Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Hypertension

Poster Session 3

(676) White coat hypertension validated on home blood pressure monitoring as predictor of adverse pregnancy outcomes

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Beth Sobba, MD

Ochsner Clinic Foundation
New Orleans, LA, United States

Coauthor(s)

Naiha Mussarat, MD

Fellow
Ochsner Clinical Foundation
New Orleans, LA, United States
MG

Mariella Gastanaduy, PhD

Ochsner Clinic Foundation, LA, United States
James D. Toppin, MD, MPH

Ochsner Health
New Orleans, LA, United States
John A. Morgan, MD

Fellow
Ochsner Clinic
Metairie, LA, United States
Shannon McCloskey, MD

Fellow
Ochsner Clinic Foundation
New Orleans, LA, United States
Joseph R. Biggio, Jr., MD, MSc

System Chair, Women's Services
Ochsner Health
New Orleans, LA, United States
F.B. Will Williams, MD,MPH

MFM Physician
Ochsner Clinic Foundation
New Orleans, LA, United States

Objective: White coat hypertension (WCH) is a common hypertensive disorder associated with cardiac morbidity in the non-pregnant population. Less described is WCH’s impact on pregnancy outcomes. The advent of home blood pressure monitoring (HBPM) allows for comprehensive blood pressure assessment throughout pregnancy. Among pregnant patients undergoing HBPM, we aim to determine the impact of WCH on subsequent diagnosis of hypertensive disorders of pregnancy (HDP) and neonatal morbidity.

Study Design: We performed a retrospective cohort study of singleton pregnancies receiving prenatal care and delivering in a large regional health system from October 2016 to March 2022. Documented pre-pregnancy chronic hypertension, antihypertensive use, severe BP elevations before 20 weeks gestation (EGA), multiple gestations, and any elevations on HBPM warranted exclusion. WCH was defined as clinic BP of either 140-159 mmHg systolic or 90-109 mmHg diastolic on two separate occasions prior to 20 weeks EGA without elevations on HBPM. The comparison group had no elevated BP in clinic or at home prior to 20 weeks EGA. Our primary outcome was diagnosis of HDP. Secondary outcomes included 5-minute Apgar score < 5, neonatal intensive care admission, small for gestational age (SGA), stillbirth, and preterm birth < 37 weeks EGA. Regression analyses controlling for obesity, maternal age, pre-gestational diabetes, and payer status generated adjusted odds ratios with 95% confidence intervals.

Results: Of 18,916 eligible pregnancies, 3,177 (17%) were classified as WCH while 15,739 (83%) were classified as normotensive. WCH patients had higher median age and body mass index, and were more likely to have pre-gestational diabetes. HDP occurred in 33% of the WCH group compared to 13% in the normotensive group (aOR 2.97, 95% CI 2.71-3.26). Stillbirth, SGA, and preeclampsia with severe features were all increased in the WCH group (Table).

Conclusion: WCH, as defined by mild BP elevations early in pregnancy not-replicated on HBPM, was associated with increased risk for HDP and perinatal morbidity.