与管理第一阶段高血压相关的围产期结果
Erin J Bailey1, Alan T N Tita, Justin Leach
1Departments of Obstetrics and Gynecology, University of Wisconsin, Madison, and Medical College of Wisconsin, Milwaukee, Wisconsin, University of Alabama at Birmingham, Birmingham, and University of South Alabama, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel University College of Medicine, Philadelphia, St. Luke's University Health Network, Fountain Hill, and Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, University of Texas at Houston, Baylor College of Medicine, and Texas Children's Hospital, Houston, UTSouthwestern Medical Center, Dallas, and University of Texas Medical Branch, Galveston, Texas, Columbia University, New York, NYU Langone Hospital-Long Island, Mineola, and NewYork-Presbyterian Queens Hospital, Queens, New York, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, Indiana University, Indianapolis, Indiana, University of Utah Health, Salt Lake City, Utah, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey, Yale University, New Haven, Connecticut, University of Colorado, Aurora, and Denver Health, Denver, Colorado, Emory University, Atlanta, Georgia, University of California, San Francisco, San Francisco, Stanford University, Palo Alto, and Arrowhead Regional Medical Center, Colton, California, and Beaumont Hospital, Royal Oak, Michigan; the Department of Biostatistics, the Division of Neonatology, Department of Pediatrics, the Division of Cardiovascular Disease, Department of Medicine, and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; MetroHealth System, Cleveland, Ohio; Intermountain Healthcare, Salt Lake City, Utah; Ochsner Baptist Medical Center, New Orleans, Louisiana; Christiana Care Health Services, Newark, Delaware; St. Peter's University Hospital, New Brunswick, New Jersey; Weill Cornell Medicine, New York, New York; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, NHLBI, Bethesda, Maryland; and the Department of Women's Health, University of Texas at Austin, Austin, Texas.
在患有轻度慢性高血压的妇女中,保持母体血压 (BP) 在130/80 mm Hg以下与更好的妊娠结果有关. 这种目标血压与较少的严重并发症和早产有关,而不会增加怀孕年龄较小的婴儿的风险.
科学领域:
- 产科和妇科 产科和妇科
- 怀孕中的心脏病学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 轻度慢性高血压影响了大量的怀孕.
- 目前的指导方针建议为患有高血压的孕妇提供BP目标.
- 在轻度慢性高血压中改善妊娠结果的最佳血压值需要进一步调查.
研究的目的:
- 评估130/80毫米平以下与130-139/80-89毫米平以下的孕产妇血压 (BP) 与怀孕结果之间的关联.
- 为了确定在轻度慢性高血压中较低的血压目标是否会改善母亲和胎儿的健康.
- 评估血压控制对综合不良妊娠结果和胎儿生长的影响.
主要方法:
- 慢性高血压和怀孕 (CHAP) 随机对照试验的二次分析.
- 平均血压低于140/90毫米的参与者被分为两组:<130/80毫米和130-139/80-89毫米.
- 主要综合结局包括有严重特征的妊娠前,35周前早产,胎盘断裂或胎儿/新生儿死亡;次要结局对妊娠年龄 (SGA) 很小.
主要成果:
- 在2096名参与者中,768人平均血压<130/80毫米,1328人平均血压为130-139/80-89毫米.
- 平均血压<130/80毫米血压与初级复合结局频率显著降低 (16.0%与35.8%相比).
- 较低的血压目标与严重妊娠前风险的降低有关,并表明35周前早产,但没有发现SGA的相关性.
结论:
- 在患有轻度慢性高血压的孕妇患者中,达到平均血压低于130/80毫米升的水平与改善妊娠结果有关.
- 这种较低的BP目标并没有增加孕期婴儿小的风险.
- 这些发现支持在孕妇中使用更密集的高血压管理策略,这些人有轻度慢性高血压.
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