ArticleBMC pregnancy and childbirth2026
Pregnancy adverse outcomes associated with change of blood pressure categories in early pregnancy among women with normotension: a retrospective cohort study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe study aimed to estimate the effect on adverse maternal or infant outcomes associated with early pregnancy changes between blood pressure (BP) categories as defined in the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.
methodsBased on ACC/AHA criteria, blood pressure measurements collected in Zhoushan from 2002 to 2022 for 73,823 women with no prior hypertension were used to classify the study population in three blood pressure categories, namley normal BP, elevated BP and stage 1 hypertension, at two separate occasions before 20 weeks of gestation. Accounting for change in blood pressure category between meaurements led to nine patient groups for evalution of pregnancy outcomes. Bar charts and Logistic regression models were used to analyze the associations.
resultsThe incidence of elevated BP and Stage 1 hypertension at study visit 1 was 6.68% and 12.15%, respectively. The BP status worsened in 9,505 (12.88%) and improved in 8,921 (12.08%) women respectively at study visit 2. For women with normal BP at study visit 1, but Stage 1 hypertension at study visit 2, the risks of gestational hypertension (odds ratio, OR = 3.21, 95% confidence interval, CI: 2.79-3.68), preeclampsia (OR = 1.88, 95% CI: 1.30-2.72), gestational diabetic mellitus (OR = 1.76, 95% CI: 1.59-1.95), and postpartum hypertension (OR = 1.62, 95% CI: 1.36-1.92) significantly increased compared to women who retained a normal BP. In women with Stage 1 hypertension at study visit 1, but elevated or normal BP at visit 2 the risks of the above diseases decreased in stepwise fashion in accordance with their BP class classification. Similar trends also existed in the association between BP class changed and adverse neonatal outcomes.
conclusionChanges in BP categories, as defined in the ACC/AHA guidelines, occuring before 20 weeks were associated with subsequent pregnancy and delivery outcomes.
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