The association of maternal chronic hypertension with perinatal death in male and female offspring: a record linkage study of 866,188 women.

OBJECTIVE: The purpose of this study was to determine whether there is a difference, by gender, in perinatal mortality in chronically hypertensive women compared with normotensive women. DESIGN: Population-based prospective cohort study. SETTING: Sweden. POPULATION: A total of 866,188 women with singleton pregnancies registered in the Swedish Medical Birth Registry 1992-2004, of which 4749 were diagnosed with chronic hypertension. METHODS: Multivariate logistic regression analysis was performed. In a first step, we adjusted for maternal characteristics and in a second step for mild and severe pre-eclampsia, gestational diabetes, placental abruption and small for gestational age. An effect modification by gender was included in the model. MAIN OUTCOME MEASURES: Odds ratios (OR) for intrauterine death, neonatal death and post-neonatal death with respect to gender of offspring. RESULTS: The unadjusted OR of intrauterine death was 4.12 (95% CI: 2.84-5.96) and 1.29 (95% CI: 0.67-2.48) for male and female offspring, respectively, and of neonatal death, it was 3.45 (95% CI: 2.13-5.59) and 2.17 (95% CI: 1.08-4.35) for male and female offspring, respectively. After multivariate analysis, the OR of intrauterine death was 3.07 (95% CI: 2.12-4.46) and neonatal death was 2.99 (95% CI: 1.84-4.85) for male offspring. For female offspring, the OR of intrauterine death was 0.98 (95% CI: 0.51-1.89) and neonatal death was 1.88 (95% CI: 0.93-3.79). CONCLUSION: Mothers with chronic hypertension have an increased risk of perinatal mortality of their male offspring.

Being born small for gestational age increases the risk of severe pre-eclampsia.

OBJECTIVE: The first aim of this study was to investigate the risk of pre-eclampsia, both mild and severe, in women born small for gestational age (SGA). The second aim was to investigate whether the risk is modified by pre-eclampsia in the previous generation. DESIGN: Population-based cohort study. SETTING: Sweden. POPULATION: A population of 118 634 women registered both as newborns and as mothers in the Swedish Medical Birth Register of 1973-2003. Of these, 6883 had been born SGA. Only primiparas and singletons were included. METHODS: The pregnancies that the women were born out of were analysed with regard to presence of pre-eclampsia, while their own pregnancies were analysed regarding age at delivery, smoking, body mass index and incidence of mild or severe pre-eclampsia. Multiple logistic regression analysis was used. In a first step, we adjusted for maternal characteristics, and in a second step, for pre-eclampsia in the previous generation. MAIN OUTCOME MEASURES: Odds ratio for mild and severe pre-eclampsia. RESULTS: In women born SGA, the adjusted odds ratio (first step) for mild pre-eclampsia was 1.19 (95% CI 1.03-1.38), while for severe pre-eclampsia it was 1.69 (95% CI 1.40-2.02) compared with those not born SGA. After the second-step adjustment, the odds ratio for mild pre-eclampsia was 1.16 (95% CI 1.00-1.35) and for severe pre-eclampsia was 1.62 (95% CI 1.35-1.95). No statistically significant effect modification from pre-eclampsia in the previous generation was shown. CONCLUSIONS: Women born SGA suffer a markedly increased risk of severe pre-eclampsia. Exposure to pre-eclampsia during a woman's own fetal development significantly increases her risk of pre-eclampsia but does not modify the SGA effect.