Chronic hypertension and risk of preterm delivery: National Longitudinal Study of Adolescents to Adult Health

Erin Delker; Gretchen Bandoli; Yvette LaCoursiere; Karen Ferran; Linda Gallo; Eyal Oren; Sheila Gahagan; Gladys A. Ramos; Matthew Allison

doi:10.1111/ppe.12858

Chronic hypertension and risk of preterm delivery: National Longitudinal Study of Adolescents to Adult Health

Erin Delker, Gretchen Bandoli, Yvette LaCoursiere, Karen Ferran, Linda Gallo, Eyal Oren, Sheila Gahagan, Gladys A. Ramos, Matthew Allison

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: Chronic hypertension during pregnancy is associated with increased risk of adverse birth outcomes. In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered thresholds to classify hypertension in non-pregnant adults to SBP ≥ 130 mmHg and DBP ≥ 80 mmHg (ie stage I hypertension), resulting in an additional 4.5-million reproductive-aged women meeting criteria for hypertension. Little is known about effects of pre-pregnancy blood pressure (BP) in this range. Objectives: To examine the effect of pre-pregnancy maternal BP on preterm delivery. Methods: We analysed the data from two waves of the National Longitudinal Study of Adolescent to Adult Health, including participants that had measured BP at Wave IV (2008–09) and a pregnancy that resulted in a singleton live birth between Waves IV and V (2016–18; n = 2038). We categorised BP using ACC/AHA cut-offs: normal (SBP < 120 mmHg and DBP < 80 mmHg), elevated (SBP 120–129 mmHg and DBP < 80 mmHg), hypertension stage I (SBP 130–139 mmHg or DBP 80–89 mmHg) and hypertension stage II (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). We estimated risk ratios (RR) with log-binomial regression adjusting for maternal demographics, anthropometrics and medication use. Results: The prevalence of preterm delivery was 12.6%. A standard deviation (SD) increment in SBP (SD = 12.2 mmHg) and DBP (SD = 9.3 mmHg) was associated with a 14% (95% confidence interval [CI] 2, 27) and 20% (95% CI 4, 37) higher risk of preterm delivery. Compared to normotensive controls, stage I (RR 1.33, 95% CI 1.01, 1.74) and stage II (RR 1.34, 95% CI 0.89, 2.00) hypertension were associated with increased risk. Conclusions: We observed greater risk of preterm delivery among women with higher pre-pregnancy BP. Women with stage I hypertension during pregnancy may benefit from increased BP monitoring. Additional studies on the utility of foetal surveillance in this group are warranted.

Original language	English (US)
Pages (from-to)	370-379
Number of pages	10
Journal	Paediatric and Perinatal Epidemiology
Volume	36
Issue number	3
DOIs	https://doi.org/10.1111/ppe.12858
State	Published - May 2022
Externally published	Yes

Keywords

blood pressure
chronic hypertension
pre-pregnancy
preterm delivery

ASJC Scopus subject areas

Epidemiology
Pediatrics, Perinatology, and Child Health

Access to Document

10.1111/ppe.12858

Cite this

@article{2812a979937b4a23a701906e14b1cbec,

title = "Chronic hypertension and risk of preterm delivery: National Longitudinal Study of Adolescents to Adult Health",

abstract = "Background: Chronic hypertension during pregnancy is associated with increased risk of adverse birth outcomes. In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered thresholds to classify hypertension in non-pregnant adults to SBP ≥ 130 mmHg and DBP ≥ 80 mmHg (ie stage I hypertension), resulting in an additional 4.5-million reproductive-aged women meeting criteria for hypertension. Little is known about effects of pre-pregnancy blood pressure (BP) in this range. Objectives: To examine the effect of pre-pregnancy maternal BP on preterm delivery. Methods: We analysed the data from two waves of the National Longitudinal Study of Adolescent to Adult Health, including participants that had measured BP at Wave IV (2008–09) and a pregnancy that resulted in a singleton live birth between Waves IV and V (2016–18; n = 2038). We categorised BP using ACC/AHA cut-offs: normal (SBP < 120 mmHg and DBP < 80 mmHg), elevated (SBP 120–129 mmHg and DBP < 80 mmHg), hypertension stage I (SBP 130–139 mmHg or DBP 80–89 mmHg) and hypertension stage II (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). We estimated risk ratios (RR) with log-binomial regression adjusting for maternal demographics, anthropometrics and medication use. Results: The prevalence of preterm delivery was 12.6%. A standard deviation (SD) increment in SBP (SD = 12.2 mmHg) and DBP (SD = 9.3 mmHg) was associated with a 14% (95% confidence interval [CI] 2, 27) and 20% (95% CI 4, 37) higher risk of preterm delivery. Compared to normotensive controls, stage I (RR 1.33, 95% CI 1.01, 1.74) and stage II (RR 1.34, 95% CI 0.89, 2.00) hypertension were associated with increased risk. Conclusions: We observed greater risk of preterm delivery among women with higher pre-pregnancy BP. Women with stage I hypertension during pregnancy may benefit from increased BP monitoring. Additional studies on the utility of foetal surveillance in this group are warranted.",

keywords = "blood pressure, chronic hypertension, pre-pregnancy, preterm delivery",

author = "Erin Delker and Gretchen Bandoli and Yvette LaCoursiere and Karen Ferran and Linda Gallo and Eyal Oren and Sheila Gahagan and Ramos, {Gladys A.} and Matthew Allison",

note = "Publisher Copyright: {\textcopyright} 2022 John Wiley & Sons Ltd.",

year = "2022",

month = may,

doi = "10.1111/ppe.12858",

language = "English (US)",

volume = "36",

pages = "370--379",

journal = "Paediatric and Perinatal Epidemiology",

issn = "0269-5022",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "3",

}

TY - JOUR

T1 - Chronic hypertension and risk of preterm delivery

T2 - National Longitudinal Study of Adolescents to Adult Health

AU - Delker, Erin

AU - Bandoli, Gretchen

AU - LaCoursiere, Yvette

AU - Ferran, Karen

AU - Gallo, Linda

AU - Oren, Eyal

AU - Gahagan, Sheila

AU - Ramos, Gladys A.

AU - Allison, Matthew

PY - 2022/5

Y1 - 2022/5

N2 - Background: Chronic hypertension during pregnancy is associated with increased risk of adverse birth outcomes. In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered thresholds to classify hypertension in non-pregnant adults to SBP ≥ 130 mmHg and DBP ≥ 80 mmHg (ie stage I hypertension), resulting in an additional 4.5-million reproductive-aged women meeting criteria for hypertension. Little is known about effects of pre-pregnancy blood pressure (BP) in this range. Objectives: To examine the effect of pre-pregnancy maternal BP on preterm delivery. Methods: We analysed the data from two waves of the National Longitudinal Study of Adolescent to Adult Health, including participants that had measured BP at Wave IV (2008–09) and a pregnancy that resulted in a singleton live birth between Waves IV and V (2016–18; n = 2038). We categorised BP using ACC/AHA cut-offs: normal (SBP < 120 mmHg and DBP < 80 mmHg), elevated (SBP 120–129 mmHg and DBP < 80 mmHg), hypertension stage I (SBP 130–139 mmHg or DBP 80–89 mmHg) and hypertension stage II (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). We estimated risk ratios (RR) with log-binomial regression adjusting for maternal demographics, anthropometrics and medication use. Results: The prevalence of preterm delivery was 12.6%. A standard deviation (SD) increment in SBP (SD = 12.2 mmHg) and DBP (SD = 9.3 mmHg) was associated with a 14% (95% confidence interval [CI] 2, 27) and 20% (95% CI 4, 37) higher risk of preterm delivery. Compared to normotensive controls, stage I (RR 1.33, 95% CI 1.01, 1.74) and stage II (RR 1.34, 95% CI 0.89, 2.00) hypertension were associated with increased risk. Conclusions: We observed greater risk of preterm delivery among women with higher pre-pregnancy BP. Women with stage I hypertension during pregnancy may benefit from increased BP monitoring. Additional studies on the utility of foetal surveillance in this group are warranted.

AB - Background: Chronic hypertension during pregnancy is associated with increased risk of adverse birth outcomes. In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered thresholds to classify hypertension in non-pregnant adults to SBP ≥ 130 mmHg and DBP ≥ 80 mmHg (ie stage I hypertension), resulting in an additional 4.5-million reproductive-aged women meeting criteria for hypertension. Little is known about effects of pre-pregnancy blood pressure (BP) in this range. Objectives: To examine the effect of pre-pregnancy maternal BP on preterm delivery. Methods: We analysed the data from two waves of the National Longitudinal Study of Adolescent to Adult Health, including participants that had measured BP at Wave IV (2008–09) and a pregnancy that resulted in a singleton live birth between Waves IV and V (2016–18; n = 2038). We categorised BP using ACC/AHA cut-offs: normal (SBP < 120 mmHg and DBP < 80 mmHg), elevated (SBP 120–129 mmHg and DBP < 80 mmHg), hypertension stage I (SBP 130–139 mmHg or DBP 80–89 mmHg) and hypertension stage II (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). We estimated risk ratios (RR) with log-binomial regression adjusting for maternal demographics, anthropometrics and medication use. Results: The prevalence of preterm delivery was 12.6%. A standard deviation (SD) increment in SBP (SD = 12.2 mmHg) and DBP (SD = 9.3 mmHg) was associated with a 14% (95% confidence interval [CI] 2, 27) and 20% (95% CI 4, 37) higher risk of preterm delivery. Compared to normotensive controls, stage I (RR 1.33, 95% CI 1.01, 1.74) and stage II (RR 1.34, 95% CI 0.89, 2.00) hypertension were associated with increased risk. Conclusions: We observed greater risk of preterm delivery among women with higher pre-pregnancy BP. Women with stage I hypertension during pregnancy may benefit from increased BP monitoring. Additional studies on the utility of foetal surveillance in this group are warranted.

KW - blood pressure

KW - chronic hypertension

KW - pre-pregnancy

KW - preterm delivery

UR - http://www.scopus.com/inward/record.url?scp=85124026815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85124026815&partnerID=8YFLogxK

U2 - 10.1111/ppe.12858

DO - 10.1111/ppe.12858

M3 - Article

C2 - 35107830

AN - SCOPUS:85124026815

SN - 0269-5022

VL - 36

SP - 370

EP - 379

JO - Paediatric and Perinatal Epidemiology

JF - Paediatric and Perinatal Epidemiology

IS - 3

ER -

Chronic hypertension and risk of preterm delivery: National Longitudinal Study of Adolescents to Adult Health

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this