Key result
While BP ≥140/90 mmHg was a good rule-in test for pre-eclampsia (positive LR >8.00), higher visit-to-visit BP variability was also associated with adverse pregnancy outcomes (adjusted RRs 1.05-1.39).
Why the study?
To evaluate the association of ACC/AHA blood pressure thresholds and visit-to-visit blood pressure variability with adverse pregnancy outcomes.
Does visit-to-visit blood pressure variability and different blood pressure thresholds predict adverse pregnancy outcomes in pregnant women?
Observational (n=3,003)
Does visit-to-visit blood pressure variability and different blood pressure thresholds predict adverse pregnancy outcomes in pregnant women?
Visit-to-visit blood pressure variability is associated with adverse pregnancy outcomes, but lowering the traditional 140/90 mmHg threshold for diagnosing pregnancy hypertension is not supported by diagnostic test properties.
Answers are grounded in this paper and cite their sources.
Visit-to-visit BP variability was associated with adverse outcomes; hypothesis-generating and does not support lowering diagnostic thresholds.
OBJECTIVE: To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit-to-visit BP variability (BPV), adjusted for BP level. DESIGN: An observational study. SETTING: Analysis of data from the population-based UK Southampton Women's Survey (SWS). POPULATION OR SAMPLE: 3003 SWS participants. METHODS: Generalised estimating equations were used to estimate crude and adjusted relative risks (RRs) of adverse pregnancy outcomes by BP thresholds, and by BPV (as standard deviation [SD], average real variability [ARV] and variability independent of the mean [VIM]). Likelihood ratios (LRs) were calculated to evaluate diagnostic test properties, for BP at or above a threshold, compared with those below. MAIN OUTCOME MEASURES: Gestational hypertension, severe hypertension, pre-eclampsia, preterm birth (PTB), small-for-gestational-age (SGA) infants, neonatal intensive care unit (NICU) admission. RESULTS: A median of 11 BP measurements were included per participant. For BP at ≥20 weeks' gestation, higher BP was associated with more adverse pregnancy outcomes; however, only BP <140/90 mmHg was a good rule-out test (negative LR <0.20) for pre-eclampsia and BP ≥140/90 mmHg a good rule-in test (positive LR >8.00) for the condition. BP ≥160/110 mmHg could rule-in PTB, SGA infants and NICU admission (positive LR >5.0). Higher BPV (by SD, ARV, or VIM) was associated with gestational hypertension, severe hypertension, pre-eclampsia, PTB, SGA and NICU admission (adjusted RRs 1.05-1.39). CONCLUSIONS: While our findings do not support lowering the BP threshold for pregnancy hypertension, they suggest BPV could be useful to identify elevated risk of adverse outcomes.
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Wilson et al. (2023) conducted an observational in Pregnancy (n=3,003). Blood pressure thresholds and visit-to-visit BP variability vs. Lower blood pressure / lower variability was evaluated on Gestational hypertension, severe hypertension, pre-eclampsia, preterm birth (PTB), small-for-gestational-age (SGA) infants, neonatal intensive care unit (NICU) admission (adjusted RRs 1.05-1.39). While BP ≥140/90 mmHg was a good rule-in test for pre-eclampsia (positive LR >8.00), higher visit-to-visit BP variability was also associated with adverse pregnancy outcomes (adjusted RRs 1.05-1.39).
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