International gestational age-specific centiles for blood pressure in pregnancy from the INTERGROWTH-21st Project in 8 countries: A longitudinal cohort study

作者：Lauren J. Green, Stephen Kennedy, Lucy Mackillop, Stephen Gerry, Manorama Purwar, Eleonora Staines Urias, Leila Cheikh Ismail, Fernando C. Barros, César G. Victora, Maria Carvalho, Eric O. Ohuma, Yasmin A. Jaffer, J. Alison Noble, Michael G. Gravett, Ruyan Pang, Ann Lambert, Enrico Bertino, Aris T. Papageorghiou, Cutberto Garza, Zulfiqar A Bhutta, José Villar, Peter Watkinson · 发表于：PLoS Medicine · 年份：2021 · DOI：10.1371/journal.pmed.1003611 · 被引用次数：20 · 研究领域：Pregnancy and preeclampsia studies、Blood Pressure and Hypertension Studies、Birth, Development, and Health

BACKGROUND: Gestational hypertensive and acute hypotensive disorders are associated with maternal morbidity and mortality worldwide. However, physiological blood pressure changes in pregnancy are insufficiently defined. We describe blood pressure changes across healthy pregnancies from the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Fetal Growth Longitudinal Study (FGLS) to produce international, gestational age-specific, smoothed centiles (third, 10th, 50th, 90th, and 97th) for blood pressure. METHODS AND FINDINGS: Secondary analysis of a prospective, longitudinal, observational cohort study (2009 to 2016) was conducted across 8 diverse urban areas in Brazil, China, India, Italy, Kenya, Oman, the United Kingdom, and the United States of America. We enrolled healthy women at low risk of pregnancy complications. We measured blood pressure using standardised methodology and validated equipment at enrolment at <14 weeks, then every 5 ± 1 weeks until delivery. We enrolled 4,607 (35%) women of 13,108 screened. The mean maternal age was 28·4 (standard deviation [SD] 3.9) years; 97% (4,204/4,321) of women were married or living with a partner, and 68% (2,955/4,321) were nulliparous. Their mean body mass index (BMI) was 23.3 (SD 3.0) kg/m2. Systolic blood pressure was lowest at 12 weeks: Median was 111.5 (95% CI 111.3 to 111.8) mmHg, rising to a median maximum of 119.6 (95% CI 118.9 to 120.3) mmHg at 40 weeks' gestation, a difference of 8...