Lower blood pressure achieved leads to better pregnant outcomes in non-severe chronic hypertensive pregnant women.

Abstract

To investigate the relationship between blood pressure (BP) achieved during pregnancy and pregnant outcomes in non-severe chronic hypertensive women. This retrospective cohort study included pregnant women who diagnosed as non-severe chronic hypertension and delivered in Shanghai Renji Hospital from January 2010 to March 2017. Based on their mean antenatal office diastolic BP (dBP), patients were divided into higher BP achieved (HBPA, dBP≥90mmHg) group or lower BP achieved (LBPA, dBP<90mmHg) group. Primary outcome measurement was the composite of fetal or neonatal mortality and morbidities. Secondary outcomes were the adverse maternal outcomes. Eligible 305 patients were included, among whom 98 were in HBPA group and 207 were in LBPA group. The HBPA group had significantly higher antenatal dBP [95.0±4.8 vs 81.7±5.6mmHg, P<0.001] than the LBPA group. After adjusting for six confounding factors (age, body-mass index (BMI), weeks of gestation at first antenatal visit, dBP measured at first antenatal visit, antihypertensive medication usage during pregnancy, complicating other medical condition), primary outcome [34.7% vs 15.9%, 2.30 (1.23-4.30)] was significantly higher in HBPA group. The incidences of SGA [21.4% vs 11.1%, 2.12 (1.03-4.38)], NICU admission [19.4% vs 6.3%, 3.54 (1.48-8.49)], preeclampsia with severe features [22.4% vs 10.6%, 2.23 (1.10-4.54)], severe hypertension [8.2% vs 0.5%, 15.68 (1.78-138.04)] were higher, and earlier gestational age at delivery [37.1±2.6 vs 37.7±2.1, P=0.031], lower birthweight [2861.0±780.0 vs 3059.0±616.3, P=0.029] in the HBPA group. Lower BP achieved during gestation in pregnant women with non-severe chronic hypertension (CH) might improve both fetal/neonatal and maternal outcomes.