Ren Jie, Fan Zhuoran, Li Jing, Wang Yujie, Zhang Junnong, Hua Shaofang
Obstetric Department, The Second Hospital of Tianjin Medical University, Tianjin, China.
J Obstet Gynaecol. 2023 Dec;43(1):2171776. doi: 10.1080/01443615.2023.2171776.
We aimed to investigate the blood pressure (BP) patterns of hypertensive disorders of pregnancy (HDP) in the first and second trimesters and its contributing factors, which may help us understand its pathogenesis and identify this group of diseases in a timely manner. SPSS 21.0 was used to describe the BP patterns of 688 HDP as well as 2050 normotensive pregnancies respectively before 28 gestational weeks, and the repeated measurements and two-way ANOVA was used to decide the significant difference of blood pressure in the same period. The results revealed blood pressure in HDP underwent a mid-pregnancy drop as normal while the drop was unremarkable in advanced-age or obesity pregnancies. Besides, we found blood pressure was significantly higher in patients during first and second trimesters, not just after 20 weeks. In conclusion, our study indicated a significant elevation of blood pressure had appeared before 20 weeks in HDP pregnancies, we should pay more attention to monitoring blood pressure before 20 weeks, especially for advanced age and obese women.IMPACT STATEMENT Gestational hypertension, preeclampsia as well as eclampsia were supposed to have the similar pathogenesis and their time of onset was strictly defined after 20 gestational weeks, while the reason for the time point was not clear. On the other hand, higher blood pressure in the first trimester was associated with increasing risk of developing HDP, while the blood pressure(BP) pattern of normal as well as HDP pregnancy was still controversial, especially for the existence of mid-trimester drop. Firstly, we found blood pressure in HDP underwent a mid-pregnancy drop as normal while the BP drop was unremarkable in advanced-age or obesity pregnancies. Secondly, we noticed the blood pressure in HDP was significantly higher than the normal before 20 weeks, which had not been proved before. On one hand, both the abnormal elevation of BP and the development of the placenta happened in the first trimester suggested toxic substances caused by the defective placenta played a vital role in the onset and aggravation of HDP, which guides us to pay more attention to monitor blood pressure before 20 weeks, especially for advanced age and obesity pregnancies. On the other hand, our results about BP patterns in HDP help us identify this group of diseases in time which can contribute to a better outcome.
我们旨在研究妊娠高血压疾病（HDP）在孕早期和孕中期的血压模式及其影响因素，这可能有助于我们了解其发病机制并及时识别这组疾病。使用SPSS 21.0分别描述688例HDP以及2050例血压正常孕妇在孕28周前的血压模式，并采用重复测量和双向方差分析来确定同期血压的显著差异。结果显示，HDP孕妇的血压在孕中期会像正常情况一样下降，而在高龄或肥胖孕妇中这种下降并不明显。此外，我们发现HDP患者在孕早期和孕中期血压均显著升高，而非仅在孕20周后。总之，我们的研究表明，HDP孕妇在孕20周前血压就已显著升高，我们应更加关注孕20周前的血压监测，尤其是高龄和肥胖女性。影响声明：妊娠期高血压、子痫前期以及子痫被认为具有相似的发病机制，其发病时间严格定义在孕20周后，但其时间点的原因尚不清楚。另一方面，孕早期血压升高与发生HDP的风险增加相关，而正常妊娠和HDP妊娠的血压模式仍存在争议，尤其是关于孕中期血压下降的存在。首先，我们发现HDP孕妇的血压在孕中期会像正常情况一样下降，而在高龄或肥胖孕妇中血压下降并不明显。其次，我们注意到HDP孕妇在孕20周前血压显著高于正常水平，这一点此前未得到证实。一方面，孕早期血压异常升高和胎盘发育均发生，提示胎盘缺陷产生的有毒物质在HDP的发病和加重中起关键作用，这引导我们更加关注孕20周前的血压监测，尤其是高龄和肥胖孕妇。另一方面，我们关于HDP血压模式的研究结果有助于我们及时识别这组疾病，从而带来更好的结局。
