Ma Shengqi, Wu Lei, Yu Qing, Chen Donghui, Geng Chunsong, Peng Hao, Yu Lugang, Zhang Mingzhi
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Department of Maternal and Child Health, Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, Jiangsu, People's Republic of China.
Risk Manag Healthc Policy. 2021 Aug 8;14:3255-3263. doi: 10.2147/RMHP.S318956. eCollection 2021.
High blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study.
Leveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package "traj" in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO.
Trajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17-20 weeks of gestation for all blood pressure components.
Our study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.
孕期高血压被认为与不良分娩结局（ABO）相关，但不同的血压变化及其影响程度尚不清楚。因此，我们旨在通过一项实际研究调查孕妇的血压轨迹（收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、脉压（PP））与ABO之间的关联。
利用2010年1月1日至2019年12月31日基于登记的队列中的28679名孕妇及其胎儿。使用常规产前检查的实际血压数据，通过R软件中的“traj”包估计血压轨迹。应用逻辑回归模型来检验孕期不同血压成分（SBP、DBP、MAP和PP）的轨迹与ABO风险之间的关联。
所有血压成分的轨迹均被分为低稳定、中度上升、中度下降和高稳定四类。在调整混杂因素后，与低稳定模式的孕妇相比，高稳定或中度上升模式的孕妇发生不良分娩结局的风险显著增加。中度下降模式的孕妇发生ABO的风险没有显著增加，但与中度上升模式的孕妇相比，其不良分娩结局的风险较低。所有血压成分的轨迹在妊娠17 - 20周时相交。
我们的研究结果表明，妊娠20周后将血压降低并维持在收缩压低于110 mmHg、舒张压低于65 mmHg的低水平，将有助于预防不良分娩结局，无论孕早期的血压水平如何。
