Ma Liangkun, Li Yini, Yang Xuanjin, Li Ye, Zhang Suhan, Hu Mingyue, Sun Yin
National Clinical Research Centre for Obstetric and Gynaecologic Diseases, Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Dongcheng, Beijing, China.
Eur J Obstet Gynecol Reprod Biol X. 2025 May 23;26:100400. doi: 10.1016/j.eurox.2025.100400. eCollection 2025 Jun.
Although blood pressure in singleton pregnancies is related to multiple adverse pregnancy outcomes, the blood pressure threshold has been controversial.
To explore the blood pressure reference threshold of singleton pregnant women in the second and third trimesters.
A bidirectional single-centre cohort study was undertaken. Clinical data were collected for women with singleton pregnancies who underwent regular antenatal examinations and delivered at Peking Union Medical College Hospital between July 2020 and June 2023. Blood pressure was recorded at 20-24 and 28-32 weeks of gestation, and hypertension and pre-eclampsia were used as the primary outcomes. The percentiles of blood pressure were calculated, and the 95th percentile was used as the upper limit for the second and third trimesters of pregnancy. Poisson regression was used to calculated adjusted relative risk (aRR) and 95 % confidence intervals (CI) were used to analyse the relationship between elevated blood pressure and adverse pregnancy outcomes, and to further explore the impact of changes in blood pressure in the second and third trimesters on pregnancy outcomes. -values < 0.05 were considered to indicate significance.
In total, 7854 pregnant women with singleton pregnancies were included in this study. For pregnant women who did not experience adverse outcomes related to blood pressure, the 95th percentiles of systolic and diastolic blood pressure in the second trimester were 131 mmHg and 80 mmHg, respectively. Corresponding data for the third trimester were 130 mmHg and 80 mmHg, respectively. Therefore, 130/80 mmHg was taken as the upper limit of blood pressure. After excluding confounding factors, regardless of trimester, the risks of gestational hypertension, pre-eclampsia, preterm birth, low birth weight and neonatal intensive care unit (NICU) admission were found to be significantly higher in pregnant women with elevated blood pressure ( < 0.05). Pregnant women with sustained elevated blood pressure (i.e. in both the second and third trimesters) had aRR values for gestational hypertension, pre-eclampsia, premature birth, low birth weight and NICU admission that were 19.08 (95 % CI 13.04-28.03; < 0.001), 11.43 (95 % CI 6.94-18.64; < 0.001), 2.53 (95 % CI 1.83-3.42; < 0.001), 2.98 (95 % CI 2.05-4.21; < 0.001) and 1.79 (95 % CI 1.29-1.79; < 0.001) times higher than those of normotensive pregnant women, respectively.
The blood pressure threshold of singleton pregnant women in the second and third trimesters is 130/80 mmHg. Sustained elevated blood pressure is harmful to the health of mothers and infants. Management and monitoring should be strengthened for pregnant women with elevated blood pressure.
尽管单胎妊娠的血压与多种不良妊娠结局相关，但血压阈值一直存在争议。
探讨单胎妊娠孕妇孕中晚期的血压参考阈值。
进行了一项双向单中心队列研究。收集了2020年7月至2023年6月在北京协和医院进行定期产前检查并分娩的单胎妊娠妇女的临床资料。在妊娠20 - 24周和28 - 32周记录血压，以高血压和子痫前期作为主要结局。计算血压百分位数，并将第95百分位数用作妊娠中晚期的上限。采用泊松回归计算调整相对风险（aRR），并使用95%置信区间（CI）分析血压升高与不良妊娠结局之间的关系，进一步探讨孕中晚期血压变化对妊娠结局的影响。P值<0.05被认为具有统计学意义。
本研究共纳入7854名单胎妊娠孕妇。对于未经历与血压相关不良结局的孕妇，孕中期收缩压和舒张压的第95百分位数分别为131 mmHg和80 mmHg。孕晚期的相应数据分别为130 mmHg和80 mmHg。因此，将130/80 mmHg作为血压上限。排除混杂因素后，无论孕周如何，血压升高的孕妇发生妊娠期高血压、子痫前期、早产、低出生体重和新生儿重症监护病房（NICU）收治的风险均显著更高（P<0.05）。血压持续升高（即在孕中期和孕晚期均升高）的孕妇发生妊娠期高血压、子痫前期、早产、低出生体重和NICU收治的aRR值分别是血压正常孕妇的19.08倍（95%CI 13.04 - 28.03；P<0.001）、11.43倍（95%CI 6.94 - 18.64；P<0.001）、2.53倍（95%CI 1.83 - 3.42；P<0.001）、2.98倍（95%CI 2.05 - 4.21；P<0.001）和1.79倍（95%CI 1.29 - 1.79；P<0.001）。
单胎妊娠孕妇孕中晚期的血压阈值为130/80 mmHg。血压持续升高对母婴健康有害。应加强对血压升高孕妇的管理和监测。
