Pregnancy Outcomes and Blood Pressure Visit-to-Visit Variability and Level in Three Less-Developed Countries
Authors: Magee Laura A. , Bone Jeffrey , Owasil Salwa Banoo , Singer Joel , Lee Terry , Bellad Mrutunjaya B. , Goudar Shivaprasad S , Logan Alexander G. , Macuacua Salésio E. , Mallapur Ashalata A. , Nathan Hannah L. , Qureshi Rahat N. , Sevene Esperança , Shennan Andrew H. , Valá Anifa , Vidler Marianne , Bhutta Zulfiqar A. , von Dadelszen Peter , Macete Eusébio , Munguambe Khátia , Sacoor Charfudin , Boene Helena , Amose Felizarda , Pires Rosa , Nhamirre Zefanias , Macamo Marta , Chiaú Rogério , Matavele Analisa , Vilanculo Faustino , Nhancolo Ariel , Cutana Silvestre , Mandlate Ernesto , Bique Cassimo , Mocumbi Sibone , Gonçálves Emília , Maculuve Sónia , Biz Ana Ilda , Mulungo Dulce , Augusto Orvalho , Filimone Paulo , Nobela Vivalde , Tchavana Corsino , Nkumbula Cláudio , Hoodbhoy Zahra , Raza Farrukh , Sheikh Sana , Memon Javed , Ahmed Imran , Hussain Amjad , Charantimath Umesh S , Katageri Geetanjali M , Kavi Avinash J , Revankar Amit P , Ramdurg Umesh Y , Bannale Shashidhar G , Dhamanekar Vaibhav B , Mungarwadi Geetanjali I , Honnungar Narayan V , Kodkany Bhalachandra S , Joshi Anjali M , Kudachi Uday S , Mastiholi Sphoorthi S , Karadiguddi Chandrappa C , Kengapur Gudadayya S , Kamble Namdev A , Chougala Keval S , Dunsmuir Dustin T , Drebit Sharla K , Kariya Chirag , Woo Kinshella Mai-Lei , Lee Tang , Li Jing , Lui Mansun , Payne Beth A , Sawchuck Diane , Sharma Sumedha , Tu Domena K , Ukah Ugochi V , Ansermino J Mark , Betrán Ana Pilar , Derman Richard , Dharamsi Shafik , Donnay France , Drebit Sharla , Dumont Guy , Engelbrecht Susheela M , Fillipi Veronique , Firoz Tabassum , Grobman William , Knight Marian , Langer Ana , Lewin Simon , Lewis Gwyneth , Mitton Craig , Schuurman Nadine , Thornton Jim , Wong Hubert , Adetoro Olalekan O , Munguambe Khátia , Payne Beth A , Sacoor Charfudin , Sharma Sumedha , Sotunsa John O , Byaruhanga Romano Nkumbwa , Darlow Brian , Hutton Eileen , Merialdi Mario , Thabane Lehana 
Published: March 2021

In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03–1.07] and OR, 1.08 [1.06–1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98–2.21] for SD and 1.52 [1.45–1.60] for ARV; diastolic: OR, 2.70 [2.54–2.87] for SD and 1.86 [1.76–1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06–1.14] for SD and 1.06 [1.02–1.10] for ARV; diastolic: OR, 1.07 [1.03–1.11] for SD and 1.06 [1.02–1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.