International Journal of Environmental Research and Public Health Article The Association of Familial Hypertension and Risk of Gestational Hypertension and Preeclampsia Małgorzata Lewandowska 1,2 1 2



 Citation: Lewandowska, M. The Association of Familial Hypertension and Risk of Gestational Hypertension and Preeclampsia. Int. J. Environ. Res. Public Health 2021, 18, 7045. https:// Medical Faculty, Lazarski University, 02-662 Warsaw, Poland; mal2015lewandowska@gmail.com Division of Gynecological Surgery, University Hospital, 60-535 Poznan, Poland Abstract: It has not been established how history of hypertension in the father or mother of pregnant women, combined with obesity or smoking, affects the risk of main forms of pregnancy-induced hypertension. A cohort of 912 pregnant women, recruited in the first trimester, was assessed; 113 (12.4%) women developed gestational hypertension (GH), 24 (2.6%) developed preeclampsia (PE) and 775 women remained normotensive (a control group). Multiple logistic regression was used to calculate adjusted odds ratios (AOR) (and 95% confidence intervals) of GH and PE for chronic hypertension in the father or mother of pregnant women. Some differences were discovered. (1) Paternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for GH (AOR-a = 1.98 (1.2–3.28), p = 0.008). This odds ratio increased in pregnant women who smoked in the first trimester (AOR-a = 4.71 (1.01–21.96); p = 0.048) or smoked before pregnancy (AOR-a = 3.15 (1.16–8.54); p = 0.024), or had pre-pregnancy overweight (AOR-a = 2.67 (1.02–7.02); p = 0.046). (2) Maternal hypertension (vs. absence of hypertension in the family) was an independent risk factor for preeclampsia (PE) (AOR-a = 3.26 (1.3–8.16); p = 0.012). This odds ratio increased in the obese women (AOR-a = 6.51 (1.05–40.25); p = 0.044) and (paradoxically) in women who had never smoked (AOR-a = 5.31 (1.91–14.8); p = 0.001). Conclusions: Chronic hypertension in the father or mother affected the risk of preeclampsia and gestational hypertension in different ways. Modifiable factors (overweight/obesity and smoking) may exacerbate the relationships in question, however, paradoxically, beneficial effects of smoking for preeclampsia risk are also possible. Importantly, paternal and maternal hypertension were not independent risk factors for GH/PE in a subgroup of women with normal body mass index (BMI). doi.org/10.3390/ijerph18137045 Academic Editor: Shane Norris Keywords: preeclampsia; gestational hypertension; family history; paternal hypertension; maternal hypertension; obesity; smoking Received: 27 April 2021 Accepted: 29 June 2021 Published: 1 July 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2021 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1. Introduction Pregnancy-induced hypertension (PIH) is a serious public health problem [1]. This disease, which is characteristic of pregnancy, develops de novo after 20 weeks of gestation and includes gestational hypertension (GH) and preeclampsia (PE) as well as PE superimposed on chronic hypertension [2]. PIH affects an average of 10% of pregnant women, although in some regions of the world this percentage is much higher [1,3,4]. Preeclampsia (PE) (in which high blood pressure is accompanied by particular organ disorders) occurs on average in 2–5% of pregnancies [2] but is seven times more common in developing than in developed countries [5]. Due to preeclampsia, 76,000 mothers and 0.5 million newborns die worldwide each year [2]. Pregnancy-induced hypertension is also a risk factor of cardiovascular disease and metabolic disorders later in life for both the mother and the child [2,3,6,7]. Early qualification of pregnant women with increased supervision (before pregnancy, or at its beginning) can promote the health of the mother and baby. The recognized PIH risk factors include pre-pregnancy obesity/overweight, maternal age, primiparity, infertility treatment and smoking as well as preeclampsia in previous pregnancies and pre-existing hypertension. A family history of hypertension is also consid- Int. J. Environ. Res. Public Health 2021, 18, 7045. https://doi.org/10.3390/ijerph18137045 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 7045 2 of 15 ered [2,7]. Family history of hypertension (which is already available before pregnancy) may predispose pregnant women to develop PIH, providing information about the potential influence of genetic and environmental factors [2,4,7–10]. However, the role of the family history of hypertension as an independent risk factor of pregnancy-induced hypertension (PIH) has not been clearly established [4,8,11–18]. Only the Society of Obstetricians and Gynaecologists of Canada (SOGC) 2014 guidelines list a family history of early cardiovascular disease among the risk factors for preeclampsia (PE) that determine the use of aspirin prophylaxis, in contrast to the guidelines of other scientific societies [11]. To date, only two studies assessed paternal or maternal hypertension separately as a risk factor of preeclampsia (PE), but the methodologies of these research were different [12,13]. In a systematic review published in 2021, it was not possible to perform a meta-analysis due to the lack of homogeneity of the studies [11]. Most of the studies to date have focused on preeclampsia risk (not on gestational hypertension) and are retrospective case-control studies [11]. To date, it has not been established how modifiable factors (such as pre-pregnancy body mass index (BMI) and smoking categories) affect the relationships in question. Can the family history of hypertension be an independent risk factor of pregnancy-induced hypertension also in the subgroup of pregnant women with normal BMI or who have never smoked? The aim of this prospective study was to assess how chronic arterial hypertension in the father and (separately) mother of pregnant women in combination with maternal pre-pregnancy body mass index (BMI) categories or smoking categories affects the risk of gestational hypertension (GH) and (separately) preeclampsia (PE). No such study was found in the literature. 2. Materials and Methods The data for this study come from a prospective cohort of women recruited at the Obstetrics and Gynecology Hospital of the Poznan University of Medical Sciences (Poland) in 2015–2016. This Research Center is a tertiary reference center for obstetrics, with 6000–8000 births annually. 2.1. Ethics All the procedures related to this research project were in line with the Helsinki Declaration and were approved by the Bioethics Committee of the Poznan University of Medical Sciences, Poland (No. 769/15). Participation in this study was voluntary. All participants signed an informed consent statement prior to the commencement of the procedures. 2.2. Inclusion Criteria The primary cohort included pregnant women enrolled at the end of the first trimester (according to appropriate criteria). In this cohort the pregnancy outcomes taken from medical records were assessed after the end of puerperium. The inclusion criteria covered the following characteristics: Caucasian race and residence in the region (Wielkopolska), age of pregnant woman between 18–45 years (at conception), gestational age during recruitment at 10–14th week and singleton pregnancy, delivery of a child without defects at a gestational age of ≥25 weeks, and the lack of any preexisting diseases (except for disorders related to abnormal weight) including the following chronic diseases: hypertension, diabetes, inflammatory (and immune) diseases, neurological disorders, renal or hepatic dysfunction and coagulation disorders. Both multiparous and primiparous women were included in the study; in both cases, family history was recorded as well as the history of prior hypertension in pregnancy (in multiparous women). Int. J. Environ. Res. Public Health 2021, 18, 7045 3 of 15 2.3. Method The recruitment process was carried out at the Central Laboratory. Information about the research project was available to all the women who reported for routine testing. The Main Personal Questionnaire was used to collect data at the recruitment stage (at the 10–14th gestational week). Information was collected on the mother’s characteristics such as age, weight before pregnancy (self-reported), blood pressure before pregnancy (self-reported), height, smoking, alcohol use, and the use of drugs before pregnancy and in the first trimester, as well as the use of vitamin supplementation micronutrient for pregnant women. The information on the course of pregnancy to date, obstetric and gynecological history, as well as socio-economic and demographic data was also collected. Data on diseases in the family (including chronic diseases such as hypertension or diabetes and pregnancy-induced hypertension in the mother or sister) was collected as well, detailing diseases in the father, mother, sisters and brothers, as well as the grandmothers and grandfathers. Importantly, the women answered the questionnaire on their own (in the presence of midwives). The second stage of the study (after the end of pregnancy and puerperium) was collecting the information on pregnancy outcomes and possible complications in the mother. The details regarding pregnancy results and other data related to the weight change in pregnancy and perinatal blood pressure values were taken from the medical records, and the information on family history (included in the medical records) was verified. An additional questionnaire completed after the 12th week of puerperium (by e-mail or telephone) was also used: it included the information on changes in puerperal blood pressure and some additional information, such as changes in smoking habits during pregnancy. All women reported refraining from the consumption of alcohol or other stimulants during pregnancy. All 1300 women who volunteered for this study and met the admission criteria at the 10–14th week of pregnancy were invited to complete the questionnaire. After the second stage of the study, 388 women were excluded due to the following reasons: delivery at gestational age
Purchase answer to see full attachment