Hypertensive disorders of pregnancy and perinatal outcomes: two prospective cohort studies of nulliparous women in India and Tanzania
Bibliographic record
Abstract
INTRODUCTION: Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited. METHODS: We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in calcium supplementation trials and had blood pressure and proteinuria assessments throughout pregnancy and at the time of labour and delivery. Generalised estimating equations were used to assess the relationship between HDP severity categories (gestational hypertension, preeclampsia without severe features and preeclampsia with severe features) and timing of HDP onset (early-onset <34 weeks vs late-onset ≥34 weeks gestation) with adverse perinatal outcomes. RESULTS: The cumulative incidence of HDP was 3.7% and 4.5% in the India and Tanzania cohorts, respectively. All HDP severity categories were associated with a significantly higher risk for perinatal death in both cohorts (p values<0.05). Pregnancies complicated by pre-eclampsia with severe features had the largest magnitude of increased risk for perinatal death as compared with pregnancies without an HDP (India RR 8.60; 95% CI 5.90 to 12.53; Tanzania RR 4.05; 95% CI 2.91 to 5.66). In both cohorts, pre-eclampsia with and without severe features, but not gestational hypertension, was associated with increased risks for preterm birth and low birth weight. Pregnancies with early-onset HDP had a high absolute risk of perinatal death (India 25.6% and Tanzania 36.9%), and the risk was markedly increased as compared with late-onset HDP (India RR 4.79; 95% CI 2.68 to 8.54; Tanzania RR 5.79; 95% CI 3.56 to 9.41). CONCLUSION: HDP were differentially associated with risks for perinatal outcomes by severity and timing of onset. Interventions that prevent, reduce the severity or delay the onset of HDP may improve perinatal outcomes in resource-limited settings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT03350516.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".