A Birth Cohort Study on Impact of the 2017 ACC/AHA Guideline on Evaluating Gestational Hypertension on the Health of Newborns and Mothers

In May 2019,Circulation Research(IF=15.211) published the study of research group of Xu Shunqing, a professor at the School of Public Health online in an Original Article, and the studywas called “Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension Associated Risks for Newborns and Mothers: A Retrospective Birth Cohort Study”(Circulation Research, 2019 May 21, DOI:10.1161/circresaha.119.314682) provided with 2017 American College of Cardiology /American Heart Association (ACC/AHA) guideline to evaluate the impact of gestational hypertension on the health of newborns and mothers. It is the first time that the study has provided evidence for the application of the new guideline of ACC/AHA in pregnant women in 2017 and the potential impact of it on monitoring, management and prevention of hypertension during pregnancy. The result shows that although the number of pregnant women diagnosed with gestational hypertension has increased significantly after the new guidelines are adopted, the guidelines could more accurately identify pregnant women and newborns with possible adverse pregnancy outcomes. Professor Xu Shunqing is the corresponding author, and Hu Jie, Li Yuanyuan and Prof. Zhang Bin are the joint first authors.

Gestational hypertension is a common pregnancy-associated disease with maternal deaths caused by it accounting for 10%-16% of all pregnancy-related deaths, which is the second leading cause of maternal death. Furthermore, the risk of adverse pregnancy outcomes in perinatal period is also significantly increased in the newborns of pregnant women with gestational hypertension. Gestational hypertension is one of types of hypertensive disorders complicating pregnancy. The American College of Obstetricians and Gynecologists (ACOG) guideline released in 2013 has defined gestational hypertension as new high blood pressure without proteinuria after 20 weeks of gestation (systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg). In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) jointly issued new guideline for the prevention, detection, evaluation and management of hypertension in adults, which recommended the use of lower blood pressure values to diagnose hypertension (systolic blood pressure ≥130mmHg or diastolic blood pressure ≥80mmHg). However, the guideline does not provide recommendations for the diagnosis of hypertension during pregnancy. In December 2018, ACOG issued two new recommendations on gestational hypertension, presenting the uncertainty of the 2017 ACC/AHA hypertension criteria for controlling elevated gestational hypertension without any change in the diagnostic criteria for gestational hypertension. Therefore, it is necessary to research whether the 2017 ACC/AHA guideline is applicable to the diagnosis of gestational hypertension and to the assessment of the impact of gestational hypertension on the health of newborns and mothers.

Since September 2012, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology and Wuhan Women and Children's Health Care Center have jointly established a large-scale project of birth cohort research, where detailed investigations have been carried out on the basic information, state of health, environmental exposure during pregnancy, health care of pregnant women and health condition of infants and young children, and complete medical records have been collected. So far, more than 20,000 pairs of mothers and infants have been included. Based on this birth cohort, Professor Xu’s team found that: the use of the 2017 ACC/AHA hypertension guideline can lead to a five-fold increase in the prevalence rate of hypertension during pregnancy. High blood pressure during pregnancy, especially in stage 2, is associated with significantly increased risk of adverse birth outcomes in newborns, as well as abnormal liver, kidney and coagulation function during pregnancy. Therefore, the use of the 2017 ACC/AHA hypertension guideline to define gestational hypertension can help improve the sensitivity of the diagnosis of gestational hypertension and more accurately identify high-risk pregnancies, thereby reducing the risk of adverse pregnancy outcomes due to gestational hypertension. The conclusions of the study need to be verified in other independent populations to further study the impact of 2017ACC/AHA hypertension guideline on the diagnosis and control of gestational hypertension on the health of newborns and mothers.