Blood Pressure Trajectories During Pregnancy and Associations with Adverse Birth Outcomes Among HIV-infected and HIV-uninfected Women in South Africa: a Group-based Trajectory Modelling Approach

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2020 Dec 1

PMID 33256639

Citations 3

Authors

Thokozile R Malaba

Annibale Cois

Hlengiwe P Madlala

Mushi Matjila

Landon Myer

Marie-Louise Newell

Affiliations

Soon will be listed here.

Abstract

Background: High blood pressure (BP) late in pregnancy is associated with preterm delivery (PTD); BP has also been associated with HIV and antiretroviral therapy (ART), but whether the relationship between BP assessed longitudinally over pregnancy and PTD and low birthweight (LBW) is modified by HIV/ART is unclear. We hypothesise the presence of distinctive BP trajectories and their association with adverse birth outcomes may be mediated by HIV/ART status.

Methods: We recruited pregnant women at a large primary care facility in Cape Town. BP was measured throughout pregnancy using automated monitors. Group-based trajectory modelling in women with ≥3 BP measurements identified distinct joint systolic and diastolic BP trajectory groups. Multinomial regression assessed BP trajectory group associations with HIV/ART status, and Poisson regression with robust error variance was used to assess risk of PTD and LBW.

Results: Of the 1583 women in this analysis, 37% were HIV-infected. Seven joint trajectory group combinations were identified, which were categorised as normal (50%), low normal (25%), high normal (20%), and abnormal (5%). A higher proportion of women in the low normal group were HIV-infected than HIV-uninfected (28% vs. 23%), however differences were not statistically significant (RR 1.27, 95% CI 0.98-1.63, reference category: normal). In multivariable analyses, low normal trajectory (aRR0.59, 0.41-0.85) was associated with decreased risk of PTD, while high normal (aRR1.48, 1.12-1.95) and abnormal trajectories (aRR3.18, 2.32-4.37) were associated with increased risk of PTD, and abnormal with increased risk of LBW (RR2.81, 1.90-4.15).

Conclusions: While HIV/ART did not appear to mediate the BP trajectories and adverse birth outcomes association, they did provide more detailed insights into the relationship between BP, PTD and LBW for HIV-infected and uninfected women.

Citing Articles

Gestational - age - specific reference intervals for blood pressure in normal pregnancy in a Southern Chinese population.

Deng Y, Liang L, Gao Y, Liao G, Chen Q, Huang Z BMC Pregnancy Childbirth. 2025; 25(1):8.

PMID: 39773091 PMC: 11706196. DOI: 10.1186/s12884-024-07117-3.

Associations of prenatal blood pressure trajectory and variability with child neurodevelopment at 2 years old.

Xu L, Cheng J, Dong X, Guo M, Chen K, Fan X BMC Med. 2024; 22(1):220.

PMID: 38816882 PMC: 11140879. DOI: 10.1186/s12916-024-03439-3.

A Scoping Review of Preterm Births in Sub-Saharan Africa: Burden, Risk Factors and Outcomes.

Mabrouk A, Abubakar A, Too E, Chongwo E, Adetifa I Int J Environ Res Public Health. 2022; 19(17).

PMID: 36078258 PMC: 9518061. DOI: 10.3390/ijerph191710537.

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