From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China (Q.L., D.-M.D., L.-J.L., X.-H.L.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, China (X.Z., W.-J.J., W.C., Y.-M.L.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (Z.Z.); and Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong Province, China (J.-M.N.).
Hypertension. 2017 Oct;70(4):804-812. doi: 10.1161/HYPERTENSIONAHA.117.09760. Epub 2017 Aug 21.
The longitudinal exposure-response relationship between trimester-specific gestational weight gain (GWG) and blood pressure (BP) during pregnancy is not well understood. We retrospectively assessed 1112 uncomplicated, normotensive pregnant women whose body weight and BP were measured from 12 to 40 weeks of gestation from a hospital-based cohort. By using growth curve modeling, a J-shaped pattern dominated diastolic BP (DBP) changing dynamics, with a midpregnancy drop at 20 to 22 weeks followed by a rebound. Using group-based trajectory modeling, 3 distinctive trajectories of DBP were identified: high-J shaped (18.5%), moderate-J shaped (48.3%), and low-J shaped (33.1%), as well as 3 distinctive GWG trajectories: high increasing (14.7%), moderate increasing (48.6%) and low increasing (36.8%). A temporal coincidence between the maximal rate of GWG and DBP transition from its nadir to rebound was observed during 20 to 22 weeks. Moreover, women in the high-increasing GWG group had the highest probability of being in the high-J DBP group. The GWG rate during the late midsecond trimester (22 to 26 weeks) was consistently associated with an elevated DBP level: for every 200 g/wk increase, the multivariable-adjusted odds ratio was 1.27 (95% confidence interval, 1.13-1.43) for the trajectory shift to the high-J group and 1.20 (95% confidence interval, 1.07-1.35) for the occurrence of diastolic prehypertension after 37 weeks. Furthermore, adding a trimester-specific GWG rate (22 to 26 weeks) contributed to the incremental yield for the prediction of diastolic prehypertension after 37 weeks. Our results thus provide the timing and extent of gestational weight control relevant to the optimized BP level during pregnancy.
孕期特定妊娠期间体重增加（GWG）与血压（BP）的纵向暴露-反应关系尚不清楚。我们回顾性评估了来自医院队列的 1112 例无并发症、血压正常的孕妇，从 12 周到 40 周测量了她们的体重和血压。通过使用生长曲线建模，发现舒张压（DBP）的变化动态以 J 形为主，在 20 至 22 周的妊娠中期出现下降，随后出现反弹。使用基于群组的轨迹建模，确定了 3 种不同的 DBP 轨迹：高 J 形（18.5%）、中 J 形（48.3%）和低 J 形（33.1%），以及 3 种不同的 GWG 轨迹：高增长（14.7%）、中增长（48.6%）和低增长（36.8%）。在 20 至 22 周期间，GWG 的最大速率与 DBP 从最低点到反弹的转变之间存在时间上的巧合。此外，在高增长 GWG 组中的女性发生高 J 形 DBP 组的概率最高。第二中期后期（22 至 26 周）的 GWG 率与 DBP 水平升高始终相关：每增加 200 g/周，轨迹向高 J 组转移的多变量调整比值比为 1.27（95%置信区间，1.13-1.43），37 周后发生舒张压前期高血压的比值比为 1.20（95%置信区间，1.07-1.35）。此外，增加特定妊娠期间的 GWG 率（22 至 26 周）有助于提高对 37 周后舒张压前期高血压的预测能力。因此，我们的研究结果提供了与孕期优化血压水平相关的妊娠期间体重控制的时间和程度。
