Conclusions that were not surprising included a statistically lower chance of indicated preterm delivery in the normal BP group than in the elevated BP or stage 1 hypertension groups. Conclusions that were not meaningful included a statistically significant lower birthweight in the elevated BP group (3,269 g) and in the stage 1 hypertension group (3,258 g) compared with the normal BP group (3,279 g), but the clinical significance of these differences is arguable.
Lastly is the issue of what these data mean for clinical practice. The idea of identifying high-risk groups is attractive, provided that there are effective intervention strategies available. If one follows the United States Preventive Services Task Force (USPSTF) recommendations for preeclampsia prevention,2 then virtually every nulliparous woman is a candidate for low-dose aspirin for preeclampsia prophylaxis. Beyond that, the current data do not support any change in the standard clinical practice of managing these “now identified” high-risk women. Increasing prenatal visits, using biomarkers to further delineate risk, and using uterine artery Doppler studies are all strategies that have been or are being investigated, but as yet they are not supported by conclusive data documenting improved outcomes—a sentiment supported by both the USPSTF3 and the authors of the study.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Until further data are available, my advice to clinicians is to pay close attention to all risk factors for any of the hypertensive disorders of pregnancy. Initial BP and BP trajectory are important but probably something that sound clinical judgment would identify anyway. My recommendation is to continue to use those methods of prophylaxis, fetal surveillance, and indications for delivery that are supported by current data and await the additional investigations that Hauspurg and colleagues suggest need to be done before altering your management of women at increased risk for any of the hypertensive disorders of pregnancy.
JOHN T. REPKE, MD