Salles Gil F, Schlüssel Michael M, Farias Dayana R, Franco-Sena Ana Beatriz, Rebelo Fernanda, Lacerda Elisa M A, Kac Gilberto
Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;
Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK;
Am J Hypertens. 2015 May;28(5):680-9. doi: 10.1093/ajh/hpu204. Epub 2014 Nov 5.
The well-known mid-trimester drop in blood pressure (BP) during normal pregnancy was recently questioned.
To describe longitudinal changes in BP during healthy pregnancies and to investigate factors associated with no mid-trimester drop in BP.
A prospective cohort with 158 healthy pregnant women was followed up in a public health care center in Rio de Janeiro, Brazil. We used linear mixed-effects models to estimate longitudinal changes in systolic BP (SBP) and diastolic BP (DBP) during pregnancy. Poisson regression models were performed to identify factors associated with no mid-trimester drop in BP.
Significant mid-trimester increase in SBP (5.6 mm Hg; 95% confidence interval (CI) = 4.6-6.7) and DBP (4.4 mm Hg; 95% CI = 3.4-5.3) was observed in 44.3% and 39.9% of the sample, respectively. Women (37.1%) who had not a mid-trimester SBP drop still had a DBP drop. White skin color (incidence ratio (IR): 1.71; 95% CI = 1.22-2.39), family history of hypertension (IR: 1.93; 95% CI = 1.29-2.89), early pregnancy obesity (IR: 2.29; 95% CI = 1.27-4.11), outside temperature variation (IR: 1.45; 95% CI = 1.00-2.10), and gestational weight gain from the first to second trimester (IR: 1.71; 95% CI = 1.01-2.88 and IR: 2.32; 95% CI = 1.39-3.89 for second and third tertiles) were characteristics associated with no mid-trimester drop in SBP. The same characteristics were associated with no mid-trimester drop in DBP, except family history of hypertension and outside temperature variation.
Some women without a mid-trimester SBP drop still present a DBP drop. The different patterns of mid-trimester change in BP seem to be determined by preexisting and pregnancy-related factors.
正常妊娠中期血压（BP）下降这一众所周知的现象最近受到质疑。
描述健康妊娠期间血压的纵向变化，并调查与妊娠中期血压未下降相关的因素。
在巴西里约热内卢的一个公共卫生保健中心对158名健康孕妇组成的前瞻性队列进行随访。我们使用线性混合效应模型来估计妊娠期间收缩压（SBP）和舒张压（DBP）的纵向变化。采用泊松回归模型来确定与妊娠中期血压未下降相关的因素。
分别在44.3%和39.9%的样本中观察到妊娠中期SBP显著升高（5.6毫米汞柱；95%置信区间（CI）=4.6 - 6.7）和DBP显著升高（4.4毫米汞柱；95%CI = 3.4 - 5.3）。妊娠中期SBP未下降的女性（37.1%）其DBP仍有下降。白人肤色（发病率比（IR）：1.71；95%CI = 1.22 - 2.39）、高血压家族史（IR：1.93；95%CI = 1.29 - 2.89）、孕早期肥胖（IR：2.29；95%CI = 1.27 - 4.11）、外界温度变化（IR：1.45；95%CI = 1.00 - 2.10）以及妊娠第一个月到第二个月的体重增加（第二个和第三个三分位数的IR分别为：1.71；95%CI = 1.01 - 2.88和IR：2.32；95%CI = 1.39 - 3.89）是与妊娠中期SBP未下降相关的特征。除高血压家族史和外界温度变化外，相同的特征与妊娠中期DBP未下降相关。
一些妊娠中期SBP未下降的女性其DBP仍有下降。妊娠中期血压变化的不同模式似乎由既往因素和与妊娠相关的因素决定
