Miller Raymond S, Rudra Carole B, Williams Michelle A
Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington 98104, USA.
Am J Hypertens. 2007 May;20(5):573-8. doi: 10.1016/j.amjhyper.2006.12.012.
Maternal second-trimester mean arterial pressure (MAP) is associated with a risk of preeclampsia in some but not all published studies. We examined average first-trimester MAP in relation to preeclampsia risk among 1655 women.
Using blood-pressure measurements recorded during prenatal care, we calculated MAP, and averaged the values within the first trimester. We defined preeclampsia according to national criteria, using information abstracted from medical records. We classified participants by MAP quartiles: <79, 79-83, 84-88, and >or=89 mm Hg. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) adjusted for prepregnancy body mass index, age, race/ethnicity, and parity.
High-quartile MAP was associated with an increased risk of preeclampsia when using current diagnostic criteria (adjusted RR versus low-quartile, 3.0; 95% CI, 1.2-7.4) but not when using older criteria (RR, 1.2; 95% CI, 0.6-2.2). First-trimester MAP did not strongly predict future preeclampsia (area under the receiver operating curve, 0.71). A MAP >/=88 mm Hg predicted preeclampsia with a sensitivity of 0.78 and a specificity of 0.63.
Although first-trimester MAP is strongly associated with risk of preeclampsia, it poorly discriminates between women who will and will not develop the disease.
在一些但并非所有已发表的研究中，孕中期孕妇平均动脉压（MAP）与先兆子痫风险相关。我们在1655名女性中研究了孕早期平均MAP与先兆子痫风险的关系。
利用产前检查时记录的血压测量值，我们计算了MAP，并取孕早期各值的平均值。我们根据国家标准，使用从病历中提取的信息来定义先兆子痫。我们根据MAP四分位数对参与者进行分类：<79、79 - 83、84 - 88和≥89 mmHg。我们计算了风险比（RR）和针对孕前体重指数、年龄、种族/民族和产次进行调整的95%置信区间（CI）。
使用当前诊断标准时，高四分位数MAP与先兆子痫风险增加相关（与低四分位数相比，调整后的RR为3.0；95%CI为1.2 - 7.4），但使用旧标准时则不然（RR为1.2；95%CI为0.6 - 2.2）。孕早期MAP并不能强烈预测未来的先兆子痫（受试者工作特征曲线下面积为0.71）。MAP≥88 mmHg预测先兆子痫的敏感性为0.78，特异性为0.63。
尽管孕早期MAP与先兆子痫风险密切相关，但它在区分会发生和不会发生该疾病的女性方面表现不佳。
