Abstract
We investigated whether a smaller reduction in 2nd trimester blood pressure (BP) is associated with the development of gestational hypertensive disease. We conducted a retrospective cohort study utilizing a clinical database at an urban safety-net hospital. Individuals ages 18-40 with a singleton gestation and 1st trimester prenatal care were included. Those with chronic hypertension were excluded. Systolic BP (SBP), diastolic BP (DBP), & mean arterial pressure (MAP) decrease were calculated. The outcome variable, gestational hypertensive disease (GHDP) included gestational hypertension and preeclampsia with and without severe features. Of N=3,355 individuals that met inclusion criteria, 18% had GHDP. The mean gestational age of 1st trimester and 2nd trimester BP values were 9.8±2.1 and 23.5±2.3weeks. Those with GHDP compared to those without GHDP had a significantly higher mean 1st trimester SBP (p<0.01), DBP (p<0.01), and MAP (p<0.01). Those with GHDP compared to those without GHDP had a significantly smaller decrease between 1st and 2nd trimester SBP (-1.7±12.3 vs -2.9±11.8, p<0.001) and MAP (-2.1±8.4 vs -2.7±7.9, p=0.01). Those with GHDP compared to those without GHDP had a smaller DBP decrease but it was not statistically significant (-2.3±8.7 vs -2.7±8.2, p=0.19). Pregnant individuals who experienced a smaller decrease in SBP and MAP were more likely to develop GHDP. A reduced physiologic drop in 2nd trimester BP may suggest underlying vascular dysregulation. Future studies investigating biological mechanisms driving diminished 2nd trimester BP decline, utilizing non-invasive hemodynamic monitoring, are necessary.
Published Version
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