Hypertension in Pregnancy: Effect of Prenatal Care on Maternal and Infant Health

Abstract

AbstractBackground. Hypertensive disorders (chronic hypertension, preeclampsia/eclampsia, preeclampsia superimposed on chronic hypertension and gestational hypertension) are present in 6% to 8% of pregnancies in the United States. The number of women of childbearing age who will develop hypertension is increasing due to the obesity epidemic and the increasing maternal age at pregnancy. In the United States, 3 to 5% of pregnant women have chronic hypertension before pregnancy or are diagnosed in the first 20 weeks of pregnancy. Chronic hypertension contributes to pregnancy related hypertension and has negative effects on maternal and infant outcomes including preterm birth and small for gestational age infants. Prenatal care is one of the most important preventative public health measures used globally and in the United States because the goal is to detect potential complications during pregnancy and provide appropriate and timely interventions. However, not all pregnant women have access to early prenatal care and adequate prenatal care. The benefits of prenatal care for maternal and infant outcomes for women with hypertensive disorders during pregnancy have not been described. Therefore, the purpose of this dissertation was to examine the influence of chronic hypertension, pregnancy induced hypertension and prenatal care on pregnancy outcomes for women and their infants.Methods. First, a secondary data analysis of the 2009-2011 Pregnancy Risks Assessment Monitoring System (PRAMS) dataset for North Carolina (Chapter 3) was conducted to understand the effects of chronic hypertension and prenatal care on maternal and infant outcomes in pregnant women. Second, to understand whether preterm infants born to women with hypertensive disorders of pregnancy differ from those of women without hypertensive disorders in terms of illness and development characteristics, a secondary data analysis of a study of maternally administered interventions for neonates was conducted in Chapter 4. Results. In Chapter 3, the results indicated that women with chronic hypertension have higher risks for pregnancy induced hypertension, preterm birth, and small for gestational age infants. In addition, first trimester or adequate prenatal care did not improve pregnancy outcomes for women with chronic hypertension as it did for women without chronic hypertension. In Chapter 4, preterm infants of women with hypertensive disorders are more likely to be small for gestational age than preterm infants of women without hypertensive disorders.Conclusion. Overall results showed that preterm infants of women with hypertensive disorders are small for gestational age when compared to preterm infants of women without hypertensive disorders. Also, prenatal care has no significant impact on improving pregnancy and birth outcomes of women with chronic hypertension.