Maimonides Evening of Research
Fellow Winner
Rodney A. McLaren
Pregnancy Outcomes Among Women with American College of Cardiology-American Heart Association Defined Hypertension
Submitter
Rodney A McLaren, Jr. MD, Maternal Fetal Medicine Fellow, Department of Obstetrics & Gynecology
Fouad Atallah, MD, Vashisht V.D. Persad, MD, Sujatha Narayanamoorthy, MD, Nikou Gougol, MD, Michael Silver, MS, Howard Minkoff, MD (Mentor)
Objectives
Chronic hypertension in pregnancy is associated with adverse maternal and neonatal outcomes. The American College of Obstetricians & Gynecologists (ACOG) defines hypertension as SBP of 140 mmHg or higher and/or DBP of 90 mmHg or more before 20 weeks gestation. Recently, the American College of Cardiology-American Heart Association (ACC-AHA) lowered their definition of hypertension. The objective of our study was to compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women.
Methods
A historical cohort study of women with singleton, non-anomalous pregnancies who presented before 20 weeks for their first prenatal visit between January 1, 2014 and January 31, 2016 with a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age. Fisher’s exact test was used to compare demographics and risk factors between the groups. Multivariable logistic regression analysis was used to predict the association of preeclampsia within the groups adjusting for additional risk factors.
Results
A total of 252 women were included. Of these, 92 (36.5%) had hypertension by ACC-AHA, 34 (13.5%) by ACOG and 126 (50%) were normotensive. Sixty percent of women with the ACOG definition developed preeclampsia compared to 45.1% of women with the ACC-AHA definition and 17.1% in the control group (p < 0.001). The rate of preeclampsia among women with hypertension by ACC-AHA criteria was not significantly different from the rate among women with hypertension by ACOG criteria (p = 0.288). Differences in small for gestational age among the groups were not significant (p=0.423).
Conclusion Implication
Women with hypertension defined by ACC-AHA have a rate of developing preeclampsia that is similar to that of women with hypertension defined by ACOG. Women with ACC-AHA hypertension should be considered for inclusion in the ACOG definition. Prospective studies on the impact of ACC-AHA hypertension in pregnancy are needed.