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：
10600834
负责人：
Yeyi Zhu
金额：
$ 74.27万
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/10600834
关键词：
Address Admission activity Affect Agreement 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 Comprehensive Health Care Computerized Medical Record Data Diabetes Mellitus Diagnosis Diastolic blood pressure Eclampsia 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 Newly Diagnosed 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 Time Triage Uncertainty Weight Woman Women&apos s Group blood pressure reduction cardiovascular risk factor care systems clinical care college comorbidity electronic medical record system ethnic minority fetal fetus nutrition hypertensive improved intrapartum maternal morbidity offspring personalized care population based post pregnancy postpartum care postpartum complications postpartum outcome pregnancy disorder pregnancy hypertension pregnant prenatal racial minority 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.

项目摘要/摘要怀孕（HDP）的高血压疾病是孕产妇发病率的主要原因，影响了35万以上每年怀孕的美国妇女。在过去的几十年中，HDP率急剧增加。临床护理和但是，通过相互矛盾的准则，这一不断增长的妇女的管理很复杂，不确定产后护理的证据以及可能影响结果的重要合并症。 2017年，美国人心脏病学/美国心脏协会（ACC/AHA）发布了新的指南，以定义慢性通过使用较低的收缩/舒张压（SBP/DBP）阈值（第1期高血压， 130-139/80-89;第2阶段，≥140/90 mmHg）从≥140/90降低。 2019年，美国产科学院妇科医生（ACOG）确认了大部分建议，但没有应用较低的BP阈值由于缺乏有关这些较低BP阈值之间关联的数据，诊断新发行的HDP 产前和产后并发症。 ACOG还认识到它没有科学证实使用20周的标记来确定高血压是否早于怀孕还是与怀孕有关用于检查整个怀孕的BP轨迹。此外，由于产后碎片，几乎没有关于产后高血压疾病以及相关的住院以及严重的母亲发病率的已知。最后，预先存在的肥胖症和糖尿病经常与HDP聚集，并使BP之间的关联复杂化怀孕和并发症的风险。为了解决这些关键的知识差距，我们提出了一个人群 - 基于大约550万在人口统计学多样化的女性的同类研究，她们在2007 - 2019年在 Kaiser Permanente North California（KPNC），一种综合医疗保健系统，具有稳定的会员资格和全面的电子病历数据。我们有独特的位置，可以及时解决重要的问题对2017年ACC/AHA未知关联在怀孕中定义的BP类别的关注围产期和产后并发症（目标1-2）。利用KPNC的BP和怀孕前，期间，期间，期间和强大的糖尿病诊断数据在怀孕前的体重，我们将有效地剖析了BP在妊娠中与合并症肥胖和糖尿病对围产期的关节作用和产后并发症（目标1-2）。最后，我们将在20之前检查连续体的BP轨迹妊娠数周和怀孕，并有并发症的风险（AIM 3）。这项研究提供了及时的无与伦比的机会解决了ACC/AHA与ACOG之间的冲突引起的担忧有关如何管理BP水平低于常规阈值的孕妇的指南。我们的调查结果可能有助于确定哪个BP水平，以及在哪个时间窗口，更近的患者监视和更改在管理中可能会启动。此外，我们的发现可能会为临床医生提供非常需要的数据以告知妊娠某些BP类别组合的女性的早期临床分类和风险分层以及合并症的肥胖和糖尿病，从而增强了个性化的护理决策和效率。