Masked Pregnancy-Associated Hypertension as a Predictor of Adverse Outcomes  

Pregnant women who have risk factors for preeclampsia may be advised by their health care provider to monitor their blood pressure at home. This can be particularly helpful for patients who experience “white coat hypertension”- when a patient’s blood pressure is normal outside of the doctors’ office, but higher when taken at a doctor’s appointment.

“Masked hypertension” is the opposite of “white coat hypertension.” Masked hypertension is when a patient has elevated blood pressure at home, but normal blood pressure readings in the doctors’ office. Researchers in this study asked: is masked hypertension in pregnancy associated with having a hypertensive disorder of pregnancy? In this study, 2,430 pregnant women who were self-monitoring their blood pressures at home were included in the analysis. All were patients within a single health care system but delivered across 6 hospitals in Louisiana. 7% (165 of 2,430) of the study population met the definition of masked hypertension – meaning their blood pressure at home was at least 140/90 mmHg twice before any high blood pressure diagnosis from office measured blood pressures. The researchers found the odds of adverse pregnancy outcomes of those patients were higher compared to patients with normal blood pressure. Rates of preeclampsia with severe features was 28% in the patients with masked hypertension (compared to 2%). Odds of preterm delivery, c-section delivery, having a baby that is small for gestational age, and having a baby admitted to the NICU were all significantly higher for patients with
masked hypertension compared to those with normal blood pressure.

Take Home Message: This study highlights the importance of self-monitoring of blood pressure outside of the doctors’ office during pregnancy to help identify women at risk for hypertension disorders of pregnancy and future delivery complications.

Link: https://pubmed.ncbi.nlm.nih.gov/37098390/

Citation: Mussarat N, Biggio J Jr, Martin J, Morgan J, Tivis R, Elmayan A, Williams FB. Masked pregnancy-associated hypertension as a predictor of adverse outcomes. Am J Obstet Gynecol MFM. 2023 Jul;5(7):100976. doi: 10.1016/j.ajogmf.2023.100976. Epub 2023 Apr 23. PMID: 37098390.