Mean arterial blood pressure: potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women

Jussara Mayrink,Débora F Leite,Janete Vettorazzi,Renato T Souza,Philip Baker,Edilberto A Rocha Filho,Louise Kenny,Iracema M Calderon,Jose G Cecatti,Maria L Costa,Francisco E Feitosa

doi:10.1186/s12884-019-2580-4

Abstract

BackgroundPrediction of preeclampsia is a challenge to overcome. The vast majority of prospective studies in large general obstetric populations have failed in the purpose of obtain a useful and effective model of prediction, sometimes based on complex tools unavaible in areas where the incidence of preeclampsia is the highest. The goal of this study was to assess mean arterial blood pressure (MAP) levels at 19–21, 27–29 and 37–39 weeks of gestation and performance of screening by MAP for the prediction of preeclampsia in a Brazilian cohort of healthy nulliparous pregnant women.MethodsThis was a cohort approach to a secondary analysis of the Preterm SAMBA study. Mean arterial blood pressure was evaluated at three different time periods during pregnancy. Groups with early-onset preeclampsia, late-onset preeclampsia and normotension were compared. Increments in mean arterial blood pressure between 20 and 27 weeks and 20 and 37 weeks of gestation were also calculated for the three groups studied. The accuracy of mean arterial blood pressure in the prediction of preeclampsia was determined by ROC curves.ResultsOf the 1373 participants enrolled, complete data were available for 1165. The incidence of preeclampsia was 7.5%. Women with early-onset preeclampsia had higher mean arterial blood pressure levels at 20 weeks of gestation, compared to the normotensive group. Women with late-onset preeclampsia had higher mean arterial blood pressure levels at 37 weeks of gestation, than the normotensive groups and higher increases in this marker between 20 and 37 weeks of gestation. Based on ROC curves, the predictive performance of mean arterial blood pressure was higher at 37 weeks of gestation, with an area under the curve of 0.771.ConclusionAs an isolated marker for the prediction of preeclampsia, the performance of mean arterial blood pressure was low in a healthy nulliparous pregnant women group. Considering that early-onset preeclampsia cases had higher mean arterial blood pressure levels at 20 weeks of gestation, future studies with larger cohorts that combine multiple markers are needed for the development of a preeclampsia prediction model.

Highlights

Prediction of preeclampsia is a challenge to overcome
There were no differences between preeclampsia and control groups
mean arterial blood pressure (MAP) in the early-onset preeclampsia group showed the highest value at 20 weeks of gestation, compared to the MBP at 20h weeks a (95%CI)

Summary

Introduction

The vast majority of prospective studies in large general obstetric populations have failed in the purpose of obtain a useful and effective model of prediction, sometimes based on complex tools unavaible in areas where the incidence of preeclampsia is the highest. The majority of prospective studies in large general obstetric populations have demonstrated a modest capacity to predict preeclampsia by clinical risk factors, and approximately only a third of these cases are identified [2]. Late-onset cases of preeclampsia (with manifestation occurring at or after 34 weeks) are the majority of cases in most clinical settings. The application of such an expensive technological screening model in low and middleincome countries is unfeasible, exactly the locations where there is a higher prevalence of preeclampsia [2,3,4]

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