Zhu Ying, Wang Hui, Wei Si-Yi, Liu Xue-Yuan, Fan Jian-Xia, Xu Chen-Ming, Lin Xian-Hua, Wu Dan-Dan
Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, 200011, China.
Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, Guangdong, China.
BMC Pregnancy Childbirth. 2025 Jul 2;25(1):704. doi: 10.1186/s12884-025-07761-3.
Increased blood pressure and triglyceride (TG) levels are linked to adverse pregnancy outcomes. Although the widespread acknowledgment that stage 2 hypertension serves as a significant predictor of preeclampsia, the prognostic significance of elevations in other blood pressure categories remains a subject of debate. Consequently, we intended to evaluate the joint influence of increased blood pressure and TG levels in the initial stages of pregnancy on preeclampsia risk and to identify a high-risk subgroup of individuals who require clinical attention.
We conducted a retrospective cohort study including 78,016 individuals with singleton births at the Shanghai International Peace Maternity and Child Health Hospital (IPMCH) between January 2014 and December 2019. The study was approved by the IPMCH Institutional Review Board. Patients were classified into four groups on the basis of blood pressure readings taken during early stages of pregnancy: normotensive, elevated, stage 1 hypertension and stage 2 hypertension, stratified by TG levels (below or above the 90th percentile). Analysis using generalized additive models and logistic regression models was conducted to investigate the relationships among blood pressure, TG levels, and preeclampsia risk.
Among the 78,016 patients, 2,204 (2.83%) developed preeclampsia. Multivariate logistic regression revealed that both stage 1 and stage 2 hypertension in early stages of pregnancy markedly increased preeclampsia risk (adjusted odds ratio (AOR), 3.40 [95% CI, 3.05-3.80]; AOR, 6.96 [95% CI, 6.15-7.88]). Generalized additive models revealed that high TG levels significantly increased the probability of preeclampsia as blood pressure increased. Stratification by blood pressure and TG levels revealed that patients with high TG levels and stage 1 or 2 hypertension exhibited a significantly greater risk of preeclampsia when compared to those with normotensive and reference TG levels, with AORs of 5.52 (95% CI, 4.61-6.62) and 10.13 (95% CI, 8.23-12.46), respectively. Interaction analysis showed stage 1 hypertension and high TG demonstrated a 1.5-fold synergistic risk of preeclampsia (OR = 1.50, P = 0.021).
The combination of increased blood pressure and high TG levels, especially high TG levels, which coincide with stage 1 or stage 2 hypertension, markedly heightened preeclampsia risk. Our findings indicate that the co-occurrence of stage 1 hypertension with high TG levels should be regarded as a notable risk factor for preeclampsia, approaching the risk level associated with stage 2 hypertension alone.
血压升高和甘油三酯（TG）水平升高与不良妊娠结局相关。尽管普遍认为2期高血压是先兆子痫的重要预测指标，但其他血压类别升高的预后意义仍存在争议。因此，我们旨在评估妊娠早期血压升高和TG水平对先兆子痫风险的联合影响，并确定需要临床关注的高危亚组个体。
我们进行了一项回顾性队列研究，纳入了2014年1月至2019年12月在上海国际和平妇幼保健院（IPMCH）单胎分娩的78016名个体。该研究获得了IPMCH机构审查委员会的批准。根据妊娠早期的血压读数，患者被分为四组：血压正常、血压升高、1期高血压和2期高血压，并按TG水平（低于或高于第90百分位数）分层。使用广义相加模型和逻辑回归模型进行分析，以研究血压、TG水平和先兆子痫风险之间的关系。
在78016名患者中，2204名（2.83%）发生了先兆子痫。多因素逻辑回归显示，妊娠早期的1期和2期高血压均显著增加了先兆子痫的风险（调整优势比（AOR），3.40 [95% CI，3.05 - 3.80]；AOR，6.96 [95% CI，6.15 - 7.88]）。广义相加模型显示，随着血压升高，高TG水平显著增加了先兆子痫的发生概率。按血压和TG水平分层显示，与血压正常且TG水平正常的患者相比，TG水平高且患有1期或2期高血压的患者先兆子痫风险显著更高，AOR分别为5.52（95% CI，4.61 - 6.62）和10.13（95% CI，8.23 - 12.46）。交互分析显示，1期高血压和高TG对先兆子痫具有1.5倍的协同风险（OR = 1.50，P = 0.021）。
血压升高和高TG水平，尤其是与1期或2期高血压同时出现的高TG水平，显著增加了先兆子痫的风险。我们的研究结果表明，1期高血压与高TG水平同时出现应被视为先兆子痫的一个显著危险因素，接近单独2期高血压相关的风险水平。
