Oral Concurrent Session 8 - Hypertension
Oral Concurrent Sessions
Lynn M. Yee, MD, MPH (she/her/hers)
Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Nicola Lancki, MPH
Biostatistician
Northwestern University
Chicago, Illinois, United States
Patrick M. Catalano, MD
Reproductive Endocrinology
MGH REU
Boston, Massachusetts, United States
Francesca Facco, MD
Associate Professor, Maternal-Fetal Medicine
UPMC
UPMC, Pennsylvania, United States
Maisa Feghali, MD
Associate Professor
Magee Women's Research Institute, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
William A. Grobman, MBA, MD
Professor
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
Erin S. LeBlanc, MD, MPH
Kaiser Permanente Center for Health Research
Portland, Oregon, United States
William L. Lowe, MD
Northwestern University
Northwestern University, Illinois, United States
Audrey Merriam, MD, MS
Yale School of Medicine
Yale School of Medicine, Connecticut, United States
Mirella Mourad, MD
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Caryn E.S. Oshiro, MS, PhD
Investigator
Kaiser Permanente Hawaii, Center for Integrated Health Care Research
Honolulu, Hawaii, United States
Camille E. Powe, MD (she/her/hers)
Associate Professor
Massachusetts General Hospital
Boston, Massachusetts, United States
Uma M. Reddy, MD, MPH
Professor
Columbia University Irving Medical Center
New York, New York, United States
Jennifer Sherr, MD, PhD
Yale School of Medicine
New Haven, Connecticut, United States
Alexandra C. Spadola, MD
Clinical Associate Professor, Maternal Fetal Medicine
Tufts University School of Medicine
Boston, Massachusetts, United States
Kimberly K. Vesco, BA, MD, MPH
Distinguished Investigator
Kaiser Permanente Center for Health Research
Portland, Oregon, United States
Erika F. Werner, MD, MS (she/her/hers)
President, Physician Organization; Professor, Maternal-Fetal Medicine
Tufts University School of Medicine
Boston, Massachusetts, United States
Noelia Zork, MD
Associate Professor
Columbia University Irving Medical Center
New York, New York, United States
Denise Scholtens, PhD
Professor and Division Chief
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Dwight J. Rouse, MD, MSPH
Professor
Women & Infants Hospital of Rhode Island / Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
Nocturnal hyperglycemia in non-pregnant adults is associated with the development of hypertension. Pregestational diabetes mellitus (DM) is a risk factor for hypertensive disorders of pregnancy (HDP) but, in the absence of DM, the relationship between first trimester glucose values and HDP is not known. We therefore evaluated the association of first trimester glycemia with HDP.
Study Design:
Planned analysis of data from a US multisite, prospective cohort study of gravidas without pregestational DM who completed a 2-hour 75g oral glucose tolerance test (OGTT) and then wore a continuous glucose monitor (CGM) for ≥ 5 days at 10-14 wks. OGTT and CGM thresholds for this analysis were chosen because they optimized prediction of gestational DM; the CGM threshold was a dichotomous measure of nocturnal (12am-6am) glucose > 133 mg/dL for ≥ 9% of values. We also evaluated mean nocturnal glucose and percent nocturnal time > 133 mg/dL. HDP was abstracted by trained staff using standard criteria. Sensitivity analyses excluded gravidas with chronic hypertension (cHTN). Poisson regression models with robust error variance were used to estimate relative risk (RR) and 95% confidence intervals (CI) for HDP adjusted for confounders defined a priori; a second model further adjusted for aspirin use.
Results:
Of 2178 gravidas enrolled from 2021-24, 2072 (95%) had OGTT data and 1930 (89%) had CGM data available for this analysis. Participant characteristics generally reflected the US population: 45% nulliparous, 31% publicly insured, 62% overweight/obese, 6% cHTN, and 35% aspirin use. Overall, 17.5% developed HDP (Figure). The 10-14 wk OGTT values, whether evaluated dichotomously or continuously, were not associated with HDP (Table). In contrast, the prespecified CGM threshold was associated with HDP (aRR 1.32, 95% CI 1.05-1.65) as was percent nocturnal time > 133 mg/dL (Table). Findings were similar after adjusting for aspirin use (aRR 1.30, 95% CI 1.04-1.62) and excluding gravidas with cHTN.
Conclusion:
First trimester nocturnal glycemia measured by CGM, but not glycemia measured by OGTT, was associated with HDP.