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Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Interaction of body mass index and hemoglobin concentration on blood pressure among pregnant women in Guangxi, China

Authors: Qiuan Zhong, Jiangyan Xu, Yingquan Long, Yingying Deng, Jinlan Hu, Xiaofei Li, Xiaoqiang Qiu

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Body mass index (BMI) and hemoglobin (Hb) are positively associated with hypertensive disorders among pregnant women. The aim of this study was to estimate a potential interaction between high BMI and high Hb concentrations on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in pregnancy.

Methods

We recruited 4497 single-birth women aged 18–43 years who received routine antenatal care at three hospitals of Guigang, Guangxi, China, from December 2007 to January 2011. Of 4497 participants, 3472 women were in the first trimester, with following up, 2986 women and 2261 women were left in the second and third trimester, respectively. Clinical data were derived from medical records of each woman. We used multivariable linear regression, by trimesters of pregnancy, to evaluate the associations of high BMI and high Hb concentrations with SBP and DBP according to cross-sectional design.

Results

In multivariable analyses, BMI was positively associated with SBP throughout all trimesters, but the corresponding association for Hb concentrations only in the first trimester, whereas both BMI and Hb concentrations were positively associated with DBP in the first and third trimesters. After full adjustment for confounding, the average differences in SBP and DBP comparing women with high BMI and high Hb to those with non-high BMI and non-high Hb were 2.9 mmHg (95% CI: 0.8 to 5.0 mmHg) and 3.9 mmHg (95% CI: 1.5 to 6.3 mmHg) in the first trimester, 2.6 mmHg (95% CI: 0.4 to 4.8 mmHg) and 1.5 mmHg (95% CI: -1.3 to 4.3 mmHg) in the second trimester, and 4.8 mmHg (95% CI: 2.3 to 7.4 mmHg) and 5.7 mmHg (95% CI: 3.2 to 8.3 mmHg) in the third trimester, respectively. With respect to the interaction, significant combined effects between high BMI and high Hb were confirmed on SBP (P = 0.02) and DBP (P = 0.004) in the third trimester, and the amount of interaction on SBP and DBP were 2.0 mmHg (95% CI: 0.1 to 3.9 mmHg) and 2.3 mmHg (95% CI: 0.4 to 4.3 mmHg), respectively.

Conclusion

Our findings suggest that high BMI and high Hb concentrations may have a synergistic effect on blood pressure in late stage of pregnancy.
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Literature
1.
go back to reference Langenveld J, Jansen S, van der Post J, Wolf H, Mol BW, Ganzevoort W: Recurrence risk of a delivery before 34 weeks of pregnancy due to an early onset hypertensive disorder: a systematic review. Am J Perinatol. 2010, 27 (7): 565-571. 10.1055/s-0030-1248944.CrossRefPubMed Langenveld J, Jansen S, van der Post J, Wolf H, Mol BW, Ganzevoort W: Recurrence risk of a delivery before 34 weeks of pregnancy due to an early onset hypertensive disorder: a systematic review. Am J Perinatol. 2010, 27 (7): 565-571. 10.1055/s-0030-1248944.CrossRefPubMed
2.
go back to reference Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet. 2006, 367 (9516): 1066-1074. 10.1016/S0140-6736(06)68397-9.CrossRefPubMed Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet. 2006, 367 (9516): 1066-1074. 10.1016/S0140-6736(06)68397-9.CrossRefPubMed
3.
go back to reference Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P: BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. Clin Sci (Lond). 2006, 111 (1): 81-86. 10.1042/CS20060015.CrossRef Leeners B, Rath W, Kuse S, Irawan C, Imthurn B, Neumaier-Wagner P: BMI: new aspects of a classical risk factor for hypertensive disorders in pregnancy. Clin Sci (Lond). 2006, 111 (1): 81-86. 10.1042/CS20060015.CrossRef
4.
go back to reference Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N: Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002, 87 (9): 4231-4237. 10.1210/jc.2002-020311.CrossRefPubMed Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N: Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002, 87 (9): 4231-4237. 10.1210/jc.2002-020311.CrossRefPubMed
5.
go back to reference Mahomed K, Williams MA, Woelk GB, Jenkins-Woelk L, Mudzamiri S, Longstaff L, Sorensen TK: Risk factors for pre-eclampsia among Zimbabwean women: maternal arm circumference and other anthropometric measures of obesity. Paediatr Perinat Epidemiol. 1998, 12 (3): 253-262. 10.1046/j.1365-3016.1998.00116.x.CrossRefPubMed Mahomed K, Williams MA, Woelk GB, Jenkins-Woelk L, Mudzamiri S, Longstaff L, Sorensen TK: Risk factors for pre-eclampsia among Zimbabwean women: maternal arm circumference and other anthropometric measures of obesity. Paediatr Perinat Epidemiol. 1998, 12 (3): 253-262. 10.1046/j.1365-3016.1998.00116.x.CrossRefPubMed
6.
go back to reference Group HSCR: Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG. 2010, 117 (5): 575-584.CrossRef Group HSCR: Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG. 2010, 117 (5): 575-584.CrossRef
7.
go back to reference Knottnerus JA, Delgado LR, Knipschild PG, Essed GG, Smits F: Haematologic parameters and pregnancy outcome: A prospective cohort study in the third trimester. J Clin Epidemiol. 1990, 43 (5): 461-466. 10.1016/0895-4356(90)90134-B.CrossRefPubMed Knottnerus JA, Delgado LR, Knipschild PG, Essed GG, Smits F: Haematologic parameters and pregnancy outcome: A prospective cohort study in the third trimester. J Clin Epidemiol. 1990, 43 (5): 461-466. 10.1016/0895-4356(90)90134-B.CrossRefPubMed
8.
go back to reference Huisman A, Aarnoudse JG: Increased 2nd trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation: early evidence of a reduced plasma volume. Acta Obstet Gynecol Scand. 1986, 65 (6): 605-608. 10.3109/00016348609158396.CrossRefPubMed Huisman A, Aarnoudse JG: Increased 2nd trimester hemoglobin concentration in pregnancies later complicated by hypertension and growth retardation: early evidence of a reduced plasma volume. Acta Obstet Gynecol Scand. 1986, 65 (6): 605-608. 10.3109/00016348609158396.CrossRefPubMed
9.
go back to reference Rasmussen S, Oian P: Smoking, hemoglobin concentration and pregnancy-induced hypertension. Gynecol Obstet Invest. 1998, 46 (4): 225-231. 10.1159/000010039.CrossRefPubMed Rasmussen S, Oian P: Smoking, hemoglobin concentration and pregnancy-induced hypertension. Gynecol Obstet Invest. 1998, 46 (4): 225-231. 10.1159/000010039.CrossRefPubMed
10.
go back to reference Yip R: Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr. 2000, 72 (1 Suppl): 272S-279S.PubMed Yip R: Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition. Am J Clin Nutr. 2000, 72 (1 Suppl): 272S-279S.PubMed
11.
go back to reference Murphy JF, O'Riordan J, Newcombe RG, Coles EC, Pearson JF: Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986, 1 (8488): 992-995.CrossRefPubMed Murphy JF, O'Riordan J, Newcombe RG, Coles EC, Pearson JF: Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986, 1 (8488): 992-995.CrossRefPubMed
12.
go back to reference Gobel BO, Schulte-Gobel A, Weisser B, Glanzer K, Vetter H, Dusing R: Arterial blood pressure. Correlation with erythrocyte count, hematocrit, and hemoglobin concentration. Am J Hypertens. 1991, 4 (1 Pt 1): 14-19.PubMed Gobel BO, Schulte-Gobel A, Weisser B, Glanzer K, Vetter H, Dusing R: Arterial blood pressure. Correlation with erythrocyte count, hematocrit, and hemoglobin concentration. Am J Hypertens. 1991, 4 (1 Pt 1): 14-19.PubMed
13.
go back to reference Brun JF, Varlet-Marie E, Raynaud de Mauverger E, Mercier J: Both overall adiposity and abdominal adiposity increase blood viscosity by separate mechanisms. Clin Hemorheol Microcirc. 2011, 48 (4): 257-263.PubMed Brun JF, Varlet-Marie E, Raynaud de Mauverger E, Mercier J: Both overall adiposity and abdominal adiposity increase blood viscosity by separate mechanisms. Clin Hemorheol Microcirc. 2011, 48 (4): 257-263.PubMed
14.
go back to reference Rasmussen S, Bergsjo P, Jacobsen G, Haram K, Bakketeig LS: Haemoglobin and serum ferritin in pregnancy–correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol. 2005, 123 (1): 27-34. 10.1016/j.ejogrb.2005.02.012.CrossRefPubMed Rasmussen S, Bergsjo P, Jacobsen G, Haram K, Bakketeig LS: Haemoglobin and serum ferritin in pregnancy–correlation with smoking and body mass index. Eur J Obstet Gynecol Reprod Biol. 2005, 123 (1): 27-34. 10.1016/j.ejogrb.2005.02.012.CrossRefPubMed
15.
go back to reference Laflamme EM: Maternal hemoglobin concentration and pregnancy outcome: a study of the effects of elevation in el alto, bolivia. Mcgill J Med. 2011, 13 (1): 47-PubMedPubMedCentral Laflamme EM: Maternal hemoglobin concentration and pregnancy outcome: a study of the effects of elevation in el alto, bolivia. Mcgill J Med. 2011, 13 (1): 47-PubMedPubMedCentral
16.
go back to reference Knol MJ, van der Tweel I, Grobbee DE, Numans ME, Geerlings MI: Estimating interaction on an additive scale between continuous determinants in a logistic regression model. Int J Epidemiol. 2007, 36 (5): 1111-1118. 10.1093/ije/dym157.CrossRefPubMed Knol MJ, van der Tweel I, Grobbee DE, Numans ME, Geerlings MI: Estimating interaction on an additive scale between continuous determinants in a logistic regression model. Int J Epidemiol. 2007, 36 (5): 1111-1118. 10.1093/ije/dym157.CrossRefPubMed
17.
go back to reference Hrazdilova O, Unzeitig V, Znojil V, Izakovicova-Holla L, Janku P, Vasku A: Relationship of age and the body mass index to selected hypertensive complications in pregnancy. Int J Gynaecol Obstet. 2001, 75 (2): 165-169. 10.1016/S0020-7292(01)00475-1.CrossRefPubMed Hrazdilova O, Unzeitig V, Znojil V, Izakovicova-Holla L, Janku P, Vasku A: Relationship of age and the body mass index to selected hypertensive complications in pregnancy. Int J Gynaecol Obstet. 2001, 75 (2): 165-169. 10.1016/S0020-7292(01)00475-1.CrossRefPubMed
18.
go back to reference O'Brien TE, Ray JG, Chan WS: Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003, 14 (3): 368-374.CrossRefPubMed O'Brien TE, Ray JG, Chan WS: Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003, 14 (3): 368-374.CrossRefPubMed
19.
go back to reference Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS: Prepregnancy body mass index as an independent risk factor for pregnancy-induced hypertension. J Womens Health (Larchmt). 2011, 20 (1): 67-72. 10.1089/jwh.2010.1970.CrossRef Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS: Prepregnancy body mass index as an independent risk factor for pregnancy-induced hypertension. J Womens Health (Larchmt). 2011, 20 (1): 67-72. 10.1089/jwh.2010.1970.CrossRef
20.
go back to reference Stuebe AM, Landon MB, Lai Y, Spong CY, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Sciscione A, Catalano P, Harper M, Saade G, Sorokin Y, Peaceman AM, Tolosa JE, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD: Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol. 2012, 207 (1): 62-e1–7CrossRefPubMedPubMedCentral Stuebe AM, Landon MB, Lai Y, Spong CY, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Sciscione A, Catalano P, Harper M, Saade G, Sorokin Y, Peaceman AM, Tolosa JE, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD: Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol. 2012, 207 (1): 62-e1–7CrossRefPubMedPubMedCentral
21.
go back to reference Tanentsapf I, Heitmann BL, Adegboye AR: Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011, 11: 81-10.1186/1471-2393-11-81.CrossRefPubMedPubMedCentral Tanentsapf I, Heitmann BL, Adegboye AR: Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011, 11: 81-10.1186/1471-2393-11-81.CrossRefPubMedPubMedCentral
22.
go back to reference Atsma F, Veldhuizen I, de Kort W, van Kraaij M, Pasker-de Jong P, Deinum J: Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals. Hypertension. 2012, 60 (4): 936-941. 10.1161/HYPERTENSIONAHA.112.193565.CrossRefPubMed Atsma F, Veldhuizen I, de Kort W, van Kraaij M, Pasker-de Jong P, Deinum J: Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals. Hypertension. 2012, 60 (4): 936-941. 10.1161/HYPERTENSIONAHA.112.193565.CrossRefPubMed
23.
go back to reference Green JR, Pawson IG, Schumacher LB, Perry J, Kretchmer N: Glucose tolerance in pregnancy: ethnic variation and influence of body habitus. Am J Obstet Gynecol. 1990, 163 (1 Pt 1): 86-92.CrossRefPubMed Green JR, Pawson IG, Schumacher LB, Perry J, Kretchmer N: Glucose tolerance in pregnancy: ethnic variation and influence of body habitus. Am J Obstet Gynecol. 1990, 163 (1 Pt 1): 86-92.CrossRefPubMed
24.
go back to reference Challier JC, Basu S, Bintein T, Minium J, Hotmire K, Catalano PM, Hauguel-de Mouzon S: Obesity in pregnancy stimulates macrophage accumulation and inflammation in the placenta. Placenta. 2008, 29 (3): 274-281. 10.1016/j.placenta.2007.12.010.CrossRefPubMedPubMedCentral Challier JC, Basu S, Bintein T, Minium J, Hotmire K, Catalano PM, Hauguel-de Mouzon S: Obesity in pregnancy stimulates macrophage accumulation and inflammation in the placenta. Placenta. 2008, 29 (3): 274-281. 10.1016/j.placenta.2007.12.010.CrossRefPubMedPubMedCentral
25.
go back to reference Norman JE, Reynolds RM: The consequences of obesity and excess weight gain in pregnancy. Proc Nutr Soc. 2011, 70 (4): 450-456. 10.1017/S0029665111003077.CrossRefPubMed Norman JE, Reynolds RM: The consequences of obesity and excess weight gain in pregnancy. Proc Nutr Soc. 2011, 70 (4): 450-456. 10.1017/S0029665111003077.CrossRefPubMed
26.
go back to reference D'Archivio M, Annuzzi G, Vari R, Filesi C, Giacco R, Scazzocchio B, Santangelo C, Giovannini C, Rivellese AA, Masella R: Predominant role of obesity/insulin resistance in oxidative stress development. Eur J Clin Invest. 2012, 42 (1): 70-78. 10.1111/j.1365-2362.2011.02558.x.CrossRefPubMed D'Archivio M, Annuzzi G, Vari R, Filesi C, Giacco R, Scazzocchio B, Santangelo C, Giovannini C, Rivellese AA, Masella R: Predominant role of obesity/insulin resistance in oxidative stress development. Eur J Clin Invest. 2012, 42 (1): 70-78. 10.1111/j.1365-2362.2011.02558.x.CrossRefPubMed
27.
go back to reference Sibai B, Dekker G, Kupferminc M: Pre-eclampsia. Lancet. 2005, 365 (9461): 785-799. 10.1016/S0140-6736(05)17987-2.CrossRefPubMed Sibai B, Dekker G, Kupferminc M: Pre-eclampsia. Lancet. 2005, 365 (9461): 785-799. 10.1016/S0140-6736(05)17987-2.CrossRefPubMed
28.
go back to reference Murai JT, Muzykanskiy E, Taylor RN: Maternal and fetal modulators of lipid metabolism correlate with the development of preeclampsia. Metabolism. 1997, 46 (8): 963-967. 10.1016/S0026-0495(97)90088-3.CrossRefPubMed Murai JT, Muzykanskiy E, Taylor RN: Maternal and fetal modulators of lipid metabolism correlate with the development of preeclampsia. Metabolism. 1997, 46 (8): 963-967. 10.1016/S0026-0495(97)90088-3.CrossRefPubMed
29.
go back to reference Berger HA, Somers VK, Phillips BG: Sleep disordered breathing and hypertension. Curr Opin Pulm Med. 2001, 7 (6): 386-390. 10.1097/00063198-200111000-00004.CrossRefPubMed Berger HA, Somers VK, Phillips BG: Sleep disordered breathing and hypertension. Curr Opin Pulm Med. 2001, 7 (6): 386-390. 10.1097/00063198-200111000-00004.CrossRefPubMed
30.
go back to reference Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL: Risk factors for severe preeclampsia. Obstet Gynecol. 1994, 83 (3): 357-361.PubMed Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL: Risk factors for severe preeclampsia. Obstet Gynecol. 1994, 83 (3): 357-361.PubMed
31.
go back to reference Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG: Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997, 96 (1): 168-173. 10.1046/j.1365-2141.1997.8532481.x.CrossRefPubMed Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG: Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997, 96 (1): 168-173. 10.1046/j.1365-2141.1997.8532481.x.CrossRefPubMed
32.
go back to reference Olsson MG, Centlow M, Rutardottir S, Stenfors I, Larsson J, Hosseini-Maaf B, Olsson ML, Hansson SR, Akerstrom B: Increased levels of cell-free hemoglobin, oxidation markers, and the antioxidative heme scavenger alpha(1)-microglobulin in preeclampsia. Free Radic Biol Med. 2010, 48 (2): 284-291. 10.1016/j.freeradbiomed.2009.10.052.CrossRefPubMed Olsson MG, Centlow M, Rutardottir S, Stenfors I, Larsson J, Hosseini-Maaf B, Olsson ML, Hansson SR, Akerstrom B: Increased levels of cell-free hemoglobin, oxidation markers, and the antioxidative heme scavenger alpha(1)-microglobulin in preeclampsia. Free Radic Biol Med. 2010, 48 (2): 284-291. 10.1016/j.freeradbiomed.2009.10.052.CrossRefPubMed
33.
go back to reference Cabrales P, Han G, Nacharaju P, Friedman AJ, Friedman JM: Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide. Am J Physiol Heart Circ Physiol. 2011, 300 (1): H49-H56. 10.1152/ajpheart.00665.2010.CrossRefPubMed Cabrales P, Han G, Nacharaju P, Friedman AJ, Friedman JM: Reversal of hemoglobin-induced vasoconstriction with sustained release of nitric oxide. Am J Physiol Heart Circ Physiol. 2011, 300 (1): H49-H56. 10.1152/ajpheart.00665.2010.CrossRefPubMed
34.
go back to reference Staessen JA, Birkenhager WH: Evidence that new antihypertensives are superior to older drugs. Lancet. 2005, 366 (9489): 869-871. 10.1016/S0140-6736(05)67147-4.CrossRefPubMed Staessen JA, Birkenhager WH: Evidence that new antihypertensives are superior to older drugs. Lancet. 2005, 366 (9489): 869-871. 10.1016/S0140-6736(05)67147-4.CrossRefPubMed
35.
go back to reference Ouzounian JG, Elkayam U: Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012, 30 (3): 317-329. 10.1016/j.ccl.2012.05.004.CrossRefPubMed Ouzounian JG, Elkayam U: Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012, 30 (3): 317-329. 10.1016/j.ccl.2012.05.004.CrossRefPubMed
36.
go back to reference Huisman A, Aarnoudse JG, Heuvelmans JH, Goslinga H, Fidler V, Huisjes HJ, Zijlstra WG: Whole blood viscosity during normal pregnancy. Br J Obstet Gynaecol. 1987, 94 (12): 1143-1149. 10.1111/j.1471-0528.1987.tb02313.x.CrossRefPubMed Huisman A, Aarnoudse JG, Heuvelmans JH, Goslinga H, Fidler V, Huisjes HJ, Zijlstra WG: Whole blood viscosity during normal pregnancy. Br J Obstet Gynaecol. 1987, 94 (12): 1143-1149. 10.1111/j.1471-0528.1987.tb02313.x.CrossRefPubMed
Metadata
Title
Interaction of body mass index and hemoglobin concentration on blood pressure among pregnant women in Guangxi, China
Authors
Qiuan Zhong
Jiangyan Xu
Yingquan Long
Yingying Deng
Jinlan Hu
Xiaofei Li
Xiaoqiang Qiu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-474

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