# Association of Non-Dipping Blood Pressure Patterns with Fetal Growth Restriction and Postpartum Chronic Hypertension in Gestational Hypertension

## TL;DR

Non-dipping blood pressure patterns in pregnant women with gestational hypertension are linked to fetal growth restriction and chronic hypertension after childbirth.

## Contribution

This study identifies non-dipping blood pressure as an independent predictor of postpartum chronic hypertension and fetal growth restriction in gestational hypertension.

## Key findings

- Non-dipping blood pressure patterns were independently associated with postpartum chronic hypertension.
- Non-dippers had higher rates of fetal growth restriction and preeclampsia.
- NDBP and elevated daytime systolic blood pressure were independent predictors of fetal growth restriction.

## Abstract

Background and Objectives: Gestational hypertension (GH) is increasingly recognized as an early manifestation of maternal cardiovascular vulnerability. Ambulatory blood pressure monitoring (ABPM) enables the evaluation of circadian blood pressure behavior, and a non-dipping blood pressure pattern (NDBP), defined as a nocturnal systolic decline of <10%, has been associated with endothelial dysfunction, placental hypoperfusion, and adverse pregnancy outcomes. However, the prognostic value of NDBP for postpartum chronic hypertension (PPCHT) remains insufficiently explored. Materials and Methods: This retrospective observational study included 196 women with gestational hypertension beyond 20 weeks of gestation who underwent ABPM between 2013 and 2025. Patients were classified as dippers (≥10% nocturnal systolic decline) or non-dippers (<10%). The primary outcome was postpartum chronic hypertension, defined as a persistent office blood pressure ≥ 140/90 mmHg or continued antihypertensive therapy at 12-month follow-ups. Secondary outcomes included fetal growth restriction (FGR), preeclampsia, and hypertensive complications. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of PPCHT and FGR. Results: In the cohort, 124 women (63.3%) exhibited a non-dipping blood pressure pattern. At 12 months postpartum, 93 women (47.4%) developed chronic hypertension. Non-dipping was significantly more frequent among women with PPCHT compared with those that remained normotensive (75.3% vs. 52.4%). Non-dippers also demonstrated higher rates of fetal growth restriction and preeclampsia. In multivariable analysis, NDBP remained independently associated with PPCHT after adjustments for age and daytime blood pressure parameters. Furthermore, NDBP and elevated daytime systolic blood pressure were independent predictors of FGR. Conclusions: A non-dipping blood pressure pattern is highly prevalent in gestational hypertension and is independently associated with both fetal growth restriction and postpartum chronic hypertension. Incorporating ABPM-derived circadian blood pressure phenotyping into antenatal assessments may improve risk stratification and support targeted postpartum cardiovascular surveillance strategies.