Gasse Cédric, Boutin Amélie, Coté Maxime, Chaillet Nils, Bujold Emmanuel, Demers Suzanne
Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Qc, Canada.
CHU de Québec-Université Laval Research Center, Quebec City, Qc, Canada.
Pregnancy Hypertens. 2018 Apr;12:178-182. doi: 10.1016/j.preghy.2017.11.005. Epub 2017 Nov 21.
To estimate the predictive value of first-trimester mean arterial pressure (MAP) for the hypertensive disorders of pregnancy (HDP).
We performed a prospective cohort study of nulliparous women recruited at 11-13 weeks. MAP was calculated from blood pressure measured on both arms simultaneously using an automated device taking a series of recordings until blood pressure stability was reached. MAP was reported as multiples of the median adjusted for gestational age. Participants were followed for development of gestational hypertension (GH), preeclampsia (PE), preterm PE (<37 weeks) and early-onset (EO) PE (<34 weeks). Receiver operating characteristic curves and the area under the curve (AUC) were used to estimate the predictive values of MAP. Multivariate logistic regressions were used to develop predictive models combining MAP and maternal characteristics.
We obtained complete follow-up in 4700 (99%) out of 4749 eligible participants. GH without PE was observed in 250 (5.3%) participants, and PE in 241 (5.1%), including 33 (0.7%) preterm PE and 10 (0.2%) EO-PE. First-trimester MAP was associated with GH (AUC: 0.77; 95%CI: 0.74-0.80); term PE (0.73; 95%CI: 0.70-0.76), preterm PE (0.80; 95%CI: 0.73-0.87) and EO-PE (0.79; 95%CI: 0.62-0.96). At a 10% false-positive rate, first-trimester MAP could have predicted 39% of GH, 34% of term PE, 48% of preterm PE and 60% of EO-PE. The addition of maternal characteristics improved the predictive values (to 40%, 37%, 55% and 70%, respectively).
First-trimester MAP is a strong predictor of GH and PE in nulliparous women.
评估孕早期平均动脉压（MAP）对妊娠期高血压疾病（HDP）的预测价值。
我们对在孕11至13周招募的初产妇进行了一项前瞻性队列研究。使用自动设备同时测量双臂血压，计算MAP，进行一系列测量直至血压稳定。MAP报告为根据孕周调整后的中位数倍数。对参与者进行随访，观察妊娠期高血压（GH）、子痫前期（PE）、早产子痫前期（<37周）和早发型（EO）子痫前期（<34周）的发生情况。采用受试者工作特征曲线和曲线下面积（AUC）来评估MAP的预测价值。使用多因素逻辑回归建立结合MAP和母亲特征的预测模型。
4749名符合条件的参与者中，4700名（99%）获得了完整的随访。250名（5.3%）参与者出现无PE的GH，241名（5.1%）出现PE，包括33名（0.7%）早产PE和10名（0.2%）EO-PE。孕早期MAP与GH（AUC：0.77；95%CI：0.74 - 0.80）、足月PE（0.73；95%CI：0.70 - 0.76）、早产PE（0.80；95%CI：0.73 - 0.87）和EO-PE（0.79；95%CI：0.62 - 0.96）相关。在假阳性率为10%时，孕早期MAP可预测39%的GH、34%的足月PE、48%的早产PE和60%的EO-PE。加入母亲特征后，预测价值提高（分别提高到40%、37%、55%和70%）。
孕早期MAP是初产妇GH和PE的有力预测指标。
