European Journal of Cardiovascular Medicine

Hypertension is one of the most common medical complications during pregnancy, affecting approximately 10% of pregnancies worldwide (Smith et al., 2021). Preexisting hypertension, hypertension present before pregnancy or diagnosed before the 20th week of gestation, poses significant risks to both maternal and fetal health (Johnson & Davis, 2022). The management of pregnant women with preexisting hypertension is a challenging aspect of obstetric care, balancing the need to control maternal blood pressure with the safety of the fetus (Williams et al., 2023).

The implications of preexisting hypertension on pregnancy outcomes are profound. Women with this condition are at an increased risk of superimposed preeclampsia, preterm birth, and placental abruption, among other complications (Martinez & Thompson, 2020). Furthermore, fetal risks include intrauterine growth restriction, low birth weight, and increased neonatal intensive care unit admissions (Nguyen & Lee, 2021).

Despite these known risks, the specific outcomes and optimal management strategies for pregnant women with preexisting hypertension remain a subject of ongoing research. Current guidelines emphasize the importance of blood pressure control, yet they offer varying recommendations regarding medication and monitoring (Patel & Robinson, 2022).

Aim:

To investigate the impact of preexisting hypertension on maternal and fetal outcomes in a cohort of 200 pregnant women.

Objectives

1. To assess the association between preexisting hypertension and maternal complications such as preeclampsia, gestational diabetes, and preterm labor.
2. To evaluate the impact of maternal hypertension on fetal outcomes including birth weight, gestational age at birth, and neonatal intensive care unit admissions.
3. To analyze the effectiveness of current hypertension management strategies in pregnant women with preexisting hypertension.

Source of Data: Data were sourced from BRIMS bidar tertiary care center, specializing in obstetrics and gynecology. These hospitals were equipped with comprehensive prenatal and postnatal care facilities, ensuring a diverse and relevant dataset.

Study Design: The research was conducted as a prospective cohort study. Pregnant women with preexisting hypertension who met the inclusion criteria were followed throughout their pregnancy and delivery to assess both maternal and fetal outcomes.

Sample Size: The study involved a total of 200 pregnant women diagnosed with preexisting hypertension. This sample size was determined based on previous similar studies, ensuring adequate power for statistical analysis.

Inclusion Criteria:

1. Pregnant women aged 18-45 years.
2. Clinical diagnosis of hypertension prior to pregnancy or before the 20th week of gestation.
3. Singleton pregnancy.

Exclusion Criteria:

1. Women with gestational hypertension or preeclampsia without a prior history of hypertension.
2. Multiple gestations (e.g., twins, triplets).
3. Preexisting chronic conditions that could independently affect pregnancy outcomes, such as diabetes or renal diseases.
4. Patients unwilling to provide informed consent.

Study Methodology: Participants were enrolled during their first prenatal visit and monitored throughout their pregnancy. Medical history, antenatal care records, medication usage, and lifestyle factors were documented. Pregnancy outcomes, including maternal complications and fetal health indicators, were recorded at delivery.

Statistical Methods: Descriptive statistics were used to characterize the sample. Comparative analyses between different severity levels of hypertension and pregnancy outcomes were conducted using chi-square tests for categorical variables and t-tests or ANOVA for continuous variables. A p-value of <0.05 was considered statistically significant.

Data Collection: Data were collected through patient interviews, medical record reviews, and direct measurements from medical examinations. Confidentiality and privacy of the participants were strictly maintained. All data were anonymized and stored securely to ensure participant confidentiality and compliance with ethical guidelines

Table 1: Association Between Preexisting Hypertension and Maternal Complications in a Cohort of 200 Pregnant Women

Table 1 presents the association between preexisting hypertension and maternal complications in a cohort of 200 pregnant women. The table provides data on the prevalence of three specific maternal complications—preeclampsia, gestational diabetes, and preterm labor—in the hypertensive group, along with statistical measures of association. It reveals a significant association between preexisting hypertension and these maternal complications, as indicated by high Chi-square values and statistically significant p-values (<0.001 for preeclampsia and preterm labor, and 0.004 for gestational diabetes). The odds ratios (OR) further suggest that women with preexisting hypertension are at increased risk for these complications, with ORs ranging from 2.2 to 3.5. Additionally, the 95% confidence intervals (95% CI) provide a range within which the true OR is likely to lie. Overall, the table highlights the heightened risk of these maternal complications in the presence of preexisting hypertension, emphasizing the importance of monitoring and managing hypertension during pregnancy.

Table 2: Impact of Maternal Preexisting Hypertension on Fetal Outcomes in 200 Pregnant Women

Table 2 presents the impact of maternal preexisting hypertension on fetal outcomes in a cohort of 200 pregnant women. The table provides data on three specific fetal outcomes—low birth weight, preterm birth (<37 weeks), and neonatal intensive care unit (NICU) admission—in the hypertensive group, accompanied by statistical measures. It demonstrates a significant association between maternal preexisting hypertension and adverse fetal outcomes, as evidenced by the low p-values (<0.001) for low birth weight and preterm birth, and a moderately significant p-value (0.003) for NICU admission. The odds ratios (OR) indicate that pregnant women with preexisting hypertension are at a significantly increased risk for these adverse fetal outcomes, with ORs ranging from 2.1 to 2.6. The 95% confidence intervals (95% CI) provide a range within which the true OR is likely to fall. In summary, the table underscores the detrimental impact of maternal hypertension on fetal health, emphasizing the need for vigilant monitoring and management during pregnancy to mitigate these risks.

Table 3: Evaluation of Hypertension Management Strategies and Their Effectiveness in a Study of 200 Pregnant Women with Preexisting Hypertension

Table 3 provides an evaluation of hypertension management strategies and their effectiveness in a study involving 200 pregnant women with preexisting hypertension. The table presents four distinct hypertension management strategies: "Diet and Lifestyle Modification," "Labetalol," "Nifedipine," and "Combination Therapy (Labetalol+Nifedipine)." For each strategy, it includes the number of responders out of the total cohort, the odds ratio (OR), 95% confidence interval (95% CI), and the associated p-value. The findings suggest varying degrees of effectiveness among the strategies. "Combination Therapy (Labetalol+Nifedipine)" shows the highest effectiveness with an OR of 2.5 and a highly significant p-value (<0.001), indicating a substantial reduction in hypertension. "Labetalol" also demonstrates effectiveness with an OR of 2.0 and a significant p-value (0.001). In contrast, "Nifedipine" and "Diet and Lifestyle Modification" appear to be less effective, with ORs close to 1 and higher p-values. Overall, the table highlights the importance of considering different management approaches and their outcomes in pregnant women with preexisting hypertension.

For table 1, contextualize these findings and provide additional insights, it's important to refer to relevant studies in the field:

In a similar cohort study of pregnant women, Gee S et al.(2022)^[1] found a comparable association between preexisting hypertension and preeclampsia, supporting the findings in Table 1. Jung YM et al.(2022)^[2] conducted a systematic review on the relationship between maternal hypertension and gestational diabetes. Their review aligns with the results presented in Table 1, emphasizing the increased risk of gestational diabetes in hypertensive pregnant women. A study by Tanner MS et al.(2022)^[3] explored the link between maternal hypertension and preterm labor. Their findings corroborate the significant association observed in Table 1, highlighting the heightened risk of preterm labor in women with preexisting hypertension.

For table 2, To provide a broader perspective and validate these findings, it's essential to reference relevant studies in the field:

In a comparative study of pregnant women with and without hypertension, Gojnic M et al.(2022)^[4] reported similar results regarding the increased risk of low birth weight in hypertensive pregnancies, supporting the findings in Table 2.

Willy D et al.(2022)^[5] conducted a meta-analysis on the association between maternal hypertension and preterm birth. Their meta-analysis aligns with the results presented in Table 2, emphasizing the elevated risk of preterm birth in women with preexisting hypertension

Lenin A et al.(2022)^[6] study focused on the impact of maternal hypertension on NICU admissions. Their research findings corroborate the significant association observed in Table 2, highlighting the increased likelihood of NICU admissions in pregnancies complicated by hypertension.

Table 3, To contextualize these findings and provide additional insights, it's crucial to refer to relevant studies in the field:

In their clinical trial, Zhang H et al.(2022)^[7] compared diet and lifestyle modification with medication-based strategies for managing hypertension during pregnancy. Their study aligns with the findings in Table 3, emphasizing the effectiveness of Labetalol and Combination Therapy.

Angras K et al.(2022)^[8] conducted a systematic review on the efficacy of different antihypertensive medications during pregnancy. Their review supports the results presented in Table 3, particularly regarding Labetalol's effectiveness.

Ardissino M et al.(2022)^[9] study investigated the use of Nifedipine in managing hypertension in pregnant women. While their results indicate some effectiveness, the findings are in line with Table 3 regarding Nifedipine's moderate impact.

The study has yielded significant insights into the complex interplay between maternal health and fetal well-being in the context of preexisting hypertension during pregnancy. The comprehensive analysis of maternal and fetal outcomes in a cohort of 200 pregnant women has provided valuable findings that warrant careful consideration.

The findings from this study underscore the critical importance of addressing preexisting hypertension in pregnant women due to its substantial impact on both maternal and fetal health. The observed associations between preexisting hypertension and adverse maternal complications such as preeclampsia, gestational diabetes, and preterm labor are supported by robust statistical evidence. These complications are not only prevalent but also significantly increase the risk for adverse fetal outcomes.

The adverse fetal outcomes, including low birth weight, preterm birth, and NICU admission, are alarming and emphasize the urgent need for effective management strategies. The study's results indicate that maternal preexisting hypertension is a major contributing factor to these adverse fetal outcomes, further highlighting the intricacies of managing hypertension during pregnancy.

In evaluating the effectiveness of hypertension management strategies, the study identifies potential interventions that can significantly mitigate the risks associated with preexisting hypertension. Notably, strategies such as Labetalol and Combination Therapy (Labetalol+Nifedipine) have demonstrated promising results in controlling hypertension and reducing adverse outcomes.

Overall, this study sheds light on the multifaceted nature of preexisting hypertension during pregnancy. It serves as a call to action for healthcare providers to prioritize the careful monitoring and management of maternal hypertension to safeguard both maternal and fetal well-being. The findings emphasize the importance of tailoring treatment strategies to the individual needs of pregnant women with preexisting hypertension, considering factors such as response to therapy and the severity of hypertension.

In conclusion, this study serves as a critical step towards enhancing our understanding of the impact of maternal preexisting hypertension on pregnancy outcomes. It provides a foundation for further research and emphasizes the need for proactive healthcare measures to ensure healthier outcomes for both mothers and their infants. Ultimately, it is hoped that this research will contribute to improving the quality of care and the overall health of pregnant women with preexisting hypertension.

LIMITATIONS OF STUDY

1. Sample Size: One of the primary limitations of the study is the relatively small sample size of 200 pregnant women. A larger sample size would have increased the statistical power of the study, allowing for more precise estimates and potentially detecting smaller effects. As a result, the findings may not be fully representative of the broader population of pregnant women with preexisting hypertension.
2. Single-Center Study: The study was conducted at a single healthcare center or institution. This limits the generalizability of the findings, as patient populations and healthcare practices can vary across different institutions and geographic regions. It may not fully capture the diversity of experiences and outcomes observed in a more diverse and multicenter setting.
3. Retrospective Nature: The study's retrospective design means that data were collected after the fact, relying on medical records and historical information. This introduces the possibility of information bias or missing data, as not all relevant variables may have been consistently recorded in the medical records.
4. Selection Bias: The cohort of pregnant women included in the study may not be entirely representative of all pregnant women with preexisting hypertension. The inclusion criteria and selection process could introduce bias, as some patients may have been excluded due to specific criteria, potentially affecting the external validity of the findings.
5. Confounding Variables: The study may not have accounted for all potential confounding variables that could influence the observed associations between preexisting hypertension and maternal/fetal outcomes. Factors such as socioeconomic status, smoking habits, and other comorbidities may not have been adequately controlled for in the analysis.
6. Missing Data: Due to the retrospective nature of the study, there may be instances of missing data or incomplete records, which could affect the accuracy and completeness of the analysis. Missing data may also introduce bias if it is not handled appropriately.
7. Treatment Variability: The study evaluated the effectiveness of hypertension management strategies; however, it did not consider the potential variability in treatment protocols or adherence to prescribed treatments. Variations in treatment approaches could impact the outcomes observed.
8. Temporal Factors: The study may not have accounted for temporal changes in clinical practice and treatment guidelines over time. Advances in medical management and obstetric care could have influenced outcomes, but these factors were not explicitly addressed.
9. Publication Bias: The study may be subject to publication bias, as positive or statistically significant results are more likely to be published, potentially leading to an overestimation of the observed associations.
10. Limited Scope: The study focused primarily on the associations between preexisting hypertension and selected maternal and fetal outcomes. Other important aspects, such as long-term maternal and child health, were not considered.

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