Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/81959
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Type: Journal article
Title: Exploration and confirmation of factors associated with uncomplicated pregnancy in nulliparous women: prospective cohort study
Author: Chappell, L.
Seed, P.
Myers, J.
Taylor, R.
Kenny, L.
Dekker, G.
Walker, J.
McCowan, L.
North, R.
Poston, L.
Citation: BMJ, 2013; 347(nov21 3):1-13
Publisher: BMJ Publishing Group
Issue Date: 2013
ISSN: 0959-8138
1756-1833
Statement of
Responsibility: 
Lucy C Chappell, Paul T Seed, Jenny Myers, Rennae S Taylor, Louise C Kenny, Gustaaf A Dekker, James J Walker, Lesley M E McCowan, Robyn A North, Lucilla Poston
Abstract: Objective: To identify factors at 15 and 20 weeks’ gestation associated with a subsequent uncomplicated pregnancy. Design: Prospective international multicentre observational cohort study. Setting: Auckland, New Zealand and Adelaide, Australia (exploration and local replication dataset) and Manchester, Leeds, and London, United Kingdom, and Cork, Republic of Ireland (external confirmation dataset). Participants: 5628 healthy nulliparous women with a singleton pregnancy. Main outcome measure: Uncomplicated pregnancy, defined as a normotensive pregnancy delivered at >37 weeks’ gestation, resulting in a liveborn baby not small for gestational age, and the absence of any other significant pregnancy complications. In a stepwise logistic regression the comparison group was women with a complicated pregnancy. Results: Of the 5628 women, 3452 (61.3%) had an uncomplicated pregnancy. Factors that reduced the likelihood of an uncomplicated pregnancy included increased body mass index (relative risk 0.74, 95% confidence intervals 0.65 to 0.84), misuse of drugs in the first trimester (0.90, 0.84 to 0.97), mean diastolic blood pressure (for each 5 mm Hg increase 0.92, 0.91 to 0.94), and mean systolic blood pressure (for each 5 mm Hg increase 0.95, 0.94 to 0.96). Beneficial factors were prepregnancy fruit intake at least three times daily (1.09, 1.01 to 1.18) and being in paid employment (per eight hours’ increase 1.02, 1.01 to 1.04). Detrimental factors not amenable to alteration were a history of hypertension while using oral contraception, socioeconomic index, family history of any hypertensive complications in pregnancy, vaginal bleeding during pregnancy, and increasing uterine artery resistance index. Smoking in pregnancy was noted to be a detrimental factor in the initial two datasets but did not remain in the final model. Conclusions: This study identified factors associated with normal pregnancy through adoption of a novel hypothesis generating approach, which has shifted the emphasis away from adverse outcomes towards uncomplicated pregnancies. Although confirmation in other cohorts is necessary, this study implies that individually targeted lifestyle interventions (normalising maternal weight, increasing prepregnancy fruit intake, reducing blood pressure, stopping misuse of drugs) may increase the likelihood of normal pregnancy outcomes.
Keywords: Humans; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Vascular Diseases; Hypertension; Body Mass Index; Pregnancy Outcome; Diet; Logistic Models; Risk Factors; Cohort Studies; Prospective Studies; Smoking; Parity; Pregnancy; Blood Pressure; Vascular Resistance; Socioeconomic Factors; Adult; Employment; Australia; Ireland; New Zealand; Female; Young Adult; Uterine Artery; United Kingdom
Rights: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
RMID: 0020133594
DOI: 10.1136/bmj.f6398
Appears in Collections:Obstetrics and Gynaecology publications

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