A JEYARUBAN1, R SHANMUGALINGAM1,2,3,4,P WU1,R CAO1, V WONG4,5, T WONG3,4,6, J FLACK3,4,6, A MAKRIS1,2,3,4
1Department of Renal Medicine, Liverpool Hospital, SWSLHD, Sydney, Auustralia, 2Women’s Health Initiative Translational Research Unit (WHITU), Ingham Institute, SWSLHD, Sydney, Australia, 3School of Medicine, Western Sydney University, Sydney, Australia, 4South Western Sydney Clinical School), University of New South Wales, Sydney, Australia, 5Department of Endocrinology, Liverpool Hospital SWSLHD, Sydney, Australia, 6Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, SWSLHD, Sydney, Australia
Aim: To investigate associations between tight blood pressure (BP) control and pregnancy outcomes in women with chronic hypertension (CH) and pre-gestational diabetes mellitus (PGDM).
Background: Hypertension is associated with poorer outcomes in pregnancy.
Method: A retrospective audit of data from pregnant women with PGDM from 2 centres in South-Western Sydney from January 2005 to June 2020 was conducted. Data were obtained from a district-wide electronic database and hospital medical records. Women with a history of CH were identified from this cohort. Pregnancy outcomes examined were preeclampsia, preterm delivery (<37 weeks) and birthweight percentile in women with tight BP control (≤135/85mmHg) compared to those with less tight BP control in the first trimester (>135/85mmHg).
Results: There were 494 women in the cohort and 46(9.3%) had a history of pre-pregnancy CH. Tight Bp control in the first trimester was seen in 30(65.2%) women. There were no significant differences between tight and less tight BP groups in age, smoking, pre-pregnancy ACE/ARB, calcium, and aspirin use. However, women with less tight BP control had a significantly higher body mass index. There were no significant differences between the groups in birth weight percentile (Mean:50(28)vs 46(27),p=0.69), preeclampsia (26.7% vs 12.5%,p=0.24) or preterm delivery (72% vs 77%,p=0.54). On multivariate analysis there was still no association between tight BP control and preterm delivery, preeclampsia rate and birthweight percentile after controlling for age, aspirin, calcium use and comorbidities.
Conclusion: In our study, first trimester tight BP control in women with PGDM and CH was not associated with a change in birthweight percentile, or preterm delivery. A larger study would help determine the effect of first trimester BP control on pregnancy outcomes.
Andrew Jeyaruban is a second year renal advanced trainee at Liverpool Hospital. He graduated from James Cook University and then did his training at Royal Brisbane hospital and Liverpool hospital. He has special interest in renal genetics, renal supportive care and obstetric medicine.