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

Figures & data

Figure 1. Flow chart of study selection process.

Table 1. Overview of the characteristics of the 23 included cohort studies.

Author, published year	Study time	Country	Study design	Sample size	Maternal age (years)^a	Multiple gestations included	Definition of exposure^b	Pregnancy outcomes	NOS score
Berger et al. 2020 [15]	2012–2016	Canada	Population-based retrospective cohort	506,483 women	Normal: not known hypertension: 33.31 ± 5.53	No	ICD-10	Preterm birth	8
Black et al. 2015 [12]	2005–2010	US	Multiple-center cohort	10,459 women	Normal: 29.3 ± 5.9 pre-hypertension: 30.1 ± 5.7	No	ICD-9	Gestational hypertension, GDM preeclampsia	7
Broekhuijsen et al. 2015 [16]	2002–2007	Netherlands	Population-based retrospective cohort	988,389 women	Normal: 30.4 ± 4.9 hypertension: 31.6 ± 4.3	No	Hypertension: SBP ≥140/DBP ≥ 90 mmHg	Preterm birth, cesarean delivery, preeclampsia, placental abruption	6
Conde-Agudelo et al. 2000 [17]	1985–1997	Uruguay	Population-based retrospective cohort	878,680 births	Total: 20–34 (median)	Yes	ICD-10	Preeclampsia	8
Delker et al. 2022 [8]	2016–2018	US	National longitudinal observational cohort	2038 women	Total: 32.2 ± 2.7	No	2017 ACC/AHA	Preterm delivery	8
Gonzalez-Valencia et al. 2020 [18]	2017–2018	Colombia	Multiple-center retrospective cohort	293 women	Normal: 24 (18–42) Pre-hypertension: 25 (18–42)	No	Pre-hypertension: SBP, 120–139/DBP, 80–90 mmHg	Gestational hypertension, preeclampsia	7
Greenberg et al. 2020 [19]	2013–2019	US	Single-center retrospective cohort	18,801 women	Not known	No	2017 ACC/AHA	HDP, preeclampsia, GDM, gestational hypertension, placental abruption, HELLP syndrome	8
Hedderson et al. 2012 [13]	1984–1996	US	Multiple-center cohort	3380 women	Not known	Yes	ICD-9	HDP	7
Jung et al. 2022 [20]	2007–2015	Korea	Population-based prospective cohort	375,305 women	Total: 30.7 ± 3.7	No	ACC	Preeclampsia, stillbirth, placental abruption, preterm birth	8
Li et al. 2016 [6]	1993–1996	China	Population-based prospective cohort	43,718 women	Normal: 24.71 ± 2.24 hypertension: 24.97 ± 2.49	No	WHO/ISH	SGA	8
Li et al. 2016 [21]	1993–1996	China	Population-based prospective cohort	44,494 women	Normal: 24.70 ± 2.24 hypertension: 24.96 ± 2.47	No	WHO/ISH	Preterm birth	8
Li et al. 2020 [22]	1993–1996	China	Population-based prospective cohort	45,628 women	Normal: 24.73 ± 2.26 Pre-hypertension: 24.60 ± 2.21 Stage 1: 24.76 ± 2.40 Stage 2: 25.33 ± 2.60	No	WHO/ISH	Preeclampsia	8
Lisonkova et al. 2020 [23]	2012–2016	Canada	Population-based retrospective cohort	1,078,323 women	Total: 30–34 (median)	No	ICD-10	HELLP syndrome	8
Mabuchi et al. 2016 [24]	2010–2013	Japan	Single-center retrospective cohort	2102 women	Normal: 33 (15–50) Pre-hypertension: 35 (22–43)	No	2019 JSH	Gestational hypertension, preeclampsia	7
Macheku et al. 2015 [25]	2000–2010	Tanzania	Birth registry-based retrospective cohort	39,993 women	Not known	No	Medical records	Placental abruption	7
Malmstrom et al. 2018 [26]	1999–2014	Norway	Birth registry-based retrospective cohort	418,897 women	Total: 25–29 (median)	Yes	Medical records	HELLP syndrome	7
Nagao et al. 2021 [27]	2003–2019	Japan	Single-center retrospective cohort	14,066 women	Normal: 34.5 ± 4.4 Pre-hypertension: 34.9 ± 5.5	No	Pre-hypertension: SBP, 120–139/DBP, 80–90 mmHg	Preterm birth, SGA	8
Reddy et al. 2010 [14]	2002–2008	US	Multiple-center retrospective cohort	174,809 women	Total: 25-29 (median)	No	Medical records	Stillbirths	8
Sutton et al. 2020 [28]	2015–2018	US	Clinical-based cohort	18,162 women	Normal: 29.7 ± 5.4 Pre-hypertension: 29.0 ± 5.7 Stage 1: 30.2 ± 5.2 Stage 2: 31.4 ± 5.3	No	2017 ACC/AHA	Preeclampsia	8
Tesfalul et al. 2022 [9]	2014–2017	US	Single-center retrospective cohort	6067 women	Normal: 33.6 ± 4.8 Pre-hypertension: 33.6 ± 4.9 Stage 1: 33.9 ± 4.9 Stage 2: 34.4 ± 5.1	No	2017 ACC/AHA	Gestational hypertension, SGA, NICU admission, preeclampsia, placental abruption, cesarean delivery, preterm birth	8
Yang et al. 2015 [7]	2010–2013	China	Population-based prospective cohort	367,425 women	Normal: 27.7 ± 4.2 hypertension: 29.2 ± 4.9	No	WHO/ISH	Preterm birth	8
Ye et al. 2020 [29]	2006–2016	China	Community-based longitudinal cohort	801 women	Normal: 29.00 ± 3.32 Pre-hypertension: 29.42 ± 3.45	No	Hypertension: SBP ≥140/DBP ≥ 90 mmHg. Pre- hypertension: 130–139/85–89mmHg	HDP	7
Zile et al. 2019 [30]	2001–2014	Latvia	Birth register-based retrospective cohort	294,355 births	Not known	Yes	Medical records	Stillbirth	5

HDP: hypertensive disorders of pregnancy; GDM: gestational diabetes mellitus; SGA: small for gestational age; NICU: neonatal intensive care unit; NOS: the Newcastle-Ottawa Scale.

^a Maternal age was presented as mean ± SD, median or ranges.

^b 2017 ACC/AHA guidelines: normal, SBP < 120 and DBP < 80 mmHg; elevated BPs, SBP 120–129 and DBP < 80 mmHg; hypertension stage 1: SBP 130–139 or DBP 80–89mmHg; hypertension stage 2, SBP ≥ 140 or DBP ≥ 90 mmHg. 2019 JSH guidelines: pre-hypertension, SBP 130–139 or DBP 85–89mmHg; hypertension, SBP ≥ 140 and/or DBP ≥ 90 mmHg. ICD-9 guidelines: elevated BPs, SBP 120–140 or DBP 80-90 mmHg; hypertension, SBP ≥ 140 and/or DBP ≥ 90 mmHg. ICD-10 guidelines: hypertension, SBP ≥ 140 and/or DBP ≥ 90 mmHg. WHO/ISH guidelines: normotensive, SBP <140 and DBP < 90 mm Hg; hypertension, SBP ≥ 140 and/or DBP ≥ 90 mmHg.

Figure 2. Summary forest plot for maternal complications in women with high blood pressure prior to or in early pregnancy. Meta-analysis for each maternal outcomes was calculated by a subgroup analysis for pre-/hypertension using Random-effects Mantel-Haenszel method. NA: not applicable, 95% CIs: 95% confidence intervals.

Figure 3. Summary forest plot for fetal complications in women with high blood pressure prior to or in early pregnancy. Meta-analysis for each fetal outcomes was calculated by a subgroup analysis for pre-/hypertension using Random-effects Mantel-Haenszel method. NA: not applicable; 95% CIs: 95% confidence intervals; NICU: neonatal intensive care unit.

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Data availability statement

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