Chronic hypertension and pregnancy outcomes: Systematic review and meta-analysis. Bramham, K., Parnell, B., Nelson-Piercy, C., Seed, P. T., Poston, L., & Chappell, L. C. BMJ (Online), April, 2014. Publisher: BMJ Publishing Group![Chronic hypertension and pregnancy outcomes: Systematic review and meta-analysis [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Objective: To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. Study selection: Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extraction: Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). Results: 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery \textless37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight \textless2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), and perinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ2=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery \textless37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight \textless2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. Conclusions: This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.
@article{bramham_chronic_2014,
title = {Chronic hypertension and pregnancy outcomes: {Systematic} review and meta-analysis},
volume = {348},
issn = {17561833},
url = {https://pubmed.ncbi.nlm.nih.gov/24735917/},
doi = {10.1136/bmj.g2301},
abstract = {Objective: To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. Study selection: Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extraction: Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). Results: 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9\%, 95\% confidence interval 21.0\% to 31.5 \%), caesarean section (41.4\%, 35.5\% to 47.7\%), preterm delivery {\textless}37 weeks' gestation (28.1\% (22.6 to 34.4\%), birth weight {\textless}2500 g (16.9\%, 13.1\% to 21.5\%), neonatal unit admission (20.5\%, 15.7\% to 26.4\%), and perinatal death (4.0\%, 2.9\% to 5.4\%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ2=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95\% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery {\textless}37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight {\textless}2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. Conclusions: This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.},
urldate = {2020-08-31},
journal = {BMJ (Online)},
author = {Bramham, Kate and Parnell, Bethany and Nelson-Piercy, Catherine and Seed, Paul T. and Poston, Lucilla and Chappell, Lucy C.},
month = apr,
year = {2014},
pmid = {24735917},
note = {Publisher: BMJ Publishing Group},
keywords = {Bethany Parnell, Cardiovascular / therapy*, Cesarean Section / statistics \& numerical data, Chronic Disease, Female, Humans, Hypertension / complications*, Hypertension / therapy*, Incidence, Kate Bramham, Lucy C Chappell, MEDLINE, Meta-Analysis, NCBI, NIH, NLM, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, Non-U.S. Gov't, PMC3988319, Pre-Eclampsia / etiology, Pregnancy, Pregnancy Complications, Pregnancy Outcome / epidemiology, PubMed Abstract, Research Support, Review, Systematic Review, doi:10.1136/bmj.g2301, pmid:24735917},
}
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{"_id":"6kFQiZLDhPHKCCHQY","bibbaseid":"bramham-parnell-nelsonpiercy-seed-poston-chappell-chronichypertensionandpregnancyoutcomessystematicreviewandmetaanalysis-2014","author_short":["Bramham, K.","Parnell, B.","Nelson-Piercy, C.","Seed, P. T.","Poston, L.","Chappell, L. C."],"bibdata":{"bibtype":"article","type":"article","title":"Chronic hypertension and pregnancy outcomes: Systematic review and meta-analysis","volume":"348","issn":"17561833","url":"https://pubmed.ncbi.nlm.nih.gov/24735917/","doi":"10.1136/bmj.g2301","abstract":"Objective: To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. Study selection: Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extraction: Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). Results: 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery \\textless37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight \\textless2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), and perinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ2=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery \\textless37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight \\textless2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. Conclusions: This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.","urldate":"2020-08-31","journal":"BMJ (Online)","author":[{"propositions":[],"lastnames":["Bramham"],"firstnames":["Kate"],"suffixes":[]},{"propositions":[],"lastnames":["Parnell"],"firstnames":["Bethany"],"suffixes":[]},{"propositions":[],"lastnames":["Nelson-Piercy"],"firstnames":["Catherine"],"suffixes":[]},{"propositions":[],"lastnames":["Seed"],"firstnames":["Paul","T."],"suffixes":[]},{"propositions":[],"lastnames":["Poston"],"firstnames":["Lucilla"],"suffixes":[]},{"propositions":[],"lastnames":["Chappell"],"firstnames":["Lucy","C."],"suffixes":[]}],"month":"April","year":"2014","pmid":"24735917","note":"Publisher: BMJ Publishing Group","keywords":"Bethany Parnell, Cardiovascular / therapy*, Cesarean Section / statistics & numerical data, Chronic Disease, Female, Humans, Hypertension / complications*, Hypertension / therapy*, Incidence, Kate Bramham, Lucy C Chappell, MEDLINE, Meta-Analysis, NCBI, NIH, NLM, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, Non-U.S. Gov't, PMC3988319, Pre-Eclampsia / etiology, Pregnancy, Pregnancy Complications, Pregnancy Outcome / epidemiology, PubMed Abstract, Research Support, Review, Systematic Review, doi:10.1136/bmj.g2301, pmid:24735917","bibtex":"@article{bramham_chronic_2014,\n\ttitle = {Chronic hypertension and pregnancy outcomes: {Systematic} review and meta-analysis},\n\tvolume = {348},\n\tissn = {17561833},\n\turl = {https://pubmed.ncbi.nlm.nih.gov/24735917/},\n\tdoi = {10.1136/bmj.g2301},\n\tabstract = {Objective: To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. Study selection: Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extraction: Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). Results: 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9\\%, 95\\% confidence interval 21.0\\% to 31.5 \\%), caesarean section (41.4\\%, 35.5\\% to 47.7\\%), preterm delivery {\\textless}37 weeks' gestation (28.1\\% (22.6 to 34.4\\%), birth weight {\\textless}2500 g (16.9\\%, 13.1\\% to 21.5\\%), neonatal unit admission (20.5\\%, 15.7\\% to 26.4\\%), and perinatal death (4.0\\%, 2.9\\% to 5.4\\%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ2=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95\\% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery {\\textless}37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight {\\textless}2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death. Conclusions: This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.},\n\turldate = {2020-08-31},\n\tjournal = {BMJ (Online)},\n\tauthor = {Bramham, Kate and Parnell, Bethany and Nelson-Piercy, Catherine and Seed, Paul T. and Poston, Lucilla and Chappell, Lucy C.},\n\tmonth = apr,\n\tyear = {2014},\n\tpmid = {24735917},\n\tnote = {Publisher: BMJ Publishing Group},\n\tkeywords = {Bethany Parnell, Cardiovascular / therapy*, Cesarean Section / statistics \\& numerical data, Chronic Disease, Female, Humans, Hypertension / complications*, Hypertension / therapy*, Incidence, Kate Bramham, Lucy C Chappell, MEDLINE, Meta-Analysis, NCBI, NIH, NLM, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, Non-U.S. Gov't, PMC3988319, Pre-Eclampsia / etiology, Pregnancy, Pregnancy Complications, Pregnancy Outcome / epidemiology, PubMed Abstract, Research Support, Review, Systematic Review, doi:10.1136/bmj.g2301, pmid:24735917},\n}\n\n","author_short":["Bramham, K.","Parnell, B.","Nelson-Piercy, C.","Seed, P. 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