Pre-pregnancy blood pressure and pregnancy outcomes: a nationwide population-based study.
Adverse pregnancy outcome
blood pressure
hypertension
preeclampsia
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
19 Mar 2022
19 Mar 2022
Historique:
received:
22
07
2021
accepted:
02
03
2022
entrez:
20
3
2022
pubmed:
21
3
2022
medline:
26
3
2022
Statut:
epublish
Résumé
Hypertension has been known to increase the risk of obstetric complications. Recently, the American College of Cardiology endorsed lower thresholds for hypertension as systolic blood pressure of 130-139 mmHg or diastolic blood pressure 80-89 mmHg. However, there is a paucity of information regarding the impact of pre-pregnancy blood pressure on pregnancy outcomes. We aimed to evaluate the effect of pre-pregnancy blood pressure on maternal and neonatal complications. In this nationwide, population based study, pregnant women without history of hypertension and pre-pregnancy blood pressure < 140/90 mmHg were enrolled. The primary outcome of composite morbidity was defined as any of the followings: preeclampsia, placental abruption, stillbirth, preterm birth, or low birth weight. A total of 375,305 pregnant women were included. After adjusting for covariates, the risk of composite morbidity was greater in those with stage I hypertension in comparison with the normotensive group (systolic blood pressure, odds ratio = 1.68, 95% CI: 1.59 - 1.78; diastolic blood pressure, odds ratio = 1.56, 95% CI: 1.42 - 1.72). There was a linear association between pre-pregnancy blood pressure and the primary outcome, with risk maximizing at newly defined stage I hypertension and with risk decreasing at lower blood pressure ranges. 'The lower, the better' phenomenon was still valid for both maternal and neonatal outcomes. Our results suggest that the recent changes in diagnostic thresholds for hypertension may also apply to pregnant women. Therefore, women with stage I hypertension prior to pregnancy should be carefully observed for adverse outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Hypertension has been known to increase the risk of obstetric complications. Recently, the American College of Cardiology endorsed lower thresholds for hypertension as systolic blood pressure of 130-139 mmHg or diastolic blood pressure 80-89 mmHg. However, there is a paucity of information regarding the impact of pre-pregnancy blood pressure on pregnancy outcomes. We aimed to evaluate the effect of pre-pregnancy blood pressure on maternal and neonatal complications.
METHODS
METHODS
In this nationwide, population based study, pregnant women without history of hypertension and pre-pregnancy blood pressure < 140/90 mmHg were enrolled. The primary outcome of composite morbidity was defined as any of the followings: preeclampsia, placental abruption, stillbirth, preterm birth, or low birth weight.
RESULTS
RESULTS
A total of 375,305 pregnant women were included. After adjusting for covariates, the risk of composite morbidity was greater in those with stage I hypertension in comparison with the normotensive group (systolic blood pressure, odds ratio = 1.68, 95% CI: 1.59 - 1.78; diastolic blood pressure, odds ratio = 1.56, 95% CI: 1.42 - 1.72). There was a linear association between pre-pregnancy blood pressure and the primary outcome, with risk maximizing at newly defined stage I hypertension and with risk decreasing at lower blood pressure ranges.
CONCLUSIONS
CONCLUSIONS
'The lower, the better' phenomenon was still valid for both maternal and neonatal outcomes. Our results suggest that the recent changes in diagnostic thresholds for hypertension may also apply to pregnant women. Therefore, women with stage I hypertension prior to pregnancy should be carefully observed for adverse outcomes.
Identifiants
pubmed: 35305601
doi: 10.1186/s12884-022-04573-7
pii: 10.1186/s12884-022-04573-7
pmc: PMC8934452
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
226Informations de copyright
© 2022. The Author(s).
Références
Lancet. 2004 Jan 10;363(9403):157-63
pubmed: 14726171
Epidemiology. 2010 Jan;21(1):118-23
pubmed: 20010214
J Am Coll Cardiol. 2009 Nov 10;54(20):1827-34
pubmed: 19892233
Am J Obstet Gynecol. 2018 Mar;218(3):337.e1-337.e7
pubmed: 29305253
J Obstet Gynaecol Can. 2011 Oct;33(10):995-1004
pubmed: 22014776
Am J Obstet Gynecol. 2015 Jul;213(1):62.e1-62.e10
pubmed: 25724400
Nat Rev Nephrol. 2016 Apr;12(4):202-4
pubmed: 26923205
Eur Heart J. 2010 Dec;31(23):2897-908
pubmed: 20846991
Ann Intern Med. 1967 Jul;67(1):48-59
pubmed: 6028658
J Am Coll Cardiol. 2018 May 15;71(19):e127-e248
pubmed: 29146535
Hypertension. 2022 Mar;79(3):599-613
pubmed: 34963295
Obstet Gynecol Sci. 2021 Nov;64(6):496-505
pubmed: 34666428
Hypertens Pregnancy. 2014 May;33(2):250-9
pubmed: 24304210
Ann Epidemiol. 1991 May;1(4):347-62
pubmed: 1669516
N Engl J Med. 2015 Nov 26;373(22):2103-16
pubmed: 26551272
Am J Obstet Gynecol. 2020 Jun;222(6):606.e1-606.e21
pubmed: 31954700
Obstet Gynecol. 2018 Oct;132(4):843-849
pubmed: 30204698
BMJ. 2014 Apr 15;348:g2301
pubmed: 24735917
Obstet Gynecol Sci. 2020 May;63(3):270-277
pubmed: 32489971
N Engl J Med. 1998 Sep 3;339(10):667-71
pubmed: 9725924
BMJ Open. 2017 Sep 24;7(9):e016640
pubmed: 28947447
Circ Res. 2019 Jul 5;125(2):184-194
pubmed: 31104583
Am J Obstet Gynecol. 2019 Sep;221(3):277.e1-277.e8
pubmed: 31255629
J Clin Epidemiol. 1989;42(7):663-73
pubmed: 2668449
Obstet Gynecol Sci. 2020 Sep;63(5):623-630
pubmed: 32756294
Clin Hypertens. 2019 Aug 1;25:20
pubmed: 31388453
Stat Med. 2010 Apr 30;29(9):1037-57
pubmed: 20087875
Prog Cardiovasc Dis. 2010 Jul-Aug;53(1):39-44
pubmed: 20620424
Lancet. 2009 Mar 21;373(9668):1009-15
pubmed: 19249092
Am J Hypertens. 2015 Jul;28(7):915-23
pubmed: 25523295
Int J Obes (Lond). 2006 Mar;30(3):507-12
pubmed: 16276361
Lancet. 2001 Jan 13;357(9250):131-5
pubmed: 11197413
Acta Physiol (Oxf). 2017 Jan;219(1):241-259
pubmed: 27124608