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?

OBJECTIVE: This study was undertaken to compare baseline characteristics an d pregnancy outcomes between normotensive women who did and those who did n ot have a rise in diastolic blood pressure of greater than or equal to 15 m m Hg in association with proteinuria. STUDY DESIGN: We studied 4302 healthy nulliparous women from the Calcium fo r Preeclampsia Prevention trial who were delivered at greater than or equal to 20 weeks' gestation. We selected as the study group normotensive women who developed proteinuria within 7 days of a rise in diastolic blood pressu re of greater than or equal to 15 mm Hg with respect to baseline on 2 occas ions 4 to 168 hours apart. Baseline blood pressure was the mean of measurem ents at 2 clinic visits before 22 weeks' gestation. Other normotensive wome n used for comparison were those who did not develop gestational hypertensi on or a rise in diastolic blood pressure of greater than or equal to 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 wome n with a rise in diastolic blood pressure of greater than or equal to 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 weigh t 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 out comes among these women. CONCLUSION: During normotensive pregnancy a rise in diastolic blood pressur e of greater than or equal to 15 mm Hg in association with proteinuria appe ars to be benign and is not a useful clinical construct.