Why the study?
Pregnant women in elevated and stage 1 blood pressure cohorts receive no increased antepartum surveillance, prompting evaluation of their risk for hypertensive disorders of pregnancy.
Does elevated blood pressure or Stage 1 hypertension prior to 20 weeks gestation increase the risk of hypertensive disorders of pregnancy compared to normal blood pressure?
Does elevated blood pressure or Stage 1 hypertension prior to 20 weeks gestation increase the risk of hypertensive disorders of pregnancy compared to normal blood pressure?
Applying the 2017 ACC/AHA blood pressure guidelines to early pregnancy identifies women with Elevated BP and Stage 1 hypertension as being at significantly increased risk for hypertensive disorders of pregnancy.
May support heightened surveillance for elevated/stage 1 BP before 20 weeks; leaves open need for prospective trials before practice change.
INTRODUCTION: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) redefined blood pressure (BP) categories in non-pregnant adults: Normal (140/90). In pregnancy, patients with BP>140/90 before 20 weeks gestation are considered to have chronic hypertension, correlating to S2. Unlike S2, pregnant women in Elevated and S1 cohorts receive no increased antepartum surveillance. The purpose of this study is to compare pregnancy outcomes between normal, elevated, and S1 cohorts to ascertain risk for hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia. METHODS: This is a retrospective review of women who received prenatal care and delivered at our institution. Patients were classified according to the new guidelines based on BP readings prior to 20 weeks gestation. S2 patients were excluded, as these patients are already known to have increased risk for HDP. The primary outcome measure is incidence of HDP. IRB approval was obtained. RESULTS: 342 patients were included: normal (n=177), elevated (n=73), and S1 (n=76). Maternal characteristics were similar (P>.05). The incidence of HDP for patients with Elevated BP is 9.59% ( P= .048) and S1 is 13.83% ( P= .002), compared to normal (3.43%). The incidence of small for gestational age, preterm delivery, and NICU admissions were similar ( P >.05). CONCLUSION: Women with S1 per the new guidelines are at increased risk for HDP of pregnancy. Further studies are warranted to determine if S1 patients will benefit from antepartum surveillance and prophylactic low dose aspirin.
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Chatterton et al. (2020) studied this question.
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