International gestational age-specific centiles for blood pressure in pregnancy from the INTERGROWTH-21st Project in 8 countries: A longitudinal cohort study

Autor: Aris T. Papageorghiou, M Carvalho, Fernando C. Barros, Eric O Ohuma, Ruyan Pang, Cesar G. Victora, J. Alison Noble, Stephen Kennedy, Peter J. Watkinson, Ann Lambert, Leila Cheikh Ismail, Michael G. Gravett, Manorama Purwar, Lauren Green, Eleonora Staines Urias, Enrico Bertino, Y A Jaffer, Cutberto Garza, Lucy Mackillop, José Villar, Stephen Gerry, Zulfiqar A Bhutta
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Longitudinal study
Maternal Health
Blood Pressure
030204 cardiovascular system & hematology
Global Health
Vascular Medicine
Fetal Development
0302 clinical medicine
Pregnancy
Medicine and Health Sciences
Prenatal
Medicine
Public and Occupational Health
Longitudinal Studies
Child
Ultrasonography
030219 obstetrics & reproductive medicine
Obstetrics
Obstetrics and Gynecology
Gestational age
General Medicine
Italy
Research Design
Child
Preschool
Hypertension
Gestation
Female
Hypotension
Brazil
Research Article
Cohort study
Adult
China
medicine.medical_specialty
Humans
India
Kenya
Ultrasonography
Prenatal
United Kingdom
Young Adult
Gestational Age
Research and Analysis Methods
Preeclampsia
Sepsis
03 medical and health sciences
Hypertensive Disorders in Pregnancy
Antenatal Care
Preschool
business.industry
medicine.disease
Pregnancy Complications
Blood pressure
Women's Health
business
Zdroj: PLoS Medicine, Vol 18, Iss 4, p e1003611 (2021)
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure. Methods and findings Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at 14 mmHg or diastolic blood pressure by >11 mmHg in fewer than 10% of women at any gestational age. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. The study’s main limitations were the unavailability of prepregnancy blood pressure values and inability to explore circadian effects because time of day was not recorded for the blood pressure measurements. Conclusions Our findings provide international, gestational age-specific centiles and limits of acceptable change to facilitate earlier recognition of deteriorating health in pregnant women. These centiles challenge the idea of a clinically significant midpregnancy drop in blood pressure.
Lauren Green and colleagues study blood pressure in pregnant women across a range of countries.
Author summary Why was this study done? Internationally applicable gestational age-specific centiles for blood pressure are needed in clinical practice to determine when women have left the “normal” range. It is uncertain whether clinically significant decreases in blood pressure occur between early and midpregnancy. What did the researchers do and find? We estimated international gestational age-specific blood pressure centiles using longitudinal blood pressure data provided by women from 8 countries who took part in the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project. On average, systolic blood pressure rose by around 8 mmHg between 12 and 40 weeks’ gestation, with no decrease in midpregnancy. Diastolic blood pressure decreased slightly (by around 0.6 mmHg) between 12 and 19 weeks, rising thereafter until 40 weeks’ gestation. At any gestational age, systolic blood pressure fell by >14 mmHg and diastolic blood pressure by >11 mmHg from baseline in fewer than 10% of women. Fewer than 10% of women increased their systolic blood pressure by >24 mmHg or diastolic blood pressure by >18 mmHg at any gestational age. What do these findings mean? Our findings challenge the frequently quoted midpregnancy blood pressure decrease, advocating for a higher index of clinical suspicion when a woman presents with a “lower than booking” blood pressure, especially in late pregnancy. We show the limits for acceptable change in blood pressure during healthy pregnancy, which should help clinicians determine patients with abnormal blood pressure rises and falls.
Databáze: OpenAIRE
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