Maternal and Perinatal Outcomes of White Coat Hypertension During Pregnancy A Systematic Review and Meta-Analysis

The aim of this meta-analysis is to investigate whether white-coat hypertension (WCH) has an adverse effect on maternal, fetal, and neonatal outcomes. Medline, EMBASE,, and Cochrane Library databases were searched electronically in December 2019. The outcomes were compared between pregnant women with WCH and normotensive controls, women with chronic hypertension, gestational hypertension or any hypertensive disorder of pregnancy. Twelve studies were eligible for inclusion in the systematic review. Women with WCH enrolled below 20 weeks had a significantly increased risk of preeclampsia (pooled risk ratio [RR], 5.43 [95% CI, 2.00-14.71]). Furthermore, women with WCH had increased risk of delivering a small-for-gestational-age newborn (RR, 2.47 [95% CI, 1.21-5.05],P=0.013) and preterm birth (RR, 2.86 [95% CI, 1.44-5.68],P=0.002). The risk of preeclampsia (risk ratio, 0.43 [95% CI, 0.23-0.78],P=0.005), small-for-gestational-age (RR, 0.46 [95% CI, 0.26-0.82],P=0.008), preterm birth (RR, 0.47 [95% CI, 0.31-0.71],P<0.001) were significantly lower with WCH compared with women with gestational hypertension. Women with WCH delivered approximate to 1 week later compared with women with chronic hypertension (mean difference, 1.06 weeks [95% CI, 0.44-1.67 weeks];P<0.001). WCH is associated with a worse perinatal and maternal outcome than normotension, but better outcomes than gestational hypertension and chronic hypertension. Therefore, diagnosis of WCH should be ascertained in pregnant women presenting with hypertension. When the diagnosis is confirmed, these women require monitoring for developing preeclampsia, small-for-gestational-age and preterm birth.