Key result
Severe Stage 2 hypertension was associated with postpartum haemorrhage (RR 2.57; 95% CI 1.35-4.86) and SGA, but lower BP thresholds were not associated with adverse outcomes.
Why the study?
Does categorizing antenatal blood pressure using lower cut-offs (2017 ACC/AHA criteria) identify pregnant women with obesity at greater risk of adverse maternal and perinatal outcomes?
Observational
Does categorizing antenatal blood pressure using lower cut-offs (2017 ACC/AHA criteria) identify pregnant women with obesity at greater risk of adverse maternal and perinatal outcomes?
Applying the lower 2017 ACC/AHA blood pressure thresholds does not improve the identification of adverse pregnancy outcomes in pregnant women with obesity compared to the traditional 140/90 mmHg threshold.
BACKGROUND: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity. METHODS: . In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: 'Normal' BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), 'Elevated' BP (sBP 120-129 mmHg and dBP <80 mmHg), 'Stage 1 hypertension' (sBP 130-139 mmHg and/or dBP 80-89 mmHg), and 'Stage 2 hypertension' (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90-109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. 'Normal' BP), and as threshold values. RESULTS: Severe 'Stage 2 hypertension' (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with 'Stage 1 hypertension' or 'Elevated BP'. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission. CONCLUSIONS: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk.
No takes yet. Share an insight, caveat, or question.
Slade et al. (2025) conducted an observational in Pregnancy with obesity. Lower antenatal blood pressure cut-offs (2017 ACC/AHA criteria) vs. Normal BP (<120/80 mmHg) or BP <160/110 mmHg was evaluated on Preterm birth, postpartum haemorrhage (PPH), small-for-gestational age (SGA), and NICU admission (RR 2.57, 95% CI 1.35-4.86). Severe Stage 2 hypertension was associated with postpartum haemorrhage (RR 2.57; 95% CI 1.35-4.86) and SGA, but lower BP thresholds were not associated with adverse outcomes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: