Cross-sectional studyindependent cross-checkfull text checked I-SRC-119 in-depth review
Belly pressure in late pregnancy and high blood pressure
The association between maternal intra-abdominal pressure and hypertension in pregnancy.
Overview
Jayasundara S et al.. PLoS One 2023 · PMID 37851647 · DOI 10.1371/journal.pone.0284230
Pressure inside the abdomen was high at term, and somewhat higher in women with high blood pressure; the study was small.
Does the study support the specific claim? Partly · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure belly pressure in pregnancy
- How was the study done?
Cross-sectional study
- How many people, animals or samples were studied?
70 women
- What was actually found?
High pressure at term; association with hypertension uncertain
- How large was the observed effect?
+1.6 mmHg antepartum (not significant)
- What do the results mean in everyday life?
Belly pressure rises in pregnancy; its role in disease is unproven
- What are the study's limitations?
Small; reporting errors
- What does it say about Elawady's specific claim?
Supports only the plausibility of the pressure idea
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
That pressure causes complications
Scientific in-depth review
1. Full reference
- Authors
- Jayasundara S et al.
- Journal
- PLoS One
- Year
- 2023
- Identifier
- PMID 37851647 DOI 10.1371/journal.pone.0284230
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works record checked
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
No specific funding; no competing interests.
2. Research question
Are antepartum and postpartum intra-abdominal pressure (IAP) associated with hypertension in pregnancy?
3. Study design and population
- Study design
- Cross-sectional study – Cross-sectional study of intravesical (intra-abdominal) pressure before and after caesarean delivery
- Population
Women with singleton pregnancies undergoing non-emergency caesarean delivery
- Country
Sri Lanka
- Period
2016-2017
- Sample size
70 (55 normotensive, 15 hypertensive)
- Inclusion and exclusion criteria
Antepartum non-emergency caesarean; Category 1 and in-labour caesareans excluded
4. Methods and endpoints
- Exposure / intervention
Hypertension in pregnancy
- Comparator
Normotensive pregnancy
- Endpoints
Antepartum and postpartum IAP (mmHg)
- Statistical methods
Multivariable linear regression adjusted for BMI, birthweight, parity
5. Actual results
- Results
Normotensive at term: mean antepartum IAP 12.7 mmHg (11.6-13.8), postpartum 7.3 mmHg (6.5-8.0; the abstract wrongly gives 11.6-13.8). Hypertensive group: antepartum IAP coefficient +1.617 mmHg (p=0.268, not significant); postpartum IAP +2.519 mmHg (p=0.018); IAP reduction -1.013 (p=0.179).
- Absolute risks
not applicable
- Authors' conclusion
At term, IAP in normotensive pregnancies is in the intra-abdominal-hypertension range of non-pregnant people; higher IAP associated with hypertension in pregnancy.
6. Strengths
- Direct IAP measurement
- Full text read
7. Weaknesses
- Small (15 hypertensive)
- Cross-sectional; cannot show cause
- Antepartum difference not significant
- Reporting errors (abstract CI; '1.6 times' misreads an additive coefficient)
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Small, cross-sectional, selected caesarean population.
9. Assessment of the statistical interpretation
Abstract CI for postpartum mean excludes the mean (copy error); the discussion's '1.6 times higher IAP' is a 1.6 mmHg difference (~13%), not significant (stats/C-SRC-65_jayasundara.py).
10. Relevance to the specific claim
Supporting side for the abdominal-pressure part: IAP is high in late pregnancy and possibly associated with hypertension. It is weak, cross-sectional evidence and says nothing about cortisol.
11. Independent contrary findings
I-INTB-23 (link with pre-eclampsia unproven).
12. Transferability to Germany and Europe
Physiology transferable.
13. Overall methodological judgement
Hypothesis-level support for one part of the claim.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | high |
| Precision of results | low |
| Directness | indirect |
| Reproducibility | not replicated |
| Consistency with the overall evidence | unknown |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | partly correct but over-interpreted |
14. Open questions
Prospective IAP studies.
15. Linked fact checks
- Pregnant women develop health problems because pregnancy causes cortisol deficiency and raised intra-abdominal pressure. – Studies with mixed or unclear results