E.A. MALOEDOVA¹, V.N. ANTONOV¹, YU.A. SEMENOV²

¹South-Ural State Medical University, Chelyabinsk

²Ural Research Institute for Maternal and Child Health, Yekaterinburg

Contact details:

Maloedova E.A. — postgraduate student of the Department of Therapy, Head of the Educational and Methodological Department

Address: 1 Repin St., 620028 Yekaterinburg, Russian Federation, tel.: +7-908-581-51-86, e-mail: jennysplean@mail.ru

The purpose — to identify clinical and anamnestic risk factors for preeclampsia against the background of chronic arterial hypertension.

Material and methods. The study group included 194 pregnant women with chronic arterial hypertension aged 18 to 45 years. The cohort of women studied was divided into two groups: group 1 (n = 117) — pregnant women without preeclampsia, group 2 (n = 77) — pregnant women with developed preeclampsia. Clinical and anamnestic data and pregnancy outcomes were compared in women in both groups (method and timing of delivery, fetal growth retardation, prematurity, hospitalization of the mother or newborn in the intensive care unit).

Results. In the group of patients with preeclampsia with chronic hypertension, compared to group 1, statistically significantly more often there was a family history of arterial hypertension (75.3 vs. 45.3%; p = 0.0001), chronic pyelonephritis (59.7 vs. 17.9%; p = 0.0001), and obesity (79.2 vs. 61.5%; p < 0.005). Diastolic blood pressure was significantly higher in group 2 than in group 1 (91.5 ± 6.9 vs. 84.7 ± 9.6 mmHg; p = 0.0001), and diastolic blood pressure ≥ 100 mmHg was detected in 27.3% of women in group 2 and in 12.0% in group 1 (p <0 .005). Women with CAH had elevated mean BP in 75.8% of cases, and the level of mean BP in group 2 significantly exceeded that in group 1: 106.1 ± 6.7 and 100.0 ± 12.7 mmHg, respectively (p < 0.005). The number of pregnant women with mean BP > 95 mmHg in group 2 was 93.5%, in group 1 — 64.1% (p = 0.0001). Pregnancy outcomes in women from group 2 were characterized by a higher frequency of preterm birth (25.7 vs. 74.3%; p = 0.001), operative delivery before 37 weeks of pregnancy (70.1 vs. 53.9%; p = 0.001), including emergency delivery for severe and/or uncontrolled hypertension and preeclampsia — 28.6 and 0.9%, respectively (p = 0.017).

Conclusion. To date, there is no accurate model for predicting preeclampsia in women with chronic arterial hypertension, but potential risk factors and biomarkers are actively studied. According to our data, the most significant clinical and anamnestic factors associated with preeclampsia against the background of chronic hypertension may be: a burdened heredity for arterial hypertension, chronic pyelonephritis, obesity, diastolic blood pressure ≥ 100 mmHg, mean blood pressure ˃ 95 mmHg. Further studies on the identification of the most significant risk factors for preeclampsia against the background of chronic hypertension will allow adequately stratifying the risks of developing this gestation complication in order to reduce the risk of adverse maternal and perinatal outcomes.

Key words: pregnancy, chronic arterial hypertension, preeclampsia, preeclampsia against the background of chronic arterial hypertension.

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