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—With the aim to describe  the daily pattern of blood pressure during the trimesters of pregnancy  in clinically healthy women as well as in pregnant women who developed  gestational hypertension or preeclampsia, we analyzed 1494  blood pressure series systematically sampled by ambulatory monitoring  for 48 hours every 4 weeks after the first obstetric visit in 124 women  with uncomplicated pregnancies, 55 with gestational hypertension, and  23 with a final diagnosis of preeclampsia. The circadian pattern of  blood pressure variation for each group and trimester of gestation was  established by population multiple-component analysis. A highly  statistically significant circadian pattern represented by  a linear model that includes components with periods of 24 and 12 hours  is demonstrated for systolic and diastolic blood  pressure for all groups of pregnant women in all trimesters  (P &lt;0.001 in all cases). The differences in circadian  rhythm–adjusted mean between complicated and uncomplicated pregnancies  are highly statistically significant in all trimesters (alwaysP &lt;0.001). There is also a statistically significant  difference in circadian amplitude (extent of daily change) of blood  pressure between healthy and complicated pregnancies in all trimesters  (alwaysP &lt;0.004). Results further indicate similar  circadian characteristics between women who later developed gestational  hypertension or preeclampsia in the first trimester of pregnancy. The  difference between these 2 groups in circadian mean is statistically  significant in the second trimester for systolic  (P =0.022) but not for diastolic blood  pressure (P =0.986). In the third trimester, the  difference in circadian mean is highly statistically significant for  both variables (P &lt;0.001). The differences in blood  pressure between healthy and complicated pregnancies can be observed as  early as in the first trimester of pregnancy. Those highly significant  differences are found when both systolic and  diastolic blood pressure for women with a later diagnosis  of gestational hypertension or preeclampsia are well within the  accepted normal physiological range of blood  pressure variability. These differing changes in the circadian pattern  of blood pressure with advancing gestational age between healthy and  complicated pregnancies offer new end points that may lead to an early  identification of hypertensive complications in pregnancy as well as to  the establishment of prophylactic intervention.

Blood Pressure Patterns in Normal Pregnancy, Gestational Hypertension, and Preeclampsia