Blood pressure patterns in the first half of pregnancy improve early prediction of preeclampsia and gestational hypertension

Newswise — Kaiser Permanente researchers discovered that routine blood pressure measurements taken during the initial stages of pregnancy can be categorized into 6 distinct patterns. These patterns accurately classify patients based on their likelihood of experiencing preeclampsia and gestational hypertension in the later stages of pregnancy.

As per the research published in the Journal of the American Heart Association on July 12, it was observed that there are 6 distinct trajectories of blood pressure during the first 20 weeks of pregnancy. These trajectories, along with various clinical, social, and behavioral risk factors, can effectively predict and classify the risk of preeclampsia and gestational hypertension in patients with low to moderate risk. Out of the identified blood pressure trajectories in early pregnancy, three were able to accurately identify 74% of the patients who later developed preeclampsia during their pregnancy. The prediction model demonstrated equal effectiveness across different racial and ethnic groups, including white, Black, Hispanic, and Asian patients involved in the study.

Lead author Erica P. Gunderson, PhD, MPH, who is a senior research scientist at the Kaiser Permanente Division of Research and a professor at the Kaiser Permanente Bernard J. Tyson School of Medicine, stated that the prediction models effectively categorized patients at higher risk of developing preeclampsia and gestational hypertension. This classification was based on the analysis of early blood pressure patterns occurring several months before the onset of these conditions.

The study involved the analysis of routine clinical blood pressure measurements and electronic medical records of nearly 250,000 pregnant patients who were in good health. Previously, another study had identified the 6 distinct blood pressure trajectories. In this new study, data from approximately 75,000 women who were not part of the earlier study were utilized. These women were categorized as low- to moderate-risk according to the current risk criteria set by the U.S. Preventive Services Task Force. It has been historically difficult to assess individual risk of preeclampsia in this particular group of patients.

According to Kari L. Carlson, MD, who serves as the associate executive director for The Permanente Medical Group, hypertensive disorders during pregnancy are significant contributors to morbidity and mortality, especially among individuals from diverse racial and ethnic backgrounds. Dr. Carlson emphasized the importance of identifying risk factors and implementing a risk stratification program along with a comprehensive treatment plan. This approach has the potential to make a significant impact on both the health of the pregnant individual and the well-being of the infant, substantially reducing the likelihood of adverse outcomes.

Co-author James M. Roberts, MD, who is a professor of obstetrics, gynecology, and reproductive science at the University of Pittsburgh, emphasized the significance of utilizing a straightforward measurement such as blood pressure, which is readily available during routine clinical care. By incorporating blood pressure readings into clinical risk assessment, healthcare professionals can more accurately identify individuals who are at the highest risk. This, in turn, enables the customization of care plans and the implementation of preventive therapies specifically tailored to those who would benefit the most.

The researchers have outlined their intention to create an automated tool that can be integrated into the electronic health record system. This tool will have the capability to identify patients in real time by analyzing their blood pressure patterns prior to 16 to 20 weeks of pregnancy. Once identified, healthcare providers can promptly inform these patients about their elevated risk for hypertensive disorders of pregnancy. Additionally, they can offer suitable interventions and provide enhanced monitoring to effectively manage and mitigate potential complications.

The study was funded by the National Heart, Lung, and Blood Institute.