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May 8, 2026BMC Pregnancy and ChildbirthOpen Access

Progressing to Stage 1 hypertension before 20 weeks is linked to ~221% higher gestational hypertension risk.

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Why the study?

The study aimed to estimate the effect of early pregnancy changes between ACC/AHA blood pressure categories on adverse maternal or infant outcomes in women with no prior hypertension.

Do changes in blood pressure categories in early pregnancy affect the risk of adverse maternal and infant outcomes in women without prior hypertension?

Population

73,823 women with no prior hypertension in Zhoushan

Comparison

Nine groups based on changes between ACC/AHA BP categories across two occasions before 20 weeks of gestation

Design

Retrospective cohort study

Key result

Transitioning from normal blood pressure to Stage 1 hypertension before 20 weeks of gestation increased the risk of gestational hypertension (OR 3.21) compared to maintaining normal blood pressure.

Authors

JWJinhua WuHCHaoyue ChengYHY N Huang

Discussion

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Overview

May warrant closer monitoring in mid-pregnancy stage 1 hypertension; leaves open benefit of treatment to prevent gestational hypertension.

Key Points

  • This study aims to assess the relationship between changes in blood pressure categories during early pregnancy and the occurrence of adverse maternal and infant outcomes.
  • Retrospective cohort study using data from 73,823 women with normotension from 2002 to 2022.
  • Blood pressure categorized into normal, elevated, and stage 1 hypertension at two occasions before 20 weeks gestation.
  • Logistic regression models and bar charts utilized to analyze pregnancy outcomes based on blood pressure category changes.
  • Increased risks of gestational hypertension (OR = 3.21), preeclampsia (OR = 1.88), gestational diabetes mellitus (OR = 1.76), and postpartum hypertension (OR = 1.62) for women with normal BP at visit 1 but stage 1 hypertension at visit 2.
  • For women with stage 1 hypertension at visit 1, risks of diseases decreased with improvements in blood pressure category.
  • Similar adverse neonatal outcomes were associated with changes in blood pressure categories before 20 weeks gestation.

Study Design

Type

Cohort (n=73,823)

Multicenter

Yes

Structured PICO

Do changes in blood pressure categories in early pregnancy affect the risk of adverse maternal and infant outcomes in women without prior hypertension?

P
Population
73,823 women with no prior hypertension, with blood pressure measurements collected at two separate occasions before 20 weeks of gestation in Zhoushan from 2002 to 2022.
I
Intervention
Change in blood pressure category (normal BP, elevated BP, stage 1 hypertension per ACC/AHA guidelines) between two visits before 20 weeks of gestation.
C
Comparator
Women who retained a normal BP (or their initial BP category).
O
Outcome
Adverse maternal or infant outcomes (including gestational hypertension, preeclampsia, gestational diabetic mellitus, and postpartum hypertension).hard clinical

Main Result

Effect estimate: OR 3.21 (95% CI 2.79-3.68)

Changes in blood pressure categories before 20 weeks of gestation in women without prior hypertension are significantly associated with subsequent adverse pregnancy and delivery outcomes.

Cite This Study

Wu et al. (2026) conducted a cohort in Normotension in early pregnancy (n=73,823). Change from normal BP to Stage 1 hypertension vs. Maintained normal BP was evaluated on Gestational hypertension (OR 3.21, 95% CI 2.79-3.68). Transitioning from normal blood pressure to Stage 1 hypertension before 20 weeks of gestation increased the risk of gestational hypertension (OR 3.21) compared to maintaining normal blood pressure.

synapsesocial.com/papers/69fd7eb0bfa21ec5bbf06ecahttps://doi.org/10.1186/s12884-026-09137-7
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