Models with six systolic BP trajectory groups plus standard clinical risk factors perform substantially better than risk factors alone
By Elana Gotkine HealthDay Reporter
THURSDAY, July 27, 2023 (HealthDay News) — Early pregnancy blood pressure (BP) patterns plus standard clinical risk factors can better predict hypertensive disorders of pregnancy, according to a study published online July 12 in the Journal of the American Heart Association.
Erica P. Gunderson, Ph.D., M.P.H., from Kaiser Permanente Northern California in Oakland, and colleagues examined whether early pregnancy BP patterns can predict hypertensive disorders of pregnancy. The retrospective cohort included 249,892 participants with systolic BP <140 mm Hg and diastolic BP <90 mm Hg or a single BP elevation ≤20 weeks of gestation. All participants had prenatal care at <14 weeks of gestation and a still or live birth delivery at Kaiser Permanente Northern California hospitals during 2009 to 2019. The sample was split into development and validation datasets (70 and 30 percent, respectively). In the validation dataset, predictive performance of multinomial logistic regression models for early-onset (<34 weeks) preeclampsia, later-onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated.
The researchers found that for predicting early- and later-onset preeclampsia and gestational hypertension, models with six systolic BP trajectory groups (0 to 20 weeks of gestation) plus standard clinical risk factors performed substantially better than risk factors alone (C-statistics, 0.747, 0.730, and 0.768 versus 0.688, 0.695, and 0.692, respectively), with excellent calibration.
“This evidence demonstrates the inherent value of early pregnancy BP patterns to identify individuals who may experience improved outcomes through higher vigilance and, ultimately, more effective interventions,” the authors write.
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