The association between blood pressure control in women during pregnancy and adverse perinatal outcomes: the TMM BirThree Cohort Study

Blood pressure (BP) control in pregnancy is essential to prevent adverse outcomes. However, BP levels for hypertension treatment are inconsistent among various guidelines. This study investigated the association between BP control and adverse perinatal outcomes. A total of 18,155 mother-offspring pairs were classified into four groups according to BP after 20 gestational weeks: normal BP (<140/90 mmHg without antihypertensive drugs), high BP (≥140/90 mmHg without antihypertensive drugs), controlled BP (<140/90 mmHg with antihypertensive drugs), and uncontrolled BP (≥140/90 mmHg with antihypertensive drugs). The prevalence of small for gestational age was 1,087/17,476 offspring in normal BP, 78/604 in high BP, 5/42 in controlled BP, and 7/33 in uncontrolled BP. Compared to normal BP, adjusted odds ratios (ORs) (95% confidence intervals (CIs)) were 1.76 (1.32–2.35) for high BP, 2.08 (0.79–5.50) for controlled BP, and 2.34 (0.94–5.85) for uncontrolled BP (multiple logistic regression analysis). Similarly, the adjusted ORs (95% CIs) were 1.80 (1.35–2.41), 3.42 (1.35–8.63), and 5.10 (1.93–13.45) for high, controlled, and uncontrolled BPs for low birth weight, respectively; 1.99 (1.48–2.68), 2.70 (1.12–6.50), and 6.53 (3.09–13.82) for high, controlled, and uncontrolled BPs for preterm birth, respectively; 1.64 (1.19–2.24), 2.17 (0.88–5.38), and 2.12 (0.80–5.65) for high, controlled, and uncontrolled BPs for admission to the Neonatal Intensive Care Unit or Growing Care Unit, respectively; and 1.17 (0.70–1.95), 2.23 (0.65–7.68), and 0.91 (0.20–4.16) for high, controlled, and uncontrolled BPs for 1-min Apgar score < 7, respectively. BP ≥ 140/90 mmHg might be taken care for preventing various adverse perinatal outcomes.