Hitachi Mami, Miyamichi Kazuchiyo, Honda Sumihisa, Wanjihia Violet, Nzou Samson Muuo, Kaneko Satoshi
Department of Ecoepidemiology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
Trop Med Health. 2025 Mar 27;53(1):41. doi: 10.1186/s41182-025-00724-6.
Hypertension in pregnancy serves to screen for adverse perinatal outcomes. In 2017, the American College of Cardiology and American Heart Association recommended a new blood pressure category with lower hypertension thresholds, excluding pregnancy. This study aimed to explore the association between the 2017 redefined blood pressure categories in pregnancy and neonatal outcomes such as preterm birth and low birth weight.
This retrospective study used electronic records of the Maternal and Child Health Handbook registered by the Women and Infant Registration System. All women who had at least one antenatal care visit and delivery between January 2017 and April 2020 and between May and December 2022 were included in the study. A birth of less than 37 weeks was defined as preterm delivery. LBW was identified based on a newborn's birthweight of less than 2500 g. The maximum blood pressure across all antenatal care visits was classified based on the newly recommended criteria. A generalized linear model with binomial distribution and logit link function was used to evaluate the association between new blood pressure categories and neonatal outcomes at different levels of health facilities.
We analyzed data from 825 women. Of these, the prevalence was 13.7% for elevated blood pressure, 15.2% for stage 1 hypertension, 4.5% for non-severe stage 2 hypertension and 1.2% for severe stage 2 hypertension. For lower-level facilities, no significant associations were identified between the redefined blood pressure category and preterm birth or low birthweight. At higher-level facilities, preterm birth was only significantly associated with severe stage 2 hypertension (adjusted odds ratio:10.94; 95% confidence interval:1.08-110.93; P = 0.04) and low birthweight showed no association with the redefined category.
This study revealed no association between redefined lower blood pressure threshold and preterm birth and low birthweight in under-resourced settings. However, previous studies in well-resourced countries with larger sample sizes also reported a significant association. Therefore, further investigations are required.
妊娠期高血压用于筛查不良围产期结局。2017年，美国心脏病学会和美国心脏协会推荐了一种新的血压类别，降低了高血压阈值，但不包括妊娠情况。本研究旨在探讨2017年重新定义的妊娠期血压类别与早产和低出生体重等新生儿结局之间的关联。
这项回顾性研究使用了妇女和婴儿登记系统登记的母婴健康手册电子记录。纳入了2017年1月至2020年4月以及2022年5月至12月期间至少进行过一次产前检查并分娩的所有妇女。孕周小于37周的分娩定义为早产。低出生体重根据新生儿出生体重小于2500克确定。根据新推荐的标准对所有产前检查中的最高血压进行分类。使用具有二项分布和logit链接函数的广义线性模型来评估不同级别医疗机构中血压新类别与新生儿结局之间的关联。
我们分析了825名妇女的数据。其中，血压升高的患病率为13.7%，1级高血压为15.2%，非重度2级高血压为4.5%，重度2级高血压为1.2%。在基层医疗机构，重新定义的血压类别与早产或低出生体重之间未发现显著关联。在上级医疗机构，早产仅与重度2级高血压显著相关（调整优势比：10.94；95%置信区间：1.08 - 110.93；P = 0.04），低出生体重与重新定义的类别无关联。
本研究表明，在资源匮乏地区，重新定义的较低血压阈值与早产和低出生体重之间无关联。然而，之前在资源丰富国家进行的样本量更大的研究也报告了显著关联。因此，需要进一步调查。
