Risk of Adverse Pregnancy Outcomes in Women With Mild Chronic Hypertension Before 20 Weeks of Gestation

Ankumah, Nana-Ama MD; Cantu, Jessica MD; Jauk, Victoria MPH, MSN; Biggio, Joseph MD; Hauth, John MD; Andrews, William PhD, MD; Tita, Alan Thevenet N. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000205
Contents: Original Research
Abstract

OBJECTIVE: To evaluate whether blood pressure (BP) less than 140/90 mm Hg is associated with lower risk of adverse pregnancy outcomes in women with mild chronic hypertension.

METHODS: This was a secondary analysis of women with chronic hypertension diagnosed before 20 weeks of gestation (either BP 140/90 mm Hg or greater on two occasions at least four hours apart or previously diagnosed and on antihypertensive therapy) enrolled in the Maternal-Fetal Medicine Units Network's High-risk Aspirin preeclampsia prevention trial. Outcomes including a primary composite (perinatal death, severe preeclampsia, placental abruption, and indicated preterm birth less than 35 weeks of gestation) and small for gestational age (SGA) were compared by study preenrollment BP analyzed as a categorical (less than 140/90, 140–150/90–99, or 151–159/100–109 mm Hg) and as a continuous variable.

RESULTS: Among 759 women with singleton pregnancy and preenrollment BP less than 160/110 mm Hg, the incidence of the primary composite outcome (10.7%, 19.0%, 30%) and SGA (8.8%, 12.3%, 23.7%) increased with increasing BP category (P values ≤.001). The adjusted odds ratio (95% confidence interval) for the primary composite was 2.0 (1.3–3.2) for 140–150/90–99 mm Hg and 3.2 (1.6–6.3) for 151–159/100–109 mm Hg compared with BP less than 140/90 mm Hg. The results for SGA were 1.6 (0.9–2.8) and 3.8 (1.8–7.9), respectively. Models including continuous systolic and diastolic BP revealed increasing adverse outcomes per 5-mm Hg rise in diastolic but not systolic BP: primary composite (19% per 5 mm Hg) and SGA (22% per 5 mm Hg).

CONCLUSION: The risks of adverse pregnancy outcomes in women with chronic hypertension are lower with preenrollment BP less than 140/90 mm Hg as compared with higher BP categories and increase with increasing BP.

LEVEL OF EVIDENCE: II

In Brief

In women with mild chronic hypertension, adverse pregnancy outcomes are lower in those with a study preenrollment blood pressure less than 140/90 mm Hg compared with 140–149/90–99 mm Hg or 150–159/100–109 mm Hg and increase with blood pressure category.

Author Information

Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.

Corresponding author: Alan Thevenet N. Tita, MD, PhD, Maternal-Fetal Medicine Division, University of Alabama at Birmingham, 1700 6th Avenue South, Women and Infants Center, Room 10270, Birmingham, AL 35233; e-mail: atita@uabmc.edu.

Presented as a poster at the Society of Maternal-Fetal Medicine 33rd Annual Meeting, February 11–16, 2013, San Francisco, California.

The authors thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Maternal-Fetal Medicine Units Network, and the High Risk Aspirin Trial Protocol Subcommittee for making the database available for the project.

The contents of this report represent the views of the authors and do not represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network or the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.