108 - Analysis of Early Trajectory Variations in Blood Pressure based on a Large Real-World Dataset: A New Approach to Predicting Preeclampsia

Poster Number: 108
Publication Number: 108.1829

Background: Preeclampsia (PE) is a common hypertensive (HT) disorder, affecting 2% to 8% of pregnancies worldwide and is a leading cause of maternal morbidity and mortality. This condition makes newborns susceptible to several neonatal complications.

Objective: The primary aim of this study is to explore the hypothesis that metabolic changes from PE manifest early. Variations in blood pressure during the first trimester, even before diagnosis, can lead to adverse outcomes for both the fetus and mother.

Design/Methods: Using data from the Mayo Clinic Platform Accelerate (MCPA) Program, a retrospective analysis of blood pressure trajectories was conducted on 87,938 pregnancies (75,982 non-preeclamptic, 11,956 preeclamptic), curated from electronic health records. In total, 2,838,762 mean arterial pressure (MAP) readings (2,157,614 non-preeclamptic, 681,148 preeclamptic) were harmonized into 4-week intervals throughout pregnancy. MAP distributions between the two groups were analyzed. Additionally, a nested subgroup analysis was performed, highlighting correlations between chronic HT and PE diagnosis, known to negatively impact medium to long-term development of cardiovascular disease.

Results: Between the beginning of pregnancy and week 12 of gestation, both groups demonstrated a negative slope in MAP. Discrepancies in MAP trajectories during this phase were significant (Mann-Whitney U test p-value < 0.001). The results persisted for the period of pregnancy after 16 weeks of gestation, where both groups experienced a positive slope. Furthermore, the nested subgroup analysis revealed that elevated MAP levels, even without a HT diagnosis, were associated with increased PE risks and potential neonatal complications.

Conclusion(s): Our findings highlight the metabolic changes associated with PE that show before the detectable complications of the disorder, causing numerous fetal and maternal conditions. The analytical exploration of MAP trajectories between non-preeclamptic and preeclamptic pregnancies, based on a real-world data collection, presents a new perspective on early detection strategies for PE. A better understanding of these subtle changes and progression of the disorder enhances the ability to predict PE onset and associated fetal risks well before the manifestation of visible signs post-20 weeks of gestation. This insight widens the timeframe for potential interventions and management of the disease. Additionally, the nested subgroup analysis suggests that initial blood pressure, rather than a HT diagnosis only, plays a crucial role in risk stratification.