Role of Gestational Hypertension and Eclampsia on Birth

Role of Gestational Hypertension and Eclampsia on Birth Weight in Georgia Presented by: Arohi Patel; Mehar Anand; Bennett Rissier; Rushan Momin; Skarlet Velasquez, MPH; Mechelle Claridy, MPH; Stephanie Eick, Ph. D(c); Michael Welton, Ph. D; Jose Cordero, MD, MPH

Problem Statement ● In Georgia, the rate of low birth weight (LBW) births is higher than the national rate and has increased slightly in recent years to close to 10% ● LBW babies are more likely to have health problems as infants and adults, including infections and chronic diseases

Objective ● The objective of this study was to investigate the association between gestational hypertension (GH) and hypertension eclampsia (HE) on LBW babies in Georgia

Background ● Common health problems associated with LBW include ○ ○ ○ ● Respiratory Distress Syndrome Intraventricular Hemorrhages (bleeding in the brain) Inability to fight infections Trouble feeding and gaining weight Sudden Infant Death Syndrome (SIDS) Later in life, LBW babies have higher risk of ○ ○ ○ Diabetes High blood pressure Heart disease Obesity Intellectual and developmental disabilities

Percentage of Low Birth Weight Infants, Georgia vs. United States

Maternal Risk Factors & Low Birth Weight Infants ● ● ● Low birth weight is defined as a birthweight of 2, 499 grams (5. 5 pounds) or less A maternal risk factor is a known cause that increases the chance of obtaining a certain outcome such as low birth weight Examples of maternal risk factors for low birth weight include: ○ ○ ○ ○ Gestational Hypertension Eclampsia Prior Cesarean Delivery Maternal Age and Height Multiparity Depression Hemorrhages

Gestational Hypertension ● Pregnancy-Induced Hypertension (PIH) ● High blood pressure during pregnancy (more than or equal to 140/90 mm. Hg) ● Can lead to preeclampsia (protein in urine and high blood pressure), eclampsia, and stroke ● Develops after week 20 in pregnancy and goes away after delivery ● Placental abruption occurs

Gestational Hypertension Literature Review ● ● Mohan, et. al. showed that gestational hypertension had a definite effect on fetal weight, resulting in low birth weight Lei, et. al. showed mothers with PIH had babies with lower birth weights than mothers without PIH Boo, et. al. demonstrated that one of the significant factors for low birth weight is PIH during pregnancy, which is found to be common in mothers of low birth weight infants Tellapragada et. al. displayed gestational hypertension as an independent factor for low birth weight with similar associations seen in various global study populations

Hypertension Eclampsia ● ● ● Occurs after Week 20 of pregnancy Characterized by seizure development in a woman Can have proteinuria (protein in urine) and fluid retention Blood clotting, pulmonary edema, kidney injury, seizures, brain damage Limits blood flow to the placenta due to abnormal or damaged blood vessels leading to fetal growth restriction and preterm birth

Hypertension Eclampsia Literature Review ● A study conducted by Fang, et al. discussed that pregnancy related hypertensive mothers and those with eclampsia had an increased risk of low birth weight ● In a study conducted by Phoa, et al. , there is a significant correlation between mothers with severe eclampsia and low birth weight babies with a frequency of 52. 4%

Methods ● Data from 2014 to 2015 Georgia Birth Certificates were used to assess the role of GH and HE on LBW babies ● Bivariate analyses were conducted to estimate unadjusted odds ratios and 95% confidence intervals ● Attributable risks were determined to calculate how LBW babies would be reduced if GH and HE were eliminated

Results: Gestational Hypertension Select Characteristic Birthweight Low Birthweight p-value Normal Birthweight Gestational Hypertension <0. 0001 Yes 3219 (12. 87) 10034 (4. 23) No 21796 (87. 13) 227055 (95. 77) Total 25015 (100. 00) 237089 (100. 00)

Results: Hypertension Eclampsia Select Characteristic Birthweight Low Birthweight p-value Normal Birthweight Hypertension Eclampsia <0. 0001 Yes 158 (0. 64) 235 (0. 10) No 24379 (99. 36) 233689 (99. 90) Total 24537 (100. 00) 233924 (100. 00)

Results: Unadjusted Odds Ratios and Attributable Risks ● Those with GH were 3. 392 times more likely to have a LBW baby (95% CI: 3. 251 - 3. 540) ● Those with HE were 6. 870 times more likely to have a LBW baby (95% CI: 5. 608 - 8. 417) ● If GH in pregnancy was eliminated, 15% of LBW births could be reduced ● If HE in pregnancy was eliminated, 31% of LBW births could be reduced

Conclusion ● We used bivariate analyses to assess associations between the risk factors and low birth weight babies in Georgia ● Gestational hypertension and hypertension eclampsia are associated with low birth weight babies in Georgia

Future Directions ● Multivariate analyses will be conducted to obtain adjusted results controlling for confounding factors

Acknowledgments Co-authors: ● ● Rushan Momin Bennett Rissier Faculty and Mentors: ● ● ● José Cordero, MD, MPH Michael Welton, Ph. D Stephanie Eick, Ph. D(c) Mechelle Claridy, MPH Skarlet Velasquez, MPH Special Thanks to the University of Georgia’s College of Public Health and Department of Epidemiology and Biostatistics

References American Pregnancy Association. (2016, March 01). Gestational Hypertension: Pregnancy Induced Hypertension. Retrieved from http: //americanpregnancy. org/pregnancy-complications/pregnancy-induced-hypertension/ Boo, N. L. , SM; Koh, KT; Lau, KF; Ravindran, J. (2008). Risk factors associated with low birth weight infants in the Malaysian population. Med J Malaysia. , 63(4), 306 -310. Centers for Disease Control and Prevention. (2018). High Blood Pressure During Pregnancy Fact Sheet. Retrieved from https: //www. cdc. gov/bloodpressure/pregnancy. htm Fang, J. , Madhavan, S. , Alderman, M. H. (1999) The influence of maternal hypertension on low birth weight: differences among ethnic populations. Ethnicity and disease. 9(3): 369 -76. Retrieved from https: //www. ncbi. nlm. nih. gov/pubmed/10600059 Hamilton, B. E. , Hoyert, D. L. , Martin, J. A. , Strobino, D. M. , & Guyer, B. (2013). Annual summary of vital statistics: 2010 -2011. Pediatrics , 131(3), 548 -58.

References Lei, F. , Liu, D. , Shen, Y. , Zhang, L. , Li, S. , Liu, X. , . . . Yan, H. (2018). Study on the influence of pregnancy-induced hypertension on neonatal birth weight. Journal of Investigative Medicine, 66(6), 1008 -1014. doi: 10. 1136/jim-2017 -000626 March of Dimes. (2018). Low birthweight. Retrieved from https: //www. marchofdimes. org/complications/low-birthweight. aspx Mohan, A. , Kumar, V. , & Prateek, G. (2018). Maternal factors affecting newborn weight at term - a study in a referral hospital. Journal of Evidence Based Medicine and Healthcare, Vol 5, Iss 13, Pp 1115 -1119 (2018)(13), 1115. doi: 10. 18410/jebmh/2018/231 Phoa, K. Y. , Chedraui P. , Pérez-López, F. R. , Wendte, J. F. , Ghiabi, S. , Vrijkotte, T. , Pinto, P. (2016) Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador, 36(5), 581 -584. doi. org/10. 3109/01443615. 2015. 1107532 Tellapragada, C. , Eshwara, V. K. , Bhat, P. , Acharya, S. , Kamath, A. , Bhat, S. , . . . Mukhopadhyay, C. (2016). Risk factors for preterm birth and low birth

References United Health Foundation. (2018). Low birthweight in Georgia in 2018. Retrieved from https: //www. americashealthrankings. org/explore/annual/measure/birthweight/state/GA World Health Organization. (2004). Low birthweight. http: //apps. who. int/iris/bitstream/handle/10665/43184/9280638327. pdf; jsessionid=091 A 021 E 48 F 13 C 24627 C 719 A 892 CF 6 C 0? sequence=1