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      The 2011 Survey on Hypertensive Disorders of Pregnancy (HDP) in China: Prevalence, Risk Factors, Complications, Pregnancy and Perinatal Outcomes

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          Abstract

          Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.

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          Most cited references28

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          Obesity, obstetric complications and cesarean delivery rate--a population-based screening study.

          This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery. A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.9 (obese), and 35 or greater (morbidly obese). Groups were compared by using univariate and multivariable logistic regression analyses. The study included 16,102 patients: 3,752 control, 1,473 obese, and 877 morbidly obese patients. Obesity and morbid obesity had a statistically significant association with gestational hypertension (odds ratios [ORs] 2.5 and 3.2), preeclampsia (ORs 1.6 and 3.3), gestational diabetes (ORs 2.6 and 4.0), and fetal birth weight greater than 4000 g (ORs 1.7 and 1.9) and greater than 4500 g (ORs 2.0 and 2.4). For nulliparous patients, the cesarean delivery rate was 20.7% for the control group, 33.8% for obese, and 47.4% for morbidly obese patients. Obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.
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            Maternal body mass index and the risk of preeclampsia: a systematic overview.

            Maternal obesity, both in itself and as part of the insulin resistance syndrome, is an important risk factor for the development of preeclampsia. Accurately quantifying the relation between prepregnancy maternal body mass index and the risk of preeclampsia may better identify those at highest risk. We performed a systematic overview of the literature to determine the association between prepregnancy body mass index and the risk of preeclampsia. Two reviewers independently retrieved all relevant English language cohort studies through a systematic search of Medline and Embase between 1980 and June 2002. Study data were abstracted in a similar fashion. For each study, the risk ratio of preeclampsia was calculated by comparing the risk of preeclampsia among women with the highest body mass index with those with the lowest. We identified thirteen cohort studies, comprising nearly 1.4 million women. The risk of preeclampsia typically doubled with each 5-7 kg/m2 increase in prepregnancy body mass index. This relation persisted in studies that excluded women with chronic hypertension, diabetes mellitus or multiple gestations, or after adjustment for other confounders. Most observational studies demonstrate a consistently strong positive association between maternal prepregnancy body mass index and the risk of preeclampsia. Increasing obesity in developed countries is likely to increase the occurrence of preeclampsia. Consideration should be given to the potential benefits of prepregnancy weight reduction programs.
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              [Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population].

              B. Zhou, (2002)
              For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of body mass index (BMI) and waist circumference for Chinese adults. The Working Group on Obesity in China (WGOC) under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases. All together 13 population studies met the criteria for enrollment, with data of 239 972 adults (20 - 70 year) surveyed in the 1990s. Data on waist circumference was available for 111 411 persons and data on serum lipids and glucose were available for more than 80 000. The study populations located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study group provided data according to a common protocol and uniform format. The center for data management in the Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight since and BMI at 28 which might identify the risk factors with specificity around 90% to be recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Analysis of population attributable risk percent illustrated that reducing BMI to normal range ( /= 28) with drugs could prevent 15% - 17% clustering of risk factors. Control the waist circumference under 85 cm for men and under 80 cm for women, could prevent 47% - 58% clustering of risk factors.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                17 June 2014
                : 9
                : 6
                : e100180
                Affiliations
                [1 ]Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
                [2 ]Department of public healthcare information administrative section, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
                [3 ]Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom
                Indiana University School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: WYZ CY YR LYZ GHL CDL YC CXJ ILM JW. Performed the experiments: CY WYZ YR. Analyzed the data: CY WYZ YR JW. Contributed reagents/materials/analysis tools: CY WYZ YR ILM. Wrote the paper: CY WYZ YR.

                Article
                PONE-D-13-42765
                10.1371/journal.pone.0100180
                4061123
                24937406
                2a78ca0a-5196-4147-8b5b-5be8222f66f5
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 October 2013
                : 23 May 2014
                Page count
                Pages: 9
                Funding
                Sources of Funding: This project was supported by the State Ministry of Health, the People’s Republic of China (Grant number 201002013) and the Beijing Health Bureau (Grant number 2009-2-11). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Population Biology
                Population Dynamics
                Medicine and Health Sciences
                Epidemiology
                Vascular Medicine
                Blood Pressure
                Hypertension
                Hypertensive Disorders in Pregnancy
                Women's Health
                Maternal Health
                Pregnancy
                Obstetrics and Gynecology
                Research and Analysis Methods
                Research Design
                Clinical Research Design
                Cross-Sectional Studies
                Retrospective Studies

                Uncategorized
                Uncategorized

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