Blood pressure trajectories during pregnancy and associations with adverse birth outcomes among HIV-infected and HIV-uninfected women in South Africa: a group-based trajectory modelling approach

Abstract

Background High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has also been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. We hypothesise the presence of distinctive BP trajectories and their association with adverse birth outcomes may be mediated by HIV/ART status. Methods We recruited pregnant women at a large primary care facility in Cape Town. BP was measured throughout pregnancy using automated monitors. Group-based trajectory modelling in women with ≥3 BP measurements identified distinct joint systolic and diastolic BP trajectory groups. Multinomial regression assessed BP trajectory group associations with HIV/ART status, and Poisson regression with robust error variance was used to assess risk of PTD and LBW. Results Of the 1583 women in this analysis, 37% were HIV-infected. Seven joint trajectory group combinations were identified, which were categorised as normal (50%), low normal (25%), high normal (20%), and abnormal (5%). A higher proportion of women in the low normal group were HIV-infected than HIV-uninfected (28% vs. 23%), however differences were not statistically significant (RR 1.27, 95% CI 0.98–1.63, reference category: normal). In multivariable analyses, low normal trajectory (aRR0.59, 0.41–0.85) was associated with decreased risk of PTD, while high normal (aRR1.48, 1.12–1.95) and abnormal trajectories (aRR3.18, 2.32–4.37) were associated with increased risk of PTD, and abnormal with increased risk of LBW (RR2.81, 1.90–4.15). Conclusions While HIV/ART did not appear to mediate the BP trajectories and adverse birth outcomes association, they did provide more detailed insights into the relationship between BP, PTD and LBW for HIV-infected and uninfected women.

Associations of prenatal blood pressure trajectory and variability with child neurodevelopment at 2 years old

“…Malaba et al applied the group-based trajectory modeling to identify categories of pregnant women characterized by different joint trajectories of SBP and DBP during pregnancy. Specifically, women were assigned to "joint groups" characterized by different combinations of SBP and DBP trajectories using a probability matrix of joint category membership and consideration of the clinical significance of observed differences [7]. Furthermore, the GBMTM, a multi-trajectory model, was used to identify synergistic changes in systolic and diastolic hypertension and fitted novel, reasonable, and clinically defined trajectories [22].…”

“…However, most studies have only considered BP at a single time point and have not explored the patterns of BP change throughout pregnancy. Clinical evidence supports the notion that BP changes in trajectory [6,7,12] and variability [13][14][15] are related to adverse birth outcomes, such as preterm delivery, low birth weight, and fetal distress, but the association of BP trajectory and variability with early childhood neurodevelopment remains largely unknown.…”

“…In another study from Japan, 755 pregnant women used home monitoring to track their BP, leading to the identification of six trajectory groups for both SBP and DBP during pregnancy: low-J-curve, low-steep J-curve, moderate J-curve, moderate-reverse J-curve, little high J-curve, and high J-curve [6]. Additionally, Malaba et al identified joint trajectory groups based on a combination of SBP and DBP trajectory in pregnant women from South Africa, resulting in groups labeled as consistent low normal, consistent normal, consistent high normal, and increasing abnormal [7]. These findings underscore the importance of adopting a longitudinal approach to BP measurement in research settings, akin to clinical practice.…”