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Association of maternal preconception blood pressure with preterm birth: a population-based cohort study

Hypertension Research volume 47, pages 467–477 (2024)Cite this article

Abstract

The association between maternal preconception blood pressure (BP) and preterm birth (PTB) is still unclear. The purpose of this study was to investigate the association between maternal preconception BP and PTB. This population-based cohort study included 715 984 Chinese women aged 20–49 years who participated in the National Free Preconception Health Examination Project and successfully had a singleton livebirth during 2014–2019 in Guangdong Province, China. Maternal preconception BP were measured by trained health workers. Multivariate logistic regression models and restricted cubic spline regressions were used to examine the association and dose–response relationship between maternal preconception BP and PTB, respectively. Maternal preconception hypertension was associated with the increased risk of PTB (adjusted odds ratios (aOR): 1.24; 95% CI: 1.14–1.34). Compared to women with normal preconception BP, the aORs for PTB were 1.09 (95% CI: 1.06–1.12), 1.24 (95% CI: 1.13–1.36), and 1.43 (95% CI: 1.15–1.79) for women with preconception elevated BP (120–139/ 80–89 mmHg, stage-1 hypertension (140–159/ 90–99 mmHg, and stage-2 hypertension (160–179/100–109 mmHg), respectively. According to the 2017 American College of Cardiology/American Heart Association criteria, maternal preconception elevated BP and hypertension were also significantly associated with an increased risk of PTB. Preconception systolic and diastolic BP showed a U-shaped (χ2 = 40.54; nonlinear P < 0.001) and linear (χ2 = 6.62; nonlinear P = 0.085) dose–response relationship with PTB, respectively. The association was modified by maternal age and preconception body mass index. These findings identify maternal preconception elevated BP and hypertension as a modifiable risk factor for PTB, providing evidence for future research studies, public health and clinical interventions.

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Acknowledgements

We would like to thank all the community workers, health workers and participants involved in the National Free Preconception Health Examination Project for their generous help during the data gathering process.

Funding

National Natural Science Foundation of China grants (No. 72274225), Guangdong Province Medical Research Funding (No. 2022314, No. B2023416, No. 2022326, and No. B2023135). The funders had no role in study design, data collection, data analysis, data interpretation, or writing the report.

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Author notes

  1. These authors contributed equally: Wenxue Xiong, Lu Han.

Authors and Affiliations

  1. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China

    Wenxue Xiong, Xijia Tang, Wen Chen, Rui Li & Li Ling

  2. NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Guangzhou, China

    Lu Han, Xiaohua Liu, Hua Nie, Weibing Qin & Yang Hu

  3. Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China

    Qiong Wang

  4. Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China

    Hui Zhang

  5. School of Mathematics, Sun Yat-sen University, Guangzhou, Guangdong, China

    Zhirong Zhang

  6. Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Li Ling

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Contributions

LH, XL, HN, WQ, and YH obtained access to the data from the National Free Preconception Health Examination Project in Guangdong Province, China. WX and LL developed the study and analytical strategy. WX, RL, ZZ did statistical analysis and WX drafted the manuscript. XT, QW, WC, HZ, and LL revised the manuscript and gave critical inputs into the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lu Han or Li Ling.

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Xiong, W., Han, L., Tang, X. et al. Association of maternal preconception blood pressure with preterm birth: a population-based cohort study. Hypertens Res 47, 467–477 (2024). https://doi.org/10.1038/s41440-023-01483-9

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