Would internal iliac artery occlusion cause gestational hypertension in the following pregnancy? A population-based study from 2008 to 2017

Objective

In animal models, internal iliac artery occlusion caused gestational hypertension; however, whether this phenomena occurs in humans is still unknown.

Materials and methods

This retrospective cohort study used data from the Birth Certificate Application of Taiwan and linked to the National Health Insurance Research Database and Taiwan Maternal and Child Health Database from 2008 to 2017. Women who underwent internal iliac artery occlusion before pregnant were identified according to diagnosis and procedure codes. The occlusion group included 328 births in 286 women with a history of internal iliac artery occlusion, and the non-occlusion control group included 2,024,882 births in 1,391,288 women.

Results

There were no significant differences in gestational hypertension-associated diseases including preeclampsia, eclampsia and HELLP syndrome between the occlusion and non-occlusion groups (4.3 % vs 3.4 %, p = 0.4). The adjusted odds ratios (ORs) of placental previa, placenta accreta spectrum and stillbirth were 1.69 (95 % confidence interval [CI] = 1.12–2.56), 3.99 (95 % CI = 2.52–6.31), 2.57 (95 % CI = 1.13–5.83), respectively, with the non-occlusion group as reference. The adjusted ORs of preterm delivery in the occlusion group were 1.48 (95 % CI = 1.08–2.04) and 2.79 (95 % CI = 1.62–4.82) for a gestational age below 37 weeks and 32 weeks, respectively.

Conclusion

Women who underwent internal iliac artery occlusion did not have a higher risk of gestational hypertension and related disease. Their offspring also had similar risks of small for gestational age, poor Apgar score, birth defects and neonatal mortality within 28 days. However, their risks of placental previa, placenta accreta spectrum, stillbirth and preterm delivery were increased.