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: 10373113
• 负责人: Yeyi Zhu
• 金额: $ 74.36万
• 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/10373113
• 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; 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; fetal; hypertensive; 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.

项目摘要/摘要 妊娠期高血压疾病(HDP)是孕产妇发病率的主要原因，影响超过350,000人 每年都有怀孕的美国妇女。在过去的几十年里，HDP的比率急剧上升。临床护理和 然而，对这一不断增长的女性群体的管理是复杂的，因为相互冲突的指导方针，不确定 产后护理的证据，以及可能影响预后的重要合并症。2017年，美国 心脏病学会/美国心脏协会(ACC/AHA)发布了新的指南来定义慢性 使用较低的收缩压/舒张压(SBP/DBP)阈值(阶段1高血压， 130-139/80-89；第二阶段，≥140/90毫米汞柱)，低于≥140/90。2019年，美国产科医师学会 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 由于缺乏关于这些较低的BP阈值之间的关联的数据，因此诊断新发的HDP 有产前和产后并发症。奥组委还认识到，它没有科学证据证明 使用20周的标记来确定高血压是在怀孕之前还是与怀孕有关，调用 用于检查怀孕期间的血压轨迹。此外，由于产后护理支离破碎，几乎没有 了解产后高血压疾病和相关的住院治疗以及严重的产妇发病率。 最后，既往存在的肥胖和糖尿病往往与HDP聚集在一起，并使BP与高血压之间的联系复杂化 怀孕和并发症的风险。为了解决这些关键的知识差距，我们建议建立一个人口- 基于对2007-2019年在人口统计学上不同的约50万名女性进行的队列研究，这些女性在 Kaiser Permanente North California(KPNC)，一个拥有稳定成员的综合医疗保健系统 和全面的电子病历数据。我们处于得天独厚的地位，能够及时解决重要的 令人关切的是，2017年ACC/AHA定义的妊娠期BP类别与 围产期和产后并发症(目标1-2)。利用KPNC对BP和 怀孕前、怀孕期间和怀孕后的体重以及怀孕前强劲的糖尿病诊断数据，我们将 能够有效地剖析妊娠合并肥胖和糖尿病的血压对围产儿的联合影响 产后并发症(目标1-2)。最后，我们将检查BP在20%之前的连续统上的轨迹 怀孕数周和跨孕期有并发症风险(目标3)。这项研究提供了一个及时和 提供无与伦比的机会来解决行政协调会/行政协调会和行政协调委员会之间的冲突所引起的关切 关于如何处理血压水平低于传统阈值的孕妇的指南。我们的 结果可能有助于确定在哪个血压水平，在哪个时间窗口，更密切的患者监测和变化 可以在管理中启动。此外，我们的发现可能会为临床医生提供急需的数据来提供信息 妊娠期合并某些BP类别的妇女的早期临床分诊和风险分层 和糖尿病并存，从而提高个性化护理决策和效率。