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Association between alcohol consumption during pregnancy and hypertensive disorders of pregnancy in Japan: the Japan Environment and Children’s Study

Abstract

This study examined the association between maternal alcohol consumption during pregnancy and hypertensive disorders of pregnancy in the Japan Environment and Children’s Study, a nationwide birth cohort study. A total of 76 940 pregnant women were included in the analysis. Information about alcohol consumption during pregnancy was obtained using two questionnaires: T1 and T2. The mean (standard deviation) gestational age in the T1 and T2 questionnaires were 16.5 (5.8) and 27.9 (3.7) weeks, respectively. Alcohol consumption was considered as an exposure, hypertensive disorders of pregnancy as an outcome, and possible confounding factors were included in a generalized linear mixed-effects model with a logit link function. Among the study subjects, 2 348 (3.1%) women developed hypertensive disorders of pregnancy. Compared with 25 300 women who never drank alcohol, 43 women who drank alcohol according to the T1 questionnaire and continued to drink ≥150 g ethanol/week according to the T2 questionnaire had significantly higher odds of hypertensive disorders of pregnancy. The adjusted odds ratio was 3.98 (95% confidence interval [CI], 1.33–11.9). In conclusion, alcohol consumption of ≥150 g ethanol/week during pregnancy is better avoided because of the high odds of developing hypertensive disorders of pregnancy. It may be meaningful that healthcare providers confirm information about alcohol consumption during pregnancy. Moreover, discontinuation of alcohol consumption is recommended to prevent the onset of hypertensive disorders of pregnancy in Japan.

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References

  1. 1.

    Patra J, Bakker R, Irving H, Jaddoe VW, Malini S, Rehm J. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)-a systematic review and meta-analyses. BJOG. 2011;118:1411–21.

  2. 2.

    Mather M, Wiles K, O’Brien P. Should women abstain from alcohol throughout pregnancy? BMJ. 2015;351:h5232.

  3. 3.

    Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017;40:213–20.

  4. 4.

    Tomimatsu T, Mimura K, Endo M, Kumasawa K, Kimura T. Pathophysiology of preeclampsia: an angiogenic imbalance and long-lasting systemic vascular dysfunction. Hypertens Res. 2017;40:305–10.

  5. 5.

    Salihu HM, Kornosky JL, Lynch O, Alio AP, August EM, Marty PJ. Impact of prenatal alcohol consumption on placenta-associated syndromes. Alcohol. 2011;45:73–79.

  6. 6.

    North RA, McCowan LM, Dekker GA, Poston L, Chan EH, Stewart AW, et al. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. BMJ. 2011;342:d1875.

  7. 7.

    Ford JB, Schemann K, Patterson JA, Morris J, Herbert RD, Roberts CL. Triggers for preeclampsia onset: a case-crossover study. Paediatr Perinat Epidemiol. 2016;30:555–62.

  8. 8.

    Ye C, Ruan Y, Zou L, Li G, Li C, Chen Y, et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One. 2014;9:e100180.

  9. 9.

    Eskenazi B, Fenster L, Sidney S. A multivariate analysis of risk factors for preeclampsia. JAMA. 1991;266:237–41.

  10. 10.

    Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol. 1997;177:1003–10.

  11. 11.

    Kawamoto T, Nitta H, Murata K, Toda E, Tsukamoto N, Hasegawa M, et al. Rationale and study design of the Japan environment and children’s study (JECS). BMC Public Health. 2014;14:25.

  12. 12.

    Michikawa T, Nitta H, Nakayama SF, Ono M, Yonemoto J, Tamura K, et al. Children’s Study G. The Japan Environment and Children’s Study (JECS): a preliminary report on selected characteristics of approximately 10,000 pregnant women recruited during the first year of the study. J Epidemiol. 2015;25:452–8.

  13. 13.

    Ishitsuka K, Nakayama SF, Kishi R, Mori C, Yamagata Z, Ohya Y, et al. Japan Environment and Children’s Study: backgrounds, activities, and future directions in global perspectives. Environ Health Prev Med. 2017;22:61.

  14. 14.

    Michikawa T, Nitta H, Nakayama SF, Yamazaki S, Isobe T, Tamura K, et al. Baseline profile of participants in the Japan Environment and Children’s Study (JECS). J Epidemiol. 2018;28:99–104.

  15. 15.

    Yokoyama Y, Takachi R, Ishihara J, Ishii Y, Sasazuki S, Sawada N, et al. Validity of short and long self-administered food frequency questionnaires in ranking dietary intake in middle-aged and elderly Japanese in the Japan Public Health Center-Based Prospective Study for the Next Generation (JPHC-NEXT) Protocol Area. J Epidemiol. 2016;26:420–32.

  16. 16.

    Sawada N, Inoue M, Iwasaki M, Sasazuki S, Yamaji T, Shimazu T, et al. Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: the Japan Public Health Center-based prospective study. Int J Cancer. 2014;134:971–8.

  17. 17.

    Watanabe Kazushi, Naruse Katsuhiko, Tanaka Kanji, Metoki Hirohito, Suzuki Y. Outline of definition and classification of “Pregnancy induced Hypertension (PIH)”. Hyperetens Res Pregnancy. 2013;1:3–4.

  18. 18.

    WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.

  19. 19.

    Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60:184–9.

  20. 20.

    Watanabe Z, Iwama N, Nishigori H, Nishigori T, Mizuno S, Sakurai K, et al. Children’s Study G. Psychological distress during pregnancy in Miyagi after the Great East Japan Earthquake: the Japan Environment and Children’s Study. J Affect Disord. 2016;190:341–8.

  21. 21.

    Helen B, Robin P. Applied Mixed Models in Medicine. Chichester: Wiley; 2015. p. 113–67.

  22. 22.

    Naimi TS, Stockwell T, Zhao J, Xuan Z, Dangardt F, Saitz R, et al. Selection biases in observational studies affect associations between ‘moderate’ alcohol consumption and mortality. Addiction. 2017;112:207–14.

  23. 23.

    Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin Exp Res. 2014;38:214–26.

  24. 24.

    Chang JJ, Strauss JF 3rd, Deshazo JP, Rigby FB, Chelmow DP, Macones GA. Reassessing the impact of smoking on preeclampsia/eclampsia: are there age and racial differences? PLoS One. 2014;9:e106446.

  25. 25.

    Wang A, Rana S, Karumanchi SA. Preeclampsia: the role of angiogenic factors in its pathogenesis. Physiology. 2009;24:147–58.

  26. 26.

    Brown CM, Garovic VD. Mechanisms and management of hypertension in pregnant women. Curr Hypertens Rep. 2011;13:338–46.

  27. 27.

    Gundogan F, Elwood G, Longato L, Tong M, Feijoo A, Carlson RI, et al. Impaired placentation in fetal alcohol syndrome. Placenta. 2008;29:148–57.

  28. 28.

    Naik VD, Lunde-Young ER, Davis-Anderson KL, Orzabal M, Ivanov I, Ramadoss J. Chronic binge alcohol consumption during pregnancy alters rat maternal uterine artery pressure response. Alcohol. 2016;56:59–64.

  29. 29.

    Ministry of Health, Labour and Welfare. Vital statistics of population. http://www.mhlw.go.jp/toukei/list/81-1a.html. Accessed 26 March 2018.

  30. 30.

    Takimoto H, Sugiyama T, Nozue M, Kusama K, Fukuoka H, Kato N, et al. Maternal antenatal body mass index gains as predictors of large-for-gestational-age infants and cesarean deliveries in Japanese singleton pregnancies. J Obstet Gynaecol Res. 2011;37:553–62.

  31. 31.

    Leemaqz SY, Dekker GA, McCowan LM, Kenny LC, Myers JE, Simpson NA, et al. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77–86.

  32. 32.

    Leanos-Miranda A, Mendez-Aguilar F, Ramirez-Valenzuela KL, Serrano-Rodriguez M, Berumen-Lechuga G, Molina-Perez CJ, et al. Circulating angiogenic factors are related to the severity of gestational hypertension and preeclampsia, and their adverse outcomes. Medicine. 2017;96:e6005.

  33. 33.

    Tooher J, Thornton C, Makris A, Ogle R, Korda A, Hennessy A. All hypertensive disorders of pregnancy increase the risk of future cardiovascular disease. Hypertension. 2017;70:798–803.

  34. 34.

    Moldenhauer JS, Stanek J, Warshak C, Khoury J, Sibai B. The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol. 2003;189:1173–7.

  35. 35.

    Sibai BM. Maternal and uteroplacental hemodynamics for the classification and prediction of preeclampsia. Hypertension. 2008;52:805–6.

  36. 36.

    Borrell LN, Beck JD, Heiss G. Socioeconomic disadvantage and periodontal disease: the Dental Atherosclerosis Risk in Communities study. Am J Public Health. 2006;96:332–9.

  37. 37.

    Wei BJ, Chen YJ, Yu L, Wu B. Periodontal disease and risk of preeclampsia: a meta-analysis of observational studies. PLoS One. 2013;8:e70901.

  38. 38.

    Emiru T, Beyene G, Tsegaye W, Melaku S. Associated risk factors of urinary tract infection among pregnant women at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia. BMC Res Notes. 2013;6:292.

  39. 39.

    Easter SR, Cantonwine DE, Zera CA, Lim KH, Parry SI, McElrath TF. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Am J Obstet Gynecol. 2016;214:387.e1–7.

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Acknowledgements

We would like to acknowledge the following members of the Japan Environment and Children’s Study as of 2017 (principal investigator, Toshihiro Kawamoto): Hirohisa Saito (National Center for Child Health and Development, Tokyo, Japan), Reiko Kishi (Hokkaido University, Sapporo, Japan), Nobuo Yaegashi (Tohoku University, Sendai, Japan), Koichi Hashimoto (Fukushima Medical University, Fukushima, Japan), Chisato Mori (Chiba University, Chiba, Japan), Shuichi Ito (Yokohama City University, Yokohama, Japan), Zentaro Yamagata (University of Yamanashi, Chuo, Japan), Hidekuni Inadera (University of Toyama, Toyama, Japan), Michihiro Kamijima (Nagoya City University, Nagoya, Japan), Takeo Nakayama (Kyoto University, Kyoto, Japan), Hiroyasu Iso (Osaka University, Suita, Japan), Masayuki Shima (Hyogo College of Medicine, Nishinomiya, Japan), Yasuaki Hirooka (Tottori University, Yonago, Japan), Narufumi Suganuma (Kochi University, Nankoku, Japan), Koichi Kusuhara (University of Occupational and Environmental Health, Kitakyushu, Japan), and Takahiko Katoh (Kumamoto University, Kumamoto, Japan).

Funding

The Japan Environment and Children’s Study was funded by the Ministry of the Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the above government.

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Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Noriyuki Iwama.

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Keywords

  • Alcohol
  • Hypertensive disorders of pregnancy
  • Pregnancy
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