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.
The authors reported the following findings:
- There were 1008, 10 766, and 11 514 patients with early‐onset preeclampsia, later‐onset preeclampsia, and gestation hypertension, respectively.
- Models with 6 systolic BP trajectory groups (0–20 weeks' gestation) plus standard clinical risk factors performed substantially better than risk factors alone to predict early‐ and later‐onset preeclampsia and gestational hypertension, with C‐statistics of 0.747, 0.730, and 0.768 versus 0.688, 0.695 and 0.692, respectively, with excellent calibration.
"In the future, these findings may be translated into an automated clinical tool within the electronic health records system, or a web‐based tool to classify BP pattern changes during early gestation for individual risk stratification of preeclampsia or gestational hypertension," the researchers concluded. "This, in turn, may improve precision medicine by more accurate identification of patients who may truly benefit most from enhanced monitoring and intervention(s)."
Reference:
Gunderson EP, Greenberg M, Sun B, Goler N, Go AS, Roberts JM, Nguyen-Huynh MN, Tao W, Alexeeff SE. Early Pregnancy Systolic Blood Pressure Patterns Predict Early- and Later-Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low-to-Moderate Risk Groups. J Am Heart Assoc. 2023 Jul 12:e029617. doi: 10.1161/JAHA.123.029617. Epub ahead of print. PMID: 37435795.
