Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg

Objective To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit‐to‐visit BP variability (BPV), adjusted for BP level. Design An observational study. Setting Analysis of data from the population‐based UK Southampton Women's Survey (SWS). Population or sample 3003 SWS participants. Methods Generalised estimating equations were used to estimate crude and adjusted relative risks (RRs) of adverse pregnancy outcomes by BP thresholds, and by BPV (as standard deviation [SD], average real variability [ARV] and variability independent of the mean [VIM]). Likelihood ratios (LRs) were calculated to evaluate diagnostic test properties, for BP at or above a threshold, compared with those below. Main outcome measures Gestational hypertension, severe hypertension, pre‐eclampsia, preterm birth (PTB), small‐for‐gestational‐age (SGA) infants, neonatal intensive care unit (NICU) admission. Results A median of 11 BP measurements were included per participant. For BP at ≥20 weeks’ gestation, higher BP was associated with more adverse pregnancy outcomes; however, only BP 5.0). Higher BPV (by SD, ARV, or VIM) was associated with gestational hypertension, severe hypertension, pre‐eclampsia, PTB, SGA and NICU admission (adjusted RRs 1.05–1.39). Conclusions While our findings do not support lowering the BP threshold for pregnancy hypertension, they suggest BPV could be useful to identify elevated risk of adverse outcomes.