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. 2020 Mar 25;15(3):e0228743.
doi: 10.1371/journal.pone.0228743. eCollection 2020.

Impact of diabetes, obesity and hypertension on preterm birth: Population-based study

Howard Berger  1 , Nir Melamed  2 , Beth Murray Davis  3 , Haroon Hasan  4 , Karizma Mawjee  1 , Jon Barrett  3 , Sarah D McDonald  5 , Michael Geary  6 , Joel G Ray  7
Affiliations

Impact of diabetes, obesity and hypertension on preterm birth: Population-based study

Howard Berger et al. PLoS One. .

Abstract

Objective: To determine the impact of pre-pregnancy diabetes mellitus (D), obesity (O) and chronic hypertension (H) on preterm birth (PTB).

Methods: Retrospective population-based cohort study in Ontario, Canada between 2012-2016. Women who had a singleton livebirth or stillbirth at > 20 weeks gestation were included in the cohort. Exposures of interest were D, O and H, individually, and in various combinations. The primary outcome was PTB at 241/7 to 366/7 weeks. PTB was further analyzed by spontaneous or provider-initiated, early (< 34 weeks) or late (34-37 weeks), and the co-presence of preeclampsia, large for gestational age (LGA), and small for gestational age (SGA). Multivariable Poisson regression models with robust error variance were used to generate relative risks (RR), further adjusted for maternal age and parity (aRR). Population attributable fractions (PAF) were calculated for each of the outcomes by exposure state.

Results: 506,483 women were eligible for analysis. 30,139 pregnancies (6.0%) were complicated by PTB < 37 weeks, of which 7375 (24.5%) had D or O or H. Relative to women without D or O or H, the aRR for PTB < 37 weeks was higher for D (3.51; 95% CI 3.26-3.78) and H (3.81; 95% CI 3.55-4.10) than O (1.14; 95% CI 1.10-1.17). The combined state of DH was associated with a significantly higher aRR of PTB < 37 weeks (6.34; 95% CI 5.14-7.80) and < 34 weeks (aRR 10.33, 95% CI 6.96-15.33) than D alone. The risk of provider initiated PTB was generally higher than that for spontaneous PTB. Pre-pregnancy hypertension was associated with the highest risk for PTB with preeclampsia (aRR 45.42, 95% CI 39.69-51.99) and PTB with SGA (aRR 9.78, 95% CI 7.81-12.26) while pre-pregnancy diabetes was associated with increased risk for PTB with LGA (aRR 28.85, 95% CI 24.65-33.76).

Conclusion: Combinations of DOH significantly magnify the risk of PTB, especially provider initiated PTB, and PTB with altered fetal growth or preeclampsia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Adjusted relative risks of pre-existing diabetes, obesity and hypertension on provider initiated and spontaneous preterm birth at <37 and <34 weeks in women with a singleton birth in Ontario, between April 1, 2012 to March 31, 2016.
Fig 2
Fig 2. Adjusted relative risks of pre-existing diabetes, obesity and hypertension on preterm birth with preeclampsia at <37 weeks in women with a singleton birth in Ontario, between April 1, 2012 to March 31, 2016.
Fig 3
Fig 3. Adjusted relative risks of pre-existing diabetes, obesity and hypertension on preterm birth with small for gestational age or large for gestational age at <37 weeks in women with a singleton birth in Ontario, between April 1, 2012 to March 31, 2016.
* Data for SGA in the combined D and H group was suppressed by BORN Ontario due to event rate below reporting threshold.
See this image and copyright information in PMC

References

    1. Bennett JE SG, Mathers CD, Bonita R, Rehm J, Kruk ME, Riley LM, et al. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target Lancet 2018;392(10152):1072–88. 10.1016/S0140-6736(18)31992-5 - DOI - PubMed
    1. Berger H, Melamed N, Murray-Davis B, Hasan H, Mawjee K, Barrett J, et al. Prevalence of Pre-Pregnancy Diabetes, Obesity, and Hypertension in Canada. Journal of Obstetrics and Gynaecology Canada. 2019;41(11): 1579–1588.e2 10.1016/j.jogc.2019.01.020 - DOI - PubMed
    1. Chatzi L, Plana E, Daraki V, Karakosta P, Alegkakis D, Tsatsanis C, et al. Metabolic syndrome in early pregnancy and risk of preterm birth. American journal of epidemiology. 2009;170(7):829–36. 10.1093/aje/kwp211 - DOI - PubMed
    1. Yanit KE, Snowden JM, Cheng YW, Caughey AB. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. American Journal of Obstetrics & Gynecology. 2012;207(4):333. e1–e6. - PMC - PubMed
    1. Bodnar LM, Catov JM, Klebanoff MA, Ness RB, Roberts JM. Prepregnancy body mass index and the occurrence of severe hypertensive disorders of pregnancy. Epidemiology. 2007;18(2):234–9. 10.1097/01.ede.0000254119.99660.e7 - DOI - PubMed

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