Impact of obesity on blood pressures measured at alternative locations during pregnancy.

BACKGROUND: In patients with obesity, the distribution of subcutaneous tissue can make blood pressure measurement on the standard location of the upper arm difficult. In these cases, alternative locations, such as the lower arm or wrist, are commonly used. It is unknown whether there is a discrepancy in these measurements for pregnant patients at extremes of body mass index. OBJECTIVE: We hypothesized that noninvasive blood pressure measurements on the lower arm and wrist will differ from blood pressure measurements on the upper arm and that this difference will be greater with increasing body mass index. STUDY DESIGN: We conducted a prospective observational study of pregnant patients from July 2020 to August 2020. We collected study subjects' biometric measurements and took 3 blood pressure measurements (systolic and diastolic blood pressures) from the upper arm, lower arm, and wrist. Measurements on the lower arm and wrist were considered alternative locations and compared with measurements on the upper arm. We stratified patients by body mass index. Agreement between locations was assessed using the Bland-Altman analysis. We used linear regression to assess the blood pressure discrepancy dependence on body mass index. RESULTS: We included 100 patients with 20 patients from each body mass index class. Blood pressure measurements at each site correlated but were discrepant. For the lower arm, there was an upward bias of 11.5 mm Hg (limit of agreement, +30.7 to -7.8) for systolic blood pressure and 11.2 mm Hg (limit of agreement, +25.9 to -2.9) for diastolic blood pressure compared with the upper arm. For the wrist, there was an upward bias of 7.1 mm Hg (limit of agreement, +35.1 to -20.9) for systolic blood pressure and 7.3 mm Hg (limit of agreement, +26.2 to -11.7) for diastolic blood pressure compared with the upper arm. Overall, there was a greater discrepancy in blood pressure measurements between the lower and upper arms with increasing body mass index. When comparing blood pressure measurements between the lower and upper arms, the discrepancy increased by 0.43 mm Hg (P<.001) for systolic blood pressure and 0.18 mm Hg (P=.02) for diastolic blood pressure with each increasing body mass index unit. There was no statistically significant change in the discrepancy of systolic (P=.45) or diastolic (P=.86) blood pressure in the upper arm vs the wrist based on body mass index. CONCLUSION: This study highlighted that blood pressure measurements are higher when taken at alternative locations, such as the lower arm and wrist, and that lower arm blood pressure measurements are increasingly discrepant from upper arm blood pressure measurements with increasing body mass index.

Awareness and Knowledge of Human Papilloma Virus and Cervical Cancer in Women with High Pap Uptake.

This cross-sectional study explored knowledge, awareness, and health practices surrounding cervical cancer prevention and screening. Patients (n = 129) were recruited from three community clinics of underserved populations in Dallas, Texas. Women between ages 18-65 were surveyed using a self-administered questionnaire to evaluate their knowledge, awareness, and attitudes related to pap tests, human papilloma virus (HPV), HPV vaccines, and cervical cancer. Most women reported having a pap test in the past 3-5 years (86.6%). Over half knew that there was an increased risk of cervical cancer with an HPV infection, abnormal pap test, or both (52%). However, less than half of women knew the purpose of a pap test (40%), the purpose of the HPV vaccine (48%), or the transmission mode of HPV (25%). Over half of participants first heard about a pap test from a doctor (60%), about one quarter from their mother (24%), and less than a quarter from others (16%). More than half of women were aware of HPV (55%), while less than half were aware of the HPV vaccine (48%). Overall, we found that while most women had a high uptake of pap tests, they had low knowledge of the purpose of a pap test, the HPV vaccine, and transmission mode of HPV. They also had low awareness of HPV and the HPV vaccine. Given that almost all cases of cervical cancer are due to HPV infection, future studies should aim to further explore the gap between knowledge and awareness of HPV and pap uptake.