Hypertension and the risk of miscarriage

American Heart Association | 2018 |  April 2 | Higher blood pressure before pregnancy may increase miscarriage risk | Science Daily 

An American study from the American Heart Association has studied women who had previously experienced miscarriages and were trying to conceive.  The clinical trial is the first of its kind to look at preconception blood pressure and reproductive outcomes in healthy women not diagnosed with high blood pressure or heart disease. The women took low-dose aspirin to determine if this reduced their risk of miscarriage (via Science Direct).
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The women in the sample  (n equal to 1,228 women) had an average age of 28.7 years, and all had experienced 1-2 pregnancy losses. They had their blood pressure (both systolic and diastolic) measured to assess their hypertension.  During the study, women had their blood pressure measured when they were trying to become pregnant, during preconception and in early pregnancy, this data was used to derive mean arterial pressure.

Key Findings:

Whether women had been randomly assigned to take low-dose aspirin as part of this clinical trial (Effects of Aspirin in Gestation and Reproduction) made no difference in the impact of blood pressure on pregnancy loss. The findings were similar for preconception and early-pregnancy blood pressure. The research indicates  that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favourably impact reproductive health.

Researchers also found:

  • Every 10-point increase in diastolic blood pressure (lower number) was associated with an 18 per cent increased risk of pregnancy loss.
  • Every 10-point increase in mean arterial pressure (an average of the lower and higher numbers) was associated with a 17 per cent increased risk of pregnancy loss.

 

Carrie J. Nobles, Ph.D., lead author of the study said: “Elevated blood pressure among young adults is associated with a higher risk of heart disease later in life, and this study suggests it may also have an effect on reproductive health.”

Abstract

Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biological rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. We evaluated preconception blood pressure and fecundability, pregnancy loss, and live birth in the EAGeR trial (Effects of Aspirin on Gestational and Reproduction; 2007–2011), a randomized clinical trial of aspirin and reproductive outcomes among 1228 women attempting pregnancy with a history of pregnancy loss. Systolic and diastolic blood pressure were measured during preconception in the first observed menstrual cycle and in early pregnancy and used to derive mean arterial pressure. Fecundability was assessed as number of menstrual cycles until pregnancy, determined through human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin–detected and clinical losses. Analyses adjusted for treatment assignment, age, body mass index, race, marital status, smoking, parity, and time since last loss. Mean preconception systolic and diastolic blood pressure were 111.6 mm Hg (SD, 12.1) and 72.5 (SD, 9.4) mm Hg. Risk of pregnancy loss increased 18% per 10 mm Hg increase in diastolic blood pressure (95% confidence interval, 1.03–1.36) and 17% per 10 mm Hg increase in mean arterial pressure (95% confidence interval, 1.02–1.35) in adjusted analyses. Findings were similar for early pregnancy blood pressure. Preconception blood pressure was not related to fecundability or live birth in adjusted analyses. Findings suggest that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favorably impact reproductive health.

The full text article can be requested by Rotherham NHS staff here

Full reference:

Nobles, C.J.  et al | 2018 | Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy | Hypertension 

Researchers make a link between gene mutation and cot death


The Lancet has published a paper on sudden infant death syndrome (SIDs),  which is the unexpected death of a seemingly healthy child. Typically, it affects children aged between 2-4 months.  It is the leading cause of post-neonatal death in high income countries, accounting for 300 deaths each year in the UK, however deaths are rare and an individual baby’s risk is low (via NIHR).

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The study, supported by the NIHR University College London Hospitals Biomedical Research Centre, identifies a correlation between a genetic mutation and SIDS or cot death. The research investigated mutations in the gene SCN4A, which controls contraction of respiratory muscles, in 278 children who had died of sudden infant death syndrome and 729 controls. These mutations ,which affects the breathing muscles are very rare and occurs in less than 5 people in every 100,000. The study found mutations in four of the 278 children who had died of SIDS (1.4% ) compared to none of healthy controls.. This means that the mutation was more common in children who had died as a result of SIDS, than in the general population.

Consultant neurologist Professor Michael Hanna, the senior author said: “Our study is the first to link a genetic cause of weaker breathing muscles with sudden infant death syndrome, and suggests that genes controlling breathing muscle function could be important in this condition. However, more research will be needed to confirm and fully understand this link.”

The full news story can be read from NIHR 

Further details about the study are available from UCL Hospitals Biomedical Research Centre  Potential genetic link to explain sudden infant death syndrome

The full text article is available to download from The Lancet

Related:

Science Daily Infant death study reveals dangerous sleep practices among babysitters, relatives, others

Boost to number of midwives as extra training places announced

Secretary of Health and Social Care Jeremy Hunt, will announce plans today  (27 March) for an extra 3000 midwives to be trained over the next four years, increasing the number of training places by a quarter.  It will start with an additional 650 midwives and maternity support staff in training next year, then a further 1000 places for the next three years. The plan will also include a new maternity support worker (MSW) role,  as well as opening new training pathways into midwifery.  As part of the same announcement Mr Hunt is expected to outline plans that ensure mothers will be seen by the same midwife throughout labour, pregnancy and birth by 2021 (via RCM).

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The Royal College of Midwives (RCM) chief executive Gill Walton said: ‘while we welcome the commitment to continuity of care, it is ambitious. The additional midwives who start training next year won’t be qualified midwives working in our maternity services until 2022. That will make a difference and it will begin to have an impact on the workload of midwives, but it will not transform maternity services right now.”

It will take seven or eight years before all of the new midwives announced today will be actually working in our maternity services. This will be offset to some extent by the extra MSWs promised. This will help make the staffing overall feel better, though we need to see details about how many more MSWs there will be.’

The full RCM response to the plan can be read here Government promises more midwives

In the media:

BBC News  NHS: Over 3,000 more midwifery training places offered

The Guardian Hunt to unveil plan for women to have same midwives through pregnancy

New technology supports new mums to breastfeed

Public Health England’s Start4Life and Amazon Alexa helping mothers to breastfeed for longer | Public Health England

Almost three-quarters of women start breastfeeding when their child is born, however by 6 to 8 weeks this drops to just 44%. This makes breastfeeding rates in England among the lowest in the world.

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Evidence shows the right support helps mothers to breastfeed for longer. A recent survey found that almost two thirds (64%) felt that access to 24 hours a day, 7 days a week breastfeeding support, such as a phoneline, website or chatbot, would make new mothers:

  • more likely to have a positive experience of breastfeeding
  • more likely to decide to try breastfeeding (59%)
  • breastfeed for longer (58%)

PHE’s programme Start4Life has created the Breastfeeding Friend to encourage parents to adopt healthy behaviours. It is available for free on a range of platforms, including Facebook Messenger, and now for the first time it will also be available as a skill for Amazon Alexa’s voice service.

Mothers can ask Alexa a variety of questions about breastfeeding and the answers will be provided tailored to the age of the baby. This means that they can get helpful advice even when their hands are full.

Full details at Public Health England

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