Gestational-age-specific reference ranges for blood pressure in pregnancy

Macdonald-Wallis, C., Silverwood, R. J., Fraser, A., Nelson, S. M. , Tilling, K., Lawlor, D. A. and de Stavola, B. L. (2015) Gestational-age-specific reference ranges for blood pressure in pregnancy. Journal of Hypertension, 33(1), pp. 96-105. (doi:10.1097/HJH.0000000000000368)

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Abstract

Objective: Pregnancy is a period of considerable change in blood pressure, with an early pregnancy decrease followed by a late pregnancy rise. High blood pressure in pregnancy is associated with adverse perinatal outcomes for the mother and offspring. We aimed to define normal ranges of blood pressure across gestation.

  Methods: We used repeated antenatal blood pressure measurements [median (interquartile range) 10 (9–11) per woman] for 10 327 women. Multilevel models were used to derive longitudinal reference ranges for SBP and DBP from 12 to 40 weeks gestation for the whole cohort, for women with normal pregnancies (without essential hypertension or preeclampsia who delivered an appropriate-size-for-gestational age infant at term) and for subgroups of normal pregnancies defined by different levels of maternal prepregnancy BMI, smoking and parity.

  Results: In normal pregnancies, the mean (95% reference range) SBP and DBP for nulliparous women at 12 weeks gestation were 112.1 (88.6–135.5) and 65.4 (48.9–81.9) mmHg, and at 37 weeks were 116.0 (92.3–139.7) and 70.0 (52.2–87.9) mmHg, respectively. For every additional 10 mmHg of blood pressure at 12 weeks, normal ranges were 2–3 mmHg higher across gestation. Reference ranges for multiparous women were 1–2 mmHg lower throughout pregnancy. Stratified reference ranges were higher for women in higher prepregnancy BMI categories, and lower for smokers than for nonsmokers throughout pregnancy.

  Conclusion: Normal ranges for blood pressure vary with gestation age and by maternal subgroups. Whole population and stratified normograms could be used as a reference to identify abnormal trajectories.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nelson, Professor Scott
Authors: Macdonald-Wallis, C., Silverwood, R. J., Fraser, A., Nelson, S. M., Tilling, K., Lawlor, D. A., and de Stavola, B. L.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Hypertension
Publisher:Lippincott Williams & Wilkins
ISSN:0263-6352
ISSN (Online):1473-5598
Copyright Holders:Copyright © 2015 Lippincott Williams & Wilkins
First Published:First published in the Journal of Hypertension 33(1):96-105
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
451351Maternal over nutrition and offspring fat mass, metabolic and vascular functionNaveed SattarNational Institute of Health (USA) (NIH(US))R01 DK077659-01RI CARDIOVASCULAR & MEDICAL SCIENCES