Blood pressure measurements within the JNC7 pre-hypertensive range after 32 weeks of gestation are a risk factor for decreased fetal growth

Fukushima, Kotaro; Morokuma, Seiichi; Tsukimori, Kiyomi; Murata, Mariko; Wake, Norio

doi:10.1038/hr.2011.158

Cited by 15 publications

(11 citation statements)

References 8 publications

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“…29 However, emerging evidence suggests that elevated BP among pregnant women without HDP is associated with increased risk of poor offspring health outcomes including fetal growth restriction and preterm delivery. [32][33][34][35] Our study extends these findings to an adverse maternal health outcome in later life.…”

Section: Discussionsupporting

confidence: 71%

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

Dunietz

Strutz

Holzman

et al. 2017

BJOG

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Objective Hypertensive disorders in pregnancy signal an increased risk of cardiovascular disease for women. However, future hypertension risk among pregnant women with moderately elevated blood pressure (BP) is unknown. We examined associations among moderately elevated BP or hypertensive disorders during pregnancy and later prehypertension or hypertension. Design Longitudinal cohort study. Setting Five communities in Michigan, USA. Sample Data are from pregnant women enrolled in the Pregnancy Outcomes and Community Health Study. We included 667 women with gestational BP measurements who participated in the POUCHmoms Study follow-up 7-15 years later. Methods Moderately elevated BP was defined as two measures of systolic BP ≥120 mmHg or diastolic BP ≥80 mmHg among women without a hypertensive disorder. Weighted multinomial logistic regression models estimated odds of prehypertension or hypertension at follow-up, adjusted for maternal confounders and time to follow-up. Main Outcome Measures Prehypertension or hypertension. Results Women meeting the moderately elevated BP criteria (64%) had significantly higher odds of hypertension at follow-up (adjusted odds ratio =2.6; 95% confidence interval: 1.2-5.5). These increased odds were observed for moderately elevated BP first identified before or after 20 weeks, and for elevated systolic BP alone or combined with elevated diastolic BP. Conclusions Moderately elevated BP in pregnancy may be a risk factor for future hypertension. Pregnancy offers an opportunity to identify women at risk for hypertension who may not have been identified otherwise.

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Section: Discussionsupporting

confidence: 71%

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

Dunietz

Strutz

Holzman

et al. 2017

BJOG

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“…We are only aware of 2 earlier studies on the effect of level of blood pressure in nonhypertensive pregnancies on fetal growth, 6,9 and both studies report results in accordance with ours. One small Japanese study found that women with prehypertension at 32 gestational weeks had a slightly increased risk of SGA birth (odds ratio 1.09; 95% CI 1.01-1.17) compared with normotensive women.…”

Section: Comparisons To Earlier Studiessupporting

confidence: 76%

“…One small Japanese study found that women with prehypertension at 32 gestational weeks had a slightly increased risk of SGA birth (odds ratio 1.09; 95% CI 1.01-1.17) compared with normotensive women. 6 The study only included 71 women with prehypertension, and adjustments were solely made for maternal BMI. The second study reports the highest birth weights in pregnancies where the highest recorded DBP during pregnancy was 80 mm Hg (at higher blood pressure levels, the birth weights decreased).…”

Section: Comparisons To Earlier Studiesmentioning

confidence: 99%

“…This study was small, but the results indicate that prehypertension at 32 gestational weeks is associated with a slightly increased risk of a small-for-gestational-age (SGA) birth. 6 During normal pregnancy, blood pressure generally decreases from the first trimester to around 20 gestational weeks and thereafter increase until delivery. 7 Larger increases in blood pressures from the early second to the third trimester are related to reduced fetal growth [8][9][10][11] and increased risk of pregnancy hypertensive disorders.…”

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confidence: 99%

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Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

et al. 2016

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Abstract-It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (≥37 weeks) singleton births (n=157 446). Using normotensive (diastolic blood pressure [DBP] <80 mm Hg) women as reference, we calculated adjusted odds ratios with 95% confidence intervals between prehypertension (DBP 80-89 mm Hg) at 36 gestational weeks (late pregnancy) and risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51-1.90) and 1.70 (1.16-2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5-2.8) per each mm Hg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth. (Hypertension.

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“…For nonpregnant adults, the risk of cardio vascular disease increases linearly as BP increases, even within the normo tensive range (Vasan et al 2001;Williams et al 2008). A few studies have examined BP as a continuous measure and found that higher BP, even within the normotensive range, also may impact birth weight and intra uterine growth restriction (Churchill et al 1997;Fukushima et al 2012). It is possible that elevated BP, albeit within the clinically normal range, alters uterine and placental perfusion, and impacts fetal growth.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Changes in Relation to Arsenic Exposure in a US Pregnancy Cohort

Farzan¹,

Chen²,

Murphy³

et al. 2014

ISEE Conference Abstracts

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Blood pressure measurements within the JNC7 pre-hypertensive range after 32 weeks of gestation are a risk factor for decreased fetal growth

Abstract: CORRESPONDENCEBlood pressure measurements within the JNC7 pre-hypertensive range after 32 weeks of gestation are a risk factor for decreased fetal growth

Cited by 15 publications

References 8 publications

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study

Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth

Blood Pressure Changes in Relation to Arsenic Exposure in a US Pregnancy Cohort

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