Postpartum blood pressure patterns in severe preeclampsia and normotensive pregnant women following abdominal deliveries: a cohort study

<b>Objective:</b> To determine blood pressure (BP) patterns in the immediate postpartum period in preeclampsia with severe features (sPE) and normotensive pregnant women who had cesarean deliveries (CD). <b>Study design:</b> The BP levels of two groups comprising 50 sPE and 90 normotensive pregnant women who had CD were measured before delivery and on days 0–3 postpartum at four time points (05:00, 08:00, 14:00, and 22:00). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) were measured in the maternal serum ≤48 h before delivery. <b>Results:</b> Antihypertensive therapy was administered to 98, 96, 82, 78, and 56% of sPE antepartum and on postpartum days 0–3, respectively. <i>De novo</i> postpartum hypertension (BP ≥ 140/90 mmHg) occurred in 24.4% (22/90) of the normotensive group but only one required antihypertensive therapy. The occurrence of <i>de novo</i> postpartum hypertension was associated with maternal weight before delivery ≥ 84.5 kg (relative risks (RR) 2.6, CI 95% 1.2–5.8, <i>p</i> = .017), and body mass index before delivery ≥ 33.3 kg/m² (RR 2.9, CI 95% 1.3–6.4, <i>p</i> = .008). In sPE, the BP decreased between predelivery period and postpartum day 0. From days 1 to 3 postpartum, there was a continuous increase in the daily mean BPs in both groups, with average daily increments (systolic/diastolic) being 5.6/4.6 mmHg and 0.6/1.3 mmHg in the sPE and normotensive women, respectively. Patient’s group and time had a significant effect on BP, <i>p</i> &lt; .001. Overall, daily mean BPs were higher in the sPE than the normotensive group (<i>p</i> &lt; .001). Perceived stress (<i>p</i> = .022), low birth weight (<i>p</i> = .002), 5 min Apgar score ≤ 6 (<i>p</i> &lt; .001) were significantly higher in the sPE group. sFlt-1/PIGF ratio was high in the hypertensive groups: sPE versus normotensive group, <i>p</i> &lt; .001; <i>de novo</i> postpartum hypertension versus normotensives group that remained normotensive, <i>p</i> = .102. <b>Conclusion:</b> Postpartum BP and antihypertensive requirements are important considerations in managing sPE and normotensive pregnancies. sPE is associated with increased maternal stress and poor perinatal outcomes.

**研究目标：** 明确合并重度子痫前期（preeclampsia with severe features, sPE）与血压正常的剖宫产（cesarean deliveries, CD）产妇产后即刻的血压（blood pressure, BP）变化模式。**研究设计：** 本研究纳入两组产妇，其中重度子痫前期组50例、血压正常组90例，均接受剖宫产术。分别于产前及产后0~3日的四个时间点（05:00、08:00、14:00、22:00）测量血压水平。于产前≤48小时采集产妇血清，检测可溶性fms样酪氨酸激酶-1（soluble fms-like tyrosine kinase-1, sFlt-1）与胎盘生长因子（placental growth factor, PIGF）。**研究结果：** 产前及产后0~3日，分别有98%、96%、82%、78%、56%的重度子痫前期产妇接受降压治疗。新发产后高血压（血压≥140/90mmHg）在血压正常组中的发生率为24.4%（22/90），但仅1例需接受降压治疗。新发产后高血压与产妇产前体重≥84.5kg（相对危险度（relative risks, RR）=2.6，95%置信区间（confidence interval, CI）：1.2~5.8，p=0.017）及产前体重指数≥33.3kg/m²（RR=2.9，95%CI：1.3~6.4，p=0.008）显著相关。在重度子痫前期组中，血压自产前至产后第0日呈下降趋势；产后1~3日，两组产妇的日均血压均呈持续升高态势，重度子痫前期组与血压正常组的日均收缩压/舒张压增幅分别为5.6/4.6mmHg与0.6/1.3mmHg。产妇分组与测量时间对血压水平存在显著影响（p<0.001）；总体而言，重度子痫前期组的日均血压显著高于血压正常组（p<0.001）。重度子痫前期组的感知应激水平（p=0.022）、低出生体重儿发生率（p=0.002）、5分钟Apgar评分（Apgar score）≤6的比例（p<0.001）均显著更高。可溶性fms样酪氨酸激酶-1/胎盘生长因子比值在高血压组中更高：重度子痫前期组 vs 血压正常组（p<0.001）；新发产后高血压组 vs 产后血压仍维持正常的血压正常组（p=0.102）。**结论：** 产后血压管理与降压药物使用需求，是合并重度子痫前期及血压正常妊娠产妇临床管理的重要考量因素。重度子痫前期与产妇应激水平升高及不良围产结局显著相关。