Antenatal blood pressure for prediction of pre-eclampsia, preterm birth, and small for gestational age babies: development and validation in two general population cohorts.
Antenatal blood pressure for prediction of pre-eclampsia, preterm birth, and small for gestational age babies: development and validation in two general population cohorts.
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DOI：
10.1136/bmj.h5948
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发表时间：
2015-11-17
期刊：
影响因子：
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通讯作者：
Tilling K
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文献类型：
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作者：
Macdonald-Wallis C;Silverwood RJ;de Stavola BL;Inskip H;Cooper C;Godfrey KM;Crozier S;Fraser A;Nelson SM;Lawlor DA;Tilling K
研究问题：孕20 ~ 36周的常规产前血压测量是否有助于预测先兆子痫及其相关不良结局？ 方法本研究采用重复产前测量血压从12 996名妇女在雅芳纵向研究的父母和子女（ALSPAC）开发预测模型，并验证这些在3005名妇女从南安普顿妇女的调查（SWS）。仅基于母体早孕特征的模型（BMI、身高、年龄、产次、吸烟、现有和先前的妊娠期高血压和糖尿病以及种族）加上初始平均动脉压与另外包括当前平均动脉压的模型、包括当前平均动脉压与分层正常图的偏差的模型、以及包括20-36周的不同胎龄两者的模型。与单独使用早孕风险因素相比，从28周开始增加血压测量改善了预测模型，但它们对早产或小于胎龄儿的预测贡献不大。虽然使用缺失数据的多重插补来增加样本量并最大限度地减少选择偏倚，但由于先兆子痫病例数略低于推荐的100例，因此验证样本的效力可能略低。自我报告了几个风险因素，可能会引入测量误差，但这反映了在临床实践中如何获得信息。从28周开始，增加常规收集的血压测量值，改善了基于妊娠早期血压和其他特征的先兆子痫预测模型，有助于减少计划的产前护理。资金，竞争利益，数据共享英国惠康信托基金，美国国立卫生研究院和英国医学研究理事会。作者的其他资金来源在完整的在线论文中详细介绍。除了CM-W，HMI和KMG之外，没有竞争的利益。
Study question Can routine antenatal blood pressure measurements between 20 and 36 weeks’ gestation contribute to the prediction of pre-eclampsia and its associated adverse outcomes? Methods This study used repeated antenatal measurements of blood pressure from 12 996 women in the Avon Longitudinal Study of Parents and Children (ALSPAC) to develop prediction models and validated these in 3005 women from the Southampton Women’s Survey (SWS). A model based on maternal early pregnancy characteristics only (BMI, height, age, parity, smoking, existing and previous gestational hypertension and diabetes, and ethnicity) plus initial mean arterial pressure was compared with a model additionally including current mean arterial pressure, a model including the deviation of current mean arterial pressure from a stratified normogram, and a model including both at different gestational ages from 20-36 weeks. Study answer and limitations The addition of blood pressure measurements from 28 weeks onwards improved prediction models compared with use of early pregnancy risk factors alone, but they contributed little to the prediction of preterm birth or small for gestational age. Though multiple imputation of missing data was used to increase the sample size and minimise selection bias, the validation sample might have been slightly underpowered as the number of cases of pre-eclampsia was just below the recommended 100. Several risk factors were self reported, potentially introducing measurement error, but this reflects how information would be obtained in clinical practice. What this study adds The addition of routinely collected blood pressure measurements from 28 weeks onwards improves predictive models for pre-eclampsia based on blood pressure in early pregnancy and other characteristics, facilitating a reduction in scheduled antenatal care. Funding, competing interests, data sharing UK Wellcome Trust, US National Institutes of Health, and UK Medical Research Council. Other funding sources for authors are detailed in the full online paper. With the exceptions of CM-W, HMI, and KMG there were no competing interests.