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Systematic Review and Meta-Analysis of 24-Hour Ambulatory Blood Pressure Monitoring in Pregnancy and Postpartum
Sadie B Sommer1, James M Muchira, Etoi A Garrison
1Author Affiliations: School of Nursing, Center for Research Development and Scholarship, Vanderbilt University (Ms Sommer, Dr Muchira, Ms Chinni, and Dr Mogos); Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Dr Garrison); Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee (Ms Walden); and Medical College of Georgia, Augusta University, Augusta, Georgia (Mr van der Eerden).
Purpose:
Early detection and management of hypertensive disorders during pregnancy and postpartum are essential. This systematic review and meta analysis aimed: (1) to examine the state of 24-hour ambulatory blood pressure (ABP) use, and (2) in a subset of studies, evaluate 24-hour ABP parameters in the prediction and identification of Hypertensive Disorders of Pregnancy (HDP).
Methods:
A comprehensive literature search was conducted in March of 2022 for English language studies published after 2000. In a subset of studies in this review, we conducted a meta analysis summarizing 24-hour, day, and night standardized mean difference (hedge's g) in systolic and diastolic blood pressure during pregnancy for individuals later diagnosed with HDP and those without.
Results:
A total of 69 articles met all established criteria and were included in this systematic review, and a subgroup of studies that reported HDP outcomes (n=14) were included in the meta analysis. Out of the 69 studies, 31 (45.61%) used 24-hour ABP devices that are not validated for pregnant individuals. Birthing individuals diagnosed with HDP had elevated 24-hour, day, and night systolic and diastolic blood pressure during second and third trimesters of pregnancy.
Conclusion:
A noticeable gap exists in the utilization of validated 24-hour ABP devices for pregnant and postpartum populations. Variations exist regarding the timing of 24-hour ABP measurements, particularly across trimesters.
Implications For Practice:
24-hour ABP monitoring could serve as one of the tools to identify and manage pregnant individuals at risk of HDP and ultimately reverse the current trend in maternal mortality.
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