uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Chronic hypertension in women after perinatal exposure to preeclampsia, being born small for gestational age or preterm
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrik)ORCID iD: 0000-0003-4427-1075
Univ Bergen, Norwegian Inst Publ Hlth, Med Birth Registry Norway, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (obstetrik)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Show others and affiliations
2017 (English)In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 31, no 2, p. 89-98Article in journal (Refereed) Published
Abstract [en]

Background: There is an established association between adverse events during perinatal life and chronic hypertension in adult life. However, disadvantageous conditions often coexist in the same pregnancy. We investigated single and joint perinatal exposure to preeclampsia, being born small for gestational age (SGA) or preterm and subsequent risk of chronic hypertension.

 

Methods: The study population consisted of 731,008 primiparous women from Norway and Sweden registered in the Medical Birth Registers, both as infants and as first time mothers between 1967-2009 (Norway) and 1973-2010 (Sweden). Risk of chronic hypertension in early pregnancy was calculated in women perinatally exposed to preeclampsia, born SGA or preterm by log-binominal regression analysis, and adjusted for maternal age and level of education in the 1st generation.

 

Results: The rate of chronic hypertension was 0.4%. Risk of chronic hypertension was associated with single perinatal exposure to preeclampsia, being born SGA or preterm with adjusted relative risks (95% confidence intervals, CI) 2.2 (95% CI 1.8, 2.7), 1.1 (95% CI 1.0, 1.3) and 1.3 (95% CI 1.0, 1.5) respectively. The risks increased after joint exposures, with an almost 4-fold risk increase after perinatal exposure to preeclampsia and preterm birth. Additional adjustment for BMI and smoking in the 2nd generation in a subset of the cohort only had a minor impact on the results.

 

Conclusions: Perinatal exposure to preeclampsia, being born SGA or preterm is independently associated with increased risk of chronic hypertension. The highest risk was seen after exposure to preeclampsia, especially if combined with SGA or preterm birth.

Place, publisher, year, edition, pages
2017. Vol. 31, no 2, p. 89-98
Keywords [en]
chronic hypertension, preeclampsia, preterm birth, small for gestational age
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-319182DOI: 10.1111/ppe.12346ISI: 000395008000001PubMedID: 28218407OAI: oai:DiVA.org:uu-319182DiVA, id: diva2:1086300
Funder
Swedish Research Council, 2014-3561The Karolinska Institutet's Research FoundationAvailable from: 2017-03-31 Created: 2017-03-31 Last updated: 2019-02-20Bibliographically approved
In thesis
1. Born Small for Gestational Age: Beyond Size at Birth
Open this publication in new window or tab >>Born Small for Gestational Age: Beyond Size at Birth
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Children born small for gestational age (SGA) run increased risk of perinatal morbidity and mortality, but also of long-term health impairment. Risks on long term may vary depending on postnatal growth patterns. The overall aim of the thesis was to gain further knowledge about long-term consequences of being born SGA, as well as the impact of perinatal exposures on postnatal growth patterns. The thesis is based on four register-based cohort studies.

In paper I, risk of chronic hypertension was assessed in 731,008 first-time mothers. Perinatal exposure to pre-eclampsia, being born SGA and preterm were all independently associated with increased risk of chronic hypertension. The risk was further enhanced after combined exposure. The strongest association was seen in combinations including pre-eclampsia.

In paper II, risk of poor school performance at time of graduation from compulsory school was assessed in 1,088,980 children born SGA at term. Being born SGA was associated with increased risk of poor school performance, following a dose-response pattern with increased risk even for birthweight for gestational age (GA) –1.01 to –2 SD. Boys with short adult stature were associated with higher risk of poor school performance than those with non-short stature.

In paper III, differences in postnatal growth patterns depending on SGA status and maternal smoking habits were assessed in 32,493 children. Children born SGA with smoking mothers had a more rapid catch-up growth than those with non-smoking mothers. Compared with children born appropriate for GA (AGA) with non-smoking mothers, only children born SGA with non-smoking mothers were associated with increased risk of short stature at 1.5 and 5 years.

In paper IV, differences in postnatal growth patterns until age five years, depending on SGA status and GA at birth, were assessed in 41,669 children born between 32-40 gestational weeks. Being born SGA and moderate to late preterm was associated with shorter stature and lower BMI, compared with being born AGA at term. SGA status had greater impact on growth and body proportions than GA at birth.

In conclusion, children born SGA are at higher risk of chronic hypertension and cognitive impairment than children born AGA. Postnatal growth patterns vary in children born SGA, depending on intrauterine exposure to smoking and GA at birth. This may modify risks of long-term health impairment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1543
Keywords
Small for Gestational Age, SGA, Epidemiology, Pregnancy, Postnatal growth, Intrauterine growth restriction, Chronic hypertension, School performance
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-374782 (URN)978-91-513-0581-3 (ISBN)
Public defence
2019-04-12, Humanistiska teatern, Engelska parken, Thunbergsv. 3H, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-03-21 Created: 2019-02-20 Last updated: 2019-05-07

Open Access in DiVA

fulltext(584 kB)91 downloads
File information
File name FULLTEXT01.pdfFile size 584 kBChecksum SHA-512
cf0d63bf8b488d54d1dc2b315a3069c24d358ea5cd113c0888b0f81f2554fba95971c02cdc67f477a07c840b11720ef371185feb4ed5ccb518fa597bc56fec42
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Lindström, LindaBergman, EvaLundgren, MariaWikström, Anna-Karin

Search in DiVA

By author/editor
Lindström, LindaBergman, EvaLundgren, MariaWikström, Anna-Karin
By organisation
Department of Women's and Children's HealthPediatrics
In the same journal
Paediatric and Perinatal Epidemiology
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 91 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 452 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf