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2014 ; 124
(5
): 933-940
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gab.com Text
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Laboratory abnormalities in pregnancy-associated hypertension: frequency and
association with pregnancy outcomes
#MMPMID25437721
Cantu J
; Clifton RG
; Roberts JM
; Leveno KJ
; Myatt L
; Reddy UM
; Varner MW
; Wapner RJ
; Thorp JM Jr
; Mercer BM
; Peaceman AM
; Ramin SM
; Samuels P
; Sciscione A
; Saade G
; Sorokin Y
Obstet Gynecol
2014[Nov]; 124
(5
): 933-940
PMID25437721
show ga
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/mm,
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.