Objective: To examine the association between chronic hypertension (CH) and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics.
Methods: This was a prospective screening study for adverse pregnancy outcomes in women with singleton pregnancies attending the first routine hospital visit at 11+0-13+6
weeks’ gestation. Data on maternal characteristics, medical and obstetric history and pregnancy outcomes were collected. Regression analysis was performed to examine the association between CH and adverse pregnancy outcomes including late miscarriage, stillbirth, pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous and iatrogenic preterm birth (PTB), small for gestational age (SGA) neonate, large for gestational age (LGA) neonate and elective and emergency cesarean section (CS).
Results: The study population of 109,932 pregnancies included 1,417 (1.3%) with CH. After adjusting for potential confounding variables from maternal characteristics, medical
and obstetric history, CH was associated with increased risk of stillbirth OR 2.38, 95% CI 1.51-3.75), PE (OR 5.76, 95% CI 4.93-6.73), SGA (OR 2.06, 95% CI 1.79-2.39), GDM (OR 1.61, 95% CI 1.27-2.05), iatrogenic PTB <37 weeks (OR 3.73, 95% CI (3.07-4.53) and elective CS (OR 1.79, 95%CI 1.52-2.11), decreased risk of LGA (OR 0.65, 0.51-0.83), and had no significant effect on late miscarriage, spontaneous PTB or emergency CS.
Conclusion: CH should be combined with other maternal characteristics and medical and obstetric history when calculating an individualised adjusted risk for adverse pregnancy complications. CH increases the risk for stillbirth, PE, SGA, GDM, iatrogenic PTB and elective CS and reduces the risk for LGA.
1. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic
hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ
2014; 348: g2301.
2. Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV.
Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of
delivery admissions. Am J Obstet Gynecol 2012; 206: 134.e1–8.
3. Robinson HP, Fleming JE. A critical evaluation of sonar crown rump length
measurements. BJOG 1975; 182: 702–710.
4. Snijders RJ, Noble P, Sebire N, Souka A, Nicolaides KH. UK multicentre project
on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency
thickness at 10-14 weeks of gestation. Fetal Medicine Foundation First Trimester
Screening Group. Lancet 1998; 352: 343–346.
5. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the
diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn
2011; 31: 90–102.
6. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The
classiﬁcation and diagnosis of the hypertensive disorders of pregnancy: statement
from the International Society for the Study of Hypertension in Pregnancy (ISSHP).
Hypertens Pregnancy 2001; 20:IX–XIV.
7. World Health Organization, Department of Non communicable Disease Surveillance.
Deﬁnition, diagnosis and classiﬁcation of diabetes mellitus and its complications.
Report of a WHO consultation. Part 1: diagnosis and classiﬁcation of diabetes
mellitus. Geneva: World Health Organization, 1999.
8. Poon LC, Tan MY, Yerlikaya G, Syngelaki A, Nicolaides KH. Birth weight in live
births and stillbirths. Ultrasound Obstet Gynecol 2016; 48: 602–606.
9. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M Das SR, de
Ferranti S, Despr
es JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jim
DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K,
Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ,
Rosamond W, Sorlie PD, Stein J, Towﬁghi A, Turan TN, Virani SS, Woo D, Yeh
RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics
Subcommittee. Heart Disease and Stroke Statistics-2016 Update: A Report From the
American Heart Association. Circulation 2016; 133: e38–360.
10. Wang Y, Wang QJ. The prevalence of prehypertension and hyper-tension among US
adults according to the new Joint National Committee guidelines. Arch Intern Med
2004; 164: 2126–2134.
11. Flenady V, Koopmans L, Middleton P, Frøen JF, Smith GC, Gibbons K, Coory
M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M. Major risk factors
for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet
2011; 377: 1331–1340.
12. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks
model in screening for preeclampsia by maternal characteristics and medical history.
Am J Obstet Gynecol 2015; 213: 62.e1–10.
13. Villar J, Carroli G, Wojdyla D, Abalos E, Giordano D, Ba’aqeel H, Farnot
U, Bergsjø P, Bakketeig L, Lumbiganon P, Campod´onico L, Al-Mazrou Y,
Lindheimer M, Kramer M; World Health Organization Antenatal Care Trial
Research Group. Preeclampsia, gestational hypertension and intrauterine growth
restriction, related or independent conditions? Am J Obstet Gynecol 2006; 194:
14. Syngelaki A, Pastides A, Kotecha R, Wright A, Akolekar R, Nicolaides KH.
First-Trimester Screening for Gestational Diabetes Mellitus Based on Maternal
Characteristics and History. Fetal Diagn Ther 2015; 38
15. Caruso A, Ferrazzani S, De Carolis S, Lucchese A, Lanzone A, Paradisi G.
Carbohydrate metabolism in gestational diabetes: effect of chronic hypertension.
Obstet Gynecol 1999; 94: 556–561.
16. Hu FB, Stampfer MJ. Insulin resistance and hypertension: the chicken-egg question
revisited. Circulation 2005; 112: 1678–1680.
17. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29:
18. National Collaborating Centre for Women’s and Children’s Health (UK).
Hypertension in Pregnancy: The Management of Hypertensive Disorders During
Pregnancy. London: RCOG Press, 2010