TY - JOUR
T1 - Pregnancy outcomes and blood pressure visit-to-visit variability and level in three less-developed countries
AU - CLIP Study Group
AU - Magee, Laura A.
AU - Bone, Jeffrey
AU - Owasil, Salwa Banoo
AU - Singer, Joel
AU - Lee, Terry
AU - Bellad, Mrutunjaya B.
AU - Goudar, Shivaprasad S.
AU - Logan, Alexander G.
AU - MacUacua, Salésio E.
AU - Mallapur, Ashalata A.
AU - Nathan, Hannah L.
AU - Qureshi, Rahat N.
AU - Sevene, Esperança
AU - Shennan, Andrew H.
AU - Valá, Anifa
AU - Vidler, Marianne
AU - Bhutta, Zulfiqar A.
AU - Von Dadelszen, Peter
AU - MacEte, Eusébio
AU - Munguambe, Khátia
AU - Sacoor, Charfudin
AU - Boene, Helena
AU - Amose, Felizarda
AU - Pires, Rosa
AU - Nhamirre, Zefanias
AU - MacAmo, Marta
AU - Chiaú, Rogério
AU - Matavele, Analisa
AU - Vilanculo, Faustino
AU - Nhancolo, Ariel
AU - Cutana, Silvestre
AU - Mandlate, Ernesto
AU - MacUacua, Salésio
AU - Bique, Cassimo
AU - Mocumbi, Sibone
AU - Gonçálves, Emília
AU - MacUluve, Sónia
AU - Biz, Ana Ilda
AU - Mulungo, Dulce
AU - Augusto, Orvalho
AU - Filimone, Paulo
AU - Nobela, Vivalde
AU - Tchavana, Corsino
AU - Nkumbula, Cláudio
AU - Qureshi, Rahat
AU - Hoodbhoy, Zahra
AU - Raza, Farrukh
AU - Sheikh, Sana
AU - Memon, Javed
AU - Ahmed, Imran
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community- Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03-1.07] and OR, 1.08 [1.06-1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98-2.21] for SD and 1.52 [1.45-1.60] for ARV; diastolic: OR, 2.70 [2.54-2.87] for SD and 1.86 [1.76-1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06-1.14] for SD and 1.06 [1.02-1.10] for ARV; diastolic: OR, 1.07 [1.03-1.11] for SD and 1.06 [1.02-1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.
AB - In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community- Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03-1.07] and OR, 1.08 [1.06-1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98-2.21] for SD and 1.52 [1.45-1.60] for ARV; diastolic: OR, 2.70 [2.54-2.87] for SD and 1.86 [1.76-1.96] for ARV); and (2) the composite outcome (systolic: OR, 1.10 [1.06-1.14] for SD and 1.06 [1.02-1.10] for ARV; diastolic: OR, 1.07 [1.03-1.11] for SD and 1.06 [1.02-1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.
KW - Blood pressure
KW - Morbidity
KW - Mortality
KW - Preeclampsia
KW - Pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85104047647&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.120.16851
DO - 10.1161/HYPERTENSIONAHA.120.16851
M3 - Article
C2 - 33775120
AN - SCOPUS:85104047647
SN - 0194-911X
VL - 77
SP - 1714
EP - 1722
JO - Hypertension
JF - Hypertension
IS - 5
ER -