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Preconception blood pressure predicts risk of pregnancy loss

06 May 2018

Healthy young women with elevations in preconception blood pressure (BP) appear to be at increased risk of pregnancy loss, according to a study.

Researchers evaluated preconception BP in relation to reproductive outcomes such as fecundability, pregnancy loss and live birth in 1,228 women (mean age 28.7 years) attempting to conceive with a history of pregnancy loss.

Systolic and diastolic BP were taken during the first observed menstrual cycle and in early pregnancy, with the resulting measurements used to obtain mean arterial pressure. Fecundability was assessed using human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin–detected and clinical losses.

Mean preconception systolic and diastolic BP were 111.6 and 72.5 mm Hg, respectively. Elevations in diastolic BP and mean arterial pressure were associated with a heightened risk of pregnancy loss. Specifically, the risk increased by 18 percent (95 percent CI, 1.03–1.36) per 10-mm Hg increase in diastolic BP and by 17 percent (1.02–1.35) per 10-mm Hg increase in mean arterial pressure. Results were similar for early pregnancy BP.

In contrast, preconception BP was not associated with fecundability or live birth.

The present data indicate that preconception BP is a marker of increased risk of pregnancy loss, independent of age, body mass index and other risk factors. They also contribute to the evidence base suggesting that early markers of cardiometabolic risk may be associated with adverse reproductive events, researchers said.

Lifestyle interventions targeting BP elevations during preconception may reduce the risk of pregnancy loss, a particular concern among women with a history of pregnancy loss, they added. Increasing physical activity and following a DASH-type (Dietary Approaches to Stop Hypertension) diet may favourably affect reproductive health and reduce future risk of cardiovascular disease among reproductive-aged women.

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