Abstract
Objective
First trimester mean arterial blood pressure (MAP) can be used to predict preeclampsia.
This study aimed to compare the performance of first trimester MAP measured with an
automated device using a standardized technique versus MAP taken manually in a typical
clinical setting.
Methods
A case-cohort study niched into a prospective cohort of pregnant women recruited at
11–14 weeks was performed. MAP was measured with an automated device on both arms
until stability was reached. These results were compared with the MAP measured with
a manual device at the closest medical visit (between 10 and 15 weeks gestation) and
noted in the medical charts. Receiver-operator characteristics curve analyses were
used to estimate the predictive values of MAP measured by both techniques.
Results
Forty-one women with preeclampsia and 167 control patients were used for the comparisons.
MAP measured with an automated device decreased significantly between 11 and 14 weeks
gestation (P < 0.001). Moreover, MAP measured with an automated device was a better predictor
of preeclampsia (area under the curve 0.70; 95% confidence interval 0.61–0.79) than
MAP measured with a manual device in a clinical setting (area under the curve 0.60;
95% confidence interval 0.50–0.70). Taken alone, MAP measured with an automated device
was associated with a detection rate of preeclampsia of 34%, for a false-positive
rate of 10%.
Conclusion
First trimester MAP can predict preeclampsia. This study demonstrated that MAP measured
with an automated device using a standardized technique is a better predictor than
MAP measured with a manual device.
Résumé
Objectif
La pression artérielle moyenne (PAM) du premier trimestre peut servir à prédire la
pré-éclampsie. Cette étude visait à comparer la précision de la PAM du premier trimestre
mesurée par un appareil automatisé au moyen d'une technique standardisée et la PAM
prise manuellement dans un milieu clinique habituel.
Méthodologie
Une étude de cohorte intégrée à une cohorte prospective de femmes enceintes recrutées
entre 11 et 14 semaines de grossesse a été réalisée. La PAM a été mesurée par un appareil
automatisé sur les deux bras jusqu’à l'atteinte de la stabilité. Les résultats ont
été comparés avec la PAM mesurée au moyen d'un dispositif manuel lors du rendez-vous
médical le plus près (entre 10 et 15 semaines de grossesse); le tout a été consigné
au dossier médical de chaque patiente. Les analyses des courbes receveuse-opérateur
ont été utilisées pour estimer les valeurs prédictives des PAM issues des deux techniques.
Résultats
Pour réaliser la comparaison, on a utilisé les résultats de 41 femmes atteintes de
pré-éclampsie et de 167 témoins. Entre 11 et 14 semaines de grossesse, la PAM mesurée
par un appareil automatisé a significativement diminué (P < 0,001). Qui plus est, la PAM mesurée par un appareil automatisé a été un meilleur
indicateur de la pré-éclampsie (zone sous la courbe : 0,70; intervalle de confiance
de 95 % : 0,61–0,79) que la PAM mesurée manuellement en milieu clinique (zone sous
la courbe : 0,60; intervalle de confiance de 95 % : 0,50–0,70). Envisagée seule, la
PAM mesurée par un appareil automatisé a été liée à un taux de 34 % pour la détection
de la pré-éclampsie et à un taux de faux positifs de 10 %.
Conclusion
La PAM du premier trimestre peut prédire la pré-éclampsie. Cette étude a démontré
que la PAM mesurée par un appareil automatisé au moyen d'une technique standardisée
est un meilleur prédicteur que la PAM mesurée au moyen d'un dispositif manuel.
Key Words
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REFERENCES
- Pre-eclampsia.Lancet. 2010; 376: 631-644
- Pre-eclampsia.Lancet. 2000; 356: 1260-1265
- Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209 (544.e1–12)
- Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: a systematic review and meta-analysis.J Obstet Gynaecol Can. 2009; 31: 818-826
- Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis.Obstet Gynecol. 2010; 116: 402-414
- Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis.Am J Perinatol. 2012; 29: 551-556
- Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis.Fetal Diagn Ther. 2012; 31: 141-146
- Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia.N Engl J Med. 2017; 377: 613-622
- Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation.Am J Obstet Gynecol. 2016; 214 (103.10–12)
- Competing risks model in early screening for preeclampsia by biophysical and biochemical markers.Fetal Diagn Ther. 2013; 33: 8-15
- A competing risks model in early screening for preeclampsia.Fetal Diagn Ther. 2012; 32: 171-178
- Study protocol for the randomised controlled trial: combined multimarker screening and randomised patient treatment with ASpirin for evidence-based PREeclampsia prevention (ASPRE).BMJ Open. 2016; 6e011801
- Mean arterial pressure at 11(+0) to 13(+6) weeks in the prediction of preeclampsia.Hypertension. 2008; 51: 1027-1033
- Inter-arm blood pressure differences in pregnant women.BJOG. 2008; 115: 1122-1130
- First-trimester mean arterial blood pressure and the risk of preeclampsia: the Great Obstetrical Syndromes (GOS) study.Pregnancy Hypertens. 2018; 12: 178-182
- Awaiting blood pressure stabilization in ambulatory pregnant women: is 5 minutes sufficient?.J Matern Fetal Neonatal Med. 2016; 30: 1933-1937
- Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults.Can J Cardiol. 2017; 33: 557-576
- Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary.J Obstet Gynaecol Can. 2014; 36: 416-441
- Office blood pressure measurement in the 21st century.J Clin Hypertens. 2018; 20: 1104-1107
- Blood pressure levels correlate with intra-individual variability using an automated device in early pregnancy.J Hum Hypertens. 2008; 22: 438-440
Article info
Publication history
Published online: October 31, 2019
Footnotes
Competing interests: See Acknowledgements.
The authors declare that they have no competing interests.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
