Association of preeclampsia with high birth weight for age

doi:10.1067/mob.2000.105735

American Journal of Obstetrics and Gynecology

Volume 183, Issue 1, July 2000, Pages 148-155

Presented at the Thirty-second Annual Meeting of the Society of Epidemiologic Research, Baltimore, Maryland, June 10-12, 1999.

https://doi.org/10.1067/mob.2000.105735 Get rights and content

Abstract

Objective: The purpose of this study was to examine the effect of gestational hypertension and preeclampsia on fetal growth. Study Design: A retrospective cohort study was conducted on the basis of 97,270 pregnancies delivered between 1991 and 1996 in 35 hospitals in northern and central Alberta, Canada. Univariate and multivariate logistic analyses were performed to examine the impact of preeclampsia and gestational hypertension on high-birth-weight (≥4200 g), large-for-gestational-age, low-birth-weight (<2500 g), and small-for-gestational-age babies. Results: The rate of high-birth-weight fetuses in women with gestational hypertension (7.3%) was higher than in those with normal blood pressure (5.6%). After we controlled for confounders, the adjusted odds ratio of high birth weight was 1.44 (95% confidence interval, 1.21-1.70) in women with gestational hypertension. Preeclampsia was also associated with a statistically nonsignificant (P =.054) increased risk of high birth weight (adjusted odds ratio, 1.40; 95% confidence interval 0.99-1.98). The rate of large-for-gestational-age babies was significantly higher in women with gestational hypertension (4.5%) and preeclampsia (4.7%) than in those with normal blood pressure (2.2%), with adjusted odds ratios of 1.50 (95% confidence interval, 1.22-1.85) for gestational hypertension and 1.87 (95% confidence interval, 1.31-2.67) for preeclampsia. Concurrently, women who had gestational hypertension were also at higher risk of having low-birth-weight (adjusted odds ratio, 2.4; 95% confidence interval, 2.13-2.93) and small-for-gestational-age (adjusted odds ratio, 2.04; 95% confidence interval, 1.68-2.48) babies. Women with preeclampsia were also at markedly higher risk of having low-birth-weight (adjusted odds ratio, 4.14; 95% confidence interval, 3.32-5.15) and small-for-gestational-age (adjusted odds ratio, 2.56; 95% confidence interval, 1.92-3.41) babies. Conclusions: There is a significant association of preeclampsia and gestational hypertension with large-for-gestational-age infants, in addition to a significant association with low-birth-weight and small-for-gestational-age infants. This study challenges the currently held belief that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia. (Am J Obstet Gynecol 2000;183:148-55.)

Section snippets

Study population

The research protocol was submitted to and approved by the Health Research Ethics Board, University of Alberta. The data for this study originate from the Northern and Central Alberta Perinatal Audit and Education Program. This program started data collection in 1991 for the purposes of monitoring obstetric interventions and of developing educational strategies to decrease the incidence of obstetric interventions. The database was derived directly from the standard labor and delivery record

Results

In the study population of 87,798 pregnancies, 2395 (2.7%) had gestational hypertension, 740 (0.8%) had preeclampsia, and 5 had eclampsia. Because of the few cases, patients with eclampsia were grouped into the preeclampsia group for analysis. The incidence of preeclampsia is lower than that generally reported because we excluded groups of women at high risk for development of preeclampsia (women with chronic hypertension, multiple pregnancy, diabetes, and hypertension that was limited to

Comment

Mothers who have preeclampsia usually have smaller babies. This is in part the result of preterm birth or shortened gestational duration (Table I) because early delivery is a consequence of preeclampsia and its only effective treatment. This has masked the fact that most infants born to mothers with preeclampsia are not small when compared with infants born to mothers without preeclampsia at the same gestational age. Moreover, our study reports 2 methods of looking at large infants for

Acknowledgements

We thank Ms Nancy Bott, the coordinator of Northern and Central Alberta Outreach Program, for data preparation.

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Cited by (161)

Preeclampsia epidemiology(ies) and pathophysiology(ies)
2024, Best Practice and Research: Clinical Obstetrics and Gynaecology
Preeclampsia/eclampsia was first described 2000 years ago. Concepts guiding diagnosis have changed over time making longitudinal studies challenging. Similarly, concepts of pathophysiology have evolved from eclampsia as a pregnancy seizure disorder to preeclampsia as a hypertensive and renal disorder to our current concept of a preeclampsia as a pregnancy specific, multisystemic inflammatory disorder. Although preeclampsia is pregnancy specific and many pathophysiologic findings begin to resolve with delivery, its impact extends beyond pregnancy. The risk of cardiovascular and neurological disease is increased after pregnancy in women who have had preeclampsia. The disorder is not a disease, but a syndrome and emerging data indicate multiple pathways to the syndrome. It is likely that our failure to have a major impact on prediction and prevention despite a large increase in understanding is due to the existence of multiple subtypes of preeclampsia. This concept should guide future research.
Preeclampsia subtypes: Clinical aspects regarding pathogenesis, signs, and management with special attention to diuretic administration
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
In 1990, Easterling and co-workers [29] reported high blood volume in preeclamptic patients. Ten years later, Xiong et al. [30] and, following some years, Scandinavian authors [31,32] reported high fetal birth weight in patients admitted with the diagnosis of PE, which excludes placental insufficiency. Moreover, opposing changes, such as increased and diminished cerebral blood perfusion was reported in preeclamptic patients [33].
During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence coupled with the extreme extent regarding the volume expansion, are likely accompanied with pathological conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and organ deficiency, such as proteinuria during the second half of pregnancy, is not a homogenous disease. Clinically speaking, two main types of preeclampsia can be distinguished, in which a marked difference between them is vascular condition, and consequently, the blood volume.
The “classic” preeclampsia, as a two-phase disease, described in the first, latent phase, in which, placenta development is diminished. Agents from this malperfused placenta generate a maternal disease, the second phase, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and thrombotic microangiopathy. In this hypovolemia-associated condition, decreasing platelet count, signs of hemolysis, renal and liver involvement are characteristic findings; proteinuria is marked and increasing. In the terminal phase, visible edema develops due to increasing capillary transparency, augmenting end-organ damages. “Classic” preeclampsia is a severe and quickly progressing condition with placental insufficiency and consequent fetal growth restriction and oligohydramnios. The outcome of this condition often leads to fetal hypoxia, eclampsia or placental abruption. The management is limited to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function, careful diminishing high blood pressure, and delivery induction in due time.
The other subtype, associated with relaxed vasculature and high cardiac output, is a maternal disease, in which obesity is an important risk factor since predisposes to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, enhanced water retention leads to lowered extremity edema, which oftentimes progresses to a generalized form and hypertension. In several cases, proteinuria appears most likely due to tissue edema. This condition already fully meets preeclampsia criteria. Laboratory alterations, including proteinuria, are modest and platelet count remains within the normal range. Fetal weight is also normal or frequently over average due to enhanced placental blood supply. It is very likely, further water retention leads to venous congestion, a parenchyma stasis, responsible for ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preeclampsia, the administration of diuretic furosemide treatment seemingly offers promise.
Trends and predictors of birth weight in Chilean children
2021, Public Health
Birth weight is an important public health indicator that reflects fetal health conditions and predicts future health. Identifying the most important factors related to birth weight would help defining preventive health strategies for both mothers and children. The objectives of this study are i. to describe, using a large birth database from a Chilean hospital, the trend of birth weight during 2002–2015, and ii. to determine factors during prenatal care associated with low and high birth weight.
This study is a secondary analysis of all single birth records at a Chilean Hospital in the southeast district of Santiago, Chile, during 2002–2015 (N = 78,931).
Sociodemographic information, clinical and obstetric history, lifestyle, and anthropometric variables were evaluated as potential predictors. Birth weight was categorized into five groups as per percentiles of weight as per gestational age. Data were extracted from clinical records. We used classification and regression tree methodology and logistic regression.
The average birth weight for the period was 3316 g (SD 566), with little variation across time. Preterm births increased from 7% in 2002 to 10% in 2015, and births >40 weeks decreased from 10.7% in 2002 to 4.4% in 2015. The percentages of small and large for gestational age changed from 10.9% and 12.7% in 2002 to 9.9% and 13.9% in 2015, respectively. The predictors included in the optimal tree were body mass index, gestational weight gain, pre-eclampsia, and gestational diabetes. We found that women with a pregestational body mass index <28 kg/m², gestational weight gain <17 kg, and preeclampsia had a probability of 41% of having a small for gestational age neonate. Conversely, women with a body mass index ≥28 kg/m², gestational weight gain ≥17 kg, and gestational diabetes had a probability of 44% of having a large for gestational age neonate.
This study showed that the most important variables explaining birth weight are those related to maternal nutritional status. Thus, the strategies to promote a normal birth weight should aim for a normal maternal weight at the beginning of pregnancy, gestational weight gain within the recommendations, and prevention of gestational diabetes and pre-eclampsia.
Preconceptional and Periconceptional Pathways to Preeclampsia
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Chapter 4 entitled “Preconceptional and Periconceptional Pathways to Preeclampsia” is a new addition to Chesley's Hypertensive Disorders in Pregnancy. The rationale for this chapter stems from the emerging evidence supporting the concept that the antecedents of preeclampsia may reside in the pre- and periconception periods and early pregnancy. Although there are undoubtedly multiple origins of preeclampsia in light of the heterogeneous nature of the syndrome, in the chapter's debut, we first discuss the potential corpus luteal and endometrial origins of the disease. Then, we present evidence for maternal cardiovascular and metabolic antecedents, and finally, the potential contribution of nutritional factors to the genesis of preeclampsia.
Angiogenesis and Preeclampsia
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The developing human placenta undergoes extensive angiogenesis (neovascularization from preexisting blood vessels) and vasculogenesis (blood vessel generation from angioblast precursor cells), along with a process of vascular mimicry (pseudo-vasculogenesis) as cytotrophoblasts convert from an epithelial to an endothelial phenotype. Failure of these changes has been linked to the pathogenesis of preeclampsia. Placentas in preeclamptic subjects produce an excess of antiangiogenic factors that enter the maternal circulation and impair vascular endothelial cell signaling of proangiogenic factors. In this chapter we discuss evidence that measurement of circulating angiogenic factors in the plasma accurately reflects the morbidity of severe disease and the risk of adverse outcomes related to preeclampsia. The mechanisms as to how antiangiogenic proteins cause preeclamptic and eclamptic signs and symptoms are reviewed, as are their implications for prevention or cure.
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^☆: Reprint requests: Dr. Xu Xiong, Perinatal Clinical Research Centre, 4510 Children’s Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, Alberta, Canada T5H 3V9. E-mail [email protected].

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General Obstetrics and Gynecology ObstetricsAssociation of preeclampsia with high birth weight for age☆

Abstract

Section snippets

Study population

Results

Comment

Acknowledgements

Placenta

Clin Perinatol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Preeclampsia: more than pregnancy-induced hypertension

Lancet

National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy

Am J Obstet Gynecol

Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study

Obstet Gynecol

General Obstetrics and Gynecology Obstetrics
Association of preeclampsia with high birth weight for age☆