Background: Preeclampsia is a global burden with 10 million incidences annually and
210 daily deaths worldwide. Diagnosis is mainly based on the features following full presentation.
Objective: This study explored whether early pregnancy circadian changes of ambulatory blood
pressure monitoring (ABPM) could predict preeclampsia and hypertension.
Methods: In a prospective study, 294 pregnant women who were referred to Sarem Women’s Hospital,
Iran were recruited. Systolic, diastolic and mean arterial pressures (MAP) were recorded
(diurnally and nocturnally) in each trimester. Dipping was defined as a minimum 10% decrease in
Results: Of the 251 women who completed the study, 25 percent (n=63) experienced blunted MAP
dipping during sleep phases in the second trimester. Eighty-nine percent (n=56) experienced hypertensive
disorder in the third trimester, one-third of which experienced preeclampsia. Of the women
with normal MAP dipping (n=188), 5 percent (n=10) had gestational hypertension and 1 percent
(n=2) became preeclamptic. (P<0.0001).
Conclusion: This study clearly demonstrated blunted blood pressure dipping overnight during the
second trimester which is a strong predictor of forthcoming pregnancy-induced hypertension and
preeclampsia. A scoring system was developed to predict hypertensive disorder and it was significantly
correlated with preeclampsia occurrence.