Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy

Prediction of hypertensive complications during pregnancy remains limited, especially in healthy and initially normotensive women. We conducted a prospective screening study for hypertensive complications in pregnant women. We studied 221 nulliparous healthy and normotensive women with singleton pregnancies whose first routine visit was carried out before the twelfth week of gestation. We tested several demographic, clinical and laboratory variables as predictors of a composite pool of prespecified events, including gestational hypertension, preeclampsia or eclampsia. We analyzed the potential additive role of ECG in the identification of women at increased risk of hypertensive disorders. Mean age at entry was 30 years. During pregnancy, there were 28 prespecified events (22 women with gestational hypertension, 5 with preeclampsia and 1 with eclampsia). In univariate analyses, blood pressure (BP), weight, body mass index (BMI) and left atrial (LA) abnormality detected by ECG in lead V(1) showed an association with the risk of hypertensive disorders (all P<0.05). In a multivariable analysis, only mean BP (OR: 3.08, 95% confidence interval (CI): 1.61-5.92; P=0.001 for each 10 mm Hg increase) and LA abnormality in lead V(1) (OR: 4.35, 95% CI: 1.84-10.31; P=0.001) were independent predictors of hypertensive disorders. The final model discriminated well between women who developed hypertensive disorders and women who remained normotensive (AUC=0.75; 95% CI: 0.67-0.84; P<0.0001). This study suggests that standard ECG is valuable to refine risk stratification for hypertensive disorders in initially normotensive pregnant women. LA abnormality, easily detected by simple visual inspection of the traditional ECG, and mean arterial pressure (MAP), allows a rapid and effective risk stratification for hypertensive disorders.