Abstract：
OBJECTIVE: To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10-14 years after delivery.
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.
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.
摘要：
目的：研究孕晚期早期血压（BP）升高与分娩后10-14年心脏代谢健康之间的关系。
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。
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。
