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 greater than or equal to 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 greater than or equal to 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 greater than or equal to 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 greater than or equal to 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 greater than or equal to 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 greater than or equal to 15 mm Hg in association with proteinuria appears to be benign and is not a useful clinical construct.