摘要
目的建立江苏省妊娠期妇女的孕周-血压曲线和各百分位数对应的血压值,研究各孕期血压<140/90 mmHg(1 mmHg=0.133 kPa)的孕妇,最终发生妊娠期高血压或子痫前期者的血压变化规律。方法建立前瞻性妊娠期纵向队列,于2017年7月至2020年9月在南京大学医学院附属鼓楼医院招募早孕期(11~13周^(+6))单胎妊娠妇女,并于中孕期(19~23周^(+6))、晚孕期(30~33周^(+6))、近预产期(35~38周^(+6))进行随访。妊娠相关信息录入Viewpoint 6.0软件进行数据管理,采用标准血压测量方法现场测量血压。使用最小均方误差(LMS)函数拟合孕周-血压曲线,并计算每个随访时间点的各百分位数对应的血压。采用logistic回归法计算血压≥第95百分位数(P95)的孕妇妊娠期高血压或子痫前期发生率的OR值。结果最终3728例单胎妊娠妇女纳入本研究,包括正常妊娠孕妇3490例(93.62%,3490/3728),妊娠期高血压或子痫前期孕妇238例(6.38%,238/3728)。孕周-血压曲线显示,与早孕期比较,收缩压、舒张压、平均动脉压均在中孕期下降,但下降幅度较小,均在2 mmHg以内;而在同一孕期,收缩压、舒张压、平均动脉压的P95与第50百分位数(P50)比较上升幅度较大,分别增加14、11、11 mmHg左右。妊娠期高血压或子痫前期的发生风险,早孕期收缩压≥P95的孕妇为收缩压<P95者的4.36倍(95%CI为2.99~6.35),早孕期舒张压≥P95的孕妇为<P95者的5.22倍(95%CI为3.65~7.46),早孕期平均动脉压≥P95的孕妇为<P95者的5.14倍(95%CI为3.61~7.32);接近预产期时,相应的发病风险分别为16.76、27.45和27.31倍。不同孕期,收缩压、舒张压、平均动脉压每增加1 mmHg,妊娠期高血压或子痫前期的发生风险相应增加,早孕期分别升高24%(OR=1.24,95%CI为1.15~1.33)、44%(OR=1.44,95%CI为1.31~1.59)、47%(OR=1.47,95%CI为1.33~1.61);中孕期与早孕期相似;晚孕期的发病风险进一步升高;接近预产期时,舒张压或平均动脉压每升高1 mmHg,可使发病风险增加100%以上,收缩压每升高1 mmHg,发病风险增加58%。收缩压、舒张压、平均动脉压预测妊娠期高血压或子痫前期的受试者工作特征曲线下面积相似,且预测效能均不佳。结论建立孕期的血压百分位数有助于妊娠期高血压或子痫前期高风险孕妇的识别;孕期血压≥血压值的P95但未达到140/90 mmHg的孕妇,妊娠期高血压或子痫前期的发生风险与血压<P95者相比已显著增加。
Objective To construct the gestational‐age‐specific blood pressure curve and percentile blood pressure values of pregnant women in Jiangsu Province,and to explore the clinic significance of the blood pressure changes in women whose blood pressure was less than 140/90 mmHg(1 mmHg=0.133 kPa)in each trimester and eventually developed pregnancy induced hypertension(PIH)or pre-eclampsia(PE).Methods A prospective longitudinal cohort during pregnancy was built.Singleton pregnant women in the first trimester(11-13+6 weeks)were recruited from July 2017 to September 2020 in Nanjing Drum Tower Hospital,and were followed up in the second trimester(19-23+6 weeks),the third trimester(30-33+6 weeks)and approaching the expected date of delivery(35-38+6 weeks).The Viewpoint 6.0 software was used to record pregnancy-related information.The blood pressure was measured by standard methods in our clinic.Least mean square(LMS)function was performed to fit the gestational-age-specific blood pressure curve and percentile blood pressure values were calculated at every follow‐up time point.Logistic regression was applied to calculate the OR for the groups with blood pressure≥95th percentile(P95).Results There were 3728 singleton pregnant women invited in this study,including 3490 normal pregnant women(93.62%,3490/3728),and 238 pregnant women with PIH or PE(6.38%,238/3728).Gestational-age-specific blood pressure curve showed that systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)decreased in the second trimester,compared with those in the first and the third trimester,however the fluctuation of blood pressure was low,but regardless of the gestational age,P95 of SBP,DBP and MAP increased by 14,11 and 11 mmHg respectively,compared with 50th percentile(P50).In the first trimester,the risk of developing PIH or PE finally in pregnant women with blood pressure≥P95 was 4.36-fold(95%CI:2.99-6.35)for SBP than women with SBP<P95,5.22-fold(95%CI:3.65-7.46)for DBP and 5.14-fold(95%CI:3.61-7.32)for MAP.When approaching the expected date of delivery,the corresponding risks of the women with blood pressure≥P95 were 16.76 times,27.45 and 27.31 times respectively than those of the women with blood pressure<P95.In the first trimester,every 1 mmHg elevation of SBP the risk developing PIH or PE increased by 24%(OR=1.24,95% CI:1.15-1.33),44%(OR=1.44,95% CI:1.31-1.59)for DBP and 47%(OR=1.47,95% CI:1.33-1.61)for MAP,respectively.The risk in the second trimester was similar to that in the first trimester,and in the third trimester,the risk was further increased.When approaching the expected date of delivery,DBP or MAP increased by 1 mmHg,the risk developing PIH or PE was double;while SBP increased by 1 mmHg,the risk increased by 58%.The areas under the receiver operator characteristic curves of SBP,DBP and MAP were similar for predicting PIH or PE,and the predictive efficiency were all poor.Conclusions Construction of percentile blood pressure values for pregnant women is helpful in identification of high-risk women of developing PIH or PE.The risk of PIH or PE in pregnant women with blood pressure≥P95 but<140/90 mmHg has significantly increased compared with women with blood pressure<P95.
作者
王媛
唐慧荣
王娅
郑明明
叶晓东
戴毅敏
胡娅莉
Wang Yuan;Tang Huirong;Wang Ya;Zheng Mingming;Ye Xiaodong;Dai Yimin;Hu Yali(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2021年第11期767-773,共7页
Chinese Journal of Obstetrics and Gynecology
基金
国家重点研发计划(2018YFC1004404)
国家自然科学基金(82071666)
江苏省临床医学中心(创新平台)建设(YXZXB2016004)。
关键词
妊娠
血压
高血压
妊娠性
先兆子痫
参考值
队列研究
Pregnancy
Blood pressure
Hypertension,pregnancy-induced
Pre-eclampsia
Reference values
Cohort studies
作者简介
通信作者:胡娅莉,Email:glyyhuyali@163.com。
