METHODS: This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120-129/below 80 mm Hg, stage 1 hypertension 130-139/80-89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10-14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score.
RESULTS: Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6-28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06-3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62-4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65-4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03-1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02-1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10-1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07-1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00-1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16-1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42-3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46-3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05-5.11) but not of low HDL cholesterol.
CONCLUSIONS: The frequency of adverse cardiometabolic outcomes at 10-14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.
方法:这是前瞻性HAPOFUS(高血糖和不良妊娠结局随访研究)的二次分析。妊娠晚期早期的血压根据美国心脏病学会/美国心脏协会的阈值进行分类:正常血压低于120/80mmHg(参考),BP升高120-129/低于80mmHg,1期高血压130-139/80-89mmHg,和2期高血压140/90mmHg或更高。妊娠后10-14年评估的心脏代谢结果是2型糖尿病和血脂异常的测量,包括低密度脂蛋白(LDL)胆固醇130mg/dL或更高,总胆固醇200mg/dL或更高,高密度脂蛋白(HDL)胆固醇40mg/dL或更低,和甘油三酯200mg/dL或更高。使用以下协变量进行调整分析:研究领域中心,随访持续时间,年龄,体重指数(BMI),高度,高血压和糖尿病家族史,吸烟和饮酒,奇偶校验,口服葡萄糖耐量试验葡萄糖z评分。
结果:在中位孕龄为27.9周(四分位距26.6-28.9周)的4,692名孕妇中,8.5%(n=399)血压升高,14.9%(n=701)患有1期高血压,6.4%(n=302)患有2期高血压。中位随访时间为11.6年,在血压升高的个体中,与血压正常的患者相比,糖尿病的发生频率更高(血压升高:调整后相对危险度[aRR]1.88,95%CI,1.06-3.35;1期高血压:aRR2.58,95%CI,1.62-4.10;2期高血压:aRR2.83,95%CI,1.65-4.95).在血压升高的个体中,LDL胆固醇升高的频率较高(BP升高:aRR1.27,95%CI,1.03-1.57;1期高血压:aRR1.22,95%CI,1.02-1.45,2期高血压:aRR1.38,95%CI,1.10-1.74),总胆固醇升高(BP升高:aRR1.27,95%CI,1.07-1.52;1期高血压:aRR1.16,95%CI,1.00-1.35;2期高血压:aRR1.4195%CI,1.16-1.71),和甘油三酯升高(血压升高:aRR2.24,95%CI,1.42-3.53;1期高血压:aRR2.15,95%CI,1.46-3.17;2期高血压:aRR3.24,95%CI,2.05-5.11),但不包括低HDL胆固醇。
结论:在妊娠早期血压大于120/80的孕妇中,分娩后10-14年心脏代谢不良结局的频率逐渐升高。