Prediction of Adverse Perinatal Outcomes and Preeclampsia in Pregnant Women with Chronic Arterial Hypertension

The objective of this study was to determine predictors and develop a prognostic model for preeclampsia (PE) and adverse perinatal outcomes in pregnant women with chronic arterial hypertension (CAH). Methods and Results: The study cohort included pregnant women (n=376) with hypertensive disorders: Group 1 –pregnant women with CAH (n=134), Group 2 – with PE on the background of CAH (n=242). Healthy pregnant women made up the control group (n=34). The diagnosis of pregnant women with CAH was made on the basis of existing national and foreign recommendations that an increase in SBP ≥140 mmHg and/or DBP ≥90 mmHg indicates CAH. All patients underwent the following examinations: a survey on a special questionnaire; an anthropometric examination; physical examination; an assessment of the content of uric acid (UA) in the blood serum and microalbuminuria (MAU) in the urine at 6-8 and 16-17 weeks of pregnancy; 12-lead ECG, echocardiography, 24-hour ambulatory blood pressure monitoring, sonography of the uterus, fetus, and placenta at 6-8 and 16-18 weeks. It was found that an inappropriate left ventricular mass (LVM) in pregnant women with CAH, a certain “phenotype” of 24-hour ABPM and indicators of metabolic disorders demonstrate the systemic nature of organ damage and appear to be a predictor of adverse perinatal outcomes and the development of PE. The revealed changes in the LV structure, which are more significant in PE on the background of CAH, suggest the association of concentric left ventricular hypertrophy and disorders of uteroplacental blood flow. Detecting abnormal blood flow from early pregnancy will reduce not only perinatal morbidity and premature birth, but also the probability of organ (LV myocardium, kidney) damage in women with CAH. To predict the risks of adverse perinatal outcomes in pregnant women with CAH and PE, a number of factors were identified that have a statistically significant relationship with the studied complications. The developed model makes it possible to predict the probability of PE and unfavorable perinatal outcomes in pregnant women suffering from CAH with high efficiency (91.1%).