No Blood Pressure Too Low for Later Preeclampsia


For most obstetric patients in the first trimester, preeclampsia risk rises at a blood pressure threshold of 140/90 mmHg. For some subgroups, the risk evaluation should occur at lower thresholds. No blood pressure reassures against possible later preeclampsia.


  • Analysis of data collected in a two-centre prospective cohort study of 137,458 singleton pregnancies that delivered at ≥ 24 weeks (2006-2020).
  • Authors compared first-trimester blood pressure readings against preterm and term preeclampsia risks.
  • They checked if alternative blood pressure thresholds were stronger predictors in certain subgroups.
  • The primary outcome was preeclampsia.


  • Compared with lower cutoffs, 140/90 mmHg was an appropriate threshold to identify most patients with higher preeclampsia risk.
  • For patients with a body mass index of < 18.5, 130/80 mmHg was a more appropriate threshold.
  • For parous patients without a preeclampsia history, 135/85 mmHg was more appropriate.
  • No blood pressure was so low that preeclampsia might not later develop.


Though the findings do not support treating elevated blood pressure or stage 1 hypertension in the general obstetric population to prevent preeclampsia, the authors wrote, “our data suggest that it would be particularly important to [preeclampsia] risk-assess them accurately” using, eg, uterine artery pulsatility index and serum placental growth factor.


Conducted by a team based primarily in London, the study appeared in the American Journal of Obstetrics and Gynecology.


A trial would be needed to determine if people in the subgroups with lower predictive cutoffs would benefit from antihypertensive treatment. Results may not be generalised to multiple pregnancies.


Authors reported no conflicts of interest.

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