Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, China.
Pregnancy Hypertens. 2021 Aug;25:62-67. doi: 10.1016/j.preghy.2021.05.006. Epub 2021 May 14.
To investigate the relationship between blood pressure (BP) achieved during pregnancy and pregnant outcomes in non-severe chronic hypertensive women.
This retrospective cohort study included pregnant women who diagnosed as non-severe chronic hypertension and delivered in Shanghai Renji Hospital from January 2010 to March 2017. Based on their mean antenatal office diastolic BP (dBP), patients were divided into higher BP achieved (HBPA, dBP ≥ 90 mmHg) group or lower BP achieved (LBPA, dBP < 90 mmHg) group. Primary outcome measurement was the composite of fetal or neonatal mortality and morbidities. Secondary outcomes were the adverse maternal outcomes.
Eligible 305 patients were included, among whom 98 were in HBPA group and 207 were in LBPA group. The HBPA group had significantly higher antenatal dBP [95.0 ± 4.8 vs 81.7 ± 5.6 mmHg, P < 0.001] than the LBPA group. After adjusting for six confounding factors (age, body-mass index (BMI), weeks of gestation at first antenatal visit, dBP measured at first antenatal visit, antihypertensive medication usage during pregnancy, complicating other medical condition), primary outcome [34.7% vs 15.9%, 2.30 (1.23-4.30)] was significantly higher in HBPA group. The incidences of SGA [21.4% vs 11.1%, 2.12 (1.03-4.38)], NICU admission [19.4% vs 6.3%, 3.54 (1.48-8.49)], preeclampsia with severe features [22.4% vs 10.6%, 2.23 (1.10-4.54)], severe hypertension [8.2% vs 0.5%, 15.68 (1.78-138.04)] were higher, and earlier gestational age at delivery [37.1 ± 2.6 vs 37.7 ± 2.1, P = 0.031], lower birthweight [2861.0 ± 780.0 vs 3059.0 ± 616.3, P = 0.029] in the HBPA group.
Lower BP achieved during gestation in pregnant women with non-severe chronic hypertension (CH) might improve both fetal/neonatal and maternal outcomes.
探讨非重度慢性高血压孕妇孕期血压控制水平与妊娠结局的关系。
本回顾性队列研究纳入了 2010 年 1 月至 2017 年 3 月在上海交通大学医学院附属仁济医院就诊并分娩的非重度慢性高血压孕妇。根据患者产前诊室舒张压（dBP）的平均值，将其分为血压控制较好组（HBPA 组，dBP≥90mmHg）和血压控制较差组（LBPA 组，dBP＜90mmHg）。主要结局测量指标为胎儿或新生儿死亡率和发病率的复合结局。次要结局为不良母儿结局。
本研究纳入了 305 例符合条件的孕妇，其中 98 例为 HBPA 组，207 例为 LBPA 组。HBPA 组的产前 dBP[95.0±4.8mmHg 比 81.7±5.6mmHg，P＜0.001]显著高于 LBPA 组。调整年龄、体质指数（BMI）、首次产前就诊时的孕周、首次产前就诊时的 dBP、孕期降压药物使用、合并其他医疗状况等 6 个混杂因素后，HBPA 组的主要结局[34.7%比 15.9%，2.30（1.234.30）]显著更高。HBPA 组的巨大儿发生率[21.4%比 11.1%，2.12（1.034.38）]、新生儿重症监护病房（NICU）入住率[19.4%比 6.3%，3.54（1.488.49）]、重度子痫前期发生率[22.4%比 10.6%，2.23（1.104.54）]更高，且分娩时的胎龄更早[37.1±2.6比 37.7±2.1，P=0.031]，出生体重更低[2861.0±780.0g 比 3059.0±616.3g，P=0.029]。
非重度慢性高血压孕妇孕期血压控制水平较低可能会改善母婴结局。
