Does a Single Elevated Blood Pressure Before 20 Weeks Increase the Risk for Preeclampsia?
BACKGROUND AND PURPOSE:
Duffy et al. (Obstetrics & Gynecology, 2021) evaluated maternal and fetal outcomes among women with a single elevated blood pressure before 20 weeks of gestation
Retrospective cohort study
Women who delivered at a hospital system between Jan, 2008 and Dec, 2019
Excluded: Women who met the ACC/AHA definition of chronic hypertension (>130 systolic or >80 diastolic) | Severe range BPs
All SBP <130 mm Hg and DBP <80 mm Hg
Single elevated blood pressure <20 weeks
Single SBP >130 mm Hg and/or single DSB >80 mm Hg
Maternal comorbidities and maternal and neonatal outcomes were extracted from electronic health records using International Classification of Diseases codes
Adjusted odds ratios (aOR) derived from logistic regression were used to describe the magnitude of association
The development of a hypertensive disorder of pregnancy
Markers of maternal morbidity
Women with a single elevated BP: 23%
Rates of hypertensive disorders of pregnancy were greater in the single elevated BP group
Single elevated BP: 10.6%
aOR 2.06 (95% CI, 2.00 to 2.13)
Single elevated BP was associated with
Gestational hypertension: aOR 2.34 (95% CI, 2.24 to 2.25)
Preeclampsia or eclampsia: aOR 1.83 (95% CI, 1.76 to 1.91)
Iatrogenic preterm delivery was also higher in the single elevated blood pressure group
Single elevated blood pressure: 3.7%
aOR 1.27 (95% CI, 1.21 to 1.33)
In addition, single elevated blood pressure was associated with
Higher rate of Apgar score <7 at 5 minutes (1.1% vs 0.9%); aOR 1.16 (95% CI, 1.07 to 1.26)
Higher proportion of fetal deaths (0.5% vs 0.4%); unadjusted P<0.001
A single elevated blood pressure before 20 weeks’ gestation is associated with increased risk for hypertensive disorders of pregnancy and iatrogenic preterm delivery
The authors state
Because these women do not meet criteria for chronic hypertension, there are currently no consensus or guideline-based recommendations regarding their antepartum management
Given the association with hypertensive disorders of pregnancy as well as adverse maternal and fetal outcomes demonstrated here, our data highlight an additional parameter to risk-stratify a portion of pregnant women who may benefit from an increased frequency of antepartum blood pressure monitoring
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