Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13 weeks.

OBJECTIVES: To examine the performance of screening for hypertensive disorders in pregnancy and to compare systolic blood pressure (BP), diastolic BP, and mean arterial pressure (MAP) measured by validated automated devices in a large population of pregnant women at 11-13 weeks.
METHODS: We recorded maternal variables and measured BP by automated devices in 9149 women with singleton pregnancies. The performance of screening for preeclampsia (PE) and gestational hypertension (GH) by combinations of disease-specific maternal factor-derived a priori risk with systolic BP, diastolic BP, and MAP was determined.
RESULTS: There were 8061 cases that were unaffected by PE or GH, 37 that developed PE requiring delivery before 34 weeks (early-PE), 128 with late-PE, and 140 with GH. The systolic BP, diastolic BP, and MAP were significantly higher in early-PE, late-PE, and GH than in the controls (p < 0.0001). The systolic BP was significantly higher in early-PE than in late-PE (p = 0.008) and both systolic BP and MAP were significantly higher in early-PE than in GH (p < 0.01). The best performance in screening was provided by MAP. The detection rate of early-PE at a 10% false-positive rate increased from 47% in screening by maternal factor-derived a priori risk alone to 76% in screening by its combination with MAP. The respective detection rates for late-PE increased from 41 to 52% and for GH increased from 31 to 48%.
CONCLUSION: The measurement of BP can be combined with the maternal factor-derived a priori risk to provide effective first-trimester screening for PE and GH.