Should the definition of preeclampsia include a rise in diastolic blood pressure of >/=15 mm Hg to a level <90 mm Hg in association with proteinuria?
OBJECTIVE
This study was undertaken to compare baseline characteristics and pregnancy outcomes between normotensive women who did and those who did not have a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria.


METHODS
We studied 4302 healthy nulliparous women from the Calcium for Preeclampsia Prevention trial who were delivered at >/=20 weeks' gestation. We selected as the study group normotensive women who developed proteinuria within 7 days of a rise in diastolic blood pressure of >/=15 mm Hg with respect to baseline on 2 occasions 4 to 168 hours apart. Baseline blood pressure was the mean of measurements at 2 clinic visits before 22 weeks' gestation. Other normotensive women used for comparison were those who did not develop gestational hypertension or a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria.


RESULTS
Except for greater weight (P <.001), body mass index (P <.001), and systolic blood pressure (P =.05) the baseline characteristics of the 82 women with a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria did not differ significantly from those of the other normotensive women. Although they had a greater rate of weight gain (P <.005), larger babies (P =.06), and a 2-fold increase in abdominal delivery (P <.001), there was little other evidence of adverse pregnancy outcomes among these women.


CONCLUSIONS
During normotensive pregnancy a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria appears to be benign and is not a useful clinical construct.
Levine
R J
RJ
Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510, USA.
Ewell
M G
MG
Hauth
J C
JC
Curet
L B
LB
Catalano
P M
PM
Morris
C D
CD
Choudhary
G
G
Sibai
B M
BM
D001724:Birth Weight; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D003971:Diastole; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000473:pathology / Q000503:physiopathology* / Q000652:urine*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011507:Proteinuria / Q000209:etiology*; D012016:Reference Values; D009626:Terminology as Topic