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The paternal role in pre-eclampsia and giving birth to a small for gestational age infant: a population-based cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrisk forskning/Högberg)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Department of Medicine, Clinical Epidemiology Unit at Karolinska Institutet, Stockholm, Sweden.
2012 (English)In: BMJ open, ISSN 2044-6055, Vol. 2, no 4, e001178- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To estimate the effect of partner change on risks of pre-eclampsia and giving birth to a small for gestational age infant.

DESIGN:

Prospective population study.

SETTING:

Sweden.

PARTICIPANTS:

Women with their first and second successive singleton births in Sweden between 1990 and 2006 without pregestational diabetes and/or hypertension (n=446 459).

OUTCOME MEASURES:

Preterm (<37 weeks) and term (≥37 weeks) pre-eclampsia, and giving birth to a small for gestational age (SGA) infant. Risks were adjusted for interpregnancy interval, maternal age, body mass index, height and smoking habits in second pregnancy, years of involuntary childlessness before second pregnancy, mother's country of birth, years of formal education and year of birth. Further, when we calculated risks of SGA we restricted the study population to women with non-pre-eclamptic pregnancies.

RESULTS:

In women who had a preterm pre-eclampsia in first pregnancy, partner change was associated with a strong protective effect for preterm pre-eclampsia recurrence (OR 0.24; 95% CI 0.07 to 0.88). Similarly, partner change was also associated with a protective effect of recurrence of SGA birth (OR 0.75; 95% CI 0.67 to 0.84). In contrast, among women without SGA in first birth, partner change was associated with an increased risk of SGA in second pregnancy. Risks of term pre-eclampsia were not affected by partner change.

CONCLUSIONS:

There is a paternal effect on risks of preterm pre-eclampsia and giving birth to an SGA infant.

Place, publisher, year, edition, pages
2012. Vol. 2, no 4, e001178- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-186861DOI: 10.1136/bmjopen-2012-001178ISI: 000315049300065PubMedID: 22936817OAI: oai:DiVA.org:uu-186861DiVA: diva2:573115
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-04-21Bibliographically approved
In thesis
1. Epidemiological Studies of Preeclampsia: Maternal & Offspring Perspectives 
Open this publication in new window or tab >>Epidemiological Studies of Preeclampsia: Maternal & Offspring Perspectives 
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Preeclampsia is a placental-related disorder characterized by generalized endothelial activation. Vascular predisposition is associated with the occurrence of preeclampsia and the recurrence risk is substantial. Onset of preeclampsia is preceded by placental hypo-perfusion, and placental over-production of vasoconstrictive agents might explain symptoms such as hypertension and proteinuria. Preeclampsia is associated with the birth of small-for-gestational-age (SGA) infants. The trajectory of postnatal growth in SGA-born children is described as catch-up, but it is unclear whether prenatal preeclampsia is independently associated with postnatal growth.

The objectives were: firstly, to study the association between partner change and prior miscarriages on the occurrence of preeclampsia and SGA; secondly, to study postnatal growth in children prenatally exposed to preeclampsia; and thirdly, to address the association between blood pressure (BP) changes during pregnancy and risks of preeclampsia and SGA.

Population-based cohort studies were performed with information from the following registers: Swedish Medical Birth Register, Uppsala Mother and Child Database and Stockholm-Gotland Obstetric Database. Associations were estimated with logistic and linear regression analyses, with adjustments for maternal characteristics, including body mass index, pre-gestational diseases and socioeconomic factors.

The results were, firstly, that partner change was associated with preeclampsia and SGA birth in the second pregnancy but depended on the outcome of the first pregnancy, and that a history of recurrent miscarriages was associated with increased risks of preeclampsia and SGA. Secondly, prenatal exposure to preeclampsia was associated with increased offspring growth in height during the first five years. This association was also seen in children born with normal birth weight for gestational age. Thirdly, pre-hypertension in late gestation and elevated diastolic BP from early to mid-gestation were both associated with SGA birth. Further, women with pre-hypertension in early gestation without lowered diastolic BP until mid-gestation seemed to represent a risk group for preeclampsia.

To conclude, the importance of previous pregnancy outcomes in the antenatal risk evaluation was highlighted. Secondly, the results imply that postnatal growth trajectory is related to maternal preeclampsia, in addition to SGA. Thirdly, the association between BP changes within a normal range and SGA may challenge the clinical cut-off for hypertension in pregnancy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1333
Keyword
Placental dysfunction, blood pressure, small-for-gestational-age, fetal growth restriction, intrauterine, prenatal exposure, postnatal height gain, linear growth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-320138 (URN)978-91-554-9920-4 (ISBN)
Public defence
2017-06-09, Rosénsalen, Akademiska sjukhuset, Ingång 95/96 nbv, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2017-05-19 Created: 2017-04-21 Last updated: 2017-06-07

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Wikström, Anna-KarinGunnarsdóttir, Jóhanna

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