Role of Mean Arterial Pressure in Mid-trimester Pregnancy for the Prediction of Gestational Hypertension and Pre-eclampsia
Ojasvi Shanker, Mamta Gupta
Gestational hypertension, Mean arterial pressure, Prediction of pre-eclampsia, Pre-eclampsia
Citation Information :
Shanker O, Gupta M. Role of Mean Arterial Pressure in Mid-trimester Pregnancy for the Prediction of Gestational Hypertension and Pre-eclampsia. J South Asian Feder Obs Gynae 2021; 13 (3):151-155.
Background: Reliable markers for the prediction of pre-eclampsia (PE) and reducing its associated maternal and perinatal morbidity are lacking.
Aims and objectives: To evaluate the role of mean arterial pressure (MAP) in the second trimester of pregnancy for predicting gestational hypertension (GH) and PE.
Materials and Methods: Three-hundred and sixteen healthy and normotensive women were enrolled in the second trimester of pregnancy. The mean MAP for the woman was recorded as an average of two MAPs at 3–4 week intervals during the second trimester of pregnancy. All women were followed till term/delivery to predict the development of GH and pre-eclampsia later.
Results: The performance of MAP for predicting the GH and PE was found to be very good. The area under the receiver operating characteristic (AUROC) for GH was 0.892 with sensitivity and specificity of 84.2 and 84.9%, respectively, whereas the AUROC for PE was 0.948 with sensitivity and specificity of 83.3 and 84.9%, respectively.
Conclusion: MAP in the second trimester of pregnancy can be used to triage women with low-risk pregnancy for pregnancy hypertension.
Clinical significance: Mid-trimester MAP is a very good parameter for the prediction of GH and PE. It should be routinely used for risk triaging in low-risk women for the development of hypertension in pregnancy.
Jeyabalan A. Epidemiology of pre-eclampsia: impact of obesity. Nutr Rev 2013;71 Suppl. 1(0 1):S18–S25. DOI: 10.1111/nure.12055. PMID: 24147919; PMCID: PMC3871181.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009;33(3):130–137. DOI: 10.1053/j.semperi.2009.02.010.
Kumari S, Gupta M, Vardan H, et al. NT pro-BNP: a biochemical marker of maternal complications in pre-eclampsia. JCDR 2017;11(11):QC12–QC16. DOI: 10.7860/JCDR/2017/28713.10855.
Shanker O, Saini V, Gupta M. Stillbirths: incidence, causes and surrogate markers of intrapartum and antepartum fetal deaths. Int J Inn Res Med Sci 2020;5(08):289–295. DOI: 10.23958/ijirms/vol05-i08/927.
Conde-Agudelo A, Villar J, Lindheimer M. World Health Organization systematic review of screening tests for pre-eclampsia. Obstet Gynecol 2004;104(6):1367–1391. DOI: 10.1097/01.AOG.0000147599.47713.5d [Erratum in: Obstet Gynecol 2005;106:869].
Conde-Agudelo A, Romero R, Lindheimer M. Tests to predict pre-eclampsia. In: Lindheimer MD, Roberts JM, Cunningham FG, editors. Chesley's hypertensive disorders of pregnancy. 3rd ed. San Diego, CA: Elsevier; 2009 [in press].
Meads CA, Cnossen JS, Meher S, et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modeling. Health Technol Assess 2008;12(6):iii–iv1–270. DOI: 10.3310/hta12060.
Ayala DE, Hermida RC, Mojon A, et al. Blood pressure variability during gestation in healthy and complicated pregnancies. Hypertension 1997;30(3):611–618. DOI: 10.1161/01.HYP.30.3.611.
Poon LC, Nicolaides KH. Early prediction of pre-eclampsia. Obstet Gynecol Int 2014;2014:297397. DOI: 10.1155/2014/297397.
Roberts JM, August PA, Bakris G, et al. Hypertension in pregnancy: executive summary. Obstet Gynecol 2013;122(5):1122–1131. DOI: 10.1097/01.AOG.0000437382.03963.88.
Umegbolu EI, Ogamba JO. Incidence of gestational hypertension among pregnant women (2006-2015) in Enugu State, Southeast Nigeria: a retrospective study. Int J Community Med Public Health 2017;4(2):357–362. DOI: 10.18203/2394-6040.ijcmph20170255.
Rajesh A, Suresh A, Muralidharan V. Serum lipid profile in second trimester as a predictor of gestational hypertension. J South Asian Feder Obst Gynae 2020;12(1):23–26. DOI: 10.5005/jp-journals-10006-1750.
Dawle SS, Bhalerao AV. Prediction of pregnancy-induced hypertension by maternal serum beta human chorionic gonadotropin levels in early second trimester of pregnancy. J South Asian Feder Obst Gynae 2018;10(2):104–109. DOI: 10.5005/jp-journals-10006-1570.
Miller RS, Rudra CB, Williams MA. First-trimester mean arterial pressure and risk of pre-eclampsia. Am J Hypertens 2007;20(5):573–578. DOI: 10.1016/j.amjhyper.2006.12.012.
Mayrink J, Souza RT, Feitosa FE, et al. Mean arterial blood pressure: potential predictive tool for pre-eclampsia in a cohort of healthy nulliparous pregnant women. BMC Pregnancy Childbirth 2019;19(1):460. DOI: 10.1186/s12884-019-2580-4.
Cnossen JS, Vollebregt KC, de Vrieze N, et al. Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis. BMJ 2008;336(7653):1117–1120. DOI: 10.1136/bmj.39540.522049.BE.
Upadhyay A, Dayal M. Prediction of pre-eclampsia by mean arterial pressure and waist circumference. New Indian J OBGYN 2019;6(1):24–27. DOI: 10.21276/obgyn.2019.6.1.6.
Poon LC, Syngelaki A, Akolekar R, et al. Combined screening for pre-eclampsia and small for gestational age at 11-13 weeks. Fetal Diagn Ther 2013;33(1):16–27. DOI: 10.1159/000341712.
Gasse C, Boutin A, Coté M, et al. First-trimester mean arterial blood pressure and the risk of pre-eclampsia: the great obstetrical syndromes (GOS) study. Pregnancy Hypertens 2018;12:178–182. DOI: 10.1016/j.preghy.2017.11.005.
Tayyar A, Krithinakis K, Wright A, et al. Mean arterial pressure at 12, 22, 32 and 36 weeks’ gestation in screening for pre-eclampsia. Ultrasound Obstet Gynecol 2016;47(5):573–579. DOI: 10.1002/uog.15815.
Ghi T, Dall'Asta A, Valensise H. Antenatal care of pre-eclampsia: from the inverted pyramid to the arrow model? Fetal Diagn Ther 2018;44(2):81–84. DOI: 10.1159/000490047.
Wright A, Wright D, Ispas CA, et al. Mean arterial pressure in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015;45(6):698–706. DOI: 10.1002/uog.14783.