OP 47 Risks of diabetes, fetal growth restriction and preeclampsia in women with chronic hypertension using new, more-inclusive definitions

Abstract

Question Previous studies evaluating pregnancy outcomes in chronic hypertension use older definitions of preeclampsia (i.e. co-existence of hypertension and proteinuria). Since the publication of the more inclusive criteria for preeclampsia (PE) by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2014, the impact on the reported rate of PE in women with chronic hypertension is unknown. Finally, the rate of fetal growth restriction (FGR) when incorporating fetal Doppler studies and amniotic fluid in addition to birthweight centile has not been reported. In women with chronic hypertension, our objectives were to, firstly, evaluate their pregnancy outcomes and, secondly, to compare rates of PE amongst our cohort when using the ISSHP-2001 versus the ISSHP-2014 updated criteria. Methods This study was carried out at the Antenatal Hypertension Clinic, Kings College Hospital, London. We identified 771 singleton pregnancies who booked between 2011 and 2016 with chronic hypertension. This included women with a pre-existing diagnosis of chronic hypertension or with two consecutive blood pressure readings ⩾140/90 mmHg prior to 20 weeks gestation. Results Fifty-five percent of women developed one or more pregnancy complications. The overall rate of PE according to the ISSHP-2014 criteria was 33% versus 15% when the older ISSHP-2001 definition was applied. Of the components contributing to the ISSHP-2014 diagnosis of PE, 53% was due to renal dysfunction, 42% FGR, 16% liver impairment and 11% thrombocytopenia. In 81% of women with PE there was one component present but in 17% and 2% there was an overlap of two and three components, respectively (Fig. 1). Furthermore, 26%, 16%, 14%, 1.7% and 1.3% of pregnancies were complicated by severe hypertension, gestational diabetes (GDM), FGR, placental abruption and fetal demise, respectively. Conclusions Women with chronic hypertension have a 55% risk of developing a complication in pregnancy related primarily to PE and GDM. Use of the ISSHP-2014 versus ISSHP-2001 definition classifies 55% more women as preeclamptic. Download : Download high-res image (176KB) Download : Download full-size image