Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)

L. Slade; N. Syeda; H. D. Mistry; J. N. Bone; M. Wilson; M. Blackman; L. Poston; K. M. Godfrey; P. von Dadelszen; L. A. Magee; the UPBEAT Consortium; Annette Briley

doi:10.1038/s41366-025-01803-8

Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)

L. Slade, N. Syeda, H. D. Mistry, J. N. Bone, M. Wilson, M. Blackman, L. Poston, K. M. Godfrey, P. von Dadelszen, L. A. Magee, the UPBEAT Consortium, Annette Briley

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity.

Methods: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) enroled women with a body mass index (BMI) ≥ 30 kg/m². In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: ‘Normal’ BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), ‘Elevated’ BP (sBP 120–129 mmHg and dBP <80 mmHg), ‘Stage 1 hypertension’ (sBP 130–139 mmHg and/or dBP 80-89 mmHg), and ‘Stage 2 hypertension’ (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90–109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. ‘Normal’ BP), and as threshold values.

Results: Severe ‘Stage 2 hypertension’ (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with ‘Stage 1 hypertension’ or ‘Elevated BP’. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission.

Conclusions: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk.

Original language	English
Pages (from-to)	1523-1531
Number of pages	9
Journal	International Journal of Obesity
Volume	49
Issue number	8
Early online date	16 Jun 2025
DOIs	https://doi.org/10.1038/s41366-025-01803-8
Publication status	Published - Aug 2025
Externally published	Yes

Keywords

Body mass index
Translational research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Slade, L., Syeda, N., Mistry, H. D., Bone, J. N., Wilson, M., Blackman, M., Poston, L., Godfrey, K. M., von Dadelszen, P., Magee, L. A., the UPBEAT Consortium, & Briley, A. (2025). Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT). International Journal of Obesity, 49(8), 1523-1531. https://doi.org/10.1038/s41366-025-01803-8

@article{1ff1c4119bcd413381746bbc003ee5f4,

title = "Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)",

abstract = "Background: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity. Methods: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) enroled women with a body mass index (BMI) ≥ 30 kg/m2. In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: {\textquoteleft}Normal{\textquoteright} BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), {\textquoteleft}Elevated{\textquoteright} BP (sBP 120–129 mmHg and dBP <80 mmHg), {\textquoteleft}Stage 1 hypertension{\textquoteright} (sBP 130–139 mmHg and/or dBP 80-89 mmHg), and {\textquoteleft}Stage 2 hypertension{\textquoteright} (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90–109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. {\textquoteleft}Normal{\textquoteright} BP), and as threshold values. Results: Severe {\textquoteleft}Stage 2 hypertension{\textquoteright} (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with {\textquoteleft}Stage 1 hypertension{\textquoteright} or {\textquoteleft}Elevated BP{\textquoteright}. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission. Conclusions: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk.",

keywords = "Body mass index, Translational research",

author = "L. Slade and N. Syeda and Mistry, {H. D.} and Bone, {J. N.} and M. Wilson and M. Blackman and L. Poston and Godfrey, {K. M.} and {von Dadelszen}, P. and Magee, {L. A.} and {the UPBEAT Consortium} and Patrick Catalano and Sara Kenyon and Penny Jackson and Daghni Rajasingham and Gail Goldberg and Catherine Nelson-Piercy and Stephanie Amiel and Lynne Greenwood and Sarah Canadine and Sian Robinson and Laura Broomfield and Helen Croker and Jane Wardle and Melody Smith and Emma Cousins and Paola Fernandez and Deborah Brown and Asma Khalil and Merane Todd and Dawn Wood and Jennifer Eadle and Jennifer Syson and Gillian Butterfield and Vicky Jones and Diane Farrar and Joanne Knight and Gillian Campbell and Kim Hinshaw and Jay Brown and Christine Hughes and Rachel Grimshaw and Sarah Lee and Natalie Patterson and Melissa Whitworth and Lynn Cherry and Paul Welsh and Sinead Miller and Laura Rooney and Savannah Bett and Maxine Fernon and Suzanne Clements and Janet Johnston and Kirsteen Paterson and Hilary Alba and Therese McSorley and Scott Nelson and Naveed Sattar and Roger Carr and Gayle Gills and Robin Durkin and Alison Rennie and Sarah Ritson and Andrea Fenn and Fiona Campbell and Claire Boag and Carly Allen and Jill Riches and Alison Kimber and Nicola Miller and Catherine McParlin and Tarja Kinnunen and Louise Hayes and Ruth Bell and Stephen Robson and Linda Hagg and Georgina Gutzwiller and {de la Llera}, Ari and Susan O{\textquoteright}Donnell and Yvonne Evans and Sile O{\textquoteright}Connor and Jill Demilew and Eugene Oteng-Ntim and Nina Khazaezadeh and Dharmintra Pasupathy and Matias Vieira and Rahat Maitland and James Butler and Elodie Lawley and Funso Adegoke and Catherine Boylen and Ignatian, {Alex Seroge} and Carolyn Gill and Deborah Ricketts and Tsigerada Tekletdadik and Anna Lucas and Hayley Tarft and Laura Scholtz and Jeni Fetherstone and Judy Filmer and Clare Hunt and Louise Goff and Bridget Holmes and Suzanne Barr and Shirlene Badger and Angela Flynn and Nashita Patel and Thomas Sanders and Jane Sandall and Paul Seed and Claire Singh and Annette Briley and Andrew Shennan",

year = "2025",

month = aug,

doi = "10.1038/s41366-025-01803-8",

language = "English",

volume = "49",

pages = "1523--1531",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Springer Nature",

number = "8",

}

Slade, L, Syeda, N, Mistry, HD, Bone, JN, Wilson, M, Blackman, M, Poston, L, Godfrey, KM, von Dadelszen, P, Magee, LA, the UPBEAT Consortium & Briley, A 2025, 'Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)', International Journal of Obesity, vol. 49, no. 8, pp. 1523-1531. https://doi.org/10.1038/s41366-025-01803-8

Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT). / Slade, L.; Syeda, N.; Mistry, H. D. et al.
In: International Journal of Obesity, Vol. 49, No. 8, 08.2025, p. 1523-1531.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)

AU - Slade, L.

AU - Syeda, N.

AU - Mistry, H. D.

AU - Bone, J. N.

AU - Wilson, M.

AU - Blackman, M.

AU - Poston, L.

AU - Godfrey, K. M.

AU - von Dadelszen, P.

AU - Magee, L. A.

AU - the UPBEAT Consortium

AU - Catalano, Patrick

AU - Kenyon, Sara

AU - Jackson, Penny

AU - Rajasingham, Daghni

AU - Goldberg, Gail

AU - Nelson-Piercy, Catherine

AU - Amiel, Stephanie

AU - Greenwood, Lynne

AU - Canadine, Sarah

AU - Robinson, Sian

AU - Broomfield, Laura

AU - Croker, Helen

AU - Wardle, Jane

AU - Smith, Melody

AU - Cousins, Emma

AU - Fernandez, Paola

AU - Brown, Deborah

AU - Khalil, Asma

AU - Todd, Merane

AU - Wood, Dawn

AU - Eadle, Jennifer

AU - Syson, Jennifer

AU - Butterfield, Gillian

AU - Jones, Vicky

AU - Farrar, Diane

AU - Knight, Joanne

AU - Campbell, Gillian

AU - Hinshaw, Kim

AU - Brown, Jay

AU - Hughes, Christine

AU - Grimshaw, Rachel

AU - Lee, Sarah

AU - Patterson, Natalie

AU - Whitworth, Melissa

AU - Cherry, Lynn

AU - Welsh, Paul

AU - Miller, Sinead

AU - Rooney, Laura

AU - Bett, Savannah

AU - Fernon, Maxine

AU - Clements, Suzanne

AU - Johnston, Janet

AU - Paterson, Kirsteen

AU - Alba, Hilary

AU - McSorley, Therese

AU - Nelson, Scott

AU - Sattar, Naveed

AU - Carr, Roger

AU - Gills, Gayle

AU - Durkin, Robin

AU - Rennie, Alison

AU - Ritson, Sarah

AU - Fenn, Andrea

AU - Campbell, Fiona

AU - Boag, Claire

AU - Allen, Carly

AU - Riches, Jill

AU - Kimber, Alison

AU - Miller, Nicola

AU - McParlin, Catherine

AU - Kinnunen, Tarja

AU - Hayes, Louise

AU - Bell, Ruth

AU - Robson, Stephen

AU - Hagg, Linda

AU - Gutzwiller, Georgina

AU - de la Llera, Ari

AU - O’Donnell, Susan

AU - Evans, Yvonne

AU - O’Connor, Sile

AU - Demilew, Jill

AU - Oteng-Ntim, Eugene

AU - Khazaezadeh, Nina

AU - Pasupathy, Dharmintra

AU - Vieira, Matias

AU - Maitland, Rahat

AU - Butler, James

AU - Lawley, Elodie

AU - Adegoke, Funso

AU - Boylen, Catherine

AU - Ignatian, Alex Seroge

AU - Gill, Carolyn

AU - Ricketts, Deborah

AU - Tekletdadik, Tsigerada

AU - Lucas, Anna

AU - Tarft, Hayley

AU - Scholtz, Laura

AU - Fetherstone, Jeni

AU - Filmer, Judy

AU - Hunt, Clare

AU - Goff, Louise

AU - Holmes, Bridget

AU - Barr, Suzanne

AU - Badger, Shirlene

AU - Flynn, Angela

AU - Patel, Nashita

AU - Sanders, Thomas

AU - Sandall, Jane

AU - Seed, Paul

AU - Singh, Claire

AU - Briley, Annette

AU - Shennan, Andrew

PY - 2025/8

Y1 - 2025/8

N2 - Background: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity. Methods: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) enroled women with a body mass index (BMI) ≥ 30 kg/m2. In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: ‘Normal’ BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), ‘Elevated’ BP (sBP 120–129 mmHg and dBP <80 mmHg), ‘Stage 1 hypertension’ (sBP 130–139 mmHg and/or dBP 80-89 mmHg), and ‘Stage 2 hypertension’ (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90–109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. ‘Normal’ BP), and as threshold values. Results: Severe ‘Stage 2 hypertension’ (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with ‘Stage 1 hypertension’ or ‘Elevated BP’. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission. Conclusions: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk.

AB - Background: Obesity is a major risk-factor for adverse pregnancy outcomes. While the 2017 American College of Cardiology/American Heart Association (ACC/AHA) classification of normal and abnormal blood pressure (BP) outside pregnancy has been suggested for use in pregnancy, the impact on adverse outcomes has not been examined specifically in women with obesity. Methods: The UK Pregnancies Better Eating and Activity Trial (UPBEAT) enroled women with a body mass index (BMI) ≥ 30 kg/m2. In secondary analyses, maximal antenatal BP was categorised by 2017 ACC/AHA criteria: ‘Normal’ BP (systolic [sBP] <120 mmHg and diastolic [dBP] <80 mmHg), ‘Elevated’ BP (sBP 120–129 mmHg and dBP <80 mmHg), ‘Stage 1 hypertension’ (sBP 130–139 mmHg and/or dBP 80-89 mmHg), and ‘Stage 2 hypertension’ (sBP ≥140 mmHg and/or dBP ≥90 mmHg, non-severe [sBP 140-159 mmHg and/or dBP 90–109 mmHg] and severe (sBP ≥160 mmHg and/or dBP ≥110 mmHg). Main outcomes were preterm birth, postpartum haemorrhage (PPH), birthweight <10th centile (small-for-gestational age, SGA), and neonatal intensive care unit (NICU) admission. Associations with adverse outcomes were adjusted for UPBEAT intervention, maternal age, booking BMI, ethnicity, parity, smoking, alcohol, and previous pre-eclampsia or gestational diabetes. Diagnostic test properties (positive and negative likelihood ratios, -LR and +LR) were assessed as individual categories (vs. ‘Normal’ BP), and as threshold values. Results: Severe ‘Stage 2 hypertension’ (vs. BP < 160/110 mmHg) was associated with PPH (RR 2.57 (1.35, 4.86)) and SGA (RR 2.52 (1.05, 6.07)) only in unadjusted analyses. No outcomes were associated with ‘Stage 1 hypertension’ or ‘Elevated BP’. All +LR were <5.0 and -LR ≥ 0.20, indicating that no BP threshold was useful as a diagnostic test to detect preterm birth, PPH, SGA, or NICU admission. Conclusions: Among pregnant women with obesity, we found no evidence that lowering the antenatal BP considered to be abnormal (from 140/90 mmHg) would assist in identifying women and babies at risk.

KW - Body mass index

KW - Translational research

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U2 - 10.1038/s41366-025-01803-8

DO - 10.1038/s41366-025-01803-8

M3 - Article

AN - SCOPUS:105008519326

SN - 0307-0565

VL - 49

SP - 1523

EP - 1531

JO - International Journal of Obesity

JF - International Journal of Obesity

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Slade L, Syeda N, Mistry HD, Bone JN, Wilson M, Blackman M et al. Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT). International Journal of Obesity. 2025 Aug;49(8):1523-1531. Epub 2025 Jun 16. doi: 10.1038/s41366-025-01803-8

Do lower antenatal blood pressure cut-offs in pregnant women with obesity identify those at greater risk of adverse maternal and perinatal outcomes? A secondary analysis of data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT)

Abstract

Keywords

UN SDGs

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