Serial BP measurements can predict early- and later-onset preeclampsia and gestational hypertension: JAHA

USA: Some women may have a higher hypertensive disorders of pregnancy (HDP) risk than suggested by the risk factors alone, considering worrisome BP (blood pressure) patterns by the 20th week of gestation, according to a retrospective study. 

"Early pregnancy BP patterns upto 20 weeks of gestation plus social, clinical, and behavioral factors more accurately discriminate HDP risk among low‐to‐moderate risk pregnancies," the authors reported in their study published in the Journal of the American Heart Association. 

The findings imply that classification of early pregnancy systolic blood pressure based on BP changes from gestation weeks' 0 through 16 to 20 in combiantion with other standard risk factors (behavioral, social, and clinical) can significantly improve individual risk stratification for gestational hypertension and early‐onset and later‐onset preeclampsia. This allows for more targeted surveillance and potentially interventions to improve adverse outcomes and hypertensive disorders of pregnancy, and avoids unnecessary interventions or additional monitoring in low-risk pregnancies. 

Previous studies have shown that a single BP measurement, clinical risk factors, biophysical parameters, and current biomarkers can effectively indetify early-onset preeclampsia risk but have limited ability to predict gestational hypertension and later-onset preeclampsia. Clinical BP patterns hold promise for improving early risk stratification for hypertensive disorders of pregnancy. 

The retrospective cohort comprising 249 892 patients were included after excluding preexisting hypertension, kidney, heart, or liver disease, or prior preeclampsia. All had diastolic BP <90 mm Hg and systolic BP <140 mm Hg or a single BP elevation ≤20 weeks' gestation, prenatal care at <14 weeks' gestation, and live birth or a still at Kaiser Permanente Northern California hospitals (2009–2019). 

The sample was randomly split into validation (n=74 967; 30%) and development (N=174 925; 70%) data sets. In the validation data set, the researchers evaluated predictive performance of multinomial logistic regression models for 

Predictive performance of multinomial logistic regression models for early‐onset (<34 weeks) preeclampsia, later‐onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated in the validation data set.