ARTERIAL BLOOD PRESSURE PHENOTYPES DEFINED BY AMBULATORY BLOOD PRESSURE MONITORING IN PREGNANCY AND ITS PROGNOSTIC VALUE FOR FUTURE MATERNAL AND NEONATAL EVENTS

Abstract

Objective: We have previously demonstrated that some ambulatory blood pressure monitoring (ABPM) values can predict maternofoetal evens in hypertensive pregnant women. The analysis of the different blood pressure (BP) phenotypes in pregnant women is still an unknown topic. Design and method: A retrospective cohort study which followed a sequential number of 274 pregnant women referred to Cardiology/Hypertension consult (mean age of 32 years), from 2007 to 2022, who underwent ABPM made with a Spacelabs 90207. Data was collected and analysed in SPSS Statistics through different parametric tests. An event was defined as the composite endpoint of multiple adverse events: preeclampsia or eclampsia, foetal or neonatal death, prematurity, low weight at birth, gestational diabetes, and maternal death. Results: In a survival Kaplan-Meier curve of events, when we compared normal versus hypertensive groups, those with hypertension had worse survival with a log rank of 6.594 (p=0.010). In a further comparison, Kaplan-Meier analysis revealed a worse survival in the hypertensive without medication group, followed by the non-controlled hypertensive and controlled hypertensive groups, with a log rank of 11.737 (p=0.003). (Fig 1) An independent-samples T test followed by a multi-variate analysis was performed, revealing significant differences between the hypertensive and non-hypertensive group for maternal age (p=0.034) and birth weight (p=0.023). In the multi-variate analysis, the hypertensive group was notably associated with a higher rate of caesarean delivery (70.2% versus 34.6%, p=0.007). Further analysis showed significant differences in birth weight between the controlled hypertensive group and the hypertensive without medication (p=0.001) and non-controlled hypertensive (p=0.002) groups. Conclusions: This study further corroborates the importance of ABPM in the diagnosis and follow-up of hypertensive pregnant women, having a major impact in both maternal and neonatal morbidity. Normotensive pregnant women had a better prognosis as compared to hypertensive pregnant women, defined by ABPM values. ABPM should be an essential tool to manage pregnant women.