Prehypertension in Early Pregnancy: What is the Significance?
ObjectiveHypertensive disorders play a significant role in maternal morbidity and mortality. There is limited data on prehypertension (pre-HTN) during the first half of pregnancy. We sought to examine the risk of adverse pregnancy outcomes in patients with prehypertension in early pregnancy (<20 weeks' gestational age).Study DesignA retrospective cohort study of 377 patients between 2013 and 2014. Patients were divided based on the highest blood pressure in early pregnancy, as defined per the JNC-7 criteria. There were 261 control patients (69.2%), 95 (25.2%) pre-HTN patients, and 21 (5.6%) chronic hypertension (CHTN) patients. The groups were compared using X2, Fisher's Exact, Studentt-test, and Mann-Whitney U test withp< 0.05 used as significance.ResultsPatients with pre-HTN delivered earlier (38.8 ± 1.9 weeks vs 39.3 ± 1.7 weeks), had more pregnancy related hypertension (odds ratio [OR], 4.62; confidence interval [CI], 2.30-9.25;p< 0.01) and composite maternal adverse outcomes (OR, 2. 10; 95% CI, 1.30-3.41;p< 0.01), NICU admission (OR, 2.21; 95% CI, 1.14-4.26;p= 0.02), neonatal sepsis (OR, 6.12; 95% CI, 2.23-16.82;p< 0.01), and composite neonatal adverse outcomes (OR, 2.05; 95% CI, 1.20-3.49;p< 0.01).ConclusionAlthough women with pre-HTN are currently classified as normal in obstetrics, they are more similar to women with CHTN. Pre-HTN in the first half of pregnancy increases the likelihood of adverse outcomes.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York.
Jonathan Y
JY
Rosner
Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, New Jersey.
Megan
M
Gutierrez
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Margaret
M
Dziadosz
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Amelie
A
Pham
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Terri-Ann
TA
Bennett
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Cara
C
Dolin
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Allyson
A
Herbst
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Sarah
S
Lee
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Medical Center, New York.
Ashley S
AS
Roman
D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D002908:Chronic Disease; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D036801:Parturition; D010343:Patient Admission / Q000706:statistics & numerical data; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D058246:Prehypertension / Q000503:physiopathology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology