Niu Zhongzheng, Anderson Elizabeth C, Yang Tingyu, Chen Xinci, Vigil Mario, Guo Fangqi, Grubbs Brendan H, Eckel Sandrah P, Toledo-Corral Claudia M, Johnston Jill, Dunton Genevieve F, Lurvey Nathana, Al-Marayati Laila, Howe Caitlin G, Habre Rima, Bastain Theresa M, Breton Carrie V, Farzan Shohreh F
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
JACC Adv. 2025 Apr;4(4):101660. doi: 10.1016/j.jacadv.2025.101660. Epub 2025 Mar 17.
Blood pressure (BP) changes during pregnancy, but less is known about heterogeneous changing patterns within a population and long-term hypertension risk.
The purpose of this study was to identify distinct gestational systolic blood pressure (SBP) trajectories and examine their association with postpartum hypertension risk.
The MADRES (Maternal and Developmental Risks from Environmental and Social Stressors) (2015-present) cohort followed 854 pregnant individuals from early pregnancy to 5 years postpartum and collected information on demographics, lifestyle, and medical records, including BP at each prenatal visit. Latent class growth modeling was used to identify gestational SBP trajectories. Incident postpartum hypertension was identified from interviews and BP measurements. Cox modeling was used to assess the association of trajectory groups with the risk of hypertension at 2 to 5 years postpartum.
We identified 3 distinct gestational SBP trajectory groups. The majority (n = 685, 80.2%) had a "consistently low" trajectory over pregnancy. A "consistently elevated" trajectory group (n = 106, 12.4%) was characterized by modestly elevated SBP within a clinically normal range but lacked a midpregnancy dip. A "high-drop-high" trajectory group (n = 63, 7.4%) consisted of most cases of gestational hypertension or pre-eclampsia. Risk of hypertension in 5 years postpartum was 4.91 (95% CI: 2.01-12.0) fold higher in the "consistently elevated" group and 5.44 (95% CI: 1.89-15.7) fold higher in the "high-drop-high" group than the "consistently low" group, after adjusting for covariates.
Pregnant individuals with consistently elevated SBP yet within the subclinical range face longer-term risk of hypertension but may not be captured by standard prenatal clinical guidelines.
孕期血压（BP）会发生变化，但对于人群中血压变化的异质性模式以及长期高血压风险了解较少。
本研究旨在识别不同的妊娠期收缩压（SBP）轨迹，并研究它们与产后高血压风险的关联。
MADRES（环境和社会应激源导致的孕产妇和发育风险）队列研究（2015年至今）对854名孕妇从孕早期至产后5年进行随访，收集人口统计学、生活方式和医疗记录信息，包括每次产前检查时的血压。采用潜在类别增长模型识别妊娠期SBP轨迹。通过访谈和血压测量确定产后高血压发病情况。使用Cox模型评估轨迹组与产后2至5年高血压风险的关联。
我们识别出3种不同的妊娠期SBP轨迹组。大多数（n = 685，80.2%）孕妇在孕期呈现“持续低水平”轨迹。“持续升高”轨迹组（n = 106，12.4%）的特点是SBP在临床正常范围内适度升高，但缺乏孕中期血压下降。“高-降-高”轨迹组（n = 63，7.4%）包括大多数妊娠期高血压或子痫前期病例。在调整协变量后，“持续升高”组产后5年高血压风险比“持续低水平”组高4.91倍（95%CI：2.01 - 12.0），“高-降-高”组比“持续低水平”组高5.44倍（95%CI：1.89 - 15.7）。
收缩压持续升高但仍在亚临床范围内的孕妇面临更高的长期高血压风险，但可能未被标准产前临床指南所涵盖。
