Abstract
BackgroundAssociations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate.MethodsData of 20,353 mothers without chronic hypertension and who delivered live singletons between January, 2014 and November, 2019, was extracted from Taicang register-based cohort. Based on SBP measured during 10 to 40 weeks of gestation, SBP trajectories were explored using latent class growth mixture model, and their associations with maternal and neonatal outcomes were assessed by logistic regression analyses.ResultsSix heterogeneous SBP trajectories were identified: low delayed-increasing (7.47%), low reverse-increasing (21.88%), low-stable (19.13%), medium-stable (21.64%), medium reverse-increasing (16.47%), and high stable (13.41%) trajectories. The high-stable trajectory had SBP around 125 mmHg in the 10th gestational week, and increased slightly onwards. When compared with the low-stable trajectory, the high-stable trajectory had maximally adjusted odds ratio (95% confidence interval) of 5.28 (2.76–10.10), 1.30 (1.13–1.50), 1.53 (1.12–2.08), 1.32 (1.06–1.65) and 1.64 (1.08–2.48) for gestational hypertension (GH), early-term delivery (ETD), preterm delivery (PTD), small for gestational age and low birth weight (LBW), respectively. Besides, the medium reverse-increasing trajectory showed significantly increased risk of GH and ETD, while the medium-stable trajectory had significantly elevated risk of ETD and PTD. Notably, SBP trajectories slightly but significantly improved risk discrimination of GH, ETD and LBW, over traditional risk factors.ConclusionWomen with different SBP trajectories were at varied risk of adverse maternal and fetal outcomes. Meanwhile, our study suggested that BP monitoring during pregnancy is necessary, especially for women with high SBP in early pregnancy or upward trajectory.
Highlights
Associations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate
Pregnant women belonged to the high-stable pattern presented the most adverse risk factor profile: they were older, and had the highest body mass index (BMI) and proportions of gestational diseases (GDM and thyroid disease)
Fetuses whose mothers grouped into the high-stable were more likely to suffer early-term delivery (ETD), preterm delivery (PTD), low birth weight (LBW) and small for gestational age (SGA), and tended to have lower Apgar score at 1 min and 5 min
Summary
Associations between trajectories of systolic blood pressure (SBP) during pregnancy and pregnant outcomes remain unclear and disparate. Hypertensive disorders in pregnancy (HDP) include preeclampsia (PE), transient gestational hypertension, gestational hypertension (GH), white-coat hypertension, masked hypertension, chronic hypertension and chronic hypertension with superimposed PE [1]. HDP affects about 5–15% of pregnancies [2]. HDP are tied with adverse fetal outcomes, including low birth weight (LBW), preterm delivery (PTD), and small for gestational age (SGA) [8,9,10]. Children suffered such adverse birth outcomes are prone to functional disabilities, type 2 diabetes mellitus and CVD later in life [11,12,13,14,15]. HDP have caught great attention in prenatal medicine and public health
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