From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.J.N., P.M., S.L.M., E.H.Y., K.K., H.P., N.J.P., L.S., E.F.S.); Graduate School of Public Health, University of Pittsburgh, PA (A.I.N.); Department of Obstetrics and Gynecology, Geisinger Commonwealth School of Medicine, Scranton, PA (B.W.); and Department of Obstetrics and Gynecology, School of Medicine, Salt Lake City, University of Utah (R.M.S.).
Hypertension. 2018 May;71(5):904-910. doi: 10.1161/HYPERTENSIONAHA.117.10705. Epub 2018 Apr 2.
Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biological rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. We evaluated preconception blood pressure and fecundability, pregnancy loss, and live birth in the EAGeR trial (Effects of Aspirin on Gestational and Reproduction; 2007-2011), a randomized clinical trial of aspirin and reproductive outcomes among 1228 women attempting pregnancy with a history of pregnancy loss. Systolic and diastolic blood pressure were measured during preconception in the first observed menstrual cycle and in early pregnancy and used to derive mean arterial pressure. Fecundability was assessed as number of menstrual cycles until pregnancy, determined through human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin-detected and clinical losses. Analyses adjusted for treatment assignment, age, body mass index, race, marital status, smoking, parity, and time since last loss. Mean preconception systolic and diastolic blood pressure were 111.6 mm Hg (SD, 12.1) and 72.5 (SD, 9.4) mm Hg. Risk of pregnancy loss increased 18% per 10 mm Hg increase in diastolic blood pressure (95% confidence interval, 1.03-1.36) and 17% per 10 mm Hg increase in mean arterial pressure (95% confidence interval, 1.02-1.35) in adjusted analyses. Findings were similar for early pregnancy blood pressure. Preconception blood pressure was not related to fecundability or live birth in adjusted analyses. Findings suggest that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favorably impact reproductive health.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.
青年时期血压升高是心血管疾病的早期风险标志物。尽管有强有力的生物学依据，但很少有研究评估孕前血压的逐渐升高是否对生殖健康有早期影响。我们评估了 EAGeR 试验（阿司匹林对妊娠和生殖的影响；2007-2011 年）中孕前血压与生育能力、妊娠丢失和活产的关系，该试验是一项针对有妊娠丢失史的 1228 名备孕女性的阿司匹林和生殖结局的随机临床试验。在首次观察到的月经周期和早孕期间测量收缩压和舒张压，并用于推导平均动脉压。生育能力评估为怀孕所需的月经周期数，通过人绒毛膜促性腺激素检测确定。妊娠丢失包括人绒毛膜促性腺激素检测和临床丢失。分析调整了治疗分配、年龄、体重指数、种族、婚姻状况、吸烟、产次和上次丢失时间。孕前收缩压和舒张压的平均值分别为 111.6 mm Hg（标准差，12.1）和 72.5（标准差，9.4）mm Hg。调整分析显示，舒张压每增加 10 mm Hg，妊娠丢失风险增加 18%（95%置信区间，1.03-1.36），平均动脉压每增加 10 mm Hg，妊娠丢失风险增加 17%（95%置信区间，1.02-1.35）。早期妊娠血压的结果类似。调整分析显示，孕前血压与生育能力或活产无关。这些发现表明，健康女性的孕前血压与妊娠丢失有关，针对年轻女性的血压生活方式干预可能对生殖健康产生有利影响。
