Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis

Loerup, Lise; Pullon, Rebecca; Birks, Jacqueline; Fleming, Susannah; Mackillop, Lucy; Gerry, Stephen; Watkinson, Peter

doi:10.1186/s12916-019-1399-1

Cited by 71 publications

(74 citation statements)

References 69 publications

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“…However, epidemiologic data are limited in the absence of defined diagnostic criteria for women with prepregnancy hypertension and/or proteinuria. Physiologic adaptations of pregnancy include a fall in BP, with a nadir in the second trimester, before rising again toward term (6). There is also gestational increase in proteinuria because of physiologic hyperfiltration and change in glomerular pore size (7,8).…”

Section: Definitions Of Preeclampsiamentioning

confidence: 99%

Updates in Diagnosis and Management of Preeclampsia in Women with CKD

Wiles

Chappell

Lightstone

et al. 2020

CJASN

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It is estimated that women with CKD are ten times more likely to develop preeclampsia than women without CKD, with preeclampsia affecting up to 40% of pregnancies in women with CKD. However, the shared phenotype of hypertension, proteinuria, and impaired excretory kidney function complicates the diagnosis of superimposed preeclampsia in women with CKD who have hypertension and/or proteinuria that predates pregnancy. This article outlines the diagnoses of preeclampsia and superimposed preeclampsia. It discusses the pathogenesis of preeclampsia, including abnormal placentation and angiogenic dysfunction. The clinical use of angiogenic markers as diagnostic adjuncts for women with suspected preeclampsia is described, and the limited data on the use of these markers in women with CKD are presented. The role of kidney biopsy in pregnancy is examined. The management of preeclampsia is outlined, including important advances and controversies in aspirin prophylaxis, BP treatment targets, and the timing of delivery.

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Section: Definitions Of Preeclampsiamentioning

confidence: 99%

Updates in Diagnosis and Management of Preeclampsia in Women with CKD

Wiles

Chappell

Lightstone

et al. 2020

CJASN

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“…A systematic review published in 2019 also reported that DBP was lowest at 21 weeks in women with normal pregnancies, but the lowest SBP was found at 10 weeks. The findings of this systematic review, however, were inconclusive because of substantial heterogeneity in the racial and social characteristics of the pregnant women in the study, study design, and time and method of BP measurements 20 …”

Section: Discussionmentioning

confidence: 83%

Correlations of spot urinary sodium and potassium with blood pressure in pregnant women: A longitudinal study in Southern Thailand

Jandee

Liabsuetrakul

Sriwimol

et al. 2020

Intl J Gynecology & Obste

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Objective To assess the changes of spot urinary sodium and potassium and blood pressure (BP) throughout pregnancy and their correlations in southern Thailand. Methods A longitudinal study was conducted in southern Thailand from March 2018 to November 2019. Spot urinary excretion of sodium per creatinine (U[Na+]/[Cr]), potassium per creatinine (U[K+]/[Cr]) and U[Na+]/[K+] ratios, and BP were measured at four time points throughout pregnancy. A one‐way analysis of variance with repeated measures and Bonferroni correction with post hoc analysis was used to identify significant differences between time points. The correlations were measured using Pearson’s correlation coefficients. Results A total of 327 pregnant women were included. Both systolic and diastolic BPs decreased gradually from up to 14 weeks of pregnancy to 18–22 weeks and then increased until 30–34 weeks. Mean spot U[Na+]/[Cr] ratios did not significantly change during the study period. Mean spot U[K+]/[Cr] ratios gradually increased, and spot U[Na+]/[K+] ratios gradually decreased. The correlation of spot U[Na+]/[Cr] and U[K+]/[Cr] ratios with BPs was weakly negative at all four time points. Conclusions Spot U[Na+]/[Cr] and U[K+]/[Cr] ratios are inversely correlated with BPs; weak correlations are found among pregnant women in southern Thailand. Further research in different populations is required to confirm its correlation and broader use.

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“…In our previous systematic review, we could not find reliable estimations of the outer centiles of heart rate postpartum. 6 In our previous work with the 4P cohort, heart rates higher than 100 bpm occurred in more than 10% of women at 40 weeks of gestation. 25 Postpartum heart rates of greater than 100 bpm were much less common, with the 90th centile for heart rate 100 bpm or less from day 1 postpartum.…”

Section: Discussionmentioning

confidence: 86%

“… 5 Identification of physiologic deterioration postpartum needs improvement, 4 but normal vital sign ranges are poorly defined. 6 Previous studies usually report values on one or two occasions often several weeks postpartum. 7 – 14 Daily data are rare, often small-scale, and outdated (Walters BNJ, Walters T. Hypertension in the puerperium [letter].…”

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confidence: 99%

“… 15 Fewer data exist for other vital signs postpartum. 6 Recommended vital signs ranges in national reports (United Kingdom, 16 Ireland, 17 United States 18 ), and modified obstetric early warning scores thresholds 19 – 22 are based on expert opinion, with wide national and international variation. Thresholds used during pregnancy are used after birth, without accommodating changes for postpartum maternal physiology.…”

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confidence: 99%

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Postpartum-Specific Vital Sign Reference Ranges

Green¹,

Pullon²,

Mackillop³

et al. 2021

Obstetrics &Amp; Gynecology

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Appendix 5. Analysis to Assess the Agreement between Self-and Clinician-Recorded ObservationsThese Bland-Altman plots represent the agreement between clinician-recorded and self-recorded vital signs recorded within one hour of each other. The purpose of this analysis was to ascertain whether it was appropriate to pool both sets of measurements in the primary analyses. Since the vital signs were not necessarily recorded simultaneously, but may be up to an hour apart, we do not expect perfect agreement. The main interest was to assess whether there was a systematic bias (i.e. the mean difference is not equal to zero) between clinician and self-recorded vital signs. Any bias would be concerning since this would suggest that clinician and self-recorded measurements may systematically differ, i.e. are not measuring the same thing.There were 517 sets of observations where there were duplicate readings within one hour of each other. The Bland-Altman plots below show little evidence of any bias, since in each case the mean difference is near to zero. In some cases, there is considerable variability (notably heart rate), but this is commensurate with the measurements being recorded up to an hour apart. We were thus satisfied that it was appropriate to combine clinician and self-recorded observations in our primary analyses.

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Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis

Cited by 71 publications

References 69 publications

Updates in Diagnosis and Management of Preeclampsia in Women with CKD

Updates in Diagnosis and Management of Preeclampsia in Women with CKD

Correlations of spot urinary sodium and potassium with blood pressure in pregnant women: A longitudinal study in Southern Thailand

Postpartum-Specific Vital Sign Reference Ranges

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