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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
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