Greater long-term blood pressure variability in pregnancy was associated with more adverse maternal outcomes (OR range 1.40-2.20) and fetal growth restriction (OR range 1.12-1.39).
Systematic Review (n=138,949)
Is long-term blood pressure and heart rate variability associated with adverse maternal and perinatal outcomes in pregnancy?
Long-term visit-to-visit blood pressure variability during pregnancy is independently associated with adverse maternal and perinatal outcomes, suggesting potential utility for risk stratification.
Effect estimate: OR range 1.12-2.20
BACKGROUND: Long-term (visit-to-visit) blood pressure variability (BPV) and heart rate variability (HRV) outside pregnancy are associated with adverse cardiovascular outcomes. Given the limitations of relying solely on blood pressure level to identify pregnancies at risk, long-term (visit-to-visit) BPV or HRV may provide additional diagnostic/prognostic counsel. To address this, we conducted a systematic review to examine the association between long-term BPV and HRV in pregnancy and adverse maternal and perinatal outcomes. METHODS AND RESULTS: Databases were searched from inception to May 2023 for studies including pregnant women, with sufficient blood pressure or heart rate measurements to calculate any chosen measure of BPV or HRV. Studies were excluded that reported short-term, not long-term, variability. Adjusted odds ratios were extracted. Eight studies (138 949 pregnancies) reporting BPV met our inclusion criteria; no study reported HRV and its association with pregnancy outcomes. BPV appeared to be higher in women with hypertension and preeclampsia specifically, compared with unselected pregnancy cohorts. Greater BPV was associated with significantly more adverse pregnancy outcomes, particularly maternal (gestational hypertension odds ratio range, 1.40-2.15, severe hypertension 1.40-2.20), and fetal growth (small-for-gestational-age infants 1.12-1.32 or low birth weight 1.18-1.39). These associations were independent of mean blood pressure level. In women with hypertension, there were stronger associations with maternal outcomes but no consistent pattern for perinatal outcomes. CONCLUSIONS: Future work should aim to confirm whether BPV could be useful for risk stratification prospectively in pregnancy, and should determine the optimal management path for those women identified at increased risk of adverse outcomes.
Wilson et al. (Tue,) conducted a systematic review in Pregnancy (n=138,949). Long-term (visit-to-visit) blood pressure variability (BPV) was evaluated on Adverse maternal and perinatal outcomes (OR range 1.12-2.20). Greater long-term blood pressure variability in pregnancy was associated with more adverse maternal outcomes (OR range 1.40-2.20) and fetal growth restriction (OR range 1.12-1.39).