Perinatal & Pediatric
Blood pressure trajectories from early pregnancy through early postpartum: A descriptive Latent Class Growth Model analysis Rui Ling* Rui Ling Ling Ling Ling Ling Ling Ling NYU Grossman School of Medicine
Background: Average blood pressure (BP) in pregnancy follows a shallow U-shape, but individual trajectories vary. This study used electronic medical records (EMR) data to investigate characteristics of latent classes of systolic (SBP) and diastolic (DBP) BP from early pregnancy through “the fourth trimester” postpartum, a critical but less studied period of cardiovascular (CV) risk.
Methods: We included women with singleton live births or stillbirths in the NYU Children’s Health and Environment Study (2016–2023). BP from EMR during nonurgent encounters was modeled with latent class growth models separately for pregnancy (N=1,563) and ≤14 weeks postpartum (N=1,326). Inclusion required a baseline and ≥2 additional BP measures per period. We used Bayesian Information Criterion, class sizes, and entropy for model selection; and Chi-square tests and Kruskal–Wallis tests for group differences.
Results: In pregnancy, we identified three classes for SBP: ‘Population average’ (92%), ‘High decrease’ (3%), and ‘Low increase’ (5%); and two for DBP: ‘Population average’ (82%) and ‘Low increase’ (18%). Both ‘Low increase’ SBP/DBP were associated with higher risk of hypertensive disorders of pregnancy (HDP). The SBP ‘High decrease’ class was enriched with prior chronic hypertension. Postpartum SBP and DBP each had three classes: ‘Low stable’ (85% for SBP; 94% for DBP), ‘High decrease’ (8% SBP; 3% DBP), and ‘High increase’ (7% SBP; 3% DBP); both ‘High increase’ and ‘High decrease’ were associated with prior HDP and chronic hypertension. We also observed class differences by race/ethnicity and other sociodemographic factors; and prenatal smoking was more prevalent in higher-risk postpartum DBP classes.
Conclusions: In a diverse, urban pregnancy cohort we identified distinct BP trajectories in pregnancy and early postpartum associated both with HDP as well as sociodemographic and behavioral characteristics that may help identify women at risk of short- and long-term CV complications.
