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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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Data availability

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

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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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Contributions

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 (2022). https://doi.org/10.1038/s41371-021-00649-7

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