The effect of impedance cardiography directed antihypertensive therapy on fetal growth restriction rates and perinatal mortality in women with chronic hypertension

•Chronic hypertension causes morbidity and mortality for the mother and fetus.•There are no guidelines for which antihypertensive therapy to initiate in pregnancy.•Maternal hemodynamic measurements optimized rates of growth restriction and perinatal mortality.•Consider informed initiation and titration of blood pressure medications in pregnancy. We sought to determine the effect of impedance cardiography directed medical antihypertensive therapy on fetal growth restriction and perinatal mortality in women with chronic hypertension. A retrospective study was conducted on 958 women referred to the Maternal Hypertension Center at Cabell Huntington Hospital between 2005 and 2014 for the indication of chronic hypertension. Serial assessments of maternal hemodynamics were obtained using non-invasive impedance cardiography. Vasodilators were initiated for increased systemic vascular resistance. Elevated cardiac output was treated with beta blockade. Blood pressure at initial visit was used to stratify patients into five groups. Initial blood pressure of 110 diastolic 3 cases of growth restriction (13%) with no perinatal deaths. There were no differences in growth restriction (p = .59) or perinatal death (p = .15) between the groups. The rates of IUGR and perinatal mortality did not increase even with increasing severity of maternal hypertension. This low cost and non-invasive test should be considered for optimizing rates of growth restriction and perinatal mortality in pregnancies complicated by chronic hypertension.