March 11, 2025

Understanding blood pressure (BP) patterns in gestational hypertension (GH) and non-severe preeclampsia (PE) is crucial for predicting maternal health risks. A recent study highlights how increasing diastolic BP patterns may contribute to adverse maternal outcomes, shedding light on risk management strategies for expectant mothers.

Study Overview

Researchers analyzed BP trends in women with GH or non-severe PE to assess their impact on maternal health. The study was based on the expectant management group from the HYPITAT study, focusing on 384 women for a 1-week BP pattern analysis.

• Gestational Hypertension (GH): Defined as diastolic BP ≥ 95 mm Hg on two occasions at least six hours apart.
• Preeclampsia (PE): Defined as diastolic BP ≥ 90 mm Hg with proteinuria.
• BP readings were taken over one week post-admission, using k-means clustering to identify distinct BP change patterns.
• A secondary analysis of a randomized controlled trial was conducted to determine the association between BP patterns and adverse maternal outcomes, such as severe morbidity, mortality, postpartum hemorrhage, and the need for a cesarean section.

Key Findings

Four distinct diastolic BP patterns were identified:

1. Steady: 54.2% of participants
2. Increasing: 16.9% of participants
3. U-shaped: 15.4% of participants
4. Decreasing: 13.5% of participants

• BP pattern variations were influenced by ethnicity (P = .01) and initial diagnosis at admission (P = .043).
• 48.7% of women experienced adverse maternal outcomes.
• A higher proportion (41.2%) of women with adverse outcomes were taking oral BP medication at admission compared to those without adverse outcomes (34.0%).
• After adjusting for cases of severe hypertension, no significant link was found between increasing diastolic BP and adverse maternal outcomes (aOR, 1.51; P = .24).

Clinical Implications

The study suggests that an increasing diastolic BP pattern could indicate a higher risk for adverse maternal outcomes. While this may align with existing clinical knowledge, the identification of specific BP trend clusters adds quantifiable evidence to support risk assessment in pregnancy care.

Limitations

Despite valuable insights, the study faced limitations:

• Small sample size, restricting the generalizability of results.
• Intervention bias, as decisions to induce labor could have impacted outcomes.
• Lack of device standardization, with manual BP measurement assumed as per Dutch guidelines.

Conclusion

Monitoring diastolic BP trends in pregnant women with GH or non-severe PE can play a critical role in identifying those at risk for complications. At Saivie Clinic, we emphasize proactive monitoring and personalized care strategies to ensure better maternal outcomes.

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