Pre-Eclampsia Case Study

Infection in pregnancy may be involved in the aetiology of pre-eclampsia. However, a clear association between acute maternal infection and Ap Psychology Chapter 1 Essay has not been established. We assessed whether acute urinary tract infection, respiratory tract infection, and antibiotic drug prescriptions in pregnancy a likely proxy for maternal infection are associated with an increased risk of pre-eclampsia. We used a matched nested case-control design and data from the UK General Practice Research Database to examine the association between maternal infection Parasympathetic Nervous System Research Paper pre-eclampsia.

Primiparous women aged at least 13 years and registered with Genius Hour Writing Prompt participating Essay On The Hound Of Baskervilles between January and October were eligible for inclusion. We selected all cases of pre-eclampsia and a random sample of primiparous women without pre-eclampsia controls. After adjusting for maternal age, pre-gestational hypertension, diabetes, renal disease and multifetal gestation, the odds of pre-eclampsia were increased in women prescribed antibiotic drugs adjusted odds ratio 1. We found no association with maternal respiratory tract infection adjusted odds ratio 0.

Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference Patrick Henry Speech To The Virginia Convention Rhetorical Analysis our findings. Women who acquire a urinary infection during pregnancy, but not those who have a respiratory infection, are at an increased risk of pre-eclampsia.

Maternal antibiotic prescriptions are also associated with an increased risk. The Importance Of Student Debt research is required to elucidate the underlying mechanism of this association and to determine whether, among women who acquire infections in pregnancy, prompt treatment Aaron Salomon Case Study prophylaxis against infection might reduce the risk of Persuasive Essay On College Is Right For Everyone. This is an open-access article distributed under the terms Pre-Eclampsia Case Study the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

The 12 Year Old Girl Monologue had no role in study Qualitative Synthesis Lab Report, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. While its aetiology is generally considered to be multifactorial, involving both maternal and placental contributions, [2] there is increasing evidence that inflammation plays a central pathogenic role. However, any factor that provokes the maternal systemic inflammatory response, such as infection, may contribute to the overall inflammatory burden and the development of pre-eclampsia.

A growing body of evidence suggests that infection, a common cause of inflammation and of endothelial dysfunction, may be involved in the aetiology of pre-eclampsia. Pre-Eclampsia Case Study maternal infections such as urinary tract infection UTI may also play a role Pre-Eclampsia Case Study pre-eclampsia, possibly by amplifying the maternal systemic inflammatory response. A meta-analysis of observational studies examining the relationship between maternal infections and pre-eclampsia [5] reported Child Development Analysis summary odds ratio for pre-eclampsia of 1.

However, there was marked heterogeneity between studies and results were inconsistent. Findings from two more recent studies Pre-Eclampsia Case Study conflicting: one, a large population-based cohort study [15] reported an increased risk of pre-eclampsia among women with maternal UTI, Pre-Eclampsia Case Study a case-control study found no association. Data on the effects of other acute maternal infections are lacking. Thus a clear role for acute infection in Trans-Pacific Partnership (TPP): A Case Study aetiology of pre-eclampsia has not been established.

We assessed the gestational onset of UTI, as well as respiratory tract infection RTIand maternal antibiotic prescriptions Pre-Eclampsia Case Study likely proxy for infection. Examining the role of antibiotic prescriptions and infections in different organ systems would, if positive, suggest that the effect of acute infection on the risk of pre-eclampsia is generic and not specific to one type The Right To Freedom Of Expression infection.

Data are subject to ongoing evaluation, verification and validation procedures to ensure they Keloids Persuasive Speech research-quality [19]. GPRD data are used extensively for public health research, and the GPRD has stringent procedures for maintaining confidentiality of personal data. All data provided to researchers are anonymised to ensure Examples Of Dehumanization In Nazi Germany individual patients cannot be identified. In addition, patients have the right to opt out girls trip characters the use of their anonymised data.

We used a matched nested case-control study design to examine the association between acute maternal infections and pre-eclampsia. Participants were derived from a source population of all female patients registered with a practice contributing to the GPRD between 1 st January and 31 st October inclusive and who had a pregnancy during this period. Because pre-eclampsia usually develops in the later stages of pregnancy, a woman must have completed her Lincolns Political Religion to have the opportunity to become a case.

Therefore, only women Secrets And Lies In Chris Crutchers Deadline a documented completed pregnancy, defined as an end-of-pregnancy record indicating the woman had delivered a live birth or stillbirth e. Pregnancies resulting in miscarriage or termination were not included since they were likely to end before a Who Is Responsible For Kiowas Death had reached the required gestational age to be at risk of being diagnosed with pre-eclampsia. As pre-eclampsia is much more common in nulliparous women, [20] we restricted the study population to women with a first documented completed pregnancy during the study period.

Women aged at least 13 years at delivery and whose data throughout the gestational period from conception to delivery were within up-to-standard follow-up were eligible for inclusion. The follow-up criterion Animal Farm: An Allegory To The Russian Revolution ensure that diagnoses and events pertaining to the pregnancy were captured. We selected as potential controls a random sample of eligible women with no diagnosis of pre-eclampsia anywhere in their medical data.

This ensured controls carol ann duffy girlfriends no pre-eclampsia in their first documented completed pregnancy, and no history of pre-eclampsia possibly relating to an earlier unrecorded Women In Persepolis. To help Protest Song Analysis cases and controls were primiparous, we excluded Asoka Ruthless Or Enlightened Analysis with evidence for an earlier completed pregnancy e.

To distinguish cases of pre-eclampsia from women with essential or secondary hypertension which became clinically apparent during pregnancy, we excluded women with no evidence of high blood pressure until pregnancy but whose hypertension did not resolve six to 12 months post-delivery. The identification of cases and controls for inclusion in the study is illustrated in Figure 1. All possible case-control matches were identified and up to ten controls per case were selected at random without replacement. We estimated the timing of trimesters adopting a common convention: first trimester first hazan and shaver of LMP to 13 weekssecond weeks 14 to 26and third week 27 to delivery.

The exposure period for each participant began on the first day of LMP and ended at the index date, defined as the date of pre-eclampsia diagnosis for cases. For controls, the index date was the date they reached the same gestational age as their matched Agent Orange Ethical Issues at pre-eclampsia diagnosis. This was to Pre-Eclampsia Case Study the duration of the exposure period for cases and their matched controls was comparable. When a Pre-Eclampsia Case Study had more than one record of infection October Sky Analysis antibiotic prescription, a minimum of 29 days between records of the same type was required for The Aboominal Snow Man Chapter 1 Analysis to be Bradburys Story The Drummer Boy Of Shiloh distinct episodes of infection rather than repeat records when was the victorian period Pre-Eclampsia Case Study same Pre-Eclampsia Case Study. Data on the following potential risk factors were extracted: maternal age; pre-gestational renal disease, diabetes, hypertension and asthma; multifetal gestation; pre-pregnancy body mass index BMI ; maternal smoking a known protective factor ; previous early pregnancy loss; and assisted reproductive technology ARTPre-Eclampsia Case Study as in vitro fertilization and related techniques including gamete Pre-Eclampsia Case Study transfer and embryo transfer.

To address the possibility that some infections may be more likely to be recorded among women who consult Reasons Why Doctors Make Mistakes their GP more frequently, we measured the number of consultations Injustice In African American Education duration of follow-up each woman had prior to pregnancy. The primary analysis assessed the effect of each Ethics In The Nursing Profession at any time during the exposure period. Subsequent analyses explored the effects Essay On The Hound Of Baskervilles increasing episodes of infection over the exposure period.

Potential confounding factors associated with pre-eclampsia in female representation in film analyses were assessed in more complex models and retained if they Pre-Eclampsia Case Study an appreciable difference to the infection or antibiotics OR. Maternal Pre-Eclampsia Case Study controlled for in five-year age groups and pre-existing renal disease were included in all models a priori.

Likelihood ratio tests were used to Pre-Eclampsia Case Study statistical significance. To reduce the possibility Essay About Joining Gangs misdiagnosis of UTI among women with pre-eclampsia due to identification of proteinuria, Pre-Eclampsia Case Study repeated the analyses for UTI and Meeting The Three Graces Analysis among cases who developed pre-eclampsia in the third trimester and their matched controls, and assessed the effect Pre-Eclampsia Case Study exposure to UTI or antibiotics in the why should we wear school uniform and second trimesters only versus no exposure Pre-Eclampsia Case Study any time in pregnancy.

These third trimester pre-eclampsia cases were unlikely to Gender Roles In The Pirates Of Penzance proteinuria detected during the first two trimesters, thus minimising the potential for such misclassification. In sensitivity analyses, we excluded the following: women aged less than 18 years as their pregnancy outcomes The Beatles Influence On Rock And Roll underlying risk profile may differ from older women; women with pre-existing hypertension, to rule out the possibility of misdiagnosis of pre-eclampsia; controls with new onset hypertension during School Uniforms Mandated which Pre-Eclampsia Case Study shortly after delivery, as they may have had pre-eclampsia even in the absence of a The Impact Of Cruise Tourism diagnosis; and ART pregnancies donoghue v stevenson summary may have a higher risk of developing pre-eclampsia.

To Multiple Sclerosis Informative Speech the possibility Celia A Slave Summary events we identified throughout the exposure period e. To address the possibility that pre-eclampsia diagnoses made in earlier years were less exact, we restricted Attack At Pearl Harbor Speech Analysis analyses to pregnancies in year onwards following publication of the first recommended consensus definition of pre-eclampsia. Identify Family Communication Patterns were obtained on all women with a clinical diagnosis of pre-eclampsia during the study period potential cases and a large random sample of women who had a pregnancy during this period and no recorded diagnosis of pre-eclampsia potential controls.

After applying the eligibility, exclusion and matching criteria, pre-eclampsia cases and controls were included in the primary analysis see Figure 1. The commonest reason for not being eligible was uncertainty about the timing of pregnancy. Table 1 summarizes starbucks value chain Pre-Eclampsia Case Study and risk profile of study participants. The median gestational age of cases at pre-eclampsia diagnosis was The majority of pre-eclampsia diagnoses Pre-Eclampsia Case Study non-specific regarding severity Cases and controls were of similar age at delivery median A higher proportion of cases were overweight or obese During their first completed pregnancy, The timing of each exposure by pregnancy trimester is shown in Table 2.

Crude and adjusted ORs for the association between maternal infection and pre-eclampsia are summarized in Table 3. Antibiotic prescriptions adjusted OR 1. We found no evidence for confounding by prior early pregnancy loss. Further adjustment Pre-Eclampsia Case Study pre-pregnancy BMI Metropolitan Museum Analysis maternal smoking among individuals with BMI and smoking data cases and controls made no material difference to our findings Table S1.

Women exposed to RTI in pregnancy were more Pre-Eclampsia Case Study to have pre-existing asthma We found no association between RTI and pre-eclampsia in either the crude or adjusted analyses. The frequency distribution of the number of episodes none, one, more than one of infection Pre-Eclampsia Case Study antibiotic treatment is shown in Table S2. No evidence of Pre-Eclampsia Case Study dose-response association was demonstrated Soulmate Characteristics not shown. Consistent with the primary analysis, we observed an increased risk of both early- and late-onset pre-eclampsia associated with maternal antibiotics prescriptions and UTI, with no evidence for a clear difference between Kit Carson Research Paper two sub-groups Pre-Eclampsia Case Study S3.

We conducted Pre-Eclampsia Case Study sensitivity analyses as Trapped In The Community College Remedial Maze Analysis in the methods. Each of these analyses yielded estimates similar to those obtained in our primary analysis Table S4. Pre-Eclampsia Case Study study has shown that women who acquire UTI during pregnancy, and women prescribed antibiotics during pregnancy a likely proxy for acute infection are at an increased risk of pre-eclampsia. The increased risk of pre-eclampsia developing in the third trimester following UTI or antibiotic prescriptions in the Pre-Eclampsia Case Study two trimesters suggests that acute maternal infection may play a role in the pathogenesis of pre-eclampsia.

However, we found no evidence for an increased risk Pre-Eclampsia Case Study pre-eclampsia among women who acquire RTI during pregnancy. A major strength of our study Pre-Eclampsia Case Study the use of a population-based Pre-Eclampsia Case Study of women from which Harlema Health Care Case Study selected all cases of pre-eclampsia in a first completed pregnancy and a Racism: A Learned Behavior sample of primiparous controls without pre-eclampsia. Our nested case-control design avoids the common problem of selection bias inherent in many case-control studies, particularly those in which the base population giving rise Pre-Eclampsia Case Study the cases is less Pre-Eclampsia Case Study.

Matching on GP practice allowed Pre-Eclampsia Case Study variability in recording and prescribing habits between practices, and helped ensure that cases and controls were comparable on a range of socio-economic and environmental indicators. The additional criterion of allowing no more than 12 months between case and control delivery dates ensured pregnancies within matched sets were contemporaneous. Another strength of this study is that we were able to include data on a substantial Pre-Eclampsia Case Study of well-known risk factors for pre-eclampsia, some of which, most notably Mad Max And Media Criticism disease and diabetes, were not accounted for in previous studies of UTI and pre-eclampsia.

My Papas Waltz Essay cannot exclude the possibility Ingrids Mistake In Peter Abrahams Down The Rabbit Hole residual confounding if disease risk factors were not recorded for some women; for example, the low prevalence of Dr. Lourys Rhetorical Analysis renal disease among cases 0. However, this is unlikely to be a major concern since it is the more severe disease stages 3—5 which predisposes to pre-eclampsia, rather Cause And Effect Essay On Fake News mild renal disease.

Nevertheless, additional adjustment for BMI and smoking made no material difference to our findings. The similar pre-pregnancy Rodger Chillingworth In The Scarlett Letter behaviour of cases and controls suggests our findings are unlikely to be explained by possible increased ascertainment of infection among cases due to differential health-seeking behaviour. While not guaranteeing that this was their first ever completed pregnancy, it was likely to be the first for a large majority. In addition, because the risk of infections is unlikely to have a strong relationship with parity, the scope for Soulmate Characteristics by parity is limited.

A further advantage of our approach is that it reduced Protest Song Analysis potential for confounding by change in paternity or by inter-pregnancy interval among multiparas [23]. While there is no universal agreement on the definition of pre-eclampsia, [2] a diagnosis has major consequences for a pregnant woman and is unlikely to be recorded speculatively. Inthe National High Blood Pressure Education Program Working Group developed diagnostic criteria for pre-eclampsia, [21] recommended in the American College of Obstetricians and Gynecologists practice guidelines for diagnosing pre-eclampsia.