Wilson, Milly G., Bone, Jeffrey N., Slade, Laura, Mistry, Hiten D., Singer, Joel, Crozier, Sarah R., Godfrey, Keith M., Baird, Janis, von Dadelszen, Peter and Magee, Laura A. (2023) Blood pressure measurement and adverse pregnancy outcomes - a cohort study testing blood pressure variability and alternatives to 140/90mmHg. BJOG: An International Journal of Obstetrics & Gynaecology. (In Press)
Abstract
Objective: to examine the relationship with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit-to-visit BP variability (BPV), adjusted for BP level.
Design: an observational study.
Setting: analysis of data from the population-based UK Southampton Women’s Survey (SWS).
Population or Sample: 3003 SWS participants.
Methods: generalised estimating equations were used to estimate crude and adjusted relative risks (RRs) of adverse pregnancy outcomes by BP thresholds, and by BPV (as standard deviation [SD], average real variability [ARV], and variability independent of the mean [VIM]). Likelihood ratios (LRs) were calculated to evaluate diagnostic test properties, for BP at or above a threshold, compared with those below.
Main Outcome Measures: gestational hypertension, severe hypertension, pre-eclampsia, preterm birth (PTB), small-for-gestational-age (SGA) infants, neonatal intensive care unit (NICU) admission.
Results: a median of 11 BP measurements were included per participant. For BP at ≥20 weeks’ gestation, higher BP was associated with more adverse pregnancy outcomes; however, only BP <140/90mmHg was a good rule-out test (negative LR <0.20) for pre-eclampsia, and BP ≥140/90mmHg a good rule-in test (positive LR >8.00) for the condition. BP ≥160/110mmHg could rule-in PTB, SGA infants, and NICU admission (positive LR >5.0). Higher BPV (by SD, ARV, or VIM) was associated with gestational hypertension, severe hypertension, pre-eclampsia, PTB, SGA, and NICU admission (adjusted RRs 1.05-1.39).
Conclusions: while our findings do not support lowering the BP threshold for pregnancy hypertension, they suggest BPV could be useful to identify elevated risk of adverse outcomes.
More information
Identifiers
Catalogue record
Export record
Contributors
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.