Department of Engineering Science, Oxford Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK.
Centre for Statistics in Medicine, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
BMC Med. 2019 Sep 11;17(1):167. doi: 10.1186/s12916-019-1399-1.
Current reference ranges for blood pressure and heart rate throughout pregnancy have a poor evidence base.
This is a systematic review and meta-analysis. We included studies measuring blood pressure or heart rate from healthy pregnant women within defined gestational periods of 16 weeks or less. We analysed systolic blood pressure, diastolic blood pressure and heart rate by gestational age. We assessed effects of measurement year and method.
We included 39 studies undertaken in 1967-2017, containing 124,349 systolic measurements from 36,239 women, 124,291 diastolic measurements from 36,181 women and 10,948 heart rate measurements from 8317 women. Mean (95% CI) systolic blood pressure was lowest at 10 weeks gestation, 110.4 (108.5, 112.3) mmHg, rising to 116.0 (113.6, 118.4) mmHg at 40 weeks, mean (95% CI) change 5.6 (4.0, 7.2) mmHg. Mean (95% CI) diastolic blood pressure was lowest at 21 weeks gestation, 65.9 (64.2, 67.7) mmHg; rising to 72.8 (71.0, 74.6) mmHg at 40 weeks, mean (95% CI) change 6.9 (6.2, 7.5) mmHg. Mean (95% CI) heart rate rose from 79.3 (75.5, 83.1) beats/min at 10 weeks to 86.9 (82.2, 91.6) beats/min at 40 weeks gestation, mean (95% CI) change 7.6 (1.8, 13.4) beats/min. Studies using manual measurement reported higher diastolic blood pressures than studies using automated measurement, mean (95 CI) difference 4.9 (0.8, 8.9) mmHg. Diastolic blood pressure increased by 0.26 (95% CI 0.10-0.43) mmHg/year. Including only higher-quality studies had little effect on findings, with heterogeneity remaining high (I statistic > 50%).
Significant gestational blood pressure and heart rate changes occur that should be taken into account when assessing pregnant women. Commonly taught substantial decreases in blood pressure mid-pregnancy were not seen and heart rate increases were lower than previously thought. Manual and automated blood pressure measurement cannot be used interchangeably. Increases in diastolic blood pressure over the last half-century and differences between published studies show contemporary data are required to define current normal ranges.
PROSPERO CRD42014009673.
目前关于血压和心率的孕期参考范围的证据基础较差。
这是一项系统评价和荟萃分析。我们纳入了在 16 周或更短的特定妊娠期间测量健康孕妇血压或心率的研究。我们根据妊娠周数分析收缩压、舒张压和心率。我们评估了测量年份和方法的影响。
我们纳入了 1967 年至 2017 年进行的 39 项研究，包含了 36239 名女性的 124349 次收缩压测量值、36181 名女性的 124291 次舒张压测量值和 8317 名女性的 10948 次心率测量值。收缩压的平均值（95%CI）在 10 周妊娠时最低，为 110.4（108.5，112.3）mmHg，在 40 周妊娠时升高至 116.0（113.6，118.4）mmHg，平均（95%CI）变化 5.6（4.0，7.2）mmHg。舒张压的平均值（95%CI）在 21 周妊娠时最低，为 65.9（64.2，67.7）mmHg；在 40 周妊娠时升高至 72.8（71.0，74.6）mmHg，平均（95%CI）变化 6.9（6.2，7.5）mmHg。心率从 10 周妊娠时的 79.3（75.5，83.1）次/分升高至 40 周妊娠时的 86.9（82.2，91.6）次/分，平均（95%CI）变化 7.6（1.8，13.4）次/分。使用手动测量的研究报告的舒张压高于使用自动测量的研究，平均（95%CI）差值为 4.9（0.8，8.9）mmHg。舒张压每年增加 0.26（95%CI 0.10-0.43）mmHg。仅纳入高质量研究对研究结果影响不大，但异质性仍然很高（I 统计>50%）。
孕期血压和心率显著变化，在评估孕妇时应予以考虑。通常认为妊娠中期血压会大幅下降，但并未观察到这种情况，而心率升高的幅度低于此前认为的水平。手动和自动血压测量不能互换使用。过去半个世纪舒张压的升高以及发表研究之间的差异表明，需要当代数据来定义当前的正常范围。
PROSPERO CRD42014009673。
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