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Being born small for gestational age increases the risk of severe pre-eclampsia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
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2007 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 3, 319-324 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The first aim of this study was to investigate the risk of pre-eclampsia, both mild and severe, in women born small for gestational age (SGA). The second aim was to investigate whether the risk is modified by pre-eclampsia in the previous generation. Design: Population-based cohort study. Setting: Sweden. Population: A population of 118 634 women registered both as newborns and as mothers in the Swedish Medical Birth Register of 1973-2003. Of these, 6883 had been born SGA. Only primiparas and singletons were included. Methods: The pregnancies that the women were born out of were analysed with regard to presence of pre-eclampsia, while their own pregnancies were analysed regarding age at delivery, smoking, body mass index and incidence of mild or severe pre-eclampsia. Multiple logistic regression analysis was used. In a first step, we adjusted for maternal characteristics, and in a second step, for pre-eclampsia in the previous generation. Main outcome measures: Odds ratio for mild and severe pre-eclampsia. Results: In women born SGA, the adjusted odds ratio (first step) for mild pre-eclampsia was 1.19 (95% CI 1.03-1.38), while for severe pre-eclampsia it was 1.69 (95% CI 1.40-2.02) compared with those not born SGA. After the second-step adjustment, the odds ratio for mild pre-eclampsia was 1.16 (95% CI 1.00-1.35) and for severe pre-eclampsia was 1.62 (95% CI 1.35-1.95). No statistically significant effect modification from pre-eclampsia in the previous generation was shown. Conclusions: Women born SGA suffer a markedly increased risk of severe pre-eclampsia. Exposure to pre-eclampsia during a woman's own fetal development significantly increases her risk of pre-eclampsia but does not modify the SGA effect.

Place, publisher, year, edition, pages
2007. Vol. 114, no 3, 319-324 p.
Keyword [en]
Generation, population based, preeclampsia, SGA
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95603DOI: 10.1111/j.1471-0528.2006.01231.xISI: 000244226900009PubMedID: 17261123OAI: oai:DiVA.org:uu-95603DiVA: diva2:169889
Available from: 2007-03-30 Created: 2007-03-30 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Chronic Hypertension and Pregnancy: Epidemiological Aspects on Maternal and Perinatal Complications
Open this publication in new window or tab >>Chronic Hypertension and Pregnancy: Epidemiological Aspects on Maternal and Perinatal Complications
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.

The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications.

The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA.

The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.

A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 46 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 241
Keyword
Obstetrics and gynaecology, chronic hypertension, preeclampsia, gestational diabetes, abruptio placenta, SGA, perinatal death, stillbirth, neonatal death, gender, generation, Obstetrik och kvinnosjukdomar
Identifiers
urn:nbn:se:uu:diva-7755 (URN)978-91-554-6831-6 (ISBN)
Public defence
2007-04-20, Törnqvistsalen, A-huset, Universitetssjukhuset, Örebro, 13:15
Opponent
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Available from: 2007-03-30 Created: 2007-03-30 Last updated: 2011-02-14Bibliographically approved

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Zetterström, KarinLindeberg, SolveigHaglund, BengtHanson, Ulf

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