Can blood pressure in the first trimester predict the development of gestational hypertensive disorders?

Abstract

This editorial refers to ‘Blood pressure tracking during pregnancy and the risk of gestational hypertensive disorders. The Generation R Study’, by R. Gaillard et al. doi:10.1093/eurheartj/ehr275 Hypertensive disorders in pregnancy remain a major cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Pregnant women with hypertension are at higher risk for severe complications such as abruption placentae, cerebrovascular accidents, organ failure, and disseminated intravascular coagulation. The fetus is at risk for intrauterine growth retardation, prematurity, and intrauterine death. Hypertension is the most common medical problem in pregnancy, accounting for approximately a quarter of all antenatal admissions. The definition of hypertension in pregnancy was not uniform for a long time;1,2 it used to be defined as an elevation in blood pressure during the second trimester from a baseline reading in the first trimester or from pre-pregnancy levels. However, a definition based on absolute blood pressure values (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) is now preferred. Hypertension in pregnancy is not a single entity but comprises (i) pre-existing hypertension; (ii) gestational hypertension with its subunit of (iii) pre-eclampsia; (iv) pre-existing hypertension with superimposed gestational hypertension with proteinuria; and (v) antenatally unclassifiable hypertension ( Table 1 ). View this table: Table 1 Classification of hypertension in pregnancy Identification of the risk factors associated with gestational hypertension, and with pre-eclampsia in particular, would be of utmost importance. Table 2 shows factors …