Long-term blood pressure changes measured from before to after pregnancy relative to nonparous women.
Long-term blood pressure changes measured from before to after pregnancy relative to nonparous women.
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DOI：
10.1097/aog.0b013e31818da09b
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发表时间：
2008-12
影响因子：
7.2
通讯作者：
Ness R
中科院分区：
文献类型：
--
作者：
Gunderson EP;Chiang V;Lewis CE;Catov J;Quesenberry CP Jr;Sidney S;Wei GS;Ness R
前瞻性研究育龄妇女妊娠后血压变化是否持续。前瞻性、以人群为基础的观察性队列：2304名（1167名黑人，1137名白人）女性（18-30岁）在基线（1985-86）无高血压，并在2、5、7、10或20年后（2005-2006）复查6次。我们获得了怀孕前后的标准化血压测量值，并根据每个时间间隔内自基线以来的累计分娩次数将妇女分为时间依赖组[0例分娩（参考）；1次中期分娩及2次或以上的中期分娩；non-hypertensive怀孕)。该研究使用多变量、重复测量线性回归模型评估了中期出生组之间收缩压和舒张压的差异，该模型根据时间、年龄、种族、基线共变量（血压、BMI、教育程度、口服避孕药使用）和随访共变量（吸烟、抗高血压药物、口服避孕药使用、体重增加）对基线胎次（未产胎和已产胎）分层。在基线时无生育的孕妇中，一次中期分娩后完全调整后的平均收缩压和舒张压（mm Hg）分别降低了- 2.06（- 2.72至- 1.41）和- 1.50(- 2.08至- 0.92)，两次或两次以上中期分娩后与未分娩相比分别降低了- 1.89（- 2.63至- 1.15）和- 1.29(- 1.96至- 0.63)（p值均<0.001）。在基线时已经分娩的妇女中，调整后的平均血压变化没有随生育数量的变化而变化。从孕前到分娩后数年，首次分娩伴随着持续的血压降低。虽然生物学机制尚不清楚，但妊娠可能造成血管内皮功能的持久改变。
To prospectively examine whether blood pressure changes persist after pregnancy among women of reproductive age. Prospective, population-based, observational cohort of 2,304 (1,167 black, 1,137 white) women (aged 18–30) who were free of hypertension at baseline (1985–86) and reexamined up to six times at 2, 5, 7, 10, or 20 years later (2005–2006). We obtained standardized blood pressure measurements before and after pregnancies, and categorized women into time-dependent groups by the cumulative number of births since baseline within each time interval [0 births (referent); 1 interim birth and 2 or more interim births; non-hypertensive pregnancies]. The study assessed differences in systolic and diastolic blood pressures among interim birth groups using multivarible, repeated measures linear regression models stratified by baseline parity (nulliparous and parous) adjusted for time, age, race, baseline covariates (blood pressure, BMI, education, oral contraceptive use), and follow-up covariates (smoking, anti-hypertensive medications, oral contraceptive use, weight gain). Among nulliparas at baseline, mean (95%CI) fully adjusted systolic and diastolic blood pressures (mm Hg), respectively, were lower by −2.06 (−2.72 to −1.41) and −1.50 (−2.08 to −0.92) after one interim birth, and lower by −1.89 (−2.63 to −1.15) and −1.29 (−1.96 to −0.63) after 2 or more interim births compared with no births (all p-value <0.001). Among women already parous at baseline, adjusted mean blood pressure changes did not differ by number of subsequent births. A first birth is accompanied by persistent lowering of blood pressure from preconception to years after delivery. Although the biologic mechanism is unclear, pregnancy may create enduring alterations in vascular endothelial function.