Adverse Outcomes with Maternal Blood Pressure Less than 140/90 in Pregnancy Complicated by Hypertension

Abstract

Objective We assessed the risk of small for gestational age and other outcomes in pregnancies complicated by chronic hypertension with blood pressure <140/90 mm Hg.

Study Design Retrospective cohort of singletons with hypertension at a single institution from 2000 to 2014. Mean systolic blood pressure and mean diastolic blood pressure were analyzed as continuous and dichotomous variables (<120/80 and 120–139/80–89 mm Hg). The primary outcome was small for gestational age. Secondary outcomes included birth weight, preeclampsia, preterm birth <35 weeks, and a composite of adverse neonatal outcomes.

Results Small for gestational age was not increased with a mean systolic blood pressure <120 mm Hg compared with a mean systolic blood pressure 120 to 129 mm Hg (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI] 0.92–2.79). Mean diastolic blood pressure <80 mm Hg was associated with a decrease in the risk preeclampsia (AOR 0.57; 95% CI 0.35–0.94), preterm birth <35 weeks (AOR 0.35; 95% CI 0.20–0.62), and the composite neonatal outcome (AOR 0.42; 95% CI 0.22–0.81).

Conclusion Mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg were not associated with increased risk of small for gestational age when compared with higher, normal mean systolic and diastolic blood pressures.

Keywords

fetal - growth restriction - hypertension - preeclampsia

• References

• 1 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
• 2 Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100 (02) 369-377
• 3 Sibai BM, Abdella TN, Anderson GD. Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynecol 1983; 61 (05) 571-576
• 4 Nakhai-Pour HR, Rey E, Bérard A. Antihypertensive medication use during pregnancy and the risk of major congenital malformations or small-for-gestational-age newborns. Birth Defects Res B Dev Reprod Toxicol 2010; 89 (02) 147-154
• 5 Sibai BM, Gonzalez AR, Mabie WC, Moretti M. A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term. Obstet Gynecol 1987; 70 (3 Pt 1): 323-327
• 6 von Dadelszen P, Magee LA. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: an updated metaregression analysis. J Obstet Gynaecol Can 2002; 24 (12) 941-945
• 7 James PA, Oparil S, Carter BL. , et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (05) 507-520
• 8 Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2014; 2 (02) CD002252
• 9 Block-Abraham DM, Adamovich D, Turan OM, Doyle LE, Blitzer MG, Baschat AA. Maternal blood pressures during pregnancy and the risk of delivering a small-for-gestational-age neonate. Hypertens Pregnancy 2016; 35 (03) 350-360
• 10 Youngstrom M, Tita A, Grant J, Szychowski JM, Harper LM. Perinatal outcomes in women with a history of chronic hypertension but normal blood pressures before 20 weeks of gestation. Obstet Gynecol 2018; 131 (05) 827-834
• 11 Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstet Gynecol 2014; 124 (01) 16-22
• 12 Ankumah NA, Cantu J, Jauk V. , et al. Risk of adverse pregnancy outcomes in women with mild chronic hypertension before 20 weeks of gestation. Obstet Gynecol 2014; 123 (05) 966-972
• 13 Magee LA, von Dadelszen P, Rey E. , et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015; 372 (05) 407-417