PREDICTING HIGH BLOOD-PRESSURE IN PREGNANCY - A MULTIVARIATE APPROACH

Objective To identify predictors of pregnancy-induced hypertension and pre-eclampsia in 212 nulliparous women before 20 weeks' gestation and at approximately 28 weeks' gestation. Study design A randomized, pros pective study in a teaching hospital, We performed standardized measur ements of systolic and diastolic arterial blood pressures, body mass i ndex, urinary calcium:creatinine ratio and components of the renin-ang iotensin system, including platelet angiotensin II binding site densit y. Attending clinicians were blinded to the results, Outcome was asses sed by one observer at the end of pregnancy, Discriminant function ana lysis was used to identify significant predictors. Results Fifty-five women had transient, presumed 'white-coat', systolic hypertension at t he time of first pregnancy visit; they were twice as likely to develop pregnancy-induced hypertension and pre-eclampsia and five times more likely to deliver prematurely, Body mass index, platelet angiotensin I I binding site density and urinary calcium:creatinine ratio measured b efore 20 weeks gestation were also significant predictors. At 28 weeks of pregnancy, measurements of the blood pressure were significant pre dictors (reflecting the near clinical expression of the disease), toge ther with the plasma angiotensinogen concentration. Conclusions A sing le systolic blood pressure reading of 140 mmHg or more before 20 weeks ' gestation indicates a higher than normal risk of pregnancy-induced h ypertension and pre-eclampsia and premature delivery, Discriminator bi ochemical variables were also identified at this time, which might all ow the more rational use of prophylactic measures, (C) 1998 Rapid Scie nce Ltd.