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Masked hypertension and neonatal outcome in high-risk pregnancies

Abstract

We previously showed that masked hypertension is a frequent finding in high-risk pregnancies and a strong predictor of preeclampsia/eclampsia. However, neonatal consequences of masked hypertension have not been deeply analyzed. Consequently, the aim of this study was to determine if masked hypertension is a risk factor for poor neonatal outcome. We evaluated a cohort of 588 high-risk pregnant women (29 ± 7 years old with 27 ± 6 weeks of gestation at blood pressure evaluation); 22.1%, 8.5%, 2.9%, and 2.6% had history of hypertension, diabetes, collagen diseases and chronic renal disease, respectively. According to the data of office and ambulatory blood pressures monitoring, women was classified as normotension (61.7%), white-coat hypertension (5.4%), masked hypertension (21.6%) and sustained hypertension (11.2%) respectively. Compared to normotension, all neonatal outcomes were worst in women with masked hypertension; neonates had lower mean birth weight (2577 (842) vs. 3079 (688) g, P < 0.001), higher prevalence of very low (12.1% vs 2.0%, P = .002) and extremely low birth weight (4.3% vs 0%, P < 0.001), and low one-minute APGAR score (7.8% vs 1.8%, P < 0.001). Furthermore, 14.2% needed admission to neonatal intensive care unit (NICE) (P = 0.001). Compared with normotension the risk for poor the combined neonatal outcome (admission to NICE plus still born) was significantly higher in masked hypertension (adjusted OR 2.58 95% CI 1.23–5.40) but not in white-coat hypertension (adjusted OR 0.41 95% CI 0.05–3.12). In conclusion, in high-risk pregnancies, masked hypertension was a strong and independent predictor for poor neonatal outcomes.

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Additional data are available from the corresponding author on reasonable request.

References

  1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels, J., et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X.

    Article  Google Scholar 

  2. Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One. 2014;9:e113715. https://doi.org/10.1371/journal.pone.0113715.

    Article  Google Scholar 

  3. Hnat MD, Sibai BM, Caritis S, Hauth J, Lindheimer MD, MacPherson C, et al. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine-Units. Perinatal outcome in women with recurrent preeclampsia compared with women who develop preeclampsia as nulliparas. Am J Obstet Gynecol. 2002;186:422–6. https://doi.org/10.1067/mob.2002.120280. Erratum in: Am J Obstet Gynecol. 2003 Jul;189:244. PMID: 11904601.

    Article  Google Scholar 

  4. Yücesoy G, Ozkan S, Bodur H, Tan T, Calişkan E, Vural B, et al. Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center. Arch Gynecol Obstet. 2005;273:43–9. https://doi.org/10.1007/s00404-005-0741-3.

    Article  Google Scholar 

  5. Gofton EN, Capewell V, Natale R, Gratton RJ. Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension. Am J Obstet Gynecol. 2001;185:798–803. https://doi.org/10.1067/mob.2001.117314.

    Article  CAS  Google Scholar 

  6. Steer PJ, Little MP, Kold-Jensen T, Chapple J, Elliott P. Maternal blood pressure in pregnancy, birth weight, and perinatal mortality in first births: prospective study. BMJ. 2004;329:1312. https://doi.org/10.1136/bmj.38258.566262.7C.

    Article  Google Scholar 

  7. Brown MA, Robinson A, Jones M. The white coat effect in hypertensive pregnancy: much ado about nothing?. Br J Obstet Gynaecol. 1999;106:474–80. https://doi.org/10.1111/j.1471-0528.1999.tb08301.x.

    Article  CAS  Google Scholar 

  8. Salazar MR, Espeche WG, Balbín E, Leiva Sisnieguez CE, Leiva Sisnieguez BC, Stavile RN, et al. Office blood pressure values and the necessity of out-of-office measurements in high-risk pregnancies. J Hypertens. 2019;37:1838–44. https://doi.org/10.1097/HJH.0000000000002140.

    Article  CAS  Google Scholar 

  9. Liro M, Gasowski J, Wydra D, Grodzicki T, Emerich J, Narkiewicz K. Twenty-four-hour and conventional blood pressure components and risk of preterm delivery or neonatal complications in gestational hypertension. Blood Press. 2009;18:36–43. https://doi.org/10.1080/08037050902836753.

    Article  Google Scholar 

  10. Eguchi K, Ohmaru T, Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, et al. Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy. J Hum Hypertens. 2016;30:62–7. https://doi.org/10.1038/jhh.2015.20.

    Article  CAS  Google Scholar 

  11. Waugh J, Perry IJ, Halligan AW, De Swiet M, Lambert PC, Penny JA, et al. Birth weight and 24-hour ambulatory blood pressure in nonproteinuric hypertensive pregnancy. Am J Obstet Gynecol. 2000;183:633–7. https://doi.org/10.1067/mob.2000.106448.

    Article  CAS  Google Scholar 

  12. Johnson S, Liu B, Kalafat E, Thilaganathan B, Khalil A. Maternal and perinatal outcomes of white coat hypertension during pregnancy: a systematic review and meta-analysis. Hypertension. 2020;76:157–66. https://doi.org/10.1161/HYPERTENSIONAHA.119.14627.

    Article  CAS  Google Scholar 

  13. Salazar MR, Espeche WG, Leiva Sisnieguez BC, Balbín E, Leiva Sisnieguez CE, Stavile RN, et al. Significance of masked and nocturnal hypertension in normotensive women coursing a high-risk pregnancy. J Hypertens. 2016;34:2248–52. https://doi.org/10.1097/HJH.0000000000001067.

    Article  CAS  Google Scholar 

  14. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019;366:I2381.

    Article  Google Scholar 

  15. Rodrigues Â, Barata C, Marques I, Almeida MC. Diagnosis of white coat hypertension and pregnancy outcomes. Pregnancy Hypertens. 2018;14:121–4. https://doi.org/10.1016/j.preghy.2018.08.452.

    Article  Google Scholar 

  16. Brown MA, Mangos G, Davis G, Homer C. The natural history of white coat hypertension during pregnancy. BJOG. 2005;112:601–6. https://doi.org/10.1111/j.1471-0528.2004.00516.x.

    Article  Google Scholar 

  17. Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol. 2013;209:544.e1–544.e12. https://doi.org/10.1016/j.ajog.2013.08.019.

    Article  Google Scholar 

  18. Sala ME, Romero MF, Romero A, Fasano MV, Varea AM, Carrera P, et al. Neurodevelopmental assessment of infants born to mothers with hypertensive disorder of pregnancy at six months of age. J Dev Orig Health Dis. 2021;20:1–7. https://doi.org/10.1017/S204017442100026X.

    Article  Google Scholar 

  19. Lv LJ, Ji WJ, Wu LL, Miao J, Wen JY, Lei Q, et al. Thresholds for ambulatory blood pressure monitoring based on maternal and neonatal outcomes in late pregnancy in a southern Chinese population. J Am Heart Assoc. 2019;8:e012027.

    Article  CAS  Google Scholar 

  20. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr, Collins KJ., et al. 2017 ACC/AHA/ AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–248. Published erratum appears in J Am Coll Cardiol 2018;71:2275–9.

    Article  Google Scholar 

  21. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133:e26–e50.

  22. Salazar MR, Espeche WG, Leiva Sisnieguez CE, Minetto J, Balbín E, Soria A, et al. Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies. Hypertens Res. 2021. https://doi.org/10.1038/s41440-021-00740-z.

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Acknowledgements

We acknowledge María Carolina Ferrari for the final English corrections.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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MS: Conceived and designed the analysis, performed the analysis, wrote the final version of the paper. WE: Conceived and designed the analysis, performed the analysis, wrote the final version of the paper. CLS: Performed the statistical analysis, and corrected the final version. PJ, VV and LSC: Collected and analyzed the neonatal outcomes data. EB and JM: Collected and analyzed the data of pregnant women. HC: Conceived and designed the analysis and corrected the final version.

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Correspondence to Martin R. Salazar.

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Salazar, M.R., Espeche, W.G., Leiva sisnieguez, C.E. et al. Masked hypertension and neonatal outcome in high-risk pregnancies. J Hum Hypertens 37, 36–41 (2023). https://doi.org/10.1038/s41371-021-00649-7

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