Skip to main content
SMFM 2025 Pregnancy Meeting Main banner
Final Program


Program Book
Icon Legend
Presentation Icons
Additional registration fee required
Additional registration fee required
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Poster Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Back

Oral Concurrent Session 5 - Hypertension

Oral Concurrent Sessions

Oral Concurrent Session 5 - Hypertension

(60) Severe Systolic Hypertension and Adverse Maternal Outcomes

Friday, January 31, 2025
2:15 PM – 2:30 PM  
Location: Aurora Ballroom B, Lobby Level

    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 , Texas, United States

  • Baha M. Sibai, MD

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

Objective: Severe hypertension (sHTN) in pregnancy is associated with maternal morbidity. The specific role of sHTN based on isolated severe systolic blood pressure has not been well studied. We aimed to examine whether sHTN diagnosed by elevated systolic BP (SBP) alone is associated with adverse maternal outcomes.

Study Design:

We conducted a secondary analysis of the Assessment of Perinatal Excellence (APEX) database. We included all the patients who had hypertension at the time of delivery, defined as SBP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg on two occasions at least 30 minutes apart. We excluded individuals with diastolic BP ≥ 110 mmHg. Our reference group were those with mild HTN, defined as: systolic BP 140-159 and/or diastolic BP 90-109. We had 3 comparison groups; group I: SBP 160-179, group II: SBP 180-199, and group III: SBP > 200 mmHg. 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. Poisson regression was applied to address possible confounders.

Results:

Overall, 38,245 individuals met the inclusion criteria, of which 32,277 (84%) had mild HTN and 5,968 (16%) had severe systolic HTN. Of those, 3,790 (63%) had SBP 160-179, 1,903 (32%) had SBP 180-199, and 275 (5%) had SBP > 200 mmHg. Higher SBP was associated with higher rates of advanced maternal age, obesity, preterm birth, and chronic HTN. Following adjustment, higher systolic BP was associated with higher rates of the composite outcome, driven mainly by higher rates of pulmonary edema and acute kidney injury. The relative risk for composite maternal outcome was 2.93 (95% CI 2.24-3.85) for SBP 160-179 mmHg, 3.92 (95% CI 2.88-5.33) for SBP 180-199, and 6.74 (95% CI 4.01-11.31) for SBP ≥ 200 mmHg. Further stratification to 10 mmHg intervals of SBP demonstrate the dose-dependent association with the composite outcome (Figure).

Conclusion:

Compared to mild HTN, severe HTN diagnosed by SBP alone was associated with maternal morbidity in a dose-dependent fashion.