title: Perinatal outcomes, blood pressure patterns and risk assessment of superimposed preeclampsia in mild chronic hypertensive pregnancy.
abstract: OBJECTIVE
  Assessment of perinatal outcomes, blood pressure (BP) patterns and risk of superimposed preeclampsia in a population with mild chronic hypertension.
  
  
  METHODS
  We investigated 223 pregnant women with mild chronic hypertension and 200 controls. Twenty-four-hour BP monitoring longitudinally in pregnancy and Doppler assessment of uterine arteries at 24 weeks' gestation were performed. Perinatal outcomes were recorded.
  
  
  RESULTS
  Superimposed preeclampsia occurred in 28.4% of hypertensive women, with an increased rate of small-for-gestational age babies (30.7% versus 8.9%), a lower birth weight (2587.75+/-832.97 versus 3167.35+/-536.3; p < 0.001) and a higher rate of caesarean sections (69.2% versus 35.5%) than controls. According to the ROC curve, the mean 24-h blood pressure (diastolic 78 mmHg [S.E.: 0.95; SP: 0.89] and systolic 121 mmHg [S.E.: 0.88; SP: 0.92]) and the mean resistance index of the uterine arteries of 0.52 (S.E.: 0.69; SP: 0.87) are better prognostic values for predicting superimposed preeclampsia.
  
  
  CONCLUSIONS
  In women with chronic hypertension in the second trimester 24-h blood pressure monitoring and Doppler velocimetry of the uterine artery are able to detect those at risk of superimposed preeclampsia. In women with circulatory adaptation to pregnancy, a good perinatal outcome is expected with proper obstetric care.
authors.affiliation: Department of Obstetrics and Gynecology, Marche Polytechnic University at Salesi Hospital, Via Corridoni 11, 60123 Ancona, Italy. s.giannubilo@univpm.it
authors.forename: Stefano Raffaele
authors.initials: SR
authors.lastname: Giannubilo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dell'Uomo
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Tranquilli
mesh_terms: D000328:Adult; D001724:Birth Weight; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D017078:Laser-Doppler Flowmetry; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging