Blood Pressure Profiles Across Pregnancy in Women with Chronic Hypertension

Objective To examine blood pressure patterns across pregnancy in women with treated chronic hypertension according to the occurrence of severe preeclampsia, growth restriction, and preterm birth <34 weeks. Methods This retrospective descriptive case study included only pregnant women receiving antihypertensive therapy. Using a random effects model, mean arterial pressures were plotted across gestation for women with and without preeclampsia, fetal growth restriction, and preterm birth <34 weeks with differences analyzed for each curve. Results Between January 2002 and December 2014, 447 women met inclusion criteria. Of these women, 65% developed severe preeclampsia, 24% delivered an infant weighing <10th percentile, and 15% had a preterm birth <34 weeks. Women diagnosed with either preeclampsia (23.3 vs 26.4 weeks; mean difference, 3.1 weeks; 95% confidence interval [CI], 2.3-4.3), fetal growth restriction (23.5 vs 24.9 weeks; mean difference, 1.4 weeks; 95% CI, 0.2-2.6), or preterm birth (19.8 vs 24.9 weeks; mean difference, 5.1 weeks; 95% CI, 3.7-6.9) reached a blood pressure nadir at a significantly earlier gestational age than those who did not. Conclusion For pregnant women with treated chronic hypertension, blood pressure patterns differ significantly in those who develop severe preeclampsia, fetal growth restriction, and preterm birth <34 weeks.