Journal article
Trends of blood pressure and heart rate in normal pregnancies: a systematic review and meta-analysis
- Abstract:
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Background: Current reference ranges for blood pressure and heart rate throughout pregnancy have a poor evidence base.
Methods: Systematic review and meta-analysis: We included studies measuring blood pressure or heart rate from healthy pregnant women within defined gestational periods of sixteen-weeks or less. We analysed systolic blood pressure, diastolic blood pressure and heart rate by gestational age. We assessed effects of measurement year and method.
Results: We included 39 studies undertaken 1967-2017, containing 124,349 systolic measurements from 36,239 women, 124,291 diastolic measurements from 36,181 women and 10,948 heart rate measurements from 8317 women. Mean (95% CI) systolic blood pressure was lowest at 10 weeks gestation, 110.4 (108.5, 112.3) mmHg, rising to 116.0 (113.6, 118.4) mmHg at 40 weeks, mean (95% CI) change 5.6 (4.0, 7.2) mmHg. Mean (95% CI) diastolic blood pressure was lowest at 21 weeks gestation, 65.9 (64.2, 67.7) mmHg; rising to 72.8 (71.0, 74.6) mmHg at 40 weeks, mean (95% CI) change 6.9 (6.2, 7.5) mmHg. Mean (95% CI) heart rate rose from 79.3 (75.5, 83.1) beats/min at 10 weeks to 86.9 (82.2, 91.6) beats/min at 40 weeks gestation, mean (95% CI) change 7.6 (1.8, 13.4) beats/min. Studies using manual measurement reported higher diastolic blood pressures than studies using automated measurement, mean (95 CI) difference 4.9 (0.8, 8.9) mmHg. Diastolic blood pressure increased by 0.26 (95% CI 0.10-0.43) mmHg /year. Including only higher quality studies had little effect on findings, with heterogeneity remaining high (I2 statistic >50%).
Conclusions: Significant gestational blood pressure and heart rate changes occur that should be taken into account when assessing pregnant women. Commonly taught substantial decreases in blood pressure mid-pregnancy were not seen and heart rate increases were lower than previously thought. Manual and automated blood pressure measurement cannot be used interchangeably. Increases in diastolic blood pressure over the last half-century and differences between published studies show contemporary data are required to define current normal ranges.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Authors
- Publisher:
- Bio Med Central
- Journal:
- BMC Medicine More from this journal
- Volume:
- 17
- Issue:
- 2019
- Article number:
- 167
- Publication date:
- 2019-09-11
- Acceptance date:
- 2019-07-29
- DOI:
- ISSN:
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1741-7015
- Keywords:
- Pubs id:
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pubs:1035928
- UUID:
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uuid:eab5e6e4-6fac-47e1-9629-10accfc5bebc
- Local pid:
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pubs:1035928
- Source identifiers:
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1035928
- Deposit date:
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2019-07-29
Terms of use
- Copyright holder:
- Loerup et al
- Copyright date:
- 2019
- Notes:
- © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
- Licence:
- CC Public Domain Dedication (CC0)
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