American Journal of Epidemiology Vol. 155, No.

3
Copyright © 2002 by the Johns Hopkins Bloomberg School of Public Health Printed in U.S.A.
All rights reserved

Preeclampsia and Gestational Hypertension and Birth Weight Xiong et al.
Impact of Preeclampsia and Gestational Hypertension on Birth Weight by
Gestational Age

Xu Xiong,1,2,5 Nestor N. Demianczuk,3 L. Duncan Saunders,2 Fu-Lin Wang,4 and William D. Fraser1

The predominant etiologic theory of preeclampsia is that reduced uteroplacental perfusion is the unique
pathogenic process in the development of preeclampsia. Decreased uteroplacental blood flow would result in lower
birth weights. To date, no study has assessed the effect of preeclampsia on birth weight by gestational age. Thus,
the authors conducted a retrospective cohort study based on 97,270 pregnancies that resulted in delivery between
1991and 1996 at 35 hospitals in northern and central Alberta, Canada. Differences in mean birth weight between
women with preeclampsia and normotensive women ranged from –547.5 g to 239.5 g for gestational age
categories ranging from ≤32 weeks to ≥42 weeks. The birth weights were statistically significantly lower among

Downloaded from http://aje.oxfordjournals.org/ by guest on September 21, 2016
mothers with preeclampsia who delivered at ≤37 weeks, with an average difference of –352.5 g. However, the birth
weights were not lower among preeclamptic mothers who delivered after 37 weeks (average difference of 49.0 g).
In Alberta, 61.2% of preeclamptic patients gave birth after 37 weeks of gestation. The authors conclude that babies
born to mothers with preeclampsia at term have fetal growth similar to that of babies born to normotensive mothers.
This finding does not endorse the currently held theory that reduced uteroplacental perfusion is the unique
pathophysiologic process in preeclampsia. Am J Epidemiol 2002;155:203–9.

birth weight; gestational age; hypertension; pre-eclampsia; pregnancy

Hypertensive disorders in pregnancy, especially pre- placental blood flow should result in decreased fetal growth,
eclampsia, remain a major cause of maternal and infant mor- with an increased risk of intrauterine growth restriction and
bidity and mortality worldwide (1). Despite numerous basic, low birth weight. However, epidemiologic studies have not
clinical, and epidemiologic studies that have been conducted conclusively established an association between preeclampsia
over the past half-century, knowledge of the etiology and or gestational hypertension and poor fetal growth (7).
pathogenesis of preeclampsia remains elusive (2). Because Birth weight is determined by both duration of gestation
the pathophysiology of preeclampsia has not yet been eluci- and rate of fetal growth. Preeclampsia significantly
dated, clinical trials have failed to demonstrate any effective increases the risk of iatrogenic preterm birth (delivery) for
prevention or treatment strategies, apart from early delivery in maternal indications. To study the effect of preeclampsia
cases where the disorder is severe (2, 3). and gestational hypertension on fetal growth, it is important
A prevailing hypothesis regarding the pathogenesis of to compare the fetal growth of babies born to mothers with
preeclampsia is the “ischemic model.” Decreased uteropla- preeclampsia or gestational hypertension with that of
cental perfusion is hypothesized to be the primary step and the babies born to mothers without these conditions at the same
point of convergence of diverse pathogenic processes in the gestational ages. To our knowledge, no study to date has
development of preeclampsia (4–6). It is intuitive that reduced examined the impact of preeclampsia and gestational
hypertension on mean birth weight by gestational week,
and no previous study has examined whether the effect of
Received for publication April 12, 2001, and accepted for publica- preeclampsia or gestational hypertension on fetal growth
tion August 15, 2001.
Abbreviations: LGA, large for gestational age; SGA, small for differs according to gestational age. Using an existing peri-
gestational age. natal database, we conducted a study to assess the effect of
1
Department of Obstetrics and Gynecology, Faculty of Medicine, preeclampsia and gestational hypertension on fetal growth
Laval University, Quebec City, Quebec, Canada. according to gestational age.
2
Department of Public Health Sciences, Faculty of Medicine,
University of Alberta, Edmonton, Alberta, Canada.
3
Department of Obstetrics and Gynecology, Faculty of Medicine, MATERIALS AND METHODS
University of Alberta, Edmonton, Alberta, Canada.
4
Health Surveillance, Alberta Health and Wellness, Edmonton, Study population
Alberta, Canada.
5
Current affiliation: St.-François d’Assise Hospital, Quebec City, The Northern and Central Alberta Perinatal Audit and
Quebec, Canada. Education Program commenced data collection in 1991 to
Reprint requests to Dr. Xu Xiong, Hôpital Saint-François d’Assise,
Centre de recherche—D1-724, 10 rue de l’Espinay, Québec, monitor the impact of educational strategies designed to
Québec G1L 3L5, Canada (e-mail: Xu.Xiong@crsfa.ulaval.ca). decrease the incidence of obstetric interventions (8, 9). The

203

3 g in a 24-hour urine collection. Preeclampsia is defined as a blood pressure of ≥140/90 mmHg with proteinuria of 1 on dipstick in two samples RESULTS taken 6 hours apart. and verified by first. To adjust for confounding effects.456 cases). Women with from the others were performed using Tukey and Bonferroni the following characteristics were excluded from the analy. Gestational age was based on the last menstrual period. Women who had had transient hypertension during (β) coefficients for preeclampsia. before pregnancy (208 cases).3 percent. Birth weight was measured shortly after delivery.05 was the critical alpha level. and pre- formed at three levels: The registry is checked for missing mature rupture of membranes. Education Program defines gestational hypertension (8. The regression cases).. Inc. These conditions squares (10. 87. the β coefficient for the vari- were excluded mainly because they are potentially con. (code 1) to normotensive status (code 0) adjusted for all After exclusion of an additional 1. 1991.5 percent were nulliparous. The initial population in the database consisted of 97. tension and preeclampsia on birth weight by gestational age. the The Northern and Central Alberta Perinatal Audit and p value was two-tailed. normotensive  0). prior small-for-gestational-age (SGA) newborn. low birth weight. 8. trimester or early second-trimester ultrasound findings. pregnancies were teenagers and 37. procedures (10). and December 31. any type of prior diabetes normotensive  0).7 percent. The statistical significance ( p value) of the β coefficients was also tested by t test. labor but had experienced no hypertension during preg.798 pregnancies remained for the also analyzed the impact of preeclampsia and gestational analysis. respectively. con. and other confound- lar disease (546 cases). or incomplete data. Data validation is per.org/ by guest on September 21. Finally. and chronic renal disease (102 ing variables as the independent variables. 6. mean birth weight between the gestational hypertension and bility of an association with both exposure and outcome. and an ongoing manual review of a random sample of charts Statistical analysis is performed to check the accuracy of information. maternal prepreg- mat from participating hospitals are reviewed by an audit nancy weight ≤45 kg.9 percent.2 g to 55. we sis: multiple pregnancies (2. differences in basis of our review of the literature and the biologic plausi. we antenatal information.270 deliveries occurred assessed which specific mean values differed significantly between July 1.204 Xiong et al. A mini. Every effort is made to sis were maternal smoking.0 for a blood pressure of ≥140/90 mmHg without or with protein. With respect to the gestational age Potentially confounding variables were selected on the categories from ≤32 weeks to ≥42 weeks. parity.0 per- trimester or early second-trimester ultrasound when available. normotensive groups ranged from –434. Babies born to women at gestational ages ≤32 weeks were pooled. Table 1 shows the characteristics of the study pop- with preeclampsia. ing pregnancy.375 cases with missing other variables included in the regression (10). preeclampsia. gestational diabetes (2. database is derived directly from the standard labor and The potentially confounding variables included in the analy- delivery record used in Alberta.9 percent. complicated by chronic hypertension and preeclampsia super. able “preeclampsia” represents the average change in birth founding variables known to be associated with both weight (g) associated with a change from preeclampsia preeclampsia or gestational hypertension and birth weight. uria of no greater than trace levels after 20 weeks of gestation.oxfordjournals. anemia. prior spontaneous and induced abor- coordinator to check for discrepancies before being entered tion.270 Eclampsia is diagnosed when convulsions occur in a woman women.6 percent smoked dur- imposed on chronic hypertension were not studied. tational hypertension or preeclampsia and normotensive Data included in this study were collected from 35 women. preexisting chronic applied multiple linear regression using birth weight as the Downloaded from http://aje. 3. and 0. cent. hypertension on birth weight by gestational age by separat- ing nulliparous and multiparous women to examine whether Definition of exposure and outcome the effect differed by parity. and chronic hypertension were 3. and 0. Analysis of variance was performed to compare mean mum of one out of every 20 records is verified against the birth weights by gestational week between women with ges- actual data entered. No.1 g. 155. Windows (SPSS. or >0. For Am J Epidemiol Vol. The incidences of gestational hypertension. prior into the database by a data clerk. hypertension  1. For example. 1996. large-for-gestational-age (LGA) newborn. gestational age was based solely on the first. If the date of the last menstrual period was not thought to be Figure 1 and table 2 show the impact of gestational hyper- accurate. maternal age. obesity ensure accuracy of the data. Post hoc pairwise multiple comparisons that Alberta hospitals in which 97. and 26. 1. Because we restricted our focus to gesta. use of antihypertensive drugs dependent variable and preeclampsia (preeclampsia  1. Illinois). Overall. and 0. The incidences of firmed by early pelvic examination. as were those born at gestational ages ≥42 weeks. 40. respectively. gestational hypertension. Records received in paper for. 2002 . preterm birth. and stillbirth were 9.4 percent were over 30 years old. (maternal prepregnancy weight ≥91 kg). 11).2 percent of the women tional hypertension and preeclampsia. Definition of potentially confounding variables producing categories of sufficient sample size to allow meaningful comparisons.528 cases). 9) as All statistical analyses were performed with SPSS 10. ulation before exclusions.9 percent. programmed computer checks and cross-tabulations are used to reduce the risk of typing errors. and other variables were estimated by the method of least nancy were also excluded (809 cases). gestational hypertension (gestational (753 cases). 2016 hypertension (695 cases). Chicago. cardiovascu.

390.4 were not statistically significant (β > 0.2 percent of babies born to mothers with preeclampsia were delivered after 37 weeks. Preeclampsia† 1. and gestational hypertension on birth weight is a function of tional hypertension than among women with normal blood gestational age. Preeclampsia and Gestational Hypertension and Birth Weight 205 TABLE 1.2 variables (β < 0. there was no statistically significant difference. for mostly among preterm births. birth Alberta. the differences in mean Parity birth weights between women with preeclampsia and Nulliparity 38. 8.1 birth weight by gestational week.476 93. examined the relation between preeclampsia or gestational tational hypertension than among babies born to women hypertension and birth weight (7.2 percent gave birth hypertension 3.org/ by guest on September 21. Yes 16.9 effect of preeclampsia and gestational hypertension on mean No 88. which we found no difference in mean birth weight between Am J Epidemiol Vol. No.oxfordjournals. both prior to and after adjustment for confounding ≤19 7. p > 0.521 51. Preterm birth Yes 8.0 DISCUSSION Low birth weight To our knowledge. g to 239. ‡ Numbers in parentheses.7 markedly lower among babies born to mothers with Mean gestational age preeclampsia than among babies born to normotensive (weeks) 39.270) in a study of the effects of preeclampsia and preeclamptic and normotensive groups ranged from –547.05). normal birth weight for their expected gestational age. tional age was similar to that of preeclampsia.025 54. However.0 No 86. These studies cant difference in mean birth weights between women with were carried out in separate populations. In fact.0 (627. 3. 155.798 82.554 49. The average unadjusted birth 20–30 51.0 effect of preeclampsia and gestational hypertension on birth Cesarean delivery weight between nulliparous and multiparous women. There was no significant difference in the Female 46. For example. in gestational hypertension and normal blood pressure.714 93. However. 12).4 weight difference at ≤37 weeks was –352. % with preeclampsia than among women with normal blood Maternal age (years) pressure.408 40.7 Table 3 shows the results of multivariable analyses of the Chronic hypertension 877 0.708 8. p < 0.0 women separately. After adjustment for confounding factors. Thus. 1991–1996 weights were statistically significantly lower among women Characteristic* No.047 37. This may explain the contra- women delivering before 37 weeks. for women delivering at ≥37 weeks. no previous study has examined the Yes 6. Canada.5 significant.677 73.3 data. ers with preeclampsia after 37 weeks to that of babies born † Includes 12 cases of eclampsia. Characteristics of the study population The differences in mean birth weight between the (n = 97.9 impact of preeclampsia and gestational hypertension on birth Infant’s sex weight by gestational age among nulliparous and multiparous Male 48. in which. In the present study. standard deviation. 2016 Gestational gave birth at 37 weeks or less.285 26.602 6.5 g. 61.775 99.01).01). in the upper gestational age categories (41 and ≥42 No 78.9 after 37 weeks. 2002 . there was no statistically signifi.0 g.5 In Alberta. The effect of decreased birth weight is found pressure. The first study.558 9.5 g.5 women with normal blood pressure were not statistically Multiparity 56.5 gestational hypertension on birth weight by gestational age. we with normal blood pressure (β < 0. These results contrast with Stillbirth our previous findings.9 weeks). The aver- Hypertensive disorders age unadjusted birth weight difference after 37 weeks was in pregnancy 49. for >30 35. the effects pointed in different directions.520 91.713 3. mean birth weights were higher among Maternal smoking women with preeclampsia than among women with normal Yes 25.6 blood pressure at 41 and ≥42 weeks. but the differences No 69. birth weights were sta.8 percent of women with preeclampsia Downloaded from http://aje. effects of preeclampsia on birth weight (8.312 59. 12).280 17. p < 0. we observed that the overall mean birth weight was No 94. sure.0 (2. The tistically significantly lower among women with gestational effect of gestational hypertension on birth weight by gesta- hypertension than among women with normal blood pres.1 However. birth weights remained dictory findings of previous epidemiologic studies that have significantly lower among babies born to women with ges. to normotensive mothers at the same gestational age.4)‡ mothers (8). Mean birth weight (g) 3. on the basis of the same Yes 303 0. most babies born to mothers with preeclampsia at term actually have women delivering before 37 weeks. 38. For women delivering at ≤37 weeks.4 women delivering after 37 weeks.651 1. the birth This study demonstrates that the effect of preeclampsia weights were generally higher among women with gesta. For women recently reported results from two separate studies of the delivering at ≥37 weeks.2) When we compared the birth weight of babies born to moth- * Cases with missing information are excluded. and 61. Normotensive 89.

4 g) as compared with those born ses of considerable pathophysiologic heterogeneity in to normotensive mothers (3.6 76.7** 224.8* 332.6** 33 29 417 434.5** 608. Impact of preeclampsia and gestational hypertension on birth weight. Easterling et al. maternal age. with No.0 145 26. had a relatively small proportion of at term have normal fetal growth cannot be reconciled with preeclamptic patients (6.007 239. 3.213.7** 245.206 Xiong et al.380.1 135.org/ by guest on September 21.658) normotensive status (n = 84. the preeclamptic group (3.241.841 9.007 19.05.0 40 622 26. ‡ SE.395) Preeclampsia (n = 745) versus versus normotensive status (n = 84.4** 28 668 462.1 363.8 67.4 39 632 20.0 6.2** 484. and pre- mature rupture of membranes. maternal prepregnancy weight of ≥91 kg.8 g). 1991–1996.097 317.642 32. in univariable analysis and multivariable linear regression analysis (n = 87.4 44. with weight B† SE‡ weight B† SE No. Alberta.4 36. No.952. Alberta. 2016 FIGURE 1. There is increasing literature supporting the hypothe- with preeclampsia (2.5 the sole genesis of preeclampsia have been discussed (13).9 61.4 57. maternal prepregnancy weight of ≤45 kg. Canada.2 85.658) Week of Study sample Study sample gestation Mean birth Mean birth No. prior large-for-gestational-age newborn.2 49.1 g) and the normotensive The finding that most babies born to preeclamptic women group (3.471 59.1 16.2** 665. the proportion of preeclampsia. standard error.2 161. The observed overall effect on birth weight may In longitudinal studies. ondary to increased maternal cardiac output. Downloaded from http://aje.5 125.097 222.2** 317.5 226.3 103. Impact of preeclampsia and gestational hypertension on birth weight (n = 87.3* 18.4 11. No. Am J Epidemiol Vol.617 5.5 g).642 45.798).2** 34 22 668 312.9 41 198 11. prior spontaneous and induced abortions.1 * p < 0. by week of gestation. † Adjusted for maternal smoking.929 22. 2002 .7 17. ** p < 0. gestational difference (g) difference (g) normotensive preeclampsia normotensive hypertension ≤32 41 1.4 ≥42 31 1.6 112.798).3** 38 432 12.01.2 21. parity.293 178.7** 227.1 141 12. anemia.9** 36 107 2.2 178.8 7 1.1** 59 1. where we observed a significantly sion is the unique pathophysiologic process in preeclampsia decreased mean birth weight among babies born to mothers (4–6).676 464.1** 24.293 189. Canada. 1991–1996 Gestational hypertension (n = 2. percent) (8).9 84 5.4 18.8** 522.9 29.9 106.5 69. 155.7 32. The limitations of the “ischemic model” as preterm births among preeclamptic patients was high (27.9 19. By studying TABLE 2.1** 36 1. (14) demonstrated depend on the relative proportions of full-term and preterm an increase in blood flow among preeclamptic patients sec- deliveries among patients with preeclampsia in the study.2** 21 417 547.8** 35 43 1.6 65.676 248.oxfordjournals.8** 37 238 5.471 239.3 116 20.841 55.8 100.4** 61 2. In the second study.9 40. prior small-for-gestational-age newborn.1** 255.617 45.5 46.7 percent) who delivered preterm the currently held belief that reduced uteroplacental perfu- (12).7 54.0 47 11.929 74.

is markedly increased in infants born significantly preterm Another possible explanation for these findings is that or in those of very low birth weight. design in which women selected for study have already had Early-onset preeclampsia and late-onset preeclampsia may preeclampsia.3* 290. the results of our recent weeks) may be more likely to be mild and less likely to lead meta-analysis suggest that preeclampsia may be protective to “iatrogenic” premature delivery.1 46.6 43.9 37.1** 34 304. standard error.3 140.4** 121.1 27. Uteroplacental hypoper- against cerebral palsy in preterm and low birth weight fusion.0 55.9 285.0 68. under such “ischemic on fetal growth. may be of too short a duration to affect infants (17).9 403.1 57.8 1. preeclampsia (8. The group of preeclamptic women which suggests that uteroplacental blood flow may be nor.460) B† SE‡ B† SE B† SE B† SE ≤32 451. However. Kingdom et al. In order to detect changes flows throughout most of their pregnancies than those who in uteroplacental perfusion before the onset of preeclampsia.0 199.9** 35 254. Although preeclampsia sig- normal uterine Doppler flow indices as measured at 20 nificantly increases the risk of low birth weight and SGA weeks and 30–34 weeks.1** 37 29.0 21.oxfordjournals.9** 192. 155. No.0 62. 2016 * p < 0.6 184. also increases the risk of high birth weight and LGA babies tational hypertension and preeclampsia and LGA infants. 12).8 133.3 38. mean birth weight (12).01. Uteroplacental hypoperfu- noted that women who became preeclamptic in the third sion may be the result of preeclampsia occurring after the trimester had substantially greater uteroplacental blood clinical expression of the disease. Finally.1** 280.0 19.3 103. in multivariable linear regression analysis (n = 87. maternal prepregnancy weight of ≤45 kg. women. who have LGA babies are probably mostly among those mal or increased in the majority of preeclamptic patients (8).7 121.4 68. ‡ SE. most previous studies on the etiology fetal size (8). if present.8 67.9 41 67. anemia. prior spontaneous and induced abortions.658) normotensive status (n = 84.3 0. our data set did not Am J Epidemiol Vol. we observed a significant association between ges.7** 832. 12).3** 33 396.5 192.org/ by guest on September 21.1 209.5 32.929) (n = 52.7 305.6** 170. † Adjusted for maternal smoking. then likely to be severe.3 53. without displacement of the mothers were appropriate-for-gestational-age or LGA. and more likely to lead to “iatrogenic” pre- conditions.3 39.0** 1. In a study of 1. remained normotensive.658) Week of Nulliparous women Multiparous women Nulliparous women Multiparous women gestation (n = 34. 3. The lower addition.024. prior small-for-gestational-age newborn. prior large-for-gestational-age newborn.7 ≥42 137.3 45.9 84.4** 414.7 103. (16) found that 85 percent and 94 Mean birth weight is influenced by both the right and left percent of women who developed preeclampsia at term had tails of the birth weight curve. decreased uteroplacental perfusion was the cause of the dis- an indicator of uteroplacental perfusion.7 22.650 Caucasian prospective or longitudinal studies are warranted. who gave birth after 37 weeks.3 39 27.5 36. resulting in a flattening approximately 90 percent of babies born to preeclamptic out of the normal distribution.05. respectively. The phenomenon of LGA A further challenge to the “ischemic model” in and high birth weight infants born to preeclamptic patients preeclampsia arises from the findings of a reduced risk of may be the result of earlier growth-enhancing effects by an cerebral palsy among preterm or low birth weight infants increased uteroplacental blood flow due to higher blood born to mothers with preeclampsia (17).2 66.798).943) (n = 51. Unfortunately. ** p < 0.3 254. Indeed.7 162.3 27. In (the right tail of the birth weight curve) (8.2 71. more likely to have a detrimental effect infants born to preeclamptic mothers. (15) ease or the result of the disease. Cerebral palsy risk pressure (8.6 336.1 21.7 28.2 120. the placental clearance of dehydroisoandrosterone sulfate.8 120. Canada.8 133.9** 88.3 23.7** 622.6 104.5** 261.6 158. weights on the right side of curve.3 213.7** 467.5 47.7 67. Gant et al. Impact of preeclampsia and gestational hypertension on birth weight.7 300. mature delivery.124) (n = 33. preeclampsia that is of early onset (≤37 weeks) may be more perfusion were the sole pathophysiologic mechanism. and premature rupture of membranes.7** 466. significant associations were noted between these weights on the left side of the curve may be offset by higher variables and low birth weight and SGA infants.8 36 244.6 38 0.4 82. it would seem likely that preterm birth of preeclampsia were of a cross-sectional or case-control is a marker of disease severity and fetal growth restriction.3 183. Preeclampsia that is of late onset (>37 oping cerebral palsy.395) Preeclampsia (n = 745) versus versus normotensive status (n = 84.6 91.2** 169.9 196. maternal age.9 40 33. It is therefore difficult to know whether be different diseases. Alberta.” would be expected to be at higher risk of devel. by week of gestation and parity.9 92.4 33. If uteroplacental hypo. Indeed.7 239. Preeclampsia and Gestational Hypertension and Birth Weight 207 TABLE 3.5** 593.2 Downloaded from http://aje. 1991–1996 Gestational hypertension (n = 2.7 78. 2002 .9 523.1 151. 18). maternal prepregnancy weight of ≥91 kg. In our recent studies babies (the left tail of the birth weight curve).

for data from causes other than preeclampsia probably have a higher preparation. Am J Obstet Gynecol 1971. Late-gestation preeclamp- sia results in perinatal obesity and increased placental weight. In: Lindheimer MD.163:1689–712. in these patients. London. Xu Xiong was supported by the Canadian Institutes of ple size was so large for the normotensive group. Clin Perinatal 1991. Further studies are needed to examine subsets of preeclampsia separately. and bolic clearance rate of dehydroisoandrosterone sulfate in preg- among these patients preeclampsia may follow the nancy. Schmucker BC. Am J Obstet Gynecol 1990. to the recently updated estimate of 6–8 percent for hyper. 1989:137–48. Cummingham limited to primiparous women. Dr. include information on the onset and severity of preeclamp. Pathogenesis of preeclampsia: a com- one or a few tertiary hospital(s) where women who have prehensive model. heterogeneous disorder (13) and that it may appear in at 14.179:1275–8. Roberts JM. Downloaded from http://aje. Obstet Gynecol 1990. Am J Obstet Gynecol 1999. et al. Geary M.6 percent to 2. 155. Siiteri PK.0 percent. The data presented here may underestimate the detrimental effects of preeclampsia on birth weight among preterm births. the incidence of preeclampsia (19). Stamford.341:1447–50.180:207–13. births does not necessarily represent a “normal” control The authors thank Nancy Bott. The incidence of preeclampsia varies nancy-induced hypertension.111:555–63. port through a Chercheur National Award from the Fond de It should be noted that the control group for preterm Recherche en Santé du Québec. tensive disorders in pregnancy. pathogenesis of preeclampsia follows the “ischemic model” 17. Other studies have been diagnosis. studies reporting the incidence of preeclampsia have been 4. FG. Saunders LD. Preeclampsia: more than preg- percent (1. Hutchinson HT. preeclampsia. Patients with restricted 15. 1996:210–12. which is lower than a previously reported rate of 5 1. eds. Davidge ST. Health Research. Thus. Pathophysiology of population-based. 1999:202–3. Roberts JM. et al. 325–61. Redman CW.175:1365–70. Friedman SA. preeclampsia often deliver at term. Dr. Peeters LL. It is less likely that the J Soc Gynecol Investig 2000. et al. Lancet 1993. we excluded women with hypertension that occurred only during labor. “ischemic model. single syndrome of preeclampsia: a hypothesis and its impli- Our data support the hypothesis that preeclampsia is a cations. Consensus studied and the criteria used for the diagnosis of report. Ness RB. From 8. Xiong X. terms of onset and severity. Heterogeneous causes constituting the Pregnancy (20. Practical statistics for medical research. 2). the overall incidence of hypertensive disor. 9. Am J 1991 to 1996. Roberts JM. Program Working Group on High Blood Pressure in 13. Sibai BM.7(suppl):89A. Wang FL. hypertension. Maternal hemodynamics in normal and preeclamptic pregnancies: a lon- least two forms (8): restricted fetal growth preeclampsia and gitudinal study.5 percent (table 1). Paediatr Perinat had occurred in northern and central Alberta since 1992 Epidemiol 1996. 6. Statistical methods in epidemiology. 11. Prevention of preeclampsia: a big disappointment. Future epidemiologic and basic scientific sia or on whether the preterm births were spontaneous or studies of preeclampsia may be needed to study these two medically induced. 7. 2016 proportion of SGA infants than women whose babies remain in utero. et al. Xiong X. Demianczuk NN. 3. William D. Friedman SA. National High Blood Pressure Education Program Working Group report on high blood pressure in pregnancy. Kahn HA. Mayes D. 5. future stud- this hypothesis. Maternal smoking and cent. Buekens P. J Reprod Med 2000. the false.oxfordjournals. Alberta is 6. preeclampsia or are at high risk of developing preeclamp. The effect of the pregnancy-induced hypertension Our data captured more than 80 percent of the births that on fetal growth: a review of the literature. Demianczuk N. Benedetti TJ. and chronic hypertension. No. Finally. Obstet Gynecol Surv 1998. 21).45:727–32.10:244–63.org/ by guest on September 21.76:1061–9.53:233–9. normal fetal growth preeclampsia. Most of these studies originated from preeclampsia. and 90 percent of those that had occurred after 1994. who are at greater risk. Many of these women may not have had true hypertensive ACKNOWLEDGMENTS disorders but rather may have represented the normal response to stress at the time of delivery. Xiong X.183:148–55.7 per- cent. Xiong X. ders. The impact of preg- published by the National High Blood Pressure Education nancy-induced hypertension on fetal growth. Sempos CT. the incidence of preeclampsia ranged from Obstet Gynecol 2000. Chesley’s hypertensive disorders in pregnancy. Hindmarsh P. preeclampsia. 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