Waugh J, Perry I J, Halligan A W, De Swiet M, Lambert P C, Penny J A, Taylor D J, Jones D R, Shennan A
Department of Obstetrics and Gynaecology, University of Leicester, Leicester, United Kingdom.
Am J Obstet Gynecol. 2000 Sep;183(3):633-7. doi: 10.1067/mob.2000.106448.
The aim of this study was to examine the relationship between maternal ambulatory blood pressure monitor measurements during pregnancy and birth weight in a population of women considered to have hypertension according to conventional antenatal clinic measurement.
A prospective observational study was carried out within the obstetric departments of Leicester Royal Infirmary and Queen Charlotte's Hospital. A total of 237 women were found to have hypertension (blood pressure >/=140/90 mm Hg) without significant proteinuria during examination in the antenatal assessment area. Sequential-day unit blood pressure recordings and a 24-hour automated ambulatory blood pressure recording were performed, and the results were compared with the principal outcome measure of birth weight.
A significant inverse association (gradient, -13.5; 95% confidence interval -23.4 to -3.6) was found between daytime ambulatory diastolic blood pressure measurement and birth weight. An increase of 5 mm Hg in daytime mean diastolic blood pressure was associated with a fall in birth weight of 68.5 g. This association remained after adjustment for potential confounders that included maternal age, maternal weight, smoking status, ethnicity, and gestational age at delivery. No such association was found between obstetric day unit assessment of blood pressure and birth weight.
There is a significant association between blood pressure and birth weight in nonproteinuric hypertensive pregnancies. The best predictor of this association is the daytime mean ambulatory diastolic blood pressure measurement. This is further evidence that maternal blood pressure may be an important confounding and potentially genetic variable in the association between birth weight and subsequent adult hypertension.
本研究旨在探讨在根据传统产前门诊测量被认为患有高血压的女性群体中，孕期母亲动态血压监测测量值与出生体重之间的关系。
在莱斯特皇家医院和夏洛特女王医院的产科部门进行了一项前瞻性观察研究。在产前评估区域检查时，共发现237名女性患有高血压（血压≥140/90 mmHg）且无明显蛋白尿。进行了连续日单位血压记录和24小时自动动态血压记录，并将结果与出生体重这一主要结局指标进行比较。
日间动态舒张压测量值与出生体重之间存在显著的负相关（梯度为-13.5；95%置信区间为-23.4至-3.6）。日间平均舒张压每升高5 mmHg，出生体重下降68.5 g。在对包括母亲年龄、母亲体重、吸烟状况、种族和分娩时孕周等潜在混杂因素进行调整后，这种关联仍然存在。在产科日单位血压评估与出生体重之间未发现此类关联。
在无蛋白尿的高血压妊娠中，血压与出生体重之间存在显著关联。这种关联的最佳预测指标是日间平均动态舒张压测量值。这进一步证明，母亲血压可能是出生体重与随后成人高血压之间关联中的一个重要混杂因素且可能是遗传变量。
