Pregnancy outcomes of women presenting with stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks

OBJECTIVE: To determine the pregnancy outcomes of women who had 2017 American College of Cardiologists stage 1 hypertension during the first prenatal clinic visit before 20 gestational weeks in a tertiary hospital in South Africa. STUDY DESIGN: A retrospective cohort study involving the review of medical records of 127 participants with stage 1 hypertension and 128 control with blood pressure (BP) less than stage 1 hypertension before 20 weeks' gestation. MAIN OUTCOME MEASURES: The primary outcome measure was progression to stage 2 hypertension (BP ≥ 140/90 mmHg). Secondary outcome measures were a combination of maternal variables (postpartum BP ≥ 140/90 mmHg, use of antihypertensives within 24 h postpartum, pulmonary oedema, and maternal death within 24 h postpartum) and perinatal variables (fetal growth restriction, gestational age at delivery, fetal compromise, abruptio placenta, birth weight, Apgar score in 1 and 5 min). RESULTS: The study and control arms were similar in age, parity, and comorbidities (p > 0.05). The following maternal outcomes were worse (p < 0.001) in the study compared to control arm: progression to stage 2 hypertension (46 % vs 1.6 %), postpartum systolic BP ≥ 140 mmHg (33.9 % vs 1.6 %), postpartum diastolic BP ≥ 90 mmHg (22.1 % vs 1.6 %) and use of antihypertensives within 24 h postpartum (27.6 % vs 0.8 %). Other outcome measures did not differ between the two groups (p > 0.05). CONCLUSIONS: Stage 1 hypertension occurring before 20 weeks' gestation increases the risk of progression to stage 2 hypertension in pregnancy and the use of antihypertensive drug therapy within 24 h postpartum.