Diane Nzelu1, Dan Dumitrascu-Biris1, Katharine F Hunt2, Mark Cordina1, Nikos A Kametas3. 1. Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. 2. Diabetes Department, Kings College Hospital, Denmark Hill, London SE5 9RS, UK; Diabetes Research Group, Diabetes and Nutritional Sciences Division, King's College London School of Medicine, London SE5 9RJ, UK. 3. Antenatal Hypertension Clinic, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK; Harris Birthright Research Centre for Fetal Medicine, Division of Women's Health, Kings College Hospital, Denmark Hill, London SE5 9RS, UK. Electronic address: nick.kametas@kcl.ac.uk.
Abstract
OBJECTIVES: In pregnant women with previous gestational hypertension: to compare the prevalence of preeclampsia as defined by the 2001 versus the 2014 International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria, to determine the rates of fetal growth restriction (FGR) as defined, not only by birthweight centile, but in combination with fetal ultrasound studies and, finally, to determine rates of other related outcomes such as gestational diabetes (GDM) and obstetric cholestasis (OC). STUDY DESIGN: This was a retrospective observational study based at the Antenatal Hypertension Clinic, Kings College Hospital, London. Routinely collected data of 773 women booked between 2011 and 2016 with a history of gestational hypertension was analysed. All women were normotensive at booking and those with chronic hypertension were excluded. MAIN OUTCOMES MEASURES: Hypertensive disorders of pregnancy (ISSHP-2014), FGR, GDM. RESULTS: Forty-nine percent developed one or more pregnancy complications, of which 72% were hypertensive disorders of pregnancy, 25.8% preeclampsia, 25% GDM and 19% FGR. Overall recurrence rate of preeclampsia was 12.5% (ISSHP-2014). Higher blood pressure and body mass index at booking were associated with higher risk of preeclampsia and GDM. Earlier gestation of previous hypertension was associated with higher risk of preeclampsia and FGR. The ISSHP-2014 compared to the 2001 guidelines classified 56% more women as having preeclampsia. CONCLUSION: Pregnant women with a history of gestational hypertension have a 49% chance of developing a complication related to a hypertensive disorder, GDM and OC. The rate of preeclampsia was more than doubled if the updated ISSHP-2014 definition was used. Crown
OBJECTIVES: In pregnant women with previous gestational hypertension: to compare the prevalence of preeclampsia as defined by the 2001 versus the 2014 International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria, to determine the rates of fetal growth restriction (FGR) as defined, not only by birthweight centile, but in combination with fetal ultrasound studies and, finally, to determine rates of other related outcomes such as gestational diabetes (GDM) and obstetric cholestasis (OC). STUDY DESIGN: This was a retrospective observational study based at the Antenatal Hypertension Clinic, Kings College Hospital, London. Routinely collected data of 773 women booked between 2011 and 2016 with a history of gestational hypertension was analysed. All women were normotensive at booking and those with chronic hypertension were excluded. MAIN OUTCOMES MEASURES: Hypertensive disorders of pregnancy (ISSHP-2014), FGR, GDM. RESULTS: Forty-nine percent developed one or more pregnancy complications, of which 72% were hypertensive disorders of pregnancy, 25.8% preeclampsia, 25% GDM and 19% FGR. Overall recurrence rate of preeclampsia was 12.5% (ISSHP-2014). Higher blood pressure and body mass index at booking were associated with higher risk of preeclampsia and GDM. Earlier gestation of previous hypertension was associated with higher risk of preeclampsia and FGR. The ISSHP-2014 compared to the 2001 guidelines classified 56% more women as having preeclampsia. CONCLUSION: Pregnant women with a history of gestational hypertension have a 49% chance of developing a complication related to a hypertensive disorder, GDM and OC. The rate of preeclampsia was more than doubled if the updated ISSHP-2014 definition was used. Crown
Keywords:
Blood pressure; Fetal growth restriction; Gestational diabetes; Hypertension; International Society for the Study of Hypertension in Pregnancy; Preeclampsia; Recurrence