Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

Laura A Magee^{1

2

3

4}, Peter von Dadelszen^{1

2

3

4}, Joel Singer^{3

5}, Terry Lee⁶, Evelyne Rey⁷, Susan Ross⁸, Elizabeth Asztalos^{9

10

11}, Kellie E Murphy^{10

11}, Jennifer Menzies³, Johanna Sanchez¹¹, Amiram Gafni¹², Andrée Gruslin¹³, Michael Helewa¹⁴, Eileen Hutton¹⁵, Shoo K Lee⁹, Alexander G Logan¹⁶, Wessel Ganzevoort¹⁷, Ross Welch¹⁸, Jim G Thornton¹⁹, Jean Marie Moutquin²⁰

Affiliations

¹ St. George's University of London, London, UK.
² St. George's University Hospitals NHS Trust, London, UK.
³ Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Centre for Health Evaluation and Outcome Sciences (CH_EOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Medicine and Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada.
⁸ Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada.
⁹ Pediatrics, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
¹¹ The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
¹² Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
¹³ Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Obstetrics and Gynaecology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁵ Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada.
¹⁶ Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, the Netherlands.
¹⁸ Obstetrics and Gynaecology, Derriford Hospital, Plymouth, UK.
¹⁹ Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK.
²⁰ Obstetrics and Gynaecology, Sherbrooke University, Sherbrooke, Quebec, Canada.

PMID: 26915709
PMCID: PMC5021204
DOI: 10.1111/aogs.12877

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

Laura A Magee et al. Acta Obstet Gynecol Scand. 2016 Jul.

. 2016 Jul;95(7):763-76.

doi: 10.1111/aogs.12877. Epub 2016 Apr 7.

Authors

Affiliations

¹ St. George's University of London, London, UK.
² St. George's University Hospitals NHS Trust, London, UK.
³ Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Centre for Health Evaluation and Outcome Sciences (CH_EOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Medicine and Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada.
⁸ Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada.
⁹ Pediatrics, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
¹¹ The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.
¹² Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
¹³ Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Obstetrics and Gynaecology, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁵ Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada.
¹⁶ Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁷ Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, the Netherlands.
¹⁸ Obstetrics and Gynaecology, Derriford Hospital, Plymouth, UK.
¹⁹ Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK.
²⁰ Obstetrics and Gynaecology, Sherbrooke University, Sherbrooke, Quebec, Canada.

PMID: 26915709
PMCID: PMC5021204
DOI: 10.1111/aogs.12877

Abstract

Introduction: For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes.

Material and methods: This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48 h, or birthweight <10th percentile) or maternal outcomes (severe hypertension, preeclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by the Akaike information criterion. For face validity, these variables were forced into the model: treatment group ("less tight" or "tight" control), antihypertensive type at randomization, and blood pressure within 1 week before randomization. Continuous variables were represented continuously or dichotomized based on the smaller p-value in univariate analyses. An area-under-the-receiver-operating-curve (AUC ROC) of ≥0.70 was taken to reflect a potentially useful model.

Results: Point estimates for AUC ROC were <0.70 for all but severe hypertension (0.70, 95% CI 0.67-0.74) and delivery at <34 weeks (0.71, 95% CI 0.66-0.75). Therefore, no model warranted further assessment of performance.

Conclusions: CHIPS data suggest that when women with chronic hypertension develop an elevated blood pressure in pregnancy, or formerly normotensive women develop new gestational hypertension, maternal and current pregnancy clinical characteristics cannot predict adverse outcomes in the index pregnancy.

Keywords: Preexisting hypertension; adverse outcome; chronic hypertension; gestational hypertension; maternal; perinatal; prediction.

PubMed Disclaimer

Figures

**Figure 1**
Risk markers associated with (a) CHIPS primary perinatal outcome, (b) birthweight <10th centile, (c) severe hypertension, (d) preeclampsia, (e) delivery at <34 weeks and (f) delivery at <37 weeks in the final multivariable regression model. *Labetalol with or without other (not methyldopa) as the reference category. †The primary perinatal outcome was pregnancy loss or high level neonatal care for >48 h (until primary discharge home or 28 days of life, whichever was later).

**Figure 2**
AUC ROC for prediction of major adverse pregnancy outcomes based on baseline characteristics of women enrolled in CHIPS.

See this image and copyright information in PMC

References

1. Androutsopoulos G, Gkogkos P, Decavalas G. Mid‐trimester maternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab. 2013;11:102–6. - PMC - PubMed
1. Hund M, Allegranza D, Schoedl M, Dilba P, Verhagen‐Kamerbeek W, Stepan H. Multicenter prospective clinical study to evaluate the prediction of short‐term outcome in pregnant women with suspected preeclampsia (PROGNOSIS): study protocol. BMC Pregnancy Childbirth. 2014;14:324. - PMC - PubMed
1. von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton PF, Cote AM, et al. Prediction of adverse maternal outcomes in pre‐eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377:219–27. - PubMed
1. Payne BA, Hutcheon JA, Ansermino JM, Hall DR, Bhutta ZA, Bhutta SZ, et al. A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low‐resourced settings: the miniPIERS (Pre‐eclampsia Integrated Estimate of RiSk) multi‐country prospective cohort study. PLoS Med. 2014;11:e1001589. - PMC - PubMed
1. Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128:2121–31. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

Affiliations

Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical