November 08, 2022
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Gunderson EP. Gunderson EP. Presentation at: American Heart Association Scientific Sessions, Nov. 5-7th 2022; Chicago (hybrid).
Disclosures:
Gunderson reports no relevant financial disclosures.
CHICAGO — Routinely measured BP patterns observed during the first half of gestation may reveal “hidden risk” for a hypertensive disorder of pregnancy among ostensibly low-risk women, according to a speaker.
For many women, hypertensive disorders during pregnancy are a warning sign for CVD. Erica P. Gunderson, PhD, MS, MPH, a life-course epidemiologist and senior research scientist in the cardiovascular and metabolic conditions section at Kaiser Permanente’s Division of Research in Oakland, California, said during a presentation at the American Heart Association Scientific Sessions. The racial-ethnic disparities in maternal death due to hypertensive disorders during pregnancy are also attributed to the four-fold higher rate of U.S. Black women than white women. Gunderson stated that the pathophysiology and treatment options for these conditions are still not fully understood.
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“There is a large need for research that was acknowledged by the [American College of Obstetricians and Gynecologists] as well as U.S. Preventive Services Task Force to develop new approaches for early prediction of these sorts of conditions that would be applicable to most clinical care settings,” said Gunderson, a recipient of the Dr. Nanette K. Wenger Research Goes Red Award.
For women who had normal BP before becoming pregnant, hypertensive disorders of pregnancies are defined as BP elevations after 20 weeks. Gestational hypertension refers to a BP of at most 140 mm Hg systolic/90 mmHg diastolic at least twice; preeclampsia refers to elevated BP and multiorgan dysfunction.
Erica P. Gunderson
In a previous analysis, in Hypertension, Gunderson and colleagues identified distinct BP trajectories from 0 to 20 weeks’ gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174,925 women with no prior hypertension or history of preeclampsia. The researchers used electronic health records to obtain clinical outcomes, covariables and longitudinal outpatient BP measurements before 20 weeks’ gestation (mean, 4.1 measurements). Researchers identified six BP groups: ultra-low-declining, low-declining, moderate-fast-decline, low-increasing, moderate-stable and elevated-stable.
Compared with women in the ultra-low-declining BP group, adjusted ORs for low-increasing, moderate-stable and elevated-stable groups were 3.25, 5.3 and 9.2, respectively, for preeclampsia/eclampsia’ and 6.4, 13.6 and 30.2, respectively, for gestational hypertension. Race and prepregnancy obesity modified the trajectory-group associations with preeclampsia/eclampsia, with highest risks for Black women, then Hispanic and Asian women for all BP trajectories, and with increasing obesity class.
“These findings are important because they serve as a first step to future research,” Gunderson said. “The next step is to develop risk prediction models using BP trajectories and some other risk factors to see how well we can identify women at different risk levels for preeclampsia within this moderate- to low-risk group, where the highest proportion of the cases occur.”
Gunderson stated that it was important to assess risk status for individuals with BPs lower than 140/90 mmHg prior to pregnancy and early gestation.
“We want to accurately discriminate risk status and get to a place where we can do a score to do individual risk stratification, and correctly target individuals who many benefit most from low-dose aspirin therapy, the current state of the therapy for prevention of early preeclampsia before 16 weeks’ gestation,” Gunderson said.
“Lastly, we reduce clinician and patient burden of intensified monitoring, which creates more encounters that may also increase some stress,” Gunderson said. “But ultimately, the primary goal is to reduce racial and ethnic disparities in pregnancy-related adverse outcomes, particularly maternal mortality.”
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