Blood pressure measurement and adverse pregnancy outcomes: a cohort study testing blood pressure variability and alternatives to 140/90 mmHg
Blood pressure measurement and adverse pregnancy outcomes: a cohort study testing blood pressure variability and alternatives to 140/90 mmHg
Objective: To examine the association 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 <140/90 mmHg was a good rule-out test (negative LR <0.20) for pre-eclampsia and BP ≥140/90 mmHg a good rule-in test (positive LR >8.00) for the condition. BP ≥160/110 mmHg 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.
American College of Cardiology/American Heart Association guidelines, adverse pregnancy outcomes, blood pressure, hypertension, hypertensive disorders of pregnancy, pre-eclampsia, preterm birth, visit-to-visit variability
Wilson, Milly G.
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Bone, Jeffrey N.
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Slade, Laura J.
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Mistry, Hiten D.
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Singer, Joel
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Crozier, Sarah R.
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Godfrey, Keith M.
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Baird, Janis
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von Dadelszen, Peter
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Magee, Laura A.
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Wilson, Milly G.
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Bone, Jeffrey N.
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Slade, Laura J.
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Mistry, Hiten D.
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Singer, Joel
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Crozier, Sarah R.
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Godfrey, Keith M.
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Baird, Janis
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von Dadelszen, Peter
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Magee, Laura A.
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Wilson, Milly G., Bone, Jeffrey N., Slade, Laura J., 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 140/90 mmHg.
BJOG: An International Journal of Obstetrics & Gynaecology.
(doi:10.1111/1471-0528.17724).
Abstract
Objective: To examine the association 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 <140/90 mmHg was a good rule-out test (negative LR <0.20) for pre-eclampsia and BP ≥140/90 mmHg a good rule-in test (positive LR >8.00) for the condition. BP ≥160/110 mmHg 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.
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BJOG - 2023 - Wilson - Blood pressure measurement and adverse pregnancy outcomes A cohort study testing blood pressure
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Accepted/In Press date: 7 November 2023
e-pub ahead of print date: 6 December 2023
Additional Information:
Funding Information:
M. G. Wilson was funded by the KCL Centre for Doctoral Training in Data‐Driven Health (ST12512). The PRECISE Network is funded by the UK Research and Innovation Grand Challenges Research Fund GROW Award scheme (MR/P027938/1). KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator [NF‐SI‐0515‐10042] and NIHR Southampton Biomedical Research Centre [NIHR203319]) and the British Heart Foundation (RG/15/17/3174, SP/F/21/150013). For Open Access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. This work was supported by funding from a UK Research and Innovation Global Challenges Research Fund (GCRF) GROW Award (MR/P027938/1).
Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Keywords:
American College of Cardiology/American Heart Association guidelines, adverse pregnancy outcomes, blood pressure, hypertension, hypertensive disorders of pregnancy, pre-eclampsia, preterm birth, visit-to-visit variability
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Local EPrints ID: 485989
URI: http://eprints.soton.ac.uk/id/eprint/485989
ISSN: 1470-0328
PURE UUID: 3a5ca00f-2e2f-473e-a294-5bd4a8a479b9
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Date deposited: 04 Jan 2024 19:35
Last modified: 14 Aug 2024 01:38
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Contributors
Author:
Milly G. Wilson
Author:
Jeffrey N. Bone
Author:
Laura J. Slade
Author:
Hiten D. Mistry
Author:
Joel Singer
Author:
Peter von Dadelszen
Author:
Laura A. Magee
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