Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York.
Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
Am J Perinatol. 2024 Nov;41(15):2135-2143. doi: 10.1055/a-2298-5347. Epub 2024 Apr 3.
The American College of Obstetrics threshold for hypertension (≥140/90 mm Hg) differs from those of the American College of Cardiology (ACC) and the American Heart Association (AHA). It is unknown if ACC/AHA hypertension levels are associated with adverse pregnancy outcomes (APOs) after 20 weeks gestation. The purpose of this study is to analyze APOs in women with blood pressure (BP) in the elevated or stage 1 range after 20 weeks gestation.
This was a secondary analysis of the nuMoM2b prospective cohort study of 10,038 nulliparous, singleton pregnancies between 2010 and 2014. BP was measured at three visits during the pregnancy using a standard protocol. Women without medical comorbidities, with normal BP by ACC/AHA guidelines (systolic BP [SBP] < 120 and diastolic BP [DBP] < 80 mm Hg) up to 22 weeks, were included. Exposure was BP between 22 and 29 weeks gestation: normal (SBP < 120 and DBP < 80 mm Hg), elevated (SBP: 120-129 and DBP < 80 mm Hg), and stage 1 (SBP: 130-139 or DBP: 80-89 mm Hg). The primary outcome was hypertensive disorder of pregnancy (HDP) at delivery. Secondary outcomes included fetal growth restriction (FGR), placental abruption, preterm delivery, and cesarean delivery. Multivariable-adjusted odds ratio (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models.
Of 4,460 patients that met inclusion criteria, 3,832 (85.9%) had BP in the normal range, 408 (9.1%) in elevated, and 220 (4.9%) in stage 1 range between 22 and 29 weeks. The likelihood of HDP was significantly higher in women with elevated BP (aOR: 1.71, 95%CI: 1.18,2.48), and stage 1 BP (aOR: 2.79, 95%CI: 1.84,4.23) compared to normal BP ( < 0.001). Stage 1 BP had twice odds of FGR (aOR: 2.33, 95%CI: 1.22,4.47) and elevated BP had three times odds of placental abruption (aOR: 3.03; 95%CI: 1.24,7.39).
Elevated or stage 1 BP >20 weeks of pregnancy are associated with HDP, FGR, and placental abruption.
· Elevated and stage 1 BP increases risk for HDP.. · Elevated BP increases risk for placental abruption.. · Stage 1 BP increases risk for FGR..
美国妇产科医师学会（American College of Obstetrics）的高血压阈值（≥140/90mmHg）与美国心脏病学会（American College of Cardiology）和美国心脏协会（American Heart Association）的标准不同。尚不清楚 ACC/AHA 的高血压水平是否与 20 周妊娠后不良妊娠结局（adverse pregnancy outcomes，APOs）相关。本研究旨在分析 20 周妊娠后血压处于升高或 1 期范围的妇女的 APOs。
这是对 2010 年至 2014 年间 10038 例初产妇、单胎妊娠的 nuMoM2b 前瞻性队列研究的二次分析。在妊娠期间，使用标准方案在三次就诊时测量血压。纳入无合并症且按照 ACC/AHA 指南（收缩压[SBP] < 120mmHg 和舒张压[DBP] < 80mmHg）至 22 周时血压正常的妇女。暴露为 22 至 29 周妊娠时的血压：正常（SBP < 120mmHg 和 DBP < 80mmHg）、升高（SBP：120-129mmHg 和 DBP < 80mmHg）和 1 期（SBP：130-139mmHg 或 DBP：80-89mmHg）。主要结局为分娩时的妊娠高血压疾病（hypertensive disorder of pregnancy，HDP）。次要结局包括胎儿生长受限（fetal growth restriction，FGR）、胎盘早剥、早产和剖宫产。使用逻辑回归模型估计多变量校正比值比（adjusted odds ratio，aOR）和 95%置信区间（confidence interval，CI）。
在符合纳入标准的 4460 例患者中，3832 例（85.9%）血压处于正常范围，408 例（9.1%）处于升高范围，220 例（4.9%）处于 22 至 29 周时的 1 期范围。与正常血压相比，血压升高（aOR：1.71，95%CI：1.18，2.48）和 1 期血压（aOR：2.79，95%CI：1.84，4.23）的 HDP 发生几率显著更高（ < 0.001）。1 期血压发生胎儿生长受限（fetal growth restriction，FGR）的几率是正常血压的两倍（aOR：2.33，95%CI：1.22，4.47），而血压升高发生胎盘早剥的几率是正常血压的三倍（aOR：3.03；95%CI：1.24，7.39）。
妊娠 20 周以上的血压升高或 1 期与 HDP、FGR 和胎盘早剥相关。
·升高或 1 期血压增加 HDP 风险。·升高的血压增加胎盘早剥的风险。·1 期血压增加胎儿生长受限的风险。
