T Lee-Ann Hawkins1, Mark A Brown2, George J Mangos3, Gregory K Davis4. 1. Departments of Medicine and Obstetrics and Gynaecology, University of Calgary, Alberta, Canada. 2. Department of Women's Health, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia; Departments of Renal Medicine and Medicine, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia. Electronic address: mbrown@unsw.edu.au. 3. Department of Women's Health, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia; Departments of Renal Medicine and Medicine, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia. 4. Department of Women's Health, St. George Hospital, University of New South Wales, Kogarah, NSW, Australia.
Abstract
OBJECTIVE: Pregnancy outcome in women with transient gestational hypertension (TGH);defined as de novo blood pressure elevation after 20weeks gestation that normalizes by subsequent evaluation in a Day Assessment Unit. STUDY DESIGN: Retrospective cohort analysis of hypertensive pregnancies between 2003 and 2008. MAIN OUTCOME MEASURES: Final hypertensive delivery diagnosis and composites of adverse maternal and fetal outcome. RESULTS: Overall 1417 women were referred; 890 met criteria; 41% (65% of study population) had TGH. Twenty percent with TGH developed gestational hypertension and 19% preeclampsia. Women with TGH who developed preeclampsia had similar composite adverse maternal outcomes to other preeclamptic women (51% vs. 63%; p=0.24) but fewer adverse fetal outcomes (50% vs. 71%; p<0.01) due to less prematurity (30% vs. 45%; p=0.02) and small for gestational age babies (33% vs. 51%; p=0.02). Within the TGH population;developing gestational hypertension or preeclampsia was associated with referral at gestation <33weeks (RRR 2.8; p<0.01);initial average systolic blood pressure 130-139mmHg (RRR 2.1; p<0.01) and initial average diastolic blood pressure 80-89mmHg (RRR 3.2; p<0.01). CONCLUSION: TGH after 20weeks is common in pregnancy. Although initial assessment implies low risk;the risk of progression to gestational hypertension or preeclampsia is substantial and warrants appropriate clinical surveillance.
OBJECTIVE: Pregnancy outcome in women with transient gestational hypertension (TGH);defined as de novo blood pressure elevation after 20weeks gestation that normalizes by subsequent evaluation in a Day Assessment Unit. STUDY DESIGN: Retrospective cohort analysis of hypertensive pregnancies between 2003 and 2008. MAIN OUTCOME MEASURES: Final hypertensive delivery diagnosis and composites of adverse maternal and fetal outcome. RESULTS: Overall 1417 women were referred; 890 met criteria; 41% (65% of study population) had TGH. Twenty percent with TGH developed gestational hypertension and 19% preeclampsia. Women with TGH who developed preeclampsia had similar composite adverse maternal outcomes to other preeclamptic women (51% vs. 63%; p=0.24) but fewer adverse fetal outcomes (50% vs. 71%; p<0.01) due to less prematurity (30% vs. 45%; p=0.02) and small for gestational age babies (33% vs. 51%; p=0.02). Within the TGH population;developing gestational hypertension or preeclampsia was associated with referral at gestation <33weeks (RRR 2.8; p<0.01);initial average systolic blood pressure 130-139mmHg (RRR 2.1; p<0.01) and initial average diastolic blood pressure 80-89mmHg (RRR 3.2; p<0.01). CONCLUSION: TGH after 20weeks is common in pregnancy. Although initial assessment implies low risk;the risk of progression to gestational hypertension or preeclampsia is substantial and warrants appropriate clinical surveillance.