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Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups

BACKGROUND: Clinical risk factors, a single blood pressure (BP) measurement, current biomarkers, and biophysical parameters can effectively identify risk of early‐onset preeclampsia but have limited ability to predict later‐onset preeclampsia and gestational hypertension. Clinical BP patterns hold p...

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Autores principales: Gunderson, Erica P., Greenberg, Mara, Sun, Baiyang, Goler, Nancy, Go, Alan S., Roberts, James M., Nguyen‐Huynh, Mai N., Tao, Wei, Alexeeff, Stacey E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492985/
https://www.ncbi.nlm.nih.gov/pubmed/37435795
http://dx.doi.org/10.1161/JAHA.123.029617
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author Gunderson, Erica P.
Greenberg, Mara
Sun, Baiyang
Goler, Nancy
Go, Alan S.
Roberts, James M.
Nguyen‐Huynh, Mai N.
Tao, Wei
Alexeeff, Stacey E.
author_facet Gunderson, Erica P.
Greenberg, Mara
Sun, Baiyang
Goler, Nancy
Go, Alan S.
Roberts, James M.
Nguyen‐Huynh, Mai N.
Tao, Wei
Alexeeff, Stacey E.
author_sort Gunderson, Erica P.
collection PubMed
description BACKGROUND: Clinical risk factors, a single blood pressure (BP) measurement, current biomarkers, and biophysical parameters can effectively identify risk of early‐onset preeclampsia but have limited ability to predict later‐onset preeclampsia and gestational hypertension. Clinical BP patterns hold promise to improve early risk stratification for hypertensive disorders of pregnancy. METHODS AND RESULTS: After excluding preexisting hypertension, heart, kidney, or liver disease, or prior preeclampsia, the retrospective cohort (n=249 892) all had systolic BP <140 mm Hg and diastolic BP <90 mm Hg or a single BP elevation ≤20 weeks' gestation, prenatal care at <14 weeks' gestation, and a still or live birth delivery at Kaiser Permanente Northern California hospitals (2009–2019). The sample was randomly split into development (N=174 925; 70%) and validation (n=74 967; 30%) data sets. Predictive performance of multinomial logistic regression models for early‐onset (<34 weeks) preeclampsia, later‐onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated in the validation data set. There were 1008 (0.4%), 10 766 (4.3%), and 11 514 (4.6%) patients with early‐onset preeclampsia, later‐onset preeclampsia, and gestation hypertension, respectively. Models with 6 systolic BP trajectory groups (0–20 weeks' gestation) plus standard clinical risk factors performed substantially better than risk factors alone to predict early‐ and later‐onset preeclampsia and gestational hypertension, with C‐statistics (95% CIs) of 0.747 (0.720–0.775), 0.730 (0.722–0.739), and 0.768 (0.761–0.776) versus 0.688 (0.659–0.717), 0.695 (0.686–0.704) and 0.692 (0.683–0.701), respectively, with excellent calibration (Hosmer‐Lemeshow P=0.99, 0.99, and 0.74, respectively). CONCLUSIONS: Early pregnancy BP patterns up to 20 weeks' gestation plus clinical, social, and behavioral factors more accurately discriminate hypertensive disorders of pregnancy risk among low‐to‐moderate risk pregnancies. Early pregnancy BP trajectories improve risk stratification to reveal higher‐risk individuals hidden within ostensibly low‐to‐moderate risk groups and lower‐risk individuals considered at higher risk by US Preventive Services Task Force criteria.
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spelling pubmed-104929852023-09-11 Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups Gunderson, Erica P. Greenberg, Mara Sun, Baiyang Goler, Nancy Go, Alan S. Roberts, James M. Nguyen‐Huynh, Mai N. Tao, Wei Alexeeff, Stacey E. J Am Heart Assoc Original Research BACKGROUND: Clinical risk factors, a single blood pressure (BP) measurement, current biomarkers, and biophysical parameters can effectively identify risk of early‐onset preeclampsia but have limited ability to predict later‐onset preeclampsia and gestational hypertension. Clinical BP patterns hold promise to improve early risk stratification for hypertensive disorders of pregnancy. METHODS AND RESULTS: After excluding preexisting hypertension, heart, kidney, or liver disease, or prior preeclampsia, the retrospective cohort (n=249 892) all had systolic BP <140 mm Hg and diastolic BP <90 mm Hg or a single BP elevation ≤20 weeks' gestation, prenatal care at <14 weeks' gestation, and a still or live birth delivery at Kaiser Permanente Northern California hospitals (2009–2019). The sample was randomly split into development (N=174 925; 70%) and validation (n=74 967; 30%) data sets. Predictive performance of multinomial logistic regression models for early‐onset (<34 weeks) preeclampsia, later‐onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated in the validation data set. There were 1008 (0.4%), 10 766 (4.3%), and 11 514 (4.6%) patients with early‐onset preeclampsia, later‐onset preeclampsia, and gestation hypertension, respectively. Models with 6 systolic BP trajectory groups (0–20 weeks' gestation) plus standard clinical risk factors performed substantially better than risk factors alone to predict early‐ and later‐onset preeclampsia and gestational hypertension, with C‐statistics (95% CIs) of 0.747 (0.720–0.775), 0.730 (0.722–0.739), and 0.768 (0.761–0.776) versus 0.688 (0.659–0.717), 0.695 (0.686–0.704) and 0.692 (0.683–0.701), respectively, with excellent calibration (Hosmer‐Lemeshow P=0.99, 0.99, and 0.74, respectively). CONCLUSIONS: Early pregnancy BP patterns up to 20 weeks' gestation plus clinical, social, and behavioral factors more accurately discriminate hypertensive disorders of pregnancy risk among low‐to‐moderate risk pregnancies. Early pregnancy BP trajectories improve risk stratification to reveal higher‐risk individuals hidden within ostensibly low‐to‐moderate risk groups and lower‐risk individuals considered at higher risk by US Preventive Services Task Force criteria. John Wiley and Sons Inc. 2023-07-12 /pmc/articles/PMC10492985/ /pubmed/37435795 http://dx.doi.org/10.1161/JAHA.123.029617 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Gunderson, Erica P.
Greenberg, Mara
Sun, Baiyang
Goler, Nancy
Go, Alan S.
Roberts, James M.
Nguyen‐Huynh, Mai N.
Tao, Wei
Alexeeff, Stacey E.
Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title_full Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title_fullStr Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title_full_unstemmed Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title_short Early Pregnancy Systolic Blood Pressure Patterns Predict Early‐ and Later‐Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low‐to‐Moderate Risk Groups
title_sort early pregnancy systolic blood pressure patterns predict early‐ and later‐onset preeclampsia and gestational hypertension among ostensibly low‐to‐moderate risk groups
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492985/
https://www.ncbi.nlm.nih.gov/pubmed/37435795
http://dx.doi.org/10.1161/JAHA.123.029617
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