Association between masked hypertension and late-onset fetal growth restriction at advanced maternal age

Abstract

Fetal growth restriction (FGR) is a major risk factor for complicated pregnancy including stillbirth. The all-pathophysiology results in uteroplacental insufficiency. Hypertension chronic or pregnancy-related complicates the all-prenatal periods. The relationship between fetal growth restriction and hypertension is well-known and this risk increases with maternal age. Late-onset FGR is diagnosed >32 weeks. Masked hypertension (MH) is a phenotype of hypertension when clinic blood pressure is in the normal range in the office but elevated outside the office. This study examined the risk of late-onset FGR and masked hypertension at advanced maternal age. Sixty pregnant women over 40 years old were included in the study who delivered at our hospital with late-onset fetal growth restriction diagnosis. After taking detailed anamnesis from all individuals included in the study, detailed physical examination, obstetric examination and ambulatory blood pressure monitoring (ABPM) were performed. Women with maternal chronic hypertension, pregestational or gestational diabetes mellitus, chronic kidney disease, rheumatoid disease history, tobacco use, cardiac arrhythmia, fetal genetic abnormality or placental abnormality were excluded from the study. The prevalence of masked hypertension was statistically significantly higher in the group with late intrauterine growth. (n:13, 43% vs n:5, 16.7% p=0.02). Office systolic BP (125.5±4.1 mmHg vs 118.5±5.7 mmHg p=0.016), 24-hour systolic BP measurement (125±9 mmHg vs 119.7±5.7 mmHg p=0.03), and ambulatory nocturnal diastolic BP measurement (66.7±10 mmHg vs. 61.±5.5 mmHg p=0.03) was higher in the group with late FGR. Hypertension can lead to complications in the perinatal period. There is a bad association between FGR and hypertension. Masked hypertension should be considered especially in advanced age pregnant individuals with FGR.