SUN-227 HyperAldosteronism in Pregnancy Predicted Impacts (H.A.P.P.I. Project):A Prospective Cohort Study

Abstract Disclosure: D. Oprea: None. A. Groleau: None. D. Laura: None. F. Lefrançois: None. M. Malick: None. A. Côté: None. M. Roy-Lacroix: None. M. Mahone: None. M. St-Jean: None. N. Sauvé: None. Background and Purpose: Primary aldosteronism (PA) is a frequent cause of secondary hypertension in young adults. However, to this day, there is still limited data regarding its prevalence and impact during pregnancy. Methods: The prospective phase of the H.A.P.P.I. project consisted of a bicentric cohort study, which was conducted between 2022 and 2024 in Quebec, Canada. All patients diagnosed with hypertensive disorders of pregnancy (HDP) who delivered in one of two university centers were eligible and were recruited during their post-partum follow-up to be screened for PA with an aldosterone/renin ratio (ARR). Additional confirmatory testing was performed if positive screening, according to local reference values. Patients with other endocrinopathies or secondary aldosteronism were excluded. Our primary objective was to determine PA prevalence among patients who experienced any subtype of HDP. Results: Among 240 included patients, 232 patients have completed their ARR screening. Preliminary results have shown positive screening in 18.1 % (n = 42) of patients, of which additional testing confirmed 18 (7.8%) PA diagnoses. Additional testing is pending for 24 patients. 44.4% (n = 8/18) of patients with confirmed PA were of African descent, as opposed to 10.0% in patients with negative PA screening (p < 0.001). Hypokalemia prevalence was not different between patients with positive PA screening and the ones with negative screening (antepartum: 14.3% (n = 3/21) vs. 13.0%, p = 1.00; post-partum: 7.1% (n = 2/28) vs. 8.3%, p = 1.00). 61.9% of patients with positive PA screening (n = 26/42) required labor induction because of HDP occurrence, compared to 49.5% of patients with negative PA screening (p = 0.173). Pre-eclampsia (54.8% (n = 23/42)) was the most frequent type of HDP in patients with positive PA screening, compared to chronic (19.1% (n = 8/42)) and gestational hypertension (40.5% (n = 17/42)). There was no difference between antepartum preeclampsia (72.9%, vs 75.6%, p = 1.00), postpartum preeclampsia (26.1%, vs. 24.4%, p = 1.00), and preeclampsia with adverse conditions (42.9%, vs. 41.6%, p = 1.00) compared to patients with negative ARR screening. Conclusion: So far, an estimated PA prevalence of 7.8% was described in patients recently diagnosed with HDP, who presented mainly as antepartum preeclampsia. Final results will be presented at the conference. Keywords: Primary Hyperaldosteronism, Aldosterone, Hypertension, Pregnancy-Induced, Pregnancy, Pregnant Women, Pregnancy Outcome. Presentation: Sunday, July 13, 2025