The assessment of blood pressure in pregnant women: pitfalls and novel approaches

Hurrell, Alice; Webster, Louise; Chappell, Lucy C; Shennan, Andrew

doi:10.1016/j.ajog.2020.10.026

Cited by 31 publications

(24 citation statements)

References 102 publications

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“…26 Recent recommendations of the American College of Cardiology and the American Heart Association to lower the threshold for the diagnosis of hypertension in nonpregnant subjects to 130/80 mm Hg 27 have now stimulated a dialogue about whether the threshold should also be applied to the diagnosis of preeclampsia. 28,29 Early evidence suggests that perinatal outcomes in pregnant women with stage 1 hypertension before 20 weeks of gestation are worse than those with normal blood pressure (stage 1 hypertension is defined as BP range 130-139/80-89 mm Hg). 30 However, more work is necessary to determine whether the diagnostic criteria should be modified.…”

Section: Ajogorgmentioning

confidence: 99%

Preeclampsia and eclampsia: the conceptual evolution of a syndrome

Erez

Romero

Jung

et al. 2022

American Journal of Obstetrics and Gynecology

129

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Section: Ajogorgmentioning

confidence: 99%

Preeclampsia and eclampsia: the conceptual evolution of a syndrome

Erez

Romero

Jung

et al. 2022

American Journal of Obstetrics and Gynecology

129

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“…Physiological and pathological changes during pregnancy may affect the accuracy of electronic sphygmomanometers. 25 Due to the limitations of the conditions at the time, the study did not use electronic sphygmomanometers certified for pregnant women, so there may be some measurement bias in BP measurement. Out-of-office (ambulatory or home) BP monitoring was not introduced in this study.…”

Section: Discussionmentioning

confidence: 99%

The relationship between high–normal blood pressure in the first half of pregnancy and the risk of hypertensive disease of pregnancy

Zou

Yang

Cai³

et al. 2022

J of Clinical Hypertension

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Early warning of hypertensive disorder in pregnancy (HDP) can improve maternal and infant outcomes. However, few studies had evaluated the warning value of highnormal blood pressure (BP) before the onset of HDP. This was a prospective cohort study to investigate the relationship between high-normal BP in the first half of pregnancy and the risk of HDP. According to the maximum BP measured before 20 +6 weeks of gestation, the cohort was divided into three groups: optimal BP (SBP < 120 mmHg and DBP < 80 mmHg), normal BP (120 mmHg ≤ SBP < 130 mmHg or 80 mmHg ≤ DBP < 85 mmHg), and high-normal BP (130 mmHg ≤ SBP < 140 mmHg or 85 mmHg ≤ DBP < 90 mmHg). The relationship between different BP levels in the first half of pregnancy and HDP risk was assessed by general linear models. Ten thousand one hundred and ninety-three normotensive pregnant women with complete information were finally included for data analysis. Among them, 532 pregnant women were diagnosed with HDP, with a total HDP incidence of 5.2%. The incidences in the optimal, normal, and high-normal BP groups were 2.4%, 6.0%, and 21.8%, respectively. Compared to women with optimal BP in the first half of pregnancy, women with high-normal BP had a 445% increased risk of HDP (aRR: 5.45, 95% CI: 4.24-7.00), and even women with normal BP had a 107% increased risk of HDP (aRR: 2.07, 95% CI: 1.68-2.56). This study demonstrated that among low-risk healthy women, women with high-normal BP in the first half of pregnancy had a significantly higher risk of HDP.

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“…Body surface area (BSA; m 2 ) was measured using the following equation: 0.007184 × height (cm) 0.725 × weight (kg) 0.425 . Systolic (SBP) and diastolic (DBP) blood pressure values were obtained manually from the brachial artery using a mercury sphygmomanometer, with the woman in a resting state, using an appropriately sized cuff 20 . Mean arterial pressure (MAP) was calculated as (2 × DBP + SBP)/3.…”

Section: Methodsmentioning

confidence: 99%

Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia

Giorgione

Melchiorre

O’Driscoll

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This study demonstrates that cardiac changes in left ventricular mass and indices of diastolic function in normotensive twin pregnancy are comparable to those observed in singleton pregnancy complicated by hypertensive disorders of pregnancy (HDP). Cardiac maladaptation in twin pregnancy was amplified in the presence of HDP, typically accompanied by increased peripheral vascular resistance compared with normotensive twin pregnancy. What are the clinical implications of this work?The similarity of cardiac findings between singleton pregnancies with HDP and normotensive twin pregnancies demonstrates the burden that twin pregnancy places on the maternal cardiovascular system, which is exacerbated further in the presence of HDP. These findings should be considered when designing effective preventative strategies in these high-risk pregnancies.

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The assessment of blood pressure in pregnant women: pitfalls and novel approaches

Cited by 31 publications

References 102 publications

Preeclampsia and eclampsia: the conceptual evolution of a syndrome

Preeclampsia and eclampsia: the conceptual evolution of a syndrome

The relationship between high–normal blood pressure in the first half of pregnancy and the risk of hypertensive disease of pregnancy

Maternal echocardiographic changes in twin pregnancies with and without pre‐eclampsia

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