU - Giordano,Daniel, AU - Ba'aqeel,Hassan, AU - Farnot,Ubaldo, AU - Bergsjø,Per, AU - Bakketeig,Leiv, AU - Lumbiganon,Pisake, AU - Campodónico,Liana, AU - Al-Mazrou,Yagob, AU - Lindheimer,Marshall, AU - Kramer,Michael, AU - ,, PY - 2005/06/22/received PY - 2005/09/12/revised PY - 2005/10/27/accepted PY - 2006/4/4/pubmed PY - 2006/5/19/medline PY - 2006/4/4/entrez SP - 921 EP - 31 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 194 IS - 4 N2 - OBJECTIVE: Preeclampsia, gestational hypertension, and unexplained intrauterine growth restriction may have similar determinants and consequences. In this study, we compared determinants and perinatal outcomes associated with these obstetric conditions. STUDY DESIGN: We analyzed 39,615 pregnancies (data from the WHO Antenatal Care Trial), of which 2.2% were complicated by preeclampsia, 7.0% by gestational hypertension, and 8.1% by unexplained intrauterine growth restriction (ie, not associated with maternal smoking, maternal undernutrition, preeclampsia, gestational hypertension, or congenital malformations). We compared the risk factors associated with these groups. Fetal death, preterm delivery, and severe neonatal morbidity and mortality were the primary outcomes. Logistic regression analyses were adjusted for study site, socioeconomic status, and (if appropriate) birth weight and gestational age. RESULTS: Diabetes, renal or cardiac disease, previous preeclampsia, urinary tract infection, high maternal age, twin pregnancy, and obesity increased the risk of both hypertensive conditions. Previous large-for-age birth, reproductive tract surgery, antepartum hemorrhage and reproductive tract infection increased the risk for gestational hypertension only. Independent of maternal age, primiparity was a risk factor only for preeclampsia. Both preeclampsia and gestational hypertension were associated with increased risk for fetal death and severe neonatal morbidity and mortality. Mothers with preeclampsia compared with those with unexplained intrauterine growth restriction were more likely to have a history of diabetes, renal or cardiac disease, chronic hypertension, previous preeclampsia, body mass index more than 30 kg/cm2, urinary tract infection and extremes of maternal age. Conversely, unexplained intrauterine growth restriction was associated with higher risk of low birth weight in previous pregnancies, but not with previous preeclampsia. Both conditions increased the risk for perinatal outcomes independently but preeclampsia was associated with considerable higher risk. CONCLUSION: Preeclampsia and gestational hypertension shared many risk factors, although there are differences that need further evaluation. Both conditions significantly increased morbidity and mortality. Conversely, preeclampsia and unexplained intrauterine growth restriction, often assumed to be related to placental insufficiency, seem to be independent biologic entities. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/16580277/Preeclampsia_gestational_hypertension_and_intrauterine_growth_restriction_related_or_independent_conditions L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(05)02436-1 DB - PRIME DP - Unbound Medicine ER -