Should the definition of preeclampsia include a rise in diastolic blood pressure of ≥15 mm Hg to a level <90 mm Hg in association with proteinuria?

Objective: This study was undertaken to compare baseline characteristics and pregnancy outcomes between normotensive women who did and those who did not have a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria. Study Design: We studied 4302 healthy nulliparous women from the Calcium for Preeclampsia Prevention trial who were delivered at ≥20 weeks' gestation. We selected as the study group normotensive women who developed proteinuria within 7 days of a rise in diastolic blood pressure of ≥15 mm Hg with respect to baseline on 2 occasions 4 to 168 hours apart. Baseline blood pressure was the mean of measurements at 2 clinic visits before 22 weeks' gestation. Other normotensive women used for comparison were those who did not develop gestational hypertension or a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria. Results: Except for greater weight (P < .001), body mass index (P < .001), and systolic blood pressure (P = .05) the baseline characteristics of the 82 women with a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria did not differ significantly from those of the other normotensive women. Although they had a greater rate of weight gain (P < .005), larger babies (P = .06), and a 2-fold increase in abdominal delivery (P < .001), there was little other evidence of adverse pregnancy outcomes among these women. Conclusion: During normotensive pregnancy a rise in diastolic blood pressure of ≥15 mm Hg in association with proteinuria appears to be benign and is not a useful clinical construct.