Evaluating the Prevalence and Reclassification of Hypertensive Disorders of Pregnancy Using the 2017 American College of Cardiology/American Heart Association and American College of Obstetricians and Gynecologists Hypertension Criteria: The Mutaba’ah Study
1
Institute of Public Health, College of Medicine and Health Sciences,, United Arab Emirates University, Al Ain, United Arab Emirates
2
Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
3
Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Current blood pressure thresholds in pregnancy are largely based on historical consensus. Recent research suggests that women with stage 1 hypertension (130–139/80–89 mmHg) according to the 2017 American College of Cardiology and American Heart Association (ACC/AHA) have increased risks of adverse maternal and neonatal outcomes. This study evaluated the impact of applying the ACC/AHA criteria, compared with the American College of Obstetricians and Gynecologists (ACOG) definition, on the prevalence and reclassification of hypertensive disorders of pregnancy and the identification of adverse maternal outcomes in the United Arab Emirates (UAE).
METHODS:
This prospective analysis used data from the Mutaba’ah Study in the UAE, including singleton live-birth pregnancies delivered between 2017 and 2024. Hypertensive status was determined using antenatal blood pressure measurements and antihypertensive medication use. Chronic hypertension was defined by elevated blood pressure before 20 weeks’ gestation and gestational hypertension at or after 20 weeks’ gestation, according to ACOG (≥140/90 mmHg) and 2017 ACC/AHA (≥130/80 mmHg) criteria. Net reclassification improvement was calculated to evaluate changes in risk classification and the detection of preeclampsia/eclampsia.
RESULTS:
Among 5599 singleton pregnancies, application of the ACC/AHA criteria increased the prevalence of hypertension from 5.7% to 26.3% (absolute increase: 20.6 percentage points). Of women initially classified as normotensive under ACOG criteria, 11.9% and 9.9% were newly identified by ACC/AHA as having chronic hypertension and gestational hypertension, respectively. Approximately two-thirds of those with gestational hypertension under ACOG were reclassified to chronic hypertension. Use of the ACC/AHA criteria resulted in a net reclassification improvement of 33.2% for detecting preeclampsia/eclampsia.
CONCLUSIONS:
Application of the 2017 ACC/AHA thresholds revealed additional instances of chronic and gestational hypertension and was associated with improved detection of women at increased risk of preeclampsia. These findings support the potential value of dynamic, longitudinal blood pressure assessment to improve maternal risk stratification.
Current blood pressure thresholds in pregnancy are largely based on historical consensus. Recent research suggests that women with stage 1 hypertension (130–139/80–89 mmHg) according to the 2017 American College of Cardiology and American Heart Association (ACC/AHA) have increased risks of adverse maternal and neonatal outcomes. This study evaluated the impact of applying the ACC/AHA criteria, compared with the American College of Obstetricians and Gynecologists (ACOG) definition, on the prevalence and reclassification of hypertensive disorders of pregnancy and the identification of adverse maternal outcomes in the United Arab Emirates (UAE).
METHODS:
This prospective analysis used data from the Mutaba’ah Study in the UAE, including singleton live-birth pregnancies delivered between 2017 and 2024. Hypertensive status was determined using antenatal blood pressure measurements and antihypertensive medication use. Chronic hypertension was defined by elevated blood pressure before 20 weeks’ gestation and gestational hypertension at or after 20 weeks’ gestation, according to ACOG (≥140/90 mmHg) and 2017 ACC/AHA (≥130/80 mmHg) criteria. Net reclassification improvement was calculated to evaluate changes in risk classification and the detection of preeclampsia/eclampsia.
RESULTS:
Among 5599 singleton pregnancies, application of the ACC/AHA criteria increased the prevalence of hypertension from 5.7% to 26.3% (absolute increase: 20.6 percentage points). Of women initially classified as normotensive under ACOG criteria, 11.9% and 9.9% were newly identified by ACC/AHA as having chronic hypertension and gestational hypertension, respectively. Approximately two-thirds of those with gestational hypertension under ACOG were reclassified to chronic hypertension. Use of the ACC/AHA criteria resulted in a net reclassification improvement of 33.2% for detecting preeclampsia/eclampsia.
CONCLUSIONS:
Application of the 2017 ACC/AHA thresholds revealed additional instances of chronic and gestational hypertension and was associated with improved detection of women at increased risk of preeclampsia. These findings support the potential value of dynamic, longitudinal blood pressure assessment to improve maternal risk stratification.
| eISSN: | 2654-1459 |
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