169 Blood pressure pattern of women with hypertensive disorders of pregnancy is highly affected by obesity

Abstract

To investigate the impact of obesity on blood pressure (BP) pattern of women with hypertensive disorders of pregnancy (HDP). A retrospective cohort study of women who delivered at a midwestern academic hospital between 3/2017 and 8/2019. We included all women who were ≥15 years old, diagnosed with HDP in the antenatal or postnatal period, and enrolled into home telehealth postpartum BP monitoring. BPs were collected from 47 time points: pre-pregnancy, each trimester, delivery day, and 42 days postpartum. The primary outcome was the estimated average BP pattern from a mixed-effects longitudinal data analysis stratified by pre-pregnancy BMI (<30 kg/m2 vs ≥30 kg/m2). The secondary outcome was the time to BP stabilization (BP<140/90 mmHg) and hypertension resolution (stabilization while free of BP medications) stratified by pre-pregnancy BMI. Data from 619 women were analyzed. Of these, 38% had gestational hypertension, 21% chronic hypertension, 8% superimposed preeclampsia, 50% preeclampsia, and 32% preeclampsia with severe features. Systolic, diastolic, and mean arterial pressure (MAP) of obese women were higher pre-pregnancy and in each trimester (All p<0.001; Figure 1). Additionally, systolic BP and MAP of obese women were higher on postpartum days 7, 30, and 42 (All p<0.05). Diastolic BP of obese women was lower on delivery day (p=0.001) and postpartum day 2 (p=0.02). Pulse pressure of obese women was higher in first (p=0.03), second (p=0.004), and third (p<0.001) trimesters, on delivery day (p=0.001), postpartum days 2 (p<0.001) and 7 (p=0.003). Obese women were 31% less likely to achieve stabilization (HR 0.69, 95% CI: 0.57-0.84, p<0.001; Figure 2A) and 27% less likely to achieve resolution (HR 0.73, 95% CI: 0.58-0.92, p=0.007; Figure 2B) than non-obese. Obese women have higher BP during pregnancy and postpartum compared to non-obese and are less likely to reach pre-pregnancy BP level by the end of puerperium. The difference in BP pattern of obese women needs to be acknowledged while providing individualized hypertension care either during pregnancy or postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)