Maternal Outcomes Associated With Lower Range Stage 1 Hypertension

Area of Science:

• Cardiology
• Obstetrics & Gynecology
• Maternal-Fetal Medicine

Background:

• The revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines for hypertension may reclassify healthy pregnant women.
• Stage 1 hypertension in pregnancy, previously considered normal, may indicate increased risks.

Purpose of the Study:

• To evaluate maternal and neonatal outcomes in nulliparous women with stage 1 hypertension under new ACC/AHA guidelines.
• To assess the impact of low-dose aspirin on outcomes in this population.

Main Methods:

• Secondary analysis of a randomized, double-blind, placebo-controlled trial.
• Included 2,947 nulliparous women with singleton pregnancies.
• Blood pressure measured between 13-25 weeks gestation; outcomes adjudicated from medical records.

Main Results:

• 164 women (5.6%) met criteria for stage 1 hypertension (BP 130-135/80-85 mmHg).
• In the placebo group, stage 1 hypertension was linked to increased preeclampsia (15.3% vs 5.4%), gestational diabetes (6.1% vs 2.5%), and preterm birth (4.2% vs 1.1%).
• Low-dose aspirin did not significantly alter rates of preeclampsia, gestational diabetes, or preterm birth in women with stage 1 hypertension compared to normotensive women.

Conclusions:

• The new ACC/AHA hypertension guidelines identify a cohort of pregnant women at higher risk.
• This includes increased risks for preeclampsia, gestational diabetes mellitus, and preterm birth.
• Low-dose aspirin did not appear to mitigate these risks in women with newly identified stage 1 hypertension.