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#Grand Rounds

Does Stage 1 Hypertension in Early Pregnancy Confer an Increased Risk for Preeclampsia?

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BACKGROUND AND PURPOSE:

  • In 2017, criteria for diagnosing hypertension in the general population changed (ACC and AHA Task Force)
  • Prehypertension category was broken in to the following 2 categories
    • Elevated BP: SBP 120 to 129 mm Hg and DBP <80 mm Hg
    • Stage 1 hypertension: SBP 130 to 139 mm Hg or DBP 80 to 89 mm Hg
  • Stage 2 hypertension defined as levels >Stage 1 (SBP ≥140 mm Hg DBP ≥90 mm Hg)
  • Sutton et al. (Obstetrics & Gynecology, 2020) investigated whether women with early pregnancy elevated BP or stage 1 hypertension are at increased risk for preeclampsia and related maternal and neonatal morbidity

METHODS:

  • Clinical cohort study
  • Data source
    • Aggregate of prenatal and delivery health records (2015 to 2018)
  • Participants
    • Singleton neonate
    • ≥2 prenatal appointments <20 weeks
  • Study design
    • Early pregnancy BP definition: Average BP <20 weeks
    • Women were classified according to current guidelines as having
      • Normal BP
      • Elevated BP
      • Stage 1 hypertension
      • Stage 2 hypertension
  • Severe maternal morbidity defined as one of the following
    • CDC 21 indicators | ICU admission | Prolonged hospital stay
  • Composite neonatal morbidity defined as a combination of the following
    • IUFD >20 weeks | Neonatal death within 28 days of life | 5-minute Apgar score <7 | NICU admission | SGA | preterm (<37 weeks) 
  • Primary outcome
    • Preeclampsia
  • Secondary outcomes
    • Severe maternal morbidity
    • Placental abruption
    • Gestational diabetes
    • Composite neonatal morbidity

RESULTS:

  • Data from 18,162 women were included
    • Normal BP: 75.2%
    • Elevated BP: 13.9%
    • Stage 1 hypertension: 5.4%
    • Stage 2 hypertension: 5.5%
  • Risk of preeclampsia increased with increasing BP category (adjusted for covariates) and was similar among black and white women
    • Normal BP: 4.7% (referent)
    • Elevated BP: 7.3% | aOR 1.29 (95% CI 1.07 to 1.56)
    • Stage 1 hypertension: 12.3% | aOR 2.35 (95% CI 1.86 to 2.96)
    • Stage 2 hypertension: 30.2% | aOR 6.49 (95% CI 5.34 to 7.89)
  • Gestational diabetes was more prevalent among women with
    • Stage 1 hypertension: 11.4% | aOR 1.50 (95% CI 1.18 to 1.91)
    • Stage 2 hypertension: 14.2% | aOR 1.65 (95% CI 1.30 to 2.10)
  • Severe maternal and neonatal morbidity were increased only among women with stage 2 hypertension
    • Maternal morbidity: aOR 2.99 (95% CI, 2.26 to 3.99)
    • Neonatal morbidity: aOR 2.67 (95% CI, 2.28 to 3.12)

CONCLUSION:

  • Women who have elevated blood pressure or stage 1 hypertension in early pregnancy are at increased risk of preeclampsia
    • Risk increases with increasing BP category
  • Women with stage 2 hypertension have the highest risk for preeclampsia and severe maternal and neonatal morbidity

Learn More – Primary Sources:

Early Pregnancy Blood Pressure Elevations and Risk for Maternal and Neonatal Morbidity

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Related ObG Topics:

Does Hypertension in Pregnancy Predict Hypertension Later in Life?
The Latest ACC/ AHA BP Category Guidelines and Risk of Hypertensive Disorders of Pregnancy
New ACC Blood Pressure Guidelines in Pregnancy: Should We Start Monitoring Prior to 140/90?

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