Adverse Pregnancy Outcomes More Likely With Hypertension History

Women with a history of chronic hypertension are three to five times more likely to have a poor pregnancy outcome than women without past hypertension, even if their blood pressure is normal before 20 weeks gestation, found a retrospective cohort study published April 6 in Obstetrics & Gynecology.

The highest risk occurred among women taking antihypertensive medication, but even women not taking medication (but with a history of chronic hypertension) had triple the risk for stillbirth, neonatal death, respiratory support, low Apgar score, seizures, or cord blood acidemia, although the findings were limited by a nongeneralizable population and some underpowered measures. 

“Although the incidence of stillbirth increased across exposure groups 1.3% [control] vs 1.9% [hypertension history but no medication] vs 2.9% [hypertension with medication] this trend was not statistically significant (P=.06) nor was it significant in adjusted analyses,” write Mallory Youngstrom, MD, from the Department of Gynecology and Obstetrics at Emory University in Atlanta, Georgia, and colleagues.

“The incidence of neonatal death (measured only in those with liveborn neonates) increased across the exposure groups (P=.03), but in adjusted analyses, the increased odds was only significant for women receiving [antihypertensive] medication.”

Compared with women without a history of hypertension, women taking antihypertensive medication also had significantly increased risks for preeclampsia, severe preeclampsia, preterm birth, and an infant small for gestational age after adjustments, but women with a history of hypertension not taking medications did not.

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