The Prediction of Adverse Outcomes in Antepartum Hypertension

Abstract

A cohort of 180 women with antepartum hypertension were studied in order to develop a method of identifying those women most likely to experience adverse outcomes from hypertension early in pregnancy so that future work could be directed toward prevention. Women with known chronic hypertension delivered an excess of small for dates, low and very low birth weight infants with a high attributable perinatal mortality. They were prognostically distinct from the women with mild blood pressure elevations first documented early in pregnancy, who experienced excellent pregnancy outcomes. Second trimester mean arterial pressure was the only early predictor of subsequent severe hypertension (P<.001). Severe hypertension, in turn, was the only predictor of adverse infant outcomes (P<.001). Since chronic hypertension can be identified before conception and is associated with an excess of adverse outcomes, it presents a unique opportunity for prospective studies of early intervention(s) aimed at prevention. Future research should require independent investigation of the prognostically distinct group of women with mild blood pressure elevation first noted early in pregnancy. Second trimester mean arterial pressure should be pursued as a method of predicting subsequent severe hypertension and may prove useful in predicting adverse infant outcomes.