Should the definition of preeclampsia include a rise in diastolic blood pressure of ≥15 mm Hg to a level <90 mm Hg in association with proteinuria?

• Published in: American journal of obstetrics and gynecology 2000-10, Vol.183 (4), p.787-792
• Main Authors: Levine, R.J., Ewell, M.G., Hauth, J.C., Curet, L.B., Catalano, P.M., Morris, C.D., Choudhary, G., Sibai, B.M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Birth Weight; Blood Pressure; Body Mass Index; Body Weight; Cesarean Section - statistics & numerical data; Diastole; Diseases of mother, fetus and pregnancy; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Medical sciences; Pre-Eclampsia - pathology; Pre-Eclampsia - physiopathology; Pre-Eclampsia - urine; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Proteinuria - etiology; Reference Values; Terminology as Topic
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1067/mob.[phone]

Objective: This study was undertaken to compare baseline characteristics and pregnancy outcomes between normotensive women who did and those who did not have a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria. Study Design: We studied 4302 healthy nulliparous women from the Calcium for Preeclampsia Prevention trial who were delivered at ≥20 weeks’ gestation. We selected as the study group normotensive women who developed proteinuria within 7 days of a rise in diastolic blood pressure of ≥15 mm Hg with respect to baseline on 2 occasions 4 to 168 hours apart. Baseline blood pressure was the mean of measurements at 2 clinic visits before 22 weeks’ gestation. Other normotensive women used for comparison were those who did not develop gestational hypertension or a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria. Results: Except for greater weight ( P < .001), body mass index ( P < .001), and systolic blood pressure ( P = .05) the baseline characteristics of the 82 women with a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria did not differ significantly from those of the other normotensive women. Although they had a greater rate of weight gain ( P < .005), larger babies ( P = .06), and a 2-fold increase in abdominal delivery ( P < .001), there was little other evidence of adverse pregnancy outcomes among these women. Conclusion: During normotensive pregnancy a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria appears to be benign and is not a useful clinical construct. (Am J Obstet Gynecol 2000;183:787-92.)