Early Pregnancy Systolic Blood Pressure Patterns Predict Early- and Later-Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low-to-Moderate Risk Groups.
Early Pregnancy Systolic Blood Pressure Patterns Predict Early- and Later-Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low-to-Moderate Risk Groups.
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DOI：
10.1161/jaha.123.029617
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发表时间：
2023-08
影响因子：
5.4
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临床风险因素、单次血压（BP）测量、当前生物标志物和生物物理参数可以有效识别早发性先兆子痫的风险，但预测晚发性先兆子痫和妊娠期高血压的能力有限。临床血压模式有望改善妊娠期高血压疾病的早期风险分层。在排除了既存高血压、心脏、肾脏或肝脏疾病或先兆子痫后，（n= 249892）均为收缩压<140 mm Hg，舒张压<90 mm Hg，或单次血压升高≤20周，产前检查<14周，以及在Kaiser Permanente北方加州医院（2009-2019年）进行的静止或活产分娩。将样本随机分为开发（N=174 925; 70%）和验证（n=74 967; 30%）数据集。在验证数据集中评价了多项逻辑回归模型对早发型（<34周）先兆子痫、晚发型（≥34周）先兆子痫和妊娠期高血压的预测性能。分别有1008例（0.4%）、10766例（4.3%）和11514例（4.6%）患者患有早发性先兆子痫、晚发性先兆子痫和妊娠高血压。具有6个收缩压轨迹组的模型在预测早发型和晚发型先兆子痫和妊娠期高血压方面，（0-20周妊娠）加标准临床风险因素的表现明显优于单独的风险因素，C统计量（95% CI）为0.747（0.720-0.775）、0.730（0.722-0.739）和0.768（0.761-0.776）与0.688（0.659-0.717）、0.695（0.686-0.704）和0.692（0.683-0.701），具有极好的校准（Hosmer-Lemeshow P分别=0.99、0.99和0.74）。妊娠20周内的早期妊娠BP模式加上临床、社会和行为因素，可以更准确地区分低至中度风险妊娠中的妊娠风险高血压疾病。早期妊娠BP轨迹改善了风险分层，以揭示隐藏在表面上低至中度风险组中的高风险个体和美国预防服务工作组标准认为风险较高的低风险个体。
Clinical risk factors, a single blood pressure (BP) measurement, current biomarkers, and biophysical parameters can effectively identify risk of early‐onset preeclampsia but have limited ability to predict later‐onset preeclampsia and gestational hypertension. Clinical BP patterns hold promise to improve early risk stratification for hypertensive disorders of pregnancy. After excluding preexisting hypertension, heart, kidney, or liver disease, or prior preeclampsia, the retrospective cohort (n=249 892) all had systolic BP <140 mm Hg and diastolic BP <90 mm Hg or a single BP elevation ≤20 weeks' gestation, prenatal care at <14 weeks' gestation, and a still or live birth delivery at Kaiser Permanente Northern California hospitals (2009–2019). The sample was randomly split into development (N=174 925; 70%) and validation (n=74 967; 30%) data sets. Predictive performance of multinomial logistic regression models for early‐onset (<34 weeks) preeclampsia, later‐onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated in the validation data set. There were 1008 (0.4%), 10 766 (4.3%), and 11 514 (4.6%) patients with early‐onset preeclampsia, later‐onset preeclampsia, and gestation hypertension, respectively. Models with 6 systolic BP trajectory groups (0–20 weeks' gestation) plus standard clinical risk factors performed substantially better than risk factors alone to predict early‐ and later‐onset preeclampsia and gestational hypertension, with C‐statistics (95% CIs) of 0.747 (0.720–0.775), 0.730 (0.722–0.739), and 0.768 (0.761–0.776) versus 0.688 (0.659–0.717), 0.695 (0.686–0.704) and 0.692 (0.683–0.701), respectively, with excellent calibration (Hosmer‐Lemeshow P=0.99, 0.99, and 0.74, respectively). Early pregnancy BP patterns up to 20 weeks' gestation plus clinical, social, and behavioral factors more accurately discriminate hypertensive disorders of pregnancy risk among low‐to‐moderate risk pregnancies. Early pregnancy BP trajectories improve risk stratification to reveal higher‐risk individuals hidden within ostensibly low‐to‐moderate risk groups and lower‐risk individuals considered at higher risk by US Preventive Services Task Force criteria.