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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2019, Vol. 15 ›› Issue (05): 512 -519. doi: 10.3877/cma.j.issn.1673-5250.2019.05.006

Special Issue: ；

Original Article

Clinical value of 24-h ambulatory blood pressure monitoring for delivery of small for gestational age infants in preeclampsia

Lijuan Lyu1, Xin Zhou2, Wei He1, Aihua Yin1,†()   

  1. 1. Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou 511460, Guangdong Province, China
    2. Department of Cardiology, Tianjin Medical University General Hospital, Tianjin300052, China
  • Received:2019-04-09 Revised:2019-09-01 Published:2019-10-01
  • Corresponding author: Aihua Yin
  • About author:
    Corresponding author: Yin Aihua, Email:
  • Supported by:
    Key Program for Prevention and Control of Eproductive Health and Major Birth Defects of National Key R&D Program of China(2016YFC1000703); Guangdong Medical Research Found(B2019013)
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Objective

To explore the values of 24-h ambulatory blood pressure monitoring (ABPM) in predicting delivery of small for gestational age (SGA) infants of pregnant women with preeclampsia (PE).

Methods

A total of 733 pregnant women with PE who gave birth in Guangdong Maternal and Child Health Hospital from June 2015 to June 2017 were selected into this study. According to SGA infants and AGA infants delivered by PE pregnant women, they were divided into group A (n=399, PE pregnant women delivered SGA infants) and group B (n=334, PE pregnant women delivered AGA infants). The following items, such as maternal age, pre-pregnancy body mass index (BMI), gestational age at delivery, fetal birth weight, glycosylated hemoglobin (HbA1c), triacylglycerol (TG), low-density lipoprotein (LDL), diastolic blood pressure, systolic blood pressure, day systolic blood pressure (dSBP), night systolic blood pressure (nSBP), 24-h systolic blood pressure (24-h SBP), day diastolic blood pressure (dDBP), night diastolic blood pressure (nDBP), and 24-h diastolic blood pressure (24-h DBP), were compared by independent-samples t test between two groups. The indexes, such as systolic nocturnal pressure drop rate (SBP-DR) and diastolic nocturnal pressure drop rate (DBP-DR), were compared between two groups by using Mann-Whitney U test. Univariate and multivariate unconditional logistic regression analysis were used to analyze the relative factors associated with blood pressure in pregnant women with PE. The area under the receiver operating characteristic (ROC) curve (ROC-AUC) was calculated using the prediction model constituted by each parameter with statistically significant difference by using the " roccomp" command in Stata 15.0 statistical software, and multiple ROC curve comparisons were performed. The procedures followed in this study were in accordance with the World Medical Association Declaration of Helsinki as revised in 2013, and informed consent for the clinical study was obtained from all subjects.

Results

① Univariate analysis showed that there were significant differences in age, pre-pregnancy BMI, gestational age at delivery, fetal birth weight, HbA1c, TG, TC, LDL, diastolic blood pressure, and nSBP, 24-h SBP, dDBP, nDBP, 24-h DBP, 24-h DBP, SBP-DR, and DBP-DR between two groups (t=3.112, 2.564, 13.901, 27.073, 3.436, -2.165, -3.690, -3.021, -3.825, -2.557, -4.836, -7.423, -6.024, Z=4.221, 5.703; P<0.05). ②Univariate logistic regression analysis showed that diastolic pressure, nSBP, SBP, dDBP, nDBP, and 24-h DBP of PE pregnant women were independent risk factors for SGA (OR=1.118, 95%CI: 1.039-1.203, P=0.003; OR=1.216, 95%CI: 1.098-1.347, P<0.001; OR=1.172, 95%CI: 1.036-1.326, P=0.011; OR=1.221, 95%CI: 1.123-1.327, P<0.001; OR=1.287, 95%CI: 1.198-1.383, P<0.001; OR=1.282, 95%CI: 1.178-1.296, P<0.001). Multivariate unconditional logistic regression analysis showed that nSBP, 24-h SBP, dDBP, nDBP and 24-h DBP of PE pregnant women were independent risk factors for SGA (OR=1.265, 95%CI: 1.135-1.410, P<0.001; OR=1.238, 95%CI: 1.085-1.412, P=0.002; OR=1.221, 95%CI: 1.120-1.331, P<0.001; OR=1.289, 95%CI: 1.197-1.388, P<0.001). ③ The results of multiple ROC curve analysis showed that the ROC-AUC of nDBP in 24-h ABPM parameters was 0.694, which was significantly larger than 0.646 of CBP diastolic pressure, and the difference was statistically significant (χ2=8.982, P=0.003).

Conclusions

The nDBP in 24-h ABPM parameters is closely related to the delivery of SGA of pregnant women with PE, which provides a new idea for blood pressure management in pregnant women with PE.

Key words: Pre-eclampsia, Blood pressure determination, Hypertension, pregnancy-induced, Infant, small for gestational age, Pregnant women
表1 2组子痫前期孕妇单因素分析结果比较
项目 A组(n＝334) B组(n＝399) t值 P值
年龄(岁，±s) 30.0±5.0 31.2±5.3 t＝3.112 0.001
孕前BMI(kg/m2，±s) 21.1±3.0 21.7±3.0 t＝2.564 0.011
分娩孕龄(周，±s) 33.8±3.3 37.0±3.0 t＝13.901 <0.001
胎儿出生体重(g，±s) 1 534.3±555.6 2 852.8±730.6 t＝27.073 <0.001
HbA1c(%，±s) 5.3±0.3 5.4±0.5 t＝3.436 0.001
TG(mg/dL，±s) 3.7±1.7 3.4±1.6 t＝－2.165 0.031
LDL(mg/dL，±s) 3.5±1.2 3.2±0.9 t＝－3.690 <0.001
CBP参数 ? ? ? ?
? 收缩压(mmHg，±s) 140.7±14.1 139.6±13.2 t＝－1.072 0.284
? 舒张压(mmHg，±s) 90.0±10.1 87.8±10.0 t＝－3.021 0.003
24-h ABPM参数 ? ? ? ?
? dSBP(mmHg，±s) 141.2±11.6 139.7±12.0 t＝－1.682 0.093
? nSBP(mmHg，±s) 137.3±14.7 133.2±14.4 t＝－3.825 <0.001
? 24-h SBP(mmHg，±s) 140.2±11.6 137.9±12.3 t＝－2.557 0.011
? dDBP(mmHg，±s) 89.8±9.2 86.6±8.9 t＝－4.836 <0.001
? nDBP(mmHg，±s) 87.0±11.3 81.0±10.8 t＝－7.423 <0.001
? 24-h DBP(mmHg，±s) 89.1±9.2 85.1±8.9 t＝－6.024 <0.001
? SBP-DR[%，M(P25～P75)] 2.9 (－1.3～14.2) 4.8 (1.3～14.7) Z＝4.221 <0.001
? DBP-DR[%，M(P25～P75)] 3.2 (－2.3～17.48) 5.7 (1.8～19.7) Z＝5.703 <0.001
表2 子痫前期孕妇分娩小于胎龄儿的血压相关影响因素的单因素logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
收缩压(每升高10 mmHg) 0.058 0.054 1.148 0.284 1.060 0.953～1.180
舒张压(每升高5 mmHg) 0.112 0.037 8.807 0.003 1.118 1.039～1.203
dSBP(每升高10 mmHg) 0.106 0.063 2.822 0.093 1.112 0.982～1.259
nSBP(每升高10 mmHg) 0.196 0.052 13.377 <0.001 1.216 1.098～1.347
24-h SBP(每升高10 mmHg) 0.159 0.063 6.465 0.011 1.172 1.036～1.326
dDBP(每升高5 mmHg) 0.200 0.426 22.607 <0.001 1.221 1.123～1.327
nDBP(每升高5 mmHg) 0.252 0.036 31.763 <0.001 1.287 1.198～1.383
24-h DBP(每升高5 mmHg) 0.249 0.043 47.393 <0.001 1.282 1.178～1.296
表3 子痫前期孕妇分娩小于胎龄儿的血压相关影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
收缩压(每升高10 mmHg) 0.103 0.058 3.170 0.075 1.108 0.990～1.240
舒张压(每升高5 mmHg) 0.129 0.039 10.828 0.001 1.137 1.054～1.228
dSBP(每升高10 mmHg) 0.156 0.067 5.327 0.021 1.168 1.024～1.333
nSBP(每升高10 mmHg) 0.235 0.055 5.867 <0.001 1.265 1.135～1.410
24-h SBP(每升高10 mmHg) 0.213 0.067 9.550 0.002 1.238 1.085～1.412
dDBP(每升高5 mmHg) 0.200 0.044 20.291 <0.001 1.221 1.120～1.331
nDBP(每升高5 mmHg) 0.254 0.038 44.476 <0.001 1.289 1.197～1.388
24-h DBP(每升高5 mmHg) 0.254 0.038 29.115 <0.001 1.289 1.197～1.388
表4 不同指标预测子痫前期孕妇分娩小于胎龄儿的受试者工作特征曲线下面积
预测模型 ROC-AUC ROC-AUC 95%CI χ2值 P值a
基础模型＋舒张压 0.646 0.607～0.686 － －
基础模型＋nSBP 0.658 0.619～0.697 0.761 0.383
基础模型＋24-h SBP 0.645 0.606～0.685 0.013 0.918
基础模型＋dDBP 0.658 0.619～0.697 1.023 0.312
基础模型＋nDBP 0.694 0.656～0.732 8.982 0.003
基础模型＋24-h DBP 0.673 0.634～0.711 3.952 0.047
图1 不同指标预测子痫前期孕妇分娩小于胎龄儿的受试者工作特征曲线下面积
[1]
麦彩园，袁力，苏念军，等. 不同24 h尿蛋白定量子痫前期孕妇的妊娠结局分析[J/CD]. 中华妇幼临床医学杂志(电子版)，2019，15(2): 211-216.
[2]
Lees CC, Marlow N, van Wassenaer-Leemhuis A, et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial[J]. Lancet, 2015, 385(9983): 2162-2172.
[3]
Macdonald-Wallis C, Tilling K, Fraser A, et al. Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort[J]. Hypertension, 2014, 64(1): 36-44.
[4]
Tranquilli AL, Giannubilo SR. Blood pressure is elevated in normotensive pregnant women with intrauterine growth restriction[J]. Eur J Obstet Gynecol Reprod Biol, 2005, 122(1): 45-48.
[5]
Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy[J]. Cochrane Database Syst Rev, 2014, 2: CD002252.
[6]
Pels A, Mol BWJ, Singer J, et al. Influence of gestational age at initiation of antihypertensive therapy: secondary analysis of CHIPS trial data (Control of Hypertension in Pregnancy Study)[J]. Hypertension, 2018, 71(6): 1170-1177.
[7]
Salles GF, Reboldi G, Fagard RH, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: the ambulatory blood pressure collaboration in patients with hypertension (ABC-H) Meta-analysis[J]. Hypetension, 2016, 67(4): 693-700.
[8]
Kovo M, Schreiber L, Elyashiv O, et al. Pregnancy outcome and placental findings in pregnancies complicated by fetal growth restriction with and without preeclampsia[J]. Reprod Sci, 2015, 22(3): 316-321.
[9]
American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists′ Task Force on hypertension in pregnancy[J]. Obstet Gynecol, 2013, 122(5): 1122-1131.
[10]
Meekins JW, Pijnenborg R, Hanssens M, et al. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies[J]. Br J Obstet Gynaecol, 1994, 101(8): 669-674.
[11]
赵舒，严滨. 子痫前期与全身炎症反应关系的研究进展[J/CD]. 中华妇幼临床医学杂志(电子版)，2017，13(5): 616-620.
[12]
Krielessi V, Papantoniou N, Papageorgiou I, et al. Placental pathology and blood pressure′s level in women with hypertensive disorders in pregnancy[J]. Obstet Gynecol Int, 2012, 2012: 684083.
[13]
Chen CP, Bajoria R, Aplin JD. Decreased vascularization and cell proliferation in placentas of intrauterine growth-restricted fetuses with abnormal umbilical artery flow velocity waveforms[J]. Am J Obstet Gynecol, 2002, 187(3): 764-769.
[14]
Fisher SJ. Why is placentation abnormal in preeclampsia[J]. Am J Obstet Gynecol, 2015, 213(4 Suppl): S115-S122.
[15]
Walker CK, Krakowiak P, Baker A, et al. Preeclampsia, placental insufficiency, and autism spectrum disorder or developmental delay[J]. JAMA Pediatr, 2015, 169(2): 154-162.
[16]
Iwama N, Metoki H, Ohkubo T, et al. Maternal clinic and home blood pressure measurements during pregnancy and infant birth weight: the BOSHI study[J]. Hypertens Res, 2016, 39(3): 151-157.
[17]
Bakker R, Steegers EA, Hofman A, et al. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study[J]. Am J Epidemiol, 2011, 174(7): 797-806.
[18]
Starling AP, Shapiro AL, Sauder KA, et al. Blood pressure during pregnancy, neonatal size and altered body composition: the Healthy Start study[J]. J Perinatol, 2017, 37(5): 502-506.
[19]
Bakker R, Steegers EA, Hofman A, et al. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study[J]. Am J Epidemiol, 2011, 174(7): 797-806.
[20]
周欣．妊娠期增重与血压调节[J]．中国实用妇科与产科杂志，2018, 34(9)：983-986.
[21]
Liro M, Gasowski J, Wydra D, et al. Twenty-four-hour and conventional blood pressure components and risk of preterm delivery or neonatal complications in gestational hypertension[J]. Blood Press, 2009, 18(1-2): 36-43.
[22]
Tranquilli AL, Giannubilo SR, Dell′Uomo B, et al. Prediction of gestational hypertension or intrauterine fetal growth restriction by mid-trimester 24-h ambulatory blood pressure monitoring[J]. Int J Gynaecol Obstet, 2004, 85(2): 126-131.
[23]
Waugh J, Perry IJ, Halligan AW, et al. Birth weight and 24-hour ambulatory blood pressure in nonproteinuric hypertensive pregnancy[J]. Am J Obstet Gynecol, 2000, 183(3): 633-637.
[24]
Brown MA, Davis GK, McHugh L. The prevalence and clinical significance of nocturnal hypertension in pregnancy[J]. J Hypertens, 2001, 19(8): 1437-1444.
[25]
Salazar MR, Espeche WG, Leiva Sisnieguez BC, et al. Significance of masked and nocturnal hypertension in normotensive women coursing a high-risk pregnancy[J]. J Hypertens, 2016, 34(11): 2248-2252.
[26]
Eguchi K, Ohmaru T, Ohkuchi A, et al. Ambulatory BP monitoring and clinic BP in predicting small-for-gestational-age infants during pregnancy[J]. J Hum Hypertens, 2016, 30(1): 62-67.
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