Poster Session 1
Rebecca Horgan, MD
Assistant Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, VA, United States
Erkan Kalafat, MD, MSc
Associate Professor
Koc University Hospital
Istanbul, Istanbul, Turkey
Elena Sinkovskaya, MD, PhD
Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
Alfred Z. Abuhamad, MD
President, Provost and Dean
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
George R. Saade, MD (he/him/his)
Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
To assess the relationship between 1st trimester blood pressure (BP) classified according to American Heart Association (AHA) guidelines and risk of preeclampsia.
Study Design:
This was a prospective longitudinal cohort study which enrolled patients at ≤ 13+6 weeks’ gestation. Data was obtained by trained research coordinators. At the 1st trimester study visit, baseline BP was classified per AHA guidelines (normal, elevated, stage I hypertension (HTN), stage II HTN). The primary outcome was the incidence of preeclampsia, defined per ACOG criteria. Cox-proportional hazard model was used to investigate the association between HTN categories and development of preeclampsia.
Results:
617 patients were included. 92 developed the primary outcome. In the first trimester, 62.2% of patients had normal BP, 15.1% had elevated BP, 20.0% had stage I HTN, and 2.8% had stage II HTN. The incidence of preeclampsia increased based on AHA classification (7.6%, 20.4%, 27.6%, 58.8%, P< 0.001, Figure 1). Compared to AHA normal BP in the 1st trimester, elevated (aHR: 2.55, 95% CI: 1.42- 4.56, P=0.002), stage I (aHR: 3.52, 95% CI: 2.10-5.89, P< 0.001) and stage II HTN (aHR: 7.58, 95% CI: 3.48-16.5, P< 0.001) had significant association with preeclampsia after adjusting for risk factors, race, and body-mass index. The Cox-regression model using AHA classification had a significantly higher concordance index compared to the model using the current classification of a singular 140mm/Hg systolic and 90mm/Hg diastolic cut-off (0.71±0.028 vs. 0.56±0.019, P< 0.001). The significant associations remained in sensitivity analyses excluding pregnancies with pre-gestational hypertension (7.4%, 20.2%, 26.2%, 33.3%, P< 0.001; 0.67±0.031 vs. 0.51±0.011, P< 0.001).
Conclusion:
First trimester BP per AHA guidelines had significant independent association with preeclampsia. AHA classification outperformed HTN diagnosis based on 140/90 mm/Hg cut-off, with all categories having more than the 10% risk of preeclampsia that was used by the USPSTF to recommend low dose aspirin.
