BMC Public Health | |
Interaction of body mass index and hemoglobin concentration on blood pressure among pregnant women in Guangxi, China | |
Xiaoqiang Qiu3  Xiaofei Li3  Jinlan Hu3  Yingying Deng3  Yingquan Long1  Jiangyan Xu2  Qiuan Zhong3  | |
[1] Department of Comprehensive Laboratory, Guigang Entry-Exit Inspection and Quarantine Bureau, Guigang, China;Department of Pediatrics, Nanning Maternal and Child Health Hospital, Nanning, China;Department of Epidemiology, Guangxi Medical University School of Public Health, 22 Shuangyong Road, Nanning, Guangxi 530021, China | |
关键词: Pregnancy; Interaction; Blood pressure; Hemoglobin; Body mass index; | |
Others : 1130510 DOI : 10.1186/1471-2458-14-474 |
|
received in 2013-05-14, accepted in 2014-05-06, 发布年份 2014 | |
![]() |
【 摘 要 】
Background
Body mass index (BMI) and hemoglobin (Hb) are positively associated with hypertensive disorders among pregnant women. The aim of this study was to estimate a potential interaction between high BMI and high Hb concentrations on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in pregnancy.
Methods
We recruited 4497 single-birth women aged 18–43 years who received routine antenatal care at three hospitals of Guigang, Guangxi, China, from December 2007 to January 2011. Of 4497 participants, 3472 women were in the first trimester, with following up, 2986 women and 2261 women were left in the second and third trimester, respectively. Clinical data were derived from medical records of each woman. We used multivariable linear regression, by trimesters of pregnancy, to evaluate the associations of high BMI and high Hb concentrations with SBP and DBP according to cross-sectional design.
Results
In multivariable analyses, BMI was positively associated with SBP throughout all trimesters, but the corresponding association for Hb concentrations only in the first trimester, whereas both BMI and Hb concentrations were positively associated with DBP in the first and third trimesters. After full adjustment for confounding, the average differences in SBP and DBP comparing women with high BMI and high Hb to those with non-high BMI and non-high Hb were 2.9 mmHg (95% CI: 0.8 to 5.0 mmHg) and 3.9 mmHg (95% CI: 1.5 to 6.3 mmHg) in the first trimester, 2.6 mmHg (95% CI: 0.4 to 4.8 mmHg) and 1.5 mmHg (95% CI: -1.3 to 4.3 mmHg) in the second trimester, and 4.8 mmHg (95% CI: 2.3 to 7.4 mmHg) and 5.7 mmHg (95% CI: 3.2 to 8.3 mmHg) in the third trimester, respectively. With respect to the interaction, significant combined effects between high BMI and high Hb were confirmed on SBP (P = 0.02) and DBP (P = 0.004) in the third trimester, and the amount of interaction on SBP and DBP were 2.0 mmHg (95% CI: 0.1 to 3.9 mmHg) and 2.3 mmHg (95% CI: 0.4 to 4.3 mmHg), respectively.
Conclusion
Our findings suggest that high BMI and high Hb concentrations may have a synergistic effect on blood pressure in late stage of pregnancy.
【 授权许可】
2014 Zhong et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150227003659177.pdf | 377KB | ![]() |
|
Figure 2. | 43KB | Image | ![]() |
Figure 1. | 102KB | Image | ![]() |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Langenveld J, Jansen S, van der Post J, Wolf H, Mol BW, Ganzevoort W: Recurrence risk of a delivery before 34 weeks of pregnancy due to an early onset hypertensive disorder: a systematic review. Am J Perinatol 2010, 27(7):565-571.
- [2]Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet 2006, 367(9516):1066-1074.
- [3]Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P: BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. Clin Sci (Lond) 2006, 111(1):81-86.
- [4]Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N: Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab 2002, 87(9):4231-4237.
- [5]Mahomed K, Williams MA, Woelk GB, Jenkins-Woelk L, Mudzamiri S, Longstaff L, Sorensen TK: Risk factors for pre-eclampsia among Zimbabwean women: maternal arm circumference and other anthropometric measures of obesity. Paediatr Perinat Epidemiol 1998, 12(3):253-262.
- [6]Group HSCR: Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010, 117(5):575-584.
- [7]Knottnerus JA, Delgado LR, Knipschild PG, Essed GG, Smits F: Haematologic parameters and pregnancy outcome: A prospective cohort study in the third trimester. J Clin Epidemiol 1990, 43(5):461-466.
- [8]Huisman A, Aarnoudse JG: Increased 2nd trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation: early evidence of a reduced plasma volume. Acta Obstet Gynecol Scand 1986, 65(6):605-608.
- [9]Rasmussen S, Oian P: Smoking, hemoglobin concentration and pregnancy-induced hypertension. Gynecol Obstet Invest 1998, 46(4):225-231.
- [10]Yip R: Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr 2000, 72(1 Suppl):272S-279S.
- [11]Murphy JF, O'Riordan J, Newcombe RG, Coles EC, Pearson JF: Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet 1986, 1(8488):992-995.
- [12]Gobel BO, Schulte-Gobel A, Weisser B, Glanzer K, Vetter H, Dusing R: Arterial blood pressure. Correlation with erythrocyte count, hematocrit, and hemoglobin concentration. Am J Hypertens 1991, 4(1 Pt 1):14-19.
- [13]Brun JF, Varlet-Marie E, Raynaud de Mauverger E, Mercier J: Both overall adiposity and abdominal adiposity increase blood viscosity by separate mechanisms. Clin Hemorheol Microcirc 2011, 48(4):257-263.
- [14]Rasmussen S, Bergsjo P, Jacobsen G, Haram K, Bakketeig LS: Haemoglobin and serum ferritin in pregnancy–correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol 2005, 123(1):27-34.
- [15]Laflamme EM: Maternal hemoglobin concentration and pregnancy outcome: a study of the effects of elevation in el alto, bolivia. Mcgill J Med 2011, 13(1):47.
- [16]Knol MJ, van der Tweel I, Grobbee DE, Numans ME, Geerlings MI: Estimating interaction on an additive scale between continuous determinants in a logistic regression model. Int J Epidemiol 2007, 36(5):1111-1118.
- [17]Hrazdilova O, Unzeitig V, Znojil V, Izakovicova-Holla L, Janku P, Vasku A: Relationship of age and the body mass index to selected hypertensive complications in pregnancy. Int J Gynaecol Obstet 2001, 75(2):165-169.
- [18]O'Brien TE, Ray JG, Chan WS: Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003, 14(3):368-374.
- [19]Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS: Prepregnancy body mass index as an independent risk factor for pregnancy-induced hypertension. J Womens Health (Larchmt) 2011, 20(1):67-72.
- [20]Stuebe AM, Landon MB, Lai Y, Spong CY, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Sciscione A, Catalano P, Harper M, Saade G, Sorokin Y, Peaceman AM, Tolosa JE, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD: Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol 2012, 207(1):62. e1–7
- [21]Tanentsapf I, Heitmann BL, Adegboye AR: Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth 2011, 11:81. BioMed Central Full Text
- [22]Atsma F, Veldhuizen I, de Kort W, van Kraaij M, Pasker-de Jong P, Deinum J: Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals. Hypertension 2012, 60(4):936-941.
- [23]Green JR, Pawson IG, Schumacher LB, Perry J, Kretchmer N: Glucose tolerance in pregnancy: ethnic variation and influence of body habitus. Am J Obstet Gynecol 1990, 163(1 Pt 1):86-92.
- [24]Challier JC, Basu S, Bintein T, Minium J, Hotmire K, Catalano PM, Hauguel-de Mouzon S: Obesity in pregnancy stimulates macrophage accumulation and inflammation in the placenta. Placenta 2008, 29(3):274-281.
- [25]Norman JE, Reynolds RM: The consequences of obesity and excess weight gain in pregnancy. Proc Nutr Soc 2011, 70(4):450-456.
- [26]D'Archivio M, Annuzzi G, Vari R, Filesi C, Giacco R, Scazzocchio B, Santangelo C, Giovannini C, Rivellese AA, Masella R: Predominant role of obesity/insulin resistance in oxidative stress development. Eur J Clin Invest 2012, 42(1):70-78.
- [27]Sibai B, Dekker G, Kupferminc M: Pre-eclampsia. Lancet 2005, 365(9461):785-799.
- [28]Murai JT, Muzykanskiy E, Taylor RN: Maternal and fetal modulators of lipid metabolism correlate with the development of preeclampsia. Metabolism 1997, 46(8):963-967.
- [29]Berger HA, Somers VK, Phillips BG: Sleep disordered breathing and hypertension. Curr Opin Pulm Med 2001, 7(6):386-390.
- [30]Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL: Risk factors for severe preeclampsia. Obstet Gynecol 1994, 83(3):357-361.
- [31]Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG: Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol 1997, 96(1):168-173.
- [32]Olsson MG, Centlow M, Rutardottir S, Stenfors I, Larsson J, Hosseini-Maaf B, Olsson ML, Hansson SR, Akerstrom B: Increased levels of cell-free hemoglobin, oxidation markers, and the antioxidative heme scavenger alpha(1)-microglobulin in preeclampsia. Free Radic Biol Med 2010, 48(2):284-291.
- [33]Cabrales P, Han G, Nacharaju P, Friedman AJ, Friedman JM: Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide. Am J Physiol Heart Circ Physiol 2011, 300(1):H49-H56.
- [34]Staessen JA, Birkenhager WH: Evidence that new antihypertensives are superior to older drugs. Lancet 2005, 366(9489):869-871.
- [35]Ouzounian JG, Elkayam U: Physiologic changes during normal pregnancy and delivery. Cardiol Clin 2012, 30(3):317-329.
- [36]Huisman A, Aarnoudse JG, Heuvelmans JH, Goslinga H, Fidler V, Huisjes HJ, Zijlstra WG: Whole blood viscosity during normal pregnancy. Br J Obstet Gynaecol 1987, 94(12):1143-1149.