Skip to main content
SpringerLink
Log in

Early pregnancy stage 1 hypertension and high mean arterial pressure increased risk of adverse pregnancy outcomes in Shanghai, China

  • Article
  • Published:
Journal of Human Hypertension Submit manuscript

A Correction to this article was published on 01 June 2021

This article has been updated

Abstract

We aimed to evaluate the influence of early pregnancy stage 1 hypertension and mean arterial pressure (MAP) on the risk of pregnancy complications, including gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. Pregnant women without early pregnancy hypertension were consecutively recruited in 2010 in Shanghai, China. Total 6104 women with blood pressure (BP) <140/90 mmHg were categorized according to early pregnancy BP and MAP levels, respectively. Multivariate adjusted logistic regression and cox regression was used to test the potential associations. Finally 313 (5.1%) pregnant women identified as stage 1 hypertension. Compared with normotensive women, women with early pregnancy stage 1 hypertension increased the risk of gestational hypertension (GH) [Adjust odds ratio (AOR) 2.295, 95% confidence interval (CI) 1.578–3.338], GDM [AOR 1.185, 95% CI 1.010–1.391], preeclampsia [AOR 2.295 95% CI 1.578–3.338], preterm delivery [AOR 1.326, 95% CI 1.026–1.713]and infants with low-birth weight [AOR 1.487, 95% CI 1.082–2.045]; Compared women with MAP < 76 mmHg, the risk of GDM increased, with an adjust hazard ratio (AHR) of 1.387 (95%CI 1.048–1.835) for 76 ≤ MAP < 88 mmHg and an AHR of 1.451 (95%CI 1.053–1.998) for MAP ≥ 88 mmHg. Especially, high MAP levels (≥ 88 mmHg) are associated with GH [AOR 2.775, 95%CI 1.805–4.266], preeclampsia [AOR 3.936, 95%CI 2.358–6.570] and preterm delivery [AOR 1.412, 95%CI 1.035–1.926]. In summary early pregnancy stage 1 hypertension is associated with adverse pregnancy outcomes. Relative higher BP levels in early pregnancy, especially elevated MAP levels should be aware by clinicians to decrease the risk of pregnancy complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Change history

References

  1. Falster K, Hanly M, Banks E, Lynch J, Chambers G, Brownell M, et al. Maternal age and offspring developmental vulnerability at age five: a population-based cohort study of Australian children. PLoS Med. 2018;15:e1002558.

    Article  Google Scholar 

  2. Chu SY, Bachman DJ, Callaghan WM, Whitlock EP, Dietz PM, Berg CJ, et al. Association between obesity during pregnancy and increased use of health care. N. Engl J Med. 2008;358:1444–53.

    Article  CAS  Google Scholar 

  3. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA. Liver disease in pregnancy. Lancet. 2010;375:594–605.

    Article  Google Scholar 

  4. Chen X, Zhao D, Mao X, Xia Y, Baker PN, Zhang H. Maternal dietary patterns and pregnancy outcome. Nutrients. 2016;8:351.

    Article  Google Scholar 

  5. Bramham K, Parnell B, Nelsonpiercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.

    Article  Google Scholar 

  6. Jong FD, Monuteaux MC, Elburg RMV, Gillman MW, Belfort MB. Systematic review and meta-analysis of preterm birth and later systolic blood pressure. Hypertension. 2012;59:226.

    Article  Google Scholar 

  7. Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol. 1996;88:309.

    Article  CAS  Google Scholar 

  8. Watila MM, Beida O, Kwari S, Nyandaiti NW, Nyandaiti YW. Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: one year prospective study. Seizure. 2015;26:7–11.

    Article  Google Scholar 

  9. Abroug F, Boujdaria R, Nouira S, Abroug S, Souissi M, Najjar MF, et al. Hellp syndrome: incidence and maternal-fetal outcome-a prospective study. Intensive Care Med. 1992;18:274–7.

    Article  CAS  Google Scholar 

  10. Leon MG, Moussa HN, Longo M, Pedroza C, Haidar ZA, Mendez-Figueroa H, et al. Rate of gestational diabetes mellitus and pregnancy outcomes in patients with chronic hypertension. Am J Perinatol. 2016;33:745–50.

    Article  Google Scholar 

  11. Charles R, Swales C, Bonnett T, Bonnett P. Hypertensive disorder of pregnancy. BMJ. 2017;356:j285.

    Article  Google Scholar 

  12. National Collaborating Centre for Ws, Children’s H. National Institute for Health and Clinical Excellence: Guidance. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: RCOG Press Copyright © 2011, Royal College of Obstetricians and Gynaecologists; 2010.

  13. Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138:e426–e483. 2017

    PubMed  Google Scholar 

  14. Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, et al. Status of hypertension in China: results from the China hypertension survey, 2012–2015. Circulation. 2018;137:2344–56.

    Article  Google Scholar 

  15. Mayrink J, Souza RT, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, et al. Mean arterial blood pressure: potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women. BMC Pregnancy Childbirth. 2019;19:460.

    Article  CAS  Google Scholar 

  16. Salles GF, Schlüssel MM, Farias DR, Francosena AB, Rebelo F, Lacerda EM, et al. Blood pressure in healthy pregnancy and factors associated with no mid-trimester blood pressure drop: a prospective cohort study. Am J Hypertens. 2015;28:680–9.

  17. Segal O, Segal G, Leibowitz A, Goldenberg I, Grossman E, Klempfner R. Elevation in systolic blood pressure during heart failure hospitalization is associated with increased short and long-term mortality. Medicine. 2017;96:e5890.

    Article  Google Scholar 

  18. Cnossen JS, Vollebregt KC, de Vrieze N, ter Riet G, Mol BW, Franx A, et al. Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis. BMJ. 2008;336:1117–20.

    Article  Google Scholar 

  19. Group NDD. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979;28:1039–57.

    Article  Google Scholar 

  20. Scheller NM, Pasternak B, Mølgaard-Nielsen D, Svanström H, Hviid A. Quadrivalent HPV vaccination and the risk of adverse pregnancy outcomes. N. Engl J Med. 2017;376:1223.

    Article  Google Scholar 

  21. Viale L, Allotey J, Cheongsee F, Arroyomanzano D, Mccorry D, Bagary M, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015;386:1845–52.

    Article  Google Scholar 

  22. Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018;218:S745–61.

    Article  CAS  Google Scholar 

  23. Everett TR, Lees CC. Beyond the placental bed: placental and systemic determinants of the uterine artery Doppler waveform. Placenta. 2012;33:893–901.

    Article  CAS  Google Scholar 

  24. Hu J, Li Y, Zhang B, Zheng T, Li J, Peng Y, et al. Impact of the 2017 ACC/AHA guideline for high blood pressure on evaluating gestational hypertension-associated risks for newborns and mothers. Circ Res. 2019;125:184–94.

    Article  CAS  Google Scholar 

  25. Wu DD, Gao L, Huang O, Ullah K, Guo MX, Liu Y, et al. Increased adverse pregnancy outcomes associated with stage 1 hypertension in a low-risk cohort: evidence from 47 874 cases. Hypertension. 2020;75:772–80.

    Article  CAS  Google Scholar 

  26. Reddy M, Rolnik DL, Harris K, Li W, Mol BW, Da Silva CostaF, et al. Challenging the definition of hypertension in pregnancy: a retrospective cohort study. Am J Obstet Gynecol. 2020;222:606.e1–21.

    Article  Google Scholar 

  27. Johnson AM, Olefsky JM. The origins and drivers of insulin resistance. Cell .2013;152:673.

    Article  CAS  Google Scholar 

  28. Solymoss BCharles, Marcil M, Mostafa Chaour M, Gilfix Brian, Mark Anne-Marie, Poitras R, et al. Fasting hyperinsulinism, insulin resistance syndrome, and coronary artery disease in men and women. Am J Cardiol. 1995;76:1152–6.

    Article  CAS  Google Scholar 

  29. Morton JS, Cooke CL, Davidge ST. In utero origins of hypertension: mechanisms and targets for therapy. Physiological Rev. 2016;96:549.

    Article  CAS  Google Scholar 

  30. Rosner JY, Gutierrez M, Dziadosz M, Pham A, Bennett TA, Dolin C, et al. Prehypertension in early pregnancy: what is the significance? Am J Perinatol. 2016;34:117–22.

    Article  Google Scholar 

  31. Xydopoulos G, Perry H, Sheehan E, Thilaganathan B, Fordham R, Khalil A. Home blood-pressure monitoring in a hypertensive pregnant population: cost-minimization study. Ultrasound Obstet Gynecol. 2019;53:496–502.

    Article  CAS  Google Scholar 

  32. Higgins JR, de Swiet M. Blood-pressure measurement and classification in pregnancy. Lancet. 2001;357:131–5.

    Article  CAS  Google Scholar 

  33. Gynecologists TACoOa. ACOG Committee Opinion No. 743 Summary: low-dose aspirin use during pregnancy. Obstet Gynecol. 2018;132:254–6.

    Article  Google Scholar 

  34. Tabacova S, Little R, Tsong Y, Vega A, Kimmel CA. Adverse pregnancy outcomes associated with maternal enalapril antihypertensive treatment. Pharmacoepidemiol Drug Saf. 2003;12:633–46.

    Article  CAS  Google Scholar 

  35. Buttar HS. An overview of the influence of ACE inhibitors on fetal-placental circulation and perinatal development. Mol Cell Biochem. 1997;176:61–71.

    Article  CAS  Google Scholar 

  36. Pieper PG. Use of medication for cardiovascular disease during pregnancy. Nat Rev Cardiol. 2015;12:718–29.

    Article  CAS  Google Scholar 

  37. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009;374:979–88.

    Article  Google Scholar 

  38. Langenveld J, Broekhuijsen K, van Baaren GJ, van Pampus MG, van Kaam AH, Groen H, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks’ gestation (HYPITAT-II): a multicentre, open-label randomised controlled trial. BMC Pregnancy Childbirth. 2011;11:50.

    Article  Google Scholar 

  39. Amro F, Sibai B. Management of hypertension in pregnancy. Semin Fetal Neonatal Med. 2020;25:101147.

  40. Saeedi M, Cao Y, Fadl H, Gustafson H, Simmons D. Increasing prevalence of gestational diabetes mellitus when implementing the IADPSG criteria: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2021;172:108642.

    Article  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (grant no. 81872720) and Shanghai Municipal Commission of Health and Family Planning (grant no. 201840066) to Pro. Lijuan Zhang.

Author information

Authors and Affiliations

  1. Shanghai East Hospital, Key Laboratory of Arrhythmias, Ministry of Education, Tongji University School of Medicine, Tongji University, Shanghai, China

    Qi Li, Liang Zheng, Yijun Gu, Dongming Jiang, Jue Li & Lijuan Zhang

  2. Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China

    Guanghua Wang

Authors
  1. Qi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liang Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yijun Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dongming Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guanghua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jue Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lijuan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jue Li or Lijuan Zhang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The original version of this article unfortunately contained a mistake. The abstract was incomplete.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Q., Zheng, L., Gu, Y. et al. Early pregnancy stage 1 hypertension and high mean arterial pressure increased risk of adverse pregnancy outcomes in Shanghai, China. J Hum Hypertens 36, 917–924 (2022). https://doi.org/10.1038/s41371-021-00523-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-021-00523-6

  • Springer Nature Limited

This article is cited by

Search

Navigation