Blood Pressure In Early Pregnancy Research Articles

Five-Feature Models to Predict Preeclampsia Onset Time From Electronic Health Record Data: Development and Validation Study.

Preeclampsia is a potentially fatal complication during pregnancy, characterized by high blood pressure and the presence of excessive proteins in the urine. Due to its complexity, the prediction of preeclampsia onset is often difficult and inaccurate. This study aimed to create quantitative models to predict the onset gestational age of preeclampsia using electronic health records. We retrospectively collected 1178 preeclamptic pregnancy records from the University of Michigan Health System as the discovery cohort, and 881 records from the University of Florida Health System as the validation cohort. We constructed 2 Cox-proportional hazards models: 1 baseline model using maternal and pregnancy characteristics, and the other full model with additional laboratory findings, vitals, and medications. We built the models using 80% of the discovery data, tested the remaining 20% of the discovery data, and validated with the University of Florida data. We further stratified the patients into high- and low-risk groups for preeclampsia onset risk assessment. The baseline model reached Concordance indices of 0.64 and 0.61 in the 20% testing data and the validation data, respectively, while the full model increased these Concordance indices to 0.69 and 0.61, respectively. For preeclampsia diagnosed at 34 weeks, the baseline and full models had area under the curve (AUC) values of 0.65 and 0.70, and AUC values of 0.69 and 0.70 for preeclampsia diagnosed at 37 weeks, respectively. Both models contain 5 selective features, among which the number of fetuses in the pregnancy, hypertension, and parity are shared between the 2 models with similar hazard ratios and significantPvalues. In the full model, maximum diastolic blood pressure in early pregnancy was the predominant feature. Electronic health records data provide useful information to predict the gestational age of preeclampsia onset. Stratification of the cohorts using 5-predictor Cox-proportional hazards models provides clinicians with convenient tools to assess the onset time of preeclampsia in patients.

Early pregnancy maternal blood pressure and risk of preeclampsia: Does the association differ by parity? Evidence from 14,086 women across 7 countries

ObjectiveTo determine if the relationship between blood pressure (BP) before 16 weeks’ gestation and subsequent onset of preeclampsia differs by parity, and by history of hypertensive disorders of pregnancy (HDP) in parous women. Study designData from two studies were pooled. First, routinely collected clinical data from three metropolitan hospitals in Sydney, Australia (2017–2020), where BP was measured as part of routine clinical care using validated mercury-free sphygmomanometers. Second, prospectively collected research data from the INTERBIO-21st Study, conducted in six countries, investigating the epidemiology of fetal growth restriction and preterm birth, where BP was measured by dedicated research staff using an automated machine validated for use in pregnancy. Main outcomeAdjusted odds ratios (aOR) (95% confidence interval (CI)) for the association of systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) with preeclampsia were obtained from logistic regression models. Models were adjusted for age, smoking, body mass index, previous hypertension, previous diabetes, and previous preeclampsia. Interactions for parity, and history of HDP in parous women were included. ResultsThere were 14,086 pregnancies (Sydney = 11008, INTERBIO-21st = 3078) in the pooled analyses, 6914 (49 %) were parous, of which 414 (6.0 %) had a history of HDP. Nulliparous women had a higher risk of preeclampsia (2.6 %) compared with parous women (1.5 %): [aOR (95 %CI) 3.61 (2.67, 4.94)], as did parous women with a history of HDP (15.0 %) compared with no history (0.7 %) [12.70 (8.02, 20.16)]. MAP before 16 weeks’ gestation (mean [SD] 78.8[8.6] mmHg) was more strongly associated than SBP or DBP with development of preeclampsia in parous women [2.22 (1.81, 2.74)] per SD higher MAP] compared with nulliparous women [1.58 (1.34, 1.87)] (p for interaction 0.013). There were no significant differences on the effect of blood pressure on preeclampsia in parous women by history of HDP (p for interaction 0.5465). ConclusionThe risk of preeclampsia differs according to parity and history of HDP in a previous pregnancy. Blood pressure in early pregnancy predicts preeclampsia in all groups, although more strongly associated in parous than nulliparous women, but no different in parous women by history of HDP.

Pregnancy-An Ideal Period to Identify Women at Risk for Chronic Hypertension.

Cardiovascular disease is the leading cause of mortality in women. Pregnancy is an ideal period to implement cardiovascular prevention strategies as women seek medical help. We aimed to develop a predictive model to identify women at increased risk for chronic hypertension (CH) based on information collected in the index pregnancy. Cohort of 26 511 women seen in 2 consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure at 11 to 13 weeks' gestation, and the development of preeclampsia or gestational hypertension (GH) in the index pregnancy. Logistic regression models were fitted for the prediction of the development of future CH by the 20th week of the subsequent pregnancy. The performance of screening and risk calibration of the model were assessed. In this study 1560 (5.9%) women developed preeclampsia or GH (index pregnancy), and 215 (0.8%) developed future CH, with a median of 3.0 years later. Predictors of development of future CH were maternal age, weight, and blood pressure; Black and South Asian ethnicity; family history of preeclampsia; parity; and development of preeclampsia or GH. Preeclampsia or GH detected 52.1% (45.2%-58.9%) of future CH. At a screen-positive rate of 10%, a model including maternal characteristics, early pregnancy blood pressure, and development of preeclampsia or GH detected 73.5% (67.1-79.3) of future CH. Early pregnancy maternal characteristics, blood pressure, and development of preeclampsia or GH identify three-fourths of women at risk for future CH. Our results offer an important preventative strategy for identifying women at increased risk of future CH, which is applicable worldwide.

PO1_16. Changes in early pregnancy blood pressure among nulliparas that developed a hypertensive disorder of pregnancy

PO1_16. Changes in early pregnancy blood pressure among nulliparas that developed a hypertensive disorder of pregnancy

Prediction and prevention of preeclampsia in women with preexisting diabetes: the role of home blood pressure, physical activity, and aspirin.

Women with type 1 or type 2 (preexisting) diabetes are four times more likely to develop preeclampsia compared with women without diabetes. Preeclampsia affects 9%-20% of pregnant women with type 1 diabetes and 7%-14% of pregnant women with type 2 diabetes. The aim of this narrative review is to investigate the role of blood pressure (BP) monitoring, physical activity, and prophylactic aspirin to reduce the prevalence of preeclampsia and to improve pregnancy outcome in women with preexisting diabetes. Home BP and office BP in early pregnancy are positively associated with development of preeclampsia, and home BP and office BP are comparable for the prediction of preeclampsia in women with preexisting diabetes. However, home BP is lower than office BP, and the difference is greater with increasing office BP. Daily physical activity is recommended during pregnancy, and limiting sedentary behavior may be beneficial to prevent preeclampsia. White coat hypertension in early pregnancy is not a clinically benign condition but is associated with an elevated risk of developing preeclampsia. This renders the current strategy of leaving white coat hypertension untreated debatable. A beneficial preventive effect of initiating low-dose aspirin (150 mg/day) for all in early pregnancy has not been demonstrated in women with preexisting diabetes.

Early Pregnancy Blood Pressure Trajectories Predict Preeclampsia and Gestational Hypertension Among Low Risk Pregnancies

Develop and validate a prediction model for risk of preeclampsia (PE) and gestational hypertension (GH) using early pregnancy blood pressure (BP) patterns plus risk factors (RF) routinely available in clinical settings among low and moderate risk pregnancies. Retrospective cohort of 249,892 low or moderate risk singleton pregnancies delivered at Kaiser Permanente Northern California hospitals in 2009-2019. Electronic health records excluded prior hypertension, heart, kidney or liver disease and history of PE. All BPs were < 140/90 at < 20 weeks gestation. Data were randomly divided into a training dataset (N=174,925;70%) for model development and a validation dataset (n=74,967;30%). We used group-based trajectory modeling of longitudinal clinical systolic BPs to identify early pregnancy BP trajectory (BPT) groups < 20 weeks. We fit multinomial logistic regression models to predict early PE (< 34 weeks), late PE (≥34 weeks) and GH including BPT alone or with multiple RF (BMI, parity, age, race/ethnicity, diabetes) vs. an initial BP alone or with other RF. C-statistics generated from the validation dataset evaluated model predictive performance. The sample of 249,892 low to moderate risk individuals had mean (SD) maternal age of 30.9 y (5.3), BMI of 26.0 kg/m2 (5.8), 57% were nulliparous, and 63% were from Black, Hispanic, or Asian groups, and 100% had all normal BPs < 20 weeks. Overall, 992 (0.4%) developed early PE, 10,612 (4.3%) late PE, and 10,854 (4.3%) GH. BPT group models performed much better (C-statistic:0.664-0.732) than models with initial BP only (0.630-0.700), multiple RF alone, or in combination (Table 1). The best model performance (0.729-0.768) to predict early PE, late PE and GH included BPT groups plus BMI, parity, age, race/ethnicity, and diabetes. Six BP patterns plus RF available in routine clinical care improved prediction of early and late PE, and GH in lower risk pregnancies. Our findings show promise to guide surveillance and strategies to distinguish risk among ostensibly low risk groups.

Maternal Cardiovascular Health in Early Pregnancy and Childhood Brain Structure.

Background Poor cardiovascular health during pregnancy has been associated with adverse neurocognitive outcomes in the offspring. We examined the associations of maternal cardiovascular health factors with brain structure in 10-year-old children. Methods and Results We included 2797 mother-offspring pairs from the Generation R Study. Maternal body mass index, gestational weight gain, blood pressure, insulin, glucose, and lipid blood concentrations were obtained in early pregnancy. Childhood structural brain measures, including global metrics of brain tissue volumes and white matter microstructure, were quantified by magnetic resonance imaging at 10 years. As compared with offspring of mothers with normal weight, those of mothers with underweight had smaller total brain volume (difference, -28.99 [95% CI -56.55 to -1.45] cm3). Similarly, as compared with offspring of mothers with gestational weight gain between the 25th and 75th percentile, those of mothers with gestational weight loss or no gestational weight gain (<25th percentile), had smaller total brain volume (difference, -13.07 [95% CI, -23.82 to -2.32] cm3). Also, higher maternal diastolic blood pressure in early pregnancy was associated with lower offspring white matter mean diffusivity (difference, -0.07 [95% CI, -0.11 to -0.02] SD score). After multiple testing correction, only the association of maternal diastolic blood pressure with lower offspring white matter mean diffusivity remained statistically significant. No associations were observed of maternal insulin, glucose, and lipid concentrations with childhood brain outcomes. Conclusions Our findings suggest that maternal cardiovascular health during pregnancy might be related to offspring brain development in the long term. Future studies are needed to replicate our findings and to explore the causal nature of the associations.

Home Blood Pressure for the Prediction of Preeclampsia in Women With Preexisting Diabetes.

Outside of pregnancy, home blood pressure (BP) has been shown to be superior to office BP for predicting cardiovascular outcomes. This work aimed to evaluate home BP as a predictor of preeclampsia in comparison with office BP in pregnant women with preexisting diabetes. A prospective cohort study was conducted of 404 pregnant women with preexisting diabetes; home BP and office BP were measured in early (9 weeks) and late pregnancy (35 weeks). Discriminative performance of home BP and office BP for prediction of preeclampsia was assessed by area under the receiver operating characteristic curves (AUC). In total 12% (n = 49/404) developed preeclampsia. Both home BP and office BP in early pregnancy were positively associated with the development of preeclampsia (adjusted odds ratio (95% CI) per 5 mm Hg, systolic/diastolic): home BP 1.43 (1.21-1.70)/1.74 (1.34-2.25) and office BP 1.22 (1.06-1.40)/1.52 (1.23-1.87). The discriminative performance for prediction of preeclampsia was similar for early-pregnancy home BP and office BP (systolic, AUC 69.3 [61.3-77.2] vs 64.1 [55.5-72.8]; P = .21 and diastolic, AUC 68.6 [60.2-77.0] vs 66.6 [58.2-75.1]; P = .64). Similar results were seen when comparing AUCs in late pregnancy (n = 304). In early and late pregnancy home BP was lower than office BP (early pregnancy P < .0001 and late pregnancy P < .01 for both systolic and diastolic BP), and the difference was greater with increasing office BP. In women with preexisting diabetes, home BP and office BP were positively associated with the development of preeclampsia, and for the prediction of preeclampsia home BP and office BP were comparable.

Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups.

Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality and confer 4-fold higher perinatal mortality in Black women. Early pregnancy blood pressure patterns may differentiate risk of hypertensive disorders of pregnancy. This study identified distinct blood pressure trajectories from 0 to 20 weeks' gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174 925 women with no prior hypertension or history of preeclampsia, prenatal care entry ≤14 weeks, and a stillborn or live singleton birth delivered at Kaiser Permanente Northern California hospitals in 2009 to 2019. We used electronic health records to obtain clinical outcomes, covariables, and longitudinal outpatient blood pressure measurements ≤20 weeks' gestation (mean 4.1 measurements). Latent class trajectory modeling identified 6 blood pressure groups: ultra-low-declining(referent), low-declining, moderate-fast-decline, low-increasing, moderate-stable, and elevated-stable. Multivariable logistic regression evaluated trajectory group-associations with the odds of preeclampsia/eclampsia and gestational hypertension' and effect modification by race-ethnicity and prepregnancy body size. Compared with ultra-low-declining, adjusted odds ratios (95% confidence intervals [CIs]) for low-increasing, moderate-stable, and elevated-stable groups were 3.25 (2.7-3.9), 5.3 (4.5-6.3), and 9.2 (7.7-11.1) for preeclampsia/eclampsia' and 6.4 (4.9-8.3), 13.6 (10.5-17.7), and 30.2 (23.2-39.4) for gestational hypertension. Race/ethnicity, and prepregnancy obesity modified the trajectory-group associations with preeclampsia/eclampsia (interaction P<0.01), with highest risks for Black, then Hispanic and Asian women for all blood pressure trajectories, and with increasing obesity class. Early pregnancy blood pressure patterns revealed racial and ethnic differences in associations with preeclampsia/eclampsia risk within equivalent levels and patterns. These blood pressure patterns may improve individual risk stratification permitting targeted surveillance and early mitigation strategies.

Early Pregnancy Blood Pressure Trajectories and Hypertensive Disorders: Differences by Pre-pregnancy BMI and Race/Ethnicity

To determine the associations between early pregnancy blood pressure (BP) trajectory patterns and development of hypertensive disorders of pregnancy (HDP) in women without chronic hypertension (CH) or prior preeclampsia (PE), and potential effect modification by body mass index (BMI) and race/ethnicity.

Preeclampsia and high blood pressure in early pregnancy as risk factors of severe maternal cardiovascular disease during 50-years of follow-up.

Studies suggest preeclampsia as a risk factor for long term cardiovascular diseases (CVD), while evidence is limited regarding the risk of high blood pressures (BP) in early pregnancy. A register-based follow-up of 2434 mothers in the Helsingborg Birth Cohort. Associations of high BP in early pregnancy (>95th percentile systolic [SBP], diastolic [BDP], or mean arterial BP [MAP]) during the first antenatal visit and/or preeclampsia with an incident CVD event (ischemic heart disease or stroke) were assessed. To model risks and adjust for co-variables, Cox proportional hazard regression was used. Of the included women, 120 (4.9%) had high SBP, 49 (2%) high DBP, 104 (4.3%) high MAP in early pregnancy; and 115 (4.7%) developed preeclampsia. During 52years of follow-up, totalling 121,457 person-years, 534 (21.9%) women experienced a CVD event. Women with preeclampsia had a higher risk of developing CVD compared to women without preeclampsia (HR 1.5, 95%CI: 1.1-2.2), while risks among women with high BPs were slightly higher. In adjusted analysis, risk estimates were approximately 50% higher than that of the reference groups for all four studied exposures. Of women with later CVD, 35 (6.6%) had preeclampsia, and another 31 (5,8%) women high SBP or high MAP. Without later preeclampsia, high SBP constituted a significant risk factor (HR 1.6, 95%CI: 1.1-2.4) for CVD. Women with SBP>95th percentile in early pregnancy, but without later preeclampsia, have a higher risk of developing CVD that is comparable to women with history of preeclampsia.

Associations of dietary glycemic index and load during pregnancy with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders

PurposeThe aim of this study was to examine the associations of dietary glycemic index and load with gestational blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders.MethodsIn a population-based cohort among 3378 pregnant Dutch women, dietary glycemic index and load were assessed from food frequency questionnaires at median 13.4 (95% range 9.9–22.9) weeks gestation. Blood pressure was measured in early-, mid- and late-pregnancy. Placental hemodynamic parameters were measured in mid- and late-pregnancy by ultrasound. Data on gestational hypertensive disorders was acquired from medical records.ResultsMean dietary glycemic index (SD) was 58 (3) and mean dietary glycemic load (SD) was 155 (47). Dietary glycemic index was not associated with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Higher dietary glycemic load SDS was associated with a higher diastolic blood pressure in early-pregnancy, remaining after adjustment for socio-demographic and lifestyle factors ((0.98 (95% CI 0.35–1.61) mmHg per SDS increase in glycemic load). No other associations of glycemic load with blood pressure or placental hemodynamic parameters and the risk of gestational hypertensive disorders were present. No significant associations of dietary glycemic index and load quartiles with longitudinal blood pressure patterns from early to late-pregnancy were present.ConclusionWithin this low-risk pregnant population, we did not find consistent associations of dietary glycemic index and load with blood pressure, placental hemodynamic parameters and the risk of gestational hypertensive disorders. Further studies need to assess whether the effects on gestational hemodynamic adaptations are more pronounced among high-risk women with an impaired glucose metabolism.

Green space, neighborhood walkability and cardiometabolic health in early pregnancy: The Healthy Start study

BACKGROUND AND AIM: Green space and neighborhood walkability have been associated with cardiometabolic health, but relationships with cardiometabolic markers during pregnancy are unclear. We estimated associations of residential green space and neighborhood walkability with cardiometabolic health in early pregnancy. METHODS: We included 1208 pregnant women enrolled in the Colorado-based Healthy Start study (2009-2014). During a study visit in early pregnancy (median 17 weeks of gestation), we measured systolic and diastolic blood pressure and collected fasting blood samples. We measured serum glucose and insulin and calculated the Homeostatic Model for Assessment of Insulin Resistance (HOMA-IR). We used the average Normalized Difference Vegetation Index (NDVI) in circular buffers of 250m, 500m and 1000m surrounding the participants’ homes to estimate exposure to green space. The walkability of the Census block group of the maternal residence was assessed by the National Walkability Index of 2010. Associations of green space and neighborhood walkability with cardiometabolic markers in early pregnancy were assessed by linear regression, adjusting for covariates. RESULTS:A higher average NDVI in all buffer sizes was associated with a lower diastolic blood pressure and (non-significantly) lower systolic blood pressure in early pregnancy. For example, women in the highest tertile of green space in a buffer of 500m (NDVI ≥0.21) had a 1.21mmHg [95%CI -2.23, -0.20] lower diastolic blood pressure than women in the lowest tertile. Additionally, pregnant women who lived in the most walkable neighborhoods had a 3.41mmHg [95%CI -5.31, -1.51] lower systolic and 2.18mmHg [95%CI -3.73, -0.63] lower diastolic blood pressure than women residing in the least walkable neighborhoods. We found no associations of green space or neighborhood walkability with glucose, insulin or HOMA-IR. CONCLUSIONS:In this racially and ethnically diverse population, higher exposure to residential green space and higher neighborhood walkability were associated with lower systolic and diastolic blood pressure in early pregnancy. KEYWORDS: Green space, Walkability, Female, Obesity and metabolic disorders

Abstract P174: First Trimester Blood Pressure Elevation May Have A Greater Impact On The Risk Of Spontaneous Abortion Than Preconception Blood Pressure

Background: Spontaneous abortion (SAB) is a common early pregnancy complication globally, impacting 15% of clinically recognized pregnancies. The biological pathways leading to SAB are not clearly understood, although early SAB is often attributed to chromosomal abnormalities. Elevated blood pressure (BP) in women of reproductive age predicts cardiovascular disease later in life, but less clear is whether elevated BP during preconception and/or early pregnancy BP elevations can affect prenatal outcomes. Hypothesis: Elevated BP during preconception and the first trimester will be positively associated with SAB. Methods: We conducted a secondary analysis of data collected from 577 primiparous women (15-35 years) who participated in the Longitudinal Indian Family hEalth (LIFE) prospective pregnancy cohort study in Telangana State, India. Resting blood pressure was measured by trained technicians using a standardized study protocol at a preconception registration visit and in the first trimester. Odds ratio (OR) and 95% confidence intervals (CI) of any SAB (&lt;22 weeks of gestation, n=108), early SAB (&lt;8 weeks of gestation, n=25), and late SAB (8 to &lt;22 weeks of gestation n=83) were assessed with a log link binomial distribution. Results: Preconception measurements were assessed at the first study visit, conducted at registration and within a mean±SD of 11±12 months prior to pregnancy. Higher than optimal preconception BP (120/80 mmHg) was not associated with SAB (OR adj 0.82 (95% CI 0.51, 1.32)). In contrast, first trimester elevated BP was associated with a two-fold increased likelihood of SAB, although results were of borderline significance (OR adj 2.12 (95%CI 0.87, 5.14). In addition, we observed an association between elevated first trimester BP and late SAB (OR adj 2.32 (95%CI 0.95, 5.68)); there were no associations between elevated preconception or first trimester BP and early SAB. Conclusions: We found that elevated first trimester but not preconception BP was associated with an increased risk of pregnancy loss, suggesting that dysregulated adaption to pregnancy may impact pregnancy loss more than preconception BP status, especially SABs that occur after 8 weeks gestation. Our findings support the notion that clinical and environmental factors may have a greater impact on later SABs as opposed to earlier losses. The null relationship with early pregnancy loss in our study may be due to an expected genetic mutation etiology for those losses. Studies exploring the trajectory of preconception and prenatal blood pressure changes and impact on pregnancy outcomes are warranted.

Epidemiological studies regarding hypertensive disorders of pregnancy: A review.

A hypertensive disorder of pregnancy (HDP) is defined as hypertension emerging after 20 weeks of gestation and resolving up to 12 weeks post-partum, and occurs in about 5% of all pregnancies. Complications associated with HDP have poor prognoses, and maternal deaths attributable to HDP are predicted to exceed 70 000 per year worldwide. Understanding the pathogenesis and risk factors of hypertensive disorders of pregnancy is important, and they are often investigated in observational studies. Given that therapeutic interventions cannot be controlled in observed studies, it is necessary to interpret which factors correspond to exposure and which factors correspond to confounding and intermediate factors in each study. From the Babies and their parents' longitudinal observation in the Suzuki Memorial Hospital on Intrauterine period study, blood pressure in early pregnancy was not only predictive of a child's birthweight, but the trajectory was also associated with the birthweight. From the larger-scale birth cohort studies currently conducted in Japan will provide the novel potential risk factors of hypertensive disorders of pregnancy and preventive strategies of them. In Japan, observational or intervention studies are just beginning to emerge. The continuation of both a distinctive cohort and a large cohort is needed, and the development of good quality intervention trials based on the results of observational studies is important.

Early Pregnancy Blood Pressure Elevations and Risk for Maternal and Neonatal Morbidity.

To investigate whether women with early pregnancy elevated blood pressure (BP) or stage 1 hypertension exhibit increased risk of preeclampsia and maternal or neonatal morbidity. We conducted a clinical cohort study of 18,162 women who delivered a singleton neonate from 2015 to 2018 and attended at least two prenatal appointments before 20 weeks of gestation. Data were collected within the Magee Obstetric Maternal and Infant database, an aggregate of prenatal and delivery health records. Early pregnancy BP was defined as average BP before 20 weeks of gestation, and women were classified with normal, elevated BP, stage 1 or 2 hypertension according to current guidelines. The primary outcome was preeclampsia. Secondary outcomes were severe maternal morbidity, placental abruption, gestational diabetes, and composite neonatal morbidity. Overall, 75.2% of the women were categorized with normal BP, 13.9% with elevated BP, 5.4% with stage 1 hypertension, and 5.5% with stage 2 hypertension. Risk of preeclampsia increased in a stepwise fashion with increasing BP category, adjusted for covariates (normal BP, 4.7%, referent; elevated BP, 7.3%, adjusted odds ratio [aOR] 1.29, 95% CI 1.07-1.56; stage 1, 12.3%, aOR 2.35, 95% CI 1.86-2.96), and stage 2, 30.2%, aOR 6.49, 95% CI 5.34-7.89). Results were similar among black and white women. Gestational diabetes was more prevalent among women with stage 1 (11.4%; aOR 1.50, 95% CI 1.18-1.91] and stage 2 hypertension (14.2%; aOR 1.65, 95% CI 1.30-2.10). Severe maternal morbidity and neonatal morbidity were increased only among women with stage 2 hypertension (aOR 2.99, 95% CI 2.26-3.99, and aOR 2.67, 95% CI 2.28-3.12, respectively). Women with elevated BP, and stage 1 and 2 hypertension in early pregnancy are at increased risk for preeclampsia. These findings emphasize the importance of applying the 2017 BP guidelines to reproductive-aged women. Strategies to incorporate these guidelines into obstetric care may also be warranted.

Blood Pressure and Angiogenic Markers in Pregnancy: Contributors to Pregnancy-Induced Hypertension and Offspring Cardiovascular Risk.

Pregnancy-induced hypertension is a severe pregnancy complication, increasing risk of long-term cardiovascular disease in mothers and offspring. We hypothesized that maternal blood pressure in pregnancy associated with offspring blood pressure; that the associations were sex-specific; and that maternal circulating placental angiogenic markers (PlGF [placental growth factor] and sFlt-1 [soluble fms-like tyrosine kinase-1]) mediated this relationship. We analyzed data from 2434 women and 2217 children from the Odense Child Cohort, a prospective Danish cohort study. Offspring blood pressure trajectory from 4 months to 5 years was highly associated to maternal first, second, and third trimester blood pressure, and mean blood pressure in pregnancy, independent of maternal and offspring covariates. There were offspring sex-specific associations: Girls from mothers in the highest quartile of first and third trimester blood pressure had significantly higher systolic blood pressure at 5 years than the rest of the cohort (mean difference±SEM: 1.81±0.59 and 2.11±0.59 mm Hg, respectively, all P<0.01); whereas boys had significantly higher diastolic blood pressure at 5 years (mean difference±SEM: 1.11±0.45 and 1.03±0.45, respectively, all P<0.05). Concentrations of PlGF at gestational week 28 correlated inversely to maternal gestational blood pressure trajectory, independent of the diagnosis of pregnancy-induced hypertension, adjusted β coefficients (95% CI) for predicting systolic blood pressure (SBP): -3.18 (-4.66 to -1.70) mm Hg, for predicting diastolic blood pressure (DBP): -2.48 (-3.57 to -1.40) mm Hg. In conclusion, maternal gestational blood pressure predicted offspring blood pressure trajectory until 5 years in a sex-differential manner. Furthermore, subtle alterations in blood pressure in early pregnancy preceded hypertension or preeclampsia, and PlGF was a mediator of cardiovascular health in pregnancy.

A Retrospective Study of the Associations of Body Weight, BMI and Hypertension With Preeclampsia [01D

INTRODUCTION: Preeclampsia is a leading cause of morbidity and mortality for mothers and neonates. We examined births between 2009 and 2018 in the University of Washington medical system (UW) to assess the associations between maternal body weight, body mass index (BMI), blood pressure prior to and early in pregnancy and preeclampsia. METHODS: Retrospective data-pull of births at UW. Analysis of variance and Chi Square were used to compare pregnancies with and without preeclampsia for maternal pre-pregnancy weight, BMI, pre- and early pregnancy blood pressure, and birth weight. RESULTS: Of the 5,972 births, 1024 (17.1%) were complicated with preeclampsia. Women with preeclampsia were twice as likely to deliver preterm (28.0% versus 13.2%; P&lt;.001); 30.5% of preterm births were complicated with preeclampsia. Women who experienced preeclampsia were heavier (81.6±1.5 kg versus 70.5±0.5 kg) with higher BMI (30.25±0.52 versus 26.22±0.18; P&lt;.001 for both). Obese women were twice as likely to develop preeclampsia (27.5% versus 11.4% for non-obese women). Blood pressure was higher in women who developed preeclampsia at 6–9 months preconception, 0–6 months preconception, and within the first and second trimesters (P&lt;.001 for all). Among women diagnosed with pre-existing hypertension (1,290; 21.6%), 77.3% developed preeclampsia compared to 0.6% in women without pre-existing hypertension (P&lt;.001). The high proportion of preeclamptic pregnancies that were preterm resulted in lower mean birthweight, but term infants did not differ. CONCLUSION: Obesity and elevated blood pressure as long as 9 months preconception and during early pregnancy were associated with preeclampsia. A diagnosis of hypertension pre-pregnancy is strongly associated with preeclampsia.

Associations of Maternal Early-Pregnancy Glucose Concentrations With Placental Hemodynamics, Blood Pressure, and Gestational Hypertensive Disorders.

Gestational diabetes mellitus is associated with increased risks of gestational hypertension and preeclampsia. We hypothesized that high maternal glucose concentrations in early pregnancy are associated with adverse placental adaptations and subsequently altered uteroplacental hemodynamics during pregnancy, predisposing to an increased risk of gestational hypertensive disorders. In a population-based prospective cohort study from early pregnancy onwards, among 6,078 pregnant women, maternal early-pregnancy non-fasting glucose concentrations were measured. Mid and late pregnancy uterine and umbilical artery resistance indices were assessed by Doppler ultrasound. Maternal blood pressure was measured in early, mid, and late pregnancy and the occurrence of gestational hypertensive disorders was assessed using hospital registries. Maternal early-pregnancy glucose concentrations were not associated with mid or late pregnancy placental hemodynamic markers. A 1 mmol/l increase in maternal early-pregnancy glucose concentrations was associated with 0.71 mm Hg (95% confidence interval 0.22-1.22) and 0.48 mm Hg (95% confidence interval 0.10-0.86) higher systolic and diastolic blood pressure in early pregnancy, respectively, but not with blood pressure in later pregnancy. Also, maternal glucose concentrations were not associated with the risks of gestational hypertension or preeclampsia. Maternal early-pregnancy non-fasting glucose concentrations within the normal range are associated with blood pressure in early pregnancy, but do not seem to affect placental hemodynamics and the risks of gestational hypertensive disorders.

Oxidative Stress, Neutrophil Elastase and Vascular Endothelial Growth Factor in Obese Pregnant Women with Preeclampsia

Oxidative stress, inflammation, and vascular endothelial proliferation and obesity are risk factors associated with preeclampsia (PE). Thepresent study aimed to investigate the levels of malondialdehyde (MDA) as a putative circulatory marker of oxidative stress, neutrophil Elastase (NE) as inflammatory marker andvascular endothelial growth factor (VEGF) as marker for vascular permeability-enhancing activities inobese women withpreeclampsia PE and compare withnormal pregnancy women. The study was carried out on 50 pregnant obese women with PE and 50 normal pregnant women. The preeclampsia women were characterized with high blood pressure 160/110 mmHg and proteinuria. The gestational age ranged from ≥32 weeks to &lt;37 weeks. Pre pregnancyweightwas recorded. Body mass index (BMI) was calculatedat delivery.SerumMDA, NEand VEGF were estimatedby ELISA. Significant higher levels of serum MAD,NE and VEGF were observed in obese PE patients as compared to normal controls. Our results suggested thatobesity;oxidative stress, NEandVEGFbiomarkers are risk factors for PE,emphasizing their role as feasible candidate risk markersfor cases withhigh blood pressure in early pregnancy.