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Pre-Pregnancy Chronic Hypertension Evaluated

Am J Obstet Gynecol; ePub 2018 Jan 2; Nzelu, et al

The rates of development of severe hypertension, preterm preeclampsia, and small for gestational age (SGA) in women with pre-pregnancy chronic hypertension are related to use of antihypertensive medications and level of blood pressure (BP) control at the first hospital visit during the first-trimester of pregnancy. This according to a prospective study of 586 women with pre-pregnancy chronic hypertension. Patients had singleton pregnancies and were subdivided according to findings in the first visit into group 1 (n=199), with BP <140/90 mmHg without antihypertensive medication, group 2 (n=220) with BP <140/90 mmHg with antihypertensive medication, and group 3 (n=167), with systolic BP ≥140 mmHg and or diastolic BP ≥90 mmHg despite antihypertensive medication. Researchers found:

  • Median gestational age at presentation was 10.0 weeks.
  • There was a significantly higher body mass index, incidence of black racial origin, and history of preeclampsia in a previous pregnancy in groups 2 and 3 compared to group 1.
  • There was a significant increase from group 1 to group 3 in incidence of severe hypertension, preterm preeclampsia with onset at <37 weeks of gestation, and SGA, but not term preeclampsia with onset at ≥37 weeks of gestation.

Citation:

Nzelu D, Dumitrascu-Biris D, Nicolaides KH, Kametas NA. Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia and small for gestational age. [Published online ahead of print January 2, 2018]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2017.12.235.