Michael Navin, Sadananthan Suresh Anand, Yuan Wen Lun, Ong Yi Ying, Loy See Ling, Huang Jonathan Y, Tint Mya-Thway, Padmapriya Natarajan, Choo Jonathan, Ling Lieng Hsi, Kramer Michael S, Godfrey Keith M, Gluckman Peter D, Tan Kok Hian, Eriksson Johan G, Chong Yap-Seng, Lee Yung Seng, Karnani Neerja, Yap Fabian, Shek Lynette Pei-Chi, Fortier Marielle V, Moritz Karen M, Chan Shiao-Yng, Velan S Sendhil, Wlodek Mary E
Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore.
Université de Paris, CRESS, Inserm, INRAE, Paris, France.
J Hypertens. 2022 Nov 1;40(11):2171-2179. doi: 10.1097/HJH.0000000000003241. Epub 2022 Jul 22.
To evaluate whether characterization of maternal and foetoplacental factors beyond birthweight can enable early identification of children at risk of developing prehypertension/hypertension.
We recruited 693 mother-offspring dyads from the GUSTO prospective mother-offspring cohort. Prehypertension/hypertension at age 6 years was identified using the simplified paediatric threshold of 110/70 mmHg. We evaluated the associations of pregnancy complications (gestational diabetes, excessive/inadequate gestational weight gain, hypertensive disorders of pregnancy), foetal growth deceleration (decline in foetal abdominal circumference at least 0.67 standard deviations between second and third trimesters), high foetoplacental vascular resistance (third trimester umbilical artery systolic-to-diastolic ratio ≥90th centile), preterm birth, small-for-gestational age and neonatal kidney volumes with risk of prehypertension/hypertension at age 6 years, after adjusting for sex, ethnicity, maternal education and prepregnancy BMI.
Pregnancy complications, small-for-gestational age, preterm birth, and low neonatal kidney volume were not associated with an increased risk of prehypertension/hypertension at age 6 years. In contrast, foetal growth deceleration was associated with a 72% higher risk [risk ratio (RR) = 1.72, 95% confidence interval (CI) 1.18-2.52]. High foetoplacental vascular resistance was associated with a 58% higher risk (RR = 1.58, 95% CI 0.96-2.62). Having both these characteristics, relative to having neither, was associated with over two-fold higher risk (RR = 2.55, 95% CI 1.26-5.16). Over 85% of the foetuses with either of these characteristics were born appropriate or large for gestational age.
Foetal growth deceleration and high foetoplacental vascular resistance may be helpful in prioritizing high-risk children for regular blood pressure monitoring and preventive interventions, across the birthweight spectrum.
评估除出生体重外，对母体和胎儿胎盘因素进行特征分析是否能够早期识别有患高血压前期/高血压风险的儿童。
我们从GUSTO前瞻性母婴队列中招募了693对母婴。使用简化的儿童高血压阈值110/70 mmHg确定6岁时的高血压前期/高血压情况。在调整了性别、种族、母亲教育程度和孕前体重指数后，我们评估了妊娠并发症（妊娠期糖尿病、妊娠期体重增加过多/不足、妊娠高血压疾病）、胎儿生长减速（孕中期和孕晚期胎儿腹围下降至少0.67个标准差）、高胎儿胎盘血管阻力（孕晚期脐动脉收缩压与舒张压之比≥第90百分位数）、早产、小于胎龄儿和新生儿肾体积与6岁时患高血压前期/高血压风险之间的关联。
妊娠并发症、小于胎龄儿、早产和低新生儿肾体积与6岁时患高血压前期/高血压风险增加无关。相比之下，胎儿生长减速与风险高72%相关[风险比（RR）=1.72，95%置信区间（CI）1.18 - 2.52]。高胎儿胎盘血管阻力与风险高58%相关（RR = 1.58，95% CI 0.96 - 2.62）。同时具有这两种特征的儿童相对于不具有这两种特征的儿童，风险高出两倍多（RR = 2.55，95% CI 1.26 - 5.16）。具有这些特征之一的胎儿中，超过85%出生时体重适合或大于胎龄。
胎儿生长减速和高胎儿胎盘血管阻力可能有助于在整个出生体重范围内，将高危儿童列为定期血压监测和预防性干预的重点对象。
