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Prehypertension in early versus late pregnancy
Jonathan Y Rosner1, Megan Gutierrez2, Margaret Dziadosz2
1a Division of Maternal Fetal Medicine, Department of OBGYN and Women's Health , Montefiore Medical Center, Albert Einstein College of Medicine , New York , NY , USA.
Summary
Early prehypertension in pregnancy significantly elevates the risk of adverse obstetrical outcomes. Late prehypertension, however, shows similar outcomes to normotensive pregnancies, with a reduced risk compared to chronic hypertension.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Health in Pregnancy
- Maternal-Fetal Medicine
Background:
- Hypertensive disorders are a major cause of maternal morbidity and mortality.
- Limited data exist on prehypertension (preHTN) during pregnancy.
- This study investigates the timing of preHTN diagnosis in relation to adverse pregnancy outcomes.
Purpose of the Study:
- To compare the risks of adverse pregnancy outcomes in women with early (<20 weeks) versus late (>20 weeks) prehypertension.
- To evaluate the association between the timing of preHTN and pregnancy-related hypertension (PRH) and composite adverse outcomes.
- To compare outcomes of early and late preHTN with normotensive and chronic hypertension groups.
Main Methods:
- Retrospective cohort study including singleton gestations.
- Patients classified into control, early preHTN, late preHTN, and chronic hypertension (CHTN) groups based on highest recorded blood pressure.
- Statistical analysis included chi-squared, Fisher's exact, Student's t-test, and Mann-Whitney U tests (p < 0.05 significance).
Main Results:
- Early preHTN was associated with significantly increased risks of PRH (OR 12.26) and composite adverse outcomes (OR 2.32) compared to normotensive controls.
- Late preHTN showed increased PRH risk (OR 4.39) versus normotensive but decreased PRH (OR 0.26) and adverse outcomes (OR 0.379) versus CHTN.
- Early preHTN carried higher risks for PRH (OR 2.85) and composite adverse outcomes (OR 1.68) compared to late preHTN.
Conclusions:
- Diagnosing prehypertension early in pregnancy (before 20 weeks) is linked to a higher risk of adverse obstetrical outcomes.
- Late prehypertension (after 20 weeks) is primarily associated with an increased risk of pregnancy-related hypertension, with other outcomes similar to normotensive women.
- The timing of prehypertension diagnosis is a critical factor in predicting pregnancy complications.
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