The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study.

BMC Pregnancy Childbirth. 2004 Aug 6;4(1):17. Epub 2004 Aug 06.
  
The effect of hypertensive disorders in pregnancy on small for gestational age 
and stillbirth: a population based study.

Allen VM, Joseph KS, Murphy KE, Magee LA, Ohlsson A.

Background 
Hypertensive disorders in pregnancy are leading causes of maternal, 
fetal and neonatal morbidity and mortality worldwide. However, studies attempting 
to quantify the effect of hypertension on adverse perinatal outcomes have been 
mostly conducted in tertiary centres. This population-based study explored the 
frequency of hypertensive disorders in pregnancy and the associated increase in 
small for gestational age (SGA) and stillbirth. 

Methods 
We used information on all pregnant women and births, in the Canadian 
province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if 
delivery occurred < 20 weeks, if birthweight was < 500 grams, if there was a 
high-order multiple pregnancy (greater than twin gestation), or a major fetal 
anomaly. 

Results 
The study population included 135,466 pregnancies. Of these, 7.7% had 
mild pregnancy-induced hypertension (PIH), 1.3% had severe PIH, 0.2% had HELLP 
(hemolysis, elevated liver enzymes, low platelets), 0.02% had eclampsia, 0.6% 
had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. 
Women with any hypertension in pregnancy were 1.6 (95% CI 1.5-1.6) times more 
likely to have a live birth with SGA and 1.4 (95% CI 1.1-1.8) times more likely 
to have a stillbirth as compared with normotensive women. Adjusted analyses 
showed that women with gestational hypertension without proteinuria (mild PIH) 
and with proteinuria (severe PIH, HELLP, or eclampsia) were more likely to have 
infants with SGA (RR 1.5, 95% CI 1.4-1.6 and RR 3.2, 95% CI 2.8-3.6, respectively). 
Women with pre-existing hypertension were also more likely to give birth to an 
infant with SGA (RR 2.5, 95% CI 2.2-3.0) or to have a stillbirth 
(RR 3.2, 95% CI 1.9-5.4). 

Conclusions 
This large, population-based study confirms and quantifies the magnitude of the 
excess risk of small for gestational age and stillbirth among births to women 
with hypertensive disease in pregnancy.

PMID: 15298717 [PubMed - as supplied by publisher]


Link to Source

The M.I.S.S. Foundation is a nonprofit, 501(c)3, international organization which provides immediate and ongoing support to grieving families, empowerment through community volunteerism opportunities, public policy and legislative education, and programs to reduce infant and toddler death through research and education.