Prehypertension identified by diastolic blood pressure (DBP) trajectories throughout pregnancy is an independent risk factor for predicting postpartum metabolic syndrome in normotensive pregnant women, according to data recently published in Hypertension.

Although previous studies have demonstrated the association between hypertension during pregnancy and future cardiovascular disease, the association between antepartum prehypertension and postpartum cardiovascular disease risk has not been defined.

Qiong Lei, from the Department of Obstetrics at Guangdong Women and Children’s Hospital in Guangzhou, Guangdong Province, China, and colleagues evaluated the relationship between antepartum BP measurements and postpartum metabolic syndrome in 507 normotensive pregnant women after giving birth.

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“Our study highlights the potential role of antepartum prehypertension in postpartum cardiovascular risk stratification and fortifies the emerging concept that the individualized mapping of multiple BP measurements over time may provide additional information on an individual’s cardiovascular risk status,” the authors wrote.

They identified 3 distinctive DBP trajectory groups, which included a low-J-shaped group (34.2%), a moderate-U-shaped group (52.6%), and an elevated-J-shaped group (13.2%). The low-J-shaped group had a DBP from 62.5 ± 5.8 to 65.0 ± 6.8 mm Hg, while the moderate-U-shaped group had a DBP from 71.0 ± 5.9 to 69.8 ± 6.2 mm Hg and the elevated-J-shaped group had a DBP from 76.2 ± 6.7 to 81.8 ± 4.8 mm Hg.

A total of 309 women completed the 1.6 year average postpartum follow-up. Of these patients, those in the elevated-J-shaped group had greater odds of developing postpartum metabolic syndrome compared with the low-J-shaped group (adjusted odds ratio [OR]: 6.55; 95% confidence interval [CI]: 1.79-23.92; P=.004).

Researchers also developed a parsimonious model that incorporated DBP, defined as inclusion in the elevated-J-shaped group but not in the DBP prehypertension group. The model also included elevated levels of fasting glucose (>4.99 mmol/L) and triglycerides (>3.14 mmol/L) at term. The model showed good discrimination and calibration for postpartum metabolic syndrome (C-statistic: 0.764; 95% CI: 0.674-0.855; P<.001).

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The elevated-J-shaped trajectory group, with mean DBP and systolic BP levels within the range of prehypertension at term, had a 5-fold increased risk of developing postpartum metabolic syndrome compared with the low-J-shaped group.

“Because BP measurement is a part of a routine pre-natal check-up, our findings provide evidence demonstrating a novel method to cost-effectively estimate future cardiovascular risk among women,” researchers  stated.

“Moreover, future work is warranted to examine the potential role of a more intensive BP management strategy during pregnancy, which has been recently demonstrated to clinically benefit a nonpregnant population in the Systolic Blood Pressure Intervention Trial (SPRINT) study.”


Lei Q, Zhou YH, Mai CY, et al. Prehypertension during normotensive pregnancy and postpartum clustering of cardiometabolic risk factors: a prospective cohort study. Hypertension. 2016. doi: 10.1161/HYPERTENSIONAHA.116.07261.