Yuan Zhichao, Wang Hai-Jun, Su Tao, Yang Jie, Chen Junjun, Peng Yuanzhou, Zhou Shuang, Bao Heling, Luo Shusheng, Wang Hui, Liu Jue, Han Na, Ji Yuelong
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
Front Nutr. 2022 Apr 13;9:862323. doi: 10.3389/fnut.2022.862323. eCollection 2022.
The relationship between first-trimester GWG ( GWG) and risk of hypertensive disorders of pregnancy (HDP) remained uncertain. This study aimed to investigate the association between GWG and risk of HDP. Meanwhile, we explored the mediated effect and constructed an early GWG category to evaluate the predictive capacity for HDP. GWG was defined as the weight difference between 13 ± 1 gestational weeks and pre-conception. HDP group was defined as having diagnosis of HDP, including gestational hypertension or pre-eclampsia (PE) during the current pregnancy. Early GWG category was constructed according to the risk of HDP within each pre-pregnancy body mass index (BMI) group. Cox regression model was utilized to check the association between the GWG and HDP. Serial mediation model was adopted to evaluate the potential mediators including mean arterial pressure (MAP) at 13th and 20th week. The logistic regression model with bootstrap was performed to assess the predictive capacity of Early GWG category and MAP for the risk of HDP. A total of 17,901 pregnant women (mean age, 29.0 years) were recruited from 2013 to 2017 at the Tongzhou Maternal and Child Health Hospital in Beijing, China. Compared to women in Class 1 of early GWG category, women in the Class 2, 3, 4 have increased risks of HDP by 1.42, 4.27, and 4.62 times, respectively (hazard ratio [] = 2.42, 95% : 2.11-2.77; = 5.27, 95% : 4.05-6.86; = 5.62, 95% : 4.05-7.79). The MAP measured at 13th and 20th week totally mediated 33.1 and 26.7% of association between GWG GWG and HDP in total participants and overweight/obesity pregnancies, respectively. The area under receiver operator characteristic curve for predictive model utilizing early GWG category and MAP measured at 13th and 20th week for the risk of HDP is 0.760 (95% : 0.739-0.777). The GWG was associated with HDP, which was partially mediated by MAP measured at 13th and 20th week. Early GWG category showed a better predictive capacity for the risk of HDP compared to the National Academy of Medicine criteria for GWG.
孕早期体重增加（GWG）与妊娠期高血压疾病（HDP）风险之间的关系仍不明确。本研究旨在探讨GWG与HDP风险之间的关联。同时，我们探究了中介效应并构建了早期GWG分类以评估对HDP的预测能力。GWG定义为妊娠13±1周时体重与孕前体重的差值。HDP组定义为被诊断患有HDP，包括本次妊娠期间的妊娠期高血压或子痫前期（PE）。根据每个孕前体重指数（BMI）组内HDP的风险构建早期GWG分类。采用Cox回归模型检验GWG与HDP之间的关联。采用系列中介模型评估潜在中介因素，包括第13周和第20周时的平均动脉压（MAP）。采用带有自抽样法的逻辑回归模型评估早期GWG分类和MAP对HDP风险的预测能力。2013年至2017年期间，在中国北京通州区妇幼保健院共招募了17901名孕妇（平均年龄29.0岁）。与早期GWG分类1级的女性相比，2级、3级、4级的女性发生HDP的风险分别增加了1.42倍、4.27倍和4.62倍（风险比[]=2.42，95%置信区间：2.11 - 2.77；=5.27，95%置信区间：4.05 - 6.86；=5.62，95%置信区间：4.05 - 7.79）。在所有参与者和超重/肥胖孕妇中，第13周和第20周测量的MAP分别完全介导了GWG与HDP之间33.1%和26.7%的关联。利用早期GWG分类以及第13周和第20周测量的MAP建立的预测模型，其预测HDP风险的受试者工作特征曲线下面积为0.760（95%置信区间：0.739 - 0.777）。GWG与HDP相关，且部分由第13周和第20周测量的MAP介导。与美国医学科学院的GWG标准相比，早期GWG分类对HDP风险显示出更好的预测能力。
