Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
JAMA Netw Open. 2021 Mar 1;4(3):e213808. doi: 10.1001/jamanetworkopen.2021.3808.
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. The impact of applying recent guideline definitions for nonpregnant adults to pregnant women is unclear.
To determine whether reclassification of hypertensive status using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline definition better identifies women at risk for preeclampsia or eclampsia and adverse fetal/neonatal events compared with the current American College of Obstetricians and Gynecologists (ACOG) definition of hypertension.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used electronic medical record data of women who delivered singleton infants between 2009 and 2014 at a large US regional health system. Data analysis was performed from July 2020 to September 2020.
Application of ACC/AHA and ACOG guidelines for the definition of chronic and gestational hypertension.
The primary maternal end point was the development of preeclampsia or eclampsia, and the primary fetal/neonatal end point was a composite of preterm birth, small for gestational age, and neonatal intensive care unit admission within 28 days of delivery. Net reclassification indices were calculated to examine how well the lower ACC/AHA diagnostic threshold reclassifies outcomes of pregnancy compared with the current ACOG definition of hypertension.
Applying the ACC/AHA criteria to 137 389 pregnancies of women (mean [SD] age at time of delivery, 30.1 [5.8] years) resulted in a 14.3% prevalence of chronic hypertension (19 621 pregnancies) and a 13.8% prevalence of gestational hypertension (18 998 pregnancies). A 17.8% absolute increase was found in the overall prevalence of hypertension from 10.3% to 28.1%. The 2.1% of women who were reclassified with chronic rather than gestational hypertension had the highest risk of developing preeclampsia compared with women without hypertension by either criterion (adjusted risk ratio, 13.58; 95% CI, 12.49-14.77). Overall, the use of the ACC/AHA criteria to diagnose hypertension resulted in a 20.8% improvement in the appropriate identification of future preeclampsia, but only a 3.8% improvement of appropriate fetal/neonatal risk classification.
Using the lower diagnostic threshold for hypertension recommended in the 2017 ACC/AHA guideline increased the prevalence of chronic and gestational hypertension, markedly improved the appropriate identification of women who would go on to develop preeclampsia, and was associated with the identification of adverse fetal/neonatal risk.
妊娠高血压疾病是孕产妇发病率和死亡率的主要原因。将最近的非妊娠成年人指南定义应用于孕妇的影响尚不清楚。
确定使用 2017 年美国心脏病学会/美国心脏协会 (ACC/AHA) 指南定义重新分类高血压状态是否比当前美国妇产科医师学会 (ACOG) 高血压定义更好地识别出患子痫前期或子痫以及不良胎儿/新生儿事件的风险妇女。
设计、地点和参与者：这项队列研究使用了一家大型美国地区卫生系统 2009 年至 2014 年间分娩单胎婴儿的女性的电子病历数据。数据分析于 2020 年 7 月至 2020 年 9 月进行。
应用 ACC/AHA 和 ACOG 指南定义慢性和妊娠高血压。
主要的产妇终点是子痫前期或子痫的发展，主要的胎儿/新生儿终点是早产、小于胎龄和新生儿重症监护病房在分娩后 28 天内入住的复合结局。计算净重新分类指数以检查较低的 ACC/AHA 诊断阈值如何更好地重新分类妊娠结局与当前 ACOG 高血压定义相比。
将 ACC/AHA 标准应用于 137389 名妇女（分娩时的平均[SD]年龄，30.1[5.8]岁）的妊娠中，慢性高血压的患病率为 14.3%（19621 例妊娠），妊娠期高血压的患病率为 13.8%（18998 例妊娠）。高血压的总体患病率从 10.3%增加到 28.1%，绝对增加了 17.8%。与任何标准的无高血压妇女相比，被重新分类为慢性而非妊娠期高血压的 2.1%的妇女发生子痫前期的风险最高（校正风险比，13.58；95%CI，12.49-14.77）。总体而言，使用 ACC/AHA 标准诊断高血压可将未来子痫前期的适当识别率提高 20.8%，但仅将胎儿/新生儿风险分类的适当性提高 3.8%。
使用 2017 年 ACC/AHA 指南推荐的较低高血压诊断阈值增加了慢性和妊娠期高血压的患病率，极大地提高了对可能发展为子痫前期的妇女的正确识别率，并与不良胎儿/新生儿风险的识别相关。
