Development of preeclampsia in pregnant women with white-coat hypertension: a systematic review and meta-analysis

Arch Gynecol Obstet. 2024 Mar;309(3):929-937. doi: 10.1007/s00404-023-07247-7. Epub 2023 Oct 4.

Abstract

Objective: Hypertensive disorders during pregnancy are a significant cause of maternal and perinatal mortality and morbidity worldwide. White coat hypertension (WCH) is a hypertensive disease characterized by an increased clinic blood pressure but normal home or workplace blood pressure. Due to variable prevalence, a subset of women with WCH may be incorrectly diagnosed with chronic hypertension, highlighting the need for accurate diagnosis. Little is known about the role of WCH in pregnancy, but a meta-analysis aims to determine whether WCH increases the likelihood of developing preeclampsia.

Methods: A systematic review and meta-analysis was conducted to determine whether there is an association between WCH and the incidence of preeclampsia in pregnant women. The search included PubMed, Embase, and Scopus databases until February 2023, using PRISMA guidelines. Pregnant women with apparent office hypertension throughout pregnancy who underwent 24-hour ambulatory blood pressure monitoring or home blood pressure monitoring were included. Meta-analysis was performed using RevMan.

Results: This study included 12 studies with a total of 4,672 pregnant women and found that women with WCH have a higher risk of developing preeclampsia compared to normotensive women (RR: 2.29, 95% CI [1.18,4.43], P = 0.01). However, when compared with pregnant women with gestational hypertension or chronic hypertension, women with WCH had a significantly lower risk of developing preeclampsia ((RR: 0.39, [0.20,0.80], p=0.009) and (RR: 0.41, [0.27,0.62], P<0.001), respectively).

Conclusion: The study recommends incorporating 24-hour ABPM into clinical practice to differentiate between chronic hypertension and WCH in early pregnancy and focus on special management for those who need it. The findings may guide future research on ABPM's role in diagnosing WCH and its effects on pregnancy outcomes.

Keywords: Ambulatory blood pressure; Hypertension; Preeclampsia; Pregnancy; White-coat hypertension.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Blood Pressure Monitoring, Ambulatory*
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced / diagnosis
  • Hypertension, Pregnancy-Induced / epidemiology
  • Incidence
  • Pre-Eclampsia* / diagnosis
  • Pre-Eclampsia* / epidemiology
  • Pregnancy
  • White Coat Hypertension* / diagnosis
  • White Coat Hypertension* / epidemiology