title: Prehypertension During Normotensive Pregnancy and Postpartum Clustering of Cardiometabolic Risk Factors: A Prospective Cohort Study.
abstract: The nonstratification of blood pressure (BP) levels may underestimate future cardiovascular risk in pregnant women who present with BP levels in the range of prehypertension (120-139/80-89 mm Hg). We prospectively evaluated the relationship between multiple antepartum BP measurements (from 11(+0) to 13(+6) weeks' gestation to term) and the occurrence of postpartum metabolic syndrome in 507 normotensive pregnant women after a live birth. By using latent class growth modeling, we identified the following 3 distinctive diastolic BP (DBP) trajectory groups: the low-J-shaped group (34.2%; DBP from 62.5±5.8 to 65.0±6.8 mm Hg), the moderate-U-shaped group (52.6%; DBP from 71.0±5.9 to 69.8±6.2 mm Hg), and the elevated-J-shaped group (13.2%; DBP from 76.2±6.7 to 81.8±4.8 mm Hg). Notably, the elevated-J-shaped trajectory group had mean DBP and systolic BP levels within the range of prehypertension from 37(+0) and 26(+0) weeks of pregnancy, respectively. Among the 309 women who completed the ≈1.6 years of postpartum follow-up, the women in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome (adjusted odds ratio, 6.55; 95% confidence interval, 1.79-23.92; P=0.004) than the low-J-shaped group. Moreover, a parsimonious model incorporating DBP (membership in the elevated-J-shaped group but not in the DBP prehypertension group as identified by a single measurement) and elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term was developed, with good discrimination and calibration for postpartum metabolic syndrome (c-statistic, 0.764; 95% confidence interval, 0.674-0.855; P<0.001). Therefore, prehypertension identified by DBP trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women.
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Qiong
authors.initials: Q
authors.lastname: Lei
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Yu-Heng
authors.initials: YH
authors.lastname: Zhou
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Cai-Yuan
authors.initials: CY
authors.lastname: Mai
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Ming-Min
authors.initials: MM
authors.lastname: Hou
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Lv
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Duan
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Ji-Ying
authors.initials: JY
authors.lastname: Wen
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Lin
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Peizhong P
authors.initials: PP
authors.lastname: Wang
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.).
authors.forename: Xuefeng B
authors.initials: XB
authors.lastname: Ling
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.). cardiolab@live.com niujmgz@163.com.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Li
authors.affiliation: From the Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China (Q.L., Y.-H.Z., C.-Y.M., M.-M.H., L.-J.L., D.-M.D., J.-Y.W., X.-H.L., J.-M.N.); Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Logistics University of PAPF, Tianjin, China (X.Z.,Y.-M.L.); Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (P.P.W.); and Department of Surgery, Stanford University, Palo Alto, CA (X.B.L.). cardiolab@live.com niujmgz@163.com.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Niu
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015233:Models, Statistical; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D058246:Prehypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: blood pressure; cohort studies; metabolic syndrome X; pregnancy; prehypertension