(1110) Pregnancy outcomes in women with elevated and stage I blood pressures after 20 weeks gestation

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised hypertension guidelines with lower blood pressure (BP) thresholds to define hypertension (HTN). The American College of Obstetricians has not revised the definition for hypertensive disorders of pregnancy (HDP). The purpose of this study is to analyze pregnancy outcomes in women with blood pressures (BP) in the elevated and stage 1 range after 20 weeks of pregnancy.

Study Design: This was a secondary analysis of the nuMoM2b cohort, a prospective study of 10,083 nulliparous individuals with singleton pregnancies between 2010 and 2014. BP was measured at 4 research visits using a standard protocol. Women without a medical condition, whose BP was normal by ACC/AHA ( < 120/ < 80) up to 22 weeks were included in the study. Exposure was defined by BP between 22-29 weeks gestation: normal ( < 120/ < 80), elevated (120-129/ < 80), and stage 1 HTN (130-139 systolic or 80-89 diastolic). The primary outcome was HDP, which included gestational hypertension, mild and severe preeclampsia. Secondary outcomes included fetal growth restriction (FGR), placental abruption, preterm delivery, and cesarean delivery. Multivariable-adjusted odds ratio (aORs) and the corresponding 95% confidence intervals (CIs) were estimated using logistic regression models.

Results: Of 4,460 patients that met inclusion criteria, 3,832 (85.9%) had BP in the normal range, 408 (9.1%) in the elevated, and 220 (4.9%) in the stage 1 HTN range between 22-29 weeks. The incidence of HDP was significantly higher in women with BP in the elevated (9.5%) and stage 1 range (14.9%) compared to those in the normal range (5.0%, p < .001). In the adjusted model, the odds of HDP was almost double in the elevated (aOR 1.71, 95% CI 1.18,2.48) and almost three times higher in the stage 1 range (aOR 2.79, 95% CI 1.84, 4.23) compared with normal range. Women with BP in the stage 1 HTN range had twice the odds of being diagnosed with FGR (aOR 2.33, 95% CI 1.22, 4.47).

Conclusion: BP in the elevated or stage 1 range >20 weeks of pregnancy is associated with HDP and FGR.

Primary Author(s)

Natalia S. Parra, MD (she/her/hers)
Resident
Columbia University Medical Center
Columbia, New York, United States

Presenting Author(s)

Sbaa Syeda, MD
Fellow
Columbia University Irving Medical Center
New York, New York, United States

Coauthor(s)

YZ
Yijia Zhang, MPH, PhD
New York Presbyterian - Columbia
New York, New York, United States
Uma M. Reddy, MD,MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
NB
Natalie Bello, MD, MPH
Cedars Sinai Medical Center
Los Angeles, California, United States
NB
Nikolas Bletnisky, BS
New York Presbyterian - Columbia
New York, New York, United States
WB
Whitney A. Booker, MD
Columbia University Irving Medical Center
New York, New York, United States