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Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth
Shengqi Ma1, Lei Wu2, Qing Yu3
1Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Insights
Maintaining low blood pressure (BP) during pregnancy, specifically below 110/65 mmHg after 20 weeks, is crucial for preventing adverse birth outcomes (ABO). High-stable or increasing BP patterns significantly elevate ABO risk.
Area of Science:
- Obstetrics and Gynecology
- Cardiovascular Health in Pregnancy
- Perinatal Epidemiology
Background:
- High blood pressure in pregnancy is linked to adverse birth outcomes (ABO), but the impact of varying BP changes remains unclear.
- Understanding these associations is vital for improving maternal and fetal health during gestation.
Purpose of the Study:
- To investigate the association between blood pressure (BP) trajectories and adverse birth outcomes (ABO) in a large, real-world cohort.
- To analyze the impact of different patterns of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) during pregnancy on ABO risk.
Main Methods:
- Utilized a register-based cohort of 28,679 pregnant women from 2010-2019.
- Estimated BP trajectories (low-stable, moderate-increasing, moderate-decreasing, high-stable) using R software's 'traj' package.
- Employed logistic regression to assess the relationship between BP trajectories and ABO risk.
Main Results:
- Identified four distinct BP trajectory patterns for SBP, DBP, MAP, and PP.
- High-stable and moderate-increasing BP patterns were significantly associated with increased ABO risk compared to low-stable patterns.
- Moderate-decreasing BP patterns showed no increased risk and a lower risk than moderate-increasing patterns.
Conclusions:
- Reducing and maintaining blood pressure below 110 mmHg (SBP) and 65 mmHg (DBP) after 20 weeks of gestation is beneficial for preventing adverse birth outcomes.
- These BP management strategies are important regardless of early pregnancy BP levels.
Background:
High blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study.
Material And Methods:
Leveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package "traj" in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO.
Results:
Trajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17-20 weeks of gestation for all blood pressure components.
Conclusion:
Our study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.
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