Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/85164
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Type: Journal article
Title: Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis
Author: Cnossen, J.
Vollebregt, K.
de Vrieze, N.
ter Riet, G.
Mol, B.
Franx, A.
Khan, K.
van der Post, J.
Citation: British Medical Journal, 2008; 336(7653):1117-1120
Publisher: British Medical Association
Issue Date: 2008
ISSN: 0959-8146
1756-1833
Statement of
Responsibility: 
Jeltsje S Cnossen, Karlijn C Vollebregt, Nynke de Vrieze, Gerben ter Riet, Ben W J Mol, Arie Franx, Khalid S Khan, Joris A M van der Post
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: Humans; Pre-Eclampsia; Blood Pressure Determination; Prenatal Diagnosis; Sensitivity and Specificity; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Blood Pressure; Reference Values; Female
Rights: BMJ: British Medical Journal © 2008
RMID: 0020136680
DOI: 10.1136/bmj.39540.522049.BE
Appears in Collections:Obstetrics and Gynaecology publications

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