From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (C.J.N., P.M., S.L.M., K.K., V.C.A., M.C., L.S., N.J.P., E.F.S.).
Obstetrics and Gynecology, School of Medicine, University of Utah (R.M.S.).
Hypertension. 2020 Sep;76(3):922-929. doi: 10.1161/HYPERTENSIONAHA.120.14875. Epub 2020 Aug 3.
Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3±6.7 mm Hg mean arterial pressure), term preeclampsia (88.3±9.8 mm Hg), and gestational hypertension (87.9±9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9±8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy. Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363.
子痫前期和妊娠高血压是妊娠常见的并发症，与母婴发病率显著相关。尽管对妊娠期间的危险因素进行了广泛的研究，但大多数发生妊娠高血压疾病的妇女并不被认为是高危人群，预防策略仍难以捉摸。我们评估了孕前血压及其在孕早期的变化，作为妊娠高血压疾病发展的新的风险标志物。EAGeR（妊娠和生殖中的阿司匹林作用）试验（2007-2011 年）将 1228 名有妊娠丢失史的健康妇女随机分为孕前开始低剂量阿司匹林组与安慰剂组，并对参与者进行了长达 6 个月经周期的妊娠尝试和妊娠期间的随访，如果她们怀孕了。在孕前和孕早期测量血压。主要结局包括早产子痫前期、足月子痫前期和妊娠高血压，从病历中提取。在 586 名妊娠超过 20 周的妇女中，早产子痫前期（平均动脉压 87.3±6.7mmHg）、足月子痫前期（88.3±9.8mmHg）和妊娠高血压（87.9±9.1mmHg）的孕前血压水平高于无妊娠高血压疾病（83.9±8.6mmHg）。从孕前到孕早期血压的变化与子痫前期的发生有关（相对风险，平均动脉压每增加 2mmHg，妊娠 4 周时为 1.13[95%CI，1.02-1.25]），尤其是早产子痫前期（相对风险，1.21[95%CI，1.01-1.45]）。阿司匹林的随机分组并没有改变血压轨迹或妊娠高血压的风险。孕前血压和孕早期的纵向变化虽然尚未得到充分探索，但却是检测和预防妊娠高血压疾病的关键窗口。注册- URL：http://www.clinicaltrials.gov。独特标识符：NCT00467363。
