title: Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study.
abstract: BACKGROUND
  Data on the potential influence of macroeconomic recessions on maternal diseases during pregnancy are scarce. We aimed to assess potential change in prevalence of pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension) during the first years of the major national economic recession in Iceland, which started abruptly in October 2008.
  
  
  RESULTS
  Women whose pregnancies resulted in live singleton births in Iceland in 2005-2012 constituted the study population (N = 35,211). Data on pregnancy-induced hypertensive disorders were obtained from the Icelandic Medical Birth Register and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Register. With the pre-collapse period as reference, we used logistic regression analysis to assess change in pregnancy-induced hypertensive disorders and use of antihypertensives during the first four years after the economic collapse, adjusting for demographic and pregnancy characteristics, taking aggregate economic indicators into account. Compared with the pre-collapse period, we observed an increased prevalence of gestational hypertension in the first year following the economic collapse (2.4% vs. 3.9%; adjusted odds ratio [aOR] 1.47; 95 percent confidence interval [95%CI] 1.13-1.91) but not in the subsequent years. The association disappeared completely when we adjusted for aggregate unemployment rate (aOR 1.04; 95% CI 0.74-1.47). Similarly, there was an increase in prescription fills of β-blockers in the first year following the collapse (1.9% vs.3.1%; aOR 1.43; 95% CI 1.07-1.90), which disappeared after adjusting for aggregate unemployment rate (aOR 1.05; 95% CI 0.72-1.54). No changes were observed for preeclampsia or use of calcium channel blockers between the pre- and post-collapse periods.
  
  
  CONCLUSIONS
  Our data suggest a transient increased risk of gestational hypertension and use of β-blockers among pregnant women in Iceland in the first and most severe year of the national economic recession.
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Védís Helga
authors.initials: VH
authors.lastname: Eiríksdóttir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Unnur Anna
authors.initials: UA
authors.lastname: Valdimarsdóttir
authors.affiliation: Faculty of Economics, University of Iceland, Reykjavik, Iceland.
authors.forename: Tinna Laufey
authors.initials: TL
authors.lastname: Ásgeirsdóttir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Arna
authors.initials: A
authors.lastname: Hauksdóttir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Sigrún Helga
authors.initials: SH
authors.lastname: Lund
authors.affiliation: Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Ragnheiður Ingibjörg
authors.initials: RI
authors.lastname: Bjarnadóttir
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Helga
authors.initials: H
authors.lastname: Zoëga
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D057172:Economic Recession; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000191:economics* / Q000453:epidemiology*; D007055:Iceland / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000191:economics / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D012042:Registries; D014478:Unemployment
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents