High mean blood pressure during the first trimester is predictive of future preeclampsia development in healthy pregnant women: a cohort study in Korea

J Yoon Park,J.-S Hong,K.J Oh,S.W Lee

doi:10.12891/ceog4792.2019

Abstract

The objective of this study was to determine the association between blood pressure (BP) in early pregnancy and the development of preeclampsia. Among 3,364 pregnant women who began perinatal care in their first trimester and were followed up until delivery, 3,003 healthy pregnant women were included after excluding 354 with comorbidities during pregnancy and seven with missing BP and proteinuria data at follow-up. The mean values of systolic and diastolic BP measurements during the first trimester were retrieved from electronic medical records. Mean BP (MBP) was calculated and plotted using the penalized smoothing spline method to analyze its association with the development of preeclampsia. In the univariate analysis, increased MBP, twin pregnancy, and high body weight were associated with increased odds for the development of preeclampsia; however, only increased MBP and twin pregnancy maintained statistical significance in multivariate analysis. A MBP ≥ 91 mmHg was associated with the development of preeclampsia [adjusted odds ratio (OR) 2.60, 95% confidence interval (CI), 1.42-4.77, p = 0.002]. Increased BP during the first trimester in previously healthy pregnant women was associated with the subsequent development of preeclampsia. This is the first study on the association between BP in the early pregnancy period and the development of preeclampsia in healthy Korean pregnant women.

Highlights

Hypertensive disorders occur in approximately 10% of all pregnancies [1]
The authors analyzed the clinical characteristics of the study population by Mean BP (MBP) quartile (Table 2)
Patient weight was positively associated with MBP quartile, unlike patient height, which was not associated with MBP

Summary

Introduction

Hypertensive disorders occur in approximately 10% of all pregnancies [1]. Half (5-6%) of these disorders can be classified as preeclampsia, either alone or superimposed on chronic hypertension [1, 2]. Preeclampsia is the most critical complication causing maternal mortality and morbidity during pregnancy. In the United States, about 12% of maternal deaths between 1998 and 2005 were attributable to preeclampsia or eclampsia [3]. Since preeclampsia is a progressive disorder, premature delivery is mandatory in many cases. This preeclampsiarelated prematurity of newborns is known to result in poor neonatal outcomes [4]. The identification of risk factors for the development of preeclampsia is essential to reduce adverse pregnancy outcomes. Nulliparity, multifetal gestation, maternal age, and obesity are well-known variables associated with the development of preeclampsia [5]

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