Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy.
Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy.
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DOI：
10.1161/hypertensionaha.117.10705
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发表时间：
2018-05
期刊：
影响因子：
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通讯作者：
Schisterman EF
中科院分区：
文献类型：
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作者：
Nobles CJ;Mendola P;Mumford SL;Naimi AI;Yeung EH;Kim K;Park H;Wilcox B;Silver RM;Perkins NJ;Sjaarda L;Schisterman EF
青年期血压升高是心血管疾病的早期风险标志。尽管有很强的生物学原理，但很少有研究评估孕前血压的逐渐增加是否对生殖健康有早期影响。我们在阿司匹林对妊娠和生殖的影响试验（2007-2011）中评估了孕前血压和生育能力，妊娠丢失和活产，这是一项在1228名有妊娠丢失史的女性中进行的阿司匹林和生殖结局的随机临床试验。收缩压和舒张压在第一个观察到的月经周期和怀孕早期的孕前测量，并用于推导平均动脉压。通过人绒毛膜促性腺激素试验确定的怀孕前月经周期数来评估生育能力。妊娠丢失包括人绒毛膜促性腺激素检测和临床丢失。分析根据治疗分配、年龄、体重指数、人种、婚姻状况、吸烟、产次和自上次丢失后的时间进行调整。平均孕前收缩压和舒张压分别为111.6（SD 12.1）和72.5（SD 9.4）mmHg。在校正分析中，舒张压每增加10 mmHg，妊娠丢失风险增加18%（95% CI 1.03，1.36），平均动脉压每增加10 mmHg，妊娠丢失风险增加17%（95% CI 1.02，1.35）。妊娠早期血压的结果相似。在校正分析中，孕前血压与生育力或活产无关。研究结果表明，健康女性的孕前血压与妊娠损失有关，针对年轻女性血压的生活方式干预可能会对生殖健康产生有利影响。
Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biologic rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. We evaluated preconception blood pressure and fecundability, pregnancy loss and live birth in the Effects of Aspirin on Gestational and Reproduction trial (2007–2011), a randomized clinical trial of aspirin and reproductive outcomes among 1228 women attempting pregnancy with a history of pregnancy loss. Systolic and diastolic blood pressure were measured during preconception in the first observed menstrual cycle and in early pregnancy, and used to derive mean arterial pressure. Fecundability was assessed as number of menstrual cycles until pregnancy, determined through human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin-detected and clinical losses. Analyses adjusted for treatment assignment, age, body mass index, race, marital status, smoking, parity and time since last loss. Mean preconception systolic and diastolic blood pressure were 111.6 (SD 12.1) and 72.5 (SD 9.4) mmHg. Risk of pregnancy loss increased 18% per 10 mmHg increase in diastolic blood pressure (95% CI 1.03, 1.36) and 17% per 10 mmHg increase in mean arterial pressure (95% CI 1.02, 1.35) in adjusted analyses. Findings were similar for early pregnancy blood pressure. Preconception blood pressure was not related to fecundability or live birth in adjusted analyses. Findings suggest preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favorably impact reproductive health.