Optimization of Simple Sphygmomanometric Blood Pressure Measurement in Routine Prenatal Care

Abstract

Background: Despite reported early subclinical hypertension of women at risk, blood pressures at threshold 140/90 mm Hg are used today to guide prenatal care. We aim to investigate the most appropriate gestation-specific threshold to measure early gestational blood pressures, allowing for a simple stratification between pregnant women at low/high risk for hypertension. Methods:Singleton pregnancies were selected at Clinic Oost-Limburg, Genk, Belgium. A standard protocol was used to measure systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) in supine and standing position, by mode of an oscillometric sphygmomanometer around 12 and 20 weeks of gestation. After delivery, outcome was categorized in normotensive or hypertensive pregnancies. In a subgroup, routine blood pressures retrieved from prenatal records were compared to standardized blood pressures. ROC analysis was used to define early gestational blood pressure thresholds with best discriminative performance for hypertension. All analyses were done in SPSS software (α ≤ 0.05).Results: A total of 780 women were measured at 12 weeks, of which 433 pregnant women were re-evaluated around 20 weeks. At both occasions, blood pressures were significantly higher in hypertensive than in normotensive pregnancies (p<0.0001). Analysis showed for DBP in standing position at cut off 79 mmHg a sensitivity, specificity, positive predictive value and negative predictive value of 72%, 64%, 15,5% and 96% at 12 weeks and 86%, 69%, 20% and 98% at 20 weeks at cut off 77 mm Hg. At 20 weeks, Area under the Curve (AUC) for DBP was 83% in standing position and 80% in supine position. For routine versus standardized blood pressure measurement, AUC was 66% versus 72% at 12 weeks and 69% versus 82% at 20 weeks, respectively. Conclusion:Simple blood pressure measurements with gestation-specific thresholds can easily be used worldwide towards improved planning of prenatal care as compared to current protocols. women who remain normotensive. Today, subclinical higher blood pressures (<140/90 mm Hg) are not considered clinically relevant. In this study, we evaluated whether early gestational diagnosis of subclinical hypertension would be helpful to identify the proportion of women destined to develop GHD, as early identification of those high risk cases could help decreasing the maternal and neonatal consequences [12]. Optimization of Simple Sphygmomanometric Blood Pressure Measurement in Routine Prenatal Methods PatientsWomen with singleton pregnancies in first or second trimester, attending the obstetric ultrasound clinic (Ziekenhuis Oost-Limburg, Genk, Belgium) for their routine obstetrics scans, were invited to

Gestational hypertensive disorders show unique patterns of circulatory deterioration with ongoing pregnancy

“…Blood pressure measurement. Blood pressure was measured twice in each participant, once in the supine and once in the standing position, to evaluate the cardiovascular orthostatic reflex response, the results of which have been reported elsewhere (54,65). Arterial blood pressure was measured from the right brachial artery using an appropriate cuff size of the automated sphygmomanometer incorporated in the impedance cardiography (ICG) monitoring device.…”

“…Hypertension is defined according to International Society for the Study of Hypertension in Pregnancy criteria as systolic and/or diastolic pressure repeatedly Ն 140 or 90 mmHg, respectively (7). As discussed elsewhere (65), blood pressures in GHD can be significantly higher than in UP, without meeting the criteria of hypertension.…”

First-Trimester Normotension Is a Weak Indicator of Normal Maternal Cardiovascular Function

“…As we reported elsewhere, first trimester values in standing position show better predictive performance for GHD than those in sitting position. 12 In addition to this, the impedance cardiography measurement (NICCOMO) also allows evaluating the orthostatic hemodynamic response after posture change between supine and active standing, which has shown to be different in preeclamptic pregnancies compared with uncomplicated pregnancies. 17 Next to this, normal reference values for a large set of maternal cardiovascular function parameters are available from a population of ≈ 1000 women with confirmed normal outcomes.…”

“…For this analysis, we only used measurements in standing position, as they show better prediction for GHD than those in sitting position. 12…”

“… First-trimester supine and standing blood pressure, cardiac output, and total peripheral resistance measurement as part of the non-invasive continuous cardiac output monitor (NICCOMO) assessment, according to a standardized protocol. 11,12 …”