Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa
Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse p...
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| Autor*in: |
Nisar, Muhammad Imran [verfasserIn] Kabole, Ibrahim [verfasserIn] Khanam, Rasheda [verfasserIn] Shahid, Shahira [verfasserIn] Bakari, Bihila Abdalla [verfasserIn] Chowdhury, Nabidul Haque [verfasserIn] Qazi, Muhammad Farrukh [verfasserIn] Dutta, Arup [verfasserIn] Rahman, Sayedur [verfasserIn] Khalid, Javairia [verfasserIn] Dhingra, Usha [verfasserIn] Hasan, Tarik [verfasserIn] Ansari, Nadia [verfasserIn] Deb, Saikat [verfasserIn] Mitra, Dipak K. [verfasserIn] Mehmood, Usma [verfasserIn] Aftab, Fahad [verfasserIn] Ahmed, Salahuddin [verfasserIn] Khan, Shahiryar [verfasserIn] Ali, Said Mohammad [verfasserIn] Ahmed, Saifuddin [verfasserIn] Manu, Alexander [verfasserIn] Yoshida, Sachiyo [verfasserIn] Bahl, Rajiv [verfasserIn] Baqui, Abdullah H. [verfasserIn] Sazawal, Sunil [verfasserIn] Jehan, Fyezah [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2024 |
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| Schlagwörter: |
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| Anmerkung: |
© The Author(s) 2024 |
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| Übergeordnetes Werk: |
Enthalten in: BMC pregnancy and childbirth - BioMed Central, 2001, 24(2024), 1 vom: 29. Juni |
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| Übergeordnetes Werk: |
volume:24 ; year:2024 ; number:1 ; day:29 ; month:06 |
| Links: |
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| DOI / URN: |
10.1186/s12884-024-06637-2 |
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SPR056419619 |
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| 245 | 1 | 0 | |a Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
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| 520 | |a Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. | ||
| 650 | 4 | |a Hypertension |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Pregnancy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Adverse outcomes |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Pakistan |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Tanzania |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Bangladesh |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Kabole, Ibrahim |e verfasserin |4 aut | |
| 700 | 1 | |a Khanam, Rasheda |e verfasserin |4 aut | |
| 700 | 1 | |a Shahid, Shahira |e verfasserin |4 aut | |
| 700 | 1 | |a Bakari, Bihila Abdalla |e verfasserin |4 aut | |
| 700 | 1 | |a Chowdhury, Nabidul Haque |e verfasserin |4 aut | |
| 700 | 1 | |a Qazi, Muhammad Farrukh |e verfasserin |4 aut | |
| 700 | 1 | |a Dutta, Arup |e verfasserin |4 aut | |
| 700 | 1 | |a Rahman, Sayedur |e verfasserin |4 aut | |
| 700 | 1 | |a Khalid, Javairia |e verfasserin |4 aut | |
| 700 | 1 | |a Dhingra, Usha |e verfasserin |4 aut | |
| 700 | 1 | |a Hasan, Tarik |e verfasserin |4 aut | |
| 700 | 1 | |a Ansari, Nadia |e verfasserin |4 aut | |
| 700 | 1 | |a Deb, Saikat |e verfasserin |4 aut | |
| 700 | 1 | |a Mitra, Dipak K. |e verfasserin |4 aut | |
| 700 | 1 | |a Mehmood, Usma |e verfasserin |4 aut | |
| 700 | 1 | |a Aftab, Fahad |e verfasserin |4 aut | |
| 700 | 1 | |a Ahmed, Salahuddin |e verfasserin |4 aut | |
| 700 | 1 | |a Khan, Shahiryar |e verfasserin |4 aut | |
| 700 | 1 | |a Ali, Said Mohammad |e verfasserin |4 aut | |
| 700 | 1 | |a Ahmed, Saifuddin |e verfasserin |4 aut | |
| 700 | 1 | |a Manu, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Yoshida, Sachiyo |e verfasserin |4 aut | |
| 700 | 1 | |a Bahl, Rajiv |e verfasserin |4 aut | |
| 700 | 1 | |a Baqui, Abdullah H. |e verfasserin |4 aut | |
| 700 | 1 | |a Sazawal, Sunil |e verfasserin |4 aut | |
| 700 | 1 | |a Jehan, Fyezah |e verfasserin |4 aut | |
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10.1186/s12884-024-06637-2 doi (DE-627)SPR056419619 (SPR)s12884-024-06637-2-e DE-627 ger DE-627 rakwb eng 610 VZ 44.00 bkl Nisar, Muhammad Imran verfasserin aut Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 Kabole, Ibrahim verfasserin aut Khanam, Rasheda verfasserin aut Shahid, Shahira verfasserin aut Bakari, Bihila Abdalla verfasserin aut Chowdhury, Nabidul Haque verfasserin aut Qazi, Muhammad Farrukh verfasserin aut Dutta, Arup verfasserin aut Rahman, Sayedur verfasserin aut Khalid, Javairia verfasserin aut Dhingra, Usha verfasserin aut Hasan, Tarik verfasserin aut Ansari, Nadia verfasserin aut Deb, Saikat verfasserin aut Mitra, Dipak K. verfasserin aut Mehmood, Usma verfasserin aut Aftab, Fahad verfasserin aut Ahmed, Salahuddin verfasserin aut Khan, Shahiryar verfasserin aut Ali, Said Mohammad verfasserin aut Ahmed, Saifuddin verfasserin aut Manu, Alexander verfasserin aut Yoshida, Sachiyo verfasserin aut Bahl, Rajiv verfasserin aut Baqui, Abdullah H. verfasserin aut Sazawal, Sunil verfasserin aut Jehan, Fyezah verfasserin aut Enthalten in BMC pregnancy and childbirth BioMed Central, 2001 24(2024), 1 vom: 29. Juni (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:24 year:2024 number:1 day:29 month:06 https://dx.doi.org/10.1186/s12884-024-06637-2 X:SPRINGER Resolving-System kostenfrei Volltext SYSFLAG_0 GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 VZ AR 24 2024 1 29 06 |
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10.1186/s12884-024-06637-2 doi (DE-627)SPR056419619 (SPR)s12884-024-06637-2-e DE-627 ger DE-627 rakwb eng 610 VZ 44.00 bkl Nisar, Muhammad Imran verfasserin aut Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 Kabole, Ibrahim verfasserin aut Khanam, Rasheda verfasserin aut Shahid, Shahira verfasserin aut Bakari, Bihila Abdalla verfasserin aut Chowdhury, Nabidul Haque verfasserin aut Qazi, Muhammad Farrukh verfasserin aut Dutta, Arup verfasserin aut Rahman, Sayedur verfasserin aut Khalid, Javairia verfasserin aut Dhingra, Usha verfasserin aut Hasan, Tarik verfasserin aut Ansari, Nadia verfasserin aut Deb, Saikat verfasserin aut Mitra, Dipak K. verfasserin aut Mehmood, Usma verfasserin aut Aftab, Fahad verfasserin aut Ahmed, Salahuddin verfasserin aut Khan, Shahiryar verfasserin aut Ali, Said Mohammad verfasserin aut Ahmed, Saifuddin verfasserin aut Manu, Alexander verfasserin aut Yoshida, Sachiyo verfasserin aut Bahl, Rajiv verfasserin aut Baqui, Abdullah H. verfasserin aut Sazawal, Sunil verfasserin aut Jehan, Fyezah verfasserin aut Enthalten in BMC pregnancy and childbirth BioMed Central, 2001 24(2024), 1 vom: 29. Juni (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:24 year:2024 number:1 day:29 month:06 https://dx.doi.org/10.1186/s12884-024-06637-2 X:SPRINGER Resolving-System kostenfrei Volltext SYSFLAG_0 GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 VZ AR 24 2024 1 29 06 |
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10.1186/s12884-024-06637-2 doi (DE-627)SPR056419619 (SPR)s12884-024-06637-2-e DE-627 ger DE-627 rakwb eng 610 VZ 44.00 bkl Nisar, Muhammad Imran verfasserin aut Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 Kabole, Ibrahim verfasserin aut Khanam, Rasheda verfasserin aut Shahid, Shahira verfasserin aut Bakari, Bihila Abdalla verfasserin aut Chowdhury, Nabidul Haque verfasserin aut Qazi, Muhammad Farrukh verfasserin aut Dutta, Arup verfasserin aut Rahman, Sayedur verfasserin aut Khalid, Javairia verfasserin aut Dhingra, Usha verfasserin aut Hasan, Tarik verfasserin aut Ansari, Nadia verfasserin aut Deb, Saikat verfasserin aut Mitra, Dipak K. verfasserin aut Mehmood, Usma verfasserin aut Aftab, Fahad verfasserin aut Ahmed, Salahuddin verfasserin aut Khan, Shahiryar verfasserin aut Ali, Said Mohammad verfasserin aut Ahmed, Saifuddin verfasserin aut Manu, Alexander verfasserin aut Yoshida, Sachiyo verfasserin aut Bahl, Rajiv verfasserin aut Baqui, Abdullah H. verfasserin aut Sazawal, Sunil verfasserin aut Jehan, Fyezah verfasserin aut Enthalten in BMC pregnancy and childbirth BioMed Central, 2001 24(2024), 1 vom: 29. Juni (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:24 year:2024 number:1 day:29 month:06 https://dx.doi.org/10.1186/s12884-024-06637-2 X:SPRINGER Resolving-System kostenfrei Volltext SYSFLAG_0 GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 VZ AR 24 2024 1 29 06 |
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10.1186/s12884-024-06637-2 doi (DE-627)SPR056419619 (SPR)s12884-024-06637-2-e DE-627 ger DE-627 rakwb eng 610 VZ 44.00 bkl Nisar, Muhammad Imran verfasserin aut Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 Kabole, Ibrahim verfasserin aut Khanam, Rasheda verfasserin aut Shahid, Shahira verfasserin aut Bakari, Bihila Abdalla verfasserin aut Chowdhury, Nabidul Haque verfasserin aut Qazi, Muhammad Farrukh verfasserin aut Dutta, Arup verfasserin aut Rahman, Sayedur verfasserin aut Khalid, Javairia verfasserin aut Dhingra, Usha verfasserin aut Hasan, Tarik verfasserin aut Ansari, Nadia verfasserin aut Deb, Saikat verfasserin aut Mitra, Dipak K. verfasserin aut Mehmood, Usma verfasserin aut Aftab, Fahad verfasserin aut Ahmed, Salahuddin verfasserin aut Khan, Shahiryar verfasserin aut Ali, Said Mohammad verfasserin aut Ahmed, Saifuddin verfasserin aut Manu, Alexander verfasserin aut Yoshida, Sachiyo verfasserin aut Bahl, Rajiv verfasserin aut Baqui, Abdullah H. verfasserin aut Sazawal, Sunil verfasserin aut Jehan, Fyezah verfasserin aut Enthalten in BMC pregnancy and childbirth BioMed Central, 2001 24(2024), 1 vom: 29. Juni (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:24 year:2024 number:1 day:29 month:06 https://dx.doi.org/10.1186/s12884-024-06637-2 X:SPRINGER Resolving-System kostenfrei Volltext SYSFLAG_0 GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 VZ AR 24 2024 1 29 06 |
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10.1186/s12884-024-06637-2 doi (DE-627)SPR056419619 (SPR)s12884-024-06637-2-e DE-627 ger DE-627 rakwb eng 610 VZ 44.00 bkl Nisar, Muhammad Imran verfasserin aut Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 Kabole, Ibrahim verfasserin aut Khanam, Rasheda verfasserin aut Shahid, Shahira verfasserin aut Bakari, Bihila Abdalla verfasserin aut Chowdhury, Nabidul Haque verfasserin aut Qazi, Muhammad Farrukh verfasserin aut Dutta, Arup verfasserin aut Rahman, Sayedur verfasserin aut Khalid, Javairia verfasserin aut Dhingra, Usha verfasserin aut Hasan, Tarik verfasserin aut Ansari, Nadia verfasserin aut Deb, Saikat verfasserin aut Mitra, Dipak K. verfasserin aut Mehmood, Usma verfasserin aut Aftab, Fahad verfasserin aut Ahmed, Salahuddin verfasserin aut Khan, Shahiryar verfasserin aut Ali, Said Mohammad verfasserin aut Ahmed, Saifuddin verfasserin aut Manu, Alexander verfasserin aut Yoshida, Sachiyo verfasserin aut Bahl, Rajiv verfasserin aut Baqui, Abdullah H. verfasserin aut Sazawal, Sunil verfasserin aut Jehan, Fyezah verfasserin aut Enthalten in BMC pregnancy and childbirth BioMed Central, 2001 24(2024), 1 vom: 29. Juni (DE-627)335489087 (DE-600)2059869-5 1471-2393 nnns volume:24 year:2024 number:1 day:29 month:06 https://dx.doi.org/10.1186/s12884-024-06637-2 X:SPRINGER Resolving-System kostenfrei Volltext SYSFLAG_0 GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 44.00 VZ AR 24 2024 1 29 06 |
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Enthalten in BMC pregnancy and childbirth 24(2024), 1 vom: 29. Juni volume:24 year:2024 number:1 day:29 month:06 |
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Hypertension Pregnancy Adverse outcomes Pakistan Tanzania Bangladesh |
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Nisar, Muhammad Imran @@aut@@ Kabole, Ibrahim @@aut@@ Khanam, Rasheda @@aut@@ Shahid, Shahira @@aut@@ Bakari, Bihila Abdalla @@aut@@ Chowdhury, Nabidul Haque @@aut@@ Qazi, Muhammad Farrukh @@aut@@ Dutta, Arup @@aut@@ Rahman, Sayedur @@aut@@ Khalid, Javairia @@aut@@ Dhingra, Usha @@aut@@ Hasan, Tarik @@aut@@ Ansari, Nadia @@aut@@ Deb, Saikat @@aut@@ Mitra, Dipak K. @@aut@@ Mehmood, Usma @@aut@@ Aftab, Fahad @@aut@@ Ahmed, Salahuddin @@aut@@ Khan, Shahiryar @@aut@@ Ali, Said Mohammad @@aut@@ Ahmed, Saifuddin @@aut@@ Manu, Alexander @@aut@@ Yoshida, Sachiyo @@aut@@ Bahl, Rajiv @@aut@@ Baqui, Abdullah H. @@aut@@ Sazawal, Sunil @@aut@@ Jehan, Fyezah @@aut@@ |
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The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. 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Nisar, Muhammad Imran |
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Nisar, Muhammad Imran ddc 610 bkl 44.00 misc Hypertension misc Pregnancy misc Adverse outcomes misc Pakistan misc Tanzania misc Bangladesh Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
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610 VZ 44.00 bkl Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa Hypertension (dpeaa)DE-He213 Pregnancy (dpeaa)DE-He213 Adverse outcomes (dpeaa)DE-He213 Pakistan (dpeaa)DE-He213 Tanzania (dpeaa)DE-He213 Bangladesh (dpeaa)DE-He213 |
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ddc 610 bkl 44.00 misc Hypertension misc Pregnancy misc Adverse outcomes misc Pakistan misc Tanzania misc Bangladesh |
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Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
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Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
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Nisar, Muhammad Imran Kabole, Ibrahim Khanam, Rasheda Shahid, Shahira Bakari, Bihila Abdalla Chowdhury, Nabidul Haque Qazi, Muhammad Farrukh Dutta, Arup Rahman, Sayedur Khalid, Javairia Dhingra, Usha Hasan, Tarik Ansari, Nadia Deb, Saikat Mitra, Dipak K. Mehmood, Usma Aftab, Fahad Ahmed, Salahuddin Khan, Shahiryar Ali, Said Mohammad Ahmed, Saifuddin Manu, Alexander Yoshida, Sachiyo Bahl, Rajiv Baqui, Abdullah H. Sazawal, Sunil Jehan, Fyezah |
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Nisar, Muhammad Imran |
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verfasserin |
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does the implementation of revised american college of cardiology and american heart association (acc/aha) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from south asia and sub-saharan africa |
| title_auth |
Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
| abstract |
Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. © The Author(s) 2024 |
| abstractGer |
Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. © The Author(s) 2024 |
| abstract_unstemmed |
Background Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. Conclusion The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension. © The Author(s) 2024 |
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Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa |
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Kabole, Ibrahim Khanam, Rasheda Shahid, Shahira Bakari, Bihila Abdalla Chowdhury, Nabidul Haque Qazi, Muhammad Farrukh Dutta, Arup Rahman, Sayedur Khalid, Javairia Dhingra, Usha Hasan, Tarik Ansari, Nadia Deb, Saikat Mitra, Dipak K. Mehmood, Usma Aftab, Fahad Ahmed, Salahuddin Khan, Shahiryar Ali, Said Mohammad Ahmed, Saifuddin Manu, Alexander Yoshida, Sachiyo Bahl, Rajiv Baqui, Abdullah H. Sazawal, Sunil Jehan, Fyezah |
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Kabole, Ibrahim Khanam, Rasheda Shahid, Shahira Bakari, Bihila Abdalla Chowdhury, Nabidul Haque Qazi, Muhammad Farrukh Dutta, Arup Rahman, Sayedur Khalid, Javairia Dhingra, Usha Hasan, Tarik Ansari, Nadia Deb, Saikat Mitra, Dipak K. Mehmood, Usma Aftab, Fahad Ahmed, Salahuddin Khan, Shahiryar Ali, Said Mohammad Ahmed, Saifuddin Manu, Alexander Yoshida, Sachiyo Bahl, Rajiv Baqui, Abdullah H. Sazawal, Sunil Jehan, Fyezah |
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10.1186/s12884-024-06637-2 |
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The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. Methods We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. Results From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. 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