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Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort.

ABSTRACT: Hypertensive disorders of pregnancy are associated with intrauterine growth restriction and preterm birth. However, the associations of patterns of blood pressure change during pregnancy with these outcomes have not been studied in detail. We studied repeat antenatal blood pressure measurements of 9697 women in the Avon Longitudinal Study of Parents and Children (median [interquartile range], 10 [9-11] measurements per woman). Bivariate linear spline models were used to relate blood pressure changes to perinatal outcomes. Higher systolic, but not diastolic, blood pressure at baseline (8 weeks of gestation) and a greater increase in systolic and diastolic blood pressure between 18 and 36 weeks of gestation were associated with lower offspring birth weight and being smaller for gestational age in confounder-adjusted models. For example, the mean difference (95% confidence interval) in birth weight per 1 mm Hg/wk greater increase in systolic blood pressure between 18 and 30 weeks was -71 g (-134 to -14) and between 30 and 36 weeks was -175 g (-208 to -145). A smaller decrease in systolic and diastolic blood pressure before 18 weeks and a greater increase between 18 and 36 weeks were associated with a shorter gestation (percentage difference in gestational duration per 1 mm Hg/wk greater increase in systolic blood pressure between 18 and 30 weeks was -0.60% [-1.01 to -0.18] and between 30 and 36 weeks was -1.01% [-1.36 to -0.74]). Associations remained strong when restricting to normotensive women. We conclude that greater increases in blood pressure, from the 18-week nadir, are related to reduced fetal growth and shorter gestation even in women whose blood pressure does not cross the threshold for hypertensive disorders of pregnancy.

SUBMITTER: Macdonald-Wallis C

PROVIDER: S-EPMC4150069 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort.

Macdonald-Wallis Corrie C Tilling Kate K Fraser Abigail A Nelson Scott M SM Lawlor Debbie A DA

Hypertension (Dallas, Tex. : 1979) 20140512 1

Hypertensive disorders of pregnancy are associated with intrauterine growth restriction and preterm birth. However, the associations of patterns of blood pressure change during pregnancy with these outcomes have not been studied in detail. We studied repeat antenatal blood pressure measurements of 9697 women in the Avon Longitudinal Study of Parents and Children (median [interquartile range], 10 [9-11] measurements per woman). Bivariate linear spline models were used to relate blood pressure cha ...[more]

PMID: 24821945

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Project description:BackgroundMaternal gestational diabetes (GDM) is an established risk factor for large size at birth, but its influence on intrauterine fetal growth in different ethnic populations is less well understood. Here, we examine the joint associations of GDM and ethnicity with longitudinal fetal growth in South Asian and White European origin women.MethodsThis study included 10,705 singletons (4747 White European and 5958 South Asian) from a prospective cohort of women attending an antenatal clinic in Bradford, in the North of England. All women completed a 75-g oral glucose tolerance test at 26-28 weeks' gestation. Ultrasound measurements of fetal head circumference (HC), femur length (FL) abdominal circumference (AC), and estimated fetal weight (EFW), and corresponding anthropometric measurements at birth were used to derive fetal growth trajectories. Associations of GDM and ethnicity with these trajectories were assessed using multilevel fractional polynomial models.ResultsEight hundred thirty-two pregnancies (7.8%) were affected by GDM: 10.4% of South Asians and 4.4% of White Europeans. GDM was associated with a smaller fetal size in early pregnancy [differences (95% CI) in mean HC at 12 weeks and mean AC and EFW at 16 weeks comparing fetuses exposed to GDM to fetuses unexposed (reference) = - 1.8 mm (- 2.6; - 1.0), - 1.7 mm (- 2.5; - 0.9), and - 6 g (- 10; - 2)] and a greater fetal size from 24 weeks' gestation through to term [differences (95% CI) in mean HC, AC, and EFW comparing fetuses exposed to GDM to those unexposed = 0.9 mm (0.3; 1.4), 0.9 mm (0.2; 1.7), and 7 g (0; 13) at 24 weeks]. Associations of GDM with fetal growth were of similar magnitude in both ethnic groups. Growth trajectories, however, differed by ethnicity with South Asians being smaller than White Europeans irrespective of GDM status. Consequently, South Asian fetuses exposed to GDM were smaller across gestation than fetuses of White Europeans without GDM.ConclusionsIn both ethnic groups, GDM is associated with early fetal size deviations prior to GDM diagnosis, highlighting the need for novel strategies to diagnose pregnancy hyperglycemia earlier than current methods. Our findings also suggest that ethnic-specific fetal growth criteria are important in identifying hyperglycemia-associated pathological effects.

Project description:Malaria during pregnancy is associated with an increased risk for low birth weight (<2500 grams). Distinguishing infants that are born premature (< 37 weeks) from those that are growth-restricted (less than the 10th percentile at birth) requires accurate assessment of gestational age. Where ultrasound is accessible, sonographic confirmation of gestational age is more accurate than menstrual dating. The goal was to pilot the feasibility and utility of adding ultrasound to an observational pregnancy malaria cohort.In July 2009, research staff (three mid-level clinical providers, one nurse) from The Blantyre Malaria Project underwent an intensive one-week ultrasound training to perform foetal biometry. Following an additional four months of practice and remote image review, subjects from an ongoing cohort were recruited for ultrasound to determine gestational age. Gestational age at delivery established by ultrasound was compared with postnatal gestational age assessment (Ballard examination).One hundred and seventy-eight women were enrolled. The majority of images were of good quality (94.3%, 509/540) although a learning curve was apparent with 17.5% (24/135) images of unacceptable quality in the first 25% of scans. Ultrasound was used to date 13% of the pregnancies when menstrual dates were unknown and changed the estimated gestational age for an additional 25%. There was poor agreement between the gestational age at delivery as established by the ultrasound protocol compared to that determined by the Ballard examination (bias 0.8 weeks, limits of agreement -3.5 weeks to 5.1 weeks). The distribution of gestational ages by Ballard suggested a clustering of gestational age around the mean with 87% of the values falling between 39 and 41 weeks. The distribution of gestational age by ultrasound confirmed menstrual dates was more typical. Using ultrasound confirmed dates as the gold standard, 78.5% of preterm infants were misclassified as term and 26.8% of small-for gestational age infants misclassified as appropriately grown by Ballard.Ultrasound should be strongly considered in prospective malaria studies with obstetric endpoints to confirm gestational age and avoid misclassification of infants as premature or growth-restricted. The use of ultrasound does require a significant investment of time to maintain quality image acquisition.

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Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort.

Publications

Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort.

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