Blood Pressure, Obesity, and Diabetes in Relation to Perinatal and Postpartum Complications

血压、肥胖和糖尿病与围产期和产后并发症的关系

基本信息

批准号：
10373113
负责人：
Yeyi Zhu
金额：
$ 74.36万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10373113
关键词：
Address Admission activity Affect American American College of Obstetricians and Gynecologists American Heart Association Antihypertensive Agents Blood Pressure California Cardiology Cardiovascular system Categories Cesarean section Chronic Clinical Clinical Data Clinical Management Cohort Studies Complications of Diabetes Mellitus Comprehensive Health Care Computerized Medical Record Conflict (Psychology)Data Deltastab Diabetes Mellitus Diagnosis Diastolic blood pressure Eclampsia Fetus Guidelines Health Hospitalization Hypertension Impairment Individual Integrated Health Care Systems Joints Knowledge Lead Life Malnutrition Maternal Mortality Maternal complication Measurement Measures Monitor Morbidity - disease rate Neonatal Neonatal Intensive Care Units Obesity Outcome Overnutrition Patients Perfusion Perinatal Pharmaceutical Preparations Population Positioning Attribute Postpartum Period Pre-Eclampsia Pregnancy Pregnancy Rate Pregnant Women Premature Birth Public Health Recommendation Research Risk Small for Gestational Age Infant System Time Triage Uncertainty Weight Woman Women&apos s Group blood pressure reduction cardiovascular risk factor care systems clinical care college comorbidity ethnic minority fetal hypertensive improved intrapartum maternal morbidity offspring perinatal complications perinatal outcomes personalized care population based postpartum care postpartum complications postpartum outcome pregnancy disorder pregnant prenatal racial and ethnic risk stratification severe maternal morbidity

项目摘要

PROJECT SUMMARY/ABSTRACT Hypertensive disorders in pregnancy (HDP) are a leading cause of maternal morbidity, affecting over 350,000 pregnant U.S. women annually. HDP rates increased dramatically in the past decades. Clinical care and management for this growing group of women is complicated, however, by conflicting guidelines, uncertain evidence for postpartum care, and important comorbidities that may impact outcomes. In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) issued new guidelines to define chronic hypertension by using lower systolic/diastolic blood pressure (SBP/DBP) thresholds (stage 1 hypertension, 130-139/80-89; stage 2, ≥140/90 mmHg) down from ≥140/90. In 2019, the American College of Obstetricians and Gynecologists (ACOG) confirmed much of this recommendation but did not apply the lower BP thresholds to diagnose new-onset HDP, due to the lack of data on the associations between these lower BP thresholds with prenatal and postpartum complication. The ACOG also recognized it is not scientifically substantiated to use the 20-week mark to determine whether hypertension predates pregnancy or is pregnancy-related, calling for examination of BP trajectories across pregnancy. Further, due to fragmented postpartum care, little is known about postpartum hypertensive disorders and associated hospitalization and severe maternal morbidity. Finally, pre-existing obesity and diabetes often cluster with HDP and complicate the association between BP in pregnancy and risk of complications. To address these critical knowledge gaps, we propose a population- based cohort study of ~0.5 million demographically diverse women who delivered singletons in 2007-2019 at Kaiser Permanente Northern California (KPNC), an integrated health care system with a stable membership and comprehensive electronic medical record data. We are uniquely positioned to timely address the important concern regarding the unknown association of the 2017 ACC/AHA defined BP categories in pregnancy with perinatal and postpartum complications (Aims 1-2). Leveraging KPNC’s unique longitudinal tracking of BP and weight before, during, and after pregnancy and robust diabetes diagnosis data before pregnancy, we will be able to efficiently dissect the joint effects of BP in pregnancy with comorbid obesity and diabetes on perinatal and postpartum complications (Aims 1-2). Finally, we will examine BP trajectories on a continuum before 20 weeks of gestation and across pregnancy with risk of complications (Aim 3). This study provides a timely and unparalleled opportunity to address the concerns arising from the conflicts between the ACC/AHA and ACOG guidelines regarding how to manage pregnant women with BP levels lower than conventional thresholds. Our findings may help identify at which BP level, and in which time window, closer patient surveillance and change in management may be initiated. Further, our findings may provide clinicians with sorely needed data to inform early clinical triage and risk stratification of women with combinations of certain BP categories in pregnancy and comorbid obesity and diabetes, thus enhancing individualized care decision and efficiency.

项目概要/摘要妊娠期高血压疾病 (HDP) 是孕产妇发病的主要原因，影响超过 350,000 人在过去的几十年里，美国孕妇的 HDP 发病率每年急剧增加。然而，由于指导方针相互冲突、不确定，对这一不断增长的妇女群体的管理十分复杂。 2017 年，美国产后护理以及可能影响结果的重要合并症的证据。心脏病学院/美国心脏协会 (ACC/AHA) 发布新指南来定义慢性病通过使用较低的收缩压/舒张压 (SBP/DBP) 阈值来治疗高血压（1 期高血压， 130-139/80-89；第 2 阶段，≥140/90 mmHg）从 2019 年的 ≥140/90 下降。妇科医生 (ACOG) 证实了这一建议的大部分内容，但没有应用较低的血压阈值由于缺乏这些较低血压阈值之间关联的数据，无法诊断新发 HDP ACOG 也承认这一说法没有科学依据。使用 20 周标记来确定高血压是否早于怀孕或与怀孕有关，呼吁此外，由于产后护理分散，对整个怀孕期间血压轨迹的检查也很少。了解产后高血压疾病以及相关的住院治疗和严重的孕产妇发病率。最后，先前存在的肥胖和糖尿病通常与 HDP 聚集在一起，并使血压与高血压之间的关联复杂化。为了解决这些关键的知识差距，我们提出了一项人口- 基于 2007 年至 2019 年约 50 万名人口多样化的单身女性的队列研究北加州凯撒医疗机构 (KPNC)，一个拥有稳定会员资格的综合医疗保健系统我们拥有独特的优势，可以及时解决重要的问题。 2017 年 ACC/AHA 定义的血压类别与妊娠期血压之间的未知关联令人担忧利用 KPNC 独特的血压和产后并发症纵向追踪。怀孕前、怀孕期间和怀孕后的体重以及孕前可靠的糖尿病诊断数据，我们将能够有效剖析妊娠合并肥胖和糖尿病的血压对围产期的联合影响最后，我们将检查 20 日前的连续血压轨迹。妊娠周和整个妊娠期间存在并发症的风险（目标 3）。解决因 ACC/AHA 和 ACOG 之间冲突引起的担忧的无与伦比的机会关于如何管理血压水平低于常规阈值的孕妇的指南。研究结果可能有助于确定血压水平和时间窗口，更密切地监测和改变患者此外，我们的调查结果可能会为上级提供急需的数据以供参考。对怀孕期间合并某些血压类别的女性进行早期临床分诊和风险分层以及肥胖和糖尿病共病，从而提高个性化护理决策和效率。