Independent effects of pregnancy induced hypertension on childhood development: a retrospective cohort study.

OBJECTIVE: To assess whether maternal hypertension in pregnancy was independently associated with additional support needs in children. STUDY DESIGN: Retrospective cohort study using linkage of birth records of all singleton deliveries occurring in primigravidae between 1995 and 2008 in Aberdeen Maternity and Neonatal Databank with the Support Needs System (SNS) dataset in Grampian. Crude and adjusted odds ratios with 95% confidence intervals of having a record in SNS in the presence of maternal pregnancy induced hypertension were calculated using logistic regression taking account of confounders such as preterm birth and low birth weight. RESULTS: After adjusting for confounding factors, neither pre-eclampsia {Adj OR 0.80 (95% CI 0.60, 1.07)} nor gestational hypertension {Adj OR 1.16 (95% CI 0.99, 1.36)} showed statistically significant associations with additional support needs. An association of pre-eclampsia with cerebral palsy seen on univariate analysis also disappeared on adjusting for confounders {Adj OR 1.26 (95% CI 0.43, 3.68)}. Birth before 32 weeks gestation and birthweight below 1500g were independently associated with additional support needs in children. CONCLUSIONS: While maternal hypertension was not found to be independently associated with special needs in children, very preterm birth and very low birthweight showed an association.

Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland.

OBJECTIVE: To determine the optimum interpregnancy interval after miscarriage in a first recorded pregnancy. DESIGN: Population based retrospective cohort study. SETTING: Scottish hospitals between 1981 and 2000. PARTICIPANTS: 30,937 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant. MAIN OUTCOME MEASURES: The primary end point was miscarriage, live birth, termination, stillbirth, or ectopic pregnancy in the second pregnancy. Secondary outcomes were rates of caesarean section and preterm delivery, low birthweight infants, pre-eclampsia, placenta praevia, placental abruption, and induced labour in the second pregnancy. RESULTS: Compared with women with an interpregnancy interval of 6-12 months, those who conceived again within six months were less likely to have another miscarriage (adjusted odds ratio 0.66, 95% confidence interval 0.57 to 0.77), termination (0.43, 0.33 to 0.57), or ectopic pregnancy (0.48, 0.34 to 0.69). Women with an interpregnancy interval of more than 24 months were more likely to have an ectopic second pregnancy (1.97, 1.42 to 2.72) or termination (2.40, 1.91 to 3.01). Compared with women with an interpregnancy interval of 6-12 months, women who conceived again within six months and went on to have a live birth in the second pregnancy were less likely to have a caesarean section (0.90, 0.83 to 0.98), preterm delivery (0.89, 0.81 to 0.98), or infant of low birth weight (0.84, 0.71 to 0.89) but were more likely to have an induced labour (1.08, 1.02 to 1.23). CONCLUSIONS: Women who conceive within six months of an initial miscarriage have the best reproductive outcomes and lowest complication rates in a subsequent pregnancy.