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Predicting high blood pressure in pregnancy: a multivariate approach
F Broughton Pipkin1, J Sharif, S Lal
1Department of Obstetrics and Gynaecology, Nottingham University School of Medicine, Nottinghamshire, UK. fiona.broughton-pipkin@nottingham.ac.uk
Journal of Hypertension
|April 16, 1998
Summary
Early systolic hypertension before 20 weeks gestation predicts pregnancy-induced hypertension and pre-eclampsia. Body mass index and urinary calcium:creatinine ratio are also key predictors for expectant mothers.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Cardiovascular Physiology in Pregnancy
Background:
- Pregnancy-induced hypertension (PIH) and pre-eclampsia are significant causes of maternal and fetal morbidity.
- Identifying reliable predictors early in gestation is crucial for timely intervention and improved outcomes.
- Previous studies have explored various risk factors, but early predictive markers remain an area of active research.
Purpose of the Study:
- To identify early predictors of pregnancy-induced hypertension and pre-eclampsia in nulliparous women.
- To assess the predictive value of blood pressure, body mass index, and biochemical markers before 20 weeks' gestation.
- To evaluate predictive markers at approximately 28 weeks' gestation for comparison.
Main Methods:
- Prospective, randomized study involving 212 nulliparous women.
- Measurements included blood pressure, body mass index, urinary calcium:creatinine ratio, and renin-angiotensin system components (e.g., platelet angiotensin II binding site density).
- Discriminant function analysis was employed to identify significant predictors.
Main Results:
- Transient systolic hypertension before 20 weeks' gestation was associated with a doubled risk of PIH/pre-eclampsia and a fivefold increased risk of premature delivery.
- Significant predictors identified before 20 weeks included body mass index, platelet angiotensin II binding site density, and urinary calcium:creatinine ratio.
- At 28 weeks, blood pressure measurements and plasma angiotensinogen concentration were significant predictors.
Conclusions:
- A systolic blood pressure of 140 mmHg or higher before 20 weeks' gestation signifies an elevated risk for PIH, pre-eclampsia, and premature delivery.
- Biochemical markers identified early in pregnancy can aid in the rational application of prophylactic measures.
- Early identification of at-risk pregnancies allows for targeted monitoring and management strategies.