Department of Obstetrics and Gynecology; Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine; The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, China.
Department of Obstetrics, Songgang People's Hospital, Bao'an District, Shenzhen City, Shenzhen, Guangdong, 518105, China.
J Hum Hypertens. 2024 Nov;38(11):758-764. doi: 10.1038/s41371-024-00944-z. Epub 2024 Aug 22.
Chronic hypertension (CH) during pregnancy, identified before or within the first 20 weeks, presents varying risks depending on the timing of diagnosis. This real-world study was conducted from January 2018 to June 2023 and included singleton pregnancies with CH to compare pre-pregnancy CH (Group 1) and newly diagnosed CH (Group 2). There were 565 women in the final analysis, with 307 in Group 1 with pre-pregnancy CH and 258 in Group 2 with new-onset CH. Those in Group 1 more frequently had pre-gestational diabetes and a history of hypertensive disorders in pregnancy, whereas Group 2 had a higher incidence of excessive gestational weight gain. Notably, 56.2% of Group 2 patients did not receive antihypertensive treatment before 20 weeks, while the proportion was 36.2% in Group 1, resulting in a significant difference in baseline blood pressure. The study revealed higher incidences of preterm preeclampsia (44.2% vs. 34.9%) and placental abruption (5.4% vs. 2.0%) in Group 2 compared to Group 1. After adjustment, logistic regression indicated that Group 2 had a 1.8-fold higher risk of preterm preeclampsia than Group 1. These findings suggest that pregnant women newly diagnosed with CH in the first 20 weeks face increased adverse outcomes compared to those diagnosed before pregnancy. Intense monitoring and earlier intervention may help manage women with new-onset CH.
慢性高血压（CH）在妊娠期间发生，在妊娠 20 周前或 20 周内诊断，根据诊断时间的不同，风险各异。这项真实世界的研究于 2018 年 1 月至 2023 年 6 月进行，纳入患有 CH 的单胎妊娠，比较了孕前 CH（第 1 组）和新诊断的 CH（第 2 组）。最终分析包括 565 名女性，其中 307 名在第 1 组，孕前 CH；258 名在第 2 组，新发 CH。第 1 组中更常患有孕前糖尿病和妊娠期高血压疾病史，而第 2 组中过度妊娠体重增加的发生率更高。值得注意的是，第 2 组中有 56.2%的患者在 20 周前未接受降压治疗，而第 1 组中的比例为 36.2%，这导致了两组患者的基线血压存在显著差异。研究表明，与第 1 组相比，第 2 组患者中早产子痫前期（44.2% vs. 34.9%）和胎盘早剥（5.4% vs. 2.0%）的发生率更高。调整后，逻辑回归表明，第 2 组早产子痫前期的风险比第 1 组高 1.8 倍。这些发现表明，与孕前诊断的 CH 相比，妊娠 20 周内新诊断为 CH 的孕妇发生不良结局的风险增加。加强监测和更早干预可能有助于管理新发 CH 的孕妇。
