Blood Pressure, Obesity, and Diabetes in Relation to Perinatal and Postpartum Complications

血压、肥胖和糖尿病与围产期和产后并发症的关系

• 批准号: 10185898
• 负责人: Yeyi Zhu
• 金额: $ 74.35万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10185898
• 关键词: Address; Admission activity; Affect; American; American College of Obstetricians and Gynecologists; American Heart Association; Antihypertensive Agents; Blood Pressure; California; Cardiology; Cardiovascular system; Categories; Cesarean section; Chronic; Clinical; Clinical Data; Clinical Management; Cohort Studies; Complications of Diabetes Mellitus; Comprehensive Health Care; Computerized Medical Record; Conflict (Psychology); Data; Deltastab; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Disease; Eclampsia; Fetus; Guidelines; Health; Hospitalization; Hypertension; Impairment; Individual; Integrated Health Care Systems; Joints; Knowledge; Lead; Life; Malnutrition; Maternal Mortality; Maternal complication; Measurement; Measures; Monitor; Morbidity - disease rate; Neonatal; Neonatal Intensive Care Units; Obesity; Outcome; Overnutrition; Patients; Perfusion; Perinatal; Pharmaceutical Preparations; Population; Positioning Attribute; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Rate; Pregnant Women; Premature Birth; Public Health; Recommendation; Research; Risk; Small for Gestational Age Infant; System; Time; Triage; Uncertainty; Weight; Woman; Women' s Group; blood pressure reduction; cardiovascular risk factor; care systems; clinical care; college; comorbidity; ethnic minority population; fetal; improved; intrapartum; maternal morbidity; offspring; perinatal complications; perinatal outcomes; personalized care; population based; postpartum care; postpartum complications; postpartum outcome; pregnancy disorder; pregnant; prenatal; racial and ethnic; risk stratification; severe maternal morbidity

PROJECT SUMMARY/ABSTRACT Hypertensive disorders in pregnancy (HDP) are a leading cause of maternal morbidity, affecting over 350,000 pregnant U.S. women annually. HDP rates increased dramatically in the past decades. Clinical care and management for this growing group of women is complicated, however, by conflicting guidelines, uncertain evidence for postpartum care, and important comorbidities that may impact outcomes. In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) issued new guidelines to define chronic hypertension by using lower systolic/diastolic blood pressure (SBP/DBP) thresholds (stage 1 hypertension, 130-139/80-89; stage 2, ≥140/90 mmHg) down from ≥140/90. In 2019, the American College of Obstetricians and Gynecologists (ACOG) confirmed much of this recommendation but did not apply the lower BP thresholds to diagnose new-onset HDP, due to the lack of data on the associations between these lower BP thresholds with prenatal and postpartum complication. The ACOG also recognized it is not scientifically substantiated to use the 20-week mark to determine whether hypertension predates pregnancy or is pregnancy-related, calling for examination of BP trajectories across pregnancy. Further, due to fragmented postpartum care, little is known about postpartum hypertensive disorders and associated hospitalization and severe maternal morbidity. Finally, pre-existing obesity and diabetes often cluster with HDP and complicate the association between BP in pregnancy and risk of complications. To address these critical knowledge gaps, we propose a population- based cohort study of ~0.5 million demographically diverse women who delivered singletons in 2007-2019 at Kaiser Permanente Northern California (KPNC), an integrated health care system with a stable membership and comprehensive electronic medical record data. We are uniquely positioned to timely address the important concern regarding the unknown association of the 2017 ACC/AHA defined BP categories in pregnancy with perinatal and postpartum complications (Aims 1-2). Leveraging KPNC’s unique longitudinal tracking of BP and weight before, during, and after pregnancy and robust diabetes diagnosis data before pregnancy, we will be able to efficiently dissect the joint effects of BP in pregnancy with comorbid obesity and diabetes on perinatal and postpartum complications (Aims 1-2). Finally, we will examine BP trajectories on a continuum before 20 weeks of gestation and across pregnancy with risk of complications (Aim 3). This study provides a timely and unparalleled opportunity to address the concerns arising from the conflicts between the ACC/AHA and ACOG guidelines regarding how to manage pregnant women with BP levels lower than conventional thresholds. Our findings may help identify at which BP level, and in which time window, closer patient surveillance and change in management may be initiated. Further, our findings may provide clinicians with sorely needed data to inform early clinical triage and risk stratification of women with combinations of certain BP categories in pregnancy and comorbid obesity and diabetes, thus enhancing individualized care decision and efficiency.

项目总结/摘要 妊娠期高血压疾病（HDP）是孕产妇发病的主要原因，影响超过35万人。 美国孕妇每年在过去的几十年里，HDP率急剧上升。临床护理和 然而，对这一日益增长的妇女群体的管理由于相互冲突的指导方针、不确定的 产后护理的证据，以及可能影响结局的重要合并症。2017年，美国 心脏病学院/美国心脏协会（ACC/AHA）发布了新的指南来定义慢性 通过使用较低的收缩压/舒张压（SBP/DBP）阈值的高血压（1级高血压， 130-139/80-89; 2期，≥140/90 mmHg）从≥140/90下降。2019年，美国产科医师学院 和妇科医生（ACOG）证实了这一建议的大部分，但没有应用较低的BP阈值 诊断新发HDP，由于缺乏这些较低BP阈值之间相关性的数据 产前产后并发症ACOG还承认， 使用20周的标记来确定高血压是否早于怀孕或与怀孕有关， 检查整个怀孕期间的血压轨迹。此外，由于分散的产后护理， 了解产后高血压疾病以及相关的住院治疗和严重的孕产妇发病率。 最后，预先存在的肥胖和糖尿病通常与HDP聚集，并使血压与糖尿病之间的关联复杂化。 怀孕和并发症的风险。为了解决这些关键的知识差距，我们建议人口- 2007年至2019年期间分娩单胎的约50万人口统计学上不同的女性的基于队列研究， Kaiser Permanente北方加州（KPNC），一个拥有稳定会员的综合医疗保健系统 和全面的电子病历数据。我们处于独特的地位，能够及时解决重要的 关于2017年ACC/AHA定义的妊娠期BP类别与以下疾病的未知关联的担忧 围产期和产后并发症（目标1-2）。利用KPNC独特的BP纵向跟踪， 怀孕前、怀孕期间和怀孕后的体重以及怀孕前的可靠糖尿病诊断数据，我们将 能够有效地分析妊娠合并肥胖和糖尿病对围生儿的联合影响， 产后并发症（目标1-2）。最后，我们将研究20岁之前连续体上的BP轨迹 妊娠周数和跨妊娠，有并发症风险（目标3）。这项研究提供了一个及时和 解决ACC/AHA和ACOG之间的冲突所引起的关注的无与伦比的机会 关于如何管理血压水平低于常规阈值的孕妇的指南。我们 研究结果可能有助于确定血压水平和时间窗，更密切的患者监测和变化 管理层可以发起。此外，我们的研究结果可以为临床医生提供急需的数据， 妊娠期合并某些BP类别的女性的早期临床分诊和风险分层 以及肥胖和糖尿病的共病，从而增强个体化护理决策和效率。