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Bahaeddine M Sibai - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis and management of Gestational Hypertension and preeclampsia.
Obstetrics and gynecology, 2003Co-Authors: Bahaeddine M SibaiAbstract:Gestational Hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild Hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe Gestational Hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications. Women with diagnosed Gestational Hypertension-preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant management depends on fetal Gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks' gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks' gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild Hypertension-preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia.
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adverse perinatal outcomes are significantly higher in severe Gestational Hypertension than in mild preeclampsia
American Journal of Obstetrics and Gynecology, 2002Co-Authors: Alan Buchbinder, Bahaeddine M Sibai, Mark A Klebanoff, Steve N Caritis, Cora Macpherson, John C Hauth, Marshall D Lindheimer, Peter Vandorsten, Mark Landon, Richard J PaulAbstract:Abstract Objective: The current literature emphasizes increased risk of adverse outcomes in the presence of proteinuria and Hypertension. The objective of this study was to compare the frequency of adverse fetal outcomes in women who developed hypertensive disorders with or without proteinuria. Study Design: The study design was a secondary analysis of data from women who had preeclampsia in a previous pregnancy (n = 598) who were enrolled in a multicenter trial of aspirin for the prevention of preeclampsia. The women had no history of chronic Hypertension or renal disease and were normotensive at study inclusion. The maternal and perinatal outcome variables assessed were preterm delivery at Results: As compared to mild preeclampsia, women who developed severe Gestational Hypertension (without proteinuria) had higher rates of both preterm delivery at P P =.001) and at P =.0161), and delivery of small-for-Gestational-age infants (20.8% vs 6.5%, P =.024) when compared to women who remained normotensive or those who developed mild Gestational Hypertension. There were no statistically significant differences in perinatal outcomes between the normotensive/mild Gestational Hypertension and the mild preeclampsia groups. Overall, women who had severe Gestational Hypertension had increased rates of preterm delivery and delivery of small-for-Gestational-age infants than women with mild Gestational Hypertension or mild preeclampsia. In the presence of severe Hypertension, proteinuria did not increase the rates of preterm delivery or delivery of small-for-Gestational-age infants. Conclusions: In women who have Gestational Hypertension or preeclampsia, increased rates of preterm delivery and delivery of small-for-Gestational-age infants are present only in those with severe Hypertension. In these women, the presence of proteinuria does not influence perinatal outcome. (Am J Obstet Gynecol 2002;186:66-71.)
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mild Gestational Hypertension remote from term progression and outcome
American Journal of Obstetrics and Gynecology, 2001Co-Authors: John R. Barton, Niki K. Bergauer, Debbie Jacques, John M Obrien, Bahaeddine M SibaiAbstract:Abstract Objective: Limited information is available regarding the progression of disease in women with mild Gestational Hypertension. Our purpose was to describe the prognostic signs in the natural course of mild Gestational Hypertension and pregnancy outcomes in women who were remote from term with mild Gestational Hypertension that was expectantly managed. Study Design: Women with mild Gestational Hypertension participating in an outpatient Hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestation who had no proteinuria by dipstick (0 or trace) on the first 2 days of program participation. Progression to preeclampsia was the primary outcome. The rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independent Student t and Fisher exact tests where applicable. Results: A total of 748 patients were studied during the observation period; preeclampsia (persistent proteinuria ≥1+) developed in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclampsia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuria developed and those in whom it did not develop. Gestational age of the infants at delivery (36.5 ± 2.4 vs 37.4 ± 2.0 weeks), birth weight (2752 ± 767 vs 3038 ± 715 g), incidence of small-for-Gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 ± 10 vs 5.0 ± 9.3 days) differed significantly in the patients with versus those without proteinuria ( P Conclusions: In patients with mild Gestational Hypertension remote from term, 46% ultimately had preeclampsia, with progression to severe disease in 9.6%. The development of proteinuria is associated with an earlier Gestational age at delivery, lower birth weight, and an increased incidence of small-for-Gestational age newborns. (Am J Obstet Gynecol 2001;184:979-83.)
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Mild Gestational Hypertension remote from term: Progression and outcome
American journal of obstetrics and gynecology, 2001Co-Authors: John R. Barton, John M. O'brien, Niki K. Bergauer, Debbie Jacques, Bahaeddine M SibaiAbstract:Limited information is available regarding the progression of disease in women with mild Gestational Hypertension. Our purpose was to describe the prognostic signs in the natural course of mild Gestational Hypertension and pregnancy outcomes in women who were remote from term with mild Gestational Hypertension that was expectantly managed. Women with mild Gestational Hypertension participating in an outpatient Hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestation who had no proteinuria by dipstick (0 or trace) on the first 2 days of program participation. Progression to preeclampsia was the primary outcome. The rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independent Student t and Fisher exact tests where applicable. A total of 748 patients were studied during the observation period; preeclampsia (persistent proteinuria > or = 1+) developed in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclampsia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuria developed and those in whom it did not develop. Gestational age of the infants at delivery (36.5 +/- 2.4 vs 37.4 +/- 2.0 weeks), birth weight (2752 +/- 767 vs 3038 +/- 715 g), incidence of small-for-Gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 +/- 10 vs 5.0 +/- 9.3 days) differed significantly in the patients with versus those without proteinuria (P <.001 for all). In patients with mild Gestational Hypertension remote from term, 46% ultimately had preeclampsia, with progression to severe disease in 9.6%. The development of proteinuria is associated with an earlier Gestational age at delivery, lower birth weight, and an increased incidence of small-for-Gestational age newborns.
Allen A. Mitchell - One of the best experts on this subject based on the ideXlab platform.
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selective serotonin reuptake inhibitor use and risk of Gestational Hypertension
American Journal of Psychiatry, 2009Co-Authors: Sengwee Toh, Martha M. Werler, Allen A. Mitchell, Carol Louik, Christina D Chambers, Sonia HernandezdiazAbstract:Objective: The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of Gestational Hypertension and preeclampsia. Method: The authors analyzed data from 5,731 women with nonmalformed infants and no underlying Hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational Hypertension was defined as incident Hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of Gestational Hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. Results: Gestational Hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 19...
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Selective Serotonin Reuptake Inhibitor Use and Risk of Gestational Hypertension
The American journal of psychiatry, 2009Co-Authors: Sengwee Toh, Martha M. Werler, Allen A. Mitchell, Carol Louik, Christina D Chambers, Sonia Hernandez-diazAbstract:The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of Gestational Hypertension and preeclampsia. The authors analyzed data from 5,731 women with nonmalformed infants and no underlying Hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational Hypertension was defined as incident Hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of Gestational Hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. Gestational Hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 199 women who were treated with SSRIs. Among women who received treatment, Gestational Hypertension was present in 13.1% of the 107 women who received treatment only during the first trimester and in 26.1% of the 92 women who continued treatment beyond the first trimester. The occurrence of preeclampsia was 2.4% among women who were not treated with SSRIs, 3.7% among women who were exposed to SSRIs only during the first trimester, and 15.2% among women who continued SSRI treatment beyond the first trimester. Relative to women who did not receive treatment, the adjusted relative risk of preeclampsia was 1.4 for women who discontinued treatment and 4.9 for women who continued treatment. SSRI exposure during late pregnancy-whether a causal factor or not-might identify women who are at an increased risk for Gestational Hypertension and preeclampsia. Further investigation is needed in order to separate the effects of treatment with SSRIs from those of underlying mood disorders.
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Methylenetetrahydrofolate reductase polymorphisms and the risk of Gestational Hypertension.
Epidemiology (Cambridge Mass.), 2005Co-Authors: Sonia Hernandez-diaz, Catherine Hayes, Martha M. Werler, Tara Devi S. Ashok, Rachel Badovinac, Karl T. Kelsey, Allen A. MitchellAbstract:Background: Evidence on the association of 5,10 methylentetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in women with Gestational Hypertension is inconsistent. It is also unknown whether the fetal genotype is relevant, or whether folic acid supplementation modifies this association. Methods: The study population was composed of U.S. and Canadian white women with nonmalformed infants participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery regarding multivitamin use in pregnancy and the occurrence of Gestational Hypertension, among other factors. DNA was extracted from cheek swabs and gene alleles determined by restriction fragment length polymorphism analysis. We compared the prevalence of the 677TT/CT and 1298CC/AC genotypes between cases with Gestational Hypertension (54 mothers and their 51 offspring) and controls (100 mothers and their 99 offspring). We also estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression to control for geographic region and calendar year. Results: The T allele was present in 69% of women with Gestational Hypertension versus 57% of control women (compared with 677CC, OR = 1.9; 95% CI = 0.9–4.0). The offspring of case and control women had a 677TT/CT genotype prevalence of 68% and 47%, respectively (2.4; 1.1–5.0). Among women supplemented with folic acid during the first 5 months of pregnancy, the ORs for maternal and fetal 677TT/CT genotypes were 0.9 (0.3–2.5) and 2.1 (0.7–6.0), respectively. Neither maternal nor fetal 1298CC/AC genotypes were associated with an increased risk of Gestational Hypertension. Conclusion: Maternal and fetal MTHFR C677T polymorphism may be associated with a moderately increased risk of Gestational Hypertension, and there is a suggestion that this association may be diminished among women receiving folate supplementation during pregnancy.
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Risk of Gestational Hypertension in Relation to Folic Acid Supplementation during Pregnancy
American journal of epidemiology, 2002Co-Authors: Sonia Hernandez-diaz, Martha M. Werler, Carol Louik, Allen A. MitchellAbstract:The authors investigated the association between folic acid supplementation and Gestational Hypertension. The study population included women with nonmalformed infants in the United States and Canada who were participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery about sociodemographic and medical factors, the occurrence of Hypertension with or without preeclampsia, and multivitamin use in pregnancy. Relative risks, adjusted for weight, parity, twin pregnancy, diabetes, smoking, education, and family income, were estimated using Cox regression models. Of 2,100 women, 204 (9.7%) reported Gestational Hypertension (onset after the 20th week of gestation). The multivariate-adjusted relative risk of developing Gestational Hypertension during the month after folic acid supplementation, compared with not using folic acid during that same month, was 0.55 (95% confidence interval: 0.39, 0.79). This finding suggests that folic acid-containing multivitamins may reduce the risk of Gestational Hypertension.
Sonia Hernandez-diaz - One of the best experts on this subject based on the ideXlab platform.
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Selective Serotonin Reuptake Inhibitor Use and Risk of Gestational Hypertension
The American journal of psychiatry, 2009Co-Authors: Sengwee Toh, Martha M. Werler, Allen A. Mitchell, Carol Louik, Christina D Chambers, Sonia Hernandez-diazAbstract:The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of Gestational Hypertension and preeclampsia. The authors analyzed data from 5,731 women with nonmalformed infants and no underlying Hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational Hypertension was defined as incident Hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of Gestational Hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. Gestational Hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 199 women who were treated with SSRIs. Among women who received treatment, Gestational Hypertension was present in 13.1% of the 107 women who received treatment only during the first trimester and in 26.1% of the 92 women who continued treatment beyond the first trimester. The occurrence of preeclampsia was 2.4% among women who were not treated with SSRIs, 3.7% among women who were exposed to SSRIs only during the first trimester, and 15.2% among women who continued SSRI treatment beyond the first trimester. Relative to women who did not receive treatment, the adjusted relative risk of preeclampsia was 1.4 for women who discontinued treatment and 4.9 for women who continued treatment. SSRI exposure during late pregnancy-whether a causal factor or not-might identify women who are at an increased risk for Gestational Hypertension and preeclampsia. Further investigation is needed in order to separate the effects of treatment with SSRIs from those of underlying mood disorders.
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Methylenetetrahydrofolate reductase polymorphisms and the risk of Gestational Hypertension.
Epidemiology (Cambridge Mass.), 2005Co-Authors: Sonia Hernandez-diaz, Catherine Hayes, Martha M. Werler, Tara Devi S. Ashok, Rachel Badovinac, Karl T. Kelsey, Allen A. MitchellAbstract:Background: Evidence on the association of 5,10 methylentetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in women with Gestational Hypertension is inconsistent. It is also unknown whether the fetal genotype is relevant, or whether folic acid supplementation modifies this association. Methods: The study population was composed of U.S. and Canadian white women with nonmalformed infants participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery regarding multivitamin use in pregnancy and the occurrence of Gestational Hypertension, among other factors. DNA was extracted from cheek swabs and gene alleles determined by restriction fragment length polymorphism analysis. We compared the prevalence of the 677TT/CT and 1298CC/AC genotypes between cases with Gestational Hypertension (54 mothers and their 51 offspring) and controls (100 mothers and their 99 offspring). We also estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression to control for geographic region and calendar year. Results: The T allele was present in 69% of women with Gestational Hypertension versus 57% of control women (compared with 677CC, OR = 1.9; 95% CI = 0.9–4.0). The offspring of case and control women had a 677TT/CT genotype prevalence of 68% and 47%, respectively (2.4; 1.1–5.0). Among women supplemented with folic acid during the first 5 months of pregnancy, the ORs for maternal and fetal 677TT/CT genotypes were 0.9 (0.3–2.5) and 2.1 (0.7–6.0), respectively. Neither maternal nor fetal 1298CC/AC genotypes were associated with an increased risk of Gestational Hypertension. Conclusion: Maternal and fetal MTHFR C677T polymorphism may be associated with a moderately increased risk of Gestational Hypertension, and there is a suggestion that this association may be diminished among women receiving folate supplementation during pregnancy.
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Risk of Gestational Hypertension in Relation to Folic Acid Supplementation during Pregnancy
American journal of epidemiology, 2002Co-Authors: Sonia Hernandez-diaz, Martha M. Werler, Carol Louik, Allen A. MitchellAbstract:The authors investigated the association between folic acid supplementation and Gestational Hypertension. The study population included women with nonmalformed infants in the United States and Canada who were participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery about sociodemographic and medical factors, the occurrence of Hypertension with or without preeclampsia, and multivitamin use in pregnancy. Relative risks, adjusted for weight, parity, twin pregnancy, diabetes, smoking, education, and family income, were estimated using Cox regression models. Of 2,100 women, 204 (9.7%) reported Gestational Hypertension (onset after the 20th week of gestation). The multivariate-adjusted relative risk of developing Gestational Hypertension during the month after folic acid supplementation, compared with not using folic acid during that same month, was 0.55 (95% confidence interval: 0.39, 0.79). This finding suggests that folic acid-containing multivitamins may reduce the risk of Gestational Hypertension.
Yeon S. Ahn - One of the best experts on this subject based on the ideXlab platform.
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Elevated plasma endothelial microparticles: Preeclampsia versus Gestational Hypertension
American journal of obstetrics and gynecology, 2004Co-Authors: Victor Hugo Gonzalez-quintero, Joaquin J. Jimenez, Loren Smarkusky, Lucia M. Mauro, Laurence L. Hortsman, Mary J. O'sullivan, Yeon S. AhnAbstract:Objective Elevated plasma endothelial microparticle levels have been found to be elevated in women with preeclampsia. However, their role in distinguishing preeclampsia from Gestational Hypertension remains to be elucidated. The objectives of this study were to compare endothelial microparticle levels among patients with preeclampsia, Gestational Hypertension, and healthy pregnant control subjects and to evaluate the effect of plasma from women with preeclampsia and Gestational Hypertension on the release of endothelial microparticles by renal microvascular endothelial cells. Study design A prospective study was conducted on 52 women with preeclampsia, 20 women with Gestational Hypertension, and 38 healthy pregnant control subjects. Endothelial microparticles were measured by flow cytometry with fluorescent monoclonal mouse anti-human antibodies against CD31, CD42b, and CD62E. Results CD31 + /42b − endothelial microparticle levels were 10497 ± 5145 counts/μL in women with preeclampsia versus 6768 ± 1810 counts/μL in women with Gestational Hypertension ( P + /42b − endothelial microparticle levels were 6119 ± 3592 counts/μL. CD62E + endothelial microparticle levels were1930 ± 966 counts/μL in women with preeclampsia versus 822 ± 150 counts/μL in women with Gestational Hypertension ( P + endothelial microparticle levels were 712 ± 160 counts/μL. Incubation of renal microvascular endothelial cells with plasma from women with preeclampsia resulted in a rise in CD31 + and CD62E + endothelial microparticle levels as compared with women with Gestational Hypertension and control subjects. Conclusion Endothelial microparticle levels are higher in women with preeclampsia than in women with Gestational Hypertension and control subjects. The measurement of endothelial microparticles may be useful as a diagnostic tool for preeclampsia in pregnant women.
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Elevated plasma endothelial microparticles: Preeclampsia versus Gestational Hypertension
American journal of obstetrics and gynecology, 2004Co-Authors: Victor Hugo Gonzalez-quintero, Joaquin J. Jimenez, Loren Smarkusky, Lucia M. Mauro, Laurence L. Hortsman, Mary J. O'sullivan, Yeon S. AhnAbstract:Elevated plasma endothelial microparticle levels have been found to be elevated in women with preeclampsia. However, their role in distinguishing preeclampsia from Gestational Hypertension remains to be elucidated. The objectives of this study were to compare endothelial microparticle levels among patients with preeclampsia, Gestational Hypertension, and healthy pregnant control subjects and to evaluate the effect of plasma from women with preeclampsia and Gestational Hypertension on the release of endothelial microparticles by renal microvascular endothelial cells. A prospective study was conducted on 52 women with preeclampsia, 20 women with Gestational Hypertension, and 38 healthy pregnant control subjects. Endothelial microparticles were measured by flow cytometry with fluorescent monoclonal mouse anti-human antibodies against CD31, CD42b, and CD62E. CD31 + /42b - endothelial microparticle levels were 10497 +/- 5145 counts/microL in women with preeclampsia versus 6768 +/- 1810 counts/microL in women with Gestational Hypertension ( P < .01). In control subjects, CD31 + /42b - endothelial microparticle levels were 6119 +/- 3592 counts/microL. CD62E + endothelial microparticle levels were 1930 +/- 966 counts/microL in women with preeclampsia versus 822 +/- 150 counts/microL in women with Gestational Hypertension ( P <.01). In control subjects, CD62E + endothelial microparticle levels were 712 +/- 160 counts/microL. Incubation of renal microvascular endothelial cells with plasma from women with preeclampsia resulted in a rise in CD31 + and CD62E + endothelial microparticle levels as compared with women with Gestational Hypertension and control subjects. Endothelial microparticle levels are higher in women with preeclampsia than in women with Gestational Hypertension and control subjects. The measurement of endothelial microparticles may be useful as a diagnostic tool for preeclampsia in pregnant women.
Martha M. Werler - One of the best experts on this subject based on the ideXlab platform.
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selective serotonin reuptake inhibitor use and risk of Gestational Hypertension
American Journal of Psychiatry, 2009Co-Authors: Sengwee Toh, Martha M. Werler, Allen A. Mitchell, Carol Louik, Christina D Chambers, Sonia HernandezdiazAbstract:Objective: The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of Gestational Hypertension and preeclampsia. Method: The authors analyzed data from 5,731 women with nonmalformed infants and no underlying Hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational Hypertension was defined as incident Hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of Gestational Hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. Results: Gestational Hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 19...
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Selective Serotonin Reuptake Inhibitor Use and Risk of Gestational Hypertension
The American journal of psychiatry, 2009Co-Authors: Sengwee Toh, Martha M. Werler, Allen A. Mitchell, Carol Louik, Christina D Chambers, Sonia Hernandez-diazAbstract:The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of Gestational Hypertension and preeclampsia. The authors analyzed data from 5,731 women with nonmalformed infants and no underlying Hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational Hypertension was defined as incident Hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of Gestational Hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors. Gestational Hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 199 women who were treated with SSRIs. Among women who received treatment, Gestational Hypertension was present in 13.1% of the 107 women who received treatment only during the first trimester and in 26.1% of the 92 women who continued treatment beyond the first trimester. The occurrence of preeclampsia was 2.4% among women who were not treated with SSRIs, 3.7% among women who were exposed to SSRIs only during the first trimester, and 15.2% among women who continued SSRI treatment beyond the first trimester. Relative to women who did not receive treatment, the adjusted relative risk of preeclampsia was 1.4 for women who discontinued treatment and 4.9 for women who continued treatment. SSRI exposure during late pregnancy-whether a causal factor or not-might identify women who are at an increased risk for Gestational Hypertension and preeclampsia. Further investigation is needed in order to separate the effects of treatment with SSRIs from those of underlying mood disorders.
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Methylenetetrahydrofolate reductase polymorphisms and the risk of Gestational Hypertension.
Epidemiology (Cambridge Mass.), 2005Co-Authors: Sonia Hernandez-diaz, Catherine Hayes, Martha M. Werler, Tara Devi S. Ashok, Rachel Badovinac, Karl T. Kelsey, Allen A. MitchellAbstract:Background: Evidence on the association of 5,10 methylentetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in women with Gestational Hypertension is inconsistent. It is also unknown whether the fetal genotype is relevant, or whether folic acid supplementation modifies this association. Methods: The study population was composed of U.S. and Canadian white women with nonmalformed infants participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery regarding multivitamin use in pregnancy and the occurrence of Gestational Hypertension, among other factors. DNA was extracted from cheek swabs and gene alleles determined by restriction fragment length polymorphism analysis. We compared the prevalence of the 677TT/CT and 1298CC/AC genotypes between cases with Gestational Hypertension (54 mothers and their 51 offspring) and controls (100 mothers and their 99 offspring). We also estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression to control for geographic region and calendar year. Results: The T allele was present in 69% of women with Gestational Hypertension versus 57% of control women (compared with 677CC, OR = 1.9; 95% CI = 0.9–4.0). The offspring of case and control women had a 677TT/CT genotype prevalence of 68% and 47%, respectively (2.4; 1.1–5.0). Among women supplemented with folic acid during the first 5 months of pregnancy, the ORs for maternal and fetal 677TT/CT genotypes were 0.9 (0.3–2.5) and 2.1 (0.7–6.0), respectively. Neither maternal nor fetal 1298CC/AC genotypes were associated with an increased risk of Gestational Hypertension. Conclusion: Maternal and fetal MTHFR C677T polymorphism may be associated with a moderately increased risk of Gestational Hypertension, and there is a suggestion that this association may be diminished among women receiving folate supplementation during pregnancy.
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Risk of Gestational Hypertension in Relation to Folic Acid Supplementation during Pregnancy
American journal of epidemiology, 2002Co-Authors: Sonia Hernandez-diaz, Martha M. Werler, Carol Louik, Allen A. MitchellAbstract:The authors investigated the association between folic acid supplementation and Gestational Hypertension. The study population included women with nonmalformed infants in the United States and Canada who were participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery about sociodemographic and medical factors, the occurrence of Hypertension with or without preeclampsia, and multivitamin use in pregnancy. Relative risks, adjusted for weight, parity, twin pregnancy, diabetes, smoking, education, and family income, were estimated using Cox regression models. Of 2,100 women, 204 (9.7%) reported Gestational Hypertension (onset after the 20th week of gestation). The multivariate-adjusted relative risk of developing Gestational Hypertension during the month after folic acid supplementation, compared with not using folic acid during that same month, was 0.55 (95% confidence interval: 0.39, 0.79). This finding suggests that folic acid-containing multivitamins may reduce the risk of Gestational Hypertension.