Academic journal article Journal of Health Population and Nutrition

Maternal Obesity and Energy Intake as Risk Factors of Pregnancy-Induced Hypertension among Iranian Women

Academic journal article Journal of Health Population and Nutrition

Maternal Obesity and Energy Intake as Risk Factors of Pregnancy-Induced Hypertension among Iranian Women

Article excerpt

INTRODUCTION

Pregnancy-induced hypertension (PIH) is an abnormality causing striking maternal, foetal and neonatal mortality and morbidity both in developed and developing countries (1). PIH is observed in forms of gestational hypertension, pre-eclampsia, and eclampsia (1). Pre-eclampsia and gestational hypertension are found in 5-10% of pregnancies in the world (2). Increase in caesarean section, abruption of premature placenta, preterm delivery, low birth-weight, stillbirth, acute renal failure, and intravascular coagulation were more frequently observed in women who developed hypertensive disorders of pregnancy (3-4). Recent studies have indicated higher risk of PIH among women with family history of hypertension, previous history of pregnancy-induced hypertension, pre-exciting diabetes, gestational diabetes mellitus, maternal age [greater than or equal to] 40 years, multiple pregnancies, nulliparity, and pre-pregnancy obesity (5-10). Some prior studies have suggested that higher pre-pregnancy body mass index is associated with increased risk of gestational hypertension and pre-eclampsia (11-15). However, there are a few studies in which this association was not observed (16). Also, excessive gestational weight gain has been proposed as a risk factor of hypertensive disorders of pregnancy in some studies (17-20). PIH is accompanied with endothelial dysfunction, oxidative stress, and inflammatory responses (1). It has been claimed that plasma C-reactive protein concentration, which may be involved in an aetiology of hypertensive disorder of pregnancy increased in obesity. Furthermore, some evidences have indicated that obesity increased endothelial function and prompted systematic inflammatory responses associated with atherosclerosis, which could play a role in PIH (21). However, previous studies are limited by improper classification of gestational weight gain sometimes by restricting study population to one BMI category and, also, none of these studies evaluated energy intake of subjects, alongside other measurements, which defiantly led to more accurate determination (19-20). Although risk factors of developing gestational hypertension may differ among various ethnic groups (22), there are a few data with regard to this issue in Iranian population. So, the aim of the present observational study was to compare pre-pregnancy body mass index, mid-arm-circumference, gestational weight gain, and energy intake of women who developed gestational hypertension with those of healthy pregnant women.

MATERIALS AND METHODS

Subjects and study design

The current research was a case-control study which has been carried out in Shahid Akbarabadi Hospital of obstetrics and gynaecology in south of Tehran (This is a referral hospital; many pregnant women had been referred to this centre) from January through May 2011. Patients referred to the hospital, diagnosed with gestational hypertension by physicians, were assessed to determine whether they had met exclusion criteria of the present study or not. Having multiple gestations, chronic hypertension, diabetes, cardiovascular or renal diseases were considered exclusion criteria in the present investigation. Subjects who had these problems were not included in the study. Also, pregnant women whose first antenatal care (ANC) visits were made after 12 weeks of gestation were excluded. Systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg, which occurred after 20 weeks of gestation for the first time was defined as gestational hypertension according to the National High Blood Pressure Education Program Working Group (23). Controls were women without gestational hypertension, who were referred to the clinic of this hospital for their antenatal care visits or were hospitalized at prenatal section of this centre for other reasons and were matched with cases for gestational age. The same procedure and exclusion criteria were applied for recruitment of cases. …

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