CHRONIC HYPERTENSION IN YOUNG WOMEN - ARE WE ADEQUATELY PREPARING FOR PREGNANCY?

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CHRONIC HYPERTENSION IN YOUNG WOMEN - ARE WE ADEQUATELY PREPARING FOR PREGNANCY?

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Co-author 1

Madeleine Cosgrave madeleinemcosgrave@gmail.com Eastern Health Clinical School, Monash University Department of Renal and Obstetric Medicine Melbourne Australia *

Co-author 2

Catherine Brumby catherine.brumby@easternhealth.org.au Eastern Health Clinical School, Monash University Department of Renal and Obstetric Medicine Melbourne Australia -

Co-author 3

Lawrence P McMahon lawrence.mcmahon@easternhealth.org.au Eastern Health Clinical School, Monash University Department of Renal and Obstetric Medicine Melbourne Australia -

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Introduction

Obstetric risk is higher in women with chronic hypertension (CHTN), and preconception blood pressure (BP) control is associated with better outcomes. Hypertension and obstetric guidelines suggest preconception optimisation which includes adequate BP control, pregnancy-safe medications and screening for causes of secondary hypertension (2HTN), however often this does not occur.

Methods

We conducted a cohort study of pregnancies in women with CHTN at two obstetric centres in Melbourne, Australia between 2008-2024. Clinical data were collected on maternal demographics, anti-hypertensive use, CHTN duration, secondary hypertension screening, and obstetric and perinatal outcomes.

Results

Among 82,083 deliveries, 492 pregnancies were affected by CHTN (prevalence 0.6%). Annual prevalence rose from 0.13% to 1.00% (trend p=0.015) over the study period. Seventy-nine women (16%) were first identified as having CHTN during the initial 20 weeks of pregnancy, suggesting poor preconception care. Blood pressure control at pregnancy booking visit in all women with CHTN was suboptimal, with 148 (35%) having systolic BP (SBP) >135mmHg. For every 1mmHg increase in SBP, there was a 2% increase in odds of preeclampsia (p=0.009). 261 (53%) women were on antihypertensive medication at conception and were more likely to have a SBP under target (<135 mmHg) at booking visit (73% vs 54%, p<0.001). Of these women, 47 (18%) were on an ACE inhibitor/angiotensin receptor blocker and while 31 (65%) ceased these prior to 8 weeks gestation, 4 (8%) were not stopped until the second trimester. Screening for 2HTN became more common over time, however in 276 pregnancies (56%) an underlying cause was not considered. A partial or full 2HTN screen was undertaken in 80 pregnancies (29%), and renal disease was the most common cause; 68 pregnancies (85%).

Conclusion

Opportunity to optimise pregnancy outcomes was missed in many pregnancies, despite 76% being planned. This study demonstrates missed preconception and early-pregnancy opportunities for improving pregnancy outcomes in women with CHTN. As highlighted in this study, preconception care and planning should focus on improving blood pressure control, use of pregnancy-safe medications and screening for secondary causes of CHTN.

Kewords