Association of pre-/early pregnancy high blood pressure and pregnancy outcomes: a systemic review and meta-analysis

Abstract

Background

Maternal high blood pressure (BP) was associated with adverse pregnancy outcomes. This study aimed to synthesize evidence on the association between high BP prior to or in early pregnancy with maternal and fetal complications.

Methods

We searched the cohort studies assessing the effect of high BP in the Medline, Embase, Web of Science and China National Knowledge Internet databases. A random-effects model was used to estimate the pooled odds ratios (ORs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERRO (CRD 42023414945).

Results

23 eligible studies were identified. High BP prior to or in early pregnancy was associated with higher odds of hypertensive disorders of pregnancy (OR 2.90, 95% CI 1.91–3.89), gestational hypertension (2.56, 2.01–3.12), preeclampsia (3.20, 2.66–3.74), gestational diabetes mellitus (1.71, 1.36–2.06), preterm birth (1.66, 1.39–1.93), stillbirth (2.01, 1.45–2.58) and neonatal intensive care unit admission (1.22, 1.08–1.37). Subgroup analyses indicated that pre-hypertension could significantly increase the odds of these outcomes except for stillbirth, though the odds were lower than hypertension.

Conclusions

High BP prior to or in early pregnancy was associated with adverse pregnancy outcomes and this association increased with hypertension severity. The findings emphasized an urgent need for heightened surveillance for maternal BP, especially pre-hypertensive status.

Keywords:

• High blood pressure
• pregnancy outcomes
• complications
• meta-analysis
• cohort study

Authors contributions

Conceptualization, XJL and NL; Methodology, XJL, MJ, and XWL; Software, MJ; Validation, YLZ, LZ, and ZWL; Data Curation, XJL and YXW; Writing-Original Draft Preparation, MJ; Writing-Review & Editing, NL; Supervision, RWY and ZWL; Funding Acquisition, XJL and NL.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Natural Science Foundation of Beijing Municipality (grant number 7234401, 7194285, and 7222245), the National Natural Science Foundation of China (grant number 81903327 and 82173527), and the Postdoctoral Science Foundation of China (grant number 88014Y0226).