Adverse Pregnancy Outcomes Associated With Moderate Elevations in Blood Pressure or Blood Glucose in Ugandan Women: A Prospective Cohort Study

dc.contributor.authorMilln, Jack
dc.contributor.authorNakabuye, Betty
dc.contributor.authorNatamba, Barnabas
dc.contributor.authorSekitoleko, Isaac
dc.contributor.authorMubiru, Michael
dc.contributor.authorNamara, Arthur
dc.contributor.authorTumwesigire, Samuel
dc.contributor.authorTino, Salome
dc.contributor.authorMirembe, Mandy
dc.contributor.authorKakanda, Ayoub
dc.contributor.authorAgaba, Brian
dc.contributor.authorNansubuga, Faridah
dc.contributor.authorZaake, Daniel
dc.contributor.authorAyiko, Ben
dc.contributor.authorKalema, Herbert
dc.contributor.authorNakubulwa, Sarah
dc.contributor.authorSekikubo, Musa
dc.contributor.authorNakimuli, Annette
dc.contributor.authorWebb, L. Emily
dc.contributor.authorNyirenda, J. Maffat
dc.date.accessioned2021-04-22T14:42:53Z
dc.date.available2021-04-22T14:42:53Z
dc.date.issued2021-05
dc.description.abstractBACKGROUND: The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recentevidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE: This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN: This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization’s criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS: Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36−5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20−2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74−3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17−3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16−2.30). CONCLUSION: Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesityen_US
dc.identifier.citationMilln, J., Nakabuye, B., Natamba, B., Sekitoleko, I., Mubiru, M., Namara, A., Tumwesigire, S., Salome, T., Mirembe, M., Kakanda, A. and Agaba, B., 2021. Adverse pregnancy outcomes associated with moderate elevations in blood pressure or blood glucose in Ugandan women; a prospective cohort study. AJOG Global Reports, 1(2), p.100007.en_US
dc.identifier.issn2666-5778
dc.identifier.urihttp://hdl.handle.net/20.500.12280/2694
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofseriesAJOG Global Reports;1(2)
dc.subjectAfricaen_US
dc.subjectGestational diabetesen_US
dc.subjectHypertensionen_US
dc.subjectLarge birthweighten_US
dc.subjectNoncommunicable diseaseen_US
dc.subjectPerinatal mortalityen_US
dc.subjectPregnancyen_US
dc.subjectUgandaen_US
dc.titleAdverse Pregnancy Outcomes Associated With Moderate Elevations in Blood Pressure or Blood Glucose in Ugandan Women: A Prospective Cohort Studyen_US
dc.typeArticleen_US

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