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The objective of this study was to evaluate and compare risk factor patterns in association with preeclampsia and gestational hypertension. The data were collected from The Swedish Medical Birth Register and include all nulliparas aged 34 years or less who gave birth at the University Hospital of Uppsala, Sweden, during 1987-1993. Of these 10,666 women, 4.4% developed gestational hypertension, and 5.2% developed preeclampsia. The following risk factors were significantly associated with increased risk of preeclampsia: type 1 diabetes (odds ratio = 5.58, 95% confidence interval 2.72-11.43), gestational diabetes (odds ratio = 3.11, 95% confidence interval 1.61-6.00), and twin birth (odds ratio = 4.17, 95% confidence interval 2.30-7.55). The positive associations between these variables and the risk of gestational hypertension were weaker and nonsignificant. Compared with underweight women (body mass index < 19.8), obese women (body mass index > 29) had increased risks of both gestational hypertension (odds ratio = 4.85, 95% confidence interval 1.97-11.92) and preeclampsia (odds ratio = 5.19, 95% confidence interval 2.35-11.48). Significantly lower risks of preeclampsia and gestational hypertension were observed for women born outside Nordic countries and in association with maternal smoking and summer birth. The similarities in risk factor patterns may indicate similarities in the biologic mechanisms underlying the two conditions.
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PMID:Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. 962 50

Hypertension in pregnancy and gestational diabetes have in common a lack of universally accepted classification and nomenclature that hinders comparison of data between research groups and contributes to the lack of consensus in the literature on these conditions. The inter-relationship of hypertension and gestational diabetes can be considered from three viewpoints according to whether hypertension is present before, during, or after the pregnancy. The first question is whether hypertension predating pregnancy predisposes to gestational diabetes. Epidemiological evidence and physiological argument based on the common etiologic factor of insulin resistance would suggest that gestational diabetes should be more common in the presence of preexisting hypertension. The limited clinical data available support this hypothesis. There are three issues concerning the coexistence of hypertension and gestational diabetes: whether gestational diabetes predisposes to pregnancy-induced hypertension, whether pregnancy-induced hypertension predisposes to gestational diabetes and what effect the combination has on morbidity and mortality. A number of studies have investigated whether pregnancy-induced hypertension is more common in women with gestational diabetes, but no consensus has been reached. There is little direct clinical evidence on the reverse issue, but data are presented to suggest that pregnancy-induced hypertension may only predispose to gestational diabetes when its etiology is gestational hypertension and not preeclampsia. The issue of how the coexistence of pregnancy-induced hypertension and gestational diabetes affects maternal or neonatal morbidity and mortality is largely unanswered. The last question is whether gestational diabetes has any prognostic significance with regard to the future development of hypertension in the mother. It is well known that gestational diabetes predisposes to subsequent NIDDM and that NIDDM is associated with a high incidence of essential hypertension. Once again insulin resistance may be a unifying factor. However, there is no direct clinical evidence that gestational diabetes predisposes to future hypertension.
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PMID:Hypertension in women with gestational diabetes. 970 24

The purpose of this study was to estimate if the erythropoietin (EPO) concentration in cord arterial blood can be an indicator of a fetal risk. We studied EPO concentration measured by enzyme immonoassay in ten patient groups: (1) control group with healthy newborns (n = 72); (2) neonates born by elective caesarean section (n = 16); (3) newborns with acidosis at birth (n = 12); (4) newborns with 1-min-Apgar < 7 (n = 8); (5) preterm neonates (n = 25); (6) newborns with gestational age > or = 242 weeks (n = 19); (7) neonates born to mothers with hypertension (n = 16); (8) newborns with signs of fetal distress in CTG (n = 29); (9) neonates born to mothers with diabetes (n = 19), divided into two subgroups: diabetes White A-D (n = 8) and gestational diabetes (n = 11); (10) neonates born to mothers with diabetes White A-D and with acidosis at birth (n = 7). The geometric mean was 26.4 mU/ml in the control group. EPO levels was found significantly increased (p < 0.01) in the following groups: (3) newborns with acidosis (52 mU/ml); (6) newborns with gestational age > or = 242 weeks (63.5 mU/ml); (8) newborns with signs of fetal distress in CTG (47.1 mU/ml); (9) neonates born to mothers with diabetes White A-D (47.7 mU/ml); (10) neonates born to mothers with diabetes White A-D and with acidosis at birth (> 64 mU/ml). We came to the conclusion that the cord arterial EPO concentration indicates a chronic fetal hypoxia and a longer duration of hypoxia before birth.
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PMID:[Erythropoietin as a marker of perinatal risk]. 971 26

The purpose of this study is to examine the correctness of the clinical data from the computerized perinatal database (PC-Log) at a Mayo Health System hospital. This computerized database is used for electronic transmission of birth certificates in Wisconsin. The paper medical record is chosen for the comparison. Random selection of 99 charts from a total of 893 births at a tertiary perinatal center during 1995. Of 310 fields in the database, 32 variables were compared to a hand abstraction of the paper medical record. PC-Log had 100% positive-predictive value (PPV) for eclampsia, prolonged rupture of membranes, pre-existing diabetes, cesarean section, and transports. The sensitivity, specificity, and PPV for other variables (abortion, congenital anomalies, gestational diabetes, maternal hypertension, and maternal employment) showed moderate to high agreement, but was poor for maternal ethanol use during pregnancy. Compared to hand abstraction, PC-Log had no recorded cases of substance abuse, antenatal steroids, hyaline membrane disease, circumcision, maternal and infant length of stay. Means for birth weight 5 minute Apgar scores did not differ, and the correlations were r = 0.982 and r = 0.960. The PC-Log showed good agreement for many but not all the variables of clinical interest.
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PMID:The computerized perinatal database: are the data reliable? 975 14

We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13-19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13-19 years), married 20-24 year-old patients, and unmarried 20-24 year-old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth-weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (>4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p<0.05), preeclampsia (p<0.004), gestational diabetes (p<0.01), history of substance abuse (p<0.0001), tobacco use (p<0.0001), and forceps delivery rates (p<0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low-risk, general population generating better than expected outcomes for pregnant teenagers.
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PMID:Use of a focussed teen prenatal clinic at a military teaching hospital: model for improved outcomes of unmarried mothers. 976 Nov 53

Pituitary adenomas are the most common pituitary disorder affecting pregnancy, and prolactinomas are the most common of the hormone-secreting pituitary adenomas. Hyperprolactinemia must be corrected to allow ovulation and fertility. Bromocriptine has been shown to be safe for use during early gestation. There is less than a 2% risk of microprolactinoma enlargement during pregnancy but a greater than 15% risk of symptomatic enlargement of a macroprolactinoma. Treatment options for patients with macroadenomas include stopping bromocriptine when pregnancy is diagnosed and reinstituting with tumor enlargement, continuous bromocriptine throughout pregnancy, and prepregnancy tumor debulking by surgery. The diagnosis of acromegaly may be difficult to make during pregnancy and relies, in part, on the persistence of the normal pulsatile secretion of growth hormone and loss of this secretory characteristic with a tumor. The growth hormone oversecretion may exacerbate tendencies to gestational diabetes, fluid retention, and hypertension. Treatment for acromegaly and other tumors generally may be deferred until after delivery. There are rare reports of enlargement of clinically nonfunctioning and growth hormone secreting tumors during pregnancy, and surveillance is needed. Tumors may need to be differentiated from lymphocytic hypophysitis. Patients with chronic hypopituitarism usually will need treatment with gonadotropins or pulsatile GnRH to become pregnant and may need increased steroid coverage during labor and delivery. Hypopituitarism developing during pregnancy is usually caused by lymphocytic hypophysitis and usually also will require steroid replacement therapy. Hypopituitarism arising postpartum may be caused by either lymphocytic hypophysitis or Sheehan's syndrome, and the latter may present as an acute or chronic syndrome. Borderline diabetes insipidus may manifest during pregnancy because of increased vasopressin degradation caused by markedly increased levels of placental vasopressinase. Treatment with desmopressin usually is satisfactory. Patients presenting with either anterior or posterior pituitary insufficiency in the peripartum period should always be evaluated for function of the other portion of the pituitary.
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PMID:Pituitary diseases in pregnancy. 988 Jan 16

Insulin resistance appears to be a causative mechanism for the development of essential hypertension. Insulin resistance syndrome consists of a cluster of abnormalities that aggravate preexisting tendencies to develop hypertension, resulting in a cascade of physiologic alterations and ultimately leading to increased rates of heart attack, stroke, and peripheral vascular disease. Like hypertension, NIDD is mediated by insulin resistance and is expressed in individuals with limited beta-cell reserve. Episodes of increased insulin resistance, such as aging, weight gain, and pregnancy, cannot be compensated for in these states, and glucose intolerance results. In the case of pregnancy, the temporary state of insulin resistance unmasks individuals with an early beta-cell defect and allows for identification of high-risk groups at a time when therapeutic interventions could result in primary prevention of disease. Evidence is beginning to accumulate that preeclampsia is at least partially mediated by insulin resistance as well, and that individuals with preeclampsia may have clinically silent but persistent alterations in insulin resistance. If this condition proves a corollary to gestational diabetes, there may be an opportunity to intervene for primary prevention of some forms of essential hypertension as well. The availability of new pharmacologic agents to enhance insulin sensitivity represents a true opportunity effectively to prevent the long-term complications associated with insulin resistance and hyperinsulinemia. To achieve this goal, early and accurate identification of populations at risk is essential. A complete understanding of the role of insulin resistance in the generation of preeclampsia will aid significantly in the discovery of the genetic polymorphisms and intracellular pathways by which insulin resistance is translated into cardiovascular disease, stroke, and nephropathy.
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PMID:Insulin resistance and preeclampsia. 989 20

Insulin plays a central role in human pregnancy. Maternal insulin sensitivity decreases with advancing gestation in order to provide glucose and possibly other nutrients for feto-placental growth and energy needs. Moreover, alterations of insulin metabolism are clearly involved in the development of gestational diabetes. In recent years, hyperinsulinaemia has been also proposed as a possible pathogenic factor in the development of gestational hypertension and preeclampsia; furthermore it has also been postulated that there is an involvement of insulin sensitivity in fetal growth restriction. These intriguing data have stimulated our interest in summarizing the physiopathological mechanisms by which the pancreatic hormone could be involved in obstetrics.
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PMID:Insulin in obstetrics: a main parameter in the management of pregnancy. 1009 80

Polycystic ovary syndrome is a common problem affecting approximately 5% of women of reproductive age when defined by clinical features of anovulation and hyperandrogenism. Metabolic derangements associated with this condition may predispose to a range of diseases with attendant morbidity and mortality risks. In general, available data support significantly increased rates of type II diabetes mellitus, dyslipidemia, and endometrial cancer in PCOS that are not completely explained by obesity; data also suggest that rates of hypertension, gestational diabetes, and pregnancy-induced hypertension may likewise be increased, although the extent to which obesity mediates these risks is not clear. The increased prevalence of several cardiovascular risk factors in PCOS and limited cross-sectional data suggest that cardiovascular disease should be more likely in PCOS, but prospective data are lacking to confirm this supposition. Limited data have suggested an association between PCOS and ovarian cancer risk and require further study. The present data do not support an increased risk for breast cancer in this condition. Long-term prospective data are clearly needed to better delineate the nature and magnitude of disease risks associated with PCOS, with appropriate adjustment for associated obesity. Such information is a necessary background for understanding the role of established and emerging PCOS therapies, including oral contraceptives, intermittent progesterone, ovulation induction agents, and insulin sensitizers, in modifying such risks. In the meantime, close follow-up of women with PCOS and encouragement of lifestyle practices likely to reduce disease risks, such as regular exercise and weight control, should be standard practice.
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PMID:The epidemiology of polycystic ovary syndrome. Prevalence and associated disease risks. 1035 18

Hypertension and diabetes frequently coexist and greatly increase cardiovascular risk. There are relatively few data on the relationship between blood pressure and plasma glucose in newly diagnosed diabetic subjects especially in Chinese. We examined the glycaemic status, blood pressure profiles and other clinical and biochemical characteristics in 1298 Hong Kong Chinese women. These women were referred to the Diabetes and Endocrine Center of the Prince of Wales Hospital for screening of diabetes. The reasons for referral included a positive family history of diabetes or a history of gestational diabetes. Of the 1298 subjects, 836 (64.4%) had normal oral glucose tolerance test, 284 (21.9%) had impaired glucose tolerance and 178 (13.7%) had diabetes. Compared to non-diabetic subjects, the odds ratio (95% confidence interval) of having hypertension in subjects with impaired glucose tolerance or diabetes were 2.83 (1.90, 4.23) (P<0.001) and 5.94 (3.94, 8.96) (P<0.001), respectively. When analyzed as a continuous variable by age-adjusted partial correlation coefficients, systolic blood pressure was correlated with body mass index, fasting and 2-h plasma glucose, while diastolic blood pressure was correlated with body mass index. Using age, body mass index, fasting and 2-h plasma glucose, glycated hemoglobin, cholesterol, triglyceride and smoking as independent variables in multivariate analysis, hypertension was independently related to age, body mass index and 2-h plasma glucose. In conclusion, increased blood pressure was common in Hong Kong Chinese women who were newly diagnosed to have glucose intolerance. Apart from age and body mass index, plasma glucose was an independent determinant for blood pressure in these subjects.
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PMID:Age, body mass index and 2-hour plasma glucose are the major determinants of blood pressure in Chinese women newly diagnosed to have glucose intolerance. 1036 70


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