Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension–Associated Risks for Newborns and Mothers

Hu, Jie; Li, Yuanyuan; Zhang, Bin; Zheng, Tongzhang; Li, Jun; Yang, Peng; Zhou, Aifen; Buka, Stephen L.; Liu, Simin; Zhang, Yiming; Shi, Kunchong; Xia, Wei; Rexrode, Kathryn M.; Xu, Shunqing

doi:10.1161/circresaha.119.314682

Cited by 57 publications

(43 citation statements)

References 49 publications

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“…We observed a prevalence of 5% for HDP in this cohort, which is consistent with findings that reported a prevalence of 4.2% for HDP in China [29]. Our results were supported by a study which suggested that exposure to high levels of PM 2.5 during early pregnancy was associated with increased prevalence of HDP [12].…”

Section: Discussionsupporting

confidence: 92%

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Zhao

Yang

et al. 2020

Environ Health

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Background Association between fine particulate matter (PM2.5) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM2.5 in early pregnancy with HDP. Methods A retrospective cohort study was performed among 8776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women’s hospital during 2014–2015. Land use regression models were used to predict individual levels of PM2.5 exposure. Results The average PM2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m− 3 [median, 51.4 μg m− 3; interquartile range, 47.3–57.8 μg m− 3]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed a positive exposure-response relationship between the PM2.5 concentration and risk of HDP. We observed an association between PM2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m− 3, 95% CI: 1.45–10.43), but not during the second trimester (RR = 0.71 per 10 μg m− 3, 95% CI: 0.40–1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46–1.38)]. Conclusion Our findings suggest that PM2.5 exposure during the first trimester is associated with the development of HDP. The effect estimate is more obvious for nulliparous women than multiparous women.

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Section: Discussionsupporting

confidence: 92%

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Zhao

Yang

et al. 2020

Environ Health

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“…[5][6][7] To our knowledge there has only been a single prior study examining the impact of applying the 2017 ACC/AHA on the prevalence of gestational hypertension, which drew its data from a group of 16 345 women from China. 8 In that study, the authors reported a 20.9% increase in the prevalence of gestational hypertension defined using the 2017 ACC/AHA criteria compared with the 7.8% increase in the current study. Although the…”

Section: Jama Network Open | Cardiologycontrasting

confidence: 39%

“…[5][6][7] To our knowledge, this is the first US-based study to examine the application of the lower threshold to women throughout the duration of pregnancy, rather than only prior to 20 weeks' gestation. 8 The objectives of this investigation were to estimate changes in diagnostic information that may result from applying the 2017 ACC/AHA BP guideline criteria to pregnant women and their offspring.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association With Maternal and Fetal Outcomes

et al. 2021

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IMPORTANCE Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. The impact of applying recent guideline definitions for nonpregnant adults to pregnant women is unclear.OBJECTIVE To determine whether reclassification of hypertensive status using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline definition better identifies women at risk for preeclampsia or eclampsia and adverse fetal/neonatal events compared with the current American College of Obstetricians and Gynecologists (ACOG) definition of hypertension. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used electronic medical record data of women who delivered singleton infants between 2009 and 2014 at a large US regional health system. Data analysis was performed from July 2020 to September 2020. EXPOSURE Application of ACC/AHA and ACOG guidelines for the definition of chronic and gestational hypertension. MAIN OUTCOMES AND MEASURESThe primary maternal end point was the development of preeclampsia or eclampsia, and the primary fetal/neonatal end point was a composite of preterm birth, small for gestational age, and neonatal intensive care unit admission within 28 days of delivery.Net reclassification indices were calculated to examine how well the lower ACC/AHA diagnostic threshold reclassifies outcomes of pregnancy compared with the current ACOG definition of hypertension. RESULTSApplying the ACC/AHA criteria to 137 389 pregnancies of women (mean [SD] age at time of delivery, 30.1 [5.8] years) resulted in a 14.3% prevalence of chronic hypertension (19 621 pregnancies) and a 13.8% prevalence of gestational hypertension (18 998 pregnancies). A 17.8% absolute increase was found in the overall prevalence of hypertension from 10.3% to 28.1%. The 2.1% of women who were reclassified with chronic rather than gestational hypertension had the highest risk of developing preeclampsia compared with women without hypertension by either criterion (adjusted risk ratio, 13.58; 95% CI, 12.49-14.77). Overall, the use of the ACC/AHA criteria to diagnose hypertension resulted in a 20.8% improvement in the appropriate identification of future preeclampsia, but only a 3.8% improvement of appropriate fetal/neonatal risk classification. CONCLUSIONS AND RELEVANCEUsing the lower diagnostic threshold for hypertension recommended in the 2017 ACC/AHA guideline increased the prevalence of chronic and gestational (continued) Key Points Question How does the prevalence of hypertension in pregnant women change when using the 2017 American College of Cardiology/American Heart Association definition, which is lower than the American College of Obstetricians and Gynecologists threshold, and is there an association with maternal or fetal outcomes? Findings In this cohort study that included 137 389 pregnancies, the prevalence of hypertension increased from 10.3% to 28.1% and resulted in a net reclassification index of 20.8% for the identification of future preeclampsia and 3.8% for the identification of fetal/ neona...

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“…We observed a prevalence of 5% for HDP in this cohort, which is consistent with findings that reported a prevalence of 4.2% for HDP in China (19). Previous studies have reported inconsistent results for the association between PM 2.5 exposure and risk of HDP.…”

Section: Discussionsupporting

confidence: 92%

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Zhao

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Association between fine particulate matter (PM 2.5 ) and hypertensive disorders of pregnancy (HDP) is inconsistent and appears to change in each trimester. We aim to investigate the association of exposure to ambient PM 2.5 in early pregnancy with HDP. A retrospective cohort study was performed among 8,776 women with singleton pregnancy who attended the antenatal clinic before 20 gestational weeks in a tertiary women’s hospital during 2014 - 2015. Land use regression models were used to predict individual levels of PM 2.5 exposure. Results The average PM 2.5 concentration during the first 20 gestational weeks ranged from 28.6 to 74.8 μg m -3 [median, 51.4 μg m -3 ; interquartile range, 47.3 - 57.8 μg m -3 ]. A total of 440 (5.0%) women was diagnosed with HDP. The restricted cubic spline showed an exposure-response relationship between the PM 2.5 concentration and risk of HDP. We observed an association between PM 2.5 exposure during the first trimester with HDP (RR = 3.89 per 10 μg m -3 , 95% CI: 1.45 - 10.43), but not during the second trimester (RR = 0.71 per 10 μg m -3 , 95% CI: 0.40 - 1.27). Compared with their counterparts, nulliparous women who were exposed to high levels of PM 2.5 in the index pregnancy had a higher risk of developing HDP [the relative excess risk due to interaction was 0.92 (0.46 - 1.38)]. Conclusion Our findings suggest that PM 2.5 exposure during the first trimester is associated with the development of HDP, and the association is modified by parity.

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Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension–Associated Risks for Newborns and Mothers

Cited by 57 publications

References 49 publications

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association With Maternal and Fetal Outcomes

Correlation between exposure to fine particulate matter and hypertensive disorders of pregnancy in Shanghai, China

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