title: Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13 weeks.
abstract: OBJECTIVE
  To examine the performance of screening for hypertensive disorders in pregnancy and to compare systolic blood pressure (BP), diastolic BP, and mean arterial pressure (MAP) measured by validated automated devices in a large population of pregnant women at 11-13 weeks.
  
  
  METHODS
  We recorded maternal variables and measured BP by automated devices in 9149 women with singleton pregnancies. The performance of screening for preeclampsia (PE) and gestational hypertension (GH) by combinations of disease-specific maternal factor-derived a priori risk with systolic BP, diastolic BP, and MAP was determined.
  
  
  RESULTS
  There were 8061 cases that were unaffected by PE or GH, 37 that developed PE requiring delivery before 34 weeks (early-PE), 128 with late-PE, and 140 with GH. The systolic BP, diastolic BP, and MAP were significantly higher in early-PE, late-PE, and GH than in the controls (p < 0.0001). The systolic BP was significantly higher in early-PE than in late-PE (p = 0.008) and both systolic BP and MAP were significantly higher in early-PE than in GH (p < 0.01). The best performance in screening was provided by MAP. The detection rate of early-PE at a 10% false-positive rate increased from 47% in screening by maternal factor-derived a priori risk alone to 76% in screening by its combination with MAP. The respective detection rates for late-PE increased from 41 to 52% and for GH increased from 31 to 48%.
  
  
  CONCLUSIONS
  The measurement of BP can be combined with the maternal factor-derived a priori risk to provide effective first-trimester screening for PE and GH.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Leona C Y
authors.initials: LC
authors.lastname: Poon
authors.forename: Nikos A
authors.initials: NA
authors.lastname: Kametas
authors.forename: Catalina
authors.initials: C
authors.lastname: Valencia
authors.forename: Teodora
authors.initials: T
authors.lastname: Chelemen
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis*; D008403:Mass Screening; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011261:Pregnancy Trimester, First