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Publications

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Ppublish 1 citation

PubMed: 38093478 DOI: 10.1111/bjh.19248

Blood pressure thresholds for the diagnosis of hypertensive disorders of pregnancy in sickle cell disease.

Br J Haematol 204(3):1039-1046

Authors: Macy L Early, Maidah Raja, Amy Luo, Marissa Solow, Kristine Matusiak, Ahizechukwu C Eke, Nadine Shehata, Kevin H M Kuo, Sophie Lanzkron, Ann Kinga Malinowski, Lydia H Pecker

Affiliations

  • Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
  • Division of Haematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Division of Haematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
  • Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Division of Maternal-Fetal Medicine & Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Division of Hematology, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Division of Maternal-Fetal Medicine, Sinai Health System, Toronto, Ontario, Canada.
  • Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
  • Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.

Abstract

In this retrospective cohort study of singleton pregnancies in people with sickle cell disease (SCD) delivered at two academic centres between 1990 and 2021, we collected demographic and SCD-related data, pregnancy outcomes, and the highest systolic and diastolic blood pressure (SBP and DBP) at seven time periods. We compared the characteristics of subjects with new or worsening proteinuria (NWP) during pregnancy to those without. We then constructed receiver operating characteristic (ROC) curves to determine the blood pressure (BP) that best identifies those with NWP. The SBP or DBP thresholds which maximized sensitivity and specificity were 120 mmHg SBP (sensitivity: 55.2%, specificity: 73.5%) and 70 mmHg DBP (sensitivity: 27.6%, specificity: 67.7%). The existing BP threshold of 140/90 mmHg lacked sensitivity in both genotype groups (HbSS/HbSβ 0 : SBP = 21% sensitive, DBP = 5.3% sensitive; HbSS/HbSβ + : SBP = 10% sensitive, DBP = 0% sensitive). Finally, percent change in SBP, DBP and MAP were all poor tests for identifying NWP. Existing BP thresholds used to diagnose hypertensive disorders of pregnancy (HDP) are not sensitive for pregnant people with SCD. For this population, lowering the BP threshold that defines HDP may improve identification of those who need increased observation, consideration of early delivery and eclampsia prophylaxis.

MeSH

Cells, Pregnancy, Hematology, Blood, Anemia, Sickle Cell, Blood Pressure, Diagnosis

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