Original Research
Perinatal Outcomes in Women With a History
of Chronic Hypertension but Normal Blood
Pressures Before 20 Weeks of Gestation
Mallory Youngstrom, MD, Alan Tita, MD, PhD,
and Lorie M. Harper, MD, MSCI
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OBJECTIVE: To compare the perinatal outcomes of
normotensive women with those of women with a history
of chronic hypertension with normal blood pressures
before 20 weeks of gestation, stratifying the latter by
whether they were receiving antihypertensive medica-
tion.
METHODS: We conducted a retrospective cohort study
of all singletons with a history of chronic hypertension
from 2000 to 2014. Exclusions were blood pressure
greater than 140/90 mm Hg before 20 weeks of gestation,
fetal anomalies, major medical problems other than
hypertension, and diabetes. For the same time period,
a randomly selected group without a diagnosis of chronic
hypertension was chosen using the same exclusion
criteria. Outcomes were compared among women with-
out chronic hypertension, women with chronic hyper-
tension on no antihypertensive medication but with
blood pressures less than 140/90 mm Hg before 20
weeks of gestation, and women with chronic hyperten-
sion on antihypertensive medication with blood pres-
sures less than 140/90 mm Hg before 20 weeks of
gestation. The primary outcome was a perinatal com-
posite of stillbirth, neonatal death, respiratory support at
birth, arterial cord pH less than 7, 5-minute Apgar score 3
or less, and seizures. Secondary outcomes assessed were
From the Department of Gynecology and Obstetrics, Emory University, Atlanta,
Georgia; and the Department of Obstetrics and Gynecology, the University of
Alabama at Birmingham, Birmingham, Alabama.
Each author has indicated that he or she has met the journal’s requirements for
authorship.
Corresponding author: Lorie M. Harper, MD, MSCI, Department of Obstetrics
and Gynecology, the University of Alabama at Birmingham, 1700 6th Avenue
South, Suite 10270, Birmingham, AL 35233; email: lmharper@uabmc.edu.
Financial Disclosure
The authors did not report any potential conflicts of interest.
© 2018 by American College of Obstetricians and Gynecologists. Published by
Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0029-7844/18
VOL. 131, NO. 5, MAY 2018
Copyright Ó by American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
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Janatha Grant, MSN, FNP-BC, Jeff M. Szychowski, PhD,
preterm birth before 37 and 34 weeks of gestation, small
for gestational age, and preeclampsia.
RESULTS: Of 830 women with chronic hypertension and
blood pressures less than 140/90 mm Hg before 20
weeks of gestation, 212 (26%) were not taking antihy-
pertensive medication and 618 (74%) were. These groups
were compared with 476 women without chronic hyper-
tension. Women with hypertension were more likely to
be older and have baseline renal disease and diabetes
compared with women in the no hypertension group. The
perinatal composite was more common in both hyperten-
sive groups: no antihypertensive medication (9.9%) and
antihypertensive medication (14.6%) compared with
women in the control group (2.9%) (adjusted odds ratio
[OR] 2.9, 95% CI 1.21–6.85 no antihypertensive medica-
tions compared with no chronic hypertension; adjusted
OR 5.0, 95% CI 2.38–10.54 antihypertensive medications
vs no chronic hypertension). The risk of early preterm
birth, small for gestational age, and preeclampsia was not
significantly increased in women with chronic hyperten-
sion and no antihypertensive medications compared with
women without chronic hypertension.
CONCLUSION: Despite normal baseline blood pres-
sures without medications before 20 weeks of gestation,
women with chronic hypertension are at an increased
risk of adverse perinatal outcomes compared with
women without.
(Obstet Gynecol 2018;131:827–34)
DOI: 10.1097/AOG.0000000000002574
C hronic hypertension in pregnancy is associated
with an increased risk for preeclampsia, eclamp-
sia, preterm delivery, and perinatal mortality.1–3
As a result of the normal physiology of preg-
nancy, including decreased vascular resistance, sys-
tolic and diastolic blood pressures (BPs) fall in early
gestation and continue to be 5–10 mm Hg below
baseline for most of the second trimester.4
OBSTETRICS & GYNECOLOGY 827
Consequently, many women with chronic hyperten-
sion will have normal BPs (less than 140/90 mm Hg)
during pregnancy without medications.
Little is known about this particular subgroup of
pregnancies complicated by chronic hypertension; the
majority of prior studies of chronic hypertension in
pregnancy use only diagnostic codes or medication
lists to assess the risks associated with chronic
hypertension. Whether women with a history of
chronic hypertension but who remain normotensive
without medication during pregnancy are at increased
risk for stillbirth, fetal growth restriction, or other
adverse perinatal outcomes during pregnancy is not
clear.
The objective of this study is to assess perinatal
outcomes in women to compare the perinatal out-
comes of normotensive women and women with
a history of chronic hypertension with normal BPs
before 20 weeks of gestation, stratifying the latter by
whether they were receiving antihypertensive
medication.
MATERIALS AND METHODS
This study was a retrospective cohort study of all
patients with chronic hypertension at the University
of Alabama at Birmingham who presented before 20
weeks of gestation for prenatal care from January 1,
2000, to June 1, 2014. Institutional board review was
obtained.
Three exposure groups were identified: 1) women
without a diagnosis of chronic hypertension (and who
had normal BPs before 20 weeks of gestation), 2)
women with a history of chronic hypertension but not
taking antihypertensive medications who had normal
BPs before 20 weeks of gestation, and 3) women with
a history of chronic hypertension who were taking
antihypertensive medications and had normal BPs
before 20 weeks of gestation.
Women with singleton gestations complicated by
chronic hypertension were identified through the
perinatal database at the University of Alabama at
Birmingham using a diagnosis of chronic hyperten-
sion. The diagnosis of chronic hypertension was
confirmed by chart review based either on maternal
history (maternal report of current diagnosis of
chronic hypertension) or the use of antihypertensive
medication before pregnancy. Women who reported
a history of “prehypertension” or who reported reso-
lution of chronic hypertension after lifestyle modifica-
tion or weight loss were excluded. For the same time
period (2000–2014), a randomly selected group of
women without a diagnosis of hypertension (n5476)
were chosen for comparison using a random number
828 Youngstrom et al Women With Chronic Hypertension but Normal Blood Pressures
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generator. Other than chronic hypertension, the same
inclusion and exclusion criteria were used to select the
nonhypertensive group of women. Trained chart ab-
stractors reviewed all charts with a standardized chart
abstraction form. Data were collected on demo-
graphic information, obstetric history, laboratory
information, BP and urinalysis at each prenatal visit,
labor course, delivery information, and neonatal out-
comes until discharge.
Women were excluded from this analysis if
BPs before 20 weeks of gestation were greater than
140/90 mm Hg or if they reported major medical
problems other than hypertension, diabetes, or base-
line renal disease. Women were also excluded if fetal
anomalies were identified before neonatal discharge
from the hospital.
All women with chronic hypertension were
treated per institutional protocol under the supervi-
sion of maternal–fetal medicine specialists, with target
BPs less than 150/90 mm Hg. Serial fetal growth was
assessed by ultrasonography after 28 weeks of gesta-
tion, and at least weekly antenatal testing was per-
formed with either contraction stress tests or
biophysical profiles starting at 32–34 weeks of
gestation.
Outcomes were compared among the three
exposure groups. The primary outcome was a perina-
tal composite of stillbirth, neonatal death, respiratory
support at birth, arterial cord pH less than 7, 5-minute
Apgar score 3 or less, and seizures. Stillbirth and
neonatal death were additionally assessed as second-
ary outcomes. Respiratory support was defined as
receiving continuous positive airway pressure or
mechanical ventilation for any amount of time. These
outcomes were chosen because they are significantly
associated with death or long-term neurologic mor-
bidity.5–9 Additional secondary outcomes were small
for gestational age (SGA; defined as birth weight less
than the 10th percentile)10 and preterm birth at less
than 37 weeks of gestation and preterm birth at
less than 34 weeks of gestation. The primary maternal
outcome was preeclampsia; secondary maternal out-
comes were severe preeclampsia and early-onset
severe preeclampsia. Preeclampsia was defined as
BPs 140/90 mm Hg or greater with either proteinuria
(protein excretion 300 mg or greater in 24 hours or
protein-to-creatinine ratio 0.3 or greater), thrombocy-
topenia (less than 100,000/mL), transaminases (aspar-
tate aminotransferase greater than twice the upper
limit of normal), or elevated creatinine (1.2 mg/dL
or greater). Severe preeclampsia was defined as pre-
eclampsia plus a severe feature (BP 160/100 mm Hg
or greater or a serum laboratory abnormality);
OBSTETRICS & GYNECOLOGY
Fig. 1. Patient derivation.
Youngstrom. Women With Chronic
Hypertension but Normal Blood Pres-
sures. Obstet Gynecol 2018.
neurologic symptoms such as headache were not
abstracted as a result of variability in recording and
so not included in the definition. Early-onset severe
preeclampsia was defined as severe preeclampsia
diagnosed before 34 weeks of gestation.
Because hypertension in pregnancy is relatively
rare, we collected data on all women with a diagnosis
of chronic hypertension from January 1, 2000, to June
1, 2014. To determine the number of nonhypertensive
women required, we estimated that approximately
800 women would be included in the study, the
primary perinatal composite outcome would occur in
10% of hypertensive women,11,12 and that groups
would be evenly distributed between receiving and
not receiving antihypertensive medications. To detect
a 50% reduction in the risk of the primary perinatal
composite outcome in women without hypertension
(or an incidence of 5%), with an a of 0.05 and a b of
0.2, 435 women without a diagnosis of chronic hyper-
tension were required. Because we anticipated that the
primary perinatal composite would be the least fre-
quent outcome, we anticipated at least 80% power to
detect a difference in our secondary outcomes of pre-
term birth, preeclampsia, and SGA. We randomly
selected a group of women from the same time period
using the same exclusion criteria as for women with
chronic hypertension. To do this, we identified
women with singleton gestations from the same time
period and no known diagnosis of chronic hyperten-
sion and assigned them a number using a random
number generator. We then reviewed charts in order
of the random number generator. Because we antici-
pated that 25–30% of women would be ineligible, we
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Copyright Ó by American College of Obstetricians
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identified 625 charts to obtain 435 eligible normoten-
sive women as controls.
Descriptive statistics were compared between the
exposure groups using analysis of variance, x2 test of
trend, or Fisher exact, as appropriate. Because we ex-
pected that women without a diagnosis of chronic
hypertension would have the lowest incidence of
adverse outcomes and that women receiving antihy-
pertensive medications would have the highest inci-
dence of adverse outcomes, we used a x2 test for
trend. Potentially confounding variables of the
exposure–outcome association were identified in the
stratified analyses. Multivariable logistic regression
models for the primary outcome were then developed
to estimate the effect of the exposure group. Co-
variates for initial inclusion in multivariable statistical
models were selected using the results of the uni-
variable and stratified analyses as well as historic
confounding variables (eg, history of preterm delivery
for preterm delivery, history of preeclampsia for
preeclampsia), and factors were removed in a back-
ward stepwise fashion based on significant changes
(10%) in the exposure adjusted odds ratio or signifi-
cant differences between hierarchical models using
the likelihood ratio test. Statistical analysis was per-
formed using STATA 13 Special Edition.
RESULTS
Of 1,478 women with chronic hypertension over the
study period, 830 were included in the analysis
(Fig. 1). Of these, 212 (26%) had BPs less than 140/
90 mm Hg and did not receive antihypertensive med-
ication and 618 (74%) had BPs less than 140/90 mm
Table 1. Maternal Demographics

No Chronic Chronic Hypertension, Less Than Chronic Hypertension, Less Than

Hypertension 140/90 mm Hg, No Antihypertensive 140/90 mm Hg, Antihypertensive
Demographic (n5476) Medication (n5212) Medications (n5618) P

Age (y) 24.865.9 28.965.8 30.565.9 ,.01

Race
Black 293 (61.7) 147 (69.3) 442 (71.5) ,.01
White 83 (17.5) 57 (26.9) 147 (23.8)
Hispanic 84 (17.7) 6 (2.8) 17 (2.8)
Other 15 (3.1) 2 (1) 12 (1.9)
Nulliparous 191 (40.1) 70 (33.0) 168 (27.2) ,.01
BMI (kg/m2) 28.567.5 39.0610.3 38.8611.0 ,.01
Tobacco use 72 (15.1) 47 (22.2) 118 (19.3) .06
Government 329 (69.1) 156 (73.6) 431 (69.7) ,.01
insurance
Pregnancy-induced 14 (2.9) 60 (28.36) 208 (33.7) ,.01
hypertension in
a prior
pregnancy
Antihypertensive 0 73 (34.4) 383 (62.4) ,.01
medications
before
pregnancy
Single agent before 0 0 509 (82.4) ,.01
20 wk of
gestation
More than 1 agent 0 0 109 (17.6) ,.01
before 20 wk
of gestation
Aspirin started during 2 (0.4) 10 (4.7) 59 (9.6) ,.01
pregnancy
Baseline renal disease 1 (0.2) 13 (6.1) 71 (11.5) ,.01
Diabetes
Gestational 13 (2.7) 25 (12.0) 79 (13.0) ,.01
Pregestational 12 (2.5) 61 (29.2) 138 (22.6)
BMI, body mass index.
Data are mean6SD or n (%) unless otherwise specified.

Hg but were receiving antihypertensive medication
before 20 weeks of gestation. We reviewed the charts
of 625 women without a diagnosis of chronic hyper-
tension to identify 476 women without chronic hyper-
tension who met inclusion criteria.
The three groups were significantly different
regarding several baseline variables (Table 1).
Women without chronic hypertension were more
likely to be younger, nulliparous, Hispanic, and have
lower body mass indexes than either group with
chronic hypertension. Women without chronic hyper-
tension were also less likely to have baseline renal
disease, gestational diabetes, or pregestational diabe-
tes. As anticipated, women without a diagnosis of
chronic hypertension had the lowest average systolic
and diastolic BPs throughout all three trimesters,
whereas women with chronic hypertension on medi-
cations had the highest BPs (Table 2).
The primary composite adverse perinatal out-
come (stillbirth, neonatal death, respiratory support at
birth, arterial cord pH less than 7, 5-minute Apgar
score 3 or less, and seizures) increased in frequency
across groups (P,.01; Table 3). After adjusting for
prior preterm delivery and nulliparity, women with
chronic hypertension and not using antihypertensive
medications were at increased risk for the adverse
composite outcome compared with women with no
chronic hypertension (adjusted odds ratio [OR] 2.9,
95% CI 1.21–6.85) as were women in the with chronic
hypertension on antihypertensive medication group
(adjusted OR 5.0, 95% CI 2.38–10.54; Table 3).
Although the incidence of stillbirth increased across
exposure groups (1.3% vs 1.9% vs 2.9%), this trend
was not statistically significant (P5.06) nor was it sig-
nificant in adjusted analyses. The incidence of neona-
tal death (measured only in those with liveborn

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Table 2. Blood Pressure Characteristics Throughout Pregnancy

No Chronic Chronic Hypertension, Less Than 140/ Chronic Hypertension, Less Than
Hypertension 90 mm Hg, No Antihypertensive 140/90 mm Hg, Antihypertensive
Characteristic (n5476) Medication (n5212) Medications (n5618) P

BP (mm Hg) at less

than 20 wk
of gestation
Systolic 109610 12268 12668 ,.01
Diastolic 6467 7367 7567 ,.01
BP at 24–27 6/7
wk of
gestation
Systolic 109611 120611 124611 ,.01
Diastolic 6469 7068 7369 ,.01
Systolic 140 or 3 (0.6) 13 (6.1) 102 (16.5) ,.01
greater
Diastolic 90 or 1 (0.2) 2 (0.9) 62 (10.0) ,.01
greater
BP at 28–31 6/7
wk of
gestation
Systolic 110611 120611 125612 ,.01
Diastolic 6468 7067 7469 ,.01
Systolic 140 or 8 (1.7) 18 (8.5) 112 (18.1) ,.01
greater
Diastolic 90 or 1 (0.2) 4 (1.9) 58 (9.4) ,.01
greater
BP at 32–36 wk of
gestation
Systolic 111611 123612 128613 ,.01
Diastolic 6569 7368 76610 ,.01
Systolic 140 or 14 (2.9) 37 (17.5) 163 (26.4) ,.01
greater
Diastolic 140 8 (1.7) 13 (6.1) 109 (17.6) ,.01
or greater
BP, blood pressure.
Data are mean6SD or n (%) unless otherwise specified.

neonates) increased across the exposure groups
(P5.03), but in adjusted analyses, the increased odds
was only significant for women receiving medication.
Similarly, the incidence of preterm birth before 34
and 37 weeks of gestation increased across exposure
groups, but the increased odds for early preterm birth
was significant only for women receiving medication
after adjusting for confounding factors. The incidence
of SGA was significantly different between groups in
unadjusted analyses, but in adjusted analyses, the odds
of SGA were significantly higher in those on antihy-
pertensive medication compared with women without
chronic hypertension.
Any diagnosis of preeclampsia, severe preeclamp-
sia, and early-onset severe preeclampsia increased
across groups (Table 4; P,.01). However, after adjust-
ing for significant confounding variables, women with
chronic hypertension not taking antihypertensive
medications were not more likely to develop pre-
eclampsia or severe preeclampsia than women in the
no hypertension group. Women on medications were
more likely to develop preeclampsia or severe
preeclampsia.
DISCUSSION
In our cohort, 25% of women with a history of chronic
hypertension were normotensive (BP less than
140/90 mm Hg) before 20 weeks of gestation without
receiving antihypertensive medication. Even so, these
women were at increased of adverse perinatal out-
comes, including perinatal death, cord blood acid-
emia, seizures, and respiratory support.
Ankumah et al performed a study similar as ours;
in their cohort women with untreated hypertension
and women using antihypertensive medication were
both more likely than women with no history of

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Table 3. Neonatal and Perinatal Outcomes

Chronic Chronic
Hypertension, Hypertension,
Less Than 140/ Less Than 140/
90 mm Hg, No 90 mm Hg,
No Chronic Antihypertensive Antihypertensive
Hypertension Medication RR AOR Medications RR AOR
Outcome (n5476) (n5212) (95% CI) (95% CI) (n5618) (95% CI) (95% CI) P*
Composite 14 (2.9) 21 (9.9) 3.4 2.9 90 (14.6) 5.0 5.0 ,.01
neonatal (1.7–6.5) (1.21–6.85) (2.9–8.6) (2.38–10.54)
outcome†
Perinatal death† 8 (1.7) 6 (2.8) 1.7 (0.6–4.8) 1.6 24 (3.9) 2.3 (1.0–5.1) 2.1 (0.90–4.72) .03
(stillbirth (0.54–4.65)
+neonatal
death)
Stillbirth‡ 6 (1.3) 4 (1.9) 1.5 (0.4–5.3) 1.5 18 (2.9) 2.3 (0.9–5.8) 2.2 .06
(0.40–5.26) (0.84–5.67)
Neonatal death§ 2/470 (0.4) 2/208 (1.0) 1.7 (0.4–7.5) 1.8 6/600 (1.0) 3.1 (1.0–9.2) 3.4 .03
(denominator (0.39–8.00) (1.12–10.36)
is live births)
Any respiratory 8 (1.7) 13 (6.3) 3.7 4.1 62 (10.4) 6.1 3.9 (1.36–11.4) ,.01
supportk (1.55–8.72) (1.17–.6) (2.95–12.59)
Cord blood 1/378 (0.3) 3/172 (1.8) — — 7/487 (1.4) — — .1
acidemia
5-min Apgar 0 1 (0.5) 8 (1.3) ,.01
score 3 or less
Seizures 0 5 (2.4) 5 (0.8) .16
Preterm birth at 68/470 (14.5) 60/208 (28.9) 2.0 (1.5–2.7) 1.7 (1.1–2.6) 236/600 (39.3) 2.7 (2.1–3.5) 2.4 (1.7–3.3) ,.01
less than 37
wk of
gestation¶
Preterm birth at 17/470 (3.6) 14/208 (6.7) 1.9 (0.9–3.7) 1.4 (0.6–3.0) 102/600 (17.0) 4.7 (2.9–7.7) 3.3 (1.8–5.9) ,.01
less than 34
wk of
gestation¶
Small for 73 (15.3) 24 (11.3) 0.7 (0.5–1.1) 0.9 (0.51– 111 (18.0) 1.2 (0.9–1.5) 1.8 (1.16–2.67) .20
gestational 1.68)
age#

RR, relative risk; AOR, adjusted odds ratio.

Data are n (%) or n/N (%) unless otherwise specified.
Composite neonatal outcome: any one of stillbirth, neonatal death, continuous positive airway pressure, ventilator, umbilical cord pH less
than 7, 5-min Apgar score 3 or less, seizures. Total of individual components is greater than the number of outcomes because they are not
mutually exclusive. Not all patients had documented cord blood gas. Denominator for neonatal death and preterm birth at less than 35
weeks of gestation was live births.
* P value based on x2 test for trend.
†
Adjusted for age, prior preterm delivery, race, body mass index, diabetes, baseline renal disease, and nulliparity.
‡
Adjusted for prior preterm delivery, nulliparity.
§
Adjusted for prior preterm delivery, nulliparity.
k
Adjusted for gestational age at delivery.
¶
Adjusted for prior preterm delivery, race, diabetes, baseline renal disease, and nulliparity.
#
Adjusted for race, body mass index, tobacco use, and diabetes.

chronic hypertension to experience preterm delivery,
growth restriction, and preeclampsia.13 However,
these data did not report BPs during pregnancy.
Su et al14 demonstrated that women with untreated
hypertension had an increased risk of preterm birth
and SGA compared with those without chronic hyper-
tension. However, no data were available on baseline
BPs during pregnancy. Ankumah et al13 in a second-
ary analysis found the lowest risk of adverse outcomes
in normotensive chronic hypertensive women at base-
line compared with those with elevated baseline BPs,
but did not distinguish by whether they were on
medication.
The strengths of this study include the a priori
determination of sample size needed for the primary
outcome. We collected detailed data on a large cohort
of women with chronic hypertension, allowing us to
clearly identify a population of women with chronic
hypertension who have BPs less than 140/90 mm Hg
without medications for whom there is a paucity of
published information. All patients had documented
BPs before 20 weeks of gestation enabling us to

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Table 4. Maternal Outcomes

Chronic Chronic
Hypertension, Less Hypertension, Less
Than 140/90 mm Than 140/90 mm
Hg, No Hg,
No Chronic Antihypertensive Antihypertensive
Hypertension Medication RR AOR Medications RR (95% AOR
Outcome (n5476) (n5212) (95% CI) (95% CI) (n5618) CI) (95% CI) P*
Any 30 (6.3) 29 (13.7) 2.2 1.5† 162 (26.2) 4.2 3.3 ,.01
preeclampsia (1.3–3.5) (0.86–2.79) (2.9–6.0) (2.07–5.18)
diagnosis
Severe 13 (2.7) 15 (7.1) 2.6 1.6† 106 (16.7) 6.1 4.0 ,.01
preeclampsia (1.3–5.3) (0.72–3.71) (3.5–10.7) (2.08–7.55)
Early-onset 0 2 (1.0) — — 45 (7.3) — — ,.01
severe
preeclampsia

RR, relative risk; AOR, adjusted odds ratio; —, not calculated as a result of 0 cases in the reference group.
Data are n (%) unless otherwise specified.
* P value based on x2 test for trend.
†
Adjusted for history of preeclampsia, diabetes, baseline renal disease, and nulliparity.

distinguish between chronic hypertension and pre-
eclampsia; additionally, all women included in the
hypertension groups had a confirmed diagnosis of
chronic hypertension. Women with a history of “pre-
hypertension” or hypertension that resolved after
weight loss surgery were excluded from the study.
One of the limitations of this study is that the
sample is from a single academic institution and
therefore may not be generalizable to other institutions.
Specifically, our cohort was largely black, obese, and
had a high incidence of pregestational diabetes. Addi-
tionally, women with chronic hypertension were differ-
ent than women without chronic hypertension in several
important baseline characteristics, including being older,
more obese, and more likely to have other medical
problems such as diabetes. Therefore, the differences in
outcomes may not be solely the result of the presence of
chronic hypertension. Although we attempted to control
for these factors using logistic regression, the possibility
of residual confounding exists. Furthermore, our sample
was based on an estimated 10% incidence of the primary
outcome with approximately 400 women in the no
medication group. However, only 25% of the sample, or
212 women with chronic hypertension, were in the no
medication group. Consequently, we had only 57%
power to detect a 50% reduction in the risk of the
primary perinatal composite outcome in women without
hypertension compared with the no medication group.
Because the individual components of the primary
composite perinatal outcome were less frequent than
the composite perinatal outcome, we had limited power
to detect a difference in stillbirth, neonatal death, and
perinatal death. Similarly, for the secondary outcome of
preterm birth before 34 weeks of gestation, we had
approximately 35% power to detect a 50% reduction in
the risk in women without hypertension compared with
the no medication group. We had more than 80%
power to detect a difference of a 50% reduction for
preeclampsia.
In summary, we found that women with a history
of chronic hypertension who are normotensive with-
out antihypertensive medication before 20 weeks of
gestation are at increased risk of adverse perinatal
outcomes compared with women without a diagnosis
of chronic hypertension.
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