The association between blood pressure control in women during pregnancy and adverse perinatal outcomes: the TMM BirThree Cohort Study

Abstract

Blood pressure (BP) control in pregnancy is essential to prevent adverse outcomes. However, BP levels for hypertension treatment are inconsistent among various guidelines. This study investigated the association between BP control and adverse perinatal outcomes. A total of 18,155 mother-offspring pairs were classified into four groups according to BP after 20 gestational weeks: normal BP (<140/90 mmHg without antihypertensive drugs), high BP (≥140/90 mmHg without antihypertensive drugs), controlled BP (<140/90 mmHg with antihypertensive drugs), and uncontrolled BP (≥140/90 mmHg with antihypertensive drugs). The prevalence of small for gestational age was 1,087/17,476 offspring in normal BP, 78/604 in high BP, 5/42 in controlled BP, and 7/33 in uncontrolled BP. Compared to normal BP, adjusted odds ratios (ORs) (95% confidence intervals (CIs)) were 1.76 (1.32–2.35) for high BP, 2.08 (0.79–5.50) for controlled BP, and 2.34 (0.94–5.85) for uncontrolled BP (multiple logistic regression analysis). Similarly, the adjusted ORs (95% CIs) were 1.80 (1.35–2.41), 3.42 (1.35–8.63), and 5.10 (1.93–13.45) for high, controlled, and uncontrolled BPs for low birth weight, respectively; 1.99 (1.48–2.68), 2.70 (1.12–6.50), and 6.53 (3.09–13.82) for high, controlled, and uncontrolled BPs for preterm birth, respectively; 1.64 (1.19–2.24), 2.17 (0.88–5.38), and 2.12 (0.80–5.65) for high, controlled, and uncontrolled BPs for admission to the Neonatal Intensive Care Unit or Growing Care Unit, respectively; and 1.17 (0.70–1.95), 2.23 (0.65–7.68), and 0.91 (0.20–4.16) for high, controlled, and uncontrolled BPs for 1-min Apgar score < 7, respectively. BP ≥ 140/90 mmHg might be taken care for preventing various adverse perinatal outcomes.

Original article and review highlighted in this month of Hypertension Research

“…In this month's issue, we provide new three insights. Ishikuro et al investigated in pregnant women the association between blood pressure (BP) control and adverse perinatal outcomes, such as perinatal and fetal deaths, small for gestational age, low birth weight, and preterm birth [3]. In this study, most of individuals were normal BP defined by <140/90 mmHg without antihypertensive medication (17476/18155 = 96.3%).…”

“…Compapred to this normal BP group, both high BP (≥140/90 mmHg) group and uncontrolled BP under antihypertensive treatment group had a higher risk of adverse perinatal outcome. However, this association was attenuated in the group with controlled BP under antihypertensive treatment [3]. Paiboonborirak et al reported that the combination of serum fatty acid binding protein-4 (FABP4) levels greater than 1.0 with the abnormal mean pulsatility index of the uterine artery (greater than 95th percentile) at gestational age 11-13(+6) weeks predicted preeclampsia [4].…”