Perinatal outcomes of pregestational hypertension according to blood pressure range at 11–14 week scan: Impact of the 2017 ACC/AHA guidelines
Journal
Frontiers in Medicine
ISSN
2296-858X
Date Issued
2022
Author(s)
Alvaro Sepúlveda-Martínez
Tomas Conrads
Rodolfo Guiñez
Javiera Guiñez
Marcelo Llancaqueo
Mauro Parra-Cordero
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Objective</jats:title><jats:p>The aim of this study was to evaluate the impact on perinatal outcomes related to placental insufficiency with the application of the new 2017 ACC/AHA guidelines to a group of chronic hypertensive pregnancies during their first-trimester assessment.</jats:p></jats:sec><jats:sec><jats:title>Study design</jats:title><jats:p>This retrospective cohort study included pregnancies with preconceptional hypertension and known perinatal outcomes. In the first trimester, a combined screening for preterm preeclampsia (p-PE) was performed, including blood pressure (BP), mean uterine artery Doppler, and maternal characteristics. Patients were divided, according to the 2017 ACC/AHA consensus, into the following groups: elevated or less, Stage 1, and Stage 2. For adverse perinatal outcome assessment, univariate and multivariate regression analyses were performed, considering the “elevated or less” group as a reference. Odds ratios (OR) were compared with linear trend analysis. The main outcomes measured were preterm PE and FGR < 3<jats:italic><jats:sup>rd</jats:sup></jats:italic> percentile.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 130 included patients, 59 (45.4%) were classified as elevated or less, 47 (36.2%) as Stage 1, and 24 (18.4%) as Stage 2. p-PE showed a significant increase according to BP range [7% (OR = 1.0), 19.6% (OR = 3.2), and 21.7% (OR = 3.7)]; trend p = 0.02, for elevated or less, Stage 1, and Stage 2, respectively. There was a non-significant increased trend of FGR < 3<jats:italic><jats:sup>rd</jats:sup></jats:italic> percentile according to the BP stage. The best multivariate predictive model for p-PE included a previous PE background (OR = 15) and mean arterial pressure in mmHg (OR = 1.1).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The use of the 2017 ACC/AHA consensus in pregnancies with chronic hypertension identifies an intermediate risk group for placental-mediated diseases.</jats:p></jats:sec>
Subjects
acc/aha guidelines
;
blood pressure
;
hypertension
;
perinatal outcomes
;
pregnancy
;
acetylsalicylic acid
;
antihypertensive agent
;
adult
;
aneuploidy
;
antihypertensive therapy
;
article
;
blood pressure
;
blood pressure measurement
;
blood pressure monitoring
;
cohort analysis
;
consensus
;
controlled study
;
doppler ultrasonography
;
female
;
fetus growth
;
fetus wastage
;
first trimester pregnancy
;
human
;
intermediate risk population
;
low drug dose
;
major clinical study
;
maternal hypertension
;
mean arterial pressure
;
newborn disease
;
odds ratio
;
outcome assessment
;
perinatal period
;
placenta
;
placenta insufficiency
;
practice guideline
;
predictive model
;
preeclampsia
;
pregnant woman
;
premature labor
;
retrospective study
;
screening test
;
small for date infant
;
trend study
;
uterine artery