THE ROLE OF SMOKING IN THE DEVELOPMENT OF ARTERIAL HYPERTENSION IN PREGNANT WOMEN
Authors:   Novokuznetsk GIDUV branch of FGBOU DPO RMANPO of the Ministry of Health of Russia, Novokuznetsk Russian Federation, Bichan Nicholai Andreevich , Rublevskaya Alina Sergeevna ,   Novokuznetsk GIDUV branch of FGBOU DPO RMANPO of the Ministry of Health of Russia, Novokuznetsk Russian Federation
Published: October 2023

Introduction. It is well known about the risk factors (RF) for arterial hypertension in the general population, however, their significance in hypertension is well known, however, their significance in pregnant women has been little studied. The purpose of the study was to evaluate the effect of the most common risk factors on the development of hypertension in pregnant women. Materials and methods. The study group consisted of 312 pregnant women suffering from hypertension, the control group - 358 pregnant women with normal blood pressure. The relative odds (OR) were calculated using the logistic regression method for the following risk factors: age, smoking, family history, and overweight. Results. With overweight (25≤ BMI ≥29.9 kg/m2), the OR for the development of hypertension was 3.1 (1.7-5.8), while with obesity (compared with normal and overweight) it increased to 12 ( 7.6-19.1). With aggravated heredity, the OR was 6.9 (4.7-10.3). OR in pregnant women with aggravated heredity on the paternal side was 5.2 (2.7-10.2), on the maternal side - 7.4 (4.6-11.8), on both parents - 9.3 (3.6 -24.9). In our study, 20% of women in the group with hypertension smoked, which is significantly more than in the group without hypertension - 13%, p=0.01. At the same time, IPI in the group of pregnant women with AH was 7.5 (2.5-15), which was significantly higher than in the control group 1.9 (1-7.5), p<0.001. It was found that smoking increased the OR of developing hypertension in pregnant women by 4.6 times (2.43-9.4). At the same time, with a pack/year index (PLI) of more than 10 (compared with non-smokers), the OR was 13.1 (5.5–29.9), which was statistically significantly higher than with smoking with a PLI ≤10 (compared with non-smokers) OR was only 2.6 (1.6-3.9), p=0.006. When comparing two groups by age, it was found that pregnant women with hypertension were older than those with normal blood pressure (32 (28-36) and 28 (24-32) years, respectively, p=0.002). ROC analysis with a probability of more than 80% determined that age over 33 years is a risk factor for the presence of hypertension in pregnant women. Thus, the risk of developing hypertension in the group of pregnant women over the age of 33 is 1.8 times higher than in the younger age group. When analyzing combinations of several FGs for the development of AH, a multiple increase in the risk in pregnant women was found. Thus, in the group of smoking women under 33 years of age, the OR for the development of AH was 2.2 (1.3-3.8), and in smoking pregnant women over 33 years of age it was 14.1 (5.9-33.5). With a combination of smoking and heredity, the OR increased to 27 (11.5-56), and with a combination of smoking and obesity - 33 (7.3-62). It is noteworthy that with a combination of obesity and hereditary burden, the risk of developing hypertension during pregnancy increased by 54 (6.2-429) times. Conclusion. Smoking ranks third among other risk factors for arterial hypertension in pregnant women, increasing the OR of developing hypertension by 13 times compared to non-smokers. The combination of smoking with other risk factors significantly increased the chance of developing hypertension in pregnant women.