High BP in early pregnancy raises preeclampsia risk during pregnancy
USA: Going by the new definitions of hypertension, women in their early pregnancy having elevated blood pressure and, stage 1 and stage 2 hypertension are at increased risk for preeclampsia, a recent study has revealed. Findings of the study, published in the journal Obstetrics & Gynecology, lay emphasis on the importance of applying the 2017 BP guidelines to reproductive-aged women.
The American College of Cardiology and the American Heart Association in their 2017 guideline modified the clinical definitions of hypertension in adults. According to the guideline, elevated BP is defined as systolic BP 120-129 mm Hg and diastolic BP less than 80, stage 1 hypertension as SBP of 130-139 or diastolic BP of 80-89 mm Hg. While stage 2 hypertension is defined as having SBP of 10 or higher and DBP of 90 or higher.
Elizabeth F. Sutton, Janet M. Catov, Magee-Womens Research Institute, Pittsburgh, PA, and colleagues conducted the study to determine whether women with early pregnancy elevated blood pressure (BP) or stage 1 hypertension are at increased risk of preeclampsia and maternal or neonatal morbidity.
For the purpose, the researchers conducted a clinical cohort study of 18,162 women who delivered a singleton neonate from 2015 to 2018 and attended at least two prenatal appointments before 20 weeks of gestation. Data were collected within the Magee Obstetric Maternal and Infant database -- an aggregate of prenatal and delivery health records.
Early pregnancy BP was defined as average BP before 20 weeks of gestation, and women were classified with normal, elevated BP, stage 1 or 2 hypertension according to current guidelines. The primary outcome was preeclampsia.
Key findings of the study include:
- 75.2% of the women were categorized with normal BP, 13.9% with elevated BP, 5.4% with stage 1 hypertension, and 5.5% with stage 2 hypertension.
- Risk of preeclampsia increased in a stepwise fashion with increasing BP category, adjusted for covariates (normal BP, 4.7%, referent; elevated BP, 7.3%, adjusted odds ratio [aOR] 1.29; stage 1, 12.3%, aOR 2.35), and stage 2, 30.2%, aOR 6.49).
- Results were similar among black and white women.
- Gestational diabetes was more prevalent among women with stage 1 (11.4%) and stage 2 hypertension (14.2%).
- Severe maternal morbidity and neonatal morbidity were increased only among women with stage 2 hypertension.
"Women with elevated BP, and stage 1 and 2 hypertension in early pregnancy are at increased risk for preeclampsia, wrote the authors."
"These findings emphasize the importance of applying the 2017 BP guidelines to reproductive-aged women. Strategies to incorporate these guidelines into obstetric care may also be warranted," they concluded.
The study, "Early Pregnancy Blood Pressure Elevations and Risk for Maternal and Neonatal Morbidity," is published in the journal Obstetrics & Gynecology.