BACKGROUND AND PURPOSE:

• White coat hypertension (WCH)
  • Hypertensive disorder with elevated office BP (≥140/90 mm Hg) but a normal blood pressure measured at home or work (<135/85 mm Hg)
  • Approximately 25% of nonpregnant individuals may have WCH
  • Prevalence in pregnant population ranges from 4% to 30%
• Johnson et al. (Hypertension, 2020) investigated whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes

METHODS:

• Systematic review and meta-analysis
• Data sources 
  • Medline | EMBASE | Clinicaltrials.gov | Cochrane Library
• Study inclusion criteria
  • Pregnant women diagnosed with apparent office hypertension throughout pregnancy who underwent 24-hour ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) | Maternal and fetal outcomes available
• Groups
  • WCH
  • Normotensive controls
  • Chronic hypertension
  • Hypertensive disorder of pregnancy
• Primary outcomes
  • Preeclampsia
  • Gestational age at delivery
  • Preterm birth (<37 weeks)
  • FGR or SGA

RESULTS:

• Total of 12 studies met criteria
• Women with WCH  had a significantly increased risk of
  • Preeclampsia: Pooled risk ratio (RR) 2.36 (95% CI, 1.16–4.78; P=0.017)
    • Subgroup analysis: Effect stronger when diagnosis at <20 weeks (RR 5.43)
  • SGA: RR 2.47 (95% CI, 1.21 to 5.05; P=0.013)
  • Preterm birth: RR 2.86 (95% CI, 1.44 to 5.68; P=0.002)
• Compared to women with gestational hypertension, women with WCH had significantly lower risks for
  • Preeclampsia: RR 0.43 (95% CI, 0.23 to 0.78; P=0.005)
  • SGA: RR 0.46 (95% CI, 0.26 to 0.82; P=0.008)
  • Preterm birth: RR 0.47 (95% CI, 0.31 to 0.71; P<0.001)
• Women with WCH delivered later compared with women with chronic hypertension
  • Mean difference: 1.06 weeks (95% CI, 0.44 to 1.67 weeks; P<0.001)

CONCLUSION:

• Women with WCH during pregnancy had worse perinatal and maternal outcomes compared to normotensive patients
• WCH was associated with better outcomes vs gestational or chronic hypertension
• The authors conclude that

Women with WCH have HBPM or ABPM and should continue to be followed up because of their increased risk of developing preeclampsia, SGA neonate, and preterm birth

Learn More – Primary Sources:

Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy
A systematic Review and Meta-Analysis

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