Beyond clinic readings: Twenty-four hour ambulatory blood pressure monitoring profiling enhances preterm delivery risk stratification in hypertensive pregnancies.

OBJECTIVE

Hypertensive disorders of pregnancy (HDP) cause significant perinatal morbidity. We developed a nomogram predicting preterm delivery risk using pre-delivery 24-h ambulatory blood pressure monitoring (ABPM) and clinical factors.

METHODS

HDP patients undergoing ABPM within 1 month pre-delivery were enrolled. Multivariable logistic regression identified preterm labor predictors. Nomogram performance was validated via receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA).

RESULTS

Compared with dipper and non-dipper types, the reverse dipper-type on 24-h ABPM was significantly associated with higher rates of preterm labor (55, 56.1% vs. 11, 30.6% vs. 75, 46.3%, respectively; P = 0.028) and cesarean delivery (91, 92.9% vs. 28, 77.8% vs. 145, 89.5%, respectively; P = 0.044). Multivariable analysis identified pregnancy weight gain (odds ratio [OR] 0.88, 95% confidence interval [CI]: 0.83-0.93, P < 0.001), gravidity (OR 3.60, 95% CI: 1.69-7.66, P = 0.001), assisted reproductive technology use (OR 3.99, 95% CI: 1.29-12.34, P = 0.016), nighttime systolic blood pressure load (OR 1.02, 95% CI: 1.00-1.04, P = 0.026), nighttime heart rate (OR 1.06, 95% CI: 1.03-1.09, P < 0.001), urine protein (OR 3.07, 95% CI: 1.27-7.45, P = 0.013), and urine output (OR 1.01, 95% CI: 1.00-1.01, P = 0.003) as independent risk factors for preterm labor in women with HDP. These seven variables were incorporated into a nomogram prediction model. The discriminative ability of the model was assessed using a ROC curve, yielding an AUC of 0.852. The DCA indicated a favorable net benefit and clinical utility for the model.

CONCLUSION

This validated nomogram improves preterm risk stratification in HDP using pre-delivery ABPM parameters.