Am J Perinatol 2021; 38(S 01): e249-e255
DOI: 10.1055/s-0040-1709465
Original Article

ACC-AHA Diagnostic Criteria for Hypertension in Pregnancy Identifies Patients at Intermediate Risk of Adverse Outcomes

1  Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
,
1  Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
2  Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
,
Brittany L. Schuh
1  Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Ahmet A. Baschat
1  Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
,
1  Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
Funding K.C.D. and B.L.S. received funding from a Kelly Resident Research Award from the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine. A.J.V. received funding through the Eunice Kennedy Shriver National Institute of Child Health & Human Development Building Interdisciplinary Research in Women's Health (BIRCWH) Award (K12-HD085845) and the Johns Hopkins University School of Medicine Robert E. Meyerhoff Professorship Award.

Abstract

Objective The aim of the study is to compare maternal and neonatal outcomes among patients who are normotensive, hypertensive by Stage I American College of Cardiology-American Heart Association (ACC-AHA) criteria, and hypertensive by American College of Obstetricians and Gynecologists (ACOG) criteria.

Study Design Secondary analysis of a prospective first trimester cohort study between 2007 and 2010 at three institutions in Baltimore, MD, was conducted. Blood pressure at 11 to 14 weeks' gestation was classified as (1) normotensive (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] <80 mm Hg); (2) hypertensive by Stage I ACC-AHA criteria (SBP 130–139 mm Hg or DBP 80–89 mm Hg); or (3) hypertensive by ACOG criteria (SBP ≥140 mm Hg or DBP ≥90 mm Hg). Primary outcomes included preeclampsia, small for gestational age (SGA) neonate, and preterm birth.

Results Among 3,422 women enrolled, 2,976 with delivery data from singleton pregnancies of nonanomalous fetuses were included. In total, 20.2% met hypertension criteria (Stage I ACC-AHA n = 254, 8.5%; ACOG n = 347, 11.7%). The Stage I ACC-AHA group's risk for developing preeclampsia was threefold higher than the normotensive group (adjusted relative risk [aRR] 3.70, 95% confidence interval [CI] 2.40–5.70). The Stage I ACC-AHA group had lower preeclampsia risk than the ACOG group but the difference was not significant (aRR 0.87, 95% CI 0.55–1.37). The Stage I ACC-AHA group was more likely than the normotensive group to deliver preterm (aRR 1.44, 95% CI 1.02–2.01) and deliver an SGA neonate (aRR 1.51, 95% CI 1.07–2.12). The Stage I ACC-AHA group was less likely to deliver preterm compared with the ACOG group (aRR 0.65, 95% CI 0.45–0.93), but differences in SGA were not significant (aRR 1.31, 95% CI 0.84–2.03).

Conclusion Pregnant patients with Stage I ACC-AHA hypertension in the first trimester had higher rates of preeclampsia, preterm birth, and SGA neonates compared with normotensive women. Adverse maternal and neonatal outcomes were numerically lower in the Stage I ACC-AHA group compared with the ACOG group, but these comparisons only reached statistical significance for preterm birth. Optimal pregnancy management for first trimester Stage I ACC-AHA hypertension requires active study.

Key Points

  • Women with first trimester American College of Cardiology-American Heart Association (ACC-AHA) Stage I hypertension were more likely to develop preeclampsia, deliver preterm, and deliver a small-for-gestational age neonate than normotensive women.

  • Women with first trimester American College of Obstetricians and Gynecologists (ACOG) hypertension (consistent with stage II ACC-AHA hypertension) had the highest numeric rate of adverse outcomes; however, compared with Stage I ACC-AHA hypertension, there was only statistically significant difference for preterm delivery.

  • The risk profile for pregnant women with Stage I ACC-AHA hypertension and women with hypertension by conventional ACOG criteria may be more similar than previously understood.

Authors' Contributions

All authors contributed to the conception and design of the study. J.J.F. performed the statistical analyses. K.C.D. and B.L.S. drafted the manuscript and J.J.F., A.A.B., and A.J.V. revised it. All authors approved the final manuscript.


Note

A preliminary version of this report was presented in oral form at the 39th Annual Society for Maternal-Fetal Medicine Annual Pregnancy Meeting (February 11–16, 2019 in Las Vegas, NV).




Publication History

Received: 03 December 2019

Accepted: 05 March 2020

Publication Date:
23 May 2020 (online)

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