Each 10% increase in the proportion of elevated home blood pressure measurements during pregnancy was associated with increased odds of developing preeclampsia (OR 1.406; 95% CI 1.136-1.792; p=0.003).
Cohort (n=86)
No
Is a higher proportion of elevated home blood pressure measurements associated with an increased risk of preeclampsia in high-risk pregnant women?
A higher proportion of elevated home blood pressure measurements during pregnancy is significantly associated with an increased risk of developing preeclampsia.
Odds Ratio: 1.406 (95% CI 1.136–1.792)
p-value: p=0.003
Objective: Hypertension during pregnancy poses significant maternal risks, including development of preeclampsia. Home blood pressure monitoring provides frequent measurements, enabling tighter control than conventional outpatient monitoring. We hypothesized that poorer blood pressure control, reflected by a higher proportion of elevated measurements, is associated with increased preeclampsia risk. Design and method: This retrospective cohort study was conducted at the outpatient clinic of the Obstetrics and Gynecology department of a large Dutch academic medical center. Eligible patients participated in our home blood pressure monitoring program, with pre-existing hypertension, a history of hypertensive disorders of pregnancy, or another condition associated with increased preeclampsia risk, and initiated monitoring before 24 weeks of gestation between January 2020 and December 2024, with at least 15 measurements. Clinical data were collected from medical records, and blood pressure measurements were extracted from the home monitoring platform Luscii. Logistic regression was used to assess the association between the proportion of elevated blood pressure measurements (systolic >=140, diastolic >=90 mmHg) and development of preeclampsia according to the 2018 ISSHP definition. Results: Of 143 pregnancies with available data, 86 met inclusion criteria, of which 25 developed preeclampsia. The median proportion of elevated measurements was 11.1% (interquartile range 2.5-26.0), with diastolic more often elevated than systolic (8.2% versus 2.5%). Women who developed preeclampsia had a significantly higher proportion of elevated measurements than those who did not (23.1% 14.3–40.7 versus 6.7% 2.3–18.1, p<0.001). For each 10% increase in elevated measurements, the odds of preeclampsia increased by 40.6% (OR 1.406, 95% confidence interval 1.136–1.792; p=0.003; Figure 1). Similar associations were observed when restricting analyses to measurements before 24 weeks of gestation (49.6%). In pregnancies complicated by preeclampsia, 18.1% 4.9–44.7 of measurements were elevated versus 4.1% 0–14 in pregnancies without preeclampsia (p=0.008); OR 1.257 (95% CI 1.042–1.535; p=0.019). Conclusions: A higher proportion of elevated home blood pressure measurements during pregnancy is associated with increased preeclampsia risk. Although studies showed that tighter blood pressure control does not prevent preeclampsia, home monitoring may capture different risk-related patterns, including time-in-range or variability. Whether modifying these patterns reduces risk needs further evaluation.
Voskamp et al. (Fri,) conducted a cohort in Hypertension during pregnancy or increased preeclampsia risk (n=86). Higher proportion of elevated home blood pressure measurements vs. Lower proportion of elevated home blood pressure measurements was evaluated on Development of preeclampsia according to the 2018 ISSHP definition (OR 1.406, 95% CI 1.136-1.792, p=0.003). Each 10% increase in the proportion of elevated home blood pressure measurements during pregnancy was associated with increased odds of developing preeclampsia (OR 1.406; 95% CI 1.136-1.792; p=0.003).