Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups.
Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups.
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孕早期血压模式可识别不同种族和族裔群体患妊娠期高血压疾病的风险。
DOI：
10.1161/hypertensionaha.121.18568
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发表时间：
2022-03
期刊：
影响因子：
8.3
通讯作者：
Alexeeff, Stacey E.
中科院分区：
文献类型：
--
作者：
Gunderson, Erica P.;Greenberg, Mara;Nguyen-Huynh, Mai N.;Tierney, Cassidy;Roberts, James M.;Go, Alan S.;Tao, Wei;Alexeeff, Stacey E.
妊娠期高血压疾病是严重孕产妇发病率和死亡率的主要原因，黑人妇女的围产期死亡率高出4倍。妊娠早期血压模式可区分妊娠期高血压疾病的风险。本研究确定了妊娠0至20周的不同血压轨迹，以评估2009年至2019年期间在Kaiser Permanente北方加州医院分娩的174925名既往无高血压或先兆子痫病史、产前护理≤14周且有死胎或活产单胎分娩的妇女的回顾性队列中随后的妊娠相关高血压。我们使用电子健康记录来获得临床结局、协变量和纵向门诊血压测量值≤20周妊娠（平均4.1次测量）。潜在类别轨迹建模确定了6个血压组：超低下降（参考）、低下降、中快速下降、低上升、中稳定和升高稳定。多变量逻辑回归评估了轨迹组与先兆子痫/子痫和妊娠期高血压几率的相关性，以及种族-种族和孕前体型的影响。与超低-下降相比，调整后的比值比（95%置信区间[CI]）低增长，中度稳定，和升高稳定组为3.25（2.7-3.9）、5.3（4.5-6.3）和9.2（7.7-11.1），妊娠高血压为6.4（4.9-8.3）、13.6（10.5-17.7）和30.2（23.2-39.4）。种族/民族和孕前肥胖改变了先兆子痫/子痫的发病组相关性（相互作用P<0.01），黑人女性的风险最高，然后是西班牙裔和亚洲女性的所有血压轨迹，肥胖类别增加。早期妊娠血压模式揭示了在同等水平和模式下与先兆子痫/子痫风险相关的种族和民族差异。这些血压模式可以改善个体风险分层，允许有针对性的监测和早期缓解策略。
Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality and confer 4-fold higher perinatal mortality in Black women. Early pregnancy blood pressure patterns may differentiate risk of hypertensive disorders of pregnancy. This study identified distinct blood pressure trajectories from 0 to 20 weeks’ gestation to evaluate subsequent pregnancy-related hypertension in a retrospective cohort of 174925 women with no prior hypertension or history of preeclampsia, prenatal care entry ≤14 weeks, and a stillborn or live singleton birth delivered at Kaiser Permanente Northern California hospitals in 2009 to 2019. We used electronic health records to obtain clinical outcomes, covariables, and longitudinal outpatient blood pressure measurements ≤20 weeks’ gestation (mean 4.1 measurements). Latent class trajectory modeling identified 6 blood pressure groups: ultra-low-declining(referent), low-declining, moderate-fast-decline, low-increasing, moderate-stable, and elevated-stable. Multivariable logistic regression evaluated trajectory group-associations with the odds of preeclampsia/eclampsia and gestational hypertension‚ and effect modification by race-ethnicity and prepregnancy body size. Compared with ultra-low-declining, adjusted odds ratios (95% confidence intervals [CIs]) for low-increasing, moderate-stable, and elevated-stable groups were 3.25 (2.7–3.9), 5.3 (4.5–6.3), and 9.2 (7.7–11.1) for preeclampsia/eclampsia‚ and 6.4 (4.9–8.3), 13.6 (10.5–17.7), and 30.2 (23.2–39.4) for gestational hypertension. Race/ethnicity, and prepregnancy obesity modified the trajectory-group associations with preeclampsia/eclampsia (interaction P<0.01), with highest risks for Black, then Hispanic and Asian women for all blood pressure trajectories, and with increasing obesity class. Early pregnancy blood pressure patterns revealed racial and ethnic differences in associations with preeclampsia/eclampsia risk within equivalent levels and patterns. These blood pressure patterns may improve individual risk stratification permitting targeted surveillance and early mitigation strategies.