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CME Credit Offered
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Poster Session 2

(662) Do Maternal Outcomes Differ by Specific Blood Pressure Parameters?

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Yossi Bart, MD

    MFM fellow
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • HM

    Hector M. Mendez-Figueroa, MD

    Associate Professor
    McGovern Medical School at UTHealth
    Houston, Texas, United States

  • Farah H. Amro, MD

    Assistant Professor
    McGovern Medical School at UTHealth Houston
    Bellaire , TX, United States

  • Baha M. Sibai, MD

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective: The role of severe hypertension (sHTN) based on isolated severe systolic or diastolic blood pressure has not been well studied. We aimed to evaluate adverse maternal outcomes in those with isolated sHTN to those with both severe systolic and diastolic hypertension.

Study Design:

We conducted a secondary analysis of the Assessment of Perinatal Excellence database. All the patients who had sHTN at the time of delivery, defined as systolic BP (SBP) ≥ 160 mmHg and/or diastolic BP (DBP) ≥ 110 mmHg on two occasions at least 30 minutes apart were included. Individuals with isolated SBP or DBP in the severe range (iSRBP) were compared to those with both (bSRBP). The primary outcome was defined as a composite of maternal outcomes, including hypertensive stroke, pulmonary edema, acute kidney injury, disseminated intravascular coagulation, cardiopulmonary arrest, and death. Multivariate logistic regression was applied to address confounders.

Results: A total of 7,788 individuals met the inclusion criteria. Of those, 5,968 (77%) had isolated SBP ≥ 160, 272 (3%) had isolated DBP ≥ 110 mmHg, and 1,548 (20%) had both. In comparison to those with bSRBP, individuals with iSRBP were older, had higher rates of obesity and multifetal gestation, and lower rates of chronic hypertension. Compared to bSRBP, those with iSRBP had lower composite outcome rates (adjusted relative risk 0.44, 95% CI 0.34-0.57), driven mainly by lower rates of pulmonary edema and acute kidney injury (Table). Intensive-care unit admission rate was also lower among individuals with iSRBP. In a sub-analysis of iSRBP, comparing individuals with isolated SBP vs. isolated DBP in the severe range, no differences in maternal outcomes were noted. Another comparison following further stratification by blood pressure showed a lower composite outcome rate among those with iSRBP compared to bSRBP when SBP was ≥ 180 mmHg (Figure).

Conclusion: Isolated severe systolic or diastolic hypertension was associated with lower rates of maternal morbidity compared to sHTN with both. This was primarily driven by lower rates of acute kidney injury and pulmonary edema.