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Hemodynamic Adaptations in Different Trimesters Among Nulliparous and Multiparous Pregnant Women; The Generation R Study.
MedLine Citation:
PMID:  22647784     Owner:  NLM     Status:  Publisher    
BackgroundIt has been suggested that maternal vascular adaptations during pregnancy differ between nulliparous and multiparous women. Therefore, we examined the associations of parity with blood pressure and hemodynamic placental function during pregnancy and risks of gestational hypertensive disorders.MethodsThe study was embedded in a population-based prospective cohort study among 8,377 pregnant women. Information about parity and gravidity was obtained at enrollment. Blood pressure was repeatedly measured in each trimester and mean pulsatility and resistance indexes of uterine artery were measured in second and third trimesters. Information on gestational hypertension and preeclampsia was available from medical records.ResultsAs compared with nulliparous women, multiparous women had a lower systolic and diastolic blood pressure in each trimester of pregnancy and a slightly higher second and third trimester uterine artery resistance and pulsatility indexes (all P values < 0.05), but a lower risk of third trimester uterine artery notching (odds ratio (OR) 0.67 (95% confidence interval (CI):0.53, 0.84)). The risks of gestational hypertension and preeclampsia were lower among multiparous women as compared with nulliparous women (OR 0.32 (95% CI: 0.24, 0.43) and OR 0.24 (95% CI: 0.16, 0.37), respectively). Among multiparous women only, we did not observe associations of parity with hemodynamic parameters.ConclusionsNulliparous pregnant women have higher blood pressure levels throughout pregnancy and higher risks of notching and gestational hypertensive disorders. The first pregnancy might be a major risk factor for maternal hemodynamic maladaptations and vascular complications. Further studies are needed to explore the underlying mechanisms and consequences for fetal growth and development.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.57.
Akashi Andrew Rurangirwa; Romy Gaillard; Eric Ap Steegers; Albert Hofman; Vincent Wv Jaddoe
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-31
Journal Detail:
Title:  American journal of hypertension     Volume:  -     ISSN:  1941-7225     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1] The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands [2] Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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