Blood Pressure and Heart Rate Variability and the Impact on Pregnancy Outcomes: A Systematic Review

Abstract

Background Long‐term (visit‐to‐visit) blood pressure variability (BPV) and heart rate variability (HRV) outside pregnancy are associated with adverse cardiovascular outcomes. Given the limitations of relying solely on blood pressure level to identify pregnancies at risk, long‐term (visit‐to‐visit) BPV or HRV may provide additional diagnostic/prognostic counsel. To address this, we conducted a systematic review to examine the association between long‐term BPV and HRV in pregnancy and adverse maternal and perinatal outcomes. Methods and Results Databases were searched from inception to May 2023 for studies including pregnant women, with sufficient blood pressure or heart rate measurements to calculate any chosen measure of BPV or HRV. Studies were excluded that reported short‐term, not long‐term, variability. Adjusted odds ratios were extracted. Eight studies (138 949 pregnancies) reporting BPV met our inclusion criteria; no study reported HRV and its association with pregnancy outcomes. BPV appeared to be higher in women with hypertension and preeclampsia specifically, compared with unselected pregnancy cohorts. Greater BPV was associated with significantly more adverse pregnancy outcomes, particularly maternal (gestational hypertension [odds ratio range, 1.40–2.15], severe hypertension [1.40–2.20]), and fetal growth (small‐for‐gestational‐age infants [1.12–1.32] or low birth weight [1.18–1.39]). These associations were independent of mean blood pressure level. In women with hypertension, there were stronger associations with maternal outcomes but no consistent pattern for perinatal outcomes. Conclusions Future work should aim to confirm whether BPV could be useful for risk stratification prospectively in pregnancy, and should determine the optimal management path for those women identified at increased risk of adverse outcomes.

JAHA Go Red for Women Spotlight on Women and Cardiovascular Disease and Stroke

“…A systematic review by Wilson et al highlighted that long‐term blood pressure variability during pregnancy, especially in women with hypertension, is associated with adverse maternal outcomes (gestational hypertension and severe hypertension), as well as adverse fetal outcomes (small for gestational age and low birth weight). 8 These findings underscore the potential for long‐term blood pressure variability to provide additional diagnostic and prognostic value beyond traditional blood pressure measurements in identifying pregnancies at risk for adverse outcomes. Another study by Kvalvik et al examined the number of pregnancies and the complications associations with each pregnancy among a Norwegian population‐based prospective study following women from 1967 to 2020.…”