Evaluation of a definition of pre-eclampsia
Objectives To determine: 1. whether an alternative definition of gestational hypertension and pre-eclampsia stratifies women according to their risk of maternal and fetal complications; 2. whether pregnancy outcome in women with gestational hypertension differs in the presence or absence of ‘+’ proteinuria; and 3. whether a blood pressure rise of ≥ 30/15 mmHg during pregnancy is associated with adverse outcome in women who remain normotensive.Design Prospective, nested case–control study.Setting Community based.Population Healthy, nulliparous women (n= 1496).Methods Women recruited into a study investigating serum markers predictive of pre-eclampsia were classified as having gestational hypertension (systolic blood pressure ≥ 140 mmHg with a rise of ≥ 30 mmHg and/or diastolic blood pressure ≥ 90 mmHg with a rise of ≥ 15 mmHg) or pre-eclampsia (gestational hypertension plus proteinuria ≥ 2+on dipstick or > 0.3 g/24 h). Maternal and fetal complications in gestational hypertension or pre-eclampsia were compared with a control group of 223 randomly selected normotensive women. The main outcome measures were severe maternal disease, preterm birth and small for gestational age infant.Results A stepwise increase in adverse maternal and fetal outcomes occurred in gestational hypertension (n= 117, 743%) and pre-eclampsia (n= 71, 4.8%). Severe maternal disease developed in 26.5% (21.4% severe hypertension alone, 5.1% multisystem disease) of women with gestational hypertension and 63.4% (21.1% severe hypertension alone, 42.3% multisystem disease) of women with pre-eclampsia (OR 4.8; 95% CI 2.4–9.5). Preterm birth and small for gestational age infants were more frequent in gestational hypertension (OR 1.7; 95% CI 0.5–5.4, and OR 2.0; 95% CI 1.0–3.7, respectively) and pre-eclampsia (OR 14.6; 95% CI 5.8–37.8, and OR 2.6; 95% CI 1.2–5.3) than in the normotensive group. Among women with gestational hypertension severe maternal disease was more common in women with ‘+’ proteinuria (41.7%) than in those with no proteinuria (15.9%): OR 3–8; 95% CI 1.5–9.8. Pregnancies were uncomplicated in the 27% of normotensive women who had a rise of ≥ 30 mmHg systolic blood pressure and/or ≥ 15 mmHg rise in diastolic blood pressure.Conclusions In the nulliparous population studied our definition of gestational hypertension and pre-eclampsia identified women at increasing risk of maternal and fetal complications. In gestational hypertension, the presence of proteinuria ‘+’ was associated with a 3.8-fold increase in severe maternal disease. Normotensive women who have a rise in blood pressure ≥ 30/15 mmHg had uncomplicated pregnancies..
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
1999 |
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Erschienen: |
Oxford, UK: Blackwell Publishing Ltd ; 1999 |
Reproduktion: |
2005 ; Blackwell Publishing Journal Backfiles 1879-2005 |
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Enthalten in: |
Zur Gesamtaufnahme - volume:106 |
Enthalten in: |
BJOG - 106(1999), 8, Seite 0 |
Beteiligte Personen: |
North, Robyn A. [VerfasserIn] |
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Links: |
Volltext [Deutschlandweit zugänglich] |
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Umfang: |
Online-Ressource |
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doi: |
10.1111/j.1471-0528.1999.tb08396.x |
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funding: |
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PPN (Katalog-ID): |
NLEJ242082971 |
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100 | 1 | |a North, Robyn A. |e verfasserin |4 aut | |
245 | 1 | 0 | |a Evaluation of a definition of pre-eclampsia |
264 | 1 | |a Oxford, UK |b Blackwell Publishing Ltd |c 1999 | |
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520 | |a Objectives To determine: 1. whether an alternative definition of gestational hypertension and pre-eclampsia stratifies women according to their risk of maternal and fetal complications; 2. whether pregnancy outcome in women with gestational hypertension differs in the presence or absence of ‘+’ proteinuria; and 3. whether a blood pressure rise of ≥ 30/15 mmHg during pregnancy is associated with adverse outcome in women who remain normotensive.Design Prospective, nested case–control study.Setting Community based.Population Healthy, nulliparous women (n= 1496).Methods Women recruited into a study investigating serum markers predictive of pre-eclampsia were classified as having gestational hypertension (systolic blood pressure ≥ 140 mmHg with a rise of ≥ 30 mmHg and/or diastolic blood pressure ≥ 90 mmHg with a rise of ≥ 15 mmHg) or pre-eclampsia (gestational hypertension plus proteinuria ≥ 2+on dipstick or > 0.3 g/24 h). Maternal and fetal complications in gestational hypertension or pre-eclampsia were compared with a control group of 223 randomly selected normotensive women. The main outcome measures were severe maternal disease, preterm birth and small for gestational age infant.Results A stepwise increase in adverse maternal and fetal outcomes occurred in gestational hypertension (n= 117, 743%) and pre-eclampsia (n= 71, 4.8%). Severe maternal disease developed in 26.5% (21.4% severe hypertension alone, 5.1% multisystem disease) of women with gestational hypertension and 63.4% (21.1% severe hypertension alone, 42.3% multisystem disease) of women with pre-eclampsia (OR 4.8; 95% CI 2.4–9.5). Preterm birth and small for gestational age infants were more frequent in gestational hypertension (OR 1.7; 95% CI 0.5–5.4, and OR 2.0; 95% CI 1.0–3.7, respectively) and pre-eclampsia (OR 14.6; 95% CI 5.8–37.8, and OR 2.6; 95% CI 1.2–5.3) than in the normotensive group. Among women with gestational hypertension severe maternal disease was more common in women with ‘+’ proteinuria (41.7%) than in those with no proteinuria (15.9%): OR 3–8; 95% CI 1.5–9.8. Pregnancies were uncomplicated in the 27% of normotensive women who had a rise of ≥ 30 mmHg systolic blood pressure and/or ≥ 15 mmHg rise in diastolic blood pressure.Conclusions In the nulliparous population studied our definition of gestational hypertension and pre-eclampsia identified women at increasing risk of maternal and fetal complications. In gestational hypertension, the presence of proteinuria ‘+’ was associated with a 3.8-fold increase in severe maternal disease. Normotensive women who have a rise in blood pressure ≥ 30/15 mmHg had uncomplicated pregnancies. | ||
533 | |d 2005 |f Blackwell Publishing Journal Backfiles 1879-2005 |7 |2005|||||||||| | ||
700 | 1 | |a Taylor, Rennae S. |e verfasserin |4 aut | |
700 | 1 | |a Schellenberg, Jean-Claude |e verfasserin |4 aut | |
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773 | 1 | 8 | |g volume:106 |g year:1999 |g number:8 |g pages:0 |
856 | 4 | 0 | |u http://dx.doi.org/10.1111/j.1471-0528.1999.tb08396.x |q text/html |x Verlag |z Deutschlandweit zugänglich |3 Volltext |
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