Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis
- 14 May 2008
- Vol. 336 (7653), 1117-1120
- https://doi.org/10.1136/bmj.39540.522049.be
Abstract
Objective To determine the accuracy of using systolic and diastolic blood pressure, mean arterial pressure, and increase of blood pressure to predict pre-eclampsia.Design Systematic review with meta-analysis of data on test accuracy.Data sources Medline, Embase, Cochrane Library, Medion, checking reference lists of included articles and reviews, contact with authors.Review methods Without language restrictions, two reviewers independently selected the articles in which the accuracy of blood pressure measurement during pregnancy was evaluated to predict pre-eclampsia. Data were extracted on study characteristics, quality, and results to construct 2×2 tables. Summary receiver operating characteristic curves and likelihood ratios were generated for the various levels and their thresholds.Results 34 studies, testing 60 599 women (3341 cases of pre-eclampsia), were included. In women at low risk for pre-eclampsia, the areas under the summary receiver operating characteristic curves for blood pressure measurement in the second trimester were 0.68 (95% confidence interval 0.64 to 0.72) for systolic blood pressure, 0.66 (0.59 to 0.72) for diastolic blood pressure, and 0.76 (0.70 to 0.82) for mean arterial pressure. Findings for the first trimester showed a similar pattern. Second trimester mean arterial pressure of 90 mm Hg or more showed a positive likelihood ratio of 3.5 (95% confidence interval 2.0 to 5.0) and a negative likelihood ratio of 0.46 (0.16 to 0.75). In women deemed to be at high risk, a diastolic blood pressure of 75 mm Hg or more at 13 to 20 weeks’ gestation best predicted pre-eclampsia: positive likelihood ratio 2.8 (1.8 to 3.6), negative likelihood ratio 0.39 (0.18 to 0.71). Additional subgroup analyses did not show improved predictive accuracy.Conclusion When blood pressure is measured in the first or second trimester of pregnancy, the mean arterial pressure is a better predictor for pre-eclampsia than systolic blood pressure, diastolic blood pressure, or an increase of blood pressure.Keywords
This publication has 40 references indexed in Scilit:
- Mean Arterial Pressure at 11 +0 to 13 +6 Weeks in the Prediction of PreeclampsiaHypertension, 2008
- We should not pool diagnostic likelihood ratios in systematic reviewsStatistics in Medicine, 2007
- Impact of Adjustment for Quality on Results of Metaanalyses of Diagnostic AccuracyClinical Chemistry, 2007
- Evidence of bias and variation in diagnostic accuracy studiesCMAJ : Canadian Medical Association Journal, 2006
- Serial assessment of cardiovascular control shows early signs of developing pre-eclampsiaJournal of Hypertension, 2004
- Antiplatelet agents for preventing pre-eclampsia and its complicationsPublished by Wiley ,2003
- There is poor agreement between manual auscultatory and automated oscillometric methods for the measurement of blood pressure in normotensive pregnant womenThe Journal of Maternal-Fetal & Neonatal Medicine, 2001
- Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in LondonBJOG: An International Journal of Obstetrics and Gynaecology, 2001
- Pregnancy outcomes in healthy nulliparas who developed hypertensionObstetrics & Gynecology, 2000
- Evaluation of Methods Used in the Prediction of Hypertensive Disorders of PregnancyObstetrical & Gynecological Survey, 1994