To evaluate maternal and neonatal outcomes in healthy, nulliparous women classified with stage 1 hypertension under the revised American College of Cardiology and American Heart Association Guidelines and to evaluate the effects of low-dose aspirin on maternal and neonatal outcomes in this population.
We conducted a secondary analysis of data from a multicenter randomized, double-blind, placebo-controlled trial of low-dose aspirin for prevention of preeclampsia in nulliparous, low-risk women recruited between 13 and 25 weeks of gestation. Of the 3,134 nulliparous women enrolled in the original study, 2,947 women with singleton pregnancies and without missing data were included in this analysis. Blood pressure was measured at enrollment between 13 and 25 weeks of gestation and outcomes were adjudicated from the medical record.
One hundred sixty-four participants were identified with lower range stage 1 hypertension (5.6%), systolic blood pressure 130–135 mm Hg, diastolic blood pressure 80–85 mm Hg, or both by the new American College of Cardiology–American Heart Association guidelines. Within the placebo group (n=1,482), women with stage 1 hypertension had a significantly increased incidence of preeclampsia compared with normotensive women, 15.3% (15/98) vs 5.4% (75/1,384) (relative risk 2.66, 95% CI 1.56–4.54, P<.001). Moreover, women with stage 1 hypertension had an increased incidence of gestational diabetes mellitus (6.1% vs 2.5%, P=.03) and more indicated preterm deliveries (4.2% vs 1.1%, P=.01). Comparing women with stage 1 hypertension and normotensive women receiving low-dose aspirin during pregnancy (n=1,465), no differences in rates of preeclampsia (7.6% vs 4.4%, respectively, P=.2), gestational diabetes mellitus, or indicated preterm deliveries were observed. Rates of placenta abruption, small for gestational age, and spontaneous preterm birth did not differ significantly between groups.
Application of the new American College of Cardiology–American Heart Association guidelines in a pregnant population identifies a cohort of women who are at increased risk for preeclampsia, gestational diabetes mellitus, and preterm birth.
Application of the new American College of Cardiology and American Heart Association Guidelines in pregnancy identifies a cohort of women at increased risk for preeclampsia.
Magee-Womens Research Institute, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Corresponding author: Elizabeth F. Sutton, PhD, 204 Craft Avenue, A336, Pittsburgh, PA 15213; email: firstname.lastname@example.org.
Data collection supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD21434, HD21366, HD21380, HD19897, HD21414, HD21386, HD21363). This work was supported by the American Heart Association (AHA16SFRN27810001) supporting Elizabeth F. Sutton, Alisse Hauspurg, Robert W. Powers, and Janet M. Catov.
Financial Disclosure The authors did not report any potential conflicts of interest.
Presented at the 65th Annual Scientific Meeting of the Society for Reproductive Investigation, March 6–10, 2018, San Diego, California.
The authors thank the women who volunteered to participate in this research study and the study staff who worked diligently to collect these data. The authors also thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Maternal-Fetal Medicine Units (MFMU) Network, and the Low Risk and High Risk Aspirin Study Subcommittees for making the database available for our research.
The content of this report represents the views of the authors and does not represent the views of the NICHD, MFMU, or the National Institutes of Health (NIH). E.F.S., A.H., R.W.P., and J.M.C. are supported in part by American Heart Association Go Red for Women Strategic Focused Research Network (AHA16SFRN27810001).
Each author has indicated that he or she has met the journal's requirements for authorship.
Received April 27, 2018
Received in revised form June 27, 2018
Accepted July 05, 2018