Abstract
Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.
Highlights
Hypertensive disorders of pregnancy (HDPs) imply an increase in maternal and neonatal morbidity and mortality as well as an increased risk of obstetric and perinatal complications [1–3]
In pregnant women with gestational diabetes mellitus (GDM), there is insufficient evidence, but in a previously published study, we reported that high nocturnal systolic BP (SBP) levels increase the risk of developing HDPs in pregnant women with GDM [14]
We found higher blood pressure (BP) levels detected by ambulatory blood pressure monitoring (ABPM) in pregnant women who subsequently developed HDPs as well as adverse obstetric and perinatal outcomes
Summary
Hypertensive disorders of pregnancy (HDPs) imply an increase in maternal and neonatal morbidity and mortality as well as an increased risk of obstetric and perinatal complications [1–3]. 12 weeks after delivery; and preeclampsia over chronic hypertension, when preeclampsia appears in women with pre-existing chronic hypertension. These disorders affect 5–10% of pregnancies worldwide [4,5], and the presence of some comorbidities, such as gestational diabetes mellitus (GDM), can increase the risk of developing HDPs [6]. It is necessary to design specific models that allow us to detect the development of HDPs in patients with GDM early in order to start preventive strategies in these women who are at increased risk. Isolated office blood pressure (BP) measurement remains the most commonly used method to detect hypertension in pregnancy in clinical practice, ambulatory blood pressure monitoring (ABPM) provides more reliable records and informs clinicians about
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