Abstract 12091: Prehypertension Before Pregnancy is Associated With Increased Risk for Hypertensive Disorders in Pregnancy and Gestational Diabetes Mellitus
Introduction: Chronic hypertension prior to pregnancy is a known risk factor fordevelopment ofpreeclampsia/eclampsia (PE/E) and gestational diabetes mellitus (GDM), but data on the effects of modestly elevated blood pressure (EBP) before pregnancy are scant. We hypothesized that pre-pregnancy prehypertension (preHTN) is associated with increased risk for hypertensive disorders in pregnancy and GDM.
Methods: The study population consisted of 10,459 women who had prenatal care and delivered a live singleton neonate at ≥20 weeks gestation at Kaiser Permanente Bellflower Medical Center in 2006-2010. HTN and preHTN in the year prior to pregnancy, demographics and anthropometrics, were identified from electronic health records. Women with pre-pregnancy HTN, defined as 2 HTN diagnoses (ICD-9 401-405), HTN diagnosis and antihypertensive medication, HTN diagnosis and EBP (SBP≥140 or DBP≥90) or 2 consecutive EBPs at separate ambulatory visits, were excluded from analysis (n=332). PreHTN was defined as 2 consecutive EBPs (120≤SBP≤140 or 80≤DBP≤90) at separate ambulatory visits. Hypertension in pregnancy, including PE/E, was identified by ICD-9 642.3-642.6 and 642.9. Mid-pregnancy 75-g oral glucose tolerance tests were used to identify GDM by recently established IADPSG criteria: any fasting glucose ≥92, 1-hr ≥180 or 2-hr ≥153 mg/dl. Multivariable logistic regression was used to test the association between pre-pregnancy preHTN and any hypertensive disorder, PE/E and GDM, adjusting for maternal age, race/ethnicity, parity, prenatal smoking and pre-pregnancy BMI.
Results: Among 10,127 women (75% Hispanic; mean±SD age: 29±6 yrs; mean±SD BMI: 27.5±6.1 kg/m2), 2,092 (20.7%) were identified as having pre-pregnancy preHTN. Overall, 851 (8.4%) developed hypertension in pregnancy, of whom 491 (4.9%) had PE/E, and 2,352 (23.2%) developed GDM. After covariate adjustment, women with preHTN in the year prior to pregnancy were 2.23 (95% CI: 1.90-2.62), 1.89 (95% CI: 1.53-2.34) and 1.28 (95% CI: 1.14-1.44) times as likely to develop any hypertension, PE/E and GDM, respectively, compared to normotensive women.
Conclusions: Prehypertension before pregnancy may warrant early screening or intervention to prevent hypertensive disorders in pregnancy and GDM.
- © 2013 by American Heart Association, Inc.