Background:
Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality and 4-fold higher perinatal mortality in Black women. Early pregnancy blood pressure patterns may differentiate risk of hypertensive disorders of pregnancy.
Methods:
This study identified distinct blood pressure trajectories from 0 to 20 weeks’ gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174 925 women with no prior hypertension or history of preeclampsia, prenatal care entry ≤14 weeks, and a stillborn or live singleton birth delivered at Kaiser Permanente Northern California hospitals in 2009 to 2019. We used electronic health records to obtain clinical outcomes, covariables, and longitudinal outpatient blood pressure measurements ≤20 weeks’ gestation (mean 4.1 measurements). Latent class trajectory modeling identified 6 blood pressure groups: ultra-low-declining(referent), low-declining, moderate-fast-decline, low-increasing, moderate-stable, and elevated-stable. Multivariable logistic regression evaluated trajectory group-associations with odds of preeclampsia and gestational hypertension and effect modification by race-ethnicity and prepregnancy body size.
Results:
Compared with ultra-low-declining, adjusted odds ratios (95% CIs) for low-increasing, moderate-stable, and elevated-stable groups were 3.25 (2.7–3.9), 5.3 (4.5–6.3), and 9.2 (7.7–11.1) for preeclampsia, and 6.4 (4.9–8.3), 13.6 (10.5–17.7), and 30.2 (23.2–39.4) for gestational hypertension. Race/ethnicity, and prepregnancy obesity modified the trajectory-group associations with preeclampsia (interaction
P
<0.01), with highest risks for Black, then Hispanic and Asian women for all blood pressure trajectories, and with increasing obesity class.
Conclusions:
Early pregnancy blood pressure patterns revealed racial and ethnic differences in associations with preeclampsia risk within equivalent levels and patterns. These blood pressure patterns may improve individual risk stratification permitting targeted surveillance and early mitigation strategies.
Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center
