Grand Rounds

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

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

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

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)

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

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