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The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study
Open accessAbstract
Background: Hypertensive disorders in pregnancy are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. However, studies attempting to quantify the effect of hypertension on adverse perinatal outcomes have been mostly conducted in tertiary centres. This population-based study explored the frequency of hypertensive disorders in pregnancy and the associated increase in small for gestational age (SGA) and stillbirth. Methods: We used information on all pregnant women and births, in the Canadian province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if delivery occurred < 20 weeks, if birthweight was < 500 grams, if there was a high-order multiple pregnancy (greater than twin gestation), or a major fetal anomaly. Results: The study population included 135,466 pregnancies. Of these, 7.7% had mild pregnancy-induced hypertension (PIH), 1.3% had severe PIH, 0.2% had HELLP (hemolysis, elevated liver enzymes, low platelets), 0.02% had eclampsia, 0.6% had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. Women with any hypertension in pregnancy were 1.6 (95% CI 1.5–1.6) times more likely to have a live birth with SGA and 1.4 (95% CI 1.1–1.8) times more likely to have a stillbirth as compared with normotensive women. Adjusted analyses showed that women with gestational hypertension without proteinuria (mild PIH) and with proteinuria (severe PIH, HELLP, or eclampsia) were more likely to have infants with SGA (RR 1.5, 95% CI 1.4–1.6 and RR 3.2, 95% CI 2.8–3.6, respectively). Women with pre-existing hypertension were also more likely to give birth to an infant with SGA (RR 2.5, 95% CI 2.2–3.0) or to have a stillbirth (RR 3.2, 95% CI 1.9–5.4). Conclusions: This large, population-based study confirms and quantifies the magnitude of the excess risk of small for gestational age and stillbirth among births to women with hypertensive disease in pregnancy.
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“In particular, hypertensive pregnancy disorders, compromised fetal growth, and fetal death often stem from placental dysfunction—either due to insufficient initial placentation or diminishing placental function with increasing gestational age14,15.”
From Multi-centre deep learning for placenta segmentation in obstetric ultrasound with multi-observer and cross-country generalization (2023) · cites this paper as [14]
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Self-citationPregnancy Outcomes in Healthy Nulliparas Who Developed Hypertension
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Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis
Flenady, V., Koopmans, L., Middleton, P., Frøen, J. F., Smith, G. C., Gibbons, K., Coory, M., Gordon, A., Ellwood, D., McIntyre, H. D., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62233-7 · Cited by 1,247
Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis
Bramham, K., Parnell, B., Nelson-Piercy, C., Seed, P. T., Poston, L., & Chappell, L. C. (2014) · BMJ · doi:10.1136/bmj.g2301 · Cited by 767
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Self-citationEtiology and prevention of stillbirth
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Metadata
- Authors
- Allen, V. M., Joseph, K., Murphy, K. E., Magee, L. A., & Ohlsson, A.
- Affiliations
- Dalhousie University (CA)
- University of Toronto (CA)
- University of British Columbia (CA)
- Corresponding author
- Allen, Victoria M
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2004-08-06
- Volume
- 4
- Issue
- 1
- Pages
- 17-17
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC515178
- OpenAlex
- W1720024051
- Cited by
- 218
- References
- 34
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 11 · 2023: 8 · 2022: 12 · 2021: 17 · 2020: 11 · 2019: 18 · 2018: 17 · 2017: 10 · 2016: 8 · 2015: 9 · 2014: 15 · 2013: 16 · 2012: 7
- FWCI
- 5.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- hypertensive disorders of pregnancy, small for gestational age, stillbirth, gestational hypertension, HELLP syndrome, eclampsia, chronic hypertension in pregnancy, pre-existing hypertension, proteinuria, perinatal outcomes, Nova Scotia
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