Robinson Research Institute, The University of Adelaide, South Australia, Australia; Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia.
Faculty of Medicine, Department of Women's and Children's Health, School of Life Course and Population Health Sciences, King's College London, London, United Kingdom.
Am J Obstet Gynecol. 2023 Aug;229(2):101-117. doi: 10.1016/j.ajog.2023.01.013. Epub 2023 Jan 16.
A relationship between the 2017 American College of Cardiology and American Heart Association blood pressure thresholds and adverse pregnancy outcomes has been reported, but few studies have explored the diagnostic test properties of these cutoffs when used within pregnancy.
Electronic databases were searched (2017-2021) for measurements of blood pressure in pregnancy at >20 weeks, classified according to the 2017 American College of Cardiology and American Heart Association criteria, and their relationship with pregnancy outcomes. Blood pressure was categorized as "normal" (systolic blood pressure of <120 mm Hg and diastolic blood pressure of <80 mm Hg), "elevated blood pressure" (systolic blood pressure of 120-129 mm Hg and diastolic blood pressure of <80 mm Hg), "stage 1 hypertension" (systolic blood pressure of 130-139 mm Hg and/or diastolic blood pressure of 80-89 mm Hg), and "stage 2 hypertension" (systolic blood pressure of ≥140 mm Hg and/or diastolic blood pressure of ≥90 mm Hg).
Studies recording blood pressure at or above 20 weeks gestation were included.
Meta-analyses were used to investigate the strength of the association between blood pressure cutoffs and adverse outcomes, and the diagnostic test properties were calculated accounting for gestation.
There were 12 included studies. The American College of Cardiology or American Heart Association blood pressure categories were determined from peak blood pressures at any point from 20 weeks of gestation and at specific gestational ages (20-27, 28-32, or 33-36 weeks of gestation), as available. A higher (vs normal) blood pressure category was consistently associated with adverse outcomes. The strength of association between blood pressure categories and adverse outcomes was the greatest with "stage 2 hypertension" (blood pressure of ≥140/90 mm Hg). The results were similar when peak blood pressure was reported either at any time from 20 weeks of gestation or within gestational age groups (as above). No blood pressure category was useful as a diagnostic "rule-out test" for adverse outcomes, as all negative likelihood ratios were ≥0.2. Only "stage 2 hypertension" was useful as a "rule in-test," with positive likelihood ratios of ≥5.0, for maximum blood pressure at >20 weeks of gestation for preeclampsia and blood pressure within any gestational age groups for preeclampsia, eclampsia, stroke, maternal death, and stillbirth.
From 20 weeks of gestation, blood pressure thresholds of 140 mm Hg (systolic) and 90 mm Hg (diastolic) were useful in identifying women at increased risk of adverse pregnancy outcomes, irrespective of the specific gestational age at blood pressure measurement. Lowering the blood pressure threshold for abnormal blood pressure at >20 weeks of gestation would not assist clinicians in identifying women at heightened maternal or perinatal risk. No American College of Cardiology or American Heart Association blood pressure threshold can provide reassurance that women are unlikely to develop adverse outcomes.
已有研究报告称，2017 年美国心脏病学会和美国心脏协会的血压阈值与不良妊娠结局之间存在关联，但很少有研究探讨这些切点在妊娠期间的诊断测试性能。
检索电子数据库（2017-2021 年），以获取超过 20 周妊娠时的血压测量值，根据 2017 年美国心脏病学会和美国心脏协会的标准进行分类，并研究其与妊娠结局的关系。血压分为“正常”（收缩压<120mmHg 和舒张压<80mmHg）、“血压升高”（收缩压 120-129mmHg 和舒张压<80mmHg）、“1 期高血压”（收缩压 130-139mmHg 和/或舒张压 80-89mmHg）和“2 期高血压”（收缩压≥140mmHg 和/或舒张压≥90mmHg）。
记录 20 周以上妊娠时血压的研究均被纳入。
采用荟萃分析方法研究血压切点与不良结局之间的关联强度，并计算考虑妊娠的诊断测试性能。
共有 12 项研究被纳入。美国心脏病学会或美国心脏协会的血压类别是根据从 20 周妊娠开始至特定妊娠周数（20-27、28-32 或 33-36 周）的任何时间点的峰值血压确定的。（血压）较高（而非正常）的类别与不良结局始终存在关联。血压类别与不良结局之间的关联强度以“2 期高血压”（血压≥140/90mmHg）最大。当峰值血压在 20 周妊娠时的任何时间或在上述妊娠年龄组内报告时，结果相似。没有任何血压类别可用作不良结局的诊断“排除试验”，因为所有阴性似然比均≥0.2。只有“2 期高血压”对于预测 20 周以上妊娠的子痫前期和任何妊娠年龄组的血压的不良结局有用，因为其阳性似然比均≥5.0。
从 20 周妊娠开始，140mmHg（收缩压）和 90mmHg（舒张压）的血压阈值可用于识别有不良妊娠结局风险增加的女性，无论血压测量的具体妊娠周数如何。降低 20 周以上妊娠时异常血压的血压阈值并不能帮助临床医生识别处于较高母体或围产期风险的女性。美国心脏病学会或美国心脏协会的任何血压阈值都不能保证女性不太可能发生不良结局。
