Relationship Between Third-Trimester Low Maternal Blood Pressure and Small-for-Gestational-Age Birth Weight in Pregnant Individuals With Mild Chronic Hypertension

Affiliations

Affiliation

¹ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; the University of Alabama at Birmingham, Birmingham, and South Alabama University, Mobile, Alabama; the University of Pennsylvania, Philadelphia, St. Luke's University Health Network, Bethlehem, Penn State University, University Park, and Magee-Womens Hospital, Pittsburgh, Pennsylvania; the University of Houston and HCA Healthcare, Houston, and the University of Texas, Austin, Texas; the University of Florida, Gainesville, Florida; MetroHealth, Cleveland, The Ohio State University, Columbus, Cincinnati Children's Hospital, Cincinnati, and Premier Health, Dayton, Ohio; Indiana University, Indianapolis, Indiana; the University of Utah, Salt Lake, Utah; Ochsner Health and Tulane University, New Orleans, Louisiana; West Virginia University, Morgantown, West Virginia; Eastern Virginia Medical School, Norfolk, Virginia; the University of Wisconsin, Madison, and the Medical College of Wisconsin, Milwaukee, Wisconsin; Saint Peter's University Hospital and Rutgers University, New Brunswick, New Jersey; the University of Mississippi, Jackson, Mississippi; NYU Langone Health, Garden City, and Cornell University, New York, New York; the University of Colorado, Aurora, Colorado; Emory University, Atlanta, Georgia; the University of California, San Francisco, San Francisco, and Stanford University, Stanford, California; Oregon Health & Science University, Portland, Oregon; the Medical University of South Carolina, Charleston, South Carolina; Vanderbilt University, Nashville, Tennessee; and the National Institutes of Health, Bethesda, Maryland.

PMID: 40638923
PMCID: PMC12252258 (available on 2026-07-10)
DOI: 10.1097/AOG.0000000000006008

Randomized Controlled Trial

Relationship Between Third-Trimester Low Maternal Blood Pressure and Small-for-Gestational-Age Birth Weight in Pregnant Individuals With Mild Chronic Hypertension

Kim Boggess et al. Obstet Gynecol. 2025.

. 2025 Jul 10;146(3):405-412.

doi: 10.1097/AOG.0000000000006008.

Affiliation

¹ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; the University of Alabama at Birmingham, Birmingham, and South Alabama University, Mobile, Alabama; the University of Pennsylvania, Philadelphia, St. Luke's University Health Network, Bethlehem, Penn State University, University Park, and Magee-Womens Hospital, Pittsburgh, Pennsylvania; the University of Houston and HCA Healthcare, Houston, and the University of Texas, Austin, Texas; the University of Florida, Gainesville, Florida; MetroHealth, Cleveland, The Ohio State University, Columbus, Cincinnati Children's Hospital, Cincinnati, and Premier Health, Dayton, Ohio; Indiana University, Indianapolis, Indiana; the University of Utah, Salt Lake, Utah; Ochsner Health and Tulane University, New Orleans, Louisiana; West Virginia University, Morgantown, West Virginia; Eastern Virginia Medical School, Norfolk, Virginia; the University of Wisconsin, Madison, and the Medical College of Wisconsin, Milwaukee, Wisconsin; Saint Peter's University Hospital and Rutgers University, New Brunswick, New Jersey; the University of Mississippi, Jackson, Mississippi; NYU Langone Health, Garden City, and Cornell University, New York, New York; the University of Colorado, Aurora, Colorado; Emory University, Atlanta, Georgia; the University of California, San Francisco, San Francisco, and Stanford University, Stanford, California; Oregon Health & Science University, Portland, Oregon; the Medical University of South Carolina, Charleston, South Carolina; Vanderbilt University, Nashville, Tennessee; and the National Institutes of Health, Bethesda, Maryland.

PMID: 40638923
PMCID: PMC12252258 (available on 2026-07-10)
DOI: 10.1097/AOG.0000000000006008

Abstract

Objective: To estimate the association between third-trimester maternal low blood pressure (BP) and delivery of a neonate with small-for-gestational-age (SGA) birth weight in patients treated for mild chronic hypertension.

Methods: This is a secondary analysis of the CHAP (Chronic Hypertension and Pregnancy) study, which randomized pregnant participants with mild chronic hypertension to treatment to achieve goal BP below 140/90 mm Hg compared with usual care. We calculated mean systolic and diastolic BPs between 28 and 34 weeks of gestation and excluded those with systolic BP of 140 mm Hg or higher or diastolic BP of 90 mm Hg or higher. We defined low BP as mean systolic BP below 110 and mean diastolic BP below 70 mm Hg or mean arterial pressure below 80 mm Hg and compared those individuals with participants with mean systolic BP of 110-139 mm Hg or mean diastolic BP of 71-89 mm Hg or both or mean arterial pressure of 80 mm Hg or higher. Our primary outcome was delivery of a neonate with SGA birth weight (birth weight below the 5th percentile). Logistic regression estimated the association between low BP and SGA birth weight, and adjusted odds ratios (aORs) and 95% CIs were reported.

Results: Of 2,408 CHAP participants, 1,205 (50.0%) met analysis criteria. Of those 1,205, 31 (2.6%) had low BP and 1,174 (97.4%) had mean BP 110/70-139/89 mm Hg; 33 (2.7%) had mean arterial pressure below 80 mm Hg, and 1,172 (97.3%) had mean arterial pressure of 80 mm Hg or higher. Having a neonate with SGA birth weight below the 5th percentile occurred in 62 participants (5.1%): 1 of the 31 (3.2%) with BP below 110/70 mm Hg and 1 of the 33 (3.0%) with mean arterial pressure below 80 mm Hg. There was no significant association between delivery of a neonate with SGA birth weight less than the 5th percentile and low BP by either mean systolic BP and mean diastolic BP (aOR 0.46, 95% CI, 0.06-3.58) or mean arterial pressure (aOR 0.53, 95% CI, 0.07-4.01). We found a nonlinear relationship between mean arterial pressure and delivery of a neonate with SGA birth weight less than the 5th percentile, and, as mean arterial pressure decreased, there was lower probability of having a neonate with SGA birth weight ( P =.02).

Conclusion: Pharmacologic treatment of mild chronic hypertension infrequently results in low BP and does not appear to be associated with delivery of a neonate with SGA birth weight less than the 5th percentile for birth weight.

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Conflict of interest statement

Financial Disclosure Justin Leach has received salary support from NIH and AHA grants, as well as stipends for grant review for PCORI. Lorraine Dugoff reports funding from ACOG, as well as money paid to her institution by Natera and Myriad to support genetics research unrelated to this study. Wendy Kinzler reports receiving funding from UpToDate and money paid to her institution by the Perinatal Consortium. Brenna Hughes reports payments from UpToDate, Johns Hopkins DSMB, and Moderna. Torri Metz reports receiving royalties from UpToDate for two topics on trial of labor after cesarean, as well as money paid to her institution by Pfizer for Phase III respiratory syncytial virus vaccine trial and for pharmacokinetic study of Paxlovid in pregnancy for mild to moderate COVID-19, for which she was site PI. She reports money paid to her institution by Moderna for Phase III respiratory syncytial virus vaccine trial, for which she was also site PI. Wendy Kinzler reports money paid to her institution by the Perinatal Consortium and reports receiving payment from UpToDate. Daniel Skupski reports payment by Cooper Surgical, Inc. Sarah Osmundson reports money paid to her by Beckman Coulter for consulting on laboratory tests. Alan Tita reports money paid to his institution by Mirvie Inc. The other authors did not report any potential conflicts of interest.

References

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1. Bailey EJ, Tita ATN, Leach J, Boggess K, Dugoff L, Sibai B, et al. Perinatal Outcomes Associated With Management of Stage 1 Hypertension. Obstet Gynecol 2023;142(6):1395–404. - PMC - PubMed
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1. Eraslan Sahin M, Sahin E, Kirlangic MM. Third-trimester persistent maternal hypotension effects on late-onset small for gestational age and adverse perinatal outcomes. PLoS One. 2023;18(7):e0286900. - PMC - PubMed
1. de Los Reyes S, Plunkett BA, Dude A. The association between persistent maternal hypotension and small for gestational age neonates. Am J Obstet Gynecol MFM. 2021;3(6):100449. - PubMed

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Relationship Between Third-Trimester Low Maternal Blood Pressure and Small-for-Gestational-Age Birth Weight in Pregnant Individuals With Mild Chronic Hypertension

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Relationship Between Third-Trimester Low Maternal Blood Pressure and Small-for-Gestational-Age Birth Weight in Pregnant Individuals With Mild Chronic Hypertension

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