Systematic Review and Meta-Analysis of 24-Hour Ambulatory Blood Pressure Monitoring in Pregnancy and Postpartum Periods.

Abstract

Purpose: Early detection and management of hypertensive disorders during pregnancy and postpartum are essential. This systematic review and meta analysis aimed: (1) to examine the state of 24-hour ambulatory blood pressure (ABP) use, and (2) in a subset of studies, evaluate 24-hour ABP parameters in the prediction and identification of Hypertensive Disorders of Pregnancy (HDP).

Methods: A comprehensive literature search was conducted in March of 2022 for English language studies published after 2000. In a subset of studies in this review, we conducted a meta analysis summarizing 24-hour, day, and night standardized mean difference (hedge's g) in systolic and diastolic blood pressure during pregnancy for individuals later diagnosed with HDP and those without.

Results: A total of 69 articles met all established criteria and were included in this systematic review, and a subgroup of studies that reported HDP outcomes (n=14) were included in the meta analysis. Out of the 69 studies, 31 (45.61%) used 24-hour ABP devices that are not validated for pregnant individuals. Birthing individuals diagnosed with HDP had elevated 24-hour, day, and night systolic and diastolic blood pressure during second and third trimesters of pregnancy.

Conclusion: A noticeable gap exists in the utilization of validated 24-hour ABP devices for pregnant and postpartum populations. Variations exist regarding the timing of 24-hour ABP measurements, particularly across trimesters.

Implications for practice: 24-hour ABP monitoring could serve as one of the tools to identify and manage pregnant individuals at risk of HDP and ultimately reverse the current trend in maternal mortality.