Preconception Blood Pressure and Its Change Into Early Pregnancy Early Risk Factors for Preeclampsia and Gestational Hypertension
Preconception Blood Pressure and Its Change Into Early Pregnancy Early Risk Factors for Preeclampsia and Gestational Hypertension
复制标题
DOI：
10.1161/hypertensionaha.120.14875
复制
发表时间：
2020-09-01
期刊：
影响因子：
8.3
通讯作者：
Schisterman, Enrique F.
中科院分区：
文献类型：
--
作者：
Nobles, Carrie J.;Mendola, Pauline;Schisterman, Enrique F.
先兆子痫和妊娠期高血压是常见的妊娠并发症，与显著的母婴发病率相关。尽管广泛的研究评估怀孕期间的风险因素，大多数妇女谁开发的妊娠高血压疾病不被认为是高风险和预防策略仍然难以捉摸。我们评估了孕前血压及其在妊娠早期的变化作为妊娠期高血压疾病发展的新风险标志物。EAGeR（阿司匹林在妊娠和生殖中的作用）试验（2007-2011）将1228名有妊娠丢失史的健康女性随机分配至孕前启动的低剂量阿司匹林组与安慰剂组，并对尝试怀孕的参与者进行长达6个月经周期的随访，如果他们怀孕，则在整个妊娠期间进行随访。在孕前和整个妊娠早期测量血压。主要结局，早产先兆子痫，足月先兆子痫和妊娠期高血压，从医疗记录中提取。在586名妊娠>20周的妇女中，早产先兆子痫的孕前血压水平较高（平均动脉压87.3 ± 6.7 mm Hg），晚期先兆子痫（88.3 +/- 9.8 mm Hg）和妊娠期高血压（87.9 +/- 9.1 mm Hg）与无妊娠期高血压疾病（83.9 +/- 8.6 mm Hg）相比。从孕前到极早期妊娠的血压变化与先兆子痫的发生有关（妊娠4周时平均动脉压每增加2 mm Hg，相对危险度为1.13 [95%CI，1.02-1.25]），尤其是早产先兆子痫（相对危险度为1.21 [95%CI，1.01-1.45]）。随机服用阿司匹林不会改变血压轨迹或妊娠期高血压风险。孕前血压和妊娠早期的纵向变化是未充分研究的，但在妊娠期高血压疾病的检测和预防中至关重要的窗口。
Preeclampsia and gestational hypertension are common complications of pregnancy associated with significant maternal and infant morbidity. Despite extensive research evaluating risk factors during pregnancy, most women who develop a hypertensive disorder of pregnancy are not considered high-risk and strategies for prevention remain elusive. We evaluated preconception blood pressure and its change into early pregnancy as novel risk markers for development of a hypertensive disorder of pregnancy. The EAGeR (Effects of Aspirin in Gestation and Reproduction) trial (2007-2011) randomized 1228 healthy women with a history of pregnancy loss to preconception-initiated low-dose aspirin versus placebo and followed participants for up to 6 menstrual cycles attempting pregnancy and throughout pregnancy if they became pregnant. Blood pressure was measured during preconception and throughout early gestation. The primary outcomes, preterm preeclampsia, term preeclampsia, and gestational hypertension, were abstracted from medical records. Among 586 women with a pregnancy >20 weeks' gestation, preconception blood pressure levels were higher for preterm preeclampsia (87.3 +/- 6.7 mm Hg mean arterial pressure), term preeclampsia (88.3 +/- 9.8 mm Hg), and gestational hypertension (87.9 +/- 9.1 mm Hg) as compared with no hypertensive disorder of pregnancy (83.9 +/- 8.6 mm Hg). Change in blood pressure from preconception into very early pregnancy was associated with development of preeclampsia (relative risk, 1.13 [95% CI, 1.02-1.25] per 2 mm Hg increase in mean arterial pressure at 4 weeks' gestation), particularly preterm preeclampsia (relative risk, 1.21 [95% CI, 1.01-1.45]). Randomization to aspirin did not alter blood pressure trajectory or risk of hypertension in pregnancy. Preconception blood pressure and longitudinal changes during early pregnancy are underexplored but crucial windows in the detection and prevention of hypertensive disorders of pregnancy.