Prediction of Preeclampsia using ACC/AHA criteria for diagnosis of Hypertension in 1st trimester of pregnancy
Anjali Chandra
, Rekha Bharti , Pratima Mittal , Neeta Dhabai , Nita Bhandari
2017 ACC/AHA guideline, blood pressure, hypertension, pregnancy induced hypertension, mean arterial pressure, prediction, pre eclampsia (PE) , first trimester of pregnancy
Abstract : Hypertensive disorders of pregnancy are associated with adverse perinatal outcomes and accounts for 14% of maternal deaths worldwide. The American Heart Association (AHA) and the American College of Cardiology (ACC) Task Force on Clinical Practice Guidelines (2017) have released a new hypertension guideline for adults, with lower blood pressure threshold to identify hypertension. 2017 ACC/AHA criteria for Hypertension are : - Normal BP: <120/80 mmHg - Elevated BP:120-129/<80 mmHg - Stage 1 HTN: 130-139/ 80-89 mmHg - Stage 2 HTN: ≥ 140/ ≥90 mmHg. AIM: Prediction of preeclampsia using 2017 ACC/AHA hypertension classification in first trimester and to evaluate MAP of Ist trimester for prediction of PE. Objective: To find out risk of development of PE in women with elevated Blood Pressure and stage 1 Hypertension during Ist trimester. Methodology : It is a retrospective study conducted at Safdarjung hospital over a period of 6 months, August 2020 and February 2021. Women coming for antenatal registration from a specified region of South Delhi were registered in a randomized control trial– WINGS study (a WHO collaborated study) . Antenatal and labour records of women registered in the trial during 6 months were retrieved from an electronic database and transferred to excel sheet Pregnancy complicated by fetal malformation, women with high risk of developing G.HTN/PE according to ACOG 2018 criteria, women with stage II hypertension and participants with incomplete data were excluded. Women were then divided into 3 groups: - Group 1: Normal Blood Pressure (<120/80 mmHg) - Group 2: Elevated Blood Pressure (120-129/<80 mmHg) - Group 3: Stage 1 hypertension (130-139/ 80-89 mmHg) Main outcome measures are relative risk of development of G. HTN and PE and a cut off of MAP of first trimester for prediction of PE. Results : The risk of developing PE increased in elevated and stage I BP category and this association was significant. The risk of PE was three times greater in elevated BP category (RR :3.58 at 95% CI) and five times greater in stage 1 hypertension (RR- 5.21 at 95% CI). The probability of HDU stay and prolong hospital stay increased with highier stages of hypertension in first trimester .There was no co relation between preterm birth and stages of hypertension .The association of different stages of hypertension with SGA and CAPO was weak . The cut off for MAP for prediction of PE from Ist trimester blood pressure is 85.3 mmHg as shown in fig 2. The NPV of Ist trimester blood pressure for G.HTN, PE and eclampsia are 97.4%, 99.8%,100% respectively (fig 2,3 and 4). Conclusion : Our study shows that even pre hypertensive group (elevated and stage 1 hypertension) have increased risk of developing pre eclampsia. In our study first trimester MAP above 85.3 mmHg shows increased probability of developing PE. So a lower threshold of BP should be established for screening of PE to prevent associated adverse events.
"Prediction of Preeclampsia using ACC/AHA criteria for diagnosis of Hypertension in 1st trimester of pregnancy ", IJSDR - International Journal of Scientific Development and Research (www.IJSDR.org), ISSN:2455-2631, Vol.9, Issue 5, page no.791 - 799, May-2024, Available :https://ijsdr.org/papers/IJSDR2405108.pdf
Volume 9
Issue 5,
May-2024
Pages : 791 - 799
Paper Reg. ID: IJSDR_211404
Published Paper Id: IJSDR2405108
Downloads: 000347391
Research Area: Medical Science
Country: New Delhi, Delhi, India
DOI: https://doi.org/10.5281/zenodo.11547138
ISSN: 2455-2631 | IMPACT FACTOR: 9.15 Calculated By Google Scholar | ESTD YEAR: 2016
An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 9.15 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator
Publisher: IJSDR(IJ Publication) Janvi Wave
