Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China.
Hypertens Res. 2024 Feb;47(2):467-477. doi: 10.1038/s41440-023-01483-9. Epub 2023 Oct 31.
The association between maternal preconception blood pressure (BP) and preterm birth (PTB) is still unclear. The purpose of this study was to investigate the association between maternal preconception BP and PTB. This population-based cohort study included 715 984 Chinese women aged 20-49 years who participated in the National Free Preconception Health Examination Project and successfully had a singleton livebirth during 2014-2019 in Guangdong Province, China. Maternal preconception BP were measured by trained health workers. Multivariate logistic regression models and restricted cubic spline regressions were used to examine the association and dose-response relationship between maternal preconception BP and PTB, respectively. Maternal preconception hypertension was associated with the increased risk of PTB (adjusted odds ratios (aOR): 1.24; 95% CI: 1.14-1.34). Compared to women with normal preconception BP, the aORs for PTB were 1.09 (95% CI: 1.06-1.12), 1.24 (95% CI: 1.13-1.36), and 1.43 (95% CI: 1.15-1.79) for women with preconception elevated BP (120-139/ 80-89 mmHg, stage-1 hypertension (140-159/ 90-99 mmHg, and stage-2 hypertension (160-179/100-109 mmHg), respectively. According to the 2017 American College of Cardiology/American Heart Association criteria, maternal preconception elevated BP and hypertension were also significantly associated with an increased risk of PTB. Preconception systolic and diastolic BP showed a U-shaped (χ = 40.54; nonlinear P < 0.001) and linear (χ = 6.62; nonlinear P = 0.085) dose-response relationship with PTB, respectively. The association was modified by maternal age and preconception body mass index. These findings identify maternal preconception elevated BP and hypertension as a modifiable risk factor for PTB, providing evidence for future research studies, public health and clinical interventions.
母亲孕前血压与早产（PTB）之间的关系尚不清楚。本研究旨在探讨母亲孕前血压与 PTB 之间的关系。这项基于人群的队列研究纳入了 2014-2019 年期间在中国广东省参加国家免费孕前健康检查项目并成功分娩单胎活产的 715984 名 20-49 岁中国女性。由经过培训的卫生工作者测量母亲孕前血压。多变量逻辑回归模型和限制立方样条回归分别用于检查母亲孕前血压与 PTB 之间的关联和剂量-反应关系。孕前高血压与 PTB 风险增加相关（调整后的优势比（aOR）：1.24；95%置信区间（CI）：1.14-1.34）。与正常孕前血压的女性相比，孕前血压升高（120-139/80-89mmHg）、1 期高血压（140-159/90-99mmHg）和 2 期高血压（160-179/100-109mmHg）的女性发生 PTB 的 aOR 分别为 1.09（95%CI：1.06-1.12）、1.24（95%CI：1.13-1.36）和 1.43（95%CI：1.15-1.79）。根据 2017 年美国心脏病学会/美国心脏协会标准，母亲孕前血压升高和高血压也与 PTB 风险增加显著相关。孕前收缩压和舒张压与 PTB 呈 U 型（χ=40.54；非线性 P<0.001）和线性（χ=6.62；非线性 P=0.085）剂量-反应关系。这种关联受到母亲年龄和孕前体重指数的影响。这些发现确定了母亲孕前血压升高和高血压是 PTB 的一个可改变的危险因素，为未来的研究、公共卫生和临床干预提供了证据。
