Is there a role for ambulatory blood pressure monitoring in pregnancy?

Abstract

1. Ambulatory blood pressure monitoring (ABPM) has been used in pregnancy for just over 20 years now and is generally well tolerated. Normal values have been established for different gestations; these are slightly higher than conventional blood pressure (BP) in normal pregnancy, presumably reflecting greater activity during the 24 h of ABPM recordings. 2. Ambulatory blood pressure monitoring is a better predictor than conventional BP for the development of pre-eclampsia and fetal growth restriction, but it is not sensitive or specific enough to be recommended for these purposes in routine practice. 3. Studies of ABPM have shown that sleep hypertension is common in women with gestational hypertension or pre-eclampsia, but detecting this in routine clinical practice does not aid usual decision making in the pregnancy, including timing of delivery. 4. Studies using ABPM have found that pregnant women who are working outside the home have higher BP than non-working women, but these data should not be interpreted to mean that not working during pregnancy will prevent gestational hypertension or pre-eclampsia. 5. The best role for ABPM is to determine whether women with office hypertension in early pregnancy have true (usually essential) hypertension or white-coat hypertension. The latter can be managed without antihypertensives and pregnancy outcomes appear good, although possibly with a slightly increased incidence of pre-eclampsia. 6. Women who have had pre-eclampsia are at greater life-time risk for cardiovascular diseases; several years postpartum these women have slightly higher ABPM-measured BP than women who had normal pregnancies and a greater propensity to metabolic syndrome.

Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy

“…3,4,35 In the present study, ABPM was very useful for detecting WCH even in patients suspected of PE or GH. 36 This is true not only in the early phase of pregnancy, 36 but also the late phase as shown in the present study. Because the pregnancy outcome is favorable in women with WCH, diagnosing WCH by ABPM is helpful to avoid early and unnecessary termination of pregnancy for hypertensive women.…”

Pregnancy-Induced hypertension

“…Despite that, a small proportion of patients with WCH in early pregnancy will develop PE later in pregnancy. 89,90 Consequently, it is essential to differentiate WCH from PIH, thus avoiding exposing these women to the possible adverse effects of antihypertensive treatment as well as unnecessary caesarean sections. In addition, detection of that group of women with WCH who are going to develop PE is important for pregnancy outcome.…”

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

“…4.1). If out-of-office BP readings cannot be obtained, it is recommended to confirm the HT diagnosis using repeated office measurements, preferably taken by a nurse [16,17].…”

“…The number of studies assessing out-of-office BP values in pregnancy is limited. Informed by the results of studies published to date, some recommendations consider readings slightly lower than in the general population (mean daytime BP ≥ 130/80 mm Hg and mean nocturnal BP ≥ 110/70 mm Hg) as the threshold for HT diagnosis in 24-hour BP recording [1,16]. However, we concluded that in the absence of data unequivocally indicating the prognostic significance and in order to avoid overtreatment in pregnancy, the same threshold BP values which are used in the general population should apply [4]…”