Laboratory abnormalities in pregnancy-associated hypertension

Frequency and association with pregnancy outcomes

Jessica Cantu*, Rebecca G. Clifton, James M. Roberts, Kenneth J. Leveno, Leslie Myatt, Uma M. Reddy, Michael W. Varner, Ronald J. Wapner, John M. Thorp, Brian M. Mercer, Alan M. Peaceman, Susan M. Ramin, Philip Samuels, Anthony Sciscione, George Saade, Yoram Sorokin

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE: To estimate the frequency of abnormal laboratory test results in pregnancy-associated hypertension and the relationship with pregnancy outcomes. METHODS: This was a secondary analysis of a multicenter trial of Vitamin C and E for prevention of pregnancy-associated hypertension in low-risk nulliparous women. Laboratory abnormalities included: platelets less than 100,000/mm3, aspartate aminotransferase 100 units/L or greater, creatinine 1.5 mg/dL or greater, lactate dehydrogenase 600 units/L or greater, total bilirubin 1.2 mg/dL or greater, or evidence of hemolysis on peripheral smear. Mild pregnancy-associated hypertension was defined as blood pressure 140-159/90-109 mm Hg. Severe pregnancy-associated hypertension was defined as persistent blood pressure 160/110 mm Hg or greater, acute antihypertensive treatment, or any blood pressure elevation associated with clinical signs of end-organ dysfunction (one or more of headache, epigastric pain, blurred vision, pulmonary edema, eclampsia, or oliguria). Pregnancy outcomes were compared across four groups: I, mild hypertension alone; II, mild hypertension+abnormal laboratory values; III, severe pregnancy-associated hypertension alone; and IV, severe pregnancy-associated hypertension+abnormal laboratory values. RESULTS: Of 9,969 women, 2,752 (27.9%) developed pregnancy-associated hypertension and of these, laboratory abnormalities occurred in 7.3%. Laboratory abnormalities increased with severity of hypertension: mild hypertension alone (4.9%), severe hypertension alone (8.9%), and mild or severe hypertension with clinical signs of end-organ dysfunction (12.2%) (P for trend<.001). Compared with women with mild hypertension alone, the adjusted odds for the perinatal composite (2-fold to 4.8-fold in Category III-IV), preterm birth (2.1-fold to 7.8-fold in Category II-IV), and other adverse perinatal outcomes increase with disease severity, particularly with laboratory abnormalities and severe clinical signs. CONCLUSION: The frequency of abnormal laboratory values in women with pregnancy-associated hypertension increases with disease severity. Adverse perinatal outcomes increase in the presence of abnormal laboratory values, particularly in those with clinical signs, likely atttributable in part to the decision to deliver early.

Original languageEnglish (US)
Pages (from-to)933-940
Number of pages8
JournalObstetrics and gynecology
Volume124
Issue number5
DOIs
StatePublished - Jan 1 2014

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Pregnancy Outcome
Hypertension
Pregnancy
Blood Pressure
Oliguria
Eclampsia
Premature Birth
Pulmonary Edema
Aspartate Aminotransferases
Hemolysis
Vitamin E
L-Lactate Dehydrogenase
Bilirubin
Antihypertensive Agents
Ascorbic Acid
Multicenter Studies
Headache
Creatinine
Blood Platelets

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cantu, J., Clifton, R. G., Roberts, J. M., Leveno, K. J., Myatt, L., Reddy, U. M., ... Sorokin, Y. (2014). Laboratory abnormalities in pregnancy-associated hypertension: Frequency and association with pregnancy outcomes. Obstetrics and gynecology, 124(5), 933-940. https://doi.org/10.1097/AOG.0000000000000509
Cantu, Jessica ; Clifton, Rebecca G. ; Roberts, James M. ; Leveno, Kenneth J. ; Myatt, Leslie ; Reddy, Uma M. ; Varner, Michael W. ; Wapner, Ronald J. ; Thorp, John M. ; Mercer, Brian M. ; Peaceman, Alan M. ; Ramin, Susan M. ; Samuels, Philip ; Sciscione, Anthony ; Saade, George ; Sorokin, Yoram. / Laboratory abnormalities in pregnancy-associated hypertension : Frequency and association with pregnancy outcomes. In: Obstetrics and gynecology. 2014 ; Vol. 124, No. 5. pp. 933-940.
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abstract = "OBJECTIVE: To estimate the frequency of abnormal laboratory test results in pregnancy-associated hypertension and the relationship with pregnancy outcomes. METHODS: This was a secondary analysis of a multicenter trial of Vitamin C and E for prevention of pregnancy-associated hypertension in low-risk nulliparous women. Laboratory abnormalities included: platelets less than 100,000/mm3, aspartate aminotransferase 100 units/L or greater, creatinine 1.5 mg/dL or greater, lactate dehydrogenase 600 units/L or greater, total bilirubin 1.2 mg/dL or greater, or evidence of hemolysis on peripheral smear. Mild pregnancy-associated hypertension was defined as blood pressure 140-159/90-109 mm Hg. Severe pregnancy-associated hypertension was defined as persistent blood pressure 160/110 mm Hg or greater, acute antihypertensive treatment, or any blood pressure elevation associated with clinical signs of end-organ dysfunction (one or more of headache, epigastric pain, blurred vision, pulmonary edema, eclampsia, or oliguria). Pregnancy outcomes were compared across four groups: I, mild hypertension alone; II, mild hypertension+abnormal laboratory values; III, severe pregnancy-associated hypertension alone; and IV, severe pregnancy-associated hypertension+abnormal laboratory values. RESULTS: Of 9,969 women, 2,752 (27.9{\%}) developed pregnancy-associated hypertension and of these, laboratory abnormalities occurred in 7.3{\%}. Laboratory abnormalities increased with severity of hypertension: mild hypertension alone (4.9{\%}), severe hypertension alone (8.9{\%}), and mild or severe hypertension with clinical signs of end-organ dysfunction (12.2{\%}) (P for trend<.001). Compared with women with mild hypertension alone, the adjusted odds for the perinatal composite (2-fold to 4.8-fold in Category III-IV), preterm birth (2.1-fold to 7.8-fold in Category II-IV), and other adverse perinatal outcomes increase with disease severity, particularly with laboratory abnormalities and severe clinical signs. CONCLUSION: The frequency of abnormal laboratory values in women with pregnancy-associated hypertension increases with disease severity. Adverse perinatal outcomes increase in the presence of abnormal laboratory values, particularly in those with clinical signs, likely atttributable in part to the decision to deliver early.",
author = "Jessica Cantu and Clifton, {Rebecca G.} and Roberts, {James M.} and Leveno, {Kenneth J.} and Leslie Myatt and Reddy, {Uma M.} and Varner, {Michael W.} and Wapner, {Ronald J.} and Thorp, {John M.} and Mercer, {Brian M.} and Peaceman, {Alan M.} and Ramin, {Susan M.} and Philip Samuels and Anthony Sciscione and George Saade and Yoram Sorokin",
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Cantu, J, Clifton, RG, Roberts, JM, Leveno, KJ, Myatt, L, Reddy, UM, Varner, MW, Wapner, RJ, Thorp, JM, Mercer, BM, Peaceman, AM, Ramin, SM, Samuels, P, Sciscione, A, Saade, G & Sorokin, Y 2014, 'Laboratory abnormalities in pregnancy-associated hypertension: Frequency and association with pregnancy outcomes', Obstetrics and gynecology, vol. 124, no. 5, pp. 933-940. https://doi.org/10.1097/AOG.0000000000000509

Laboratory abnormalities in pregnancy-associated hypertension : Frequency and association with pregnancy outcomes. / Cantu, Jessica; Clifton, Rebecca G.; Roberts, James M.; Leveno, Kenneth J.; Myatt, Leslie; Reddy, Uma M.; Varner, Michael W.; Wapner, Ronald J.; Thorp, John M.; Mercer, Brian M.; Peaceman, Alan M.; Ramin, Susan M.; Samuels, Philip; Sciscione, Anthony; Saade, George; Sorokin, Yoram.

In: Obstetrics and gynecology, Vol. 124, No. 5, 01.01.2014, p. 933-940.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Laboratory abnormalities in pregnancy-associated hypertension

T2 - Frequency and association with pregnancy outcomes

AU - Cantu, Jessica

AU - Clifton, Rebecca G.

AU - Roberts, James M.

AU - Leveno, Kenneth J.

AU - Myatt, Leslie

AU - Reddy, Uma M.

AU - Varner, Michael W.

AU - Wapner, Ronald J.

AU - Thorp, John M.

AU - Mercer, Brian M.

AU - Peaceman, Alan M.

AU - Ramin, Susan M.

AU - Samuels, Philip

AU - Sciscione, Anthony

AU - Saade, George

AU - Sorokin, Yoram

PY - 2014/1/1

Y1 - 2014/1/1

N2 - OBJECTIVE: To estimate the frequency of abnormal laboratory test results in pregnancy-associated hypertension and the relationship with pregnancy outcomes. METHODS: This was a secondary analysis of a multicenter trial of Vitamin C and E for prevention of pregnancy-associated hypertension in low-risk nulliparous women. Laboratory abnormalities included: platelets less than 100,000/mm3, aspartate aminotransferase 100 units/L or greater, creatinine 1.5 mg/dL or greater, lactate dehydrogenase 600 units/L or greater, total bilirubin 1.2 mg/dL or greater, or evidence of hemolysis on peripheral smear. Mild pregnancy-associated hypertension was defined as blood pressure 140-159/90-109 mm Hg. Severe pregnancy-associated hypertension was defined as persistent blood pressure 160/110 mm Hg or greater, acute antihypertensive treatment, or any blood pressure elevation associated with clinical signs of end-organ dysfunction (one or more of headache, epigastric pain, blurred vision, pulmonary edema, eclampsia, or oliguria). Pregnancy outcomes were compared across four groups: I, mild hypertension alone; II, mild hypertension+abnormal laboratory values; III, severe pregnancy-associated hypertension alone; and IV, severe pregnancy-associated hypertension+abnormal laboratory values. RESULTS: Of 9,969 women, 2,752 (27.9%) developed pregnancy-associated hypertension and of these, laboratory abnormalities occurred in 7.3%. Laboratory abnormalities increased with severity of hypertension: mild hypertension alone (4.9%), severe hypertension alone (8.9%), and mild or severe hypertension with clinical signs of end-organ dysfunction (12.2%) (P for trend<.001). Compared with women with mild hypertension alone, the adjusted odds for the perinatal composite (2-fold to 4.8-fold in Category III-IV), preterm birth (2.1-fold to 7.8-fold in Category II-IV), and other adverse perinatal outcomes increase with disease severity, particularly with laboratory abnormalities and severe clinical signs. CONCLUSION: The frequency of abnormal laboratory values in women with pregnancy-associated hypertension increases with disease severity. Adverse perinatal outcomes increase in the presence of abnormal laboratory values, particularly in those with clinical signs, likely atttributable in part to the decision to deliver early.

AB - OBJECTIVE: To estimate the frequency of abnormal laboratory test results in pregnancy-associated hypertension and the relationship with pregnancy outcomes. METHODS: This was a secondary analysis of a multicenter trial of Vitamin C and E for prevention of pregnancy-associated hypertension in low-risk nulliparous women. Laboratory abnormalities included: platelets less than 100,000/mm3, aspartate aminotransferase 100 units/L or greater, creatinine 1.5 mg/dL or greater, lactate dehydrogenase 600 units/L or greater, total bilirubin 1.2 mg/dL or greater, or evidence of hemolysis on peripheral smear. Mild pregnancy-associated hypertension was defined as blood pressure 140-159/90-109 mm Hg. Severe pregnancy-associated hypertension was defined as persistent blood pressure 160/110 mm Hg or greater, acute antihypertensive treatment, or any blood pressure elevation associated with clinical signs of end-organ dysfunction (one or more of headache, epigastric pain, blurred vision, pulmonary edema, eclampsia, or oliguria). Pregnancy outcomes were compared across four groups: I, mild hypertension alone; II, mild hypertension+abnormal laboratory values; III, severe pregnancy-associated hypertension alone; and IV, severe pregnancy-associated hypertension+abnormal laboratory values. RESULTS: Of 9,969 women, 2,752 (27.9%) developed pregnancy-associated hypertension and of these, laboratory abnormalities occurred in 7.3%. Laboratory abnormalities increased with severity of hypertension: mild hypertension alone (4.9%), severe hypertension alone (8.9%), and mild or severe hypertension with clinical signs of end-organ dysfunction (12.2%) (P for trend<.001). Compared with women with mild hypertension alone, the adjusted odds for the perinatal composite (2-fold to 4.8-fold in Category III-IV), preterm birth (2.1-fold to 7.8-fold in Category II-IV), and other adverse perinatal outcomes increase with disease severity, particularly with laboratory abnormalities and severe clinical signs. CONCLUSION: The frequency of abnormal laboratory values in women with pregnancy-associated hypertension increases with disease severity. Adverse perinatal outcomes increase in the presence of abnormal laboratory values, particularly in those with clinical signs, likely atttributable in part to the decision to deliver early.

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