Molecular and Clinical Sciences Research Institute, St George's University of London Molecular and Clinical Sciences Research Institute, London, UK
Maternal Medicine, St George's University Hospitals NHS Foundation Trust, London, UK.
BMJ Open. 2022 Apr 1;12(4):e060087. doi: 10.1136/bmjopen-2021-060087.
Hypertensive disorders occur in approximately 10% of women during pregnancy. There is robust population-based data to show that women who have hypertension in pregnancy are much more likely to develop cardiovascular disease (CVD) in the postpartum period. Women with a hypertensive disorder of pregnancy (HDP) are twice more at risk of heart disease and stroke, and four times more likely to develop hypertension after birth. Two out of three women who had HDP will die from CVD. Recent evidence suggests that young women with HDP develop signs of CVD in the immediate postpartum period, rather than several decades later as previously presumed. If confirmed, this concerning finding presents healthcare practitioners with an opportunity to influence women's cardiovascular health by advising on lifestyle choices and considering therapeutic interventions to prevent the development of CVD.
This prospective cohort study design will ask approximately 300 participants to complete 3 days of home blood pressure monitoring every fortnight for 12 weeks postpartum and will culminate with a 24-hour episode of ambulatory blood pressure monitoring at 12 weeks postpartum. Women and healthcare professionals will complete questionnaires surrounding postpartum care for women who had HDP and knowledge of CVD risk. In addition, the relationship between hypertension and factors likely to influence outcomes such as severity of HDP, maternal age, body mass index and ethnicity will be analysed using logistic regression. Blood pressure and data from questionnaires will be analysed using descriptive statistics, with temporal stratification.
Research ethics approval was obtained from London-West London & GTAC Research Ethics Committee. Research outputs will be published and disseminated through midwifery, obstetric or general practitioner targeted academic journals. The patient and public involvement group will disseminate findings to women who have experienced HDP among their peer groups.
NCT05137808.
怀孕期间约有 10%的女性会出现高血压疾病。有大量基于人群的资料显示，患有妊娠高血压的女性在产后更有可能患上心血管疾病（CVD）。患有妊娠高血压疾病（HDP）的女性患心脏病和中风的风险增加一倍，产后发生高血压的风险增加四倍。三分之二患有 HDP 的女性会死于 CVD。最近的证据表明，患有 HDP 的年轻女性在产后立即出现 CVD 的迹象，而不是以前认为的几十年后才出现。如果这一令人担忧的发现得到证实，这将为医疗保健从业者提供一个机会，通过提供生活方式选择方面的建议，并考虑治疗干预措施来预防 CVD 的发展，从而影响女性的心血管健康。
这项前瞻性队列研究设计将要求大约 300 名参与者在产后每两周完成 3 天的家庭血压监测，并且在产后 12 周时完成长达 24 小时的动态血压监测。女性和医疗保健专业人员将围绕患有 HDP 的女性的产后护理和 CVD 风险知识完成问卷。此外，还将使用逻辑回归分析高血压与可能影响结局的因素之间的关系，如 HDP 的严重程度、产妇年龄、体重指数和种族。血压和问卷调查数据将使用描述性统计进行分析，并进行时间分层。
已从伦敦-西伦敦和 GTAC 研究伦理委员会获得研究伦理批准。研究成果将通过以助产士、产科或全科医生为目标的学术期刊发表和传播。患者和公众参与小组将向其同龄组中经历过 HDP 的女性传播研究结果。
NCT05137808。
